PURPOSE: To investigate the effects of cataract grade based on wide-field fundus imaging on macular thickness measured by spectral domain optical coherence tomography (SD-OCT) and its signal-to-noise ratio (SNR). METHODS: Two hundred cataract patients (200 eyes) with preoperative measurements by wide-field fundus imaging and macular SD-OCT were enrolled. Cataract severity was graded from 1 to 4 according to the degree of macular obscuring by cataract artifact in fundus photo images. Cataract grade based on wide-field fundus image, the Lens Opacity Classification System III, macular thickness, and SD-OCT SNR were compared. All SD-OCT B-scan images were evaluated to detect errors in retinal layer segmentation. RESULTS: Cataract grade based on wide-field fundus imaging was positively correlated with grade of posterior subcapsular cataracts (rho = 0.486, p < 0.001), but not with nuclear opalescence or cortical cataract using the Lens Opacity Classification System III. Cataract grade was negatively correlated with total macular thickness (rho = −0.509, p < 0.001) and SD-OCT SNR (rho = −0.568, p < 0.001). SD-OCT SNR was positively correlated with total macular thickness (rho = 0.571, p < 0.001). Of 200 eyes, 97 (48.5%) had segmentation errors on SD-OCT. As cataract grade increased and SD-OCT SNR decreased, the percentage of eyes with segmentation errors on SD-OCT increased. All measurements of macular thickness in eyes without segmentation errors were significantly greater than those of eyes with segmentation errors. CONCLUSIONS: Posterior subcapsular cataracts had profound effects on cataract grade based on wide-field fundus imaging. As cataract grade based on wide-field fundus image increased, macular thickness tended to be underestimated due to segmentation errors in SD-OCT images. Segmentation errors in SD-OCT should be considered when evaluating macular thickness in eyes with cataracts.
Artifacts ; Cataract* ; Classification ; Fundus Oculi ; Humans ; Iridescence ; Retinaldehyde ; Signal-To-Noise Ratio ; Tomography, Optical Coherence

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 recurrence percentage and risk factors of recurrence in rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) by in two groups of patients according to combined cataract surgery. METHODS: The recurrence percentage of RRD and risk factors after PPV over 20 years, performed by a single surgeon from January 1997 to September 2016, were retrospectively evaluated by classification into two groups according to combined cataract surgery. The risk factors were the patients' factors (age and sex), duration of disease, preoperative visual analyses, posterior capsular tears (PCR) during cataract surgery, the tamponade used, retinal detachment ranges, macular status, number and position of retinal tears, proliferative vitreoretinopathy (PVR) grade, and vitreous opacity. A total of 158 cases were included in the study. RESULTS: The recurrence percentage of RRD was not associated with combined cataract surgery. In the combined cataract surgery group, PCR (p = 0.020), inferior retinal tears (p = 0.037), and PVR above grade B (p = 0.037) were associated with the recurrence of RRD using univariate logistic regression analyses, but PCR (odds ratio 1.880, p = 0.021) was the only significant risk factor for RRD using multivariate logistic regression analyses. CONCLUSIONS: Cataract surgery can be performed at any time, but there should be consideration of the recurrence of RRD if there was PCR during combined cataract surgery.
Cataract* ; Classification ; Humans ; Logistic Models ; Polymerase Chain Reaction ; Recurrence* ; Retinal Detachment ; Retinal Perforations ; Retrospective Studies ; Risk Factors* ; Tears ; Vitrectomy ; Vitreoretinopathy, Proliferative

PURPOSE: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole. METHODS: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery. RESULTS: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003). CONCLUSIONS: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.
Cataract* ; Classification ; Epiretinal Membrane* ; Gases ; Humans ; Iridescence ; Refractive Errors ; Retinal Perforations* ; Vitrectomy*

