Phacodynamics: Mastering the Tools and Techniques of Phacoemulsification Surgery, Fourth Edition

Barry S. Seibel, MD

  • $229.95
  • ISBN 10 1-55642-688-7
  • ISBN 13 978-1-55642-688-9
  • 400 pp Hard Cover
  • Pub. Date: 2005
  • Order# 66887

What surgical advancements have spawned from the evolution of phaco technology? Join the thousands of surgeons who have utilized Phacodynamics: Mastering the Tools and Techniques of Phacoemulsification Surgery for over 20 years to understand and benefit from the advantages of phaco technology.

The revised, expanded, and updated Fourth Edition of this classic text includes over 300 simple, yet elegant, figures and illustrations detailing the latest machine technologies and surgical techniques.

In addition to examining the intricate relationship between the surgeon and the phaco machine, Dr. Barry Seibel profiles how the most recent advancements in machine technology can enhance your surgical procedures and optimize your results. With schematic figures and illustrations to accompany the detailed descriptions, surgeons can readily identify and distinguish between various flow pumps, vacuum pumps, and ultrasound power modulations. Surgery can then be customized moment by moment for each individual patient to maximize safety and efficacy.

New topics included that are unique to this Fourth Edition:

  • Bimanual Microincision Phaco
  • Ultrasound Power Modulations including Burst and Pulse Modes
  • AquaLase and Laser Surgical Technologies
  • Expanded Horizontal Chopping Techniques including PreChop
  • Vertical Chopping Techniques and Instrumentation
  • Bimanual Irrigation and Aspiration
  • Phacodynamic Complications
  • Phacodynamics of Surgical Instrument Design

Phacodynamics, Fourth Edition utilizes a simplified approach to explain all the latest advancements in phaco technology and surgery and should be in the hands of all surgeons practicing in this specialized area.

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 One: 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 Two: 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 Three: 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 Four: 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 Five: 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 Six: 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

Reviews of previous editions:

"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."

— Frederick S. Brightbill, MD Archives of Ophthalmology

"The other books tell you what to do. This book tells you why and how. The illustrations are superb, demonstrating clearly how phacoemulsification works and why some maneuvers must, necessarily, work better than others. This book is critical if you want to master the art and science of phacoemulsification."

— Paul S. Koch, MD, Koch Eye Associates, Warwick, RI

"This book will be utilized best by that cataract surgeon who wants to truly understand the technology that he holds in his hands. I am sure that this added level of comprehension would easily enhance any cataract surgeons capabilities."

— Leonid Skorin, Jr., MD, DO, FAOCO, Journal of the Osteopathic College of Ophthalmology and Otorhinolaryngology

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