Tough View Due To Fungal Keratitis
Thomas A. Oetting, MS, MD; Luke Wendel, MD; Michael D. Wagoner, MD, PhD
The patient had a bout of fungal keratitis which was expertly managed by Dr. Michael Wagoner (on our faculty and a expert in this area). He felt she was stable and that removing the cataract might help her rehabilitation.
The patient's cornea had significant (especially inferior) scarring which made visualization very tricky. She had almost 360 degrees of central posterior synechiae and a small pupil. Her cataract was dense.
I (TAO) used hooks in this case as it offers several advantages over the Malyugin ring. 1) the placement of the hooks can occur w/o OVD (ophthalmic viscosurgical device ) which makes placement of trypan stain easier later and allows for a large pupil when placing the stain. 2) the placement of the hooks is a convenient way to lyse the posterior synechiae 3) the hooks are easier to place than the ring with poor visualization, and 4) it is easier to convert to large incision ECCE (extra capsular cataract extraction) with hooks than with a ring and this was a possibility.
The rhexis was tricky as the residual synechiae were hard to tell from the capsule. We added more cohesive OVD often to ease the view as it is clear (more clear than dispersive) and it pushed aside any pigment. The cornea was very cloudy so we used trypan to see the rhexis. We also placed Ocucoat on the corneal surface which adds some magnification and smoothes the surface.
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