Baxter's Blog

In cases of subluxated lens, zonular dehiscence, vitreous in A.C. pre op, or the need for secondary lens exchange with a posterior capsule rent, I would strongly recommend pre op IV mannitol.
A capsular ring may be indicated but would also advise IV mannitol 2 - 2 - 2 : 20%, 200ml rapidly Read more:

If you are operating for a limited time overseas, it may be helpful to leave written instruments [ check list ] on seeing the one week post op cataract patient. Here are some of my suggestions but I am sure you can write out [ leave behind ] your own suggestions for the eye nurse or other Read more:

Your supply of fluorescein strips can be extended [ prolonged ] by cutting each strip in half lengthwise. See attachment. Each " half " strip is enough to check the IOP in both eyes.This will obviously add to your supply of fluorescein strips. Read more:

Fluorescein drops can be made in the eye clinic by adding 0.4 ml of a 10% fluorescein solution [ such as what is used for IV fluorescein angiography ] to a 15 ml eye drop bottle of proparacaine or tetracaine. This will be the same concentration in the commercially prepared drops for checking IOP Read more:

My deceased good friend, John Cheatham MD, used to get upset how many times poor patients in the developing world were required to come back, over and over, prior to having a local cataract operation. In the States, no one requires lab work, EKG, chest X - ray, consultation on routine, healthy Read more:

I recently received a copy of Dr. William Dean's DVD " Sutureless ECCE " which is excellent. His DVD shows clearly the manual small incision cataract extraction technique. One nice thing, there is a written part [ text ] that is on the screen while the instructor is also speaking. Therefore an Read more:

Seeing patients with markedly updrawn pupils, for whatever reason, is not rare in the developing world. When living previously in east Africa, I used to operate on these patients, using a lot of viscoelastic and a long blade van ness scissors to do a pupilloplasty and reshape the pupil. I still Read more:

I am currently in Belize and last week was almost out of all goniodrops with no possible in country replacement for any hydroxypropyl methycellose. I was actually diluting the methycellose 2.5% drops with Optive artificial tears to make it last longer. I use a lot of methycellose as we have Read more:

Here are a great list of very useful websites for reference of for teaching ophthalmology. Some of them have excellent resources for the developing world.
#1. www.webeye.ophth.uiowa.edu/eye-health Large Superb Int. Eye Health Reference #2. www. pqmd.org Partnership for Quality Read more:

In the developing world, depending on the location, most ophthalmic surgeons are still doing standard extracapsular lens extraction with sutures and pc IOL insertion. This is a fine operation that works well and many good surgeons are quite comfortable with this procedure with few complications. Read more:

Use one needle and two syringes. I prefer a 27gauge 1 1/4 inch needle which is usually readily available and much cheaper than the retrobulbar needles.

The first syringe should contain 4 ml Xylocaine [ lidocaine ] 2% with or without epinephrine and 2 ml [ 8 mg ] of dexamethasone. Be sure this Read more:

If you are in the O.R. and having difficulty cutting a fibrotic, rubbery, tenacious anterior capsule, pupillary membrane, or cocoon [ capsule ] wrapped around an implant, then help may be closer than you think.

A straight 30 G 1/2 inch needle will often cut a fibrotic capsule / membrane when no Read more: