DOCSLIB.ORG

EK Evolves: Are PDEK and Hybrid DMEK on the Horizon?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
EK Evolves: Are PDEK and Hybrid DMEK on the Horizon? CORNEA CLINICAL UPDATE EK Evolves: Are PDEK and Hybrid DMEK on the Horizon? dvances in endothelial kerato- 1 2 plasty are giving patients with Acorneal endothelial dysfunction ever-more novel treatment options even though Descemet stripping auto mated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial ker- atoplasty (DMEK) are the mainstays. “The field of endothelial keratoplasty is a dynamic one; it has been revolu- 3 4A 4B tionized in the last 20 years, and we are continuing to refine our surgical ap- proaches,” said Kathryn A. Colby, MD, PhD, at the University of Chicago. Some might say that this trend of innovation is attributable in part to the fact that DSAEK and DMEK have their drawbacks. Amar Agarwal, MS, FRCS, FRCOphth, at Dr. Agarwal’s Eye STEPS. Stills from the PDEK video mentioned on page 29 show (1) creation of the Hospital and Eye Research Centre in Type 1 Big Bubble to harvest the donor graft, (2) graft injection into recipient Chennai, India, noted, “In DSAEK, the eye, (3) the eye on postop day 1, and (4A,4B) the preop eye compared with the donor tissue is about 80 to 150 mi- eye at 3 months postop. crons. So, effectively, a 500-µm cornea will become a 600- to 650-µm cornea keratoplasty (PDEK), an emerging pro- and described the technique in March [after surgery], and the endothelium cedure intended to address both chal- 2014 in the British Journal of Ophthal- has to pump more. lenges. In another corner of the field, mology.1 Candidates include patients “In DMEK, the donor tissue is only Donald T.H. Tan, MD, at the Singapore with endothelial decompensation such 15 µm, which is good,” he said. How- National Eye Centre, is developing as Fuchs dystrophy and pseudophakic ever, for this procedure, he noted that hybrid DMEK (H-DMEK, see sidebar), or aphakic bullous keratopathy, he said. only grafts from older donors can be another technique designed to combine The procedure involves transplanting used. This is because in donors younger the best of both DSAEK and DMEK. only 25 µm of tissue: the pre-Descemet than age 40-50, the endothelium layer, the Descemet membrane, and adheres so strongly to the stroma that PDEK the endothelium. “The pre-Descemet they cannot be separated. Dr. Agarwal performed the first PDEK layer gives a splinting effect to the graft Enter pre-Descemet endothelial procedure in India in September 2013 and makes it easy to manipulate,” said Dr. Agarwal. Several benefits of PDEK are directly attributable to the graft’s BY LORI BAKER-SCHENA, MBA, EDD, CONTRIBUTING WRITER, INTERVIEW- relative stiffness, he said. ING AMAR AGARWAL, MS, FRCS, FRCOPHTH, ALAN N. CARLSON, MD, Bigger donor pool. Unlike DMEK, KATHRYN A. COLBY, MD, PHD, AHAD MAHOOTCHI, MD, AND DONALD T.H. which relies on grafts from donors Amar Agarwal, MD, FRCS, FRCOphth MD, Amar Agarwal, TAN, MD, FRCS, FRCOPHTH. aged 40 years and older, PDEK has no EYENET MAGAZINE • 27 donor age restriction, said Dr. Agar- get the DMEK graft to unscroll, sur- tissue may be at risk of falling through wal. “The youngest we have used is a geons intentionally shallow the anterior to the posterior segment. 9-month-old donor.2 This gives us the chamber. But in complicated situations, Lower detachment risk? Based big advantage of healthier grafts with a such as in patients with vitrectomized on what he’s seen in his practice, better endothelial cell count.” eyes or those with prior Nd:YAG poste- Dr. Agarwal said that the 10-µm pre- Easier manipulation. As with DSAEK, rior capsulotomy in whom the anterior Descemet layer lowers the risk of PDEK grafts can be manipulated more chamber can be difficult or impossible detachment compared to DMEK. easily than DMEK grafts, Dr. Agarwal to shallow, it may be a challenge to And in correspondence to the Journal said. Alan N. Carlson, MD, at Duke Eye un roll the DMEK graft. PDEK grafts of Cataract and Refractive Surgery, Institute, in Durham, North Carolina, are ideal for these complex patients,” Dr. Agarwal and colleagues reported agreed, noting that DMEK can be un- he said. outcomes in 12 PDEK patients. Eight predictable. “You could have the perfect Dr. Colby added that in some patients, grafts adhered successfully, and there procedure, and the graft tissue itself you may not want to do a DSAEK, but were 4 detachments, 3 of which did not would end up scrolling or detaching. you can’t do a DMEK. She said that she require intervention. None detached With PDEK, I feel I have better control sees a case for PDEK or H-DMEK in completely.3 of the tissue because of the added Dua patients with aphakia, iris defect, or a Good visual outcomes. Of the cases (pre-Descemet) layer.” vitrectomized eye—situations in which he has done so far, Dr. Agarwal said that Advantage for complex