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Moderator
Kenneth J. Rosenthal, MD, FACS
Panelists
Karolinne M. Rocha, MD, PhD, ABO; Elmer Y. Tu, 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
Scott L. Geller, MD
Purpose
Raise awareness of the potential for missed diagnosis of patients with the acute onset of blurred vision after cataract surgery. Proper history taking techniques and physical evaluation are discussed.
Methods
In house chart review of the history and treatment of patients incorrectly diagnosed initially, later correctly diagnosed with blurred vision due to the acute onset of vitreous opacities within a 6 month period after cataract surgery.
Results
Dry eye syndrome was the most common misdiagnosis. Treatment by laser vitreolysis in 83 eyes resulted in improvement in the cases reviewed over a 2 year period. 5 patients had transient increases of IOP.
Conclusion
Misdiagnosis of patients complaining postoperatively of blurred vision was most often dry eye syndrome, followed by capsule opacity, retinal disease, or dysphotopsia. Proper history taking and physical examination is essential for an appropriate therapeutic approach.
Presenting Author
Ervin Fang, MD
Purpose
Over 30 million cataract surgeries are performed annually worldwide, usually with IV sedation and unilaterally. Systemic anesthesia prolongs recovery, increases costs, and requires caregiver support. This observational study evaluates the safety and effectiveness of performing unilateral and bilateral cataract surgery without systemic sedation.
Methods
A consecutive series of 1,093 eyes were operated on by a single surgeon at two centers from May 2024 to April 2025. Patients did not receive IV or oral sedation. Ocular anesthesia consisted of topical lidocaine drops and intracameral preservative-free lidocaine with epinephrine. Outcomes measured included intraoperative complications, postoperative safety, and patient recovery.
Results
Of the cohort, 334 patients underwent simultaneous bilateral cataract surgery and 425 underwent unilateral surgery. The mean patient age was 76.3 years; 47.3% were male and 52.7% female. Ethnic distribution included Asian (12%), Caucasian (30%), Hispanic (38%), and Other (20%). Intraoperative and postoperative complications were rare: there were no cases of endophthalmitis, one case of toxic anterior segment syndrome (TASS), and three anterior vitrectomies. All patients had uneventful postoperative courses, with no reported falls or accidents. Many patients were ambulatory immediately after surgery, and some were able to drive themselves home.
Conclusion
Sedation-free cataract surgery safely avoids anesthesia, IVs, and fasting, reducing barriers, costs, and recovery time. Bilateral surgery speeds visual rehabilitation, enhancing seniors’ quality of life. This approach offers a practical, patient-centered approach to modern cataract surgery.
Presenting Author
Jamal O Azhari, MD
Co-Authors
Ahmed Sallam (MD, PhD, FRCOphth), Carina Sanvicente (MD)
Purpose
To evaluate and compare the surgical outcomes of cataract extraction in eyes in eyes with phacomorphic glaucoma versus those with chronic angle closure glaucoma.
Methods
A 10-year, retrospective case-control study of 30 eyes at an academic tertiary care center. The cohorts were split into 15 eyes diagnosed with phacomorphic glaucoma (PG) and 15 eyes with chronic angle closure glaucoma (CACG). The evaluated parameters were split between preop, intra-op, and postop. Preoperative clinical characteristics included visual acuity (VA), intraocular pressure IOP), anterior chamber depth (ACD), and axial length (AL). Intraoperative events included vitreous loss (VL) and placement of a posterior chamber intraocular lens (PCIOL). Postoperative outcomes assessed final VA, IOP control, number of glaucoma medications, and need for additional surgical intervention.
