PURPOSE: To describe current cataract surgery practice patterns and changing trends among Korean ophthalmologists. METHODS: A survey of members of the Korean Society of Cataract and Refractive Surgery was performed in July 2018. One hundred and two (12.7%) of 801 questionnaires were returned for analysis. The data were analyzed using descriptive statistics and compared with previous surveys. RESULTS: Most of the respondents (75%) had been in practice for 6 or more years and performed an average of 31 cataract surgeries per month. The preferred method for cataract surgery was phacoemulsification (95%); 5% used a femtosecond laser. The use of topical anesthesia markedly increased from 69% (2012) to 80% (2018). The use of optical biometry exceeded that of ultrasound A-scan biometry. A multifocal intraocular lens was used by 76% of the respondents compared with 44% of the respondents in 2012. Topical nonsteroidal anti-inflammatory drugs were used by 70% of the respondents postoperatively. Most (59%) of these anti-inflammatory drugs were prescribed for 4 weeks. CONCLUSIONS: This survey provided a comprehensive update of the present cataract surgery practices in the Republic of Korea. The results emphasized the increasing use of premium intraocular lenses, optical biometry, and topical anesthesia.
Anesthesia ; Biometry ; Cataract ; Lenses, Intraocular ; Methods ; Phacoemulsification ; Refractive Surgical Procedures ; Republic of Korea ; Surveys and Questionnaires ; Ultrasonography

PURPOSE: To compare the new swept-source optical coherence tomography based IOL Master 700 to both the partial coherence interferometry based IOL Master 500 and ultrasound A-scan in terms of the ocular biometry and the prediction of postoperative refractive outcomes. METHODS: A total 67 eyes of 55 patients who received cataract surgery were included in our study. The axial length, anterior chamber depth, and keratometry were measured using IOL Master 700, IOL Master 500, and A-scan. The predictive errors, which are the differences between predictive refraction and post-operative refraction 1 month after surgery, were also compared. RESULTS: Axial length measurements were not successful in 5 eyes measured using IOL Master 700 and in 12 eyes measured using IOL Master 500. The mean absolute postoperative refraction predictive errors were 0.63 ± 0.50 diopters, 0.66 ± 0.51 diopters, and 0.62 ± 0.51 diopters for IOL Master 700, IOL Master 500, and A-scan, respectively, and these values exhibited no statistically significant differences. The mean axial lengths were 24.25 ± 2.41 mm, 24.24 ± 2.40 mm, and 24.22 ± 2.39 mm; the mean anterior chamber depths were 3.09 ± 0.39 mm, 3.17 ± 0.39 mm, and 3.15 ± 0.46 mm; and the mean keratometry values were 44.12 ± 1.82 diopters, 44.57 ± 2.10 diopters, and 43.98 ± 1.84 diopters for the IOL Master 700, IOL Master 500, and A-scan groups, respectively. None of these parameters showed statistically significant differences between the three groups. Regarding pair-wise comparison, there were significant differences between the IOL Master 700 and the other devices. CONCLUSIONS: The ocular biometric measurements measured using IOL Master 700, IOL Master 500, and A-scan showed no significant differences. However, IOL Master 700 demonstrated a superior ability to successfully take biometric measurements compared to IOL Master 500. Therefore, IOL Master 700 is capable of measuring ocular biometry for cataract surgery in clinical practice.
Anterior Chamber ; Biometry* ; Cataract ; Humans ; Interferometry ; Lenses, Intraocular ; Tomography, Optical Coherence ; Ultrasonography*

