"Overall, this is a practical concise guidebook for the cataract surgeon facing perioperative challenges and complications."
— S. Rumelt, Department of Ophthalmology, Western Galilee-Nahariya Medical Center, Nahariya, Israel,
David F. Chang, MD is a Summa Cum Laude graduate of Harvard College and earned his MD at Harvard Medical School. He completed his ophthalmology residency at the University of California, San Francisco (UCSF) where he is now a clinical professor. Dr. Chang is Chairman of the American Academy of Ophthalmology (AAO) Annual Meeting Program Committee, having previously chaired the Cataract Program Subcommittee. He organized and was the program co-chair for the first 6 AAO “Spotlight on Cataracts” Symposia. He has been selected to deliver the following named lectures: Transamerica Lecture (UCSF), Williams Lecture (UCSF), Wolfe Lecture (University of Iowa), DeVoe Lecture (Columbia-Harkness), Gettes Lecture (Wills Eye Hospital), Helen Keller Lecture (University of Alabama), Kayes Lecture (University of Washington, St. Louis), and Thorpe Lecture (Pittsburgh Ophthalmology Society). He has received 2 AAO Secretariat Awards (2003 and 2006). He was the inaugural recipient of the UCSF Department of Ophthalmology’s Distinguished Alumni Award (2005) and received the 2006 Charlotte Baer Award honoring the outstanding clinical faculty member (of more than 2000 active clinical faculty) at the UCSF Medical School. He was the 2007 recipient of the Strampelli Medal from the Italian Ophthalmological Society. Dr. Chang is vice-chair of the AAO Practicing Ophthalmologist Curriculum Commit-tee for Cataract and Anterior Segment, which developed the American Board of Ophthalmology knowledge base for the MOC examination. He is also on the AAO Cataract Preferred Practice Pattern Panel. Dr. Chang is chair of the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee and is a member of the ASCRS Eye Surgery Education Council Presbyopia Task Force. He is on the scientific advisory board for the UCSF Collaborative Vision Research Group, American Medical Optics, Calhoun Vision, Medennium, Peak Surgical, and Visiogen, and is the medical monitor for the Visiogen Synchrony accommodating IOL Food and Drug Administration (FDA) monitored trial. He is co-chief medical editor for Cataract & Refractive Surgery Today and is the cataract editor for 2 online educational sites: the AAO’s “Specialty Clinical Updates” and the Ocular Surgery News “Ophthalmic Hyperguides.” He is editor of the Cataract & Refractive Surgery Today Virtual Textbook of Cataract Surgery and was the principal author of Phaco Chop: Mastering Techniques, Optimizing Technology, and Avoiding Complications (published by SLACK Incorporated), which was the first ophthalmic textbook to have a paired DVD featuring instructional surgical video.
Contents Dedication Acknowledgments About the Editor About the Associate Editors Contributing Authors Preface Foreword by I. Howard Fine, MD Section I: Preoperative Questions Question 1: With Coexisting Macular Disease, How Can I Tell Whether It Is Worth Doing Cataract Surgery? Douglas D. Koch, MD Question 2: When Can Cataract Surgery Alone Be Performed in Patients With Fuchs’ Dystrophy? Walter J. Stark, MD Question 3: What Should I Do Differently for Glaucoma Patients? Bradford J. Shingleton, MD Question 4: Which Patients Need a Combined Glaucoma Procedure? Thomas Samuelson, MD Question 5: What Should I Do Differently in Patients at Higher Risk for Retinal Detachment? Richard J. Mackool, MD Question 6: With How Large a Zonular Dialysis Can Phaco Be Performed? Bonnie An Henderson, MD Question 7: I Have a Cataract Patient With a Traumatic Iris Defect and Glare Symptoms. What Should I Do? Francis W. Price, Jr, MD Question 8: How Important Is It to Reduce or Eliminate Spherical Aberration and Is There an Advantage to Having Some Present? Jack T. Holladay, MD, MSEE, FACS Question 9: What Intraocular Lens Should I Use in the Postkeratorefractive Patient? Warren E. Hill, MD, FACS Question 10: How Do I Perform Cataract Surgery in Eyes With a Phakic Intraocular Lens? Paul Koch, MD Question 11: When Should I Use a Toric Intraocular Lens Versus Astigmatic Keratotomy Versus Laser Bioptics? Kerry D. Solomon, MD Question 12: My Astigmatic Keratotomy Results Are Unpredictable. How Can I Improve Them? R. Bruce Wallace III, MD, FACS Question 13: For How Long Should Topical Antibiotics and Nonsteroidal Anti-Inflammatory Drugs Be Used Before and After Cataract Surgery? Francis S. Mah, MD Section II: Intraoperative Questions Question 