Steinert's Cataract Surgery

4th Edition - January 5, 2023
Authors: Sumit Garg, Douglas D. Koch
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 5 6 8 1 1 - 1

Offering authoritative coverage, Steinert's Cataract Surgery, 4th Edition, takes you step by step from preoperative evaluation and preparation through the full range of surgica… Read more

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Offering authoritative coverage, Steinert's Cataract Surgery, 4th Edition, takes you step by step from preoperative evaluation and preparation through the full range of surgical techniques and the mitigation and management of complications. New editors, Drs. Sumit (Sam) Garg and Douglas D. Koch, along with a who’s who list of top international experts, provide practical technical guidance on all aspects of cataract surgery in a newly streamlined, easy-to-read format. From IOL calculations to glaucoma and astigmatism considerations, perioperative drug delivery to methods of iris repair, this up-to-date 4th Edition delivers essential clinical information, core foundational knowledge, and advanced techniques from cover to cover.

Cover image
Title page
Table of Contents
Any screen, Any time, Anywhere
Copyright
Dedication
Acknowledgments
Contributors
Video TOC
Introduction
Part I: Preoperative Considerations
1. Pathology and Classification of Cataracts
Abstract
ContentS
Key Points
Lens Embryology
The Crystalline Lens
Cataract Formation
Lens Opacities Classification System
Types of Cataracts
Pseudoexfoliation and True Exfoliation
Summary
References
2. Preoperative Evaluation and Preparation of the Cataract Patient
Abstract
Table of Contents
Key Points
Introduction
Evaluation of Visual Disability
Contrast Sensitivity Function
Glare Disability
Ocular Scatter Index and Higher Order Aberrations
Assessment of Visual Potential
Obtaining a History
Contact Lens Use
Prior Corneal Refractive Surgery
Medical History
Spinal Disease, Dementia, and Tremor
Preoperative Examination and Concomitant Conditions
Ocular Surface Disorder
Blepharitis
Corneal Endothelial Disease
Glaucoma
Uveitis
Intraoperative Floppy Iris Syndrome
Zonular Support
Patient Counseling and Informed Consent
Potential Risks and Complications of Cataract Surgery (Not All Inclusive)
Astigmatism Management
General Risks and Potential Complications of Astigmatism Correction
Peripheral Corneal Relaxing Incisions
Toric Intraocular Lens
Presbyopia Correction
Timing of Sequential Cataract Surgery
Immediately Sequential Bilateral Cataract Surgery
Flowchart For Evaluation of a Patient With Cataracts
Summary
References
3. Current Concepts in Intraocular Lens Power Calculations
Abstract
Table of Contents
Key Points
Introduction
Biometry
Axial Length
Corneal Power
Other Variables
Formulas
Usage
Personalization
Clinical Variables
Patient Needs and Desires
Special Circumstances
Postoperative Problems and Errors
Future Work
Summary
References
4. Intraocular Lens Calculations After Refractive Surgery
Abstract
Introduction
Problems Induced by Corneal Refractive Surgery
Solutions to Problems Induced By Corneal Refractive Surgery
Tools for Intraocular Lens Power Calculation
Intraoperative Measurements
Comparative Data for the Modern Formulas Including Intraoperative Measurements
Premium Intraocular Lens Use in PostRefractive Patients
Summary
References
Part II: Intraocular Lenses
5. Principles of Intraocular Lens Design and Biomaterials
Abstract
Table of Contents
Key Points
Introduction
The Evolution of the Intraocular Lens
Intraocular Lens Construction and Sites of Fixation
Intraocular Lens Optics
Intraocular Lens Materials
