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Agustina Palacio, MD, Douglas Sigford, MD, Nathan Podoll, MD, Shlomit Schaal, MD, PhD
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A minimally invasive 25G vitrectomy and trans-scleral IOL fixation is performed for an aphakic patient. The patient was an 80 year-old Caucasian gentleman who previously presented with dropped nucleus secondary to complicated cataract surgery. A foldable Akreos lens is inserted through a 2.8 mm corneal incision. V8 GORE-TEX suture was used to fixate the lens in place through small 25G scleral incisions. Patient's vision improved from 20/400 to 20/40 a week after surgery.
Posted: 9/09/2014
Agustina Palacio, MD, Douglas Sigford, MD, Nathan Podoll, MD, Shlomit Schaal, MD, PhD
A minimally invasive 25G vitrectomy and trans-scleral IOL fixation is performed for an aphakic patient. The patient was an 80 year-old Caucasian gentleman who previously presented with dropped nucleus secondary to complicated cataract surgery. A foldable Akreos lens is inserted through a 2.8 mm corneal incision. V8 GORE-TEX suture was used to fixate the lens in place through small 25G scleral incisions. Patient's vision improved from 20/400 to 20/40 a week after surgery.
Posted: 9/09/2014
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Just Now
Bhushan Khare
10 years ago
rotating the suture inside the eye may prevent exposure , but for that smaller sutures than 8-0 may be better to rotate thru 25 G openings very elegant technique
ahmed elshafey
10 years ago
Thank you for posting this nice video, did you experience any conjunctival sloughing or Gore-tex knot exposure post-op? thanks in advance.
ari weitzner
10 years ago
most surgeons it seems make a groove or flap to conceal the suture to avoid exposure later on. nice surgery.
Shlomit Schaal
10 years ago
I now use a partial thickness scleral groove to connect sclerotomy sites, temporally and nasally. The grooves are used to bury the Gore-Tex sutures. With the 8-0 suture I had no incidents of exposure. Thank you for the comments.
Shlomit Schaal
10 years ago
Thank you for your kind comment. We make the lens calculations according to presumed placement of the the intraocular lens in the ciliary sulcus, rather than the capsular bag. As you know, the amount of the power change is dependent on the "base power" of the intraocular lens. The greater the power, the greater the difference. There are online charts available in which this calculation has been made over a standard range of base powers. The capsular bag effective lens position (ACD) is approximately 5.20 mm (as with MA60AC), the effective lens position for the ciliary sulcus is 4.70 mm. This works pretty well for achieving sharp post-op vision, providing the macula is intact.
Eduardo Uchiyama
10 years ago
Great video, thanks for sharing. One question, how do you decide on lens power?
Craig Chaya
10 years ago
Brilliant! I knew the Akreos was good for something outside of the bag. Very nice summary and very elegant.
Shlomit Schaal
10 years ago
Thank you for your comment. We enjoy doing these cases, with good results. If you watch part 1 and part 2 of this series you would appreciate the upgraded technique.