Journal of Cataract & Refractive Surgery

Intraocular lens calculations: Call for more deterministic models

William J. Dupps — 2010-09-01

The problem of intraocular lens (IOL) power selection in cataract surgery continues to dominate the psyche of cataract and refractive surgeons and the pages of this journal. The extraordinary number of formulas devoted to this task can be intimidating and illustrates the ongoing need for a more definitive solution than empirical probability-based models that are only partially patient-specific.

Optic capture in the anterior capsulorhexis during combined cataract and vitreoretinal surgery

Joo Eun Lee, Jeong Hyo Ahn, Wan Soo Kim, Seung Youn Jea — 2010-09-01

We describe an optic capture technique that can be used during combined cataract and vitreoretinal surgery if in-the-bag implantation of an intraocular lens (IOL) is not possible. The IOL is placed in the ciliary sulcus, and optic capture is performed behind an intact anterior continuous curvilinear capsulorhexis, with the haptics remaining in the sulcus. The technique maintains IOL stability and separation of the anterior and posterior segments intraoperatively and postoperatively.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Microwash or macrowash technique to maintain a clear cornea during cataract surgery

2010-09-01

We describe a technique of irrigating and thereby rapidly and effectively clearing the cornea of relatively large amounts of surface contaminants that reduce surgical visibility and may contribute to endophthalmitis. This technique is referred to as “macrowash.” If the technique is required, it is usually at the commencement of cataract surgery, immediately after placement of the surgical drape. The technique not only saves time, but also reduces the volume of irrigating solution required by the “microwash” technique, which is traditionally carried out by the scrub nurse/surgical assistant using a Rycroft cannula attached to a 15 mL container of irrigating solution.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular lens power calculation after myopic excimer laser surgery: Clinical comparison of published methods

Giacomo Savini, Kenneth J. Hoffer, Michele Carbonelli, Piero Barboni — 2010-09-01

Purpose: To compare results of intraocular lens (IOL) power calculation methods after myopic excimer laser surgery.Setting: Private practice.Methods: In this prospective study, eyes having phacoemulsification after myopic excimer laser surgery were classified into Group 1 (preoperative corneal power available, refractive change known), Group 2 (preoperative corneal power available, refractive change uncertain), and Group 3 (preoperative corneal power unavailable, refractive change known even if uncertain). The IOL power was calculated using the following methods: clinical history, Awwad, Camellin/Calossi, Diehl, Feiz, Ferrara, Latkany, Masket, Rosa, Savini, Shammas, Seitz/Speicher, and Seitz/Speicher/Savini.Results: The lowest mean absolute errors (MAEs) in IOL power prediction in Group 1 (n = 12) and Group 2 (n = 11), respectively, were with the methods of Seitz/Speicher/Savini (0.51 diopter [D] ± 0.44 [SD] and 0.55 ± 0.50 D), Seitz/Speicher (0.58 ± 0.47 D and 0.54 ± 0.45 D), Savini (0.60 ± 0.44 D and 0.65 ± 0.63 D), Masket (0.82 ± 0.49 D and 0.69 ± 0.51 D), and Shammas (0.77 ± 0.43 D and 1.11 ± 0.50 D). In Group 3 (n = 5), the lowest MAEs were with the methods of Masket (0.23 ± 0.27 D), Savini (0.49 ± 0.86 D), Seitz/Speicher/Savini (0.68 ± 0.36 D), Shammas (0.84 ± 0.98 D), and Camellin/Calossi (0.91 ± 0.84 D).Conclusions: When corneal power is known, the Seitz/Speicher method (with or without Savini adjustment) seems the best solution to obtain an accurate IOL power prediction. Otherwise, the Masket method may be the most reliable option.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of intraocular lens power prediction methods using the American Society of Cataract and Refractive Surgeons Post-Keratorefractive Intraocular Lens Power Calculator

Li Wang, Warren E. Hill, Douglas D. Koch — 2010-09-01

Purpose: To evaluate the accuracy of methods of intraocular lens (IOL) power prediction after previous laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) using the American Society of Cataract and Refractive Surgery IOL power calculator.Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, and private practice, Mesa, Arizona, USA.Methods: The following methods were evaluated: methods using pre-LASIK/PRK keratometry (K) and surgically induced change in refraction, methods using surgically induced change in refraction, and methods using no previous data. The predicted IOL power was calculated with each method using the actual refraction after cataract surgery as the target. The IOL prediction error was calculated as the implanted IOL power minus the predicted IOL power. Arithmetic and absolute IOL prediction errors, variances in mean arithmetic IOL prediction error, and percentage of eyes within ±0.50 diopter (D) and ±1.00 D of refractive prediction errors were calculated.Results: Methods using surgically induced change in refraction or no previous data had significantly smaller mean absolute IOL prediction errors, smaller variances, and a greater percentage of eyes within ±0.50 D and ±1.00 D of refractive prediction errors than methods using pre-LASIK/PRK keratometry (K) values and surgically induced change in refraction (all P<.05 with Bonferroni correction). There were no statistically significant differences between methods using surgically induced change in refraction and methods using no previous data.Conclusion: Methods using surgically induced change in refraction and methods using no previous data gave better results than methods using pre-LASIK/PRK K values and surgically induced change in refraction.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Precision of biometry, keratometry, and refractive measurements with a partial coherence interferometry–keratometry device

H. John Shammas, Steven Chan — 2010-09-01

Purpose: To evaluate the precision of the axial length (AL), keratometry (K), anterior chamber depth (ACD), astigmatism, and minus astigmatic cylinder axis measurements by a partial coherence interferometry (PCI)–keratometry device.Setting: Private practice, Lynwood, California.Methods: This prospective comparative observational study analyzed measurements in the second eye to have cataract surgery. Before surgery in the first eye, AL, K, ACD, astigmatism, and cylinder axis in both eyes were measured with an IOLMaster PCI device. The measurements were repeated approximately 1 month later, before second eye-surgery. The 2 sets of measurements were compared.Results: The study evaluated 121 eyes of 121 patients. The interclass correlation coefficient (ICC) for AL was 0.999 in all 3 signal-to-noise ratio (SNR) categories; the highest difference range was with an SNR below 100. Astigmatism, K, and cylinder axis had a high correlation in flat corneas (K reading <42.0 diopters [D]) (ICC = 0.994, 0.978, and 0.918, respectively) and a poorer correlation with K readings between 42.0 D and 44.0 D (ICC = 0.905, 0.774, and 0.456, respectively) and K readings above 44.0 D (ICC = 0.988, 0.729 and 0.446, respectively).Conclusions: The precision of the PCI measurements was extremely high for AL with low fluctuations (95% limits of agreement [LoA], 0.06 mm) and was relatively high for K readings with higher fluctuations (95% LoA, 0.55 D) and for ACD (95% LoA, 0.2 mm). The precision of astigmatism and cylinder axis was high in flat corneas and relatively low in steeper corneas.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Analysis of biometry and prevalence data for corneal astigmatism in 23 239 eyes

