Manual small incision cataract surgery

Last updated
Manual small incision cataract surgery
Other namesMSICS
Specialty Ophthalmology

Manual small incision cataract surgery (MSICS) is an evolution of extracapsular cataract extraction (ECCE); the lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing. The wound is relatively smaller than that in ECCE but is still markedly larger than a phacoemulsification wound. Comparative trials of MSICS against phaco in dense cataracts have found no statistically significant difference in outcomes but MSICS had shorter operating times and significantly lower costs. [1] MSICS has become the method of choice in the developing world because it provides high-quality outcomes with less surgically induced astigmatism than ECCE, no suture-related problems, quick rehabilitation, and fewer post-operative visits. MSICS is easy and fast to learn for the surgeon, cost effective, simple, and applicable to almost all types of cataract. [2]

Contents

Description

MSICS is a procedure that was developed to reduce costs in comparison with phacoemulsification, which requires expensive high-tech equipment that needs skilled maintenance, and is relatively unsuited to less developed regions, and to eliminate the need for suturing the incision, by using a self-sealing incision. [1] [3] This reduces operating time, and for some geometries of incision, considerably reduces surgery induced astigmatism, or induces a reduction in pre-surgery astigmatism. The procedure is fast, economical, effective, and produces results statistically similar to phaco surgery. It is extensively used in less developed countries and regions, with good outcomes. [4]

Contraindications

The same general contraindications for cataract surgery apply. Specific contraindications for MSICS include hard or dense cataracts where the nucleus is too large for the MSICS incision; [5] and in cases where the nucleus is found to be deformed on a nanophthalmic (very small) eye. [Note 1] [5]

Preparation and precautions

Preparation may begin three-to-seven days before surgery with the preoperative application of NSAIDs and antibiotic eye drops. The pupil is dilated using drops if the IOL is to be placed behind the iris to help better visualise the cataract and for easier access. [2]

Anaesthesia

Anaesthesia may be placed topically as eyedrops or injected next to (peribulbar) or behind (retrobulbar) the eye [6] or sub-tenons. Local anaesthetic nerve blocking has been recommended to facilitate surgery. [2] Topical anaesthetics may be used at the same time as an intracameral lidocaine injection to reduce pain during the operation. [6] Oral or intravenous sedation may also be used to reduce anxiety. General anaesthesia is rarely necessary but may be used for children and adults with medical or psychiatric issues affecting their ability to remain still during the procedure. [6] [7]

Site preparation

The operation may occur on a stretcher or a reclining examination chair. The eyelids and surrounding skin are swabbed with a disinfectant, such as 10% povidone-iodine, and topical povidone-iodine is put in the eye. The face is covered with a cloth or sheet with an opening for the operative eye. The eyelid is held open with a speculum to minimize blinking during surgery. [3] Pain is usually minimal in properly anaesthetised eyes, though a pressure sensation and discomfort from the bright operating microscope light is common. [7] Bridle sutures [Note 2] may be used to help to stabilize the eyeball during sclerocorneal tunnel incision, and during extraction of the nucleus and epinucleus through the tunnel. [2]

Surgical technique

A defining characteristic of this technique is in the incision made for access to the cataract, which is smaller than for ECCE, and larger than for phacoemulsification, but like phaco, the wound is self sealing due to its geometry.

Incision

The small incision into the anterior chamber of the eye is made at or near the corneal limbus, where the cornea and sclera meet, either superior or temporal. [2] Advantages of the smaller incision include use of few-or-no stitches and shortened recovery time. [8] The "small" incision is small in comparison with the earlier ECCE incision but considerably larger than the phaco incision. The precise geometry of the incision is important as it affects the self-sealing of the wound and the amount of astigmatism caused by distortion of the cornea during healing. A sclerocorneal or scleral tunnel incision is commonly used, which reduces induced astigmatism if suitably formed. [1] [3] A sclerocorneal tunnel, a three-phase incision, starts with a shallow incision perpendicular to the sclera, followed by an incision through the sclera and cornea approximately parallel to the outer surface, and then a beveled incision into the anterior chamber. This structure provides the self-sealing characteristic because internal pressure presses together the faces of the incision. [2]

Incision geometries and their characteristics

The incision provides access to the interior of the anterior chanber for access to the lens, a passage for removal of the lens, and a passage for insertion of the IOL. The primary characteristic of scleral tunnel incisions is self sealing, which is a consequence of the location relative to the limbus, and the shape of the wound, which also influences the post operative astigmatism. [1]

The characteristics of an incision that is reliably self-sealing include: [1]

  • Approximately square incisional geometry – the length and width of the incision surfaces are roughly equal,
  • The external incision opening is narrower than the internal opening with a tunnel that flares between them,
  • An external incision shape that allows some stretch,
  • The incision must extent at least a millimetre into the cornea, and follow the curve of the edge of the cornea.

