Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus.

PURPOSE: The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus. METHODS: In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively. RESULTS: Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 ( P < 0.001) and 0.06 ± 0.12 ( P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from -5.39 ± 3.89 diopters (D) preoperatively to -2.29 ± 2.65 D ( P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from -4.70 ± 2.86 D preoperatively to -3.55 ± 2.45 D ( P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up ( P > 0.05). CONCLUSIONS: Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.

CIRCLE Software for Management of Epithelial Ingrowth After SMILE.

PURPOSE: To report a novel therapeutic use of CIRCLE software (Carl Zeiss Meditec) to manage visually significant epithelial ingrowth following small incision lenticule extraction surgery (SMILE). METHODS: Case series. RESULTS: In this case series, the authors describe three eyes with progressive and visually significant epithelial ingrowth following an uneventful SMILE procedure. The management of epithelial ingrowth following SMILE is challenging, given the small access incision to the interface and the risk of incomplete removal. All cases were successfully managed by converting the SMILE cap into a flap using the CIRCLE software, which provided the necessary access to the original SMILE interface. Once the flap was lifted, the epithelial in-growth was completely debrided from the underlying stroma and undersurface of the flap, followed by a thorough interface wash. Postoperative recovery was uneventful, with no recurrence noted in any of the eyes. CONCLUSIONS: Use of CIRCLE software provides a novel and unique approach to successfully treating vision-threatening epithelial ingrowth after SMILE. [J Refract Surg. 2021;37(11):776-780.].

Small incision lenticule extraction retreatment in a patient with high residual refractive error after photorefractive keratectomy: A case report.

A 36-year-old male underwent uneventful small incision lenticule extraction (SMILE) for the correction of his high residual refractive error 12 years after photorefractive keratectomy (PRK). Preoperatively, uncorrected distance visual acuity (UDVA) was counting fingers in both eyes. Corrected distance visual acuity was 20/20 in the right and 20/30 in the left eye due to amblyopia. One month after SMILE, UDVA was 20/20 and 20/30 in the right and left eye, respectively; post-PRK corneal haze had reduced. During the 4-year follow-up, UDVA remained stable and there were no complications. SMILE could be a good alternative approach for retreatment in post-PRK patient.

Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus.

The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of "CXL plus" was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols.

Femtosecond-Assisted Big Bubble: A Feasibility Study.

PURPOSE: To evaluate the feasibility of femtosecond laser-assisted (FA) tunnel creation as a pretreatment for creating a big bubble (BB) to pneumo-dissect the corneal stroma from Descemet membrane. METHODS: Five human cadaver eyes received pretreatment using a femtosecond laser. An intrastromal tunnel, along with a side cut, was achieved using customized femtosecond corneal disruption (custom mask). Before treatment, optical coherence tomography was performed and the intrastromal tunnel was intended to achieve a parallel orientation with respect to the corneal endothelial cell layer (50 µm above the endothelium). Surgical dissection of the side cut using a Sinskey hook was performed, followed by insertion of a deep anterior lamellar keratoplasty cannula into the tunnel and pneumo-dissection (BB). All corneas after treatment were prepared for histologic evaluation (light microscopy). RESULTS: FA pretreatment was successful in all 5 cadaveric corneas, and the BB was achieved in all eyes as well. Histologic evaluation of the corneas revealed complete separation of Descemet membrane and stroma in all eyes, with no remaining stroma attached to Descemet membrane and no signs of perforation. CONCLUSIONS: FABB seems feasible because pneumo-dissection of the corneal stroma from Descemet membrane was achieved in all human cadaver corneas of this experimental study. Optical coherence tomography, corneal histology, and macroscopic evaluation revealed complete Descemet-stromal separation.

Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone.

