Phacoemulsification

© 1998, 2000, 2004 Sunita Agarwal, Athiya Agarwal, Amar Agarwal

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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Transferred to Digital Printing 2005

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 Taylor & Francis, a member of the Taylor & Francis Group. Tel.: +44 (0) 20 7583 9855 Fax.: +44 (0) 20 7842 2298 E-mail: info@dunitz.co.uk Website: http://www.dunitz.co.uk/

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Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer.

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This two volume book on Phacoemulsification is dedicated to two wonderful people whom we have come to know and worked with

John Bond

Amy McShane

Contributors

A Beléndez MD Spain

A Fimia MD Universidad de Murcia Murcia, Spain

Aamir Asrar MD

Consultant Ophthalmic Surgeon Amanat Eye Hospital

Pakistan

Abhay R Vasavada MS FRCS Raghudeep Eye Clinic

Near Shreeji Complex

Opp. Gurukul Road, Memnagar Ahmedabad-380 052, India

Alejandro Espaillat MD

ELK County Eye Clinic

765 Johnsonburg Road, St Marys PA 15857, United States

Amar Agarwal MS FRCS FRCOphth Consultant

Dr. Agarwal’s Eye Hospital 19 Cathedral Road Chennai-600 086, India

15 Eagle Street, Langford Town Bangalore, India

Ana Claudia Arenas MD Calle 104#46 A 10

Casa 9, Santa Fe De Bogota 8 Colombia

Andrea M Izak MD 40 Bee St#323 Charleston SC 29403 United States

Angel Saiz MD

Department of Ophthalmology Hospital De Galdakao Galdakao, Vizcaya, Spain

Anthony Maloof MD

Westmead Hospital

Hawkesbury Road Westmead, NSW 2145 Australia

Asha B MS

Dr. Agarwal’s Eye Hospital 15 Eagle Street

Bangalore 560 025, India

Ashok Garg MS PhD Garg Eye Hospital 235, Model Town Dabra Chowk

Hisar, Haryana, India

AT Gasch MD Department of Health and Human Services Bethesda, USA

Athiya Agarwal MD DO FRSH Consultant

Dr. Agarwal’s Eye Hospital 19 Cathedral Road Chennai-600 086, India

15 Eagle Street, Langford Town Bangalore, India

Augusto Cezar Lacava MD Brazil

Barry S Seibel MD

1515 Vermon Avenue 7th Floor, Station C

USA Los Angeles, California USA

C González MD Universidad de Murcia Murcia, Spain

Carlos Cortes-Valdes MD Chairman

Professor of Ophthalmology Department of Ophthalmology Hospital General Universitario Gregorio Maranon

Madrid Spain-Europe

C Leon

1A Calle 30–80 Zona 7 Utalan I Guatemala City

Guatemala

Charles D Kelman MD

The Eye Centre, 220 Madison Avenue at 37th Street, New York NY 10016, USA

Chi-Chao Chan MD National Institute of Health Building 10, Room 10N/206 Bethesda, MD 20892 United States

Clement K Chan MD

Southern California Desert Retina Consultants, PO Box 2467

Palm Springs CA 92263 USA

Cyres Mehta

Mehta International Eye Institute Sea Side, 147 Colaba Road Mumbai-400 005, India

D Aron-Rosa

France

D Bremond Gignac MD France

David J Apple MD

Centre for Research on Ocular Therapeutics and Biodevices Storm Eye Institute Charleston

USA

David Meyer MD

Faculty of Medicine Department of Ophthalmology Cape Town

South Africa

Demetrio Pita-Salorio MD Professor and Head

Department of Ophthalmology and Ocular Morphology Unit University of Barcelona

Spain

E Villegas MD Universidad de Murcia Murcia, Spain

Elizabeth A Davis

Minnesota Eye Consultants

9117 Lyndale Aves, Bloomington MN 55420, United States

Ellen Anderson Penno MD Gimbel Eye Centre Calgary, Alberta

Canada

Enrique Chipont MD

Instituto Oftalmologico De Alicante Alicante, Spain

F Mateos MD

Universidad Miguel Hernandez de Elche, Alicante, Spain

Francisco Contreras-Campos MD Clinica Ricardo Palma

Av. Javier Prado Este 1038

PISO 10 San Isidro Lima Peru

Gabor Rado MD

Budapest, Hungary

George Salacz MD Hungary

Guillermo L Simon-Castellvi MD Clinica Oftalmologica Simon Simon Eye Clinic

Barcelona, Spain

Hampton Roy MD Hampton Roy Eye Center 9800 Lile Drive, Suite 660 Little Rock, Arkansas, USA

Hiroshi Tsuneoka MD Department of Ophthalmology Jikei University School of Medicine 3–19–18 Nishishinbashi

Minato-ku

Tokyo, 103–8461, Japan

Howard V Gimbel MD Gimbel Eye Centre

Suite 450, 4935–40, Avenue N.W. Calgary, Alberta

Canada T3A 2N1

I Howard Fine MD FACS

Oregon Eye Surgery Center

1550, Oak Street

#5, Eugene

USA

I Pascual MD

Departmet I De Optica

Universidad De Alicante

Apartado 99 E-03080 Alicante, Spain

J Agarwal FORCE DO FICS

Dr. Agarwal’s Eye Hospital

19 Cathedral Road

Chennai-600 086, India

15 Eagle Street, Langford Town

Bangalore, India

J Hoyos-Chacón

Instituto Oftalmologico De Sabadell

Barcelona, Spain

J Laiseca MD

Barcelona, Spain

Jack A Singer MD

Singer Eye Center

45, South Main Street

Randolph, VT 05060, United States

J Leon

Chirurgie Oculaire BD G Pompidou

20137 Port-Vecchio, France

Jagat Ram MD

PGI, Chandigarh, India

Jairo E Hoyos MD

Instituto Oftalmologico De Sabadell

Barcelona, Spain

James P Gills MD

Luke Cataract and Intraocular Lens

Institute, 1570 US Highway, 19N

PO Box 5000, Tamponsprings

Florida 34688–5000, United States

Javier Mendicute MD

Department of Ophthalmology

Hospital De Gipuzkoa, San

Sebastian, Gipuzkoa, Spain

Javier Orbegazo MD

Chairman

Department of Ophthalmology

Hospital De Galdakao

Galdakao, Vizcaya, Spain

Jaya Thakur MD

Orbis International Fellow

Tilganga Eye Centre

Kathmandu, Nepal

Jesús Costa-Vila MD

Barcelona, Spain

JM Legeais MD PhD

Ophthalmology Department

Hotel Dieu

1 Place Du Parvis Notre Dame

Paris-775181, France

Johnny L Gayton MD

216 Corder Road

Warner Robins, GA 31088, USA

Jorge L Alio MD

Instituto Oftalmologico De Alicante

Alicante, Spain

Jose L Urcelay-Segura MD

Glaucoma Service-Department of Ophthalmology

Hospital General Universitario

Gregorio Maranon

Madrid, Spain-Europe

Jozsef Gyory MD

Hungary

JP Lassau MD

France

JR Fontenla MD

Barcelona, Spain

Juan Carlos Sanchez Caballero MD

Brazil

Julio Ortega-Usobiaga MD

Department of Ophthalmology

Hospital General Universitario

Gregorio Maranon

Madrid, Spain-Europe

Kayo Nishi MD

Nishi Eye Hospital

Osaka, Japan

Keiki R Mehta MD

Mehta International Eye Institute

147 Shahid Bhagat Singh Road

Colaba Road

Near Colaba Bus Station

Mumbai-400 005, India

L Carretero MD Universidad de Alicante Alicante, Spain

Liliana Werner MD

Center for Research on Ocular Therapeutics and Biodevices Storm Eye Institute Charleston, USA

Lucio Buratto MD

Centre Ambrosiano Microchirurgia Oculare, Milano, Italy

Luis W Lu MD

Eye Physician-ELK County Eye Clinic, 765 Johnsonburg Road

ST Marys PA 15857, United States

M Edward Wilson MD Miles Center for Pediatric Ophthalmology Charleston, USA

Mahipal S Sachdev MD New Delhi Center for Sight

A-23 Green Park, Aurobindo Marg New Delhi-110 016, India

Marc Canals-Imhor MD Barcelona, Spain

Mark Packer MD

Oregon Eye Surgery Center 1550, Oak Street, #5 Eugene Or 97401 United States

Melania Cigales MD

Instituto Oftalmologico De Sabadell Barcelona, Spain

Namrata Sharma MD C-18 B, DDA Flats, Munirka New Delhi

Nilesh Kanjani DO Dip NB Dr. Agarwal’s Eye Hospital India and Dubai

Okihiro Nishi MD Director

Jinshikai Medical Foundation Nishi Eye Hospital Higashinari Ku Nacuamichi 4–426–537 Osaka, Japan

P Giardini MD Camo-Centro Ambrosiano Microchirurgia Oculare Milano, Italy

Pandelis Papadopoulos MD

Director Ophthalmological Diagnostic and Therapeutic Center Ophthalmo-Check Ltd

42 Poseidon Avenue, Paleo Faliro Athens, Hellas, Greece

Paul Liebenberg MD

Faculty of Medicine Department of Ophthalmology Cape Town

South Africa

Pradeep Venkatesh MD AIIMS, Delhi, India

R Fuentes MD Universidad de Alicante Alicante, Spain

Raminder Singh MS

Raghudeep Eye Clinic

Opp. Gurukul Road

Near Shreeji Complex, Memnagar Ahmedabad 380 052, India

Randall J Olson MD University of Utah Department of Ophthalmology Moran Eye Centre, 50-N Medical Drive, Salt Lake City UT 84132–0001, United States

