As the prevalence of myopia has recently increased, there is growing interest in interventions to slow myopia progression. The choroid, the rearmost and largest part of the uveal layer, is a tissue rich in blood vessels located between the retina and the sclera. Recent advancements in diagnostic equipment have enabled direct imaging of the choroid, leading to increased research on its role in both normal and pathological conditions. Regarding myopia, it has been reported that; 1) the choroidal thickness decreases as the degree of myopia and axial length increase, 2) in the case of moderate to high concentrations of atropine or orthokeratology lenses, which are known to slow myopic progression, choroidal thickening is accompanied from the early stages of application, and 3) the mechanism by which choroidal thickening slows myopia progression is also being actively investigated. As a result, the choroid is being recognized as a therapeutic target for developing new interventions to slow myopia progression. Additionally, the increase in choroidal thickness has been reported as a predictive factor for the subsequent myopia progression, suggesting its potential role as a biomarker for assessing the likelihood of future myopia progression.

Purpose: To report two cases of successful management of infectious corneal ulcer with temporary conjunctival flap.Case summary: Two patients with acute necrotic corneal ulcer with impending perforation were treated with conjunctival flap surgery, which was subsequently removed within 2 weeks. The inflammation subsided, the ulcer healed with mild to moderate corneal opacity, and the patients achieved improved visual acuity. Conclusions Temporary conjunctival flap can prevent corneal perforation and aid in accelerating wound healing in infectious corneal ulcer and may be an effective therapeutic alternative.

Purpose: To present a case of oculomotor nerve atrophy complicated by herpes zoster ophthalmicus (HZO).Case summary: A 68-year-old man with a history of type 2 diabetes and dyslipidemia complained of diplopia and deviation in left eye. On examination, visual acuity was 20/25 in right eye and 20/20 in left eye. Prism and alternate cover tests revealed right exotropia and hypertropia in the primary position. Examination of ductions and versions showed limitation of adduction and depression in the right eye. On detailed history taking, we found that his symptoms started after suffering HZO on right side about 2 years ago. He was prescribed antiviral agents from a dermatology clinic and was told that all symptoms would improve after medication so he didn't undergo an ophthalmologic examination at that time. Magnetic resonance imaging confirmed that diffuse atrophy of oculomotor nerve in cistern along with atrophic changes of medial rectus and inferior rectus muscles in right eye. A diagnosis of strabismus complicated by HZO-induced oculomotor nerve atrophy was done. Conclusions Ophthalmoplegia secondary to HZO may not be self-limiting and have a poor prognosis resulting in cranial nerve atrophy. A detailed imaging investigation of extraocular muscle and cranial nerves along with thorough history taking are required for proper diagnosis and better prognosis.

Purpose: To report a case of irreversible corneal endothelial cell damage associated with amantadine administration.Case summary: A 60-year-old female patient was referred with bilateral painless corneal edema. There was no history of ocular trauma or surgery. The was no sign of ocular surface inflammation, such as, conjunctival injection, either. At presentation, her best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/50 in the left eye. Review of the past medical history revealed that she had been diagnosed with Parkinson’s disease and had been taking amantadine (100 mg, twice a day) for 3 years. At 7 weeks after cessation of amantadine, corneal edema was resolved bilaterally and BCVA improved to 20/30 in the right eye and 20/20 in the left eye. However, specular microscopy showed low endothelial cell density (ECD) with 886 ± 297/mm2 in the right eye and 926 ± 374/mm2 in the left eye. At 4 months after cessation, there was no corneal edema and BCVA was 20/25 in the right eye and 20/20 in the left eye. However, ECD was low with 852 ± 249/mm2 in the right eye and 903 ± 332/mm2 in the left eye. Conclusions In cases with bilateral corneal edema without no obvious pathology, the history of medication, such as, amantadine, should be reviewed. Although cessation of amantadine can lead to improvement of corneal edema, irreversible damage of the corneal endothelial cells may remain. Serial evaluation of corneal endothelial cells is therefore recommended in patients with systemic amantadine administration.

Purpose: To evaluate the correlation between matrix metalloproteinase-9 (MMP-9) point-of-assay and clinical symptoms and signs of dry eye disease. Methods: We performed a retrospective study for patients diagnosed with dry eye. MMP-9 (InflammaDry) was performed on 235 patients. Patients were assessed using Schirmer test, corneal staining score, tear film breakup time (TBUT) and the Ocular Surface Disease Index (OSDI). Results: The score of Schirmer test was lower significantly in MMP-9 positive group than in MMP-9 negative group (for each 4.21 ± 5.80 mm, 5.96 ± 8.14 mm; p = 0.035). TBUT was shorter significantly in MMP-9 positive group than in MMP-9 negative group (for each 5.46 ± 4.06 s, 8.27 ± 4.75 s; p = 0.0008). The ratio of positive corneal stain (for each 83%, 31%) and OSDI even or greater than 13 (for each 80%, 75%) was significantly higher in MMP-9 positive group than in MMP-9 negative group (p = 0.00001, p = 0.0044). The value of MMP-9 point-of-care assay showed showed the negative correlation with Schirmer test (Rs = 0.383, p < 0.001), and TBUT (Rs = 0.310, p < 0.05), and showed the positive correlation with corneal staining score (Rs = 0.527, p < 0.001), OSDI (Rs = 0.510, p < 0.001). Conclusions MMP-9 point-of-assay accords with clinical symptoms and signs of Dry eye disease, and may be helpful in diagnosing Dry eye disease.

