from the editor
Intraocular lens power accuracy: How are we doing?
Nick Mamalis, MD

letters

Bipseudophakia

Deep lamellar keratoplasty with trypan blue intrastromal staining

Obtaining lenticules for lamellar transplantation

Defining mesopic and scotopic

Postoperative infectious endophthalmitis

Suture fixation of a foldable acrylic IOL

Capsule contraction in polypseudophakia

consultation section
refractive surgical problem, edited by Thomas Kohnen, MD
A 25-year-old man had bilateral LASIK for approximately −5.00 D. The BSCVA is now 20/40 with +0.75 −0.25 × 120 in the right eye, and the patient reports seeing 3 images. The LASIK flap with a superior hinge shows circular peripheral flap fibrosis, slight interface “haze,” and vertical folds starting from the superior hinge to the center of the flap. The patient asks for visual improvement in the right eye.
Michael C. Knorz, MD, John E. Sutphin, MD, Ayad A. Faro, MD, Perry S. Binder, MD, Jonathan H. Talamo, MD, Jorge L. Alió, MD, PhD

techniques
Management of posterior polar cataract  
I. Howard Fine, MD, Mark Packer, MD, Richard S. Hoffman, MD

articles

Bacterial endophthalmitis after small-incision cataract surgery: Effect of incision placement and intraocular lens type  
Yasunori Nagaki, MD, Seiji Hayasaka, MD, Chiharu Kadoi, MD, Masayuki Matsumoto, MD, Shuiichiro Yanagisawa, MD, Kazuhiko Watanabe, MD, Konomi Watanabe, MD, Yoriko Hayasaka, MD, Nariko Ikeda, MD, Shoichi Sato, MD, Yasushi Kataoka, MD, Mika Togashi, MD, Tomohiro Abe, MD
Bacterial endophthalmitis after small-incision cataract surgery was associated with the incision site but not with the IOL material.

Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema  
Mandi D. Conway, MD, Christina Canakis, MD, Charalampos Livir-Rallatos, MD, Gholam A. Peyman, MD
Eight eyes of 8 patients with recalcitrant chronic pseudophakic CME were injected intravitreally with 1 mg triamcinolone acetonide. Visual acuity improved in all patients; repeated injections were required.

Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: Four-year follow-up
José L. Güell, MD, PhD, Andrés F. Rodriguez-Arenas, MD, Oscar Gris, MD, PhD, Francoise Malecaze, MD, PhD, Fortino Velasco, MD
Extraction of the crystalline lens by uneventful phacoemulsification with implantation of an IOL is a relatively safe procedure for patients with myopia.

Retinal detachment after cataract extraction and refractive lens exchange in highly myopic patients
Giuseppe Ravalico, MD, Cinzia Michieli, MD, Odilla Vattovani, MD, Daniele Tognetto, MD
The functional results were good and the incidence of postoperative complications was low in highly myopic patients who had cataract extraction and low-power IOL implantation.

Outcomes of surgery for posterior polar cataract
Ken Hayashi, MD, Hideyuki Hayashi, MD, Fuminori Nakao, MD, Fumihiko Hayashi, MD
Removal of posterior polar cataracts can be performed safely if the appropriate surgical technique is selected based on size of the opacity and hardness of the lens nucleus.

Previous cataract surgery in a defined Swedish population
Mats Lundström, MD, Susanne Albrecht, RN
A study of the prevalence of previous cataract surgery in a defined Swedish population found that although there is a much higher prevalence than in the literature, the surgical volume is increasing, even in older age groups.

Small-incision manual extracapsular cataract surgery in Ghana, West Africa
James Paul Guzek, MD, Andrea Ching, MD
Small-incision extracapsular cataract surgery was performed in 200 eyes in rural West Africa with excellent results. Sutureless ECCE should be considered by visiting and national ophthalmologists.

Analysis of intraocular lens power calculation in post-radial keratotomy eyes
Lin Chen, MD, PhD, Mark J. Mannis, MD, James J. Salz, MD, Francisco J. Garcia-Ferrer, MD, Jayne Ge, MD
Hyperopia, a complication of post-RK cataract surgery, can be reduced from 83% to 42% when myopia is targeted and to 44% when a calculated K is used in IOL calculations.

