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Clinical Practice in Ophthalmology
Sandeep Saxena
1:
Cornea and External Diseases
CONJUNCTIVITIS
BACTERIAL CONJUNCTIVITIS
Pathogenesis
Agents
Mechanism of Disease
Clinical Characteristics
Acute Bacterial Conjunctivitis
Hyperacute Bacterial Conjunctivitis
Chronic Bacterial Conjunctivitis
VIRAL CONJUNCTIVITIS
Signs
Laboratory Diagnosis
Treatment
Complications
Prognosis
ALLERGIC CONJUNCTIVITIS
Immunologic Reactions of Conjunctiva and Cornea
Acute Allergic Conjunctivitis
Pathogenesis
Treatment
Seasonal Allergic Conjunctivitis
Vernal Keratoconjunctivitis
Giant Papillary Conjunctivitis
Atopic Keratoconjunctivitis
Chlamydial Conjunctivitis
Trachoma
Clinical Characteristics and Staging
Diagnosis
Treatment
Adult Inclusion Conjunctivitis
Neonatal Inclusion Conjunctivitis
VITAMIN A DEFICIENCY
Pathophysiology
Clinical Manifestations of Xerophthalmia
Ocular Manifestations
Conjunctival Manifestations
Corneal Manifestations
Keratomalacia
Xerophthalmic Fundus
Diagnosis and Treatment
PTERYGIUM
Etiopathogenesis
Clinical Features
Management
SCLERITIS AND EPISCLERITIS
Clinical Definitions and Classification
Clinical Features
Episcleritis
Scleritis
Anterior Scleritis
Diffuse Anterior Scleritis
Nodular Scleritis
Necrotizing Scleritis
Posterior Scleritis
Corneal Changes in Scleritis
Etiology
Rheumatoid Arthritis
Wegener's Granulomatosis and Polyarteritis Nodosa
Relapsing Polychondritis
Other Associated Systemic Diseases
Infections
Granulomatous Lesions
Therapeutic Regimes for Scleral Disease
Episcleritis Therapy
Surgery in Necrotizing Keratitis
DRY EYE
Classification and Causes
Sjögren's Syndrome
Non-Sjögren Tear Deficient Dry Eyes
Meibomian Gland Disease
Lids and Blink Disorders
Clinical Features and Diagnostic Tests
Symptoms
Clinical Tests
Treatment
Artificial Tear Solutions
Ointments
Artificial Tear Inserts
Mucolytic Agents
Punctal Occlusion
Moisture Chambers
Bandage Contact Lenses
Penetrating Keratoplasty
Keratoprosthesis
Psychologic Aspects
OCULAR SURFACE DISEASE AND RECONSTRUCTION
Ocular Surface
Etiology of Corneal Stem-Cell Deficiency
Clinical Presentation and Diagnosis of Corneal Stem Cell Deficiency
Management of Partial Stem Cell Deficiency
Management of Total Stem Cell Deficiency
Surgical Technique for Auto-Limbal Transplantation
Surgical Technique for Allo-Limbal Transplantation
Amniotic Membrane Transplantation
BACTERIAL CORNEAL ULCER
Pathogenesis
Causative Organism
Clinical Approach
Laboratory Diagnosis
Treatment
Antibiotics
Ocular Morbidity
FUNGAL KERATITIS
Classification and Epidemiology
Pathophysiology
Clinical Features
Diagnostic Evaluation
Histopathologic Findings
Treatment
Medical
Surgical
ACANTHAMOEBIC KERATITIS
Pathogenesis
Clinical Features
Diagnosis
Treatment
HERPES SIMPLEX KERATITIS
Virus and Epidemiology
Pathogenesis, Latency and Reactivation
Diagnosis
Type of Inflammation and Cellular Infiltrate
Immunological Methods
Polymerase Chain Reaction
Culture
Clinical Features
Primary Ocular HSV Disease
Recurrent Ocular HSV Disease
Corneal Epithelial Lesions
Herpetic Stromal Keratitis
Treatment
Drugs
Systemic Treatment
Specific Treatment
Primary Infection
Recurrent Infection
Epithelial Disease
Stromal Keratitis
Surgical Management
Penetrating Keratoplasty
HERPES ZOSTER OPHTHALMICUS
Virus and Epidemiology
Pathogenesis, Latency and Reactivation
Diagnosis
Type of Inflammation and Cellular Infiltrate
Culture
Serology
Clinical Features and Course
Treatment
Antiviral drugs
Specific Treatment
NON-INFECTIVE ULCERATIVE KERATITIS
Diagnostic Approach
Symptoms
Clinical History
Systems Review
Diagnostic Tests
Therapy
CORNEAL SURGERY AND KERATOPLASTY
Treatment of Corneal Foreign Bodies
Stromal Puncture (Epithelial Reinforcement)
Corneal Laceration Repair
Suture Placement Techniques
Clinical Initial Management Protocol
Penetrating Keratoplasty
Case Selection
Indications for Keratoplasty
Contraindications
Relative Contraindications
Presurgical Preliminaries
Eye Exposure, Fixation and Scleral Support
Trephination of Donor Material
Removal of Recipient Button
Viscoelastics
Suturing of the Corneal Button
Handling the Iris and Vitreous
Follow-up Evaluation Frequency
Early Wound Problems
Medications
Suture Removal
Glaucoma Monitoring
Infections
FUTURE TRENDS: PROGRESS IN CORNEA DIAGNOSTICS
Specular Microscopy
Confocal Microscopy
Tandem Scanning Confocal Microscope
Slit Scanning Confocal Microscope
2:
Refractive Surgery
PRINCIPLES OF REFRACTIVE SURGERY
PHOTOREFRACTIVE KERATECTOMY
Surgical Procedure
Postoperative Measures
Postoperative Course and Complications
Optical
Ocular
LASER IN SITU KERATOMILEUSIS
Indications
Patient Selection Criteria
Preoperative Assessment
History
Contraindications of LASIK
Clinical Examination
Microkeratomes for LASIK
Hansatome
Moria LSK Carriazo-Barraquer Microkeratome
MORIA LSK One Disposable
Surgical Technique
Preparation of Operating Room
Patient Preparation
Corneal Marking
Application of Suction Ring
Tonometry
Corneal Flap Making