Intraocular Lens Pathology
Summary
References
6. Polymethyl Methacrylate Posterior- and Anterior-Chamber Intraocular Lenses
Abstract
Table of Contents
Key Points
Introduction
Indications
Lack of Capsular/Zonular Support
Secondary Lens Implantation
In Association with Penetrating Keratoplasty
Patient Selection
Preoperative Management
Surgical Procedure
Potential Complications
Postoperative Management
Summary
Video 6.1: PMMA ACIOL Surgical Steps
Video 6.2: Scleral-Fixated PMMA PCIOL Surgical Steps
References
7. Posterior Chamber Intraocular Lenses
Abstract
Table of Contents
Key Points
Introduction
Alternative Fixation of the Intraocular Lens in the Posterior Chamber
Summary
References
8. Toric Intraocular Lenses
Abstract
Introduction
Causes
Comorbidities
Preoperative Management
Surgical Procedure
Potential Complications
Postoperative Management
Summary
References
9. Presbyopia-Correcting Intraocular Lenses
Abstract
Table of Contents
Key Points
Introduction
Causes
Comorbidities
Dry Eye Disease
Corneal Dystrophies
Age-Related Macular Degeneration or Retinal Disorders
Glaucoma
Pseudoexfoliation Syndrome or Post trauma
Indication and Preoperative Management
Patient’s Motivations
Indication and Patient Selection
Preoperative Examinations
Presbyopia-Correcting Intraocular Lenses
Monovision
Multifocal Intraocular Lenses
Extended Depth-of-Focus Intraocular Lenses
Accommodating Intraocular Lenses
Potential Complications
Optical Phenomena
Dry Eye Disease
Residual Refractive Error
Secondary Cataract
Surgical Procedure
Astigmatism
Previous Refractive Surgery
Postoperative Management
Summary
References
10. Adjustment Of Intraocular Lens Power
Abstract
Table of Contents
Introduction
Directly Modifiable IOLs
Indirectly Modifiable IOLs
Summary
References
11. Modular Intraocular Lenses
Abstract
Table of Contents
Key Points
Introduction
Summary
References
Part III: Anesthesia and Initial Steps
12. Anesthesia for Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Systemic Anesthesia
Regional Anesthesia (Retrobulbar, Peribulbar, Sub-Tenon’s)
Retrobulbar Block Technique
Complications of Ophthalmic Regional Block Anesthesia
Topical Anesthesia
Additional Uses for Intracameral Anesthesia
Techniques for Topical Anesthesia
References
13. Ophthalmic Viscosurgical Devices
Table of Contents
Key Points
Introduction
Rheological Characteristics of OVD
Categories of OVDs
Viscoelastic Compounds
Current Commercial OVDs
Clinical Uses of Ophthalmic Viscosurgical Devices
Complications of Ophthalmic Viscosurgical Devices
Summary
References
14. Antibiotic Prophylaxis and Endophthalmitis
Abstract
Table of Contents
Key Points
Introduction
Endophthalmitis Prevention
Treating Endophthalmitis
Summary
References
15. Inflammation in Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Pathogenesis
Preoperative Considerations
Pre-Existing Uveitis
Herpetic Disease
Diabetes
Intraoperative Strategies for Control of Inflammation
Intraocular Injection of Steroid
Intracameral Nsaid Delivery
Intracameral Insert
INTRACANALICULAR Insert
Future of Drug Delivery
Postoperative Inflammation
Treatment
Acute Postoperative Inflammation
Chronic Postoperative Inflammation
Pseudophakic Cystoid Macular Edema
Summary
References
16. Incision Construction
Abstract
Table of Contents
Key Points
Indications for Clear Corneal Incisions
Clear Corneal Surgical Technique
Profiles of Clear Corneal Incisions
Femtosecond Laser–Assisted Corneal Wound
Intraoperative and Postoperative Complications
Summary
References
17. Capsulotomy
Abstract
Table of Contents
Key Points
Introduction
History
The Ideal Capsulotomy
Early and Late Postoperative Capsulotomy Considerations
