Index 963

Index

A

Acetylation polymorphism 37 Alpha chymotrypsin 186 Aminoglycosides 461

Anesthesia for cataract surgery 143

anesthesia for children 145 complications 145

general anesthesia procedure 144 local anesthesia 146

method of anesthesia

induction 144 maintenance 145

Anterior chamber maintainer 362 Anterior segment complications in SICS

anesthetic 469

chemosis 470

globe perforation 470 retrobulbar hemorrhage 469 subconjunctival hemorrhage 470

during cortical aspiration 476

posterior capsular rupture 477 retained lens matter 476

during hydroprocedures 473 during nucleus delivery 473

damage to corneal endothelium 475 dropped nucleus 475

incomplete rotation of nucleus in the bag 474 small CCC 473

postoperative 480

corneal complications 482 related to anterior capsulotomy 472

can opener capsulotomy 473 continuous curvilinear

capsulorhexis 472

related to intraocular lens 479 shallow anterior chamber 479 wound related

deep incision 470

depth of the incision 470

detachment of Descemets’s membrane 471

Index 964

iris prolapse 472 scleral disinsertion 471 superficial incision 470

Antibiotics 461 Antiinflammatory drugs 464 Antisepsis 130

Astigmatic neutral zone 374 Astigmatism in SICS 496

astigmatically neutral funnel 498 distance from cornea 498

effect of surgery 497 entry point at cornea 498 incision type 497

length of the incision 498

managing preexisting astigmatism 498 with the rule and against the rule 497

Atkinson block 148

B

Biometer 106

Blackspots 82 Blood agar 138

Blumenthal’s technique 344

advantages of the technique 351 anterior chamber maintainer 345 capsulotomy 345

closing up 350 cortical cleanup 349

hydroprocedures and nucleus prolapse 348 IOL insertion 350

nucleus expression 348 principle 345

scleral incision 346

side ports and ACM port 345 tunnel and internal opening 347

Boyle’s apparatus 120 BSS plus solution 185

C

Capsular bag 291 Capsular bag filling 196

Capsulorhexis 194, 281, 443 complications 287

captured viscoelastics 288 discontinuity of the capsulorhexis 287 insufficient capsulorhexis size 287 tear into the zonula 287

difficult cases 285

broken posterior capsule 286

capsules of infants, children and juveniles 285

Index 965

capsulorhexis in calcified capsules or anterior flaps 285 pigmentosa 285

posterior capsulorhexis 285 pseudoexfoliation syndrome 285 small pupil 285

uveitis 285

disadvantages 288 forceps technique 283 history 281

needle technique advantages 282

Capsulorhexis size 285 Capsulostripsis 284 Cataract 22

congenital 23 diabetic 20 infantile 23

Cataract formations 38, 61, 82

biochemical alterations in lens 62 deposition of extraneous materials 62 granular material deposition 62

lens epithelium opacification 62 lens fibers opacification 61

new opaque fibers development 62 pigment accumulation 62

Cataract in diabetic adults 33 Cataract surgery 211

in pediatric patient 196 Causes of age related cataract 26

drug related factors 46

allopurinol 48 amiodarone 49 antimalarial drugs 49 corticosteroids 46

diuretics and antihypertensives 49 hypocholesterolemic drugs 49 phenothiazines 48

environmental factors 45 metabolic factors

diabetes mellitus 32 personal factors 26

body mass index 27

education and marital status 27 gender 26

social factors 28

alcohol 30 smoking 28

systemic diseases

dehydrational crisis 44 hypertension 44

Index 966

renal failure 45 Cautery 259

Caveats 272 Cephalosporins 461 Chondroitin sulfate 183 Choroidal detachment 493 Classification of cataract 62

acquired 70 anterior polar 69

associated with systemic diseases 80 capsular 62, 67 chlorpromazine-induced 78 complicated (secondary) 80 congenital 66

congenital membranous 68

copper (chalcosis) and iron (siderosis) 79 coronary 69

cortical 63 cortical senile 71

cuneiform or soft 71 developmental 69 diabetic 75 electrical 79

embryonic nuclear 67 galactokinase deficiency 75 galactosemic 75 hypermature 65

morgagnian 65 sclerotic 65 senile 73

hypocalcemic 76 immature 65

in Fabry’s disease 76 in Lowe’s syndrome 76 in mannosidosis 76

in myotonic dystrophy 76 in Wilson’s disease 76 intumescent 65

lamellar 67

lamellar (zonular) 64 mature 65 metabolic 75 miotics-induced 78 nuclear 64

nuclear senile 74 nutritional 76 posterior polar 69 punctate 69 radiational 79 senile 70

senile nuclear 70

Index 967

steroid-induced 77 subcapsular 63 subcapsular senile 70 supranuclear 64 sutural 65, 68 syndermatotic 79 total congenital 68 toxic 77

traumatic 77 zonular 69

Cleaning 133, 138 Clear-corneal incisions 254 Cleavage of lens structure 194 Collagen 184

