from the editor
Seeing and believing
Emanuel S. Rosen, FRCSE

guest editorial
Restoring accommodation to the presbyopic eye: How do we measure success?
W.N. Charman, PhD, DSc

letters
Misleading statistical comparison
Retinal nerve fiber loss after acute intraocular pressure elevation
Low-dose tissue plasminogen activator
Flap position in laser in situ keratomileusis
Why is the A-constant not a constant?

consultation section
cataract surgical problem, edited by Samuel Masket, MD
A 1-eyed 55-year-old woman with congenital glaucoma sustained a retinal detachment earlier and now has moderate cataract formation and progressive loss of zonules with increasing phacodonesis.
David Allen, FRCOphth, Chris Wood, FRCOphth, David Steel, FRCOphth, Ehud Assia, MD, Alessandro Franchini, MD, James A. Davison, MD, Harry B. Grabow, MD, Marlene R. Moster, MD, Louis D. Nichamin, MD, Matteo Piovella, MD, Fabrizio Camesasca, MD, Thomas W. Samuelson, MD, Bradford J. Shingleton, MD

techniques
Subluxated lens: Phacoemulsification with iris hooks
Severino Santoro, MD, Carmela Sannace, MD, Maria Caterina Cascella, MD, Nicola Lavermicocca, MD

Sealed-capsule irrigation device
Amar Agarwal, MS, FRCS, FRCOphth, Sunita Agarwal, MS, Athiya Agarwal, MD, Anthony Maloof, MD

Endoillumination-assisted cataract surgery in a patient with corneal opacity
Akira Nishimura, MD, PhD, Akira Kobayashi, MD, PhD, Yasunori Segawa, MD, PhD, Kazuhisa Sugiyama, MD, PhD

Cataract surgery without preoperative eyedrops
Robert J. Cionni, MD, Marci´lio G. Barros, MD, Adam H. Kaufman, MD, Robert H. Osher, MD

articles
Understanding the accommodating intraocular lens  
Azhar Rana, MD, David Miller, MD, Peter Magnante, PhD
This study theoretically evaluated various accommodating IOL configurations (ie, singlets and doublets) and calculated the accommodative amplitudes for different amounts of IOL movement. The distance required to achieve a given amount of accommodation was inversely related to the power of a moving convex lens.

Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure 2288 elevation after phacoemulsification
John M. Katsimpris, MD, Dimitrios Siganos, MD, Anastasios G.P. Konstas, MD, PhD, Vassilios Kozobolis, MD, Nikolaos Georgiadis, MD
Brimonidine drops controlled IOP elevations after small-incision cataract surgery.

In vivo and in vitro repeatability of Hartmann-Shack aberrometry
Alireza Mirshahi, MD, Jens Bühren, MD, Daniel Gerhardt, MD, Thomas Kohnen, MD
Small HOAs will be difficult to eliminate because the repeatability of Hartmann-Shack measurements is poor.

Effect of laser in situ keratomileusis on optic nerve head topography and retinal nerve fiber layer thickness  
Jess T. Whitson, MD, James P. McCulley, MD, H. Dwight Cavanagh, MD, PhD, Julia Song, MD, R. Wayne Bowman, MD, Lars Hertzog, MD
LASIK did not produce changes in optic nerve head topography or nerve fiber layer thickness as measured by the Heidelberg Retina Tomograph in myopic patients treated with or without betaxolol.

To lift or recut: Changing trends in LASIK enhancement
Roy S. Rubinfeld, MD, David R. Hardten, MD, Eric D. Donnenfeld, MD, Raymond M. Stein, MD, Douglas D. Koch, MD, Mark G. Speaker, MD, PhD, Joseph Frucht-Pery, MD, Anthony J. Kameen, MD, Gerald J. Negvesky, MD
Recutting LASIK flaps resulted in a significant loss of BCVA and subjective visual difficulties.

Understanding, retaining, and removing dispersive and pseudodispersive ophthalmic viscosurgical devices  
Steve A. Arshinoff, MD, FRCSC, Edward Wong
Both dispersive and viscoadaptive OVDs demonstrate enhanced anterior chamber retention as a result of the inability of the aspirating port to maintain contact with the OVD, but for different reasons.

