Moderator
Eric D. Rosenberg, DO, MSE
Panelists
Elmer Y. Tu, MD, ABO
John F. Doane, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Bruno C. Trindade, MD, PhD
Co-Authors
Leticia Crepaldi MD, Isadora Coelho MD
Purpose
To describe the management of anterior lenticonus in Alport's Syndrome
Methods
6 eyes of 3 consecutive patients with Alport's syndrome were included for analysis. A full ophthalmological examination including corneal aberrometry, macular and anterior segment OCT were performed before and after surgery in all patients. Phacoaspiration was performed in all patients after a routine manual capsulorhexis. IOL power calculation was performed using Barrett Universal Formula II for all eyes. A monofocal IOL was implanted inside the capsular bag for all patients.
Results
All of the included patients had already performed renal transplantation for chronic renal failure. Clear lens extraction was uneventful in all patients. There was a statistically significant improvement of both uncorrected and best-corrected visual acuity in all patients. UCVA improved from LogMAR 1.46�0.24 to 0.21�0.10 p<0.001. bcva="" improved="" from="" logmar="" 0.98�0.42="" to="" 0.11�0.08="">< />
Conclusion
Anterior lenticonus can be safely managed by clear lens extraction with IOL implantation in eyes of patients with Alport's syndrome. Care should be taken when performing anterior capsulorhexis due to the thinning of the anterior capsule in this condition.
Presenting Author
Ehud I. Assia, MD
Purpose
To report our clinical experience in performing cataract surgery in eyes with posterior polar cataract, and specifically using femtosecond laser-assisted cataract surgery (FLACS) and hydrodissection.
Methods
Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of PPC, were retrospectively reviewed. All surgeries were done by using FLACS. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule.
Results
There were 3 men and 3 females, ages 39-73 years (average 52.5years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule prior to phacoemulsification. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to small posterior capsulorhexis (PCCC). PC-IOLs were implanted within the capsular bags and no postoperative complications were recorded during follow-up in all eyes.
Conclusion
Hydrodissection is more gentile to the capsule than any other surgical maneuvercan and can be safely performed in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Femtosecond laser capsulotomy and lens fragmentation may further assist surgery in these cases.
Presenting Author
Anat Maytal, MD
Co-Authors
Adi Einan-Lifshitz MD, Biana Dubinsky-Pertzov MPH, MD, Oron Mahler MD
Purpose
Spectacle-free visual acuity is now considered a standard expectation from cataract surgery. However, meeting these expectations becomes more challenging in patients lacking capsular support. In order to address those needs, we have employed the four-flanged intraocular lens (IOL) scleral fixation technique using toric IOL.
Methods
Patients in whom toric IOL was implanted due to corneal astigmatism using the four-flanged scleral fixation technique were included. Patients� medical records were reviewed, and pre- and postoperative data were collected. We used the 4 closed-loop haptics Artis T PL lens (Cristalens), fixated to the sclera with 7-0 prolene suture, positioned 2.5 mm from the limbus. Primary outcome was postoperative IOL position. Secondary outcomes included uncorrected and corrected visual acuity, refractive results, and postoperative complications.
Results
Six eyes of six patients were included in this study, the average age was 59 years, 50% were males. Three eyes required secondary IOL implantation due to complex trauma involving additional ocular tissue damage, one eye had secondary IOL implantation soon after complicated cataract surgery, and two eyes underwent IOL exchange for subluxated lens. Preoperative corneal astigmatism values were 2.3, 4.5, 9.3, 1.7, 6.6, and 4.0D. Postoperative cylinders on manifest refraction were 1.5, 1.0, 2.5, 0.5, 1.75, and 1.5D, respectively. One patient had postoperative ERM and mild pseudophakic CME. On last follow-up, all IOLs were aligned according to the planned axis.
Conclusion
Fixation of a toric lens using the four-flanged scleral fixation technique is an effective technique, feasible even in the most complex cases. It provides satisfying IOL alignment and stability and allowing the patient to achieve the best possible visual acuity given the challenging circumstances of the case.
