Moderator
Sahar Bedrood, MD, PhD, ABO
Panelists
Richard Tipperman, MD
Simon S. Fung, MD, MA, FRCOphth
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 P. Berdahl, MD
Co-Authors
Vance Thompson MD, David Dyk MS, Satish Yalamanchili MBA, MS, Sarah Makari OD, Ali Aboughaida MS
Purpose
To demonstrate intraocular pressure (IOP) control using UNITY VCS during cataract surgery based on initial clinical experience and bench testing.
Methods
A prospective single-arm clinical study evaluated the safety and performance of the UNITY VCS in adults presenting for routine cataract surgery. In addition, bench testing using an eye model and calibrated pressure sensor measured IOP control error by evaluating the pressure difference between the IOP setpoint and the measured IOP during aspiration flow (for 10 seconds) after reaching steady state (5 seconds after aspiration is initiated). To test the system at its limits, 30 phacoemulsification handpieces were tested at 20-120 mmHg IOP and 15-60 cc/min aspiration flow rate and 15 I/A handpieces were tested at 20-120 mmHg IOP and 15-30 cc/min aspiration flow rate.
Results
50 subjects underwent cataract surgery using UNITY VCS with exceptional anterior chamber stability observed during all cases. This is supported by results from the bench where the highest expected IOP control error at the lowest/most physiological IOP (20 mmHg) and highest aspiration flow rate was 2.36 � 2.13 at 60 cc/min and 4.19 � 1.97mmHg at 30 cc/min during phacoemulsification and I/A, respectively. These results compare favorably to physiologic IOP diurnal variation in normal patients (5.0 � 2.7mmHg) and demonstrate that IOP would be expected to be maintained approximately within 18 to 22 mmHg when the IOP is set to 20 mmHg during the phacoemulsification step.
Conclusion
UNITY VCS demonstrates excellent IOP control during cataract surgery as observed clinically and on the bench. Maintaining IOP at the desired surgeon setpoint with minimal fluctuation throughout surgery may reduce intraoperative and postoperative complications, especially in more complex cases.
Presenting Author
Sanchay Gupta, MD, MBA
Co-Authors
Li Wang MD, PhD, Mitchell Weikert MD, MS, Douglas Koch MD, Xuesen Cheng MD, PhD, Kusona Fortingo BSc, Allison Chen MD, MPH
Purpose
To compare the objective refraction obtained from the WaveDyn Vision Analyzer at various pupil sizes to the manifest refraction in pseudophakic eyes.
Methods
The WaveDyn is a Shack-Hartmann wavefront sensor that has the highest resolution commercially available with approximately 2,870 lenslets over a 7.0-mm pupil. This device captures a video of the eye�s dynamic optical system over time. In this study, manifest refraction will be performed and recorded by the optometrist without knowing the results from the WaveDyn. Objective refraction obtained from the WaveDyn at different pupil sizes (3 to 5 mm) will then be compared to the manifest refraction. Differences in sphere, spherical equivalent, and astigmatism will be evaluated.
Results
64 pseudophakic eyes were included in the study. 25 of these eyes were male (39.1%), mean age was 70.5 +/- 7.6 years, and mean IOL power was 19.0 +/- 4.5 diopters. Mean deviation in spherical refraction at 3 mm, 3.5 mm, and 4 mm was -0.14, -0.09, and -0.09 diopters respectively (p = 0.026, 0.146, 0.202), where deviation was defined as the WaveDyn refraction minus the optometrist manifest refraction. Mean deviation in cylindrical refraction was +0.21, +0.16, and +0.88 (p = <0.001, 0.002,="" 0.03).="" finally,="" mean="" deviation="" in="" spherical="" equivalent="" was="" -0.03,="" -0.01,="" and="" +0.35="" (p="0.396," 0.912,="">
Conclusion
This analysis demonstrates that varying the pupil size on the WaveDyne Vision Analyzer may influence the degree of deviation between the objective refraction and manifest refraction. Additional eyes will be included and this analysis will be expanded to cover a broader range of pupil sizes.
