Moderator
Stephen D. Klyce, PhD
Panelists
Mina A. Farahani, MD, ABO
KAMRAN M. RIAZ, 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
Sara Sardari, PhD
Purpose
To compare the intraocular lens (IOL) power calculated with Haigis, Hoffer Q, Holladay 1, and SRK/T formulas between the IOL Master 500 and Pentacam AXL according to the lens status
Methods
All participants underwent optometric examinations including the measurement of visual acuity and refraction as well as slit lamp biomicroscopy to determine the lens status. Biometric measurements and intraocular lens power calculation were done using the IOL Master 500 and Pentacam AXL
Results
After applying the exclusion criteria, 1865 right eyes were analyzed. The mean IOL difference between the two devices was -0.33�0.35, -0.38�0.39, -0.41�0.43, and -0.51�0.43 according to the SRK/T, Holladay, Hoffer Q, and Haigis formulas, respectively. The Pentacam calculated larger IOL power values in all cases. The 95% limits of agreement between the two devices for the above formulas were -1.01 to 0.35, -1.14 to 0.39, -1.25 to 0.43, and -1.35 to 0.33, respectively. There was a significant correlation between the IOL power difference and the difference in three biometric components, including axial length, mean keratometry reading, and anterior chamber depth.
Conclusion
Although the difference in the calculated IOL power between IOL Master 500 and Pentacam AXL is not significant clinically, the results of these two devices are not interchangeable due to the wide limits of agreement, especially for the Haigis formula; therefore, it is necessary to optimize lens constants for the Pentacam.
Presenting Author
Rajendra Prasad, MD, MBBS
Purpose
Is to describe an efficient and safe device Trishool the wedge tool designed with the principle of classical simple machine and Griffith�s theory of brittle fracture to crack and break the mature hard cataract into full thickness free segments including the posterior plate with much ease and which is also free from high intensity shock and strain
Methods
We incorporated triangular wedge design into the tip of the terminator in which pointed apex of wedge is kept at the inner edge of the tip while wide and flat base of wedge is placed at the posterior surface of the tip. Simply drawing the wedge inner edge of the terminator through the equator of the nucleus after hooking it around generate transversal fracture force with amplification, induce full thickness nuclear crack which automatically traverses through the entire nucleus breaking it into two complete free segments. Emulsification of full thickness free segments makes surgical maneuvers much easier and facilitates the overall procedure with higher level of efficiency and safety.
Results
Wedges have been successfully used in rock excavation system since the ancient time to crack and break solid hard rocks. We used terminator the wedge tool in 1000 cases of hard cataract of LOCS grade II to grade VI nucleus in our study. We found that terminator the wedge tool was highly efficient, safe and simple to crack and break these hard nuclei into multiple free segments. Surgery was conducted successfully in all the 1000 eyes. Full thickness cracking was possible in 99.1% of cases. 0.9 % of cases nucleus was removed in total with ECCE technique. In one case PCR due to excessive stress force directed posteriorly. Cornea was clear in 98.2% of cases on first postoperative day.
Conclusion
Trishool the triple edge wedge tool is the simplest of tools, with its unique physical property, enables us to crack and break the hardest of hard cataract with very little effort and much easier surgical manoeuvre. Nuclear cracking is highly efficient, least traumatic giving minimal stress on the zonule's and posterior capsule.
Presenting Author
Shwetha Mudalegundi, BSc
Co-Authors
Neil Kelkar MD, Kevin Eid MSc, MD, Nick Mamalis MD, Liliana Werner PhD, MD, Melissa Yao MD, Jesse Chew FRCSC, MD
Purpose
To perform a detailed laboratorial assessment of the variability in morphology (shape of opening port and surface finishing), as well as patency of Chang hydrodissection cannulas used in cataract surgery.
Methods
A total of 34 disposable cannulas from 3 different manufacturers were evaluated in this study. Seventeen cannulas were primed with solution, and then underwent analyses under gross and light microscopy. Seventeen other cannulas were directly removed from the package, and underwent the same above-mentioned analyses, before priming. Selected cannulas from both groups were also evaluated under scanning electron microscopy and surface analyses.
Results
There was variability in all parameters evaluated in this study, including opening ports that were irregular in shape, partially or totally blocked, as well as a cannula with a second, lateral opening port. The surface finishing of the ports was also variable, with cannulas exhibiting sharp and/or irregular edges, as well as what appeared to be metallic debris. Fluid streams obtained with the cannulas also varied, and while some cannulas produced a normal stream, others produced a weak stream, no stream, or double stream.
