Journal of Cataract & Refractive Surgery

Negative dysphotopsia following cataract surgery

Nick Mamalis — 2010-03-01

There are two kinds of light—the glow that illuminates and the glare that obscures.James Thurber One of the most vexing symptoms that can affect patients following modern cataract surgery is dysphotopsia. This photic phenomenon, which occurs in pseudophakic patients, has many different forms. So-called positive dysphotopsia is usually noted as phenomena such as light rings, arcs, streaks, flashes, and halos that may interfere with vision. These images are noted near the central axis of vision and can be induced by peripheral light sources. Positive dysphotopsia is usually related to bright artifacts of light on the retina. Tester et al. used the term dysphotopsia to describe the visual phenomena encountered by phakic and pseudophakic patients, including flashes of light, glare, and light sensitivity.

Scleral fixation of intraocular lenses combined with penetrating keratoplasty

Fahad A. Al-Qahtani — 2010-03-01

I describe a technique for transscleral fixation of a posterior chamber intraocular lens (PC IOL) combined with penetrating keratoplasty. Partial-thickness trephination of the cornea is followed by full-thickness penetration of the anterior chamber at 12 o'clock and 6 o'clock through 5.5 and 2.0mm incisions, respectively. Scleral fixation of a PC IOL is performed through the incisions under a closed chamber followed by replacement of the diseased graft with a donor button. The results in 5 eyes of 5 patients with aphakic bullous keratopathy and lack of capsule support are reported.Financial Disclosure: The author has no financial or proprietary interest in any material or method mentioned.

Hydroimplantation: Foldable intraocular lens implantation without an ophthalmic viscosurgical device

Harshul Tak — 2010-03-01

I describe a technique for implantation of a 1-piece acrylic foldable intraocular lens (IOL) using an irrigation cannula of the phaco machine without using an ophthalmic viscosurgical device (OVD). The irrigating cannula introduced through a side port provides excellent stability and positioning to the eye; if required, the cannula tip is used to guide the leading haptic of the IOL into the capsular bag. The fluid coming from the side port via a bimanual irrigation cannula maintains adequate formation of the capsular bag and anterior chamber while the foldable IOL is inserted. The hydroimplantation technique has the advantage of increased efficiency, reduced surgical time and cost, no need for OVD removal from behind the IOL or for additional instrumentation, no OVD-induced intraocular pressure elevation postoperatively, and no risk of early capsular bag distension syndrome.Financial Disclosure: The author has no financial or proprietary interest in any material or method mentioned.

Functional assessment of accommodating intraocular lenses versus monofocal intraocular lenses in cataract surgery: Metaanalysis

Ako Takakura, Prashanth Iyer, Jared R. Adams, Susan M. Pepin — 2010-03-01

Purpose: To compare accommodating intraocular lens (IOLs) and monofocal IOLs in restoring accommodation in cataract surgery.Setting: Dartmouth Medical School and Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.Methods: In this metaanalysis, 2 researchers independently extracted data, assessed trial quality, and contacted authors for missing information. Because of measurement-scale variations, outcomes were pooled for distance-corrected near visual acuity (DCNVA) as standardized mean differences with 95% confidence intervals [CIs] and anterior displacement of the lens as weighted mean differences (95% CI).Results: The metaanalysis comprised 12 randomized controlled studies of 727 eyes. Based on 10 studies that compared DCNVA, accommodating IOLs were favored but failed the test of heterogeneity (I2 = 94%). Pooling the 6 homogeneous trials (I2 = 43%) showed no difference (standardized mean difference, −0.16; 95% CI, −0.56 to 0.25). Heterogeneity could not be explained by any characteristic of the study population or methodology. Based on 4 studies that evaluated pilocarpine-induced IOL shift, there was a significant anterior compared with the control (weighted mean difference, 95% CI, −0.36 − 0.47 to −0.24]), although the studies were heterogeneous (I2 = 58%). Three of 5 studies mentioning posterior capsule opacification (PCO) reported increased rates in the accommodating IOL group postoperatively.Conclusions: There was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. Further randomized controlled studies with standardized methods evaluating adverse effects (eg, PCO) are needed to clarify the tradeoffs.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Color discrimination by patients with different types of light-filtering intraocular lenses

2010-03-01

Purpose: To evaluate photopic and mesopic color discrimination in patients with different types of light-filtering intraocular lenses (IOLs).Setting: Peking University Third Hospital, Peking University Eye Center, Beijing, China.Methods: Cataract patients with different types of IOLs were enrolled 3 months postoperatively. Overall and partial color discrimination under photopic (1000 lux) and mesopic (40 lux) conditions were evaluated with the Farnsworth-Munsell (FM) 100-hue test. Corrected distance visual acuity (CDVA) was tested under both conditions. Subjective visual quality was assessed with the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25).Results: The study evaluated 43 patients with a blue light–filtering IOL (15 photochromic, 13 yellow tinted) or an IOL filtering ultraviolet light only (n = 15). The difference in the FM 100-hue total error scores under photopic or mesopic conditions was not statistically significant between groups. There were no statistically significant differences in partial error scores in the 10 bands of the FM 100-hue color circle under photopic conditions. Under mesopic condition, there were statistically significant differences in partial error scores in the green to blue–green band (color caps 36 to 46) and the blue–green to blue band (color caps 46 to 54) (P = .005 and P = .030, respectively). There were no statistically significant differences in mean overall or subheading NEI VFQ-25 scores.Conclusions: Filtering blue lights under mesopic conditions seemed to modify color discrimination in the green-to-blue bands postoperatively. The modification did not disturb overall color discrimination or cause subjective discomfort.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Optical aberrations in professional baseball players

2010-03-01

Purpose: To determine the presence, type, and size of optical higher-order aberrations (HOAs) in professional athletes with superior visual acuity and to compare them with those in an age-matched population of nonathletes.Setting: Vero Beach and Fort Myers, Florida, USA.Methods: Players from 2 professional baseball teams were studied. Each player's optical aberrations were measured with a naturally dilated 4.0 mm pupil using a Z-Wave aberrometer and a LADARWave aberrometer.Results: One hundred sixty-two players (316 eyes) were evaluated. The HOAs were less than 0.026 μm in all cases. Spherical aberration C(4,0) was the largest aberration with both aberrometers. There were small but statistically significant differences between the aberrometers in mean values for trefoil C(3,3) and C(3,−3) and secondary astigmatism C(4,2). Although statistically significant, the differences were clinically insignificant, being similar at approximately 0.031 diopter (D) of spherical power. A statistically significant difference was found between the professional baseball players and the control population in trefoil C(3,−3). These differences were clinically insignificant, similar to 0.071 D of spherical power.Conclusions: Professional baseball players have small higher-order optical aberrations when tested with naturally dilated pupils. No clinically significant differences were found between the 2 aberrometers. Statistically significant differences in trefoil were found between the players and the control population; however, the difference was clinically insignificant. It seems as though the visual system of professional baseball players is limited by lower-order aberrations and that the smaller HOAs do not enhance visual function over that in a control population.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Oral acetaminophen (paracetamol) for additional analgesia in phacoemulsification cataract surgery performed using topical anesthesia: Randomized double-masked placebo-controlled trial

