Complications During and After Cataract Surgery [recurso electrónico] A Guide to Surgical Management

Every cataract surgeon is afraid of complications, but while complications cannot be entirely avoided, it is possible to learn to master them. This practical handbook clearly explains how to manage the various complications that may arise during cataract surgery, from a subluxated intraocular lens to a dropped nucleus. It provides the surgeon with clear instructions on how best to proceed in the manner of a cookbook, by first describing the ingredients (equipment) and preparation (planning) and then providing step by step descriptions of technique with the aid of numerous helpful color illustrations and several accompanying surgical videos. Surgical pearls and tips and tricks are highlighted. Using this book, the reader will become a better and more complete cataract surgeon, well equipped to cope with the full range of potential complications. -- Publisher Preface 6 Abbreviations 8 Contents 10 Part I: Complication Management Using a Phacoemulsification Machine 13 1: Basics 14 1.1 Difficulty of Cataract Surgery in Relation to Density of Nucleus 15 1.2 Difficulty of Cataract Surgery in Relation to Other Factors 15 1.3 Anatomy of Different IOL Implantation Sites 15 1.4 Small-Gauge Vitrectomy 23 1.5 SICS: The Modified ECCE 27 2: Equipment 29 2.1 Devices 29 2.2 Standard Instruments for Anterior Segment Procedures 32 3: Planning for Surgical Complications 42 3.1 Different Cases for Surgical Planning 49 3.2 Correct IOL Choice 51 4: General Surgical Techniques for Anterior Segment Surgery 56 4.1 Anaesthesia 56 4.2 Standard Instruments for Phacoemulsification 57 4.3 Phacoemulsification of an Easy Cataract 63 4.4 Phacoemulsification of a Difficult Cataract 87 4.4.1 Small Pupil: Implantation of Iris Retractors and Malyugin Ring 87 4.4.1.1 Small Pupil 87 Instrumentation for Widening with Push-Pull Instruments 87 Instrumentation and Material for Iris Retractor Insertion 87 Insertion of a Malyugin Ring 93 Spincterectomy in Small Fibrosed Pupil 93 4.4.1.2 Posterior Synechiae 97 4.4.2 Problems During Capsulorhexis 97 4.4.2.1 Flat Anterior Chamber 97 4.4.2.2 Extending Capsulorhexis 97 4.4.2.3 Outside Notch in the Rhexis 103 4.4.2.4 White Mature Nucleus: Injection of VisionBlue® 103 4.4.3 Problems During Hydrodissection 103 4.4.3.1 Iris Prolapse 103 4.4.3.2 Excessive Pressure from Behind During Surgery 107 4.4.4 Complications During Phacoemulsification 107 4.4.4.1 Posterior Capsule Rupture and Dropping Nucleus 107 4.4.4.2 Lens Capture 109 4.4.5 Problems During I/A: Implantation of Capsular Tension Ring 109 4.4.5.1 Reflux (Backflush) Function 109 4.4.5.2 I/A with Small Pupil 109 4.4.5.3 Zonular Lysis: Implantation of a Capsular Tension Ring 109 4.4.6 Problems During IOL Implantation 113 4.4.7 Problems During Final Steps 117 4.5 Traumatic Cataract 119 4.6 SICS 125 4.6.1 Standard Instruments for SICS 127 4.6.2 SICS Surgery 129 4.7 Summary 137 5: Special IOL Fixation Techniques 139 5.1 Iris-Claw IOL Implantation 140 5.1.1 Standard Instruments for Iris-Claw IOL Implantation 140 5.1.2 Iris-Claw IOL Implantation Surgery 140 5.2 Intrascleral IOL Implantation (Scharioth Technique) 146 5.2.1 Standard Instruments for Intrascleral IOL Implantation 150 5.2.2 Intrascleral IOL Implantation Surgery 150 5.3 Scleral IOL Fixation 158 5.4 Summary 160 6: Possible Surgeries After Insertion of a Trocar at Pars Plana 163 6.1 Introduction 163 6.2 Anterior Vitrectomy from Pars Plana 164 6.2.1 Basics of Anterior Vitrectomy 164 6.2.2 Special Instruments and Material for Anterior Vitrectomy 166 6.2.3 Anterior Vitrectomy from the Limbus 174 6.2.4 Anterior Vitrectomy from Pars Plana 174 6.3 Recovery of a Subluxated Nucleus from Pars Plana 182 6.4 Recovery of a Subluxated IOL from Pars Plana 182 6.5 Removal of Posterior Capsular Opacification from Pars Plana 182 6.6 Summary 182 7: Complication Management for Anterior Segment Cases 192 7.1 