Cataract Surgical Curriculum
A. END OF FIRST YEAR - BEGINNER
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2. Describe steps in cataract surgery
- d.Mastering Phacoemulsification: A Simplified Manual of Strategies for the Spring, Crack, and Stop & Chop Technique
- e.The Moss Technique for Draping
- f. Orbis Phacoemulsification Training Course
- g.AAO Videos: Steps of Phacoemulsification
- h.Divide and Conquer Nucleofractis Phacoemulsification
- i.Chip and Flip Phacoemulsification
- j. The Veronica Technique for Draping
- k. Povidone-iodine prep
- l. How to drape
3. Prepare IOL for injection
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b. The Unfolder Silver and Gold Series Implantation Systems – Instructions for Use – Allergan
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g. Monarch II IOL Delivery System – Closed-System Delivery – Acrysof
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h. Monarch II IOL Delivery System – One Step, In-the-Bag Implantation Using Single Piece IOL – Acrysof
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4. Set up and use microscope, function of knobs
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5. Place, ties, and bury knot, single 10-0 nylon suture
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6. Discuss timing, technique, complications YAG / posterior capsulotomy
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a.A Prospective Study of Cystoid Macular Edema after NeoDymiun: YAG Laser Posterior Capsulotomy
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d.Rhegmatogenous Retinal Detachment after YAG Laser Posterior Capsulotomy
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e.Incidence of Retina Detachment after Cataract Surgery and NeoDymium: YAG Laser Capsulotomy
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f.Diagnostic and Surgical Techniques: Use of Nd:YAG Laser Capsulotomy
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h.Risk Factors for Retinal Detachment after Cataract Surgery – A Case Control Study
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m.A Systematic Overview of the Incidence of Posterior Capsule Opacification
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r. Posterior opacification incidence and yag rates for ZCB00 and SA60AT
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s. Factors for posterior capsule opacification after phacoemulsification
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x. Retinal detachment after uncomplicated phaco and yag capsulotomy
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y. Rate of retinal detachment after phaco and yag capsulotomy
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7. Setup YAG
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8. Perform YAG / posterior capsulotomy
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9. Prep and drape for cataract surgery
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10. Scrub tech for third year resident
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11. Wet-lab suturing, incisions, phaco, IOL injection
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12. Practice Capsulorhexis and Cataract Surgery Using Pig Eyes
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13.Optimizing Resident Education
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14. Surgical Training of Ophthalmology Residents
B. END OF SECOND YEAR – ADVANCED BEGINNER
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1. Perform five uncomplicated phaco < 45 minutes using two hands
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2. Describe anatomy for regional anesthesia, retrobulbar, and peribulbar
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3. Perform regional anesthesia
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4. Describe anatomy of lens, capsule, zonules, sulcus
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a.The Relationship between the Stretching Capability of the Anterior Capsule and Zonules
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b.Analysis of Zonular-Free Zone and Lens Size in Relation to Axial Length of Eye with Age
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d.The Elastic Properties of the Lens Capsule in Capsulorhexis
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f.Ideal Size of an Intraocular Lens for Capsular Bag Fixation
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5. Signs of weak zonules or posterior capsule rupture
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6. Extracapsular cataract extraction
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7. Techniques for Hyrdodissection & Hydrolineation
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8. Describe biometry for IOL calculation
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a.Theoretical Approach to Intraocular Lens Calculation using Gaussian Optics
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g.Cataract Extraction after Silicone Oil Repair of Retinal Detachments Due to Necrotizing Retinitis
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i.Holladay: A Three-Part System for Refining Intraocular Lens Power Calculations
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j.Development of the SRK / T Intraocular Lens Implant Power Calculation Formula
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k.Comparison of the SRK /T Formula and Other Theoretical and Regression Formulas
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l.Posterior Corneal Curvature and its Influence on Corneal Dioptic Power
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o.Accuracy of the Newer Generation Intraocular Lens Power Calculation Formula in Long and Short Eyes
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q.IOL Intraocular Lens Power Calculations. Advanced A-Scan Techniques
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w. Haigis-L
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aa. +3.50 diopters surprise after phaco and pcIOL and IOL calculations
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bb. IOLMaster and different formulas for short axial lengths
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cc. Optical biometry and IOL calculations with different formulas for different axial lengths
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dd. Optimizing IOL calculations in eyes with axial lengths greater than 25 mm
- ee. IOL Calculations using the IOLMaster in eyes with long axial lengths and various formulas
- ff. Comparison of 9 IOL calculation formulas
- gg. IOL power calculation for eyes with axial lengths greater than 26 mm
