Surgical Tsunami

In this surgical video, Dr. Amar Agarwal encounters a host of intraoperative complications that arose during a combined glaucoma filtering and cataract removal surgery. At the start of the surgery, Dr. Agarwal uses a special drill, which is designed create a corneal scleral channel to shunt aqueous into the subconjunctival space. However, the iris is caught in the drill as it enters the anterior chamber, resulting in a 360-degree iridodialysis and hyphema. After a careful phacoemulsification and 3-piece IOL implantation, the surgeon tries to salvage the remaining, ripped iris tissue by unrolling and suturing it back into place. However, this approach is abandoned after the suture begins to cheese wire the tissue, leaving no option other than removing the rest of the iris tissue and replacing the first IOL with an aniridic glued IOL. An inadvertent jolt during movement of the trocar AC maintainer duringr IOL explantation causes a posterior chamber rupture. Despite the many set-backs, Dr. Agarwal’s team is able to successfully implant a centered aniridic IOL and complete the trabeculectomy.