BackgroundBecause the ciliary sulcus is vertically oval and only a limited range of EVO Implantable Collamer Lens (ICL) sizes is available, suboptimal vault is sometimes unavoidable. This study evaluated whether a simple 90-degree vertical-horizontal rotation of non-toric ICLs can correct low or high vault without changing lens size.MethodsThis retrospective case series included consecutive eyes with suboptimal vault after primary implantation of non-toric ICL at a single refractive surgery center. Eyes with low vault underwent rotation from vertical to horizontal orientation, and eyes with high vault underwent rotation from horizontal to vertical. The primary outcome was the change in central vault; secondary outcomes included the proportion of eyes within a target vault of 250-750 µm, changes in refraction, IOP, and angle parameters.ResultsFifteen eyes from 11 patients were included (7 low-vault with vertical to horizontal, 8 high-vault with horizontal to vertical). In the low-vault group, mean vault increased from 106.57 to 324.86 µm (P < 0.001), with eyes in the target range increasing from 0% to 85.7% (P = 0.031). In the high-vault group, mean vault decreased from 946.88 to 561.38 µm (P < 0.001), and eyes in the target range increased from 0% to 100.0% (P = 0.016). Visual acuity, refraction, IOP, and angle parameters were generally stable, and no complications occurred.ConclusionsIn eyes with suboptimal vault after non-toric ICL implantation, 90-degree vertical-horizontal rotation can predictably move vault into a safer range without changing lens size and may be considered as a minimally invasive option before planning ICL exchange in selected cases.

PURPOSE:To evaluate vault change after implantable collamer lens (ICL) exchange and identify outcome predictors, emphasizing age effects. SETTING:High-volume refractive surgery center, South Korea. DESIGN:Single-center retrospective cohort. METHODS:Records of ICL implantations (2013 to 2024) were reviewed. Eyes requiring exchange were classified upsizing, same-size, or downsizing. Primary outcome: 6-month vault change; secondary: endothelial cell density (ECD). Indications for exchange and age-vault relationships were assessed. RESULTS:Of 22 739 eyes, 110 (0.48%) underwent exchange: upsizing 70, same-size 27, downsizing 13. Indications differed by group: downsizing for high vault (13/13, 100%); upsizing for low vault (24/70, 34.3%) or toric rotation (44/70, 62.9%); same-size for residual refraction (17/27, 63.0%) or toric status change (10/27, 37.0%). Upsizing increased vault from 311.6 ± 223.0 μm to 481.0 ± 278.6 μm (Δ +169.4 μm; P < .001), with smaller gains at age 35 years or older. Downsizing reduced vault from 1284.2 ± 240.7 μm to 539.1 ± 176.1 μm (Δ -745.1 μm; P < .001), restoring 12 of 13 eyes (92.3%) to a prespecified safe range. Same-size exchange produced a small decrease (Δ -62.8 μm; P = .043). Across upsizing and downsizing, older age is linked to vault reduction, yielding smaller gains after upsizing (P = .013) and larger decreases after downsizing (P = .017). ECD showed small but significant declines across all groups (P < .050). CONCLUSIONS:Vault change after ICL exchange was strategy-dependent: downsizing reliably reduced excessive vault, same-size exchange produced minimal change, and upsizing yielded smaller gains that diminished with increasing age. ICL exchange requires careful planning that accounts for exchange strategy, preoperative vault, and patient age.

