CataractCoach™ 2367: nanophthalmic eye challenges in cataract surgery

[@feyzadicleisik]

Tough case, flawless execution, excellence from an excellent surgeon👏

[@StevenGSafran]

In eyes this small I would make my pars plana entry more anterior....about 2-2.5mm back from the limbus and angle down toward the optic nerve away from the lens. I always use Mannitol for eyes under 21mm and usually can avoid a PPV but not always. I'd also consider a scleral window and since you already have the port in I'd do IZHV (iridozonulohyloidovitrectomy) to create a unicameral eye and prevent aqueous misdirection. In cases like this I prefer to use a dispersive viscoelastic like viscoat to create AC depth but some folks prefer Healon 5 which I think is fine if you remove it all to prevent a pressure spike. Finally if I am going to use a single piece lens I'd make a scleral tunnel on the steep axis to place the lens as this will avoid astigmatism and be more secure. In this case you've already taken conj. down for the PPV (which can be done transconj without peritomy) so at that point you might as well make a scleral tunnel and consider a scleral window. It would be interesting to know how this patient did and if there was any issue with aqueous misdirection.

[@islamabdelmoneim8595]

Nice

[@rogeriochorta]

If a misdirection occurs, we can perform the ppv many times.

[@StevenGSafran]

@@rogeriochorta Repeating the PPV won't help unless you create a unicameral eye. You need to do an IZHV to treat aqueous misdirection. Removing more vitreous or even all of the vitreous won't create a unicameral eye if the lens iris diaphragm is still intact. Even with IZHV you may need scleral window in such a small eye to prevent uveal effusion.

[@leijiang8994]

@@StevenGSafran those are great points! do you find there is any risk of periphery bag damage when doing a IZHV?

[@StevenGSafran]

With proper technique, I think it is extremely unlikely that you would damage the capsular bag

[@nadirunlu4479]

Wow.. Great surgery by talented hands.. 🙌

[@MrFMANT]

İt's definitely a tough case, congratulations and thanks Dr Ozcan for sharing his case.

[@Dr.AdnanAlHassani]

What a hard challenge!

[@preethyprasanth6298]

Great job👏

[@mikaild3289]

Great surgery

[@WilliamTannure]

The idea of partial ppv prior, even without seeing, is a well strategy to lower the anterior segment and helps the surgeon get more anterior chamber space. This is a balls of steel surgery. Well done

[@oscargranda5385]

Is not advisable use two iol instead one???

[@doc.g9497]

Piggy back may be worse in these cases. Eye is too small…

[@valentinbachet]

I like how slow but flawless it goes. He’s clearly enjoying it, no need to rush to show how « good because fast » you are. This is the step where you know you are almost in the end of the learning curve :)