patients. the anterior chamber might not suffi- postoperative edema improves, and Ahad Mahootchi, MD, in private prac- ciently shallow for successful unscroll- vision stabilizes in PDEK patients as tice in Zephyrhills, Florida, noted, “To ing of a DMEK graft, or where DMEK rapidly as it does in DMEK patients. Hybrid DMEK The basic idea behind hybrid DMEK clinical series of about 90 H-DMEK EndoGlide (coupled with an anterior (H-DMEK) is to make it more like cases in both standard and more chamber maintainer). This allows for DSAEK, said Donald Tan, MD, FRCS, challenging cases, which he plans to a closed chamber procedure, which FRCOphth, in Singapore. “This is be- submit for publication. Of the cases, minimizes fluctuation of anterior cause there is greater reproducibility over 40 were in eyes that ordinarily chamber depth. Both are important with DSAEK and surgeons are more would be unsuitable for DMEK. These to a successful procedure and allow comfortable with it, whereas DMEK were performed in the latter half of surgeons to tackle these more chal- requires much skill and can be more the series, once the technique had lenging cases, he noted. stressful for the surgeon.” been refined. These complex cases He added that because the tissue What is hybrid DMEK? H-DMEK included aphakia, aniridia, vitrecto- is always held right-side up with the uses a standard DSAEK approach mized eyes, eyes with tube shunts, forceps, it is generally not possible to with a few differences. During donor and previous failed penetrating kera- have an inadvertent “upside-down” graft preparation, the Descemet toplasties or DSAEK. graft. Further, this means that addi- membrane and endothelium is sepa- Despite the difficulty of these tional donor preparation steps such rated from the pre-cut DSAEK tissue, cases, the series had a relatively low as the placement of an “S” stamp the DMEK graft is laid back loose- primary graft failure rate of 2.2% and mark, to signify the exact orientation ly over the stroma, and the whole a rebubbling rate of 8.8%. There were of the tissue, is not required. complex is coiled into an EndoGlide 2 documented cases of endothelial Considerations. Because H-DMEK Ultrathin DSAEK inserter (Network rejection, which were subsequently utilizes the EndoGlide DSAEK surgi- Medical Products). Once the Endo- reversed with topical steroids. cal approach, Dr. Tan recommended Glide is inserted inside the anterior He reports that in his own prac- that surgeons have sufficient expe- chamber, the surgeon uses intraoc- tice, his H-DMEK endothelial cell loss rience with this form of inserter and ular forceps to pull only the DMEK rates are about 24% now that he with using this “pull-through” forceps tissue from the inserter, leaving the has become very proficient with the technique before attempting or stroma in the cartridge, which is procedure. When he first started, his adapting the H-DMEK technique then removed. The DMEK tissue is cell loss rates were 37%, and he has to their practice. always right-side up, and the forceps brought these rates down steadily Of note, Dr Tan has developed provides enhanced surgeon control with practice. a new DMEK EndoGlide inserter over the DMEK tissue, which tends to Benefits.Dr. Tan said that H-DMEK specifically for DMEK surgery, which naturally uncoil of its own accord in gives enhanced surgical control of may further simplify the H-DMEK the anterior chamber. the graft tissue and also control procedure. It is currently undergoing Results. Dr. Tan just completed a of the anterior chamber with the clinical trials. 28 • AUGUST 2018 In the same 12-patient study, corrected Type 1 BB. In this approach, injec- Carolina, to determine how the eye distance visual acuity (CDVA) at 90 tion of air separates the pre-Descemet bank could prepare PDEK grafts days was between 20/35 and 2/90 for all layer (Dua layer)/Descemet membrane/ effectively and predictably in order to but 2 patients whose CDVA was 20/200, endo thelium complex from the residual minimize waste of corneal donor tissue and at 1 month, 1 eye had minimal stromal bed. The graft is approximately and endothelial cell loss. The result, interface haze.3 25 µm thick and 7.5 to 8 mm in diam- said Dr. Carlson, is that “Miracles in Dr. Agarwal added that PDEK may eter. Research has shown that the Dua Sight Eye Bank has done a tremendous have a role for badly scarred corneas. In layer confers additional strength to the job preparing tissue that is preloaded a prospective, interventional study, Dr. recipient cornea.5 and prestamped.” Agarwal’s group reported on 4 patients Type 2 BB. This contrasts with the In Florida. Dr. Mahootchi adopted with chronic pseudophakic bullous Type 2 BB in which the Descemet DMEK, due in large part to the avail- kera topathy who underwent PDEK or membrane is separated from the pos- ability of preloaded and prestamped coupled with epithelial debridement.
