Cataract surgery

This video illustrates key steps of cataract surgery. It is a compilation of clips from several of my surgeries over the past few months (during ophthalmology residency). Below is a brief breakdown of the steps throughout the video.

0:00-0:02 Paracentesis incision -- used for viscoelastic insertion, second instrument access
0:02-0:12 Viscoelastic -- gel used as a space maintainer, for protection of adjacent tissues, etc
0:14-0:20 Initial strike -- first portion of making a triplanar primary wound/incision
0:20-0:27 Wound construction cont'd -- two more planes to complete a triplanar incision (note the change in angle of the keratome during this clip)
0:27-0:50 Trypan blue -- used to stain the anterior lens capsule for visualization when a cataract is very dense (can be done under viscoelastic or under an air bubble)
0:50-1:20 Capsulorrhexus -- tearing of the anterior lens capsule to create access to the lens/cataract. We aim to get a continuous curvilinear capsulorrhexis if at all possible (continuous, round opening).
1:20-1:31 Iris hooks -- these can be used in cases with small, poorly dilated pupils
1:31-1:36 Hydrodissection -- mobilizes the lens/cataract with a dissecting wave of fluid
1:36-1:40 Hydrodelineation -- mobilizes inner lens (nucleus) from the surrounding lens
1:40-2:01 Grooving -- using ultrasonic handpiece to break up the lens/cataract and suck it out (phacoemulsification). There are many techniques to removing the lens nucleus.
2:01-2:11 Cracking and spinning -- mechanically cracking the lens using a second instrument and spinning it for further diassembly and removal
2:11-3:19 Grooving, cracking, and phacoemulsifying lens -- finishing nuclear disassembly/removal
3:19-3:30 I&A of epinucleus -- using an irrigation and aspiration handpiece to remove epinucleus (softer layer further out from the center)
3:30-3:44 I&A of cortex -- stripping lens cortex (outer layer) from the capsule (The posterior capsule is about 4-5 microns thick, plus or minus a little, making it only about half as thick as a red blood cell is wide! And it's important to try and avoid breaking it!)
3:44-4:02 Polishing -- mechanically polishing off cortical fragments from the posterior capsule with a microabrasive tip
4:02-4:12 Viscoelastic -- re-inflating the chamber with gel for intraocular lens (IOL) insertion
4:12-4:24 IOL insertion -- injecting a foldable IOL
4:24-4:42 Spinning IOL with Sinskey hook -- positioning the IOL (normally it does not require nearly this much manipulation)
4:42-4:46 IOL centered
4:46-4:49 Suture -- most cataract surgery across the country is sutureless, although adding a suture provides some additional structural support and seems to lower (an already very low) risk of infection. During my training, we are doing this routinely, although the vast majority of our incisions are self-sealing anyway
4:49-5:07 Viscoelastic removal -- removing the injected gel from the eye
5:07-5:11 Burying the suture knot -- we spin the suture to bury the knot so it isn't exposed and irritating to the eyelid
5:11-5:19 Removing viscoelastic from under the IOL -- sometimes we have to slip behind the IOL to completely remove the gel
5:19-5:26 Recentering the IOL
5:26-5:36 Checking wound integrity and testing eye pressure -- we always want to make sure the incision is sealed and watertight and that the eye pressure is okay

Category:

Education

Tags:

• cataract surgery
• andy edwards
• phacoemulsification
• iris hooks
• capsulorrhexis
• hydrodissection
• hydrodelineation
• nuclear disassembly
• epinuclear removal
• ia
• i&a
• irrigation and aspiration
• cortical removal
• cortex removal
• capsular polishing
• iol
• intraocular lens implant
• suture
• texas tech

[Nadaqueverconelbalde]

You're good...

By the way, which year R??

[edwaan]

@Nadaqueverconelbalde

Sorry it's been so long. These clips were from the beginning of my second year of ophthalmology residency. I am now done and in private practice.

@ maggies1buddy

I hope everything went well (it almost always does). Enjoy the new vision!

@stillmakinitinlife93

Thanks. The patients should never have any pain. They can feel cold fluid or sometimes pressure, but no pain. :)

[Capricornprincessa]

Aghhh

[Raqwaza17]

The inside looked like a live thing was in it

[stillmakinitinlife93]

this is super sick! i'd feel bad if that guy felt it and knew what was going on!

but you are pretty skilled from the looks of it lol..

[maggies1buddy]

I am going in 2 weeks! Very anxious. Can you wear makeup? Will I be able to ride my m/c a couple days later? Is that much l bleeding normal? This is scary.

[carlsononly]

Dude youre skilled :D I may not be a doctor but I know this, youre skilled :D

[awesome2554]

OMG OMG OMG OMG OMG OMG OMG OMG OMG, thats sick, i hope i dont have to be that guy :(