guest editorial
New pieces for the puzzle: Nonsteroidal anti-inflammatory drugs and corneal ulcers
Francis W. Price, Jr., MD

letters
Limbal relaxing incision for the management of mixed astigmatism after photorefractive keratectomy and laser thermal keratoplasty
Hüseyin Bayramlar, MD, Yüksel Totan, MD, Mutlu Cihan Daghoglu, MD

Pupillometry using videokeratography in eyes with dark brown irides
Rajesh Fogla, DNB, FRCS, Srinivas K. Rao, MD

Closed chamber iridodialysis repair using a needle with a distal hole
Dr. Pramod Bhende

Retinal detachment after photorefractive keratectomy
J. Fernando Arevalo, MD

Etiology of buttonhole flaps
James P. Pulaski, MD

Manual sutureless cataract surgery using a claw vectis
Ajay Tripathi, FRCS(Glasgow), FRCS(Edin)

Laser in situ keratomileusis in a patient with Sturge-Weber syndrome
Majid Moshirfar, MD, William L. Soscia, MD, Mark Mifflin, MD

Two cases of late opacification of the Hydroview hydrogel intraocular lens
Robert I. Murray, FRCS

consultation section
cataract surgical problem, edited by Samuel Masket, MD
A 68-year-old woman who had previous bilateral Jones tubes placed for chronic epiphora associated with canalicular obstruction was referred for lacrimal evaluation before bilateral cataract surgery. The tubes were functional; however, cultures were positive for P aeruginosa, S aureus, and M catarrhalis, all ciprofloxacin sensitive. Cataract surgery in the right eye was uneventful, but the IOL was underpowered and the patient left hyperopic. The fellow cataractous eye has a minimal myopic refractive error. Although the right eye corrects to 20/20 with spectacles, the patient is intolerant of the optical error. What would be the best course of management?
Douglas D. Koch, MD, Henry D. Perry, MD, Tobias Neuhann, MD, I. Howard Fine, MD, José L. Güell, MD, Francis S. Mah, MD, Deepinder K. Dhaliwal, MD

techniques
Flexible iris hooks for phacoemulsification in patients with iridoschisis
Guy T. Smith, FRCOphth, Christopher S.C. Lui, FRCOphth

Quarters extraction technique for manual phacofragmentation
Junsuke Akura, MD, Shuzo Kaneda, MD, Mika Ishihara, MD, Kazuki Matsuura, MD

articles
Surgical correction of severe myopia with an angle-supported phakic intraocular lens
Juan J. Pérez-Santonja, MD, Jorge L. Alió, MD, Ignacio Jiménez-Alfaro, MD, Miguel A. Zato, MD
Implantation of ZSAL-4 anterior chamber phakic IOLs is effective and predictable in the correction of severe myopia, with minimal damage to the corneal endothelium. However, some complications related to angle-supported IOLs occur.

Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses
Jorge L. Alió, MD, PhD, Fernando de la Hoz, MD, Jose Maria Ruiz-Moreno, MD, PhD, Tamer F. Salem, MD
Implantation of phakic anterior chamber IOLs may cause nuclear cataract. Thus, their use should be carefully considered in patients older than 40 years and those with axial lengths greater than 30.0 mm.

Diffuse lamellar keratitis associated with epithelial defects after laser in situ keratomileusis
Mahnaz N. Shah, MD, Manjula Misra, MD, Kirk R. Wihelmus, MD, MPH, Douglas D. Koch, MD
Epithelial defects following LASIK are associated with the development of diffuse lamellar keratitis.

Anatomic factors affecting microkeratome placement in laser in situ keratomileusis.
Wipawee Booranapong, MD, Porntip Malathum, MEd, Stephen G. Slade, MD
The anatomic factors affecting placement of the Automated Corneal Shaper and Hansatome microkeratomes were evaluated. Factors looked at were vertical orbital width, horizontal interpalpebral fissure, corneal diameter, and position of the corneal apex relative to the lateral orbital rim.

Comparison of tear secretion and tear film instability after photorefractive keratectomy and laser in situ keratomileusis
Jae Bum Lee, MD, Chang Hoon Ryu, MD, Jeong-Ho Kim, MD, Eung Kweon Kim, MD, Hong Bok Kim, MD
Dry eye is more severe after LASIK than after PRK. Careful observation and proper treatment for dry eye are required after both procedures but are particularly necessary in the early post-LASIK period.

Goldmann applanation tonometry after Intacs corneal ring segments
Josef Ruckhofer, MD, Eric J. Linebarger, MD, David J. Schanzlin, MD
Intacs corneal ring segments slightly lowered IOP without correlation to other tested parameters. The difference in IOP between Intacs eyes and control eyes was statistically but not clinically significant.

Visual complaints associated with the AcrySof acrylic intraocular lens
Michael A. Farbowitz, MD, Norman A. Zabriskie, MD, Alan S. Crandall, MD, Randall J. Olson, MD, Kevin M. Miller, MD
Lens exchange resolved the glare complaints of a series of patients who were implanted with AcrySof IOLs.

Positive and negative dysphotopsia in patients with acrylic intraocular lenses
James A. Davison, MD
Bright glare or streaks from a point source of light and temporal dark shadows appear to be associated with square-optic-edge, high-refractive-index acrylic IOLs.

Cataract extraction with multifocal intraocular lens implantation: Clinical, functional, and quality-of-life outcomes. Multicenter clinical trial in Germany and Austria
Jonathan Javitt, MD, MPH, Hans-Peter Brauweiler, MD, Karl W. Jacobi, MD, Ulrich Klemen, MD, Stephan Kohnen, MD, Claus-Dieter Quentin, MD, Christian Teping, MD, Thoai Pham, MD, Michael C. Knorz, MD, Detleff Pöetzsch, MD
In a multicenter prospective clinical trial, patients who had bilateral implantation of a multifocal Array IOL had better overall vision, less visual limitation, and less spectacle dependency than patients receiving a monofocal IOL.

Viscocanalostomy for primary open-angle glaucoma: The Gross Pankow experience.
Matthias U.H. Drüsedau, FRCSEd, FCS(Ophth) SA, Kurt-Dietrich von Wolff, MMed, FCS(Ophth) SA, FRCOphth, Holger Bull, Dr med, Bernhard von Barsewisch, Prof Dr med
Viscocanalostomy, a nonperforating surgery for open-angle glaucoma, reduced the need for antiglaucoma medications and allowed reasonable IOP control with few postoperative complications. However, this study did not find the high success rates reported earlier.

Phacoemulsification time and power requirements in phaco chop and divide and conquer nucleofractis techniques
Tina Wong, MRCOphth, Melanie Hingorani, FRCOphth, Vincent Lee, FRACO, FRACS
A randomized prospective study found that phaco chop nucleofractis required less phaco power and time and less operating time than divide and conquer without an increase in intraoperative or postoperative complications.

Determinants of patient satisfaction after cataract surgery in 3 settings
Marjan D. Nijkamp, MHSc, Rudy M.M.A. Nuijts, MD, PhD, Bart van den Borne, PhD, Carroll A.B. Webers, MD, PhD, Frans van der Horst, PhD, Fred Hendrikse, MD, PhD
In addition to helping patients form realistic expectations of their medical outcome, patient education and counselling were the main determinants of patient satisfaction after cataract surgery.

laboratory science
Lack of correlation between intraocular inflammation and after-cataract formation in the rabbit eye
Niklas Wallentin, PhD, Björn Lundgren, PhD, Claes Lundberg, PhD
Pro-inflammatory treatment did not increase and anti-inflammatory treatment did not decrease the development of after-cataract in rabbits.

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).