Small-angle neutron scattering from CuCrZr coupons and components.

Small-angle neutron scattering (SANS) is performed to analyse the microstructural state of a reference CuCrZr material with carefully controlled heat treatments, small-scale manufacturing mock-ups of assemblies and high-heat-flux-exposed mock-ups for fusion reactor components. The information derived from the SANS data corresponds well to existing literature data based on microscopic-scale techniques, but is obtained at millimetre scale with minimal surface preparation. The manufacturing method and high-heat-flux testing conditions are confirmed to have little impact on the microstructural properties, demonstrating the validity of these treatments for scaled-up reactor components.

Edge profile analysis of Joint European Torus (JET) Thomson scattering data: Quantifying the systematic error due to edge localised mode synchronisation.

The Joint European Torus (JET) high resolution Thomson scattering (HRTS) system measures radial electron temperature and density profiles. One of the key capabilities of this diagnostic is measuring the steep pressure gradient, termed the pedestal, at the edge of JET plasmas. The pedestal is susceptible to limiting instabilities, such as Edge Localised Modes (ELMs), characterised by a periodic collapse of the steep gradient region. A common method to extract the pedestal width, gradient, and height, used on numerous machines, is by performing a modified hyperbolic tangent (mtanh) fit to overlaid profiles selected from the same region of the ELM cycle. This process of overlaying profiles, termed ELM synchronisation, maximises the number of data points defining the pedestal region for a given phase of the ELM cycle. When fitting to HRTS profiles, it is necessary to incorporate the diagnostic radial instrument function, particularly important when considering the pedestal width. A deconvolved fit is determined by a forward convolution method requiring knowledge of only the instrument function and profiles. The systematic error due to the deconvolution technique incorporated into the JET pedestal fitting tool has been documented by Frassinetti et al. [Rev. Sci. Instrum. 83, 013506 (2012)]. This paper seeks to understand and quantify the systematic error introduced to the pedestal width due to ELM synchronisation. Synthetic profiles, generated with error bars and point-to-point variation characteristic of real HRTS profiles, are used to evaluate the deviation from the underlying pedestal width. We find on JET that the ELM synchronisation systematic error is negligible in comparison to the statistical error when assuming ten overlaid profiles (typical for a pre-ELM fit to HRTS profiles). This confirms that fitting a mtanh to ELM synchronised profiles is a robust and practical technique for extracting the pedestal structure.

The effect of high polyphenol oxidase grass silage on metabolism of polyunsaturated fatty acids and nitrogen across the rumen of beef steers.

Polyphenol oxidase (PPO) activity in red clover (Trifolium pratense) has been reported to reduce both proteolysis and lipolysis, resulting in greater N use efficiency and protection of PUFA across the rumen. Although high levels of PPO have been reported in grasses such as cocksfoot (orchard grass; Dactylis glomerata), no in vivo research has determined whether grass PPO elicits the same response as red clover PPO. To test the hypothesis that silage ensiled from grass with high levels of PPO protects N and PUFA across the rumen, 6 steers with ruminal and duodenal cannulas were offered cocksfoot silage (CO; high-PPO grass), perennial ryegrass silage (PR; Lolium perenne; low-PPO grass), or red clover silage (RC; high-PPO control) at 16 g DM/kg BW daily with the experiment consisting of two 3 × 3 Latin squares with 21-d periods, consisting of 12 d of diet adaptation, 6 d of duodenal marker infusion, 2 d of duodenal sampling, and 1 d of ruminal sampling. All silages were well preserved, with DM of 34.4, 55.3, and 45.4% for CO, PR, and RC. Activity of PPO in silages was low due to deactivation but was greater in CO than either PR or RC (0.15 vs. 0.05 and 0.08 µkatal/g DM). Protein-bound phenol (mg/g DM) as a measure of the degree of oxidation and an indication of PPO protection was greatest for RC (15.9) but comparable for PR (10.1) and CO (12.2). Biohydrogenation of C18 PUFA was significantly lower on RC compared to the 2 grass silages with CO greater than PR. Despite lower levels of total fatty acid intake and subsequent duodenal flow, CO resulted in greater levels of phytanic acid and total branched and odd chain fatty acids in duodenal digesta than RC or PR. Ruminal ammonia concentration was greatest for RC, with no difference between the grasses. Duodenal flow of microbial N and efficiency of microbial protein synthesis were lowest for CO and comparable for RC and PR. The CO (high-grass PPO) did not result in elevated levels of C18 PUFA escaping the rumen or improve efficiency of total N transfer through the rumen compared to PR. The RC resulted in a greater flow of N and nonmicrobial N to the duodenum than the 2 grasses with PR greater than CO.

