Challenging Cataract Surgery in an Extremely Shallow AC Guided by Full-Range SS-iOCT!

A challenging cataract surgery was performed in a patient with chronic uveitis, corneal edema, pupillary synechiae with peripheral anterior synechiae, and an extremely shallow anterior chamber (AC) in the left eye (Fig. 1), using a digital navigation surgical microscope (Focean, TowardPi) integrated with 100 kHz full-range swept-source intraoperative OCT.

GIF 1. Viscoelastic was injected into the anterior chamber. Localized detachment of Descemet’s membrane was observed (arrow) near the corneal incision under real-time SS-iOCT imaging.

GIF 2. Viscoelastic was injected through the iris into the space between the posterior iris and the anterior lens capsule.

GIF 3. A clear corneal tunnel incision was created, followed by full-thickness penetration of the iris. Viscoelastic was then injected between the posterior iris and the anterior lens capsule.

GIF 4. Pupilloplasty was performed by excising fibrotic pupillary synechiae from behind the iris.

GIF 5. The fibrotic anterior lens capsule was opened using a cystotome.

GIF 6. The lens cortex was carefully and completely removed.

GIF 7. The integrity of the posterior capsule was confirmed under iOCT guidance, and an intraocular lens (IOL) was implanted into the capsular bag.

GIF 8. Descemet’s membrane was repositioned using an anterior chamber air bubble under iOCT guidance.

One month after surgery, the patient’s visual acuity improved from hand motion (HM) to finger counting at 50 cm (FC/50 cm) (Fig. 2).

Case courtesy of Prof. Wen Xu, Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University.

The TowardPi microscope is not yet cleared by CE/MDR or FDA.