Unique cataract cases call for special measures

William W. Culbertson, MD, described three such techniques: cryoanalgesia, pupil dilation with an injectable device for the presence or expectation of small pupils, and sealed capsule irrigation.

An ice bath in a plastic bag is applied to the lids and globe for 15 minutes, after which topical povidone iodine is applied. The globe is irrigated with chilled balanced salt solution (BSS) while the incisions are being made. The chilled viscoelastic is injected, and phaco is performed with the chilled BSS. Finally, the IOL is inserted while the incision is irrigated with chilled BSS.

"The patient felt nothing during the procedure," Dr. Culbertson said. "She behaved as if we had injected a retrobulbar anesthetic. The phaco proceeded normally.