1: J Cataract Refract Surg. 2012 Jan 30; [Epub ahead of print] 

Bilateral delayed nonpupillary block angle closure after insertion of phakic
intraocular lens.

Chai J, Angunawela RI, Perera S, Tan D.

Publication Types:
    LETTER

PMID: 22296844  [PubMed - as supplied by publisher]

2: J Cataract Refract Surg. 2012 Jan 30; [Epub ahead of print] 

Combined Descemet-stripping automated endothelial keratoplasty and
phacoemulsification with toric intraocular lens implantation for treatment of
failed penetrating keratoplasty with high regular astigmatism.

Scorcia V, Lucisano A, Beltz J, Busin M.

From the Department of Ophthalmology (Scorcia, Lucisano, Busin), Magna Graecia
University, Catanzaro and the Department of Ophthalmology (Beltz, Busin), Villa
Igea Hospital, Forli, Italy.

We present the case of a 57-year-old woman who had combined Descemet-stripping
automated endothelial keratoplasty (DSAEK) and phacoemulsification with
implantation of a toric intraocular lens (IOL). Surgery was intended to treat a
cataract developing in a post-penetrating keratoplasty (PKP) eye with high
astigmatism and endothelial decompensation. Six months after uneventful surgery,
the cornea was clear and the corrected distance visual acuity was 20/20 with a
refraction of +0.25 -1.00 x 10 (from -3.00 -8.50 x 12 preoperatively). The
internal topography map (OPD-Scan) showed an IOL rotation of 4 degrees. The
endothelial cell loss was 15% of the eye-bank value. Descemet-stripping
automated endothelial keratoplasty combined with phacoemulsification and toric
IOL implantation is a relatively simple and very effective procedure for eyes
with endothelial failure and high post-PKP astigmatism. The speed of visual
rehabilitation and final visual acuity achieved with this approach was superior
to that obtained with other surgical procedures. FINANCIAL DISCLOSURE: Dr. Busin
received royalties from Moria in 2008, 2009, and 2010, and his travel expenses
were partly reimbursed by Moria from 2005 to 2011. No other author has a
financial or proprietary interest in any material or method mentioned. Copyright
(c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22296843  [PubMed - as supplied by publisher]

3: J Cataract Refract Surg. 2012 Jan 30; [Epub ahead of print] 

Matched comparison of rotational stability of 1-piece acrylic and plate-haptic
silicone toric intraocular lenses in Asian eyes.

Chua WH, Yuen LH, Chua J, Teh G, Hill WE.

From Singapore National Eye Centre (W-H. Chua, Yuen, J. Chua, Teh), Singapore;
East Valley Ophthalmology (Hill), Mesa, Arizona, USA.

PURPOSE: To evaluate and compare the postoperative rotational stability of a
1-piece acrylic toric intraocular lens (IOL) (Acrysof) and a plate-haptic
silicone toric IOL (Staar) in Asian eyes. SETTING: Singapore National Eye
Centre, Singapore. DESIGN: Prospective randomized control trial. METHODS: Eyes
of Chinese patients having cataract surgery were randomized to receive the
acrylic toric IOL or the silicone toric IOL. Postoperatively, patients returned
at 1 day, 1 week, and 1 and 3 months. The eyes were dilated and slitlamp
retroillumination photography of the toric IOL was performed to assess
rotational stability. RESULTS: The acrylic IOL was implanted in 24 eyes and the
silicone IOL in 26 eyes. The mean age of the patients was 68.2 years (range 42
to 82 years). The mean IOL rotation from baseline to 3 months postoperatively
was 4.23 +/- 4.28 degrees in the acrylic IOL group and 9.42 +/- 7.80 degrees in
the silicone IOL group; the difference was statistically significant (P=.01). Of
the acrylic IOLs, 73% were rotated less than 5 degrees at 3 months; none was
rotated more than 15 degrees at 3 months. The silicone toric IOLs showed greater
rotational movement, with 37% being rotated less than 5 degrees and 21% being
rotated more than 15 degrees. CONCLUSION: The acrylic toric IOL had better
rotational stability than the silicone toric IOL. FINANCIAL DISCLOSURE: No
author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22296842  [PubMed - as supplied by publisher]

4: J Cataract Refract Surg. 2012 Jan 25; [Epub ahead of print] 

Outcomes of cataract surgery in patients with neovascular age-related macular
degeneration in the era of anti-vascular endothelial growth factor therapy.

Tabandeh H, Chaudhry NA, Boyer DS, Kon-Jara VA, Flynn HW Jr.

