Ординатура / Офтальмология / Английские материалы / The Art of Phacoemulsification_Mehta, Alpar_2001
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THE ART OF PHACOEMULSIFICATION
The purpose of this volume is to consider, in-depth, all aspects of Phacoemulsification. It is hoped that it will provide the ophthalmic surgeon who intends to commence Phacoemulsification surgery with the information necessary for effective and safe participation. For those who are already in this exciting field, this book should provide a useful source of reference. It is designed to consider both the problem and its solution. The solution has many variations but all should take into account the vulnerable tissues that are required to be protected during surgery.
Every step of Phacoemulsification procedure is critical in determining the final surgical outcome. The surgery is a sequence of steps, each fundamentally important to the entire procedure. Thus while this treatise has designed to allow the readers to refine and enhance their surgical technique, it should reveal the latest advances in both the science and art of the modern technique of Phacoemulsification cataract surgery.
The Art of Phacoemulsification has been conceptualized by some of the foremost cataract surgeons in the world. These contributing authors share their preferred techniques and ideas presenting the most advanced methods of surgical procedures, the newest equipment available, and their methods of managing the cataract patient.
It will undoubtedly be apparent to many readers that some subjects have received a greater emphasis than others. These represent to some extent, our special interests and experiences.
The major task of keeping abreast of the dynamic changes in Phacoemulsification surgery is nearly nondescribable. No single surgeon can speak authoritatively about every subject. Nor can every aspect of the subject be covered. This book covers a fair set of surgical methods and complications. Each chapter thus is an insight into the technique suitable for each surgeon and most importantly; the technique, which best suits that particular case. Each surgeon provides a detailed description directly from his or her experience of the more important Phacoemulsification techniques and his or her reaction to each new development.
All contributors are aware that the production of a book having such a large volume of information, takes many months. Time and tide wait for none and certainly; the fast changing field of Phacoemulsification has new developments literally every day. The subject is developing rapidly, but it is our hope that the wealth of experience incorporated here will be valuable not only in the present time, but also for the future.
This book is a multi-authored text and is, as such, abounds in differing literary styles. The editors have sought to provide a level of organizational conformity and scientific balance without sacrificing the originality and style of the individual authors. A distinctive feature of this book is the diversity of its many outstanding contributors.
Probably the outstanding characteristic of this book is the editors’ ability to select critically important contributions to the management of cataract problems. These are analyzed and evaluated based on their vast experiences as ophthalmic surgeons and consultants.
PREFACE 
xi
We would like to thank the contributing authors who are by their own right, considered the outstanding leaders in the field of Cataract surgery. This book would be non-existent without the devoted and tireless efforts of these physicians who contributed to this text while maintaining a rigorous daily practice.
With promising laser techniques on the horizon, non-invasive Cataract surgery may soon be feasible. Many of these exciting developments are arriving so rapidly that even senior consultants in the field are often hard-pressed to keep up with the latest advances. What the future holds for us is difficult to portend, but one thing is certain, it will be exciting.
Finally, the editors wish to take the liberty to express their deep appreciation to Jaypee Brothers Medical Publishers, India’s premier medical publication company, for their unflagging encouragement and tireless assistance in the production of The Art of Phacoemulsification. Mr Jitender P Vij, the Managing Director of Jaypee is truly a gem of a man, not only for his great faith that I would, one day, finally finish this epitome, but also for the general all-round editorial assistance given, the well laidout pages and the crisp photographs which have made it, truly, a world class book.
Keiki R Mehta
John J Alpar
Contents
1. |
Commencing Phacoemulsification: The Basics .................................................. |
1 |
|
Keiki R Mehta, Ranjit H Maniar |
|
2. |
The Phacomachine ................................................................................................... |
15 |
|
Mahipal S Sachdev, Pradeep Venkatesh |
|
3. |
New Phacomachines Offer More Control......................................................... |
32 |
|
David E Allen |
|
4. |
Cavitating Microbubbles Create Shock Waves that |
|
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Emulsify Cataract...................................................................................................... |
45 |
|
Peter L Davis |
|
5. |
Local Anesthesia ....................................................................................................... |
51 |
|
KR Murthy |
|
6. |
Ocular Anesthesia for Small-Incision |
|
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Cataract Surgery ........................................................................................................ |
58 |
|
Samuel Masket |
|
7. |
The Limbal Incision ................................................................................................ |
64 |
|
Shashi Kapoor |
|
8. |
No Anesthesia Cataract Surgery .......................................................................... |
76 |
|
Amar Agarwal, Athiya Agarwal, Sunita Agarwal |
|
9. |
Clear Corneal Cataract Surgery............................................................................ |
86 |
|
Keiki R Mehta, Cyres K Mehta |
|
10. |
Capsulorrhexis: A Beginner’s Guide .................................................................. |
94 |
|
Shashi Kapoor |
|
11. |
Capsulorrhexis: Principles and Advanced Techniques ................................ |
103 |
|
Shrikant Kelkar |
|
12. |
Hydrodissection and Hydrodelineation ........................................................... |
112 |
Keiki R Mehta, Cyres K Mehta
xiv
THE ART OF PHACOEMULSIFICATION
13.Phacoemulsification: The Quadrantic Cracking, Chopping and
|
Stuffing Technique ................................................................................................. |
118 |
|
Noshir M Shroff, Ranjan Dutta, Gurpreet Singh |
|
14. |
Current Phacoemulsification Techniques ......................................................... |
130 |
|
Richard Packard |
|
15. |
Phaco Slice and Separate..................................................................................... |
154 |
|
Steve A Arshinoff |
