Validation and Reliability of the Cataract-related Visual Function Questionnaire (CVFQ)

Purpose@#To evaluate the reliability and validity of the Cataract-related Visual Function Questionnaire (CVFQ). @*Methods@#A prospective cross-sectional study of 141 cataract patients was conducted from March 2022 to June 2022. The questionnaire was created based on a literature review and advice from an expert panel. This study determined its construct validity, criterion validity, internal consistency, and test-retest reliability. @*Results@#The CVFQ consists of 15 items distributed among five categories: overall visual quality, overall visual function, distance vision, near vision, and glare. In the exploratory factor analysis of validity, the first three principal components explained 77.8% of the variance. The p-values in the Spearman correlation test comparing the pre- and postoperative total CVFQ score and best-corrected visual acuity (BCVA) were 0.006 and 0.004, respectively. In the reliability analysis, Cronbach’s alpha was > 0.9 for internal consistency and the p-values of each subcategory were all significant in the analysis of test-retest reliability. @*Conclusions@#Our results indicate that the CVFQ is useful for measuring the visual quality and visual function of cataract patients in Korea.

Clinical Outcomes of Boston Type-I Keratoprosthesis Implantation: A 4-year Retrospective Study in South Korea

Purpose@#To evaluate the long-term results of Boston type-I keratoprosthesis implantation in Korea. @*Methods@#Medical records of six patients (six eyes) who underwent Boston type-I keratoprosthesis implantation between August 2018 and November 2019 were retrospectively reviewed for more than 36 months. @*Results@#The mean follow-up period was 44.3 ± 7.0 months. Best corrected visual acuity (BCVA) improved significantly for all six eyes, from 2.33 ± 0.51 logarithm of the minimum angle of resolution (logMAR) to 0.67 ± 0.59 logMAR. The vision recovered immediately after the surgery in all patients. Retroprosthetic membrane developed in three of the patients, but the visual acuity remained unchanged. Anatomical success was achieved in all six eyes after Boston type-I keratoprosthesis implantation. @*Conclusions@#The long-term analysis of Boston type-I keratoprosthesis implantation showed a faster recovery and improved visual acuity compared with conventional penetrating keratoplasty. Without the use of systemic immunosuppressants, all six eyes showed long-term survival of the Boston keratoprosthesis. Boston type-I keratoprosthesis implantation may be used in patients with recurrent graft failure after keratoplasty. This was the first study investigating the long-term results of Boston keratoprosthesis implantation in Korean patients.

Long-term Clinical Outcome of Refractive Corneal Inlays for Compensation of Presbyopia

Purpose@#To study the long-term efficacy and safety of Flexivue Microlens refractive corneal inlays in Koreans for compensation of presbyopia. @*Methods@#Flexivue Microlens inlays were implanted in nine eyes at Samsung Medical Center from October 2015 to February 2018. The follow-up period was 1.95 ± 0.6 years. Pre- and postoperative near/intermediate/distant visual acuity, spherical equivalent, contrast sensitivity, defocus curve, keratometry, and patient satisfaction were evaluated retrospectively. @*Results@#The uncorrected near visual acuity (UNVA) of the operated eye increased significantly to 0.27 ± 0.10 logarithm of the minimal angle resolution (logMAR) after 6 months (p = 0.012). At the last observation, it was 0.32 ± 0.21 logMAR, which improved compared to before surgery, but the difference was not significant (p = 0.127). The binocular UNVA improved significantly to 0.19 ± 0.78 logMAR at 6 months postoperatively (p = 0.017) and to 0.21 ± 0.13 logMAR at the last observation (p = 0.028). There was no difference in the binocular uncorrected distant visual acuity (UDVA) before and after surgery, but the UDVA of the operated eye decreased significantly to 0.38 ± 0.15 logMAR at 6 months postoperatively (p = 0.007) and to 0.32 ± 0.21 logMAR at the last observation (p = 0.012). Satisfaction with near vision improved significantly after surgery; 14.3% of the patients had a score of 4 (good) or higher and 42.9% did not require near-vision glasses. In one case, the inlay was removed after 17 months due to blurred vision. @*Conclusions@#The Flexivue Microlens has a low risk of complications and is a reversible technique. However, the near vision improvement was temporary and distance vision deteriorated. In addition, the Koreans examined had relatively low satisfaction and high spectacle dependence.

Astigmatism Correction during Femtosecond Laser-assisted Transepithelial Arcuate Keratotomy Using the Wound Open Method

Purpose@#The purpose of this study was to compare corneal astigmatism correction between “wound open” and “wound intact” methods during femtosecond laser-assisted transepithelial arcuate keratotomy. @*Methods@#From April 2016 to December 2018, a retrospective survey was conducted on patients undergoing femtosecond laser cataract surgery at the Ophthalmology Department of Samsung Medical Center. Size comparison and vector analysis of corneal astigmatism before and after surgery were performed in the wound open and wound intact groups. @*Results@#In the wound open and wound intact groups, the target-induced astigmatism (TIA) was 1.28 ± 0.55; and 1.26 ± 0.29 diopters, the surgically induced astigmatism (SIA) was 0.80 ± 0.52; and 0.53 ± 0.32 diopters, and the correction index (CI) was 0.63 ± 0.28; and 0.43 ± 0.26, respectively. The astigmatism correction was superior in the wound open group (p = 0.048, p = 0.025). In a subgroup with TIA 1.2 diopters, the SIA was 1.09 ± 0.59; and 0.54 ± 0.37 diopters and the CI was 0.60 ± 0.28; and 0.36 ± 0.23 in the wound open and wound intact groups, respectively (p = 0.022, p = 0.047). Thus, astigmatism correction was superior in the wound open group. @*Conclusions@#The wound open method during femtosecond laser-assisted transepithelial arcuate keratotomy was superior for astigmatism correction compared to the wound intact method.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Two Cases of Corneal Neovascularization Treatment Using High-frequency Radio Wave Electrosurgery

Purpose@#To report two cases of treatment using high-frequency radio wave electrosurgery for corneal neovascularization that recurred after medication and laser photocoagulation attempts.Case summary: (Case 1) A 53-year-old man visited our hospital complaining of corneal opacity. The best-corrected visual acuity in the left eye was 0.6. Lipid keratopathy indicated new inferior vessels. There was no significant change in corneal opacity after medication and laser photocoagulation; however, the recurrence of feeder vessels was observed. Therefore, electrocautery was performed via high-frequency radio wave electrosurgery. Visual acuity, measured 1 month later, improved to 0.9. Over the subsequent 4-year observation period, new vessels did not recur and the corneal opacity decreased gradually. (Case 2) A 23-year-old woman visited complaining of left eye pain. She had undergone laser photocoagulation three times for corneal new vessels. Visual acuity in her left eye was 0.4. Recurrence of new vessels at the upper cornea was observed, and electrocautery was performed. After 2 months, corneal opacity decreased without revascularization, and visual acuity improved to 0.5. @*Conclusions@#In patients with corneal neovascularization, electrocautery using high-frequency radio wave electrosurgery is simple and effective and can reduce corneal opacity and improve vision without complications.

Case Report of Brown McLean Syndrome

Purpose@#To report two rare cases of Brown McLean syndrome after cataract surgery in a patient with aphakia.Case summary: (Case 1) A 54-year-old woman with Marfan’s syndrome who had aphakia and peripheral corneal edema after left eye cataract surgery 4 years ago. The patient had an elevated lesion in the peripheral cornea without involving the central cornea, and had symptoms of pain, irritation and tearing. Specular microscopy showed normal endothelial cell density and morphology in the edematous cornea. The peripheral corneal edema improved after use of antibiotics, autoserum eyedrops and 5% NaCl eyedrops. (Case 2) A 61-year-old woman with aphakia in her left eye after bilateral cataract surgery 11 years ago, underwent surgery for a macular hole in both eyes. The patient developed peripheral corneal erosions and edema in the left eye 2 months after the surgery. Specular microscopy showed normal endothelial cell density and morphology. The peripheral corneal edema was static over the years while using 5% NaCl eyedrops and artificial tears, and did not progress to involve the central cornea. @*Conclusions@#Brown McLean syndrome is a rare disease but the possibility should be considered if a patient with aphakia after cataract surgery has peripheral corneal edema for several years.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Two Cases of Corneal Neovascularization Treatment Using High-frequency Radio Wave Electrosurgery

