mkdir -p /home/daytona/workspace/cataract-ppt && ls /home/daytona/workspace/cata…

~/cataract-ppt/cataract_ppt.js

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pres.title = "Management of Cataract: ECCE and SICS";
pres.author = "Ophthalmology";

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// ═══════════════════════════════════════════════════════════════════
//  SLIDES START HERE
// ═══════════════════════════════════════════════════════════════════

// 1. TITLE
titleSlide(
  "Management of Cataract\nECCE & SICS",
  "Extracapsular Cataract Extraction and Manual Small Incision Cataract Surgery"
);

// 2. OVERVIEW / OUTLINE
contentSlide("Overview", [
  "Cataract is the leading cause of reversible blindness worldwide",
  "Surgery is the only definitive treatment - no proven medical therapy exists",
  "Two major manual techniques remain clinically relevant:",
  { text: "ECCE — Extracapsular Cataract Extraction (large incision)", indent: true },
  { text: "SICS / MSICS — Manual Small Incision Cataract Surgery (self-sealing tunnel)", indent: true },
  "Phacoemulsification has replaced ECCE in high-income settings; SICS fills a vital role globally",
  "This presentation covers:",
  { text: "Preoperative assessment (systemic + ophthalmic)", indent: true },
  { text: "Surgical steps of ECCE and SICS in sequence", indent: true },
  { text: "IOL selection and postoperative considerations", indent: true },
  { text: "Complications and their management", indent: true },
]);

// ─── SECTION 1: PREOPERATIVE ASSESSMENT ─────────────────────────
sectionDivider("PART 1\nPreoperative Assessment");

// 3. Indications for Surgery
contentSlide("Indications for Cataract Surgery", [
  "Visual improvement — the primary indication",
  { text: "Opacity sufficient to cause difficulty with daily activities (driving, reading, work)", indent: true },
  { text: "Snellen acuity alone does not determine surgical timing — functional impairment matters more (AAO BCSC)", indent: true },
  "Medical indications (surgery for ocular health):",
  { text: "Phacolytic glaucoma — lens protein leaks, clogs trabecular meshwork", indent: true },
  { text: "Phacomorphic glaucoma — swollen lens causes angle closure", indent: true },
  { text: "Lens-induced uveitis (phacoantigenic)", indent: true },
  { text: "Dense cataract preventing monitoring or treatment of fundus pathology", indent: true },
  "Clear lens exchange for high refractive errors (relative indication)",
  "Patient motivation and expectations must be discussed preoperatively",
]);

// 4. Systemic Preoperative Assessment
contentSlide("Systemic Preoperative Assessment", [
  "Routine bloods and ECG NOT required for local anaesthesia (Kanski 10th ed)",
  "If GA planned: urea & electrolytes, random blood glucose, FBC, ECG",
  "Key systemic conditions to screen:",
  { text: "Diabetes: check glycaemic control; defer if poorly controlled", indent: true },
  { text: "Hypertension: defer if systolic >170 or diastolic >100 mmHg", indent: true },
  { text: "MI in past 3–6 months: defer elective surgery", indent: true },
  { text: "Anticoagulants: check INR within 24 hours pre-op; antiplatelet drugs usually continued", indent: true },
  { text: "Systemic alpha-blockers (e.g. tamsulosin): warn — causes Intraoperative Floppy Iris Syndrome (IFIS)", indent: true, color: C.red },
  "Allergies: iodine/shellfish (use chlorhexidine instead), latex, local anaesthetics, sulfonamides",
  "MRSA screening: follow local protocol",
]);

// 5. Ophthalmic Preoperative Assessment I
contentSlide("Ophthalmic Assessment — External & Anterior Segment", [
  "Visual Acuity — Snellen chart; record best corrected VA",
  "Cover test — detect heterotropia; warn patient of possible diplopia post-op if squint present",
  "Pupillary responses — APD implies posterior pole pathology; cataract alone never causes APD",
  "Ocular adnexa — treat blepharitis, dacryocystitis, lagophthalmos BEFORE surgery (risk of endophthalmitis)",
  "Cornea — specular microscopy and pachymetry if cornea guttata/reduced endothelial count present",
  { text: "Arcus senilis and stromal opacities reduce surgical field clarity", indent: true },
  "Anterior chamber — shallow AC makes surgery difficult; plan accordingly",
  "Pupil dilation — note preoperative dilation; poorly dilating pupil needs intracameral mydriatic or iris hooks",
  { text: "Pseudoexfoliation: weak zonules (phakodonesis), fragile capsule, poor mydriasis — high-risk eye", indent: true, color: C.red },
]);

