Karla Ranđelović

Background and Objectives: Achieving a postoperative refractive outcome close to the target is crucial in cataract surgery, as residual refractive errors can affect visual quality and patient satisfaction. Methods: This study evaluates the relationship between preoperative target refraction, postoperative intraocular lens (IOL) shift, and refractive stability. Prospective, observational study conducted at the Clinical Hospital Centre Sestre Milosrdnice, Zagreb, Croatia, involving patients undergoing routine cataract surgery with monofocal IOL implantation. Ninety-four eyes undergoing phacoemulsification with implantation of one of three monofocal IOLs (PCB00, RayOne HA, Akreos Adapt) were included. Preoperative biometry assessed axial length, anterior chamber depth, central corneal thickness, and white-to-white distance. Target refraction was −0.75 to 0.00 D. IOL position and refraction were measured at 1 week, 1 month, and 6 months postoperatively. Patient satisfaction was evaluated at all three time points. Results: All three IOLs demonstrated comparable in-the-bag stability over 6 months, with minimal longitudinal shift (all p > 0.05). Postoperative refractive outcomes were generally comparable, but RayOne HA showed a slightly more myopic deviation, whereas PCB00 and Akreos Adapt remained closer to emmetropia. The differences reflect the extent of deviation from the intended postoperative refraction, with statistically significant intergroup differences at 1 month (p = 0.004) and 6 months (p = 0.045). Conclusions: All three IOLs provided stable positioning and excellent visual outcomes. However, small differences in refractive predictability suggest that IOL design may influence the accuracy of target refraction. Tailoring target refraction according to IOL type may improve the likelihood of achieving emmetropia and optimize patient satisfaction.

Background and Objectives: Corneal cross-linking (CXL) is the standard treatment for progressive keratoconus, but delayed epithelial healing remains a concern, increasing infection risk and patient discomfort. Studies suggest that insulin may promote corneal epithelial cell migration and proliferation, potentially accelerating wound healing. Its benefit has been observed in neurotrophic keratitis and diabetic epithelial defects, and it may offer similar effects post-CXL. Our objective is to evaluate the effect of topical insulin on epithelial healing after CXL in a small case series. Materials and Methods: Eight patients undergoing CXL for keratoconus were divided into two groups (n = 4 each). The insulin group received topical insulin eye drops (1 IU/mL in Systane^®) five times daily, in addition to standard postoperative care. The control group received Systane^® alone with the same regimen. Daily follow-up included slit-lamp exam, anterior segment OCT, and photodocumentation until epithelial defect closure. Results: Baseline parameters (central corneal thickness, keratoconus stage, Schirmer test, tear break up test) were comparable. While not statistically significant, the insulin group showed numerically smaller epithelial defects on day 2, suggesting a possible trend toward faster healing. By day 3, re-epithelialization was complete in all patients. Pain decreased over time in both groups without significant differences. No adverse effects were noted. Conclusions: Topical insulin may modestly accelerate epithelial healing after CXL, as suggested by smaller defects on day 2 in the insulin group. Although results were not statistically significant, the trend warrants further investigation in larger studies.