Illustrative Guide to Cataract Surgery

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One of the main problems with textbooks on surgical technique is that they too often “tell†rather than “showâ€. Certainly, reading long descriptions of a particular procedure can help us develop a fundamental understanding of how the procedure should be performed. However, at a certain point, the specifics need to be illustrated for the reader so that (s)he can delve into the details, details that might end up making the difference between a successful procedure… and referral to a vitreoretinal colleague. Some fine points can be very difficult to transfer to the reader. Precisely, how large should a capsulorhexis be compared to the pupil diameter? Where, in relation to anterior segment structures, should the phaco tip be held during vertical chopping? And where should the helper instruments like the chopper and sweep be positioned in relation to the phaco tip? Clearly, text descriptions can only go into so much detail before images become necessary to bridge the gap between theory and practice.

In the “Illustrative Guide to Cataract Surgery: A Step-by-Step Approach to Refining Surgical Skills,†images form the core of the information provided. Edited by Dr Amar Agarwal and Dr Soosan Jacob, both of Chennai, India, and published by Slack Incorporated, this illustrated guide goes through the fine points of cataract surgery, both standard and complex. Realising that surgical photographs can be difficult to understand due to suboptimal lighting, reflections, air bubbles and media haziness, the authors have redrawn each photograph in a simple, unadorned format that is simple to comprehend. Additionally, purchase of the book entitles the reader to view cataract surgery videos on the accompanying, password-protected website.

The book is divided into four sections. Section I: Phaco Surgery covers the standard cataract surgery and its many variants. Each step is illustrated and described in the accompanying legends. Knowing that each individual step can be performed using several different techniques as well as with distinct instruments, the authors cover each of these as well. For example, the main port can be constructed using a uni-, a bi-, or a triplanar technique; the capsulorhexis technique is shown using a cystitome and forceps; nucleus removal is shown in its various incarnations.

Section II: Microincision Cataract Surgery is a very focused section describing both coaxial and biaxial techniques, with a short explanation of their relative “pros†and “cons.â€

Section III: Challenging Cases will be of particular interest to residents or fellows nearing the end of their training, or surgeons looking to either brush up on their own trusted technique or considering trying a new one. This section discusses mature cataracts, iris hooks, the Malyugin ring, posterior polar cataracts and subluxated cataracts. A great deal of attention is given to the management of cases with small pupils. Later in the section, the treatment of the subluxated lens is described using several tools.

Of course, this would all be unduly optimistic without Section IV: Complications. What to do with a torn rhexis, how to manage iridodialysis and how to react upon rupture of the posterior capsule – step-by-step instructions for the some of the most dreaded intraoperative complications.

The editors might have considered referring to other authors’ work more frequently than to their own, as this would strengthen the evidence in favour of a particular technique. Nevertheless, this book is appropriate for medical students who are observing cataract surgery in the operating room; ophthalmology residents during their cataract rotation; and instructors of cataract surgery in training centres, who might make good use of the techniques described and the images provided.

BOOKS EDITOR
Leigh Spielberg
PUBLICATION
Illustrative Guide to Cataract Surgery:
A Step-by-Step Approach to Refining Surgical Skills
EDITORED BY
Dr Amar Agarwal and Dr Soosan Jacob
PUBLISHED BY
Slack Incorporated