Advanced Surgical Technique

Reposition of Dislocated PCL Reposition of dislocated PCL with vitreous prolapse utilizing a pars plana approach followed by iris-implant fixation sutures.

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Removal of Dense Brunescent Cataract Removal of an extremely dense, maximally opaque brunescent nuclear cataract highlights this case. Dr Mackool uses Trypan Blue to stain the anterior capsule and a Beehler Pupil Dilator to stretch the poorly dilated pupil.

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Iris Flocculi A patient presenting with Iris Flocculi gives us an excellent opportunity to demonstrate how to successfully treat this rare condition.

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Aphakic Refraction Cataract-implant surgery (aphakic refraction technique) in an eye that is status post lasik, has marked pseudoexfoliation, a miotic pupil, congenital anterior polar cataract and iris atrophy.

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Phaco Efficency Phaco efficiency in a patient with poor limited ability to cooperate. Autosert IOL insertion.

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Cataract-implant with IFIS RJ Mackool Toric Axis Marker (Crestpoint Management). Use of iris crypts to increase view of periphery of toric lens.

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IOL Exchange Multipiece IOL to single piece toric IOL using Mackool Foldable IOL Removal System. Autosert IOL insertion.

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Cat XT S/P Lasik Corneal striae and aphakic refraction technique with discussion of irregular astigmatism, spherical aberration. Secondary insertion of toric IOL.

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Femtosecond Laser-Assisted Extraction of a Mature White Traumatic Cataract This patient has had a penetrating ocular injury during which a metallic foreign body passed through both the anterior and posterior capsule of the crystalline lens.

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Shallow Chamber, Miotic Pupil and Zonular Laxity Dr Mackool demonstrates the use of a pars plana vitrectomy, pupil dilator and capsule retractors for dealing with this trifecta!

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Zonular Dehiscence in a One-Eyed Patient Phacoemulsification is performed in a one-eyed, high myope with posterior staphyloma and an axial length >30mm. Trypan Blue is used to stain the capsule. Zonular dehiscence with vitreous prolapse is discovered intra-operatively.

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Pseudoexfoliation and Capsule Support Devices 84 year old patient with pseudoexfoliation and zonular laxity. Capsule staining, Insertion of both MST capsule retractors and Mackool Capsular Support System retractors, and injection of a capsular tension ring are demonstrated and discussed.

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The Severe Blepharospastic Patient The topic is management of severe blepharospasm and Bell’s phenomenon during cataract surgery in a patient with Floppy Iris Syndrome and a mid-dilated pupil. The use of Trypan Blue and techniques to manage the sleeping patient are also demonstrated.

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The Claustrophobic Patient A claustrophobic patient is made more comfortable by the use of a simple draping technique. The patient has had previous LASIK surgery, and an Aphakic Refractive Technique is used to determine the correct IOL power.

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A Discussion of Aphakic Refraction Technique.  A discussion of Aphakic Refraction Technique, with unique discussion of retinal anesthesia and retinal astigmatism. Also very good examples of phaco chop technique, capsule staining. Cataract extraction is performed on day 1 with the refraction and IOL implantation performed the next morning.

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Endothelial Dystrophy and Zonular Laxity Dr. Mackool discusses techniques to preserve the endothelium in this patient with a low cell count. Zonular laxity is observed, and the signs of this condition are demonstrated, as is "in-situ" lens removal to avoid zonular stress. Methods to protect the posterior capsule and endothelium are also shown.

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Use of Trypan Blue and a Beehler Pupil DilatorUse of Trypan Blue and a Beehler Pupil Dilator is demonstrated on a cataract patient presenting with Pseudoexfoliation. Proper positioning of the phaco infusion sleeve, bimanual nucleus rotation to create less zonular stress and gentle removal of the epinucleus are highlighted.

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Repositioning a Rotated Toric IOL In this case Dr Mackool demonstrates how to reposition a Toric IOL that spontaneously rotated away from its original position.

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©2014 Dr. Richard J. Mackool, MD

The machine settings, parameters, and techniques shown in these videos have been established by the surgeon.

ABOUT DR. MACKOOL

 

Dr Richard Mackool is an internationally recognized expert in the field of ocular microsurgery. He is an inventor of numerous instruments and techniques for cataract removal and IOL designs, has published hundreds of papers and several textbooks, lectured throughout the world, and surgeons from every continent have travelled to New York to attend courses conducted by him. He has performed more than 50,000 ophthalmic procedures, specializing in cataract-implant surgery, corneal refractive and transplant surgery, and vitreous microsurgery. His widely-read monthly column, PhacoTips℠, appeared in Ocular Surgery News for 20 years.