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.

 

Patient A

Answer
This is pseudoexfoliation syndrome. Pupil dilatation is poor and there is risk of zonular dialysis.

 
 

Patient B

Answer
The patient has hyper-extensibility of the joint. 
This is a sign of Ehler-Danlos's syndrome. 
The patient is at risk of lens subluxation.

 
 

Patient C

Answer
Patient has physical signs (stiff back and kyphosis) 
of ankylosing spondylitis. The problems encountered 
will include:
Posturing of the patient during operation
Poorly dilated pupil due to anterior synechiae
 
 

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
Patient D (80 year-old)

Answer
This patient's biometry shows average keratometry readings 
and axial lengths but high minus refraction. These changes 
are seen in patients with significant nuclear sclerosis.
The lenses are likely to be large and hard. A large lens will 
give a shallow anterior chamber making capsulorrhexis difficult
for the inexperienced surgeon. A hard nucleus increases the 
phaco time and in the hand of inexperienced surgeon complication
such as corneal oedema is increased.

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