Publications by authors named "Choun-Ki Joo"

205 Publications

Association with Corneal remodeling Related Genes, ALDH3A1, LOX and SPARC Genes Variations in Korean Keratoconus Patients.

Korean J Ophthalmol 2021 Feb 18. Epub 2021 Feb 18.

CK St. Mary's Eye Center, Seoul, Korea.

Purpose: To determine whether the cornea remodeling-related genes aldehyde dehydrogenase 3A1 (ALDH3A1), lysyl oxidase (LOX), and secreted protein acidic and rich in cysteine (SPARC) were potential susceptibility candidate genes for keratoconus in Korean patients, we investigated the associations of single nucleotide polymorphisms (SNPs) in these three genes in Korean patients with keratoconus.

Methods: Genomic DNA was extracted from blood samples of unrelated patients with keratoconus and healthy control individuals. For screening of genetic variations, all exons from the entire coding regions of the ALDH3A1, LOX, and SPARC genes were directly sequenced to determine the presence of mutations. Control individuals were selected from the general population without keratoconus.

Results: In this study, we detected nine SNPs in ALDH3A1, four SNPs in LOX, and 18 SNPs in SPARC. rs116992290, IVS3-62c>t, rs116962241, and rs2228100 in ALDH3A1 and rs2956540 and rs1800449 in LOX were significantly different between patient and control groups. In the SPARC gene, the distribution of the *G allele of EX10+225 T>G (p = 0.018, odds ratio = 1.869) was strongly associated with the risk of keratoconus in the Korean population. In haplotype analysis, C-G of rs2956540-rs2288393 in LOX (p=0.046) and C-C-G and G-G-G of rs60610024-rs2228100-rs57555435 (p=0.021 and p<0.001), G-A of IVS3-62 a>g - rs116962241 in ALDH3A1 (p=0.048) predisposed significantly to Keratoconus. After cross-validation consistency (CVC) and permutation tests, two locus model was the best SNP variations interaction pattern.

Conclusions: Our results suggested that genetic variations in ALDH3A1, LOX, and SPARC genes were associated with a predisposition for keratoconus in Korean individuals. Moreover, variations in ALDH3A1and LOX may serve as strong biomarkers for keratoconus.
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http://dx.doi.org/10.3341/kjo.2020.0138DOI Listing
February 2021

A Randomized, Placebo-Controlled Phase II Clinical Trial of 0.01% or 0.02% Cyclosporin A with 3% Trehalose in Patients with Dry Eye Disease.

J Ocul Pharmacol Ther 2021 Jan-Feb;37(1):4-11

CK St. Mary's Eye Center, Seoul, Korea.

To compare the efficacy and safety of HU00701 (0.01% cyclosporin  + 3% trehalose), HU007 (0.02% cyclosporin  + 3% trehalose) (all w/v), and placebo in patients with moderate to severe dry eye disease (DED). This was a multicenter, randomized, double-masked, parallel, placebo-controlled phase II study. In total, 114 patients were randomly assigned to the HU00701, HU007, placebo, or reference group. There was a 2-week run-in period before the 12-week intervention. Efficacy and safety were evaluated every 4 weeks. The primary endpoint, change in corneal staining score from baseline to week 12, did not differ significantly among the control, HU00701, and HU007 groups in the full analysis. Of the secondary endpoints, only the tear film breakup time differed significantly at week 12 between the placebo and HU00701 groups. Twenty adverse events were reported by 15 patients, but the rate did not differ significantly among the 4 groups. The laboratory test, vital signs, and physical examination data showed no significant changes during the study. HU00701 and HU007 are safe, and HU007 effectively reduces the corneal staining score in patients with moderate-to-severe DED (NCT02917512).
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http://dx.doi.org/10.1089/jop.2020.0104DOI Listing
January 2021

Regulation of Ras homolog family member G by microRNA-124 regulates proliferation and migration of human retinal pigment epithelial cells.

Sci Rep 2020 09 22;10(1):15420. Epub 2020 Sep 22.

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Uncontrolled retinal pigment epithelial (RPE) cell proliferation/migration contribute to the pathological tractional membrane development in proliferative vitreoretinopathy. Recent studies reported that microRNA (miR)-124 controls various cellular functions via the direct targeting of small Ras homolog family member G (RHOG). Therefore, we investigated the role of the neuron-specific miR-124 and RHOG in RPE cell proliferation/migration. Alterations in miR-124 and RhoG expression, as per cell confluence were evaluated through quantitative real-time PCR and western blotting, respectively. After transfection with miR-124, we quantified RPE cell viability and migration and observed cell polarization and lamellipodia protrusions. We evaluated the expression of RHOG/RAC1 pathway molecules in miR-124-transfected RPE cells. Endogenous miR-124 expression increased proportionally to RPE cell density, but decreased after 100% confluence. Overexpression of miR-124 decreased cell viability and migration, BrdU incorporation, and Ki-67 expression. Inhibition of endogenous miR-124 expression promoted RPE cell migration. Transfection with miR-124 reduced cell polarization, lamellipodia protrusion, and RHOG mRNA 3' untranslated region luciferase activity. Like miR-124 overexpression, RhoG knockdown decreased RPE cell viability, wound healing, and migration, and altered the expression of cell cycle regulators. These results suggest that miR-124 could be a therapeutic target to alleviate fibrovascular proliferation in retinal diseases by regulating RPE proliferation/migration via RHOG.
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http://dx.doi.org/10.1038/s41598-020-72360-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508981PMC
September 2020

Ocular surface inflammation induces de novo expression of substance P in the trigeminal primary afferents with large cell bodies.

Sci Rep 2020 09 16;10(1):15210. Epub 2020 Sep 16.

CK St. Mary's Eye Center, Seoul, Republic of Korea.

