Search
Search
Gary Hirshfield MD
Show Description +
In this case, Dr. Gary Hirshfield removes an unstable in-the-bag IOL following a posterior capsular rent and replaces it with a sulcus IOL. The Akreos IOL is cut and extricated with the Mackool Lens Removal System. When the sulcus lens in inserted, the nasal haptic goes under the anterior capsule. After the lens is maneuvered into place with the aid of a kuglen hook and plenty of OVD, Kenalog is introduced to confirm the absence of vitreous.
Posted: 11/03/2009
Gary Hirshfield MD
In this case, Dr. Gary Hirshfield removes an unstable in-the-bag IOL following a posterior capsular rent and replaces it with a sulcus IOL. The Akreos IOL is cut and extricated with the Mackool Lens Removal System. When the sulcus lens in inserted, the nasal haptic goes under the anterior capsule. After the lens is maneuvered into place with the aid of a kuglen hook and plenty of OVD, Kenalog is introduced to confirm the absence of vitreous.
Posted: 11/03/2009
.00_15_53_12.Still001_1750861703.png?auto=compress,format&w=504)
Please log in to leave a comment.
Comments
Just Now
karsten burdach
6 years ago
Dear Gary, what was the reason for not suturing this lens, using a Gore-Tex transscleral-sutured method, as that lens has 4 haptics, which is ideal for that technique?
Thandeka Myeni
12 years ago
thank you so much for this video. it helped me a lot
14 years ago
Thanks for sharing this! good save, and well narrated.
1435 56435
14 years ago
Thanks for sharing. After removal of the Akreos, inflating the sulcus w/ a COHESIVE OVD would have created more space so that the leading haptic would have been in the sulcus. It looks that the sulcus may have not been adequately inflated. I enjoyed the video. Lots of good teaching points.
millie fell
15 years ago
Great teaching video. It's the complicated cases that we really learn from. Thank you.
Stephen O'Connell
15 years ago
Thanks for posting this video Dr. Hirschfield - excellent management of a difficult problem that we all encounter
nahui nahui
15 years ago
very good
ari weitzner
15 years ago
in hindsight, perhaps i would have placed the trailing haptic into the sulcus, and then dialed the lens and thus getting the nasal haptic into the sulcus.
kang pil sung
15 years ago
thanks , for this video. Dr Gary Hirshfield
Gary Hirshfield
15 years ago
I belive I used an MA60, 6 mm 3 piece lens
sharon gross
15 years ago
what IOL is used to implant in sulcus? which model #of acrysoft?
ari weitzner
15 years ago
just make sure the akreos doesnt behave badly in sulcus like the acrysof. i just saw a pt done elsewhere with bad ugh syndrome from acrysof in sulcus.
marcos gomez
15 years ago
Thanksfully you had a Lumera, when dealing with capsules it makes a huge difference. One question, the rexis looks small enought to capture an Akreos with one hatic in sulcus, next in the bag, next sulcus and last in the bag. I´ve tried it once, the result was -0,75 because of the more anterior position of the lens, one year later the lens is stable with fibrosis securig the "bag in the lens" position as pioneered by Dr. Tassignon.
Gary Hirshfield
15 years ago
Thank you, great idea. I call that reverse iris capture I am not sure if the akreos would be stable and not slip back into the bag but it definitely would be worth a try and then to evaluate the stability intraop. Thank you next time I'll try that.
Gary Hirshfield
15 years ago
thanks, I've gotten experienced at fixing "goofs" I frankly don't know if that's a good thing!! I agree an acrysof would have been a much safer less traumatic insertion but the Akreos would have been find had I done a more careful atraumatic insertion. In future cases like this I will go the the one piece acrysof.
ari weitzner
15 years ago
only good surgeons post their goofs- thank you dr. h.
ramiro marchesi
15 years ago
nice movement...good video. thanks for show this kind of complication. i could lern how to pick up the aptic fron the bag. thanks
Arun Thiru
15 years ago
Very poor quality video recording. It keeps cutting out
Arun Thiru
15 years ago
Gary,
Gary Hirshfield
15 years ago
Eye doctor
Paolo Rossini
15 years ago
Gary, don't worry, good job.
lawrence frank
15 years ago
Good recovery. There was a ton of viscoat left behind. How was the pressure?
Gary Hirshfield
15 years ago
These cases get 500 mg po Diamox post op and again at night along with Combigan BID. That plus the miochol yielded a 1 day post op pressure of 15.
View More