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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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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