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Modern Ophthalmology (3 Volumes)
LC Dutta, Nitin K Dutta
SECTION 1: DISORDERS OF THE EYELIDS
CHAPTER 1:
Anatomy of the Eyelids
DEVELOPMENT OF THE EYELIDS
Structure of Eyelids
Blood Supply
Lymphatics
Nerve Supply of the Eyelids
CHAPTER 2:
Congenital Eyelid Anomalies
EPICANTHAL FOLDS
Treatment
TELECANTHUS
Treatment
EPIBLEPHARON
BLEPHAROPHIMOSIS
Treatment
EURYBLEPHARON
COLOBOMA OF LID
Treatment
ANKYLOBLEPHARON
CRYPTOPHTHALMOS
CHAPTER 3:
Anomalies of the Eyelid Margin and Cilia
TRICHIASIS
Treatment
DISTICHIASIS
ENTROPION
Congenital Entropion
Senile (Involutional/Atonic) Entropion
Spastic Entropion
Treatment
Lower Lid Retractor Tucking4 (Figs 3.5A and B)
Full Thickness Horizontal Shortening of the Lid
Lid Bracing Sutures (Snellen-Quickerdt)
Modified Wheeler's Procedure (Orbicularis Bracing)
Cicatricial Entropion
Treatment
ECTROPION
Congenital Ectropion
Senile or Involutional Ectropion
Treatment
Paralytic Ectropion
Cicatricial Ectropion
Mechanical Ectropion
CHAPTER 4:
Blepharitis and Meibomian Gland Dysfunction
INTRODUCTION
CLASSIFICATION
Anterior Blepharitis
Pathogenesis
Clinical Features
Differential Diagnosis
Management
Meibomian Gland Dysfunction
ANATOMY AND PHYSIOLOGY OF MEIBOMIAN GLANDS
Pathogenesis
Clinical Features
Treatment
CONCLUSION
CHAPTER 5:
Inflammatory Diseases of the Eyelids
STYE (HORDEOLUM EXTERNUM)
Treatment
CHALAZION (MEIBOMIAN CYST)
Treatment
HORDEOLUM INTERNUM (ACUTE MEIBOMITIS)
TARSITIS
BLEPHARITIS
Clinical Features
Treatment
HERPES ZOSTER
Clinical Features
Treatment
DERMATITIS
Treatment
MOLLUSCUM CONTAGIOSUM
WARTS (VERRUCA VULGARIS)
CHAPTER 6:
Anomalies of the Eyelid Position
PTOSIS (BLEPHAROPTOSIS)
Myogenic Ptosis
APONEUROTIC PTOSIS
Neurogenic Ptosis
Mechanical Ptosis
Pseudoptosis
Evaluation of Ptosis
History
Examination of the Eye
Examination of Eyelid
Assessment of Lid Position
Assessment of Levator Function
Ocular Movements
Abnormal Synkinetic Movements
Bell's Phenomenon
Tear Film
Corneal Sensations
Phenylephrine Test
Surgical Treatment
Fassanella Servat Operation
Levator Resection
Frontalis Sling Surgery (Fig. 6.11)
Aponeurotic Repair
Other Surgical Procedures
Complication of Ptosis Surgery
LID RETRACTION
CHAPTER 7:
Tumors of the Eyelids*
EPITHELIAL TUMORS
Benign Epithelial Tumors
Squamous Cell Papilloma
Pseudocarcinomatous Hyperplasia
Keratoacanthoma
Seborrheic Keratosis
Inverted Follicular Keratosis
Precancerous Lesions
Actinic Keratosis
Bowen's Disease (Intraepithelial Epithelioma)
Radiation Dermatosis
Xeroderma Pigmentosum
Malignant Epithelial Tumors
Basal Cell Carcinoma
Clinical Features
Treatment
Nevoid Basal Cell Carcinoma Syndrome
Squamous Cell Carcinoma (Fig. 7.8)
MELANOCYTIC TUMORS
Benign Melanocytic Tumors
Nevus Cell Tumors
Dermal Melanocytic Tumors
Epidermal Melanocytic Tumors
Malignant Melanocytic Tumors
Malignant Melanoma
Melanoma Arising From Nevus
Dysplastic Nevus Syndrome
GLANDULAR AND OTHER ADNEXAL TUMORS
Sebaceous Gland Tumors
Benign Lesions
Sebaceous Gland Cell Carcinoma
Clinical Features
Treatment
VASCULAR TUMORS
Capillary Hemangioma
Nevus Flammeus
Cavernous Hemangiomas
Lymphangioma
Glomus Tumor
Angiosarcoma
NEUROGENIC TUMORS
Neurofibromatosis (von Recklinghausen's disease)
Plexiform Neurofibroma
Diffuse Neurofibroma
Molluscum Fibrosum (Fibroma Molluscum)
CHAPTER 8:
Miscellaneous Conditions of the Eyelids
FLOPPY EYELID SYNDROME
Pathology
Management
SECTION 2: DISEASES OF CONJUNCTIVA
CHAPTER 9:
Anatomy of the Conjunctiva
ANATOMY
Conjunctival Glands
1. Mucin Secretors
2. Accessory Lacrimal Glands (Fig. 9.2)
Conjunctival Epithelium
Tarsal Conjunctival Epithelium
Limbal Conjunctival Epithelium
Epithelial Cysts
Wound Healing and Inflammation
Arteries
Veins
Lymphatics
Nerve Supply
Caruncle
Plica Semilunaris
Epitarsus
CHAPTER 10:
Clinical Manifestations of Conjunctival Diseases
DISCHARGE
Hyperemia
Papilla
Follicles
Membrane Formations
Conjunctival Concretions
Conjunctival Ulcers
Conjunctival Edema (Chemosis)
Angular Conjunctivitis
Phlyctenular Keratoconjunctivitis
Nodule at Limbus
SUBCONJUNCTIVAL HEMORRHAGE
Lymphadenopathy
Pigmentations
Acquired Pigmentation of Conjunctiva
CHAPTER 11:
Viral Conjunctivitis
FOLLICULAR CONJUNCTIVITIS
Folliculosis
Acute Follicular Conjunctivitis
Pathophysiology
Clinical Manifestations
PHARYNGOCONJUNCTIVAL FEVER (PCF)
EPIDEMIC KERATOCONJUNCTIVITIS (EKC)
Clinical Picture
Diagnosis
Treatment
Prevention
HERPES VIRUS HOMINIS (HERPES SIMPLEX)
Clinical Picture
Epidemiology
Treatment
ACUTE EPIDEMIC HEMORRHAGIC CONJUNCTIVITIS
Chronic Follicular Conjunctivitis
Chronic Conjunctivitis
CHAPTER 12:
Trachoma
CHLAMYDIA TRACHOMATIS
Epidemiology of Trachoma
Classification of Trachoma
McCallan's Classification
Clinical Picture
Effect of Scarring in Various Structures
Diagnosis
Treatment
Prevention
CHAPTER 13:
Bacterial and Special Conjunctival Conditions
ACUTE PURULENT CONJUNCTIVITIS
ACUTE CATARRHAL CONJUNCTIVITIS
CHRONIC CATARRHAL CONJUNCTIVITIS
MEMBRANOUS AND PSEUDOMEMBRANOUS CONJUNCTIVITIS
PHLYCTENULAR KERATOCONJUNCTIVITIS
Clinical Manifestations
Symptoms
Signs
Differential Diagnosis
Inflamed Pinguecula
Infective Ulcers
Marginal Ulcers
Vernal Keratoconjunctivitis
Treatment
Prognosis
OCULAR CICATRICIAL PEMPHIGOID
Differential Diagnosis
Pathology
Treatment
ERYTHEMA MULTIFORME MAJOR (STEVENS-JOHNSON SYNDROME)
CHAPTER 14:
Laboratory Diagnosis of Extraocular Infective Organisms
STANDARD METHODS
Cytological Tests
Direct Detection Tests
Culture and Isolation Test
Serological Tests
TEST FOR RAPID IDENTIFICATION OF ORGANISMS
Fungus Identification
Fluorescein Conjugated Lectin
Affinity Membrane Test for Superficial Corneal Herpes
Limulus Amebocyte Lysate Assay
Use of Monoclonal Antibody
Nucelic Acid Hybridization Reactions
Electron Microscopy
Immunofluorescent Staining
CHAPTER 15:
Allergic Conjunctivitis and Allied Conditions
SEASONAL ALLERGIC CONJUNCTIVITIS
Clinical Features
Management
VERNAL KERATOCONJUNCTIVITIS
Clinical Features
Pathogenesis of VKC
