Cataract and refractive surgery : progress III

Chapter 1 Anterior Segment Imaging Martin Heur, William J. Dupps, Jr 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Placido-Disc Based Imaging . . . . . . . . . 2 1.3 Slit-Scanning Imaging . . . . . . . . . . . . . . 2 1.4 Scheimpflug Imaging . . . . . . . . . . . . . . . 2 1.5 Arc-Scanning Ultrasound . . . . . . . . . . . 3 1.6 Optical Coherence Tomography Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.7 Comparison of Imaging Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.7.1 Pachymetry . . . . . . . . . . . . . . . . . . . . . . . . 4 1.7.2 Refractive Surgery . . . . . . . . . . . . . . . . . . 7 1.7.3 Biometry . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.7.4 Lamellar Corneal Surgery . . . . . . . . . . . 8 References . . . . . . . . . . . . . . . . . . . . . . . . . 9 Chapter 2 Microincisional Lens Surgery Jorge L. Alió, Pawel Klonowski, Bassam El Kady 2.1 Introduction: The Trends Towards Microincision Cataract Surgery . . . . . . 11 2.2 MICS Definition . . . . . . . . . . . . . . . . . . . . . 12 2.3 Indication for MICS Surgery . . . . . . . . . 12 2.4 Our Surgical Technique Step by Step . . . . . . . . . . . . . . . . . . . . . . . . 13 2.4.1 MICS Anesthesia . . . . . . . . . . . . . . . . . . . . 13 2.4.2 MICS Incision . . . . . . . . . . . . . . . . . . . . . . . 13 2.4.3 MICS Capsulorhexis . . . . . . . . . . . . . . . . . 13 2.4.4 MICS Hydrodissection, Hydrodelineation . . . . . . . . . . . . . . . . . . . 14 2.4.5 MICS Prechopping . . . . . . . . . . . . . . . . . . 14 2.4.6 MICS Phacoemulsification and Removal Section . . . . . . . . . . . . . . . 15 2.5 Flat Instruments Concept . . . . . . . . . . . 17 2.6 Fluidics in MICS . . . . . . . . . . . . . . . . . . . . . 17 2.7 Irrigation and Aspiration: Creating a Balanced Fluidics Environment . . . . 19 2.8 Is MICS Worthwhile? . . . . . . . . . . . . . . . . 20 2.8.1 Clinical Outcome . . . . . . . . . . . . . . . . . . . 20 2.8.2 Outcome of the Incision . . . . . . . . . . . . 20 2.8.3 Astigmatism Control with MICS . . . . . 21 2.8.4 Corneal Aberration Control with MICS . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.9 End of the Surgery . . . . . . . . . . . . . . . . . . 23 2.10 Future of MICS . . . . . . . . . . . . . . . . . . . . . . 24 References . . . . . . . . . . . . . . . . . . . . . . . . . 24 Chapter 3 Capsular Tension Rings Rupert Menapace 3.1 History of the Concept . . . . . . . . . . . . . . 27 3.2 Applications and Designs . . . . . . . . . . . 28 3.2.1 Impact of a CTR on IOL Positioning and Refraction . . . . . . . . . . . . . . . . . . . . . . 28 3.2.2 The CTR as a Surgical Tool . . . . . . . . . . . 29 3.2.2.1 Localized Zonular Dehiscence . . . . . . . 29 3.2.2.2 Generalized Zonular Weakness . . . . . . 29 3.2.2.3 Posterior Capsulorhexis . . . . . . . . . . . . . 30 3.2.2.4 Combined Cataract and Vitreous Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.2.3 Modified CTR for Special Purposes . . 31 3.2.3.1 CTRs for Iris Defects . . . . . . . . . . . . . . . . . 31 3.2.3.2 CTRs for Sulcus Suture Fixation . . . . . . 32 3.2.3.3 Capsular Tension Segments . . . . . . . . . 33 3.2.4 The CTR as a Measuring Gauge . . . . . . 34 3.2.4.1 Quantification of the Diameter of the Evacuated Capsular Bag . . . . . . 34 3.2.4.2 Quantification of Bag Diameter Changes During Capsular Shrinkage . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.2.5 CTRs and After-Cataract Formation . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.2.6 The Capsular Bending Ring . . . . . . . . . 36 3.2.7 Full-Circle Capsular Bending Rings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 3.2.7.1 ‘Tailed’ Capsular Bending Ring . . . . . . 38 3.2.7.2 Foldable Closed Ring . . . . . . . . . . . . . . . 38 3.3 Surgical Technique . . . . . . . . . . . . . . . . . 40 3.3.1 Timing of Ring Insertion . . . . . . . . . . . . 40 3.3.2 Insertion Techniques and Instruments . . . . . . . . . . . . . . . . . . . . 40 3.3.3 Sizing of the Capsulorhexis . . . . . . . . . 41 3.4 Complications, Prophylaxis and Management . . . . . . . . . . . . . . . . . . 41 3.4.1 Intraoperative Complications . . . . . . . 41