Cataract and Refractive Surgery

by Kohnen, Thomas; Koch, Douglas D.

• ISBN13: 9783540200468
• ISBN10: 3540200460
• Edition: 1st
• Format: Hardcover
• Copyright: 2004-10-16
• Publisher: Springer Verlag

Summary

The topic of the second volume of the series in "Essentials in Ophthalmology" is cataract and refractive surgery, a realm of ophthalmic care that has undergone revolutionary changes in the past 10 years. Worldwide, the removal of the opaque crystalline lens is the most frequently performed surgical intervention in the human body, and refractive surgery encompasses an increasing array of procedures with rapidly growing surgical volumes. The goal of the editors of this book has been to provide up-to-date clinically relevant overviews and to highlight the most interesting fields of research and controversy.The first half of the book focuses on new cataract surgical techniques and devices, including topical anaesthesia, small incision cataract surgery, modern intraocular lenses and ophthalmic viscosurgical devices. Special attention is devoted to difficult situations, such as mature, uveitic and pediatric cataracts, and to the prevention and management of complications.The second half of the book describes current and evolving modalities - both corneal and lenticular - to correct human refractive errors. Particular emphasis is placed on topics related to quality of vision, such as wavefront technology, measuring quality of vision, and issues in pupil measurement. Many of these topics pertain also to cataract surgery, indicating the merging of technologies that is occurring in these two major ophthalmic subspecialties.

Table of Contents

Cataract Surgery
CHAPTER 1 Topical and Intracameral Anaesthesia for Cataract Surgery
ROBERTO BELLUCCI, SIMONETTA MORSELLI
1.1 Introduction	1	(1)
1.1.1 Foreword	1	(1)
1.1.2 History	1	(1)
1.1.3 Definitions	2	(1)
1.2 Bases of Topical/Intracameral Anaesthesia in Cataract Surgery	2	(1)
1.2.1 Physiological Bases	2	(1)
1.2.2 Pharmacological Bases	2	(1)
1.2.3 Surgical Bases	3	(1)
1.3 Drugs Employed	3	(3)
1.3.1 Topical Anaesthetic Drugs	3	(1)
1.3.2 Ester-Bound Compounds	4	(1)
1.3.3 Amide-Bound Compounds	4	(1)
1.3.4 Influence of Formulation	5	(1)
1.4 Routes of Administration	6	(3)
1.4.1 Eyedrop Instillations	6	(1)
1.4.2 Gel Application	7	(1)
1.4.3 Drug-Soaked Sponges	8	(1)
1.4.4 Intracameral Irrigations	8	(1)
1.4.5 Viscoelastic-Borne Anaesthesia	9	(1)
1.5 Preferred Procedures	9	(1)
1.5.1 Patient Selection and Counselling	9	(1)
1.5.2 Surgery Adaptation	9	(1)
1.5.3 Management of Complications	10	(1)
1.5.4 Postoperative Instructions	10	(1)
1.6 Clinical Experience	10	(2)
1.6.1 Topical Anaesthesia	10	(1)
1.6.2 Intracameral Anaesthesia	11	(1)
1.7 No Anaesthesia Cataract Surgery	12	(1)
1.8 Current Recommendations	12	(2)
1.8.1 Treatment Schedule	12	(1)
1.8.2 Drug Selection	13	(1)
1.9 Conclusions	14	(1)
