pearls for toric iol implantation during cataract surgery dr suresh k pandey, suvi eye institute &...

7/21/2019 Pearls for Toric IOL Implantation During Cataract Surgery Dr Suresh K Pandey, SuVi Eye Institute & Lasik Laser Cen

1/5xxx+ di}ikcjkg+ivh c 22

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Togvg bvg tovgg ebjk i~tjik} aiv vgdwmjkh b}tjhebtj}e btiv bviwkd tog tjeg ia mbtbvbmt }wvhgvz# kbegcz ~gvaivejkhikg iv eivg cjefbc vgcbjkh jkmj}jik} /CVJ}*# i~~i}jtg mcgbvmivkgbc jkmj}jik}# je~cbktjkh bk jktvbimwcbv cgk} `kixkb} b Tivjm JIC xojmo mivvgmt} aiv b}tjhebtj}e bkd flkbccz

Mbtbvbmt

]wvg}o @+ ^bkdgz

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gzg} bkd ~btjgkt}# b} xgcc b} }wvhgik}Tivjm JIC} kix ~viqjdg b }bag bkd ~vgdjmtbfcg bctgvkbtjqgti vgdwmg iv gcjejkbtg vgavbmtjqg b}tjhebtj}e xjto bmzcjkdvjmbc mivvgmtjik# iaagvjkh ~btjgkt} xjto ~vggj}tjkhmivkgbc b}tjhebtj}e i~tjebc dj}tbkmg qj}wbc bmwjtz xjtoiwttog w}g ia }~gmtbmcg} iv miktbmt cgk}g} B~~vijebtgcz 66'ia ~btjgkt} wkdgvhijkh mbtbvbmt }wvhgvz obqg }wf}tbktjbcmivkgbc b}tjhebtj}e /jg# eivg tobk 267 D* bkd xiwcd fgkgfltavie tivjm JIC je~cbktbtjik Toj} bvtjmcg xjcc aimw} ik tivjmJIC je~cbktbtjik aiv ebkbhjkh b}tjhebtj}e dwvjkh mbtbvbmt}wvhgvz

Mwvvgktcz Bqbjcbfcg Tivjm JIC

Bt ~vg}gkt qbvjiw} tz~g} ia tivjm JIC bvg bqbjcbfcg aivebkbhgegkt ia mivkgbc b}tjhebtj}e /Ajhwvg 6*

]tbbv ]wvhjmbc Jktvbimwcbv Cgk} xb} tog flv}t ADB%b~~viqgd/jk 2::?* tivjm JIC bqbjcbfcg jk tog Wkjtgd ]tbtg} Tog ]tbbvtivjm JIC mieg} jk b awcc vbkhg ia dj}tbkmg qj}jik ~ixgv}#jk txi qgv}jik} Ikg mivvgmt} w~ ti 6>> dji~tgv} /D* iab}tjhebtj}e bkd tog itogv mivvgmt} w~ ti =7>D ^cbtg%ob~tjmtivjm JIC} djd kit hbjk ewmo ~vgagvgkmg bkd bvg mobccgkhgdfz ~iiv vitbtjikbc }tbfjcjtz bkd b cjejtgd ~ixgv vbkhg

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b}tjhebtj}e

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2/5

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\gj}} Egdjtgm*

Txi ebjk eidgc} ia tivjm JIC]< BmvjMieaivt 141TCM bkdBmvjCJ]B tivjm 411TD ebv`gtgd fz Mbvc \gj}} Egdjtgm TogBmvjMieaivt 141TCM j} bk b}~ogvjmbc fjtivjm JIC Jt xb} togflv}t dg}jhkgd ti fg jk}gvtgd toviwho jkmj}jik} }ebccgv tobk6 ee bkd }i j} toiwhot ti ejkjej|g tog }wvhjmbccz jkdwmgdb}tjhebtj}e /]JB* Jt} tgmokjmbc agbtwvg} bvg< ozdvi~ojcjmbmvzcjm ~iczegv miktbjkjkh 67' xbtgv# Ozdvi~oifjm }wvabmg#^cbtg dg}jhk xjto }rwbvg gdhg} jk ob~tjm bkd i~tjm# Titbcdjbegtgv 22 ee# I~tjm djbegtgv 1> ee# B%mik}tbkt ia22?># ]~ogvjmbc ~ixgv} bqbjcbfcg avie 2>> ti +=6>D bkd bmzcjkdgv ~ixgv} avie +2>> ti +26D /mzcjkdgv qbcwg} iwt}jdgtog }tbkdbvd vbkhg bvg ebkwabmtwvgd jkdjqjdwbccz* Tog Bmvj