- 9. Current Status of IOL Formulas
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10. Difficult IOL Calculations
- 11. Diagnosing and Treating Dry Eyes Prior to Cataract Surgery
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12.IOL calculation with silicone oil
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13. Describe anterior vitrectomy
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14. Describe use of capsular dye
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b.Trypan Blue Capsule Staining to Visualize the Capsulorhexis in Cataract Surgery
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c.Staining of the Lens Capsule for Circular Continuous Capsulorhexis in Eyes with White Cataract
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e.Biomechanical Changes in the Anterior Lens Capsule after Trypan Blue Staining
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h. Figures 1, 2
- i. Trypan Blue and Capsule Rigidity and Strength
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15. Describe physics of capsulorhexis
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16. Describe physics of clear corneal incisions with keratomes
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17. Phacodynamics – Seibel
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18. Understand coding for cataract surgery including complex and anterior vitrectomy
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19. Describe clinical grading of cataracts, nuclear, posterior subcapsular, cortical
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20. Dense and Mature Cataracts, Affect on Pupil Response in Contralateral Eye
21. Grading of anterior segment inflammation
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22. Corneal endothelial cell loss and phacoemulsification
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23. Posterior Vitreous Detachment and Retinal Detachment After Phacoemulsification
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24. Phacoemulsification Needles, Sleeves, and Wound Size
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25. Hydration of Incisions
- 26. Non-steroidals and macular thickness After Phacoemulsification
- a. Nepafenac, VA, CMA and Routine Phacoemulsification
- b. Nepafenac, Ketorolac, CME in Routine Phacoemulsification
- c. Meta analysis of prevention of postop macular thickness
- d. Nepafenac + dexamethasone vs dexamethasone + placebo
- e. OCT macular thickness after phaco, NSAID vs no NSAID
- 27. Big Data and Cataract Surgery
- a. Risk Factors and Incidence of Macular Edema after Cataract Surgery: A Database Study of 81984 Eyes
- b. Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery.
- c. United Kingdom National Ophthalmology Database Study of Cataract Surgery: Report 3: Pseudophakic Retinal Detachment
- d. The Cataract National Dataset electronic multicentre audit of 55567 operations: risk stratification for posterior capsule rupture and vitreous loss
- e. Big Data Cataract Summary
C. END OF THIRD YEAR – PROFICIENT
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1. Five uncomplicated phacos < 30 minutes using two hands
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2. Describe Himalayan cataract surgery technique for extracapsular surgery
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3. Describe OVD selection, properties
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4. Describe IOL selection, material, size, one-piece, three-piece
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b.Loop Memory of Haptic Materials in Posterior Chamber Intraocular Lenses
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c.The Capsular Bag after Short- and Long-term Fixation of Intraocular Lenses
- f. Glistenings
- g. positive and negative dysphotopsia
- h. negative dysphotopsia
- i. IOL surfaces and postoperative glare
- j. edge glare and IOL designs
- k. postoperative glare and IOL designs
- l. Shedding light on dysphotopsias
- m. Aspheric IOL selection
- n. Aspheric IOL selection and wavefront topography
- o. Management of negative dysphotopsia
- p. Positive and negative dysphotopsias 2
- q. IOL decentration and tilt
- r. IOL material and design
- s. History of the posterior chamber IOL
- t. Negative Dysphotopsia - A perfect storm
- u. Preventative approach for negative dysphotopsia
- v. IOL glistening size and visual acuity
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5. Specialty Intraocular Lenses
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a. Toric IOL
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f. Outcome of toric IOL after adjusting for ADC and IOL spherical equivalent
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l. Contribution of posterior corneal astigmatism to total corneal astigmatism
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m. Correcting astigmatism with toric IOLs and posterior corneal astigmatism
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n. Astigmatism and meridian with total corneal power, simulated keratometry, and automated keratometry
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o. Surgeons strive for refractive stability with no astigmatism after cataract surgery
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y. Corneal thickness profile and posterior corneal astigmatism in normal corneas
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dd. Low and moderate-high astigmatic correction with toric IOLs
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ee. A New Method for analyzing vectors for changes in astigmatism
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kk. Toric IOL orientation and residual refractive astigmatism
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nn. New toric IOLs
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oo. Toric IOL orientation and residual refractive astigmatism
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qq. Clinical considerations of Symfony extended depth of focus IOL
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6. Intumescent Cataract
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7. Anticoagulation and Cataract Surgery
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8. Describe IFIS, pathophysiology, incidence management
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a.Intraoperative Floppy Iris Syndrome Associated with Tamsulosin
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c.α1-Adrenergic Receptor Antagonists and the Iris: New Mechanic Insights into Floppy Iris Syndrome
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d.α1-Adrenergic Antagonists and Floppy Iris Syndrome: Tip of the Iceberg?
