Rita Vought, Victoria Vought, John D Gelles, Frances Lai, Adam Zaki, Steven A Greenstein, Peter S Hersh
{"title":"Subjective patient perceptions of cataract and refractive surgery in an online forum.","authors":"Rita Vought, Victoria Vought, John D Gelles, Frances Lai, Adam Zaki, Steven A Greenstein, Peter S Hersh","doi":"10.1097/j.jcrs.0000000000002039","DOIUrl":"10.1097/j.jcrs.0000000000002039","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793515","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}
{"title":"Seeking a European c onsensus on s imulation- b ased c ataract s urgical t raining: an ESCRS p osition s tatement.","authors":"Lida P Lalou, Sarah Maling","doi":"10.1097/j.jcrs.0000000000002036","DOIUrl":"10.1097/j.jcrs.0000000000002036","url":null,"abstract":"<p><p>Cataract surgery training across Europe remains heterogeneous despite high procedural demand, and a harmonized simulation pathway is lacking. This special report sets out an ESCRS position on cataract simulation training and seeks European consensus on it; it is not binding on national training bodies, does not replace national curricula, and does not establish a European credential or right to operate. It synthesizes European training surveys, evidence on simulation-related performance and safety benefits, and ESCRS educational infrastructure. An outline pathway is described for discussion, comprising entry assessment, foundation skills, core phacoemulsification, complication management, supervised operating-room progression, and maintenance of competency. Questions are posed, rather than criteria proposed, on progression from simulation to live surgery, on assessment, and on documentation, access, and sustainability. Model-eye and VR modalities are mapped to complementary stages of training, and implementation issues are identified around national portfolio integration, regional hubs, the ESCRS Moving Simulator, sustainability metrics, and equity monitoring. ESCRS does not endorse any simulator or commercial platform. National societies and the European Board of Ophthalmology are invited to join a structured consensus process, which will report agreed operational recommendations in a second manuscript within approximately 12 months.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793550","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}
{"title":"From earlier to updated quadrifocal intraocular lens designs: objective optical metrology analysis.","authors":"Eun Ah Jeong, Seung Pil Bang, Seth Pantanelli, Sujin Kang, Sonia H Yoo","doi":"10.1097/j.jcrs.0000000000002042","DOIUrl":"10.1097/j.jcrs.0000000000002042","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the optical performance of the Clareon PanOptix and Clareon PanOptix Pro intraocular lenses (IOLs) using interferometric metrology and identify measurable optical differences.</p><p><strong>Setting: </strong>Physiological Optics Laboratory, Daegu, South Korea.</p><p><strong>Design: </strong>Experimental optical-bench investigation.</p><p><strong>Methods: </strong>3 +20.0-diopter samples each of the PanOptix and PanOptix Pro IOLs were analyzed using a Mach-Zehnder interferometer in a model eye incorporating +0.27 μm corneal spherical aberration (SA). Microscopic imaging, wavefront reconstruction with Zernike analysis, diffractive-step profile reconstruction, point-spread function (PSF)-based retinal image simulation, halo analysis, and through-focus modulation transfer function (MTF) analysis were performed.</p><p><strong>Results: </strong>Both IOLs showed broadly similar diffractive architecture and SA profiles. Peak-to-valley step-profile amplitudes were comparable, although the PanOptix Pro showed localized differences in the reconstructed step-height contour. PSF-based analyses showed broadly similar focal behavior, but the PanOptix Pro demonstrated clearer Sloan F contour preservation and more evident central PSF-core brightness at the far-intermediate position. In through-focus average MTF (aMTF) profiles, the PanOptix Pro showed a modestly higher far-focus peak and a less pronounced post-peak dip, particularly at 4.5 and 3.0 mm pupils. MTF50 analysis showed a similar overall pattern, with greater variability and more apparent intermodel differences at larger pupil sizes.