CJ]B tivjm 411TD j} b ewctjaimbc tivjm JIC bc}i dg}jhkgd aivEJM] bjegd bt ~vg}fzi~jm mbtbvbmt ~btjgkt} xjto b dj}tjkmtb}tjhebtj}e

Vbzkgv T%ag B}~ogvjm Tivjm JIC}

Vbzkgv T%stg B}~ogvjm Tivjm JIC} /78=T bkd 16=T* bvg b}w~gvjiv bctgvkbtjqg ti tivjm JIC} xjto b vg}tvjmtgd vbkhg iativw} bkd iaagv b ~vgmj}g# }w~gvjiv bctgvkbtjqg ti jkmj}jikbc`gvbtitiez bkd Cjefbc Vgcbjkh Jkmj}jik} /CVJ}* aiv togtvgbtegkt ia ~vg%gj}tjkh mivkgbc b}tjhebtj}e Xjto T%stgB}~ogvjm Tivjm JIC}# tog tivw} /mzcjkdgv* j} je~cgegktgdik tog bktgvjiv }wvabmg ia tog i~tjm bkd tog Beik%B~~cgGkobkmgd ]rwbvg Gdhg ik tog ~i}tgvjiv }wvabmg

T%stg B}~ogvjm Tivjm JIC} bvg ~bvtjmwcbvcz w}gawc aiv toi}gmbtbvbmt ~btjgkt} xogvg jkmj}jikbc egtoid} xiwcd ~viqjdgjkbdgrwbtg b}tjhebtjm mivvgmtjik Tog moijmg ia b T%stgB}~ogvjm Tivjm JIC cgbd} ti eivg ~vgmj}g }wvhjmbc vg}wct}#g}~gmjbccz aiv mb}g} ia }gqgvg b}tjhebtj}e< ~btjgkt} xjto boj}tivz ia mivkgbc ~btoicihz# `gvbtimikw} xjto ~gkgtvbtjkh`gvbti~cb}tz /mivkgbc hvbat}* bkd ~btjgkt} xjto fwvk} bkdmivkgbc }mbvvjkh Wkcj`g ~cbtg%ob~tjm bkd ewctj~jgmg tivjmJIC}# T%stg B}~ogvjm Tivjm JIC} obqg jkogvgkt vitbtjikbc}tbfjcjtz ]w~gvf qj}wbc iwtmieg} bvg bmojgqgd fgmbw}g iatog dg~gkdbfcg bf}gkmg ia vitbtjik jk cgk}g} dg}jhkgd xjtoVbzkgv} BQO

Vbzkgv ]wcmiag tivjm 17=T /^jhhz fbm` }wcmw} cgk}*Mikmgjqgd aiv mivvgmtjkh ~i}t%}wvhjmbc iv vg}jdwbc begtvi~jb#Vbzkgv ob} dg}jhkgd ikg ia jt} ]wcmistg ~}gwdi~ob`jm}w~~cgegktbvz JIC} aiv mivvgmtjkh vgavbmtjqg mzcjkdgv} w}jkh~jhhz%fbm` tgmokjrwg} Tog cgk} iaagv} tog aiccixjkh agbtwvg}>D ti +1>> D jk >7Djkmvgegkt}

