This case was anonymously submitted and the question was posed: is it permissible to use all of these techniques in a routine cataract case? The surgeon first uses a femtosecond laser to create a capsulotomy and to divide the lens nucleus. Then a subtenon’s block is given through a conjunctival opening and a traction suture is placed at the limbus and the eye is fixated. Fluorescein dye is used to stain the blade while 4 paracentesis incisions are made. To an experienced surgeon, this seems like a lot of additional and perhaps unnecessary steps for a routine cataract surgery. But if you feel that you need to do these steps to achieve a good outcome for your patient, then please, by all means, do whatever you need to do. Just be cautious of using too many crutches which could impeded the development of your own skills. What is your take on this routine cataract case? And what advice do you have to offer this beginning surgeon? Please comment below
Cleaning LECs from the anterior capsule would do more good for this patient than all the other stuff that was added to the procedure to be honest. Learning how to make a manual rhexis and how to do effective chopping will make this surgeon much more efficient, less stressed and feel more in control with better dilation and better visibility. This looks like a pretty routine case and if you add all this extra stuff (and leave out important things like cleaning LECs) you will be stressed, distracted and slow and while it’s OK (and strongly recommended actually) to do whatever you have to do to get through your case safely, learning how to be efficient and to avoid extra unnecessary steps will reduce stress for physician and patient, decrease time on the table and chances for the patient to descend deeper into restlessness and bad behavior where they need more anesthesia and a viscious cycle is created where both surgeon and patient start sweating it out.