Here, we see significant conjunctival chemosis during a resident cataract surgery. Although the main incision is appropriately made, it has likely nicked part of the conjunctiva. The conjunctiva becomes progressively more edematous throughout the surgery. In this case, the resident initially ignores the chemosis, then attempts and fails to reduce the chemosis by making a large incision with Westcott scissors.
1. As soon as you start noticing conjunctival chemosis, STOP. Make several small radial incisions (4-6) with a sideport or supersharp blade to allow for fluid to drain.
2. If you wait too long, trying to make one large incision and milking fluid out of the subconjunctival space will likely not work, as tenons and other tissues become hydrated.
3. Keep sufficient distance between the chopper and the phaco probe to allow for good chops. When the two are too close together, there is not enough leverage to chop well.
4. As always, rhexis size is critical. Too small, and it will make the rest of the surgery significantly harder. Shoot for at least a 5 to 5.5mm rhexis.