Presenting Author
Ken Hayashi, MD, PhD
Co-Authors
Motoaki Yoshida MD, Shin-ichi Manabe PhD, MD, Akira Hirata MD
Purpose
To predict high-risk factors for zonular complications during cataract surgery due to preexisting severe zonular dehiscence in eyes with pseudoexfoliation syndrome (PXF).
Methods
Three-hundred fifteen eyes of 315 consecutive patients with PXF scheduled for phacoemulsification surgery underwent preoperative examination of various ocular parameters using an anterior segment-optical coherence tomography and other devices. When zonular complications occurred during surgery due to zonular dehiscence, scleral fixation of the intraocular lens (IOL) or implantation of a capsular tension ring (CTR) was performed. High-risk factors for these intraoperative zonular complications were examined using classification-tree and logistic regression analyses.
Results
Of the 315 eyes, 31 (9.84%) underwent scleral IOL fixation or CTR implantation. High-risk factors identified were small pupillary diameter after mydriasis < 6.30 mm, shallow anterior chamber depth < 2.074 mm, and lens decentration > 0.260 mm. Based on exact logistic regression, the odds ratio was 4.81-fold higher for eyes with poor mydriasis than for eyes without poor mydriasis (p = 0.006, 95% confidence interval 1.49 - 18.23), 23.99-fold higher for eyes with poor mydriasis and a shallow anterior chamber (p < 0.001, 5.92 - 109.02), and 287.39-fold higher for eyes with poor mydriasis, a shallow chamber, and great lens decentration (p < 0.001, 50.46 - ?).
Conclusion
In eyes with PXF, high-risk factors for zonular complications during cataract surgery due to preexisting severe zonular dehiscence were poor mydriasis, shallow anterior chamber, and large lens decentration, suggesting the importance of evaluating these conditions preoperatively.
Presenting Author
Zarmeena Vendal, MD
Purpose
Evaluate clinical and patient-reported outcomes following bilateral implantation of the violet light-filtering Tecnis Symfony OptiBlue IOL in patients diagnosed as glaucoma suspects or with mild glaucoma.
Methods
Ambispective, non-comparative, observational study of 25 cataract patients who are suspected to have glaucoma or who were diagnosed with mild glaucoma based on baseline visual field examination and have undergone cataract surgery with bilateral implantation of the Tecnis Symfony OptiBlue/Tecnis Symfony OptiBlue toric IOL (with a plano target in the dominant eye and a 0.5 D mini-monovision target in the nondominant eye). Eyes with visual field defect within 5� of fixation, optic nerve head damage, or any retinal disease will be excluded. Outcomes include change in IOP from baseline, monocular and binocular uncorrected visual acuities, and patient-reported outcomes.
Results
Monocular postop MRSE was -0.30 � 0.42 D. Mean uncorrected vision was 0.06 logMAR at distance, 0.04 intermediate, and 0.12 near. Monocularly, 95% of eyes achieved UDVA of 20/30 or better and 100% achieved UIVA/UNVA of J3 or better. Binocularly, all subjects were 20/30 or better at all distances. Patients were spectacle independent at distance and intermediate, with 95% and 85%, respectively, saying they did not require glasses, and 65% were spectacle independent at near. Overall, 90% to 95% reported being mostly or completely satisfied at distance and intermediate, while 70% were completely/mostly satisfied with near vision without glasses. Mean IOP was reduced by 4.0 mmHg.
Conclusion
The results of this study suggest that violet-light filtering EDOF IOLs can provide mild glaucoma patients with the opportunity to enjoy good vision at all distances.
Presenting Author
Shail A. Vasavada, DNB, FRCS
Co-Authors
Abhay Vasavada MS, FRCS, Shyamal Dwivedi MD, Vaishali Vasavada MS, Samaresh Srivastava MD
Purpose
To study the effect of Phacoemulsification using a physiological intraocular pressure(IOP)and high IOP on the retinal and optic nerve head(ONH)perfusion.
