Most respondents were 30 to 49 years of age (88%), male (78%), and had more than 6 years of surgical experience (75%). Most respondents also worked for university hospitals (48%), followed by private clinics (31.4%), and eye hospitals (15%). The respondent demographics are shown in Table 1.

The average monthly volume of cataract surgeries performed by KSCRS members was 31 cases. Seventy-two percent performed 1 to 5 post refractive surgeries per month, 5% performed 6 to 10 surgeries, 2% performed >10 surgeries, and 21% did not perform post refractive surgery. These surgeons preferred phacoemulsification (95%) and 5% used a femtosecond laser. None of the members performed planned extracapsular cataract extraction. Surgeons were assisted during the procedures by residents (41%), nurses (16%), and nursing assistants (15%). The surgical instruments were managed and sterilized by nurses (83%) and nursing assistants (15%). Ninety-four percent of the respondents selected the IOL power, and 4% of the respondents had the residents perform this task.

Optical biometry was used by 92% of the respondents for IOL calculations, and ultrasound biometry was used by 73% of the respondents. Seventy-eight percent of respondents used IOLmaster (Carl Zeiss Meditech, Jena, Germany), 73% used ultrasound A-scan biometry, 14% used Lenstar (Haag-Streit, Koeniz, Switzerland), and 8% used ALscan (Nidek, Gamamori, Japan). Thirty-four percent of the respondents used single equipment, 23% used an IOLmaster, and 8% used an ultrasound A-scan. Sixty-six percent used more than two instruments; the most common combination was ultrasound A-scan biometry and the IOLmaster (44%).

Topical anesthesia was used by 80% of the respondents (from 69% in 2012). Subtenon anesthesia was used by 14% of the respondents (from 17% in 2012), and retrobulbar block was used by 5% (from 10% in 2012) (Fig. 1) [7].

Temporal clear corneal incisions were used by 50% of the respondents, followed by a steep axis incision (15%). The temporal site was the preferred incision meridian (57%), with little variation since 2006 (Fig. 2) [7]. A cataract incision size of 2.8 mm was used by 64% of the respondents (from 61% in 2012), and a size of 2.2 mm was used by 31% (from 24% in 2012) [7]. Among ophthalmic viscoelastic devices, HEALON (Johnson & Johnson, New Brunswick, NJ, USA) was used by 65% of the respondents; HEALON GV (Johnson & Johnson) was used by 10%; Viscoat (Alcon Laboratories, Fort Worth, TX, USA) was used by 7%; and HEALON 5 (Johnson & Johnson) was used by 3%. Forceps were used by 68% of the respondents for continuous curvilinear capsulorhexis, a bent needle was used by 24%, and a femtosecond laser was used by 2%. Capsular polishing was performed by 95% of the respondents during surgery; 5% of the respondents did not use this technique. Forty-eight percent of the respondents used both anterior and posterior capsules, while 44% and 3% of the respondents used only an anterior capsule or posterior capsule, respectively.

In 2001, an acrylic IOL was the preferred optic material, exceeding half of the total number of IOLs used (Fig. 3) [6]. In 2018, acrylic was preferred by 98% of the respondents and silicone by 2%; poly (methyl methacrylate) was not used by any respondent (0%). Among the total number of cataract surgeries, 64% of the respondents used a toric IOL less than 5%, and 84% used multifocal IOLs less than 10% (Fig. 4). Twenty-four percent of the respondents did not use multifocal IOLs; and 66% of the respondents treated less than 10 cases per month, while 8% treated 10-50 cases per month. Eighty-seven percent of the respondents also used multifocal IOLs for patients who were treated with corneal refractive surgery, and it constituted less than 30% of the total cataract surgery cases.

Eighty-two percent of the respondents using multifocal IOLs had been using bifocal IOLs, 48% had been using trifocal IOLs, and 30% had been using both types of IOLs. The types of preferred multifocal IOLs are shown in Table 2.

Forty-seven percent of the respondents did not use oral antibiotics postoperatively, and 31% used oral antibiotics postoperatively for less than 3 days. Forty-one percent of the respondents (from 77% in 2012) prescribed antibiotics for 3 to 7 days. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) were used together with topical steroids by 60% of the respondents, 10% used topical NSAIDs alone, and 30% did not use topical NSAIDs. More than half (53%) of the respondents used topical antibiotics and steroids for 1 month, and 26% of the respondents continued to use topical antibiotics and steroids longer than 1 month. In a similar manner, 52% of the respondents used topical antibiotics and NSAIDs for 1 month postoperatively. Twenty percent of the respondents finished follow-up visits at 1 month postoperatively, 30% finished visits at 3 months, 15% finished visits at 6 months, and 26% continued to visit every year. Most respondents (72%) prescribed reading glasses at 1 month postoperatively.

Ninety-four percent of the respondents (from 80% in 2012) observed posterior capsular rupture during surgery in less than 5% of cases, and 71% observed posterior capsular rupture during surgery in less than 1% of cases. More than half (54%) of the respondents did not observe patients with postoperative endophthalmitis, 23% observed postoperative endophthalmitis once, and 23% observed postoperative endophthalmitis in less than five cases. Fifty-eight percent of those who observed postoperative endophthalmitis estimated that the occurrence was less than 0.1%. More than half (52%) of the respondents observed severe postoperative uveitis, and 63% of these respondents estimated that the occurrence was less than 0.1% of cases.

The occurrences of other complications such as toxic anterior segment syndrome with severe endothelial cell damage, intraocular pressure spikes requiring medication, clinically significant pseudophakic cystoid macular edema, retinal detachment, dysphotopsia, IOL sulcus fixation, and unplanned aphakia are shown in Fig. 5. More than half (53%) of the respondents did not observe IOL subluxation or dislocation in uncomplicated cases over the past 10 years, 16% observed this complication once, 31% observed this complication in less than five cases, and 1% observed this complication in 10 cases or more. Among secondary IOL implantation techniques, conventional scleral fixation with suture material was used by 76% of the respondents; the Hoffmann technique was used by 10%; the iris-fixated IOL technique was used by 10%; and the glued intrascleral haptic fixation was used by 2%.