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Andres Alza, MD, Eduardo Galletto, MD
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Andres Alza, MD, and Eduardo Galletto, MD, present the case of a 90-year-old patient who presented with cataracts, glaucoma, and inactive uveitis in both eyes. This patient was diagnosed with glaucoma and cataract, but decided not to undergo surgery because of high surgical risk for the eye. At the time of the consultation the patient showed pupillary seclusion, but no peripheral iridotomy was done. The surgeons decided to conduct an emergency surgery combining penetrating trabeculectomy with phacoemulsification and IOL implantation as well as application in sub-Tenon's triamcinolone injection. As of the date this video was created, the patient shows no eye uveitis and has good vision and good eye pressure.
Posted: 9/17/2012
Andres Alza, MD, Eduardo Galletto, MD
Andres Alza, MD, and Eduardo Galletto, MD, present the case of a 90-year-old patient who presented with cataracts, glaucoma, and inactive uveitis in both eyes. This patient was diagnosed with glaucoma and cataract, but decided not to undergo surgery because of high surgical risk for the eye. At the time of the consultation the patient showed pupillary seclusion, but no peripheral iridotomy was done. The surgeons decided to conduct an emergency surgery combining penetrating trabeculectomy with phacoemulsification and IOL implantation as well as application in sub-Tenon's triamcinolone injection. As of the date this video was created, the patient shows no eye uveitis and has good vision and good eye pressure.
Posted: 9/17/2012
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Andres German Alza
11 years ago
https://www.facebook.com/andresalzamedico
Andres German Alza
11 years ago
https://www.facebook.com/andresalzamedico
Andres German Alza
12 years ago
The better IOL for use in Cataract surgery on an eye with long-standing uveitis is the hydrophilic acrylic.
Andres German Alza
12 years ago
Surgery: 1 - Open conjunctiva and Tenon enough to facilitate the formation of the filtration bleb . Perform a soft surface cauterization. 2 - Make a thin sclero - corneal lid. Use the same incision to introduce the phaco. 3 – Create an anterior chamber with heavy viscoelastic substance. With a spatula we do lysis of anterior synechiae and immediately perform a second insicion. Then break the synechiae with bimanual iris dilator and perform a gentle stretching of the iris. This must be done carefully as the iris is more fragile and can also be sclerotic or vascularized. 4 - Fill the anterior chamber with viscoelastic substance and make a capsulorrhexis on a stiff anterior capsule .The capsulorhexis should be large to prevent capsular retraction or anterior capsule synechiae. 5 - Perform hydrodissection and hydrodelineation to separate the lens nucleus from the cortex and epinucleus. 6 - Make phacoemulsification of epinucleus and nucleous with phaco shop-technique. 7 – Make visco-dissection as to be able to vacuum epinucleous with synechiae 8 – Fill anterior chamber with viscoelastic substance and inject the hydrophilic acrylic IOL. 9 – Perform a penetrating trabeculectomy with iridectomy. Finally vacuum the viscous applied. 10 - Apply carbachol and air, and close the scleral lid. Then close conjunctiva by pulling the ends and stretching it to avoid seidel. 11 - Apply in sub-Tenon a triamcinolone injection. 12 –post surgical care indicates treatment with eye drops of ciprofloxacin and dexamethasone and some drops of pilocarpine to avoid a late mydriasis of the pupil.
Andres German Alza
12 years ago
The better IOL for use in Cataract surgery on an eye with long-standing uveitis is the hydrophilic acrylic.