Suture fixation of dislocated endothelial grafts.

PURPOSE: To share the experience of suturing the displaced endothelial grafts in three patients who developed this complication following a posterior endothelial keratoplasty. METHODS: Prospective evaluation of three patients who underwent surgical revision by suture fixation for dislocated endothelial graft. The surgeries were performed immediately after noting the complication during the post-op visits and were followed up for 6 months. Assessments at follow-up visits include visual acuity, pachymetry, endothelial cell count, topography, and corneal slit-lamp digital photography. RESULTS: No significant postoperative complications were encountered in any of the three eyes after graft suturing. The vision was worse than hand movements in all, following the graft dislocation and this improved to an average of 20/50 at 6-month post-op. In two of the three eyes the endothelial cell count reduced from 2600 cells preoperatively to 1251 and 988 cells, respectively. Mean topographic astigmatism after the suture removal was 2.4 D. CONCLUSION: Suture fixation of early endothelial graft dislocation seems to be a good alternative in dislocated endothelial discs as it provides a good refractive and visual outcome, instead of converting it to a standard full-thickness penetrating keratoplasty.

Early pathological features of the cornea in toxic epidermal necrolysis.

AIM: To describe the early pathological changes in the cornea during toxic epidermal necrolysis (TEN). METHOD: Demonstration of histological features of sequential corneal samples taken during management of complications of TEN in a young adult. RESULTS: Early vacuolation of basal keratinocytes and late infiltration of the cornea with CD 8 lymphocytes were observed. These changes are similar to those found in cutaneous TEN and may represent weakening of the stromal-epithelium interface with resultant recurrent erosion and chronic inflammation. CONCLUSIONS: Similar changes were found in avascular corneal tissue to those previously described in skin. The initial insult may be traumatic. We propose that a cytokine-mediated response contributes to the initial insult, either in response to and/or by accelerating severe inflammation. This precedes a cytotoxic infiltration which may exacerbate episodes of recurrent erosion. This provides a new insight into the mechanism of disease in the cornea following TEN.

Multifocal versus monofocal intraocular lenses after cataract extraction.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision however still requires additional refractive power usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006), NRR (2006, Issue 3) and PUBMED searched on 25 July 2006, limit: 90 days (entry date). We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal intraocular lenses for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality was assessed. Where possible, statistical summary measures were calculated otherwise data were tabulated. MAIN RESULTS: Ten trials were identified, and a further three are pending review. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal IOLs (standardised mean difference (SMD) 0.03, 95% Confidence Interval (CI) -0.13 to 0.19). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (Peto odds ratio (OR) 1.05, 95% CI 0.67 to 1.63). Unaided near vision was improved with the multifocal IOLs. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.17, 95% CI 0.12 to 0.24). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. AUTHORS' CONCLUSIONS: Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.

Demonstration of polymorphism among Brucella ovis field isolates by pulsed-field gel electrophoresis.

Brucella ovis is recognized worldwide as an important pathogen of sheep, and has also been identified in farmed deer in New Zealand. Previously, only one strain type of B. ovis has been identified. The objective of this paper was to perform pulsed-field gel electrophoresis (PFGE) on field isolates of B. ovis to determine whether strain variations exist, whether sheep and deer are affected by the same strains, and to compare the performance of the rare-cutting restriction enzymes XbaI and SwaI. Ten B. ovis isolates from sheep and two from deer in New Zealand, as well as the type strain, were subjected to PFGE analysis using both XbaI and SwaI. PFGE of XbaI restriction fragments produced two banding patterns consisting of 27-28 bands, which were found to be 98% similar by cluster analysis, and were named X1 and X1a. PFGE of SwaI restriction fragments resulted in three banding patterns consisting of 13-15 bands each. Ten of the isolates had identical banding patterns and were named S1. One isolate differed by one band, representing a subtype named S1a. Two isolates differed by six bands, representing a different strain type of B. ovis and this was named S2. Cluster analysis showed S2 to be 78% similar to the S1/S1a cluster. Both strain types were isolated from both sheep and deer. Thus, two distinct strain types of B. ovis were identified in New Zealand, which is the first report of more than one strain type being identified worldwide. Neither strain was species-specific for sheep or deer. The restriction endonuclease SwaI was found to be more discriminatory than the enzyme XbaI, which has been used in previous studies.

