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Advances in Ophthalmology—1
Ashok Garg, Suresh K Pandey, Vidushi Sharma, David J Apple
SECTION I: CATARACT
1:
Anesthesia in Cataract Surgery—An Update
INTRODUCTION
ANESTHESIA FOR CATARACT SURGERY
General Anesthesia
GENERAL ANESTHESIA PROCEDURE
Preoperative Preparation
Chronic (Obstructive) Respiratory Disease
Cardiovascular Disease
Diabetes Mellitus
Dystrophia Myotonica
Premedication
METHOD OF ANESTHESIA
Induction
Maintenance
ANESTHESIA FOR CHILDREN
COMPLICATIONS OF GENERAL ANESTHESIA
Local Anesthesia
Orbicularis Oculi Akinesia
Gills-Loyd Modified Retrobulbar Block
COMPLICATIONS OF RETROBULBAR INJECTION
Retrobulbar Hemorrhage
PERFORATION OF THE GLOBE
RETINAL VASCULAR OBSTRUCTION
SUBARACHNOID INJECTION
PERIBULBAR (PERIOCULAR) TECHNIQUE
Technique
Advantages
Drawback
Mechanism
Superior Rectus Injection
Tenon's Capsule Injection
Parabulbar (Flush) Akinesia
TOPICAL ANESTHESIA
Indications to use Topical Anesthesia
HOW TO ACHIEVE SURFACE ANESTHESIA FOR INTRAOCULAR SURGERY
CAN ONE CONVERT HALF WAY THROUGH SURGERY UNDER TOPICAL ANESTHESIA
Advantages of Topical Anesthesia
Disadvantages of Topical Anesthesia
NO ANESTHESIA CATARACT SURGERY
2:
No Anesthesia Clear Corneal Phacoemulsification
BACKGROUND
PROSPECTIVE RANDOMIZED DOUBLE-MASKED STUDY
Patients
Anesthetic Techniques
Surgical Technique
Parameters Assessed
Results
OUR STUDY AND OTHER SURGEON'S EXPERIENCE WORLDWIDE
NO ANESTHESIA CLEAR CORNEAL PHACOEMULSIFICATION SURGERY: WHY DOES IT WORK?
Surgical Factors
Anatomical Factors
CONCLUSION
3:
Corneal Endothelium and its Protection in Phacoemulsification
THE IMPORTANCE OF THE ENDOTHELIUM
EVALUATION OF THE ENDOTHELIUM: THE ENDOTHELIAL MICROSCOPE
Variations in Endothelial Cell Count
Healing of Lost Endothelial Cell Areas
Minimal Cell Density
Late Corneal Decompensation
Steps to Prevent Cell Loss
Prevent IOL Contact
Care with Irrigating Solutions
Use Preservative Free Intracameral Solutions
Use Iced (4°) Irrigating Solutions
Why Endothelial Cell Loss with Phaco?
The Surgeon has to Take Special Care
Endothelial Cell Protection Techniques in Phacoemulsification
Decrease Fluid Input Coupled with Zero Suction
Viscoelastic Protection
Use of Freezing Solutions
Pulse Phaco Usage
Proper Tip Placement
The Advent of the Concept of Physical Endothelial Cell Protection
Hema Intracameral Endothelial Contact Lens
The Design of the Hema Hood
The Material of the Hema Hood
The Surgical Technique of using the Hema Hood
Preparation of the Hood for Usage
Insertion of the Hood
Phacoemulsification Procedure with the Hood
Removal of the Hood following Surgery
Postsurgical Evaluation
Endothelial Cell Analysis
Hema Intracameral Contact Lens Endothelial Cell Loss: Average Cell Loss in Phaco with the Hema Hood
In Summary
4:
Phacoemulsification with Cryoanalgesia—A New Approach
INTRODUCTION
SURGICAL TECHNIQUE
Paracentesis
Clear-corneal Incision
Capsulorhexis and Nuclear Hydrodissection
Phacoemulsification
Cortical Aspiration
IOL Implantation and Incision Closure
COMMENT
5:
No Anesthesia Cataract Surgery
INTRODUCTION
INCISION
CAPSULORHEXIS
PHACOEMULSIFICATION TECHNIQUES
INTRAOCULAR LENS IMPLANTATION
NO ANESTHESIA CLEAR LENS EXTRACTION
SPECIFIC PRECAUTIONS IN NO ANESTHESIA CATARACT SURGERY
DISCUSSION
6:
Phakonit
HISTORY
PRINCIPLE
TERMINOLOGY
TECHNIQUE OF PHAKONIT FOR CATARACTS
Anesthesia
INCISION
RHEXIS
HYDRODISSECTION
PHAKONIT
ANTI-CHAMBER COLLAPSER
SURGE
TECHNIQUE
DISCUSSION
PHAKONIT THINOPTX ROLLABLE IOL
LENS INSERTION TECHNIQUE
ROLLECTOR
TOPOGRAPHY
LASER PHAKONIT
THREE PORT PHAKONIT
SUMMARY
7:
Phakonit with Acritec IOL
HISTORY
PRINCIPLE
TERMINOLOGY
