Series Editors Ashok Garg MS PhD FIAO(Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre
235-Model Town, Dabra Chowk Hisar- 125 005 (India)
Emanuel Rosen MD
Medical Director Rosen Eye Associates
Harbour City Salford Quays M50 3 BH, UK
Editors Gian Maria Cavallini MD
Director Institute of Ophthalmology, University of Modena and Reggio Emilia
via del Pozzo 71-41100, Modena Italy
Arturo Perez Arteaga MD
Medical Director Centro Oftalmologico Tlalnepantla Dr Perez-Arteaga Vallarta No 42
Tlalnepantla, Centro, Estado de, Mexico, 54000, Mexico
Boris Malyugin MD PhD
Chief of Department of Cataract and Implant Surgery Deputy Director General S Fyodorov Eye Microsurgery Complex State Institution
Beskundnikovsky blvd 59A 127486 Moscow, Russia
Bojan Pajic MD
Chief Corneal and Refractive Surgery Department Vision Care
Klinik Pallas Louis Giroud Str.20, 4600 Olten Switzerland
Foreword Robert J Weinstock
7Contributors
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Instant Clinical Diagnosis in Ophthalmology (Lens Diseases)
© 2009, 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: 2009
9788184484823
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
5Dedicated to
— My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and 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, a renowned International Ophthalmologist for his constant support, guidance and expertise
— Ashok Garg
The memory of my step daughter Nicola Ross who enjoyed benefits from refractive surgery, were cut short by a tragic fatal illness
— Emanuel Rosen
I dedicate my work to all the people in the world with ophthalmic diseases, with the best wish to improve our quality of care with this kind of material. I also dedicate this opus to Prof Ashok Garg, because he has trusted me a lot
— Arturo Perez Arteaga
To my father Edvard Malyugin for everything and to my wife Natalia for her continuous support and love
— Boris Malyugin
To my son Valentin Aleksandar
— Bojan Pajic
- A Dhivya ms
- Dr. Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai 600 086, India
- AK Grover md frcs
- Chairman
- Department of Ophthalmology, Sir Gangaram Hospital
- Rajinder Nagar New Delhi India
- Alejandro Tello md
- Centro Oftalmologico Virgilio Galvis
- Bucaramanga, Santander Colombia
- Amar Agarwal ms, frcs, frc ophth
- Consultant
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai 600 086, India
- Armando Capote md
- Vice Chairman Microsurgery Center
- Cuban Institute of Ophthalmology
- Ramon Pando Ferrer
- Havana
- Cuba
- Arturo Perez Arteaga md
- Medical Director
- Centro Oftalmologico Tlalnepantla
- Dr. Perez Arteaga Vallarta no. 42
- Tlalnepantla, Centro, Estado de Mexico
- 54000, Mexico
- Ashok Garg ms phd frsm
- Chairman and Medical Director
- Garg Eye Institute and Research Centre
- 235-Model Town, Dabra Chowk
- Hisar 125 005 (India)
- Athiya Agarwal md, do, frsh
- Consultant
- Dr. Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai 600 086, India
- Bassam El Kady md
- Faculty of Medicine
- Ain Shams University and Clinical Research Fellow
- Vissum-Instituto Oftalmologico de Alicante
- Department of Research and Development
- Alicante, Spain
- Bojan Pajic md
- Department of Ophthalmology
- Vedis, Klinik Pallas
- 4600 Olten
- Switzerland
- Boris Malyugin md phd
- Chief of Department of Cataract and Implant Surgery
- Dy Director General
- S. Fyodorov Eye Microsurgery complex State Institution
- 127486 Moscow
- Beskudnikovsky blvd 59A Russia
- Brigitte Pajic Eggspuehler md
- AugenZentrumPajic (AZP) Research Institute
- Titlisstrasse 44, 5734
- Reinach, Switzerland
- C Cheisi md
- Institute of Ophthalmology
- University of Modena and Reggio Emilia
- via del Pozzo 71-41100, Modena Italy
- Chandresh Baid ms
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai 600 086, India
- Cristina Masini md
- Institute of Ophthalmology
- University of Modena and Reggio Emilia
- via del Pozzo 71-41100, Modena
- Italy
- Cyres K Mehta ms fsvh fage
- Director and Consultant
- Mehta International Eye Institute
- Seaside, 147, Colaba Road
- Mumbai 400 005, India
- Elizabeth A Davis md
- Minnesota Eye Consultants
- 9117, Lyndale Aves, Bloomington
- MN 55420, USA
- Emanuel Rosen md
- Medical Director
- Rosen Eye Associates
- Harbour Cty
- Salford Quays
- M50 - 3 BH, UK
- Eneida de la C Perez md
- Cuban Institute of Ophthalmology
- Ramon Pando Ferrer
- Havana, Cuba
- Forrest Fleming md
- Cataract and Refractive Surgeon
- The Eye Institute of West Florida
- 148, 12th Street SW
- Largo, Florida 33770, USA
