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Purpose: To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA)., Setting: Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea., Design: Prospective, randomized, comparative case series., Methods: Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups., Results: The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (-0.22 ± 0.18 D and -0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group., Conclusions: In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.

Purpose: To evaluate the changes in corneal higher-order aberrations (HOAs) after corneal wavefront-guided transepithelial photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE)., Setting: Yonsei University College of Medicine and Eyereum Eye Clinic, South Korea., Design: Retrospective case series., Methods: Medical records of patients having either corneal wavefront-guided transepithelial PRK or small-incision lenticule extraction were examined. The root-mean-square total HOAs, 3rd-order coma aberration, and 4th-order spherical aberration were measured preoperatively and 6 months postoperatively. Independent t tests and analysis of covariance were used to compare changes in corneal HOAs between the 2 groups., Results: The study comprised 77 eyes having corneal wavefront-guided transepithelial PRK and 81 eyes having small-incision lenticule extraction. The total HOAs and spherical aberration increased after transepithelial PRK (all P < .001), whereas coma aberration was stable after transepithelial PRK. The total HOAs, spherical aberration, and coma aberration increased after small-incision lenticule extraction (P < .001 for total HOAs, spherical aberration; P = .004 for coma). At 6 months postoperatively, total HOAs and spherical aberration were significantly larger in the transepithelial PRK group than in the small-incision lenticule extraction group. Coma aberration was larger in the small-incision lenticule extraction group than in the transepithelial PRK group. Spherical aberration induction was significantly smaller in the small-incision lenticule extraction group than in the transepithelial PRK group (P < .001), and coma aberration induction was larger in the small-incision lenticule extraction group than in the transepithelial PRK group (P = .011)., Conclusions: Small-incision lenticule extraction demonstrated that the induction of total HOAs was comparable to corneal wavefront-guided transepithelial PRK, accompanied by smaller spherical aberration induction and larger coma aberration induction. During small-incision lenticule extraction, surgeons should aim to obtain optimum centration for smaller induction of corneal HOAs., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate and compare the clinical outcomes, including visual acuity, refractive errors, and aberrations, between aberration-free transepithelial photorefractive keratectomy (PRK) and corneal wavefront-guided transepithelial PRK in eyes with myopic astigmatism., Setting: Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea., Design: Retrospective comparative case series., Methods: Patients with myopic astigmatism were treated with aberration-free transepithelial PRK or corneal wavefront-guided transepithelial PRK using a 1050 Hz high-repetition excimer laser. The safety, efficacy, predictability, and corneal aberrations were compared preoperatively and 1, 2, 3, and 6 months postoperatively., Results: The study comprised 188 patients (188 eyes); 91 eyes had aberration-free transepithelial PRK and 97 eyes corneal wavefront-guided transepithelial PRK. Six month after surgery, the mean uncorrected distance visual acuity was comparable (-0.06 logMAR ± 0.07 [SD] aberration-free group; -0.06 ± 0.06 logMAR wavefront-guided group). The safety, efficacy, and predictability of refractive and visual outcomes were also comparable between groups. Corneal total root-mean-square (RMS) higher-order aberrations (HOAs) increased after treatment in both groups, although fewer RMS HOAs were induced in the corneal wavefront-guided group than in the aberration-free group. Spherical aberration increased similarly after treatment in both groups. However, coma and trefoil increased only in the aberration-free group., Conclusions: Aberration-free transepithelial PRK and corneal wavefront-guided transepithelial PRK were safe and effective for correction of myopic astigmatism without difference in visual acuity and refractive outcomes. However, the corneal wavefront-guided profile induced fewer corneal aberrations than the aberration-free profile., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the changes in clear corneal incision (CCI) healing resulting from the postoperative administration of nonsteroidal antiinflammatory drugs (NSAIDs) or steroids using anterior segment optical coherence tomography (AS-OCT)., Setting: Institute of Vision Research, Department of Ophthalmology, Yonsei University, Seoul, South Korea., Design: Prospective randomized comparative study., Methods: Eyes having cataract surgery were randomly given an NSAID (bromfenac 0.1% [Bronuck]) or a steroid (prednisolone acetate 1.0% [Pred Forte]). Using AS-OCT, structural changes of CCIs were examined 1 day and 1, 3.5, and 23 weeks postoperatively. The incidence and size of 5 wound deformities (endothelial gape, Descemet membrane detachment, epithelial detachment or defect, posterior misalignment, loss of coaptation) were analyzed. The