Presenting Author
Rosa Braga-Mele, MD, FRCSC
Co-Authors
Guangyao Jia PhD, Satish Yalamanchili MBA, MS, Sarah Makari OD
Purpose
To evaluate total ultrasound (US) energy in Torsional (Tors) and a new 4D ultrasound mode (4D) in both porcine cadaver eyes (simulating grade 1-3 cataracts) and artificial lenses (simulating dense grade 4+ cataracts) using cumulative dissipated energy (CDE) and a novel calorimetric energy measurement method in Joules (J).
Methods
Artificial dense and microwaved lower density porcine lenses were emulsified using UNITY VCS with Tors and 4D. Energy (CDE and J) and US time were recorded from the machine and data was analyzed using a two-sided independent samples t-test in SAS. Controlled bench testing was also conducted to compare Tors and 4D for a specified artificial lens weight. Ultrasound tip was inserted into 0.5-gram distilled water fixture. Peak temperature rise in water after application of ultrasound for 5-10 seconds was used to calculate total ultrasound energy and establish US energy-power level correlations. Time and energy needed to emulsify similar lens weight was recorded as s/mg and J/mg, respectively.
Results
66 cadaver porcine eyes (33 Tors, 33 4D) and 64 artificial lenses (32 Tors, 32 4D) demonstrated statistically significant less energy (CDE and J) and US time with 4D when compared to Tors (p<0.05). compared="" to="" softer="" porcine="" lenses,="" harder="" artificial="" lenses="" required="" more="" average="" energy="" and="" time="" with="" tors="" while="" 4d="" required="" slightly="" less="" average="" energy="" and="" time.="" bench="" testing="" using="" artificial="" dense="" cataracts="" controlled="" for="" weight="" showed="" a="" 49%="" improvement="" in="" efficiency="" (2.79�0.77="" vs="" 5.48�1.27="" s/mg)="" and="" cde="" (0.67�0.18="" vs="" 1.32�0.30="" per="" mg)="" as="" well="" as="" 43%="" reduction="" in="" total="" energy="" into="" eye="" (0.75�0.21="" vs="" 1.32�0.30="" j/mg)="" with="" 4d="" when="" compared="" to="">
Conclusion
Energy in J allows direct comparison of ultrasound modalities using different phaco machines. The novel 4D ultrasound mode is more efficient and reduces the amount of energy dissipated at the incision site and delivered into the eye when compared to torsional ultrasound which may translate to better corneal health and visual outcomes.
Presenting Author
Kerry D. Solomon, MD
Co-Authors
Helga Sandoval MD, MSc, Richard Potvin OD
Purpose
The purpose of this study is to evaluate and compare the performance of two different phacoemulsification systems when using the optimized settings for each device, in patients undergoing routine cataract surgery and implantation of a posterior chamber intraocular lens (PCIOL).
Methods
Prospective, randomized, double-masked study that includes 40 patients undergoing bilateral cataract surgery. The first eye undergoing surgery is randomized to group 1 (Quatera 700) or group 2 (Centurion). The fellow eye receives the alternate treatment. Pachymetry, macular thickness, intraocular pressure, best-corrected visual acuity are assessed preoperatively, and 1, 7, 30 and 90 days after surgery. Specular microscopy is evaluated pre and 3-months postoperative. Lens removal time (from end of rhexis to complete nucleus removal) is assessed. Statistical analysis comparing both groups and baseline to postoperative visits is conducted. A P-value <.05 is considered statistically significant.
Results
TBD
Conclusion
TBD
Presenting Author
Tyler Whitaker, BSc
Co-Authors
Reiker Ricks BSc, Coby Soule BSc, Tanner Nelson BSc, Nathan Sherbotie BSc, Jessie Montgomery BSc, Jeff Pettey MBA, MD, Randall Olson MD
Purpose
To evaluate the MICOR cataract extraction device for a post-occlusion pressure surge. Zeiss� MICOR cataract extraction device has all machinery fitted compactly within the handpiece itself and as such has no outflow tubing. Theoretically, if there is no outflow tubing there should be no post-occlusion surge.
Methods
This study uses the Zeiss� novel MICOR cataract extraction device which is compared against Alcon�s Centurion platform using the Ozil handpiece as a control. Both devices had their tips fitted within a pressure sensing chamber and were set to maintain an equivalent IOP of 60 mmHg. For each trial the Alcon device�s vacuum setting was set to 450 mmHg, aspiration flow was set to 30 cc/min and the foot pedal was depressed to position two continually. The MICOR has no such settings, but the trigger was fully depressed for each trial to assure consistency between trials. Within the pressure sensing chamber, occlusion was created and broken and pressure changes were recorded.
