Table Of ContentBasic Techniques of
Ophthalmic Surgery
Third Edition
Jean R. Hausheer, MD
Executive Editor
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American Academy of The Acad emy provides this material for educational purposes only. It is not in-
Ophthalmology tended to represent the only or best method or procedure in every case, nor to
replace a physician’s own judgment or give specific advice for case management.
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Christopher J. Rapuano, MD such. Some materials may include information on applications that are not con-
Secretary for Lifelong Learning and sidered community standard, that reflect indications not included in approved
Assessment FDA labeling, or that are approved for use only in restricted research settings.
The FDA has stated that it is the responsibility of the physician to determine
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Financial Disclosures
Acad emy staff members who contributed to the development of this product
state that within the 12 months prior to their contributions to it they have had
no financial interest in or other relationship with any entity discussed in this
book that produces, markets, resells, or distributes ophthalmic health care goods
or ser vices consumed by or used in patients, or with any competing commercial
product or ser vice.
The authors and reviewers state that within 12 months prior to their contributions
to this product and for the duration of development they have had the following
financial relationships:*
Dr. Allen: Horizon Pharma (C)
Dr. Bollinger: National Eye Institute (S)
Dr. Brubaker: Aerie Phar ma ceu ti cals (C, S, L), Alcon Laboratories (C, S, L), Al-
lergan (C, S, L), Glaukos (S), Ivantis (S), New World Medical (C, L)
Dr. Chuck: Novartis Phar ma ceu ti cals (C), Shire (C), TECLens (C, O), Univer-
sity of California (P)
Dr. Cohen: Shire (L), Sight Sciences (L)
Dr. Davis: Johnson & Johnson Vision (C), Refractec (O)
Dr. Dresner: Poriferous LLC (P)
Dr. Dunn: Abbvie (L)
Dr. Ehlers: Aerpio (C, S), Alcon Laboratories (C, S), Allergan (C), Bioptigen
(C, P), Carl Zeiss Meditec (C), Genentech (C, S), Leica Microsystems (C, P),
National Eye Institute (S), Novartis Pharma AG (C, S), Regeneron Pharmaceuticals
(S), Santen (C), ThromboGenics (C, S)
Dr. Galor: Allergan (C), Dompe (C), Novaliq GmbH (C), Shire (C)
Dr. Greenwood: Alcon (L), Allergan (C), Equinox (C, O), Glaukos (L), Johnson
& Johnson (L), Nevaker (C), New World Medical (C, L), STAAR Surgical (L),
Valeant Phar ma ceu ti cals (L)
Dr. Johnson: BeiGene (S), Diachi Sankyo (S), Incuron (S), Novartis (S), Samus
Therapeutics (S)
Dr. Hammersmith: Shire (C, L)
Dr. Hersh: Avedro (O)
Dr. Holds: Cypris Medical (O), Horizon Phar ma ceu ti cals (C), Revance Thera-
peutics (O), Springer (P), Sun Biopharma (O)
Dr. Koreishi: Allergan (L), Bausch + Lomb (L), Shire (L), VisionCare (C)
Dr. Lee: Elsevier (P), Shire (C), Johnson & Johnson Vision (L)
Dr. Lim: Alcon Laboratories (C), Chengdu Kanghong (S), Clearside (S), CRC
Press/Taylor and Francis (P), Genentech (C, L, S), JAMA Ophthalmology Edi-
