Episode 36: Resorbed Mature Cataract and Phacolytic Glaucoma
Ocular trauma suffered 30 years ago has left this young man with a calcified and partially resorbed cataract, advanced phacolytic glaucoma and complete absence of zonular support. Completing our 3-part
series of complicated cases, this video begins with a discussion of
the preoperative OCT image. During the procedure I discuss its formidable challenges and explain the methods necessary to remove the extremely rigid lens.
- Published in 2018 Videos
Episode 35: Dense nucleus, lax zonule and capsular tension ring insertion.
Continuing with complicated cases, this month I demonstrate removal of a dense cataract in an eye with zonular laxity and a possible preexisting posterior capsule defect. Techniques employed include hydrodelineation, insertion of capsule retractors, and insertion of a capsular tension ring.
- Published in 2018 Videos
Episode 34: They Only Get to Move Once…
We will finish up our year with 3 rather complex cases. This month, our 57 year old patient is extremely anxious about having cataract surgery. She had uveitis and glaucoma in childhood for which a nasal thermal sclerectomy was performed at the age of 8. She subsequently developed a cataract, but opted to postpone surgery until the lens had become quite dense. She has a low endothelial cell count, possibly as a result of prior uveitis and/or intraocular surgery. Because of patient movement during the early stages of the procedure, we use tape to restrain head movement and I deliver a retrobulbar block to improve her ability to remain stationary.
- Published in 2018 Videos
Episode 33: MIGS: Placement of a Trabecular Meshwork Stent to Lower IOP
We change it up a bit this month by showing 2 implantations of a stent into the trabecular meshwork in eyes with glaucoma. The first case shows a straightforward insertion, and the second demonstrates successful insertion after failure of the initial attempt.
The cataract and IOL insertion of each case were routine, so we present only the MIGS portion of each case.
- Published in 2018 Videos
Episode 32: Cataract, Vitreous Opacification and Zonular Weakness
For our viewers who have requested complexity, this one certainly fits the bill: a highly myopic eye with previous retinal detachment, scleral buckle and partial pars plana vitrectomy, residual anterior vitreous opacification, shallow anterior chamber, convex anterior capsule, extreme zonular weakness, infusion misdirection syndrome and 3 diopters of astigmatism requiring toric IOL implantation. Whew!
- Published in 2018 Videos
Episode 31: Anticipation and Prevention
This is a routine case during which I discuss anticipation and prevention of problems caused by patient coughing, infusion misdirection syndrome, and finally the intracameral antibiotic controversy.
- Published in 2018 Videos
Episode 30: Dense Nucleus with Pseudoexfoliation
In this case I demonstrate techniques used to remove a dense nucleus in an eye with pseudoexfoliation. Signs of Infusion Misdirection Syndrome and methods to protect the posterior capsule when this problem exists are also presented.
- Published in 2018 Videos
Episode 29: The Use of Intraoperative Aberrometry to Confirm Toric IOL Power Calculation in a Highly Myopic Eye
After first removing the anterior subcapsular cataract in a highly myopic patient, I then demonstrate the use of intraoperative aberrometry to confirm the toric IOL power calculation. Discussions include how to best manage a significantly deep chamber and how to correct the rare occurrence of a toric IOL that rotates postoperatively.
- Published in 2018 Videos
Episode 28: Phakic Refractive IOL Explantation and Simultaneous Cataract-IOL Implantation
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.
- Published in 2018 Videos
Episode 27: Determination of IOL Power in Keratoconic Eyes
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.
- Published in 2018 Videos
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