Phacoemulsification Amar Agarwal, Athiya Agarwal, Sunita Agarwal
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1Jaypee Gold Standard Mini Atlas Series PHACOEMULSIFICATION
2Jaypee Gold Standard Mini Atlas Series: PHACOEMULSIFICATION
Sunita Agarwal MS DO FSVH Athiya Agarwal MD DO FRSH Amar Agarwal MS FRCS FRC Ophth Dr Agarwal's Group of Eye Hospitals and Eye Research Centre 19 Cathedral Road, Chennai - 600086, India
3Published 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
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Jaypee Gold Standard Mini Atlas Series Phacoemulsification
© 2007, Jaypee Brothers Medical Publishers
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 authors and the publisher.
First Edition: 2007
9788184480580
Typeset at JPBMP typesetting unit
Printed at Printed and Bound in India
4Dedicated to
Dr Clement Chan
5
6FOREWORD
Probably no technique in the history of Ophthalmology has stirred as much interest and literature as phacoemulsification has. This is caused, not only by the frequency of the disease it treats, but also because of the ever evolving and demanding technique and technology.
This Mini Atlas Phacoemulsification we have in our hands offers us a concise, well illustrated and demonstrative approach to intricacies of the phaco world. With so many photographs and illustrations, this Mini Atlas is an easily accessible and navigable data source.
It starts with a section on basics of phaco and the simple, yet very helpful concept of gas forced infusion forwarded by Sunita Agarwal few years ago, going through other steps of the phaco technique. A section on tough cases like subluxated nuclei then follows.
Complications and nightmares do face even the most experienced surgeon, and on these, thanks to the phenomenal number of cases done and taught at the Agarwal hospitals, a special section is dedicated.
We all remember the debate between the classical extracapsular and phaco surgeons in the mid-late 1980s, and whether it was worthy to make a 3.2 mm incision to be widened later to implant the then only available 6 mm diameter lens. We all knew the 3.2 mm incision would eventually win, and so it did! For the past few years, we are facing a similar (smaller) 7debate with the introduction of phaconit by Dr Agarwal which was popularized as microphaco, bimanual phaco, or microincision cataract surgery (MICS). Dr Agarwal is still going down the millimeter scale and is now presenting phaco through a 0.7 mm tip. Advances in IOL manufacturing and technology will no doubt help these surgical achievements more and more. Will the day come when we look back at the horribly large 3.2 mm incision?
Once again, Dr Amar Agarwal presents us with a fine addition to the library of Ophthalmology, which is a very helpful companion for all surgeons aspiring to improve their surgical results using the latest techniques available.
Ahmad K Khalil MD PhD
Associate Professor of Ophthalmology
National Research Institute of Ophthalmology
Board Member and Treasurer
Egyptian Society for Cataract and Corneal Diseases
Office Bearer, Egyptian Society of the Glaucomas
Office: Saridar Clinic Tower,
92 Tahrir St. Dokki, Cairo, Egypt
8PREFACE
Cataract surgery has become extremely delicate. The reason is as we go smaller and smaller moving from ECCE to phaco to microphakonit the surgery gets more demanding. That is the reason why this book has been written. The idea is basically to teach everyone the intricacies of the surgical techniques.
This book is a small book so that it can be kept in the operation theatre or carried in the hand. When one is starting a tough case the book can be read easily so that the difficulty of the case can be easily conquered. There are lots of figures also in the book so that one can understand the concept easily.
We hope this book will help you master the surgery in a faster and better way. We would like to thank Shri JP Vij from Jaypee Brothers Medical Publishers (P) Ltd., New Delhi and the others of Jaypee to help us bring out this book.
Sunita Agarwal
Athiya Agarwal
Amar Agarwal