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Phacoemulsification in patients unable to lie flat for cataract surgery: face-to-face positioning with surgeon on the contralateral side of the patient

Poster Details

First Author: C.Dimitriou UK

Co Author(s):    R. Moosavi   M. Pajaujis   T. Eke        

Abstract Details


The aim of our study was to demonstrate a technique for phacoemulsification in patients unable to lie flat for cataract surgery, using a face-to-face upright seated positioning, with the surgeon positioned on the contralateral side to the operated eye.


We present a case series from a university hospital ophthalmology department in the United Kingdom. Five patients undergoing cataract surgery were unable to lie flat, mainly due to spinal kyphosis and/or orthopnoea. Standard positioning was not possible, therefore we used the face-to-face position, as previously described.


One patient had a fixed face-turn, which meant that it was more ergonomic for the surgeon to sit on the contralateral side for cataract surgery. For the other four patients, contralateral surgeon position was used for a combination of astigmatism management and achieving a position for surgery that was comfortable for both patient and surgeon. The right-handed surgeon finds it easiest to operate on the 0 degree axis (for a right eye, a nasal approach) when seated at the patient’s left side, and at the 270 degree (inferior) axis when seated at the patient’s right side.


There were no significant operative complications. Good visual outcomes after surgery were achieved for all patients. When exploring all options for patient and surgeon comfort, we have found some cases in which it was preferable for the surgeon to be positioned on the opposite side of the patient to the cataract. A patient seated in the erect or semi-recumbent position for surgery, between 30 and 80 degrees from the horizontal plane, requires the microscope to be tilted to between 45 and 60 degrees from the vertical plane, in order to have the eye ‘on axis’.


Face-to-face cataract surgery is an option for patients who are unable to lie flat and in whom general anaesthesia is considered high risk. Topical-intracameral anaesthesia allows the eye to remain ‘on axis’, perpendicular to the microscope, for safer surgery. Face-to-face positioning can be challenging, even for an experienced surgeon. Therefore we believe that it is important to ensure that both patient and surgeon are comfortable before commencing what may be a prolonged operation. In the authors’ opinion, the contralateral approach minimises the inherent additional risks associated with face-to-face cataract surgery and maximises the post-operative visual potential. FINANCIAL DISCLOUSRE: NONE

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