Moderator
Omar F. Almallah, MD, ABO
Panelists
Ashraf F Ahmad, MD, ABO
Alexander Knezevic, MD
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
Simon Trottier, MD
Co-Authors
Paul Harasymowycz FRCSC, MSc, MD, Ali Salimi MD, MSc, Emilia Harasymowycz BSc
Purpose
To define the incidence of the development of lens particles behind the posterior capsule at the end of routine cases of Femtosecond Laser-Assisted Cataract Surgery (FLACS), and measure the association of this LPBS (Lens Particles in Berger's Space) phenomenon with pre-existing systemic and ocular morbidities and parameters.
Methods
Retrospective observational single-center study, with medical record review of all 1948 patient eyes who underwent FLACS by the same surgeon from October 2021 to March 2024. Exclusion criteria were as follows: previous posterior segment surgery, incomplete cataract surgery and intra-operative posterior capsule rupture. All files of eyes with occurrence of LPBS (226) were included in our final analysis, and an equal number of eyes without occurrence of LPBS were randomly selected. Correlation between pre-existing systemic and ocular morbidities and the advent of LPBS was evaluated using binary logistic regression. All data was anonymized.
Results
LPBS developed in 226 out of 1948 eyes undergoing FLACS, for an incidence of 11.6%. Higher age (p = .012), pigment dispersion syndrome (p =.039) and longer axial length (p = .002), lens thickness (p = .008) and anterior chamber depth (p = .035) were all found to be significant predictors of the occurrence of LPBS. A positive but non statistically significant association was also found with male sex and per-operative zonulysis.
Conclusion
To our knowledge, this is the largest study up to date on LPBS. We identified four new risk factors for the occurrence of LPBS: pigment dispersion syndrome, longer axial length, anterior chamber depth and lens thickness. Our results concur with the hypothesis that LPBS might be a consequence of weakened zonular apparatus.
Presenting Author
Bharti Kashyap, MS
Co-Authors
Birendra Prasad Kashyap MS, Dr.Bibhuti Kashyap DNB, MD, Nidhi Gadkar DNB, MS
Purpose
To compare the visual outcomes among Femto Laser Arcuate Incisions, Image guided manual arcuate incision and Toric IOLs for management of coexisting cataract and corneal astigmatism, ranging from .75D to -1.50D. Mild astigmatism (.75D to -1.50D) can be corrected by Femto Corneal Arcuate Incisions, Image guided manual arcuate incision or Toric IOLs.
Methods
This is a comparative study of 144 eyes of nuclear cataract grade 3, age between 50-65yrs at a Tertiary Eye Hospital, Ranchi, India. The 144 eyes of patients were non-randomly divided into three groups; Femto Arcuate Incisions (Gr1), Image guided manual arcuate incision (Gr2) & Toric IOLs (Gr3) comprising of 48 eyes in each group. The three groups underwent phaco cataract surgery with astigmatic correction by Femto arcuate (Gr1), Image Guided Manual Arcuate (Gr2), Toric IOL (Gr3) respectively. At 7 days and 180 days Main outcomes were Visual acuity, spherical equivalent, contrast sensitively as modular transfer function on Aberrometer.
Results
Mean age in Group 1,2&3 were 59.06 ± 3.41, 59.15 ± 2.89 and 59.04 ± 2.89 for 62 males and 82 females are comparable among three groups p= .89 & p=.65 respectively. ANOVA VA at 7 days is comparable p=.96 At 180 days it is significantly better in Toric group as compared to GR1&GrII p=.034 & p= .029 respectively. Mean change (7days-180days) VA .047 in Toric group is Sig. better as compared to Femto Laser & Image guided group p= .001 for each group. At 180 days Sph. Equivalent Sig. less in Gr3, p=0.022. MTF shows Sig. better in Toric photopic condition at 5 &10 CPD p=.007& p=.000 respectively for GR1 & Gr2. Similarly, MTF Mesopic Sig. better p=.001& p=.000 in Toric as compared to GR1 & Gr2.
