Gerd U. Auffarth

• From Evidence to Outcomes: Excellence in Intraocular Lenses - Clinical Insights and Comparative Evaluation of Modern Presbyopia-Correcting IOLs
  戴明正 Ming-Cheng TaiTaiwan Moderator

  Gerd U. AuffarthGermany Speaker Unhappy Patient with Two Different Diffractive IOLs.Title: Unhappy Patient with Two Different Diffractive IOLs Author: Gerd U. Auffarth This is a case report about a 76-year-old patient who attended my clinic in 2008. He underwent cataract surgery on his right eye and an IQ Restor SN6AD1 was implanted. The second eye was not operated on for almost nine years, and then, in 2017, the patient underwent cataract surgery on the left eye. Interestingly, a different surgeon performed the surgery and said that the original intraocular lens (IOL) was no longer available, so a Tecnis Symfony ZXR00 was implanted instead. The patient was not satisfied with the outcome. He complained of blurred vision, could not read road signs while driving, and had different colour perception in both eyes. He noticed that the image in his right eye with the blue filter lens appeared more brown than the image in his left eye, and he could not get used to this over the years. In daily life, this was very bothersome for him. The patient complained that the doctors tried several corrective lenses and PCO laser was performed on the right eye. All without any positive effect on this vision. The results of the visual acuity examination were: uncorrected 20/30 in both eyes and 20/25 binocularly for distance. For near vision, it was 20/40 in both eyes and 20/30 binocularly. His refraction was +0.5, -0.25 @ 130° in the right eye and +0.25, -0.5 @ 77° in the left eye. The patient was not satisfied with the visual outcome and the different optics, as the AcrySof IQ Restor is a multifocal IOL with a 3.0 near addition and a blue light filter, whereas the Tecnis Symfony has an extended depth of focus design and no blue light filter. The surgical options were IOL explantation of one or both lenses and reimplantation of either a monofocal or another multifocal intraocular lens. However, the previous laser capsulotomy on the right eye could be problematic for this. In addition, the patient did not want any extensive surgery. The aim was to help him by achieving good binocular visual performance, with particular focus on visual quality and balanced performance. Visual acuity was not really something that could be addressed. In the end, the patient received a special pinhole add-on lens (Morcher Extrafocus). This is a pinhole optic with a central opening of 1.3 mm, which was placed in the right eye. This reduced the amount of light entering the eye and consequently diminished colour perception, which made the visual impression more similar to that of the left eye. One week after the surgery, the patient was extremely satisfied, especially because he could see and read in balance. Visual acuity remained at 20/30, similar to before. However, after two months, his visual acuity had improved on both sides between 20/25 and 20/20, and it was 20/20 for distance and near vision as well. He is now a very satisfied patient as he wouldn't say there is a big difference between his right and left eyes, he doesn't need glasses anymore, and his quality of life has improved.
• From Evidence to Outcomes: Excellence in Intraocular Lenses - Can TECNIS Eyhance™ IOL Replace Monofocal IOLs? An Evidence-Based Discussion
  陳宏吉 Hung-Chi Chen Moderator

  潘立岩 Li-Yen Pan Speaker

• Section 1
  孫啟欽 Chi-Chin SunTaiwan Moderator

  潘志勤 Chih-Chin PanTaiwan Moderator 眼科醫師在校園視力保健及公共衛生推廣中的角色摘要 眼科醫師在校園視力保健及公共衛生推廣中，扮演著遠超過「診療者」的多元且關鍵角色。他們是整個視力保健體系中的專家、倡議者、教育者與把關者。 眼科醫師在此領域中的多重角色： 一、 校園視力保健中的直接角色 在校園這個第一線場域，眼科醫師的角色從被動治療轉為主動出擊。 二、 公共衛生推廣中的核心角色 在更宏觀的公衛層面，眼科醫師是政策與民眾之間的橋樑，是推動全民視覺健康的引擎。 總結 眼科醫師在校園視力保健與公衛推廣中的角色，已從傳統的「醫療端」向前延伸至「預防端」和「政策端」。對於提升整體國民的視覺健康與生活品質，及一個國家的公共衛生和發展至關重要。