References	14	(5)
CHAPTER 2 Surgical Techniques for Small Incision Cataract Surgery
I. HOWARD FINE, MARK PACKER, RICHARD S. HOFFMAN
2.1 Introduction	19	(1)
2.2 Wound Construction and Architecture	19	(3)
2.3 Continuous Curvilinear Capsulorhexis	22	(2)
2.4 Hydrodissection and Hydrodelineation	24	(1)
2.4.1 Cortical Cleaving Hydrodissection	24	(1)
2.4.2 Hydrodelineation	24	(1)
2.5 Nucleofractis Techniques	25	(9)
2.5.1 Divide and Conquer Technique	26	(1)
2.5.2 Phaco Fracture Technique	26	(1)
2.5.3 Chip and Flip Technique	27	(1)
2.5.4 Crack and Flip Technique	27	(1)
2.5.5 Phaco Chop	28	(1)
2.5.6 Choo Choo Chop and Flip	28	(4)
2.5.7 Laser Phacoemulsification	32	(1)
2.5.8 Bimanual Ultrasound Phacoemulsification	33	(1)
2.6 Conclusion	34	(1)
References	34	(3)
CHAPTER 3 Ophthalmic Viscosurgical Devices
STEVE A. ARSHINOFF
3.1 Introduction	37	(1)
3.2 History	38	(1)
3.3 Physical Properties of OVDs	39	(1)
3.4 Generic or Proprietary Nomenclature	40	(1)
3.5 Currently Marketed Polymers	40	(1)
3.5.1 Sodium Hyaluronates	40	(2)
3.5.2 Chondroitin Sulphate	42	(1)
3.5.3 Hydroxypropylmethylcellulose (HPMC)	43	(1)
3.6 Polymers no Longer Marketed as OVDs	43	(1)
3.6.1 Polyacrylamide	43	(1)
3.6.2 Collagen IV	43	(1)
3.7 The Physical (Rheologic) Properties of OVDs and Their Measurement	44	(1)
3.7.1 Viscosity (Dynamic)	44	(1)
3.7.2 Plasticity	44	(1)
3.7.3 Pseudoplasticity	44	(1)
3.7.4 Elasticity	45	(1)
3.7.5 Rigidity	46	(1)
3.7.6 Cohesion and Dispersion	46	(1)
3.8 Important Viscoelastic Rheologic Properties in the Various Steps of Cataract Surgery	47	(2)
3.9 Choosing Viscoelastics for Specific Procedures	49	(1)
3.9.1 Higher-Viscosity Cohesives	49	(1)
3.9.2 Lower-Viscosity Dispersives	50	(1)
3.10 The Viscoelastic Soft Shell Technique	50	(6)
3.10.1 Background and Rationale	50	(2)
3.10.2 The Dispersive-Cohesive Viscoelastic Soft Shell Technique	52	(1)
3.10.3 Method	52	(2)
3.10.4 Using the Soft Shell Technique	54	(1)
3.10.5 Application of the Soft Shell Technique to specific problems	55	(1)
3.11 Viscoadaptives - Healon5	56	(4)
3.11.1 Development	56	(2)
3.11.1 Viscoadaptive Use in Complications	58	(1)
3.11.2 The Ultimate Soft Shell Technique	58	(1)
3.11.3 Removal of Viscoadaptives	59	(1)
3.12 Conclusion	60	(1)
References	61	(2)
CHAPTER 4 Foldable Intraocular Lenses
LILIANA WERNER, NICK MAMALIS
4.1 Introduction and Brief Overview of Biomaterials Used for the Manufacture of Foldable Intraocular Lenses	63	(1)
4.2 Silicone Intraocular Lenses	64	(2)
4.2.1 Plate Intraocular Lenses	64	(1)
4.2.2 Three-Piece Intraocular Lenses	65	(1)
4.3 Acrylic Intraocular Lenses	66	(7)
4.3.1 Hydrophobic Acrylic Intraocular Lenses	66	(4)
4.3.2 Hydrophilic Acrylic (Hydrogel) Intraocular Lenses	70	(3)
4.4 Specialized Foldable Intraocular Lenses	73	(8)
4.4.1 Multifocal Intraocular Lenses	73	(1)
4.4.2 Toric Intraocular Lenses	74	(1)
4.4.3 Aspheric Intraocular Lenses	75	(1)
