Bilateral Femtosecond Laser-Assisted Cataract Surgery in Patient With Nystagmus and Astigmatism
Narrative Responses:
Purpose
Strategy to perform a femtosecond bilateral laser cataract surgery in a patient with nystagmus, astigmatism, myopia and anisometropia in topical anesthesia.
Methods
A 67 years old male patient with bilateral cataract and horizontal nystagmus asked for cataract surgery with femtolaser. He was also affected by myopic astigmatism with anisometropia. The cardiologist suggested to perform surgery in topical anesthesia because in therapy with Warfarin and Carddioaspirin. The patient was so submitted to a sequential (1 week distance) bilateral femtosecond laser cataract surgery docking in topical anesthesia even if affected by nystagmus (which is a current contra-indication for cataract surgery assisted by femtosecond laser). Biometry, topo-tomographies, markings and surgery were complicated by eyes movement induced by nystagmus. A bilateral toric IOL was implanted.
Results
After 3 days the patient could reach 20/20 uncorrected visual acuity in each eye (movies of the surgery with its postop results will be presented). For that reason the nystagmus was then considered acquired and not congenital. The only side-effect were the sub-conjunctival hemorrhages induced by the femtosecond laser docking, which lasted around 1 week. This was due to the nystagmus movement during the docking and mainly because the patient was in therapy with antiaggregant (which his cardiologist suggested to continue also the day of the surgery avoiding peribulbar anesthesia for the possible general related complications).
Conclusion
It is well known that the most difficult part during a conventional cataract surgery in patient with nystagmus is the capsulorrhexis. The femtocataract was very helpful in this case because the rhexis was performed with few difficulties and in less time in topical anesthesia without any complications and surprising results.