1: J Cataract Refract Surg. 2008 May;34(5):874-5. 

Conductive keratoplasty for asymmetric corneal astigmatism.

Ardjomand N, Wohlfart C, McAlister JC, El-Shabrawi Y, Vidic B.

Publication Types:
    Letter

PMID: 18471652 [PubMed - in process]

2: J Cataract Refract Surg. 2008 May;34(5):874-5. 

Teflon-tipped forceps.

Green LK, Giordano C, Stark WJ.

Publication Types:
    Letter

PMID: 18471651 [PubMed - in process]

3: J Cataract Refract Surg. 2008 May;34(5):871-3. 

Chandler syndrome manifesting as ectropion uvea following laser in situ
keratomileusis.

Mocan MC, Bozkurt B, Orhan M, Irkec M.

From the Departments of Ophthalmology, Faculty of Medicine, Hacettepe University
(Mocan, Orhan, Irkec), and Selcuk University (Bozkurt), Ankara, Turkey.

We report the case of a 30-year-old woman with recent onset of unilateral iris
distortion and glaucoma that was noticed following uneventful laser in situ
keratomileusis (LASIK). The corneal endothelium in the right eye appeared normal
with the slitlamp microscope, and LASIK-related anterior segment ischemia was
initially considered in the differential diagnosis. However, in vivo confocal
microscopy revealed abnormal endothelial cells, confirming the diagnosis of
iridocorneal endothelial syndrome. In patients having refractive corneal
procedures, in vivo confocal microscopy is recommended to diagnose preexisting
corneal abnormalities that might otherwise remain undetected.

PMID: 18471650 [PubMed - in process]

4: J Cataract Refract Surg. 2008 May;34(5):868-70. 

Lens reabsorption following self-induced needling and subsequent intracapsular
secondary intraocular lens placement.

Painter SL, Imrie FR, Mayer EJ.

From the Department of Ophthalmology (Painter), Stoke Mandeville Hospital,
Aylesbury, and Bristol Eye Hospital (Imrie, Mayer), University of Bristol
(Mayer), Bristol, United Kingdom.

We present the case of a young man who inadvertently penetrated his cornea and
lens with a needle used for injecting heroin. Three years later, the lens had
completely reabsorbed leaving a fibrosed capsular bag. We describe the surgical
techniques used to insert a secondary intraocular lens into the capsular bag
with excellent visual outcome.

PMID: 18471649 [PubMed - in process]

5: J Cataract Refract Surg. 2008 May;34(5):864-7. 

Creation of an extremely thin flap using IntraLase femtosecond laser.

Choi SK, Kim JH, Lee D, Oh SH, Lee JH, Ahn MS.

From the Department of Ophthalmology, Ilsan Paik Hospital, Inje University,
Ilsan, Korea.

A 43-year-old woman had laser in situ keratomileusis (LASIK) using the IntraLase
femtosecond laser (IntraLASIK) to create 110 mum flaps. Despite uneventful flap
formation, the flaps in both eyes were extremely thin, making it difficult to
lift them. The flap in the right eye resembled an epi-LASIK epithelial flap. It
was lifted uneventfully. The flap in the left eye was stretched and torn on
lifting, and the procedure was therefore postponed. After 6 months, the
IntraLASIK surgical procedure was repeated in the left eye using a thicker and
smaller flap than in the first procedure. Despite the improvements associated
with using an IntraLase femtosecond laser, thinner-than-intended corneal flaps
can occur. Early recognition of such a flap can prevent further complications.

PMID: 18471648 [PubMed - in process]

6: J Cataract Refract Surg. 2008 May;34(5):859-63. 

Epithelial breakthrough during IntraLase flap creation for laser in situ
keratomileusis.

Seider MI, Ide T, Kymionis GD, Culbertson WW, O\'Brien TP, Yoo SH.

From the Bascom Palmer Eye Institute, Miami, Florida, USA.

We report the clinical manifestations and outcomes in 4 patients who experienced
premature gas-bubble leakage during raster lamellar dissection during IntraLase
femtosecond laser corneal flap creation. Three patients experienced a
full-thickness epithelial breakthrough and the fourth, a flap tear. The patient
who experienced the flap tear was unable to have laser in situ keratomileusis
successfully. The flap complications did not result in a decreased best
corrected visual acuity in any patient but may have resulted in epithelial
ingrowth in one and a corneal scar and microstriae in another. Potential
predisposing factors for epithelial breakthrough, the incidence of epithelial
breakthrough, and methods for avoiding and salvaging traumatic corneal flaps are
discussed.

