r/Ophthalmology

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.

Hi everyone, I’m a second-year ophthalmology resident and I started learning cataract surgery about a month ago.
I actually completed my first full cataract surgery last week, which went quite well, but I’m still having some difficulties in the cases after that.
The capsulorhexis is going well for me, as well as the other steps such as cortical aspiration and IOL implantation. The most difficult part for me at the moment is hydrodissection and especially cracking the nucleus.
With hydrodissection, I enter under the capsule, lift the edge of the rhexis slightly and inject, but I often have difficulty seeing a clear wave passing through the nucleus. I usually see small “pseudo-waves” or little waves, but rarely a clear wave that travels all the way across the nucleus.
I usually try again from the other side, at 6 and 12 o’clock, and eventually the fluid passes through, but sometimes I feel like I’m filling the space too much between the posterior capsule and the nucleus.

I’ve watched many videos from Cataract Coach and other cataract surgeons on YouTube, but despite that, my hydrodissection only works occasionally.
All my colleagues tell me that it mainly comes with experience, but since we are many residents we need to improve as much as possible with every case.
For those of you who have more experience, what do you think are the most common mistakes that make hydrodissection difficult? Do you have any practical tips for getting a good hydrodissection wave and improving nucleus cracking?
Any advice would be really appreciated. Thanks!

I finished my residency a little over a year ago and I’m now working at a different hospital. We also use the Alcon Centurion for cataract surgery, but here the handpiece heats up very quickly, making it very easy to burn the main incision.
To avoid burning the incision, I’ve found that I have to press the foot pedal only halfway and use short bursts, because if I press it all the way down, the handpiece gets extremely hot.
Has anyone else experienced this? Personally, I never had this problem when using the Centurion before, but I’m having it consistently at this hospital.
Any advice on how to troubleshoot or fix this problem would be greatly appreciated. Thanks!

Hey everyone, how are you?
Basically, just what the title says. I’m currently doing my residency at a hospital that I won’t name because I don’t want to dox myself, but I’m not really happy there.
I was pretty disappointed that I didn’t get into Clínicas, Rivadavia, Lagleyze, or Santa Lucía. So I keep having this thought in the back of my mind that I’m training at a mediocre place instead of one of those hospitals. It really gets me down, and I think about it pretty much every day.
I’ve considered taking the residency entrance exam again, but ophthalmology is already very difficult to get into, so I’m not sure.
In case anyone is wondering what I don’t like about my current program:
Patient volume: It’s very low, and most of the patients are elderly.
Surgery: There isn’t much surgical volume.
Academics: We don’t really have case conferences or much academic activity within the department. We residents give classes to each other, but beyond that there isn’t much.
Few subspecialties: We have one attending who does orbit, one retina specialist, and two oculoplastics specialists. Other than that, there isn’t much.
Prestige: Being somewhere that isn’t particularly prestigious gets to my ego. I did my entire medical degree at Clínicas and was also a teaching assistant there, so it really bothers me that I’m not doing my residency there.
That’s pretty much it. I mainly wanted to vent and hear what you guys think.

Btw : I’m not from the states, I’m from Argentina.

I am having trouble finding the right power for sculpting. Sometime, the attending says I use too much power and other times not enough. I also keep moving the eye away from the me. Any tips? - a PGY3 struggling in surgery 😑

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