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ABSTRACT: Corneal collagen crosslinking with riboflavin photosensitization and ultraviolet irradiation is a novel approach to limiting the progression of keratoconus in patients by increasing the elastic modulus of the degenerate cornea. Beneficial reductions in corneal steepness and aberrations after crosslinking also frequently occur. In a previous study, we described a computational modeling approach to simulating topographic progression in keratoconus and regression of disease with corneal collagen crosslinking. In the current study, this model has been expanded and applied to the inverse problem of estimating longitudinal time-dependent changes in the corneal elastic modulus after crosslinking using in vivo measurements from 16 human eyes. Topography measured before crosslinking was used to construct a patient-specific finite element model with assumed hyperelastic properties. Then the properties of the cornea were altered using an inverse optimization method to minimize the difference between the model-predicted and in vivo corneal shape after crosslinking. Effects of assumptions regarding sclera-to-cornea elastic modulus ratio and spatial attenuation of treatment effect due to ultraviolet beam characteristics on the predicted change in elastic modulus were also investigated. Corneal property changes computed by inverse finite element analysis provided excellent geometric agreement with clinical topography measurements in patient eyes post-crosslinking. Over all post-treatment time points, the estimated increase in corneal elastic modulus was 110.8±48.1%, and slightly less stiffening was required to produce the same amount of corneal topographic regression of disease when the sclera-to-cornea modulus ratio was increased. Including the effect of beam attenuation resulted in greater estimates of stiffening in the anterior cornea. Corneal shape responses to crosslinking varied considerably and emphasize the importance of a patient-specific approach.
Experimental Eye Research 05/2013; · 3.26 Impact Factor
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ABSTRACT: To assess corneal microarchitecture and regional epithelial thickness profile in eyes with keratoconus, postoperative corneal ectasia (ectasia), and normal unoperated eyes (controls) using spectral-domain optical coherence tomography (SD-OCT).
Regional corneal epithelial thickness profiles were measured with anterior segment SD-OCT (Optovue RTVue-100, Optovue Inc., Fremont, CA). Epithelial thickness was assessed at 21 points, 0.5 mm apart, across the central 6-mm of the corneal apex in the horizontal and vertical meridians.
One hundred twenty eyes were evaluated, including 49 eyes from 29 patients with keratoconus, 32 eyes from 16 patients with ectasia, and 39 eyes from 21 control patients. Average epithelial thickness at the corneal apex was 41.18 ± 6.47 μm (range: 30 to 51 μm) for keratoconus, 46.5 ± 6.72 μm for ectasia (range: 34 to 60 μm), and 50.45 ± 3.92 μm for controls (range: 42 to 55 μm). Apical epithelial thickness was significantly thinner in eyes with keratoconus (P < .0001) and ectasia (P = .0007) than in controls. Epithelial thickness ranges in all other areas varied widely for keratoconus (range: 21 to 101 μm) and ectasia (range: 30 to 82 μm) compared to controls (range: 43 to 64) (P = .0063).
SD-OCT demonstrated significant central and regional epithelial thickness profile differences between keratoconus, ectasia, and control eyes, with significant variability and unpredictability in ectatic eyes. This regional irregularity may necessitate direct epithelial thickness measurement for treatments where underlying stromal variations may be clinically relevant, including corneal collagen cross-linking or topography-guided ablations.
Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2013; 29(3):173-9. · 2.54 Impact Factor
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ABSTRACT: OBJECTIVES:: The free-living amoeba Acanthamoeba castellanii is a rare cause of contact lens-associated microbial keratitis. The cyst stage of this amoeba is noted for its resistance to disinfection by multipurpose contact lens solutions (MPS). This report examines and reviews the potential survival modes of A. castellanii in MPS. METHODS:: Trophozoites of A. castellanii (ATCC 30234) at densities from 10 to near 10 were incubated in 3 different MPS in a laminar flow hood for 24 hours at ambient temperatures. The dried films of MPS and phosphate-buffered saline (PBS) controls were examined before and after the addition of a peptone-yeast extract-glucose recovery broth (PYG) for the presence of amoeboid trophozoites and resistance stages over at least 7 days. The parallel exposure of trophozoites to MPS without evaporation or addition of PYG was similarly examined. RESULTS:: Amoeboid trophozoites were not recovered in PYG nor were cyst-like structures observed in any MPS with near 10 densities. Progressively with 10 to 10 trophozoites, varied survival modes, particularly aggregates of trophozoites associated with cyst-like structures and occasional amoeboid forms and double-walled cysts with ostioles, became more evident. These morphotypes were most prominent after evaporation and typically first observed in the PYG. CONCLUSIONS:: Trophozoites of A. castellanii near 10 and progressively to 10 densities are capable of expressing a variety of "short-term" survival modes in MPS, notably with the added stress of evaporation. Expression of these alternate survival modes in MPS may relate, in part, to contamination of contact lens cases and difficulties in developing standardized MPS efficacy tests.
Eye & contact lens 08/2012;
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ABSTRACT: PURPOSE: To determine the minimum depth of phototherapeutic keratectomy (PTK) required for diffuse haze removal in granular corneal dystrophy type 2 and to determine whether Fourier domain optical coherence tomography (FD-OCT) can be an effective technique for predicting the exact required depth of ablation. METHODS: The depth of ablation used for diffuse stromal haze removal was evaluated with the slit lamp and serially taken photographs during the PTK procedure. The depth of diffuse haze was measured preoperatively using FD-OCT. RESULTS: Forty-three eyes of 30 patients were included in this study. The mean age of the patients was 62.0 ± 8.4 years. The mean depth of PTK required was 43.7 ± 6.2 μm (range, 31-59 μm). The mean follow-up period for 29 eyes of 22 patients, who had follow-up periods of more than 6 months, was 21.0 ± 12.0 months. The mean best spectacle-corrected visual acuity of these 29 eyes was 0.43 ± 0.15 preoperatively and 0.71 ± 0.16 (P = 0.022) 1 month postoperatively. Of the 43 eyes of 30 patients, FD-OCT was evaluated in 29 eyes of 22 patients. The mean preoperative depth of diffuse haze using FD-OCT was 44.3 ± 6.4 μm. The mean depth of ablation required to remove diffuse stromal haze was 44.5 ± 5.9 μm. The actual ablated depths correlated well with the depth of haze detected by FD-OCT preoperatively (intraclass correlation coefficient = 0.719). CONCLUSIONS: FD-OCT is an accurate method of predicting the depth of PTK required to remove visually significant diffuse haze in patients with granular corneal dystrophy type 2. We advocate the use of slit-lamp biomicroscopy after the initial 30-μm ablation to determine the necessity for any further ablation.
Cornea 04/2012; · 1.73 Impact Factor
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R Doyle Stulting,
Alan Sugar,
Roy Beck,
Michael Belin,
Mariya Dontchev,
Robert S Feder,
Robin L Gal,
Edward J Holland,
Craig Kollman,
Mark J Mannis,
Francis Price,
Walter Stark,
David D Verdier
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ABSTRACT: PURPOSE:: To assess the relationship between donor and recipient factors and corneal allograft rejection in eyes that underwent penetrating keratoplasty in the Cornea Donor Study. METHODS:: Overall, 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) were followed for up to 5 years. Associations of baseline recipient and donor factors with the occurrence of a probable or definite rejection event were assessed in univariate and multivariate proportional hazards models. RESULTS:: Eyes with pseudophakic or aphakic corneal edema (n = 369) were more likely to experience a rejection event than eyes with Fuchs dystrophy (n = 676) [34% ± 6% vs. 22% ± 4%; hazard ratio = 1.56; 95% confidence interval (CI), 1.21-2.03]. Among eyes with Fuchs dystrophy, a higher probability of a rejection event was observed in phakic posttransplant eyes compared with those that underwent cataract extraction with or without intraocular lens implantation during penetrating keratoplasty (29% vs. 19%; hazard ratio = 0.54; 95% CI, 0.36-0.82). Female recipients had a higher probability of a rejection event than male recipients (29% vs. 21%; hazard ratio = 1.42; 95% CI, 1.08-1.87) after controlling for the effect of preoperative diagnosis and lens status. Donor age and donor recipient ABO compatibility were not associated with rejection. CONCLUSIONS:: There was a substantially higher graft rejection rate in eyes with pseudophakic or aphakic corneal edema compared to that in eyes with Fuchs dystrophy. Female recipients were more likely to have a rejection event than male recipients. Graft rejection was not associated with donor age.
