We will finish up our year with 3 rather complex cases. This month, our 57 year old patient is extremely anxious about having cataract surgery. She had uveitis and glaucoma in childhood for which a nasal thermal sclerectomy was performed at the age of 8. She subsequently developed a cataract, but opted to postpone surgery until the lens had become quite dense. She has a low endothelial cell count, possibly as a result of prior uveitis and/or intraocular surgery. Because of patient movement during the early stages of the procedure, we use tape to restrain head movement and I deliver a retrobulbar block to improve her ability to remain stationary.
Pseudoexfoliation, zonular laxity, poor dilation, a shallow anterior chamber and a convex anterior capsule are all present in this 85 year old patient.