Peter Christian Hoffmann, Werner W. Hütz — 2010-09-01

Purpose: To present and analyze biometry data sets and prevalence data for corneal astigmatism in a large population.Setting: High-volume eye surgery center, Castrop-Rauxel, Germany.Methods: Axial length (AL), corneal radii, anterior chamber depth (ACD), and horizontal corneal diameter (white-to-white [WTW] distance) were optically measured by partial coherence interferometry (IOLMaster). Patient data sets acquired between 2000 and 2006 were reviewed and analyzed.Results: The study evaluated 23 239 data sets of 15 448 patients with a median age of 74 years. The mean values were as follows: AL, 23.43 mm ± 1.51 (SD); corneal radius, 7.69 ± 0.28 mm; WTW distance, 11.82 ± 0.40 mm; and ACD, 3.11 ± 0.43 mm. The ACD and axis of astigmatism were correlated with age. The AL, corneal radius, ACD, and WTW were correlated with one other. Eight percent of eyes had corneal astigmatism greater than 2.00 diopters (D), and 2.6% had more than 3.00 D. Astigmatism was with the rule (WTW) in 46.8% of eyes, against the rule in 34.4%, and oblique in 18.9%. High astigmatism was predominantly WTW.Conclusions: The results in this analysis might provide normative data for cataract patients and a useful reference for multiple purposes. The correlation of AL with corneal radius, ACD, and corneal diameter in normal eyes was not present in eyes with extreme myopia or hyperopia.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Anterior chamber phakic intraocular lens implantation in children to treat severe anisometropic myopia and amblyopia: 3-year clinical results

Amir Pirouzian, Kenneth C. Ip — 2010-09-01

Purpose: To evaluate the midterm efficacy of Verisyse anterior chamber phakic intraocular lens (AC pIOL) implantation in reducing clinically significant (>−8.0 diopters) myopic anisometropia in children who have been noncompliant with traditional medical treatment.Setting: Private practice in affiliation with San Diego Children's Hospital, San Diego, California, USA.Methods: A retrospective interventional chart review identified highly anisometropic myopic pediatric patients in a single practice who had AC pIOL implantation in the more myopic eye. None of the patients were compliant with spectacle correction or contact lens therapy, and all had dense amblyopia. Preoperative and postoperative visual acuity, stereoacuity, central corneal thickness, motor alignment, and endothelial cell counts were performed in all patients. Occlusion therapy was initiated subsequent to pIOL implantation.Results: The review identified 7 patients ranging in age from 5 to 11 years; the postoperative follow-up was 34 to 36 months. All patients had a significant improvement (>6 lines) in visual acuity postoperatively. The mean corrected distance visual acuity was 20/40 at 3 years. All patients had improved stereoacuity Randot testing, from a mean of 0 seconds of arc preoperatively to a mean of 185 seconds of arc at 3 years. No intraoperative or postoperative complications were identified.Conclusions: Results indicate that AC pIOL implantation can be considered an alternative modality to manage clinically significant, severe anisometropic myopia in pediatric eyes when there is poor patient compliance with traditional medical treatment. Long-term follow-up of corneal endothelial cell density after pediatric AC pIOL implantation is strongly encouraged.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes

2010-09-01

Purpose: To evaluate whether intracameral triamcinolone has an effect on anterior segment inflammation and visual axis obscuration after pediatric cataract surgery with intraocular (IOL) implantation.Setting: Iladevi Cataract and IOL Research Institute, Ahmedabad, India.Methods: This retrospective age-matched case-control study comprised consecutive eyes of children having phacoaspiration, posterior capsulectomy, vitrectomy, and IOL implantation. In the study group, eyes received a standardized application of an intracameral preservative-free triamcinolone acetonide suspension intraoperatively. In the control group, age-matched consecutive eyes had surgery with a similar technique but without intracameral preservative-free triamcinolone acetonide. Cell deposits, posterior synechias, visual axis obscuration, and intraocular pressure (IOP) were evaluated 1 month and 12 months postoperatively.Results: The mean patient age at surgery was 9.15 months ± 5.04 (SD) in the study group (41 eyes) and 9.34 ± 5.10 months in the control group (83 eyes) (P = .91). The visual axis was not obscured in any eye in the study group, while 9 eyes (10.8%) in the control group had an obscured axis; the difference between groups was statistically significant (P<.029). Six eyes (7.2%) in the control group required secondary membranectomy with pars plana vitrectomy. There was a statistically significant difference between the 2 groups in posterior synechias and cell deposits (both P<.033) and no significant difference in preoperative or postoperative IOP (P = .29 and P = .50, respectively).Conclusion: Pediatric eyes receiving intracameral triamcinolone intraoperatively had significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Aqueous penetration of moxifloxacin 0.5% ophthalmic solution and besifloxacin 0.6% ophthalmic suspension in cataract surgery patients

