To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2026 Annual Meeting registration.
Moderator
Yousuf Khalifa, MD, FACS
Panelists
Omar F. Almallah, MD, ABO; Kenneth J. Rosenthal, MD, FACS
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
Pooja J. Nambiar, MPH
Co-Authors
Evan Patel (BSc), Hejin Jeong (BA), Katherine Talcott (MD), Rishi Singh (MD), Nadia Abbass (BA, MA), Urvi Gupta (MD), Aleksandra Rachitskaya (MD)
Purpose
Combined phacovitrectomy (PCV) is a popular alternative to sequential vitrectomy followed by phacoemulsification (PPV/phaco), yet the optimal timing of PPV and phaco is unclear. We compared visual outcomes, complication rates, and treatment burden of PCV and PPV/phaco for macular hole(MH), epiretinal membrane(ERM), and vitreomacular traction(VMT).
Methods
We conducted a retrospective, eye-level review of adults (373 eyes-211 Combined, 162 Sequential) undergoing combined PCV or sequential PPV/phaco at the Cole Eye Institute (2013-2023). Patients with prior cataract/posterior segment surgery, glaucoma, or AMD were excluded. Primary outcomes included best-corrected visual acuity (BCVA), refractive error measured as spherical equivalent (SEQ), intraocular pressure (IOP), and postoperative complication rates at 12-18m follow-up. Secondary outcomes included healthcare utilization and chronic topical drop use. Statistical analyses consisted of t-tests, Mann-Whitney U, chi-square tests, Fisher's exact test, and unadjusted risk ratios with 95% CI.
Results
Among 373 eyes (211 Combined, 162 Sequential), both cohorts had comparable BCVA improvement at 12-18m (Combined:0.36±0.36 vs Sequential:0.31±0.28 logMAR, p=0.97) and IOP reduction (?1.76±3.94 vs ?0.90±3.51 mmHg, p=0.17). Sequential surgery yielded higher emmetropia in the MH sub-cohort (95% vs 79%, p<0.0001), while ERM/VMT refractive outcomes were similar. Median surgical time was shorter for Combined cases (102 vs 111 min, p<0.0001). Sequential cases had higher visit burden (11.14±3.31 vs. 7.85±3.30; p<0.0001) and lower attendance rates (0.90±0.10 vs. 0.92±0.15; p<0.0001). Postoperative complications were rare and similar, with unadjusted risk ratios showing no significant differences.
Conclusion
In this cohort, combined and sequential procedures achieved similar BCVA and IOP with comparably low complication rates. Combined PCV patients had improved visit attendance, while PPV/phaco provided more predictable refractive outcomes, especially for MH. Surgical timing should be tailored based on patient priorities and clinical context.
Presenting Author
Dan B. Tran, MD
Purpose
To understand the refractive accuracy of the Light Adjustable Lens (LAL) following manual versus femtosecond laser-created capsulotomy.
Methods
A retrospective analysis of visual acuity outcomes of 90 patients who underwent cataract surgery and implantation of the light adjustable lens. The number of postoperative adjustments needed to achieve the target refraction were also evaluated for each group. Enhancement rates and need for secondary procedures were analyzed. Postoperative complications including posterior capsular opacification (PCO) rates and intraocular lens centration were documented and reported. Statistical analysis will include comparison of means using t-tests for continuous variables and chi-square tests for categorical variables, with significance set at p<0.05.
Results
A total of 82 eyes underwent femto laser–assisted capsulotomy and 26 eyes underwent manual capsulotomy. The mean number of LDD treatments was 1.5 in the femto group and 1.6 in the manual group. The proportion of eyes requiring 1–2 treatments was 91.5% in the femto group and 88.5% in the manual group. 85.5% in the femto group and 80.0% in the manual group were within ±0.25 D of intended cylinder correction. The rate of PCO was 2.43% (2/82) in the femto capsulotomy group and 0% in the manual capsulotomy group.
