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Moderator
Steve H. Dewey, MD, ABO
Panelists
Jessica B. Ciralsky, MD; Ken D. Novak, 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
Steven M Silverstein, MD, FACS
Purpose
This paper centers around the special circumstances when performing a primary posterior capsulotomy is preferred at the time of cataract surgery, including children and certain retina patients.
Methods
This presentation utilizes a (most unusual!) case report to introduce and discuss the topic of the necessity for, and preferred timing to perform a primary posterior capsulotomy at the time of cataract surgery.
Results
The patient described in the case report had an excellent outcome, as demonstrated by a noticeable positive change in behavior. The data presented is derived from published papers on the subject of primary posterior capsulotomy.
Conclusion
There are important patient populations including pediatric patients, specific retina patients, and patients with limited mental or physical capacity for whom performing a primary posterior capsulotomy is preferred over attempting a YAG laser capsulotomy, or returning the patient to surgery for a second procedure.
Presenting Author
Tushar Talaparthy, BSc
Co-Authors
Abdelrahman Elhusseiny (MD)
Purpose
This nationally representative study identifies key racial and socioeconomic factors associated with having received cataract surgery in the U.S. It also explores the association between a history of cataract surgery and household food insecurity.
Methods
This was a cross-sectional analysis of 1,412 U.S. adults aged 40 and older from the 2003-2008 National Health and Nutrition Examination Survey (NHANES). Cataract surgery status was self-reported. We used survey-weighted logistic regression to analyze the association between undergoing cataract surgery and various sociodemographic factors, including race, education, and food insecurity, while adjusting for clinical and other covariates.
Results
After multivariable adjustment, Non-Hispanic Black adults had 68% lower odds of having undergone cataract surgery compared to Non-Hispanic White adults (aOR: 0.32; p=0.011). Participants with a college education had significantly lower odds of surgery compared to those with less than a high school education (aOR: 0.63; p=0.027). Hypertension was associated with higher odds of surgery (aOR 1.15; p=0.016), but food insecurity was not (p=0.125).
Conclusion
Significant racial and educational disparities in access to cataract surgery persist in the United States, even after accounting for insurance and poverty status. Systemic reforms and targeted outreach are needed to ensure equitable access to vision-restoring care for all populations.
Presenting Author
David F. Chang, MD
Co-Authors
Stephanie Chen (MD), Gitanjali Baveja (MD)
Purpose
To quantify and compare the cost, waste, and carbon emissions of single-use and reusable phacoemulsification tubing/cassettes and knives.
Methods
This is a retrospective data review conducted at a single-specialty ambulatory surgery center. The cost, waste, and carbon emissions from using an approved multi-use tubing/cassette system from July 1, 2024 through June 30, 2025 were estimated and compared to those generated by single-use tubing/cassettes with the same phacoemulsification machine (Part 1). In Part 2, the cost, waste, and carbon emissions from reusable diamond knives were estimated and compared to those from using single-use metal knives for the equivalent number of cataract and other IOL-related surgeries over a 10-year period. Life-cycle equivalent analysis was performed to determine the carbon footprint of each component.
Results
For 2,700 cataract and IOL-related surgeries performed during one year, reusable cassette/tubing packs reduced cost by 66.7% ($121,500 for single-use vs. $40,500 for multi-use). For every 1,000 procedures, the reusable pack would save 322.8 kg of plastic waste and 938.3 kgCO2eq, equivalent to driving a car 2,283mi (3,674km). Over 10 years, 50,100 procedures were performed at our center. For every 1,000 procedures, using diamond knives was estimated to save $18,300 (keratomes) and $12,130 (paracentesis blades) compared to disposable metal alternatives. Moreover, plastic waste and carbon emissions were reduced by over 99%, with the majority of the impact attributable to the reusable handle.
Conclusion
Cost, waste, and carbon emissions are considerably reduced by reusable phacoemulsification products, such as diamond surgical knives and multi-use phacoemulsification tubing/cassettes. This provides a major opportunity to improve the sustainability of cataract surgery.
Presenting Author
Austin S. Nakatsuka, MD
Co-Authors
Meghan Sharma (MD, MPH), Lieu Lowrie (MD), Catherine Johnson (MD, MPH)
Purpose
To evaluate whether there is a significant association between anterior capsule polishing (ACP) and incidence of positive and negative dysphotopsia post-cataract removal.
