2nd Edition

Phaco Chop and Advanced Phaco Techniques Strategies for Complicated Cataracts

By David F. Chang Copyright 2013

    While chopping techniques are particularly advantageous for complicated cataracts, they must be integrated with other devices and strategies. Phaco Chop, the best-selling cataract surgery book, has been revised and updated into a Second Edition to reflect the many advances over the past few years. More than half of the 30 total chapters are new. These detail strategies for complicated cases and introduce femtosecond laser nuclear fragmentation techniques.

    Dr. David F. Chang is widely acknowledged as one of the best cataract surgical teachers. His video instruction courses for phaco chop and complicated cataracts have consistently ranked among the best attended and top rated at the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgeons meetings for over a decade.

    The Four Main Sections inside the Second Edition:

    • Phaco Chop Techniques
    • Phacodynamics of Chopping
    • Femtosecond Laser Nuclear Pre-Chopping
    • Complicated Cases and Complications – Strategies and Management

    Section One is a detailed guide for learning phaco chop. The faculty from Dr. Chang’s popular phaco chop course outlines their pearls based upon extensive experience teaching residents and transitioning surgeons.

    Section Two provides the general principles of instrumentation and configuring machine parameters. Separate chapters specifically address optimizing the Infiniti, Signature, and Stellaris platforms for chopping.

    Section Three introduces femtosecond laser nuclear pre chopping with separate chapters on the LenSx, LensAR, and Optimedica platforms.

    Section Four covers small pupils and IFIS, rock hard and white mature cataracts, weak zonules, and extremely long and short eyes with an emphasis on managing posterior capsule rupture, advanced IOL fixation strategies, and avoiding and managing capsulorrhexis complications.

    Bonus Video Material!

    Phaco Chop and Advanced Phaco Techniques, Second Edition includes instructional video that complements and supplements the content of the book.

    With your book purchase, you will receive a DVD that contains 26 surgical videos in high definition 3D format. With the enclosed 3D glasses—learning intraocular surgical techniques is taken to a new level.

    Additionally, you will receive access to a website that includes additional companion surgical videos narrated by Dr. Chang in 2D format—watch, listen, view repeatedly, and learn the techniques!

    The narrated videos produced by Dr. Chang illustrate advanced surgical techniques and technologies. Together with over 400 high-resolution operative photographs, this paired format overcomes the limitations of learning new and advanced surgical techniques from written text alone.

    With its comprehensive and integrated emphasis on advanced surgical techniques, optimizing phaco technology, and complication management, Phaco Chop and Advanced Phaco Techniques: Strategies for Complicated Cataracts, Second Edition will appeal to residents and transitioning surgeons as well as high volume surgeons interested in honing their most advanced phaco skills.

    Dedication

    Acknowledgments

    About the Author

    Contributing Authors

    Foreword by Robert H. Osher, MD

    Introduction

    Section I Phaco Chop Technique

    Chapter 1 Why Learn Chopping? David F. Chang, MD

    Chapter 2 Horizontal Chopping: Principles and Pearls Randall J. Olson, MD

    Chapter 3 Vertical Chopping: Principles and Pearls Louis D. \u201cSkip\u201d Nichamin, MD

    Chapter 4 Comparing and Integrating Horizontal and Vertical Chopping David F. Chang, MD

    Chapter 5 Transitioning to Phaco Chop: Pearls and Pitfalls David F. Chang, MD

    Chapter 6 Phaco Prechop Takayuki Akahoshi, MD

    Chapter 7 Biaxial Microincision Chopping Mark Packer, MD, FACS, CPI

    Section II Phacodynamics of Chopping

    Chapter 8 Understanding the Phacodynamics of Chopping Barry S. Seibel, MD

    Chapter 9 Optimizing Machine Settings for Chopping Techniques David F. Chang, MD

    Chapter 10 Optimizing the Alcon Infiniti for Chopping David F. Chang, MD and Barry S. Seibel, MD

    Sidebar: Ultra Chopper Theory and Technique Alan S. Crandall, MD

    Chapter 11 Optimizing the AMO Signature for Chopping David F. Chang, MD

    Chapter 12 Optimizing the Bausch + Lomb Stellaris for Chopping Louis D. \u201cSkip\u201d Nichamin, MD

    Section III Femtosecond Laser Nuclear Prechopping

    Chapter 13 Femtosecond Laser Nuclear Fragmentation (LenSx Platform) Robert J. Cionni, MD

    Chapter 14 Femtosecond Laser Nuclear Fragmentation (LensAR platform) Louis D. \u201cSkip\u201d Nichamin, MD

    Chapter 15 Femtosecond Laser Nuclear Fragmentation (Catalys Platform) Barry S. Seibel, MD

