Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial.

Importance: Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations. Objectives: To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD. Design, Setting, and Participants: This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily. Interventions: rTG ω-3 Fatty acid supplementation vs grape-seed oil. Main Outcome Measures: The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change. Results: A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was -20.5 (16.0) and -22.7 (15.7), respectively, in the ω-3 group and -15.1 (20.2) and -18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = -5.4; 95% CI, -12.15 to 1.33; P = .12 and at 12 weeks = -3.9; 95% CI, -10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group. Conclusions and Relevance: This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD. Trial Registration: CRIS Identifier: KCT0004927.

Visual Outcomes According to Age After Bilateral Implantation of Trifocal Intraocular Lenses.

PURPOSE: To investigate the effect of age on visual outcomes after the bilateral implantation of trifocal intraocular lenses (IOLs). METHODS: A total of 290 patients (580 eyes) who underwent bilateral implantation of a trifocal IOL were enrolled in this retrospective case-control study. Patients were divided into five age groups: 45 to 49, 50 to 54, 55 to 59, 60 to 64, and 65 years and older. Postoperative monocular uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), uncorrected near visual acuity (UNVA), binocular distance-corrected defocus curve, spectacle dependence for near and distance vision, and patient satisfaction scores were compared among the five groups. RESULTS: The 45 to 49 years group had significantly better mean UDVA (0.02 ± 0.05 logMAR) and UNVA (0.02 ± 0.04 logMAR) than the 65 years and older group (0.06 ± 0.09 and 0.09 ± 0.09 logMAR; P = .029 and P < .001; respectively). However, no significant differences were observed in the mean CDVA among the groups. Binocular visual performance of the 45 to 49 years group was better than that of the 65 years and older age group at defocuses of +1.00, +0.50, -1.00, and -3.00 D. No significant differences were observed in spectacle dependence for near and distance vision or in patient satisfaction scores among the five groups. CONCLUSIONS: Bilateral implantation of trifocal IOLs can provide excellent near and distance vision in both young and older patients. However, UDVA and UNVA revealed considerably worse results in the older group, although no significant difference was observed in CDVA and postoperative refractive errors by age. [J Refract Surg. 2024;40(4):e270-e277.].

New Korean Guidelines for the Diagnosis and Management of Dry Eye Disease.

New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: "Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms." The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.

Cytomegalovirus Corneal Endotheliitis: A Comprehensive Review.

Cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis are the most common ocular diseases caused by CMV infections in immunocompetent patients. The incidence of CMV corneal endotheliitis is relatively high in middle-aged men. CMV corneal endotheliitis presents with mild anterior chamber inflammation, corneal edema, keratic precipitates, and elevated intraocular pressure. It resembles Posner-Schlossman syndrome and Fuchs uveitis because of the elevated intraocular pressure. Without proper diagnosis and treatment, it may progress to bullous keratopathy or glaucoma, necessitating keratoplasty or glaucoma surgery. Therefore, early diagnosis and treatment are important for a good prognosis. Aqueous humor analysis can facilitate the diagnosis of CMV corneal endotheliitis, and early antiviral treatment can decrease the risk of corneal compensation or glaucomatous optic atrophy. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of CMV corneal endotheliitis along with the evidence for early clinical diagnosis and active antiviral treatment.

Modified intraocular lens power selection method according to biometric subgroups Eom IOL power calculator.