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16. |
Cataract Extraction and Lens Implantation: |
|
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The Implosion Technique .................................................................................... |
161 |
|
Eric J Arnott |
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17. |
Phacoemulsification in Special Situations ...................................................... |
170 |
|
Rasik B Vajpayee, Tanuj Dada |
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18. |
Zen in the Art of Phaco ...................................................................................... |
177 |
|
Jonathan P Ellant |
|
19. |
My Personal Technique of Vertical “Hubbing” |
|
|
Phacoemulsification ................................................................................................ |
187 |
|
Keiki R Mehta |
|
20. |
Innovative Nucleotomy Techniques .................................................................. |
204 |
|
Vijay K Dada, Namrata Sharma, Tanuj Dada |
|
21. |
Phacoemulsification in White Cataracts .......................................................... |
214 |
|
Rasik B Vajpayee, Tanuj Dada, Vishal Gupta |
|
22. |
Phacoemulsification in Difficult Cases ............................................................ |
223 |
|
Inderjit Singh |
|
23. |
Irrigation and Aspiration following Phacoemulsification .......................... |
246 |
|
Keiki R Mehta, Cyres K Mehta |
|
24. |
Foldable Intraocular Implants ............................................................................ |
253 |
|
Vijay K Dada, Namrata Sharma, Tanuj Dada |
|
25. |
History of Lens Implantation ............................................................................. |
263 |
|
Eric J Arnott |
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26. |
Implantation Techniques of Acrylic Foldable Intraocular Lens |
|
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and its Clinical Results ........................................................................................ |
268 |
|
Tetsuro Oshika |
|
27. |
The Mini-loop Plate and Accommodating Lenses ....................................... |
288 |
|
J Stuart Cumming |
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28. |
Suprahard Cataracts: Their Evaluation and Management ......................... |
299 |
Keiki R Mehta, Kirit K Mody
|
CONTENTS |
xv |
29. |
Stretch Pupilloplasty for Small Pupil Management in |
|
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Cataract Surgery ...................................................................................................... |
314 |
|
Luther L Fry |
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30. |
Management of Glaucoma in Cataract Patients ........................................... |
322 |
|
Gowri J Murthy, KR Murthy |
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31. |
Phacoemulsification in the Previously Filtered Eye .................................... |
329 |
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Garry P Condon, Luis W Lu |
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32. |
Phacoemulsification in Patients with Significant Astigmatism................ |
344 |
|
Luis W Lu, Louis D Nichamin |
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33. |
Cataracts in Patients with Uveitis..................................................................... |
353 |
|
Enrique Chipont, Jorge L Alio |
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34. |
Corneal Endothelium and its Protection in |
|
|
Phacoemulsification ................................................................................................ |
365 |
|
Keiki R Mehta, Cyres K Mehta |
|
35. |
Phacoemulsification in the Presence of Pseudoexfoliation: |
|
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Challenges and Options ....................................................................................... |
381 |
|
I Howard Fine, Richard S Hoffman |
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36. |
Phacoemulsification in Severe Chronic Obstructive |
|
|
Pulmonary Disease ................................................................................................. |
388 |
|
I Howard Fine, Richard S Hoffman |
|
37. |
The Prevention of Complications and their Management in |
|
|
Phacoemulsification ................................................................................................ |
393 |
|
Keiki R Mehta |
|
38. |
Management of Posterior Chamber IOL Capture ........................................ |
415 |
|
Durval M Carvalho, Durval M Carvalho Jr |
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39. |
IOL Scleral Fixation in Aphakic Eyes ............................................................. |
422 |
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Durval M Carvalho, Durval M Carvalho Jr |
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40. |
Phakonit and Laser Phakonit ............................................................................. |
446 |
|
Amar Agarwal, Athiya Agarwal, Sunita Agarwal |
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41. |
Pharmacology of Intraocular Solutions and Drugs used in |
|
|
Phacoemulsification ................................................................................................ |
453 |
|
Keiki R Mehta, TP Lahane |
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42. |
Triple Procedure with Phocoemulsification before Trephination ............ |
462 |
|
Emilio Balestrazzi, Leopoldo Spadea, Luigi Mosca |
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43. |
Multiport Phaco Tip: A Safer and More Effective |
|
|
Training Device for Phacoemulsification ........................................................ |
471 |
Keiki R Mehta
xvi |
THE ART OF PHACOEMULSIFICATION |
|
44. |
Intraocular Lenses Dislocated into the Vitreous .......................................... |
479 |
|
John J Alpar |
|
45. |
Favit: A New Technique to Manage Dropped Nuclei................................ |
486 |
|
Amar Agarwal |
|
46. |
Laser Phaco Cataract Surgery ............................................................................. |
493 |
|
Sunita Agarwal, J Agarwal, T Agarwal |
|
47. |
Endoscopy-Assisted Phacoemulsification ......................................................... |
500 |
|
Claude S Leon, Joseph A Leon, Danielle Aron-Rosa |
|
48. |
Phacoemulsification: The Eye Camp Way ...................................................... |
507 |
|
Keiki R Mehta, Kirit K Mody, Ranjit H Maniar, Cyres K Mehta, Akhil Bharadwaj |
|
|
Index ............................................................................................................................ |
529 |
The Art of
Phacoemulsification
The primary intent of this book is to provide an introduction to the subject of Phacoemulsification. Presentation of the material begins with the most fundamental aspects and builds up successive levels of knowledge. Every step of Phacoemulsification procedure is critical in determining the final surgical outcome. The surgery is a sequence of steps, each fundamentally important to the entire procedure.
