1. Dr Md Anisur Rahman Anjum
Associate Professor
National Institute of Ophthalmology
Dhaka. Bangladesh
MARCH 19, 2014 anjumk38dmc@gmail.com 1
2. Question
• In the pre-assessment clinic, you came across
four patients with the following signs and
biometry. Give the reasons why these patients
are not suitable for the inexperienced surgeon
to carry out cataract extraction and implant.
MARCH 19, 2014 anjumk38dmc@gmail.com 2
5. FIG=4
Right Eye
K1 = 42.75
K2 = 42.50
Axial length = 21.75mm
Refraction = -8.25D
VA = 6/24
Left Eye
K1 = 42.25
K2 = 42.50
Axial length = 22.00mm...
Refraction = -7.55D
VA = 6/24
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6. ANS=1
• This is a pseudoexfoliation syndrome.
Pupil dilatation is poor. And there is risk
of zonular dialysis.
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7. ANS=2
• This patient has hyper-extensibility of
joint. This is a sign of Ehler-Danlos’s
Syndrome. The patient is at risk of lens
subluxation.
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8. ANS=3
Patient has physical signs (stiff back and
kyphosis) ankylosing spondilytis. The
problems encountered will include.
Posturing of the patient during operation.
Poorly dilated pupil due to anterior
synechia.
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9. ANS=4
The patient’s biometry shows average keratometric
readings & axial length but high minus refraction.
These changes are seen in patient with significant
nuclear sclerosis.
The lenses are likely to be large and hard. A large lens
will give a shallow A/C making capsulorrhexis
difficult for the inexperienced surgeon. A hard
nucleus increases he phaco time and in the hand of
inexperienced surgeon complication such as corneal
edema increased.
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