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Purpose: To compare the clinical outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) with a transscleral-sutured intraocular lens (IOL) and solitary DSAEK., Setting: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan., Design: Retrospective case series., Methods: Cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and solitary DSAEK cases were studied. The logMAR acuity, astigmatism, endothelial cell density (ECD), graft survival rate, and complications (eg, IOL dislocation, cystoid macular edema [CME]) were analyzed., Results: Thirty-seven DSAEK cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and 147 solitary DSAEK cases were evaluated. The logMAR corrected distance visual acuity (CDVA) improved significantly at 24 months, from 1.34 ± 0.49 (SD) to 0.48 ± 0.38 after DSAEK with transscleral-sutured IOLs and from 1.17 ± 0.69 to 0.17 ± 0.25 after solitary DSAEK. The logMAR CDVA after DSAEK with transscleral-sutured IOLs was significantly worse than that with solitary DSAEK at 6, 12, and 24 months (P < .01). The postoperative astigmatism with DSAEK with transscleral-sutured IOLs was significantly higher than with solitary DSAEK because of the larger sclerocorneal incision (P < .02). There were no significant differences in ECD or graft survival rates between DSAEK with transscleral-sutured IOLs and solitary DSAEK. The incidence of CME in DSAEK with transscleral-sutured IOLs (4/37 eyes [11%]) was higher than with solitary DSAEK (2/147 [1.4%]) (P = .02). The CME resolved with topical diclofenac and sub-Tenon injection of triamcinolone acetonide in all eyes., Conclusion: The graft survival rates after DSAEK with transscleral-sutured IOLs were equivalent to those after solitary DSAEK, although the incidence of CME was higher than after solitary DSAEK., Financial Disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To propose the new anterior-posterior method (A-P method) that does not require historical data to calculate intraocular lens (IOL) power after laser in situ keratomileusis (LASIK) and to compare the accuracy of the method with other IOL formulas after LASIK., Setting: Keio University Hospital, Tokyo, Japan., Design: Case series., Methods: Eyes having phacoemulsification and IOL implantation after myopic LASIK were analyzed retrospectively. The A-P method is a modification of the double-K method using the SRK/T formula in which the estimated pre-LASIK keratometry (K) power calculated from the post-LASIK posterior sagittal power in the 6.0 mm zone is used for the preoperative K value in the double-K method and the post-LASIK anterior sagittal power is used for the postoperative K value. The accuracy of the A-P method was compared with that of other formulas that do not require preoperative data and with formulas that require preoperative data., Results: The median values of the arithmetic and absolute prediction errors using the A-P method were 0.16 diopter (D) and 0.54 D, respectively. The prediction errors using the A-P method were within ± 0.50 D in 46.4% of eyes and within ± 1.00 D in 75.0%. The percentage of eyes within ± 1.00 D of the prediction errors with the A-P method was highest with the no-history methods., Conclusion: The A-P method may be a good option for calculating IOL power in eyes having cataract surgery after LASIK when preoperative LASIK data are unavailable., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the changes in functional visual acuity before and after neodymium:YAG (Nd:YAG) laser capsulotomy., Setting: Keio University Hospital, Tokyo, Japan., Design: Case series., Methods: Eyes that had previous cataract surgery with a clinical diagnosis of central posterior capsule opacity requiring Nd:YAG laser capsulotomy were evaluated. All patients had refractive error and corrected distance visual acuity (CDVA) measurements; slitlamp microscopy examinations, including posterior capsule opacification evaluation; high-contrast visual acuity measured at 5 m using a Landolt chart; 10% low-contrast visual acuity (LCVA); functional visual acuity; wavefront examination; and a Schirmer test without anesthesia., Results: The study enrolled 9 patients (4 women, 5 men; 10 eyes) with a mean age of 57.3 years ± 7.0 (SD) (range 47 to 68 years). Although there was no significant difference in CDVA before and after Nd:YAG capsulotomy, there was a significant improvement in the mean functional visual acuity, from 0.18 ± 0.11 logMAR (range -0.03 to 0.31 logMAR) to 0.08 ± 0.07 logMAR (range -0.04 to 0.18 logMAR) (P < .05). The LCVA improved significantly after Nd:YAG laser capsulotomy (P = .003). Higher-order aberrations and the root mean square of the 4th-order coefficients decreased significantly after capsulotomy, and these aberrations were significantly correlated with functional visual acuity and LCVA., Conclusion: Results indicate that measurement of functional visual acuity is useful in assessing the quality of vision in patients who have Nd:YAG laser capsulotomy after cataract surgery., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the predictability of total postoperative spherical aberration after aspheric intraocular lens (IOL) implantation using preoperative corneal spherical aberration., Setting: Keio University Hospital, Tokyo, Japan., Methods: Corneal and ocular higher-order aberrations (HOAs) were analyzed preoperatively and postoperatively in eyes having cataract extraction with aspheric IOL implantation. The predicted postoperative total spherical aberration Z(4,0) was calculated by adding the preoperative corneal spherical aberration and the labeled spherical aberration of the IOL. The prediction error of the postoperative total spherical aberration was calculated by subtracting the predicted postoperative total spherical aberration from the postoperative total spherical aberration. Surgically induced corneal spherical aberration was calculated by subtracting the postoperative from the preoperative corneal spherical aberration., Results: There were no statistically significant differences between preoperative and postoperative corneal spherical aberration, 3rd-order aberration, or HOAs. The prediction error of the postoperative total spherical aberration was within +/-0.05 microm in 9 (24.3%) of the 37 eyes evaluated and within +/-0.10 microm in 18 eyes (48.6%). Statistically significantly correlations were found between the surgically induced corneal spherical aberration and prediction error of postoperative total spherical aberration, the preoperative corneal spherical aberration and surgically induced corneal spherical aberration, and the preoperative corneal spherical aberration and prediction error of postoperative total spherical aberration., Conclusions: Predictability of postoperative ocular spherical aberration after cataract surgery with aspheric IOL implantation was insufficient because of the surgically induced corneal spherical aberration. Considering surgically induced corneal spherical aberration could improve the predictability of postoperative ocular spherical aberration., ((c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the long-term efficacy of a biconvex accommodating intraocular lens (IOL) to restore near visual performance., Setting: Department of Ophthalmology, Keio University Hospital, Tokyo, Japan., Methods: This 4-year study comprised eyes that had cataract surgery with implantation of a 1CU accommodating IOL. At all postoperative visits, the following were assessed: subjective spherical equivalent (SE) refraction; uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA), and corrected (CNVA) near visual acuities; change in minimum additional (add) power (diopters) to attain CNVA; and accommodation amplitude. A questionnaire was administered at the last visit., Results: Twelve eyes of 8 cataract patients (mean age 59.0 years +/- 18.4 [SD]) were evaluated. Postoperatively, the mean SE at 1 year and 4 years was significantly more hyperopic than at 1 month (P<.05). The mean UDVA increased significantly at 4 years compared with 1 month (P<.05). There were no significant changes in CDVA, UNVA, CNVA, and DCNVA throughout the follow-up period. The change in the minimum add power to attain CNVA and in the subjective and objective accommodation amplitudes also did not change significantly over time. Eighty-three percent of patients reported being satisfied with the results., Conclusion: Four years after implantation of an accommodating IOL, most patients had good vision and were satisfied, although the accommodation amplitude for near vision was not sufficient throughout the follow-up., (Copyright (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effect of age on anterior chamber depth (ACD) and anterior chamber volume (ACV) after laser in situ keratomileusis (LASIK) for myopia., Setting: Department of Ophthalmology, Keio University School of Medicine, and a private clinic, Tokyo, Japan., Methods: In this retrospective study, patients who had uneventful LASIK for myopia or myopic astigmatism were divided into 2 groups: younger (younger than 40 years) and older (40 years and older). Central corneal thickness, central corneal true net power, ACV, and central ACD were measured using a rotating Scheimpflug camera preoperatively and 1 month postoperatively. These parameters were compared between the 2 groups., Results: The study evaluated 161 eyes of 83 patients (mean age 34.5 years +/- 8.3 [SD]). The decreases in central ACD and ACV after LASIK were statistically significant in the younger group (P<.0001 and P = .0050, respectively) but not in the older group., Conclusion: Central ACD and the ACV decreased significantly after LASIK in younger patients (<40 years) but not in older patients, indicating that age influences changes in ACD and ACV after LASIK.

