Removal Of Cortex Research Articles

Finger-Controlled Nonultrasonic Lens Extractor.

To report initial surgical experience and learning curve with a novel finger-controlled, ultrasoundless lens extractor device and provide insights for future surgical endeavors. Bascom Palmer Eye Institute (Miami, FL). Single-center, non-comparative, retrospective, consecutive case series. 61 eyes of 51 individuals with cataract. All surgeries were performed with the miCOR® 700 lens extractor (Carl Zeiss Meditec Inc, Dublin, CA) by a single experienced physician. Nuclear density was graded preoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP) and pachymetry were evaluated pre- and postoperatively. Surgical videos were reviewed to collect data on time for each surgical step and complications. Regression analyses assessed the learning curve, performance improvement and effects of nuclear density on surgical time and postoperative pachymetric variation. Subjects had a mean age of 72.2 ± 7.6 years. Increased surgical experience significantly reduced procedure time (P < 0.001), nuclear removal time (P = 0.018) and cortex removal time (P = 0.002). Higher nuclear density resulted in longer procedure (P < 0.001) and nuclear removal time (P < 0.001). One posterior capsular rent occurred, not attributed to the lens extractor. No thermal damage to the corneal wound was observed. Postoperative CDVA improved significantly (P < 0.001 for eyes without ocular comorbidities, P = 0.016 for eyes with ocular comorbidities). All cases of corneal edema and IOP spikes resolved within a month. The miCOR® 700 lens extractor offers an innovative, cost-effective approach to cataract surgery. Further research is needed to compare it with conventional phacoemulsification techniques.

Phacoemulsification to MSICS: A transfer of skills study in a simulated environment.: Transfer of phacoemulsification surgical skills to MSICS.

To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Copenhagen Academy for Medical Education and Simulation, Denmark. Prospective controlled experimental study. The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis. The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.

3D Heads-up digital filters for cataract surgery and corneal transplantation.

To describe the advantages of Ngenuity 3D digital filters for enhancing visualization during cataract and corneal transplant surgery. All surgeries were performed by the same experienced surgeon (L.M.) using the Ngenuity 3D heads-up visualization system connected to a microscope. Images were simultaneously captured with and without the filter in each of the following phases: endothelial evaluation, capsulorhexis, capsule rupture, vitreous leak, cortex removal, visco removal, corneal suture, descemetorhexis, DMEK graft preparation and insertion. In cataract surgery, green and monochrome filters facilitate capsulorhexis in difficult situations by highlighting the anterior capsule and can improve visualization of a posterior capsular tear. The enhanced contrast of the monochrome filter is also useful for cortex and viscoelastic removal. In corneal surgery, the green filter highlights the rim of the DMEK graft during tissue preparation, the yellow filter enhances the contrast of the stained DMEK graft in the anterior chamber, the monochrome filter simplifies descemetorhexis by improving visualization of the Descemet/endothelial layer and allows a better view in red saturated images while performing sutures. Ngenuity digital filters have the potential to enhance tissue visualization during cataract and corneal surgeries, especially in poor visibility conditions.

Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology.

Evaluate the impact of high vs low intraoperative intraocular pressure (IOP) during phacoemulsification on anterior and posterior physiology. Private practice in Des Moines, Iowa. Prospective, randomized, paired-eye clinical trial of patients anticipating bilateral cataract surgery. 27 participants randomized at the time of their first cataract surgery to either low IOP or high IOP group. The subsequent cataract surgery was performed under the alternate condition. During phacoemulsification and cortex removal, IOP was maintained either at low (≤28 mm Hg) or at high (≥55 to 60 mm Hg) levels. The primary outcome was fluid usage, with secondary outcomes of central corneal thickness, foveal avascular zone area, foveal and macular thickness, endothelial cell density (ECD), and postoperative inflammation. Surgery with low IOP settings used less fluid (40.0 mL vs 55.6 mL, P < .0001). Corneal thickness changes were smaller in low IOP eyes at 1 day and 1 week (3.0% vs 8.1%, P = .01; 3.1% vs 4.4%, P = .01) but were similar by 1 and 3 months. ECD dropped less in low IOP eyes at 1 and 3 months (-1.7% vs -12.3%, P = .001, 2.1% vs -8.9%, P = .0003.) IOP remained a significant predictor of ECD change when relationship was controlled for fluid use and phacoemulsification energy. Retinal parameters did not vary among all eyes or when compared by IOP setting. Visual acuity was similar at all timepoints. Low IOP settings resulted in less inflammation and less corneal trauma, as evidenced by a smaller drop in ECD and less postoperative corneal edema, when compared with high IOP settings. Retinal parameters did not change significantly. The different outcomes did not result in a difference in visual acuity.

