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Purpose: To investigate the clinical outcomes of new hydrophobic trifocal intraocular lens with hydroxyethyl methacrylate in the Korean population., Methods: This prospective, multicenter, and observational study evaluated the clinical outcomes of 80 eyes of 40 patients with age-related cataract underwent cataract surgery using CNWT (Clareon PanOptix). Assessment included monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity (at 60cm), near visual acuity (at 40 and 33 cm), uncorrected defocus curves, questionnaires evaluating photic phenomena, spectacle independence, and spectacle free satisfaction., Results: At postoperative 3 months, mean uncorrected binocular visual acuities were 0.04, 0.04, 0.03 logarithm of the minimum angle of resolution (logMAR) at far, intermediate, and near distances, respectively. All patients achieved uncorrected binocular visual acuity of 0.2 logMAR or better. Monocular and binocular defocus curve indicated a mean visual acuity of 0.2 logMAR or better at the defocus range of +1.0 to - 3.0 diopters (100 to 33 cm) and +1.0 to - 3.5 diopters (100 to 28 cm). High spectacle independence was observed at all distances, with 37.5% patients reporting photic phenomena., Conclusions: The Clareon PanOptix intraocular lens has shown positive clinical outcomes, providing a viable option for cataract surgery. These lenses effectively address patients' visual needs, especially in intermediate and near distance tasks, reducing dependence on glasses.

Purpose: To determine the incidence of spontaneous regression of congenital corneal opacity (CCO) and identify clinical factors associated with the regression., Methods: Medical records and anterior segment photographs were reviewed of 57 eyes in 35 patients with CCO that were not related to congenital glaucoma, tumors, infection, trauma, or metabolic disorders and were followed up without corneal transplantation for longer than one year at Seoul National University Hospital. Spontaneous regression of corneal opacity was defined as a decrease in corneal opacity significant enough for visual axis clearance. Data on demographics, systemic, and ocular characteristics were collected and compared between patients who had spontaneous regression of CCO and those who did not., Results: Spontaneous regression of corneal opacity developed in 32 eyes (22 patients, 56.1%) out of 57 CCO eyes (35 patients) at the mean 8.2 ± 5.4 months of age (the median 6.7 months). Absence of combined ocular anomalies such as iris anomaly, lens opacity, and peripheral corneal vascularization was significantly associated with the regression of opacity., Conclusions: Corneal opacity can spontaneously regress in 56.1% of eyes with CCO during the first year of life. Careful follow-up with amblyopia management can be one of treatment options for CCO.

Purpose: To compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts., Methods: Eighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas., Results: Uncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were -0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group ( p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups., Conclusions: Trifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2019 The Korean Ophthalmological Society.)

Purpose: To determine the efficacy of 4-haptic bitoric intraocular lens (IOL) implantation in Asian patients with cataract and astigmatism., Methods: A total of 19 eyes with ≤25.0 mm axial length and ≥0.75 diopters (D) corneal astigmatism were included in this prospective non-comparative study. All subjects underwent phacoemulsification with implantation of an AT Torbi 709M IOL. Visual and refractive outcomes as well as toric IOL axis were evaluated during a 3-month follow-up. Errors in predicted residual spherical equivalent were calculated by subtracting predicted residual spherical equivalent from postoperative refraction., Results: Uncorrected and corrected distance visual acuity improved significantly 3 months after surgery, from 0.43 to 0.05 and from 0.24 to -0.05, respectively. Mean refractive cylinders also decreased significantly, from -1.91 preoperatively to -0.54 D 3 months after surgery. Mean J0 and J45 decreased 3 months postoperatively, from 0.26 to 0.03 D and from 0.24 to -0.06 D, respectively. After 3 months, mean absolute IOL rotation was 1.81°. Errors in predicted residual spherical equivalent showed a hyperopic shift of 0.35 D., Conclusions: Implantation of 4-haptic bitoric IOL proved to be effective for correcting astigmatism in Asian eyes during cataract surgery., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2019 The Korean Ophthalmological Society.)

