Surgically induced astigmatism with superior and temporal incisions in cases of with-the-rule preoperative astigmatism

PURPOSE: To evaluate surgically induced astigmatism (SIA), postoperative astigmatism, and uncorrected visual acuity (UCVA) after cataract surgery with superior corneal, superior scleral, and temporal corneal 4.0 mm sutureless incisions in cases of preoperative with-the-rule (WTR) astigmatism. SETTING: Hopital des Quinze-Vingts, Paris, France. METHODS: This prospective evaluation included patients having phacoemulsification with foldable lens implantation through a 4.0 mm incision. Patients with preoperative WTR astigmatism were randomly assigned to 1 of 3 incisions: superior corneal (Group 1), superior scleral (Group 2), or temporal corneal (Group 3). All patients had autokeratometry preoperatively and postoperatively (1 day, 1 week, 1 month, 1 year). Surgically induced astigmatism using the vector method, postoperative astigmatism, and UCVA (patients whose spherical equivalent was with +/- 1 diopter) were evaluated. RESULTS: Ninety patients were included in the study; there were 30 in each incision group. One year postoperatively, Group 1 had 1.52 diopters (D) of SIA and 1.36 D of postoperative astigmatism; 53.5% of patients had a UCVA of 20/32 or better, Group 2 had 0.69 D of SIA (P < .05) and 0.67 D of postoperative astigmatism (P < .05); 82.7% of patients had a UCVA of 20/32 or better (P < .05). Group 3 had 0.69 D (P > .05), 0.98 D (P < .05), and 79.3% (P > .05), respectively. CONCLUSIONS: In this study, the superior corneal incision produced significant SIA, leading to high postoperative astigmatism and poor UCVA. The scleral and temporal incisions produced minimal SIA and good UCVA.     

Changes in 31P-relaxation times during organ preservation: observations on cold stored human donor livers

PURPOSE: To compare the clinical outcome of phacoemulsification and foldable silicone intraocular lens (IOL) implantation through a 3.0 mm temporal clear corneal incision and 3.0 mm superior scleral tunnel incision. SETTING: Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan. METHODS: Eighty cataractous eyes of 78 patients with pre-existing against-the-rule (ATR) astigmatism were recruited for this prospective, randomized study. The patients were assigned to one of the two groups. Data on uncorrected and corrected visual acuities, keratometry, flare intensity measurement, and central cornea endothelial cell count were evaluated preoperatively and at 2 days, 1 week, and 1 and 3 months postoperatively. RESULTS: Although the pre-existing keratometric cylinder decreased in the temporal clear corneal incision group and increased in the superior scleral tunnel incision group, the amount of cylinder shift was not significantly different. Mean scalar shift of keratometric cylinder in the corneal incision group was 1.19 diopters (D) at 2 days postoperatively, 0.86 D at 1 week, and 0.56 D at 3 months and in the scleral incision group, 1.09 D at 2 days, 0.76 D at 1 week, and 0.65 D at 3 months. Eighty percent of the eyes in each group achieved an uncorrected visual acuity of 20/40 or better from the second day postoperatively. No statistically significant difference in visual rehabilitation or other parameters was noted between the groups throughout the study. Complications including corneal endothelial cell loss and wound incompetence requiring suturing were observed in the temporal clear corneal incision group. CONCLUSIONS: Both incisions offered satisfactory clinical results, but the superior scleral tunnel incision resulted in fewer complications. Minimal corneal keratometric change induced by a 3.0 mm incision was not related to uncorrected visual rehabilitation.     

The contribution of A. G. Ginetsinski? to the theory of the chemical transmission of synaptic signals

OBJECTIVES: To verify corneal topography and astigmatism after cataract surgery with 8 mm scleral tunnel incisions closed with a continuous 10-0 nylon suture. SETTING: Institute of Ophthalmology, University of Verona, Italy. METHOD: Twenty eyes were studied for 12 months after cataract extraction with 8 mm, sutured, scleral tunnel incisions. Corneal topography (EyeSys 2.1) was evaluated for the first 5 months. Astigmatism (absolute and induced) was measured by Javal ophthalmometry preoperatively and 1, 7, 30, 60, 90, 150, and 360 days after surgery. RESULTS: In the week following surgery, corneal shape was minimally affected and uncorrected visual acuity was not compromised. Mean with-the-rule induced cylinder was less than 1.00 diopter (D). After 5 and after 12 months, the mean induced cylinder was still less than 1.50 D but with an against-the-rule shift in almost all eyes. CONCLUSIONS: Sutured 8 mm tunnel incisions showed good results in terms of absolute cylinders but late against-the-rule shift could not be avoided.     

Combined cataract and glaucoma procedures using temporal cataract surgery

PURPOSE: To evaluate whether separating the procedures in a combined procedure by performing a temporal cataract incision and superior trabeculectomy induces the lower astigmatism of a temporal cataract incision without sacrificing intraocular pressure (IOP) control. SETTING: EyeSight Associates, Warner Robins, Georgia. METHODS: This study evaluated 50 consecutive eyes receiving a superior cataract incision with a superonasal trabeculectomy and 65 eyes receiving a temporal cataract incision with a superonasal trabeculectomy. RESULTS: After 3 months, a substantially greater proportion of temporal incision cases had controlled IOP without medication. A substantially higher proportion in the superior incision group had uncontrolled IOP at each time period. Mean surgically induced cylinder was higher in the superior incision group at every time period. The superior group had early with-the-rule mean induced cylinder that decayed to against-the-rule, with a mean induced cylinder with keratometry at the final available visit (more than 3 months) of -1.01 diopter (D). The temporal group started with a negligible induced cylinder (-0.13 D) that drifted slightly with the rule to a final mean induced cylinder of +0.49 D. At the last visit, 31% in the superior incision group and 57% in the temporal incision group had an uncorrected visual acuity of 20/40 or better, and 72% and 94%, respectively, had a best corrected acuity of 20/40 or better. CONCLUSION: Separating the cataract and glaucoma procedures frees the surgeon to use newer astigmatically neutral techniques for the cataract incision.     

Induced astigmatism and its decay with a frown incision

Forty consecutive patients selected for cataract extraction by phacoemulsification were studied to evaluate prospectively the amount of and changes in surgically induced astigmatism from a 5 mm to 6 mm pocket incision with the external opening made convex against the limbus (frown incision). All incisions had an internal corneal valve and were closed by a single X-stitch to counteract the relaxing effect of the pocket in the 90-degree meridian. Surgically induced astigmatism calculated by simple subtraction was 0.64 +/- 0.90 diopters (D) (P < .0001) on the first postoperative day, 0.03 +/- 0.58 D (P = .75) six weeks after surgery, and -0.18 +/- 0.44 D (P = .01) six months after surgery. Calculated from polar equivalents, the induced astigmatism on the first postoperative day was 0.98 D +/- 1.03 D (P = .0001), after six weeks -0.11 D +/- 0.64 D (P = .30), and after six months -0.28 D +/- 0.49 D (P = .0009). On the first postoperative day 42% of eyes had less than 0.5 D of induced astigmatism, 68% had less than 1.0 D, and 79% had less than 1.5 D. After six weeks the respective percentages increased to 61%, 97%, and 97% and after six months to 84%, 100%, and 100%. The distribution of patients with against-the-rule, oblique, and with-the-rule astigmatism preoperatively was nine, 20, and 11, respectively, and 11, 19, and nine after six months. The amount of astigmatism induced from the 5 mm to 6 mm frown incision did not differ from that found in previously published studies of smaller incisions (to about 4 mm).(ABSTRACT TRUNCATED AT 250 WORDS)     

