Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100254
Paisan Ruamviboonsuk , Nishant V. Radke , Mary Ho , Chi-Chun Lai , Wai Ching Lam , William F. Mieler , Mahesh P. Shanmugam , Chi Wai Tsang , Doric W.K. Wong , Peranut Chotcomwongse , Nicola Y. Gan , Pei-Ting Lu , Sriram Simakurthy , Simon K.H. Szeto , Francesco M. Bandello , Andrew Chang , Lu Chen , Jay Chhablani , Adrian T. Fung , Min Kim , Dennis S.C. Lam
Purpose
To establish expert consensus on the contemporary surgical management of rhegmatogenous retinal detachment (RRD) using a structured Delphi approach.
Methods
A panel of experienced vitreoretinal surgeons participated in a multiround Delphi survey evaluating statements related to surgical approach, vitrectomy techniques, tamponade selection, anesthesia, postoperative care, special populations, and future technologies. Consensus was defined as ≥ 75 % agreement. Voting outcomes were analyzed to identify areas of agreement and topics requiring further discussion.
Results
Strong consensus emerged on tailoring surgical choice to patient age, lens status, and retinal break characteristics. Scleral buckle (SB) was preferred in younger, phakic patients, while pars plana vitrectomy (PPV) was favored in pseudophakic eyes and complex detachments. Pneumatic retinopexy was supported for limited superior breaks. Small-gauge vitrectomy (23–27 gauge, G), meticulous peripheral vitreous management, and judicious use of perfluorocarbon liquids were widely endorsed. Postoperative positioning, careful intraocular pressure monitoring, and early intervention for macula-on detachments were emphasized. Moreover, macula-off retinal detachment (RD) may carry good prognosis especially in young patients. Areas of ongoing debate included the comparative benefit of PPV versus SB depending on lens status, the default use of silicone oil in complex detachments, and adoption of 27 G+ instruments in pediatric cases. Emerging technologies, including widefield imaging, intraoperative optical coherence tomography, artificial intelligence–assisted analysis, and pharmacologic adjuvants, were recognized as promising but require further validation.
Conclusions
This Delphi study provides structured guidance on RRD management while identifying areas of ongoing debate. Consistently, individualized surgical strategy, meticulous vitreous management, and careful postoperative care remain central to optimizing anatomical and functional outcomes, highlighting the importance of clinical judgment in evolving surgical practice.
{"title":"International consensuses and guidelines on rhegmatogenous retinal detachment (RRD) surgery by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI)","authors":"Paisan Ruamviboonsuk , Nishant V. Radke , Mary Ho , Chi-Chun Lai , Wai Ching Lam , William F. Mieler , Mahesh P. Shanmugam , Chi Wai Tsang , Doric W.K. Wong , Peranut Chotcomwongse , Nicola Y. Gan , Pei-Ting Lu , Sriram Simakurthy , Simon K.H. Szeto , Francesco M. Bandello , Andrew Chang , Lu Chen , Jay Chhablani , Adrian T. Fung , Min Kim , Dennis S.C. Lam","doi":"10.1016/j.apjo.2025.100254","DOIUrl":"10.1016/j.apjo.2025.100254","url":null,"abstract":"<div><h3>Purpose</h3><div>To establish expert consensus on the contemporary surgical management of rhegmatogenous retinal detachment (RRD) using a structured Delphi approach.</div></div><div><h3>Methods</h3><div>A panel of experienced vitreoretinal surgeons participated in a multiround Delphi survey evaluating statements related to surgical approach, vitrectomy techniques, tamponade selection, anesthesia, postoperative care, special populations, and future technologies. Consensus was defined as ≥ 75 % agreement. Voting outcomes were analyzed to identify areas of agreement and topics requiring further discussion.</div></div><div><h3>Results</h3><div>Strong consensus emerged on tailoring surgical choice to patient age, lens status, and retinal break characteristics. Scleral buckle (SB) was preferred in younger, phakic patients, while pars plana vitrectomy (PPV) was favored in pseudophakic eyes and complex detachments. Pneumatic retinopexy was supported for limited superior breaks. Small-gauge vitrectomy (23–27 gauge, G), meticulous peripheral vitreous management, and judicious use of perfluorocarbon liquids were widely endorsed. Postoperative positioning, careful intraocular pressure monitoring, and early intervention for macula-on detachments were emphasized. Moreover, macula-off retinal detachment (RD) may carry good prognosis especially in young patients. Areas of ongoing debate included the comparative benefit of PPV versus SB depending on lens status, the default use of silicone oil in complex detachments, and adoption of 27 G+ instruments in pediatric cases. Emerging technologies, including widefield imaging, intraoperative optical coherence tomography, artificial intelligence–assisted analysis, and pharmacologic adjuvants, were recognized as promising but require further validation.