Abstract
PURPOSE: We present a case of bilateral sequential cataract phacoemulsification surgery in a patient with very elevated BMI (120 kg/m(2)), and describe the surgical technique, perioperative challenges, and relevant literature on cataract surgery in morbidly obese patients. OBSERVATIONS: A 51-year-old male, weighing 745 lbs. (BMI 120 kg/m(2)), with a medical history significant for multiple comorbidities, including hypertension, heart failure, and acute hypoxic respiratory failure, presented with longstanding and progressive bilateral vision loss. He had a dense white cataract with light perception vision in the right eye and 2+ nuclear sclerosis with 4+ posterior subcapsular cataract and 20/70 pinhole vision in the left eye. Intraoperatively, the patient was placed on a bariatric bed in a reclined position and hyperextended neck. The headboard was removed, and a plastic board with foam pads was used for head positioning. Phacoemulsification with intraoperative posterior capsulotomy was performed in both eyes to prevent the need for future YAG laser capsulotomy. Topical anesthesia without sedation was used. Postoperatively, the patient achieved 20/30 uncorrected visual acuity in both eyes with no complications. CONCLUSIONS AND IMPORTANCE: Phacoemulsification cataract surgery in patients with severe obesity requires personalized management, modified positioning, and tailored surgical techniques.