This study evaluates the accuracy of a newly developed intraocular lens (IOL) power calculation method that applies four different IOL power calculation formulas according to 768 biometric subgroups based on keratometry, anterior chamber depth, and axial length. This retrospective cross-sectional study was conducted in at Korea University Ansan Hospital. A total of 1600 eyes from 1600 patients who underwent phacoemulsification and a ZCB00 IOL in-the-bag implantation were divided into two datasets: a reference dataset (1200 eyes) and a validation dataset (400 eyes). Using the reference dataset and the results of previous studies, the Eom IOL power calculator was developed using 768 biometric subgroups. The median absolute errors (MedAEs) and IOL Formula Performance Indexes (FPIs) of the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, Ladas Super, SRK/T, and Eom formulas using the 400-eye validation dataset were compared. The MedAE of the Eom formula (0.22 D) was significantly smaller than that of the other four formulas, except for the Barrett Universal II and Ladas Super formulas (0.24 D and 0.23 D, respectively). The IOL FPI of the Eom formula was 0.553, which ranked first, followed by the Ladas Super (0.474), Barrett Universal II (0.470), Holladay 1 (0.444), Hoffer Q (0.396), Haigis (0.392), and SRK/T (0.361) formulas. In conclusion, the Eom IOL power calculator developed in this study demonstrated similar or slightly better accuracy than the Barrett Universal II and Ladas Super formulas and was superior to the four traditional IOL power calculation formulas.

Effects of particulate matter exposure on the expression of the SARS-CoV-2 ACE2 receptor in ocular surface tissues and cells.

Particulate matter (PM) has been reported to be one of the risk factor for COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, although the ocular surface is deeply affected by both PM exposure and SARS-COV-2 infection, no studies have investigated the effects of PM exposure on the ocular route of SARS-COV-2 infection. To this end, we explored the effects of PM on the expression of SARS-COV-2-associated receptors and proteins in ocular surface. Herein, short- and long-term PM-exposed rat models were established by topically administering PM for 3 and 10 days, respectively. Immortalized human corneal epithelial cells (HCECs) and human conjunctival epithelial cells (HCjECs) were exposed to PM. ACE2, TMPRSS2, CD147, and ADAM17 expression levels were measured by western blot analysis. Our results show that short-term PM exposure had little effect on the expressions of ACE2, TMPRSS2, and CD147 in ocular surface tissues. However, long-term PM exposure decreased the ACE2 expression in conjunctival tissues and increased the CD147 expression in corneal or conjunctival tissues. PM exposure reduced the ACE2 expression by increasing the ADAM17 expression and ACE2 shedding level in HCECs and HCjECs. Our findings suggest that long-term PM exposure down-regulate the expression of the SARS-CoV-2 receptor ACE2 in conjunctival tissues through ADAM17-dependent ACE2 shedding. However, long-term PM exposure up-regulates the expression of another SARS-CoV-2 receptor CD147 in ocular surface tissues, accompanied by ocular surface damage and cytotoxicity. This study provides a new insight into uncovering potential risk factors for infection with SARS-CoV-2 via the ocular route.

Surgical time and efficacy of illuminated chopper-assisted cataract surgery involving miosis after femtosecond laser pretreatment.

PURPOSE: To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser pretreatment. METHODS: As retrospective study, three hundred thirty-six eyes of 336 consecutive patients who underwent the femtosecond laser and illuminated chopper-assisted cataract surgery were included. Cases with pupil less than 6 mm after femtosecond laser pretreatment were included in the miosis group. Pupil diameter, surgical time, and improved efficacy (100/surgical time×pupil size) were compared between eyes with and without miosis. RESULTS: Of 336 eyes, 20 were included in the miosis group (6.0%). Pupil diameter was smaller in eyes with miosis than in those without miosis (5.23 ± 0.38 mm vs 7.35 ± 0.64 mm, p < 0.001); however, surgical time was not different (6.86 ± 0.73 min vs 6.60 ± 1.27 min, p = 0.071) between the two groups. Mechanical pupil dilations were not needed in any cases. As a result, improved efficacy was calculated to be higher in patients with miosis (2.83 vs 2.14, p < 0.001). CONCLUSION: In terms of surgical time and improved efficacy, using the illuminated chopper simplified cataract surgery involving miosis after femtosecond laser pretreatment. The use of an illuminated chopper is expected to be a good solution for femtosecond laser-assisted cataract surgeries.

Comparing Ocular Toxicity of Legacy and Alternative Per- and Polyfluoroalkyl Substances in Zebrafish Larvae.