PURPOSE:To compare epidemiologic trends, clinical characteristics, and treatment patterns of acute postoperative endophthalmitis (APE) and endogenous endophthalmitis (EE) in a nationwide cohort. METHODS:This retrospective cohort study used Korean National Health Insurance Service claims data from 2013 to 2022. Patients with confirmed endophthalmitis treated by intravitreal injection (IVI) or pars plana vitrectomy (PPV) were included. A total of 7625 patients with APE and 649 with EE were analyzed. APE required recent intraocular surgery; EE required systemic infection and exclusion of corneal ulcer - associated endophthalmitis. Outcomes included yearly trends, patient profiles, treatment type (IVI, PPV, or combined), and outpatient care within one year. RESULTS:Among 16,009 patients with endophthalmitis, 7625 (47.6%) had APE and 649 (4.1%) had EE. APE cases increased until 2020-peaking during a fungal outbreak from contaminated viscoelastic material - then declined. The proportion of IVI-related APE rose from 13.1% in 2013 to 26.2% in 2022. EE cases remained stable. EE patients were younger (mean age, 62.6 vs. 67.6 years) and had greater comorbidity (mean Charlson Comorbidity Index, 1.30 vs. 0.98). IVI-only was most common in both groups, whereas combined IVI with PPV was more frequent in EE. Outpatient care was less common in EE (57.6% vs. 83.4%) yet lasted longer (median 269 vs. 67 days) with more IVIs (mean 3.48 vs. 2.62 injections). CONCLUSION:APE was more prevalent and increasingly IVI-associated. EE, though less common, involved greater systemic morbidity and longer treatment duration. Findings underscore the need for infection control in IVI and multidisciplinary EE care.

The increasing use of electronic cigarettes (e-cigarettes) has raised concerns regarding their potential health effects, including ocular outcomes such as age-related macular degeneration (AMD). While conventional cigarette smoking is a well-established risk factor for AMD, the associations of exclusive e-cigarette use and former smoking with early AMD remain unclear. We analyzed 7,780 adults aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey (2016–2021). Based on self-reported smoking history and e-cigarette use, participants were classified as non-smokers, former smokers, or exclusive e-cigarette users. Early AMD was assessed through standardized ophthalmologic examinations conducted by trained ophthalmologists. Biomarkers of nicotine exposure (urinary cotinine), systemic inflammation (hsCRP), and oxidative stress (vitamin E) were compared across groups. Survey-weighted logistic regression evaluated associations with early AMD. Exclusive e-cigarette users had markedly higher nicotine exposure than non-smokers (P < 0.001). Both former smokers and exclusive e-cigarette users showed higher log-transformed hsCRP than non-smokers (both P < 0.01), whereas vitamin E did not differ significantly. In adjusted models, exclusive e-cigarette use was not significantly associated with early AMD (AOR = 1.25; 95

Purpose To evaluate the effect of topical 0.1% tacrolimus on corneal neovascularization (CoNV) and compare its efficacy with 1% prednisolone acetate. Methods In this prospective, multicenter, evaluator-masked, randomized study, patients with CoNV were randomized to 0.1% tacrolimus or 1% prednisolone acetate. Eye drops were administered four times daily for 4 weeks, then twice daily for an additional 4 weeks. Clinical assessments included CoNV grade, visual acuity, intraocular pressure, and ocular surface staining scores. A linear mixed model was used to evaluate treatment effects. Results Forty-six patients (tacrolimus group, n = 24; prednisolone group, n = 22) were analyzed. Most baseline characteristics were comparable between groups, except for endothelial cell density, which was significantly lower in the tacrolimus group (P = 0.040). In both groups, CoNV grade decreased significantly from baseline to week 4 (tacrolimus group: 2.025 ± 0.162 to 1.733 ± 0.162, P = 0.003; prednisolone group: 1.852 ± 0.168 to 1.625 ± 0.168, P = 0.035), with no significant between-group difference (P = 0.688). No significant change in CoNV grade was observed from week 4 to week 8 in either group. Over the 8-week period, significant within-group decrease in CoNV grade was observed in the tacrolimus group only (2.025 ± 0.162 to 1.697 ± 0.164, P = 0.019). Conclusion Both 0.1% tacrolimus and 1% prednisolone acetate reduced CoNV during the first 4 weeks. The sustained reduction in CoNV through 8 weeks in the tacrolimus group suggests its potential as an alternative or adjunctive therapy for CoNV, warranting further investigation.