Prevention of Capsular Fusion Syndrome
The Purkinje I and IV Methods for Visual Axis Identification And Centration
Modern-Day Capsulotomy Methods
Manual Refractive Capsulotomy
Current Standard Techniques of Capsulorrhexis
Precision Pulse Refractive Capsulotomy
Femtosecond Laser Refractive Capsulotomy
Complications and Special Situations
Posterior Capsulorrhexis
Summary
References
18. Hydrodissection and Hydrodelineation
Abstract
Table of Contents
Key Points
Introduction
Hydrodissection Surgical Technique
Hydrodelineation Surgical Technique
Discussion
References
Part IV: Nuclear Disassembly
19. Basic Principles of the Phacoemulsifier
Abstract
Table of Contents
Overview
Key Points
Intraocular Pressure, Flow, and Aspiration
Key Points
Flow Pump/Peristaltic, Aspiration, and Vacuum
Key Points
Vacuum Pump/Venturi, Aspiration, and Vacuum
Key Points
Ultrasound Power and the Phaco Needle
Key Points
The Four Forces that Create Emulsification
Key Points
Modulation Of Ultrasound
Postocclusion Surge
Key Points
Corneal Incision Contracture/Corneal Wound Burn
Key Points
References
20. Advanced Principles of Phacoemulsification Platforms
Abstract
Table of Contents
The Alcon Centurion
Bausch & Lomb Stellaris
Johnson & Johnson Veritas Vision System
Summary
References
21. Extracapsular Cataract Extraction and Manual Small-Incision Cataract Surgery
Abstract
Table of Contents
Large Incision Manual Ecce
Anesthesia
Surgical Procedure (Converting from Phaco to Manual Ecce) [ Video 21.1]
Potential Complications
Postoperative Management
Summary (Manual ECCE)
Manual Small-Incision Cataract Surgery
Indications and Comorbidities
Anesthesia
Surgical Procedure (Msics) [ Videos 21.2-21.5]
Potential Complications
Postoperative Management
Summary (MSICS)
References
22. Principles of Nuclear Disassembly
Abstract
Table of Contents
Key Points
Introduction
Basic Principles of Nuclear Disassembly
Classic Nuclear Disassembly Techniques
Nuclear Density
Disassembly in Special Situations
Learning Nuclear Disassembly
Summary
References
23. Phaco Chop Techniques
Abstract
Table of Contents
Key Points
Introduction
Advantages of Chopping
Phaco Chop Variations
Stop and Chop
Prechop Techniques
Horizontal Chop Technique
Initial Chop
Removing the Chopped Fragments
Comparing Horizontal and Vertical Chop: Which Technique?
Diagonal/Vertical Chop for Brunescent Nuclei
Comparison of Horizontal and Vertical Choppers
Complications
Summary
References
24. Tilt and Tumble Supracapsular Phacoemulsification
Abstract
Table of Contents
Indications
Preoperative Preparation
Operative Procedure
Postoperative Care
Summary
25. Biaxial Microincision Phacoemulsification
Abstract
Table of Contents
Key Points
Introduction
Surgical Technique
Summary
References
26. Femtosecond Laser-Assisted Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
The Technology
Steps of the Procedure
References
27. Cortical Removal
Abstract
Table of Contents
Introduction
Key Points
Cortex: Managing the Inconsistencies
Techniques for Routine Challenges
Capsule Polishing
Cortical Removal And Femtosecond Laser-Assisted Cataract Surgery
Strategies For Stubborn Cortex
Cortical Removal After Posterior Capsule Rupture
Capsule Polishing
SUMMARY
References
Part V: Astigmatism Management
28. Preoperative Evaluation and Considerations of Astigmatism
Abstract
Table of Contents
Introduction
The Measurement of Corneal Astigmatism
The Posterior Cornea
Lens Tilt
Toric IOL Calculators
Corneal Surgically Induced Astigmatism
Toric iol Calculators for the Unusual Corneas
Single-Angle and Double-Angle Plots for Astigmatism Data Presentation
Summary
