When residents are learning cataract surgery, one of the struggles is getting the phaco incision right. The incision is critical to the success of the surgery in so many different ways. A good incision will induce a mild and predictable astigmatic change, a poor one will not. A good incision will allow easy access to the anterior segment without excessive leakage, a poor incision will hinder movement and even allow iris prolapse. A good incision will provide predictable fluidics and a stable anterior chamber, a poor incision will not and will make the risk of capsule rupture higher. A good incision will seal appropriately and for the long term, a poor incision will not and may allow pathogens to enter the eye.
This video shows a resident doing an excellent phaco incision and then we take it a step beyond and analyze this incision with intra-operative OCT imaging to truly understand the architecture. We also place a 10-0 nylon suture to show the effect that it has on tissue approximation. There is so much to be learned from this video.
click to learn how this resident finally made a great phaco incision: