June 2008




Ankylosing spondylitis—and other positioning concerns


The patient I operated on had ankylosing spondylitis, a progressive rheumatoid disease of this spine that causes his hunchback body position. He didn’t have it when he was younger. His spine, through inflammation and scarring, has bent into that position. He cannot see in front of him when he’s walking—he’s staring at the ground. According to the Spondylitis Association of America, Sherman Oaks, Calif., in the most advanced cases, a patient’s inflammation can lead to new bone formation on the spine. This causes the spine to fuse in a fixed, immobile position, leading to the forward-leaning posture. Although there is not yet a cure for ankylosing spondylitis, patients and physicians use treatments and medicine to reduce its symptoms. The Spondylitis Association reports that there are at least half a million people with ankylosing spondylitis in the United States, but they say this number actually may be higher because the disease is under-recognized. It is more prevalent than multiple sclerosis, cystic fibrosis, and Lou Gehrig’s disease combined, the association reports.

Ironically, the summer in which I operated on this patient, an article was published in the American Journal of Ophthalmology on performing phacoemulsification in patients who cannot lie flat for surgery. The article comes from G. S. Ang, J. M. Ong, and T. Eke, Department of Ophthalmology, Norfolk & Norwich University, Norwich, United Kingdom. The investigators described surgery in two patients who both were positioned erect or semirecumbent in a standard cataract surgical chair. “The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. The surgeon sat beside the patient, and while facing him or her, operated at nearly arm’s length,” they wrote. Both patients had uneventful surgeries and good visual outcomes.

Ankylosing spondylitis—and other positioning concerns Ankylosing spondylitis—and other positioning concerns
Ophthalmology News - EyeWorld Magazine
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