4.4.4 Intraocular Lenses with Special Blockers (Blue Blocker)	76	(1)
4.4.5 Accommodative Intraocular Lenses	76	(2)
4.4.6 Intraocular Lenses for Very Small Incisions	78	(2)
4.4.7 Adjustable Power Intraocular Lenses	80	(1)
4.5 Summary	81	(1)
References	82	(3)
CHAPTER 5 "Accommodative" IOLs
OLIVER FINDL
5.1 Introduction	85	(7)
5.1.1 Background	85	(1)
5.1.2 Apparent Accommodation or Depth of Field	86	(1)
5.1.3 Focus Shift Principle	86	(1)
5.1.4 Clinical Assessment	87	(2)
5.1.5 Accommodative IOLs	89	(3)
5.1.6 Lens Refilling	92	(1)
5.2 Clinical Experience with Available IOLs	92	(4)
5.2.1 Conventional IOLs	92	(1)
5.2.2 Accommodative IOLs	93	(3)
5.3 Current Clinical Practice and Recommendations	96	(2)
References	98	(3)
CHAPTER 6 Prevention of Posterior Capsule Opacification
RUPERT M. MENAPACE
6.1 Definition, Types and Natural Behaviour of "After-Cataract"	101	(4)
6.2 Quantification of After-Cataract	105	(1)
6.3 Prevention of After-Cataract	105	(6)
6.3.1 Removing LEC from the Equator to Reduce the Proliferative Potential	105	(1)
6.3.2 Erecting Mechanical Barriers to Prevent LEC Migration	106	(5)
6.4 Rationale for Investigating Alternatives: "Optic Edge Barrier Failures"	111	(9)
6.4.4 Factors Influencing Fibrotic After-Cataract Formation	114	(1)
6.4.5 The Role of Optic Material	115	(1)
6.4.6 The Role of Patient Age	115	(1)
6.4.7 Alternatives to the Sharp-Edged Optic	116	(4)
References	120	(3)
CHAPTER 7 Management of the Mature Cataract
SAMUEL MASKET
7.1 Introduction	123	(2)
7.2 Cortical (Intumescent) Mature Cataracts	125	(3)
7.3 What to Do When Things Go Wrong	128	(1)
7.4 The Nuclear Mature (Brunescent) Cataract	128	(1)
7.5 Surgical Management	129	(2)
References	131	(2)
CHAPTER 8 The Treatment of Uveitic Cataract
ARND HEILIGENHAUS, CARSTEN HEINZ, MATTHIAS BECKER
8.1 Introduction	133	(1)
8.2 Basics for Cataract Formation in Uveitis	133	(1)
8.3 Basics for the Consideration of IOL Implantation	134	(1)
8.3.1 Uveal Biocompatibility	134	(1)
8.3.2 Capsular Biocompatibility	135	(1)
8.4 Patient Selection	135	(1)
8.4.1 Aetiology of Uveitis	135	(1)
8.4.2 Indications and Contraindications in Cataract Surgery	135	(1)
8.5 Timing of Surgery and Preoperative Management	136	(1)
8.5.1 Timing of Surgery	136	(1)
8.5.2 Preoperative Anti-inflammatory Medication	136	(1)
8.6 Surgery	137	(1)
8.6.1 Intraoperative Medication	137	(1)
8.6.2 Approaches to Cataract Surgery	137	(1)
8.7 Extracapsular Cataract Extraction	138	(1)
8.8 Phacoemulsification	138	(1)
8.9 Lensectomy	139	(1)
8.9.1 Pars Plana Approach to Lensectomy - Anterior Vitrectomy	139	(1)
8.9.2 Limbal Approach to Lensectomy - Anterior Vitrectomy	139	(1)
8.10 IOL Implantation	140	(2)
8.10.1 General Concerns	140	(1)
8.10.2 Indications and Contraindications	140	(1)
8.10.3 Placement of the Intraocular Lenses	140	(1)
8.10.4 IOL Material	141	(1)
8.10.5 IOL Design	141	(1)
8.10.6 IOL Explantation	141	(1)
