How many times have you or someone you know dropped a nucleus in residency (i.e retained fragments needing PPV)? Would appreciate honest answers...

I had 2-3 cases where I dropped some cortex which was observed afterwards and did not necessitate PPV. I had 1 dropped nucleus when I operated on a 92 yo guy with 4++++ NS; he did not have any evidence of zonular laxity pre-op, but intra-op most of his zonules magically turned into dust. I watched that bad boy sink like an anchor. I was a chief at an outside hopsital at that time and I was doing all cases there; next day I got to use fragmetome and removed the nucleus from the back. That's what I call continuity of care :)

How many times have you or someone you know dropped a nucleus in residency (i.e retained fragments needing PPV)? Would appreciate honest answers...

I've had one dropped nucleus currently at about 180 primary cases. It doesn't happen too often to the other guys either.

Full nucleus drop is probably uncommon. Have heard of 1-2/year out of 500-600 cases/year. Posterior capsular rupture with retained fragments a little more common. Posterior capsular rupture with retained cortex even more common. Happens to the best of us.

I had one of those- I've done about 160+ phacos. I've also torn 2 capsules (including a spectacular posterior polar during hydrodelineation- no lens loss). This 4+, PXF beast went deep-six on me while I was probably executing an overly aggressive crackin' move- headed for davy jones locker before all the lens was removed. Happened at the VA and, like posted before me, did the PPV a couple days later. He's sportin 20/20 BCVA w/ his ACIOL, so as much as it will always produce a code brown and should be avoided- it is not the end of the world. Oddest thing is this pt is my biggest fan because of all of the face time I put in with him. It definitely humbled me, and I learned a ton about when and when not to use aggressive stop-and-chop. Probably why I only had one.

I would say its hard to compare numbers as not all cataracts are created equal- if your doing trauma, PXF, uveitis, posterior polar cats all day at your program you can expect some extra OR time- its well know that our county hospital is where the Ant Vit is always on stand-by as this place produces some real nightmare caddys.

Another one of our residents said she thought "tearing the PC was part of the procedure" her first couple of cases- but she is great now.

I had one of those- I've done about 160+ phacos. I've also torn 2 capsules (including a spectacular posterior polar during hydrodelineation- no lens loss). This 4+, PXF beast went deep-six on me while I was probably executing an overly aggressive crackin' move- headed for davy jones locker before all the lens was removed. Happened at the VA and, like posted before me, did the PPV a couple days later. He's sportin 20/20 BCVA w/ his ACIOL, so as much as it will always produce a code brown and should be avoided- it is not the end of the world. Oddest thing is this pt is my biggest fan because of all of the face time I put in with him. It definitely humbled me, and I learned a ton about when and when not to use aggressive stop-and-chop. Probably why I only had one.

I would say its hard to compare numbers as not all cataracts are created equal- if your doing trauma, PXF, uveitis, posterior polar cats all day at your program you can expect some extra OR time- its well know that our county hospital is where the Ant Vit is always on stand-by as this place produces some real nightmare caddys.

Another one of our residents said she thought "tearing the PC was part of the procedure" her first couple of cases- but she is great now.