When the goal is to implant a toric IOL in an eye with recurring bouts of uveitis, poster synechiae, an extremely shallow chamber and a previous iridectomy, a step-by-step approach is required. Here I demonstrate my approach including a pars plana vitrectomy to first deepen the anterior chamber.
After posting so many complicated cases, I thought it may be time to review my standard procedure with this one-eyed patient showing some slight macular degenerative changes. Leaving this patient myopic for better reading vision quality, my chopping technique, settings, and the benefits of vacuuming the posterior capsule are all discussed.
Endothelial protection is always important, though in a patient with severe corneal dystrophy and a shallow anterior chamber, it is even more critical. In this case, I discuss several pearls for safe removal of the nucleus in a patient with a severely compromised endothelium.
We start our 4th season with a very interesting case! My preoperative plan was to use a toric IOL in this 89 year old patient with a very dense cataract. After discovering a complete lack of zonular support, I perform a vitrectomy and change my lens choice to an AC IOL. I discuss control of the remaining astigmatism near the end of the procedure.