Junko Yoshida, Alisa Kim, Kimberly A. Pratzer, Walter J. Stark — 2010-09-01

Purpose: To determine the aqueous humor concentrations of moxifloxacin and besifloxacin after routine preoperative topical dosing in patients having cataract surgery.Setting: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.Methods: In this prospective randomized parallel double-masked clinical trial, 1 drop of commercially available moxifloxacin 0.5% ophthalmic solution or besifloxacin 0.6% ophthalmic suspension was administered every 10 minutes for a total of 4 doses beginning 1 hour before routine cataract surgery. Aqueous humor was sampled via the paracentesis, and antibiotic concentrations were determined using validated high-performance liquid chromatography procedures.Results: The study enrolled 50 patients. The aqueous concentration of the antibiotic agent was detectable in all 23 moxifloxacin samples and in 10 (40%) of the 25 besifloxacin samples (P<.0001, Pearson chi-square test). The mean aqueous concentration in the moxifloxacin samples was 50-fold higher than in the besifloxacin samples (1.6108 μg/mL versus 0.0319 μg/mL) when all samples were included (P<.0001, Wilcoxon test), while the moxifloxacin concentration was 38-fold higher than the besifloxacin concentration (1.6108 μg/mL versus 0.0422 μg/mL) in the samples with detectable antibiotic agent (P<.0001).Conclusions: After topical preoperative administration, moxifloxacin 0.5% ophthalmic solution had a 38-fold to 50-fold higher concentration in the aqueous humor than besifloxacin 0.6% ophthalmic suspension. Besifloxacin was undetectable in more than half the aqueous humor samples.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Transconjunctival single-plane sclerocorneal incisions versus clear corneal incisions in cataract surgery

Shigeru Sugai, Fumiaki Yoshitomi, Tetsuro Oshika — 2010-09-01

Purpose: To compare a transconjunctival single-plane sclerocorneal incision with 2 tiny conjunctival cuts at both ends and a clear corneal incision (CCI) in cataract surgery.Setting: Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.Methods: Patients having routine cataract surgery were randomly divided into 2 groups based on incision type; that is, transconjunctival single-plane sclerocorneal or CCI. The incidence of intraoperative ballooning of the conjunctiva (chemosis) and the percentage of eyes that required stromal hydration to securely close the wound in each group were recorded and compared.Results: Each group comprised 61 eyes (61 patients). No eye in the transconjunctival sclerocorneal group and 6 eyes (9.8%) in the CCI group developed intraoperative conjunctival chemosis (P = .027, Fisher exact probability test). Corneal stromal hydration was required in 2 eyes (3.3%) and 15 eyes (24.6%), respectively (P = .001).Conclusion: The transconjunctival single-plane sclerocorneal incision was effective and combined the merits of CCI incisions and sclerocorneal incisions.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Visual outcomes after implantation of a refractive multifocal intraocular lens with a +3.00 D addition

Julián Cezón Prieto, María José Bautista — 2010-09-01

Purpose: To assess the visual outcomes after cataract surgery with implantation of a refractive multifocal intraocular lens (IOL) with a +3.00 D addition (add).Setting: Centro Internacional de Microcirugia Ocular, Seville, Spain.Methods: This prospective study evaluated visual outcomes after cataract surgery with implantation of a Rayner M-flex 630F +3 IOL over a 12-month follow-up. Monocular and binocular uncorrected and corrected distance, intermediate, and near visual acuities were recorded. Distance contrast sensitivity under photopic and mesopic conditions, subjective dysphotopic phenomena, and subjective spectacle dependence were assessed.Results: The study enrolled 32 eyes of 22 patients. Twelve months postoperatively, the mean monocular corrected distance acuity was 0.03 ± 0.05 logMAR and the mean corrected near acuity was 0.04 ± 0.05 logMAR. The binocular uncorrected and corrected near acuity was 0.25 ± 0.08 logMAR and 0.03 ± 0.02 logMAR, respectively, at 6 months, with no changes thereafter. No patients reported dysphotopic phenomena at the 12-month visit. Of patients having binocular IOL implantation, 90% were spectacle independent for distance vision and 70% for near vision at 6 months.Conclusion: The refractive multifocal IOL with a +3.00 D add provided satisfactory visual outcomes through a full range of vision.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Intraocular stability of an angle-supported phakic intraocular lens with changes in pupil diameter

Jorge L. Alió, David P. Piñero, Esperanza Sala, Francisco Amparo — 2010-09-01

Purpose: To use anterior segment optical coherence tomography (AS-OCT) to evaluate the stability of a recently released angle-supported phakic intraocular lens (pIOL) in the anterior segment with changes in pupil diameter.Setting: Keratoconus Unit, Vissum Corporation, Alicante, Spain.Methods: In this observational cross-sectional study of consecutive eyes with moderate to high myopia, an AcrySof Cachet pIOL was implanted with the aim of minimizing the refractive error. An analysis of the position and stability of the pIOL before and after pharmacologic pupil dilation was performed 3 months postoperatively using the Visante AS-OCT system. A measurement protocol that included several anatomic parameters was developed and applied; the parameter values before and after dilation were compared.Results: Twenty eyes of 20 patients ranging in age from 24 to 48 years old were evaluated. The anterior chamber depth increased significantly with pupil dilation (mean change 0.06 mm ± 0.08 [SD]) (P<.01). A significant change was also observed in the distance between the center of the cornea at the endothelial plane and the anterior surface of the pIOL (mean change 0.03 ± 0.05 mm) (P = .01). The distances between the peripheral edges of the pIOL and the corneal endothelium and the distance between the crystalline lens and the pIOL did not change significantly (P≥.14).Conclusion: The angle-supported pIOL showed excellent intraocular behavior after pupil dilation, with no shortening of the distance between the pIOL and corneal endothelium at the center or peripheral edges of the pIOL.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Rotational and centration stability of an aspheric intraocular lens with a simulated toric design

Phillip J. Buckhurst, James S. Wolffsohn, Shehzad A. Naroo, Leon N. Davies — 2010-09-01

Purpose: To assess the stability of the Akreos AO intraocular lens (IOL) platform with a simulated toric design using objective image analysis.Setting: Six hospital eye clinics across Europe.Methods: After implantation in 1 eye of patients, IOLs with orientation marks were imaged at 1 to 2 days, 7 to 14 days, 30 to 60 days, and 120 to 180 days. The axis of rotation and IOL centration were objectively assessed using validated image analysis.Results: The study enrolled 107 patients with a mean age of 69.9 years ± 7.7 (SD). The image quality was sufficient for IOL rotation analysis in 91% of eyes. The mean rotation between the first day postoperatively and 120 to 180 days was 1.93 ± 2.33 degrees, with 96% of IOLs rotating fewer than 5 degrees and 99% rotating fewer than 10 degrees. There was no significant rotation between visits and no clear bias in the direction of rotation. In 71% of eyes, the dilation and image quality was sufficient for image analysis of centration. The mean change in centration between 1 day and 120 to 180 days was 0.21 ± 0.11 mm, with all IOLs decentering less than 0.5 mm. There was no significant decentration between visits and no clear bias in the direction of the decentration.Conclusion: Objective analysis of digital retroillumination images taken at different postoperative periods shows the aspheric IOL platform was stable in the eye and is therefore suitable for the application of a toric surface to correct corneal astigmatism.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Reproducibility of intraocular lens decentration and tilt measurement using a clinical Purkinje meter

