from the editor
Corneal thoughts
Emanuel S. Rosen, FRCSE

letters
Ciprofloxacin precipitates in the corneal epithelium
H.N. Madhavan, MD, PhD, Srinivas K. Rao, MD

Vanishing iris
Jean Oscar Kono Kono, MD, Ines M. Lanzl

Planned vitrectomy procedure
Robert H. Osher, MD

Bandage contact lens after LASIK
Richard J. Mackool, MD

Conjunctival ballooning during phacoemulsification
José R. Villada, MRCOphth, Jaime Javaloy, MD, Jorge L. Alió, MD, PhD

correspondence
Simultaneous microhook and endocapsular ring stabilization for compromised zonular apparatus
Vijay K. Dada, MBBS, MS, Namrata Sharma, MD, Mayank S. Pangtey, MD, Tanuj Dada, MD

In vitro comparison of ciprofloxacin, ofloxacin, and providone–iodine for surgical prophylaxis
Michael R. Keverline, MD, Regis P. Kowalski, MASCP, Deepinder K. Dhaliwal, MD

Trypan-blue-assisted posterior capsule plaque removal
Namrata Sharma, MD, Vishal Gupta, MD, Rasik B. Vajpayee, MBBS, MS

Topical sodium hyaluronate before LASIK
Pascal Annonier, MD, Anupam Chatterjee, MD, ChB, FRCSEd, Vinod Gupta, MD, FRCOphth, Lynn Wilcox, RGN

Intraocular lens with short haptics: A manufacturing defect
F. Hakan Öner, MD, Ismet Durak, MD

consultation section
cataract surgical problem, edited by Samuel Masket, MD
A 73-year-old active schoolteacher and musician with pseudoexfoliation had uneventful phacoemulsification and in-the-bag foldable acrylic IOL implantation 5 years ago. The IOL–capsular bag complex became loose; 2 attempts were made to achieve IOL centration and fixation. The patient presented with reduced acuity and glare disability in the right eye, which has a poorly fixated IOL with significant pseudophacodonesis and IOL tilt. The tilt induces 6.0 D of refractive astigmatism. Intraocular pressure is 26 mm Hg in the right eye, and pseudoexfoliation at the pupil margin and areas of broad synechias are seen. The left eye has modest nuclear cataract formation. What is the best management plan?
Roger C. Furlong, MD, David J. Spalton, FRCP, FRCS, FRCOphth, Louis D. "Skip" Nichamin, MD, Michael Blumenthal, MD, Luis W. Lu, MD, Oliver Findl, MD, Giuseppe Ravalico, MD, Tom Oetting, MD, Mahipal S. Sachdev, MD, Ike K. Ahmed, MD, FRCS(C)

techniques
Deep lamellar keratoplasty with trypan blue intrastromal staining
Emilio Balestrazzi, MD, Angelo Balestrazzi, MD, Luigi Mosca, MD, Alessandra Balestrazzi, MD

articles
Photorefractive keratectomy in children  
William F. Astle, MD, FRCS(C), Peter T. Huang, MD, FRCS(C), Anna L. Ells, MD, FRCS(C), Robin G. Cox, MB, BS, FRCP(C), Micheline C. Deschenes, MSc, Heather M. Vibert, OC(C)
Photorefractive keratectomy was an accurate and effective treatment modality in children who fail traditional forms of treatment for myopic anisometropia and bilateral high myopia.

Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis
Jack T. Holladay, MD, MSEE, Joseph A. Janes, OD
Topographic data after LASIK indicate the effective optical zone decreases and the aspheric Q-value increases (oblate direction) with the amount of excimer treatment.

Evaluation of corneal functional optical zone after laser in situ keratomileusis
Brian S. Boxer Wachler, MD, Vu N. Huynh, Ayman F. El-Shiaty, MD, Damien Goldberg, MS
The functional optical zone of the cornea decreased after LASIK. Spherical aberrations within the zone related to the amount of myopic treatment.

Methods of estimating corneal refractive power after hyperopic laser in situ keratomileusis
Li Wang, MD, David W. Jackson, MD, Douglas D. Koch, MD
Accuracy for determining corneal refractive power in hyperopic LASIK eyes could be improved significantly when the postoperative corneal topographic measurements were adjusted according to the amount of LASIK-induced refractive change. A nomogram was provided.