Load more

Recommended publications
  • 5267830313.Pdf
    DR. AGARWAL’S EYE HOSPITAL LIMITED 1 CONTENTS Page No. Company Information 2 Financial Highlights 3 Notice to Shareholders 4 Directors’ Report 11 Management Discussion and Analysis 15 Corporate Governance Report 15 Auditors’ Certificate on Corporate Governance 26 Independent Auditors’ Report to the Members 28 Secretarial Compliance Certificate 32 Balance Sheet 36 Profit and Loss Account 37 Cash Flow Statement 38 Notes on Financial Statement 41 Attendance Slip and Proxy Form 59 2 DR. AGARWAL’S EYE HOSPITAL LIMITED COMPANY INFORMATION Board of Directors Dr. Amar Agarwal (Chairman cum Managing Director) Dr. Athiya Agarwal (Wholetime Director) Dr. Adil Agarwal (Wholetime Director) Dr. Anosh Agarwal (Wholetime Director) Dr. Jasvinder Singh Saroya Mr. M. R. G. Apparao Mr. Prabhat Toshniwal Mr. Sanjay Anand Auditors M/s. M. K. Dandeker & Co. Chartered Accountants, 244, Angappa Naicken Street, Chennai 600 001. Registered Office 19 (Old No.13), Cathedral Road, Chennai 600 086. Bankers (1) State Bank of India, Gopalapuram Branch, Chennai - 600 086. (2) State Bank of India, Industrial Finance Branch, Chennai 600 002. Share Transfer Agents Integrated Enterprises (India) Ltd. 2nd Floor, Kences Towers, No.1, Ramakrishna Street, North Usman Road, T.Nagar, Chennai 600 017. Tel: 2814 0801-03 Email: [email protected] DR. AGARWAL’S EYE HOSPITAL LIMITED HOSPITAL EYE AGARWAL’S DR. Financial Highlights Rs. in crore For the year ended 2012-13 2011-12 2010-11 2009-10 2008-09 2007-08 2006-07 2005-06 2004-05 2003-04 Total Income 109.73 105.68 104.01
    [Show full text]
  • Agarwal AR 19.Indd
    Contents Page No Chairman’s Desk 3 Board of Directors 5 A Word from Chairman - Clinical Board 9 Industrial Update 12 Notice to Shareholders 15 Directors’ Report 29 Management Discussions and Analysis Report 46 Corporate Governance Report 50 A word from the CFO 61 Financial Highlights 62 Independent Auditor’s Report 65 Balance Sheet as at 31st March, 2019 72 Statement of Profit and Loss for the year ended 31st March 2019 73 Statement of changes in equity for the year ended 31st March 2019 74 Cash Flow Statement as on 31st March 2019 75 Notes Forming Part of the Financial Statements for the year ended 76 31st March 2019 Press Clippings 120 NABH Accredited 126 Route map to AGM venue 128 CORPORATE Chairman’s INFORMATION Desk DIRECTORS Dr. Amar Agarwal (DIN: 00435684) ..................... Chairman Cum Managing Director Dr. Athiya Agarwal (DIN: 01365659) .................... Whole-time Director Dr. Adil Agarwal (DIN: 01074272) ........................ Director Mr. Sanjay Anand (DIN: 02501139) ...................... Independent Director Mr T. R. Ramasubramanian (DIN: 08207929) ........ Independent Director Mrs. Lakshmmi Subramanian (DIN: 00001439) .... Independent Director CHIEF FINANCIAL OFFICER Dear Shareholders, Ms. Saradha Govindarajan I look back nearly 60 years to when we initially set out to build the first Eye care hospital under our name, and then to the journey thereafter, in nurturing it into the world-class Eye care institution it COMPANY SECRETARY & COMPLIANCE OFFICER has grown into today. Now the hospital chain in its 62nd year of service has a total presence of 22 Ms. Jully H. Jivani hospitals across India. Our motivation for the pursuit of our goals has not wavered a bit through this eventful and challenging journey.We believe we are best suited to lead the eye care space in the AUDITORS coming years M/s.
