Clinical Experience of Using a Combination of Dexamethasone and Levofloxacin After Cataract Surgery.

Background: Where routine prophylactic antibiotics have been adopted following cataract surgery, rates of endophthalmitis have been decreasing. Intracameral and topical antibiotics are currently used to prevent endophthalmitis after cataract surgery. When applying topical antibiotics, there are different recommendations on the frequency and duration of therapy. The development of bacterial resistance to the excessive and long-term use of antibiotics is a growing problem worldwide. The goal is to achieve a good antibiotic effect with the shortest possible use of antibiotics. Objective: The aim of this study was to compare the effectiveness of a new combination therapy of dexamethasone and levofloxacin for seven days after cataract surgery with the previous regimen of dexamethasone, neomycin sulfate, and polymyxin B, which was given for 21 days. Methods: A retrospective analysis of medical records and administered a questionnaire was conducted to assess the effectiveness of postoperative therapy in our cataract surgery patients. The study involved 52 patients who underwent surgery within the last year, performed by a single surgeon at our institution. The findings can help us improve the quality of care we provide and optimize our patients' overall quality of life. Results: We conducted an in-depth study on 52 individuals who underwent cataract surgery at our institution. The prescribed therapeutic regimen for the participants included administering Ducressa solution four times daily for the first seven days and Maxidex solution three times daily for the subsequent 14 days. The study found that none of the participants experienced complications after surgery, and all found it easy to instill the medication. The prescribed regimen effectively managed the postoperative recovery of the participants, and the medication was well-tolerated. Conclusion: Our research found that a new combination of levofloxacin and dexamethasone, when used topically, may require a shorter treatment period, reducing the risk of antibiotic resistance and providing a safe alternative for endophthalmitis prevention.

Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence.

BACKGROUND: Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS: The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS: According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS: The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.

Combined Cataract and Corneal Transplantation Surgery Without Viscosurgical Devices.

Background: The most common complications after performing the triple Descemet's stripping automated endothelial keratoplasty (DSAEK), which combines the cataract phacoemulsification, intraocular lens implantation and DSAEK procedure, are detachment or decentration of the donor lamella and postoperative interface haze. One reason for this is the retained viscoelastic used during surgery. Objective: This study aimed to describe triple DSAEK procedure without the usage of viscoelastic and to discuss its potential benefits on surgical outcomes. Methods: The surgical procedures and outcomes of patients with Fuchs' dystrophy and lens opacification who underwent the triple DSAEK were retrospectively reviewed. The surgical procedure was described, and postoperative complications were studied. Results: The study included 10 eyes of 10 patients. Capsulorhexis and IOL implantation performed in locally potentiated anesthesia compared to general anesthesia did not significantly differ (P > 0,05). The mean preoperative best-corrected visual acuity was 0.75 LogMar. The mean postoperative best-corrected visual acuity was 0.2 LogMar. The central graft thickness before surgery was 129.6 µm and 6 months after surgery was 114.2 µm. Successful attachment of the donor lamellae was observed in all 10 patients. None of the patients had postoperative interface haze or any other possible viscoelastic caused complication. Conclusion: Although viscoelastic can facilitate certain aspects of the triple DSAEK procedure, we conclude that this procedure can be performed completely without its use. If performed by a trained surgeon, the procedure can be feasible without the complications of donor lamella detachment, decentration, or interface haze.

Short-Term Effect of Conventional Versus Accelerated Corneal Cross-Linking Protocol on Corneal Geography and Stability.