Purpose: To evaluate the feasibility of correcting spherical aberration with aspheric intraocular lenses (IOLs) in cataract surgery based on individual pupil diameter., Setting: Keio University Hospital, Tokyo, Japan., Methods: In this prospective study, eyes having cataract surgery were divided into 4 groups based on IOL type: aspheric SN (AcrySof SN60WF), aspheric ZA (Tecnis ZA9003), aspheric PY (Hoya PY-60 AD), and spherical (AcrySof Natural SN60AT). Postoperative higher-order aberrations (HOAs) of the cornea and whole eye and the pupil diameter under photopic and mesopic conditions were measured. The HOA was calculated using the individual pupil diameter. The correlation between corneal and ocular spherical aberrations and pupil diameter was evaluated., Results: Each group comprised 30 eyes. Ocular spherical aberrations were significantly lower than corneal spherical aberrations under mesopic conditions in the aspheric SN group, the aspheric ZA group, and the aspheric PY group (P<.05); there was no significant difference between the aberrations in the spherical group. Linear regression showed significant correlations between postoperative corneal and ocular spherical aberrations (beta = 0.39, aspheric SN; beta = 0.38, aspheric ZA; beta = 0.58, aspheric PY; beta = 0.79, spherical). The differences in corneal and ocular spherical aberrations were significantly correlated with pupil diameter in the aspheric IOL groups but not in the spherical IOL group., Conclusions: The amount of spherical aberration correction by aspheric IOLs varied depending on IOL type and individual pupil diameter. The linear regression equation in this study may make it possible to customize postoperative ocular spherical aberration after cataract surgery.