The size of the incision, i.e. the straight line distance between the ends of the external opening, is determined primarily by the expected size of the nucleus, and secondarily by the size of the IOL, and is usually between 5 and 8 mm. The distance between the outer opening of the tunnel and the inner opening should be at least 4 mm for a good seal. The shape of the outer opening may be straight or curved, and will affect astigmatism and the tendency for wound edge separation. A small flap of the conjunctiva is folded back before making the initial incision perpendicular to the sclera. [1]

The "frown" form is a curve with the ends further from the limbus than the middle, and has a lesser tendency to induce astigmatism or separate on the outside edge. [1]

A straight incision follows a great circle route across the sclera, with the ends equidistant from the edge of the cornea. This induces moderate astigmatism. [1]

Blumenthal side cuts are short cuts at the ends of a straight incision which angle obliquely away from the cornea. This induces minimal astigmatism and is used for a wide tunnel. [1]

A "smile" incision is parallel to the edge of the cornea. It is an easy incision but induces more astigmatism and is more prone to separation. [1]

The "chevron" incision is much like the frown but comprises two straight lines of equal length. This shape induces minimal astigmatism. [1]

The tunnel extends from the scleral incision approximately parallel to the outer surface, and slightly deeper than half the thickness of the sclera, and should extend at least a millimetre into the cornea. The inner edge should follow the curve of the corneal edge. [1]

As the incision heals, the meridian along which the wound is centered tends to progressively flatten, which may continue for up to 3 weeks until healing is complete. The geometry of the incision may be chosen to permanently reduce pre-operative refractive error, or maintain original cornea shape. [1]

Maintaining the eye shape

The depth of the anterior chamber and position of the posterior capsule may be maintained during surgery by OVDs or an anterior chamber maintainer, which is an auxiliary cannula providing a sufficient flow of BSS to maintain the stability of the shape of the chamber and internal pressure. [4] [9] [ clarification needed ]

Capsulorhexis

Using an instrument called a cystotome, an anterior capsulotomy, also known as a cystotomy, is made to open the front surface of the lens capsule , giving access to the lens. [10] The continuous curvilinear capsulorhexis technique is in common use, and is preferred as it produces a tougher edge without stress raisers and is less likely to tear further during the procedure. [11] A posterior capsulotomy is an opening of the back portion of the lens capsule, which is not usually necessary or desirable unless it has opacified. [12] The types of capsular openings commonly used in MSICS are the continuous curvilinear capsulorhexis, the can-opener capsulotomy, and the envelope capsulotomy. [4]

Extraction of the lens

The cataract is removed from the capsule and anterior chamber using hydroexpression [Note 3] viscoexpression, [Note 4] or more-direct mechanical methods. [4] [13] [14]

The extraction of the cataract must be done with due care so as not to compromise the integrity of the tunnel; the endothelium and capsule are also vulnerable to injury. Bisection, trisection and fragmentation into more pieces is possible, but all must be removed. The pressure in the eye can be maintained at the desired level by using an anterior chamber maintainer, or may be allowed to drop to ambient atmospheric pressure. Larger well-structured tunnels and larger capsulorhexis are acceptable to allow better control of the surgery. [15]

Various methods may be used:

Management with irrigating vectis: [Note 5] Hydrodissection is performed until a part of the nucleus prolapses into the anterior chamber, or the surgeon hooks and lifts the nucleus edge, and rotates it until it prolapses into the anterior chamber. The nucleus is then removed through the tunnel using an irrigating vectis. Viscoelastic is injected above and below the nucleus to protect the endothelium. A bridle suture is used to steady the globe. The irrigating vectis is inserted under the nucleus, then withdrawn towards the tunnel until the nucleus starts to enter the tunnel. At this point BSS is injected into the chamber through the vectis to provide pressure to expel the nucleus while the vectis is withdrawn with it. An iris spatula may be used in the sandwich technique, where the spatula is used to hold the nucleus against the vectis. [16] [17]

Alternatively, the nucleus may be guided out of the eye through the tunnel with the help of a Sheet's glide, [Note 6] and pushed out by internal pressure induced by adding saline from the anterior chamber maintainer or injecting viscoelastic into the chamber. [15] The nucleus may be broken into a few pieces to aid removal, or removed in one piece. [7]

Phacosection is the division of the nucleus into two or three narrower parts. This avoids stretching the tunnel and thereby reduces surgically induced astigmatism and possible damage to the endothelium. The epinucleus and most of the cortex are divided and removed along with the nucleus. [15]

