GHEI Senior Guide

GHEI Rotation

Goal: To participate in as much surgery as possible, gain exposure to all the surgical subspecialties, cater your experience to your future goals.

Try to be in rooms where:

The attending does not have a fellow (you get to do more)
It’s a case you’re interested in, even if it’s just to watch
You have primary cases with that surgeon later in the day
Fellow’s academic cases – often they may need help and will let you scrub in
Also bounce around between rooms to show face and interest in other surgeries with attendings that do have fellows.
Garg and Farid often will let you scrub into their cataracts even if there is a fellow there, but for cornea cases the fellow and attending are primary.

Even when there is a fellow you can still be involved/scrub in, but often you might just be watching unscrubbed.

Rough Attending OR Schedule Without Fellows

Monday

Turn on the laser and verify alignment with calibration kit at least 45 min prior to 1st case
H&Ps and mark pts as you see check in
Dr. Wade: you basically act like his fellow
- Set up Wade OR sheet in advance and print him a copy on the day of surgery
- Add laser cases to the Catalys, include LRIs as you think is appropriate and verify with Wade prior to each case
- Load patients to Callisto and ORA as appropriate
- To dos: OP note, DC order
- He does his own charging
- For non-laser cases, he likes to have marked calipers at 5.5mm at the start of the case to mark visual axis for centering rhexis
- He is trialing reducing postop drops for cataract surgery with subconj kenalog:
- If ONH is normal, no steroid response, no glaucoma history/risk, and is >45 years old; he will do subconjunctival kenalog for the end of the case.
- Tell circulator and have tech draw up 0.2cc on a 1cc syringe/30G needle, then you push out to 0.15cc and draw back air to 0.2cc. Injecting air disperses kenalog subconjunctivally better and 0.05cc stays in the hub, so he actually injects 0.1cc kenalog. Edit the op note accordingly if used.
Dr. Alpa Patel: she is pretty self-sufficient, so you don’t help her much unless Wade is out, but she’ll let you do stuff on her private cases sometimes
- She will add her own Catalys, do her own Op notes, DC orders, charging

Tuesday

Turn on the laser and verify alignment with calibration kit at least 45 min prior to 1st case
H&Ps and mark all pts as you see check in
Dr. Behshad:
- He preps his own OR sheet that says which cases are laser, toric, IOLs, but it is helpful for you to look ahead and make your own sheet so you can help load cases in the catalys laser
- Load patients to Callisto and ORA as appropriate
- To dos: DC order
- He does his own catalys laser settings but you can suggest/put some that you think like you do for Wade. He does his own op note, charging
Dr. Suh:
- If you’re working with him, you can help by putting DC instructions for the ointment and DC order
- Make sure ointment gets to the family postop (can tell PACU RN or hand to family yourself)
- He lets you assist and perform strabismus surgery.
- He pulls his own sutures, does his own op note, charging
- To do: DC orders (if you’re helping him, otherwise he’ll do them himself)
Dr. Vivek Patel:
- If you’re working with him, you can help put in Rx ointment for postop and DC order
- He lets you assist and perform strabismus surgery, and can go see postop adjustable sutur visits in PM
- He does his own op note, charging
- To do: Rx, DC orders (if you’re helping him, otherwise he’ll do them himself)

Wednesday

Turn on the laser and verify alignment with calibration kit at least 45min-1hr prior to 1st case
- Farid has a lot of cases, sometimes the cornea fellow comes super early and does this already to put pts in since she has a lot

H&Ps and mark all pts as you see check in
Dr. Farid:
- To do: Op note, scrub in for one room while fellow does another. DC orders
- Fellow typically loads cases into Catatlys, Callisto
- Optoms load pts into ORA in advance
- She does charging

Dr. Grob:

Check that the procedure matches the plan last discussed in clinic note or telephone/MyChart note. Especially if cosmetic components are/are not being done update consent as needed. Make sure cosmetic cases are appropriately listed in the consent as cosmetic (because pt has to pay more).

She pulls her own sutures, does her own op note, charging, DC orders, Rx

To do: DC orders (if you get to them before her)

Thursday

Turn on the laser and verify alignment with calibration kit at least 45min-1hr prior to 1st case (Garg has a lot of cases, sometimes the cornea fellow comes super early and does this already to put pts in since he has a lot)

H&Ps and mark all pts as you see check in
Dr. Gore:
- She lets you assist and perform strabismus surgery.
- To do: DC order
- She does op note, Rx, charging
Dr. Vivek Patel: see above
Dr. Garg
- To do: Op note, scrub in for one room while fellow does another, DC orders
- Fellow typically loads cases into Catatlys, Callisto
- Optoms load pts into ORA in advance
- He does charging

Friday

H&Ps and mark all pts as you see check in

Dr. Tao:
- Usually has his fellow and/or international fellow with him, if he is alone, prioritize helping his room
- To do: Op note (fellow often does this), Rx, DC instructions, DC order
- He does charging
Dr. Ediriwickrema
- To do: Rx, DC instructions, DC order
- She does op note, charging
Resident OR Block Time: 4th Friday AM 7:15a-noonish
- Staffed by a community attending (currently Dr. Keith Rundle)
- Prioritize straight forward cases so that you can focus on learning the instruments that he brings and his techniques (which are different than GHEI/VA). POD0 appts will be at PAV2 that afternoon.

IMC/Main OR Senior Cases

GHEI ORs might close if there are not enough patients to fill full days, your case might be moved to IMC.