PMID: 18471647 [PubMed - in process]

7: J Cataract Refract Surg. 2008 May;34(5):853-8. 

Prevention of endophthalmitis by collagen shields presoaked in fourth-generation
fluoroquinolones versus by topical prophylaxis.

Haugen B, Werner L, Romaniv N, Haymore J, Kleinmann G, Mamalis N, Olson RJ.

From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah,
USA.

PURPOSE: To compare the prophylaxis of collagen shields presoaked in antibiotics
versus antibiotic drops after bacterial anterior chamber challenge. SETTING:
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
METHODS: Forty rabbits received bilateral 0.03 mL intracameral injections of
Staphylococcus epidermidis (5 x 10(8) colony-forming units). Four groups of 10
rabbits had their eyes randomized to receive (1) 3 mg/mL gatifloxacin (Zymar)
drops or shield in Zymar, (2) Zymar drops or shield in 10 mg/mL gatifloxacin
(Tequin), (3) 5 mg/mL moxifloxacin (Vigamox) drops or shield in Vigamox, or (4)
balanced salt solution (BSS) drops or shield in BSS. Each eye received Zymar,
Vigamox, or BSS 4 times 1 hour before injection. The antibiotic-BSS was
administered every 2 hours (5 doses total). One day later, signs of
endophthalmitis were scored under the slitlamp. RESULTS: Groups 1 and 2 had
significantly lower endophthalmitis incidences (total score >/=8) than the BSS
controls. Shield scores were not significantly different from those of the
counterpart drops. The comparison between drops was not significant (P = .0513);
the difference between shields (P = .0232) and the post-comparison Zymar versus
BSS shields (P = .0021) were significant. CONCLUSIONS: Topical therapy with
gatifloxacin before and after intraocular bacteria challenge led to lower
incidences of endophthalmitis in rabbits. Prophylaxis with presoaked collagen
shields was not statistically different than that with topical drops.

PMID: 18471646 [PubMed - in process]

8: J Cataract Refract Surg. 2008 May;34(5):846-52. 

Role of cavitation in the phacoemulsification process.

Zacharias J.

From Clinica Ophthalmologica Pasteur, Santiago, Chile.

PURPOSE: To determine the role of cavitational energy as a mechanism responsible
for the emulsification of the lens during phacoemulsification. SETTING: Clinica
Ophthalmologica Pasteur, Santiago, Chile. METHODS: Cavitation and its
relationship to phacoemulsification power were documented using a combination of
light sources, high-speed video recording techniques, and computerized control
and by monitoring environmental pressure. The suppression of cavitation from the
phaco process was achieved by building an environmental hyperbaric system
capable of retaining the phacoemulsification system\'s ability to provide
irrigation, aspiration, and vacuum necessary at standard and elevated pressures.
The pressure level was controlled and monitored through a computer interface
alongside the simultaneous video monitoring of cavitation bubble creation
changes during pressure rise or fall. Last, evaluation and measurement of
phacoemulsification was performed on real cataract fragments in the presence and
absence of cavitation. RESULTS: Cavitation around the phaco tip mainly occurred
at longitudinal ultrasonic power levels of 30% or more. Cavitation bubble
formation was observed during the backstroke or as the tip moved away from the
lens material and collapsed during the forward displacement of the phaco tip.
Cavitation at any power level was successfully suppressed when the pressure in
the hyperbaric chamber increased beyond 2.0 bar (29.1 psi) above atmospheric
pressure. Phacoemulsification performance in the presence or absence of
cavitation was comparable. CONCLUSION: This study found strong evidence that
cavitation plays no role in phacoemulsification, leaving the jackhammer effect
as the only important mechanism responsible for the lens-disrupting power of
phacoemulsification.

PMID: 18471645 [PubMed - in process]

9: J Cataract Refract Surg. 2008 May;34(5):842-5. 

Microbial cultures of the microkeratome blade immediately after flap
construction in laser in situ keratomileusis.

