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    Cataract Surgery: Past-Present-Future

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    Nica Lopez Fernandez
    This document provides a summary of the history and evolution of cataract surgery from ancient times to modern techniques. It discusses early manual extraction methods like couching and ICCE. It then covers the development of ECCE and introduction of IOLs. Recent advances like SICS, phacoemulsification, MICS, femtosecond laser-assisted surgery, and ongoing research into zero-energy cataract removal techniques are also summarized. The document serves to outline the major past, present and future trends in cataract surgical methods.

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    Cataract Surgery: Past-Present-Future

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    Nica Lopez Fernandez
    25 views44 pages
    This document provides a summary of the history and evolution of cataract surgery from ancient times to modern techniques. It discusses early manual extraction methods like couching and ICCE. It then covers the development of ECCE and introduction of IOLs. Recent advances like SICS, phacoemulsification, MICS, femtosecond laser-assisted surgery, and ongoing research into zero-energy cataract removal techniques are also summarized. The document serves to outline the major past, present and future trends in cataract surgical methods.

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    cataractsurgery-pastpresentfuture-190619034555

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    This document provides a summary of the history and evolution of cataract surgery from ancient times to modern techniques. It discusses early manual extraction methods like couching and ICCE. It then covers the development of ECCE and introduction of IOLs. Recent advances like SICS, phacoemulsification, MICS, femtosecond laser-assisted surgery, and ongoing research into zero-energy cataract removal techniques are also summarized. The document serves to outline the major past, present and future trends in cataract surgical methods.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    25 views44 pages

    Cataract Surgery: Past-Present-Future

    Uploaded by

    Nica Lopez Fernandez
    This document provides a summary of the history and evolution of cataract surgery from ancient times to modern techniques. It discusses early manual extraction methods like couching and ICCE. It then covers the development of ECCE and introduction of IOLs. Recent advances like SICS, phacoemulsification, MICS, femtosecond laser-assisted surgery, and ongoing research into zero-energy cataract removal techniques are also summarized. The document serves to outline the major past, present and future trends in cataract surgical methods.

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    of 44

    31/07/2017

    CATARACT SURGERY
    PAST-PRESENT-FUTURE

    Presenter- Moderator -
    Dr. Rohit Agrawal Dr. Sachin Daigavane Sir

    Conductor-
    Dr. Archana Thool Ma’am
    PAST PRESENT FUTURE
    INTRODUCTION
    • HISTORY OF CATARACT SURGERY
    • COUCHING
    • ICCE
    • CONVENTIONAL ECCE
    • ERA OF IOL
    • SICS
    • PHACOEMULSIFICATION
    • MICS
    • FEMTO SECOND LASER CATARACT SURGERY
    • ZERO ENERGY CATARACT SURGERY
    • FUTURE ON-GOING RESEARCH
    HISTORY OF CATARACT SURGERY
     4000 YEARS BACK- SHUSHURUTA - COUCHING
     1600 A.D.- DEVIES - ICCE
     20th CENTURY- ECCE
     40 YEARS BACK- SUTURES + ICCE WITH IOL
     20 YEARS BACK- SUTURES + ECCE WITH IOL
     15 YEARS BACK- PHACO EMULSIFICATION
     RECENTLY- TOPICAL TORSIONAL MICROPHACO WITH
    FOLDABLE MULTIFOCAL/TORIC LENSES
     NOW & FUTURE - FEMTO CATARACT
    COUCHING
    • Also known as “LENS DEPRESSION”
    • Involves using a sharp instrument to push the cloudy lens to the bottom of the
    eye
    • It was done “WITHOUT A MICROSCOPE”
    • A sharp instrument, such as a thorn or needle, is used to pierce the eye either at
    the edge of the cornea or the sclera, near the limbus
    • The opaque lens is pushed downwards, allowing light to enter the eye.
    • Once the patients sees shapes or movement, the procedure is stopped
    • The patient is left without a lens (aphakic)
    ICCE- INTRACAPSULAR CATARACT
    EXTRACTION
    • In this technique, the entire cataractous lens along with the intact capsule is
    removed.
    • Weak and degenerated zonules are a pre-requisite for this method.
    • A cryoprobe is used to remove the lens complete with its capsule
    • After which anterior chamber IOLs are implanted
    • It has been almost entirely replaced by planned extracapsular technique
    • At present the only indications of ICCE is markedly subluxated and dislocated
    lens.
    • ADVANTAGES OF ICCE:
    • Simple, cheap, easy and does not need sophisticated microinstruments
    • ICCE is less time consuming
    • Can be done in dislocated or subluxated lens

    • DISADVANTAGES OF ICCE:
    • PCIOL cannot be implanted
    • Post-op complications like C.M.E., R.D., endophthalmitis are more
    CONVENTIONAL EXTRA CAPSULAR
    CATARACT EXTRACTION-
    • In this technique cataract is extracted by making an opening in the anterior
    capsule of the lens known as anterior capsulotomy.
    • Corneo-scleral section from 10-2 o’ clock is made for cataract extraction
    • In this type of operation rigid PCIOL is inserted in the capsular bag.
    • And corneo-scleral section is then sutured with 9-0 or 10-0 sutures
    Types of Capsulotomy-
    • CAN OPENER CAPSULOTOMY

    • CONTINUOUS CURVILINEAR CAPSULORRHEXIS


    • LINEAR CAPSULOTOMY (ENVELOPE TECHNIQUE)
    ERA OF IOLs-
    • Sir Harold Ridley was the first to successfully implant an intraocular lens on
    November 29, 1949, at St Thomas' Hospital , London.
    • That first intraocular lens was manufactured from Polymethylmethacrylate
    (PMMA)
    TYPES OF IOL-

    ACIOL PCIOL
    EVOLUTION OF IOLs
    1. First generation IOLs

    • Ridley lenses
    • Disadvantages – posterior dislocation
    poor surgical technique

    2. Second generation IOLs

    • Rigid and semi-rigid anterior chamber IOLs


    • Advantages – reduce posterior dislocation
    • Disadvantage – corneal decompensation
    UGH syndrome
    3. Third generation IOLs

    • Iris supported lens


    • Advantages- less corneal decompensation
    • Disadvantages – iris chaffing
    pupillary distortion
    inflammation
    4. Fourth generation IOLs

    • Modern anterior chamber lens


    • Flexible loops and multiple point fixation
    • Advantages – more stable, better design, less complications
    • Disadvantages – anterior chamber is not the physiological site for IOL
    5. Fifth generation IOLs

    • PMMA lenses
    • Rigid posterior chamber iol
    6. Sixth generation IOLs

    Foldable IOL

    7. Seventh generation IOLs

    Multifocal IOL
    8. Eighth generation IOLs

    Accomodative IOL

    Phakic refractive IOL


    SICS- MANUAL SMALL INCISION CATARACT
    SURGERY
    • In this technique ECCE with intraocular lens implantation is
    performed through a sutureless self-sealing valvular
    sclerocorneo tunnel incision.
    • Types of incision in SICS-
    1. Frown incision

    2. Straight incision
    Steps in manual SICS

    SUPERIOR
    RECTUS BRIDLE
    SUTURE

    CONJUNCTIVAL
    FLAP

    SCLERAL
    INCISION
    SCLERO-CORNEAL
    TUNNEL WITH
    CRESENT KNIFE

    SIDE PORT ENTRY


    AND ANTERIOR
    CAPSULOTOMY

    ENTRY INTO
    ANTERIOR CHAMBER
    FROM TUNNEL AND
    ITS EXTENSION
    HYDRODISSECTION
    AND
    HYDRODELINATION

    NUCLEUS PROLAPSE
    INTO ANTERIOR
    CHAMBER

    NUCLEUS DELIVERY
    IRRIGATION AND
    ASPIRATION OF
    THE CORTEX

    PCIOL
    IMPLANTATION IN
    THE CAPSULAR
    BAG

    WOUND CLOSURE
    PHACOEMULSIFICATION-
    • Phacoemulsification, introduced by Kelman in 1967, is
    undoubtedly one of the most important innovations in
    ophthalmology.
    • This allows the removal of cataract through a 3.0 mm incision,
    thus eliminating many of the complications of wound healing
    related to large incision surgery and greatly shortens the recovery
    period.
    • Cataract is emulsified using ultra-sonic energy.
    • Ultrasonic power is most often produced by enclosed
    piezoelectric crystals which convert electricity into mechanical
    vibration.
    • Normal frequency of various phaco machines ranges from 20,000
    to 80,000 (20-80 KHz) Hertz.
    • Phaco machines come with a foot switch to control functions of
    the machine.
    STEPS IN PHACOEMULSIFICATION-
    CLEAR
    CORNEAL
    INCISION

