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Moderator
Steve A. Arshinoff, MD, FRCSC
Panelists
Tat-Keong Chan, MD, FRCS; Mohamed Abou Shousha, 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
Sujin Kang, MD
Co-Authors
Dena Ballouz (MD), Darlene Miller (PhD), Harry Flynn (MD), Sonia Yoo (MD), Salomon Merikansky (MD)
Purpose
To evaluate 2025 in vitro susceptibility of ocular pathogens from cataract surgery cases at Bascom Palmer Eye Institute to commonly used topical prophylactic antibiotics and compare results with national ARMOR data to assess adequacy of current empiric regimens. Methodologic and formulation-related limitations are acknowledged.
Methods
Retrospective review of isolates (n=30/species) from intraocular fluids of post-cataract surgery patients at Bascom Palmer Eye Institute in 2025: S. aureus, S. epidermidis, other coagulase-negative staphylococci, S. viridans, P. aeruginosa, and other gram-negative rods. Susceptibility testing (Etest/Kirby-Bauer, CLSI) was performed for ciprofloxacin, levofloxacin, moxifloxacin, gentamicin, trimethoprim, and polymyxin B. Intrinsic resistance or non-indication was recorded. Rates were descriptively compared with ARMOR. Limitations include reliance on in vitro methods and lack of direct testing of drops containing benzalkonium chloride (BAK).
Results
At BPEI in 2025, fluoroquinolone susceptibility was low for S. aureus (66-69%; ARMOR 73-76%) and S. epidermidis (70%; ARMOR 65-70%), but high for other coagulase-negative staphylococci (CoNS, 93%; ARMOR 65-69%), gram-negative rods (90%), and P. aeruginosa (93%; ARMOR 93%). Gentamicin showed broad activity across most species (93-97%), consistent with ARMOR. S. viridans was intrinsically resistant. Polymyxin B testing was invalid; estimated Polytrim coverage from trimethoprim results was poor for S. aureus (20%; ARMOR 96%), lower for CoNS (43%; ARMOR 72%), and moderate for gram-negative rods (63%).
Conclusion
At BPEI in 2025, fluoroquinolone coverage for S. aureus and S. epidermidis was slightly lower than ARMOR, while gram-negative coverage matched. Gentamicin maintained broad activity. Trimethoprim activity for S. aureus was far lower than ARMOR, suggesting limited prophylactic utility.
Presenting Author
Eva I. Liang, MD
Purpose
Dry eye disease (DED) is common in patients needing cataract surgery and can be further exacerbated in the postoperative period. Perfluorohexyloctane ophthalmic solution (PFHO) is approved for treatment of signs and symptoms of DED. This study evaluated the effects of PFHO treatment before and after cataract surgery in patients with DED.
Methods
This prospective, multicenter, open-label, phase 4 study (NCT06346340) enrolled patients with DED who were candidates for phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Patients instilled PFHO in both eyes QID for 30 days preoperatively and received a second 30-day PFHO treatment beginning approximately 1 month after surgery. Total corneal fluorescein staining (tCFS), rated on a 0-15 scale; eye dryness, rated on a 100-mm visual analog scale (VAS); Ocular Surface Disease Index (OSDI); root mean square (RMS) higher-order aberrations (HOA) in the central 6.0 mm of the cornea; and visual acuity were assessed before and after each PFHO treatment period.
Results
The study enrolled 97 patients. Mean (SD) tCFS score improved from 5.0 (2.7) to 2.1 (2.2) and 1.3 (1.8) after the first and second 30-day PFHO treatments, respectively (P<0.001 for both). Reductions from baseline in eye dryness VAS score from 62.3 (19.0) to 37.5 (23.1) and 25.9 (23.3), respectively, were observed, while OSDI score improved from 51.9 (16.9) to 30.1 (17.6) and 11.9 (10.9; P<0.001 for all). Most patients experienced stable or improved RMS HOAs after PFHO treatment. The percentage of patients with best-corrected visual acuity (BCVA) of 20/20 or better was 86.0% at the first postsurgical assessment and 91.8% after 30 days of subsequent PFHO treatment.
Conclusion
Presurgical PFHO treatment resulted in statistically significant reductions in signs and symptoms of DED with further improvement after postoperative treatment, including more patients with BCVA of 20/20 or better. These findings support a role for PFHO in pre-and postoperative management of DED in patients undergoing cataract surgery.