8.11 Combined Vitrectomy	142	(1)
8.11.1 Anterior Vitrectomy	142	(1)
8.11.2 Pars Plana Vitrectomy (PPV)	142	(1)
8.12 Typical Intraoperative Complications and Their Management	143	(2)
8.12.1 Band Keratopathy	143	(1)
8.12.2 Synechiae	143	(1)
8.12.3 Miosis	144	(1)
8.12.4 Hyphema	144	(1)
8.12.5 Vitreous Loss and Membranes	144	(1)
8.13 Typical Postoperative Complications and Their Management	145	(1)
8.13.1 Inflammation	145	(1)
8.13.2 Ocular Hypertension and Glaucoma	145	(1)
8.13.3 Ocular Hypotony	146	(1)
8.13.4 Retinal Detachment, Macular Pucker and Uveal Effusion	146	(1)
8.13.5 Synechiae	146	(1)
8.13.6 Hyphema and Rubeosis	147	(1)
8.13.7 Posterior Capsule Opacification	147	(1)
8.13.8 Deposits of cells on the IOL	147	(1)
8.13.9 Contact Lenses and Amblyopia	148	(1)
8.13.10 Cystoid Macular Oedema	148	(1)
8.14 Visual Outcome After Cataract Surgery in Patients with Uveitis	149	(1)
8.15 Final Remarks	149	(1)
References	149	(4)
CHAPTER 9 Paediatric Cataract Surgery
CHARLOTTA ZETTERSTROM
9.1 Introduction	153	(3)
9.1.1 Aetiology	153	(1)
9.1.2 Morphology	154	(1)
9.1.3 Amblyopia and Congenital Cataracts	155	(1)
9.2 Congenital Dense Cataract	156	(3)
9.2.1 Pre-operative Examination	156	(1)
9.2.2 Surgical Technique in Infants	157	(2)
9.3 Cataracts in Older Children	159	(1)
93.1 Pre-operative Examination	159	(1)
9.3.2 Surgical Technique	160	(1)
9.4 IOL Power and Model	160	(4)
9.4.1 Post-operative Treatment	161	(1)
9.4.2 Post-operative Complications	162	(2)
9.5 Current Clinical
Recommendations	164	(1)
References	164	(3)
CHAPTER 10 Prevention and Treatment of Post-cataract Surgery Infection
WOLFGANG BEHRENS-BAUMANN
10.1 Introduction	167	(1)
10.1.1 Incidence	167	(1)
10.1.2 Sources of Contamination	168	(1)
10.2 Prevention of Post-operative Endophthalmitis	168	(2)
10.2.1 Preoperative Prophylaxis	168	(1)
10.2.2 Intraoperative Prophylaxis	169	(1)
10.2.3 Postoperative Prophylaxis	170	(1)
10.3 Treatment of Post-cataract Endophthalmitis	170	(2)
10.3.1 Diagnostic Measures	170	(1)
10.3.2 Anti-infective Therapy	170	(1)
10.3.3 Anti-inflammatory Therapy	171	(1)
10.3.4 Surgery	171	(1)
10.4 Conclusion	172	(1)
References	172	(5)
Refractive Surgery
CHAPTER 11 Future Trends in Refractive Surgery
JACQUELINE T. KOO, ERIC J. LINEBARGER, RICHARD L. LINDSTROM, DAVID R. HARDTEN
11.1 Introduction	177	(1)
11.2 Cornea	177	(5)
11.2.1 Corneal Tissue Removal	177	(3)
11.2.2 Corneal Volume Addition	180	(1)
11.2.3 Corneal Relaxation	181	(1)
11.2.4 Corneal Compression	181	(1)
11.3 Ciliary Body	182	(1)
11.4 Lens	182	(2)
11.5 Crystalline Lens Replacement	184	(1)
11.6 Phakic Intraocular Refractive Lenses	185	(1)
11.7 Conclusion	186	(1)
References	186	(3)
CHAPTER 12 LASIK - Laser In Situ Keratomileusis
MICHAEL C. KNORZ
12.1 History	189	(1)
12.2 Patient Selection, Technique and Results	190	(3)
12.2.1 Patient Selection	190	(2)
12.2.2 Technique	192	(1)
12.2.3 Results	192	(1)