2010-09-01

Purpose: To determine the reproducibility of intraocular lens (IOL) decentration and tilt measurements with a new Purkinje meter instrument.Setting: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.Methods: After pupil dilation, images of pseudophakic eyes with a plate-style IOL (Akreos Adapt) were obtained using a recently developed Purkinje meter. Intraocular lens decentration and tilt were evaluated by analyzing the captured images using a semiobjective method by marking the reflexes in the images and automatic calculation using a dedicated software program. In study 1, examiner 1 examined the eyes first followed by examiner 2. Ten minutes later, examiner 1 performed a second measurement, after which the intraexaminer and interexaminer reproducibility were determined. In study 2, a Purkinje meter was used to measure pseudophakic eyes with slitlamp finding of clinical IOL decentration, IOL tilt, or both. The results were compared with retroillumination photographs and slitlamp findings.Results: In study 1, there was high intraexaminer reproducibility for decentration (r = 0.95) and tilt (r = 0.85) and high interexaminer reproducibility for decentration (r = 0.84) and tilt (r = 0.75). In study 2, even in extreme cases of decentration and/or tilt, the Purkinje meter measurements were possible and appeared to correlate well with slitlamp findings.Conclusions: Acquisition of images in pseudophakic eyes with the Purkinje meter was simple and rapid. The method was highly reliable for 1 examiner and between 2 examiners.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Ocular aberrations and visual performance with an aspheric single-piece intraocular lens: Contralateral comparative study

Ahmed Assaf, Ahmed Kotb — 2010-09-01

Purpose: To study spherical aberration, coma, and trefoil after implantation of a single-piece aspheric Tecnis intraocular lens (IOL) in cataract patients and the influence on photopic and mesopic contrast sensitivity.Setting: Ophthalmology Department, Ain-Shams University Hospitals, Cairo, Egypt.Methods: In this randomized prospective contralateral comparative study, patients had bilateral senile cataract. Eyes with a pathological condition other than cataract that might influence postoperative visual function were excluded. The aspheric IOL was compared with the Sensar AR40e spherical IOL. The IOL selection was randomized. Study criteria included corrected distance visual acuity (CDVA), wavefront aberrometry, and contrast visual acuity.Results: Fifty-six eyes of 28 patients were enrolled. All patients completed the 2-month postoperative visit. There was no significant difference between the IOLs in CDVA (P>.05). Ocular spherical aberration was significantly lower with aspheric IOLs than spherical IOLs (P<.001). Two months after surgery, eyes with the aspheric IOL had better photopic contrast sensitivity and better mesopic contrast sensitivity at all cycles per degree. There was no significant difference in 3rd-order aberrations (coma and trefoil) between IOLs.Conclusions: After cataract surgery, the single-piece aspheric IOL resulted in significantly lower ocular spherical aberration and significantly better mesopic contrast sensitivity. No significant difference in 3rd-order aberrations indicates that both IOLs had satisfactory centration in the capsular bag.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Central corneal thickness measurements after myopic photorefractive keratectomy using Scheimpflug imaging, scanning-slit topography, and ultrasonic pachymetry

2010-09-01

Purpose: To compare central corneal thickness (CCT) measurements obtained with a dual Scheimpflug camera system (Galilei), a scanning-slit topographer (Orbscan II), and an ultrasound (US) pachymeter (SP-2000) after photorefractive keratectomy (PRK) for myopia.Setting: Ophthalmic Research Center, Labbafinejad Medical Center, Tehran, Iran.Methods: This prospective study enrolled patients who had PRK to correct myopia or myopic astigmatism and a postoperative follow-up of at least 5 months. The CCT was measured in a single session using Scheimpflug imaging, scanning-slit topography, and US pachymetry. Data were analyzed with paired t tests, linear regression, and Bland-Altman plots.Results: The mean CCT in the 100 eyes (50 patients) was 524.06 μm ± 38.56 (SD) with Scheimpflug imaging, 505.92 ± 47.35 μm with scanning-slit topography, and 496.97 ± 42.74 μm with US pachymetry. The lower to upper 95% limits of agreement (LoA) with US pachymetry were 2.4 to 51.8 μm for Scheimpflug imaging and −22.2 to 40.1 μm for scanning-slit topography. After application of a correction factor (0.95), the mean corrected Scheimpflug CCT measurement was 497.33 ± 36.59 μm and the lower to upper 95% LoA with US pachymetry were −25.9 to 25.5 μm. The acoustic factor for scanning-slit topography was 0.94.Conclusions: The CCT measurements in eyes that had PRK were thicker with Scheimpflug imaging than with US pachymetry or scanning-slit topography in the late postoperative period. With application of a correction factor, the Scheimpflug measurements were closer to US pachymetry values and had better agreement than scanning-slit topography.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of simulated keratometric changes induced by custom and conventional laser in situ keratomileusis after myopic ablation: Retrospective chart review

Cheri Leng, Vahid Feiz, Bagher Modjtahedi, Majid Moshirfar — 2010-09-01

Purpose: To determine the relationship between the achieved refractive change and the change in simulated keratometry (K) after myopic laser situ keratomileusis (LASIK) and compare this relationship between custom and conventional treatments.Setting: Department of Ophthalmology, University of California, Davis, Sacramento, California, and John A. Moran Eye Center, Salt Lake City, Utah, USA.Methods: The change in simulated K and the refractive change induced by custom myopic LASIK and conventional LASIK were determined. The relationship between the variables was analyzed by regression methods.Results: Custom treatment was performed in 106 eyes and conventional treatment in 224 eyes. Simple linear regression analysis did not fit the clinical observation when the refractive change was less than 2.00 diopters (D) of myopic correction with both treatments. Under the linear model and nonlinear model, each unit of refractive change yielded a greater change in corneal topographic power with custom treatment than with conventional treatment. With both treatments, the rate of change in simulated K was not constant and was much more variable with lower amounts of correction. The relationship was more constant and linear with larger amounts of refractive correction.Conclusions: The relationship between the measured change in simulated K and the induced refractive change better fit a nonlinear relationship with smaller amounts of refractive correction in custom LASIK and conventional LASIK. Under all forms of analysis, custom treatments yielded a greater per-unit change in corneal curvature than conventional treatments, especially for refractive corrections of 4.00 D and higher.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: Prospective randomized clinical trial