PURPOSE: To compare the results of corneal collagen cross-linking (CXL) alone with combined simultaneous topography-guided photorefractive keratectomy plus CXL (tPRK-CXL) for progressive keratoconus for a 3-year interval. DESIGN: Prospective, comparative interventional case series. PARTICIPANTS: Forty-eight patients (60 eyes) with progressive keratoconus. METHODS: Thirty eyes underwent combined tPRK with a solid-state laser (maximum ablation depth, 50 µm) followed by CXL, and 30 eyes underwent CXL alone. Groups were matched in terms of age and keratoconus stage. MAIN OUTCOME MEASURES: Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), keratometry, and corneal confocal microscopy. RESULTS: Mean follow up was 39±11 months. Mean age at operation was 28±5.82 years. Before surgery, average CDVA in the tPRK-CXL group was 0.26±0.17 logarithm of the minimum angle of resolution (logMAR), and in the CXL group was 0.24±0.18 logMAR (P = 0.58). At last follow-up, CDVA was 0.09±0.10 logMAR in the tPRK-CXL group and 0.15±0.12 logMAR in the CXL group (P < 0.05). In both groups, no patient lost more than 2 lines of Snellen visual acuity, whereas 19 eyes and 8 eyes in the tPRK-CXL group and in the CXL group, respectively, gained 2 or more lines of CDVA. Before surgery, average UDVA was 0.83±0.54 logMAR in the tPRK-CXL group and 0.86±0.62 logMAR in the CXL group (P = 0.79). At last follow-up, UDVA was 0.27±0.25 logMAR in the tPRK-CXL group and 0.69±0.58 logMAR in the CXL group (P < 0.001). Before surgery, steep and flat keratometry had no significant differences between groups, and at last follow-up, both steep and flat keratometry readings were significantly flatter in the tPRK-CXL group compared with the CXL group. Depth of CXL treatment, as evaluated by confocal microscopy, was 269.8±31.8 µm in the CXL group and 299.7±29.8 µm in the tPRK-CXL group (P < 0.001). No differences were found in endothelial cell density. CONCLUSIONS: Simultaneous tPRK followed by CXL in this series of keratoconus patients offered significantly improved vision to treated patients in comparison with CXL alone, and similar results regarding postoperative stability. Safety concerns regarding corneal thickness were taken into account in treatment planning.

Comparison of surgically induced astigmatism between femtosecond laser and manual clear corneal incisions for cataract surgery.

PURPOSE: To assess the surgically induced corneal astigmatism (SIA) introduced by femtosecond laser-assisted clear corneal incisions (CCIs) for cataract extraction and to compare it with the SIA of manually created CCIs. SETTING: Bascom Palmer Eye Institute, Miller School of Medicine, Miami, Florida, USA. DESIGN: Prospective nonrandomized comparative case series. METHODS: Eyes received femtosecond laser-assisted CCIs (Group 1) or manual CCIs (Group 2). The surgical plan included 1 primary and 1 secondary port; the sites of the incisions were the same in both groups and were diametrically opposed between the right eye and left eye. The SIA was assessed using the preoperative and 1-month postoperative keratometric values obtained from corneal topography examinations. RESULTS: This study included 72 eyes of 68 patients with a mean age of 69.0 years ± 9.87 (SD) (range 36 to 90 years). Thirty-six eyes received femtosecond laser-assisted CCIs (Group 1) and 36 received manual CCIs (Group 2). The mean preoperative topographic corneal astigmatism was -1.19 ± 0.68 diopters (D) (range 0 to 2.50 D) and -0.92 ± 0.63 D (range 0.10 to 2.45 D) for Group 1 and Group 2, respectively, whereas, 1 month after cataract surgery, it was -1.16 ± 0.63 D (range 0.20 to 2.57 D) and -0.95 ± 0.64 D (range 0.21 to 2.37 D), respectively. Multivariate vector analysis revealed no statistically significant difference between the 2 groups for preoperative astigmatism, postoperative astigmatism, and SIA (P > .05 for all comparisons between Group 1 and Group 2). CONCLUSION: Femtosecond laser-assisted and manual corneal incisions for cataract surgery did not appear to significantly alter corneal astigmatism, whereas they showed comparable SIA. FINANCIAL DISCLOSURE: Drs. Yoo and Donaldson are speakers for and consultants to Alcon Surgical, Inc., and Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Corneal collagen cross-linking (CXL) combined with refractive procedures for the treatment of corneal ectatic disorders: CXL plus.

PURPOSE: To discuss current combined corneal collagen cross-linking (CXL) and refractive surgical techniques (herein termed "CXL plus") for the treatment of corneal ectatic disorders to improve functional visual acuity in addition to corneal stability from CXL alone. METHODS: Literature review. RESULTS: Efficacious combined treatments with CXL include: photorefractive keratectomy, transepithelial phototherapeutic keratectomy, intrastromal corneal ring segments implantation, phakic intraocular lens implantation, and multiple combined procedures. Some uncertainty remains as to the optimal strategies for each patient. A decision tree is proposed to facilitate optimal patient management. CONCLUSIONS: With multiple adjuvant techniques, CXL plus is likely to benefit many patients with corneal ectatic disorders. The appropriate combined procedure will depend on multiple factors, such as refraction, corneal thickness, and degree of irregular astigmatism.

Long-term follow-up of corneal collagen cross-linking for keratoconus--the Cretan study.

PURPOSE: The aim of this study was to present the long-term results of corneal collagen cross-linking (CXL) in patients with keratoconus. METHODS: In this prospective, interventional case series, patients with progressive keratoconus underwent CXL treatment according to the Dresden protocol. Visual, refractive, and topographic outcomes along with endothelial cell density were evaluated preoperatively and at 1, 2, 3, 4, and 5 years postoperatively. RESULTS: Twenty-one patients (25 eyes) were enrolled. The mean follow-up was 43.7 ± 12.2 (range, 24-60) months. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected visual acuity and the mean best spectacle-corrected visual acuity improved significantly from 0.92 ± 0.54 and 0.29 ± 0.21 preoperatively to 0.63 ± 0.41 (P = 0.010) and 0.18 ± 0.18 (P = 0.011), respectively, at the last follow-up. Mean steep and mean flat keratometry readings reduced significantly from 52.53 ± 6.95 diopters (D) and 48.11 ± 5.98 D preoperatively to 49.10 ± 4.50 D (P < 0.001) and 45.58 ± 3.81 D (P = 0.001), respectively, at the last follow-up. The mean endothelial cell density was 2708 ± 302 cells per square millimeter preoperatively and did not change significantly (P > 0.05) at any postoperative interval (2593 ± 258 cells/mm at the last follow-up; P = 0.149). CONCLUSIONS: CXL seems to be effective and safe in halting progression of keratoconus over a long-term follow-up period up to 5 years postoperatively.

Long-term results of combined transepithelial phototherapeutic keratectomy and corneal collagen crosslinking for keratoconus: Cretan protocol.

PURPOSE: To present the long-term results of combined transepithelial phototherapeutic keratectomy (PTK) and corneal collagen crosslinking (CXL) for keratoconus. SETTING: Vardinoyiannion Eye Institute of Crete, University of Crete, Heraklion, Crete, Greece. DESIGN: Prospective case series. METHODS: Patients with progressive keratoconus had combined transepithelial PTK and CXL (Cretan protocol). Visual and refractive outcomes and the endothelial cell density (ECD) were evaluated preoperatively and postoperatively. RESULTS: Twenty patients (23 eyes) were enrolled; postoperatively 23 eyes were evaluated at 1 and 2 years, 11 at 3 years, and 7 at 4 years. The mean follow-up was 33.83 months±10.82 (SD) (range 24 to 56 months). No intraoperative or postoperative complications occurred. The mean uncorrected distance visual acuity improved significantly from 0.99±0.57 logMAR preoperatively to 0.61±0.36 logMAR at the last follow-up (P<.001) and the mean corrected distance visual acuity, from 0.27±0.24 logMAR to 0.17±0.14 logMAR (P=.018), respectively. The mean steep and mean flat keratometry readings decreased significantly from 53.39±7.14 diopters (D) and 47.17±4.87 D, respectively, preoperatively to 49.99±4.36 D (P<.001) and 45.47±2.95 D (P=.002), respectively, at the last follow-up. The mean corneal astigmatism improved significantly from -6.27±4.19 D preoperatively to -4.52±2.80 D (P<.001) at the last follow-up. No significant ECD alterations occurred (P>.05). CONCLUSION: Combined transepithelial PTK and CXL was effective and safe in keratoconic patients over a long-term follow-up. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Safety of high-intensity corneal collagen crosslinking.

