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Moderator
Allison J Chen, MD, MPH, ABO
Panelists
Amy Lin, MD, ABO; Claudia E Perez-Straziota, 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
Ikeda Lal, MS, MBBS
Co-Authors
Harbansh Lal (MS)
Purpose
To compare the intra-operative complication rate of two different methods of a novel lenticular massage technique for intumescent white cataracts
Methods
Seventy-two eyes of 70 patients who underwent phacoemulsification for intumescent white cataracts without red reflex were included in the study. Group 1 consisted of 26 eyes of 26 patients and underwent the lenticular massage technique with a 27-gauge cannula under a cohesive ophthalmic visco-surgical device (OVD). Group 2 consisted of 46 eyes of 44 patients where the intumescent white lens was massaged with bimanual irrigation and aspiration cannula, under continuous irrigation, before staining the anterior capsule. Both groups were compared in terms of intra-operative complications.
Results
The anterior capsular tear extension occurred in 2 eyes in group 1 (complication rate 7.69%). The tear did not extend radially to the posterior capsule in both of these cases. No anterior capsular radial tear or extension was noted in group 2 and a continuous curvilinear capsulorhexis could be achieved in all the eyes in this group (complication rate 0%).
Conclusion
The novel technique lenticular massage for intumescent white cataracts under continuous irrigation, with bimanual irrigation aspiration cannula provides a controlled, central capsulorhexis and reduces the incidence of intra-operative complications.
Presenting Author
John A. Hovanesian, MD
Co-Authors
Matthew Rauen (MD)
Purpose
To determine whether phacoemulsification infusion pressure levels affect postoperative corneal health, inflammation, incidence of new posterior vitreous detachment (PVD) and visual acuity as well as intraoperative usage of ultrasound, fluid and aspiration, reverse pupillary block and need for sedation.
Methods
In this prospective, randomized, contralateral-eye study, one eye of each participant underwent surgery with infusion pressure set at 28 mmHg and the other at 65 mmHg. Intraoperative outcome measures at one week and one month included use of BSS fluid, aspiration time, ultrasound cumulative dissipated energy, intraoperative use of sedation and incidence of reverse pupillary block. Postoperative measures included visual acuity, including low contrast acuity , summed ocular inflammation score, change in central corneal thickness, corneal edema, corneal densitometry, and the incidence of new posterior vitreous detachment.
Results
Compared to higher infusion pressure, eyes operated with lower infusion pressure had significantly less use of BSS (37.6 ± 18.3 vs 42.3 ± 19.0 cc) and cumulative dissipated energy ultrasound time during surgery (4.78 ± 3.25 vs 5.59 ± 3.31), less incidence of reverse pupillary block (0 vs 11%), and a nonsignificant trend toward less use of sedation and narcotic. On day 1 postoperatively, inflammation (0.77 ± 0.64 vs 1.25 ± 0.96), change from baseline in corneal thickness (18.2 ± 14.5 vs 29.6 ± 32.4) and corneal edema (0.40 ± 0.69 vs 0.94 ± 0.96) were significantly less with lower infusion pressure. No difference was noted in total aspiration time, visual acuity, or incidence of PVD.
Conclusion
Using lower infusion pressure during cataract surgery has significant advantages, with significantly less fluid, ultrasound energy, reverse pupillary block, postop inflammation, corneal thickness change, and corneal edema. These findings confirm earlier studies, showing that lower infusion pressure may lead to more tolerable and safer surgery.