Cornea 04/2012; 31(10):1141-1147. · 1.73 Impact Factor
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ABSTRACT: To report the histopathologic findings of the iridocorneal endothelial (ICE) syndrome and posterior polymorphous membranous dystrophy (PPMD) in 3 patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK), and to correlate these findings with the clinical diagnosis.
Three patients with clinical findings compatible with either ICE syndrome (1 patient) or PPMD (2 patients) underwent DSAEK. The DSAEK specimens were processed for light microscopy, immunhistochemical staining for cytokeratins AE1/3 and MAK6, and electron microscopy.
Examination of the DSAEK specimens showed multilayered endothelial cells and thickened Descemet membrane in all cases. Immunohistochemical staining for cytokeratins was positive in the endothelium in all cases. Ultrastructural examination showed a thickened Descemet membrane and wide-spaced collagen in Descemet membrane in 1 case of PPMD but not in 2 cases of ICE syndrome, including 1 case that carried the clinical diagnosis of PPMD. In 2 cases, the histopathologic evaluation of the DSAEK specimen confirmed the clinical diagnosis; however, in 1 case the pathological diagnosis was ICE syndrome, while the clinical diagnosis was PPMD.
ICE syndrome and PPMD can be diagnosed and differentiated from one another by histopathologic evaluation of corneal specimens obtained at the time of DSAEK. We recommend submitting the corneal tissue obtained during DSAEK for pathological examination when the etiology of corneal edema is unclear.
Cornea 02/2012; 31(9):1060-4. · 1.73 Impact Factor
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ABSTRACT: To assess the corneal architecture and reproducibility of LASIK flap thickness created by the Amadeus II mechanical microkeratome (Ziemer Ophthalmic Systems AG) using Fourier-domain optical coherence tomography (OCT; Optovue Inc).
Anterior segment Fourier-domain OCT was used to analyze the morphology of 58 LASIK flaps from 30 patients created with the Amadeus II microkeratome 140-μm head and ML7090CLB blades (Med-Logics Inc) at 2 weeks postoperatively. Flap thickness was assessed at 10 points across the central 6 mm of the cornea (horizontal and vertical meridians). Postoperative central corneal flap thickness measured by Fourier-domain OCT was compared with intraoperative ultrasound pachymetry measurements.
No significant difference was noted between central flap thickness measured by intraoperative pachymetry (107.2 ± 14 μm) and postoperative OCT (111.7 ± 11 μm; P=.07, correlation coefficient=0.86). Fourier-domain OCT measurements demonstrated functionally planar flap architecture (standard deviation [SD] of thickness across the flap=4.9 μm, SD range across the flap=2 to 9 μm) for the microkeratome flaps.
The Amadeus II microkeratome with Med-Logics blades created thin, reproducible, functionally planar flaps as measured by Fourier-domain OCT. Central flap thickness measured by intraoperative ultrasound pachymetry was equivalent to that measured 2 weeks postoperatively by OCT.
