In order to perform cataract surgery upon this non-English speaking patient, I first have to remove an iris-fixated anterior chamber lens implanted 11 years previous. This case highlights removal of the phakic IOL, the value of a translator during surgery and the use of intraoperative aberrometry to determine the correct IOL power.
This case demonstrates the use of intraoperative aberrometry plus the Aphakic Refraction Technique to best determine the final IOL power in a keratoconic eye. Tips for visualization, a comparison of phaco chop and divide and conquer and the advantages of a high IOP setting round out this very educational case.
Patience is a critically important trait for all surgeons to develop and maintain. In this patient, Dr Mackool demonstrates its value during removal of a red/brunescent cataract in a one-eyed patient.
In response to viewer requests, this video demonstrates the Divide and Conquer procedure using a curved ultrasonic needle (Balanced Tip). A useful method of eyelash isolation is also shown.
An eye with a shallow anterior chamber is at increased risk for endothelial cell loss during phacoemulsification. A convex anterior capsule increases the risk of anterior capsulotomy “runout”.
In this case I discuss and demonstrate techniques that protect the endothelium and prevent capsulorhexis problems in these eyes.
Determination of the correct IOL power for a highly myopic eye with posterior staphyloma is fraught with difficulty. Here I employ two methods that can permit measurement of both the spherical and astigmatic power of the desired IOL, including the degree of “retinal astigmatism” caused by the staphyloma. I demonstrate the use of both wavefront technology and the Aphakic Refraction Technique (manifest refraction) to calculate the power of the IOL that is then inserted on the day following
This patient has persistent negative dysphotopsia after cataract-implant surgery performed 18 months ago. A combination of techniques is used to achieve the desired reposition of the IOL optic (reverse optic capture).
Treatment of one diopter of astigmatism is also demonstrated by the placement of 2 penetrating limbal relaxing incisions (PLRIs) at the steep corneal meridian.
In this case I present a variety of phaco techniques and pearls as cataract extraction and multifocal IOL implantation is performed in an eye with a small pupil and moderately floppy iris. A spit screen is utilized to demonstrate surgeon hand position throughout most of the procedure.
A very interesting case, indeed! Here we will see a patient with considerable head movement, very advanced corneal endothelial dystrophy, pseudoexfoliation, and zonular laxity that prevents nucleus rotation.
This month’s case features methods for dealing with the problem of a patient with a very active Bell’s Phenomenon.
The use and design of my primary chopper to protect the posterior capsule during phacoemulsification, methods to remove extremely adherent lens cortex, and the creation of Penetrating Limbal Relaxing Incisions after implantation of a multifocal IOL are also discussed and demonstrated.