Purpose: To derive the optimized intraocular lens (IOL) constants from automated and manifest refraction after cataract surgery in Korean patients, and to evaluate whether there is a difference in optimized IOL constants according to the refraction method. Methods: This retrospective multicenter cohort study enrolled 4,103 eyes of 4,103 patients who underwent phacoemulsification and in-the-bag IOL implantation at 18 institutes. Optimized IOL constants for the SRK/T, Holladay, Hoffer Q, and Haigis formulas were calculated via autorefraction or manifest refraction of samples using the same biometry and IOL. The IOL constants derived from autorefraction and manifest refraction were compared. Results: Of the 4,103 eyes, the majority (62.9%) were measured with an IOLMaster 500 followed by an IOLMaster 700 (15.2%). A total of 33 types of IOLs were used, and the Tecnis ZCB00 was the most frequently used (53.0%). There was no statistically significant difference in IOL constants derived from autorefraction and manifest refraction when IOL constants were optimized with a large number of study subjects. On the other hand, optimized IOL constants derived from autorefraction were significantly smaller than those from manifest refraction when the number of subjects was small. Conclusions It became possible to use the IOL constants optimized from Koreans to calculate the IOL power. However, if the IOL constant is optimized using autorefraction in a small sample group, the IOL constant tends to be small, which may lead to refractive error after surgery.

Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

Purpose: To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. Conclusions To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Purpose: To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. Methods: A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. Results: The largest percentage of respondents (39%) had <5 years of practical experience, and 40% had >11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. Conclusions This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.

Purpose: To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. Conclusions To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

Purpose: To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. Methods: A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. Results: The largest percentage of respondents (39%) had <5 years of practical experience, and 40% had >11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. Conclusions This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

PURPOSE: Anti-vascular endothelial growth factor (VEGF) agents have been used for the last 10 years, but their safety profile, including cytotoxicity against various ocular cells such as retinal pigment epithelial (RPE) cells, remains a serious concern. Safety studies of VEGF agents conducted to date have primarily relied on healthy RPE cells. In this study, we assessed the safety of three anti-VEGF agents, namely, ranibizumab, bevacizumab, and aflibercept, on senescent RPE cells. METHODS: Senescent human induced pluripotent stem cell-derived RPE cells were generated by continuous replication and confirmed with senescence biomarkers. The viability, proliferation, protein expression, and phagocytosis of the senescent RPE cells were characterized 3 days after anti-VEGF treatment with clinical doses of ranibizumab, bevacizumab, or aflibercept. RESULTS: Clinical doses of ranibizumab, bevacizumab, or aflibercept did not decrease the viability or alter proliferation of senescent RPE cells. In addition, the anti-VEGF agents did not induce additional senescence, impair the protein expression of zonula occludens-1 and RPE65, or reduce the phagocytosis capacity of senescent RPE cells. CONCLUSIONS: Clinical dosages of ranibizumab, bevacizumab, or aflibercept do not induce significant cytotoxicity in senescent RPE cells.
Aging ; Bevacizumab* ; Biomarkers ; Endothelial Growth Factors ; Epithelial Cells* ; Humans ; Phagocytosis ; Ranibizumab* ; Retinaldehyde* ; Vascular Endothelial Growth Factor A