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Purpose: To derive the optimized intraocular lens (IOL) constants from automated and manifest refraction after cataract surgery in Korean patients, and to evaluate whether there is a difference in optimized IOL constants according to the refraction method.Methods: This retrospective multicenter cohort study enrolled 4,103 eyes of 4,103 patients who underwent phacoemulsification and in-the-bag IOL implantation at 18 institutes. Optimized IOL constants for the SRK/T, Holladay, Hoffer Q, and Haigis formulas were calculated via autorefraction or manifest refraction of samples using the same biometry and IOL. The IOL constants derived from autorefraction and manifest refraction were compared.Results: Of the 4,103 eyes, the majority (62.9%) were measured with an IOLMaster 500 followed by an IOLMaster 700 (15.2%). A total of 33 types of IOLs were used, and the Tecnis ZCB00 was the most frequently used (53.0%). There was no statistically significant difference in IOL constants derived from autorefraction and manifest refraction when IOL constants were optimized with a large number of study subjects. On the other hand, optimized IOL constants derived from autorefraction were significantly smaller than those from manifest refraction when the number of subjects was small.Conclusions: It became possible to use the IOL constants optimized from Koreans to calculate the IOL power. However, if the IOL constant is optimized using autorefraction in a small sample group, the IOL constant tends to be small, which may lead to refractive error after surgery.

Purpose: To report the effect of removal of a central descemet membrane on the endothelial function, morphology, and clinical symptoms of eyes with Fuch’s endothelial dystrophy.Methods: From August 2019 to January 2021, patients with Fuch’s endothelial dystrophy, i.e., with confluent, central corneal guttae and cataracts that required surgery, underwent phacoemulsification, intraocular lens implantation, and central descemet membrane stripping. To evaluate the effect of descemet stripping only (DSO), visual acuity and intraocular pressure were measured, and corneal pachymetry, slit-lamp and specular microscopy, and anterior segment optical coherence tomography performed, before surgery and at 1, 7, and 30 days and 3 and 6 months after surgery.Results: Seven patients (10 eyes) were included. Visual acuity improved from 1.01 ± 0.40 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.33 ± 0.22 logMAR 6 months after surgery (p = 0.008). The mean central corneal thickness decreased from 578.50 ± 36.88 μm preoperatively to 568.50 ± 48.61 μm 6 months after surgery; the difference was not significant (p = 0.507). The endothelial cell count increased significantly from 663.80 ± 356.40/mm2 preoperatively to 1,082.00 ± 274.46/mm2 6 months after surgery (p = 0.043).Conclusions: DSO can serve as a useful alternative when corneal transplantation is not possible in patients with Fuch’s endothelial dystrophy, but treatment efficacy and safety require further evaluation.

Purpose: To analyze the change in the weekly incidence of epidemic keratoconjunctivitis (EKC) per 1,000 outpatients during the coronavirus disease 2019 (COVID-19) pandemic by comparing the mean weekly proportion of EKC of 2020 with that from 2016 to 2019.Methods: Using data from the Korea Disease Control and Prevention Agency for 2016-2020, we analyzed the weekly proportion of EKC per 1,000 outpatients. The data were also analyzed according to age, semester and vacation periods, region, and social distancing stages. For the Daegu data, we also analyzed the effects of social distancing in an area.Results: The mean weekly proportion of EKC per 1,000 outpatients in 2020 was lower than in previous years for all ages (2016-2019 19.77 ± 7.17‰, 2020 7.28 ± 2.97‰; p < 0.001). During the semester, the mean difference between 2016-2019 and 2020 was significant, particularly for preschool children. In Daegu, the weekly proportion of EKC per 1,000 outpatients during the extra 12-18 weeks of social distancing was significantly lower (2016-2019, 18.78 ± 6.61‰; 2020, 8.94 ± 2.92‰; p < 0.001).Conclusions: The public health interventions implemented during the COVID-19 outbreak not only reduced the prevalence of COVID-19 but also reduced the prevalence of EKC. Therefore, maintaining hygiene principles and standard precautions may help prevent EKC.

Purpose: To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi’s varicelliform eruption. Case summary: A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi’s varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the follow-up period. Conclusions: Patients diagnosed with Kaposi’s varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement. J Korean Ophthalmol Soc 2016;57(10):1640-1644

Purpose: To evaluate clinical outcomes after cataract surgery with bilateral implantation of the diffractive trifocal intraocular lens (IOL). Methods: Forty-four eyes of 22 patients were analyzed in the present study from July 2014 to December 2014. Phacoemulsification with bilateral implantation of an AT Lisa tri 839 MP IOL (Carl Zeiss Meditec, Jena, Germany) was performed. Over a 6-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, and spherical equivalent refraction. Visual quality and patient satisfaction were evaluated using a Quality of Vision questionnaire. Finally, the defocus curve was measured. Results: The mean monocular UNVA, UIVA, and UDVA were 0.23, 0.22, and 0.02 log MAR at 1 month, 0.21, 0.20, and 0.01 log MAR at 3 months and 0.20, 0.22, and 0.01 log MAR at 6 months postoperatively, respectively. The mean binocular UNVA, UIVA, and UDVA were 0.16, 0.12, and 0.0 log MAR at 1 month, 0.15, 0.11, and 0.0 log MAR at 3 months and 0.15, 0.13, and 0.0 log MAR at 6 months postoperatively, respectively. Twelve patients reported glare and 17 patients reported halo. Defocus curve showed best visual acuity results at 0.0 D and second peak at 2.5 D. The intermediate-vision values were stable. Conclusions: Diffractive trifocal IOL provided excellent distance, intermediate, and near visual outcomes. J Korean Ophthalmol Soc 2015;56(9):1331-1337

