Investigation of the Changes in Refractive Surgery Trends in Korea

PURPOSE: To evaluate changes in clinical practice in the field of refractive surgery in Korea over the past 10 years. METHODS: A survey consisting of 59 multiple-choice questions regarding the preferred types of refractive surgery, excimer laser machine, and presbyopia surgery was mailed to 742 members of the Korean Society of Cataract and Refractive Surgery in January 2016, and 50 members responded to the survey. These data were compared with the 2005 or 2007 survey results.

2012 Survey of KSCRS and KOS Member: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigated the current trends and changes in the field of cataract surgery in Korea. METHODS: The members of the Korean Society of Cataract and Refractive Surgery (KSCRS) and the members of the Korean Ophthalmological Society (KOS) participated in a survey on cataract surgery in 2012, the 16th survey, consisting of 108 multiple-choice questions, mailed in July 2013 to 301 KSCRS and KOS members. Sixty two (20.6%) members answered the questions. Current data were compared with previous surveys performed in 2006 and 2009. RESULTS: Most of the respondents (46%) were in the fourth decade, 43% in the fifth decade and 10% in the sixth decade of life. The duration of hospital stay had decreased annually and the use of topical anesthesia (69%) was the most preferred. Self-sealing wound construction was the main wound closure technique in phacoemulsification (72%). The most preferred intraocular lens (IOL) for cataract surgery was hydrophobic acrylic (76%) which showed an increasing trend. The implantation of phakic IOL was performed by 41% of the respondents and interest in the value added IOLs such as presbyopia IOL and toric IOL had increased annually. In addition, to minimize astigmatism following cataract surgery, several methods were performed according to the degree of astigmatism. However, there was little interest in new cataract surgery techniques such as femtosecond laser and many respondents were skeptical whether to adopt the femtosecond laser cataract surgery system. CONCLUSIONS: This survey summarized current trends and changes in the field of cataract surgery in Korea.

Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

PURPOSE: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. METHODS: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. RESULTS: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. CONCLUSIONS: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

Prevalence and Risk Factors of Dry Eye Syndrome in the Incheon Area

PURPOSE: To investigate the prevalence, clinical manifestations, and risk factors of dry eye syndrome (DES) among people over 50 years old in the Incheon area. METHODS: A cross-sectional prevalence study was performed on 462 people over 50 years old in Dong-gu, Incheon. DES was defined as the constant or frequent presence of symptoms of both dryness and irritation. Symptoms and past medical history were assessed by a survey. Eye examination included slit lamp examination, Schirmer test, and tear break-up time (T-BUT). Age, sex, living habits, systemic and eye diseases were also analyzed to determine the risk factors of DES. RESULTS: The prevalence of DES was 26.2%. The major symptoms were as follows in descending order: dryness (77.9%), tearing (75.2%), and sandiness (72.7%). An average of 12.1 +/- 6.0 mm in the Schirmer test and 6.7 +/- 2.4 seconds in the T-BUT were significantly different in the DES group from the normal group (p < 0.001). Variables such as age, sex, living habits, and eye diseases were not related to the diagnosis of DES, whereas diabetes was the only risk factor of DES with statistical significance (p = 0.03). CONCLUSIONS: In the present study, the prevalence of DES among people over 50 years old in the Incheon area was 26.2%. Schirmer test and T-BUT were considered to be helpful tools for the diagnosis of DES, and diabetes was a significant risk factor of DES.

2006 Survey for KSCRS Members: Current Trends in Refractive Surgery in Korea

PURPOSE: To investigate the current situation and future trends in the field of refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed on cataract and refractive surgery. The 2006 annual survey, consisting of 63 multiple-choice questions, was mailed in July 2007 to 298 KSCRS members. Forty-eight (16.1%) of the members responded to the survey. The current data were compared with those of previous annual surveys and with those of the USA. RESULTS: The society members in their forties accounted for the highest percentage (39%) of the respondents, and LASIK was the most common (50%) of the refractive surgeries. Among the possible complications that arise after refractive surgeries, the regression of corrected vision after PRK, and dry eye syndrome after LASIK accounted for the highest proportion. LASIK was preferred for patients with myopia less than -12 diopter, and phakic IOL was preferred for patients with myopia more than -12 diopter. Almost all of the respondents answered that the most promising refractive surgery is LASIK or phakic IOL. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.

