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ISRS: International Society of Refractive Surgery

Wang, Keratocous and Keratoectasia

Online Advanced Release

Articles appearing in this "Online Advanced Release" section have been peer-reviewed and accepted for publication in the Journal of Refractive Surgery and posted online before print publication. Articles appear on this site after copyediting and author corrections, but before final proofing. The content of the article will usually remain unchanged, and possible further corrections are fairly minor. The final published article will specify the issue and page numbers. Once the final version is available in print, the version posted here will be removed from this site.

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Table of Contents

Topographic Stability After Hyperopic LASIK

Diego de Ortueta, MD; Samuel Arba Mosquera, MSc
Submitted: 10/6/09; Accepted: 2/2/10; Posted: 3/1/10

In 66 consecutive eyes treated for hyperopic astigmatism with the SCHWIND ESIRIS excimer laser and followed for 36 months, there was stability of both topographic indices and manifest refraction.
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Topography-guided Transepithelial Surface Ablation in Treatment of Recurrent Epithelial Ingrowths
Xiangjun Chen, MD, MS; Aleksandar Stojanovic, MD; Tore A. Nitter, MD, PhD
Submitted: 5/18/09; Accepted: 2/2/10; Posted: 3/1/10

Transepithelial topography-guided surface ablation was performed for recurrent epithelial ingrowth with visual disturbances caused by irregular astigmatism after LASIK. Twelve months postoperatively, visual rehabilitation and a regular aspheric corneal surface were achieved.
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Optimized Zernike Term Selection in Customized Treatments for Laser Corneal Refractive Surgery: Case Report

Samuel Arba Mosquera, MSc; Diego de Ortueta, MD
Submitted: 6/25/09; Accepted: 1/28/10; Posted: 3/1/10

By selecting certain Zernike terms deemed to be more visually important, and ignoring others, wavefront-guided aberrations can be used with removal of less corneal tissue.
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LASIK for Myopic Astigmatism and Presbyopia Using Non-linear Aspheric Micro-monovision With the Carl Zeiss Meditec MEL 80 Platform

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, PhD, MSTOptom
Submitted: 12/30/08; Accepted: 12/1/09; Posted: 3/1/10

In a series of 272 myopic eyes with a spherical equivalent refraction ranging from -0.25 to -8.50 D, monovision was treated using the Zeiss MEL 80 platform with a target refraction of plano for the distance eye and -0.75 to -2.00 D for the near eye. Binocularly, 99% of patients achieved 20/20 or better and could read J5 at mean 1-year follow-up.
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Implantation of a Complete Corneal Ring in an Intrastromal Pocket for Keratoconus

Haifa Mahmood, MD; R.S. Venkateswaran, OD; Albert Daxer, MD, PhD
Submitted: 3/5/09; Accepted: 1/21/10; Posted: 2/15/10

In a series of six eyes with keratoconus, a complete 9-mm diameter corneal ring was implanted at 300-µm depth in a corneal pocket. Uncorrected distance visual acuity ranged from 20/125 to 20/400 preoperatively and from 20/35 to 20/100 postoperatively (six of seven eyes saw better than 20/60).
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Evaluation of a Risk Factor Scoring System for Corneal Ectasia After LASIK

Perry S. Binder, MS, MD; William B. Trattler, MD
Submitted: 10/12/09; Accepted: 1/20/10; Posted: 2/15/10

In a retrospective review of 1702 eyes with myopic refractive error and normal corneal topography analyzed by the Randleman Ectasia Risk score, none developed ectasia but 5.4% would have been eliminated from LASIK surgery and 6.8% would have been warned they were at moderate risk of postoperative LASIK ectasia.
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Effect of Pupil Size on Visual Acuity in a Laboratory Model of Pseudophakic Monovision

Takushi Kawamorita, CO, PhD; Hiroshi Uozato, PhD; Tomoya Handa, CO, PhD; Misae Ito, CO, MSc; Kimiya Shimizu, MD, PhD
Submitted: 8/27/09; Accepted: 1/13/10; Posted: 2/15/10

Using a modified Liou-Brennan model eye, decreasing pupil diameter and increasing myopia progressively improved near visual acuity.
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Corneal Spherical Aberration of Eyes With Cataract in a Japanese Population

Masataka Shimozono, MD; Akiyoshi Uemura, MD, PhD; Yasuhiko Hirami, MD, PhD; Kazuhiro Ishida, MD, PhD; Yasuo Kurimoto, MD, PhD
Submitted: 7/27/09; Accepted: 1/13/10; Posted: 2/15/10

In a series of 257 Japanese eyes with cataract, corneal spherical aberration, which varied from patient to patient and was correlated with axial length, was smaller than previous studies of Caucasian eyes.
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Conductive Keratoplasty to Treat Hyperopic Overcorrection After LASIK for Myopia

John S.M. Chang, MD; Silvania Y.F. Lau, BSc
Submitted: 5/31/09; Accepted: 1/13/10; Posted: 2/15/10

In a series of seven eyes that were hyperopic after myopic LASIK, LightTouch conductive keratoplasty produced changes of -0.63 to -2.38 D, with early regression.
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Treatment of Highly Aberrated Eyes Using the NIDEK CXIII Excimer Laser

Damien Gatinel, MD, PhD; Harkaran S. Bains
Submitted: 11/24/08; Accepted: 1/13/10; Posted: 2/15/10

Three eyes with reduced visual quality due to previous decentration or laceration underwent topography-guided ablation. In all eyes, the functional optical zone increased and wavefront aberrations decreased with selective flattening of the intended corneal region.
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Transepithelial Corneal Collagen Cross-linking in Keratoconus

Antonio Leccisotti, MD, PhD; Tahmina Islam, FRCS, MRCOphth
Submitted: 7/15/09; Accepted: 12/30/09; Posted: 2/15/10