TECHNIQUE OF PHAKONIT FOR CATARACTS
Anesthesia
INCISION
RHEXIS
PHAKONIT
ACRITEC IOL
LENS LOADING TECHNIQUE
LENS INSERTION TECHNIQUE
LASER PHAKONIT
SUMMARY
8:
Endocapsular Lensectomy
INTRODUCTION
CONVENTIONAL TECHNIQUES WITH THE FRAGMENTER
INFUSION OPTIONS
LENS CAPSULE REMOVAL
FRAGMENTER OPTIONS
PHACOEMULSIFICATION WITH PARS PLANA VITRECTOMY
ANTERIOR LENS CAPSULE RETENTION AND LENS IMPLANTATION IN THE SULCUS
ENDOCAPSULAR LENSECTOMY
SUMMARY
9:
Phaco in Subluxated Cataracts
INTRODUCTION
HISTORY
ADVANTAGES
DESIGNS AND DESCRIPTIONS
INDICATIONS
APPLICATIONS
Zonular Dehiscence
Zonular Weakness
TECHNIQUE
Anesthesia
INCISIONS
CAPSULORHEXIS
HYDRODISSECTION–HYDRODELINEATION
IMPLANTATION OF CAPSULAR RING
PHACOEMULSIFICATION
CORTICAL ASPIRATION
IMPLANTATION OF THE INTRAOCULAR LENS
Key Points with the Use of Capsular Tension Rings
SPECIAL CONDITIONS
SUMMARY
10:
Update on Pediatric Cataract Management
INTRODUCTION
DIAGNOSIS OF PEDIATRIC CATARACTS
CATARACT SURGERY IN CHILDREN
How does Pediatric Cataract Surgery Differ from Adult?
Indications for Treatment
Optical Rehabilitation
Aphakic Glasses
Contact Lenses
Epikeratophakia
Intraocular Lens Implantation
SURGICAL TECHNIQUES
Historical Perspective
Anesthesia
Wound Construction
Viscoelastic Substances
Anterior Capsule Management
Manual Continuous Curvilinear Capsulorhexis
Vitrector-cut Anterior Capsulectomy (Vitrectorhexis)
Bipolar Radiofrequency Capsulotomy
Lens Substance Removal
Primary Intraocular Lens Implantation
Secondary Intraocular Lens Implantation
Management of the Posterior Capsule
Primary Posterior Capsulotomy and Anterior Vitrectomy
Posterior Capsulorhexis with Intraocular Lens Optic Capture
Neodymium (Nd): YAG Laser Posterior Capsulotomy
DYE-ENHANCED PEDIATRIC CATARACT SURGERY
PEDIATRIC TRAUMATIC CATARACTS AND THEIR MANAGEMENT
Epidemiology and Etiology
Surgical Management
Visual Results and Postoperative Complications
PERIOPERATIVE AND POSTOPERATIVE TREATMENT
POSTOPERATIVE COMPLICATIONS AND MANAGEMENT
Early Onset
Uveitis
Corneal Edema
Endophthalmitis
Noninfectious Inflammation
Intermediate/Late Onset
Capsular Bag Opacification
Secondary Membrane Formation
Pupillary Capture
Deposits on IOL Surface
IOL Decentration
Glaucoma
Retinal Detachment
Cystoid Macular Edema
Hemorrhagic Retinopathy
RESIDUAL REFRACTIVE ERROR
MANAGEMENT OF AMBLYOPIA
SUMMARY AND CONCLUSIONS
11:
Favit—A Technique for Removing Dropped Nucleus duing Phacoemulsification
FAVIT
INTRODUCTION
SURGICAL TECHNIQUE
DISCUSSION
CONCLUSION
12:
Management of Dislocated Implants by the Vitreoretinal Approach*
ANTERIOR CHAMBER INTRAOCULAR LENS (ACIOL)
POSTERIOR CHAMBER INTRAOCULAR LENS (PCIOL)
Location of PCIOL Fixation
Opened Eye or External Approach
Closed Eye or Internal Approach: Pars Plana Techniques
Scleral Loop Fixation
The Grieshaber Snare
Use of Perfluorocarbon Liquid
The 25 Gauge IOL Forceps
Temporary Haptic Externalization
One-piece Silicone Plate IOL
Managing Eyes with Two Intraocular Implants
SUMMARY
13:
Air Pump to Prevent Surge
INTRODUCTION
SURGE
NEW TECHNIQUE
METHOD
CONTINUOUS INFUSION
ADVANTAGES
TOPICAL OR NO ANESTHESIA CATARACT SURGERY
DISADVANTAGES
SUMMARY
14:
Trypan Blue in the Management of Mature Cataracts
INTRODUCTION
RHEXIS IN MATURE CATARACTS
TRYPAN BLUE
TECHNIQUE
ADVERSE EFFECTS
STERILIZATION
INDOCYANINE GREEN DYE
SUMMARY
15:
My Personal Technique of Vertical Hubbing Phacoemulsification
PREOPERATIVE PREPARATION
ANESTHESIA TECHNIQUE
PREFERRED PHACOEMULSIFIER
DRAPING and PREOPERATIVE PREPARATION OF THE EYE
MONITORING PATIENTS IN THE THEATRE
OPERATIVE PROCEDURE
THE INCISIONS
CORNEAL ENTRY
THE CAPSULORHEXIS
HYDRODISSECTION AND HYDRODELAMINATION
PHACOEMULSIFICATION TECHNIQUE