Presenting Author
Bharti Kashyap, MS
Co-Authors
Birendra Prasad Kashyap (MS), Nidhi Gajendragadkar (FRCS), Prakhyat Roop (MD, MBBS)
Purpose
To compare intraoperative parameters CDE, Aspiration volume and time with circumferential sequential nucleotomy (Gr1) vs deep vertical nucleotomy (Gr2) in dense cataract and its effect on 1st and 7th day postop endothelial cell count, central corneal thickness, uncorrected distance visual acuity and 1 month postop uncorrected distance visual acuity
Methods
Prospective comparative study between circumferential sequential nucleotomy Gr1 vs deep vertical nucleotomy Gr2 in dense cataract for Intraoperative outcomes measure were CDE, Aspiration vol and time. 1&7 day postop outcomes measure were Endothelial Cell Count, Central Corneal Thickness, UCDVA & 1month postop outcome measures UCDVA. 100eyes each group, Single surgeon. Preop data comparable. Inclusion criteria: 4+ nuclear sclerosis on LOC III scale, sequential cataract surgery, Age 50-75yrs, ECD>2000 cells/mm2, No Astig. & ocular morbidity, same viscoelastic and phaco machine with similar parameters in each group, Axial eye length variations upto 0.4mm. No zonular laxity, 5.5mm dilatation.
Results
Intra op CDE values & Aspiration Time significantly less in Gr1 p=.0001, 95% CI (7.81, 9.96) & p=0.03, 95% CI (1.49, 34.5). Post op day 1 Central Corneal Thickness significantly more in Gr2 p=.04, 95% CI (0.018, 25.94), Preop Endothelial Cell Count between Gr1 & Gr2 comparable. P=0.097, 95% CI (-2.60,30.64). Postop Day1 ECC is significantly higher in Gr1, Mean diff.=-119, p=.0001, 95% CI (-141.26, -96.74), Mean reduction in ECC significantly higher in Gr2, P<.0001, 95% CI (121.05, 145.15). Post op day 1 Photopic UCDVA significantly better in Gr1 p=.0001, 95% CI (0.278,0.282). Post op day7 Central Corneal Thickness & Endothelial Cell Count and Post op 1month UCDVA comparable.
Conclusion
Surgeons can consider circumferential sequential nucleotomy in dense cataracts (NS Grade IV+) as intra op significantly less CDE and Asp. Time results in sig. less Central Corneal Thickness, sig. better Endothelial cell count in early post op period which results in significantly better Uncorrected visual acuity on post op day 1.
Presenting Author
Chaerim Kang, BA
Co-Authors
Paul Greenberg (MD, MPH), Thomas Oetting (MD), Terrell Kashner (PhD), Patrick Morhun (MD), Angela Zhu (MD)
Purpose
To evaluate the rate of immediate (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) in the United States Department of Veterans Affairs (VA), this study examined the impact of COVID-19 pandemic on ISBCS utilization and its independent associations with the patient health, travel burden, and the surgeon experience.
Methods
In this retrospective cross-sectional study, we used data from the VA electronic health records, with ISBCS cases confirmed by chart review. We included patients who underwent ISBCS (same day) or DSBCS (2-14 days apart) under topical anesthesia at VA surgery centers from January 1, 2004, to May 11, 2023. Those receiving regional blocks or general anesthesia were excluded. The primary outcome was ISBCS vs DSBCS choice. Independent associations were evaluated with generalized linear mixed models, using facility random effects and fixed effects for patient demographics and health, surgeon experience, travel distance, and pandemic period (pre- vs post- March 13, 2020).
Results
Of 44,295 patients, 952 (2.1%) underwent ISBCS and 43,343 (97.9%) DSBCS. Adjusted pandemic bilateral cataract surgeries (BCSs) were 231.1% (p<.001) more likely to be ISBCS than pre-pandemic. Each SD increase in ocular comorbidities reduced ISBCS by 65.3% (95%CI [-93.8, -41.0]) pre-pandemic, but only -14.3% (95%CI [-30.7, 0.1]) during the pandemic (p<.001). Each SD increase in facility BCS frequency increased ISBCS by 169.9% (95%CI [124.1, 225.1]) pre-pandemic, dropping to 32.6% (95%CI [8.5, 62.1]) during the pandemic (p<.001). Each SD increase in travel time raised ISBCS by 11.9% (95%CI [5.3, 18.9]) pre-pandemic and 46.6% (95%CI [26.0, 70.5]) during the pandemic (p=.001).
