{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:47:42Z","timestamp":1793832462060,"version":"4.6.1"},"reference-count":30,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This exploratory, randomized, patient-masked, intra-individual pilot study evaluated the feasibility of intraoperative swept-source optical coherence tomography (SS-OCT) for quantifying capsular-bag dynamics during cataract surgery and explored potential differences between an adaptive fluidics system (AFS) and a gravity-based fluidics system (GFS). Methods: Twenty-seven myopic cataract patients (54 eyes) underwent bilateral phacoemulsification, with one eye randomly assigned to AFS and the fellow eye to GFS using the same phacoemulsification platform (Stellaris\/Stellaris Elite, Bausch &amp; Lomb, Rochester, NY, USA). Intraoperative SS-OCT scans were acquired at six predefined surgical stages (M1\u2013M6) to measure anterior and posterior capsule distances relative to the corneal endothelium. Intraoperative discomfort was assessed using a visual analog scale. Results: Of 648 attempted scans, 392 (60.5%) were analyzable, confirming partial feasibility of the prototype system. At the onset of phacoemulsification with irrigation on (M2), the predefined primary endpoint, anterior-capsule distance was greater with GFS than with AFS (4.23 \u00b1 0.58 mm vs. 3.72 \u00b1 0.73 mm), corresponding to greater mean deepening from baseline under GFS (1.19 mm) than under AFS (0.63 mm). However, this difference was not statistically significant after adjustment for multiple comparisons. No significant inter-system differences were found at other timepoints, and overall discomfort scores were similar (p = 0.70). Conclusions: Intraoperative SS-OCT enabled real-time visualization and partial quantitative assessment of capsular-bag dynamics during cataract surgery. The observed difference at the initiation of phacoemulsification may suggest reduced anterior-capsule deepening with adaptive fluidics, but this comparison was not statistically significant after multiplicity adjustment. The 39.5% measurement failure rate underscores the need for technical refinement before routine clinical implementation.<\/jats:p>","DOI":"10.3390\/diagnostics16142282","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:35:52Z","timestamp":1784630152000},"page":"2282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility of Intraoperative SS-OCT for Assessing Capsular-Bag Dynamics During Cataract Surgery: Pilot Randomized Intra-Individual Comparison of Adaptive Versus Gravity-Based Fluidics"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0479-5894","authenticated-orcid":false,"given":"Stefan","family":"Georgiev","sequence":"first","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Palkovits","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Dana-Fisus","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2517-0375","authenticated-orcid":false,"given":"Manuel","family":"Ruiss","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Pilwachs","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Leisser","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Findl","sequence":"additional","affiliation":[{"name":"Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/j.jcrs.0000000000000457","article-title":"Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017","volume":"47","author":"Dickman","year":"2021","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1167\/iovs.08-2996","article-title":"Intraocular pressure and calculated diastolic ocular perfusion pressure during three simulated steps of phacoemulsification in vivo","volume":"50","author":"Zhao","year":"2009","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/j.jcrs.2008.04.042","article-title":"Effect of bottle height and aspiration rate on postocclusion surge in Infiniti and Millennium peristaltic phacoemulsification machines","volume":"34","author":"Ward","year":"2008","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jcrs.2015.08.017","article-title":"Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems","volume":"42","author":"Nicoli","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sharif-Kashani, P., Fanney, D., and Injev, V. (2014). Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol., 14.","DOI":"10.1186\/1471-2415-14-96"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.jcrs.2017.09.001","article-title":"Effect of high-vacuum setting on phacoemulsification efficiency","volume":"43","author":"Ting","year":"2017","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Luo, Y., Xu, G., Li, H., Ma, T., Ye, Z., and Li, Z. (2023). Application of the active-fluidics system in phacoemulsification: A review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020611"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.jcrs.2016.01.045","article-title":"Intraocular pressure study using monitored forced-infusion system phacoemulsification technology","volume":"42","author":"Jensen","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"619","DOI":"10.4103\/ijo.IJO_1146_18","article-title":"Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study","volume":"67","author":"Khokhar","year":"2019","journal-title":"Indian J. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1016\/j.jcrs.2011.05.039","article-title":"Outcomes of cataract surgery in eyes with a low corneal endothelial cell density","volume":"37","author":"Yamazoe","year":"2011","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liu, Y., Hong, J., and Chen, X. (2023). Comparisons of the clinical outcomes of Centurion\u00ae active fluidics system with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1294808"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1159\/000452158","article-title":"Cataract surgery with a new fluidics control phacoemulsification system in nanophthalmic eyes","volume":"7","author":"Chang","year":"2017","journal-title":"Case Rep. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1097\/j.jcrs.0000000000000664","article-title":"Efficacy and complications of cataract surgery in high myopia","volume":"47","author":"Yao","year":"2021","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_14","first-page":"438","article-title":"Effect of phacoemulsification on corneal endothelial cells in patients with axial high myopia and cataract","volume":"27","author":"Lin","year":"2019","journal-title":"J. Clin. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.jcrs.2004.01.030","article-title":"Management of lens-iris diaphragm retropulsion syndrome during phacoemulsification","volume":"30","author":"Cionni","year":"2004","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1097\/j.jcrs.0000000000000551","article-title":"Ocular biometry with swept-source optical coherence tomography","volume":"47","year":"2021","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1016\/j.ophtha.2013.04.007","article-title":"Reproducibility of a long-range swept-source optical coherence tomography ocular biometry system and comparison with clinical biometers","volume":"120","author":"Grulkowski","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/bjophthalmol-2013-304731","article-title":"Using continuous intraoperative optical coherence tomography measurements of the aphakic eye for intraocular lens power calculation","volume":"99","author":"Hirnschall","year":"2015","journal-title":"Br. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/j.jcrs.0000000000000812","article-title":"Evaluation of intraoperative aphakic eye axial length measurements using swept-source OCT","volume":"48","author":"Hienert","year":"2022","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.ophtha.2017.12.037","article-title":"The DISCOVER study 3-year results: Feasibility and usefulness of microscope-integrated intraoperative OCT during ophthalmic surgery","volume":"125","author":"Ehlers","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3315","DOI":"10.1364\/OL.35.003315","article-title":"Intraoperative spectral domain optical coherence tomography for vitreoretinal surgery","volume":"35","author":"Tao","year":"2010","journal-title":"Opt. Lett."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1364\/BOE.477386","article-title":"Surgical microscope integrated MHz SS-OCT with live volumetric visualization","volume":"14","author":"Britten","year":"2023","journal-title":"Biomed. Opt. Express"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jcjo.2021.05.018","article-title":"Agreement of optical coherence tomography thickness measurements between Heidelberg Eye Explorer and ImageJ software","volume":"57","author":"Mahmoudzadeh","year":"2022","journal-title":"Can. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5196","DOI":"10.1167\/iovs.13-11991","article-title":"Predicting the postoperative intraocular lens position using continuous intraoperative optical coherence tomography measurements","volume":"54","author":"Hirnschall","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.jcrs.2018.02.026","article-title":"Aqueous volume loss associated with occlusion break surge in phacoemulsifiers from 4 different manufacturers","volume":"44","author":"Aravena","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3323","DOI":"10.1007\/s40123-023-00814-w","article-title":"Fluid supplementation through weakened zonules via side-port incision to maintain intraocular pressure in high myopic eyes","volume":"12","author":"Wang","year":"2023","journal-title":"Ophthalmol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1080\/07853890.2022.2098375","article-title":"A prospective randomized clinical trial of active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract (AGSPC)","volume":"54","author":"Luo","year":"2022","journal-title":"Ann. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jcrs.2016.01.037","article-title":"Clinical study using a new phacoemulsification system with surgical intraocular pressure control","volume":"42","author":"Solomon","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40662-017-0087-5","article-title":"Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification","volume":"4","author":"Malik","year":"2017","journal-title":"Eye Vis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1007\/s10792-017-0674-4","article-title":"Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics","volume":"38","year":"2018","journal-title":"Int. Ophthalmol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:52:07Z","timestamp":1784631127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":30,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16142282"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16142282","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}