3078: phaco with prior vitreous hemorrhage
Performing phaco in the presence of a vitreous hemorrhage significantly increases operative complexity due to the loss of the red reflex. Without retroillumination, defining the anterior capsule edge, gauging nuclear depth, and monitoring posterior capsular mechanics become more difficult. The strategic use of trypan blue dye is helpful to stain the anterior capsule, providing vital contrast against the dark posterior backdrop to ensure a controlled, continuous curvilinear capsulorhexis. Furthermore, high-intensity side illumination or endo-illumination can help compensate for the absent red reflex during nuclear disassembly, helping the surgeon maintain precise depth perception throughout emulsification. Watch the video to see how this resident surgeon navigates the challenge of operating without a red reflex and successfully completes phaco in an eye with vitreous hemorrhage. What visualization strategies or lighting techniques do you rely on most when a red reflex is completely absent? Please comment your thoughts below.