PurposeTo examine recent nationwide trends in cataract surgeries and laser peripheral iridotomy (LPI) in Korea, and to assess their temporal association and patient-level characteristics influencing procedure patterns.MethodsThis retrospective cohort study used data from the Korean National Health Information Database. Individuals aged 65 years and older who underwent cataract surgery or LPI between 2016 and 2021 were analyzed. Primary outcomes included the annual volumes of cataract surgeries and LPIs, their temporal association, patient demographics, the proportion of LPI patients subsequently undergoing cataract surgery, and the interval to surgery.ResultsCataract surgeries increased annually until 2019, declined in 2020, and rose again in 2021, whereas LPI procedures steadily decreased after 2017. A negative correlation was observed between annual cataract surgeries and LPIs (r = -0.657, P = 0.156), although not statistically significant. Among patients aged 65-74 years, the correlation was significant (r = -0.943, P = 0.005). Among those who underwent LPI, 92.1% subsequently received cataract surgery, with a median interval of 121 days between procedures.ConclusionThis nationwide study demonstrated a temporal association and demographic characteristics underlying the recent increase in cataract surgeries and the concurrent decline in LPI procedures in Korea. Notably, most patients who underwent LPI subsequently received cataract surgery within a relatively short interval, suggesting a possible clinical shift toward earlier lens extraction in the management of angle closure.

Purpose:To evaluate the use of mechanical pupil dilation and capsule staining, and the rate of posterior capsule rupture (PCR) and cystoid macular edema (CME) in illuminated chopper-assisted cataract surgery. Methods:One university hospital, retrospective non-randomized consecutive case series. Six hundred forty-eight eyes of 648 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. The use of iris hooks and capsule staining, pupil size, operation time, and complications (PCR and CME) were evaluated. Results:In 39 of the 648 eyes (6.02%), the red reflex was insufficient for safe cataract surgery. Of 39 eyes, iris hooks and capsule staining were used in 7 (17.9%) and 1 (2.56%), respectively, while even without any iris hooks or capsule staining, illuminated chopper-assisted capsulorhexis was safely performed in 31 (79.5%) eyes. The rates of PCR and clinically significant CME were 0% (0/648 eyes) and 4.1% (26/648 eyes), respectively. Conclusions:Not only the use of mechanical pupil dilation and capsule staining but also PCR were very low in illuminated chopper-assisted cataract surgery.

Both diquafosol and rebamipide improve signs and symptoms of dry eye disease (DED), but no clinical study has directly compared their immediate effects. This study compared the 30-min therapeutic and mucin-secreting effects of 3% diquafosol (DQS) and 2% rebamipide (REB). In this prospective, randomized, double-blinded study, 30 DED patients received DQS in one eye and REB in the fellow eye. Visual analog scale (VAS) score, tear break-up time (TBUT), ocular staining score (OSS), lipid layer thickness, corneal sensitivity, tear meniscus height, and tear levels of MUC5AC and MUC1 were measured before and 30 min after instillation. The mean age was 34.8 ± 13.8 years, and 23 patients were female. Both treatments significantly improved VAS score and TBUT at 30 min (all P < 0.05). VAS score improvement was greater with DQS than REB (P = 0.03), whereas TBUT changes were comparable (P = 0.141). Tear MUC5AC levels significantly increased after both treatments (both P ≤ 0.001), while MUC1 levels remained unchanged (P = 0.377/0.262). Changes in MUC5AC were similar between groups (P = 0.254). Overall, DQS and REB showed comparable early clinical benefits 30 min after instillation in DED, including symptom relief, improved tear film stability, and increased tear MUC5AC.

