Purpose: To report the proportion of ocular involvement in primary Sjögren syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. Methods: This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear breakup time (TBUT), meibomian gland dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro, anti-La, and antinuclear antibodies, rheumatoid factor, erythrocyte sedation rate, and C-reactive protein were included as systemic serum titers of markers. Patients with (group 1) and without (group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Results: Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (73.7%) in group 1 and 31 (26.3%) in group 2. Group 1 showed higher meibum quality scores (p = 0.016), meibum expressibility (p = 0.010), and lid margin abnormalities on the lower lid (p = 0.029) and lower TBUT (p = 0.016) than group 2. OSS, TBUT, and the Schirmer test statistically differed (p < 0.001, p = 0.041, and p = 0043, respectively) between the patients who satisfied both ocular criteria (n = 46) and those who satisfied only one criterion (n = 41). There were no statistical differences in serum titers of markers between the two groups. Conclusions About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 73.7%, and half of these patients met both ocular criteria. Only anti-Ro antibodies negatively correlated with TBUT. Also, OSS, TBUT, and Schirmer test were statistically different between the two subgroups.

Purpose: To report the proportion of ocular involvement in primary Sjögren syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. Methods: This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear breakup time (TBUT), meibomian gland dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro, anti-La, and antinuclear antibodies, rheumatoid factor, erythrocyte sedation rate, and C-reactive protein were included as systemic serum titers of markers. Patients with (group 1) and without (group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Results: Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (73.7%) in group 1 and 31 (26.3%) in group 2. Group 1 showed higher meibum quality scores (p = 0.016), meibum expressibility (p = 0.010), and lid margin abnormalities on the lower lid (p = 0.029) and lower TBUT (p = 0.016) than group 2. OSS, TBUT, and the Schirmer test statistically differed (p < 0.001, p = 0.041, and p = 0043, respectively) between the patients who satisfied both ocular criteria (n = 46) and those who satisfied only one criterion (n = 41). There were no statistical differences in serum titers of markers between the two groups. Conclusions About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 73.7%, and half of these patients met both ocular criteria. Only anti-Ro antibodies negatively correlated with TBUT. Also, OSS, TBUT, and Schirmer test were statistically different between the two subgroups.

Purpose: To report the proportion of ocular involvement in primary Sjögren syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. Methods: This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear breakup time (TBUT), meibomian gland dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro, anti-La, and antinuclear antibodies, rheumatoid factor, erythrocyte sedation rate, and C-reactive protein were included as systemic serum titers of markers. Patients with (group 1) and without (group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Results: Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (73.7%) in group 1 and 31 (26.3%) in group 2. Group 1 showed higher meibum quality scores (p = 0.016), meibum expressibility (p = 0.010), and lid margin abnormalities on the lower lid (p = 0.029) and lower TBUT (p = 0.016) than group 2. OSS, TBUT, and the Schirmer test statistically differed (p < 0.001, p = 0.041, and p = 0043, respectively) between the patients who satisfied both ocular criteria (n = 46) and those who satisfied only one criterion (n = 41). There were no statistical differences in serum titers of markers between the two groups. Conclusions About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 73.7%, and half of these patients met both ocular criteria. Only anti-Ro antibodies negatively correlated with TBUT. Also, OSS, TBUT, and Schirmer test were statistically different between the two subgroups.

Purpose: To report the proportion of ocular involvement in primary Sjögren syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. Methods: This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear breakup time (TBUT), meibomian gland dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro, anti-La, and antinuclear antibodies, rheumatoid factor, erythrocyte sedation rate, and C-reactive protein were included as systemic serum titers of markers. Patients with (group 1) and without (group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Results: Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (73.7%) in group 1 and 31 (26.3%) in group 2. Group 1 showed higher meibum quality scores (p = 0.016), meibum expressibility (p = 0.010), and lid margin abnormalities on the lower lid (p = 0.029) and lower TBUT (p = 0.016) than group 2. OSS, TBUT, and the Schirmer test statistically differed (p < 0.001, p = 0.041, and p = 0043, respectively) between the patients who satisfied both ocular criteria (n = 46) and those who satisfied only one criterion (n = 41). There were no statistical differences in serum titers of markers between the two groups. Conclusions About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 73.7%, and half of these patients met both ocular criteria. Only anti-Ro antibodies negatively correlated with TBUT. Also, OSS, TBUT, and Schirmer test were statistically different between the two subgroups.