Fifty-one patients with keratoconus underwent transepithelial corneal collagen cross-linking in the worse of two eyes. At 12 months after surgery, 1.00 to 1.50 D of central corneal flattening occurred with a wide range of results; progression of corneal steepness during that 1 year was less in the cross-linked eyes than in the control eyes.
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INTACS Followed by KeraRing Intrastromal Corneal Ring Segment Implantation for Keratoconus

Efekan Coskunseven, MD; George D. Kymionis, MD, PhD; Michael A. Grentzelos, MD; Alexandra E. Karavitaki, MD; Dimitra M. Portaliou, MD; Mirko R. Jankov II, MD, PhD; Ebru Arslan, BSc
Submitted: 8/10/09; Accepted: 12/29/09; Posted: 2/15/10

Two patients with keratoconus with implanted INTACS segments underwent additional single KeraRing segment implantation, resulting in a significant improvement in both uncorrected and corrected distance visual acuity with significant flattening of the keratometric values.
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Effect of Topical 0.5% Morphine on Postoperative Pain After Photorefractive Keratectomy

Ella G. Faktorovich, MD; Allan I. Basbaum, PhD, FRS
Submitted: 5/19/09; Accepted: 12/29/09; Posted: 2/15/10

In a series of 40 patients, 0.5% morphine drops used every 2 hours for 1 day and every 4 hours for 2 additional days after PRK modestly reduced pain in 20 patients when compared to 20 controls without slowing epithelial healing.
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Pentacam Characterization of Corneas With Fuchs Dystrophy Treated With Descemet Membrane Endothelial Keratoplasty

Robert O. Kwon, MD; Marianne O. Price, PhD; Francis W. Price, Jr, MD; Renato Ambrósio, Jr, MD; Michael W. Belin, MD
Submitted: 10/7/09; Accepted: 12/9/09; Posted: 2/15/10

In a series of 29 eyes with Fuchs corneal dystrophy that received Descemet membrane endothelial keratoplasty (DMEK), the anterior corneal curvature measured by the Pentacam did not change from pre- to postoperative and was similar to normal corneal curvature. Corneal thickness decreased significant postoperatively.
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Factors Related to the Correction of Astigmatism by LASIK After Penetrating Keratoplasty

Hyun Soo Lee, MD, PhD; Man Soo Kim, MD, PhD
Submitted: 5/30/09; Accepted: 12/9/09; Posted 2/15/10

A series of 75 eyes with penetrating keratoplasty with all sutures removed received LASIK with the VISX S4 laser for the correction of 2.25 to 10.00 D of refractive astigmatism (mean 6.80 D), reducing the astigmatism to a range of 8.75 to 0.25 (mean 2.90 D); mean spherical equivalent refraction was decreased from 5.60 to 1.20 D. Vector analysis of the astigmatism is reported.
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Decision Assistant Wizard to Standardize Optimal Outcomes in Excimer Laser Refractive Corneal Surgery

Maria Clara Arbelaez, MD; Tobias Ewering, OD; Samuel Arba Mosquera, MSc
Submitted: 4/29/09; Accepted: 12/9/09; Posted: 2/15/10

A five-step decision tree can help guide surgeons in selecting the most appropriate use of excimer laser programs (eg, wavefront-guided or only spherocylindrical correction) for individual eyes.
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Outcomes of Corneal Spherical Aberration-guided Cataract Surgery Measured by the OPD-Scan

Jonathan D. Solomon, MD
Submitted: 6/2/09; Accepted: 11/11/09; Posted: 2/1/10

In a series of 40 consecutive eyes with cataract surgery using preoperative corneal spherical aberration as a guide, 3 intraocular lenses (Tecnis Z9003, Alcon AcrySof SN60WF, and Bausch & Lomb LI61AOV) were selected to create a postoperative total ocular spherical aberration near zero. Total postoperative ocular spherical aberration for the entire group measured 0.019 &mirco;m.
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Corneal Collagen Cross-linking With Riboflavin and UVA Irradiation in Pellucid Marginal Degeneration

Leopoldo Spadea, MD
Submitted: 6/21/09; Accepted: 12/9/09; Posted: 1/15/10

Corneal collagen cross-linking was performed in a patient with pellucid marginal degeneration, resulting in improved corrected distance visual acuity, a 1.40-D reduction in keratometric astigmatism, and a decrease in ectasia apex from 82.00 D to 78.00 D.
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Distribution of Angle Kappa Measurements With Orbscan II in a Population-based Survey

Hassan Hashemi, MD; Mehdi KhabazKhoob, MSc; Kamran Yazdani, MD; Shiva Mehravaran, MD; Ebrahim Jafarzadehpur, PhD; Akbar Fotouhi, MD, PhD
Submitted: 3/15/09; Accepted: 12/8/09; Posted: 1/15/10

In a population-based group of 800 eyes, the mean angle kappa was 5.46° (range: 2.0 to 9.0°; 95% confidence interval, 5.3 to 5.62).
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Mechanism of Action of the Tetraflex Accommodative Intraocular Lens

James S. Wolffsohn, PhD; Leon N. Davies, PhD; Navneet Gupta, PhD; Shehzad A. Naroo, PhD; George A. Gibson, PhD; Toshifumi Mihashi, PhD; Sunil Shah, FRCS, FRCOphth
Submitted: 6/20/09; Accepted: 12/1/09; Posted: 1/15/10

In 13 eyes that received the Tetraflex accommodating intraocular lens followed for at least 2 years, measurements indicate that the lens does not move in an anterior-posterior direction, but may undergo flexing changes that affect higher order aberrations, which might account for the improved near vision with the lens in some patients.
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Intraoperative Complications of LASIK Flaps Using the IntraLase Femtosecond Laser in 3009 Cases

James A. Davison, MD, FACS; Steven C. Johnson, MD
Submitted: 3/26/09; Accepted: 11/25/09; Posted: 1/15/10