Conclusion
In a large integrated healthcare system without financial disincentives, ISBCS rates rose sharply during the pandemic. Risk factors for bilateral infections became less influential, while convenience-related factors became more influential, highlighting the need for improved models to better explain drivers of ISBCS utilization.
Presenting Author
Dineshkumar N. Maru, MBBS, MS
Purpose
To compare the efficacy of the contact lens-shell technique(CST) vs the soft-shell technique(SST) in minimizing endothelial cell loss(ECL) during phacoemulsification in high-risk cataracts.
Methods
A prospective randomized study was conducted on 40 eyes with high-risk cataracts (small pupil, mature and hard cataract) underwent phacoemulsification using either CST or soft shell technique (SST) with 20 eyes in each group between Jan to July 25. The CST used soft-bandage contact lens (Etaficon A hydrogel) as a mechanical protector, while the SST used viscoelastic agents, HPMC 2.4% and sodium hyaluronate 1.4% during surgery to protect corneal endothelium. Outcomes were assessed at 1, 7, and 30 post-op days(PODs), measuring visual acuity (UCVA & BCVA), intraocular pressure (IOP), and central corneal thickness(CCT), whereas corneal endothelial cell count(ECC) was measured at 7 and 30 PODs.
Results
No significant differences were observed in UCVA, BCVA, or CCT(P>0.05). At 1day post-op, IOP was significantly lower in CST (13.2±2.92 mmHg) versus SST (16.96±6.32 mmHg, P=0.02). By 30 days, CST demonstrated significantly reduced ECL (3.02%±5.31%) compared to SST (8.81%±12.78%, P=0.03).
Conclusion
The Contact Lens Shell Technique reduced the endothelial cell loss and protected the corneal endothelium during phacoemulsification in high-risk cases.
Presenting Author
Ayça Bulut Ustael, MD
Co-Authors
Ozlem Evren Kemer (MD), Emine Esra Karaca (MD), Yonca Asfuro?lu (MD, FEBO)
Purpose
To compare the effects of phacoemulsification performed under low versus standard intraocular pressure (IOP) settings on postoperative endothelial cell density (ECD) and phacoemulsification parameters in patients with mature cataracts.
Methods
This retrospective study included 51 mature cataract patients undergoing phacoemulsification.24 were operated with standard intraocular pressure (IOP, 50-60 mmHg) and 27 with low IOP (36 mmHg).Mean age was 70.9 ± 5.3 years in the standard group and 70.1 ± 6.2 in the low-IOP group,with comparable sex distribution.All surgeries were performed by similarly experienced surgeons using the soft-shell technique,first injecting dispersive viscoelastic beneath the endothelium and then 1.8% cohesive viscoelastic.Pre- and postoperative ECD were measured by specular microscopy.Cumulative dissipated energy (CDE),phaco time,and total fluid use were recorded.Mann-Whitney U and Wilcoxon tests were applied.
Results
Preoperative ECD was 2611 cells/mm� in the standard IOP group and 2502 cells/mm� in the low IOP group. Postoperatively, mean ECD was 1904 cells/mm� in the low IOP group and 1418 cells/mm� in the standard group, a significant difference (p=0.02). Endothelial cell loss averaged 45.6% with standard IOP and 24.0% with low IOP (p=0.033). No significant differences were observed between the groups in terms of CDE (p=0.962), phaco time (p=0.396), or total fluid usage (p=0.231). Visual acuity improved significantly in both groups (p<0.001). Negative correlations were noted between CDE and postoperative ECD (p=0.006) and between phaco time and endothelial cell loss (p=0.032).
Conclusion
Phacoemulsification performed under low IOP settings provided superior endothelial cell preservation compared with standard IOP settings, despite similar phaco parameters. In high-risk cases such as mature cataracts, lowering the IOP during surgery may represent a safer strategy to minimize endothelial damage.
