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Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 25 June 2026 | Viewed by 7226

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Dr. Janusz Skrzypecki

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Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, 01-756 Warsaw, Poland
Interests: intraocular lens power calculation; cataract surgery; intraocular lens design; EDoF IOLs; multifocal IOLs

Special Issue Information

Dear Colleagues,

Cataract surgery remains one of the most commonly performed and highly successful procedures in modern ophthalmology. Over the past few decades, advancements in surgical techniques, intraocular lens (IOL) technology, and perioperative management have significantly improved patient outcomes, enhancing both safety and visual quality. This Special Issue explores the latest innovations, challenges, and future directions in cataract surgery and IOL development.

Key topics covered in this issue include the following:

Modern Surgical Techniques

Advances in phacoemulsification technology and femtosecond laser-assisted cataract surgery
Innovations in small-incision cataract surgery (SICS) and micro-incision techniques
Evolving strategies for complex cases, including dense cataracts and coexisting ocular conditions

Next-Generation Intraocular Lenses

New IOL materials and surface coatings to improve biocompatibility and reduce complications
Multifocal, extended depth of focus (EDOF), and accommodating IOLs for enhanced visual outcomes
Customizable and light-adjustable IOLs for postoperative refractive fine-tuning

Optimizing Visual Outcomes

Advances in biometry and IOL power calculation formulas for improved refractive accuracy
Management of residual refractive errors and astigmatism correction with Toric IOLs
Patient-reported outcomes and quality-of-life improvements following cataract surgery

Perioperative and Postoperative Management

Strategies to prevent and manage intraoperative complications
Innovations in postoperative care, including anti-inflammatory regimens and novel drug delivery systems
Long-term IOL performance, posterior capsule opacification (PCO) prevention, and secondary interventions

Future Perspectives in Cataract Surgery

Artificial intelligence and machine learning applications in surgical planning and outcome prediction
Robotics and automation in cataract surgery
Potential impact of gene therapy and regenerative medicine in lens restoration

This Special Issue provides a comprehensive review of the latest developments in cataract surgery and intraocular lenses, offering valuable insights for ophthalmic surgeons, researchers, and industry professionals. By bridging current research with clinical practice, we aim to highlight the evolving landscape of cataract treatment and pave the way for future innovations that enhance patient care.

Dr. Janusz Skrzypecki
Guest Editor

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Keywords

cataract surgery
intraocular lens power calculation
intraocular lenses
EDoF IOL
multifocal IOL
monofocal IOL
laser refractive surgery

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Published Papers (7 papers)

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Research

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10 pages, 627 KB

Open AccessArticle

Speculum-Induced Intraocular Pressure Elevation During Cataract Surgery and Its Association with Axial Length: A Retrospective Clinical Study

by Hisaharu Suzuki

J. Clin. Med. 2026, 15(7), 2520; https://doi.org/10.3390/jcm15072520 - 26 Mar 2026

Viewed by 124

Abstract

Background/Objectives: This study aimed to characterize eyelid speculum-induced intraocular pressure (IOP) elevation during cataract surgery and identify ocular biometric factors that stratify susceptibility to this pressure response. This study was conducted at Zengyo Suzuki Eye Clinic, Kanagawa, Japan. Methods: In this retrospective observational study, we analyzed 100 eyes that underwent routine cataract surgery. IOP was measured immediately before and within 10 s of speculum opening in the seated position using a rebound tonometer. The eyelid speculum was opened to a maximal opening position, and the opening width was recorded. Biometric parameters included axial length (AL), central corneal thickness, white-to-white distance, anterior chamber depth, and temporal angle-opening distance. Associations between IOP elevation and biometric factors were analyzed. IOP elevation rate was quantified as the percentage increase from baseline. The discriminatory performance of axial length was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 100 patients (100 eyes) were included in the analysis. Mean IOP increased significantly from 15.75 ± 2.77 mmHg before speculum placement to 21.42 ± 5.54 mmHg after placement. The mean IOP elevation rate was 36.0 ± 27.4%. Shorter AL was consistently associated with a greater proportional IOP elevation. ROC analysis demonstrated consistent stratification of IOP elevation susceptibility by AL (area under the curve [AUC] = 0.645), with eyes shorter than 23.84 mm showing greater pressure elevation (sensitivity, 73.1%; specificity, 56.0%). Eyes in the upper quartile of the IOP elevation rate exhibited relatively greater pressure elevation. Conclusions: Eyelid speculum placement imposes a clinically meaningful IOP load during cataract surgery, with shorter ALs making eyes more biomechanically susceptible to IOP elevation. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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20 pages, 955 KB

