The Flap Lift Suture.

that an axial length decrease results in myopia. The study that is cited in the paper regarding the influences among refractive outcomes (axial length, keratometry readings, and AC depth) did not mention refractive outcome as a result of those measurements. Therefore, the question is how do the investigators account for a myopic shift in an eye with a decrease in axial length? One possibility that could lead to a myopic outcome with a shorter postoperative axial length would be anterior shift of intraocular lens. Another potential change that could result in a myopic shift is a steepening of the average keratometric power of the cornea. Kim et al showed that with noninvasive methods of lowering intraocular pressure, axial length significantly decreased and resulted in a predicted refractive difference per 10mm Hg intraocular pressure decrease of +0.15D. That is, a hyperopic shift occurred secondary to axial length decrease.2 This matter deserves further study. We would suggest a randomized, prospective study with a specific refractive target (plano or 0.50D), with preoperative and postoperative axial length, anterior chamber depth, and keratometry to clarify the anticipated refractive shift in this patient group (combined cataract and glaucoma surgery).