Presenting Author
Jason Bacharach, MD
Purpose
Dry eye disease (DED) is common in patients undergoing cataract surgery. Perfluorohexyloctane ophthalmic solution (PFHO) forms an anti-evaporative monolayer at the tear-film surface to reduce both signs and symptoms of DED. This study evaluated whether preoperative PFHO treatment affected postoperative refractive accuracy.
Methods
This prospective, multicenter, open-label, phase 4 study (NCT06346340) enrolled patients with DED who were candidates for phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Patients instilled PFHO in both eyes QID for 30 days preoperatively and received a second 30-day PFHO treatment beginning approximately 1 month after surgery. The 30-day postoperative standard-of-care visit included assessment of refractive outcome (manifest refraction). The primary endpoint was the mean difference between absolute deviations from predicted refractive error in the study eye.
Results
The study enrolled 97 patients (75.3% female; mean age, 68.6 years). The mean difference between absolute deviations in predicted refractive error measured before and after presurgery PFHO treatment was -0.027 ± 0.167 D (P=0.1385). The difference in the baseline predicted refractive error and the predicted refractive error post-PFHO treatment was within 0.3 D for 94.2% of study eyes. The percentage of patients with calculated IOL power within +0.50 D of the correct IOL power was 72.1% before and 83.7% after PFHO treatment. Two adverse events were considered related to treatment (mild eye pruritus and mild noninfective conjunctivitis).
Conclusion
In patients with DED undergoing cataract surgery, PFHO did not alter the accuracy of preoperative biometry and keratometry measurements or impact the predicted refractive error. The accuracy of IOL power determination was increased after preoperative PFHO treatment. PFHO was well tolerated in this patient population.
Presenting Author
Zachary Ofenloch, BSc
Co-Authors
Kendall Donaldson (MD, MS), Sarah Tajran (MD, MS), Zubair Ansari (MD), Adam Rothman (MD)
Purpose
This study evaluates the burden of post-operative eye drops following cataract surgery from both the patient and the practice (staff and physician) perspective. We evaluated patient challenges and acceptance of potential drop alternatives, as well as the time spent on managing drop-related issues in the practice.
Methods
200 patients were recruited to take an 11-question survey during a routine post-operative appointment following uncomplicated cataract surgery. In addition, a staff survey of 10 staff members was performed (including administrative assistants, 4 cataract surgeons, triage technicians, and a nurse practitioner) assessing the approximate clinic workload related to post-operative drops. Patient responses focused on drop compliance, challenges with drop administration, pharmacy or insurance issues, need for assistance, and acceptance of drop less alternatives. Responses were de-identified and statistically analyzed using chi-squared tests.
Results
Many patients face challenges with drop administration and with their insurance or pharmacy, requiring additional instruction and phone calls beyond their standard post-operative care. 18.6% of patients reported difficulty using their post-operative drops, and 23.3% required assistance from a caregiver. 62.8% preferred a drop-less option, and 53.5% expressed willingness to pay out-of-pocket for such a solution. However, statistical testing revealed no significant correlation between drop difficulty and willingness to pay (p = 0.86). From the staff perspective, 90% received frequent questions on timing and drop administration and 40% spent 30-60 minutes weekly on drop-related concerns.
Conclusion
Many cataract surgery patients experience challenges with post-operative drop regimens and express interest in drop-less alternatives. Surgeons and staff members also spend significant time and effort managing issues related to post-operative drops. These findings support exploration of drop-less alternatives for cataract surgery.
Presenting Author
Ivan Mac, MD
Purpose
To evaluate the efficacy of nepafenac 0.3% ophthalmic suspension in preventing clinically meaningful vision loss (≥15-letter decrease in BCVA) associated with post- cataract macular edema through Day 90.
Methods
This was a post-hoc pooled analysis of two randomized, double-masked, vehicle- controlled clinical studies (Study 067 and Study 071). Subjects undergoing cataract surgery were randomized to nepafenac 0.3% or vehicle. The per-protocol population was analyzed for the incidence of BCVA loss of ≥15 letters from baseline at any postoperative visit through Day 90. Between-group comparisons were made using odds ratios (OR) with 95% confidence intervals (CI).
Results
In Study 067, BCVA loss occurred in 17.2% of nepafenac-treated subjects (48/279) versus 34.5% of vehicle-treated subjects (96/278), corresponding to a 17.3% reduction (95% CI: -24.5, -10.2; OR 0.39, p<0.0001). In Study 071, incidence was 15.3% with nepafenac (42/275) versus 24.9% with vehicle (69/277), a 9.6% reduction (95% CI: - 16.3, -3.0; OR 0.54, p=0.0051). Pooled analysis demonstrated significantly lower rates of ≥15-letter BCVA loss with nepafenac (16.3%; 90/554) compared to vehicle (29.7%; 165/555), with a 13.5% reduction (95% CI: -18.4, -8.6; OR 0.46, p<0.0001).
