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Soosan Jacob FRCS
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In this video, I demonstrate a case where PDEK and E-PDEK are combined with a closed chamber translocation of a PCIOL placed in the AC to a glued IOL and iridoplasty. PDEK or Pre-Descemet's Endothelial Keratoplasty as first described by Prof. Amar Agarwal gives a more robust graft than a DMEK graft. It is more easily handled and less liable to tears. I also demonstrate my own technique of E-PDEK/ E-DMEK or Endoilluminator Assisted PDEK/ DMEK where an endoilluminator gives fascinating clarity and 3-dimensional depth perception and allows all steps of surgery to be carried out easily. I use pressurized air infusion for Descemetorhexis and for attaching the graft. An iridoplasty is vital in those cases where air does not fill the AC well due to a broken iris-IOL diaphragm. The iridoplasty restores a taut iris-IOL diaphragm and allows a good air fill which is very essential for a successful PDEK. It is done using Osher's modified Siepser knot.
Posted: 2/24/2014
Soosan Jacob FRCS
In this video, I demonstrate a case where PDEK and E-PDEK are combined with a closed chamber translocation of a PCIOL placed in the AC to a glued IOL and iridoplasty. PDEK or Pre-Descemet's Endothelial Keratoplasty as first described by Prof. Amar Agarwal gives a more robust graft than a DMEK graft. It is more easily handled and less liable to tears. I also demonstrate my own technique of E-PDEK/ E-DMEK or Endoilluminator Assisted PDEK/ DMEK where an endoilluminator gives fascinating clarity and 3-dimensional depth perception and allows all steps of surgery to be carried out easily. I use pressurized air infusion for Descemetorhexis and for attaching the graft. An iridoplasty is vital in those cases where air does not fill the AC well due to a broken iris-IOL diaphragm. The iridoplasty restores a taut iris-IOL diaphragm and allows a good air fill which is very essential for a successful PDEK. It is done using Osher's modified Siepser knot.
Posted: 2/24/2014
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Just Now
Soosan Jacob
11 years ago
I agree! It's definitely not the right place to implant an IOL
ari weitzner
11 years ago
lol! i guess patients are not suing doctors in india! if a surgeon put a pc iol in ac here in usa, he'd get sued in 2 seconds, would lose, and he'd never do it again.
Soosan Jacob
11 years ago
Thanks Tom! Its always a pleasure hearing from you.
Soosan Jacob
11 years ago
Thanks Tom! Its always a pleasure hearing from you.
Soosan Jacob
11 years ago
Thanks Tom! Its always a pleasure hearing from you. :-)
Soosan Jacob
11 years ago
It is unfortunate but some surgeons do place a PCIOL in the AC over the iris when faced with a PC rent and inadequate sulcus for sulcus placement. It is definitely not the right thing to do and should never be done but unfortunately such cases do present once in a while referred or coming for a second opinion for the bullous keratopathy that of course invariably develops. This was one such case who came for a second opinion.
Soosan Jacob
11 years ago
My personal preference in such cases is to convert it into a glued IOL which can be done closed chamber and hence is very easy to perform. Also gives all the stability of a Glued IOL. PDEK has advantages of being able to use young grafts of any age, even as young as 1 year unlike DMEK. Also the extra 15 microns given by the Dua's layer adds a resilience to the graft unlike th DMEK graft which is very prone to tears. The E-DMEK/ E-PDEK gives beautiful visualization throughout the surgery even through hazy corneas and grafts that have lost their stain. Striking clarity and depth perception is got.
thomas oetting
11 years ago
another beautiful surgery by dr Jacobs. thanks for sharing your work with us all.
Jose Lucena
11 years ago
Some surgeons take a dislocated IOL from the vitreous and put it in the anterior chamber after vitrectomy in stead of exchange it for a AC IOL or fix it to sulcus. It is not a good idea but I have seen some patients with this procedure.
ari weitzner
11 years ago
but the initial surgery was cataract extraction, not dislocation of iol. why put a pc iol in the ac instead of an ac iol?
ari weitzner
11 years ago
why was pc iol placed in ac in the first place?
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