What to Do When Patients Cannot Lie Flat for Cataract Surgery

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Face-to-face positioning works when patients are not able to lie flat for cataract surgery–when the surgeon is experienced, according to a prospective care series involving 240 eyes of 179 individuals. 

Participants were diagnosed with severe kyphosis, orthopnea, or both. They underwent phacoemulsification in the upright position, facing the surgeon, who was seated or standing. The same surgeon performed all procedures over 13 years. Investigators looked at reasons for positioning difficulty, position adopted, and perioperative complications. They collected data on full systemic monitoring of 34 patients, and satisfaction data on 90. Among the results: 

  • Vitreous loss occurred in 5%. 
  • None had systemic adverse events, and vital signs remained stable during the procedure. 
  • All reported a willingness to have face-to-face positioning again.

The authors noted that all patients who undergo surgery in this position need to be counseled about the possibility of postop complications. 

Sohail T, Pajaujis M, Crawford S, Chan J, Eke T. Face-to-face upright seated positioning for cataract surgery in patients unable to lie flat: Case series of 240 consecutive phacoemulsifications. J Cataract Refract Surg. 2018;44(9):1116-1122. doi: https://doi.org/10.1016/j.jcrs.2018.06.045 

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