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12:00
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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。
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Filomena RIBEIROPortugal
Speaker
Neuroadaptation in Premium IOL PatientsNeuroadaptation is a key determinant of visual success and satisfaction after implantation of premium intraocular lenses. This session will discuss how the brain adapts to new optical conditions created by simultaneous vision IOLs, integrating multiple focal points while minimising photic phenomena. Clinical data and patient-reported outcomes will illustrate the variability and time course of adaptation, highlighting the influence of IOL design and individual neural plasticity. Understanding and supporting neuroadaptation are essential to optimise outcomes and enhance patient experience with modern premium IOL technologies.ESCRS Multiformulas IOL Power Calculator AccuracyAccurate intraocular lens (IOL) power calculation remains a critical determinant of refractive outcomes following cataract surgery. The ESCRS IOL Calculator integrates modern formulas to improve prediction accuracy and support IOL selection across diverse biometric profiles. This lecture will review recent data assessing the performance of the ESCRS Calculator in comparison with individual formulas, focusing on its refractive predictability, consistency across axial lengths, and clinical usability.
Results from validation studies and real-world datasets will be presented, highlighting the calculator’s strengths and limitations, as well as its role in optimising outcomes in standard and challenging eyes. The session will also address practical considerations for integration into clinical workflow and the ongoing evolution of formula combinations as biometry and lens technology continue to advance.
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Prin RojanapongpunThailand
Speaker
Intraoperative Aberrometry: Benefits or Distractions?Intraoperative Aberrometry (IA) is a microscope-mounted aberrometer that uses a laser wavefront analyzer to provide an intraoperative refractometer with live measurement. IA utilizes real-time wavefront analysis to measure IOL power in the aphakic state (after I&A but before IOL implantation), guiding Toric IOL axis alignment, and confirming final refraction in the pseudophakic stage (after IOL implantation). IA serves as an IOL power verification process by providing aphakic measurements.
IA has demonstrated improved accuracy compared to preoperative biometry and is most beneficial in complex cases, including post-refractive surgery eyes, eyes with uncertainty in preoperative biometry, and cases involving premium and toric IOL implantation, which results in less postoperative residual astigmatism.
IA accuracy is highly dependent on meeting specific intraoperative conditions. Erroneous measurements can occur due to factors like eyelid squeezing, speculum pressure, eye position/fixation, abnormal eye pressure, media conditions (OVD type and refractive index), corneal status, small pupil size, and IOL specifics. Caution is recommended when IA readings disagree significantly with preoperative measurements (e.g., a vector difference of 0.5 D in cases of low astigmatism).
Conclusion: Intraoperative Aberrometry is beneficial, especially for eyes with abnormal axial length, prior refractive surgery, toric IOLs, multifocal lenses, or uncertain biometry. IA functions as an additional measurement and verification tool. While IA can be beneficial when the surgeon masters the technique and all variables are optimized, it could be a distraction if optimization is not met.
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Matteo PiovellaItaly
Speaker
Refractive cataract surgery to correct and eliminate presbyopia to achieve better vision in patients undergoing cataract surgerySynopsis Refractive cataract surgery is now replacing standard high-volume, low-cost cataract
surgery with monofocal IOL implantation. The possibility is to correct refractive defects, myopia,
hyperopia and astigmatism and overcome presbyopia limitations. It is necessary to change the
preoperative patient procedures and manage Meibomian gland dysfunction in cataract patients.