// 6. Ophthalmic Preoperative Assessment II
contentSlide("Ophthalmic Assessment — Posterior Segment & Biometry", [
  "Lens assessment:",
  { text: "Nuclear hardness graded (LOCS III system — AAO): soft, moderate, brunescent, black/white", indent: true },
  { text: "Black nuclear opacities → ECCE preferred over phaco (Kanski)", indent: true },
  { text: "Posterior subcapsular cataract → may cause glare disproportionate to acuity", indent: true },
  "Fundus examination — exclude AMD, diabetic retinopathy, retinal detachment",
  { text: "If fundus not visible: B-scan ultrasonography to exclude RD before surgery", indent: true },
  "Electroretinogram (ERG) / potential acuity meter in dense cataracts to assess retinal function",
  "Biometry — ESSENTIAL for IOL power calculation:",
  { text: "Axial length: IOL Master (optical) preferred; ultrasound A-scan if cornea opaque", indent: true },
  { text: "Keratometry: corneal curvature (K readings)", indent: true },
  { text: "Formulae: SRK-T (average eyes), Hoffer Q (short <22mm), Holladay/Haigis (long >26mm)", indent: true },
  { text: "Soft CL: remove 1 week pre-biometry; rigid GP lens: 6 weeks (Kanski)", indent: true, color: C.red },
]);

// 7. Informed Consent and Preparation
contentSlide("Consent and Preoperative Preparation", [
  "Informed consent should include:",
  { text: "Risk of endophthalmitis (~1 in 1000), posterior capsule tear (~1%), PCO", indent: true },
  { text: "Refractive surprise: 90% within 1D of target; 66% within 0.5D", indent: true },
  { text: "Pre-existing conditions affecting visual outcome (AMD, glaucoma)", indent: true },
  "Preoperative drops:",
  { text: "Mydriatics: tropicamide 1% + phenylephrine 2.5% or 10% — start 1 hour before", indent: true },
  { text: "Povidone-iodine 5% conjunctival drops — standard endophthalmitis prophylaxis (AAO)", indent: true },
  { text: "Topical NSAID (e.g. ketorolac) 3 days pre-op — reduces intraoperative miosis and CME risk (AAO BCSC)", indent: true },
  "Antibiotic prophylaxis:",
  { text: "Intracameral cefuroxime 1 mg at end of surgery (ESCRS protocol) — gold standard", indent: true },
  { text: "Topical antibiotic (moxifloxacin/tobramycin) 3 days preoperatively in many centres", indent: true },
  "Anaesthesia: topical, intracameral, peribulbar, or sub-Tenon (most cataract surgery done under LA)",
]);

// ─── SECTION 2: IOL ─────────────────────────────────────────────
sectionDivider("PART 2\nIntraocular Lens Selection");

// 8. IOL Types and Design
twoColSlide(
  "Intraocular Lens — Types and Considerations",
  "IOL Materials & Designs",
  [
    "PMMA (rigid) — standard for ECCE, 5.5-7mm optic",
    "Acrylic (hydrophobic / hydrophilic) — foldable, used in small incisions",
    "Silicone — foldable, avoid if silicone oil likely later",
    "One-piece: haptics and optic same material",
    "Three-piece: polypropylene haptics (more flexible placement options)",
    "Toric IOLs — correct pre-existing astigmatism",
    "Multifocal/EDOF — presbyopia correction",
  ],
  "Target Refraction",
  [
    "Aim for emmetropia in most cases",
    "Bilateral simultaneous surgery: discuss refractive balance",
    "Monovision: dominant eye for distance, fellow eye for near (selected patients)",
    "Post-refractive surgery eyes: use special formulae (Masket, Haigis-L, Barrett True-K)",
    "A-constant: personalise to individual surgeon's outcomes",
    "PMMA IOL for ECCE: 5.5–6.5mm optic fits 6–8mm capsular bag after ECCE",
  ]
);

