Insights in Cataract and Refractive Surgery

The effect of 2% rebamipide ophthalmic solution on early dry eye after SMILE surgery: a retrospective study: Jin Hyoung Kim, Mu Yan Kim, Young A Kwon, Sung Wook Park, Sung Won Byun, Seong Woo Lee, Sung Hyup Lim; Insights Cataract Refract Surg 2025;10(3):91-102. Published online October 31, 2025; DOI: https://doi.org/10.63375/icrs.25.013

Abstract PDF ePub: Purpose
The aim of this study was to investigate the effect of rebamipide 2% ophthalmic solution on early dry eye following small incision lenticule extraction (SMILE) surgery by analyzing dry eye indicators before and after the procedure.
Methods
In this retrospective study, an initial sample of 372 SMILE surgery patients were divided into a rebamipide group (artificial tears and 2% rebamipide) and a control group (artificial tears only). Changes in dry eye indicators, including the Ocular Surface Disease Index (OSDI), corneal fluorescein staining (CFS) score, tear meniscus height (TMH), tear break-up time (TBUT), and dry eye classification, were analyzed at 2 and 4 weeks postoperatively in comparison with the preoperative baseline.
Results
In total, 250 patients (250 eyes) were selected: 135 in the rebamipide group and 115 in the control group. Preoperative characteristics such as gender, age, spherical equivalent refraction, ablation depth, and optical zone size showed no significant differences between the two groups. Both groups demonstrated a significant increase in OSDI and CFS scores at 2 weeks postoperatively, followed by a decrease at 4 weeks, with no significant differences between groups. TMH increased significantly in the rebamipide group at 2 and 4 weeks (P=0.043, P=0.004), but showed no significant change in control group or intergroup difference. No significant difference was found in the first TBUT between the two groups at any time point, but the average TBUT significantly and rapidly increased from 2 to 4 weeks postoperatively in the rebamipide group (P=0.001). The dry eye classification was significantly lower in the rebamipide group at 4 weeks postoperatively (P=0.014).
Conclusion
The use of rebamipide 2% ophthalmic solution immediately after SMILE surgery is expected to be helpful in treating early postoperative dry eye, as it increased TMH and TBUT starting from 2 weeks postoperatively.

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Results of multifocal intraocular lens implantation in patients who underwent corneal refractive surgery: Eun Chul Kim; Insights Cataract Refract Surg 2025;10(3):76-82. Published online October 31, 2025; DOI: https://doi.org/10.63375/icrs.25.011

Abstract PDF ePub: Purpose
The aim of this study was to evaluate the clinical results of multifocal intraocular lenses in patients who underwent corneal refractive surgery.
Methods
Thirty eyes (16 patients; Synergy: ZFR00V) were retrospectively enrolled. Uncorrected and corrected near visual acuity (UNVA, CNVA), intermediate visual acuity (UIVA, CIVA), and distant visual acuity (UDVA, CDVA), manifest refraction spherical equivalent (MRSE), and satisfaction score were assessed before and after surgery.
Results
The postoperative UDVA, UIVA, UNVA, and MRSE of the three groups exhibited improvements compared to the preoperative data (P<0.05). The error between the postoperative refraction and the intraocular lens calculation was smaller with the Barrett True K formula than with the Haigis-L formula (P<0.05). The defocus curve at 0 diopter (D) increased, from –1 to –1.5 D, and from –2.5 to –4.0 D, indicating improved vision at distant, intermediate, and near distances. Distance satisfaction (1.47±0.63), near satisfaction (1.25±0.71), and overall satisfaction (1.36±0.42) were good, but light scattering and halo satisfaction (1.97±0.85) yielded a poor result.
Conclusion
In patients with cataracts who underwent corneal refractive surgery, multifocal intraocular lens implantation resulted in excellent uncorrected visual acuity at distant, intermediate, and near distances. However, careful consideration should be given to patient selection due to the incidence of side effects such as glare and halos.

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Trabecular microbypass using iStent combined with cataract surgery: Yeoun Sook Chun; Insights Cataract Refract Surg 2025;10(2):42-51. Published online June 30, 2025; DOI: https://doi.org/10.63375/icrs.25.007

Abstract PDF ePub: Minimally invasive glaucoma surgery has revolutionized conventional glaucoma treatment due to its simple procedures, rapid recovery, and few complications. iStent, a trabecular microbypass that can be implanted via combined cataract surgery, has the advantage of lowering intraocular pressure (IOP) independent of bleb formation. Furthermore, it is straightforward to implement and does not involve a substantial burden. iStent has a synergetic effect with phacoemulsification. Combining iStent with phacoemulsification yielded a greater reduction of IOP and glaucoma eyedrops, as well as higher rates of visual field change, than when either modality was used in isolation. iStent has emerged as a new treatment option for patients with mild to moderate glaucoma. This review aims to improve readers’ understanding of iStent by summarizing the surgical techniques needed to correctly insert it for optimal outcomes and discussing problem-solving in the context of patient care.

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Visual and refractive outcomes of keratorefractive lenticule extraction using VISUMAX 800 (SMILE Pro) to correct myopia in Koreans: a 3-month follow-up study: Sang-Mok Lee, Si-Hoon Park, Tae Keun Yoo, Jae Hyoung Park, Beom Jin Cho, Kee Yong Choi, Jong Woo Kim; Insights Cataract Refract Surg 2025;10(1):13-18. Published online February 28, 2025; DOI: https://doi.org/10.63375/icrs.25.004

Abstract PDF ePub: Purpose
The aim of this study was to report the clinical outcomes of SMILE Pro surgery in Korean myopia patients.
Methods
A retrospective analysis was conducted on the medical records of 90 patients (178 eyes) who underwent SMILE Pro surgery at our institution between October 2023 and June 2024 and were followed for 3 months postoperatively.
Results
Preoperative best corrected visual acuity was 0.009±0.020 (logarithm of the minimum angle of resolution). The average spherical equivalent was –5.13±2.16 diopters (range, –1.00 to –10.10 diopters), and the average astigmatism was –1.21±0.91 diopters (range, 0 to –4.0 diopters). Postoperatively, the uncorrected distance visual acuity at 1 day, 1 week, 1 month, and 3 months were 0.061±0.054, 0.013±0.027, 0.009±0.023, 0.005±0.021, respectively. At 3 months postsurgery, the predictive accuracy for spherical equivalent was 100% within ±0.5 diopters and 98.9% within ±0.25 diopters. For astigmatism, the predictive accuracy was 97.2% within ±0.25 diopters and 99.4% within ±0.5 diopters 97.2% and 99.4%. The scores for the efficacy and safety of refractive surgery at 3 months were both 1.01±0.05.
Conclusion
SMILE Pro surgery for myopia correction in Korean patients demonstrated excellent efficacy, safety, and predictive accuracy, with no significant difference compared to conventional SMILE surgery.

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$Insights Cataract Refract Surg : Insights in Cataract and Refractive Surgery$

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