Purpose@#To report two cases of treatment using high-frequency radio wave electrosurgery for corneal neovascularization that recurred after medication and laser photocoagulation attempts.Case summary: (Case 1) A 53-year-old man visited our hospital complaining of corneal opacity. The best-corrected visual acuity in the left eye was 0.6. Lipid keratopathy indicated new inferior vessels. There was no significant change in corneal opacity after medication and laser photocoagulation; however, the recurrence of feeder vessels was observed. Therefore, electrocautery was performed via high-frequency radio wave electrosurgery. Visual acuity, measured 1 month later, improved to 0.9. Over the subsequent 4-year observation period, new vessels did not recur and the corneal opacity decreased gradually. (Case 2) A 23-year-old woman visited complaining of left eye pain. She had undergone laser photocoagulation three times for corneal new vessels. Visual acuity in her left eye was 0.4. Recurrence of new vessels at the upper cornea was observed, and electrocautery was performed. After 2 months, corneal opacity decreased without revascularization, and visual acuity improved to 0.5. @*Conclusions@#In patients with corneal neovascularization, electrocautery using high-frequency radio wave electrosurgery is simple and effective and can reduce corneal opacity and improve vision without complications.

Case Report of Brown McLean Syndrome

Purpose@#To report two rare cases of Brown McLean syndrome after cataract surgery in a patient with aphakia.Case summary: (Case 1) A 54-year-old woman with Marfan’s syndrome who had aphakia and peripheral corneal edema after left eye cataract surgery 4 years ago. The patient had an elevated lesion in the peripheral cornea without involving the central cornea, and had symptoms of pain, irritation and tearing. Specular microscopy showed normal endothelial cell density and morphology in the edematous cornea. The peripheral corneal edema improved after use of antibiotics, autoserum eyedrops and 5% NaCl eyedrops. (Case 2) A 61-year-old woman with aphakia in her left eye after bilateral cataract surgery 11 years ago, underwent surgery for a macular hole in both eyes. The patient developed peripheral corneal erosions and edema in the left eye 2 months after the surgery. Specular microscopy showed normal endothelial cell density and morphology. The peripheral corneal edema was static over the years while using 5% NaCl eyedrops and artificial tears, and did not progress to involve the central cornea. @*Conclusions@#Brown McLean syndrome is a rare disease but the possibility should be considered if a patient with aphakia after cataract surgery has peripheral corneal edema for several years.

Diagnostic Utility of Polymerase Chain Reaction for Acanthamoeba in Contact Lens-related Keratitis with Epithelial Defects

PURPOSE@#To report contact lens related Acanthamoeba keratitis with corneal epithelial defect cases which were diagnosed using polymerase chain reaction (PCR).CASE SUMMARY: A 51-year-old male visited our hospital for loss of visual acuity and ocular pain in both eyes. He had been wearing therapeutic contact lenses in both eyes for 4 days prior to his visit, and showed a corneal epithelial defect with corneal edema in both eyes. The corneal edema did not improve after treatment for bacterial and herpes keratitis, so we conducted PCR for Acanthamoeba using the aqueous fluid in the anterior chamber, which showed positive results. A 32-year-old male complained of low visual acuity and ocular pain in both eyes. He had a history of corneal erosion. He had been wearing therapeutic contact lenses in both eyes for 3 days prior to his visit for a corneal epithelial defect. We suspected recurrent corneal erosion syndrome, but PCR for Acanthamoeba of the corneal scraping showed positive results. A 26-year-old female visited our hospital for ocular pain, and discomfort in her left eye. Because of severe dry eye, she had been wearing therapeutic contact lenses for 6 weeks prior to her visit. Her left eye showed corneal infiltration and epithelial defects. The left cornea scraping was positive for bacteria, and PCR for Acanthamoeba also showed positive results.@*CONCLUSIONS@#Clinicians should consider the use of PCR for the early diagnosis of Acanthamoeba keratitis in contact lens-related keratitis with corneal epithelial defects.