We evaluated the changes in substance P (SP)-expressing trigeminal neurons (TNs) innervating the cornea following ocular surface inflammation. Ocular surface inflammation was induced in Sprague-Dawley rats using 0.1% benzalkonium chloride (BAK). The corneal staining score, corneal epithelial apoptosis, conjunctival goblet cells, and density of corneal subbasal nerve plexus (SNP) were assessed, and the mRNA levels of SP, interleukin (IL)-1β, IL-6, and tumour necrosis factor-α were measured in corneas and ipsilateral trigeminal ganglia (TG). SP-immunoreactivity (IR) was measured in corneal intraepithelial nerves and TNs. The cell size of corneal TNs in the TG was calculated. All parameters were observed immediately (BAK group), at 1 week (1 w group), and 2 months (2 m group) after 2 weeks of BAK application. BAK caused an increase in the corneal staining score and the number of apoptotic cells, loss of conjunctival goblet cells, reduced density of corneal SNP, and upregulated expression of SP and inflammatory cytokines in both the cornea and TG in the BAK group but those changes were not observed in the 2 m group. On the other hand, SP-IR% and mean cell size of corneal TNs increased significantly in the BAK, 1 w, and 2 m groups, compared to the control. Our data suggest that following ocular surface inflammation, large-sized corneal TNs which normally do not express SP, expressed it and this phenotype switching lasted even after the inflammation disappeared. Long-lasting phenotypic switch, as well as changes in the expression level of certain molecules should be addressed in future studies on the mechanism of corneal neuropathic pain.
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http://dx.doi.org/10.1038/s41598-020-72295-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494893PMC
September 2020

Femtosecond laser induced nano-textured micropatterning to regulate cell functions on implanted biomaterials.

Acta Biomater 2020 10 2;116:138-148. Epub 2020 Sep 2.

Center for Biomaterials, Korea Institute of Science & Technology, Seoul 02792, Republic of Korea; Division of Bio-Medical Science and Technology, Korea Institute of Science and Technology School, Korea University of Science and Technology, Seoul 02792, Republic of Korea. Electronic address:

Posterior capsular opacification (PCO) is the most common complication of cataract surgery. PCO is due to the proliferation, migration, and epithelial-to-mesenchymal transition of the residual lens epithelial cells (LECs) within the lens capsule. As surface topography influences cellular response, we investigated the effect of modulating the dimensions of periodic nano-textured patterns on the surface of an intraocular lens material to regulate lens epithelial cell functions such as cell adhesion, migration, orientation, and proliferation. Patterned poly(HEMA) samples were prepared by a femtosecond laser microfabrication, and the behaviors of human B-3 LECs were observed on groove/ridge patterns with widths varying from 5 to 40 µm. In the presence of ridge and groove patterns, the adherent cells elongated along the direction of the patterns, and f-actin of the cells was spread to a lesser extent on the nano-textured groove surfaces. Both single and collective cell migrations were significantly inhibited in the perpendicular direction of the patterns on the nano-textured micro-patterned samples. We also fabricated the patterns on the curved surface of a commercially available intraocular lens for in vivo evaluation. In vivo results showed that a patterned IOL could help suppress the progression of PCO by inhibiting cell migration from the edge to the center of the IOL. Our reports demonstrate that nano- and microscale topographical patterns on a biomaterial surface can regulate cellular behavior when it is implanted into animals.
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http://dx.doi.org/10.1016/j.actbio.2020.08.044DOI Listing
October 2020

Corrigendum to "Impact of peripheral optical properties induced by orthokeratology lens use on myopia progression" [Heliyon 6 (4), (April 2020) Article e03642].

Heliyon 2020 Jul 30;6(7):e04510. Epub 2020 Jul 30.

Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, 601 Elmwood Ave., Box 314, 14642, Rochester, New York, USA.

[This corrects the article DOI: 10.1016/j.heliyon.2020.e03642.].
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http://dx.doi.org/10.1016/j.heliyon.2020.e04510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399116PMC
July 2020

Comparison of visual outcomes after femtosecond laser-assisted LASIK versus flap-off epipolis LASIK for myopia.

BMC Ophthalmol 2020 Jul 29;20(1):310. Epub 2020 Jul 29.

Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: This study clinically evaluated the visual outcomes after refractive surgery for myopia using femtosecond laser-assisted in situ keratomileusis (femto-LASIK) and flap-off epipolis LASIK (epi-LASIK).

Methods: In this retrospective case series study, 40 eyes of 27 patients were divided into two groups depending on the technique used for refractive surgery. Femto-LASIK and flap-off epi-LASIK flaps were created using femtosecond laser and Epi-K™ epikeratome, respectively. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, manifest refraction, corneal asphericity, and corneal higher-order aberrations (HOAs) were assessed pre- and postoperatively.

Results: The improvement in logarithm of the minimum angle of resolution (logMAR) UDVA after refractive surgery was statistically significant for both groups (P < 0.001 for all groups); it was significant better in UDVA in femto-LASIK than flap-off epi-LASIK, 0.03 ± 0.06 logMAR (femto-LASIK) and 0.54 ± 0.31 logMAR (flap-off epi-LASIK), at 1 day postoperatively; 0.02 ± 0.05 logMAR (femto-LASIK) and 0.14 ± 0.13 logMAR (flap-off epi-LASIK), at 1 week postoperatively (P < 0.001 and P = 0.019). With regard to the corneal HOAs, the increment in spherical aberration (Z) was greater in flap-off epi-LASIK than femto-LASIK: 0.626 ± 0.232 μm and 0.479 ± 0.139 μm in the front cornea; 0.556 ± 0.227 μm and 0.430 ± 0.137 μm in the total cornea (P = 0.016 and P = 0.017). However, the back corneal HOA changes did not have a significant effect on the total corneal HOA changes.

Conclusion: Femto-LASIK yielded better early visual outcomes than did flap-off epi-LASIK, but there was no significant difference between the outcomes of the two procedures, 1 week postoperatively.
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http://dx.doi.org/10.1186/s12886-020-01579-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392686PMC
July 2020

New IOL formula using anterior segment three-dimensional optical coherence tomography.

PLoS One 2020 20;15(7):e0236137. Epub 2020 Jul 20.

Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, Rochester, New York, United State of America.

This retrospective study was aimed to compare prediction errors from various combinations of biometric data generated using optical coherence tomography (OCT) and develop a new intraocular lens (IOL) formula using biometric data. 145 eyes from 145 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) were enrolled to the present study and they were divided into a training set (n = 92) and a test set (n = 53). Preoperative axial length (AL) and corneal radius were measured using partial coherence interferometry. The anterior chamber depth (ACD), lens meridian parameter (LMP), lens thickness (LT), thickness of anterior and posterior parts of the crystalline lens (aLT and pLT), and anterior segment length were measured by OCT. From a training set, we developed eight regression equations and analyzed the predictive accuracy. The regression equation using AL, LMP, and pLT (-1.143 + 0.148*AL + 0.428*LMP + 0.254*pLT) showed the strongest correlation with effective lens position (ELP) and smallest standard deviation of ELP prediction error. IOL formula generated using AL, LMP, and pLT yielded the highest predictive accuracy. In a test set, the new IOL formula also produced narrowest range of prediction error, smallest median absolute error, and highest percentages within ±0.25, ±0.50 than existing IOL formulas. The IOL formula considering AL, LMP and pLT will help to improve predictive accuracy in FLACS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236137PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371164PMC
September 2020

Wireless smart contact lens for diabetic diagnosis and therapy.