Excimer Laser Ablation
Replacement of the Flap
Postoperative Management
Complications of LASIK
Preoperative
Intraoperative
Postoperative
Management of Important Complications
Incomplete Flap
Free Corneal Cap
Flap Wrinkling and Flap Misalignment
Interface Infection
Glare and Halos
Overcorrection, Undercorrection and Regression of the Effect
Recent Advances in LASIK
Wave Front Guided LASIK
Wave Front Technology
Hartman-Shack Method (Shack's Modification of Hartman Screen)
Tscherning Aberroscope
Ray Tracing
Ray Tracing Refractometer
Advantages
Limitations
LASER THERMOKERATOPLASTY
Indications
Patient Selection
Surgical Technique
Postoperative Management
Complications
Results of LTK
Future of LTK
ASTIGMATIC KERATOTOMY
Causes of Astigmatism
Treatment of Astigmatism
Astigmatic Keratotomy
Principles
Types of Incision
Preoperative Work-up and Patient Selection
Criteria for Patient Selection
Surgical Technique
Postoperative Care
Complications
Intraoperative
Postoperative
Conclusion
INTACS (INTRASTROMAL SEGMENT)
Advantages of Intacs
Indications
Mechanism of Action
Patient Preparation
Surgical Technique
Postoperative Care
Complications
Intraoperative
Postoperative
Refractive
SCLERAL EXPANSION FOR PRESBYOPIA
Scleral Expansion to Improve Presbyopia
Scleral Expansion by PMMA Segments
Surgical Technique
Scleral Expansion by Radial Sclerotomy
Surgical Technique
Complications
Results of Scleral Expansion
FUTURE TRENDS
3:
Primary Angle-Closure Glaucoma and Optic Disc Assessment
PRIMARY ANGLE-CLOSURE GLAUCOMA
Epidemiology
Risk Factors for Primary Angle-closure Glaucoma
Family History
Age
Gender
History of Symptoms
Refractive Error
Race
Pathogenesis and Pathophysiology
Plateau Iris
Controversies in Definition
Chronic Angle-closure Glaucoma
Combined Mechanism Versus Mixed Mechanism
Creeping Angle-closure Glaucoma
Clinical Presentation of Angle-closure Glaucoma
Management of Angle-closure Glaucomas
Medical Treatment
Laser Treatment
Filtration Surgery
OPTIC DISC ASSESSMENT
Methods of Optic Disc Examination
Features of Glaucomatous Optic Disc Damage
Cup Disc Ratio
Asymmetry of Optic Disc Cupping
Neuroretinal Rim Evaluation
Vascular Changes
Configuration of Vessels
Peripapillary Atrophy
Retinal Nerve Fiber Layer Abnormalities
Myopic Changes versus Glaucoma
Differential Diagnosis
Physiological Cupping
Optic Nerve Coloboma
Congenital Optic Disc Pit
Anterior Ischemic Optic Neuropathy
Neurological Causes
FUTURE TRENDS: OPTIC NERVE IMAGING IN GLAUCOMA
4:
Primary Open Angle Glaucoma and Automated Visual Field Assessment
PRIMARY OPEN ANGLE GLAUCOMA
Diagnosis
Primary Open Angle Glaucoma
Ocular Hypertension
Etiopathogenesis
Causes of Elevated Intraocular Pressure
Changes in the Optic Nerve Head
Mechanical and Vascular Theories
Neuroprotection and Glaucoma
Genetics and Glaucoma
Autoimmunity
Approach to Diagnosis and Treatment of Primary Open Angle Glaucoma
Risk Factors
History
Symptoms
Signs
Screening for Glaucoma
Management of Glaucoma—Principles
Principles of Medical Therapy for Glaucoma
Establish a Baseline
Setting a Pressure Goal
Lowering Intraocular Pressure
Follow-up
Treatment of High-Risk Glaucoma Suspects
Newer Trends in the Concept of Medications
Laser Therapy
Argon Laser Trabeculoplasty (ALT)
Other Laser Procedures
Surgery
Newer Surgical Techniques: Non-Penetrating Filtering Procedures
Phacotrabeculectomy
AUTOMATED VISUAL FIELD ASSESSMENT
Test Algorithms
Full Threshold Program
Evaluation of a Single Test
General Information
Reliability Indices
Raw Data and Gray Scale
Total Deviation
Pattern Deviation
Global Indices
Glaucoma Hemifield Test
Common Factors Influencing Automated Perimetry
Cataract
Miotic Pupil
Edge Artifacts
Fatigue Related Artifacts
Patient Behavior-the Moderate and Extreme
Criteria for Progression of Visual Field
Advanced Analysis
Alternative Strategies and New Programs
Fastpac
Swedish Interactive Thresholding Algorithms (SITA)
Short Wave Length Automated Perimetry
Frequency Doubling Technology Perimetry
FUTURE TRENDS
5:
Congenital Glaucoma and Miscellaneous Glaucomas
CONGENITAL GLAUCOMA
PRIMARY CONGENITAL GLAUCOMA
Clinical Presentation
Diagnosis
Examination under Anesthesia
Interpretation of Results
Differential Diagnosis
Etiopathogenesis
Management
Medical
Surgical
Long Term Follow-up and Prognosis
NEOVASCULAR GLAUCOMA
Factors Predisposing to Neovascular Glaucoma
Diabetic Retinopathy
Central Retinal Vein Occlusion
Carotid Artery Obstructive Disease
Clinicopathologic Course
Rubeosis Iridis
Secondary Open-Angle Glaucoma
Secondary Angle-Closure Glaucoma
Differential Diagnosis (Table 5-3)
Primary (Acute Congestive) Angle-Closure Glaucoma
Glaucoma Associated with Anterior Uveitis
Post Vitrectomy Dilatation
Fuch's Heterochromic Iridocyclitis
Resolving Hyphema
Histopathology
Management
Panretinal Photocoagulation
Panretinal Cryoablation
Goniophotocoagulation
Medical Management
Surgery
LENS INDUCED GLAUCOMA
Phacolytic Glaucoma
Clinical Features
Diagnosis
Management
Lens Particle Glaucoma
Management