2010-03-01

Purpose: To evaluate the clinical analgesic efficacy of 1.0 g oral acetaminophen (paracetamol) given in addition to topical anesthesia before phacoemulsification cataract surgery.Setting: Inpatient and outpatient ophthalmology clinics, Bydgoszcz, Poland.Methods: Consecutive patients with age-related cataract having phacoemulsification under topical anesthesia (tetracaine 0.5%) were enrolled in a prospective double-blind randomized placebo-controlled study. Patients were randomly assigned to preoperative oral administration of a placebo medication or to oral administration of 1.0 g acetaminophen. The main outcome measure was intensity of pain during and after surgery. Pain intensity was measured using a 10 cm baseline visual analog scale and a discrete 5-category verbal rating scale.Results: The study comprised 160 consecutive patients (80 in each group). Intraoperatively, the mean visual analog scale pain intensity score was 2.17 ± 1.81 in the placebo group and 1.45 ± 1.17 in the acetaminophen group and the mean verbal rating scale score, 1.11 ± 0.73 and 0.67 ± 0.66, respectively (P<.01). Postoperatively, the mean visual analog scale score for pain was 1.47 ± 1.39 in the placebo group and 0.56 ± 0.61 in the acetaminophen group and the mean verbal rating scale score, 0.94 ± 0.79 and 0.28 ± 0.41, respectively (P<.01). There was no significant difference in patient behavior during surgery and no significant adverse effects of acetaminophen use.Conclusion: Preoperative oral administration of acetaminophen 1.0 g was effective, convenient, safe, and cost effective in reducing intraoperative and postoperative pain in phacoemulsification performed using topical anesthesia.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: Randomized double-masked clinical trial

Antonio M. Fea — 2010-03-01

Purpose: To compare phacoemulsification alone and phacoemulsification with micro-bypass stent implantation in eyes with primary open-angle glaucoma.Setting: Instituto di Fisiopatologia Clinica, Clinica Oculistica, Universita' di Torino, Torino, Italy.Methods: In this prospective double-masked randomized clinical trial, patients had phacoemulsification alone (control group) or phacoemulsification with iStent implantation (combined group). Primary outcomes were intraocular pressure (IOP) and reduction in medication use over 15 months and IOP after a 1-month washout of ocular hypotensive agents (ie, 16 months postoperatively).Results: The baseline IOP was similar between groups (combined group: 17.9 mm Hg ± 2.6 [SD]; control group: 17.3 ± 3.0 mm Hg) (P = .512). Three patients in the control group were lost to follow-up. The mean IOP was 14.8 ± 1.2 mm Hg in the combined group and 15.7 ± 1.1 mm Hg in the control group at 15 months and 16.6 ± 3.1 mm Hg and 19.2 ± 3.5 mm Hg, respectively, after washout; the IOP was statistically significantly lower in the combined group than in the control group at both time points (P = .031 and P = .042, respectively). At 15 months, the mean number of medications was lower in the combined group than in the control group (0.4 ± 0.7 and 1.3 ± 1.0, respectively; P = .007), as was the proportion of patients on ocular hypotensive medication (33% and 76%, respectively).Conclusions: Phacoemulsification with stent implantation was more effective in controlling IOP than phacoemulsification alone; the safety profiles were similar.Financial Disclosure: The author has no financial or proprietary interest in any material or method mentioned.

Surgically induced astigmatism after phacoemulsification with and without correction for posture-related ocular cyclotorsion: Randomized controlled study

2010-03-01

Purpose: To report the impact of posture-related ocular cyclotorsion on one surgeon's surgically induced astigmatism (SIA) results and the variance in SIA.Setting: Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland.Methods: This prospective randomized controlled study included eyes that had phacoemulsification with intraocular lens implantation. Eyes were randomly assigned to have (intervention group) or not have (control group) correction for posture-related ocular cyclotorsion. In the intervention group, the clear corneal incision was placed precisely at the 120-degree meridian with instruments designed to correct posture-related ocular cyclotorsion. In the control group, the surgeon endeavored to place the incision at the 120-degree meridian, but without markings.Results: The intervention group comprised 41 eyes and the control group, 61 eyes. The mean absolute SIA was 0.74 diopters (D) in the intervention group and 0.78 D in the control group; the difference between groups was not statistically significant (P>.5, unpaired 2-tailed Student t test). The variance in SIA was 0.29 D2 and 0.31 D2, respectively; the difference between groups was not statistically significant (P>.5, unpaired F test).Conclusions: Attempts to correct for posture-related ocular cyclotorsion did not influence SIA or its variance in a single-surgeon series. These results should be interpreted with full appreciation of the limitations of currently available techniques to correct for posture-related ocular cyclotorsion in the clinical setting.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular lens exchange in patients with negative dysphotopsia symptoms

Péter Vámosi, Béla Csákány, János Németh — 2010-03-01

Purpose: to evaluate the results of intraocular lens (IOL) exchange in cases of severe negative dysphotopsia and to measure the distance between the iris and the IOL optic using ultrasound biomicroscopy (UBM).Setting: Szent Rókus Hospital and Eye Clinic, Semmelweis University, Budapest, Hungary.Methods: Data of patients with major negative dysphotopsia symptoms after phacoemulsification with IOL implantation were reviewed retrospectively. In cases in which IOL exchange was performed to diminish the symptoms, the distance between the iris and the anterior surface of the IOL optic was measured by UBM and compared with that in a group of nonsymptomatic pseudophakic patients (control group).Results: in 3806 cataract procedures, 5 eyes (4 patients) had severe negative dysphotopsia symptoms. Intraocular lens exchange was performed in 3 cases. In 1 case, the secondary IOL was implanted in the reopened capsular bag and the symptoms persisted. In 2 cases, the secondary IOL was implanted in the ciliary sulcus and the symptoms resolved. On UBM, the mean iris–optic distance was 0.45 mm ± 0.07 (SD) in the symptomatic group, 0.59 ± 0.29 mm in the control group (n = 21) (P = .353), and 0.00 mm in the sulcus-fixated group.Conclusions: The iris–optic distance was not statistically significantly different between eyes with severe negative dysphotopsia symptoms and nonsymptomatic eyes. However, when IOL exchange reduced the iris–IOL distance, the severe negative dysphotopsia symptoms resolved.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Repeatability of corneal power and wavefront aberration measurements with a dual-Scheimpflug Placido corneal topographer