References
29. Corneal Incisional Approaches for Reducing Astigmatism During Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Corneal Incisional Approaches
Manual Corneal Incisional Approaches
Femtosecond Laser-Assisted Corneal Incisional Approaches
Preoperative Evaluation And Planning
Nomograms
Surgical Procedure
Femtosecond Cris
Outcomes
Femtosecond Penetrating CRIs
Femtosecond Intrastromal CRIs
Prospective Comparative Studies
Potential Complications
Summary
References
30. Toric Intraocular Lenses: Selection and Alignment Methods
Abstract
Table of Contents
Key Points
Introduction
Preoperative Management
Surgical Procedure
Postoperative Management
Summary
References
31. Managing Residual Postoperative Astigmatism
Abstract
Table of Contents
Key Points
Introduction
Causes
Initial Assessment
Management Options
IOL Rotation, Repositioning, and Exchange
IOL Exchange
IOL Exchange
Limbal Relaxing Incisions (Lri)
Corneal Refractive Surgery
Light Adjustable Lens (LAL)
Summary
References
Part VI: Complex Cases
32. Ultradense Cataract
Abstract
Table of Contents
Key Points
Introduction
Risk Factors
Preoperative Management
Potential Visual Acuity
Lens Calculations
Density Measurement
Posterior Evaluation
Surgical Procedure
Preoperative Modifications
Instrument Modifications
Wound Construction
Capsulorrhexis
Hydrodissection
Phacomodulation
Nuclear Disassembly Techniques
Cortical Irrigation and Aspiration
Lens Placement
Potential Complications
Postoperative Management
Summary
References
33. Intumescent Cataract
Abstract
Table of Contents
Key Points
Introduction
Causes
Comorbidities
Preoperative Management
Subtype Classification
Surgical Procedure
Potential Complications
Postoperative Management
Summary
References
34. Management of Weak Zonules
Abstract
Table of Contents
Key Points
Introduction
Causes
Comorbidities
Surgery
Capsulorhexis
Capsule Stabilization
Capsule-Stabilizing Devices
Anterior Capsular Supporting Devices
Tips and Tricks
Special Considerations
Summary
References
35. Cataract Surgery in the Small Pupil
Abstract
Table of Contents
Key Points
Introduction
Causes
Uveitis
Pseudoexfoliation Syndrome (PXE)
Trauma
Use of Medications: IFIS
Narrow-Angle Glaucoma
Preoperative Management
Pharmacologic Pupil Expansion
Surgical Procedure
Overview of Intraoperative Small Pupil Enlargement Techniques
Specific Small Pupil Scenarios
Phacoemulsification Surgery
Potential Complications
Postoperative Management
Summary
References
36. Phacoemulsification in the Glaucoma Patient
Abstract
Table of Contents
Key Points
Introduction
The Effect of Cataract Extraction on IOP
Angle Surgery Concomitant with Cataract Extraction
Subconjunctival Stent Method
Trabecular Meshwork Unroofing Method
Trabecular Meshwork Stent Method
Tube Shunts and Trabeculectomy
Combined Phacoemulsification-Tube Shunt
Combined Phacoemulsification-Trabeculectomy
Postoperative Management and Complications of Combined Surgeries
Summary
References
37. Cataract Surgery in Combination With Corneal Surgery
Abstract
Table of Contents
Key Points
Introduction
Anterior Cornea
Salzmann’s Nodular Degeneration
Pterygium
Corneal Stroma
Biometry in Keratoconus
Treatment of Astigmatism in Keratoconus
IOL Asphericity and Keratoconus
Intraoperative Considerations In Keratoconus
Pinhole Implant
Penetrating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty (DALK)
Cataract Surgery After PK
Combined Cataract Surgery and PK
Preoperative Diagnostic Testing
Biometry
Anesthesia
Surgery
Corneal Endothelial Disease
Cataract Surgery Alone
Cataract Surgery with Transplant for Fuchs’ Dystrophy
Descemet’s Stripping Only (DSO) Combined with Cataract Surgery
