Index

A

Accurus surgical system (ALCON) aspiration, 81

biaxial anterior vitrectomy, 82 biaxial irrigation/aspiration, 82 external forced infusion, 76 financial benefits, 80

fluid inflow, 76

internal air pump, 77–79 internal forced infusion, 76–77 irrigation, 81

multifunctional hybrid surgical possibilities, 80 phacoemulsification, 81–82

phaco settings, 79 surgical parameters, 81–82

venturi-based aspiration system, 79–80 Acri.Comfort 646TLC bitoric intraocular lens, 268 AcriFlex MICS 46CSE intraocular lens, 215, 216

Acri.LISA 366D biconvex diffractive-refractive single-piece intraocular lens, 268–269

AcriTec intraocular lenses bifocal IOL, 268–269 bitoric IOL, 268 implantation techniques, 269 materials, 266–267

optical design, 267–268

Abbot medical optics (AMO) Signature BMICS, 88, 89

chamber stabilization environment (CASE ), 87–88 CMICS, 88

Ellips technology, 87

Age-related eye disease study (AREDS), 257 Akahoshi super micro combo prechopper, 31 Akreos AO MI60 intraocular lens, 213, 269–270 Alcon infiniti system

BMICS, 86–87

machine fluidics, tip size, 84–86 setting up, 84

technology, 84

ultrasound and modulation setting, 86

American Society of Cataract and Refractive Surgery (ASCRS), 157–159

Antibiotic prophylaxis intracameral injection, 158–159 subconjunctival injection, 158 topical antibiotics, 157

Anti-vaulting haptic (AVH) technology, 271 Aspheric intraocular lenses, 210

aberration frequency distribution, 251–252 AcrySof IQ IOL, 249

aspheric correction, 250 benefits, 249–250 feasibility study, 254

performance limitations, 254–255 power calculation, 251

predicted vs. measured wavefront, 253 preoperative vs. post operative aberration, 254 pseudophakic IOL, 249

selection, 250–251 shrink wrap effect, 252 spherical aberration, 249 Tecnis IOL, 249

Auxiliary instruments

gas forced infusion, 34–35 scissors, 34

surge prevention, 35

B

Beehler pupil dilator, 100

Biaxial micro incision phacoemulsification (BiMICS).

See also Incomplete capsulorhexis, biaxial phaco; Vitreous loss

advantages, 146–147 Alcon infiniti, 86–87 AMO signature, 88, 89

capsulorhexis construction, 97

chamber stability, surgical control, 96–97 chopping techniques, 98

cortical cleaving hydrodissection, 97 disadvantages, 147–148

high myopia, 163

1.2 mm incision, 144–145 incision construction, 97 instruments, 173 intraocular cautery, 173

intraoperative floppy iris syndrome (IFIS), 168–170 iris bombé, 170–171

irrigating choppers, 97–98 irrigation flow, 95

large iridodialysis and zonular defects, 167–168 lens removal, 96

mature cataract, 164–165

microcornea, 167

posterior capsule rupture, 165–166 posterior polar cataract, 163–164 posterior subluxated cataract, 164 pseudoexfoliation, 166

punctured posterior capsule, 165 refractive lens exchange, 171–172 rock-hard nuclei, 166–167

stellaris vision enhancement system, 92–93 surgical technique, 144–146

switch hands ability, 95–96, 167 very shallow anterior chambers, 171

Biaxial prechop technique, 181–183 Bimanual MICS technique, 12–13 BiMICS vs. CoMICS

advantages/disadvantages, 153, 155 astigmatism, 152, 153 capsulorhexis forceps, 152, 153 historical background, 150

incision-assisted IOL implantation, 154 instrumentation, 150, 151

IOL implantation, 152, 153 irrigation-aspiration, 151, 154 microphacodynamics, 150–151 phaco knives, 152

phaco machines, 152, 154 phaco pumps, 152, 154 phacotips, 152

set up, 149, 150

ultrasound power delivery, 152, 154 Blue light filtering intraocular lenses

AcrySof® Natural IOL, 258–259 age-related macular degenerative, 257–258 benefits and considerations, 261

clinical experience, 260–261

etiology and epidemiological studies, 258 HOYA IOL, 259

photochemical damage, 257–258 refractive lens exchange, 258 SoftPort AO lens, 259

uveal melanoma, 258 vision quality, 259–260 yellow barrier, 257 yellow chromophore, 258