12.3 Complications	193	(3)
12.3.1 Microkeratome-Related Flap Complications	193	(1)
12.3.2 Other Flap Complications	194	(1)
12.3.3 Interface Complications	195	(1)
12.4 Quality of Vision	196	(2)
12.5 Customized Ablations	198	(2)
12.5.1 Wavefront Measurements	199	(1)
12.5.2 Wavefront-Guided Treatments	199	(1)
12.5.3 What Are the Benefits of Customised LASIK?	199	(1)
References	200	(3)
CHAPTER 13 LASEK vs PRK
CHUN CHEN CHEN, DIMITRI T. AZAR
13.1 Introduction	203	(1)
13.2 Surgical Technique of LASEK and PRK	204	(3)
13.2.1 Personal Experience (Azar's Technique)	204	(2)
13.2.2 Camellin's Technique	206	(1)
13.2.3 Vinciguerra's Techinique (Butterfly Technique)	206	(1)
13.2.4 Gel Assisted LASEK	206	(1)
13.3 Clinical Results of LASEK vs PRK	207	(1)
13.4 Electron Microscopy	208	(1)
13.4.1 Preparation of Specimens for Electron Microscopy	208	(1)
13.4.2 Electron Microscopic Analysis of Epithelial Sheets Removed Using 20% Alcohol	208	(1)
13.5 Corneal Wound Healing After the Refractive Process	209	(1)
13.5.1 Epithelial Wound Healing	210	(1)
13.5.2 Stromal Wound Healing	210	(1)
13.6 Epithelial Cell Viability	210	(5)
References	215	(2)
CHAPTER 14 Refractive Keratotomy: Does It Have a Future Role in Refractive Surgery?
MITCHELL P. WEIKERT, DOUGLAS D. KOCH
14.1 Introduction	217	(1)
14.2 History of Refractive Keratotomy	217	(1)
14.3 Principles of Refractive Keratotomy	218	(2)
14.4 Techniques of Refractive Keratotomy [5]	220	(3)
14.5 Major Clinical Trials in Refractive Keratotomy	223	(2)
14.6 Complications of Refractive Keratotomy	225	(2)
14.6.1 Hyperopic Drift	225	(1)
14.6.2 Diurnal Fluctuation	225	(1)
14.6.3 Other Complications	226	(1)
14.7 Refractive Keratotomy for the Management of Astigmatism	227	(5)
14.7.1 Cataract Incision Placement	227	(1)
14.7.2 Opposite Clear Corneal Incisions	228	(1)
14.7.3 Arcuate and Transverse Keratotomy	228	(2)
14.7.4 Peripheral Corneal Relaxing Incisions	230	(2)
14.8 Conclusion	232	(1)
References	232	(3)
CHAPTER 15 Phakic Intraocular Lenses
DENNIS C. LU, DAVID R. HARDTEN, RICHARD L. LINDSTROM
15.1 Introduction	235	(1)
15.1.1 Limitations of Keratorefractive Procedures	235	(1)
15.1.2 Role of Lenticular Refractive Procedures	236	(1)
15.2 Evolution and Classification of Phakic IOLs	236	(7)
15.2.1 Anterior Chamber Angle-Fixated Lenses	236	(4)
15.2.2 Anterior Chamber Iris-Fixated Lenses	240	(1)
15.2.3 Posterior Chamber Lenses	241	(2)
15.3 Evaluation of the Phakic IOL Patient	243	(2)
15.3.1 General Patient Factors	243	(1)
15.3.2 Refraction	243	(1)
15.3.3 Anatomic Factors	244	(1)
15.3.4 Pre-existing Ocular Pathology	244	(1)
15.3.5 IOL Sizing for Fixated Lenses	244	(1)
15.3.6 IOL Calculations	244	(1)
15.3.7 Peripheral Iridectomy or Iridotomy	245	(1)
15.4 Surgical Technique	245	(1)
15.4.1 Anterior Chamber Angle Fixated	245	(1)
15.4.2 Anterior Chamber Iris Fixated	246	(1)
15.4.3 Posterior Chamber Angle Fixated	246	(1)
