Phacoemulsification Amar Agarwal, Priya Narang
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1Step by Step® Phacoemulsification2
3Step by Step® Phacoemulsification
Third Edition
Editor Amar Agarwal MS FRCS FRCOphth Chairman and Managing Director Dr Agarwal's Group of Eye Hospitals and Eye Research Center Chennai, Tamil Nadu, India Priya Narang MS Director Narang Eye Care and Laser Center Ahmedabad, Gujarat, India Foreword Audrey Talley Rostov
4
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Step by Step® Phacoemulsification
First Edition: 2005
Second Edition: 2006
First Edition: 2015
9789351527831
Printed at
5Dedicated to
Warren Hill
6Contributors 7Foreword to the Third Edition
Cataract is a significant global health problem and a leading cause of blindness worldwide. Although great strides have been made in the field of cataract and anterior segment surgery, there is still much work to be done. Since the introduction of phacoemulsification by Dr Charles Kelman over 40 years ago, there have been significant surgical advancements in phaco technology and IOL techniques.
Dr Amar Agarwal and his colleagues are innovators in the field of cataract and anterior segment surgery and are especially well known for their popularization of glued IOL techniques. They have a wealth of experience in complex case scenarios and are internationally applauded for their informative presentations on transforming the “Longest Day” in the operating suite into sight- restoring cataract surgical procedures.
With the third edition of Step by Step® Phacoemulsification, Drs Amar Agarwal and Priya Narang deliver another compilation of cataract surgical techniques designed to teach both the comprehensive cataract surgeons as well as the advanced anterior segment reconstructive surgeons. This step-by-step textbook provides a matrix for surgical decision making and learning a variety of cataract surgical techniques as well as the management of intraoperative and postoperative complications. Well-researched and beautifully illustrated topics include the management of mature cataracts, subluxated cataracts and endocapsular ring segments, small pupil phaco, phakonit and microphakonit, glued IOL and IOL scaffold techniques and the management of infectious endophthalmitis and cystoid macular edema.8
The authors demonstrate a commitment to continuous improvement in patient care by providing strands of phaco pearls obtained from their vast clinical and surgical experiences. Through the advancement of education and teaching of cataract surgical skills, Drs Agarwal and colleagues provide us with this comprehensive approach to help eliminate blindness and restore vision from this very treatable disease.
Audrey Talley Rostov MD
Cornea, Cataract and
Refractive Surgeon
9Foreword to the Second Edition
The topic of this book needs no introduction. Cataract surgery has been at the forefront of ophthalmic consciousness forever. Cataract, opacification of the lens, is one of the most common causes of loss of useful vision, with an estimated 16 million people worldwide affected. Several risk factors have been identified in addition to increasing age including genetic composition, exposure to ultraviolet light, and diabetes. However, no method to halt the formation of a cataractous lens has been shown to be effective. Nevertheless, advances in surgical removal of cataracts, including small-incision surgery, use of viscoelastics, and the development of intraocular lenses, have made treatment very effective and visual recovery rapid in most cases. Despite these advances, cataract continues to be a leading public-health issue that will grow in importance as the population increases and life expectancy is extended worldwide.
Phacoemulsification, first developed by Kelman in 1967, is currently the procedure of choice for the surgical management of cataracts. The search continues for innovations that allow easier manipulation of intraocular lenses through even smaller incisions. The smaller incision in phacoemulsification allows for the maintenance of a near-normal anterior chamber during surgery, decreasing the risks. Smaller incisions have decreased the duration of the procedure and, more importantly, hastened postoperative visual recovery. Dr Amar Agarwal and colleagues have become one of the most important modern-day innovators with the invention of revolutionary techniques such as phakonit. Cataract removal through a sub-1.0 mm incision and implantation10 of a rollable intraocular lens, and no-anesthesia clear corneal phacoemulsification.
For these reasons, the appearance of the second edition of Dr Agarwals’ Step by Step Series on Phaco by Drs Sunita Agarwal, Athiya Agarwal, and Amar Agarwal to help ophthalmologists learn the newest techniques on cataract surgery is a wonderful gift to all of us and our patients. The book has been beautifully illustrated and divided into 12 masterful chapters including important topics such as Gas Forced Infusion, No Anesthesia Cataract Surgery with the Karate Chop Technique, Phaco in Subluxated Cataracts, Mature Cataracts, Small Pupil Phacoemulsification, Combined Cataract and Glaucoma Surgery, Managing Dislocated Lens Fragments, The Malpositioned Intraocular Implant, Infectious Endophthalmitis, Cystoid Macular Edema, Bimanual Phaco/Phakonit/MICS: Surgical Technique, Microphakonit: Cataract Surgery with A 0.7 mm Tip.
Contributors of this book are both educators and treaters. There was no way for them to have developed these techniques except to do it. Their accumulated knowledge is the result of tremendous clinical and academic efforts and their expertise flows to the reader with the hope that individual lives will benefit. In bringing their work to press, Drs Sunita Agarwal, Athiya Agarwal, and Amar Agarwal have done a great service to patients living with cataracts and to the doctors caring for them. Those who will read and study this text have already demonstrated that they care for their patients and that they want to learn. We now just need to move forward together to give our patients the gift of sight.
J Fernando Arevalo MD FACS
Clinica Oftalmologica Centro Caracas
The Arevalo-Coutinho Foundation
for Research in Ophthalmology
Caracas, Venezuela
11PREFACE
We are honored to have been asked to edit the third edition of Step by Step® Phacoemulsification. With this edition, we aim to find more knowledgeable and productive information—all in one book. This ambitious goal was set to provide the readers with the most comprehensive and current information covering the broad field within phacoemulsification. It is hoped that the edition captures the current state of the vital and dynamic science from international perspective.
New to the edition are the chapters on handling complications in phacoemulsification surgery areas that have developed significantly in recent years. The remaining chapters have been thoroughly updated to reflect developments since the last edition. The book has a display of chapters on varied topics covering every aspect of phacoemulsification surgery with a brilliant display of figures.
We hope that the book will be a valuable reference for readers, health professionals, and a useful resource for educators and established professionals.
Amar Agarwal
Priya Narang