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Ehrich and Kolbegger show in their papers that aniseikonia should not prevent binocular functions in a uniocular aphakia. This is contrary to our own experiences. In this paper we suggest that the results of Ehrich and Kolbegger must be worse in spite of their final conclusions. Their hypotheses are discussed.
Parkinson's disease (PD) is a neurodegenerative disease characterized by a loss of dopaminergic neurons in the substantia nigra. There is a need for genetic animal models of PD for screening and in vivo testing of novel restorative therapeutic agents. Although current genetic models of PD produce behavioral impairment and nigrostriatal dysfunction, they do not reproduce the loss of midbrain dopaminergic neurons and 3,4-dihydroxyphenylalanine (L-DOPA) reversible behavioral deficits. Here, we demonstrate that Pitx3-deficient aphakia (ak) mice, which have been shown previously to exhibit a major loss of substantia nigra dopaminergic neurons, display motor deficits that are reversed by L-DOPA and evidence of "dopaminergic supersensitivity" in the striatum. Thus, ak mice represent a novel genetic model exhibiting useful characteristics to test the efficacy of symptomatic therapies for PD and to study the functional changes in the striatum after dopamine depletion and L-DOPA treatment.
The combination of long axis measurement (ultrasonic) and corneal measurement is well adapted to determination of refraction in aphakia. In a group of 35 persons the results of this method were compared with subjective refraction measurement and skiascopy. "Ultrasonic" refraction was less than one dioptre different from subjective refraction in 62% of cases. We found that ultrasonic-determined axis length was consistently 0.4 mm shorter than the axis length calculated from subjective refraction measurements. The clinical application and accuracy of the method are described. With the help of a nomogram one can read off the refraction, when axis length and corneal curvature are known.
The monocular and binocular vision will always be disturbed after unilateral cataract extraction in childhood. The treatment therefore not only means operation, but also correction of the optic error, pleoptics and orthoptics. In 40 cases of unilateral aphakia (12 congenital, 28 traumatical) the prognosis depends on the age of the individual and maintenance of treatment. The older the child and the sooner therapy is started the better are the functional results.
It was for the first time in the ophthalmologic practice that a possibility was demonstrated to ensure relatively high and stable functional results, in a significant number of patients with transplanted kidney (TK), related with different-type cataract extraction and with implantation of a variety of PMMA IOLs, i.e. model of B.A. Alexeev, "Storz" company models made from domestic and foreign-made PMMA and domestic-silicone models (P = 70). It was established that IOL implantation in patients with TK is possible in all cases provided the kidney transplant is compensated for and there are no foci of acute or chronic inflammation in the body. A minimal trauma caused by surgery and the suggested scheme of postoperative management (intramuscular injections of antibiotics and supplementary administration of solutions of poludan, naclof, catachrom and actovegin-gel made alongside with routine instillations) cuts the risk of infectious-and-inflammatory as well as of degenerative-and-dystrophic complications in patients with TK receiving the suppressor therapy. Clinical examinations denoted that the intraocular aphakia correction in patients with TK is a method of choice accelerating the medical and social rehabilitation in the discussed patients' category provided the therapeutic-and-diagnostic as well as preventive measures, as required by their status, are being taken.
A study was carried out on contrast vision in 26 aphakic patients (48 operated eyes) and 37 pseudophakic patients (37 operated eyes); in some cases an intraocular PMMA lens had been implanted, in others an IOGEL (polimacon) had been implanted. The level of sensitivity to contrast in both cases was found to be lower than expected by the Vistech company for aphakics. At the same time a comparative study was carried out of the results obtained for sharpness of vision in aphakic and pseudophakic patients, with the traditional tests of Snellen (long sightedness) and Parinaud (short sightedness) and those obtained with the Contrast Sensitivity Test System (VCTS-6500 for long sightedness and VCTS-6000 for short sightedness). The former tests were found to overestimate the visual results. Corrected aphakia was found to affect the sensitivity to contrast more than in pseudophakic cases. Nevertheless no significant differences were found between contrast vision in eyes with PMMA lens implantation and eyes with IOGEL (polimacon) lens implantation. Summing up, alterations in the sensitivity to contrast undetected by the simple measurement of visual sharpness were found.
Color vision examinations were performed using a clinical test battery and two spectral laboratory methods. With aphakia and iris-clip lenses (ICL) there were slight acquired blue-yellow defects six months to three years after surgery, especially when the more sensitive laboratory methods were used. They were possibly caused by photochemical damage to the retina or by a barrier deprivation syndrome. Color vision with posterior chamber lenses (PCL) was superior to that with ICL, and in aphakic subjects it was quite normal. In the clinical tests no differences could be found between PCLs of clear PMMA material and those with UV absorbing properties. Slight acquired blue-yellow defects in the immediate postoperative phase after implantation of PCLs can be attributed to postoperative irritation and are reversible. Lasting and severe blue-yellow defects indicate inflammation or macular edema.
Seventeen cases of unilateral aphakia secondary to acquired cataracts and dislocated lenses were presented. Final visual acuity was 20/70 or better in 12 of our 17 patients. Binocular single vision has been maintained in four cases. Ten patients had a posttherapy tropia. Early surgery and treatment particularly in the young child is stressed in order to maintain normal binocular single vision. Where once traumatized eyes were felt to be "sick" eyes and better left alone, current surgical and therapeutic methods make restoration of vision and binocularity a reasonable goal.
Soft contact lenses have been successfully adapted to inverted telescope units used to restore effective binocularity to selected unilateral aphakic patients. Techniques for adapting such units to the patient have been outlined and results have been reviewed. Differences between hard and soft contact lens techniques have been contrasted. The practitioner is encouraged to utilize these methods when binocularity would be a clear advantage to the patient with unilateral aphakia. The author hopes to adapt these techniques to the treatment of infants and young children in the future.
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The authors report their procedure of contact lens adaptation in child and particularly after traumatic cataract. Adaptation in the briefest time following cataract surgery is absolutely necessary in order to undertake jointly the orthoptic treatment of amblyopia.
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Aniseikonia as well as binocular vision and depth perception are measured in 114 patients with unilateral pseudophakos. 86% of the cases exhibit a small degree of aniseikonia (3% or less). However, binocular vision and stereopsis remain subnormal or approximatively normal.
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