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Advanced Approaches to Cataract and Refractive Surgery
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Advanced Approaches to Cataract and Refractive Surgery

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

Deadline for manuscript submissions: closed (18 February 2025) | Viewed by 4220

Special Issue Editor

Dr. Majid Moshirfar

E-Mail Website
Guest Editor
Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
Interests: ReLEx; LASIK; SMILE; implantable collamer lens; Verisyse lens; multifocal IOL; trifocal IOL corneal inlay; corneal lenticule; CLEAR; cataract surgery; excimer laser; femtosecond laser
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to announce the launch of our new, upcoming Special Issue “Advanced Approaches to Cataract and Refractive Surgery”, which will feature in the Journal of Clinical Medicine. The following topics listed below are some that will be of interest to our readers:

  • Subjective and objective outcome analysis of newer models of diffractive and refractive multifocal IOLs (PanOptix, Synergy, Symfony, Odyssey, and others);
  • Allogeneic corneal stromal tissue for augmentation in ectasia;
  • Corneal inlays and onlays for the management of presbyopia and hyperopia;
  • Cataract surgery in patients with a history of phakic IOLs (anterior and posterior chamber);
  • Visual comparisons of all existing platforms concerning ReLEx;
  • Comparing outcomes, tilt/centration, and complications of the sutureless Yamani technique, the modified Yamani technique, glued IOLs, and sutured IOLs;
  • Clinical outcomes of newer ICL models for the correction of presbyopia;
  • Utilization and impact of artificial intelligence in corneal refractive surgery;
  • Utilization of new IOL calculators for patients with a history of corneal refractive surgery.

While some innovations may not succeed in the clinical setting, others will, and there is always room for improvement in preventive or curative clinical management. I invite cornea specialists, residents, general ophthalmologists, optometrists, clinical vision scientists, and those working in biocompatible materials sciences to contribute articles to this Special Issue. I welcome retrospective and prospective studies, case series, and research on relatively novel cataract and corneal refractive surgeries and their outcomes.

Eye professionals aim to maintain and improve eye health and prevent eye diseases. It is essential to advance our understanding of innovative corneal biomaterials, platforms, and procedures. This effort benefits patients, the public, medical practitioners, and eye health providers. Let us focus on contributing to this knowledge for the betterment of eye care.

Dr. Majid Moshirfar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ReLEx
  • LASIK
  • SMILE
  • implantable collamer lens
  • Verisyse lens
  • multifocal IOL
  • trifocal IOL corneal inlay
  • corneal lenticule
  • CLEAR
  • cataract surgery
  • excimer laser
  • femtosecond laser

