Cataract and Lens Surgery

Contents
Introduction
1 Implantation of Artificial Intraocular Lenses—A Brief History
Bibliography
2 Epidemiology
References
3 Anatomy and Physiology of the Anterior Segment
Cornea
Aqueous Humor Outflow
Iris
Ciliary Body
Lens
Lens Transparency and Accommodation
References
4 Cataract Forms and Grading
Cataract Types
Grading of Cataracts
References
5 Optical Principles
Radiation Optics or Geometrical Optics (GO)
Refraction
Refractive Power D
Aberration
Wave Optics
Diffraction and Interference
Zernike Polynomials
Lens Design
Bibliography
6 Digitalization in Lens Surgery
Introduction
Digital Working Environment
Example of a Digital Workflow Setting in a University Eye Clinic Setting
Digital Toric Lens Surgery: From Planning to Surgery
Outlook: Artificial Intelligence
References
Examination
7 Medical History
The Start of the Conversation
Ask About Relevant General Medical Conditions
Ophthalmologic History
Refraction/Glasses/Contact Lens
References
8 Testing of Visual Function: Visual Acuity, Refraction, Contrast Sensitivity
The Visual Acuity
Standards of Distance Visual Acuity Determination
Standards of Near Visual Acuity Determination
Objective Refraction Determination—Subjective Refraction Determination
Objective Refraction
Subjective Refraction
Postoperative Visual Acuity Prognosis in Dense Media Opacities
Measurement of Retinal Visual Acuity by Laser Interference/Retinometer
Estimation of Retinal Visual Acuity with the Purkinje Choroidal/Retinal Vessel Shadow Figure
Neuronal Functional Testing of the Retina
Contrast Vision
Objective Measurement of Quality of Vision
References 
9 Assessment of Optical Phenomena
References
10 Slit Lamp Examination
References
11 Binocular Vision and Motility
Conclusion
References
12 Measurement of Intraocular Pressure
References
13 Eyelids
References
14 Optical Biometry
References
15 Scheimpflug Tomography and Measurement of Higher Order Aberrations
Scheimpflug Tomography
Measurement of Higher Order Aberrations
References
16 OCT of the Anterior Segment
References
17 OCT of the Posterior Segment
References
18 Measurement of Endothelial Cells
References
19 Tear Film Analysis
References
20 Pupillometry
Conclusion
References
21 Congenital and Childhood Cataract Examination and Indication for Newborns and Children
References
22 Anaesthesia for Cataract Surgery
Conclusion
References
Choosing the Right Lens
23 Design and Material of Intraocular Lenses
Design of Intraocular lenses
Material of Intraocular lenses
References
24 General Introduction to IOL Calculation
References
25 Formula Optimisation and Use of the IOL WEB Platform IOLCon
26 Surgically Induced Corneal Astigmatism
References
27 Lens Calculation in Short and Long Eyes
References
28 IOL Calculation for Particularly Dense Lenses
References
29 Intraocular Lens Calculation: Toric and Multifocal Intraocular Lenses
Introduction
Posterior Surface of the Cornea
Formulae for Toric IOLs
References
30 Multifocal Intraocular Lens
Conclusion
References
31 IOL Power Calculation for Secondary IOL Implantation
Sulcus-Fixated IOLs
Iris-Fixated IOLs
Scleral-Fixated IOLs
References
32 IOL Power Calculation After Refractive Surgery
References
33 IOL Calculation in Patients with Fuchs’ Endothelial Dystrophy
References
34 IOL Calculation in Patients with Keratectasia
References
35 Planning Lens Calculation in Pediatric Cataract
References
36 IOL Calculation in Patients with Retinal Diseases
References
37 Aspheric Intraocular Lens: Indications
References
38 Indications for Toric Intraocular Lenses
Background
Astigmatism Correction
Indications for Toric Multifocal Intraocular Lenses
Indications for Limbal Relaxing Incisions
Treatment Options of Irregular Astigmatism
Measurement of Corneal Astigmatism
Conclusion
References
39 Indications for Multifocal and Extended Depth of Focus Intraocular Lenses
Introduction
References
40 Supplementary Intraocular Lenses
Introduction
Implantation
Indications
Conclusion
References
41 Considerations in Surgery of Eyes with Cataract and Vitreo-Retinal Diseases
Sequential or Combined Cataract and Vitreous Surgery
Patients with Cataract and Epiretinal Membrane (ERM)
Patients with Cataract and Age-Related Macular Degeneration
Patients with Cataract and Diabetic Retinopathy
Multifocal IOL in Vitreo-Retinal Diseases
References
42 Considerations in the Amblyopic Patient When Planning Cataract Surgery
Which Intraocular Lens to Use?
