Moderator
Amy Lin, MD, ABO
Panelists
Jennifer M. Loh, MD, ABO
Gustavo M. Hüning, MD, MBA
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
John A. Hovanesian, MD, FACS
Co-Authors
Matthew Rauen MD
Purpose
To determine whether adjusting IOP settings to near physiologic levels could potentially lead to better cataract surgical outcomes, particularly in terms of corneal clarity in the post-operative period. By comparing these two different IOP settings, we can determine the impact of IOP on surgical efficiency and quality of results.
Methods
This prospective, randomized, contralateral-eye controlled, open-label clinical study of patients undergoing routine cataract extraction evaluated central corneal thickness one day following surgery as well as the summed ocular inflammation score, total BSS usage, and aspiration time as well as other surgical parameters.
Results
Forty patients completed bilateral surgery and follow-up at the time of this analysis. Comparing eyes with physiologic (28 mmHg) phaco infusion pressure to fellow eyes with commonly used higher infusion pressure settings (65 mmHg), mean central corneal thickness at postop day 1 was 11.4 � 36.1 � thinner (P<0.05), surgical="" aspiration="" time="" was="" 14="" seconds="" shorter=""><0.03), and="" sois="" at="" 1="" day="" was="" 0.6="" grade="" lower=""><0.0007) in="" the="" low="" infusion="" pressure="" group.="" no="" statistically="" significant="" differences="" were="" seen="" in="" visual="" acuity="" at="" day="" 1="" or="">
Conclusion
Compared with more traditional settings, phacoemulsification performed with physiologic infusion pressure (28 mmHg) required significantly less aspiration time and led to significantly less corneal edema and inflammation at day 1. No significant differences in visual acuity were identified in this study.
Presenting Author
Kin Sheng LIM, MD
Purpose
To report 1 year outcomes of a randomised controlled trial (RCT) in POAG with cataract, comparing differences in intraocular pressure, medication use and adverse events between participants randomised to receive cataract surgery alone or cataract surgery with endoscopic cyclophotocoagulation (ECP).
Methods
UK based, multicentred, randomised controlled surgical interventional landmark study. Patients had a washout period prior to surgery and at 1 year post surgery in which all glaucoma medications were stopped. Intraocular pressure was measured at 9 and 11am. Randomisation occured at the point of uncomplicated cataract surgery. Patients and follow up investigators were masked to treatment.
Results
79 - cataract surgery with ECP and 83 - cataract surgery alone. Mean IOP reductions were higher with phaco ECP (-5.85 [SD6.75] versus -5.28 [SD5.38]). Median IOP was also calculated given non normal distribution of IOP outcomes, which also found a higher reduction for ECP (-7.5 versus -5.5). Success defined as IOP ? 21 and ? 20% reduction from baseline was seen in 41% of control cases and 54.4% of ECP cases. Medication reduction was similar in both arms (-0.7 control vs -0.8 ECP) . Adverse events were monitored; higher rates of anterior uveitis were seen in the ECP arm compared to phaco (27% versus 6%). CMO rates were similar (9% versus 6%).
Conclusion
ECP demonstrates a greater reduction in mean and median IOP as well as success rates, refractive outcomes and medication reductions were similar. Most adverse events seen with ECP were self limiting but higher rates of uveitis were noted.
Presenting Author
Kangjun Li, MD
Purpose
To examine the efficacy and safety of one step without viscoelastic agent in one day sequential bilateral (OIO) technique for phakic implantable collamer lens implantation (Evo-ICL).
Methods
A prospective, randomized, comparative, single-masked clinical trial. A total of 268 patients [530 eyes] were randomly distributed into OIO group (270 eyes) and SDP group (260 eyes). Consecutive eligible myopia and myopic astigmatism patients were randomized to undergo Evo-ICL. The patients were randomized to either OIO technique or standard process (SDP) alone, with two incision and separating sequential bilateral Evo-ICL on different days. The main outcome were intra- and postoperative complications.Secondary outcomes were refractive outcomes, intraocular pressure (IOP), endothelial cell density (ECD), corneal densitometry values (CDs) and vault at 3 and 12 months.