correlation between the mean total wound deformity scores (wound instability) and surgically induced astigmatism (SIA) was evaluated., Results: The bromfenac group comprised 29 eyes and the prednisolone group, 30 eyes. During the 6-month follow-up, the overall changes in wound instability were not significantly different between groups, although epithelial detachment or a larger defect was more frequent in the bromfenac group between 1 week and 3.5 weeks postoperatively. The SIA at 1 week was positively correlated with wound instability and wound instability at 1 day was positively correlated with cataract grading in both groups., Conclusions: No significant difference in the conformational changes of cataract wounds (aside from increased epithelial detachment or defect in bromfenac group) was observed between NSAIDs and steroids administered postoperatively. In the early postoperative period, high wound instability was associated with SIA, possibly contributing to worse visual outcomes., 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 evaluate the effects of photorefractive keratectomy (PRK) combined with corneal wavefront-guided ablation profiles and hyperaspheric ablation profiles on changes in higher-order aberrations (HOAs)., Setting: Yonsei University College of Medicine and Eyereum Clinic, Seoul, South Korea., Design: Comparative observational case series., Methods: Medical records of patients who had corneal wavefront-guided hyperaspheric PRK, corneal wavefront-guided mild-aspheric PRK, or non-corneal wavefront-guided mild-aspheric PRK were analyzed. The logMAR uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), and changes in corneal aberrations (root-mean-square [RMS] HOAs, spherical aberration, coma) were evaluated 1, 3, and 6 months postoperatively., Results: The records of 61 patients (96 eyes) were reviewed. There was no statistically significant difference in logMAR UDVA or MRSE between the 3 groups at any timepoint. Corneal RMS HOAs were significantly smaller in the corneal wavefront-guided hyperaspheric group and the corneal wavefront-guided mild-aspheric group than in the noncorneal wavefront-guided mild-aspheric group at each timepoint. Corneal spherical aberration was significantly smaller for corneal wavefront-guided hyperaspheric PRK than for noncorneal wavefront-guided mild-aspheric PRK 6 months postoperatively. Changes in corneal spherical aberration (preoperatively and 6 months postoperatively) in corneal wavefront-guided hyperaspheric PRK were significantly smaller than in corneal wavefront-guided mild-aspheric PRK (P = .046). Corneal coma was significantly smaller with corneal wavefront-guided hyperaspheric PRK and corneal wavefront-guided mild-aspheric PRK than with noncorneal wavefront-guided mild-aspheric PRK 3 months and 6 months postoperatively., Conclusion: Corneal wavefront-guided hyperaspheric PRK induced less corneal spherical aberration 6 months postoperatively than corneal wavefront-guided mild-aspheric PRK and noncorneal wavefront-guided mild-aspheric PRK., 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 assess the accuracy of 3 corneal horizontal meridian marking techniques using the iTrace Surgical Workstation in preoperative assessment for toric intraocular lens (IOL) implantation., Setting: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea., Design: Prospective comparative observational study., Methods: Patients were allocated into 3 groups. Three techniques-marking with a nonpendular marker with a surgeon's direct visualization, slitlamp-assisted marking with a pendulum-attached marker, and slitlamp-assisted marking with a horizontal slit beam-were used to perform the horizontal meridian marking. The marks were immediately documented and aligned with the Zaldivar toric caliper transparent topographic map. Using a horizontal reference meridian determined by the toric caliper, the accuracy of corneal horizontal marking techniques was quantitatively evaluated by determining the rotational deviation and vertical misalignment., Results: For rotational deviation, the pendular marking showed the fewest errors to the horizontal reference meridian (mean error -0.66 degrees; mean absolute error [MAE] 3.77 degrees). There was a significant difference between the pendular marking and the surgeon's direct visual marking. For the MAE, the pendular marking showed less deviation than the surgeon's direct visual marking and the horizontal slit-beam marking. With vertical misalignment, there was no significant difference between the 3 different corneal horizontal meridian marking techniques., Conclusion: The slitlamp-assisted technique with the pendulum-attached marker was more precise than marking with a nonpendular marker with a surgeon's direct visualization and marking with a horizontal slit beam in preoperative assessment for toric IOLs., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Unlabelled: We describe 2 cases of traumatized and torn laser in situ keratomileusis (LASIK) flaps, partially flipped anteriorly or posteriorly, fixed for 8 months or 4 months, and accompanied by epithelial ingrowth. The 2 patients had had uneventful bilateral LASIK 6 years and 1 year before the trauma. In Case 1, the anteriorly flipped flap was removed with transepithelial phototherapeutic keratectomy. Next, mitomycin-C 0.04% was applied for 30 seconds. In Case 2, the portion of the flap that was flipped posteriorly and buried under the