Phacoanaphylactic Glaucoma
Management
Phacomorphic Glaucoma
Management
GLAUCOMAS ASSOCIATED WITH LENS DISPLACEMENT
Pupillary Block
Phacolytic Glaucoma
Concomitant Trauma
STEROID INDUCED GLAUCOMA
INFLAMMATORY GLAUCOMAS
Fuch's Heterochromic Iridocylitis
Treatment
Posner Schlossman Syndrome (Glaucomatocyclitic crisis)
Treatment
TRAUMA RELATED GLAUCOMA
Chemical Burns
Penetrating Injuries
Mechanism of Glaucoma
Management
Contusion Injuries
Mechanism of Glaucoma
Management
OTHER GLAUCOMAS
Iridoschisis
Management
Epidemic Dropsy Glaucoma
Management
6:
Technological Advances in Intraocular Lenses and Instrumentation
INTRAOCULAR LENS MATERIALS AND DESIGNS
Square Edge Effect
Intraocular Lens Haptics
Intraocular Lens Materials
Acrylate/Methacrylate Polymer
Foldable IOLs
Silicone Elastomers
IOL IMPLANTATION TECHNIQUES
Implantation of Rigid IOLs
Foldable Lens Delivery Systems
Folding and Implantation Forceps for Foldable IOLs
Implantation Technique of Foldable IOLs using Folders and Forceps
Cartridge Injector System
BASICS OF PHACOEMULSIFICATION
Ultrasonic Handpiece
Mechanism of Phacoemulsification
Irrigation Aspiration Handpiece
Aspiration Pump
Peristaltic Pump
Venturi Pump
Diaphragmatic Pump
Concentrix Pump
Foot Pedal
SPECIFICATION OF A BASIC MODEL PHACO MACHINE
Burst and Pulse Mode Phaco
Power Modulations in Phacoemulsification
Instruments used for Incisions
Phaco Choppers
Phaco Tips
Standard Phaco Tip
Kelman Tip
Microflow Tip
Microseal Tip
Masket Ergo Tip
Cobra Tip
Mackool Tip
Mackool-Kelman Tip
Endocapsular Ring
VISCOELASTIC SUBSTANCES
Toxicity of Viscoelastics
FUTURE TRENDS IN PHACOEMULSIFICATION
Phacotmesis
Phaco Laser
Why Laser Assisted Cataract Surgery?
Pulsed Hot Water Technology
THE FUTURE OF FOLDABLE IOLS
7:
Phacoemulsification
LENS HARDNESS GRADING SYSTEM IN CATARACT
Lens Opacities Classification Systems
LOCS I
LOCS II (modified) and LOCS III
Japanese Co-operative Cataract Epidemiology Study Group System
Lens Photography
Lens Video Imaging
Nuclear Color
ANESTHESIA
Topical Anesthesia
Intracameral Anesthesia
Technique
CATARACT INCISION
Side-Port Entry
Scleral Flap Incisions
Depth
Width
Length
Different Types of Scleral Incisions
Curved Parallel to the Limbus
Straight and Tangential to the Limbus
Frown Incision (Singer's)
Corneal Valve Incision
Technique
Limbal Incision
Wound Stability
Wound Healing
Patient Comfort
Refractive Stability
Wound Architecture
Wound Geometry
Wound Design
Temporal Limbal Incision
Hinge Incisions
Langerman's Hinge
Creating the Hinge
CAPSULORHEXIS
Forceps Capsulotomy
Needle Capsulotomy
Mechanics
Special Circumstances
Intumescent Cataract
Milky White Cataract
HYDROPROCEDURES
Terminology and Classification
Hydrodissection
Hydrodelineation
Technique of Hydrodissection and Hydrodelineation
Hydrodissection
Hydrodelineation
NUCLEOFRACTIS TECHNIQUES
Principles of Phacoemulsification
Isolation of Phacoemulsification Tip Into Manipulation, Cutting and Suction
Nuclear Rotation
Nuclear Segmentation
Nuclear Fragment Removal
Endocapsular Phacoemulsification
Endocapsular Phacoemulsification without Nuclear Cleavage
Endocapsular Emulsification with Nucleus Cleavage
Chip and Flip Phacoemulsification
Technique
Spring Surgery
Technique
Endocapsular Emulsification Techniques with Nucleus Cracking
Phacoemulsification by Divide and Conquer
Four Quadrant Cracking
Fractional 2:4 Phaco
Crater Divide and Conquer
V-Style
Down Slope Sculpting
Phaco-Sweep
Multidirectional Divide and Conquer Technique
Phaco Chop
Stop and Chop
Quick Chop
Auto-Crack Chop
Choo-Choo Chop and Flip Phacoemulsification
Petalloid Phacoemulsification
Akahoshi Pre-Chopping Technique
Epinucleus Management
Cortical Clean up
Profile of Foldable Phaco Intraocular Lenses
Memory Lens
Alcon Acrysof Lens
AMO Phacoflex Lens
Pharmacia CeeOn Foldable Lens
Storz Hydroview Lens
Corneal Acrygel Lens
STAAR Foldable IOL
Acqua
Surgical Considerations in Insertion of Foldable IOLs
Foldable Lens Insertion
Technique
COMPLICATIONS AND MANAGEMENT
Wound Construction
Hyphema
Anterior Capsulotomy
Corneal Complications
Iris Injury
Vitreous Loss
Conversion to Extracapsular Cataract Extraction
CHALLENGING SITUATIONS
IOL Power Calculation after Refractive Surgery
Clinical History Method
Contact Lens Method
IOL Power Calculation in Corneal Transplant Eyes
Hard Nucleus
The Central Flip
Other Technique
Phaco in White and Black Cataracts
White Cataract
Black Cataract
Subluxated Lens
Preoperative Evaluation
Small Pupil
Post-vitreoretinal Surgery
SECONDARY IOL IMPLANTATION
MANUAL SMALL-INCISION CATARACT SURGERY
Basic Steps
FUTURE TRENDS
8:
Pediatric Cataract Surgery and Intraocular Lens Implantation
BLINDNESS IN CHILDREN
CHILDHOOD CATARACT
Etiology of Childhood Cataract
Morphology
Ocular Examination
Laboratory Work-up
Cataract Surgery in Children
OPTIONS IN THE MANAGEMENT OF PEDIATRIC APHAKIA
Aphakic Glasses, Contact Lenses and Epikeratophakia
Intraocular Lens Implantation in Children
Why Is There An Increase in the Use of IOLs in Pediatric Cataract Surgery?