Purpose: To analyze changes in refractive error among elementary school children under the age of 13 who visited an outpatient clinic for eye examinations before and after the onset of the COVID-19 pandemic. Methods: A retrospective analysis of medical records was conducted to calculate the spherical equivalent refractive error of the right eye for 3,854 children aged 6 to 12 who attended our ophthalmology department from 2016 to 2023. We analyzed the average refractive error and myopia prevalence by year and subsequently performed a subgroup analysis by dividing the children into two age groups: 6-9 years old and 10-12 years old. To provide insight into long-term trends, data from 4,351 subjects aged 6-12 years from the 4th, 5th (2008-2012), and 7th (2016) Korea National Health and Nutrition Examination Surveys were also analyzed for reference. Results: The mean refractive error for subjects visiting our clinic throughout the study period was -1.51 ± 2.12 D. A trend of increasing myopic values in refractive error was observed from 2017 to 2021, with a more substantial change noted in 2020 compared to other years, though not reaching statistical significance. In the subgroup analysis, the change in refractive error for the 6-9-year-old group was more pronounced in 2020 but did not reach statistical significance, and no specific trend was identified in the 10-12-year-old group. Myopia prevalence exhibited a consistent increase since 2019 in the 6-9 age group, with a higher proportion of moderate myopia in 2020 compared to previous years. Conversely, no distinct trend was observed in the 10-12-year-old group. Conclusions Although statistical significance was not reached, it appears that the increase in indoor activities due to COVID-19 had an impact on the changes in refractive values for elementary school children, especially in the lower grades of elementary school in 2020.

Purpose: To report a case of suprasellar Rathke's cleft cyst accompanying visual field defect found in a patient complaining of decreased visual acuity after cataract surgery.Case Summary: A 62-year-old male patient who showed a best-corrected visual acuity (BCVA) of 0.6 after left eye cataract surgery visited our hospital two months after surgery with decreased vision. He showed a best corrected visual acuity of 0.2, did not have relative afferent pupillary defect, and there were no specific findings on fundus examination. In the full field perimetry test, partial visual field loss in superior temporal quadrants were found in both eyes, being more prominent in left eye. In ganglion cell layer measurements using optical coherence tomography, a symmetric thinning in the thickness of the nasal ganglion cell layer was observed in both eyes, which was consistent with the visual field test. It was discovered that a liquid solid mass with a diameter of 21 mm in the upper part of the pituitary gland was compressing the optic chiasm in orbit magnetic resonance imaging. The patient was then referred to neurosurgery for pituitary surgery using transsphenoidal approach and diagnosed with Rathke's cleft cyst on histopathologic examination. Three months after surgery, the BCVA has increased to 0.5 and the visual field test showed no scotoma. Conclusions We report a case that Rathke's cleft cyst above the sella turcica inducing visual disturbances, emphasizing the importance of early detection and treatment through neuroophthalmological evaluation in a patient presenting with unexplained visual impairment.

Rigid gas permeable (RGP) contact lenses are made of materials with excellent oxygen permeability and wettability, so they not only improve oxygen permeability compared to existing lenses, but also provide correction of refractive errors and improved vision in irregular corneas such as keratoconus. However, the hard material of the lens along with hypoxia and hypercapnia of the cornea caused by wearing RGP contact lenses cause various physiological changes in the cornea. Physiological changes in the cornea that may occur when wearing RGP contact lenses include mucin balls, decreased corneal epithelial thickness and increased size, decreased epithelial barrier function, corneal erosion and staining, decreased keratocyte density, decreased corneal sensitivity, and stromal opacities, contact lens‐induced peripheral ulcers, endothelial blebs, increased endothelial polymegethism, and changes in corneal shape. It is necessary to know the performance of the RGP contact lenses being prescribed, be aware of the physiological changes in the cornea caused by wearing RGP contact lenses, and provide the correct lens prescription along with appropriate education to the patient.

Scleral lenses lies on the sclera, not the cornea, and help to improve vision in cases of irregular cornea or ocular surface diseases, and to treat ocular surface diseases with moisture to the cornea. The fitting rate of scleral lenses is increasing due to improvements in scleral lens materials and advancements in anterior segment imaging equipment. In order to successfully fit scleral lenses, it needs to understand the structure and principles of scleral lenses and select appropriate patients. There is no absolute contraindication of scleral lenses, but regular follow‐up is recommended for patients who require caution.

Purpose: To compare the clinical outcomes of one-piece aspheric intraocular lens in the patient group with mild zonule weakness and control group.Method: Among the patients who underwent cataract surgery since 2017, 30 patients (average age of 68.26 ± 8.99 years, 14 men, 16 women) and 35 eyes were selected. Prior to surgery, information on LOCS staging, endothelial cell count, intraocular pressure, axial length, and corneal refractive index were analyzed retrospectively. The average follow-up period after surgery was 3 months. The absolute value of the difference between the spherical equivalent value and the target refractive value in the patient group and the control group at 1 month and 3 months after surgery was compared. Results: The absolute value of the difference in refractive value after 1 month in the patient group was found was 0.61 ± 0.41 Diopters and 0.51 ± 0.42 Diopters in the control group, showing no statistically significant difference (p > 0.05). After 3 months, the absolute value of the refractive value difference was 0.46 ± 0.27 Diopters in the patient group and 0.46 ± 0.32 Diopters in the control group, indicating no statistically significant difference (p > 0.05). Conclusions The one-piece aspheric intraocular lens enVista MX60 does not show statistically significant clinical difference in the difference between the postoperative refractive value and the target refractive value in the patient group, so it may be actively considered for use in the patient with mild zonule weakness.