Khan AM, Larson B, Noth J, Rosen R, Bouchard C.

From the Department of Ophthalmology (Khan, Larson, Bouchard), Loyola University
Medical Center, Maywood; and Hinsdale Surgical Center (Larson, Noth), and the
Microbiology Laboratory (Rosen), Hinsdale Hospital, Hinsdale, Illinois, USA.

PURPOSE: To assess the incidence of positive cultures from samples of the
microkeratome blade after routine laser in situ keratomileusis (LASIK)
procedures as a measure of the risk for postoperative infectious keratitis.
SETTING: Hinsdale Surgical Center, Hinsdale, Illinois, USA. METHODS: In this
prospective study, 99 microkeratome blades (Hansatome) were cultured after
routine LASIK procedures by multiple surgeons at an ambulatory surgery center.
Cultures were sent for routine aerobic and anaerobic growth. Positive cultures
were then sent for routine sensitivities. RESULTS: Five of 99 swabs of
microkeratome blades were culture positive. Four cultures grew Staphylococcus
epidermidis and 1, Staphylococcus warneri. Two of the staphylococcal cultures
were resistant to ciprofloxacin and levofloxacin but sensitive to moxifloxacin
and gatifloxacin. CONCLUSIONS: The study demonstrated a 5% positive culture rate
from the microkeratome blade after routine LASIK surgery by multiple surgeons in
an ambulatory surgery center. No patient with positive cultures developed
postoperative infectious keratitis. Factors other than the presence of bacteria
contribute to the development of clinical infection.

PMID: 18471644 [PubMed - in process]

10: J Cataract Refract Surg. 2008 May;34(5):835-41. 

Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome:
Results in 30 consecutive cases.

Chang DF.

From a private practice, Los Altos, California, USA.

PURPOSE: To evaluate a new disposable, small-pupil expansion device in
tamsulosin patients with intraoperative floppy-iris syndrome (IFIS) having
cataract surgery. SETTING: Private practice, Los Altos, California, USA.
METHODS: The 5-0 polypropylene Malyugin pupil expansion device (MicroSurgical
Technology) was used in 30 eyes from 21 tamsulosin patients having routine
cataract surgery. The pupil diameter was measured at the beginning and end of
surgery, and the severity of IFIS was graded. Intraoperative and postoperative
complications were recorded. RESULTS: The device maintained a constant 6.0 mm
pupil diameter throughout surgery. Although iris prolapse was still possible,
there were no significant intraoperative or postoperative complications despite
the fact that 93% of the eyes had moderate to severe IFIS. All eyes achieved a
best corrected visual acuity of at least 20/25. There was a tendency for ring
deformation if flash sterilization was used without sufficient cooling time.
CONCLUSIONS: The disposable Malyugin pupil expansion device was highly effective
at maintaining an adequate pupil opening in eyes with IFIS. It is easier and
faster to use than iris retractors and other pupil expansion rings and
represents an excellent small-pupil strategy.

PMID: 18471643 [PubMed - in process]

11: J Cataract Refract Surg. 2008 May;34(5):831-4. 

Vitreous loss during phacoemulsification in glaucoma patients: Long-term
intraocular pressure control.

Sharma TK, Nessim M, Kyprianou I, Kumar V, Shah P, O\'Neil E.

From the Birmingham and Midland Eye Centre, City Hospital, Birmingham, United
Kingdom.

PURPOSE: To assess the long-term effect of vitreous loss during
phacoemulsification on intraocular pressure (IOP) control in glaucoma patients.
SETTING: Birmingham and Midland Eye Centre, City Hospital, Birmingham, United
Kingdom. METHODS: In this study, 26 glaucoma cases with vitreous loss during
phacoemulsification were identified from operative room records. The cases were
performed from January 1999 to December 2001. Minimum follow-up was 12 months.
Postoperative IOP control in eyes with vitreous loss (Group 1) was assessed and
compared with that in stable fellow eyes (Group 2), which served as controls.
Another control group (Group 3) comprised patients with primary open-angle
glaucoma who had successful phacoemulsification. Case notes of 22 patients from
the same period fulfilled these criteria. RESULTS: The 3 groups were comparable
in age, sex, laterality, ethnicity, mean IOP, and mean number of medications
preoperatively. Twelve months after surgery, 43.2% in Group 1, 23.1% in Group 2
(P<.05) and 4.5% in Group 3 had significantly worse IOP; the differences between
Group 1 and Groups 2 and 3 were statistically significant (P<.05). Intraocular
pressure control was significantly better in Group 3 than in Group 2 (P<.05).
CONCLUSIONS: Vitreous loss during cataract surgery in glaucoma patients
adversely affected IOP control in the long term. Results suggest that uneventful
cataract surgery in glaucoma patients improves IOP control.

