Tooba Sohail1, Mykolas Pajaujis1, Sarah E Crawford1, Jian W Chan1, Tom Eke2. 1. From Ophthalmology (Sohail, Pajaujis, Eke) and Anaesthesiology (Crawford, Chan), Norfolk & Norwich University Hospital, Norwich, United Kingdom. 2. From Ophthalmology (Sohail, Pajaujis, Eke) and Anaesthesiology (Crawford, Chan), Norfolk & Norwich University Hospital, Norwich, United Kingdom. Electronic address: tom.eke@nnuh.nhs.uk.
Abstract
PURPOSE: To present a case series of patients who were unable to lie flat for cataract surgery. SETTING: University teaching hospital, district hospital, and private practice, Norwich, United Kingdom. DESIGN: Prospective case series. METHODS: All patients had phacoemulsification using face-to-face upright seated positioning. The patient sits upright or semi-recumbent, and the surgeon sits or stands, facing the patient. The microscope is rotated forward, and surgery is done via an incision in the lower half of the cornea, using topical intracameral anesthesia. All 240 face-to-face cases, performed by the same surgeon, were prospectively recorded. The database included reasons for positioning difficulty, position adopted, and per-operative complications. Data on full systemic monitoring of 34 patients and satisfaction data on 90 patients were also recorded. RESULTS: In 13 years, 240 eyes (179 patients) had face-to-face surgery. Common diagnoses were severe kyphosis, orthopnea, or both. No patient was refused face-to-face surgery since the service was started. The rate of vitreous loss was 12 (5%) of 240 cases. However, all patients (100%) received a posterior chamber intraocular lens. No patient had any systemic adverse event, and vital signs remained stable during surgery. All respondents stated that they would be happy to have face-to-face positioning again. CONCLUSIONS: Face-to-face positioning, in the hands of an experienced surgeon, was an acceptably safe approach for patients unable to lie flat for cataract surgery. It might be the only option for some patients. However, all patients should be counseled regarding the increased risk for operative complications.
PURPOSE: To present a case series of patients who were unable to lie flat for cataract surgery. SETTING: University teaching hospital, district hospital, and private practice, Norwich, United Kingdom. DESIGN: Prospective case series. METHODS: All patients had phacoemulsification using face-to-face upright seated positioning. The patient sits upright or semi-recumbent, and the surgeon sits or stands, facing the patient. The microscope is rotated forward, and surgery is done via an incision in the lower half of the cornea, using topical intracameral anesthesia. All 240 face-to-face cases, performed by the same surgeon, were prospectively recorded. The database included reasons for positioning difficulty, position adopted, and per-operative complications. Data on full systemic monitoring of 34 patients and satisfaction data on 90 patients were also recorded. RESULTS: In 13 years, 240 eyes (179 patients) had face-to-face surgery. Common diagnoses were severe kyphosis, orthopnea, or both. No patient was refused face-to-face surgery since the service was started. The rate of vitreous loss was 12 (5%) of 240 cases. However, all patients (100%) received a posterior chamber intraocular lens. No patient had any systemic adverse event, and vital signs remained stable during surgery. All respondents stated that they would be happy to have face-to-face positioning again. CONCLUSIONS: Face-to-face positioning, in the hands of an experienced surgeon, was an acceptably safe approach for patients unable to lie flat for cataract surgery. It might be the only option for some patients. However, all patients should be counseled regarding the increased risk for operative complications.