Iris Hooks Research Articles

Floppy iris. How is floppy iris syndrome managed? What do urologists and ophthalmologists say?

This study focuses on the effect of chronic treatment on the eye, regarding the so-called Intraoperative Floppy Iris Syndrome (IFIS) or Floppy Iris Syndrome, which can occur during cataract surgery. The study aimed to establish the influence of tamsulosin, used in benign prostatic hyperplasia (BPH) treatment on the iris, during cataract surgery, considering the increased incidence of both conditions in older age. This study included one hundred male patients, operated on for cataracts at the Ofta Total Clinic and Dr. Stănilă Medical Centre, in Sibiu, out of 601 patients operated on for cataracts between February and October 2022. Of the 100 patients, 24 used medication for BPH. 5 patients used prostamol, a phytotherapeutic preparation, which is an extract from Serenoarepens, and the remaining 19 used tamsulosin, which is an alpha-blocker, most commonly used in the treatment of BPH, considered the first-line treatment option. In 15 patients, we intraoperatively managed, a medium mydriasis through pharmacological dilation, including intracameral administration of phenocaine and mechanical dilation or stripping. In 4 patients it was necessary to apply iris dilators. Due to the small pupil in 2 patients, we caught the iris in the phacoemulsification probe, and a small, incomplete iris coloboma was formed. Sometimes, there was a turnover of Descemet in 4 patients. The pupil remained semi-dilated and slightly areflective in the patients to whom we applied iris hooks. The patients' visual acuity was satisfactory, between 0.9 and 0.6. The topic gives rise to many discussions. It seems that stopping the administration of tamsulosin for a short time does not help the occurrence of IFIS, because the iris lesions seem irreversible. Patients at risk of developing cataracts should be evaluated and possibly referred to an ophthalmologist to determine surgery before starting treatment for BPH and to competently assess the administration of this medication. Collaboration between urologists and ophthalmologists is required for patients prone to the appearance of cataracts since both conditions are frequently encountered in elderly patients.

Capsular Tension Ring and Iris Hook Use in The Management of Cataract with Phacoemulsification Method in Dogs

The purpose of this study is to evaluate the surgical outcome of capsular tension ring and iris hook use during phacoemulsification in dogs with zonular weakness and miotic pupils. This study includes nineteen dogs (29 eyes) that underwent phacoemulsification (15 dogs/25 eyes) and extracapsular cataract extraction surgery (4 dogs/4 eyes) between February 2014 and February 2015. Patients with any ophthalmic problem other than cataracts were not included in the study. Some dogs did not achieve pharmacologic pupil dilation. These dogs required the use of iris hooks or the insertion of capsular tension rings. The capsular tension ring insertion was used in dogs with zonular rupture in more than half of the zonules. Capsular tension rings were inserted in cases of zonular dialysis and iris hooks were placed to widen the pupil. Fifteen dogs (25 eyes) underwent phacoemulsification, while 4 (4 eyes) received extracapsular cataract extraction (ECCE) surgery due to the difficulty of phacoemulsification in hypermature cataracts. Iris hooks were used in four dogs (8 eyes) for drug-resistant miotic pupils. Capsular tension rings were inserted to stabilize the lens capsule during phacoemulsification and to centralize the intraocular lens (IOL) in the bag. Capsular tension rings in cases of zonular dialysis and iris hooks in drug-resistant miotic pupils improved the success of cataract operations with phacoemulsification. Both are safe and useful for zonular weakness and for maintaining mydriasis during surgery.

Attaining the optimal flange technique for transscleral capsular bag stabilization using iris hooks.

To investigate the flange properties of different iris hooks. Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria. Laboratory study. The flanging properties of 4 different iris hooks made from polypropylene (PP), elastic polymer (EP), and nylon were investigated with different heating distances and both with and without forceps gripping. The maximum diameter of the flanges was measured, and the shape of the flanges was evaluated. Although both nylon and EP iris hooks had too small flange diameters for intrascleral fixation, PP iris hooks had a sufficient flange diameter (>330 μm) and mushroom-like shape. Furthermore, in PP hooks, heating distance was directly proportional to flange diameter. The findings of this study suggest that only PP iris hooks are suitable for flanged intrascleral fixation, which is off-label, to secure adequate fixation.

