Single pass four throw pupilloplasty (SFT) is a technique of pupilloplasty, for iris repair and reconstruction. It uses a single pass, railroad technique to create a helical loop that is self-retaining and self-locking. SFT can be used in a wide variety of clinical situations such as a fixed dilated pupil, traumatic mydriasis, in case of optic capture and for retention of air bubble following PDEK. SFT can also be used to lower the intraocular pressure in situations such as silicone oil induced glaucoma. In this video, Prof Amar Agarwal takes us through 3 different clinical scenarios where an SFT was performed.
#irisrepair #pupilloplasty #SFT
Soft cataract management could be challenging for many of us. They could lead to cheese wiring or crater formation making their subsequent management difficult. The four techniques described will enable nucleus disassembly either in the supracapsular plane or even within the capsular bag.
Managing a deficient posterior capsule requires surgical skill and expertise. Our in-house innovation, the glued IOL is a scleral fixated IOL, secured using fibrin glue, without the need for sutures. A peripheral iridectomy can enhance the outcomes of glued IOL, especially in large eyes, where it is possible to externalise greater length of the haptic, thereby conferring long-term stability to the IOL. In this video, Prof. Amar Agarwal takes us through the advantages of a PI in glued IOL.
Different techniques of phacoemulsification are being practised, each with their own pros and cons, each being used in different clinical scenarios. In this video, Prof. Venkatesh takes us through the variations of the direct chop technique and its uses in different grades of cataract.
Learn how to confidently manage complex trauma cases involving scleral tears, uveal prolapse, and iridodialysis with aphakia. Master practical techniques to restore anatomy, stability, and vision in the most demanding scenarios.
Hydrodissection is important in all cases of Phaco as it enables nucleus rotation and easy cortical aspiration. Hydrodelineation, on the other hand is performed only in selected cases. When u decide to perform both, which should be done first ? Prof.Venkatesh explains this in this video.
Continuous curvilinear capsulorhexis (CCC) is an important step of Phacoemulsification that has a bearing on the subsequent steps of surgery. An adequately sized and centered rhexis is vital to performing phaco. In this video, Prof.Venkatesh explains the commonly encountered difficulties while performing a CCC and tips to overome them.
Struggling with a compromised capsular bag? We bring to you our in-house innovation - The Glued IOL. Whether you are someone new to the technique or someone looking to refine your technique, we have something for everyone in this video. We take you through the lessons we have learnt along the way, in the years of practicing Glued IOL and mastering it.
Phacoemulsification is the most common cataract surgical technique performed worlwide with millions of surgeries performed every year. Wound construction in Phaco is of paramount importance and can inlfuence all the subsequent steps of the surgery. Watch this video as Prof.Venkatesh takes us through the steps of creation of a perfect clear corneal incision.
Microcornea is defined as horizontal corneal diameter of less than 10mm. Patients with microcornea can develop cataract in childhood as a syndromic association or develop age related cataracts. Because of the difficulty in placing IOL in a small eye, these patients are left aphakic many a times. We describe the triad of microcornea-aphakia-Sommering ring and the management of such patients with glued IOL and Sommering ring removal after glued IOL, using the IOL as a scaffold.
IOL drop during or after a cataract surgery is one of the most dreaded complications for a surgeon. IOL retrieval from the posterior segment can be complicated by retinal tears, hemorrhages, retinal detachment especially when forceps are used for the same. The extrusion cannula assisted levitation (ECAL) describes a technique of IOL retrieval using an extrusion cannula that minimizes the risks associated with forceps. In this video, Dr.Ashvin Agarwal performs ECAL assisted IOL retrieval followed by fixation of the same IOL using glued IOL technique and pupilloplasty.
Phacoemulsification is the most commonly performed cataract surgical technique worldwide with millions of surgeries performed every year. Understanding the mechanical principles underlying the phaco machine allows the surgeon to optimize the settings, safely perform the surgery and troubleshoot any problems that might be encountered during the surgery. In this video, Prof.Venkatesh takes you through the basics of phacodynamics.
Pinhole pupilloplasty (PPP) utilises the pin hole optics that cuts off peripheral rays of light and allows only the central rays to pass through. PPP is useful in cases of high corneal astigmatism and higher order aberrations (HOA) such as corneal scarring, post keratoplasty, post corneal injury, keratoconus. In such cases, PPP improves both the quantity and quality of vision by reducing astigmatism and HOA. In this video, watch Prof Amar Agarwal perform PPP in this patient who had a sutured corneal tear and traumatic cataract.
