from the editor
Uncannily prescient
Emanuel S. Rosen, FRCSE

letters
Rapid removal of silicone oil after phacoemulsification combined with silicone oil removal through a posterior capsulorhexis
Harinder Singh Sethi, MD

Reinventing the wheel
Klaus D. Teichmann, MD

Incomplete conjunctival ballooning during phacoemulsification
Tarek A. Saleh, FRCSEd

Cortical removal simplified by J-cannula irrigation
Rajeev Sudan, MD, V.K. Dada, MS, R. Muralidhar, MBBS

consultation section
cataract surgical problem, edited by Samuel Masket, MD
A 70-year-old woman reports nocturnal glare after cataract surgery. She has modest decentration of a single-piece AcrySof IOL, and it appears that 1 haptic was placed in the bag while the other haptic was implanted in the ciliary sulcus. Compounding factors include intermittent exotropia and cataract in the fellow eye.
Richard B. Packard, MD, Paul H. Ernest, MD, Mario Oyarzu´n, MD, Stephen S. Lane, MD, Cze-Hong Low, MD, David W. Langerman, MD, Vladimir Pfeifer, MD, Kerry D. Solomon, MD, Robert J. Cionni, MD

techniques
Peeling the fibrous membrane from the anterior capsule for capsulorhexis contraction after phacoemulsification in aphakic patients
Kan Koizumi, MD, Akihide Watanabe, MD, Noriko Koizumi, MD, PhD, Shigeru Kinoshita, MD, PhD

Nucleus cryoinversion for extraction of highly complicated cataracts
Joshua Ben-nun, MD, Yaniv Barkana, MD

articles
Induced optical aberrations following formation of a laser in situ keratomileusis flap  
Ioannis G. Pallikaris, MD, PhD, George D. Kymionis, MD, PhD, Sophia I. Panagopoulou, Charalambos S. Siganos, MD, PhD, Michalis A. Theodorakis, Aristofanis I. Pallikaris
Although final visual acuity and refractive error may remain unaffected, the formation of a flap during LASIK can modify the existing natural higher-order aberrations.

Cost-effectiveness of cataract surgery: Method to assess cost-effectiveness using registry data
Gisela Kobelt, MBA, Mats Lundström, MD, Ulf Stenevi, MD
In a study relating observed utilities to clinical outcomes measures in a database, a model was used to estimate the cost-effectiveness of cataract extraction in the absence of large outcomes studies.

Contact lens fitting to correct irregular astigmatism after corneal refractive surgery
Jorge L. Alió, MD, PhD, José I. Belda, MD, PhD, Alberto Artola, MD, PhD, Magdalena Garcia-Lledó OD, Amr Osman, MD
Contact lens fitting improved the poor visual outcome in patients with severe irregular astigmatism induced by corneal refractive surgery.

Two-site phacotrabeculectomy with intraoperative mitomycin-C: Fornix- versus limbus-based conjunctival opening in fellow eyes  
Vassilios P. Kozobolis, MD, Charalambos S. Siganos, MD, Emmanuelle V. Christodoulakis, Nikolai P. Lazarov, MD, Maria G. Koutentaki, MD, Ioannis G. Pallikaris, MD
Phacotrabeculectomy using intraoperative mitomycin-C with a fornix- or limbus-based conjunctival flap significantly decreased IOP and limited the number of glaucoma medications needed postoperatively. Faster visual acuity improvement, less surgical time, and more frequent early leakage were recorded in the fornix-based group.

Corneal endothelial cell density and pachymetry measured by contact and noncontact specular microscopy
László Módis Jr., MD, PhD, Achim Langenbucher, PhD, Berthold Seitz, MD, EBOD
Contact and noncontact specular microscopes measured similar endothelial cell density in normal and postkeratoplasty corneas; however, the contact method resulted in higher pachymetry values.

