Upright phacoemulsification may be worth learning for patients who cannot lie flat
Key takeaways:
- Some patients cannot lie flat and need to be operated on in an upright position.
- A surgeon at the ESCRS winter meeting offered pearls on how to handle these cases.
ATHENS, Greece — For patients who cannot lie flat, it is important to learn how to perform phacoemulsification in the upright position, according to a speaker.
“I don’t think every cataract surgeon needs to be able to do this, but there is a small cohort of patients out there that will certainly find it useful,” Naadir Ansari, MBBS, said at the ESCRS winter meeting.
First, position the patient comfortably with head support and looking forward. The microscope needs to be rotated to the horizontal position, which dictates the surgeon’s sitting position, beside the patient, close to their knees.
“Down by the knees, there is no space to put the pedals where I might want them,” Ansari said, showing the audience an example of one of his patients.
To avoid too much spinal rotation, he positions the pedals toward the patient, one on top of the other, using a stool.
The physician’s arms are stretched out laterally, a position that requires muscle strength to be maintained. Ansari recommended not waiting until the arms get sore to take a rest because tremors can become an issue. Instead, he suggested using natural breaks in the procedure to relax the arms for brief moments.
“The procedure itself is what we normally do. You’re just at a different angle,” Ansari said. “You just need to remember that less dense things go up, and more dense things go down.”
Holding the phacoemulsification probe and other instruments may require a slightly different position of the hand and wrist. Resting on the patient’s cheek can aid with stability.
Ansari operated on six eyes of five patients using this upright technique, with good outcomes. Three more eyes of two patients are awaiting surgery, and two more surgeons at his hospital in Sheffield, United Kingdom, are taking up this technique.
“This is quite good because when I started everyone said it could not be done,” he said.
He recommended selecting patients carefully because this method of performing surgery is theoretically riskier, there are consent issues, and the vitreoretinal team cannot help if problems occur. In 40% of patients Ansari brought in for upright surgery, it was possible to recline the chair eventually.
“This isn’t for everyone, and as a surgeon, you need to be comfortable with patients being very mobile in a reclined position first because in the upright position, they’re even more mobile. There is a learning curve, and obviously different units will have different equipment, circumstances and surgeons,” he said.
Collapse
Ansari N. Upright phacoemulsification – technique and outcomes. Presented at: ESCRS winter meeting; Feb. 28-March 2, 2025; Athens, Greece.
Read more about