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Small Incision Cataract Surgery (Manual Phaco)
Kamaljeet Singh
1:
Anatomy of the Lens
2:
History of Cataract Surgery
3:
Sterilization
INTRODUCTION
HISTORY
AREAS OF STERILIZATION
The Operating Room Air
Air-Conditioning
Quality Check
The Operating Room Water
Filtration
Reverse Osmosis
Electronic Control
The Operating Room Walls, Floor, Ceiling and Fixtures
Cleansing
Disinfection
The Operating Room Macroinstruments
Microscope
Phaco Machines
Boyles Apparatus
The Operating Room Microinstruments
Tray I with Liquid Soap and Sterile Water
Ultrasonic Cleansing
Cidex or Glutaraldehyde 2%
Isopropyl Alcohol 70%
Sterile Water
Boiling
Ethylene Oxide Sterilization
Autoclave
The Operating Room Linen and Accessories
Linen
Medication
Parenteral
Probes and Tubings
The Operating Room Personnel
Footwear
Clothing
Cap and Mask
The Patient
Change of Clothes
Skin and Incision Site Disinfection
Sterile Disposable Surgical Drape
STERILIZERS
Methods of Sterilization
Terminology
Sterilization
Disinfection
Cleaning
Methods
Quality Control
Factors Influencing Resistance
Sterilization and Disinfection Policy
CULTURE RATE
MacConkey's Agar
Nutrient Agar
Blood Agar
STERILIZATION CONTROL
Plate Test
Culture Test from Walls, Floor, Fixtures, Furniture
All Fluids to be Cultured
All Fluids used Parenterally to be Checked for pH Value
Specialized Equipment Cultures
When, Where and Why to Use Biologicals When?
Surgeons Hands Cultured
Linen and Textiles Cultured
4:
Viscoelastics
PHYSICAL AND CHEMICAL PROPERTIES OF VISCOELASTICS
VISCOELASTIC SUBSTANCES
Hyaluronic Acid (Sodium Hyaluronate)
Methylcellulose
Preparation
Advantages of HPMC
Contaminants/Particulate matter in HPMC
Chondroitin Sulphate
Disadvantages
Uses of Viscoelastic Substances
Complications
Comparative Studies Using Different Viscoelastics
5:
Comparison of Various ECCE Techniques
6:
Managementof Diabetes inCataract Surgery
PRINCIPLES OF MANAGEMENT
MINOR SURGERY
SURGERY IN PATIENTS NOT TREATED WITH INSULIN
SURGERY IN INSULIN-TREATED PATIENTS
POSTOPERATIVE CARE
PRACTICALITIES OF MANAGEMENT
INTRAVENOUS FLUIDS
MONITORING DURING SURGERY
Emergency Surgery
7:
Management of Hypertension in Cataract Surgery
INTRODUCTION
Definition of Blood Pressure
Management
CONCLUSION
8:
Preoperative Evaluation for SICS
9:
Biometry
10:
Ocular Anaesthesia
11:
Anaesthetist's Role in Ocular Surgery
12:
Postoperative Infections: Prevention and Management
PREVENTION OF POSTOPERATIVE ENDOPHTHALMITIS
Operating Room Layout
Ventilation
Cleaning, Disinfection and Sterilisation of OR
OR Discipline
Sterilisation of Instruments
Flash Sterilisation
Filtration
Chemical agents
Plasma Sterilisation
Monitoring of Sterilisation Protocol
Sterile Surgical Protocol
Irrigating Fluids and Viscoelastic Agents
Subconjunctival Antibiotics
Surgery of Infected Cases
MANAGEMENT OF POSTOPERATIVE ENDOPHTHALMITIS
13:
The Manual Small Incision: Surgical Aspects-I
14:
The Manual Small Incision: Astigmatic Considerations–II
15:
Capsulotomy for Small Incision Cataract Surgery
16:
Hydroprocedures
INTRODUCTION
CONCENTRIC ANATOMY OF THE LENS
Hard Core Nucleus
Epinucleus
Superficial Cortex
HISTORY
HYDRODISSECTION
Conventional Hydrodissection
Technique
Cortical Cleavage Hydrodissection
Hydro-free Dissection
HYDRODELINEATION OR HYDRODEMARCATION
Manual
Hydrosonic Hydrodelineation
COMPLICATIONS OF HYDROPROCEDURES
DISCUSSION
17:
Nucleus Prolapse from Capsular Bag
18:
The Phaco Sandwich Technique
19:
Modified Fish Hook Technique
20:
Manual Phaco-fracture
21:
Microvectis Technique
22:
Modified Blumenthal's Technique
TUNNELING FORWARDS
Envelope Technique
Can-op Rhexis
Fixing the AC Maintainer
Completing the Tunnel
Hydroprocedures
Hydrodissection
Hydrodelineation/Hydrodelamination/Hydrodemarcation
Nuclear Management and Delivery
Precautions
