Editor
Sandeep Saxena MS MAMS
Member, National Academy of Medical Sciences
India
Fellow, Barnes Retina Institute and Anheuser-Busch Eye Institute,
St. Louis, USA
Fellow, New York-Presbyterian, The University Hospitals of Columbia and Cornell,
New York, USA
Assistant Professor, Department of Ophthalmology Member, KGMC Institute of Clinical Epidemiology CSM Medical University (Upgraded King George's Medical College)
Lucknow, India
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Clinical Practice in Ophthalmology
© 2003, Sandeep Saxena
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition : 2003
Publishing Director: RK Yadav
9788180611353
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
To
My parents Dr RC Saxena and Mrs Madhu Saxena
My mentors
Dr Dipak Kumar, Drs Harvey Lincoff, Travis A Meredith
Matthew A Thomas and Lawrence A Yannuzzi
and
Sangeeta, Puneet, Madhulika, Manoj, Vandana and Shreeya
7Contributors
- Harmohina Bagga md
- VST Centre for Glaucoma Care
- LV Prasad Eye Institute
- Hyderabad
- Tinku Bali ms
- Department of Ophthalmology
- CSM Medical University
- (Upgraded King George's Medical College), Lucknow
- M Baskaran do dnb
- Glaucoma Department
- Sankara Nethralaya
- Chennai
- Prashant Bhartiya ms dnb frcs
- Senior Registrar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Jyotirmay Biswas ms
- Head
- Uveitis Department
- Sankara Nethralaya, Chennai
- Gagandeep S Brar md
- Assistant Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh
- Taraprasad Das md
- Director
- Smt Kannuri Santhamma Retina Vitreous Centre
- LV Prasad Eye Institute, Hyderabad
- Mahendra D Dive ms dnb
- Incharge, Laser Vision Correction Centre, Doctor Eye Hospital
- Mumbai
- Kumar J Doctor ms dnb
- Doctor Eye Institute
- Mumbai
- Lingam Gopal ms dnb
- Assistant Director
- Head, Vitreoretinal Department
- Sankara Nethralaya, Chennai
- Santosh G Honavar md
- Director
- Ophthalmic Plastic Surgery, Orbital Diseases and Ocular Oncology Division, LV Prasad Eye Institute
- Hyderabad
- Arun Jain md
- Associate Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh
- Subhadra Jalali ms
- Consultant
- Smt Kannuri Santhamma Retina Vitreous Centre
- LV Prasad Eye Institute
- Hyderabad
- Kasinathan ms
- Vitreoretinal Department
- Sankara Nethralaya, Chennai
- Pratima Kathil ms
- Vitreoretinal Department
- Sankara Nethralaya
- Chennai
- Atul Kumar md dnb mnams
- Additional Professor
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Ajit B Majji ms dnb
- Consultant
- Smt Kannuri Santhamma Retina Vitreous Centre
- LV Prasad Eye Institute
- Hyderabad
- Kanwar Mohan ms
- Formerly
- Associate Professor and Incharge
- Squint Clinic
- Post-Graduate Institute of Medical Education and Research
- Chandigarh.
- Chief
- Squint Clinic
- Grewal Eye Institute
- Chandigarh
- Krishna R Murthy do
- Vitreoretinal Department
- Sankara Nethralaya
- Chennai
- Krishna R Murthy ms
- Vitreoretinal Department
- Sankara Nethralaya
- Chennai
- Praveen R Murthy ms dnb
- Vitreoretinal Department
- Sankara Nethralaya
- Chennai
- Milind N Naik md
- Ophthalmic Plastic Surgery, Orbital Diseases and Ocular Oncology Division, LV Prasad Eye Institute
- Hyderabad
- Sanjeev K Nainiwal md dnb mnams
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- P Namperumalsamy ms do
- Director
- Aravind Eye Hospitals and Post-Graduate Institute of Ophthalmology
- Madurai
- Arun Narayanaswamy dnb
- Glaucoma Department
- Sankara Nethralaya, Chennai
- S Natarajan do
- Medical Director
- Aditya Jyot Eye Hospital, Mumbai
- Rajiv Nath ms dnb m med sci
- Professor
- Department of Ophthalmology
- CSM Medical University
- (Upgraded King George's Medical College), Lucknow
- Jagat Ram md
- Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh
- Rajiv Raman ms dnb
- Uveitis Department
- Sankara Nethralaya
- Chennai
- SR Rathinam do dnb
- Head
- Uvea Clinic
- Aravind Eye Hospitals and Post-Graduate Institute of Ophthalmology
- Madurai
- Manotosh Ray ms frcs
- Senior Research Associate
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Jagjit S Saini md
- Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh
- Puneet Saxena btech ms mba
- i 2 Technologies
- Dallas, Texas
- USA
- Sandeep Saxena ms mams
- Member
- National Academy of Medical Sciences, India
- Fellow, Barnes Retina Institute and Anheuser-Busch Eye Institute
- St. Louis, USA
- Fellow, New York-Presbyterian
- The University Hospitals of Columbia and Cornell, New York, USA
- Assistant Professor
