This is a complete cataract case, shown start to finish, where I perform the entire surgery and present it to you unedited and uncut. If you want to see many videos of me as the exclusive surgeon performing complete cataract cases then check out this link. This patient has nanophthalmos and a high degree of hyperopia and astigmatism. Our goal is to take the patient from a pre-op refraction of +9.50 -2.50 x 025 to a post-op refraction of close to emmetropia / plano (0.00) without residual astigmatism with a toric IOL. In this video I give you my best pearls for success in these tough cases including how to do the IOL calculations.
A shallow anterior chamber and a tight globe are the 2 bugbears in such nanophthalmic eyes.
In such cases i do a 25 gauge trocar cannula assisted pars plana single port vitrectomy to soften the globe by removing 1 mL of vitreous approx.
Then through the limbal sideport I inject healon to deep the shallow anterior chamber by pushing the iris lens diaphragm posteriorly. This leads to a deep AC with the anterior capsule flattened out and not convex which aid’s capsulorhexis and creates space for nuclear disassembly away from the corneal endothelial cells
This simple step make a difficult case into a routine Phaco emulsification.
I call this a toilet vitrectomy and can be used in narrow angle glaucoma and malignant glaucoma especially