from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.colors import HexColor, black, white
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, Image, HRFlowable, KeepTogether)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.lib import colors
import os

OUTPUT = '/home/daytona/workspace/sics_pdf/SICS_MSICS_Ophthalmology.pdf'
IMG_DIR = '/home/daytona/workspace/sics_pdf'

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

W, H = A4
usable_w = W - 4*cm

# ── Colours ──────────────────────────────────────────────────────────────────
NAVY     = HexColor('#1a3a5c')
TEAL     = HexColor('#2e7d9e')
LTBLUE   = HexColor('#ddeef6')
MIDBLUE  = HexColor('#b0d4e8')
LTGREY   = HexColor('#f5f5f5')
MIDGREY  = HexColor('#dddddd')
DARKTEXT = HexColor('#1a1a1a')

# ── Styles ────────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def S(name, parent='Normal', **kw):
    s = ParagraphStyle(name, parent=base[parent])
    for k,v in kw.items(): setattr(s, k, v)
    return s

title_style  = S('DocTitle',  fontSize=22, textColor=NAVY, spaceAfter=4,
                 fontName='Helvetica-Bold', alignment=TA_CENTER, leading=26)
sub_style    = S('DocSub',    fontSize=11, textColor=TEAL, spaceAfter=2,
                 fontName='Helvetica-Oblique', alignment=TA_CENTER)
src_style    = S('DocSrc',    fontSize=8,  textColor=HexColor('#555555'),
                 fontName='Helvetica-Oblique', alignment=TA_CENTER, spaceAfter=6)
h1_style     = S('H1',        fontSize=13, textColor=white,
                 fontName='Helvetica-Bold', leading=18, spaceAfter=0,
                 spaceBefore=10, leftIndent=6, rightIndent=6)
h2_style     = S('H2',        fontSize=11, textColor=NAVY,
                 fontName='Helvetica-Bold', leading=14, spaceBefore=10, spaceAfter=3,
                 borderPad=2)
body_style   = S('Body',      fontSize=9.5, textColor=DARKTEXT,
                 fontName='Helvetica', leading=14, spaceAfter=4,
                 alignment=TA_JUSTIFY)
bullet_style = S('Bullet',    fontSize=9.5, textColor=DARKTEXT,
                 fontName='Helvetica', leading=13, spaceAfter=2,
                 leftIndent=14, firstLineIndent=-10)
caption_style= S('Caption',   fontSize=8,  textColor=HexColor('#444444'),
                 fontName='Helvetica-Oblique', alignment=TA_CENTER,
                 spaceAfter=6, spaceBefore=2)
quote_style  = S('Quote',     fontSize=9,  textColor=HexColor('#2a5470'),
                 fontName='Helvetica-Oblique', leading=13, leftIndent=14,
                 rightIndent=14, spaceBefore=4, spaceAfter=4)
table_hdr    = S('TblHdr',    fontSize=9,  textColor=white,
                 fontName='Helvetica-Bold', alignment=TA_CENTER, leading=12)
table_cell   = S('TblCell',   fontSize=9,  textColor=DARKTEXT,
                 fontName='Helvetica', alignment=TA_LEFT, leading=12)
table_cell_c = S('TblCellC',  fontSize=9,  textColor=DARKTEXT,
                 fontName='Helvetica', alignment=TA_CENTER, leading=12)
step_num     = S('StepNum',   fontSize=18, textColor=TEAL,
                 fontName='Helvetica-Bold', alignment=TA_CENTER, leading=20)

# ── Helper: section header band ───────────────────────────────────────────────
def section_header(text):
    tbl = Table([[Paragraph(text, h1_style)]], colWidths=[usable_w])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), NAVY),
        ('TOPPADDING',    (0,0),(-1,-1), 6),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(-1,-1), 10),
        ('RIGHTPADDING',  (0,0),(-1,-1), 10),
        ('ROUNDEDCORNERS', [4]),
    ]))
    return tbl

def sub_header(text):
    return Paragraph(f'<font color="#2e7d9e"><b>{text}</b></font>', h2_style)

def bullet(text):
    return Paragraph(f'• {text}', bullet_style)

def body(text):
    return Paragraph(text, body_style)

def sp(h=4):
    return Spacer(1, h)

def hr():
    return HRFlowable(width='100%', thickness=0.5, color=MIDBLUE, spaceAfter=4, spaceBefore=4)

def img(fname, width_cm, caption=''):
    path = os.path.join(IMG_DIR, fname)
    if not os.path.exists(path):
        return []
    w = width_cm * cm
    from PIL import Image as PILImage
    with PILImage.open(path) as im:
        iw, ih = im.size
    h = w * ih / iw
    elems = [Image(path, width=w, height=h)]
    if caption:
        elems.append(Paragraph(caption, caption_style))
    return elems

def two_images(f1, f2, cap1='', cap2=''):
    """Side-by-side two images, each half the usable width minus gap."""
    half = (usable_w - 0.5*cm) / 2
    from PIL import Image as PILImage
    def make_cell(fname, cap):
        path = os.path.join(IMG_DIR, fname)
        if not os.path.exists(path):
            return Paragraph('(image)', caption_style)
        with PILImage.open(path) as im:
            iw, ih = im.size
        h = half * ih / iw
        items = [Image(path, width=half, height=min(h, 7*cm))]
        if cap:
            items.append(Paragraph(cap, caption_style))
        from reportlab.platypus import KeepInFrame
        return items
    c1 = make_cell(f1, cap1)
    c2 = make_cell(f2, cap2)
    t = Table([[c1, c2]], colWidths=[half, half])
    t.setStyle(TableStyle([
        ('VALIGN', (0,0),(-1,-1), 'TOP'),
        ('ALIGN',  (0,0),(-1,-1), 'CENTER'),
        ('LEFTPADDING',  (0,0),(-1,-1), 2),
        ('RIGHTPADDING', (0,0),(-1,-1), 2),
    ]))
    return t

def info_box(text):
    tbl = Table([[Paragraph(text, quote_style)]], colWidths=[usable_w])
    tbl.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,-1), LTBLUE),
        ('TOPPADDING',    (0,0),(-1,-1), 8),
        ('BOTTOMPADDING', (0,0),(-1,-1), 8),
        ('LEFTPADDING',   (0,0),(-1,-1), 12),
        ('RIGHTPADDING',  (0,0),(-1,-1), 12),
        ('BOX',           (0,0),(-1,-1), 1, TEAL),
        ('ROUNDEDCORNERS',[4]),
    ]))
    return tbl

def make_table(headers, rows, col_widths=None):
    header_row = [Paragraph(h, table_hdr) for h in headers]
    data = [header_row]
    for row in rows:
        data.append([Paragraph(str(c), table_cell if i < 2 else table_cell_c)
                     for i,c in enumerate(row)])
    if not col_widths:
        col_widths = [usable_w / len(headers)] * len(headers)
    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    style = TableStyle([
        ('BACKGROUND',    (0,0),(-1,0),  TEAL),
        ('TEXTCOLOR',     (0,0),(-1,0),  white),
        ('ALIGN',         (0,0),(-1,0),  'CENTER'),
        ('VALIGN',        (0,0),(-1,-1), 'MIDDLE'),
        ('ROWBACKGROUNDS',(0,1),(-1,-1), [white, LTGREY]),
        ('GRID',          (0,0),(-1,-1), 0.4, MIDGREY),
        ('TOPPADDING',    (0,0),(-1,-1), 5),
        ('BOTTOMPADDING', (0,0),(-1,-1), 5),
        ('LEFTPADDING',   (0,0),(-1,-1), 6),
        ('RIGHTPADDING',  (0,0),(-1,-1), 6),
        ('ROUNDEDCORNERS',[3]),
    ])
    tbl.setStyle(style)
    return tbl

def step_box(num, title, items):
    """Numbered step block."""
    num_cell  = Paragraph(str(num), step_num)
    title_p   = Paragraph(f'<b>{title}</b>', S(f'st{num}', fontSize=10,
                           fontName='Helvetica-Bold', textColor=NAVY, leading=14))
    content   = [title_p] + [Paragraph(f'• {i}', bullet_style) for i in items]
    tbl = Table([[num_cell, content]], colWidths=[1.2*cm, usable_w - 1.2*cm])
    tbl.setStyle(TableStyle([
        ('VALIGN',        (0,0),(-1,-1), 'TOP'),
        ('BACKGROUND',    (0,0),(0,0),   LTBLUE),
        ('BACKGROUND',    (1,0),(1,0),   LTGREY),
        ('TOPPADDING',    (0,0),(-1,-1), 6),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(0,0),   0),
        ('LEFTPADDING',   (1,0),(1,0),   8),
        ('RIGHTPADDING',  (0,0),(-1,-1), 6),
        ('BOX',           (0,0),(-1,-1), 0.5, MIDBLUE),
    ]))
    return tbl

# ═══════════════════════════════════════════════════════════════════════════════
# BUILD DOCUMENT
# ═══════════════════════════════════════════════════════════════════════════════
story = []

# ── Title block ───────────────────────────────────────────────────────────────
title_banner = Table(
    [[Paragraph('Small Incision Cataract Surgery', title_style)],
     [Paragraph('Manual Small-Incision Cataract Surgery (MSICS)', sub_style)],
     [Paragraph('Source: Kanski\'s Clinical Ophthalmology, 10th Edition — Chapter 10, pp. 335–336', src_style)]],
    colWidths=[usable_w]
)
title_banner.setStyle(TableStyle([
    ('BACKGROUND',    (0,0),(-1,-1), LTBLUE),
    ('TOPPADDING',    (0,0),(-1,-1), 10),
    ('BOTTOMPADDING', (0,0),(-1,-1), 6),
    ('LEFTPADDING',   (0,0),(-1,-1), 12),
    ('RIGHTPADDING',  (0,0),(-1,-1), 12),
    ('BOX',           (0,0),(-1,-1), 1.5, TEAL),
]))
story.append(title_banner)
story.append(sp(10))