Results
Preoperative VA was worse in PG patients vs CACG (logMAR 1.78 vs 0.58)(p = 0.0018). Additionally, PG patients had higher preoperative IOP (57 mmHg vs 33 mmHg) (p-0.001), shorter AL (22.6 mm vs 23.51 mm) (p=0.0084); and shallower ACD (2.1mm vs 2.7mm) (p=0.0025). Vitreous loss occurred in 20% of PG patients compared to 0% in CACG (p=0.224). A PCIOL was placed in 80% of PG eyes and all 15 CACG eyes (p=0.224). Postoperative VA was worse in PG patients vs CACG (logMAR of 1.14 vs 0.37)(p = 0.004). PG patients had higher change in IOP (45 mmHg vs 19 mmHg) (p=0.003) and required fewer glaucoma surgeries (p=0.001) but did not have a difference in the number of glaucoma medications (0 vs 2) (p=0.223).
Conclusion
The higher rate of VL in PG and inability to place PCIOL compared to CACG is clinically relevant. In PG patients, IOP control is mostly achieved with cataract surgery, reducing the need for further glaucoma surgical intervention. However, PG patients have worse preop and postop VA.
Presenting Author
Ayesha Musthafa, MBBS, MS
Co-Authors
Naren Shetty (MS, PhD), Ravikrishna Kanaradi (MBBS, DO), Poornachandra B (MBBS, MS), Swaminathan Sethu (PhD)
Purpose
To assess the efficacy of capsular tension ring (CTR) implantation combined with anterior capsular polishing in preventing capsular phimosis in retinitis pigmentosa (RP) patients and to evaluate intraocular inflammatory biomarkers.
Methods
Prospective interventional study including 20 Retinitis pigmentosa patients (40 eyes) undergoing bilateral cataract surgery. One eye received CTR implantation with anterior capsular polishing; the fellow eye served as control. Patients were followed for 6 months with periodic assessment of capsular phimosis. Tears and aqueous samples were collected for inflammatory biomarker analysis using a novel kit.
Results
Eyes treated with CTR and capsular polishing demonstrated significantly lower incidence of capsular phimosis, improved visual outcomes, and reduced IOL decentration and tilt. Both groups exhibited elevated inflammatory biomarkers, notably IL-1 and MMP9 levels (p < 0.05).
Conclusion
CTR combined with anterior capsular polishing effectively prevents capsular phimosis in RP, enhancing postoperative outcomes. Biomarker data suggest the benefit of prolonged anti-inflammatory therapy.
Presenting Author
Ailin Song, MD
Co-Authors
Melissa Daluvoy (MD), Jay Lusk (MD, MBA), Lauren Wilson (PhD), Brian Mac Grory (MD)
Purpose
Controversies exist over whether modern cataract surgery increases the risk of ischemic optic neuropathy (ION). The limited literature on this topic is mostly from single institutions. The purpose of this study was to determine if cataract surgery is associated with an increased risk of ION in a large nationwide population in the United States.
Methods
This study used a self-controlled case series (SCCS) design using Epic Cosmos, a nationwide electronic health record data set representing more than 300 million patients. The SCCS method is well established in epidemiology and uses patients as their own controls to control for measured and unmeasured time-invariant confounding. Age and season were additionally adjusted. Routine cataract surgery and ION were defined by CPT and ICD-10 codes respectively. Primary models treated eyes as independent units; secondary models treated each patient as one unit and allowed for overlapping risk windows between two eyes. P-values were adjusted for multiplicity.
Results
Between January 1, 2021 and December 31, 2024, 853,267 patients underwent 1,369,812 routine cataract surgeries, of whom 757 unique patients developed ION. The risk of ION was elevated in the first year after cataract surgery (incidence rate ratio [IRR] 4.37, 95% CI 2.61-7.31, p<0.001). There was no increased risk of ION observed in days 0-7, 0-14, 0-21, or 0-30 after cataract surgery (all p>0.05). The risk was elevated within days 0-60 (IRR 2.33, 95% CI 1.61-3.376, p<0.001) and days 60-365 (IRR 2.46, 95% CI 1.48-4.09, p=0.001). The greatest incidence density of ION occurred at approximately 60 days. Models using the patient as the unit of analysis rather than the eye yielded similar results.
