Fundamentals of
Clinical Ophthalmology
Series Editor:
Susan Lightman
Cataract Surgery
Andrew Coombes and David Gartry
Fundamentals of Clinical Ophthalmology:
Cataract Surgery
Fundamentals of Clinical Ophthalmology series
Cornea
Edited by Douglas Coster
Glaucoma
Edited by Roger Hitchins
Neuro-ophthalmology
Edited by James Acheson and Paul Riordan-Eva
Paediatric Ophthalmology
Edited by Anthony Moore
Plastic and Orbital Surgery
Edited by Richard Collin and Geoffrey Rose
Scleritis
Edited by Paul McCluskey
Strabismus
Edited by Frank Billson
Uveitis
Edited by Susan Lightman and Hamish Towler
Fundamentals of Clinical Ophthalmology:
Cataract Surgery
Edited by
ANDREW COOMBES
St Bartholomew’s Hospital and The Royal London Hospital, London, UK
DAVID GARTRY
Moorfields Eye Hospital, London, UK
Series editor
SUSAN LIGHTMAN
Department of Clinical Ophthalmology,
Institute of Ophthalmology/Moorfields Eye Hospital,
London, UK
© BMJ Publishing Group 2003
BMJ Books is an imprint of the BMJ Publishing Group
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise,
without the prior written permission of the publishers.
First published in 2003
by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR
www.bmjbooks.com
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0 7279 1201 1
Typeset by SIVA Math Setters, Chennai, India
Printed and bound in Malaysia by Times Offset
Contents
Contributors |
vii |
|
Preface to the Fundamentals of Clinical Ophthalmology Series |
ix |
|
Preface |
xi |
|
Acknowledgements |
xiii |
|
1 |
Teaching and learning phacoemulsification |
1 |
2 |
Incision planning and construction for phacoemulsification |
11 |
3 |
Capsulorhexis |
25 |
4 |
Phacoemulsification equipment and applied phacodynamics |
36 |
5 |
Phacoemulsification technique |
46 |
6 |
Biometry and lens implant power calculation |
66 |
7 |
Foldable intraocular lenses and viscoelastics |
84 |
8 |
Non-phacoemulsification cataract surgery |
102 |
9 |
Anaesthesia for cataract surgery |
115 |
10 |
Cataract surgery in complex eyes |
125 |
11 |
Vitreous loss |
158 |
12 |
Postoperative complications |
168 |
v
CONTENTS |
|
|
|
|
|
|
|
13 |
Cataract surgery in the Third World |
193 |
|
14 |
Cataract surgery: the next frontier |
200 |
|
Index |
208 |
|
|
|
|
|
|
vi
Contributors
Charles Claoe
Consultant Ophthalmologist
Harold Wood Hospital
Essex, UK
Andrew Coombes
Consultant Ophthalmologist
St Bartholomew’s Hospital and The Royal London Hospital
London, UK
Jack Dodick
Chairman of the Department of Ophthalmology
Manhattan Eye, Ear and Throat Hospital
New York, USA
Jonathan Dowler
Consultant Ophthalmologist
Moorfields Eye Hospital
London, UK
David Gartry
Consultant Ophthalmologist
Moorfields Eye Hospital
London, UK
Peter Hamilton
Consultant Ophthalmologist
Moorfields Eye Hospital
London, UK
Colm Lanigan
Consultant Anaesthetist
Lewisham Hospital
London, UK
Thomas Neuhann
Consultant Ophthalmologist
Munich, Germany
vii
CONTRIBUTORS
Marie Restori
Consultant Medical Physicist
Moorfields Eye Hospital
London, UK
Paul Rosen
Consultant Ophthalmologist
The Radcliffe Infirmary
Oxford, UK
Helen Seward
Consultant Ophthalmologist
Croydon Eye Unit
Surrey, UK
Hamish Towler
Consultant Ophthalmologist
Whipps Cross Hospital
London, UK
Sarah-Lucie Watson
Specialist Registrar
Moorfields Eye Hospital
London, UK
David Yorston
Specialist Registrar
Moorfields Eye Hospital
London, UK
viii
Preface to the
Fundamentals of Clinical Ophthalmology series
This book is part of a series of ophthalmic monographs, written for ophthalmologists in training and general ophthalmologists wishing to update their knowledge in specialised areas. The emphasis of each is to combine clinical experience with the current knowledge of the underlying disease processes.
Each monograph provides an up to date, very clinical and practical approach to the subject so that the reader can readily use the information in everyday clinical practice. There are excellent illustrations throughout each text in order to make it easier to relate the subject matter to the patient.
The inspiration for the series came from the growth in communication and training opportunities for ophthalmologists all over the world and a desire to provide clinical books that we can all use. This aim is well reflected in the international panels of contributors who have so generously contributed their time and expertise.
Susan Lightman
ix
Preface
Cataract surgery is a dynamic and complex field and is, without doubt, a fundamental part of ophthalmology. This book aims to cover the subject comprehensively, particularly the technical aspects of learning, performing, and teaching phacoemulsification. The inclusion of chapters on the Third World and the future of cataract surgery provide the reader with a broader perspective.
The structure of the text, cross-referencing between chapters, and a detailed index minimise repetition. For example, intraoperative complications are discussed within the relevant individual chapters on technique (although vitreous loss and the dropped nucleus have a chapter devoted to them), whereas postoperative complications are grouped together. For those who would like more detail, the text has been thoroughly referenced.
Inevitably, some knowledge has been assumed and some detail omitted, but we hope that this book will be useful to both trainees and established cataract surgeons.
Andrew Coombes and David Gartry
xi