Sci Adv 2020 Apr 24;6(17):eaba3252. Epub 2020 Apr 24.

Department of Materials Science and Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-ro, Nam-gu, Pohang, Gyeongbuk 37673, Korea.

A smart contact lens can be used as an excellent interface between the human body and an electronic device for wearable healthcare applications. Despite wide investigations of smart contact lenses for diagnostic applications, there has been no report on electrically controlled drug delivery in combination with real-time biometric analysis. Here, we developed smart contact lenses for both continuous glucose monitoring and treatment of diabetic retinopathy. The smart contact lens device, built on a biocompatible polymer, contains ultrathin, flexible electrical circuits and a microcontroller chip for real-time electrochemical biosensing, on-demand controlled drug delivery, wireless power management, and data communication. In diabetic rabbit models, we could measure tear glucose levels to be validated by the conventional invasive blood glucose tests and trigger drugs to be released from reservoirs for treating diabetic retinopathy. Together, we successfully demonstrated the feasibility of smart contact lenses for noninvasive and continuous diabetic diagnosis and diabetic retinopathy therapy.
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http://dx.doi.org/10.1126/sciadv.aba3252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182412PMC
April 2020

Impact of peripheral optical properties induced by orthokeratology lens use on myopia progression.

Heliyon 2020 Apr 4;6(4):e03642. Epub 2020 Apr 4.

Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, 601 Elmwood Ave., Box 314, 14642, Rochester, New York, USA.

The objective of the present retrospective comparative cohort study was to compare the impact of wearing glasses versus an orthokeratology (Ortho-K) lens on peripheral optical properties and myopia progression in a population of South Korean children. Participants included children with myopia, between 8 and 12 years of age (n = 22 eyes), and divided into two groups: those who used glasses (Group I, n = 9) and those who used an Ortho-K lens (Group II, n = 13). Myopia progression over one year was quantified by changes in the central axial length of the eye. Keratometry and corneal aberrations on both the anterior and posterior surfaces of the eye were obtained using a Scheimpflug camera. A custom-developed Shack-Hartmann aberrometer was also used to measure peripheral aberrations across the horizontal visual field, up to 30°, and along the nasal-temporal meridian in 10-degree steps. Central axial elongation was larger in Group I (0.59 ± 0.21 mm) than in Group II (0.34 ± 0.18 mm) ( = .01). Relative peripheral spherical refractions at 10 and 20° nasally and at 10° temporally ( = 0.04, 0.049, and 0.042, respectively) relative to the fovea were positively correlated with central axial elongation in Group II. Group II exhibited an increase in peripheral ocular high order aberrations, such as horizontal coma and asymmetric trefoil. The use of Ortho-K lenses was found to slow the rate of central axis elongation in children with myopia. This effect might be related to an increase in both peripheral spherical refraction and peripheral ocular higher order aberrations with Ortho-K lens use.
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http://dx.doi.org/10.1016/j.heliyon.2020.e03642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132157PMC
April 2020

Site of clear corneal incision in cataract surgery and its effects on surgically induced astigmatism.

Sci Rep 2020 03 3;10(1):3955. Epub 2020 Mar 3.

Department of Ophthalmology, Catholic Institute for Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Clear corneal incision (CCI) is a commonly used surgical approach in cataract surgery. In this prospective study, we evaluated the effect of CCI site on surgically induced astigmatism (SIA) and other postoperative astigmatic changes. CCIs were constructed based on the steep meridian of the total corneal refractive power in the 4.0-mm-zone (TCRP), and patients were divided into four groups: temporal, superotemporal, superonasal, and superior according to the site of the incision. TCRP analysis demonstrated a statistically significant reduction of astigmatism with superior incisions (P < 0.001), and the combined mean polar values for SIA changed significantly in the temporal (Hotelling T = 1.977), superotemporal (Hotelling T = 0.544), superonsal (Hotelling T = 1.066), and superior incision groups (Hotelling T = 1.134) (all P < 0.001). The posterior axis alignment should be considered in cataract surgery with CCI, and the SIA is affected by axis rotation, and incision orientation.
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http://dx.doi.org/10.1038/s41598-020-60985-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054299PMC
March 2020

Subsurface calcification of hydrophilic refractive multifocal intraocular lenses with a hydrophobic surface: A case series.

Medicine (Baltimore) 2019 Dec;98(50):e18379

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea.

Rationale: Opacification of monofocal intraocular lenses (IOLs) of various designs and materials has been reported. Hydrophilic acrylic IOLs are more prone to opacification than hydrophobic IOLs, but IOL surface modification by hydrophobic materials may improve biocompatibility, and few opacifications of such monofocal lenses have been reported to date. However, here we describe the characteristics of opacification of hydrophilic refractive multifocal IOLs with a hydrophobic surface modification in a cluster of patients who underwent uneventful cataract surgery.

Patient Concerns: In this retrospective observational case series, the medical records of 7 patients in whom opacification of the IOL was identified after implantation of LS-313 MF30 (Lentis M plus, Oculentis), from November 2017 to May 2019, were reviewed.

Diagnosis: All patients had undergone bilateral implantation of LS-313 MF30 IOLs. Ten eyes of 7 patients showed significant opacification at a mean 49.1 ± 10.2 months postoperatively.

Interventions: The IOLs of 4 cases were explanted.

Outcomes: All of the opacified cases had received LS-313 MF30 IOLs from February 2014 to August 2014 and experienced decreased visual acuity after 44.6 ± 10.5 months. The explanted IOLs of 4 cases were evaluated by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), Alizarin-red, and von Kossa staining. These explanted IOLs showed fine and evenly distributed, whitish deposits on the entire IOL, particularly below the surface. Although the constituent of the deposits was identified as calcium by Alizarin-red and von Kossa stain, SEM, and EDX analysis showed no surface deposits of calcium. Paraffin-embedded sections of the IOLs were prepared, and calcium deposition was confirmed by EDX analysis at the subsurface region of the IOL.

