Though we don’t often show the process of draping for cataract surgery, it is an important step of the procedure. Draping allows access to the eye and complete visualization while keeping a neat sterile field. The drapes should isolate the eyelashes so that they are not in the surgical field. Ideally, the plastic drape should wrap around the lid margin so that the bacterial flora are isolated. In addition, we want to prevent any of the oils from the eyelid margin from contaminating the tear film.
Take you time and make the draping clean and neat. Keep in mind that the adhesive drapes do not stick well if the eyelids are wet or moist. While endophthalmitis is rare, estimated to be about 1 in 4000, the source of the bacteria is typically from the patient’s own eyelashes or eyelids. Draping helps keep these bacteria away from our surgical incisions and may help reduce the risk of infection.
This video shows a very efficient and well-performed cataract surgery, but I can’t help but dwell on the poor draping of the eyelashes. Yes, the surgery was fine and even less than 5 minutes, but the draping was ugly. This is a case where the patient did not receive enough sedation and then was squirming around while the drapes were applied. In retrospect, it would have been better to stop and re-drape the patient after she settled down. Fortunately, the case went beautifully and she has achieved excellent vision.
For beginning surgeons, proper draping will make the rest of your surgery easier. And when you’re still learning, you should take every advantage possible.
Click below to see the video of a great cataract surgery but not such great draping:
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