Ординатура / Офтальмология / Английские материалы / Master's Guide to Manual Small Incision Cataract Surgery (MSICS)_Garg_2009

Foreword

In this 21st century, blindness is still one of mankind major scourges and cataract is the most common cause of curable blindness in over 50 million people worldwide. There in lies the global ophthalmic communities daunting present and future challenge.

Visual rehabilitation through cataract surgery has made gargantuan strides over the past 30 years. These three decades were preceded by a drawn out period of gradual surgical changes and difficulties, namely switching from extracapsular to intracapsular extraction, sand bags and prolonged bed confinement, functionally crippling aphakic glasses, intraocular lens failure to name but a few. Then came a period of unprecedented advances such as the evolution of fine sutures, incorporating the operating microscope and microsurgical techniques, the rediscovery of extracapsular surgery (including

Kelman phacoemulsification), refinement of intraocular lens design and manufacture, small incisions, and the advent of viscoelastics. With these and other advances cataract surgery evolved from highly successful procedure to a miracle operation. A short, painless outpatient procedure with rapid visual recovery! Yes, a miracle procedure! Inspite of phenomenal surgical outcomes, cataract surgery is generally under appreciated.

What we can do today is so impressive! Thanks to Macpharland for we don’t need sutures most of the time. We can operate on steep meridian to reduce astigmatism, reduce dependence on glasses with monovision, multifocal or accomodating implants, do combined procedures for glaucoma, corneal dystrophy and astigmatism. We can do all the above with implementation of relatively inexpensive manual small incision techniques and instrumentation and with the use of viscoelastics.

These techniques that are presented in the following chapters have more in common with each other than differences. The main similar characteristics are found in the small incision cascades which includes the scleral or corneal tunnel incision, anterior capsulotomy, hydrodissection, nucleus fragmentation and fragment removal, removal of the residual epinucleus and cortex and finally intraocular lens implantation. These maneuvers have a common thread, they are performed manually through suture free small incisions.

Incorporating tunnel wound architecture provides us maximum flexibility in planning our surgery as well as during the performance of surgery. Optimal tunnel construction is a mandatory prerequisite for smooth and efficient performance of the rest of the surgical cascade. Careful planning and execution allows one to handle proficiently every cataractous contingency from the softest to the hardest and darkest cataract.

The manual small incision fragmentation techniques described in the subsequent chapters produce superb outcomes that are indistinguishable from those of phacoemulsification.

High-tech and expensive cataract equipment is not currently available in many areas of our planet. Using manual small incision techniques, ophthalmologists in every corner of the world can provide their patients world class visual results. Manual small incision techniques are very relevant for us today and will likely to remain relevant for the foreseeable future.

I wish to congratulate the Chief Editor Dr Ashok Garg and the Associate Editors Dr Amulya Sahu, Dr Francisco J Guiterrez Carmona, Dr Carlos Infantes, Dr Keiki Mehta, Dr CS Dhull, Dr MS Ravindra and Dr RS Dhaliwal for their wonderful efforts to assemble these outstanding contributions and to nurture this valuable treatise to fruition so that we and our colleagues can enhance our knowledge as well as our skills.

Peter G Kansas MD FACS

Clinical Professor of Ophthalmology Albany Medical College, Albany, New York President, Kansas Eye Surgery Associates PC 24, Century Hill Drive, Latham, New York 12110, USA Ph. 518 439 6696, e-mail: pkansas@gmail.com

Preface

Ophthalmology has undergone tremendous advancements in the last two decades worldwide. Cataract Surgery especially Microphaco, Microcoaxial phaco is most commonly performed by Eye Surgeons worldwide with excellent results but with a tag of high cost. Manual Small incision cataract surgery (MSICS) has emerged as best alternative to phacoemulsification which retains most of the advantages of phacoemulsification delivered at a lower cost even in high volume cataract surgery and in rock hard cataracts.

MSICS achieves best unaided visual acuity with rapid postoperative recovery and minimal complications. MSICS is certainly a desirable modern goal. MSICS is the effective and best way of removing larger back log of cataract surgery especially in developing countries at an affordable cost with best visual results. Ophthalmologists who decide to opt MSICS technique shall find it in their best way. Some may opt it to maintain the small incision whenever phaco fails or in dense cataracts. While some may decide to use the MSICS technique for all cataract cases with equal ease as phaco.

The book has been conceptualized and written with the sole idea to provide comprehensive details of all available MSICS techniques in the world under one umbrella. The International Masters of MSICS have shared their experiences in form of chapters in this unique book. Truly this book shall serve as Master’s Guide to Manual Small Incision Cataract Surgery. A DVD provided with this book, shows various MSICS techniques being performed by leading experts for the benefit of ophthalmologists who can master MSICS step by step sitting in their clinical chambers.

Hats off to our publisher Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (DirectorPublishing) and all staff members of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for their untiring efforts in the timely preparation of this useful book.

It is encouraging to witness the rapid rise of MSICS at an International level as a low cost alternative to Phaco Surgery which offers the smaller incision size of phaco with added benefit of not requiring expensive equipments.

We hope the present book on MSICS shall serve as Ready Reckoner to ophthalmologists worldwide who are interested to master this technique for the benefit of their cataract patients.

Editors

Contents