JUN 17, 2013
The authors present an extreme case of a cataract surgery patient who was unable to lie flat and unable to be transferred from his motorized wheelchair.
The 68-year-old man had poor mobility due to a stroke, slept upright because of orthopnea, and had poor neck extension. After the options and risks were discussed, surgery was performed under topical intracameral anesthesia using face-to-face positioning with the patient seated upright in his wheelchair. The operating microscope was rotated toward the horizontal plane, and the surgeon stood at the patient's side with the patient's face almost upright. The surgeon, who was right-handed, used a temporal corneal incision (0 degree) in the left eye and an inferior incision (270 degrees) in the right eye.
Surgery and recovery were uneventful. Given a pre-existing epiretinal membrane in the left eye, the patient was very happy with the uncorrected distance visual acuity outcome of 6/9 in the right eye and 6/18 in the left eye.
The authors conclude that face-to-face positioning is a useful option for patients who cannot be positioned to face an overhead microscope. However, they recommend positioning the patient's face as horizontally as possible for safer surgery. Topical intracameral anesthesia allows the eye to remain "on axis" throughout surgery, and it is important to ensure that both the patient and surgeon will be comfortable before starting what might be a long operation. They emphasize that this technique should only be attempted by experienced phaco surgeons.