In a consecutive series of 3009 LASIK operations using the IntraLase femtosecond laser to create the corneal flap, 0.37% of eyes had an intraoperative complication, most commonly a disruption of the suction ring adherence.
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Optical and Topographic Changes in Keratoconus After Implantation of Ferrara Intracorneal Ring Segments

Islam Mahmoud Hamdi, FRCS(Glasg), PhD
Submitted: 1/30.09; Accepted: 11/17/09; Posted: 1/15/10

In a series of 37 eyes with varying types of keratoconus, Ferrara Ring intracorneal ring segments were implanted, flattening the central cornea, improving the optical path difference refraction, decreasing the RMS for higher order aberrations, but no difference in the point spread function or modulation transfer function values.
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Outcomes and Patient Satisfaction After Presbyopic Bilateral Lens Exchange With the ReSTOR IOL in Emmetropic Patients

José F. Alfonso, MD, PhD; Luís Fernández-Vega, MD, PhD; Beatriz Valcárcel, OD; Teresa Ferrer-Blasco, PhD; Robert Montés-Micó, PhD
Submitted: 5/2/08; Accepted: 11/3/09; Posted: 1/15/10

In a series of 23 patients that underwent presbyopic lens exchange with bilateral AcrySof ReSTOR Natural IOL implantation, all eyes were within ±0.50 D of the desired refraction and all patients reported good quality of vision and satisfaction at distance and near 6 months postoperatively.
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Corneal Ablation Depth Readout of the MEL 80 Excimer Laser Compared to Artemis Three-dimensional Very High-frequency Digital Ultrasound Stromal Measurements

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, MST(Optom), PhD
Submitted: 5/22/09; Accepted: 10/15/09; Posted: 1/15/10

In a series of 121 eyes, the depth of the stromal ablation as measured by the Zeiss MEL 80 excimer laser was approximately 20 µm greater than the readings obtained postoperatively of corneal thickness alone by the Artemis very high-frequency ultrasound.
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Pupil Size, White-to-White Corneal Diameter, and Anterior Chamber Depth in Patients With Myopia

José F. Alfonso, MD, PhD; Teresa Ferrer-Blasco, PhD; José M. González-Méijome, PhD; M. García-Manjarres, OD; Sofia C. Peixoto-de-Matos, OD; Robert Montés-Micó, PhD
Submitted: 8/20/09; Accepted: 11/3/09; Posted: 12/15/09

In a series of 964 myopic eyes, the white-to-white diameter was constant at approximately 11.69 mm; anterior chamber depth averaged approximately 3.23 mm in the shallower and higher myopic eyes; average photopic pupil size was 4.90 mm; and average mesopic pupil size was 6.50 mm, decreasing with higher myopia.
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Determining Spherocylindrical Correction Using Four Different Wavefront Error Analysis Methods: Comparison to Manifest Refraction

Charles E. Campbell, BS
Submitted: 7/14/09; Accepted: 11/3/09; Posted: 12/15/09

In a series of 882 eyes measured before vision correction surgery with the VISX laser, smaller pupil methods measured the spherical component better whereas larger pupil measurements measured the astigmatic component better compared to manifest refraction. The spherical equivalent refraction was not optimally measured with any of the four approaches (standard deviation 0.94 D). A manifest refraction should be incorporated in preoperative wavefront-guided excimer laser corneal surgery planning.
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US FDA Clinical Trial of the Tetraflex Potentially Accommodating IOL: Comparison to Concurrent Age-matched Monofocal Controls

Donald R. Sanders, MD, PhD; Monica L. Sanders, BS; Tetraflex Presbyopic IOL Study Group
Submitted: 5/12/09; Accepted: 11/3/09; Posted: 12/15/09

In the US 12-center FDA clinical study, 255 patients received Tetraflex potentially accommodating IOLs bilaterally and 101 patients received 3-piece hydrophilic acrylic STAAR monofocal IOLs. Patients with the Tetraflex lens could read faster at smaller print sizes, wore reading glasses less frequently, and had better uncorrected distance visual acuity.
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Traumatic Flap Striae 6 Years After LASIK: Case Report and Literature Review

Roxana Ursea, MD; Matthew T. Feng, MD
Submitted: 5/1/09; Accepted: 11/3/09; Posted: 12/15/09

The authors present a case of ocular trauma 6 years after LASIK that resulted in a flap striae without flap dislocation as well as a literature review of striae and their management.
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Quantitative Assessment of Bandage Soft Contact Lens Wear Immediately After LASIK

Faik Orucov, MD; Joseph Frucht-Pery, MD; Frederick D. Raiskup, MD; Eyal Strasman, MD; David Landau, MD; Abraham Solomon, MD
Submitted: 4/27/09; Accepted: 11/3/09; Posted: 12/15/09

In a series of 161 consecutive patients with bilateral simultaneous LASIK, soft contact lenses were applied immediately after surgery. Overnight wear was associated with more flap edema and mucoid secretion the next morning. The authors suggest applying a lens for 1 hour after surgery and then removing it.
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LASIK Flap Buttonhole Treated Immediately by PRK With Mitomycin C

George D. Kymionis, MD, PhD; Dimitra M. Portaliou, MD; Alexandra E. Karavitaki, MD; Maria S. Krasia, MD; Georgios A. Kontadakis, MD, MSc; Aimilianos A. Stratos, MD; Sonia H. Yoo, MD
Submitted: 2/25/09; Accepted: 11/3/09; Posted: 12/15/09

Three patients who underwent LASIK that resulted in a buttonhole formation in their left eye received immediate photorefractive keratectomy with mitomycin C. Three months postoperatively, all patients were seeing 20/20.
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Effects of Decentration of Photorefractive Keratectomy on the Induction of Higher Order Wavefront Aberrations

