from the editor
Infections after corneal refractive surgery: Can we do better?
Thomas Kohnen, MD

letters
Posterior capsule opacification in 5.5 mm versus 6.0 mm AcrySof lenses
Prashant Bhartiya, MD

Enlargement of a preexisting capsulorhexis
Mr. Nachiketa, MD, FRCSed, Vineeta Munshi, MD, FRCSed

Pars plana vitreous tap for phacoemulsification in the crowded eye
Richard J. Mackool, MD

Pupillary capture technique
Miguel Paciuc, MD

Use of the Fugo blade in complicated cases
Daljit Singh, MD, DSc

correspondence
Corneal endothelial cell density after trypan blue capsule staining in cataract surgery
Bart T.H. van Dooren, MD, Peter W.T. de Waard, MD, Hester Poort-van Nouhuys, MD, W. Houdijn Beekhuis, MD, Gerrit R.J. Melles, MD, PhD

Trypan-blue-assisted capsulorhexis for trainee phacoemulsification surgeons
Tanuj Dada, MD, Manotosh Ray, MD, Prashant Bhartiya, MD, Rasik B. Vajpayee, MBBS, MS

consultation section
cataract surgical problem, edited by Samuel Masket, MD
Dislocation of the capsule bag/IOL complex occurring several years after uneventful cataract surgery in eyes with pseudoexfoliation has become more prevalent since the advent of capsulorhexis and complete encasement of the IOL in the capsular bag. What is the best cataract surgical method in a relatively young, healthy individual with signs of pseudoexfoliation?
David F. Chang, MD, H. Burkhard Dick, MD, Richard L. Lindstrom, MD, Thomas W. Samuelson, MD, Nicole J. Anderson, MD, Okihiro Nishi, MD, Lisa Brothers Arbisser, MD, Robert H. Osher, MD, Robert J. Cionni, MD, Sükrü Bayraktar, MD, Mark Packer, MD, Ken Hayashi, MD, Abhay R. Vasavada, FRCS, James A. Davison, MD

techniques
Floaterectomy: Combined phacoemulsification and deep anterior vitrectomy
Federico Mossa, MD, Yvonne M. Delaney, MRCPI, FRCOphth, Paul H. Rosen, FRCS, FRCOphth, Rubina Rahman, FRCOphth

Two-incision push-pull capsulorhexis for pediatric cataract surgery
Ken K. Nischal, FRCOphth

Modified technique using flexible iris retractors in clear corneal cataract surgery
Thomas Oetting, MD, Luis C. Omphroy, MD

articles
Cyclotorsion: A possible cause of residual astigmatism in refractive surgery  
Martha J. Tjon-Fo-Sang, MD, PhD, Jan-Tjeerd H.N. de Faber, MD, Christine Kingma, CO, W. Houdijn Beekhuis, MD
Photorefractive keratectomy goals are based on binocular keratometry readings, whereas the treatment occurs under monocular fixation. Disruption of cyclofusion may result in cyclotorsion, resulting in residual astigmatism.

Correlation between refractive and measured corneal power changes after myopic excimer laser photorefractive surgery
Shuan Chen, MD, Fung-Rong Hu, MD
Corneal power measured by keratometry and videokeratography underestimated the actual corneal flattening after photorefractive surgery. This was adjusted by a linear regression formula.

Depth and age-dependent distribution of keratocytes in healthy human corneas: A study using scanning-slit confocal microscopy in vivo
Jens Berlau, PhD, Hans-Henner Becker, MD, Joachim Stave, PhD, Constanze Oriwol, MD, Rudolf F. Guthoff, MD
In healthy corneas, there was a high keratocyte density adjacent to Bowman’s and Descemet’s membranes and also fewer keratocytes in patients older than 50 years.

Intraocular pressure after bilateral cataract surgery using Healon, Healon5, and Healon GV  
Steve A. Arshinoff, MD, FRCSC, David A. Albiani, Janet Taylor-Laporte, RN, COA
In bilateral paired cataract surgery, there was no difference in IOP spikes among the Healon5, Healon GV, and Healon groups.

