Ординатура / Офтальмология / Английские материалы / The Art of Phacoemulsification_Mehta, Alpar_2001
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The Art of
Phacoemulsification
The Art of
Phacoemulsification 
Editors
Keiki R Mehta MD MBBS DOMS MS (Ophth) FORCE (India) DO (Ireland) DO (London) FRSH (London) FIOS (USA)
Medical Director: Mehta International Eye Institute
Chief: Ophthalmic Services, Colaba Eye Hospital
Chief: Surgical Services, Netra Rukshak, Rural Eye Services Wing, Mumbai, India Head: Eye Department, Breach Candy Hospital and Research Centre, Mumbai
Hon Ophthalmic Consultant Surgeon: Armed Forces, India
Hon Ophthalmic Consultant to the Governor of Maharashtra
Past President: All India Ophthalmological Society, Intraocular Implant Society, India
and
John J Alpar MD FACS FICS PA
Diplomate: American Board of Ophthalmology
Diplomate: Hungarian Board of Ophthalmology
Clinical Professor: Texas Tech University School of Medicine
Medical Director: Panhandle Ophthalmological Research Foundation, Texas, USA Fellow: American Academy of Ophthalmology, Saint Luke Eye Institute
Amarilo, Texas, USA
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The Art of Phacoemulsification
© 2001, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published on good faith that the material provided by editors is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 2001
ISBN 81-7179-790-3
Publishing Director: RK Yadav
Typeset at JPBMP typesetting unit
Printed at Gopsons Paper Ltd., Noida
Contributors
Alpar John J MD FACS FICS PA
Clinical Professor
Texas Tech University School of Medicine
Medical Director
Panhandle Ophthalmological Research Foundation, Texas, USA
Fellow
American Academy of Ophthalmology Saint Luke Eye Institute
Amarilo, Texas, USA
Fine Howard I MD
Clinical Assistant Professor
Oregon Health Sciences University Portland, Oregon
Oregon Eye Assocciates, Eugene Oregon, USA
Richard S Hoffman MD
Oregon Eye Associates, Eugene, Oregon, USA
Fry Luther L MD
Director and Chief
Fry Associates PA/Ophthalmology
310 East Walnut, Garden City, Kansas, USA
Jonathan P Ellant MD
Chief
St Clare’s Hospital and Health Care Center
Assistant Professor
Mt Sinai School of Medicine New York, USA
Luis W Lu MD FACS
Instructor
University of Pittsburgh School of Medicine ELK County Eye Clinic
Center for Advanced Eye Care St. Marys, Pennsylvania, USA
Garry P Condon MD
Director, Division of Glaucoma
Allegheny General Hospital
MCP Hahnaman University
Pittsburgh, Pennsylvania, USA
Louis D Nichamin MD
Medical Director
Laurel Eye Clinic
Brookville, Pennsylvania, USA
Masket Samuel MD
Clinical Professor
Jules Stein Eye Institute
UCLA, Los Angeles, USA
Allen David E MD FRCOphth
Consultant Ophthalmologist
City Hospitals, Sunderland
Sunderland Eye Infirmary
Queen Alexandra Road, Sunderland, UK
Arnott Eric J MD DO FRCS FRCOphth
Consultant Ophthalmologist
Arnott Eye Centre, Trottsford Farm
Headley, Nr Brandon Hamshire, UK
Packard Richard MD FRCS FRCOphth
Ophthalmic Surgeon
Prince Charles Eye Unit
Windsor, UK
Durval Carvalho M MD
Chief
Cataract Department
Centro Brasileiro de Cirurljia, de Olhros (CBCO);
Member
Conselho da Sociedade Brasileria de Cataracta, Brazil
vi 
THE ART OF PHACOEMULSIFICATION
Durval Carvalho M Jr MD
Doctorate, Departamento de Oftalmologia da Universidade Sao Paulo (USP)
Member, Departamento de Oftalmologia da Universidade Federal de Goias (UFG), Brazil
Arshinoff Steve A MD FRCSC
Ophthalmic Surgeon
York Finch Eye Associates
2115 Finch Avenue W, Suite 316, Toronto, Ontario, Canada
Davis Peter L MD, FRCS (C)
Senior Ophthalmologist
North Okanagan Health District
Vernon BC V1T 2M9, Canada
Aron-Rosa Danielle MD
Ophthalmic Surgeon
28 Ave, Raphael, Paris, France
Joseph Leon A MD
Consulting Surgeon
Polyclinique Comiti, Dept of Ophthalmology 20000, Ajaccio, France
Claude S Leon MD
France
Emilio Balestrazzi MD
Professor, Dipartimento Di Discipline Chirurgiche, Via Vettoio, Blocco 117A, 6710 Coppito (AQ), Italy
Leopoldo Spadea MD
University of L’AQuila
S Salvatore Hospital, L’AQuila, Italy
Luigi Mosca MD
University of L’AQuila
S Salvatore Hospital, L’AQuila, Italy
Oshika Tetsuro MD
Ophthalmic Surgeon
University of Tokyo School of Medicine
7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
Alio Jorge L MD PhD
Professor and Chairman of Ophthalmology,
Medical Director
Instituto Oftalmologico de Alicante IOIS General Secretary, AVDA–DE Denia, Alicante, Spain
Enrique Chipont MD PhD
Ophthalmic Surgeon
Instituto Oftalmologico de Alicante IOIS General Secretary, AVDA–DE Denia, Alicante, Spain
Agarwal Amar MS FRCS FRCOphth (Lon)
Consultant Ophthalmic Surgeon
Dr Agarwal’s Eye Institute
13 Cathedral Road, Chennai, India
Agarwal Athiya MD (Path) FRSH (Lon) DO
Consultant Ophthalmic Surgeon
Dr Agarwal’s Eye Institute
13 Cathedral Road, Chennai, India
Agarwal Jaiveer MD
Director and Chief
Dr Agarwal’s Eye Institute
13 Cathedral Road, Chennai, India
Agarwal Sunita MD FSVH (WG) FRSH (Lon) DO
Director and Chief
Dr Agarwal’s Eye Institute
15 Eagle Street, Bangalore, India
Agarwal T MD