</div></div><div><h3>Conclusions</h3><div>This Delphi study provides structured guidance on RRD management while identifying areas of ongoing debate. Consistently, individualized surgical strategy, meticulous vitreous management, and careful postoperative care remain central to optimizing anatomical and functional outcomes, highlighting the importance of clinical judgment in evolving surgical practice.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100254"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.apjo.2025.100253
Paisan Ruamviboonsuk
{"title":"A continuation on consensus statements for medical and surgical retinal diseases","authors":"Paisan Ruamviboonsuk","doi":"10.1016/j.apjo.2025.100253","DOIUrl":"10.1016/j.apjo.2025.100253","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 5","pages":"Article 100253"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145306818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100230
Simone Pirodda , Antonio Martinez-Abad , Jorge L. Alio del Barrio , Ana Belen Plaza-Puche , Pilar Yebana , Giuseppe Giannaccare , Jorge L. Alio
<div><h3>Purpose</h3><div>To report the clinical outcome, observations and complications related to the sulcus implantations of a new accommodative intraocular lens, the Lumina (AkkoLens Clinical b.v., Breda, The Netherlands) along the twenty-four-month period.</div></div><div><h3>Methods</h3><div>This prospective, observational multicenter study included 103 eyes from 66 patients who underwent implantation of the Lumina accommodative intraocular lens (IOL) at two specialized centers, each employing a distinct sulcus-based implantation model. At Resbiomed-Vissum Eye Clinic (Sofia, Bulgaria), 54 eyes were treated using the Initial Model, in which the main corneal incision was aligned with the patient’s positive corneal meridian. In contrast, at Vissum Instituto Oftalmológico (Alicante, Spain), 49 eyes were treated with the Optimized Model, characterized by a standardized horizontal access tunnel (0–180°), regardless of corneal topography. Patients were evaluated at predefined postoperative intervals (1 day; 1, 3, 6, 12, and 24 months). Visual and refractive parameters—including UDVA, CDVA, UNVA, BCNVA, and CDNVA—along with postoperative observations and complications, were systematically documented. Due to statistically significant differences observed in several baseline and postoperative parameters, the two cohorts were analyzed separately.</div></div><div><h3>Results</h3><div>On postoperative day one, non-severe clinical biomicroscopic findings were observed in 21,35 % of eyes, including mild corneal edema (8.74 %), transient ocular hypertension (5.83 %), pigment dispersion (1.94 %), and moderate IOL tilting (1.94 %).</div><div>At the first postoperative month, the rate of clinical observations related to the surgery was 8.73 %, with additional findings including moderate IOL decentration and one case of macular edema. From month three onward, abnormal findings such as remained below 1 % due to one case of ocular hypertension. From 12–24 months, the abnormal findings were observed at 2.91 %, such as pigment deposits (1.94 %), IOL decentration (0.97 %), and delayed ocular hypertension (0.97 %). Despite these events, both cohorts with two sulcus-based models achieved excellent final outcomes. Among patients who experienced complications from the first postoperative month onward, visual acuity at 24 months remained highly favorable. In the Sofia group (Center 1): UDVA 0.08 ± 0.05, CDVA − 0.02 ± 0.02, UNVA 0.4 ± 0.15, BCNVA 0.10 ± 0.04, and CDNVA 0.20 ± 0.03 logMAR. In the Alicante group (Center 2): UDVA was 0.04 ± 0.11 logMAR, CDVA − 0.05 ± 0.04, UNVA 0.38 ± 0.18, BCNVA 0.03 ± 0.05, and CDNVA 0.34 ± 0.11.</div></div><div><h3>Conclusion</h3><div>The Lumina IOL exhibited a favorable long-term safety profile, with no major sight-threatening adverse events. Early postoperative observations were transient and clinically insignificant, while late complications—though likely lens-related—did not compromise visual quality. These findings support the anato
