Cataract Surgery: Advanced Techniques for Complex and Complicated Cases (Essentials in Ophthalmology)

517 Pages·2022·36.419 MB·English

by  Jorge L. Alió (editor), H. Burkhard Dick (editor), Robert H. Osher (editor)

Essentials in Ophthalmology
Series Editor: Arun D. Singh
Jorge L. Alió
H. Burkhard Dick
Robert H. Osher   Editors
Cataract
Surgery
Advanced Techniques for Complex and
Complicated Cases
Essentials in Ophthalmology
Series Editor
Arun D. Singh, Cleveland Clinic Foundation, Cole Eye Institute,
Cleveland, OH, USA
Essentials in Ophthalmology aims to promote the rapid and efficient transfer
of medical research into clinical practice. It is published in four volumes per
year. Covering new developments and innovations in all fields of clinical
ophthalmology, it provides the clinician with a review and summary of recent
research and its implications for clinical practice. Each volume is focused on
a clinically relevant topic and explains how research results impact diagnostics,
treatment options and procedures as well as patient management.
The reader-friendly volumes are highly structured with core messages,
summaries, tables, diagrams and illustrations and are written by internationally
well-known experts in the field. A volume editor supervises the authors in
his/her field of expertise in order to ensure that each volume provides cutting-
edge information most relevant and useful for clinical ophthalmologists.
Contributions to the series are peer reviewed by an editorial board.
More information about this series at https://link.springer.com/bookseries/5332
Jorge L. Alió • H. Burkhard Dick
Robert H. Osher
Editors
Cataract Surgery
Advanced Techniques for Complex
and Complicated Cases
Editors
Jorge L. Alió Robert H. Osher
Division of Ophthalmology Cincinnati Eye Institute
School of Medicine University of Cincinnati
Miguel Hernandez University Video Journal of Cataract, Refractive &
Alicante, Spain Glaucoma Surgery
Cincinnati, OH, USA
Cornea, Refractive and Cataract
Surgery Unit H. Burkhard Dick
Vissum Miranza Alicante, Spain Ruhr University Eye Clinic
Bochum, Germany
ISSN 1612-3212 ISSN 2196-890X (electronic)
Essentials in Ophthalmology
ISBN 978-3-030-94529-9 ISBN 978-3-030-94530-5 (eBook)
https://doi.org/10.1007/978-3-030-94530-5
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Foreword
Cataract surgery remains the most common ophthalmic procedure performed
worldwide. Intravitreal injections are a close second, but they are often per-
formed by a retinal sub-specialist. Cataract surgery remains the bread and
butter of the comprehensive ophthalmologist, the cornea sub-specialist, and
the glaucoma sub-specialist, and is also frequently performed by our retina-
vitreous and pediatric sub-specialist colleagues. In 2020, as many as 4,000,000
cataract surgeries were performed in the USA and nearly 28,000,000 glob-
ally. In spite of those large numbers, every year there are more patients suf-
fering from reduced vision that could be corrected with cataract surgery. If
the 8 per 1000 population cataract surgeries performed each year in Europe is
the appropriate number, we would need to increase cataract surgery proce-
dures performed per year in the world to twice that done today, or 56,000,000
per year, to fully meet the demand.
At ophthalmology meetings worldwide, attendance at educational pro-
grams that relate to cataract surgery are dominant. While many patients with
cataract present without significant co-morbidities, over 50% have one or
another additional diagnosis that make the surgery more complex. Ocular
surface disease(OSD), especially dry eye disease and blepharitis/meibomian
gland dysfunction, impacts over 50% of the senior population presenting with
cataract. While not a significant factor intraoperative, it is critical to manage
OSD in the preoperative period to achieve good biometry and rapid and high-
quality recovery of vision. Glaucoma or ocular hypertension is present in
15–20% of patients with cataract. Some evidence of macular disease, often
only uncovered with ocular coherence tomography, is observable in at least
another 25%. Corneal topographic abnormalities are common. One or another
systemic disorder including diabetes mellitus, hypertension, and arterioscle-
rotic vascular disease are more often present than absent in the patient over
age 65. A multitude of other co-morbidities, from keratoconus to axial myo-
pia, all impact the cataract surgeon’s plan and their patient’s intraoperative
and postoperative course. When I see a patient with a visually significant
cataract, I expect to place one or more other diagnosis in my clinical record
in nearly every case. This makes management of the complex and compli-
cated cataract patient more the rule than the exception.
It takes years of training and experience to become expert at managing the
broad array of complexities that challenge us cataract surgeons every week.
To help us better prepare, Professor Jorge Alio, MD, of Spain, Professor
Burkhard Dick, MD, of Germany, and Robert Osher, MD, of the United
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vi Foreword
States, have joined together with a rare group of surgeons who are superb
teachers and highly experienced in the management of complex and compli-
cated cataracts. The end result is the book Cataract Surgery in Complicated
and Complex Cases. This book is recommended reading for every cataract
surgeon, from trainee to master surgeon. It is a book that belongs on every
cataract surgeon’s desk, and it will be opened frequently in the course of
everyday practice.