- Department of Ophthalmology
- Member, KGMC Institute of Clinical Epidemiology
- CSM Medical University
- (Upgraded King George's Medical College), Lucknow, India
- G Chandra Sekhar md
- Director
- VST Centre for Glaucoma Care
- LV Prasad Eye Institute
- Hyderabad
- Mahesh P Shanmugam do
- Consultant
- Vitreoretinal Department
- Sankara Nethralaya
- Chennai
- Radhika Tandon md
- Assistant Professor
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Manoj K Tangri btech ms mba
- Hewlett-Packard, Fort Collins, Colorado
- USA
- Hem K Tewari md
- Chief
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Hemkala L Trivedi ms doms
- Associate Professor
- Department of Ophthalmology
- BYL Nair Hospital and TN Medical College
- Mumbai
- Rasik B Vajpayee ms
- Professor and Head
- Cornea and Refractive Surgery
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Vasumathy Vedantham ms frcs
- Smt. Kannuri Santhamma Retina Vitreous Centre
- LV Prasad Eye Institute
- Hyderabad
- Geeta K Vemuganti md
- Ophthalmic Pathology Division
- LV Prasad Eye Institute
- Hyderabad
- Pradeep Venkatesh md
- Assistant Professor
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Lalit Verma md
- Additional Professor
- Dr Rajendra Prasad Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi
- Lingam Vijaya ms
- Head
- Glaucoma Department
- Sankara Nethralaya
- Chennai
The pace of change in ophthalmology is rapid and requires us to constantly update our skills and knowledge. We are subspecialized to a degree that demands that we must stay in close communication with our colleagues to be able to follow the advances occurring in the separate subdivisions of our specialty. In this challenging intellectual environment a text bringing together respected authors from multiple disciplines is particularly welcome, and Dr Saxena has accomplished this task with great success. Twenty-one chapters cover new concepts and technological advances in the diagnosis and management of common ophthalmic disorders. Several chapters deal with advances in lens surgery, and several authorities cover new concepts in retinal disease including macular and submacular surgery. Modern concepts in corneal disease, glaucoma, oculoplastics, ocular oncology, infectious and inflammatory diseases, strabismus, trauma, and optic nerve disorders are each presented by experts in Indian ophthalmology. As ophthalmology has become more complex we are driven to establish higher standards of scientific proof for our treatments and simultaneously to run our practices with greater efficiency to be able to bring the best of high technology to bear on our patients problems while being mindful of cost. Thus, I was particularly pleased to see practice management and clinicial trials covered in this text. Dr Saxena is an extraordinarily gifted and energetic physician and academician who, along with his fellow authors, has produced a book, which is an important contribution to contemporary ophthalmic education. Readers will benefit greatly from this accomplishment.
Travis A. Meredith md
Sterling A Barrett Distinguished Professor
Chairman, Department of Ophthalmology
University of North Carolina
Chapel Hill, USA
11Preface
With the evolution of new diagnostic and therapeutic modalities, the ophthalmologist has become more involved in decision-making for patients. The challenge facing the ophthalmologist lies in maintaining an up-to-date practical knowledge. This thirst for knowledge is typical of those who are fascinated by the subject but is also true of those who develop a great understanding of the subject.
Clinical Practice in Ophthalmology, a multi-authored text, was conceptualized in New York, USA. The publisher and the contributing authors were contacted on Internet to lay the groundwork. This book summarizes the present knowledge of clinical ophthalmology and practice management. The value of this book lies in the quality and expertise of the authors of the selected subjects. The authors have presented the material to provide the reader with a quick but comprehensive review of the major ophthalmological issues. This pragmatic book provides an understanding of diseases so important to the everyday practice of ophthalmology. I hope this book will find a meaningful and valued place in the libraries of ophthalmologists, today and in future.
This book would not have been possible without the guidance of my mentors, cooperation of my family and help of Dr SK Bhasker.
Sandeep Saxena