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e.ASCRS White Paper: Clinical Review of Intraoperative Floppy-Iris Syndrome
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k. Intracameral ketorolac and phenylephrine effects on pupil diameter and postop pain
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9. Understand phacoemulsifier settings
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10. Understand phacoemulsifier output
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a.Surge
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11. Incision(wound) burn
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12. Perform IOL biometry with ultrasound and manual keratometry and IOL Master
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13. Describe vertical and horizontal chopping techniques
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14. Techniques for emulsification of hard cataracts
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15.Techniques for emulsification of soft nuclei
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16. Describe the use of iris expansion devices
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b. Iris Hooks
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c.Morcher Capsular Tension Rings – Normal, Myopic, Highly Myopic – Morcher GmbH
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d. Malyugin Ring
- e. Injector for Morcher Pupil Dilator – Geuder
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17. Capsular tension rings
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18. Fate of anterior capsule radial tears
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19. Dislocated Dense Cataract
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20. Understand anterior vitrectomy techniques
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21. Management of the posteriorly dislocated nucleus
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f. Management of Retained Lens Fragments After Phacoemulsification
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g. Pars plana vitrectomy for management of retained lens material
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h. Management of retained lens fragments with and without pars plana vitrectomy
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22. Retained Lens Fragments Anterior
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23. Cataract surgery after pars plana vitrectomy and/or intravitreal injections
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24. Cataract surgery and ARMD
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25. Lens Iris Diaphragm Retropulsion Syndrome
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a. LIDRS
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- 26. Aqueous Misdirection
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27. Cataract surgery and Fuchs' dystrophy
- 28. Pseudoexfoliation and Phaco
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29. Describe anterior and posterior positive pressure
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30. Describe issues and technique for IOL placement into sulcus
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b.Secondary Placement of Posterior Chamber Intraocular Sulcus Fixed and Scleral Sutured
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e.Scleral Fixation (Reverse Scleral Pocket) Without Conjunctival Dissection
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f.Scleral Pockets Sutured pcIOL(Video, Dr. Christopher Riemann, Cincinnati Eye Institute)
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g.Scleral Pockets Sutured pcIOL(Video, Dr. Kenneth Cohen, UNC)
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h.Scleral Fixation Using Suture Retrieval Through a Scleral Tunnel
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j.Reverse Scleral Pocket IOL Fixation and Iridoplasty:http://www.youtube.com/watch?v=O7BJEnJGHfQ
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31. Implantation of Anterior Chamber IOL
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32. IOL Dislocations
- 33. Reversed Optic IOL
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34. Siepsor slipknot for iris repair & iris fixation of subluxated IOLs
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35. IOL Explantation
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36. Techniques for posterior polar cataracts
- 37. Cataract operation in the small eye
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38. Toxic anterior segment syndrome
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39. Astigmatism management in cataract surgery
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40. Femto second laser assisted cataract surgery
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e. Meta-analysis of saftey and efficacy of femtosec vs manual cataract surgery
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f. Femtosecond laser arcuate keratotomy and corneal astigmatism and aberrations
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g. Vitreous loss manual versus femtosecond laser phacoemulsification
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h. Femtosecond laser versus standard phacoemulsifcation outcomes and saftey
- 41. Postoperative Endophthalmitis