Li Wang, Mariko Shirayama, Douglas D. Koch — 2010-03-01

Purpose: To evaluate the repeatability of the Galilei dual-Scheimpflug analyzer in measuring corneal curvature, wavefront aberrations, pachymetry, and anterior chamber depth (ACD).Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.Methods: Three consecutive measurements were performed in 1 eye of each subject. The following were evaluated: (1) mean total corneal power at the central, paracentral, and peripheral zones (0.0 to 4.0 mm, 4.0 to 7.0 mm, and 7.0 to 8.0 mm, respectively) and posterior corneal power (Kavg); (2) corneal higher-order wavefront aberrations (6.0 mm pupil); (3) mean pachymetry at the central, paracentral, and peripheral zones; and (4) ACD. Repeatability was assessed by calculating the within-subject standard deviation (SD), coefficient of variation (COV), and intraclass correlation coefficient (ICC).Results: The study enrolled 20 subjects. The SD was 0.09 diopter (D), 0.05 D, and 0.19 D for central, paracentral, and peripheral total corneal power, respectively, and 0.03 D for posterior Kavg. The COV ranged from 0.10% to 0.35%, and the ICC was 0.996 or more (P<.001). For 3rd-order coma and trefoil, the SD was 0.08 μm and 0.09 μm, respectively. For 4th-order spherical aberration, astigmatism, and tetrafoil, the SDs were lower (0.02 μm, 0.04 μm, and 0.09 μm, respectively). The SD was 1.68 μm, 1.98 μm, and 2.82 μm for central, paracentral, and peripheral pachymetry, respectively, and 0.04 mm for ACD.Conclusion: Dual-Scheimpflug measurements of corneal power, pachymetry, ACD, and corneal aberrations for Zernike terms in the middle of the Zernike tree showed excellent repeatability.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Manual limbal markings versus iris-registration software for correction of myopic astigmatism by laser in situ keratomileusis

Elizabeth P. Shen, Wei-Li Chen, Fung-Rong Hu — 2010-03-01

Purpose: To compare the efficacy and safety of manual limbal markings and wavefront-guided treatment with iris-registration software in laser in situ keratomileusis (LASIK) for myopic astigmatism.Setting: National Taiwan University Hospital, Taipei, Taiwan.Methods: Eyes with myopic astigmatism had LASIK with a Technolas 217z laser. Eyes in the limbal-marking group had conventional LASIK (PlanoScan or Zyoptix tissue-saving algorithm) with manual cyclotorsional-error adjustments according to 2 limbal marks. Eyes in the iris-registration group had wavefront-guided ablation (Zyoptix) in which cyclotorsional errors were automatically detected and adjusted. Refraction, corneal topography, and visual acuity data were compared between groups. Vector analysis was by the Alpins method.Results: The mean preoperative spherical equivalent (SE) was −6.64 diopters (D) ± 1.99 (SD) in the limbal-marking group and −6.72 ± 1.86 D in the iris-registration group (P = .92). At 6 months, the mean SE was −0.42 ± 0.63 D and −0.47 ± 0.62 D, respectively (P = .08). There was no statistically significant difference between groups in the astigmatism correction, success, or flattening index values using 6-month postoperative refractive data. The angle of error was within ±10 degrees in 73% of eyes in the limbal-marking group and 75% of eyes in the iris-registration group.Conclusion: Manual limbal markings and iris-registration software were equally effective and safe in LASIK for myopic astigmatism, showing that checking cyclotorsion by manual limbal markings is a safe alternative when automated systems are not available.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Visual acuity and higher-order aberrations with wavefront-guided and wavefront-optimized laser in situ keratomileusis

Claudia E. Perez-Straziota, J. Bradley Randleman, R. Doyle Stulting — 2010-03-01

Purpose: To compare visual acuity and higher-order aberrations (HOAs) after wavefront-guided and wavefront-optimized laser in situ keratomileusis (LASIK).Methods: This retrospective study comprised refraction-matched myopic eyes that had wavefront-guided (Visx Star S4 laser) or wavefront-optimized (WaveLight Allegretto Wave laser) LASIK targeted for emmetropia. Preoperative and postoperative manifest refraction spherical equivalent (MRSE), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and preoperative and postoperative HOAs were compared.Results: Preoperatively, there were no significant differences between the wavefront-guided and wavefront-optimized groups in age, sex, corneal thickness, MRSE, or HOAs (all P>.05). The mean MRSE was −2.88 diopters (D) ± 2.6 (SD) and −2.96 ± 2.6 D, respectively, preoperatively and −0.01 ± 0.25 D and −0.02 ± 0.33 D, respectively, postoperatively; 96% of all eyes were within ±0.50 D of emmetropia postoperatively. There were no differences in UDVA, CDVA, MRSE, or HOAs between groups (all P>.05). The UDVA was 20/20 or better in 85% of eyes in the wavefront-guided group and 86% of eyes in the wavefront-optimized group. All eyes had 20/25 or better CDVA postoperatively; no eye lost 2 lines of CDVA. Fourteen eyes were converted from wavefront-guided to wavefront-optimized treatment because of poor limbal ring alignment (8 eyes), a wave scan not consistent with the manifest refraction (5 eyes), and no iris registration (1 eye).Conclusions: Wavefront-guided LASIK and wavefront-optimized LASIK produced equivalent visual outcomes and no differences in HOAs. Wavefront-guided treatment could not be performed in many eyes because of difficulties during wavefront measurement.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Efficacy, safety, and flap dimensions of a new femtosecond laser for laser in situ keratomileusis