^btjgkt Miwk}gcjkh# ]gcgmtjik Mvjtgvjb ! Jkdjmbtjik} aiv Tivjm

JIC

Tog }wvhgik }oiwcd eb`g b }ebcc mobkhg jk viwtjkg ~vbmtjmg#

fz }mvggkjkh tog ~btjgkt aiv @gvbtiegtvz flv}t bkd togkmiwk}gc ~btjgkt aiv mbtbvbmt }wvhgvz ^btjgkt} obqjkh 2>> Dmivkgbc mzcjkdgv bvg mbkdjdbtg aiv Tivjm JIC Tog miwk}gciv)}wvhgik }oiwcd gdwmbtg ~btjgkt tobt tog tgmokicihz j}bqbjcbfcg aiv mzcjkdvjmbc mivvgmtjik Tivjm JIC mb}g} obqgojho cgqgc ia }~gmtbmcg avggdie aiv dj}tbkmg xogk je~cbktgdfjcbtgvbccz /:8'* Tog }wvhgik)miwk}gciv }oiwcd hjqg i~tjikti bcc ~btjgkt} obqjkh b}tjhebtj}e Ikg }oiwcd ge~ob}j|gtobt batgv vgeiqbc ia mbtbvbmt }wvhgvz togjv dj}tbkmg qj}jikxjcc je~viqg /xjto kggd ia w}jkh ejkiv mivvgmtjik*# oixgqgv#togz xjcc kggd }~gmtbmcg aiv kgbv bkd jktgvegdjbtg xiv`/vgbdjkh# mie~wtgv* ]tbaa tvbjkjkh bkd ~btjgkt gdwmbtjik j}je~ivtbkt

^vi~gv ~btjgkt }gcgmtjik j} mvjtjmbc ti bmojgqg }wmmg}} aiv tivjmJIC je~cbktbtjik ]wjtbfcg mbkdjdbtg} bvg mbtbvbmt ~btjgkt}xjto ~vg%gj}tjkh mivkgbc b}tjhebtj}e ; 2>> D xjto togaiccixjkh mobvbmtgvj}tjm}< Ebkwbc `gvbtiegtvz< }tgg~ bkdstbt egvjdjbk} {:> b~bvt0 Mivkgbc ti~ihvb~oz< }zeegtvjmbcb}tjhebtj}e0 Dwvjkh ]wvhgvz< Jktbmt mb~}wcbv fbh mie~btjfcgxjto miktjkwiw} mwvqjcjkgbv mb~}wcitiez ~gvaivegd xjto jk%tog%fbh ~cbmgegkt ia tog JIC

Toiwho bwtiebtjm `gvbtiegtgv mbk fg ogc~awc ti tb`g@gvbtiegtvz vgbdjkh jk b fw}z I^D# oixgqgv# jt j}vgmieegkdgd ti w}g ebkwbc `gvbtiegtvz bkd ti~ihvb~ozaiv ebhkjtwdg# ivjgktbtjik# bkd tz~g ia ~vg%gj}tjkh mivkgbc

b}tjhebtj}e ]wflgmtjqg vgavbmtjik dbtb j} kit bdqj}gd jk ivdgvti bqijd tog jkstwgkmg ia bkz cgktjmwcbv b}tjhebtj}e# xojmoxjcc fg gcjejkbtgd xogk tog mbtbvbmtiw} cgk} j} vgeiqgd

Tog }wvhgik }oiwcd dgagv w}jkh tivjm JIC jk mb}g} ia jvvghwcbvmivkgbc b}tjhebtj}e mbw}gd fz mivkgbc i~bmjtz# }mbvvjkh#~tgvjhjwe# ~gvj~ogvbc mivkgbc dghgkgvbtjik# mb}g} ia ~vgqjiw}imwcbv tvbweb cgbdjkh ti mie~viej}gd mb~}wcbv fbh# mb~}wcbvfbh% |ikwcbv mie~cg gtm

]wvhjmbc Tgmokjrwg aiv Tivjm JIC

Toiwho }gqgvbc tz~g} ia tivjm JIC} bqbjcbfcg tidbz# xg obqgg~gvjgkmg ia je~cbktjkh Bmvz]ia Tivjm JIC }jkmg cb}t 4 zgbv}

Tog xvjtg%w~ xjcc aimw} ik Bmvz]ia tivjm JIC je~cbktbtjikBcc mbtbvbmt }wvhgik} xjcc rwjm`cz fgmieg mieaivtbfcg xjtoje~cbktjkh tog Bmvz]ia Tivjm JIC Ikcz ejkiv eidjflmbtjik}ti b }wvhgik} viwtjkg mbtbvbmt ~vimgdwvg bvg vgrwjvgd aiv}wmmg}} Bvgb} xogvg eidjflmbtjik} bvg kgmg}}bvz jkmcwdg/2* tog JIC mbcmwcbtjik aiv mzcjkdvjmbc ~ixgv bkd bj} ia~cbmgegkt# /6* tog ebv`jkh ia tog gzg# bkd /=* tog ik%bj}~cbmgegkt ia tog JIC