Colored halos 82

Computerized videokeratography 210 Conjunctival flap 442

Conjunctival flap retraction 484 Conventional cataract surgery 400 Cornea 208

normal 210 Cortex removal

aspiration 301

automated 302 manual 302

expression hydro-expression 301 visco-expression 301

Cortical aspiration 302 method 303

subincisional cortex 304

with anterior chamber maintainer 303 with I/A cannula 303

precautions 306

management of anterior capsular tags 306 management of the capsule 306

posterior capsular adherence 306

Cortical cataracts 19 Corticosteroids 464 Culture rate 137

Cystoid macular edema 487, 503

chronic CME 507 diabetes and CME 508

diagnosis and natural course 506

fluorescein angiography 507 signs 506

symptoms 506 management

medical 488

Index 968

surgical 489 pathophysiology 503 posterior capsule status 505 surgical factors 504 treatment 508

argon laser photocoagulation 509 carbonic anhydrase inhibitors 508 corticosteroids 508

hyperbaric oxygen 509

Nd: YAG laser vitreolysis 509 nonsteroidal antiinflammatory drugs 508 pars plana vitrectomy 509

vitreous disturbance 505

D

Decontamination 130

Defects in the lens capsule 542 Density of the cataract 109 Diagnosis of glaucoma 440 Diathermy capsulotomy 284 Disinfection 130, 132 Dislocated IOLs 492 Dislocated lens material 543 Distortion 82

Double wire snare 430

Double wire snare splitter technique 429 surgical technique 430

Down’s syndrome 80 Dyslipidemia 34 Dystrophia myotonica 80

E

Endophthalmitis 490, 547 clinical features

acute postoperative 547 chronic postoperative 548 endogenous 549

diagnosis 549 intravitreal injections 550 medical treatment 549 role of vitrectomy 491 vitrectomy

advantages 550 core vitrectomy 553

culture and sensitivity testing 553

infusion cannula versus infusion sleeve 552 IOL removal 552

limbal or pars plana approach 552 pupillary membrane 552

Index 969

timing 550

wound closure 550

Epinucleus 291 Epinucleus removal 300

aspiration

automated 301 manual 301

expression

hydro-expression 300 visco-expression 300

Etiology of infantile cataract 24

genetic 24 idiopathic 26 infectious 25

laser photocoagulation 26 medications 26 metabolic 25 prematurity 26

radiation induced 26 trauma 26

Extracapsular cataract extraction 91, 211

F

Favit 511

complications 517 technique 512

anesthesia 514

Filtration 132 Fishhook technique 417

technique 418

capsular opening 419 completing the surgery 420 hydrodissection 419 nucleus hook extraction 419 nucleus mobilization 419 tunnel construction 418

Fluoroquinolone group 461

Focused electromagnetic field technology 103 Foldable IOL 212

G

25 gauge IOL forceps 534 Glare 82

Glaucoma 42 Glaukomflecken 81 Grieshaber snare 534

H

Haptic externalization 535

Index 970

Hook 417

Human crystalline lens

anatomy-histology 5 as an osmometer 14 growth 6

Human lens 290 surgical anatomy 291

Hyalectin 182 Hyaluronidase 187 Hydrodelineation 294

advantages 296 classification 294 precautions 296 technique 295

Hydrodissection 292, 443

advantages 294 classification 292 technique 292

Hydrogel intraocular lenses 330 Hydroprocedures 291

complication 296 history 291 instruments 291

Hyphema 483

Hypotony 484

I

Image blur 82

Incisions for cataract surgery 275 Intact lens 524

Intracapsular cataract extraction 91 Intracapsular cryoextraction 93 Intraocular lens

