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Recording, reviewing cataract surgeries crucial to improving safety
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ROME — Improving safety and avoiding complications are fundamental goals of cataract surgery. At the 2019 OSN Italy meeting, one surgeon said that there is no better way to do this than systematically videotaping, logging and evaluating all surgeries.
“There are a lot of mistakes that take place during cataract surgery, and you cannot identify all of the steps that led you to that specific problem unless you have a systematic way of going back, organizing the complications that do occur and reviewing them,” Steven H. Dewey, MD, said.
One rule Dewey has adopted after becoming aware of the source of recurrent problems is to restrain patients physically by taping their heads to reduce side-to-side movements and medically by administering sodium benzoate to suppress coughing and sneezing, and adding ketamine to the propofol sedation for better analgesia and amnesia.
He consistently observed that the superior approach was associated with log entries such as “difficult approach,” “challenging” and “movement.”
“We could see on the videos that though restrained, patients still moved axially, they still coughed, and the forehead became a fulcrum. So, I avoid operating superiorly; I operate temporally. If the patients move, you move side to side with them as opposed to them moving into the needle suddenly,” Dewey said.
Shielding the non-operated eye avoids confusion in case of misapplied dilating drops. Applying intracameral dilation to everyone helps to be on the safe side in case of intraoperative floppy iris syndrome.
“There is no way to perfectly screen every at-risk individual. Observing my video cases, I learned that you cannot tell how small the pupil is going to be at the end of the case. If everyone receives the potential benefits from the basic steps used to improve outcomes in IFIS cases, the screening for the IFIS risk becomes inconsequential,” Dewey said.
He also recommended using the safest instruments and sizing the incision properly.
“Manufacturers have recommended incision sizes for their phaco needles and associated sleeves, but it is typically the side-port incision that gives us problems. If the side port is larger than the shaft of the instrument, there is a lot of leakage and chamber bounce. You cannot see this during surgery — you see it on video,” Dewey said. – by Michela Cimberle
Reference:
Dewey SH. 10 steps for improving operating room efficiency and outcomes. Presented at: OSN Italy meeting; May 24-25, 2019; Rome.
Disclosure: Healio.com/OSN could not confirm relevant financial disclosures at the time of publication.