Eyeworld

I OCTOBER 2020 | EYEWORLD | 59 With continued floppiness impacting the surgery, Dr. Mahendra inserted a Malyugin ring, finding phaco thereafter much easier. However, despite the Malyugin ring, iris prolapsed again through the sideport and the main incision. where he was unaware of prior tamsulosin use. This slight bulge of iris tissue was put back in easily, but as the case progressed, the iris con- stricted, and at one point, iris moved into the phaco tip. "As I tried to take my nuclear pieces, time and again the iris comes into the phaco tip," he said. continued on page 60 Recovering mentally from complications Uday Devgan, MD, Clinical Professor of Ophthalmology at UCLA, Los Angeles, California, shared a resident's case video. To start, the resident surgeon was operating with an open posterior capsule and was, at times, losing pieces of the nucleus into the vitreous. The patient was going to need a pars plana vitrectomy and lensectomy. The first thing to do is "accept that you've had a complication and avoid de- nial. … Two, recover now and minimize the iatrogenic trauma." Step three is to advocate for your patient. "There was a complication, whether it was an iatrogenic issue or the patient had bad tissue, and now you have to be your patient's advocate to help them recover. You need to be able to ask for help. … There is no harm in asking for help, in fact, it is the right thing to do. Your patients will appreciate it." Dr. Devgan said it's important to take a breath, compose yourself, acknowledge the complication, decide how to best handle it, and be prepared to move on to the next case. "It's important that you give 100% of your energy, your focus to the next patient. Most of us do many surgeries in a single day. If you have 10 surgeries lined up for the day and you have a complication on patient number three, understand that it's going to take you longer to fix that complication, so now the rest of the patients are going to be delayed. That's OK; give the time that the patient needs and for you to recover that complication. Also, you need to have your mind back in the game, your mind refocused so the patients in your surgical lineup are going to have your best efforts. You can't dwell on what's already happened." Despite the extra surgeries that were needed in the case that Dr. Devgan used to highlight his point about mentally handling complications, he said the patient ended up doing great. Dr. Devgan's steps for overcoming complications are: 1. Accept that there was a complication. Avoid denial. 2. Recover from the complication. Minimize iatrogenic trauma. 3. Be an advocate for your patient. Explain what happened postoperatively and ask for help when you need it. 4. Refocus, compartmentalize so you can give 100% of your effort to your next patient. Watch Dr. Devgan's video at bit.ly/326asfw. Relevant disclosures Devgan: CataractCoach.com Contact Devgan: Devgan@gmail.com At a glance • Iris prolapse or iris trauma in the phaco tip is often associated with IFIS, too small or too wide of an incision, too much OVD, and/or too much pressure. • Physicians said to be careful of the last piece of nuclear material, after which the iris, due to the change of fluidics in the eye, might come toward the phaco tip. • It is important to be prepared to suture the iris in case of trauma; practice with a simulation eye. About the doctors Manish Mahendra, MD Director Khairabad Eye Hospital and Mahendra Eye Institute Kanpur, India Thomas Oetting, MD Rodolfo N. Perez Jr., MD, and Margaret Perez Professor in Ophthalmology Education University of Iowa Iowa City, Iowa Relevant disclosures Oetting: None Mahendra: None Contact Oetting: thomas-oetting@uiowa.edu Mahendra: drmanishmahendra@gmail.com

• Blank Page
• Blank Page (1)