u/Iryoujuujisya

3rd year (PGY-4) resident here.

I would like to some tips and demonstrative videos of how to safety take out the last quadrant.

I've broken bag twice so far, but both times, its been the same story.

White cataract with brunescent center, taking up the last quadrant, and there is a post-occlusion surge and the capsule comes up to the phaco tip.

I have been pushing the capsule back with my connor wand and I've been told that I am phaco-ing too close to the endothelium if anything...

Other things I've tried was to try epinucleus setting to slowly eat up the quadrant but it didn't really work for very dense cataracts like these.

Also I am trying to get partial occlusion of the tip rather than full occlusion, but its been kind of difficult to actually achieve this consistently.

If there are any tips or videos to avoid this post-occlusion surge causing capsule rupture, It would be immensely helpful.

Low key everytime I see a dense cataract, I feel like I will go into the surgery scared unless I have a good way of preventing this from happening.

Thank you in advance.

Residents having dry eye... tale as old as time.

My dry eyes have been getting worse, been putting buckets of ivizia in my eyes for the past few months.

Then an attending got me a sample of Miebo... and its just... different.

Ugh I hate to admit it. Every time a patient comes in begging for miebo and miebo only, I low key rolled my eyes. But holy, it feels different. I can FEEL it coating my eyes. No burning sensation in the beginning like the other drops do. I never would've thought I can feel the drop actually working to prevent evaporation.

Damn you B&L.

I'm still not thrilled about prescribing it. I understand Novaliq did all the FDA trials to get it approved first-in-class, etc. But the price just does NOT make sense to me based on its efficacy. Even if its partially covered, I don't want insurance companies paying B&L for a drop that costs fraction of what it costs out-of-pocket in other countries just because they had a good market strategy.

But you bet I'm gonna tell patients to grab evotears when they go to Europe.

Sorry, just had to vent. After this sample runs out, I'm going back to ivizia. Or maybe any other preservative free drops.

Maybe someone can change my mind.

EDIT: I am NOT in favor of miebo. I'm actually more interested in newer treatments like tryptyr or tyrvaya, wondering how patients do with those. Or even things like diquafosol used in asia.