Two-incision radial keratotomy for low myopia with astigmatism

PURPOSE: To evaluate the effectiveness of two-incision radial keratotomy (RK) in correcting low-magnitude refractive myopic astigmatism. SETTING: Two clinical study sites, one in St. Louis, Missouri, USA, the other in Caracas, Venezuela. METHODS: Fifty-seven eyes of 43 patients with low-magnitude myopic astigmatism had two-incision RK at one of two clinical study sites. In the initial phase of this series, 10 eyes with amblyopia at the 20/30 level had surgery at one center. Refractive keratotomy was performed with the radial incision placed in the plus cylinder axis of refraction. This axis was verified as the meridian of greatest corneal curvature by standard keratometry and computer-assisted corneal topographic analysis. Two eyes received a second operation (enhancement). RESULTS: Mean follow-up was 11.1 months (range 6 to 12 months). Mean preoperative and postoperative myopic spherical equivalent measured -1.42 diopters (D) +/- 0.51 (SD) and -0.14 +/- 0.39 D, respectively; the mean reduction was 1.28 +/- 0.59 D (P = .0001). Mean preoperative and postoperative refractive astigmatism was 1.41 +/- 0.45 D and 0.48 +/- 0.33 D, respectively (P = .0001). Mean preoperative and postoperative keratometric astigmatism was 1.26 +/- 0.54 D and 0.31 +/- 0.35 D, respectively, a mean reduction of 0.95 D (P = .0001). The surgical meridian was flattened by an average of 2.06 D by keratometry and the orthogonal meridian, by an average of 1.10 D. Preoperative uncorrected visual acuity (UCVA) was 20/40 or better in five (9%) eyes (range counting fingers to 20/40). Postoperative UCVA acuity was 20/40 or better in all eyes (mean acuity 20/25). In the nonamblyopic subgroup mean postoperative UCVA was 20/24. CONCLUSIONS: A limited number of radial incisions placed in the topographically confirmed axis of greatest curvature are effective in the treatment of low-magnitude myopic astigmatism.     

Relationship between preoperative axis of astigmatism and postoperative astigmatic change after superior scleral incision phacoemulsification

PURPOSE: To evaluate the effect of the preoperative axis of astigmatism on the outcome of corneal astigmatism after sutured 5.2 to 5.7 mm superior incision phacoemulsification. SETTING: Departments of Opthalmology, Odense and Vejle Hospitals, Denmark. METHODS: Seventy-three consecutive patients with preoperative corneal astigmatism of 2.0 diopters (D) or less, axial length between 20.0 and 25.5 mm, and no eye disease except cataract were grouped according to preoperative with-the-rule (WTR) or against-the-rule (ATR) astigmatism. The keratometric cylinder, induced keratometric cylinder (subtraction), and induced cylinder (Jaffe) were measured and calculated 10 to 12 months postoperatively. RESULTS: The postoperative keratometric cylinder and induced keratometric cylinder were significantly higher in the ATR group (P < .00001; mean difference [95% confidence limits]: 0.76 D [0.54; 0.98] and 0.69 D [0.46; 0.92], respectively). There was no significant difference between groups in induced cylinder (Jaffe). CONCLUSION: The estimated differences were significantly in favor of patients with preoperative WTR astigmatism. The findings support using temporal incision in cases with a preoperative ATR axis of astigmatism.     

Further study of hepatitis C virus RNA detection in formalin-fixed, paraffin-embedded liver tissues by ligation-dependent polymerase chain reaction

AIM: Refractive cataract surgery using corneal incisions is aiming at neutralization of preoperative astigmatism. PATIENTS AND METHODS: 61 patients with preoperative astigmatism of 2.25 +/- 0.98 were included in the treatment. A self-sealing corneal tunnel incision measuring 4.0 to 4.1 mm in external diameter and 6.5 to 7.0 mm in internal diameter (stretch incision) was performed on the steeper axis. After capsulorhexis and phacoemulsification a 5 mm PMMA lens was implanted without suturing. Keratometry and corneal topography were performed preoperatively, 3 days and 1 year respectively following surgery. The statistical analysis was based on the Wilcoxon signed ranks test. RESULTS: Surgical induced astigmatism (IA) following superior incisions in cases of astigmatism with the rule (n = 29) amounted to 1.93 +/- 0.97, while lateral incisions in cases of astigmatism against the rule (n = 29) led to an IA of 1.35 +/- 0.73. Axial shifts by more than 30 degrees were 23% following superior incisions and 17%, after lateral incisions. We observed. astigmatic reduction of 1.3 D after superior incisions and 0.7 D following lateral incisions. CONCLUSION: By 4 mm corneal cataract incisions on the steeper axis a high preoperative astigmatism can be reduced significantly without additional keratotomies.     