In vivo confocal microscopy through-focusing to measure corneal flap thickness after laser in situ keratomileusis  
Fusun Gokmen, MD, James V. Jester, MD, W. Matthew Petroll, PhD, James P. McCulley, MD, H. Dwight Cavanagh, MD, PhD
Flap thickness after LASIK performed with the ACS and Hansatome microkeratomes was measured by in vivo CMTF. Both microkeratomes significantly undercut corneal flaps, with the Hansatome showing significantly greater variation.

Strategy to reduce the number of patients perceiving impaired visual function after cataract surgery  
Mats Lundström, MD, PhD, Klas Göran Brege, MD, Ingrid Florén, MD, PhD, Ulf Stenevi, MD, PhD, William Thorburn, MD, PhD
A strategy for reducing the number of patients perceiving more visual disability after cataract surgery than before surgery was tested. The number of patients with specific reasons (anisometropia, disturbance from the fellow eye) for a poor outcome that the study focused on was considerably less.

Prophylactic intracameral cefuroxime: Efficacy in preventing endophthalmitis after cataract surgery  
Per G. Montan, MD, Gisela Wejde, MD, Gabor Koranyi, MD, Margareta Rylander, MD
One milligram of intracameral prophylactic cefuroxime instilled at the conclusion of 32180 cataract operations was associated with a low incidence (0.06%) of endophthalmitis. Only 1 endophthalmitis case was caused by a cefuroxime-sensitive bacterial strain.

Prophylactic intracameral cefuroxime: Evaluation of safety and kinetics in cataract surgery
Per G. Montan, MD, Gisela Wejde, MD, Hans Setterquist, MD, Margareta Rylander, MD, Charlotta Zetterström, MD
In cataract surgery, 1 mg of prophylactic intracameral cefuroxime raised no safety concerns. With an assumed constant elimination rate, the treatment achieved minimal inhibitory concentrations for relevant species for 4 to 5 hours postoperatively.

Determining the lowest trypan blue concentration that satisfactorily stains the anterior capsule
Huseyin Yetik, MD, Kazim Devranoglu, MD, Sehirbay Ozkan, MDD
Trypan blue stained the anterior capsule even at 0.0125% concentration, and staining was performed after viscoelastic injection into the anterior chamber. With these settings, the trypan blue is safer and easier to use routinely as the dye is carcinogenic.

Plate-haptic silicone intraocular lens implantation: Long-term results
Noémi Maár, MD, Irene Dejaco-Ruhswurm, MD, Martin Zehetmayer, MD, Christian Skorpik, MD
The 10-year results of Staar AA 4203 lens implantation suggest stable refraction, good IOL centration, and low Nd:YAG posterior capsulotomy rates.

Phacotrabeculectomy: Peripheral iridectomy or no peripheral iridectomy?
Bradford J. Shingleton, MD, Iftikhar M. Chaudhry, MD, Mark W. O’Donoghue, OD
In a retrospective study of 126 eyes of 117 patients randomized for peripheral iridectomy or no peripheral iridectomy during phacotrabeculectomy and followed for 12 months, there was no significant difference between the groups in vision, IOP, or bleb development. Complications were rare in both groups.

Results of cataract surgery in previously vitrectomized eyes
Zsolt Birö, MD, PhD, Balint Kovacs, MD, PhD
The results of manual and phacoemulsification cataract surgery in previously vitrectomized eyes were compared. Although the number of complications was similar between the 2 groups, phacoemulsification proved superior to manual ECCE because IOP was well controlled during surgery by the small incision.

Vitrectomy for retained lens fragments in the vitreous after phacoemulsification
Lars-Jörgen Hansson, MD, Jörgen Larsson, MD, PhD
Sixty-six eyes with retained lens fragments after phacoemulsification had vitrectomy–lensectomy. Neither the timing of the vitrectomy nor the phakic state of the eye significantly affected the outcomes.

Binocular function of the patient with the refractive multifocal intraocular lens
Nobuyuki Shoji, MD, Kimiya Shimizu, MD
Bilateral implantation with the refractive multifocal IOL produced better results; however, patients with unilateral implantation tended not to use spectacles for reading when the procedure was performed in the dominant eye.