Richard L. Lindstrom, MD
Founder and Attending Surgeon: Minnesota Eye Consultants
Minneapolis, MN, USA
Adjunct Professor Emeritus: University of Minnesota
Department of Ophthalmology, Minneapolis, MN, USA
Visiting Professor: University of California Irvine
Gavin Herbert Eye Institute, Irvine, CA, USA
Preface
When I look back at my career, it’s hard for me to believe that I performed my
first cataract surgery as a second-year resident at the Bascom Palmer Eye
Institute in Miami, Florida, in 1978. It seems like yesterday! Although phaco-
emulsification had been introduced by Charles Kelman, MD, almost a decade
before, it was still very unpopular and “off limits” to the residents. It seemed
so obvious to me that a smaller incision would reduce the risk of complica-
tions, and I would sneak up to the operating room in the evening and practice
emulsifying the lens in Eye Bank eyes. I waited until Dr. Ed Norton, our
famous chairman, was supposed to be out of town and then scheduled a
patient to be the first phacoemulsification performed by a resident at Bascom
Palmer. I am still haunted by the fact that in a middle of a case, I heard Dr.
Norton’s voice over my shoulder say “Bobby, this better go well!” Had it not,
I would probably be engaged in the practice of neuro-ophthalmology today.
It has been amazing to witness the evolution of small incision cataract
surgery over the last four decades. Incisions have shrunk, sutures are gone,
and patients can return to their normal activities almost immediately.
Innovations are the hallmark of this subspecialty, and every year, we see the
debut of sophisticated diagnostics, better IOL formulae, improved machines,
new intraocular lens options, novel devices and instrumentation, and safer
surgical techniques. I cannot imagine a subspecialty that has had more excit-
ing changes, and I am so grateful that I went into ophthalmology rather than
proctology!
Cataract surgeons have hit the jackpot for other reasons. What could pos-
sibly be more satisfying than taking a patient who is legally blind and giving
them the opportunity to enjoy crystal clear vision the day following surgery.
Our patients are extremely happy and appreciate the recovery of the gift of
sight. Our work is delicate and rarely marred by complications. How lucky
we are to have chosen this subspecialty!
Yet even with unprecedented surgical success, every cataract surgeon will
eventually encounter anxiety-provoking challenging cases. Cataract surgeons
are familiar with challenges. We have learned to tackle the mature lens, the
white lens, and the loose lens. We have tamed the once-dreaded posterior
polar cataract. We are comfortable managing very large eyes and very small
eyes as well as coexisting corneal, retinal, and glaucoma comorbidities. Small
pupils can be managed by pharmacologic or mechanical solutions, and dam-
aged irises can be reconstructed almost as good as new. While complications
are less frequent today than ever before, they still happen. However, the cata-
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viii Preface
ract surgeon can achieve excellent outcomes in both challenging and compli-
cated cases by sound knowledge, meticulous preparation, and skillful
dexterity.
I am honored to serve as a co-author of this book with Drs. Jorge Alio and
Burkhard Dick. Each of these extraordinary surgeons has spent his career
making cutting-edge contributions and has devoted an enormous amount of
time to teaching colleagues how to perform better and safer cataract surgery.
I am confident that this book will expand the expertise of the reader and
enhance the joy that every cataract surgeon should experience throughout his
or her career.
Robert H. Osher, MD
Professor of Ophthalmology
University of Cincinnati
Cincinnati, OH, USA
Medical Director Emeritus
Cincinnati Eye Institute
Cincinnati, OH, USA
Editor, Video Journal of Cataract,
Refractive & Glaucoma Surgery
Cincinnati, OH, USA
Contents
1 Key Elements in the Risk Evaluation . . . . . . . . . . . . . . . . . . . . . . 1
Wen Fan Hu, Marissa Larochelle, Randall Olson,
and Jeff Pettey
2 Technology and Devices Involved in Cataract Surgery
in Special Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Mark Packer
3 The Hard Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Angela Verkade and Kendall E. Donaldson
4 Intumescent Cataract and Preventing the Argentinian
Flag Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Gabriel B. Figueiredo and Carlos G. Figueiredo
5 Pediatric Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
H. Burkhard Dick
6 The Unstable Lens in the Adult Patient . . . . . . . . . . . . . . . . . . . . 53
M. Victoria De Rojas Silva
7 IOL Implantation with Zonulopathy . . . . . . . . . . . . . . . . . . . . . . 83
David F. Chang
8 Cataract Surgery in Eyes with Ocular Surface
Problems and Severe Dry Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Christoph Holtmann and Gerd Geerling
9 Cataract Surgery in Stevens-Johnson Syndrome
and Pemphigoid Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Volkan Tahmaz, Philipp Steven, and Claus Cursiefen
10 Cataract Surgery in Keratoconus . . . . . . . . . . . . . . . . . . . . . . . . . 113
Jorge L. Alió and Francesco D’Oria
11 Cataract in Cases with Previous Corneal Graft Surgery;
High Astigmatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Mitchell Weikert and Anirudh Mukhopadhyay
12 Cataract Surgery in Eyes with Fuchs Endothelial
Corneal Dystrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Theofilos Tourtas, Julia M. Weller, and Friedrich E. Kruse
ix