Astroglial changes in the cerebral cortex of AIDS brains: a morphometric and immunohistochemical investigation

Sutureless phacoemulsification with implantation of a 7-mm PMMA intraocular lens was performed through a modified scleral tunnel in 100 consecutive patients. This was done to minimize postoperative astigmatism while retaining the advantages of implanting intraocular lenses with large optics. Visual and keratometric results and complications are reported after completion of a follow-up period of 6 months for the first 30 patients. Average uncorrected visual acuity improved from 0.13 preoperatively to 0.30 as early as 1 week postoperatively. Average best-corrected visual acuity improved from 0.23 before surgery to 0.51 as early as 1 week after surgery. No significant changes in visual acuity were recorded thereafter. The absolute value of keratometric astigmatism was not increased significantly at any postoperative examination time. The induced cylinder (Jaffe and Clayman) shifted from -1.27 D x 166 degrees at 1 week to 1.18 D x 91 degrees at 1 month postoperatively without further relevant changes thereafter. Endothelial cell loss did not differ from that reported by other authors after conventional cataract surgery. Corneal thickness was not increased significantly at any postoperative examination time. Implantation of intraocular lenses with large optics through a scleral tunnel allows quick visual rehabilitation as well as early stability of refraction.     

Resource management of cataract patients: effect of four contemporary incisions on postoperative visits required

PURPOSE: To assess the effect of four contemporary cataract surgery incisions on the number of postoperative visits required. SETTING: Cataract service of a large free-standing eye hospital in a capital city. METHODS: This study comprised a prospective evaluation of three incisions for phacoemulsification and a retrospective assessment of age- and sex-matched patients having conventional corneal section extracapsular cataract extraction. All patients had age-related cataract. Main outcome measures were complications, best corrected and uncorrected visual acuities 6 weeks after surgery, and number of visits before discharge. Follow-up was at least 6 months. RESULTS: Patients who had small and scleral incisions had better uncorrected visual acuities 6 weeks postoperatively because they had less astigmatism. Patients who had small and scleral incisions required significantly fewer postoperative visits before discharge. CONCLUSION: A prospective assessment of the feasibility and acceptability of reduced postoperative follow-up after phacoemulsification using a scleral tunnel is required.     

Predicting the refractive result after cataract surgery

PURPOSE: To study the accuracy of predicting visual results after cataract surgery using a mathematical model of surgically induced refractive change and a previously published regression formula predicting uncorrected visual acuity as a function of the resulting spherocylinder. SETTING: Outpatient cataract clinic at a university hospital. METHODS: In this prospective study with a 4 month follow-up, 333 patients had phacoemulsification using a 6 or 4 mm scleral tunnel incision. Final refraction and uncorrected visual acuity were predicted based on preoperative and 1 day postoperative measurements, which were compared with the final visual results. RESULTS: A significant correlation was found between the observed and the predicted visual acuity in each eye (P < .01). CONCLUSION: The visual outcome of cataract extraction can be predicted from a theoretical model of the surgically induced refractive change.     

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification

PURPOSE: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. SETTING: Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA. METHODS: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups. RESULTS: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%). CONCLUSION: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.     