TECHNIQUE OF VERTICAL ‘HUBBING' PHACOEMULSIFICATION
Nuclear Stabilization
Coring the Nucleus
Snapping the Periphery
Pulse Aspiration of the Ring
INDICATIONS
16:
The Prevention of Complications and their Management in Phacoemulsification
PREVENTIVE ASPECTS PRIOR COMMENCING PHACOEMULSIFICATION
Positioning of the Patient
Checking the Intraocular Pressure
Oxygen or Fresh Air Under the Drapes
Placement of the Lid Retractor
Aspiration of Excess Fluid
COMPLICATIONS AT VARIOUS PHASES OF PHACOEMULSIFICATION SURGERY
Clear Corneal Incision
The Problem with Side Port Incision
Complications During Capsulorhexis
Problems with the Capsulorhexis
Prevention of Complications with Hydrodissection
Managing Complications in Hydrodissection
Impending Rupture of the Posterior Capsule
Managing the Ruptured Capsule after Hydrodissection
Problems and their Management During Phacoemulsification of the Nucleus
Problems with Nucleo-fractis and In Situ (Four Quadrant) Phaco Fracture Technique
Complications with the Phaco Chop Techniques
Managing Problems with the Phaco Chop Technique
Fixation of the Nucleus
Selection of the Chopper
Placement of the Chopper Tip
Proper Holding of the Nucleus for a Chop
Rotation Following the Phaco Chop
To Convert or not to Convert into ECCE that is the Question
Problems in Conversion to ECCE
Managing the Intact Posterior Capsule
Intraoperative Primary Posterior Capsulotomy
Method of Usage of Polishing Cannula
Causes for Rupture of the Posterior Capsule
Signs of a Posterior Capsular Rupture
Managing the Broken Posterior Capsule
Rupture of the Posterior Capsule without Hyaloid Face Rupture
Rupture of the Posterior Capsule, with Hyaloid Face Rupture, but without Luxation of Nuclear Material into the Vitreous
Rupture of the Posterior Capsule, with Hyaloid Face Rupture, with Luxation of Nuclear Material into the Vitreous
17:
Laser Phaco Cataract Surgery
INTRODUCTION
HISTORY
LASER CATARACT SURGERY
PIONEERS
INSTRUMENTATION
THE SUNITA AGARWAL LASER PHACO PROBE
ANATOMY OF DR SUNITA AGARWAL LASER PHACOEMULSIFICATION PROBE
COMPARISON
LASER PHOTON
IN-BUILT
USES
SURGICAL PROCEDURE
ADVANTAGES
HOW SMALL WILL OUR INCISIONS GO
CONCLUSION
18:
Corneal Topography in Phakonit
INTRODUCTION
ROLLABLE IOL
SURGICAL TECHNIQUE
TOPOGRAPHIC ANALYSIS AND ASTIGMATISM
DISCUSSION
CONCLUSION
19:
Attacking Childhood Cataract Blindness in the Economically Emerging Countries
CHILDHOOD BLINDNESS, PEDIATRIC CATARACTS: A GLOBAL PERSPECTIVE
THE FINANCIAL BURDEN
CHILDHOOD CATARACT MANAGEMENT
PEDIATRIC CATARACT SURGERY IN THE ECONOMICALLY EMERGING COUNTRIES
SURGICAL MODALITIES FOR PEDIATRIC CATARACT
PEDIATRIC CATARACT SURGERY IN THE ECONOMICALLY EMERGING COUNTRIES: SPECIAL ISSUES
EYE-CARE MODEL FOR PEDIATRIC CATARACT MANAGEMENT IN THE ECONOMICALLY EMERGING COUNTRIES
SIMULTANEOUS BILATERAL PEDIATRIC CATARACT SURGERY OR IMMEDIATELY SEQUENTIAL CATARACT SURGERY
ROLE OF OPHTHALMOLOGISTS FROM INDUSTRIALIZED NATIONS
PEDIATRIC CATARACT SURGERY IN THE ECONOMICALLY EMERGING COUNTRIES
ACKNOWLEDGEMENT
20:
Update on Capsular Dye Enhanced Cataract Surgery
INTRODUCTION
OPHTHALMIC DYES FOR ANTERIOR CAPSULORHEXIS
Introduction
Capsulorhexis in Absence of Red Reflex
Use of Ophthalmic Dyes in CCC
Study Comparing 3 Ophthalmic Dyes and 2 Surgical Techniques
Preparation of the Ophthalmic Dyes
Surgical Technique
Results
Clinical Application and Guidelines for Surgeons
OPHTHALMIC DYES FOR PHACOEMULSIFICATION
Introduction
Study of Dye-enhanced Phacoemulsification
Surgical Technique
Results
Learning Critical Steps of Phacoemulsification
CCC
Hydrodissection/Hydrodelineation
Nuclear Emulsification
Cortical Clean-up
Possible Clinical Application and Future Trials
