Clinical Outcomes after Bilateral Implantation of Trifocal Diffractive Intraocular Lenses and Extended Depth of Focus Intraocular Lenses.

The purpose of this retrospective study is to investigate clinical outcomes of bilateral implantation of diffractive trifocal intraocular lenses (IOLs) and extended depth of focus IOLs in Koreans. The clinical outcomes of cataract surgery with bilateral implantation of PanOptix, FineVision, Symfony, and MiniWell were evaluated. Uncorrected distant, intermediate (80 cm, 60 cm), near (40 cm) visual acuity, defocus curve, manifest refraction, contrast sensitivity, and higher-order aberrations, quality of vision, spectacle independence, and subjective satisfaction at postoperative 3 months were assessed. A total of 136 eyes in 68 patients were included in the analyses. PanOptix and FineVision performed better visual acuity compared to Symfony and MiniWell at 40 cm distance. Defocus curve showed broad range of vision in PanOptix and FineVision with visual acuity of more than 0.1 logarithm of the minimum angle of resolution at -2.5 diopter (D) of defocus power, while Symfony and MiniWell presented excellent intermediate vision without a dip at defocus power of -0.5 D to -1.0 D. Glare, halo, and starburst were significantly less in MiniWell compared to others. In conclusion, all four IOLs presented satisfactory clinical outcomes. PanOptix and FineVision provided good near and intermediate vision, while Symfony and MiniWell provided good intermediate vision. MiniWell induced little dysphotopsia.

Comparison of penetrating femtosecond laser-assisted astigmatic keratotomy and toric intraocular lens implantation for correction of astigmatism in cataract surgery.

This study tried to compare the clinical outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for astigmatism correction and identify factors affecting the efficacy of FSAK and toric IOL implantation in astigmatism correction. This retrospective case series comprised patients with corneal astigmatism ranging between 0.5 D and 4.5 D. Patients underwent FSAK or toric IOL implantation for cataract treatment and correction of astigmatism at the Samsung Medical Center, a tertiary surgical center, between April 2016 and December 2018. All patients underwent examination before and at three months after the surgery for comparative evaluation of refractive astigmatism, corneal high order aberrations and irregularity index. The astigmatism correction was analyzed by the Alpins method. Subgroup analysis of preoperative factors was based on the extent of target-induced astigmatism (TIA), the degree of astigmatism, and astigmatism classification based on topography. Thirty-one eyes underwent toric IOL implantation and 35 eyes underwent FSAK. The refractive astigmatism was significantly decreased in both toric IOL (P = 0.000) and FSAK group (P = 0.003). The correction index (CI) of refractive astigmatism was 0.84 ± 0.39 in the toric IOL and 0.71 ± 0.60 in the FSAK group. There was no difference between the two groups (P = 0.337). The CI of the FSAK group was significantly lower than in the toric IOL group when TIA was more than 1.5 D (P = 0.006), when correcting against-the-rule (P = 0.017), and limbus-to-limbus astigmatism (P = 0.008). In conclusion, toric IOL implantation is an effective and safe procedure for correcting preoperative astigmatism in cataract surgery in the short-term observation.

Intense pulsed light plus meibomian gland expression versus intense pulsed light alone for meibomian gland dysfunction: A randomized crossover study.

PURPOSE: To investigate the comparative efficacy of intense pulsed light (IPL) therapy alone with that of IPL plus meibomian gland expression (MGX) for meibomian gland dysfunction (MGD). METHODS: This is a prospective randomized crossover clinical trial. Sixty patients were enrolled and randomly assigned to two groups. All of patients underwent four treatment sessions in total, which were two weeks apart. Group 1 underwent two sessions of IPL therapy with MGX, as well as two sessions of IPL alone. Group 2 received two sessions of IPL therapy alone, and two sessions of IPL therapy with MGX. The following parameters were measured at baseline (BL), 2 weeks after the second treatment session (FU1), and 2 weeks after the fourth treatment session (FU2): tearfilm break-up time (BUT), Oxford grade for corneal staining, meibomian gland expressibility (MGE), meibum quality (MQ), and ocular surface disease index (OSDI). The separate effect of MGX on improvement of MGD parameters was evaluated using generalized estimating equation (GEE). RESULTS: The mean age of the participants was 57.52 ± 10.50 years. The BUT, Oxford grade, MGE, MQ, and OSDI of both groups improved significantly (from baseline) by the end of four treatment sessions (FU2 compared to BL; all p-values <0.05). The MGE and MQ significantly improved after the first and second treatment sessions (FU1 compare to BL; all p-values < 0.001). However, the improvement was not statistically significant after the third and fourth treatment sessions (FU2 compared to FU1; p-value of 0.388 for MGE and 0.645 for MQ in group 1, 0.333 for MGE and 0.333 for MQ in group 2). The IPL plus MGX therapy produced greater improvements in the BUT scores than did IPL therapy alone (p = 0.003 by GEE). In contrast, the Oxford grade, MGE, MQ, and OSDI were not influenced by the addition of MGX to IPL (p = 0.642, 0.663, 0.731, and 0.840, respectively by GEE). CONCLUSION: IPL therapy effectively improves the subjective symptoms and objective ocular findings of MGD. MGX enhanced the improvement of BUT driven by IPL therapy. The meibomian gland function (MGE and MQ) recovers faster in response to IPL therapy than did the other parameters.

