Eyeworld

EW CATARACT 40 June 2016 by Liz Hillman EyeWorld Staff Writer cases where he sits on the opposite side of the eye on which he is oper- ating. This may be the only way to approach some patients with a bent spine and associated fixed face turn, but the technique is useful for astig- matism management as well. To perform phaco while a patient is sitting, Dr. Eke said all the ophthalmologist really needs is a chair that is comfortable for the patient, a microscope that will turn and angle accordingly (with eye- pieces that rotate upward to com- pensate), and experience in manag- ing complex cataracts. The actual process of performing the cataract bent neck. Also, some patients may have a poor heart, lungs, or muscles, making them high-risk for general anesthesia," Dr. Eke continued. If surgery is not done for any of these reasons, the patient's cataract only gets worse, diminishing his or her visual acuity and quality of life. Dr. Eke has published several papers about doing phaco on a patient who is sitting upright. 1–3 He recently highlighted a bit more information on the procedure in a new article published in the March 2016 issue of the Journal of Cataract & Refractive Surgery (JCRS). 4 Dr. Eke, who has performed more than 200 upright, seated phaco procedures, describes with the article coauthors "Some people can't lie flat because of a medical condition. Often it's a heart or lung condition that makes them very breathless when they lie flat, or a neurological problem like myotonic dystrophy. Spinal problems like arthritis or ankylosing spondylitis don't help either," Dr. Eke said. "Depending on the condition, some might get really unwell if you forced them to lie flat, and in some extreme cases there's an actual risk of death if the patient lies flat for any length of time. "Some patients who can't lie flat are suitable for a general anesthetic. However, the anesthesiologist may have a lot of difficulty managing the airway if the patient has a very "There's still a big unmet need" F or some patients, physical conditions or health issues prevent them from doing something as simple as lying completely flat. As such, this makes performing cataract surgery a daunting, if not dangerous, task, which some surgeons choose to avoid. Tom Eke, MD, Norfolk and Norwich University Hospitals, U.K., however, is encouraging ophthal- mologists to be brave in the face of performing phaco on a patient in a semi-reclined or seated position. Phaco in a patient who can't lie flat continued on page 42 Dr. Eke is positioned on the patient's left to operate on the right eye. He uses this technique for some patients with severe positioning difficulty (spinal deformity that includes a face turn) or, as in this case, for easier management of astigmatism in patients who can't lie completely flat for surgery. Dr. Eke finalizes the position for phaco on the left eye of a patient who can't lie flat. Source: Tom Eke, MD

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