Posterior Capsule Rupture 192 7.1.1 IOL Scaffolding for Residual Lens Pieces in Capsular Rupture (Agarwal Technique) 203 7.2 Zonular Lysis 205 7.2.1 Surgery I: Phaco and Capsular Tension Ring 209 7.2.2 Surgery I Continued: Lens Capsule Extraction and Implantation of Scleral- or Iris-Fixated IOL 211 7.2.3 Surgery II: ICCE and Implantation of an Iris-Claw IOL 215 7.3 Management of an Anteriorly Dislocated Intraocular Lens 223 7.3.1 Management of a Decentred Intraocular Lens 223 7.4 Management of an Anteriorly Dislocated Bag-IOL Complex 239 7.4.1 Removal of Bag-IOL Complex and Secondary Iris-Claw IOL Implantation 239 7.4.2 Scleral Fixation of Dislocated Bag-IOL Complex (Hoffmann Technique) 247 7.5 Summary 253 Part II: Complication Management Using a Vitrectomy Machine 254 8: General Surgical Techniques for Posterior Segment Surgery 255 8.1 Standard Instruments for Pars Plana Vitrectomy 256 8.2 Binocular Indirect Ophthalmo Microscope (BIOM) 266 8.3 Anaesthesia 266 8.4 Pars Plana Vitrectomy 270 9: Complication Management for Posterior Segment Cases 285 9.1 Management of a Posteriorly Dislocated Nucleus (Dropped Nucleus) 286 9.1.1 Extraction of a Posteriorly Dislocated Nucleus with Fragmatome 286 9.1.2 Extraction of a Posteriorly Dislocated Nucleus with PFCL 296 9.2 Management of a Posteriorly Dislocated Bag-IOL Complex 300 9.2.1 IOL Extraction and Implantation of an Iris-Fixated IOL 300 9.2.2 Scleral and Intrascleral Fixation of the Dislocated IOL 306 9.3 Summary 308 10: Surgical Pearls 310 10.1 Intraocular Lens Exchange 311 10.2 Extraction of an Acrylic IOL Through IOL Refolding 317 10.3 Extraction of a Silicone IOL Through Bisecting of IOL 321 10.4 Iris Capture by the IOL Optic 327 10.5 Iridoplasty 331 10.6 Implantation of an Iris Prosthesis 333 10.6.1 Implantation of a Foldable Iris Prosthesis 335 10.6.2 In-the-Bag Implantation of an Iris and IOL Prosthesis 337 10.6.3 Scleral Fixation of an Iris and IOL Prosthesis 337 11: Materials and Companies 342 12: Compilation of All Pits and Pearls 347 Index 349 How can one best master a rupture of the posterior capsule during cataract surgery? How should one operate on a dropped nucleus? What is the ideal management for a subluxated intraocular lens? If you are seeking answers to these and similar questions, then this is the book for you. Every surgeon is afraid of complications, but while complications cannot be entirely avoided, it is possible to learn to master them. This practical handbook clearly explains how to manage the various complications that may arise during cataract surgery. It provides the surgeon with clear instructions on how best to proceed in the manner of a cookbook, by first describing the ingredients (equipment) and preparation (planning) and then providing step by step descriptions of technique with the aid of numerous helpful color illustrations and several accompanying surgical videos. Surgical pearls and pitfalls are highlighted. Using this book, the reader will become a better and more complete cataract surgeon, well equipped to cope with the full range of potential complications Front Matter....Pages i-xi Front Matter....Pages 1-1 Basics....Pages 3-17 Equipment....Pages 19-31 Planning for Surgical Complications....Pages 33-46 General Surgical Techniques for Anterior Segment Surgery....Pages 47-129 Special IOL Fixation Techniques....Pages 131-154 Possible Surgeries After Insertion of a Trocar at Pars Plana....Pages 155-183 Complication Management for Anterior Segment Cases....Pages 185-246 Front Matter....Pages 247-247 General Surgical Techniques for Posterior Segment Surgery....Pages 249-278 Complication Management for Posterior Segment Cases....Pages 279-303 Surgical Pearls....Pages 305-336 Materials and Companies....Pages 337-341 Compilation of All Pits and Pearls....Pages 343-344 Back Matter....Pages 345-346 Ulrich Spandau, Gabor Scharioth. Includes Index. Additional Video Material Available Online. Mode Of Access: World Wide Web.