Background: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation., Methods: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method., Results: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of -0.5, -1.0, -1.5, and -2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], -0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.07, -0.01; P = 0.006 and MD, -0.07 logMAR; 95% CI, -0.13, -0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other., Conclusion: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: To investigate the clinical features of corneal opacity and the surgical outcome of penetrating keratoplasty (PK) in eyes with congenital glaucoma., Methods: A retrospective review was made of the records from 320 eyes of 193 patients who were diagnosed with congenital glaucoma between January 1981 and January 2016. Anterior segment photographs at disease presentation were examined for the presence and severity of corneal opacity. Data on patient demographics, intraocular pressure (IOP), ocular and systemic comorbidities, ocular surgery and its outcome were collected., Results: Overall, corneal opacification was observed in 248 of 320 eyes (77.5%). Out of 248 eyes with corneal opacification, 53 eyes had Haab striae alone, and 195 eyes presented with either nebulomacular corneal opacity (128 eyes, iris details visible through opacity) or leukomatous corneal opacity (67 eyes, iris details invisible through opacity). In 12 eyes with severe leukomatous corneal opacity, PK was performed at the mean age of 18.6 months (range 4-57 months). The grafts failed in 6 eyes (50%) due to endothelial rejection (4 eyes) or graft infection (2 eyes) during the mean 80.6 months of follow-up (range 15-228 months). The median survival time was 36 months. The graft failure was significantly associated with smaller corneal diameter at the time of surgery, but not with the age, IOP, combined aniridia, simultaneous glaucoma or lens surgery., Conclusion: Congenital glaucoma was combined with corneal opacity in 77.5%. The corneal transplant survival was 50% in eyes with congenital glaucoma and total corneal opacity.

Purpose: This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN., Methods: All patients were classified by age (≤18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (≤5 days), IVIG (≤6 days), or amniotic membrane graft transplantation (AMT) (≤15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage., Results: The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS)., Conclusions: Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.

We report the case of a 37-year-old man with a high myopic keratoconus eye that was treated with a posterior chamber toric implantable collamer lens (ICL) in Korea. The patient had a history of contact lens intolerance and did not want to have a corneal transplantation. His uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity were 0.02 and 0.4 in the left eye, respectively. Preoperatively, the manifest refraction was -12.0 -3.5 × 30A. Postoperatively, the manifest refraction was -1.75 × 180A. UCVA improved markedly after implantation. No intraoperative or postoperative complications were observed during 20 months of follow-up. Toric ICL implantation may be a possible alternative surgical option for the visual rehabilitation of high myopic astigmatism in keratoconus patients with rigid gas permeable contact lens intolerance and in patients who do not want to get a corneal transplant.

Background: To investigate the long-term results and visual outcomes of penetrating keratoplasty (PKP) in Peters anomaly., Methods: Twenty-three eyes from 22 patients with Peters anomaly who underwent PKP from 1998 to 2008 were reviewed retrospectively. Patients who were followed for more than 3 years after the first PKP were included in this study. The systemic and ophthalmic features of the recipients were assessed, and the various prognostic factors for graft survival were evaluated. Disease severity was determined according to other accompanying eye anomalies in mild or severe form. The final visual outcomes were presented with respect to graft clarity., Results: Among the 22 patients, 14 patients had unilateral disease, and eight patients had bilateral disease. Associated systemic anomalies were observed in six patients. The mean age at the first PKP was 42.4 months. Nineteen eyes (83 %) underwent PKP after 12 months of age. The graft failure rates at 1 year, 3 years, 5 years, and 10 years after PKP were 30 %, 39 %, 70 %, and 77 % respectively. Graft rejection within 1 month after PKP and severe disease were significant risk factors for graft failure. The mean final VAs in the clear-graft group and the failed-graft group were 1.883 logMAR and 2.767 logMAR (P < 0.001)., Conclusion: The results of delayed PKP in Peters anomaly were not inferior compared to the results of PKP performed at an earlier period in previous studies. If other congenital ophthalmic anomalies were present or graft rejection occurred within 1 month after PKP, the chance of graft failure was significantly increased.

Purpose: To investigate the effects of anterior chamber depth (ACD) and white-to-white (WTW) diameter on vault in eyes with implantable collamer lenses (ICL V4, STAAR Surgical AG) and to evaluate the effect of vault on visual outcomes and other biometric changes., Methods: Twenty-eight eyes of 16 patients who underwent ICL implantation were retrospectively reviewed. Patients were divided into two groups (A1, A2) according to preoperative ACD (> or = 3.3 mm and < 3.3 mm, respectively), two groups (B1, B2) based on WTW diameter (> or = 11.55 mm and < 11.55 mm, respectively), and two groups (C1, C2) according to the difference of ICL diameter and sulcus length (> or = 0.25 mm and < 0.25 mm, respectively). Vault, endothelial cell density, and visual performance were compared between each set of groups. Correlations of vault with WTW diameter, ACD, and diametric difference of the ICL from the sulcus were analyzed., Results: The high ACD and WTW groups showed significantly higher vaults (0.59 +/- 0.32 mm and 0.57 +/- 0.36 mm, respectively) than the low ACD and WTW groups (0.26 +/- 0.17 mm and 0.25 +/- 0.14 mm, respectively; P = .01 and .01), whereas the differences of diameter between the sulcus and ICL were not related to significant vault differences. The WTW diameter wascorrelated more closely to the vault than the ACD or sulcus diameter (r = 0.70, P < .001), whereas the vault difference did not affect visual quality or endothelial cell density., Conclusions: A high WTW diameter or ACD is likely to render a high vault, regardless of any difference in the ICL and sulcus diameters.

Purpose: To evaluate visual outcome and the changes of contrast sensitivity (CS) after diffuse lamellar keratitis (DLK)., Methods: Using retrospective chart review, 48 eyes of 25 patients who underwent laser in situ keratomileusis (LASIK) with Visx S4 (VISX Inc., Santa Clara, CA) and M2 (Moria, France) and who were followed for at least six months were included. They were divided into two groups: DLK and non-DLK, by diagnosis of DLK or its absence after LASIK. Postoperative logMAR visual acuities and logCS measured using the VCTS 6500 (Vistech Consultants, Inc., Dayton, OH) were compared with preoperative values in the DLK and non-DLK groups at three and six months after LASIK., Results: There was no difference in logMAR visual acuity between the DLK and non-DLK groups until the sixth postoperative month. However, CS was significantly decreased at 12 and 18 cycle/degree compared with preoperative values (p=0.043 and p=0.045, respectively) in the DLK group, whereas CS was significantly increased at 12 cycle/degree in the non-DLK group (p=0.042) at six months., Conclusions: DLK seemed to be strongly associated with a postoperative decrease of CS.

To report the efficacy and safety of large diameter scleral lenses and determine their suitability in Asian subjects with intractable ocular surface diseases. This prospective study enrolled intractable ocular surface diseases subjects with uncorrected visual acuity > counting finger but ≥ 0.3 logMAR and best-corrected visual acuity (BCVA) ≥ 0.3 logMAR, to fit large diameter scleral lenses for 12 weeks. 21 eyes (13 subjects) consisting ten eyes (47.6%) with persistent epithelial defects, 6 (28.6%) with graft-versus-host disease, 4 (19.0%) with Stevens–Johnson syndrome and one (4.8%) with severe dry eye were ultimately enrolled. Primary outcome measures were the visual acuity, corneal and conjunctival fluorescein staining, Ocular Surface Disease Index (OSDI), and National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). At week 12 with large diameter scleral lenses, BCVA improved from 0.77 logMAR to 0.27 logMAR (P < 0.001). High-grade corneal and conjunctival fluorescein staining proportion decreased from 61.90 to 14.29% and 52.38 to 9.52%, respectively (P = 0.0036 and 0.0063, respectively). OSDI and NEI-VFQ-25 improved from 67.89 to 34.69 and 51.40 to 64.48, respectively (P < 0.001). No adverse effects were observed. In Asians with intractable ocular surface diseases, large diameter scleral lens improves visual acuity and alleviates signs and symptoms of ocular surface diseases without any significant complications. Trial registration Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Project No. HI12C0015 (A120018)). Clinical Trials.gov, NCT04535388. Registered 18 August 2020—Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04535388. [ABSTRACT FROM AUTHOR]

