from the editor
Aberration-correcting intraocular lenses
Thomas Kohnen, MD

guest editorial
Creutzfeldt-Jakob disease and eye surgery–new disease, old disease
Andrew Tullo, MD, FRCOphth

letters
Conjunctival lymphatic system
Staining acrylic IOLs
Comments on anesthesia for cataract surgery
Healon5 as a treatment option for recurrent flat anterior chamber after trabeculectomy

consultation section
cataract surgical problem, edited by Samuel Masket, MD
A 74-year-old 1-eyed woman has colobomatous microphthalmos and a very dense cataract for which she was referred.
Garry P. Condon, MD, David F. Chang, MD, Daniel A. Black, FRACO, FRACS, Douglas D. Koch, MD, Joseph Caprioli, MD, Luis W. Lu, MD, Michael E. Snyder, MD, Dean Corbett, MBChB, FRANZCO, Stephen S. Lane, MD

techniques
Visualizing vitreous using Kenalog suspension
Scott E. Burk, MD, PhD, Andrea P. Da Mata, MD, Michael E. Snyder, MD, Susan Schneider, MD, Robert H. Osher, MD, Robert J. Cionni, MD

articles
Impact of a modified optic design on visual function: Clinical comparative study
Ulrich Mester, MD, Patrick Dillinger, MD, Nicola Anterist, MD
The average spherical aberration of the eye can be compensated by an aspherical IOL with a prolate anterior surface, resulting in significant improvement in contrast sensitivity.

Laser-assisted subepithelial keratectomy for myopia: Two-year follow-up
Rudolf Autrata, MD, PhD, Jaroslav Rehurek, MD, PhD
In a prospective comparative study of 184 eyes, LASEK significantly reduced the level of postoperative pain and corneal haze compared to PRK.

Intraocular lens movement caused by ciliary muscle contraction  
Oliver Findl, MD, Barbara Kiss, MD, Vanessa Petternel, MD, Rupert Menapace, MD, Michael Georgopoulos, MD, Georg Rainer, MD, Wolfgang Drexler, PhD
Ciliary muscle contraction caused forward movement of plate- and ring-haptic IOLs, resulting in less than 0.5 D accommodation in most cases. No forward movement was found with 3-piece IOLs.

Measurement of accommodation after implantation of an accommodating posterior chamber intraocular lens
Achim Langenbucher, PhD, Stefan Huber, Nhung X. Nguyen, MD, Berthold Seitz, MD, Gabriele C. Gusek-Schneider, MD, Michael Küchle, MD
Results show that accommodation after implantation of accommodating IOLs should be assessed using several techniques, including subjective and objective.

Cataract surgery in patients with age-related macular degeneration: One-year outcomes
Ana Maria Armbrecht, DO, FRCS(Ed), Catherine Findlay, MSc, PhD, Peter Alan Aspinall, MSc, PhD, Adrian Robert Hill, PhD, FCOptom, FAAO, Baljean Dhillon, BMedSci, FRCOphth, FRCS(Ed), FRCS(Glasg)
Patients with ARMD having cataract surgery had significant improvement in objective and self-perceived visual function with no increased risk of progression to wet ARMD.

Clinical results of excimer laser photorefractive keratectomy for high myopic anisometropia in children: Four-year follow-up  
Rudolf Autrata, MD, PhD, Jaroslav Rehurek, MD, PhD
Multizone PRK in 21 children with high myopic anisometropia and contact-lens intolerance provided excellent visual and refractive results, with acceptable safety and efficacy indices and good binocular vision over a long-term follow-up.

Distance and near contrast sensitivity function after multifocal intraocular lens implantation
Robert Montés-Micó, OD, MPhil, Jorge L. Alió, MD, PhD
Distance contrast sensitivity with the Array multifocal IOL was similar to that with monofocal IOLs 3 to 6 months postoperatively. Near correction improved with time but was always lower than at distance and than near corrected vision with monofocal IOLs.

Peripheral corneal relaxing incisions combined with cataract surgery
Li Wang, MD, Manjula Misra, MD, Douglas D. Koch, MD
Peripheral corneal relaxing incisions effectively reduced preexisting astigmatism during cataract surgery. A nomogram is proposed.

Limbal relaxing incisions for primary mixed astigmatism and mixed astigmastism after cataract surgery
Hüseyin Bayramlar, MD, Mutlu C. Dağlioğlu, MD, Mehmet Borazan, MD
Limbal relaxing incisions corrected primary mixed astigmatism and mixed astigmatism after cataract surgery with no serious complications.

