About the Book
Presents fundamental component of an atlas that displays images of phacoemulsification surgery in varied situation.
Divided into four sections.
Provides important information on surgical steps and complication management during modern cataract surgery.
Aims to provide accurate and structured approach.
Emphasises on teaching skills which are based on rigorous and current research.
Equips the reader with new information and current concepts in surgical practice.
Provides an interactive DVD-ROM with videos showcasing the surgical aspect of handling numerous clinical condition of phacoemulsification and its complications.
About the Author
Amar Agarwal MS FRCS FRCOphth
Priya Narang MS
Table of Contents: Section 1 PHACO BASICS
Amar Agarwal, Priya Narang
Diagrammatic Representation of the
Connection of Air Pump to the Infusion Bottle 2
Internal Gas Forced Infusion 4
Viscoelastic being Injected with a 26 G
Needle Attached to a 1 mL Syringe 6
Framing a Clear Corneal Incision 8
Location of the Incision 9
Size of the Incision 9
Plane of the Incision 10
Capsulorhexis being done with a Bent 26 Gauge Needle 11
Capsulorhexis Flap 12
Vertical Chop 15
Chopping the Nuclear Hemisegments 17
Pull out Nuclear Fragments from Bag and Emulsify 19
Bi-manual Cortical Aspiration 20
Section 2 CHALLENGING CASES
Amar Agarwal, Priya Narang
Pseudoexfoliation 24
Deposition of Fluffy Amorphous Material Around
the Pupil in Pseudoexfoliation 25
Pigment Deposition on Anterior Capsule 27
xviii Phacoemulsification
Posterior Synechia 28
Posterior Polar Cataract 30
Trypan Blue Enhanced Capsulorhexis being
Performed in a Miotic, Fibrotic Pupil 32
Surgical Tips 33
Subluxation of the Lens and its Management 37
Modified Cionni’s Capsular Tension Ring 39
Lenticular Coloboma 41
Iris Coloboma 43
Soemmering Ring 44
Posterior Lenticonus 46
Section 3 COMPLICATIONS
Amar Agarwal, Priya Narang
Sleeveless Phacotip Assisted Levitation of
Dropped Nucleus (SPAL) Technique—Step 1 50
Spal Technique—Step 2 53
Dropped Nucleus Lying on the Retina 54
Managing the Anterior Chamber
Opacities and Herniated Vitreous 55
Posterior Vitrectomy and Phacofragmentation 56
Insulating the Retina with Perfluorocarbon 59
Principle of an Ophthalmic Endoscopic System 60
Removal of Entire Hard Lens Fragment with
Perfluorocarbon 64
Management of Lens Coloboma with Glued IOL 69
Dislocated IOL on the Retina 72
Sleeveless Extrusion Cannula
for Levitation of Dropped IOL 72
Surgical Technique 73
Perfluorocarbon Liquids 76
25-G Chang Passive-Action IOL Forceps 78
Temporary Haptic Externalization 80
Removal of a Plate Haptic IOL 84
Management of Eyes with two Intraocular Implants 87
Endophthalmitis: Methods of Collecting Specimens 90
Clinical Features 91
Organisms Associated with Acute
Postoperative Endophthalmitis 93
Delayed-onset Endophthalmitis 94
Propionibacterium Endophthalmitis 94
Diagnostic Workup and
Microbiological Studies 96
Techniques of Specimen Collection 97
Endophthalmitis (Anterior Chamber Washout
before Vitrectomy) 99
Antimicrobial Therapy 100
Corticosteroid Therapy 103
Vitrectomy 104
Cystoid Macular Edema 107
Macular Edema 108
Cystoid Macular Edema 108
Cme and Aciol—Possible Pathophysiology 112
Clinical Appearance of CME 113
Contents xix
xx Phacoemulsification
Macular Function Tests
in Cystoid Macular Edema 116
Optical Coherence Tomography in CME 116
Sequela of CME: Post-CME Lamellar Hole 117
Prophylactic Treatment 118
Therapy for Established CME 119
Glued IOL 123
Glued IOL (Continued) 125
Traumatic Iridodialysis 127
Boston Keratoprosthesis (KPro) 129
Decentration of the Capsular Bag and IOL 131
IOL Scaffold 132
Glued IOL Scaffold 134
Pre-Descemet’s Endothelial Keratyoplasty
with Glued IOL 137
Surgical Considerations
for Combined Procedure 140
Surgical Technique 140
Preoperative and Postoperative Image of
Patient of PDEK with Glued IOL 142
Refractive Concern 144
Section 4 MICROINCISION CATARACT SURGERY
(PHAKONIT AND MICROPHAKONIT)
Amar Agarwal, Priya Narang
Clear Corneal Incision Made with a Special Knife (MST, USA) 146
Capsulorhexis Initiated with a Needle 148
MST Rhexis Forceps used to Perform the Rhexis
in a Mature Cataract 150
Designs of Agarwal Irrigating Choppers 151
Phakonit Irrigating Chopper and Phako Probe
without the Sleeve Inside the Eye 152
Phakonit being done 154
Bimanual Irrigation Aspiration Completed 155
Soft Tip Irrigation-aspiration from MST, USA 156
Thinoptx Roller Cum Injector Inserting
the IOL in the Capsular Bag 157
Comparison between Phaco Foldable IOL and
Phakonit Thinoptx IOL 158
Microphakonit 160
Microphakonit Completed. The Nucleus
has been Removed 162
Bimanual Irrigation-aspiration with the 0.7 mm Set 164
Bimanual Irrigation-aspiration Completed 165
Index 167
Contents xxi