from the editor
LASIK reporting: Preserving our responsibility to our patients
Douglas D. Koch, MD

letters
Bacterial contamination of the anterior chamber during phacoemulsification
Floaterectomy
Hydrodissection and cortex removal times
Predicting changes in corneal asphericity after hyperopic LASIK
Flap-induced aberration
Concern about long-term results of IOL implantation in Fuchs’ heterochromic uveitis
Biocompatibility

erratum

consultation section
cataract surgical problem, edited by Samuel Masket, MD
Complicated cataract surgery resulted in loss of iris tissue, complex retinal detachment, glare disability, and symptomatic anisometropia.
Jorge L. Alió, MD, PhD, Priscilla Perry Arnold, MD, William J. Fishkind, MD, Rupert Menapace, MD, Randall J. Olson, MD, Ehud Assia, MD, Ken Hayashi, MD, Thomas A. Oetting, MD, Steven H. Dewey, MD, Thomas Kohnen, MD

techniques
Cataract induction in pig eyes using viscoelastic endothelial protection and a formaldehyde—methanol mixture
Vinicius S. Saraiva, MD, Fabio H.C. Casanova, MD
Small-gauge, sutureless pars plana vitrectomy to manage vitreous loss during phacoemulsification
K.V. Chalam, MD, Shailesh K. Gupta, MD, Sanjay Vinjamaram, MD, Vinay A. Shah, MD

articles
Interaction between aberrations to improve or reduce visual performance   
Raymond A. Applegate, OD, PhD, Jason D. Marsack, Roberto Ramos, Edwin J. Sarver, PhD
The RMS wavefront error is not a good predictor of high contrast acuity for typical state-of-the-art refractive surgery outcomes. New metrics must be developed based on the optical transfer function, the neural transfer function, or both.

Epi-LASIK: Comparative histological evaluation of mechanical and alcohol-assisted epithelial separation
Ioannis G. Pallikaris, MD, PhD, Irini I. Naoumidi, PhD, Maria I. Kalyvianaki, MD, Vikentia J. Katsanevaki, MD
Mechanical separation of human cornea epithelial disks had less effect on the epithelial integrity than deepithelialization by alcohol concentrations of 15% or 30%.

Photorefractive keratectomy to correct hyperopic shift after radial keratotomy
Hélène Joyal, MD, Jacques Grégoire, MD, FRCSC, Anne Faucher, MD, FRCSC
This retrospective clinical series showed PRK to correct hyperopic shift after RK to be effective, predictable, and safe. It can be used successfully to correct RK-induced hyperopia in patients with small to moderate refractive errors.

Clinical outcomes of wavefront-guided laser in situ keratomileusis: 6-month follow-up
Daisuke Aizawa, MD, Kimiya Shimizu, MD, Mari Komatsu, MD, Misae Ito, MD, Masanobu Suzuki, MD, Koji Ohno, MD, Hiroshi Uozata, PhD
Wavefront-guided LASIK is a refractive surgery procedure that maintains and improves visual functions.

Optical aberrations of the human anterior cornea
Li Wang, MD, PhD, Eric Dai, MD, Douglas D. Koch, MD, Arif Nathoo
Anterior corneal wavefront aberrations varied greatly among subjects, and total HOA increased slightly with age.

Ablation centration in myopic laser in situ keratomileusis: Comparing the Visx S3 ActiveTrak and the Visx S2  
JoAnn A. Giaconi, MD, Edward E. Manche, MD
Ablation centration as well as visual and refractive results for myopic LASIK were similar with the pupil-tracking Visx S3 and the nontracking Visx S2 excimer lasers.

Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia
Antonio Leccisotti, MD, PhD, Stefania V. Fields, AO
Angle-supported phakic IOLs safely and effectively corrected myopia associated with keratoconus stage I to II and improved uncorrected and best corrected visual acuities. Astigmatism was unchanged but well tolerated by the patients.