Conclusion
Nepafenac significantly reduced the risk of clinically meaningful visual acuity loss associated with post-cataract macular edema through 90 days postoperatively. These findings support the role of nepafenac in preserving vision following cataract surgery in patients at risk for postoperative macular edema.
Presenting Author
Jae Yong Kim, MD, PhD
Co-Authors
Hoseok Chung (MD), Kyu Sang Eah (MD), Hun Lee (MD, PhD)
Purpose
To compare preoperative and postoperative changes at 1 and 3 months in post-cataract surgery dry eye patients treated with topical 2% rebamipide (G1), 3% diquafosol (G2), and 0.1% hyaluronic acid (G3).
Methods
This was a single-center prospective study. Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), NEI corneal/conjunctival staining score, Schirmer test, tear osmolarity, and MMP-9 levels were measured in G1, G2, and G3 at baseline and 1 and 3 months after surgery. Between-group comparisons were performed using ANOVA on the changes (? = 1 month or 3 months - baseline), while within-group changes were assessed with paired t-tests.
Results
For OSDI, intergroup differences in change were significant at both 1 and 3 months (p < 0.05). All three groups showed significant reductions at 1 month (p < 0.001). At 3 months, significant reductions persisted in the diquafosol and hyaluronic acid groups (p < 0.001). In the Schirmer test, the hyaluronic acid group showed a significant increase at 3 months (p = 0.026). For NEI corneal staining, intergroup differences at 1 month were significant (p < 0.05), with hyaluronic acid showing a significant reduction (G3: 4.88 ± 2.42 ? 2.35 ± 1.66, p < 0.001).
Conclusion
After cataract surgery, rebamipide improved symptoms in the early postoperative period, diquafosol contributed to sustained improvement up to 3 months, and hyaluronic acid showed significant benefits not only in symptoms but also in tear secretion and corneal status.
Presenting Author
Dominique Tynan, MD
Co-Authors
Toshit Varshney (MD), Ella Preston (BSc), Robin Hamilton (FRCOphth, MBBS, MD), Gus Gazzard (MD, FRCOphth, MA, MBBS), Ian Yeung (MA, FRCOphth)
Purpose
To evaluate the effect of cataract surgery (CS) on intraocular pressure (IOP) spike rates after intravitreal injections (IVI) in patients at Moorfields Eye Hospital (MEH). IOP spikes can be a risk for glaucoma patients.
Methods
Retrospective audit of all IVIs performed at MEH from 29/01/10 to 28/01/25. IOP spikes were defined as ?10mmHg increase (IOP+10), or a post-IVI value of >40mmHg (IOP>40) compared to the baseline IOP recorded pre-IVI. Visits with incomplete IOP data were excluded. Eyes with recorded MEH CS and IVI data both pre- and post- their CS date were included. IOP+10 and IOP>40 spike rates for the last IVI pre- and the first IVI post-CS and all recorded IVI pre- and all recorded IVI post-CS were compared with chi square tests. IOP+10 and IOP>40 spike rates by year relative to CS were plotted and Cochran-Armitage trend and deviation-from-trend tests assessed linearity 11 years pre- and 10 years post-CS.
Results
1866 eyes (23,494 IVIs) were analysed; median IOP recording was 22 minutes post-IVI. IOP+10 spike rate was significantly higher in the last pre- vs first post-CS IVI (30.9%, n=1866 vs 24.3%, n=1866; p<0.01), while IOP>40 spike rate was not significant (1.4% vs 0.9%; p=0.16). Across all IVIs, IOP+10 spike rate was significantly higher post- vs pre-CS (31.9%, n=11080 vs 29.8%, n=12414; p<0.01), while IOP>40 spike rate was not significantly different (1.2% vs 1.5%; p=0.48). Pre-CS, both IOP+10 and IOP>40 spike rates rose linearly with no deviation (p<0.01), post-CS only IOP+10 showed a significant linear trend with no deviation (p<0.01) (see Figure 1 and 2).
Conclusion
Pre-CS, IVI IOP+10 and IOP>40 spike rates increase linearly with time. Post-CS IOP+10 rates initially drop, then linearly increased again. We propose further study to see if age and/or repeated IVI cause IOP spike rates to rise over time. We hope clinicians find these results useful in managing cataracts and glaucoma in IVI patients.