{"title":"A new accommodative sulcus-based intraocular lens, two years follow-up clinical observations and complications","authors":"Simone Pirodda , Antonio Martinez-Abad , Jorge L. Alio del Barrio , Ana Belen Plaza-Puche , Pilar Yebana , Giuseppe Giannaccare , Jorge L. Alio","doi":"10.1016/j.apjo.2025.100230","DOIUrl":"10.1016/j.apjo.2025.100230","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the clinical outcome, observations and complications related to the sulcus implantations of a new accommodative intraocular lens, the Lumina (AkkoLens Clinical b.v., Breda, The Netherlands) along the twenty-four-month period.</div></div><div><h3>Methods</h3><div>This prospective, observational multicenter study included 103 eyes from 66 patients who underwent implantation of the Lumina accommodative intraocular lens (IOL) at two specialized centers, each employing a distinct sulcus-based implantation model. At Resbiomed-Vissum Eye Clinic (Sofia, Bulgaria), 54 eyes were treated using the Initial Model, in which the main corneal incision was aligned with the patient’s positive corneal meridian. In contrast, at Vissum Instituto Oftalmológico (Alicante, Spain), 49 eyes were treated with the Optimized Model, characterized by a standardized horizontal access tunnel (0–180°), regardless of corneal topography. Patients were evaluated at predefined postoperative intervals (1 day; 1, 3, 6, 12, and 24 months). Visual and refractive parameters—including UDVA, CDVA, UNVA, BCNVA, and CDNVA—along with postoperative observations and complications, were systematically documented. Due to statistically significant differences observed in several baseline and postoperative parameters, the two cohorts were analyzed separately.</div></div><div><h3>Results</h3><div>On postoperative day one, non-severe clinical biomicroscopic findings were observed in 21,35 % of eyes, including mild corneal edema (8.74 %), transient ocular hypertension (5.83 %), pigment dispersion (1.94 %), and moderate IOL tilting (1.94 %).</div><div>At the first postoperative month, the rate of clinical observations related to the surgery was 8.73 %, with additional findings including moderate IOL decentration and one case of macular edema. From month three onward, abnormal findings such as remained below 1 % due to one case of ocular hypertension. From 12–24 months, the abnormal findings were observed at 2.91 %, such as pigment deposits (1.94 %), IOL decentration (0.97 %), and delayed ocular hypertension (0.97 %). Despite these events, both cohorts with two sulcus-based models achieved excellent final outcomes. Among patients who experienced complications from the first postoperative month onward, visual acuity at 24 months remained highly favorable. In the Sofia group (Center 1): UDVA 0.08 ± 0.05, CDVA − 0.02 ± 0.02, UNVA 0.4 ± 0.15, BCNVA 0.10 ± 0.04, and CDNVA 0.20 ± 0.03 logMAR. In the Alicante group (Center 2): UDVA was 0.04 ± 0.11 logMAR, CDVA − 0.05 ± 0.04, UNVA 0.38 ± 0.18, BCNVA 0.03 ± 0.05, and CDNVA 0.34 ± 0.11.</div></div><div><h3>Conclusion</h3><div>The Lumina IOL exhibited a favorable long-term safety profile, with no major sight-threatening adverse events. Early postoperative observations were transient and clinically insignificant, while late complications—though likely lens-related—did not compromise visual quality. These findings support the anato","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100230"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100221
Kelvin H. Wan , Xiao Ying Wang , Kenny H.W. Lai , Jorge L. Alio , Marcus Ang , Colin Chan , Tommy C.Y. Chan , George P.M. Cheng , Ahmed Elsheikh , Jesper Hjortdal , Guofu Huang , Vishal Jhanji , Jodhbir S. Mehta , Srinivas K. Rao , Masaki Sato , Walter Sekundo , Namrata Sharma , Rohit Shetty , Yan Wang , Yueying Xiao , Dennis S.C. Lam