PURPOSE: To evaluate the clinical results after phacoemulsification in mature and immature cataracts. METHODS: Mature cataract was defined as a classification of C5 by Lens Opacities Classification System III compared with other types of cataracts as controls. The present study included 37 (37 eyes) patients diagnosed with mature cataracts that received phacoemulsification and were followed up for at least 1 year. Thirty-seven (37 eyes) patients with other types of cataracts were selected randomly as controls. Intraoperative factors and rate of complications during and after surgery were evaluated. Best corrected visual acuity (BCVA), corneal endothelial cell density and central macular thickness (CMT) were measured during the 1 year of follow-up and compared with the controls. RESULTS: Twenty-seven eyes (mature cataracts) and 36 eyes (controls) received a complete continuous curvilinear capsulorhexis (CCC). The success rate of complete CCC was significantly high in the control eyes (p = 0.025). However, in mature cataract patients, 3 cases of posterior capsule rupture occurred among the 6 cases of radial tear of the anterior capsule, resulting in implantation of the lens in the sulcus. Posterior capsular ruptures were observed in 4 patients with mature cataracts and in 1 control with no statistically significant difference in the occurrence rate. Total phacoemulsification time and effective phacoemulsification time were significantly longer in the mature cataract patients (p = 0.038 and p = 0.041, respectively). BCVA, the amount of corneal endothelial cell density reduction and CMT at postoperative 1 year was not different between the two groups. CONCLUSIONS: The success of complete CCC was a significant factor for the occurrence of intraoperative complications in mature cataract surgery. Based on the clinical results, the mature cataract patients and controls had a similar visual prognosis.
Capsulorhexis ; Cataract* ; Classification ; Endothelial Cells ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Phacoemulsification* ; Prognosis ; Rupture ; Tears ; Visual Acuity

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 seek for mechanisms to prevent fixed dilated pupil including Urrets-Zavalia syndrome after intraocular surgery by analyzing and classifying the causes of such cases. METHODS: Medical records and anterior segment photographic images of patients with fixed dilated pupil who underwent penetrating keratoplasty, lamellar keratoplasty, or cataract surgery were analyzed in a retrospective manner from April, 1984 to February, 2014. RESULTS: Among 15 cases of postoperative fixed dilated pupil, 8 eyes of keratoconus eyes had received penetrating keratoplasty done and 7 eyes with ocular disorders other than keratoconus underwent intraocular surgeries. In cases 1 and case 2, which received penetrating keratoplasty for keratoconus, dilated pupil with regular pupil border, iris atrophy, and secondary glaucoma occurred; these cases were classified as group 1 and diagnosed as Urrets-Zavalia syndrome. Cases from 3 to 8 which also received penetrating keratoplasties due to keratoconus, irregularly dilated pupil, severe iris atrophy, posterior synechiae after moderate to severe inflammation in the anterior chamber, and fibrotic membrane on the anterior capsule occurred; these cases were classified as group 2. Finally, cases 9 to 15, which had mild inflammation, no fibrotic membrane, and regularly fixed dilated pupil after receiving other intraocular surgeries were classified as group 3. CONCLUSIONS: Differences exist between definite Urrets-Zavalia syndrome and postoperative fixed dilated pupil with regards to regularity of pupillary margin, degree of iris atrophy, posterior synechiae, fibrotic membrane, and posterior subcapsular opacity. Therefore, a new classification of fixed dilated pupil after intraocular surgery which addresses these characteristics is required and various trials to prevent the adverse postoperative complications of fixed dilated pupil should be performed. Preventive measures may include careful control of intraocular pressure, restricting atropine use, completely removing of viscoelastics, and minimal air or gas injection.
Anterior Chamber ; Atrophy ; Atropine ; Cataract ; Classification* ; Corneal Transplantation ; Glaucoma ; Humans ; Inflammation ; Intraocular Pressure ; Iris ; Keratoconus ; Keratoplasty, Penetrating ; Medical Records ; Membranes ; Postoperative Complications ; Pupil* ; Retrospective Studies

PURPOSE: To investigate the results using the OQAS and the Pentacam in cataract patients classified according to the type of lens opacity. METHODS: The present study included 124 eyes of 92 patients who had cataract surgery at Seoul St. Mary's Hospital from December 2011 to January 2012 and were classified into nuclear, cortical, and posterior subcapsular cataract patients. The lens opacity was determined with OSI, MTF, Strehl ratio, width 10%, width 50% and the opacity of Scheimpflug image by the OQAS and the Pentacam. Additionally, the correlation between subjective cataract classification and objective opacity value was analyzed. RESULTS: The nuclear cataract group showed a 6.40 +/- 2.41 OSI value and had high opacity. The cortical cataract group showed the highest MTF cut-off value (12.02 +/- 6.19 C/deg). When evaluating Pentacam results, the posterior subcapsular cataract group had the lowest average level of lens opacity (9.12 +/- 1.08) followed by in increasing order, the cortical cataract group (9.79 +/- 1.67) and the nuclear cataract group (11.08 +/- 1.84). The results were statistically significant (p < 0.001). The OSI value of the OQAS was significantly correlated with nuclear and posterior opacity (p = 0.049, p = 0.039, respectively) except cortical opacity (p = 0.781). MTF and nuclear opacity showed statistically significant correlation and the lens opacity of Pentacam was correlated with nuclear and posterior opacities. In cortical cataract with severe peripheral opacity, the cortical opacity showed significant correlation with Maximum. CONCLUSIONS: The OQAS and Pentacam results showed high correlation with the nuclear and posterior opacities which can be useful for cataract surgery.
Cataract* ; Classification ; Humans ; Seoul