Presenting Author
Vinita Yadav, MS, MBBS
Co-Authors
Naren Shetty (MS, PhD), Swaminathan Sethu (PhD)
Purpose
To evaluate the impact of pre-operative topical steroids on ocular surface immune cell subsets and tear fluid inflammatory cytokines in cataract surgery patients.
Methods
A prospective study was conducted on 40 cataract patients (ages 45-65), divided into a control group (n=20) without pre-operative steroids and a case group (n=20) receiving prednisolone acetate 1% eye drops (4�/day for 3 days pre-operatively, continuing post-operatively per standard tapering). Patients with retinal, glaucoma, or corneal pathologies, steroid use, or complicated cataracts were excluded. Tear fluid biomarkers (Schirmer's test, ocular surface wash) were assessed pre-surgery, at 1 and 3 months post-op, with additional pre-op assessments in the case group. Statistical analysis included the Shapiro-Wilks test for data distribution and two-way repeated measures ANOVA (P<0.05).
Results
Patients in the case group who received pre-operative steroids exhibited a significant reduction in key inflammatory biomarkers, including TNF-?, IL-6, IL-17A, VEGF-A, and ICAM-1, at both 1-month and 3-month post-operative time points which was not noticed in the control group. The findings suggest that pre-operative steroid use helps regulate the ocular surface immune response, potentially reducing post-surgical inflammation and improving recovery outcomes.
Conclusion
Pre-operative topical steroid use effectively modulates inflammatory cytokines, contributing to better ocular surface stability and reduced inflammatory response following cataract surgery. These findings support the potential benefits of pre-operative steroid administration in optimizing post-operative healing.
Presenting Author
Nadav Shemesh, Sr., MD, MHA
Co-Authors
Nir Erdinest (PhD, BScOptom), David Smadja (MD), Benjamin Stern (MD), Itay Lavy (MD)
Purpose
To evaluate the efficacy of topical ROCK inhibitor Ripasudil in managing pseudophakic bullous keratopathy (PBK). PBK causes irreversible corneal edema following cataract surgery, typically manifesting 8 months to 7 years post-operatively, presenting significant management challenges.
Methods
Clinical data were extracted from electronic medical records, including visual acuity, intraocular pressure, central corneal thickness, and endothelial cell count before and after treatment. Patients were treated with topical Ripasudil for periods ranging from three to five months, three times daily, with adjustments based on disease severity.
Results
The first case report showed that the patient experienced enhanced best-corrected visual acuity (BCVA) and decreased corneal thickness after three months of Ripasudil administration, accompanied by a reduction in central stromal edema. The second case exhibited a comparable trend, with improvements in BCVA and central corneal thickness (CCT) following three months of Ripasudil therapy. The third case demonstrated a therapeutic clinical effect, characterized by the complete resolution of stromal haze and edema after eleven months of Ripasudil treatment, along with a decrease in CCT and an improvement in BCVA.
Conclusion
These findings suggest that Ripasudil may be an effective treatment option for PBK, potentially delaying or avoiding the need for corneal transplantation. Further research is needed to establish the long-term efficacy and safety of Ripasudil for this condition.
Presenting Author
Angelica Hanna, BSc
Co-Authors
Jawad Muayad (BSc), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
To evaluate the use of topical non-steroidal anti-inflammatory drugs (NSAIDs), on the risk of common complications after cataract surgery, including cystoid macular edema (CME), postoperative anterior chamber inflammation, and corneal edema.
Methods
A retrospective cohort study was conducted using electronic medical records data from an international electronic health record network. Data from 120 health care organizations across 17 countries were analyzed. Patient outcomes were assessed up to 3 months following cataract surgery. Propensity score matching (PSM) was used to balance covariates such as age, sex, diabetes and ocular comorbidities. Patients who received steroid drops after surgery were excluded. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.
Results
137,762 patients were included. After propensity score matching, the mean age in both cohorts was 70.1 years and 54% were female. Patients who received NSAIDs following cataract surgery were significantly less likely to develop CME compared to those not being treated with an NSAID (RR = 0.753; 95% CI, 0.686 - 0.827). Patients receiving NSAIDs also had a significantly decreased risk of anterior chamber inflammation after surgery compared to those not receiving NSAIDs (RR = 0.873; 95% CI, 0.766 - 0.995). The risk of developing corneal edema was also significantly lower in those treated with NSAIDs compared to those not using NSAIDs (RR = 0.619; 95% CI, 0.519 - 0.738).