Methods
Patients undergoing cataract extraction with intraocular lens implantation were consented and randomized to one of four experimental groups: no anterior capsule polishing, 360° polishing, 180° nasal polishing, and 180° temporal polishing. Patients were surveyed about whether they experience symptoms of positive dysphotopsia (PD, defined as unwanted images) or negative dysphotopsia (ND, defined as dark crescents/shadows at the side of their vision) and what their overall satisfaction was at the 1-week, 1-month, and 3-month post-operative timepoints.
Results
125 patients with a mean age of 71 years were included. At 1-week, the 180° nasal polishing and the 360° polishing groups were significantly more likely to report a higher score on the dark shadow severity scale than the control group (OR: 157, p = 0.04 and OR: 2265, p = 0.02, respectively). At 1-month, the 180° temporal polishing group was significantly less likely to report a higher score on the dark shadow severity scale than the 180° nasal polishing group (OR: 0.02, p = 0.05). Although we observed significant effects for these measures, other comparisons were not significant.
Conclusion
In this randomized control trial of 125 patients from one institution, anterior capsule polishing was occasionally associated with increased severity of ND symptoms with no significant effects on PD. Alternative methods to ACP should be considered for the prevention of ND.
Presenting Author
David Mikhail, BSc
Co-Authors
Jason Kwok (MD), Ana Miguel (PhD), Amrit Rai (MD, FRCSC), Amandeep Rai (MD), Iqbal Ike Ahmed (MD, FRCSC), Matthew Schlenker (MD, FRCSC)
Purpose
To objectively quantify the motion paths of surgical instruments during cataract surgery across a resident's training, identifying patterns of skill acquisition and proficiency development.
Methods
A total of 100 cataract surgery videos performed by a single resident from their 6th to 760th case were collected. Motion tracking software was used to annotate trajectories of 11 surgical instruments per frame. Six motion parameters, including total path length, average velocity, average acceleration, root mean square jerk, average angular change, and workspace coverage, were extracted per instrument per video. Monotonic trends were assessed using the Mann-Kendall test and Theil-Sen slope estimation, with Spearman's correlation measuring the association between case number and performance metric values. Pettitt's change-point analysis identified significant transitions in skill progression.
Results
All 11 instruments demonstrated statistically significant reductions in at least one motion parameter. Path length consistently decreased across training, with the largest reductions seen in the cannula (-11.8%, 95% CI: [-17.4%, -6.8%], P<0.001), phacoemulsification handpiece (-11.5%, 95% CI: [-14.1%, -8.7%], P<0.001), and cystotome (-8.9%, 95% CI: [-11.8%, -5.9%], P<0.001). The IOL inserter had the greatest reduction in average angular change of 3.0% (-1.70°) (95% CI: [-3.9%, -2.0%], P<0.001). Pettitt's analysis demonstrated significant shifts in surgical efficiency around case 300 for most instruments, though improvements in certain advanced tasks (e.g., lens implantation) emerged later.
Conclusion
This study revealed distinct, instrument- and task-specific learning curves in cataract surgery. A shift around case 300 marked a milestone in proficiency, beyond the current minimum of 86 cases. These findings show how video-based motion tracking analytics can provide data-driven feedback, guiding targeted instruction and standardizing training.
Presenting Author
Samar A. Alswailem, MD
Purpose
To our knowledge, limited research exists on immediate sequential bilateral cataract surgery (ISBCS) among ophthalmologists in Asian countries. This study evaluates the attitudes, practices, and barriers related to ISBCS among board-certified ophthalmologists in a rapidly growing Asian economy.
Methods
A cross-sectional study using a validated electronic questionnaire was distributed to board-certified ophthalmologists in the region. The questionnaire included 25 specific questions divided into four domains: benefits and importance, controlling factors, surgeons’ perspectives and selectivity, and reasons for adopting or rejecting ISBCS.
Results
Of 95 ophthalmologists surveyed, 73 (76.8%) were male and 22 (23.2%) female. Most (60%) had over 10 years of experience, and 69.5% worked in government hospitals. Only 17.9% currently performed ISBCS (Group A), while 76.8% had never performed it (Group B), and 5.3% had stopped (Group C). Among practitioners (Group A), 88.2% used ISBCS in 1–20% of cases, citing benefits like fewer hospital visits, faster recovery, and reduced cost. Barriers included concerns about bilateral endophthalmitis, legal risks, and refractive surprises. Some non-practicing surgeons were open to ISBCS for specific cases, like patients needing general anesthesia or congenital cataracts.
