William F. Maloney

Crack and flip phacoemulsification technique

ABSTRACT The crack and flip phacoemulsification technique combines the advantages of circumferential division of the nucleus and nucleofractis techniques. As such, it adds safety and control to the procedure. We describe each of the surgical maneuvers, including machine settings, and explain the rationale for maneuvers and machine settings.

Astigmatism control for the cataract surgeon: A comprehensive review of surgically tailored astigmatism reduction (STAR)

ABSTRACT It is increasingly possible for the cataract surgeon to control astigmatism. Based on a review of 4,000 consecutive patients, three categories of astigmatism and cataract patients are identified. A specific approach to astigmatism control for each category is discussed. Preliminary results on the use of astigmatic keratotomy in conjunction with cataract surgery are presented.

Synthetic cataract teaching system for phacoemulsification

ABSTRACT This paper describes a surgical training system for teaching and practicing the necessary skills to perform phacoemulsification, endocapsular phacoemulsification, and small incision intraocular lens insertion techniques. The surgical system includes head, bilateral globes, removable corneas, and replaceable synthetic cataracts of varying density. This synthetic system simulates ocular surgery more closely than previously used animal eyes and allows the surgeon to practice new techniques in laboratory courses and in the operating facility.

Universal small incision for cataract surgery

ABSTRACT The goal of small incision cataract surgery is to perform the entire procedure, cataract removal and intraocular lens insertion, through the smallest incision possible. Ideally the incision would be 3.0 mm in length, but because of practical considerations, a slightly larger wound is typically used. We describe a universal trapezoidal wound that is astigmatically neutral and provides the benefits of the ideal 3.0 mm incision, but allows the use of any small incision lens requiring an incision of 5.2 mm or less.

Transverse astigmatic keratotomy An integral part of small incision cataract surgery

ABSTRACT Transverse astigmatic keratotomy (TAK) is used with an astigmatically neutral wound to control against‐the‐rule astigmatism. Previously both wound manipulation and TAK have been used to alter astigmatism, but with the advent of astigmatically neutral small incision surgery, astigmatism control involves TAK alone. This paper discusses the TAK approach to astigmatism control and includes a nomogram for incision size.

Tutorial in Phaco-emulsification

Summary This three-step approach to emulsification provides maximum corneal protection because it is undertaken entirely within the posterior chamber, and all emulsification progresses away from the endothelium. Complete loosening of the nucleus before final removal prevents the most common error in phacoemulsification: getting painted into a corner with no means to remove the less accessible nuclear remnant. Finally, while actively emulsifying, the tip is always well centred in the middle of the anterior chamber where visualization is best and the chamber is deepest. The guiding principles for a posterior chamber phaco-emulsification are: (1.) Phaco-emulsify only where you can see clearly and where you are in full control; (2.) Phaco-emulsify only from top to bottom; one sculpts progressively away from the corneal endothelium. Never phaco-emulsify from beneath where the nuclear portion above may come in contact with the endothelium; (3.) Always keep the nucleus in one piece and never get stuck with uncontrollable partial nuclear remnants; (4.) When sculpting, utilize the principle of an ice cream scoop in hard ice cream—that is, take shallow, progressively deeper bites; (5.) Never use position three unless you are ready to phaco-emulsify some nuclear material.