Cataract and Refractive Surgery in ; a Survey of KSCRS Members From 1995~2006

PURPOSE: This purpose of this report was to study trends in cataract and refractive surgeries conducted during the past twelve years and to compare results to previous reports from the ASCRS and New Zealand (NZ) in order to forecast future medical services. METHODS: We surveyed members of the Korean Society of Cataract and Refractive Surgery (KSCRS) every year from 1995 to 2006, and studied changes in cataract and refractive surgeries (RS). RESULTS: The duration of hospitalization has been gradually decreasing to the point that a one day hospitalization following surgery has become common. The rate of topical anesthesia use has significantly increased since 1998. Sutureless incision methods are now commonly practiced. The use of acryl IOL as an optic material has been gradually increasing for cataract surgeries. KSCRS members showed an interest in the special intraocular lenses as multifocal IOL. While Excimer laser PRK was the most popular refractive surgery during the first stage, KSCRS members increasingly prefer LASIK to the Excimer laser PRK. Regression of the corrected visual acuity, dry eye, night halo, and flashes were the most common complications following refractive surgeries. Medical disputes related to PRK and LASIK have been gradually increasing throughout the study period. CONCLUSIONS: We confirm that the KSCRS practice styles for cataract and RS are similar to those of the ASCRS and NZ. We infer a world-wide trend from the comparison of these three societies.

2007 Survey for KSCRS Members: Current Trends in Refractive Surgery in Korea

PURPOSE: To investigate the current situation and future trends in the field of refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed on cataract and refractive surgery. The 2007 annual survey, consisting of 66 multiple-choice questions, was mailed in August 2008 to 336 KSCRS members. Fifty (14.9%) members answered. Current data were compared with those of previous annual survey and with those of the USA. RESULTS: The respondents in their forties accounted for the highest percentage (38%) of the subjects, and VISX S4 was the most popularly used (32%). The use of IntraLase femtosecond laser (AMO, USA) had increased. LASIK still accounted for the highest percentage (48%) of refractive surgeries. LASIK was preferred for myopia less than -8D, and phakic IOL was preferred for myopia more than -8D. Almost all the respondents answered that most promising refractive surgery is phakic IOL and the respondents who preferred LASIK decreased. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.

2006 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: To investigate the current situation and future trends in the field of cataract surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have conducted annual surveys on cataract and refractive surgery. The 2006 annual survey, consisting of 89 multiple-choice questions, was mailed in February 2007 to 289 KSCRS members. Sixty (20.7%) members answered the questions. Current data were compared with data of previous annual surveys and with data of surveys in the United States and Europe. RESULTS: Fifty-one percent of the respondents were in their fifties. The duration of hospital stays has decreased annually, and the use of topical anesthesia (53%) has not changed. Self-sealing wound construction was the main wound closure technique in phacoemulsification (52%). The implantation of phakic intraocular lenses (IOL) was performed on 50% of the respondents, and the preferred IOLs for small incision cataract surgery were acrylic (87%). Interest in the added value of IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract surgery in Korea.

2007 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigated the current situation and future trends in the field of cataract surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have conducted annual surveys regarding cataract and refractive surgery. The 2007 annual survey, consisting of 85 multiple-choice questions, was mailed in February 2008 to 301 KSCRS members. Sixty-two (20.6%) members answered the questions. Current data were compared with data from previous annual surveys and with surveys in the United States and Europe. RESULTS: Fifty-four percent of the respondents were over 50 years of age. The duration of hospital stay has decreased annually and the use of topical anesthesia (57%) has slightly increased. Self-sealing wound construction was the main wound closure technique in phacoemulsification (60%). The implantation of phakic intraocular lenses (IOL) was performed in 56% of the respondents and the most preferred IOL for small incision cataract surgery were acrylic (88%). Interest in the additional value of IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract surgery in Korea.

Development of Toxic Anterior Segment Syndrome Immediately after Uneventful Phaco Surgery

PURPOSE: We report on 15 cases of suspected toxic anterior segment syndrome after uneventful phaco surgery. METHODS: We retrospectively reviewed the charts of patients who had developed toxic anterior segment syndrome (TASS) after uneventful phacoemulsification for senile cataracts between April and December of 2005. Clinical features and all possible causes were investigated including irrigating solutions or drugs, surgical instruments or intraocular lenses, sterilization techniques for instruments, or any other accompanying disease. RESULTS: The patients consisted of 2 males and 13 females with an average age of 64.7+/-10.9 years. Five different surgeons had performed their phaco surgeries. No abnormal preoperative or operative findings were reported. Nevertheless, all 15 patients developed a moderate degree of corneal edema. Ordinary treatments were not helpful. We suspect that lack of sterilization resulted in the development of the syndrome, because after ethylene oxide gas sterilization was replaced with autoclaving, no such incidents have occurred. CONCLUSIONS: Toxic anterior segment syndrome requires special attention and thorough management, including sterilization of reused surgical instruments.

