1: J Cataract Refract Surg. 2009 Apr;35(4):792. 

Pilot study and functional results following implantation of the M-flex 630F
multifocal intraocular lens.

Aslam SA, Kashani S, Jones E, Claoue C.

Publication Types:
    Letter

PMID: 19304110 [PubMed - in process]

2: J Cataract Refract Surg. 2009 Apr;35(4):792-4. 

Stiles-Crawford effect revisited: considerations for refractive surgery.

Brown SM.

Publication Types:
    Letter

PMID: 19304109 [PubMed - in process]

3: J Cataract Refract Surg. 2009 Apr;35(4):788-91. 

Acanthamoeba keratitis with perforation after corneal crosslinking and bandage
contact lens use.

Rama P, Di Matteo F, Matuska S, Paganoni G, Spinelli A.

Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy.
rama.paolo@hsr.it

A 32-year-old man with keratoconus developed corneal melting 5 days after
riboflavin/ultraviolet-A corneal collagen crosslinking (CXL). Corneal scraping
was positive for Acanthamoeba. The patient was unaware that he was wearing a
bandage contact lens and repeatedly rinsed his face and eyelids with tap water.
Because of corneal perforation, a large therapeutic keratoplasty a chaud was
performed. Although CXL is considered a safe procedure, this case emphasizes the
potential risks. We discuss the potential effects of deepithelialization,
contact lens placement, instillation of topical nonsteroidal antiinflammatory
drugs and anesthetic agents, and the possible role of apoptosis when performing
CXL treatment for keratoconus.

PMID: 19304108 [PubMed - in process]

4: J Cataract Refract Surg. 2009 Apr;35(4):785-7. 

Bilateral Salzmann-like nodular corneal degeneration after laser in situ
keratomileusis imaged with anterior segment optical coherence tomography and
high-frequency ultrasound biomicroscopy.

VanderBeek BL, Silverman RH, Starr CE.

Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New
York 10021, USA. brian.vanderbeek@yahoo.com

Examination of a 34-year-old patient 7 years after laser in situ keratomileusis
(LASIK) showed Salzmann-like nodules in both eyes, causing irregular astigmatism
and decreased visual acuity. Two new imaging modalities were used to demonstrate
the characteristics of this complication. Anterior segment optical coherence
tomography (OCT) (Visante) scans showed hyperreflective nodules that varied in
thickness from 0.35 mm to 0.56 mm. High-frequency ultrasound biomicroscopy
illustrated the destruction of Bowman layer underlying these lesions. Both
modalities demonstrated nodules as hyperreflective material covered by an
abnormally thin layer of epithelium. Salzmann-like nodular degeneration is a
rare but possible cause of decreased visual acuity and irregular astigmatism
after LASIK surgery. Ultrasound biomicroscopy and OCT can demonstrate many of
the established histopathologic findings in vivo.

PMID: 19304107 [PubMed - in process]

5: J Cataract Refract Surg. 2009 Apr;35(4):782-4. 

Anterior segment optical coherence tomography-aided diagnosis and primary
posterior chamber intraocular lens implantation with fibrin glue in traumatic
phacocele with scleral perforation.

Prakash G, Ashokumar D, Jacob S, Kumar KS, Agarwal A, Agarwal A.

Dr. Agarwal\'s Eye Hospital and Eye Research Centre, Chennai, India.

We describe the case of a middle-aged woman who presented to us after injury
from a clenched fist 3 days previously. The diagnosis was occult scleral
perforation, severe conjunctival chemosis, and traumatic aphakia. However, the
lens could not be localized during posterior segment examination. An anterior
segment optical coherence tomography (AS-OCT) examination showed scleral
discontinuity and a heterogeneous reflection in the subconjunctival area,
suggesting a possible phacocele. Surgical exploration confirmed these findings.
Aphakia was managed using the "glued intraocular lens" technique in the same
sitting. This case highlights the use of AS-OCT in noncontact exploration of the
traumatized anterior segment and in diagnosis of a possible phacocele along with
an occult scleral perforation with uveal prolapse. To our knowledge, this is the
first report of successful implantation of a glued IOL as a primary procedure
combined with scleral perforation repair.

PMID: 19304106 [PubMed - in process]

6: J Cataract Refract Surg. 2009 Apr;35(4):778-81. 

Spontaneous bilateral late-onset Descemet membrane detachment after successful
cataract surgery.

Gatzioufas Z, Schirra F, Low U, Walter S, Lang M, Seitz B.

Department of Ophthalmology, Saarland University, Homburg/Saar, Germany.
zisis.gatzioufas@uniklinikumsaarland.de

We report the case of a 68-year-old man who developed bilateral Descemet
membrane detachment (DMD) 4 weeks after successful cataract surgery and discuss
the possible role of an underlying predisposition to DMD. Surgical intervention
with gas injection in the anterior chamber resulted in excellent visual acuity
restoration in the patient. To our knowledge, this is the first report of
spontaneous bilateral DMD in the late postoperative period after cataract
extraction.

PMID: 19304105 [PubMed - in process]

7: J Cataract Refract Surg. 2009 Apr;35(4):774-7. 

Case of late-onset corneal decompensation after iris-fixated phakic intraocular
lens implantation.

van Eijden R, de Vries NE, Cruysberg LP, Webers CA, Berenschot T, Nuijts RM.

Department of Ophthalmology, Academic Hospital Maastricht, the Netherlands.

A 48-year-old myopic patient with bilateral anterior chamber depth of 3.1 mm and
endothelial cell density (ECD) of 2525 cells/mm(2) and 2638 cells/mm(2)
preoperatively had bilateral implantation of an Artisan iris-fixated phakic
intraocular lens (pIOL). Five years postoperatively, unilateral corneal stromal
edema was seen in a circumscribed area overlying the temporal ridge of the pIOL
in the right eye; the ECD was 1631 cells/mm(2) and the pachymetry, 586 microm.
Explantation of the pIOL was refused by the patient. Seven years
postoperatively, the ECD was 413 cells/mm(2) in the right eye and corneal
decompensation occurred. The progressive unilateral endothelial loss was
explained by excessive rubbing of the eyes because of chronic itching and an
anterior shift of the pIOL over the 7 years as demonstrated by anterior optical
coherence tomography.