Methods
Prospective,Randomized,single masked trial in 80 eyes(80 patients)with non-proliferative diabetic retinopathy undergoing cataract surgery.Eyes will be randomized to:group I(low IOP,20mmHg)or group II(high IOP,55mmHg).Intraoperatively, cumulative dissipated energy (CDE),fluid used and patient comfort on visual analog scale.Retinal vessel density,Perfusion density at superficial retinal layers at the posterior pole as well as perfusion and flux index at the RPC layer was documented by optical coherence tomography angiography(OCTA)at the following time points:within 2 hours of surgery,1 day and 1 month postoperatively.Anterior chamber inflammation compared on postoperative day 1 and week 1.
Results
Ongoing studies,results to be updated
Conclusion
Ongoing study,results to be updated
Presenting Author
Shail A. Vasavada, DNB, FRCS
Co-Authors
Abhay Vasavada MS, FRCS, Vaishali Vasavada MS, Samaresh Srivastava MD
Purpose
To report demographic profile, risk factors of and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in the dead bag syndrome
Methods
Propsective, interventional case series in patients with late of IOLs and spontaneous posterior capsule rupture (PCT) in a clear posterior capsule with relatively intact zonules, characteristic of the dead bag syndrome. IOL explantation of the decentered / dislocated IOL along with pars plana vitrectomy and intrascleral fixation of an IOL using the Yamane technique was performed. Outcome measures- demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange surgery.
Results
30 eyes had in-the-bag IOL decentration and 16 had total dislocation. Mean age 68.7�8.9 years,91% patients were males.36 had unilateral IOL disease,7 had bilateral,with/without IOL decentration.Mean duration from cataract surgery to IOL exchange was16.8 yrs.>50% eyes had myopia(AL>24mm).4(9.3%)had pseudoexfoliation.Mean followup after IOL exchange surgery was 10.9�9.8 mths.Single-piece hydrophobic acrylic IOL was most common.87% eyes had an improvement in corrected distance visual acuity(CDVA),95% eyes had CDVA of <0.3logmar.intraop soemmering�s="" ring="" was="" seen="" in="" 72%.postop="" complications�transient="" iop="" spike="" in="" 8(17%),cme,erm="" in="" 6(13%)each.3="" had="" pre-existing="" glaucoma,which="" remained="">
Conclusion
Dead bag syndrome has spontaneous degenerative changes in the posterior capsule, leading to rupture and late decentration. It is seen predominantly in males gender and myopia is the most common association.Using Yamane technique, visual outcomes are good with an acceptable rate of postoperative complications.
Presenting Author
Brandon D. Ayres, MD, ABO
Co-Authors
Cathleen McCabe MD, Nicole Fram MD
Purpose
To evaluate the safety and performance of a, 510k-approved, 27-gauge, sharp needle-tip probe for pars plana assisted anterior vitrectomy (PPAAV) used to address vitreous prolapse during IOL repositioning/exchange or secondary IOL cases.
Methods
In this open-label, prospective multicenter study, 27 patients with clinical indications for PPAAV underwent vitrectomy surgery with a pars plana approach using a novel, single-step, 27-gauge, sharp needle-tip vitrectomy probe (Vista 1-Step) capable of 22,000 cuts per minute (cpm), Surgeons� assessments of ease of insertion and performance compared to similar devices were recorded on the operative day. Subjects were monitored for 90 days for adverse events (AEs), including retinal tear or detachment, retinal hemorrhage, sclerotomy wound leak, hypotony, choroidal detachment, vitreous hemorrhage, residual vitreous prolapse and endophthalmitis.
Results
No eyes had residual vitreous prolapse characterized by pupil peaking or vitreous strands. There was 1 case of hypotony at 1 day (3.7%) in an eye undergoing scleral fixation of an IOL. There were no other device-related AEs throughout the 90-day follow-up. There was 1 other non-device-related ocular AE intraoperatively (3.7%), 3 (11.1%) on 1 day; 4 (14.8%) at or before 1 week; 9 (33.3%) at or before 1 month; and 3 (11.1%) at or before 3 months. Mean ease of insertion into the sclera was rated 3.44/5.00 by surgeons, with 59.3% of cases rated 4 to 5 (easy/very easy). The device was rated similar to or better than other guillotine cutter handpieces in 100% of cases.
