Insights in Cataract and Refractive Surgery

Presbyopia-correcting intraocular lens options in myopic eyes undergoing cataract surgery: Sang Beom Han; Insights Cataract Refract Surg 2026;11(1):1-8. Published online February 26, 2026; DOI: https://doi.org/10.63375/icrs.25.016

Abstract PDF ePub: With ongoing advancements in surgical techniques and intraocular lens (IOLs) technologies, cataract surgery is increasingly recognized as a form of refractive procedure aimed at enhancing overall visual performance rather than being viewed solely as lens extraction. In parallel with this shift, a growing number of aging individuals with myopia are actively seeking spectacle independence following cataract surgery. The selection of IOLs for presbyopia correction in patients with myopia presents distinct clinical and refractive challenges, necessitating careful preoperative evaluation and individualized surgical planning. In this review, the author summarizes current evidence regarding the use of various IOLs, including monofocal, enhanced monofocal, extended depth-of-focus, and multifocal IOLs, for presbyopia correction in myopic patients and discusses key considerations involved in selecting the most appropriate IOL for this specific population.

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Therapeutic effects of diquafosol ophthalmic solution and carbomer eye gel in dry eye patients with lid wiper epitheliopathy: Jong Suk Song, In Ho Woo; Insights Cataract Refract Surg 2026;11(1):9-14. Published online February 26, 2026; DOI: https://doi.org/10.63375/icrs.25.019

Abstract PDF ePub: Purpose
This study aimed to evaluate the therapeutic effects of 3% diquafosol tetrasodium ophthalmic solution (Diquas) and a carbomer-based, lipid-containing eye gel (Liposic, Bausch & Lomb) in dry eye patients with lid wiper epitheliopathy (LWE) that was refractory to topical treatment with conventional artificial tears.
Methods
Thirty-three dry eye patients with LWE of the upper eyelid were treated with 3% diquafosol ophthalmic solution administered six times daily and a carbomer-based, lipid-containing eye gel administered four times daily. After the 2-week treatment period, changes in ocular symptoms were assessed using a visual analog scale (VAS), and changes in ocular signs were evaluated using tear film break-up time (TBUT), corneal staining, and LWE grading.
Results
The mean patient age was 37.58±12.35 years (range, 21–67 years); six patients were male and 27 were female. At baseline, the mean VAS symptom score was 7.18±1.47, and the mean TBUT was 2.78±0.78 seconds. After 2 weeks of treatment, the mean VAS score decreased to 4.87±1.97, and the mean TBUT increased to 3.68±1.08 seconds (both P<0.05). The mean corneal staining score was 1.09±1.50, and the mean LWE grade was 5.76±0.61 at baseline. Following treatment, these values decreased to 0.55±0.83 and 2.24±1.95, respectively (both P<0.05). Among the objective parameters, only the LWE grade showed a significant correlation with the VAS score.
Conclusion
The LWE grade showed a significant correlation with ocular symptoms. Combined treatment with diquafosol ophthalmic solution and a carbomer-based, lipid-containing eye gel demonstrated excellent therapeutic effects in dry eye patients with LWE who were refractory to treatment with conventional artificial tears.

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Impact of anterior chamber depth to axial length ratio on conventional intraocular lens power calculation formulas performance in axial myopia: Youngsub Eom, Jinhwan Park, Youngbin Song, Dong Hyun Kim, Jong Suk Song; Insights Cataract Refract Surg 2026;11(1):15-22. Published online February 26, 2026; DOI: https://doi.org/10.63375/icrs.25.017

Abstract PDF ePub: Purpose
To evaluate the effects of the ratio of anterior chamber depth to axial length (ACD/AL), as well as axial length (AL) itself, on the accuracy of conventional intraocular lens (IOL) power calculation formulas in eyes with axial myopia.
Methods
This retrospective cross-sectional study included 60 eyes from 44 patients with an AL greater than 25.0 mm who underwent uncomplicated phacoemulsification with IOL implantation. Eyes were categorized into high and low AL groups using an AL threshold of 27.0 mm, and into high and low ACD/AL groups based on the median ACD/AL value of 13.4. The median absolute errors (MedAEs) predicted by the Sanders-Retzlaff-Kraff theoretical (SRK/T) and Haigis formulas were compared according to AL and ACD/AL groupings.
Results
In the low ACD/AL group and in the high AL group, the MedAEs predicted by the Haigis formula were lower than those predicted by the SRK/T formula (P=0.002 and P=0.012, respectively). The MedAEs predicted by both the SRK/T and Haigis formulas were significantly lower in the high ACD/AL group than in the low ACD/AL group (P<0.001 and P=0.010, respectively). In contrast, no significant difference was observed between the low and high AL groups in the MedAEs predicted by the Haigis formula. When the ACD/AL ratio was less than 13.4, postoperative refractive outcomes were more hyperopic with both formulas.
Conclusion
In eyes with a long AL and a relatively shallow ACD, the Haigis formula demonstrated superior accuracy among conventional IOL power calculation formulas. Under these anatomical conditions, targeting slightly more myopic postoperative refractions may therefore be advisable.

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Large incisional tear caused by abrupt Bell’s phenomenon during pocket irrigation in femtosecond laser-assisted small incision lenticule extraction: Sang Beom Han; Insights Cataract Refract Surg 2026;11(1):23-25. Published online February 26, 2026; DOI: https://doi.org/10.63375/icrs.25.015

Abstract PDF ePub: Purpose
This study reports a case of a large incisional tear caused by abrupt Bell’s phenomenon during pocket irrigation in femtosecond laser-assisted small incision lenticule extraction (SMILE).
Case
summary: A 28-year-old male patient underwent SMILE surgery. During pocket irrigation of the right eye, Bell’s phenomenon suddenly occurred, resulting in a large inferior arcuate extension of the incision that reached the inferior cap margin. After confirming wound integrity and the absence of additional tissue damage, a bandage contact lens was applied. On postoperative day 7, the incision was self-sealed with intact wound integrity. Three months postoperatively, uncorrected distance visual acuity was 20/20 in both eyes. The right cornea remained stable, although a faint residual scar was observed at the site of the incisional tear.
Conclusion
Abrupt eye movements during pocket irrigation in SMILE can cause large incisional tears. Surgeons should exercise heightened vigilance during irrigation, particularly in anxious or uncooperative patients, to prevent such complications.

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