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Uday Devgan
United States
Приєднався 28 вер 2011
Uday Devgan MD, author of CataractCoach.com, teaches the best techniques of cataract surgery!
CataractCoach™ 2293: case 350 with a dense cataract
A dense cataract is more challenging because of the difficulty in breaking it into smaller pieces (nucleo-fractis) and the increased ultrasonic energy that is required to emulsify it. Our guest surgeon is at the beginning of a long career and attempts this tough cataract surgery for case number 350. As you can see in the title picture, the chop technique worked well and this case proceeds beautifully. There are still some things that could use improvement and we welcome comments from all viewers in this regards. Please comment below.
Переглядів: 1 626
Відео
CataractCoach™ 2292: small pupil phaco without a ring
Переглядів 4,3 тис.9 годин тому
This patient has a small pupil and cataract surgery will be more challenging in this case. We can use a step-wise approach to enlarge the pupil: start with pharmacologic agents like phenylephrine or epinephrine, then perhaps consider pupil stretching along with Osher's visco-mydriasis, and if needed move to iris hooks or pupil expansion rings. In this video our guest surgeon (anonymous since th...
CataractCoach™ 2291: Quiz: Will there be lens milk? p2
Переглядів 2,8 тис.11 годин тому
Time for the second part of our CataractQuiz™: For today's video and for yesterday's, the question is, "Will there be lens milk?" meaning will there be egress of liquefied lens cortex from this white cataract? Is it intumescent (fluid-filled) or not? What is the risk of Argentinian flag sign? Can you determine this before surgery via a detailed slit-lamp microscope examination?
CataractCoach™ 2290: CataractQuiz: Will there be lens milk? p1
Переглядів 4 тис.14 годин тому
Time for a two part CataractQuiz™: For today's video and for tomorrow's, the question is, "Will there be lens milk?" meaning will there be egress of liquefied lens cortex from this white cataract? Is it intumescent (fluid-filled) or not? What is the risk of Argentinian flag sign? Can you determine this before surgery via a detailed slit-lamp microscope examination?
CataractCoach™ 2289: scleral suture fixation of a toric IOL
Переглядів 2,3 тис.16 годин тому
This patient had trauma which resulted in a ruptured globe as you can see from the large corneal laceration which was previously repaired. The patient had a pars plana vitrectomy and lensectomy as well and is now aphakic. The corneal laceration has induced a large degree of corneal astigmatism which would be nicely offset with a toric IOL, however there is no capsular bag. How do you implant a ...
CataractCoach™ 2288: Podcast 72: Abha Amin MD
Переглядів 57719 годин тому
Dr Abha Amin is an expert cataract, corneal, and glaucoma surgeon who does a great job with very complex anterior segment cases and ocular trauma. She gave a recent presentation where she shared pearls for these difficult cases and I was taking notes. In this podcast she explains her background and pathway including the double-fellowship training and then shares her secrets for success in conqu...
72: CataractCoach Podcast 72: Abha Amin MD
Переглядів 32819 годин тому
Dr Abha Amin (www.wmchealth.org/physicians/627c117e-b3be-4a36-b062-e9a8f67839fc) is an expert cataract, corneal, and glaucoma surgeon who does a great job with very complex anterior segment cases and ocular trauma. She gave a recent presentation where she shared pearls for these difficult cases and I was taking notes. In this podcast she explains her background and pathway including the double-...
CataractCoach™ 2287: case 71 for a senior resident
Переглядів 3,4 тис.21 годину тому
Now you may be thinking, "Wait a minute, didn't CataractCoach just feature a resident case 71 video last week?" And you would be right. That case can be reviewed here cataractcoach.com/2024/08/03/2280-pgy4-residents-71st-case-critique/ and today we have a different resident who also happened to submit a case which was labelled as the 71st cataract case of residency. While it is tempting to comp...
CataractCoach™ 2286: resident ultra chopper case
Переглядів 4 тис.23 години тому
The ultra-chopper is attached to your phaco tip in place of the phaco needle and it can then harness the ultrasonic power to effectively cut into even a dense nucleus to divide it. Once the nucleus is split into quadrants, the regular phaco needle can be placed on the handpiece and quadrant removal can be accomplished. In this case, the cataract is not very dense but the resident surgeon uses t...
CataractCoach™ 2285: traumatic cataract with iridodialysis
Переглядів 3,2 тис.День тому
Traumatic cataracts are challenging because we are not often aware of the full extent of the damage to the delicate ocular structures. In this case, we can see a white cataract with subcapsular fibrosis as well as iridodialysis. Our guest surgeon does a great job with this tough case and demonstrates why it is important to know the MSICS technique. Great case would you have done the same approa...
CataractCoach™ 2284: Cataract Quiz: What is this dark crescent?
