Insights in Cataract and Refractive Surgery

Clinical results of combined Descemet membrane keratoplasty and cataract operation (triple Descemet membrane keratoplasty) from imported donor corneas: a retrospective study: Hyung Keun Lee, Sung Soo Kang, Jin Suk Chun, So Young Kim, Dong Ihll Lee; Insights Cataract Refract Surg 2025;10(3):83-90. Published online October 31, 2025; DOI: https://doi.org/10.63375/icrs.25.014

Abstract PDF ePub: Purpose
This study reports the clinical outcomes, after triple Descemet membrane endothelial keratoplasty (DMEK) performed using imported corneas.
Methods
A retrospective study was conducted on 30 eyes of 26 patients who underwent Descemet's membrane keratoplasty concurrently with cataract surgery, referred to as triple DMEK, from January 2023 to June 2025. After routine preoperative examinations for keratoplasty as well as cataract surgery, uneventful DMEK surgery was performed concurrently with cataract surgery. All patients visited the clinic at 1, 3, 6, and 12 months after surgery to observe changes, including uncorrected and best spectacle corrected visual acuity, refractive error, corneal thickness, and endothelial cell density.
Results
Preoperatively, 12 of the 30 eyes had Fuchs corneal endothelial dystrophy and 12 had endothelial failure following phakic intraocular lens implantation. The average observation period for the subjects was 437±263 days. After triple DMEK surgery, the patients' uncorrected visual acuity gradually improved from 0.73±0.6 (logMAR) before surgery to 0.65±0.54 at 3 months and 0.29±0.26 at 1 year (P<0.001). The change in corneal thickness was 565.7±70.0 μm before surgery, 535.2±44.2 μm at 3 months after surgery, 549.7±73.5 μm at 6 months, and 535.82±49.0 μm at 12 months, but no statistical significance was found compared to before surgery at any time point (P>0.05). The endothelial cell density was 798±363 cells/mm2 before surgery, 1,479±475 cells/mm2 at 3 months after surgery, 1,456±456 cells/mm2 at 6 months, 1,332±346 cells/mm2 at 12 months, and 1,399±519 cells/mm2 at the last visit (P<0.001).
Conclusion
Triple DMEK surgery, which is performed for various corneal diseases, is relatively safe. No significant endothelial damage, refractive changes, or visual acuity abnormalities were observed up to one year after surgery. Future prospective studies including a larger number of participants are warranted to evaluate the safety and clinical outcomes of triple DMEK using imported corneas.

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Phacoemulsification in patients with diabetes: from preoperative evaluation to postoperative management: Yeoun Sook Chun; Insights Cataract Refract Surg 2025;10(3):65-75. Published online October 31, 2025; DOI: https://doi.org/10.63375/icrs.25.012

Abstract PDF ePub: Diabetes mellitus is one of the most common chronic diseases worldwide and is a leading cause of blindness in patients over the age of 50 years. Patients with diabetes have an elevated risk of developing cataracts compared to individuals without diabetes; furthermore, cataracts also tend to progress more rapidly in this population, leading to the need for surgery at a younger age. This review aims to summarize the key considerations in the management of cataract surgery in patients with diabetes, from preoperative evaluation to postoperative care. Patients with diabetes often present with unstable refractive status, dry eye disease, corneal epithelial defects, and recurrent corneal erosions. They also tend to have reduced corneal endothelial cell density and small pupils, both of which increase the risk of intraoperative complications. Postoperatively, these patients are at risk of developing pseudophakic cystoid macular edema, posterior capsular opacification, endophthalmitis, progression of diabetic retinopathy, and neovascular glaucoma. Patients with long-standing or poorly controlled diabetes face a higher likelihood of postoperative complications, highlighting the importance of regular ophthalmic follow-up examinations. Furthermore, adjunctive treatments such as timely intravitreal injections of anti-vascular endothelial growth factor agents may reduce the risk of vision-threatening complications following cataract surgery.

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Delayed toxic anterior segment syndrome after cataract surgery: a case report: Yeoun Sook Chun; Insights Cataract Refract Surg 2025;10(1):26-31. Published online February 28, 2025; DOI: https://doi.org/10.63375/icrs.25.005

Abstract PDF ePub: Purpose
This report describes an unusual case of delayed toxic anterior segment syndrome (TASS) following cataract surgery and its treatment.
Case
summary: A 55-year-old male patient underwent uneventful phacoemulsification with implantation of an intraocular lens (IOL) and eye patching with ophthalmic ointment at the end of the operation. At 1 week postoperatively, a significant increase in the number of anterior chamber inflammatory cells and multiple gray-white deposits on the anterior surface of IOL were noted. All laboratory tests to exclude infectious endophthalmitis were negative. Under the presumptive diagnosis of delayed TASS, an intensive topical steroid was administered. The number of anterior chamber cells decreased; however, the patient complained of blurry vision and multiple whitish precipitates remained on the IOL. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment was performed to disrupt and remove the precipitates. The deposits were easily and clearly removed using the laser, and there was no recurrence during a 2-year follow-up.
Conclusion
Delayed-onset TASS can manifest as lumpy white inflammatory cell deposits that cannot be controlled with topical steroids. However, Nd:YAG laser treatment can effectively remove inflammatory precipitates.

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