Sang-Bumm Lee, MD, PhD; Bo-Sung Hwang, MD; Jun-Yeop Lee, MD
Submitted: 12/6/08; Accepted: 10/27/09; Posted: 12/15/09

In 95 eyes that received excimer laser PRK using a manually adjusted technique for the VISX S4 ActiveTrak system, increasing decentration produced increases in total higher order aberration, spherical aberration, and coma. A literature review of the change in higher order aberrations after refractive surgery is included.
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Device for Improving Quantification of Reading Acuity and Reading Speed

Alois K. Dexl, MD, MSc; Horst Schlögel, PhD; Michael Wolfbauer; Günther Grabner, MD
Submitted: 7/4/08; Accepted: 10/14/09; Posted: 12/1/09

A new device, the Salzburg Reading Desk, which uses the Radner reading charts and video-stereo-photometry to measure reading distance, allows automatic evaluation of reading acuity and reading speed at best reading distance under standardized conditions. Reading vision at best distance was found to be better than at fixed distance.
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Sequential In Vivo Confocal Microscopy Study of Corneal Wound Healing After Cross-linking in Patients With Keratoconus

J. Oscar Croxatto, MD; Adriana E. Tytiun, MD; Carlos J. Argento, MD, PhD
Submitted: 3/16/09; Accepted: 10/13/09; Posted: 11/16/09

Corneal cross-linking induces cellular wound healing and alters the normal structure and cellularity of the cornea for up to 3 years after treatment.
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Intraoperative Videokeratography in Penetrating Keratoplasty and Excimer Laser-assisted Lamellar Keratoplasty for Keratoconus

Leopoldo Spadea, MD; Arianna Fiasca, MD; Simone Federici, MD
Submitted: 12/17/08; Accepted: 10/13/09; Posted: 11/16/09

Videokeratography was used to adjust suture tension to minimize surgically induced astigmatism. Astigmatism decreased significantly in groups, and final astigmatism after 2 years was closely related to early postoperative values, indicating the benefit of intraoperative adjustments.
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Biomechanical and Tomographic Analysis of Unilateral Keratoconus

Bruno M. Fontes, MD; Renato Ambrósio, Jr, MD, PhD; Marcella Salomão, MD; Guillermo C. Velarde, DSc; Walton Nosé, MD
Submitted: 9/27/08; Accepted: 10/6/09; Posted: 11/16/09

Using the Ocular Response Analyzer to measure biomechanical properties of eyes with keratoconus, fellow eyes in the same patient, and control groups, the authors did not find statistically significant differences among these three groups, although the keratoconus in fellow eyes had numerically different values compared to normal control eyes.
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Repeatability of Layered Corneal Pachymetry With the Artemis Very High-frequency Digital Ultrasound Arc-Scanner

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, MST(Optom), PhD; Ronald H. Silverman, PhD; D. Jackson Coleman, MD
Submitted: 12/30/08; Accepted: 9/29/09; Posted: 11/16/09

Using Artemis very high-frequency digital ultrasound, repeatability values for corneal epithelial thickness was 0.58 µm and for the stroma, cornea, LASIK flap, and residual stromal bed was approximately 1.7 &mirco;m.
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Epithelial Thickness After Hyperopic LASIK: Three-dimensional Display With Artemis Very High-frequency Digital Ultrasound

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, MST(Optom), PhD; Ronald H. Silverman, PhD; D. Jackson Coleman, MD
Submitted: 5/22/09; Accepted 9/22/09; Posted: 11/16/09

Using high resolution ultrasound to measure corneal epithelial thickness in 65 eyes following LASIK for hyperopia showed a doughnut pattern, with thinner epithelium over the apex and thicker epithelium paracentrally at the 3.4-mm radius.
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Pentacam Scheimpflug Evaluation of Corneal Volume After LASIK

Camila M. Gadelha P. Diniz, MD; Rossen M. Hazarbassanov, MD; Ester Yamazaki, MD; Celina Murata, MD; Felipe Mallmann, MD; Mauro Campos, MD
Submitted: 1/6/09; Accepted: 9/3/09; Posted: 11/16/09

In a series of 49 eyes that underwent LASIK for myopia and were analyzed by the Pentacam Scheimpflug instrument, there was a good correlation between the spherical equivalent refraction treated and the laser ablation volume.
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LASIK Outcomes Following Multifocal and Monofocal Intraocular Lens Implantation

David P. Piñero, PhD; María José Ayala Espinosa, MD, PhD; Jorge L. Alió, MD, PhD
Submitted: 12/23/08; Accepted: 10/6/09; Posted: 11/2/09

LASIK treatment for residual refractive error after cataract surgery and intraocular lens implantation improved visual function. Outcomes were better for eyes with monofocal intraocular lenses than with multifocal intraocular lenses. Hyperopic eyes implanted with multifocal intraocular lenses had the poorest results.
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Determination of Corneal Elasticity Coefficient Using the ORA Database

Sergei E. Avetisov, MD, PhD; Ivan A. Novikov; Irina A. Bubnova, MD; Alexei A. Antonov, MD; Vladimir I. Siplivyi, MD
Submitted: 12/14/08; Accepted: 9/22/09; Posted: 11/2/09

Using the Ocular Response Analyzer, the authors studied normal, keratoconic, postoperative LASIK, and glaucoma eyes, finding different elasticity coefficients among these groups.
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Prospective Randomized Trial of Limbal Relaxing Incisions Combined With Microincision Cataract Surgery

Masayuki Ouchi, MD, PhD; Shigeru Kinoshita, MD, PhD
Submitted: 2/6/09; Accepted: 8/13/09; Posted: 10/15/09

In a series of eyes that had cataracts removed using bimanual microincision cataract surgery technique, 96 eyes had limbal relaxing incisions for astigmatism and 93 had no relaxing incisions, with both groups having a mean preoperative cylinder of approximately 1.70 D. At 6 months postoperative, the mean astigmatism was 0.56 in the limbal relaxing incision group and 1.51 in the non-incision group.
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Persistent Subepithelial Haze in Thin-flap LASIK

