Clinical Practice in Small Incision
Cataract Surgery (Phaco Manual)
Clinical Practice in Small Incision Cataract Surgery Phaco
Manual
Editors
Ashok Garg MS, PhD, FIAO(Bel), FRSM, ADM, FICA, FAIMS, FICS
National and International Gold Medalist
Medical Director
Garg Eye Institute & Research Centre
235-Model Town, Dabra Chowk Hisar, India
Luther L Fry MD
Fry Eye Associates
PA/Ophthalmology
Garden City, Kansas, USA
Francisco J Gutiérrez-Carmona MD, PhD
Associate Professor
Ophthalmologic Research Institute
Ramon Castroviejo
Hoyo de Manzanares, Madrid, Spain
Geoffery Tabin MD
Associate Professor of Ophthalmology
University of Vermont
College of Medicine
Burlington, Vermont, USA
Suresh K Pandey MD
Instructor, John A Moran Eye Center
Department of Ophthalmology
and Visual Sciences
University of Utah
Salt Lake City, Utah, USA
Foreword
Pandelis A Papadopoulos
LONDON AND NEW YORK A MARTIN DUNITZ BOOK
© 2004 Ashok Garg, Luther L Fry, Geoffery Tabin, Franciso J Gutiérrez-
Carmona, Suresh K Pandey
First published in India in 2004 by 
Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India Phones:
23272143, 23272703, 23282021, 23245672 m\, Fax: +91–011–23276490 e-mail: jpmedpub@del2.vsnl.net.in, Visit our website: http://www.jaypeebrothers.com/ This edition published in the Taylor & Francis e-Library, 2006.
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First published in the United Kingdom by Taylor & Francis, a member of the Taylor & Francis Group in 2004. Exclusively distributed worldwide (excluding the Indian Subcontinent) by Martin Dunitz, a member of the Taylor & Francis Group.
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ISBN 0-203-31182-5 Master e-book ISBN
ISBN - (OEB Format)
ISBN 1 84184 467 5 (Print Edition)
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Dedicated to
My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and guidance.
My Respected Parents, my wife Dr. Aruna Garg, son Abhishek and daughter Anshul for their endless support and constant encouragement.
My dear friend Dr. Amar Agarwal for his expert advice and whole hearted support in this endeavour.
ASHOK GARG
My wife, Ardis and my sons, Eric and David whose sacrifices have made my career in Ophthalmology possible.
LUTHER L FRY
My wife, Jean, son Danny and daughters Sara, Ali, Emilia, and Livia for their love and support.
To my partner in Himalayan Cataract Project, Dr. Sanduk Ruit.
To Dr Ashok Garg for making this book come to life.
GEOFFERY TABIN
My wife, Carmen and my daughters Marta, Laura for their love and support.
All my teachers and particularly Prof. Ramon Castroviejo who taught me the elegance and excellence in ocular surgery.
Dr Amar Agarwal for his friendship
FRANCISCO J GUTIÉRREZ-CARMONA
Param Pujya Gurudev, Pt. Shri Ram Sharma Acharya and Mata Bhagawati Devi Sharma, Shantikunj, Haridwar, India for their blessings.
My respected parents (Shri Kameshwar Prasad Pandey, and Smt. Maya Devi Pandey) for helping me set higher goals.
My loving spouse, Dr. Vidushi for her constant support.
My teacher and colleagues (particularly Dr Liliana Werner, Prof. David J Apple) for transmitting their skills and expertise with passion and enthusiasm.
SURESH K PANDEY
Contributors
Albrecht Hennig
Lahan Eye Hospital
C/o UMN
PO Box 126
Kathmandu
Nepal
Amar Agarwal
Director
Dr Agarwal’s Eye Hospital Pvt Ltd
19, Cathedral Road
Chennai-600086
India
Andrea M Izak
Department of Ophthalmology
Storm Eye Institute
Charleston SC
USA
Arif Adenwala
Consultant
Aditya Jyot Eye Hospital
Aashirwad, Vikaswadi, Dadar TT
Mumbai-400014
India
Arun Kshetrapal
Kshetrapal Eye Hospital and Research Centre
Kutchery Road
Ajmer-305001
India
Ashok Garg
Medical Director
Garg Eye Institute and Research Centre
235, Model Town, Dabra Chowk
Hisar-125005
India
Athiya Agarwal
Dr Agarwal’s Eye Hospital Pvt Ltd
19, Cathedral Road
Chennai-600086
India
Azimuddin Azim Siraj
Dr Agarwal’s Eye Hospital Pvt Ltd 19, Cathedral Road Chennai-600086
India
Clement K Chan
Southern California Desert Retina Consultant
PO Box 2467
Palm Springs CA 92263 USA
Cyres Mehta
Consultant
Mehta International Eye Institute Colaba Eye Hospital
Sea side, 147-Colaba Road Mumbai-400005
India
David J Apple
Director
John A Moran Eye Centre Department of Ophthalmology and Visual Sciences
5th Floor, University of Utah 50, North Medical Drive Salt Lake City
Utah-84132 USA
David Meyer
Professor and Chairman Department of Ophthalmology Faculty of Health Sciences University of Stellenbosch and Tygerberg, Academic Hospital South Africa