PURPOSE: To compare the measurement results and the accuracy of the predicted refractive error after cataract surgery among 3 ocular biometry devices; OA-2000®, IOL Master® and A-scan ultrasound in posterior subscapular cataracts. METHODS: Biometry measurements including axial length, anterior chamber depth and the keratometry of 80 cataractous eyes were measured using ultrasonography, OA-2000® and IOL Master®. To calculate the intraocular lens (IOL) power, the SRK/T formula was used and 3 months after cataract surgery, the refractive outcome was compared to the preoperatively predicted refractive error. RESULTS: The number of eyes measured by the 3 devices (A-scan, IOL Master® and OA-2000®) was 57 (group A) and the number of eyes measured by 2 devices (A-scan and OA-2000®) was 22 (group B). When cataract grading was performed based on the Lens Opacity Classification system III, the severity of posterior subscapular opacity was significantly different between the 2 groups (p = 0.001). Although no difference was observed in the measured biometry values including axial length, anterior chamber depth and keratometry in groups A and B, the predicted refractive error was significantly different in group B; OA-2000® showed a significantly higher accuracy in predicting IOL power than A-scan. CONCLUSIONS: In cataract patients whose posterior subscapular opacity is not severe, the accuracy for predicting refractive error after cataract surgery was not significantly different among the 3 devices included in our study (A-scan, IOL Master® and OA-2000®). However, in patients with severe posterior subscapular opacity, OA-2000®, that provides a Fourier domain light source-calculated predicted refractive error of IOL may be more accurate.
Anterior Chamber ; Biometry ; Cataract ; Classification ; Humans ; Interferometry* ; Lenses, Intraocular ; Refractive Errors ; Ultrasonography*

PURPOSE: To compare the clinical outcomes during phacoemulsification when using active fluidics (Centurion®) and gravity-based fluidics (Infiniti®) in immediate sequential bilateral cataract surgery. METHODS: From January 2015 to September 2015, 68 eyes of 34 patients with bilateral cataract were assigned to receive immediate sequential bilateral cataract surgery by Centurion® in one eye and Infiniti® in the other eye. We measured and compared intraoperative factors, including cumulative dissipated energy (CDE), ultrasound time, mean amount of balanced salt solution (BSS) used, and pain using a scale. Best corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were also evaluated preoperatively and 1 month postoperatively. RESULTS: Intraoperative measurements showed significantly less CDE (5.05 ± 2.18 vs. 7.05 ± 3.82), ultrasound time (24.65 ± 9.68 vs. 34.95 ± 17.95 seconds), and mean amount of BSS used (37.06 ± 10.25 vs. 44.88 ± 16.38 mL) in the Centurion® group than in the Infiniti® group (p = 0.011, p = 0.005, p = 0.021, respectively). The intraoperative pain scale was 0.26 ± 0.51 in the Centurion® group and 0.50 ± 0.71 in the Infiniti® group, and was not significantly different (p = 0.121). BCVA, increase of CCT and decrease of ECD were not significantly different between the two groups at 1 month postoperatively. CONCLUSIONS: The efficacy of phacoemulsification in the Centurion® group was superior to that in the Infiniti® group. The level of intraoperative pain and clinical outcomes 1 month after surgery were not significantly different between the two groups.
Cataract* ; Endothelial Cells ; Humans ; Phacoemulsification* ; Ultrasonography ; Visual Acuity

PURPOSE: To report the accuracy of intraocular lens (IOL) formulas according to axial length, anterior chamber depth, and mean corneal curvature when performing biometry with an immersion type A-scan with mannual keratomery and an IOL Master®. METHODS: Retrospective medical chart reviews were carried out for 82 eyes of 65 patients who underwent cataract surgery performed by a single surgeon. Biometry was performed using IOL Master®, mannual keratometry, and immersion type A-scan ultrasound in sequence. Prediction diopter was obtained using Sanders-Retzlaff-Kraff/Theoretical (SRK-T) and Holladay 1 formulas calculated with the biometric value measured by mannual keratomery and A-scan, and using SRK-T and, Holladay 2 formulas with IOL Master®. The final refractive outcome was determined as manifested refraction at least 7 weeks after the surgery, and it was compared with the preoperative prediction dipoter (D) of the IOL formulas. RESULTS: Mean axial length and mean keratomtric measurements as determined by A-scan with mannual keratomery showed significant statistical differences from those of IOL Master®. However, there was no difference in postoperative mean absolute error between biometric measurements, or among formulas according to axial length, anterior chamber depth, or mean corneal curvature. However, the percentage of actual refraction within ±0.50 D of the intended refraction was dirrerent among the four formalas according to axial length, anterior chamber dept, mean corneal curvature. CONCLUSIONS: Biometry measurement using the immersion-type A-scan with mannual keratomery is as accurate as that using IOL Master® for predicting the postoperative refractive state of cataract surgery. However, it is suggested that the best IOL formula be chosen according to axial length, anterior chamber depth, and mean corneal curvature.
Anterior Chamber ; Biometry ; Cataract ; Humans ; Immersion ; Interferometry* ; Lenses, Intraocular* ; Retrospective Studies ; Ultrasonography*