Chaotic characteristics of renal nerve peak interval sequence in normotensive and hypertensive rats

BACKGROUND AND OBJECTIVE: To determine whether corneal topography and visual recovery are affected by suturing a temporal, clear corneal incision for cataract surgery. PATIENTS AND METHODS: Forty-one consecutive phacoemulsification patients (39 eyes) had a 3.2-mm incision sutured with one 10-0 nylon, radial suture removed after 1 postoperative week. Visual acuity (VA) and corneal topography, including best fit sphere (BFS), best fit cylinder (BFC), principle meridian, topographic irregularity (TI), and vector-corrected astigmatism (VCA), were measured preoperatively and 1 day, 1 week, and 1 month postoperatively. Two-tailed t tests and Pearson correlations were calculated. RESULTS: From the preoperative measurement to 1 week postoperatively, VA improved, BFS (P = .005) and TI (P = .033) increased, and VCA shifted with-the-rule. From 1 week to 1 month postoperatively, BFS (P = .012) and TI (P = .002) decreased. BFC and its direction did not change. Almost all measures were significantly correlated. CONCLUSION: The benefits of sutureless surgery on corneal topography and visual recovery are not degraded by using a suture to prevent wound leakage.     

Arcuate keratotomy to correct naturally occurring astigmatism

PURPOSE: To evaluate retrospectively the safety, efficacy, and complications of arcuate keratotomy (AK) in correcting naturally occurring astigmatism. SETTING: Laser Ultravision Institute, Montreal, Canada. METHODS: Surgically induced refractive change was evaluated in 25 eyes of 15 patients with naturally occurring astigmatism. All patients had mixed or compound myopic astigmatism and were treated with AK alone or both AK and radial keratotomy (RK). Minimum follow-up of 24 months was necessary for inclusion in this study. We used vector analysis to evaluate the refractive and keratometric astigmatic change at 1 month and 1 and 2 years. RESULTS: Ten eyes (40%) had AK only and 15 eyes (60%), both AK and RK. It was necessary to redeepen the original incisions in 21 eyes (84%). All patients had improved uncorrected visual acuity postoperatively. The reduction in refractive cylinder, quantified by vector analysis, was significant. Two years postoperatively, mean reduction was 3.30 diopters (D) +/- 1.32 (SD) in eyes that had AK alone and 2.71 +/- 1.53 D in eyes that had both AK and RK. CONCLUSION: Arcuate keratotomy is an effective and safe method for correcting naturally occurring astigmatism. Further analysis of this series of patients is planned.     

Refractive results after photorefractive excimer laser treatment in mild myopic and in mild hyperopic eyes

Evaluation of 12-month results of photorefractive keratectomies (PRK) performed in low myopic (0 to -6.0 D) and low hyperopic (0 to +6.0 D) eyes. Myopic and hyperopic PRK treatments with the Aesculap Meditec MEL 60 ArF excimer laser. Prospective study, 30 eyes per group. The change in best corrected visual acuity (VA), refraction required, uncorrected VA and the postoperative haze were compared at the 12th postoperative month. The average preoperative correction in the low myopic eyes (Group I) was -4.65 +/- 1.24 D, which decreased to -0.17 +/- 0.56 D during the follow-up. In mild hyperopic eyes (Group II) the preoperative refraction was +3.9 +/- 0.93 D and decreased to +1.23 +/- 1.59 D post-PRK. Comparing the pre- and postoperative average best corrected VA values, there was no statistical change in either group. In the low myopic group all eyes had a 20/40 or better uncorrected VA, in hyperopic eyes 11 had a VA of 20/40 or better, four had a worse uncorrected VA. In Group I, 86.6% of the eyes were within +/-1.0 D of the intended refraction at 12 months postoperatively. In Group II, 46.7% of the eyes were within +/-1.0 D of final refraction. There were no intergroup differences in subjective complaints, reepithelization and average postoperative haze. Both methods are able to alter the refractive power of the cornea toward emmetropia. The predictability of the method was to be found higher in cases of mild myopia than in mild hyperopia. The upper limit of myopia is above -6.0 D, but in hyperopia, with the present technical facilities, good postoperative results can be obtained only as far as +4.25 D of preoperative refractive error.     