Normally three treatments should be applied: BlephEx (Alcon) to eliminate Demodex blepharitis
Biofilm and to open glands duct LipiFlow (J&J) to get postoperative refractive emmetropia. In this
course, we will review state-of-the-art knowledge on refractive cataract surgery in pursuing highly
satisfactory uncorrected distance, intermediate and near vision. Routine dry eye management will
be discussed. Advanced biometry, multiple shots and new procedures will be explained and
demonstrated .The new technical model for the adoption of refractive cataract surgery: biometry evaporative dry eye pupil-dependent trifocal IOLsSynopsis PRESENTATION will certify as postoperative precise IOL power detection is based on quality of
tear film to provide cornea smooth surface.Improvements . Multiple biometry exams are needed
until refractive IOLs power stabilization
Objective The MAPRY/clear oil protocol is based on consecutive session with three phisical
treatments. First treatment applied is Blephex(LLC) to remove Demodex, Biofilm and to unclog
excretory channels of the meibomian glands Second Treatment,LipiFlow (J&J),replaces occlusions
of the MG warming the material responsible of MGD improving a solid sttatification into the liquid
state easier to remove. ILux (Alcon)expels deeply from the meibomian glands the substances
responsible for their obstruction. The MAPRY protocol is based on one session per month at least
for 5 months, depending the grade and penetration ofhronic eyelids inflammation
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Burkhard DickGermany
Speaker
ESCRS Cataract Guidelines RecommendationsThe ESCRS Cataract Guidelines represent a comprehensive and evidence-based framework designed to support cataract surgeons across Europe in delivering safe, effective, and consistent care. In this presentation, an overview of the most relevant recommendations will be provided as well as key updates based on the latest clinical evidence.
Drawing from robust literature reviews and expert consensus, the ESCRS Guidelines cover the full patient journey: from preoperative assessment and biometry, to surgical technique, IOL selection, intraoperative considerations, and postoperative care. Emphasis will be placed on areas of evolving practice (SV IOL and infection prophylaxis).
Background will be given on how the guideline development process was designed to ensure practical relevance while maintaining scientific rigor, and how implementation can be supported across diverse healthcare settings. The goal is not only to standardize best practices but also to allow flexibility where justified by patient needs or surgical complexity.
This talk aims to provide attendees with clear, actionable insights from the ESCRS Cataract Guidelines that can enhance surgical outcomes and support continuous quality improvement in cataract care.IOL Exchange in the Premium IOL Era: Challenges and SolutionsThe rise of simultaneous vision intraocular lenses (SV IOLs), including multifocal, extended depth of focus, and toric designs, has significantly expanded visual outcomes in cataract and refractive surgery. However, this progress has been accompanied by an increase in the complexity and frequency of postoperative patient dissatisfaction, leading to a higher demand for IOL exchange in select cases.
This presentation explores the unique challenges of IOL exchange in the era of SV IOL technologies. Key indications for explantation will be reviewed, including suboptimal visual quality, dysphotopsia, residual ametropia, and rotational instability. Emphasis will be placed on clinical decision-making, diagnostic precision, and the timing of intervention, particularly in light of evolving patient expectations. Surgical strategies for safe and effective explantation will be discussed.
In addition, the importance of careful patient selection, preoperative counseling, and enhanced biometric planning as critical factors in reducing the need for IOL exchange will be highlighted. Emerging technologies that may support more accurate IOL selection and customization will also be briefly introduced.
This talk aims to provide practical guidance for surgeons facing the growing demands of managing SV IOL complications and achieving optimal outcomes through safe exchange procedures.
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Thomas KOHNENGermany
Speaker
Power and Precision: The New Era of Phacoemulsification TechnologyBridging Cornea and Lens: The Modern Role of Phakic IOLs in a Myopic WorldFrom Awareness to Action: Stepwise Learning to Manage Capsular Rupture During Cataract Surgery
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Justin SherwinAustralia
Speaker
Two Eyes, One Day: The Evolving Landscape of Immediate Sequential Cataract SurgeryImmediate bilateral sequential lens-based surgery is increasingly adopted as a safe, effective, and patient-centred option for cataract and lens-based refractive procedures. This presentation reviews recent evidence on epidemiology, practice patterns, and outcomes across cataract surgery, refractive lens exchange, and phakic IOL implantation.
Studies demonstrate high efficacy in achieving refractive targets, rapid recovery of binocular vision, and consistent improvements in quality of life. Advances in biometry, surgical technology, and IOL design have further enhanced predictability and safety. Safety remains central, with very low rates of bilateral complications when established risk-reduction protocols—separate instrumentation, asepsis, and adherence to guidelines—are followed.
Comparisons with delayed sequential surgery show equivalent visual and refractive outcomes, along with reduced healthcare burden. This session will highlight current evidence on efficacy, safety, visual and refractive outcomes, and patient-reported benefits, while considering future directions in the expanding role of immediate bilateral sequential lens-based surgery.
