Determination of the correct IOL power for a highly myopic eye with posterior staphyloma is fraught with difficulty. Here I employ two methods that can permit measurement of both the spherical and astigmatic power of the desired IOL, including the degree of “retinal astigmatism” caused by the staphyloma. I demonstrate the use of both wavefront technology and the Aphakic Refraction Technique (manifest refraction) to calculate the power of the IOL that is then inserted on the day following
In this case I present a variety of phaco techniques and pearls as cataract extraction and multifocal IOL implantation is performed in an eye with a small pupil and moderately floppy iris. A spit screen is utilized to demonstrate surgeon hand position throughout most of the procedure.