Treatment of VKC
Drug Therapy
Mast Cell Stabilizers
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Corticosteroids
Method of Injection
Cyclosporine
ATOPIC KERATOCONJUNCTIVITIS
Management
GIANT PAPILLARY CONJUNCTIVITIS
Pathomechanism of Formation of Papillae
Differential Diagnosis from Vernal Conjunctivitis
Management
CONTACT HYPERSENSITIVITY
CHAPTER 16:
Dry Eyes
PHYSIOLOGY OF TEARS
Lipid Layer
Aqueous Layer
Mucin Layer
FLUIDS OF TEAR FILM
TEAR FILM ABNORMALITIES
Aqueous Deficiency
Drugs Affecting Tear Production
Mucin Deficiency
Lipid Abnormality
Impaired Eyelid Function
Epitheliopathy
CLINICAL FEATURES
Examination
Investigations
Schirmer's Test
Tear Lysozyme Assay
Lactoferrin Radial Immunodiffusion Assay
Fluorescein Dilution Test
Tear Osmolarity
Conjunctival Scraping
Conjunctival Impression Cytology
Technique
Staining Procedure
Tear Fern Test
Natural Course of Disease
DIFFERENTIAL DIAGNOSIS OF DRY EYE
DRY EYE SYNDROMES
Dacryoadenitis
Congenital Absence of Lacrimal Gland
Riley-Day Syndrome
Cholinergic Blockade
Chronic Blepharoconjunctivitis
ATYPICAL DRY EYE SYNDROMES
Trigeminal Nerve Paralysis
Facial Nerve Paralysis
Exposure Keratitis
Environmental Factors
Hypovitaminosis A
DRY EYE ASSOCIATED CONDITIONS
Rheumatoid Arthritis
Salivary Gland Dysfunction
Systemic Lupus Erythematosus
MANAGEMENT OF DRY EYES
Tear Substitutes
Tear Conservation
Tear Stimulants
Anti-inflammatory Therapy
Contact Lenses
Decreasing Tear Viscosity
Estrogen
Topical Vitamin A
Surgical Measures
Mucous Membrane Grafting
Keratoprosthesis
CHAPTER 17:
Ocular Surface Squamous Neoplasia
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
Clinical Features
Diagnosis
CYTOLOGY
HISTOPATHOLOGY
Treatment
SURGICAL EXCISION
Cryotherapy
Chemotherapy
Radiotherapy
Immunotherapy
Prognosis
CONCLUSION
GLOSSARY
CHAPTER 18:
Conjunctival Tumors
DERMOIDS
EPISCLERAL OSSEOUS CHORISTOMA
EPITHELIAL TUMORS
Papilloma
Keratoses
Leukoplakia
Premalignant and Malignant Lesions
Melanotic Lesions
Inflammatory Lesion
VASCULAR TUMORS
Telangiectasia
Hemangiomata
Lymphangiomas
Lymphomas
Kaposi's Sarcoma
Treatment
CHAPTER 19:
Degenerative Conditions of Conjunctiva
PINGUECULA
PTERYGIUM
Treatment
SECTION 3: DISEASES OF CORNEA
CHAPTER 20:
Applied and Functional Anatomy of the Cornea
CONGENITAL ABNORMALITIES OF CORNEA
Microcornea (Anterior Microphthalmos)
Megalocornea (Anterior Megalophthalmos)
Cornea Plana
Anterior Embryotoxon
Posterior Embryotoxon
Congenital Sclerocornea
Congenital Corneal Opacity (Leucoma)
Congenital Anterior Staphyloma
Posterior Keratoconus
PIGMENTATION OF THE CORNEA
Iron
Silver
Copper
Gold
Melanin
ANATOMY OF THE SCLERA
Blood Supply
Congenital Anomalies of Sclera
Ehler-Danlos Syndrome
CHAPTER 21:
Various Methods of Examination of the Cornea
SLIT LAMP BIOMICROSCOPY
Modern Clinical Slit Lamp Biomicroscope
Forms of Illumination: Principles and Applications
Direct Illumination
Indirect Illumination
Diffuse Illumination3
Role of Vital Dyes in Corneal Examination
Sodium Fluorescein
Rose bengal
Other Techniques
PACHOMETRY (PACHYMETRY)
Optical Doubling8
Optical Focusing
Ultrasonic Pachometry9
FLUOROPHOTOMETRY
KERATOMETRY
Manual Keratometers
Automated Keratometers
CORNEAL ESTHESIOMETRY
Testing of Corneal Sensation
Physiological Variations in Corneal Sensitivity32
Ultrasound Biomicroscopy
CHAPTER 22:
Specular Microscopy
HISTORY
OPTICAL PRINCIPLES (Fig. 22.1)
CLINICAL SPECULAR MICROSCOPY could either be
Using a Narrow Slit of Light
Using a Wide Slit of Light
Techniques of Specular Microscopy
Factors affecting Image Quality
Indications for Specular Microscopy
Methods of Evaluation of Corneal Endothelium
Eye Bank Specular Microscopy for Examination and Evaluation of Donor Corneal Endothelium
Instrumentation
Qualitative Analysis
Cell Density
Altered Cell Shape
Quantitative Cell Analysis
Parameters Obtained by Cell Analysis
Coefficient of Variation
Percentage of Hexagonality
SUMMARY
CHAPTER 23:
Applications of Corneal Topography
EVOLUTION OF CORNEAL TOPOGRAPHY
Normal Corneal Topography
Available Corneal Topography Systems
CLINICAL APPLICATIONS OF CORNEAL TOPOGRAPHY
Keratoconus
Contact Lens Fitting in Keratoconus
Corneal Diseases
Rigid Contact Lens Fitting
Post-PK Astigmatism
Radial Keratotomy
Photorefractive Keratectomy (PRK)
Astigmatic Keratotomy (Fig. 23.10)
READING AND INTERPRETATION OF CORNEAL TOPOGRAPHY
LIMITATIONS OF CORNEAL TOPOGRAPHY
SUMMARY
CHAPTER 24:
Corneal Ulcer
PATHOGENESiS OF CORNEAL ULCERATION
Histopathology and Stages of Corneal Ulceration
Progressive Stage
Regressive Stage
Healing Stage
Mechanisms of Corneal Stromal Ulceration
Bacterial Corneal Ulceration
Herpes Simplex Ocular Disease
Fungal Corneal Ulceration
Acanthameba Corneal Ulceration
ETIOLOGIC FACTORS OF CORNEAL ULCER
Infective Corneal Ulceration
Bacteria
Gram-positive Cocci
Gram-positive Bacilli
Mycobacteria
Gram-negative Cocci
Gram-negative Bacilli/Coccobacilli
Fungi
Moniliaceous (Hyaline) Filamentous Fungi
Dematiaceous Filamentous Fungi
Yeasts and Yeast-like Fungi
Dimorphic Fungi
Others
Viruses
Protozoa
Noninfective Corneal Ulceration
RISK FACTORS
Bacterial Keratitis
Fungal Keratitis
Viral Keratitis
Acanthameba Keratitis
CLINICAL FEATURES
Bacterial Keratitis
Fungal Keratitis
Viral Keratitis
Primary Herpes Simplex Infection
Recurrent Herpes Simplex Infection
Acanthameba Keratitis
DIAGNOSIS OF KERATITIS
Bacterial, Fungal, and Acanthameba Keratitis
Collection and Processing of Corneal Scrapings
Interpretation of Smears
Interpretation of Cultures
Viral Keratitis
Techniques of Diagnosis
TREATMENT
Medical Treatment
Bacterial Keratitis
Initial Treatment
Choosing the Appropriate Antibacterial Agent
Selecting the Route and Frequency for Drug Delivery
Viral Keratitis
Primary Herpes Simplex Virus Infection
Recurrent Herpes Simplex Virus (HSV) Keratitis
Herpes Zoster Ophthalmicus (HZO)
Fungal Keratitis
Acanthameba Keratitis
Noninfectious Corneal Ulceration
Determination of Etiology and Primary Therapy
Promotion of Epithelial Healing
Tissue Adhesives
