Top 10 Common Mistakes in Phaco Surgery and How to Avoid Them | Phaco Training

Phacoemulsification, or phaco surgery, has revolutionized cataract removal. Yet, even seasoned surgeons can stumble. Let's explore the top 10 mistakes in phaco surgery and how to avoid them, ensuring better outcomes for your patients.

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  1. Inadequate Hydrodissection

Proper hydrodissection is crucial for smooth nucleus rotation and extraction. Insufficient fluid injection can lead to incomplete cortical cleaving, making the procedure more challenging.

Solution: Ensure a visible fluid wave during hydrodissection. Use multiple injections if necessary, and gently rotate the nucleus to confirm adequate separation.

  1. Incorrect Incision Construction

Poor incision architecture can result in wound leakage and increased risk of endophthalmitis.

Solution: Create a three-plane incision with appropriate width and length. Aim for a self-sealing wound that maintains anterior chamber stability throughout the procedure.

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  1. Premature Entry into the Lens Capsule

Entering the capsule too early can lead to capsular tears and complications.

Solution: Complete hydrodissection and rotation before attempting to enter the lens capsule. Ensure proper visualization and maintain a stable anterior chamber.

  1. Inefficient Nucleus Chopping

Ineffective chopping techniques can prolong surgery time and increase the risk of complications.

Solution: Master various chopping techniques (horizontal, vertical, or hybrid) and choose the most appropriate method based on lens density and your skill level.

  1. Excessive Phaco Power

Using too much ultrasound energy can damage corneal endothelial cells and prolong recovery time.

Solution: Employ burst or pulse modes to reduce overall phaco energy. Utilize techniques like phaco-chop to minimize ultrasound usage.

  1. Poor Chamber Maintenance

Inadequate anterior chamber stability can lead to posterior capsule rupture and other complications.

Solution: Maintain proper bottle height and ensure balanced irrigation and aspiration. Use viscoelastic devices judiciously to protect corneal endothelium and maintain space.

  1. Insufficient Cortical Clean-up

Residual cortical material can lead to postoperative inflammation and posterior capsule opacification.

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Solution: Perform thorough cortical aspiration using tangential stripping techniques. Pay special attention to subincisional cortex.

  1. Inaccurate IOL Power Calculation

Incorrect lens power selection can result in suboptimal visual outcomes and patient dissatisfaction.

Solution: Use multiple formulas for IOL power calculation, especially in challenging cases. Consider intraoperative aberrometry when available.

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  1. Improper IOL Insertion and Positioning

Misaligned or malpositioned IOLs can cause visual disturbances and may require reoperation.

Solution: Ensure proper orientation of the IOL before insertion. Confirm complete unfolding and centration of the lens within the capsular bag.

  1. Overlooking Wound Closure

Inadequate wound closure can lead to postoperative hypotony, infection, and induced astigmatism.

Solution: Carefully inspect all incisions at the end of surgery. Use hydration techniques or sutures if necessary to ensure watertight closure.

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By being aware of these common pitfalls and implementing the suggested solutions, you can enhance your surgical technique and improve patient outcomes. Remember, continuous learning and practice are key to mastering phacoemulsification. Embrace new technologies and techniques, but always prioritize patient safety and surgical precision.

Mahendra Eye Institute | Eye Hospital in Kanpur

Location: Kanpur, Uttar Pradesh, India

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