Preparation for phacosection is by hydrodissection to separate the cortex from the capsule, but hydrodelineation is not done and the entire lens is carefully released from the capsule and removed into the anterior chamber through the capsulorhexis opening, avoiding stress on the zonules. The lens is then divided into narrower sections by any one of several possible methods, and the sections are then extracted individually. The epinucleus and most of the cortex remain attached to the nucleus, and get removed with it during these maneuvers. [15]

Prosthetic lens insertion

Following cataract removal, an IOL is usually inserted into the posterior capsule. [7] When the posterior capsule is damaged, the IOL may be inserted into the ciliary sulcus, [18] or a glued intraocular lens technique may be applied. [19] It is economical to use a rigid IOL if the incision size is already over 6 mm wide, but foldable IOLs can also be used if cost is not a limiting factor or incision size is <5 mm. [4]

Removal of OVDs

After the IOL is inserted, ophthalmic viscosurgical devices are aspirated or flushed out and replaced with BSS. Residues of OVDs can cause raised intraocular pressure (IOP) by blocking the trabecular meshwork until they dissipate. IOP spikes can cause damage to the optic nerve and visual disturbances in patients with glaucoma. Postoperative endophthalmitis is also associated with OVD residue. [20]

Wound sealing

The surgeon checks the incision does not leak fluid because wound leakage increases the risk of microorganisms gaining access into the eye and predisposing it to endophthalmitis. An antibiotic/steroid combination eye drop is put in, and an eye shield may be applied, sometimes supplemented with an eye patch. [7] A well constructed scleral tunnel should be self-sealing, but if it does not seal sufficiently, one or more sutures will be added. [7] [1]

Contingency procedures

A change from MSICS to ECCE is appropriate when the nucleus is too large for the MSICS incision; [5] and in cases where the nucleus is found to be deformed during MSICS on a nanophthalmic (very small) eye. [Note 1] [5]

Complications

Complications can develop during and after surgery.

During surgery

Posterior capsular rupture, a tear in the posterior capsule of the natural lens, is the most-common complication during cataract surgery. [8] Posterior capsule rupture can cause lens fragments to be retained, corneal oedema, and cystoid macular oedema; it is also associated with increased risk of endophthalmitis and retinal detachment. [8] [21] It may make it necessary to place the IOL outside the capsular bag.

Suprachoroidal hemorrhage is a rare complication. [22]

Intraoperative floppy iris syndrome has an incidence of around 0.5% to 2.0%. [8] Iris or ciliary body injury has an incidence of about 0.6%-1.2%. [8] In the event of a posterior capsule rupture, fragments of the nucleus can find their way through the tear into the vitreous chamber; this is called posterior dislocation of nuclear fragments. [7]

After surgery

Slit lamp photo of IOL showing Posterior capsular opacification (PCO) visible a few months after implantation of intraocular lens in eye, seen on retroillumination Posterior capsular opacification on retroillumination.jpg
Slit lamp photo of IOL showing Posterior capsular opacification (PCO) visible a few months after implantation of intraocular lens in eye, seen on retroillumination

Complications after cataract surgery are relatively uncommon. Posterior vitreous detachment (PVD) may occur but does not directly threaten vision. [23]

Some people develop a posterior capsular opacification (PCO), also called an after-cataract. This may compromise visual acuity, and can usually be safely and painlessly corrected using a laser. [24] to create a clear central visual axis. [25]

Patients who have had cataract surgery are at an increased risk of developing rhegmatogenous retinal detachment (RRD)—the most-common form of retinal detachment. [26] Toxic anterior segment syndrome (TASS), a non-infectious inflammatory condition, may occur following cataract surgery. [27]

Endophthalmitis is a serious infection of the intraocular tissues, usually following intraocular surgery complications or penetrating trauma, and one of the most-severe. It is rare in cataract surgery due to the use of prophylactic antibiotics. [28] Hypopyon occurs about 80% of the time. [8]

Glaucoma may occur and may be very difficult to control. It is usually associated with inflammation, especially when small fragments or chunks of the nucleus access the vitreous cavity. [29]

Mechanical pupillary block can occur when contact between the edge of the pupil and an adjacent structure blocks the flow of aqueous through the pupil. This is more frequent as a complication of anterior chamber intraocular lens implantation, but has been known to occasionally occur with posterior IOL implantation. [30]

Swelling of the macula, the central part of the retina, results in macular oedema and can occur a few days or weeks after surgery. Most such cases can be successfully treated. [31] Uveitis–glaucoma–hyphema syndrome is a complication caused by the mechanical irritation of a mis-positioned IOL over the iris, ciliary body or iridocorneal angle. [32]

