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Looking through a corneal scar
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In my post from July 1, I described a patient with a long-standing central corneal scar, dense cataract and pseudoexfoliation. Yesterday I performed her surgery, which went very well. The primary challenge was achieving a reasonable view while looking through the corneal scar. Since the direct, paraxial microscope light caused a lot of reflection from the white stromal opacity, I elected to use pure coaxial microscope lighting. This made the red reflex very bright and allowed for retroillumination of the surgical field.
 Capsulorrhexis performed while looking through a corneal scar. |
The picture here shows that despite the cataract and the corneal scar, the view for the capsulorrhexis was quite good. This allowed me to make a controlled, well-centered, 5.5-mm opening in the anterior lens capsule. The rest of the procedure went smoothly as well, with the lens implant placed securely within the capsular bag. The patient did very well and achieved a level of vision that she hasn't had in years. While doing the cataract surgery cured just her cataract and not her corneal scar, she is happy with the resultant vision and she does not wish to pursue corneal surgery. I agree — sometimes, less is more.
See Dr. Devgan share more expert insight live at OSN New York 2010, to be held November 19-21, 2010 at the Sheraton New York Hotel & Towers. Learn more at OSNNY.com.