Surgical Techniques in Ophthalmology (Cataract Surgery) Ashok Garg, Jorge L Alio
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1SURGICAL TECHNIQUES IN OPHTHALMOLOGY CATARACT SURGERY
2
3SURGICAL TECHNIQUES IN OPHTHALMOLOGY CATARACT SURGERY
Editors-in-Chief
Ashok Garg MS, PhD, FRSM, ADM, FAIMS, FICA International and National Gold Medalist Chairman and Medical Director, Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk Hisar-125005 (India)
Jorge L Alio MD, PhD Professor and Chairman of Ophthalmology Medical Director Instituto Oftalmologico De Alicante Avda. Denia S/n 03016 Alicante, Spain Foreword David F Chang
4Editors
5
6Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Surgical Techniques in Ophthalmology (Catract Surgery)
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
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: 2010
9788184487763
Typeset at JPBMP typesetting unit
Printed at
7Dedicated 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 patiencxe during all these days of hard work.
– My dear friend Dr. Amar Agarwal, a leading International Ophthalmologist from India for his continued support & guidance.
— Ashok Garg
– To Mayca, Jorge, Fernando and Maria Lucia and most especially to my beloved wife Maria, for the hours that were taken from our family life to make this book possible.
— Jorge L Alio
– Nothing will be cherished more than you to come, my first grand child.
— Marie Jose Tassignon
– My father Stephen M. Weinstock, MD. In addition to his tremendous success as an ophthalmologist, he continues to inspire and support me in all that I do. With patience and understanding he has taught me the importance of honesty and balance in my life.
— Robert J Weinstock
– 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 parents for their inspiration, teaching and motivation.
– My brother Peter for his continued support, guidance and inspiration in my professional career.
— Shui H Lee
– To my father Edvard Malyugin for everything and to my wife Natalia for her continuous support and love.
— Boris Malyugin
– To my family, who make it all so worthwhile.
— D Ramamurthy
– My family without whose help it would not have been possible to do book.
— Mahipal S Sachdev
– My dear wife Dr. Indira Dhull and my children Tushar and Chirag.
— CS Dhull
– My wife Lorena and my sons Pier Francesco, Enrico Maria, Massimiliano and Chiara that, with their love and patience, enable me to get energies and ardor for my work.
— Gian Maria Cavallini
– I dedicate this book to India's Talented ophthalmologists, in the fervent hope that they may become increasingly devoted to refractive surgery.
— Roberto Pinelli
– To my son Valentin Aleksandar.
— Bojan Pajic
– I dedicate my work to all the people in the world with ophthalmic diseases, with the best wish that we can improve with this kind of material our quality of care. I also dedicate this opus to Prof. Ashok Garg, because he has trusted in my work many times.
— Arturo Perez-Arteaga
– My parents for everything.
– To Vini my Best friend.
— Cyres K Mehta
8Contributors
9
12Foreword
Complicated cataract cases challenge all ophthalmologists, regardless of their level of experience. Although complex cases may comprise only 5–10% of all patients in a typical cataract practice, much of our continuing surgical education is devoted to solving problems posed by these eyes. As with most challenging problems in medicine and surgery, there is no single approach that works ideally and consistently well for everyone. This is what makes these patients so difficult, and why having an armamentarium of different strategies to select from is prudent.
In their new book on Surgical Techniques in Ophthalmology (Cataract Surgery), renowned Editors Ashok Garg and Jorge Alio have assembled an impressive collection of chapters devoted to complex cases and advanced topics in cataract surgery. Equally noteworthy is their lineup of international contributors who have written detailed descriptions of their pearls and strategies. In most cases, these experts have taken a step-by-step approach to describing their techniques, which are illustrated with a generous number of photos and diagrams. The editors have wisely decided to invite multiple authors to describe differing approaches to advanced problems and topics. The geographic diversity of these experts assures that the reader will be exposed to a variety of different techniques and technologies.
There is appropriate emphasis on the removing the dense cataract and multiple contributors describe a wide assortment of strategies ranging from biaxial and coaxial microincisional surgery to several methods of manual small incision extracapsular surgery. The entire gamut of phaco methods is covered as well. Finally, many new and innovative technologies and approaches are introduced in this book. These range from using intraoperative wavefront aberrometry, to glue-fixating IOL haptics to the sclera in the absence of capsular support.
With new technological advances arriving at such a rapid rate, it is a remarkably exciting time to be a cataract surgeon. Of course, these developments challenge us to constantly assimilate and incorporate new ideas and devices. This timely and comprehensive book seeks to provide cutting edge knowledge about advanced cataract surgical topics as clearly as possible. A host of international experts have generously shared their clinical experience and pearls. This reference will undoubtedly benefit all experienced cataract surgeons and their patients.
David F Chang md
Professor of Ophthalmology
762, Altos Oaks Drive, Suite 1
Los Altos, CA 94024, USA
Ph. 001-650-948-9123
Fax : 001-650-948-0563
13Preface
Ophthalmic Surgery technology has undergone rapid advancements and innovations in last two decades. From Modest and conventional surgical techniques in early eighties, now it has become high-tech surgery with least indoor stay and excellent visual outcomes. Microincision surgery in both anterior and posterior segments, corneal and lenticular refractive surgery, modern keratoplasty techniques, pediatric and strabismus surgery, oculoplastic and reconstructive surgery and stem cell transplantation have entirely changed the scenario in ophthalmic surgery today.
Modern ophthalmic surgery is a vast subject. It is important for ophthalmologists to master various surgical steps in the ophthalmic surgery procedures of their interest. There are very few qualities international Surgical Techniques in Ophthalmology books which can teach and guide the ophthalmologists to master various surgical techniques properly. Keeping in view of this factor, we have conceptualized the present series of Surgical Techniques in Ophthalmology books which shall contain 8 volumes. These volumes shall cover all aspects of ophthalmic surgery in a comprehensive and easy-to-read format. These volumes shall focus on especially Cataract surgery, Corneal and Lenticular Refractive surgery, Glaucoma surgery, Corneal surgery, Retinal surgery, Pediatric surgery, Oculoplastic and Reconstructive surgery, Strabismus and Neuroophthalmic surgery. A panel of International Eminent ophthalmologists are contributing chapters in these volumes for the benefit of ophthalmologists worldwide.
First volume deals with all important topics of cataract surgery. In this volume, International cataract experts show surgical steps of various cataract surgery techniques, management of complex cataracts, complications and recent advances in cataract surgery technology in a lucid manner.
Our gratitudes are due to Shri Jitendar P Vij (CEO), Mr. Tarun Duneja (Director, Publishing) and all staff members of our publisher M/s Jaypee Brothers Medical Publishers (P) Ltd. who took keen interest in this project and for speedy completion of this mega task.
We expect that present series of Surgical Techniques in Ophthalmology books shall serve as quick look reference books for ophthalmologists worldwide to sharpen their surgical skills.
— Editors