OPHTHALMIC DYES FOR POSTERIOR CAPSULORHEXIS
Introduction
Study on Dye-enhanced Posterior Capsulorhexis
Surgical Technique
Results
Clinical Application and Future Trials
OPHTHALMIC DYES FOR PEDIATRIC CATARACT SURGERY
SUMMARY AND CONCLUSIONS
21:
Update on Ophthalmic Viscosurgical Devices
BACKGROUND
CLASSIFICATION OF THE OVDs
High Viscous–cohesive OVDs
Super Viscous–cohesive OVDs
Lower Viscosity—Dispersive OVDs
Soft Shell Technique
Viscoadaptive OVD—Healon-5®
Characteristics and Advantages of the Viscoadaptive OVDs
CLINICAL APPLICATIONS OF THE OVDs
Use of OVDs in Cataract Surgery
Capsulorhexis
Cleavage of Lens Structure
Nuclear Emulsification
Irrigation and Aspiration
Capsular Bag Filling and IOL Implantation
Cataract Surgery in Pediatric Patient
Use of the OVDs in Glaucoma Surgery
Viscocanalostomy
OVDs for Intraocular Delivery of Dyes or Anesthetic Agents
Viscostaining of the Anterior Lens Capsule
Use of OVDs in Topical Ophthalmic Anesthesia (Viscoanesthesia)
Removal of the OVDs
COMPLICATIONS OF OVDs
SUMMARY AND CONCLUSIONS
22:
Update on Twenty First Century Cataract—Intraocular Lens Surgery
BACKGROUND
LARGE INCISION CATARACT SURGERY and IMPLANTATION OF RIGID LENSES
SMALL INCISION CATARACT SURGERY and IMPLANTATION OF FOLDABLE LENSES
ULTRASMALL INCISION CATARACT SURGERY AND IMPLANTATION OF ROLLABLE LENSES
THE FUTURE CHALLENGES
Eradication of Posterior Capsule Opacification
Restoration of Accommodation
23:
Update on Posterior Capsule Opacification: Etiopathogenesis, Clinical Manifestations, Pharmacological and Surgical Prevention
INTRODUCTION
POSTERIOR CAPSULE OPACIFICATION (SECONDARY CATARACT) Background and Significance
WHY TO ERADICATE PCO?
ETIOPATHOGENESIS
CLINICAL MANIFESTATIONS
PREVENTION OF POSTERIOR CAPSULE OPACIFICATION
Three Surgery Related Factors to Reduce PCO
Hydrodissection-enhanced Cortical Clean-up
In-the-Bag (Capsular) Fixation
Capsulorhexis Edge on IOL Surface
Three IOL-related Factors to Reduce PCO
Biocompatibility
Maximal IOL Optic Posterior Capsule Contact
Barrier Effect of the IOL Optic
Confirmation of 6 Factors in Clinical Studies
Pharmacological Prevention of PCO
ANALYSIS OF ND: YAG POSTERIOR CAPSULOTOMY RATES
SUMMARY AND CONCLUSIONS
24:
Pediatric Cataract—IOL Surgery:Past, Present and Future
INTRODUCTION
PEDIATRIC CATARACT—INTRAOCULAR LENS SURGERY: PAST (1951 TO 1989–90S)
PEDIATRIC CATARACT—INTRAOCULAR LENS SURGERY: PRESENT (1990S: TO PRESENT)
PEDIATRIC CATARACT—INTRAOCULAR LENS SURGERY: FUTURE
SUMMARY
25:
Update on Delayed Postoperative Opacification of Rigid and Foldable Intraocular Lenses
OVERVIEW
INTRODUCTION
SECTION I: DELAYED OPACIFICATION OF PMMA IOL OPTIC BIOMATERIAL: “SNOWFLAKE” OR CRYSTALLINE OPACIFICATION
SECTION II. OPACIFICATION OF FOLDABLE HYDROPHILIC ACRYLIC LENSES
Introduction
Bausch and Lomb: Hydroview™ (H60M)
Medical Developmental Research: SC60B-OUV™
Ophthalmic Innovations International, Inc.: Aqua-Sense™
Clinicopathological Analyses
Gross and Light Microscopic Analyses
Histochemical Stainings
Scanning Electron Microscopy
Energy Dispersive X-Ray Spectroscopy
Possible Factors Involved in the Pathological Mechanism
Prevention and Treatment
SUMMARY
ACKNOWLEDGEMENT
26:
Corneal Topography in Cataract Surgery
INTRODUCTION
CORNEA
KERATOMETRY
KERATOSCOPY
COMPUTERIZED VIDEOKERATOGRAPHY
ORBSCAN
NORMAL CORNEA
CATARACT SURGERY
EXTRACAPSULAR CATARACT EXTRACTION
NON-FOLDABLE IOL
FOLDABLE IOL
ASTIGMATISM INCREASED
BASIC RULE
UNIQUE CASE
PHAKONIT
SUMMARY
SECTION II: REFRACTIVE SURGERY
27:
Aberropia—A New Refractive Entity
INTRODUCTION
WAVEFRONT ANALYSIS
ABERROPIA
ABERROPIA PATIENTS
ZYOPTIX
RESULTS
DISCUSSION
CONCLUSION
28:
Presbyopic LASIK
INTRODUCTION
PREVIOUS EXCIMER LASER TECHNIQUES
HISTORY
PRINCIPLE
PROLATE AND OBLATE CORNEA
TECHNIQUE
KERATOMETRY AND PACHYMETRY
ASTIGMATISM
PLANO EXAMPLE
Example 1
HYPEROPIC EXAMPLES
Example 2
Example 3
MYOPIC EXAMPLE
Example 4
SUMMARY
29:
Zyoptix
INTRODUCTION
ABERRATIONS
ZYOPTIX LASER
ORBSCAN
ABERROMETER
ZYLINK
RESULTS
DISCUSSION
CONCLUSION
30:
Ocular Pharmacokinetics in Refractive Surgery
INTRODUCTION
PRK (PHOTOREFRACTIVE KERAteCTOMY)
Preoperative Ocular Therapeutics
Topical Anesthesia
Dosage
Postoperative (Postprocedure) Therapeutic Management
Epithelial Defect Closure
Post PRK Management
Modulation of Refractive and Visual Results
Recent Update in Post PRK Medications
Complications of Topical Steroids
Clinical Symptoms
Treatment
LASIK SURGERY
Preprocedure Therapeutic Medications
Topical Anesthesia
Post-Procedure Therapeutic Medications
Phases of Healing
31:
Phakic Refractive Lens (PRL)—Indications and Techniques
INTRODUCTION
PATIENT SELECTION
Myopic Range
Hyperopic Range
Unilateral High Myopia with Amblyopia in Children
Combined Astigmatism
Keratoconus Correction and Correction of the Refractive Error after Previous Surgery
Poor Candidates
PREOPERATIVE PREPARATION
PRL Power Calculation
Russian Method: Vertex Chart
Holladay Refraction Formula
Iridectomy
Surgical
Laser
Medications
PREPARATION OF THE PATIENT
ANESTHESIA
Local
INSTRUMENTATION
Incision
Insertion
Manipulation
Iridectomy
Other
HANDLING THE IMPLANT
SURGICAL STEPS
Incision
Viscoelastic Insertion
Paracentesis
Lens Insertion
Retroiris Placement and Centration
Iridectomy
Viscoelastic Removal
Pupil Constriction
Incision Closure
Cortisone Subconjunctival Injection
Patch
OPERATIVE MEDICATIONS
General
POSTOPERATIVE CARE
CONCLUSION
PEDIATRIC USAGE
FUTURE APPLICATIONS
Piggyback Over IOLs
Pseudophakic Ametropia Correction
Multifocal Correction
32:
Visual Acuity with Contact Lenses Vs LASIK in Myopia
INTRODUCTION
OPTICAL PHYSIOLOGY
Retinal Image for an Emmetrope
Retinal Image for a Myope
MATERIALS AND METHODS
RESULTS
CONCLUSION
33:
Contact Lens Fitting in Refractive Surgery
CONTACT LENS FITTING AFTER RADIAL KERATOTOMY
Indications for Contact Lens Fitting in RK Surgery
Fitting Procedure
Choice of RGP Trial Lenses
Fitting Technique
Post Fitting Complications and Failures
CONTACT LENS FITTING AFTER PHOTOREFRACTIVE KERATECTOMY (PRK)
Indications for Post PRK Contact Lens Fitting
CONTACT LENS FITTING IN LASIKSURGERY
Contact Lens Fitting before LASIK Surgery
Fellow Eye
Corneal Warpage
Contact Lens Fitting in Post-LASIK Phase
Immediate Post LASIK Surgery Period
Early Post LASIK Surgery Period
34:
Primary Posterior Corneal Elevation
INTRODUCTION
ORBSCAN
PRIMARY POSTERIOR CORNEAL ELEVATION
DISCUSSION
SUMMARY
SECTION III: GLAUCOMA
35:
Modern Glaucoma Surgery
INTRODUCTION
GLAUCOMA SURGERY
METHODS
RESULTS
COMPLICATIONS
CONCLUSION
36:
Laser Sclerotomy, Laser Phakonit and IOL Implantation
INTRODUCTION
HISTORY
ND:YAG LASER
LASER SCLEROTOMY WITH ND:YAG – INSTRUMENTATION
SURGICAL TECHNIQUE
Paracentesis
Clear Corneal Incision
Laser Sclerotomy
Peripheral Iridectomy
Closure of Incision
Laser Phakonit and IOL Implantation
Phakic Laser Sclerotomy
Laser Sclerotomy in Pseudophakia and Aphakia
37:
Viscocanalostomy
INTRODUCTION
OPERATIVE TECHNIQUE
COMPLICATIONS
RESULTS IN TWO GROUPS OF PATIENTS
Group 1. “Pretoria-Group” (R Stegmann)
Group 2. “Cologne-Group” (N Körber)
DISCUSSION
The Spanish Experience
38:
Update on Antiglaucoma Therapy
MIOTICS
Cholinergic Agents
Acetylcholine Chloride
Pilocarpine
Pilocarpine Ocular Therapeutic System (Ocusert)
Pilocarpine and Epinephrine Combinations
Pilocarpine and Physostigmine Combination
Carbachol