Purpose: To evaluate the effect of spherical aberration on visual function under natural pupil conditions after cataract surgery., Setting: Keio University Hospital, Tokyo, Japan., Methods: This study comprised cataract patients who had cataract extraction with implantation of an acrylic intraocular lens. Preoperative and postoperative visual acuity, higher-order aberration in the whole eye, contrast sensitivity function, and pupil diameter under photopic and mesopic conditions 1 month after surgery were measured. The area under log contrast sensitivity function (AULCSF) and spherical aberration corresponding to the individual pupil diameter under photopic and mesopic conditions were evaluated., Results: One hundred seven eyes of 79 patients (30 men, 49 women; mean age 68.0 years +/- 9.6 [SD]) were evaluated. The mean pupil diameter was 2.9 +/- 0.50 mm under photopic conditions and 3.6 +/- 0.57 mm under mesopic conditions. The mean spherical aberration was 0.03 +/- 0.04 mum (range -0.12 to 0.34 mum) under photopic conditions and 0.05 +/- 0.10 mum (range -0.14 to 0.55 mum) under mesopic conditions. The postoperative AULCSF without glare under photopic conditions was significantly negatively correlated with spherical aberration (P = .014). The postoperative AULCSF with and without glare under mesopic conditions was significantly negatively correlated with spherical aberration (P<.001 and P = .01, respectively)., Conclusions: Postoperative spherical aberration had a significant effect on visual function under photopic and mesopic conditions. This result indicates that reduced postoperative spherical aberration improves postoperative visual function under photopic and mesopic conditions.

Purpose: To investigate the anatomic variations of entrance pupil decentration and tilting angle of the iris in healthy subjects and the influence of these factors on the outcome of laser in situ keratomileusis (LASIK)., Setting: Minamiaoyama Eye Clinic, Tokyo, Japan., Methods: The degree of pupil decentration and tilting angle of the iris in 2280 eyes of 1144 myopic patients without abnormal findings by ophthalmologic examination were assessed using Orbscan. Of these, 901 eyes of 467 patients had LASIK. Multiple analysis of variance (ANOVA) was used to determine risk factors for reduction of postoperative best spectacle-corrected visual acuity (BSCVA) considering patient age, refractive power, tilting angle of the iris, pupil decentration, and corneal power., Results: The mean pupil decentration in all eyes was 0.19 mm +/- 0.11 (SD) (range 0 to 0.9 mm); tilting angle of the iris was 4.06 +/- 1.41 degrees (range 0.19 to 12.69 degrees). By multiple ANOVA, refractive power, pupil decentration, and tilting angle of the iris were significant for the reduction of BSCVA., Conclusions: Some eyes with pupil decentration or tilting angle of the iris could not be detected under typical ophthalmologic examination but only with topographic examination. Attention should be paid to eyes with large pupil decentration and tilting angle of the iris because these may be risk factors for reduction of postoperative BSCVA during corneal refractive surgeries.