Effect of cataract surgery on the progression of diabetic retinopathy   
Jin Chung, MD, Mu-Yan Kim, MD, Hyeun-Seung Kim, MD, Jin-Seong Yoo, MD, Young-Chun Lee, MD
Diabetic retinopathy was more progressed in eyes having cataract surgery than in nonoperated fellow eyes. The presence of diabetic nephropathy aggravated retinopathy progression after cataract surgery in patients with preoperative diabetic retinopathy.

Topical versus retrobulbar anesthesia for combined phacotrabeculectomy: Prospective randomized study
Iqbal Ike K. Ahmed, MD, Norman A. Zabriskie, MD, Alan S. Crandall, MD, Thomas A. Burns, MD, Stephen C. Alder, PhD, Bhupendra C.K. Patel, MD
Topical anesthesia provided operative conditions and patient comfort comparable to that of retrobulbar anesthesia for combined phacotrabeculectomy in a prospective randomized study.

Long-term endothelial cell loss after phacoemulsification: Peribulbar anesthesia versus intracameral lidocaine 1%: Prospective randomized clinical trial  
Tim Heuermann, MD, Christian Hartmann, MD, PhD, Norbert Anders, MD, PhD
There was no statistically significant difference in corneal endothelial cell loss 20 months after cataract surgery with peribulbar anesthesia or with topical anesthesia by an intracameral lidocaine injection.

Biocompatibility of hydrophilic intraocular lenses
Daniele Tognetto, MD, Lisa Toto, MD, Enzo Ballone, PhD, Giuseppe Ravalico, MD
Results show that hydrogel IOLs have different forms of biocompatibility related to the chemical composition of the biomaterial.

Preliminary results of cataract extraction with implantation of a single-piece AcrySof intraocular lens
Aldo Caporossi, MD, Fabrizio Casprini, MD, Gian Marco Tosi, MD, Stefano Baiocchi, MD
Preliminary data show that the single-piece AcrySof SA30AL IOL has good biomechanical properties. The PCO observed in 1 case requires further study.

Significant postoperative refractive errors in vivo with the Mentor MemoryLens intraocular lens
Travis D. Nelson, Norman A. Zabriskie, MD, David E. Brodstein, MD, Matthew R. Baker, Steven C. Alder, Bradley W. Richards, MD
Eyes with a Mentor MemoryLens had significantly variable results compared with those with 2 other currently used IOLs, possibly because of the hydrophilic nature of the lens material.

Relationship of AcrySof acrylic and PhacoFlex silicone intraocular lenses to visual acuity and posterior capsule opacification
Michael T. Halpern, MD, PhD, Dave Covert, MBA, Carmelina Battista, PharmD, Arthur J. Weinstein, MD, Ralph D. Levinson, MD, Lihan Yan, MS
Based on claims data analysis, patients receiving MA30BA or MA60BM acrylic IOLs experienced less decrease in visual acuity, less PCO, and fewer Nd:YAG procedures than patients receiving SI-30NB or SI-40NB silicone IOLs.

Effect of laser in situ keratomileusis on retinal nerve fiber layer thickness measurements by scanning laser polarimetry
Michael S. Kook, MD, Sang-un Lee, MD, Hung-won Tchah, MD, Kyung-rim Sung, MD, Ryu-hwa Park, Kyung-rhee Kim
Laser in situ keratomileusis changed nerve fiber layer thickness measurements by scanning laser polarimetry. This should be considered when using scanning laser polarimetry as a diagnostic and follow-up tool for glaucoma.

Reversibility and exchangeability of intrastromal corneal ring segments
Stanley M. Chan, MD, Hamza N. Khan, MD, MPH
In 24 eyes with ICRS, ring segment exchange or removal with subsequent LASIK improved the refractive outcome. Removals achieved a reversal of the refractive effect within a mean of 4 weeks.

Predictability and outcomes of photoastigmatic keratectomy using the Nidek EC-5000 excimer laser
Sunil Shah, FRCSE, FRCOphth, Anupam Chatterjee, FRCSE, Ronald J. Smith, MD
Photorefractive keratectomy goals are based on binocular keratometry readings, whereas the treatment occurs under monocular fixation. Disruption of cyclofusion may result in cyclotorsion, resulting in residual astigmatism.

Selective argon laser suturelysis versus needle suturelysis to treat induced corneal astigmatism after cataract surgery
Chee-Chew Yip, MBBS (S’pore), MMed (Ophth), FRCSEd, FCSHK, Hung-Ming Lee, MBBS (S’pore), MMed (Ophth), FRCSEd, FAMS, Gerard Nah, MBChB (Aberd), MMed (Ophth), FRCSEd, Victor Yong, MBBS (S’pore), FRCSEd, FRCOphth, FAMS, Kah-Guan Au Eong, MBBS, MMed (Ophth), FRCSEd, FRCS(Glasg), DRCOphth, FAMS
Argon laser suturelysis was safe and effective in the treatment of corneal astigmatism after ECCE, and patients preferred it to needle suturelysis.

laboratory science
Alkalinization increases penetration of lidocaine across the human cornea  
Gabriele Fuchsjäger-Mayrl, MD, Martin Zehetmayer, MD, Herbert Plass, PhD, Klaus Turnheim, MD
In isolated human corneas, the effect of a solution pH change from 5 to 7 on the rate of penetration of lidocaine was studied. At pH 7, the corneal permeability of topically applied lidocaine was significantly increased, offering clinical advantages.

Downregulated expression of ADAM9 in anterior polar cataracts
Jung Min Lim, PhD, Jin-Hak Lee, MD, Won-Ryang Wee, MD, Choun-Ki Joo, MD
This study evaluated the regulation of ADAMs in LECs of patients with anterior polar cataracts and whether ADAMs are regulated by growth factors in cultured LECs.

Effect of vancomycin on Staphylococcus epidermidis adherence to poly(methyl methacrylate) intraocular lenses
Taraprasad Das, MD, Savitri Sharma, MD, Adiraju V. Muralidhar, Endophthalmitis Research Group
Staphylococcus epidermidis adhered to PMMA IOLs in high and low bacterial loads. Treating the IOLs with vancomycin reduced the bacterial adherence and thus could reduce post-cataract endophthalmitis. This suggests the possibility of devices that can be placed in the anterior chamber for sustained release of the antibiotic agent.

case reports

Bilateral acute postoperative retinal detachment after cataract extraction: Case report and review of the literature
Raymond Zimmerman, MD, Jay I. Perlman, MD, PhD

Stabilization of flat anterior chamber after trabeculectomy with Healon5
Richard S. Hoffman, MD, I. Howard Fine, MD, Mark Packer, MD

Posttraumatic neovascularization in a cataractous crystalline lens
Yih-Shiou Hwang, MD, Chi-Chun Lai, MD, Jiahn-Shing Lee, PhD, Ko-Jen Yang, MD, Tun-Lu Chen, MD

Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation
Javier Moreno-Montañés, MD, PhD, Hortensia Sánchez-Tocino, MD, Rosa Rodriguez-Conde, MD

Bilateral infectious keratitis after a laser in situ keratomileusis enhancement procedure
Palanisamy S. Suresh, MS, FRCS (Ed), David S. Rootman, MD, FRCSC

Methicillin-resistant Staphylococcus aureus keratitis after excimer laser photorefractive keratectomy
Werner Förster, MD, Karsten Becker, MD, Daniela Hungermann, MD, Holger Busse, MD

Reactivation of presumed adenovirual keratitis after laser in situ keratomileusis
Nilgün Safak, MD, Kamil Bilgihan, MD, Gökhan Gürelik, MD, Sengül Ö zdek, MD, Berati Hasanreisoglu, MD

Information for Authors

Assigment 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 five 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).