Surgical Management of Corneal Ulceration and Perforations
CHAPTER 25:
Diagnostic Methods in Ocular Microbiology
RECEPTION PROCEDURES
Accessioning System
Reporting System
Laboratory Data Management
PROTOCOL FOR COLLECTION OF SAMPLES
Sample Collection Devices
Kimura Platinum Spatula
Bard Parker Blade Number 15
Calcium Alginate Swab
Needle and Syringe
Cotton Swabs
Glass Slides
Sample Collection Methods
Blepharitis
Conjunctivitis
Keratitis
Endophthalmitis
Dacryocystitis and Canaliculitis
Orbital Cellulitis
Contact Lenses and Solutions
Donor Corneal Rims and Media
DIRECT MICROSCOPIC EXAMINATION
Light Microscopy
Fluorescence Microscopy
Electron Microscopy
CULTURE METHODS
Bacterial Cultures
Fungal Cultures
Anaerobic Cultures
Mycobacterial Culture
Acanthameba Cultures
Viral Cultures
INTERPRETATION OF CULTURE RESULTS
ANTIMICROBIAL SUSCEPTIBILITY TESTING
NEWER METHODS IN THE DIAGNOSIS OF OCULAR INFECTIONS
CHAPTER 26:
Keratomycosis
INCIDENCE
EPIDEMIOLOGY
COMMON FUNGI RESPONSIBLE FOR KERATOMYCOSIS
Filamentous Fungi
Yeast
AETIOLOGY
PREDISPOSING FACTORS
PATHOGENESIS
CLINICAL FEATURES
Filamentous Fungus
Yeast Infection
LABORATORY DIAGNOSIS
Scraping and Debridement of Ulcer
Technique of Scraping
Smear
Culture
Corneal Biopsy
Other Methods
MANAGEMENT
Medical
Drugs
Comments
Dosage Schedule
Adjunct Therapy
Surgical
Therapeutic Penetrating Keratoplasty
Evisceration
CONCLUSION
CHAPTER 27:
Viral Keratitis
INTRODUCTION
Herpes Simplex Virus (HSV)
Mode of Infection
Clinical Features
CLASSIFICATIONS OF HSV-INDUCED OCULAR DISEASE
Primary Infection
Recurrent Infection
INFECTIOUS EPITHELIAL KERATITIS (IEK) (caused by reactivation of live virus)5
Corneal Vesicle
Dendritic Ulcer
Geographic Ulcer
Limbal Ulcer
Sequelae of Infectious Epithelial Keratitis (IEK)
NEUROTROPHIC KERATOPATHY
Etiology
Signs
Complications of Neurotrophic Keratopathy
STROMAL KERATITIS6
Necrotizing Stromal Keratitis
Clinical Features
Stromal Immune Keratitis (Interstitial Keratitis)
Clinical Features
ENDOTHELITIS
Pathogenesis
Diskiform
Diffuse Endothelitis
Linear Endothelitis
DIAGNOSIS OF VIRAL KERATITIS
Sources of Specimen Collection
Processing of the Infective Sample
SPECIMEN EXAMINATION
RAPID ANTIGEN DETECTION7
IMMUNOFLUORESCENCE/FLUORESCENT ANTIBODY TEST
Direct Immunoflourescence
Enzyme-Linked Immunoabsorbent Assay (ELISA)
Principle
Advantages
Disadvantages
VIRAL PROPAGATION IN TISSUE CULTURE
Methods of Detection of Virus Growth in Cell Culture
SEROLOGIC TEST
Disadvantages
POLYMERASE CHAIN REACTION (PCR)
Technique of PCR
Denaturation
Annealing
DNA Synthesis
Management
IDU
Vidarabine
Trifluridine
Acyclovir
BVDU
ROLE OF STEROIDS:9 CONTROVERSIAL (Table 27.9)
Steroid Therapy
Indications of Oral Steroids
GUIDELINES FOR TREATMENT
Primary Disease
Recurrent Disease
Infective Epithelial Keratitis (IEK)
Neurotrophic Keratopathy (NK)
Stromal Keratitis
Indications for Oral Acyclovir
Treatment of Active Viral Disease
Prophylaxis Against Recurrence
Adjuvant Therapy and Surgical Treatment
HERPES ZOSTER KERATITIS
Epidemiology12
OCULAR INVOLVEMENT
Corneal Manifestations14
Corneal Changes
PEK
PSEUDODENDRITES
ANTERIOR STROMAL INFILTRATES
KERATOUVEITIS/ENDOTHELITIS
SERPIGINOUS ULCERATION
SCLEROKERATITIS
CORNEAL MUCOUS PLAQUES
DISCIFORM KERATITIS
NEUROTROPHIC KERATOPATHY
EXPOSURE KERATOPATHY
INTERSTITIAL KERATITIS
SECONDARY CORNEAL EDEMA
Ophthalmic Complications of HZO
Lid
Conjunctiva
Sclera and Episclera
Uvea
Extraocular Muscles
Optic Nerve and Retina
Acute Retinal Necrosis
Neuralgia
DIAGNOSIS OF HZO (DISCUSSED EARLIER IN DETAIL)
MORPHOLOGIC
Immune Detection
VIRAL ISOLATION
SEROLOGICAL TESTS
CELL-MEDIATED IMMUNITY
TREATMENT OF HZO
General
Adults
Children
ADVANTAGES OF ORAL ACYCLOVIR
DERMAL eruption
STROMAL KERATITIS
UVEITIS
Nonhealing Epithelial Defects
Corneal Mucous Plaques
Pain
Antidepressants in Postherpetic Neuralgia
Penetrating Keratoplasty
Newer Drugs in the Management of HZO
Summary of Recommended Treatment for Acute Herpes Zoster
CHAPTER 28:
Corneal Degenerations and Dystrophies
CORNEAL DEGENERATIONS
Epithelial and Bowman's Membrane Dystrophies
Meesmann's Juvenile Hereditary Epithelial Dystrophy
Band-shaped Corneal Opacity
Dystrophic Recurrent Erosion (Epithelial basement membrane dystrophy: Cogan's microcystic epithelial dystrophy: Finger-print-map-dot dystrophy)
Reis-Buckler's Dystrophy
Anterior Crocodile Shagreen or Anterior Mosaic Dystrophy of Vogt
Stromal Dystrophies
Granular Dystrophy—Groenouw's Type I: (Bread-crumb dystrophy)
Macular Dystrophy (Groenouw II)
Lattice Dystrophy (Biber-Haab-Dimmer)
Gelatinous Drop-like Dystrophy
Central Crystalline Dystrophy (Schneider's Crystalline Dystrophy)
Fleck Dystrophy (Speckeled dystrophy of Francois and Neetens)
Endothelial Dystrophies
Corneal Guttata
Fuchs’ Dystrophy
Posterior Polymorphous Dystrophy
Keratoglobus
LOCATIONAL CORNEAL DEGENERATIONS
Central Degenerations
Cornea Farinata
Salzmann's Nodular Degeneration
Hyaline Degeneration
Lipid Degeneration
Pigmentary Degeneration (Depositions)
Wilson's Disease (Hepatolenticular degeneration)
Peripheral Degenerations
Arcus Senilis
White Limbal Girdle of Vogt
Pellucid Marginal Degeneration
Terrien's Degeneration
CHAPTER 29:
Keratoconus
ETIOLOGY
Enzyme Theory
Connective Tissue Abnormality Theory
Genetic Theory
Hormonal Theory
Eye Rubbing
ASSOCIATIONS
CLINICAL FEATURES
Keratometry
Ophthalmoscopy
Retinoscopy
Keratoscopy
Computer- assisted Video Keratoscopy
Pachymetry (Pachometry)
HISTOPATHOLOGY
Differential Diagnosis
Keratoglobus
Posterior Keratoconus
Pellucid Marginal Degeneration
MANAGEMENT
Phakic Intraocular Lens
CHAPTER 30:
Peripheral Corneal Ulcers
MARGINAL KERATITIS
VERNAL KERATOCONJUNCTIVITIS (VKC) (Detail in Chapter 15)
MOOREN'S ULCER
Step I Topical Steroids
Step II Conjunctival Resection
Step III Systemic Immunosuppressive
Step IV Other Surgical Procedure
Step V Rehabilitation
RHEUMATOID ARTHRITIS
Systemic Lupus Erythematosis (SLE)
Sjögren's Syndrome
Wegener's Granulomatosis
Polyarteritis Nodosa (PAN)
Relapsing Polychondritis