anterior chamber 532 posterior chamber 532

closed eye or internal approach 533 location 532

opened eye or external approach 533 scleral loop fixation 533

Intraocular lens implantation 546 IOL formula

Binkhorst 106

regression (empirical) 107 Sanders-Retziaff-Kraff 107 theoretical 106

IOL implantation 196, 315

instruments 316 technique 316

lens implantation 318

Index 971

lens insertion 318 IOL postoperative refraction

binocular correction 108 monocular correction 108

IOL power calculation 109 Iridectomy 444 Iridodialysis 479

Iris prolapse 481 Iris shadow test 83 Iritis 482

Irrigating solutions 185

extraocular 186 intraocular 185

Irrigating vectis 388 Irrigation and aspiration 196

J

Jaws slider pincer technique 422

instruments 423 technique 423

Juvenile diabetic cataract 32

K

Keratometry 209

Keratoscopy 209 Kuglin hook 266

cortex aspiration 270

L

Laser cataract surgery 96 Laser phakonit 101 Learning curve 421 Lens 8

active transport processes 15

amino acids 16 ascorbic acid 17 cation 15

glutathione-sulfhydryl proteins 16 lipids 17

water and electrolyte 15

applied physiology 19 biochemistry 13 capsule 8

epithelial cells 8

glucose metabolism 17, 18 proteins 14

substance (cortex and nucleus) 9

Lens fragments 524 Leukokoria 83

Index 972

Limbal relaxing incision 259

Loss of vision 82

M

MacConkey’s agar 137 Maddox rod test 86 Management of cataract 84

anesthesia for cataract surgery

general 87 local 87

medical treatment 84

measures to delay cataract progression 84 measures to improve vision 84

removal of cataractogenic factors 84 surgical treatment

indications 85 preoperative evaluation 85

preoperative medications 86 Management of dislocated lens 524

dislocated lens fragments 529 surgical techniques 525

pars plana vitrectomy 526 phacofragmentation 526 posterior cryoextraction 528 removal by endoscopy 529

removal by perfluorocarbon liquid 528 timing of surgery 525

Manual multiphacofragmentation 356 surgical technique

anterior capsulotomy 357 extraction of the cortex 359

hydrodissection and luxation of the nucleus 358 incision 357

IOL implantation 359

manipulation of nuclear fragments 359 nuclear fragmentation 358

wound closure 359

Manual phacofragmentation 361

Manual small incision cataract surgery 239, 241, 244, 388, 499, 519 difficult situations 392

cataracts with existing filtration blebs 396 cataracts with pseudoexfoliation 396 hard black cataract 395

small pupil 393 subluxated cataracts 396 white cataract 394

intraoperative complications

capsulotomy 500 iris trauma 501

Index 973

nuclear luxation 500

rupture of the posterior capsule 501 wound construction 500

irrigation-aspiration of the cortex 391 management of hard cataracts 391

nucleus prolapse through can-opener capsulotomy 519 nucleus prolapse through capsulorhexis

intracapsular flip 520

partial hydroprolapse and wheeling 520 postoperative complications

corneal edema 501

high intraocular pressure 502 postoperative endophthalmitis 502 shallow anterior chamber 501

preoperative assessment

clinical examination 245 retinal function tests 245

preoperative medications 247 surgical procedure

capsulotomy 389 nucleus removal 389 peritomy 388 scleral tunnel 389

side port incision 389

techniques for specific type of cataracts 521

bimanual technique 522

hard brown/black cataracts 521 hypermature cataracts 521 mature cortical cataracts 521 small pupil approach 522 subluxated cataracts 522

Memory lens 332 Methylcellulose 183

adverse reactions 184 indications 184

Methylcellulose 464

Mini nuc cataract surgery 458 Miotics 462

Modern cataract-intraocular lens surgery 620

future challenges 625

large incision cataract surgery and implantation of rigid lenses 620 small incision cataract surgery and implantation of foldable lenses 621

ultrasmall incision cataract surgery and implantation of rollable lenses 623

Modern tunnel incision cataract surgery 367 Modified blumenthal technique 436

ACM in phacoemulsif ication 439 assisted delivery 438

insertion of ACM 437 mini-incisional surgery 439

Index 974

phacofracture 438 phacosection 438

principle of the technique 437

Molding flash and silicone IOL 325 Mydriatics and cycloplegics 462 Myopia 41

Mystique of 4.00 mm 429

N

Nadbath block 149

No anesthesia cataract surgery 157 Non-foldable IOL 212

Nuclear emulsification 194 Nuclear sclerosis 20 Nucleus 291

Nucleus delivery in SICS 597

delivery in anterior chambers removal of nucleus out of the wound 598

Blumenthal technique 598

chop bisector/chop trisector technique 605 chopsticks technique 605

double wire snare splitter technique 609 fish hook technique 606

hybrid technique 607

jaws slider pincer technique 608

manual phacofracture Cardona’s technique 602 phaco sandwich technique 602

phacofracture 600

prechop manual phacofragmentation 604 quarters extraction technique 604

use of claw vectis 605

using of plain wire vectis 605 visco expression 599

Nucleus management 443 Nucleus management in SICS 309

complications 311

dropped nucleus 314 posterior capsular rupture 312 prolapse of iris 311

vitreous loss 314

delivering the nucleus 310 dislocating equator of the nucleus 309 fluidics of hydro-expression 310 fluidics of visco-expression 311 minification of the nucleus 310