Farhad Hafezi, MD, PhD; Theo Seiler, MD, PhD
Submitted: 3/19/09; Accepted: 9/3/09; Posted: 10/1/09

Two patients with distinct subepithelial haze and reduced corrected distance visual acuity after femtosecond thin-flap LASIK are presented, representing a new potential complication in thin-flap LASIK.
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Intraocular Straylight and Contrast Sensitivity After Contralateral Wavefront-guided LASIK and Wavefront-guided PRK for Myopia

Jackson Barreto, Jr, MD; Mirella T.S. Barboni, MSc; Claudia Feitosa-Santana, PhD; João R. Sato, MSc; Samir J. Bechara, MD; Dora F. Ventura, PhD; Milton Ruiz Alves, MD
Submitted: 1/22/09; Accepted: 9/3/09; Posted: 10/1/09

In a prospective, randomized right/left eye contralateral study of 11 patients who received PRK in one eye and LASIK in the other eye using the wavefront-guided NIDEK EC-5000CXIII excimer laser with the OPDCAT platform, there was no difference between PRK and LASIK in terms of the amount of induced higher order aberrations, which increase was approximately 0.12 µm for total higher order aberrations.
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Corneal Collagen Cross-linking for Ectasia After Excimer Laser Refractive Surgery: 1-year Results

Paolo Vinciguerra, MD; Fabrizio I. Camesasca, MD; Elena Albè, MD; Silvia Trazza
Submitted: 3/22/09; Accepted: 8/5/09; Posted: 9/15/09

In a series of 13 eyes that exhibited corneal ectasia after excimer laser corneal surgery, collagen cross-linking demonstrated approximately 3.00 D of flattening of the average simulated keratometry, approximately 1.50 D decrease in spherical equivalent myopia, and improvement in best spectacle-corrected visual acuity.
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Transplantation of Endothelium and Descemet's Membrane for Aphakic Corneal Edema in 1980

Kenneth J. Hoffer, MD, FACS; John D. Hofbauer, MD
Submitted: 3/3/09; Accepted: 7/23/09; Posted: 9/15/09

A single historical case of unsuccessful transplantation of the corneal endothelium and Descemet's membrane is described.
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Effect of Monochromatic Induced Aberrations on Visual Performance Measured by Adaptive Optics Technology

Hélène Rouger, MSc; Yohann Benard, MSc; Richard Legras, PhD
Submitted: 4/8/09; Accepted: 7/29/09; Posted: 9/1/09

In four patients, adaptive optics were used to induce lower and higher order optical aberrations, indicating that Zernike modes near the center and top of the Zernike pyramid decreased visual acuity more than those at the edge or the bottom of the pyramid.
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Corneal Limbal Marking in the Treatment of Myopic Astigmatism With the Excimer Laser

Celine Bucher; Bruno Zuberbuhler, MD; Michael Goggin, FRCSI(Ophth); Adrian Esterman, AStat, PhD; Isaak Schipper, MD
Submitted: 10/8/08; Accepted: 7/23/09; Posted: 8/17/09

In a retrospective study of 108 eyes with myopic astigmatism that underwent LASIK or LASEK with or without corneal limbal marking, the 12-month refractive outcome was not influenced by limbal marking, with achieved cylinder and spherical reduction as well as refractive predictability being similar in both groups.
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Role of Corneal Biomechanical Properties in Applanation Tonometry Measurements

Tae-Hyun Kwon, PhD; Jamshid Ghaboussi, PhD; David A. Pecknold, PhD; Youssef M.A. Hashash, PhD
Submitted: 12/22/08; Accepted: 7/20/09; Posted: 8/17/09

Using a finite element model of the cornea for the simulation of Goldmann applanation tonometry, corneal biomechanical properties are shown to be as important as the central corneal thickness in influencing measured intraocular pressure.
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Outcomes After Topography-based LASIK and LASEK With the WaveLight Oculyzer and Topolyzer Platforms

Arthur B. Cummings, MD; Nadia Mascharka, MSc
Submitted: 2/4/09; Accepted: 7/16/09; Posted: 8/17/09

In a noncomparative case series, 143 eyes underwent topography-guided LASEK or LASIK treatments using the Oculyzer (Scheimflug-based) or Topolyzer (Placido-disk based) platforms. Both platforms provide good, comparable outcomes in patients with myopia and mixed astigmatism; however, the Oculyzer resulted in slightly better uncorrected visual acuity in patients with hyperopia.
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Comparison of Rosenbaum Pupillometry Card Using Red and Blue Light to Colvard and Iowa Pupillometers

Lawrence Y. Ho, MD; Thomas M. Harvey, MD; Joseph Scherer, MD; Mamtha Balasubramaniam, MS; Deepinder K. Dhaliwal, MD; Francis S. Mah, MD
Submitted: 2/6/08; Accepted: 7/16/09; Posted: 8/17/09

In a cross-sectional study of 200 eyes, two observers performed pupillometry using four scotopic pupil measuring techniques. Due to the complex interaction among observer, pupillometry technique, and iris color, the four techniques cannot be compared nor can the measurements between observers.
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Contrast Sensitivity Comparison Between AcrySof ReSTOR and Acri.LISA Aspheric Intraocular Lenses

José F. Alfonso, MD, PhD; Cristina Puchades, MSc; Luis Fernández-Vega, MD, PhD; Carmen Merayo, OD; Robert Montés-Micó, PhD
Submitted: 11/26/08; Accepted: 7/1/09; Posted: 8/3/09