Treatment of myopic astigmatism with the Summit Apex Plus excimer laser

PURPOSE: To assess the results of surface sequential toric photorefractive keratectomy (PRK) with the Summit Apex Plus excimer laser using an erodible mask. METHODS: A prospective study was performed on consecutive eyes having surface sequential toric PRK over a 4 month treatment period. Attempted astigmatism correction varied from 70 to 100%, depending on the power and axis of the cylinder. The myopic correction was adjusted so the combined treatment aim was emmetropia. Refraction, manual keratometry, corneal haze, and visual acuity data from preoperative and follow-up visits over 12 months were divided into various groups based on the preoperative refraction and analyzed. RESULTS: Fifty-nine eyes from 48 patients had sequential toric PRK. Preoperatively, the mean spherical equivalent at glasses plane (SEGP) was -4.88 diopters (D) +/- 3.20 (SD) and the mean refractive cylinder, 2.02 +/- 1.04 D. The mean attempted cylinder correction was 1.87 D. At 12 months the mean SEGP was -0.02 +/- 0.67 D, which was not statistically significant from plano. The mean refractive cylinder was 0.84 +/- 0.84 D, which was statistically significantly different from zero cylinder power. There was a statistically significant correlation between the preoperative and the 12 month postoperative refractive cylinder powers. At 12 months, 34 of 43 eyes (79.1%) had an uncorrected visual acuity of 6/12 or better. While 2 eyes in one patient (4.7%) lost two lines of best corrected visual acuity, with a final acuity of 6/12 in each, no patient lost more than two lines. CONCLUSION: The manifest refraction cylinder power is not fully corrected with the current treatment algorithms; however, surface sequential toric PRK using an erodible mask is capable of treating compound myopic astigmatism with moderate success.     

Surgical correction of postkeratoplasty astigmatism with the Hanna arcitome

PURPOSE: To report the results of arcuate keratotomy performed with the Hanna arcitome in patients with postkeratoplasty astigmatism. SETTING: Department of Ophthalmology, Saint-Antoine Hospital, Paris VI University, Paris, France. METHODS: This retrospective study comprised 22 eyes (22 patients) with postkeratoplasty astigmatism. Paired symmetrical arcuate keratotomy was performed with the Hanna arcitome. Outcome measures included refraction, videokeratography, and keratometry. RESULTS: At 6.6 months +/- 8.9 (SD) after surgery, the mean increase in best spectacle-corrected visual acuity (BSCVA) was 2.1 +/- 2.4 lines. Thirteen eyes gained 2 lines or more of BSCVA, and 15 gained 3 lines or more of uncorrected visual acuity. Two patients had a decrease in BSCVA: 1 had lens opacification unrelated to arcuate keratotomy and 1, increased corneal irregularity. Mean refractive astigmatism was 6.94 +/- 2.11 diopters (D) preoperatively and 3.85 +/- 1.95 D postoperatively (P < .01). Mean change in keratometric astigmatism was -51 +/- 36%. Astigmatism decreased in 21 eyes as measured by manifest refraction, keratometry, and videokeratography; it increased in 1 cornea with a microperforation. CONCLUSIONS: The results of arcuate keratotomy performed with the Hanna arcitome were comparable to those with freehand relaxing incisions. The instrument made safer and more uniform arcuate incisions than a freehand technique.     