</p><p><strong>Conclusions: </strong>The PanOptix Pro preserves the fundamental design and SA profile of the original PanOptix while showing localized diffractive step-height modifications. Together with clearer far-intermediate F-image preservation, sustained central PSF-core brightness, and a shallower post-peak aMTF dip, these findings are consistent with a relative redistribution of optical energy toward the far-intermediate region, supporting greater far-intermediate optical continuity without substantial changes in nominal add power or overall focal structure.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793467","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}
Giacomo Savini, Kenneth J Hoffer, Arianna Grendele, Catarina C P Coutinho, Gianluca Cappuccini, Domenico Schiano-Lomoriello
{"title":"Agreement between slitlamp retroillumination images and Scheimpflug retroillumination display for toric intraocular lens orientation.","authors":"Giacomo Savini, Kenneth J Hoffer, Arianna Grendele, Catarina C P Coutinho, Gianluca Cappuccini, Domenico Schiano-Lomoriello","doi":"10.1097/j.jcrs.0000000000002038","DOIUrl":"10.1097/j.jcrs.0000000000002038","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793443","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}
Waseem Nasser, Adir Sommer, Dror Ben Ephraim Noyman, Margarita Safir, Tzahi Sela, Gur Munzer, Igor Kaiserman, Eyal Cohen, Michael Mimouni
{"title":"Predictors for retreatment following laser-assisted in situ keratomileusis for high myopia.","authors":"Waseem Nasser, Adir Sommer, Dror Ben Ephraim Noyman, Margarita Safir, Tzahi Sela, Gur Munzer, Igor Kaiserman, Eyal Cohen, Michael Mimouni","doi":"10.1097/j.jcrs.0000000000002033","DOIUrl":"10.1097/j.jcrs.0000000000002033","url":null,"abstract":"<p><strong>Purpose: </strong>To identify risk factors for retreatment after laser-assisted in situ keratomileusis (LASIK) in eyes with high myopia.</p><p><strong>Setting: </strong>Care Vision Laser Center, Tel Aviv, Israel.</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Methods: </strong>Data from eyes with myopia ≥6 diopters (D) treated between 2000 and 2022 were analyzed. Eyes were grouped according to retreatment status. Preoperative and intraoperative parameters were compared using t tests and chi-square tests. Generalized estimating equations (GEE) logistic regression accounting for intereye correlation, including variables with P < .1, was performed to identify independent predictors of retreatment.</p><p><strong>Results: </strong>The study included 2100 eyes (2020 controls and 80 retreatments). Retreatment eyes had shorter contact lens-free intervals ( P = .029) and a higher proportion of baseline cylinder <-1.0 D (32.5% vs 21.9%, P = .025). Significant differences were observed in uncorrected distance visual acuity ( P = .026) and corrected distance visual acuity ( P = .034). Intraoperatively, retreatment cases had higher treated cylinder ( P = .043), greater ablation depth (104.7 ± 14.8 vs 100.6 ± 12.5 μm, P = .004), and the optical-zone distribution differed between groups, with more 6.0 mm treatments and no 7.0 mm treatments in retreatment eyes ( P < .001). Retreatment was also associated with earlier surgical years ( P < .001) and use of the EX200 laser ( P = .01). GEE logistic regression identified 2 independent predictors: baseline cylinder <-1.0 D (odds ratio [OR] 2.208, 95% CI 1.126-4.330, P = .021) and EX200 laser use (OR 4.776, 95% CI 2.496-9.140, P < .001).</p><p><strong>Conclusions: </strong>LASIK retreatment in high myopia is independently associated with higher baseline refractive cylinder and older laser technology (EX200). Optimizing patient selection and adopting modern laser platforms may reduce the likelihood of additional procedures.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721815","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}
