CATARACT SURGERY Edited by Farhan Husain Zaidi Cataract Surgery Edited by Farhan Husain Zaidi Contributors Matthew A. Cantrell, Heather R. Bream-Rouwenhorst, Christopher Watts, Thomas A. Oetting, James A. Davison, Hiroshi Kobayashi, Mammie Motiang, Alparslan Apan, F.J. Ascaso, V. Huerva, Farhan Husain Zaidi, Radin Tahvildari, Hanieh Fattahi, Ahmad Amjadi, Yury Spirochkin, Takao Tanaka, Maiko Hirose, Shigemitu Ishii, Satoshi Fujita, Keisuke Kimura, Allan Storr-Paulsen, Anders Behndig, Björn Lundberg, Gunnie Bäckström, Taiji Sakamoto, Toshio Hisatomi, Anselmo G. De Oliveira, José A. Cardillo, Fernando Paganelli, Acácio A. S. Lima-Filho, Arnóbio A. Da Silva-Júnior, Atilla Bayer, Rehab Ismail, Ahmed Sallam, Emin Kurt, Hüseyin Mayalı, Baseer U. Ahmad, Igor Estrovich, Thomas Steinemann, Elvis Ojaimi, David T. Wong, Avinash Pathengay, Stephen G. Schwartz, Harry W. Flynn Jr., Darlene Miller, Rosario Díez, Lourdes Jordano, César Hita, Miltiadis K Tsilimbaris, Chrysanthi Tsika, Vasilios Diakonis, Aleksandra Karavitaki, Ioannis Pallikaris, Ramin Daneshvar, George K. Andrikopoulos, Sotirios P. Gartaganis, Kemal Örnek, A.C. Schefler, T.G. Murray, Nel T. Tijmes, Lawan Abdu Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Sandra Bakic Typesetting InTech Prepress, Novi Sad Cover InTech Design Team First published January, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Cataract Surgery, Edited by Farhan Husain Zaidi p. cm. ISBN 978-953-51-0975-4 Contents Preface IX Section 1 Pre-Operative Care 1 Chapter 1 Pathophysiology and Pre-Operative Evaluation of Patients at Risk for Intraoperative Floppy Iris Syndrome (IFIS) 3 Matthew A. Cantrell, Heather R. Bream-Rouwenhorst, Christopher Watts and Thomas A. Oetting Chapter 2 Prevention and Management of Intraoperative Floppy Iris Syndrome 15 James A. Davison Chapter 3 Anticoagulant and Antiplatelet Use in Cataract Surgery and Combined with Posterior Vitrectomy 31 Hiroshi Kobayashi Chapter 4 Pre-Operative Evaluation 43 Mammie Motiang Chapter 5 Anaesthetic Management in Cataract Surgery 53 Alparslan Apan Section 2 Operative Surgery and the History of Cataract Surgery 73 Chapter 6 The History of Cataract Surgery 75 F.J. Ascaso and V. Huerva Chapter 7 Major Advances in Cataract Surgery 91 Farhan Husain Zaidi Chapter 8 In-Vitro Thermal Study of Different Tips in Various Operating Modes of the Sina Phacoemulsification System 105 Radin Tahvildari, Hanieh Fattahi and Ahmad Amjadi VI Contents Chapter 9 Hydrodynamic Analysis and Irrigation Device Design for the Coaxial and Bimanual Phacoemulsification Techniques in Cataract Surgery 121 Yury Spirochkin Chapter 10 Dual OVD (Ophthalmic Viscosurgical Devices) Sealing Technique 137 Takao Tanaka, Maiko Hirose, Shigemitu Ishii, Satoshi Fujita and Keisuke Kimura Chapter 11 Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery 143 Allan Storr-Paulsen Chapter 12 Intracameral Mydriatics in Cataract Surgery 149 Anders Behndig, Björn Lundberg and Gunnie Bäckström Chapter 13 Chromovitrectomy in Vitreous Loss During Cataract Surgery 173 Taiji Sakamoto and Toshio Hisatomi Chapter 14 Trans-Scleral Controlled-Release of Drugs for Cataract Surgery 183 Anselmo G. De Oliveira, José A. Cardillo, Fernando Paganelli, Acácio A. S. Lima-Filho and Arnóbio A. Da Silva-Júnior Chapter 15 Combined Cataract and Glaucoma Surgery 197 Atilla Bayer Section 3 Complications 219 Chapter 16 Complications Associated with Cataract Surgery 221 Rehab Ismail and Ahmed Sallam Chapter 17 Early Post-Operative Complications in Cataract Surgery 245 Emin Kurt and Hüseyin Mayalı Chapter 18 Post-Operative Infections Associated with Cataract Surgery 259 Baseer U. Ahmad, Igor Estrovich and Thomas Steinemann Chapter 19 Endophthalmitis, Prevention and Treatment 265 Elvis Ojaimi and David T. Wong Chapter 20 Endophthalmitis Following Cataract Surgery: Clinical Features, Treatment and Prophylaxis 285 Avinash Pathengay, Stephen G. Schwartz, Harry W. Flynn Jr. and Darlene Miller Contents VII Chapter 21 Toxic Anterior Segment Syndrome (TASS) and Prophylaxis Against Postoperative Endophthalmitis 301 Rosario Díez, Lourdes Jordano and César Hita Chapter 22 Macular Edema and Cataract Surgery 323 Miltiadis K Tsilimbaris, Chrysanthi Tsika, Vasilios Diakonis, Aleksandra Karavitaki and Ioannis Pallikaris Section 4 Cataract Surgery in Special Situations 337 Chapter 23 Cataract Surgery and Dry Eye 339 Ramin Daneshvar Chapter 24 Pseudoexfoliation and Cataract 353 George K. Andrikopoulos and Sotirios P. Gartaganis Chapter 25 Cataract Surgery in Retina Patients 371 Kemal Örnek Chapter 26 Cataract Surgery in Patients with a History of Retinoblastoma and Melanoma 391 A.C. Schefler and T.G. Murray Chapter 27 Cataract Surgery in People with a Severe Learning Disorder 407 Nel T. Tijmes Chapter 28 The Management of Age Related Cataract in Sub-Saharan Africa 419 Lawan Abdu Preface It has been a privilege to have been