References
43 Cataract Surgery—Considerations When Planning Monovision
Traditional Monovision Versus Modest Monovision
Neurophysiology
Optics and IOLs
Spectacles
Multifocal Intraocular Lenses
Accommodative Intraocular Lenses
Monofocal IOLs
Extended Depth of Focus IOLs
History
Incorporating Modest Monovision in Your Practice
Compromises
Patient Selection and Counselling
Testing for Dominance
Contraindications
Disruption of Binocular Fusion
Impaired Acuity
Poor Comprehension
Management of Dissatisfied Patients
Address the Alternatives
Broach Monovision
Choose Distance
Demonstrate Defocus
Conclusion
References
Surgical Techniques
44 Phacodynamics
Acknowledgements
Bibliography
45 General Cataract Surgery
Side Ports
Main Incision
Hydrodissection and Hydrodelineation
Phacoemulsification
Divide and Conquer
Implantation of the Iintraocular Lens
Hydration
References
46 Lens Surgery for Particularly Soft Lenses
47 Surgical Techniques—Cataract Surgery in Very Hard Lenses
Choice of Anaesthesia in Dense Cataract Surgery
Phacoemulsification in Dense Cataracts
Incision and Anterior Capsulorhexis
Extracapsular Cataract Extraction (ECCE) and Manual Small Incision Cataract Surgery (MSICS) for Dense Cataract Emulsification
Newer Techniques/Devices for Dense Cataract Surgery
Endocapsular Manual Nucleus fragmentation in Phacoemulsification
Complications During Dense Cataract Surgery
Conclusion
References
48 Posterior Subcapsular Cataract
Pre-operative Considerations
Conclusion
References
49 Cataract Surgery in Short and Long Eyes
Hyperopes
Preoperative Discussion, Examination, and Planning
Intraoperative Considerations
Postoperative Follow Up
Myopes
Preoperative Discussion, Examination, and Planning
Intraoperative Considerations
References
50 Reduction of Astigmatism by Corneal Incisions
References
51 Special Surgical Features When Using Toric and Multifocal Intraocular Lenses
Special Surgical Features When Using Multifocal Intraocular Lenses
References
52 Corneal Complications and Management Associated with Cataract Surgery
Dry Eye
Incision-Associated Complications
Corneal Endothelial Damage
References
53 Iris Complications and Management in Cataract Surgery
The Narrow, Rigid Pupil
Surgical Management of Narrow, Rigid Pupils
The Narrow, Atonic Pupil in IFIS
Surgical Management of IFIS
Iris Prolapse
Conclusion
References
54 Zonular Disorders and Management in Cataract Surgery
Introduction
References
55 Complication Management in Case of Damage to the Lens Capsule or Loss of Lens Fragments
Introduction
References
56 Extracapsular and Intracapsular Cataract Extraction
Introduction
References
57 Biaxial (Bimanual) Microincisional Cataract Surgery
References
58 Exchange of Intraocular Lenses
Introduction
Explanting the Lens from the Capsular Bag
References
59 Implantation of Anterior Chamber Lenses
Introduction
About the Anterior Chamber Lens
Prerequisites for Implantation
Preparation of the Implantation
Implantation
References
60 Sulcus IOLs
Introduction
Indications/Contraindications
Surgery Technique
Choice of IOL
Complications
Conclusion
References
61 Retropupillary Iris Claw Intraocular Lens Implantation for Aphakia Correction
Introduction
Historical Information
The Technique Using Standard Instruments (“Artisan Tweezers”)
Complications
Comparison with Other Implants and Implantation Techniques
Contraindications/Disadvantages
References
62 Implantation of Scleral-Fixed Intraocular Lenses
Scleral Pocket Fixation of 3-Piece IOLs
Scleral Suture Fixation of 1-Piece IOLs
Modified Yamane Scleral Fixation of 3-Piece IOLs
Multi-point Scleral Fixation of IOLs
References
63 Cataract Surgery After Trauma
Introduction
Injury Mechanisms
Cataract in Open Globe Injuries
Cataract in Closed Globe Trauma (Contusion)
Timing of Cataract Surgery
Advantages and Disadvantages of Primary Lens Extraction
Advantages and Disadvantages of Secondary Lens Extraction
Primary Aphakia and Secondary Implantation
Surgical Technique Traumatic Cataract Extraction
Postoperative Complications
Traumatic Cataract in Children
Summary
References
64 Paediatric Cataract Surgery
Introduction
Immediate Versus Delayed Sequential Surgery
Continuous Curvilinear Capsulorhexis (CCC)
Other Anterior Capsulotomy Techniques
Special Case of Intumescent White Cataracts
Hydrodissection and Hydrodelineation
Lens Aspiration and Lensectomy
Posterior Capsulotomy
Anterior Core Vitrectomy
Aphakia or Pseudophakia?