{"title":"Preoperative corneal irregular astigmatism and long-term visual outcomes after multifocal intraocular lens implantation.","authors":"Raimo Tuuminen, Piotr Kanclerz, Sohee Jeon","doi":"10.1097/j.jcrs.0000000000002028","DOIUrl":"10.1097/j.jcrs.0000000000002028","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinical significance of preoperative higher-order aberrations in the long-term visual outcomes after multifocal intraocular lens (mIOL) implantation.</p><p><strong>Setting: </strong>Keye Eye Center, Seoul, Korea.</p><p><strong>Design: </strong>Retrospective single-center clinical cohort study.</p><p><strong>Methods: </strong>Bilateral implantation of PanOptix mIOL with 3-year follow-up. Eyes were stratified based on total corneal irregular astigmatism (TCIA) in Scheimpflug tomography into low (≤0.15 μm), moderate (>0.15 to <0.30 μm), and high (≥0.30 μm) TCIA groups.</p><p><strong>Results: </strong>In the cohort of 474 eyes of 237 patients, those with high TCIA had greater prevalence of prior refractive surgery (16% vs 2%; P < .001), greater spherical aberration (0.45 ± 0.26 diopters [D] vs 0.28 ± 0.10 D; P < .001), and lower central corneal thickness (511 ± 43 μm vs 548 ± 30 μm; P = .001) than those with low TCIA. High TCIA resulted in worse uncorrected distance visual acuity (UDVA) at 1 year (0.11 ± 0.10 vs 0.03 ± 0.08 logMAR units; P = .001) and at 3 years (0.16 ± 0.15 vs 0.04 ± 0.08 logMAR units; P < .001) compared with low TCIA, despite comparable postoperative refractive outcomes. At 3 years, Strehl ratio (0.024 ± 0.019 vs 0.041 ± 0.027; P = .001), photopic (1.23 ± 0.14 vs 1.39 ± 0.20; P < .001), and mesopic area under the log contrast sensitivity function (0.91 ± 0.16 vs 1.06 ± 0.19; P < .001) were worse in high TCIA group compared with low TCIA group. Greater preoperative TCIA was associated with poorer age-adjusted and sex-adjusted UDVA ( B = 0.174, 95% CI 0.101-0.248, P < .001), corrected distance visual acuity ( B = 0.261, 95% CI 0.132-0.389, P < .001), and Strehl ratio ( B = -0.598, 95% CI -0.865 to -0.332, P < .001) at 3 years.</p><p><strong>Conclusions: </strong>High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after mIOL implantation.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722500","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}
Abu Bakar Butt, Angelica Hanna, Minoo Tohidi Kaloorazi, Sara KamaliZonouzi, Melody Hanna, Brendan K Tao, Joshua C Teichman
{"title":"Incidence of femtosecond laser-assisted LASIK flap complications: A Systematic Review.","authors":"Abu Bakar Butt, Angelica Hanna, Minoo Tohidi Kaloorazi, Sara KamaliZonouzi, Melody Hanna, Brendan K Tao, Joshua C Teichman","doi":"10.1097/j.jcrs.0000000000002031","DOIUrl":"10.1097/j.jcrs.0000000000002031","url":null,"abstract":"<p><strong>Topic: </strong>This review evaluated the incidence and visual significance of flap-related complications in femtosecond LASIK.</p><p><strong>Clinical relevance: </strong>Femtosecond laser-assisted LASIK has largely replaced mechanical microkeratomes for flap creation due to improved precision and safety. Understanding the incidence and clinical consequences of flap-related complications is essential for patient counseling and surgical planning.</p><p><strong>Methods: </strong>A systematic search of Ovid MEDLINE, Embase, and CINAHL was conducted from database inception to October 10, 2024 including English-language clinical reports of patients undergoing femtosecond LASIK that reported flap-related complications. Small case series (<5 patients), secondary articles, conference abstracts, and cost-analysis studies were excluded. Study screening and data extraction were performed independently by two reviewers. The primary outcome was the incidence of LASIK flap complications stratified by femtosecond laser platform; secondary outcomes included postoperative visual acuity. Risk of bias was assessed at the outcome level using RoB 2 for randomized clinical trials and ROBINS-I for observational studies. Findings were synthesized narratively with descriptive summary of incidence proportions; no meta-analysis was performed due to heterogeneity in study designs and laser platforms. The review was registered in PROSPERO (CRD42024608238) with no post-submission amendments.