For the entire last year, the only true surgeries that I’ve performed as primary surgeon were pterygia–those bat-winged conjunctival growths on the medial bulbar conjunctiva. I would typically rip the entire bat-wing off with some Westcott scissors and scrape down the cornea with a #57 blade. Most of the time, I used a battery-powered diamond burr to smooth out the cornea–that’s how the wimps do it. Afterward, I transpose a part of the superior bulbar conjunctiva over to cover the exposed wound. It typically took me 30 minutes (on a good day) to finish the case.

In these cases, I never entered the eye (intentionally).

Last week, I performed an anterior capsulotomy on a 10-month old girl. This involved loading up the Accurus vitrectomy surgical system to chew up the phimosis that developed after cataract surgery. This was a relatively simple procedure, involving an anterior chamber maintainer and another 23G port for instrumentation. However, it was my first attempt at intraocular surgery. The feeling is different. When you’re working inside the eye, there is a sense of uncertainty, even when you have direct visualization of your work. The eye is like a ball–you’re working on the inside without opening it up.  It was an even stranger feeling to run the vitrectomy system without ever having performed cataract surgery.

Running the vitrector (without having broken a posterior capsule) was a blast. The little pieces of capsule eddied toward the probe head at different rates, depending on how much I depressed the foot pedal. Before I knew it, I had chewed up the phimosis, and the case was completed.

I feel that I have been initiated.

medicine ophthalmology