Posters

Fixating on fixation: a survey of trainee preferences for fixation of the eye during creation of main incision during phacoemulsification surgery

Poster Details

First Author: E.Lim UK

Co Author(s): M. Stahl   M. Kanda   C. Gunasekera              

Abstract Details

Purpose:

It is often said that disagreement is a signal for undiscovered value. In cataract surgery, one such area of disagreement across surgeons is on the best method for fixating the eye whilst creating the main incision. As trainees, we are often given conflicting advice about the “best way” to perform this step. We set out to explore the reasons underlying the variability in this step, through a structured survey of surgeon preferences and the underlying rationale for these preferences.

Setting:

Ophthalmic surgeons from North London, South London, Thames Valley, East of England and Severn deaneries across 17 hospitals in the UK were surveyed. Responses were received from specialist trainees ranging from first year trainees to fellows and one consultant. A total of 39 responses were received.

Methods:

A national survey was distributed amongst ophthalmology residents across the UK. Participants were asked to describe their preferred method for fixation of the eye, their rationale for doing this, if they switched from a previous method and why. Information on associated factors such as type of anaesthesia, location and structure of incisions were also collected.

Results:

The commonest method was fixation with forceps (78%) with 56% of those being Colibri forceps. 50% of forceps users cited ‘good stabilisation’ as the reason. 72% of this group had never tried other methods.  The second most common method was using a cut surgical spear (12.5%) with ‘No subconjunctival haemorrhage’ cited by 75% of respondents as the reason. 100% of this group had switched from other methods. Methods receiving single responses included using a side-port cannula, a gloved finger and a Thornton fixation ring. Interestingly, the specific rationales for the chosen methods considerably overlapped between the various methods.

Conclusions:

The study reveals that whilst most surgeons prefer a form of forceps-based fixation for creating their main incision, the rationales for this varied and overlapped with those using other methods. There was also a surprising lack of experimentation with other methods even in more senior surgeons, highlighting that perhaps surgeons should be encouraged to try a variety of options before developing a set preference. However, there are limitations to assessing the best technique for fixation of the eye through a survey format, the best technique is the one that the surgeon feels safe and appropriate for the particular case.

Financial Disclosure:

None