Conclusion
PPAAV with a 22,000-cpm, 27-gauge, sharp needle-tip vitrectomy probe can be safely performed with a low rate of complications in eyes requiring anterior vitrectomy. The 1-Step Vitrectomy Probe was rated highly by surgeons for ease of use and vitreous cutting efficiency compared to limbal-based or conventional pars plana devices.
Presenting Author
Liwei Ma, MD, PhD
Purpose
To describe a technique for the double-suture four-point flange intrascleral fixation of rotationally asymmetric multifocal intraocular lenses(IOL)
Methods
Design:Retrospective, interventional, noncomparative, case series. A total of 11 eyes of 11 patients with a dislocated cataract or aphakic without lens capsule were enrolled.�After the cataract removed ,rotationally asymmetric multifocal IOLs was fixed by four-point intrascleral flange with double 7-0 polypropylene suture.For the patients with pupil bigger than 4mm, the pupiloplasty was performed with 1 or 2 stitches. Preoperative and postoperative visual acuity,refractive results, postoperative IOL tilt and ecentration, intra-operative and postoperative complications were recorded.
Results
All the surgeries went uneventful , no severe intraoperative and postoperative complications occured.At 3 months after operation ,the mean postoperative uncorrected distance visual acuity (UDVA) was 0.08� 0.05 logMAR. The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 � 0.08logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.05 � 0.06logMAR. The mean postoperative residual spherical equivalent values were ? 0.34 � 0.36 D. VF-14 questionnaire showed that no difficulty was found in >85% of subjects for all of the tasks. The mean tilt of IOL was 3.95 �2.18 degree and the mean decentration of the IOL was 0.26 � 0.14 mm.
Conclusion
The technique of four-point flange intrascleral fixation for �rotationally asymmetric multifocal IOLs is feasible. The rotationally asymmetric multifocal IOLs might be used for the presbyopia correction in the patients withou capsular support.
Presenting Author
Boris E. Malyugin, MD, PhD
Purpose
Several techniques have been proposed to recover displaced IOLs including IOL refixation to the sclera or to the iris and IOL exchange. Here we present the novel technique of lens refixation to the iris utilizing the 9-0 double thread forged together with the bipolar cautery.
Methods
7 patients (7 eyes) with "IOL-Capsular Bag Complex" decentrations and subluxations were observed. Mean time after cataract extraction was 6+/-2,5 years. Ocular comorbidities included pseudoexfoliation syndrome in 7 eyes, glaucoma with IOP controlled on medications � 5 eyes, previous glaucoma surgery � 2 eyes.
Results
The technique was used in 7 cases with no major adverse events. IOLs were stable and positioned centrally. Patients were followed for 9 months after surgery. One corneal edema resolved spontaneously, and two transitory postop pressure spikes were controlled with topical medications.
Conclusion
Double Thread Flange Iris Fixation is a very useful Technique for "IOL-Capsular Bag Complex" dislocations of various degrees.
Presenting Author
Vasyl Shevchyk, MD, PhD
Co-Authors
Georgii Parkhomenko PhD, MD
Purpose
To assess the efficacy and safety of performing a combined Nd:YAG capsulotomy on both the anterior and posterior lens capsule in a single session for treating Capsular Bag Distension Syndrome (CBDS).
Methods
Three patients presenting with CBDS were observed and underwent laser treatment (MR Q, Meridian Medical) following a specific protocol: a laser capsulotomy of the anterior capsule was first performed in an area free from haptic elements. Once the turbid fluid drained into the anterior chamber and the posterior capsule moved closer to the IOL, a laser capsulotomy of the posterior capsule was conducted. The procedure was recorded using a Sony Alpha a6400 camera. Anterior segment swept-source OCT imaging (Anterion, Heidelberg Engineering) and IOP measurements (iCare, Finland) were performed before the laser capsulotomy, immediately afterward, at 1-month and 1-year follow-ups.