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Pannet PangputhipongThailand
Speaker
Phacoemulsification: Challenging and Interesting CasesPhacoemulsification in complex cases is always challenging. Situations such as hard nucleus, intumescent cataract, posterior polar cataract, loose zonule, or small pupil require special surgical techniques to overcome the difficulties. In some patients, multiple complexities may occur simultaneously, making the procedure extremely challenging—sometimes described as a surgeon’s nightmare.
This presentation will highlight selected interesting cases and demonstrate strategies to manage them safely, guiding surgeons on how to navigate through these “war zone” scenarios with confidence.Challenges in Soft Nucleus: Don’t Drown in Shallow WaterPhacoemulsification in soft nuclei can be challenging if inappropriate techniques are used. The soft nature of the nucleus makes nuclear disassembly difficult. Chopping and rotation are not easily performed because the chopper tends to cut through the nuclear mass when cracking or rotational force is applied, without achieving satisfactory results. The phaco tip also cannot hold the nucleus firmly enough during chopping or pulling.
“Stab Test” using a 27g. hydrodissection canular to determine the hardness of the nucleus before performing hydrodissection is essential, in order to choose the most appropriate phaco technique.
Special techniques such as Hydro Subluxation + Aspiration, Hydro Subluxation + Flip & Chop, Half Bowl + Rim Aspiration, and Chip & Flip (I. Howard Fine) will be discussed, including phacodynamics for soft nuclei.
When proper techniques are applied, surgery can be performed safely and effectively.
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Marco FantozziItaly
Speaker
Intracorneal Implants in the Cataract Age: Expanding Vision Beyond LensesIntracorneal Implants in the Cataract Age: Expanding Vision Beyond Lenses
Introduction:
Intracorneal implants were developed as an additive, minimally invasive, and removable approach to address presbyopia and loss of accommodation. Designed to complement rather than replace existing ocular structures, they can be used in near-emmetropic eyes or combined with laser refractive procedures and monofocal intraocular lenses (IOLs) for pseudophakic patients. This study aimed to evaluate the long-term outcomes of combined cataract surgery and intracorneal microlens implantation
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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.
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許詠瑞 Yung-Ray HsuTaiwan
Speaker
Loose Zonules, Steady Hands: Saving the Unstable LensZonular dehiscence with vitreous prolapse represents one of the most challenging scenarios in cataract surgery. This case involves a 65-year-old female referred intraoperatively for severe temporal zonular dialysis extending 120° with vitreous prolapse into the anterior chamber.
In such situations, initial management options depend on the degree of capsular support and the surgeon’s familiarity with the anterior or posterior segment approaches. Possible options include: (1) primary pars plana lensectomy and vitrectomy (PPLV) with Yamane double-needle intrascleral fixation of an IOL; (2) anterior vitrectomy with in-the-bag or supplemental scleral fixation of a one-piece IOL using sutures; (3) pars plana vitreous levitation–assisted phacoemulsification; or (4) use of hooks or rings to preserve capsular support for in-the-bag implantation.
In this case, I stabilized the anterior capsule using iris retractors, performed a careful anterior vitrectomy, and completed a slow-motion phacoemulsification to minimize zonular stress. Following cortical cleanup, both an in-the-bag IOL and capsular tension ring (CTR) were successfully implanted. The patients visual acuity on postoperative day 1 was 0.9.
This surgical video illustrates a practical surgical maneuver with controlled movements, vitreous management, and structural stabilization techniques that allow safe phacoemulsification even in the setting of profound zonular loss.Pattern and Distribution of Uveitis Etiologies in Taiwan: A Multi-Center Perspective Uveitis is a heterogeneous group of intraocular inflammatory disorders with diverse etiologies and variable regional patterns. To delineate the current epidemiologic landscape of uveitis in Taiwan, a nationwide multicenter retrospective study was conducted collaboratively by the Taiwan Ocular Inflammation Society. Newly diagnosed uveitis cases from July 2022 to June 2023 were collected from 15 tertiary referral centers across northern, central, southern, and eastern Taiwan.