C

Capsular bag lenses, 271–272 Capsule rupture, 165–166 Capsule tears, 188–191

Capsulorhexis, 28–29. See also Incomplete capsulorhexis, biaxial phaco; Microcapsulorhexis

hard cataract, 199–200 intumescent cataracts, 198–199 micro incisions, 133

Seibel Rhexis Ruler, 134

trypan blue capsule staining, 135 viscoelastic efflux, 134

zonular compromise, 133–134 CareFlex IOL, 215

Cataract surgery, 140–143. See also Hard and intumescent cataracts; Microincisional cataract surgery

Chamber stability

artificial eye, presssure dynamics, 58–59 time-integrated vacuum, 59

Clarity, cornea, 280

Clear corneal incisions (CCIs) construction technique, 109–112 endophthalmitis prophylaxis, 113

funnel-shaped incision vs. parallel-walled tunnel, 62–63 grooved incisions, 109, 110

hypotony, 109, 110 incision alteration, 108–110

single plane incision, 108, 110 stromal hydration, 111, 113

thermal incision damage (see Thermal incision damage) Coaxial microincision cataract surgery (CoMICS). See also

BiMICS vs. CoMICS fluidics, 52–54

incision size, 54–55 torsional ultrasound, 55

Collamer intraocular lenses, 266 Color perception, 259

Continuous curvilinear capsulorhexis (CCC), 177–179 Corneal aberrometry, 287, 288

Corneal astigmatism and aberrations, MICS incision. See also Induced corneal aberrations

control, 286–287 corneal aberrometry, 287 objective evaluation, 286

optical coherence tomography (OCT), 287 preoperative vs. postoperative outcomes, 287–289 sub 2 mm incision surgery, 289–290

surgical outcomes, 286

Corneal endothelium, safety issues. See also Endothelial cell loss (ECL)

biaxial MICS vs. phacoemulsification, 293–294 capsulorhexis, 294–295

cataract surgery incision, 292 cell loss management, 293, 294

coaxial and biaxial MICS, 294–295 corneal edema, 294

intraocular pressure, 294 microincision benefits, 292–293 occlusion, 294

wound burn, 293

Corneal incision burns, 279–280

D

Descemet’s tear, 279

E

Effective phaco time (EPT), 277–278 Elliptical phaco, 45–46

Endophthalmitis, 283–284. See also Infection prophylaxis antibiotic prophylaxis (see Antibiotic prophylaxis) antibiotic regime, 113

pathogenesis, 105 risk evaluation, 103

side-port incisions, 114 surgeon’s practice, 104

wound construction (see Wound construction) Endothelial cell loss (ECL)

biaxial MICS vs. phacoemulsification, 293–294 cataract density, 283

corneal damage, 283 harder cataracts, 294

MICS vs. coaxial phaco, 282 nucleus density, 293

phaco power, 294 power modulation, 294

Energy emission, thermal damage infrared thermal image, 200 kick, 119

longitudinal movement, 119–200 micropulse settings, 119

thermal inertia, 119 tip temperature, 200

transient cavitation, 119

European Society of Cataract and Refractive Surgery Surgeons (ESCRS), 158, 159

Extracapsular technique, 192

F

Fine/Hoffman microincision capsulorhexis forceps, 29, 145 Fine Ikeda super micro capsulorhexis forceps, 29

Fish mouth phenomenon, 224 Flat instruments

linear incision, 35 wound integrity, 35–36

Fluidics

aspiration efficiency, 57–58 aspiration flow, 52 aspiration rate, 43

vs. biaxial MICS, 53 cadaver eye model, 53–54 chamber stability, 58–59 high vacuum settings, 52

holdability, 59–62 (see also Holdability, fluidics) incision configuration, 62–63

inflow, 42

infusion-assisted high-flow high-vacuum phacoaspiration, 65–66

irrigation flow, 52

Oertli OS3 and Oertli CataRhex SwissTech platforms, 66–67

outflow, 42–43

phaco technique, 63–65 physical considerations, 57–62

Frequency, 37

Fukasaku hydrochop canula, 31

G

Giannetti MICS capsulorhexis forceps, 29

H

Hard and intumescent cataracts biaxial technique, 196 capsulorhexis, 198–200 hydrodissection, 200–201 incision, 196–198

microbiaxial technique, 205–206 phacoemulsification, 201–205 types, 196

Healon 5, 167–169 High myopia, 163 Holdability, fluidics

bigger needle opening, 60 bottle height, 60 definition, 59, 60

Oertli instruments, 60–61

phaco hand piece scheme, 59–60 vacuum settings, 60

Holladay II formula, 251 HOYA intraocular lenses

blue light filtering IOL, 259 Hoya Y-60H MICS IOL, 215–216

Hybrid pump, 43 Hydrodelineation, 163–164

advantages, 137 cannula placement, 137

epinuclear rim trimming, 137–138 posterior cortex, 138, 139 viscodissection, residual cortex, 138