Conclusion
Overall number of adjustments was similar between groups. Fewer eyes required rescue treatment in the femto group. Accuracy to target for astigmatism was higher in the femto group. Results suggest femto laser–created capsulotomy provide more stable capsular environment and more predictable treat-to-target when combined with Light Adjustable Lens.
Presenting Author
Christoph F. Kranemann, MD
Purpose
To weight the importance of total intraocular fluid usage versus ultrasound energy during phacoemulsification.
Methods
Consecutive patients were prospectively followed after phacoemulsification with 2 different systems. The total fluid aspirated as well as collected in the drape bag were measured at the end of the procedure. All patients underwent a full eye examination pre and post-operatively and a corneal endothelial cell count at day 1, week 1 and month 3.
Results
204 eyes were enrolled. Total ultrasound was 4.40 with System 1 and 4.75 with System 2.The total fluid aspirated was 38.2 ml with system 1 and 33.8 mm with system 2. Corneal edema was present in 21 eyes with System 1 and 19 eyes with system 2 (P.1 and none at month 3. Corneal endothelial counts were 2145 preop and 1980 postop with system 1 and 2050 with system 2 (P<.1), All cases of corneal edema had fluid usage >55 ml.
Conclusion
Higher fluid use during phacoemulsification appears to potentially correlate to cornea edema/reduced endothelial cell count and prolonged healing.
Presenting Author
Rajendra Prasad, MD, MBBS
Purpose
Purpose: Is to evaluate the efficacy of a new surgical approach Hydissect, in minimizing the risks of further disruption of posterior capsular defect in complex posterior polar cataract.
Methods
We advocated a new surgical technique Hydissect, a low vacuum controlled bimanual irrigation aspiration cannula controlled dissection, separation and extraction of cortical matter, epinuclear membrane and polar cataractous plaque with simultaneous posterior capsulorrhexis in 6 cases of complex posterior polar cataract, having complete adhesion of cataractous plaque and defective posterior capsule.
Results
Surgery was conducted successfully in all the 6 eyes. The incidence of successful posterior capsular rhexis was 100 %, vitrectomy was required in 2 out of 6 cases (33.3 %), in the bag IOL was placed in all our cases 6 of 6 cases (100 %). Conclusion:
Conclusion
Complex posterior polar cataract is one of the difficult surgical challenges due to its high incidence of inadvertent posterior capsular disruption and intraoperative complications. Hydissect was highly effective in preventing the risks of further disruption of posterior
Presenting Author
David V. Folden, MD
Purpose
To evaluate the effect of capsulotomy size (4.6 mm vs 5.6 mm) on the final position of the intraocular lens (IOL), as measured by postoperative anterior chamber depth (ACD) at 3 months following cataract surgery.
Methods
A prospective, paired-eye study was conducted to assess the impact of capsulotomy size on final intraocular lens (IOL) position. Patients undergoing bilateral cataract surgery had one eye randomized to a 4.6 mm capsulotomy and the fellow eye to a 5.6 mm capsulotomy using a computer-generated sequence. Standard phacoemulsification and identical IOLs were used in both eyes. The paired-eye design controlled for anatomical variability, including axial length, anterior chamber depth, lens thickness, and white-to-white distance. The primary outcome was anterior-posterior IOL position at 12 weeks, measured with biometry.
Results
TBD
Conclusion
TBD
Presenting Author
Mitchell C. Shultz, MD
Co-Authors
Asael Papour (PhD)
Purpose
To evaluate the phacometric parameters and clinical outcomes collected using the cloud-based database.
Methods
This retrospective study included patients who underwent cataract surgery with the Stellaris Elite system (Bausch & Lomb). This phaco system is connected to a cloud-based digital database (Eyetelligence, Bausch & Lomb), which provides an effective way to collect large data sets from surgeons across the country. Data collected were infusion actual time (IAT), infusion average pressure (IAP), effective phacoemulsification time (EPT), and ultrasound average power (UAP). Intraocular pressure (IOP), endothelial cell density (ECD) and safety outcomes were also collected.