Subluxated lenses can occur secondary to trauma, ocular conditions such as pseudoexfoliation, systemic diseases such as Marfan's syndrome. Subluxated lenses are managed according to the degree of subluxation, with devices such as capsular tension ring and segment, and in severe cases with secondary IOL's. In this video we take you through the step-by-step management of a subluxated lens using Ahmed capsular tension segment : flanged technique.
Refractory glaucoma is where IOP cannot be brought under control despite maximal medical therapy and conventional surgical techniques such as trabeculectomy. Glaucoma drainage devices (GDD) such as the Ahmed valve, Molteno, Baerveldt divert aqueous from anterior chamber to an external reservoir. They are useful in cases such as uveitic glaucoma, neovascular glaucoma, glaucoma after keratoplasty and VR surgery, conjunctival scarring from previous surgeries. In this video we show you the step by step implantation of an Ahmed glaucoma valve in two eyes, one post keratoplasty and one post VR surgery.
Large non oppositional iris defects can cause significant glare and discomfort to the patients. In this video we show you the trifold technique of iris repair, which combines trocar assisted iris repair on either side along with a single pass four throw pupilloplasty. This technique can also be combined with other procedures such as Glued IOL and PDEK, thereby giving additional benefit.
PDEK is a valuable procedure in endothelial disorders like Fuch's dystrophy and bullous keratopathy, where it bypasses the need for a penetrating keratoplasty and its associated complications. In this video we take you through a PDEK perfomed in a patient with ICE syndrome. PDEK can also be combined with Phacoemulsification and IOL implantation, as well as Glued IOL
The phakic ICL is an intraocular refractive procedure done for patients with high refractive errors that cannot be corrected with laser vision correction, or for patients who are unsuitable for laser based procedures. This video takes you through the step-by-step procedure of ICL implantation and ICL loading.
Anterior chamber IOL's / ICL's can cause complications such as corneal decompensation, uveitis, glaucoma. Managing such cases can be tricky and needs expertise. Here we have a patient with an anterior chamber phakic ICL who went in for corneal decompensation and bullous keratopathy. His ICL was explanted, phacoemulsification and IOL implantation was done follwed by a PDEK along with pupilloplasty, all in one sitting. Watch this video to know how a meticulously done surgery can give highly satisfactory results, both for the surgeon and patient.
Lenticular coloboma is a peripheral flattening in the otherwise perfectly bi-convex natural lens due to absence of zonules, the reinforcement structure at that site. This creates a communication between the anterior segment and the vitreous. We start out this video by techniques to minimise complications. We go on to explain a unique procedure to expedite you in these cases. Learn this innovative technique through a well performed surgical video and an accurately animated explanation. Do not miss out the amazing metaphor at the beginning.
Sometimes when you try making a PDEK bubble especially In older age corneas the chances of getting a TYPE 2 bubble is higher. In this video we discuss how to salvage this with keen observation and still achieve a Type 1 bubble .
A unique innovation in the management of keratoconus, CAIRS, the brainchild of Dr.Soosan Jacob is revolutionising its management and gaining popularity the world over. INTACS, with synthetic segments is fraught with disadvantages such as extrusion, migration of segments, corneal melt etc. and managing these, become an even greater challenge. To overcome this, CAIRS uses corneal stromal segments harvested from donor corneas. This video takes you through the advantages and technique of performing CAIRS and the many modifications and innovations that make this procedure truly one of a kind !!
Does one-size-fit all ? Of course not ! And the same applies to our eyes as well. CAIRS, a novel in-house technique in the management of keratoconus, has been further refined with customisation. Customised CAIRS, as the name implies, caters to each eye individually, by customisation of the segments, which are tailor made according to the individual's corneal topography. Bring Femtolaser into the picture and we have more accurately crafted CAIRS segments ! Let us take you through this innovation and its many advantages in this video.
Posterior chamber phakic IOL We all understand the difficulties in the intricacies of placing an ICL. Many early and late complications can be expected. Inversion of the ICL may be noted on table, on POD 1 or even years later after when cataract develops. This video deals with various tips and tricks right from identifying the correct side, loading the ICL, positions for injecting to dealing with the late postop complications. Even the best of us can err and it doesn't become a crime if you know how to correct it, right?
IOL drop during or after a cataract surgery is a surgeons' nightmare. Posterior dislocation of the IOL can also occur secondary to causes such as trauma and pseudoexfoliation. Explantation of the IOL becomes challenging and might be riddled with complications such as iatrogenic retinal tears, retinal detachment, retinal haemorrhages etc. especially with the use of forceps. Extrusion cannula assisted levitation (ECAL) describes a technique of IOL retreival using a cannula that minimises the risks associated with forceps. We guide you through a step-by-step ECAL IOL retrieval technique in this video and explain its advantages over the use of forceps. With experiments for better understanding, this video is a must watch !!
