This surgical video demonstrates the management of a hyper-mature cataract with zonular insufficiency in the left eye of a 69-year-old male with a history of glaucoma. Preoperative examination revealed vision limited to count fingers, advanced lens opacity, and an absent fundus view in the left eye. Intraoperatively, iris retractors were used for poor pupillary dilation, and trypan blue aided visualization in the absence of red reflex. Following aspiration of liquefied cortex, capsular bag collapse and inferior zonular loss were noted. Intracapsular cataract extraction was performed using a lens loop, followed by anterior vitrectomy and implantation of an anterior chamber intraocular lens with a Sheets glide. A second anterior vitrectomy was completed to ensure a clear visual axis. Retrospective history revealed prior blunt trauma from a baseball injury, likely contributing to the patient’s lens instability. Postoperative recovery was uncomplicated, and the patient achieved a final visual acuity of 20/50 in the left eye.
School: Harvard Medical School
External Dacryocystorhinostomy
This video demonstrates an external dacryocystorhinostomy surgery with insertion of a nasolacrimal duct stent in a patient with a history of dacryocystitis of rare fungal etiology.
Direct Brow Lift
The procedure in this video demonstrates a direct brow lift.
Bleb Needling in Trabeculectomy Revision
In this video, a patient presenting with an obstructed trabeculectomy bleb has a revision performed using an ab externo bleb needling approach. The procedure begins by inserting a corneal traction suture for improved access to the scarred bleb and is followed by the insertion of an infusion canula providing a continuous source of balanced salt solution. A bent 25- or 27-gauge needle is then used to carefully disrupt the scar tissue within the bleb. The procedure concludes with the injection of mitomycin-c, an anti-fibrotic agent that aims to promote the longevity of the cleared bleb.
Ab Externo Trabeculotomy Performed via Illuminated Microcatheter
In this video, a 7-month-old patient presenting with primary congenital glaucoma and corneal clouding has an ab externo trabeculotomy performed on her left eye. The procedure begins with subconjunctival dissection and formation of a temporal scleral flap to locate the back wall of Schlemm’s canal (SC). A 270-degree circumferential trabeculotomy is performed with an illuminated microcatheter. The microcatheter is blocked from completing a full 360 degree pass due to scarring from a previously failed superior trabeculectomy. A scleral cutdown is used to retrieve the microcatheter. Another 40 degrees of trabecular meshwork (TM) is incised in the opposite direction using a metal trabeculotome.
Evisceration
This video demonstrates an evisceration surgery with placement of a 16mm silicone implant in a patient with a blind, painful eye.
Punctal Dilation and Mini-Monoka Stent Insertion
This video demonstrates punctal dilation and insertion of a Mini-Monoka stent for treatment of epiphora due to punctal/canalicular stenosis.
Lacrimal Probing and Irrigation
This video demonstrates lacrimal probing and irrigation to investigate the anatomy, patency, and functional status of the lacrimal drainage system.
Lower Lid Internal Blepharoplasty
The procedure in this video demonstrates a cosmetic lower lid internal blepharoplasty.
Thermal Punctal Cautery for Chronic Ocular Surface Disease
In this video, permanent punctal occlusion is performed with high-temperature thermal cautery for the treatment of refractory ocular surface dryness, in this case due to graft-versus-host disease.