PMID: 19304104 [PubMed - in process]

8: J Cataract Refract Surg. 2009 Apr;35(4):770-3. 

United Kingdom survey of antibiotic prophylaxis practice after publication of
the ESCRS Endophthalmitis Study.

Gore DM, Angunawela RI, Little BC.

Moorfields Eye Hospital, London, United Kingdom. danielmgore@gmail.com

The European Society of Cataract & Refractive Surgeons Endophthalmitis Study
published preliminary results in 2006 showing a near 5-fold decrease in the
rates of postoperative endophthalmitis with the use of intracameral cefuroxime.
The study findings have generated considerable controversy, and 1 year later its
recommendations had been heeded by only 6% of American Society of Cataract and
Refractive Surgery (ASCRS) members. This poll sought to gauge the uptake among
surgeons in the United Kingdom and survey their response to its findings.
Fifty-five percent of respondents were using intracameral cefuroxime; 48% had
switched after publication of the ESCRS study. Of those remaining, 68% reported
their main concern was the risk for dilution errors in the absence of a
commercially preformulated preparation, with 67% stating they would switch if
such a product became available. Sixty-eight percent considered the lack of a
subconjunctival cefuroxime treatment arm within the study a major methodology
flaw. Sixty-seven percent said they do not consider penicillin allergy a
contraindication to intracameral cefuroxime use, with the remaining 33% opting
for alternative antibiotic prophylaxis. The majority of United Kingdom and
Ireland Society of Cataract and Refractive Surgeons members have switched to
intracameral cefuroxime, despite the absence of previously preferred practice in
the study design. The major barrier to its further use appears to be the lack of
a commercially available preformulated preparation.

PMID: 19304103 [PubMed - in process]

9: J Cataract Refract Surg. 2009 Apr;35(4):766-9. 

Endophthalmitis rates after implantation of the intraocular Collamer lens:
survey of users between 1998 and 2006.

Allan BD, Argeles-Sabate I, Mamalis N.

Moorfields Eye Hospital, London, United Kingdom. bruce.allan@ucl.ac.uk

An anonymous on-line survey was sent to 234 intraocular Collamer lens (ICL)
(Staar Surgical) surgeons in 21 countries to determine how many of their ICL
cases had been complicated by endophthalmitis between January 1998 and December
2006. A second questionnaire about the infection details and treatment outcome
was sent to those who reported cases of endophthalmitis. Ninety-five (40%)
surgeons responded to the survey. They had implanted 17954 ICLs during the study
period. Three surgeons reported 1 case of endophthalmitis each, a rate of
0.0167% (95%) confidence interval 0 to 0.036%) or approximately 1 case of
endophthalmitis per 6000 ICL implantations. Follow-up details were available in
2 cases. Staphylococcus epidermidis was cultured in both cases, and both were
treated without loss of vision. Endophthalmitis may be less common after ICL
implantation than after cataract surgery. Further studies are required to define
the rate and prognosis for endophthalmitis after ICL implantation to assist in
accurate preoperative patient counseling.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19304102 [PubMed - in process]

10: J Cataract Refract Surg. 2009 Apr;35(4):759-65. 

Intraocular lens power calculation after previous laser refractive surgery.

Hoffer KJ.

Jules Stein Eye Institute, University of California Los Angeles, Los Angeles,
California 90402, USA. khoffermd@aol.com

Methods to attempt more accurate prediction of intraocular lens power in
refractive surgery eyes are many, and none has proved to be the most accurate.
Until one is identified, a spreadsheet tool is available and can be used. It
automatically calculates all the methods for which data are available on a
single sheet for the patient\'s chart. The various methods and how they work are
described.

PMID: 19304101 [PubMed - in process]

11: J Cataract Refract Surg. 2009 Apr;35(4):753-8. 

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free
lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%.

Borazan M, Karalezli A, Oto S, Akova YA, Karabay G, Kocbiyik A, Celasun B,
Demirhan B.

Department of Ophthalmology, Baskent University School of Medicine, Ankara,
Turkey. borazan74@hotmail.com

PURPOSE: To determine and compare the amount of apoptosis and changes in rabbit
corneal endothelial cell morphology after intracameral administration of
different anesthetic agents. SETTING: Department of Ophthalmology, Baskent
University Medical Faculty, Ankara, Turkey. METHODS: Right eyes of 64 Vienna
white rabbits were injected intracamerally with preservative-free lidocaine
hydrochloride 2%, ropivacaine 1%, levobupivacaine 0.75%, or fortified balanced
salt solution (BSS Plus) (control). Animals were humanely killed 1 day or 7 days
later. Terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was
used to detect apoptosis. Corneal endothelial cells and apoptotic cells were
counted by light microscopy. The morphologic appearance was determined by
transmission electron microscopy (TEM). RESULTS: Apoptotic cell density was high
in the anesthetic groups on day 1 (P<.01); there was no significant difference
between groups at 7 days. Apoptotic cell density declined significantly between
1 day and 7 days in the anesthetic groups (P<.05) but not in the control group.
There was no difference in endothelial cell density between the 4 groups at 1 or
7 days. All anesthetic groups showed degenerative changes on TEM, with the least
change in the preservative-free lidocaine hydrochloride 2% group. CONCLUSIONS:
Intracameral injections of preservative-free lidocaine, ropivacaine, and
levobupivacaine induced significantly more apoptotic endothelial cell loss than
BSS Plus and led to morphologic changes in the corneal endothelial cells in the
early period. This effect was temporary, with recovery by 7 days. Considering
the limited proliferative capacity in human eyes, the induced apoptosis might
result in the permanent cell loss and enlargement in human corneal endothelium.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19304100 [PubMed - in process]

12: J Cataract Refract Surg. 2009 Apr;35(4):747-52. 

Modulation transfer function: rigid versus foldable phakic intraocular lenses.

Artigas JM, Peris C, Felipe A, Menezo JL, Sanchez-Cortina I, Lopez-Gil N.