Open AccessArticle

Impact of Flap Thickness on Refractive Outcomes and Corneal Biomechanics Following Myopic Femtosecond Laser-Assisted LASIK

by Joanna Wierzbowska, Marcin Smorawski, Janusz Sierdziński, Łukasz Stróżecki and Anna Maria Roszkowska

J. Clin. Med. 2026, 15(5), 1923; https://doi.org/10.3390/jcm15051923 - 3 Mar 2026

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Abstract

Background/Objectives: Femtosecond laser-assisted LASIK (FS-LASIK) is currently the most commonly performed procedure for the correction of myopia and myopic astigmatism. However, it inherently weakens the biomechanical integrity of the cornea due to flap creation and stromal ablation. This prospective study aimed to compare refractive and corneal biomechanical parameters after myopic FS-LASIK with different flap thicknesses and to identify parameters that may influence the change in corneal biomechanics after surgery. Methods: A total of 246 eyes were enrolled and divided into two groups based on flap thickness: 110 µm (n = 129) and 140 µm (n = 117). All procedures were performed using a femtosecond LDV Ziemer laser and standardized ablation profiles with similar ablation depths. Visual acuity, refractive outcomes, and corneal biomechanical parameters—corneal hysteresis (CH) and corneal resistance factor (CRF)—were assessed preoperatively and during a 6-month follow-up using the Ocular Response Analyzer (ORA). Multivariate regression analysis was used to identify predictors of biomechanical change. Results: The groups did not differ in preoperative values of the mean refractive spherical equivalent, keratometry, central corneal thickness, CH and CRF. At 6 months, both groups achieved comparable refractive outcomes, with no significant differences in uncorrected or corrected distance visual acuity, efficacy index and safety index. However, the thicker flap group exhibited significantly greater reductions in CH (−2.89 vs. −2.04 mmHg, p < 0.05) and CRF (−3.61 vs. −2.77 mmHg, p < 0.05), as well as greater biomechanical weakening per micron of ablation. Multivariate regression identified anterior weighted biomechanical index (AWBI) and flap thickness as the strongest predictors of CH reduction, while flap thickness, residual stromal bed thickness, ablation depth, and central corneal thickness contributed to CRF changes. Conclusions: While FS-LASIK with both flap thicknesses achieved equally effective visual outcomes, thicker flaps were associated with significantly greater biomechanical weakening. Flap thickness had a stronger influence on corneal biomechanics than ablation depth. These findings support consideration of flap thickness in surgical planning to optimize corneal biomechanical stability. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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12 pages, 631 KB

Open AccessArticle

The Effect of Dry Eye Disease Treatment Prior to Cataract Surgery on Refractive Error Reduction

by Katarzyna Biela, Mateusz Winiarczyk, Beata Gumieniak-Goch and Jerzy Mackiewicz

J. Clin. Med. 2026, 15(4), 1640; https://doi.org/10.3390/jcm15041640 - 21 Feb 2026

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Abstract

Background/Objectives: Dry-eye disease (DED) is a disorder of the eye surface associated, among other things, with tear film instability. It can lead to abnormal biometry results, especially with respect to keratometry. DED is more common in the elderly population. Its prevalence is often underestimated. Failure to provide adequate treatment prior to biometry may result in refractive errors after cataract surgery. The purpose of this study was to quantify the impact of DED on refractive predictability in cataract surgery and assess whether short, preoperative ocular-surface optimization reduces the mean absolute error (MAE) of postoperative refraction, regardless of DED. Methods: Seventy patients undergoing cataract surgery were divided into three groups: A—individuals with DED who were receiving treatment; B—individuals without DED who were receiving treatment; and C—a control group. In all groups, biometry was performed twice, before and after treatment (groups A and B) or at two-week intervals without treatment (group C). All of the individuals underwent cataract surgery. Refractive error was calculated one month after surgery for both biometry measurements (before and after treatment). Results: After dry eye treatment, a reduction in refractive error was achieved in both groups with and without DED. The MAE in the group with DED was 0.39 ± 0.31 vs. 0.27 ± 0.30 (p < 0.001), and the MAE for those without DED was 0.30 ± 0.25 vs. 0.24 ± 0.20 (p = 0.043). No significant differences in biometric measurements were observed in any of the groups. The most variable parameter was corneal astigmatism in the DED group. Conclusions: Proper preparation of the eye surface for biometric measurement reduces refractive errors after surgery. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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18 pages, 1750 KB