- Frederic Hehn md
- Centre de La Vision
- Nations Vision
- 23, Boulevard de l'europe
- 54500 Vandoeuvre, France
- Gauri Nagpal md
- Senior Resident
- Department of Ophthalmology
- Sir Gangaram Hospital
- Rajinder Nagar, New Delhi India
- Gian Maria Cavallini md
- Director
- Institute of Ophthalmology
- University of Modena and Reggio Emilia
- via del Pozzo 71-41100, Modena Italy
- Hiroshi Tsuneoka md
- Associate Professor
- Deptt of Ophthalmology
- Jikei University Daisan Hospital
- 4-11-1, Izumihoncho, Komae
- Tokyo 201-8601, Japan
- Jasna Ljubic md
- General Hospital
- Department of Physical Medicine and Rehabilitation, 16000, Leskovac
- Serbia, Switzerland
- Jorge L Alio md phd
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03015
- Alicante, Spain
- Jose L Rodriguez Prats md phd
- Consultant Ophthalmologist
- Instituto Oftalmologico De Alicante
- Alicante, Spain
- P Kaushik mbbs
- Doctor Eye Institute
- Spenta Mansion, Ist floor,
- SV Road, Andher (W), Mumbai
- Kayo Nishi md
- Nishi Eye Hospital
- Osaka, Japan
- Keiki Mehta ms do fios
- Chairman and Medical Director
- Mehta International Eye Institute
- 147, Shahid Bhagat Singh Road
- Colaba Road
- Mumbai 400 005, India
- Kumar J Doctor md
- MS (Ophth), DNB (Ophth)
- Doctor Eye Institute
- Spenta Mansion, Ist floor,
- SV Road, Andher (W)
- Mumbai
- Luca Campi md
- Institute of Ophthalmology
- University of Modena and Reggio Emilia,
- via del Pozzo 71-41100, Modena,
- Italy
- Luis Felipe Vejarano md
- Medico Oftalmologo
- Fundacion Oftalmologica Vejarano
- Nacional Bascom Palmer Eye Institute
- Carrera 3, No. 5-54
- Popayan, Cauca-Colombia
- South America
- 572-8241926
- Marcelino Rio md
- Cuban Institute of Ophthalmology
- Ramon Pando Ferrer
- Havana, Cuba
- Okihiro Nishi md
- Director
- Nishi Eye Hospital
- Osaka, Japan
- Pawel Klonowski md phd
- Vissum-Instituto Oftalmologico de Alicante,
- Department of Research and Development,
- Alicante, Spain
- Peter W Reick md
- Director der Augenklinik
- Charite-Universitatsmedizine Berlin
- Campus Virchow Klinikum
- Augustenburger Platz 1
- 13353, Berlin Germany
- Richard L Lindstrom md
- Minnesota Eye Consultants, PA
- 710 East, 24 th Street, Suite 106,
- Minneapolis, MN 55404
- USA
- Roberto Bellucci md
- Chief of Ophthalmic Unit
- Hospital of Verona
- University of Verona
- Italy
- Robert J Weinstock md
- Director
- Cataract and Refractive Surgeon
- The Eye Institute of West Florida
- 148, 12th Street SW
- Largo, Florida 33770 USA
- Roberto Pinelli md
- Director
- Istituto Laser Microchirurgia Oculare
- Crystal Palace
- Via Cefalonia, 70
- 25124 Brescia
- Italy
- Rohit Om Parkash ms
- Director
- Dr. Om Parkash Eye Institute
- 117-A, The Mall
- Amritsar
- India
- Rupesh V Agrawal md
- Consultant
- Comprehensive Ophthalmology
- Uveitis and Ocular Trauma
- LV Prasad Eye Institute
- Kallam Anjil Reddy Campus
- Banjara Hills
- Hyderabad 500 034
- India
- Satish Desai md
- Comprehensive Ophthalmology
- Uveitis and Ocular Trauma
- LV Prasad Eye Institute
- Kallam Anjil Reddy Campus
- Banjara Hills
- Hyderabad 500 034
- India
- Shaloo Bageja ms
- Consultant
- Ophthalmologist
- Department of Ophthalmology
- Sir Gangaram Hospital
- Rajinder Nagar Delhi India
- Shiao Chang md
- Nishi Eye Hospital
- Osaka, Japan
- Shilpa Kodkany ms
- Asst Professor of Ophthalmology
- JN Medical College, Belgaum
- Simonetta Morselli md
- Director
- Anterior Segment Surgery
- Ophthalmic Unit
- Hospital of Verona
- University of Verona, Italy
- Simone Pelloni md
- Institute of Ophthalmology
- University of Modena and Reggio Emilia
- via del Pozzo 71-41100, Modena, Italy
- SK Gibran md
- Consultant St Paul's Eye Unit
- Royal Liverpool University Hospital
- Prescot Street
- Liverpoor - L 78 XP, UK
- Soosan Jacob ms
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai 600 086 India
- Stephen M Weinstock md
- Cataract and Refractive Surgeon
- The Eye Institute of West Florida
- 148, 12th Street SW
- Largo, Florida 33770 USA
- Sunita Agarwal ms do psvh
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road, Chennai 600 086
- India
- Yutaro Nishi md
- Nishi Eye Hospital
- Osaka Japan
As Ophthalmologists and Cataract Surgeons, we are all fascinated by the human lens. When I was a young medical school student, I vaguely remember one small section in the anatomy and physiology textbook discussing the human lens. Then there was embryology, which maybe, gave a little more attention to this tiny part of the body and two pages was devoted to the topic.
