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.

A Patient-Centered Counseling Framework

Explain dysfunctional lens syndrome, set expectations for presbyopia-correcting lens optics, and troubleshoot early dissatisfaction.

Jason E. Stahl, MD

Cataract and Refractive Surgery Today

When I counsel patients on refractive lens exchange (RLE), I describe it as a four-in-one procedure. With today’s advanced technologies, we surgeons can correct patients’ distance vision, we can correct their near vision, we can prevent cataracts so they will not need cataract surgery later, and we can stabilize what I consider the unstable part of the optical system—the crystalline lens. I explain that we are treating dysfunctional lens syndrome not only to improve patients’ vision today but for the rest of their lives, and I describe RLE as the ultimate antiaging procedure. Twenty-five years ago, it was difficult to explain to patients with presbyopia why a lens-based approach might be preferable to corneal refractive surgery. That gap largely reflected what was lacking: a dysfunctional lens syndrome framework, advanced lens implants, and diagnostics that could show patients what was changing in the crystalline lens and why a lens-based approach might be a better long-term strategy than LASIK in the presbyopic age group. A SHARED FRAMEWORK: DYSFUNCTIONAL LENS SYNDROME The term dysfunctional lens syndrome (DLS) helped bridge the aforementioned gap by framing aging of the crystalline lens as a spectrum rather than a binary cataract/no cataract diagnosis. The DLS model breaks down as follows: Stage No. 1 is presbyopia—a loss of accommodation and “zoom”; Stage No. 2 reflects the progressive degradation of optical quality, including early lenticular opacification and an increasing magnitude of higher-order aberrations that can reduce contrast sensitivity, dampen brightness, and alter color perception; and Stage No. 3 is a visually significant cataract that interferes with the activities of daily living.1 MAKING LENTICULAR CHANGES VISIBLE: OBJECTIVE DIAGNOSTICS Objective diagnostics further improved patient education.

More than 3 Million Bottles of Eye Drops Recalled

Eyetube

A major recall is announced for several store-brand OTC eye drops; the FDA extends dosing intervals for Eylea HD in patients with Wet AMD and DME; and Bausch + Lomb launches its second full range of vision IOL in Europe. Learn more about your ad choices. Visit megaphone.fm/adchoices