How Does Pediatric Cataract Surgery Differ from Adult?
The Operation
IOL Power Calculation
IOL Selection
Current Surgical Techniques
The Lensectomy and Anterior Vitrectomy Technique
Primary Posterior Capsulectomy, Anterior Vitrectomy with IOL Implantation
Posterior Circular Curvilinear Capsulorhexis with Optic Capture
Secondary Intraocular Lens Implantation
OPERATIVE PROBLEMS AND COMPLICATIONS IN PEDIATRIC CATARACT SURGERY
Postoperative Management
Postoperative Complications in Pediatric Cataract Surgery
Uveitis
Posterior Capsular Opacification
Pupillary Capture
Decentration of IOL
Glaucoma
Secondary Membrane Formation
Retinal Complications
Amblyopia
Change in the Axial Length of the Globe and Refractive Errors
Visual Outcome
9:
Inflammatory and Infectious Disorders of Uvea
INTRODUCTION
Naming and Meshing
Laboratory Diagnosis
Treatment
ANTERIOR UVEITIS
HLA B27 Associated Anterior Uveitis
Juvenile Rheumatoid Arthritis
Fuchs’ Heterochromic Iridocyclitis
Lens Induced Uveitis
Leprosy Uveitis
Viral Uveitis
Intermediate Uveitis
POSTERIOR UVEITIS
Toxoplasmosis
Tuberculosis
Retinal Vasculitis
White Dot Syndromes
Acute Multifocal Placoid Pigment Epitheliopathy
Acute Retinal Pigment Epithelitis
Multiple Evanescent White Dot Syndrome
Multifocal Choroiditis and Pan Uveitis Syndrome
Punctate Inner Choroidopathy
Subretinal Fibrosis and Uveitis Syndrome
Serpiginous Choroidopathy
Birdshot Retinochoroidopathy
PANUVEITIS
Sarcoidosis
Acute Retinal Necrosis
Vogt-Koyanagi-Harada Syndrome
Sympathetic Ophthalmia
Behcet's Syndrome
Leptospirosis
Syphilis
Endogenous Endophthalmitis
10:
Acquired Immunodeficiency Syndrome and Eye
INTRODUCTION
HUMAN IMMUNODEFICIENCY VIRUSES
POSTERIOR SEGMENT LESIONS
Noninfectious Retinopathy (HIV Retinopathy)
Opportunistic Infections
Cytomegalovirus Retinitis
Varicella Zoster Virus Disease
Acute Retinal Necrosis
Progressive Outer Retinal Necrosis
Frosted Branch Angiitis
Treatment of Viral Retinitis
Ganciclovir
Foscarnet
Acyclovir
Catheter-less Therapy
Oral Ganciclovir
Intravenous Cidofovir
Ganciclovir Intraocular Implant
Intravitreal Ganciclovir
Intravitreal Foscarnet
Intravitreal Cidofovir
Intravitreal Fomivirsen
Investigational Agents
Ocular Toxoplasmosis
Ocular Syphilis
Mycobacterial Infection
Fungal Infection
Pneumocystis Carinii Choroidopathy
ADNEXAL AND ANTERIOR SEGMENT LESIONS IN AIDS
Herpes Zoster Ophthalmicus
Molluscum Contagiosum
Lid Infections
Conjunctival Squamous Cell Carcinoma
Keratoconjunctivitis Sicca
Infectious Keratitis
Anterior Uveitis
ORBITAL INFECTIONS
NEURO-OPHTHALMIC LESIONS
NEOPLASMS
Ophthalmic Kaposi's Sarcoma
Lymphoma
MANAGEMENT
Retinal Detachment in CMV Retinitis
Ocular Manifestations of HIV in the Era of HAART
Management of HIV Infections and Opportunistic Infections
Antiretroviral Therapy
Indications for Antiretroviral Therapy
What Therapy to Initiate?
Investigations
When to Change Therapy?
