Triple Procedure for Managing Pseudophakic Bullous Keratopathy

In this clinical video, Dr. Amar Agarwal describes how he treated a patient with pseudophakic bullous keratopathy using a triple procedure of glued IOL, single-pass 4-throw pupilloplasty and pre-Descemet’s endothelial keratoplasty (PDEK). The patient had a complicated ocular history, and had already undergone 6 surgeries over a span of 4 years. After removing the epithelium, Dr. Agarwal inserts a trocar AC maintainer and makes 2 scleral flaps and a sclerotomy behind the limbus. He then removes the Descemet's membrane, endothelium and fibrous tissue attached to the iris, and discovers a subluxated lens. The IOL was stabilized by externalizing the haptics and tucking them into Scharioth pockets. Next, Dr. Agarwal performs a single-pass 4-throw pupilloplasty to break the peripheral anterior synechiae and normalize the closed angle. Finally, a PDEK graft was prepared and inserted into the anterior chamber. Fibrin glue was applied to the scleral pockets at the end of surgery.

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