PURPOSE: To evaluate the safety of a new high-intensity corneal collagen crosslinking (CXL) treatment protocol for keratoconus. SETTING: Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. DESIGN: Prospective interventional case series. METHODS: Patients with progressive keratoconus had CXL using a new treatment protocol with 9 mW/cm(2) irradiance for duration of 10 minutes. The rate of reepithelialization, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and steep and flat keratometry (K) values were evaluated preoperatively and 3 months postoperatively. RESULTS: Nine patients (10 eyes) were enrolled. No intraoperative or early postoperative complications were observed in any patient. The ECD did not change significantly 3 months postoperatively (P=.169). The CDVA improved from 0.19 logMAR ± 0.20 (SD) preoperatively to 0.10 ± 0.16 logMAR 3 months postoperatively; however, the improvement did not attain significance (P=.141). No eye lost lines of CDVA. The mean steep K readings decreased significantly from 48.04 ± 2.57 diopters (D) preoperatively to 46.51 ± 2.81 D 3 months postoperatively (P=.047); the mean flat K readings did not change significantly postoperatively (P=.285). CONCLUSIONS: Corneal collagen crosslinking at 9 mW/cm(2) irradiance for 10 minutes did not cause significant changes in ECD or intraoperative or early postoperative complications. None patient lost a line of CDVA 3 months after the procedure. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Femtosecond laser-assisted astigmatic keratotomy for postoperative trabeculectomy-induced corneal astigmatism.

PURPOSE: To describe a case of postoperative trabeculectomy-induced corneal astigmatism treated with femtosecond laser-assisted astigmatic keratotomy. METHODS: After trabeculectomy, the patient demonstrated change in manifest refraction from -0.5 diopters preoperatively to mixed astigmatism of -3.5 + 5.25@100 postoperatively and a decrease in uncorrected distance visual acuity from 20/60 preoperatively to 20/200 at 1 month postoperatively. Because the patient was intolerant to spectacle use, she underwent femtosecond laser-assisted astigmatic keratotomy. RESULTS: After astigmatic keratotomy there was improvement in corneal topographic astigmatism from 4.15 to 0.81 diopters with uncorrected distance visual acuity of 20/60(-2) and manifest refraction of -0.75 + 1.0@90 at 3 months postoperatively. There were no intraoperative or postoperative complications. CONCLUSIONS: Femtosecond laser-assisted astigmatic keratotomy may be considered in eyes with postoperative trabeculectomy-induced mixed astigmatism.

Factors affecting DSAEK graft lenticle adhesion: an in vitro experimental study.

PURPOSE: The aim of this study was to evaluate different factors that affect Descemet stripping automated endothelial keratoplasty (DSAEK) donor graft lenticle adhesion to the recipient cornea. METHODS: This experimental study included 10 eye bank recipient corneas and 10 donor DSAEK lenticles. Recipient corneas were mounted on an artificial anterior chamber (AC), whereas donor lenticles were placed beneath the host cornea. Using optical coherence tomography and imaging software, the interface gap (IG) between the donor and recipient cornea was quantified to evaluate the effect of variations in AC air fill pressure, AC air fill duration, corneal massage, and corneal venting incisions on DSAEK donor graft lenticle adhesion. RESULTS: Different intraocular pressures (IOP) under air for the same time intervals, do not significantly correlate with the IG; nevertheless, it was noticed that the IG decreases as the IOP increases. With respect to the magnitude of AC IOP, there was no statistically significant difference when comparing 10 mm Hg with 30 mm Hg and assessing IG (P = 0.4). Complete air-fluid exchange resulted in significantly higher IG when compared with AC air bubble of 10 and 30 mm Hg that was sustained for 1 hour (P < 0.05). Furthermore, corneal surface massage did not facilitate DSAEK graft adhesion (P = 0.59). Finally, paracentral venting incisions followed by interface fluid aspiration seemed to significantly decrease the IG (P = 0.014). CONCLUSIONS: Corneal venting incisions and higher AC IOP values seem to facilitate DSAEK donor graft lenticle adhesion to the recipient cornea.

Long term followup of photorefractive keratectomy with adjuvant use of mitomycin C.

Purpose. To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC). Methods. This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval. Results. Mean preoperative spherical equivalent (SEQ) was -6.03 ± 1.87 D (diopters) and reduced to -0.09 ± 0.53 D at the last postoperative examination. Mean followup was 44.73 ± 18.24 months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was 2658 ± 153 cells/mm(2). Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery.

Simultaneous conventional photorefractive keratectomy and corneal collagen cross-linking for pellucid marginal corneal degeneration.

