Sometimes Even Experts Struggle during Surgery

As we gain more experience and hone our surgical skills, we achieve the state of flow where the procedure progresses naturally and efficiently. But there are still cases which pose more of a challenge and even expert surgeons can seem to struggle, to a degree, during cataract surgery.

This case is a good example of that. It is still efficient and less than 10 minutes and the patient still achieves a great visual outcome without complications. But my feeling during this case was that I was struggling to push the case along. Many steps seemed more challenging than I expected. The anterior chamber was shallower that I desired and there was very little working room. The pupil came down and made lens cortex removal more difficult, necessitating a bimanual approach. And even the IOL insertion was more involved since it had to go through a smaller pupil.

Again, in the end the result was just fine and that patient achieved 20/20 vision with a close to plano refraction. Any ophthalmologist who sees the patient in the future will see my signature of a well-done incision and capsulorhexis. But the case was not a breeze — it was more effort and work than I predicted. We must remember that every patient, in fact every eye, will be slightly different and will bring its own challenges.

Click below to learn from this video and hear my explanation of the struggle:


  1. Hello Uday Devgan. Your website is fantastic. I learn a lot. Just a question, how do you do the lidocaine and epinephrine solution that you use in te beginning of the case? Thanks a lot.

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