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.
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!
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.
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.
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.
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.