Studies comparing the ocular toxicity potential between legacy and alternative PFAS are lacking. To address this research gap, zebrafish larvae were exposed to both legacy PFAS (i.e., perfluorooctanesulfonic acid [PFOS] and perfluorooctanoic acid [PFOA]) and their corresponding alternatives (i.e., perfluorobutanesulfonic acid [PFBS] and perfluorobutanoic acid [PFBA]). Alterations in their visual behaviors, such as phototactic and optomotor responses (OMR), were assessed at sublethal concentrations. Gene expression variations in visual function-associated pathways were also measured. Visual behavioral assessment revealed that PFOS exposure resulted in concentration-dependent reductions in phototactic responses at 10-1000 µg/L, with PFOA exerting reduction effects only at 100 mg/L. However, their two alternatives had no effect at all tested concentrations. Following an improved contrast-OMR (C-OMR) assessment, PFOS decreased the OMR to a water flow stimulus at 10, 100, and 1000 µg/L. The gene expression analysis revealed that PFOS exposure markedly downregulated most genes involved in the opsins in the photoreceptor and phototransduction cascade, which explains the observed visual behavior changes well. Our findings indicate that PFOS is the most likely PFAS to cause visual toxicity, with PFOA present but less likely, and their substitutes, PFBS and PFBA, cannot be classified as visually toxic to zebrafish.

Four-flanged polypropylene optic piercing technique for scleral fixation of multifocal intraocular lens.

BACKGROUND: To evaluate the feasibility of creating flanges using an optic piercing technique with a 6 - 0 polypropylene monofilament for scleral fixation of dislocated one-piece diffractive multifocal intraocular lenses (IOLs). STUDY DESIGN: Experimental study and case series. SUBJECTS: Optical bench test and eyes with IOL dislocation. METHODS: Two separate 6 - 0 polypropylenes were penetrated twice at the opposite peripheral optic of the TECNIS Synergy IOL (Johnson & Johnson Vision). The root mean square of the modulation transfer function (MTFRMS), at between + 1.00 and - 4.00 D of defocus, was measured in the TECNIS Synergy IOL both with and without optic piercing in the optical bench study. This case series included three eyes from two patients who underwent scleral-fixation of multifocal IOLs using the four-flanged polypropylene optic piercing technique. The postoperative corrected distance visual acuity (CDVA) at 4 m, the uncorrected near visual acuity (UNVA) at 40 cm, and IOL centration were evaluated. RESULTS: The optical bench test showed no differences in MTFRMS values measured in the TECNIS Synergy IOL, either with or without optic piercing at all defocuses. In all three case series, the postoperative CDVA at 4 m was 20/20 and UNVA at 40 cm was J1. Postoperative anterior segment photographs showed good centration of IOLs in all cases. CONCLUSION: The four-flanged polypropylene optic piercing technique for multifocal IOL scleral fixation can provide excellent clinical outcomes and IOL stability after surgery without diminishing the performance of the multifocal IOLs.

Efficacy and safety of 1% and 2% rebamipide clear solution in dry eye disease: a multicenter randomized trial.

BACKGROUND: To evaluate the efficacy of 1% and 2% rebamipide clear solution in the treatment of dry eye disease (DED). METHODS: Two hundred twenty patients with DED were randomly assigned to one of three groups: the 1% rebamipide, 2% rebamipide, or placebo (eye drops containing the same ingredients, except for the active components). Each eye drop was instilled four times daily for 12 weeks. Changes in tear film break-up time (TBUT), corneal and conjunctival staining score, Schirmer 1 test, and the Ocular Surface Disease Index (OSDI) from baseline to 12-week visit between the study groups were compared for efficacy assessment. RESULTS: The mean age of study patients was 43.8±14.2 years. The 1% and 2% rebamipide groups showed greater improvement in TBUT (1.99±1.87 and 2.02±2.21 s) at 12 weeks from baseline than the placebo group (1.25±2.93 s). The 2% rebamipide group showed greater improvement in the corneal staining score (- 3.15±2.00) at 12 weeks from baseline than the placebo group (- 2.85±1.80). The 1% and 2% rebamipide groups showed improvement in Schirmer 1 test (1.27±3.86 and 1.50±4.14 mm) at 12 weeks of treatment, but not the placebo group (0.55±2.99 mm). Both the rebamipide groups and the placebo group showed significantly improved OSDI after treatment for 12 weeks; however, there was no significant difference among the three groups. CONCLUSIONS: 1% and 2% rebamipide clear solutions are an effective therapeutic option for improving TBUT and tear volume, and stabilizing the corneal staining score in DED.