Pediatric cataract surgery with or without anterior vitrectomy
Maria Kugelberg, MD, Charlotta Zetterström, MD, PhD
A retrospective study found that anterior vitrectomy should be considered when cataract surgery is performed in children younger than 7 years and that in older children, anterior vitrectomy is not necessary.

Contrast sensitivity after laser in situ keratomileusis: One-year follow-up  
Jay W.W. Chan, MPhil, Marion H. Edwards, PhD, George C. Woo, OD, PhD, Victor C.P. Woo, MD
Contrast sensitivity generally decreased after LASIK, and recovery took at least 6 months. The reduction in contrast sensitivity, which was greater with higher amounts of myopia, seems to be due to optical factors.

Risk factors for epithelial erosions in laser in situ keratomileusis
Mounir Bashour, MD, CM, FRCSC
Epithelial defects with LASIK occurred more frequently in patients with fair skin types.

Prevalence of seropositivity for hepatitis C virus in cataract patients and the general population
Koichi Yoshida, MD, Hitoshi Nakano, MD, Fumiaki Yoshitomi, MD, Tetsuro Oshika, MD
An epidemiologic study suggests that hepatitis C virus infection may play a role in the development and/or progression of age-related cataract.

Anterior uveitis after laser in situ keratomileusis
Enrique Suarez, MD, Francia Torres, MD, Juan C. Vieira, MD, Ernesto Ramirez, MD, J. Fernando Arevalo, MD
Although no cause-effect relationship in post-LASIK anterior uveitis was established, patients and clinicians should be aware of the possible signs and symptoms of intraocular inflammation after LASIK.

Ultrasound biomicroscopy of the Artisan phakic intraocular lens in hyperopic eyes  
Mihai Pop, MD, Yves Payette, MSc, Magdi Mansour, MD
The intraocular position of the iris-claw phakic IOL for hyperopia was evaluated using ultrasound biomicroscopy.

Management of retinal detachments in pseudophakic patients with Artisan lenses
Ivanka van der Meulen, MD, Frans Gunning, MD, Ype Henry, MD, Willemien de Vries-Knoppert, MD, Nitza Gortzak-Moorstein, MD, Marc D. de Smet, MD
A review of a case series of Dutch patients who had Artisan lenses to correct aphakia after complicated cataract surgery and subsequent retinal detachment found that the overall success rate of treating the detachment was high, with good preservation of vision.

Elschnig pearl formation along the neodymium:YAG laser posterior capsulotomy margin: Long-term follow-up
Daijiro Kurosaka, MD, Katsuhiko Kato, MD, Hiroyo Kurosaka, MD, Mami Yoshino, MD, Kunihiko Nakamura, MD, Kazuno Negishi, MD
Although Elschnig pearls along the posterior capsulotomy margin occurred within 2 years in about 80% of patients who received a posterior capsulotomy, most pearls regressed several years later.

Latanoprost and clinically significant cystoid macular edema after uneventful phacoemulsification with intraocular lens implantation
Patrick C. Yeh, MD, Saras Ramanathan, MD
The results of a retrospective study indicate a clinical association between latanoprost use and postoperative CME after uneventful phacoemulsification and IOL implantation in patients with no known risk factor for CME.

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract
Soosan Jacob, MS, DNB, Amar Agarwal, MS, FRCS, FRCOphth, Athiya Agarwal, MD, FRSH, DO, Sunita Agarwal, MS, DO, Saurabh Chowdhary, MBBS, DO, Reena Chowdhary, MBBS, DO, Anand A. Bagmar, MBBS
Trypan blue was used as a safe adjunct for performing capsulorhexis and phacoemulsification in eyes with white cataract in the absence of a red reflex.

Management of the small pupil for clear corneal cataract surgery
Robert M. Kershner, MD
Thirty patients with small pupils had cataract surgery after insertion of the Perfect Pupil pupil expander. The pupil size was 3.2 mm preoperatively, 7.8 mm during the procedure, and 4.3 mm after removal. There were no complications.

