Soosan Jacob, MS, FRCS, DNB

The regenerative capacity of stem cells has been of great interest in every field of medicine.

Anterior lamellar keratoplasty continues to evolve, with newer surgical techniques and improved surgical instruments, and this progressive, forward movement is transforming the landscape of corneal surgery.

Keratoconus has been successfully treated with synthetic intrastromal corneal ring segments for many years now; however, there is an associated risk with implanting a synthetic substance within the cornea. With a complication rate of up to 30% reported in some series, many are hesitant to implant these devices despite the good outcomes with topography and vision.

One of the major problems in endothelial keratoplasty is graft detachment or dislocation. This is more common in thin membrane endothelial keratoplasties such as Descemet’s membrane endothelial keratoplasty and pre-Descemet’s endothelial keratoplasty. It especially becomes an issue in eyes that need to undergo surgeries such as secondary IOL implantation, phacoemulsification or glaucoma surgery combined with endothelial keratoplasty. It is also a problem in eyes that have more complex anterior segment abnormalities such as those with aphakia, glaucoma drainage devices or lack of a stable iris-IOL diaphragm. Various techniques employed in the past for avoiding detachment include the use of long-acting gases such as C3F8 or SF6, staging surgeries into multiple sittings as well as avoiding thin membrane endothelial keratoplasty and instead performing Descemet’s stripping automated endothelial keratoplasty in complex eyes.

Acute corneal hydrops occurs secondary to a tear in the Descemet’s membrane and results from aqueous seepage into the stroma, forming fluid clefts.

Subluxated cataracts are managed depending on the degree of zonular dialysis. For a subluxation of up to one quadrant, a capsular tension ring may be used. However, for larger subluxations, some form of scleral fixation is necessary to avoid a decentered or subluxated bag in the postoperative period.

WASHINGTON ― At the American Society of Cataract and Refractive Surgery meeting here, Soosan Jacob, MS, FRCS, DNB, describes a new technique she is using in thin membrane endothelial keratoplasty procedures.

Difficult lenticular extraction may sometimes occur in small incision lenticule extraction, especially if the posterior lenticular plane is inadvertently dissected before the anterior plane. Dr. Jacob has described the white ring sign as a means to facilitate easy identification of the anterior plane from the posterior plane of dissection and thereby prevent difficult and complicated SMILE lenticule extraction.

Descemet’s membrane detachment is a complication occasionally faced by every ophthalmologist. It has been previously classified as planar, or less than a 1-mm gap between Descemet’s membrane and stroma, or nonplanar, or more than a 1-mm gap between Descemet’s membrane and stroma, based on morphology.

NEW YORK ― At OSN New York 2017, Soosan Jacob, MS, FRCS, DNB, discusses her Waring Medal presentation on her innovative surgical technique she dubbed Presbyopic Allogenic Refractive Lenticule, or PEARL, in which she implants the lenticule obtained from the SMILE procedure in the patient’s nondominant eye to correct presbyopia.