A comparison of accommodation amplitudes in pseudophakic eyes measured with three different methods.

PURPOSE: To compare the accommodative amplitudes with three different methods in pseudophakic eyes with different types of intraocular lenses (IOLs). METHODS: Fifty-one pseudophakic eyes of 44 patients (age: 72.02+/-8.53 years) were studied. One of two different types of IOL were implanted (N=30, three-piece Alcon Acrysof MA60AC and N=21, one-piece Alcon Acrysof SA60AT) in-the-bag after standard phacoemulsification. The time of the examinations was 13.85+/-7.35 months postoperatively. We measured the amplitude of accommodation with three different methods: (1) subjective minus-lenses-to-blur method; (2) a new optical device (ACMaster, Carl Zeiss, Jena, Germany) using partial coherence interference (PCI) technique under physiological stimulus; and (3) objective anterior chamber depth measuring with a standard A-scan ultrasonic device (Ultrascan Imaging System, Alcon Laboratories, Forth Worth, TX, USA) before and after pharmacological relaxation of ciliary muscle. RESULTS: We measured -0.83+/-0.63 D amplitude of accommodation with subjective minus-lenses-to-blur method. The IOL position did not change significantly during physiological accommodation effort measured with PCI method (-0.026+/-0.134 mm). The change in the IOLs position between near fixating and after ciliary muscle relaxation was -0.18+/-0.28 mm measured with ultrasound. There were no significant differences between values of one-piece and three-piece IOL groups. CONCLUSION: The amplitude of accommodation measured by subjective and objective methods are different and are not comparable with each other. We did not observe any difference between values of examined two types of IOLs.

[The role of infection control in the prevention of postoperative endophthalmitis]. / Die Bedeutung der Infektionskontrolle in der Prävention der postoperativen Endophthalmitiden.

INTRODUCTION: Infection control programs play an important role in the fight against nosocomial infections. They include all written protocols used and practical procedures performed before, during and after surgery. The authors describe the role of infection control in the prevention of postoperative endophthalmitis. PATIENTS AND METHODS: Retrospective data of endophthalmitis cases following elective eye penetrating surgeries performed at the Departments of Ophthalmology of the University of Debrecen and of the Hajdú-Bihar County Hospital in the periods between 1997-2001 and 2002-2003 were evaluated. Infection control methods for prevention have been in use in both institutes since 2002. RESULTS: The incidences of postoperative endophthalmitis before and after 2002 were 0.09 % and 0.07 %, respectively. Endophthalmitis cases in both periods occurred sporadically. Between 1997 and 2001 women accounted for 63.6 %, while they made up 80 % between 2002 and 2003; In the first period 63.6 % were older than 60 years whereas this group made up and 100 % in the second period. During the two periods accompanying chronic systemic diseases also had to be taken into consideration in 80 % and in 63.6 % of the cases, respectively. Intraoperative loss of the vitreous body was present in 27.2 % (1997-2001), and in 20 % (2002-2003) of the cases. CONCLUSIONS: We did not find any statistically significant difference between the incidence of postoperative endophthalmitis in the two periods. We think, however, that further studies involving more patients and longer study periods will reveal a correlation between the use of infection control methods and the prevention of both sporadic and epidemic cases of endophthalmitis, therefore all available data concerning this problem should be published. Moreover, the introduction of infection control policies into clinical practice will make prevention deliberate and more effective.

[Clinicopathological characteristic of keratoglobus]. / Die klinisch-pathologischen Merkmale des Keratoglobus.

BACKGROUND: This study describes the clinical, topographical, pachymetrical, and histological features of a unique corneal disorder: keratoglobus. CASE REPORT: Ultrasound pachymetry proved that the structure of the cornea was evenly thinning towards the periphery. Histological examinations disclosed the absence of Bowman's membrane and the thinning of the stromal lamellae. CONCLUSION: On account of the thickness of the recipient's periphery, penetrating keratoplasty proved to be a reasonable surgical procedure in this case.

[Tear examinations in primary peripheral lipid keratopathy]. / Untersuchungen der Tränenflüssigkeit im Falle einer primären peripheren Lipidkeratopathie.

The authors report a case of a bilateral peripheral lipid keratopathy, rising differential diagnostic points as well. After several year-long follow-up period the peripheral corneal opacity left the center unaffected. The diagnosis was confirmed by tear examinations which disclosed elevated level of fatty and phosphorous content compared to healthy control eyes.

Comparison of different keratometers with the EyeSys videokeratoscope.

We compared the accuracy and the reproducibility of the measurements using a Haag-Streit, a Shin-Nippon, and a Carl Zeiss keratometer and an EyeSys videokeratoscope. Two investigators performed 20 measurements on 3 calibrated steel balls and 5 measurements on 22 normal corneas with all instruments. Calculating the accuracy of the measurements the limits of the 95% confidence intervals of the bias were determined. The accuracy was better than +/-0.1D for the keratometers, whereas it was better than +/-0.25D for the EyeSys videokeratoscope. The coefficient of reproducibility (1.96 x standard deviation) on test balls and corneas was smaller than 0.25D in the case of the Shin-Nippon and Carl Zeiss keratometers and the EyeSys videokeratoscope whereas it was between 0.25-0.5D in the case of the Haag-Streit keratometer. The Carl Zeiss keratometer was the best with respect to the accuracy and reproducibility of the measurements. Paired t-test was used to find possible significant differences between the results of the two investigators, but only clinically insignificant differences were found.

In ophthalmology new possibilities for the use Nd:YAG laser.

Results of the technical development in laser technology created new possibilities in ophthalmic surgery, too. The easy access to various lasers offers an extraordinary opportunity for eye surgeons. At the Department of Ophthalmology of the University Medical School of Debrecen we performed 1400 laser treatments in 1996. Out of that 1100 were retinal Argon laser coagulations because of diabetic retinopathy, 200 YAG laser capsulotomies because of secondary cataract, and 30 laser iridotomies because of glaucoma. Additional 70 laser treatments were performed for special indications. During the laser treatment of the retina and the choroid we use Argon gas lasers, whereas the Nd:YAG laser used in the anterior segment of the eye is a solid-state laser. Our pulse mode modus synchronized Nd:YAG apparatus can produce megawatts of energy in nanoseconds. Authors give an account of the Nd:YAG lasers' possibilities in therapy (capsulotomy, iridotomy), present the most frequent indications of treatments in 1996, and compare it with international literature data. Authors demonstrate the newest principles of the Nd:YAG laser treatment of secondary membranes that are occasionally formed in the anterior chamber especially in the area of the pupil following cataract surgery.