**Contents**


Reprinted from: *J. Clin. Med.* **2022**, *11*, 3867, doi:10.3390/jcm11133867 ................ **67**


## **Preface to "Current Challenges and Advances in Cataract Surgery"**

I have organized this Special Issue to discuss appropriate IOL formulas, the proper use of special intraocular lenses, and the current status of cataract surgery for special ocular situations, and invited research papers. We received a number of submissions and, through detailed peer review, we were able to carefully select excellent research papers for publication.

Chang et al. collected aqueous humor during cataract surgery and, by examining this, showed that the alpha-2-HS-glycoprotein, called fetuin-a, could be a potential aqueous 35 biomarker associated with DM and smoking, which are cataract risk factors.

The new IOL power calculation formula for post-LASIK eyes by Iida et al. is considered a very useful study in the context of the increasing number of post-refractive cataract surgery patients. The comments of Cione et al. on this paper and the response of Iida et al. must also be of interest to the reader. Similarly, we believe that the IOL power calculation after SMILE is also information that will be needed in the future. Lischke et al. reported that the ray-tracking method showed superior predictability in IOL power calculation over empirically optimized IOL power calculation formulae that were originally intended for use after Excimer-based keratorefractive procedures. The improvement in postoperative visual quality is an important and unavoidable issue in current cataract surgery, and the report by Brunner et al. on the more accurate calculation and insertion of toric IOLs is very informative. A problem that has been vexing many surgeons is IOL calculation in highly myopic or long-axis eyes. The reports of Moshirfar et al. and Omoto et al. must be of grea<sup>t</sup> help to surgeons. The study by Yoo et al. on the most effective lens position according to preoperative axis length is also very interesting.

The surgical method demonstrated by Sandali et al., which applies the 3D system to patients who have difficulty lying supine during surgery, should be a bright light for patients and their families who have given up on surgery. The review by Toro et al. shows that intraoperative anterior segment, OCT, is not only useful for novel surgeons, but is also a useful tool for education on and managemen<sup>t</sup> of the complicated cases of cataract surgery for expert surgeons. Scleral-fixated occurs when in-the-bag IOL fixation fails for some reason, but it is also possible that the IOL fixation is unstable, resulting in reduced visual function. Chen YL et al. provide an in-depth discussion of this. The study by Dołowiec-Kwapisz et al. of the spectacle dependence of EDOF and the photic phenomenon provides important information when recommending this type of IOL to patients. A thorough preoperative explanation of the degree of dependence on spectacle would avoid unnecessary problems due to decreased postoperative satisfaction. FLAC is attracting attention as the next generation of cataract surgery, but various problems have been pointed out. Dry eyes are one of them. Chen WT et al. point out this problem by conducting a meta-analysis. As mentioned above, the papers discuss a variety of topics, from preoperative to intraoperative and postoperative, and I believe that this is a very interesting Special Issue.

Finally, I would like to express my sincere respect to all the authors, who submitted excellent papers, and to the reviewers who took the trouble to review them.

> **Nobuyuki Shoji** *Editor*

#### *Article* **Proteomic Analysis of Aqueous Humor Proteins in Association with Cataract Risks: Diabetes and Smoking**

**Wei-Cheng Chang 1,2, Cho-Hao Lee 3, Shih-Hwa Chiou 4,5,6,7, Chen-Chung Liao 8 and Chao-Wen Cheng 1,9,10,\***



**Abstract:** Cataracts are one of the most common eye diseases that can cause blindness. Discovering susceptibility factors in the proteome that contribute to cataract development would be helpful in gaining new insights in the molecular mechanisms of the cataract process. We used label-free nanoflow ultra-high-performance liquid chromatography–tandem mass spectrometry to compare aqueous humor protein expressions in cataract patients with different cataract risk factors such as diabetes mellitus (DM) and smoking and in controls (with cataract) without risk exposure. Eight patients with diabetes and who smoked (with double risk factors), five patients with diabetes and five patients who smoked (both with a single risk factor), and nine aged-matched cataract controls patients (non-risk exposure) were enrolled. In total, 136 aqueous humor proteins were identified, of which only alpha-2-Heremans–Schmid (HS)-glycoprotein was considered to be significantly riskassociated because it was differentially expressed in these three groups and exhibited increased expression with increasing risk factors. Significant changes in the aqueous humor level of alpha-2- HS-glycoprotein between DM and control samples and between smoking and control samples were confirmed using ELISA. The alpha-2-HS-glycoprotein, called fetuin-a, could be a potential aqueous biomarker associated with DM and smoking, which were cataract risk factors.

**Keywords:** aqueous humor; label free; cataract; risk factor; proteomics; alpha-2-HS-glycoprotein; fetuin-A