    [Show full text]
  • Visually Significant Traumatic Cataract
    CATARACT SURGERY COMPLEX CASE MANAGEMENT Section Editors: Thomas A. Oetting, MS, MD; Tal Raviv, MD; and Audrey R. Talley Rostov, MD eyetube.net Visually Significant Traumatic Cataract BY PRIYA NARANG, MS; AMAR AGARWAL, MS, FRCS, FRCOPHTH; H. BURKHARD DICK, MD, PHD; TIM SCHULTZ, MD; RICHARD J. MACKOOL, MD; RICHARD J. MACKOOL JR, MD; AND TAL RAVIV, MD CASE PRESENTATION A 50-year-old man presents with a visually significant (Courtesy of Priya Narang, MS, and Amar Agarwal, FRCS, FRCOphth.) traumatic cataract (following blunt trauma 5 years ago). About 7 clock hours of zonular loss (Figure 1) and phaco- donesis are present. Small wisps of vitreous are visible at the edge of the lens. How would you approach this case? —Case prepared by Tal Raviv, MD. (Courtesy of Tal Raviv, MD.) Figure 2. The design of the glued ECR and its positioning in the direction of dialysis. the hemi-ring segment portion and are designed to sit Figure 1. A traumatic cataract with 7 clock hours of zonu- within the fornix of the capsular bag. The scrolls engage lar loss and mild vitreous prolapse in a young patient. the margin of the capsulorhexis, and the haptic anchors the entire bag transsclerally (Figure 2). Once the scrolls PRIYA NARANG, MS, AND have engaged the capsulorhexis’ margin, pulling on the AMAR AGARWAL, MS, FRCS, FRCOPHTH exteriorized haptic centers the entire capsular bag com- Figure 1 shows traumatic subluxation of the lens with plex. Phacoemulsification then commences. The choice 7 clock hours of zonular loss. The clinical picture is sug- and positioning of the IOL depend on the degree and gestive of phacodonesis, and small wisps of vitreous are location of zonular disruption.
    [Show full text]
  • REFRACTIVE Laser
    4 Cover Story REFRACTIVE Laser QUEST FOR PERFECTION LASIK banks on mature technology and reduced complication rates to stay ahead of the competition by Dermot McGrath aser-assisted in situ how many patients fall under the terminally complication rates in recent years. keratomileusis (LASIK) has dissatisfied category over the long term, the “There has definitely been an been assessed and improved by fact that the FDA in the US received just improvement over the past few years which I still believe many more than a decade of clinical 140 “negative reports relating to LASIK” I would attribute to improved technology, “patients disappear studiesL and technological innovation since for the time period 1998-2006 suggests to with better preoperative diagnostics and from their surgeon’s the procedure was first introduced. As some observers that LASIK complication also much better patient screening in terms practices after the one one of the most popular elective surgical and/or dissatisfaction rates are probably of anterior and posterior surface, corneal year of ‘free’ follow- procedures in the world, with one of the under-reported. thickness, and even family history to help up care that most highest safety profiles, LASIK remains the A 2008 study on LASIK complications prevent complications such as post-LASIK provide. Consequently, primary dynamo driving today’s global carried out at Wills Eye Institute (J ectasia,” said Francesco Carones MD, refractive surgery market. Cataract Refract Surg. 2008 Jan;34(1):32- Co-founder and medical director of the I do believe we have However, given the huge volume of 9.), for instance, found that only 29 per Carones Ophthalmology Centre in been underestimating procedures performed since its inception, cent of patients referred for problems Milan, Italy.
