Aphakic DSAEK with artisan lens скачать в хорошем качестве

Aphakic DSAEK with artisan lens

This is a nice contrast video to a DMEK operation which I now normally do as first line in endothelial disease This case had severe corneal decompensation with aphakia and after long discussion the decision was made to combine surgery with DSAEK and insertion of a aphasic artisan iris claw lens. Every case is different and based on the complexity and trying to minimise multiple surgeries and relatively quicker visual recovery the decision was made to combine surgery DSAEK (ultra thin) with artisan IOL. Please note, it is really important to ensure there is no vitreous in the anterior chamber and in this case it was clear that some vitreous was prolapsing through the pupil. Use of triamcinolone is essential to visualise the vitreous which may not be easily apparent especially through a oedematous cornea. Notes; remove epithelium to improve view in this case the endothelium/ DM was quite thickened and scarred which made it easy to remove. note how much better the view through the cornea was after this. Why not DMEK? this was aphakic patient, view was poor and involved insertion of artisan lens which all combine to increase risk of technicality in DMEK Why artisan iris clip lens? Decision was made based on avoidance of multiple surgeries. View through cornea not great and would not tolerate VR procedure if IOL was difficult to place with scleral fixation. All decisions made to minimise risk and have the best outcome for that particular case. This case did extremely well with excellent post op vision from a pre-exisiting vision of hand movements Use of SF6 just to have that extra bit of tamponade. Fold on DSAEK flattens over few days; note use of lacrimal cannula to massage cornea