PURPOSE: To compare the incidence of posterior capsular opacification (PCO) based on low and high fluid-dynamic parameters during cataract surgery and evaluate the importance of these findings. METHODS: This retrospective study included 125 eyes in 73 patients with senile cataract who received a cataract surgery between September 2013 and March 2014. Patients were divided into 2 groups: those with low (vacuum: 180 mm Hg, aspiration flow: 18 mL/min, bottle height: 55 cm) and high (vacuum: 400 mm Hg, aspiration flow: 22 mL/min, bottle height: 90 cm) fluidic parameters during the nucleus was removal. We measured the total surgery time, ultrasound time, and balanced salt solution consumption during phacoemulsification. Best corrected visual acuity (BCVA), PCO score, PCO percentage and severity were measured at 3, 6 and 12 months postoperatively. Endothelial cell density (ECD) was measured preoperatively and 12 months postoperatively. RESULTS: The study included 20 eyes of 13 patients with low parameters and 20 eyes of 15 patients with high parameters. There was no statistically significant difference in the mean total surgery time, ultrasound time or fluid consumption between the two groups. BCVA and ECD were not significantly different between the two groups during the postoperative follow-up. PCO score, percentage and severity were higher in the low parameter group at 3, 6 and 12 months postoperatively. CONCLUSIONS: Surgery with low fluid-dynamic parameters is equally effective as with high parameters in terms of surgical time and postoperative BCVA. However, the incidence of PCO was higher in the low fluid-dynamic parameter group up to 12 months. Surgical efforts to reduce remnant lens epithelial cells are needed during low fluidic-dynamic parameter surgery.
Cataract ; Endothelial Cells ; Epithelial Cells ; Follow-Up Studies ; Humans ; Incidence* ; Operative Time ; Phacoemulsification ; Retrospective Studies ; Ultrasonography ; Visual Acuity

PURPOSE: To investigate the accuracy of intraocular lens power calculations using simulated keratometry (simK) of dual Scheimpflug analyzer and 5 types of formulas in cataract patients. METHODS: The keratometry (K), axial length (AXL) and anterior chamber depth (ACD) were measured using ultrasound biometry (USB) combined with auto-keratometry (Auto-K), parital coherence interferometry (PCI; IOL master®) and dual Scheimpflug analyzer (DSA; Galilei®) in 39 eyes of 39 patients. Predicted refraction was calculated using Auto-K, mean K of PCI, and simK and total corneal power (TCP) of DSA in the Sanders-Retzlaff-Kraff (SRK-T) formula. The SRK-II, SRK-T, Holladay II, Haigis, and Hoffer-Q formula were used to calculate predicted refraction with the simK of DSA and AXL of USB. Manifest refraction, mean numerical error (MNE) and mean absolute error were evaluated 1, 3 and 6 months after cataract surgery. RESULTS: TCP of DSA was lower compared with other keratometric values (p < 0.05). The MNE was not different among Auto-K, mean K and simK. The MNE using TCP was larger compared with Auto-K, mean K and simK at 1 month after surgery (p < 0.05). There was a difference in MNE between simK and TCP of DSA at 6 months after surgery (p < 0.05). The MNE of SRK-T formula was the smallest in the intraocular lens (IOL) power calculation using the simK of DSA. CONCLUSIONS: We suggest using IOL power calculations with simK of DSA and SRK-T formula rather than TCP of DSA in cataract patients with normal corneas.
Anterior Chamber ; Biometry ; Cataract ; Cornea ; Humans ; Interferometry ; Lenses, Intraocular* ; Ultrasonography

PURPOSE: To compare the measurement results of 3 ocular biometry devices, A-scan ultrasound and two types of partial coherence interferometers in normal and cataractous eyes. METHODS: This study included 42 normal eyes and 40 cataractous eye. Axial length and anterior chamber were measured using three ocular biometry measurements, ultrasonography (HiScan®, Optikon 2000, Rome, Italy), IOL Master® (Carl Zeiss, Jena, Germany), and AL-scan® (Nidek, Gamagori, Japan), and mean corneal curvature and corneal diameter were measured using two partial coherence interferometers. The results were compared in each group. RESULTS: Significant differences in measurements existed among the 3 ocular biometry devices (A-scan ultrasound, IOL Master® and AL-scan®) in normal eyes (p < 0.001) and cataractous eyes (p = 0.034). However, the measurements were not significantly different between the 2 partial coherence interferometers (IOL Master® and AL-scan®) in both groups. We confirmed lower agreement among the 3 ocular biometry devices in cataractous eyes compared with normal eyes in terms of a larger range of 95% agreement and error in cataractous eyes. CONCLUSIONS: Significant differences in measurements were observed when using the 3 ocular biometry devices in both normal and cataractous eyes. Because of low agreements between ocular biometry devices in cataractous eyes, complementing the measurements between ocular biometry devices is necessary when measuring cataractous eyes.
Anterior Chamber ; Biometry* ; Cataract ; Complement System Proteins ; Ultrasonography*