</p><p><strong>Results: </strong>Twenty-seven studies published between 1997 and 2024 were included, comprising 28,531 eyes across multiple countries. The most frequently reported intraoperative event was opaque bubble layer, occurring in 19.7% of eyes (range 2.0-56.4%). Diffuse lamellar keratitis was reported in 6.3% of eyes and typically resolved without long-term visual impact. Epithelial ingrowth (2.1%), microstriae (1.6%), and incomplete flaps (0.17%) were uncommon. Other flap-related events, including buttonholes, free caps, epithelial defects, and traumatic flap injuries, were rare (<1%).</p><p><strong>Conclusions: </strong>Femtosecond LASIK is associated with low rates of clinically significant flap-related complications, with excellent visual outcomes in most cases. Standardized reporting and longer-term prospective studies are needed to further refine complication benchmarks across femtosecond platforms.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721801","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}
Dimitris Kazakos, Stephen J Hannan, Jan A Venter, David Teenan, Huba J Kiss, Noelle C Hannan, Colin W Berry, David R Cooper, Dasi Raju, Steven C Schallhorn, Julie M Schallhorn
{"title":"Incidence and outcomes of intraocular lens exchanges in patients dissatisfied with multifocal lenses: 15-year retrospective dataset analysis.","authors":"Dimitris Kazakos, Stephen J Hannan, Jan A Venter, David Teenan, Huba J Kiss, Noelle C Hannan, Colin W Berry, David R Cooper, Dasi Raju, Steven C Schallhorn, Julie M Schallhorn","doi":"10.1097/j.jcrs.0000000000001908","DOIUrl":"10.1097/j.jcrs.0000000000001908","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the incidence, clinical outcomes, and adverse event rates of intraocular lens (IOL) exchange in patients dissatisfied with presbyopia-correcting multifocal IOLs.</p><p><strong>Setting: </strong>Private clinics, United Kingdom.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>Data of patients who underwent multifocal IOL implantation between 2007 and 2021 and required the exchange of IOLs due to quality of vision issues or insufficient near vision were reviewed. IOL exchanges for other reasons (dislocation, opacification, or other adverse events) were not included in the analysis. Visual and refractive outcomes of the lens exchange procedure were analyzed for the last available follow-up.</p><p><strong>Results: </strong>The mean time from the primary procedure to the IOL exchange was 13.6 ± 8.3 months. The total IOL exchange rate was 0.63% (688 of 109 274 lenses). Of these, 637 exchanges (0.58%) were performed because of quality of vision issues, and 51 (0.05%) were exchanged primarily because of insufficient near vision (eg, IOL with lower near addition exchanged for an IOL with stronger near addition). Post-IOL exchange, 71.7% (493/688) and 91.3% (628/688) were within 0.50 diopter (D) and 1.00 D of emmetropia, respectively. The mean postexchange uncorrected distance visual acuity was 0.11 ± 0.21 logMAR (20/25 -0.5 ). The anatomical position of the secondary IOL was as follows: in-the-bag fixation 86.8% (597/688), ciliary sulcus fixation 12.5% (86/688), and alternative fixation (iris claw, scleral fixation, or IOL suturing) in 0.7% of cases (5/688).</p><p><strong>Conclusions: </strong>Patients requiring an IOL exchange due to dissatisfaction with multifocal lenses achieved favorable refractive and visual outcomes. In-the-bag implantation of secondary IOL was possible in most cases.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"757-765"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201754","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}
Klemens P Kaiser, Jascha A Wendelstein, Leonard Seewald, Tyll Jandewerth, Petra Davidova, Achim Langenbucher, Thomas Kohnen