Novel trocar assisted intraocular lens and capsular bag complex fixation.

To describe the innovative technique of trocar-assisted intraocular lens (IOL) and capsular bag complex fixation. In this technique, initial pupil dilatation is achieved either with intracameral adrenaline or with the help of iris hooks. Automated anterior vitrectomy is performed in cases with vitreous prolapse. A 25 G trocar cannula is placed at the limbus through a paracentesis opposite the zonular dialysis area. The cannula lumen act as a guide to pass the double-arm polypropylene suture attached to the needle. This prevents any inadvertent corneal injury and acts as a perpendicular tract to pass the needle through IOL capsular bag complex. We performed this technique in 9 cases with an excellent outcome with a minimum of 3 months of follow-up. All patients had well-centred IOL. There was no incidence of corneal injury, Descemet membrane detachment, iris trauma, IOL tilt, decentration, dislocation, vitreous prolapse or retinal detachment. All patients achieved excellent visual acuity ranging from 6/12-6/6 postoperatively. The novel trocar-assisted IOL bag complex fixation technique is very effective and allows smooth IOL fixation in technically challenging cases with IOL subluxation. The trocar acts as a guide to prevent injury to the surrounding tissue, and IOL fixation is achieved with minimal manipulations in the anterior chamber. It also prevents the need for IOL explantation in these cases.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

"Capsule drape wrap"-a new technology for iridoschisis management during phacoemulsification.

To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap". "Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously. The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery. "Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges.

The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann-Whitney U test, Pearson's Chi-square test, and Fisher's exact test were used for statistical analysis. Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.

A case report on cataract surgery in eyes with bilateral inferior iridoschisis

PurposeThe purpose of the paper is to report a case of bilateral inferior iridoschisis who underwent cataract surgery with intraocular lens implantation successfully with the help of iris hooks or pupillary expanders.Design/methodology/approachA 71-year-old male presented with inferior iridoschisis in both eyes, history of angle closure glaucoma (ACG), cataract and shallow anterior chamber (AC) angles inferiorly. A localized area of iris stroma is cleaved in two with anterior atrophic portion disintegrating into fibrils from the posterior stroma, and muscle layer is termed as iridoschisis. Iridoschisis is a rare condition associated with fibrillary iris degeneration, narrow drainage angles and cataract.FindingsPreoperative and postoperative ocular examination, including visual acuity, intraocular pressure and degrees of iris damage, was evaluated. Cataract surgery was performed under topical anesthesia with flexible iris hooks. There were no intraoperative complications whereas marked corneal edema was shown at immediate postoperative period but subsided completely in two weeks’ time. Visual acuity improved from 20/60 to 20/25.Practical implicationsThis case report demonstrates that while iridoschisis care during cataract surgery has been reported to be difficult, cataract extraction was managed using iris hooks.Originality/valueThis paper reports the successful management of cataract in a patient with bilateral inferior iridoschisis.

Complications and visual outcome of cataract surgery in pseudoexfoliation patients