Background: Currently, various types of toric intraocular lenses (IOL) have been manufactured and can be divided into three types according to the location of correction component; front-toric IOL (correction on anterior IOL surface), back-toric IOL (correction on posterior IOL surface), and bi-toric IOL (correction on both anterior and posterior IOL surfaces). In this study, we aimed to investigate the effectiveness of reducing corneal astigmatism of either normal or post-penetrating keratoplasty (PKP) corneas according to the type of implanted toric IOLs.Methods: Medical records were retrospectively reviewed in 370 patients who had undergone phacoemulsification with posterior chamber toric IOL insertion (front-toric IOL, back-toric IOL or bi-toric IOL). Subjects were divided into 2 groups; subjects who had no history of corneal disease with corneal astigmatism more than 1.00 diopters (D) (G1) and subjects who received previous PKP with all corneal sutures removed and had corneal astigmatism more than 1.25 D (G2). Preoperatively intended target from SRK/T was evaluated. Refractive astigmatism and its vector analysis (J0, J45), mean numerical error (MNE) and mean absolute error (MAE) were assessed at least a month after cataract surgery.Results: Mean preoperative corneal astigmatisms were 2.2 D and 4.0 D in G1 and G2, respectively. There was significant reduction of mean postoperative refractive astigmatism to 0.89 D in G1 and to 2.33 D in G2. In G1, bi-toric IOL showed significantly more improved refractive astigmatism than back-toric IOL. In G2, no difference in refractive astigmatism according to toric IOL type was observed. While G2 showed no difference in MNE among toric IOLs, in G1, bi-toric IOL showed significant hyperopic shift compared to back-toric IOL. In both groups, there was no significant difference in MAE according to type of IOL. No postoperative complications were observed.Conclusion: Our study suggests that all types of toric IOL are beneficial in correcting astigmatism of normal and post-PKP corneas. Noticeably, bi-toric IOL showed significantly better results in refractive astigmatism than back-toric IOL in normal cornea. However, bi-toric IOL showed a more hyperopic shift compared to back-toric IOL. Among post-PKP corneas, all types of toric IOL showed similar results. [ABSTRACT FROM AUTHOR]

Effects of chemical injuries on the cornea and limbus have been widely studied; however, little is known about glaucoma after ocular chemical injuries. We herein investigated the incidence, risk factors, and outcome of glaucoma in patients with ocular chemical burns. Medical records were reviewed of patients who visited our clinic for chemical injuries to the ocular surface. Patients were divided into glaucoma and non-glaucoma groups based on high intraocular pressure (IOP) readings. Clinical characteristics, treatment method, and therapeutic and visual outcomes were compared between the two groups. Of 29 patients (40 eyes), 9 patients (15 eyes, 37.5%) were diagnosed with glaucoma at 2.64 ± 2.92 months after injury. Factors associated with glaucoma included male gender (p = 0.0114), bilateral ocular involvement (p = 0.0478), severe ocular surface involvement (Dua grades IV-VI, p = 0.0180), poor initial visual acuity (p = 0.0136), high initial IOP (p < 0.0001), pupil involvement at initial examination (p = 0.0051), and the need for amniotic membrane transplantation in the acute stage (p = 0.0079). At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001). These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns. [ABSTRACT FROM AUTHOR]