Contrast sensitivity in eyes receiving the Acri.LISA 366D and the AcrySof ReSTOR SN6AD3, both diffractive-refractive multifocal IOLs, demonstrated normal values under photopic conditions and decreased values under mesopic and scotopic conditions with no significant difference between the two lens styles.
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Development of a New Subjective Questionnaire: The Freedom from Glasses Value Scale (FGVS)

Pierre Lévy, MD; Dani Elies, MD; Ole Dithmer, MD; Irène Gil-Campos, MSc; Khadra Benmedjahed, MSc; Gilles Berdeaux, MD, PhD; Benoit Arnould, PhD
Submitted: 10/27/08; Accepted: 6/30/09; Posted: 8/3/09

A new subjective patient questionnaire with 25 items based on patient interviews, the Freedom from Glasses Value Scale has been developed and is awaiting clinical trial.
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A Prospective Randomized Comparison of Four Femtosecond LASIK Flap Thicknesses

Gaurav Prakash, MD; Amar Agarwal, MS, FRCS, FRCOphth; Anil Yadav, DNB; Soosan Jacob, MS, DNB, FRCS; Dhivya Ashok Kumar, MD; Athiya Agarwal , MD, DO; Raheel Akhtar, Boptom
Submitted: 2/2/09; Accepted: 6/9/09; Posted: 8/3/09

In a prospective randomized trial of femtosecond flaps in LASIK with thicknesses of 90, 100, 110, and 120 µm, flaps are found to be planar in all four groups and clinical outcomes were similar in all four groups.
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An Intraocular Lens Power Calculation Formula Based on Optical Coherence Tomography: A Pilot Study

Maolong Tang, PhD; Yan Li, PhD; David Huang, MD, PhD
Submitted: 1/29/09; Accepted: 6/11/09; Posted: 7/15/09

Using a prototype high-speed anterior segment OCT system to calculate intraocular lens power in 27 eyes not having previous corneal surgery, a new formula was developed that gave a spherical equivalent refractive outcome of 0.04±0.44 D, comparable to standard theoretical IOL power calculation formulas.
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High and Low Contrast Visual Acuity After Artiflex Phakic Intraocular Lens Implantation for the Correction of Myopia

Lucien A.M. van Philips, MD
Submitted: 3/13/08; Accepted: 6/11/09; Posted: 7/15/09

In a series of 42 consecutive myopic eyes treated with the Artiflex phakic intraocular lens, best spectacle-corrected visual acuity under high and low contrast conditions increased significantly.
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Finite Element Modeling of Corneal Biomechanical Behavior

Ahmed Elsheikh, PhD
Submitted: 10/13/08; Accepted: 6/8/09; Posted: 7/15/09

Finite element models are used to simulate corneal nonuniform thickness, topography, boundary conditions, hyperelastic behavior, hysteretic behavior and isotropy, stomal interlamellar adhesion, and layered construction.
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Anterior Segment Optical Coherence Tomography Measurement of Flap Thickness After Myopic LASIK Using the Moria One Use-Plus Microkeratome

Hui-Jin Chen, MD; Ying-Jie Xia, MD; Yan-Ying Zhong, BS; Xiao-Li Song, BS; Yue-Guo Chen, MD
Submitted: 12/22/08; Accepted: 6/8/09; Posted: 7/15/09

Using Zeiss Visante anterior segment OCT to measure LASIK flap thickness in 136 eyes, LASIK flaps achieved with the Moria One Use-Plus and M2 90-µm head microkeratomes showed nonuniform thickness.
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Traumatic Dislocation of LASIK Flaps 4 and 9 Years After Surgery

Hyunjin Jane Kim, MD; Cary M. Silverman, MD
Submitted: 12/25/08; Accepted: 5/27/09; Posted: 7/15/09

In two eyes with traumatic LASIK flap dislocation 4 and 9 years after surgery, flaps were repositioned and final uncorrected visual acuity was 20/20 in one eye and 20/25 in the other.
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Comparison of LASIK With the OPDCAT or OATz Algorithm Using the NIDEK EC-5000CXII Excimer Laser

Yoshiko Hori-Komai, MD; Ikuko Toda, MD; Takahiro Yamamoto, MD; Kazuo Tsubota, MD
Submitted: 7/11/08; Accepted: 5/7/09; Posted: 7/1/09

In a series of 274 eyes studied retrospectively, using the NIDEK excimer laser platform demonstrated that eyes treated with a total aspheric algorithm based on refraction, wavefront, and topography induced less higher order aberrations than those treated with a customized aspheric transition zone only.
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Clinical Results With the Light Adjustable Intraocular Lens

Christoph Winkler von Mohrenfels, MD; Josefina Salgado, MD; Ramin Khoramnia, MD; Mathias Maier, MD; Chris P. Lohmann, MD, PhD
Submitted 10/10/08; Accepted: 5/7/09; Posted: 6/22/09

In a series of 10 eyes with cataracts, the Calhoun light adjustable intraocular lens was implanted, with refraction modified by one or two ultraviolet irradiation adjustments and a final lock-in of the refraction, producing a mean spherical equivalent refraction of –0.07±0.21 D.
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Posterior Chamber Phakic Implantable Collamer Lens: Changes in Vault During 1 Year

Takashi Kojima, MD; Masahiro Maeda, MD; Yoko Yoshida, MD; Mayuka Ito; Tomoaki Nakamura, MD; Shuya Hara, MD; Kazuo Ichikawa, PhD, MD
Submitted: 1/4/09; Accepted: 5/6/09; Posted: 6/22/09

In a series of 36 eyes in which the phakic Implantable Collamer Lens was placed, those with an initial high vault showed a decrease in the vault over 3 months, and thereafter in all eyes the vault remained stable up to 1 year.
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Comparison of Corneal and Total Ocular Aberrations Before and After Myopic LASIK