# ── Overview ──────────────────────────────────────────────────────────────────
story.append(section_header('Overview'))
story.append(sp(6))
story.append(body(
    'Manual Small-Incision Cataract Surgery (MSICS) is a variant of extracapsular cataract extraction (ECCE). '
    'It was developed for high-volume surgical management of dense cataracts, particularly in lower-resource settings. '
    'It does not require phacoemulsification technology yet achieves comparable visual outcomes.'
))
story.append(sp(4))
story.append(info_box(
    '"MSICS is faster and avoids the need for expensive technology. Visual rehabilitation is comparable to phacoemulsification." '
    '— Kanski\'s Clinical Ophthalmology, 10th ed., p. 336'
))
story.append(sp(8))

# ── Extraction methods comparison table ───────────────────────────────────────
story.append(section_header('Context: Cataract Extraction Methods'))
story.append(sp(6))
story.append(make_table(
    ['Technique', 'Incision Size', 'Key Feature'],
    [
        ['ICCE (intracapsular)', '~12 mm', 'Whole lens + capsule removed with cryoprobe'],
        ['ECCE (conventional)', '8–10 mm', 'Nucleus expressed; sutures required; astigmatism risk'],
        ['MSICS', '5–7 mm', 'Self-sealing sclero-corneal tunnel; no sutures needed'],
        ['Phacoemulsification', '2.4–2.8 mm', 'Ultrasonic fragmentation; most technologically advanced'],
    ],
    col_widths=[3.5*cm, 3*cm, usable_w - 6.5*cm]
))
story.append(sp(8))
for el in img('fig_10_10_icce_ecce.png', 12,
              'Fig. 10.10  Manual cataract surgery — (A) Intracapsular extraction; (B) extracapsular extraction.  (Kanski\'s, p.336)'):
    story.append(el)
story.append(sp(10))

# ── Pre-operative preparation ─────────────────────────────────────────────────
story.append(section_header('Pre-operative Preparation'))
story.append(sp(6))
story.append(bullet('Position: Supine on operating table'))
story.append(bullet('Antisepsis: Povidone-iodine (Betadine) 5% applied to periocular area'))
story.append(bullet('Draping & speculum: Universal (lid) speculum to keep eye open'))
story.append(bullet('Operating microscope: Interpupillary distance adjusted for monocular viewing'))
story.append(sp(10))

# ── Anaesthesia ───────────────────────────────────────────────────────────────
story.append(section_header('Anaesthesia'))
story.append(sp(6))
story.append(sub_header('1. Topical / Surface Anaesthesia'))
story.append(bullet('Agent: Oxybuprocaine (proxymetacaine) eye drops'))
story.append(bullet('Quick; avoids injection — ~5% of patients still experience intraoperative pain'))
story.append(sp(4))
story.append(sub_header('2. Peribulbar Block (preferred for MSICS)'))
story.append(bullet('Upper lateral 1/3 of orbit'))
story.append(bullet('Lower medial 2/3 / lateral 1/3 junction'))
story.append(bullet('Nerves blocked: CN III, V (branches), VI, VII — provides both akinesia and analgesia'))
story.append(sp(4))
story.append(sub_header('3. Sub-Tenon\'s Block (alternative)'))
story.append(bullet('Blunt cannula injected under Tenon\'s capsule — fewer complications than sharp needle blocks'))
story.append(sp(10))

# ── Surgical steps ────────────────────────────────────────────────────────────
story.append(section_header('Surgical Steps'))
story.append(sp(8))

steps = [
    (1, 'Sclero-Corneal Tunnel Incision', [
        'Self-sealing scleral tunnel starting ~2 mm posterior to limbus',
        'Incision length: ~5–7 mm (allows nucleus delivery without sutures)',
        'Beveled tunnel creates valve effect — no sutures required',
        'Instrument: Crescent knife / scleral tunnel knife (preset blade)',
    ]),
    (2, 'Side Port (Paracentesis)', [
        'Made ~90° from the main incision',
        'Provides entry for second instrument (chopper / vectis)',
        'Instrument: MVR blade or keratome preset to 2.8 mm',
    ]),
    (3, 'Anterior Capsulotomy (CCC)', [
        'Trypan blue injected under viscoelastic to stain anterior capsule (essential in dense/mature cataracts)',
        'Technique: Continuous curvilinear capsulorhexis (CCC)',
        'No capsular tags permitted — intact round rhexis essential',
        'Instrument: Cystotome or Utrata forceps',
    ]),
    (4, 'Hydrodissection', [
        'BSS injected beneath anterior capsule to separate cortex from capsule',
        'Confirmed when lens rotates freely in the capsular bag',
        'Hydrodelineation: separates nucleus from epinucleus (additional step if needed)',
        'Instrument: Hydrodissection cannula',
    ]),
    (5, 'Nucleus Expression', [
        'Viscoelastic injected first to protect corneal endothelium',
        'Vectis slides beneath nucleus; nucleus delivered en bloc through the tunnel',
        'Key distinction from phaco: no fragmentation required',
        'Instrument: Irrigating vectis (wire loop with infusion)',
    ]),
    (6, 'Cortical Aspiration', [
        'Residual cortex aspirated after nucleus removal',
        'Double-lumen design: one port irrigates, the other aspirates simultaneously',
        'Instrument: Simcoe cannula (irrigation-aspiration)',
    ]),
    (7, 'IOL Implantation', [
        'OVD (viscoelastic) re-injected into capsular bag and anterior chamber',
        'Best OVD: sodium hyaluronate (highest mol. weight) or hydroxymethylcellulose',
        'Rigid PMMA or foldable IOL implanted into capsular bag',
        'OVD irrigated out thoroughly after implantation (prevents raised IOP / secondary glaucoma)',
        'IOP maintained post-irrigation with Ringer\'s lactate',
    ]),
    (8, 'Wound Closure', [
        'Self-sealing tunnel — usually no sutures required',
        'Wound integrity confirmed: anterior chamber must be well-formed',
        'Corneal wound sealed by hydration with BSS if needed',
    ]),
]

for num, title, items in steps:
    story.append(KeepTogether([step_box(num, title, items), sp(6)]))

story.append(sp(4))

# ── Intraoperative images ─────────────────────────────────────────────────────
story.append(section_header('Intraoperative Images (Kanski\'s Fig. 10.11)'))
story.append(sp(8))

for el in img('fig_10_11A_tunnel.png', 11,
              'Fig. 10.11A  Scleral tunnel incision (MSICS)'):
    story.append(el)
story.append(sp(6))

for el in img('fig_10_11BC_stain_nucleus.png', 11,
              'Fig. 10.11B/C  Blue staining of anterior capsule before capsulorhexis; nucleus expression'):
    story.append(el)
story.append(sp(10))

# ── Instruments table ─────────────────────────────────────────────────────────
story.append(section_header('Key Instruments Summary'))
story.append(sp(6))
story.append(make_table(
    ['Instrument', 'Purpose'],
    [
        ['Universal speculum',            'Lid retraction'],
        ['Crescent / scleral tunnel knife','Sclero-corneal tunnel construction'],
        ['MVR blade / keratome (2.8 mm)', 'Side port / paracentesis'],
        ['Cystotome / Utrata forceps',    'Capsulorhexis'],
        ['Hydrodissection cannula',       'Cortical separation from capsule'],
        ['Irrigating vectis',             'Nucleus delivery (en bloc)'],
        ['Simcoe cannula',                'Cortical aspiration (irrigation-aspiration)'],
        ['PMMA / foldable IOL injector',  'Lens implantation'],
        ['Sodium hyaluronate / HPMC OVD', 'Anterior chamber maintenance, endothelial protection'],
    ],
    col_widths=[6*cm, usable_w - 6*cm]
))
story.append(sp(10))

# ── MSICS vs Phaco ────────────────────────────────────────────────────────────
story.append(section_header('MSICS vs Phacoemulsification'))
story.append(sp(6))
story.append(make_table(
    ['Feature', 'MSICS', 'Phacoemulsification'],
    [
        ['Incision size',         '~5–7 mm scleral tunnel',         '2.4–2.8 mm clear corneal'],
        ['Technology',            'Low (manual)',                    'High (phaco machine)'],
        ['Cost',                  'Low',                             'High'],
        ['Dense cataracts',       'Excellent',                       'Challenging (high power)'],
        ['Induced astigmatism',   'Low (scleral incision)',          'Very low (corneal)'],
        ['Visual outcomes',       'Comparable',                      'Comparable'],
        ['Sutures required',      'Usually none',                    'None'],
    ],
    col_widths=[5*cm, (usable_w-5*cm)/2, (usable_w-5*cm)/2]
))
story.append(sp(16))

# ── Footer note ───────────────────────────────────────────────────────────────
story.append(hr())
story.append(Paragraph(
    'Source: Kanski\'s Clinical Ophthalmology: A Systematic Approach, 10th Edition, '
    'Chapter 10 — Cataract, pp. 335–336',
    S('Footer', fontSize=8, textColor=HexColor('#555555'), fontName='Helvetica-Oblique',
      alignment=TA_CENTER)
))

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story)
print(f'PDF created: {OUTPUT}')

"""Shared helpers for both PDFs."""
from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.colors import HexColor, white
from reportlab.platypus import (Paragraph, Spacer, Table, TableStyle,
                                 Image, HRFlowable, KeepTogether)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
import os

