Tips for Improving Cataract Surgery Visualization in Corneal Pathology

Drs. Arthur Okonkwo and Ahmed Bardan present the case of a patient with iridiocorneal endothelial syndrome and corneal decompensation requiring cataract surgery. Preoperatively, the view for cataract surgery was optimized using topical 5% NaCl hypertonic saline 4 times daily. During the procedure, the high red reflex illumination was increased, magnification was increased, and microscope background illumination was reduced; the operating theater lights were lowered to improve the red reflex. Vision blue was used to stain the anterior capsule under air. Epithelial debridement and hydroxypropyl methylcellulose on the cornea were performed to further enhance the view. The eye was tilted throughout so that phacoemulsification could be viewed through areas with less stromal scarring and better visualization. Due to the likelihood of fibrin release, the patient had a staged DSAEK 2 months later.

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