Amar Agarwal, MS, FRCS, FRCOphth, pioneered phakonit, which is phako with needle incision technology. This technique was popularized as bimanual phaco, microincision cataract surgery, 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 as well as FAVIT, a new technique for removing dropped nuclei. The air pump, which was a simple idea of using an aquarium fish pump to increase the fluid in the eye in bimanual phaco and coaxial phaco, has helped prevent surge, which became the basis for various techniques that involve forced infusion for small incision cataract surgery.
Dr. Agarwal also discovered a new refractive error called aberropia. He was the first to perform a combined surgery of microphakonit (700-micron cataract surgery) and a 25-gauge vitrectomy in the same patient, thus using the smallest incisions possible for cataract surgery and vitrectomy. He was also the first surgeon to implant a new mirror telescopic intraocular lens (IOL), the Lipshitz macular implant, for patients suffering from age-related macular degeneration.
Dr. Agarwal was the first in the world to implant a glued IOL, in which a posterior chamber IOL is fixed in an eye without any capsules using fibrin glue. The Malyugin ring for small-pupil cataract surgery was also modified as the Agarwal modification of the Malyugin ring for miotic pupil cataract surgeries with posterior capsular defects. Dr. Agarwal’s Eye Hospital performed the first anterior segment transplantation in a 4-month-old child with anterior staphyloma. He also pioneered 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 capsular ruptures. Dr. Agarwal combined glued IOL and IOL scaffold in cases of posterior chamber rupture, in which there is no iris or capsular support, and termed the technique glued IOL scaffold. Doctors at Dr. Agarwal’s Eye Hospital also performed the first glued endocapsular ring in a case of subluxated cataract.
Pre-Descemet’s endothelial keratoplasty (PDEK) was created by Dr. Agarwal. In this technique, the pre–Descemet’s layer and Descemet’s membrane with endothelium are transplanted en bloc in patients with a diseased endothelium. Doctors at Dr. Agarwal’s Eye Hospital performed the first contact lens-assisted collagen crosslinking (CACXL), a new technique for crosslinking thin corneas. He has also worked on E-DMEK, in which an endoilluminator is used to assist in DMEK surgeries. Dr. Agarwal designed a new instrument called the trocar anterior chamber maintainer, which helps provide infusion through the anterior chamber and works like a trocar cannula.
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, the American Academy of Ophthalmology, and the European Society of Cataract and Refractive Surgeons. He has also written more than 60 books, which have been published in various languages, including English, Spanish, and Polish. He also trains doctors from all over the world on phaco, bimanual phaco, LASIK surgery, and retinal surgery. He is Chairman and Managing Director of Dr. Agarwal’s Group of Eye Hospitals, which has 60 eye hospitals all over the world.
