Phacoemulsification in a Monocular Patient with Marked Cervical Kyphosis

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Phacoemulsification in a Monocular Patient with
Marked Cervical Kyphosis

• Fabio H Casanova, MD PhD

Federal University of São Paulo Paulista School
of Medicine São Paulo, Brazil
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Purpose

• To demonstrate the surgical approach in a patient
  with cervical kyphosis during phacoemulsification
  and evaluate feasibility

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Methods

• 60-year-old, male, monocular patient
• Decreased vision in OS
• Long-standing ankylosing spondylitis
• ECCE 2 years earlier in his right eye with no IOL
  implantation. He developed CME with decreased
  vision in OD.
• BSCVA was 20/400 in both eyes
• Extensive spinal deformities, including cervical
  kyphosis, prevented him from being positioned
  satisfactorily for surgery

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Ocular examination
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At Operating Room
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Results

• The best position for the surgeon operating
  chair on the left of the patient and resting over
  patient's shoulder and thorax, and using an
  orthopedic support, which allowed the patients
  head to be reclined to a position of 45 to 60
  degrees to the horizontal

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Surgeons position
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Results

• Phaco with foldable IOL implantation in the
  capsular bag uneventfully under topical
  anesthesia which facilitated during the surgery
  since the patient could move his eye according to
  the surgeon's request aiming a better surgical
  field

Incisions
Phaco
IOL implant
Surgeons view
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Results

• UCVA was 20/30 and BSCVA was 20/25

Surgeons view
1st postoperative day
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Conclusion

• Successful phacoemulsification was performed,
  although the angle of approach for the surgeon
  and the operating microscope was awkward. In
  selected cases, good results can be achieved.
  Additional care must be taken in these
  challenging cases. Patients must be aware of
  potential complications.