For this very tough cataract case, our guest surgeon is Dr Lucy Shen from the Mass Eye / Harvard in Boston, and she does a great job with a dense cataract, small pupil, and neo-vascular glaucoma. There is a pre-existing Ahmed tube seton which will alter the intra-op fluidics. This patient presented with elevated IOP, microcystic edema, and a dense cataract preventing further panretinal photocoagulation. Significant surgical challenges included an immobile iris and an extremely shallow anterior chamber. The initial attempt to use a Malyugin ring was unsuccessful due to a mechanical malfunction where a loop failed to hook the iris securely. After removing the ring and stabilizing the area with Viscoat, two iris hooks were placed. During the procedure, a corneal cyst formed at an iris hook site; this was managed via decompression and a strategic side cut to prevent recurrence while preserving the epithelium to ensure healing in the diabetic patient. The lens was removed using a divide and conquer technique. Throughout the phacoemulsification, Viscoat was used aggressively to maintain AC depth and prevent flattening. Following cortex removal and wound hydration, the iris hooks were removed. The surgery concluded with CPC and a subconjunctival dexamethasone injection to control inflammation. Wow, what a great case!
