Posters

Sometimes rolling back to previous cataract techniques is inevitable

Poster Details

First Author: S.Moutzouri GREECE

Co Author(s): D. Balatsoukas   E. Kanonidou                 

Abstract Details

Purpose:

Cataract surgery in patients with chronic uveitis is challenging for a variety of reasons. Our aim is to present a difficult case of a young patient with an extremely fibrotic anterior capsule which was impossible to open despite employing multiple instruments.

Setting:

Department of Ophthalmology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece

Methods:

A 26-year old woman with a history of chronic uveitis, strabismus, hyperopia, cerebral palsy and mental retardation was referred to our ophthalmological department for cataract surgery of the left eye (OS). Thorough preoperative evaluation was difficult due to the inability of the patient to cooperate. Slit lamp examination revealed an intumescent white cataract (OS) and posterior synechiae of the iris. No sign of active intraocular inflammation was present. The patient was scheduled for cataract extraction under general anesthesia.

Results:

Intraoperatively posterior synechiolysis was performed in an attempt to achieve adequate pupillary dilation. Anterior capsule was stained with trypan blue and an ophthalmic viscoelastic device (OVD) was instilled to maintain the chamber pressurized and to improve dilation of the pupil. However, tearing the anterior capsule either with the trapezoidal or the paracentesis blade proved to be difficult due to the presence of fibrotic elements. Micro-scissors were used to cut the fibrotic bands but also failed to create a capsular opening. The surgery was cancelled and the patient was re-scheduled for intracapsular cataract extraction (ICCE).

Conclusions:

Uveitic cataract surgery presents specific difficulties. This case was complicated by central posterior synechiae from the iris to the anterior lens capsule and a small pupil overlying an extremely fibrotic capsule. Extracapsular cataract extraction requiring opening of the anterior capsule proved to be impossible and utilization of ICCE was necessary.

Financial Disclosure:

None