Face-to-face phacoemulsification using a slitlamp in patients who are unable to lie flat.

Phacoemulsification can be challenging in patients who are unable to lie flat or sit in a reclined position that exceeds 30 degrees to 45 degrees during surgery. We describe a new technique that we have used on 4 eyes of two patients. Both were operated on while sitting in a strictly upright position, resting their chin in front of a mobile slitlamp in the same manner as during a standard ophthalmologic examination. The surgeon sits on the other side of the slitlamp, facing the patient, and operates via a temporal corneal incision. The described operating conditions were deemed perfectly adequate by the experienced surgeon. Both patients recovered a corrected distance visual acuity of 20/20 in both eyes and said they would recommend this surgery to anyone who cannot lie flat. Surgeons should consider this technique when standard surgical positioning is not possible.