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Phaco with Corneal Adherent Leukoma

This is a case of 65 year old female for cataract surgery but with an adherent leukoma on the right eye due to trauma when she was 7 years old. Her vision was hand movement with good light projection and had sensory exotropia around 15 degrees by hirschberg. There was poor visualization of the capsule under the corneal scar thus making capsulorrhexis difficult. Adding to this, there is poor dilation due to the adherent iris plugging the old scar. Iris hooks were used to increase dilation and aid in visualization of the capsule for capsulorrhexis. Adequately sized and continuous rrhexis was done despite poor view under the scar making it a blind manuever. For the phacoemulsification proper, a pothole chop was planned but since the nucleus was soft, proper use of the chopper along with efficient phaco aspiration was employed. After removal of the cataract, a single piece intraocular lens was inserted and the patient had a good outcome one day post operatively.