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Corneal opacities and cataract surgery: this is how to do it!
First Author: A. Mokka GREECE
Co Author(s): D. Stampouli I. Vagiakis V. Athanasiadis S. Zachariadi
To present a challenging surgical case of phacoemulsification and chronic extensive stromal corneal opacities. We discuss the peri-operative and intra-operative considerations to minimize the risk of complications.
Ophthalmology department, General Hospital of Xanthi. Xanthi, Greece
A 77-year-old Caucasian male presented to outpatient ophthalmic services complaining of a bilateral gradual reduction in vision.He was on oral treatment for hypertension, hyperuricaemia and benign prostate hypertrophy.His previous ocular and family history were unremarkable.There was no history of trauma.On examination, best corrected visual acuity (BCVA) was OD 2/10+ OS 1/10.Anterior segment examination revealed bilateral multiple central and peripheral extensive corneal stromal opacities, in the absence of an epithelial defect.Lens opacities were dense and consisted of 2+ nuclear sclerotic as well as 3+ cortical cataracts bilaterally.Following informed written consent with a guarded visual prognosis,cataract surgery was planned in both eyes.
Phacoemulsification surgery under topical anaesthesia was planned due to mild bradycardia (43-45 bpm).Enhanced visualization with Trypan Blue was key to achieve a complete continuous and round capsulorrhexis.Following this, loss of dilation and persistant iris prolapse through the main incision occurred despite adequate wound construction,at the initial introduction of the phacoemulsification probe into the anterior chamber.The extent of Intraoperative Floppy Iris Syndrome (IFIS) was resistant to pharmacological dilatation and subsequent safe progression with phacoemulsification was only achievable with four mechanical iris expansion hooks.Cortical matter aspiration and intraocular lens implantation in the bag followed and the operation ended without any complications.
Corneal opacities pose challenges during phacoemulsification surgery. This cohort of patients often have multiple ocular comorbidities (resulting in delayed presentations), previous trauma, or inflammatory conditions, which cataract surgeons may encounter. We discuss the risk factors, perioperative and intraoperative considerations, and demonstrate how with careful surgical planning and utilization of surgical adjuncts, surgical complications can be avoided in cases with corneal opacification.
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