Mastering Phacoemulsification in Difficult Situations Tanuj Dada, Jagat Ram, Prema Padmanabhan, Haripriya Aravind
INDEX
×
Chapter Notes

Save Clear

1Mastering Phacoemulsification in Difficult Situations
23Mastering Phacoemulsification in Difficult Situations
Tanuj Dada md Associate Professor, Clinical Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi Jagat Ram ms Professor of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research Chandigarh Prema Padmanabhan ms Director, Cataract and Refractive Surgery Service, Medical Research Foundation, Sankara Nethralaya Chennai Haripriya Aravind ms Chief, Cataract and IOL Services, Aravind Eye Hospital Madurai
4
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 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,
Rel: 32558559 Fax: +91-11-23276490, +91-11-23245683 e-mail: jaypee@jaypeebrothers.com
Visit our website: www.jaypeebrothers.com
Branches
Mastering Phacoemulsification in Difficult Situations
© 2008, 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 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: 2008
9788184481792
Typeset at JPBMP typesetting unit
Printed at Ajanta
5Dedicated to
Kabir
The Weaver of God's name
Lord, I weave the cloth of Thy name The fruitless toil of weaving for the world has come to an end;
I have attained The dazzling state of bliss – Free from fear, free from pain I am the weaver, O Lord, of Thy Name;
I weave and reap the profit of inner rapport with Thee I am the weaver of the Lord's Name
—Kabir6
7Contributors 9Foreword
Cataract surgeons around the world are hungry for the methods and techniques which help them tackle difficult surgical situations. Much has been written about the many different techniques of phacoemulsification and about the management of complications.
The contributors of Mastering Phacoemulsification in Difficult Situations have made a significant contribution to the literature of cataract surgery by their exhaustive description of difficult situations a cataract surgeon may face. This includes the challenges of different anatomical variations as well as the unique considerations necessary when doing surgery for cataracts associated with many different eye diseases and a large number of systemic diseases.
This textbook is presented in a very logical format, starting with the basic principles of phacoemulsification in routine cataract surgery. The book then outlines the unique considerations, requirements, and potential complication of difficult situations. These are thoroughly covered and well illustrated in an easy to read reference format with excellent use of headings, titles, and subtitles.
We all know that a picture is worth a thousand words. If a picture is worth a thousand words then a segment of video worths ten thousand words.
What makes this book so informative and valuable is the depth of experience and knowledge the contributors bring to this work. These experts are from the four major ophthalmic institutes of India in collaboration with four major ophthalmic institutions around the world. This book is scholarly, complete, clinically relevant, practical, well illustrated, and reader-friendly.
Encountering unusual and previously unmet difficulties during surgery can be a lonely and frightening experience. The contributors, with this book, have given all cataract surgeons the benefit of someone having traveled the road before them showing a suggested path not only to give them courage but also expert advice to aid them in tackling difficult situations in cataract surgery.
No single surgeon could, in a lifetime of practice, encounter all of these various difficult situations. This is a book that can meet the needs of every ophthalmologist from the experienced cataract surgeon to the fresher one. Even those not doing cataract surgery will benefit, as so many of the conditions described affect other structures of the eye.
I will treasure having Mastering Phacoemulsification in Difficult Situations in my library for a quick, practical, and authoritative reference not only for myself but also for the residents and fellows that I mentor.
Howard V Gimbel md mph facs frcsc
Professor and Chairman
Department of Ophthalmology
Loma Linda University, Loma Linda
CA, USA 92354
Executive Medical Director
Gimbel Eye Centre
4935 40th Ave. NW Suite 450
Calgary, Alberta, Canada
T3A-2N1
1011Foreword
Phacoemulsification is likely the most common surgical procedure performed in the world presently, and arguably the most successful procedure when considered on a cost to benefit ratio. Because “phaco” is completed under a surgical microscope, it lends itself readily to video-recording and, in turn, to a sharing of the surgical experience locally, nationally, and internationally. This has allowed surgical techniques to be studied and improved upon by cataract surgeons globally. As a result, the percentage of successful surgical outcomes has continued to rise since the advent of phacoemulsification. Moreover, the management of “high risk,” complex, and complicated cataract cases has been facilitated, as surgeons have viewed the work of others and made personal contributions. Such is the case now with this valuable new and comprehensive cataract video text from Tanuj Dada, Jagat Ram, Prema Padmanabhan, Haripriya Aravind and many other contributors. This remarkable new volume considers and presents videos of routine surgery and many complex situations; as a result, it should be valuable to cataract surgeons around the globe. Hopefully, it will stimulate surgeons to consider newer variations of technique to further elevate surgical outcomes in all situations. Ultimately, patients are the true beneficiaries of works of this nature.
