From AI to lenticules, this inspiring symposium delivered transformative insights for surgeons worldwide.
An opening day symposium of the 37th annual meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2025) in Ahmedabad, India, set the tone for a meeting that celebrates both innovation and clinical wisdom.
Under the stewardship of chairs Drs. Rohit Shetty, Sonu Goel, Soosan Jacob and Samaresh Srivastava, the symposium, Innovations and Insights in Cataract and Refractive Surgery, brought together the sharpest minds and the latest technologies shaping cataract and refractive surgery today. From lenticule-based procedures and phakic IOL innovations to artificial intelligence and complication management, every presentation brimmed with transformative insights for surgeons across the region.
Posterior capsule rupture–from panic to planning
Dr. Rohit Om Parkash (India) opened with a masterclass on handling one of cataract surgery’s most dreaded complications: posterior capsule rupture (PCR). His message was clear: panic must give way to planning.
“Posterior capsule rupture and vitreous collapse, they are two events. They are not a singular event,” he reminded the audience, emphasizing the chronology and subtle nuances that can define outcomes. He outlined the importance of prophylactic low parameters, stable chamber settings, and AHF-friendly maneuvers.
By adopting “slow-motion phacoemulsification,” he explained, surgeons can turn the anterior hyaloid face into an ally rather than a foe. His live case demonstrations showed how low intraocular pressure, calibrated incisions and careful manipulation allowed safe IOL placement even in complex PCR cases. “Surgical planning in an event of PCR should cause no panic mode. You have to use your mind,” he concluded, underscoring wisdom over reaction.
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Artificial intelligence–partner, not replacement
Taking the audience into the digital frontier, Prof. Dr. Sri Ganesh (India) addressed the role of artificial intelligence (AI) in refractive surgery. He traced AI’s trajectory in ophthalmology—from early automated detectors to deep learning models in diabetic retinopathy, glaucoma and age-related macular degeneration (AMD). But the spotlight was on refractive surgery.
Highlighting platforms like Alcon’s (Geneva, Switzerland) Innoveyes and ZEISS (Jena, Germany) Visulyze diagnostic devices, he showed how AI is personalizing treatments with digital twins, ray-tracing ablations and predictive nomograms.“AI creates a 3D eye model with ray tracing technology, a digital twin, tailored for a personalized procedure,” he explained.
Beyond corneal refractive surgery, he demonstrated AI’s applications in phakic IOL sizing, premium IOL planning, and custom algorithms like CustomLens AI. Far from replacing surgeons, he stressed AI’s potential to “reduce time, cost and increase quality,” especially for non-experts seeking guidance in complex refractive decisions.
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Lenticule-based surgery–the era of KLEX
Few talks sparked as much buzz as Prof. Dr. Mahipal Sachdev’s (India) deep dive into Keratorefractive Lenticule Extraction (KLEx). He outlined the evolution from ZEISS’ VISUMAX 500/800 to Johnson & Johnson’s (New Jersey, United States) ELITA and Ziemer’s (Port, Switzerland) portable Z8 systems.
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Introducing SILK (smooth incision lenticular keratomileusis) and CLEAR (corneal lenticule extraction advanced refractive), he explained how low-energy biconvex lenticules create optical outcomes rivaling camera lenses. “A biconvex lenticule essentially gives you the best quality of vision,” he said, noting the submicron precision these systems now achieve.
Equally fascinating were the clinical pearls he shared: the “meniscus sign,” “white ring sign” and “bubble release sign” — intraoperative cues that help surgeons identify correct dissection planes. Beyond refractive correction, he showcased innovative uses of harvested lenticules—from stromal expansion in thin corneas to implants for hyperopia and keratoconus. In closing, he emphasized that KLEX is more than a name; it is a unifying language that reflects a global consensus on lenticule extraction’s future.
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Laser cataract surgery still has a role to play
Dr. Gaurav Luthra (India) revisited the ongoing debate about femtosecond laser-assisted cataract surgery (FLACS). Acknowledging meta-analyses showing little difference in outcomes versus manual phaco, he asked: “If the technology is not offering anything dramatic, why is it still around?”
His answer lay in specific scenarios. FLACS shines in intumescent cataracts, post-RK eyes, posterior polar cataracts and black brunescent cataracts—situations where precision rhexis and reduced energy matter most. He also highlighted new advances like Johnson & Johnson’s CATALYS cOS 7.0 Premium system, integrated with Alcon’s biometers for seamless iris registration and toric alignment. “You do away with image guidance systems,” he said, underscoring its growing efficiency.
He concluded by noting that while not for every case, FLACS is here to stay for challenging eyes and premium IOLs.
Complications and their rescue
No symposium is complete without tackling complications. Prof. Dr. Namrata Sharma (India) discussed strategies for handling complications in femtosecond LASIK, SMILE and phakic IOLs. She emphasized that while complications are unavoidable, successful outcomes depend on early recognition and appropriate management.
For femtosecond LASIK, she described challenges such as opaque bubble layers, vertical gas breakthrough, suction loss and incomplete flaps. Many can be managed intraoperatively with adjustments, but in cases like vertical gas breakthrough, it is safer to abort and reschedule.
With SMILE or lenticule extraction in general, issues include suction loss, incomplete or adherent lenticules and dissection difficulties. She outlined signs such as the “edge sign” and stressed the value of microscope-integrated intraoperative OCT, which allows surgeons to visualize retained or mis-dissected lenticules and guide safe extraction.
In phakic IOL surgery, complications ranged from flipped or inverted lenses to improper vaulting, pigment dispersion, and rare endophthalmitis. IOCT guidance, she noted, enables precise vault assessment and supports timely intervention. Some cases may require exchange, especially when retinal pathology is involved.
New tools for old problems
Dr. Kumar Doctor (India) added a practical twist by introducing his innovation—the irrigating wire. Designed to retract the iris and facilitate 360° cortical aspiration, it proved invaluable in small pupils and intraoperative miosis.
“The beauty is that this can also be used after the IOL is implanted in the bag,” he explained, demonstrating its versatility for viscoelastic removal and toric IOL alignment. Simple, ingenious tools like this remind the community that innovation doesn’t always require a laser—it can be forged at the tip of an idea.
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Pinhole pupilloplasty–harnessing aberration control
Closing the session, Dr. Soosan Jacob (India) presented her pioneering work on pinhole pupilloplasty (PPP). By creating a customized small aperture centered on the visual axis, PPP offers a versatile solution for aberropia—eyes plagued by higher-order aberrations.
“PPP harnesses the Stiles-Crawford effect and wavefront filtration,” she explained, emphasizing how it reduces light scatter, sharpens images and increases depth of focus. Unlike pinhole IOLs or corneal inlays, PPP is adjustable intraoperatively, cost-effective and adaptable to complex eyes—from keratoconus to failed grafts. Her message was clear: in highly aberrated eyes, PPP expands the horizon of what refractive surgery can achieve.
Editor’s Note: The 37th annual meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2025) is being held from 21-23 August in Ahmedabad, India. Reporting for this story took place during the event.This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.