Primary repair and intraocular lens implantation after perforating eye injury
Mehmet Baykara, MD, Murat Dogru, MD, PhD, Hikmet Özçetin, MD, Haluk Ertürk, MD
Primary IOL implantation in 10 patients with a penetrating corneoscleral lens injury led to a BSCVA of better than 20/100 in all patients. Six patients had a BSCVA of 20/20.

Lenticular astigmatism in tilted disc syndrome
Abuzer Günduüz, MD, Cem Evereklioglu, MD, Hamdi Er, MD, Ibrahim F. Hepşen, MD
The tilted disc syndrome is associated with an increased incidence of lenticular astigmatism, and undesired optical results are possible after uneventful refractive or cataract surgery if the surgeon is unaware of this condition.

laboratory science
Vitality of epithelial cells after alcohol exposure during laser-assisted subepithelial keratectomy flap preparation  
Bernhard Gabler, MD, Christoph Winkler von Mohrenfels, MD, Alexandra K. Dreiss, MD, John Marshall, PhD, Chris P. Lohmann, MD, PhD
Epithelial cells remained vital with up to 30 seconds of exposure to 20% ethanol.

Fluorescence-guided laser removal of chemically damaged cornea
Roy S. Chuck, MD, PhD, Mark E. Arnoldussen, PhD, Ashley Behrens, MD, Paula M. Sweet, MT, Gregory H. Bearman, PhD, Warren S. Grundfest, MD
Wavelength shifts in excimer laser-induced fluorescence indicated the transition between severely acid-damaged and underlying tissue.

Mathematical modeling of the forces between an intraocular lens and the capsule
James F. Boyce, PhD, Gurpreet Saab Bhermi, FRCOphth, David J. Spalton, FRCP, FRCS, FRCOphth, Austin R. El-Osta, MSc
A mathematical model predicted that a square-edged optic IOL would exert increased pressure on the posterior capsule at the IOL edge, inducing a mechanical barrier to LEC migration.

case reports
Iatrogenic ring scotoma after laser in situ keratomileusis
Sandra M. Brown, MD, Jose Morales, MD

Cataract surgery after holmium:YAG laser thermal keratoplasty
Paul H. Ernest, MD

Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens
Tasha Micheli, FRANZCO, FRACS, Leanne M. Cheung, MBBS(Hons), Shanel Sharma, MBBS, Nagi N. Assaad, MBBS, Magdalena Guzowski, MBBS, Ian C. Francis, FRANZCO, FRACS, FASOPRS, Jenny Norman, MSc, Minas T. Coroneo, FRANZCO, MD, FRACS

Lens-induced astigmatism after perforating scleral injury
Klaus Ludwig, MD, PhD, Said Moradi, MD, Guenther Rudolph, MD, Klaus-Peter Boergen, MD, PhD

Delayed pupillary capture and noninvasive repositioning of a posterior chamber intraocular lens after pupil dilation
Virgilio Galvis, MD, Alejandro Tello, MD, Sandra Montezuma, MD

Antiinflammatory effect of preoperative ketorolac in phacoemulsification
Ronald M. Caronia, MD, Henry D. Perry, MD, Eric D. Donnenfeld, MD

Aspergillus niger endophthalmitis after cataract surgery
Gagandeep Singh Brar, MD, Jagat Ram, MD, Sushmita Kaushik, MD, Arunaloke Chakraborti, MD, Mangat R. Dogra, MD, Amod Gupta, MD

correspondence
Epithelial ingrowth after LASIK
Richard J. Mackool, MD, Vivian R. Monsanto, MD

Double-ring corneal arcus
Shishir Agrawal, MS, DNB, FRCS, Jaya Agrawal, MS, DNB, FRCS, Trilok Prakash Agrawal, MS

Intravitreal injections: Does globe size matter?
Klaus D. Teichmann, MD

Traumatic cataract from asymptomatic nonmetallic foreign body
Abdel Hakim Taguri, MRCOphth, FRCSEd, Augusto Azuara-Blanco

Intraocular lens dialing ab externo
Ahmad M. Mansour, 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).