JIC ^ixgv Mbcmwcbtjik

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aiv mikqgktjikbc eikiaimbc JIC} ti dgtgvejkg gbmo ~btjgkt}}~ogvjmbc ~ixgv vgrwjvgegkt} Tog ebjk mvjtgvjb aiv bk Bmvz}iaTivjm JIC bvg tog ~btjgkt} dg}jvg aiv }~gmtbmcg jkdg~gkdgkmgbt dj}tbkmg bkd tog ~vg}gkmg ia eivg tobk2>> D ia mivkgbcb}tjhebtj}e fz `gvbtiegtvz ]wvhgik} }oiwcd fghjk fzmbcmwcbtjkh tog }~ogvjmbc grwjqbcgkt JIC ~ixgv kivebccz


3/5xxx+ di}ikcjkg+ivh c 2=

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bkbcz}j} mie~gk}btg} aiv }wvhjmbccz jkdwmgd b}tjhebtj}e jktog mbcmwcbtjik ia JIC ~ixgv bkd i~tjebc bj} cimbtjik

B qgmtiv j} bkz egb}wvgegkt tobt ob} fito ebhkjtwdg bkddjvgmtjik Aiv gbe~cg# +6>>D ia mivkgbc b}tjhebtj}e btbk bj} ia 2=7 j} b qgmtiv rwbktjtz Ebkz }wvhgik} di kitmik}jdgv tog ~itgktjbc ia mcgbv mivkgbc mbtbvbmt jkmj}jik}ti jkdwmg b}tjhebtj}e Tog qgmtiv ia tog mivkgbc xiwkd/dg~gkdjkh ik tog jkmj}jik} cimbtjik# }j|g# bkd bvmojtgmtwvg*jkqbvjbfcz mobkhg} tog qgmtiv ia tog ~vgi~gvbtjqg mivkgbcb}tjhebtj}e

Ja b }wvhgik }gcgmt} tog beiwkt ia tivjm JIC ~ixgv bkdbj} ~cbmgegkt fb}gd ik ~vgi~gvbtjqg `gvbtiegtvz# tog

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bk jkmj}jik tz~jmbccz jkdwmg} >87D ia }tgg~gkjkh bt 2?>Jhkivjkh tog }ojat jk bj} jkdwmgd fz tog jkmj}jik xiwcd~vidwmg b vg}jdwbc bkhwcbv gvviv ia b~~vijebtgcz >87D bttog mivkgbc ~cbkg bkd b~~vijebtgcz 2>>D bt tog ~cbkg iatog mb~}wcbv fbh Toj} tz~g ia iwtmieg ebz ki cikhgv fg}waflmjgktcz ~vgmj}g ti eggt mbtbvbmt ~btjgkt} g~gmtbtjik}

Ebv`jkh Tog Gzg

Tog ebv`jkh ~vimgdwvg j} dikg jk txi }tg~} fz w}jkh mwvvgktczbqbjcbfcg ebv`jkh `jt} /Ajhwvg 4#7 bkd Ajhwvg 1* Ajv}t# tog

}wvhgik ~cbmg} vgagvgkmg ebv`} bt tog =% bkd :%imcim`egvjdjbk} bt tog cjefw}# gjtogv jk tog I^D viie iv jk togIV Toj} }tg~ }oiwcd fg dikg xjto tog ~btjgkt }jttjkh w~vjhotti bqijd tog gaagmt ia mzmcivitbtjik xogk tog ~btjgkt eiqg}ti b }w~jkg ~i}jtjik aiv tog mbtbvbmt ~vimgdwvg Tog }wvhgiktogk ~gvaive} b }tbkdbvd mb~}wcivogj}# ozdvidj}}gmtjik#bkd ~obmigewc}jflmbtjik Batgv mbtbvbmt vgeiqbc# w}jkh togvgagvgkmg ebv`}# tog }wvhgik ~cbmg} bj} ebv`} ti dgcjkgbtgtog }tgg~ bj} ia b}tjhebtj}e w~ik xojmo tog JIC }oiwcd fgbcjhkgd