Purpose: To report the proportion of ocular involvement in primary Sjögren syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. Methods: This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear breakup time (TBUT), meibomian gland dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro, anti-La, and antinuclear antibodies, rheumatoid factor, erythrocyte sedation rate, and C-reactive protein were included as systemic serum titers of markers. Patients with (group 1) and without (group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Results: Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (73.7%) in group 1 and 31 (26.3%) in group 2. Group 1 showed higher meibum quality scores (p = 0.016), meibum expressibility (p = 0.010), and lid margin abnormalities on the lower lid (p = 0.029) and lower TBUT (p = 0.016) than group 2. OSS, TBUT, and the Schirmer test statistically differed (p < 0.001, p = 0.041, and p = 0043, respectively) between the patients who satisfied both ocular criteria (n = 46) and those who satisfied only one criterion (n = 41). There were no statistical differences in serum titers of markers between the two groups. Conclusions About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 73.7%, and half of these patients met both ocular criteria. Only anti-Ro antibodies negatively correlated with TBUT. Also, OSS, TBUT, and Schirmer test were statistically different between the two subgroups.

Purpose: To report a case of recurrent subepithelial infiltrates (SEIs) after epidemic keratoconjunctivitis (EKC), which improved with the use of topical cyclosporin and tacrolimus.Case summary: A 33‐year‐old female patient with bilateral EKC developed multiple SEIs, which were worse in the left eye, after applying topical antibiotics and steroid for 3 weeks. She was administered 0.5% loteprednol etabonate every 2 hours, which was gradually tapered to once a day, and 0.1% cyclosporine once daily. However, the SEIs recurred. Therefore, 0.1% cyclosporine was administered twice a day in both eyes and the frequency of administration of steroid eye drops was increased. The dose of steroid eye drops was reduced, but two attempts to taper the dose failed. SEIs in the right eye improved with the use of 0.1% cyclosporine. However, SEIs in the left eye recurred on tapering the steroid dose. Therefore, topical 0.02% tacrolimus ointment was administered once daily in the left eye. After 2 weeks of using tacrolimus, the topical steroids were discontinued. SEIs were well‐controlled for 6 months with 0.1% cyclosporine administered 1‐2 times/day in the right eye and 0.02% tacrolimus administered 1 time/3 days in the left eye. Conclusions Topical cyclosporine and tacrolimus can minimize the requirement for steroids, and treat chronic and recurrent SEIs after EKC.

Purpose: This study reports a case of meibomian gland dysfunction associated with bortezomib, which is a treatment of choice for multiple myeloma.Case summary: A 59‐year‐old female patient presented to our hospital with a complaint of dryness that had worsened for 2 months and eye discharges that were difficult to remove even after washing her face. The patient had been diagnosed with multiple myeloma 5 months prior and had undergone four cycles of bortezomib therapy. Slit‐lamp microscopy revealed a number of pouting of the meibomian gland (MG) orifices in both eyes. Meibography revealed that more than one‐third and less than twothirds of the total MG area of both upper lids were lost and more than two‐thirds of the total MG area of both lower lids were lost. No clinically significant improvements were noted at 8 months despite thorough eyelid hygiene therapy, including warm compresses, topical antibiotics, steroids, and artificial tears. However, when the patient revisited our clinic 2 months after completing bortezomib treatment, the subjective symptoms had improved and all of the pouting of MG orifices had disappeared. There was no significant difference in the MG dropout area for either eye compared with the observations from a previous visit during bortezomib treatment. Conclusions Clinicians should be aware that MG dysfunction may occur or worsen in patients receiving bortezomib treatment and should consider this when establishing a treatment plan for meibomian dysfunction or when educating patients.

