A prospective trial was set up to compare pseudoaccommodation. Fifty patients were randomized into two groups. Group 1 comprised 25 patients who had a monofocal implant and a postoperative refractive aim of -0.3 to -1.3 diopter (D) spherical equivalent and an astigmatic component between 1.0 and 1.75 D cylinder. Group 2 comprised 25 patients who had a new multizone refraction style multifocal implant and a postoperative refractive aim of -0.5 to +0.5 D spherical equivalent and an astigmatic component of less than 1.0 D cylinder. Eighty percent of postoperative refractions in Group 1 and 88% in Group 2 were within 0.5 D either side of the refractive aim. Forty-eight percent of Group 1 and 72% of Group 2 could see both 20/40 and J3 unaided. Four percent of Group 1 and 84% of Group 2 could read J2 with the distance correction. Sixteen percent of Group 1 and 48% of Group 2 could read J2 at 25 cm unaided (P = .03). Sixty-four percent of Group 1 and 88% of Group 2 stated they could manage daily activities without glasses. However, 88% of Group 1 and 52% of Group 2 requested reading glasses to improve clarity of the smallest print.

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During the first half of the 20th century there was a strong controversy over the route for removal of an intraocular foreign body (IOFB) lying in the posterior segment of the eye. In the early years the anterior route was substantially the method of choice (Barkan and Barkan, 1927;Verhoeff, 1932 I961-1970, further details of which are published in the accompanying paper (Percival, I972). Double perforations have been excluded, and when five cases in which the site of the foreign body was either in the optic nerve or never known and two cases of transfixion are also excluded, there remain I 14 vitreous or preretinal foreign bodies and 39 foreign bodies clinically impacted in the retina or choroid. This group of I53 IOFBs, fifteen of which were non-magnetic, form the basis for the following study.Route of extraction The majority of foreign bodies were removed by the posterior route, and Table I compares the incidence of complications related to three different methods. As large foreign bodies are naturally associated with a high complication rate, all IOFBs known to be over 5 cu. mm. in size are excluded from this Table. In order that the methods should be comparable, all foreign bodies removed through the wound of entry, whether corneal or scleral, are also excluded. This tends to eliminate complications arising at the time of injury when the perforating wound was large and the ocular damage that much greater.The anterior route method involved drawing the foreign body into the anterior chamber with a magnet and extraction through a keratome incision. The high incidence of complications and poor prognosis is striking: even retinal detachment occurred twice as frequently as after posterior route extractions.

Fig. i shows that the incidence of IOFB is slowly declining and is currently around twenty a year or just under two a month, compared with an average of 35 a year between 1932 and 1951. As is to be expected, the majority of patients were young adult males. Only eight of the injuries occurred in females. Only seventeen of the men involved were over 49 years of age, and six were under i5, three of the latter being unfortunately injured by an air-gun pellet. Cause of injuryThe hammer and chisel is still the most common single cause (Table I) and the resulting injuries tend to do better than those from other causes as the foreign bodies tend to be smaller. Of the 2i8 known causes, the incidence of hand-hammer injuries was 63 per cent. compared with 73 per cent. in the 1932-1951 period. Although the incidence of machine-tool injuries was 24 per cent. compared with I8 per cent., the incidence per year of these injuries is actually decreasing, owing, probably, to the greater sense of protection in industry. The number of non-magnetic foreign bodies was 25 (io per cent.) but, contrary to the forecast by Kraus and Briggs (I945), the number of these occurring as

Purpose To assess the degree of accuracy of postoperative refraction that may be achieved with modern techniques and a new lens of modern design. Methods Five hundred eyes underwent refraction at one week and one month following phacoemulsification and implantation of the Centerflex  lens (Rayner Intraocular Lenses Ltd style 570H). Results were compared with the target that had been computerised at the time of surgery, using the Hoffer Q formula for axial lengths less than 22.0 mm, the SRK-T for lengths greater than 24.5 mm and a mean of the two formulae for lengths between 22.0 and 24.5 mm. Statistical analysis used Fisher's exact and one way ANOVA tests. Results At one month 97% of refractions were within 1.0 D spherical equivalent (SE) of target and 81% within 0.5 SE. The mean absolute error was 0.37 ؎ 0.39 SD. 75.8% of all eyes achieved 6/12 unaided and 88.6% achieved 6/9 with correction. In only 1.2% the refraction between one week and one month had altered by 0.5 D or more. Conclusions The Centerflex  when combined with modern methods of power calculation, can be associated with a high degree of accuracy in postoperative refraction.

The visual results of 55 bifocal lens implantations are compared with 55 matched PMMA monofocal implantations. 84% of the eyes with bifocal implants compared with 20% of the eyes with monofocal implants could read N8 or better with the distance correction (p less than 0.001). 52% of +/- 3.5D bifocal eyes could read N5 with the distance correction. The mean reading addition for a near point of 25 cm was 0.3D in the bifocal group and 2.2D in the monofocal group. 20% of eyes with bifocal implants could not be corrected to N5 at a comfortable distance (p = 0.005). It was found that the clear advantages of this bifocal lens must be countered in a minority by a loss in quality of vision particularly for reading.