From Retina Vitreous Associates Medical Group (Tabandeh, Boyer), Beverly Hills,
California, New England Retina Associates (Chaudhry, Kon-Jara), New London,
Connecticut, and Bascom Palmer Eye Institute (Flynn), Miami, Florida, USA.

PURPOSE: To evaluate the visual outcomes, choroidal neovascular complex status,
and adverse events in patients with visually significant cataract and
neovascular age-related macular degeneration (AMD) who had cataract surgery.
SETTING: Private practices, Beverly Hills, California, and New London,
Connecticut, USA. DESIGN: Case series. METHODS: Data were abstracted from the
medical records of patients with neovascular AMD treated by anti-vascular
endothelial growth factor (anti-VEGF) therapy who had cataract surgery. The main
outcome measures were Snellen corrected distance visual acuity (CDVA),
perioperative adverse events, and status of the choroidal neovascular complex.
RESULTS: The study enrolled 30 eyes of 28 patients. The CDVA was 20/40 or better
in 10% of eyes preoperatively and 40% postoperatively; 20/50 to 20/100 in 53%
and 33%, respectively; and 20/200 or worse in 37% and 27%, respectively. The
change in CDVA from preoperatively to postoperatively was statistically
significant, with a mean change of 0.22 logMAR +/- 0.27 (SD) at 2 months
(P<.0001), 0.22 +/- 0.36 logMAR at 6 months (P=.001), and 0.17 +/- 0.54 logMAR
at the last follow-up (P=.01). Patients received a mean of 0.32 injections per
month postoperatively compared with 0.49 injections per month preoperatively.
Perioperative macular adverse events did not occur in any eye. CONCLUSIONS: With
regular evaluations and appropriate treatment with anti-VEGF agents, cataract
surgery did not appear to be associated with an increased incidence of
perioperative complications or macular adverse events. FINANCIAL DISCLOSURES:
Dr. Tabandeh is a consultant/advisor to Alcon and Allergan. Dr. Boyer is a
consultant/advisor to Alcon, Allergan, Genentech, Regeneron, Novartis, Pfizer,
and Optos and has received lecture fees from Allergan, Alcon, Genentech, and
Pfizer. No other author has a financial or proprietary interest in any material
or method mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier
Inc. All rights reserved.

PMID: 22284725  [PubMed - as supplied by publisher]

5: J Cataract Refract Surg. 2012 Jan 19; [Epub ahead of print] 

Modulation of central corneal thickness by various riboflavin eyedrop
compositions in porcine corneas.

Vetter JM, Brueckner S, Tubic-Grozdanis M, Vossmerbaumer U, Pfeiffer N, Kurz S.

From the Department of Ophthalmology (Vetter, Brueckner, Vossmerbaumer,
Pfeiffer, Kurz) and the Department of Pharmacy (Tubic-Grozdanis), University
Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.

PURPOSE: To evaluate the modulatory effect of various riboflavin 0.1% and 0.2%
compositions on the central corneal thickness (CCT) in fresh porcine corneas.
SETTING: Department of Ophthalmology, Johannes Gutenberg University of Mainz,
Mainz, Germany. DESIGN: Experimental study. METHODS: The CCT in freshly
enucleated porcine globes was measured by ultrasound pachymetry before and after
(if applicable) deepithelialization and every 10 minutes thereafter during 120
minutes of eyedrop application. In Groups 1 and 2 (controls), no eyedrops were
applied. In Groups 3 and 4, isotonic riboflavin eyedrops were used. In Groups 5
to 9, hypotonic riboflavin eyedrops were given. In Groups 10 and 11,
preparations for transepithelial crosslinking were applied. In Groups 2 to 9,
deepithelialization was performed. The final CCT in the groups was compared by
analysis of variance. RESULTS: One hundred ten freshly enucleated porcine globes
were used. The mean final CCT compared with preoperative values was 97% +/- 4%
(SD) in Group 1, 91% +/- 4% in Group 2, 66% +/- 5% in Group 3, 151% +/- 13% in
Group 4, 65% +/- 2% in Group 5, 105% +/- 3% in Group 6, 120% +/- 4% in Group 7,
130% +/- 4% in Group 8, 132% +/- 4% in Group 9, 114% +/- 2% in Group 10, and
114% +/- 4% in Group 11. The differences between Group 1 and each of Groups 3,
4, 5, 7, 8, and 9 were statistically significant (P<.05). CONCLUSION: There was
considerable variation in the final CCT as a result of varying riboflavin
eyedrop compositions. FINANCIAL DISCLOSURE: No author has a financial or
proprietary interest in any material or method mentioned. Copyright (c) 2012
ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22265425  [PubMed - as supplied by publisher]

6: J Cataract Refract Surg. 2012 Jan 19; [Epub ahead of print] 

Complications of inadvertent filtering blebs after cataract extraction.