W, H   = A4
LM = RM = 2 * cm
UW = W - LM - RM          # usable width

NAVY    = HexColor('#1a3a5c')
TEAL    = HexColor('#2e7d9e')
LTBLUE  = HexColor('#ddeef6')
MIDBLUE = HexColor('#b0d4e8')
LTGREY  = HexColor('#f5f5f5')
MIDGREY = HexColor('#dddddd')
DARK    = HexColor('#1a1a1a')
GREY55  = HexColor('#555555')
GREY44  = HexColor('#444444')
GREY2a  = HexColor('#2a5470')

base = getSampleStyleSheet()

def S(name, parent='Normal', **kw):
    s = ParagraphStyle(name, parent=base[parent])
    for k, v in kw.items():
        setattr(s, k, v)
    return s

title_s  = S('T',  fontSize=22, textColor=NAVY, spaceAfter=4,
             fontName='Helvetica-Bold', alignment=TA_CENTER, leading=26)
sub_s    = S('Su', fontSize=11, textColor=TEAL, spaceAfter=2,
             fontName='Helvetica-Oblique', alignment=TA_CENTER)
src_s    = S('Sr', fontSize=8,  textColor=GREY55,
             fontName='Helvetica-Oblique', alignment=TA_CENTER, spaceAfter=6)
h1_s     = S('H1', fontSize=13, textColor=white,
             fontName='Helvetica-Bold', leading=18, spaceAfter=0,
             spaceBefore=10, leftIndent=6, rightIndent=6)
h2_s     = S('H2', fontSize=11, textColor=NAVY,
             fontName='Helvetica-Bold', leading=14, spaceBefore=10, spaceAfter=3)
body_s   = S('Bo', fontSize=9.5, textColor=DARK,
             fontName='Helvetica', leading=14, spaceAfter=4, alignment=TA_JUSTIFY)
bul_s    = S('Bu', fontSize=9.5, textColor=DARK,
             fontName='Helvetica', leading=13, spaceAfter=2,
             leftIndent=14, firstLineIndent=-10)
cap_s    = S('Ca', fontSize=8,  textColor=GREY44,
             fontName='Helvetica-Oblique', alignment=TA_CENTER,
             spaceAfter=6, spaceBefore=2)
qt_s     = S('Qt', fontSize=9,  textColor=GREY2a,
             fontName='Helvetica-Oblique', leading=13, leftIndent=14,
             rightIndent=14, spaceBefore=4, spaceAfter=4)
thdr_s   = S('Th', fontSize=9,  textColor=white,
             fontName='Helvetica-Bold', alignment=TA_CENTER, leading=12)
tcel_s   = S('Tc', fontSize=9,  textColor=DARK,
             fontName='Helvetica', alignment=TA_LEFT, leading=12)
tcelc_s  = S('Tcc',fontSize=9,  textColor=DARK,
             fontName='Helvetica', alignment=TA_CENTER, leading=12)
stepn_s  = S('Sn', fontSize=18, textColor=TEAL,
             fontName='Helvetica-Bold', alignment=TA_CENTER, leading=20)
foot_s   = S('Ft', fontSize=8,  textColor=GREY55,
             fontName='Helvetica-Oblique', alignment=TA_CENTER)

# ── Flowable helpers ──────────────────────────────────────────────────────────

def section_hdr(text):
    t = Table([[Paragraph(text, h1_s)]], colWidths=[UW])
    t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,-1), NAVY),
        ('TOPPADDING',    (0,0),(-1,-1), 6),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(-1,-1), 10),
        ('RIGHTPADDING',  (0,0),(-1,-1), 10),
    ]))
    return t

def sub_hdr(text):
    return Paragraph(f'<font color="#2e7d9e"><b>{text}</b></font>', h2_s)

def bullet(text):
    return Paragraph(f'• {text}', bul_s)

def body(text):
    return Paragraph(text, body_s)

def sp(h=6):
    return Spacer(1, h)

def hr():
    return HRFlowable(width='100%', thickness=0.5, color=MIDBLUE,
                      spaceAfter=4, spaceBefore=4)

def info_box(text):
    t = Table([[Paragraph(text, qt_s)]], colWidths=[UW])
    t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,-1), LTBLUE),
        ('TOPPADDING',    (0,0),(-1,-1), 8),
        ('BOTTOMPADDING', (0,0),(-1,-1), 8),
        ('LEFTPADDING',   (0,0),(-1,-1), 12),
        ('RIGHTPADDING',  (0,0),(-1,-1), 12),
        ('BOX',           (0,0),(-1,-1), 1, TEAL),
    ]))
    return t

def make_table(headers, rows, col_widths=None):
    hrow = [Paragraph(h, thdr_s) for h in headers]
    data = [hrow]
    for row in rows:
        data.append([Paragraph(str(c), tcel_s) for c in row])
    if not col_widths:
        col_widths = [UW / len(headers)] * len(headers)
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,0),  TEAL),
        ('TEXTCOLOR',     (0,0),(-1,0),  white),
        ('ALIGN',         (0,0),(-1,0),  'CENTER'),
        ('VALIGN',        (0,0),(-1,-1), 'MIDDLE'),
        ('ROWBACKGROUNDS',(0,1),(-1,-1), [white, LTGREY]),
        ('GRID',          (0,0),(-1,-1), 0.4, MIDGREY),
        ('TOPPADDING',    (0,0),(-1,-1), 5),
        ('BOTTOMPADDING', (0,0),(-1,-1), 5),
        ('LEFTPADDING',   (0,0),(-1,-1), 6),
        ('RIGHTPADDING',  (0,0),(-1,-1), 6),
    ]))
    return t

def step_box(num, title, items, accent=TEAL):
    num_p   = Paragraph(str(num), stepn_s)
    title_p = Paragraph(f'<b>{title}</b>',
                        S(f'st{num}x', fontSize=10, fontName='Helvetica-Bold',
                          textColor=NAVY, leading=14))
    content = [title_p] + [Paragraph(f'• {i}', bul_s) for i in items]
    t = Table([[num_p, content]], colWidths=[1.2*cm, UW - 1.2*cm])
    t.setStyle(TableStyle([
        ('VALIGN',        (0,0),(-1,-1), 'TOP'),
        ('BACKGROUND',    (0,0),(0,0),   LTBLUE),
        ('BACKGROUND',    (1,0),(1,0),   LTGREY),
        ('TOPPADDING',    (0,0),(-1,-1), 6),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(0,0),   0),
        ('LEFTPADDING',   (1,0),(1,0),   8),
        ('RIGHTPADDING',  (0,0),(-1,-1), 6),
        ('BOX',           (0,0),(-1,-1), 0.5, MIDBLUE),
    ]))
    return t

def title_banner(main, sub, source):
    t = Table([
        [Paragraph(main,   title_s)],
        [Paragraph(sub,    sub_s)],
        [Paragraph(source, src_s)],
    ], colWidths=[UW])
    t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,-1), LTBLUE),
        ('TOPPADDING',    (0,0),(-1,-1), 10),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(-1,-1), 12),
        ('RIGHTPADDING',  (0,0),(-1,-1), 12),
        ('BOX',           (0,0),(-1,-1), 1.5, TEAL),
    ]))
    return t

def embed_img(fname, width_cm, caption='', img_dir='/home/daytona/workspace/sics_pdf'):
    path = os.path.join(img_dir, fname)
    if not os.path.exists(path):
        return []
    from PIL import Image as PI
    w = width_cm * cm
    with PI.open(path) as im:
        iw, ih = im.size
    h = w * ih / iw
    elems = [Image(path, width=w, height=h)]
    if caption:
        elems.append(Paragraph(caption, cap_s))
    return elems

"""PDF 1 — SICS / MSICS only."""
import sys
sys.path.insert(0, '/home/daytona/workspace/sics_pdf')
from pdf_helpers import *
from reportlab.platypus import SimpleDocTemplate, KeepTogether
from reportlab.lib.pagesizes import A4

OUT = '/home/daytona/workspace/sics_pdf/01_SICS_MSICS.pdf'

doc = SimpleDocTemplate(OUT, pagesize=A4,
                        leftMargin=LM, rightMargin=RM,
                        topMargin=2*cm, bottomMargin=2*cm)

story = []

# ── Title ─────────────────────────────────────────────────────────────────────
story += [
    title_banner(
        'Small Incision Cataract Surgery (SICS)',
        'Manual Small-Incision Cataract Surgery — MSICS',
        "Source: Kanski's Clinical Ophthalmology, 10th Edition — Chapter 10, pp. 335–336"
    ),
    sp(10),
]

# ── Overview ──────────────────────────────────────────────────────────────────
story += [
    section_hdr('Overview'),
    sp(6),
    body('MSICS is a variant of extracapsular cataract extraction (ECCE) designed for '
         'high-volume management of dense cataracts, particularly in lower-resource settings. '
         'It does not require a phacoemulsification machine yet delivers visual outcomes '
         'comparable to phacoemulsification.'),
    sp(4),
    info_box('"MSICS is faster and avoids the need for expensive technology. '
             'Visual rehabilitation is comparable to phacoemulsification." '
             "— Kanski's Clinical Ophthalmology, 10th ed., p. 336"),
    sp(8),
]

# ── Comparison table ──────────────────────────────────────────────────────────
story += [
    section_hdr('Context: Cataract Extraction Techniques'),
    sp(6),
    make_table(
        ['Technique', 'Incision', 'Key Feature'],
        [
            ['ICCE',            '~12 mm', 'Whole lens + capsule removed with cryoprobe; sutures required'],
            ['ECCE (classic)',  '8–10 mm', 'Nucleus expressed; large limbal incision; sutures + astigmatism risk'],
            ['MSICS',           '5–7 mm',  'Self-sealing sclero-corneal tunnel; no sutures; no phaco machine'],
            ['Phacoemulsification','2.4–2.8 mm','Ultrasonic fragmentation; technologically advanced; not covered here'],
        ],
        col_widths=[3.8*cm, 2.8*cm, UW - 6.6*cm]
    ),
    sp(8),
] + embed_img('fig_10_10_icce_ecce.png', 12,
    'Fig. 10.10  Manual cataract surgery — (A) Intracapsular; (B) Extracapsular extraction.  (Kanski\'s, p.336)') + [sp(10)]