Ocular Manifestations, Treatment Outcome and Clinical Course of Infective Keratitis of Keratitis-Ichthyosis-Deafness Syndrome

PURPOSE@#To report the ocular manifestations and treatment outcomes of infective keratitis in a patient with keratitis-ichthyosis-deafness (KID) syndrome and to report a newly discovered mutation in the GJB2 gene in Korea.CASE SUMMARY: A 32-month-old boy was referred to the Ophthalmology Clinic for bilateral corneal opacity and glare. The patient showed alopecia, hyperkeratotic skin in both limbs, and hearing loss in both ears. Ocular examination showed loss of eyebrows and eyelashes, hyperkeratotic lesions of the eyelids, mucopurulent discharge in the eyelids, and opacity and scarring with superficial vascularization and conjunctivalization in both corneas. Molecular analysis showed a pathogenic variant in the GJB2 gene and confirmed the diagnosis of KID syndrome. Superficial keratectomy and amniotic membrane transplantation were performed in both eyes. Corneal opacity recurred in the left eye; treatment with bevacizumab eyedrops was instituted and penetrating keratoplasty was performed in the left eye. Corneal stromal opacity relapsed in the left eye; 5% vancomycin and 5% ceftazidime eyedrops were started and methicillin-resistant Staphylococcus aureus was cultured from a corneal scraping specimen.@*CONCLUSIONS@#A careful observation of ocular manifestations in KID syndrome is needed to prevent infective keratitis and limbal cell deficiency; intensive antibiotic eyedrop treatment is recommended to prevent permanent visual impairment.

Bilateral Cataract after Taking Oxcarbazepine

PURPOSE: To report a case of bilateral posterior subcapsular cataract after taking oxcarbazepine (Trileptal®, Novartis, Basel, Swiss). CASE SUMMARY: A 19-year-old female visited our clinic with decreased vision in both eyes. Her best-corrected visual acuity was 0.3 in the right eye and 0.5 in the left eye, and slit-lamp examination revealed a bilateral cortical opacity and subcapsular cataract. She had been taking oxcarbazepine for epilepsy for 10 years, which was discontinued 3 years ago. Her mother had undergone cataract surgeries when she was approximately 46 years of age. No other risk factors for cataract were present. CONCLUSIONS: In the present case, bilateral cortical opacity and subcapsular cataract were assumed to be associated with the use of oxcarbazepine. We suggest that oxcarbazepine could induce a cataract and recommend a regular follow-up by a qualified ophthalmologist.

A Case of Corneal Dysplasia with Identification of POLH Gene Variants in Xeroderma Pigmentosum

PURPOSE: To discuss the clinical course and diagnosis of corneal dysplasia in a xeroderma pigmentosum patient based on a genetic evaluation. CASE SUMMARY: A 42-year-old female visited our clinic for decreased left visual acuity and corneal opacity. She had undergone several surgeries previously due to the presence of basosquamous carcinoma in the left lower eyelid, neurofibroma, and malignant melanoma of the facial skin. The patient showed repeated corneal surface problems, with a suspicious dendritic lesion; however, antiviral therapy was ineffective, and herpes simplex virus polymerase chain reaction results were negative. Despite regular follow-ups, the patient showed neovascularization around the corneal limbus and an irregular corneal surface. We performed corneal debridement with autologous serum eye drops for treatment. The patient's visual acuity and corneal surface improved after the procedure. The impression cytology result was corneal dysplasia. In whole exome sequencing, two pathogenic variants and one likely pathogenic variant of the POLH gene were detected. CONCLUSIONS: This is the first genetically identified xeroderma pigmentosum case with ophthalmological lesions of the eyelid and cornea in Korea. Debridement of the irregular corneal surface and autologous serum eye drop administration in xeroderma pigmentosum could be helpful for improving visual acuity.

Comparison of Efficacy and Sensation of Instillation between 0.05% Cyclosporine Nanoemulsion and Microemulsion Type

PURPOSE: To evaluate and compare the efficacy and sensation of instillation between 0.05% cyclosporine nanoemulsion group and microemulsion group. METHODS: This is a double-blind, prospective randomized clinical trial. Patients had 2 weeks of wash-out period before the study. They were randomly assigned to either nanoemulsion group or microemulsion group and treated with each group's cyclosporine eye drop. Artificial eye drop and topical steroid were used together according to severity of dryness of cornea. We checked every patient's Break-up time (BUT), Schirmer test, Staining Score and Ocular surface disease index (OSDI) on baseline, 1 month and 3 months after. Patients also self-checked frequency of use of artificial eye drop and topical steroid. Sensation of instillation was also checked. RESULTS: Both nanoemulsion eye-drop and microemulsion eye-drop improved BUT, Schirmer test, Staining Score and OSDI throughout 12 weeks. The nanoemulsion type reduced OSDI significantly compared to the microemulsion type. The mean frequency of use of artificial tear and topical steroid was similar in both groups. Foreign body sense score was higher in microemulsion group. CONCLUSIONS: 0.05% cyclosporine nanoemulsion type has simillar efficacy and subjectively less foreign body sensation.