Lessens: Significant opacification of these hydrophilic refractive multifocal IOLs with hydrophobic surface modification was found to be due to abnormal calcification of the subsurface of the IOL. Clinicians must be aware of the opacification of this IOL design, despite surface modification. In particular, it should be noted that there is a high likelihood that the patient may experience vision-related symptoms even with moderate opacity and that opacification may lead to a burdensome IOL exchange.
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http://dx.doi.org/10.1097/MD.0000000000018379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922436PMC
December 2019

Preoperative biometric measurements with anterior segment optical coherence tomography and prediction of postoperative intraocular lens position.

Medicine (Baltimore) 2019 Dec;98(50):e18026

Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, Rochester, New York, USA.

The purpose of this study is to evaluate the biometric parameters of crystalline lens components and to find effective factors for predicting postoperative intraocular lens (IOL) position. This retrospective study included 97 eyes from 97 patients with a mean age of 63.00 ± 12.38 (SD) years. The biometric measurements were performed by means of a 3-dimensional optical coherence tomography (3D-OCT) device. Specifically, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), lens meridian parameter (LMP), white-to-white diameters (WTW), anterior segment length (ASL), the anterior part of lens (aLT), and the posterior part of lens (pLT) were measured. Additionally, axial length (AL) and corneal radius (CR) were measured by the partial coherence interferometry. Ninety-seven eyes were divided into thin lens group (LT < 4.5 mm) and thick lens group (LT ≥ 4.5 mm). The differences between the above two groups were also analyzed. Postoperative IOL position was measured by 3D-OCT at 3 months postoperatively and regression formulas for predicting postoperative IOL position were developed by various combinations of preoperative factors. As lens thickened, ACD and AD became shallow (all P < .001). AD, ACD, ASL, aLT, and pLT showed statistically significant differences between two subgroups classified on the basis of LT (all P < .001). Meanwhile, the value obtained by subtracting aLT from pLT did not show any association with the other biometric measurements. The combination of ACD, aLT, pLT, AL, CR, and WTW showed the highest correlation with postoperative IOL position (R = 0.536, P < .001). In conclusion, pLT-aLT was an independent factor not affected by any other variables and did not show significant difference between thin lens group and thick lens group. The subdivision of the lens structure using 3D-OCT helps to predict postoperative IOL position.
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http://dx.doi.org/10.1097/MD.0000000000018026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922509PMC
December 2019

Accuracy of toric intraocular lens implantation using automated vs manual marking.

BMC Ophthalmol 2019 Aug 3;19(1):169. Epub 2019 Aug 3.

Department of Ophthalmology and Visual Science, College of Medicine, Catholic University of Korea, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.

Background: Accurate alignment of toric intraocular lens (TIOL) to steep corneal astigmatic axis is important to achieve effective postoperative results. The authors compare the accuracy of astigmatism correction using automated and manual marking in TIOL implantation during cataract surgery.

Methods: One hundred thirty-two eyes with nuclear density from Grade 2 to 4 were randomly subdivided into 2 groups (automated and manual marking). All patients underwent manual marking and the steep axis was compared to SensoMotoric Instruments (SMI). After phacoemulsification, 62 patients underwent toric IOL implantation using the SMI and 70 patients underwent toric IOL implantation using manual marking. Intraoperative measurement was the steep axis difference. Clinical measurements included preoperative and postoperative best corrected visual acuity (BCVA), and TIOL axis.

Results: The intraoperative steep axis difference between SMI and manual marking was 7.86 ± 6.4 degrees. The difference between the preoperative steep axis and the postoperative TIOL axis using SMI (3.63 ± 1.12 degrees) was significantly lower than that using manual marking (8.29 ± 2.23 degrees) (P < 0.05).

Conclusions: The steep axis measurements may be different when using SMI vs. manual marking. The SMI is more accurate than manual marking for TIOL implantation during cataract surgery.

Trial Registration: Current Controlled Trials ISRCTN12294725 , Retrospectively registered, on 20 July 2018.
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http://dx.doi.org/10.1186/s12886-019-1175-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679531PMC
August 2019

Comparison of keratometric measurements between color light-emitting diode topography and Scheimpflug camera.

BMC Ophthalmol 2019 Apr 26;19(1):98. Epub 2019 Apr 26.

Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.

Background: To determine the agreement of measurements between color light-emitting diode corneal topography (Cassini) and Scheimpflug camera keratometry (Pentacam HR).

Methods: The current retrospective study investigated 117 right eyes of 117 healthy patients before cataract surgery from June 2017 to July 2017. Steep K, flat K, mean K, astigmatism, and axis for both anterior and posterior corneal surface were measured using the two devices. The measured values were converted into J vectors such as J0 and J45. The mean difference for those measurement values were compared between the two instruments, and the agreement was evaluated using the Bland-Altman plot I.

Results: There were statistically significant differences in mean K (44.21D [43.34 to 45.34] and 44.30D [43.30 to 45.10] by Cassini and Pentacam [P = 0.004]) and astigmatism (0.90D [0.58 to 1.30] and 0.70D [0.40 to 1.30] by Cassini and Pentacam [P = 0.002]) on the anterior corneal surface and flat K (- 6.21D [- 6.39 to - 6.07] and - 6.30D [- 6.5 to - 6.10] by Cassini and Pentacam [P < 0.001]), mean K (- 6.39D [- 6.54 to - 6.25] and - 6.40D [- 6.60 to - 6.30] by Cassini and Pentacam [P = 0.019]), and astigmatism (0.33D [0.22 to 0.47] and 0.30D [0.15 to 0.40] by Cassini and Pentacam [P = 0.002]) on the posterior corneal surface. The mean difference (= Cassini - Pentacam) with 95% limit of agreement for mean K and astigmatism of the anterior corneal surface were 0.082D (- 0.60 to 0.76) and 0.11D (- 0.73 to 0.95) for measurements obtained by the two instruments, respectively. Regarding keratometric values from the posterior corneal surface, the mean differences for flat K, mean K, and astigmatism were - 0.081D (- 0.42 to 0.26), - 0.030D (- 0.32 to 0.26), and 0.067D (- 0.33 to 0.46), respectively. Intraclass correlation coefficients for steep K, flat K, mean K, and vector J0 were higher than 0.9 in the anterior cornea. Positive correlation in steep K, flat K, mean K, astigmatism, and J0 was found between two devices in both anterior and posterior cornea (P < 0.001).

