This document discusses common pitfalls when learning phacoemulsification surgery and how to overcome them. It identifies issues that can occur with pre-operative evaluation, patient positioning, incision creation, capsulorhexis, hydrodissection, nucleus rotation, phacoemulsification, cortex removal, IOL implantation, and stromal hydration. For each step, it provides tips on how to address technical challenges and avoid complications through proper surgical techniques. The goal is to help new surgeons learn from mistakes and improve their skills in phacoemulsification.

1. What are common Pitfalls While
Learning Phacoemulsification
surgery and How to Overcome?
Dr. Suresh K Pandey
MS (Ophthalmology, PGIMER)
Anterior Segment Fellowship (USA)
Dr. Vidushi Sharma
MBBS (AIIMS), MD (Ophthalmology,
AIIMS)
FRCS (UK)
SuVi Eye Institute & Research Centre
C-13, TALWANDI, KOTA, RAJASTHAN, INDIA
Email- suvieye@gmail.com
www.suvieye.com
Phone +91 9351412449

2. -William Arthur Ward
The mediocre teacher tells.
The good teacher explains.
The superior teacher
demonstrates.
 The great teacher inspires.
SuVi Eye Institute & Lasik Laser Center,
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

3. Dedicated To great teachers in Ophthalmology
who inspired us & several ophthalmologists globally
 Prof. Amod Gupta
 Prof . Jagat Ram
 Prof. (Late) David J. Apple
 Dr. Anthony J. Maloof
 Dr. E. John Milverton
 Dr. Amar Agarwal
 Dr. Abhay R. Vasavada
 Dr. S. S. Badrinath
 Dr. G. N. Rao
 Dr. (Late) G. Venkataswami
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

4. SODOTO
See one!, Do One!!, Teach One!
SuVi Eye Institute & Lasik Laser Center,
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

5. COMMON PITFALLS
WHILE LEARNING
PHACOEMULSIFICATION
SURGERY
SuVi Eye Institute & Lasik Laser Center,
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

6. Failure to evaluate case
pre-operatively
 Look carefully for the history (systemic-
e.g. BPH- intake of tamsulosin leading to
IFIS)
 Slit Lamp Examination- Corneal status,
density of cataract, pupillary dilatation,
missing subtle signs of (PXF, Zonular
Dehiscence) etc.
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

7. Failure to Position Patient and
Microscope properly
 Make your patient comfortable (as
surgery make take little extra time
for beginner surgeon)
 Make sure to position patient properly
on the operating table with proper
position of head & chin.
 Proper patient positioning is very
helpful to optimize the red reflex
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

8. Failure to Make Proper Incision
 Side Port Incision- too small (can lead to
difficulty in inserting instruments) or too
large (leaky incision)
 Main Incision- Too Limbal- leading to
Conjunctival Ballooning (create peritomy
in the beginning to avoid 360 ballooning)
 Descement Detachment during making
incision-check for instruments tip- may be
bent/blunt
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

9. Capsulorhexis
 CCC- Too Small or Too Large
 Run Away Rhexis
 Pearls to Do good CCC:
 Use high density OVD (Chondroitin Sulfate based OVD helpful
to coat endothelium and provide good space (Alcon
Viscoat/Discovisc)
 Use Trypan blue Dye to stain anterior capsule
 Aim for 5.5 mm capsulorhexis
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

10. Hydrodissection
 Inadequate hydrodissection
 Capsule Block Syndrome-
 Avoid by pressing on the lip of the
incision to burp out OVD.
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

11. Nucleus Rotation
 Failure to rotate the nucleus
 Causes: incomplete hydrodissecton
 Use two instruments to rotate the
nucleus to minimize zonular stress
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

12. Phaco Chop
 Inability to hold the nucleus
 Use adequate vacuum and burst mode
 Pressing the side-port incision with
second instrument
 Using High Phaco Power
 Use Vaccum and chopper
 Forget to use Chondoin Sulfate based
OVD to coat Endothelium frequently
during nuclear emulsification
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

13. Irrigation and Aspiration
 Difficulty to removal Subincisional Cortex
 Use bimanual irrigation/aspiration
 Posterior Capsule rent
 Keep the tip of aspiration port facing up
 Remove the aspiration port first then the
irrigation port
 Zonular Dehiscence
 Engage the peripheral cortex and bring it to
center
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

14. Foldable IOL Implantation
 Failure to load IOL correctly
 Practice IOL loading in cartridge and
practice in few model eyes
 IOL Upside down
 Flip the IOL in the anterior chamber
 Failure to remove OVD from capsular
bag
 Manage the IOP spike
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

15. Stromal Hydration
 Too much hydration
 Hydrate the both lips and roof of
incision; wait for few seconds and then
check for leaky incision
 Remove the speculum carefully and look
for the anterior chamber/corneal fold
 If Anterior chamber is shallow or there is
fold on cornea (due to hypotony) inject
some BSS again in the anterior chamber
 Put sutures if incision are leaky
SuVi Eye Institute & Lasik Laser Center
KOTA, RAJASTHAN, INDIA
www.phacolasiktraining.com

16. What are common Pitfalls While
Learning Phacoemulsification
surgery and How to Overcome?
Dr. Suresh K Pandey
MS (Ophthalmology, PGIMER)
Anterior Segment Fellowship (USA)
Dr. Vidushi Sharma
MBBS (AIIMS), MD (Ophthalmology,
AIIMS)
FRCS (UK)
SuVi Eye Institute & Research Centre
C-13, TALWANDI, KOTA, RAJASTHAN, INDIA
Email- suvieye@gmail.com
www.suvieye.com
Phone +91 9351412449