torial Board (C), Jannsen (S), Kodiak (C), Ohr (S), Opthea (C), pSivida (C),
Quark (C), Regeneron Phar ma ceu ti cals (S), Santen (C), Second Sight Medical
Products (S)
Dr. MacRae: Bausch + Lomb (P), Clerio Vision (O)
Dr. McCann: Lidliftgoggle . com (O)
*C = con sul tant fees, paid advisory boards, or fees for attending a meeting; L = lecture fees
(honoraria), travel fees, or reimbursements when speaking at the invitation of a commercial
sponsor; O = equity own ership/stock options of publicly or privately traded firms (exclud-
ing mutual funds) with manufacturers of commercial ophthalmic products or commercial
ophthalmic ser vices; P = patents and/or royalties that might be viewed as creating a poten-
tial conflict of interest; S = grant support for the past year (all sources) and all sources used
for a specific talk or manuscript with no time limitation
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Dr. Mian: Kedrion (C), National Eye Institute, Shire, VisionCare (S)
Dr. Miller: Alcon Laboratories (C), Bausch + Lomb (O), ianTECH/Zeiss (C),
Johnson & Johnson Vision (C)
Dr. Langer: Matrix Surgical USA (C)
Dr. Pineda: Amgen (C), Elsevier (P), Healthy Mee (O), Ophthotech (C), Sanofi (C)
Dr. Sarkisian: Alcon Laboratories (C, L, S), Allergan (C, L), Bausch + Lomb (C,
L), Beaver- Visitec International (C), Glaukos (C, S), Katena Products (C), New
World Medical (C), Omeros (C), Santen (C), Sight Sciences (C, O, S)
Dr. Schwartz: Aerie Phar ma ceu ti cals (L), Allergan (L, C)
Dr. Sheybani: Alcon Laboratories (C), Allergan (C), Glaukos (C), Katena Prod-
ucts (C)
Dr. Sohn: DORC International BV/Dutch Ophthalmic USA (C), Oxford Bio-
medica (S), Sanofi Fovea (S)
Dr. Soiberman: National Eye Institute (S)
Dr. Suh: Allergan (C), Shire (C)
Dr. Thorne: AbbVie (C), Allergan (S), Clearside (C), Gilead Sciences (C), Na-
tional Eye Institute (S)
Dr. Turbin: Biogen (O), Merck & Co (O), Mount Sinai/NEI/SiHTT Trial (C, S),
TITFX (O)
Dr. VanderVeen: OPHTEC (L), Retrophin (S)
Dr. Waggoner: Allergan (C), Johnson & Johnson Vision (L), Keralink Interna-
tional (L)
Dr. Wladis: Bausch + Lomb (C), FuzeHub (S), Lions Eye Foundation (S), Patent
62/332,690 (P), Praxis Biotechnology (O), Valeant (C)
Dr. Yoo: Carl Zeiss Meditec (C), Kala Phar ma ceu ti cals (C), Resolve Oph-
thalmics (C)
Dr. Zarbin: Aerie Phar ma ceu ti cals (S), Boehringer Ingelheim Pharma (C),
Calhoun Vision (C), Cell Cure (C), Chengdu Kanghong Biotechnology (C),
Coherus Biosciences (C), Daiichi Sankyo (C), EyEngineering (C), Frequency
Therapeutics (C, O), Genentech (C), Healios KK (C), Hoffman LaRoche (C),
IRIDEX (C, L), Isarna Therapeutics (C), Makindus (C), Novartis Phar ma ceu ti-
cals (C, L), Ophthotech (C), Percept (C, O), Rutgers University (P)
The other authors and reviewers state that within the past 12 months, they have
had no financial interest in or other relationship with any entity discussed in
this book that produces, markets, resells, or distributes ophthalmic health care
goods or ser vices consumed by or used in patients, or with any competing com-
mercial product or ser vice.