Now, many of us find that our daily life revolves around this complex delicate tissue that is so vital to the visual system. We look at the lens many times a day under high magnification at the slit lamp. We spend countless hours in the operating room carefully trying to remove cataracts without damaging other parts of the delicate eye. And of course, the ophthalmic industry and surgeons are continuously trying to replicate the crystalline lens and reproduce artificial lens for implantation in the human eye that functions like the natural lens.
Regarding lenticular surgery, it is hard to imagine that there is another subspecialty in medicine that has improved and evolved so rapidly. Within a few decades, cataract removal in developed countries has gone from a high risk and high morbidity procedure to possibly the safest and most efficient surgery available with such a dramatic effect on quality of life.
We are extremely grateful to Dr Ashok Garg and his co-editors for assembling this thorough and definitive textbook on the human lens and lenticular surgery. Seldom do you find a reference so complete, starting with the basics of clinical lenticular disease and finishing with state-of-the-art advanced surgical techniques for lens removal.
His panel of international experts have dissected every facet of the human lens and presented highly detailed and informative chapters. By tapping into resources and perspectives from around the globe, Dr Garg and his co-editors have provided the most comprehensive and encompassing lens textbook available.
Whether you are a novice Ophthalmologist who is just beginning to explore the depths of cataract surgery, or a well-seasoned Cataract Surgeon who is looking to add new techniques and improve your results, you will find this reference to be a valuable companion. Through the efforts of leading surgeons from around the world, we are able to benefit from their experience and allow patients to receive better care.
Dr Robert J Weinstock md
Cataract and Refractive Surgeon
The Eye Institute of West Florida
148 13th Street SW Largo, Florida 33770, USA
Tel.: 001-727-585-6644, E-mail: RJWeinstock@yahoo.com
13Preface
The modern day busy and fast life Ophthalmologists are glued to their clinical and surgical practice and have little time to read large volume books. The need of hour is to have a pocket size ready reckoner enriched with complete and up-to-date information of diseases in a most comprehensive manner. At present, very few Quality Ready Reference Books are available at an International level.
After a detailed research and according to the need of Ophthalmologists, we have developed a series of 10 Volume Ready Reference Books termed as Instant Clinical Diagnosis in Ophthalmology. This series covers Oculoplastic and Reconstructive Surgery, Retina, Lens, Glaucoma, Refractive Surgery, Pediatric Ophthalmology, Strabismus, Anterior Segment Diseases, Cornea and Neuro-ophthalmology. The present series has been designed to provide up-to-date information of concerned diseases in a comprehensive and lucid manner along with high quality clinical photographs in an easy to read format. International Masters of concerned subject have contributed chapters in this series covering pathophysiology, clinical signs and symptoms, investigations, differential diagnosis, treatment and prognosis in a simplified manner.
This volume deals with Lens Diseases. Section 1 deals with clinical aspects of various types of lens diseases. Congenital and developmental anomalies, various senile cataracts, traumatic cataracts, complicated and dismetabolic cataracts are covered nicely in this section. Section 2 deals with special surgical aspects of lens diseases available today. International experts have covered microphaco, micro coaxial, biaxial, torsional phaco and 3-D cataract surgery comprehensively for the benefit of the readers. The unique concept of combining clinical and surgical aspects of lens diseases is to have an edit attraction of this volume.
We are highly thankful to our publisher M/s Jaypee Brothers Medical Publishers (P) Ltd. specially Sh. Jitendar P Vij (CEO), Mr. Tarun Duneja (Director, Publishing) and all staff members for their dedication and hard efforts put in the preparation of High Quality Series of Instant Clinical Books.
We hope this 10 volume set of ready reference pocket size books shall provide complete and useful clinical information to Ophthalmologists all around the world and shall help them accurately and precisely diagnose, treat and manage their clinical case confidently to the satisfaction and expectations of their valued patients. We also hope this Ready Reckoner shall serve as a useful companion onto every clinician desk.
Editors