Stability of refraction, accommodation, and lens position after implantation of the 1CU accommodating posterior chamber intraocular lens
Michael Küchle, MD, Berthold Seitz, MD, Achim Langenbucher, PhD, Peter Martus, PhD, Nhung X. Nguyen, MD, for the Erlangen Accommodative Intraocular Lens Study Group
For up to 12 months after implantation, the 1CU accommodating IOL provided stable refraction, IOL position, accommodation, and distance-corrected near visual acuity.

Lack of fluorophotometric evidence of aqueous–vitreous barrier disruption after posterior capsulorhexis  
Veva De Groot, MD, Mia Hubert, PhD, Jaap A. Van Best, PhD, Sanne Engelen, Stefan Van Aelst, PhD, Marie-José Tassignon, MD, PhD
This fluorophotometric study found that a surgically controlled posterior curvilinear capsulorhexis did not enhance the passage of fluorescein from the anterior chamber into the anterior vitreous at least 1 year after cataract surgery compared to the fellow control eye operated on with the same surgical technique but without capsulorhexis.

Two-year results of conductive keratoplasty for the correction of low to moderate hyperopia
Danny Y. Lin, MD, Edward E. Manche, MD
Mild hyperopic regression and refractive stability were observed at the 2-year follow-up after CK. At 2 years, CK demonstrated excellent safety, efficacy, and predictability profiles.

Comparison of LADARVision and Visx Star S3 laser in situ keratomileusis outcomes in myopia and hyperopia
Michael S. Seward, MD, Deniz Oral, MD, R. Wayne Bowman, MD, Mohamed-Sameh H. El-Agha, MD, H. Dwight Cavanagh, MD, PhD, James P. McCulley, MD
LASIK treatment of hyperopia in this study found superior results with LADARVision compared with Visx Star S3. No difference was seen in treatment of low and moderate myopia.

Epithelial-defect-masquerade syndrome after laser in situ keratomileusis: Characteristic clinical findings and visual outcomes
Dimitri T. Azar, MD, Amy Scally, OD, Sadeer B. Hannush, MD, Sarkis Soukiasian, MD, Mark Terry, MD
Epithelial ingrowth should be suspected in cases of delayed reepithelialization and persistent epithelial defects after LASIK.

Intracameral mydriatics in phacoemulsification cataract surgery
Björn Lundberg, MD, Anders Behndig, MD, PhD
Intracameral mydriatics were a safe and efficient mydriatic regimen for phacoemulsification surgery. Although they resulted in slightly smaller pupils, the pupils did not contract during surgery.

Prednisolone and flurbiprofen drops to maintain mydriasis during phacoemulsification cataract surgery
M. Yusuf Shaikh, FRCS, J. Simon Mars, FRCOphth, Chris J. Heaven, FRCS
In the presence of epinephrine in the intraocular irrigating solution, pretreatment with topical flurbiprofen 0.03% or prednisolone 1% failed to produce a clinically meaningful miosis-inhibiting effect compared to a placebo.

Treatment of acute pseudophakic cystoid macular edema: Diclofenac versus ketorolac
David S. Rho, MD
A randomized prospective study of 34 patients with clinical CME after cataract surgery showed equal efficacy of diclofenac sodium 0.1% solution and ketorolac tromethamine 0.5% in improving CME and visual acuity.

Neodymium:YAG laser capsulotomy in vitrectomized pseudophakic eyes with persistent endotamponade
Thomas S. Dietlein, MD, Christoph Lu¨ke, MD, Philipp C. Jacobi, MD, Bernd Kirchhof, MD, Guenter K. Krieglstein, MD
An Nd:YAG laser capsulotomy in pseudophakic eyes with endotamponade was successfully performed in selected cases. However, the rate of reintervention was relatively high and the prognosis was limited because of retinal pathology.

Transscleral fixation of a foldable intraocular lens in aphakic vitrectomized eyes
Jae Kyoun Ahn, MD, Hyeong Gon Yu, MD, Hum Chung, MD, Won Ryang Wee, MD, Jin-Hak Lee, MD
Secondary transscleral fixation of a foldable PC IOL through a small incision can be another option for visual rehabilitation in aphakic vitrectomized eyes with previous severe vitreoretinal disease.

Refractive outcomes after arcuate keratotomy using the Terry astigmatome
Mehmet Baykara, MD, Murat Dogru, MD, PhD, Hikmet Özçetin, MD
Arcuate keratotomy using a Terry astigmatome was safe and reliable in selected cases of astigmatism.