Conclusions: Corneal refractive power and astigmatism tend to be higher when measured using Cassini than Pentacam HR in both anterior and posterior cornea. The two different devices might not be used interchangeably.

Trial Registration: Retrospectively registered. Registration number: KC17RESI0439 .
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http://dx.doi.org/10.1186/s12886-019-1106-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486681PMC
April 2019

Effect of Air Injection Depth on Big-bubble Formation in Lamellar Keratoplasty: an Ex Vivo Study.

Sci Rep 2019 03 7;9(1):3785. Epub 2019 Mar 7.

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

This study evaluated the effect of air injection depth in the big-bubble (BB) technique, which is used for corneal tissue preparation in lamellar keratoplasty. The BB technique was performed on ex vivo human corneoscleral buttons using a depth-sensing needle, based on optical coherence tomography (OCT) imaging technology. The needle tip, equipped with a miniaturized OCT depth-sensing probe, was inserted for air injection at a specified depth. Inside the corneal tissue, our needle obtained OCT line profiles, from which residual thickness below the needle tip was measured. Subjects were classified into Groups I, II, III, and IV based on injection depths of 75-80%, 80-85%, 85-90%, and >90% of the full corneal thickness, respectively. Both Type I and II BBs were produced when the mean residual thicknesses of air injection were 109.7 ± 38.0 µm and 52.4 ± 19.2 µm, respectively. Type II BB (4/5) was dominant in group IV. Bubble burst occurred in 1/16 cases of type I BB and 3/16 cases of type II BB, respectively. Injection depth was an important factor in determining the types of BBs produced. Deeper air injection could facilitate formation of Type II BBs, with an increased risk of bubble bursts.
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http://dx.doi.org/10.1038/s41598-018-36522-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405887PMC
March 2019

Association of human antigen class I genes with cold medicine-related Stevens-Johnson syndrome with severe ocular complications in a Korean population.

Br J Ophthalmol 2019 04 31;103(4):573-576. Epub 2019 Jan 31.

Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Background/aims: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are a spectrum of diseases that cause an acute vesiculobullous reaction in the skin and mucous membranes. The occurrence of these diseases is associated with various drugs, a large proportion of which is comprised cold medicines (CM). We try to investigate the association between human leucocyte antigen (HLA) class I genes and CM-related SJS/TEN (CM-SJS/TEN) with severe ocular complications (SOC) in the Korean population.

Methods: This multicentre case-control study enrolled 40 Korean patients with CM-SJS/TEN with SOC and 120 age-matched and sex-matched Korean healthy volunteers between January 2012 and May 2014. HLA genotyping was performed using PCR followed by hybridisation with sequence-specific oligonucleotide probes. RESULTS : The carrier frequency and gene frequency of HLA-A*02:06 were 37.5 % and 20.0 %, respectively, in patients, and 16.7 % and 9.6 %, respectively, in controls (p=0.018). The carrier frequency of HLA-C*03:04 was 30 % in patients and 10.8 % in controls, and gene frequency of HLA-C*03:04 was 15 % in patients and 5.4 % in controls (p=0.003). The carrier frequency and gene frequency of HLA-C*03:03 were 2.5 % and 1.3 %, respectively, in patients, and 20 % and 10.4 %, respectively, in controls (p=0.006). CONCLUSIONS : As per our results, we suggest that HLA-A*02:06 and HLA-C*03:04 might be positive markers for CM-SJS/TEN with SOC, and HLA-C*03:03 might be an indicator of protection against CM-SJS/TEN with SOC in the Korean population.
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http://dx.doi.org/10.1136/bjophthalmol-2018-313263DOI Listing
April 2019

Accuracy of swept-source optical coherence tomography based biometry for intraocular lens power calculation: a retrospective cross-sectional study.

BMC Ophthalmol 2019 Jan 24;19(1):30. Epub 2019 Jan 24.

Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: To evaluate the accuracy of biometric measurements by a swept-source optical coherence tomography (SS-OCT) based biometry for intraocular lens (IOL) power calculation.

Methods: This retrospective observational study enrolled 431 patients undergoing cataract surgery. The charts were reviewed to investigate the failure rate of axial length (AL) measurement of the SS-OCT biometer, partial coherence interferometry (PCI), and A-scan ultrasonography (US) according to cataract type and severity. AL and keratometry in 164 eyes with the same IOL inserted were measured using the SS-OCT biometer, PCI, and A-scan US. The SRK/T formula was used to calculate IOL power. The mean absolute error (MAE) and percentage of eyes with a prediction error (PE) of ±0.50 D were compared.

Results: The AL measurement failure rate was 0.00% for A-scan US, 2.32% for the SS-OCT biometer, and 15.31% for PCI. The number of eyes measured using three devices (SS-OCT biometer, PCI, and A-scan US) was 128 (Group A) and the number of eyes measured using two devices (SS-OCT biometer and A-scan US) was 36 (Group B). The score of posterior subcapsular opacity was significantly different between two groups (p < .001). The SS-OCT biometer and PCI showed significantly lower MAE compared to A-scan US in Group A (p = 0.027). Using SS-OCT biometer, MAE showed no significant difference between Group A (0.36 ± 0.27) and Group B (0.36 ± 0.31) (p = 0.785). Whereas, MAE of A-scan US was significantly higher than Group A (0.47 ± 0.39) in Group B (0.64 ± 0.36) (p = 0.023).

Conclusions: Using biometry with advanced OCT is useful in clinical practice as it is more effective in obtaining biometric measurements in the eyes with PSC and provides accurate measurements for IOL power calculation regardless of cataract type and severity.

Trial Registration: Retrospectively registered. Registration number: KC16RISI1020 . Registered 03 January 2018.
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http://dx.doi.org/10.1186/s12886-019-1036-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346505PMC
January 2019

Gender-differences in age-related changes of corneal astigmatism in Korean cataract patients.

BMC Ophthalmol 2019 Jan 24;19(1):31. Epub 2019 Jan 24.

Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Background: This cross-sectional study investigated age-related changes in anterior, posterior, and total corneal astigmatism and evaluated sex differences in corneal astigmatism with increasing age in cataract patients.

