CataractCoach 2996: phacolytic glaucoma after ruptured globe

[00:00:00][music] >> cataractcoach.com fake lens glaucoma after ruptured globe cornea iris lens perforation 6 weeks ago and now the pressure is 28 and the vision is light perception only.

[00:00:11]Let's see the vision restoration with a pinhole surgery following penetrating injury.

[00:00:15]Trauma is 6 weeks ago light perception vision 28 is the IOP on max meds. Look at that. Well, we're thankful to the ophthalmologist who came in in the middle of the night and sutured this up.

[00:00:25]But obviously there's some work to be done. Now, we are sure there is no intraocular foreign body that's already been determined and so now we see there's a corneal laceration that's been sutured. There's an irregular pupil the kind of white cataract with the lens capsule certainly pierced. So first step here break that synechiae nice and gently break the synechiae there. Now when you put the trypan blue dye be very careful the caps already wide open. Who knows what it's going to be like. When you put the trypan in I just put a few drops here. Maybe under air or put viscoelastic first and then maybe a couple drops of trypan blue on. Let's see what does the capsule even look like. Ooh, I bet you the capsule is wide open.

[00:01:01]I bet you that he's breaking more synechiae. But see the viscoelastic was injected it just looks like the capsule's wide open. I think the capsule kind of slightly stained with some iris material.

[00:01:11]And let's take a look here. Just eyedrop a very little trypan in. Clearly some iris damage that's going to have to be sutured and you can see where the patient's laceration there is. Luckily the very central part of the cornea looks pretty reasonable. There's the trypan. Yeah, just a little bit painted on. I love watching professional eye lot operator. Really just an incredible surgeon. Probably one of the most incredible surgeons I've ever seen operate. He's really incredibly skilled.

[00:01:36]I should go back and do a fellowship with him. Is it too late for a 50-something-year-old guy? No. Washing the trypan now look at that the the lens material is just kind of washing out of the eye. Yeah, just the eye probe you don't even need a fake a probe. Just aspirate this thing right out of there.

[00:01:50]Yeah, looks like a young patient too. I don't have the full history here but I bet he's a pretty young patient. I think the patient was doing some sort of construction work, and not wearing safety glasses. Do you know in the USA every hammer that is sold has stamped on the handle of the hammer that you have to wear safety glasses because that metal on metal hammering is the very common cause of having a chip or fragment of sliver of metal boom shooting right inside the eye.

[00:02:15]So you can see the lens material is very soft. You can move just with the eye probe. Now look at that. Wow, the capsule anterior capsule has been just kind of destroyed. The posterior capsule is intact. And look at this, a single piece lens can go in the capsular bag.

[00:02:27]So not really much of a wreck. So it's just the lens material was was aspirated out.

[00:02:31]But there is an opening right there centrally. There's some sort of anterior capsulotomy that lens goes totally in the capsular bag. That looks great. And now it's time for the pupilloplasty.

[00:02:42]So let's see what's going on with the cornea last week. He got it six weeks ago.

[00:02:46]I don't know if I want to cut all these just yet. Let's take a look. Cut them out. Or you can You can always check the cornea. If you can put You're already on the OR table. You can put more if you need to.

[00:02:54]And um you see the blood vessels growing through into the cornea. Obviously this cornea has been severely injured.

[00:03:00]And again now an 0 10 0 polypropylene.

[00:03:03]That's the blue one on the long needle.

[00:03:05]That's probably the CIF-4 needle.

[00:03:07]And with this you can do a nice looking pupilloplasty. So you want to do that pinhole pupilloplasty as been described before by Amar Agarwal. And you want to do that pupilloplasty and center up the pupil just away from that corneal scar.

[00:03:22]Don't make the pupil right under the corneal scar. And we've We're seeing from Dr. Agarwal's work here, you can actually have Here's that fourth row 1 2 3 4 fourth row pupilloplasty. We've seen from Agarwal's work, you can have this pupil a bit off center and it still has a very good visual outcome for the patient here.

[00:03:39]So again now tying the suture up and let's see what we get here for the pupil.

[00:03:43]And yes, it's going to be a bit of a fixed pupil. And that's okay here now.

[00:03:47]We say, "What if there's some posterior segment damage this and that?" You know what? No problem. You can always go back to the OR. You can use a YAG laser and pop the sutures in the clinic if you need to. You can There's always options.

[00:03:58]So, let's not worry too much about that.

[00:03:59]Let's get this patient some vision back.

[00:04:01]And again, we're sure there's no posterior segment damage.

[00:04:04]There's no intraocular foreign body. The patient's already had a good look at the posterior segment. And now getting that iris kind of back into position and creating a pupil, small pupil. And look how the pupil's being created just away from slightly away from the center and just and away from that scar. And make sure you close up the pupil underneath the scar cuz that's always going to just scatter light and not going to be very good. And you'll be impressed by the visual outcome. Now, look at this. You think all the pupil's a little decent?

[00:04:32]It's okay. Patient's going to do great.

[00:04:34]And you'll be so amazed this patient ends up achieving great vision, very useful vision. Here's the end of the case. There's the pupil. Looks fantastic. And that's going to let in plenty of light for the patient. And you've got one week post-op, 20/50 vision, pressure 15. Fantastic.

[00:04:51]Beautiful looking result. Thank you for sharing. Remember, submit your video cataractcoach.com. We get 60 videos or more a week. So, make sure you follow the directions exactly.