Intraocular Surgery in Kyphosis: An Easier Approach
A 49-year-old obese male with controlled secondary glaucoma needed cataract surgery in the right eye. He had ankylosing spondylitis-related extreme kyphosis and a neck in fixed flexion. His pulmonary reserve was also very low. The past ocular history was positive for recurrent uveitis and glaucoma shunt surgery in the right eye. The pupil was small and fixed from posterior synechia. Cataract density was +4, and the best-corrected visual acuity was 20/200. The anterior chamber was shallow and the glaucoma shunt tube was visible at the 11 o'clock position. The patient was planned for pupillary dilation using iris retraction hooks, lens capsule staining with trypan blue and phacoemulsification with intraocular implantation under local anesthesia. The anesthesiologist was reluctant to use general anesthesia because of the patient's disability and poor health.\nIn the operating room, the patient could only recline to about 40° from the vertical axis despite maximal reverse Trendelenburg position and a number of pillows under his back, neck, head and legs (fig. ). With the surgeon at the temporal side of the patient, the eye was also seen reclining at 40° (fig. ). While trying to focus the microscope, it became evident that by grasping the eye at the inferior limbus with a fine forceps and pulling it upwards, it could be moved to a more desirable horizontal position. A single 7/0 VicrylTM (polyglactin) corneal retraction suture was placed at the limbus at the 6 o'clock position to achieve the desired view (fig. ). The assistant surgeon was able to rotate the eye to the desired positions during the whole procedure by relaxing or pulling the suture. There were no intraocular complications, and the postoperative recovery was uneventful. The final best-corrected visual acuity was 20/30.