Conclusion
In this nationwide study, the risk of ischemic optic neuropathy was approximately 4 times higher within the first year after routine cataract surgery. The risk was highest around 60 days after surgery. The self-controlled case series design ensures that the association is not due to confounding by time-invariant factors.
Presenting Author
Chris Zajner, BSc
Co-Authors
Khaldon Abbas (MD), Tom Sheidow (MD), Monali Malvankar-Mehta (PhD), Fahad Butt (BSc), Phil Hooper (MD), Verena Juncal (MD)
Purpose
Intraocular lens (IOL) insertion in the capsular bag is ideal for cataract surgery, but alternatives are needed when capsular support is absent. This study assesses the clinical outcomes and safety of combined pars plana vitrectomy (PPV) with scleral-fixated Akreos IOL implantation using 8-0 prolene sutures.
Methods
This is a single-center, retrospective case series. The clinical charts of patients at a single institution who underwent scleral-fixated Akreos IOL implantation with pars plana vitrectomy (2015-2024) were reviewed. Data on demographics, surgical indications, best corrected visual acuity (BCVA), intraocular pressure (IOP), and postoperative complications were collected. Wilcoxon ranked sign test was used to assess differences between baseline and final follow-up data of continuous data. A p-value <0.05 was considered significant.
Results
A total of 699 eyes of 662 patients were included. The mean age at the time of surgery was 75.9±13.2 years(49.1% male). The mean follow-up period was 18.7 months (range 1-93 months). The mean BCVA improved from 1.23±0.73 LogMAR (20/340 Snellen) preoperatively to 0.64±0.65 LogMAR (20/87 Snellen) at final follow-up (p<0.0001). The mean IOP was 18.00±6.71 mmHg preoperatively and 16.23±5.76 mmHg at final follow-up (p= 0.01). Postoperative complications included transient elevated IOP(15.3%; n?=?78), cystoid macular edema (7.1%, n=36), corneal decompensation(3.5%; n=18), and retinal detachment(1.2%; n?=?6). Suture-related complications were observed in seven patients(1.4%) by the final follow-up.
Conclusion
A scleral-sutured posterior chamber IOL technique combined with PPV demonstrated significant improvements in visual acuity and was well tolerated. The overall safety profile was favorable, with few suture-related issues observed. This technique is a viable alternative for posterior chamber IOL placement when secondary IOL implantation is required.
Presenting Author
Benjamin J Park, MD
Co-Authors
Francisco Mendes (MD), Xuesen Cheng (MD, PhD), Li Wang (MD, PhD), Kusona Fortingo (BSc), Allison Chen (MD, MPH), Mitchell Weikert (MD, MS), Douglas Koch (MD)
Purpose
In eyes following uncomplicated cataract surgery, to evaluate early postoperative changes in anterior chamber depth (ACD), IOL tilt and decentration, central corneal thickness (CCT), and corneal power, as measured using the Eyestar 900 swept-source optical coherence tomography (SS-OCT) biometer (Haag-Streit).
Methods
ACD, lens tilt, lens decentration, CCT, and corneal power were measured with the SS-OCT on 1 day and 3 weeks postoperatively. Measurements from these two time points were compared to assess early postoperative changes in these parameters.
Results
A total of 27 eyes have been analyzed so far. Comparing postoperative day 1 (POD1) to postoperative week 3 (POW3), the following changes were observed. CCT decreased from 555.90 ± 57.64 μm to 537.74 ± 43.31 μm (p=0.011). There was a decrease of the ACD from 4.92 ± 0.37 mm to 4.86 ± 0.33 mm (p<0.001). Mean keratometry showed steepening from 43.15 ± 2.48 D to 43.47 ± 2.23 D (p=0.006). The IOL tilt angle changed from 4.65° ± 1.33° to 4.94° ± 1.85° (p=0.374). X-decentration shifted from -0.02 ± 0.28 mm to 0.03 ± 0.25 mm (p=0.386), and Y-decentration shifted from -0.03 ± 0.27 mm to 0.03 ± 0.17 mm (p=0.388).