Conclusion
Femto Laser & Image Guided Arcuate Incisions (Gr1 &2) and Toric IOLs(Gr3) reduced astigmatism 7days Post cataract surgery. WHAT THIS STUDY ADDS: Astigmatism correction was significantly less effective in due course of time in the FLACS group and Manual group as compared to the Toric IOLs.
Presenting Author
Jack M Chapman Jr., MD, ABO
Purpose
This study was designed to evaluate the efficiency of two different workflow scenarios for laser assisted cataract surgery: 1) a single room, non-sterile procedure or, 2) a single room model with a sterile procedure and compare additional efficiencies one year later.
Methods
In this prospective, single site study, 23 patients were consecutively enrolled and assigned to non-sterile laser cataract surgery using a single room model (LenSx Femtosecond Laser System, Alcon, Ft. Worth, TX) or sterile laser cataract surgery using a single room model (ALLY, LENSAR, Orlando, FL) from June-Sep 2023. One year later, 23 subjects were enrolled to assess time savings related to experience with the model. Procedure parameters collected were laser set up, docking, suction time, total laser time, docking attempts, surgeon total case time, patient total case time, transition to phacoemulsification start time, and transition preparation and draping time. Comparisons were made.
Results
In 2023, time savings in the sterile room model included total femto time (surgeon) of 00:01:08 (p=0.022), total case time (surgeon) of 00:03:30 (p=0.001) and total case time (patient) of 00:03:01 (p= 0.637). One year later, total time savings in the sterile room model increased to: total femto time savings (surgeon) 00:01:36 (p=0.001), total case time (surgeon) 00:05:13 (p=0.001) and total case time (patient) 00:07:57 (p=0.02), There was additional time savings in the sterile model from femto complete to phaco start of 00:03:42 (p=<0.001) as a result of minimizing the turnover time required to move from non-sterile to sterile workflows.
Conclusion
The single room sterile laser cataract surgery model demonstrated superior efficiency to the single room non-sterile model, providing significant time saving for both the staff and surgeon. At 12 months, increased efficiencies and additional time savings were realized as a result of experience with the new workflow.
Presenting Author
Joaquin O De Rojas, MD, ABO
Co-Authors
Denise Visco MD, MBA, John Ladas PhD, MD
Purpose
This study aims to develop, train, and evaluate a machine learning (ML) model using retrospective data to predict optimal arcuate keratotomy (AK) incision lengths for femtosecond laser-assisted cataract surgery (FLACS), with the goal of improving postoperative refractive outcomes.
Methods
A retrospective analysis was conducted on 720 patient records (2018–2021, surgeon DV) and 59 (2023, surgeon JD) who underwent FLACS with AKs using the LensAR system. After applying exclusion criteria, two ML models (extreme gradient boosting and monotonic neural network) were trained on preoperative and operative features to predict optimized arcuate incision length (degrees). Model performance was assessed using standard ML metrics.
Results
After applying exclusion criteria, 443 entries were used to train and evaluate two models. Model 1 (XGBoost) had a Mean Absolute Error (MAE) of 1.2° for arcuate sweep and an R² of 0.88, with key predictors being treated astigmatism, age, and residual astigmatism. Model 2 (a monotonic neural network) had a 2.0° MAE and an R² of 0.68. For treated astigmatism, Model 2 had a 0.07 D MAE and 0.12 D RMSE, with 92% of predictions within 0.25 D and 100% within 0.50 D.
Conclusion
Model 1 offers the strongest arcuate sweep prediction, but Model 2 is more reliable for clinical use due to its constrained design, ensuring a direct relationship between astigmatism and arcuate sweep. These models demonstrate the potential of machine learning to enhance and refine arcuate keratotomy planning.
