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.

Refractive Lens Exchange in the Presbyopic Gray Zone

Optimizing outcomes through patient selection and expectation-setting.

Travis Parker, MD, and Greg Parkhurst, MD

Cataract and Refractive Surgery Today

Presbyopia is profoundly frustrating for patients. This age-related condition manifests as a progressive loss of accommodation that impairs their near and intermediate visual acuity. Patients may strain to read and may experience intermittently blurry distance vision due to accommodative spasm. They also find themselves increasingly reliant on optical aids and other work-arounds to perform everyday tasks—challenges that can substantially erode their quality of life. Refractive lens exchange (RLE) has emerged as a highly effective intervention for the majority of suitable presbyopic patients. The procedure can substantially reduce the spectacle dependence of appropriately selected candidates and enhance their visual function across all distances. In our practice, RLE consistently yields high patient satisfaction rates. The procedure not only corrects presbyopia, but it also preempts future cataract development, making RLE a comprehensive, long-term solution. There is, however, a presbyopic gray zone inhabited by patients who have excellent corrected distance visual acuity, no cataracts, and increasing difficulty with their near visual acuity. Achieving optimal outcomes in these individuals requires meticulous patient selection, a thorough preoperative evaluation, and precise expectation alignment.

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