tasked with editing a book with an international authorship including many distinguished contributors on the topic of cataract surgery. Not only is cataract surgery the most commonly performed operation in the world but cataract remains the leading cause of blindness worldwide. Inevitably one must decide which topics to focus discussion on in such a work to make it readable, original, and lasting. The generality of the field of cataract surgery is considered, often through gaining a deeper insight by considering the development of advances in the field. More specific discussions have focussed on areas that have remained and likely will remain topical owing to their practical importance. I have sought to include work which is original but which underpins core aspects to the overall field of cataract surgery. This book is divided into four sections. The first, Pre-operative Care, is considered from a variety of perspectives – the pathophysiology of floppy iris syndrome, an area that has been topical for the best part of a decade, as well as how to reduce risk to patients from this condition. Also included are studies clearly and concisely considering the effects of antiplatelet and anticoagulant drugs in cataract and vitreoretinal surgery, followed by a broader overview of pre-operative assessment in patients undergoing cataract surgery. In the second section, Operative Surgery and the History of Cataract Surgery, a variety of topics are introduced by study of the main milestones in the development of cataract surgery, both directly but also by studying the effects of parallel advances in vision science especially optics. The chapter on Major Advances in Cataract Surgery, which I wrote myself, I included despite my duality of interest as Editor as the publishing house and my predecessor as Editor, who started the project accepted the Chapter for publication, and it remained relevant to the final book. After these overviews of cataract surgery surgical instrumentation and fluidics are discussed from a physical scientific and mathematical perspective. Studies on the use of ophthalmic viscosurgical devices to reduce intraocular pressure rises in small incision cataract surgery are presented, a topic that leads to discussions of the management of intraocular floppy iris syndrome. These are followed by descriptions of studies of a variety of pharmacological adjuncts administered during cataract surgery. Technical X Preface considerations are discussed in cataract surgery when combined with trabeculectomy, non-penetrating glaucoma surgery, and less common glaucoma procedures. In the third section of the book, Complications, in addition to a broad overview of problems from cataract surgery, the topic of endophthalmitis and its differential diagnoses includingtoxic anterior segment syndrome are considered in depth by a number of authors from different perspectives. The problem of postoperative macular oedema is also considered from basic scientific, pharmacological and clinical perspectives. In the final section, Cataract Surgery in Special Situations, both specific conditions and extreme environments are considered. The common problem of dry eye, both before and after cataract surgery, is discussed with exceptional clarity including rarely described insights into the underlying anatomy and disturbed pathophysiology of the condition in the context of cataract surgery. The implications to the management of cataract posed by pseudoexfoliation, as well as both common and rare retinal diseases, and the very rare but important situation of patients with a history of intraocular tumours are considered in this context also. In the last two chapters the challenges posed by patients with severe learning disorders in the Netherlands are discussed, contrasting with the problems posed by even routine cataract surgery in sub-Saharan Africa. A multi-author works poses editorial challenges, especially when the contributions involve a combination of topics ranging from the history of medicine through to highly technical descriptions of experiments from both the physical and biological sciences, including submissions from many different continents. After the importance of the topic itself my next consideration has been the clarity of presentation. Some otherwise interesting submissions could not be accepted for this reason only. With the staff from the publishing house I permitted the contributors to express themselves in the language of the international medical and scientific community in the field which uses both British English and American English. References have been accommodated in House Style or, owing to the sheer variety of articles, a format very closely resembling it balancing uniformity and readability with technical clarity. The choice of chapters should also ensure the book, or at least large sections of it, remain significantly useful and informative into the future in what is an ever-developing field which is continually advancing on many fronts. Farhan Husain Zaidi Consultant Ophthalmic Surgeon, Maidstone and Tunbridge Wells NHS Trust, Kent, Honorary Fellow, Moorfields Eye Hospital, London, UK [...]