PMID: 18471642 [PubMed - in process]

12: J Cataract Refract Surg. 2008 May;34(5):827-30. 

Combined phacoemulsification and viscogoniosynechialysis in patients with
refractory acute angle-closure glaucoma.

Razeghinejad MR.

From the Department of Ophthalmology and Poostchi Ophthalmology Research Center,
Khalili Hospital, Shiraz Medical University, Shiraz, Iran.

PURPOSE: To evaluate the effectiveness of phacoemulsification and
viscogoniosynechialysis in managing refractory acute angle-closure glaucoma
(ACG) unresponsive to laser iridotomy and medical therapy. SETTING: Department
of Ophthalmology, Khalili Hospital, Shiraz Medical University, Shiraz, Iran.
METHODS: Eleven patients with acute ACG who did not respond to standard therapy
and who had peripheral anterior synechia (PAS) of 270 degrees or less had
phacoemulsification and viscogoniosynechialysis. After phacoemulsification, the
anterior chamber was deepened with an ophthalmic viscosurgical device, which was
then injected near the angle without touching any ocular structure to release
the PAS. RESULTS: Eleven patients with a mean age of 58.9 years were included
over a mean follow-up of 7.8 months. Preoperatively, the mean intraocular
pressure (IOP) was 39.4 mm Hg and the mean number of antiglaucoma medications,
3.8. Postoperatively, the mean IOP decreased to 13.4 mm Hg (P = .003) and the
mean number of medications, to 0.4 (P = .002). The mean logMAR visual acuity
improved from 0.94 to 0.55 (P = .007). In 8 eyes (72.8%), IOP was controlled
without antiglaucoma therapy. Of patients whose IOP was controlled with
medication, 1 was on 3 medications and the others on 1 medication. In all
patients except the one whose IOP was controlled by 3 medications, the
previously occluded trabecular meshwork was exposed over 360 degrees on
gonioscopy. CONCLUSION: Combined phacoemulsification and viscogoniosynechialysis
was an effective and safe treatment for the management of refractory acute ACG
that was unresponsive to laser iridotomy and medical therapy.

PMID: 18471641 [PubMed - in process]

13: J Cataract Refract Surg. 2008 May;34(5):823-6. 

Effect of a single intraoperative sub-Tenon injection of triamcinolone acetonide
on the progression of diabetic retinopathy and visual outcomes after cataract
surgery.

Kim SY, Yang J, Lee YC, Park YH.

From the Department of Ophthalmology and Visual Science, College of Medicine,
Catholic University of Korea, Seoul, Korea.

PURPOSE: To assess the effect of a single intraoperative sub-Tenon injection of
triamcinolone acetonide on the progression of diabetic retinopathy (DR), visual
outcomes, and cystoid macular edema (CME) after cataract surgery. SETTING:
Department of Ophthalmology and Visual Science, College of Medicine, The
Catholic University of Korea, Seoul, Korea. METHODS: This prospective controlled
study comprised 46 eyes of 23 diabetic patients. The control group comprised
eyes not treated with a triamcinolone acetonide injection, and the triamcinolone
group comprised contralateral eyes treated with a single posterior sub-Tenon
injection of triamcinolone acetonide at the end of cataract surgery. The visual
acuity, central macular thickness (CMT) by optical coherence tomography, and
progression of DR were compared between the 2 groups. RESULTS: One month
postoperatively, the mean change in lines of best corrected visual acuity was
significantly greater in the triamcinolone group (P = .045) and the mean change
in CMT was significantly greater in the control group (P = .015). The incidence
of CME was higher in the control group (P = 0.04). Scores for progression of DR
at 6 months were not statistically significantly different between the 2 groups
(P = 0.08). CONCLUSIONS: A posterior sub-Tenon injection of triamcinolone
acetonide lowered the incidence of CME after cataract surgery in diabetic
patients, improved visual recovery, and reduced the amount of CMT increase in
the short term (/=1 line) in 53% of 142 eyes in the first
year, 57% of 66 eyes in the second year, and 58% of 33 eyes in the first year or
remained stable (no lines lost) in 20%, 24%, and 29%, respectively. Two patients
had continuous progression of keratoconus and had repeat crosslinking
procedures. CONCLUSIONS: Despite the low number of patients with a follow-up
longer than 3 years, results indicate long-term stabilization and improvement
after collagen crosslinking. Thus, collagen crosslinking is an effective
therapeutical option for progressive keratoconus.

