Dr. Seibel’s Book

Phacodynamics, Fourth Edition!

WORLD-RENOWNED TEXTBOOK ON CATARACT SURGERY WRITTEN AND ILLUSTRATED BY: DR. BARRY SEIBEL

Dr. Seibel’s textbook, Phacodynamics, is a result of his commitment to innovation and excellence in eye surgery. An international bestseller on the subject of cataract surgery, Phacodynamics explains in fine detail the methods and motivations behind each and every step for achieving ultimate individualization of refractive surgery. Dr. Seibel pioneered this specialized method of study to help surgeons develop a deeper understanding of the fundamental surgical principles, as well as the minute details of phaco-machine technology.

Over 300 informative figures and illustrations
Learn the latest machine technologies and surgical techniques
Identify and distinguish between flow pumps, vacuum pumps, and ultrasound power modulations
Customize surgery for each patient

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Four Editions In Five Languages

Dr. Seibel's Cataract Surgery Textbooks Through the Years and Around the World

Only a small fraction of I% of all doctors are leading experts in their field to the extent of publishing a textbook on their subject of expertise. As rare as this accomplishment is, however, according to medical book publisher John Bond, most books are •one and done•, meaning that it is relatively uncommon for books to be so popular and enduring that they merit a second edition; more than 2 editions are particularly scarce. Similarly, only a small percentage of textbooks are translated into even one other language. Especially uncommon in a major medical textbook is having it authored (and extremely rarely illustrated) by a single physician, as most textbooks of this type are written by many different doctors with the book cover listing the doctor who edited the book.

At four editions, four translations, and sole authorship (and illustrations), Dr. Seibel’s textbook Phacodynamics bas been one of the most unique, popular and important books in the field of modern cataract surgery. With a signature style of illustration and distinctive engineering perspective, it explains the complex technology and principles of cataract surgery in a logical fashion that facilitates Custom Cataract Surgery to provide the safest, gentlest, and most effective operation for each individual patient. According to industry-leading medical publisher SLACK, it is the number one selling cataract surgery textbook in the history of their company, having helped thousands of surgeons to provide better care to millions of patients worldwide.

FROM THE PUBLISHER:

“Dear Dr. Seibel:

I wanted to follow up on the release of your new edition of “PHACODYNAMICS: Mastering the Tools and Techniques of Phacoemulsification Surgery, Fourth Edition.” The release of the book was another success for you!

Over the years, your books have a had a tremendous impact on ophthalmology and all of cataract surgery. PHACODYNAMICS has become the bible for ophthalmologists worldwide. Your signature style of illustration along with your unique presentation of clinical material, surgery, and technology make it a one-of-a-kind for cataract surgery, and medicine.

The sales of the book through the last 12 years continues to be great. It ranks as one of the top books ever in the history of our company for ophthalmology and is number one for cataract surgery!

I believe you are the only author in the history of ophthalmology to have been both the sole author and illustrator of a textbook like yours, let alone into four editions!

You should be proud of the international acclaim the book has and how you have helped countless surgeons to perform cataract surgery better on tens of millions of patients world wide. Thanks for your time, expertise, and attention to detail and education. The profession and medicine are better for it.”

– John Bond, Vice President
SLACK Incorporated Book Publishing

REVIEWS:

“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

“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

“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

“As in the previous editions, Dr. Seibel demonstrates his unique gift for being able to simplify complex engineering concepts to a clinically understandable and practical level. His signature style of illustration gives us stepwise visual tools to understand what is otherwise happening too rapidly in real time.”

– David F. Chang, M.D.

Phacodynamics: Mastering the Tools and Techniques of Phacoemulsification Surgery, Fourth Edition has been completely revised and substantially expanded to include detailed descriptions and illustrations of the latest machine technologies and surgical techniques available today.

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

This new edition not only covers the most up-to-date technology but is enhanced by improved schematic graphics, illustrations, and descriptions.

In addition to examining the intricate relationship between the surgeon and the phaco machine, this book provides an in-depth analysis of the basic mechanical physics of the surgical maneuvers and equipment as they combine to produce the best possible results.

The focus on technology centers on the relationships among flow rate, rise time, vacuum, and ultrasonics, as well as many other key surgical concepts. It details such topics as: machines, including a schematic machine; ultrasound; phaco tip angles; phaco needle dimensions and shapes; the logic behind setting machine parameters; and individual phaco techniques. Current information is provided on equipment and accessories, including new pumps such as the rotary vane pump and the scroll pump. For the first time, pumps are divided into flow-based and vacuum-based categories and then compared and contrasted for a better understanding. No matter which technique is used, this book leads you through each surgical situation with comprehensive clarity to demonstrate what the next step should be.

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SECTIONS INCLUDE:

Machine Technology
Logic of Setting Machine Parameters
Overview of Phacoemulsification Techniques
Irrigation and Aspiration Techniques
Physics of Capsulorhexis

SPECIAL FEATURES:

Completely updated and expanded to reflect all the latest techniques and technology.
Description of ultrasonics including new tip designs, styles, sizes, and the effects on fluidics.
Includes a detailed look at the clinical application of fluidics.
Detailed description and logic of chopping techniques including Dr. Nagahara’s Chop Technique and the Seibel Chopper.
Explains why to use specific methods.
Categorizes and compares flow-based and vacuum-based pumps.
Discussion and illustrations of ultrasound relating to nuclear density.
Enhanced schematic graphics, illustrations, and descriptions.
Includes a total of 133 color illustrations.

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 Phacoemulsification Techniques

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
901/4 and 451/4 IA Tips
Bimanual Irrigation and Aspiration
Using the IOL to Help Remove Cortex
Epinuclear Mobilization via Cortical Pulley

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 Five: Physics Of Capsulorhexis

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