Damien Gatinel, MD, PhD; Pierre-Alexandre Adam, MD; Slim Chaabouni, MD; Jacques Munck, OD; Maud Thevenot, OD; Thanh Hoang-Xuan, MD; Stefan Pieger, Dipl.Ing; Masanao Fujieda, MSE; Harkaran S. Bains, BSc(Hons)
Submitted: 1/8/09; Accepted: 5/5/09; Posted: 6/22/09

In a series of 57 myopic eyes treated with LASIK, the authors hypothesize that postoperatively, there may be alterations in the crystalline lens to change the higher order aberrations for the total eye based on the new set of higher order aberrations that appear after the myopic LASIK.
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Night Driving Simulation in a Randomized Prospective Comparison of Visian Toric Implantable Collamer Lens and Conventional PRK for Moderate to High Myopic Astigmatism

Steven Schallhorn, MD; David Tanzer, MD; Donald R. Sanders, MD, PhD; Monica Sanders, BS; Mitch Brown, OD; Sandor E. Kaupp, MS
Submitted: 1/16/09; Accepted: 5/5/09; Posted: 6/22/09

In a prospective, randomized series of 43 eyes implanted with a Visian Toric Implantable Collamer Lens and 45 eyes of different patients receiving conventional PRK with the VISX Star S3 excimer laser, eyes with the IOL could identify objects in a night driving simulator better than those treated with PRK.
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Anterior Chamber Depth Measurement in Pseudophakic Eyes: A Comparison of Pentacam and Ultrasound

Giacomo Savini, MD; Thomas Olsen, MD; Claudio Carbonara, MD; Sebastiano Pazzaglia, MD; Piero Barboni, MD; Michele Carbonelli, MD; Kenneth J. Hoffer, MD, FACS
Submitted: 8/7/08; Accepted: 5/5/09; Posted: 6/22/09

In a series of pseudophakic eyes, the Pentacam and immersion biometry were statistically similar, provided that manual measurements are used and not automatic measurements.
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Microbial Keratitis After Intrastromal Corneal Ring Segment Implantation

M. Emilia Mulet, MD, PhD; Juan J. Pérez-Santonja, MD; Consuelo Ferrer, PhD; Jorge L. Alió, MD, PhD
Submitted: 11/11/08; Accepted: 4/28/09; Posted: 6/22/09

In a series of 212 eyes that received an intrastromal corneal ring segment, 1.4% had acute microbial keratitis, mostly from gram-positive cocci.
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Comparing Conventional and Wavefront-optimized LASIK for the Treatment of Hyperopia

Daniel S. Durrie, MD; Ryan T. Smith, MD; George O. Waring IV, MD; Jason E. Stahl, MD; Frank J. Schwendeman, OD
Submitted: 10/27/08; Accepted: 4/23/09; Posted: 6/22/09

In a series of 51 hyperopic eyes, the wavefront optimized ALLEGRETTO excimer laser produced generally better clinical results than the conventional LADAR4000 excimer laser, including less induced spherical aberration.
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Temperature Increase in Human Cadaver Retina During Direct Illumination by Femtosecond Laser Pulses

Hui Sun, PhD; Eric Mikula, MS; Ronald M. Kurtz, MD; Tibor Juhasz, PhD
Submitted: 1/28/09; Accepted: 4/17/09; Posted: 6/22/09

Using an iFS IntraLase Advanced Femtosecond Laser emitting 600 fs pulses with a repetition rate of 150 kHz at 1053 nm wavelength in human eye bank eyes, exposure of the cornea produced minimal temperature elevations that would create subclinical effects in the retina.
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Changes in Higher Order Wavefront Aberrations After Contact Lens Corneal Refractive Therapy and LASIK Surgery

Robert N. Goldstone, BA; Elvin H. Yildiz, MD; Vincent C. Fan, MD; Penny A. Asbell, MD
Submitted: 11/11/08; Accepted: 4/15/09; Posted: 5/15/09

Both contact lens corneal refractive therapy (CRT) and LASIK increase higher order aberrations at 1 month after treatment, but the increase with CRT is greater than that with LASIK, especially for spherical aberration. Changes after CRT are reversible; changes after LASIK are not.
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Refractive Surgery Trends and Practice Style Changes in Germany Over a 3-year Period

Ingo Schmack, MD; Gerd U. Auffarth, MD; Daniel Epstein, MD; Mike P. Holzer, MD
Submitted: 11/18/09; Accepted: 4/2/09; Posted: 5/15/09

Refractive surgery in Germany remains a dynamic field of ophthalmology, illustrating trends and practice styles that are in line with other European countries.
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Epithelial, Stromal, and Total Corneal Thickness in Keratoconus: Three-dimensional Display With Artemis Very-high Frequency Digital Ultrasound

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, FRCOphth; Marine Gobbe, MST(Optom), PhD; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Ronald H. Silverman, PhD; D. Jackson Coleman, MD
Submitted: 12/15/08; Accepted: 4/14/09; Posted: 5/15/09

In keratoconus eyes, the epithelial thickness pattern forms a "doughnut," with the thinnest area overlying the apex of the cone and the thickest area surrounding the base of the cone.
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Visian Toric Implantable Collamer Lens for Correction of Compound Myopic Astigmatism

Daniel Elies, MD; Tirso Alonso, MD; Javier Puig, MD, PhD; Oscar Gris, MD, PhD; José Luís Güell, MD, PhD; Andreu Coret, MD, PhD
Submitted: 5/13/08; Accepted: 3/31/09; Posted: 5/15/09

In a retrospective analysis of 63 myopic astigmatic eyes that underwent implantation of a STAAR Toric Implantable Collamer Lens, 94% of eyes had a spherical equivalent refraction within ±1.00 D and 83% within ±0.05 D, and astigmatism was reduced to 0.38@99.6 from 2.17@93 preoperatively.
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Microbial Keratitis After LASIK