PMID: 18471635 [PubMed - in process]

19: J Cataract Refract Surg. 2008 May;34(5):789-95. 

Comparison of and correlation between anterior and posterior corneal elevation
maps in normal eyes and keratoconus-suspect eyes.

Schlegel Z, Hoang-Xuan T, Gatinel D.

From Ophthalmology, Rothschild Foundation and AP-HP Bichat-Claude Bernard
Hospital, and the Center of Expertise and Research in Optics for Clinicians,
Paris, France.

PURPOSE: To compare the anterior and posterior corneal elevation maps between
keratoconus-suspect eyes and normal eyes. SETTING: Rothschild Foundation, AP-HP,
University Paris VII, Hopital Bichat Claude Bernard, Paris, France. METHODS: The
anterior and posterior corneal surface elevations were analyzed and compared in
60 normal myopic patients and 48 keratoconus-suspect patients. The anterior and
posterior best-fit sphere radii, central and thinnest corneal pachymetries,
anterior and posterior aconic shape parameters (aconic radius, aconic
asphericity, aconic toricity), and anterior and posterior elevation in the 1.0
mm radius zone were analyzed. The correlations between elevation and aconic
shape parameters between the anterior and posterior surfaces were compared.
RESULTS: The mean central and thinnest pachymetry values were significantly
lower in keratoconus-suspect eyes (P<.0001). Compared with normal eyes,
keratoconus-suspect eyes had significantly increased anterior toricity (P =
.0002) and posterior toricity (P<.0001), more negative asphericity (P = .042),
and higher posterior elevation (P<.0001). The correlation between aconic
toricity and the anterior and posterior corneal surfaces was better in
keratoconus-suspect eyes than in normal eyes. Aconic asphericity and apical
curvature were less correlated in keratoconus-suspect eyes than in normal eyes.
CONCLUSIONS: The posterior corneal elevation and the corneal thickness values
were different in keratoconus-suspect eyes. The correlation between the anterior
and posterior corneal aconic shapes was between keratoconus-suspect eyes and
normal eyes.

PMID: 18471634 [PubMed - in process]

20: J Cataract Refract Surg. 2008 May;34(5):785-8. 

Changes in posterior corneal elevation after laser in situ keratomileusis
enhancement.

Vicente D, Clinch TE, Kang PC.

From the Georgetown University School of Medicine (Vicente), Washington,
District of Columbia, and a private practice (Clinch, Kang), Chevy Chase,
Maryland, USA.

PURPOSE: To evaluate changes in posterior corneal elevation using the Pentacam
topographer (Oculus) in patients having laser in situ keratomileusis (LASIK)
enhancement. SETTING: Private practice, Chevy Chase, Maryland, USA. METHODS: The
Pentacam device was used to evaluate the changes in posterior corneal elevation
above the best-fit sphere before LASIK enhancement and after LASIK enhancement
in 24 eyes. The change in posterior corneal elevation in eyes for which
pre-primary LASIK data were available was also evaluated. RESULTS: After LASIK
enhancement, the mean change in posterior corneal elevation was 5 mum. The mean
posterior corneal elevation was 12 +/- 7 mum before LASIK enhancement and 16 +/-
6 mum after enhancement; the difference was statistically significant (P =
.004). In eyes for which pre-primary LASIK data were available, the mean change
in posterior corneal elevation after primary LASIK was 2 mum. The mean posterior
corneal elevation was 11 +/- 5 mum before LASIK enhancement and 11 +/- 7 mum
after enhancement. CONCLUSIONS: There was a statistically significant difference
in posterior corneal elevation between before LASIK enhancement and after LASIK
enhancement. However, the change in posterior corneal elevation was much smaller
than previously reported values and below the sensitivity of the Pentacam
topographer.