Consultant Ophthalmic Surgeon
Dr Agarwal’s Eye Institute
13 Cathedral Road, Chennai, India
Col Akhil Bharadwaj MD
Chief Eye Surgeon, Armed Forces, Asvini, Colaba Mumbai, India
Dada Vijay K MD DOMS
Chief and Professor
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Namrata Sharma MD
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Tanuj Dada
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Kapoor Shashi MD
Consulting Ophthalmic Surgeon
Kapoor Eye Clinic, 409 Om Chambers Kemps Corner
Mumbai, India
CONTRIBUTORS 
vii
Kelkar Shrikant MD
Director and Chief
National Institute of Ophthalmology 1187/30, Ghole Road, Shivaji Nagar Pune, India
Lahane Tatyarao P MD
Professor and Head
Grant Medical College
JJ Group of Hospitals Mumbai, India
Maniar Ranjit H MD
Head, Shushrusha Hospital, Mumbai
Honorary Ophthalmic Consultant
Jankikund Hospital, Chitrakoot
Mehta Cyres K MD
Consultant Ophthalmologist
Mehta International Eye Institute Colaba Eye Hospital
Mumbai, India
Mehta Keiki R MD
Medical Director
Mehta International Eye Institute Chief, Ophthalmic Services Colaba Eye Hospital
Chief, Surgical Services
Netra Rukshak: Rural Eye Services Wing Head, Eye Department
Breach Candy Hospital and Research Centre Sea Side, 147 Shahid Bhagat Singh Road, Mumbai, India
Mody Kirit K MD FRCS
Medical Director
Salil Eye Clinic & Contact Lens Centre,
506 Om Chambers, 123 August Kranti Marg, Kemps Corner, Mumbai,
Hon Professor
Grant Medical College
Hon Eye Surgeon
GT General Hospital Conwest Jain Clinic Hospital Smt. Lilavati Hospital Mumbai, India
Murthy Gowri J MD
Consultant Ophthalmic Surgeon
Prabha Eye Clinic
504, 40th Cross, 8th Block Jayanagar, Bangalore, India
Murthy KR MD
Consultant Ophthalmic Surgeon
Prabha Eye Clinic
504, 40th Cross, 8th Block Jayanagar, Bangalore, India
Sachdev Mahipal S MD
Cornea Fellowship (USA), Phacoemulsification, Excimer Laser, Cornea and Contact Lens Specialist
New Delhi Centre for Sight
A-23 Green Park, Aurobindo Marg New Delhi, India
Pradeep Venkatesh
Pool Officer
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Shroff Noshir M MD
Medical Director
Shroff Eye Centre
A-9 Kailash Colony
New Delhi, India
Ranjan Dutta MD
Shroff Eye Centre
A-9, Kailash Colony
New Delhi, India
Gurpreet Singh DO
Shroff Eye Centre
A-9, Kailash Colony
New Delhi, India
Vajpayee Rasik B MD
Professor
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Vishal Gupta MD
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India
Inderjit Singh
Professor and Head
Coffs Harbour Hospital
69 Albany Street, Coffs Harbour
New South Wales 2450, Australia
Preface
Advances in the field of Cataract surgery and intraocular implantation over the last 50 years have been astonishing. Phacoemulsification, had a slow beginning, but in the last 5 years has exploded forwards. Improvements in technique are increasing at a rapid pace, as the advantages of small incision cataract surgery, the instant patient rehabilitation physical and visual are obvious. Nevertheless, the ultimate expression of minimal patient inconvenience and minimal delay in resumption of patient’s lifestyle is the legacy of Phacoemulsification
It was in the winter of 1989 when one of us (KRM) performed our first cataract operation utilizing Phacoemulsification. From that moment onwards, we had no doubts that this was a winning combination and in future all cataract operations would be performed with this technique and with this technique only. The procedure has changed since then. It has evolved and improved significantly. The technique has been perfected. The technology has progressed. The quality of the surgery is now virtually unsurpassable, and most importantly, surgeons all over the world now trust and rely on the Phacoemulsification technique.
Old concepts change, giving way to new ideas, as fresh advances in all fields of science and medicine forge ahead. Phacoemulsification surgery and its complications are no exception. We have tried to be highly selective in modifying old concepts and including not only those changes that have widespread acceptance but also have included newer developments which will make their mark in the new millennium.
The visual needs of patients are dictated by their circumstances, which include age, occupation, leisure interests, and their independence. As an adviser to a patient, the ophthalmic surgeon must consider the individual requirements of the patient and balance these against the potential risks of surgical treatment. As a surgeon, his or her attitude is tempered by his or her experience, knowledge of the experiences of others and confidence in his or her own ability to achieve perfection of results that should shine as a beacon of excellence in the community.
The primary intent of the book, The Art of Phacoemulsification is to provide an introduction to the subject of Phacoemulsification as well as the framework on which could be constructed the study of that discipline. Presentation of the material begins with the most fundamental aspects and builds up successive levels of knowledge.