Seasoned ophthalmologists frequently ask the technique for helping a resident surgeon complete that very first cataract surgery case. As we know, the learning curve for phaco is quite difficult and steep and there is virtually no chance that beginning residents can complete their very first case completely unaided. The key to the way that I attend and teach these new surgeons is handholding, or more precisely, co-holding the instruments with them. We also must ensure success in the early steps of the procedure since a misstep there can lead to more complications. I also want to ensure that it is a positive experience for the new surgeon.
The requirements that I have prior to booking your very first cataract surgery include:
- knowing your patient inside and out, including IOL calcs and ocular comorbidities
- performing a reliable retrobulbar or peri-bulbar anesthetic injection
- draping and positioning the patient
- setting up all equipment in the operating room
- being able to load the IOL into the injector
- reliably place a 10-0 nylon suture with correct form
- know the steps of surgery
If you are able to complete those requirements then we can proceed with your very first phaco surgery. This video gives my hints for success, including pearls like making an extra paracentesis incision for the attending and then pre-chopping the nucleus.