Concurrent Penetrating Keratoplasty and Cataract Extraction in Eye With Descemetocel and Acute Corneal Perforation

Ozana Moraru, MD

Eyetube

Ozana Moraru, MD, performs penetrating keratoplasty and cataract extraction in an eye with a post-abscess large corneal leucoma and descemetocel, which unexpectedly perforated. She walks through her approach to this complicated case, including the use of vacuum trephine. She demonstrates the extraction of a mature, brown cataract with cortex aspiration and penetrating keratoplasty. Dr. Moraru then implants a three-piece PCIOL in sulcus.

Combining Vitreoretinal Surgery With EDOF IOL Implantation

The lens technology’s potential to reduce patients’ trips to the OR and loss of accommodation.

Peter Stalmans, MD, PhD

Cataract and Refractive Surgery Today

Cataract surgery is often thought of as an age-related procedure. In numerous European countries, however, including Belgium, where I practice, many patients receiving a vitrectomy undergo concurrent cataract surgery if they are older than 50 years of age to minimize the number of surgical procedures they will require and maximize their UCVA. IOL selection in this situation is challenging because these individuals are typically active members of the workforce who require crisp intermediate and near visual acuity. My colleagues and I therefore conducted a study to evaluate patient satisfaction when vitrectomy was combined with the implantation of an extended depth of focus (EDOF) IOL (AT LARA, Carl Zeiss Meditec).1 WHY AN EDOF IOL? Traditional multifocal IOLs are designed to provide better near visual acuity and greater spectacle independence than monofocal IOLs.2 Patients who receive multifocal IOLs, however, are more likely to experience glare, halos,2,3 and reduced contrast sensitivity.3 An EDOF lens was selected for our study because it can provide good intermediate visual acuity with fewer unwanted visual effects.4 Participants with more than mild corneal astigmatism received a toric model. Earlier research demonstrated high patient satisfaction with EDOF lenses.5,6 Our study is the first to gauge patient satisfaction with an EDOF IOL implanted following a vitrectomy. The study also explored whether unilateral or bilateral IOL status had an impact on quality of life. METHODOLOGY Patients who underwent a vitrectomy at the University Hospitals Leuven in Belgium from January 2019 to January 2022 were invited to participate in our study. In addition to patients with vision-threatening conditions such as retinal detachment (RD) and epiretinal membrane, the study enrolled a small number of individuals who elected to undergo a vitrectomy to remove floaters. Among patients with an RD, only those with macula-on detachments at the time of the procedure or those with macula-off detachment of less than 24 hours’ duration were included.

Practice Makes Progress

Marion Munk, MD, and Justis P. Ehlers, MD

Retina Today

It’s always fascinating when trendy technology seeps into health care. While working on this issue, our news feeds were overrun with stories of surgeons using Apple’s new Vision Pro in the OR.1 According to the press release, a nurse used the device to help with instrument selection, data visualization, and procedure monitoring.1 Cool stuff, and even if you aren’t an Apple aficionado, you have to admit this “spatial computer” is impressive.2 The news caught our eyes, but it didn’t surprise us because the field of retina was way ahead of the curve with this technology. The first ophthalmic exoscope—the Beyeonics One visualization system—that integrates augmented reality into a surgical headset was installed into an ophthalmic surgical suite years ago.3 Not only that, but the company recently announced the integration of intraoperative OCT into the headset, making it something of a spatial computer itself—for the surgeon.4 Retina has always been a field defined by technologic advancement, and our imaging tools are a great example. In an explosion of innovation in the early 2000s, we saw the advent of 3D visualization in the OR, intraoperative OCT, and OCT angiography (OCTA). Since then, it has been a slow march of improvement. For example, the January/February issue highlighted the addition of fluorescein angiography to surgical 3D heads-up displays. Other issues have touched on scanning laser ophthalmoscope-based multimodal fundus imaging and ultra-widefield technologies for the detection of diabetic eye disease. To catch up on these articles, see Further Reading. Some technology still in the pipeline may be poised to hit the clinic in the next few years; K. Bailey Freund, MD, and others have been lecturing on high-resolution OCT for a while now, with Retina Today following closely since its inaugural issue in 2006.5 While researchers work on fine-tuning the next generation, we asked experts to share their insights to help you perfect your skills with the imaging tools at your disposal.