This book has been prepared by some of the foremost cataract surgeons in the world. These contributing authors share their preferred techniques and ideas presenting the most advanced methods of surgical procedures, the newest equipment available, and their methods of managing the cataract patient.
This is a uniquely up-to-date book which covers scientific principles and current clinical and research trends, with practical information on patient assessment, variable surgical techniques, clinical results and the identification, avoidance and the management of complications.
Keiki R Mehta, one of India’s foremost cataract surgeons, commenced intraocular implants in India in 1972, and developed in 1975, for the first time in the world, a soft HEMA Intraocular implant.
He initiated Phacoemulsification for cataract surgery in 1979 and is known as the “Father of Phacoemulsification in India“.
An exceptional surgeon, he has operated live in workshops, teaching phaco all over India. Dr Mehta is a popular teacher in great demand at conferences and symposia and has written many scientific books and published scientific papers, both at national and international level. He has been awarded eight gold medals and innumerable oration awards from national / international bodies. Extremely innovative, he has been on the cutting edge of technology and has devised multiple new techniques and instruments.
John J Alpar is an exceptionally skilled surgeon , edited an extremely popular book, which literally became in the 1990’s, a bible for implant surgeons, termed ” Fechner’s Intraocular Lenses”,. With Professor Fechner of Hanover, Germany, Dr Alpar produced a book, impressive by its well-organized structure, its wealth of information, its practicality and the superb technique of presentation.
A prodigious speaker and author, Dr Alpar has delivered 178 lectures, published 158 scientific articles , 11 chapters, 4 books and attended over 320 meetings. Widely traveled, he is a life member of the All India, Mexican and Hungarian Ophthalmological Societies, the Indian and Canadian Implant Societies, and is member of the Medical Societies in Peru, Japan, France. Dr John Alpar is respected worldwide for the quality of his work, the scope of his knowledge, his sharp intellect and brilliance and his keen, incisive analysis of facts.
Contributors include |
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• Alpar John J • Fine Howard I • Fry Luther L • Jonathan P Ellant • Luis Lu W • Masket Samuel • |
Allen David E • Arnott |
Eric J • Richard Packard • Durval Carvalho M • Durval Carvalho M Jr • Arshinoff Steve A • |
Davis Peter L • Aron- |
Rosa Danielle • Joseph Leon A • Emilio Balestrazzi • Oshika Tetsuro • Alio Jorge L • Enrique Chipont • Agarwal Amar |
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• Agarwal Athiya • Agarwal Jaiveer • Agarwal Sunita • Agarwal T • Col Akhil Bharadwaj • Dada Vijay K • Kapoor |
|
Shashi • Kelkar Shrikant • Lahane Tatyarao P • Maniar Ranjit H |
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ISBN 81-7179-790-3 |
Rs. |
JAYPEE BROTHERS
MEDICAL PUBLISHERS (P) LTD
B-3 EMCA House, 23/23B Ansari Road, Daryaganj Post Box 7193, New Delhi 110 002, India
Keiki R Mehta
Ranjit H Maniar
Commencing
Phacoemulsification: 1
The Basics
INTRODUCTION
Phacoemulsification is a superb technique, but to be able to conduct it comfortably and effectively all the appliances, solutions and even the personnel in the theatre need to be properly located and trained to respond to any situation which may arise. It is imperative that the surgeon understands the basic applications of each of the different requirements. For maximum efficiency and safety, proper location and arrangements, right from the operating table, the microscope, the surgeon’s chair, the instruments on the trolley, the placement of the staff nurse, the assistants, and even that of the wardboys, have to be carefully planned and worked out in advance.
Phacoemulsification is an instrument-based surgery. It is also a high-pressure surgery, with periods of calm alternating with high tension. Moreover, as such there must be adequate space in the theatre so that effective and rapid movement when and if required can take place smoothly. Too compact a theatre is a sure prescription for disaster.
THE OPERATING ROOM: REQUIREMENTS AND NECESSITIES
The operating room—requirements and necessities of primary importance is a properly designed and functioning operating room or theatre (Fig. 1.1). There are many important points, which need to be considered. Some of them will be felt unnecessary, but the strength of any chain is dependent on the weakest link. Thus every link has to be given its importance and considered on its own merits.