This is an extremely challenging cataract case because the view is so limited due to the corneal status. There is extensive corneal neovascularization and stromal scarring which makes the view particularly poor when using direct lighting from the microscope. Much of the microscope light fails to penetrate the cornea and instead is reflected back to the surgeon in the form of glare.
Our guest surgeon, Dr Egor Arkhipov from Russia, uses an innovative approach in terms of lighting. For part of the procedure, he inserts a light pipe via the paracentesis to visualize the trypan blue-stained lens capsule. Then for nucleus removal, he makes use of chandelier lighting in the vitreous cavity to retro-illuminate the cataract. The case goes beautifully but it is a true challenge that takes about 45 minutes to complete. The result is a huge improvement.
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