Sex hormones and their receptors in patients with age-related cataract
Xiao-Hong Zhang, PhD, Hui-Min Sun, MD, Jian Ji, MD, Hong Zhang, MD, Wen-Jiang Ma, Zhi Jin, Jia-Qin Yuan, MD
There were no differences between men and women with age-related cataract in the levels of estradiol or progesterone in serum. The testosterone level was significantly higher in men than in women. The corresponding sex hormone receptors were not detected in cataract LECs.

Thyroid disease and vertical rectus muscle overaction after retrobulbar anesthesia
Soo Kyung Han, MD, Jeong-Min Hwang, MD
Permanent vertical strabismus after local anesthesia resulted from overactive vertical rectus muscles, mostly the superior rectus muscle. Half the patients having a thyroid function study had abnormal findings.

Special Section: Measuring Ocular Parameters

Optical and ultrasound measurement of axial length and anterior chamber depth for intraocular lens power calculation
János Németh, MD, PhD, Orsolya Fekete, MD, Norbert Pesztenlehrer, MD
The measurements for IOL calculation using the optical method based on partial coherence interferometry were as accurate as those using conventional ultrasound.

Comparison of anterior chamber depth measurement methods in phakic and pseudophakic eyes
Katharina Kriechbaum, MD, Oliver Findl, MD, Barbara Kiss, MD, Stefan Sacu, MD, Vanessa Petternel, MD, Wolfgang Drexler, MD
Anterior chamber depth measurements assessed with the optical photographic technique of the IOLMaster correlated with laser interferometry in phakic eyes but not in pseudophakic eyes.

Comparison of 2 A-scans
Sverker Norrby, PhD, Eva Lydahl, MD, PhD, Gabor Koranyi, MD, Mikaela Taube, RN
Separate A-constants are sometimes required because of systemic differences between equipment for axial length measurement. Much confusion about IOL power calculation could be avoided if standards were set.

Reduction of trend errors in power calculation by linear transformation of measured axial lengths  
Sverker Norrby, PhD, Eva Lydahl, MD, PhD, Gabor Koranyi, MD, Mikaela Taube, RN
Power calculation usually results in the undercorrection of short eyes and overcorrection of long eyes, despite personalization of formula constants. Transformation of axial length data, to a scale that is optimal for the calculation formula used, reduces these errors and improves the overall predictability of postoperative refraction.

Comparison of 4 methods for quantifying posterior capsule opacification  
Oliver Findl, MD, Wolf Buehl, MD, Rupert Menapace, MD, Michael Georgopoulos, MD, Georg Rainer, MD, Hannes Siegl, MSc, Alexandria Kaider, MSc, Axel Pinz, PhD
In a study comparing 3 PCO analysis systems and subjective grading, the fully automated AQUA analysis system showed promising results.

Comparison of a digital and a handheld infrared pupillometer for determining scotopic pupil diameter
Thomas Kohnen, MD, Evdoxia Terzi, MD, Jens Bühren, MD, Eva-Maria Kohnen, MD
The digital infrared pupillometer (Procyon) showed higher repeatability and agreement in measuring scotopic pupil size than a handheld device (Colvard).

Objective method to measure corneal clarity before and after laser in situ keratomileusis
Jay W.W. Chan, MPhil, Marion H. Edwards, PhD, George C. Woo, OD, PhD, Victor C.P. Woo, MD
An objective and reliable technique in corneal clarity measurement is demonstrated and applied to LASIK eyes. Corneal clarity decreased after LASIK but recovered rapidly 1 month after surgery.

Central and peripheral corneal thickness measurement with Orbscan II and topographical ultrasound pachymetry
Jose Manuel González-Méijome, OD, Alejandro Cerviño, OD, Eva Yebra-Pimentel, OD, PhD, Manuel A. Parafita, MD, PhD
Orbscan II measurements would agree better with those of ultrasound pachymetry if equations were applied to the center and peripheral measurements.

Autorefractory after laser in situ keratomileusis
Dimitrios S. Siganos, MD, PhD, Corina Popescu, MD, Nikolaos Bessis, DOpt, Georgios Papastergiou, MD
After LASIK, automated refractometry tends to overestimate spherical and cylinder power compared to subjective refraction even under cycloplegia. Retreatments after LASIK should be based on subjective refraction rather than automated refractometry.