Results
Current literature suggests performing a posterior capsulotomy for CBDS, which drain the fluid into the vitreous cavity. But, this introduce proteins into the vitreous, potentially leading to inflammation or bacterial endophthalmitis (Propionibacterium acnes). While anterior capsulotomy is often performed when the posterior capsule is not visible, it has been associated with CBDS recurrence. In our approach, capsulotomy of both capsule resulted in significant improvements in visual acuity for all patients. The anterior chamber cleared completely within 30 minutes. No increase in IOP or signs of CBDS recurrence were detected during whole follow-ups.
Conclusion
Combined Nd:YAG capsulotomy of the anterior and posterior capsule in a single session is a highly effective and safe treatment for Capsular Bag Distension Syndrome.
Presenting Author
R Prakhya, MBBS, MS
Co-Authors
Savio Pereira MS, DNB, Supriya Sri Ganesh MBBS, MS
Purpose
Purpose: This study assesses outcomes of ICL explantation during cataract surgery, considering ICL type.
Methods
Methods: Three patients with ICL explantation and cataract surgery were analyzed, focusing on pre-op status, ICL type, intra-op complications, and post-op outcomes.
Results
Results: 1) A 51-year-old with 25 years of ICL implantation experienced blurred vision, pigment dispersion + cataract. Post-cataract surgery and ICL explantation, vision improved to 6/6 with -2.5 D cyl. 2) A 60-year-old with 20 years of ICL implantation also had blurred vision and cataract. Post-surgery, vision improved to 6/6 with -1 D cyl. 3) A 45-year-old with 8 years of V4C ICL implantation had shorter surgery, improved recovery and no spectacle dependence after surgery.
Conclusion
Conclusion: Duration of ICL implantation and ICL type influence surgical ease, recovery, and visual outcomes. Pre-op planning should consider ICL type and implantation duration for optimal surgery and IOL choice.
Presenting Author
R Prakhya, MBBS, MS
Co-Authors
Sri Ganesh MS, Savio Pereria MBBS, MS, Supriya Sri Ganesh MBBS, MS
Purpose
Purpose: To present a case series of bilateral cataract surgery in patients who have undergone previous Presbyond Laser Blended Vison (LBV) correction.
Methods
Methods: A retrospective case series of 4 patients who underwent cataract surgery in both eyes after previous Presbyond LBV. Barrett True K formula was used for IOL power calculation was done with a plano target for dominant eye and with a myopic target for the non-dominant eye based on the previous target refraction used for Presbyond surgery.Aspheric monofocal IOL was implanted, preserving the mini monovision. Aberrometry was done pre operatively and the spherical aberration was assessed. Post operative visits were conducted at day 1, day 15 and 3 months, where UDVA, UIVA, UNCA, CDVA, CIVA, CNVA, aberrometry, Ocular Scatter Index(HDA) ,and subjective questionnaire were assessed.
Results
Results: At 3 months post operatively no eyes lost 2 or more lines of BCVA. 3 out of 4 of patients had Binocular UDVA of LogMAR 0 and UIVA of LogMar 0.2 at 60cm, UNVA was LogMar 0 at 3 months post operatively. 1 patient had UDVA of LogMar 0.1, UIVA of LogMar 0.18 and UNVA of LogMar 0.1 at 3 months post operatively. Spherical equivalent refractive accuracy in all eyes was within +/- 0.50DS of target refraction. No patients had change of more than 0.5D spherical equivalent from post operative day 1 to 3 months.
Conclusion
Conclusion: These results indicate that cataract surgery after Presbyond LBV can deliver good visual outcomes for distance, intermediate and near vision with spectacle independence, effectively maintaining the benefits of the previous Laser Blended Vision treatment.
Presenting Author
Amit Gupta, MS
Co-Authors
Chintan Malhotra MS, Divya Reddy Challa MD, Byanjana Bashyal MD, Sraddha Limbu MS
Purpose
To report refractive outcomes of cataract surgery using Intraoperative Biometry with ORA (Optiwave Refractive Analysis) in post-optical keratoplasty (OPK) eyes.