Results
We found no evidence of post-occlusion surge, as we have mathematically defined it, in our trials with the MICOR device, which allowed for no direct comparison against the Centurion Vision System. When the MICOR tip was unoccluded, the pressure within the chamber would drop precipitously from the set pressure. When the MICOR tip was occluded, the chamber would repressurize to the set pressure. Additional experiments showed that by depressing the trigger of the MICOR device and maintaining the tip unoccluded, the pressure within the chamber would drop from the set bottle height by an average of 28.83 mmHg. It took 6.6 seconds on average to reach a steady state pressure.
Conclusion
Our experiment proved our hypothesis that the MICOR device would generate no post-occlusion surge. We found evidence of a mismatch between inflow and outflow created by the MICOR device which causes a drop in pressure of about 30 mmHg if the tip of the MICOR remains unoccluded for seven or more seconds while the trigger is depressed.
Presenting Author
Inder P. Singh, MD
Purpose
The Eyetelligence platform provides an effective way to collect large data sets from surgeons across the country. We wanted to evaluate, using large numbers never been documented before, phaco metrics such as energy and fluid use of various Phaco techniques from surgeons across the country.
Methods
Through its apps, algorithms and analytics, Eyetelligence (ET, Bausch + Lomb) cloud based Digital Platform, connects Stellaris Elite to the secure cloud and provides surgeons with robust case level data. Parameters include Infusion Actual Time, Infusion Average Pressure, Aspiration Actual Time, Aspiration Average Vacuum, Aspiration Effective Vacuum Time, Ultrasound Actual Time, Ultrasound Average Power and Ultrasound Effective Time. This helps surgeons to track their surgical parameters and gain valuable insights when analyzing their procedures over time. We were able to anonymously collect this data and for the first time, present averages from thousands of surgeons around the country.
Results
For 2,015,772 surgical cases from 369,802 surgeons, the average fluid usage was 80.11 mL, the average infusion time was 459.76 sec (7.66 min), the average infusion pressure was 70.5 mmHg, the average aspiration time was 183.65 sec (3.06 min), the average aspiration vacuum was 236.6, the average aspiration vacuum time was 78.04 sec (1.30 minutes), the average ultrasound time was 24.70 seconds, the average ultrasound power was 14.36, and the average ultrasound effective time was 4.56 seconds. More detailed comparisons of these parameters between various phaco techniques will be presented. Data from residency programs will also be separated and compared to the practicing MD population.
Conclusion
To our knowledge this data set is the largest volume of cases analyzed to date. Surgeons can measure case parameters and gain valuable insights to analyze their procedures over time. It provides a unique opportunity for surgeons to compare their parameters to a large database to help them improve efficiency and improve hopefully patient outcomes.
Presenting Author
Nir Shoham-Hazon, MD
Co-Authors
Thierry Perreault-Carranza MD, Alejandro Lichtinger MD, Yanis Saheb MD
Purpose
To evaluate the repeatability of three swept-source optical coherence tomography (SS-OCT) biometers, the Zeiss IOLMaster 700, the Heidelberg ANTERION, and the Tomey OA-2000, and compare the agreement in optical biometry measurements and the predicted intraocular lens power (IOLP).
Methods
In this prospective comparative study, 57 eyes scheduled for cataract surgery underwent three consecutive measurements with three different biometers. Parameters measured include axial length, flat keratometry, steep keratometry, average keratometry, keratometry steep axis, anterior chamber depth, central corneal thickness, aqueous depth, lens thickness, white-to-white distance, and predicted intraocular lens power. Repeatability was assessed through within-subjects standard deviation, repeatability coefficient, coefficient of variation (CV), and intraclass correlation coefficient (ICC). Device agreement was evaluated using ICC and Bland-Altman plots.