CHAPTER 31:
Ocular Chemical Burns
EPIDEMIOLOGY
SOURCES OF COMMON INJURIOUS CHEMICALS (Table 31.2)
Alkalis
Acids
PATHOMECHANISM OF CHEMICAL INJURY
Inflammation
Ocular Surface Damage
Stromal Ulceration
EVOLUTION OF TISSUE INJURY AND CLINICAL PRESENTATION
Treatment of Ocular Chemical Burn
Acute Phase Treatment
Intermediate Phase Treatment (Treatment of Reparative Phase)
Surgical Treatment including Rehabilitation
CHAPTER 32:
Eye Banking
EYE BANK STRUCTURE AND FUNCTION
ORGANIzATION OF AN EYE BANK
EQUIPMENT FOR AN EYE BANK
REGULATORY LAWS FOR EYE BANKING
STRATEGIES TO ENHANCE EYE COLLECTION
Grief Counseling
Publicity
Operational Efficiency
Legal Improvement
TISSUE RETRIEVAL
Preliminary Procedures
Collection of Blood
Preparation
Enucleation
In Situ Corneoscleral Excision
Donor Cornea Viability Evaluation Methods
Gross Examination
Biomicroscopic Examination
Specular Microscopy
Documentation
CORNEA PRESERVATION
Tissue Media Preservation
CHAPTER 33:
Penetrating Corneal Transplantation
BACKGROUND
INDICATIONS
Some Specific Indications for Penetrating Keratoplasty
Keratoconus
Corneal Edema
Failed Graft
Herpes Simplex Keratitis
Corneal Infections (Non-viral)
Corneal Dystrophies
Keratoplasty in Children
PROGNOSIS
Gr I Excellent Prognosis
Gr II Good Prognosis
Gr III Fair Prognosis
Gr IV Guarded Prognosis
Gr V Poor Prognosis
DONOR CORNEA
Donor Corneal Preservation
Methods of Assessing Corneal Endothelial Viability
Methods of Corneal Preservation
Short-term Storage
Intermediate-term Storage
McCarey-Kaufman medium
Chondroitin Sulfate Enriched Media
Long-term Storage
SURGICAL TECHNIQUES
Anesthesia
Field Preparation and Draping
Eye Exposure, Fixation, and Scleral Support
Trephining of Recipient Button
Motorized Trephines
Suction-Fixation Trephines
Chamber Entry and Corneal Button Removal
Management of the Lens
Management of Vitreous
IOL Insertion
Trephination of Donor Material
Graft Placement and Chamber Maintenance
Suturing the Corneal Button
Final Evaluation
COMPLICATIONS
Complications Early
Primary Graft Failure
Glaucoma
Epithelial Defects
Intermediate Complications
Graft Rejection
Graft Infection
Wound Dehiscence
Late Complications
Recurrence of Disease
Late Graft Failure of Unknown Etiology
Postkeratoplasty Astigmatism
EPILOGUE
ACKNOWLEDGEMENTS
CHAPTER 34:
Current Status of Lamellar Keratoplasty
HISTORICAL BACKGROUND
LAMELLAR KERATOPLASTY (LK)
Advantages of LK
Problems of LK
Terminology
Indications
Tectonic Grafts
Optical Grafts
Therapeutic Grafts
Sources of Donor Tissue for LK
Precision on Graft Cutting
Methods of Lamellar Dissection4-6
INDICATIONS OF LK1,2,7-12
Revolution of Surgical Techniques
Surgical Steps
Conventional Inlay LK
Inlay Modified Segmental LK
Inlay Keyhole Lamellar Keratoplasty
Inlay Annular LK
Onlay Lamellar Keratoplasty (Epikeratoplasty)13-15
Onlay Limbal Transplantation (Stem Cell Transplant)
Keratoepithelioplasty
Inlay Deep LK with Descemetoendotheliotomy (Double Chamber Technique)
Inlay Sclerokeratoplasty as an Adjuvant to PK
Donor Tissue Preparation and Fixation
CHAPTER 35:
Evolution of Refractive Keratoplasty
CHAPTER 36:
Photorefractive Keratectomy Technique and Postoperative Regimen
PREOPERATIVE EVALUATION
Preparation of the Patient
Surgical Technique
PRK FOR ASTIGMATISM
Cylindrical Ablation
Elliptic Ablation
PRE AND POSTOPERATIVE MEDICAL TREATMENT
Corticosteroids
Nonsteroidal Anti-inflammatory Agents
Other Wound Healing Modulators
CHAPTER 37:
Laser-Assisted In Situ Keratomileusis (LASIK)
INTRODUCTION
PREOPERATIVE EVALUATION
Motivation
Age
Refraction
CONTRAINDICATIONS
Motivation
Age
Refraction
Ocular Pathology
Systemic Pathology
Pre LASIK Examination
CLINICAL EXAMINATION
STABILITY OF REFRACTION
CONTACT LENS
MEDICAL AND OPHTHALMIC PROBLEMS
EXPECTATION
REFRACTION
FUNDOSCOPY
CORNEAL TOPOGRAPHY
PACHOMETRY (Figs 37.1A and B)
PUPIL SIZE
LASER-TISSUE INTERACTION (Figs 37.2 and 37.3)
FLUENCE TEST
EYE TRACKING
LASER DELIVERY SYSTEM
BROAD BEAM (Fig. 37.6)
SCANNING SLIT
FLYING SPOT
MICROKERATOME (Table 37.1)
LASIK PROCEDURE
Operating Room Preparation
Laser Machine Preparation
Surgeon Preparation
Instrument Preparation (Figs 37.8 to 37.12)
Patient Preparation
Complications of Lasik
PREOPERATIVE
INTRAOPERATIVE
POSTOPERATIVE COMPLICATIONS
CHAPTER 38:
Limbal Transplantation of Stem Cells
ABOUT THE STEM CELLS
CATEGORIES OF CORNEAL STEM CELL DISEASES
Unequivocal Corneal Stem Cell Loss
Aklali-injured Eye
Other Chemical Injuries
Dry Eye
Excision of Neoplasia
Extensive Limbal Surgery
Probable Stem Cell Diseases
Naturally Occurring
Environmentally Induced
Iatrogenically Induced
Possible Stem Cells Diseases
Neurotrophic Keratitis
Cyclocryotherapy
Peritomy
TREATMENT OF STEM CELL DISEASE
Bulbar Conjunctival Transplantation
Autogenous Stem Cell Transplantation
Corneal Stem Cell Autotransplantation
Corneal Stem Cell Homotransplantation
Transplantation of Cultured Corneal Limbal Stem Cells
CHAPTER 39:
Mooren's Ulcer
EPIDEMIOLOGICAL FEATURES
ETIOLOGY
Pathology
CLINICAL FEATURES
Classification
Type I
Type II
Symptoms
Signs
PATHOGENESIS
DIAGNOSIS
Differential Diagnosis of Peripheral Ulceration Keratitis (PUK)
Ocular Infections
Noninfectious
Systemic Infectious
MANAGEMENT OF MOOREN'S ULCERS
Medical Treatment
Surgical Treatment
CHAPTER 40:
Scleritis and Episcleritis
CLINICAL DEFINITIONS AND CLASSIFICATION
CLINICAL FEATURES
Anterior Scleritis
Diffuse Anterior Scleritis
Nodular Scleritis
Necrotizing Scleritis
Necrotizing Scleritis with Inflammation
Necrotizing Scleritis without Inflammation (Scleromalacia Perforans)
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
SECTION 4: DISEASES OF THE LENS
CHAPTER 41:
Anatomy-Histology of the Human Crystalline Lens
ACKNOWLEDGEMENT
CHAPTER 42:
Displacement of the Lens: Etiology and Management
SUBLUXATION
DISLOCATION OR LUXATION
ETIOLOGY OF DISLOCATED LENS
Simple Ectopia Lentis
Ectopia Lentis et Pupillae
Microspherophakia
Marfan's Syndrome
Homocystinuria
Weil-Marchesani Syndrome7,8
Ocular Diseases Causing Displacement of the Lens