Fundacion Oftalmologica del Mediterraneo, Departamento de Optica, Facultad de
Fisica, Universidad de Valencia, Valencia, Spain. jose.artigas@uv.es

PURPOSE: To study in a standard eye model the changes in modulation transfer
function (MTF) of a monofocal intraocular lens (IOL) when a phakic IOL (pIOL) is
placed in the anterior chamber, compare the MTFs of the rigid Artisan pIOL and
foldable Artiflex pIOL, and evaluate the temporal evolution of the MTF of the
foldable pIOL after the mechanical stress the pIOL undergoes when injected.
SETTING: Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. METHODS: The
MTF values of the IOLs were calculated from the cross-line spread function
recorded with the Opal Vector System. The measurements were taken using an eye
model following the British and EN-ISO standards with 2.0 mm, 3.0 mm, 4.0 mm,
and 5.0 mm pupils. A 28.00 diopter (D) Ophtec monofocal IOL was used as the
crystalline lens. The 2 pIOLs were -9.00 D. RESULTS: The MTF of the rigid pIOL
was slightly better than the MTF of the foldable pIOL with all pupil sizes. Both
pIOLs provided good optics quality when compared with the monofocal IOL. The
injection effect of the foldable IOL disappeared after 2 hours. CONCLUSIONS: The
MTF of the monofocal IOL was slightly reduced with implantation of a negative
pIOL in the anterior chamber. The rigid pIOL provided better optical performance
than the foldable pIOL with all pupil sizes, as shown by the MTF values. The
decrease in MTF caused by the mechanical stress on the foldable pIOL was
nullified after 2 hours with no effect on optical quality.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19304099 [PubMed - in process]

13: J Cataract Refract Surg. 2009 Apr;35(4):738-46. 

Effect of time sequences in scanning algorithms on the surface temperature
during corneal laser surgery with high-repetition-rate excimer laser.

Mrochen M, Schelling U, Wuellner C, Donitzky C.

Institute for Refractive and Ophthalmic Surgery, Swiss Federal Institute of
Technology, Zurich, Switzerland. Michael.mrochen@iroc.ch

PURPOSE: To investigate the influence of temporal and spatial spot sequences on
the ocular surface temperature increase during corneal laser surgery with a
high-repetition-rate excimer laser. SETTING: Institute for Refractive and
Ophthalmic Surgery, Zurich, Switzerland, and WaveLight AG, Erlangen, Germany.
METHODS: An argon-fluoride excimer laser system working at a repetition rate of
1050 Hz was used to photoablate bovine corneas with various myopic, hyperopic,
and phototherapeutic ablation profiles. The temporal distribution of ablation
profiles was modified by 4 spot sequences: line, circumferential, random, and an
optimized scan algorithm. The increase in ocular surface temperature was
measured using an infrared camera. RESULTS: The maximum and mean ocular surface
temperature increases depended primarily on the spatial and temporal
distribution of the spots during photoablation and the amount of refractive
correction. The highest temperature increases were with the line and
circumferential scan sequences. Significant lower temperature increases were
found with the optimized and random scan algorithms. CONCLUSIONS:
High-repetition-rate excimer laser systems require spot sequences with optimized
temporal and spatial spot distribution to minimize the increase in ocular
surface temperature. An ocular surface temperature increase will always occur
depending on the amount of refractive correction, the type of ablation profile,
the radiant exposure, and the repetition rate of the laser system.

PMID: 19304098 [PubMed - in process]

14: J Cataract Refract Surg. 2009 Apr;35(4):732-7. 

Effect of hydrodynamic parameters on corneal endothelial cell loss after
phacoemulsification.

Baradaran-Rafii A, Rahmati-Kamel M, Eslani M, Kiavash V, Karimian F.

Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical
Center, Shahid Beheshti University, Tehran, Iran.

PURPOSE: To evaluate the effect of power, vacuum, and flow rate on endothelial
cell loss after phacoemulsification. SETTING: Labbafinejad Medical Center
Medical Center, Tehran, Iran. METHODS: In a prospective randomized clinical
trial, phacoemulsification was performed in 2 groups (high vacuum and low
vacuum) with 3+ nuclear sclerosis. The stop-and-chop technique was used with the
Sovereign machine. Machine parameters during the chop stage were vacuum 400 mm
Hg in the high-vacuum group and 200 mm Hg in the low-vacuum group and flow rate,
40 cc/min and 20 cc/min, respectively. Endothelial cell density preoperatively
before and 1, 6, and 12 weeks postoperatively were compared. RESULTS: Each group
comprised 30 eyes. The mean US power was 9.2% +/- 4.3% (SD) in the low-vacuum
group and 13.1% +/- 4.6% in the high-vacuum group (P = .001) and the mean phaco
time, 1.28 +/- 1.0 minutes and 0.88 +/- 0.6 minutes, respectively (P = .04).
Total US energy and total fluid consumed were similar between groups. After 12
weeks, the mean endothelial cell loss was 9.0% +/- 4.0% in the low-vacuum group
and 9.6% +/- 4.6% in the high-vacuum group (P = .6). There was a relationship
between total US energy and endothelial loss (P<.001); however, total fluid
volume was not a significant predictor (P = .19). CONCLUSIONS: Vacuum level did
not have a significant effect on total US energy or total fluid consumed during
phacoemulsification. There was a strong relationship between total US energy and
endothelial cell loss but not between total infused fluid and endothelial cell
loss.

PMID: 19304097 [PubMed - in process]

15: J Cataract Refract Surg. 2009 Apr;35(4):725-31. 

Outcomes of cataract surgery in children with chronic uveitis.

Quinones K, Cervantes-Castaneda RA, Hynes AY, Daoud YJ, Foster CS.

Massachussets Eye Research and Surgery Institution, Cambridge, Massachusetts,
USA.