Small incision lenticule extraction (SMILE) surgery was developed in 2008 as an extension of the femtosecond lenticule extraction procedure. Over the years, SMILE has become a highly popular laser refractive surgery offering a minimally invasive alternative to LASIK for correcting myopia and myopic astigmatism. Despite its benefits such as a flapless femtosecond laser procedure with reduced corneal nerve disruption, the procedure’s relative novelty necessitates standardization. Given the myriads of emerging information and variability, a panel of 22 international experts is formed by the Asia Pacific Myopic Society (APMS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to explore the controversy and to work out a consensus on SMILE. This consensus manuscript arises from a systematic exploration of current literature and is supported by the collective insights of international experts in the field of refractive surgery. The panel convened to review the issues, engage in discussion, develop proposals, and vote to establish consensus across four areas: 1) preoperative assessment, 2) preoperative surgical planning, 3) intraoperative considerations, and 4) postoperative management in a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). Consensus was achieved when at least 75 % of the experts had voted for “strongly agree” or “agree” on the consensus statement concerned. 63 consensus statements were discussed, with 51 (81.0 %) statements reaching consensus. By establishing standardized consensus, this paper aims to reduce variability and enhance predictability and safety in refractive outcomes. Ongoing research is encouraged on issues where consensus could not be reached among the international panel of experts (IPE).
{"title":"Controversies, consensuses and guidelines on Small Incision Lenticule Extraction (SMILE) by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS)","authors":"Kelvin H. Wan , Xiao Ying Wang , Kenny H.W. Lai , Jorge L. Alio , Marcus Ang , Colin Chan , Tommy C.Y. Chan , George P.M. Cheng , Ahmed Elsheikh , Jesper Hjortdal , Guofu Huang , Vishal Jhanji , Jodhbir S. Mehta , Srinivas K. Rao , Masaki Sato , Walter Sekundo , Namrata Sharma , Rohit Shetty , Yan Wang , Yueying Xiao , Dennis S.C. Lam","doi":"10.1016/j.apjo.2025.100221","DOIUrl":"10.1016/j.apjo.2025.100221","url":null,"abstract":"<div><div>Small incision lenticule extraction (SMILE) surgery was developed in 2008 as an extension of the femtosecond lenticule extraction procedure. Over the years, SMILE has become a highly popular laser refractive surgery offering a minimally invasive alternative to LASIK for correcting myopia and myopic astigmatism. Despite its benefits such as a flapless femtosecond laser procedure with reduced corneal nerve disruption, the procedure’s relative novelty necessitates standardization. Given the myriads of emerging information and variability, a panel of 22 international experts is formed by the Asia Pacific Myopic Society (APMS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to explore the controversy and to work out a consensus on SMILE. This consensus manuscript arises from a systematic exploration of current literature and is supported by the collective insights of international experts in the field of refractive surgery. The panel convened to review the issues, engage in discussion, develop proposals, and vote to establish consensus across four areas: 1) preoperative assessment, 2) preoperative surgical planning, 3) intraoperative considerations, and 4) postoperative management in a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). Consensus was achieved when at least 75 % of the experts had voted for “strongly agree” or “agree” on the consensus statement concerned. 63 consensus statements were discussed, with 51 (81.0 %) statements reaching consensus. By establishing standardized consensus, this paper aims to reduce variability and enhance predictability and safety in refractive outcomes. Ongoing research is encouraged on issues where consensus could not be reached among the international panel of experts (IPE).</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100221"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100226
Kelvin H. Wan , Xiao Ying Wang , Kenny H.W. Lai , Jorge L. Alio , Marcus Ang , Colin Chan , Tommy C.Y. Chan , George P.M. Cheng , Ahmed Elsheikh , Jesper Hjortdal , Guofu Huang , Vishal Jhanji , Jodhbir S. Mehta , Srinivas K. Rao , Masaki Sato , Walter Sekundo , Namrata Sharma , Rohit Shetty , Yan Wang , Yueying Xiao , Dennis S.C. Lam
{"title":"Corrigendum to “Controversies, consensuses and guidelines on Small Incision Lenticule Extraction (SMILE) by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS)” [Asia-Pac J Ophthalmol (2025) 100221]","authors":"Kelvin H. Wan , Xiao Ying Wang , Kenny H.W. Lai , Jorge L. Alio , Marcus Ang , Colin Chan , Tommy C.Y. Chan , George P.M. Cheng , Ahmed Elsheikh , Jesper Hjortdal , Guofu Huang , Vishal Jhanji , Jodhbir S. Mehta , Srinivas K. Rao , Masaki Sato , Walter Sekundo , Namrata Sharma , Rohit Shetty , Yan Wang , Yueying Xiao , Dennis S.C. Lam","doi":"10.1016/j.apjo.2025.100226","DOIUrl":"10.1016/j.apjo.2025.100226","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100226"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100231