Anticholinesterase Agents
Physostigmine
Demecarium Bromide
Echothiophate Iodine
Isoflurophate
Precautions While Using Anticholinesterase Agents
Adverse Reactions of Anticholinesterase Agents
Ocular Side Effects
Systemic Side Effects
ALPHA-ADRENERGIC AGONISTS
Apraclonidine
Brimonidine Tartrate (Alphagan)
Dapiprazole
Clonidine
SYMPATHOMIMETICS
Epinephrine
Dipivalyl Epinephrine (Dipivefrin Hydrochloride, DPE)
ADRENERGIC BLOCKING AGENTS (BETA BLOCKERS)
Betaxolol
Carteolol
Levobunolol
Metipranolol
Timolol Maleate
CARBONIC ANHYDRASE INHIBITORS
Acetazolamide
Dichlorphenamide
Methazolamide
Dorzolamide
Brinzolamide
ETHOXAZOLAMIDE
PROSTAGLANDINS
Latanoprost (Xalantan)
Bimatoprost (Lumigan)
Unoprostone (Rescula)
Travoprost (Travatan)
Hyperosmotic Agents
CALCIUM CHANNEL BLOCKERS
ANTIMETABOLITES (ANTI-FIBROPROLIFERATIVE AGENTS)
5-Fluorouracil (5FU)
Mitomycin C
Daunorubicin
RECENT ADVANCES IN GLAUCOMA THERAPY
Unoprostone
Ocular Hypotensive Lipids (OHL)
Neuroprotective Agents
Alpha-2 Agonists
NMDA Antagonists
Eliprodil
Riluzole
L-deprenyl
FUTURE DIRECTIONS
THE ROLE OF NEUROREGENERATION
39:
Triple Procedure—Trabeculectomy with Phaco and IOL Implantation
INTRODUCTION
TWO-STEP SURGICAL TECHNIQUE
PREPARATION OF THE SCLERAL FLAP
PHACO
COMPLETING THE TRABECULECTOMY
POSTOPERATIVE CARE
DISCUSSION
SECTION IV: RETINA
40:
Update on Photodynamic Therapy (Verteporfin) in Age-related Macular Degeneration
INTRODUCTION
TECHNIQUE
VERTEPORFIN
POST-TREATMENT REGIME
Preparation of the Patient for PDT
Calculation of the Treatment Spot Size Required Covering the CNV
Procedure
Results
Results of VIP Study14
CONCLUSION
41:
Indocyanine Green Angiography
INTRODUCTION
ADVANTAGES OF ICG
HISTORY
Realtime ICG Angiography
Wide Angle Image
Digital Subtraction
PHARMACOLOGY
TOXICITY
TECHNIQUE
VARIOUS PHASES OF ICG ANGIOGRAPHY
ICG IN AGE-RELATED MACULAR DEGENERATION
ICG Dye Enhanced Diode Laser Photocoagulation
Feeder Vessel Treatment
Idiopathic Polypoidal Choroidal Vasculopathy (IPCV)
Central Serous Chorioretinopathy
Intraocular Tumors
Choroiditis
Bird Shot Retinochoroidopathy
Serpiginous Choroiditis23
Multifocal Choroiditis
AMPPE24
MEWDS25
Vogt Koyanagi Harada Disease
SUMMARY
42:
Perfluorocarbon Liquids in Vitreoretinal Surgery
INTRODUCTION
TYPES
PHYSICAL PROPERTIES
Density
Relative Density or Specific Gravity
Refractive Index
Laws of Refraction
Surface Tension
Viscosity
Vapor Pressure
Boiling Point
INDICATIONS
Giant Tears
Proliferative Vitreoretinopathy
Proliferative Diabetic Retinopathy
Dislocated Crystalline Lenses or Intraocular Lenses
Miscellaneous
OTHER MEDICAL APPLICATIONS
COMPLICATIONS
43:
Trypan Blue Assisted Epiretinal Membrane Removal
INTRODUCTION
PATIENTS AND TECHNIQUE
RESULTS
CONCLUSION
44:
Diabetic Retinopathy—Current Concepts and Recent Advances
INTRODUCTION
PATHOGENESIS
Microscopic Changes
CLASSIFICATIONS OF DIABETIC RETINOPATHY
EPIDEMIOLOGY
Sex Predilection
Non-proliferative Diabetic Retinopathy
Microaneurysms
Retinal Hemorrhages
Hard Exudates and Retinal Edema
Diabetic Maculopathy
Cotton-Wool Spots (CWS)
Venous Caliber Abnormalities
Intraretinal Microvascular Abnormalities (IRMA)
Proliferative Diabetic Retinopathy
RISK FACTORS FOR DIABETIC RETINOPATHY
DIFFERENTIAL DIAGNOSIS
Fluorescein Angiography
Angiographic Risk Factors for Progression of NPDR to PDR
MANAGEMENT
Clinical Trials of Diabetic Retinopathy
Medical Care
Non-Proliferative Diabetic Retinopathy
PROGNOSIS
Surgical Care—Vitrectomy for Diabetic Retinopathy
Peripheral Cryotherapy
Practical Conclusions
Patient Education
RECENT ADVANCES IN DIABETIC RETINOPATHY MANAGEMENT
Medical Advances
Gene Therapy
VEGF (Vascular Endothelial Growth Factor)/ Growth Factor Inhibitors
