ESCRS eConnect Webinar - ESCRS London 2026. Why you shouldn't miss it! A sneak Preview

Good evening, Burkhard, and to, to, to, to, two nice presentation, but thanks very much.

Well, our symposium is focused on, on, on lamellar surgery, the combination of lamellar and, and cataract surgery.

And I w- I will cover some of the ideas, uh, during my talk, but, uh, but we, we have a, a group of very experienced surgeons, uh, from all Europe and US who will share their experience with us.

So, uh, so I will, um, talk the, the, about some, uh, key issues on the modern ma- management of cataract and lamellar corneal surgery.

Have no financial disclosures, focus on this talk.

And, um, well, with some differences in different regions, the main indication of, uh, of, for corneal transplantation are keratoconus, Fuchs' corneal dystrophy, and reintervention.

Uh, also with some regional differences, posterior and anterior lamellar techniques are progressively replacing full thickness.

And also, remember that 85% of post full thickness and 95% of post, uh, endothelial transplantation reintervention are because of chronic endothelial failure, and most of them will be replaced by another lamellar corneal surgery.

And this is the case for in US, this is the case in Europe, as you can see the figures on the right side of the screen.

And this is particularly the case in, um, uh, our, uh, institution.

So central corneal transplant procedures and cataract surgery, one of the most frequent combinations the corneal surgeon needs to deal with.

And, uh, the classical triple is not as much the classical.

So I will focus in these new, uh, issues.

Uh, and always this talk is focused only in those combinations that are present when the ocular surface is healthy, because if not, we would be talking about different things.

Quickly, there are three possibilities.

First cataract, second keratoplasty, first keratoplasty and a second stage cataract, and the th- two things at the same time.

When we can do cataract first, uh, when it, it is possible to avoid or significantly delay keratoplasty, such as in guttata or in certain corneal opacities, as you can s- you can see on the left side of the screen, um, you, you obviously need to explore this, this eye because to take this decision is not, is not easy.

But, uh, as you can see in this example of, of, uh, Fuchs' case, uh, despite of having this not very nice endothelial appearance, vision has been 20/20 of cataract surgery for many months.

So there are certain situations where you sh- should, uh, do this option, uh, taking into account, uh, that you need to, especially in the Fuchs' case, to protect the endothelium with the best strategies that you might have.

The second situation is to do first cataract, first keratoplasty, excuse me, and second cataract.

The main advantage of this order obviously is refractive, and it is indicated when cataract surgery, if any time needed, will be significantly delayed.

There are three key issues, surgical technique, the use or not of toric IOLs, and the, the issue of refractive enhancements.

So obviously, uh, regarding surgical technique, and doesn't matter if you had pre-op, uh, uh, before a full thickness, a deep anterior lamellar, as you, as you can see on the left si- uh, hand video, or an endothelial transplantation, EDME, on the right side video.

You need to protect, and I recommend to use, uh, always and several injections during the surgery, um, viscoelastic, particularly, uh, the dis- dispersive viscoelastic.

And the way to control that the viscoelastic is there is to observe these bubbles.