Results
All devices showed excellent repeatability for most parameters (CV < 1%, ICC > 0.93), except OA-2000, which showed higher variability (CV > 1%) for ACD, AQD, LT, and IOLP. High agreement for AL, keratometry, and predicted IOLP (ICC > 0.918) and moderate agreement for K2 axis (ICC ? 80) were observed among devices. ANTERION and IOLMaster 700 displayed the strongest agreement across most parameters (ICC > 0.96), while OA-2000 had poor agreement for ACD, AQD, and LT. Bland-Altman analysis revealed narrow limits of agreement (LoA) between ANTERION and IOLMaster 700 for most parameters, while comparisons involving OA-2000 showed wider LoA, particularly for ACD, AQD, LT, K2 axis, and IOLP.
Conclusion
While these findings suggest that all devices show good repeatability, ANTERION and IOLMaster 700 demonstrated better agreement with each other than OA-2000 for most parameters. The measurements from different devices may impact IOL power calculations, particularly for ACD, AQD, and LT, and may not be interchangeable.
Presenting Author
Vivekanandan VR Ramakrishnan, MS
Purpose
1) To study the clinical outcomes with respect to centration following the new technique of SFIOL 2) To study the visual outcome in terms of Visual Acuity and Spherical Equivalent at post-operative day 30 3) To study the intra and post-operative complications associated with the new technique of SFIOL 4) To note the duration of the surgery
Methods
We conducted a prospective interventional study among 74 patients with aphakia having inadequate capsular support who underwent secondary IOL implantation using the novel Four Flange Technique for scleral fixation of IOL using PMMA IOL. The surgical procedure was performed by creating 2 flanges using 7-0 polypropylene on the IOL dialing holes and 2 flanges on the sclera externally using a thermocautery. The clinical outcomes of the techniques were evaluated on POD 1 and POD 30 including visual acuity, spherical equivalent and IOL centration. Intra-operative and post-operative complications and duration of surgery was also recorded
Results
Conclusion
Novel four flange technique of SFIOL has clinical outcomes comparable to existing techniques. The peculiarities are that it can be performed by an anterior segment surgeon, does not require specialised IOL (uses PMMA IOL) and ease of performing. It will benefit the developing countries, where the majority of surgeries performed are MSICS.
Presenting Author
Francisco Mendes, MD
Co-Authors
Kusona Fortingo BSc, Dylan McBee BSc, Li Wang PhD, MD, Douglas Koch MD, Xuesen Cheng MD, PhD, Mitchell Weikert MD, MS, Allison Chen MD, MPH
Purpose
To compare the objective refraction obtained from the WaveDyn Vision Analyzer to the manifest refraction performed by an Optometrist and technicians in pseudophakic eyes.
Methods
The WaveDyn is a Shack-Hartmann wavefront sensor that has the highest resolution commercially available with approximately 2,870 lenslets over a 7.0-mm pupil. This device captures a video of the eye�s dynamic optical system over time. Manifest refraction was performed by an Optometrist and a technician without knowing the results from the WaveDyn. Objective refraction obtained from the WaveDyn was compared to the manifest refraction from the Optometrist and technicians. Differences in sphere, spherical equivalent, and astigmatism were evaluated.
Results
In Group 1 (Optometrist + Technician, n=39), the differences between the WaveDyn Standard and manifest refraction were small, with a mean spherical equivalent (SE) of -0.78 for WaveDyn and similar values for the Optometrist and Technician. In Group 2 (Optometrist, n=27), the mean SE difference was slightly greater, with the WaveDyn Standard showing -0.52. Group 3 (Technician, n=53) demonstrated the least variation, with WaveDyn Standard (-0.20 SE) and Technician results closely aligned. The data suggests WaveDyn�s measurements are consistent with manifest refraction, especially in Technician-performed tests.
Conclusion
The WaveDyn Vision Analyzer shows comparable results to manifest refraction in pseudophakic eyes, with minor differences in spherical equivalent across groups. As more eyes are included, these findings will be updated for greater accuracy and clinical relevance.
Presenting Author
Pallak Kusumgar, MS
Co-Authors
Neeraj Israni MS
Purpose
To compare the effectiveness of a newly designed Slit Lamp-based Toric Marker (STORM) for corneal marking with conventional marking techniques.