Open AccessArticle

Preoperative Diquafosol vs. Intense Pulsed Light with Gland Expression for MGD: Effects on Refractive Accuracy and Tear Film Stability in Cataract Surgery

by Takeshi Teshigawara, Tatsukata Kawagoe, Yuki Mizuki, Miki Akaishi, Takuto Sakono, Kazuro Yabuki, Seiichiro Hata, Akira Meguro and Nobuhisa Mizuki

J. Clin. Med. 2025, 14(24), 8946; https://doi.org/10.3390/jcm14248946 - 18 Dec 2025

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Objectives: To compare the effects of two preoperative dry eye treatments—3% diquafosol sodium (DQS) and intense pulsed light with meibomian gland expression (IPL-MGX)—on refractive accuracy in cataract surgery and identify tear break-up time (TBUT) thresholds predictive of refractive success. Methods: In this prospective, paired-eye study, 62 patients (124 eyes) with meibomian gland dysfunction underwent bilateral cataract surgery with the same trifocal intraocular lens. One eye received DQS, while the fellow eye underwent four IPL-MGX sessions before biometry. Postoperative absolute prediction error (P-SE) was compared. TBUT and higher-order aberrations (HOAs) were evaluated. Logistic regression identified predictors of refractive accuracy, and receiver operating characteristic (ROC) analysis assessed the predictive value of TBUT for P-SE thresholds of <0.25 D and <0.50 D. Results: P-SE was significantly lower in IPL-MGX–treated eyes than in DQS-treated eyes (mean paired difference −0.11 D, p < 0.001). Success rates within <0.25 D and <0.50 D were higher with IPL-MGX (p < 0.01). TBUT and HOAs were predictors in univariate models, but only TBUT remained significant in the multivariable analysis (odds ratio, 4.90 per 1-s increase; 95% confidence interval, 1.92–12.51; p < 0.001). ROC analysis supported TBUT cutoffs of 7 s (<0.25 D) and 6 s (<0.50 D). Conclusions: IPL-MGX may improve refractive accuracy compared to DQS. TBUT appeared to be the most consistent predictor, and achieving ≥6 s was associated with higher likelihood of refractive success. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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15 pages, 1307 KB

Open AccessArticle

Does DeepSeek Provide Clinically Acceptable Intraocular Lens (IOL) Power Predictions in Cataract Surgery? A Proof-of-Concept Study

by Giovanni Ottonelli, Giacomo De Rosa, Jacopo Celada Ballanti, Alessandro Gaeta, Paolo Vinciguerra and Alessandra Di Maria

J. Clin. Med. 2025, 14(24), 8870; https://doi.org/10.3390/jcm14248870 - 15 Dec 2025

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Abstract

Background/Objectives: Accurate intraocular lens (IOL) power calculation is vital for achieving the desired postoperative spherical equivalent (SE) in cataract surgery. Generative Artificial-Intelligence (AI) systems are increasingly being used in ophthalmology to refine diagnostic and surgical planning. However, it is still unknown whether a low-cost, easily accessible generative AI model like DeepSeek can match the accuracy of conventional biometric formulas. To evaluate the accuracy of DeepSeek, an open-source generative artificial intelligence (AI), in predicting postoperative refractive spherical equivalent compared to the Barrett Universal II formula in uncomplicated cataract surgeries. Methods: This study analyzed biometric data from 50 eyes of 50 patients who underwent cataract surgery between July 2024 and January 2025 at Humanitas Research Hospital in Milan, Italy. Only uncomplicated cases of emmetropia with Alcon AcrySof^® SA60WF IOL implantation were included. 30–40 days postoperative subjective refraction was measured with a calibrated trial-frame and 6 m logMAR chart by an experienced optometrist. Prediction error (PE), median absolute error (MedAE), standard deviation (SD), and cumulative frequency of PE diopters range were calculated. A Wilcoxon signed-rank test was performed to assess statistical significance. Results: Barrett showed MedAE 0.36 D [0.16–0.64] and MAE 0.43 D (95% CI, 0.34–0.52) while DeepSeek-R1 showed MedAE 0.76 D [0.52–1.01] and MAE 0.77 D (95% CI, 0.67–0.87). Cumulative accuracy (AE threshold) at ±0.25/±0.50/±0.75/±1.00/±1.25/±1.50/±1.75 D was 37.7/71.7/81.1/92.5/100.0/100.0/100.0% for Barrett Universal II and 11.1/25.9/50.0/74.1/88.9/96.3/100.0% for DeepSeek-R1 (McNemar p < 0.01 at each threshold). The paired comparison of per-eye absolute errors favored Barrett (Wilcoxon signed-rank test, p < 0.0001). Conclusions: In this cohort, Barrett Universal II outperformed DeepSeek-R1 across MedAE/MAE and cumulative accuracy thresholds, with a significant paired difference. A general-purpose generative model used off-the-shelf (fixed A-constant, no ophthalmology-specific tuning) did not match the accuracy of a validated vergence-based formula; established formulas remain the reference standard for clinical IOL power calculation. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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17 pages, 1917 KB