Topical thiotepa treatment for recurrent corneal haze after photorefractive keratectomy
Ellen Anderson Penno, MD, Dennis A. Braun, OD, Aasim Kamal, MD, W. Keith Hamilton, MD, Howard V. Gimbel, MD
Five eyes with recurrent haze following myopic PRK were retreated with PTK and postoperative topical thiotepa. All eyes showed improved UCVA and BCVA.

Evaluation of the corneal endothelium after hyperopic laser in situ keratomileusis
Yoshiaki Nawa, MD, Tetsuo Ueda, MD, Kozo Masuda, ORT, Hidetoshi Ishibashi, MD, Yoshiaki Hara, MD, Hiroshi Uozato, PhD
Corneal endothelial cells did not decrease after hyperopic LASIK. Hypothetical calculation revealed that a +5.0 D correction invoked a 0.1% underestimation in the cell count.

Special Section: Posterior Capsule Opacification: Clinical

Posterior capsule opacification and neodymium:YAG capsulotomy rates with AcrySof acrylic and PhacoFlex II silicone intraocular lenses  
Paul H. Ernest, MD
In a fellow-eye comparison of the Alcon AcrySof MA30BA and the AMO PhacoFlex II SI-40NB, the AcrySof IOL led to a lower incidence and severity of PCO and fewer Nd:YAG capsulotomies.

Posterior capsule opacification after phacoemulsification: Silicone CeeOn Edge versus acrylate AcrySof intraocular lens  
Giovanni Prosdocimo, MD, Giorgio Tassinari, MD, Michele Sala, MD, Arturo Di Biase, MD, Pier Giorgio Toschi, MD, Maurizio Gismondi, MD, Ulisse Corbanese, MD
Eighteen months after phacoemulsification and in-the-bag IOL implantation, eyes with a silicone CeeOn Edge IOL had significantly less PCO than eyes with an acrylate AcrySof IOL.

Posterior capsule opacification: Comparison of 3 intraocular lenses of different materials and design
Gisela Wejde, MD, Maria Kugelberg, MD, Charlotta Zeterström, MD, PhD
In a prospective randomized single-surgeon study, the AcrySof MA60BM IOL led to significantly less PCO than the 809C HSM PMMA IOL and SI-40NB silicone IOL 2 years postoperatively.

Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy
Michael Georgopoulos, MD, Oliver Findl, MD, Rupert Menapace, MD, Wolf Buehl, MD, Matthias Wirtitsch, MD, Georg Rainer, MD
Neodymium:YAG laser capsulotomy altered the morphology of regeneratory secondary cataract in the surrounding posterior capsule and may lead to capsule opacification in eyes with silicone IOLs. Reclosure was observed with hydrogel IOLs.

Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation
Anthony Maloof, FRANZCO, Geoff Neilson, E. John Milverton, FRANZCO, Suresh K. Pandey, MD
Sealed-capsule irrigation provides a mechanism for precise evaluation of suitable pharmacologic agents to prevent PCO.

Posterior capsule opacification: Silicone plate-haptic versus AcrySof intraocular lenses
Kiran A. Abhilakh Missier, MD, Rudy M.M.A. Nuijts, MD, PhD, Khiun F. Tjia, MD
Posterior capsule opacification was significantly less and the Nd:YAG laser capsulotomy rate lower after AcrySof IOL implantation than after Staar plate-haptic IOL implantation. This did not seem to affect BCVA (logMAR) as there was no significant difference in this parameter between groups.

Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors
Nam Ju Kim, MD, Jin Hak Lee, MD
The rate of PCO was less in patients with risk factors for PCO when an acrylic IOl was implanted.

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after cataract surgery
Jagat Ram, MD, Gagandeep S. Brar, MD, Sushmita Kaushik, MD, Amit Gupta, MD, Amod Gupta, MD
Results show that PCO after cataract surgery in children depends on management of the posterior capsule rather than on IOL design or material.