Methods
We developed a new Slit Lamp-based Toric Marker to facilitate hands-free, precise toric marking. A total of 60 consecutive eyes were included in the study: 30 eyes marked with STORM and 30 eyes marked using conventional techniques. Corneal marks were evaluated through photographic analysis using digital planimetry software. Postoperative residual astigmatism was assessed and statistically compared between the two groups.
Results
Analysis using digital planimetry software showed that STORM achieved significantly more accurate corneal mark placements and intraocular lens (IOL) alignments compared to conventional methods. Postoperative residual astigmatism at 6 months was notably better correlated with anticipated values in the STORM group
Conclusion
The Slit Lamp-based Toric Marker (STORM) demonstrated superior accuracy and reproducibility in corneal marking compared to traditional techniques, leading to improved postoperative astigmatic outcomes.
Presenting Author
Matteo Piovella, MD
Co-Authors
Barbara Kusa MD
Purpose
Radial tears in the manual capsulorhexis increase the rate of surgical complications.Zepto precision pulse capsulotomy (PPC) technology(Centricity Vision- Fremont,California)is compared with manual continuous curvilinear capsulorhexis (CCC) outcomes by the reproducibility, uniformity, circularity, diameter size and complications rate.
Methods
A novel mechanical capsulotomy method and technology called PPC and trade named Zepto was adopted on 526 consecutive eyes with cataract. Incision size 2,4 mm. Suction time 10 seconds. Minimum Anterior chamber depth 2mm.Callisto system adoption to better center the cup After learning curve mechanical capsulotomy rapresents the safer and more effective also if compared with manual expert surgeon capsulorhexis
Results
Preoperatevely the ACD was 2.77 � 0.43. ECC preop was 2378 � 443 and 6 months postop 2268,20 � 241 with a 4.61 % lost cells. We experienced 30 anterior radial tears (5.7%) during the learning curve and later in difficult cases. Zepto adopting in white cataract avoid argentina flags complication
Conclusion
The Zepto PPC technology creates a precise circular anterior capsulotomy. This technique allows cataract surgeons to reduce the rate of capsulorhexis and cataract surgery complications. This device helps also expert catarct surgeon to reduce % of capsular bag complications
Presenting Author
Mitchell P. Weikert, MD, MS, ABO
Co-Authors
Li Wang PhD, MD, Douglas Koch MD, Xuesen Cheng MD, PhD, Kusona Fortingo BSc, Francisco Mendes MD
Purpose
To investigate the repeatability of objective refraction obtained with a high-resolution Shack-Hartmann wavefront sensor (WaveDyn Vision Analyzer) and to compare it to the manifest refraction in pseudophakic eyes with previous LASIK/PRK/RK.
Methods
The WaveDyn is a Shack-Hartmann wavefront sensor with the highest commercially-available resolution (2,870 lenslets over a 7-mm pupil). It captures a video of the eye�s dynamic optical system over time and displays an objective refraction. In pseudophakic eyes with previous LASIK/PRK/RK, 3 repeated measurements with the WaveDyn will be performed. An optometrist will perform a manifest refraction blinded to the objective wavefront measurement. Repeatability of the objective refraction will be analyzed via within-subject standard deviation, coefficient of variance, and intraclass correlation coefficient. Differences between the objective refraction and manifest refraction will be evaluated.
Results
The study enrolled 23 pseudophakic eyes with a history of refractive surgery (RK, PRK, LASIK). The within-subject standard deviations (Sw) were 0.22 D for sphere, 0.21 D for cylinder, and 0.21 D for SEQ. Sw values for vertical coma Z(3,-1) and horizontal coma Z(3,1) were 0.107 �m and 0.119 �m, respectively. Primary spherical aberration Z(4,0) had an Sw of 0.100 �m, and RMS HOA (3rd to 6th order) had an Sw of 0.033 �m. Mean Coefficient of Variation (CoV) values were -36.7% (sphere), 11.3% (cylinder), 15.2% (SEQ), 54.6% (Z(3,-1)), 12.9% (Z(3,1)), -44.1% (Z(4,0)), and 10.9% (RMS HOA).
Conclusion
The Shack-Hartmann wavefront sensor demonstrated good repeatability for RMS HOA measurements with low within-subject variability. However, greater variability was observed for sphere, cylinder, and SEQ measurements, especially in eyes with prior refractive surgery. Additional eyes will be included, and results will be updated accordingly.
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