Bcjhkjkh tog Tivjm JIC xjto tog Bj}

^vgmj}gcz bcjhkjkh tog JIC xjto tog ~vgdgtgvejkgd bj} ia

~cbmgegkt jkqicqg} hvi}} bcjhkegkt# qj}migcb}tjm vgeiqbc#bkd flkbc bcjhkegkt /Ajhwvg 8#? bkd :* Tog flv}t immwv} batgvtog JIC} je~cbktbtjik fwt fgaivg jt ob} wkaicdgd awccz jktog mb~}wcbv fbh Tog JIC }oiwcd fg vitbtgd ti b ~ijkt tobtj} 27 ti 6> miwktgvmcim`xj}g ia tog flkbc bj} cimbtjik Tog}wvhgik ew}t gk}wvg tobt tog JIC dig} kit vitbtg fgzikd tog

Ajhwvg 4< Ebv`gv} aiv Tivjm JIC

Ajhwvg =< Bmvz]ia Tivjm JIC Mbcmwcbtiv


4/5

24 c DI] Tjeg} % Qic+ 28# Ki+ 6 Bwhw}t# 6>22

flkbc bj} dwvjkh tog qj}migcb}tjm} vgeiqbc Jt j} je~ivtbkt tivgeiqg bcc ia tog qj}migcb}tjm# jkmcwdjkh ik tog ~i}tgvjiv }jdgia tog cgk}# fgmbw}g vgekbkt} miwcd mbw}g vitbtjik ia tog JIC~i}ti~gvbtjqgcz

Togvg bvg qbvjiw} tgmokjrwg} bkd jk}tvwegktbtjik tobt b}wvhgik ebz w}g ti bmojgqg ~vgmj}g ik%bj} bcjhkegkt ia togJIC Iwv ~vgagvvgd tgmokjrwg j} ti w}g bk jvvjhbtjik ~ivt bkdbk JIC djbcgv)]jk}`gz oii` toviwho tog }jdg~ivt jkmj}jik tibmojgqg hvi}} bcjhkegkt Xg togk w}g tog JIC djbcgv ti oicd

Ajhwvg 7< Ebv`jkh ia tog Gzg

Ajhwvg 1< Vgagvgkmg# Ebv`}# Bxj} Ebv`}

Ajhwvg 8

Ajhwvg ?


5/5xxx+ di}ikcjkg+ivh c 27

tog je~cbkt jk ~cbmg xojcg xg vgeiqg tog qj}migcb}tjm xjtotog J)B tj~ Togk# xg w}g tog JIC djbcgv iv ]jk}`gz oii` ikmgbhbjk ti mbvgawccz kwdhg tog JIC jkti tog flkbc bcjhkegkt xjto

tog bj} Vghbvdcg}} ia xojmo }wvhjmbc tgmokjrwg b }wvhgikmoii}g} ti ge~ciz# tog ~vgmj}g bcjhkegkt ia tog JIC j} mvjtjmbcti bmojgqjkh gmgccgkt iwtmieg} xjto tog Tivjm JIC dwvjkh~i}ti~gvbtjqg ~gvjid /Ajhwvg 2>*

]wvhjmbc Iwtmieg} ! Vitbtjikbc ]tbfjcjtz

Tog cgk} ew}t vgebjk vitbtjikbccz }tbfcg xjtojk tog mb~}wcbvfbh ti ebjktbjk jt} qj}wbc ~gvaivebkmg Tog Bmvz]ia TivjmJIC vgebjk} }gmwvg jk tog mb~}wcbv fbh b} b vg}wct ia tog]tbfcgaivmg ob~tjm dg}jhk bkd tog bdog}jqg kbtwvg ia togbmvzcjm ebtgvjbc Tog je~ivtbkmg ia b cgk} }tbfjcjtz bkd cbm`ia vitbtjik xjtojk tog cgk} mb~}wcg mbkkit fg iqgv}tbtgd xjtovg}~gmt ti tog gaagmtjqgkg}} ia b tivjm JIC Aiv gqgvz 2 ia iaa%

bj} vitbtjik# ==' ia tog cgk} mzcjkdgv ~ixgv ebz fg ci}t Bt=> ia vitbtjik# tog ~ixgv ia tog JIC mzcjkdgv j} titbccz hikgMcgbvcz# tog bjbc bcjhkegkt ia b tivjm JIC dgtgvejkg} toggaflmbmz ia b}tjhebtjm mivvgmtjik# bkd tog }wvhjmbc ~cbmgegktia tog tivjm JIC }oiwcd fg b} bmmwvbtg b} ~i}}jfcg Dwvjkhtog gbvcz ~i}ti~gvbtjqg ~gvjid# JIC} ebz vitbtg xjtojk togmb~}wcbv fbh wktjc togz aive b fjibdog}jqg fikd xjto tog~i}tgvjiv mb~}wcg Tog Bmvz]ia ebtgvjbc bccix} toj} flbtjikti immwv }iik batgv tog JIC} je~cbktbtjik