Presenting Author
Shreya Saraogi, MS
Co-Authors
Naren Shetty (MS, PhD), Tejal Sj (MS)
Purpose
To evaluate the role of phacoemulsification probe tip exposure on corneal endothelial cell loss and central corneal thickness (CCT) in hard cataracts, comparing between more and less tip exposure.
Methods
A prospective study was conducted on 57 eyes in each group undergoing phacoemulsification for hard cataracts using either a more tip exposure or a less tip exposure on phaco probe. Tip exposure was measured from the phaco tip till the silicone sleeve, with the less tip exposure set at 0.5 mm and more tip exposure at 1.25 mm. Corneal endothelial cell density (ECD) and Central corneal Thickness (CCT) were measured preoperatively and on postoperative days 1 (POD1) and 30 (POD 30). Intraoperative cumulative dissipated energy (CDE) was also recorded. Median [IQR] values were calculated, and intergroup comparisons were performed.
Results
less tip exposure group had lower CDE (9.31 [7.43 to 14.65]) than more tip exposure group (12.00 [8.67 to 17.72]), this difference was statistically significant (p = 0.05). Cell count and CCT were lowest before surgery, peaked on day 1,improved by day 15 & day 30 in less tip exposure group. Compared to more tip exposure group, the short tip group showed better recovery with lower endothelial cell counts loss (2571 to 2277 cells/mm2 vs. 2482 to 2233 cells/mm2) and less corneal oedema, demonstrated by a smaller increase in CCT (535 to 527 µm vs. 517 to 528 µm) at day 15 and day 30. differences were statistically significant inless tip exposure group stabilised faster by post operative day 15.
Conclusion
The less-tip exposure group showed reduced endothelial cell loss & less Central corneal Thickness post cataract surgery.
Presenting Author
Baoxian Zhuo, MD
Co-Authors
Jin Yang (PhD), Wenqian Shen (MM)
Purpose
To evaluate the clinical outcomes of the enhanced monofocal intraocular lens TECNIS Eyhance (ICB00) in cataract patients with epiretinal membrane (ERM), and to explore its feasibility as an alternative option for those unsuitable for multifocal IOLs
Methods
This prospective, multicenter, randomized, single blinded comparative study enrolled 221 patients, divided into an ICB00 group (experiment group, n = 125) and a DCB00 group (a monofocal IOL, control group, n = 96). Subgroup analysis was performed based on ERM severity. Outcomes included uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, UNVA) and best-corrected visual acuity (BCVA) at 1 week, 1 month, and 3 months postoperatively. Objective visual quality were assessed using iTrace; defocus curves (+2.0D to -4.0D) were analyzed; and subjective visual quality and photic phenomena were evaluated via questionnaire.
Results
A significant interaction was observed between IOL type and ERM grade for UIVA and BCVA at 3 months (both P < 0.05). The ICB00 group showed significantly better intermediate and near visual acuity in patients with Grade ?1 ERM (P < 0.05). However, in Grade 3 ERM patients, BCVA was worse in the ICB00 group (0.15 ± 0.07 vs 0.05 ± 0.06, P = 0.014). The ICB00 group demonstrated better visual acuity across the defocus range of -0.5D to -4.0D (P < 0.05). No significant differences were observed in objective optical quality parameters, but the ICB00 group reported higher spectacle independence for intermediate and near vision (P < 0.05) and less difficulty with fine handwork tasks.
Conclusion
The TECNIS ICB00 IOL provides visual quality comparable to a monofocal IOL while significantly improving intermediate and near vision and spectacle independence in cataract patients with Grade 0-1 ERM, representing a safe and effective option for this population. Its benefits are limited in patients with Grade 2 or higher ERM.
Presenting Author
Ahmed F. Shakarchi, MD, MPH
Co-Authors
Fatma Shakarchi (MD, MSc), Muhammad Chauhan (MD, MS), Ahmed Sallam (MD, PhD, FRCOphth)
Purpose
To determine if prior ocular surgery is a risk factor for unilateral uveitis in patients without systemic autoimmune disease, and to determine the types of surgery with increased uveitis risk.