Johnson SM, Pike EC, Feinstein EG.

From the Department of Ophthalmology (Johnson, Pike), University of Virginia
Medical Center, and the University of Virginia School of Medicine (Feinstein),
Charlottesville, Virginia, USA.

We report 2 cases of inadvertent filtering blebs that developed
vision-threatening complications many years after uneventful cataract extraction
with scleral incisions. These inadvertent blebs can create complications similar
to the intentionally produced blebs from trabeculectomy surgery; thus, follow-up
and management should be handled in a similar manner. FINANCIAL DISCLOSURE: No
author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22265185  [PubMed - as supplied by publisher]

7: J Cataract Refract Surg. 2012 Jan 19; [Epub ahead of print] 

Idiopathic peripheral necrotizing keratitis after femtosecond laser in situ
keratomileusis.

Bucci MG, McCormick GJ.

From the University of Vermont College of Medicine (Bucci), Burlington, and the
Ophthalmic Consultants of Vermont (McCormick), South Burlington, Vermont, USA.

We report a case of necrotizing peripheral keratitis after laser in situ
keratomileusis (LASIK) using the low-energy Femto LDV femtosecond laser in a
31-year-old helicopter pilot with no history of medical or ocular disease. The
severe peripheral flap inflammation resulted in stromal necrosis that was
unresponsive to intensive topical steroid but improved rapidly on oral
prednisone. The uncorrected distance visual acuity was maintained at 20/15 in
both eyes, and the flaps were left undisturbed rather than attempting a more
aggressive intervention such as a flap lift with culture and antibiotic
irrigation. Identification of sterile corneal infiltration must be distinguished
from infectious etiologies as the treatment is distinctly different. Although
increased corneal infiltration has been reported with increasing femtosecond
laser energy level for flap creation, to our knowledge this is the first report
of necrotizing sterile corneal infiltration after LASIK with the low-energy
femtosecond laser. FINANCIAL DISCLOSURE: Neither author has a financial or
proprietary interest in any material or method mentioned. Copyright (c) 2012
ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22265184  [PubMed - as supplied by publisher]

8: J Cataract Refract Surg. 2012 Jan 19; [Epub ahead of print] 

Modified capsular tension ring implantation in eyes with traumatic cataract and
loss of zonular support.

Buttanri IB, Sevim MS, Esen D, Acar BT, Serin D, Acar S.

From Haydarpasa Numune Education and Research Hospital II Eye Clinic, Istanbul,
Turkey.

PURPOSE: To evaluate the outcomes of implantation of a Cionni modified capsular
tension ring (CTR) and a posterior chamber intraocular lens (PC IOL) in patients
with traumatic cataract and loss of zonular support. SETTING: Eye Clinic II,
Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. DESIGN:
Case series. METHODS: Eyes with traumatic cataract and loss of zonular support
had phacoemulsification with implantation of a foldable IOL and a 1- or 2-eyelet
modified CTR. Preoperative features, preoperative and postoperative corrected
distance visual acuity (CDVA), intraoperative performance, IOL position, and
complications were evaluated. RESULTS: The study enrolled 16 eyes (16 patients).
The mean CDVA was 0.89 logMAR +/- 0.41 (SD) preoperatively and 0.33 +/- 0.43
logMAR at the last postoperative examination (P=.001). Postoperatively, the mean
spherical equivalent was -0.23 diopter (D) (range -1.50 to +1.00 D) and the mean
postoperative astigmatism, 1.59 D (range 0.50 to 4.00 D). Eight eyes (50.0%) had
phacodonesis preoperatively; no eye had pseudophacodonesis postoperatively.
Preoperatively, 10 eyes (62.5%) had symptomatic decentration. Two eyes (12.5%)
had asymptomatic nonprogressive decentration in the early postoperative period;
no eye had symptomatic decentration throughout the follow-up. Three eyes (18.8%)
preoperatively and 1 eye (6.2%) postoperatively had vitreous in the anterior
chamber. Four eyes (25.0%) required anterior vitrectomy. Other complications
were symptomatic posterior capsule opacification in 8 eyes (50.0%) and transient
increased intraocular pressure in 2 eyes (12.5%). CONCLUSION: The use of a
modified CTR preserved the capsular bag and resulted in good PC IOL centration
with few significant complications in patients with traumatic cataract and loss
of zonular support. FINANCIAL DISCLOSURE: No author has a financial or
proprietary interest in any material or method mentioned. Copyright (c) 2012
ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22265183  [PubMed - as supplied by publisher]

9: J Cataract Refract Surg. 2012 Jan 18; [Epub ahead of print] 

Patient-perceived pain during laser in situ keratomileusis: Comparison of fellow
eyes.

