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Moderator
Sahar Bedrood, MD, PhD, ABO
Panelists
Huck A. Holz, MD; 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
Barbara Kusa, MD
Co-Authors
Matteo Piovella (MD)
Purpose
The miLOOP (Carl Zeiss Meditec)is a micro interventional device designed to provide endocapsular lens fragmentation in dense cataract and complicated cases Single use device, finger controlled. Every cataract extraction is based on the needs to divide the nucleus minimum by two
Methods
miLOOP was adopted 401 Eyes of 200 patients with medium/hard cataract to split the nucleus in two part or more.The metal loop was inserted in the capsular bag and open through the edge of idrodelineation rime. Once the loop is in the proper position the loop is retracted to split the nucleus. The learning curve needs 50 cases experience. Use of proper amount of viscoelastics is mandatory
Results
The nucleus was split in two or more pieces in all patient. It is necessary a learning curve adotping the device in simple cases to be confident in the proper use to avoid device related complications In one case the loop did not match the capsular bag and caused zonula damage with no important complication. One retinal detachment and 4 posterior capsule opening
Conclusion
miLOOP adoption in medium dense cataract and in complicated makes hard nucleus cataract removal more controlled and safe A proper learning curve needed
Presenting Author
Sangeeta Abrol, MS, MPH, MBA
Co-Authors
Nishi Satish (MBBS, MS)
Purpose
The purpose of this paper is to describe the various methods of managing cataract in eyes of patients with coloboma ( iris and fundal)
Methods
We included 8 eyes in this short case series and performed a thorough pre operative assessment. All eyes with fundal coloboma were given a barrage laser before performing cataract surgery. On table decisions and difficulties were recorded and analysed. Long term ( 6 months) follow up of development of posterior segment complications were noted.
Results
Afternoon removal of Cataractous lens using phaco emulsification, a capsular tension ring was placed first,followed by a foldable intraocular lens. The patients vision post operatively on day 1 was 6/9p on Snellens chart, with a stable PCIOL and no anterior chamber reaction. On day 7, the fundal coloboma was lasered, to prevent any posterior segment complications further on.
Conclusion
Colobomatous cataractous lenses pose a risk while operating - irregular anterior chambers,uneven pupillary dilatation and capsular support may all be compromised. This review posts a step by step approach to each complication as it comes.
Presenting Author
Mais Alkilany, MD, MRCSEd
Purpose
To present challenges and lessons learned from performing cataract surgery in the presence of central corneal opacity, and to highlight illumination techniques that improve surgical safety in limited-visualization settings.
Methods
A patient with dense central corneal opacity underwent phacoemulsification. Visualization difficulties during capsulorhexis, nuclear disassembly, and cortical cleanup were mitigated by adjusting surgical illumination. Oblique slit-beam illumination and retroillumination through peripheral clear cornea were utilized to optimize intraoperative visibility.
Results
Adjusting illumination significantly improved visualization, allowing safe completion of capsulorhexis, phacoemulsification, and intraocular lens implantation without complications.
Conclusion
Cataract surgery in eyes with central corneal opacity requires adaptable illumination strategies to optimize visualization and surgical safety. Slit-beam and retroillumination are practical approaches. This case highlights practical lessons for surgeons encountering limited-visualization scenarios.
Presenting Author
Vinita Yadav, MS, MBBS
Co-Authors
Ronald Yeoh (FRCSEd, FRCOphth), Naren Shetty (MS, PhD), Amulya Punati (MBBS, MS), Tejal Sj (MS)
Purpose
This study aimed to identify biomarkers in aqueous samples and anterior capsules and analyze its contribution to the formation of anterior capsular fibrosis.
Methods
In this prospective clinical study, we recruited 96 cataract surgery patients, divided into two groups: 58 with fibrosed capsules and 38 with normal capsules, all aged 40-80 years. Pediatric cases were excluded. Pre-operative assessments included slit-lamp photography and AS-OCT. Pre-operative treatment comprised non-steroidal anti-inflammatory and antibiotic drops, with steroids avoided. During routine cataract surgery, aqueous humor samples were collected for biomarker analysis. Metabolites were extracted and analyzed using UPLC-MS/MS. Statistical analysis was performed using MetaboAnalyst v6.0.