Presbyopia-Correcting IOLs
Summary
References
38. Cataract Surgery in Uveitic Patients
Table of Contents
Key Points
Introduction
Causes
Comorbidities
Preoperative Evaluation and Management
Counseling
Decision to Place an Intraocular Lens (or not)
Perioperative Medications
Antimicrobial Prophylaxis
Immunosuppressive Medications
Surgical Planning
Surgical Procedure
Band Keratopathy
Phacoemulsification
Capsulorrhexis
Zonular Weakness
Intraoperative Medical Management
Potential Complications
Hypotony
Ocular Hypertension/Glaucoma
Delayed Complications
Indications for Intraocular Lens Explantation
Postoperative Management
Postoperative Medical Management
Summary
References
39. Retinal Considerations in Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Preoperative Assessment
Peripheral Retinal Pathology
Diabetic Retinopathy
Proliferative Disease
Diabetic Macular Edema
Other Nondiabetic Vascular Retinopathies
Age-Related Macular Degeneration
Dry Age-Related Macular Degeneration
Wet Age-Related Macular Degeneration
Other Causes of Choroidal Neovascular Membrane
Medication Toxicities
Retinitis Pigmentosa and Other Inherited Retinal Diseases
Prior Posterior Segment Interventions
Posterior Segment Operative Complications
Combined Cataract Extraction And Pars Plana Vitrectomy
Intraocular Lens Considerations in the Retina Patient
Toric Intraocular Lense
Multifocal Intraocular Lenses
Summary
References
40. Pediatric Cataract Surgery
Abstract
Key Points
Introduction
Causes
Comorbidities
Microspherophakia
Congenital Aniridia
Persistent Fetal Vasculature
Lenticonus
Zonulopathy
Preoperative Management
Indications of Surgical Treatment
Anesthesia
Surgical Procedure,,,
Incision
Anterior Capsulorhexis
Cataract Removal
Endocapsular Tension Ring Implantation
Posterior Capsulorhexis
Anterior Vitrectomy
Intraocular Lens
Final Surgical Steps
Postoperative Management
Potential Surgical Complications
Secondary Visual Axis Opacification
Glaucoma
Other Rarer Surgical Complications
Amblyopia Treatment and Visual Rehabilitation
Summary
References
41. Intraocular Lens Exchange and Secondary Intraocular Lens Placement
Abstract:
Table of Contents
Key Points
Introduction
Indications
Patient Comorbidities
Intraoperative Complications During Phacoemulsification
Postcataract Surgery Complications
Patient Dissatisfaction
Patient Population
Eye Examination
Surgical Techniques
Capsule or Sulcus-Supported Intraocular Lens
Scleral-Fixated Intraocular Lens
Scleral-Suture Fixated Intraocular Lenses
Sutureless Scleral Fixation
Iris-Fixated Posterior-Chamber Intraocular Lens
Anterior-Chamber Intraocular Lenses
Complications of Secondary Intraocular Lenses
Intraocular Lens Malposition and Tilt
Postoperative Uveitis
Iris Chafe
Suprachoroidal Hemorrhage
Postoperative Endophthalmitis
Retinal Detachment
Refractive Outcome
Summary
References
42. Traumatic Cataract
Abstract
Key Points
Introduction
Causes
Capsular Status
Angle Status
Imaging
Anesthesia Alternatives
Vital Dyes
Anterior Vitrectomy
Hydro/Viscodissection
Lens Removal
Zonular Weakness Management
Potential Complications
Postoperative Management
Summary
References
43. Iris Repair and Iris Prosthesis
Abstract
Table of Contents
Key Points
Introduction
Iris Repair vs. Iris Prosthesis
Preparations for Iris Repair
Intraocular Knots For Iris Suturing
Types of Iris Repair
Iris Prostheses
Iris Defects That May Not Be Amenable to Repair
Slit Lamp Examination for Consideration of Iris Prosthesis
Device Selection
Device Ordering
Implantation Techniques
Pitfalls/Complications of Iris Prostheses
Summary
References
44. Surgery in Short and Eyes