Purpose: To evaluate the level of agreement between ANTERION (Heidelberg Engineering, Heidelberg, Germany), OA-2000 (Tomey, Nagoya, Japan), and IOLMaster 500 (Carl Zeiss AG, Jena, Germany). Methods: Fifty-one eyes of 51 patients were included in the study. Flat keratometry (K) and steep K, vector component of astigmatism (Jackson cross-cylinder at 0° and 90° [J0] and Jackson cross-cylinder at 45° and 135° [J45]), anterior chamber depth, and axial length were compared using the three devices. Repeated measures analysis of variance was conducted to compare the mean values of the biometrics. Pearson correlation test was conducted to analyze the correlations of the measured values, and a Bland-Altman plot was used to assess the agreement between the three devices. The predicted intraocular lens power of each device was compared to the others using the SRK/T, Haigis, Barrett Universal II, and Kane formulas. Results: All K values measured using ANTERION were flatter than those of other instruments. However, good agreement was observed for flat K (ANTERION - OA-2000; 95% limits of agreement [LoA], 0.86 diopters [D]) and steep K (ANTERION - OA2000; 95% LoA, 0.93 D) and OA-2000 - IOLMaster 500 (95% LoA, 0.93 D). J0 and J45 vector components of astigmatism were not statistically different; however, the agreements were poor between the devices (95% LoA ≥1.97 D). Anterior chamber depth values of ANTERION and OA-2000 were interchangeable (95% LoA, 0.15 mm). The axial length showed a high agreement (95% LoA ≤0.17 mm) among the three devices. The predicted intraocular lens powers of the three devices were not interchangeable regardless of formulas (95% LoA ≥1.04 D). Conclusions Significant differences in ocular biometrics were observed between ANTERION and the other two devices. This study demonstrated that only axial length showed good agreement among devices.

Purpose: To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. Methods: This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. Results: Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p < 0.05). There were also significant differences in the most of the keratometric values of the posterior corneal surface (p < 0.05) except J0 (p = 0.410). Both devices showed strong positive correlations in steep K, flat K, astigmatism (r > 0.81, p < 0.001) with wide ranges of a 95% limit of agreement. Vectoral components were significantly correlated (r > 0.78, p < 0.001) with narrow 95% limit of agreement, except J45 of the posterior surface (r = 0.39, p = 0.004). In the corneal HOAs, there were statistically significant differences in the vertical coma, horizontal trefoil, spherical aberration, and root mean square of each fifth- and sixth-order Zernike coefficient (p = 0.043, p = 0.041, p < 0.001, p < 0.001, and p < 0.001, respectively). Other HOAs showed moderate to strong positive correlations (r > 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). Conclusions Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.

Purpose: To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. Methods: This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. Results: Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p < 0.05). There were also significant differences in the most of the keratometric values of the posterior corneal surface (p < 0.05) except J0 (p = 0.410). Both devices showed strong positive correlations in steep K, flat K, astigmatism (r > 0.81, p < 0.001) with wide ranges of a 95% limit of agreement. Vectoral components were significantly correlated (r > 0.78, p < 0.001) with narrow 95% limit of agreement, except J45 of the posterior surface (r = 0.39, p = 0.004). In the corneal HOAs, there were statistically significant differences in the vertical coma, horizontal trefoil, spherical aberration, and root mean square of each fifth- and sixth-order Zernike coefficient (p = 0.043, p = 0.041, p < 0.001, p < 0.001, and p < 0.001, respectively). Other HOAs showed moderate to strong positive correlations (r > 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). Conclusions Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.