Conclusion
The findings in this study raise concerns about potential damage to the capsule during hydrodissection by irregularities and debris in the cannulas. Priming before use in surgery is advisable to confirm appropriate fluid flow.
Presenting Author
Antonio J. Villegas, PhD
Purpose
This study evaluates the Viscochopper device in cataract surgery, focusing on its ability to reduce complications such as posterior capsule rupture, endothelial cell loss, and vitreous loss. The study explores whether the device helps maintain a stable surgical field and minimizes turbulent flow to enhance surgical safety.
Methods
This experimental study, using prospective data from human eye anatomical models and no patient involvement, assessed the Viscochopper device paired with the Centurion cataract machine and conventional viscoelastic. Outcomes measured included surgical field stability, prevention of posterior capsule rupture, vitreous loss, and the theoretical preservation of endothelial cells. A comprehensive literature review shaped the methodology. Results were benchmarked against standard surgical techniques to determine if the Viscochopper provides a safer, more controlled surgery experience by mitigating common complications. The findings rely on theoretical assumptions and model-based evaluations.
Results
The results indicate that the Viscochopper device theoretically achieves its goals by enhancing surgical field stability, reducing the risk of posterior capsule rupture, minimizing vitreous loss, and mitigating the surge phenomenon in human eye models. However, the potential benefit of endothelial cell preservation remains theoretical, as actual endothelial counts were not feasible. These findings underscore the device's capabilities, including managing vitreous loss during capsule ruptures. Clinical trials are essential to validate its effectiveness and safety, particularly concerning endothelial protection.
Conclusion
The Viscochopper device demonstrates potential benefits in enhancing surgical field stability and managing vitreous loss during cataract surgeries. However, its effects on endothelial cells remain theoretical, highlighting the need for clinical trials to confirm its efficacy and safety in real-world scenarios.
Presenting Author
Hisaharu Suzuki, MD, PhD
Co-Authors
Satish Yalamanchili MBA, MS, Mai Kurose MS, Takashi Horie MS, Sarah Makari OD
Purpose
To evaluate the anterior chamber stability of UNITY VCS (UVCS) when compared to CENTURION with Active Sentry (CAS) using the slit side view (SSV) technique during simulated occlusion break.
Methods
Ten porcine eyes underwent testing at IOP of 20, 30, 40 mm Hg, vacuum limits of 550, 600, 650 mm Hg, and aspiration rate of 40 mL/min. Eyes had 2.4 mm incision created then transferred to slit lamp where the phacoemulsification handpiece and eye were fixed to minimize leakage. An IOP sensor was inserted into the anterior chamber. Continuous irrigation was used to stabilize IOP before an occlusion break was simulated 3 times by pinching the aspiration line with pliers for 3 seconds then released. IOP changes were recorded via a calibrated pressure transducer and SSV images were continuously recorded to determine ACD change ratio, surge duration, and surge volume during occlusion break event.
Results
UVCS and CAS were used in each eye and the choice of first machine was alternated. The ACD change was statistically significantly less with UVCS/UCS when compared to CAS (0.15 � 0.01 vs 0.43 � 0.07 mm, p<0.001), a="" 2.8="" times="" improvement="" in="" ac="" stability.="" average,="" baseline="" iop="" was="" within="" 0.7="" and="" 3.2="" mmhg="" from="" the="" iop="" set="" point="" with="" uvcs/ucs="" and="" cas,="" respectively.="" during="" occlusion="" break,="" the="" minimum="" iop="" was="" maintained="" significantly="" closer="" to="" baseline="" with="" uvcs/ucs="" vs="" cas="" (19.1="" �="" 5.4="" vs="" 26.9="" �="" 6.0="" mmhg,=""><0.001). post-occlusion="" break="" surge="" volume="" and="" duration="" were="" significantly="" less="" with="" uvcs/ucs="" vs="" cas=""><0.001) with="" a="" mean="" recovery="" time=""><0.17 seconds="" with="" uvcs/ucs="" regardless="" of="">
Conclusion
UVCS/UCS maintained AC stability better than CAS during simulated occlusion break testing which may improve surgeon confidence to operate at lower IOP and clinical outcomes. Recovering from post-occlusion break surge faster than reported human reaction times suggests that UVCS/UCS can compensate for fluctuations faster than the surgeon can react.
