1990: Quiz: How do you safely finish this case?

Cataract Quiz! As you are doing cortex removal with the IA probe you suddenly notice that the posterior capsule is wide open. Now what? Think about it. You’re under stress, your blood pressure and pulse both go up, you feel that epinephrine surge and you need to control your hands and your feet. What specifically do you do? Comment below before watching the video.

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  1. I shall start infusion through side port before withdrawing IA Probe, inject triamcinolone through side port . If vitreous detecyed in AC, shall perform anterior vitrectomy. when AC is free from vitreous shall insert 3 piece IOL. If bag can be opened it will be placed in bag, if not, then in sulcus.

  2. Keep irrigation on, second hand Visco injection, if no prolapse, 3P IOL in sulcus, good hydration of paracenthesis and incision

  3. The #1 rule is to stay calm. My heart rate and pulse do not increase when complications occur because I take beta blockers. I have to because I operate with residents and this happens a lot. I ask the scrub tech and circulators for the vitrectomy set up and they all know that includes dispersive viscoelastic, triamcinolone, Miochol, 10-0 nylon, subconj ancef/dexamethasone, 3 piece IOL, etc. We keep all that stuff ready in the room and we are all used to this. The #2 rule is not to let the AC collapse. If we can get the 3 piece lens in with optic capture and no vitreous to any wounds then it is a success. Put a suture in the main wound as soon as the IOL is in. Make sure to use intracameral moxi and a little triamcinolone in AC at the end. Give Diamox in the PACU and another one in the evening at home. Watch the patient closely in the post op period for RD, endophthalmitis, and CME.

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