Results
Eyetelligence cloud data were obtained from 3753 eyes at the investigator’s site (study group) and compared with a larger Eyetelligence cloud database of 1.3 million eyes (control group). The absolute phaco time was shorter in the study group than in the control group (12 vs 27 seconds). The average phaco power used was lower in the study group (14.7% vs 17%). Fluid usage in the study group was also lower (37.2 vs 59.9 mL). The foot pedal maximum settings were lower, and the US modulation setting was majorly “multiple burst” in the study group compared to “pulsed” modulation in the control group. There were no adverse events in the study group, and IOP remained comparable to baseline.
Conclusion
Phacoemulsification parameters differed between a small single-surgeon population and a large general population. Low power settings, reduced maximum foot-pedal power, and a switch to ‘Multi burst’ mode in most cases reduced phaco time and minimized fluid usage, thereby enhancing surgical efficiency with the Stellaris Elite.
Presenting Author
Yanfeng Zeng, BM BCh
Purpose
To evaluate the efficacy of femtosecond laser in the treatment of congenital cataract.
Methods
A total of 24 patients (28 eyes) with congenital cataract were collected from Lixiang Eye Hospital of Soochow University. Routine preoperative examinations were performed. After the patient was under general anesthesia, the patient's eyeball was sucked with a disposable vacuum suction ring. Subsequently, femtosecond laser was employed for anterior capsulotomy and corneal incision. Phacoemulsification was then carried out. Posterior capsulotomy and anterior vitrectomy were performed in patients under 6 years of age or with mental retardation. The foldable IOL was injected into the capsular pocket. The corneal incision was watertight.
Results
Twenty-eight eyes with congenital cataract underwent LenSx femtosecond laser-assisted cataract surgery. Capsulorhexis was successfully performed in all cases without intraoperative complications. The diameter of capsulorhexis is controllable and negatively correlated with the age of patients.
Conclusion
Femtosecond laser-assisted capsulorhexis is a safe and effective method for pediatric cataract surgery, providing superior CCC and reducing complications to improve visual outcomes.
Presenting Author
William B. Trattler, MD
Co-Authors
Marilyn Zuniga (OD), Carlos Buznego (MD), P Dee G. Stephenson (MD, FACS), Lee Katzman (MD), Steven Sarkisian (MD), Joshua Duncan (DO), Peter Cornell (MD)
Purpose
This study aims to evaluate the iris registration success rate on a 3D confocal structured illumination laser platform, where the iris registration is performed using preoperative high-resolution diagnostic images and color-LED topography, in order to map diagnostic measurements—such as the axis of astigmatism—to the patient's eye during FLACS.
Methods
Muli-center, muti-surgeon, retrospective, non-interventional study of approximately 5,000 eyes that previously underwent FLACS and had preoperative diagnostics using third generation color-LED topography (Cassini Technologies, B.V.). Preoperative high-resolution diagnostic images were exported from the corneal topographer and uploaded to the laser platform (LENSAR, Inc.) to perform iris registration during FLACS to compensate for cyclorotation. Iris registration success rate (% of FLACS cases in which iris registration is achieved), full cyclotorsion distribution (magnitude and direction - CW/CCW), and % of cases with iris registration failure were recorded.
Results
Study results will be updated by February 15, 2026 (TBD).
Conclusion
Study conclusions will be updated by February 15, 2026 (TBD).
Presenting Author
Buki Kim, MD
Purpose
To evaluate the incidence, intraoperative stage-specific distribution, and associated factors of anterior capsule radial tears occurring during femtosecond laser–assisted cataract surgery (FLACS).
Methods
Video records of 838 consecutive eyes that underwent FLACS at a single center by a single surgeon were retrospectively reviewed. The incidence of anterior capsule radial tears was determined, and each case was classified according to the intraoperative stage at which it occurred. Potential associated factors, including capsular tags and incomplete laser cuts, were additionally evaluated.