Irvine Medical Center – Chao Family Comprehensive Cancer Center

19200 Jamboree Road, Irvine, CA 92612

Parking: Gold parking building level B2 to enter directly onto the lower surgical floor. Parking is free as of 5/2025.

NPs at IMC might put in H&Ps for cases
Due to BMI, health risks, etc, some patients cannot be done at GHEI. Ask schedulers if IMC is an alternative
Social issues/housing that requires inpatient admission overnight after surgery usually needs Main OR. You will need to find an attending or fellow who is wiling to staff these cases.
Try to group these cases together in one day.

CorneaGen

How to order tissue:

Email: tissue@corneagen.com

Subject "Urgent request UC Irvine Orange Medical Center (main hospital)
Note tissue needed (PKP tissue) and patient details
CC the cornea fellow on call

Call phone #: 206-561-9347 and confirm they received the email. You can also text the number

If in the middle of the night or during the day receiving tissue is the same:

Pick up tissue from blood bank on 3rd floor. Blood bank has to receive and enter the tissue into TrackCore otherwise it causes problems.

Cataract Surgery Technologies

Catalys Turn On Video.mp4

Catalys Femtosecond Laser

Turn on system (key to right for <2 seconds not longer
Log in user (UCI) and password (Ghei1234)
Select Enable System on Home Screen
Window will appear starting the initialization process
Follow instructions when prompted to push up then remove the disposable lens carriage

Once initialization is complete and “OK” button is enabled, patient treatments may be entered

Wait 15 minute warm up to finish
Perform Verification Alignment with calibration test model

Serial number: SN44106415 IT Help Line: 1-800-511-0911 OPT #4

Callisto - microscope dipslay

Upload IOLm data from Zeiss Forum
Import IOLm data to local OR room microscope (needs good quality sclera IOLm photo)
Patient data imported to one Callisto does not automatically sync to another Callisto
Prepare: z-align for each toric patient

Optional: can prepare rhexis size guide for your own patients

ORA - intraoperative aberrometer

Can manually enter data at the ORA machine
- Patient data entered on one ORA will automatically sync another ORA
Can remotely enter data using AnalyzOR site: https://home.wavetecvision.com/ORWeb/aspx/common/login.aspx
- Remote access accounts can be granted by contacting Gordon, Terri (terri.gordon@Alcon.com)
- Cornea attendings use the IOLm ant Ks
- For assistance, please contact Alcon Technical Support at 800-832-7827.

PAV2 Senior Cataract Clinic:

Pre-Op Appointments

You have flexibility to add extra preop/postop clinic at PAV2 as needed. Discuss with Marlen and coordinate with your surgery schedulers so that you are moving postops and preops accordingly. Just make sure you don't schedule surgeries or post-ops at GHEI while you're at PAV2! This is helpful if you go on vacation and want to maintain surgical volume by still seeing pre-ops. Remember to discuss with Marlen and clinic staff when you plan vacation so you dont have a full clinic booked when you are out!
Prechart and put desired testing in pre-visit planning
When signing up patients, remember:
- Place OR orders and consent the patient for each eye separately if performing on separate days
- Staff each preop the day you see them with an attending and go over lens choice in the moment.
- Have the patient talk with the surgery scheduler before leaving and tell the scheduler:
  - Duration of surgery
  - Attending: if no preference (Can book for first available) or if prefer to schedule with certain attendings
  - If needs preop repeat measurements, preop IVA 1-2 weeks prior, etc
  - Special considerations for booking (ie. Dialysis MWF)
  - Signed IOL Order sheet: Best to turn into the surgery scheduler the day you preopped them or as soon as you can. Must submit 1 week prior to scheduled case.
  - Write “resident case, no charge” for the IOL order sheet:
    - First 10 cases of femtosecond laser (Catalys) - need to be done with Wade, Garg, or Farid to count toward credentialling
    - Use of Callisto/ORA
    - Premium IOL (toric, EDOF, mfIOL) - first 20 are free of each category for Alcon, unsure for J&J
  - If surgery schedulers are gone, leave a note for them at their desk and message them to confirm they received it and give the pt a surgery folder.
- Cataracts – can be done with any cornea or glaucoma faculty. Schedulers will prioritize scheduling with cornea faculty unless otherwise asked. For uveitic cataracts, specify to do them with Dr. Kedhar or Dr. Lee.
- MIGS – can be done with any glaucoma faculty
- PTG – can be done with any cornea faculty

Post-Op Appointments

The first post-op appointment can be at GHEI or PAV2.
- Cases Monday-Wednesday = POD1 at GHEI
- Cases Thursday-Friday = POD1 at PAV2 PM
- If you add a PAV2 clinic half day, you will need to adjust these on a case by case basis with your scheduling team.
Post-op appointments after the first one can only be at PAV2
Staff post-ops with the attending you did the case with or any attending/fellow if unavailable
Get MRx to determine refractively if on target

Vacations while at GHEI/PAV2:

When one attending is out on vacation, you don’t get a free day off, you need to be with other attendings in other rooms.
When GHEI is closed and ophtho cases move to IMC, you go to IMC.
Notify surgery schedulers, attendings, and fellows in advance of your vacation and remind them via email closer to the actual dates. Constantly review your clinic and OR schedule to ensure no patients are booked while you are out. Schedule post-ops a bit further out POD1, then POW2, with closer follow up prn. Prepare Wade OR sheet while you’re out for the fellow.

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