# ── Pre-op ────────────────────────────────────────────────────────────────────
story += [
    section_hdr('Pre-operative Preparation'),
    sp(6),
    bullet('Patient position: Supine on the operating table'),
    bullet('Antisepsis: Povidone-iodine (Betadine) 5% applied to the periocular skin and conjunctival sac — left for minimum 3 minutes'),
    bullet('Draping: Plastic drape isolating lids and lashes from the surgical field'),
    bullet('Lid speculum: Universal speculum inserted to keep the eye open'),
    bullet('Operating microscope: Interpupillary distance adjusted; monocular viewing for the surgeon'),
    sp(10),
]

# ── Anaesthesia ───────────────────────────────────────────────────────────────
story += [
    section_hdr('Anaesthesia'),
    sp(6),
    sub_hdr('1. Topical / Surface Anaesthesia'),
    bullet('Agent: Oxybuprocaine (proxymetacaine) eye drops'),
    bullet('Advantage: Quick onset, avoids injection risk'),
    bullet('Limitation: ~5% of patients still experience intraoperative pain'),
    sp(6),
    sub_hdr('2. Peribulbar Block (most commonly used for MSICS)'),
    bullet('Injection sites: upper lateral 1/3 of orbit AND lower medial-lateral junction'),
    bullet('Nerves blocked: CN III, V (branches), VI, VII — provides akinesia + analgesia'),
    bullet('Agent: Lignocaine 2% ± hyaluronidase'),
    sp(6),
    sub_hdr('3. Sub-Tenon\'s Block (alternative)'),
    bullet('Blunt cannula passed under Tenon\'s capsule after conjunctival nick'),
    bullet('Fewer serious complications vs sharp needle blocks'),
    sp(10),
]

# ── Surgical steps ────────────────────────────────────────────────────────────
story += [section_hdr('Surgical Steps — MSICS'), sp(8)]

steps = [
    (1, 'Sclero-Corneal Tunnel Incision', [
        'Site: ~2 mm posterior to the surgical limbus (scleral side)',
        'Length: 5–7 mm — wide enough for en-bloc nucleus delivery without sutures',
        'Shape: Beveled, creating a valve mechanism — self-sealing, no sutures required',
        'Instrument: Crescent knife (tunnel dissection), then keratome to enter anterior chamber',
    ]),
    (2, 'Side Port (Paracentesis)', [
        'Small stab incision ~60–90° from the main tunnel',
        'Provides access for a second instrument (vectis / chopper) during surgery',
        'Instrument: MVR blade or preset keratome (2.8 mm)',
    ]),
    (3, 'Capsule Staining & Capsulorhexis (CCC)', [
        'Trypan blue dye injected beneath viscoelastic to stain the anterior capsule blue',
        'Essential in mature/dense cataracts where the red reflex is absent',
        'CCC performed as a continuous curvilinear tear — no tags permitted',
        'Instrument: Cystotome (bent needle) or Utrata capsulorhexis forceps',
    ]),
    (4, 'Hydrodissection', [
        'BSS injected beneath anterior capsule edge to free cortical attachments',
        'A fluid wave should pass behind the nucleus — lens then rotates freely',
        'Hydrodelineation (optional): separates nucleus from epinucleus',
        'Instrument: Hydrodissection cannula (blunt-tipped)',
    ]),
    (5, 'Nucleus Expression (en bloc delivery)', [
        'Viscoelastic injected to protect corneal endothelium and maintain AC depth',
        'Irrigating vectis passed beneath the nucleus inside the capsular bag',
        'Nucleus delivered in one piece through the scleral tunnel',
        'Key difference from phaco: no fragmentation required',
        'Instrument: Irrigating vectis (wire loop with infusion port)',
    ]),
    (6, 'Cortical Aspiration', [
        'Residual cortical matter aspirated after nucleus removal',
        'Simcoe cannula: dual-lumen — one port irrigates BSS, the other aspirates cortex simultaneously',
        'Instrument: Simcoe irrigation-aspiration cannula',
    ]),
    (7, 'IOL Implantation', [
        'OVD re-injected into the capsular bag and AC for space and endothelial protection',
        'Best OVD choices: sodium hyaluronate (highest molecular weight) or hydroxymethylcellulose',
        'Rigid PMMA IOL (one-piece, designed for MSICS) placed into the capsular bag',
        'Alternatively, a foldable IOL can be injected through the tunnel',
        'OVD thoroughly irrigated out — retained viscoelastic causes IOP spike / secondary glaucoma',
        'IOP maintained post-irrigation with balanced salt solution (BSS) or Ringer\'s lactate',
    ]),
    (8, 'Wound Closure', [
        'Self-sealing sclero-corneal tunnel — sutures are usually not required',
        'AC must be well-formed and wound water-tight before finishing',
        'Corneal wound sealed by hydration (BSS injection into stroma) if needed',
        'Prophylaxis: intracameral antibiotic (e.g. cefuroxime) and/or subconjunctival steroid/antibiotic',
    ]),
]

for num, title, items in steps:
    story += [KeepTogether([step_box(num, title, items), sp(6)])]

story.append(sp(4))

# ── Intraoperative images ─────────────────────────────────────────────────────
story += [
    section_hdr("Intraoperative Images — MSICS (Kanski's Fig. 10.11)"),
    sp(8),
] + embed_img('fig_10_11A_tunnel.png', 11,
    'Fig. 10.11A  Self-sealing sclero-corneal tunnel incision (MSICS) — Kanski\'s, p.336') + [sp(6)] \
  + embed_img('fig_10_11BC_stain_nucleus.png', 11,
    'Fig. 10.11B/C  Trypan blue staining of anterior capsule (left); nucleus expression through tunnel (right) — Kanski\'s, p.336') \
  + [sp(10)]

# ── Instruments table ─────────────────────────────────────────────────────────
story += [
    section_hdr('Key Instruments — MSICS'),
    sp(6),
    make_table(
        ['Instrument', 'Purpose / Step'],
        [
            ['Universal speculum',           'Lid retraction — pre-op'],
            ['Crescent knife',               'Sclero-corneal tunnel dissection — Step 1'],
            ['Keratome (preset 2.8 mm)',     'Entry into anterior chamber — Step 1'],
            ['MVR blade',                    'Side port / paracentesis — Step 2'],
            ['Cystotome / Utrata forceps',   'Anterior capsulotomy (CCC) — Step 3'],
            ['Hydrodissection cannula',      'Cortical separation — Step 4'],
            ['Irrigating vectis',            'En-bloc nucleus delivery — Step 5'],
            ['Simcoe I/A cannula',           'Cortical aspiration — Step 6'],
            ['Sodium hyaluronate / HPMC OVD','AC maintenance, endothelial protection — Steps 3,7'],
            ['PMMA / foldable IOL injector', 'Lens implantation — Step 7'],
        ],
        col_widths=[6*cm, UW - 6*cm]
    ),
    sp(10),
]

# ── MSICS advantages/limitations ─────────────────────────────────────────────
story += [
    section_hdr('Advantages & Limitations of MSICS'),
    sp(6),
    make_table(
        ['Advantages', 'Limitations'],
        [
            ['No phacoemulsification machine required', 'Larger incision than phaco (5–7 mm vs 2.4 mm)'],
            ['Lower cost — suited for high-volume camps', 'Requires good surgical technique for tunnel construction'],
            ['Excellent for dense / hard nuclei', 'PMMA IOL requires slightly larger wound than foldable'],
            ['Self-sealing — usually no sutures', 'Not suitable for very shallow anterior chambers'],
            ['Comparable visual outcomes to phaco', 'Longer learning curve than phaco for modern trainees'],
        ],
        col_widths=[UW/2, UW/2]
    ),
    sp(16),
]

# ── Footer ────────────────────────────────────────────────────────────────────
story += [
    hr(),
    Paragraph("Source: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition, "
              "Chapter 10 — Cataract, pp. 335–336", foot_s),
]

doc.build(story)
print(f'Created: {OUT}')

"""PDF 2 — Phacoemulsification only."""
import sys
sys.path.insert(0, '/home/daytona/workspace/sics_pdf')
from pdf_helpers import *
from reportlab.platypus import SimpleDocTemplate, KeepTogether
from reportlab.lib.pagesizes import A4

OUT = '/home/daytona/workspace/sics_pdf/02_Phacoemulsification.pdf'

doc = SimpleDocTemplate(OUT, pagesize=A4,
                        leftMargin=LM, rightMargin=RM,
                        topMargin=2*cm, bottomMargin=2*cm)

story = []

# ── Title ─────────────────────────────────────────────────────────────────────
story += [
    title_banner(
        'Phacoemulsification',
        'Modern Standard Technique for Cataract Extraction',
        "Source: Kanski's Clinical Ophthalmology, 10th Edition — Chapter 10, pp. 336–339"
    ),
    sp(10),
]

# ── Overview ──────────────────────────────────────────────────────────────────
story += [
    section_hdr('Overview'),
    sp(6),
    body("Phacoemulsification ('phaco') is the standard method of cataract extraction in high-income "
         "countries and regional centres worldwide. It uses ultrasonic vibration to emulsify the lens nucleus "
         "through a 2.4–2.8 mm clear corneal incision. The technique demands a dedicated phacoemulsification "
         "machine, specialized handpiece, and trained surgeon, but produces excellent refractive outcomes, "
         "rapid visual recovery, and a self-sealing sutureless wound."),
    sp(10),
]

