Purpose: To develop a preoperative risk score to predict the need for anesthesiologist intervention during cataract surgery under topical anesthesia, aiming to minimize the routine anesthesiologists’ presence in the operating room without compromising patient safety. Methods: This retrospective observational study included 817 patients who underwent phacoemulsification with intraocular lens implantation under topical anesthesia at the Eye Clinic of Trieste from April to October 2022. Preoperative ocular and systemic data were analysed. Univariate and multivariate logistic regression analyses were used to identify significant predictors of anesthesiologist intervention, forming a scoring system. The optimal cut-off value of the scoring system was determined using the receiver operating characteristic (ROC) curve analysis, with Youden's Index applied to maximize sensitivity and specificity Results: Key risk factors for anesthesiologist intervention included advanced age (>90 years), corneal opacities, retinal pathologies that required intravitreal treatment, high-grade cataract opacity (LOCS III stages 5 and 6), poor mydriasis (pupil diameter <4.0 mm), poor patient compliance, shallow anterior chamber depth (<2.5 mm), and phacodonesis. The scoring system demonstrated 73.5% sensitivity and 69.2% specificity, with a cut-off correlating with a higher likelihood of intervention. Conclusion: The proposed preoperative risk score effectively identifies patients needing anesthesiologist involvement during cataract surgery, optimizing resource allocation. Further studies should incorporate additional systemic health parameters to enhance predictive capability, promoting efficient and safe surgical practices in ophthalmology.

Background/Objectives: Enhanced monofocal intraocular lenses (IOLs) aim to extend functional vision into the intermediate range while preserving the distance visual quality of standard monofocal aspheric lenses. This study compared the clinical and patient-reported outcomes of two enhanced monofocal IOLs, TECNIS Eyhance™ and Evolux™, and characterised the anterior surface profile of the Evolux™ optic. Methods: This single-centre, retrospective comparative case series included consecutive patients who received bilateral implantation of either Evolux™ or TECNIS Eyhance™ between February and July 2023. Primary outcomes were monocular uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA). Secondary outcomes included monocular and binocular distance and near visual acuity, binocular intermediate visual acuity, spherical equivalent and patient-reported outcomes assessed using the Revised Heidelberg Daily Task Evaluation (DATE) questionnaire. Equivalence testing, Welch’s t-test, and covariate-adjusted ANCOVA were performed. Anterior surface profilometry of the Evolux™ IOL was conducted using an optical profilometer. Results: A total of 44 patients were included, 14 in the Evolux™ group and 30 in the TECNIS Eyhance™ group. Monocular and binocular UIVA and DCIVA were statistically equivalent between groups (TOST p = 0.028, 0.016, 0.008, and 0.005, respectively). Monocular and binocular distance outcomes were likewise equivalent. Binocular distance-corrected near visual acuity was significantly better in the Evolux™ group (0.164 ± 0.084 vs. 0.233 ± 0.112 logMAR; p = 0.030; Cohen’s d = 0.661), without a corresponding monocular difference. This isolated finding should be interpreted cautiously given the exploratory, multiple-outcome analysis and because it did not retain statistical significance after covariate adjustment for baseline biometric imbalances. Conclusions: In this exploratory study, both IOLs showed no statistically significant differences in intermediate and distance visual outcomes at one month after second eye surgery. The unadjusted binocular near vision finding for Evolux™, which did not retain significance after covariate adjustment, warrants further investigation in prospective, adequately powered, biometrically balanced studies.