Purpose: To determine the 6-month effect of conventional (CXL30) and accelerated cross-linking with a UVA intensity of 9 mW/cm2 (CXL10) on corneal stability and to investigate whether there was a difference in ABCD grading system parameters regarding the two different procedures. Methods: Twenty-eight eyes of 28 patients with a documented keratoconus (KN) progression were included. Patients were selected to undergo either epi off CXL30 or CXL10. At the baseline and the follow-up visits after one (V1), three (V2), and six months (V3), the patients underwent complete ophthalmic examination and corneal tomography. Results: In the CXL30 group, all the parameters from the ABCD grading system significantly changed from baseline to V3; parameter A decreased (p = 0.048), B and C increased (p = 0.010, p < 0.001), and D decreased (p < 0.001). In the CXL10 group, there were no changes in parameters A (p = 0.247) and B (p = 0.933), though parameter C increased (p = 0.001) and D decreased (p < 0.001). After an initial decline after one month, visual acuity (VA) recovered on V2 and V3 (p < 0.001), and median maximal keratometry (Kmax) decreased in both groups (p = 0.001, p = 0.035). In the CXL30 group, there were significant changes in other parameters; average pachymetric progression index (p < 0.001), Ambrósio relational thickness maximum (ARTmax) (p = 0.008), front and back mean keratometry (p < 0.001), pachymetry apex (PA) (p < 0.001), and front elevation (p = 0.042). However, in the CXL10 group, there were significant changes only in ARTmax (p = 0.019) and PA (p < 0.001). Conclusion: Both epi-off CXL protocols showed similar short-term efficacy in improving VA and Kmax, halting the progression of KN, and both similarly changed tomographic parameters. However, the conventional protocol modified the cornea more significantly.

Pseudophakic Cystoid Macular Oedema (PCME) Prevention in Patients with Non-Proliferative Diabetic Retinopathy (NPDR)-Randomized Controlled Trial.

Background and Objectives: The purpose of this study was to compare the effect of topical bromfenac and dexamethasone on the intraocular concentration of interleukin 6 (IL-6) and incidence of pseudophakic cystoid macular oedema (PCME) after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Ninety eyes of patients with mild-to-moderate NPDR that underwent phacoemulsification cataract surgery were divided into three groups. A detailed description of the clinical study protocol is described later in paper. In short, Group 1 received topical bromfenac (0.9 mg/mL), Group 2 dexamethasone (1 mg/mL), and Group 3 placebo, both preoperatively and postoperatively. Additionally, all patients received combined topical steroid and antibiotic drops (dexamethasone, neomycin and polymyxin B) 3 weeks postoperatively. On the day of the surgery, aqueous humour samples (0.1-0.2 mL) were obtained and IL-6 concentrations were analysed. Central foveal subfield thickness (CFT) measured using spectral-domain optical coherence tomography (SD-OCT) was analysed preoperatively and postoperatively. Results: There was no significant difference in IL-6 concentrations between groups. Postoperative CFT was significantly lower in the dexamethasone group compared to the placebo group. In addition, the correlation between IL-6 and CFT was statistically significant in the dexamethasone group. No patient developed PCME in any of the three groups. No adverse events were reported during the study. Conclusion: Topical bromfenac and dexamethasone have no significant effect on intraocular IL-6 concentration in patients with NPDR. Topical bromfenac is not more effective than topical dexamethasone in reducing postoperative CFT in patients with NPDR.

Tolerability in Glaucoma Patients Switched from Preserved to Preservative-Free Prostaglandin-Timolol Combination: A Prospective Real-Life Study.

Purpose: To evaluate the effect of switching from preserved prostaglandin analog-timolol fixed combinations (PG-timolol FCs) to preservative-free latanoprost-timolol FC (PF-LT) on intraocular pressure (IOP), ocular surface health, and tolerability in glaucoma and ocular hypertension (OH) patients with the concurrent ocular surface disease (OSD). Methods: This was a longitudinal, prospective, interventional, real-life study among 42 patients. Up to 3 visits were planned, at baseline, 30, and 90 days to assess efficacy on IOP decrease and local tolerance. The severity of OSD symptoms [Ocular Surface Disease Index (OSDI) questionnaire], subjective drug tolerability [visual analog scale (VAS)], conjunctival hyperemia (McMonnies scale), and tear break-up time (TBUT) were the main parameters assessed. Results: Data from 36 patients were available for statistical analysis. IOP was significantly reduced at day 30 and day 90 compared to baseline (16 vs 14 vs 14 mmHg, p < 0.001). Significant improvement was demonstrated in OSD symptoms, signs, and VAS scores from the baseline to the second and third visits. Median OSDI (27.1 vs 9.6 vs 4.2, p < 0.001), conjunctival hyperemia (2 vs 1 vs 1, p < 0.001), corneal surface staining (p < 0.001), and conjunctival staining scores (p < 0.001), and the percentage of patients with eyelid and periocular hyperemia (61.1 vs 12.5 vs 2.8%, p < 0.001), significantly decreased. TBUT (4 vs 5 vs 6 s, p < 0.001) and VAS score regarding tolerability (5 vs 2 vs 1, p < 0.001) significantly increased. Conclusion: A switch from preserved PG-timolol FCs to PF-LT improved tolerability and optimized IOP control, providing better adherence with greater chances of treatment success.