Modeling delay of age at natural menopause with planned tissue cryopreservation and autologous transplantation

Ovarian tissue cryopreservation has been proven to preserve fertility against gonadotoxic treatments. It has not been clear how this procedure would perform if planned for slowing ovarian aging. This study aimed to determine the feasibility of cryopreserving ovarian tissue to extend reproductive life span and delay menopause by autotransplantation near menopause. Based on the existing biological data on follicle loss rates, a stochastic model of primordial follicle wastage was developed to determine the years of delay in menopause (denoted by D) by ovarian tissue cryopreservation and transplantation near menopause. Our model accounted for (1) age at ovarian tissue harvest (21-40 years), (2) the amount of ovarian cortex harvested, (3) transplantation of harvested tissues in single vs multiple procedures (fractionation), and (4) posttransplant follicle survival (40% [conservative] vs 80% [improved] vs 100% [ideal or hypothetical]). Our model predicted that, for most women aged <40 years, ovarian tissue cryopreservation and transplantation would result in a significant delay in menopause. The advantage is greater if the follicle loss after transplant can be minimized. As an example, the delay in menopause (D) for a woman with a median ovarian reserve who cryopreserves 25% of her ovarian cortex at the age of 25 years and for whom 40% of follicles survive after transplantation would be approximately 11.8 years, but this extends to 15.5 years if the survival is 80%. As another novel finding, spreading the same amount of tissue to repetitive transplants significantly extends the benefit. For example, for the same 25-year-old woman with a median ovarian reserve, 25% cortex removal, and 40% follicle survival, fractionating the transplants to 3 or 6 procedures would result in the corresponding delay in menopause (D) of 23 or 31 years. The same conditions (3 or 6 procedures) would delay menopause as much as 47 years if posttransplant follicle survival is improved to 80% with modern approaches. An interactive Web tool was created to test all variables and the feasibility of ovarian tissue freezing and transplantation to delay ovarian aging (here). Our model predicts that with harvesting at earlier adult ages and better transplant techniques, a significant menopause postponement and, potentially, fertile life span extension can be achieved by ovarian tissue cryopreservation and transplantation in healthy women.

Safety and efficiency of lens cortex removal assisted by fluid jet

BackgroundThis retrospective study investigated the safety and efficiency of lens cortex removal assisted by a fluid-based capsular polishing technique called a fluid jet. MethodsThis was a retrospective case study. A total of 300 patients were included in this study. All patients underwent phacoemulsification using two different surgical sequences: a fluid jet before irrigation/aspiration (I/A) and an I/A before the fluid jet. They were divided into two groups: the fluid jet before I/A group (group 1, 150 eyes) and the I/A before the fluid jet group (group 2, 150 eyes). The frequencies of posterior capsule rupture (PCR) and posterior capsule being sucked into the I/A tip were recorded. The times of the fluid jet, I/A cortex, and entire procedure were noted. ResultsPCR occurred only in group 2. Compared with group 1, the posterior capsule being sucked into the I/A tip was more frequent in group 2 (P = 0.003). The fluid jet time was longer in group 1 than that in group 2 (P < 0.001). The I/A cortex time was shorter in group 1, and total time for fluid jet and I/A cortex together was shorter in group 2 (P = 0.014 and P = 0.007, respectively). However, the time of the entire procedure was shorter in group 1 (P < 0.001). ConclusionsFluid jet-assisted lens cortex removal is safe, time-saving, and simple to perform.