Other possible complications include Elevated intraocular pressure; [33] swelling or oedema of the cornea; displacement or dislocation of the IOL implant (rare); unplanned high refractive error—either myopic or hypermetropic—due to error in the ultrasonic biometry (measurement of the eye length and calculation of the required intraocular lens power); cyanopsia, in which the patient's vision is tinted blue and often occurs for a few days, weeks or months after removal of a cataract; and floaters, which commonly appear after surgery. [34]

Recovery and rehabilitation

Following cataract surgery, side-effects such as grittiness, watering, blurred vision, double vision or a red or bloodshot eye may occur, and will usually clear after a few days. Full recovery can take four-to-six weeks. [35] Patients are usually advised to avoid getting water in the eye during the first week after surgery, and to avoid swimming for two-to-three weeks as a conservative approach, to minimise risk of bacterial infection. [7] Patients should avoid driving for at least 24 hours after the surgery, largely due to effects from the anaesthesia, possible swelling affecting focus, and pupil dilation causing excessive glare. At the first post-operative check, the surgeon will usually assess whether vision is suitable for driving. [36]

After surgery, to prevent contamination, the eyes should not be rubbed and the use of eye makeup, face cream or lotions should be avoided. Excessive dust, wind, pollen or dirt should also be avoided. Sunglasses should be worn on bright days because the eyes will be more sensitive to bright light for a while. [37]

Topical anti-inflammatory drugs and antibiotics are commonly used in the form of eye-drops to reduce the risk of inflammation and infection. A shield or eye-patch may be prescribed to protect the eye while sleeping. The eye will be checked to ensure the IOL remains in place, and once it has fully stabilised, after about six weeks, vision tests will be used to check whether prescription lenses are needed. [35] [8] Where the focal length of the IOL is optimised for distance vision, reading glasses will generally be needed for near focus.[ citation needed ] The patient should not participate in contact or extreme sports or similar activities until cleared to do so by the eye surgeon. [38]

Outcomes

After full recovery, visual acuity depends on the underlying condition of the eye, the choice of IOL, and any long-term complications associated with the surgery. More than 90% of operations are successful in restoring useful vision, with a low complication rate. [39]

History

MSICS was a later development in cataract surgery after phacoemulsification was already established. It is a technique which does not rely on high tech and expensive equipment, and is not much used in Western countries. In developing countries where cost is a more significant factor in limiting access to medical support, and the necessary maintenance for phaco equimpment may not be available or convenient, MSICS is a cost-effective alternative with comparable outcomes. [1]

Self-sealing cataract incisions were mentioned by R. P. Kratz et al. in 1980 and by L. J. Girard in 1984. Kratz described the tunnel as an astigmatically neutral way of accessing the anterior chamber. In 1984, B. H. Thrasher et al. showed that incision position relative to the limbus has a strong effect on surgically induced astigmatism, as a 9 mm posterior incision induces less astigmatism than a 6 mm limbal incision. [1]

In 1987, M. Blumenthal and J. Moissiev described the use of the anterior chamber maintainer (ACM) in ECCE, which combined with a reduction in incision size can keep the eye at a normal internal pressure during surgery. [4]

In 1990, Michael McFarland developed a sutureless incision geometry, and S. L. Pallin described a chevron shaped incision for sutureless closure. In 1991, J. A. Singer described the "frown" incision as a way to minimise asigmatism when using a rigid IOL. [1]

In 1999, S. Ruit et al. described a technique using a 6.5–7 mm temporal scleral tunnel with a straight incision 2 mm from the limbus. A V-shaped capsulorhexis was followed by hydrodissection, and the nucleus was delivered by viscoexpression. The cortical residue was aspirated and an IOL was implanted in the capsular bag. [4]

Around 2009 P. Kosakarn developed a technique of manual phacofragmentation called double-nylon loop, by which the lens is divided into three pieces so that the incision can be smaller and sutureless, and which allows implantation of foldable IOL to be implanted. [4]

K.P. Malik et al. modified the MSICS technique c2016 by a continuous infusion of 2% hydroxymethyl cellulose through the AC maintainer during nuclear delivery to prevent corneal endothelial cell loss. [4]

See also

Notes

    1. 1 2 Nanophthalmic: Exceptionally small eyes.
    2. ↑ Bridle suture: A suture passing through the superior rectus muscle of the eye, used to rotate the eyeball downwards in eye surgery.
    3. ↑ Hydroexpression: Method of removing the lens from the capsule and anterior chamber by carrying it out in a flow of saline solution.
    4. ↑ Viscoexpression: Method of removing the lens from the capsule and anterior chamber by carrying it out in a flow of viscoelastic material.
    5. ↑ Irrigating vectis: A form of rigid cannula with a loop at the end which can support the nucleus, and which has one or more holes at the distal end, through which BSS or viscoelastic material can be introduced.
    6. ↑ Sheets glide: A sheets glide, glide sheet, or lens glide is a thin disposable strip of low friction material inserted into the incision to protect the wound surfaces while extracting a lens or lens fragment, or inserting an IOL. [Sheets JH, Maida JW. Lens glide in implant surgery. Arch Ophthalmol. 1978 Jan;96(1):145-6. doi: 10.1001/archopht.1978.03910050095024. PMID 623543].