A total of 1,654 cases were analyzed. The mean age at onset was 49.5 ± 18.3 years, with nearly equal sex distribution (50.6% male). Anatomical classification includes anterior uveitis (64.3%), followed by panuveitis (22.4%), posterior uveitis (11.0%), and intermediate uveitis (2.3%). Etiologically, 43.6% were non-infectious, 23.5% infectious, and 32.9% undifferentiated. The leading non-infectious entities were HLA-B27/ankylosing spondylitis–related uveitis (15.4%), glaucomatocyclitic crisis (5.0%), and Vogt-Koyanagi-Harada syndrome (3.3%). Among infectious causes, herpetic anterior uveitis (7.7%), cytomegalovirus anterior uveitis (5.1%), and endogenous bacterial endophthalmitis (3.9%) predominated.
This large-scale multicenter study represents the most comprehensive epidemiological overview of uveitis in Taiwan to date. The unique disease pattern and relevant diagnostic challenges will be analyzed in this talk.
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王孟祺 Meng-Chi WangTaiwan
Speaker
Blinded by White: Cracking the Mature Cataract Safely (Presentation and Discussion)This is an unusual white cataract with posterior synechiae and silicone oil in the vitreous cavity following previous retinal detachment surgery.Before starting the procedure, we noticed some emulsified silicone oil at the apex of the anterior chamber.I injected trypan blue through the side port to stain the anterior capsule, followed by OVD injection from the opposite angle to replace and remove the dye as well as the silicone oil.After using a flat needle to separate the posterior synechiae, four iris hooks were placed to enlarge the small, fixed pupil. Unfortunately, the initial staining was insufficient, so I performed a second capsule stain.At this point, wrinkles and fibrosis over the anterior capsule were noted, so I decided to use an MVR blade to create the initial cut for the CCC.The anterior capsule had thickened significantly, making it hard to tear. After several unsuccessful attempts to tear the anterior capsule with the CCC forceps, I switched to microscissors to complete the capsulorhexis as round as possible.Regrettably, it was not possible to complete the capsulorhexis on the opposite side, so I attempted to use the CCC forceps once more. Fortunately, I was finally able to complete the capsulorhexis, although it was quite small and irregular. Since the anterior capsule was quite thick, I was not concerned about causing a radial tear during hydrodissection.It was quite easy to rotate the nucleus afterwards.Since the nucleus was rock-hard, I attempted to use the stop-and-chop technique, initiated by a long and deep sculpting.If the sculpting is not deep enough, it will be difficult to crack and completely bisect the hard nucleus.Take your time and spread your phaco tip and second instrument along the trench, section by section.Afterwards, rotate the nucleus 90 degrees away. At the same time, the milkified cortex was floating outside the capsule.I buried the phaco tip as deep as possible into the center of the nucleus. This allowed me to hold the nucleus firmly and chop it vertically without detaching it from the phaco tip.After cracking the nucleus into smaller pieces, I was able to manage each piece within the central pupillary area safely and efficiently.It is important to separate the leathery tethering part of the posterior pole completely; otherwise, it will be difficult to keep the nucleus pieces under control. If you follow this principle and take your time, you will be able to complete emulsification safely and effectively within the limited space, with a CDE of only 18.77. Another surprise emerged after I cleaned the nucleus: I found a large central fibrotic plaque on the posterior capsule, with nearly no epinucleus or cortex remaining. Silicon oil was shiny behind the posterior capsule.In this situation, it’s impossible to perform primary posterior continuous curvilinear capsulorhexis (CCC); therefore, I decided to use a YAG laser to open the posterior capsule one month later.Following the injection of OVD into the capsular bag, an aspheric hydrophobic intraocular lens (IOL) was implanted smoothly.After removing the iris hooks, I used micro scissors to trim the redundant tags from the CCC margin.The entire procedure was completed with stroma hydration for the main wound and all side ports. We could notice the dense fibrotic plaque over the central axis during the slit lamp examination the day after surgery. However, the central visual axis could still become clear after YAG capsulotomy, and fundus photography could be taken beautifully.