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Section Editors
Richard C. Allen, MD, PhD David B. Lyon, MD
(Section Editor, Ophthalmic Plastic Surgery) (Section Editor, Ophthalmic Plastic Surgery)
Professor, Department of Ophthalmology Professor and Vice Chairman
Cullen Eye Institute Director of Oculofacial Plastic and Reconstructive
Baylor College of Medicine Surgery
Houston, TX Department of Ophthalmology
University of Missouri– Kansas City
Jacob W. Brubaker, MD School of Medicine
(Section Editor, Glaucoma Surgery) Kansas City, Missouri
President
Sacramento Eye Con sul tants Sarah M. Nehls, MD
Sacramento, CA (Section Editor, Refractive Surgery)
Associate Professor of Ophthalmology
Alex W. Cohen, MD, PhD Ser vice Chief of the Cornea Ser vice and Director
(Section Editor, Anterior Segment Surgery, Refractive of Refractive Surgery
Surgery) Department of Ophthalmology and
Partner Visual Sciences, School of Medicine and
Eye Physicians and Surgeons, LLP Public Health
Visiting Assistant Professor University of Wisconsin– Madison
Department of Ophthalmology and Visual Sciences Madison, Wisconsin
University of Iowa Hospitals and Clinics
Iowa City, Iowa Christina Rapp Prescott, MD, PhD
(Section Editor, Anterior Segment Surgery)
Pavlina S. Kemp, MD Assistant Professor of Ophthalmology
(Section Editor, Strabismus Surgery) Wilmer Eye Institute
Clinical Assistant Professor Johns Hopkins University School of Medicine
Department of Ophthalmology and Visual Sciences Baltimore, Mary land
University of Iowa
Iowa City, Iowa Steven R. Sarkisian, Jr., MD
(Section Editor, Glaucoma Surgery)
Scott A. Larson, MD Founder and CEO
(Section Editor, Strabismus Surgery) Oklahoma Eye Surgeons, PLLC
Clinical Professor Oklahoma City, Oklahoma
William E. Scott Professor of Pediatric Ophthalmology
Department of Ophthalmology and Visual Sciences Elliott H. Sohn, MD
University of Iowa (Section Editor, Globe Trauma)
Iowa City, Iowa Associate Professor
Director of Ret ina Fellowships
Robert E. Leonard II, MD Department of Ophthalmology and Visual Sciences
(Section Editor, Vitreoret i nal Surgery) Institute for Vision Research
Ret i nal Associates of Oklahoma University of Iowa Carver College of Medicine
Oklahoma City, Oklahoma Iowa City, Iowa
v
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Contributors
Jean R. Hausheer, MD Yassine Daoud, MD
Executive Editor Assistant Professor of Ophthalmology
Clinical Professor, Department of Ophthalmology Cornea, Cataract, and External Disease
Dean McGee Eye Institute Wilmer Eye Institute
University of Oklahoma School of Medicine Johns Hopkins University School of Medicine
Oklahoma City, Oklahoma Baltimore, Mary land
Robert S. Bailey Jr., MD Elizabeth A. Davis, MD
Thorp Bailey Weber Eye Associates Partner
Plymouth Meeting, Pennsylvania Minnesota Eye Con sul tants
Chief, Cataract and Primary Eye Care Ser vice Bloomington, Minnesota
Wills Eye Hospital
Clinical Associate Professor of Ophthalmology Steven C. Dresner, MD
Sidney Kimmel Medical College at Thomas Jefferson Eyesthetica, PC
University Santa Monica, California
Philadelphia, Pennsylvania Clinical Professor of Ophthalmology
Keck School of Medicine
Rhonda V. Barrett, MD University of Southern California
Rock Hill Eye Center Los Angeles, California
Rock Hill, South Carolina
James P. Dunn, MD
Neelakshi Bhagat, MD, MPH Director, Uveitis Unit
Professor of Ophthalmology Ret ina Division, Wills Eye Hospital
Director of Vitreo- Retinal and Macular Surgery Professor of Ophthalmology
Institute of Ophthalmology and Visual Science Sidney Kimmel College of Medicine/Thomas Jefferson
Rutgers– New Jersey Medical School University