    [Show full text]
  • Model Curriculum Handbook
    Ministry of Health and Family Welfare Allied Health Section 2015-16 Model Curriculum Handbook OPTOMETRY Model Curriculum Handbook OPTOMETRY Ministry of Health and Family Welfare Allied Health Section Contents Contributors to drafting and review ............................................................................................................... 3 List of Abbreviations ..................................................................................................................................... 5 Chapter 1: Introduction to the Handbook.................................................................................................... 11 Who is an Allied and Healthcare Professional? ......................................................................................... 11 Scope and need for allied and healthcare professionals in the Indian healthcare system ............................ 11 Learning goals and objectives for allied and healthcare professionals ....................................................... 12 Introduction of new elements in allied and healthcare education .............................................................. 17 Competency-based curriculum ............................................................................................................. 17 Promoting self-directed learning of the professionals ........................................................................... 17 Credit hours vs traditional system .......................................................................................................
    [Show full text]
  • SHOULD LASIK BE REBRANDED? Experts Debate Whether the Leading Refractive Surgery Procedure Needs a New Name
    COVER FOCUS COVER POINT/COUNTERPOINT: SHOULD LASIK BE REBRANDED? Experts debate whether the leading refractive surgery procedure needs a new name. BY SOOSAN JACOB, MS, FRCS, DNB; AMAR AGARWAL, MS, FRCS, FRCOPHTH; MARC MULLIE, MD, FRCSC; MICHAEL LAWLESS, MBBS, FRANZCO, FRACS; DAN Z. REINSTEIN, MD, MA(CANTAB), FRCSC, DABO, FRCOPHTH, FEBO; VANCE THOMPSON, MD; AND J. TREVOR WOODHAMS, MD Point: refractive surgery procedure. The advantages that this tech- nique offers are numerous. For starters, the absence of a flap A LASIK Rebrand is in Order and the use of a small incision together act to eliminate flap- By Soosan Jacob, MS, FRCS, DNB; Amar Agarwal, MS, related complications such as striae, flap dislodgement, and FRCS, FRCOphth; and Marc Mullie, MD, FRCSC epithelial ingrowth. Similarly, because of decreased disruption of the anterior corneal innervation, there is faster recovery Rebrand Refractive Surgery of corneal sensitivity and less patient experience of dry eye by Introducing a New Procedure than is seen with LASIK.3 Most important, the presence of the Soosan Jacob, MS, FRCS, DNB; and nearly intact anterior stromal layer of the cornea allows better Amar Agarwal, MS, FRCS, FRCOphth maintenance of biomechanical strength after SMILE compared Corneal refractive surgery has evolved with LASIK.4,5 The entire procedure is completed with a single over the years, progressing through techniques from cuts in the cornea (RK), to excimer laser surface ablation (PRK), to intrastromal ablation under a flap (LASIK). The last of these approaches has been the most successful technique thus AT A GLANCE far, with widespread worldwide acceptance and penetration. WHAT YOUR PEERS ARE SAYING The LASIK flap itself has evolved, from being created with a ABOUT LASIK REBRANDING mechanical microkeratome to being cut with a femtosecond • Instead of rebranding LASIK specifically, it could be laser.
    [Show full text]
  • Image of the Month the Human Choroid, Reconstructed in 3D
    APRIL 2016 # 29 Image of the Month Upfront Profession Sitting Down With The human choroid, Growing your own Benchmarking your practice Amar Agarwal, Chairman of reconstructed in 3D crystalline lens against your peers Dr Agarwal’s Eye Hospital 03 08 – 10 60 – 64 66 – 67 www.theophthalmologist.com DUAL-SEGMENT PUMP TECHNOLOGY + Precise fluidics + Pulsatile-free + Quick vacuum rise + Versatile performance PERFORMANCE IN EVERY DETAIL Superior chamber stability through superior engineering.†,1,2 That’s the Centurion® Effect. Active Fluidics™ Technology • Helps to Maintain Chamber Stability: Detects and compensates to help provide superior chamber stability3 compared to INFINITI®4 • Less Surge: Less surge at any tested vacuum level3,5 • More Consistent IOP4 : Up to 80% less surge area3,5 Contact your Alcon representative to schedule a demonstration and experience the Centurion® Effect for yourself. †As compared to the INFINITI® Vision System, bottle gravity system. 1. Lorente R, Fanney D, Injev V, Sharif-Kashani P. Quantification of occlusion break surge in peristaltic-based phacoemulsification systems. ASCRS-ASOA Symposium and Congress; April 25-29, 2014; Boston, USA.2. Nicoli M, Miller K, Dimalanta R, Loke D; Jules Stein Eye Institute, UCLA. IOP Stability Measurement and Comparison Between Gravity-Fed and Actively Controlled Phacoemulsification Systems. 2014. 3. Sharif-Kashani P, Fanney D, Injev V. Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol. 2014;14:96. 4. Nicoli CM, Dimalanta R, Miller K. Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems. J Cataract Refract Surg. 2016;42(1):157-162. 5. Alcon data on file.
