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.

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.

Objectives -To compare the cost effectiveness and safety of inpatient cataract surgery (with one night in hospital postoperatively) with ambulatory day case surgery under local anaesthesia.

From 783 consecutive extracapsular cataract extractions with intact posterior capsules at the close of surgery, 655 eyes were available for examination three years after surgery and 447 eyes were available five years after surgery. By five years postoperatively, the need for secondary capsulotomy was 49% of 67 eyes that had not received an implant, 23% of 159 eyes that had received a Binkhorst iridocapsular lens, and 13% of 221 eyes that had received a posterior chamber lens. Among posterior chamber lenses, the surface area of the implant was considered to be a more important factor in inhibiting capsule opacification than posterior vaulting of the lens. Posterior vaulting was associated with a lower incidence of epithelialization but a higher incidence of capsular fibrosis. A small subgroup of 19 glaucoma triple procedures examined at three years showed a significantly higher incidence of capsulotomy (21.0%) than the other 369 posterior chamber lens implantations examined at three years (6.8%).

SummaryA clinical analysis of best cases four to 12 months postoperatively was made to assess the function of 47 3M multifocal implants, 40 Iolab multifocal implants and 24 AMO multifocal implants. Overall 86 (79%) eyes could see 6/12 and N6 unaided. The multifocal function for each lens worked well for distance, intermediate and near in the majority but an increase in depth of field was at a cost of reduced resolution effi ciency. The 3M lens was associated with symptoms of poor optical quality in 29.8% and with an inability to read N 5 with correction in 17 %. The Iolab lens provided bet ter reading vision but less good distant vision than the other types and was associated with symptoms of poor optical quality in 15%. Many of these had a pupil diameter greater than 3.5 mm. The AMO lens gave a poorer unaided reading vision than the other lens types but had the lowest incidence of optical symptoms.

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Materials and methodsAll patients who had undergone extracapsular cataract extraction with an intact capsule at surgery and insertion of a posterior chamber implant between 1981 and 1986 were called for examination two, three, and five years after surgery. Perforating injuries and secondary implantations were excluded. The age range at surgery was 29 to 94 (mean 74) years. Of the 958 patients (1170 eyes) called for review two years after surgery, 18 had moved from the district, 122 had died, and 818 were examined. Of these 197 had undergone bilateral surgery, making the total number of eyes examined 1015. By three years the death toll had risen to 17%, 17 patients (19 eyes) were untraceable, and 619 patients (741 eyes) were examined. Four hundred and fifty-eight operations were eligible for five-year follow-up, having been performed prior to 1984. Of these, 128 were lost because the patient had died (28%), 22 eyes (21 patients) were untraceable, and 308 eyes were examined.The lenses examined at two years were grouped (a) as 182 planoposterior convex anterior (CA) lenses; (b) as 431 reversed optic or convex posterior (CP) lenses; (c) as 320 lasergap lenses; and (d) as 82 biconvex hydrogel lenses made of polyhydroxyethyl methacrylate (38% water), the design of which has 918 on 9 May 2018 by guest. Protected by copyright.

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