Presenting Author
Tsukasa Hanemoto, MD, PhD
Purpose
This study introduces the "Round Divider", a novel instrument designed to overcome challenges in cataract surgery, especially in cases with small pupils, and evaluates its efficacy and safety.
Methods
The Round Divider by Inami Co. has a 0.5mm rounded drum-shaped tip and a 1.2mm extended blade, similar to a chopper. Its spherical tip minimizes the risk of posterior capsule damage during nucleus division, while its length allows entry into ultrasound (US) grooves without catching the iris, even in small pupils. This design reduces the need for precise mechanical alignment. We evaluated 20 cataract surgeries (nuclear grade 3) with the Round Divider (RD group) and compared them to 20 cases with the Phaco Chopper (PC group). Postoperative assessments included corneal endothelial cell loss, cumulative dissipated energy (CDE), and operative time.
Results
The mean endothelial cell loss was 5.2�2.9% in the PC group and 4.6�2.4% in the RD group. The CDE was 8.5�2.6 in the PC group and 8.5�2.3 in the RD group. The mean operative time was 7.4�1.2 minutes in the PC group and 7.1�1.3 minutes in the RD group. There were no statistically significant differences between the groups (Mann-Whitney U test, P< />
Conclusion
The Round Divider demonstrated a safety comparable to the phaco chopper for nucleus division in cataract surgery, making it suitable for both standard and complex cases.
Presenting Author
Morgan Micheletti, MD, ABO, FACS
Co-Authors
Kendrick Wang MD, Brad Hall PhD
Purpose
To evaluate the reduction of manual a-scans and potential clinic time savings of two swept-source optical coherence tomography (SS-OCT) biometers and to determine the need for confirmatory a-scans.
Methods
This study is a single-center, prospective, non-interventional, observational study of 70 patients who previously underwent complex cataract surgery for reasons of poor visualization or red reflex and had a preoperative biometry with the IOL Master 700 and Argos. Outcomes measures included the percentage of eyes that were able to acquire axial length measurements, the percentage of eyes that required ultra-sound a-scans due to missing axial length, the percentage of eyes that had to use the enhanced retina visualization (ERV) mode, technician time and patient time, and differences between postoperative axial lengths and preoperative axial lengths.
Results
To date, 43 eyes have been enrolled. The Argos was able to successfully acquire axial length (AL) in 42/43 eyes, compared to 35/43 for IOL Master 700. In addition, preoperative ERV mode was needed in 12/43 eyes. The mean absolute difference in preoperative AL measurements compared to postoperative AL measurements were 0.16 � 0.40 mm for Argos and 0.49 � 1.29 mm for IOL Master 700. The mean absolute difference in preoperative AL manual A-scan measurements compared to postoperative AL measurements were 0.54 � 1.23 mm for Argos and 0.51 � 1.23 mm for IOL Master 700.
Conclusion
Interim data suggests SS-OCT biometers improve AL accuracy in dense lenses. Argos outperformed IOL Master 700, with a smaller pre-to-postoperative AL difference. When Argos acquires a value, confirmatory a-scans may not be necessary, reducing technician workload and improving clinic efficiency without compromising accuracy.
Presenting Author
Reiker G Ricks, BSc
Co-Authors
Liliana Werner PhD, MD, Jeff Pettey MBA, MD, Neil Kelkar MD, Kevin Eid MSc, MD, Emilie Ungricht BEng, MD
Purpose
To quantify the damage to the corneal endothelium from a new handheld lens fragmentation device (Micor 700, Zeiss) and compare it with damage from a standard phacoemulsification device (Centurion, Alcon).
Methods
Fifteen New Zealand white rabbits received bilateral surgery. Their eyes were divided into 3 groups: Intrepid Balanced Tip of the Centurion Ozil handpiece, Micor 700 half throttle, and Micor 700 full throttle. There were 2 by 2 combinations of devices/groups, with 5 rabbits in each combination. After incision, the tip of the device was inserted into the anterior chamber and activated for 30 seconds. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (X400 photographs from 5 specific areas, and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss.
Results
The overall differences among the 3 groups regarding intact, damaged, and lost cells were statistically significant. However, by applying the Bonferroni correction, only the post-hoc pairwise comparisons between groups 1 (phaco tip) and 2 (miCOR tip, half throttle, without lens agitator engaged) were statistically significant regarding the 3 above-mentioned parameters.
