Pinguecula As A Natural Landmark For Temporal Cci Planning: A Verion-Based Angular Reliability Study

Published 2026 - 44th Congress of the ESCRS

Reference: PP09.03 | Type: Free paper | DOI: 10.82333/21ed-m314

Authors: Dr Dora Marinčić* ¹ , Prof. Dr Biljana Kuzmanović Elabjer ² , Dr Tea Frkanec ¹ , Prof. Dr Mladen Bušić ²

¹University Hospital "Sveti Duh",University Eye Department,Zagreb,Croatia;University Josip Juraj Strossmayer in Osijek,Faculty of Dental Medicine and Health Osijek,Osijek,Croatia, ²University Hospital "Sveti Duh",University Eye Department,Zagreb,Croatia;University Josip Juraj Strossmayer in Osijek,Faculty of Dental Medicine and Health Osijek,Osijek,Croatia;University Josip Juraj Strossmayer in Osijek,Faculty of Medicine Osijek,Osijek,Croatia

Purpose

To evaluate whether pinguecula can serve as a natural anatomical landmark for planning a temporal clear corneal incision (CCI) at the horizontal (0°/180°) meridian by measuring its angular closeness using VERION imaging.

Setting

University Eye Department, University Hospital "Sveti Duh", Zagreb, Croatia

Methods

Prospective observational study of cataract-surgery candidates (Jan 2023–Jan 2024). Pinguecula (temporal and, when present, nasal) was identified via slit-lamp examination and on VERION™ Image Guided System images. Angular deviation (degrees) between the superior border of the pinguecula and the horizontal meridian (0°/180°) was recorded. Primary endpoint was the proportion of measurements within ±5° (exact binomial 95% confidence interval [CI]). Outcomes were additionally reported separately for temporal and nasal pingueculae.

Results

Data included 144 patients, 229 eyes, and 250 measurements with recorded deviation. A total of 250 pinguecula measurements with recorded deviation were analysed (temporal n=97; nasal n=153). Overall, pinguecula lay within ±5° of the horizontal meridian in 191/250 measurements (76.4%; 95% CI 70.6–81.5). Among measurements within ±5°, deviation was 2.2±1.8°(mean±SD) and median 2°(IQR 0–3). Temporal pingueculae: 71/97 (73.2%; 95% CI 63.2–81.7) within ±5°; within-±5° deviation median 3° (IQR 1–4). Nasal pingueculae: 120/153 (78.4%; 95% CI 71.1–84.7) within ±5°; within-±5° deviation median 2° (IQR 0–3).

Conclusions

Pinguecula demonstrated moderate-to-high positional reliability within ±5° of the horizontal meridian overall (76.4%), with comparable performance for temporal and nasal lesions, supporting its utility as a practical natural landmark for temporal CCI planning when digital marking is unavailable. However, while pinguecula may serve as a useful natural cue, achieving a ±5° target may still require adjunctive marking or image-guidance systems when high precision is desired.