Low-dose tissue plasminogen activator in the management of anterior chamber fibrin formation
Nick Georgiadis, MD, Kostas Boboridis, MD, Nick Halvatzis, MD, Nicolas Ziakas, MD, Vagia Moschou, MD
Low-dose tissue plasminogen activator (0.2 mL of 125 μg/mL) was a safe and efficient method with minimal side effects for the management of postoperative anterior chamber fibrin formation.

Corneal endothelial cell protection with a dispersive viscoelastic material and an irrigating solution during phacoemulsification: Low-cost versus expensive combination
Barbara Kiss, MD, Oliver Findl, MD, Rupert Menapace, MD, Vanessa Petternell, MD, Matthias Wirtitsch, MD, Thomas Lorang, PhD, Manfred Gengler, PhD, Wolfgang Drexler, PhD
A combination of Viscoat and BSS Plus (expensive combination) was only slightly more effective than Ocucoat with Ringer’s solution (inexpensive combination) in protecting the cornea during phacoemulsification.

Evaluation of the practicality of optical biometry and applanation ultrasound in 253 eyes
Mana Tehrani, MD, Frank Krummenauer, PhD, Eric Blom, MD, H. Burkhard Dick, MD
In eyes scheduled for cataract surgery, 17% could not be measured with optical biometry because of poor visual acuity and lens opacity; 4% could not be measured with ultrasound biometry.

Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound
Mana Tehrani, MD, Frank Krummenauer, PhD, Rajiv Kumar, MD, H. Burkhard Dick, MD
Optical biometry and ultrasound applanation biometry produced statistically significant differences in axial length measurements in patients with cataract or a clear crystalline lens.

Corneal topographic results after eccentric, biconvex penetrating keratoplasty
Ágnes Kerényi, MD, Ildikó Süveges, DSc
Eccentric, biconvex PKP sparing the visual axis may provide a regular central corneal surface and corresponding good visual acuity.

Special Section: The Cornea After LASIK
Clinical

Recovery of corneal sensation after myopic correction by laser in situ keratomileusis with a nasal or superior hinge  
Yuji Kumano, MD, Hiroyasu Matsui, MD, Ikuko Zushi, MD, Asami Mawatari, Takao Matsui, MD, Teruo Nishida, MD, Miho Miyazaki, MD
A large decrease in corneal sensitivity was apparent 1 month after LASIK. Corneal sensitivity remained significantly decreased but had recovered slightly by 3 months after surgery, and recovery appeared complete by 12 months.

Changes in corneal asphericity after laser in situ keratomileusis
Rosario G. Anera, PhD, Jose R. Jiménez, PhD, Luis Jiménez del Barco, PhD, Javier Bermúdez, PhD, Enrique Hita, PhD
Increases in postsurgical corneal asphericity higher than expected justify the proposal of new ablation algorithms and the study of variables that could influence the ablation.

Quality of vision after laser in situ keratomileusis: Influence of dioptric correction and pupil size on visual function
Yuan-Chieh Lee, MD, Fung-Rong Hu, MD, I-Jong Wang, MD, PhD
The amount of attempted correction of spherical equivalent or astigmatism was correlated with glare and halo symptoms after LASIK. Pupil size was not significantly correlated with these symptoms, BSCVA, or contrast sensitivity in post-LASIK patients with "uniform" topography who have scotopic pupils not larger than 7.0 mm.

Early spatial changes in the posterior corneal surface after laser in situ keratomileusis
Do-Hyung Lee, MD, PhD, Sejung Seo, MD, Kui Won Jeong, MD, PhD, Soo-Cheol Shin, OD, John A. Vukich, MD
The extent of postsurgical forward shift of the posterior corneal surface was analyzed relative to the residual stromal thickness and ablation ratio per total cornea. Increased forward shift correlated with a thinner residual corneal bed and a higher ablation percentage.

Sequential lift and suture technique for post-LASIK corneal striae
Richard J. Mackool, MD, Vivian R. Monsanto, MD
A suturing technique designed to eliminate post-LASIK corneal striae is described. The method of suturing and sequence of flap elevation reduces the time required for the procedure, eliminates the need to fixate the flap with forceps, and increases the accuracy of suture placement.

Keratectasia in 2 cases with pellucid marginal corneal degeneration after laser in situ keratomileusis  
Rajesh Fogla, DNB, FRCS, Srinivas K. Rao, DO, Prema Padmanabhan, MS
Iatrogenic keratectasia is a potential complication following LASIK in eyes predisposed to corneal ectasia. Rapid progression of PMCD is noted if LASIK is performed in these eyes.