Pseudoexfoliation syndrome is a multifactorial diffuse disease and is diagnosed clinically on slit lamp examination of the eye by the deposition of white, dandruff like material on different structures in anterior segment i:e corneal endothelium, iris, pupillary margin, anterior lens capsule, zonules and trabecular meshwork. The aim of study was to study demographic features, intraoperative and postoperative complications and the visual outcome of cataract surgery in pseudoexfoliation patients. 93 eyes of 93 patients with pseudoexfoliation posted for cataract surgery were included in the study. 79.56% patients were of more than 60 years of age group.43 patients were male and 50 patients were female. 44 patients had pseudoexfoliation syndrome in both eyes and 49 patients had either right eye or left eye involvement. Intraoperative problems encountered were poor pupillary dilatation, capsular bag prolapse, zonular dehiscence, posterior capsular rent, residual cortical matter and positive vitreous pressure. Postoperative complications reported were corneal edema, raised intraocular pressure, significant anterior chamber cell reaction, left cortical matter and exudative membrane. Best corrected visual acuity was more than 6/18 in 67 eyes, between 6/60-6/24 in 16 eyes, and less than 6/60 in 10 eyes. At 1 month, best corrected visual acuity was more than 6/18 in 92 eyes. Cataract surgery in pseudoexfoliation patients is associated with high risk of complications. Use of iris hooks and capsule tension rings where required during the surgery can decrease the intraoperative complications and thus will give better visual outcome.

Three-piece intraocular lens in the sulcus with optic capture in patients with mild to moderate zonular weakness in exfoliation.

To study the use of sulcus placement of a 3-piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3-piece IOL implanted in the sulcus with optic capture over a 5-year period between January 2017 and January 2022 were included in this retrospective case series. The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil-expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of "in the bag" posterior chamber IOL or major complications. There was a significant improvement in visual acuity. The sulcus placement of 3-piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of "in the bag" IOL.

CLINICAL EXPERIENCE WITH INTRAOPERATIVE FLOPPY IRIS SYNDROME

Purpose: This study was conducted to recognise the incidence, risk factors, complications and the management of intraoperative oppy iris syndrome (IFIS). Retrospective analysis of the preoperative da Materials and Methods: ta, systemic comorbidities, medication history and intraoperative observations was conducted in 1116 eyes (of 482 males and 634 females), who underwent cataract surgery from January 2021 to June 2022. The mean age of patients was 67.08±8.18 Results: years. The incidence of IFIS observed is (44) 3.9%. 28 (84%) men with Tamsulosin dosage had IFIS features. But 16 (36%) patients who were not exposed to any alpha blockers also showed the features of IFIS. Hypertension was found to be a signicant risk factor while diabetes, coronary heart diseases were not. The mean duration of drug intake was 23.11 ± 23.42 months not affecting the severity of IFIS. Surgical difculties like posterior capsule rupture ve (11.4%) and iris prolapse were noted in six (13.6%) cases and additional measures like intracameral adrenaline, iris hooks and viscoelastic device were used to manage them. Despite the increased operative time, the surgical outcome was good in all the patients. The Conclusion: incidence of IFIS is higher in patients with intake of Tamsulosin. Its usage and hypertension were the risk factors associated. Thus it is imperative to create awareness to elicit a thorough medical history preoperatively. The critical aspects of IFIS are stratication of performative risk, prompt preoperative prophylaxis and surgical technique with the aid of mechanical and pharmacological agents. Eliciting a reliable history of current or past α1AR antagonist consumption in the presence of hypertension is essential.

Flanged iris hook for capsular bag stabilization.

A new surgical technique was demonstrated for fixating the capsular bag to the sclera using a capsular tension segment (CTS) and a flanged iris hook. In a patient with a 180-degree zonular dialysis, a capsular tension ring was implanted into the capsular bag, and a CTS was placed into the zonular dialysis area after cataract removal. Then, an iris hook was directed to the anterior chamber through a side port opposite the zonular dialysis area. After the hook tip was placed into the eyelet of the CTS, a 30-gauge injector was used to guide the hook tip out. Tension was adjusted to ensure the capsular centralization, and a flange was created using cautery. Finally, the procedure was completed by embedding the flange into the sclera. This method is simple, minimally invasive, and time-saving by eliminating the scleral suturing, scleral flaps, or large conjunctival dissections.

Two-Year Follow-Up of Clinical Efficacy of Femtosecond Laser, Modified Capsular Tension Ring, and Iris Hook-Assisted Surgical Treatment of Lens Subluxation in Patients with Elevated Intraocular Pressure.

