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The Art of Phacoemulsification
Keiki R Mehta, John J Alpar
1:
Commencing Phacoemulsification: The Basics
INTRODUCTION
THE OPERATING ROOM: REQUIREMENTS AND NECESSITIES
Lighting
Air-conditioning and Ventilation
Noise Level in the Theatre
Electrical Power and Outlets
Power Generators
Scrubbing Facilities
Personnel in the Theatre
Theatre Autoclave
The Operating Table
The Surgical Chair
Operating Microscope
Preoperative Microscope Positioning
Footwear Use in the Theatre
The Patient in the Operating Theatre
Positioning the Patient in the Theatre
Preparation of the Eye
Draping the Eye
Use of Lid Stitches
Suction Facilities
2:
The Phacoemulsifier
INTRODUCTION
The Machine: Basic Features
Irrigation Handpiece
Irrigation-Aspiration (I-A) Handpiece
Metal Sleeves
Silicone Sleeves
The Diathermy Handpiece
Anterior Vitrectomy Handpiece
Ultrasonic Handpiece
Bimanual
Magnetostrictive Handpiece
Advantages and Disadvantages of Magnetostrictive Handpiece
Piezoelectric Handpiece
Advantages and Disadvantages of Piezoelectric Handpiece
Phaco Tip
Analyzing the Tips
Tuning the Phaco Tip
Phaco Power Settings
Phacoemulsification Terminology
How does phacoemulsificatlon work?
Irrigation System
Aspiration System
Aspiration Pumps
Peristaltic Pump
Advantages of a Peristaltic Pump
Disadvantages of a Petlstaltlc Pump
Venturi Pump
Advantages of a Venturi Pump
Disadvantages of a Venturi Pump
Diaphragm Pump
Advantages of Diaphragm Pump
DIsadvantages of a DIaphragm Pump
Physics of Phaco: Certain Aspects
Rise Time and Pump Flow
RelationshIp of Illse TIme and Pump Flow
Vacuum Settings
RelationshIp Between Pump Flow, Irrigation and Aspiration
Fluidic Balance
Irrigation Bottle Height
Height of the Tubes Running from the Handpiece to the Machine
Enhancing Fluidics in a Phaco emulsification Machine
Foot Pedal
What Mode is the Machine Functioning?
Tactile Feedback
AudHoty Feedbacks
Essentials of a Good Phacoemulsifier
3:
New Phacomachines Offer More Control
INTRODUCTION
THE MACHINE IN PRINCIPLE
SURGEON'S REQUIREMENTS DURING THE PROCEDURE
Efficient Removal of Fluid and Particles from the Eye
Efficient Removal of Lens, Reducing the Amount of Phaco Energy Used
Stable Intraocular Environment
Reduced Flow of Fluid through the Eye
PRINCIPLES OF LENS REMOVAL AND MAKING BEST USE OF MACHINE PARAMETERS
Control of Power
Control of Flow
Control of Vacuum
Sophisticated Foot Pedals
Sophisticated Microprocessors
4:
Cavitating Microbubbles Create Shock Waves that Emulsify Cataract
INTRODUCTION
History
Basics of Phaco Transducers
Cavitation (Transient)
Activity Around Phaco Needles
5:
Local Anesthesia
INTRODUCTION
Mechanism of Action
Local Anesthetic Agents
TECHNIQUES OF LOCAL ANESTHETIC INJECTIONS
Retrobulbar Injection
Peribulbar Injection
Procedure of Posterior Peribulbar Block (DUANE)*
Complications
Alternative Methods (Table 5.3)
6:
Ocular Anesthesia for Small-Incision Cataract Surgery
INTRODUCTION
Methods
7:
The limbal Incision
INTRODUCTION
Posterior Limbal Incision
Incision Design
Incision Shape
Langerman Hinge and Gills Modification
Site
Scleral Incisions
Limbal Incision
Superolateral Incisions
LIMBUS vs CLEAR CORNEA
8:
No Anesthesia Cataract Surgery
INTRODUCTION
Phacoemulsification
Agarwal Karate Chop Technique
Incision
Rhexis
Hydrodissection