Conclusion
miCOR is a handheld, finger-controlled lens removal device with a blunt and rounded tip that vibrates at a low frequency, using mechanical agitation for nuclear disassembly. This acute rabbit study suggests CEC damage from the device, when the lens agitator is engaged is comparable to that of standard torsional phacoemulsification.
Presenting Author
Yun-Hee Choi, PhD
Co-Authors
Nayoon Park BA, Myung-Sun Song MS, MD, Dong Hyun Kim PhD, MD, Yoon-Hyeong Choi PhD, Jaehak Jung PhD, Eunhye Shin MS
Purpose
The potential health risks associated with microplastic (MP) exposure have been a significant global concern and many plastic products are used in cataract surgery. Our study aimed to investigate the prevalence and characteristics of MP exposure during cataract surgery.
Methods
The numbers and characteristics of MPs were investigated in irrigation saline, balanced salt solution (BSS), viscosurgical device, intraocular inflow and outflow fluid through phaco machine, and operating room (OR) indoor air during cataract surgery. Raman spectroscopy was used to identify the size and characteristics of MPs. Scanning electron microscopy with energy dispersive spectroscopy was used to examine surface morphologies of MPs.
Results
MPs were detected in the inflow from phaco machine into eyes (0.07�0.06/mL), outflow from eyes into phaco machine (19.70�24.06/mL), and OR indoor air (0.18�0.05/mL). A significantly greater number of MPs were identified in the outflow compared to the inflow. In the inflow, only fragments were observed, whereas in the outflow, both fragments (95.7%) and fibers (4.3%) were detected. With regard to size, only MPs sized 10�19 �m were detected in inflow, whereas smaller MPs sized 5�9 �m (30.9%) were additionally detected in outflow. Regarding polymer type, the inflow exhibited only PE or PP types, while the outflow revealed the presence of PE (95.3%), PP (4.3%), PS (0.3%), and PET (0.1%).
Conclusion
This is the first study to identify MP exposure during cataract surgery. MPs could enter the eye during cataract surgery, potentially originating from surgical instruments or the indoor environment. Also, MPs may be present in the lens or intraocular fluid of cataract patients.
Presenting Author
Rosa Braga-Mele, MD, FRCSC
Co-Authors
Mikhail Ovchinnikov PhD, Ahmad Gad PhD, MSc, Satish Yalamanchili MBA, MS, Sarah Makari OD
Purpose
UNITY VCS uses a thermal algorithm to predict the corneal incision temperature increase. If the functionality is enabled, the system can modulate ultrasound power such that a surgeon�s selected corneal incision temperature threshold is never exceeded. The purpose of the study is to evaluate the prediction accuracy of this thermal algorithm.
Methods
The algorithm predicts the change in the corneal incisional temperature using an equation that considers key factors such as time, ultrasound power and aspiration flow rate. To determine its accuracy, the prediction error was calculated by taking the difference of the predicted temperature increase from the actual increase in temperature at the incision site as measured clinically using the Forward Looking Infrared (FLIR) camera during phacoemulsification (phaco). Data was continuously collected then processed using MATLAB. The mean and standard deviation of the prediction error was analyzed and reported.
Results
35 patients with dense cataracts underwent phacoemulsification using predominantly torsional ultrasound energy. Torsional ultrasound power was set to 75% power and rarely increased to 100% power. Longitudinal ultrasound was sometimes added sequentially and rarely exceeded 65% power. Aspiration flow rate was typically set at 30-40 cc/min. Throughout the duration of each procedure, over one million temperature data were analyzed. The mean and standard deviation of the prediction error was -0.68 � 2.45 degrees Celsius (oC). The negative sign of the mean value indicates that the algorithm overestimated the actual temperature increase, providing a conservative prediction of temperature increase.
Conclusion
A novel algorithm predicted corneal incision temperature increase during phaco. Modulating ultrasound power using this algorithm may improve surgeon confidence resulting in better efficiency and reduce thermal injury especially in dense cataracts or with inexperienced surgeons.
Presenting Author
John Kan, MBBS, FRCOphth
Co-Authors
Tun Kuan Yeo FRCOphth, Aaron Ng FRCOphth, Kok Yao Low MD
Purpose
To evaluate the clinical and safety outcomes in eyes with zonulytic cataracts requiring the adjunctive use of capsular stabilization devices such as capsular tension rings (CTR), Cionni modified capsular tension rings (mCTR) and capsular tension segments (CTS).
