This patient has an intumescent white cataract which has swelled so much that it is pushing up against the iris which has shallowed the anterior chamber and resulted in angle closure. The ultimate treatment is cataract surgery so that we can replace the thick cataractous lens with a thin man-made IOL and restore the anterior chamber depth and open the angle. The toughest part of this case is doing the capsulorhexis with an anterior chamber depth of less than 1 mm. What would be your approach?
Does AC depth such as 1.5 mm or less prompt you to refer to a retina colleague for cataract surgery so they can do a vitrectomy to decompress the vitreous to create more space for surgery? Or do you think an anterior chamber can be adequately deepened with a thick viscoelastic (Healon 5) and pre-op IV Diamox?