Methods
10 post OPK eyes underwent intraoperative aphakic refractive and IOL power estimation using ORA. Refractive outcomes and predictive accuracy with ORA was compared with 'planned' outcome.
Results
All eyes were 20/70 or better, 6 (60 %) eyes were 20/50 or better. Preoperative versus postoperative, mean spherical refractive error was - 4.81 � 5.19 D versus 0.84 � 0.93, MRSE was � 6.09 � 5.28 versus � 0.25 � 0.395, cylinder was -2.625 � 1.43 D versus -2.19 � 1.56. Mean absolute prediction error was 0.34�0.22D with ORA versus 0.66�0.34D (p=0.08). ORA recommended IOL values were ? �0.5 D in 80% and ? � 1.0 D in 100% eyes compared to 37.5% ? �0.5 D, 75 % ? �1.0 D and 100 % ? � 2 D.
Conclusion
Optiwave Refractive Analysis significantly improves the refractive outcomes of cataract surgery in post OPK eyes
Presenting Author
Sonu Goel, DNB, None
Co-Authors
Madhav Goel MBBS, Purnima Dhand MS, MBBS
Purpose
To evaluate results of secondary IOLs using Gore-tex transscleral fixation in terms of- safety and efficacy intra and post-operative complications stability of IOL post operatively
Methods
32 cases of subluxated lenses were managed with 8-0 Gore-tex transscleral fixation using Lasso technique Retrospective analysis was done in terms- UCVA, BCVA Ease of surgical Technique Intra and post operative complications Long term stability SLE , AS-OCT on Follow up to look for complications :- Hyphaema Secondary Intraocular pressure rise IOL instability Corneal edema
Results
30 out of 32 patients had safety and efficacy index of more than 1 All patients gained visual acuity of four lines or more than the pre- operative status Capsular tear was encountered in 2 patients and hence procedure was aborted 1 was managed with Yamane technique while the other one underwent retro iris fixation All patients showed IOL centration and stability over 1 year period No post �operative complication observed
Conclusion
suture used is 8-0 polytetrafluoroethylene (Gore-Tex)�,greater durability,fatigue resistance than 10-0 polypropylene This avoids making large sclerotomies ,preserves conjunctiva knots are buried without the need for creating flaps� reduces suture related issues Ease of technique and bag stability makes it first choice for scleral fixtation
Presenting Author
Grzegorz Labuz, PhD, BEng
Co-Authors
Ramin Khoramnia MD, Gerd Auffarth MD, PhD
Purpose
In rare cases, postoperative refractive surprises may result from incorrectly labeled intraocular lens (IOL) power. During explantation procedures, failed implants often need to be hemidissected to reduce patient risk. This study investigates whether the diopter power of hemidissected IOLs can still be accurately measured.
Methods
In this study, 8 monofocal, 2 (mono) extended-depth-of-focus (EDoF) and 2 diffractive-trifocal IOLs were hemidissected. The optical metrology of the IOLs pre and post cutting was performed using an optical-bench system. Measurements were performed in monochromatic (546?nm) light at room temperature. The magnification method described in the ISO 11979-2 standard was followed to determine the diopter power of an intact IOL. Then, following hemidissection, one measurement was taken with two halves adjacent to each other, and then one piece was tested separately.
Results
The mean (�standard deviation) IOL power was 20.28 �0.30?D for the intact IOLs. After cutting the lenses, the measurements of two adjacent halves resulted in 20.34 �0.31D. Confirming the nominal power using only one half yielded 20.37 �0.31D. Of the 12 IOLs, the maximum deviation from the pre-cut power was 0.62D (one half) and 0.46D (two halves). Statistical testing confirmed the lack of significant differences between the powers of the whole IOL, and with one- and two-piece measurement (ANOVA, P =.77).
Conclusion
We demonstrated that the nominal power of hemidissected explanted lenses can be reliably measured across various IOL types. Our results showed that measuring a single half produced results comparable to testing both halves together. Therefore, verifying the labeled power of explanted hemidissected lenses is a viable option.
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