Traumatic Displacement of the Lens
Management
Subluxated Crystalline Lens
Clear Lens
Cataractous Lens
DISLOCATED LENS
CHAPTER 43:
Etiopathogenesis of Senile Cataract: Prospects of Medical Therapy
FORMATION OF CATARACT
DEFINITION OF CATARACT
CLASSIFICATION OF CATARACT
ETIOPATHOGENESIS OF CATARACT
Personal Factors
Dietary Factors
Medical Factors
Environmental Factors
Role of Sunlight, UV Radiation, and Thermal Effect
Other Factors
BIOCHEMICAL CHANGES IN CATARACT
PROSPECTS OF MEDICAL THERAPY OF CATARACT
Anticataract Drugs
Antioxidants
Aldose Reductase Inhibitors
CHAPTER 44:
Work-up for Cataract Surgery
GENERAL PHYSICAL STATUS
EVALUATION OF THE EYE
External Eye and Adnexa
Visual Status
Sensitivity to Light
Potential Acuity Meter (PAM)
Laser Interferometry
Contrast Sensitivity and Glare
Pupillary Reaction to Light
B-scan Ultra Sonography
Examination of the Anterior Segment
Cornea
Anterior Chamber
Indications for lens implantation
PREOPERATIVE PREPARATION
Various Method of Sterilization of Instruments
IOL Power
CHAPTER 45:
Evolution of Modern Intraocular Lens Surgery
LARGE INCISION CATARACT SURGERY and IMPLANTATION OF RIGID LENSES
SMALL INCISION CATARACT SURGERY and IMPLANTATION OF FOLDABLE LENSES
Foldable Lenses Manufactured from Hydrophobic and Hydrophilic Acrylic and Silicone Biomaterials
ULTRA-SMALL INCISION CATARACT SURGERY and IMPLANTATION OF ROLLABLE LENSES
The Future Challenges
ERADICATION OF POSTERIOR CAPSULE OPACIFICATION
New Concept for PCO Eradication: Sealed Capsule Irrigation (SCI)
RESTORATION OF ACCOMMODATION
Accommodative Intraocular Lenses
SUMMARY AND CONCLUSIONS
CHAPTER 46:
History of IOL
PROGRESS OF IOL DEVELOPMENT
First Generation
Second Generation (Development of Anterior Chamber Lenses) (Figs 46.1 to 46.4)
Third Generation IOLs (Iris Supported, Iris Clip)
Other Advantages of Iris Clip Lens
Disadvantages of the Iris Clip Lens
Fourth Generation
Fifth Generation
Advantages of Posterior Chamber Lens
FURTHER ADVANCES AND FUTURE OF IOL
MATERIALS
Types of IOLs
Materials for the Optics of the Lens
PMMA
Other Optic Materials
Materials for Haptics
Polyamides—Perlon, Supramid, Nylon 66
Polyethylene Terephthelate (Dacron) and Polyethylene Glycolterephthelate (Mersiline)
Polypropylene (Prolene)
PMMA
IOL Design Features
Optional Features
Clinical Features
STERILIZATION
Chemical Sterilization
Gas Sterilization
Radiation Sterilization
POWER CALCULATION
Empirical
Calculating IOL Power by Biometry
SRK Formula
Theoretical Formulae
Holladay Formula16
Sources of Error in IOL Power Calculation
Error in Determination of Axial Length of the Eye
Error in Keratometry
A-Constant Error
CHAPTER 47:
Foldable IOLs
PHAKIC IOLs
SMART LENS: A NEW IOL TECHNOLOGY
IOL WITH ENDOCAPSULAR RING DESIGN
SUTURE-FREE IOL FIXATION IN CAPSULELESS EYES
COLLAMER IOL
MULTIFOCAL INTRAOCULAR LENSES
Refractive MIOLs
Two-Zone/Target or Center Surround MIOL
Three-zone MIOL
Five-zone Spherical Curve MIOL
Diffractive MIOLs
ACCOMMODATING INTRAOCULAR LENS
LASER ADJUSTABLE IOL
TORIC INTRAOCULAR LENSES
PIGGYBACK INTRAOCULAR LENSES
IMPLANTABLE MINIATURIZED TELESCOPE (IMT)
ANIRIDIA IOL
THINOPTX ROLLABLE IOL
NEGATIVE SPHERICAL IOL
BLUE LIGHT-FILTERING IOL
COMPLICATIONS OF FOLDABLE INTRAOCULAR LENSES
Descemet's Membrane Detachment caused by IOL during Insertion
Posterior Capsular Rupture during IOL Insertion
IOL Damage during Insertion
Bag Sulcus Fixation
IOL Decentration
Lens Dislocation
Silicone Oil Adherence to IOL
IOL Discoloration
IOL Glistenings
Glare
Capsular Bag Distension Syndrome
CAPSULAR CONTRACTURE SYNDROME
Endophthalmitis
CHAPTER 48:
Anesthesia for Cataract Surgery
HISTORICAL BACKGROUND
CATARACT SURGERY ANESTHESIA
REGIONAL ANESTHESIA
Role of Hyaluronidase
Preparation of Local Anesthetic Solution
SEVENTH NERVE BLOCK
O'Brien's Block
Retrobulbar Block
PERIBULBAR (PERIOCULAR) INJECTION
SUBTENON ANESTHESIA
COMFORTABLE REGIONAL ANESTHESIA
TOPICAL ANESTHESIA
Technique
Advantages of Topical Anesthesia
LOCAL ANESTHESIA
Premedication
Side Effects and Complications of Local Anesthesia
GENERAL ANESTHESIA
Technique for General Anesthesia
Premedication
Induction of Anesthesia
Intubation
Maintenance of Anesthesia
Extubation and Recovery
CONCLUSIONS
CHAPTER 49:
Extracapsular Cataract Extraction and IOL Implantation
PREOPERATIVE EVALUATION
Ophthalmic Examination
Slit-lamp Biomicroscope Examination
Refraction and Visual Acuity
Tonometry
Fundus Evaluation
IOL Power Calculation
Special Tests
SURGICAL TECHNIQUES
Anesthesia
Incision
Corneoscleral Incision
Anterior Capsulotomy
Multipuncture Capsulotomy
Continuous Curvilinear Capsulorhexis
Hydroprocedure
Hydrodissection
Nucleus Removal
Cortex Removal
Irrigating Fluids
Manual Irrigation and Aspiration Cannula
Technique
Removal of Cortex by Simcoe's Method
Posterior Capsule Cleaning
IOL Implantation and Wound Closure
Techniques of Implantation
Suturing
Constriction of Pupil
Subconjunctival injection or Intracameral Vancomycin
Postoperative Treatment and Refraction
INTRAOCULAR LENS IMPLANTATION
Implantation Site (Figs 49. 7A and 49.7B)
Ciliary Sulcus Fixation
In the Bag Fixation
Asymmetric Fixation
Configuration
Looped Design
IOL Material
PMMA
Foldable
SUMMARY
CHAPTER 50:
Techniques of Nonphaco Small Incision Cataract Surgery (SICS)
ANESTHESIA
SCLEROCORNEAL POCKET TUNNEL INCISION
The External Incision
Method of Tunnel Dissection
Constructing the Side Ports
CAPSULOTOMY
COMPLETING THE TUNNEL
HYDROPROCEDURES (Figs 50.5 and 50.6)
NUCLEUS PROLAPSE OUT OF THE BAG
NUCLEAR DELIVERY USING ANTERIOR CHAMBER MAINTAINER (Fig. 50.9)
MICROVECTIS TECHNIQUE (Fig. 50.10)
PHACOSANDWICH TECHNIQUE
PHACOFRACTURE/PHACOSECTION TECHNIQUE
ROLE OF ACM IN PHACOSANDWHICH AND PHACOSECTION TECHNIQUES
THE FISH HOOK TECHNIQUE
Cortex, Aspiration, Intraocular Lens Implantation and Wound Closure
IOL Implantation
Wound Closure
CONCLUSION
CHAPTER 51:
Concept and Principles of Phacomachine
ULTRASONIC HANDPIECE
Mechanism of Phacoemulsification
PHACO TIPS/NEEDLES
IRRIGATION ASPIRATION HANDPIECE