Distinct patterns of interictal intracranial EEG in focal cortical dysplasia type I and II

ObjectiveFocal cortical dysplasia (FCD) is the most common malformation causing refractory focal epilepsy. Surgical removal of the entire dysplastic cortex is crucial for achieving a seizure-free outcome. Precise presurgical distinctions between FCD types by neuroimaging are difficult, mainly in patients with normal magnetic resonance imaging findings. However, the FCD type is important for planning the extent of surgical approach and counselling. MethodsThis study included patients with focal drug-resistant epilepsy and definite histopathological FCD type I or II diagnoses who underwent intracranial electroencephalography (iEEG). We detected interictal epileptiform discharges (IEDs) and their recruitment into repetitive discharges (RDs) to compare electrophysiological patterns characterizing FCD types. ResultsPatients with FCD type II had a significantly higher IED rate (p < 0.005), a shorter inter-discharge interval within RD episodes (p < 0.003), sleep influence on decreased RD periodicity (p < 0.036), and longer RD episode duration (p < 0.003) than patients with type I. A Bayesian classifier stratified FCD types with 82% accuracy. ConclusionTemporal characteristics of IEDs and RDs reflect the histological findings of FCD subtypes and can differentiate FCD types I and II. SignificancePresurgical prediction of FCD type can help to plan a more tailored surgical approach in patients with normal magnetic resonance findings.

Twist Technique to Stop Fluid Leakage and Fixate the Eye During Bimanual Cortex Removal in Phacoemulsification.

Leakage of fluid through the side port during aspiration of the cortex leads to instability of the anterior chamber. In addition, eye movement may cause an unintended pulling of the irrigation probe out of the corneal wound resulting in collapsing of the anterior chamber. Both situations could pose a challenge to the surgeon and increase the risk of serious intraoperative complications. Therefore, we describe a simple effective maneuver to avoid these conditions during bimanual cortex removal and viscoelastic washout. In Khaled technique, rotating the irrigation probe outwards causes complete occlusion of the lumen of the side port and a simultaneous stabilization of the anterior chamber. Twisting the incision by the irrigation probe also offers better fixation of the eye at the edge of the side port and a subsequent reduction of eye movement.

A robust role for motor cortex.

The role of motor cortex in non-primate mammals remains unclear. More than a century of stimulation, anatomical and electrophysiological studies has implicated neural activity in this region with all kinds of movement. However, following the removal of motor cortex, rats retain most of their adaptive behaviors, including previously learned skilled movements. Here we revisit these two conflicting views of motor cortex and present a new behavior assay, challenging animals to respond to unexpected situations while navigating a dynamic obstacle course. Surprisingly, rats with motor cortical lesions show clear impairments facing an unexpected collapse of the obstacles, while showing no impairment with repeated trials in many motor and cognitive metrics of performance. We propose a new role for motor cortex: extending the robustness of sub-cortical movement systems, specifically to unexpected situations demanding rapid motor responses adapted to environmental context. The implications of this idea for current and future research are discussed.

How keratin cortex thickness affects iridescent feather colours.

The bright, saturated iridescent colours of feathers are commonly produced by single and multi-layers of nanostructured melanin granules (melanosomes), air and keratin matrices, surrounded by an outer keratin cortex of varying thicknesses. The role of the keratin cortex in colour production remains unclear, despite its potential to act as a thin film or absorbing layer. We use electron microscopy, optical simulations and oxygen plasma-mediated experimental cortex removal to show that differences in keratin cortex thickness play a significant role in producing colours. The results indicate that keratin cortex thickness determines the position of the major reflectance peak (hue) from nanostructured melanosomes of common pheasant (Phasianus colchicus) feathers. Specifically, the common pheasant has appropriate keratin cortex thickness to produce blue and green structural colours. This finding identifies a general principle of structural colour production and sheds light on the processes that shaped the evolution of brilliant iridescent colours in the common pheasant.