Karate Chop—Two Halves
Karate Chop—Further Chopping
Pulse Phaco
Cortical Washing and Foldable IOL Implantation
Stromal Hydration
Pad, S/C Injections
Agarwal Chopper
Soft Cataracts
Topical Anesthesia Cataract Surgery
No Anesthesia Cataract Surgery
CONCLUSION
9:
Clear Corneal Cataract Surgery
INTRODUCTION
CONTROVERSIES REGARDING CLEAR CORNEAL INCISIONS
CLASSIFICATION OF CORNEAL TUNNEL INCISIONS (after Fine et al)
Location
Architecture
Size and Planar Configuration
STRENGTH OF CLEAR CORNEAL INCISIONS VERSUS LIMBAL OR SCLERAL INCISIONS
TECHNIQUES
New Blade Technologies
CLEAR CORNEAL INCISIONS AND ASTIGMATISM
TOPOGRAPHIC CONTROL OF CORNEAL ASTIGMATISM
CONCLUSION
10:
Capsulorrhexis (CCC): A Beginner's Guide
INTRODUCTION
Terminology
Anatomy of Lens Capsule
Technique
Prerequisites
Instruments
Initiation of Tear
Technique
Two-staged CCC
Two-staged CCC is Particularly Useful
Posterior CCC (PCCC)
Intumescent Cataracts and CCC
Advantages of CCC
ECCE and CCC
Complications of CCC
CAPSULAR CONTRACTION SYNDROME
Role of IOL Material
Prevention
Role of Nd:YAG Laser
CAPSULAR BAG HYPERDISTENTION
HYPERPROLIFERATION OF LENS EPITHELIAL CELLS
11:
Capsulorrhexis: Principles and Advanced Techniques
ANTERIOR CAPSULORRHEXIS
History
Physics of Capsulorrhexis
Capsulorrhexis with Shearing
Capsulorrhexis with Ripping
Initiation of Capsulorrhexis
Methods
Principles
Advantages of CC Capsulorrhexis
Intraoperative Advantages
Postoperative Advantages
Difficulties during Rhexis
Rhexis Escape
Capsulorrhexis in Special Cases
POSTERIOR CAPSULORRHEXIS
Special Techniques
Trypan Blue Staining
Diathermy Capsulotomy
CONCLUSION
12:
Hydrodissection and Hydrodelineation
HYDRODISSECTION
Hydrodissection Technique
Viscohydrodissection
HYDRODELINEATION OR HYDRODELAMINATION
Decompression of the Capsule Bag
Hydrofracture
CONCLUSION
13:
Phacoemulsification: The Quadrantic Cracking, Chopping and Stuffing Technique
INTRODUCTION
Four-Quadrant Cracking (Shepherd's Modification of Gimbel's Divide and Conquer Technique)
Stop and Chop (Koch's Modification of Nagahara's Phaco Chop Technique)
QUADRANTIC CRACKING, CHOPPING AND STUFFING TECHNIQUE
Preliminary Steps
Central Debulking and Pregrooving
Cracking
Segment Removal
Epinucleus Removal
CONCLUSION
14:
Current Phacoemulsification Techniques
INTRODUCTION
PATIENT PREPARATION AND ANESTHESIA
Preparation
Topical Anesthesia
Peribulbar Anesthesia
Medication Mixture
Technique
PHACOMACHINES IN USE
Tips and Sleeves
INCISIONS
Side Port Incisions
Temporal Incision
ANTERIOR CHAMBER MAINTENANCE
Capsulorrhexis
Capsulorrhexis Size
Reasons for Problems with Capsulorrhexis
HYDRODISSECTION
LENS REMOVAL
General Points
Technique for Soft Nuclei
Emulsification
Technique for Medium Hard Nuclei
Emulsification
Tips for Judging the Depth in the Nucleus when Sculpting
Technique for Hard Nuclei
Emulsification in Special Situations
Small Pupil
Enlargement of the Pupil
Combined Glaucoma and Cataract Surgery
White Cataracts
When Removing the Nucleus
EPINUCLEUS REMOVAL
IRRIGATION/ASPIRATION
CAPSULAR CLEANING
Capsule Polishing
Vacuuming the Capsule
Posterior Capsulorrhexis
INTRAOCULAR LENS IMPLANTATION
General Consideration
Viscoelastic
Wound Sizing
Lens Implant
Implantation
VISCOELASTIC REMOVAL
INCISION CLOSURE
Closing the Self-Sealing Wound
Suturing the Wound
FINAL CONSIDERATIONS
15:
Phaco Slice and Separate*