Conclusion
Measurements taken with the Eyestar 900 SS-OCT biometer demonstrate IOL stability in the early postoperative period. IOL decentration and tilt showed nonsignificant changes post operatively. More data is forthcoming.
Presenting Author
Ahmad Kunbaz, MD
Co-Authors
Serap Karaca (MD), Ceren Cemre Beyca (MD), Esma Ecem Ersoy (FEBO, MD), Gozde Aydogdu (MD), Ebubekir Durmus (MD), Fehim Esen (MD)
Purpose
To determine whether phacoemulsification produces early, clinically relevant shifts in OCT-based glaucoma biomarkers in eyes with pseudoexfoliation (PXF) without glaucoma and whether such changes differ from non-PXF eyes, potentially confounding short-term glaucoma risk assessment.
Methods
Prospective cohort of 55 eyes undergoing uncomplicated phacoemulsification (PXF n=26; controls n=29). Examinations were pre-op, 1 week, 1 month, and 3 months. Outcomes: logMAR visual acuity (VA), intraocular pressure (IOP), macular structure through OCT (central macular thickness, ganglion cell complex, inner plexiform layer), peripapillary RNFL (global and sectors), peripapillary choroidal thickness (PPCT), Bruch's membrane opening (BMO), and minimum rim width (MRW).
Results
IOP and macular OCT (CMT, GCL, IPL) did not differ between groups at any visit (all p>0.05). Within PXF, RNFL changed from preoperative to 3 months in superior-nasal (p=0.003), temporal (p=0.03), and inferior-temporal (p=0.02) sectors. Between groups, nasal RNFL was higher in PXF at preoperative and 1 month (p=0.003 and p=0.009) but not at 3 months (p=0.07). At 3 months, PPCT was thinner in PXF in the inferonasal sector (p=0.0226). In PXF, BMO increased from baseline to 1 month (global p=0.0010) and remained higher at 3 months (global p=0.04), with sectoral differences at 3 months nasally compared with controls (p=0.0116). MRW increased in PXF at 3 months (p=0.03)
Conclusion
Phacoemulsification can trigger early postoperative OCT shifts (RNFL, BMO, PPCT) that may confound glaucoma risk assessment. During this period, OCT should be interpreted with caution. Larger, longer studies are needed to determine when these metrics stabilize.
Presenting Author
Maria C. Orejarena, MD
Co-Authors
Jia Yue You (MD, FRCSC), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
To evaluate postoperative best-corrected visual acuity, manifest refraction, patients' satisfaction, and symptoms resolution after IOL exchange due to opacification.
Methods
Retrospective chart review of 118 consecutive patients who underwent IOL exchange for opacification between 2014 and 2024. All procedures retained the capsular bag, and IOLs were placed either in the bag, sulcus or via reverse optic capture (ROC). Primary outcome was postoperative best-corrected distance visual acuity (CDVA, LogMAR) 3-months after IOL-exchange. Data collection included manifest spherical equivalent (MSE), intraoperative and postoperative complications, and patient satisfaction. Correlations between preoperative visual acuity and Ocular Scatter Index (OSI) scores were analyzed. The impact of prior YAG-laser capsulotomy on surgical outcomes was assessed using odds ratios.
Results
Mean time to IOL exchange was 7.7 years (range, 0.3-14.1). Mplus bifocal IOLs accounted for 93.2% of exchanges. 55.1% of eyes had prior capsulotomy. Main complaints were decreased vision (72.8%), glare (31.6%) and halos (30.5%). IOLs were placed either in the bag (48.3%), sulcus (46.6%) or via ROC (5.1%). Postoperative CDVA improved from 0.2±0.2 to 0.1±0.1 (p<0.01). Postoperative MSE changed from -0.3±2D to -0.1±1D (p=0.73). Overall, 99.2% of patients were satisfied with the surgical outcome. One case of dissatisfaction was attributable to corneal decompensation. Prior capsulotomy increased the risk of intraoperative vitreous prolapse (odds ratio=4.5, 95%CI 2.0-10.5).