A comparison of Salmonella serotypes isolated from New Zealand sea lions and feral pigs on the Auckland Islands by pulsed-field gel electrophoresis.

The Salmonella serotypes S. Cerro and S. Newport were isolated from New Zealand sea lions (Phocarctos hookeri) and feral pigs on the Auckland Islands in the New Zealand subantarctic region. The isolates were typed by pulsed-field gel electrophoresis using Xba1 as the restriction enzyme. The isolates were indistinguishable, which suggests that Salmonella infection cycles between sea lions and pigs in this environment. Apart from a previous isolation from a single New Zealand fur seal (Arctocephalus forsteri), S. Newport has not been recorded in any animals from New Zealand, but it is associated with gastroenteritis in humans. Contamination of the marine environment by human waste is a possible source of infection for marine mammals and warrants further investigation.

Duration of infection and strain variation in Streptococcus uberis isolated from cows' milk.

The duration of infection and pulsed-field gel electrophoresis (PFGE) types of bovine intramammary Streptococcus uberis isolates were examined. Milk samples were collected in duplicate from all 4 glands of 503 cows from 5 herds within 1 to 3 d of parturition and from 113 cows with clinical mastitis in the same herds throughout lactation. Glands from which S. uberis was isolated were resampled at 28-d intervals.The prevalence of S. uberis was 12% for cows around parturition, and the median duration of infection was 16 d. Cows >2 yr old had a longer duration of infection than 2 yr old cows, and duration varied among herds. A total of 173 different PFGE types were identified from a total of 234 S. uberis isolates. Each farm had a unique set of PFGE types. Only 3 PFGE types were common to each of 3 pairs of cows, and these occurred on the same farm. Where S. uberis was isolated on more than one occasion from a gland, only 55% of the PFGE types were the same across time. For cows with multiple glands infected, only one-half (9 of 18) had the same PFGE type in more than one gland. No predominant PFGE type was identified in any herd. It is concluded that there was wide heterogeneity of PFGE types, that the environment rather than other cows was the likely source of S. uberis infections, and that glands may be infected with multiple S. uberis PFGE types over a lactation.

Epidemiological and molecular evidence of a monophyletic infection with Staphylococcus aureus causing a purulent dermatitis in a dairy farmer and multiple cases of mastitis in his cows.

An epidemiological and molecular investigation of a cutaneous suppurative infection with Staphylococcus aureus in a dairy farmer, occurring concurrently with an outbreak of clinical mastitis in his herd, was carried out. A common aetiology for the diseases in the farmer and his cows was established by combining clinical evidence with a molecular genomic analysis of the bacterial isolates using pulsed field gel electrophoresis of DNA macro-restriction fragments. This case indicates the possibility of the emergence and circulation of anthropozoonotic clones of S. aureus in dairy herds. It also provides further evidence of the severe impact of infection with highly virulent clones on dairy lactating cattle.

Validation of Orbscan II posterior corneal curvature measurement for intraocular lens power calculation.