Jost B. Jonas, Hiu Ying Enne Leung
{"title":"A collaboration between East and West","authors":"Jost B. Jonas, Hiu Ying Enne Leung","doi":"10.1016/j.apjo.2025.100231","DOIUrl":"10.1016/j.apjo.2025.100231","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100231"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100222
Kenny H.W. Lai , Xiao Ying Wang , Kelvin H. Wan , Allon Barsam , Scott D. Barnes , Alison L.S. Chiu , Arthur B. Cummings , Alaa M. Eldanasoury , Guofu Huang , Kazutaka Kamiya , Barbara Leyssens , Shi-Ming Li , Mark Packer , Julian Stevens , Tae Keun Yoo , Lynn Yeo , Xingkai Zhan , Dennis S.C. Lam , Xingtao Zhou
Phakic Intraocular Lens (pIOL) has been studied for correction of high myopia and myopic astigmatism long before the advent of laser refractive surgery. It offers excellent visual and refractive outcomes, but the inherited risk of intraocular surgery cannot be overlooked. The posterior chamber pIOL (PC-pIOL), designed to be placed in the ciliary sulcus, may offer additional advantages compared to its anterior chamber counterparts. Given the complexity of sulcus anatomy and individual variations, controversies exist regarding perioperative management, implant selection, and operative techniques, necessitating standardisation. Given the emergence of novel approaches and long-term clinical data, a panel comprising 19 international experts from 9 countries/territories was formed by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS). The panel critically reviewed the subject and synthesised 58 consensus statements that aim to provide evidence-based, real-world practice recommendations for optimal outcomes in PC-pIOL surgery.
{"title":"Controversies, consensuses and guidelines on posterior chamber phakic intraocular lens for the correction of myopia and myopic astigmatism in healthy phakic eyes by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS)","authors":"Kenny H.W. Lai , Xiao Ying Wang , Kelvin H. Wan , Allon Barsam , Scott D. Barnes , Alison L.S. Chiu , Arthur B. Cummings , Alaa M. Eldanasoury , Guofu Huang , Kazutaka Kamiya , Barbara Leyssens , Shi-Ming Li , Mark Packer , Julian Stevens , Tae Keun Yoo , Lynn Yeo , Xingkai Zhan , Dennis S.C. Lam , Xingtao Zhou","doi":"10.1016/j.apjo.2025.100222","DOIUrl":"10.1016/j.apjo.2025.100222","url":null,"abstract":"<div><div>Phakic Intraocular Lens (pIOL) has been studied for correction of high myopia and myopic astigmatism long before the advent of laser refractive surgery. It offers excellent visual and refractive outcomes, but the inherited risk of intraocular surgery cannot be overlooked. The posterior chamber pIOL (PC-pIOL), designed to be placed in the ciliary sulcus, may offer additional advantages compared to its anterior chamber counterparts. Given the complexity of sulcus anatomy and individual variations, controversies exist regarding perioperative management, implant selection, and operative techniques, necessitating standardisation. Given the emergence of novel approaches and long-term clinical data, a panel comprising 19 international experts from 9 countries/territories was formed by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS). The panel critically reviewed the subject and synthesised 58 consensus statements that aim to provide evidence-based, real-world practice recommendations for optimal outcomes in PC-pIOL surgery.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100222"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100228
H. Burkhard Dick , Ronald D. Gerste , Suphi Taneri
Femtosecond laser-assisted cataract surgery (FLACS) is a well-established procedure that consistently delivers excellent visual and refractive outcomes. It is associated with a low complication rate and has relatively few contraindications. Among its many advantages, the exceptionally precise capsulotomy is particularly beneficial for the implantation of centration-sensitive intraocular lenses (IOLs). FLACS has demonstrated clinical value even in patients with ocular comorbidities. Numerous studies have compared FLACS with conventional phacoemulsification cataract surgery (CPCS), a widely accepted and highly effective procedure that remains the current golden standard. While FLACS offers distinct technological advantages, it continues to evolve and has not yet reached its full potential, largely due to economic challenges.
