Baxter's Blog

Ideally the visiting eye team / surgeon should be seeing and operating on poor patients rather than middle class patients. If you are operating on middle class patients than you might be weakening any eye care infrastructure already available in that community. Depending on where you are working, Read more:

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: