Manual Small Incision Cataract Surgery (MSICS)
Jaypee Gold Standard Mini Atlas Series®
Manual Small Incision Cataract Surgery (MSICS)
Editors Ashok Garg MS, Ph.D., FIAO (Bel) FRSM, ADM, FAIMS, FICA
International & National Gold Medalist, Medical Director Garg Eye Institute & Research Centre 235-Model Town,
Dabra Chowk, Hisar-125005 (India)
Francisco J Gutérrez-Carmona MD, Ph.D
Associate Professor Ophthalmologic Research Institute, Ramon Castroviejo, Zarracin 25-Urb La Berzosa, 28240, Hoyo de Manzanares,
Madrid (Spain)
Luther L Fry MD
Director Fry Eye Associates, PA/Ophthalmology, 340, East Walnut, Kansas 67846-2562,
Garden City (USA)
Amulya Sahu MS
Director Sahu Eye Hospital, A-1, Wimla Apts., Marve Road, Malad (West),
Mumbai-110064 (India)
MS Ravindra MS
Director Karthik Netralaya, 89, 7th Cross, NR Colony
Bangalore-560050 (India)
Foreword
Carlos Infantes
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Jaypee Gold Standard Mini Atlas Series® MSICS
© 2008, Jaypee Brothers Medical Publishers
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.
First Edition: 2008
9788184482768
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4Dedicated to
- My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation.
- My Respected Parents, teachers, my wife, Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
- My dear friend Dr. Amar Agarwal, a leading International Ophthalmologist from India for his continued support and guidance.
Ashok Garg
My wife, Ardis and my sons, Eric and David whose sacrifices have made my career in ophthalmology possible.
My wife, Carmen and my daughters Marta and Laura for their love and support. All my teachers and particularly Prof. Ramon Castroviejo who taught me the elegance and excellence in ocular surgery.
Dr Amar Agarwal for his friendship.
Francisco J Gutierrez-Carmona
To my parents for their love, to my wife for her faith, to my sons, Dr Chinmaya Sahu and Dr Aditya Sahu for their companionship, to almighty for making life meaningfull.
Amulya Sahu
6CONTRIBUTORS
- Albrecht Hennig MD
- Lahan Eye Hospital
- C/o UMN, PO Box 126,
- Kathmandu, Nepal
- Amulya Sahu MS
- Director
- Sahu Eye Hospital
- A-1, Wimla Apts., Marve Road
- Malad (W), Mumbai
- India.
- Arif Adenwala MS
- Consultant
- Aditya Jyot Eye Hospital (P) Ltd.
- Plot No. 153, Road No. 9
- Major Parmeshwaran Road
- Opp. SIWS College, Gate No. 3
- Wadala, Mumbai-400031
- India
- Arun Kshetrapal MS
- Kshetrapal Eye Hospital and Research Centre
- Kutchery Road, Ajmer-305001
- India
- Ashok Garg MS, Ph.D, ADM, FRSM
- Chairman and Medical Director
- Garg Eye Institute and Research Centre, 235, Model Town
- Dabra Chowk, Hisar-125005
- India
- Chinmaya Sahu MS
- Sahu Eye Hospital
- A-1, Wimla Apts, Marve Road
- Malad (W), Mumbai, India
- Francisco J Gutiérrez-Carmona MD, Ph.D
- Zarracin, 25-Urb, La Berzosa
- 28240, Hoyo de Manzanares
- Madrid, Spain
- Jagannath Boramani MS
- Surya Netralaya
- 51, 4th Floor, Shanti Centre
- Sec-17, Vashi
- Navi Mumbai-400703, India.
- Kamaljeet Singh MS
- Associate Prof. Ophthamology
- 410, MLN Medical College,
- Allahabad, India.
- KPS Malik MS
- Prof. and Head
- Department of Ophthalmology
- Vardhman Medical College
- Safdarjung Hospital
- New Delhi, India.