Jérôme C. Vryghem, Thibaut Devogelaere, Pavel Stodulka — 2010-03-01

Purpose: To evaluate the clinical results of a preproduction femtosecond laser for flap creation in laser in situ keratomileusis (LASIK).Setting: Private practice, Brussels, Belgium.Methods: This study comprised myopic eyes with a plano target refraction and a target flap thickness of 110 μm. The LASIK flap was created with a Ziemer LDV femtosecond laser. Prospective evaluation included flap dimensions, intraoperative and postoperative complications, and visual outcomes.Results: Sixty-three patients (111 eyes; mean age 37.2 years) were evaluated. Preoperatively, the mean corrected distance visual acuity (CDVA) was 1.34 (Snellen) and the mean manifest refraction spherical equivalent (MRSE), −4.91 diopters (D) ± 2.45 (SD). Six months postoperatively, the mean CDVA was 1.33; the mean MRSE, −0.05 ± 0.3 D; and the mean uncorrected distance visual acuity (UDVA), 1.27. The UDVA was 20/25 or better in 98.2% of eyes and 20/20 or better in 94.6% of eyes. The MRSE was within ±0.50 D in 95.5% of eyes and within ±1.00 D in 99.1% of eyes. The cylinder was 0.50 D or less in 99.1% of eyes. The mean flap thickness was 106.6 ± 12.6 μm. The most frequent complications were epithelial sloughing (10.8%), a decentered cut (4.5%), flap adhesions (5.4%), a slightly irregular flap border (5.4%), and microstriae (5.4%); all were mild.Conclusions: Overall, the flap dimensions and refractive results were predictable and the complication rate was acceptable after LASIK using the new femtosecond laser for flap creation.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

First clinical results of epithelial laser in situ keratomileusis with a 1000 Hz excimer laser

2010-03-01

Purpose: To evaluate the safety, stability, and efficacy of the first clinical cases of epithelial laser in situ keratomileusis (epi-LASIK) performed using a 1000 Hz excimer laser system.Setting: Klinikum Rechts der Isar, Munich, Germany.Methods: The epi-LASIK procedure was performed using an EpiLift microkeratome and a WaveLight Concept System 1000 laser. Preoperatively and 1, 3, and 6 months postoperatively, a complete ophthalmic examination was performed. The examination included objective and subjective refraction, uncorrected and corrected distance visual acuities, and topography.Results: The study comprised 30 eyes of 17 patients. The mean spherical equivalent was −4.36 diopters (D) ±1.77 (SD) preoperatively, 0.07 ± 0.38 D 1 month postoperatively, −0.06 D ± 0.25 D at 3 months, and −0.05 ± 0.24 D at 6 months. Six months postoperatively, 90% of patients were within ±0.50 D of the intended correction and all were within ±1.00 D. At 3 months, 25 eyes had a clear cornea and 5 eyes had trace haze.Conclusions: In this pilot series, the use of the 1000 Hz excimer laser did not lead to the clinical side effects that are potentially associated with the use of a high repetition rate. The safety, stability, and efficacy of the laser were high although no adjustments to the nomogram were made.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Limbal relaxing incisions at the time of apodized diffractive multifocal intraocular lens implantation to reduce astigmatism with or without subsequent laser in situ keratomileusis

2010-03-01

Purpose: To evaluate the visual and refractive outcomes of limbal relaxing incisions (LRIs) to reduce astigmatism at the time of apodized diffractive multifocal intraocular lens (IOL) implantation.Setting: University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.Methods: This retrospective review comprised consecutive patients who had LRIs at the time of lens extraction and AcrySof ReSTOR IOL implantation. A subgroup of patients had subsequent laser in situ keratomileusis (LASIK) for residual refractive error correction.Results: The study evaluated 73 eyes (59 patients); 21 eyes (28.7%) of 59 patients had further LASIK (LRI+LASIK). The mean follow-up was 13.2 months ± 6.4 (SD). The mean keratometric astigmatism decreased from 1.49 ± 0.71 diopters (D) preoperatively to 0.56 ± 0.57 D at the last follow-up (P<.001). Although the LRI+LASIK group had significantly greater corneal astigmatism than the LRI-only group preoperatively (P = .005) and 1 month (P = .030) and 6-months (P = .014) postoperatively, there was no statistically significant difference between the 2 groups at the last follow-up (P = .528). At the last follow-up, the uncorrected distance visual acuity was 20/25 or better and the uncorrected near visual acuity was J1 or better in 32 (76%) of 42 eyes in the LRI-only group and in 17 (81%) of 21 eyes in the LRI+LASIK group.Conclusion: Limbal relaxing incisions at the time of apodized diffractive multifocal IOL implantation, with or without subsequent LASIK, were effective and safe in reducing astigmatism.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Straylight measurements in laser in situ keratomileusis and laser-assisted subepithelial keratectomy for myopia

2010-03-01

Purpose: To compare straylight values before and 3 months after laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) and to analyze the causes of any change.Setting: Private refractive surgery clinic, Driebergen, The Netherlands.Methods: Straylight was measured before and after LASIK or LASEK with a C-Quant straylight meter; values were recorded as the straylight parameter log(s). Main outcome measures were the difference between postoperative and preoperative straylight values and factors causing a difference between the values.Results: The study evaluated 102 eyes having LASIK and 137 eyes having LASEK. On average, there was significant improvement in straylight values postoperatively in both groups. The mean decrease was −0.016 log(s) in the LASIK group and −0.026 log(s) in the LASEK group. Nonparametric testing (sign test) showed that the improvement in straylight was statistically significant in more than 50% of eyes in both groups. Straylight improved in 62 eyes in the LASIK group (P<.001) and 78 eyes in the LASEK group (P<.02) and deteriorated in 35 eyes and 58 eyes, respectively. There was an increase in straylight in 17 eyes (7.1%). Clinical correlations were found in some eyes that had increased postoperative straylight values.Conclusion: On average, straylight values 3 months after LASIK and LASEK were slightly decreased from baseline values.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Keratorefractive effect of microwave keratoplasty on human corneas

Allon Barsam, Anne Patmore, David Muller, John Marshall — 2010-03-01

Purpose: To determine the change in dioptric power on excised human corneoscleral buttons after microwave keratoplasty application and to determine the qualitative effect on the cornea using histology and scanning electron microscopy.Setting: Department of Academic Ophthalmology, Rayne Institute, St. Thomas' Hospital, London, United Kingdom.Methods: Excised human corneoscleral buttons were treated with a prototype microwave keratoplasty ring applicator. A 28.12 W, 1-second application was performed on the corneas using a 6.0 mm diameter inner conductor and an 8.4 mm diameter outer conductor. Videokeratography was performed with a topographic modeling system (TMS-1) before and after microwave keratoplasty. The induced change in corneal curvature was calculated using the mean dioptric power of rings situated 2.0 to 6.0 mm from the geometrical apex of the corneas. Scanning electron microscopy and toluidine-blue light microscopy were performed to determine the effect on the corneal stroma.Results: Six excised corneoscleral buttons from 6 donors were used. The mean reduction in curvature after microwave keratoplasty application was 3.07 diopters ± 2.62 (SD). Scanning and light microscopy showed microwave-induced shrinkage of corneal stromal collagen with little disturbance to the overlying epithelium.Conclusion: Microwave keratoplasty reduced corneal curvature and has therapeutic potential as a noninvasive alternative to excimer laser surgical correction of myopia and as a treatment for corneal ectasia.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Comparison of real-time intraocular pressure during laser in situ keratomileusis and epithelial laser in situ keratomileusis in porcine eyes