Hydrodissection, 179–180 cortical cleavage, 136–137

hard and intumescent cataracts, 200–201 IFIS, 168

refractive lens exchange, 171 Hydrosurgery, 179–180 Hydroview iris protector ring, 101 Hyperopic correction, 274–275

I

Incision burns, 279–280

Incision configuration. See also Clear corneal incisions (CCIs) advantages and disadvantages, 63

small clear corneal incisions (CCIs), 62–63 soft infusion sleeve addition, 63 topographical stability, 62

Incision damage, 278–279. See also Thermal incision damage Incision quality

analysis, 298–304 biaxiality technique, 297 evaluation, 299, 304

incision imaging (OCT) outcomes, 304, 306–309 incision size reduction, 297, 298

OCT imaging assessment, 310–311

topographic and aberrometric outcomes, 306, 309 visual outcomes, 304, 305

Incision size

ex vivo study, 54 microincisions, 55 thermal protection, 54–55

Incomplete capsulorhexis, biaxial phaco biaxial anterior vitrectomy, 184–185 biaxial I/A, 184

biaxial prechop technique, 181–183 clinical manifestation, 175–176 hydrodissection, 179–180

lens salute position, 180–182 mechanical fragmentation, 183 positive IOP, 181, 183–184

Induced corneal aberrations coma, 281–282

modulation transfer function, 281 Scleral incision, 280–281 simulated keratometry values, 281 vectoral astigmatic analysis, 281

Infection prophylaxis antibiotics, 104 chemoprophylaxis, 104 endophthalmitis, 103

postoperative infection, 103–104 postsurgical endophthalmitis, 105 preoperative antibiotic prophylaxis, 105 risk evaluation, 102–104

sample protocol, 106–107 sterile preparation, 105–106

Infrared thermal image, 120

Infusion-assisted high-flow high-vacuum phacoaspiration, 65–66

Injectable polymers limitation, 274 liquid polymer, 274

residual refractive error correction, 275 silicone polymer, 274–275

Injectors

cartridges, 226–227 characteristics, 225–226 injector bodies, 227 objectives, 224–225 plunger, 227

principal sub-2 injector, 228–229 pushing system, 227

In-the bag implantation, 271 Intraocular cautery, 173

Intraocular lenses (IOL), 275. See also Multifocal intraocular lenses (MIOL)

biaxial microincisions vs. phacoemulsification technology, 263–264

clinical manifestation, 220–221 design, 222–223

haptic design, 223

hydrophilic acrylic materials, 222 incomplete capsulorhexis, 185 injectors, 223–229

IOL, 221–223 microincision definition, 221 optic design, 223

posterior barrier, 223 prerequisites, 221

sub-2 injection techniques, 230–234 technology, 51

visco elastic substances (VES) and injection, 229–230 Intraoperative floppy iris syndrome (IFIS)

biaxial microincision phacoemulsification, 168–169 coaxial irrigation, 169–170

endonucleus removal, 168–169 epinucleus removal, 169

hydrodelineation and hydrodissection, 168 small pupil, 170

subincisional cortical removal, 169–170

Intumescent cataracts. See Hard and intumescent cataracts IOLtech MICS lens, 214

Iridodialysis and zonular defects, 167–168

Iris bombé, 170–171 Iris surgery

inferiorly/distally sphincterotomy, 102–103 proximal sphincterotomy, 101–102 pupillary membrane dissection, 103 pupilloplasty technique, 103

superior sector iridectomy, 102 Irrigation/aspiration instruments

19 G instruments, 31–33

21 G instruments, 33–34

K

Kelman capsulorhexis forceps, 29

L

Lens salute technique, 180–182

Lester hook, 166

Lipofuscin, 258

Longitudinal ultrasound, 6–7

M

Malignant melanoma, 167–168 Malyugin ring, 101, 102 Mature cataract, 164–165 Microcapsulorhexis

biaxial micro-capsulectomy, 176–177 biaxial vs. coaxial approach, 176

CCC creation and performance, 177–178 initial capsule puncture, 176, 177 multiple capsular punctures, 179 multiple capsulectomy, 178–179