Open AccessArticle

Visual Outcomes of a Non-Diffractive Extended Depth-of-Focus Intraocular Lens in Patients with Early-Stage Age-Related Macular Degeneration

by Emilio Dorronzoro-Ramirez, Miguel Angel Sanchez-Tena, Cristina Alvarez-Peregrina, Jose Miguel Cardenas Rebollo, Dayan Flores Cervantes and Celia Sánchez-Ramos

J. Clin. Med. 2025, 14(17), 5953; https://doi.org/10.3390/jcm14175953 - 23 Aug 2025

Viewed by 1945

Abstract

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of visual impairment in older adults and often coexists with cataracts. The indication of presbyopia-correcting intraocular lenses (IOLs) in these patients remains controversial. This study aimed to evaluate the clinical performance of a non-diffractive extended depth-of-focus (EDOF) IOL (LuxSmart™) compared to a monofocal plus IOL (Tecnis Eyhance™) in cataract patients with early-stage dry AMD. Methods: In this prospective observational study, 41 patients with early-stage AMD underwent bilateral cataract surgery with either LuxSmart™ or Tecnis Eyhance™ IOL implantation, targeting postoperative emmetropia. The eye selected for analysis was the first eye scheduled for surgery. Preoperative and postoperative evaluations included high and low-contrast distance visual acuity, intermediate and near visual acuity, defocus curves, ocular light scatter (halometry), and quality of life assessment (NEI VFQ-25). Postoperative biometric accuracy and refractive outcomes were also analyzed. Results: Both IOLs showed high refractive accuracy, with 100% of eyes within ±0.50 D of target. Postoperative uncorrected distance visual acuity was 0.10 ± 0.06 LogMAR for Eyhance and 0.07 ± 0.02 for LuxSmart (p = 0.06). Low contrast VA at 20% was 0.22 ± 0.11 (Eyhance) and 0.26 ± 0.16 (LuxSmart) (p = 0.49). Depth of focus was approximately 1.75 D for both lenses. Light scatter (LDI) improved postoperatively in both groups with no significant differences (p = 0.54). VFQ-25 scores showed improvement in daily activities, though no changes were observed in driving or mental health domains. Conclusions: Both lenses are safe and effective options for early AMD patients undergoing cataract surgery, providing good functional vision at multiple distances Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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Review

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50 pages, 632 KB

Open AccessReview

Current Trends in Presbyopia Correction—A Comprehensive Review

by Ewelina Trojacka, Joanna Przybek-Skrzypecka, Janusz Skrzypecki, Jacek P. Szaflik and Justyna Izdebska

J. Clin. Med. 2026, 15(1), 215; https://doi.org/10.3390/jcm15010215 - 27 Dec 2025

Viewed by 2351

Abstract

Presbyopia is a physiological phenomenon and one of the leading factors contributing to decreased near visual acuity. The prevalence of presbyopia, its social and economic consequences and the prolongation of human life place the correction of presbyopia among the top challenges in modern ophthalmology. Despite the numerous methods currently available for correcting presbyopia, there is still no ideal technique that, by restoring the eye’s age-related loss of physiological accommodation, would provide long-term effectiveness without adverse effects. This article offers an overview of the existing knowledge on the etiology of presbyopia and the available methods of its correction, with particular emphasis on refractive surgery techniques. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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