Ashvin Agarwal, MD

This case explains the method of performing a four-in-one combination procedure: IOL explantation, glued IOL implantation and single-pass four-throw pupilloplasty with an optical penetrating keratoplasty. The specialty of the procedure shown is that it reduces the open-sky time that one would normally employ.

This is a case of pseudophakic bullous keratopathy with a subluxated three-piece IOL. In this approach, repair with glued IOL and single-pass four-throw pupilloplasty is completed first, which lays a foundation upon which air tamponades and presses the donor PDEK graft onto the recipient host, thereby improving the results of pre-Descemet’s endothelial keratoplasty surgery.

This video showcases the steps involved in the surgical management of a case of persistent hyperplastic primary vitreous, or PHPV. After conjunctival peritomy and partial-thickness scleral flaps are done, capsulorrhexis is performed after injecting trypan blue dye. Removal of the soft cortical matter is done with a phacoemulsification probe.

This surgery showcases the steps involved in a complication management of coloboma cataract. The surgeon, while implanting the IOL, had a rhexis run posteriorly, and the surgeon salvages the situation by changing gears from plan A to plan B and eventually implanting a lens using the glued IOL technique and also closing the iris defect using the single-pass four-throw pupilloplasty technique. During the first part of the procedure, the surgeon also shows vitrectomy-assisted phacoemulsification, which is used to reduce positive pressure during such aqueous misdirection cases.

This video describes the management of a subluxated single-piece rigid IOL, Soemmering ring and high IOP. To treat this, we have planned to do a trabeculectomy and refix the same IOL with a glued IOL. A vitrector is used to release the synechiae and dislodge the Soemmering ring, and then it is brought above the IOL optic so as to effectively compartmentalize the anterior and posterior chamber, thus making the scaffold ineffective and, as a result, the pieces sink into the vitreous cavity. The haptics are externalized and then tucked into the scleral pockets. Single-pass four-throw pupilloplasty is performed to avoid optic capture due to the lack of anterior capsular rim. Trabeculectomy is performed for the high IOP, and the case is closed.

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