    [Show full text]
  • Educational Qualifications
    CURRICULUM VITAE PERSONAL NAME : Dr. Sunita Agarwal I have been fortunate to be born in a family of ophthalmologists. My grandfather Dr. Raghvir S. Agarwal was a noted ophthalmologist of his time in India. My father Dr. Jaivir Agarwal is the founder of Dr. Agarwal ‘s Eye Institute, Chennai, mother Dr. Mrs. Tahira Agarwal is also a renowned ophthalmic surgeon currently practicing as a corneal specialist. My brother Dr. Amar Agarwal and myself both are ophthalmic surgeons, extensively engaged in ophthalmic research, teaching are currently practicing with our parents at Chennai. Dr. Athiya Agarwal, wife of Dr Amar Agarwal is also a part of the team. EDUCATIONAL QUALIFICATIONS 1. COMPLETED MATRICULATION FROM SACRED HEART CHURCH PARK SCHOOL IN 1975 I had a complete childhood with schooling from one of the finest institutions in the country. As is well known convent education brings with it a flare to the child and close proximity with God. In any format the individual gets to think of the less fortunate and realizes the pain and anguish of our school teachers and convent nuns. I was extremely mischievous and was called out to the Principals office very often still in this developed a close camaraderie with my Principal Teacher Sister Clare. So much so that till today she remembers me fondly of tying my unruly hair in her own ribbons or admonishing me for one of my little crimes. I also happened to be the School pupil leader in the my last year occasion came on a day when I had just come back from Delhi after winning the national gold medal for swimming for 1974, and as I entered school the election had taken place in my absence, this was one of few times I saw tears (of joy) in my fathers year.
    [Show full text]
  • Sizing and Centering the Capsulorhexis by WILLIAM BOND, MD; BROCK K
    CATARACT SURGERY PHACO PEARLS Sizing and Centering the Capsulorhexis BY WILLIAM BOND, MD; BROCK K. BAKEWELL, MD; AMAR AGARWAL, MS, FRCS, FRCOPHTH; AND DAVID SPALTON, FRCS, FRCP, FRCOPHTH Most surgeons have performed the capsulorhexis since its groundbreaking, simultaneous introduction in 1990 by Thomas Neuhann, MD, and Howard Gimbel, MD.1 Now, as the use of aspheric and presbyopia-correcting IOLs becomes widespread, the sizing and centration of the capsulorhexis have never been more essential. Sufficiently sized for the intend- ed IOL and adequately centered, the capsulorhexis is the framework for the production of a stable postoperative IOL/bag complex and the achievement of excellent postoperative vision. How do surgeons optimize the capsulorhexis? —William J. Fishkind, MD, Section Editor WILLIAM BOND, MD tear reappears, of course, I redirect it parallel to the iris Over the years, I have favored a large capsulorhexis for and less peripherally. better access to the lens proper, because I believe that the The other common cause of extending a capsulorhex- anterior capsule is part of the cataract. In the event of a is too far is not to regrasp the tearing flap frequently posterior capsular rupture, there is virtually always enough. The tear will circumferentially expand as the enough anterior capsule to support a PCIOL in the sulcus, edge gets farther from the forceps. This scenario seems no matter how large the capsulorhexis was initially. Fur- elementary but can easily happen. A minimum of two thermore, it has been my experience that there are many regrabbings close to the tearing flap’s edge, after the ini- more longitudinal tears in the anterior capsule in the tial grab, is what I find easiest.
