More Phaco Nightmares: Conquering Cataract Catastrophes

Amar Agarwal, MS, FRCS, FRCOphth
ISBN 10:
ISBN 13:
Publication Date:
Item Number:
Product Dimensions:
7.00 x 10.00 x 1.50 inches

eBook Available:

Amazon Kindle

Book Description

Even the most experienced cataract surgeon can encounter stressful situations in the operating room.  With the new edition of More Phaco Nightmares: Conquering Cataract Catastrophes, surgeons can be prepared to manage unavoidable complications with ease.

Dr. Amar Agarwal, along with over 35 of today’s cataract surgery leaders, explain all there is to know about phacoemulsification and bring their extensive experience with their own surgical nightmares. The book contains 5 sections that gradually escalate from the basics to nightmares, furnishing phaco surgeons with complicated scenarios and the essential guidance to assess, manage, and resolve.

Featuring updated content and brand new, state-of-the-art chapters on a variety of complex situations, More Phaco Nightmares is the toolkit surgeons need to stay in control when facing unique and especially challenging intra- and postoperative complications.
Sample chapters include:
  • The Phaco Machine
  • Air Pump, Gas-Forced Infusion, and Active Fluidics
  • Intraoperative Floppy Iris Syndrome
  • Single-Pass Four-Throw Pupilloplasty
  • Management of Capsule Rupture at Cataract Surgery
  • Malpositioned Intraocular Lens
  • Optic Capture
  • Glued Intraocular Lens
  • Management and Prevention of Negative Dysphotopsia
  • Pseudophakic Cystoid Macular Edema
More than 350 illustrations and photographs supplement the text, providing visual as well as textual references for each case. Plus, an accompanying video website contains over 4 hours of new, original, high-quality video content, offering additional visual learning to demonstrate the techniques discussed.
Offering cutting-edge information, More Phaco Nightmares: Conquering Cataract Catastrophes will guide surgeons on how to mitigate the common problems and unanticipated disasters that may arise for even the most experienced surgeons.

More Information



Website Contents


About the Editor

Contributing Authors


Foreword by Elizabeth Yeu, MD

Section I            Phaco: Machine and Technique

Chapter 1              The Fluidics and Physics of Phaco

Barry S. Seibel, MD

Chapter 2              The Phaco Machine

William J. Fishkind, MD, FACS

Chapter 3              Air Pump, Gas-Forced Infusion, and Active Fluidics

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 4              Preparing for the Transition to Phacoemulsification

Samuel Boyd, MD; Cristela F. Aleman, MD; and Benjamin F. Boyd, MD

Section II          Difficult Cases

Chapter 5              Astigmatism in Cataract Surgery

Jennifer Loh, MD, and William Trattler, MD

Chapter 6              Pediatric Cataract Surgery

Rupal H. Trivedi, MD, MSCR, and M. Edward Wilson, MD

Chapter 7              Small Pupil

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 8              Intraoperative Floppy Iris Syndrome

Bryan S. Lee, MD, JD, and David F. Chang, MD

Chapter 9              Posterior Polar Cataracts

Khoa Pham, MD; Sanjay Kedhar, MD; and Sumit (Sam) Garg, MD

Chapter 10            Subluxated Cataract

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 11            Phacoemulsification in White Cataract

Abhay R. Vasavada, MS, FRCS (England); Vaishali Vasavada, MS; and Samaresh Srivastava, DNB

Chapter 12            Iris Reconstruction

David T. Truong, MD, and Kevin M. Miller, MD

Chapter 13            Single-Pass Four-Throw Pupilloplasty

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 14            Combined Cataract and Glaucoma Surgery

Kevin R. Tozer, MD, and Thomas W. Samuelson, MD

Section III        Posterior Capsule Rupture: What Next?

Chapter 15            Trocar Anterior Chamber Maintainer: An Improvised New Concept of Infusion

Amar Agarwal, MS, FRCS, FRCOphth, and Priya Narang, MS

Chapter 16            Management of Capsule Rupture at Cataract Surgery

Steve Charles, MD

Chapter 17            Intraocular Lens Scaffold

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 18            Dropped Nucleus

Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 19            Malpositioned Intraocular Lens

Ashvin Agarwal, MBBS, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 20            Posterior Capsule Rupture and Posterior Polar Cataracts

Samaresh Srivastava, DNB, and Abhay R. Vasavada, MS, FRCS (England)

Section IV         Intraocular Implantation in Eyes With Deficient Capsules

Chapter 21            Optic Capture

Thomas A. Oetting, MS, MD

Chapter 22            Iris Suturing of an Intraocular Lens

Yassine Daoud, MD, FACS, and Walter J. Stark, MD

Chapter 23            Scleral-Fixated Intraocular Lens

Daniel C. Terveen, MD, and John P. Berdahl, MD

Chapter 24            Glued Intraocular Lens

Athiya Agarwal, MD, DO, FRSH, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 25            Flanged Intrascleral Intraocular Lens Fixation With Double-Needle Technique