Actual anterior-posterior corneal radius ratio in eyes with prior myopic laser vision correction according to axial length.

We retrospectively evaluate the actual anterior-posterior (AP) corneal radius ratio in eyes with previous laser correction for myopia (M-LVC) according to axial length (AL) using biometry data exported from swept-source optical coherence tomography between January 2018 and October 2021 in a tertiary hospital (1018 eyes with a history of M-LVC and 19,841 control eyes). The AP ratio was significantly higher in the LVC group than in the control group. Further, it was significantly positively correlated with AL in the LVC group. We also investigated the impact of the AP ratio, AL and keratometry (K) on the absolute prediction error (APE) in 39 eyes that underwent cataract surgery after M-LVC. In linear regression analyses, there were significant correlations between APE and AL/TK, while APE and AP ratio had no correlation. The APE was significantly lower in the Barrett True-K with total keratometry (Barrett True-TK) than in the Haigis-L formula on eyes with AL above 26 mm and K between 38 and 40 D. In conclusion, in eyes with previous M-LVC, AP ratio increases with AL. The Barrett True-K or Barrett True-TK formulas are recommended rather than Haigis-L formula in M-LVC eyes with AL above 26 mm and K between 38 and 40D.

Role of Chondroitin Sulfate Proteoglycan 5 in Steroid-Induced Cataract.

Steroid-induced cataracts (SIC) are defined as cataracts associated with the administration of corticosteroids. Long-term glucocorticoid treatment for inflammatory diseases reportedly increases the risk of SIC, and steroids can induce cataracts by disrupting ocular growth factor balance or homeostasis. In this study, we verified the effect of chondroitin sulfate proteoglycan 5 (CSPG5) using dexamethasone (dexa)-treated human lens epithelial (HLE-B3) cells and the lens epithelium from the anterior capsule of SIC patients obtained during cataract surgery. CSPG5 expression increased in the lens epithelium of SIC patients. The downregulation of CSPG5 suppressed the dexa-induced epithelial-mesenchymal transition (EMT)-related protein expression and motility in HLE-B3 cells. The disruption of the transcription factors EZH2 and B-Myb downregulated CSPG5, dexa-induced fibronectin expression, and cell migration in HLE-B3 cells, reaffirming that CSPG5 expression regulates EMT in lens epithelial cells. Taken together, these results indicate that the steroid-induced effects on lens epithelial cells are mediated via alterations in CSPG5 expression. Therefore, our study emphasizes the potential of CSPG5 as a therapeutic target for the prevention and treatment of SIC.

Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope.

PURPOSE: To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. SETTING: 4 tertiary institutions in Korea. DESIGN: Prospective, randomized, paired-eye, controlled pilot study. METHODS: 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. RESULTS: The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. CONCLUSIONS: Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.

Short-term changes in tear osmolarity after instillation of different osmolarity eye drops in patients with dry eye.

