Phacoemulsification Surgery Rasik B Vajpayee, Namrata Sharma, Suresh K Pandey, Jeewan S Titiyal
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1Phacoemulsification Surgery2
3Phacoemulsification Surgery
Editors Rasik B Vajpayee MS FRCSEd Head, Cornea and Refractive Surgery Services Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Namrata Sharma MD DNB MNMAS Assistant Professor Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Suresh K Pandey MD Assistant Professor John A Moran Eye Center Department of Ophthalmology and Visual Sciences University of Utah 50 North Medical Drive, Salt Lake City Utah-84132, USA Intraocular Implant Unit, Sydney Eye Hospital Scholar, Save Sight Institute University of Sydney, Sydney, NSW Australia Jeewan S Titiyal MD Additional Professor Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
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Phacoemulsification Surgery
© 2005, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2005
9788180615160
Typeset at JPBMP typesetting unit
Printed at Paras Offset Pvt Ltd., C-176, N.I.A., Phase-1, New Delhi
5Dedicated to
My wife Madhu and children Mihika and Shubhankar
— Rasik B Vajpayee
My parents, My spouse Subhash and daughter Vasavdatta
— Namrata Sharma
My parents, Shri Kameshar Prasad Pandey, and Smt Maya Devi Pandey for instilling values of sincerity, honesty and integrity
My spouse Dr Vidushi, for her constant support, and encouragement
— Suresh K Pandey
My respected parents, My dear wife Basanti Titiyal and My children Hemant and Renuka
— Jeewan S Titiyal
6
7Contributors 11Foreword
The “state-of-the-art” for cataract surgery remains a work in progress. Despite economic and regulatory pressures, the science continues to progress. During my training period it was typical for cataract surgery patients to remain hospitalized for 5 days and not expect to see well for months; seeing well meant the use of aphakic spectacles or contact lenses. But, the marriage of biomedical engineering and surgical ingenuity has allowed the evolution of cataract rehabilitation to become one of the true “miracles” of modern medicine, and likely the single best procedure with respect to cost versus benefit.
As the science evolves, it is necessary from time to time to compile a comprehensive text of the subject's progress. This is most necessary, as it both stimulates new ideas for furthering the science as well as serves as reference point for current surgeons. Writing a comprehensive text on the subject is a prodigious task. The extensive clinico-surgical experience of Prof Rasik B Vajpayee and Dr Suresh K Pandey's extensive background in intraocular lens related ocular pathology and experimental implant and cataract surgery combine well with his clinical skills to provide a broad perspective and wide base of information for the reader. The editors have assembled a group of contributors to create a fully comprehensive book regarding virtually all aspects of present day cataract surgery. While some authors are well known to all in the “cataract community,” some are known only to a few of us. Nevertheless, the final product offers a consistent, comprehensive, and well-organized approach to the subject matter.
Phacoemulsification Surgery is an excellent textbook, and all who perform and teach current cataract surgical techniques will find this text to be of interest and of value. I am delighted to write foreword of this textbook and congratulate editors—Prof Rasik B Vajpayee, Dr Namrata Sharma, Dr Suresh K Pandey, Dr Jeewan S Titiyal and all the contributors on their accomplishments and thank them for the great effort on behalf of the profession and the patients that it serves.
March 10, 2005
Samuel Masket md
Clinical Professor of Ophthalmology
UCLA Geffen School of Medicine
Los Angeles, USA
- Consultation Section Editor of the Journal of Cataract and Refractive Surgery
- Member of the Board of Trustees of the American Academy of Ophthalmology
- Formerly Chairman of the Cataract Special Interest Committee of the American Society of Cataract and Refractive Surgery
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13Foreword
The Introduction of Intraocular Lenses by Sir Harold Ridley in 1949 initiated a period of rapid progress in cataract and implant surgery, which rapidly improved outcomes for patients undergoing cataract surgery. With the advent of phacoemulsification pioneered by Charles Kelman and foldable lens implants, visual recovery after surgery is almost immediate and cataract surgery has been transformed from a major surgical procedure requiring hospitalisation to an outpatient procedure with an almost immediate return to active life.
It is a misconception however to suggest that the outstanding results that are now available are due to the operation becoming a simpler procedure. The reality is that modern cataract surgery is an extremely sophisticated procedure and any surgeon endeavouring to achieve state-of-the-art results, requires a high level of surgical skill, training and knowledge. It is, therefore, a distinct pleasure to write a foreword for a book on “Phacoemulsification Surgery,” which brings together up-to-date information from many authors and provides a comprehensive text covering the many facets of knowledge required, in performing state-of-the-art, modern cataract surgery. The opinions expressed in this book reflect the diverse backgrounds of the authors who are well-respected leaders in the field. The editors have succeeded in bringing together different viewpoints to produce a text of even consistency emphasising the recognition of common underlying principles.
