Mastering the Art of Bimanual Microincision Phaco (Phakonit/MICS) Ashok Garg, I Howard Fine, David F Chang, Keiki R Mehta
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1Mastering the Art of Bimanual Microincision Phaco (Phakonit/MICS)
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3Mastering the Art of Bimanual Microincision Phaco (Phakonit/MICS)
Editors Ashok Garg MS, Ph.D, FIAO (Bel) FRSM, FAIMS, ADM, FICA International and National Gold Medalist Medical Director Garg Eye Institute and 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) Jerome Jean — Phillippe Bovet MD Consultant Ophthalmic Surgeon FMH Clinique de L'oeil 15, Avenyue Du Bois-de-law Chapelle CH-1213, Onex, Switzerland Suresh K Pandey MD Achievement Awardee, AAO Assistant Professor John A Moran Eye Centre Department of Ophthalmology and Visual Sciences University of Utah, 50 North Medicla Drive Salt Lake City, Utah-8413 USA Intraocular Implant Unit Sydney Hospital and Sydney Eye Hospital Scholar to University of Sydney Save Sight Institute and Discipline of Ophthalmology Sydney, NSW, Australia-2001 I Howard Fine MD FACS Clinical Professor of Ophthalmology Oregon Health and Science University Chief Consultant Drs Fine, Hoffman and Packer, LLC 1550-Oak St, Ste 5 Eugene, OR 97401, USA Keiki R Mehta MS, DO, FRSH, FIOS Chairman and Medical Director Mehta International Eye Institute and Colaba Eye Hospital Seaside 147, Shahid Bhagat Singh Road Mumbai-400005 (India) Luis Felipe Vejarano MD Medical Director Fundacion Oftalmologica Vejarano, Nacional Bascom Palmer Eye Institute Carrera: 3#5-54 Popayan - Colombia South America Cyres K Mehta MS, FAGE, FSVH, FNRERF, FSEC Director and Consultant Ophthalmic Surgeon The Mehta International Eye Institute and Colaba Eye Hospital Seaside 147, Shahid Bhagat Singh Road Mumbai-400005 (India) 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
e-mail: jaypee@jaypeebrothers.com
Visit our website: www.jaypeebrothers.com
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Mastering the Art of Bimanual Microincision Phaco (Phakonit/MICS)
© 2005, Editors
All rights reserved. No part of this publication and interactive CD ROMs 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 to be settled under Delhi jurisdiction only.
First Edition : 2005
9788180615429
Typeset at JPBMP typesetting unit
Printed at Replika Press Pvt. Ltd.
5Dedicated to
My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings & motivation.
My Respected Parents, teachers, my wife Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
My dear friend Dr Amar Agarwal who invented the technique of Phakonit (Bimanual Phaco) for the first time in the world in 1998.
Ashok Garg
Our patients who entrust their vision to our Surgical intervention & who stimulate us to continually seek improved technology and techniques.
I Howard Fine
My wife, Victoria and my children Courtney and Alex.
David F Chang
Zena the light of my life.
Keiki R Mehta
Yveric, Luc and Fanny Laure.
Silvio Korol, who was not only a teacher but also an intellectual guide and a friend.
Jerome Bovet
My wife and son who help me & support me in all my ophthalmology worse and also had been a lot of time without me. They are reason of my life & the engine in my career, in my progress & in my personal development.
To thank my parents who always were in the right place in the right moment & always support my ideas.
To a very good friend of mine & colleague in the clinic Dr Alejandro Tello who push me to write & show to the world all my techniques and new ideas and also help me invaluably with all my chapters & articles.
L Felipe Vejarano
My parents Shri Kameshwar Prasad Pandey and Smt Maya Devi Pandey, for instilling values of sincerity, honesty and integrity.
My spouse, Dr Vidushi, for her love, and constant support.
Suresh K Pandey
My parents for everything.
To Vini my Best friend.
Cyres K Mehta
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7Contributors
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11Foreword
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 11–12 mm incision for intracapsular cataract surgery to the current state-of-the-art cataract removal and lens implantation through a 2.5–3.5 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.
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.–2.0 millimeter incisions. These techniques, while continuously evolving, are now robust enough to teach to every ophthalmic surgeon.
This book, Mastering the Art of Bimanual Microincision Phaco (Phakonit/MICS) written by Internationally renowned Dr Ashok Garg and his co-editors summarize the current art and science of minimally invasive cataract surgery. Accompanied by two interactive CD ROMs, this book provides the interested surgeon a quality base of knowledge to expand their cataract surgery and lens implantation skills.
Dr Richard L Lindstrom md
Minnesota Eye Consultants, PA
710 East 24th Street, Suite 106
Minneapolis, MN 55404, USA
Ph. 612-813-3633
E-mail : rllindstrom@mneye.com
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13Preface
Cataract surgery has undergone rapid advancements in last 2 decades. From simple intra to ECCE-IOL implantation-Phacoemulsification and now to Bimanual Microincision phaco. Indeed cataract surgery is Elective and outdoor procedure now. There is no indoor stay for the patient in high tech Microphaco surgery—a major revolution. There is need to master this technique and all related issues by all ophthalmologists.
Our book on Microphaco in its most advanced presentation, is a sincere effort to spread knowledge and to provide finer details of this technique. A number of leading International Microphaco Surgeons serving the people in different parts of the world have shared their skills and experiences about bimanual phaco in this book for the benefit of readers.
56 chapters of this book cover all aspects of Microphaco from Anatomy of lens to various operative techniques, complications management, recent advances and future technologies. Two interactive CD ROMs are also being provided with the book showing various Microphaco operative techniques being done by leading International Microphaco surgeons.
Our special thanks to Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (General Manager [Publishing]) and all staff members of M/s Jaypee Brothers Medical Publishers (P) Ltd. who took active interest in this project and never ruffled to prepare this high quality International Microphaco book. Each author in this book had made every effort to shape this book as an indispensable companion to our readers.
It gives us great pleasure to present this book to ophthalmologists with the hope it shall enrich them with comprehensive and complete up-to-date information about Bimanual Microphaco.
Editors