Rutgers University Philadelphia, Pennsylvania
Newark, New Jersey
Daliya Dzhaber, MD
Kathryn E. Bollinger, MD, PhD Postdoctoral Research Fellow
Associate Professor of Ophthalmology, Cell Biology Cornea, Cataract, and External Disease
and Anatomy Wilmer Eye Institute, Johns Hopkins University School
Director, Glaucoma Ser vice of Medicine
Augusta University Baltimore, Mary land
Augusta, Georgia
Justis P. Ehlers, MD
Susan R. Car ter, MD Norman C. and Donna L. Harbert Endowed Chair for
The Eye Center Ophthalmic Research
Warren, New Jersey Director, Tony and Leona Campane Center for
Clinical Associate Professor of Ophthalmology Excellence in Image- Guided Surgery and Advanced
Department of Ophthalmology and Visual Science Imaging Research
Rutgers– New Jersey Medical School Cole Eye Institute
Rutgers University Cleveland Clinic
Newark, New Jersey Cleveland, Ohio
Lawrence P. Chong, MD Christina J. Flaxel, MD
VMR Institute Professor of Ophthalmology
Huntington Beach, California Casey Eye Institute
Professor of Clinical Ophthalmology Oregon Health and Science University
Doheny Eye Institute Portland, Oregon
Los Angeles, California
Anat Galor, MD
Lucy Cobbs, MD Associate Professor of Ophthalmology
New York University School of Medicine Bascom Palmer Eye Institute
New York, New York Miami, Florida
vii
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viii ● Contributors
Irina Bykhovskaya Ganelis, MD Holly B. Hindman, MD, MPH
Medical and Surgical Director The Eye Care Center
Los Angeles Eye Institute Canandaigua, New York
Los Angeles, California Clinical Associate Professor
Flaum Eye Institute
Roberta E. Gausas, MD University of Rochester
Chief, Oculofacial and Orbital Surgery Rochester, New York
Scheie Eye Institute
University of Pennsylvania School of Medicine John B. Holds, MD
Philadelphia, Pennsylvania Ophthalmic Plastic and Cosmetic Surgery, Inc.
Clinical Professor of Ophthalmology and
Steven J. Gedde, MD Otolaryngology, Head and Neck Surgery
John G. Clarkson Chair in Ophthalmology Saint Louis University
Vice Chairman of Education St. Louis, Missouri
Professor of Ophthalmology
Bascom Palmer Eye Institute Camille M. Hylton, MD
Miami, Florida Ophthalmic Surgeons and Physicians
Tempe, Arizona
Michael Greenwood, MD
Vance Thompson Vision Daniel A. Johnson, MD
Instructor Professor and Chair, Department of Ophthalmology
Department of Surgery University of Texas Health Science Center at San
University of North Dakota School of Medicine and Antonio
Health Sciences San Antonio, Texas
Fargo, North Dakota
David R. Jordan, MD
Suqin Guo, MD Professor of Ophthalmology
Professor of Ophthalmology University of Ottawa Eye Institute
Pediatric Ophthalmology and Strabismus Ottawa, Ontario, Canada
Institute of Ophthalmology and Visual Science
Rutgers– New Jersey Medical School Robert Kersten, MD
Rutgers University Professor of Clinical Ophthalmology
Newark, New Jersey Ophthalmic Plastic and Reconstructive Surgery
University of California, San Francisco
Pankaj C. Gupta, MD, MS San Francisco, California
Director, Anterior Segment/Cornea and External
Disease/Refractive Surgery Aaleya Koreishi, MD
University Hospitals Eye Institute Cornea Con sul tants of Texas
Case Affiliated Hospitals Residency Program in Fort Worth and Arlington, Texas
Ophthalmology
Assistant Professor of Ophthalmology Paul D. Langer, MD
CWRU Department of Ophthalmology and Visual Professor of Ophthalmology
Sciences Director, Division of Ophthalmic Plastic,
Cleveland, Ohio Reconstructive, and Orbital Surgery
Rutgers– New Jersey Medical School
Kristin M. Hammersmith, MD Rutgers University
Associate Professor of Ophthalmology Newark, New Jersey