LENS CARE COMPLIANCE RATES AND PERCEPTIONS AMONG RIGID GAS PERMEABLE CONTACT LENS WEARERS - A PILOT STUDY.

The aim was to estimate compliance rate among rigid gas permeable lens wearers (RGPLW) in lens system care, identify procedures in lens care process with poorest compliance levels, and assess concordance between participant reported practices and their subjectively perceived compliance. The study included outpatient RGPLW managed at Zagreb University Hospital Center in Zagreb, Croatia. They filled out a questionnaire that included demographic data, duration of lens wear, self-evaluation compliance grade, and 14 lens care procedures and wearing habits indicative of compliance. There were 50 patients (mean age 34.6 years, 68% female). Full compliance was found in a single patient. The mean number of non-compliant procedures was 5.48, with 32% of participants non-compliant in more than 50% of the compliance criteria. Critical procedures of the lens care process were infrequent lens case exchange (74%), using tap water for lens (70%), and improper case cleaning (68%). The mean lens case replacement time was 9.8 months (SD 6.76), with only 26% of patients replacing lens case at least once in 3 months. Excessive daily lens wear was associated with greater total number of non-compliant procedures (p<0.0008). RGPLW were aware of their inappropriate lens care only when achieved non-compliance in almost 50% of the procedures. In conclusion, lens wearers were not aware of their extremely low compliance rate in several aspects of lens and lens case maintenance. Study results indicated the key procedures the practitioners should focus on when evaluating subjective and objective compliance and reinforcing care and hygiene education of RGPLW.

Influence of Donor Thickness on Visual Acuity in Descemet's Stripping Automated Endothelial Keratoplasty.

Purpose: Conventional Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) is a corneal transplantation procedure where the patient's inner dysfunctional layer is replaced with donor lamella. The data currently present in the literature about the correlation between lamellar thickness and visual acuity is sometimes contradictory and lacks clarity. Methods: Study included 55 eyes that underwent the conventional DSAEK procedure. Patients had no other comorbidities that could affect visual acuity. Data about lamellar thickness and visual acuity were measured six months after surgery with anterior segment optical coherent tomography (A5-OCT). Results: The results show that visual acuity before surgery improved from 0.82 to 0.25 logMAR after surgery. Better visual acuity of 0.20 logMAR was achieved with postoperative lamellas thinner than 124 µm, while statistically significantly lower visual acuity of 0.29 logMAR was gained with postoperative lamellas thicker than 124 µm. Conclusion: Our results suggest that the goal after conventional DSAEK is to have postoperative lamellas thinner than 124 µm in the eye, as this will result in better postoperative visual acuity. This value represents the optimal thickness for conventional DSAEK surgery that could minimize tissue loss for eye banks and surgeons may experience fewer problems during surgery, while obtaining good final visual acuity.

POSTOPERATIVE THINNING OF LAMELLAR DONOR GRAFT AFTER CONVENTIONAL DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY.

- The purpose of this study was to evaluate postoperative deturgescence of lamellar donor graft after conventional Descemet's stripping automated endothelial keratoplasty (DSAEK). It was a prospective study that included 55 eyes of patients (mean age 70.9±9.4 years; female 61.8%, male 38.2%). Preoperative thickness of lamella was compared with postoperative thickness six months after surgery. Central lamellar graft thickness decreased from 142±27 µm preoperatively to 124±20 µm 6 months postoperatively (p<0.01). After performing conventional DSAEK corneal transplantation, surgeons should expect deturgescence of corneal graft and reduction in thickness of lamellae by about 12% of initial thickness according to our results. We found this information important for better planning of surgical procedures and knowing what to expect after surgery, as well as for better cooperation with eye banks when ordering pre-cut corneal tissue.

