Review: fixing beginner mistakes

Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look at this pic and see how many issues need fixing:

  • The hands are not holding the instruments correctly. The right hand should be holding the phaco probe like a pen or pencil. The odd grip in the photo does not allow for fine control within the eye. The left hand is also holding the chopper in an odd manner.
  • The hand position needs to be improved also. The phaco probe in the right hand should be at a less steep angle and the chopper in the left hand should be brought towards the surgeon.
  • Both of these issues are causing the eye to be pushed toward the nasal canthus which means that the eye is no longer in primary. This compromises the view into the eye and makes it more difficult to operate.

These issues need to be address first, before we work on learning an advanced technique like phaco chop. You must start with the basics before progressing — like the saying goes, you must learn to walk before you learn to run.

Click below to hear the teaching points for this novice surgeon case:


  1. Hello Dr. Devgan,

    I was taught to hold the instruments like a dart, rather than a pencil, to allow for increased range of motion while still maintaining fine control. What are your thoughts?

    1. not much range of motion is needed. The anterior chamber white-to-white diameter is 11 or 12 mm. The AC depth is 3 or 4 mm. The cataract has a 9 mm diameter and 4 mm depth. The capsulorhexis is 5 mm. The IOL optic is 6 mm. The incision is less than 3 mm. The eye is tiny and you can certainly achieve more than enough travel by holding a pencil.

      You have spent your whole life holding a pencil and writing with precision. How many hours have you spent playing darts? With that said, hold the instruments in the manner that gives you the most control.

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