PURPOSE: To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS: Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS: In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25–1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13–3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71–11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03–2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18–1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31–1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01–1.62; p=0.039) were found to be related to APE development. CONCLUSION: The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.
Cataract Extraction ; Cataract ; Endophthalmitis ; Foreign Bodies ; Glaucoma ; Hominidae ; Humans ; Hypertension ; Incidence ; Insurance ; Kidney Failure, Chronic ; Korea ; Male ; Phacoemulsification ; Risk Factors ; Sutures ; Vitrectomy

PURPOSE: To evaluate the protective effect of applying an ophthalmic viscosurgical device (OVD) to the ocular surface during cataract surgery and its ability to prevent dry eye syndrome. METHODS: Twenty-four patients aged 50 to 75 years who underwent cataract surgery at Seoul National University Bundang Hospital and agreed to participate in the study were included and divided into two groups: a study group who underwent cataract surgery after application of an OVD to the ocular surface, and a control group who underwent cataract surgery without application of an OVD. DisCoVisc was used as the OVD in the study group, while other factors including surgical techniques and administration of anesthetic agents were performed in both groups in the same manner. Indicators of dry eye syndrome including ocular staining score, tear break-up time, and tear osmolality were analyzed. Ocular surface disease index and a visual analog scale were analyzed for dry eye symptoms, and the amount of balanced salt solution used during surface irrigation and operation time were also analyzed. RESULTS: Significant improvement in the tear break-up time, corneal ocular staining score, and ocular surface disease index score in the study group compared with the control group one week after operation (by the Mann-Whitney test). Use of OVD was associated with longer operating time. CONCLUSIONS: OVD applied to the ocular surface during cataract surgery had a protective effect on the ocular surface one week after surgery.
Anesthetics ; Cataract Extraction ; Cataract ; Dry Eye Syndromes ; Humans ; Osmolar Concentration ; Seoul ; Tears ; Visual Analog Scale

OBJECTIVE: To evaluate the effect of different cumulative energy composite parameters on the outcomes of phacoemulsification cataract surgery in patients with type 2 diabetes mellitus. METHODS: A total of 252 patients with cataract (involving 252 eyes) and type 2 diabetes mellitus received phacoemulsification cataract surgery in our hospital between January, 2017 and June, 2019. The patients were divided into group A (150 cases) and group B (102 cases) for cataract phacoemulsification with cumulative energy composite parameters of 8 and 10, respectively, and 90 nondiabetic patients received cataract phacoemulsification with a cumulative energy composite parameters of 10 served as the control. The macular thickness, best corrected visual acuity, visual acuity, and postoperative leakage in the 3 groups were evaluated at 1 week, 1 month, and 3 months after the surgery. RESULTS: The visual acuity was significantly improved after phacoemulsification better in all the 3 groups. At 3 months after the surgery, the proportions of patients with visual acuity ratio < 0.1 or >1.0, macular thickness, best corrected visual acuity and permeability differed significantly between groups A and B ( < 0.05), but not between group A and the control group ( > 0.05). At 1 month and 3 months after the surgery, the proportion of patients with visual acuity ratio < 0.1 was significantly lower and the rate of visual acuity ratio >1.0 was higher in group A than in group B. At 1 month after the operation, the total leakage rate in group A (31.1%) was higher than that in the control group (21.1%) but comparable with that in group B; at 3 months, the total leakage rates were significantly lower in group A than in group B (10.0% 32.4%, < 0.05), and the leakage resulted mainly from local and diffuse permeation. CONCLUSIONS Phacoemulsification can effectively improve the visual acuity of cataract patients especially in non-diabetic patients. A lower cumulative energy composite parameter achieves better outcomes in type 2 diabetic patients with cataract. The macular thickness, local infiltration and diffuse leakage can be used as indicators for assessing visual recovery and stabilization after phacoemulsification.
Cataract ; Cataract Extraction ; Diabetes Mellitus, Type 2 ; Humans ; Phacoemulsification ; Visual Acuity

Cataract is a major cause of blindness and vision impairment disease, and the main therapy for cataract is operation. For improving the postoperative efficiency, cataract surgery has gradually transformed from traditional restorative surgery to refractive surgery with modern technique. Visual quality is one of the crucial indicators for assessing imaging quality and surgical efficiency in cataract patients. Although several instruments are available, each has its advantage and disadvantage. In the clinic, the optimum visual quality analysis methods should be selected according to the principle, function and clinical significance to meet the practical needs of different cataract patients.
Blindness ; Cataract ; Cataract Extraction ; Humans ; Prevalence ; Vision Disorders ; Visual Acuity