Posterior Capsule Opacification and Nd:YAG Rates with Two Acrylic Intraocular Lenses after Age-Related Cataract Treatment: Three-year Results.

OBJECTIVE: To compare the incidence and intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) over three years. METHODS: Eighty-three patients underwent cataract surgery with implantation of Acreos Adapt AO or Acrysof SA60AT. PCO values were assessed using a photographic image analysis system (EPCO 2000) and the amount of PCO at the slit lamp. RESULTS: Mean PCO score was 2.78 ± 1.55 for the Acreos Adapt AO and 2.32 ± 1.20 for the Acrysof SA60AT (P=.229). There were no significant differences in the median EPCO values in the entire IOL optics area (0.60 ± 0.26 vs 0.58 ± 0.23; P=.745) and in the central 3-mm zone (0.28 ± 0.13 vs 0.27 ± 0.12; P=.638). Neodymium:YAG capsulotomy was performed in 28% of eyes with Acreos Adapt AO and 23.33% with Acrysof SA60AT (P=.692). CONCLUSION: Both IOLs had comparable PCO and Nd:YAG rates three years postoperatively.

Comparison of Optic Nerve Head Morphology in Patients with Primary Open Angle Glaucoma and Non-Arteritic Anterior Ischemic Optic Neuropathy.

The aim of this study was to assess damage to retinal ganglion cells (RGC) and morphology of the optic nerve head (ONH) in patients with primary open angle glaucoma (POAG) and non-arteritic anterior ischemic optic neuropathy (NAION). The study included three groups of patients, as follows: 40 eyes with POAG, 40 eyes with NAION and 40 eyes with refraction anomaly. All patients underwent standard automated perimetry and analysis of ONH topography by using confocal scanning laser ophthalmoscopy (CSLO)-HRT II. Visual field defects such as decreased retinal sensitivity prevailed in the eyes with POAG, whereas in the eyes with NAION they were mostly manifested as concentrically narrowed visual field and quadrant excesses. Topographic ONH alterations, examined by HRT II, showed the same number of sectors to be affected in the eyes with POAG and NAION. A larger number of sectors in the upper part of ONH were affected in the eyes with NAION. Optic disc morphology differed significantly between the eyes with POAG and NAION by a higher rate of neuroretinal rim thinning and higher mean cup depth in the POAG group.

The Effect of Body Position on Intraocular and Intracranial Pressure in Rabbits.

BACKGROUND: The correlation between cerebrospinal fluid (CSF) and intraocular pressure (IOP) is still unclear. We compared CSF and IOP measured by the same invasive technique using a new experimental model in rabbits during changes of body position. METHODS: Pressure changes were recorded in the lateral ventricle (LV), the cortical subarachnoid space (CSS), and the anterior ocular chamber of anesthetized rabbits (n = 12). Animals and measuring instruments were both fixed on a board at an adequate hydrostatic level. RESULTS: In a horizontal position, control IOP (15.1 ± 1.6 cmH2O) and CSF pressure in the LV (12.4 ± 0.6 cmH2O) and CSS (12.2 ± 0.9 cmH2O) were similar during the 60-min period. When changing the body position from horizontal to vertical (upright), CSF pressures decreased drastically (LV = -5.5 ± 2.6 cmH2O and CSS = -7.7 ± 2.3 cmH2O), while the IOP decreased moderately (IOP = 13.3 ± 0.5 cmH2O). CONCLUSION: Change in body position from horizontal to vertical causes drastic changes in CSF pressure and moderate changes in IOP. Thus, IOP is not reflected by the CSF pressure. In an upright position, the values of CSF pressure were equal to the hydrostatic distance between measuring points and the foramen magnum, which suggests that CSF pressure inside the cranium depends on its anatomical and biophysical features, and not on CSF secretion and absorption.

Ocular surface disease in pseudoexfoliation syndrome.

