Dr. SOHAM BASAK

Abstract

This video shows DMEK-triple with manual small incision cataract surgery (MSICS) in Fuchs’ dystrophy, chronic anterior uveitis and advanced cataract. A 74-year-old lady presented with hand motion vision in left eye. Clinical examination showed corneal edema, shallow AC, peripheral iridotomy, small pupil with posterior synechia, and hard brown cataract. Posterior segment appeared normal on ultrasound.

Phaco with pupil expander was possible, but as DMEK novice, MSICS was a safer option. After synechiolysis and placing iris hooks, nucleus delivered with irrigating vectis. Next, vitrector assisted inferior PI and host Descemet stripping was done. Donor graft was prepared by surgeon. Sclero-corneal tunnel was sutured prior to graft insertion and unfolded using no-touch technique.Postoperative period was uneventful, and she regained 20/80 vision at 1 week.

From a beginner’s perspective, MSICS with iris hooks is a safe technique for handling a small pupil and hard cataract in DMEK-triple.