Results
Anterior capsule radial tears were observed in 8 eyes (0.96%). Among these, 4 cases (50%) occurred during I&A, 2 cases (25%) during manual removal of capsulotomy, 1 case (12.5%) during IOL insertion, and 1 case (12.5%) during hydrodissection. Following femtosecond laser treatment, capsular tags were identified in 3 eyes (37.5%), and a partial incomplete cut was observed in 2 eyes (25%); no specific findings were noted in the remaining 3 eyes (37.5%). On postoperative day 1, retained cortex and toric IOL misalignment were noted in 2 eyes, and I&A was performed for cortex removal and axis realignment. No other intraoperative or postoperative complications were observed.
Conclusion
The incidence of radial tear was 0.96% in FLACS. Tears developed at various stages, most frequently during I&A. Radial tears were associated with capsular tags, uncut, and technical factors during surgery. Although most cases achieved favorable outcomes, 2 eyes requiring reoperation showed reduced visual performance and residual complications.
Presenting Author
David Sung Yong Kang, MD
Co-Authors
Tae-im Kim (MD, PhD), Byunghoon Chung (MD), Kangyoon Kim (MD), Samuel Arba Mosquera (PhD)
Purpose
To evaluate visual and refractive outcomes following sequential corneal wavefront?guided TPRK and subsequent implantation of an extended depth of focus (EDOF) intraocular lens (IOL) in patients with pronounced corneal higher?order aberrations secondary to prior laser vision correction (LVC).
Methods
Twelve cataract patients were retrospectively enrolled, with 7 having a history of LASIK and 5 having undergone TPRK. Corneal wavefront?guided TPRK was performed to reduce higher?order aberrations, and cataract surgery was scheduled 3 to 4 months later. Visual and refractive outcomes—including uncorrected binocular distance (UDVA) and near (UNVA) visual acuities, corrected distance visual acuity (CDVA), and both corneal and ocular higher?order aberrations (HOA)—were evaluated 3 months after cataract surgery.
Results
Mean logMAR values for UDVA, UNVA, and CDVA were 0.01 ± 0.12, 0.08 ± 0.34, and -0.02 ± 0.15, respectively. Postoperative corneal measurements showed coma of 0.30 ± 0.35 µm, spherical aberration of 0.10 ± 0.21 µm, and RMS total corneal HOA of 0.37 ± 0.30 µm. Ocular assessments revealed coma of 0.18 ± 0.24 µm, spherical aberration of -0.19 ± 0.23 µm, and RMS total ocular HOA of 0.35 ± 0.28 µm. No cases of dysphotopsia were observed.
Conclusion
Sequential EDOF IOL implantation following corneal wavefront?guided TPRK in patients with markedly aberrated corneas due to prior LVC proved safe and effective, with no instances of dysphotopsia.
Presenting Author
Trey Bishop, III, MD
Purpose
To evaluate the iris registration success rate on an SD-OCT guided laser platform after integration of preoperative topographical pattern recognition images from a color LED corneal topographer, which maps diagnostic astigmatic measurements to compensate for cyclorotation during FLACS.
Methods
Muli-center, muti-surgeon, retrospective, non-interventional study of approximately 3,000 eyes that previously underwent FLACS based on high-resolution preoperative color LED topography and iris imaging (Cassini Technologies, B.V.). The preoperative data was integrated with the laser platform (J&J Vision), which used iris registration to compensate for cyclorotation. Iris registration success rate (% of FLACS cases in which iris registration is achieved), full distribution of total observed rotation during FLACS, and iris registration failure rates were recorded.
Results
Data were collected from two separate clinical sites. Site A contributed 3,829 eyes from 3 surgeons, and Site B contributed 2,661 eyes from 11 surgeons undergoing FLACS. Among 6,490 total cases, the integrated iris-registration–guided workflow achieved an overall iris-registration success rate of 92.54% (6,006 eyes), with a failure rate of 7.46% (484 eyes).