Nd:YAG Laser Capsulotomy Rates in the Netherlands; Practice Variation and Association with Physician Practice Styles.

To determine the practice variation in rate of Nd:YAG laser capsulotomy within one year after cataract surgery and to identify possible associations with physician practice styles. All hospitals and private clinics in The Netherlands. Retrospective observational study. In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centres with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification. The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each centre (Pearson correlation coefficient, 0.89, P < 0.001). In general, ophthalmology centres with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (instead of bimanual), and more often used hydrophilic IOLs (compared to only using hydrophobic IOLs). We found a significant practice variation in performing Nd:YAG laser capsulotomy within one year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.

Quelling the Area Tempesta: Removal of the Piriform Cortex Improves the Outcomes of Surgery for Temporal Lobe Epilepsy.

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Commentary: Changing trends and preferred surgeons' practice for nucleus delivery in manual small-incision cataract surgery-Haven't they changed?

Commentary: Changing trends and preferred surgeons' practice for nucleus delivery in manual small-incision cataract surgery-Haven't they changed?

Vacuum-assisted cortex removal - A novel change to the tradition.

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum.

O-225 Endometrioma and fertility preservation: how can we save the oocytes?

Abstract Endometriosis is a benign estrogen-dependent disease In the ovary, endometrioma formation may cause local inflammation, giving rise to structural alterations to the ovarian cortexwhich manifest as massive fibrosis and loss of cortex-specific stroma that maintains follicular nests. Subsequent dysregulation of folliculogenesis results in “burn out” of the stockpile of dormant follicles. Moreover, endometriomas contain much higher concentrations of free iron, reactive oxygen species (ROS) and proteolytic enzymzes which could reach adjacent ovarian tissue and lead to follicular loss and intraovarian vascular injury. Fertility preservation is a major challenge when therapeutic approaches of ovarian endometrioma are contemplated. Surgery is often proposed in cases of endometrioma more than 3 cm in size but there are two main risks associated with the surgical treatmant of endometrioma : 1. the risk of excessive surgery (removal or destruction of normal ovarian cortex together with the endometrioma pseudocapsula).Close the ovarian hilus, ovarian tissue removed with the endometrioma wall contained follicles in more than 60% of cases in a study of Muzii and some meta-analyses have revealed significant decreases in AMH after excision. 2. The risk of incomplete surgery with subsequent early recurrence. A correct surgical approach is therefore the first step to preserve oocytes and several techniques are discussed. How to preserve fertility in women at risk of premature ovatian insufficiency (POI) due to severe and/or recurrent ovarian endometriosis? Two main options are currently available : 1. COS,ovum pick-up and vitrification of oocytes is an important fertility preservation approach. Cobo et all published several series and reported high cumulative live birth rates in women less than 35 years, suggesting that patients with endometrioma should be encouraged to freeze oocytes at a younger age. 2. In some circonstances, orthotopic autotransplantation of cryopreserved ovarian cortex (which has led to more than 200 live births ) could be proposed to maintain the follicular pool.

Surgical Results of Phacoemulsification Performed by Residents: A Time-Trend Analysis in a Teaching Hospital from 2005 to 2021.