PURPOSE: To evaluate the outcomes of cataract surgery in children with chronic
uveitis. SETTING: Massachusetts Eye Research and Surgery Institution, Boston,
Massachusetts, USA. METHODS: This retrospective chart review was of patients
younger than 17 years with a history of uveitis who had cataract surgery before
June 2004. RESULTS: Thirty-four children (41 eyes) were identified. The mean age
of the 10 boys and 24 girls was 9.8 years (range 4 to 17 years) and the mean
total follow-up, 4.1 years (range 0.3 to 15.7 years). Twenty-one children had
juvenile idiopathic arthritis-associated uveitis, 7 had pars planitis, and 6 had
other conditions. Sixteen patients had concomitant posterior segment pathology,
25 received perioperative immunomodulatory therapy, and 13 had intraocular lens
(IOL) implantation. The postoperative best corrected visual acuity improved in
35 of 41 eyes; 31 eyes had an improvement of 3.6 lines at 1 year. Most patients
(92%) improved after IOL implantation. Most patients (88%) who received
immunomodulatory therapy attained better vision, but this was not statistically
significant compared with those who did not (P = .47). Similarly, there was no
statistically significant difference between those with posterior pathology and
those without. At the end of the analysis (1 year), the cumulative probability
of improvement in visual acuity in 41 eyes reached 0.91. CONCLUSION: In most
cases, and with optimum control of intraocular inflammation, cataract surgery
improved the visual outcome in children with chronic uveitis. Intraocular lens
implantation was well tolerated in most cases, which may result in optimal
vision.

PMID: 19304096 [PubMed - in process]

16: J Cataract Refract Surg. 2009 Apr;35(4):720-4. 

Management of congenital cataract in children younger than 1 year using a
25-gauge vitrectomy system.

Chee KY, Lam GC.

Department of Ophthalmology, Princess Margaret Hospital for Children, Subiaco,
Western Australia, Australia.

PURPOSE: To evaluate the safety and efficacy of a 25-gauge vitrectomy system for
the management of congenital cataract in children younger than 1 year. SETTING:
Princess Margaret Hospital for Children, Western Australia, Australia. METHODS:
Children in a tertiary pediatric hospital and private practice had cataract
extraction using a 25-gauge vitrectomy system between January 2005 and June
2008. Each eye had anterior vitrectorhexis, lens aspiration, posterior
vitrectorhexis, and anterior vitrectomy through two 25-gauge limbal side ports.
The ports were created with a 25-gauge trocar or a 0.6 mm paracentesis knife.
The eyes were left aphakic. RESULTS: Nineteen (95%) of the 20 eyes (14 children)
had a successful surgical outcome with the 25-gauge vitrectomy system. One eye
was converted to the 20-gauge system because of an unusually tough and fibrous
lens capsule. The limbal side ports in 16 of 17 eyes created with the 25-gauge
trocar required suturing to seal the ports; none of the 3 eyes with side ports
created with the paracentesis knife required suturing. There were no significant
intraoperative or postoperative complications other than ocular hypertension in
1 eye. CONCLUSIONS: The 25-gauge vitrectomy system appears safe and effective
for the management of infantile cataract. Advantages include more precise
manipulations with smaller instruments in infant eyes, a more stable anterior
chamber, and less postoperative astigmatism.

PMID: 19304095 [PubMed - in process]

17: J Cataract Refract Surg. 2009 Apr;35(4):715-9. 

Effect of diabetes mellitus on biomechanical parameters of the cornea.

Goldich Y, Barkana Y, Gerber Y, Rasko A, Morad Y, Harstein M, Avni I, Zadok D.

Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel.
doctor.goldich@gmail.com

PURPOSE: To compare parameters of biomechanical response of the human cornea
measured as corneal hysteresis (CH) and corneal resistance factor (CRF) in
patients with diabetes mellitus and healthy control subjects. SETTING:
Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel.
METHODS: In the right eye of each participant, the CH, CRF, Goldmann-correlated
intraocular pressure (IOPg), and corneal-compensated intraocular pressure
(IOPcc) were measured with the Ocular Response Analyzer. Central corneal
thickness (CCT) was measured by ultrasonic pachymetry and intraocular pressure
by Goldmann applanation tonometry (IOP GAT). Findings were compared between the
2 groups (control and diabetic). RESULTS: Forty diabetic patients (17 women, 23
men) and 40 healthy subjects (19 women, 21 men) were prospectively recruited.
The mean CH was 9.3 mm Hg +/- 1.4 (SD) and 10.7 +/- 1.6 mm Hg and the mean CRF
was 9.6 +/- 1.6 mm Hg and 10.9 +/- 1.7 mm Hg in the control group and diabetic
group, respectively (both P < .0001). Diabetic corneas were significantly
thicker (P = .019); the mean CCT was 530.3 +/- 35.9 microm in the control group
and 548.7 +/- 33.0 microm in the diabetic group. The CH and CRF remained
significantly different in multivariate analysis that included CCT. There was no
statistically significant difference between the 2 groups in IOPcc, IOPg, or IOP
GAT measurements. CONCLUSIONS: Diabetes mellitus affected biomechanical
parameters of the human corneas, including increased CH, CRF, and CCT. Whether
this observation has implications in the clinical management and understanding
of corneal ectasia and glaucoma requires further study.

PMID: 19304094 [PubMed - in process]

18: J Cataract Refract Surg. 2009 Apr;35(4):710-4. 

Assessment of visual performance in pseudophakic monovision.

Ito M, Shimizu K, Amano R, Handa T.

Department of Rehabilitation, Orthoptics and Visual Science Course, School of
Allied Health Science, Kitasato University, Kanagawa, Japan.
misae@kitasato-u.ac.jp

PURPOSE: To assess the visual performance and acceptability of pseudophakic
monovision and examine its relationship to age. SETTING: Department of
Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. METHODS: This
retrospective study examined patients with pseudophakic monovision using
monofocal intraocular lenses. Refractive errors, visual acuity at various
distances, contrast sensitivity, and near stereopsis were measured. Patient
satisfaction with monovision was evaluated using a questionnaire. RESULTS:
Eighty-two patients (age 49 to 87 years) were evaluated. The mean difference in
spherical equivalent refractive error between each patient\'s eyes was 2.27
diopters. Most patients had a binocular uncorrected visual acuity of 0.10 logMAR
or better at all distances. For contrast sensitivity, binocular summation was
observed at 1.5 to 6.0 cycles per degree. Near stereopsis was in the normal
range, which was up to 100 seconds of arc. Questionnaire responses showed that
81% of patients (64% <60 years; 87% between 60 years and 70 years; 94% older
than 70 years) were satisfied with the results. CONCLUSION: Pseudophakic
monovision was an effective approach for managing loss of accommodation after
cataract surgery in patients older than 60 years; however, a careful selection
process is required.

PMID: 19304093 [PubMed - in process]

19: J Cataract Refract Surg. 2009 Apr;35(4):703-9. 

Comparison of early postoperative clinical outcomes of photorefractive
keratectomy and lamellar epithelial debridement.

Youm DJ, Tchah H, Choi CY.

Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk
Samsung Hospital, Seoul, Korea.

PURPOSE: To compare early postoperative clinical outcomes of photorefractive
keratectomy (PRK) and lamellar epithelial debridement (LED). SETTING: Department
of Ophthalmology, Kangbuk Samsung Hospital, Seoul, Korea. METHODS: This
prospective study was of patients randomly assigned to have PRK or LED. In the
LED group, an epithelial flap was created using an Amadeus II epikeratome.
Postoperative follow-up was at 1, 3, and 7 days and 1, 3, and 6 months. The
outcome parameters were uncorrected visual acuity (UCVA), best corrected visual
acuity (BCVA), higher-order aberrations (HOAs), epithelial healing time, and
corneal haze. RESULTS: The study comprised 39 patients (76 eyes). The mean
preoperative spherical equivalent (SE) was -3.96 diopters (D) +/- 1.24 (SD) in
the PRK group and -4.06 +/- 1.39 D in the LED group. Postoperative UCVA was
significantly better in the LED group 1 day postoperatively. The UCVA was 20/20
or better in 14.6% in the PRK group and 42.9% in the LED group (P = .006); 20/25
or better in 41.5% and 82.9%, respectively (P = .000); and 20/40 or better in
80.5% and 100%, respectively (P = .006). On subsequent follow-up visits, the
UCVA was comparable between groups. No eye lost lines of BCVA at 3 months. There
was no difference between groups in postoperative SE refraction, HOAs, or
corneal haze. CONCLUSIONS: Lamellar epithelial debridement and PRK had
comparable safety and efficacy in the surgical correction of low to moderate
myopia. The UCVA was significantly better after LED than after PRK 1 day
postoperatively and equivalent thereafter.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19304092 [PubMed - in process]

20: J Cataract Refract Surg. 2009 Apr;35(4):695-702. 

Wavefront aberrations in eyes with decentered ablations.

Padmanabhan P, Mrochen M, Viswanathan D, Basuthkar S.

Medical & Vision Research Foundation, Tamil Nadu, India. drpp@snmail.org

PURPOSE: To compare the refractive and functional outcomes and wavefront
profiles in eyes with decentered ablations and eyes with well-centered
ablations. SETTING: Medical Research Foundation, Chennai, Tamil Nadu, India.
METHODS: This retrospective analysis comprised eyes with topographically
diagnosed decentered ablations after laser in situ keratomileusis (LASIK).
Refraction, contrast sensitivity, and ocular wavefront aberrations were measured
preoperatively and 1 month postoperatively. The induced aberrations in these
eyes were compared with those in eyes with well-centered ablations. RESULTS:
Forty-six eyes (38 patients) had decentered ablations and 60 eyes (32 patients),
well-centered ablations. The mean decentration in the study group was 0.86 mm
+/- 0.29 (SD) (range 0.35 to 1.61 mm). There was no significant correlation
between decentration and attempted refractive correction. There was, however, a
statistically significant (P<.05) linear correlation between the distance of
decentration and the magnitude of induced tilt (r = -0.31), coma (r = -0.41),
and secondary astigmatism (r = 0.36). The induced changes in tilt, oblique
astigmatism, vertical coma, and spherical aberration were statistically
significantly higher in eyes with decentered ablations than in eyes with
well-centered ablations. A statistically significantly higher percentage of eyes
(87%) with well-centered ablations than eyes with decentered ablations (70%) had
a postoperative uncorrected visual acuity (UCVA) of 20/20 or better. There was
no significant difference in contrast sensitivity between groups. CONCLUSION:
Eyes with decentered ablations had a significantly higher magnitude of induced
aberrations and lower UCVA than eyes with well-centered ablations.

PMID: 19304091 [PubMed - in process]

21: J Cataract Refract Surg. 2009 Apr;35(4):688-94. 

Effect of anterior and posterior corneal surface irregularity on vision after
Descemet-stripping endothelial keratoplasty.

Yamaguchi T, Negishi K, Yamaguchi K, Murat D, Uchino Y, Shimmura S, Tsubota K.

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: To evaluate irregularity of the anterior and posterior cornea before
and after Descemet-stripping endothelial keratoplasty (DSEK) and its effect on
visual acuity. SETTING: Department of Ophthalmology, Keio University School of
Medicine, Tokyo, Japan. METHODS: Corneal data were acquired using a rotating
Scheimpflug camera before and 1 month and 3 months after DSEK. Anterior and
posterior corneal elevation data were decomposed into a set of Zernike
polynomials up to the 8th order within a 4.0 mm diameter region. Total
higher-order root mean square (HO-RMS) and RMS from the 3rd to 8th order were
calculated. The effects of anterior and posterior surface irregularity on visual
acuity were evaluated. RESULTS: This clinical study comprised 13 consecutive
eyes of 12 bullous keratopathy patients. The mean best corrected visual acuity
(BCVA) was 1.11 logMAR +/- 0.5 (SD) preoperatively, 0.49 +/- 0.49 logMAR 1 month
postoperatively, and 0.27 +/- 0.32 logMAR at 3 months. The HO-RMS of the
anterior surface 1 month (P = .040) and 3 months (P = .048) postoperatively was
significantly lower than preoperatively. There were no significant differences
in posterior surface HO-RMS between preoperatively and 1 month (P = .45) and 3
months (P = .054). The postoperative BCVA was significantly correlated with
HO-RMS (P<.001), but not with posterior surface HO-RMS, at 3 months (P = .354).
CONCLUSION: Postoperative BCVA correlated with irregularity of the anterior
surface but not the posterior surface. In addition to corneal transparency,
regularity of the anterior surface is an important factor in visual acuity after
DSEK.