Conclusion
In this large, multi-center dataset of FLACS cases, integration of color LED topography with an SD-OCT–guided laser platform demonstrated a high iris-registration success rate. These findings support the reliability and scalability of topography-based iris registration for cyclorotation compensation during FLACS.
Presenting Author
Deepak u Megur, FRCSEd
Purpose
To assess the appearance/disappearance of transverse lenticular striations on the trench floor as a practical intraoperative marker of adequate groove depth, enabling timely lateral separation, improving first-attempt cracking success, and enhancing teaching across cataract densities.
Methods
A prospective observational study was conducted at a single tertiary eye care center. Eyes with nuclear sclerosis grade ≥2 (LOCS III) undergoing divide-and-conquer phacoemulsification were included. The presence, depth, and fading of transverse striations were recorded intraoperatively. Twenty trainees (each with >50 prior phaco cases) and 4 experienced surgeons performed approximately 30 cases each. Outcomes included recognition rates, first-attempt crack success, depth variation by cataract density, and intraoperative complications.
Results
All surgeons (100%) identified the appearance of striations at ~20–30% nuclear depth and their disappearance at ~70% depth in NS grade 2–3 and ~85–90% in denser nuclei. First-attempt cracking success was 100% when lateral separation was attempted after striations faded, compared with <50% in a historical trainee cohort not using this cue. No posterior capsule ruptures occurred. Recognition and application of striations as a depth marker significantly improved safety and training outcomes.
Conclusion
Disappearance of lenticular striations is a simple, reliable marker of trench depth in divide-and-conquer phacoemulsification. It is invaluable for training new surgeons by improving safety and reproducibility, and equally helpful for experienced surgeons when managing dense, brunescent nuclei.
Presenting Author
Vitor D. Marin, MD
Co-Authors
Wallace Chamon (MD), Dimitri Azar (MD)
Purpose
To investigate the Argentinian Flag Sign in cataract surgery through a comprehensive analysis of publicly available surgical videos. Specifically, the study aims to quantitatively and qualitatively analyze surgical videos to better understand the underlying biomechanics, the onset of the phenomenon, and its propagation.
Methods
A systematic Google search using the term "cataract argentinian flag video" retrieved candidate videos. After applying exclusion criteria — such as absence of the Argentinian flag sign, incomplete footage, poor quality, playback alteration, or duplication — 50 videos were selected. Each was analyzed at 60 fps in QuickTime Player. Variables assessed included: number of tear directions (distinct propagation paths); time to spontaneous rupture onset (interval from capsule puncture to spontaneous tear); pre-rupture capsulorhexis proportion (ratio of capsulorhexis to capsule diameter at rupture onset); rupture duration time; tear propagation speed; and iris behavior during the phenomenon.
Results
Tear propagation was bidirectional in 45 (90%), unidirectional in 3 (6%), and tridirectional in 2 (4%) videos; no cases exceeded 3 directions. Time to spontaneous rupture was measurable in 44 (88%) videos, ranging from 0.017 to 61.133s (mean 9.267s). Pre-rupture proportion was measurable in 48 (96%) videos and ranged from 0 to 0.910 (mean 0.409). Rupture duration was measurable in 48 (96%) videos and ranged from 0.017 to 35.367s (mean 1.431s). Average propagation speed was measurable in 47 (94%) videos and ranged from 0.090 to 398.530 mm/s (mean 40.865 mm/s). Instantaneous elliptic iris dilation occurred in 33 of 47 (70%) videos, its direction was perpendicular to the rupture propagation.
Conclusion
Rupture duration is often shorter than the average human reaction time (0.25 s), hindering surgeon's response and highlighting the importance of its prevention. Additionally, we described the instantaneous elliptic pupillary dilation as a new finding that may be associated with the biomechanics of the Argentinian flag sign.
Presenting Author
Ishan Bhanot, BSc, BA
Co-Authors
Kamran Riaz (MD), Karanpreet Multani (MD), David Seo (BSc)
Purpose
To assess the visual results, refractive outcomes, and complication rates between ISHF-IOL (Yamane) and Gore-Tex sutured fixation of modified toric IOL (GSF-MTIOL).