Refractive Surgery 2005 in Korea

PURPOSE: This study investigates the current situation and future trends in the field of refractive surgery in Korea. METHODS: Since 1995, members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been surveyed annually on cataract and refractive surgery. The 2005 annual survey, consisting of 63 multiple-choice questions, was mailed in June 2005 to 300 KSCRS members. Fifty-four (18.0%) members responded. Current data were compared with those of previous annual surveys and with data from the USA. RESULTS: The highest percentage of patients were in their forties (37%), and LASIK accounted for the highest percentage of refractive surgeries (81%). Of complications arising after refractive surgery, the degeneration of corrected vision after PRK and dry eye syndrome after LASIK accounted for the high proportions. LASIK was preferred for myopia less than -12 diopter, and phakic IOL was preferred for myopia greater than -12 diopter. Almost all respondents answered that the most promising refractive surgery is LASIK or phakic IOL. CONCLUSIONS: This survey summarized the current trends and changes in cataract and refractive surgery in Korea.

2005 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigates the current state of and future trends in the field of cataract surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have made annual surveys on cataract and refractive surgery. The 2005 annual survey, consisting of 76 multiple-choice questions, was mailed in February 2005 to 300 KSCRS members. Sixty-six (22.0%) members answered the questions. Current data were compared with those of previous annual surveys and with those of surveys in the United States. RESULTS: Forty-six percent of the respondents were in the fifth decade. The duration of hospital stay has decreased annually and the use of topical anesthesia (44%) did not change. Self sealing wound construction was the main wound closure technique in phacoemulsification (63%). The implantation of phakic IOL was performed by 38% of the respondents and the most preferred intraocular lenses for small incision cataract surgery were acrylic (79%). Interest in the value added IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract surgery in Korea.

The Complications after Intravitreal Injection of Triamcinolone Acetonide

PURPOSE: This study was performed to ascertain the complications including intraocular pressure (IOP) elevation and cataract progression, can possibly arise after 4.0 mg triamcinolone (TA) is injected into the vitreous cavity in the treatment of macular diseases, and to analyze the influential factors. METHODS: This retrospective study comprises 325 eyes of 289 patients followed for over 6 months. All patients had undergone an intravitreal TA injection between March 2004 and September 2005. Visual acuities and intraocular pressures had been measured preoperatively, and at 1 day, 7 days, 1, 3, 6, 12, and 18 months postoperatively. Likewise, changes in crystalline lenses were observed at the same periods. RESULTS: The maximum IOP was significantly increased compared with preoperative IOP (P<0.0001). The average pressure measured at 1, 3, 6, and 18 months postoperatvely, was significantly increased (P<0.05). IOP elevation was observed in 52 eyes (16%). This complication was improved after treatment in most cases, but 2 eyes (0.62%) required surgical repair. Cataract progression was observed at 56 eyes (21.50%); posterior subcapsular opacity accounted for the highest proportion (42 eyes, 16.1%) and 6 eyes (2.3%) required surgery. Younger age (P=0.005) and the presence of diabetes mellitus (P=0.035) were significantly associated with TA-induced IOP elevation and cataract progression, respectively. CONCLUSIONS: Although intravitreal TA injection is effective in treating macular diseases, careful consideration of complications such as IOP elevation and cataract progression and their related risk factors must be taken when choosing the proper treatment.

A Case of Plexiform Neurofibroma with Severe Ptosis and Proptosis

PURPOSE: We present a case of plexiform neurofibroma that extensively invaded cranial and temporal bone, eyelid, orbit and uveal tissues, showing signs of severe ptosis and proptosis and symptoms of headache and ocular pain. METHODS: A 24-year old woman visited our clinic with pain and progressive proptosis, which had persisted for 2 weeks. She had a history of congenital neurofibromatosis. There were multiple Cafe-au-lait spots on her extremities, trunk, and face. Also, she had severe ptosis in her upper left eyelid, proptosis, and a distorted and asymmetric facial form. The cornea was markedly edematous. An enhanced computed tomography scan revealed an uncertain circumscribed soft tissue mass with enlargement of the eyeball and orbit, coupled with sphenoid wing dysplasia and herniation of the dura mater into the orbit due to expansion and bony destruction of the superior orbital wall. Under general anesthesia, the patient underwent excision and histopathologic biopsy of intraocular neurofibroma through evisceration. RESULTS: The tumor had black-colored multilobular nodules whose dimensions were 1.5x1.2x0.4 cm. After a histopathologic examination, the tumor was determined to be a pigmentary hamartoma of the uvea. Based on the clinical and histologic findings, we diagnosed the patient with plexiform neurofibroma with type I neurofibromatosis.