2010-09-01

Purpose: To compare the outcomes of mechanical and femtosecond laser–assisted tunnel creation for intrastromal corneal ring segment (ICRS) implantation in eyes with keratoconus.Setting: Kartal Training and Research Hospital, Istanbul, Turkey.Methods: In this prospective study, consecutive eyes with keratoconus were randomly assigned to have ICRS tunnel creation with a mechanical device or a femtosecond laser. Keraring ICRS with a 5.0 mm diameter and 160-degree arc length were implanted in all cases. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and keratometry (K) readings were measured preoperatively and 1 year postoperatively, and the data in the mechanical group and the femtosecond group were compared statistically.Results: One year postoperatively, there was significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder in both groups (P .05). Anterior corneal perforation, superficial segment placement, and segment extrusion occurred in 1 eye each in the mechanical group. Segment migration occurred in 1 eye in the femtosecond group.Conclusion: Despite intraoperative complications in the mechanical group, the visual and refractive outcomes were similar to those in the femtosecond group.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Modification and refinement of astigmatism in keratoconic eyes with intrastromal corneal ring segments

2010-09-01

Purpose: To analyze corneal astigmatic changes after implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes using the Alpins vectorial method.Setting: Vissum Corporation, Alicante, Spain.Methods: Keraring ICRS were implanted in eyes with a diagnosis of keratoconus. One of 3 surgeons performed the ICRS implantations using femtosecond technology and following the same protocol. Visual, refractive, keratometric, and corneal aberrometric changes were evaluated during a 12-month follow-up. Corneal astigmatic changes were also analyzed using the following Alpins vectorial components: targeted induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector, magnitude of error, flattening effect, and torque.Results: Postoperatively, there was significant visual improvement (P = .03), significant central flattening (P = .03), and a significant reduction in manifest astigmatism (P<.01). The magnitude of SIA vector was significantly lower than the TIA postoperatively (P≥.02). The mean magnitude of the difference vector 3 months postoperatively was +2.96 diopters (D) ± 1.68 (SD). The mean magnitude of error remained negative and unchanged (P≥.10). The mean magnitude of the flattening effect was significantly lower than the TIA at all postoperative visits (P≤.01). The mean magnitude of torque vector was 1.21 ± 0.98 D at 3 months. Significant negative correlations were found between preoperative corneal astigmatism and the magnitude of error and difference vector at all postoperative visits.Conclusion: Although ICRS implantation significantly reduced the magnitude of corneal astigmatism, there was a trend toward undercorrection and the meridian of correction was not appropriate in all cases, showing the need for nomogram adjustments.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Surface roughness of intraocular lenses with different dioptric powers assessed by atomic force microscopy

Marco Lombardo, Stefan Talu, Mihai Talu, Sebastiano Serrao, Pietro Ducoli — 2010-09-01

Purpose: To analyze the optic surface roughness and morphology of 2 types of hydrophobic acrylic intraocular lenses (IOLs) with various dioptric powers using atomic force microscopy (AFM).Setting: Technical University of Cluj-Napoca, Faculty of Mechanics, Cluj-Napoca, Romania.Methods: Atomic force microscopy was used to characterize the topography of 2 types of hydrophobic acrylic IOLs from a single manufacturer (SN60AT and SA30AL) with dioptric powers ranging from 10.0 diopters (D) to 30.0 D. The AFM analysis was performed in contact mode using a V-shaped silicon nitride cantilever with a pyramidal tip curvature of 15 nm and a nominal spring constant of 0.2 N/m. Detailed surface characterization of the IOL optic was obtained using 6 quantitative parameters provided by the AFM software.Results: Five of 6 roughness parameters indicated statistically significant differences (P<.05) between IOLs with different dioptric powers, with the 10.0 D IOL in both models providing the smoothest optic surface. Between models with the same dioptric power, the SN60AT model had lower values of each surface roughness parameter than the SA30AL model.Conclusions: Atomic force microscopy was an accurate tool for assessing the surface properties of IOL optics. Manufacturing processes were responsible for introducing detectable differences in the topography of IOL biomaterials with identical copolymer constituents but different dioptric powers. Nanometric analysis may assist IOL manufacturers in developing IOLs with optimal surface characteristics.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Corneal shaping and ablation of transparent media by femtosecond pulses in deep ultraviolet range

2010-09-01

Purpose: To assess the performance of a newly developed solid-state femtosecond ultraviolet (UV) laser system in corneal ablation.Setting: Vilnius University, Laser Research Centre, Vilnius, Lithuania.Methods: Femtosecond pulses in the deep UV range (205 nm) were obtained by the generation of the fifth-harmonic of an amplified Yb:KGW laser system (fundamental output at 1027 nm). Coupled with galvanometric beam-scanning mirrors, this system allowed ablation shaping of transparent media, including poly(methyl methacrylate) (PMMA), collagen, and ex vivo porcine corneas. The surfaces of ablated structures were characterized using a noncontact confocal optical profiler.Results: Spherical structures were successfully formed in all 3 materials tested. A 10.0 diopter refraction change in the cornea was produced in 180 seconds. The resulting surface quality was significantly higher (roughness length >100 μm versus approximately 6 μm) in gelatin and ex vivo corneas than in PMMA.Conclusion: The solid-state femtosecond UV laser system seems an attractive alternative to the currently used ophthalmic argon–fluoride excimer laser system because of its small footprint, silent operation, and ability to generate femtosecond light pulses at both 1027 nm (suitable for flap creation) and 205 nm (corneal ablation).Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Emerging antibiotic resistance in ocular infections and the role of fluoroquinolones