Methods: This study evaluated eyes with cataracts from May 2009 and July 2013. All eyes underwent a complete ophthalmological examination and corneal Scheimpflug imaging by a Pentacam camera (Oculus, Wetzlar, Germany). Anterior, posterior, and total corneal astigmatism were determined. Power vector J and linear regression analyses were determined and compared with respect to age and sex.

Results: Four hundred and fifteen patients (217 men, 198 women) aged 20-89 years were evaluated. For anterior corneal astigmatism, 100% of patients who were 20-39 years old had with-the-rule (WTR) in both sexes. WTR was significantly lower in patients 80-89 years old (25.6% of men and 37.8% of women). For total corneal astigmatism, WTR also tended to decrease with increasing age: 93.3% of men and 100% of women 20-39 years old versus 20.9% of men and 31.1% of women 80-89 years old. The regression coefficient of both the anterior corneal and total corneal J vector values analyzed by age were - 0.018 in men and - 0.016 in women (both p < .001).

Conclusions: The against-the-rule shift was faster for total corneal astigmatism than for anterior corneal astigmatism and it occurred earlier in men than in women.

Trial Registration: Retrospectively registered. Registration number: KC15RISI0241 . Registered April 20, 2016.
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http://dx.doi.org/10.1186/s12886-018-1001-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346567PMC
January 2019

Long-term outcome of intrastromal corneal ring segments in keratoconus: Five-year follow up.

Sci Rep 2019 01 22;9(1):315. Epub 2019 Jan 22.

Department of Ophthalmology and Catholic Institute for Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

To evaluate the effectiveness of intrastromal corneal ring segment (ICRS) use in keratoconus after five years. ICRS has been widely used to correct astigmatism and improve visual acuity in keratoconus. Although the short-term outcome is well known to be effective, long-term outcome has rarely been reported. A retrospective chart review was done. A total of 30 eyes diagnosed with keratoconus and treated with INTACS (Addition Technology, Sunnyvale, CA, USA) were included. Visual acuity, refraction, indices of corneal irregularity, and higher-order aberration were evaluated at preoperative, two months, one year, three years, and five years postoperatively. Uncorrected distance visual acuity (UDVA) and spherical and spherical equivalent were improved (p < 0.05) for three years. However, they worsened (p < 0.05) at five years to preoperative values. On the other hand, corrected distance visual acuity (CDVA) was improved for five years (p < 0.05). Topographic keratometry was flattened, and corneal irregularity indices were improved at five years (all p < 0.05). Coma RMS was improved (p < 0.05) continuously for five years. ICRS has advantages in improving CDVA with topographic stabilization and decreasing coma in keratoconus for five years.
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http://dx.doi.org/10.1038/s41598-018-36668-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342932PMC
January 2019

Comparison of refractive outcomes between femtosecond laser-assisted cataract surgery and conventional cataract surgery.

Medicine (Baltimore) 2018 Dec;97(52):e13784

Flaum Eye Institute, Center for Visual Science, The Institute of Optics, University of Rochester, Rochester, New York, USA.

The purpose of our study is to compare the predictive accuracy of femtosecond laser-assisted cataract surgery with the results of conventional cataract surgery. This prospective study included 83 eyes from 83 patients who underwent femtosecond laser-assisted cataract surgery and 83 eyes from 83 patients who underwent conventional cataract surgery. Preoperative IOL power calculations were performed with the partical coherence interferometry. Femtosecond laser-assisted capsulotomy was based on 5.2 mm scanned capsule center. Following phacoemulsification, 1-piece IOL was inserted into the capsular bag. Refractive outcome was measured 3 months postoperatively with manual refraction. Predicted refraction was assessed by the Barret-Universal II, Haigis, Hoffer Q, SRK/T, and T2 formulas. We applied optimized IOL constants and retrospectively personalized IOL constants. There was no difference in preoperative demographic data. When the optimized IOL constants were used, the femtosecond laser-assisted group produced significantly lower MAEs in the Barret-Universal II, Hoffer Q, SRK/T, and T2 formulas (P < .05). After the personalization of IOL constants, there were statistical differences in the Barret-Universal II, Hoffer Q (P < .05). The standard deviation of ME and MedAE were also relatively lower with femtosecond laser-assisted group. In conclusion, femtosecond laser-assisted cataract surgery with Catalys femtosecond laser system produced better refractive outcomes than conventional cataract surgery.
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http://dx.doi.org/10.1097/MD.0000000000013784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314757PMC
December 2018

Marked infiltration of neutrophils at the upper palpebral conjunctiva in patients with chronic graft-versus-host disease.

Ocul Surf 2019 04 20;17(2):295-302. Epub 2018 Dec 20.

Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Republic of Korea; Catholic Institute for Visual Science, College of Medicine, Catholic University of Korea, Republic of Korea. Electronic address:

Purpose: Neutrophils may be involved in the local pathophysiology of chronic graft-versus-host disease (cGVHD). We evaluated neutrophil infiltration in cGVHD using conjunctival impression cytology (IC) and its clinical correlation with ocular surface status and neutrophil enzyme levels in tears.

Methods: This cross-sectional observational study included 76 patients with cGVHD. The ocular surface was assessed for the tear break-up time, Schirmer I test, corneal and conjunctival staining score, meiboscore, and the ocular surface disease index questionnaire. Conjunctival IC was performed at the temporal, superior bulbar, and upper palpebral conjunctiva, and the number of neutrophils (cells/high power field [HPF]) was calculated. Neutrophil elastase (NE), myeloperoxidase (MPO), and matrix metalloperoxidase-8 and -9 levels in tear washes were measured in 20 patients.

Results: The number of neutrophils was significantly greater at the upper palpebral conjunctiva (median [range], 16.5 [0 to 147] cells/HPF) than at the temporal and superior bulbar conjunctiva (0 [0 to 70] and 0 [0 to 105] cells/HPF; P < 0.0001). The number of neutrophils at the upper palpebral conjunctiva showed moderate correlations with the corneal staining score and the NE and MPO levels in tears (r = 0.668, 0.553, and 0.563, respectively; P < 0.0001, P = 0.014, and 0.012).