El Rami H, Fadlallah A, Fahd D, Fahed S.

From Ophthalmic Consultants of Beirut, Lebanese American University, Beirut,
Lebanon.

PURPOSE: To compare pain scores during laser in situ keratomileusis (LASIK)
between first-eye surgery and second-eye surgery. SETTING: Private practice,
Beirut, Lebanon. DESIGN: Cohort study. METHODS: Sequential bilateral LASIK was
performed between January 2010 and January 2011 by the same surgeon using a
Schwind Amaris excimer laser. Hemodynamics and intraocular pressure (IOP) were
monitored intraoperatively. Patients graded their pain perception on a 4-point
scale after the completion of each eye's surgery. RESULTS: The study enrolled
154 patients. The first surgery was performed in the right eye in 106 patients
and in the left eye in 48 patients. Patients reported discomfort during suction
(mean pain score 0.80 +/- 0.56 [SD]). More pain was reported during second-eye
surgery by 74% of patients; 2% reported more pain in the first eye, and 24%
reported equal pain in both eyes. The mean pain score was 0.63 +/- 0.35 in the
first eye and 0.93 +/- 0.51 in the second eye (P=.01). Pain was higher during
second-eye surgery whether the procedure was started in the right eye or in the
left eye. Systolic blood pressure was also higher during second-eye surgery
(P=.001). There was no statistically significant difference in diastolic blood
pressure, heart rate, IOP, or suction-ring pressure. CONCLUSIONS: Patients had
more pain during second-eye LASIK for reasons that are not clear. A
psychological explanation or regional sensitization processes are potential
factors and should be studied. FINANCIAL DISCLOSURE: No author has a financial
or proprietary interest in any material or method mentioned. Copyright (c) 2012
ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22261327  [PubMed - as supplied by publisher]

10: J Cataract Refract Surg. 2012 Jan 18; [Epub ahead of print] 

Topical-intracameral anesthesia without preoperative mydriatic agents for
Descemet-stripping automated endothelial keratoplasty and phacoemulsification
cataract surgery with intraocular lens implantation.

Oberg TJ, Sikder S, Jorgensen AJ, Mifflin MD.

From the John A. Moran Eye Center (Oberg, Jorgensen, Mifflin), University of
Utah Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah, and
the Wilmer Eye Institute (Sikder), Johns Hopkins University, Baltimore,
Maryland, USA.

We describe a technique for a new triple procedure comprising
phacoemulsification and intraocular lens (IOL) implantation followed immediately
by Descemet-stripping automated endothelial keratoplasty (DSAEK). It is
performed under topical anesthesia, with dilation accomplished using
methylparaben-free lidocaine 1% with no added epinephrine. In a case series of
32 patients, adequate dilation was achieved and no patient reported significant
intraoperative discomfort. No operative or postoperative complications were
encountered, and visual rehabilitation was quick and satisfactory. Topical
anesthesia eliminated the risks associated with retrobulbar and peribulbar
blocks, as well as the risks associated with general anesthesia. Intracameral
dilation with preservative-free lidocaine 1% provided adequate and short-lived
dilation, alleviating the need for intraoperative pharmacologic constriction
when transitioning from IOL implantation to DSAEK. FINANCIAL DISCLOSURE: No
author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22261326  [PubMed - as supplied by publisher]

11: J Cataract Refract Surg. 2012 Jan 18; [Epub ahead of print] 

Reliability and repeatability of swept-source Fourier-domain optical coherence
tomography and Scheimpflug imaging in keratoconus.

Szalai E, Berta A, Hassan Z, Modis L Jr.

From the Department of Ophthalmology, University of Debrecen, Medical and Health
Science Center, Debrecen, Hungary.