“Phacoemulsification Surgery” is an excellent text providing detailed information for both novice and experienced cataract surgeons. A total of 47 chapters compiled in the five sections of this book provide the essential steps in teaching and learning phacoemulsification surgery. The text covers phacoemulsification equipment, phacodynamics, intraocular lens implantation and focus on surgical technique for routine and complex cases. The text in most chapters is accompanied by tables and comprehensive diagrams that help explain the mechanics and surgical art of phacoemulsification surgery. Superb clinical/surgical photographs are provided, which will be of assistance for the resident in training to understand the surgical steps of phacoemulsification and intraocular lens implantation. Topics such as viscoelastic devices, anesthesia for phacoemulsification surgery and the critical area of intraocular lens power calculation are also covered, as well as the management of intraoperative postoperative complications.
Experienced cataract surgeons will find the text an enjoyable update to their familiar field of practice, whilst the book will be a valuable learning experience for ophthalmologists in training and general ophthalmologists and any professional who would like to keep in touch with the latest thinking in respect to the management of cataract surgery and intraocular lens implantation.14
This book on “Phacoemulsification Surgery” is a well-focused and timely publication and the editors—Dr Rasik B Vajpayee, Dr Namrata Sharma, Dr Suresh K Pandey, and Dr Jeewan S Titiyal and all the contributors are to be congratulated for their contribution to this most important aspect of modern ophthalmology.
March 10, 2005
Graham Barrett mbbs franzco fracs
Associate Professor of Ophthalmology
Lions Eye Institute
Head of Department of Ophthalmology
Sir Charles Gairdner Hospital
Senior Lecturer University of Western Australia
Founding President of the Australasian Society of Cataract & Refractive Surgeons
President of the Asia Pacific Association of Cataract & Refractive Surgeons
15Foreword
Phacoemulsification has become the standard procedure for cataract surgery throughout the world. With advancements in medical technology, the surgical technique has evolved into a rapid sight restoring procedure with minimal complications.
The current text on phacoemulsification compiled by Rasik Vajpayee and his team, offers an excellent resource for cataract surgeons at all stages of their careers. It contains basic information for the residents of ophthalmology and trainee surgeons and advanced microsurgical techniques for the expert phacoemulsification surgeons. Management of special situations in phacoemulsification is a valuable addition to the standard texts on phacoemulsification. The descriptions are formulated by a renowned faculty with a vast surgical experience and expertise. The book provides a practical, concise and updated information on all aspects of phacoemulsification and will be a valuable addition to the existing literature on the subject.
Prof. Vijay Kumar Dada
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17Preface
The phacoemulsification surgery, which has completely revolutionized the approach towards the cataract management, is the most gratifying and the result-oriented advancement in the field of ocular surgery. With the newly emerging technological advances, phacoemulsification surgery is in an ever-evolving stage. There are many books on phacoemulsification surgery some old; some recent; and yet some forthcoming. There are some books, which deal with the basic technique, and some on advanced techniques. Many newer and better techniques are being added everyday to the existing armamentarium by the innovative surgeons. Our book is a step to update the current literature. It is a comprehensive guide and has been written to provide knowledge about the phacoemulsification surgery to the novice surgeons as well as the experts in a user-friendly style. Experts from all over the world have amalgamated their knowledge in such a manner so as to make the chapters readable and comprehensive in an easy style. The chapters give practical tips without going into too many theoretical aspects.
The book has been divided into five sections each of which deals with a comprehensive understanding of the various aspects of phacoemulsification surgery. These include the preoperative work up, the basic technique of phacoemulsification surgery, the complications associated and the technique required for complex situations. We did not aim to make the book the text encyclopedic: instead our aim was to produce an authoritative and a compact book. We hope that the readers will enjoy reading it as much as we enjoyed creating it.
Rasik B Vajpayee
Namrata Sharma
Suresh K Pandey
Jeewan S Titiyal
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19Acknowledgements
We are thankful to the authors who have taken out their invaluable time for the creation of the book. We are grateful to our fellows and residents who in their indelible quest for knowledge helped us to find new answers and innovations. Our heartfelt gratitude to our family members who allowed us time to create this book.