Results
Volcano plot fold change analysis revealed 4733 upregulated and 1863 downregulated metabolites in the aqueous humor of fibrosed capsules compared to normal capsules. PLS-DA plot demonstrated clear separation between aqueous humor samples of normal and fibrosed capsules. Discriminant metabolomic features were identified based on the Variable Importance in Projection (VIP) score. Top VIP score metabolites, including 3-Indolepropionic acid, Quipazine, Harmaline, Morphinan-3-ol, Bunitrolol, and Tacedinaline, were upregulated in control samples compared to fibrotic samples. These metabolites are implicated in anti-inflammatory and anti-fibrotic processes.
Conclusion
Fibrosis and inflammation modulating metabolites identified in this study could serve as potential biomarkers for anterior capsular fibrosis. This discovery provides a foundation for developing targeted therapeutic interventions to mitigate fibrosis following cataract surgery.
Presenting Author
Shail A. Vasavada, DNB, FRCS
Co-Authors
Sankaranarayanan Rajkumar (PhD), Abhay Vasavada (MS, FRCS), Vandana Nath (MS, DO), Samaresh Srivastava (MD), Vaishali Vasavada (MS)
Purpose
Purpose: To investigate potential genetic variants associated with spontaneous Posterior Capsule Rupture (sPCR) in patients diagnosed with Dead Bag Syndrome (DBS).
Methods
Methods: We collected blood samples from 30 DBS patients and 37 controls. Whole-exome sequencing (WES) was performed. Genetic variants in genes encoding extracellular matrix (ECM) components of the lens capsule were screened. The association of selected variants with DBS was analysed using the Optimal Unified Sequence Kernel Association Test (SKAT-O) in R and Logistic Regression. Genes showing significant associations were further analysed using in silico predictions via the Ensembl Variant Effect Predictor (eVEP) to assess their potential impact on protein function.
Results
Results: Three genes—FBN2 (P=.027, OR=4.9, 95% CI=0.56-42.72), LAMB1 (P=.005, OR=11.0, 95% CI=1.56-77.31), and LAMB2 (P=.091, OR=8.2, 95% CI=1.03-65.57)—were found to be positively associated with DBS. A total of 15 distinct, functionally deleterious genetic variants, including 6 in FBN2, 3 in LAMB1, and 6 in LAMB2 genes were identified across 17 (56.7%) patients with DBS. Of the 17 patients, 5 (29.4%) carried a common genetic variant (p.Ile1547Thr; rs35915664, MAF=0.016) in the LAMB1 gene, which was absent in controls.
Conclusion
Conclusions: The genetic variants found in FBN2, LAMB1, and LAMB2 genes may compromise the strength and stability of the lens capsule over time, predisposing individuals to DBS and sPCR later in life. The study shows for the first time that the DBS has a genetic predisposition.
Presenting Author
Ahmed S Sabri, DO
Purpose
To evaluate four novel indices—Cornea–Internal Aberration Ratio (CIAR), Kappa–Ring Mismatch (KRM), Pupil–Ring Match Index (PRMI), and MTF–Strehl Gap (MSG)—derived from standard i-Trace reports for optimizing selection of trifocal IOL candidates.
Methods
This retrospective study included 60 eyes from 30 patients evaluated preoperatively with i-Trace for trifocal IOL implantation. Novel indices (CIAR, KRM, PRMI, MSG) were calculated from standard reports. Based on these parameters, 46 eyes were implanted with trifocal IOLs, while 14 unsuitable eyes received alternative IOLs. Postoperative evaluation at 3 months included uncorrected distance, intermediate, and near visual acuity (Snellen), contrast sensitivity, dysphotopsia (bothersome vs non-bothersome), and satisfaction on a 5-point scale. Statistical associations were analyzed.
Results
TBD
Conclusion
CIAR, KRM, PRMI, and MSG indices from routine i-Trace reports offered objective guidance for trifocal IOL selection. In 60 eyes, they predicted dysphotopsia and dissatisfaction more effectively than the fitness flag while helping exclude unsuitable cases.
Presenting Author
Deepak u Megur, FRCSEd
Purpose
To report outcomes of posterior polar cataract surgery using a three-point modification—(1) anterior chamber maintainer, (2) oval capsulorhexis, and (3) low infusion pressure—and compare posterior capsule rupture (PCR) rates with a historical control group.