Переглядів 4,7 тис.День тому
The CataractQuiz™ series here on CataractCoach™ is among the most popular category of videos that we publish. If you just love these quizzes then you can see all of them on the CataractCoach.com website under the Quiz heading. cataractcoach.com/category/quiz/ In this case, you are just starting the capsulorhexis when you notice a dark crescent at the pupil margin. What is that? Why did that hap...
CataractCoach™ 2283: white cataract sutureless MSICS
Переглядів 4,3 тис.День тому
Here at CataractCoach we have long extolled the virtues of MSICS: manual, shelved incision cataract surgery, where we make a larger scleral incision and remove the nucleus whole in an extra-capsular manner. This is the modern (and far better) version of the old ECCE surgery: extra-capsular cataract extraction that was taught decades ago. The main advantage here is the incision which is so nicel...
CataractCoach™ 2282: phakic IOL tips tricks
Переглядів 3,2 тис.День тому
Yesterday we featured a great podcast with Dr Roger Zaldivar who has a very extensive experience using phakic IOLs, particularly the Evo Visian ICL which he implants more than 1000 times per year. In his refractive surgery practice, he is doing more phakic IOLs than keratorefractive surgeries such as LASIK. In this video he shows us his best tips and tricks for phakic IOL insertion and also exp...
CataractCoach™ 2281: Podcast 71: Roger Zaldivar MD
Переглядів 675День тому
Dr Roger Zaldivar is a refractive and cataract surgeon at the Instituto Zaldivar in Mendoza, Argentina, a multi-generation ophthalmology practice. Recently he has produced an AI method of sizing phakic IOLs like the Visian ICL using image data from ultrasound biomicroscopy (UBM). And his practice now often prefers implanting a phakic IOL instead of corneal laser vision correction and he implant...
71: CataractCoach Podcast 71: Roger Zaldivar MD
Переглядів 313День тому
Dr Roger Zaldivar is a refractive and cataract surgeon at the Instituto Zaldivar (www.institutozaldivar.com/) in Mendoza, Argentina, a multi-generation ophthalmology practice. Recently he has produced an AI method of sizing phakic IOLs like the Visian ICL using image data from ultrasound biomicroscopy (UBM). And his practice now often prefers implanting a phakic IOL instead of corneal laser vis...
CataractCoach™ 2280: PGY4 resident's 71st cataract case critique
Переглядів 4 тис.День тому
CataractCoach™ 2280: PGY4 resident's 71st cataract case critique
CataractCoach™ 2279: achieving surgical efficiency in cataract surgery
Переглядів 4,5 тис.14 днів тому
CataractCoach™ 2279: achieving surgical efficiency in cataract surgery
CataractCoach™ 2278: iris scaffold and IOL scaffold to create a barrier
Переглядів 3,2 тис.14 днів тому
CataractCoach™ 2278: iris scaffold and IOL scaffold to create a barrier
CataractCoach™ 2277: CataractQuiz: Why is the rhexis edge moving?
Переглядів 2,9 тис.14 днів тому
CataractCoach™ 2277: CataractQuiz: Why is the rhexis edge moving?
CataractCoach™ 2276: Yamane SFIOL pearls from a retina surgeon
Переглядів 3 тис.14 днів тому
CataractCoach™ 2276: Yamane SFIOL pearls from a retina surgeon
CataractCoach™ 2275: IOL exchange with an open posterior capsule
Переглядів 4,4 тис.14 днів тому
CataractCoach™ 2275: IOL exchange with an open posterior capsule
CataractCoach™ 2274: podcast 70: Shannon Wong MD
Переглядів 1,3 тис.14 днів тому
CataractCoach™ 2274: podcast 70: Shannon Wong MD
70: CataractCoach Podcast 70: Shannon Wong MD
Переглядів 37114 днів тому
70: CataractCoach Podcast 70: Shannon Wong MD
CataractCoach™ 2273: resident's 40th cataract case
Переглядів 5 тис.14 днів тому
CataractCoach™ 2273: resident's 40th cataract case
CataractCoach™ 2272: damaged caused by a pupil expansion ring
Переглядів 4,3 тис.21 день тому
CataractCoach™ 2272: damaged caused by a pupil expansion ring
CataractCoach™ 2271: what to do when the nucleus drops
Переглядів 7 тис.21 день тому
CataractCoach™ 2271: what to do when the nucleus drops
CataractCoach™ 2270: angle closure glaucoma with corneal edema
Переглядів 4,9 тис.21 день тому
CataractCoach™ 2270: angle closure glaucoma with corneal edema
CataractCoach™ 2269: intra-lenticular foreign body cataract surgery
Переглядів 3,5 тис.21 день тому
CataractCoach™ 2269: intra-lenticular foreign body cataract surgery
CataractCoach™ 2268: trabeculectomy assisted with Prolene suture
Переглядів 3,4 тис.21 день тому
CataractCoach™ 2268: trabeculectomy assisted with Prolene suture
CataractCoach™ 2267: Podcast 69: Francesco Carones MD
Переглядів 44221 день тому
CataractCoach™ 2267: Podcast 69: Francesco Carones MD
my mentor never used anything like a ring or a retractor..... so I learned it like him with now more than 6k op´s without a singel time have to use a ring. I think I forgot how to use them anyway 😃
Stop&Chop or an initial debulk would hv been better. Replenish OVD after 2 quadrants. I.O.L insertion was appalling.