Effect of central corneal thickness on surgically induced astigmatism in cataract surgery
Se Joon Woo, MD, Jin-Hak Lee, MD
Surgically induced astigmatism 1 day after temporal, clear corneal incision cataract surgery had a negative correlation with central corneal thickness when the previous astigmatism was against the rule.

Traumatic subconjunctival crystalline lens dislocation
Nazife Sefi Yurdakul, MD, Şeyda Uğurlu, MD, Ayça Yilmaz, MD, Ahmet Maden, MD
Scleral rupture with crystalline lens dislocation into the subconjunctival space secondary to blunt trauma is rare. The visual outcome is reasonably good with timely intervention.

laboratory science
Effect of ophthalmic viscosurgical devices on lens epithelial cells: A morphological study
Camille Budo, MD, G. Goffinet, Dennis Bellotto, W. Matthew Petroll, PhD
Study in a rabbit model suggest that OVDs should be used carefully in phakic IOL procedures.

update/review
Ectasia after laser in situ keratomileusis
Perry S. Binder, MD
Eighty-five post-LASIK ectasia case reports were analyzed. In cases without preexisting corneal pathology, no specific residual corneal thickness was associated with the risk for ectasia.

case reports
Refractive lensectomy and accommodating lens implantation in a case of hyperopia
Ingrid E. Lehrer, MD, Manfred R. Tetz, MD, Katharina Dumke, Peter Ruokonen, MD

Imaging scleral expansion bands for presbyopia with optical coherence tomography
Christopher Wirbelauer, MD, Amir Karandish, MD, Henning Aurich, MD, Duy Thoai Pham, MD

Collamer intraocular lens implantation with active uveitis
Jonathan Stanwood Till, MD

Implantation of a custom intraocular lens with a 30-diopter torus for the correction of high astigmatism after penetrating keratoplasty
Mana Tehrani, MD, Bernhard Stoffelns, MD, H. Burkhard Dick, MD

Effect of flap hinge placement on post-laser in situ keratomileusis wound healing in the presence of superior corneal vascularization
Trevin R. Wallin, MD, Mitchell P. Weikert, MD, Majid Moshirfar, MD

Corneal perforation after conductive keratoplasty with previous refractive surgery
George D. Kymionis, MD, PhD, Patrik Titze, MD, Marinos M. Markomanolakis, MD, Ioannis M. Aslanides, MD, PhD, Ioannis G. Pallikaris, MD, PhD

Favorable outcome using a black diaphragm intraocular lens for traumatic aniridia with total iridectomy
Yung-Jen Chen, MD, Pei-Chang Wu, MD

Suture fixation of an intraocular lens combined with pars plana vitrectomy and gas tamponade
Tsukasa Hanemoto, MD, Hidenao Ideta, MD, Tsutomu Kawasaki, MD, Ryuichi Ideta, MD, Michiko Okuyama, MD

correspondence
Injection of an intraocular lens without an injector
Martin Wenzel, MD, Frank Auer, MD, Martin Bechmann, MD

Pseudokeratoprosthesis after corneal melt in a pseudophakic eye
Mohammed Musadiq, FRCS, Thomas Paul Joseph Meaney, FRCOphth, Vinod Kumar, FRCOphth

Water modulation of lens epithelial cells during cataract surgery
Jonathan G. Crowston, FRCOphth, Anthony Maloof, FRANZCO, Paul Healey, FRANZCO, Geoff Neilson, E. John Milverton, FRANZCO

our appreciation

2003 index

information for authors

assignment of copyright form

Continuing Medical Education
CME Coordinator: David E. Silverstone, MD

Ophthalmologists who read the Journal of Cataract & Refractive Surgery can now earn 5 CME credits in Category 1 of the Physician's Recognition Award of the American Medical Association. Questions have been developed for 5 articles in this issue, marked with a symbol () in the table of contents. Detailed instructions and a copy of the CME quiz can be obtained from the ASCRS web site (http://www.ascrs.org) or ASCRS Fax-on-Demand (732-578-4472).

The American Society of Cataract and Refractive Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. ASCRS takes responsibility for the content, quality, and scientific integrity of this CME activity.

The American Society of Cataract and Refractive Surgery designates this educational activity for a maximum of 5 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.