José L. Hernández-Verdejo, Laura de Benito-Llopis, Miguel A. Teus — 2010-03-01

Purpose: To compare real-time intraocular pressure (IOP) between laser in situ keratomileusis (LASIK) and epithelial LASIK (epi-LASIK) in porcine eyes during flap creation using a microkeratome or an epikeratome, respectively.Setting: Vissum Madrid, Madrid, Spain.Methods: In this prospective study, a Moria microkeratome was used in 1 eye (LASIK group) and an Epi-K epikeratome in the other eye (epi-LASIK group) to create a lamellar corneal flap and an epithelial flap, respectively, in freshly enucleated porcine eyes. The IOP changes during the procedures were recorded by direct cannulation using a reusable blood pressure transducer connected to the anterior chamber.Results: Each group comprised 17 eyes. In the LASIK group, the mean IOP was 113.65 mm Hg ± 10.78 (SD) during suctioning and 112.35 ± 11.51 mm Hg during cutting phases. The mean duration of the phases was 9.00 ± 1.46 seconds and 6.06 ± 1.14 seconds, respectively. In the epi-LASIK group, the mean IOP was 92.57 ± 20.86 mm Hg during suctioning, 82.09 ± 20 mm Hg during cutting, and 67.28 ± 13.49 during low vacuum. The mean duration of the phases was 25.88 ± 1.96 seconds, 33.82 ± 2.81 seconds, and 29.71 ± 3.29 seconds, respectively. The IOP values were significantly different between the 2 groups (all comparisons P<.05).Conclusion: Real-time IOP measured during suctioning and flap creation by direct cannulation of the anterior chamber in freshly enucleated porcine eyes showed a significant increase in IOP during LASIK and epi-LASIK; the increase was lower in the epi-LASIK group.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Acrylic intraocular lens damage after folding using a forceps insertion technique

Jay C. Erie, Brant Newman, Michael A. Mahr, Amir R. Khan, Malcolm McIntosh — 2010-03-01

Purpose: To analyze intraocular lens (IOL) surface abnormalities seen after folding using a forceps insertion technique.Setting: Mayo Clinic, Rochester, Minnesota, USA.Methods: Acrylic AcrySof MA60AC IOLs were examined using an Axio Imager microscope before and after they were folded using a forceps insertion technique. Differential interference contrast, brightfield reflected light, and darkfield reflected light imaging techniques were used as necessary. The effects of temperature, time, and ophthalmic viscosurgical device (OVD) on optic surface abnormalities after folding were studied.Results: All 17 IOLs examined had smooth, defect-free optic surfaces before folding. After folding, anterior optic surface depressions were observed in all IOLs; the depressions corresponded to the contact area of the titanium insertion forceps. Surface depressions were present up to 72 hours after folding, were more pronounced when an insertion forceps with a high degree of wear was used, and were greater when the IOL was warmed to 98°F before folding. Coating the IOL surface with OVD before grasping it with the insertion forceps prevented formation of depressions.Conclusions: The anterior optic surface of the acrylic IOL was vulnerable to forceps-induced surface depressions. Surface abnormalities were prevented by coating the anterior optic surface with OVD before grasping it with a metal insertion forceps.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Ocular penetration of topically applied linezolid in a rabbit model

2010-03-01

Purpose: To evaluate ocular penetration of topically applied linezolid, a new antibiotic agent targeted against gram-positive organisms.Setting: Laboratory of Pharmacology, University Hospital of Strasbourg, Strasbourg, France.Methods: New Zealand White rabbits were divided into 3 equal groups. One drop of 50 μL (2 mg/mL) linezolid was administrated in Group 1. In Group 2, eyes were dosed in accordance with a keratitis protocol (1 drop of 2 mg/mL every 15 minutes for 1 hour). Aqueous humor was sampled 6 times from immediately after to 3 hours after drop delivery. In Group 3, a keratitis protocol was implemented before the animals were humanely killed. Conjunctiva, cornea, vitreous, and blood samples were collected 1 hour and 2 hours after the last drop. Linezolid concentrations were measured by high-performance liquid chromatography.Results: Each group comprised 8 rabbits. In Group 1 and Group 2, the peak linezolid concentration in the aqueous humor (mean 0.87 mg/L ± 0.16 [SD] and 2.17 ± 0.4 mg/L, respectively) was 45 minutes after the last drop delivery. In Group 3, the concentrations 1 hour and 2 hours after the last drop were higher than 3 μg/g in the conjunctiva samples and higher than 4 μg/g in the cornea samples. The linezolid concentration in the vitreous and serum was negligible.Conclusions: Linezolid levels in the aqueous humor, conjunctiva, and cornea exceeded the minimum inhibitory concentration of most gram-positive organisms that cause bacterial keratitis and endophthalmitis. Linezolid could be a valuable alternative in cases of increased resistance to vancomycin.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Effect of varying microkeratome parameters on laser in situ keratomileusis interface surfaces

R. Krishna Sanka, Evan S. Loft, J. Bradley Randleman — 2010-03-01

Purpose: To evaluate the effect of altering microkeratome parameters (oscillation rates and head-advance speeds) and repeated blade use on human and porcine laser in situ keratomileusis interface surface quality and to evaluate correlations between human and porcine interface surface quality.Setting: Emory Vision, Atlanta, Georgia, USA.Methods: Corneal flaps were created in porcine eyes and human cadaver eyes with an Amadeus I microkeratome using varying head-advance speeds and oscillation rates. Microkeratome blades were used once in 18 porcine eyes, twice in 18 human eyes (simulating clinical use), and 5 times in 15 porcine eyes. The interface surface was imaged with electron microscopy, with overall bed quality and surface smoothness graded from 1 to 5 (smoothest to roughest) by 5 masked corneal specialists using the same grading criteria for porcine eyes and human eyes.Results: Neither oscillation rates nor head-advance speeds consistently influenced bed smoothness in any group. There were no differences in bed quality between first cuts and second cuts in human eyes or between porcine eyes with multiple blade use. Porcine eyes had statistically significantly smoother stromal beds than human eyes (P<.01); there was no correlation between porcine eye scores and human eye scores (r = −0.1).Conclusions: Neither alterations in microkeratome parameters nor repeated blade use consistently influenced stromal bed quality in human or porcine eyes. No subjective correlation existed between stromal bed qualities of porcine corneas and human corneas; therefore, future studies evaluating corneal stromal bed quality should be performed in human corneas only.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Pseudophakic eye with obliquely crossed piggyback toric intraocular lenses