PURPOSE: To evaluate the repeatability and reliability of a recently introduced
swept-source Fourier-domain anterior segment optical coherence tomography
(AS-OCT) system and a high-resolution Scheimpflug camera and to assess the
agreement between the 2 instruments when measuring healthy eyes and eyes with
keratoconus. SETTING: Department of Ophthalmology, Medical and Health Science
Center, University of Debrecen, Debrecen, Hungary. DESIGN: Evaluation of
diagnostic test or technology. METHODS: Three consecutive series of anterior
segment images were taken with AS-OCT (Casia SS-1000) followed by rotating
Scheimpflug imaging (Pentacam high resolution). Axial keratometry in the steep
and flat meridians and astigmatism values were recorded. Pachymetry in the apex,
center, and the thinnest position and anterior chamber depth (ACD) measurements
were also taken. RESULTS: This study enrolled 57 healthy volunteers (57 eyes)
and 56 patients (84 eyes) with keratoconus. Significant difference was found in
all measured anterior segment parameters between normal eyes and keratoconic
eyes (P<.05). In keratoconic eyes, the difference between repeated measurements
was less with AS-OCT than with Scheimpflug imaging in every keratometry and
astigmatism value, in apical thickness, and in ACD. For keratometry, the
thinnest and central pachymetry measurement repeatability was better in healthy
eyes than in keratoconic eyes with both instruments. In general, the mean
difference between AS-OCT and Scheimpflug imaging was higher in cases of
keratoconus. CONCLUSIONS: Significant differences in keratometry, pachymetry,
and ACD results were found between AS-OCT and Scheimpflug imaging. However, the
repeatability of the measurements was comparable. FINANCIAL DISCLOSURE: No
author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22261325  [PubMed - as supplied by publisher]

12: J Cataract Refract Surg. 2012 Jan 18; [Epub ahead of print] 

Collagen crosslinking and toric iris-claw phakic intraocular lens for myopic
astigmatism in progressive mild to moderate keratoconus.

Guell JL, Morral M, Malecaze F, Gris O, Elies D, Manero F.

From Instituto Microcirugia Ocular (Guell, Morral, Gris, Elies, Manero),
Universitat Autonoma de Barcelona (Guell), and the Department of Cornea and
Anterior Segment Diseases and Department of Refractive Surgery (Morral),
Institut Clinic d'Oftalmologia, Hospital Clinic i Provincial, Barcelona, Spain;
Purpan Hospital and the Centre de Physiopathologie Toulouse Purpan (Malecaze),
Institut National de la Sante et de la Recherche Medicale, Toulouse, France.

PURPOSE: To report the long-term results of combined collagen crosslinking (CXL)
and toric phakic intraocular lens (pIOL) implantation to correct myopic
astigmatism in patients with progressive mild to moderate keratoconus. SETTING:
Instituto de Microcirugia Ocular, Barcelona, Spain. DESIGN: Case series.
METHODS: From November 2006 to July 2009, CXL was performed in eyes with proven
progressive keratoconus. Once refraction and topography stabilized, toric
Artiflex/Artisan pIOL implantation was performed to correct residual myopic
astigmatism. A complete ophthalmologic examination, including manifest
refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities,
biomicroscopy, tonometry, fundoscopy, keratometry, corneal tomography, and
central endothelial cell count (ECC), was performed before each procedure and
postoperatively at 3 months and at yearly intervals up to 5 years. Main outcome
measures were accuracy and stability of the spherical equivalent (SE) and
cylinder, keratometry, UDVA (efficacy), CDVA (safety), central ECC, and
complications. RESULTS: The median follow-up in the 9 patients (17 eyes) was
36.9 months +/- 15.0 (SD). The median interval between CXL and pIOL implantation
was 3.9 +/- 0.7 months. Fourteen eyes (82%) were within +/-0.50 diopter (D) of
the attempted SE correction and 13 eyes (76%) were within +/-1.00 D of the
attempted cylinder correction. The mean difference in simulated keratometry
between preoperatively and the last follow-up was 0.17 +/- 0.45 D (range -0.55
to 1.45 D). The postoperative UDVA was 20/40 or better in 16 eyes (94%). No eye
lost lines of CDVA. No significant decrease in central ECC occurred (P>.05).
CONCLUSION: Combined CXL and toric iris-claw pIOL implantation effectively and
safely corrected myopic astigmatism in progressive mild to moderate keratoconus.
FINANCIAL DISCLOSURE: Dr. Guell is a consultant to Ophtec. No other author has a
financial or proprietary interest in any material or methods mentioned.
Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights
reserved.

PMID: 22261324  [PubMed - as supplied by publisher]

13: J Cataract Refract Surg. 2012 Jan 14; [Epub ahead of print] 

Long-term visual outcome after cataract surgery: Comparison of healthy eyes and
eyes with age-related macular degeneration.

Monestam E, Lundqvist B.

From the Department of Clinical Sciences/Ophthalmology, Faculty of Medicine,
Norrlands University Hospital, Umea University, Umea, Sweden.

