Technique to exclude temporal lash incursion in phacoemulsification surgery Olivia J.K. Fox, BMSc(Hons), Benjamin W.C. Sim, MB BS, Sai Win, MB BS, Ravjit Singh, BSc, Shahriar Amjadi, BSc, MB BS, Ashish Agar, FRANZCO, PhD, Allan Bank, FRANZCO, FRACS, Ian C. Francis, FASOPRS, PhD We describe the use of a Steri-Strip to exclude lashes in cataract surgery cases in which the lashes impinge on the operative field. The technique has been used in 25 cases and achieved uniformly successful lash exclusion. In 6 cases, the strip became partially dislodged and required reposition- ing intraoperatively, after which it achieved complete lash exclusion. No complications have been observed. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2012; 38:1885–1887 Q 2012 ASCRS and ESCRS Online Video The exclusion of lashes from the operative field in modern cataract surgery using either temporal or superior clear corneal incisions may help to prevent acute postoperative bacterial endophthalmitis. 1 Although we recognise that wound suturing is one of the most important factors in preventing acute post- operative bacterial endophthalmitis, 1–5 we believe lash exclusion must also be considered. Temporal lash exclusion assists in maintaining a sterile surgical environment as it precludes incursion of temporal lashes and the temporal eyelid from the operative field. This is particularly important in patients with deep-set eyes, relative enophthalmos, or short palpebral fissures. Lash exclusion prevents the phaco tip and/or the second instrument from con- tacting the lashes or the lid. The cumulative cataract surgical experience in our group is 73 years. Recently, we developed a technique of residual lash exclusion following draping for phaco- emulsification surgery. Although we have always attempted to exclude eyelash incursion with rigorous draping at the commencement of cataract surgery, the drape occasionally leaves a small section of the lateral canthus, particularly the upper lid, exposed, allowing lashes to enter the operative field. Traditionally, temporal lashes have been excluded by placing an extra Steri-Strip (R1547, 3M Health Care) with the ribbing perpendicular to the lid margin. Because of the elasticity and inertia of the ribbing, the strip often dislodges. We describe a method of lash exclusion by placing the strip with the ribbing parallel to the lid margin. SURGICAL TECHNIQUE It was serendipitously observed that a 1.0 cm length of Steri-Strip with the ribbing placed parallel to the lid margin (Figure 1) ensured definitive lash exclusion for the duration of the surgical procedure. This tech- nique was first used in 2011, when the scrub nurse was asked for a short strip to achieve lash exclusion. The scrub nurse conveniently trimmed the protruding 1.0 cm of the strip from its backing paper (Figure 2) and then applied the segment with the ribbing parallel to the lid margin. At the end of the case, the segment remained in perfect position (Figure 3). Submitted: June 16, 2012. Final revision submitted: July 16, 2012. Accepted: July 23, 2012. From the Department of Ophthalmology (Sim, Win, Singh, Amjadi, Agar, Bank, Francis), Prince of Wales Hospital, the University of New South Wales (Sim, Win, Singh, Amjadi, Agar, Bank, Francis), the University of Notre Dame (Fox), and the Ophthalmic Surgery Centre (Fox, Sim, Win, Singh, Amjadi, Bank, Francis), Sydney, Australia. Presented at the COSSOM Scientific Meeting, Prince of Wales Hospital, Sydney, Australia, December, 2011. Corresponding author: Ian C. Francis, FASOPRS, PhD, Suite 12, 12-14 Malvern Avenue, Chatswood, 2067, New South Wales, Australia. E-mail: iancfrancis@gmail.com. Q 2012 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/$ - see front matter 1885 http://dx.doi.org/10.1016/j.jcrs.2012.09.005 TECHNIQUE