Abstract
Table of Contents
Key Points
Introduction
Short Eyes
Preoperative Management
Surgical Procedure
Postoperative Management
Long Eyes
Preoperative Management
Surgical Procedure
Postoperative Management
Summary
References
Part VII: Intraoperative Complications
45. Risk Management in Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Preoperative Considerations
Intraoperative Issues
Postoperative Issues
Summary
References
46. Intraoperative Complications
Abstract:
Table of Contents
Key Points
Anesthesia
Retrobulbar Hemorrhage
Wound Construction
Incision Leak
Tear of Descemet’s Membrane
Capsulorhexis
Complications During Phacoemulsification
Acute Corneal Clouding
Inadvertent Cannula Injection
Expulsive Suprachoroidal Hemorrhage
Summary
References
47. Vitrectomy for the Anterior Segment Surgeon
Abstract
Table of Contents
Key Points
Introduction
Anatomic Considerations
Indications for Vitrectomy
Principles of Vitrectomy
Anterior Versus Pars Plana Vitrectomy
Managing Vitreous Loss
Managing Retained Lens Fragments
Post Vitrectomy Management and Referral
References
48. Issues in Wound Management
Abstract
ContentS
Introduction
Wound Construction
Wound Healing
Compromise of Wound Integrity
Summary
References
49. Surgical Instrument Care and Toxic Anterior Segment Syndrome
Abstract
Key Points
Introduction
Surgical Instrument Care
Toxic Anterior Segment Syndrome (Tass)
Summary
References
Part VIII: Postoperative Complications
50. Corneal Edema After Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Causes
Preoperative
Intraoperative
Postoperative
Preoperative Assessment
Postoperative Assessment
Hypertonic Solutions
Anti-inflammatory Therapy
Descemet’s Membrane Detachment
Anterior-Chamber Iol
Corneal Transplantation
Future Therapeutics
Summary
References
51. Glaucoma After Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Causes
Comorbidities
Management Considerations
Potential Complications
Summary
References
52. Retinal Complications of Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Pseudophakic Cystoid Macular Edema/Irvine-Gass Syndrome
Retained Lens Fragments
Retinal Detachment
Endophthalmitis
Hemorrhagic Occlusive Retinal Vasculitis
Summary
References
53. Subluxated Intraocular Lenses
Abstract
Table of Contents
Key Points
Introduction
Incidence and Etiology
Symptoms and Signs
Patient Evaluation
Management
Surgical Management
Summary
References
54. Neodymium:Yttrium-Aluminum-Garnet Laser Applications in the Cataract Patient
Abstract
Table of Contents
Key Points
Introduction
Procedure Specifics
Nd:Yag Laser Capsulotomies
Nd:Yag Anterior Capsulotomy for Capsular Contraction Syndrome
Nd:Yag Laser Iridotomy
Nd:Yag Anterior Hyaloid Vitreolysis for Malignant Glaucoma
Nd:Yag Laser Vitreolysis
Summary
References
55. Management of Dysphotopsia
Abstract
Key Points
Positive Dysphotopsia
Nonsurgical Management of PD
Negative Dysphotopsia
Nonsurgical Management of ND
Diffractive-Optic Dysphotopsia (DD)
Nonsurgical Management of DD
IOLs Designed to Prevent Dysphotopsia
Surgical Strategies for Management of Dysphotopsia
References
56. Refractive Enhancements After Cataract Surgery
Abstract
Table of Contents
Key Points
Introduction
Causes
Factors Confounding Keratometry Measurements
Factors Confounding Axial Length Measurements
Lens-Based Issues
Evaluation
Surgical Management
Corneal-Based Surgery
Lens-Based Surgery
Refractive Enhancements to Address Presbyopia
Future Developments
Summary
References
INDEX
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Steinert's Cataract Surgery

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Sumit Garg

Douglas D. Koch