Gems of Ophthalmology CATARACT SURGERY
Gems of Ophthalmology CATARACT SURGERY
Editors
HV Nema MS
Formerly, Professor and Head Department of Ophthalmology Institute of Medical Sciences Banaras Hindu University
Varanasi, Uttar Pradesh, India
Nitin Nema MS DNB
Professor Department of Ophthalmology Sri Aurobindo Institute of Medical Sciences
Indore, Madhya Pradesh, India
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 235, 2nd floor, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
Email: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2019, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Gems of Ophthalmology—Cataract Surgery
First Edition: 2019
9789352704019
Printed at
- Abhay R Vasavada MS FRCS
- Director, Illadevi Cataract and
- Intraocular lens Research Center and
- Raghudeep Eye Clinic
- Ahmedabad, Gujarat, India
- Albert Galand MD
- Professor and Chairman
- Department of Ophthalmology
- University of Liege
- Liege, Belgium
- Amrutha Padhaye MS
- Rajan Eye Care Hospital (P) Ltd
- Chennai, Tamil Nadu, India
- Anurag Badhani MS DNB FRCS–I
- Fellow (Vitreoretinal Services)
- LV Prasad Eye Institute
- Bhubaneswar, Odisha, India
- Arindam Chakravarti MS
- Consultant
- Center for Sight
- Dwarka, New Delhi, India
- Arshi Misbah MS
- Senior Resident
- Department of Ophthalmology
- MLB Medical College
- Allahabad, Uttar Pradesh, India
- Arup Chakrabarti MS
- Director
- Chakrabarti Eye Care Center
- Thiruananthapuram, Kerala, India
- Ashish Khodifad DNB
- Fellow, Vitreoretina
- Aravind Eye Hospital and
- Postgraduate Institute of
- Ophthalmology
- Puducherry, India
- Bela Kamboj MS
- Fellow, LV Prasad Eye Institute
- Hyderabad, Telangana, India
- David J Apple MD
- Professor Ophthalmology and
- Pathology
- Director, Research on Ocular
- Therapeutics and Biodevices
- Department of Ophthalmology
- Storm Eye Institute
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Frank Joseph Goes MD
- Director, Oagchirurgie-Oagheekunde, Antwerp, Belgium
- Geetika Badhani DNB
- Senior Resident, Ophthalmology
- Deen Dayal Upadhyay Hospital
- New Delhi, India
- Gitansha Sachdev MS FICO
- Center for Sight
- Safdarjung, New Delhi, India
- H Verbraeken MD
- Professor
- Department of Ophthalmology
- University of Ghent, Ghent, Belgium
- Himanshu Shekhar MD
- Senior Registrar
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- I Howard Fine MD PC
- Physician and Surgeon
- Ophthalmology
- Oregon Eye Associate
- Eugene, Oregon, USA
- Jagat Ram MS
- Professor, Department of
- Ophthalmology, Postgraduate
- Institute of Medical Education and
- Research, Chandigarh, India
- Jagruti P Desai MS
- Consultant, Illadevi Cataract and
- Intraocular Lens Research Center and
- Raghudeep Eye Clinic
- Ahmedabad, Gujarat, India
- Jaime Javaloy MD
- Consultant
- Miguel Hernández University School
- of Medicine
- Alicante, Spain
- Jeewan S Titiyal MD
- Professor, Dr RP Center for
- Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Jorge L Alió MD PhD
- Director, Department of Cornea and
- Refractive Surgery, VISSUM, Instituto
- Oftalmológico de and Miguel
- Hernández University School of
- Medicine, Alicante, Spain
- Kamaljeet Singh MS
- Professor and Head
- Department of Ophthalmology
- MLB Medical College
- Allahabad, Uttar Pradesh, India
- Lalit Verma MD
- Ophthalmologist
- Center for Sight
- Dwarka, New Delhi, India
- Liliana Werner MD PhD
- Visiting Assistant Professor
- and Director, Lions Biomaterial
- Laboratory
- Department of Ophthalmology
- Storm Eye Institute
- Medical University of South Carolina
- Charleston, South Carolina, USA
- M Edward Wilson MD
- N Edgar Miles Center for Pediatric
- Ophthalmology, Department of
- Ophthalmology, Storm Eye Institute
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Manas Nath DO FAICO
- Consultant, Department of Cataract
- and Refractive Services, Aravind Eye
- Hospital and Postgraduate Institute
- of Ophthalmology, Puducherry, India
- Mathew Kurian Kummelil MS
- Consultant, Narayan Nethralaya
- Bengaluru, Karnataka, India
- Meena Chakrabarti MS DO DNB
- Senior Consultant
- Chakrabarti Eye Care Center
- Thiruananthapuram, Kerala, India
- Mohan Rajan MS
- Director
- Rajan Eye Care Hospital (P) Ltd
- Chennai, Tamil Nadu, India
- Moulindu Paul MS
- Consultant
- Rajan Eye Care Hospital (P) Ltd
- Chennai, Tamil Nadu, India
- Mahipal S Sachdev MD
- Center for Sight
- Safdarganj, New Delhi, India
- Murali K Aasuri MS
- Consultant, LV Prasad Eye Institute
- Hyderabad, Telangana, India
- Naresh Babu MS
- Consultant, Aravind Eye Hospital
- and Postgraduate Institute of
- Ophthalmology
- Madurai, Tamil Nadu, India
- Neelam Runda MD
- Resident
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- PD Ramamurthy MD
- Chairman
- The Eye Foundation
- Coimbatore, Tamil Nadu, India
- Parul Sony MD
- Senior Registrar
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Piers Percival FRCS FCOphth
- Consultant Ophthalmic Surgeon
- Scarborough District Hospital
- Scarborough, UK
- Pradeep Venkatesh
- Professor, Dr RP Center for
- Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Rajendra Prasad MD
- Director and Consultant
- RP Eye Institute
- New Delhi, India
- Rajesh Sinha MD FRCS
- Professor
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Rengaraj Venkatesh DNB
- Head and Consultant
- Department of Glaucoma
- Services, Aravind Eye Hospital
- and Postgraduate Institute of
- Ophthalmology, Puducherry, India
- Richard S Hoffman MD
- Ophthalmic Consultant
- Oregon Eye Associate
- Eugene, Oregon, USA
- Rohit Om Prakash MS
- Consultant, Cataract Surgery
- Dr Om Prakash Eye Institute
- Amritsar, Punjab, India
- Rohit Shetty DNB FRCS
- Vice President
- Consultant
- Narayan Nethralaya
- Bengaluru, Karnataka, India
- Sat Pal Garg MD
- Professor, Dr RP Center for
- Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Shreesh Kumar MD
- Consultant, The Eye Foundation
- Coimbatore, Tamil Nadu, India
- Shruti Mahajan MS
- Consultant, Refractive Surgery
- Dr Om Prakash Eye Institute
- Amritsar, Punjab, India
- Sonia Rani John DNB
- Chakrabarti Eye Care Center
- Thiruananthapuram, Kerala, India
- Soumya Ganesh Nanaiah MS
- Consultant, Narayan Nethralaya
- Bengaluru, Karnataka, India
- Sudeep Das MS
- Consultant, Narayan Nethralaya
- Bengaluru, Karnataka, India
- Sujatha Mohan MS
- Consultant
- Rajan Eye Care Hospital (P) Ltd
- Chennai, Tamil Nadu, India
- Supreet Singh Juneja MS
- Junior Consultant
- Aravind Eye Hospital and
- Postgraduate Institute of
- Ophthalmology
- Madurai, Tamil Nadu, India
- Suresh K Pandey MD
- Department of Ophthalmology
- Storm Eye Institute
- Medical University of South Carolina
- Charleston, South Carolina, USA
- Tushya Om Prakash MS
- Consultant, Cataract Surgery
- Dr Om Prakash Eye Institute
- Amritsar, Punjab, India
- Valsa Stephen MS DO DNB
- Consultant
- Chakrabarti Eye Care Center
- Thiruananthapuram, Kerala, India
- Vijay Kumar Sharma MD
- Senior Resident
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
In spite of launching of “Vision 2020: The right to sight program”, cataract continues to remain the main cause of visual impairment and blindness. Cataract has become a serious public health problem in developing countries. According to WHO estimates, cataract is responsible for 51% of blindness. As the world population is rapidly aging, cataract cases are increasing and cataract backlog is accumulating each year.
With the introduction of recent technology, the cataract surgery has completely changed. During the past 50 years, a number of innovations have transformed cataract surgery from intracapsular cataract extraction to phacoemulsification with intraocular lens (IOL) implantation and near normal recovery of vision. The cataract surgery is now considered as a refractive procedure. The most significant landmark innovation was performed by Ridley in 1949 by implanting an IOL after extraction of opaque lens. However, his innovation was fiercely criticized and not adopted by majority of eye surgeons. Later, it was accepted universally. Many formulas were introduced to calculate the power of the IOL to be implanted in order to achieve excellent refractive results.
The other outstanding discovery was phacoemulsification by Charles Kelman in 1967. A small percentage of surgeons realized the value of phacoemulsification surgery and performed the surgery with implantation of rigid 5 mm IOL. Subsequently, foldable IOLs were manufactured to be used through a small 3 mm self-sealing clear corneal incision. Bifocal, toric, and accommodative IOLs are now available to suit the need of individual patients.
Besides improvisation in IOL and incision, there is refinement in the phacoemulsification machine to make the operative technique more safe, simple and rewarding. Attempts are being made to make the surgery, postoperatively drop-free procedure by injecting corticosteroid and moxifloxacin intracamerally/intravitreally.
The present book covers a wide range of topics on cataract surgery such as Manual small-incision cataract surgery, Dye-enhanced cataract surgery, Pediatric cataract Surgery and IOL Implantation, etc. A number of chapters on phacoemulsification in difficult situations such as Posterior polar cataract, White cataract, Hard cataract, and Cataract surgery in small pupil, Subluxated lens and Compromised cornea have also been included for the benefit of young cataract surgeons. We have given useful surgical tips on how to efficiently manage these cases without creating complications. The chapter on Dropped nucleus or nuclear fragment cautions the cataract surgeon where to stop.
Femtosecond laser (FL) has made its inroads in cataract surgery also. FL clear corneal incision, capsulotomy and softening of nucleus make phacoemulsification easy and provide excellent results. Chapters contributed by Sachdev and Sachdev and Nanaiah, et al. reveal merits of the new procedure. Undoubtedly, after phacoemulsification, femtolaser-assisted cataract surgery is the landmark advancement in cataract surgery because it offers precision and safety. The various safe and recent options for performing capsulotomy is described by Chakrabarti in his chapter on anterior capsulotomy.
We assure the readers that the major part of the work presented in this book comes from the Recent Advances in Ophthalmology series edited by us. In each chapter, the author/s has provided references for the benefit of those who want to read the topic in detail.
The book is multi-authored, therefore, repetition could not be avoided. Readers can take the advantage of knowing the views of different authors. However, special effort has been put to avoid ambiguity.
The book is concise and information on cataract surgery is presented in an easily readable form. It is profusely illustrated. Postgraduate students, residents, and general ophthalmologists can learn not only how to perform a safe cataract surgery but also to tackle difficult cases.
HV Nema
Nitin Nema
Acknowledgments
We wish to record our grateful thanks to all the authors for their spontaneity, cooperation and hard work. Some of them have revised their chapters. Our special thanks go to Drs Mahipal S Sachdev, Arup Chakrabarti, Rohit Om Prakash, and Venkatesh Rengaraj for contributing their chapters on a short notice.
Credit goes to Mr Jitendar P Vij (Group Chairman), and Mr Ankit Vij (Managing Director) of Jaypee Brothers Medical Publishers (P) Ltd. who have agreed to start a new series—Gems of Ophthalmology. “Cataract Surgery” is the fifth book of this series.