Simultaneous Hand Position and Microscope View

For young ophthalmologists, learning how to hold the instruments and position the hands during cataract surgery can be difficult to learn. This video is a routine cataract case where we have two simultaneous camera angles: the main view is of my hands and the instruments and the smaller picture-in-picture is the microscope view.

Remember that during surgery, we do not look at our hands at all: they are not in the microscope view and we don’t look away from the microscope while we have instruments in the eye. The hands do their work with proprioception.

For setting up the microscope and for surgeon positioning, look at the picture above. The microscope is directly above the eye and the central viewing tube of the microscope is perpendicular to the floor of the room. Remember that the iris is also parallel to the floor as explained in this video. The surgeon’s oculars are tilted at a slight downward angle to make it comfortable and ergonomic. My arms are bent at about a 90 degree angle at the elbow. The patient’s head is positioned close to me so that I do not need to extend my arms to perform the surgery. This is my ideal set-up for the microscope.

Click below for the picture-in-picture simultaneous view of routine cataract surgery:

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