Results
There were no intra-operative complications. Of these, 6 patients experienced ICL exchange because abnormal vault (OIO:1.11%; SDP 1.15%) and 4 patients experienced high IOP (OIO:0;SDP1.53%) in the immediate postoperative period, which was resolved without incident. At 3 months, OIO achieved similar results as SDP in terms of efficacy index(0.98�0.22 vs. 0.98�0.20; P = 0.58) and safety index(1.2�0.2 vs. 1.2�0.2; P = 0.56). A similar trend was observed in CECs, CDs and ALD in two groups (all P > 0.05) at 3 months. Notably, these changes did not affect the safety, efficacy, and predictability of post-recovery OIO and SDP eyes at 12 months.
Conclusion
The results from this randomized trial suggest that one step in one day technique for Evo-ICL produced promising clinical results in terms of safety, efficacy, and convenience at 3 and 12 months of follow-up.
Presenting Author
Samaresh Srivastava, MD
Co-Authors
Shail Vasavada DNB, FRCS, Vaishali Vasavada MS, Abhay Vasavada MS, FRCS
Purpose
To compare the occurrence of incisional Descemet�s detachments (DD) in manual phacoemulsification (PE) versus femtosecond laser assisted cataract surgery (FLACS)
Methods
Prospective interventional case series in 300 eyes(300 patients)undergoing PE (group I, n=300) or FLACS(group II, n=150).In group II FLACS was used to create a trapezoidal incision with external width of 2.2mm,internal 2.3mm.Group I was subdivided into - group Ia(150 eyes)- single plane temporal,corneal,2.2mm square incision, group II(150 eyes)-trapezoidal incision with 2.2mm external and internal flare. Outcome- presence of DD clinically at the end of surgery(Clinical and AS OCT) performed within an hour of surgery and epithelial/endothelial misalignment at the incision.Also manual and FLACS incisions were created in human cadaver eyes and incision architecture compared on histomorphology.
Results
Ongoing study, results of 50 eyes each presented here, will be updated before presentation. Intraoperatively, varying degrees of DD at the incision were seen in 55% eyes in group I, compared to 11% eyes in group II. Postoperatively, DD was seen in 40% eyes in group I compared to only 5% in group II, the difference being statistically significant. Histomorphologic evaluation of incisional collagen showed more misalignment of the roof and floor of the incision in the manual group compared to laser incisions. Also, there was greater collagen disorganisation around the incision in the manual group.
Conclusion
Group II had lower incidence of DD on AS-OCT as well as lesser collagen architecture distortion. The femtosecond laser allows creation of precisely sized trapezoidal incisions for more wiggle space at the internal entry causing less trauma. To be updated based on final results.
Presenting Author
Adi Einan-Lifshitz, MD
Co-Authors
Asaf Shemer MD, Eran Pras MD, Biana Dubinsky-Pertzov MPH, MD, Yogev Giladi BSc
Purpose
In general surgery, gender mismatches between surgeons and patients can potentially lead to worse surgical results. Our purpose was to evaluate whether patients undergoing elective cataract surgery encounter varying intraoperative complications depending on the gender of the operating surgeon.
Methods
This is a retrospective cohort analysis of patients who underwent elective cataract surgery for 10 years in one tertiary medical center. We manually reviewed all surgical reports. We excluded combined surgeries. We classified all reports as uneventful or eventful. Then, we subdivided all eventful cases by the type of intraoperative complication. Intraoperative complications included: corneal chemical burn, Descemet membrane detachment, anterior capsular rupture, intraoperative floppy iris syndrome, posterior capsular rupture, vitreous loss, nucleus drop, IOL tear, zonulolysis, phacodonesis, iridodyalysis, CTR/CTS placement, retrobulbar hemorrhage and expulsive suprachoroidal hemorrhage.
Results
A total of 14,825 surgical reports by 46 surgeons were reviewed. A 6.59% (n=978) intraoperative complication rate was found in our cohort. The most common complication was posterior capsule rapture (2.13%), followed by vitreous loss (2.03%) intraoperative floppy iris syndrome (1.6%), zonulolysis (0.91%) and anterior capsular rupture (1.39%). We did not find a statistical difference in the rate of any intraoperative complications between male surgeons and female surgeons (6.62% vs 6.54%, respectively, p=0.590). Over the years, we have observed a significant decline in the risk of overall intraoperative complications at our center (p< />
Conclusion
In our study, we found no notable statistical variance in intraoperative complication rates for standard cataract surgery when comparing male and female surgeons. These results could strengthen our comprehension of the gender influence within the field of cataract surgery.