Background/Objectives: The aim of this study was to compare the efficacy of correcting myopia and myopic astigmatism between small incision lenticule extraction (SMILE) surgery performed using VisuMax 500 and that using VisuMax 800. Methods: Patients who underwent myopia correction using either VisuMax 500 (493 eyes of 249 patients) or VisuMax 800 (169 eyes of 85 patients) employing the nomogram of VisuMax 500 were enrolled in this retrospective case–control study. At 2 months after the operation, the percentage of eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 and residual refractive error were compared between the two groups. Additionally, the percentage of eyes with refractive astigmatism angle of error within ±15° and the mean absolute angle of error were analyzed. Results: In the VisuMax 500 and 800 groups, 99% and 97% of eyes achieved a postoperative UDVA of 20/20, respectively. Postoperative residual astigmatism was similar between the two groups, but residual myopia was significantly lower in the VisuMax 800 group (−0.09 ± 0.50 cylinder diopters [CD]) compared to the VisuMax 500 group (−0.21 ± 0.49 CD; p-value = 0.005). Additionally, 84% of eyes in the VisuMax 800 group achieved astigmatism correction within ±15° of the intended meridian, significantly outperforming the 71% in the VisuMax 500 group (p-value = 0.002), with a significantly smaller mean absolute angle of error (8.3 ± 12.2° and 14.1 ± 20.1°; p-value < 0.001). Conclusions: Both VisuMax 500 and VisuMax 800 effectively corrected myopia. However, in terms of the accuracy of astigmatism axis correction, VisuMax 800 demonstrated superior precision compared to VisuMax 500. This study may be limited by perceived bias associated with evaluating two platforms from the same manufacturer.

Zebrafish are widely used to investigate visual function, owing to their well-defined retinal organization and optical transparency during early developmental stages. Here, we evaluate the effectiveness of a color vision optomotor response (CV-OMR) assay for assessing zebrafish with red cone ablation. Tg (thrb:gal4;UAS:epNTR-p2a-mCherry) transgenic zebrafish were used to ablate red cones via the addition of metronidazole (MTZ). Transgenic zebrafish larvae were treated with MTZ for 0, 12 and 24 h at 5 days post-fertilization, resulting in Tg(+)MTZ(-), Tg(+)MTZ(+)12 h and Tg(+)MTZ(+)24 h groups, respectively. The areas of mCherry-expressing cells, representing red cones in tissue sections, were compared. The mean mCherry expression area was smallest in the Tg(+)MTZ(+)24 h group (16.5 ± 7.6 μm2), followed by the Tg(+)MTZ(+)12 h (404.1 ± 200.9 μm2) and Tg(+)MTZ(-) groups (1,066.6 ± 252.2 μm2; P < 0.001). At 6 days post-fertilization, zebrafish larvae were evaluated using the CV-OMR assay comprising two colors. Results were reported as the area under the curve of the ratio of larvae at the starting point curve. The ratio of larvae at the starting point decreased most rapidly in the Tg(+)MTZ(-) group and most slowly in the Tg(+)MTZ(+)24 h group. There were significant differences in the area under the curve of the ratio of larvae at the starting point curve among the three groups. In conclusion, the CV-OMR assay demonstrated the ability to differentiate color vision impairment based on the extent of red cone ablation. The CV-OMR assay used in this study may prove valuable for evaluating color vision in zebrafish with various eye diseases.

The purpose of this study was to compare preoperative anxiety and intraoperative pain between the first and second cataract surgeries in patients who underwent immediate sequential bilateral cataract surgery (ISBCS). This retrospective study was conducted between June 20, 2023, and September 20, 2023, at Korea University Guro Hospital. A total of 170 cataract surgeries was included, and 130 eyes underwent ISBCS. Clinical records, including patients’ intraoperative pain score (visual analog scale [VAS] for pain, 1–10 points) and patients’ preoperative anxiety score (VAS for anxiety (VASA), 1–10 points), were investigated. Also, correlations between clinical factors and pain scores were analyzed. The pain score did not significantly differ between the first and second surgeries in ISBCS patients (2.51 ± 1.16 vs. 2.43 ± 1.36 points) (P = 0.692). However, the anxiety score recorded before the second eye surgery was significantly lower compared to that recorded before the first eye surgery. (3.32 ± 1.68 vs. 2.31 ± 1.29 points) (P < 0.001). Among the clinical factors, only the anxiety score was significantly correlated with the pain score (P = 0.013). We suggest ISBCS may serve as a beneficial strategy for a better surgery experience, reducing patients’ anxiety during surgery.