    [Show full text]
  • Press Release Dr. Agarwals Eye Hospital Limited
    Press Release Dr. Agarwals Eye Hospital Limited June 13, 2019 Rating Amount Facilities Rating1 Rating Action (Rs. crore) Long-term Bank Facilities - - Withdrawn Total Facilities - Details of facilities in Annexure-1 Detailed Rationale, Key Rating Drivers and Detailed description of the key rating drivers CARE has withdrawn the outstanding ratings of ‘CARE BBB+; Stable’ *Triple B Plus; Outlook: Stable+ assigned to the bank facilities of Dr. Agarwal’s Eye Hospital Limited (DAEHL) with immediate effect. The above action has been taken at the request of DAEHL and ‘No Objection Certificate’ received from the bank that has extended the facilities rated by CARE. Detailed description of the key rating drivers: At the time of last rating on December 04, 2018 following were the rating strengths and weaknesses (updated for the information available from BSE website): Key Rating Strengths Vast experience of the promoters in eye care services: DAEHL was promoted by Padma Bhushan late Dr J. Agarwal and his family members, who have been in the profession of providing eye care solutions for over five decades extending up to the third generation currently. His son, Dr Amar Agarwal, MBBS, MS, FRCS, FRC Ophth, the current Chairman and Managing Director, has over two decades of experience in the eye care sector. He handles the operations of the company on a day-to- day basis along with his wife, Dr Athiya Agarwal and his sons, Dr Adil Agarwal and Dr Anosh Agarwal. Established brand presence and long-operational track record: DAEHL has established itself as one of the leading eye care hospital chains in the Tamil Nadu region.
    [Show full text]
  • Mastering Phaco Nightmares and Worst Case Scenarios: a Video Based Course
    Mastering phaco nightmares and worst case scenarios: A video based course Prof Amar Agarwal MS, FRCS,FRCOphth POSTERIOR CAPSULAR RUPTURE Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. The incidence of posterior capsule complications is related to the type of cataract and conditions of the eye, increases with the grade of difficulty of the case, and furthermore is influenced by the level of experience of the surgeon. Timely recognition and a planned management, depending upon the stage of surgery during which the posterior capsule tear has occurred, is required to ensure an optimal visual outcome. COMMON RISK FACTORS FOR POSTERIOR CAPSULAR RUPTURE (PCR): 1. Intraoperative factors causing variation in anterior chamber depth 2. Type of cataract 3. Extended rhexis Intraoperative factors causing variation in anterior chamber depth Intraoperative shallow anterior chamber could be due to various reasons. It may be a tight lid speculum, tight drapes, or pull from the recollecting bag. In all the above cases, remove the precipitating factor (Remove the speculum pressure, remove the tight drapes and collecting bags). Variation in the amount of space in the anterior and posterior chambers may result from changes in the intraocular pressure (IOP) due to an alteration in the equilibrium between inflow and outflow of fluid. Diminished inflow may be secondary to insufficient bottle height, tube occlusion or compression, bottle emptying, too tight incisions compressing the irrigation sleeve, or the surgeon moving the phaco tip out of the incision, making the irrigation holes come out of the incision.
    [Show full text]
  • Assisted Pre-Descemet Endothelial Keratoplasty
    Journal name: Clinical Ophthalmology Article Designation: Letter Year: 2015 Volume: 9 Clinical Ophthalmology Dovepress Running head verso: Jacob et al Running head recto: E-DMEK and E-PDEK open access to scientific and medical research DOI: http://dx.doi.org/10.2147/OPTH.S95282 Open Access Full Text Article LETTER Endoilluminator-assisted Descemet membrane endothelial keratoplasty and endoilluminator- assisted pre-Descemet endothelial keratoplasty Soosan Jacob1,2 Dear editor Amar Agarwal1 We read with great interest the article by Kobayashi et al on the use of endoillumination Dhivya Ashok Kumar1 probe-assisted Descemet membrane endothelial keratoplasty (DMEK) for bullous 1 1Dr Agarwal’s Eye Hospital and Eye keratopathy secondary to argon-laser iridotomy. We would like to bring to the author’s Research Centre, 2Dr Agarwal’s notice that one of us (SJ) described the use of external endoillumination for DMEK, Refractive and Cornea Foundation (DARCF), Chennai, India and the same was published under our names in 2014 as endoilluminator-assisted transcorneal illumination for DMEK,2 with study patients included from January 2013. There are also numerous other references to this online.3–6 We have termed this tech- nique endoilluminator-assisted DMEK or E-DMEK and endoilluminator-assisted pre- Descemet endothelial keratoplasty (E-PDEK) when applied to PDEK.7 E-DMEK makes the surgery simpler by allowing good visualization and better surgeon comprehension of graft morphology and dynamics and enhanced visualization and three-dimensional depth perception through edematous and hazy corneas (Figure 1). The technique also aids the surgeon with better comprehension of graft orientation and positioning (Video S1). We would like to gently bring to the authors’ attention that our work was the initial report on E-DMEK, and that this has been missed in their citation.
    [Show full text]