PMID: 18471633 [PubMed - in process]

21: J Cataract Refract Surg. 2008 May;34(5):774-84. 

Objective accommodation measurements in prepresbyopic eyes using an
autorefractor and an aberrometer.

Win-Hall DM, Glasser A.

University of Houston, College of Optometry, Houston, Texas, USA.

PURPOSE: To test the repeatability of the iTrace wavefront aberrometer (Tracey
Technologies, Inc.) and the WR-5100K autorefractor (Grand Seiko Co., Ltd.) and
to measure accomodation in young and phakic prepresbyopic subjects. SETTING:
University of Houston, College of Optometry, Houston, Texas, USA. METHODS: This
study comprised 30 young adults and 15 prepresbyopic subjects. Accommodation was
stimulated with near charts presented at various distances. Measurements were
repeated 3 times for each target distance with both instruments. For test-retest
reliability, the entire protocol was repeated on 3 additional days in 3
prepresbyopic subjects as well as twice on the same day in the young adults.
RESULTS: The mean age was 25.5 years +/- 3.25 (SD) (range 21 to 31 years old) in
the young adult group and 41.2 +/- 2.98 years (range 38 to 49 years) in the
prepresbyopic group. Bland-Altman analysis of repeated measures of the young
subjects had limits of agreements (LoA) of 1.58 diopters (D) or less for each
instrument and when compared between instruments. Normalized mean stimulus
response functions in the prepresbyopic group were similar for the 2
instruments. Bland-Altman analysis of the accommodation measurements between the
2 instruments showed a mean difference of 0.07 D and an LoA of 0.70 D. Repeated
measures of 3 prepresbyopic subjects had a range of standard deviations from
0.07 to 0.51 D. CONCLUSION: The accommodative responses measured with the 2
instruments were not significantly different, and testing showed both
instruments to be suitable for objective measurement of accommodation in a
phakic prepresbyopic population with low accommodative amplitudes.

PMID: 18471632 [PubMed - in process]

22: J Cataract Refract Surg. 2008 May;34(5):769-73. 

Intraindividual comparison of color contrast sensitivity in patients with clear
and blue-light-filtering intraocular lenses.

Schmidinger G, Menapace R, Pieh S.

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

PURPOSE: To evaluate the effect of blue-light-filtering intraocular lenses
(IOLs) with a yellow chromophore on color contrast sensitivity by
intraindividual comparison with an identically designed IOL without a blue-light
filter. SETTING: Medical University of Vienna, Department of Ophthalmology,
Vienna, Austria. METHODS: Randomized implantation of an AF-1 (UV) IOL (Hoya) in
1 eye and an AF-1 (UY) IOL (Hoya) in the contralateral eye was performed after
phacoemulsification and primary posterior curvilinear capsulorhexis. Three
months postoperatively, the best distance-corrected visual acuity was evaluated.
Before color contrast sensitivity testing, a heterochromatic flicker test was
performed in both eyes to avoid error in brightness matching. Central and
peripheral tritan color contrast sensitivities were evaluated using the
Moorfields Vision System (CH Electronics). RESULTS: Visual acuity did not differ
significantly between the 2 IOL groups (P>.05). The central color contrast
sensitivity threshold also did not differ significantly between eyes with a
clear IOL and eyes with a yellow IOL at any tested spatial frequency. The
peripheral color contrast sensitivity test showed slightly higher color contrast
sensitivity thresholds in eyes with a yellow IOL, although the differences were
not statistically significant. Two patients independently reported subjective
changes in color perception in the eye with the yellow IOL. CONCLUSION: In this
intraindividual comparison, the implantation of a blue-light-filtering IOL did
not lead to a clinically significant change in color contrast sensitivity.

PMID: 18471631 [PubMed - in process]

23: J Cataract Refract Surg. 2008 May;34(5):763-768. 

Optical quality of the eye after lens replacement with a pseudoaccommodating
intraocular lens.

Montes-Mico R, Ferrer-Blasco T, Charman WN, Cervino A, Alfonso JF,
Fernandez-Vega L.

