Ординатура / Офтальмология / Английские материалы / The Art and the Science of Cataract Surgery_Boyd, Barraquer_2000

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ACKNOWLEDGMENTS

All the text in this Volume has been written by the author. I am very much indebted to the Master Consultants and to all Guest Experts who are listed in this Front Section of the ATLAS. They are all highly recognized, prestigious authorities in their fields and provided me with most valuable information, perspectives and insights.

The production of this ATLAS is a major enterprise. In addition to our dedicated staff at HIGHLIGHTS, three of my most valuable collaborators have been vital to its success: Robert C. Drews, M. D., as Co-Editor of the English Edition; Cristela Ferrari de Aleman, M.D., an expert in phacoemulsification who advised me in all the technical stages of the step-by-step small incision surgical procedures and Samuel Boyd, M.D., for his strong support, valuable advice derived from his expertise in all the vitreoretinal techniques related to cataract surgery.

Among my closest collaborators in HIGHLIGHTS, Andres Caballero, Ph.D., the ProjectDirector and Kayra Mejia, my editorial right handProductionManager of many years have gone the extra mile to accomplish a very difficult task in production of this work.

To each person mentioned in this page, on behalf of the thousands of readers of HIGHLIGHTS, I express my profound recognition and gratitude.

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DEDICATION

This 25th Volume of the Atlas and Textbooks of HIGHLIGHTS is dedicated to my colleagues in 106 nations worldwide who faithfully read the HIGHLIGHTS in seven major languages.

May "THEART ANDTHESCIENCE OF CATARACTSURGERY" contribute to your further understanding of what is best for your patients. May it also help you to master the "state of the art" techniques in your continuous quest for the right answers. May it provide you with insights in your efforts to rehabilitate vision to millions of people who are still blind from cataract, a curable disease.

"The Art and the Science of Cataract Surgery" is also dedicated to the countless ophthalmic surgeons who, through combined efforts with leaders and scientists in industry, have made of modern cataract surgery the safest and most effective major operation in the field of medicine.

And, by all means, to the great innovators each of whom developed a new era for cataract surgery in their time. Symbolically, IGNACIO BARRAQUER, M.D., whose innovation of intracapsular extraction by mechanized suction in 1917 resulted in the first practical and efficient method to remove a cataract without vitreous loss. To JOAQUIN BARRAQUER, M.D., for his pioneering work in rendering ophthalmic surgery under the microscope a feasible and practical new method leading to the era of microsurgery. To CHARLES KELMAN, M.D., who, by providing us with phacoemulsification, started the new era of small incision surgery. And to HAROLD RIDLEY, M.D., the symbol of intraocular lens implantation.

The recognition to the great innovators is for their ingenuity and for their courage. All innovators stimulate opposition. They all encountered strong opposition but they overcame it through their courage and results.

BENJAMIN F. BOYD, M.D., F.A.C.S.

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AUTHOR AND

EDITOR-IN-CHIEF

BENJAMIN F. BOYD, M.D., D.Sc. (Hon), F.A.C.S.

Doctor Honoris Causa

Immediate Past President, Academia Ophthalmologica Internationalis Honorary Life Member, International Council of Ophthalmology

Recipient of the Duke-Elder International Gold Medal Award (International Council of Ophthalmology), the Barraquer Gold Medal (Barcelona), the First Benjamin F. Boyd Humanitarian Award and Gold Medal for the Americas (Pan American), the Leslie Dana Gold Medal and the National Society for Prevention of Blindness Gold Medal (United States), Moacyr Alvaro Gold Medal (Brazil), the Jorge Malbran Gold Medal (Argentina), the Favaloro Gold Medal (Italy).

Recipient of The Great Cross Vasco Nuñez de Balboa Panama's Highest National Award.