- K Thiruvenkata Krishnan MS
- Aravind Eye Hospital,
- Abhishekapakkam,
- Luther L Fry MD
- Fry Eye Associates
- PA/Ophthalmology
- 310, East Walnut, Garden City
- Kansas-67846-2562, USA
- MS Ravindra MS
- Director,
- Karthik Netralaya,
- Ashok Nagar, 89, 7th CrossNR Colony, Bangalore-560050
- India
- Nikhilesh Trivedi MS
- Consultant Ophthalmologist
- Bhatera Road,
- Balaghat-481001, India
- Praputsaoran Kosakaran MD
- Department of Ophthalmology
- Prapokklao Hospital
- Chanthaburi, Thailand
- RD Ravindran MS
- Aravind Eye Hospital,
- Abhishekapakkam,
- Pondicherry-605007, India
- Ramesh Kshetrapal MS
- Kshetrapal Eye Hospital and Research Centre,
- Kutchery Road,
- Ajmer-305001, India
- Ranjit S Dhaliwal MS, DOMS
- Eye Infirmary, Hira Mahal
- Radha Soami Marg
- Nabha-147201, India
- Ruchi Goel MS
- Consultant Ophthalmologist
- Department of Ophthalmology
- Guru Nanak Eye Centre
- New Delhi, India
- Vaijayanti Deodhar MS, DOMS
- Deodhar Eye Hospital
- 39/25, Erandawane
- Karve Road, Pune-411004
- India
Small incision manual cataract surgery has also improved significantly with the passage of time. As a matter of fact similar results as with phacoemulsi-fication can be obtained. Using this approach in difficult cases was still possible without having to enlarge the incision to 10-12 mm. Independency from technology becomes important in many situations. Also when speaking to surgeons who do or have practised SIMCS, there is a common agreement that transition to phaco-emulsification was easy. The intraocular manipulation, respecting the eye structures required by SIMCS makes the difference as opposed to plain transition from planned ECCE to phacoemulsification.
I greatly appreciate that such an excellent and experienced communicator as Dr. Ashok Garg, has combined his effort together with the co-editors Dr. Luther L. Fry, Dr. Francisco J. Gutiérrez-Carmona, Dr. Amulya Sahu and Dr. MS Ravindra to write Mini Atlas Book, with the important contribution of a selected group of experts in this field.
The book is mainly dedicated to describe several manual techniques including nuclear manipulation or 9fragmentation, fragment extraction, strategies in the use of several viscoelastic devices, the use of an anterior chamber maintainer, etc. A whole chapter on complications and their avoidance is also included. In other words, the reader will find many ideas to either learn or enrich from his manual small incision cataract surgery mini atlas.
I would like to give my warmest thanks to Dr. Ashok Garg for honouring me with the task of writing the foreword to his book. I am convinced that it will help many surgeons to improve their surgical skills for the benefit of their patients.
Carlos Infantes
Medical Director
Clínica Oftalmológica Dr. Infantes
03730 Jávea (Alicante) Spain
Tel. 96 5791229
Fax: 96 6460424
Mob.699 967011
10PREFACE
Manual Small Incision Cataract Surgery (MSICS) has improved significantly with the passage of time. Similar visual results can be obtained as with phaco with much lesser costs. Being proficient in MSICS not only makes the ophthalmologist independent of machine technology but also it has many other advantages as it is very useful in difficult situations like hard cataracts. Proficiency in MSICS makes the transition to phacoemulsification much easy.
This Mini Atlas of MSICS contains 15 chapters covering various techniques of MSICS beautifully by International Masters of this field. All MSICS techniques are described with more figures step by step for better understanding.
We are thankful to Shri Jitendar P Vij, Chairman and Managing Director, Mr Tarun Duneja (General Manager, Publishing) and all staff members of M/s Jaypee Brothers Medical Publishers (P) Ltd. for active interest and support provided in the publication.
This Mini Atlas on MSICS shall be invaluable companion to ophthalmologists as ready reckoner in operation theatre and clinical OPD for quick review.
Editors