Journal of refractive surgery (Thorofare, N.J.: 1995) 08/2011; 27(10):759-63. · 2.54 Impact Factor
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Cornea 06/2011; 30(8):945-7. · 1.73 Impact Factor
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Jonathan H Lass,
Roy W Beck,
Beth Ann Benetz,
Mariya Dontchev,
Robin L Gal,
Edward J Holland,
Craig Kollman,
Mark J Mannis,
Francis Price,
Irving Raber,
Walter Stark, R Doyle Stulting,
Alan Sugar
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ABSTRACT: To identify baseline (donor, recipient, and operative) factors that affect endothelial cell loss following penetrating keratoplasty for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic or aphakic corneal edema).
In a subset (n = 567) of Cornea Donor Study participants, preoperative and postoperative endothelial cell densities (ECDs) were determined by a central reading center. Multivariate regression analyses were performed to examine which baseline factors correlated with ECD over time.
Larger grafts (P < .001), younger donor age (P < .001), and female donor (P = .004) were significantly associated with higher ECD during follow-up. Median endothelial cell loss at 5 years was 68% for grafts larger than 8.0 to 9.0 mm in diameter, 75% for grafts 7.0 mm to smaller than 8.0 mm in diameter, and 74% for grafts 8.0 mm in diameter. Grafts from female donors experienced a 67% cell loss compared with a 72% cell loss among grafts from male donors. Method of tissue retrieval, donor cause of death, history of diabetes, and time from death to preservation or to surgery were not significantly associated with changes in ECD over time.
Following penetrating keratoplasty for endothelial dysfunction conditions, larger donor graft size, younger donor age, and female donor were associated with higher ECD over 5 years. These data warrant exploring the possibility that similar associations may exist following endothelial keratoplasty.
clinicaltrials.gov Identifier: NCT00006411.
Archives of ophthalmology 05/2011; 129(9):1149-54. · 3.86 Impact Factor
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Archives of ophthalmology 04/2011; 129(4):509-10. · 3.86 Impact Factor
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Journal of cataract and refractive surgery 01/2011; 37(1):1-3. · 2.75 Impact Factor
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Journal of refractive surgery (Thorofare, N.J.: 1995) 01/2011; 27(1):7-9. · 2.54 Impact Factor
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ABSTRACT: To evaluate the clinical features of and histologic findings from failed Descemet stripping automated endothelial keratoplasty (DSAEK).
This retrospective observational case series evaluated 47 consecutive corneal specimens from 42 patients who underwent either penetrating keratoplasty or repeated DSAEK for failed DSAEK. Clinical information was obtained for the cases. Sections of the specimens were examined using light microscopy. Immunohistochemical staining was performed for cytokeratins AE1/AE3 and for the myogenic marker smooth-muscle actin when indicated. Transmission electron microscopic examination was performed in some cases.
Graft survival ranged from 0.5 to 34 months. Histologic examination showed that 94% of the specimens (44 of 47) had endothelial cell loss. Residual host Descemet membrane (19%; 9 of 47), fibrocellular tissue (19%; 9 of 47), epithelial implantation (15%; 7 of 47), and fungal infection (4%; 2 of 47) were also identified. Immunohistochemical stains were positive for AE1/AE3 in the epithelial implantations and for smooth-muscle actin in cells in the fibrocellular proliferations.
The principal cause of failed DSAEK is endothelial cell loss. Residual host Descemet membrane, fibrocellular tissue at the edge of the lenticule, and epithelial implantation are common histologic findings. Fungal infection may occur in the setting of DSAEK.
Archives of ophthalmology 08/2010; 128(8):973-80. · 3.86 Impact Factor
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ABSTRACT: To study the effect of flap thickness on visual acuity and refractive outcomes after laser in situ keratomileusis (LASIK) using 2 blade types with a mechanical microkeratome.
Emory Vision, Atlanta, Georgia, USA.
This retrospective analysis was of LASIK cases performed between January 2005 and June 2006 using an Amadeus I microkeratome and an ML7090 CLB blade (blade A) or a Surepass blade (blade B). Outcomes analyzed included flap thickness, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), the enhancement rate, and surgical complications 3 months postoperatively.
Two hundred sixty-three eyes of 153 patients were analyzed; blade A was used in 158 eyes and blade B, in 105 eyes. The mean flap thickness was significantly thinner with blade A than with blade B (107 microm +/- 12 [SD] versus 130 +/- 20 microm) (P<.0001). There was no overall correlation with either blade between flap thickness and UDVA, CDVA, or MRSE (all r<0.2). At 3 months, there was no statistically significant difference in UDVA, CDVA, or MRSE between the 2 blade groups at 3 months (all P > .10), and there was no difference in the complication rates.
Flap thickness did not affect visual or refractive outcomes with a mechanical microkeratome with either blade type.
Journal of cataract and refractive surgery 05/2010; 36(5):810-3. · 2.75 Impact Factor
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ABSTRACT: To compare visual acuity and higher-order aberrations (HOAs) after wavefront-guided and wavefront-optimized laser in situ keratomileusis (LASIK).
This retrospective study comprised refraction-matched myopic eyes that had wavefront-guided (Visx Star S4 laser) or wavefront-optimized (WaveLight Allegretto Wave laser) LASIK targeted for emmetropia. Preoperative and postoperative manifest refraction spherical equivalent (MRSE), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and preoperative and postoperative HOAs were compared.
Preoperatively, there were no significant differences between the wavefront-guided and wavefront-optimized groups in age, sex, corneal thickness, MRSE, or HOAs (all P>.05). The mean MRSE was -2.88 diopters (D) +/- 2.6 (SD) and -2.96 +/- 2.6 D, respectively, preoperatively and -0.01 +/- 0.25 D and -0.02 +/- 0.33 D, respectively, postoperatively; 96% of all eyes were within +/-0.50 D of emmetropia postoperatively. There were no differences in UDVA, CDVA, MRSE, or HOAs between groups (all P>.05). The UDVA was 20/20 or better in 85% of eyes in the wavefront-guided group and 86% of eyes in the wavefront-optimized group. All eyes had 20/25 or better CDVA postoperatively; no eye lost 2 lines of CDVA. Fourteen eyes were converted from wavefront-guided to wavefront-optimized treatment because of poor limbal ring alignment (8 eyes), a wave scan not consistent with the manifest refraction (5 eyes), and no iris registration (1 eye).
Wavefront-guided LASIK and wavefront-optimized LASIK produced equivalent visual outcomes and no differences in HOAs. Wavefront-guided treatment could not be performed in many eyes because of difficulties during wavefront measurement.
Journal of cataract and refractive surgery 03/2010; 36(3):437-41. · 2.75 Impact Factor
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ABSTRACT: To evaluate the effect of mitomycin C (MMC) on the exacerbation of corneal opacity that occurs in patients with granular corneal dystrophy type II (GCD II) after refractive corneal surface ablation.
Ten eyes of patients with GCD II who underwent refractive corneal surface ablation with MMC were compared with 10 eyes that were not treated with MMC. Best spectacle-corrected visual acuity, the degree of corneal opacity, and contrast sensitivity were evaluated at least 3 years after surgery. Corneal opacities were quantified using Pentacam densitometry maps.
No measured between-group value showed a statistically significant difference.
Simultaneous application of MMC does not prevent exacerbation of GCD II after refractive corneal surface ablation.
Cornea 03/2010; 29(5):490-6. · 1.73 Impact Factor
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Jonathan H Lass,
Alan Sugar,
Beth Ann Benetz,
Roy W Beck,
Mariya Dontchev,
Robin L Gal,
Craig Kollman,
Robert Gross,
Ellen Heck,
Edward J Holland,
Mark J Mannis,
Irving Raber,
Walter Stark, R Doyle Stulting
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ABSTRACT: To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema.
In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail.
Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (+/-95% confidence interval) of failure was 13% (+/-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm(2) vs 2% (+/-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm(2) or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm(2).
Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm(2).