    Related Research Articles

    <span class="mw-page-title-main">Cataract</span> Clouding of the lens inside the eye, causing poor vision

    A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.

    <span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

    Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

    <span class="mw-page-title-main">Radial keratotomy</span> Refractive surgical procedure to correct myopia (nearsightedness

    Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness). It was developed in 1974 by Svyatoslav Fyodorov, a Russian ophthalmologist. It has been largely supplanted by newer, more accurate operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens.

    <span class="mw-page-title-main">Refractive surgery</span> Surgery to treat common vision disorders

    Refractive surgery is optional eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Refractive eye surgeries are used to treat common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

    <span class="mw-page-title-main">Phacoemulsification</span> Method of cataract surgery

    Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.

    <span class="mw-page-title-main">Intraocular lens</span> Lens implanted in the eye to treat cataracts or myopia

    An Intraocular lens (IOL) is a lens implanted in the eye usually as part of a treatment for cataracts or for correcting other vision problems such as short sightedness and long sightedness; a form of refractive surgery. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic lens. Both kinds of IOLs are designed to provide the same light-focusing function as the natural crystalline lens. This can be an alternative to LASIK, but LASIK is not an alternative to an IOL for treatment of cataracts.

    <span class="mw-page-title-main">Phakic intraocular lens</span> Lens implanted in eye in addition to the natural lens

    A phakic intraocular lens (PIOL) is an intraocular lens that is implanted surgically into the eye to correct refractive errors without removing the natural lens. Intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery are known as pseudophakic.

    <span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

    Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL) implant.

    <span class="mw-page-title-main">Astigmatism</span> Type of eye defect

    Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. This results in distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble driving at night. Astigmatism often occurs at birth and can change or develop later in life. If it occurs in early life and is left untreated, it may result in amblyopia.

    Howard V. Gimbel FRCSC, AOE, FACS, CABES, is a Canadian ophthalmologist, university professor, senior editor, and amateur musician. He is better known for his invention, along with Thomas Neuhann, of the continuous curvilinear capsulorhexis (CCC), a technique employed in modern cataract surgery.

    <span class="mw-page-title-main">Eric Arnott</span> British ophthalmologist

    Eric John Arnott, MA, FRCS, FRCOphth was a British ophthalmologist and surgeon who specialized in cataracts, a condition which in many parts of the world still remains the principal cause of blindness. He is known for inventing new surgical techniques for treatment of various ophthalmological disorders, and received professional awards for his contributions.

    <span class="mw-page-title-main">Capsulotomy</span> Incision into the capsule of the crystalline lens of the eye

    Capsulotomy is a type of eye surgery in which an incision is made into the capsule of the crystalline lens of the eye. In modern cataract operations, the lens capsule is usually not removed. The most common forms of cataract surgery remove nearly all of the crystalline lens but do not remove the crystalline lens capsule. The crystalline lens capsule is retained and used to contain and position the intraocular lens implant (IOL).

    The aim of an accurate intraocular lens power calculation is to provide an intraocular lens (IOL) that fits the specific needs and desires of the individual patient. The development of better instrumentation for measuring the eye's axial length (AL) and the use of more precise mathematical formulas to perform the appropriate calculations have significantly improved the accuracy with which the surgeon determines the IOL power.

    David J. Apple was an ophthalmic pathologist who conducted research on the pathology of intraocular lens complications as well as ophthalmic surgery in general. He was a medical historian and biographer of Sir Harold Ridley, the inventor of the intraocular lens (IOL).

    He often stated that Harold Ridley changed the world. What we can say about David Apple is that he vastly improved the world that Harold Ridley changed

    Dr Amar Agarwal M.S., FRCS, F.R.C.Ophth is an Indian ophthalmologist and chairman and managing director of Dr. Agarwal's Eye Hospital and Eye Research Centre in India, which includes 140+ eye hospitals. He is the recipient of the Best Doctor award of the State government from then Chief Minister of Tamil Nadu J Jayalalithaa on 15 August 2014. He is also the past President of the International Society of Refractive Surgery (ISRS) and Secretary General of the Intraocular Implant and Refractive Society of India (IIRSI).