Purpose: To investigate the efficacy and safety of implantation of an iris-claw phakic intraocular lens (PIOL), Artisan Myopia, in Asian eyes., Setting: Minamiaoyama Eye Clinic, Tokyo, Japan., Methods: Forty-four eyes of 32 Japanese patients and 1 Korean patient with high myopia had Artisan Myopia lens implantation to correct their refractive errors. Lens models, 5/8.5 or 6/8.5 (optic diameter/overall diameter), were chosen as standard lens model. A smaller lens model (5/7.5-Artisan Myopia Small) was implanted in eyes with corneal diameter less than 11.0 mm. Postoperative examinations were performed on 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, corneal endothelial cell counts, intraocular pressure, and complications were evaluated., Results: Artisan Myopia Small lenses were implanted in 4 eyes (9.1%) and 8.5 mm diameter lenses were implanted in 40 eyes. Preoperative UCVA (logMAR) improved from 1.57 to 0.09 at 1 month after surgery and no regression was observed thereafter. Postoperative manifest refraction was -1.02 +/- 0.87 D (-3.25 to -0.00 D), and within 1.0 D in 20 eyes (55.6%), within 2.0 D in 32 eyes (88.9%) at 1 month after surgery, and stable during the follow-up period. The final BCVA decreased 2 lines in 2 eyes (4.5%) due to progression of age-related cataract. No serious complications such as angle closure or progressive endothelial cell loss were observed., Conclusion: Implantation of an Artisan iris-claw PIOL implantation may be a safe and effective procedure for Asian eyes.

Purpose: To prospectively assess the clinical outcome after implantation of the 1CU accommodating intraocular lens (IOL) and a foldable acrylic IOL (AcrySof, Alcon)., Setting: Department of Ophthalmology, Tokyo Dental College, Ichikawa Hospital, Ichikawa, and Minami Aoyama Eye Clinics, Tokyo, Yokohama, Japan., Methods: Twenty-two eyes of 16 patients with cataract had phacoemulsification implantation of 1CU accommodating IOL. Twenty eyes of 10 age-matched and sex-matched patients with cataract had the same surgery but with a foldable acrylic IOL. All patients had assessments of the amplitude of accommodation, refraction, uncorrected and best corrected distance and near visual acuity, and distance corrected near visual acuity before surgery up to 12 months after surgery. Contrast visual acuities were measured 1 year after surgery. Anterior segment photography, intraocular pressure measurements, specular microscopy, and computerized topography were also performed., Results: The final best corrected distance visual acuity was above 20/25 in all eyes with the 1CU and the AcrySof IOLs. The mean distance corrected near visual acuity was significantly higher in the 1CU IOL group than in the acrylic IOL group after 3 months. None of the eyes with the AcrySof IOL implants displayed an accommodative response at any examination. The peak mean amplitude of accommodation with the 1CU IOLs was observed at 3 months and was 0.5 diopters +/- 0.44 (SD). Accommodation amplitude declined after 6 months., Conclusion: The 1CU IOL provided additional near acuity postoperatively, but the benefit disappeared at 12 months with a concomitant decrease in accommodation amplitude owing to an increase in anterior and posterior capsular opacities.