Purpose. To investigate visual performances after a unilateral or bilateral implantation of enlarged depth-of-focus intraocular lens in patients with cataract. Methods. In this prospective study, uneventful phacoemulsification and TECNIS® Symfony intraocular lens implantation were performed in 20 eyes of 17 patients. At postoperative 1, 4, and 12 weeks, the logarithm of the minimal angle of resolution visual acuity at far, intermediate, and near distances and the spherical equivalent in manifest refraction and automated refraction were measured. A questionnaire was used to investigate glare, spectacle dependency, and satisfaction at 12 weeks. The mean numerical error and mean absolute error were compared between intraocular lens formulas to assess the best-fit formula. Results. The logarithm of the minimal angle of resolution visual acuity significantly improved to 0.02 at far, 0.02 at intermediate, and 0.27 at near distances at 12 weeks (p<0.05). Spherical equivalent was −0.79 D on automated refraction and was significantly lower than −0.26 D measured on manifest refraction. Patients' satisfaction score was 9.06, 8.94, and 6.65 for far, intermediate, and near distances, respectively. Near glasses were required in 5 patients and 2 patients complained of photic phenomenon. Visual performances were not significantly different between bilateral and unilateral implanted patients. No patients reported bilateral imbalance due to unilateral surgery. The mean numerical error was closest to 0 D using the Barrett Universal II formula. The mean absolute error was not significantly different between these formulas. Conclusion. Unilateral or bilateral implantation of the enlarged depth-of-focus intraocular lens seems to be equally effective in improving visual performances in patients with cataract. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes of contact lens fitting in eyes with keratectasia after laser in situ keratomileusis (LASIK) to optimize the performance of the contact lenses.Setting: Contact Lens Clinic, Seoul National University Hospital, Seoul, Korea.Methods: Six eyes of 4 patients with keratectasia were examined. Keratectasia was diagnosed based on abnormal topographic findings, progressive myopic changes, and uncorrected visual acuity with glasses. A multicurve lens or reverse-geometry lens (RGL) was selected based on the anterior elevation map. The base curve radius and peripheral parameters were determined based on the axial map and the evaluation of the fluorescein pattern of the lens. The contact lens fitting characteristics and visual acuity were evaluated. Patients were interviewed about their level of comfort, daily contact lens wear time, and glare.Results: Multicurve lenses and RGLs were fitted in 4 eyes and 2 eyes, respectively. The base curve radius of the multicurve lenses ranged from 7.2 to 7.5 mm; the alignment curve radius of RGLs was 7.6 mm in both cases. The radii of peripheral curves were customized to enhance tear interchange. Visual acuity improved to 20/30 or better in all eyes. All patients were completely satisfied with the comfort of the fitting. The mean daily wearing time was 12.7 hours. One patient reported tolerable glare in the eye after being fitted with an RGL.Conclusion: Proper contact lens fitting based on topographic data and slitlamp evaluation allowed good visual rehabilitation and comfortable extended daily wear in patients with keratectasia after LASIK. [Copyright &y& Elsevier]

Background: This study aimed to investigate the outcome of therapeutic penetrating keratoplasty (TPK) for medically-uncontrolled infectious keratitis, and to determine the factors associated with the recurrence of infection after TPK. Methods: A 10-year retrospective study of medically-uncontrolled infectious keratitis with positive culture results, who received TPK at a tertiary referral center in Korea was performed. Data collection included patient demographics, medical history, pre- and post-operative findings, surgical procedures, causative microorganisms, and visual acuities (VA). The primary outcome measure was the recurrence of infection after TPK, and the factors were compared between patients with and without recurrence. Results: A total of 19 patients (19 eyes) were analyzed, of which 6 eyes (31.6%) had infection recurrence at 21.6 ± 22.84 months after TPK. Recurrence occurred more frequently in the female sex (vs. male, p = 0.013) and in longer duration (>30 days) from infection onset to TPK (vs. ≤30 days, p = 0.025). Final best-corrected-VA was poorer in patients with recurrence than those without (LogMAR 1.60 ± 0.97 vs. 2.40 ± 0.46, p = 0.026). Evisceration was performed in 2 out of 6 patients with recurrence (33.3%), while none was performed in those without recurrence (p = 0.028). Conclusion: Infection recurrence after TPK was 31.6%. Given the poor outcome of TPK in eyes with recurrence, close monitoring and intensive treatment are required post-TPK. [ABSTRACT FROM AUTHOR]