INTRODUCTION
Method
Hydrodissection
GETTING READY TO SLICE
The First Slice
The Second and Subsequent Slices
Completing the Procedure
SUMMARY
16:
Cataract Extraction and Lens Implantation: The Implosion Technique
INTRODUCTION
The Surgical Approach
The Incision
Reconstitution of AC with Viscoelastic Solution
Capsulorrhexis
Hydrodissection
Phacoemulsification of Lens Contents
Divide and Conquer
The Implosion Method
The Chop
Aspiration of Residual Cortex
Lens Implantation
CONCLUSION
17:
Phacoemulsification in Special Situations
INTRODUCTION
SMALL PUPIL
UVEITIS
SUBLUXATED LENS
POSTVITRECTOMY
INTUMESCENT CATARACT
PSEUDOEXFOLIATION
18:
Zen in the Art of Phaco*
CONCLUSION
19:
My Personal Technique of Vertical “Hubbing” Phacoemulsification
PREOPERATIVE PREPARATION
ANESTHESIA TECHNIQUE
PREFERRED PHACOEMULSIFIER
DRAPING AND PREOPERATIVE PREPARATION OF THE EYE
MONITORING PATIENTS IN THE THEATER
OPERATIVE PROCEDURE
THE INCISIONS
CORNEAL ENTRY
THE CAPSULORRHEXIS
HYDRODISSECTION AND HYDRODELAMINATION
PHACOEMULSIFICATION TECHNIQUE (Figs 19.8 to 31)
Technique of Vertical “Hubbing” Phacoemulsification
Indications
20:
Innovative Nucleotomy Techniques
INTRODUCTION
MODIFIED PHACOEMULSIFICATION IN SITU
PETALLOID PHACOEMULSIFICATION
Technique
SINUS FRACTURE AND INTRANUCLEAR NUCLEOTOMY
Technique
SLIT NUCLEOTOMY
21:
Phacoemulsification in White Cataracts
INTRODUCTION
REASONS FOR CATARACTS TURNING WHITE
MORPHOLOGICAL CLASSIFICATION
Type A (Fig. 21.1)
Type B (Fig. 21.2)
Type C (Fig. 21.3)
Type D
MANAGEMENT OF WHITE CATARACTS
Preoperative Considerations
Ophthalmic History
Examination
Further Tests
Surgical Considerations
Capsulotomy
General Tips to Help Improve Visibility during Capsulorrhexis
Specific Tips
Radiofrequency Endodiathermy for Capsulotomy
Hydrodissection
Tips for Nuclear Removal
Type A Cataracts
Type B Cataracts
Type C Cataracts
Tips for Cortical Aspiration
Tips for Lens Implantation
Postoperatively
22:
Phacoemulsification in Difficult Cases
INTRODUCTION
General Considerations
Difficult Cases
SMALL PUPILS
Pupil Enlarging Surgery
Pupilloplasty Surgery
Iris Retractors
Pupil Stretching Devices
Pupil Stretching Techniques
Anterior Capsulotomy
Hydrodissection
Phacoemulsification
Cortical Clean-up
Discussion
MATURE HARD NUCLEUS
Technique
MATURE WHITE CATARACT
Capsulorrhexis
Other Techniques of Visualization of the Anterior Capsule
Hydrodissection
Phacoemulsification
PSEUDOEXFOLIATION SYNDROME (PES)
Capsulorrhexis
Phacoemulsification
Intraocular Lens Type
TRAUMATIC CATARACT
Technique
Capsulorrhexis
Phacoemulsification
Miscellaneous Cases
High Myopia
POSTVITRECTOMY PATIENTS
SUMMARY
23:
Irrigation and Aspiration Following Phacoemulsification
INTRODUCTION
BASIC PARAMETERS FOR COMMENCING IRRIGATION/ASPIRATION
THE IDEAL CIRCUMSTANCES FOR IRRIGATION/ASPIRATION
THE BASIC SURGICAL PRINCIPLES OF CONDUCTING PROPER IRRIGATION/ASPIRATION
RECOGNITION OF POSTERIOR CAPSULE CAPTURE
ASPIRATION VARIABILITY FOR SUBINCISIONAL CORTEX REMOVAL
Techniques for Subincisional Cortex Removal
The Ice-cream Scoop Maneuver
The Bimanual Technique
The IOL Sweep Technique
IOL Compression Aspiration Technique
MANAGING THE VITREOUS IN THE ANTERIOR CHAMBER
CONCLUSION
24:
Foldable Intraocular Implants
EXPLANTATION OF IOLs
FUTURE OF FOLDABLE IMPLANTS
25:
History of Lens Implantation
INTRODUCTION