Role of Aldose Reductase Inhibitors (ARIs)
Aminoguanidine
Pyruvate
Protein Kinase C (PKC)/Di Acyl Glycerol (DAG) Inhibitors
Inhibitors oh Intracellular Signaling
Inhibitors of Toxic Effects of Macular Edema
Prevention of Generation of Vasoactive Agents
Vitamin E
Anticoagulants
Angiotensin Converting Ezyme (ACE) Inhibitors and Diabetic Retinopathy
Measurement of Retinal Blood Flow
Surgical Advances
Triamcinolone
Use of tPA (Tissue Plasminogen Activator)
Pancreatic and Islet Transplants
CONCLUSIONS
45:
Advances in the Management of Age-related Macular Degeneration
INTRODUCTION
ALTERNATE LASER TECHNIQUES
FEEDER VESSEL THERAPY
PHOTODYNAMIC THERAPY
TRANSPUPILLARY THERMOTHERAPY
RADIATION THERAPY
ANTIANGIOGENIC AGENTS
SURGICAL CARE
Tissue Plasminogen Activator (tPA) Assisted Submacular Surgery
RPE Transplantation
Transplanted RPE Cells: Survival
Retinal Prosthesis Implantation
Epiretinal Approach
Subretinal Approach
Visual Cortex Prosthesis
Gene Therapy
Primary Prevention of ARMD
PREVENTION STUDIES
Prophylactic Treatment of AMD (PTAMD)
PATIENT EDUCATION
IMPLANTABLE MINIATURISED TELESCOPE (IMT)
Advantages
Diasadvantages
Central Optical Cylinder
Support System
Surgical Technique
Interior Decorator Approach
SECTION V: OCULAR THERAPEUTICS
46:
Update on Routes of Administration and Drug Delivery Systems in Ophthalmology
LOCAL APPLICATION
Methods of Local Application of Drugs
Application to the Corneal Surface
Membrane Bound Devices
Ocusert System
Drug Impregnated Inserts
Hydrogel Contact Lens Delivery
Osmotic Pumps
Periocular Administration
Subconjunctival Route
Retrobulbar Route
Intracameral Administration
Intravitreal Administration
Parabulbar (Flush) Administration
Peribulbar Administration
Direct Injection into the Globe
SYSTEMIC ADMINISTRATION
MEDICATION'S FORMS USED IN OPHTHALMOLOGY
Medication Devices Used in Ophthalmology
Contact Lenses
Corneal Shields
Cotton Pledgets
Filter Paper Strips
Artificial Tear Inserts
Membrane Bound Inserts
PRACTICAL TIPS FOR USE OF VARIOUS OPHTHALMIC MEDICATIONS
47:
Update on Antibacterial Therapy
INDICATIONS FOR ANTIMICROBIAL THERAPY
MECHANISMS OF RESISTANCE OF ANTIBIOTICS
INDICATIONS
DISADVANTAGES
CLASSIFICATION OF ANTIBACTERIAL DRUGS
Beta-lactams
Penicillins
Natural Penicillins
Semisynthetic Penicillin
Cephalosporins
Aminoglycosides
Gentamicin
Tobramycin
Amikacin
Sisomycin
Neomycin
Netilmycin
Kanamycin
Framycetin
Streptomycin
Tetracyclines
Tetracycline
Doxycycline
Chlortetracycline Hydrocholorate
Methacycline
Minocycline
Oxytetracycline
Therapy of Ocular Infections (Tetracyclines)
Sulphonamides
Chloramphenicol
Microlides
Erythromycin
Roxithromycin
Clindamycin
Vancomycin
Spiramycin
Azithromycin
Clarithromycin
Polypeptides
Polymixin B
Bacitracin
Antimicrobial Peptides
Defensins
Cecropins
Megainins
Fluoroquinolones
Norfloxacin
Ciprofloxacin
Ofloxacin
Pefloxacin
Lomefloxacin
Sparfloxacin
LEVOFLOXACIN
Miscellaneous
Use of Antibiotics in Irrigating Solutions for Intraocular Surgery
Intravitreal Antibiotics
48:
Update on Anti-inflammatory Therapy
CORTICOSTEROID
Systemic Corticosteroids
Indications for Systemic Steroids
Complications
Complications of topical steroids
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
Classification and Structure of NSAIDs (Fig. 48.1)
Mechanism of Action
Inhibition of Prostaglandin Synthesis
Arachidonic Acid (AA) Metabolites and Inflammation
Pharmacokinetics
Ocular Indications for Use of NSAIDs
Maintenance of Intraoperative Mydriasis
Reduction of Postoperative Inflammation
Prevention and Treatment of Aphakic and Pseudophakic Cystoid Macular Edema
Uveitis
Scleritis and Episcleritis
