Here, we see significant conjunctival chemosis during a resident cataract surgery. Although the main incision is appropriately made, it likely nicked part of the conjunctiva. The conjunctiva gradually 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. Trying to make one large incision and milking fluid out of the subconjunctival space will likely not work as fluid is trapped in the tenons and other tissues.
3. Keep sufficient distance between the chopper and the phaco probe to allow for good chops. Having the two in too close of proximity does not give you enough leverage to make chops.
4. As always, rhexis size is critical. Too small, and it will make the res of the surgery significantly harder. Shoot for at least a 5 to 5.5mm rhexis.