Founder and Chief Consultant, Ophthalmology Center of Clinica Boyd, Panama, R.P.; Editor-in-Chief, Highlights of Ophthalmology's ten Editions (Brazilian, Chinese, English, German, Indian, Italian, Japanese, Middle East and Spanish); Author, Highlights of Ophthalmology's Atlas and Textbooks (25 Volumes); Diplomate, American Board of Ophthalmology; Past-President (1985-1987) and Executive Director ((1960-1985) Pan American Association of Ophthalmology; Fellow, American Academy of Ophthalmology; Fellow, American College of Surgeons; Guest of Honor, American Medical Association, 1965; Guest of Honor, American Academy of Ophthalmology, 1978 and Barraquer Institute in Barcelona, 1982 and 1988; Doctor Honoris Causa of Five Universities; Recipient of the Great Cross of Christopher Columbus, Dominican Republic's highest award, for "Contributions to Humanity"; Founding Professor of Ophthalmology, University of Panama School of Medicine (1953-1974); Former Dean and Chief, Department of Surgery, University of Panama School of Medicine (1969-1970); O'Brien Visiting Professor of Ophthalmology, Tulane University School of Medicine, New Orleans, 1983; Honorary Professor of Ophthalmology at Four Universities; Past-President, Academy of Medicine and Surgery of Panama; Honor Member, Ophthalmological Societies of Argentina, Bolivia, Brazil, Canada, Colombia, Costa Rica, Chile, Dominican Republic, Guatemala, Mexico, Paraguay, Peru; Recipient of the Andres Bello Silver Medal from the University of Chile for "Extraordinary Contributions to World Medical Literature."

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MASTER CONSULTANTS

JOAQUIN BARRAQUER, M.D., F.A.C.S., Director and Chief Surgeon,

BarraquerOphthalmologyCenter;Barcelona,Spain. ProfessorofOphthalmology,

Autonomous University of Barcelona, Spain. Chair, Academia Ophthalmologica

Internationalis.

MICHAEL BLUMENTHAL, M.D., Director, Ein Tal Eye Center, Israel. Professor of Ophthalmology, Sidney A. Fox Chair in Ophthalmology, Tel Aviv University. Past President, European Society of Cataract and Refractive Surgery.

EDGARDO CARREÑO, M.D., Assistant Professor of Ophthalmology, University of Chile; Director, Carreño Eye Center, Santiago, Chile.

VIRGILIO CENTURION, M.D., Chief of the Institute for Eye Diseases, Sao Paulo, Brazil.

JACK DODICK, M.D., Chief, Department of Ophthalmology, Manhattan Eye and Ear Hospital, New York. Clinical Professor of Ophthalmology, Columbia University College of Physicians and Surgeons, New York.

CRISTELA FERRARI ALEMAN, M.D., Associate Director, Cornea and Anterior Segment, Boyd Ophthalmology Center. Clinical Professor, University of Panama School of Medicine, Panama, Rep. of Panama.

I. HOWARD FINE, M.D., Clinical Associate Professor of Ophthalmology, Oregon Health Sciences University. Founding Partner, Oregon Eye Surgery Center.

HOWARD V. GIMBEL, M.D., MPH, FRCSC, Professor and Chairman, Department of Ophthalmology, Loma Linda University, California; Clinical Assistant Professor, Department of Surgery, University of Calgary, Alberta, Canada;ClinicalProfessor,DepartmentofOphthalmology,UniversityofCalifornia, San Francisco, California; Founder and Director, Gimbel Eye Centre in Calgary, Albert, Canada.

RICHARD LINDSTROM, M.D., Medical Director, Phillips Eye Center for TeachingandResearch. ClinicalProfessor,,UniversityofMinnesota,Minneapolis.

MAURICE LUNTZ, M.D., Chief of Glaucoma Service, Manhattan Eye and Ear Hospital, New York. Clinical Professor of Ophthalmology, Mt. Sinai School of Medicine, New York.

OKIHIRO NISHI, M.D., Director of Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan.

MIGUEL A. PADILHA, M.D., Professor and Chairman, Department of Ophthalmology, School of Medical Sciences of Volta Redonda, Rio de Janeiro. Professor, Graduate Course of the Brazilian Society of Ophthalmology and Director, Central Department of Ophthalmology, Brazilian College of Surgeons. Former President, Brazilian Society of Cataract and Intraocular Implants.

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CO-EDITOR

ENGLISH EDITION

Robert C. Drews, M.D., F.A.C.S., F.R.C.Ophth.

Professor Emeritus of Clinical Ophthalmology, Washington University School of

Medicine, St. Louis, Missouri.

