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CataractPhiladelphia

Cataract Surgery Philadelphia

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Cataract Surgery & Corneal Disease Treatment – James S. Lewis, MD

Serving Bucks County, Philadephia, Warminster, King of Prussia, Delaware Valley, Phoenixville, Montgomery County and Conshohocken


Sometimes patients have been told their cornea is “weak” and may not tolerate cataract surgery. Most of these patients have too few corneal endothelial cells and are described as having corneal endothelial dystrophy. Sometimes too few of these cells are the result of severe trauma, prolonged inflammation (uveitis), or previous surgery.

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Although it is difficult to predict whether the cornea will tolerate cataract surgery, we use multiple techniques including endothelial cell examination, specular microscopy, and optical coherence tomography of the cornea to make that determination. If it is likely the cornea will fail, we perform what is called a triple procedure which includes cataract surgery, intraocular lens insertion, and endothelial cell transplant (DSEK).

In the last few years the prolonged recovery period forced surgeons to delay triple procedures until a patient’s vision was extremely poor. These cases involved full thickness corneal transplants (Penetrating keratoplasty, PK), 16 or more sutures, restricted activities, and high degrees of postoperative astigmatism. Now that we can transplant only the deficient portion of the cornea, the endothelial cells, patients recover very quickly, have only a handful of sutures, have almost no postoperative astigmatism and virtually no limitation of activities.

In cases in which cataract surgery has been performed and the corneal endothelial cells fail, DSEK (Descemet’s Striping Endothelial Keratoplasty), a 20 minute, out patient procedure, is frequently done in our practice.

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Other cases of corneal disease like Herpetic Scarring, Corneal Lacerations, Stromal Dystrophy and Microbial Ulcers with Scarring can be addressed with our Excimer Laser using what is called PTK (Phototherapeutic Keratoplasty). When the scarring is too deep an MDALK technique can be performed. MDALK (Maximum Depth Automated Lamellar Keratoplasty, or the Big Bubble) removes the diseased corneal tissue leaving only the healthy endothelial cells. This technique reduces corneal rejection, large degrees of postoperative astigmatism, and achieves excellent visual results. Furthermore, MDALK has a significantly reduced level of activity restriction and suture removal two to four times earlier than standard Penetrating Keratoplasty.

When full thickness corneal transplantation is needed, with or without combined cataract surgery, we have two options. The latest, FAK (femtosecond assisted keratoplasty) which is also known as IEK (Intralase™ enabled Keratoplasty). A laser like the one used for flap creation during LASIK is used to fashion both the donor and recipient cornea using a specialized tongue in groove template. The precision of this laser allows for outstanding tissue apposition, rapid healing, earlier recovery, and reduced postoperative astigmatism. Dr. Mike Aronsky of Kremer Eye Center and I are the only approved and experienced IEK team in the region.

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Sometimes full thickness corneal transplantation and cataract surgery with posterior chamber lens implantation using a mechanical trephine is the best option. Although recovery can take 10 to 12 months our results have been outstanding. Much of this is the result of our ERAPK system.

ERAAPK, (Excessive Regular Ammetropia/Astigmatism following Penetrating Keratoplasty) was the subject of a paper I published in 1991. We now have the world’s largest pool of ERAAPK patients (approximately 500 eyes). ERAAPK uses the excimer laser to perform an advanced surface ablation on post-operative corneal transplant patients. Few if any ERAAPK patients require RGP (rigid gas permiable) contact lenses after surgery. In fact, many are either entirely spectacle free or in need of “normal” glasses.

We also perform Femtosecond Assisted INTACS for Keratoconus and will begin ribo-flavin cross-linking after FDA approval is granted.


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Cataract Surgery in conjunction with Corneal Disease Management has been revolutionized in the last few years. We are proud to provide the most up to date surgical and laser techniques.

CALL FOR AN APPOINTMENT

(215) 886-9090

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Full compliance with all guidelines 😷 related to the Coronavirus crisis

Lewis LASIK
Our practice will start seeing patients again on M Our practice will start seeing patients again on Monday, May 11th in full compliance with all local, state, and federal guidelines. This includes masks, social distancing, and the disinfection of all common surfaces. Elective surgeries are also being rescheduled. Care will be taken to avoid office congestion and minimize exposure to COVID-19.

We require: ➡️ You do not have fever, chills, shaking, muscle pain, headache, sore throat, or a loss of taste or smell ➡️ You have not had exposure to anyone with a flu-like illness within the past two weeks ➡️ You wear a mask or equivalent facial covering over both your nose and mouth ➡️ You agree to maintain social distancing ➡️ You avoid touching your eyes, nose, mouth, and face ➡️ You enter the office alone if possible

Expect to hear from our staff shortly. You may contact us at your convenience from links at jameslewismd.com
Chorioretinal folds are a known finding following Chorioretinal folds are a known finding following penetrating glaucoma surgery, as in these two cases who underwent Ahmed valve tube shunt placement. Prevalence is estimated between 10-50% of incisional glaucoma surgeries.