Methods
This was a single-centre, retrospective case series. Data of all cataract surgeries from 2014 to 2017 was reviewed, and surgeries that required the use of the abovementioned capsular stabilization devices were identified. Clinical outcomes included post-operative visual acuity and refraction. Safety outcomes included the incidence of post-operative complications as we well as need for further procedures. Analysis of data was performed to determine risk factors for zonulysis in each case, the type of device used, sutures used for fixation (if any), and mean follow up duration post-operatively.
Results
78 eyes from 74 patients were included, with a mean follow up duration of 25.4 months (0.2 � 76.3 months). The most common risk factor for zonulopathy was trauma (n=26; 33.3%). Devices used included Morcher CTS Type D (n=75; 96.1%), Cionni CTR (n=2; 2.6%), and a combination of both (n=1; 1.3%). Concurrent CTR was used in 56 eyes (71.8%). Fixation methods included 7-0 GoreTex (n=55; 70.5%), 8-0 GoreTex (n=11; 14.1%), 10-0 Prolene (n=7, 9.0%) and 6-0 Prolene (n=4; 5.1%). Mean visual acuity improved post-surgery to LogMAR 0.28 from 0.67 (p<0.05). the="" majority="" had="" no="" post-operative="" complications="" (n="56;" 71.8%),="" and="" eyes="" with="" complications="" were="" not="" specifically="" related="" to="" the="" use="" of="">
Conclusion
The use of sutured capsular stabilization devices, with or without concurrent capsular tension rings, in eyes with zonulysis can achieve good visual outcomes with a low incidence of post-operative complications.
Presenting Author
Kurt Hanebrink, MD
Co-Authors
Serra Tuzun BSc, Michael Snyder MD, Adam Kaufman MD, Benjamin Likins MD
Purpose
Artificial iris prostheses, such as the CustomFlex� Iris Prosthesis (CFIP), are important devices that improve photic symptoms and cosmesis in patients with iris deficiencies. The purpose of this study is to demonstrate that CFIP can be successfully placed in quiet eyes with history of herpes zoster ophthalmicus (HZO)-related iris atrophy.
Methods
A retrospective chart review of cases that had CFIP placed by a single surgeon at a single center in Cincinnati, Ohio between 2008-2023, seeking eyes with HZO-related iris atrophy. The inclusion criteria included patients with HZO with iris atrophy associated with anterior uveitis with or without keratitis. Exclusion criteria included posterior segment inflammation and concomitant corneal surgery. Pre-operative, surgical, and post-operative data were collected, deidentified and analyzed.
Results
Seven eyes of females and two eyes of males were identified with HZO uveitis. Five eyes also had HZO keratitis. The average age at surgery was 65 years (32-95). All patients had significant photic symptoms and none had active inflammation. The average pre-operative corrected visual acuity (BCVA) was 1.00 logMAR (0.10-3.3). All surgeries were uneventful. All CFIPs were placed within the capsular bag at the time of cataract surgery with IOL placement. The average follow up was 46 months (1-135). All patients reported reduced photic symptoms. All patients had no inflammation at one month. The average post-operative BCVA was 0.21 logMAR (0-0.70). No patients had device-related complications.
Conclusion
CFIP is an effective therapeutic modality in a iris atrophy secondary to HZO. They can be implanted safely without significant risk of inciting significant intraocular inflammation, and patients experience improvements in both photic symptoms and BCVA.
Presenting Author
Mohan Rajan, FRCS, FACS
Co-Authors
Sujatha Mohan FRCS
Purpose
To prevent argentina flag sign in white intumescent cataracts
Methods
510 eyes of 510 patients with white intumescent cataract were taken up for this study. Trephine blue was used to stain the anterior capsule. The punchorhexis was done using a straight 15 degree phaco tip bevel down using 40% phaco power, 350-400mm Hg vacuum on the stellaris phaco machine. Once a punch was made the rhexis was completed either with the phaco needle itself (phaco rhexis) or with uttrata forceps.
Results
In all eyes except 2 eyes the punchorhexis was successful
Conclusion
Punchorhexis is an effective method of achieving good rhexis in white intumescent cataract there by preventing argentina flag sign.
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