PMID: 19304090 [PubMed - in process]

22: J Cataract Refract Surg. 2009 Apr;35(4):682-7. 

Mitomycin-C in hyperopic photorefractive keratectomy.

Leccisotti A.

Ophthalmic Surgery Unit, Casa di Cura Rugani, Siena, Italy. leccisotti@libero.it

PURPOSE: To evaluate the effects of topical mitomycin-C (MMC) after hyperopic
photorefractive keratectomy (PRK). SETTING: Private practice, Siena, Italy.
METHODS: In this prospective study, a sponge with 0.2 mg/mL MMC or balanced salt
solution (controls) was placed on the stroma for 45 seconds after PRK performed
using a Technolas 217z laser. After epithelialization, fluorometholone 0.1%
eyedrops were used for 4 months in both groups. RESULTS: The MMC group comprised
88 eyes (mean spherical equivalent [SE] +3.51 diopters [D] +/- 1.04) and the
control group, 91 eyes (mean SE +3.50 +/- 1.03 D). At 18 months, the mean SE was
-0.10 +/- 0.37 D and 0.22 +/- 0.70 D, respectively, and the mean defocus
equivalent, 0.34 +/- 0.32 D and 0.69 +/- 0.74 D, respectively (both P<.05). The
mean best spectacle-corrected visual acuity (BSCVA) was 0.06 +/- 0.08 logMAR in
the MMC group and 0.08 +/- 0.10 logMAR in the control group; 2 eyes and 11 eyes,
respectively, lost more than 0.1 logMAR of BSCVA. The mean uncorrected visual
acuity (UCVA) was 0.13 +/- 0.11 logMAR in the MMC group and 0.21 +/- 0.20 logMAR
in the control group (P<.05). The UCVA was better than 20/40 in 94% of eyes and
80% of eyes, respectively. The efficacy index was 0.87 and 0.67, respectively.
Haze at 18 months was 0.05 +/- 0.11 in the MMC group and 0.23 +/- 0.46 in the
control group (P<.05). No endothelial damage was observed in either group.
CONCLUSION: Mitomycin-C prevented haze formation and improved predictability and
efficacy. No adverse effects occurred.

PMID: 19304089 [PubMed - in process]

23: J Cataract Refract Surg. 2009 Apr;35(4):677-81. 

Objective assessment of inflammation after cataract surgery: comparison of 3
similar intraocular lens models.

Monnet D, Tepenier L, Brezin AP.

Universite Paris Descartes, Hopital Cochin, Paris, France.

PURPOSE: To compare postoperative inflammation in patients receiving 1 of 3
AcrySof intraocular lenses (IOLs): MA60AC (Group 1), SA60AT (Group 2), or SN60AT
(Group 3). SETTING: Service d\'Ophtalmologie, Universite Paris Descartes Hopital
Cochin, Paris, France. METHODS: This prospective randomized 3-month study
included eyes that received 1 of the 3 IOL models with standard surgery and
postoperative care. Anterior chamber cells were assessed at the slitlamp and
anterior chamber flare values, with a Kowa 500 flare meter. RESULTS: Fifty-nine
patients (59 eyes) with a mean age of 72.7 years were evaluated. Group 1 and
Group 2 comprised 20 eyes each and Group 3, 19 eyes. No eye had anterior chamber
cells at baseline. In all 3 groups, the presence of anterior chamber cells was
highest 1 week postoperatively and generally decreased at subsequent visits,
with no statistically significant differences between IOL groups at 1 week (P =
.2655), 1 month (P = .073), or 3 months (P = .5766). A similar proportion of
eyes in each IOL group had residual cells in the anterior chamber at 3 months;
the cells were not clinically significant. In all groups, the mean flare values
were low (<11 photons/ms) at baseline (P = .4522) and statistically similar
between groups at each subsequent visit (P>or=.2801). There were no adverse
events. CONCLUSION: The 3 IOLs models, including the blue light-filtering model,
had similar anterior chamber cells and flare values over a 3-month period,
showing the lack of difference in inflammation induced by cataract surgery with
implantation of the 3 similar IOL models.

PMID: 19304088 [PubMed - in process]

24: J Cataract Refract Surg. 2009 Apr;35(4):672-6. 

Visual acuity comparison of 2 models of bifocal aspheric intraocular lenses.

Alfonso JF, Puchades C, Fernandez-Vega L, Montes-Mico R, Valcarcel B,
Ferrer-Blasco T.

Fernandez-Vega Ophthalmological Institute, Surgery Department, School of
Medicine, University of Oviedo, Oviedo, Spain. j.alfonso@fernandez-vega.com

PURPOSE: To compare visual acuity after bilateral implantation of 2 models of
multifocal aspheric intraocular lenses (IOLs). SETTING: Fernandez-Vega
Ophthalmological Institute, Oviedo, and University of Valencia, Valencia, Spain.
METHODS: Prospective study of patients who had bilateral implantation of an
AcrySof ReSTOR SN6AD3 IOL (Group 1) or an Acri.LISA 366D IOL (Group 2). Six
months postoperatively, binocular uncorrected and best corrected distance visual
acuity, uncorrected-distance and best distance-corrected near visual acuity,
best corrected intermediate visual acuity, and the defocus curve were measured
in both IOL groups. RESULTS: Group 1 comprised 36 eyes (18 patients) and Group
2, 40 eyes (20 patients). The mean binocular values in Group 1 and Group 2,
respectively, were as follows: best corrected distance acuity, -0.05 +/- 0.09
logMAR and -0.08 +/- 0.08 logMAR (both approximately 20/20); best
distance-corrected near acuity, -0.01 +/- 0.16 logMAR and -0.05 +/- 0.07 logMAR;
best corrected intermediate acuity at 80 cm, 0.20 +/- 0.18 logMAR (approximately
20/32) and 0.16 +/- 0.13 logMAR (approximately 20/25) and at 60 cm, 0.16 +/-
0.16 logMAR (approximately 20/25) and 0.18 +/- 0.13 logMAR (approximately
20/25). There were no statistically significant between-group differences in
visual acuity at any distance (P>.3). Defocus curves were similar between groups
(2.00 to -5.00 diopters) (P>.26). CONCLUSIONS: The 2 multifocal aspheric IOL
models gave similar and good high-contrast visual acuity at distance and near.
Intermediate visual acuity, also comparable between IOL models, was better than
published results of a spherical IOL model.