Presenting Author
Jeffrey Whitman, MD, ABO
Purpose
To compare the number of post-op adjustments between two adjustable lens models, with or without prior corneal surgery. The new LAL model, with slightly extended depth of focus, may enhance early near vision and potentially reduce follow-up visits compared to the standard LAL.
Methods
In this evaluation, an adjustment is a non-invasive procedure using UV light to modify the lens curvature after implantation, correcting spherical and cylindrical errors. Up to 3 adjustments can be performed on the lens. The new LAL model group included 26 eyes without prior corneal surgery. The standard LAL group had 36 eyes without and 39 eyes with prior surgery (LASIK or RK). Adjustments were based on each patient's visual needs, and the total number of adjustments was compared between groups.
Results
In the new LAL model group, the 26 eyes with virgin corneas required an average of 1.53 post-operative adjustments, with a median of 1 adjustment. In the standard LAL model group, the 36 eyes with no prior corneal surgery had an average of 1.81 adjustments, with a median of 2. For the 39 eyes with prior LASIK or RK surgery in the standard LAL group, the average was 2.02 adjustments, with a median of 2.
Conclusion
This study demonstrates that the new LAL model, with extended depth of focus, reduced post-op adjustments by 15.5% in virgin corneas compared to the standard LAL. This suggests fewer follow-up visits, enhancing efficiency and patient satisfaction. Ongoing studies are exploring further benefits and long-term outcomes.
Presenting Author
Matthew P. Rauen, MD, ABO
Purpose
To investigate whether phacoemulsification at physiologic (low) intraocular pressure (IOP) vs high IOP will impact patient discomfort and the surgeon�s experience.
Methods
Prospective, single-surgeon, randomized, paired-eye design recruiting 73 subjects and 146 eyes. First eye randomized to high or low IOP setting, contralateral eye receives other IOP setting. Inclusion criteria include anticipated bilateral, sequential cataract surgery on equally dense cataracts with no significant ocular history. Patient, surgeon anesthesiologist and post-operative technicians blinded to study group. Primary outcome is the proportion of patients requiring treatment for breakthrough discomfort. Secondary endpoints include physiologic (BP, pulse) responses to pain, the incidence of pupillary block, and surgeon�s experience on patients� cooperation during surgery.
Results
Patients in the low IOP group required breakthrough pain medication (0% v 15%, p=0.001) and pupillary block (12% vs 32%, p=0.007) when compared to the high IOP group. No differences in physiologic pain responses were detected. Surgeon assessment of patient cooperation (2.97 v 2.66, p<0.001) and surgeon experience (2.98 v 2.62, p<0.001) were better in the low IOP group compared to the high IOP group. In the 47 eyes >24.5mm, differences in patient cooperation (p=0.005) and surgeon experience (p=0.002) persisted, but only 2 patients required breakthrough medication, making comparison difficult.
Conclusion
Low IOP settings during phacoemulsification breakthrough discomfort less pupillary block, greater patient cooperation and a better experience for the surgeon.
Presenting Author
Karanpreet S Multani, BSc
Co-Authors
Jared Raabe MD, Liam Redden BSc, MD, Kamran Riaz MD, David Hoang BSc, Nitin Rangu BA, David Murphy MD, Kai Ding PhD, Jascha Wendelstein MD
Purpose
To compare clinical and refractive outcomes of three methods for surgical correction of aphakia: anterior chamber IOL (ACIOL), intrascleral haptic fixation IOL (ISHF-IOL), and Gore-Tex suture fixation of modified eyelet toric IOL (GSF-MET IOL).