  蔡俊斌 Chun-Pin TsaiTaiwan Moderator
• Minimize Further Dehiscence of Zonules in Patients with Large Zonular Weakness
  賴俊杰 Chun-Chieh LaiTaiwan Speaker Trends and Market Share of Presbyopia-Correcting Intraocular Lenses in Taiwan & Asia In this section, we will talk about the trends and market share of presbyopia-correcting intraocular lenses in Taiwan and Asia.Minimize Further Dehiscence of Zonules in Patients with Large Zonular Weakness Zonular weakness increases the likelihood of dealing with complicated cataract surgery and encountering postoperative complications. These risks include intra- and postoperative complications from cataract surgery, such as posterior capsular rupture, vitreous loss, and lens dislocation and decentration. Common risk factors for weak zonules are pseudoexfoliation syndrome, mature cataracts, high myopia, Marfan syndrome, and prior ocular surgery. Signs of weak zonules include iridodonesis, phacodonesis, abnormal anterior chamber depth or asymmetry, angle asymmetry on gonioscopy, and vitreous in the anterior chamber. Zonular dehiscence and lens subluxation or dislocation can be seen in advanced zonulopathy. But most of the time, weak zonules may not be noticed until after the surgery has begun. Intraoperative signs of weak zonules include anterior chamber depth fluctuation, difficulty puncturing the anterior lens capsule, star-shaped striae on the capsule surface during the capsulorhexis, lens movement when manipulations, and difficulty in rotating the nucleus within the capsular bag despite adequate hydrodissection. In this video discussion, we will talk about how to minimize further dehiscence of zonules in patients with large zonular weakness during operation and make the cataract surgery safer.
• Solution for Residual Large Lens Material with PCR
  許粹剛 Tsui-Kang HsuTaiwan Speaker When the Capsule Gives Way: Winning the Posterior Rupture BattleCataract surgery is the most commonly performed operation in ophthalmology and despite tremendous instrumental and technological advancements, posterior capsular rupture (PCR) still occurs. PCR occurs both in all eye surgeons, although with a higher frequency in the newer starter group. Additionally, certain types of cataracts are prone to this development. If handled properly in a timely method, the eventual outcome may be no different from that of an uncomplicated case. However, improper management may lead to serious complications with a higher incidence of permanent visual impairment. The speech disclose the management of PCR from two perspectives: 1. Identifying patients with higher risk and know the sign of early PCR, and measures to manage such patients by surgical maneuver, and 2. Intraoperative management of posterior capsular rupture with anterior vitrectomy with different setting and various case scenarios to prevent further long-term complications. Solution for Residual Large Lens Material with PCRCompromise of the posterior capsule can occur in the hands of both new and experienced surgeons. Learning how to prevent, avoid, or efficiently manage posterior capsular rupture (PCR) is important. If PCR is present with residual lens material and vitreous loss, it is important to disentangle the vitreous from any nuclear/cortical fragments to ensure their safe removal without creating vitreous traction in case of retinal detachment. The vitreous can be stained by using preservative-free triamcinolone to delineate its presence in the anterior chamber and any incarceration in the wound. Anterior vitrectomy can be performed to remove the vitreous from the anterior segment properly. Alternatively, suppose the surgeon is comfortable with a pars plana approach which is better route. In that senario, a pars plana vitrectomy can be done, which helps to pull the vitreous back to the posterior segment, and avoids excessive anterior chamber manipulation. The pars plana approach may also permit better access to residual lens material—the vitrector may be used to clear nuclear and cortical material with a change in settings. At the end of the case, the wounds should be checked carefully to ensure no vitreous is present. A suture or more if necessary, depending on wound size, should be placed at the primary wound. Pupillary miosis should be done to inspect the pupil. If the pupil is peaked, there is likely vitreous still present in the anterior chamber and possibly in the wound. Once the vitreous is adequately cleared, one may carefully resume phacoemulsification and insert an IOL in various methods.
• Managing Large Posterior Capsular Rupture with Residual Cortex in Toric or Premium IOL Cases 
  黃宇軒 Yu-Hsuan HuangTaiwan Speaker Managing Large Posterior Capsular Rupture with Residual Cortex in Toric or Premium IOL CasesManaging a large posterior capsular rupture (PCR) during cataract surgery is particularly challenging when a one-piece toric or premium IOL is planned. This case demonstrates that, when partial posterior capsular support remains, in-the-bag implantation of a single-piece premium IOL is still feasible with careful assessment and technique. A large central PCR occurred unexpectedly after nucleus removal. Early recognition, immediate stabilization of the anterior chamber with viscoelastic, lowering IOP, and preventing tear extension were essential steps. Residual cortex was safely removed using dry aspiration with a Simcoe cannula combined with gentle polishing, allowing complete cleanup without further damage. Although alternative IOL options were unavailable, the rupture did not align with the astigmatic axis, and sufficient capsule remained to support a toric IOL. The IOL was placed in the bag, and reverse optic capture (ROC) was performed to enhance long-term stability. ROC preserved the effective lens position by capturing the optic anterior to the capsulorhexis while keeping the haptics in the bag. Postoperatively, the IOL remained well-centered with favorable refractive outcomes. This case shows that large PCR does not necessarily preclude premium IOL use when managed with proper surgical strategy, including ROC.
• Astigmatism with TK more Accurate for Toric Calculation?
  FAM Han BorSingapore Speaker Astigmatism with TK more Accurate for Toric Calculation?This presentation explores the impact of Total Keratometry (TK) on the calculation of toric intraocular lenses (IOLs), focusing on the role of posterior corneal astigmatism (PCA) in refractive outcomes. Drawing on large datasets and recent studies, it highlights that PCA is a significant factor in toric IOL planning, with traditional keratometry often leading to over-correction of with-the-rule (WTR) and under-correction of against-the-rule (ATR) astigmatism. The presentation reviews evidence showing that using measured PCA values, rather than predicted ones, improves the accuracy of postoperative astigmatism prediction, especially when the steep axis of PCA is non-vertical. Comparative analysis of various toric IOL formulas demonstrates that EVO formulas with measured PCA yield the smallest centroid errors and highest percentage of eyes within 0.50D of predicted astigmatism, particularly in cases with non-vertical PCA. The findings underscore the importance of incorporating TK and measured PCA into toric IOL calculations to optimise refractive outcomes for cataract patients.
• Panel Discussion 
• Section 2
  吳孟憲 Meng-Hsien WuTaiwan Moderator