Methods
A retrospective comparative case series was performed on 123 eyes with posterior polar cataract. Group 1 included 73 eyes operated with a three-point modification: (1) anterior chamber maintainer, (2) oval capsulorhexis, and (3) low infusion pressure. Group 2 included 50 historical controls managed with standard precautions with a 5.0 mm round CCC and without an AC maintainer. All surgeries were performed by a single surgeon using phacoemulsification with hydrodelineation and no hydrodissection. The primary outcome was posterior capsule rupture (PCR) incidence. Secondary outcomes included association with clinical and OCT subtypes.
Results
PCR occurred in 5/73 eyes (6.8%) with the three-point modification versus 9/50 eyes (18.0%) in controls (RR, 0.38; 95% CI, 0.14–1.07; OR, 0.33; 95% CI, 0.11–1.07; Fisher’s exact p = 0.082). Subgroup analysis showed greatest benefit in Singh Type 2 eyes, with PCR reduced from 28.6% (6/21) to 6.9% (2/29, p = 0.056). Age and sex distributions were comparable between groups.
Conclusion
A three-point modification—anterior chamber maintainer, oval rhexis, and low infusion pressure—reduced PCR from 18% to 6.8%, with the greatest benefit in Type 2 eyes. Visual outcomes were favourable, with most eyes achieving BCVA ≥20/30. These refinements improve safety and predictability in Posterior Polar Cataract Surgery surgery.
Presenting Author
Irene S. Zhou, BSc
Co-Authors
Jacklyn Vainshtein (BSc), Victoria Wang (MD, MS), Dagny Zhu (MD)
Purpose
To evaluate visual, refractive, and safety outcomes of reverse optic capture (ROC) in treating temporal negative dysphotopsia (ND) in pseudophakic eyes previously implanted with a trifocal or extended depth of focus (EDOF) intraocular lens (IOL).
Methods
A retrospective, non-comparative case series of all pseudophakic patients previously implanted with the PanOptix trifocal or Vivity EDOF IOLs via femtosecond laser-assisted cataract surgery who underwent ROC for the treatment of symptomatic temporal ND was done (December 2022 to June 2025). Any eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Preoperative characteristics, postoperative change in manifest refraction spherical equivalent (MRSE), and patient-reported improvement in ND symptoms were recorded.
Results
19 eyes of 14 patients (mean age 58±5 years; 53% PanOptix, 47% Vivity) were included. Initial presentation time of ND symptoms was 16±29 days with an interval to ROC of 12±6 months. ROC was successful in 17 eyes, 2 were aborted for anterior capsular tears from other underlying pathology (1 underwent bag-to-sulcus IOL exchange). ROC was done in 79% of left eyes that had OS cataract surgery, 90% of right eyes that had OD cataract surgery, and 60% of both eyes in bilateral cataract surgery. Of 17 successful ROCs (53% OS, 47% OD), 82% noted symptom resolution and 18% improvement. Post-ROC mean MRSE was -0.25±0.43D, with a -0.44±0.02D myopic shift, without loss of BCVA or UNVA. No adverse events.
Conclusion
Secondary ROC is a safe and effective treatment for temporal ND in eyes with presbyopia- correcting IOLs, yielding high rates of symptom resolution or improvement, stable refractive outcomes, and no significant adverse events, while potentially negating the need for IOL exchange.
Presenting Author
Yong Wang, MD
Purpose
To describe the Image-Guided Belt Loop-Flanged Technique for Knotless Refixation of the Multifocal Intraocular Lens (IOL)-Capsular Bag Complex Dislocation
Methods
Preop, digital refs via IOLMaster 700 determined reference axis, exported to Callisto; ref image matched to delineate IOL target axis. Under image guidance, punctures marked 2mm post-limbus (IOL haptics: 11:30, contralateral 5:30). 30G bent needle inserted 2.0mm post-limbus at 5:30; tip penetrates capsule, passes under haptic. 7-0 suture (main incision, 23G forceps) threaded into needle, withdrawn; end fixed with 0.3mm flange (electrocoagulation melt). ~0.5mm anterior to puncture, second 30G needle inserted (over haptic, tip out contralateral paracentesis); suture’s other end threaded in, withdrawn to form flange. Repeat opposite side for "belt loop"; fix second haptic similarly.