Methods
Single-site (tertiary care academic center), multi-surgeon retrospective case series of eyes undergoing one of three surgical techniques for aphakia correction between 2017 and 2024. Eyes were excluded if there was failure to follow up and subsequent missing data. Comparative clinical and refractive outcomes were recorded, including corrected distance visual acuity (CDVA), spherical equivalent (SE), refractive cylinder (RefCyl), defocus equivalent (DEQ), cystoid macular edema (CME) rates, and return to the operating room (ROR). Statistical analyses included descriptive statistics, Chi-Square tests, one-way ANOVA, and two-sample t-testing.
Results
After exclusions, 357 eyes were analyzed with 52 (14.56%) eyes in the ACIOL group, 243 (68.07%) eyes in the ISHF-IOL group, and 62 (17.37%) eyes in the GSF-MET IOL group. All 3 groups had similar postoperative CDVA in eyes without significant comorbidities (p = 0.23). The ACIOL group had statistically significant better postoperative CDVA when all eyes were included (p = 0.002). SE, RefCyl, and ROR were similar among all groups (p=0.87, p=0.91, and p=0.08, respectively). CME rates were similar among all 3 groups (p = 0.94).
Conclusion
All three surgical techniques can provide good postoperative CDVA with similar safety.
Presenting Author
Haruka Horie, MD
Co-Authors
Eiichi Nishimura MD, PhD
Purpose
Currently, the flange method of intrascleral fixation is widely used in ophthalmology, but postoperative exposure of the flange at the tip of haptics and postoperative infection have been reported. In this study, we discuss a new flange technique using scleral flap.
Methods
A retrospective study of 12 eyes that underwent intrascleral fixation with scleral flap using V-lance from October 2023 to June 2024 at Showa University Fujigaoka Rehabilitation Hospital. A 1x1mm scleral flap was created with the V-lance 2mm from the corneal limbus. After inserting a 30-gauge needle receiving under the scleral flap, IOL haptics directly put the edge of the leading haptic in the lumen of the 30-gauge needle. The guiding needle is removed from the eye, and the tip of the haptic is cut off to create a flange, which is then implanted under the scleral flap. The decentration and tilt of the IOL at 1 week, 1 month, and 3 months were postoperatively measured by ASOCT.
Results
Postoperatively, 2 eyes (16%) had low intraocular pressure, 2 eyes (16%) had high intraocular pressure, and 1 eye (8%) underwent STTA for postoperative macular edema. Postoperative IOL decentration and tilt were 0.5 � 0.22 mm and 10.3 � 4.51�. There was no postoperative subconjunctival exposure of the IOL haptics with infection. The tips of all haptics were embedded in the sclera.
Conclusion
This technique appears to be a simple and inexpensive method for preventing exposure and infection of the IOL haptics after intrascleral fixation.
Presenting Author
Irene S. Zhou, BSc
Co-Authors
Dagny Zhu MD
Purpose
To compare visual outcomes and patient satisfaction of mix-and-match implantation of a trifocal and non-diffractive, extended-depth-of-focus (EDOF) IOL versus bilateral implantation of a trifocal IOL.
Methods
A retrospective, comparative study of patients who had femtosecond-laser assisted cataract or refractive lens exchange surgery with mix-and-match Clareon PanOptix and Vivity IOLs (Sept. 2022�Nov. 2023) versus bilateral AcrySof PanOptix trifocal IOLs (Sept. 2019�Aug. 2020) was done. Eyes with prior keratorefractive surgery or pathology were excluded. Primary endpoints were binocular best corrected visual acuity at distance (BCDVA), intermediate (DCIVA), and near (DCNVA) at 3 months. Secondary endpoints included uncorrected visual acuity at distance (UDVA), intermediate (UIVA), and near (UNVA). Spectacle independence, visual disturbances, and patient satisfaction were also assessed.
Results
100 eyes of 50 patients (mean age 57�6 years) for mix-and-match implantation and 78 eyes of 39 patients (mean age 56�6 years) for bilateral PanOptix implantation were included. Binocular CDVA and DCIVA were better for mix-and-match implantation (p<0.01), while binocular DCNVA was similar between both groups (p>0.05). Positive dysphotopsia frequency, severity, and bothersomeness were less with mix-and-match implantation (p<0.05). Specifically, 0% of mix-and-match patients and 25.6% of bilateral PanOptix patients were bothered �very much� by starbursts (p<0.0001). Patient satisfaction and spectacle independence were similar between both groups (p>0.05).
