[Reproducibility of measurements of the peripapillary retinal nerve fibre layer thickness. Optical coherence tomography versus retinal thickness analyzer]. / Reproduzierbarkeit der Messung der peripapillären Nervenfaserschichtdicke. Optische Kohärenztomographie versus Retinal Thickness Analyzer.

PURPOSE: The aim of this study was to compare the intra- and inter-examiner reproducibility of measurements obtained by optical coherence tomography (OCT) and retinal thickness analyzer (RTA). PATIENTS AND METHODS: During a period of 2 months, 22 eyes of 16 patients and 6 healthy subjects were included. Two examiners (EMH, RK) successively performed three measurements of the peripapillary retinal nerve fibre layer (RNFL) thickness with RTA and OCT. The reproducibility of three individual measurements of one examiner (intra-examiner) as well as the reproducibility of the measurements between both examiners (inter-examiner) was evaluated using the Friedman test and sign test. RESULTS: The average thickness of the peripapillary RNFL was 154.4 microm for the first investigator (EMH) and 155.1 microm for the other investigator (RK) measured with RTA. The results obtained by OCT were 137.3 microm (EMH) and 138.9 microm (RK), respectively, generally indicating a threefold smaller range. Comparing the three measurements of one single examiner, no appreciable intra-observer dependency neither for RTA (EMH: p=0.19, RK: p=0.95) nor for OCT (EMH: p=0.51, RK: p=0.62) was observed. Inter-examiner analysis for RTA and OCT also revealed an acceptable reproducibility. CONCLUSIONS: Measurements of peripapillary RNFL thickness using RTA and OCT exhibited intra- and inter-observer agreement.

[Near vision after implantation of monofocal versus multifocal intraocular lenses]. / Nahvisus nach Implantation monofokaler versus multifokaler Intraokularlinsen.

AIM: Object of this study was to compare the near visual acuity between eyes with monofocal intraocular lens (MONO) and myopic target refraction in comparison with eyes after refractive multifocal intraocular lens (MIOL) implantation and emmetropic to slight hyperopic target refraction. PATIENTS AND METHOD: 89 eyes of 83 patients underwent cataract surgery, in 49 eyes a MONO (SI-40NB, Allergan) was implanted, in 40 eyes a refractive MIOL (SA-40N, Allergan). At day 2 after surgery and after 5 months the uncorrected near visual acuity, the near visual aculty with distance correction and with an addition of +3 diopters (D) were determined. The refractive outcome targeted in case of MIOL implantation was emmetropia to slight hyperopia and myopia for the MONO subjects. The eyes with MONO were classified in 4 categories depending on their postoperative refractive error (spherical equivalent, SE): category 1 with SE +1 to > 0 D, category 2 with SE 0 to > -1 D, category 3 with SE -1 to > -2 D and category 4 with a SE -2 to > -3 D. RESULTS: We found a statistically significant better uncorrected near visual acuity in eyes with MIOL than in MONO subjects for category 1-3. In category 4 there was no statistically significant difference between MONO and MIOL. With best distance correction near visual acuity in MIOL was statistically significant better than in all 4 MONO categories. After adding 3 D, there was no statistically significant difference between the groups. CONCLUSION: Even in case of a myopic target refraction near visual acuity in eyes of the MONO group was statistically significant worse than in the eyes of the MIOL group. Only in case of postoperative SE of < or = -2 D eyes of the MONO group had a near visual acuity similar to the eyes of the MIOL group. This advantage is accomplished with a decrease in the uncorrected distance visual acuity.

Intraocular pressure after small incision cataract surgery: temporal sclerocorneal versus clear corneal incision.