{"title":"Femtosecond laser-assisted cataract surgery","authors":"H. Burkhard Dick , Ronald D. Gerste , Suphi Taneri","doi":"10.1016/j.apjo.2025.100228","DOIUrl":"10.1016/j.apjo.2025.100228","url":null,"abstract":"<div><div>Femtosecond laser-assisted cataract surgery (FLACS) is a well-established procedure that consistently delivers excellent visual and refractive outcomes. It is associated with a low complication rate and has relatively few contraindications. Among its many advantages, the exceptionally precise capsulotomy is particularly beneficial for the implantation of centration-sensitive intraocular lenses (IOLs). FLACS has demonstrated clinical value even in patients with ocular comorbidities. Numerous studies have compared FLACS with conventional phacoemulsification cataract surgery (CPCS), a widely accepted and highly effective procedure that remains the current golden standard. While FLACS offers distinct technological advantages, it continues to evolve and has not yet reached its full potential, largely due to economic challenges.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100228"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100227
Bianca N. Susanna , Tanner J. Ferguson , J. Bradley Randleman
As the number of cataract patients with a history of corneal refractive surgery continues to rise, it is necessary to understand how to appropriately manage their surgical outcomes. These cases are uniquely complex due to altered corneal optical properties, reduced predictability in intraocular lens (IOL) power calculations, and higher visual expectations. This review outlines key principles for optimizing refractive accuracy and patient satisfaction in this population. Topics include preoperative corneal imaging interpretation, current IOL power calculation strategies (including modern formulas and ray tracing software), management of astigmatism, and IOL selection based on aberration profile. We also evaluate the role of presbyopia-correcting IOLs, including light-adjustable, trifocal, extended depth of focus, and small-aperture options. Through a comprehensive synthesis of recent evidence and expert recommendations, this review provides practical guidance for surgeons to achieve successful outcomes of cataract surgery in post-refractive eyes.