  陳俊良 Jiunn-Liang ChenTaiwan Moderator

  黃維仁 Wei-Jen HuangTaiwan Moderator
• Unhappy Patient with Two Different Diffractive IOLs
  Gerd U. AuffarthGermany Speaker Unhappy Patient with Two Different Diffractive IOLs.Title: Unhappy Patient with Two Different Diffractive IOLs Author: Gerd U. Auffarth This is a case report about a 76-year-old patient who attended my clinic in 2008. He underwent cataract surgery on his right eye and an IQ Restor SN6AD1 was implanted. The second eye was not operated on for almost nine years, and then, in 2017, the patient underwent cataract surgery on the left eye. Interestingly, a different surgeon performed the surgery and said that the original intraocular lens (IOL) was no longer available, so a Tecnis Symfony ZXR00 was implanted instead. The patient was not satisfied with the outcome. He complained of blurred vision, could not read road signs while driving, and had different colour perception in both eyes. He noticed that the image in his right eye with the blue filter lens appeared more brown than the image in his left eye, and he could not get used to this over the years. In daily life, this was very bothersome for him. The patient complained that the doctors tried several corrective lenses and PCO laser was performed on the right eye. All without any positive effect on this vision. The results of the visual acuity examination were: uncorrected 20/30 in both eyes and 20/25 binocularly for distance. For near vision, it was 20/40 in both eyes and 20/30 binocularly. His refraction was +0.5, -0.25 @ 130° in the right eye and +0.25, -0.5 @ 77° in the left eye. The patient was not satisfied with the visual outcome and the different optics, as the AcrySof IQ Restor is a multifocal IOL with a 3.0 near addition and a blue light filter, whereas the Tecnis Symfony has an extended depth of focus design and no blue light filter. The surgical options were IOL explantation of one or both lenses and reimplantation of either a monofocal or another multifocal intraocular lens. However, the previous laser capsulotomy on the right eye could be problematic for this. In addition, the patient did not want any extensive surgery. The aim was to help him by achieving good binocular visual performance, with particular focus on visual quality and balanced performance. Visual acuity was not really something that could be addressed. In the end, the patient received a special pinhole add-on lens (Morcher Extrafocus). This is a pinhole optic with a central opening of 1.3 mm, which was placed in the right eye. This reduced the amount of light entering the eye and consequently diminished colour perception, which made the visual impression more similar to that of the left eye. One week after the surgery, the patient was extremely satisfied, especially because he could see and read in balance. Visual acuity remained at 20/30, similar to before. However, after two months, his visual acuity had improved on both sides between 20/25 and 20/20, and it was 20/20 for distance and near vision as well. He is now a very satisfied patient as he wouldn't say there is a big difference between his right and left eyes, he doesn't need glasses anymore, and his quality of life has improved.
• Management of Retained Lens Fragment in Anterior Chamber
  許志堅 Chih-Chien HsuTaiwan Speaker
• A Challenging Case: Lens Subluxation with Hypermature Cataract in Nystagmus Patient. 
  陳矜芸 Chin-yun ChenTaiwan Speaker A Challenging Case: Lens Subluxation with Hypermature Cataract in Nystagmus Patient.A discussion about management of high risk cataract surgery. In nystagmus case, retrobulbar anesthesia before surgery is a good choice. In mature cataract surgery, we must face higher surgical risks to prevent more postoperative complications.If coupled with lens dislocation, what weapons can help us overcome the difficulty?In addition, carefulness and patience as well as calmness and calmness may be the biggest winners.
• Operating on the Edge: Surviving Cataract Surgery in Post-AACG Zonular Disaster
  曾垂鍊 Chui-Lien TsenTaiwan Speaker Operating on the Edge: Surviving Cataract Surgery in Post-AACG Zonular DisasterThis video demonstrates the surgical management of a mature cataract in an eye with a history of acute angle-closure glaucoma (AACG) complicated by zonular dialysis. The procedure highlights key steps for anterior chamber stabilization, controlled capsulorhexis under shallow conditions, and safe nucleus removal using phaco techniques. Intraoperative support with capsular tension ring and viscoelastic-assisted chamber maintenance was critical to preserving capsular integrity. Despite severe zonular weakness, careful pacing and early mechanical stabilization allowed successful in-the-bag intraocular lens implantation with minimal intraoperative complications. Postoperative recovery was stable with good visual outcome. Cataract surgery after AACG with zonular compromise remains one of the most technically demanding situations in anterior segment surgery. This case illustrates that with meticulous fluidic control, supportive devices, and adaptive strategy, even a “zonular disaster” can end with a safe and satisfying surgical result.
• Panel Discussion