// ─── SECTION 3: ECCE ─────────────────────────────────────────────
sectionDivider("PART 3\nExtracapsular Cataract Extraction\n(ECCE)");

// 9. ECCE Overview
contentSlide("ECCE — Overview and Indications", [
  "Introduced by Daviel (1753); modern ECCE popularised in 1970s–80s",
  "Standard technique before phacoemulsification became universal",
  "Posterior capsule intentionally preserved → supports IOL implantation in bag",
  "Advantages:",
  { text: "No expensive equipment needed — cost-effective", indent: true },
  { text: "Ideal for hard/brunescent nuclei (Grade 4–5) where phaco risks thermal burn", indent: true },
  { text: "Safer when zonular weakness, corneal disease, or shallow AC makes phaco difficult", indent: true },
  { text: "Lower learning curve than phacoemulsification (Steinert)", indent: true },
  "Disadvantages:",
  { text: "Large limbal incision (8–10 mm) requires sutures — induces astigmatism", indent: true },
  { text: "Slower visual rehabilitation; wound-related complications", indent: true },
  { text: "Posterior capsule opacification (PCO) in up to 50% at 3 years", indent: true },
  "ECCE still preferred when phaco conversion is necessary intraoperatively (PCR)",
]);

// 10. ECCE Steps 1-5
stepSlide("ECCE — Surgical Steps (1 to 6)", [
  { text: "Conjunctival peritomy", sub: "Limbus-based or fornix-based; expose superior sclera 1–2 mm" },
  { text: "Superior rectus traction suture (optional)", sub: "4-0 silk beneath superior rectus tendon to rotate globe inferiorly" },
  { text: "Haemostasis", sub: "Wet-field cautery to scleral episcleral vessels" },
  { text: "Scleral / limbal incision", sub: "Straight or frown incision, 8–10 mm width, full thickness at limbus" },
  { text: "Paracentesis (side port)", sub: "Stab incision at 2 or 10 o'clock; allows AC maintenance during surgery" },
  { text: "Anterior capsulotomy (can-opener or CCC)", sub: "Can-opener: multiple punctures around 360° — simpler but weaker edge; CCC preferred (Steinert)" },
]);

// 11. ECCE Steps 6-12
stepSlide("ECCE — Surgical Steps (7 to 12)", [
  { text: "Hydrodissection", sub: "BSS under anterior capsular flap → fluid wave separates cortex from capsule" },
  { text: "Nucleus expression", sub: "Counter-pressure at 6 o'clock with lens loop; anterior pressure above corneoscleral incision → nucleus delivered" },
  { text: "Cortical aspiration", sub: "Simcoe irrigation-aspiration cannula; remove cortex systematically 360°; preserve posterior capsule" },
  { text: "Posterior capsule polishing (optional)", sub: "Reduces incidence of posterior capsule opacification (PCO)" },
  { text: "IOL implantation", sub: "Rigid PMMA IOL placed in capsular bag; lower haptic first, then upper haptic (Kanski)" },
  { text: "Wound closure", sub: "10-0 nylon interrupted or continuous sutures; achieve watertight closure; check IOP" },
]);

// 12. ECCE — Special Techniques
contentSlide("ECCE — Technical Points and Pitfalls", [
  "Anterior capsulotomy options:",
  { text: "Can-opener capsulotomy: radial tears 360° — adequate for nucleus delivery but edge tears may extend posteriorly", indent: true },
  { text: "CCC (capsulorhexis) — produces continuous tear, stronger edge, preferred if possible (Steinert)", indent: true },
  { text: "Envelope technique: horizontal cut only — preserves zonular support", indent: true },
  "Nucleus delivery:",
  { text: "Assistant maintains infusion or AC maintainer during delivery to avoid AC collapse", indent: true },
  { text: "Sinskey hook (vectis) under nucleus; counter-pressure at 6 o'clock limbus", indent: true },
  { text: "Irrigating vectis helps maintain AC during nucleus expression", indent: true },
  "Pitfalls:",
  { text: "Premature entry into AC before adequate incision length → vitreous loss risk", indent: true, color: C.red },
  { text: "Posterior capsule tear during cortex aspiration — convert to anterior vitrectomy if vitreous presents", indent: true, color: C.red },
  { text: "Wound burn / wound dehiscence from tight sutures — check IOP and wound integrity", indent: true, color: C.red },
]);

