ASCRS New
July 2021

Ophthalmology Quicksand Chronicles, an ASCRS podcast hosted by Nicole Fram, MD, and Elizabeth Yeu, MD, features an expert guest on each episode who shares their “quicksand moments” in the OR, lessons learned from those moments, and how these vulnerable situations ultimately helped them evolve as surgeons. The following is a recap of some of the information shared in recent episodes. 

“The Complexities of the Colobomatous Eye”

In April, Drs. Fram and Yeu welcomed guest Ashvin Agarwal, MD, to talk about “The Complexities of the Colobomatous Eye.”

Dr. Agarwal shared a case from about 6 years ago of a colobomatous eye with a brown cataract where he was employing a technique called vitrectomy-assisted phacoemulsification (VAP), which involved placing a trocar and doing a dry vitrectomy. 

As challenges began to arise with the case, Dr. Agarwal stressed that one of the most important things is to have a backup plan. Surgeons often get committed to a particular procedure and don’t want to adapt, he said, noting that he had committed to phaco in his case but may have chosen a different option in hindsight. 

“The Pressure is On”

John Berdahl, MD, joined Drs. Fram and Yeu to discuss handling pressure in the eye as well as a case of suprachoroidal hemorrhage.

Dr. Berdahl shared a case of one of his fellows and noted that he had a similar complication as a fellow. The patient had trauma in the past and DSAEK, but the pressure wasn’t controlled on medications. The patient was in the OR for iStent (Glaukos) and ECP. 

Initially, the view was not great and it progressed to a suprachoroidal hemorrhage. Dr. Berdahl said he reassured the fellow to continue handling the case.

Remembering his own case of suprachoroidal hemorrhage earlier in his career, Dr. Berdahl said it was one of the worst things to happen to him.

Later the discussion focused on surgeon vulnerability and feeling bad after a complication. “The moment I stop feeling bad when there’s [a complication] when the patient put their trust in me is the moment I don’t deserve their trust,” he said, noting that “the most dangerous thing is the doctor who just doesn’t care.” 

“The Tale of the Tennis Ball and the Traumatic Cataract”

Marjan Farid, MD, joined Drs. Fram and Yeu to discuss a patient with a traumatic cataract from a tennis ball injury several years earlier. With a traumatic cataract, you don’t know what to expect when you get in there, Dr. Farid said, though she thought it would likely be dense but didn’t know how the zonules would react. 

She used the femtosecond laser in this case, as well as miLOOP (Carl Zeiss Meditec) and capsule retractors to help.

Her patient was well informed in advance about the potential complexity of the case and knew that a second surgery might be necessary.

Dr. Farid noted movement from the capsule and the whole lens, which was extremely mature and brunescent. She was eventually able to get the lens out by lifting up the anterior wound edge.

Dr. Farid noted that she likes to utilize the Yamane technique, with a modification using a 27-gauge trocar. She has not seen any long-term dislocation using the Yamane technique.

To watch/listen to full episodes, visit ascrs.org/clinical-education/podcasts-qc.