Cataract-implant surgery was performed in a very highly myopic young woman with several disabilities, retinopathy of prematurity and an extremely dense cataract with an appearance that resembles spherophakia. Phacoemulsification, insertion of capsule retractors, a capsular tension ring and a 40 diopter IOL were done in a necessarily deliberate manner. General anesthesia was avoided by the reassuring support of the patient's mother who accompanied the patient into the operating room and maintained constant contact with her throughout the operation. Both the appearance of the cataract and logistics of the procedure are rare.
In this myopic patient with low ocular rigidity, I demonstrate both my phaco chop technique and simultaneous astigmatic correction using a pair of full thickness i.e. Penetrating, Limbal Relaxing Incisions.
In this case I discuss implantation of a trifocal IOL with astigmatic correction. Ascertainment of proper alignment of the toric IOL at the desired corneal meridian is also demonstrated.
In this patient with severe claustrophobia and a moderately shallow AC, I discuss several maneuvers/techniques that can reduce patient anxiety and increase the safety of nucleus removal.
A patient with dysphotopsia requiring IOL exchange has had a prior Yag laser posterior capsulotomy. After performing a pars plana vitrectomy, a secondary capsulorhexis is demonstrated followed by IOL exchange with optic capture.