2010-03-01

A 72-year-old man presented with high astigmatism (2.25 −5.0 × 45) induced by long-term rotation of a toric intraocular lens (IOL). Corneal astigmatism was 3.78 diopters (D). The corrected distance visual acuity (CDVA) was 20/32. Because of the risk of repositioning, a secondary toric IOL of −3.0/6.0 D especially designed for sulcus implantation was piggybacked through 3.5 mm sutureless clear-corneal incision with a cylindrical axis obliquely crossed with that of the primary IOL. Eight months postoperatively, the corneal astigmatism was 5.04 D. The CDVA was 20/25 with a refraction of 1.0 −2.5 × 70. No interlenticular opacification or significant rotation or decentration of the secondary toric IOL was observed. The refractive properties of this pseudophakic eye were analyzed using a mathematical approach. The calculated postoperative refraction was 0.84 −1.7 × 47. A piggyback toric IOL can be implanted in an obliquely crossed style that allows a secondary toric IOL to correct astigmatism induced by long-term toric IOL rotation.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Immunohistochemical observation of anterior subcapsular cataract in eye with spontaneously regressed retinoblastoma

Kumi Shirai, Yuka Okada, Shizuya Saika — 2010-03-01

We report the histological findings of secondary cataract in an eye with a spontaneously regressed retinoblastoma to obtain keys to clarify the mechanism of this phenomenon. During phacoemulsification, opacified anterior capsule was obtained, fixed in formalin, and embedded in paraffin. Paraffin sections of the specimen were histologically observed. Hematoxylin–eosin staining showed extracellular matrix accumulation in the extracted fibrous anterior subcapsular opacification. Immunohistochemistry revealed the presence of fibrous collagen types and cellular fibronectin. Presumed lens cells amid matrix were positively labeled for vimentin, α-smooth muscle actin, and phospho-Smad2. Histology of the fibrous anterior subcapsular opacification tissue showed the possibility of epithelial-mesenchymal transition of the lens epithelial cells in the secondary cataract following a spontaneously regressed retinoblastoma.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Bilateral Descemet membrane detachment after canaloplasty

Pat-Michael Palmiero, Zeynep Aktas, Olivia Lee, Celso Tello, Zaher Sbeity — 2010-03-01

We report a case of bilateral Descemet membrane detachment (DMD) after canaloplasty in a 70-year-old Portuguese man with primary open-angle glaucoma. The patient developed bilateral DMD immediately following consecutive (1 week apart) canaloplasty surgery in both eyes. Slitlamp biomicroscopy, gonioscopy, and Fourier-domain optical coherence tomography (FD-OCT) findings are described. On postoperative day 1, in both cases, slitlamp biomicroscopy revealed an unscrolled inferonasal DMD and a clear cornea with deep and quiet anterior chambers. Gonioscopy showed an intact, lightly pigmented, and distended trabecular meshwork with no evidence of suture extrusion. High-resolution FD-OCT revealed a widely dilated canal of Schlemm, trabecular distention, and a retrocorneal hyperreflective membrane corresponding to a DMD. At 3 months, the DMD resolved spontaneously in both eyes. Although DMD is a known complication of canaloplasty, the occurrence of bilateral symmetrically located DMDs in our case suggests a possible anatomical predisposition in addition to factors induced by the surgical technique.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Long-term pathological follow-up of obsolete design: Pannu universal intraocular lens

2010-03-01

We studied an enucleated postmortem eye from an 82-year-old white donor who had been implanted with a Pannu “universal” intraocular lens (IOL) in the anterior chamber approximately 20 years earlier. This IOL has design features characteristic of a 1-piece, C-loop posterior chamber IOL. Magnetic resonance imaging showed a relatively well-centered IOL in the anterior chamber with haptics impinging on the iris. Gross and light microscopic analyses of the eye and the IOL showed peripheral anterior synechiae enclaving one haptic, areas of angle widening, significant attenuation of the corneal endothelium, multiple areas of iris trauma secondary to optic and haptic iris abrasion, large areas of pigment dispersion in the angle, diffuse pigment accumulation within the anterior chamber, and attenuation of the ganglion cell layer. The histopathological findings were consistent with glaucoma and chronic inflammation.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Pseudomonas keratitis after collagen crosslinking for keratoconus: Case report and review of literature

Namrata Sharma, Praful Maharana, Gurnarinder Singh, Jeewan S. Titiyal — 2010-03-01

A 19-year-old woman presented with a 3-day history of pain, redness, and diminution of vision occurring one day after collagen crosslinking (CXL) with riboflavin and ultraviolet-A had been performed for keratoconus in the right eye. On presentation, severe keratitis with a 7.0mm×6.0mm central infiltrate was present. Culture results from the patient's contact lens and corneal scrapings were positive for Pseudomonas aeruginosa. Keratitis can occur following CXL because of the presence of an epithelial defect, use of a soft bandage contact lens, and topical corticosteroids in the immediate postoperative period, and patients should be counseled about it.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Efficacy of topical anesthesia for foldable phakic intraocular lens implantation for the correction of myopia

Lucien A.M. van Philips — 2010-03-01

Topical anesthesia is not widely used for foldable Artiflex phakic intraocular lens (pIOL) (Ophtec BV) implantation. Retrobulbar, peribulbar, and even general anesthesia are the more common techniques. As a less invasive technique, topical anesthesia reduces the risk for systemic complications and eliminates the complications from injection anesthesia such as globe perforation, retrobulbar hemorrhage, retinal vascular occlusion, ptosis, and optic nerve damage. The advantages of topical anesthesia are faster visual recovery, higher patient satisfaction, easy application, minimal discomfort on administration, rapid onset of anesthesia, and lower costs. To my knowledge, this is the first report of the efficacy of topical anesthesia for implantation of an Artiflex pIOL for the correction of myopia. The study used the visual analog pain scale described by Stevens.