Suggested Regimens for Patients Who Failed Antiretroviral Therapy
Antiretroviral Therapy in Patients with Tuberculosis
Patients with Active Tuberculosis: Possible Antiretroviral Treatment Options
11:
Macular and Allied Disorders
AGE-RELATED MACULAR DEGENERATION
Nonneovascular Age-Related Macular Degeneration
Diagnosis
Neovascular Age-Related Macular Degeneration
Diagnosis
Management
CENTRAL SEROUS RETINOPATHY
Diagnosis
Differential Diagnosis
Etiopathogenesis
Management
POSTSURGICAL CYSTOID MACULAR EDEMA
Diagnosis
Differential Diagnosis
Etiopathogenesis
Management
MYOPIA
Diagnosis
Clinical Features
Differential Diagnosis
Etiopathogenesis
Management
PARAFOVEAL TELANGIECTASIS
Diagnosis
Differential Diagnosis
Management
RETINAL ARTERY MACROANEURYSM
Diagnosis
Management
PHOTIC RETINOPATHY
Diagnosis
Etiopathogenesis
Management
RADIATION RETINOPATHY
Diagnosis
Etiopathogenesis
Management
HEREDOMACULAR DEGENERATIONS
Vitelliform Dystrophy (Best's Disease)
Diagnosis
Fundus Flavimaculatus (Stargardt's Dystrophy)
Cone Dystrophy
Familial Macular Retinoschisis
DRUG INDUCED MACULOPATHY
Chloroquine Toxicity
RETINITIS PIGMENTOSA
Etiopathogenesis
Typical Retinitis Pigmentosa
Investigations
Atypical Retinitis Pigmentosa
Systemic Associations
Treatment
COLOR CODING FOR RETINAL LESIONS
FUTURE TRENDS
12:
Retinal Vascular Disorders
INTRODUCTION
DIABETIC RETINOPATHY
Nonproliferative Diabetic Retinopathy
Clinical Signs
Proliferative Diabetic Retinopathy
Clinical Signs
Visual Loss in Diabetic Retinopathy
Management
Medical Management
Laser Photocoagulation
Laser Treatment Techniques
Surgery
New Management Strategies
HYPERTENSIVE RETINOPATHY
Pathogenesis of Ocular Changes
Grading
Clinical Features
Pathophysiology
Management
HYPERTENSIVE CHOROIDOPATHY AND OPTIC NEUROPATHY
ARTERIAL OCCLUSIONS
Cotton-wool Spots
Branch Retinal Artery Obstruction
Clinical Features
Treatment
Central Retinal Artery Occlusion
Clinical Features
Ancilliary Tests
Systemic Association
Management
Ophthalmic Artery Obstruction
Cilioretinal Artery Obstruction
Ocular Ischemic Syndrome
VENOUS OCCLUSIVE DISEASES OF RETINA
Central Retinal Vein Occlusion
Pathogenesis
Clinical Features
Natural Course and Complications
Management
Medical Therapy
Systemic Corticosteroids
Laser Photocoagulation
Surgery
Branch Retinal Vein Occlusion
Clinical Features
Complications
Management
Laser Photocoagulation
Surgery
Hemi-central Vein Occlusion
Clinical Features
Management
EALES’ DISEASE
FUTURE TRENDS
Enzymatic Manipulation of the Posterior Hyaloid in Diabetic Retinopathy
13:
Surgical Management of Vitreoretinal Diseases
INTRODUCTION
RHEGMATOGENOUS RETINAL DETACHMENT
Symptomatology
Clinical Features
Retinal Break
Other Features
Evaluation
Identifying the Retinal Break
Diagnosis
Management
Scleral Buckling
Conjunctival Opening
Tagging the Muscles
Inspection of the Sclera
Localization of the Retinal Break
Technique of Localization
Difficulties in Localization
Retinopexy
The Buckle
Buckling Materials
Choice of Buckle
Implant Vs Exoplant
Subretinal Fluid Drainage
Indications for Drainage
Choosing the Site for Drainage
Drainage Inside Vs Outside the Bed of the Buckle
Technique of Drainage
Intraocular Injection
Role of Paracentesis
Concluding Steps
Complications of Scleral Buckling
Preoperative Complications
Intraoperative Complications
Early Postoperative Complications
Late Postoperative Complications
ALTERNATE METHODS OF RETINAL REATTACHMENT
Pneumatic Retinopexy
Principle
Indications
Contraindications
Surgical Technique
Complications
Balloon Buckle
Adjunct Techniques
Primary Vitrectomy for Rhegmatogenous Retinal Detachment
REVISION SURGERY
Approach to Management of Recurrent/ Persistent Retinal Detachment
Gas Injection
Revision Buckling
Pars Plana Vitrectomy
Results of Scleral Buckling
PROLIFERATIVE VITREORETINOPATHY
Classification
Pathogenesis
Information from Clinical Studies
Information from Basic Studies
Pathology
Surgical Management of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy
Do all the Cases of RRD with PVR need Vitrectomy?
When to Operate in an Eye with PVR?