Conclusions: Our results suggest that neutrophils at the upper palpebral conjunctiva associate with the clinical manifestations and inflammatory status of the ocular surface in cGVHD. Conjunctival neutrophils should be addressed when assessing the inflammatory activity of ocular cGVHD and exploring its pathogenesis.
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http://dx.doi.org/10.1016/j.jtos.2018.12.007DOI Listing
April 2019

Corneal power changes with Scheimpflug rotating camera after hyperopic LASIK.

Medicine (Baltimore) 2018 Dec;97(50):e13306

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

To evaluate surgically induced refractive change (SIRC) by manifest refraction and corneal power changes using an automated keratometer and Scheimpflug rotating camera, and to find the best keratometric measurements reflecting SIRC after hyperopic laser-assisted in situ keratomileusis (LASIK).This retrospective study included 18 eyes of 18 patients undergoing hyperopic LASIK using the Schwind Amaris 750S excimer laser. All measurements were performed preoperatively and 12 months postoperatively. Cycloplegic manifest refractions were performed and keratometric measurements were obtained via an RK-5 automated keratometer and a Pentacam rotating Scheimpflug camera. Sim K, true net power (TNP), and total corneal refractive power (TCRP) at 2.0 to 5.0 mm were analyzed using a Scheimpflug camera.The mean manifest refractive changes in the spherical equivalent (SE) at the corneal plane were 2.32 ± 1.65 D at 12 months postoperatively. The refractive power changes by the automated keratometer and Sim K were significantly less than SIRC (P = .043 and P = .048, respectively). Both TNP and the TCRP in the 5.0 mm zone produced lesser mean differences with SIRC (0.05 D and 0.06 D) and showed closer agreements with SIRC on Bland-Altman plots and higher correlation coefficients with SIRC.Corneal power measured on the anterior corneal surface underestimated SIRC. TCRP at the 5.0 mm zone provided by a Pentacam Scheimpflug camera reflected the SIRC accurately and precisely, and would be applicable for prediction of intraocular power before cataract surgery and follow-up measurement of corneal refractive power.
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http://dx.doi.org/10.1097/MD.0000000000013306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320111PMC
December 2018

Development of a Conjunctivitis Outpatient Rate Prediction Model Incorporating Ambient Ozone and Meteorological Factors in South Korea.

Front Pharmacol 2018 9;9:1135. Epub 2018 Oct 9.

Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea.

Ozone (O) is a commonly known air pollutant that causes adverse health effects. This study developed a multi-level prediction model for conjunctivitis in outpatients due to exposure to O by using 3 years of ambient O data, meteorological data, and hospital data in Seoul, South Korea. We confirmed that the rate of conjunctivitis in outpatients (conjunctivitis outpatient rate) was highly correlated with O ( = 0.49), temperature ( = 0.72), and relative humidity ( = 0.29). A multi-level regression model for the conjunctivitis outpatient rate was well-developed, on the basis of sex and age, by adding statistical factors. This model will contribute to the prediction of conjunctivitis outpatient rate for each sex and age, using O and meteorological data.
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http://dx.doi.org/10.3389/fphar.2018.01135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189411PMC
October 2018

Use of the Crystalline Lens Equatorial Plane as a New Parameter for Predicting Postoperative Intraocular Lens Position.

Am J Ophthalmol 2019 02 17;198:17-24. Epub 2018 Sep 17.

Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, Rochester, New York, USA.

Purpose: To assess whether preoperative crystalline lens equatorial plane (LEP) reliably predicts the postoperative position of the intraocular lens (IOL).

Design: Comparative, interventional case series.

Methods: Phacoemulsification and IOL implantation (Group I, ZCB00; Group II, EC-1PAL; and Group III, CT Asphina) were performed for 104 eyes. Lens geometry parameters, including LEP, were obtained from a femtosecond laser cataract surgery system prior to surgery. LEP was defined as the distance from the front surface of the cornea to the equatorial plane of the crystalline lens. Postoperative anterior chamber depth (ACD) was measured using a Scheimpflug camera. Median absolute error was calculated using an optical ray-tracing method that incorporated LEP into an individualized eye model, and the results were compared with those from the Haigis formula.

Results: Preoperative ACD (3.27 ± 0.39 mm [R = 0.428], 3.30 ± 0.47 mm [R = 0.591], and 3.49 ± 0.39 mm [R = 0.373] in Groups I, II, and III, respectively) and LEP (4.81 ± 0.29 mm [R = 0.570], 4.84 ± 0.27 mm [R = 0.634], and 4.97 ± 0.23 mm [R = 0.565] in Groups I, II, and III, respectively) were found to have significant positive correlations with postoperative ACD (5.24 ± 0.40 mm, 5.02 ± 0.31 mm, and 5.19 ± 0.26 mm in Groups I, II, and III, respectively). Stepwise regression analysis showed that postoperative ACD was significantly correlated with LEP in all groups. Median absolute errors predicted by the ray-tracing method using LEP were smaller than those from the Haigis formula in all groups.

Conclusions: LEP is a promising measure from preoperative crystalline lens geometry and could serve as a new parameter to improve refractive outcomes in cataract surgery.
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http://dx.doi.org/10.1016/j.ajo.2018.09.005DOI Listing
February 2019

Predictive accuracy of partial coherence interferometry and swept-source optical coherence tomography for intraocular lens power calculation.

Sci Rep 2018 09 13;8(1):13732. Epub 2018 Sep 13.

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

The purpose of this study is to compare the predictive accuracy of intraocular lens (IOL) calculations made with partial coherence interferometry (PCI, IOLMaster, version 5) and swept-source optical coherence tomography (SS-OCT, Argos). Axial length (AL), mean keratometry value (K), and anterior chamber depth (ACD) were obtained using PCI and SS-OCT optical biometers. Intraocular lens (IOL) power calculations were made using the Barret-Universal II, Haigis, Hoffer Q, SRK/T, and T2 formulas and compared the predictive accuracy between biometers. In 153 eyes (153 patients), axial length measurements made with PCI (24.65 ± 2.35 mm) and SS-OCT (24.62 ± 2.29 mm) were significantly different (P < 0.001). Corneal power (P = 0.97) and anterior chamber depth (P = 0.51) were not significantly different between biometer. The mean absolute error was not significantly different between the five IOL power calculation formulas for either PCI or SS-OCT measurements. When AL was 24.5-26.0 mm, mean absolute error derived from SS-OCT was smaller than mean absolute error derived from PCI for all five IOL power calculation formulas (all P < 0.05). In conclusion, predictive accuracy of PCI and SS-OCT were nearly the same. However, in medium-long eyes, the predictive accuracy of SS-OCT for IOL calculations was higher.
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http://dx.doi.org/10.1038/s41598-018-32246-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137182PMC
September 2018

Effects of Residual Anterior Lens Epithelial Cell Removal on Axial Position of Intraocular Lens after Cataract Surgery.