President Elect of the American Ophthalmological Society

GoldMedalofPan-AmericanAssociationof Ophthalmology; RaynerMedal,United Kingdom Intraocular Implant Society; Binkhorst Medal, American Intraocular Implant Society; Gold Medallion of the National Academy of Science of Argentina; The Montgomery Medal, Irish Ophthalmological Society; Gold Medal of the University of Rome; Gold Medal of the Missouri Ophthalmological Society.

Former Chief of Surgery, Bethesda General Hospital, St. Louis, Missouri, and Former Chief of the Section of Ophthalmology, Bethesda General Hospital, St. Louis and St. Luke's Hospital, St. Louis, Missouri. Past Chairman of the Council of the American Ophthalmological Society, Former member of the American Board of Ophthalmology, and of the Board of Trustees, Washington University in St. Louis. Past President of the Pan American Association of Ophthalmology, International Ophthalmic Microsurgery Study Group, International Intraocular Implant Club, American Intra-Ocular Implant Society, Southern Medical Association, Section on Ophthalmology, Missouri Ophthalmological Society, Missouri Association of Ophthalmology, St. Louis Ophthalmological Society, St.LouisSocietyfortheBlind, Past VicePresident,American Academy of Ophthalmology.

Named Lectures: the Luedde Memorial Lecturer, St. Louis University School of Medicine; Rayner Lecture, United Kingdom Intraocular Implant Society; Binkhorst Lecture, American Intraocular Implant Society; C. Dwight Townes Memorial Lecture, Louisville Kentucky; The MontgomeryLecture, Dublin, Irish OphthalmologicalSociety; Boberg-Ans Lecture, Copenhagen, Denmark, ESCRS; G. Victor Simpson Lecture, Washington DC; Gradle Lecture, PAAO; Joseph P. Bryan Glaucoma Lecture, Durham, North Carolina.

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GUEST EXPERTS

EVERARDOBAROJAS,M.D.,Dean, PreventionofBlindnessandRehabilitation

of Sight Society, Mexico, D.F.

PROF. RUBENS BELFORT JR., M.D., Professor and Chairman, Department of Ophthalmology, Federal University of São Paulo (Escola Paulista de MedicinaHospital São Paulo), Brazil; Chair, Academia Ophthalmologica Internationalis.

RAFAEL CORTEZ, M.D., Director, Ophthalmic Surgery Center (CECOF),

Caracas, Venezuela.

FRANCISCO GUTIERREZ C., M.D., Ph.D, Anterior Segment Surgery and Pediatric Ophthalmologist Specialist, Department of Ophthalmology, Hospital General de Segovia, Spain. Former Fellow of Ramon Castroviejo, M.D.

FRANCISCO MARTINEZ CASTRO, M.D., Associate Professor of Ophthalmology,AutonomousUniversityofMexico. ConsultantinUveitis,Institute of Ophthalmology "Conde de Valenciana" and Seguro Social Medical Center, Mexico, D.F.

JUAN MURUBE, M.D., Professor of Ophthalmology, University of Alcala and Chairman, Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain.

DAVID McINTYRE, M.D., Head, McIntyre Clinic and Surgical Center, Bellevue,

Washington.

CARLOS NICOLI, M.D., Associate Professor of Ophthalmology, University of Buenos Aires, Argentina. Director, "Oftalmos" Institute.

FELIXSABATES,M.D.,ProfessorandChairman,DepartmentofOphthalmology,

University of Missouri, Kansas City School of Medicine, Missouri.

JUAN VERDAGUER, M.D., Academic Director, Los Andes Ophthalmological Foundation, Santiago, Chile; Professor of Ophthalmology, University of Chile; ProfessorofOphthalmology,UniversityofLosAndes; PastPresident,PanAmerican Association of Ophthalmology.

LIHTEH WU, M.D., Associate Surgeon in Vitreoretinal Diseases, Instituto de Cirugia Ocular, San Jose, Costa Rica. Consultant in Vitreoretinal Diseases, Department of Ophthalmology, Hospital Nacional de Niños, San Jose, Costa Rica.

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CONTENTS

FOCUSING AND OVERVIEW OF WHAT IS BEST

Tackling the Challenges

Role of Small Incision Manual Extracapsulars

IOL's of Choice

The Best Phaco Techniques

CHAPTER 1

SURGICAL ANATOMY OF THE HUMAN LENS

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