Purpose: To assess the effect of preoperative tear function on early changes in functional visual acuity (FVA) after laser in situ keratomileusis (LASIK)., Setting: Minamiaoyama Eye Clinic, Tokyo, Japan., Methods: This prospective single-center study assessed the effect of preoperative and postoperative tear functions on FVA in 30 eyes of 15 patients who had LASIK. Functional visual acuity was defined as the binocular recognition acuity measured by the FVA tester (Wellsystem) during a 10-second, blink-free period. All patients had a Schirmer test with anesthesia and tear-film breakup time (BUT) measurements preoperatively and 1 day and 1 week after LASIK. Corneal topography and Landolt visual acuity and FVA measurements were performed before surgery and 1 day and 1 week after LASIK. Eyes with a Schirmer test reading less than 5.0 mm and a BUT less than 5 seconds were grouped as definite dry eye (DDE). Eyes with a normal Schirmer test score but a shortened BUT were grouped as probable dry eye (PDE)., Results: In all patients, the best uncorrected Landolt visual acuity was 20/20 or better at the postoperative examination times. In the DDE group, the mean preoperative FVA declined from 1.2 to 0.75 +/- 0.16 (SD) at 1 day and increased to 1.2 at 1 week. No change in FVA was observed postoperatively in the PDE group., Conclusion: Laser in situ keratomileusis patients with low basal tearing and full uncorrected distance Landolt acuity may experience a transient decrease in FVA that returns to baseline within 1 week.

Purpose: To prospectively assess the clinical and visual outcomes of phacoemulsification and implantation of a rollable intraocular lens (IOL) with a thin optic and compare the results with those of implantation of a foldable acrylic IOL., Setting: Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan., Methods: Sixteen consecutive eyes of 8 patients (4 women, 4 men) with corticonuclear cataract had small-incision clear corneal phacoemulsification with implantation of a rollable ThinOptX IOL (ThinOptX Inc.) in the capsular bag. Twenty eyes of 10 age- and sex-matched patients (5 women, 5 men) with the same diagnosis had phacoemulsification and intracapsular implantation of an AcrySof foldable acrylic IOL (MA60BM, Alcon). The patients' refractive status and uncorrected and best corrected distance visual acuities were assessed preoperatively and 1 week and 1, 3, and 6 months after surgery. The uncorrected and best corrected near acuities were measured before and 6 months after surgery. Contrast visual acuity was measured with variable contrast charts 1, 3, and 6 months after surgery, and the results in the 2 IOL groups were compared. Anterior segment photography, intraocular pressure (IOP) measurement, specular microscopy, and fundoscopy were done before surgery and at 1, 3, and 6 months., Results: The final best corrected distance acuity was better than 20/25 in all eyes with a ThinOptX IOL and 18 eyes (90%) with an AcrySof IOL. The best corrected near acuity was better than 20/40 in 12 eyes (75%) and 14 eyes (70%), respectively. The mean contrast acuity with charts 2 and 3 was significantly higher in the ThinOptX group than in the AcrySof group at all examinations (P<.05). The final mean postoperative induced astigmatism was 0.06 diopter (D) +/- 0.50 (SD) and 0.25 +/- 0.68 D, respectively (P>.05). There were no differences in IOP or corneal endothelial cell density between the 2 groups at any examination. No intraoperative or postoperative complications occurred., Conclusions: ThinOptX IOL implantation provided best corrected near and distance visual acuities comparable to those provided by the AcrySof IOLs. The significantly higher contrast acuities attained after implantation of the ThinOptX lens may be attributable to its ultrathin properties.

Purpose: To investigate the refractive outcomes after arcuate keratotomy for astigmatism., Setting: Uludag University, Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey., Method: Sixteen eyes of 11 patients with astigmatism had arcuate keratotomy using the Terry astigmatome. The mean age of the patients was 36 years +/- 10 (SD). All patients received preoperative and postoperative ophthalmic examinations consisting of best spectacle-corrected (BSCVA) and uncorrected (UCVA) visual acuities, corneal topography, and ultrasonic pachymetry. Surgery was performed using topical anesthesia of oxybuprocaine 0.1% eyedrops. The Terry astigmatome was selected by the mean paracentral (estimated incision area) corneal thickness. All patients received topical ofloxacin 0.3% and topical diclofenac 0.1% eyedrops postoperatively., Results: The mean corneal astigmatism was -4.0 +/- 1.1 diopters (D) (range -2.2 to -6.0 D) preoperatively and -1.8 +/- 0.8 D (range -0.6 to -3.0 D) postoperatively. The mean surgically induced corneal astigmatism was 2.5 +/- 0.6 D. The mean UCVA (logMAR) was 0.74 +/- 0.25 preoperatively and 0.18 +/- 0.23 1 week postoperatively, and the mean BSCVA (logMAR) was 0.19 +/- 0.24 and 0.19 +/- 0.23, respectively. There were no intraoperative or postoperative complications., Conclusion: Arcuate keratotomy using the Terry astigmatome was a safe and reliable treatment for corneal astigmatism.