14: Under Topical Anesthesia, the Patient Is Uncooperative and Complaining of Pain. What Should I Do? Kenneth J. Rosenthal, MD, FACS Question 15: How Should I Proceed if I Made a Poor Clear Corneal Incision? Randall J. Olson, MD Question 16: What Should I Do if the Chamber Is So Shallow That It Does Not Deepen Much With Viscoelastic? Johnny Gayton, MD Question 17: My Capsulorrhexis Flap Tore Radially. How Should I Proceed? Rosa Braga-Mele, MEd, MD, FRCSC Question 18: Despite Attempting Hydrodissection, I Cannot Rotate the Nucleus. How Should I Proceed? William J. Fishkind, MD, FACS Question 19: Following Hydrodissection, the Iris Is Prolapsing and the Globe Is Very Firm. How Should I Proceed? I. Howard Fine, MD Question 20: How Do I Proceed if I See a Small Wound Burn With Whitening of Corneal Stroma? How Would I Close a Severe Corneal Burn? Robert H. Osher, MD Question 21: How Should I Manage a Small or Large Descemet’s Membrane Detachment? Terry Kim, MD Question 22: After Inserting the Phaco Tip, the Chamber Dramatically Deepens and the Patient Complains of Pain. How Should I Proceed? Robert J. Cionni, MD Question 23: What Should I Do Differently With a Posterior Polar Cataract? Samuel F. Masket, MD Question 24: What Should I Do Differently With a Hypermature White Cataract? Steve A. Arshinoff, MD, FRCSC Question 25: What Is the Best Way to Manage Intraoperative Floppy Iris Syndrome? David F. Chang, MD Question 26: After Chopping or Cracking a 4+ Nucleus, a Leathery Posterior Plate Still Connects the Fragments Centrally. How Should I Proceed? Roger F. Steinert, MD Question 27: During Phaco, the Posterior Capsule Is Trampolining More Than Usual. How Should I Proceed? Barry S. Seibel, MD Question 28: What Are the Earliest Intraoperative Clues of Posterior Capsular Rupture? Lisa B. Arbisser, MD Question 29: The Capsular Bag Is Unexpectedly Mobile During Phaco. When Should I Implant a Capsular Tension Ring and Which Size Should I Use? Iqbal Ike K. Ahmed, MD, FRCSC Question 30: What Should I Do When the Diameter of My Completed Capsulorrhexis Is Very Small? Howard V. Gimbel, MD, MPH, FRCSC, FACS Question 31: When Should an Anterior Vitrectomy Be Performed Via the Pars Plana Versus the Limbus? Louis D. "Skip" Nichamin, MD Question 32: When and How Do I Stain the Vitreous With Intracameral Kenalog? Scott E. Burk, MD, PhD Question 33: When and How Should I Implant an Intraocular Lens in the Ciliary Sulcus? Thomas A. Oetting, MS, MD Question 34: When and How Should I Suture Fixate a Posterior Chamber Intraocular Lens? Elizabeth A. Davis, MD, FACS Question 35: When and How Should I Implant an Anterior Chamber (Angle-Supported) Intraocular Lens? Manus C. Kraff, MD Question 36: Based Upon the ESCRS Randomized Study, Should I Use Intracameral Antibiotics? Which Agent? Eric D. Donnenfeld, MD Question 37: When Do You Use Intracameral Drugs (and at What Dosages) for Cataract Surgery? James P. Gills, MD Section III: Postoperative Questions Question 38: What Is the Best Way to Prevent and Manage Postoperative Intraocular Pressure Spikes? Richard A. Lewis, MD Question 39: On Postoperative Day 1, the Anterior Chamber Is Shallow and the Patient Is Unexpectedly Very Myopic. What Should I Do? Luther L. Fry, MD Question 40: Following Uneventful Surgery, Three of My Eight Patients Have 4+ Cell and Fibrin on Postoperative Day 1. What Should I Do? Nick Mamalis, MD Question 41: How Should I Manage Prolonged or Recurrent Iritis Following Uncomplicated Surgery? Michael B. Raizman, MD Question 42: For How Long Can I Safely Observe a Piece of Descended Lens Material? Stanley Chang, MD Question 43: How Should I Manage a Postoperative Refractive Surprise? Mark Packer, MD Question 44: What Causes My Patients to Complain About Temporal Shadows or Reflections, and How Should I Manage Persistent Symptoms? Kevin M. Miller, MD Question 45: What Should I Do About the Second Eye in a Patient Complaining About Severe Halos After the First Multifocal? Kevin L. Waltz, OD, MD Question 46: Can I Mix Different Multifocal Intraocular Lenses or Multifocal With Monofocal Intraocular Lenses? Richard L. Lindstrom, MD Question 47: Following a Posterior Capsular Rent, the Sulcus-Fixated Intraocular Lens Has Become Decentered. How Should I Proceed? Garry P. Condon, MD Question 48: How Do I Explant an Intraocular Lens 6 Months Following Surgery? Stephen Lane, MD Question 49: My Pseudoexfoliation Patient Has Newly Discovered Pseudophaco-donesis 5 Years Following Surgery. How Should I Proceed? Alan S. Crandall, MD Financial Disclosures Index