Lens Power
Traditional IOL Implantation Technique Associated with High VAO and Reoperation Rate in Young Children
Optic Capture and BIL Technique to Reduce Reoperations Due to VAO
Surgical Correction of Aphakia
Completing the Operation
Importance of Data Bases for Progress
Summary
References
65 Cataract Surgery for Corneal Pathologies
References
66 Cataract Surgery Strategies for Iris Pathologies
Conclusion
References
67 Cataract Surgery in Special Circumstances—PEX and Zonular Weakness
References
68 Cataract Surgery for Retinal Diseases
1. Special intraoperative features of cataract surgery in retinal diseases
References
69 Cataract and Glaucoma
Preoperative considerations:
Intraoperative considerations:
Postoperative notes:
References
70 Cataract Surgery in Patients with Radiation-Induced Cataract
Fundamentals of Radiobiology
Frequency of Cataract Development After Radiotherapy of the Eye
Form of Cataract After Radiotherapy
Rationales for Performing Cataract Surgery
Dissemination of Tumor Cells Due to Cataract Surgery
Contraindications for Cataract Surgery
References
Systematic Overview
71 Cataract Surgery in Eyes with Uveitis
Introduction
Preoperative Goals
Surgical Procedure
Type of Intraocular Lens
Postoperative Care
References
72 Systematic Overview of Cataract Surgery
Intraoperative Complications
Postoperative Complications
References
73 Aspheric Intraocular Lenses
Introduction
Aspheric IOL Design
Efficacy of Aspheric IOLs
Drawbacks of Aspheric IOLs
Benefits of Spherical Aberration
Selecting the Correct IOL for the Patient
Summary
References
74 Systematic Overview of Toric Intraocular Lenses
Introduction
Toric IOLs-Intracapsular
Positioning of the Toric IOL
Marking of the Target Axis
Manual Marking Techniques
Digital-Assisted Marking Techniques
Intraoperative Alignment
Residual Astigmatism and Postoperative Rotation
Additives IOLs and Special Lenses
Summary
References
75 Systematic Overview of Monovision
Complications
Conclusion
References
76 Systematic Overview of Multifocal Intraocular Lenses
Complications and Postoperative Problems
Conclusion
References
77 Intraocular Lens Fixation in the Ciliary Sulcus: A Systematic Overview
Quality of Available Data and Evidence
Choice of IOL Power
Results and Complication Rate
References
78 Systematic Overview on Secondary Intraocular Lenses
Main Text
Secondary IOL Implantation
Secondary Implantation in the Capsular Bag
Secondary Implantation in the Ciliary Sulcus
Iris Fixation
Scleral Fixation
Sutured IOL Scleral Fixation
Sutureless Scleral Fixation
Long-Term Stability
Conclusion
References
79 Systematic Review of Add-on Intaocular Lenses
Data on Correction of Refractive Errors in Pseudophakic Patients by Add-on Iols
Correction of Astigmatism
Conclusion
Add-on Intraocular Lenses for Correction of Presbyopia
Conclusion
Data on Dysphotopsia After Add-on Implantation
References
80 Systemic Overview of Experimental Lens Surgery
Introduction
Accommodative IOL
Artificial Intelligence
Green Cataract Surgery and Sustainability
Electrical IOL Devices
Lens Regeneration Following Lens Extraction
Drug Eluting IOL
Pharmacological Cataract Therapy–Molecular Biology
Political and Economic Innovation Projects
Postoperative Non-invasive Adjustment of Dioptric IOL Power
Robotics
3D-Printed IOL
Conclusion
References
Postoperative Management
81 Perioperative Management in Cataract Surgery
Corticosteroids
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Antibiotics
Virustatics
Antiglaucoma Agents
Osmotic Agents
References
82 Posterior Capsular Opacification
Introduction
References
83 Refractive Surprise After Lens Surgery—Error Prevention and Problem Management
Cases with a History of Previous Surgery
Biometry Errors
IOL Calculation Formulas
Intraoperative and Postoperative Complications
Sources of Error When Implanting Toric Artificial Lenses
Human and Technical Failure
References
84 Management of the Unhappy Patient
Introduction
Reasons for Dissatisfaction: Monofocal IOLs
Multifocal IOLs
Avoiding Problems by Adequate Preoperative Discussions and Ocular Measurement
Why are Patients Unhappy?