role of ACM 311 Nutrient agar 138

O

O’Brien’s technique 87, 147

Ocular biometry

Index 975

axial length measurement 105 keratometric measurements 106

Ocular trauma 43

One-piece silicone plate IOL 538

Opacification of foldable hydrophilic acrylic lenses 581

Bausch and Lomb: hydroview 582 clinicopathological analyses 585

energy dispersive X-ray spectroscopy 586 gross and light microscopic analyses 585 histochemical stainings 586

medical developmental research 583 ophthalmic innovations 584

possible factors involved in the pathological mechanism 587 prevention and treatment 591

scanning electron microscopy 586 Ophthalmic dyes for anterior capsulorhexis 218

capsulorhexis in absence of red reflex 218 clinical application 222

guidelines for surgeons 222

use of ophthalmic dyes in CCC 219

Ophthalmic dyes for pediatric cataract surgery 233 Ophthalmic dyes for phacoemulsification 227

dye-enhanced phacoemulsification 227 learning critical steps of phaco-emulsification

CCC 229

cortical clean-up 230 hydrodissection/hydrodelineation 229 nuclear emulsification 230

possible clinical application and future trials 230 Ophthalmic dyes for posterior capsulorhexis 230

clinical application 231

dye-enhanced posterior capsulorhexis 231 Ophthalmic viscosurgical devices 190, 463

classification 191, 192

high viscous 191 lower viscosity 191 viscoadaptive 193

clinical applications 194

for intraocular delivery of dyes 198 in cataract surgery 194

in glaucoma surgery 196

in topical ophthalmic anesthesia 199 complications 202

capsular bag distension syndrome 203 capsular block syndrome 203 crystallization on the IOL surfaces 202 increase in intraocular pressure 202 pseudo-anterior uveitis 203

removal 199

Index 976

Orbicularis oculi akinesia 87, 147

Orbscan 210

P

Parabulbar (flush) akinesia 154 Pediatric cataract 612

intraocular lens surgery 613

future 618

past (1951 to 1989–90s) 613 present (1990s: to present) 615

Perfluorocarbon liquid 534, 545 Perforation of ciliary body Perforation of the globe 151 Peribulbar (periocular) technique 152 Peristaltic vs venturi pump 511 Peritomy 259, 372

Phaco anesthesia 158

Phaco sandwich technique 412

complications 416 instrumentation 412 preoperative preparation 412 surgical technique

capsulotomy 413 cortical cleanup 416 hydrodissection

hydrodelineation 414

IOL implantation 416 nuclear delivery 415 nuclear luxation 415 wound closure 416 wound construction 413

Phacoemulsification 93 Phacofracture technique 353

anesthesia 354 capsulorhexis 354 complications 355 hydroprocedure 354 incision 354 nuclear luxation 354 nucleus delivery 355

Phacosection technique 367

anesthesia 368

anterior capsulotomy 376 cortical aspiration 382 entry into the eye 371

fluidics and open and closed chamber concepts 375 guidelines for beginners 386

implantation of intraocular lens 384 instrumentation 369

nucleus management 378

Index 977

patient selection 368 preparation 368

Phacotmesis 103

Phakonit 95, 216 technique 624

Polyacrylamide 184 Polylethylmethacrylate 320

biocompatibility 321

IOL and surface processing

coating with a deposit 322 grafting on new molecules 322

heparin surface-modified lenses 322 lenses treated with cold plasma CF4 324 surface passivated intraocularlenses 324 Teflon-coated lenses 322

treating of the surface 322

Polypeptides 461

Posterior capsular opacification 485 Posterior capsular polishing 307 Posterior capsule opacification 555

analysis of ND: YAG posterior capsulotomy rates 567

clinical manifestations 558 etiopathogenesis 556 pharmacological prevention 563 prevention 558

three IOL-related factors 561

barrier effect of the IOL optic 562 biocompatibility 561

maximal IOL optic posterior capsule contact 562 three surgery related factors 558

capsulorhexis edge on IOL surface 561 hydrodissection-enhanced cortical clean-up 558 in-the-bag (capsular) fixation 561