Methods
We conducted a retrospective laterality-matched cohort study of 565 patients with unilateral uveitis and no autoimmune disease. For each patient, we compared the surgical history of the uveitic eye to the fellow control eye. We reviewed records for incisional surgeries, laser procedures, and intravitreal injections, and calculated matched odds ratios using McNemar's test. We excluded all patients who developed uveitis within 3 months or less after surgery.
Results
Uveitic eyes had significantly higher odds of prior ocular procedures (20.0%) compared with fellow control eyes (14.3%) (matched OR, 1.9; 95% CI, 1.3-2.9). Statistically significant higher odds were observed with incisional surgeries (OR 2.0), laser procedures (OR 2.4), and intravitreal injections (OR 4.8). Complex cataract surgery (OR 3.3), corneal surgery (OR 4.0), glaucoma surgery (OR 3.8), and vitrectomy (OR 4.6), while routine cataract surgery was not (OR 1.0).
Conclusion
Prior ocular surgery was significantly associated with unilateral uveitis, independent of systemic disease. Ocular procedures may predispose to a longer-term inflammatory reaction. This underscores the need for heightened surveillance and tailored perioperative care in at-risk patients undergoing surgeries with a relatively high uveitis risk.
Presenting Author
Yong-Soo Byun, MD, PhD
Purpose
To compare postoperative outcomes between two flanged techniques for intraocular lens (IOL) scleral fixation.
Methods
This retrospective study included 148 eyes that underwent flanged IOL scleral fixation (Yamane: n = 124; Canabrava: n = 24). Refractive prediction error, actual lens position (ALP), ocular residual astigmatism (ORA), and postoperative complications were evaluated.
Results
At 3 months, mean ± SD prediction error was −0.24 ± 0.81 D (Yamane) and −0.52 ± 0.57 D (Canabrava), with no significant difference. ORA was significantly higher in the Yamane group. Mean ACD was 4.43 ± 0.13 mm vs 4.17 ± 0.43 mm, with similar means but greater variance in the Canabrava group (F = 3.3675, P = 0.0009). No significant ACD change occurred between 3 and 12 months. IOL revision rates were 8.1% and 8.3%, respectively.
Conclusion
The Canabrava technique was associated with less IOL tilt, whereas the Yamane technique demonstrated smaller variability in ALP. Both techniques showed low rates of reoperation and complications, indicating that they are safe and effective approaches for IOL scleral fixation.
Presenting Author
Ahmed Sallam, MD, PhD, FRCOphth
Co-Authors
Muhammad Chauhan (MD, MS)
Purpose
When secondary IOL implantation is needed without capsular support, options include anterior chamber, iris-, or scleral-fixated lenses, placed with pars plana or anterior vitrectomy. PPV decreases the risk of retinal traction but adds complexity, time, and cost. This study compares complication rates of secondary IOL surgery with vs. without PPV.
Methods
A large multicenter, database, retrospective study using a United States subset of the TriNetX database. We analyzed data from propensity-score-matched patients who underwent secondary IOL surgery with pars plana vitrectomy (PPV) (cohort 1) and without PPV (i.e., with anterior vitrectomy (AV) or no vitrectomy) (cohort 2). We performed analysis per eye. We calculated the hazard ratios of postoperative risks of rhegmatogenous retinal detachment (RD), endophthalmitis, epiretinal membrane (ERM), suprachoroidal hemorrhage (SCH), cystoid macular edema (CME), bullous keratopathy (BK),and glaucoma.
Results
After matching, there were 4,615 subjects in each cohort. Risks of RD - (HR 1.90 [1.14; 3.16] at one month, 1.99 [1.40; 2.83] at three months, 1.59 [1.23; 2.05] at three years) and ERM - (HR 4.11 [2.47; 6.84] at one month, 2.85 [2.12; 3.83] at three months, 1.91 [1.58; 2.31] at one year, 1.69 [1.43; 1.99] at three years) were higher in secondary IOL surgery with PPV at all time points. Risk of endophthalmitis was higher at one month(HR 1.99 [1.28; 3.09]). Risk of CME was similar after one month post-operatively, but was greater in the PPV cohort at three months (HR 1.47 [1.20; 1.80]). The risk of SCH up to one month was similar between both cohorts. Risks of BK and glaucoma were similar.