Conclusion
Mix-and-match implantation of the Clareon PanOptix trifocal and Vivity EDOF IOL is a safe and effective approach, resulting in similarly high levels of spectacle independence and patient satisfaction with fewer nighttime visual disturbances compared to bilateral implantation of the AcrySof PanOptix trifocal IOL.
Presenting Author
Irene S. Zhou, BSc
Co-Authors
Dagny Zhu MD
Purpose
To compare visual outcomes and patient satisfaction of mix-and-match implantation of a trifocal and non-diffractive, extended-depth-of-focus (EDOF) IOL versus bilateral implantation of a non-diffractive EDOF IOL via micro-monovision approach.
Methods
A retrospective comparative study of patients who had femtosecond-laser assisted cataract surgery with mix-and-match implantation of the Clareon PanOptix trifocal and Vivity EDOF IOLs (Sep 2022-Nov 2023) versus bilateral Clareon Vivity IOLs (plano dominant eye; -0.25 non-dominant eye) (Jun 2022-Feb 2024) was done. Eyes with prior keratorefractive surgery or pathology were excluded. Primary endpoints were binocular best corrected visual acuity at distance (BCDVA), intermediate (DCIVA), and near (DCNVA) at 3 months. Secondary endpoints included uncorrected visual acuity at distance (UDVA), intermediate (UIVA), and near (UNVA), spectacle independence, dysphotopsias, and patient satisfaction.
Results
100 eyes of 50 patients (mean age 57�6 years) for mix-and-match implantation and 46 eyes of 23 patients (mean age 56�6 years) for bilateral Vivity implantation were included. Binocular CDVA and DCIVA were similar between the two groups (p>0.05). Binocular DCNVA and UNVA were better for mix-and-match (p<0.05). Frequency, severity, and bothersomeness of haloes were less with bilateral Vivity implantation (p<0.05), while starburst and glare were similar (p>0.05). Patient satisfaction and spectacle independence were similar between the groups (p>0.05), with 90% vs. 96% satisfaction and 84% vs. 87% complete spectacle independence for mix-and-match and bilateral Vivity implantation, respectively.
Conclusion
Mix-and-match implantation of the Clareon PanOptix and Vivity IOL is a safe and effective approach, resulting in better near vision and slightly greater visual disturbances but similar levels of patient satisfaction compared to bilateral implantation of the Clareon Vivity. The best IOL approach must be matched to each patients� lifestyle.
Presenting Author
Juan J Arce-Frances, MD, ABO
Purpose
This study aims to compare quality of life and spectacle independence, measured by VFQ-25, in patients with bilateral Eyhance IOL implantation versus aspheric monofocal IOL using mini-monovision strategy at 6 weeks post-surgery. Secondary objectives include quality of life, refractive outcomes, and binocular defocus curves at the same interval.
Methods
This prospective, randomized clinical trial will include patients over 50 years with bilateral cataract and no other ocular pathologies. Participants will undergo phacoemulsification with bilateral Eyhance IOL implantation or standard aspheric monofocal IOL with mini-monovision strategy. Outcomes will be measured at 6 weeks post-surgery using the VFQ-25 questionnaire, assessing quality of life, spectacle independence, visual acuity, refractive outcomes, and binocular defocus curves. Data will be analyzed using SPSS and GraphPad PRISM software.
Results
TBD
Conclusion
TBD
Presenting Author
Thiago A. Moulin, MD
Co-Authors
Robert Weinstock MD, Subhashini Chandrasekaran MD, Mariam Bakhtyari BSc, Renee Bondurant BSc
Purpose
Compare the safety, efficacy and length of surgical time of routine cataract surgery with a novel, augmented-reality surgical headset. We hypothesize similar safety, efficacy and surgical time.
