pressure, leading to spontaneous inflow of ocular sur-face fluid into the anterior chamber by the suction ef-fect of the wound.

Vikas Sharma, MD, MRCD(Ed), MRCOphthShreyasi Sharma, MBBS

Sugato Paul, FRCSBhaskar Gupta, M.S., MRCophthWigan, Lancashire, United Kingdom

REFERENCES1. Vasavada AR, Praveen MR, Pandita D, et al. Effect of stromal hy-

dration of clear corneal incisions: quantifying ingress of trypan

blue into the anterior chamber after phacoemulsification. J Cata-

ract Refract Surg 2007; 33:623–627

2. Lundstrom M, Wejde G, Stenevi U, et al. Endophthalmitis after

cataract surgery; a nationwide prospective study evaluating inci-

dence in relation to incision type and location. Ophthalmology

2007; 114:866–870

3. Berdahl JP, DeStafeno JJ, Kim T. Corneal wound architecture

and integrity after phacoemulsification; evaluation of coaxial,

microincision coaxial, and microincision bimanual techniques.

J Cataract Refract Surg 2007; 33:510–515

Laser-assisted subepithelial keratectomy withMMC to treat post-LASIK myopic regression

Cagıl et al.1 evaluated laser-assisted subepithelialkeratectomy (LASEK) in the treatment of post-laserin situ keratomileusis (LASIK) residual refraction. Sur-face ablation could theoretically be the ideal procedurein cases of post-LASIK regression when in-the-bed en-hancement is not advisable, but it has been associatedwith the development of dense haze.2 Although laterreports did not find a high incidence of haze,3,4 thestudy by Cagıl et al.1 shows that it is an important is-sue. The authors found haze when ablations greaterthan �2.00 diopters (D) were performed and sug-gested that the use of mitomycin-C (MMC) could pos-sibly avoid this complication.

We have treated 4 eyes with post-LASIK regressionusing LASEK andMMC 0.02% for 30 seconds over theablated stroma, programming an undercorrection of10% of the intended correction. The ablation was per-formed with the Esiris excimer laser (Schwind EyeTech Solutions) using a photorefractive keratectomynomogram and a conventional ablation. The opticalzone was 6.0 mm with a transition zone of 1.0 mm.

Case 1 A 35-year-old woman had uneventful LASIKusing a 6.0mmoptical zone to correct refractive defects(right eye, C0.50 �1.75 � 180; left eye, �0.75 �2.00 �10). The preoperative central corneal thickness (CCT)was 503 mm in both eyes. Six months postoperatively,there was regression, with no signs of ectasia (righteye, C0.50 �1.00 � 180; left eye, �0.25 �1.00 � 15).The patient had LASEKCMMC in both eyes. Sixmonths postoperatively, there was an overcorrectionin the left eye (right eye, �0.50 D; left eye, C1.00 D).No haze was detected.

Case 2 A 45-year-old woman came to our clinic be-cause of regression of the myopic defect in the lefteye after LASIK performed at another center. Shehad no data regarding the initial surgery. Refractionin the left eye was �1.25 D, and the CCT was 394 mm.Topography showed no signs of corneal ectasia. Threemonths after LASEKCMMC, the left eye appearedconsiderably overcorrected: C2.75 D.

Case 3 A 55-year-old man had successful LASIK us-ing a 6.0 mm optical zone to correct a myopic defect(right eye, �5.25 �1.75 � 165). The preoperative CCTwas 505 mm. One year postoperatively, the patientshowed regression (�1.00 sphere), with normal topog-raphy and a clear lens. Three months after LASEKCMMC, therewas anovercorrection:C2.50�0.50� 155.

There are 2 possible causes of our unpredictable re-sults, which seem to contradict the results obtained by

1674 LETTERS

REPLY: We appreciate the comments of Sharmaet al. Over a period of time, we have adopted the pro-cedure of phacoemulsification through temporal clearcorneal incisions. We found that in our hands, per-forming phacoemulsification through a superior inci-sion was difficult and also produced severe stress onthe incision during emulsification. Therefore, we didnot attempt to address this question in our paper,but we agree that the study suggested by Sharmaet al. comparing superior and temporal incisionswould be interesting.

In reference to comparing the effect of woundhydration onbimanual (1.2mm) andmicrocoaxial pha-coemulsification (2.2mm),weperformedarandomizedclinical trial and found that ingress of trypan blue intothe anterior chamber after phacoemulsification (trypanblue was used as a tracer) was significantly more withbimanual than with microcoaxial and attained statisti-cal significance (P!.001) (V.A. Vasavada, MD, ‘‘Com-parative Quantification of Ingress of Trypan Blue intothe Anterior Chamber After Bimanual or MicrocoaxialPhacoemulsification,’’ presented at the ASCRS Sympo-sium on Cataract, IOL and Refractive Surgery, SanDiego, California, USA, April 2007).

We totally agree with the observation about carefulremoval of the speculum after phacoemulsification.We clearly demonstrated the phenomenon of sponta-neous ingress of trypan blue in our ASCRS presen-tation.dAbhay R. Vasavada, MS, FRCS, MamidipudR. Praveeni, DO, Deepak Pandita, MS, DevarshiU. Gajjar, PhD, Vaishali A. Vasavada, MS, VirajA. Vasavada, MS, Shetal M. Raj, DO, Kaid Johar, MPhil,PhD

J CATARACT REFRACT SURG - VOL 33, OCTOBER 2007