Samuel Masket
Immediate Past President
American Society of Cataract and Refractive Surgery (ASCRS)
Clinical Professor of Ophthalmology
Jules Stein Eye Institute
UCLA, Geffen School of Medicine
Los Angeles, USA
1213Preface
Phacoemulsification has now become the standard surgical practice for cataract extraction across the globe. The main challenge faced by any phaco surgeon is to perform the surgery, again and again without having any complications in a variety of cases. However, the surgeon is often faced with a difficult situation which increases the risk of complications and demands a change in surgical maneuvers and machine dynamics. In the event of an unavoidable complication (like posterior capsule rupture in a posterior polar cataract), the surgeon should be able to manage the case with certain surgical principles to ensure optimal visual rehabilitation.
The current manuscript deals with basics of phacodynamics and outlines the practical principles and surgical caveats involved in managing several difficult and special situations encountered during phacoemulsification. It also elaborates on the management of important complications which may occur during the surgery.
The reader can gain from the surgical expertise of over 30 well renowned national and international phaco surgeons and learn individual techniques for managing different types of cataracts.
The book is intended to be a comprehensive video assisted textbook both for residents and practising ophthalmologists who are doing cataract surgery. It has been put together as a collaborative effort from the four major ophthalmic training institutes in India in association with expert international faculty from across the globe, so that the reader can get a proper perspective of surgical techniques and individual innovative variations.
We hope that this book will help the reader in learning new surgical skills, improve the standard of care and ultimately benefit the cataract patient.
Tanuj Dada
Jagat Ram
Prema Padmanabhan
Haripriya Aravind
14Acknowledgements
This book has only been possible with the blessings of my parents, Drs Kamlesh and Vijay Kumar Dada and support of my soul-mate Geeta. Words are not enough to thank them for kindling in me the spirit to achieve academic excellence and at the same time to pursue the quest for the Overself, the ultimate goal of human existence.
Anand Aggarwal
I wish to thank Prof. Anita Panda, who has been a beacon of support and affection and treated me like her own family member, providing help and guidance in all professional and personal matters at all times. Working under her guidance and imbibing her tremendous energy has been an enriching experience for me.
This book has been possible with the hard work, dedication and sincere effort of one person—my dear friend, Dr Anand Aggarwal. He is one of the outstanding senior residents of RP Centre and has single handedly compiled all the chapters and videos with great skill.
I want to especially acknowledge the time and effort put in by two of our best junior residents, both of whom hail from Mumbai, the dynamic duo of Dr Sourabh Patwardhan and Dr Vivek Dave. Working with them has been a pleasure and a privilege.
I wish to thank, Prof. Sat Pal Garg who has been a teacher, guide and friend for his encouragement and help. He has been a pillar of strength for all of us and gone out of the way to get our work done.
Sourabh Patwardhan
I also wish to thank my teachers Prof. RV Azad, Prof. Rasik B Vajpayee, Prof. Pradeep Pharma, Prof. Ramanit Sihota, Prof. JS Titiyal, Prof. Radhika Tandon, Prof. Sudershan Khokar, Prof. Rajpal, Prof. Mandeep Bajaj and Prof. Supriyo Ghose, Head of the RPC family. I also wish to thank Dr Namarata Sharma, Dr Harinder S Sethi, Dr M Vanathi, and Dr Rajesh Sinha for helping me at all times.
I also wish to express my heartfelt gratitude to the senior and junior residents of RP Centre who have made this work possible. I thank Drs Vishal Jhanji, Sujith Vengayil, Shalini Mohan, Shibal Bhartiya, Subroto Mandal, Ritu Gadia, Munish Dhawan, Chandrashekhar Kumar, Tejinder Pal Singh and Jatin Ashar.
Vivek Dave
I also wish to thank Harminder and Mohan for photography, Ramesh at our library for video editing, and office staff Lalmani, and Santosh for their help.