Marguerite McDonald, Joseph M. Blondeau — 2010-09-01

Resistance to antibiotic agents is becoming increasingly prevalent among ocular infections. Between 19% and 60% of Streptococcus pneumoniae and Staphylococcus aureus isolates have been shown to be resistant to macrolide antibiotic agents, penicillin, and older fluoroquinolones. Although topical fluoroquinolones are considered first-line treatment of ocular infections, as much as 85% of methicillin-resistant S aureus isolates are resistant to ophthalmic fluoroquinolones, including the newer 8-methoxy fluoroquinolones, gatifloxacin and moxifloxacin. Besifloxacin, an 8-chlorofluoroquinolone, has a lower minimum inhibitory concentration against multidrug-resistant staphylococcal strains than other fluoroquinolones and less selective pressure for resistance development because of the lack of a systemic counterpart. In addition to the development of new antibacterial agents, antibiotic resistance in ocular infections may be reduced by following the same strategies used to minimize antimicrobial resistance in systemic infections.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Visually significant haze after retreatment with photorefractive keratectomy with mitomycin-C following laser in situ keratomileusis

Anthony Liu, Edward E. Manche — 2010-09-01

Photorefractive keratectomy (PRK) with the adjunctive use of mitomycin-C (MMC) for the treatment of residual refractive error after laser in situ keratomileusis (LASIK) has been shown to be safe and effective, with no occurrences of visually significant postoperative haze reported. We report a case of visually significant haze after PRK with MMC for residual myopia following LASIK.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned.

Long-term follow-up of first-generation posterior chamber phakic intraocular lens

2010-09-01

We present a patient who received a first-generation posterior chamber phakic intraocular lens (PC pIOL) (Fyodorov IOL) to correct myopia 18 years previously. After a long lapse in the follow-up, the patient presented with a reduced endothelial cell count. Although the cataractogenic effect of first-generation PC pIOLs is well known, no sign of cataract was present. The patient was totally satisfied even after 18 years. To our knowledge, this is the first report of a long follow-up of a patient implanted with a first-generation PC pIOL.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Clinicopathologic correlation of capsulorhexis phimosis with anterior flexing of single-piece hydrophilic acrylic intraocular lens haptics

2010-09-01

We describe 2 cases in which patients with 4-looped single-piece hydrophilic acrylic intraocular lenses (IOLs) exhibited postoperative complications including capsulorhexis phimosis, decentration, tilt, hyperopic shift, and luxation leading to explantation of the IOL–capsular bag complex. The excessive capsule fibrosis led to anterior flexing of the IOL haptics in both cases, even in the presence of a capsular tension ring (CTR). Histopathological analyses revealed a thick fibrocellular tissue attached to the inner surface of the anterior capsules, corresponding to the anterior capsule opacification and folds. An amorphous substance was observed on the outer surface of the anterior capsule in the case with a CTR, suggesting pseudoexfoliation material. These and similar cases raise concerns about the postoperative behavior of highly flexible IOLs in the presence of excessive capsular bag fibrosis.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Secondary pigment dispersion syndrome with single-piece acrylic IOL

Omar Hadid, Roly Megaw, Rona Owen, Scott Fraser — 2010-09-01

The concept of secondary pigment dispersion syndrome (PDS), in which a mechanical cause of the dispersion is known, has been reported with various intraocular lenses (IOLs). We present 3 cases of PDS following insertion of an AcrySof SA60AT IOL (Alcon, Inc.).

Anterior capsular entrapment in an equatorial crack formed during injection of hydrophilic acrylic intraocular lens

Karl Mercieca, Anne Morrison — 2010-09-01

The Akreos AO intraocular lens (Bausch & Lomb) is a widely used hydrophilic acrylic intraocular lens (IOL) with excellent postoperative outcomes. We report a case in which the IOL developed a crack along the equatorial region during injection into the capsular bag in an otherwise routine phacoemulsification procedure. The IOL was loaded into a Hydroport SI injector (PS27) (Bausch & Lomb), and hydroxypropyl methylcellulose (Coatel HPMC) (Bausch & Lomb) ophthalmic viscosurgical device was used to fill the capsular bag and injector. The IOL was injected in a staggered rather than smooth fashion, with a small pause midway during IOL insertion. The IOL left the injector in a slightly oblique position; the crack opened initially as the latter part of the IOL passed through it and then snapped in and captured the 3 o'clock edge of the anterior capsule (). As a result of this “capsulorhexis capture,” 1 of the IOL's 4 haptics was located in the sulcus, with the other 3 haptics in the capsular bag. Attempts to dislodge the IOL from the capsule proved futile, and it was deemed safer to leave the IOL in that position. Corrected distance visual acuity was 6/6 Snellen 1 week postoperatively and remained so at successive visits. The IOL was stable and central with no visible tilt up to 6 months postoperatively.

Refractive Surgical Problem: September consultation #1

Sonia H. Yoo — 2010-09-01

A 39-year-old woman who had bilateral laser in situ keratomileusis (LASIK) 5 months ago presents for poor quality of vision in both eyes. She has no significant systemic history. Before LASIK, the refraction was −5.25 +0.75 × 90 and the corrected distance visual acuity (CDVA) 20/20 in both eyes. The preoperative keratometry (K) readings were 43.50 diopters (D) and 44.37 D in the right eye and 43.62 D and 44.75 D in the left eye. shows the preoperative corneal topography and pachymetry maps. The LASIK procedure was performed with a Visx Star S4 excimer laser (Abbott Medical Optics) using a multizone treatment. The profile was 3 ablations of −3.80 D with a 5.0 mm, 5.5 mm, and 6.0 mm optical zone, respectively. The overcorrection led to bilateral loss of CDVA and visual distortions.

September consultation #2

George D. Kymionis — 2010-09-01

In this case, the most important issue to rule out before further surgical intervention is post-LASIK corneal ectasia. The refraction went from −5.25 +0.75 × 90 in both eyes preoperatively to +6.50 D in the right eye and +7.00 D in the left eye postoperatively. Furthermore, the K values of both corneas decreased by approximately 10.00 D. The refractive and K values show that the ablation in both corneas was to correct approximately −10.00 to −12.00 D. The risk for post-LASIK ectasia in such cases is significant because the attempted correction exceeded 10.00 D (despite the small ablation zones and depth). This patient should be followed for at least 12 months after the refractive surgery to evaluate possible changes in corneal topography, UDVA, and CDVA to rule out ectasia or regression. In addition, anterior segment optical coherence tomography (AS OCT) imaging could provide information about flap thickness and residual corneal bed thickness; these 2 anatomic parameters offer additional clinical data (risk factors) for the evaluation of possible corneal ectasia.

