Superior Incision: Hand Position & Microscope Views

While I prefer the temporal approach for routine cataract surgeries, some surgeons prefer a superior incision. Many beginning surgeons who operate from the superior position have requested a video showing the simultaneous views of the hands and through the operating microscope.

A good surgeon should be able to do the cataract surgery from either the superior or the temporal position. In general, there is an advantage of making a limbal / corneal incision on the steep axis and that is why I am using the superior position for this patient. The decision between temporal and superior is discussed in this previous article.

This patient has about 0.75 diopters of corneal astigmatism which is steep at 90 degrees (with-the-rule astigmatism). The main phaco incision is made at the 90 degree mark superiorly using a 2.8mm keratome. Then this same keratome is used to make a penetrating incision of about 2.0mm inferiorly at the same steep 90 degree axis. This worked well and the patient ended up with no corneal astigmatism after healing.

The hand positioning and instrument holding is about the same as previous videos where I am operating temporally. There are a lot of subtle but important hand movements in this video. If you are a beginning ocular surgery, don’t simply watch these videos — instead you should be carefully studying them.

Click below to learn from this video of hand positioning with a superior approach:

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