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Eyetube Picks | April '13

Eyetube Picks

Reviewing surgical videos can be a crucial and important resource. As a resident, I remember video-taping every single case I performed. Once recorded, I would review each case multiple times (by myself, with fellow residents, and/or attendings). I would even bring the tapes back to my hometown over holidays to review with my father (a practicing ophthalmologist at the time). As a resident, I performed around 100 to 200 cataract surgeries; recording and reviewing the videos allowed me to expand and make the most of this relatively limited hands-on experience. Furthermore, having reviewed hundreds of my own cases, it became easier to review and appreciate other surgeons’ videos and pick up minor nuances to incorporate into my own technique. This was back in the day of VCRs, which made it a bit cumbersome to review cases: you had to have a VCR handy, you had to be patient when searching through the tapes to find the exact spot you wanted to play, and you had to have roommates who would tolerate playing these tapes on the apartment TV. Good cases were like gold among residents: tapes showing particular key techniques or common pitfalls to avoid would be passed down year to year. Eventually the tape would be lost, broken, or replayed too many times and the quality would deteriorate. Now things have changed dramatically. With the advent of modern digital recording equipment and online resources like Eyetube, videos can be recorded, stored, and played from almost anywhere in world within minutes. Physicians can pull up the video on a hand-held device or smartphone and review a technique minutes before stepping into an OR to perform the technique. Below I highlight a few different videos that help show the range of resources we have available at our fingertips.

New technology: Glaukos iStent

Recently released in the United States, the iStent Trabecular Micro-Bypass Stent (Glaukos Corporation) is designed for cataract surgeons to implant during cataract surgery to help lower IOP in glaucoma patients. Dr. Ike Ahmed shows his technique for implanting the device. Most cataract surgeons have never viewed the chamber’s angle during cataract surgery. I highly recommend reviewing this video prior to stepping into the OR for your first iStent procedure. It is important to understand the anatomy and landmarks and subtle maneuvers necessary for implanting this device.

Review prior to trying: The IOL Exchange

Dr. Uday Devgan narrates a beautiful case of an IOL exchange of one premium lens for another. Some good pearls to note here are that it is possible to remove one style of premium IOL and exchange it for another. Also, Dr. Devgan demonstrates the pearl of leaving the first lens in the eye until after the second lens is inserted, allowing for safer cutting and removal of the first lens and using the second lens as a barrier to protect the posterior capsule.

Video Classic: Argentinean Flag Syndrome

Nearly every surgeon has heard about this potential complication in cataract surgery involving “white” lenses, but not everyone has seen a case like this. It is worth reviewing this well-made, informative and entertaining video by Drs. Daniel Perrone and Roberto Albertazzi.

Glad it was not me: Posterior Capsule Spider by Lisa Arbisser, MD

Dr. Arbisser has been a great contributor of surgical videos. She recently won the ACES/SEE 2013 Luther Fry video competition. The particualr video is a classic example of why you should record every case. Feel free to delete the good ones, but you will always learn something from the cases that go wrong. It can be painful to review your complicated videos and even more painful to share them; however, we all learn from those that do. Thank you Dr. Arbisser and everyone else who has shared their complicated cases.

If you couldn’t make the meeting: Daily coverage video of Jim Loden, MD Discussing laser LRIs at the ACOS summer meeting 2012 in Deer Valley

You cannot attend every meeting and often a key pearl will be mentioned that you may miss. Eyetube’s Daily Coverage allows you to stay up-to-speed with the latest information without having to traveling too extensively. For example, femtosecond lasers are transforming cataract surgery. There are undoubtedly huge clinical benefits with this technology; however, there are also hurdles and pitfalls to be aware of. Make sure to listen to Dr. Loden’s discussion on why not to create a LASIK flap over an intrastromal LRI!

Shameless Self Promotion: One of my case study videos: Intraoperative Abberrometry

This case was performed using an older platform, but it still is a good demonstration of how technology help treat astigmatism at the time of cataract surgery. Of note: we were fortunate to video the initial case and we also took video of the 1 week postoperative examination, where we repeated the intraoperative aberrometry and showed the tight correlation between the objective intraoperative readings, the 1 week postoperative objective readings, and the subjective, in-the-chair manifest refraction.

Zero Ultrasound Cataract Surgery

This case demonstrates the use of a new irrigation aspiration “phaco-free” tip that may eliminate ultrasound during cataract surgery. A new tip design in combination with femtosecond laser softening opens the door to the elimination of ultrasound and seeks to provide faster postoperative recovery. Initial femtosecond laser cataract surgeries were performed with traditional phaco hand pieces. This video demonstrates an early step toward a whole new paradigm in hand pieces specifically designed for femtosecond laser cataract surgery.

April '13