Background: To investigate the efficacy and safety of the retention ring-assisted continuous application of 0.1% riboflavin in pulsed-light accelerated corneal collagen cross-linking on the progression of keratoconus.Methods: The medical records of 20 eyes of 18 patients with progressive keratoconus who received collagen cross-linking at Seoul National University Hospital were retrospectively reviewed. Isotonic 0.1% riboflavin was continuously applied for 10 min using an 8.0-mm retention ring before the irradiation and accelerated cross-linking was applied with 30-mW pulsed-ultraviolet light at a wavelength 365 nm for eight minutes (1 s on/1 s off; 30 mW/cm2, cumulative dose of 7 .2J/cm2) without further intermittent application of riboflavin. Visual acuity, refractive error, topographic index, corneal thickness, and endothelial cell density were evaluated before the operation and at 1, 3, 6, and 12 months.Results: The best corrected visual acuity in logMAR improved from preoperative 0.43 to 0.17 in 12 months (p = 0.050). Maximum keratometry decreased from 51.8 D to 50.4 D at 6 months (p = 0.015) and 50.1 D at 12 months (p = 0.0003). Astigmatism decreased from preoperative 5.5 D to 4.1 D at 12 months (p < 0.0001). Thinnest corneal thickness decreased at three and 6 months but recovered in 12 months (p > 0.05). Endothelial cell density decreased at postoperative 1 month (p = 0.02) but gradually recovered in 12 months (p > 0.05).Conclusions: Retention ring-assisted continuous application of riboflavin for 10 minutes in pulsed-light accelerated cross-linking is a comparably safe and effective treatment for halting the progression of keratoconus in 12 months when compared to outcomes of the standard Dresden protocol shown in previous reports. [ABSTRACT FROM AUTHOR]

Purpose: To report the therapeutic effect of corneoscleral contact lenses (CLs) with a diameter of 14.0 mm on the refractory ocular surface diseases.Methods: Medical records of 13 eyes (of nine patients) attempted for fitting with corneoscleral CLs for the management of the severe refractory ocular surface diseases were retrospectively reviewed including Stevens-Johnson syndrome (SJS; eight eyes) and chronic ocular graft-versus-host disease (GVHD; five eyes). Lenses were fitted to improve refractory punctate epithelial erosions (PEE, ten eyes) and persistent epithelial defect (PED, three eyes with SJS) despite the proper medical management. Short-term (1 month) and long-term (12 months) changes in the best corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, mean wearing time, and National Eye Institute's Visual Function Questionnaire-25 (VFQ-25) were evaluated.Results: Of the 13 eyes, ten eyes were successfully fitted with the corneoscleral CLs. The fitting was failed in three eyes due to small palpebral fissure and shortened fornices (two eyes) and handling difficulty (one eye). At one-month follow-up after successful fitting in ten eyes, mean wearing time was 12.6 h (6.5-17, all day long) and BCVA improved from 0.56 ± 0.59 to 0.27 ± 0.46 in logMAR (P = .018). For the eight well-fitted eyes with refractory PEE, CFS score improved from 7.38±2.20 to 5.13±2.48 (P = .024). PED improved in all two eyes which were successfully fitted with corneoscleral CLs (Of the three eyes with PED, one eye failed fitting). At 12-month follow-up, mean wearing time was 11.4 h and the improved BCVA and CFS score were maintained. Furthermore, no adverse events attributable to corneoscleral CLs use occurred.Conclusion: The corneoscleral CLs with a diameter of 14.0 mm were successfully fitted in ten out of 13 eyes with severe refractory ocular surface diseases and demonstrated therapeutic benefits in the well-fitted eyes. The corneoscleral CL can be an option in the management of severe refractory ocular surface diseases. [ABSTRACT FROM AUTHOR]