{"title":"Incision-induced astigmatic changes in eyes undergoing simultaneous phakic intraocular lens explantation and phacoemulsification.","authors":"Klemens P Kaiser, Jascha A Wendelstein, Leonard Seewald, Tyll Jandewerth, Petra Davidova, Achim Langenbucher, Thomas Kohnen","doi":"10.1097/j.jcrs.0000000000001909","DOIUrl":"10.1097/j.jcrs.0000000000001909","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate surgically induced astigmatism (SIA) in bilensectomy, the simultaneous phakic intraocular lens (pIOL) explantation and femtosecond laser-assisted cataract surgery, comparing outcomes between corneal and scleral incision approaches.</p><p><strong>Design: </strong>Retrospective consecutive case series.</p><p><strong>Setting: </strong>Tertiary referral university hospital.</p><p><strong>Methods: </strong>Preoperative and 3-month postoperative Scheimpflug-based tomography was used to assess anterior (simK) and total corneal refractive power (TCRP). In eyes with soft pIOL, removal was performed through a temporal 2.2 mm corneal incision that was manually enlarged to 2.4 to 2.6 mm (C-Ex group). In eyes with rigid pIOL, explantation was through a 6 mm superior scleral incision (S-Ex group). Vector analysis was performed, and SIA variability was evaluated through difference vectors (DV) and 80% and 95% confidence ellipses (CE) as well as 95% confidence polygonal areas.</p><p><strong>Results: </strong>41 eyes (29 patients) were included (23 C-Ex group and 18 S-Ex). Mean absolute astigmatism difference was 0.47 ± 0.32 diopter (D) for simK and 0.53 ± 0.38 D for TCRP. DV magnitudes were 0.66 ± 0.40 D and 0.77 ± 0.53 D, respectively, with no significant difference ( P = .998). Analysis of centroid and medoid values, as well as CE areas, showed lower variance under simK compared with TCRP (CE 80%: 0.65 D 2 vs 0.92 D 2 ; CE 95%: 1.22 D 2 vs 1.72 D 2 , respectively). After 3 months, the S-Ex group exhibited comparable astigmatic outcomes with the C-Ex group for soft pIOLs.</p><p><strong>Conclusions: </strong>simK and TCRP yield similar SIA magnitudes, although TCRP reveals greater variability. Steep meridian shifts in magnitude and axis are common after bilensectomy and must be considered when implanting toric intraocular lenses. Further large-scale, longitudinal studies are required to confirm these results.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"766-773"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201757","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}
{"title":"Study on the relationship between bacterial endotoxin and the onset of toxic anterior segment syndrome.","authors":"Koichi Ono, Emi Sugizaki, Shaimaa Ibrahim, Genki Koyama, Yasuo Nakamura, Yuji Haishima","doi":"10.1097/j.jcrs.0000000000001916","DOIUrl":"10.1097/j.jcrs.0000000000001916","url":null,"abstract":"<p><strong>Purpose: </strong>To comprehensively analyze the contamination status of pyrogen including bacterial endotoxins, considered as one of the onset agents of toxic anterior segment syndrome (TASS), in medical devices used for cataract surgery, and to improve the cleanliness of the devices by new sterilization technology.</p><p><strong>Setting: </strong>Innovative Decontamination Technology Development and Evaluation Center, Miura Co. Ltd., Yokohama, Japan.</p><p><strong>Design: </strong>Experimental study.</p><p><strong>Methods: </strong>The pyrogen levels of the medical devices were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike the endotoxin test. Pyrogen inactivation tests were further performed using low-temperature ozone/hydrogen peroxide mixed gas sterilization.</p><p><strong>Results: </strong>Significant pyrogen levels from 0.22 to 11.6 endotoxin units (EU)/product as a worst case were detected in 7 of 11 medical devices. These products might have exceeded the previously reported threshold (0.02 to 0.05 EU/eye) for inducing dose-dependent inflammatory responses in the mammalian vitreous during actual use. However, our study revealed that pyrogen contamination in the devices was reduced below the detection limit after ozone/hydrogen peroxide mixed gas sterilization under an elaborate treatment mode at 50°C.</p><p><strong>Conclusions: </strong>The precise amount of pyrogen required to induce human TASS remains unknown; however, currently available medical products for intraocular surgery were found to be contaminated with nonnegligible amounts of pyrogens, and the possibility of a causal relationship between actual product use and the onset of TASS cannot be ruled out. This potential risk could be eliminated by replacing the current sterilization method with ozone/hydrogen peroxide mixed gas treatment.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"813-818"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}