Micro-coaxial phacoemulsification (C-MICS) aspiration bypass system (ABS), 6

vs. conventional coaxial and bimanual techniques, 5–6 incision, architectural integrity, 6

smaller dimensions, 6 thermal protection, 6 torsional ultrasound, 9–10

Microcornea, 167 Microincisional cataract surgery

auxiliary instruments (see Auxiliary instruments) capsulorhexis forceps, 28–29

concept, 25

flat instruments, 35–36 incision, 27–28

irrigation/aspiration instruments, 31–34

prechopping, 30–31 (see also Prechopping instruments) 0.7 mm Microincisional cataract surgery (MICS) anterior vented gas forced infusion (AVGFI) system, 15 capsulorhexis, 18

conditions and application, 14 drawbacks, 14

fluid outflow, irrigating choppers, 15, 16

25-gauge transconjunctival sutureless vitrectomy, 21–22s glaucoma surgery, 20–21

hydrodissection, 18 incision, 18

irrigating instruments, 17–18 vs. 0.9 mm MICS, 16 phacoemulsification, 19–20 phaco tip, 16–17

prechopping, 18–19 pressured infusion, 14–15 principles, 14

vacuum level, 16

Micro-incisional cataract surgery intraocular lenses (MICS IOL)

AcriFlex MICS 46CSE IOL, 215, 216 AcriTec IOL, 266–269

Akreos AO MI60 IOL, 269–270

Akreos MI60 AO micro-incision IOL, 213 capsular bag stability and PCO rate, 217 CareFlex IOL, 215

Hoya Y-60H, 215–216 incision size, 209–210 injectable polymers, 273–275 IOLtech MICS lens, 214

MicroSlim and SlimFlex MICS IOLs, 214–215 Miniflex IOL, 216

optical quality, 216–219 Rayner IOL, 271–273 refractive index, 210 requirement, 209–210 Smart IOL, 265, 266

Staar Afinity IOL, 265–267 Tetraflex IOL, 270–271

TetraFlex KH-3500 and ZR-1000, 214 ThinOptX IOL, 264

ThinOptX MICS IOLs, 212–213 Zeiss–Acri.Tec MICS IOLs, 210–212

Microkeratome, 294–295 Microphthalmos, 167 Micro-pulse phaco, 45

MicroSlim and SlimFlex MICS intraocular lens, 214–215 Miniflex intraocular lens, 216

Mix and match implantation, 272 Morcher pupil dilator type 5S ring, 101 Morcher pupil expander ring, 169 Multifocal intraocular lenses (MIOL)

Acri.LISA characteristics, 244–245 Acri.LISA toric, 247

biometry, 247

defocus curve, 245, 246 halos, 246–247

intermediate distance vision, 246 near vision, 246

photopic contrast sensitivity, 245, 246 satisfaction score, 245, 247

visual acuity, 245, 246 Mydriasis, 100

N

Nichamin triple choppers, 30, 31 Non-longitudinal phaco

elliptical phaco, 45–46 micro-pulse phaco, 45 torsional phaco, 45, 46 Nucleus emulsification, 8–9

O

Occlusion, 44, 45, 294

Oertli OS3 and Oertli CataRhex SwissTech platforms

bimanual MICS, 66 coaxial MICS, 66 equipment, 66–67 machine settings, 67

One-hand chopper maneuvers, 30 Ophthalmic viscosurgical device (OVD), 294

capsular staining, 129–130 classification, 125–127

Fuchs endothelial dystrophy, 129 intraoperative floppy iris syndrome, 130–131 rheology, 125

routine, 126–128

soft shell technique (SST), 126 trabeculectomy, 128–129

ultimate soft shell technique (USST), 126 zonular deficiency, 129

Optical coherence tomography (OCT). See also Incision quality

MICS incision evaluation, 287 objective analysis, 286

P

Pars plana vitrectomy, 164, 171, 192 Phacoemulsification

aspiration fluid, 202

bimanual micro-incisional phaco, 47 chopping technique, 203–205 flipping technique, 204

incision leakage, 202 infusion rate, 201–202

micro-incisional coaxial phaco, 47–48 micro-incisional phaco, 47

vaccum levels, 202–203 Vejarano’s irrigating chopper, 202

Phaco power modification duration alteration, 40–41 emission alteration, 41–42 stroke length alteration, 40

Polar cataract, 163–164

Posterior assisted levitation (PAL) technique, 192 Posterior capsule opacification (PCO), 209 Post-occlusion surge (POS)

experimental setup, 72

Infiniti, Legacy, Millennium and Sovereign machines, 73 Stellaris vs. Signature machines, 73, 74

Postoperative endophthalmitis (POE)

antibiotic prophylaxis (see Antibiotic prophylaxis) wound construction (see Wound construction)

Power generation frequency, 37 phaco energy, 38 stroke length, 37

sustained cavitation, 39 transient cavitation, 38–39 tuning, 37–38

Power modulation phacoemulsification, 69

post-occlusion surge, amplitude measurement, 72–74 ultrasound, intricacies, 70–71

unoccluded flow vacuum, 69–70

wound burn rates, variable incidence, 71–72