Presenting Author
William B. Trattler, MD, ABO
Purpose
To evaluate the accuracy of toric intraocular lenses aligned with iris-registered, laser assisted refractive capsulotomy during routine cataract surgery in patients with lower powers of astigmatism less than or equal to 1.25D of total corneal astigmatism. Also, a determination as to whether measured or estimated total corneal power is most accurate
Methods
44 subjects with total corneal astigmatism of less than or equal to 1.25D who received a monofocal toric IOL designed to reduce astigmatism by 0.83D (MX60ET125, B&L) or 1.0D (ZCU125, JNJ) at the cornea plane were reviewed. All patients underwent iris registration & femtosecond guided refractive capsulotomies (LENSAR, Orlando, FL). Power calculations were determined using total/anterior corneal power with the Ambient (Cassini, Needham, MA), IOLMaster 700 (Zeiss, Dublin, CA) and Pentacam (Oculus, Arlington, WA). Primary effectiveness endpoints included: Reduction in refractive cylinder, % within 0.50D of intended correction, % D reduction in refractive astigmatism (mean), UDVA, & SEQ accuracy
Results
32 female & 12 male eyes were part of the registry, with an average age of 77 (Range 58 to 87). 34 of 39 (87.2%) eyes targeted for distance achieved 20/25 or better UCVA. 37 of 41 (90.2%) eyes were within 0.5D of SE using the Barrett formula (3 eyes were either 20/20 (2) or 20/25 (1) UCVA and were not refracted). The average preop measured total corneal astigmatism on IOL master 700 was 1.02D. The average postop refractive astigmatism of 41 eyes was 0.32D. The reduction of astigmatism with the low power toric IOLs was 0.70D (1.02-0.70D = 0.32D). 33 of 41 (80.5%) eyes had refractive cylinder of 0.5D or less postop. 39 of 41 (95.1%) eyes had a refractive cylinder of 0.75D or less postop
Conclusion
Low power toric IOLs aligned with iris-registered, laser assisted refractive capsulotomy can provide very good visual outcomes in patients with low levels of total corneal astigmatism (less than or equal to 1.25D). In this review, 87.2% of eyes achieved 20/25 or better UCVA and 80.5% of eyes achieved a refractive cylinder of 0.5D or less postop.
Presenting Author
Taylor B Strange, DO, ABO
Purpose
The purpose of the study was to examine the workflow efficiency of laser assisted cataract surgery (LENSAR, Orlando, FL) when performed as an inclusive sterile procedure versus performing the laser portion of the surgery non-sterile. The comparison was made to determine workflow improvements and time savings for the surgeon and patient.
Methods
62 eligible subjects with an operable, uncomplicated cataract were prospectively (n=29 ALLY subjects) or retrospectively (n=33 LLS subjects) enrolled in this single site study. IRB approval was obtained (Salus, Austin, TX) and subjects were enrolled into one of two groups, the non-sterile or the sterile surgical environment. Tracking of time and motion, and all aspects of the laser cataract procedure was undertaken by 3rd party observers to eliminate bias. Procedure parameters collected included all applicable time intervals for surgeon, staff and patient including marking, docking, femto procedure time, phaco procedure time, total OR time, surgeon and patient total case time.
Results
62 subjects were enrolled in two groups. Statistically significant time savings in the all-sterile single room model included mean time from laser to phacoemulsification start time, 0:16:44 non-sterile model vs 0:01:15 sterile model p=<0.001, surgeon total case time, 0:25:03 non-sterile vs 0:08:07 sterile p=<0.001), and patient preop to discharge time, 1:27:55 non-sterile vs 1:12:28 sterile, p=<0.001. The sterile model provided 0:14:06 and 0:16:56 total procedure time savings for patient and surgeon, respectively.
Conclusion
Laser assisted cataract surgery in a sterile environment provides significant improvements in workflow and time savings. These improvements allow for additional cases to be added to the surgery schedule, earlier completion of surgical days and less time a patient spends in the surgical environment.
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