Time for our large, worldwide group of tens of thousands of ophthalmologists to help out a colleague. This anonymous surgeon is about 3 years after completion of residency/fellowship training and has done another 1000 cataract surgeries. You can see from the video that the surgical skill and technique are both very good.
But this surgeon is perplexed because on post-op day 1 many of these routine cataract patients have corneal edema. Watch the video carefully and then comment below giving your advice to improve the case and reduce the incidence of post-op corneal edema after routine cataract surgery. Thank you in advance for your help!
Definitely agree with duty cycle optimization. In addition – and I could be wrong here – that dispersive OVD looks fairly thin, probably HPMC. Switching to a sodium hyaluronate-based OVD may be worth a try. At least it could provide a short-term improvement (in case these higher priced OVDs are not sustainable for your surgery center) while you refine your phaco settings. Overall your technique looks solid. Also, if you’re injecting intracameral moxi at the end, make sure it’s preservative-free.
A couple of suggestions. Some of the edema may be related to case time, with more fluid being run through the eye for a longer (10 minutes + case) as compared to a shorter case time as we see with the master (Uday’s typical case times are 5-7 minutes). The video in this case was sped up, but it’s apparent that the actual case time was, as I recall, something like 13 minutes.
Some patients may also have guttata, which are easily missed clinically (you won’t see them if you don’t look for them) and these of course are also more likely to have edema
I dont see any flaws in the technique
He could try refilling the chamber with more dispersivo OVD during the US and before I/A, and use a little Triamcinolone at the end of the case
Using a different US duty cicle as you mentioned would also help
It would be interesting to know which brand of trypan blue and OVD is he using
The 80% duty cycle + probably leaving some OVD in the eye at the end of the surgery