From the Optometry Research Group (Montes-Mico, Ferrer-Blasco, Cervino), Optics
Department, University of Valencia, and the Fernandez-Vega Ophthalmological
Institute (Alfonso, Fernandez-Vega), Valencia, and the Surgery Department
(Alfonso, Fernandez-Vega), School of Medicine, University of Oviedo, Oviedo,
Spain; Faculty of Life Sciences (Charman), University of Manchester, Manchester,
United Kingdom.

PURPOSE: To examine the optical quality of healthy presbyopic eyes before and
after implantation of the pseudoaccommodating AcrySof ReSTOR Natural intraocular
lens (IOL) (Alcon Laboratories) by measuring visual acuity and wavefront
aberrations. SETTING: University of Valencia, Fernandez-Vega Ophthalmological
Institute, Valencia, Spain. METHODS: Monocular refraction and photopic distance
(6 m) and near (0.33 m) visual acuities were determined before and after clear
lens extraction with bilateral AcrySof ReSTOR Natural IOL implantation in 30
hyperopic eyes (+0.50 to +4.00 diopters [D]) of presbyopic patients with low
astigmatism (.05). In contrast,
a significant axial shift of the IOL in the anterior direction was observed in
control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive
shift was significantly higher in control eyes than in eyes with PPCCC-POBH
(P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly
reduced postoperative anterior movement of the IOL.

PMID: 18471628 [PubMed - in process]

26: J Cataract Refract Surg. 2008 May;34(5):743-8. 

Modified transscleral fixation technique for refixation of dislocated
intraocular lenses.

Nikeghbali A, Falavarjani KG.

From the Eye Research Center, Rassoul Akram Hospital, Iran University of Medical
Sciences, Tehran, Iran.

PURPOSE: To evaluate the results of transscleral fixation of dislocated
posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics
through a clear corneal incision. SETTING: Department of Ophthalmology, Rassoul
Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. METHODS: This
retrospective interventional case series comprised 21 eyes (21 patients) in
which a dislocated posterior chamber IOL was transsclerally refixated using a
small superior clear corneal incision for externalization of the haptics. The
suture was tied to the externalized haptic, after which the tied haptic was
placed back in the anterior chamber and dialed to externalize the second haptic.
After the second externalized haptic was tied, the IOL was reimplanted in the
ciliary sulcus. The minimum follow-up was 6 months. RESULTS: The mean follow-up
was 42.7 months +/- 21 (SD). The difference between the mean best corrected
visual acuity before IOL dislocation (0.34 +/- 0.21 logMAR) and the mean after
IOL refixation (0.38 +/- 0.19 logMAR) was not statistically significant (P =
.16, t test). During follow-up, the PC IOL remained well centered in all eyes
and no tilt or dislocation was observed. CONCLUSION: Scleral fixation of
dislocated PC IOLs using temporary haptic externalization through a clear
corneal incision minimized the need for complicated intraocular maneuvers, had a
low incidence of complications, and provided an easy and effective way to
reposition dislocated PC IOLs.

PMID: 18471627 [PubMed - in process]

27: J Cataract Refract Surg. 2008 May;34(5):735-42. 

Long-term effects of phacoemulsification with intraocular lens implantation in
normotensive and ocular hypertensive eyes.

Poley BJ, Lindstrom RL, Samuelson TW.

From Volunteers in Medicine (Poley), Hilton Head, South Carolina, and a private
practice (Lindstrom, Samuelson), Minneapolis, Minnesota, USA.