Partial retraction of Malyugin pupil expansion device to improve safety during ring removal

Matthew Rauen, Thomas Oetting — 2010-03-01

The iris billowing, iris prolapse, and intraoperative miosis associated with intraoperative floppy-iris syndrome (IFIS) can limit the anterior segment surgeon's ability to perform efficient and safe phacoemulsification. Identification of the association between systemic α-antagonists and IFIS has allowed appropriate planning and anticipation of surgical events. Several authors have described techniques for approaching these cases. The Malyugin pupil expansion device, which was recently introduced, has become the preferred device for IFIS cases in our training program because of its ease of use and the predictable pupillary aperture. Despite our enthusiasm, we have occasionally observed intraoperative behaviors of the Malyugin ring that can limit safe usage. For example, complete retrieval of the ring into the inserter barrel during ring removal can result in unpredictable and chaotic ring behavior that can damage intraocular structures.

Epi-Shugarcaine with plain balanced salt solution for prophylaxis of intraoperative floppy-iris syndrome

Richard Schulze — 2010-03-01

In 2005, Chang and Campbell published their finding of the association between intraoperative floppy-iris syndrome (IFIS) and tamsulosin (Flomax), a systemic α1-adrenergic antagonist typically prescribed for symptoms of benign prostatic hypertrophy. Intraoperative floppy-iris syndrome is characterized by loss of the normal muscle tone of the iris, resulting in persistent iris prolapse to the wound and intraoperative miosis. Since the first report, several preoperative and intraoperative strategies to combat this vexing problem have been designed. These strategies range from the use of preoperative cycloplegia with atropine, iris retractors, the Malyugin ring, altered fluidic parameters for phacoemulsification, and more retentive ophthalmic viscosurgical devices (OVDs) such as sodium hyaluronate 2.3% (Healon5). In 2006, the late Joel Shugar hypothesized that high doses of intraoperative epinephrine (epi-Shugarcaine) could overcome the adrenergic blockade caused by tamsulosin to combat IFIS. The recipe for epi-Shugarcaine has been reported. It should be noted that epi-Shugarcaine can be safely formulated from fortified balanced salt solution (BSS Plus) or standard balanced salt solution (BSS).

Refractive Surgical Problem: March consultation #1

José L. Güell — 2010-03-01

A 34-year-old woman had laser in situ keratomileusis (LASIK) in both eyes in August 2000 at another clinic. Preoperatively, the corrected distance visual acuity (CDVA) was 20/25 with −8.25 −0.50 × 175 in the right eye and 20/20 with −7.50 −0.75 × 175 in the left eye. Although no topographic information is available, Javal keratometry was 45.0/46.0@85 in the right eye and 45.0/46.0@90 in the left eye and central ultrasonic pachymetry was 522 μm and 529 μm, respectively.

March consultation #2

Roberto Bellucci — 2010-03-01

Late corneal ectasia is a rare complication of LASIK that could not have been anticipated in this patient at the time of surgery. The patient's vision has been good for 8 years, decreasing thereafter in the left eye only. Although the attempt to correct the ectasia with ICRS implantation cannot be commended, the high astigmatism likely developed because 2 segments were implanted rather than only an inferior segment, which is all that was required. After ring segment explantation, we must still solve the problem in the left eye, which will probably extend to the right eye in the near future.

March consultation #3

Günther Grabner — 2010-03-01

From the data given, there is no real need for additional testing because there seems to be a clear progression from 5 to 9 years postoperatively. That the surgeon implanted ICRS in the left eye confirms this.

Factors affecting stromal hydration of clear corneal incision architecture

Yi Jun Hu, Ping Hou, Wei Qi Chen — 2010-03-01

We have some comments about the article by Calladine et al. that we would like to share with the authors. First, one factor that might cause the difference in architecture between hydrated clear corneal incisions (CCIs) and nonhydrated CCIs is the corneal stromal edema at the incision site induced by hydration. The authors might have to record the grade of edema at the CCIs before hydration under the surgical microscope. This measurement could serve as the baseline status of the CCI edema before hydration. The difference in the baseline status between the 2 study groups might contribute to the architectural differences detected by anterior segment optical coherence tomography.

Letter to the Editor

Andleeb Zafar — 2010-03-01

I congratulate Calladine et al. on conducting a very useful and informative study. With an increasing number of cataract surgeons making smaller clear corneal incisions, it is important to know whether stromal hydration improves wound integrity and reduces the risk for wound leakage.

Reply: Factors affecting stromal hydration of clear corneal incision architecture

Daniel Calladine — 2010-03-01

The comments of Hu et al. and Zaffar highlight some of the challenges faced when conducting similar clinical studies. While we recognize that a small amount of corneal edema at the CCI site commonly occurs as a direct result of cataract surgery, it is unlikely to occur in large amounts in routine cases. If a significant amount of edema occurs, it is easily visible at the end of surgery as a local area of white corneal opacification around the CCI; this was not seen in our study. In our study, stromal hydration was performed generously with balanced salt solution to produce a visibly significant amount of local corneal edema. While we accept this was a subjective intervention, the optical coherence tomography (OCT) images are objective and clearly demonstrate the boundary between hydrated cornea and surrounding nonhydrated cornea. In light of this, we are confident with our conclusion that stromal hydration tended to increase the local corneal thickness around the CCI, which significantly increased the measured incision length. To further support this, we reexamined some eyes in the study that had stromal hydration a month after surgery. At this time point, local corneal thickness at the CCI site had returned to normal and the incision length was shortened, in line with our study findings.

Benefits of stromal hydration

2010-03-01

We appreciate Calladine et al.'s very relevant study highlighting the benefits of performing stromal hydration at the end of phacoemulsification surgery. The architecture and integrity of clear corneal incisions are crucial in preventing endophthalmitis. Ingress of contaminants from the ocular surface into the anterior chamber has been speculated as an important mechanism for postoperative contamination. This may be particularly relevant ain cases of early postoperative hypotony.

Variation of cross-chop technique

Soon-Phaik Chee — 2010-03-01

I read with interest the cross-chop technique described by Kim during which the chopper is used to make a horizontal chop in the heminucleus with the phaco probe bracing the fragment; the name comes from the “X” configuration caused by crossing the instruments. This technique is said to be a safe and consistent method of disassembling the lens without rotating the nucleus; it is particularly recommended for weak zonules. I agree this is an excellent technique and have been using it successfully to avoid rotating the nucleus when tackling complicated cataracts, such as the dense posterior polar cataract.

Reply: Variation of cross-chop technique

Dooho Brian Kim — 2010-03-01

I have read Chee's article on posterior polar cataracts describing a similar rotationless chop technique. Similar to many innovative concepts in surgery, cross chop is a modification of preexisting techniques. Chee's success affirms my feeling that cross chop is reliable and safe; however, I would like to highlight a few distinctions.

