Phacodynamics Mastering the Tools and Techniques of Phacoemulsification Surgery

Dedication

Acknowledgments

Preface to the Fourth Edition

Preface to the Third Edition

Preface to the Second Edition

Preface to the First Edition xiv

Foreword to the Fourth Edition

Foreword to the Third Edition

Section I: Machine Technology

Machine Overview

Bimanual Microincision Phaco: Alternate Irrigation Path

Foot Pedal

Irrigating Bottle

Flow Pumps

Flow Pumps: Overview and Peristaltic Pump

Scroll Pump

Flow Pumps: Direct Control of Flow and Indirect Control of Vacuum

Flow Pumps: Tip Occlusion Effects on Flow and Vacuum

Flow Pumps: Direct Vacuum Control with Tip Occlusion

Rise Time: Flow Pumps

Rise Time: Flow Pump Compliance

Rise Time: Flow Pump Venting and Vacuum Limit Preset

Schematic Machine: Flow Pump

Relationship Among Flow Rate, Rise Time, and Vacuum

Relationship Between Flow and Vacuum 1

Relationship Between Flow and Vacuum 2

Vacuum Pumps

Vacuum Pumps: Overview and Venturi

Diaphragm Pump

Rotary Vane Pump

Vacuum Pumps: Direct Control of Vacuum and Indirect Control of Flow

Vacuum and Flow Pumps: Flow Resistance

Vacuum Pumps: Control of Flow and Grip; Vacuum Transfer Upon Tip Occlusion

Vacuum Pumps: Direct Control of Vacuum and Grip

Vacuum Pump Emulation by Flow Pumps

Control Strategy: Flow Pump vs Vacuum Pump

Rise Time: Vacuum Pumps

Vacuum Pumps: Relationship Between Rise Time and Vacuum

Vacuum Pumps: Pedal Control of Rise Time

Clinical Fluidics

Fluidic Resistors Affecting Flow: Vacuum Pump

Fluidic Resistors Affecting Flow: Vacuum Pump vs Flow Pump

Fluidic Resistors Affecting Vacuum: Flow Pump

Vacuum Degradation in Aspiration Line

Bottle Height: Relationship to Flow

Baseline Resistance to Flow

Flow Control: Vacuum vs Flow Pumps

Compliance and Air Venting

Compliance and Fluid Venting

Surge

External Surge Suppression

Ultrasound

Ultrasound Overview

Sculpt vs Occlude

Ultrasound: Gel vs Solid

Ultrasound Power Modulations: Linear Continuous

Ultrasound Power Modulations: Fixed Panel Continuous

Ultrasound Power Modulation: Pulse Mode

Ultrasound Power Modulation: Burst Mode

Ultrasound Power Modulation: HyperPulse

Ultrasound Power Modulations: Decreased Ultrasound Time

Pulse and Burst Modes Contraindication with Sculpting

Phaco Needle Tip Angles: Occludability 1

Phaco Needle Tip Angles: Occludability 2

Tip Angles and Aspiration Port Surface Area

Phaco Needle Dimensions

Ultrasonic Cavitation and Needle Design

Thermal Implications of Ultrasound: Needle Designs

Alternate Modalities of Phacoemulsification: Ultrasound Variations

Alternate Modalities to Ultrasound: Laser

AquaLase and Laser Surgical Techniques

Irrigation and Aspiration Tips

Individual Machine Characteristics

Section II: Logic of Setting Machine Parameters

Overview of Logic Behind Setting Machine Parameters

Anterior Chamber Currents

Flow Rates and Currents

Force and Currents

Flow and Vacuum Settings 1: Distal Followability

Flow and Vacuum Settings 2: Proximal Followability

Flow and Vacuum Settings 3: Grip

Control Inputs and Aspiration Port Occlusion: Flow Pumps vs Vacuum Pumps

Parameter Modulation with Hardware Modification

Sculpting Settings: Vacuum, Flow, and Bottle Height

Sculpting Settings: Ultrasound

Linear Phaco Sculpting

Quadrant Settings 1

Quadrant Settings 2

Settings for Quadrant/Fragment Emulsification: Balancing Fluidics and Ultrasound

Phaco Chop Settings: Horizontal Chop

Modified Horizontal Chop: Stop and Chop 1

Modified Horizontal Chop: Dynamic Linear Parameter Adjustment

Vertical Chop Settings 1

Vertical Chop Settings 2

Epinucleus Settings 1

Epinucleus Settings 2

Cortical Removal Settings

Viscoelastic Removal Settings

Section III: Overview of Phacoemulsifcation Techniques

Viscoelastic Removal Settings

Overview of Phaco Methods

Sculpting Angle of Attack

Minimum Groove Width

Posterior Groove

Judging Groove Depth

Peripheral Groove

Physical Obstructions to Sculpting

Use Low to Moderate Scope Magnification

Tip Manipulations for Sculpting Groove

Avoiding Iris During Sculpting

Layers of the Lens

Hydrodissection Fluid Dynamics

Nuclear Rotation: Torque Principles

Nuclear Rotation: Clinical Application of Torque

Rotating Nucleus: Pulling with Phaco Tip

Rotating Nucleus: Effects of Friction

Optimal Instrument Placement for Nuclear Manipulation

Nuclear Segmentation 1

Nuclear Segmentation 2

Nuclear Segmentation 3

Nuclear Segmentation 4

Fault-Line Phaco

Horizontal Chopping Techniques 1

Horizontal Chopping Techniques 2

Horizontal Chopping Techniques 3: Seibel Chopper

Horizontal Chopping Techniques 4: Flat-Head Phaco Tip

Vertical Chopping Techniques

Chopper Instrumentation

Akahoshi Prechop

Vacuum Seal

Vacuum Seal: Needle Bevel

Fragment Manipulation 1

Fragment Manipulation 2

Fragment Manipulation 3

Fragment Manipulation 4: Viscodissection

One-Handed Strategies 1

One-Handed Strategies 2

Pivot Around Incisions 1

Pivot Around Incisions 2

Section IV: Irrigation and Aspiration Techniques

Cortical Classification

Cortical Removal: Large Pieces Instead of Small Bites

IA Port Turned Posteriorly

Capsule Vacuum

Manual Cortical Removal

90º and 45º IA Tips

Bimanual Irrigation and Aspiration

Using the IOL to Help Remove Cortex

Epinuclear Mobilization via Cortical Pulley

Section V: Physics of Capsulorrhexis

Stress and Strain

Shear vs Rip

Capsulorrhexis with Shearing

Capsulorrhexis with Ripping

Maintaining Chamber Depth

Combining Techniques

Capsulorrhexis Initiation 1

Capsulorrhexis Initiation 2

Capsulorrhexis Initiation 3

Capsulorrhexis Initiation 4

Anterior Cortical Opacities

Capsulorrhexis Enlargement

Section VI: Phacodynamic Complications

Complication 1

Complication 2

Complication 3

Complication 4

Complication 5

Complication 6

Appendices

Appendix A: Implied Surface Area in Units of mm Hg

Appendix B: Aspiration Port Surface Area Derivation

Appendix C: Summary of Pressure Terminology

Appendix D: Phacodynamic Analysis in Instrument Design

Bibliography

Index

Biography

Barry S. Seibel, MD. Clinical Assistant Professor of Ophthalmology, University of California, Los Angeles School of Medicine.

I learned more about phacoemulsification surgery (in this book) than in all previous course time. The text is brilliantly illustrated. The diagrams amplify and refine the written paragraphs. This is a book that every cataract surgeon must review. This book has my highest recommendation. I wish I had written it.