Outcomes of a Novel Positioning Technique for Ophthalmic Surgery in Patients With Atypical Anatomy

In cataract extraction surgery, patient positioning and surgeon comfort are necessary for success. The patient's head must be flat and parallel to the floor to minimize complications and permit the use of a standard ophthalmic microscope. This position is often difficult in patients with spinal abnormalities, such as age-related hyperkyphosis or the exaggeration of the thoracic spine curvature. Multiple methods have been proposed to improve positioning in patients with spinal abnormalities. While these positions benefit the patient, they are often uncomfortable for the surgeon due to a lack of space or increased difficulty during the surgery. We propose a new surgical stool that, when used with the Trendelenburg position, can optimize patient positioning and surgeon comfort without increasing the risk of complications.  A retrospective chart review was conducted of eight patients (15 eyes) with spinal deformities that necessitated the proposed positioning for cataract surgery. The measured outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal edema, non-centered lens placement, retained native lens material, and cystoid macular edema (CME). Immediate postoperative outcomes, such as cumulative dissipated energy (CDE), capsular membrane rupture, use of Malyugin ring or iris hooks, and placement of wound sutures, were measured as surrogates of surgery difficulty.  Analysis demonstrated that the outcomes of patients with hyperkyphosis who underwent cataract surgery with the novel positioning were non-inferior to the outcomes of standard cataract surgery on non-hyperkyphotic patients. There was also no apparent difference in qualitative outcomes between the two groups. This pilot study shows that our novel positioning method provides a cost-effective alternative for ophthalmic surgery in patients with hyperkyphosis without increased risk of complications.