Conclusion
IOL exchange was successful in managing late IOL opacification, providing favorable visual outcomes, high patient satisfaction, and a minimal risk profile, with capsulotomy identified as a significant risk factor for intraoperative vitreous prolapse.
Presenting Author
Mayank A. Nanavaty, PhD
Co-Authors
Issac Levy (MD), Ritika Mukhija (MBBS, MD, FRCOphth)
Purpose
To compare the binocular defocus curves following monofocal, monofocal lens with mini-monovision (difference of -0.75D) versus enhanced monofocal intraocular lenses (IOL).
Methods
A comparative observational study of three groups of patients aimed for mini-monovision with standard monofocal, monofocal IOL with mini-monovision versus enhanced monofocal IOL. All patients underwent immediate sequential bilateral cataract surgery. In the mini-monovision group, the dominant eye was aimed for distance emmetropia, and the other eye for -0.75D. Patients were followed up 3 months. The primary outcome was comparison of binocular defocus curves (between -2.5Dsph and 1.0Dsph adds) . Secondary outcomes included binocular uncorrected (UDVA), best corrected distance visual acuity (BCDVA) at 4 meters.
Results
Twenty-one patients were included in each group. There was no significant difference between the defocus curves between monofocal mini-monovision versus enhanced monofocal group between -1Dsph add to +0.5Dsph add (p>0.05). However, the defocus curve had broad landing zone with enchanced monofocal IOL. But there was a statistically significant difference between binocular defocus curves with monofocal lens Vs. mini-monovision (p<0.05) and enhanced monofocal (p<0.05) between -1Dsph add to +1.0Dsph add. There was no significant difference in binocular UDVA and BCDVA at 4 meters between all three groups (p>0.05).
Conclusion
Enhanced monofocals and mini-monovision with monofocal IOLs (-0,75D difference between eyes) gives similar binocular intermediate vision and this is significantly better compared to binocular monofocal IOL with distance corrections only.
Presenting Author
Ece Dogruel, MD
Co-Authors
Gülay Yalç?nkaya çak?r (FEBO), Nilay kandemir Besek (MD), Ahmet Kirgiz (FEBO), Seda Liman Uzun (FRCSEd), Sibel Ahmet (FEBO, FRCSEd, MD), Burcu Kemer Atik (MD), Muhammed ?brahim Menzek (MD)
Purpose
To evaluate long-term outcomes and risk factors of phacoemulsification in posterior polar cataract (PPC) at a tertiary center.
Methods
This retrospective study included 101 eyes operated for PPC between 2014-2024. Demographics, keratometry, complications, posterior capsule status, IOL placement, postoperative complications, and secondary surgeries were reviewed. Uncorrected and corrected distance visual acuities (UDVA, CDVA), and intraocular pressure (IOP) were compared pre- and postoperatively (day 1, week 1, month 1, month 6, year 1, and final visit).
Results
Among 101 eyes, posterior capsule rupture occurred in 29% and anterior vitrectomy in 15%.Postoperative UDVA(0.40 logMAR)and CDVA(0.23) improved significantly versus preoperative values(0.78 and 0.70;both p<0.001).IOP remained unchanged.One epinucleus drop required no secondary surgery.IOL was implanted in the bag in 87% and in the sulcus in 13%(with optic capture in 7).Logistic regression predicted rupture(R�=0.775, p=0.001),though no single factor was significant;preop CDVA and left-eye involvement showed trends.Linear regression identified preop CDVA as the only predictor of final CDVA (?=0.45,p=0.001).Rupture cases had worse CDVA(p=0.048).Postoperative complications occurred in 2%.