Alzheimer''s disease: the advent of effective therapy

PURPOSE: To investigate the astigmatic keratotomy effect of a modified single-hinge cataract incision. SETTING: Department of Ophthalmology, San Juan de Dios Hospital, Tenerife, Spain. METHODS: This prospective study evaluated the astigmatic changes resulting from preincision grooves of less than 40, 45, and 55 degrees in arc length used with a single-hinge, self-sealing cataract incision in 144 eyes that had against-the-rule corneal astigmatism preoperatively. The intended 90% depth preincision was centered on the steep meridian and lengthened according to the amount of preoperative astigmatism. Outcome measurements were obtained by calculating the surgically induced astigmatism vectors and the postoperative keratometry changes 1 day, 1 week, and 1, 3, and 6 months after surgery. RESULTS: Three months postoperatively, astigmatism decreased by 0.03, 0.30, and 0.68 diopter in the less than 40, 45, and 55 degree incision length groups, respectively. The differences between the 45 and 55 degree groups and the less than 40 degree group was statistically significant (P < .05). Similar results were observed 6 months after surgery. CONCLUSION: The astigmatic preincision modification produced statistically significant increasing reductions in preoperative astigmatism according to preincision length.     

Correlation of pituitary hormones in serum of male patients with fertility problems

The advent of the excimer laser has brought about the potential for improved vision in many individuals with myopia and astigmatism. However, photoastigmatic refractive keratectomy (PARK) remains a matter of controversy. The purpose of our study was to determine the predictability of VISX 20/20 excimer laser photorefractive keratectomy in the treatment of myopic astigmatism. PATIENTS AND METHODS: Our study comprised 31 eyes of 22 patients with myopic astigmatism. All patients underwent treatment with a VISX 20/20 excimer laser and were followed up for 6 months. Complete 12-month follow-up data were available from 18 eyes. Park was performed in eyes with myopia between -1.5 and -10.0 D and with astigmatism between -0.5 and -5.5 D. Thus, the corresponding spherical equivalent ranged from -1.75 to -10.5 D. RESULTS: Six months postoperatively, 21/31 (62%) eyes were within +/- 1.0 D of the target refraction and 13/31 (42%) within +/- 0.5 D of the target refraction. In 13 of 15 eyes (87%) with myopia less than -6.0 D, an uncorrected visual acuity of at least 0.8 was noted. In eyes with myopia greater than -6.0 D, 9/16 (56%) showed an uncorrected visual acuity of at least 0.5. Six months after PARK, an increase of one line on the Snellen Visual Acuity Chart was observed in 8/31 (26%) and an increase of two lines was noted in eyes 3/31 (10%). One of 31 eyes (3%) showed an increase of three lines. A decrease in visual acuity of 1 line on the Snellen Visual Acuity Chart was found in 4/31 (13%), and in 3/31 eyes (10%) a decrease of 2-4 lines was noted. Overall, we observed a statistically significant reduction of astigmatism from 1.93 +/- 1.43 D to 0.93 +/- 0.63 D. Reduction of corneal astigmatism less than -1.25 D was not statistically significant. In eyes with astigmatism ranging from -1.25 to -2.5 D or greater than -2.75 D, a significant reduction of the mean astigmatism was noted. The postoperative regression of astigmatic correction was low. However, an axis shift of more than 15 degrees was found in 42%/35% of eyes by subjective refraction (miosis/cycloplegia) and in 33% in corneal topography. No central islands were noted. CONCLUSION: Photoastigmatic refractive keratectomy (PARK) constitutes a potential means of correcting myopic astigmatism. In eyes with astigmatism greater than -1.0 D a significant reduction of 60% of the mean astigmatism was noted. However, the considerable proportion of eyes with a postoperative axis shift greater than 15 degrees and a decrease in visual acuity of two or more lines indicates that further research is needed on excimer laser surgery to improve the reliability and safety.     

A preliminary report of small incision cataract surgery by phacoemulsification

The results of 34 cases with cataract extracted by phacoemulsification were preliminarily reported. Postoperatively, they achieved corrected visual acuities > 1.0 in 24 eyes (70.59%) in one week and in 25 eyes (73.53%) after 3 months. The post-operative astigmatism showed a tendency of change from with-the-rule shifting to against-the-rule. The rate of the corneal endothelial cell loss was 13.28%. No severe intra- and post-operative complications were found. It is concluded that the small incision, slight post-operative reaction and fast visual rehabilitation inherent in phacoemulsification procedures are more beneficial to patients than the conventional extracapsular cataract extraction.