Archives of ophthalmology 01/2010; 128(1):63-9. · 3.86 Impact Factor
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ABSTRACT: To evaluate the use of Fourier-domain optical coherence tomography (FD-OCT) in the selection and planning of surgical procedures to treat GCD2 (granular corneal dystrophy type 2).
An RTVue-100 FD-OCT (Optovue, Fremont, California) was used to determine the size, depth and location of deposits in six patients with homozygous or heterozygous GCD2.
The RTVue-100 FD-OCT revealed the depth of the deposits quite precisely, allowing the determination of the appropriate depth of PTK (phototherapeutic keratectomy) and the appropriate selection of lamellar versus penetrating keratoplasty as the procedure of choice. In each case, visually significant opacities were adequately removed or would be removed.
FD-OCT provides useful information for the selection and planning of surgical procedures to remove corneal opacities in patients with GCD2.
The British journal of ophthalmology 10/2009; 94(3):341-5. · 2.92 Impact Factor
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ABSTRACT: Over the past several decades mycotic keratitis has been considered a rare sequel to hydrogel contact lens wear. In 2005–2006 an upswing in the incidence of Fusarium keratitis was associated with a disproportionate use of one multipurpose contact lens solution (MPS, ReNu with MoistureLoc, Bausch & Lomb, Rochester, NY). The MPS, as manufactured and marketed, was sterile and met regulatory guidelines for antimicrobial activity. A multivariant interaction of poor hygienic practices and the contact lens paraphernalia were associated with a mostly selective contamination in or on the lens storage case by members of the F. solani/F. oxysporum species complexes from the environment of the user. A decline of the anti-fusaria properties of the MPS in the lens case appeared related to its dissociation from drying, or dilution and the potential for sorption of antimicrobial solution components (e.g., alexidine) to various hydrogel lenses. These factors and capacities of the fusaria for rapid amplification by microcycle conidiation, production of dormant resistant cells, and potential for attachment and penetration of hydrogel lenses, were linked to the occasional selective fungal survival and growth during storage of the lens in MPS. Lack of a manual rubbing-cleaning step in the MPS disinfection process was considered a risk factor for keratitis.
Medical Mycology 07/2009; 46(5):397-410. · 2.46 Impact Factor
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ABSTRACT: To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention.
Emory Eye Center, Atlanta, Georgia, USA.
This retrospective review comprised eyes of patients dissatisfied with visual outcomes after multifocal IOL implantation. Outcomes analyzed included type of visual complaint, treatment modality for each complaint, and degree of clinical improvement after intervention.
Thirty-two patients (43 eyes) reported unwanted visual symptoms after multifocal IOL implantation, including in 28 eyes (65%) with an AcrySof ReSTOR IOL and 15 (35%) with a ReZoom IOL. Thirty patients (41 eyes) reported blurred vision, 15 (18 eyes) reported photic phenomena, and 13 (16 eyes) reported both. Causes of blurred vision included ametropia (12 eyes, 29%), dry eye syndrome (6 eyes, 15%), posterior capsule opacification (PCO) (22 eyes, 54%), and unexplained etiology (1 eye, 2%). Causes of photic phenomena included IOL decentration (2 eyes, 12%), retained lens fragment (1 eye, 6%), PCO (12 eyes, 66%), dry-eye syndrome (1 eye, 2%), and unexplained etiology (2 eyes, 11%). Photic phenomena attributed to PCO also caused blurred vision. Thirty-five eyes (81%) had improvement with conservative treatment. Five eyes (12%) did not have improvement despite treatment combinations. Three eyes (7%) required IOL exchange.
Complaints of blurred vision and photic phenomena after multifocal IOL implantation were effectively managed with appropriate treatment. Few eyes (7%) required IOL exchange. Neodymium:YAG capsulotomy should be delayed until it has been determined that IOL exchange will not be necessary.
Journal of cataract and refractive surgery 07/2009; 35(6):992-7. · 2.75 Impact Factor