SUBSEQUENT MODIFICATIONS
RECENT ADVANCES
26:
Implantation Techniques of Acrylic Foldable Intraocular Lens and its Clinical Results
INTRODUCTION
IMPLANTATION
INTRAOPERATIVE COMPLICATIONS
EXPLANTATION
CLINICAL DATA
CONCLUSION
27:
The Mini-loop Plate and Accommodating Lenses
28:
Suprahard Cataracts: Their Evaluation and Management
INTRODUCTION
BASIC SURGICAL PREPARATIONS
Prepare the Third Port
Be Sure of a Good Capsulorrhexis
Do a Very Cautious Hydrodissection
Rotation of the Nucleus
The Use of Iced Methylcellulose and Cold (+4°) C Infusion Solutions
ANESTHESIA FOR BRUNESCENT AND OPALESCENT CATARACTS
Incision Placement
SURGICAL TECHNIQUES: BRUNESCENT AND OPALESCENT CATARACTS
Surgical Technique: Brunescent/Black Cataract
The Deshelling Technique
The Pizza Flop Technique
Saddle-Hump Phacoemulsification
Phaco Settings and Surge Protection in Brunescent Cataracts
Surgical Technique: Opalescent Cataracts
Tangential Chopping Technique
Vertical ‘Hubbing’ Phacoemulsification
The Use of Foldable Lenses and Injectors
CONCLUSION
29:
Stretch Pupilloplasty for Small Pupil Management in Cataract Surgery
INTRODUCTION
Technical Tips and Caveats
30:
Management of Glaucoma in Cataract Patients
MANAGEMENT OF CATARACTS, AND GLAUCOMA (WITHOUT PRIOR FILTRATION PROCEDURE)
Filtration Surgery Alone, Followed by Possible Cataract Extraction Later
In a Glaucoma Patient with Minimal Lens Opacities
In patients with Uncontrolled Glaucoma
Cataract Extraction Alone
Combined Cataract Extraction and Glaucoma Surgery
ECCE + IOL + Trabeculectomy
PHACO-Trabeculectomy
Management of Cataracts with a Pre-existing Glaucoma Filter
31:
Phacoemulsification in the Previously Filtered Eye
INTRODUCTION
Surgical Approaches
Preoperative Considerations
Special Considerations during Cataract Surgery
Postoperative Considerations
Combined Bleb Revision Techniques
Internal Bleb Revision
External Bleb Revision
Hypotony Maculopathy
SUGGESTIONS
32:
Phacoemulsification in Patients with Significant Astigmatism
INTRODUCTION
Considerations
Incision Decisions
Correcting the Spherical Component
Correcting the Astigmatism Component
The Surgical Plan
Excimer Laser Correction of Astigmatism
SURGICAL TECHNIQUE
CONCLUSION
33:
Cataracts in Patients with Uveitis
INTRODUCTION
Clinical Presentation
Surgical Indications
Visually Significant Cataract
Glare
Improvement of Posterior Pole Visualization
Preoperative Management
Surgical Technique
INTRAOCULAR LENSES
COMBINED SURGERIES
Glaucoma
Cataract-Vitrectomy
Postoperative Inflammation
FOLLOW-UP
ADDENDUM
Multicentrical International Intraocular Inflammation Society (IOIS) Study Protocol
Timing of the Procedure (IOIS recommendations)
34:
Corneal Endothelium and its Protection in Phacoemulsification
THE IMPORTANCE OF THE ENDOTHELIUM
EVALUATION OF THE ENDOTHELIUM: THE ENDOTHELIAL MICROSCOPE
Contact Endothelial Microscope
Non-contact Endothelial Microscope
VARIATIONS IN ENDOTHELIAL CELL COUNT
Healing of Lost Endothelial Cell Areas
Minimal Cell Density
Late Corneal Decompensation
STEPS TO PREVENT CELL LOSS
Prevent IOL Contact
Care with Irrigating Solutions
Use Preservative Free Intracameral Solutions
Use Iced (4° C) Irrigating Solutions
WHY ENDOTHELIAL CELL LOSS WITH PHACO
The Surgeon has to Take Special Care
During Tunnel Construction
Introduction of the Phaco Tip in the Chamber
With the Insertion of the Capsulorrhexis Forceps
Doing Peripheral Rhexis in Tight Eyes
Time of Insertion of the IOL
ENDOTHELIAL CELL PROTECTION TECHNIQUES IN PHACOEMULSIFICATION
Decrease Fluid Input Coupled with Zero Suction
Viscoelastic Protection
Use of Freezing Solutions
Pulse Phaco Usage
Proper Tip Placement
THE ADVENT OF THE CONCEPT OF PHYSICAL ENDOTHELIAL CELL PROTECTION
Hema Intracameral Endothelial Contact Lens
The Design of the Hema Hood
The Material of the Hema Hood
Preparation of the Hood for Usage
Insertion of the Hood
Phacoemulsification Procedure with the Hood
Removal of the Hood Following Surgery
Postsurgical Evaluation
Endothelial Cell Analysis
Hema Intracameral Contact Lens Endothelial Cell Loss: Average Cell Loss in Phaco with the Hema Hood
CONCLUSION
35:
Phacoemulsification in the Presence of Pseudoexfoliation: Challenges and Options
INTRODUCTION
Technique
Glaucoma
Small Pupils
Capsulorrhexis
Hydrodissection and Hydrodelineation
Phacoemulsification
Capsular Ring
CONCLUSION
36:
Phacoemulsification in Severe Chronic Obstructive Pulmonary Disease
INTRODUCTION
Cough
Oxygen Therapy
Positioning for Surgery
Phacoemulsification
CONCLUSION
37:
The Prevention of Complications and their Management in Phacoemulsification
INTRODUCTION
PREVENTIVE ASPECTS PRIOR COMMENCING PHACOEMULSIFICATION
Positioning of the Patient
Checking the Intraocular Pressure
Oxygen or Fresh Air under the Drapes
Placement of the Lid Retractor
Aspiration of Excess Fluid
COMPLICATIONS AT VARIOUS PHASES OF PHACOEMULSIFICATION SURGERY
Clear Corneal Incision
The Problem with Side Port Incision
Complications during Capsulorrhexis
Prevention of Complications with Hydrodissection
Impending Rupture of the Posterior Capsule
Problems and their Management during Phacoemulsification of the Nucleus
Problems with Nucleofractis and in situ (Four quadrant) Phaco Fracture Technique
Complications with the Phaco-Chop Techniques
Problems in Conversion to ECCE
Intraoperative Primary Posterior Capsulotomy
Method of Polishing the Capsule
Causes for Rupture of the Posterior Capsule
Signs of a Posterior Capsular Rupture
Managing the Broken Posterior Capsule
Rupture of the Posterior Capsule without Hyaloid Face Rupture
Rupture of the Posterior Capsule, with Hyaloid Face Rupture, but without Luxation of Nuclear Material into the Vitreous
Rupture of the Posterior Capsule, with Hyaloid Face Rupture, with Luxation of Nuclear Material into the Vitreous
38:
Management of Posterior Chamber IOL Capture
INTRODUCTION
PUPILLARY CAPTURE WITHOUT POSTERIOR SYNECHIAE
PUPILLARY CAPTURE WITH POSTERIOR SYNECHIAE
Treatment of the IOLs Captures with Posterior Synechiae
Surgical Technique for Correction of the IOLs Captures
Complications in the Surgery of the Captures
39:
IOL Scleral Fixation in Aphakic Eyes
INTRODUCTION
INDICATION FOR SCLERAL FIXATION
INTRAOCULAR LENSES ADAPTED FOR SCLERAL FIXATION
SUTURES USED IN SCLERAL FIXATION
USING VIDEOENDOSCOPY
SURGICAL TECHNIQUE
Introduction
Strategy
Preparing the Sclera
Flieringa ring in the Scleral Fixation
Preparation of the Needle with the Suture
Passing the Needle through the Sclera
The Incision in the Scleral Fixation
How to Place the Suture to the IOL
IOL Placement in Scleral Fixation
Suture Fixation in the Sclera
Removal of the Viscoelastic Substance
Closure of the Eye
