AMO array multifocal versus monofocal intraocular lenses: long-term follow-up.

PURPOSE: To assess prospectively the visual outcomes of multifocal and monofocal intraocular lens (IOL) implantation in selected patients with a minimum follow-up of 18 months. SETTING: Department of Ophthalmology, National Health Service (INSALUD). Puerta de Hierro University Clinic, Madrid, Spain. METHODS: This prospective study comprised two groups of 50 eyes each: one with AMO Array multifocal IOLs and the other with monofocal IOLs. Main outcome measures were Snellen and Regan 96% distance visual acuities; Jaeger and decimal near acuities; Regan contrast sensitivity test at 96, 50, 25, and 11%; brightness acuity test (BAT) on distance acuity at Regan 96%; depth of focus measured with the Regan 96% distance test; defocusing from +3s to -4s; subjective evaluation of optical side effects. RESULTS: The differences between groups in mean distance vision and BAT results were not statistically significant Contrast sensitivity results at 96 and 50% were similar, but there were significant differences of 0.94 and 1.14 lines on the 25 and 11% charts, respectively (P < .01). Near vision without addition in the multifocal group was significantly better and depth of focus significantly wider than in the monofocal group (P < .001). CONCLUSION: With appropriate patient selection, the AMO Array IOL provided distance acuity and contrast sensitivity similar to that of the monofocal IOLs and excellent intermediate vision. Near vision, without spectacles, with the multifocal lens was functionally acceptable although short of refractive power for best acuity results.

Episcleral iridium-192 wire therapy for choroidal melanomas.

PURPOSE: To evaluate the effectivity of high-dose episcleral iridium-192 wires in the treatment of choroidal melanoma. METHODS AND MATERIALS: In 1983, the Departments of Radiation Oncology and Ophthalmology at the Clínica Puerta de Hierro, Madrid, Spain, initiated a clinical study using removable episcleral iridium-192 wires in the treatment of choroidal melanoma. Sixty-six evaluable patients were treated from January 1983 through July 1992. Two patients had a small sized tumor (3%), 28 had a medium sized tumor (42%), and 36 patients had a large tumor (54%). The mean follow-up was 40 months (6-118 months). The dose to the apex of the tumor ranged from 66 to 97 Gy (mean 76.6 Gy), and the doses at 2 mm depth ranged from 77 to 433 Gy (mean 200 Gy). RESULTS: Tumor regression or stabilization was observed in 53 of the 66 patients (90%). Visual acuity improved following treatment in 5 out of 54 patients (9%), remaining unchanged in 30 out of 54 (56%), and decreased in 19 out of 54 (35%) patients. The remaining seven patients had undergone enucleation. Late complications have been documented in 20 out of 66 patients (30%), including 6 patients in whom enucleation was required because of radiation-related complications. The probability of survival and survival free of local progression was 93% at 5 years and 79% at 10 years. The probability of retaining the treated eye is 82% after the fifth year posttreatment. CONCLUSIONS: Treatment of choroidal melanomas with episcleral iridium-192 wires is as effective as treatment with other radioactive applications. We feel that our results using iridium-192 wires are comparable to the other methods. However, we think that our technique is simple to implement, relatively inexpensive, and well tolerated.