OP8.6 | IMG Team Participation in Cataract Surgery — Summary & Reflection

KEY TAKEAWAYS

The IMG's role in the cataract surgical team spans three phases. Pre-operatively: instil mydriatics (tropicamide 1% ± phenylephrine 5–10%, starting 60 minutes before surgery, target pupil >6–7 mm); check BP (<180/110 to proceed) and blood glucose (<250 mg/dL for elective surgery in diabetics); apply povidone-iodine 5% to the conjunctival sac (gold-standard endophthalmitis prophylaxis); verify consent form and IOL power; confirm correct eye. Intraoperatively: maintain sterile technique (scrub or scout role); identify and pass instruments correctly; confirm IOL label before opening; participate in WHO Surgical Safety Checklist — verbal correct eye confirmation. Post-operatively: write standard post-op prescription (antibiotic + steroid drops, tapered over 6 weeks ± NSAID); counsel patient on PCO ('not a recurrence; treated by laser, not repeat surgery'); recognise red flags — endophthalmitis (day 2–7: pain, red eye, hypopyon, severe VA loss → emergency same-day ophthalmology referral), elevated IOP, wound leak. In NPCBVI camp settings: community screening (VA + torch/red reflex), patient selection, post-op counselling in local language, follow-up coordination. Vision 2020 'Right to Sight' provides the global framework; CSR target is 8,000/million in India; cataract = ~65% of India's blindness burden.

REFLECT

You are at a rural camp. Fifty-four patients have had surgery over two days; you are on the post-operative ward on day 2. Patient 47 — a 65-year-old woman — is complaining of pain and reduced vision. You check: her vision is counting fingers, down from 6/18 at discharge. There is a haze in the anterior chamber. Reflect on: What is your differential diagnosis? What is the most dangerous diagnosis you must not miss? What specific steps do you take right now — in the next 10 minutes — in this camp setting without immediate access to an operating theatre or intravitreal antibiotic kits? What do you say to the patient and to the accompanying camp team? Then reflect more broadly: what structures at the camp itself (follow-up protocols, stock of intravitreal antibiotics, telephone referral pathways) could have made this situation easier to manage? This is system-level clinical thinking — the kind that turns a good camp doctor into an effective public health practitioner.