Limbal Incision Suture
Vitrectomy in Scleral Fixation
Complications in Scleral Fixation
40:
Phakonit and Laser Phakonit
INTRODUCTION
Principle
Phakonit to Correct Refractive Errors
Terminology
Technique of Phakonit
Anesthesia
Incision
Rhexis
Hydrodissection
Phakonit
CORTICAL WASHING, FOLDABLE IOL IMPLANTATION AND STROMAL HYDRATION
DISCUSSION
LASER PHAKONIT
SUMMARY
41:
Pharmacology of Intraocular Solutions and Drugs Used in Phacoemulsification
INTRODUCTION
ANTISEPTIC SOLUTIONS
IRRIGATING SOLUTIONS
Laboratory Studies
Contamination of Irrigating Solution
Reuse
VISCOELASTIC SUBSTANCES
ANTIBIOTICS
ANTIINFLAMMATORY AGENTS
ALTERNATE ADDITIVES
MYDRIATICS AND MIOTICS
42:
Triple Procedure with Phacoemulsification before Trephination
INTRODUCTION
Our Personal Technique of Triple Procedure
Surgical Technique
Postoperative Therapy
43:
Multiport Phaco Tip: A Safer and More Effective Training Device for Phacoemulsification
INTRODUCTION
THE FUNCTIONS OF A PHACO TIP
BASIC PROBLEMS WITH A PHACO TIP
Inadvertent Capsular Contact
Blockage of the Bore of the Tip
Sudden Collapse of the Anterior Chamber due to Surge
Corneal/Scleral Burns
WHERE LIES THE ANSWER TO THESE PROBLEMS?
THE MULTIPORT PHACO TIP: ITS DESIGN
How does the New Multiport Phaco Tip Function?
Advantages of the New Multiport Phaco Tip
The Multiport Phaco Tip: A New Teaching Tool
How does this Tip Differ from Other Multiport Tips?
Availability of the Phaco “Trainer” Tips
CONCLUSION
44:
Intraocular Lenses Dislocated into the Vitreous
A CASE REPORT*
PERSONAL EXPERIENCE
Visual acuity
CONCLUSION
45:
Favit: A New Technique to Manage Dropped Nuclei
INTRODUCTION
FAVIT—A NEW METHOD TO REMOVE DROPPED NUCLEI
Basics
Peristaltic Vs Venturi Pump
Favit Technique
Anesthesia
DISCUSSION
SUMMARY
46:
Laser Phaco Cataract Surgery
INTRODUCTION
Pioneers
Instrumentation
The Sunita Agarwal Laser Phaco Probe
Comparison
Laser Photon
In-Built
Uses
Surgical Procedure
Laser Phakonit
How Small will our Incisions Go
CONCLUSION
47:
Endoscopy-Assisted Phacoemulsification
INTRODUCTION (Figs 47.1A to C)
PHACOENDOSCOPY (Figs 47.2 and 3)
Phacoemulsification under Endoscopic Control
Endoscopy of the Posterior Implantation
ENDOSCOPIC SUTURE TECHNIQUES FOR PC-IOLs (Figs 47.4 and 5)
Method
Technique
COMBINED ENDOSCOPIC PROCEDURES DURING PHACOEMULSIFICATION
Endoscopy-assisted Combined Glaucoma Cataract Surgery (Figs 47.6 and 7)
Endoscopy-assisted Vitrectomy for Complicated Phacoemulsification (Fig. 47.8)
48:
Phacoemulsification: The Eye Camp Way
THE CONCEPT OF “EYE CAMPS”
COMPROMISES IN AN EYE CAMP
ORGANIZATION OF A PHACO EYE CAMP—HOW DOES ONE PROCEED
THE OPERATING ROOM SET-UP
THE SURGEONS
STERILIZATION FACILITIES
PERSONNEL IN THE THEATER
POWER GENERATORS
PREOPERATIVE CARE AND EVALUATION
DURING SURGERY
Postoperative Advantages
FINANCIAL IMPLICATIONS OF A PHACO EYE CAMP VS ROUTINE ECCE EYE CAMP
Advantages of Phaco over ECCE as an Eye Camp Alternative
Final Analysis
PROBLEMS OF A PHACO EYE CAMP
HOW GOOD IS INDIA'S ATTEMPT AT CONTROL OF BLINDNESS FOLLOWING CATARACT SURGERY
POOR OUTCOMES IN CATARACT SURGERY
Where are the Answers?
Why not Small Incision ECCE Rather than Phaco. Is it a Viable Option?
Endothelial Holocaust
Why the Endothelial Holocaust
PHACO VS ECCE EYE CAMP: THE FINAL WORD
INDEX
TOC
Index
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