Purpose: To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma., Methods: Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV(R)) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth(R), Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration., Results: The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy., Conclusions: Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

A healthy 21-year-old man had laser in situ keratomileusis (LASIK) in the right eye for a refractive error of -7.0 diopters. The electrocardiogram findings and heart rate were recorded before LASIK; during eye lid speculum insertion, vacuum application, corneal flap preparation, and excimer laser keratectomy; and after the procedure. The pre-LASIK heart rate was 90 pulses/min. Severe bradycardia of 40 beats/min developed during vacuum application, and the procedure was terminated. Severe bradycardia caused by an oculocardiac reflex may occur during LASIK, and patients should be closely monitored during the procedure.

Purpose: To study the visual and refractive changes in patients with superficial corneal opacities after excimer laser phototherapeutic keratectomy (PTK)., Setting: Eye Clinic, Kobe Kaisei Hospital, Kobe, Japan., Methods: One hundred twelve eyes of 80 patients with superficial corneal opacities had PTK with the Nidek EC-5000 excimer laser system. All patients had routine ophthalmic examinations including uncorrected and Landolt best corrected visual acuity (BCVA) measurements, subjective and objective refractions, keratometry, EyeSys (Premier Laser Systems, Inc.) corneal topography performed before and 1 week and 1, 3, 6, and 12 months after PTK, and pachymetry performed before and 12 months after PTK. The change in refractive status within 12 months of PTK and the relationship between factors such as ablation depth, transition zone (TZ) setting, and use of masking agents and the amount of hyperopic shift were also assessed., Results: The BCVA increased by more than 2 lines in 65.1% of eyes and by 1 line in 24.1%. The BCVA did not change in 12 eyes (10.8%) because of cataract or underlying retinal disease. A mean hyperopic shift of 3.42 +/- 1.15 diopters (D) (range 1.00 to 5.25 D) was seen in all eyes at 12 months. The hyperopic shift peaked 1 month after PTK and tended to decline after that; it stabilized at 12 months., Conclusion: Although PTK is a safe and efficient method for the treatment of superficial corneal opacities, induced hyperopia after the procedure remains a major problem. A shallow ablation depth (less than 100 microm), presence of a TZ setting, and use of a masking agent decrease the hyperopic shift significantly.

Purpose: To assess the surface morphology and cause of glistenings in an explanted AcrySof intraocular lens (IOL)., Setting: Shakai Hoken Kobe Central Hospital, Kobe, Japan., Methods: A 63-year-old Japanese man had implantation of an AcrySof IOL in the capsular bag. One month postoperatively, he had a neodymium:YAG laser capsulotomy for posterior capsule opacification, which changed the IOL's position in the capsular bag. A few months later, the patient developed disabling night glare from intralenticular glistenings and progressive hyperopic refractive error. The IOL was explanted and then analyzed by optical microscopy and atomic force microscopy (AFM). Laboratory analysis of control AcrySof IOLs kept in a balanced salt solution at steady room and body temperature for 2 months was also performed to evaluate the cause of the glistenings observed clinically., Results: Optical microscopy showed that the explanted AcrySof IOL had several microvacuoles; no abnormalities were observed in the control AcrySof IOLs before or after folding at the room and body temperatures. The AFM analysis showed a significant change in the surface morphology of the explanted IOL, including vacuolar formations in the posterior surface as well as numerous anterior surface irregularities. No microvacuoles or surface morphology alterations were observed in the control AcrySof IOLs by AFM analysis., Conclusions: The glistenings in the explanted AcrySof IOL were likely caused by temperature changes and not mechanical stress from folding.