    <span class="mw-page-title-main">Glued intraocular lens</span> Surgical treatment for eyes lacking functional lens capsules

    In ophthalmology, glued intraocular lens or glued IOL is a surgical technique for implantation, with the use of biological glue, of a posterior chamber IOL in eyes with deficient or absent posterior capsules. A quick-acting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive properties, is used.

    Intraocular lens scaffold, or IOL scaffold technique, is a surgical procedure in ophthalmology. In cases where the posterior lens capsule is ruptured and the cataract is present, an intraocular lens (IOL) can be inserted under the cataract. The IOL acts as a scaffold, and prevents the cataract pieces from falling to the back of the eye. The cataract can then be safely removed by emulsifying it with ultrasound and aspiration. This technique is called IOL scaffold, and was initiated by Amar Agarwal at Dr. Agarwal's Eye Hospital in Chennai, India.

    <span class="mw-page-title-main">Phacolytic glaucoma</span> Medical condition

    Phacolytic glaucoma (PG) is a form of glaucoma which is caused due to a leaking mature or immature cataract. Inflammatory glaucoma which occurs in phacolysis is a condition which is a result of the leakage of protein within the lens into the capsule of a mature or hyper mature cataract and involves a simple procedure to be cured that is referred to as cataract extraction.

    Clear lens extraction (CLE), also known as refractive lensectomy or refractive lens exchange (RLE) is a surgical procedure in which clear lens of the human eye is removed. Unlike cataract surgery, where cloudy lens is removed to treat cataract, clear lens extraction is done to surgically correct refractive errors such as high myopia. It can also be done in hyperopic or presbyopic patients who wish to have a multifocal IOL implanted to avoid wearing glasses. It is also used as a treatment for diseases such as angle closure glaucoma.

    <span class="mw-page-title-main">History of cataract surgery</span> Development of the procedure for removing an opacified lens from the eye

    Cataract surgery has a long history in Europe, Asia, and Africa. It is one of the most common and successful surgical procedures in worldwide use, thanks to improvements in techniques for cataract removal and developments in intraocular lens (IOL) replacement technology, in implantation techniques, and in IOL design, construction, and selection. Surgical techniques that have contributed to this success include microsurgery, viscoelastics, and phacoemulsification.