Purpose: To report a case of peripheral ulcerative keratitis in a case of primary herpes simplex infection. Case summary: A 7-year-old male complaining of pain, redness, and decreased vision in the left eye 5 days in duration visited our clinic. The patient had also vesicular lesions over the edematous left upper eyelid. Slit-lamp examination revealed peripheral ulcerative keratitis with stromal infiltration involving the superior peripheral cornea. Corneal sensation in the left eye was decreased. The patient was advised to use topical and oral antiviral agents and a topical steroid. After 5 days of follow-up, the corneal lesions were decreased and vesicles were absent. Six months later, only minor opacities remained in the cornea. Conclusions: We report the first case report in Korea of peripheral ulcerative keratitis with blepharoconjunctivitis presented as primary herpes simplex infection which responded to antiviral and steroid treatment in a young male. J Korean Ophthalmol Soc 2014;55(5):761-765

Purpose: To evaluate the efficacy of preand post-operative use of topical 0.05% cyclosporine A (CsA) in mild dry eye patients having refractive surgery. Methods: This randomized prospective study included 40 patients with mild dry eye syndrome who were scheduled for laser in situ keratomileusis (LASIK). All patients were divided into 2 groups. Patients in the CsA group used both 0.1% sodium hyaluronate (HA) and 0.05% CsA from 2 weeks before to 8 weeks after the surgery, while patients in the control group used 0.1% HA only. Ocular surface disease index (OSDI), tear film break-up time (TF-BUT), Oxford Stain Score (OSS), and tear osmolarity were evaluated before surgery and 1, 4, and 8 weeks after surgery. Results: TF-BUT was significantly longer in the CsA group at 1 and 4 weeks post-operatively (p = 0.024, p = 0.036) compared to the control group. Tear osmolarity was significantly lower in the CsA group at 1 week post-operatively (p = 0.004) compared to the control group. Conclusions: The preand post-operative use of topical 0.05% CsA is effective in alleviating dry eye symptom after LASIK in patients with dry eye syndrome. J Korean Ophthalmol Soc 2014;55(12):1752-1757

Purpose: To evaluate the effect of a preoperative subconjunctival injection of mitomycin C or triamcinolone in patients with recurrent pterygium. Methods: The records of 50 eyes of 50 patients who received excision of recurrent pterygium between June 2006 and January 2007 were reviewed. The recurrence rate and postoperative fibrovascular growth were compared in the preoperative subconjunctival mitomycin C, or triamcinolone injection group and non-treated control group. Additionally, the quantitative expression level of the transforming growth factor-1, -2 (TGF-1, -2), connective tissue growth factor (CTGF), and vascular endothelial growth factor (VEGF) in excised sample of the pterygium was assessed. Results: There was no statistically significant difference in the recurrence rate and the relative gene expression level of growth factors in the triamcinolone group and the mitomycin group when compared with the non-treated control group. Postoperative fibrovascular proliferation was more severe in the triamcinolone group than other groups. Conclusions: Subconjunctival mitomycin C or triamcinolone as adjunctive therapy before pterygium excision did not influence the recurrence rate of pterygium.

Purpose: To report the results of femtosecond laser-assisted‘mushroom-shaped wound-configurized keratoplasty’in 6 patients based on the results of experimental models in rabbits’and enucleated porcine eyes. Methods: Mushroom-shaped donor corneal grafts were designed and transplanted in 3 rabbit eyes and 10 enucleated porcine eyes. The histologic findings were observed and wound burst pressure compared between penetrating keratoplasty (PKP) and mushroom-shaped keratoplasty. The‘mushroom-shaped wound-configurized keratoplasty’was subsequently performed in 6 eyes of 6 patients. Results: In all eyes of the rabbits, histologic findings showed stable wound structure. In the porcine models, mushroom-shaped keratoplasty showed a better resistance to IOP than PKP after complete suture. Patients who underwent the surgery showed an improvement of over 2 lines in Snellen visual acuity after the operation. The mean follow-up period was approximately 11 months. Complete suture removal was performed within 6 months and accurate and stable wound structure was identified. Conclusions: Wound-configurized keratoplasty with femtosecond laser and mechanical dissection’has shown several advantages in the lamellar structure of the wound. Stable wound structure, less astigmatism, rapid suture removal and visual rehabilitation was achieved.

Purpose: To report the first cases of Descemet’s stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. Methods: Four eyes of 4 patients who had corneal edema from pseudophakic bullous keratopathy were enrolled. We performed femtosecond laser-assisted Descemet's membrane stripping endothelial keratoplasty (DSEK). We then evaluated preoperative and postoperative best corrected visual acuities (BCVA), manifest refractions, keratometries, topographic astigmatisms, corneal pachymetries, and perioperative complications. Results: The mean follow-up period was 6 months. Three of the four eyes had successful transplantations. Since the operation, these patients have shown improvement in visual acuity and have recovered from corneal edema. However, in one patient, the transplanted corneal disc was dislocated, and he needed an additional procedure for reattachment. Conclusions: The lack of corneal incisions or sutures in DSEK was helpful for maintaining corneal curvature and globe integrity after surgery. The surgery resulted in rapid visual rehabilitation and prevented suture-induced complications. With a femtosecond laser, we could prepare donor cornea in an automated and standardized fashion. In conclusion, femtosecond laser-assisted DSEK has significant advantages over standard penetrating keratoplasty for patients with pseudophakic bullous keratopathy.