Special Section: Posterior Capsule Opacification: Laboratory

Pharmacologic prevention of posterior capsule opacification: In vitro effects of preservative-free lidocaine 1% on lens epithelial cells
Luis G. Vargas, MD, Marcela Escobar-Gomez, MD, David J. Apple, MD, Daphne S. Hoddinott, Josef M. Schmidbauer, MD
Preservative-free lidocaine 1% diminished the amount of live LECs compared with BSS by facilitating cortical cleanup or by a mild direct toxic effect in a rabbit model. The use of this agent for hydrodissection might enhance cortical cleanup to the level of cell cleanup, thus helping to prevent PCO.

In vitro model for the study of human posterior capsule opacification  
Austen A.R. El-Osta, MSc, David J. Spalton, FRCS, FRCP, John Marshall, PhD
Evaluation of a method of maintaining postmortem capsular bags in vitro culture to study LEC dynamics showed that LECs grow more rapidly in young eyes than in old eyes and LECs from pairs of eyes have a similar proliferative potential. The model is suited to study the relationship between IOLs and LECs in vitro.

Transcription activation in lens epithelial cells after anterior capsule rubbing in rats: Expression of c-Fos
Kumi Shirai, MD, PhD, Shizuya Saika, MD, PhD, Yuka Okada, MD, PhD, Emiko Senba, MD, PhD, Yoshitaka Ohnishi, MD, PhD
C-Fos expression in equatorial LECs after minor mechanical stimulus to the anterior capsule indicates the activation of these cells upon minor stimuli to the capsule in rats.

Inhibition of lens epithelial cell migration at the intraocular lens optic edge: Role of capsule bending and contact pressure
Toshiyuki Nagamoto, MD, PhD, Takaaki Fujiwara, MD
A sharp capsule bend did not inhibit cell migration. Inhibition of cell migration at the optic edge was associated with contact pressure between the optic edge and the posterior capsule.

Implantation of a single-piece, hydrophilic, acrylic, minus-power foldable posterior chamber intraocular lens in a rabbit model: Clinicopathologic study of posterior capsule opacification
Luis G. Vargas, MD, Andrea M. Izak, MD, David J. Apple, MD, Liliana Werner, MD, PhD, Suresh K. Pandey, MD, Rupal H. Trivedi, MD
Low PCO scores were achieved after implantation of a biconcave, single-piece, hydrophilic acrylic foldable IOL in rabbit eyes. The IOL has a continuous square optic edge that forms a 360-degree barrier to LEC ingrowth.

case reports

Systematic underablation in laser in situ keratomileusis: Ablation pattern identified by advanced topographical analysis
Sandra M. Brown, MD, Charles E. Campbell

Inferior corneal steepening after a partial flap without laser ablation mimicking corneal ectasia
W. Andrew Lyle, MD, George J.C. Jin, MD, PhD

Preoperative neodymium:YAG anterior capsulotomy in intumescent cataract: Preventing extension of the capsular tear to the lens periphery
Josephine C. Richards, FCOphth(SA), Dale C. Harrison, FCOphth(SA)

Recurrent microhyphema despite intracapsular fixation of a posterior chamber intraocular lens
Rod Foroozan, MD, Janine G. Tabas, MD, Mark L. Moster, MD

Excessive fibrin after cataract surgery associated with aminocaproic acid use
Nada S. Jabbur, MD

Corneal bed perforation by laser ablation during laser in situ keratomileusis
Asuka Imamura, MD, Shiro Amano, MD, Tetsuro Oshika, MD

Traumatic cataract formation after vigorous ocular massage
Johnny Tang, MD, Ira J. Salzman, MD, Michael D. Sable, MD

correspondence

Device for intraoperative measurement of capsulorhexis dimensions
Incision width after single-piece AcrySof lens implantation with a Monarch injector

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.