Stage-by-stage provision of a high safety profile of phacoemulsification in a patient with combined pathology of keratoconus stage I and IV, swelling cataract and strabismus
Authors:   Eye Center «Vostok-Prozrenie», Moscow, Russian Federation, Anisimova S.Y. , Anisimova N.S. ,   Eye Center «Vostok-Prozrenie», Moscow, Russian Federation
Published: June 2024

Purpose. Provision of preoperative preparation of the patient for the uncomplicated course of phacoemulsification and the postoperative period in a patient with cataracts. Material and methods. The paper presents a clinical case of phacoemulsification of swelling and immature cataracts in a patient N., 59 years old, with a diagnosis of keratoconus IV degree and I degree in the paired eye. In this regard, the patient was recommended to perform phacoemulsification surgery with implantation of intraocular Toric IOL and Tecnis Eyhance IOL on the paired eye to achieve maximum visual acuity in the distance, but maintaining high visual acuity in the eyes with keratoconus stages I and IV. 2 days before surgery, 4x instillations of the NSAID Indocollir (indomethacin) 0.1% (Bausch & Lomb, USA) were prescribed to prevent an inflammatory reaction and maintain mydriasis during surgery. Also, to prevent surgical complications during phacoemulsification of swelling cataracts, instillations of carbonic anhydrase inhibitor (ICA) 2 r/s were prescribed to reduce IOP and reduce the volume of the vitreous body. Results. No complications were detected during the operations, and there was no tendency to myosis. After the operation, the patient was in the clinic for 1 hour. Instillations of Indocollir, antibiotic, corticosteroid and Cornergel (dexpanthenol 5%) are prescribed at night and in the morning. The patient removes the monofocal bandage in the morning and instillates Indocollir, antibiotic, corticosteroids and corneregel (5% dexpanthenol). On the 1st post/op day visual acuity was 0.1 best corrected 0.4. IOP of 18 mm Hg. On the 5th day, the antibiotic was canceled, and the steroid drug was replaced with instillations of the drug fluorometholone for 2 weeks, instillations of Indocollir and corneregel were continued until 4 weeks post/op. After phacoemulsification in the paired eye with implantation of a monofocal IOL Tecnis Eyhance, visual acuity on the 1st day was 0.7 and text No. 5 was read at a distance of 40 cm. In 1 month visual acuity in the distance was 1.0, reading text No. 7 at a distance of 35 cm. According to the OCT of the macular, no clinically significant edema was detected, and no inflammatory reactions were detected in the postoperative period, which indicates the effectiveness of prescribing the NSAID Indocollir 0.1% with rapid withdrawal of antibiotics and corticosteroids, which allowed to minimize the load on the surface of the eye. Conclusion. The preliminary administration of NSAID preparations (indomethacin 0.1%) a day before surgery before ultrasound phacoemulsification allows maintaining the necessary mydriasis for safe operation. Postoperative management of the patient on NSAIDs (indomethacin 0.1%) avoids prolonged instillation of corticosteroids. Implantation of a monofocal IOL with a gradual increase in optical power from the periphery to the center provides patients with keratoconus with high visual acuity in the distance and at an average distance. Key words: cataract surgery, phacoemulsification, combined pathology, keratoconus, NSAID, indomethacin, monofocal IOL