Purpose To report a long-term trend of surgical results of phacoemulsification performed by residents in a teaching hospital. Methods This study analyzed 1,409 consecutive cases of phacoemulsification performed by residents under a single supervisor from July 2005 to March 2021. The 15.75-year period was divided into seven equal intervals for time-trend analysis. Main Outcome Measures. Rates of completion and complications were collected to assess the surgical results. Results The overall completion rate was 60.5% (852/1409), and the intraoperative complication rate was 14.5% (204/1409). The completion rates from the first to the seventh interval were 44.7%, 54.2%, 60.6%, 50.6%, 65.1%, 72.5%, and 81.8%, respectively. The completion rate improved significantly with time, mainly in the steps of anterior capsulorhexis and nucleus emulsification. The intraoperative complication rates from the first to the seventh interval were 27.4%, 20.4%, 14.0%, 11.8%, 8.2%, 9.6%, and 7.3%, respectively. The complication rate also decreased significantly with time, mainly in the steps of anterior capsulorhexis, nucleus emulsification, and cortex removal. The major complications included anterior capsulorhexis tear (n = 95), vitreous loss (n = 40), iris damage or prolapse (n = 36), and posterior capsule tear without vitreous loss (n = 29). There was a significant improvement of surgical results with the level of residency in the completion rate but not in the complication rate. Conclusions With a long-term evolution in the surgical training curriculum, it is possible to reach a goal of both higher completion and lower complication rates of resident-performed phacoemulsification.

Comment on: Purifying air over the operating field with a new mobile laminar airflow device to reduce the possibility of airborne contamination.

We were interested to read the recent article by Osher et al.1 We had also previously reviewed the poster by Osher and Figueiredo, “A New Technology for Purifying the Surgical Field”, at the 2019 ASCRS Annual Meeting in San Diego that had a nice picture of the Operio System located adjacent to the patient and the surgical field. Point 1, we wish that photograph had been included in this article and the reason for the orientation or of the machine discussed further in the article. Prior to the San Diego meeting, we became concerned with the plethora of lint-like fibers on the surgical field at our institution, both clear and blue, particularly after visualizing one in Bela Lugosi-like horror in the anterior chamber on the first postoperative day (Figure 1). After recovery and ensuring that the patient did not develop endophthalmitis, we initiated a Quality Assurance Project that sought to identify the number, risk factors, and location of these fibers during a senior resident's 3-month surgical rotation (A.H.). Eighty-nine surgeries were performed between the attending and the senior resident, and 15 fibers were identified. Most fibers were seen on the approach to the eye as an instrument was inserted, but 7 were seen in the eye during nucleus manipulation, capsulorhexis, and cortex removal. Similar to the article by Osher et al., we had no episodes of toxic anterior segment syndrome, chronic uveitis, or endophthalmitis (Table 1).Figure 1 Table 1. - Fiber Location During Phacoemulsification Surgery. Cataract procedure step Cases, n Intracameral moxifloxacin injection 3 Cortex removal 3 Capsulorhexis 2 Nuclear cracking and manipulation 2 Wound closure 2 IOL injection 1 Viscoelastic removal 1 Trabecular microbypass device 1 Regarding Table 2, the denominator is 99 in the laminar flow group and 50 in the control group. We noted on initial review that the total number of fibers seen in the laminar air flow group was 13 in 99 eyes vs the control group of 16 in 50 eyes, which is only a difference of 3, which if we increased the denominator to 100 in the control group, the total number of fibers would probably double. In personal communication with the primary author, it became clear that the salient point that the article conveyed is that in the laminar air flow group, the number of fibers directly on the field was zero. In other words, all fibers in the laminar air flow group were brought onto the surgical field by an instrument that is similar to our small series, which had a very high fiber rate of 16.9%. Watson et al. in their comment on this article focus on the trend to move toward office-based surgery and they discuss a laminar downflow hood that they have been using for 1 year.2 As such, Osher et al. and Watson et al. should be complimented for addressing important factors in our surgical microenvironments including air flow, ventilation systems, the revolving door-like atmosphere in a teaching environment, and our drapes and gowns. Point 2, we would go further, like our orthopedic colleagues, to attempt to close our operating rooms to transit to protect the laminar flow, locate our automated medication dispensing systems inside our operating rooms, and recommend that we seek to eliminate or find alternatives to article and cloth-based drapes and towels. We support the efforts by Osher et al. to eliminate what we aptly defined in our Quality Assurance Project as “Fibers, Fibers, Everywhere!”