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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12 pages, 212 KiB  
Article
Corneal Endothelial Cell Loss in Shallow Anterior Chamber Eyes After Phacoemulsification Using the Eight-Chop Technique
by Tsuyoshi Sato
J. Clin. Med. 2025, 14(9), 3045; https://doi.org/10.3390/jcm14093045 - 28 Apr 2025
Viewed by 252
Abstract
Objectives: In this study, the correlation between anterior chamber depth (ACD) and corneal endothelial cell density (CECD) loss was evaluated, and an assessment was made of the safety and efficacy of the eight-chop technique in cataract surgery for patients with shallow anterior chamber [...] Read more.
Objectives: In this study, the correlation between anterior chamber depth (ACD) and corneal endothelial cell density (CECD) loss was evaluated, and an assessment was made of the safety and efficacy of the eight-chop technique in cataract surgery for patients with shallow anterior chamber (SAC) depth. Methods: The technique was applied to patients with SAC and normal ACD, defined as <3 mm and ≥3 mm, respectively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), CECD, coefficient of variation, percentage of hexagonal cells, and central corneal thickness were assessed pre- and postoperatively. Operative time, phaco time, aspiration time, cumulative dissipated energy (CDE), and volume of fluid used were recorded intraoperatively. Results: A total of 180 eyes from 99 patients (mean age, 74.8 ± 5.1 years; 28 men, 71 women) were analyzed. In the SAC group, the mean operative time, phaco time, aspiration time, CDE, and volume of fluid used were 4.7 min, 15.4 s, 65.6 s, 5.87, and 26.6 mL, respectively, demonstrating favorable surgical metrics. CECD loss was 1.3% at 7 weeks, 1.1% at 19 weeks, and 0.9% at 1 year, with no significant decrease after surgery in the SAC group. No correlation was observed between CECD loss and ACD in either group. Conclusions: These findings suggest that the eight-chop technique is a minimally invasive and effective approach that preserves corneal endothelial integrity, even in patients with SAC depth. Full article
(This article belongs to the Special Issue Advanced Approaches to Cataract and Refractive Surgery)
11 pages, 716 KiB  
Article
Minimizing Endothelial Cell Loss in Hard Nucleus Cataract Surgery: Efficacy of the Eight-Chop Technique
by Tsuyoshi Sato
J. Clin. Med. 2025, 14(8), 2576; https://doi.org/10.3390/jcm14082576 - 9 Apr 2025
Viewed by 317
Abstract
Objectives: To estimate the efficacy of the eight-chop technique in phacoemulsification surgeries for patients with hard nucleus cataracts by investigating the reduction of corneal endothelial cell density (CECD) after phacoemulsification and intraoperative parameters. Methods: Patients were categorized into three groups (Grade [...] Read more.
Objectives: To estimate the efficacy of the eight-chop technique in phacoemulsification surgeries for patients with hard nucleus cataracts by investigating the reduction of corneal endothelial cell density (CECD) after phacoemulsification and intraoperative parameters. Methods: Patients were categorized into three groups (Grade IV, IV plus, and V) according to the hardness of their lens nuclei. Surgeries were performed using the eight-chop technique. Key intraoperative metrics (operative time, phaco time, aspiration time, cumulative dissipated energy [CDE], and fluid volume used) were measured. Pre- and postoperative assessments included corrected-distance visual acuity, intraocular pressure (IOP), central corneal thickness, variation in the size of the endothelial cells, percentage of hexagonal cells, and CECD. Results: Overall, 89 eyes from 67 patients with cataracts were evaluated. The mean operative time, phaco time, aspiration time, CDE, and fluid volume used across Grades IV, IV plus, and V were 10.5 min, 38.9 s, 135.6 s, 19.2, and 53.0 mL, respectively. At 19 weeks postoperatively, the CECD decreased by 0.2%, 6.8%, and 9.6% for Grades IV, IV plus, and V, respectively, with an average decrease of 3.7%. Significant reductions in postoperative IOP were observed across all groups compared with preoperative IOP (p < 0.01). Loss of CECD significantly correlated with phaco time, CDE, and fluid volume (p = 0.027, p < 0.01, and 0.034, respectively). Conclusions: The eight-chop technique in phacoemulsification for hard nucleus cataracts resulted in minimal CECD loss. It may provide an effective surgical solution for patients with hard nucleus cataracts. Full article
(This article belongs to the Special Issue Advanced Approaches to Cataract and Refractive Surgery)
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10 pages, 1243 KiB  
Article
Eight-Chop Technique in Phacoemulsification Using Iris Hooks for Patients with Cataracts and Small Pupils
by Tsuyoshi Sato
J. Clin. Med. 2024, 13(23), 7298; https://doi.org/10.3390/jcm13237298 - 30 Nov 2024
Cited by 2 | Viewed by 865
Abstract
Objectives: This study investigated the efficacy and safety of performing phacoemulsification using the eight-chop technique with iris hooks in patients with small pupils. Methods: The iris hooks and control groups each included 65 eyes. Cataract surgeries were performed using the eight-chop technique. [...] Read more.