AIMS: To validate the use of Orbscan II slit-scanning topography for measuring posterior corneal curvature, by comparing corneal power calculations using this value with the standard keratometric method of corneal power calculation. METHOD: Corneal measurements were taken from both eyes of 15 normal subjects using the Javal-Schiotz keratometer and the Orbscan II topographer. Corneal power was calculated using standard keratometric indices of 1.337.5 or 1.331.5 and Javal-Schiotz keratometry. Corneal power was then recalculated using the thick-lens formula, with anterior corneal curvature from the Javal-Schiotz or Orbscan II and posterior measurements from the Orbscan II; in addition, the 3.0 mm 'Mean Power' value from the Orbscan II software was noted. Six comparisons were then made using mean-difference plots. RESULTS: The smallest difference and therefore the most predictable agreement was between Javal-Schiotz keratometry using a refractive index of 1.331.5 and the thick-lens formula using Javal-Schiotz anterior curvature and Orbscan II posterior curvature. The mean difference was 0.27 D with a confidence interval of 0.02-0.52 D. CONCLUSIONS: In normal eyes, data on posterior corneal curvature from the Orbscan II can be used to calculate corneal power in close agreement with the standard keratometric method. This suggests the use of the Orbscan II in eyes that have previously undergone refractive surgery, for calculation of intraocular lens power prior to cataract surgery.

Salmonella Brandenburg - emergence of a new strain affecting stock and humans in the South Island of New Zealand.

AIMS: To report information on the spread of a new strain of Salmonella Brandenburg, which affected livestock and humans in the South Island of New Zealand, and a series of small case studies designed to investigate potential transmission of infection. METHODS: Information on the occurrence and spread of S. Brandenburg in livestock was gathered from laboratory diagnostic submissions, from case studies on the faecal excretion rate in ewes, carrier status of black-backed gulls (Larus dominicanus), spread of S. Brandenburg organisms in sheep yards, infection in lambs going to meat plants, and from post-abortion pathological changes in the reproductive tract of ewes. RESULTS: A newly recognised strain of S. Brandenburg was first diagnosed in aborting sheep from a flock in mid Canterbury in the South Island in 1996. Subsequently, the disease spread to other farms in mid and south Canterbury in 1997 and to Southland and Otago in the lower half of the South Island in 1998-2003. In 1999, the same strain was responsible for abortions in cattle and gastroenteritis in calves and adult cattle. The same strain of bacterium also caused disease in horses, goats, deer, pigs and humans. Spread of the disease on farms was strongly associated with aborting ewes, which resulted in considerable environmental contamination. During the abortion season, black-backed gulls appeared to spread the disease to other farms. Other potential sources of infection were carrier sheep, contaminated water sources and contaminated sheepyard dust. Damage to the reproductive tract may affect the ability of surviving ewes to conceive. CONCLUSION: Important features of this disease are its high morbidity and mortality within a flock or herd, rapid local spread and its role as an occupational, health and safety risk to farm workers and their families.

Multifocal versus monofocal intraocular lenses after cataract extraction.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens implantation. Near vision however still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) intraocular lenses are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal intraocular lenses. OBJECTIVES: The objective of this review is to assess the effects of multifocal intraocular lenses, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Eyes and Vision Group trials register) on the Cochrane Library (Issue 1 2002), MEDLINE (1966 to March 2002) and EMBASE (1980 to February 2002). The reference lists of relevant articles were searched. Investigators of included studies and manufacturers of multifocal intraocular lenses were contacted for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal intraocular lens of any type with a monofocal intraocular lens as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality assessed. Where possible, statistical summary measures were calculated, otherwise data was tabulated. MAIN RESULTS: Eight trials were identified. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal intraocular lenses (Peto Odds Ratio (OR) 1.21, 95% Confidence Interval (CI) 0.75 to 1.96). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (Peto Odds Ratio 1.43, 95% CI 0.99 to 2.09). Unaided near vision was improved with the multifocal intraocular lenses. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.15, 95% CI 0.11 to 0.22). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. REVIEWER'S CONCLUSIONS: Multifocal intraocular lenses are effective at improving near vision relative to monofocal intraocular lenses. Whether that improvement outweighs the adverse effects of multifocal intraocular lenses will vary between patients, with motivation to achieve spectacle independence likely to be the deciding factor.

Prospective randomised double-masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses.

AIMS: To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL. METHODS: Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire). RESULTS: naided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P < 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P < 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01). CONCLUSIONS: Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group.

An epidemic of salmonellosis caused by Salmonella Typhimurium DT160 in wild birds and humans in New Zealand.

