Sclerotomy-assisted phacoemulsification in a nanophthalmic eye: Tackling intraoperative complications
Aditya S Kelkar, Harsh H Jain, Mounika BolisettyBackground:
Nanophthalmos (axial length <20.5 mm) poses a unique surgical challenge due to a crowded anterior segment and increased scleral thickness which can produce positive vitreous pressure during cataract surgery, increasing the risk for intraoperative complications.
Purpose:
To demonstrate the role of sclerotomy during phacoemulsification in nanophthalmic eye to mitigate intraoperative complications.
Synopsis:
A 38-year-old male having nanophthalmic eye (axial length 18 mm) with visually significant cataract underwent phacoemulsification accompanied by in-the-bag intraocular lens implantation. YAG peripheral iridotomy was performed 1 week prior to the surgery, and intravenous mannitol was administered preoperatively. Despite these precautions, the anterior chamber remained shallow. Visco-cohesive agents were used to maintain space, but the iris prolapsed during initial capsulorhexis attempts, leading to intraoperative hyphema. An intraoperative 25-gauge sclerotomy was performed inferotemporally, which led to anterior chamber deepening. Capsulorhexis was then completed with the use of cystitome and rhexis forceps. The remainder of the surgery was uneventful, and the trocar was removed at the end of the surgery. The main corneal wound was sutured with 10-0 Nylon to prevent further iris prolapse and wound leak. The postoperative course was uneventful, and the patient achieved a best corrected visual acuity of 20/20.
Video Link:
https://youtu.be/Xqwlj_biXKU