Wanted to give a taste of my average surgical day here right now. These pictures are my surgeries from Friday morning. I'm doing about 10 surgeries every morning. Hoping to increase that number soon. If I only did straightforward white cataracts i could probably do 15 in a half day right now. But, right now I'm getting lots of experience with complex African cataracts. There are guys in India who do this surgery in 3 minutes!!! Maybe after I've been doing this for 10 years I can do that to, but I doubt it. I don't have it in me to operate that fast, I'm too cautious.
1. I try to start the day with a straight forward mature cataract. This one was over in about 10 minutes.
2. These mature whites are my favorite to take out these days. Lots of them here, and the patients are always happy the next day.
3. Another mature white cataract. I'm concerned about the capsule in all of these cases, but with a can opener rhexis I have yet to see the argentinian flag sign. Did see that when I tried a CCC on one of these
4. As the population here in Angola gets more "well nourished" due to increasing ease of food supply after the long war, the prevelance of diabetes and PSC cataracts grows as well. I get a good number of these now. I'm staying in practice for CCC with these. I have trypan blue which helps with the poor optics of my microscope.
5. Now my day really begins. This young woman has a retinal detachment in this eye, and will not see well after surgery. However, she was desparate for some cure this "white eye" . She is 27 and suffers the social stigma of an abnormal eye. I don't have cosmetic contact lenses or corneal tatooing (sorry Dr Pineda). So we decided to take out the cataract. I was concerned about losing vitreous here and having retinal spill out of my wound, so I made a 6.5mm tunnel, but only entered with my keratome. From there I performed a canopener (would like to use CCC for all of these, but unfotunately my visco elastic is not very good. These compressed bags filled with liquid cortex shoot out to the periphery when punctured) I aspirated the cortex with simcoe cannula, polished the bag with the same and inserted a lens in the sulcus. No vitreous!
6. Old trauma here in a young patient. No real nucleus, only fibrotic capsule. These are tough. Sometimes there is a hole in the posterior capsule before surgery begins. I found a space where the anterior and posterior capsules weren't fused together, cut it with cystotome and injected visco. From there I cut the fibrotic anterior capsule with scissors, washed the capsule only to find a perfectly round hole in the capsule. No vitreous came forward so I placed the lens in the sulcus, did a happy dance and got out of the eye. I had to leave some adherent material on the posterior capsule, but "the enemy of good is better" so I happily took my prize and called it good. I have tried to clean the bag completely in other cases only to have to remove a large amount of vitreous after I broke the bag.
7. Same story, second verse. Young patient, 24, had trauma as a child now has this cataract. When I arrived here I refused to do these surgeries. But now, I know a little more how important image is to the Angolan people. Having this stigma of an unusual appearing eye is not good. This patient was happy the following day becase the eye looked normal, his vision was only counting fingers. The doctor was happy too because I didn't break capsule.
8. 13 year old boy with traumatic cataract causing cornea edema and inflammation, Cornea was punctured with some type of needle, it also punctured anterior capsule spilling lens contents into the anterior chamber, but managed to stop short of the posterior capsule. This injury happend several weeks ago, I'm not sure if he will see again, but surgery went well. I made a tunnel, entered only with keratome. Used simcoe to remove cortex. Enlarged wound, placed a lens with optic in bag, haptics in sulcus. The capsule had split like the Argentinian flag from trauma, so I was unable to place completely in bag.
9. This is a not uncommon case. This lens spontaneously dislocated into the AC. This was actually pretty easy, I gave pilocarpine before surgery. Made a tunnel, removed lens with lens loop. Looked for vitreous, but there was none to the wound. Placed ACIOL, made iridotomy. placed a suture and called it good.
10. Now that I look at this pre-op photo, not sure if this was a wise move to take off the pterygium here. 70 year old man, he had 5 diopters of cyl which corresponded to ptyergium. We will see how it turns out. I do all of these with conjunctival autografts, I use 10-0 nylon 4 sutures (1 at each corner) and they have been looking really good at 1 months time.
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