September consultation #3

Samir Melki — 2010-09-01

In this case, inadvertent overcorrection after myopic LASIK led to a significant hyperopic result. The visual rehabilitation of this patient has to address the CDVA as well as the UDVA.

September consultation #4

J. Bradley Randleman — 2010-09-01

A laser programming error that grossly overtreated the central cornea leaves this patient with 2 compounded problems: induced high hyperopia and a small central optical zone. High hyperopia limits the surgical alternatives, and the small optical zone will compromise visual quality after any individual surgical treatment; therefore, the best outcome will likely require a combination of treatment modalities to attain best uncorrected acuity.

September consultation #5

Jimmy K. Lee — 2010-09-01

Not only was this patient overcorrected, the postoperative topographic maps show that the treatment was decentered (temporally) in both eyes. Primary hyperopic correction of more than 5.00 or 6.00 D with conventional or custom wavefront LASIK, PRK, laser-assisted subepithelial keratectomy, or conductive keratoplasty is very difficult to treat without regression. Although wavefront-guided retreatment for consecutive hyperopia after primary myopic treatment has been reported, most patients had low preoperative hyperopia (range 0.50 to 1.50 D).

September consultation #6

Shachar Tauber — 2010-09-01

In this unfortunate situation, this 39-year-old woman has marked overcorrection, visual distortions, and a loss of CDVA after bilateral LASIK for a rather routine refractive error. Although the question posed regards treatment, several points have to be raised about the initial LASIK.

September consultation #7

David C. Ritterband — 2010-09-01

This patient with poor-quality vision after myopic LASIK requires careful handling because of the poor refractive outcome. She has become a consecutive hyperope with a large overcorrection in both eyes. The multizone ablation as described is not capable of being performed in the United States with a Visx Star S4 laser. Myopic corrections of less than 6.00 D with this laser are usually 1 zone with a blend in the United States. I admit I am unfamiliar with a 3-zone ablation profile as described.

September consultation #8

Volkan Hurmeric — 2010-09-01

This is a very rare complication of excimer laser surgery, with reports consisting of a few case reports of data-entry errors resulting from entering an incorrect sign or using the information of another patient. In this patient, the ablation was planned to achieve a multiple optical zone; however, incorrect preoperative data entry resulted in excessive ablation and an extremely frustrating refractive outcome. The postoperative corneal topography shows a small optical zone and extremely flat corneal center.

Differentiating transient and permanent negative dysphotopsia

Robert H. Osher — 2010-09-01

I would like to comment on the case report about negative dysphotopsia by Cooke. Since the entire argument is based on an article by me, I feel compelled to point out that the author's cardinal premise is incorrect.

Reply: Differentiating transient and permanent negative dysphotopsia

David L. Cooke — 2010-09-01

I appreciate Osher's research and the contribution he has made to our understanding of this rather perplexing issue. In my case report, I intended to make a distinction between transient and permanent symptoms by stating, “Osher divided symptomatic patients by how long the symptoms lasted—short term or long term.” Later, I stated, “He divided his findings into those with short-term symptoms and long-term symptoms.”

Optical phenomena causing negative dysphotopsia

Seshubabu Gosala — 2010-09-01

In his article, Cooke rightly ruled out temporal incisions and other purported causes as a source of negative dysphotopsia. The association of unique anatomic predisposition resulting in prominent globes, dark irides, blue irides is incidental and cannot be implicated as a cause as these features are found in persons who have not had cataract surgery. What differentiates persons with negative dysphotopsia from normal persons is cataract surgery. Since the superior temporal incisions are also associated with such experiences, one must try to understand the comment “by putting hands to the side of each eye, the shadow went away” in terms of optical phenomena.

Reply: Optical phenomena causing negative dysphotopsia

David L. Cooke — 2010-09-01

Gosala presents an interesting concept that negative dysphotopsia might represent negative afterimages. In the Science article that Gosala cites, subjects fixated on and were adapted for 20 seconds to an image. They then observed the afterimages on a blank screen in a semidark room. Negative afterimages typically occur after the stimulus is removed. Curiously, the opposite occurred in the patient in my case report. He did not have an adaptation period followed by an image. The image was constant until he put his hands to the side of each eye, presumably blocking the stimulus.

Negative dysphotopsia with spherical intraocular lenses

Michael Wei, Dan Brettell, Gaurav Bhardwaj, Ian C. Francis — 2010-09-01

We congratulate Cooke on the resolution of his patient's dysphotopsia symptomatology following bilateral intraocular lens (IOL) exchange using a temporal clear corneal incision. As erstwhile scholars of Latin, we would also like to point out that unless the patient had the probably unique, or at least highly unusual, symptom of an isolated episode of abnormal visual phenomena, the correct word should be the plural of the first declension word (of both Greek and Latin origin); that is, dysphotopsiae.

Comments on lift and crack technique for risky cataract cases

Sagar Bhargava, Mona Bhargava — 2010-09-01

We have some observations about the lift and crack technique described by Cakir and Utine. In our practice at a tertiary center in eastern India, almost 20% of the cataracts are brunescent or black cataracts. We do not think the lift and crack technique is very useful in these cases for the following reasons: (1) This technique advocates through and through division of nucleus which may not be possible because of the thickness as well as the physical properties of brunescent cataracts. (2) The attempt to perform this maneuver may lead to sudden instability and turbulence of the cataract in the anterior chamber. (3) The endothelial cell loss rate after emulsification of a hard cataract is high, and mechanical contact with the nuclear fragments is a principal risk factor for endothelial injury. This is a primary concern with this technique, which advocates a crack in the pupillary plane; subsequent control of the movement of nucleus pieces will not be as good as in endocapsular phacoemulsification. Endothelial contact with nuclear fragments can be minimized by performing endocapsular phacoemulsification.

Lift and crack technique for phacoemulsification

Gianluca Carifi, Bruno Zuberbuhler — 2010-09-01

We were not able to extract clear indications to implement the lift and crack technique in our practice. Cakir and Utine did not indicate the appropriate cataract density for their technique. We imagine they would use the technique for cataracts that would have required extracapsular cataract extraction (ECCE). We are skeptical about using this technique in cases of zonule weakness in the absence of a clear definition of the degree of instability, as selection of a technique should be based on the degree of zonular dialysis.