Conclusion
Patients who were treated with NSAIDs after cataract surgery have significantly decreased risk of developing cystoid macular edema, iritis or corneal edema compared to those who were not treated with NSAIDs. Given their strong safety profile, NSAIDs may be considered an important part of the postoperative drop regimen for routine cataract surgery.
Presenting Author
Ibrahim Abboud, BSc
Co-Authors
Abdelrahman Elhusseiny (MD, MSc), Amin Zakkour Khudari (PharmD)
Purpose
This study investigates the comparative risk of developing age-related cataract among patients treated with ?2-agonists versus those receiving other antihypertensive agents, Beta-blockers (BB), Angiotensin-Converting Enzyme Inhibitors (ACE-i)/Angiotensin receptor blockers (ARBs), or calcium channel blockers (CCBs), within a U.S. national cohort.
Methods
We conducted a retrospective cohort study using the TriNetX database to evaluate the risk of developing age-related cataract among patients aged ?40 years treated with ?2-agonists compared with those receiving BB, ACE-i, ARBs, or CCBs over 1, 3, and 5 year follow-up. Eligible patients had ?4 prescriptions of the assessed medication and ?3 ophthalmology visits within five years, while those exposed to any of the other comparator medications were excluded. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), controlling for demographics, systemic comorbidities, ocular conditions, and concurrent medication use.
Results
Patients on ?2-agonists [n=7525; 52.4 ± 12.4 years] had a lower risk of cataract compared with those on BB [n=82593; 64.6 ± 13.9 years] at 1 year [aHR=0.801, 95% CI (0.759-0.846), p<0.001], 3 years [0.784 (0.745-0.825), p<0.001], and 5 years [0.785 (0.747-0.824), p<0.001]. Similarly, compared with ACE-i or ARBs [n=104831; 61.0 ± 11.8 years], ?2-agonists use had a reduced risk at 1y [0.919 (0.868-0.973), p=0.004], 3y [0.896 (0.850-0.945), p<0.001], and 5y [0.886 (0.843-0.932), p<0.001]. A comparable pattern between ?2-agonists and CCBs was observed [n=22995; 64.3 ± 13.2 years]: 1y [0.974 (0.909-1.043), p=0.452], 3y [0.970 (0.911-1.033), p=0.343], and 5y [0.962 (0.905-1.022), p=0.209].
Conclusion
In a large US cohort, ?2-agonists use was associated with a protective effect against developing age-related cataract compared with beta-blockers and ACE inhibitors/ARBs, independent of potential confounders. Findings support ?2-agonists as a potential therapeutic class with implications for cataract prevention.
Presenting Author
Abdullah Ahmed, MBBS
Co-Authors
Mohammadali Ashraf (MD), Hasan Khan (MD), Mahrukh Chaudhry (MBBS), Hajirah Saeed (MD, MPH)
Purpose
To identify primary suspect drugs associated with posterior subcapsular cataract development through comprehensive pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) and characterize drug safety signals.
Methods
This is a retrospective observational pharmacovigilance analysis of FAERS reports (2003-2025). Cases with posterior subcapsular cataract as adverse events were identified using MedDRA preferred terms. Signal detection employed five algorithms: proportional reporting ratio (PRR), chi-squared test, reporting odds ratio (ROR), information component (IC), and empirical Bayes geometric mean (EBGM). Positive signals required: ?3 cases, PRR?2.0, ?�?4.0, ROR lower bound>1.0, EBGM05?2.0, and IC025>0. Only primary suspect drugs were analyzed.
Results
Analysis included 439 cases across 90 drugs (mean age 40.5±21.0 years). Eighty-three drugs demonstrated positive safety signals. Strongest associations: ozurdex (PRR=522.2, 18 cases), cidofovir (PRR=364.7, 8 cases), tropicamide (PRR=157.8, 4 cases), cyclopentolate (PRR=135.4, 3 cases), and netarsudil (PRR=122.3, 6 cases). Drug classes included antivirals, intravitreal corticosteroids, mydriatics, anti-VEGF agents, and topical antibiotics. Seventy-four drugs had ROR?5, with 46 drugs showing ROR?10, indicating very high-risk associations.
Conclusion
Eighty-three drugs across multiple therapeutic classes demonstrate significant associations with posterior subcapsular cataracts. Antiviral agents and intravitreal corticosteroids show the strongest signals. These findings warrant enhanced patient monitoring and informed consent discussions