# ── Phacodynamics ─────────────────────────────────────────────────────────────
story += [
    section_hdr('Phacodynamics (Machine Settings)'),
    sp(6),
    make_table(
        ['Parameter', 'What It Means', 'Clinical Implication'],
        [
            ['Irrigating bottle height',
             'Controls infusion pressure / IOP',
             'Higher bottle = more flow; set to maintain stable AC'],
            ['Aspiration flow rate (AFR)',
             'Volume of fluid removed per minute (mL/min)',
             'High AFR = faster removal but less power; raise bottle to compensate; avoid high AFR as a trainee'],
            ['Vacuum (mmHg)',
             'Suction generated at phaco tip during occlusion',
             'Determines grip on lens material; high vacuum = faster but riskier capsule'],
            ['Post-occlusion surge',
             'Sudden outflow burst when tip occlusion breaks',
             'Can rupture capsule; modern machines suppress it; use lower settings to minimise'],
        ],
        col_widths=[3.5*cm, 5*cm, UW - 8.5*cm]
    ),
    sp(10),
]

# ── Pump types ────────────────────────────────────────────────────────────────
story += [
    section_hdr('Pump Types'),
    sp(6),
    sub_hdr('Peristaltic (Flow) Pump'),
    bullet('Compresses tubing over rollers to pull fluid and lens material into the tip'),
    bullet('Vacuum builds only after tip occlusion — pump slows and stops at set maximum'),
    bullet('AFR and vacuum can be set independently'),
    sp(4),
    sub_hdr('Venturi (Vacuum) Pump'),
    bullet('Creates negative pressure by passing compressed gas across a vessel entrance'),
    bullet('Vacuum and AFR are synchronized — no independent AFR adjustment'),
    bullet('Vacuum is always available, even before tip occlusion'),
    sp(4),
    sub_hdr('Hybrid Pump'),
    bullet('Combines elements of both; offered by some modern phaco machines'),
    sp(10),
]

# ── Handpiece ─────────────────────────────────────────────────────────────────
story += [
    section_hdr('Phaco Handpiece'),
    sp(6),
    body('The phaco handpiece contains a hollow titanium needle enclosed by a fluid-cooling sleeve. '
         'The sleeve protects the cornea from thermal and mechanical damage during ultrasonic vibration. '
         'The emulsifying action is mediated by very high-frequency (ultrasonic) vibration via jackhammer, '
         'cavitation, and acoustic streaming effects. Tips of differing shapes and sizes are available, '
         'each with different cutting and holding characteristics. Some machines offer torsional phaco '
         'action or water jet-mediated phacoemulsification as alternatives.'),
    sp(8),
] + embed_img('phaco_tip_10_12b.png', 7,
    'Fig. 10.12A  Phaco tip (titanium needle with enclosing sleeve) — Kanski\'s, p.337') + [sp(4)] \
  + embed_img('phaco_handpiece_10_12.png', 10,
    'Fig. 10.12B  Phaco handpiece in position during surgery — Kanski\'s, p.337') + [sp(10)]

# ── OVDs ─────────────────────────────────────────────────────────────────────
story += [
    section_hdr('Ophthalmic Viscosurgical Devices (OVDs / Viscoelastics)'),
    sp(6),
    body('OVDs are bio-polymers essential to every step of phaco surgery. They maintain intraocular space, '
         'protect the corneal endothelium, and manipulate tissue. They must be completely removed at the end '
         'of surgery to prevent a postoperative IOP spike.'),
    sp(6),
    make_table(
        ['OVD Type', 'Properties', 'Main Use'],
        [
            ['Cohesive\n(e.g. sodium hyaluronate — Healon)',
             'High molecular weight; maintains space well; easier to remove',
             'AC maintenance during CCC; capsular bag inflation for IOL insertion'],
            ['Dispersive\n(e.g. Viscoat)',
             'Adherent to surfaces; harder to remove; fewer air bubbles retained',
             'Corneal endothelial protection; filling around fragile structures'],
            ['Adaptive / Hybrid',
             'Mixed cohesive-dispersive properties',
             'Pupil dilatation; posterior synechiae lysis; difficult cases'],
        ],
        col_widths=[4*cm, 6*cm, UW - 10*cm]
    ),
    sp(6),
    info_box("Soft-shell technique: inject dispersive OVD first (outer layer for endothelial protection), "
             "then cohesive OVD (inner layer for space). Used routinely or in high-risk corneas (e.g. cornea guttata)."),
    sp(10),
]

# ── Pre-op preparation ────────────────────────────────────────────────────────
story += [
    section_hdr('Pre-operative Preparation'),
    sp(6),
    bullet('Topical anaesthetic instilled (oxybuprocaine eye drops)'),
    bullet('Povidone-iodine 5% (or chlorhexidine) instilled into conjunctival sac — minimum 3 minutes contact time'),
    bullet('Eyelids and lashes cleaned with povidone-iodine'),
    bullet('Plastic drape applied — lashes and lid margins excluded from the surgical field'),
    bullet('Lid speculum inserted'),
    sp(8),
] + embed_img('phaco_prep_10_13.png', 12,
    'Fig. 10.13  Preparation — (A) Povidone-iodine conjunctival instillation; (B) skin cleaning; '
    '(C) plastic drape and speculum isolating the operative field from eyelids.  (Kanski\'s, p.338)') + [sp(10)]

# ── Surgical steps ────────────────────────────────────────────────────────────
story += [section_hdr('Surgical Steps — Phacoemulsification'), sp(8)]

steps = [
    (1, 'Side Port (Paracentesis)', [
        'Created ~60° to the left of the main incision (right-handed surgeons)',
        'Some surgeons make two side ports ~180° apart',
        'Viscoelastic injected into the anterior chamber through this port',
        'Instrument: MVR blade or paracentesis knife',
    ]),
    (2, 'Main Corneal Incision', [
        'Clear corneal incision 2.4–2.8 mm; triple-plane (self-sealing) construction',
        'Sited on the steepest corneal axis to neutralize pre-existing astigmatism, or temporally for better access',
        'Temporal incisions reduce induced astigmatism but carry slightly higher endophthalmitis risk',
        'Instrument: Microkeratome / keratome preset to 2.4–2.8 mm',
    ]),
    (3, 'Capsulorhexis (CCC)', [
        'Trypan blue staining if red reflex is poor (dense/mature cataract)',
        'Continuous curvilinear capsulorhexis performed under OVD cover',
        'If rhexis runs peripherally — inject cohesive OVD to flatten capsule and redirect the tear centrally',
        'Instrument: Cystotome (bent 26G needle) or Utrata capsulorrhexis forceps',
    ]),
    (4, 'Hydrodissection', [
        'Blunt cannula inserted just beneath the capsulorhexis edge',
        'Fluid gently injected under the capsule — hydrodissection wave visible with adequate red reflex',
        'Nucleus should rotate freely confirming complete cortical separation',
        'Instrument: Hydrodissection cannula',
    ]),
    (5, 'Nucleus Emulsification', [
        '<b>Divide and Conquer:</b> Two perpendicular grooves sculpted, then quadrants cracked and emulsified individually — safe, widely used',
        '<b>Phaco Chop (horizontal):</b> Blunt chopper passed under capsule, rotated vertically at equator — lower energy, faster but steeper learning curve',
        '<b>Phaco Chop (vertical):</b> Pointed-tip chopper; does not pass beyond rhexis edge — nucleus split into pieces',
        '<b>Stop and Chop:</b> Hybrid of divide-and-conquer + chop techniques',
        'Instrument: Phaco handpiece (titanium needle + sleeve) + second instrument chopper',
    ]),
    (6, 'Cortical Aspiration', [
        'Cortical segments carefully engaged with vacuum, peeled centrally from capsule, and aspirated',
        'Methods available: automated coaxial I/A, bimanual automated I/A, or manual Simcoe cannula',
        'Instrument: I/A handpiece (coaxial or bimanual) or Simcoe cannula',
    ]),
    (7, 'IOL Implantation', [
        'Capsular bag filled with cohesive OVD',
        'Loaded IOL injector cartridge introduced through the main wound',
        'Foldable IOL slowly injected and unrolled inside the capsular bag',
        'Toric IOL: rotated to correct meridional alignment after implantation',
        'OVD aspirated before or after toric alignment',
        'Instrument: IOL injector with cartridge; I/A handpiece for OVD removal',
    ]),
    (8, 'Wound Closure & Prophylaxis', [
        'Side port(s) and main wound sealed by corneal stromal hydration (saline injection = hydrosealing)',
        'AC must be well formed and wound water-tight before finishing',
        'Intracameral antibiotic: cefuroxime 1 mg / 0.1 mL (standard prophylaxis)',
        'Optional: subconjunctival antibiotic + steroid injection, or topical antibiotic drops',
    ]),
]

for num, title, items in steps:
    story += [KeepTogether([step_box(num, title, items), sp(6)])]

story.append(sp(4))

# ── Instruments table ─────────────────────────────────────────────────────────
story += [
    section_hdr('Key Instruments — Phacoemulsification'),
    sp(6),
    make_table(
        ['Instrument', 'Purpose / Step'],
        [
            ['Universal speculum',             'Lid retraction — pre-op'],
            ['MVR blade / paracentesis knife', 'Side port — Step 1'],
            ['Keratome (2.4–2.8 mm)',          'Main corneal incision — Step 2'],
            ['Cystotome / Utrata forceps',     'Capsulorhexis (CCC) — Step 3'],
            ['Hydrodissection cannula',        'Cortical separation — Step 4'],
            ['Phaco handpiece (titanium tip + sleeve)', 'Nucleus emulsification — Step 5'],
            ['Chopper (blunt / pointed)',      'Nucleus division (chop technique) — Step 5'],
            ['Coaxial / bimanual I/A handpiece', 'Cortical aspiration — Step 6'],
            ['OVD (cohesive / dispersive)',    'Space maintenance, endothelial protection — multiple steps'],
            ['Foldable IOL + injector cartridge', 'Lens implantation — Step 7'],
        ],
        col_widths=[6.5*cm, UW - 6.5*cm]
    ),
    sp(10),
]

