Joaquin De Rojas, MD shares key steps for TransplantREADY DSAEK | Center For Sight скачать в хорошем качестве

Joaquin De Rojas, MD shares key steps for TransplantREADY DSAEK | Center For Sight

Dr. Joaquin De Rojas shares his technique and key steps with other surgeons to shorten theirlearning curve when using the TransplantReady DSAEK from Lions Eye Institute for Transplant and Research (LEITR). Dr. De Rojas is a practicing ophthalmologist at Center For Sight in Sarasota, Florida. 0:20 - Summary Key Steps Transplant READY DSAEK; Step 1: Make a 3.5mm incision 1:46 – Step 2: Circulator gently pours cannula with preloaded DSAEK graft into hand over basin filled with BSS 1:52 – Step 3: Connect 5 ml syringe to cannula 2:01 – Step 4: Remove sponge from tip while submerged in basin 2:10 – Step 5: Mobilize graft with reverse Sinskey 2:34 – Step 6: Enter the eye with cannula bevel-down and twist to bevel-up once inside 2:52 – Step 7: Use BSS infusion from syringe to insert DSAEK and unfold within the eye 0:02 - Throughout my first 30 cases, there was a learning curve, but I have learned little surgical tidbits or tips that have really made it easier for me, and I want to share with you some of these tips. 0:20 - Summary Key Steps Transplant READY DSAEK Step 1: Make a 3.5 – 3.6 mm incision I am now using a 3.2 millimeter blade to open up the old cataract incision and slightly enlarge it to about 3.5 to 3.6 millimeters. 0:37 - I go across the eye, and I scoreDescemet's membrane. I start left first and then I go back to the origin, And I go towards the right while following my marks. I then will go across the eye and try to peel back from the Descemetorhexis thereto create a starting point for my scraper. Reason for the scraper: so I can more easily go back and forth to peel back Descemet's and the old endothelium that is now compromised in this case of Pseudophakic Bullous Keratopathy. 1:19 – I then use a forceps, Descemetorhexis forceps, this one is made from RUMEX, and I have taken out the Descemet’s layer in total. You can see that as I spread it there on the cornea. 1:36 – After removing the viscoelastic from the eye, I am already ready to get the transplant ready. This is the TranslplantREADY system from LEITR. 1:46 – Step 2: Circulator gently pours preloaded cannula into hand over basin We have BSS underneath in a basin, which provides a nice safety net. 1:52 – Step 3: Slowly connect TransplantREADY cannula with tissue to a 5 ml syringe I take the TransplantREADY LEITR tissue and I connect it. 2:01 – Step 4: Remove sponge while submerged Now, I do this submerged in BSS. This ensures that no bubbles enter the end of the cannula. 2:10 – Step 5: Mobilize graft with reverse Sinskey The next step is: I will take a reverse Sinskey to just gently nudge the tissue a little bit towards the bevel, just to loosen up any adhesions that could be between the stroma and the Weiss cannula. 2:34 – Step 6: Enter bevel-down and twist to bevel-up Because the incision is 3.5, I can very easily go in bevel-down and then twist once I am past the pupil to make the cannula bevel-up. This is the same way that I do DMEKs as well. Once I am in there, I start injecting in pulses, quick little pulses, and eventually the graft should come out nicely. 2:52 – Step 7: Stay in the eye and use BSS in syringe to open up graft Now, the most important part here: DO NOT COME OUT OF THE EYE TOO QUICKLY.. Stay in the eye. You saw I went back in further into the eye. Keep injecting in pulses to unfold that graft and twist the cannula as needed. 3:03 Next, I put a suture through the main incision (just a 10-0 nylon). I do a slip knot, I don’t tighten it all the way just yet –it’s just to keep that incision sealed so when I put the air in in subsequent steps it will not leak out of this incision. Become a part of the Center For Sight Family! Follow us on: Facebook:   / centerforsight2020   Instagram:   / centerforsight2020   LinkedIn:   / center-for-sight   For more information: www.centerforsight.net https://centerforsight.net/staff/joaq...