Shin Yamane, MD, PhD

Section V           Miscellaneous

Chapter 26            Complications of Femtosecond Laser–Assisted Cataract Surgery

Soosan Jacob, MS, FRCS, DNB, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 27            Bullous Keratopathy Managed With Endothelial Keratoplasty Including Pre-Descemet’s Endothelial Keratoplasty

Dhivya Ashok Kumar, MD, FICO, FAICO, and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 28            Management and Prevention of Negative Dysphotopsia

Samuel Masket, MD, and Nicole R. Fram, MD

Chapter 29            Pseudophakic Cystoid Macular Edema

J. Fernando Arevalo, MD, FACS; Carlos F. Fernandez, MD; and
Fernando A. Arevalo, BS

Chapter 30            Postoperative Endophthalmitis, Toxic Anterior Segment Syndrome, and Other Postoperative Inflammatory Syndromes

Michael N. Cohen, MD, and Andre J. Witkin, MD

Chapter 31            Vitrectomy-Assisted Phacoemulsification

Ashvin Agarwal, MBBS, MS; Priya Narang, MS; and Amar Agarwal, MS, FRCS, FRCOphth

Financial Disclosures


About the Editors

Amar Agarwal, MS, FRCS, FRCOphth, is the pioneer of phakonit, which is phaco with needle incision technology. This technique became popularized as bimanual phaco, microincision cataract surgery (MICS), or microphaco. He was the first to remove cataracts through a 0.7-mm tip with the technique called microphakonit. He also discovered no-anesthesia cataract surgery and FAVIT, a new technique to remove dropped nuclei. This technique is now called sleeveless phaco tip–assisted levitation (SPAL). The air pump, which was a simple idea of using a fish aquarium pump to increase the fluid into the eye in bimanual phaco and co-axial phaco, has helped prevent surge. This built the basis of various techniques of forced infusion like active fluidics for small incision cataract surgery. He also discovered a new refractive error called aberropia. He was also the first to do a combined surgery of microphakonit (700-micron cataract surgery) with a 25-gauge vitrectomy in the same patient, thus having the smallest incisions possible for cataract and vitrectomy. He was the first surgeon to implant a new mirror telescopic IOL (Lipshitz macular implant) for patients suffering from age-related macular degeneration. He was the first in the world to implant a glued IOL. In this, a PC-IOL is fixed in an eye without any capsules using fibrin glue. The Malyugin ring for small pupil cataract surgery was also modified by him as the Agarwal modification of the Malyugin ring for miotic pupil cataract surgery with posterior capsular defects. Dr. Agarwal’s Eye Hospital also did the first anterior segment transplantation in a 4-month-old child with anterior staphyloma. Dr. Agarwal has brought out the technique of IOL scaffold, in which a 3-piece IOL is injected into an eye between the iris and the nucleus to prevent the nucleus from falling down in posterior capsule ruptures. He has combined glued IOL and IOL scaffold in cases of posterior capsule rupture where there is no iris or capsular support and termed the technique glued IOL scaffold. Dr. Agarwal’s Eye Hospital also did a glued endocapsular ring in cases of subluxated cataract for the first time.
Pre-Descemet’s endothelial keratoplasty (PDEK) was initiated by Dr. Agarwal. In this, the pre-Descemet’s layer and the Descemet’s membrane with endothelium are transplanted en bloc in patients with diseased endothelium. Dr. Agarwal’s Eye Hospital first did contact lens–assisted collagen cross-linking (CACXL), a new technique for cross-linking thin corneas, and they have also worked on E-PDEK, in which an endoilluminator is used to assist in PDEK surgeries. Dr. Agarwal designed the new instrument called the trocar anterior chamber maintainer, now in complicated cases, which helps give infusion through the anterior chamber and works like a trocar cannula. He also started a new technique of iris suturing called single-pass four-throw (SFT) pupilloplasty. This is used for closed-angle glaucoma and for mydriatic cases.
He was the principal investigator for the Bausch & Lomb study in the first human eyes using hypersonic vitrectomy with Vitesse. The first 20 surgeries of posterior vitrectomy were done at Dr. Agarwal’s Eye Hospital. He was also the first in the world to use hypersonic vitrectomy with the Vitesse for a case of posterior capsule rupture with nuclear fragments. He did an anterior vitrectomy, posterior vitrectomy, and nuclear fragment removal with the same Vitesse 23-gauge probe.
Dr. Agarwal has performed more than 150 live surgeries at various conferences. His videos have won many awards at the film festivals of the American Society of Cataract and Refractive Surgery, American Academy of Ophthalmology, and European Society of Cataract and Refractive Surgeons. He has also written more than 75 books, which have been published in various languages (English, Spanish, and Polish). In his center, he trains doctors from all over the world on phaco, glued IOL, LASIK, and retinal surgeries. He is the chairman and managing director of Dr. Agarwal’s Group of Eye Hospitals, which has 75 eye hospitals across 14 countries all over the world. He can be contacted at The website of the hospital is