Conclusion
While retina surgery is sometimes required due to posterior lens dislocation or other concomitant retinal pathology, our study suggests that performing secondary IOL placement with AV alone in otherwise less complicated cases provides a favorable post-operative risk profile in addition to shortened operating times and decreased surgery cost.
Presenting Author
Claudia R Morgado, MD
Co-Authors
Marcony Santhiago (MD, PhD), Juliana Santos (MD), Nicole Larivoir (MD)
Purpose
to assess the agreement of pachymetry parameters obtained with a Dual-Scheimpglug tomographer (Galilei G6), a Scheimpflug tomographer (Pentacam HR) and a spectral-domain optical coherence tomography (RTVue SD-OCT) device in normal eyes and in eyes with keratoconus (KC).
Methods
Retrospective observational study including 349 normal eyes and 48 eyes with keratoconus. Central corneal thickness (CCT), thinnest point thickness (TCT), zonal pachymetry at four peripheral locations, and percentage of tissue altered (PTA) for simulated ablation depths of 45 µm and 90 µm were compared among the three devices. Intraclass correlation coefficients (ICC), repeated measures ANOVA, and Bland Altman analyses were performed.
Results
In normal eyes there was no significant difference between Pentacam e Galilei devices for CCT and TCT, however there were significant diferences in all peripheral measures (p<0.05). In keratoconic eyes, CCT and TCT did not differ significantly, but the ICC between devices was low (? 0.29). For a simulated ablation depth of 45?µm, the PTA did not differ significantly among the devices, whereas at 90?µm a statistically significant difference was detected between both tomographers (Pentacam and Galilei) and the OCT scanner (p < 0.001). The limits of agreement for the three technologies widened progressively from central to peripheral zones and were broader in KC.
Conclusion
Although mean pachymetric values were comparable in keratoconus, the low inter device repeatability precludes interchangeability, especially for progression analysis.
Presenting Author
Claudia R Morgado, MD
Co-Authors
Marcony Santhiago (MD, PhD), Nicole Larivoir (MD), Juliana Santos (MD)
Purpose
To explore the correlation between epithelial behavior markers derived from optical coherence tomography (OCT) and topographic inferior-superior asymmetry (IS), and to compare these epithelial values across different IS subgroups.
Methods
526 eyes undergoing refractive surgery evaluation were randomly selected. Each patient underwent imaging examinations, including Placido-disk corneal topography and OCT. 4 epithelial parameters—minimum (thinnest), maximum (thickest), difference between minimum and maximum, and standard deviation—were analyzed. ANOVA/Kruskal-Wallis tests compared these parameters across IS subgroups, while Pearson correlation assessed the relationship between continuous IS values and each epithelial parameter. Multiple linear regression evaluated IS's predictive effect on epithelial metrics. Correlations were investigated considering the entire IS spectrum and in 2 separate IS subgroups(below and above 1.4).
Results
Higher IS values (IS > 1.4) corresponded to significantly greater epithelial variability (difference between minimum and maximum, and standard deviation, p<0.0001) compared to lower IS groups. Across all IS values, moderate, significant correlations were found between IS and epithelial variability (difference, r=0.57; standard deviation, r=0.59; p<0.0001). Subgroup analysis indicated that significant correlations between IS and epithelial variability measures were present only in the high-asymmetry group (IS > 1.4). Multiple linear regression confirmed that IS significantly predicts epithelial variability, particularly in this subgroup.
Conclusion
A moderate correlation exists between IS and epithelial thickness variability, particularly in eyes with high asymmetry, as supported by regression analysis, indicating IS's predictive value. However, these epithelial markers are less useful in eyes with low asymmetry.