remaining intact LASIK flap was restored to its original normal position and epithelial ingrowth was removed mechanically with a microcurette. Irrigation with 20% ethanol was performed to inhibit the recurrence of interfacial epithelial ingrowth. The stretched amniotic membrane overlay over the cornea and sclera was sutured tightly to the episclera as the biologic pressure patch for the inhibition of epithelial re-ingrowth. Good visual acuity was restored in both cases., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To calculate the keratometric (K) reading in corneas modified by myopic keratorefractive surgery using the total corneal refractive power (TCRP) of the Pentacam rotating Scheimpflug camera., Setting: University hospitals and private clinics, South Korea, Design: Evaluation of diagnostic test or technology., Methods: The study comprised healthy eyes, eyes having myopic keratorefractive surgery, and eyes having cataract surgery after myopic keratorefractive surgery. The conversion equation from the TCRP in the central 4.0 mm zone (TCRP4) to a K reading was derived in normal corneas. This equation was rechecked and its application range extended in corneas modified by myopic keratorefractive surgery. Then, the predictability of the TCRP method, combining the K reading derived from the TCRP4 and the Holladay 2 formula, was evaluated in a case series of cataract surgery patients who had previous myopic keratorefractive surgery., Results: The K reading derived from the TCRP4 was obtained by adding 0.7 diopter (D). This conversion factor was applicable after myopic keratorefractive surgery because changes in TCRP4 were equal to changes in refraction in the 4.0 mm zone. The TCRP method predicted intraocular lens power within ± 0.5 D in 83% and within ± 1.0 D in 94% of eyes having cataract surgery after myopic keratorefractive surgery., Conclusion: The TCRP4 of the rotating Scheimpflug camera was successfully converted into the equivalent K reading, and the TCRP method showed good predictability in corneas modified by myopic keratorefractive surgery., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To use Fourier-domain optical coherence tomography (OCT) to evaluate the wound characteristics of clear corneal incisions (CCIs) created with a metal or diamond blade in cataract surgery., Setting: Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea., Design: Prospective comparative observational study., Methods: Patients who had cataract surgery were randomized into 2 groups based on whether a metal blade (Group 1, 37 eyes) or diamond blade (Group 2, 33 eyes) was used to create a 2.8 mm temporal CCI. One day, 1 week, and 1 month postoperatively, structural characteristics of the CCI were analyzed using RTVue-100 Fourier-domain OCT. Parameters included incision angle, corneal thickness, epithelial or endothelial gaps, and Descemet membrane detachment. Visual acuity, surgically induced astigmatism (SIA), and ocular aberrations were evaluated., Results: There was a significant difference in corneal thickness at the 1.0 mm temporal side from midpoint. The mean uncorrected distance visual acuity in Group 2 (33 eyes) improved significantly over time. In both groups, corneal thickness at the midpoint, 1.0 mm temporal side, and 1.0 mm nasal side from the midpoint of the incision significantly decreased over time. At all timepoints, temporal and nasal thickness in Group 2 was significantly greater than in Group 1 (37 eyes), with the exception of temporal thickness at 1 month. In both groups, wound healing was reliable over time. There were no significant between-group differences in SIA or changes in aberrations., Conclusions: Corneal thickness at the incision site showed a significant difference between the 2 groups. Both groups achieved structural stabilization., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate changes in the pain-suppressing potency of 2 preoperatively applied topical nonsteroidal antiinflammatory drugs (NSAIDs) after photorefractive keratectomy (PRK) using a time-serial pain-scoring system., Setting: Saeyan Eye Center, Seoul, South Korea., Design: Comparative case series., Methods: Ninety-four patients were randomly assigned to 2 groups: ketorolac group (ketorolac 0.5% in 1 eye and ofloxacin 0.3% in the other eye) and diclofenac group (diclofenac 0.1% in 1 eye and ofloxacin 0.3% in the other eye). One drop of each ophthalmic drug was applied 3 times to each eye 30 minutes before PRK. No other NSAID or steroid was prescribed until 4 days after PRK. The patients were asked to score the postoperative pain in each eye with a visual analog scale at 6, 18, 24, 36, 48, 72, and 96 hours., Results: The natural peak of pain was located between 24 and 36 hours. Initially, the degree of pain reduction was constant for both NSAIDs; it dropped after 24 hours and 36 hours in the ketorolac group and the diclofenac group, respectively. The postoperative time-serial pattern of the pain score changed in the diclofenac group but not in the ketorolac group compared with the pattern in the ofloxacin-treated eye. The visual outcome was not affected by either NSAID, and significant complications were not noticed for a mean of 7 months., Conclusions: The duration and pattern of the action may vary according to types of NSAIDs. Preemptive topical diclofenac 0.1% was a safe and effective method for post-PRK pain control., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)