Lidocaine versus ropivacaine for topical anesthesia in cataract surgery
Enrico Martini, MD, Gian Maria Cavallini, MD, Luca Campi, MD, Norma Lugli, MD, Giovanni Neri, MD, Paolo Molinari, MD
Comparison of the anesthetic performance of topical lidocaine and topical ropivacaine in cataract surgery found that ropivacaine is an adequate alternative to lidocaine for topical use.

Ropivacaine–lidocaine versus bupivacaine–lidocaine for retrobulbar anesthesia in cataract surgery
Harvey S. Uy, MD, Arnel A. de Jesus, MD, Alvin A. Paray, MD, John D.G. Flores, MD, Loreto B. Felizar, MD
Ropivacaine–lidocaine used as a retrobulbar anesthetic agent was as effective as bupivacaine–lidocaine in producing surgical analgesia and akinesia in ECCE.

laboratory science
Effect of indocyanine green intraocular stain on human and rabbit corneal endothelial structure and viability: An in vitro study
Glenn P. Holley, Abu Alam, PhD, Aantariksha Kiri, MD, PhD, Henry F. Edelhauser, PhD
Three-minute exposure of ICG 0.5% in BSS had no damaging effect on the corneal endothelium and provides safety data for using ICG stain in cataract surgery.

Digital image analysis of trypan blue and fluorescein staining of anterior lens capsules and intraocular lenses
Wilfram L. Fritz, MD
The intensity of anterior capsule staining with trypan blue or fluorescein was analyzed using digital photographic image analysis. There was rapid uptake of trypan blue and slow uptake of fluorescein. In PMMA and silicone IOLs, there was no staining and in acrylic IOLs, intense uptake of both dyes.

Bimanual phacoemulsification through 2 stab incisions: A wound-temperature study  
William Soscia, MD, James G. Howard, Randall J. Olson, MD
Creating a wound with ultrasound and a bare needle in human cadaver eye-bank eyes was difficult and clinically unlikely.

Microphacoemulsification with WhiteStar: A wound-temperature study
William Soscia, MD, James G. Howard, Randall J. Olson, MD
WhiteStar technology in a human cadaver eye-bank eye study eliminated the risk of wound burn with microphaco at all clinically reasonable parameters.

Visoelastic protection from endothelial damage by air bubbles
Eung Kweon Kim, MD, PhD, Stephen M. Cristol, MD, MPH, Shin J. Kang, MD, Henry F. Edelhauser, PhD, Hyung-Lae Kim, MD, Jae Bum Lee, MD
A viscoelastic material that remained in the eye during phacoemulsification protected the endothelium from damage by air bubbles.

update/review
New phacoemulsification technologies
I. Howard Fine, MD, Mark Packer, MD, Richard S. Hoffman, MD
New phacoemulsification technology including laser and sonic systems, power modulation, oscillatory tip motion, vortex phacoemulsification, and fluid-based cataract extraction are reviewed.

case reports
Lensectomy in the management of glaucoma in spherophakia
Colin E. Willoughby, FRCOphth, Peter K. Wishart, FRCS, FRCOphth

Cataract surgery in cataracta membranacea
Alexander H. Heuring, MD, Sabine Menkhaus, MD, Sven Walter, MD, Wolfgang Behrens-Baumann, MD

Surgical identification of posterior lenticonus
Thandalam S. Kalyanasundaram, FRCS(Oph), Michael A. Bearn, FRCS, FRCOphth

Late spontaneous resolution of a massive detachment of Descemet’s membrane after phacoemulsification
Maria T. Iradier, MD, Eva Moreno, MD, Concepcion Aranguez, MD, Juan Cuevas, MD, Julian García Feijoo, MD, Julian Garcia Sanchez, MD

Expulsive hemorrhage before phacoemulsification
Gennarfrancesco Iaccarino, MD, Nicola Rosa, MD, Mary Romano, MD, Luigi Capasso, MD, Antonio Romano, MD

Traumatic subluxation causing variable position of the crystalline lens
Angela V.P. Loo, FRCS, Jimmy S.M. Lai, FRCS, FRCOphth, Clement C.Y. Tham, FRCS, Dennis S.C. Lam, FRCS, FRCOphth

Pupillary block after phakic anterior chamber intraocular lens implantation
Navid Ardjomand, MD, Heimo Kölli, MD, Bertram Vidic, MD, Yosuf El-Shabrawi, MD, Jürgen Faulborn, 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).