GLUED IOL: Glued Intrascleral Haptic Fixation of a PC IOL Amar Agarwal
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1GLUED IOL2
3GLUED IOL: Glued Intrascleral Haptic Fixation of a PC IOL
Editor Amar AgarwalMS FRCS FRCOphth Chairman and Managing Director Dr Agarwal's Group of Eye Hospitals and Eye Research Center Chennai, Tamil Nadu, India Foreword Eric Donnenfeld
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editor specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editor. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Glued IOL
First Edition : 2013
9789350259962
Printed at Ajanta Offset
5Dedicated to
David W Parke II
Executive Vice President and CEO
American Academy of Ophthalmology
USA
6
7Contributors 9Foreword
Dr Amar Agarwal is an international leader in anterior segment surgery who constantly asks and answers the question of how can we improve our surgical techniques to the betterment of our patients. He is one of the most unique thinkers of our time in ophthalmic anterior segment surgery. His videos are masterpieces of innovation that have helped educate an entire generation of ophthalmologists. In addition, he is a prolific writer with over 55 books to his credit. Not only he is a superb surgeon with many innovative instrumentations and surgical techniques to his credit, but most remarkably, he possesses the rarest of all personal attributes. He is an original thinker as well as daring, bold, creative, logical and innovative. His patient care is firmly and well-grounded on the fundamental principle that no matter what we do. Our patients come first and we should do everything to maximize their visual outcome. No case is too complex for Dr Agarwal. In addition, Dr Agarwal, despite all of his accomplishments, is humble and self-effacing, always giving credit to anyone who has in anyway contributed to his training or surgical idea. If I could send my most demanding surgical cases to only one person or seek consultation from one individual, it would be Dr Amar Agarwal.
One of the most demanding and difficult surgical techniques is to implant an intraocular lens (IOL) in a patient without adequate support for a posterior chamber IOL. An anterior chamber IOL is often a reasonable option but in far too many cases anterior synechiae, glaucoma, or a compromised cornea make this alternative impossible. In addition, anterior chamber IOLs following complex cataract surgery have an increase risk of cystoid macular edema. This left suturing a posterior chamber IOL as the only surgical option prior to Dr Agarwal's glued posterior chamber IOL. Suturing a posterior chamber IOL to the iris or through the pars plana to the sclera are both technically challenging procedures and are associated with late complications. An additional option is quite welcome.
Dr Agarwal's invention of the fibrin glued intrascleral haptic fixation of a posterior chamber IOL is a classic example of the prepared mind investigating a new technology. When Dr Agarwal first learned of the use of fibrin glue in the management of pterygia, he was impressed with the technique like all of us who treat this condition. Most surgeons would have stopped there. However, Dr Agarwal's response was to investigate additional uses for fibrin glue. As a premier anterior segment surgeon, he knew the importance of a new technique for implanting a posterior chamber IOL. However, his additional training in vitreoretinal surgery provided him with the tools for microsurgical implantation through the pars plana under a scleral flap. This approach has been the hallmark of Dr Agarwal's career; never accept the conventional wisdom, employ all of your resources and advance patient care.
Dr Agarwal's new book represents the best of his unique and original approach to anterior segment ocular surgery. The book is a comprehensive analysis of the use of fibrin glue to facilitate intrascleral haptic fixation of a posterior chamber IOL. It summarizes all of the best and most useful and practical pearls that he has developed. Dr Agarwal has brought together an internationally recognized authors and a comprehensive series of videos to demonstrate his signature technique. This book will be widely read by anterior segment surgeons who wish to add to their surgical armamentarium and will be an important contribution to ophthalmology.
Eric Donnenfeld MD
Clinical Professor
Department of Ophthalmology
Trustee Dartmouth Medical School
New York University (NYU)
New York, USA
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11Preface
The expansion of knowledge in cataract, has been truly remarkable, as evidenced by the advances and new body of literature. With the glued IOL and intrascleral haptic fixation techniques, secondary IOL implantation has gone to another level. The focus of this textbook has been not so much to express one point of view on the science and handling the secondary IOL fixation, but rather to present a balanced view that is pertinent.
The goal was to create a clinically based book and an academic reference that would serve to bring the explosion of new techniques and therapeutic interventions to doctors in trenches who see such patients. This book is non-traditional in several ways. Photos, illustrations and tables are sprinkled liberally throughout the book where appropriate. The book is divided into four sections.
I would like to thank all the authors who contributed to this book and help to make this book a reality. I would also like to thank Shri Jitendar P Vij (Group Chairman), Ms Sunita Katla (Publishing Manager), Ms Chetna Vohra (Senior Manager Business Development) and the entire team of Jaypee-Highlights who have brought out this book. An attempt has been made to create an informative, useful tool for all the surgeons who are interested in this technique. This should ultimately benefit our patients who place their trust in us for proper management.
Editor
12Acknowledgments
I wish I could say that I had done extensive research and come out with the concept of a glued IOL. But that would be far from the truth. The actual truth is the idea just came to me from the Lord above and as with all discoveries and inventions, the whole concept of glued IOL are his and his alone.
Nothing in this world moves without him and so also this book was only written by him.