Conclusion
ISBCS remains underutilized in this region due to safety concerns and institutional policies. However, many ophthalmologists recognize its potential benefits and may consider its use under certain conditions. Further research is needed to assess clinical outcomes, patient perspectives, and cost-effectiveness to promote wider acceptance of ISBCS.
Presenting Author
Jamie L Surgent-Nahay, MS, BSc
Co-Authors
Mina Farahani (MD)
Purpose
To share a case where Belantamab mafodotin-related microcyst-like epithelial changes (MECs) produced predictable refractive shifts that were used to guide a refractive outcome during cataract surgery.
Methods
A retrospective case report of a patient with refractory multiple myeloma on the antibody-drug conjugate Belantamab mafodotin who developed MECs with alternating myopia and emmetropia. The patient's refractive shifts after each treatment were predictable and gave him either uncorrected distance or near vision. This refractive shift was used to guide intraocular lens selection.
Results
A 68-year-old male on Belantamab mafodotin for refractory multiple myeloma presented with blurry vision. His baseline refraction was -2.00 sphere OU (BCVA 20/20 OU). After treatments, MECs developed, causing a +2.00D shift, leading to emmetropia. The patient alternated between spectacle independence for distance or near as his keratopathy developed and cleared. He adapted well to the refractive shifts. Further into his infusions, he experienced a drop in vision from cataracts. He underwent cataract surgery OU targeted to -2.00D OU, expecting he would experience similar refractive shifts post operatively related to his keratopathy. He has continued to have these functional refractive shifts.
Conclusion
The development and resolution of corneal MECs and their associated refractive shifts can be anticipated in patients on antibody-drug conjugates, a rapidly expanding class of chemotherapy often used for refractory oncology patients. These refractive shifts can be analyzed in patients to help determine a refractive goal prior to cataract surgery.
Presenting Author
Yong Woo Lee, MD, PhD
Co-Authors
Seungsoo Rho (MD, PhD)
Purpose
To analyze inflammatory cytokine concentrations in the aqueous humor by cataract type and severity, specifically comparing them in relation to the presence of posterior subcapsular cataract (PSC).
Methods
We prospectively recruited patients undergoing routine cataract surgery. PSC presence was documented via slit-lamp examination and anterior segment photography during cataract diagnosis. Aqueous humor samples were collected prior to surgery and analyzed using quantitative multiplexed antibody assays to measure the concentrations of 10 inflammatory cytokines. Cytokine concentrations were compared according to PSC status.
Results
Overall, 80 eyes of 80 patients were included, 45 with and 35 without PSC. Compared with those in the non-PSC group, patients with PSC showed significantly higher aqueous humor concentrations of IFN-?. No significant correlation was observed between PSC status and the aqueous humor concentrations of other examined inflammatory cytokines.
Conclusion
IFN-? expression tended to be higher in eyes with PSC than in those without PSC, suggesting a possible role in PSC pathophysiology.
Presenting Author
Ivo M Ferreira, MD
Co-Authors
Satish Yalamanchili (MBA, MS), Sarah Makari (OD), Guangyao Jia (PhD)
Purpose
A new 4D Phaco volumetric ultrasound (US) modality was recently developed as part of a novel phacoemulsification machine (UNITY VCS/CS). This bench study compares the lens emulsification efficiency and total energy of two ultrasound modalities: volumetric vs torsional US and tip design with volumetric US mode: hybrid vs balanced tip.
Methods
15 artificial Kitaro lens samples (simulating LOCS III NO4 NC4 P1 C1 cataract) were emulsified with balanced tip using the torsional (Tors) and the new 4D phaco (4D) US modalities. In both groups, US power, vacuum, IOP, and flow rate were set to 60% fixed, 450mmHg, 55mmHg, and 40cc/min, respectively. Additional 42 Kitaro lens samples were weighed in milligrams (mg) and emulsified at 60% fixed 4D US power, 550 mmHg vacuum, 38 mmHg IOP and 38 cc/min flow rate to evaluate the difference in efficiency and energy dissipation between the hybrid and balanced tips. US time, energy in Joules and cumulative dissipated energy (CDE) were evaluated for all tested conditions.
Results
Compared to Tors, 4D demonstrated better efficiency across all measured metrics with balanced tip, including mean aspiration volume by 26% (14.20±3.76 vs 19.20±5.66cc, p<0.01), aspiration time by 35% (37.07±8.18 vs 56.93±14.85s, p<0.0001), and US time by 52% (20.81±6.57 vs 43.35±13.47s, p<0.0001). 4D also showed a 52% reduction in energy delivered into the eye (27.47±8.70 vs 57.63±17.89J, p<0.0001) and a 52% reduction in energy dissipated at the incision, measured as CDE (4.99±1.58 vs 10.40±3.23, p<0.0001). Using 4D, the hybrid tip required significantly less US energy in Joules/mg compared to balanced tip (p<0.001). Data analysis is ongoing, and results will be updated prior to deadline.
Conclusion
The novel 4D Phaco with the UNITY VCS/CS is more efficient and reduces the total energy delivered to the eye when compared to traditional torsional US, which may translate to less postop corneal edema and quicker visual recovery. The higher efficiency afforded by the 4D Phaco volumetric cutting may allow use of hybrid tip in dense cataracts.
Presenting Author
Samina F Zamindar, MS, DOMS
Purpose
To develop and validate a Patient-Reported Experience Measure (PREM) tool for cataract surgery in India, focusing on patient perspectives on safety, communication, and care processes, thereby addressing critical gaps in measuring and improving patient-centered surgical care in low-resource settings.
Methods
A multiphase study was conducted across 16 Indian hospitals. Phase 1 involved tool development through literature review, expert panel discussions (n=31), and content validation (CVI≥0.8). Phase 2 piloted the 14-item tool with 240 patients, establishing reliability (KR-20=0.801). Phase 3 implemented the tool with 582 patients, assessing reliability, validity, and domain-specific performance, including communication and safety, using descriptive statistics and validity indices.
Results
The tool showed excellent validity (mean CVI=0.982) and reliability (KR-20=0.801). Patient-reported adherence was high for hand hygiene (97.6%), identity verification (99.7%), and postoperative guidance (99.0%). Gaps were identified in anesthesia understanding (92.1%) and financial counseling (95.7%). Domain analysis revealed highest scores for Patient Communication (M=3.90, SD=0.33), followed by Clinical Care (M=1.96, SD=0.19), highlighting strengths and areas needing attention.
Conclusion
This validated PREM tool effectively captures patient experiences in cataract surgery, identifying both strengths and gaps. Its integration into practice offers a scalable approach to enhance patient-centered care and surgical safety in resource-limited healthcare settings.
Presenting Author
Selcan ekicier Acar, MD
Purpose
To assess cataract awareness and identify demographic and knowledge-related factors associated with delayed cataract surgery among patients attending a tertiary eye hospital in Turkey.
Methods
A cross-sectional survey was conducted among 1,100 adult outpatients between May and August 2025. The questionnaire evaluated demographics, cataract knowledge, symptom recognition, treatment understanding, and actual treatment-seeking behavior. Delayed surgery was defined as ≥12 months from diagnosis to surgery. Logistic regression was used to identify independent predictors of delayed surgery.
Results
Of 1,100 participants (mean age 52.4 ± 11.2 years; 54% female), 68% reported awareness of cataracts, but only 42% correctly identified the lens as the affected structure. While 77% recognized surgery as the primary treatment, 39% believed medications could cure cataracts. Among 310 participants diagnosed with cataract, 55% underwent surgery, whereas 45% experienced delayed or no surgery. Multivariate analysis showed that lower educational level (OR 2.4; 95% CI 1.6–3.6), lack of health insurance (OR 1.9; 95% CI 1.2–3.0), and poor knowledge of treatment options (OR 2.7; 95% CI 1.8–4.0) were independently associated with delayed surgery.
Conclusion
Despite moderate awareness of cataracts, misconceptions about treatment and socioeconomic barriers significantly contribute to delayed surgery. Targeted educational interventions and improved access to care may enhance timely surgical uptake and reduce preventable visual impairment.
Presenting Author
Madhu Shekhar, MS
Co-Authors
Albanuddin Md (MS)
Purpose
To evaluate the clinical characteristics, surgical outcomes, and visual recovery in a cohort of patients with lenticonus undergoing cataract surgery. This study highlight the association between lenticonus and systemic conditions, specifically Alport syndrome, and emphasizes ophthalmologist's role in the early diagnosis of these systemic diseases
Methods
This retrospective study included 18 eyes from 14 patients presenting with lenticonus. Comprehensive anterior and posterior segment evaluations were performed using slit-lamp biomicroscopy. Visual acuity was assessed pre-and postoperatively using LogMAR chart. Subjective refraction, wavefront aberrometry and anterior segment OCT (AS-OCT) were done. Surgical intervention either manual small incision cataract surgery (MSICS) or phacoemulsification—was selected based on cataract grade and performed by an experienced surgeon. Systemic history was thoroughly reviewed to identify potential associations, and further referral to a physician was made wherever necessary
Results
Out of the total 18 eyes, 5 had anterior lenticonus, 5 had posterior lenticonus, and 8 eyes had both. Spontaneous rupture of the anterior lens capsule in 1eye, Posterior polymorphous corneal dystrophy and lamellar macular hole in 1 eye. A typical bull's eye aberrometry pattern was noted in most of our cases, which can be used for early diagnosis. Out of the 18 eyes, 6 eyes underwent MSICS and 12 eyes underwent phacoemulsification. Mean preoperative UCVA was 0.78 LogMAR (range: 0.6-1.08), improving significantly to 0.24 LogMAR postoperatively (range: 0.18-0.78; p < 0.001). Of the 14 patients, 7 were diagnosed with Alport syndrome, 2 of whom were identified during ophthalmic evaluation
Conclusion
There was a significant improvement in UCVA after cataract surgery in all cases. Aberrometry plays an important role in early diagnosis. Out of 7 patients with Alport syndrome, 2 were diagnosed after presentation. This underscores the ophthalmologist's pivotal role in early detection of such systemic conditions, which may otherwise go undetected.
Presenting Author
Daniel Laroche, MD
Co-Authors
Devin Giordano (BA)
Purpose
To evaluate the role of lens thickness in intraocular pressure (IOP) control following cataract surgery alone versus combined cataract and glaucoma surgery in a predominantly Black patient population.
Methods
We conducted a retrospective cohort study of patients aged ?50 years from a majority African American, Black, and Caribbean population who underwent either cataract surgery alone or combined cataract-glaucoma surgery at a single ophthalmology practice in Queens, New York. Preoperative biometric data—including lens thickness, axial length, and anterior chamber depth—were collected alongside comprehensive ophthalmic examinations. Patients were stratified by surgical type and glaucoma status. Outcomes assessed over a 3?month follow?up included changes in IOP, number of glaucoma medications, and visual function indices.
Results
190 eyes from an initial 360 cases met inclusion criteria. Surgery resulted in a significant mean IOP reduction of -2.27 mmHg overall. Cataract surgery alone saw a modest IOP decrease (-1.69 mmHg), while combined procedures saw superior IOP reduction and a decrease in glaucoma medication use. Mean lens thickness was 4.53 mm across the whole sample, and was slightly greater among patients undergoing combined surgery compared to cataract surgery alone at 4.55 mm and 4.51 mm, respectively. Subgroup analyses demonstrated that patients with preoperative IOP ?18 mmHg had thicker lenses (4.84 mm) and achieved greater postoperative IOP reduction in the cataract surgery-alone group (-7 mm Hg).
Conclusion
Increased lens thickness was associated with higher preop IOP, greater surgical complexity, and larger postop IOP reductions. Lens thickness may be a valuable biomarker for surgical planning, identifying patients at higher risk for glaucoma progression who may benefit from combined surgery.
Presenting Author
Lawrence Woodard, MD
Co-Authors
Li-Chen Pan (MPH), Carine C.W. Hsiao (MS)
Purpose
As the aging population increases, the burden of cataract surgery is expected to rise, making surgical efficiency increasingly important to meet patient needs. To model the impact of UNITY� VCS (UVCS) on potential operating room patient throughput when compared to CENTURION� Vision System with ACTIVE SENTRY� (CAS) under various practice scenarios.
Methods
Leveraging operating room turnover time data from a multicenter, prospective, real-world, observational time-and-motion study involving patients with non-complicated age-related cataract. Using these data, we developed 2 scenario-based models to simulate surgical capacity across a standard OR day. Scenarios included (1) high-capacity scheduling day and (2) a more balanced scheduling day for an ambulatory surgical center. For each scenario, we calculated changes in the number of procedures that could be scheduled per day.
Results
Data from the time-and-motion study assessing 303 patients that underwent cataract surgery (n=161 CAS; n=142 UVCS) found that the use of UVCS was associated with a statistically significant reduction of 52.81 seconds (p<0.016) in operating room turnover time per case compared with CAS. In the high-capacity framework with 15-minute time blocks (30 cases/day), this equated to 26.5 additional minutes per day and in the balanced scheduling scenario of 20-minute time blocks (25 cases/day), this equated to 22 additional minutes per day. Using these results, scenario modeling demonstrated that reducing turnover by 53 seconds/case consistently created enough capacity to add 1 additional case/OR day.