Results
17patients (17 eyes) (10M/7F) were includes; age 64.37±11.56y (37–81). Dislocated IOLs: diffractive multifocal/EDOF. Dislocation time post-phaco: 65.8±46.1m; causes: trauma (64.7%), spontaneous (35.3%). Axial length 23.79±5.94mm; preop CEC 2386±954 cells/mm². Outcomes: IOL fixation time 13.32±5.68min. Preop/post-op 3M UCVA: 0.62±0.45/0.07±0.05 logMAR (P=0.000). Post-op UNVA (60/40cm): 0.09±0.07/0.07±0.06. Residual SE: -0.37±0.31D. Post-op 3M: IOL tilt 4.26±3.71°, decentration 0.41±0.28mm; CEC 2249±773. Complications: Intraop: angle hemorrhage (5.88%). Post-op: corneal edema (11.76%), hypotony/elevated IOP (5.88%/11.76%); no vision risk.
Conclusion
Conclusions: The Image-Guided Belt Loop-Flanged Technique for multifocal IOL-capsular bag complex dislocation is efficient (short fixation time), safe (low complication rate), and yields good visual outcomes with minimal IOL decentration.
Presenting Author
Mehmet Baykara, MD
Co-Authors
Esin Sogutlu Sari (MD), Mehmet Kiristioglu (MD), Nazmiye ülkü Tüzemen (MD), Cüneyt Özak?n (MD), Güven Özkaya (PhD), Tuncay Topac (MD)
Purpose
To investigate the in vitro interactions of 1.0% sodium hyaluronate (ophthalmic viscosurgical device, OVD) with Gram-positive and Gram-negative bacteria, and to evaluate how it influences the efficacy of intracameral prophylactic antibiotics—moxifloxacin and cefuroxime—commonly used in cataract surgery
Methods
An in vitro laboratory simulation mimicking the anterior chamber was designed using sterile Eppendorf tubes. Four ATCC bacterial strains—Staphylococcus aureus, two S. epidermidis strains, and Pseudomonas aeruginosa—were tested with cefuroxime and moxifloxacin. Experiments were conducted in five sequential steps: (1) assessing bacterial retention within OVD, (2) testing antibiotic-bacteria interactions in OVD, (3) simulating aqueous humor circulation, (4) evaluating residual OVD antibiotic retention, and (5) analyzing OVD-bacteria-antibiotic interactions with centrifugation and deep/supernatant culture. Colony counts were performed, and reductions were analyzed statistically
Results
Susceptibility testing showed S. aureus and one S. epidermidis strain were sensitive to both antibiotics, whereas biofilm-forming S. epidermidis (ATCC 35984) and P. aeruginosa were resistant to cefuroxime. Across all steps, significant bacterial reduction occurred after antibiotic exposure (p<0.001). Moxifloxacin consistently achieved lower bacterial counts than cefuroxime, with notable superiority in steps 2 and 4. Step 3 demonstrated further bacterial reduction under circulation, though P. aeruginosa showed limited response with moxifloxacin. Step 5 confirmed that residual OVD with antibiotics retained antibacterial effect, minimizing potential infection risk
Conclusion
Moxifloxacin was more effective than cefuroxime against Gram-positive and Gram-negative strains, including cefuroxime-resistant isolates. Residual OVD did not appear to sustain bacterial growth in the presence of antibiotics. Findings support prophylactic use of moxifloxacin, with in vivo validation recommended
Presenting Author
Ahmed Sallam, MD, PhD, FRCOphth
Co-Authors
Fatma Shakarchi (MD, MSc), Ahmed Shakarchi (MD, MPH)
Purpose
To describe the rationale, technique, and outcomes of intraoperative posterior capsulotomy in complex cataract surgery cases where postoperative Nd:YAG capsulotomy was deemed impractical due to systemic or cognitive limitations.