PURPOSE: To compare intraocular pressure (IOP) after phacoemulsification and foldable intraocular lens (IOL) implantation using a temporal sclerocorneal or clear corneal incision. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: One hundred patients (100 eyes) with cataract having phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision. Intraocular pressure was measured preoperatively and 6 hours, 1, 2, and 3 days, and 5 months postoperatively. Statistical significance was determined by nonparametric group comparisons using 2-sample random Wilcoxon tests. RESULTS: Six hours postoperatively, the median IOP increase was significantly higher in the sclerocorneal tunnel group (57%) than in the clear corneal incision group (18%) (P <.001). No significant between-group difference in IOP was found at 1, 2, or 3 days or 5 months. At 5 months, IOP was 0.6 mm Hg lower than preoperatively in the sclerocorneal tunnel group and 1.5 mm Hg lower in the clear corneal group. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, the immediate postoperative IOP increase was higher in eyes having a sclerocorneal incision than in those having a clear corneal tunnel incision. These results could be important in eyes with decreased outflow facility or preexisting optic nerve damage.

Contrast sensitivity and glare disability by halogen light after monofocal and multifocal lens implantation.

BACKGROUND: Standard examination of contrast sensitivity under conditions of glare disability is performed with incandescent light. A new halogen glare test that simulates glare as seen with oncoming vehicle headlights was used to measure glare disability in patients implanted with multifocal and monofocal intraocular lenses (IOLs). METHODS: 28 patients with an average age of 69 years (SD 12 years) were implanted with a monofocal IOL (SI-40NB, Allergan) and 28 patients with an average of 66 years (12 years) were implanted with a refractive multifocal IOL (Array-SA-40N, Allergan). All patients were followed for 5 months postoperatively. Contrast sensitivity at four spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) with and without a glare source were measured using the halogen glare test (CSV-1000 HGT). Statistical analysis was performed using the two sample Wilcoxon test. The local significance level was set at 0.05. RESULTS: When tested at the lowest spatial frequency (3 cpd) without halogen glare, contrast sensitivity was lower in the multifocal group than in the monofocal group (p=0.0292). With additional glare, there was no difference between both groups. At all other spatial frequencies (6, 12, and 18 cpd), when tested without halogen glare (6 cpd, p=0.5250; 12 cpd, p=0.8483; 18 cpd, p=0.9496) and with moderate (3 cpd, p=0.7993; 6 cpd, p=0.4639; 12 cpd, p=0.7456; 18 cpd, p=1.0) and high halogen glare (3 cpd, p=0. 1513; 6 cpd, p=0.2016; 12 cpd, p=0.3069; 18 cpd, p=0.9933), there was no statistically significant difference between groups. Patients in both groups of age 70 or older had reduced contrast sensitivity without halogen glare and with moderate and strong glare. When monofocal and multifocal patients older than 70 years of age were analysed separately, there was no statistically significant difference in contrast sensitivity with and without glare. Astigmatism >1 dioptre had no significant influence on contrast sensitivity and glare disability when monofocal and multifocal eyes were compared. CONCLUSION: Reduced contrast sensitivity was found in the multifocal group only at the lowest spatial frequency without halogen glare. The monofocal and multifocal groups had no statistically significant differences in contrast sensitivity with moderate and strong glare. These results suggest no difference in glare disability induced by halogen light similar to oncoming vehicle headlights for patients implanted with monofocal and multifocal IOLs.

Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification.

OBJECTIVE: To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: One hundred eyes of 100 patients were examined at a German University eye hospital. INTERVENTION: One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. MAIN OUTCOME MEASURES: Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photometry. Statistical inference was mainly based on nonparametric group comparisons by use of two sample Wilcoxon tests. RESULTS: Mean anterior chamber flare in the group with sclerocorneal tunnel increased from 7.5 photon counts/ms preoperatively to 19.6 at 6 hours postoperatively and decreased to 11.1 (day 1), 11.7 (day 2), 11.6 (day 3), and 9.2 (5 months) during the postoperative course. The mean flare in the clear corneal tunnel incision group increased from 7.7 preoperatively to 12.9 at 6 hours postoperatively and then decreased to 9.2 (day 1), 9.8 (day 2), 9.1 (day 3), and 9.2 (5 months). Individual postoperative flare changes were significantly lower in the clear corneal tunnel group at the day of surgery (P<0.0001), as well as at day 1 (P = 0.0011), day 2 (P = 0.0079), and day 3 (P = 0.0020). After 5 months, no statistically significant difference was found. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, postoperative alteration in the blood-aqueous barrier was statistically significantly lower with the clear corneal tunnel incision group compared with the sclerocorneal incision group, in the first 3 days postoperatively.