// ─── SECTION 4: SICS / MSICS ─────────────────────────────────────
sectionDivider("PART 4\nSmall Incision Cataract Surgery\n(SICS / MSICS)");

// 13. SICS Overview
contentSlide("SICS — Overview and Advantages", [
  "Manual Small Incision Cataract Surgery (MSICS / SICS) — a variant of ECCE designed for high-volume cataract camps in developing regions",
  "Pioneered by Blumenthal (1994) and popularised for dense cataracts in South Asia and Africa",
  "Key principle: self-sealing sclero-corneal tunnel incision — no sutures required",
  "Advantages over conventional ECCE (Kanski / AAO):",
  { text: "Smaller incision (6–7 mm at sclera) → less astigmatism than ECCE", indent: true },
  { text: "Self-sealing — no sutures, faster healing", indent: true },
  { text: "No expensive phacoemulsification machine needed", indent: true },
  { text: "Effective for dense/black cataracts (Grade 4-5) — ideal in resource-limited settings", indent: true },
  { text: "Shorter learning curve than phacoemulsification", indent: true },
  { text: "Visual outcomes comparable to phacoemulsification (AAO BCSC, Section 11)", indent: true },
  "Limitation: requires intact posterior capsule; not suitable for subluxated lens",
]);

// 14. SICS Steps 1-6
stepSlide("SICS — Surgical Steps (1 to 6)", [
  { text: "Conjunctival peritomy", sub: "Fornix-based; expose 3–4 mm of superior sclera, haemostasis with cautery" },
  { text: "Scleral groove", sub: "Partial-thickness groove 2–3 mm behind limbus, 6–7 mm wide, using crescent blade" },
  { text: "Sclero-corneal tunnel dissection", sub: "Crescent blade dissects forward into clear cornea (2-planed tunnel — Blumenthal technique); tunnel width = nucleus diameter" },
  { text: "Internal corneal incision", sub: "3.2 mm keratome enters AC; extends internal opening to ≥5.5–6 mm using side-port blade" },
  { text: "Anterior capsulotomy (CCC or can-opener)", sub: "Stain capsule with trypan blue 0.06% if poor red reflex; CCC preferred for in-bag IOL (Kanski)" },
  { text: "Hydrodissection and hydrodelineation", sub: "BSS injected under capsule; fluid wave separates cortex; nucleus mobilised" },
]);

// 15. SICS Steps 7-12
stepSlide("SICS — Surgical Steps (7 to 12)", [
  { text: "Viscoelastic injection (OVD)", sub: "Sodium hyaluronate or methylcellulose fills AC; protects corneal endothelium" },
  { text: "Nucleus prolapse into AC", sub: "Sinskey hook rotates nucleus; tilting manoeuvre brings nucleus into anterior chamber" },
  { text: "Nucleus expression / delivery", sub: "Viscoexpression (Blumenthal) or irrigating vectis; 'push-pull' of nucleus through tunnel — posterior lip depressed; one-piece delivery" },
  { text: "Cortical aspiration", sub: "Simcoe I&A cannula; systematically aspirate cortex 360°; sub-incisional cortex last" },
  { text: "IOL implantation in capsular bag", sub: "Foldable PMMA or acrylic IOL; if rigid PMMA — extend incision minimally; haptics placed in bag" },
  { text: "Viscoelastic removal and wound check", sub: "Thorough viscoelastic removal; tunnel self-seals on hydration; Seidel test confirms no leak; IOP check" },
]);

// 16. Tunnel Architecture in Detail
contentSlide("SICS — Tunnel Design: Why it Matters", [
  "The sclero-corneal tunnel is what makes SICS self-sealing — its geometry is everything:",
  { text: "External incision (scleral groove): 2–3 mm posterior to limbus, partial thickness (~50% scleral depth)", indent: true },
  { text: "Length of tunnel: 2–3 mm — creates valve effect; longer = better seal but harder to manoeuvre IOL", indent: true },
  { text: "Internal opening in clear cornea: must be anterior enough to avoid iris prolapse", indent: true },
  { text: "Width: must accommodate nucleus diameter (typically 6.0–6.5 mm for average nucleus)", indent: true },
  "Blumenthal AC Maintainer:",
  { text: "Infusion cannula keeps AC formed continuously during surgery — prevents surge and iris prolapse", indent: true },
  { text: "Allows one-handed nucleus expression — critical teaching point (Steinert)", indent: true },
  "Tunnel shape variants:",
  { text: "Straight: easiest to construct", indent: true },
  { text: "Frown (chevron): reduces post-op astigmatism — preferred in many centres", indent: true },
  { text: "Inverted V/Trapezoidal: better self-sealing for large nuclei", indent: true },
]);