# ── Complications table ───────────────────────────────────────────────────────
story += [
    section_hdr('Operative Complications'),
    sp(6),
    make_table(
        ['Complication', 'Cause', 'Consequence / Management'],
        [
            ['Posterior capsular rupture',
             'Excessive phaco energy, surge, inadvertent aspiration',
             'Vitreous loss; risk of CMO, retinal detachment, endophthalmitis; requires anterior vitrectomy'],
            ['Zonular dialysis',
             'Pre-existing weakness (pseudoexfoliation, trauma)',
             'IOL instability; may need capsular tension ring'],
            ['Corneal endothelial damage',
             'Thermal injury from phaco tip, inadequate OVD',
             'Corneal oedema / decompensation; prevented by dispersive OVD + cooling sleeve'],
            ['Dropped nucleus',
             'Posterior capsular rupture with nuclear descent',
             'Requires vitreoretinal surgery'],
            ['Suprachoroidal haemorrhage',
             'Sudden IOP drop in high-risk eyes',
             'Rare but severe; close wound immediately'],
        ],
        col_widths=[3.8*cm, 5*cm, UW - 8.8*cm]
    ),
    sp(16),
]

# ── Footer ────────────────────────────────────────────────────────────────────
story += [
    hr(),
    Paragraph("Source: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition, "
              "Chapter 10 — Cataract, pp. 336–339", foot_s),
]

doc.build(story)
print(f'Created: {OUT}')

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/sics_pdf/pdf_helpers.py'

"""Clean Cataract Lecture Notes PDF — reorganized from Kanski's 10th ed."""
import sys
sys.path.insert(0, '/home/daytona/workspace/sics_pdf')
from pdf_helpers import *
from reportlab.platypus import SimpleDocTemplate, KeepTogether, PageBreak
from reportlab.lib.pagesizes import A4
import urllib.request, os

OUT     = '/home/daytona/workspace/cataract_notes/Cataract_Lecture_Notes.pdf'
IMG_DIR = '/home/daytona/workspace/cataract_notes'

# ── Download Kanski images we need ───────────────────────────────────────────
imgs_to_get = {
    'lens_anatomy.png':    'https://cdn.orris.care/cdss_images/a2674d6ec496b5de9e01cd831d3b38fad72b4369b523c13cca36a6fd099d9385.png',
    'cataract_types.png':  'https://cdn.orris.care/cdss_images/8f47e4d9562ef9c21dcd7285b65b80aa39d01ca73c60bcd20fce50e8df09e498.png',  # Fig 10.2
    'maturity.png':        'https://cdn.orris.care/cdss_images/18a11284776dc8383f080698a4286203f8feab76ff5f3db2ff56ea53aacbccac.png',  # Fig 10.3
}
for fname, url in imgs_to_get.items():
    path = os.path.join(IMG_DIR, fname)
    if not os.path.exists(path):
        try:
            urllib.request.urlretrieve(url, path)
            print(f'Downloaded {fname}')
        except:
            print(f'SKIP {fname}')

doc = SimpleDocTemplate(OUT, pagesize=A4,
                        leftMargin=LM, rightMargin=RM,
                        topMargin=2*cm, bottomMargin=2*cm)

def note_box(label, text_list):
    """Highlighted note / remember box."""
    content = [Paragraph(f'<b>★ {label}</b>', S('nl', fontSize=9, fontName='Helvetica-Bold',
                           textColor=HexColor('#7d3c00'), leading=13))]
    for t in text_list:
        content.append(Paragraph(f'• {t}', S('nb', fontSize=9, fontName='Helvetica',
                                  textColor=DARK, leading=13, leftIndent=8)))
    t = Table([[content]], colWidths=[UW])
    t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0),(-1,-1), HexColor('#fff8e7')),
        ('BOX',           (0,0),(-1,-1), 1,    HexColor('#f0a500')),
        ('TOPPADDING',    (0,0),(-1,-1), 6),
        ('BOTTOMPADDING', (0,0),(-1,-1), 6),
        ('LEFTPADDING',   (0,0),(-1,-1), 10),
        ('RIGHTPADDING',  (0,0),(-1,-1), 10),
    ]))
    return t

story = []

# ═══════════════════════════════════════════════════════════════════════════════
# COVER BANNER
# ═══════════════════════════════════════════════════════════════════════════════
story += [
    title_banner(
        'CATARACT',
        'Complete Lecture Notes — Ophthalmology',
        "Based on: Kanski's Clinical Ophthalmology, 10th Edition, Chapter 10"
    ),
    sp(12),
]

# ── Quick index ───────────────────────────────────────────────────────────────
idx_data = [
    [Paragraph('<b>Topic</b>', thdr_s), Paragraph('<b>Page</b>', thdr_s)],
    [Paragraph('1. Definition & Lens Anatomy', tcel_s),     Paragraph('1', tcelc_s)],
    [Paragraph('2. Aetiology & Risk Factors', tcel_s),      Paragraph('1', tcelc_s)],
    [Paragraph('3. Types of Cataract', tcel_s),             Paragraph('2', tcelc_s)],
    [Paragraph('4. Morphological Classification', tcel_s),  Paragraph('2', tcelc_s)],
    [Paragraph('5. Clinical Features & Symptoms', tcel_s),  Paragraph('3', tcelc_s)],
    [Paragraph('6. Investigations', tcel_s),                Paragraph('3', tcelc_s)],
    [Paragraph('7. Indications for Surgery', tcel_s),       Paragraph('3', tcelc_s)],
    [Paragraph('8. Surgical Techniques Overview', tcel_s),  Paragraph('4', tcelc_s)],
    [Paragraph('9. IOL Types', tcel_s),                     Paragraph('4', tcelc_s)],
    [Paragraph('10. Complications', tcel_s),                Paragraph('5', tcelc_s)],
    [Paragraph('11. Special Cataracts', tcel_s),            Paragraph('5', tcelc_s)],
]
idx_tbl = Table(idx_data, colWidths=[UW - 2*cm, 2*cm])
idx_tbl.setStyle(TableStyle([
    ('BACKGROUND',    (0,0),(-1,0),  TEAL),
    ('ROWBACKGROUNDS',(0,1),(-1,-1), [white, LTGREY]),
    ('GRID',          (0,0),(-1,-1), 0.4, MIDGREY),
    ('TOPPADDING',    (0,0),(-1,-1), 5),
    ('BOTTOMPADDING', (0,0),(-1,-1), 5),
    ('LEFTPADDING',   (0,0),(-1,-1), 8),
    ('ALIGN',         (1,0),(-1,-1), 'CENTER'),
    ('VALIGN',        (0,0),(-1,-1), 'MIDDLE'),
]))
story += [idx_tbl, sp(14)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 1 — DEFINITION & LENS ANATOMY
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('1.  Definition & Lens Anatomy'), sp(6)]

story += [
    body('<b>Cataract:</b> Any opacity of the crystalline lens, regardless of its effect on vision. '
         'It is the leading cause of treatable blindness worldwide.'),
    sp(6), sub_hdr('Lens Anatomy'),
    bullet('Biconvex, avascular, transparent structure — situated behind the iris and in front of the vitreous'),
    bullet('Enclosed by an elastic <b>capsule</b> — thickest at the anterior lens capsule, thinnest at the posterior pole'),
    bullet('<b>Lens epithelium</b>: single layer of cells beneath the anterior capsule; only metabolically active zone'),
    bullet('<b>Cortex</b>: outermost lens fibers — younger fibers; more susceptible to hydration and opacification'),
    bullet('<b>Nucleus</b>: central core of oldest compacted fibers; hardens with age (nuclear sclerosis)'),
    bullet('Lens has <b>no blood supply</b> — nourished by aqueous humour (anterior) and vitreous (posterior)'),
    bullet('Lens grows throughout life — new fibers laid down at equator; old fibers compressed centrally'),
    sp(6),
    note_box('Key Biochemistry', [
        'Main protein: crystallins (α, β, γ) — maintain transparency by short-range order',
        'Energy: primarily anaerobic glycolysis (lens is largely anaerobic)',
        'Antioxidant: glutathione (GSH) — protects against oxidative damage; depleted in cataract',
        'Sorbitol pathway (polyol pathway): in diabetes — glucose → sorbitol (aldose reductase) → osmotic overhydration → cortical opacification',
    ]),
    sp(10),
]
story += embed_img('lens_anatomy.png', 11,
    'Fig. 10.1  Cross-sectional anatomy of the anterior segment showing lens structure  (Kanski\'s, p.322)', IMG_DIR) + [sp(10)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 2 — AETIOLOGY & RISK FACTORS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('2.  Aetiology & Risk Factors'), sp(6)]

story += [
    make_table(
        ['Category', 'Cause / Condition'],
        [
            ['Age (most common)', 'Age-related nuclear sclerosis, cortical & PSC cataract'],
            ['Metabolic', 'Diabetes mellitus (snowflake/cortical), hypocalcaemia (tetanic cataract), Wilson\'s disease (sunflower cataract), galactosaemia'],
            ['Drugs', 'Long-term corticosteroids (PSC), chlorpromazine, amiodarone, miotics (anterior subcapsular)'],
            ['Trauma', 'Blunt (Vossius ring, rosette/stellate cataract), penetrating (total white cataract), electric shock, radiation'],
            ['Uveitis', 'Posterior synechiae → complicated cataract (PSC most common pattern)'],
            ['Myopia (high)', 'Nuclear cataract develops earlier'],
            ['Systemic diseases', 'Myotonic dystrophy (Christmas tree → star-shaped cortical/PSC), atopic dermatitis (anterior shield cataract), Down syndrome'],
            ['Congenital / hereditary', 'Maternal rubella (total/nuclear), galactosaemia, Lowe syndrome, TORCH infections'],
            ['Radiation', 'X-ray, UV-B, infrared (glassblower\'s cataract — PSC)'],
            ['Nutritional', 'Vitamin C deficiency, dehydration (diarrhoeal disease)'],
        ],
        col_widths=[4.5*cm, UW - 4.5*cm]
    ),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 3 — TYPES OF CATARACT
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('3.  Types of Cataract (by Location)'), sp(6)]