J Ophthalmol 2018 19;2018:9704892. Epub 2018 Aug 19.

Catholic Institute for Visual Science, The Catholic University of Korea, Seoul, Republic of Korea.

Purpose: The aim of this study was to assess the effects of residual anterior lens epithelial cell (LEC) removal by anterior capsule polishing on the effective lens position (ELP) and axial position stability of the intraocular lens (IOL) after cataract surgery via postoperative measurement of the anterior chamber depth.

Methods: We enrolled 30 patients (60 eyes) requiring bilateral cataract surgery for age-related cataracts. Meticulous anterior capsule polishing and removal of residual LECs under the capsule were performed using a bimanual irrigation/aspiration system for one randomly selected eye in each patient. The eye without polishing served as a control. ELP was measured at five different time points after surgery, and axial shifting of IOL was determined at each visit by comparison with the position at the previous visit.

Results: The polishing and control groups showed significant differences with regard to the mean ELP at 1 (3.40 ± 0.29 versus 3.53 ± 0.32 mm, resp.; =0.026) and 2 months (3.42 ± 0.32 versus 3.61 ± 0.35 mm, resp.; =0.001) after surgery, the mean standard deviation for the five ELP values (0.087 ± 0.093 versus 0.159 ± 0.138 mm, =0.001), and the root mean square of the change in ELP at each follow-up visit (0.124 ± 0.034 versus 0.246 ± 0.038 mm, =0.047). The eyes in the control group exhibited a tendency for backward IOL movement with a concurrent hyperopic shift in refraction of approximately 0.2 diopter at 2 months after surgery.

Conclusion: Our findings suggest that residual anterior LEC polishing enhances the axial position stability of IOLs, without any complications, after cataract surgery.
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http://dx.doi.org/10.1155/2018/9704892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120298PMC
August 2018

The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia.

Am J Ophthalmol 2018 11 9;195:161-170. Epub 2018 Aug 9.

Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address:

Purpose: To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia.

Design: Prospective, nonrandomized clinical study.

Methods: Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection.

Results: A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%).

Conclusion: Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.
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http://dx.doi.org/10.1016/j.ajo.2018.07.040DOI Listing
November 2018

Efficacy of 0.015% intracameral epinephrine for significant miosis induced by photodisruption during femtosecond laser-assisted cataract surgery.

Medicine (Baltimore) 2018 Aug;97(31):e11693

Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu Catholic Institute for Visual Science Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Despite the various advantages of femtosecond laser-assisted cataract surgery (FLACS), pupillary constriction during laser photodisruption is considered one of the most unfavorable events. This study aimed to investigate the efficacy of intracameral 0.015% epinephrine injection for miosis after laser pretreatment during FLACS.A total of 82 patients who underwent FLACS for age-related cataracts were investigated in this retrospective study. The epinephrine group included patients who received intracameral epinephrine injection for miosis after femtosecond laser pretreatment, while the no-epinephrine group included the patients who underwent FLACS without intracameral epinephrine due to minimal miosis. Quantitative pupil area measurements were performed through the analysis of captured images extracted from surgical videos of both femtosecond laser pretreatment and phacoemulsification.Laser photodisruption induced miosis in both groups, although the degree of miosis was greater in the epinephrine group (4.65 ± 0.87 mm) than in the no-epinephrine group (6.30 ± 0.65 mm; P < .001). The intracameral epinephrine injection significantly increased the pupil diameter from 4.65 ± 0.87 to 5.49 ± 0.76 mm (21.61 ± 22.68%; P < .001) and the pupil area from 70.28 ± 24.46 to 96.49 ± 25.24 mm (52.89 ± 63.54%; P < .001). After additional viscomydriasis, there was no difference between groups in pupil diameter (epinephrine vs no-epinephrine group; 6.10 ± 0.77 vs 6.39 ± 0.65 mm; P = .073).A single intracameral injection of 0.015% epinephrine provided immediate and appropriate redilation of pupil in patients with significant miosis after femtosecond laser photodisruption. Intracameral epinephrine is a simple and practical option for pupil redilation in case of miosis during FLACS.
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http://dx.doi.org/10.1097/MD.0000000000011693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081127PMC
August 2018

Clinical results of the open ring PMMA guider assisted capsulorrhexis in cataract surgery.

BMC Ophthalmol 2018 May 10;18(1):116. Epub 2018 May 10.

Department of Ophthalmology & Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

Background: To compare the results of continuous curvilinear capsulorrhexis(CCC) after application of an open ring-shaped guider compared with a free-hand procedure in eyes with cataracts.

Methods: This study comprised patients undergoing cataract surgery in Seoul St.Mary's Hospital, The Catholic University of Korea. Eyes were grouped depending on the capsulotomy method; CCC was performed by free-hand procedure on 94 eyes (free-hand group), and it was performed under the guidance after introduction of an open ring-shaped guider on consecutive 89 eyes (guided group). Horizontal and vertical diameter, area and circularity of capsulotomy were measured postoperatively at one day, two months and six months. Differences in parameters and the percentage of ideal capsulorrhexis were analyzed between the two groups.

Results: On the first postoperative day, the vertical diameter in the guided group (5.24 ± 0.16 mm) was significantly longer than that of the free-hand group (5.01 ± 0.65 mm, P = 0.019). The area of capsulotomy was larger in the guided group (21.55 ± 0.87 mm) than that of the free-hand group (20.34 ± 2.96 mm, P < 0.001). Circularity in the guided group (0.84 ± 0.03), was significantly greater than that of the free-hand group (0.69 ± 0.17, P = 0.036). Ideal capsulorrhexis was obtained in 60 eyes (67%) in the free-hand group and 81 eyes (86%) in the guided group.

Conclusions: After introduction of an open ring-shaped guider, CCC became larger and more circular with less anterior capsular contracture. The rate of acquiring ideal capsulorrhexis was higher in the guided group than it was in the free-hand group for six months after surgery.
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http://dx.doi.org/10.1186/s12886-018-0782-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946449PMC
May 2018