Again, time to learn from a routine case — this is the type of case that is your “bread and butter” as we would say in the USA. You have each done this case many times, and for the more experienced surgeons, you’ve done this case thousands of times. Since this is 90% of what we do from week to week, it is helpful to review the video to pick up a few pointers.
The first thing is that the surgeon (me) is loading the toric IOL into the injector because the new scrub technician is used to only the pre-loaded IOLs and she is still learning how to load these types of IOLs. This is a good opportunity to review again the technique of loading a single-piece acrylic IOL into the injector, something which we have previously covered here.
The other helpful review is to remember that astigmatism is a vector, and as such it has both magnitude and direction. The steep axis of astigmatism on the cornea is at about 100° which means that ideally the phaco incision should be placed in such a manner that this stays precisely at 100° even if the magnitude changes. If we place the incision right at 100° then it would help reduce the astigmatism. Instead, we want to sit and operate form the temporal position and that means that we should make the incision at 190° which is the same as 10° because this will not change the direction of the astigmatism, but rather it will just slightly increase the magnitude. And we an easily account for that by increasing the toric power correction that is on the IOL.
Watch the video for the complete review and annotation. It is helpful to review these routine, normal cases because that is what you will see in your clinic the most often.
Click below to start the video and see the details of the surgery:
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