Role of Buckle along with Vitrectomy
Role of Lens Sacrifice
Advantages of Lens Removal
Disadvantages of Lens Removal
Procedure of Lens Removal
Role of IOL Sacrifice
Extent of Vitrectomy
Membrane Peeling Techniques
Subretinal Band Removal
Role of Retinotomies and Retinectomies
Retinal Reattachment
Uses of Perfluorocarbon Liquids
Retinopexy
Choice of Tamponade
Silicone Oil Removal
Results
Recent Innovations in the Management of Proliferative Vitreoretinopathy
Endoscopic Surgery93, 94
Erbium: Yag Laser Vitrectomy
Pharmacological Modulation
GIANT RETINAL TEAR
Etiology
Clinical Presentation
Variables
Management
Technique of Scleral Buckling
Vitreoretinal Surgery
Management of Inverted Flap
Present Technique
Surgical Technique
Lens Management
IOL Management
Management of Edge of Tear
Management of the Anterior Flap
Management of Proliferative Vitreoretinopathy
Role of Perfluorocarbon Liquids
Retinal Reattachment
Technique of Air Fluid / Air PFCL and Silicone Oil Fluid / Silicone Oil PFCL Exchange
Retinopexy
Role of Peripheral Buckle
Iridectomy
Postoperative Positioning
Recurrent Retinal Detachment
Silicone Oil Removal
Fellow Eyes with Giant Retinal Tear
MANAGEMENT OF DISLOCATED LENS AND INTRAOCULAR LENS
Clinical Scenario
Dislocated Crystalline Lens
Clinical Evaluation
Management Options
Observation
Lens Removal
Correction of Coexisting Retinal Detachment
Correction of Aphakia
Dislocated Nucleus/Lens Fragments/Cortex
Subsequent Management
Observation
Surgical Management
Dislocated IOL
Management
Management of Subluxated IOL (Decentration)
Management of Dislocated IOL
ENDOPHTHALMITIS
Clinical Presentation
Postoperative Endophthalmitis
Time of Onset
Symptomatology
Signs
Endogenous Endophthalmitis
Traumatic Endophthalmitis
Bleb Related Endophthalmitis
Corneal Involvement with Endophthalmitis
Panophthalmitis
Ultrasonographic Features of Endophthalmitis
Management
Diagnosis
Microbiological Investigations
Specimens for Processing
Collection of Specimens
Processing of the Specimens
Interpretation
Medical Therapy
Route of Administration
Vitrectomy
Management of the Intraocular Lens
Procedure for Removal of IOL
Management in the Presence of Corneal Involvement
Cases with Retinal Detachment on Ultrasonography
Second Intervention
Complications
Prognosis
Routine Antiseptic Measures that can Reduce the Occurrence of Postoperative Infections
Intravitreal Drug Dosage and Formulation
Important Messages from the Endophthalmitis Vitrectomy Study
RETINOPATHY OF PREMATURITY
Etiopathogenesis
International Classification of Retinopathy of Prematurity
Examination Protocol
Examination Procedure
Treatment of Threshold Disease
Technique of Laser Therapy
Complications of Laser Treatment
Technique of Cryotherapy
Complications of Cryotherapy
Effect of Treatment
Sequelae of Regressed ROP
Treatment of Retinal Detachment
Scleral Buckling
Removal of the Buckle
Results of Scleral Buckling
Vitreoretinal Surgery
Results
FUTURE TRENDS
Assessing Fibrovascular Ingrowth with Ultrasound Biomicroscopy (UBM)
14:
Macular and Submacular Surgery
INTRODUCTION
CHOROIDAL NEOVASCULARIZATION
Etiopathogenesis
Clinical Features
Management
Photodynamic Therapy
Transpupillary Thermotherapy
Surgical Treatment
Macular Translocation
Limited Macular Translocation
360° Retinal Rotation
MACULAR HOLE
Clinical Features
Pathogenesis and Classification
Differential Diagnosis
Management
Maculorrhexis
Surgical Technique
EPIRETINAL MEMBRANE
Clinical Features
Histopathology
Management
PERSISTENT DIFFUSE DIABETIC MACULAR EDEMA
FUTURE TRENDS
15:
Ocular Oncology
INTRODUCTION
RETINOBLASTOMA
Incidence
Genetics
Age at Diagnosis
Clinical Features
Differential Diagnosis
Evaluation of a Case of Retinoblastoma
Ancillary Tests
Ultrasonography
Computed Tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Metastatic Work up
Examination of Parents and Siblings
Pathogenesis
Histopathology
Management
Enucleation
Cryotherapy
Photocoagulation
External Beam Radiotherapy
Brachytherapy
Chemoreduction
Transpupillary Thermotherapy
Thermochemotherapy
Prognosis
Clinical Staging Systems in Retinoblastoma
Second Tumors in Retinoblastoma
Trilateral Retinoblastoma
Follow up
RETINOCYTOMA OR RETINOMA
UVEAL MELANOMA
Melanoma of Iris
Choroidal and Ciliary Body Melanomas
Ciliary Body Melanoma
Choroidal Melanoma
Pathophysiology and Prognosis of Uveal Melanoma
Diagnosis
Ultrasonography
Management
Treatment Modalities
Radiotherapy
VASCULAR TUMORS OF CHOROID AND RETINA
Choroidal Hemangioma
Circumscribed Choroidal Hemangioma
Pathology
Differential Diagnosis
Management
Diffuse Choroidal Hemangioma
VASCULAR TUMORS OF RETINA
