1245: tips to improve phaco technique

Dear CataractCoach viewers and fans, I need your help for this video. This is an anonymous resident surgeon who has done 20 cataract surgeries so far and now requests an independent critique with tips to improve his/her phaco technique. In this video, I give my advice throughout with my commentary and voiceover, but we also want to hear from you — our colleagues. Particularly for our beginning surgeons who have less than 500 cases of experience, your input is so valuable since you are closer to this early stage of learning than I am. It seems like it was just a recently, but I finished my residency training more than 20 years ago.

please click to watch this video and then leave a comment giving your best advice:

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  1. Good hands. Try sitting temporally. Small rhexis as mentioned, After hydrodissectiion, add dispersive and turn the nucleus with second instrument to assure mobility. Check phaco irrigation ports (looked oblique).

  2. Very nice case for 20 cases. My advice is to take your time and pay attention to the little details like draping. as mentioned by Dr. Devgan. Use a Lieberman speculum or
    a wired speculum so that you don’t have a large metal piece blocking the lid. As mentioned above a temporal position is more comfortable and a Koch-Cionni speculum works well for that.

  3. Great start! Couple things that may help. I would use an instrument in the paracentesis to steady the eye when making your main wound, or if you want to use forceps, grab firmly at the limbus instead of the conj in the fornix. The latter is too stretchy and can even tear. I would also consider learning to operate temporally starting out. The speculum is more out of the way and the Bell’s reflex is not going to hurt you like it is in this situation. Also when you are starting out don’t be afraid to keep refilling the ac with viscoelastic when making the rhexis, as this will help keep the anterior lens flat, keep the iris dilated, and help prevent runout.

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