This study investigated short-term changes in tear osmolarity of dry eye patients after using artificial tears containing sodium hyaluronate (SH) at different osmolarities. It comprised 80 patients with dry eye whose tear osmolarity measurement using the TearLab osmolarity system was 300 mOsm/L or greater. Patients who had external ocular disease, glaucoma, or other concomitant ocular pathology were excluded. After being randomly divided into four groups, the participants received different kinds of SH eye drops as follows: Groups 1-3 were given one of three concentrations (0.1%, 0.15%, and 0.3%) of isotonic drops, while Group 4 received 0.18% hypotonic SH eye drops. The tear osmolarity concentrations were evaluated at baseline and again at 1-, 5-, and 10-min after instillation of each eye drop. Tear osmolarity showed a significant decrease after instillation of four types of SH eye drops after up to 10 min compared to baseline. Patients who received hypotonic SH eye drops showed an enhanced decrease in tear osmolarity compared with the isotonic SH eye drops after 1 min (p < 0.001) and 5 min (p = 0.006), but the difference was not significant at 10 min (p = 0.836). The enhanced immediate effect of hypotonic SH eye drops at lowering tear osmolarity in patients with dry eye seems to be limited unless these drops were used frequently.

Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges.

Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann-Whitney U test, Pearson's Chi-square test, and Fisher's exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.

Clinical Outcomes of Intrascleral Fixation of Intraocular Lens Compared to Ciliary Sulcus Implantation and Transscleral Fixation.

PURPOSE: To compare the clinical outcomes of intrascleral fixation of the three-piece intraocular lenses (IOLs) 2.5 mm posterior to the limbus with ciliary sulcus implantation and transscleral fixation 2.5 mm posterior to the limbus. METHODS: Sixty-five eyes of 65 patients who underwent ciliary sulcus implantation or transscleral or intrascleral fixation of the AMO Sensar AR40e IOL were retrospectively reviewed. The postoperative refractive prediction error, back-calculated effective lens position (ELP), corrected distance visual acuity (CDVA), and postoperative residual cylinder were compared. RESULTS: There were significant differences in the median (interquartile range) postoperative refractive prediction error (diopters [D]) among the three groups (p < 0.001): for ciliary sulcus implantation (33 eyes), -0.89 D (-1.21 to -0.56 D); for transscleral fixation (10 eyes), -0.40 D (-0.78 to -0.22 D); and for intrascleral fixation (22 eyes), 0.01 D (-0.28 to 0.34 D). Significant differences (p < 0.001) were observed in the median back-calculated ELP: for ciliary sulcus implantation, 4.35 mm (3.95 to 4.55 mm); for transscleral fixation, 4.51 mm (4.34 to 4.76 mm); and for intrascleral fixation, 4.90 mm (4.56 to 5.35 mm). There were no differences in the median postoperative CDVA (0, 0.10, and 0 logarithm of the minimum angle of resolution, respectively; p = 0.083) and the residual cylinder (-0.75, -1.50, and -0.63 D, respectively; p = 0.074) among three groups. CONCLUSIONS: Intrascleral fixation showed no myopic shift and the most posterior lens position, while ciliary sulcus implantation induced the greatest myopic shift and the most anterior lens position. However, there was no significant difference in the postoperative CDVA or astigmatism among the eyes with different IOL insertion methods, demonstrating good IOL stability and vision outcomes.

New technology using crystalline lens autofluorescence for presbyopia and cataract grading.

PURPOSE: To investigate whether fundus autofluorescence (FAF) obtained using an ultra-wide field (UWF) fundus camera with an artificial opacity pattern can grade the degree of presbyopia and nuclear cataract. METHODS: Sixty eyes of 30 patients were enrolled in this prospective diagnostic study. The nuclear cataract (nuclear color/opalescence (NC/NO)) was graded according to the Lens Opacity Classification System III. The monocular near point of accommodation (NPA) was measured in eyes with NC3/NO3 or less. The mean gray value difference between the central 8 artificial opacity lesions and peripheral 8 artificial opacity lesions in the retinal AF was measured. The correlation between the mean gray value difference, NPA, and nuclear cataract grade was analyzed. RESULTS: The mean nuclear cataract grade of 60 eyes was 3.2 ± 1.6 and mean NPA of 37 eyes was 45.3 ± 16.1 cm. The mean gray value differences increased with increasing nuclear cataract grade (eyes with NC/NO grade 1, 53.3 ± 11.4; 2, 78.3 ± 13.6; 3, 95.2 ± 12.2; 4, 101.6 ± 11.9; 5, 109.0 ± 22.9; and 6, 121.1 ± 12.0; p < 0.001). The mean gray value difference was positively correlated with both the monocular NPA (R2 = 0.637; ß coefficient = 1.009; 95% CI, 0.748 to 1.271; p < 0.001) and nuclear cataract grade (R2 = 0.661; ß coefficient = 12.437; 95% CI, 10.097 to 14.778; p < 0.001). CONCLUSIONS: The FAF camera with an artificial opacity pattern attached can be used to effectively diagnose the degree of presbyopia and nuclear cataract.

Effect of surgical microscope and illuminated chopper on anterior chamber temperature.

BACKGROUND: To evaluate the effect of the light intensity of the surgical microscope and illuminated chopper on the anterior chamber temperature. STUDY DESIGN: Experimental study. METHODS: A model eye (Kitaro WetLab System; FCI Ophthalmics, Pembroke, MA, USA) was used in this experimental study. The illuminance of a surgical microscope (Leica M300; Leica Microsystems, Wetzlar, Germany) and illuminated chopper (iChopper NAM-25 GB; Oculight, Korea) with a light source (iVision; Oculight) was measured using an illuminometer. In addition, the temperature in the anterior chamber of the model eye filled with balanced salt solution when using the surgical microscope with a light intensity from level 1 to level 6 and the illuminated chopper at 99% light intensity was measured for 10 min. RESULTS: The anterior chamber temperature was increased by 0.2, 0.5, 1.0, and 1.4 ℃ when using the surgical microscope at level 3 (10050 lux), 4 (16490 lux), 5 (24900 lux), and 6 (32500 lux), respectively, for 10 min. The illuminated chopper at 99% light intensity (14893 lux) positioned in the anterior chamber increased the anterior chamber temperature by 0.2° C after 10 min, which was equal to the increase in the temperature caused by the surgical microscope at level 3. CONCLUSION: The photothermal effect of the illuminated chopper directly positioned in the anterior chamber appeared to be similar to that of a microscope with similar illuminance. Therefore, the illuminated chopper is safe in terms of anterior chamber temperature changes in cataract surgery.

A Multicenter, Randomized, Double-Blind Evaluation of the Efficacy of TJO-087 Versus 0.05% Cyclosporine A in Moderate to Severe Dry Eye.

Purpose: To compare the efficacy and ocular tolerability of a 0.08% nanoemulsion cyclosporine A (CsA) (TJO-087) once daily versus a conventional 0.05% emulsion CsA twice daily in dry eye disease. Methods: 178 patients with dry eye disease were randomly assigned to one of two groups: the TJO-087 or CsA0.05% group. Changes in the Ocular Surface Disease Index (OSDI), tear film break-up time (TBUT), corneal and conjunctival staining scores, and Schirmer test scores from baseline to the 32-week visit were compared between both groups. To evaluate ocular tolerability of the study formulations, 7 symptoms (stinging/burning, itching, blurred vision, sandiness/grittiness, dryness, light sensitivity, and pain or soreness) were evaluated (the higher the score, the lower the tolerability) at each follow-up visit. Results: A total of 155 eyes of 155 patients were enrolled. The TJO-087 and CsA0.05% groups showed significant improvement in OSDI, TBUT, ocular surface staining, and Schirmer test scores at 32 weeks from baseline. There was no difference in the extent of improvement in all efficacy parameters. There were no differences in the ocular tolerability scores between the 2 groups at all visits, except that the itching score was higher in the TJO-087 group than in the CsA0.05% group at week 8. Conclusions: Using topical 0.08% CsA once daily is an effective therapeutic option for improving the symptoms and signs in dry eye disease, with a tolerability comparable with that of conventional 0.05% CsA. This trial was registered at the US National Library of Medicine ClinicalTrials.gov (http://clinicaltrial.gov) as NCT05245604 (registration date: 19/06/2020).