Methods
Prospective, unmasked, non-randomized non-inferiority comparative study of otherwise-healthy eyes undergoing routine cataract surgery at the Eye Institute of West Florida, Largo, FL. Eyes undergo surgery with either the Beyeonics (Beyeonics Vision, Tirat Carmel, Israel) or the Ngenuity (Alcon, Fort Worth, TX) imaging systems. Outcomes: Visual acuity at 30 min, 1 day and 1 month postoperatively; Complication rate (vitrectomy, iris damage, need for capsular tension ring, need for a second procedure within 1 month, intraocular pressure spike); length of surgery (in time).
Results
TBD
Conclusion
TBD
Presenting Author
Mitchell C. Shultz, MD, ABO
Co-Authors
Asael Papour PhD
Purpose
To evaluate the relationship between phacoemulsification machine settings and utilization, specifically focusing on total power and time. Utilizing big-data analytics from the Bausch + Lomb Eyetelligence� cloud-based digital platform, the goal is to enhance surgical efficiency and improve patient outcomes.
Methods
A retrospective analysis was conducted on consecutive eyes operated on by a single surgeon (n=3,753), compared with a larger dataset from the Eyetelligence� cloud database in the US (n=1,000,000). All surgeries utilized the Stellaris Elite (Bausch + Lomb) vacuum-based surgical platform. Extracted data included machine usage settings and surgical parameters such as foot pedal settings, ultrasound modulation type, Absolute Phaco Time (APT), average percent phaco power (US/%Avg), and Total Fluid Usage (TFU).
Results
Significant differences were observed between the single surgeon and the broader dataset of one million surgeries: US/%Avg was 14.7 versus 17 (p=0.00), APT was 12 seconds versus 27.4 seconds (p=0.00), TFU was 37.2 ml versus 59.9 ml (p=0.00), and the maximum foot pedal power setting was 28.4 versus 39.9 (p=0.00). Ultrasound modulation types also differed significantly: for the single surgeon, MultipleBurst was used 63.81%, Pulsed 21.6%, and Continuous 14.6%, compared to the broader data where Pulsed was used 60.56%, Continuous 24.2%, and MultipleBurst 12.54%.
Conclusion
The findings suggest that lower power settings, optimized foot pedal control, and selection of energy modulation can reduce phaco time, enhance surgical efficiency, and minimize fluid usage. These insights support the role of cloud analytics in optimizing surgical techniques, improving surgeon performance, and ultimately enhancing patient outcomes.
Presenting Author
Khaldon Abbas, MD
Co-Authors
Lulu Bursztyn MD, BEng, FRCSC, MSc
Purpose
Assessment of surgical time in Immediate Sequential Bilateral Cataract Surgery (ISBCS) versus Delayed Sequential Bilateral Cataract Surgery (DSBCS) have mostly focused on the time between patient�s operating room entrance and exit. We aim to assess the surgical time between the start of draping and drape removal for each eye in ISBCS vs DSBCS.
Methods
This is a retrospective study. Patients undergoing cataract surgery between Feb and July 2024 will have their data summarized and include sex, age, comorbidities, date and time of surgery, surgical characteristics, whether they had ISBCS or DSBCS, and surgical time between drape application to drape removal for each eye. The surgical time for the first eye and the second eye will be compared. Paired sample t-tests will be used to assess differences in surgical time between first and second eye. Independent sample t-tests will also be used to compare surgical time between ISBCS and DSBCS. Logistic regression will be used to determine factors leading to a longer surgical time.
Results
There was a total of 100 eyes (50 patients) in the ISBCS group and 102 eyes (51 patients in the DSBCS group. The mean age was 73.36�8.30 (66% female) and 72.14�9.52 (60% female) in the ICBCS and DSBCS, respectively. The average surgical time for the first eye was 10.02 minutes and 11.73 minutes in the ISBCS and DSBCS group, respectively (p=0.0053). The average surgical time for the second eye was 10.34 minutes and 10.84 minutes in the ISBCS and DSBCS group, respectively (p=0.3974). The mean difference between the first and second eye was 0.32�2.00 minutes and -0.88 � 4.76 minutes, for the ISBCS and DSBCS group, respectively (p=0.106).
Conclusion
Our results indicate that the observed surgical time difference in the simultaneous and non-simultaneous groups between the first and second eye was not different. This may potentially be due to the significant difference in surgical time in the first eye between groups which may be explained by potential pre-operative characteristic differences.
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