Edward Wilson
Professor and Chairman Storm Eye Institute Charleston SC
USA
Francisco J Gutiérrez-Carmona
Zarracin, 25-Urb La Berzosa
28240, Hoyo de Manzanares Madrid
Spain
Gaurav Shah
Consultant
Gaurav Laser Academy and Varsha Nursing Home 105-A, Patel Shopping Centre Chandavarkar Road Borivili(W)
Mumbai-400092 India
Geoffery Tabin
Associate Professor of Ophthalmology University of Vermont
College of Medicine
Burlington, Vermont USA
Gerald R Schultz
Assistant Clinical Professor Department of Ophthalmology Loma Linda University
Loma Linda
California USA
Haripriya Aravind
Aravind Eye Hospital Madurai
India
Jagannath Boramani
Surya Netralaya
51, 4th Floor, Shanti Centre Sector 17, Vashi
Navi Mumbai-400703 India
Jean-Marc Legeais
Hospital Hotel Dieu Service d’ophtalmologie
1, Place due Parvis Notre Dame 75181, Paris Cedex 04,
France
KPS Malik
Department of Ophthalmology Vardhman Mahavir Medical College and Safdarjung Hospital
New Delhi, India
K Thiruvenkata Krishnan
Aravind Eye Hospital Abhishekapakkam
Pondicherry-605007 India
Kamal Nagpal
Consultant Retina Foundation
Shahibaug, Near Underbridge Ahmedabad 380004
India
Kamal jeet Singh
Associate Professor, Ophthalmology 410, MLN Medical College Allahabad
India
Keiki Mehta
Medical Director
Mehta International Eye Institute Colaba Eye Hospital
Sea side, 147, Colaba Road Mumbai-400005
India
Liliana Werner
Assistant Professor
John A Moran Eye Centre
Department of Ophthalmology and Visual Sciences 5th Floor, University of Utah
50, North Medical Drive Salt Lake City Utah-84132
USA
Luther L Fry
Fry Eye Associates
PA/Ophthalmology
310, East Walnut Garden City Kansas-67846–2562 USA
MS Ravindra
Director
Karthik Netralaya
Ashok Nagar, 89, 7th Cross, NR Colony Bangalore-560050
India
Manish Nagpal
Consultant
Retina Foundation, Shahibaug
Near Underbridge, Ahmedabad 380004
India
Minu Mathen
Arvind Eye Hospital
Madurai
India
Nikhilesh Trivedi
Bhatera Road
Balaghat-481001
India
Nilesh Kanjani
Dr Agarwal’s Eye Hospital Pvt Ltd
19, Cathedral Road
Chennai-600086
India
PN Nagpal
Medical Director
Retina Foundation
Shahibaug, Near Underbridge
Ahmedabad-380004
India
Pandelis A Papadopoulos
Director
Ophthalmology Department
Athens Metropolitan Hospital
Medical Director
Diagnostic, Therapeutic and Research Centre
Ophthalmo-check, 42, Poseidon Ave
Paleo Faliro, 17561, Athens, Hellas
Greece
Paul Liebenberg
Faculty of Medicine
Department of Ophthalmology
Cape Town
South Africa
RD Ravindran
Aravind Eye Hospital
Abhishekapakkam
Pondicherry-605007
India
Ramesh Kshetrapal
Kshetrapal Eye Hospital and Research Centre
Kutchery Road, Ajmer-305001
India
Ranjit S Dhaliwal
Eye Infirmary
Hira Mahal, Radha Soami Marg
Nabha-147201
India
Ruchi Goel
Consultant
Hindu Rao Hospital
New Delhi
India
RM Shanbhag
Hon Prof of Ophthalmology
Grant Medical College, Mumbai
Hon Ophthalmic Surgeon
PD Hinduja Hospital
Mumbai
India
Sasikanth
Dr Agarwal’s Eye Hospital Pvt Ltd
19, Cathedral Road
Chennai -600086
India
Rupal H Trivedi
Storm Eye Institute
Department of Ophthalmology
Medical University of South Carolina
167, Ashley Avenue
Charleston SC
USA
Samuel L Pallin
Medical Director
The Lear Eye Clinic
10615 W, Thunderbird A100
Sun City, AZ 85351–3018
USA
Sanduk Ruit
Consultant
Tilganga Eye Centre
Gaushala, Kathmandu
Nepal
Shushmita
Consultant
Gaurav Laser Academy and
Varsha Nursing Home
105-A, Patel Shopping Centre
Chandavarkar Road
Borivili(W)
Mumbai-400092
India
SNatarajan
Medical Director Aditya Jyot Eye Hospital Aashirwad, Vikaswadi
Dadar TT, Mumbai-400014 India
Steve Charles
Charles Retina Institute
6401, Poplar Avenue, Suite 190 Memphis, Tennessee
USA
Steven G Lin
Southern California Desert Retina Consultant, Palm Springs
USA
Sunita Agarwal
15, Eagle Street
Langford Town
Bangalore (India)
Villa No.2, Roundhouse 3 Al Wasl Road
Dubai PB 9168 Dubai
Suresh K Pandey
John A Moran Eye Centre Department of Ophthalmology and Visual Sciences
5th Floor, University of Utah
50, North Medical Drive, Salt Lake City Utah-84132
USA
Tamer A Macky
Assistant Professor Department of Ophthalmology Cario University, Cario Egypt
Tobias H Neuhann
Founder and Medical Director Aam Augenklinik
AM Marienplatz Marienplatz 18, Munich Germany
Venkatesh Rengaraj
Aravind Eye Hospital
Abishekapakkam
Pondicherry-605007
India
Vidushi Sharma
RP Centre for Ophthalmic Sciences
AIMS
NewDelhi-110029
India
Yogesh Shah
Medical Director
Gaurav Laser Academy and
Varsha Nursing Home
105-A, Patel Shopping Centre
Chandavarkar Road
Borivili(W) Mumbai-400092
India