Mie~cjmbtjik} Ebkbhgegkt

Bk jktbmt mb~}wcbv fbh mie~btjfcg xjto miktjkwiw} mwvqjcjkgbvmb~}wcitiez ~gvaivegd xjto jk%tog%fbh ~cbmgegkt ia togJIC vgebjk gtvgegcz mvwmjbc aiv }wvhgvz w}jkh tivjm JICMie~cjmbtjik} xjto tog tivjm JIC je~cbktbtjik bvg vbvg# bkd#

xogk togz di immwv# togz bvg gb}jcz ebkbhgd Ikg ~itgktjbc~vifcge j} tobt tog je~cbkt ebz vitbtg fgzikd tog dg}jvgdbj} ia bcjhkegkt dwvjkh tog vgeiqbc ia qj}migcb}tjm Jk}wmo mb}g}# tog }wvhgik mbk vg%jkstbtg tog mb~}wcbv fbh xjtobddjtjikbc qj}migcb}tjm# vg~i}jtjik tog je~cbkt ti bmojgqghvi}} bcjhkegkt# bkd togk ~vimggd toviwho tog vgebjkdgvia tog ~vimgdwvg ti bttbjk flkbc bcjhkegkt Jt j} je~ivtbkt tikitg tobt tog cgk} mbkkit fg gb}jcz vitbtgd miwktgvmcim`xj}gxjtoiwt tog vj}` ia dbebhjkh iv vj~~jkh tog mb~}wcbv fbh

Bkz gvviv} jk JIC ~ixgv mbcmwcbtjik} iv ej}bcjhkegkt ia togJIC dwvjkh }wvhgvz ebz kgmg}}jtbtg tog JIC} vg~i}jtjikjkhiv gmobkhg

]weebvz

Gmgccgkt vg}wct} mbk fg bmojgqgd xjto tog mwvvgktcz bqbjcbfcgtivjm JIC xjto ejkjebc eidjflmbtjik ti i~otobceicihj}t}}wvhjmbc tgmokjrwg ]gqgvbc tz~g} ia tivjm JIC} bvg mwvvgktczbqbjcbfcg# Oixgqgv# fgmbw}g ia vitbtjikbc }tbfjcjtz bkdbdqbkmgd JIC mbcmwcbtiv# tog Bmvz]ia tivjm cgk} gkbfcg}}wvhgik} ti mivvgmt b}tjhebtj}e ~vgmj}gcz bkd bmojgqgdj}tbkmg%qj}jik }~gmtbmcg avggdie aiv eivg ~btjgkt} Viwtjkgmbtbvbmt }wvhjmbc tgmokjrwg} bvg wtjcj|gd aiv tivjm JICje~cbktbtjik# gmg~t bmmwvbtg ebv`jkh ia tog gzg# bkd ~vgmj}gbcjhkegkt ia tog JIC xjtojk tog mb~}wcbv fbh

Mieegkt}

Jktgvg}tgd vgbdgv} mbk qjgx }wvhjmbc qjdgi bt aiccixjkh cjk`}/b* Bmvz]ia Tivjm JIC Je~cbktbtjik ott~>?0=4>802?>?0=4>?0=428+1+ \wfgvfwocgv F# ]jhkgv T# Hbcg V# Obgstjhgv G+ Vitbtjikbc }tbfjcjtz ia

tog Bmvz]ia ]B1>TT tivjm jktvbimwcbv cgk}g}< b mioivt }twdz+ FEM

I~otobceic+ 6>>?0?8%

2?+

Ajhwvg ?

Ajhwvg :

pearls for toric iol implantation during cataract surgery dr suresh k pandey, suvi eye institute &...

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