Visual Improvement in High Myopic Amblyopic Adult Eyes following Phakic Anterior Chamber Intraocular Lens Implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H(R)) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1~5) numeric scale. RESULTS: The mean age of patients was 37.3+/-9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10+/-5.41 diopters (D). The postoperative mean refraction (SE) was -1.75+/-0.76 D at six months. The postoperative BCVA improved an average 3.92+/-1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.

Refractive Surgery 2004 in Korea

PURPOSE: This study investigates both the current situation and future trends in the field of refractive surgery in Korea. METHODS: Members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed regarding cataract and refractive surgery since 1995. The 2004 annual survey, which consisted of 58 multiple-choice questions, was mailed in May 2004 to 322 KSCRS members; fifty-four (16.8%) members responded. Data from the 2004 survey was compared with that of previous annual surveys and similar studies from the USA. RESULTS: The respondents indicated that patients in their forties accounted for the highest percentage (57%) of subjects, and LASIK accounted for the highest percentage (82%) of refractive surgeries. Degeneration of corrected vision, night halo, and glare accounted for a high proportion of the complications arising after refractive surgery. LASIK was the preferred method for treating myopia less than -12 diopters, while phakic IOL was preferred for myopia more than -12 diopters. Lastly, more respondents indicated that they had experienced legal problems associated with PRK or LASIK than the previous year. CONCLUSIONS: LASIK remains the refractive surgery procedure of choice, although wavefront-guided ablation is gaining in popularity. Approximately half of the respondents indicated they used MMC in their refractive surgeries.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

Epidemiologic Studies of Keratoplasty in Korea

PURPOSE: To report an epidemiologic study of keratoplasty in which we analyze basic data of corneal transplants and corneal donations in Korea. METHODS: From June 2004 through October 2004, questionnaires were distributed to 25 hospitals. The questionnaires were about the characteristics of patients registered in eye banks for keratoplasty from May 2001 to April 2003, and about the results of keratoplasties performed from May 2002 to April 2003. RESULTS: The leading corneal diseases in patients registered for keratoplasty were infectious keratitis (22.0%), trauma (21.0%), and pseudophakic and aphakic bullous keratopathy (13.8%), in that order. The leading indications in corneal recipients were: trauma (15.5%), pseudophakic and aphakic bullous keratopathy (13.7%), and infectious keratitis (10.7%), in that order. In 233 cases of keratoplasties, penetrating keratoplasty was performed in 229 cases (98.3%) and lamellar keratoplasty was performed in 4 cases (1.7%). The most common combined surgery was cataract extraction. Common causes of graft failure were rejection of donor cornea and infection. Imported donor corneas were used in sixty-one cases (26.2%) among the 233 total keratoplasties. CONCLUSIONS: We constructed an epidemiologic data base of patients registered for keratoplasty, corneal donation, and the results of keratoplasties throughout Korea.

2004 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigates the current situation and future trends in the field of cataract and refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been surveyed annually on cataract and refractive surgery. The 2005 annual survey, consisting of 74 multiple-choice questions, was mailed in February 2005 to 364 KSCRS members. Seventy-six (20.8%) members answered. Current data were compared with those of previous annual surveys and with those of annual surveys of ASCRS (American Society of Cataract and Refractive Surgery) members. RESULTS: The duration of hospitalization has decreased annually and the use of topical anesthesia (49%) has hemained stationary. Self sealing wound construction was the main wound closure technique in phacoemulsification (66%). Acrylic intraocular lenses are the most preferred (75%) for small incisioncataract surgery. The implantation of phakic IOL was performed by 30% of respondents and interests in the value added by IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.

A Case of Congenital Corneal Keloid

PURPOSE: To describe a case of unilateral corneal keloid and present the clinical and histopathological findings and the management. METHODS: A 23-year-old Asian male patient was examined for a white spot on the left cornea that had been present since birth. On biomicroscopic examination, a well-demarcated vascularized corneal mass was found located nasal to the center. The pupil was displaced superiorly, and gonioscopic examination showed peripheral iridocorneal adhesion at 12 o'clock. The patient underwent penetrating keratoplasty. RESULTS: Histopathologic study showed a variously thickened epithelial layer, an absence of Bowman's layer, subepithelial fibrovascular hyperplasia, and an absence of dermal elements. These histopathologic findings suggested a congenital corneal keloid. The central graft cornea remained clear at 18 months after surgery and the patient was satisfied with the result. CONCLUSIONS: Penetrating keratoplasty may be an effective surgical option for congenital keloids in young adult patients.