Conclusion
Efficiency gains from reduced turnover may offer increased surgical throughput in both high-capacity and more balanced scheduling models. These findings highlight the importance of workflow optimization in expanding cataract surgery capacity - particularly in response to growing global demand for cataract procedures driven by aging populations.
Presenting Author
Julie M Schallhorn, MD
Purpose
To report the visual and refractive outcomes in subjects with previous corneal laser vision correction (LVC) surgery who underwent cataract surgery with toric intraocular lenses (IOLs) implantation assisted with VERACITY surgical planner (Carl Zeiss Meditec, Jena, Germany).
Methods
This retrospective study included 399 cataract surgery cases reported on VERACITY database. Preoperative biometry measurements were performed using IOLMaster 700 using Barrett True-K formula and total keratometry. Target refraction in the IOL calculation was ± 0.25 D. Study outcomes included postop cylinder (primary endpoint), spherical equivalent (SE) and uncorrected distance visual acuity (UDVA). A subgroup analysis based on IOL design (monofocal (MON) vs multifocal (MUL) IOLs) and type of preop astigmatism (against-the-rule (ATR) vs with-the-rule (WTR)) was also performed.
Results
Mean subject age was 67.3 ± 7.6, and 53% were female. Postop cylinder was 0.48 ± 0.45 D in the whole population, 0.50 ± 0.48 D vs 0.45 ± 0.39 D in MON vs MUL subgroups, and 0.48 ± 0.47 D vs 0.46 ± 0.39 D in ATR vs WTR subgroup. Postop SE was -0.14 ± 0.54 D in the whole population, -0.11 ± 0.55 vs -0.19 ± 0.51 D in MON vs MUL subgroups, and -0.18 ± 0.55 D vs -0.03 ± 0.51 D in ATR vs WTR subgroups. Postop LogMAR UDVA was 0.05 ± 0.11 in the whole population, 0.05 ± 0.12 vs 0.05 ± 0.10 in MON vs MUL subgroups, and 0.04 ± 0.11 vs 0.05 ± 0.09 in ATR vs WTR subgroups.
Conclusion
The results of this study showed that subjects with antecedent LVC and who underwent cataract surgery with toric IOL implantation using IOLMaster and anterior and posterior keratometry, and assisted with VERACITY surgical planner, exhibited good refractive and visual outcomes, regardless the type of IOL design or preop astigmatism.
Presenting Author
Kubra Gul Olke, MD
Co-Authors
Gokhan Celik (MD), Furkan Ciftci (MD), F?rat Selen (MD), Ezgi Mavigok (MD), Mehmet Ozmen (MD)
Purpose
To identify preoperative predictors of intraoperative pain intensity during cataract surgery and to develop a predictive model for individualized pain risk assessment.
Methods
This prospective study enrolled 218 patients scheduled for cataract surgery, one eye per patient. Preoperative data included systemic comorbidities, cataract type/density, surgical sequence, ectropion uveae, iris colour, pseudoexfoliation, blepharitis treatment, TBUT, Oxford score, and Schirmer. Optical biometry provided axial length, anterior chamber depth, and white-to-white; Pentacam measured central corneal thickness and ICA. Validated Beck Anxiety Inventory and OSDI were given preoperatively. A single surgeon used a standard technique. Intraoperative pupil size, nucleofractis, ultrasound power/time, and duration were recorded. Immediate postoperative pain was scored on a 0-10 VAS scale.
Results
Partial correlation analysis controlling for surgical parameters revealed significant associations between pain and ICA (p=0.001, r=-0.222), ectropion uveae (p=0.003, r=0.226), light iris color (p=0.006, r=0.192), TBUT (p=0.021, r=0.161), Schirmer score (p=0.040, r=0.143), and blepharitis presence (p=0.009, r=0.183). Stepwise regression analysis identified ICA (p=0.001), iris color (p=0.046), ectropion uveae (p=0.004), and TBUT (p=0.006) as significant independent predictors.
Conclusion
Preoperative anxiety did not correlate with intraoperative pain. Conversely, narrow iridocorneal angle, ectropion uveae, light iris pigmentation, and shortened TBUT were significant predictors of heightened pain. These findings support individualized anesthetic strategies and informed patient counseling to optimize surgical comfort.