ASPIRATION PUMP
PERISTALTIC PUMPS
VENTURI PUMP
DIAPHRAGMATIC PUMP
FOOT PEDAL
Specification of a Phacomachine
CHAPTER 52:
Removal of Subincisional Cortex in Small Incision Cataract Surgery
INTRODUCTION
VERTICALIZATION OF THE COAXIAL TIP
EXTENSION OF THE INCISION
TECHNIQUE OF USING VISCOELASTIC
MOBILIZATION CORTEX USING AN IOL
TECHNIQUE WITH A CURVED COAXIAL CANNULA
MOBILIZATION OF THE CORTEX WITH MANUAL ASPIRATION, SUCK AND SPIT TECHNIQUE
SYSTEM USING TWO SEPARATE CANNULAS: (BIMANUAL I/A)
Technical Features of the Two Cannulas
Handles
Cannulas
Principles for Use of Two Cannulas
Incisions for Two Cannulas
Technique
Advantages of Bimanual Technique
Useful Hints
CONCLUSION
CHAPTER 53:
Phacoemulsification in Difficult Situations
PHACOEMULSIFICATION IN DIFFERENT TYPE OF CATARACTS
Posterior Polar Cataract
White Cataract
Technique of Staining the Anterior Capsule
Hard Nucleus
Intumescent Cataract
Pediatric Cataracts
Subluxated or Dislocated Cataract
Surgical Technique
IOL Insertion
Capsular Tension Ring (Endocapsular Ring)
Implantation Technique
Sizes of CTR
PHACO IN COLOBOMATOUS EYES
PHACOEMULSIFICATION IN POST-SURGICAL EYES
Phacoemulsification in a Vitrectomized Eye
Cataract in Post-Trabeculectomy Eyes
PHACOEMULSIFICATION WITH SMALL PUPIL
PHACOEMULSIFICATION IN PATIENTS WITH PSEUDOEXFOLIATION
PHACOEMULSIFICATION IN UVEITIC EYES
CHAPTER 54:
Phacoemulsification for Surgeons in Transition
MENTAL BLOCK
PROBLEM OF COORDINATION
Surgeons Ability
Selection of Initial Patients
Selection of Eye
Use of Operating Microscope
Phaco Machine Specification
Role of Phaco Skill Transfer Courses
Understanding Phaco Setting for Phacoemulsification
Problems Faced by the Surgeons in Transition and their Management
Phaco Incisions
Continuous Curvilinear Capsulorhexis (CCC)
Hydrodissection and Hydrodelineation
Phacoemulsification Techniques
When to Convert to Conventional Extracapsular Cataract Surgery
CHAPTER 55:
Complications of Phacoemulsification
OPERATIVE COMPLICATIONS
Complications in General
Complications Related to Incision
Complications Related to Anterior Capsulotomy
CAPSULAR BAG SYNDROME
Complications Related to Hydro Procedures
Chamber Collapse
CORNEAL COMPLICATIONS
Complications from Retained Lens Matter
Posterior Capsular Tear
Endophthalmitis
RETINAL COMPLICATIONS
GLAUCOMA DUE TO VISCOELASTIC
POSTERIOR CAPSULE OPACIFICATION
CHAPTER 56:
Posterior Capsule Opacification: Pathogenesis, Management and Prevention
EVALUATION TECHNIQUES FOR POSTERIOR CAPSULE OPACIFICATION
Prevention of Posterior Capsule Opacification
Hydrodissection-enhanced Cortical Clean-up
In-the-Bag Fixation of IOL
Capsulorhexis Edge on the IOL Surface
Biocompatibility of IOL
Maximum IOL Optic Posterior Capsule Contact
Barrier Effect of IOL Optic
Pharmacological Techniques and Immunological Inhibitors for PCO
Management of Posterior Capsule Opacification
A New Entity: Interlenticular Opacification (ILO) or Opacification of Piggyback IOL
CHAPTER 57:
Multifocal IOLs
INTRODUCTION
PRINCIPLE OF MULTIFOCALITY
PATIENT SELECTION
Exclusion Criteria
BIOMETRIC CONSIDERATIONS2-4
POSTOPERATIVE OUTCOME ANALYSIS
MULTIFOCAL IOL STYLES 1, 5, 6
Refractive
AMO ARRAY Refractive IOL (Fig. 57.2)
Iolab Nuvue Refractive IOL
Storz True Refractive Multifocal IOL
Morcher Refractive Bifocal Lens
Domilens Progressive Multifocal IOL
Diffractive Multifocal Lenses
3 M Multifocal IOL
Pharmacia CeeOn 808X and 811E Diffractive Bifocal IOL
New Accommodating Lens
VISUAL OUTCOMES
Visual Acuity
Depth of Focus
Contrast Sensitivity
Visual Symptoms
Driving Ability
Spectacle use and Patient Satisfaction
CONCLUSIONS
CHAPTER 58:
Piggyback IOLs
PRIMARY PIGGYBACK IOL IMPLANTATION
High Hyperopes
Minus Power Piggyback Lenses
Toric Piggyback IOLs
Multifocal Piggyback IOL
Secondary Piggyback Implantation
POWER CALCULATION FOR A PIGGYBACK IOL (GILLS’ NOMOGRAM FOR POWER CALCULATION)6
Primary Implantations
Secondary Implantation
IMAGE QUALITY
DEPTH OF FOCUS USING A PIGGY BACK SYSTEM
COMPLICATIONS
CHAPTER 59:
Secondary Intraocular Lens Implantation
DEFINITION
INDICATIONS
Aborted Primary Lens Implantation
Bilateral Aphakia with or without Macular Diseases
Relative Contraindications of Secondary IOLI
IOL Exchange: Explantation
Preoperative Preparation for Secondary IOLI
Associated Surgical Procedures
Secondary IOLI Following ICCE
Incision
Peripheral Anterior Synechiolysis
Viscoelastic Substance
Measurement of IOL Length
Management of Vitreous in Anterior Chamber
Secondary IOL Implantation in Children
Indication for Secondary IOLI in Children
Complications of Secondary IOLI
CHAPTER 60:
Scleral-Fixated PCIOL
INDICATIONS
AB-INTERNO APPROACH
AB-EXTERNO APPROACH6
COMPLICATIONS
RECENT ADVANCES
CHAPTER 61:
Management of Postoperative Endophthalmitis
MEDICAL TREATMENT
Drug Pharmacokinetics
ROUTES OF ADMINISTRATION
SURGICAL TREATMENT
RATIONALE FOR VITRECTOMY
SURGICAL TECHNIQUE
Use of Antibiotics
Use of Corticosteroids
Postoperative Management
COMPLICATIONS
Preparation of Commonly Used Intravitreal Solutions
ENDOPHTHALMITIS VITRECTOMY STUDY17
Results18
CHAPTER 62:
Ophthalmic Viscosurgical Devices
INTRODUCTION
CLASSIFICATION OF THE OVDs
HIGH VISCOUS—COHESIVE OVDs
SUPER VISCOUS—COHESIVE OVDs
LOWER VISCOSITY-DISPERSIVE OVDs
SOFT SHELL TECHNIQUE
VISCOADAPTIVE OVD- HEALON-5Â
Characteristics and Advantages of the Viscoadaptive OVDs
SURGICAL APPLICATION OF THE OVDs
Use of OVDs in Cataract and Refractive Surgery
Capsulorhexis
Cleavage of Lens Structure by OVD
Nuclear Emulsification
Irrigation and Aspiration
Capsular Bag Filling and IOL Implantation
Cataract Surgery in Pediatric Cases
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 USE OF OVDs
Raised Intraocular Pressure (IOP)
Crystallization on the IOL Surfaces
Capsular Block Syndrome or Capsular Bag Distension Syndrome
Pseudo-anterior Uveitis
SUMMARY AND CONCLUSIONS
CHAPTER 63:
Complications of Intraocular Lens Implantation
INTRAOPERATIVE COMPLICATIONS
POSTOPERATIVE COMPLICATIONS
Endophthalmitis
LATE COMPLICATIONS