Reply: Comments on lift and crack technique for risky cataract cases & Lift and crack technique for phacoemulsification

Hanefi Cakir, Canan Asli Utine — 2010-09-01

We appreciate Bhargava and Bhargava and Carifi and Zuberbuhler's comments about the lift and crack technique we described for risky cataract cases. We agree with Bhargava and Bhargava that this technique was not defined for brunescent or black cataracts but rather for grade III to IV dense cataracts, which can be horizontally chopped and cracked. A through-and-through division of the nucleus is not always necessary in this technique, but segmentation into smaller triangular nuclear pieces is aimed for, similar to the technique shown in Bhargava and Bhargava's Figure 1. On the other hand, we believe that in situ chops with lateral separation would jeopardize the capsule integrity in the presence of incomplete capsulorhexis and/or zonular instability, particularly in brunescent cataracts. We also agree that a dense nucleus piece that is not held appropriately with high vacuum and phacoemulsified quickly can cause both endothelial injury and capsule tear because of sudden instability and turbulence in the anterior chamber. For this reason, we recommend using the high vacuum of the phaco tip to grasp the nucleus at the center rather than peripherally so the vector forces are not inadvertently distributed to other areas of the nucleus. To minimize the endothelial cell loss, we do not recommend phacoemulsification in the anterior chamber but at the pupillary plane, particularly when endocapsular phacoemulsification would be risky because of incomplete capsulorhexis or zonular instability.

Usefulness of hydroimplantation technique for foldable IOL implantation

Peter Bohm — 2010-09-01

The hydroimplantation technique for inserting a foldable intraocular lens (IOL) without an ophthalmic viscosurgical device (OVD) described by Tak is, in my opinion, effective and safe. I use the irrigation cannula of the bimanual irrigation/aspiration device not only during implantation, but also in other situations that occur during cataract surgery. First, after I create 2 standard paracenteses, I find it useful to introduce an irrigating cannula into the eye through the left paracentesis to allow stability and positioning of the eye during a clear corneal incision. I then fill the anterior chamber with OVD but keep the irrigating cannula in the anterior chamber, which enables me to stabilize the eye during a continuous curvilinear capsulorhexis. It also allows me to add balanced salt solution to the anterior chamber by the foot pedal–driven irrigation mode in case I have to distend the anterior chamber or the eye is too soft during the procedure.

Erratum

2010-09-01

In the article “First Clinical Results of Epithelial Laser In Situ Keratomileusis With a 1000 Hz Excimer Laser” (J Cataract Refract Surg 2010; 36:449–455), the authors' claim that the paper presented the first clinical results of 1000 Hz excimer laser refractive surgery was intended to refer specifically to the Wavelight Concept 1000 Hz system. The trade name of the laser was removed from portions of the text during the editorial process and led to the unintended impression that the claim necessarily encompassed all 1000 Hz systems.

Editorial Board

2010-09-01

Masthead

2010-09-01

Visual Acuity Chart

2010-09-01

Journal of Cataract & Refractive Surgery

Intraocular lens calculations: Call for more deterministic models

Optic capture in the anterior capsulorhexis during combined cataract and vitreoretinal surgery

Microwash or macrowash technique to maintain a clear cornea during cataract surgery

Intraocular lens power calculation after myopic excimer laser surgery: Clinical comparison of published methods

Evaluation of intraocular lens power prediction methods using the American Society of Cataract and Refractive Surgeons Post-Keratorefractive Intraocular Lens Power Calculator

Precision of biometry, keratometry, and refractive measurements with a partial coherence interferometry–keratometry device

Analysis of biometry and prevalence data for corneal astigmatism in 23 239 eyes

Anterior chamber phakic intraocular lens implantation in children to treat severe anisometropic myopia and amblyopia: 3-year clinical results

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes

Aqueous penetration of moxifloxacin 0.5% ophthalmic solution and besifloxacin 0.6% ophthalmic suspension in cataract surgery patients

Transconjunctival single-plane sclerocorneal incisions versus clear corneal incisions in cataract surgery

Visual outcomes after implantation of a refractive multifocal intraocular lens with a +3.00 D addition

Intraocular stability of an angle-supported phakic intraocular lens with changes in pupil diameter

Rotational and centration stability of an aspheric intraocular lens with a simulated toric design

Reproducibility of intraocular lens decentration and tilt measurement using a clinical Purkinje meter

Ocular aberrations and visual performance with an aspheric single-piece intraocular lens: Contralateral comparative study

Central corneal thickness measurements after myopic photorefractive keratectomy using Scheimpflug imaging, scanning-slit topography, and ultrasonic pachymetry

Comparison of simulated keratometric changes induced by custom and conventional laser in situ keratomileusis after myopic ablation: Retrospective chart review

Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: Prospective randomized clinical trial

Modification and refinement of astigmatism in keratoconic eyes with intrastromal corneal ring segments

Surface roughness of intraocular lenses with different dioptric powers assessed by atomic force microscopy

Corneal shaping and ablation of transparent media by femtosecond pulses in deep ultraviolet range

Emerging antibiotic resistance in ocular infections and the role of fluoroquinolones

Visually significant haze after retreatment with photorefractive keratectomy with mitomycin-C following laser in situ keratomileusis

Long-term follow-up of first-generation posterior chamber phakic intraocular lens

Clinicopathologic correlation of capsulorhexis phimosis with anterior flexing of single-piece hydrophilic acrylic intraocular lens haptics

Secondary pigment dispersion syndrome with single-piece acrylic IOL

Anterior capsular entrapment in an equatorial crack formed during injection of hydrophilic acrylic intraocular lens

Refractive Surgical Problem: September consultation #1

September consultation #2

September consultation #3

September consultation #4

September consultation #5

September consultation #6

September consultation #7

September consultation #8

Differentiating transient and permanent negative dysphotopsia

Reply: Differentiating transient and permanent negative dysphotopsia

Optical phenomena causing negative dysphotopsia

Reply: Optical phenomena causing negative dysphotopsia

Negative dysphotopsia with spherical intraocular lenses

Comments on lift and crack technique for risky cataract cases

Lift and crack technique for phacoemulsification

Reply: Comments on lift and crack technique for risky cataract cases & Lift and crack technique for phacoemulsification

Usefulness of hydroimplantation technique for foldable IOL implantation

Erratum

Editorial Board

Table of Contents

Masthead

Visual Acuity Chart