If the anonymous resident really has only 20 cataracts as primary surgeon then his/her technique is excellent. A lot of good learning points are told in this video.
I am a resident doctor too.. and I can totally correlate with this video as I did similar errors last week (Inadequate space superiorly for incision, Corneal wrinkles, small rehxis). Thanks for sharing. Other inputs from the experts in the comment section can be of much help. Thanks.
Great learning from the video. Even I face similiar issues. I thing I noticed is resident is rotating the nuclear pieces with phaco probe more often and chopper/sinskey less often. Its better to use left hand chopper to rotate nuclear pieces. Even I am working on that...
1. Good Drapping 2. Bigger rehxis 3. Pivot well inside the incision with capaular porceps . 4. He should adjust the head position to keep the eye centerd 5. He colud enlarge the rehxis size after iol implantation to prevent capsular phemosis in future .
You should definitely try the temporal approach, it makes a big difference in the hability of maintaining the eye in primary position. It made a big difference for me. Now I don't do it any other way.
@@victorbanda2107 You are not approaching and inserting instruments into your main wound as a steep of an angle to get around the brow when you are in the temporal position. It gives you a bit more room to work with.
During bimanual I/A, more centered, but notice that the resident is pushing the eye back into the orbit (note the peripheral conjunctival wrinkles). Did not cause a problem, but if either instrument were to slip more into the eye, the eye could move anterior, and the posterior capsule could be toast before they can stop it.
I think you hit all the big points and nice work for the resident being only 20 cases in. Just two quick thoughts glad the pupil ended up dilating and staying dilated but when a pupil comes down in a case I know may be tough I consider putting in an i-ring…maybe not in this case since the dilation ended up being pretty large but borderline cases may benefit…so much easier than having to throw in hooks mid-case. Also, I like using a Kelman forceps in the para when making the main wound. That or a Thornton fixation ring may help keep things more stable vs. a CTA or forceps just on the surface like in this case. Great job to the resident!
Take your time to preparing good head and eye of the patient, Also the drepping+spekulum before you start your first incision,, i think during my process of learing, those preparation does improve surgeon comfort and efectiveness of the procedure.
I strongly recommend periocular and retrobulbar anesthesia for a beginner resident. As my experience, a small rexis is a fast escape from the risks which are related to the eye movements of the patient. The fear of running rexis to the periphery force the surgeon to make a quick but smaller rexis. So I think, a stabilized eye with retrobulbar anesthesia will provide comfort for the surgeon to perform a rexis in demanded size.
Hello Sir , I am a eye surgeon from India . I am learning phaco , have done 22 cases till now , had rents in 6 cases. And the rent mostly happens while taking the last piece of nucleus during phaco 3, or during bimanual. How to avoid rent during phaco 3 while taking the last piece ? Pls guide . Thanks
For someone with 20 cases under his belt, he’s done well. Watching Cataract coach will make him a good surgeon when he graduates. Good luck.
If the anonymous resident really has only 20 cataracts as primary surgeon then his/her technique is excellent. A lot of good learning points are told in this video.
I am a resident doctor too.. and I can totally correlate with this video as I did similar errors last week (Inadequate space superiorly for incision, Corneal wrinkles, small rehxis). Thanks for sharing. Other inputs from the experts in the comment section can be of much help. Thanks.
Good surgery with brilliant learning points from Dr. Devgan .... Thank you
If you want to use trypan blue, try using it with an air bubble injected before the dye. Works perfectly every time.
great input. thank you.
Great learning from the video. Even I face similiar issues.
I thing I noticed is resident is rotating the nuclear pieces with phaco probe more often and chopper/sinskey less often. Its better to use left hand chopper to rotate nuclear pieces. Even I am working on that...
My suggestion will be to counsel and ease the patient intraoperatively, as he is looking to have apprehension also.
1. Good Drapping
2. Bigger rehxis
3. Pivot well inside the incision with capaular porceps .
4. He should adjust the head position to keep the eye centerd
5. He colud enlarge the rehxis size after iol implantation to prevent capsular phemosis in future .
great input. thank you.
You should definitely try the temporal approach, it makes a big difference in the hability of maintaining the eye in primary position. It made a big difference for me. Now I don't do it any other way.
I am curious how is the temporal position helps you to have eye in primary position?
@@victorbanda2107 You are not approaching and inserting instruments into your main wound as a steep of an angle to get around the brow when you are in the temporal position. It gives you a bit more room to work with.
Good learning video, especially about head position. Thank you 👍🏻
Kudos to the resident surgeon ! May be using air bubble with tryp blue would have helped.
great input. thank you.
During bimanual I/A, more centered, but notice that the resident is pushing the eye back into the orbit (note the peripheral conjunctival wrinkles). Did not cause a problem, but if either instrument were to slip more into the eye, the eye could move anterior, and the posterior capsule could be toast before they can stop it.
great input. thank you.
Great great great advice sir
I think you hit all the big points and nice work for the resident being only 20 cases in. Just two quick thoughts glad the pupil ended up dilating and staying dilated but when a pupil comes down in a case I know may be tough I consider putting in an i-ring…maybe not in this case since the dilation ended up being pretty large but borderline cases may benefit…so much easier than having to throw in hooks mid-case.
Also, I like using a Kelman forceps in the para when making the main wound. That or a Thornton fixation ring may help keep things more stable vs. a CTA or forceps just on the surface like in this case.
Great job to the resident!
great input. thank you.
Take your time to preparing good head and eye of the patient, Also the drepping+spekulum before you start your first incision,, i think during my process of learing, those preparation does improve surgeon comfort and efectiveness of the procedure.
Good job for a beginner surgeon, but, keep a good head position, use a bubble air with blue and take your time when you are making ccc.
What precautions to be taken in doing Phaco in patients after controlling IOP with medication
5 mm Rhexis + head in primary position will improve the performance.
I strongly recommend periocular and retrobulbar anesthesia for a beginner resident. As my experience, a small rexis is a fast escape from the risks which are related to the eye movements of the patient. The fear of running rexis to the periphery force the surgeon to make a quick but smaller rexis. So I think, a stabilized eye with retrobulbar anesthesia will provide comfort for the surgeon to perform a rexis in demanded size.
Gracias...
Rhexis should have been enlarged before closing.
Hello Sir ,
I am a eye surgeon from India .
I am learning phaco , have done 22 cases till now , had rents in 6 cases.
And the rent mostly happens while taking the last piece of nucleus during phaco 3, or during bimanual.
How to avoid rent during phaco 3 while taking the last piece ?
Pls guide .
Thanks
Protect the bag with your second
He/she is not a 20 cases surgeon…
Are you not an indian. What is the accent of your language. Please improve your accent
He is an American of Indian origin. Hence the accent. He is based in the US..