Ophthalmology, being an equipment dependent speciality, is at the centre of constant technological advancements and upgradation. Novel Ophthalmic Analyzer ( NOA ) is our contribution to this armamentarium. It combines spectral domain OCT and optical biometry to give high resolution retinal imaging along with parameters such as ACD, axial length, lens thickness, corneal thickness etc. that help in IOL power calculation. Needless to say it saves time and resources !! Watch this video to know more about NOA .
High corneal astigmatism and higher order aberrations hampering your patient's quality of vision ?!! Pinhole pupilloplasty ( PPP ) to your rescue ! Based on pin hole optics, that cuts off peripheral rays and allows only the central rays of light to pass through, PPP can effectively improve the quality of vision in such patients. In some cases, PPP can even obviate the need for a keratoplasty !! This video explains the principle and indications for a PPP, showing you how a cost effective, equipment independent procedure can significantly enhance the patients' quality of vision.
Pinhole pupilloplasty (PPP) uses the single pass four throw (SFT) technique of pupilloplasty to make the pupil approximately 1-1.5mm in size. Conditions associated with high astigmatism and aberrations are commonly encountered in our clinical practice. These conditions affect the patients vision quantitatively and qualitatively. PPP uses the pin hole optics that cut off peripheral rays and allow only the central rays of light to pass through thereby improving the patients vision. PPP also has the advantage of being an easily reversible procedure. Let us take you through this in-house innovation in this video.
Higher order aberrations ( HOA ) are optical irregularities of the eye that affect the quality of the retinal image. In contrast to lower order aberrations, they cannot be corrected by conventional spectacles or contact lenses. HOA's are perceived by patients as dysphotopsia, glare and reduction in contrast sensitivity. Cornea accounts for approximately 90% of optical aberrations. Watch this fascinating video to learn about pinhole optics and how the novel technique of pin hole pupilloplasty (PPP) can help improve the quality of vision in patients with highly aberrated corneas such as post RK, post corneal transplantation, and scarred corneas, sometimes even bypassing the need for an OPK !!! Sounds unbelievable right ?!!! But it is possible and this video will tell you how !!
Non appositional iris defects are often seen in cases of trauma and can cause significant glare and discomfort to the patients. The trocar assisted iridodialysis repair is a modification of Dr.Snyder's "hang-back" technique. Entrapment of corneal tissue during the hang-back technique is often encountered while maneuvering the needle. The trocar assisted technique overcomes this complication, wherein the lumen of the cannula acts as a guide for the needle. It also prevents unnecessary movement of the needle in the anterior chamber thereby allowing this procedure to be used in technically challenging situations. Watch this video to know more!!
Perimetry is an indispensable tool in the management of glaucoma, various neurological and neuro-ophthalmological conditions. Technological advancements such as virtual reality and artificial intelligence are now becoming a part of our lives and Ophthalmology cannot be far behind in adopting these techologies. We bring to you a novel autoperimeter that uses virtual reality and is compararable to the Humphrey's field analyser. HFA has the disadvantage of being an in-clinic procedure whereas this autoperimeter is portable and can be used in the field. This video brings to you the operation and advantages of this innovative equipment.
PDEK is a great surgery where you have the advantage of a thick graft of 25 microns , younger donor with high specular count .For someone looking to transition from DSEK surgeries PDEK is a great start .Can be performed with ease in vitrectomised eyes as well .
Fine Tuning Pinhole Pupilloplasty Pupilloplasty gone wrong? Too large? Too small? Off centre? Results not upto your expectations? Fret not! Experience our own Prof Dr Amar Agarwal, a master in pupilloplasty take you step by step through fine tuning pupilloplasty in complicated cases. You can also find a bonus on the mechanics on how a pinhole actually works and various innovative instruments used to guide in this procedure in this video
We often encounter iris defects in our practice which can be secondary to trauma or sometimes iatrogenic. This can cause symptoms to the patient such as glare and diplopia. Single pass four throw pupilloplasty (SFT) is a technique of iris repair and reconstruction, that requires only a single pass, uses the rail road technique, and creates a helical loop configuration that is self-retaining and self-locking. SFT can also be used in fixed dilated pupil post-surgery. It has also been found beneficial in patients with angle closure glaucoma with synechiae where SFT pulls the peripheral iris away from the angle, breaks the synechiae and enhances aqueous outflow. It can also be used in patients undergoing glued IOL to prevent optic capture, and in patients undergoing PDEK for retention of air bubble in the anterior chamber. This video takes you through the surgical steps of performing an SFT.
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