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Importance Patients with Ankylosing Spondylitis frequently have fixed kyphosis of their spine together with pain. This makes achieving acceptable head position for ocular surgery difficult. The proposal of new methods that result in successful intraocular surgery will reduce morbidity and sight loss in this group of patients. Objective To describe a novel technique using a vacuum bean bag positioner which enabled cataract surgery to be performed successfully under local anaesthesia. To allow prospects of technique development to standardise cataract surgery positioning in this cohort. Results A 42 year-old male patient underwent phacoemulsification under Sub-Tenon's local anaesthetic with intra-ocular lens implant in the inverted position with no immediate post-operative complications. Conclusions and Relevance Standard operating theatre equipment combined with a vacuum bean bag positioner, soft supports and securing straps can attain a position that is feasible for awake ocular surgery in patients with gross anatomical changes affecting the neck.

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