Ophthalmology
Cataract resources from the Ophthalmology Hyperguide.
Radial keratotomy (RK) surgery was performed on my left eye several years prior to developing bilateral cataracts. My markedly dominant left eye was distance corrected and my nondominant right eye was kept at near…
In the 1960s, removing a cataract through a 3-mm incision was considered impossible. Doing the "impossible" required a resolution of contradictions which was attained through ingenious application of new technology. As…
The challenges surgeons face in lens/IOL surgery — to identify and obtain the elusive "state of the art" status — can be staggering. Many of these challenges are described in this tutorial.
Dye staining of the anterior capsule is one of the most important advances in the management of complicated cataracts. With the recent U.S. Food and Drug Administration approval of trypan blue, U.S. surgeons are able to…
Among the operative challenges faced by the cataract surgeon, the miotic pupil is the most common obstacle. The miotic pupil is also a condition that is associated with the greatest likelihood for intraoperative…
Cataracts occur commonly in patients with uveitis for at least two reasons. First, and most importantly, uveitis itself promotes cataract formation. In fact, patients who have more severe or more frequent bouts of…
Before performing any initial incision (scleral tunnel, corneal scleral, or a clear corneal), the paracentesis port should be made approximately 70° from the center of the planned surgical wound. This provides optimum…
For the past decade, cataract surgeons have been following the progress and development of laser phacoemulsification systems.1-6 This technology has always promised two potential advantages. First, a system that…
Cataract surgery with intraocular lens (IOL) implantation has evolved in the past 2 decades. The use of phacoemulsification through a small, clear corneal incision continues to increase yearly.1 IOLs have also evolved…
Complications of the corneal epithelium after cataract surgery and IOL implantation are rare. However, these complications should be identified and treated.
Over the past several years, the concept of refractive cataract surgery has received increased attention from surgeons, and the need for its adoption has recently been made urgent by the approval and availability of new…
Whereas most patients who receive state-of-the-art sutureless cataract surgery have excellent unaided vision postoperatively, patients with significant preexisting astigmatism cannot achieve the same results without…
Hydrodissection of the nucleus in cataract surgery has traditionally been perceived as the injection of fluid into the cortical layer of the lens under the lens capsule to separate the lens nucleus from the cortex and…
Cortical removal is perhaps the most overlooked step of cataract surgery, but it is the most important step in reducing the incidence of the most common complication of cataract surgery - posterior capsule opacification…
There are more than 2 million cataract surgeries performed each year in the United States. Fortunately, the incidence of postoperative endophthalmitis is relatively low, with an estimated five to 10 cases per 10,000.1,2…
It has been more than one-half of a century since the first intraocular lens (IOL) was implanted by Harold Ridley on November 29, 1949, at St. Thomas Hospital in London.1 Dr. Ridley replaced the cataractous natural…
Beginning with the silicone taco lens, many ophthalmologists predicted that foldable IOLs were simply a flash in the pan and not going to have any lasting impact. Early on, people reported that some of these lenses were…
Although the achievement of uncorrected 20/20 visual acuity remains a laudable target for any cataract or refractive surgeon, the goal of high-quality vision increasingly reflects our understanding of the visual system…
Successful cataract surgery depends upon the latest techniques, state-of-the art instrumentation, and latest advances in viscoelastic technology. To maximize the benefits of the various available viscoelastics such as…
The history of PMMA intraocular lenses (IOLs) began with Harold Ridley in mid-twentieth century Britain. However, the idea of the IOL is considerably older and dates back to the beginning of modern cataract surgery.
Although capsulorrhexis is the most important step of cataract surgery, hydrodissection is probably the most underrated. Hydrodissection produces a broad fluid wave that separates the epinucleus and the capsule. Nucleus…
Incisional burns may range in severity from mild collagen shrinkage to severe whitening with gaping of the wound (Slide 1). Thermal injuries appear to be more common with clear corneal incisions, either because mild…
An indication for explanting an intraocular lens (IOL) can occur either at the time of primary implantation or months to years later. An explantation is indicated when an IOL becomes damaged or malpositioned, or when…
Interpseudophakos/interlenticular opacification (IPO/ILO) has emerged as a late complication of piggyback IOL implantation.1-4 IPO/ILO is characterized by ingrowth of lens epithelial cells (LECs) between the IOLs, 1 to…
Several measurements of the eye are helpful in determining the appropriate intraocular lens (IOL) power to achieve a desired refraction. These measurements include central corneal refractive power (keratometry…
Modern phaco strategies seek to subdivide the nucleus into small maneuverable pieces. This "disassembly" of the nucleus has two advantages: (1) The 10-mm wide nucleus can be removed through an intact 5-mm capsulorhexis.…
Zonular compromise, whether congenital, iatrogenic, traumatic, or due to disease, presents a serious challenge to cataract surgeons. Every step of the surgical procedure from capsulotomy to final removal of the…
Modern cataract surgery has advanced to offer unprecedented patient benefits and has attained a level of successful outcomes where it may now be viewed as a refractive procedure. It is important to recognize, however,…
Mature white (cortical) and brown (nuclear) cataracts are challenging for many reasons. The capsulorhexis is difficult to visualize because of the lack of any red reflex and the liberation of cortical "milk" following…
Microphthalmos is a rare, potentially devastating condition occurring in 0.046% to 0.11% of patients in several large ophthalmic out-patient populations.1 Congenital microphthalmos can be either associated with coloboma…
The wide use of lasers in ophthalmology has not escaped the field of cataract surgery. Now, surgeons can offer their patients cataract laser surgery. In June 2000, the U.S. Food and Drug Administration (FDA) approved…
New technology brings challenges and opportunities to the anterior segment surgeon. The drive toward less traumatic surgery and more rapid visual rehabilitation after cataract surgery has spawned various modalities for…
Lens extraction with the implantation of an IOL is the most commonly performed refractive procedure in the world today. Since the invention of the IOL by the late Sir Harold Ridley in 1949, lens implantation has been…
In November 1998, the Staar (Monrovia, Calif) plate haptic toric IOL became the first toric lens approved by the U.S. Food and Drug Administration. Earlier and concurrent studies have suggested that the plate haptic…
Despite the continuing threat of amblyopia, in children, the prognosis for a good visual outcome after cataract surgery has improved dramatically over the past two decades. Not only has there been an increased…
Despite the continuing threat of amblyopia, in children, the prognosis for a good visual outcome after cataract surgery has improved dramatically over the past two decades. Not only has there been an increased…
Evidence of zonular laxity can be obtained preoperatively, during surgery but before phacoemulsification, or during nucleus and/or cortex removal.