Jefferson Medical College
Director, Cornea Fellowship Program W. Barry Lee, MD
Wills Eye Hospital Eye Con sul tants of Atlanta
Philadelphia, Pennsylvania Medical Director, Georgia Eye Bank
Atlanta, Georgia
Peter S. Hersh, MD
The Cornea & Laser Eye Institute Theresa G. Leung, MD
Teaneck, New Jersey Lone Star Eye Care
Clinical Professor of Ophthalmology Sugar Land, Texas
Institute of Ophthalmology and Visual Science
Rutgers– New Jersey Medical School
Rutgers University
Newark, New Jersey
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Contributors ● ix
Jennifer I. Lim, MD Shahzad I. Mian, MD
Professor of Ophthalmology Professor, Department of Ophthalmology and Visual
Marion H. Schenk, Esq., Chair in Ophthalmology for Sciences
Research of the Aging Eye Terry J. Bergstrom Collegiate Professor for Resident
Director of Ret ina Ser vice Education in Ophthalmology and Visual Sciences
University of Illinois at Chicago Associate Chair, Education
Chicago, Illinois Kellogg Eye Center
Ann Arbor, Michigan
T. Peter Lindquist, MD
SouthEast Eye Specialists Mark D. Mifflin, MD
Chattanooga, Tennessee Professor of Ophthalmology
Associate Medical Director, Georgia Eye Bank Director of Cornea & Refractive Surgery
Atlanta, Georgia John A. Moran Eye Center
University of Utah, Department of Ophthalmology
Tiffany Liu, MD Salt Lake City, Utah
Assistant Professor
Wilmer Eye Institute Kevin M. Miller, MD
Johns Hopkins University School of Medicine Kolokotrones Chair in Clinical Ophthalmology
Baltimore, Mary land Chief of Cataract and Refractive Surgery
Director, Anterior Segment Diagnostic Laboratory
Scott M. MacRae, MD Stein Eye Institute and Department of Ophthalmology
Professor of Ophthalmology David Geffen School of Medicine
Professor of Visual Science University of California Los Angeles
Flaum Eye Institute Los Angeles, California
University of Rochester Medical Center
Rochester, New York Yasaman Mohadjer, MD
Eye Institute of West Florida
David J. Massop, MD Largo, Florida
Resident Physician
Department of Ophthalmology Osama Mustafa, MD
University of Texas Health Science Center at San Cornea, Cataract, and Refractive Surgery Ser vices
Antonio Wilmer Eye Institute
San Antonio, Texas Johns Hopkins University School of Medicine
Baltimore, Mary land
Louise A. Mawn, MD
Associate Professor of Ophthalmology and Lilian Nguyen, MD
Neurological Surgery John F. Hardesty, MD, Department of Ophthalmology
Department of Ophthalmology and Visual Science and Visual Science
Vanderbilt University School of Medicine Washington University School of Medicine in St. Louis
Nashville, Tennessee St. Louis, Missouri
John D. McCann, MD, PhD Neal V. Palejwala, MD
Medical Director, Center for Facial Appearances Inc., Ret i nal Con sul tants of Arizona
Sandy, Utah Phoenix, Arizona
Chair, Department of Ophthalmology, Intermountain
Medical Center Parag Parekh, MD, MPA
Chair, Division of Ophthalmology, Salt Lake Regional Founder, ClearView Eye Con sul tants
Medical Center State College, Pennsylvania
Salt Lake City, Utah
Roberto Pineda II, MD
Alan W. McInnes, MD Thomas Y. and Clara W. Butler Chair in
Aesthetic Eye, PC Ophthalmology
Ea gle, Idaho Cornea and Refractive Surgery Ser vice
Chair of Staff Mas sa chu setts Eye and Ear Infirmary
St. Alphonsus Regional Medical Center Associate Professor of Ophthalmology
Boise, Idaho Harvard Medical School
Boston, Mas sa chu setts
Dale R. Meyer, MD
Director, Ophthalmic Plastic Surgery Jed T. Poll, MD
Lions Eye Institute Utah Eye Centers
Professor of Ophthalmology, Albany Medical College Ogden, Utah
Albany (Slingerlands), New York
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