Aim of the study is to determine connection between pseudoexfoliation (PEX) syndrome and symptoms and signs of ocular surface disease. Tear film break-up time test, Schirmer II test and assessment of lid parallel conjunctival folds were performed in 40 PEX syndrome patients and 40 controls. All data was statistically analyzed. Results show statistically significant difference in every component between groups, most prominent in tear film break up time test. We have concluded that patients with PEX syndrome have higher predisposition of tear function disorders and that both components of dry eye syndrome are present in PEX syndrome.

Can medical students recognize depression? A survey at the Zagreb School of Medicine.

OBJECTIVE: The objective of this study was to investigate medical students' knowledge and attitudes towards depression. METHODS: Students attending their final year at Zagreb School of Medicine completed a set of standardized questionnaires, including attitudes towards psychiatric medication, attitudes towards depression, and personality inventory. RESULTS: In total, 199 students completed the questionnaire (response rate 77 %). Most medical students were only partially able to correctly identify major symptoms of depression, but did suggest referral to mental health specialists as the most appropriate course of action. They recognized social and biological causes of depression. Degree of correct identification of symptoms of depression correlated positively with non-stigmatizing attitudes towards depression and negatively with stigmatizing attitudes towards depression. CONCLUSION: Students' attitudes toward depression may influence their recognition of symptoms of depression. Incorporation of these findings in development of undergraduate medical curricula may improve students' recognition of depression.

Lens wearers non-compliance - is there an association with lens case contamination?

PURPOSE: This study aims to investigate the association of compliance amongst lens wearers and lens case contamination as assessed by the microbial profile of lens cases. METHODS: Fifty-two asymptomatic lens wearers filled out questionnaires seeking demographic data and several aspects of compliance to lens wear. Subsequently, contamination profiles of the inside bottom and rim of their lens cases was obtained for bacteria, fungi and Acanthamoeba. The association of the self-reported responses in the questionnaire with contamination profile of the lens case was then analyzed. RESULTS: Based on compliance criteria, 21% of the participants were described as fully compliant lens wearers. Contamination of lens case was prevalent in 42% of the cases. Frequent non-compliant behaviours reported by study participants included, showering and sleeping with contact lenses, and irregular lens case replacement. In comparison to soft contact lens wearers prevalence of non-compliance and contamination amongst rigid gas permeable (RGP) lens wearers was significantly greater. There was a statistically significant correlation between bacterial contamination and current case age. CONCLUSION: These results suggest that majority of lens wearers do not fully comply with recommendations for lens wear and case care. Crucially, none of the fully compliant patients had contaminated lens cases. However it would appear that several non-compliant behaviours significantly increase the risks of case contamination. These results suggest that greater efforts should be invested with lens wearers to ensure enhanced compliance as this is likely to reduce the possibility of case contamination.

Contact lenses as the best conservative treatment of newly diagnosed keratoconus--epidemiological retrospective study.

Keratoconus is a progressive, non-inflammatory corneal ectasia characterized by thinning and weakening of the corneal stroma which results in its' protrusion. The onset is during puberty and progresses until the fourth decade of life. In earlier stages, good visual acuity can be provided with spectacles. With progression, contact lenses are considered to be a better therapy. Aim of this study was to determine if there is statistically significant difference between best corrected visual acuity (BCVA) obtained by spectacles and contact lenses in newly diagnosed keratoconus patients, as well as to determine which type of contact lenses provide better BCVA in keratoconus patients. We conducted a 5-year retrospective study of all 2891 patients attending our Contact Lens Department for the first time, searching for patients newly diagnosed with keratoconus. Data were obtained on gender, age, education level, treated eyes, corneal changes, keratoconus severity, BCVA with spectacles, contact lenses and best fitted contact lens type. All patients underwent standard ophthalmic exam, refractometry and keratometry have been done, followed by a spectacles correction and lens fitting. Wilcoxon signed rank test was used for statistical analysis. Results showed that of all 2891 patients examined for the first time, 137 patients (4.74%) have been newly diagnosed with heratoconus, there was male bias (72.26%), mean age 27.7 +/- 9.9 years. Most patients had high school education (51.11%), 3.70% had present corneal changes, 50.37% had mild heratoconus. Majority had keratoconus on both eyes (36.3%) or keratoconus of right eye (26.67%). There was a statistically significant difference (p<0.001) between the BCVA obtained with contact lenses (0.82 +/- 0.21 Snellen chart) rather than spectacles (0.37 +/- 0.27 Snellen chart). The best corrected visual acuity was achieved with rigid gas permeable (RGP) lenses in majority of kera- toconus eyes (51.85%), with semi-gas permeable (SGP) lenses in 43.39%, in 4.23% with polymethyl methacrylate (PMMA) lenses and with hard-soft gas permeable (GP) contact lenses in 0.53% of keratoconus eyes. We have showed that there is a statistically significant difference in BCVA achieved better with contact lenses than with spectacles. RGP lenses are most frequently used in conservative treatment of heratoconus, but SGP lenses were also shown to be a good option that gives equally satisfying final visual acuity with subjective comfortable feeling of contact lens wear.