// 17. Side-by-side comparison
twoColSlide(
  "ECCE vs. SICS — Key Differences",
  "ECCE",
  [
    "Incision: 8–10 mm limbal (full thickness)",
    "Requires sutures (10-0 nylon)",
    "Higher post-op astigmatism (up to 3–4D)",
    "AC maintainer optional",
    "Rigid PMMA IOL usually required",
    "Wound healing: 6–8 weeks",
    "Best for: posterior polar cataract, subluxation (modified approach)",
    "Conversion to ICCE possible if needed",
    "Higher risk of wound complications, suture-related astigmatism",
    "Historical workhorse — still used in specific situations (Steinert)",
  ],
  "SICS",
  [
    "Incision: 6–7 mm sclero-corneal tunnel",
    "Self-sealing — no sutures needed",
    "Less astigmatism (1–1.5D)",
    "AC maintainer (Blumenthal) integral to technique",
    "PMMA or foldable IOL",
    "Wound healing: faster, 2–4 weeks",
    "Best for: dense/hard cataracts, limited resources, high-volume settings",
    "Cannot easily convert to ICCE",
    "Key advantage: no machine dependency (AAO BCSC)",
    "Comparable visual outcomes to phaco at 3 months",
  ]
);

// ─── SECTION 5: IOL IMPLANTATION ─────────────────────────────────
// 18. IOL Implantation in ECCE/SICS
contentSlide("IOL Implantation — In-Bag Technique", [
  "In-bag placement is the gold standard for both ECCE and SICS (Steinert)",
  "Steps after cortex aspiration:",
  { text: "1. Confirm capsular bag integrity — no radial tears, intact posterior capsule", indent: true },
  { text: "2. Refill bag with viscoelastic (OVD)", indent: true },
  { text: "3. For ECCE: rigid PMMA IOL (5.5–6 mm optic) introduced with forceps or glide; lower haptic first, dial upper haptic into bag", indent: true },
  { text: "4. For SICS: same sequence; if foldable used — fold and insert through small wound, then unfold in bag", indent: true },
  { text: "5. Centre IOL and confirm haptic placement in bag (not in sulcus)", indent: true },
  { text: "6. Remove OVD thoroughly — retained viscoelastic → postoperative IOP spike", indent: true },
  "Sulcus fixation — if posterior capsule torn: IOL haptics placed in ciliary sulcus; 3-piece IOL preferred",
  "AC IOL — last resort if capsular support inadequate",
  { text: "Risk of endothelial damage, UGH syndrome (Uveitis-Glaucoma-Hyphema)", indent: true, color: C.red },
]);

// ─── SECTION 6: ANAESTHESIA ──────────────────────────────────────
// 19. Anaesthesia
twoColSlide(
  "Anaesthesia for Cataract Surgery",
  "Local Anaesthesia (preferred)",
  [
    "Topical (drops only) — amethocaine / proxymetacaine; patient must cooperate",
    "Intracameral (lidocaine 1% unpreserved) — supplements topical; reduces iris sensation",
    "Sub-Tenon block — blunt cannula, Pinky/Murdoch cannula; excellent akinesia + analgesia; lowest risk (Kanski)",
    "Peribulbar block — inferotemporal + superonasal injection; akinesia in 10–15 min",
    "Retrobulbar block — direct retro-orbital; risk of optic nerve injury, brainstem anaesthesia — largely abandoned",
    "~5% patients experience pain under topical/intracameral alone",
  ],
  "General Anaesthesia",
  [
    "Indicated: children, severe anxiety, claustrophobia, tremors, inability to lie flat",
    "Pre-op workup as per GA protocol",
    "LMA preferred over ETT — avoids coughing on extubation",
    "Suxamethonium increases IOP transiently — avoid in open globe",
    "Target: smooth induction and emergence",
    "IFIS risk still present under GA if patient on tamsulosin",
  ]
);

