from the editor
Measuring patient outcomes after refractive surgery
Douglas D. Koch, MD

letters
Staining the anterior capsule
Suresh K. Pandey, MD, Liliana Werner, MD, PhD, David J. Apple, MD

Combined technique: AK and LASIK
Louis D. Nichamin, MD

Misleading tonometry after LASIK
Robert K. Maloney, MD

Chronic or saccular endophthalmitis: diagnosis and management
José Augusto Abreu, MD, PhD, Luis Cordovès, MD

Postoperative myopia with subsequent hyperopic shift after phacoemulsification and multifocal IOL implantation
Girish G. Kamath, DO, MS, DNB, FRCSed, FRCOphth, Somdutt Prasad, MS, FRCSed, Yogesh J. Patwala, MS, MRCOphth, Russell P. Phillips, DO, FRCSed, FRCOphth, MD

consultation section
refractive surgical problem, edited by Thomas Kohnen, MD
A 41-year-old woman had bilateral hyperopic LASIK for symmetrical hyperopia 18 months previously. Surgery in the right eye was uneventful, but an incomplete flap was made in the left eye and no laser treatment was done. Now, the patient has intractable glare in the right eye, severely affecting driving and work. She wears a contact lens with difficulty in the left eye, and remedies including pilocarpine help little. The LASIK flap is well healed in the right eye and incomplete in the left. The hinges are nasal and flap diameters small in both eyes. Corneal topography shows evidence of poor treatment in the right eye and a normal corneal pattern in the left eye. Given the patient’s history and findings, how would you proceed?
Theo Seiler, MD, PhD, Ronald R. Krueger, MD, Ann Laurenzi, OD, Klaus Ludwig, MD, PhD, Michael A. Lawless, FRACO, FRACS, FRCOphth, M. Bowes Hamill, MD, Patrick I. Condon, MCh, FRCS, FRCOphth, Scott M. MacRae, MD, Dan Epstein, MD, PhD

techniques
Crater-and-chop technique for phacoemulsification in hard cataracts
M. Vanathi, MD, Rasik B. Vajpayee, MBBS, MS, Radhika Tandon, MD, FRCOphth, FRCS, Jeewan S. Titiyal, MD, Vishal Gupta, MD

Slipknot for scleral fixation of intraocular lenses
Shih-Chung Lee, MD, Sung-Huei Tseng, MD, Hon-Chun Cheng, MD, Fred Kuanfu Chen, MBBS(Hons)

articles
Patient outcomes of refractive surgery: the refractive status and vision profile
Oliver D. Schein, MD, MPH, Susan Vitale, PhD, MHS, Sandra D. Cassard, ScD, Earl P. Steinberg, MD, MPP
The Refractive Status and Vision Profile, a validated questionnaire, detected clinically significant change in functional status, quality of life, and satisfaction with vision following refractive surgery.

Rhegmatogenous retinal detachment in myopic eyes after laser in situ keratomileusis: frequency, characteristics, and mechanism
J. Fernando Arevalo, MD, Ernesto Ramirez, MD, Enrique Suarez, MD, Rafael Cortez, MD, George Antzoulatos, MD, Julian Morales-Stopello, MD, Gema Ramirez, MD, Francia Torres, MD, Rafael Gonzalez-Vivas, MD
Rhegmatogenous retinal detachment after LASIK to correct myopia was uncommon. Patients scheduled for LASIK should have a thorough dilated indirect fundoscopy and prophylactic treatment of any retinal lesion predisposing to the development of an RRD.

Accuracy of Orbscan pachymetry measurements and DHG ultrasound pachymetry in primary laser in situ keratomileusis and LASIK enhancement procedures
Nader G. Iskander, MD, Ellen Anderson Penno, MD, N. Timothy Peters, MD, Howard V. Gimbel, MD, PhD, Maria Ferensowicz
DGH ultrasound and Orbscan pachymetry measurements were assessed in corneas prior to primary LASIK and LASIK enhancements. Compared with theoretic bed thickness, DGH ultrasound was more accurate, especially in corneas that had had LASIK.

Refractive changes after excimer laser phototherapeutic keratectomy
Murat Dogru, MD, PhD, Chikako Katakami, MD, PhD, Akio Yamanaka, MD, PhD
Shallow ablations, installation of a transition zone, and use of masking agents appeared to lessen the hyperopic shift induced by PTK.

Assessment of anterior chamber flare and cells after laser in situ keratomileusis
Sherif M. El-Harazi, MD, Alice Z. Chuang, PhD, Richard W. Yee, MD
Anterior chamber flare and cells increased following LASIK. The inflammatory markers returned to the preoperative baseline measurements by day 7.

Color vision after laser in situ keratomileusis
Yi-Yu Tsai, MD, Jane-Ming Lin, MD
In this prospective study, color vision was evaluated preoperatively and 1 day, 1 week, and 1 month after LASIK. No significant difference was found.

Effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension after phacoemulsification and intraocular lens implantation
Jimmy S.M. Lai, FRCS, FRCOphth, John K.H. Chua, FRCS, Angela Loo, FRCS, S.Y. Ho, FRCS, Dennis S.C. Lam, FRCS, FRCOphth
Latanoprost produced no significant IOP-lowering effect when a single dose was given after phacoemulsification and PC IOL implantation. Its ineffectiveness was not the result of the concurrent use of intracameral acetylcholine.

Intraindividual comparison of the effects of a fixed dorzolamide - timolol combination and latanoprost on intraocular pressure after small incision cataract surgery
Georg Rainer, MD, Rupert Menapace, MD, Oliver Findl, MD, Vanessa Petternel, MD, Barbara Kiss, MD, Michael Georgopoulos, MD
In the early postoperative period, a fixed dorzolamide–timolol combination was more effective than latanoprost in reducing IOP after small incision cataract surgery

Anterior chamber maintainer versus viscoelastic material for intraocular lens implantation: case-control study
Bradford J. Shingleton, MD, Peter V. Mitrev, MD
The use of an anterior chamber maintainer system for implantation of a foldable IOL after phacoemulsification may result in lower first preoperative day IOP than use of a viscoelastic material.

Limbal relaxing incisions in congenital astigmatism: 6 month follow-up
Koray Budak, MD, Gül Yilmaz, MD, Bekir Sitki Aslan, MD, Sunay Duman, MD
A prospective study found that limbal relaxing incisions are a practical and conservative option for reducing astigmatism less than 2.00 D.

Corneal topographic changes induced by different oblique cataract incisions
Giorgio Beltrame, MD, Maria L. Salvetat, MD, Marzio Chizzolini, MD, Giobatta Driussi, MD
In a prospective study of different oblique cataract incisions, surgically induced astigmatism was of similar magnitude but different axis orientation in right and left eyes. The change in corneal shape was significantly less with the scleral tunnel incision.

Glistenings in the AcrySof intraocular lens: pilot study
Gregory Christiansen, MD, F. Jane Durcan, MD, Randall J. Olson, MD, Kathryn Christiansen, MPH
An examination of 42 AcrySof IOLs found that glistenings occurred frequently. A larger study is warranted to determine how glistenings change over time and affect vision.

Cellular reaction on the anterior surface of 4 types of intraocular lenses
Andrea Müllner-Eidenböck, MD, Michael Amon, MD, Jörg Schauersberger, MD, Andreas Kruger, MD, Claudette Abela, MD, Vanessa Petternel, MD, Thomas Zidek, MD
A study of 4 types of foldable IOLs found lens-related differences in cellular reaction after cataract surgery. The incidence of LECs was highest with the hydrogel Hydroview lens and lowest with the acrylic AcrySof. The lowest incidence of all cells was with the silicone CeeOn 920 IOL.

Simultaneous bilateral cataract extraction
Tarun K. Sharma, FRCSEd, Therese Worstmann, FRCS
A retrospective analysis of case notes of 144 patients (288 eyes) having bilateral cataract extraction simultaneously showed a satisfactory visual outcome without significant bilateral complications, indicating that the procedure is safe.

Shape of lens epithelial cells after intraocular lens implantation
Kiyoyuki Majima, MD, Yoshinao Majima, MD
Morphological observations after cataract surgery showed fibrous collagen fibers in regions with LECs and capsule contact with the IOL optic. The fibers appeared in more areas in eyes with a silicone IOL than in those with a PMMA IOL.

Epiretinal membranes after extracapsular cataract surgery
Claus E. Jahn, MD, Viktoria Minich, Stefan Moldaschel, MD, Birgit Stahl, MD, Philipp Jedelhauser, MD, Gundula Kremer, MD, Martina Kron, PhD
The prevalence of epiretinal membrane increased during the first 6 months after uneventful extracapsular cataract extraction.

laboratory Science
Differences in incision shape based on the keratome bevel
Junsuke Akura, MD, PhD, Taisaku Funakoshi, MD, Kazuaki Kadonosono, MD, PhD
Keratomes with 3 types of bevel were inserted into artificial sheets and domes. The incisions with the bibevel keratome had a linear shape, those with the bevel-down keratome had a V shape, and those with the bevel-up keratome, an inverse-V shape.

Effect of poly(ethylene glycol) graft polymerization of poly(methyl methacrylate) on cell Adhesion: In vitro and in vivo study
Mee Kun Kim, MD, In Suk Park, Hyung Dal Park, ME, Won Ryang Wee, MD, Jin Hak Lee, MD, Ki Dong Park, PhD, Soo Hyun Kim, PhD, Young Ha Kim, PhD
Poly(ethylene glycol) grafting decreased cell adhesion on PMMA. This process may be applicable to reduce retroprosthetic membrane formation in keratoprosthetic patients.

case reports
Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis
Gary S. Schwartz, MD, David H. Park, MD, Susan Schloff, MD, Stephen S. Lane, MD

Astigmatism after corneal thermal injury
Brian Chou, OD, Brian S. Boxer Wachler, MD

Postoperative inflammation in a patient with multiple sclerosis
James M. Coombs, F. Jane Durcan, MD

Acute transient bilateral diabetic posterior subcapsular cataracts
Preeti Sharma, MS, Abhay R. Vasavada, MS, FRCS

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).