Methods
Retrospective, single-center study of eyes undergoing ISHF-IOL (Yamane) or GSF-MTIOL from January 2019 to May 2025. Patient demographics, past ocular history and procedures, biometry data, preoperative visual acuity, and intraoperative complications were recorded. Post-operative visual acuity (1 week, 1 month, 3 months, and 6 months) and complications, including IOL tilt, CME, retinal detachment (RD), and the need for re-operation, were analyzed.
Results
A total of 311 eyes (249 ISHF-IOL, 62 GSF-MTIOL) were analyzed. ISHF-IOL were older (66.8 vs. 62.5 years, p=0.037), more often male (65.1% vs. 48.4%, p=0.016), and had higher glaucoma prevalence (23.7% vs. 11.3%, p=0.033). Dislocated IOL was the primary indication more often in Yamane cases (54.6% vs. 27.4%, p<0.001). At ?6 months, GSF-MTIOL achieved superior UDVA (0.5 vs. 0.8 logMAR, p=0.038) and BCVA (0.3 vs. 0.5 logMAR, p=0.029). In ISHF-IOL, persistent anterior chamber inflammation and the need for reoperation were associated with prior RD and RD repair by vitrectomy (p?0.024). In this cohort, IOL tilt was associated with a steeper K1 (43.8 vs. 43.1 D, p=0.036).
Conclusion
In eyes with moderate keratometric astigmatism, GSF-MTIOL yielded superior long-term visual and refractive results versus ISHF-IOL. Overall complications were similar, but ISHF-IOL eyes with prior retinal detachment/repair had a higher risk of inflammation and reoperation. Steeper corneas also increase the risk of IOL tilt.
Presenting Author
Fuxiang Zhang, MD
Purpose
To present a lesser-known, modified hydrodissection (HD) technique performed through the paracentesis, designed for cases of intraoperative floppy iris syndrome (IFIS) where standard hydrodissection via the main clear corneal incision (CCI) leads to repeated iris prolapse.
Methods
In cases of IFIS where iris prolapse occurred repeatedly through the main CCI, the author employed a modified HD technique using a Chang cannula inserted through the side port (paracentesis), while keeping the main CCI closed. A slow and gentle hydrodissection was carried out using balanced salt solution (BSS).
Results
This technique proved effective when the main CCI was kept sealed and the hydrodissection was performed slowly and gently. The fluid wave was clearly visible, and the nucleus became freely mobile by the end of the maneuver, without any iris prolapse.
Conclusion
Modified hydrodissection through the paracentesis may offer a safer and more controlled approach in IFIS cases—especially in eyes with a shallow anterior chamber—by reducing the risk of iris prolapse associated with traditional hydrodissection through the main incision.
Presenting Author
Fuxiang Zhang, MD
Purpose
To present a lesser-known modification of the divide and conquer (D&C) technique that facilitates lifting approximately 40% of the nucleus out of the capsular bag for emulsification.
Methods
In the traditional D&C approach, a central trough is sculpted to divide the nucleus into two equal halves (50/50). In this modified technique, the initial trough is created off-center, resulting in two uneven nuclear halves (approximately 40/60). This allows the smaller half (about 40%) to be more easily lifted to the iris plane for phacoemulsification. Once the smaller portion is removed, the remaining 60% can be emulsified using standard techniques.
Results
Based on the author's experience, elevating and emulsifying the initial 40% is significantly easier than with the traditional equal-halves method. This modification improves nucleus mobility and efficiency during surgery. The approach can be successfully applied to nuclear, cortex, posterior subcapsular or mixed cataracts.
Conclusion
This modified 40/60 divide and conquer technique may offer improved handling, especially in cases with large, thick, or dense nuclei. It provides a simpler and more controlled approach for nucleus removal compared to the traditional 50/50 division.