Richard L Lindstrom

Clinical Professor of Ophthalmology University of Minnesota Minneapolis, MN, USA

Richard S Hoffman

Oregon, USA

Robert M Kershner MD PC FACS Orange Grove Eye Center

1925 W, Orange Grove Road #303 Tucson, AZ 85710

United States

Roberto Bellucci MD Camo-Cebtro Ambrosiano Microchirurgia Oculare

Milano

Italy

RR Sasikanth MD

Consultant

Dr. Agarwal’s Eye Hospital

India and Dubai

Rupert Menapace MD

Professor, Universitats-Augenklinik

Vienna General Hospital

Wahringer, Gurtel, Wien

Vienna, Austria

Samuel L Pallin MD FACS

Medical Director

The Lear Eye Clinic

10615 W Thunderbird A100

Sun City

AZ 85351–3018, USA

Samuel Masket MD

2080, Century Park East

Suite 911, Los Angeles, CA 90067

United States

Soosan Jacob MS FRCS

Consultant

Dr. Agarwal’s Eye Hospital

Chennai, Bangalore,

India and Dubai

Steve Charles MD

Charles Retina Institute

6401 Poplar Avenue, Suite 190

Memphis, Tennessee

USA

Steven G Lin MD

Southern California Desert Retina

Consultants, Palm Springs

USA

Sundaram MS

Dr. Agarwal’s Eye Hospital

15 Eagle Street

Bangalore 560 025, India

Sunita Agarwal MS DO FSVH (Germany)

Dr. Agarwal’s Eye Hospital

19 Cathedral Road

Chennai-600 086, India

15 Eagle Street, Langford Town

Bangalore, India

Suresh K Pandey MD Center for Research on Ocular Therapeutics and Biodevices Storm Eye Institute Charleston, USA

Susanna Recsan MD Hungary

T Agarwal FORCE DO FICS

Dr. Agarwal’s Eye Hospital 19 Cathedral Road Chennai-600 086, India

15 Eagle Street

Langford Town

Bangalore, India

Takako Hara MD

Hara Eye Hospital Nishi 1–1–11

Utsunomiya, Japan 320 0861

Tetsuro Oshika MD

Tokyo University School of Medicine Department of Ophthalmology 7–3–1, Hongo, Bunkyo-Ku

Tokyo, Japan 113 8655

Tobias Neuhann MD Founder and Medical Director

Aam Augenklinik AM Marienplatz Marienplatz 18, Munich

Germany

TR Indumathy Dip NB DO

Dr. Agarwal’s Eye Hospital India

Tsutomu Hara MD

Hara Eye Hospital Nishi 1–1–11

Utsunomiya, Japan 320–0861

Valerio De Iorio MD

Instituto Oftalmologico De Alicante Alicante, Spain

Virgilio Centurion MD Instituto De Molestias Oculares AV, Ibirapuera

624, CEP, Sao Paulo, Brazil

Warren E Hill MD 7525 E Broadway Road #6 Mesa, AZ 85208–2057 United States

Wataru Kimura MD

Kimura Eye Hospital

2–3–28 Nakadori

Kure City

Hiroshima

Japan 737

William J Fishkind MD FACS

Fishkind and Bakewell

5599 North Oracle Road

Tucson

Arizona 85704–3821, USA

Foreword to the Third Edition

Authoring a medical textbook is a labor of love. For months and months, the act of writing, correcting, rewriting, editing, proofreading, corresponding, negotiating, etc. replaces hobbies and recreational pursuits. Yet when all is said and done, an immense sense of satisfaction embraces the author, who by this time has aged considerably.

The authors of the third edition are to be congratulated for bringing this collaborative work to fruition. The encyclopedic table of contents in combination with an erudite and highly experienced international faculty offer two volumes of information to the reader. Moreover the microphacoemulsification section reflects the leading contribution that Dr. Agarwal’s group is making in the evolution toward even smaller incision surgery.

Being on the “cutting edge” can be a mixed blessing, but investing the time and effort necessary to share information is always a rewarding task for those surgeons who have contributed their work. I hope that the reader is also rewarded by becoming a more knowledgeable cataract surgeon after digesting the contents of the third edition of this textbook on phacoemulsification.

Robert H Osher MD Professor of Ophthalmology University of Cincinnati College of Medicine Medical Director Emeritus Cincinnati Eye Institute

Foreword to the Second Edition

Dr Amar Agarwal’s brilliant mind has captured the idea of presenting the most advanced techniques of Cataract Surgery, at the dawn of the new millennium in this splendid book,

Phacoemulsification, Laser Cataract Surgery and Foldable IOLs.

The reader can enjoy not only a skilful description of classic cataract surgery, but also Dr Agarwal’s great experience, opening new horizons in this field. I whole-heartedly recommend the book and am honored to Foreword this second edition which will almost certainly be as great a success as the first one. I am very proud to share the knowledge arising from Dr Agarwal’s book who is one of the leaders in the field of cataract surgery and a great colleague and friend.

Spyros Georgaras MD President of the Hellenic Union of Specialized Ophthalmologists

Greek Intraocular Implant and Refractive Surgery Society Research & Therapeutic Institute “Ophthalmos” Ophthalmological Center “Hygeia-Ophthalmos”