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.

Imaging Epiretinal Proliferation Using OCT

En face OCT–based identification of proliferative changes may guide surgical strategies in full-thickness macular holes.

Kotaro Tsuboi, MD

Retina Today

KEY TAKEAWAYS The presence of epiretinal proliferation is an important biomarker for determining surgical strategy when treating lamellar macular holes and full-thickness macular holes. Researchers can capture en face OCT imaging with customized segmentation settings to clearly visualize a subclinical proliferative change barely seen on traditional en face OCT with the superficial slab or cross-sectional image, termed preretinal abnormal tissue. The author proposes incorporating en face OCT imaging to improve the classification of fullthickness macular holes and identify preretinal abnormal tissue preoperatively. The author also recommends membrane peeling when preretinal abnormal tissue is detected on en face OCT. Epiretinal proliferation (EP), first described by Witkin et al in 2006, is a medium-reflective material that fills the space between the inner border of the epiretinal membrane (ERM) and the retinal nerve fiber layer on spectral-domain OCT (Figure 1A).1 EP is frequently observed in eyes with lamellar macular hole (LMH) and full-thickness macular hole (FTMH).2 When EP is identified with preoperative OCT, surgeons often encounter sticky yellowish tissues around the MH during surgery (Figure 1B). Figure 1. This preoperative cross-sectional OCT image demonstrates EP as a medium reflective material (arrow) located between the inner border of the ERM and the retinal nerve fiber layer (A). Intraoperatively, EP is seen as a sticky yellowish tissue contiguous to the MH during membrane peeling (B, arrow). Here, I discuss the value of EP detection with en face OCT and propose its inclusion in preoperative imaging for MHs. WHY EPIRETINAL PROLIFERATION MATTERS The presence of EP is an important biomarker for determining surgical strategy.