Capillary Hemangioma of the Retina
Cavernous Hemangioma of the Retina
Racemose Hemangioma
Vasoproliferative Tumor of the Retina
OCULAR METASTASIS
Investigations
Differential Diagnosis
Management
PRIMARY INTRAOCULAR LYMPHOMA
Differential Diagnosis
Management
INTRAOCULAR LEUKEMIA
CHOROIDAL OSTEOMA
Diagnosis
Differential Diagnosis
Management
MEDULLOEPITHELIOMA
Investigations
Differential Diagnosis
Management
RETINAL ASTROCYTOMA
Systemic Associations
Ancillary Tests
Management
PHAKOMATOSES SYNDROMES
16:
Optic Nerve Disorders
INTRODUCTION
DIAGNOSIS OF OPTIC NERVE DISORDERS
Common Symptoms of Optic Nerve Disorders
Common Signs in Optic Nerve Disorders
Differential Diagnosis
OPTIC NEURITIS
Clinical Symptoms
Clinical Signs
Differential Diagnosis
Prognosis
Conversion to Multiple Sclerosis
Treatment
Optic Neuritis in Children
Neuroretinitis
Infectious and Parainfectious Optic Neuritis
Post Vaccination Optic Neuritis
Inflammatory Optic Neuritis
NEUROMYELITIS OPTICA (DEVIC'S DISEASE)
Clinical Features
Diagnosis
Treatment
PAPILLEDEMA
Pathogenesis
Symptoms and Signs
Ophthalmoscopic Appearance of Papilledema
Diagnosis
Treatment
ISCHEMIC OPTIC NEUROPATHY
Clinical Features
Management
Medical
Surgical
OPTIC ATROPHY
LEBER'S HEREDITARY OPTIC NEUROPATHY
RADIATION OPTIC NEUROPATHY
TOXIC OPTIC NEUROPATHY
COMPRESSIVE OPTIC NEUROPATHY
DRUG INDUCED TOXICITY
TRAUMATIC OPTIC NEUROPATHY
UNCOMMON AND MISCELLANEOUS OPTIC NEUROPATHIES
Papillophlebitis
Partial Central Vein Occlusion
Diabetic Papillopathy
Parasitic Infestation of the Optic Nerve
Thyroid-related Optic Neuropathy
Sarcoid Optic Neuropathy
Shock Optic Neuropathy
CONGENITAL ANOMALIES OF THE OPTIC DISC
Optic Disc Pit
17:
Diseases of the Eyelid and Orbit
PTOSIS
Evaluation of Ptosis
Management of Ptosis
Choice of Surgery for Congenital Ptosis
Choice of Surgery for Acquired Ptosis
Surgical Techniques
Fasanella-Servat Procedure
Levator Resection
Tarso-frontal Sling
Complications
Conclusion
TUMORS OF THE EYELID
Sebaceous Carcinoma
Incidence
Clinical Presentation
Management
Histopathology
Prognosis
Conclusion
Squamous Cell Carcinoma
Basal Cell Carcinoma
Clinical Appearance and Histopathology
Management
Micrographic (Mohs’) Surgery
Excision with Frozen Section or Permanent Section Control
Radiotherapy and Electron Beam Therapy
Chemotherapy
Cryotherapy
Photodynamic Therapy
Carbon-Dioxide Laser Treatment
PROPTOSIS
Classification of Proptosis
Evaluation of a Case of Proptosis
Diagnosis
ORBITAL CELLULITIS
Bacterial Infection
Fungal Infection
Parasitic Infection
CYSTS
Dermoid and Epidermoid Cysts
Teratomas
Meningoencephalocele
Microphthalmos with Cyst and Congenital Cystic Eye
Mucocele
Cysts of the Optic Nerve Sheath
Dacryocele
Hematic Cysts
Simple Cysts
VASCULAR LESIONS
Capillary Hemangioma
Lymphangiomas
Cavernous Hemangioma
Carotid Cavernous Fistula
Orbital Varix
NERVE SHEATH TUMORS
Neurofibroma
Schwannoma (Neurilemmoma)
LACRIMAL GLAND LESIONS
Epithelial Cyst (Dacryops)
Pleomorphic Adenoma
Primary Carcinomas
METASTASES
FUTURE TRENDS
18:
Strabismus
AMBLYOPIA
Types of Amblyopia
Strabismic Amblyopia
Anisometropic Amblyopia
Stimulus Deprivation Amblyopia
Isoametropic (Refractive) Amblyopia
Meridional Amblyopia
Idiopathic Amblyopia
Pathomechanism of Amblyopia
Clinical Characteristics
Diagnosis of Amblyopia
Treatment
Occlusion
Type of Occluder
Follow-up
When to Stop Full-Time Occlusion?
How to Maintain the Improved Vision?
Penalization
Pleoptics
CAM Vision Stimulator
Pharmacological Agents
Role of Patient Compliance
Prognosis
STRABISMUS IN CHILDHOOD
Convergent Squint in a Child
Infantile Esotropia
Accommodative Esotropia
Refractive Accommodative Esotropia
Non-refractive Accommodative Esotropia
Partially Accommodative Esotropia
Acquired Non-accommodative or Basic Esotropia
Other Conditions Which May Present with Esotropia
Duane's Retraction Syndrome (DRS) Type 1
Nystagmus Blockage Syndrome (NBS)
Congenital Sixth Nerve Palsy
Sensory Esotropia
Moebius’ Syndrome
Clinical Evaluation
Measurement of the Deviation
Assessment of Visual Acuity
Examination of Extraocular Movements
Cycloplegic Refraction
Measurement of Fusional Divergence Amplitude
Fundus Examination
Treatment
Correction of the Refractive Error
Treatment of Amblyopia
Role of Surgery
DIVERGENT SQUINT IN A CHILD
Infantile Exotropia
Treatment
Intermittent Exotropia
Natural History
Symptoms
Clinical Evaluation
Occlusion Test
Lateral Incomitance
Vertical Deviation
Sensory Adaptations
Refractive Errors
Treatment
Surgical Treatment
Indications for Surgery
Choice of Surgical Procedure
Where Should You Overcorrect?
Where Should You Undercorrect?