// ─── SECTION 7: COMPLICATIONS ────────────────────────────────────
sectionDivider("PART 5\nComplications");

// 20. Intraoperative Complications
contentSlide("Intraoperative Complications", [
  "Posterior Capsule Rupture (PCR) — most significant intraoperative complication:",
  { text: "Incidence: ~1–2% in ECCE; signs: sudden AC deepening, pupil dilation, nucleus descent", indent: true, color: C.red },
  { text: "Management: inject dispersive OVD (Viscoat), anterior vitrectomy if vitreous presents, IOL in sulcus or AC IOL", indent: true },
  "Nucleus drop into vitreous — refer to vitreoretinal surgeon; do NOT chase into vitreous (Steinert)",
  "Suprachoroidal haemorrhage:",
  { text: "Risk: axial length >26mm, glaucoma, cardiovascular disease, prolonged surgery", indent: true, color: C.red },
  { text: "Signs: sudden resistance, shallowing AC, dark red reflex; CLOSE EYE IMMEDIATELY", indent: true, color: C.red },
  "Iris prolapse — too early AC entry, inadequate tunnel length; reposition with BSS",
  "Zonular dialysis — suspect in pseudoexfoliation, trauma, high myopia; use CTR (capsular tension ring)",
  "Intraoperative Floppy Iris Syndrome (IFIS) — tamsulosin; use iris hooks / Malyugin ring",
  "Corneal oedema — excessive OVD loss, repeated instrument trauma; use dispersive OVD continuously",
]);

// 21. Postoperative Complications
contentSlide("Postoperative Complications", [
  "Endophthalmitis (most feared):",
  { text: "Incidence ~0.08–0.1%; presenting POD1–7 with pain, red eye, hypopyon, decreased VA", indent: true, color: C.red },
  { text: "Causative: Staph epidermidis (most common), Staph aureus, Gram-negative rods", indent: true },
  { text: "Management: intravitreal vancomycin + ceftazidime ± vitrectomy (EVS trial); steroids reduce inflammation", indent: true },
  "Posterior Capsule Opacification (PCO) — most common late complication:",
  { text: "Up to 50% at 5 years in ECCE (higher than phaco); reduced by square-edge IOL design", indent: true },
  { text: "Treatment: Nd:YAG capsulotomy — quick, effective office procedure", indent: true },
  "Cystoid Macular Oedema (CME / Irvine-Gass syndrome):",
  { text: "Peaks at 6–10 weeks; treat with topical NSAID ± steroid", indent: true },
  "Corneal decompensation / bullous keratopathy — if low pre-op endothelial count",
  "Refractive surprise (>1D from target) — spectacles, LASIK, or IOL exchange",
  "Retinal detachment — higher risk in high myopes; patient must report sudden floaters/flashes",
  "Wound dehiscence (ECCE) — suture-related; re-suture if Seidel positive",
]);

// 22. Postoperative Management
contentSlide("Postoperative Management", [
  "Topical medications (standard regimen — AAO BCSC):",
  { text: "Topical steroid (prednisolone acetate 1% or dexamethasone 0.1%) — QID tapering over 4–6 weeks", indent: true },
  { text: "Topical antibiotic (moxifloxacin or tobramycin) — QID for 1–2 weeks", indent: true },
  { text: "Topical NSAID — ketorolac or nepafenac QID for 4 weeks; reduces CME risk", indent: true },
  "Follow-up schedule:",
  { text: "Day 1 — wound check, IOP, visual acuity, anterior chamber reaction", indent: true },
  { text: "Week 1 — healing, suture integrity (ECCE), IOP", indent: true },
  { text: "Week 4–6 — final refraction, suture removal (if significant astigmatism from tight sutures)", indent: true },
  { text: "3 months — spectacle prescription once refraction stable", indent: true },
  "Patient instructions:",
  { text: "Avoid rubbing eye; no swimming for 4 weeks; dark glasses outdoors", indent: true },
  { text: "Report immediately: sudden pain, loss of vision, increasing redness (signs of endophthalmitis)", indent: true, color: C.red },
  "ECCE: sutures can be removed selectively at slit lamp to correct residual astigmatism (from 6 weeks)",
]);

