Nuances of cataract surgery in corneal scar

Background: Phacoemulsification is routinely used for cataract extraction. There are instances when severe corneal opacification limits visualization of anterior segment details, and here, refinement of the surgical steps is needed to achieve favorable outcomes. The complexity of cataract removal in eyes with corneal scarring is influenced not only by the extent of scarring but also by its density, location, and associated thinning which may cause visual distortion. Thorough preoperative planning including precise intraocular lens (IOL) power calculation and anticipation of intraoperative challenges is essential. These strategies help minimize the need for combined or repeat procedures and contribute to improved visual outcomes and patient satisfaction. Purpose: Cataract surgery in patients with coexisting corneal scar poses certain unique challenges. Synopsis: The video emphasizes on addressing the unique challenges during the phacoemulsification with coexisting corneal scar with case-based examples. With patients with irregular corneas, one must aim for myopia. The potential need for glasses, contact lenses, or IOL exchange for any residual refractive surprises must be adequately counseled. Intraoperatively, incision placement depends on the location of the scar, use of coaxial illumination, and dispersive viscoelastic for increasing magnification and improving visualization. [1] Pupil expansion tools like iris hooks or Malyugin rings must be kept as a backup, and Trypan blue enhances capsule visibility. [1] Chandelier illumination provides enhanced visibility through scared cornea, and fiberoptic illumination helps visualize the CCC margin, assess nucleus impalement depth, and guide chopping and IOL implantation. This approach optimizes outcomes and patient satisfaction. Highlights: Any patient with corneal scars presents a challenge in differentiating the extent of blurry vision caused by the cornea versus the lens. Poor visualization can preclude safe phacoemulsification using conventional microscope illumination. This necessitates alternative techniques such as transcorneal fiberoptic illumination. It is important to consider location of wound placement and optimization of surgical view in these patients undergoing cataract surgery. The surgery is highly demanding and protracted, though the final visual outcome may still be limited by corneal opacity. Various surgical options must be discussed, and counseling is crucial to set realistic expectations. Video Link: https://youtu.be/riZv1DDXQdE.