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林純如 Chun-Ju LinTaiwan
Speaker
Post-Op Red Flag: Beating Inflammation or Infection?Cataract surgery is one of the most frequently performed ophthalmic procedures and is generally associated with excellent visual outcomes. However, postoperative inflammation or infection can still lead to serious complications if not promptly recognized and managed. Distinguishing routine postoperative inflammation from sterile hyper-inflammatory reactions or early infectious endophthalmitis remains a clinical challenge. Importantly, reviewing the patient’s past medical and ocular history is essential, as underlying conditions such as uveitis, autoimmune disease, or prior ocular surgeries can significantly increase the risk and severity of postoperative inflammatory responses. Typical postoperative inflammation usually presents within the first few days and responds effectively to topical corticosteroids and nonsteroidal anti-inflammatory medications. In contrast, red flag signs—such as severe ocular pain, rapid vision decline, hypopyon, fibrin formation, or marked anterior chamber reaction—should raise suspicion for infectious endophthalmitis and prompt urgent intervention. Risk factors including wound leak, retained lens fragments, vitreous loss, or systemic immunosuppression further heighten concern. When media opacity limits direct examination, imaging tools such as anterior segment OCT and B-scan ultrasonography may assist diagnosis. Additionally, evidence supports tailored anti-inflammatory regimens perioperatively. Early recognition, patient education regarding warning symptoms, and timely referral to specialized care are critical in preventing irreversible visual loss. By identifying subtle clinical cues and considering patient-specific risk factors, ophthalmologists can effectively differentiate inflammation from infection and safeguard postoperative visual outcomes.
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許聖民 Sheng-Min HsuTaiwan
Speaker
Pseudophakic Macular Edema: Stopping Vision Loss Before It StartsPseudophakic macular edema (Ervine-Gass syndrome) remains the most common cause of decreased visual acuity after uneventful cataract surgery. Previous study reported that 26.8% of eyes with pseudophakic macular edema did not recover 6/6 vision. Clinically significant pseudophakic macular edema impairing patients' vision is found in 1-2% of patients with its peak 6 weeks following surgery, but subclinical macular edema can be seen in about 30% of patients in FA and up to 40% in OCT. To date, there are no uniform recommendations for the treatment of pseudophakic macular edema. Therefore, I will present two cases of pseudophakic macular edema here and discuss the strategies for treatment.
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蔡翔翎 Shawn TsaiTaiwan
Speaker
Get the Things Right: Correction of IOL SubluxationDislocation of an intraocular lens (IOL) is an uncommon (0.2–3%) yet potentially serious complication, in which the IOL deviates from its normal anatomical position. It may arise from complicated cataract surgery, ocular trauma, previous vitreoretinal surgery, high myopia, or systemic or ocular conditions associated with zonular weakness. While mild cases may be observed initially, surgical intervention is usually required when significant visual symptoms occur. Various surgical techniques can be employed depending on the surgeon’s experience and the clinical scenario. In this presentation, I will demonstrate two approaches: the “twist-and-out” IOL removal and the “Yamane technique” for secondary IOL fixation. The advantages, limitations, and practical considerations of these techniques will also be discussed.
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簡克鴻 Ke-Hung ChienTaiwan
Speaker
End the Bad Luck: Strategies for Refractive SurpriseDr. Chien will discuss the phenomenon of refraction surprise following cataract surgery—a postoperative outcome in which the patient’s refractive result differs from the intended target. Despite significant advancements in biometry technology, intraocular lens (IOL) power calculation formulas, and surgical techniques, refractive unpredictability can still occur and remains a noteworthy challenge in contemporary cataract surgery.
A variety of factors may contribute to refraction surprise, including inaccurate axial length measurement, corneal surface irregularities, posterior corneal astigmatism, unrecognized IOL tilt or decentration, and intraoperative issues such as capsular instability. Additionally, postoperative anatomical changes may further alter refractive outcomes.
Recognizing risk factors early and ensuring meticulous preoperative assessment are essential. When refraction surprise does occur, management options depend on both the underlying etiology and the magnitude of refractive deviation. Strategies include corneal refractive enhancement, piggyback IOL implantation, IOL exchange, or non-surgical approaches such as updating spectacles or contact lenses. Through case discussions and surgical experience sharing, Dr. Chien will present practical methods for preventing, diagnosing, and managing this complication—ultimately enhancing patient satisfaction and improving visual outcomes.
701C
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14:00
17:00
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EN
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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。
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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.
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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.
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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.
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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.
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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.
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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.
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曾垂鍊 Chui-Lien TsenTaiwan
Speaker
Operating on the Edge: Surviving Cataract Surgery in Post-AACG Zonular Disaster This 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.
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