A belt-and-suspenders approach can be helpful for difficult cataract surgeries

ByUday Devgan, MD

A fellow ophthalmologist in Los Angeles referred his uncle to me: an 80-year-old gentleman with a dense cataract, a history of Flomax use, a poorly dilating pupil and a host of other issues that could complicate the cataract surgery. The patient was monocular as well and had a high level of apprehension about having surgery on his only seeing eye. But because his vision was at the 20/200 level, he knew that he had to do something, or else he would eventually become blind from the cataract.

Intraoperative use of iris hooks is evident at the inferior pupillary margin, and a suture is seen in the temporal incision.

I am always humbled and flattered when another ophthalmologist refers a patient to me, let alone a family member. I was honored to perform the surgery for this patient, but my blood pressure and pulse were creeping higher as the surgery day approached.

For these types of cases, I prefer a belt-and-suspenders approach in which I am particularly deliberate and additional precautions are taken to ensure that things go well. In this case, I used iris hooks to secure the iris out of the way and prevent issues such as iris prolapse, and at the end of the case, I placed a suture in the main incision to make sure that it sealed well. While I don't place a suture in 99% of eyes, in this case it helped both the patient and me sleep better.