What a great podcast
350 cases in a residency is amazing; I ask the patient to look towards me as I am inserting the cartridge
That is one slick resident
❤
Yea no thanks 😮
I would postpone the elective case until the necessary equipment was available… i.e. a pupil expansion device. Life is too short for me to be that hard on myself.
Good experienced surgeon indeed..
That nucleus fragment at 3:32, if not removed in the cut segment of the video, will show up in AC in the next days.
I would say better to be safe than sorry. High risk of anterior capsule margin tear. The method of blind iol insertion under bubbles was absolutely not recommended. As someone else in the comments said, wouldn’t want your surgery to go down this way.
👀
Many blind movements
Ummm….not helpful as a teaching tool. But Fun to watch though.
The question is would you want to have your own cataract removed like that? I would not lol
Absolutely
Dr Devgan, beautiful case, tks, wouldn't it be helpful to have a UBM image before the surgery to better understand what happened after the trauma?
sure -- that would be helpful
Very experienced and skillful Surgeon
Unnecessary adventure
When i m doing surgery at Silopi State Hospital
Jun Oda from Brasil?
Congrats. I’ve done some cases as well. However, the risk of tearing the anterior capsulorhexis is high. Nowadays, I prefer to use an iris hook.
This surgeon shows so much skill. That’s for sure. But if something goes wrong you might blame yourself of not using any helping tools that are all available to you to ensure maximum patient safety
Excellent Sir.
too much tear film debris, higher risk of endophthalmitis. Not good to forgo the drape.
Thank the Lord fir blesding and gealung your eyes.❤
I had a case today where it def did NOT look like a lens milk cataract and lo and behold nearly had an Agentinian flag sign.
Send me a video so we can learn together
enjoying these quizzes!
In addition to not draping (which we will overlook), the lids are not retracted far enough for the wounds, and the instruments keep touching the lids which stimulates the patient. Unless this is general anesthesia or a block, there is a guarantee that the patient will move. Part of topical is not touching the lids, and especially the lashes.
I prefer not to retract the lids too far with the speculum because it can cause posterior pressure, eyelid pain, and postop ptosis. The amount of exposure in this video seems perfect to me.
Great restraint regarding the drapes Dr Devgan 😂👌🏾
Perfect and smooth way of talking about the drapes.
We don't talk about drapes ~~
Use visco before last piece, make sideport smaller, groove depth would be deeper
Great stuff
Netão é monstroooooo
Hi sir ..how often do you change the tip and sleeve of phaco probe to new tip and sleeve and tubing...and how do you know it has to be changed...can you please sir make a video on that??
Good question!
Another way to predict it would be to look at the biometry. An intumescest lens will tipically be thicker and have a more marked anterior curvature!
No sir. There won’t be liquified cortical matter.
🥛. 👏
Thanks So Much! This is exactly the perspective I needed to hear. You are the best, Doc!
Prof. These hard cases I need them 20 minutes at least ❤❤❤
What a wonderful podcast
I love iris claw 🙏
We need a bigger range of toric iris claws, preferably custom made to each patient like Carlevale torics.
How does this single-piece acrylic IOL in the sulcus not cause UGHS?
Because there is no sulcus anymore. It's a unicameral eye at this point. The point of a SFIOL is that there is in adequate capsular support, hence the suture supported IOL. And the lens is some ways from the iris to prevent chafing (which can happen)
@@gingerbreadman1217 That was my question. Does chafing from these haptics cause less chance of UGHS then, say, other single piece acrylics?
It does if it’s not placed posteriorly enough and then there’s probably more risk of tilting. The haptics could be amputated to reduce the risk, since the are not needed for anything. Luxated and scleral fixated in-the-bag one piece IOL’s are less prone to causing UGH than these without capsular bag. A toric lens designed for scleral fixation (or even a toric 3-piece IOL) would be ideal, but none are available in the US afaik, so people have to come up with different ways of going around the problem.
@@Antroid1 Thanks for the enlightenment!
Could you please do us a favor and put an intro to the video or something? You know, so those of us who are just casually scrolling by don't have to see a scene from Saw play out as we go by.
Uday is a National Treasure!! Thanks Uday!!
If there was no Uday, somebody would have to invent the guy. Thank you for teaching us all the tricks dear prof!
thank you!
I do a better technique I will Post video
How about +40D?
Much to learn by listening to his narration and watching the video. thank you!