... 2006; Venkatesh et al., 2007) Aside from IFIS, α1AR antagonist therapy prior to cataract surgery has been shown to predispose patients to complications following cataract surgery (Bell et al., 2009) A nested case control study examined health care records of 96,128 Canadian men aged 66 years or older who had undergone cataract surgery over a 5 year period Post-operative complications that were examined... iris prolapse during cataract surgery (Chang & Campbell, 2005) While α1AR antagonists are often used for various urological conditions, they also block α1AR receptors in the iris dilator muscle and may worsen muscle tone and lead to the iris billowing sometimes seen in cataract surgery Without adequate pupil dilation, IFIS reduces visualization of the surgical field, including the cataract itself This... hyperplasia Ann Pharmacother, Vol.44, No.2, (February 2010), pp 302-310 12 Cataract Surgery Chang, DF & Campbell, JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin J Cataract Refract Surg, Vol.31, No.4, (April 2005), pp 664-673 Chang, DF.; Osher, RH & Wang, L et al (2007) Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax) Ophthalmology Vol.114,... zonule character So a 4.5 mm pupil in a normal eye with an average character cataract of LOCS III NO 3.7 NC 3.7, (Chylack 1993) will likely be maintained because surgery should be routine, brief, and uneventful But that same pupil size may not be 16 Cataract Surgery maintainable during a longer more difficult case such as if the cataract is very soft, very hard, or if it is accompanied by an inherently... poor muscle tone and the subsequent iris billowing sometimes seen in cataract surgery (Schwinn & Afshari, 2006) Figure 1 illustrates the clinical dilemma of IFIS and the subsequent potential for surgical complications Adapted or Reprinted with permission from 'Editorials: Floppy Iris Syndrome: Why BPH Treatment Can Complicate Cataract Surgery, ' June 15, 2009, American Family Physician Copyright © 2009... significantly increased with exposure to other α1AR antagonists or to previous exposure to tamsulosin or other α1AR antagonists However, tamsulosin use within 14 days of cataract surgery increased the risk for complications 10 Cataract Surgery Currently, risk of IFIS has only been associated with systemic use of α1AR antagonists In a study comparing the incidence of IFIS between topical and systemic... history of α1AR antagonists is poor pupillary dilation (Oetting, 2009) This can and should be noted during the office pre-operative cataract surgery evaluation, and not just on the day of surgery When the pupil does not dilate well, the surgeon should be wary of IFIS during surgery Although poor dilation can also be a harbinger of other intra ocular conditions such as pseudoexfoliation and trauma, recognition... Rights Reserved Fig 1 Iris damage following cataract surgery in a patient taking tamsulosin Although Chang and Campbell first associated IFIS with tamsulosin in 2005, other available α1AR antagonists were subsequently linked to IFIS as well (Dhingra et al., 2007; Herd, 2007; Package insert Rapaflo, 2008; Settas & Fitt, 2006; Venkatesh et al., 2007) 6 Cataract Surgery Potentially, the high α1AAR-specific... during surgery needs to be a critical part of the surgery planning process Whatever the pupil diameter is at the start of a case, it will only stay the same or get smaller as the case goes on We have a good estimate of surgical pupil size when we see patients in the office so we can plan ahead Sometimes the pupil gets larger before surgery vs the clinic because of the stronger drops used in surgery. .. had no history of tamsulosin exposure Furthermore, IFIS was reported in both eyes of the five patients taking tamsulosin that required bilateral cataract surgery Despite the authors' initial identification of a potentially serious complication of cataract surgery, reported limitations of the study include lack of covariate data and the modest reported use of α1AR antagonists at 1.9% (Chang & Campbell, . Section 2 Operative Surgery and the History of Cataract Surgery 73 Chapter 6 The History of Cataract Surgery 75 F.J. Ascaso and V. Huerva Chapter 7 Major Advances in Cataract Surgery 91 Farhan. Chapter 23 Cataract Surgery and Dry Eye 339 Ramin Daneshvar Chapter 24 Pseudoexfoliation and Cataract 353 George K. Andrikopoulos and Sotirios P. Gartaganis Chapter 25 Cataract Surgery in. distinguished contributors on the topic of cataract surgery. Not only is cataract surgery the most commonly performed operation in the world but cataract remains the leading cause of blindness