Background/Aims: To investigate the effectiveness of re-esterified triglyceride form of omega 3 (rTG-omega 3) on patients with meibomian gland dysfunction (MGD) after cataract surgery.Methods: This multicenter, randomized, investigator-blinded, clinical study was conducted between June 2021 and March 2023 and enrolled 107 patients with MGD who had undergone cataract surgery within 3 months at seven sites across South Korea. Patients were randomly assigned to rTG-omega 3 group or a control group. We compared (1) tear film break-up time (TBUT) (s), (2) corneal fluorescein staining score [National Eye Institute/Industry (NEI) scale], (3) conjunctival fluorescein staining score (NEI scale), (4) strip meniscometry (SM) tube score (mm), (5) MGD stage, (6) MG quality, (7) MG expressibility, (8) Standard Patient Evaluation of Eye Dryness (SPEED) score, and (9) Ocular Surface Disease Index (OSDI) scores at baseline and 6 and 12 weeks.Results: TBUT, corneal fluorescein staining score, and SM tube score were significantly improved in the rTG-omega 3 group compared with control group (P = 0.005, P = 0.003, and P = 0.0049, respectively). Subjective questionnaire responses were also improved significantly (SPEED score, P = 0.022; OSDI score, P = 0.0011). MGD parameters were not significantly different. However, during subanalysis, significant improvements in MG quality and expressibility were observed in the MGD stage 4 group with rTG-omega 3 supplementation (P = 0.0177 and P = 0.0205, respectively).Discussion: rTG-omega 3 supplementation facilitated improvements in both objective and subjective parameters. In particular, MG quality and expressibility were significantly improved in the severe MGD group.

Meibomian gland dysfunction (MGD) has traditionally been explained by the ductal-centric hypothesis, which attributes disease progression to ductal obstruction and secondary acinar atrophy. However, this model does not fully account for all clinical and pathological features. Recognizing these limitations, the meibocyte-centric hypothesis has emerged, proposing that intrinsic meibocyte dysfunction and acinar degeneration may play a primary role. In this context, this narrative review incorporates selected original data from animal models to contrast the ductal-centric and meibocyte-centric hypotheses, and synthesizes current concepts of MGD pathogenesis through a comprehensive literature review. In particular, two models illustrated how ductal blockage and meibocyte injury differentially affect gland morphology. Experimental findings supporting the ductal-centric hypothesis include ductal obstruction and orifice blockage leading to secondary acinar degeneration. Observations such as gland dropout without obstruction and lid margin dimpling are not fully explained by this model. In contrast, experimental studies demonstrate that meibocyte damage leads to gland dysfunction without ductal dilatation, highlighting intrinsic cellular pathology as a complementary driver to the traditional obstruction model. In addition, immune-mediated processes are increasingly recognized as a distinct pathogenic axis that interacts with both ductal and acinar pathways. This evolving perspective carries important therapeutic implications, as current ductal-focused treatments may be insufficient to address acinar pathology. Future approaches should target both ductal and acinar compartments, with emphasis on restoring meibocyte function, modulating immune pathways, and promoting glandular regeneration.

Intraocular Lenses (IOLs) have revolutionized cataract surgery, evolving from simple monofocal designs to advanced multifocal technologies that aim to reduce dependence on glasses after surgery. However, multifocal IOLs remain one of the most debated topics in ophthalmology, with passionate advocates and critics. This controversy stems from the balance between their potential benefits and limitations. The Asia-Pacific Academy of Professors of Ophthalmology (AAPPO) formed an international panel of 25 experts from 14 countries/territories who prepared and voted on consensus statements in twelve key areas: (1) the concept of multifocality; (2) refractive vs diffractive designs; (3) blur and haloes; (4) dysphotopsia; (5) understanding diffractive IOL designs; (6) neuroadaptation; (7) factors that may affect the success of multifocal IOLs; (8) alternatives to multifocal IOLs; (9) extended depth of focus IOLs; (10) other considerations; (11) newer IOL designs; (12) future considerations. Among the 47 consensus statements, 46 (97.8%) have achieved over 75% agreement. These statements can provide a practical guide for ophthalmologists to provide the optimal care of patients when multifocal IOL implantation is considered when performing cataract surgery or refractive lensectomy.