PURPOSE: To evaluate the long-term effect of phacoemulsification with
intraocular lens (IOL) implantation alone in normotensive and ocular
hypertensive eyes. SETTING: Private practices, Minneapolis, Minnesota, and
Savannah, Georgia, USA. METHODS: The IOP before surgery, 1 year after surgery,
and at the final chart recording in 588 eyes having phacoemulsification with IOL
implantation was retrospectively reviewed. Before surgery, eyes were divided
into 5 groups based on IOP at surgery, patient age at surgery, years of
postoperative follow-up, and a comparison between IOP at 1 year and IOP at the
final check. RESULTS: The final mean IOP reduction was 6.5 mm Hg (27%) in the 31
to 23 mm Hg presurgical IOP group (n = 19), 4.8 mm Hg (22%) in the 22 to 20 mm
Hg group (n = 62), 2.5 mm Hg (14%) in the 19 to 18 mm Hg group (n = 86), and 1.6
mm Hg (9%) in the 17 to 15 mm Hg group (n = 223). In the 14 to 9 mm Hg group (n
= 198), the mean IOP at the final examination was 0.2 mm Hg higher (0.1%
increase). CONCLUSIONS: Stratifying eyes according to presurgical IOP showed
greater long-term IOP reductions than previously reported. The reduction was
proportional to the presurgical IOP. The decrease was greatest in eyes with the
highest presurgical IOP. The IOP remained unchanged in eyes with the lowest
presurgical IOP. The IOP reductions at 1 year were sustained over 10 years and
were similar in patients of all ages.

PMID: 18471626 [PubMed - in process]

28: J Cataract Refract Surg. 2008 May;34(5):727-34. 

Repeatability of corneal first-surface wavefront aberrations measured with
Pentacam corneal topography.

Shankar H, Taranath D, Santhirathelagan CT, Pesudovs K.

From the Department of Ophthalmology, Flinders Medical Centre, Bedford Park,
South Australia, Australia.

PURPOSE: To assess the repeatability of corneal wavefront aberrations derived
from Pentacam (Oculus) corneal topography. SETTING: Flinders Eye Centre,
Flinders Medical Centre, Bedford Park, South Australia, Australia. METHODS:
Forty-five normal participants and 10 participants with keratoconus were tested.
Intraobserver and interobserver repeatability was determined using 4 observers
within and between sessions. Topographical maps were exported to external
software, and corneal first-surface wavefront aberrations were calculated using
a 10th-order Zernike expansion over a 6.0 mm optical zone. Repeatability was
determined with Bland-Altman limits of agreement and expressed as the
coefficient of repeatability (COR). RESULTS: Initial data showed high wavefront
aberrations in normal participants and poor repeatability. Topographical maps
showed extrapolated topography in zones without data acquisition; maps with less
than 6.0 mm of complete data were excluded in the final analysis. The mean
wavefront aberrations for normal participants remained high, but repeatability
improved. The COR relative to the magnitude of wavefront aberrations was high
(average 100%) across all modal pairs and orders, although best for total
higher-order root mean square. Participants with keratoconus had higher
magnitude wavefront aberrations and poorer repeatability but similar COR to
average wavefront aberration ratios. Examination of raw elevation data showed
poor repeatability. CONCLUSIONS: Wavefront aberrations calculated from Pentacam
corneal topography were large in magnitude, and reliability was poor, largely
due to variability in corneal elevation data. Intraobserver and interobserver
reliability within and between sessions was comparable. The Pentacam was not
reliable in measuring corneal wavefront aberrations.

PMID: 18471625 [PubMed - in process]

29: J Cataract Refract Surg. 2008 May;34(5):724-726. 

Modified Malyugin ring iris expansion technique in small-pupil cataract surgery
with posterior capsule defect.

Agarwal A, Malyugin B, Kumar DA, Jacob S, Agarwal A, Laks L.

From Dr. Agarwal\'s Eye Hospital and Eye Research Centre (Amar Agarwal, Athiya
Agarwal, Kumar, Jacob), Chennai, India; the Department of Cataract and Implant
Surgery (Malyugin), S. Fyodorov Eye Microsurgery Complex State Institution,
Moscow, Russia; and MicroSurgical Technology (Laks), Redmond, Washington, USA.

We describe a simple technique involving modification of iris expansion with the
Malyugin ring (MicroSurgical Technology) in nondilating small-pupil cataract
surgery with preexisting posterior capsule defect or intraoperative posterior
capsule tear. A 6-0 polyglactin suture is placed in the leading scroll of the
Malyugin ring, and the end of the suture is secured at the main port incision.
This prevents the iris expander from inadvertently dropping into the vitreous
during intraoperative manipulation.

PMID: 18471624 [PubMed - as supplied by publisher]

30: J Cataract Refract Surg. 2008 May;34(5):723. 

May consultation # 5.

Randleman JB.

Atlanta, Georgia, USA.

PMID: 18471623 [PubMed - in process]