Intraocular lens calculation in extreme myopia

Paul-Rolf Preussner — 2010-03-01

Haigis suggests a solution to overcome the problem of a systematic hyperopic outcome of intraocular lens (IOL) calculations with third-generation formulas in very long eyes. He proposes to distinguish between positive and negative IOL powers by different formula constants. For his formula, he proposed a constant of a0 = 2.77 mm for positive power IOLs and of a0 = 1.73 mm for negative power IOLs, corresponding to the SRK/T A-constants of 121.2 and 114.4, respectively. In a subsequent paper with Haigis as a coauthor, these A-constants were modified to 126.63 for positive-power MA60MA IOLs (Alcon, Inc.) and 104.43 for negative-power MA60MA IOLs.

Reply: Intraocular lens calculation in extreme myopia

Wolfgang Haigis — 2010-03-01

Systematic hyperopic outcomes after IOL implantations in extreme myopia are frequently observed clinically. I traced the problem to the use of the same IOL constants for both plus and minus IOLs and proposed as a solution to distinguish between positive and negative IOL powers by separate sets of IOL constants. This concept was shown to work in model calculations in my article as well as with clinical data in the Petermeier et al. article, producing a mean arithmetic prediction error of 0 D (see also typical results for one patient in ).

Limitations of Fourier-domain OCT

Aris Konstantopoulos, Parwez Hossain — 2010-03-01

At the time of writing this letter, the RTVue-100 (Optovue, Inc.) used by Wylęgala et al. is the only commercially available Fourier-domain optical coherence tomography (OCT) device that can scan the anterior segment without “personal” modifications. Similar to all commercially available Fourier-domain OCT devices, it uses shorter wavelength light than the Visante-OCT (Carl Zeiss Meditec) (840 nm versus 1310 nm). It scans at a faster rate (26 000 A-scans/s) than time-domain OCT devices (2048 A-scans/s for Visante-OCT). This improves image quality by achieving higher resolution and also reducing motion artifact.

Reply: Limitations of Fourier-domain OCT

Edward Wylęgała, Slawomir Teper, Anna Karolina Nowińska, Michał Milka — 2010-03-01

We can definitely claim that anterior segment OCT is a noncontact, high-resolution imaging technique with many possible clinical applications: keratoplasty, keratorefractive surgery, Descemet membrane detachment, ocular injury; even corneal infectious diseases. As far as we know, there are 3 commercially available spectral domain anterior segment modalities that do not require personal modifications: RTVue-100 (Optovue Inc.), Cirrus HD-OCT model 4000 (Carl Zeiss Meditec), and SOCT Copernicus HR (Optopol Technology SA).

Erratum

2010-03-01

In the December issue, in the article “Preoperative Topical Moxifloxacin 0.5% and Povidone–Iodine 5.0% Versus Povidone–Iodine 5.0% Alone to Reduce Bacterial Colonization in the Conjunctival Sac” (J Cataract Refract Surg 2009;35:2109-2114), the name of the first author is spelled incorrectly. The correct name of the first author is Orly Halachmi-Eyal, MD.

Editorial Board

2010-03-01

Visual Acuity Chart

2010-03-01

Journal of Cataract & Refractive Surgery

Negative dysphotopsia following cataract surgery

Scleral fixation of intraocular lenses combined with penetrating keratoplasty

Hydroimplantation: Foldable intraocular lens implantation without an ophthalmic viscosurgical device

Functional assessment of accommodating intraocular lenses versus monofocal intraocular lenses in cataract surgery: Metaanalysis

Color discrimination by patients with different types of light-filtering intraocular lenses

Optical aberrations in professional baseball players

Oral acetaminophen (paracetamol) for additional analgesia in phacoemulsification cataract surgery performed using topical anesthesia: Randomized double-masked placebo-controlled trial

Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: Randomized double-masked clinical trial

Surgically induced astigmatism after phacoemulsification with and without correction for posture-related ocular cyclotorsion: Randomized controlled study

Intraocular lens exchange in patients with negative dysphotopsia symptoms

Repeatability of corneal power and wavefront aberration measurements with a dual-Scheimpflug Placido corneal topographer

Manual limbal markings versus iris-registration software for correction of myopic astigmatism by laser in situ keratomileusis

Visual acuity and higher-order aberrations with wavefront-guided and wavefront-optimized laser in situ keratomileusis

Efficacy, safety, and flap dimensions of a new femtosecond laser for laser in situ keratomileusis

First clinical results of epithelial laser in situ keratomileusis with a 1000 Hz excimer laser

Limbal relaxing incisions at the time of apodized diffractive multifocal intraocular lens implantation to reduce astigmatism with or without subsequent laser in situ keratomileusis

Straylight measurements in laser in situ keratomileusis and laser-assisted subepithelial keratectomy for myopia

Keratorefractive effect of microwave keratoplasty on human corneas

Comparison of real-time intraocular pressure during laser in situ keratomileusis and epithelial laser in situ keratomileusis in porcine eyes

Acrylic intraocular lens damage after folding using a forceps insertion technique

Ocular penetration of topically applied linezolid in a rabbit model

Effect of varying microkeratome parameters on laser in situ keratomileusis interface surfaces

Pseudophakic eye with obliquely crossed piggyback toric intraocular lenses

Immunohistochemical observation of anterior subcapsular cataract in eye with spontaneously regressed retinoblastoma

Bilateral Descemet membrane detachment after canaloplasty

Long-term pathological follow-up of obsolete design: Pannu universal intraocular lens

Pseudomonas keratitis after collagen crosslinking for keratoconus: Case report and review of literature

Efficacy of topical anesthesia for foldable phakic intraocular lens implantation for the correction of myopia

Partial retraction of Malyugin pupil expansion device to improve safety during ring removal

Epi-Shugarcaine with plain balanced salt solution for prophylaxis of intraoperative floppy-iris syndrome

Refractive Surgical Problem: March consultation #1

March consultation #2

March consultation #3

Factors affecting stromal hydration of clear corneal incision architecture

Letter to the Editor

Reply: Factors affecting stromal hydration of clear corneal incision architecture

Benefits of stromal hydration

Variation of cross-chop technique

Reply: Variation of cross-chop technique

Intraocular lens calculation in extreme myopia

Reply: Intraocular lens calculation in extreme myopia

Limitations of Fourier-domain OCT

Reply: Limitations of Fourier-domain OCT

Erratum

Editorial Board

Visual Acuity Chart

Table of Contents