This is another great example of how even an experienced, expert surgeon can encounter a complication during cataract surgery. This is a very difficult case with a dense cataract, small pupil, pseudo-exfoliation, floppy iris syndrome, uncontrolled glaucoma and in a patient who is elderly and on blood thinner (anti-coagulation) medication. There is posterior pressure and shallowing of the anterior chamber during surgery and the red reflex changes from the bright orange to a darker hue as the patient develops a choroidal hemorrhage. Watch the video and tell me the time at which you think the choroidal hemorrhage first occurs. I am not 100% sure.
I left my comments on YouTube but will repeat them here:
I would not have done a vitrectomy here. There are so many things to discuss….one of which is that the blind suture pass for the Goniotomy could have misdirected at the beginning of the case and caused a small choroidal bleed and then dropping the pressure with the vitrectomy allowed it to expand later. But bottom line is that you have the lens in the eye and the eye is closed you don’t want to do a blind vitrectomy at that point because you can do more harm than good. You can wait things out and if needed go back and reposition the lens at another time when the storm has passed. When you are doing a phaco and you have a lot of posterior pressure the safest thing to do is give Mannitol and wait! If you can, take an indirect Ophthalmoloscope and look and see what’s going on