15.4.4 Posterior Chamber Phakic Refractive Lens	246	(1)
15.5 Post-operative Course and Enhancements	246	(1)
15.6 Results	247	(4)
15.6.1 Myopic Results	247	(1)
15.6.2 Hyperopic Results	247	(4)
15.6.3 Toric Results	251	(1)
15.7 Complications	251	(3)
15.8 Conclusions	254	(1)
References	254	(3)
CHAPTER 16 Refractive Lens Exchange
JOSE LUIS GÜELL, NANCY SANDOVAL, FELICIDAD MANERO, OSCAR GRIS
16.1 Introduction	257	(1)
16.2 Myopia	258	(5)
16.2.1 Visual Results	258	(1)
16.2.2 Complications	259	(4)
16.3 Hyperopia	263	(5)
16.3.1 Visual Results	263	(4)
16.3.2 Complications	267	(1)
16.3.3 Multifocal IOLs	267	(1)
16.4 Surgical Technique: Phaco-rolling	268	(1)
References	269	(2)
CHAPTER 17 The Concept of Wavefront-Guided Corneal Surgery
LI WANG, DOUGLAS D. KOCH
17.1 Principle of Wavefront Technology	271	(8)
17.1.1 Basics of Wavefront Aberration	271	(1)
17.1.2 Visual Benefit of Higher-Order Aberration Correction	272	(1)
17.1.3 Principles of Measuring Wavefront Aberration	273	(2)
17.1.4 Quantifying Wavefront Aberrations	275	(4)
17.2 Accuracy and Repeatability of Wavefront Aberrometers	279	(2)
17.2.1 WaveScan	279	(1)
17.2.2 Zywave	280	(1)
17.2.3 COAS	280	(1)
17.2.4 Tscherning Aberrometer	281	(1)
17.2.5 Tracey VFA	281	(1)
17.3 Clinical Outcome of Wavefront-Guided Corneal Surgery	281	(4)
17.3.1 Methods	281	(2)
17.3.2 Summary of Results	283	(2)
17.4 Limitations of Wavefront-Guided Corneal Surgery	285	(1)
17.5 Future of Wavefront-Guided Corneal Surgery	285	(1)
References	286	(3)
CHAPTER 18 The Pupil and Refractive Surgery
EMANUEL ROSEN
18.1 Introduction	289	(1)
18.2 Pupillometry and Refractive Surgery	289	(3)
18.2.1 The Pupil and the Cornea	290	(2)
18.3 Planning Corneal Refractive Surgery	292	(2)
18.4 Pupils and Night Vision	294	(1)
18.5 Pupillary Unrest, Anisocoria and Measurement	295	(1)
18.6 How Should Pupils Be Measured?	296	(2)
18.6.1 Data Acquisition and Processing System	296	(1)
18.6.2 Illumination	296	(2)
18.7 Pupillometry Studies	298	(4)
18.7.1 Precision	298	(1)
18.7.2 Accuracy	299	(3)
References	302	(1)
CHAPTER 19 Quality of Vision After Refractive Surgery
THOMAS KOHNEN, JENS BÜHREN, THOMAS KASPER, EVDOXIA TERZI
19.1 Introduction	303	(1)
19.2 Defining Quality of Vision	303	(3)
19.2.1 Subjective Symptoms	304	(1)
19.2.2 Visual Function	305	(1)
19.2.3 Optical Image Quality	305	(1)
19.2.4 The Role of Anatomy	306	(1)
19.3 Measuring Quality of Vision	306	(4)
19.3.1 Subjective: Questionnaires	307	(1)
19.3.2 Functional	307	(1)
19.3.3 Optical: Wavefront Sensing, MTF, PS F	308	(2)
19.3.4 Anatomical: Biomicroscopy, Corneal Topography	310	(1)
19.4 Specific Changes in Quality of Vision After Refractive Surgery	310	(2)
19.4.1 Incisional Surgery	310	(1)
19.4.2 Excimer Surgery	311	(1)
19.4.3 Intraocular Lens Procedures	312	(1)
19.5 Future Approaches to Improve Quality of Vision After Refractive Surgery	312	(1)
References	313	(2)
Subject Index	315