At 106 years old, this remarkable gentleman had been living with severely reduced vision from dense cataracts. Poor eyesight had taken away his independence — limiting his mobility and making him reliant on family for even the simplest daily activities. At iSurgeon, he underwent right eye phacoemulsification and left eye small-incision cataract surgery (SICS) performed by Dr Rawjee. Today, he is once again able to perform his activities of daily living independently — moving around confidently and reclaiming his dignity and freedom.His family is deeply grateful, and moments like these remind us that age is never a barrier to restoring vision and quality of life. Both SICS and phacoemulsification are effective, vision-restoring cataract procedures. Phacoemulsification involves ultrasound energy, which may lead to greater endothelial cell loss, especially in dense cataracts or compromised corneas. SICS avoids ultrasound energy and is often gentler on the endothelium, making it a valuable option in advanced or hard nuclei. A larger incision is made during SICS and may induce more postoperative astigmatism, though this is often predictable and manageable with excellent final visual outcomes. Both techniques have an important place in modern cataract surgery. Patient factors — cataract density, corneal health, ocular comorbidities and access to technology — should guide decisions rather than a “one-size-fits-all” approach. 📸Pictured here with his surgeon, Dr Kashmira Rawjee, after cataract surgery

Cross linking often stops progression of keratoconus, however does not improve refractive outcomes. PTK (phototherapeutic keratectomy) uses the same excimer laser used in LASIK and PRK. This laser can be combined with cross-linking in keratoconus patients with a suitable cornea to improve the topography and optics. PTK can be performed at the time of cross-linking to reduce corneal surface irregularities. PTK helps reduce higher-order aberrations and can lead to improved corneal topography and enhanced quality of vision. Suitable patients are those with a pachymetry greater than 450um and lower levels of irregular astigmatism. PTK can also be performed after cross-linking. Below is a case study of patient: History: 21 year old lady with keratoconus progression. We planned to perform a PTK of 50um to reduce the irregularity over the cone. The amount of microns is determined by the epithelial map which allows us to precisely remove a specific depth of epithelium and irregular stroma. Based on this epi map we have decided to go with 50um to remove the epithelium. This was followed by a standard cross-linking. Traditionally in crosslinking we use alcohol to remove the epithelium. Post operative: One can note that the axial map is improved showing reduced K readings. The refraction and visual acuity have also improved: Refraction: Pre Op L) -4.00/-6.00X141 Post Op L) -4.50/-4.75X145 Visual Acuity: Pre Op VAL) 0.6 Post Op VAL) 0.7 Patients undergoing crosslinking combined with PTK will often have good best corrected visual acuity with spectacles and improved quality of vision

Often patients are told that corneal refractive surgery is not possible for presbyopia. However, there are solutions like Presbyond laser blended vision and Allotex inlays. Both are performed via LASIK surgery. At iSurgeon, we offer both procedures and recommend specific procedures based on refractive and anatomical findings. Allotex inlay is suitable for patients who want to reduce their need for reading glasses and still maintain distance vision. These corneal inlays (known as lenticules) are obtained from natural corneal tissue making them biocompatible, safe, effective, and reversible. Each inlay is custom-shaped to match your individual eye. Allotex can be used in combination with laser refractive procedures such as LASIK (which is used to correct distance vision) to reduce your reliance on reading glasses, multifocal or bifocal glasses by addressing both near and distance vision needs. Benefits of Allotex: - Natural and biocompatible: Allotex is made from human donor tissue which means it is naturally compatible with your eye and well-tolerated over the long term. - Minimally invasive: Allotex does not require major surgery, making recovery smoother and faster. - Seamless integration: The inlay is specially designed to fit naturally within your eye, working well with your existing eye structures. - Reversible: If needed, the procedure can be safely reversed. - Reduced dependence on glasses: Allotex can significantly improve near vision, making you less dependent on reading glasses, bifocals, or multifocals. Suitable candidates for Allotex: - Plano presbyopes to +2.50 - Myopes -0.25 to -3.00 - Cylinder up to -2.00

What is CAIRS? Many patients with keratoconus struggle with reduced best corrected visual acuity or may be contact lens intolerant. While cross-linking only stops progression it does not improve vision. Fortunately, there are other solutions to improve a patients best possible corrected vision. One such option is CAIRS (Corneal Allogenic Intrastromal Ring Segments). This minimally invasive procedure involves implanting corneal donor tissue segments into the cornea to flatten the cone and regularise the cornea. As a result, it can allow for a more stable refraction, improved contact lens tolerance, and in some cases may even achieve functional vision with spectacles alone. It is different from PMMA rings (Intacts/Kerra-ring), having no risk of extrusion, it is biocompatible and therefore safer and more effective. Who is a suitable candidate for CAIRS? - BCVA less than 0.5 (6/12 or worse) - Contact lens intolerance - Patients wishing to avoid a full-thickness corneal transplant - Previously cross-linked patients - Previous corneal transplant patient