Prashant Garg, MD; Sunita Chaurasia, MS; Pravin K. Vaddavalli, MS; Muralidhar R, MS; Vikas Mittal, MD, DNB; Usha Gopinathan, PhD
Submitted: 9/21/08; Accepted: 4/2/09; Posted: 5/8/09

Infection after LASIK performed in a tropical climate can be caused by unusual organisms such as fungi, Nocardia, and Acanthamoeba, therefore, detailed microbiology workup is needed for definitive diagnosis and treatment.
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An Inter-eye Comparison of Refractive Outcomes Following Cataract Surgery

John Landers, MBBS, MPH, PhD; Michael Goggin, FRCSI(Ophth), FRANZCO, MS
Submitted: 10/9/08; Accepted: 4/2/09; Posted: 5/8/09

The difference between postoperative refractive outcome and preoperative target refraction of the second eye following bilateral cataract surgery with IOL implantation is independent of that from the first eye.
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Visual Acuity Outcomes With SA60D3, SN60D3, and ZM900 Multifocal IOL Implantation After Phacoemulsification

Cheryl Ngo, MBBS; Mandeep Singh, MRCSEd, MMed(Ophth); Chelvin Sng, MBBS; Seng-Chee Loon, FRCSEd, MMED(Clin Epi); Yiong-Huak Chan, PhD; Lennard Thean, FRCSEd, FAMS
Submitted: 9/15/08; Accepted: 3/5/09; Posted: 5/8/09

A retrospective study of 108 eyes implanted with SA60D3, SN60D3, and ZM900 IOLs following phacoemulsification for cataract found that each lens provided equally good uncorrected visual acuity and best spectacle-corrected visual acuity, although the ZM900 lens provided better binocular distance corrected near acuity than the SA60D3 or SN60D3.
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Changes in Ocular Response Analyzer Parameters After LASIK

Shihao Chen, MD, OD, MS; Ding Chen, MD; Jianhua Wang, PhD, MD; Fan Lu, MD, OD, MS; Qinmei Wang, MD; Jia Qu, MD, MS
Submitted: 3/24/08; Accepted: 3/25/09; Posted: 4/15/09

Corneal biomechanical properties measured by corneal hysteresis and corneal resistance factor with the Ocular Response Analyzer were decreased at 10 days after LASIK. Minimal recovery (approximately 10% of the changes) was achieved by 3 months. The changes in biomechanical properties may affect intraocular pressure measurement.
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Contribution of Optical Zone Decentration and Pupil Dilation on the Change of Optical Quality After Myopic Photorefractive Keratectomy in a Cat Model

Jens Bühren, MD; Geunyoung Yoon, PhD; Scott MacRae, MD; Krystel Huxlin, PhD
Submitted: 12/1/08; Accepted: 3/11/09; Posted: 4/15/09

Pupil diameter and decentration of the optical zone affected the change of retinal image quality, with a higher influence of the pupil diameter. Microdecentrations of <500 µm are unlikely to be the reason for night vision disturbances in otherwise asymptomatic eyes.
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Femtosecond Thin-flap LASIK for the Correction of Ametropia After Penetrating Keratoplasty

Irina S. Barequet, MD; Ami Hirsh, MD; Samuel Levinger, MD
Submitted: 5/10/08; Accepted: 2/18/09; Posted: 4/15/09

In a series of 11 consecutive eyes, from approximately 1 to 13 years after penetrating keratoplasty, femtosecond thin-flap laser was done without serious complications and with improved visual function.
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Comparison of LASIK and Photorefractive Keratectomy for Myopia From -10.00 to -18.00 Diopters Ten Years After Surgery

Mohamad Rosman, MD, FRCSEd, FAMS; Jorge L. Alió, MD, PhD; Dolores Ortiz, PhD; Juan J. Perez-Santonja, MD
Submitted: 5/15/08; Accepted: 2/18/09; Posted: 4/1/09

In a retrospective study of 51 eyes that underwent PRK and 141 eyes that underwent LASIK for myopia of -10.00 to -18.00 D, the percentage of eyes with uncorrected visual acuity of 20/40 or better was higher in the LASIK group than in the PRK group throughout 10-year follow-up. In eyes that underwent PRK, haze was a significant long-term problem.
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Structural-functional Correlations of Corneal Innervation After LASIK and Penetrating Keratoplasty

Oliver Stachs, PhD; Andrey Zhivov, MD; Robert Kraak, MD; Marine Hovakimyan, PhD; Andreas Wree, MD; Rudolf Guthoff, MD
Submitted: 7/15/08; Accepted: 2/10/09; Posted: 4/1/09

Confocal microscopy of the subbasal nerve plexus in the cornea after LASIK and penetrating keratoplasty demonstrates that normal anatomy is not achieved during recovery, even though normal sensation occurs after LASIK by about 6 months; however, it does not occur completely normally in penetrating keratoplasty.
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Adjustable Intracorneal Ring in a Lamellar Pocket for Keratoconus

Albert Daxer, MD, PhD
Submitted: 7/31/08; Accepted: 2/3/09; Posted: 3/18/09

After creating a limbus-to-limbus lamellar pocket, a flexible complete intracorneal ring is inserted, and can be adjusted within the stromal pocket as reported in one case of keratoconus.
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Cause of Monocular Diplopia Diagnosed by Combining Double-pass Retinal Image Assessment and Hartmann-Shack Aberrometry

Guillermo M. Pérez, OD, MSc; Salomé Abenza, MD; Alvaro De Casas, MD; Jose M. Marín, MD; Pablo Artal, PhD
Submitted: 8/27/08; Accepted: 2/3/09; Posted: 3/18/09

In a patient with 20/20 UCVA and monocular diplopia and minimal lens changes on slit lamp examination, the combination of the optical quality analysis system and a Hartmann-Schack aberrometer demonstrated that double vision was generated by the lens. Cataract surgery was successful and the monocular diplopia disappeared.
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