    References

    1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Haldipurkar, S.S.; Shikari, Hasanain T.; Gokhale, Vishwanath (2009). "Wound construction in manual small incision cataract surgery". Indian Journal of Ophthalmology. 57 (1): 9–13. doi: 10.4103/0301-4738.44491 . ISSN   0301-4738. PMC   2661512 . PMID   19075401.
    2. 1 2 3 4 5 6 Gurnani, B.; Kaur, K. (6 December 2022). "Manual Small Incision Cataract Surgery". StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. PMID   35881728. Archived from the original on 1 February 2023. Retrieved 2 March 2023.
    3. 1 2 3 Gurnani, Bharat; Kaur, Kirandeep (6 December 2022). "Phacoemulsification". StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. PMID   35015444. Archived from the original on 30 January 2023. Retrieved 20 February 2023.
    4. 1 2 3 4 5 6 7 8 9 Singh, K.; Misbah, A.; Saluja, P.; Singh, A.K. (December 2017). "Review of manual small-incision cataract surgery". Indian J Ophthalmol. 65 (12): 1281–1288. doi: 10.4103/ijo.IJO_863_17 . PMC   5742955 . PMID   29208807.
    5. 1 2 3 4 Agarwal, Ashvin (March 2019). "When and How to Convert to ECCE: Extracapsular cataract extraction remains a useful plan B." crstoday.com. Archived from the original on 2 March 2023. Retrieved 2 March 2023.
    6. 1 2 3 Minakaran, N.; Ezra, D.G.; Allan, B.D. (July 2020). "Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults". The Cochrane Database of Systematic Reviews. 2020 (7): CD005276. doi:10.1002/14651858.cd005276.pub4. PMC   8190979 . PMID   35658539.
    7. 1 2 3 4 5 6 7 8 Cionni, Robert J.; Snyder, Michael E.; Osher, Robert H. (2006). "6: Cataract surgery". In Tasman, William (ed.). Duane's Ophthalmology. Vol. 6. Lippincott Williams & Wilkins. Archived from the original on 20 February 2023. Retrieved 16 February 2023– via www.oculist.net.
    8. 1 2 3 4 5 6 7 Moshirfar, Majid; Milner, Dallin; Patel, Bhupendra C. (June 21, 2022). "Cataract Surgery". www.ncbi.nlm.nih.gov. National Center for Biotechnology Information. PMID   32644679. Archived from the original on 24 February 2023. Retrieved 8 February 2023.
    9. ↑ Devgan, Uday (27 January 2019). "Use of an AC maintainer in Cataract Surgery". cataractcoach.com. Archived from the original on 1 March 2023. Retrieved 1 March 2023.
    10. ↑ Oetting, Thomas. "Capsulorhexis using a cystotome needle during cataract surgery". Archived from the original on 26 August 2008. Retrieved 28 May 2008.
    11. ↑ Sharma, Bhavana; Abell, Robin G; Arora, Tarun; Antony, Tom; Vajpayee, Rasik B (2019). "Techniques of anterior capsulotomy in cataract surgery". Indian Journal of Ophthalmology. 67 (4): 450–460. doi: 10.4103/ijo.IJO_1728_18 . PMC   6446625 . PMID   30900573.
    12. ↑ Salmon, John F. (2020). Kanski's Clinical Ophthalmology: A Systematic Approach (9th ed.). Edinburgh. p. 331. ISBN   978-0-7020-7713-5. OCLC   1131846767. Archived from the original on 2020-06-16. Retrieved 2023-02-20.{{cite book}}: CS1 maint: location missing publisher (link)
    13. ↑ Thim, K.; Krag, S.; Corydon, L. (March 1993). "Hydroexpression and viscoexpression of the nucleus through a continuous circular capsulorhexis". J Cataract Refract Surg. 19 (2): 209–12. doi:10.1016/s0886-3350(13)80944-3. PMID   8487162. S2CID   35741983. Archived from the original on 2023-03-01. Retrieved 2023-03-01.
    14. ↑ Varshney, S.; Jhala, L.S. (November 2022). "Hydroexpression - A novel technique to deliver nucleus in small-incision cataract surgery". Indian J Ophthalmol. 70 (11): 4066. doi: 10.4103/ijo.IJO_1594_22 . PMC   907245 . PMID   36308162.
    15. 1 2 3 4 Ravindra, M.S. (January–February 2009). "Nucleus management in manual small incision cataract surgery by phacosection". Indian J Ophthalmol. 57 (1): 41–3. doi: 10.4103/0301-4738.44509 . PMC   2661521 . PMID   19075409.
    16. ↑ Srinivasan, A. (January–February 2009). "Nucleus management with irrigating vectis". Indian J Ophthalmol. 57 (1): 19–21. doi: 10.4103/0301-4738.43045 . PMC   2661511 . PMID   19075403.
    17. ↑ Bayramlar, Hüseyin; Çekiç, Osman; Totan, Yüksel (March 1999). "Manual tunnel incision extracapsular cataract extraction using the sandwich technique". Journal of Cataract & Refractive Surgery. 25 (3): 312–315. doi: 10.1016/S0886-3350(99)80077-7 . PMID   10079434.
    18. ↑ Mehta, R.; Aref, A.A. (November 2019). "Intraocular Lens Implantation In The Ciliary Sulcus: Challenges And Risks". Clin. Ophthalmol. 27 (13): 2317–2323. doi: 10.2147/OPTH.S205148 . PMC   6885568 . PMID   31819356.
    19. ↑ Mohan, S.; John, B.; Rajan, M.; Malkani, H.; Nagalekshmi, S.V.; Singh, S. (June 2017). "Glued intraocular lens implantation for eyes with inadequate capsular support: Analysis of the postoperative visual outcome". Indian J Ophthalmol. 65 (6): 472–476. doi: 10.4103/ijo.IJO_375_16 . PMC   5508457 . PMID   28643711.