    SIDE PORT
    ENTRY

    CAPSULOTOMY
    INITIAL
    TRENCHING

    FOUR QUADRANT
    DIVIDE AND
    CONQUER

    PHACO CHOP
    IRRIGATION AND
    ASPIRATION

    PCIOL
    IMPLANTATION
    (MOSTLY
    FOLDABLE IOL)

    WOUND
    APPOSITION BY
    HYDRO
    MICS- MICRO INCISIONAL CATARACT
    SURGERY
    • Micro incision cataract surgery (MICS) is an approach to cataract surgery
    through incision less than 1.8 mm with the purpose of reducing surgical
    invasiveness, improving at the same time surgical outcomes.
    • The main confirmed advantages of MICS are the control and avoidance of
    surgically induced corneal astigmatism and the decrease of postoperative
    corneal aberrations.
    • Microincision cataract surgery (MICS) was described first time by one of the
    authors named Jorge Alió in 2002 in Spain
    • Agarwal et al. and Tsuneoka et al. described in parallel this surgical approach to
    cataract surgery with other denominations such as Phaconit or bimanual
    phacoemulsification-aspiration.
    Phaco probe tips-
    • These are made up to titanium.
    • It can have an opening angulation of 0°,
    15°, 30°, and 45°.
    • Greater angulation facilitates sculpting
    whereas lower angle is good for occlusion.
    • The tip is covered with silicon sleeve that
    insulates and protects the tissue at the
    incision site.
    FEMTO SECOND CATARACT SURGERY-
    • Current femtosecond laser technology systems use
    neodymium:glass 1053 nm (near-infrared) wavelength light.
    • This feature allows the light to be focused at a 3 mm spot size,
    accurate within 5 mm in the anterior segment
    • It works on the principle of photodisruption.
    • Uses-
    1. CLEAR CORNEAL INCISION
    2. ARCUATE INCISION
    3. CCC
    4. LENS FRAGMENTATION
    FEMTOSECOND CATARACT SURGERY Video….
    ZERO ENERGY CATARACT SURGERY-
    • Laser assisted cataract surgery has opened the door towards zero
    energy(ultrsonic) cataract surgery.
    • Through femtosecond laser it is possible to fragment the nucleus
    into very small aspirable particles
    • This results in zero or negligible use of phacoenergy for breaking
    the nucleus
    • Can be done for grade 2-3 cataracts
    NEW INNOVATIONS-
    • VERION
    • It is a image guided system for phaco catarct surgery
    • It gets linked to the operating microscope
    • It takes into consideration keratometry readings of the patient
    • Has 3 functions-
    • Shows the surgeon exact position for incision which will cause least
    astigmatism
    • Shows the size of capsulorhexis
    • Centration after IOL implantation
    • CAPSULAR TENSION RINGS

    • MALYUGIN RING
    FUTURE ON GOING RESEARCH
    • The idea of rebuilding the crystalline lens by
    filling it with an appropriate substance goes
    back at least to Julius Kessler (1959).
    • Initial experiments in this field date from
    1981, and in 1987 the group led by Jean-
    Marie Parel in Miami demonstrated on
    primates the viability to recover
    accommodation by means of replacement of
    the lens material by a transparent gel
    • Various laboratories throughout the world
    are currently working on a project named
    Phaco-Ersatz (substitution of the crystalline
    lens)
    References-
    • PARSON’S DISEASES OF EYE
    • A.K. KHURANA
    • KANSKI CLINICAL OPHTHALMOLOGY
    • DOS JOURNAL
    THANK YOU….
    NEXT PG ACTIVITY
    • 01/08/2017
    • CASE PRESENTATION
    • PRESENTER- DR. SAPAN SIR
    • MODERATOR- DR. KAMBLE MADAM
    • CONDUCTOR- DR. ARCHANA MADAM

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