PURPOSE: We analyzed time series changes in cataract surgeries in Korea, and provide basic data to enhance the efficiency of medical services for cataract surgery. METHODS: Among cataract surgery statistics registered in the Korean National Health Insurance Cooperation from 2006 to 2012, we used data regarding the number of patients and operations and the number of patients and operations per 100,000 people. We analyzed various time series changes, including differences by sex and age. RESULTS: The total numbers of patients from 2006 to 2012 by year were 207,370; 228,170; 250,289; 268,548; 289,867; 308,111; and 302,182, respectively. The total numbers of operations from 2006 to 2012 by year were 272,920; 305,807; 338,332; 365,874; 398,338; 428,158; and 420,905, respectively. The number of patients and operations per 100,000 people were highest in men 80 to 84 years old and women 75 to 79 years old. Comparing the number of operations in 2006 and after, the patient age group with the highest increase rate changed from over 85 years old to 75–79 years old since 2010 in men and from over 85 years old to 50–54 years old since 2009 in women. For each year investigated, the number of operations performed was higher than the number of patients who received operations. CONCLUSIONS: Over the study period, the number of cataract surgeries increased, while the age of cataract patients decreased. Additionally, the number of cataract-related surgeries increased in relation to the number of patients.
Cataract Extraction ; Cataract* ; Epidemiology ; Female ; Humans ; Korea* ; Male ; National Health Programs

PURPOSE: We report a rare case of isolated traumatic aniridia in a pseudophakic eye. CASE SUMMARY: A 69-year-old female came to our emergency department complaining of right eye pain and visual disturbance after trauma due to fall on the stairs. Five years earlier she had undergone an uncomplicated right sutureless phacoemulsification cataract extraction through a 2.2 mm temporal clear corneal incision, followed by insertion of a folding intracapsular intraocular lens. Total iris expulsion occurred through the cataract incision without extension of the wound or disruption of the posterior capsule or intraocular lens. CONCLUSIONS: We report a rare case of isolated traumatic aniridia in a pseudophakic eye, which has not been reported in the Republic of Korea.
Aged ; Aniridia ; Cataract ; Cataract Extraction ; Emergency Service, Hospital ; Eye Pain ; Female ; Humans ; Iris ; Lenses, Intraocular ; Phacoemulsification ; Republic of Korea ; Wounds and Injuries

PURPOSE: To report a case of multicentric Castleman disease that presented with scleritis. CASE SUMMARY: A 42-year-old male presented with decreased visual acuity in the left eye. Castleman disease had been diagnosed 21 months before and treated with systemic steroids and combined chemotherapy. Best-corrected visual acuity (BCVA) of the left eye was 0.02 and the intraocular pressure was 42 mmHg. Scleral edema and corneal edema were noted using a slit lamp examination. The anterior chamber cell was 2+ according to Standardization of Uveitis Nomenclature criteria. The fundus was invisible due to the anterior segment lesion. After one month, scleritis developed in the right eye and the patient complained of ocular pain. Topical steroids and non-steroidal anti-inflammatory drugs were prescribed. Due to recurrent scleritis and anterior uveitis, cataract extraction and laser iridectomy were performed on the left eye, and systemic steroids and the antimetabolite methotrexate were started. After 9 years of follow-up, all medications were stopped and there was no recurrence of inflammation, with a BCVA of 1.0 in both eyes. CONCLUSIONS: Treatment of a patient with scleritis accompanied with Castleman disease using systemic steroids and methotrexate resulted in a good prognosis.
Adult ; Anterior Chamber ; Cataract Extraction ; Corneal Edema ; Drug Therapy ; Edema ; Follow-Up Studies ; Giant Lymph Node Hyperplasia ; Humans ; Inflammation ; Intraocular Pressure ; Iridectomy ; Male ; Methotrexate ; Prognosis ; Recurrence ; Scleritis ; Slit Lamp ; Steroids ; Uveitis ; Uveitis, Anterior ; Visual Acuity