Methods
We included 10 patients undergoing phacoemulsification with intraoperative posterior capsulotomy. The first was a 51-year-old male with extreme obesity (BMI 120 kg/m�), whose physical condition precluded safe positioning for outpatient YAG laser capsulotomy. The second to the tenth patients were patients with advanced dementia, for whom postoperative cooperation for laser procedures was not feasible. All patients underwent in-the-bag intraocular lens implantation and surgical posterior capsulorhexis using a viscoelastic tamponade technique to preserve anterior hyaloid integrity. Perioperative modifications, including anesthesia, were tailored to optimize surgical access and safety.
Results
Patients achieved significant visual improvement postoperatively, with final acuity ranging from 20/30 to 20/40 in verbal patients. No intraoperative or postoperative complications occurred over a two-month follow-up. In all cases, surgical posterior capsulotomy effectively prevented posterior capsule opacification (PCO) and eliminated the need for future Nd:YAG intervention.
Conclusion
Intraoperative posterior capsulotomy is a feasible strategy in select high-risk patients for whom standard postoperative YAG capsulotomy is contraindicated or impractical. This approach ensures long-term visual axis clarity and improves surgical outcomes in diverse populations, including the morbidly obese, demented, pediatric, or non-ambulatory.
Presenting Author
Roberto Gonzalez-Salinas, MD, PhD
Co-Authors
Jes�s Hern�ndez-D�az (MD), Ver�nica Flores (MD), Sebastian Reyes (None), Grecia Ortiz-Ramirez (MD)
Purpose
Purpose: To assess the residual astigmatism using vectorial analysis after scleral IOL fixation with a 4-point Gore-Tex suture of a toric IOL in patients with aphakia.
Methods
A review of the electronic file of aphakia patients who underwent toric intraocular lens scleral fixation surgery at the Hospital de la Ceguera in the period March 2024 to September 2025. The residual astigmatism was assessed using vectorial analysis, as well as the postoperative spherical equivalent, UCVA, and BCVA. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS v.20) and GraphPad PRISM version 20.
Results
TBD
Conclusion
TBD
Presenting Author
Matthew W. Wade, MD
Co-Authors
Junru Yan (MD), Celine Ton (BSc), Jonathan Lam (BSc, MS), Paul Zhou (MD), Christopher Yang (MD)
Purpose
To examine a novel case of LAL rotation after implantation in the sulcus.
Methods
Exploratory, retrospective single case report utilizing patient chart review spanning two years following surgery.
Results
Rotation of the LAL (approximately 20 degrees compared to intraoperative position) resulted in iris chafing and refractive instability, requiring an IOL exchange.
Conclusion
The patient demonstrates a post-operative complication of LAL implantation that has not yet been reported in the literature. This indicates that LAL implantation in the sulcus may not be suitable for some patients based on anatomical concerns.
Presenting Author
Jamshid F. Mamatov, MD
Co-Authors
Mokhiryam Alieva (MD), Kamoliddinbekzod Yusupov (MS), Javokhir Ibatov (MD)
Purpose
To present a complex case of bilateral secondary glaucoma in a 35-year-old female with suspected Alport syndrome, highlighting the ocular manifestations—high myopia, anterior lenticonus, and early cataracts—and the importance of early diagnosis and individualized management to preserve vision.
Methods
A detailed ophthalmologic evaluation was performed, including best-corrected visual acuity (BCVA), refraction, intraocular pressure (IOP) measurement, fundus examination, and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL). The patient underwent sequential phacoemulsification with posterior chamber intraocular lens implantation under retrobulbar anesthesia in the right eye and topical anesthesia in the left eye. Postoperative intraocular pressure control was achieved with fixed-combination topical therapy (brinzolamide/timolol and latanoprost).
Results
Initial examination revealed markedly elevated IOP (30.5 mmHg OD, 41.0 mmHg OS), optic disc pallor, and advanced glaucomatous cupping in the left eye. OCT confirmed inferotemporal GCL thinning in OS and early inferonasal attenuation in OD, with significant RNFL loss in OS. Following surgery, the right eye achieved full visual rehabilitation (VA 1.0), while visual recovery in the left eye was limited (VA 0.3) due to preexisting optic nerve damage. IOP was effectively controlled postoperatively.
Conclusion
This case highlights the importance of recognizing ocular signs of Alport syndrome, including anterior lenticonus and secondary glaucoma. Careful surgical planning, OCT-based monitoring, and strict postoperative IOP control are essential to prevent optic nerve damage and preserve long-term visual function.