Distance Vision Less Than Expected or “Waxy”
Reading Vision Less Than Expected and Poor in Low Light
Poor Intermediate Vision
Dark Shadows or Flickering Lights in the Temporal Field
Glare and Haloes
A Structured Approach to Provide Solutions for the Unhappy Patient
Distance Vision Issues
Near Vision Problems
Poor Intermediate Vision
Negative and Positive Dysphotopsias
Glare and Haloes
In Summary
References
85 Management After Opacification of Intraocular Lenses
Calcification in Hydrophilic IOLs
Primary IOL Calcification
Secondary IOL Calcification
Glistenings
References
86 Management After Dislocation of an Intraocular Lens
Introduction
Procedure for Dislocated IOL
References
87 Treatment of Postoperative Intraocular Pressure Increase
References
88 Treatment of Postoperative Cystoid Macular Edema
Etiology
Diagnostics
Course
Risk Factors
Therapy
References
89 Postoperative Inflammation
References
90 Dry Eye Management in Patients Undergoing Cataract Surgery
Epidemiology
Diagnosis of Dry Eye
Treatment of DED in Patients Undergoing Cataract Surgery
General Treatment Principles
Preoperative Management
Intraoperative Management
Postoperative Management
References
Femtoseconds Laser-Assisted Lens Surgery
91 Basic Principles of the Femtosecond Laser-Based Tissue Surgery
Introduction
Laser Beam Propagation
Dielectric Breakdown
Shock Waves and Cavitation Bubble
System Optimization
Femtosecond Laser Cataract Laser Systems
Patient Interface and Docking
Imaging
Capsulotomy
Lens Fragmentation
Corneal Incisions
Newer Technologies
References
92 Corneal Incisions with the Femtosecond Laser
Conclusion
References
93 Capsulotomy Using the Femtosecond Laser
Special Techniques
Mature Lenses
Posterior Capsulotomy
References
94 Fragmentation with the Femtolaser
References
95 Special Features of Cataract Surgery Using the Femtosecond Laser
Conclusion
References
96 Comparison of Conventional Lens Surgery to Femtosecond Laser-Assisted Lens Surgery
Conclusion
References
Phakic Intraocular Lenses
97 Overview and Indications of Phakic IOL
Overview of Phakic IOL
Phakic IOL Versus LVC
Presbyopia, Reversibility and Effects on Biometry
Choosing the Right Implant—Sizing and Vaulting
Special Features of Toric ICL
Conclusion
References
98 Surgical Techniques for the Use of Phakic Intraocular Lenses
Conclusion
References
99 Management of Surgical Complications When Implanting Phakic IOLs
References
100 Systematic Overview of Phakic Intraocular Lenses
Overview Phakic Intraocular Lenses
Results After Implantation of Phakic Intraocular Lenses
Safety/Effectiveness
Predictability/Stability
Postoperative and Long-term Complications of Phakic Intraocular Lenses
Surgically Induced Astigmatism (SIA)
Corneal Endothelial Cell Loss
Pigment Dispersion and Lens Coatings
Chronic Inflammation and Uveitis
Pupil Ovalization and Iris Retraction
Pressure Increase and Pupillary Block
Lens Rotation, as Well as Lens Power and Position
Cataract Formation
Retinal Detachment
Further Complications
Conclusion
References
Other sources:
Index