Minimally Invasive Cataract Surgery Ashok Garg, I Howard Fine, David F Chang, Hiroshi Tsuneoka
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1Step by Step Minimally Invasive Cataract Surgery
23Step by Step Minimally Invasive Cataract Surgery (Bimanual Phaco/MICS)
Editors Ashok Garg MS, Ph.D., FIAO (Bel) FRSM, ADM, FAIMS, FICA International & National Gold Medalist Medical Director Garg Eye Institute & Research Centre 235-Model Town, Dabra Chowk Hisar-125005 (India) David F Chang MD Clinical Professor of Ophthalmology University of California, San Francisco, Private Practice 762, Altos Oaks Drive Los Altos, CA-94024 (USA) I Howard Fine MD Clinical Professor of Ophthalmology Oregon Health & Science University Chief Consultant Drs. Fine, Hoffman & Packer, LLC 1550-Oak St., Ste 5, Eugene OR 97401, USA Hiroshi Tsuneoka MD Associate Professor Department of Ophthalmology Jikei University School of Medicine Jikei University Daisan Hospital 4-11-1 Izumihonchou, Komae-shi Tokyo, 201-8601 (Japan) Foreword Dr Richard L Lindstrom
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Fax: +91-11-23276490, +91-11-23245683
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Step by Step Minimally Invasive Cataract 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.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition : 2005
9788180615412
Typeset at JPBMP typesetting unit
Printed at Paras Offset Pvt. Ltd., C-176, N.I.A., Phase-1, New Delhi
5Dedicated to
Our Good Friend Dr Amar Agarwal
The Inventor of Phakonit Technique in the World
67Contributors 9Foreword
Minimally invasive surgery is a worthy goal for all surgical fields. Our patients and society demand that we surgeons and the industry that supports us develop procedures that are equally effective to the classic approaches but safer and capable of being performed on a same day discharge basis in an ambulatory surgery center. Such minimally invasive procedures must allow the individual patient a shorter and more comfortable recovery with less morbidity and a lower incidence of complications. They should also enhance efficiency and reduce the cost per procedure, an important factor in a global economy severely stretched to meet the health care needs of its citizens.
In most surgical fields, a smaller incision is the sinequanon of minimally invasive surgery. For example, the modern knee reconstruction by arthroscopy or cholecystectomy through a laparoscopic incision. Ophthalmology is no different.
Ophthalmology has been a leader in the development of minimally invasive surgery. During my 30-year career we have evolved from an 11 to 12 mm incision for intracapsular cataract surgery to the current state of the art cataract removal and lens implantation through a 2.5 to 3.5 millimeter incision. Yet, our patients still occasionally suffer from wound related complication such as wound leak and sight-threatening endophthalmitis, prompting cataract surgeon innovators to continue their quest for yet smaller incision and less invasive procedures.10
Under several banners, including microincision cataract surgery, microphaco, and phakonit a global consortium of surgeons and industry leaders have developed the capability to remove a cataract through two or three 1.0 to 2.0 millimeter incisions. These techniques, while continuously evolving, are now robust enough to teach to every ophthalmic surgeon.
This book Step by Step Minimally Invasive Cataract Surgery (Bimanual Phaco/MICS) written by Internationally renowned Dr Ashok Garg and his co-editors summarize the current art and science of minimally invasive cataract surgery.
Dr Richard L Lindstrom MD
Minnesota Eye Consultants, P.A.
710 East 24th Street, Suite 106,
Minneapolis, MN 55404, USA
Ph. 612-813-3633
E-mail: rllindstrom@mneye.com
11Preface
Phacoemulsification techniques have advanced at an astounding rate in last one decade. The most recent breakthrough is still further reduction in the size of incision from standard 3.2 mm to below 1 mm and implanting the foldable IOLs through the same incision. This technique known as Minimally Invasive Microincision Cataract Surgery (MICS) is really worthwhile technique to deliver quality vision and rapid rehabilitation of the patient.
Since the Introduction of Microincision technique by Dr Steven Shearing in 1985, this technique has been expanded, modified and refined by a number of leading International Ophthalmologists specially Dr Amar Agarwal, Howard Fine, Hiroshi Tsuneoka, Randall Olson and Jorge Alio. MICS brings with it a deluge of advances, modifications and evolving techniques.
This step by step International MICS book cover all aspects of Minimally Invasive Cataract Surgery from its evolution to various advanced operative techniques, complications management and future prospects in a simplified and concise manner for the benefit of ophthalmologists worldwide.12
We are highly thankful to our publisher Jaypee Brothers Medical Publishers (P) Ltd specially Shri Jitendar P Vij (CMD) and Mr Tarun Duneja (General Manager – Publishing) who took keen interest in the book and extended whole hearted support to publish this quality International MICS reference book in a short time.
We are certain that this handy reference book on MICS shall enrich the ophthalmologists with newer technologies in Minimally Invasive Cataract Surgery in their day-to-day clinical practice and shall occupy a pride place on their table.
Editors