PURPOSE: To compare the effect of femtosecond laser-assisted cataract surgery with conventional cataract surgery on effective phacoemulsification time (EPT). METHODS: This study included 66 patients 100 eyes who underwent femtosecond laser-assisted cataract surgery and 68 patients 100 eyes who underwent conventional cataract surgery. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. The groups were further analyzed according to preoperative Lens opacities classification system (LOCS) III grading. Patients who had femtosecond laser-assisted cataract surgery underwent lens fragmentation with quadrant, hybrid, or grid pattern and the EPT was respectively evaluated. RESULTS: The mean EPT was 5.85 +/- 4.31 seconds in the femtosecond laser-assisted cataract surgery group and 10.34 +/- 6.61 seconds in the conventional group. Overall, EPT was statistically significantly lower in the femtosecond laser-assisted cataract surgery group compared to the conventional group. When the groups were analyzed according to LOCS III grading, this result was consistent for all cataract grades and the reduction in EPT was increased with the higher LOCS III grade. When the groups were analyzed according to lens fragmentation patterns, the mean EPT was lower with 350 microm grid pattern than the quadrant or hybrid pattern. CONCLUSIONS: The femtosecond laser-assisted system in cataract surgery can be an efficient cataract surgery using lower EPT compared to the conventional procedure. Additionally, significant differences were observed in the mean EPT of cataract surgery using the femtosecond laser-assisted system among the 3 lens fragmentation pattern groups.
Cataract* ; Classification ; Humans ; Phacoemulsification* ; Ultrasonography

PURPOSE: To investigate the safeness of cataract surgery in older subjects by comparing the outcomes among different age groups. METHODS: The present study included 150 patients (150 eyes) diagnosed with cataracts that visited the hospital from January 2014 to May 2015 and received phacoemulsification and intraocular lens implantation. The subjects were divided into 5 age groups (40-50, 50-60, 60-70, 70-80 and 80-90). Among the study subjects, 30 patients from each age group were measured for best corrected visual acuity (BCVA), and endothelial cell density (ECD) 2 months after surgery. Intraoperative ultrasound time, cumulative dissipated energy (CDE) and volume of balanced salt solution were also compared among the subjects. RESULTS: The nuclear sclerosis of cataracts before surgery was significantly lower in the 40-50 (2.85 ± 1.05), 50-60 (3.20 ± 0.81), and 60-70 age groups (3.39 ± 0.67) than the 70-80 (4.23 ± 0.68) and 80-90 age groups (4.47 ± 0.51). The CDE during surgery was significantly lower in the 40-50 (10.10 ± 3.20), 50-60 (11.20 ± 3.20) and 60-70 age groups (12.40 ± 3.50) than in the 70-80 (15.10 ± 3.80) and 80-90 age groups (16.70 ± 3.90; p < 0.05). BCVA was not significantly different among the age groups 2 months after surgery (p > 0.05). The reduction (%) of ECD 2 months after surgery was significantly lower in the 40-50 (17.94 ± 13.50), 50-60 (17.46 ± 9.08) and 60-70 age groups (19.12 ± 16.01) than in the 70-80 (26.36 ± 10.82) and 80-90 age groups (31.80 ± 16.86; p < 0.05). CONCLUSIONS: After cataract surgery, BCVA was not significantly different among the age groups. These findings indicate that cataract surgery using phacoemulsification in older patients is recommended and a viable option since it is relatively safe and provides excellent BCVA effects.
Cataract* ; Endothelial Cells ; Humans ; Lens Implantation, Intraocular ; Phacoemulsification ; Sclerosis ; Ultrasonography ; Visual Acuity