Povidone iodine (halogens) 462 Pseudophakic bullous keratopathy 484 Pseudophakic lasik 111

Pupillary capture 480

R

Retinal detachment 493

Retinal vascular obstruction 151 Retro-ocular (retrobulbar) injection 89, 149

complications 150 Gills-Loyd modified 150

S

Scleral punch technique 443

Scleral tunnel 442

Index 978

Sclerectomy 443 Sclerosis 11

Secondary cataract 43 Senile cataractogenesis 19 Shafing syndrome

SICS in pediatric cataracts 447

postoperative medications 454 surgical procedure anesthesia 448

anterior capsulectomy 450 management of posterior capsule 453 primary IOL implantation 452 removal of lens matter 451

selection of IOL power 453 tunnel incisions 449 viscoelastics 449

Silicone for IOL 325

biocompatibility 326

discoloration and capsular opacification 328 surface modification 328

Small incision manual technique 257

anterior capsulotomy 260 hydrodissection 263 incision 258

nucleus delivery 263 small pupils 260

Small incision non-phacoemulsification 440

antimetabolites 445

combined trabeculectomy indications 441

preoperative evaluation 441 technique 442

complications

intraoperative 445 postoperative 446

Small incision sutureless cataract surgery 401 temporal small incision extracapsular surgery 404

astigmatic change 405 complications 406 methods 405

refraction and visual acuity 406

Small pupil or miosis 474 Snellen visual acuity 83 Snow flake cataract 32

Snowflake or crystalline opacification 578 study of explanted lenses 579

Sodium hyaluronate 180, 183, 463

administration and dosage 181 advantages 181

adverse reactions 182 dosage 181

Index 979

indications 180 precautions 182

Soft acrylic IOLS 332, 329

hydrophilic 332 hydrophobic 333 surface quality 334

Soft shell technique 192 Spaeth block 148 Steam sterilizers 130 Sterilant gases 132 Sterilization 112, 130

areas 115 history 113

operating room air 115

operating room linen and accessories 123

linen 123

probes and tubings 126 operating room macroinstruments 117

microscope 118 phaco machines 118

operating room microinstruments 120

autoclave 123 boiling 122

cidex or glutar aldehyde 121 ethylene oxide 122 isopropyl alcohol 121

liquid soap and sterile water 120 sterile water 121

ultrasonic cleansing 121 operating room personnel 126

cap and mask 129 clothing 127 footwear 127

operating room walls, floor, ceiling and fixtures 117 operating room water 116

patient

change of clothes 129

skin and incision site disinfection 129 sterile disposable surgical drape 129

Sterilization and disinfection policy 136 Sterilization control 139

Sterilizers 129 Subarachnoid injection 152 Subtle signs 83 Superficial cortex 291 Superior rectus 372

Superior rectus injection 89, 154 Surgical enzymes 186

Surgical psychodynamics 542 Sutureless cataract incisions 251

Index 980

common denominator 252 properties 252

T

Tenon’s capsule injection 90, 154 Topical anesthesia 90, 154, 457

advantages 156, 458 case selection 458 disadvantages 156, 458 indications to use 155

ocular complications of retro/peribulbar anesthesia 457 techniques of ophthalmic anesthesia 457

Topography 208 Tunnel incision 373

U

UGH syndrome

Uniocular polyopia 82

Urokinase 187

Uveitis 43

V

Van Lint’s akinesia 88, 147 Viscoanesthesia 199 Viscoanesthesia solution 160

current study 167

evaluation of endothelial toxicity 161 experimental study 163

removal time of viscoelastic/viscoanesthetic solutions from the capsular bag 169

current in vitro study 172 evaluation of the toxicity 174 in vitro experimental study 170

toxicity to intraocular structures 165

histopathological examination 166 in vitro animal study 165

surgical procedure 165

Viscoat 183 Viscocanalostomy 196 Viscoelastic substances 178

commercially available 180 criteria for selection 179 indications 179

Viscostaining of the anterior lens capsule 198 Viscosurgery 189

Vitrectomy 489 Vitreous hemorrhage 489 Vitreous loss 543 Vitritis 494

Index 981

W

Windshield Wiper syndrome 480

Wound construction for small incision manual surgery 276

complications during wound construction 278 conversion to standard ECCE wound 279 design and architecture of wound 276 dimensions of wound 276

pre-existing astigmatism 277 procedure of wound construction 277

anesthesia 278 instruments used 278

technique 278

site of wound 276 stability of the wound 277

Z

Zonular dehiscence 474