Phacoemulsification surgery can be described based on its two fundamental components. First, ultrasound energy is used to emulsify the nucleus. Second, a fluidic circuit is used to remove the emulsate through a small…
All phacoemulsification machines consist of a computer to generate ultrasonic impulses, a transducer, and piezo electric crystals that turn these electronic signals into mechanical energy. The energy that is created is…
The authors have no financial or proprietary interest in any product mentioned in this tutorial. Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY.
Cystoid macular edema (CME) is a disease entity that has been studied in ophthalmic literature. CME is a disruption of the blood-retinal barrier that leads to the accumulation of fluid in the retinal extracellular space…
Postoperative endophthalmitis is a rare but potentially devastating complication of cataract surgery. Postoperative endophthalmitis can be either sterile or infectious. Sterile endophthalmitis is also known as the toxic…
A well-centered posterior chamber IOL is the anatomic goal of every cataract surgery. Good centration is best assured by in-the-bag placement of both haptics and a capsulorrhexis sized slightly smaller than the optic…
Retained posterior nuclear fragments greatly increase the risk of postoperative complications and must usually be retrieved through a subsequent three-port vitrectomy. Therefore, the diagnosis and management of…
For the past 50 years, ophthalmic surgeons have witnessed enormous breakthroughs in the treatment of many ocular diseases and disorders, especially in the field of cataract surgery and its ability to correct preexisting…
In 1985, 76% of the members of the American Society of Cataract and Refractive Surgeons (ASCRS), responding to an annual survey, indicated a preference for retrobulbar anesthesia with a supplemental facial nerve block…
With early intracapsular surgical procedures, ophthalmologists purposefully created large superior sector defects. Often, iris tissue became incarcerated in a corneal or scleral wound, thereby, creating marked…
The increased risk of developing rhegmatogenous retinal detachment (RRD) following cataract extraction is well recognized. With the evolution of cataract surgery from intracapsular, aphakic techniques to extracapsular…
In 1993, my colleagues and I first described the implantation of two intraocular lenses (IOLs) in the eye, piggybacking, to provide adequate power in a case of microphthalmos.1 Since then, piggybacking IOLs has become…
The phaco chop technique was a revolutionary addition to the advancement of cataract surgery. However, one difficulty with the technique was the creation of the intracapsular jigsaw puzzle and the limitation of…
Intraoperative suprachoroidal hemorrhage and the consequential expulsive hemorrhage that can occur constitute the most serious complication in ocular surgery. The conversion to phacoemulsification has decreased the…
IOL implantation is an effective form of visual rehabilitation at the time of cataract extraction. However, IOLs also benefit patients who originally underwent cataract extraction without a lens implant and are now…
Hydroexpression with an irrigating vectis is a simple technique of sutureless extracapsular cataract extraction (ECCE) using a combination of mechanical and hydrostatic forces to express out the nucleus.1 An irrigating…
A brunescent nucleus challenges every phacoemulsification surgeon. Successful management of a rock-hard cataract requires that each surgeon first understand and then use specific strategies to overcome these…
Presbyopia Accommodation is the process that allows the human crystalline lens to change its focus from far to intermediate or near vision. With age, the crystalline lens loses its ability to focus on near objects,…
An anterior capsulotomy is the capsular incision necessary to allow removal of the nucleus and cortex. It should be capable of preserving the integrity of the capsular bag against the asymmetric forces that occur during…
The four quadrant divide and conquer phacoemulsification procedure (Slide 1), or in situ fracture as I originally named it, was first performed in 1988. This tutorial discusses the origination and the steps of the four…
Cataract surgery is considered to be the premier surgery for ophthalmic surgeons. With declining interest in refractive surgery, ophthalmic surgeons are now faced with cataract surgery in the baby-boomer generation.…
By optical coherence biometry (OCB), axial length measurements with the IOLMaster are the equivalent of upright, ultra-high-resolution immersion A-scan ultrasonography, approximately five times more accurate than…
The increased acceptance of topical anesthesia, phacoemulsification, and small foldable IOLs has prompted the development of clear corneal cataract surgery techniques.1 Operating through small corneal incisions that are…
Modern cataract surgery performed with phacoemulsification allows meticulous intraocular control and minimal incision size. However, inherent risks of capsular rupture exist. Therefore, surgeons performing cataract…
The presence of vitreous gel in the anterior chamber is associated with an increased risk of serious intraoperative and postoperative complications. It is fortunate that the incidence of many vision-threatening…
Various nontoxic ophthalmic dyes have been extensively used as diagnostic agents for the detection and management of different ocular disorders. Table 1 summarizes the use of various dyes in ophthalmology. Dyes such as…
At the start of the new millennium, the world of ophthalmology hailed a celebration of its own: the 50th anniversary of Sir Harold Ridley's original IOL implant. More recently, a lesser but significant revolution has…
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