• Is it possible to get cataract surgery but not in a lie flat position?


    Question:

    I need cataract surgery on my right eye, however I cannot lie flat and need a surgeon who can do the surgery while I’m in a sitting position. Is this possible?


    Answer:

    Your question is very challenging. First, we must determine if your inability to lie flat is structural (back/neck problems) or if it is related to cardiovascular/respiratory issues. Cataract surgery is one of, if not the safest, major surgery. This is because it usually occurs in a controlled environment. Preoperative variables are reduced and standard patient conditions are usually controlled. I think all cataract surgeons would say that, in a perfect world, all of their patients would be able to lie flat and also lie still throughout the brief surgery. However, we have all had to accommodate patients who cannot do so. Adjustable surgical tables often allow us to provide for patients who are unable to straighten their neck or back. I have done a few cases where the table was rotated such that the legs of the patient looked like they were pointing at the ceiling in order to assure that the eye is parallel to the floor. This would be like a reclining chair that just kept on reclining. The ophthalmologist might also be able to adjust the positioning of the microscope at an angle.

    Patients who have cardiovascular/respiratory problems that prevent them from lying flat would need to work with their internist to have their health condition treated as best as possible. Oxygen is routinely supplied as part of cataract surgery.

    Cataract surgery has been successfully performed on patients in positions that are not flat. The farther the patient is from flat the less standard the surgical conditions are, and thus I think the rate of complications increases. That doesn’t mean it can’t be done, however. Long ago, I recall seeing an old black and white movie of the famous Dr. Barraquer of Spain perform a cataract surgery on a patient in the fully sitting position. This occurred 40 or more years ago and was not done using modern techniques.

    In summary, there is a reasonable expectation that your ophthalmologist or someone he/she might refer you to will be able to minimize your problem with lying flat and would be able to complete your cataract surgery in a safe and successful manner. Please discuss this fully with your ophthalmologist.


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