Supplementary Material for: Case Report: Successful Cataract Surgery in a Patient with a Port Delivery System (PDS) Implant for Diabetic Macular Edema

The Port Delivery Platform with ranibizumab (PDS) with ranibizumab is a novel, surgically implanted device designed for continuous intraocular anti-VEGF delivery, approved for neovascular age-related macular degeneration and other retinal vascular diseases, including diabetic macular edema (DME) and diabetic retinopathy (DR). While it can reduce treatment burden, the PDS implant introduces unique surgical considerations, particularly during subsequent ocular procedures. We report a case of successful cataract extraction and intraocular lens implantation in a 72-year-old female with a PDS implant for DME, enrolled in the Pagoda trial. Cataract surgery was performed via clear corneal incisions while carefully avoiding manipulation of the conjunctiva or implant. The procedure was uneventful, and the implant remained stable intraoperatively and postoperatively. The patient experienced improved visual acuity and underwent an uncomplicated implant refill after 15 days with confirmation of adequate implant coverage at the 6-month follow-up. This case highlights key surgical considerations to preserve implant integrity and conjunctival health during cataract surgery in eyes with PDS implants. To our knowledge, this is the first report of cataract surgery in a PDS-implanted eye outside a clinical trial, emphasizing that standard phacoemulsification techniques can be safely adapted with proper precautions in this context.