PURPOSE: To report the related factors of posterior capsule rupture and the difference of postoperative visual prognosis after phacoemulsification by analyzing clinical features of the surgery performed by ten novice ophthalmologists. METHODS: We retrospectively evaluated electronic medical records of 326 patients (412 phacoemulsification cases) who underwent surgery by novice ophthalmologists certified by the Board of Ophthalmology after a resident training program. RESULTS: The number of cataract surgeries performed by each surgeon within the ophthalmology fellowship period (6 months - 2 years) ranged from 16 to 75 eyes, and perioperative posterior capsule ruptures occurred in 64 of 412 eyes (15.5%). Factors such as age, sex, laterality, axial length and clinical courses were not related to the rate of posterior capsule rupture. Nucleosclerosis was significantly related to the posterior capsule rupture rate and was especially higher in the group with a grade higher than five compared to that in the groups with a grade less than 5 based on the Lens Opacities Classification System III (p = 0.033). Factors of surgeon's subspecialty, nucleofractis method, and period between residency and the fellowship were not related to the posterior capsule rupture rate, except when considering anesthetic methods. The posterior capsule rupture rate was less frequent in the retrobulbar surgery group than the topical surgery group (p = 0.046). Postoperative visual outcomes were significantly different at postoperative day one and one month (p = 0.023, 0.022, respectively) but not at postoperative two months (p = 0.059). CONCLUSIONS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in posterior capsule rupture rate between nucleosclerosis and anesthesia groups. Postoperative visual outcome differed at postoperative day one and one month but not after two months postoperatively.
Anesthesia ; Cataract ; Classification ; Education ; Electronic Health Records ; Fellowships and Scholarships ; Humans ; Internship and Residency ; Learning Curve ; Ophthalmology ; Phacoemulsification* ; Prognosis ; Retrospective Studies ; Rupture* ; Specialization

PURPOSE: To report the related factors of posterior capsule rupture and the difference of postoperative visual prognosis after phacoemulsification by analyzing clinical features of the surgery performed by ten novice ophthalmologists. METHODS: We retrospectively evaluated electronic medical records of 326 patients (412 phacoemulsification cases) who underwent surgery by novice ophthalmologists certified by the Board of Ophthalmology after a resident training program. RESULTS: The number of cataract surgeries performed by each surgeon within the ophthalmology fellowship period (6 months - 2 years) ranged from 16 to 75 eyes, and perioperative posterior capsule ruptures occurred in 64 of 412 eyes (15.5%). Factors such as age, sex, laterality, axial length and clinical courses were not related to the rate of posterior capsule rupture. Nucleosclerosis was significantly related to the posterior capsule rupture rate and was especially higher in the group with a grade higher than five compared to that in the groups with a grade less than 5 based on the Lens Opacities Classification System III (p = 0.033). Factors of surgeon's subspecialty, nucleofractis method, and period between residency and the fellowship were not related to the posterior capsule rupture rate, except when considering anesthetic methods. The posterior capsule rupture rate was less frequent in the retrobulbar surgery group than the topical surgery group (p = 0.046). Postoperative visual outcomes were significantly different at postoperative day one and one month (p = 0.023, 0.022, respectively) but not at postoperative two months (p = 0.059). CONCLUSIONS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in posterior capsule rupture rate between nucleosclerosis and anesthesia groups. Postoperative visual outcome differed at postoperative day one and one month but not after two months postoperatively.
Anesthesia ; Cataract ; Classification ; Education ; Electronic Health Records ; Fellowships and Scholarships ; Humans ; Internship and Residency ; Learning Curve ; Ophthalmology ; Phacoemulsification* ; Prognosis ; Retrospective Studies ; Rupture* ; Specialization