COVER STORY Thankfully, there are ophthalmic ‘props’ that can help prevent and mitigate complications when they arise. According to Dr. Misra, there have been various advances that have helped reduce complications in retina practice. Innovations like 25- and 27-gauge vitrectomy systems, newer designs in forceps and cutters, as well as intraoperative OCT (iOCT), have allowed surgeons to lower the rate of iatrogenic breaks, while improving the ability to identify and peel membranes. “All surgical advances in ophthalmology are targeted towards making it less invasive and reducing the overall complication rate,” said Dr. Misra.
Keep learning: tips for beginners When complications occur, surgeons often rely on previous experience to overcome any challenges. However, newer surgeons might not have that backlog of prior cases to draw from. “Even a beginner can perform all the steps of the surgery easily – but what sets apart an experienced surgeon [from a beginner], is his ability to gauge impending complications and swiftly take measures to mitigate the problem,” said Dr. Misra. He added that beginners should keep in mind that complications are part of the learning process – and they can occur in the hands of the most experienced surgeons, too. “One should accept their complications and use them as steppingstones to greater surgical conquests in the future. Though unfortunate, a complication will teach more than many uneventful surgeries,” continued Dr. Misra. “The single most important factor in managing complications is to keep calm once a complication occurs, pause for a moment, rethink your strategy and go ahead.” In addition, he suggests that younger surgeons should always be in ‘learning mode’. “As they say, ‘life is too short to learn from your own mistakes’,” said Dr. Misra. To optimize the learning of surgical procedures, he suggests using the REPEAT strategy: Read, Observe and Assist, Perform, Audit and Teach.
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The single most important factor in managing complications is to keep calm once a complication occurs, pause for a moment, rethink your strategy and go ahead. – Dr. Diva Kant Misra
Final curtain call Following a stand-up comedy routine, success is measured in laughter and applause – and while vitreo-retinal surgeons often deserve a standing ovation following complicated procedures, visual outcomes are simply not measured by clapping. Like comedians interacting with an audience, surgeons can find themselves in situations where quickthinking is required to deliver the punch line (or successfully complete the
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surgery). And sometimes improvisation during complications, like in the cases described by Drs. Chang and Misra, is vital to patient satisfaction and outcomes. Of course, improvisation in comedy is unplanned . . . but in surgery, every element must be carefully considered. Therefore, through preparation, planning and continued learning, there can be less improv in the OT and more efficient management of complications.
*Nagpal MP, Mahuvakar SA, Chaudhary PP, et al. Chandelier-assisted retroillumination for phacoemulsification in phacovitrectomy. Indian J Ophthalmol. 2018;66:1094-1097.
About the Contributing Doctors Associate Professor Andrew Chang (PhD FRANZCO), is an ophthalmologist and retinal specialist. He is head of ophthalmology and head of the Retinal Unit at the Sydney Eye Hospital, clinical associate professor at the University of Sydney and medical director of Sydney Retina Clinic. In international ophthalmology, he serves as the secretary general of the Asia-Pacific Vitreoretinal Society (APVRS) and council member of the Asia Pacific Academy of Ophthalmology (APAO). Other professional roles include clinician advisor to the Department of Health Australia, board director of Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Sydney Eye Hospital Foundation. He is the recipient of the Achievement Award and Distinguished Service Award of the APAO and the RANZCO Teaching Award. [Email: achang@sydneyretina.com.au] Dr. Diva Kant Misra (MBBS, DO, DNB, MNAMS, FVRS) is a vitreoretina, ocular oncology & ROP consultant at Eye Q Super Apecilaity Eye Hospital in Lucknow, India. He completed his retina training from reputed institutes like Sri Sankaradeva Nethralaya, Guwahati and Byers Eye Institute, Stanford, California, USA. He holds the post of general secretary, Young Ophthalmologists Society of India & Chief Editor, Young Ophthalmologists Times. He is the recipient of various International ophthalmic awards like the Achievement Award by Asia Pacific Academy of Ophthalmology (APAO) 2019, Ophthalmic Hero of India 2019 & 2018, The Yasuo Tano Award from APAO 2017 and the APVRS Award 2018, and IJO Best of Best Award 201718. He has published extensively and has been invited faculty at various international conferences like American Academy of Ophthalmology (AAO), APAO and EURETINA, and has presented in conferences held at various international locales (WOC Mexico, APAO Singapore, APAO Hong Kong, APVRS Malaysia, EURETINA Vienna) and national forums. [Email: divakant@gmail.com]