Conclusion
Phacoemulsification in PPC provides favorable long-term visual outcomes,although the risk of posterior capsule rupture remains considerable.Preoperative visual acuity best predicts postoperative vision.Despite higher intraoperative challenges,with careful surgical management, postoperative complications and secondary interventions remain rare.
Presenting Author
Deepak u Megur, FRCSEd
Purpose
To report outcomes and practical red flags when performing phacoemulsification in eyes with a torn/discontinuous anterior capsulorhexis using a standardized rescue protocol.
Methods
Prospective observational, single-surgeon, consecutive series of 32 protocol-adherent eyes (one pre-protocol case excluded). Steps: enlarge a small capsulotomy when needed; anterior-chamber maintainer with low infusion; no hydrodissection; no nucleus rotation; continuous assessment of the flap-motility sign; gentle division with earliest possible first-fragment emulsification; supracapsular emulsification of remaining fragments. When the posterior capsule remained intact, IOLs were placed in the bag with haptics ~90° from the tear axis; if PCR was suspected, phaco was aborted and converted to MSICS.
Results
PCR occurred in 2/32 eyes (6.3%). Both involved dense nuclei with stressful division and unintended in-bag rotation; phaco was aborted and converted to MSICS, anterior vitrectomy performed, and residual fragments manually expressed. No nucleus drops occurred. In the PCR eyes, multipiece IOLs were placed in the sulcus. When the posterior capsule remained intact, IOLs were placed in the bag with haptics ~90° from the tear axis. The red-flag triad—hard nucleus, difficult division, and unintended rotation—correlated with PCR and triggered conversion.
Conclusion
A disciplined, low-infusion, no-rotation, AC-maintainer–assisted protocol—and flap-motility–guided decisions—yielded low PCR with zero nucleus drops in eyes with torn rhexis. Vigilance for the red-flag triad and early conversion to MSICS are pivotal. The technique is pragmatic and readily teachable for trainees and experienced surgeons.
Presenting Author
Ravi D. Patel, MD, MBA
Co-Authors
P Dee G. Stephenson (MD, FACS)
Purpose
To explore the real-world clinical performance and outcomes of the enVista ASPIRE Toric (ETA) enhanced monofocal IOLs, including surgeon satisfaction. This sub-analysis focuses on outcomes with the ETA IOL.
Methods
This multicenter, retrospective, real-world study included 6 cataract surgeons in the US who had conducted cataract surgery using monofocal toric IOLs for ?3 years, including ?5 cases with ETA. In this sub-analysis, participants completed a retrospective user experience survey and provided a convenience sample of ?5 patient cases of ETA implantation following cataract extraction using a standardized case report form. Outcomes included corrected and uncorrected distance and uncorrected intermediate visual acuity (CDVA, UDVA, UIVA), refractive outcomes, surgeon satisfaction, and adverse events (AE). The protocol received central IRB exemption.
Results
This sub-analysis included 53 eyes of 35 patients implanted with ETA by 5 surgeons. Mean±SD spherical equivalent (SEQ) target was ?0.04±0.17 (n=53)?. After up to 3 months post-surgery, 95% of eyes achieved a monocular CDVA of 20/25 or better (n=39); 85% achieved a monocular UDVA of 20/25 or better (n=53); 93% achieved a monocular UIVA of 20/32 or better (n=43). Mean±SD SEQ outcome was 0.00±0.32 (n=48)?. Mean±SD residual cylinder was ?0.34±0.33 (n=48)?. No serious safety events were noted. The mean surgeon satisfaction score for overall lens performance was 9.6 (10=very satisfied; n=5).
Conclusion
In this real-world retrospective case review, the ETA lens delivered good distance and functional intermediate vision for most patients following cataract surgery, with a mean residual cylinder of <0.5 D, and minimal occurrences of visual changes or AEs. Surgeons reported high levels of satisfaction with the lens.
