A 74-year-old woman with a history of right varicella zoster keratouveitis and hypopyon formation was referred for cataract surgery. Her visual acuity was 20/200. There was mild nuclear sclerosis, and corneal stromal scarring over the inferior half of the cornea, a small membrane-bound pupil, and high peripheral anterior synechiae (PAS) from 6 to 9 o'clock position demonstrated on ultrasound biomicroscopy (Figures 1 and 2 JOURNAL/jcrsoc/04.03/02158035-202601000-00012/figure1/v/2026-03-20T164959Z/r/image-tiff JOURNAL/jcrsoc/04.03/02158035-202601000-00012/figure2/v/2026-03-20T164959Z/r/image-tiff ). The intraocular pressure and B-scan ultrasonography were normal. The eye had been quiescent for 6 months, maintained on oral valaciclovir 500 mg twice daily. The left eye did not have significant cataract and was emmetropic. The patient wanted to have the cataract surgery first before deciding on corneal surgery. Describe how you would manage the case, including intraocular lens (IOL) calculation, detailing the surgical steps, and highlighting how you would enhance visualization of the anterior segment during surgery.
Chee et al. (2026) studied this question.