Progression of conjunctival primary acquired melanosis (PAM) to widely spreaded malignant melanoma.

Primary acquired melanosis (PAM) is an acquired pigmentation of the conjunctival epithelium, a preinvasive pigmented lesion. When it is associated with cellular atypia it can lead to the developement of melanoma. We report a case report of malignant melanoma of the conjuntiva, which arrised from the conjuntival PAM. The disease was too extensive for ocular conservation, therefore exenteration was performed. This case highlights the need for regular follow-up of patients with melanocytic lesions of the ocular adnexa, and particular attention to the surgical technique, and careful follow-up to detect further disease activity.

Compliance among soft contact lens wearers.

Contact lens compliance is proven to be crucial for preventing lens wear-related complications because of the interdependence of the steps in lens care regime and their influence on lens system microbial contamination. Awareness of the patients' lens handling compliance as well as correct recognition of non-compliant behaviours is the basis for creating more targeted strategies for patient education. The aim of this study was to investigate compliance among soft contact lens (SCL) wearers in different aspects of lens care handling and wearing habits. In our research 50 asymptomatic lens wearers filled out a questionnaire containing demographic data, lens type, hygiene and wearing habits, lenses and lens care system replacement schedule and self-evaluation of contact lens handling hygiene. We established criteria of compliance according to available manufacturer's recommendations, prior literature and our clinical experience. Only 2 (4%) of patients were fully compliant SCL wearers. The most common non-compliant behaviours were insufficient lens solution soaking time (62%), followed by failure to daily exchange lens case solution and showering while wearing lenses. 44% of patients reported storing lenses in saline solution. Mean lens storage case replacement was 3.6 months, with up to 78% patients replacing lens case at least once in 3 months. Average grade in self evaluating level of compliance was very good (4 +/- 0.78) (from 1-poor level of hygiene to 5-great level of hygiene). Lens wearers who reported excessive daily lens wear and more than 10 years of lens wearing experience were also found to be less compliant with other lens system care procedures. (t = -2.99, df=47, p < 0.0045 and t = -2.33, df= 48, p < 0.024, respectively). Our study indicates that almost all patients had some degree of non-compliance in lens system maintenance steps. Most common non-compliant behaviours were the ones that are crucial for maintaining lens sterility and preventing infection. Despite the low objective compliance rate, self grading was relatively high. Therefore, these results indicate the need for patient education and encouragement of better lens wearing habits and all of the lens maintenance steps at each patient visit.

Effect of the against the rule myopic astigmatism on the near vision of the elderly.

In the two groups of patients with myopic astigmatism the uncorrected near vision was tested after catatract surgery. Each group with 20 patients ages 60-80. All patients enrolled in study have uncorrected far vision 0.5 or better on Snellen tables. In the first group patients were with the rule after surgery myopic astigmatism (1-1.50 Diopter), and in the second group were patients with against the rule after surgery myopic astigmatism (1-1.50 Diopter). Patients in the second group with against the rule astigmatism achieved significantly (p<0.01) better uncorrected near vision.