    Section IV Complicated Cases and Complications: Strategies and Management

    Chapter 16 Capsulorrhexis: Sizing Objectives and Pearls David F. Chang, MD

    Chapter 17 Conquering Capsulorrhexis Complications David F. Chang, MD

    Chapter 18 Pearls for Hydrodissection and Hydrodelineation David F. Chang, MD

    Chapter 19 Strategies for the Rock Hard Nucleus David F. Chang, MD

    Chapter 20 Advanced Phaco Techniques for Brunescent Nuclei: Cross-Action Chop Circumferential Disassembly Lisa B. Arbisser, MD

    Chapter 21 Strategies for Small Pupils David F. Chang, MD

    Chapter 22 Intraoperative Floppy Iris Syndrome David F. Chang, MD

    Chapter 23 Strategies for Weak Zonules David F. Chang, MD

    Chapter 24 Intraocular Lens Implantation With Abnormal Zonules David F. Chang, MD

    Chapter 25 Phaco in Highly Myopic Eyes David F. Chang, MD

    Chapter 26 Phaco Within the Crowded Anterior Segment David F. Chang, MD

    Chapter 27 Strategies for Managing Posterior Capsule Rupture David F. Chang, MD

    Chapter 28 Intraocular Lens Implantation Following Posterior Capsule Rupture David F. Chang, MD

    Chapter 29 Strategies for Unplanned Anterior Vitrectomy Lisa B. Arbisser, MD

    Chapter 30 Posterior Capsule Rupture and Vitreous Loss: Advanced Approaches Louis D. \u201cSkip\u201d Nichamin, MD

    Financial Disclosures

    Index

    Biography

    David F. Chang, MD is a Summa Cum Laude graduate of Harvard College and Harvard Medical School. He completed his ophthalmology residency at the University of California, San Francisco (UCSF) where he is now a clinical professor. Having chaired the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee, Dr. Chang joined the ASCRS Executive Committee in 2009, serving as president in 2012-2013. He is also chairman of the American Academy of Ophthalmology (AAO) Cataract Preferred Practice Pattern Panel, immediate past chair of the AAO Practicing Ophthalmologist Curriculum Panel for Cataract/Anterior Segment, and in 2009 completed his 5-year term as chair of the AAO Annual Meeting program committee. Dr. Chang is a board member of the ASCRS Foundation and serves on the medical advisory board of 2 global humanitarian organizations (Himalayan Cataract Project and Project Vision). He is also an adjunct clinical professor of ophthalmology at the Chinese University in Hong Kong and honorary professor for the Zhongshan Ophthalmic Center of Sun Yat-Sen University in China.

    In 2006, Dr. Chang became only the third ophthalmologist to ever receive the Charlotte Baer Award honoring the outstanding clinical faculty member at the UCSF Medical School. He has received the highest honor for cataract surgery from the ASCRS (Binkhorst Medal), the AAO (Kelman Lecture), the Asia Pacific Association of Cataract and Refractive Surgery (Lim Medal), the United Kingdom and Ireland Society of Cataract & Refractive Surgery (Rayner Medal), the Canadian Society of Cataract and Refractive Surgery (Award of Excellence/Stein Lecture), the Indian Intraocular Implant and Refractive Society (Gold Medal), the Italian Ophthalmological Society (Strampelli Medal), and the Royal Australia and the New Zealand College of Ophthalmologists (Gregg Medal). He has also been asked to give the Keynote Lecture for the Asia Pacific Academy of Ophthalmology Annual Meeting.

    Dr. Chang has been selected to deliver the following additional named lectures: Transamerica Lecture (UCSF), Wolfe Lecture (University of Iowa), DeVoe Lecture (Columbia-Harkness), Gettes Lecture (Wills Eye Hospital), Helen Keller Lecture (University of Alabama), Williams Lecture (UCSF), Kayes Lecture (University of Washington, St. Louis), Thorpe Lecture (Pittsburgh Ophthalmology Society), Schutz Lecture (New York University Medical Center), Wallace-Evan Lecture (Casey Eye, Oregon), Kambara Lecture (Loma Linda), Boyaner Lecture (McGill), Herbert Lecture (UC Irvine), Rodriguez Lecture (Univ Arizona), Jules Stein Lecture (UCLA-Jules Stein), Paton Medal Lecture (Baylor/Cullen Eye), Weinstock Lecture (Wills Eye Hospital), and the Proctor Lecture (UCSF/Proctor Foundation). In addition to the AAO Achievement and Senior Achievement awards, Dr. Chang is also a 6-time AAO Secretariat Award recipient. He was the inaugural recipient of the UCSF Department of Ophthalmology’s Distinguished Alumni Award (2005).

    Dr. Chang is the chief medical editor of EyeWorld, associate international editor for the Asia-Pacific Journal of Ophthalmology, and served for 5 years as co-chief medical editor for Cataract and Refractive Surgery Today. He was the textbook editor of Cataract Surgery Today (CRST 2009), Mastering Refractive IOLs—The Art and Science (SLACK Incorporated 2008) and Curbside Consultation in Cataract Surgery (SLACK Incorporated 2007), the series editor for the 8 SLACK Incorporated Curbside Consultation ophthalmology textbooks, and the principal author of Phaco Chop (SLACK Incorporated 2004).