PMID: 19304087 [PubMed - in process]

25: J Cataract Refract Surg. 2009 Apr;35(4):663-71. 

Wavefront aberrations, depth of focus, and contrast sensitivity with aspheric
and spherical intraocular lenses: fellow-eye study.

Nanavaty MA, Spalton DJ, Boyce J, Saha S, Marshall J.

Department of Ophthalmology, St. Thomas\' Hospital, London, United Kingdom.

PURPOSE: To compare wavefront aberration, depth of focus, contrast sensitivity,
and in vivo modulation transfer function (MTF) after fellow-eye implantation of
aspheric and spherical intraocular lenses (IOLs). SETTINGS: Department of
Ophthalmology, St. Thomas\' Hospital, London, United Kingdom. METHODS: This
prospective randomized controlled study comprised patients with bilateral
cataract who received an aspheric AcrySof SN60WF IOL or a spherical AcrySof
SN60AT IOL in the first eye and the other IOL in the second eye. Assessments at
3 and 6 months included 100% and 9% logMAR best corrected visual acuity (BCVA)
and photopic and mesopic functional acuity contrast testing. Total internal and
corneal aberrations and depth of focus were computed. Distance-corrected near
logMAR acuity was available at 12 months. RESULTS: At 3 and 6 months, there was
no significant difference in 100% and 9% BCVA or photopic contrast sensitivity.
Mesopic contrast sensitivity was better and total and internal spherical
aberrations were significantly less with the aspheric IOL. Total and internal
eye vertical coma was reduced with aspheric IOL. Total MTF was not significantly
different between groups. The aspheric IOL group had 0.46 diopter less depth of
focus than the spherical IOL group at 6 months (P<.05). Distance-corrected near
acuity was significantly better with the spherical IOL. CONCLUSIONS: Aspheric
IOLs significantly reduced spherical aberration, improving mesopic contrast
sensitivity. Vertical coma was reduced with aspheric IOLs. Reduction of
aberrations may be responsible for reduced depth of focus with aspheric IOLs.
This may be disadvantageous for near vision and reading ability.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19304086 [PubMed - in process]

26: J Cataract Refract Surg. 2009 Apr;35(4):650-62. 

Comparison of ray-tracing method and thin-lens formula in intraocular lens power
calculations.

Jin H, Rabsilber T, Ehmer A, Borkenstein AF, Limberger IJ, Guo H, Auffarth GU.

International Vision Correction Research Centre, Department of Ophthalmology,
University of Heidelberg, Germany.

PURPOSE: To compare the accuracy of the thin-lens and ray-tracing methods in
intraocular lens (IOL) power calculations in normal eyes and eyes after corneal
refractive surgery. SETTING: International Vision Correction Research Centre,
University of Heidelberg, Heidelberg, Germany. METHODS: Pseudophakic eye models
were constructed using Zemax optical software, importing corneal radii (normal
ray tracing) and corneal surface elevation data (individual ray tracing)
measured by Pentacam Scheimpflug photography. Algorithms to predict IOL position
(effective lens position [ELP]) or postoperative anterior chamber depth
[ACD(post)]) (Haigis, Hoffer Q, Norrby, Olsen 2) were used in the thin-lens and
ray-tracing methods. Intraocular lens power was calculated in 25 eyes after
corneal refractive surgery using normal and double-K modified thin-lens and
ray-tracing methods. RESULTS: Back-calculation of ELP and ACD(post) were well
correlated. Using algorithms of Haigis, Hoffer Q, Norrby, and Olsen 2 to predict
IOL position, mean absolute prediction errors (MAEs) of the thin-lens formula
were 0.64 diopters (D) +/- 0.52 (SD), 0.57 +/- 0.46 D, 0.59 +/- 0.42 D, and 0.61
+/- 0.47 D, respectively; MAEs of normal ray-tracing method were 0.64 +/- 0.50
D, 0.58 +/- 0.44 D, 0.59 +/- 0.41 D, and 0.62 +/- 0.45 D, respectively; MAEs of
individual ray-tracing method were 0.66 +/- 0.52 D, 0.59 +/- 0.45 D, 0.59 +/-
0.43 D, and 0.62 +/- 0.50 D, respectively. No statistical differences were found
between the thin-lens and ray-tracing methods. CONCLUSION: Theoretical thin-lens
formulas were as accurate as the ray-tracing method in IOL power calculations in
normal eyes and eyes after refractive surgery.

PMID: 19304085 [PubMed - in process]

27: J Cataract Refract Surg. 2009 Apr;35(4):643-9. 

Acute-onset nosocomial endophthalmitis after cataract surgery: incidence,
clinical features, causative organisms, and visual outcomes.