Purpose: To investigate the impact of the distance from the most-anterior surface of the optic to the principal object plane (POP) and from the foremost haptic to the principal object plane (H-POP) on the intraocular lens (IOL) power calculation. Setting: A tertiary hospital. Design: Optical simulation and retrospective cross-sectional study. Methods: The optical simulation study plotted changes in the POP and H-POP as a function of IOL power using ICB00 IOL configuration data. The clinical study included 102 eyes of 102 patients implanted with ICB00 IOL to examine the correlation between changes in both the POP and the H-POP, and the prediction error calculated using the Barrett Universal II formula with varying IOL power. Results: The ICB00 IOL showed minor fluctuations in the POP (0.21 mm to 0.30 mm) with changing IOL power. The H-POP increased stepwise from 5.0 D, peaking at 0.60 mm at 16.0 D, then decreased to a minimum of 0.14 mm at 34.0 D. The prediction error graph primarily mirrored the pattern of changes in the H-POP rather than the POP with varying IOL power. Linear regression showed a significant myopic shift in prediction error as IOL power increased beyond 16.0 D (Y = –0.069X+1.420, R2=0.178, p<0.001). Conclusion: For the ICB00 IOL, the H-POP has more impact on IOL power calculation than the POP itself. For more accurate IOL power calculations, it is essential for all IOL manufacturers to provide comprehensive information on both optic and haptic geometries, which will enable the precise calculation of H-POP.

Contact lenses are widely used not only for vision correction but also for various other purposes, and their global usage continues to increase steadily. However, contact lens wear carries the risk of several complications, among which microbial keratitis is a serious condition that can lead to significant visual impairment. Contact lens wearers are reported to have up to an 80-fold higher risk of developing microbial keratitis compared to non-wearers, with Pseudomonas aeruginosa being the most commonly identified pathogen. Infections caused by non-bacterial organisms such as fungi and Acanthamoeba are also not uncommon. The risk of infection is closely related to factors such as lens material, wearing habits, and hygiene practices. Early diagnosis and pathogen-specific treatment are critical in determining the prognosis. In recent years, increasing antibiotic resistance, the emergence of novel infectious diseases, and changes in climate and environmental conditions have complicated the etiology and treatment of microbial keratitis, demanding more effective responses. Education on proper lens care and hygiene remains the most essential preventive measure, and prompt diagnosis followed by appropriate treatment is vital when infection occurs. In addition to conventional antibiotic therapy, new treatment modalities such as corneal cross-linking and rose bengal photodynamic antimicrobial therapy are being explored clinically, warranting further research and the establishment of standardized guidelines. This review aims to provide a comprehensive overview of the epidemiology, pathophysiology, causative organisms, diagnostic approaches, treatment strategies, and emerging therapies for contact lens-related microbial keratitis.

To investigate visual outcomes and optical performance of a new non-constant aberration aspheric monofocal intraocular lens (IOL). This study included consecutive patients who underwent phacoemulsification with implantation of either the CT LUCIA® 621P intraocular lens (Carl Zeiss Meditec AG, Jena, Germany; 32 eyes, 25 patients) or the Tecnis® ZCB00 intraocular lens (Johnson & Johnson Vision, Santa Ana, CA, USA; 38 eyes, 27 patients). Monocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), uncorrected intermediate visual acuity (UIVA), and objective optical quality were measured 3 months after surgery. The optical bench test measured the root mean square of the modulation transfer function (MTTRMS) of each IOL at defocus levels between +1.00 D and −2.50 D at intervals of 0.25 D at varying pupil sizes (2.0–5.0 mm) in 1.0 mm steps. There was no difference in UDVA, UNVA, and objective optical quality between CT LUCIA and ZCB00 groups. On the other hand, UIVA was higher in the CT LUCIA group (0.19 ± 0.12 logMAR) compared to the ZCB00 group (0.32 ± 0.05 logMAR; p < 0.001). For all tested pupil sizes, the MTFRMS values for both CT LUCIA and ZCB00 IOLs were similar across defocus ranges from +1.00 to −0.75 D. However, the CT LUCIA IOL consistently exhibited higher MTFRMS values than the ZCB00 IOL at defocus levels from −1.25 to − 2.50 D. The CT LUCIA IOL provides comparable distance visual acuity and optical quality to ZCB00 IOL, with superior performance at intermediate distances.