{"title":"Cataract surgery following refractive surgery: Principles for success","authors":"Bianca N. Susanna , Tanner J. Ferguson , J. Bradley Randleman","doi":"10.1016/j.apjo.2025.100227","DOIUrl":"10.1016/j.apjo.2025.100227","url":null,"abstract":"<div><div>As the number of cataract patients with a history of corneal refractive surgery continues to rise, it is necessary to understand how to appropriately manage their surgical outcomes. These cases are uniquely complex due to altered corneal optical properties, reduced predictability in intraocular lens (IOL) power calculations, and higher visual expectations. This review outlines key principles for optimizing refractive accuracy and patient satisfaction in this population. Topics include preoperative corneal imaging interpretation, current IOL power calculation strategies (including modern formulas and ray tracing software), management of astigmatism, and IOL selection based on aberration profile. We also evaluate the role of presbyopia-correcting IOLs, including light-adjustable, trifocal, extended depth of focus, and small-aperture options. Through a comprehensive synthesis of recent evidence and expert recommendations, this review provides practical guidance for surgeons to achieve successful outcomes of cataract surgery in post-refractive eyes.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100227"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.apjo.2025.100224
Sanjeev P. Srinivas , Alvin L. Young , Anders Behndig , David F. Chang , Sorcha Ní Dhubhghaill , Youngsub Eom , Alex Hoi Fan , Oliver Findl , Kjell Gunnar Gundersen , Rohit C. Khanna , Thomas Kohnen , Francis S. Mah , Kevin M. Miller , Mayank A. Nanavaty , Rudy Nuijts , Tetsuro Oshika , Gede Pardianto , Nicolaas J. Reus , Sanduk Ruit , Namrata Sharma , Jorge L. Alió
Phacoemulsification has revolutionized cataract surgery since its introduction by Charles Kelman in 1967, becoming the gold standard for cataract removal in most parts of the world. Despite its widespread adoption and high success rates, there exist controversies within the ophthalmic community regarding various aspects of the procedure. An international panel comprising 25 experts from 18 countries/territories was established by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to work on this consensus project. A total of 15 sections with 61 consensus statements were evaluated by the panel. Femtosecond laser assisted cataract surgery was not considered better than Phaco. An interferometer was considered essential for measuring the ocular parameters, and the need to choose an appropriate intraocular lens (IOL) formula was stressed. When considering multifocal IOLs, an assessment of the patient’s personality profile, and a thorough discussion of the pros and cons of the choice before surgery was essential. Proper informed consent was also essential. The need to address complications like TASS promptly including a reassessment of operating rooms protocols was stressed. Finally, there was general agreement that manual surgeries have a significant role to play in eyes with large, dense nuclei and in populations where low-cost, high-volume surgery was necessary. Manual but sutureless approach was preferred where appropriate. Since there was agreement on about 60 % of the 61 consensus statements, it reflected that there were variations in the real-world practice. Further studies are warranted and a follow-up consensus exercise after more information is available is worth considering.
{"title":"Controversies, consensuses and guidelines on modern cataract surgery by the academy of Asia-Pacific professors of ophthalmology (AAPPO)","authors":"Sanjeev P. Srinivas , Alvin L. Young , Anders Behndig , David F. Chang , Sorcha Ní Dhubhghaill , Youngsub Eom , Alex Hoi Fan , Oliver Findl , Kjell Gunnar Gundersen , Rohit C. Khanna , Thomas Kohnen , Francis S. Mah , Kevin M. Miller , Mayank A. Nanavaty , Rudy Nuijts , Tetsuro Oshika , Gede Pardianto , Nicolaas J. Reus , Sanduk Ruit , Namrata Sharma , Jorge L. Alió","doi":"10.1016/j.apjo.2025.100224","DOIUrl":"10.1016/j.apjo.2025.100224","url":null,"abstract":"<div><div>Phacoemulsification has revolutionized cataract surgery since its introduction by Charles Kelman in 1967, becoming the gold standard for cataract removal in most parts of the world. Despite its widespread adoption and high success rates, there exist controversies within the ophthalmic community regarding various aspects of the procedure. An international panel comprising 25 experts from 18 countries/territories was established by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to work on this consensus project. A total of 15 sections with 61 consensus statements were evaluated by the panel. Femtosecond laser assisted cataract surgery was not considered better than Phaco. An interferometer was considered essential for measuring the ocular parameters, and the need to choose an appropriate intraocular lens (IOL) formula was stressed. When considering multifocal IOLs, an assessment of the patient’s personality profile, and a thorough discussion of the pros and cons of the choice before surgery was essential. Proper informed consent was also essential. The need to address complications like TASS promptly including a reassessment of operating rooms protocols was stressed. Finally, there was general agreement that manual surgeries have a significant role to play in eyes with large, dense nuclei and in populations where low-cost, high-volume surgery was necessary. Manual but sutureless approach was preferred where appropriate. Since there was agreement on about 60 % of the 61 consensus statements, it reflected that there were variations in the real-world practice. Further studies are warranted and a follow-up consensus exercise after more information is available is worth considering.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 4","pages":"Article 100224"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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