Allergic and Giant Papillary Conjunctivitis
Reduction of Discomfort after Refractive Surgery
Various Topical NSAIDs used Commonly in Ophthalmic Practice Worldwide
Phenylalkanoic Acids
Indoles
Phenyllactin Acid
General Local and Systemic Toxicity of NSAIDs
IMMUNOSUPPRESSIVE AGENTS IN OPHTHALMOLOGY
Selection of Patients
Alkylating Agents
The Antimetabolites
The Antibiotic Cyclosporin A
Ocular Drug Toxicity of Immunosuppressive Agents used in Ophthalmic Conditions
49:
Update on Ophthalmic Dyes
INTRODUCTION
FLUORESCEIN SODIUM
FLUOREXON
ROSE BENGAL
LISSAMINE GREEN
INDOCYANINE GREEN
TRYPAN BLUE
VERTEPORFIN (VISUDYNE)
50:
Quick Look Ocular Therapeutics—An Update
ANTIBACTERIALS
51:
Future Drugs in Ophthalmology
INTRODUCTION
Preclinical Trials
IND Filing
Clinical Trials
NDA Review
Post-market Surveillance
INVESTIGATIONAL DRUGS
SECTION VI: MISCELLANEOUS
52:
Dry Eye and Its Management—An Update
INTRODUCTION
CAUSES OF REDUCED TEAR PRODUCTION (ETIOLOGY)
CLINICAL EVALUATION
Symptoms
Signs
Precorneal Tear Film
Marginal Tear Strip
Corneal Changes
DIAGNOSTIC TEAR FILM TESTS (FOR TEAR HYPOSECRETIONS)
Tear Film Break-up Time (BUT)
Schirmer's Test
Vital Dye Staining
Lysozyme Assay
Tear Globulin Assay
Tear Osmolarity
Biopsy of Conjunctiva
Conjunctival Impression Cytology
MANAGEMENT OF DRY EYE
Tear Conservation
Tear Substitutes (Tear Replacement)
Artificial Tear Solutions (Eyedrops)
Topical Solution Containing Longer Lasting Mucoadhesive
Ointments
Ocular Inserts (Solid Devices)
Gel Tears and Sodium Hyaluronate (0.1%)
Soft Contact Lens Therapy
Punctal Plugs (Tear Drainage Reduction)
Mucolytics
Topical Retinoids
Systemic Therapy
Oral Bromhexine
Treatment of Associated Conditions
Blepharitis
Infections
53:
Update on Toric Contact Lenses
ASTIGMATISM
Contact Lens Correction of Astigmatism
Toric Lens Stabilization Method
TORIC SOFT CONTACT LENS FITTING
Toric Lens Fitting
Initial Lens Power Selection
Useful Tips for Toric Lens Fitting
Dispensing and Follow up Care of Toric Lenses (Care and Maintenance)
RIGID TORIC CONTACT LENS
BITORIC RGP LENS
Front Surface Toric RGP Lens
FURTHER READING
54:
Plastic Surgery and Laser Treatment in Ophthalmology
INTRODUCTION
AGING OF THE FACE
LASERS USED FOR COSMETIC TREATMENT
Treatment Effect of the CO2 Laser
Treatment Effect of the Argon Laser
Conventional Surgical Blepharoplasty versus CO2 Laser Supported Treatment and Forehead Lifting
With and without Forehead Lifting
LASER-ASSISTED UPPER LID BLEPHAROPLASTY
LASER-ASSISTED LOWER EYELID BLEPHAROPLASTY
Technique of Lower Lid Blepharoplasty
FULL FACE BY CO2 Laser
Combined with Upper and/or Lower Eyelid Blepharoplasty
TECHNIQUE AND LASER SETTING
Blepharoplasty and Skin Resurfacing
Removal of Facial Telangiectasias or/and Hemangioma with an Argon Laser
PREOPERATIVE AND POSTOPERATIVE TREATMENT
Patient Education
Preoperatively
Postoperatively
COMPLICATIONS
Hyperpigmentation
Erythema
Wound Complication
55:
Sterilization, Disinfection and Antiseptics in Ophthalmology—An Update
PHYSICAL METHODS
Dry Heat
Flaming
Incineration
Hot Air Oven
Moist Heat
Temperature below 100°C
Temperature at 100°C
Precautions during Autoclaving
Filtration
Ionising Radiation
CHEMICAL METHODS
Ethylene Oxide (C2H4O)
Formalin
Precautions when using Formalin
SOAKING IN LIQUID CHEMICALS
Glutaraldehyde
Isopropyl Alcohol
Sodium Hypochlorite
Biguanides (Polyhexanide and Chlorhexidine)
Povidone Iodine (Halogens)
Phenols
Acetone
Cetrimide
Betapropiolactone (BPL)
Alcoholic Rub-in Hand Disinfectant
Cutasept
Concentrated Cold Sterilizer
Bacillocid
Bacillol 25
Baktolin 5.5
AIDS AND DISINFECTION IN RELATION TO OPHTHALMOLOGY
INDEX
TOC
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