types = [
    ('Posterior Subcapsular (PSC)', [
        'Lies just in front of the posterior capsule',
        'Granular/plaque-like on slit-lamp; black and vacuolated on retroillumination',
        'Vacuoles = swollen Wedl (bladder) cells — same as PCO cells',
        'Worst visual effect for its size — located at nodal point of the eye',
        'Key symptoms: severe glare (car headlights), worse in bright light / near work (miosis worsens it)',
        'Causes: steroids, uveitis, radiation, diabetes, high myopia',
    ]),
    ('Anterior Subcapsular (ASC)', [
        'Under the anterior capsule — fibrous metaplasia of lens epithelium',
        'Associated with: atopic dermatitis (anterior shield cataract), trauma, miotics',
    ]),
    ('Nuclear Sclerotic', [
        'Exaggeration of normal ageing — yellowing (urochrome pigment), later browning, rarely black',
        'Best seen with oblique slit-lamp beam',
        'Associated myopia due to ↑ refractive index of nucleus → "second sight of the aged" (patient can read without glasses again)',
        'Retroillumination: good red reflex with subtle nucleus-cortex distinction',
    ]),
    ('Cortical', [
        'Involves anterior, posterior, or equatorial cortex',
        'Starts as clefts and vacuoles (cortical hydration) → cuneiform (wedge-shaped) or radial spoke-like opacities',
        'Initially inferonasal quadrant; common symptom: glare',
        'Associated: diabetes, UV exposure',
    ]),
    ('Christmas Tree', [
        'Uncommon — polychromatic, needle-like formations in deep cortex and nucleus',
        'Associated: myotonic dystrophy',
    ]),
]

for title, items in types:
    story += [KeepTogether([sub_hdr(title)] + [bullet(i) for i in items] + [sp(6)])]

story += [sp(4)]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 4 — MORPHOLOGICAL CLASSIFICATION (MATURITY)
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('4.  Morphological Classification — Maturity'), sp(6)]

story += [
    make_table(
        ['Stage', 'Features', 'Key Finding'],
        [
            ['Immature',   'Lens partially opaque; cortex still clear in parts', 'Red reflex present; shadow test +ve (iris shadow on lens)'],
            ['Mature',     'Entire lens opaque — completely white', 'No red reflex; shadow test negative (no iris shadow)'],
            ['Hypermature','Lens shrunken; anterior capsule wrinkled due to water leakage out', 'Calcium deposits on capsule; risk of phacolytic glaucoma'],
            ['Morgagnian', 'Hypermature + liquefied cortex → nucleus sinks inferiorly', 'Brown nucleus at bottom; liquefied cortex above — gravity dependent'],
        ],
        col_widths=[3*cm, 6*cm, UW - 9*cm]
    ),
    sp(6),
    note_box('Shadow Test (Oblique Illumination)', [
        'Light shone obliquely from temporal side',
        'Immature cataract: crescent-shaped iris shadow falls on the lens (pupil area)',
        'Mature cataract: no shadow — lens fully opaque',
        'Hypermature: may be hard to assess; capsule may show iridescence',
    ]),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 5 — CLINICAL FEATURES & SYMPTOMS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('5.  Clinical Features & Symptoms'), sp(6)]

story += [
    sub_hdr('Symptoms'),
    bullet('<b>Progressive painless blurring of vision</b> — most common presenting complaint'),
    bullet('<b>Glare</b> — especially PSC and cortical; worse with oncoming headlights at night'),
    bullet('<b>Myopic shift</b> — nuclear cataract increases refractive index → "second sight" (near vision improves temporarily)'),
    bullet('<b>Uniocular diplopia / polyopia</b> — irregular refraction through opaque areas'),
    bullet('<b>Coloured halos</b> — around lights; cortical and PSC cataracts'),
    bullet('<b>Fading of colour vision</b> — nuclear cataract (yellowish lens filters blue light)'),
    bullet('<b>Frequent change in spectacle prescription</b>'),
    sp(8), sub_hdr('Signs — Examination Findings'),
    make_table(
        ['Examination Method', 'Finding'],
        [
            ['Visual acuity (Snellen)',        'Reduced; worse in bright light in PSC'],
            ['Torch / oblique illumination',   'Visible lens opacity; shadow test for maturity'],
            ['Slit-lamp biomicroscopy',        'Best assessment of type, density, and location of opacity'],
            ['Retro-illumination',             'PSC: black vacuolated opacity; nuclear: subtle hue change'],
            ['Direct ophthalmoscopy',          'Reduced or absent red reflex depending on density'],
            ['Pupil reactions',                'Normal (no RAPD) unless posterior segment disease coexists'],
        ],
        col_widths=[5.5*cm, UW - 5.5*cm]
    ),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 6 — INVESTIGATIONS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('6.  Investigations'), sp(6)]

story += [
    sub_hdr('Pre-operative Assessment'),
    bullet('<b>Visual acuity</b> — Snellen chart; pinhole VA to isolate refractive vs. organic cause'),
    bullet('<b>Slit-lamp examination</b> — type, density, location of cataract; corneal status; IOP'),
    bullet('<b>Fundus examination</b> — check posterior segment (retina, macula, disc) before surgery; if view poor → B-scan ultrasound'),
    bullet('<b>B-scan ultrasound</b> — to rule out posterior segment pathology (retinal detachment, vitreous haemorrhage) when fundus not visible'),
    bullet('<b>Biometry (A-scan / optical biometry)</b> — axial length measurement for IOL power calculation'),
    bullet('<b>Keratometry</b> — corneal curvature for IOL calculation (used in SRK/T, Haigis, Barrett formulas)'),
    bullet('<b>Corneal endothelial cell count (specular microscopy)</b> — if corneal disease suspected'),
    bullet('<b>Potential acuity testing</b> — Maddox rod, laser interferometry — estimates macular function behind dense cataract'),
    sp(6),
    note_box('IOL Power Calculation Formulas', [
        'SRK/T formula: most widely used for normal axial lengths (22–25 mm)',
        'Haigis formula: better for short or long eyes',
        'Barrett Universal II: most accurate across all axial lengths (current standard)',
        'Holladay 2: used for abnormal corneas and post-refractive surgery eyes',
        'Target refraction: aim for emmetropia (or patient\'s preferred target)',
    ]),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 7 — INDICATIONS FOR SURGERY
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('7.  Indications for Surgery'), sp(6)]

story += [
    sub_hdr('Visual Indications (most common)'),
    bullet('Vision reduced to the extent that it interferes with the patient\'s daily activities or occupation'),
    bullet('VA < 6/18 (or worse) is a common threshold in many healthcare systems'),
    bullet('Glare / difficulty driving at night despite acceptable Snellen acuity'),
    sp(4), sub_hdr('Medical / Absolute Indications'),
    bullet('<b>Phacolytic glaucoma</b> — hypermature cataract leaks lens proteins → macrophage-mediated trabecular blockage → ↑ IOP'),
    bullet('<b>Phacomorphic glaucoma</b> — intumescent (swollen) mature lens pushes iris forward → angle closure → ↑ IOP'),
    bullet('<b>Phacoanaphylaxis (lens-induced uveitis)</b> — immune response to leaked lens proteins'),
    bullet('<b>Lens subluxation / dislocation</b> — traumatic or Marfan syndrome'),
    bullet('<b>To visualise / treat posterior segment</b> — dense cataract obscuring view of retina needing laser or surgery'),
    sp(4), sub_hdr('Paediatric Indications'),
    bullet('Dense unilateral cataract → deprivational amblyopia — surgery within first weeks of life is urgent'),
    bullet('Bilateral cataract — surgery by 6–10 weeks; optical rehabilitation with spectacles / contact lenses + patching essential'),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 8 — SURGICAL TECHNIQUES
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('8.  Surgical Techniques — Overview'), sp(6)]

story += [
    make_table(
        ['Technique', 'Incision', 'Key Feature', 'Current Status'],
        [
            ['ICCE\n(Intracapsular)', '~12 mm', 'Whole lens + capsule removed en bloc; cryoprobe used', 'Obsolete — only for dislocated lens without capsule support'],
            ['ECCE\n(Extracapsular)', '8–10 mm', 'Nucleus expressed; cortex aspirated; posterior capsule left intact; sutures required', 'Still used in resource-limited settings with very hard nuclei'],
            ['MSICS\n(Manual SICS)', '5–7 mm scleral tunnel', 'Self-sealing tunnel; nucleus delivered en bloc; no phaco machine; no sutures', 'Standard in developing world / high-volume camps'],
            ['Phacoemulsification', '2.4–2.8 mm clear corneal', 'Ultrasonic emulsification; foldable IOL; rapid visual recovery; sutureless', 'Gold standard in developed countries'],
            ['Femtosecond laser-assisted', '2.4–2.8 mm (laser-made)', 'Laser capsulorhexis, pre-fragmentation; reduces phaco energy', 'Premium option — higher cost, longer time'],
        ],
        col_widths=[2.8*cm, 2.8*cm, 6*cm, UW - 11.6*cm]
    ),
    sp(6),
    note_box('Must Know for Exams', [
        'ICCE → Anterior chamber IOL (AC-IOL) used as no capsular support',
        'ECCE / MSICS / Phaco → Posterior chamber IOL (PC-IOL) in capsular bag',
        'MSICS advantage over ECCE: self-sealing, no sutures, less astigmatism',
        'Phaco advantage: smaller incision, faster recovery, less astigmatism',
        'Phaco disadvantage: expensive, difficult in very hard (brunescent) nuclei',
    ]),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 9 — IOL TYPES
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('9.  Intraocular Lens (IOL) Types'), sp(6)]