Nuclear Delivery by Hydroexpression
SECTION NOT TAKING UP NUCLEUS—CAUSES
Solution
Cortical Clean-up
IOL Placement
Closure of Section
23:
Small Incision Manual Phaco-section Using the Anterior Chamber Maintainer
24:
Manual Multiphacofragmentation: A New Technique for Cataract Surgery
INTRODUCTION
SURGICAL TECHNIQUE
Anterior Capsulotomy
Incision
Hydrodissection and Luxation of the Nucleus
Nuclear Fragmentation
Manipulation of Nuclear Fragments
Extraction of the Cortex and Remains of Nucleus
IOL Implantation and Wound Closure
25:
The New Method of Manual-phacofragmentation (Phaco-drainage)
CONCLUSION
26:
Temporal Tunnel Incision in SICS
ADVANTAGE OF TEMPORAL INCISION
Reduction against the Rule (ATR) Astigmatism
Useful in Secondary and Combined Procedure
Stable Incision
Corneal Topographic Changes
SURGICAL STEPS
COMPLICATIONS
CONCLUSION
27:
Cortical Clean-up
28:
Intraocular Lenses
OPTIC MATERIALS FOR IOLs
Polymethylmethacrylate (PMMA)
Silicone
Hydrogel
Acrylic
HAPTIC MATERIALS FOR IOLs
Nylon (polyamide)
Polymethylmethacrylate (PMMA)
Polypropylene (Prolene)
Polyvinylidene fluoride (PVDF)
Haptic Design
BASIC PRINCIPLES OF IOL MANUFACTURE
Lathe Cutting
Injection Molding
Compression Molding
Cast Molding
PROFILE OF RIGID IOLs USED FOR SMALL INCISION CATARACT SURGERY
FOLDABLE IOLs
Advantages
Disadvantages
Surgical Considerations in the Insertion of Foldable IOLs
MULTIFOCAL INTRAOCULAR LENSES
REFRACTIVE MIOLs
Target or Centre Surround MIOL
DIFFRACTIVE MIOLs
ACCOMMODATING INTRAOCULAR LENS
TORIC INTRAOCULAR LENSES
PIGGYBACK INTRAOCULAR LENSES
COMPLICATIONS OF FOLDABLE INTRAOCULAR LENSES
29:
The Technique of IOL Implantation in SICS
CONCLUSION
CARE TO BE TAKEN
30:
Wound Closure
31:
When and How to Convert?
WHEN TO CONVERT?
HOW TO CONVERT?
32:
Current Status of Medications in Cataract Surgery
CONCLUSIONS
33:
Complications of Manual Phaco
INTRAOPERATIVE COMPLICATIONS
POSTOPERATIVE COMPLICATIONS
34:
Management of Posteriorly Dislocated Lenses
35:
Post-surgical Endophthalmitis
INCIDENCE AND AETIOLOGY
POST-SURGICAL BACTERIAL ENDOPHTHALMITIS
Clinical Features
Confirmation of Diagnosis
Treatment of Postoperative Bacterial Endophthalmitis
ANTIMICROBIAL THERAPY
Intravitreal Antibiotics in Post-surgical Endophthalmitis
Intravenous Antibiotics in Post-surgical Bacterial Endophthalmitis
Topical and Subconjunctival Antibiotics in Post-surgical Bacterial Endophthalmitis
ANTI-INFLAMMATORY THERAPY: ROLE OF CORTICOSTEROIDS
SUPPORTIVE THERAPY
VITRECTOMY IN POST-SURGICAL ENDOPHTHALMITIS
ENDOPHTHALMITIS VITRECTOMY STUDY
POST-SURGICAL FUNGAL ENDOPHTHALMITIS
Clinical Features
Confirmation of Diagnosis
MANAGEMENT OF POSTOPERATIVE FUNGAL ENDOPHTHALMITIS
Systemic Antifungal Therapy
INTRAVITREAL ANTIFUNGAL THERAPY
Vitrectomy in Fungal Endophthalmitis
PROPIONIBACTERIUM ACNES ENDOPHTHALMITIS
STERILE ENDOPHTHALMITIS (POSTOPERATIVE INFECTION VS INFLAMMATION)
36:
Posterior Segment Disorders and SICS
ACCIDENTAL GLOBE PERFORATION
Clinical Features
Management
CENTRAL RETINAL ARTERY OCCLUSION
EXPULSIVE HAEMORRHAGE
Introduction
Clinical Features
Management
VITREOUS LOSS
Clinical Features
Management
CHOROIDAL DETACHMENT
Clinical Features
Management
CYSTOID MACULAR OEDEMA (CME)
Introduction and Epidemiology
Clinical Features
Management
Photic Maculopathy
DIABETIC RETINOPATHY AND CATARACT
Epidemiology
Approach to Management
RETINAL DETACHMENT FOLLOWING CATARACT SURGERY
Introduction and Epidemiology
Approach to Management
POSTCATARACT SURGERY ANTERIOR ISCHAEMIC OPTIC NEUROPATHY (AION)
Pathogenesis
Clinical Features and Management
Outer Retinal Ischaemic Infarction
Age Related Macular Degeneration and Cataract
37:
Glaucoma and SICS
38:
Paediatric Cataract: My Experiences
39:
SICS in Paediatric Cataracts
40:
Posterior Capsule Opacification
INDEX
TOC
Index
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