Laser in situ keratomileusis combined with topography-supported customized ablation after repeated penetrating keratoplasty
Zoltán Z. Nagy, MD
Laser in situ keratomileusis combined with topography-supported customized ablation in a patient with high spherical myopia and irregular astigmatism after PKP resulted in a significant reduction in spherical myopia and astigmatism.

Laboratory Science

Corneal flap complications in refractive surgery: Part 1: Development of an experimental animal model
Mike P. Holzer, MD, Luis G. Vargas, MD, Helga P. Sandoval, MD, David T. Vroman, MD, Terrance J. Kasper, MD, Sandra J. Brown, RN, David J. Apple, MD, Kerry D. Solomon, MD
An animal model for corneal LASIK flap complications was developed and surgical parameters were evaluated to create reproducible and well-sized flaps.

Corneal flap complications in refractive surgery: Part 2: Postoperative treatments of diffuse lamellar keratitis in an experimental animal model
Mike P. Holzer, MD, Helga P. Sandoval, MD, Luis G. Vargas, MD, Terrance J. Kasper, MD, David T. Vroman, MD, David J. Apple, MD, Kerry D. Solomon, MD
Diffuse lamellar keratitis was induced in rabbit eyes and treated postoperatively with a mast-cell stabilizer, NSAID, fluoroquinolone antibiotic agent, or corticosteroid.

Histological and immunohistochemical findings after laser in situ keratomileusis in human corneas  
Wolfgang E. Philipp, MD, Lilly Speicher, MD, Wolfgang Göttinger, MD
The interlamellar or interface wound-healing response is generally very poor after LASIK with the consequence of a biomechanically ineffective superficial lamella.

Proteoglycan alterations in the rabbit corneal stroma after a lamellar incision
Andrew J. Quantock, PhD, Sara Padroni, MD, Che J. Connon, PhD, Gordon Milne, David J. Schanzlin, MD
Lamellar, microkeratome-based incisions of the cornea lead to the formation of unusually large proteoglycan filaments in the healing stroma that might help facilitate tissue remodeling.

Evaluation of corneal flap dimensions and cut quality using the SKBM automated microkeratome
Arne Viestenz, MD, Achim Langenbucher, PhD, Carmen Hofmann-Rummelt, Laszlo Modis, MD, Anja Viestenz, MD, Berthold Seitz, MD
Differences in blade quality and flap size and thickness were apparent with multiple use of blades in the SKBM microkeratome.

case reports
Implantation of Intacs and a refractive intraocular lens to correct keratoconus
Joseph Colin, MD, Sylvie Velou, MD

Anterior chamber iris-fixated phakic intraocular lens for anisometropic amblyopia
Ruchi Saxena, MS, Helena M. van Minderhout, BO, Gregorius P.M. Luyten, MD, PhD

Phakic implantation of a black intraocular lens in a blind eye with leukocoria
Robert H. Osher, MD, Michael E. Snyder, MD

Necrosis of the eyelids and sclera after retrobulbar anesthesia
Ashok Sharma, MD, Amit Gupta, MD, Supratik Bandyopadhyay, MD, Anand S. Vinekar, MBBS, Jagat Ram, MD, Mangat R. Dogra, MD, Amod Gupta, MD

Phacoemulsification in a case of microspherophakia
Sudarshan Khokhar, MD, Mayank S. Pangtey, MD, Parul Sony, MD, Anita Panda, MD

In-the-bag dislocation of a hydrophilic acrylic intraocular lens
Yvonne Hesse, MD, Christoph W. Spraul, MD, Karin A. Brückner, MD, Gerhard K. Lang, MD

correspondence
Bimanual retroIOL aspiration for complete removal of ophthalmic viscosurgical devices
Tanuj Dada, MD, Vijay K. Dada, MD, Harinder S. Sethi, MD

The Irvine-Francis Cannual: A new instrument for manual aspiration of tenacious subincisional cortex
Leanne M. Cheung, BSc(MED), MB BS(Hons), Meng K. Wan, MB BS, MPH, Simon Irvine, MB BS, FRANZCO, Ian C. Francis, FRACS, FRANZCO, FASOPRS

Phakonit with an AcriTec IOL
Amar Agarwal, MS, FRCS, FRCOpth, Sunita Agarwal, MS, FSVH, FRSH, DO, Athiya Agarwal, MD, DO, FRSH

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.