EyeWorld India September 2018 Issue

EWAP FEATURE 13 September 2018 Views from Asia-Paci c Soosan JACOB, MS, DNB, FRCS Director and Chief, Dr. Agarwal’s Refractive and Cornea Foundation Senior Consultant, Cataract and Glaucoma Services Dr. Agarwal’s Group of Eye Hospitals & Eye Research Centre No.19, Cathedral Road, Chennai 600086 Tel. no. +91-44-33008800 Fax no. +91-44-28115871 dr_soosanj@hotmail.com T he challenging cases described in this article would strike a chord with many surgeons as something similar that they have experienced. Similar to Dr. Braga-Mele’s case, I remember a colleague’s case of a white cataract where the patient had retained his mobile phone in a hidden inner pocket despite standing instructions to all patients to leave behind personal items (including mobile phones, wallets, etc.) with their attenders. Well, as luck would have it, the patient’s phone rang just while the laser capsulotomy was being created leading to a sudden suction loss and an incomplete capsulotomy secondary to the patient’s sudden movements in an attempt to stop the phone from ringing. Of course, the capsulotomy was completed manually and thus also the case uneventfully— however, this does go to show how much importance some extraneous in uences and completely unexpected events can have on the surgery despite best intentions of the surgeon. “ Care also needs to be taken to keep the team completely involved in all steps of surgery. ” - Soosan Jacob, MS, DNB, FRCS Care also needs to be taken to keep the team completely involved in all steps of surgery. Mistakes such as in the case described by Dr. Miller can happen and assisting staff should therefore be clearly educated about drugs that are used and differences between them. It is important to label any drugs, especially clear ones such as mitomicin-C that are loaded and kept on the operating trolley in order to avoid mistakes such as misidentifying it to be BSS or viscoelastic and accidentally injecting it into the eye. The staff should also be educated on other key aspects of surgery such as machine functioning, priming, etc., in order to decrease the pressure on the surgeon and to have a harmonious and peaceful atmosphere in the operating room. It is advisable not to have a rapid turnover of staff and to preferably operate with the same few set of scrub nurses assisting rather than constantly having new ones which adds to the pressure of surgery. A few responsible individuals should also be identi ed and integrated into the team as circulating nurses/techs who can help additionally by providing the correct equipment, instruments, devices, and drugs, and also keep a tab on other important matters to avoid commonly occurring mistakes such as aspiration without irrigation secondary to an empty irrigating bottle or wrong settings on the machine. Editors’ note: Dr. Jacob declared no relevant nancial interests.