Comparison of Intraocular Lens Power Calculation Methods Following Myopic Laser Refractive Surgery: New Options Using a Rotating Scheimpflug Camera

PURPOSE: To evaluate and compare published methods of calculating intraocular lens (IOL) power following myopic laser refractive surgery. METHODS: We performed a retrospective review of the medical records of 69 patients (69 eyes) who had undergone myopic laser refractive surgery previously and subsequently underwent cataract surgery at Samsung Medical Center in Seoul, South Korea from January 2010 to June 2016. None of the patients had pre-refractive surgery biometric data available. The Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug total corneal refractive power (TCRP) 3 and 4 mm (SRK-T and Haigis), Scheimpflug true net power, and Scheimpflug true refractive power (TRP) 3 mm, 4 mm, and 5 mm (SRK-T and Haigis) methods were employed. IOL power required for target refraction was back-calculated using stable post-cataract surgery manifest refraction, and implanted IOL power and formula accuracy were subsequently compared among calculation methods. RESULTS: Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug TCRP 4 mm (Haigis), Scheimpflug true net power 4 mm (Haigis), and Scheimpflug TRP 4 mm (Haigis) formulae showed high predictability, with mean arithmetic prediction errors and standard deviations of −0.25 ± 0.59, −0.05 ± 1.19, 0.00 ± 0.88, −0.26 ± 1.17, 0.00 ± 1.09, −0.71 ± 1.20, and 0.03 ± 1.25 diopters, respectively. CONCLUSIONS: Visual outcomes within 1.0 diopter of target refraction were achieved in 85% of eyes using the calculation methods listed above. Haigis-L, Barrett True-K (no history), and Scheimpflug TCRP 4 mm (Haigis) and TRP 4 mm (Haigis) methods showed comparably low prediction errors, despite the absence of historical patient information.

Lamina Cribrosa Changes after Laser In Situ Keratomileusis in Myopic Eyes

PURPOSE: To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS: Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS: Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS: The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.

Myopic Shift after Implantation of a Novel Diffractive Trifocal Intraocular Lens in Korean Eyes

PURPOSE: To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses (IOLs) in Koreans. METHODS: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVision IOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to −4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuity were assessed one month postoperatively, and manifest refraction was performed during every visit. RESULTS: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p < 0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to the target refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001). CONCLUSIONS: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediate vision in presbyopic eyes. POD FineVision IOLs show myopic shift in a Korean population; therefore, surgeons should be cautious when selecting IOL power in such patients.

The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification

PURPOSE: In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS: Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS: Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS: LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.

Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

PURPOSE: To assess the prevalence and the risk factors of dry eye disease after refractive surgery. METHODS: A retrospective study was performed on 180 eyes of 98 patients based on medical records. Those who had tear break-up time less of than 5 seconds or had an Oxford stain scale equal to or greater than 2 were defined to have dry eye disease. We analyzed the prevalence of dry eye, compared demographic and clinical features of the dry eye group and normal group, and found risk factors of dry eye after refractive surgery. RESULTS: The prevalence of postoperative dry eye was 62.2%. Compared to the normal eye group, the dry eye group had a significantly higher proportion of women (p = 0.016), older age (p = 0.001), and thin cornea (p = 0.002). The most significant risk factor of dry eye after refractive surgery was presence of dry eye before refractive surgery (odds ratio [OR] = 9.02, confidence interval [CI] = 3.8-21.4). Old age was also found to be an independent risk factor of dry eye after refractive surgery (OR = 1.06, CI = 1.01-1.11). CONCLUSIONS: The risk of dry eye after refractive surgery was increased in older age and preoperative dry eye disease. In order to prevent post-refractive surgery dry eye, caution should be exercised in middle aged patients with preoperative dry eye disease.