Clinical application of the Lens Opacities Classification System III in the performance of phacoemulsification
James A. Davison, MD, Leo T. Chylack Jr., MD
Using the LOCS III cataract grading system allows surgeons to better estimate the ultrasound energy and BSS volume needed during phacoemulsification.

laboratory science

Adhesion of soluble fibronectin, vitronectin, and collagen type IV to intraocular lens materials
Reijo J. Linnola, MD, PhD, Malin Sund, MD, PhD, Riikka Ylönen, MD, Taina Pihlajaniemi, MD, PhD
A significant difference in fibronectin adhesion to hydrophobic and hydrophilic soft acrylate IOLs was found when IOLs were incubated with radioactive-iodine-labeled fibronectin.

Wound healing in rabbit corneas after photorefractive keratectomy and laser in situ keratomileusis
Takeshi Miyamoto, MD, Shizuya Saika, MD, Akio Yamanaka, MD, Yoshiji Kawashima, MD, Yoshitaka Suzuki, Yoshitaka Ohnishi, MD
Cellular response by keratocytes and epithelial cells was more marked in rabbit corneas treated by PRK than in those treated by LASIK.

Effect of 3-piece AcrySof and downsized heparin-surface-modified poly(methyl methacrylate) intraocular lenses in infant rabbit eyes
Anna Lundvall, MD, Charlotta Zetterström, MD, PhD, Björn Lundgren, PhD, Ulla Kugelberg, MD, PhD
In infant rabbit eyes, both a downsized HSM PMMA IOL and an AcrySof IOL reduced after-cataract formation; neither IOL affected axial length. However, the AcrySof was deformed and caused occlusion of the pupil.

Scanning electron microscopic and histologic evaluation of the AcrySof SA30AL acrylic intraocular lens: Manufacturing quality and morphology in the capsular bag
Marcela Escobar-Gomez, MD, David J. Apple, MD, Luis G. Vargas, MD, Liliana Werner, MD, PhD, Stella N. Arthur, MD, Suresh K. Pandey, MD, Andrea M. Izak, MD, Josef M. Schmidbauer, MD
Evaluation of the AcrySof SA30AL single-piece foldable posterior chamber IOL showed excellent surface finish. The lens is characterized by a truncated optic edge, which facilitated reduction of PCO.

update/review

Possible adverse effects of drugs used in refractive surgery
Frederick W. Fraunfelder, MD, Larry F. Rich, MD
Side-effect profiles of medications used in corneal refractive surgery are reviewed, and guidelines for managing patients who may develop an adverse drug reaction are provided.

special report

International Intraocular Lens & Implant Registry 2003
Jack T. Holladay, MD, MSEE

case reports

Recurrence of keratitis after excimer laser keratectomy
Nada S. Jabbur, MD, Terrence P. O'Brien, MD

Conductive keratoplasty to correct residual hyperopia after corneal surgery
Ian F. Comaish, FRCOphth, Michael A. Lawless, FRACO, FRCOphth

Localized liquefied after-cataract
Izumi Namiki, MD, Kensaku Miyake, MD, Ichiro Ota, MD, Sampei Miyake, MD

Sudden decrease in vision caused by liquefied after-cataract
Vinícius Coral Ghanem, MD, Emir Amin Ghanem, MD

Recurrence of secondary opacification and development of a dense posterior vitreous membrane in patients with myotonic dystrophy
Inger K. Gjertsen, MD, Kjell U. Sandvig, MD, PhD, Nils Eide, MD, Birger A. Olsen, MD

Corneal degeneration after silicone oil tamponade in a photorefractive keratectomy treated eye
Oliver Pinter, MD, Anton Haas, MD, Christph Faschinger, MD

correspondence

Corneal ectasia after LASIK
Hani G. Faraj, MD, Damien Gatinel, MD, Philippe J. Chastang, MD, Thanh Hoang-Xuan, MD

Traumatic laceration of a posterior capsule
Preston H. Blomquist, MD

Herpes simplex keratitis after photorefractive keratectomy
Zoltan Zsolt Nagy, MD, Edit Keleman, MD, Andrea Kovacs, 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 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).