Pic 1.) several linear chorioretinal folds throughout the posterior pole. Intraocular pressure was 4mmHg at the time of this photo. The fundus and visual acuity returned to baseline within a week as IOP leveled at 10mmHg.
Pic 2.) Small choroidal folds can be seen distributed temporal to the macula. This image also demonstrates a large hemorrhage consistent with ocular decompression retinopathy.
Pic 3.) shows complete resolution of the choroidal folds and hemorrhage after 4 weeks in patient 2.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry  #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity #glaucoma #glaucomasurgery #retina #chorioretinalfolds
Inflammation of the anterior chamber can create fi Inflammation of the anterior chamber can create fibrin plaques that are readily seen within the pupil. The second and third images demonstrate an almost completely occluded pupil with synechia formation. The fourth image demonstrates an ultrasound biomicroscopy image of a patient in angle closure following complete pupil occlusion from fibrin (blue arrow). Aggressive corticosteroid therapy can ‘melt’ the fibrin and cycloplegics can mechanically disrupt it. Nd:YAG laser can also instantly disrupt total occlusion.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry #ocularinflammation #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Descemet stripping endothelial keratoplasty (DSEK) Descemet stripping endothelial keratoplasty (DSEK) is a corneal transplant procedure that replaces only the innermost cells of the cornea. It is readily combined with cataract surgery to improve refractive outcomes. This is a one day post operative visit of a DSEK showing faint edema and remaining air bubble. The air bubble will typically dissolve over the first 48-72 hours.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #corneatransplant #dsek #fuchsdystrophy #endothelium #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Ocular surface disease is a complex state that rep Ocular surface disease is a complex state that represents a poorly performing pre-corneal tear film. It can frustrate many patients and can be challenging for clinicians. No two cases are alike.

In this case, a young patient without evidence of desiccation or inflammation had persistent physical symptoms. Biomicroscopy revealed clear lid margins, no conjunctival injection, and no corneal epitheliopathy. Meibography (imaging the meibomian glands) provides insight into the cause. A previous course of oral medication that acts on sebaceous glands has likely impacted his meibomian glands as well. The gland dropout is easily seen as truncation and atrophy. The final video demonstrates a noninvasive tear-breakup time where the red squares are regions with early loss of tear film stability.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #dryeye #ocularsurfacedisease #OSD #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
Iris cysts are benign. If suspected, they should b Iris cysts are benign. If suspected, they should be imaged with ultrasound biomicroscopy (UBM) to confirm the diagnosis and rule out other causes of iris elevation.
#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #ubm #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
There are various types of cornea transplantation There are various types of cornea transplantation procedures and each is best suited for different patients based on diagnosis and other factors. This is an MDALK (maximum depth anterior lamellar keratoplasty) that retains the innermost layer of cells and membrane, but replaces as much diseased tissue as possible. It has excellent clarity and comparatively good visual outcomes. 
#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity #mdalk #corneatransplant
Corneal infection! This series of images highlight Corneal infection! This series of images highlights a case of pseudomonas aeruginosa microbial keratitis (corneal infection) related to contact lens wear. Keep in mind the cornea is about 0.5 millimeters thick! Not much room to allow an infection to move deeper.
Pic 1. The resultant scar after the infection cleared.
Pic 2. At presentation, the eye is injected (red) with a large central infiltrate (immune response) and necrotic stromal tissue (dying cells). Pic 3. There was extensive inflammation in the anterior chamber including fibrin strands
Pic 4. Note the presence of a hypopyon (accumulation of white blood cells at the bottom of the anterior chamber).
Pic 5. This is two days after initiating treatment with fortified antibiotics. The pupil is intentionally dilated (for comfort) and anterior chamber inflammation is improving. There is a small unrelated fiber present that was subsequently removed.
Pic 6. A closer look at the scar and the shadow it casts. These scars disrupt the vision permanently. Fortunately this patient has achieved good acuity, yet blur, glare and haze can be persistent.
(Sorry for poor photo quality in pictures 2/3/4)

It is important to work quickly to identify the organism responsible for these infections to tailor treatment appropriately. If left untreated infection can spread to devastating results.

#ophthalmology #ophthalmologist #ophthalmictech #ophthalmologyresident #ophthalmicphotography #ophthalmicsurgery #cornea #corneasurgery #eyesurgeon #eyesurgery #microbialkeratitis #eye #oculardisease #optometry #optometrystudent #optom #sunyoptometry #osuopt #salusuniversity
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At the Philadelphia, Pennsylvania cataract surgery offices of Dr. James S. Lewis, patients are assured the highest quality treatments and impeccable care. Dr. Lewis and his team use the latest surgical technologies and techniques to deliver the best possible results. CataractPhiladelphia offers a wide range of premium IOLs, including PanOptix, Vivity, Toric and Light Adjustable Lens. Dr. Lewis also treats patients with both cataracts and glaucoma through an enhanced range of micro-invasive glaucoma surgical options.

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* currently only PanOptix, Vivity, Toric, and the Light Adjustable Lens patients qualify for ONCE AND DONE.

 
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CALL FOR AN APPOINTMENT

(215) 886-9090

8380 Old York Road
Suite 110
Elkins Park, PA 19027

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