We receive about 30 to 50 videos from surgeons every week and from those, we can only pick a few for CataractCoach.com since we post one video a day. When I saw this video from a senior resident, I was surprised — and not in a good way. This resident surgeon has done about 200 cases but it seems as if the level of experience is just 20 cases. Looking at the picture, you can see poor draping with eyelashes touching the cornea, iris prolapse without understanding why, and a failure to keep the eye in primary position. The surgery took 35 minutes so it has been sped up at 4x speed so that we can show the entire case. Dear anonymous resident, please, please, please do better than this. Put in the effort to learn more — much more. You are in danger of falling so far behind in your surgical skills that you may not become a successful surgeon. Please leave your comments below to help this young doctor.
Thanks for sharing this video.
So many learning points here.
A. I would re drape and get the lashes away. B. Instruments can help bring the eye in primary. C. Capsular block led to iris prolapse. Inject small amounts during hydrodissection and press gently on the nucleous to prevent capsular block..
D. Keep leading and good luck
was this a Flomax patient? If so, Omidria in the irrigation might help.
Another technique , once the iris is reposited, place extra Viscoat over the site of the prolapse, between iris and corneal.
In extreme cases, close the incision and do a new incision with a longer corneal tunnel portion so Iris has a harder time prolapsing.
The last thing you should do in case of an iris prolaps is add more visco or more cohesive visco. You should minimize the outgoing flow/force, so lower your bottle and gently sweep the iris back into the anterior chamber from the inside (via the opposite) sideport. And keep your bottle low for the rest of the procedure.
Idiot.
specifically what are you being critical of?
I am surprised that no one advised the resident to burp the eye to relieve pressure and prevent iris prolapse from worsening/recurring. Sometimes just burping the eye will decrease the IOP and allow the iris to be nudged back in from the outside. When the eye won’t stay in primary, it’s often due to poor surgeon position. Consider adjusting your seat so that you are comfortable. Try operating further from the cornea when doing nucleus disassembly (think iris plane). It’s a skill that becomes harder to learn with time once bad habits set in. If nuclear fragments and phaco are close to endothelium, the patients will suffer from a lot of postoperative corneal edema.
This case is well managed by surgeon and and is completed with the Iol in eye hence should not be marked as poorly operating as a managed complication is a nullified complication and should not be counted well done by surgeon