Purpose To evaluate the outcomes of femtosecond laser, modified capsular tension ring, and iris hook-assisted surgical treatment of lens subluxation in patients with elevated intraocular pressure (IOP). Methods Fifteen patients with lens subluxation and elevated IOP were enrolled in this study. All patients underwent femtosecond-laser-assisted cataract surgery/phacoemulsification/intraocular lens implantation/modified capsular tension ring (MCTR) implantation with iris hook assistance. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), IOP, number of glaucoma medication complications, endothelial cell density (ECD), and tilt of the lens were recorded before and after surgery. All patients were observed for 24 months postoperatively. Results UCVA and BCVA increased significantly at 1 month, 6 months, 12 months, and 24 months, compared with preoperative UCVA and BCVA (P < 0.001). IOP significantly decreased at 1 month, 3 months, 6 months, 12 months, and 24 months, compared with preoperative IOP (P < 0.001). 3 patients received glaucoma medications to control IOP after surgery. All medications were discontinued at 3 months postoperatively. Conjunctival redness or hemorrhage was observed in 11 patients (73.3%); transient corneal edema was observed in 3 patients (20.0%); and posterior capsule opacification occurred in 1 patient (6.67%). The ECD and tilt of the lens are within an acceptable range. Conclusion The combined use of a femtosecond laser, MCTR, and iris hooks is an effective and safe method for treating patients with lens subluxation and elevated IOP.

Iridodialysis repair - A simplified approach.

Background:Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging.Purpose:To describe an simplified approach of iridodialysis repair using 9-0 prolene suture.Synopsis:We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9-0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5-6 knots under the scleral flap. Intra-operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre-operative symtoms and had good visual recovery.Highlights:We describe a simplified approach of iridodialysis repair that can significantly reduce the patient’s troublesome symptoms such as glare and monocular double vision.Online Video Link: https://youtu.be/-axYnSfWSb0

Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes.

To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes. A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (Synergeties™) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures. With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P<0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, P<0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, P<0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups. Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.

Loose zonules in cataract surgery.

This review will focus on identifying causes of zonulopathy during cataract surgery and discuss various modalities for treatment. There are multiple different options for capsular bag support in the setting of zonulopathy, including capsular or iris hooks, capsular tension rings as well as capsular tension segments (CTS). Surgical techniques on how to insert these devices are many and can be customized based upon the surgeon's preference and the patient's eye anatomy. Recognizing zonular weakness is critical to achieve stable postoperative vision and avoid future complications. Depending on the degree of zonulopathy, various treatment options can be pursued, ranging from capsular tension hooks or iris hooks, capsular tension rings or sutured or scleral fixated CTS.

Phacoemulsification with combination of CTR and Iris Hook in Subluxated Cataract

Purpose: To report a management of challenging case of phacoemulsification in cataract with subluxated lens. Methods: A 63 male patient referred to RSDS with secondary lens induced glaucoma and cataract with subluxation around 210O on left eye. Patient was planned to undergone Phacoemulsification with combination of CTR and Iris Hook for lens extraction. Result: Postoperative result is satisfactory with minimal corneal edema. After 6 weeks of follow-up uncorrected vision is 5/8 with correction of S+0.25 became 5/5 and IOP is stable at 17 mmHg and the IOL was in placed in the bag and well centered. Conclusion: Phacoemulsification with iris hooks combined with CTR is one of surgery option that is safe and widely attainable for cataract with subluxated lens.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma.

To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. The mean ages and male-to-female ratios of the groups were similar (p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups (p > 0.05, for all). Some surgical manipulations, including pupillary stretching (p = 0.004), pupillary membrane peeling (p = 0.021), iris hook using (p = 0.041), and capsular tension ring implantation (p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar (p > 0.05, for both), the mean APP value was significantly lower in Group 2 (p = 0.011). The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study.

Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis. A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders. One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis. The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.

Incidence, management, and outcome of complex cataracts in a tertiary eye set up

Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.