Differential Effect of the Metabolic Syndrome on the Incidence of Retinal Vein Occlusion in the Korean Population: A Nationwide Cohort Study.

Purpose: To investigate the impact of the metabolic syndrome (METS) on the incidence of retinal vein occlusion (RVO). Methods: This is a retrospective cohort study using Korean National Health Insurance System data. 23,153,600 subjects without previous history of RVO underwent a National Health Screening Program examination between 2009 and 2012. They were monitored for RVO development (registration of diagnostic code for RVO) until 2015. Presence of METS was defined using the data from the National Health Screening Program examination according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel III. A multivariate adjusted Cox regression analysis was used to reveal hazard ratios and 95% confidence interval for RVO development in the presence of METS. Results: The age of the subjects was 47.64 ± 13.51 years. In this cohort, 11,747,439 (50.7%) were male, 11,406,161 (49.3%) were female, and 6,398,071 subjects (27.6%) were diagnosed with METS. The overall incidence of RVO was 0.947 per 1000 person-years. The adjusted hazard ratio of RVO in the presence of METS was 1.458 (95% confidence interval, 1.440-1.475; P < 0.001) after adjusting for age, sex, smoking status, alcohol consumption, physical activity, and income. Among all of the criteria for METS diagnosis, elevated blood pressure was the greatest risk for RVO development (adjusted hazard ratio, 1.610; 95% confidence interval, 1.589-1.631; P < 0.001). Conclusions: METS and each of diagnostic criteria was associated with an increased risk of RVO development. Elevated blood pressure seems to be especially important factors for RVO development. Translational Relevance: Our results provide information about the link between METS and RVO.

Higher incidence of penetrating keratoplasty having effects on repeated keratoplasty in South Korea: A nationwide population-based study.

PURPOSE: To investigate the incidence of corneal transplantation and identify rates and risk factors of repeated corneal transplantation in South Korea. METHODS: This is a retrospective population-based cohort study using the Korean National Health Insurance System database. Among the entire South Korean population (N = 51,827,813), we included those who underwent corneal transplantation more than once between January 2006 and December 2016, and analyzed the annual incidence of keratoplasty. The person-year incidence of repeated keratoplasty after the first operation was calculated according to risk factors including age group, sex, income level, surgical method, surgical etiology, and presence of major systemic diseases. Cox regression analysis was employed to evaluate the hazard ratios of those risk factors on repeated keratoplasty. RESULTS: A total of 9,452 cases of corneal transplantation occurred from January 2006 to December 2016. The average annual incidence of corneal transplantations was 1.694 per 100,000. The proportion of penetrating keratoplasty steadily decreased from 92.22% in 2006 to 77.81% in 2016. The average incidence of repeated keratoplasty among those who underwent corneal transplantation at least once was 43.24 per 1,000 person-years. Males had a greater incidence of repeated keratoplasty compared to females (males: 47.66 per 1,000, females: 36.04 per 1,000). The age group from 20 to 39 years demonstrated the lowest incidence of repeated keratoplasty at 24.94 per 1,000. Keratoconus had the lowest incidence of repeated keratoplasty (22.82 per 1,000). CONCLUSION: This study may provide a better understanding of corneal diseases, help predict disease burden, and plan health care systems accordingly in South Korea.

Deep Learning-Based Prediction of Refractive Error Using Photorefraction Images Captured by a Smartphone: Model Development and Validation Study.

BACKGROUND: Accurately predicting refractive error in children is crucial for detecting amblyopia, which can lead to permanent visual impairment, but is potentially curable if detected early. Various tools have been adopted to more easily screen a large number of patients for amblyopia risk. OBJECTIVE: For efficient screening, easy access to screening tools and an accurate prediction algorithm are the most important factors. In this study, we developed an automated deep learning-based system to predict the range of refractive error in children (mean age 4.32 years, SD 1.87 years) using 305 eccentric photorefraction images captured with a smartphone. METHODS: Photorefraction images were divided into seven classes according to their spherical values as measured by cycloplegic refraction. RESULTS: The trained deep learning model had an overall accuracy of 81.6%, with the following accuracies for each refractive error class: 80.0% for ≤-5.0 diopters (D), 77.8% for >-5.0 D and ≤-3.0 D, 82.0% for >-3.0 D and ≤-0.5 D, 83.3% for >-0.5 D and <+0.5 D, 82.8% for ≥+0.5 D and <+3.0 D, 79.3% for ≥+3.0 D and <+5.0 D, and 75.0% for ≥+5.0 D. These results indicate that our deep learning-based system performed sufficiently accurately. CONCLUSIONS: This study demonstrated the potential of precise smartphone-based prediction systems for refractive error using deep learning and further yielded a robust collection of pediatric photorefraction images.