AIM: This study reports an outbreak of salmonellosis due to S. Typhimurium DT160 which caused extensive mortality in wild birds and enteric disease in humans in New Zealand during the winter and spring months of the year 2000. METHODS: Necropsies were performed and microbiological examinations undertaken on wild birds from populations in which mass mortality was reported, and on captive indigenous birds which died suddenly during the winter and spring of 2000. Affected tissues were examined histologically and isolates of S. Typhimurium were phage typed and examined using pulsedfield gel electrophoresis (PFGE). Isolates of S. Typhimurium obtained from cases of human enteric disease which occurred during these months were phage typed, examined using PFGE and compared with the bird isolates. RESULTS: Central and northern areas of the South Island and the southern North Island were worst affected with die-offs of several hundreds of sparrows and other birds reported in rural areas. Mortalities reached a peak in winter (July-August) 2000 and decreased to small numbers during the spring and early summer. The birds usually died of an acute septicaemia with multifocal necrotising lesions in the liver and spleen. Human cases throughout the country increased gradually over the same period. Isolates from birds, livestock and humans examined using PFGE were indistinguishable from one another. CONCLUSION: This strain of Salmonellahas emerged as a major cause of septicaemia in wild birds in New Zealand. Because of the close association between house sparrows (Passer domesticus) and humans, the organism also poses a serious zoonotic risk. The possibility that the infection may spread to involve indigenous species needs investigation.

Single intraoperative application of 5-Fluorouracil versus placebo in low-risk trabeculectomy surgery: a randomized trial.

PURPOSE: Trabeculectomy is the procedure of choice for the surgical control of glaucoma, and is often augmented by intraoperative 5-fluorouracil application to reduce scarring. This study aims to assess the validity of this technique with a randomized placebo-controlled trial. METHODS: Patients without risk factors for bleb failure other than previous drop use who were undergoing trabeculectomy surgery as their first ocular procedure were randomized to receive fluorouracil or placebo. The main outcome measures were intraocular pressure and bleb morphology. RESULTS: Results from 40 eyes of 36 patients are presented; 23 eyes were treated with fluorouracil, and 17 eyes were treated with placebo. Mean intraocular pressure at 1 year and at the final follow-up examination was significantly lower than preoperatively, but was not different between fluorouracil and placebo groups. Kaplan-Meier survival analysis also failed to show any difference, though there was a trend toward better survival of an intraocular pressure of 16 mm Hg or lower. Bleb morphology was examined postoperatively in 24 patients, with no differences found between fluorouracil and placebo groups. CONCLUSIONS: No significant difference was found in trabeculectomy outcome between fluorouracil-treated and placebo-treated eyes. The study was too small to state definitively that no such difference exists, but suggests that any treatment effect is likely to be small.

Multifocal versus monofocal intraocular lenses after cataract extraction.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens implantation. Near vision however still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) intraocular lenses are available that are claimed to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal intraocular lenses. OBJECTIVES: The objective of this review is to assess the effects of multifocal intraocular lenses, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL (which includes the Cochrane Eyes and Vision Group specialised register), MEDLINE and EMBASE. The reference lists of relevant articles were searched. Investigators of included studies and manufacturers of multifocal intraocular lenses were contacted for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal intraocular lens of any type with a monofocal intraocular lens as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality assessed. Where possible, statistical summary measures were calculated, otherwise data were tabulated. MAIN RESULTS: One ongoing and six completed trials were identified. There was significant variability between the trials in the outcomes reported. Unaided distance acuity was similar in multifocal and monofocal intraocular lenses (Peto odds ratio 1.27 (95% Confidence Interval (CI) 0.76 to 2.11)), with a small increase in the proportion of multifocal intraocular lens participants achieving less than 6/6 best corrected visual acuity (Peto odds ratio 1.64 (95% CI 1.10 to 2.42)). Unaided near vision tended to improve with the multifocal intraocular lenses. This resulted in decreased spectacle dependence with use of the multifocal intraocular lenses (Peto odds ratio 0.16 (95% CI 0.11 to 0.23)). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. REVIEWER'S CONCLUSIONS: Multifocal intraocular lenses are effective at improving near vision relative to monofocal intraocular lenses. Whether that improvement outweighs the adverse effects of multifocal intraocular lenses will vary between patients, with motivation to achieve spectacle independence likely to be the deciding factor.