How to Manage the Cortex After CTR Insertion.

Capsular tension ring (CTR) realizes safe cataract surgery. However, residual cortex removal becomes difficult with CTR. Originally, the flushing technique was developed for intracameral antibiotic administration. Using this technique with larger amounts of solution enables surgeons to 1) deliver antibiotics to the anterior chamber and area behind the intraocular lens, resulting in stable, scheduled antibiotic concentration and 2) entirely irrigate and displace the area, leading to the effective cleansing of residual substances and bacterial pollution. When performing the flushing technique, the residual cortex and debris that were not eliminated by ordinary irrigation and aspiration can be pushed out to the anterior chamber. Applying flushing technique to CTR cases, the residual cortex and debris trapped between the CTR loop and capsular equator is lifted into the anterior chamber and easily removed. If the capsular bag is polluted by bacteria, it may also be lifted to the anterior chamber.

Hydro-dispersion of subincisional cortex

BackgroundA simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.MethodsA disposable 27-gauge blunt needle attached to a 5.0-ml syringe containing balanced salt solution (BSS) is introduced through the side port incision into the anterior chamber. The tip of the needle is directed toward the capsule fornix beneath the incision site, and BSS is flushed to disperse the remaining cortex. Thereafter, the coaxial irrigation/aspiration device is used to remove the loosened cortex.ResultsThis technique was used in 60 eyes of 60 patients with difficulty of removing cortical remnant in the subincisional space. Subincisional cortical material was successfully removed in 93.3% (56/60 eyes). There were no intraoperative and postoperative complications related to this procedure.ConclusionsThe hydro-dispersion technique is a simple and safe approach to remove the subincisional cortical material that is difficult to manage with the standard coaxial irrigation/aspiration device.

Evaluation of Artificial Intelligence–Based Intraoperative Guidance Tools for Phacoemulsification Cataract Surgery

Complications that arise from phacoemulsification procedures can lead to worse visual outcomes. Real-time image processing with artificial intelligence tools can extract data to deliver surgical guidance, potentially enhancing the surgical environment. To evaluate the ability of a deep neural network to track the pupil, identify the surgical phase, and activate specific computer vision tools to aid the surgeon during phacoemulsification cataract surgery by providing visual feedback in real time. This cross-sectional study evaluated deidentified surgical videos of phacoemulsification cataract operations performed by faculty and trainee surgeons in a university-based ophthalmology department between July 1, 2020, and January 1, 2021, in a population-based cohort of patients. A region-based convolutional neural network was used to receive frames from the video source and, in real time, locate the pupil and in parallel identify the surgical phase being performed. Computer vision-based algorithms were applied according to the phase identified, providing visual feedback to the surgeon. Outcomes were area under the receiver operator characteristic curve and area under the precision-recall curve for surgical phase classification and Dice score (harmonic mean of the precision and recall [sensitivity]) for detection of the pupil boundary. Network performance was assessed as video output in frames per second. A usability survey was administered to volunteer cataract surgeons previously unfamiliar with the platform. The region-based convolutional neural network model achieved area under the receiver operating characteristic curve values of 0.996 for capsulorhexis, 0.972 for phacoemulsification, 0.997 for cortex removal, and 0.880 for idle phase recognition. The final algorithm reached a Dice score of 90.23% for pupil segmentation and a mean (SD) processing speed of 97 (34) frames per second. Among the 11 cataract surgeons surveyed, 8 (72%) were mostly or extremely likely to use the current platform during surgery for complex cataract. A computer vision approach using deep neural networks was able to pupil track, identify the surgical phase being executed, and activate surgical guidance tools. These results suggest that an artificial intelligence-based surgical guidance platform has the potential to enhance the surgeon experience in phacoemulsification cataract surgery. This proof-of-concept investigation suggests that a pipeline from a surgical microscope could be integrated with neural networks and computer vision tools to provide surgical guidance in real time.