Objectives: This study investigated the efficacy and safety of performing phacoemulsification using the eight-chop technique with iris hooks in patients with small pupils. Methods: The iris hooks and control groups each included 65 eyes. Cataract surgeries were performed using the eight-chop technique. The operative time, phaco time, aspiration time, cumulative dissipated energy, and volume of fluid used were measured. Best-corrected visual acuity, corneal endothelial cell density (CECD), and intraocular pressure (IOP) were measured preoperatively and postoperatively. Results: In total, 130 eyes of 107 patients (mean age, 75.9 ± 7.1 years; 58 men, 72 women) with cataracts were evaluated. The mean operative time, phaco time, aspiration time, cumulative dissipated energy, and volume of fluid used were 10.6 min, 20.7 s, 101.1 s, 7.8, and 38.0 mL, respectively, in the iris hooks group and 4.6 min, 16.2 s, 72.1 s, 7.0, and 28.9 mL, respectively, in the control group. The decrease in CECD at 19 weeks postoperatively was 2.1% and 1.2% for the iris hooks and control groups, respectively. In both groups, IOP decreased significantly (all p < 0.01) at 7 and 19 weeks postoperatively. No intraoperative complications were found in either group. Conclusions: The eight-chop technique using iris hooks resulted in a small postoperative reduction in CECD and excellent values for intraoperative outcome measures. In addition, those cataract surgeries were very short, efficient, and safe, without complications. The eight-chop technique using iris hooks could provide an ideal solution for patients with small pupils. Full article
(This article belongs to the Special Issue Advanced Approaches to Cataract and Refractive Surgery)
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10 pages, 10582 KiB  
Article
Visual Prognosis Following Cataract Surgery in Highly Myopic Patients with Prior History of Verisyse Phakic Intraocular Lens Implantation
by Bosten A. Loveless, Kayvon A. Moin, Majid Moshirfar, Tyler V. Olson and Phillip C. Hoopes
J. Clin. Med. 2024, 13(16), 4760; https://doi.org/10.3390/jcm13164760 - 13 Aug 2024
Cited by 1 | Viewed by 1308
Abstract
Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. [...] Read more.
Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction. Full article
(This article belongs to the Special Issue Advanced Approaches to Cataract and Refractive Surgery)
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21 pages, 1270 KiB  
Systematic Review
Contrast Sensitivity and Stereopsis Outcomes Following LASIK Presbyopia Correction Based on the Corneal Aberration Modulation or Corneal Multifocality Induction Methods: A Systematic Review
by Joanna Wierzbowska, Zofia Pniakowska and Anna M. Roszkowska
J. Clin. Med. 2025, 14(3), 871; https://doi.org/10.3390/jcm14030871 - 28 Jan 2025
Viewed by 1072
Abstract
Background. Modern laser vision correction for presbyopia treatment involves non-linear aspheric corneal ablation with the controlled induction of spherical aberration modulation to extend the depth of focus or corneal multifocality induction methods with or without micro-monovision in the non-dominant eye to provide [...] Read more.
Background. Modern laser vision correction for presbyopia treatment involves non-linear aspheric corneal ablation with the controlled induction of spherical aberration modulation to extend the depth of focus or corneal multifocality induction methods with or without micro-monovision in the non-dominant eye to provide continuous clear vision across distances. Anisometropia and the new higher-order aberrations pattern may be potential risk factors for postoperative stereopsis and contrast sensitivity (CS) deterioration. Purpose. The objective of this systematic review was to assess articles published until 2023 in which CS and/or stereopsis were reported following LASIK presbyopia treatment. Methods. We searched the PubMed, Scopus and Web of Science databases in accordance with the PRISMA 2020 flow diagram. The inclusion criteria specified original papers evaluating the outcomes of laser presbyopia correction as well as the pre- and postoperative assessment of stereopsis and/or CS. The Quality Assessment Tool was applied to assess the risk of bias. Results. We identified 13 studies, including 856 presbyopes (1712 eyes), with preoperative refractive errors from −11.13 D to +5.75 D, with the follow-up range between 3 and 30 months. Either contrast sensitivity improvement or no change following Presbyond® Laser Blended Vision and PresbyMAX® Hybrid was found in the reviewed articles. Some authors reported a significant CS reduction after symmetrical PresbyLASIK, wavefront-guided LASIK and aspheric monovision LASIK. Several studies assessing the effect of Presbyond® LBV on stereopsis showed conflicting results, with the near stereopsis being reduced, unchanged or increased. A significant decrease in stereopsis was reported after aspheric monovision LASIK. Conclusions. The Presbyond® Laser Blended Vision is a safe procedure in terms of the preservation of contrast sensitivity for presbyopia treatment. More studies are needed to elucidate the impact of aspheric corneal ablation methods or other methods inducing corneal multifocality with or without micro-monovision on stereopsis and contrast sensitivity. Full article
(This article belongs to the Special Issue Advanced Approaches to Cataract and Refractive Surgery)
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