Results of Surgery
Factors Affecting Surgical Results
ADULT STRABISMUS
Special Points in Clinical Presentation
Asthenopia
Symptomatic Alternation
Special Points in Assessing Adults with Strabismus
Surgery for Adult Strabismus
Restoration of Binocular Fusion and Elimination of Diplopia
Expansion of Binocular Visual Fields in Patients with Esotropia
Improvement in Psychosocial Functioning
Postoperative Diplopia in Adult Strabismus
Surgical Overcorrection for Intermittent Exotropia in Adults
Stability of Strabismus Surgery in Adults
Central Fusion Disruption
SURGICAL MANAGEMENT FOR STRABISMUS
Preparation of Patient and Parents for Surgery
Preoperative Preparation of the Eye
Anesthesia for Strabismus Surgery
Recession of Rectus Muscle
Special Points for Surgery on Vertical Rectus Muscles
Resection of Rectus Muscle
Adjustable Sutures
Inferior Oblique Weakening Procedures
Indications
Technique of Inferior Oblique Recession
Park's Method
Fink's Method
Elliot and Nankin's Method
Superior Oblique Weakening Procedures
Indications
Tenotomy of the Superior Oblique muscle
Superior Oblique Tendon Silicone Expander
Muscle Transposition Procedures
Jensen's Procedure
Hummelsheim Procedure
Augmented Hummelsheim Procedure
Postoperative Care
Complications Following Strabismus Surgery
Perforation of the Globe
Periocular Infection
Lost Muscle
Anterior Segment Ischemia
Corneal Dellen
Conjunctival Cyst
Suture Granuloma
Botulinum Toxin in the Management of Strabismus
Mechanism of Action
Preparation of Type A Toxin
Technique of Injection
Onset and Duration of Action of Botulinum Toxin
Side Effects
Uses of Botulinum Toxin in Squint Management
Current Status of Botulinum Toxin in Strabismus Management
FUTURE TRENDS
Considerations of LASIK in Children with Amblyopia
Sutureless Strabismus Surgery
Antifibroblastic Agents for Reducing Scarring after Strabismus Surgery
19:
Ocular Trauma
INTRODUCTION
EVALUATION AND INITIAL MANAGEMENT
OCULAR TRAUMA CLASSIFICATION SYSTEM
Types of Injury
Grade of Injury
Relative Afferent Pupillary Defect
Zone of Injury
ANCILLARY TESTING
Electrophysiological Tests
X-ray
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
ANTERIOR SEGMENT TRAUMA
Conjunctival Injury
Corneal Injury– Closed Globe Injury
Corneoscleral Tears
Subconjunctival Hemorrhage
Suturing Technique
Stellated Corneal Lacerations
Scleral Tear Repair
Hyphema
Surgical Procedure
Angle Recession Glaucoma
Traumatic Cataract
Postoperative Management
CLOSED GLOBE POSTERIOR SEGMENT TRAUMA
Mechanism of Contusion
Traumatic Maculopathies
Traumatic Retinal Tears and Detachment
Traumatic Endophthalmitis
OPEN GLOBE POSTERIOR SEGMENT TRAUMA
Vitrectomy and Penetrating Injury
Timing of Vitrectomy
Indications
Basic Steps
Special Situations in Vitrectomy
Perforating (Double Penetrating Injury)
INTRAOCULAR FOREIGN BODY
MANAGEMENT OF DISLOCATED CRYSTALLINE LENS
CHEMICAL INJURIES OF THE EYE: ACID AND ALKALI BURNS
Alkali Burns
Clinical Course and Evaluation
Acid Burns
FUTURE TRENDS
Temporary Keratoprosthesis
Perfluorocarbon Liquids
Wide Angle Viewing Systems
Ultrasound Biomicroscopy
Endoscopy
20:
Ophthalmology Practice Management
INTRODUCTION
Setting Specific Goals for Success
Making Resolutions
Successful Practice
Office Planning and Procedures
Strategic Practice Plan
Situation Analysis
Analysis of Your Practice's Strengths, Weaknesses, Opportunities and Threats
Mission Statement
Goal Setting
Tactical Planning
Implementation
Positioning the Practice
Competitive Practice Analysis
Marketing
Smart Marketing Plan
Budgeting the Marketing Plan
Price issue
Market Share
Patient Service
Patient Care
Improving Referrals
Benchmarking Ophthalmology Practice
Embracing Efficiency
Adopting New Technology
Computers in Medical Practice
Impact of Information Technology
Doing Business on the World Wide Web
21:
Clinical Trials in Ophthalmology
INTRODUCTION
Advanced Glaucoma Intervention Study (AGIS)
Amblyopia Treatment Study (ATS)
Purpose
Age-Related Eye Disease Study (AREDS)
Purpose
Berkeley Orthokeratology Study
Purpose
Branch Vein Occlusion Study (BVOS)
Purpose
Central Vein Occlusion Study (CVOS)
Purpose
Results
Complications of Age-Related Macular Degeneration Prevention Trial (CAPT)
Collaborative Corneal Transplantation Studies (CCTS)
Congenital Esotropia Observational Study (CEOS)
Collaborative Initial Glaucoma Treatment Study (CIGTS)
Correction of Myopia Evaluation Trial (COMET)
Purpose
Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) – Outcome Study of Cryotherapy for Retinopathy of Prematurity
Purpose
Diabetic Retinopathy Study (DRS)
Purpose
Diabetic Retinopathy Vitrectomy Study (DRVS)
Purpose
Early Treatment Diabetic Retinopathy Study (ETDRS)
Purpose
Early Manifest Glaucoma Trial (EMGT)
Purpose
Endophthalmitis Vitrectomy Study (EVS)
Purpose
Fluorouracil Filtering Surgery Study (FFSS)
Glaucoma Laser Trial (GLT) Glaucoma Laser Trial Follow-up Study (GLTFS)
Ganciclovir Implant Study for Cytomegalovirus Retinitis
Studies of Ocular Complications of AIDS (SOCA)—Ganciclovir-Cidofovir CMV Retinitis Trial (GCCRT)
Purpose
Herpetic Eye Disease Study (HEDS) I
Purpose
Herpes Stromal Keratitis, Not on Steroid Trial (HEDS-SKN)
Herpes Stromal Keratitis, on Steroid Treatment (HEDS-SKS)
Herpes Simplex Virus Iridocyclitis, Receiving Topical Steroids (HEDS-IRT)
Herpes Stromal Keratitis, Not on Steroid Trial (HEDS-SKN)
Herpes Stromal Keratitis, on Steroid Treatment (HEDS-SKS)
Herpes Simplex Virus Iridocyclitis, Receiving Topical Steroids (HEDS-IRT)
Herpetic Eye Disease Study (HEDS) II
Purpose
Herpes Simplex Virus Epithelial Keratitis Trial (HEDS-EKT)
Acyclovir Prevention Trial (HEDS-APT)
Ocular HSV Recurrence Factor Study (HEDS-RFS)
Intravenous Immunoglobulin Therapy in Optic Neuritis
Purpose
Ischemic Optic Neuropathy Decompression Trial (IONDT)
Ischemic Optic Neuropathy Decompression Trial Follow-up (IONDT Follow-up)
Krypton-Argon Regression of Neovascularization Study (KARNS)
Purpose
Effects of Light Reduction on Retinopathy of Prematurity (Light-ROP)
Longitudinal Optic Neuritis Study (LONS)
Purpose
Longitudinal Study of Ocular Complications of AIDS (LSOCA)
Purpose
Macular Photocoagulation Study (MPS)
INDEX
TOC
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