Early days in the operating room

Some of the delegates and presenters who attended yesterday's Young Ophthalmologists Programme At yesterday’s YO programme, Dr Paul Rosen sought to put young cataract surgeons at ease with his advice on how to approach those early days in the operating room. He advises trainees to ask their mentor to “talk me through the procedure”, and to plan for the unfortunate possibility of a complication. Preoperatively, of course, an intraocular lens (IOL) power has to be calculated. “Don’t use the SRK I or II formulae anymore!” urged Dr Nino Hirnschall. “They are obsolete,” he said. Besides avoiding these formulae, it doesn’t much matter which formula is used. “Optimising the IOL constants for each IOL model for the method of axial length measurement, optical or acoustic, has a much greater imact on the predictability of the refractive outcome than choosing between modern IOL formulae,” he added. “In order to prepare patients for the possibility of imperfect refractive outcomes, show them the actual results of the calculations in order to make it clear that formulae aren’t perfect and that there exists a range of possible outcomes,” Dr Hirnschall suggested. Dr Richard Packard advised delegates to make sure that cataract surgery incisions are properly paired with the instruments and IOL inserter being used. “Mismatching between the two leads to leakage, which is often the real reason that the anterior chamber is unstable,” he said. “If the incision is too small, distortion of the wound will occur, and once you start enlarging the incision, you destroy the architecture, increasing the amount of surgically-induced astigmatism and decreasing the wound’s ability to seal,” he added. Dr Nic Reus also gave delegates a pearl of advice regarding surgical skills preparation. “Practice variable techniques, such as dyeing the anterior capsule or using a different capsulorhexis technique, before you actually need it, so you are proficient before it’s too late,” he said.