PURPOSE: To compare the long-term longitudinal visual acuity outcomes after
cataract surgery in eyes with age-related macular degeneration (AMD) at surgery
and eyes without comorbidity. SETTING: University-based eye clinic. DESIGN:
Longitudinal cohort study. METHODS: Patients having cataract surgery were
evaluated over 1 year. A clinical eye examination and corrected distance visual
acuity (CDVA) measurement were performed preoperatively and postoperatively as
well as 5 and 10 years postoperatively for eligible patients. The patients were
divided into functional groups depending on postoperative signs of macular
degeneration and postoperative CDVA. RESULTS: The study evaluated 810 patients.
The rate of CDVA decline with age was faster in AMD patients than in patients
without comorbidity. The slope of the visual acuity decline was similar in the 2
subgroups with AMD (almost normal CDVA and reduced CDVA postoperatively). After
adjustment for age, there was a mean loss of 2.3 logMAR letters in patients with
no comorbidity and 6.4 letters in patients with AMD at surgery for each decade
of increasing age. More than 75% of AMD patients had better CDVA 10 years after
surgery than before surgery. CONCLUSIONS: Patients with signs of AMD at cataract
surgery had a longitudinally worse visual outcome than patients without clinical
signs of AMD. However, there is no reason to discourage patients with concurrent
visually significant cataract and AMD from having surgery because most AMD
patients had better CDVA 10 years after surgery than before surgery. FINANCIAL
DISCLOSURE: Neither author has a financial or proprietary interest in any
material or method mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by
Elsevier Inc. All rights reserved.

PMID: 22245170  [PubMed - as supplied by publisher]

14: J Cataract Refract Surg. 2012 Jan 14; [Epub ahead of print] 

Epidemiology of postoperative endophthalmitis in an Asian population: 11-year
incidence and effect of intracameral antibiotic agents.

Tan CS, Wong HK, Yang FP.

From the Department of Ophthalmology, Tan Tock Seng Hospital, and the National
Healthcare Group Eye Institute, Singapore.

PURPOSE: To describe the incidence of postoperative endophthalmitis after
cataract surgery in a multiethnic Asian population over an 11-year period,
compare the endophthalmitis rates before and after the use of intracameral
antibiotic agents, and identify potential risk factors for endophthalmitis.
SETTING: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. DESIGN:
Cohort study. METHODS: The incidence and risk factors for postoperative
endophthalmitis in patients who had cataract surgery over 11 years were
reviewed. Subconjunctival antibiotic agents only were administered over 7 years;
in the subsequent 4 years, intracameral cefazolin (1.0 mg/0.1 mL) was used.
RESULTS: The overall incidence of postoperative endophthalmitis in 50 177 was
0.042%. Over the 7 years without intracameral antibiotics, the endophthalmitis
rate was 0.064% (19/29 539). With the use of intracameral cefazolin, the
incidence decreased to 0.01% (2/20 638) (multivariate odds ratio [OR], 13.6; 95%
confidence interval [CI], 3.15-58.58; P<.001). The independent risk factors for
endophthalmitis were age (OR, 1.05; 95% CI, 1.01-1.09; P=.025) and male sex
(0.06% versus 0.02%; OR, 2.96; 95% CI; 1.15-7.65; P=.025). CONCLUSIONS: There
was a significant reduction in the rate of postoperative endophthalmitis in a
multiethnic Asian population with the use of intracameral cefazolin. Men and
older patients were at a higher risk for endophthalmitis. FINANCIAL DISCLOSURE:
No author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22245169  [PubMed - as supplied by publisher]

15: J Cataract Refract Surg. 2012 Jan 14; [Epub ahead of print] 

Effect of topical anesthetic agents and ethanol on corneoepithelial wound
healing in an ex vivo whole-globe porcine model.

Tappeiner C, Flueckiger F, Boehnke M, Goldblum D, Garweg JG.

From the Department of Ophthalmology (Tappeiner), Inselspital, and the Swiss Eye
Institute (Garweg), University of Bern, Bern, the Department of Ophthalmology
(Goldblum), University Hospital Basel, University Basel, Basel, and the
Institute of Virology and Immunoprophylaxis (Flueckiger), Mittelhaeusern,
Switzerland; the Institute of Ophthalmology (Boehnke), Rothenbaumchaussee,
Hamburg, Germany.

PURPOSE: To assess the impact of topical anesthetic agents and ethanol on ocular
surface wound healing using an ex vivo whole-globe porcine model. SETTING:
Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
DESIGN: Experimental study. METHODS: Standardized corneoepithelial lesions (5.0
mm diameter, 40 mum depth) were created with excimer laser light in freshly
enucleated porcine eyes. The globes (6 per group) were exposed to different
concentrations of ethanol (2.0% to 99.0%), cocaine (2.0% to 10.0%), procaine
hydrochloride (0.4%), tetracaine (0.5% to 1.0%), or lidocaine (2.0%), 3
drops/hour for 3 hours. Control solutions were physiologic saline, balanced salt
solution, and tissue-culture medium. After 20 to 26 hours, wound-healing
response was compared by measuring the diameter of each corneoepithelial lesion.
RESULTS: The mean diameter of corneoepithelial lesions exposed to physiologic
saline decreased from 4.78 mm +/- 0.19 (SD) to 4.44 +/- 0.17 mm between 20 and
26 hours. After 24 hours, the mean lesion size, compared with physiological
saline, was larger after cocaine 5.0% (5.20 +/- 0.26 mm) and 10.0% (5.39 +/-
0.12 mm), tetracaine 0.5% (5.59 +/- 0.35 mm) and 1.0% (5.55 +/- 0.27 mm), and
procaine hydrochloride 0.4% (5.76 +/- 0.12 mm), but not after lidocaine 2.0%
(5.01 +/- 0.17 mm). Balanced salt solution, tissue-culture medium, ethanol 2.0%
to 99.0%, and cocaine 2.0% did not inhibit the wound-healing response.
CONCLUSIONS: In an ex vivo whole-globe porcine model, lidocaine 2.0% and cocaine
2.0% were the least toxic anesthetic agents. At all concentrations, ethanol had
no impact on wound healing. FINANCIAL DISCLOSURE: No author has a financial or
proprietary interest in any material or method mentioned. Copyright (c) 2012
ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

PMID: 22245168  [PubMed - as supplied by publisher]

16: J Cataract Refract Surg. 2012 Jan 11; [Epub ahead of print] 

Results of laser in situ keratomileusis performed using solid-state laser
technology.

Pinero DP, Perez-Cambrodi RJ, Gomez-Hurtado A, Blanes-Mompo FJ,
Alzamora-Rodriguez A.

From Alicante Oftalmologica, Oftalmar (Pinero, Perez-Cambrodi, Blanes-Mompo,
Alzamora-Rodriguez), Hospital Internacional Medimar, the Foundation for Visual
Quality (Fundacion para la Calidad Visual) (Pinero, Perez-Cambrodi,
Gomez-Hurtado, Blanes-Mompo, Alzamora-Rodriguez), and the Departamento de Optica
(Pinero), Farmacologia y Anatomia, Universidad de Alicante, Alicante, Spain.

PURPOSE: To evaluate and report the visual, refractive, and aberrometry outcomes
of laser in situ keratomileusis (LASIK) to correct low to moderate myopia using
a commercial solid-state laser. SETTING: Oftalmar, Medimar International
Hospital, Alicante, Spain. DESIGN: Prospective case series. METHODS: This study
evaluated consecutive eyes with low to moderate myopia that had LASIK performed
using a Pulzar Z1 solid-state laser. Visual, refractive, and aberrometry changes
as well as potential complications were evaluated. RESULTS: The study enrolled
60 eyes (34 patients). The mean follow-up was 8.5 months (range 6 to 13 months).
There was a significant improvement in logMAR uncorrected distance visual acuity
(UDVA) postoperatively (P<.01). No significant change was detected in logMAR
corrected distance visual acuity (CDVA) (P=.21). The postoperative logMAR UDVA
was 0.1 (approximately 20/25) or better in 57 eyes (95.00%). The mean overall
efficacy index was 0.99 and the mean safety index, 1.02. Postoperatively, 1 eye
(1.67%) lost lines (1 line) of CDVA. The postoperative spherical equivalent was
within +/-0.50 diopter in 58 eyes (96.67%). There was a small, but statistically
significant increase in the primary coma root mean square (0.17 mum) and in the
magnitude of primary spherical aberration (0.09 mum). No severe complications
occurred. CONCLUSION: Laser in situ keratomileusis using the solid-state laser
provided predictable correction of low to moderate myopia, minimizing the
induction of higher-order aberrations and preserving CDVA. FINANCIAL DISCLOSURE:
No author has a financial or proprietary interest in any material or method
mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc. All
rights reserved.

PMID: 22244611  [PubMed - as supplied by publisher]

17: J Cataract Refract Surg. 2012 Jan 11; [Epub ahead of print] 

Using artificial intelligence to predict the risk for posterior capsule
opacification after phacoemulsification.

Mohammadi SF, Sabbaghi M, Z-Mehrjardi H, Hashemi H, Alizadeh S, Majdi M, Taee F.

