 Alright, so let's go ahead and get started for our cornea grand rounds. So before we get to our main event, we have Mark Mifflin is going to present a couple of interesting cases. It might be interesting to us, but we had a talk by Dr. Byrd and I think one of the fellows, Brent, presented this case of a really unfortunate guy who got a canthamoeba keratitis from using well water on his contacts. I wanted to show you some follow up on him because if you look at the literature, there are actually a lot of, you know, when you kind of look at case series, many of these kinds of eyes end up getting enucleated or eviscerated. So sometimes you can get a really good outcome with visual outcome, a good visual outcome as well, so I just wanted to show that. So this was his eye before his surgery after nine months of anti-amoeba therapy and one prior failed graft. So just to remind you, we had a lot of synechia in the anterior chamber. We had a mature cataract. We had to dissect his iris away from both the angle and the lens to get at it. And then we were able, fortunately, to put a lens in the bag and clean him up, do a transplant. And fortunately, he did well and did not require any additional a canthamoeba treatment. His posterior segment turned out to be normal. And there's his eye two weeks ago. He's, whoops, it's ruining, I don't know why, it's going to have a delay here. But anyway, there it is, two weeks ago and he is just at the point where we're starting to get ready to remove sutures. So he does have about six diopters of the stigmatism, but he corrected to 2030 with that. So he's going to retain good vision, fortunately his optic nerve is okay. He does have some, he has a lot of synechia. We were able to free most of them up, but I'm worried about eventual glaucoma in him. He's taking calm again twice a day and his pressure is normal on six doses of steroid, strong steroid a day. But anyway, I thought that was good for people to see. So there can be hopeful and good outcomes with advanced a canthamoeba. The next case is a similar age gentleman about 50 years old who was very unfortunate, well first he had keratoconus, his original transplant was performed by Dr. Olson many, many years ago. He suffered a ruptured globin. It's a little bit hard to see here, but he had an anoridia IOL put in with a repeat PK and we did that about 10 years ago and his graft eventually failed. So we're doing a DSEC here, this is a couple of weeks ago, Dr. Pooley and I are working on this together and you know, his anoridia IOL has been really stable and he's had good vision prior to his graft failure. And so, yeah, yeah, and I think this is going to loop and I'll show you here. So I've obviously edited this a lot and so the graft, the donor tissue has been put into the eye here and at this stage we normally will suture the incision, which you'll see Dr. Pooley getting ready to do here. Typically put some more anesthetic on the eye, watch the graft, oops, I don't know if you can see that, we'll run it again, but it's like, okay, where'd it go? Dr. Pooley is like trying to divine it back. He's like, I'm like, where'd the graft go? Because I had looked away, he's like, I don't know, I think it folded up in the enter chamber but so I put on the indirect and sure enough it's over the optic nerve and really no visible space notable around this IOL, which has a six millimeter optic and it's about a 10 and a half or 11 millimeter, I guess it's, no, it's actually even bigger than that. About a 12 millimeter black skirt around it and so it's sutured to the sclera but I think if you watch, I actually pushed down, so it is my fault Dr. Pooley, pushed down with the, just kind of hit this cannula here and it redirected the fluid and that forced it. When I was putting the extra numbing drops in, you'll see that in just a minute. So there's the graft, there's no air in there. Had we put air in or clamped off our infusion, we wouldn't have gotten into trouble. But trying to be nice to the patient, give him an extra numbing drop here, there it went. I don't know if you could see that on the video. So anyway, we were perplexed because he has an aniridia IOL which is sutured to the sclera. There's really no way to get around that thing reliably. I talked with the retina team and we didn't have backup tissue so we kind of closed him up and prayed and cursed and then we were kind of planning on just doing a sclerotomy and removing the tissue through a sclerotomy because I didn't want to take the aniridia IOL out. But we just said, oh, desperation, why don't you sleep on your stomach because we saw him the next day and the graft was still sitting over the optic nerve. And then, why this is so slow, it's not advancing, sorry. I killed the computer, neither one's working. Okay, yeah, so thank you. This was the on day five after he was sleeping on his stomach and the interesting thing is that our dislocation was inferior through this space down here but the graft somehow resurfaced through the top so there's some dynamic openings happening there around that IOL which appears to go all the way to the sulcus but obviously doesn't. The lens is actually sutured, I just know this from memory, you can't even really see the sutures anymore but the haptics would be over here and over here. And then, we did a, sorry, why is it not working? I can't make it advance. What did you do, Amy? Oh, this one here. I was using the, what would just go, we don't need to use the slideshow, we'll just go on the regular slides, we're almost done here. So just showing, I decided to do a PK on him because of the, just the challenges of, you know, perhaps letting this happen again and we didn't really want to do any more surgery on the side, it's been through a lot so you can still see the graft kind of I think up there in the, it had stayed put for three or four days and we were able to just take it out and do a transplant and he's doing really well. So interesting case. So just thought I'd present that, thank you.