Al-Mezaine HS, Kangave D, Al-Assiri A, Al-Rajhi AA.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh,
Saudi Arabia. almez2001@hotmail.com

PURPOSE: To estimate the incidence of acute-onset endophthalmitis after cataract
surgery and to report its clinical features, microbiology, and final visual
outcomes. SETTING: King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
METHODS: This was a retrospective observational case series. RESULTS: The
10-year incidence of acute-onset endophthalmitis after cataract surgery was
0.068%: 0.049% for extracapsular cataract extraction (ECCE) and 0.085% for clear
corneal phacoemulsification (P = .268). The incidence of endophthalmitis was
0.053% during the first 5 years of the study and 0.08% during the next 5 years.
The most common presenting features were pain and poor red reflex. Of the 20
cases, 18 were culture positive. The culture isolates showed Staphylococcus
species in 7 eyes (35%), Streptococcus species in 7 eyes (35%), polymicrobial or
mixed infections in 3 eyes (15%), and Propionibacterium acnes in 1 eye (5%). Two
patients (10%) achieved a final visual acuity of 20/40 or better, 5 (25%) had
worse than 20/40 to better than 20/200, and 8 (40%) had worse than 20/200; 5
eyes (25%) were eviscerated. Visual outcomes were good in endophthalmitis cases
after phacoemulsification and in cases caused by Staphylococcus epidermidis and
worse in cases that had Streptococcus species endophthalmitis. CONCLUSIONS:
Clear corneal phacoemulsification had a 1.73-fold higher risk for acute
endophthalmitis than ECCE. Although the incidence of endophthalmitis after ECCE
was lower than after phacoemulsification, the outcome was much worse in
post-ECCE endophthalmitis cases. Poor visual outcomes were associated with more
virulent organisms and delayed presentation.

PMID: 19304084 [PubMed - in process]

28: J Cataract Refract Surg. 2009 Apr;35(4):637-42. 

Prophylactic intracameral cefazolin after cataract surgery: endophthalmitis risk
reduction and safety results in a 6-year study.

Garat M, Moser CL, Martin-Baranera M, Alonso-Tarres C, Alvarez-Rubio L.

Ophthalmology Department, Hospital General de L\'Hospitalet, Consorci Sanitari
Integral, L\'Hospitalet de Llobregat, Barcelona, Spain.

PURPOSE: To assess the use of intracameral cefazolin in preventing
endophthalmitis in cataract surgery. SETTING: Ophthalmology Department,
L\'Hospitalet de Llobregat, Barcelona, Spain. METHODS: This study was of
phacoemulsification procedures performed from January 2002 to December 2007. In
January 2004, intracameral cefazolin given at the end of the surgery was added
to the prophylaxis protocol of cataract surgery. The cumulative incidence of
postoperative endophthalmitis before and after the addition of intracameral
cefazolin was compared. RESULTS: During the study period, 18579
phacoemulsification procedures were performed. In the 2-year period before
introduction of intracameral cefazolin prophylaxis, 25 cases of endophthalmitis
were diagnosed in 5930 surgeries, leading to a cumulative incidence of 0.422%
(95% confidence interval [CI], 0.279%-0.613%). After the introduction of
cefazolin, 6 cases of endophthalmitis were diagnosed in 12649 surgeries, an
incidence of 0.047% (95% CI, 0.019%-0.099%). When only microbiologically proven
cases were considered, the cumulative endophthalmitis incidence was 0.388% (95%
CI, 0.252%-0.572%) in the first study period and 0.032% (95% CI, 0.010%-0.076%)
in the second study period (P<.0000001). The relative risk for presenting with
endophthalmitis in the first study period compared with the second period was
8.89 (95% CI, 3.65-21.65). CONCLUSIONS: A 2.5 mg/0.1 mL intracameral bolus of
cefazolin provided excellent prophylactic effectiveness, with a reduction in the
incidence of endophthalmitis from 0.422% to 0.047%, corresponding to a relative
risk reduction of 88.7% (95% CI, 72.6%-95.4%). Cefazolin fulfills international
recommendations on antimicrobial prophylaxis for surgical site infections and is
easier to obtain in developing countries.

PMID: 19304083 [PubMed - in process]

29: J Cataract Refract Surg. 2009 Apr;35(4):629-36. 

Incidence of post-cataract endophthalmitis at Aravind Eye Hospital: outcomes of
more than 42,000 consecutive cases using standardized sterilization and
prophylaxis protocols.

Ravindran RD, Venkatesh R, Chang DF, Sengupta S, Gyatsho J, Talwar B.

Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Pondicherry,
India. rdr@pondy.aravind.org

PURPOSE: To report the incidence of postoperative endophthalmitis at a
high-volume eye hospital in southern India using a modified cost-effective
sterilization protocol. SETTING: Aravind Eye Hospital and Post Graduate
Institute of Ophthalmology, Pondicherry, India. METHODS: In this retrospective
observational series at a single eye hospital, records of patients who had
cataract surgery using a modified sterilization protocol from January 2007
through August 2008 and developed postoperative endophthalmitis within the first
3 postoperative months were drawn from a computerized database. The patient\'s
socioeconomic status, the surgeon\'s experience, and the type of cataract
procedure performed were analyzed as possible risk factors using the chi-square
test/Fischer exact test. RESULTS: During the study period, 42426 cataract
surgeries were performed. From these, 38 cases of presumed postoperative
endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases
were in the manual large- and small-incision extracapsular cataract extraction
(ECCE) group, which had a statistically higher rate than the phacoemulsification
group (P = .016). There was no statistical difference in the endophthalmitis
rates between private patients and charity patients for either surgical method
(manual ECCE or phacoemulsification). CONCLUSIONS: The modified sterilization
and asepsis protocol adopted to facilitate high-volume cataract surgery in a
clinical setting appeared to be safe and effective in preventing postsurgical
endophthalmitis. Despite a 3:1 ratio of manual ECCE to phacoemulsification and
the elimination of certain traditional sterilization practices, the rate of
endophthalmitis in this generally underserved patient population with multiple
risk factors for infection was comparable to that reported in other modern
settings.

PMID: 19304082 [PubMed - in process]

30: J Cataract Refract Surg. 2009 Apr;35(4):625-8. 

Simple technique for graft insertion in Descemet-stripping (automated)
endothelial keratoplasty using a 30-gauge needle.

Balachandran C, Ham L, Birbal RS, Wong TH, van der Wees J, Melles GR.

Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.

We describe a needle insertion technique for graft insertion in
Descemet-stripping (automated) endothelial keratoplasty (DSEK/DSAEK). A folded
donor posterior corneal disk is inserted through a 5.0 mm scleral tunnel
incision over a plastic glide using a 30-gauge needle. The technique enables
safe and easy graft insertion without vertical or horizontal compression of the
donor tissue, causing minimal trauma to the donor endothelium and/or host
structures.

PMID: 19304081 [PubMed - in process]