story += [
    sub_hdr('By Material'),
    bullet('<b>PMMA (polymethylmethacrylate)</b> — rigid; used in ECCE/MSICS; requires larger incision; durable'),
    bullet('<b>Acrylic (hydrophobic)</b> — most common foldable material; low PCO rate due to square edge; used in phaco'),
    bullet('<b>Hydrophilic acrylic (HEMA)</b> — flexible; slightly higher PCO rate'),
    bullet('<b>Silicone</b> — foldable; not used if vitreoretinal surgery may be needed (silicone oil sticks to it)'),
    sp(4), sub_hdr('By Design / Function'),
    make_table(
        ['IOL Type', 'Feature', 'Indication'],
        [
            ['Monofocal (standard)', 'Single focal point — corrects for distance; reading glasses still needed', 'Routine cataract surgery'],
            ['Toric IOL', 'Cylindrical element corrects pre-existing corneal astigmatism; must be aligned to correct axis', 'Patients with significant regular corneal astigmatism'],
            ['Multifocal / EDOF', 'Simultaneous focus at multiple distances; reduces spectacle dependence', 'Premium — motivated patients; avoid if macular disease'],
            ['Accommodative', 'Attempt to flex with ciliary muscle; limited real-world effect', 'Premium option; results variable'],
            ['Sulcus-fixated IOL', 'Placed in ciliary sulcus (not capsular bag) when posterior capsule ruptured', 'Complicated surgery — posterior capsule rupture'],
            ['AC-IOL', 'Anterior chamber; angle-supported', 'ICCE, aphakia, failed PC-IOL placement'],
        ],
        col_widths=[3.5*cm, 6*cm, UW - 9.5*cm]
    ),
    sp(6),
    note_box('Square-Edged Optic', [
        'Creates a mechanical barrier at the posterior capsule edge',
        'Significantly reduces PCO (posterior capsular opacification) rate',
        'May cause dysphotopsia (arc-shaped shadow) — more common with square edge',
    ]),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 10 — COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('10.  Complications of Cataract Surgery'), sp(6)]

story += [sub_hdr('Intraoperative Complications')]
story += [
    make_table(
        ['Complication', 'Mechanism', 'Management'],
        [
            ['Posterior capsule rupture (PCR)',
             'Most feared intraop complication; phaco surge, excessive energy, or instrument trauma to capsule',
             'Stop phaco; convert to manual extraction if needed; anterior vitrectomy for vitreous loss; place IOL in sulcus or AC'],
            ['Vitreous loss',
             'Follows PCR — vitreous enters anterior segment',
             'Thorough anterior vitrectomy; prevent vitreous wick syndrome'],
            ['Dropped nucleus / lens fragment',
             'Nuclear fragment falls into vitreous through PCR',
             'Do not chase; close wound; refer for pars plana vitrectomy'],
            ['Suprachoroidal (expulsive) haemorrhage',
             'Sudden massive intraoperative bleeding behind choroid; rare; risk ↑ in high myopia, glaucoma, HTN',
             'Close wound immediately; pressure; later drainage if needed'],
            ['Zonular dialysis',
             'Weak zonules (pseudoexfoliation, Marfan, trauma) → nucleus instability',
             'Capsular tension ring; if severe → sulcus or AC-IOL'],
        ],
        col_widths=[3.5*cm, 5*cm, UW - 8.5*cm]
    ),
    sp(8), sub_hdr('Early Postoperative Complications'),
    make_table(
        ['Complication', 'Features', 'Management'],
        [
            ['Corneal oedema',
             'Striate keratopathy — endothelial damage from phaco energy or OVD retention; usually resolves',
             'Hypertonic saline drops; most self-limiting in 1–2 weeks'],
            ['Raised IOP (early)',
             'Retained OVD, steroid response, inflammation, hyphema, vitreous in AC',
             'IOP-lowering drops; wash out OVD if needed'],
            ['Uveitis / iritis',
             'Inflammatory response; especially in diabetics, uveitis patients',
             'Topical steroids; NSAIDs'],
            ['Wound leak / flat AC',
             'Poorly constructed incision or wound gape',
             'Pressure patching or suture'],
            ['Hyphema',
             'Bleeding into AC — trauma to iris or ciliary body',
             'Usually resolves; avoid antiplatelets'],
        ],
        col_widths=[3.5*cm, 5*cm, UW - 8.5*cm]
    ),
    sp(8), sub_hdr('Late Postoperative Complications'),
    make_table(
        ['Complication', 'Features', 'Management'],
        [
            ['Posterior Capsular Opacification (PCO) ★ MOST COMMON late complication',
             'Wedl (bladder) cells migrate to posterior capsule → visual deterioration, glare, PCO usually 6 months – 2 years post-op',
             'Nd:YAG laser posterior capsulotomy — creates opening in posterior capsule; quick, effective, permanent'],
            ['Cystoid Macular Oedema (CMO / Irvine-Gass syndrome)',
             'Perifoveal capillary leakage; peak 4–6 weeks post-op; presents as central visual blurring after initial good vision',
             'Topical NSAIDs + steroids; most resolve spontaneously; intravitreal treatment if chronic'],
            ['Retinal detachment',
             'Risk ↑ with PCR, vitreous loss, high myopia, young male; may present months–years later',
             'Urgent vitreoretinal surgery'],
            ['Endophthalmitis',
             'Sight-threatening infection; acute (<1 week — Staph. aureus, Strep.) or chronic/delayed (P. acnes — white plaques on IOL)',
             'Intravitreal antibiotics (vancomycin + ceftazidime); vitrectomy if severe (EVS criteria)'],
            ['IOL dislocation / decentration',
             'Zonular weakness, PCR, capsule contraction',
             'Reposition or exchange IOL'],
            ['Bullous keratopathy',
             'Chronic corneal decompensation from endothelial damage',
             'DMEK / DSAEK corneal transplant'],
        ],
        col_widths=[4*cm, 5*cm, UW - 9*cm]
    ),
    sp(6),
    note_box('Endophthalmitis — Prophylaxis', [
        'Povidone-iodine 5% into conjunctival sac — single most effective prophylactic measure',
        'Intracameral cefuroxime 1 mg/0.1 mL at end of surgery (ESCRS trial evidence)',
        'Incidence with intracameral cefuroxime: ~0.03% vs ~0.07% without',
        'Topical antibiotic drops pre/post-operatively — additional but lesser benefit',
    ]),
    sp(10),
]

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 11 — SPECIAL CATARACTS
# ═══════════════════════════════════════════════════════════════════════════════
story += [section_hdr('11.  Special / Secondary Cataracts'), sp(6)]

story += [
    sub_hdr('Diabetic Cataract'),
    bullet('Classic: rare — bilateral snowflake cortical opacities in young diabetics; may mature rapidly or resolve'),
    bullet('Common: accelerated age-related cataract; nuclear sclerosis common and fast-progressing'),
    bullet('Mechanism: hyperglycaemia → ↑ aqueous glucose → sorbitol accumulation (aldose reductase) → osmotic overhydration'),
    bullet('Refractive: fluctuating myopia/hyperopia with plasma glucose; resolve once glucose controlled'),
    bullet('Pre-op assessment: check for diabetic retinopathy / maculopathy — DME worsens post-op'),
    sp(6),
    sub_hdr('Traumatic Cataract'),
    bullet('<b>Blunt trauma:</b> Vossius ring (iris pigment imprint on anterior lens capsule); rosette/stellate posterior subcapsular opacity'),
    bullet('<b>Penetrating trauma:</b> total white cataract; may have foreign body inside lens'),
    bullet('<b>Electric shock / lightning:</b> PSC cataract — bilateral; appears within weeks-months'),
    bullet('<b>Radiation (ionizing):</b> PSC cataract — latent period years; seen in radiotherapy / nuclear exposure'),
    bullet('<b>Infrared (heat):</b> glassblower\'s cataract — exfoliation of anterior capsule (true exfoliation)'),
    sp(6),
    sub_hdr('Complicated Cataract (Secondary to Ocular Disease)'),
    bullet('Uveitis → PSC most common pattern; also total cataract in severe/prolonged inflammation'),
    bullet('Glaucoma (on miotics) → anterior subcapsular opacity'),
    bullet('High myopia → nuclear cataract earlier; cortical also common'),
    bullet('Retinitis pigmentosa → PSC cataract'),
    bullet('Acute congestive glaucoma → anterior subcapsular (glaukomflecken) — grey-white spots = necrotic lens epithelial cells; permanent; diagnostic marker'),
    sp(6),
    sub_hdr('Congenital Cataract'),
    bullet('<b>Lamellar (zonular):</b> most common; shell-like opacity around clear nucleus; autosomal dominant'),
    bullet('<b>Nuclear:</b> central; associated with rubella, galactosaemia'),
    bullet('<b>Posterior polar:</b> posterior capsule at pole; risk of PCR during surgery'),
    bullet('<b>Total/complete:</b> dense; urgent surgery to prevent amblyopia'),
    bullet('Causes: TORCH (Toxoplasmosis, Rubella — most common, CMV, HSV), galactosaemia, Down syndrome, Lowe syndrome, idiopathic/hereditary'),
    bullet('Rule: treat dense unilateral congenital cataract within 6 weeks of life; bilateral within 10 weeks'),
    sp(10),
]

# ── Footer ─────────────────────────────────────────────────────────────────────
story += [
    hr(),
    Paragraph("Source: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th Edition, "
              "Chapter 10 — Cataract | Notes compiled for Ophthalmology Lecture", foot_s),
]

doc.build(story)
print(f'Created: {OUT}')