// 23. Summary comparison table
contentSlide("Summary: ECCE vs. SICS vs. Phacoemulsification", [
  "─── ECCE ───",
  { text: "Incision: 8–10 mm | Sutures: Yes | Equipment: Basic | Best for: Hard nuclei, limited resources, phaco conversion", indent: true },
  { text: "Astigmatism: High (3–4D) | Visual rehab: 6–8 weeks | PCO rate: Up to 50% at 5 years", indent: true },
  "─── SICS / MSICS ───",
  { text: "Incision: 6–7 mm scleral tunnel | Sutures: No | Equipment: Basic + AC maintainer", indent: true },
  { text: "Best for: Hard/dense cataracts, high-volume settings, developing regions", indent: true },
  { text: "Astigmatism: Moderate (1–2D) | Visual rehab: 2–4 weeks | Outcomes comparable to phaco (WHO data)", indent: true },
  "─── Phacoemulsification ───",
  { text: "Incision: 2.2–2.8 mm | Sutures: None | Equipment: Phaco machine (expensive)", indent: true },
  { text: "Best for: Average cataracts, developed settings | Astigmatism: Minimal (<0.5D)", indent: true },
  { text: "Visual rehab: 24–48 hours | Current global gold standard for cataract surgery (AAO)", indent: true },
]);

// 24. References
contentSlide("References", [
  "Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition (Bowling, 2024)",
  { text: "Chapter 10: The Lens — Management of Acquired Cataract (pp. 314–344)", indent: true },
  "American Academy of Ophthalmology (AAO) — Basic and Clinical Science Course, Section 11: Lens and Cataract (2023–2024)",
  { text: "Chapters: Preoperative Evaluation, Surgical Techniques, Complications, IOL Selection", indent: true },
  "Steinert RF (ed). Cataract Surgery: Technique, Complications, and Management, 3rd Edition (Saunders/Elsevier, 2010)",
  { text: "Chapters: ECCE Technique, MSICS, Surgical Complications, IOL Power Calculation", indent: true },
  "Blumenthal M, Ashkenazi I, Assia E, Cahane M. Prevention of intraoperative small-pupil syndrome using a new anterior chamber maintainer. Ophthalmic Surg. 1992;23(9):612-5",
  "Ruit S et al. A prospective randomized clinical trial of PHACO vs. MSICS in Nepal. Ophthalmology. 2007;114(11):2013-9",
  "ESCRS Endophthalmitis Study Group. Prophylaxis of postoperative endophthalmitis following cataract surgery. J Cataract Refract Surg. 2007;33(6):978-88",
]);

// 25. END SLIDE
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end.addShape(pres.ShapeType.rect, { x: 0, y: 2.6, w: 10, h: 0.06, fill: { color: C.gold } });
end.addText("Thank You", {
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  fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", align: "center",
});
end.addText("Management of Cataract: ECCE and SICS", {
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end.addText("Kanski 10th ed  •  AAO BCSC Section 11  •  Steinert's Cataract Surgery 3rd ed", {
  x: 0.5, y: 4.9, w: 9, h: 0.4,
  fontSize: 10, color: "AABBCC", fontFace: "Calibri", align: "center",
});

// ─── WRITE FILE ────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/cataract-ppt/Cataract_ECCE_SICS.pptx" })
  .then(() => console.log("Done: Cataract_ECCE_SICS.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/cataract-ppt && node cataract_ppt.js 2>&1

ls -lh /home/daytona/workspace/cataract-ppt/Cataract_ECCE_SICS.pptx

cd /home/daytona/workspace/cataract-ppt && file Cataract_ECCE_SICS.pptx && pytho…

cd /home/daytona/workspace/cataract-ppt && python3 -c " import zipfile, sys z = …

cd /home/daytona/workspace/cataract-ppt && libreoffice --headless --convert-to p…

libreoffice --headless --convert-to pdf /home/daytona/workspace/cataract-ppt/Cat…

libreoffice --headless --convert-to pdf /home/daytona/workspace/cataract-ppt/Cat…

cp /tmp/Cataract_ECCE_SICS.pdf /home/daytona/workspace/cataract-ppt/Cataract_ECC…