PURPOSE: To present the results after simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking for pellucid marginal corneal degeneration. METHODS: In this prospective, interventional case series, 6 patients (8 eyes) with pellucid marginal corneal degeneration were enrolled. All patients underwent simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking; corneal epithelium was removed by transepithelial phototherapeutic keratectomy during treatment (Cretan protocol plus conventional photorefractive keratectomy). Visual and refractive outcomes were evaluated along with endothelial cell density preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS: No intraoperative or postoperative complications were observed in any of the patients. LogMAR mean uncorrected distance visual acuity improved significantly from 1.05 ± 0.33 preoperatively to 0.41 ± 0.27 (P = .018) at 12 months postoperatively. Mean corrected distance visual acuity did not change significantly (P > .05) postoperatively. Mean spherical equivalent improved significantly from -3.52 ± 2.29 diopters preoperatively to -1.57 ± 1.76 diopters (P = .028) at last follow-up. Mean corneal astigmatism was significantly reduced from -6.83 ± 2.33 diopters preoperatively to -4.71 ± 1.89 diopters (P = .018) at the last follow-up. No endothelial cell density alterations were observed throughout the follow-up period (P > .05). CONCLUSIONS: Simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking seems to be an effective, safe, and promising treatment for the management of pellucid marginal corneal degeneration.

Femtosecond laser-assisted intracorneal biopolymer insertion for the symptomatic treatment of bullous keratopathy.

PURPOSE: To describe a new minimally invasive surgical technique for the symptomatic management of bullous keratopathy in blind eyes. METHODS: Four patients with severe corneal edema due to endothelial decompensation and no visual function in the affected eye presented for the relief of their ocular symptoms (pain and tearing). Femtosecond laser technology was used to create a deep corneal pocket into which silicone oil was inserted. RESULTS: After the procedure, all patients demonstrated immediate relief of their symptoms, along with restoration of a normal corneal surface 7 days after the procedure (no bullae and no epithelial defects). All patients remained free of symptoms during the entire follow-up period (from 24 to 31 months). Anterior to the inserted implant, the corneal lamellae remained compact, transparent, and without bullae; whereas the posterior corneal stroma under the implant was edematous. No intraoperative or postoperative complications were noted. CONCLUSIONS: Intracorneal insertion of silicone oil is a feasible new technique for the symptomatic treatment of bullous keratopathy in blind eyes.

High-resolution optical coherence tomography-guided donor tissue preparation for descemet membrane endothelial keratoplasty using the reverse big bubble technique.

PURPOSE: The aim of this study was to assess the feasibility of high-resolution spectral domain optical coherence tomography (HR-SDOCT) to guide donor tissue preparation in Descemet membrane endothelial keratoplasty using the reverse big bubble technique. METHODS: Three corneoscleral discs were included in this ex vivo experimental study. A 27-G cannula was introduced into each cornea at the periphery by 3 different surgeons. Each surgeon attempted to achieve the ideal depth (pre-Descemetic plane) of the tip of the cannula for air injection to produce the reverse big bubble to separate the Descemet membrane (DM) from the posterior stroma. A supine optical coherence tomography system built at the Ophthalmic Biophysics Center of the Bascom Palmer Eye Institute was used to estimate in real-time the depth reached by the tip of the cannula in the posterior stroma during tissue preparation. RESULTS: After air injection, 1 successful big bubble was obtained, while each of the other corneoscleral discs had intrastromal emphysema and DM perforation. On HR-SDOCT evaluations, artifacts were noticed at the tip of the cannula. The successful big bubble demonstrated the separation of the DM and the stroma without intrastromal hyperreflectivity. Emphysema was visualized on the HR-SDOCT as a hyperdense intrastromal area shadowing the posterior structures of the anterior chamber. CONCLUSIONS: The HR-SDOCT-guided reverse big bubble technique may be a useful method to prepare donor tissue in Descemet membrane endothelial keratoplasty. Further improvements in high-resolution optical coherence tomography technology are needed this promising technique.

Grid pattern delivered to the cornea during femtosecond laser-assisted cataract surgery.

UNLABELLED: A 63-year-old patient had cataract surgery in the left eye performed using the femtosecond laser. The laser successfully created the capsulotomy, but as the femtosecond lens fragmentation was being performed, the patient suddenly moved and the eye disengaged from the patient interface. As this happened, the surgeon stopped the treatment, but inspection of the cornea revealed a partial lens fragmentation grid pattern in the temporal cornea. This inadvertent occurrence did not affect the final surgical result. FINANCIAL DISCLOSURE: Dr. Yoo is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.