From the Eye Research Center (Mohammadi, Z-Mehrjardi, Hashemi, Majdi), Farabi
Eye Hospital, the Students' Scientific Research Center (Z-Mehrjardi), and the
Sports Medicine Research Center (Taee), Tehran University of Medical Sciences;
the Faculty of Industrial Engineering (Sabbaghi, Alizadeh), K.N. Toosi
University; and Noor Research Center (Hashemi), Noor Eye Hospital, Tehran, Iran.

PURPOSE: To apply artificial intelligence models to predict the occurrence of
posterior capsule opacification (PCO) after phacoemulsification. SETTING: Farabi
Eye Hospital, Tehran, Iran. DESIGN: Clinical-based cross-sectional study.
METHODS: The posterior capsule status of eyes operated on for age-related
cataract and the need for laser capsulotomy were determined. After a literature
review, data polishing, and expert consultation, 10 input variables were
selected. The QUEST algorithm was used to develop a decision tree. Three
back-propagation artificial neural networks were constructed with 4, 20, and 40
neurons in 2 hidden layers and trained with the same transfer functions
(log-sigmoid and linear transfer) and training protocol with randomly selected
eyes. They were then tested on the remaining eyes and the networks compared for
their performance. Performance indices were used to compare resultant models
with the results of logistic regression analysis. RESULTS: The models were
trained using 282 randomly selected eyes and then tested using 70 eyes. Laser
capsulotomy for clinically significant PCO was indicated or had been performed 2
years postoperatively in 40 eyes. A sample decision tree was produced with
accuracy of 50% (likelihood ratio 0.8). The best artificial neural network,
which showed 87% accuracy and a positive likelihood ratio of 8, was achieved
with 40 neurons. The area under the receiver-operating-characteristic curve was
0.71. In comparison, logistic regression reached accuracy of 80%; however, the
likelihood ratio was not measurable because the sensitivity was zero.
CONCLUSION: A prototype artificial neural network was developed that predicted
posterior capsule status (requiring capsulotomy) with reasonable accuracy.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any
material or method mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by
Elsevier Inc. All rights reserved.

PMID: 22244610  [PubMed - as supplied by publisher]

18: J Cataract Refract Surg. 2012 Jan 11; [Epub ahead of print] 

Serious ocular complications of cosmetic iris implants in 14 eyes.

Hoguet A, Ritterband D, Koplin R, Wu E, Raviv T, Aljian J, Seedor J.

From the Department of Ophthalmology, New York Eye and Ear Infirmary, and New
York Medical College, Valhalla, New York, USA.

PURPOSE: To report the presentation and subsequent management of a series of
patients presenting with cosmetic iris implants. SETTING: New York Eye and Ear
Infirmary, New York, New York, USA. DESIGN: Case series. METHODS: In this
evaluation of patients with NewColorIris cosmetic iris implants, data collected
included patient demographics, visual acuity, intraocular pressure (IOP),
endothelial cell count, and slitlamp examination findings at presentation.
Medical and surgical interventions and the postoperative course were recorded.
RESULTS: Fourteen eyes of 7 patients (ages 22 to 60; 71% men) were identified.
Nine eyes (64%) presented with decreased visual acuity, 7 (50%) had elevated
IOP, 5 (36%) had corneal edema, and 5 (36%) had anterior uveitis. All 14 eyes
had explantation of the iris prosthesis (range 4 to 33 months after placement).
The minimum follow-up after implant removal in all eyes was 2 months (range 2 to
28 months). Intraoperative complications included suprachoroidal hemorrhage
during explantation in 1 eye. Postoperative complications included corneal edema
(8 eyes), cataract (9 eyes), and increased IOP/glaucoma (7 eyes). Secondary
surgeries included Descemet-stripping automated endothelial keratoplasty (5
eyes), cataract extraction with intraocular lens placement (7 eyes),
trabeculectomy (3 eyes), glaucoma drainage implant placement (3 eyes), and
penetrating keratoplasty (1 eye). CONCLUSIONS: The cosmetic iris implants may
result in severe ocular morbidity. Complications in our series included uveitis,
glaucoma, corneal edema, and decreased visual acuity. Although explantation
helped stabilize symptoms, additional medical and surgical intervention to
control IOP and corneal decompensation was required in many cases. FINANCIAL
DISCLOSURE: No author has a financial or proprietary interest in any material or
method mentioned. Copyright (c) 2012 ASCRS and ESCRS. Published by Elsevier Inc.
All rights reserved.

PMID: 22244609  [PubMed - as supplied by publisher]