Illustrative Guide to Cataract Surgery

Prof. Amar Agarwal, MS, FRCS, FRCOphth is the pioneer of phakonit, which is phako with a needle incision technology. This technique became popularized as bimanual phaco, microincision cataract surgery (MICS), or microphaco. He was the first to remove cataracts through a 0.7-mm tip with the technique called microphakonit. He has also discovered no anesthesia cataract surgery and FAVIT (FA=fallen, VIT=vitreous), a new technique to remove dropped nuclei. The air pump, which was a simple idea of using an aquarium fish pump to increase the fluid into the eye in bimanual phaco and co-axial phaco, has helped prevent surge. This built the basis of various techniques of forced infusion for small incision cataract surgery. He has also discovered a new refractive error called aberropia. He also was the first to do a combined surgery of microphakonit (700-µm cataract surgery) with a 25-gauge vitrectomy in the same patient, thus having the smallest incisions possible for cataract and vitrectomy. He was also the first surgeon to implant a new mirror telescopic IOL (LMI) for patients suffering from age-related macular degeneration. He has been the first in the world to implant a glued IOL. In this procedure, a PC IOL is fixed in an eye without any capsules, using fibrin glue. He also modified the Malyugin ring for small pupil cataract surgery, known as the Agarwal modification of the Malyugin ring for miotic pupil cataract surgeries with posterior capsular defects. Dr. Agarwal’s Eye Hospital has performed a first-time anterior segment transplantation in a 4-month-old child with anterior staphyloma. The turnaround technique for intrastromal ring segments being managed if passed through a false channel creation has also been started in Dr. Agarwal’s eye hospital. Prof. Agarwal has received many awards for his work in ophthalmology, the most significant being the Casebeer award, Barraquer award, and the Kelman award. He is the President-elect of the ISRS/AAO and the Chair of the ISRS-AAO Multimedia Library Editorial Board. His videos have won many awards at the film festivals of ASCRS, AAO, and ESCRS. He has written more than 50 books which have been published in English, Spanish, and Polish. He also trains doctors from all over the world in his center on phaco, bimanual phaco, LASIK, and retina. He heads Dr. Agarwal’s Eye Hospitals, which has 40 locations. He is also a Professor of Ophthalmology at Ramachandra Medical College in Chennai, India. He can be contacted through SLACK Incorporated at bookspublishing@ slackinc.com. Dr. Soosan Jacob, MS, FRCS, DNB, MNAMS is a Senior Consultant Ophthalmologist in Dr. Agarwal’s Eye Hospital, Chennai, India. She has won many international awards for video films and challenging cases at prestigious international conferences in the United States, as well as the Special Gold Medal of the Indian Intraocular Implant and Refractive Society (IIRSI). She is a noted speaker and has been invited to conduct courses and deliver lectures in numerous national and international conferences. She has special interest in cutting-edge surgical techniques for cataract, cornea, glaucoma, and refractive surgery, including intrastromal ring segments, ocular surface reconstruction, subluxated cataracts, new refractive solutions, and so on. Dr. Jacob was the first to bring out the concept of anterior segment transplantation. In this procedure the cornea, sclera, and an artifical iris, pupil, and IOL are transplanted enbloc in patients with anterior staphyloma. She also devised a new technique in the surgery of ptosis where the sling surgery can be done with primarily a one-stab incision rather than three, thus improving the postoperative cosmetic appearance of the patient. She has devised 2 new techniques: the Turnaround technique and the Double Pass Turnaround technique for successful completion of femtosecond laser-assisted Intacs implantation in eyes with false channel dissection for both symmetric and asymmetric Intacs segments. She has also described a new technique of relaxing descemetotomy for taut Descemet’s membrane detachment in the cornea, and has proposed a new classification system and treatment algorithm for Descemet’s membrane detachments. She has authored many articles and numerous chapters in 27 textbooks by international and national publishers, and is also the editor for 9 textbooks in ophthalmology. She is on the senior faculty for the DNB (Diplomate of National Board) postgraduate training program and phacoemulsification and LASIK training program for overseas doctors. She is on the editorial boards of the ISRS/AAO Multimedia Library and of the Ocular Surgery News–Asia Pacific Edition, and is also an executive committee member of the Indian Intraocular Implant and Refractive Society. Her life and work has been featured on the cover page of Ocular Surgery News in the article titled Ophthalmic Innovator Balances Love of Surgery, Research and Teaching.She can be contacted through SLACK Incorporated at bookspublishing@slackinc.com.

Dedication Acknowledgments About the Editor and Associate Editor Contributing Authors Preface Foreword Section I Phaco Surgery Chapter 1 Incision, Rhexis, and Hydrodissection Chapter 2 Divide and Conquer and Chapter 3 Stop and Chop Phacoemulsification Chapter 4 Tilt and Tumble Technique of Nucleus Removal Chapter 5 Horizontal Chapter 6 Vertical Chopping Chapter 7 Cortical Aspiration Techniques and Difficulties Chapter 8 Intraocular Lens Implantation Nisha Sinha, MS; and Section II Microincision Cataract Surgery Chapter 9 Coaxial Microincision Cataract Surgery and Chapter 10 Biaxial Microincision Cataract Surgery Section III Challenging Cases Chapter 11 Phaco in Mature Cataracts and Chapter 12 Iris Hooks in Small Pupil Phaco Chapter 13 Use of Malyugin Ring for Small Pupil Phacoemulsification Chapter 14 Phacoemulsification in Posterior Polar Cataracts Chapter 15 Subluxated Cataracts Section IV Complications Chapter 16 Torn Rhexis Chapter 17 Management of Iridodialysis Chapter 18 Posterior Capsular Rupture Soosan Financial Disclosures Index