Pupillary IOL Removal, Soemmering Removal, Akreos IOL, and Posterior Lamellar Transplant DSAEK

Ozana Moraru, MD

Eyetube

The video presents a complex procedure in an eye with history of traumatic cataract in childhood, operated at that time by intracapsular extraction and implantation of a pupillary IOL. This IOL started to harm and decompensate the corneal endothelium. The patient presented with bullous keratopathy and a recommendation for corneal transplant. Ozana Moraru, MD, prepared for a posterior lamellar transplant UT-DSAEK (ultra-thin DSAEK) and removal of the pupillary IOL. After IOL removal, Dr. Moraru also observed two large and thick halves of a Soemmering long-standing cortex remnant. A superior iridotomy due to large atrophic iris was fixed by iris suture with the Siepser technique. Since there was no capsular support, she implanted an Akreos IOL sutured at the sclera in four points using Gore-Tex sutures.

Surgical Options for Patients With Cataracts and Open-Angle Glaucoma

Recent studies evaluated the efficacy of MIGS combined with phacoemulsification.

Maxwell de la Paz, BS, and Linda M. Tsai, MD

Cataract and Refractive Surgery Today

Key Takeaways Recent studies have evaluated the efficacy of MIGS combined with phacoemulsification in eyes with open-angle glaucoma. Trabecular procedures combined with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. Compared to phacoemulsification alone, combining the procedure with MIGS appeared to provide a greater reduction in IOP and the number of medications required postoperatively without decreasing safety. Trabecular Procedures Combined with Cataract Surgery for Open- Angle Glaucoma: A Report by the American Academy of Ophthalmology Richter GM, Takusagawa HL, Sit AJ, et al1Industry support for this study: None ABSTRACT SUMMARY This report compared the IOP reduction of various trabecular procedures combined with cataract surgery to that of cataract surgery alone in patients with hypertensive open-angle glaucoma (OAG). Patient-specific considerations that might guide procedure selection were also investigated. STUDY IN BRIEF A report drawing on 10 randomized controlled trials found that combining trabecular procedures with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. The trabecular procedures themselves showed no clear benefits over one another for IOP or medication reduction, but direct comparison studies are required. The risks of uveitis and bleeding were among the factors that might influence surgeons’ choice of trabecular procedure. WHY IT MATTERS In patients with well-controlled hypertensive open-angle glaucoma, cataract surgery may reduce their medication burden by 0.8 to 1 at 2 years. When cataract surgery is combined with a trabecular procedure, a further 0.4-reduction may occur.1,2 Because the combined trabecular procedures in this AAO report offered similar benefits, patient factors and surgeon preference may be more important when offering specific options.

A Rare Case of Choroidal Vitiligo

Recognize this uncommon sign of varicella-zoster reactivation.

Tina Tang, MD, and Nauman Chaudhry, MD

Retina Today

A 66-year-old immunocompetent woman with a history of recurrent cutaneous lesions was referred for evaluation of retinal lesions in the left eye noted during a routine examination. Her cutaneous lesions were characterized as discrete erythematous macules and small papules on her lower back. Her BCVA was 20/20 OU with normal IOPs and anterior segment examination. Dilated fundus examination of her left eye showed irregular yellowish choroidal lesions temporal to the macula and focal areas of hypopigmentation nasal to the disc (Figure 1). OCT of her left eye showed trace epiretinal membrane with no definite mass lesion (Figure 1, Inset). Fundus autofluorescence revealed hyperautofluorescence corresponding to the yellow lesions, along with hyperfluorescent changes on fluorescein angiography. ICG angiography of the left eye revealed early blocked cyanescence in the area of the lesions temporal to the macula (Figure 2A) with late foci of hyperfluorescence nasal and temporal to the disc (Figure 2B). Work-up revealed positive varicella-zoster virus (VZV) immunoglobulin G, but immunoglobulin M was negative. The ocular oncology service ruled out ocular lymphoma. Her choroidal lesions slowly enlarged over the next 6 years with regular monitoring and no definite mass on OCT (Figure 3).