To study the change of the dominant eye in the age-related cataract patients before and after surgery, to analyze the correlation between the orientation of the dominant eye and the visual quality, and to observe whether the patients with the change in dominant eye were converted to dizziness.
 Methods: A total of 44 patients, with age-related cataract between 60 and 80 years old were enrolled. Group A: the non-dominant (secondary) eye served as the surgical eye (n=35); Group B: the dominant eye served as the surgical eye (n=9); Group C: the operation was performed on the contralateral eye after a month (n=28). Measurement of the dominant eye was performed before operation, 1 week after operation and 1 month after the operation. The changes in the uncorrected distance visual acuity (UCDVA), contrast sensitivity (CS), best corrected visual acuity (BCVA) and spherical equivalent (SE) between the dominant and non-dominant eye were compared.
 Results: The UCDVA, CS, BCVA and SE were significantly improved at 1 day after the operation. There was significant difference between the 2 groups (P<0.05). Preoperative: in group A, the UCDVA, CS, BCVA of ocular dominance were better than the non-dominant eye with significant difference (P<0.05), while there was no significant difference between the SE (P>0.05); in group B, the UCDVA, CS, BCVA in the dominant eye were better than the non-dominant eye's, but the difference was not statistically significant (P>0.05). After operation: the UCDVA, CS and BCVA in the dominant eye in group A and group B were higher than those of the non-dominant eye with statistical difference (P<0.05), but there was no statistical difference between SE (P>0.05). The dominant eye's transformation occurred in group A when the non-dominant eye's postoperative visual quality improved over the leading eye. The transformation rate was 60% in 1 week, and the conversion rate was 80% in 1 month. In group C, the dominant eye reduction rate was 100%, and the visual quality was not significant difference between the two eyes (P>0.05). After the operation, the patients with the dominant eye's transformation felt discomfort, which could be relieved within 1 week.
 Conclusion: The location of the dominant eye was correlated with uncorrected visual acuity, contrast sensitivity, and the best corrected visual acuity. The dominant eye's transformation occurred when the non-dominant eye's postoperative visual quality improved over the leading eye after the surgery. If the contralateral eye's surgery was performed in a short term, the dominant eye can be returned to the initial state.
Aged ; Aged, 80 and over ; Cataract ; therapy ; Cataract Extraction ; Humans ; Middle Aged ; Phacoemulsification ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the long-term visual outcomes and complications of cataract surgery in eyes previously treated for retinoblastoma. METHODS: We reviewed the medical records of patients who underwent cataract extraction and intraocular lens implantation at Seoul National University Children's Hospital for a secondary cataract that developed after retinoblastoma treatment. RESULTS: During the period between 1990 and 2014, 208 eyes of 147 patients received eye-salvaging treatment (radiotherapy, chemotherapy, and local therapy) for retinoblastoma at Seoul National University Children's Hospital. Among these eyes, a secondary cataract was detected in 17 eyes of 14 patients, and five eyes of five patients underwent cataract surgery. The median age of cataract formation was 97 months (range, 38 to 153 months). The medial interval between the diagnosis of retinoblastoma and cataract formation was 79 months (range, 29 to 140 months). All patients received posterior chamber intraocular lens insertion after irrigation and aspiration of the lens through a scleral tunnel incision. Anterior vitrectomy and posterior capsulotomy were performed in two eyes and a laser capsulotomy was subsequently performed in one eye. No intraoperative and postoperative complications occurred. The median follow-up after surgery was 36 months (range, 14 to 47 months). The final best corrected visual acuities were improved in all five eyes. No intraocular tumor recurrences or metastases occurred. CONCLUSIONS: After retinoblastoma regression, cataract extraction in our series was not associated with tumor recurrence or metastasis. Visual improvement was noted in every patient.
Capsule Opacification ; Cataract Extraction ; Cataract* ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Medical Records ; Neoplasm Metastasis ; Posterior Capsulotomy ; Postoperative Complications ; Radiotherapy ; Recurrence ; Retinoblastoma* ; Seoul ; Visual Acuity ; Vitrectomy

PURPOSE: In the present study, a case of silicone band migration following an encircling procedure was reported. CASE SUMMARY: A seven-year-old male was admitted to our hospital after undergoing primary corneal suture and cataract extraction for traumatic corneal laceration and cataract in the left eye at another hospital. The cornea was well sutured, but due to vitreous bleeding and retinal detachment, we performed vitrectomy and silicone oil injection in combination with scleral buckling. The retina was well attached for 7 months following the procedure but the silicone oil was removed due to uncontrolled intraocular pressure elevation. Ten days later, the patient was readmitted for blurred vision in the left eye and vitreous bleeding as well as superotemporal retinal detachment were observed. During vitrectomy, we could not locate the indentation caused by scleral buckle, therefore extraocular area was closely examined. The scleral fixation sutures were well maintained in all 4 quadrants but the silicone band was not observed within the sutures. The band was located anterior to the fixation sutures and was displaced anterior to the medial rectus muscle insertion. The encircling silicone band was removed. The encircling procedure was again performed with a new silicone band combined with vitrectomy and silicone oil injection. Retinal attachment has been maintained and the silicone band well anchored since the operation. CONCLUSIONS: Anterior migration of the silicone band through the outer layer of the sclera or one or more tendons of recti muscles is a rare but potential complication of scleral buckling. Hence, clinicians must note the possibility of this complication when retinal detachment recurs and the encircling buckle is not observed.
Cataract ; Cataract Extraction ; Cornea ; Hemorrhage ; Humans ; Intraocular Pressure ; Lacerations ; Male ; Muscles ; Retina ; Retinal Detachment ; Retinaldehyde ; Sclera ; Scleral Buckling ; Silicon* ; Silicones* ; Sutures ; Tendons ; Vitrectomy