Περιγραφή
Cataracts are a very common condition whereby the lens of the eye becomes cloudy causing blurred vision. Over time, a cataract can get worse, eventually leading to blindness if untreated. Cataracts are the most common cause of blindness worldwide. Phacoemulsification surgery is the most widely used method for cataract management.
Simplified Phacoemulsification is a step by step guide to the complete technique of phacoemulsification.
Beginning with an introduction to the anatomy and development of the lens, patient selection and the phacoemulsification machine used in the procedure, the following chapters describe the complete process from anaesthesia, suturing and incision, through the different basic and technical aspects of the technique. The final section examines instruments used for phaco surgery.
Written in an easy to read, short note format, this comprehensive manual includes more than 280 full colour images and figures to enhance learning.
Key points
- Step by step guide to phacoemulsification
- Covers complete process from basic anatomy and development, to anaesthesia and suturing, and technical aspects of the procedure
- Easy to read, short note format
- Includes more than 280 full colour images, figures and illustrations
Περιεχόμενα
1. Anatomy and Development of Lens 1
Lens Capsule 1
Lens Epithelium 2
Lens Fibers 2
Lens Proteins 3
Lens Metabolism 3
Development of Lens 3
2. Selection of Patient 6
History 6
General Examination 6
Systemic Examination 7
Other Factors 8
Local Examination 8
Slit-Lamp Photograph of Cataracts—Selection and Analysis 12
3. Phacoemulsification Machine 21
Parts of Phaco Machine 21
Preperation or Tuning of the Phaco Machine 31
Cleaning of Phaco Machine 31
Following are the Important Terms
Concerned with the Phaco Machine 31
Irrigation and Aspiration 35
4. Anesthesia 36
Types of Anesthesia 36
Local or Regional Anesthesia 36
Topical Anesthesia 37
General Anesthesia 37
Regional Anesthesia 38
Topical Anesthesia 38
General Anesthesia 39
5. Bridle Sutures 40
Superior Rectus Bridle Suture 40
Inferior Rectus Bridle Suture 41
Complications 42
6. Incision 43
IncisionS Used in Surgery 43
Principle of Incision 44
Construction of Wound 44
Procedure 46
Advantages and Disadvantages of Different
Types of Main Port Incision 54
Correlation of Phaco Fluidics with Incision 56
Correlation of Incision with Iris Movement 56
7. Capsulorhexis 58
Anatomical Consideration 58
Prerequisites 59
Physics of Capsulorhexis 59
Instruments 60
Solutions 63
Technique of Capsulorhexis 64
Zones of the Capsulorhexis 67
Speed of the Capsulorexis 69
Viscoelatstics in Capsulorhexis 69
Anatomical Variations 71
How to Practice Capsulorhexis 72
Running Away of the Capsulorhexis 72
8. Hydro Procedures 80
Procedure 81
Complication 83
Advantages 84
Disadvantages 84
9. Trench of Nucleus 88
Definition 87
Prerequisite 88
Technique 88
What is the Ideal Trench 90
Variations of Trench in Different Types of Cataract 95
Complications of Trench 97
Factors Needed to Master this Important Step of Phaco 97
Variations in Design of Trench During Learning
Phase and Trench Related to Different Mind Set 97
10. Division of Nucleus 109
Prerequisite 109
Principle 109
Techniques 111
Akahoshi Prechopper 115
Toshniwal Prechopper 115
Procedure 116
Important Tips Related to Division 117
Different Happenings During Division 118
Correlation of Trench with Division 119
Division in Soft Cataract 120
Complications of Division 121
Difficulties During Division 121
11. Hold and Chop of Nucleus 130
Instruments Needed 130
Principle of Hold 131
Role of Vacuum and Aspiration Flow Rate 132
Role of Energy 132
Positions of Foot Pedal 132
Functions of Foot Pedals 132
Principle of Chop 133
Types of Chopping 133
Parameter of Hold 134
Prerequistie for Hold and Chop 135
Rotation of Nucleus 135
Principle of Rotation 135
Correlation of Hold and Chop with Foot Pedal 138
Variations for Hold 141
Complications During Hold and Chop 142
Difficulties During Hold and Chop 142
Difficult Situations for Hold and Chop 142
Role of Chopper 142
Misuse of Chopper 143
Placement of Chopper 143
Types of Choppers 143
Complications due to the Chopper 144
Speed of the Chopper 144
12. Removal of Small Pieces of Nucleus 154
Instruments 154
Principle 155
Ideal Site to Remove Small Pieces 155
Parameters 156
Correlation of Foot Pedal with Parameter is Most Important 156
Role of Energy, Vacuum and Flow Rate 157
Phaco Tip 160
Role of Chopper 163
Misuse of Chopper 166
Viscoelastics and Viscocannula 166
Complication 167
13. Irrigation and Aspiration 178
Types 178
Coaxial Irrigation-Aspiration 178
Cap-Vac Mode 184
Bimanual Irrigation-Aspiration 185
Manual Irrigation and Aspiration 188
Indication in Phaco 189
Complication 189
14. Intraocular Lens—Basic and Technical Aspects 199
Material Use 199
Types of Lenses 199
Different Classification 200
Other Classification 200
Foldable Lens 201
Poly Methyl Methacrylate Lens 203
Finishing Steps of Phaco Surgery after Putting IOL 203
15. No Hydro in Phaco 205
History 205
Definition 206
Evolution of Phaco Surgery in Authors Practice Related to
Hydroprocedures 207
16. Instruments for Phaco Surgery 209
Index 219