Objective and subjective evaluation of photic phenomena after monofocal and multifocal intraocular lens implantation.

OBJECTIVE: To objectively measure and compare halo, flicker, and glare disability in pseudophakic eyes with monofocal (MONO) and multifocal (MULTI) intraocular lenses (IOLs) with respect to the influence of corneal surface quality, astigmatism, and age. DESIGN: Prospective case series. PARTICIPANTS: This clinical trial involved 28 eyes of 28 patients after small-incision cataract surgery with a MONO silicone IOL and 28 eyes of 28 patients with zonal-progressive silicone IOL. INTERVENTION: A computer program objectively determined halo, glare, and flicker. Corneal surface quality and astigmatism were measured using computerized videokeratography. Ray-tracing analysis was performed based on the videokeratography data to calculate retinal peak distance and distortion index. A questionnaire was sent to all patients to evaluate the incidence of subjective photic phenomena. RESULTS: Mean halo size (square degrees +/- standard deviation) valued 6.1 (+/- 1.3) in the MONO group and 7.2 (+/- 2.3) in the MULTI group with no statistically significant difference between MONO and MULTI. Flicker (in % contrast to add) was -0.7 (+/- 2.9) in the MONO group and -1.0 (+/- 4.2) in the MULTI group with no statistical differences. Glare (in % contrast to add) was 5.5 (+/- 16.5) in the MONO group and 6.5 (+/- 18.0) in the MULTI group with no statistical differences. Patients in the MONO group older than 70 years of age had significantly more glare than those younger than 70 years (P = 0.017). In the MULTI group, patients with corneal shape irregularities (peak distance > 6.0 microm) or astigmatism (> 1 diopter) had statistically significant greater halos than did patients with regular corneal shape (peak distance < or = 6.0 microm) or astigmatism (< or = 1 diopter) (P < 0.005). Three of 27 MONO patients and 9 of 28 MULTI patients noticed light sensations (mainly halos) after surgery that were not present before surgery, with the majority not being bothered by these at all. CONCLUSION: In monofocal as well as in multifocal eyes, halo and glare disability occurred. Patient age, corneal surface quality, and IOL design played an important role in these photic phenomena. Because these photic phenomena may be more prevalent in night driving conditions, the authors' study suggests that night driving ability, especially in the elderly patient with pseudophakia, should be examined carefully.

Comparative pharmacodynamics and plasma levels of beta-adrenoceptor blocking drugs.

1. Metoprolol (ME), pindolol (PI) and propranolol (PR) were studied in nine subjects at different doses and at 'maximum beta-adrenoceptor blockade' at a defined exercise load. Exercise tests were performed after each dosing period; isoprenaline stimulation was studied at the highest dose level. 2. ME and PR reduced heart rate at rest with most doses tested, while PI had no effect on resting heart rate. 3. Exercise heart rate was reduced with the smallest daily doses (ME 75 mg; PI 7.5 mg; PR 60 mg), and maximum reduction was from 163 to 116 beats/min (ME), 124 (PT) and 115 (PR) beats/min with daily doses of 242, 23 and 233 mg, respectively. 4. Resting blood pressure was not significantly affected by any beta-adrenoceptor blocker dose, but exercise induced blood pressure decreased from 166 to 130 (ME), 138 (PI) and 131 (PR) mm Hg, respectively. 5. Mean plasma concentrations at 'maximum beta-adrenoceptor blockade' were 158 (ME), 24 (PI) and 159 (PR) ng/ml without significant differences in the plasma level variation between beta-adrenoceptor blockers. 6. Isoprenaline doses required to increase heart rate by 30 beats/min were 3.8 microgram (control), 22 microgram (ME), 458 microgram (PI) and 200 microgram (PR), respectively. The differences may be due to different ratios of beta 1, beta 2 activity of the beta-adrenoceptor blockers tested.