Purpose: To evaluate the effects of cataract surgery on postoperative dry eye in patients who had been treated for preoperative dry eye.Methods: This study was conducted retrospectively on 31 eyes who underwent cataract surgery at a single institution between January 2023 and August 2023. All patients were treated with warm compression, lid hygiene, and 0.1% a non-preservative fluorometholone for 4 weeks prior to the cataract surgery to manage preoperative dry eye. Symptom Assessment Questionnaire in Dry Eye (SANDE) score, tear film break-up time (TBUT), Schirmer test, corneal/conjunctival staining score (CSS/ConSS), and meibomian gland dysfunction stage were assessed pre- and post-operatively. Tear meniscus height, tear lipid layer thickness (LLT) using IDRA were also compared pre- and post-operatively.Results: The mean age of the patients was 71.4 ± 8.9 years, and there were 11 males. Before cataract surgery, the mean SANDE score, TBUT, and ConSS were 31.9 ± 35.5, 4.5 ± 1.3, and 0.5 ± 0.5, respectively, and they improved significantly after cataract surgery to 15.4 ± 22.1, 5.9 ± 1.1, and 0.1 ± 0.3, respectively (p = 0.007, < 0.001, < 0.001). Preoperative LLT was 58.4 ± 15.6 nm and decreased significantly to 48.1 ± 12.5 nm postoperatively (p < 0.001). Compared to women, men showed a greater improvement in the symptoms and signs of dry eye after surgery, and the tear secretion and LLT were significantly reduced in women compared to men after surgery. In addition, the group whose LLT decreased after surgery had a greater degree of meibomian gland atrophy before surgery compared to the group without such a decrease in LLT (p = 0.037).Conclusions: Preoperative treatment for dry eye improved the symptoms and signs of dry eye after cataract surgery. The effect of preoperative dry eye treatment was more pronounced in men.

PurposeTo analyze the latest annual trends in immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) among patients with bilateral cataracts in Korea, and to identify the factors influencing the choice of surgery and the outcomes associated with ISBCS and DSBCS.MethodsThis retrospective, nationwide cohort study included all patients aged 65 and older who were covered by the Korean National Health Insurance and underwent ISBCS or DSBCS from 2016 to 2021. The study recorded yearly numbers of ISBCS and DSBCS procedures, the interval between surgeries in DSBCS cases, patient demographics, types of implanted intraocular lenses (IOLs), and the incidence of cystoid macular edema and endophthalmitis following ISBCS or DSBCS.ResultsA total of 50 878 (7.2%) patients underwent ISBCS, and 658 609 (92.8%) patients underwent DSBCS. ISBCS cases more than doubled in 2020 (7902) from 2019 (3703) before increasing even more significantly in number in 2021 (33 645). Age, hospital size, ocular and systemic comorbidities, type of IOL, and calendar year were associated with receiving ISBCS. In 2020 alone, the incidence of postoperative endophthalmitis among ISBCS patients was significantly higher (1.39 per 1000 procedures) than among DSBCS patients (0.40 per 1000 procedures; P = 0.001).ConclusionThe number of patients undergoing ISBCS for bilateral cataracts increased annually, particularly after the onset of the COVID-19 pandemic in Korea in 2020. However, this significant rise in ISBCS also led to a surge in the incidence of postoperative endophthalmitis in 2020.