2970: cataract in congenital glaucoma eye
Cataract surgery in an eye with congenital glaucoma and multiple prior surgeries is a high-stakes scenario requiring a high degree of caution. The primary pitfalls are a non-dilating pupil, zonular weakness, and a weakened corneal endothelium. Chronic inflammation and synechiae cause a rigid, small pupil that necessitates mechanical expansion devices, though the atrophic iris tissue tears easily. Crucially, the zonular apparatus is often structurally weak from chronic pressure fluctuations and past surgical manipulation, causing a mobile lens complex; a capsular tension ring may be needed to stabilize the capsular bag. Furthermore, the corneal endothelium is already critically compromised from past surgeries and pressure spikes. Surgeons must use viscoelastic to protect the remaining endothelial cells from further damage. Finally, incision placement is restricted; you must completely avoid superior scleral zones to safeguard existing, functional filtering blebs or tubes, often requiring a temporal clear corneal approach.