    20. ↑ Mitani, Arisa; Suzuki, Takashi; Tasaka, Yoshitaka; Uda, Takahiro; Hiramatsu, Yukako; Kawasaki, Shiro; Ohashi, Yuichi (2014). "Evaluation of a new method of irrigation and aspiration for removal of ophthalmic viscoelastic device during cataract surgery in a porcine model". BMC Ophthalmol. 14 (129): 129. doi: 10.1186/1471-2415-14-129 . PMC   4232668 . PMID   25376934.
    21. ↑ Wang, Robert C.; Fuller, Dwain G.; Hutton, William S. (2006). "66: Retained Lens Material". In Tasman, William (ed.). Duane's Ophthalmology. Vol. 6. Lippincott Williams & Wilkins. Archived from the original on 19 February 2023. Retrieved 16 February 2023– via www.oculist.net.
    22. ↑ Chaturvedi, Vivek; Sabherwal, Ryan; Kim, Leo A.; Pittner, Andrew; Bhagat, Neelakshi; Lim, Jennifer I; Mukkamala, Lekha; Patel, Nimesh (23 June 2022). Patel, Nimesh (ed.). "Suprachoroidal Hemorrhage". Eyewiki. American Academy of Ophthalmology. Archived from the original on 13 December 2022. Retrieved 22 February 2023.
    23. ↑ Hilford, D.; Hilford, M.; Mathew, A.; Polkinghorne, P.J. (2009). "Posterior vitreous detachment following cataract surgery". Eye. 23 (6): 1388–1392. doi: 10.1038/eye.2008.273 . PMID   18776863.
    24. ↑ "Videos: YAG Laser Capsulotomy". Pacific Cataract and Laser Institute. Archived from the original on 2 April 2019. Retrieved 2 April 2019.
    25. ↑ Karahan, Eyyup; Er, Duygu; Kaynak, Suleyman (Summer 2014). "An Overview of Nd:YAG Laser Capsulotomy". Medical Hypothesis, Discovery & Innovation in Ophthalmology Journal. 3 (2): 45–50. PMC   4346677 . PMID   25738159.
    26. ↑ Steel, D. (March 2014). "Retinal detachment". BMJ Clinical Evidence. 2014. PMC   3940167 . PMID   24807890.
    27. ↑ "Toxic Anterior Segment Syndrome After Cataract Surgery". Centers for Disease Control and Prevention. 29 June 2007. Archived from the original on 13 March 2013. Retrieved 18 April 2013.
    28. ↑ "Endophthalmitis". Lecturio. Archived from the original on 19 July 2021. Retrieved 19 July 2021.
    29. ↑ Gokhale, Parag A.; Patterson, Emory (May–June 2007). "Elevated IOP After Cataract Surgery". Glaucoma today. Bryn Mawr Communications, LLC. Archived from the original on 2023-02-25. Retrieved 2023-02-25.
    30. ↑ Gaton, D.D.; Mimouni, K.; Lusky, M.; Ehrlich, R.; Weinberger, D. (September 2003). "Pupillary block following posterior chamber intraocular lens implantation in adults". Br J Ophthalmol. 87 (9): 1109–11. doi:10.1136/bjo.87.9.1109. PMC   1771845 . PMID   12928277.
    31. ↑ Lim, B.X.; Lim, C.H.; Lim, D.K.; Evans, J.R.; Bunce, C.; Wormald, R. (November 2016). "Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery". The Cochrane Database of Systematic Reviews. 2016 (11): CD006683. doi:10.1002/14651858.CD006683.pub3. PMC   6464900 . PMID   27801522.
    32. ↑ Zemba, M.; Camburu, G (2017). "Uveitis-Glaucoma-Hyphaema Syndrome. General review". Romanian Journal of Ophthalmology. 61 (1): 11–17. doi:10.22336/rjo.2017.3. PMC   5710046 . PMID   29450365.
    33. ↑ Masket, Samuel; Rorer, Eva; Stark, Walter; Holladay, Jack T.; MacRae, Scott; Tarver, Michelle E.; Glasser, Adrian; Calogero, Don; Hilmantel, Gene; Nguyen, Tieuvi; Eydelman, Malvina (January 2017). "Special Report: The American Academy of Ophthalmology Task Force Consensus Statement on Adverse Events with Intraocular Lenses". Ophthalmology. 124 (1): 142–144. doi: 10.1016/j.ophtha.2016.09.031 . PMID   27726961. Archived from the original on 2023-04-17. Retrieved 2023-02-27.
    34. ↑ Hayashi, K.; Hayashi, H. (2006). "Visual function in patients with yellow tinted intraocular lenses compared with vision in patients with non-tinted intraocular lenses". British Journal of Ophthalmology. 90 (8): 1019–1023. doi:10.1136/bjo.2006.090712. PMC   1857188 . PMID   16597662.
    35. 1 2 "Recovery - Cataract surgery". www.nhs.uk. 15 January 2018. Archived from the original on 12 February 2019. Retrieved 12 February 2023.
    36. ↑ "How Many Days Rest Are Needed After Cataract Surgery?". southcaleye.com. 18 May 2022. Archived from the original on 9 December 2022. Retrieved 22 February 2023.
    37. ↑ Dudek, Lara (15 September 2020). "After Cataract Surgery: Dos and Don'ts". Archived from the original on 26 February 2023. Retrieved 22 February 2023.
    38. ↑ Porter, Daniel (1 August 2022). "When to Resume Exercise After an Eye Surgery or Injury". www.aao.org. American Academy of Ophthalmology. Archived from the original on 28 February 2023. Retrieved 28 February 2023.
    39. ↑ Wong, Tien Yin (5 May 2001). "Effect of increasing age on cataract surgery outcomes in very elderly patients". BMJ. 322 (7294): 1104–6. doi:10.1136/bmj.322.7294.1104. PMC   1120237 . PMID   11337443.
    This page is based on this Wikipedia article
    Text is available under the CC BY-SA 4.0 license; additional terms may apply.
    Images, videos and audio are available under their respective licenses.