Malposition of PC IOLs
Decentration
Pupil capture
Iris Chaffing
Wound Dehiscence
Formation of Filtering Bleb
Dislocations
Lost Lens Syndrome
Intermittent Corneal Touch
Secondary Glaucoma
Management
UGH (Ellingson's) Syndrome
Management
Late Uveitis
Persistent Corneal Edema and Decompensation
Problems Related to IOL
Management
Cystoid Macular Edema
Management
SECTION 5: GLAUCOMA
CHAPTER 64:
Gross and Microanatomy of the Angle of the Anterior Chamber
CHAPTER 65:
Gonioscopic Appearances of Normal and Pathological Conditions
GONIOSCOPIC ANATOMY OF THE NORMAL CHAMBER ANGLE
PATHOLOGICAL CONDITIONS
PSEUDOEXFOLIATION SYNDROME
PIGMENT DISPERSION SYNDROME
IRIDOCORNEAL ENDOTHELIAL SYNDROME
ANIRIDIA
AXENFELD SYNDROME
NEOVASCULARIZATION OF THE IRIS AND ANGLE
TUMORS
SOME POSSIBLE MISINTERPRETATIONS
CHAPTER 66:
Primary Open Angle Glaucoma
RISK FACTORS FOR POAG
Intraocular Pressure
Age
Gender
Race
Steroid Usage
Family History
Central Corneal Thickness (CCT)
Optic Nerve Cupping
Diabetes Mellitus
Systemic Hypertension
Myopia
Migraine
Disk Hemorrhages
PATHOGENESIS
Raised IOP
Mechanism of Optic Nerve Damage
DIAGNOSIS
Symptomatology
Evaluation
Examination
Intraocular Pressure
Examination of the Nerve Head
Visual field Examination
MANAGEMENT
Principles
Ocular Hypertension (OHT)
Choosing a Target Pressure
TREATMENT
To Decrease IOP
Medical Treatment
Laser Treatment
Surgical Treatment
To Protect Irreversible Damage of Glaucoma
Conclusion
CHAPTER 67:
Normal Tension Glaucoma
DEFINITION
CLINICAL PICTURE
DIFFERENTIAL DIAGNOSIS
Glaucoma
Ersatz Glaucoma
Others
EPIDEMIOLOGY
Work-up
PATHOGENESIS
TREATMENT
CHAPTER 68:
Optic Nerve Head and Retinal Nerve Fiber Layer Imaging
STEREOPHOTOGRAMMETRY
Principle
Instruments
RODENSTOCK OPTIC NERVE HEAD ANALYZER
Advantage
Disadvantages
Parameters Measured
Accuracy and Sources of Error
CONFOCAL LASER SCANNING
Principle
Instruments
HEIDELBERG RETINA TOMOGRAPH
Advantages
Disadvantages
Parameters Measured
Accuracy and Sources of Error
SCANNING LASER POLARIMETRY
Advantages
Disadvantages
Accuracy/Resolution
RASTER STEREOGRAPHY
Principle
Instrument
GLAUCOMA SCOPE
Disadvantages
Parameters
OPTICAL COHERENCE TOMOGRAPHY
Advantages
Sensitivity and Specificity
CONCLUSIONS
ACKNOWLEDGEMENT
CHAPTER 69:
Automated Perimetry
INSTRUMENTATION
Stimulus Source
Fixation Control
Data Storage
TESTING STRATEGIES
Suprathreshold Screening
Threshold Related Screening
Threshold Determination
Test Patterns
INTERPRETATION OF RESULTS
Statistical Interpretation of Results
Use of Probability Statistics to Define the Normal Visual Field
Humphrey Field Analyzer
Evaluation of the Gray Scale
Artifacts Simulating Visual Field Defects
Detection of Progressive Glaucomatous Visual Field Loss
RECENT ADVANCES IN AUTOMATED PERIMETRY
Swedish Interactive Thresholding Algorithm (SITA)7
CONCLUSION
CHAPTER 70:
Primary Angle Closure Glaucoma
HISTORICAL BACKGROUND
ANATOMICAL FEATURES
Biometry
Anterior Chamber Depth
Lens Position, Thickness, and Anterior Lens Curvature
Lens Thickness: Ocular-Axial Length Ratio
Width and Depth of Angle
Physiology
Lens Factors
Iris Factors
Muscle Factors
Clinical Pathology
Angle
Iris
Lens
Zonules
Optic Nerve and Retina
Epidemiology
Sex
Age
Race
SPECIAL METHODS OF EXAMINATION
Peripheral AC Depth
Primary Angle Closure (Glaucoma) Suspect (PACS)
Gonioscopy
Provocative Tests
CLINICAL TYPES AND FEATURES
Intermittent Angle Closure Glaucoma
Subacute Angle Closure Glaucoma
Acute Angle Closure Glaucoma
Creeping Angle Closure Glaucoma
Chronic Angle Closure Glaucoma
MANAGEMENT
Intermittent and Subacute Angle Closure Glaucoma
Acute Angle Closure Glaucoma
Medical Therapy
Miotics
Physical Methods
Supportive Therapy
Summary of the Approach25
Iridectomy
Iridoplasty
Management After Iridectomy
Long-term Management
Chronic and Creeping Angle Closure Glaucoma
Plateau Iris
MANAGEMENT OF THE FELLOW EYE AND ASYMPTOMATIC NARROW ANGLES
CHAPTER 71:
Secondary Glaucoma
INTRODUCTION
SECONDARY GLAUCOMA DUE TO SYSTEMIC DISEASE
Epidemic Dropsy Glaucoma
Systemic Amyloidosis
Pseudoexfoliative Syndrome
CHILDHOOD SECONDARY GLAUCOMA
Retinoblastoma
Retinopathy of Prematurity (ROP)
Aniridia
Nanophthalmos (nanos Gr. = dwarf)
LENS INDUCED GLAUCOMA (Table 71.2)
Glaucoma due to Lens Swelling (Phacomorphic)
Hypermature Cataract and Phacolytic Glaucoma
Hyperosmotic glaucoma
Phacolytic Glaucoma
Displacement of Lens
Lens—particle Glaucoma
Phacoanaphylactic Glaucoma
NEOVASCULAR GLAUCOMA (NVG) (SYN: THROMBOTIC GLAUCOMA, HEMORRHAGIC GLAUCOMA, RUBEOTIC GLAUCOMA, 100 DAYS GLAUCOMA, AND CONGESTIVE GLAUCOMA)
Pathogenesis
Pathologic Process of Neovascularization
NVI and NVG in Diabetes
NVG in CRVO
Rhegmatogenous Retinal Detachment
Carotid Artery Insufficiency
Management of Neovascular Glaucoma
Treatment of Acute Episode
Surgical Treatment
Cyclo-ablative Procedure
Laser Cycloablation
GLAUCOMA DUE TO UVEAL CAUSES
Uveal Inflammation
Anterior Uveitis
Posner-Schlossman Syndrome: Glaucomatocyclitic Crisis41
Secondary Glaucoma Resulting from Miscellaneous Inflammation
Schwartz Syndrome
Glaucoma Caused by Other Diseases of the Iris
Pigment Dispersion Glaucoma
Essential Atrophy of the Iris
Secondary Glaucoma due to Tumification of the Uveal Tract
IATROGENIC CAUSES OF SECONDARY GLAUCOMA
Steroid Glaucoma
POSTOPERATIVE GLAUCOMA
Glaucoma after Cataract—IOLI operation
Secondary Glaucoma after Scleral Buckling Operation
After Vitrectomy Operation
Glaucoma after Nd: YAG Laser Posterior Capsulotomy
Glaucoma after Penetrating Keratoplasty
SECONDARY GLAUCOMA FOLLOWING INJURY
Perforating Injury
Concussion Injury
Glaucoma Due to Disruption of Angle Structure
Miscellaneous Causes of Secondary Glaucoma
Angle Closure Glaucoma in Non-rubeotic CRVO
Secondary Glaucoma due to Scleritis
CHAPTER 72:
Malignant Glaucoma
DEFINITION OF MALIGNANT GLAUCOMA
CONDITIONS OF DEVELOPMENT
Pathogenesis
CLINICAL PICTURE
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Medical
Laser Therapy
Nd: YAG Laser
Surgery
Phakic Eyes
Aphakic Eyes
CHAPTER 73:
Primary Pigmentary Dispersion Syndrome and Pigmentary Glaucoma
CLINICAL FEATURES
PIGMENT DISPERSION GLAUCOMA
Gonioscopic Findings
Other Associated Findings
Retinal Disorder
Pathogenesis of Pigmentary Dispersion Syndrome
Course of the Disease
DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF PIGMENTARY GLAUCOMA
Surgical Treatment
Trabecular Aspiration
Peripheral Iridotomy
Trabeculectomy
CHAPTER 74:
Pseudoexfoliation Syndrome
DEFINITION
HISTORY
EPIDEMIOLOGY
Incidence without Glaucoma
Incidence with Glaucoma
Systemic Associations
Heredity
CLINICAL PICTURE
Conjunctiva and Cornea
Iris and Pupil
Anterior Chamber and Angle
Lens, Zonules, and Ciliary Body
Intraocular Pressure
Blood-Aqueous Barrier in Pseudoexfoliation Syndrome
PATHOPHYSIOLOGY
Origin of Exfoliation Material
Anterior Segment
Lens and Zonules
Etiopathogenesis
Nature of the Exfoliative Material
MECHANISM OF GLAUCOMA
DIAGNOSIS
Techniques
Differential Diagnosis
MANAGEMENT
Medical Therapy
Laser Therapy
Trabeculectomy
Trabecular Aspiration
ECCE
Prognosis
CHAPTER 75:
Pharmacognosy and Pharmacokinetics of Ocular Hypotensive Agents
CHOLINERGIC DRUGS
Parasympathomimetics
Pilocarpine
Carbachol
Anticholinesterases
Echothiophate (Phospholine Iodide)
Isoflurophate
Demecarium Bromide
Physostigmine (Eserine)
ADRENERGIC AGONISTS
Nonselective Alpha-Adrenergic Agonists
Epinephrine
Dipivefrin Hydrochloride [Dipivalyl Epinephrine (DPE)]
Selective Alpha-Adrenergic Agonists
Clonidine
Apraclonidine
Brimonidine
ADRENERGIC BLOCKING AGENTS
Available Beta-Blockers
ISA (Intrinsic Sympathomimetic Activity)
Timolol
Levobunolol
Metipranolol
Betaxolol
Carteolol
CARBONIC ANHYDRASE INHIBITOR (CAI)
Mechanism of action
Oral CAI
Acetazolamide
Methazolamide
Dichlorphenamide (Daranide)
Ethozolamide
Topical CAI
Dorzolamide or MK 507: (Trusopt)
PROSTAGLANDINS (PG)
HYPEROSMOTIC INTRAVENOUS AGENTS
Oral Glycerol
Isosorbide
Mannitol
Urea
NEUROPROTECTIVE AGENTS21
CHAPTER 76:
Current Trends in Drug Therapy of POAG
DRUG ACTION ON SYMPATHETIC ADRENERGIC RECEPTORS
Beta Blockers
Timolol
Betaxolol 0.5% (Glucoptic, Iobet)
Levobunolol (Betagan)
Alpha Receptor Agonist Drugs
Epinephrine
Dipivefrin (Dipivalyl epinephrine, Propine)
Apraclonidine
Brimonidine Tartrate 0.2% (Alphagan)
TOPICAL CARBONIC ANHYDRASE INHIBITOR—DORZOLAMIDE 2% (TRUSOPT, MERCK)
BRINZOLAMIDE 1% (AZOPT, ALCON)
PROSTAGLANDINS
Latanoprost
Untoward Side Effects of Latanoprost Therapy
Unoprostone 0.15% (Rescula, Novartis)
Bimatoprost 0.03% (Lumigan, Allergan)
Travoprost 0.004% (TRAVOTAN, ALCON)
Drug-Combination in Treatment of POAG
(a) Reducing Aqueous Formation
(b) Increasing Aqueous Outflow
CONCLUSION
CHAPTER 77:
Laser Applications in Glaucoma
INTRODUCTION
ARGON LASER TRABECULOPLASTY (ALT)
Indications of Trabeculoplasty
Types of Glaucoma that Respond to Trabeculoplasty
Contraindication
Technique
Mechanism of Action
Complications
Results of ALT
LASER PERIPHERAL IRIDOTOMY/IRIDECTOMY
Indications
Contraindications
Pretreatment Regimen
Argon Laser Iridotomy
Nd:YAG Irodotomy
Contraindications of Laser Iridotomy
Choice of Laser for Iridotomy
Complications
CYCLODESTRUCTIVE PROCEDURES
Cyclophotocoagulation (CPC)
History
Mechanism of Action
Tissue Effects
Indications
Contraindications
Techniques
Trans-scleral CPC (TSCPC)
Lasers used
Laser mode
Procedure
Laser settings (Table 77.2)
Postoperative medications
Procedure
Results
Common complications
Uncommon complications
Advantages of TSCPC over cyclocryotherapy
Transpupillary CPC
Limitation
Procedure
Laser settings
Other Modalities of CPC
MISCELLANEOUS USES OF LASER
Laser Gonioplasty
Indications
Complications
Argon-Laser Suturelysis
Complications
Laser Revision of Failing Blebs
Laser Treatment of Bleb for Hypotony
Argon Laser Closure of Cyclodialysis Cleft
Complications
Laser Goniopuncture
Laser Goniophotocoagulation
LASER TREATMENT FOR MALIGNANT GLAUCOMA
Newer Laser Procedures for Glaucoma
Non-Invasive Ab-interno Procedures
Invasive Ab-interno Procedures
Invasive Ab-externo Procedures
Laser Sclerostomy Ab-externo vs Ab-interno
CHAPTER 78:
Phacotrabeculectomy
ROLE OF ANTIMETABOLITES IN GLAUCOMA SURGERY
TECHNIQUES
Conjunctival Flap
Mitomycin C
Scleral Tunnel Design
Pupil
Capsulorhexis
Phacoemulsification
Trabeculectomy
Flap Closure
Postoperative Care
COMPLICATIONS
Hypotony Maculopathy
Bleb Failure
Leaking Bleb
Endophthalmitis
MODIFICATIONS OF PHACOTRABECULECTOMY
Combined Phacoemulsification with Trabeculotomy Ab-externo
Nonstitch Phacotrabeculectomy
Phacotrabeculectomy with Modified Scleral Tunnel and Single Stitch Closure
Twinsite Phacotrabeculectomy
Our Modification
CHAPTER 79:
Antimetabolites in Glaucoma Filtration Surgery
SEQUENCE OF EVENTS IN WOUND HEALING2
ANTIMETABOLITES IN GLAUCOMA FILTRATION SURGERY
5-Fluorouracil
Mechanisms of Action7
Indications
Contraindications
Dosage and Modes of Application
Clinical Use
Complications7,11,12
Mitomycin-C (MMC)
Mechanism of Action7
Ocular Pharmacokinetics of Mitomycin-C
Dosage
Surgical Technique
Indications of Mitomycin-C15-18
Complications of Mitomycin-C
INHIBITORS OF COLLAGEN ORGANIZATION AND OTHERS
CONCLUSION
CHAPTER 80:
Management of Blebrelated Problems
FILTERING BLEBS
BLEB HISTOLOGY
BLEB-RELATED PROBLEMS
OVERFILRATION
Clinical Features
MANAGEMENT OF OVERFILTERING BLEBS CONSERVATIVE MANAGEMENT
SURGICAL TREATMENT
OTHER MODALITIES
BLEB LEAKAGE
Clinical Findings
Management Precautions During Surgery
Treatment of Early Bleb Leaks Conservative Management
Surgical Revision
Other Modalities
Late Bleb Leaks
THE FAILING BLEB
Early Bleb Failure
Prevention and Management of Early Failing Blebs
Intraoperative Measures
Postoperative Measures
Late Failure of Filtration
THE ENCAPSULATED BLEB
MANAGEMENT
THE SYMPTOMATIC BLEB
Management
BLEB-RELATED INFECTION (FIG. 80.8)
Clinical Features
Management
Prevention
CONCLUSION
CHAPTER 81:
Artificial Drainage Devices in Glaucoma Surgery
INTRODUCTION
HISTORICAL PERSPECTIVE
POSTERIOR TUBE SHUNT IMPLANTS
Molteno Implant
Ahmed Glaucoma Valve (Mateen Ahmed PhD)
Baerveldt Implant
SCHOCKET PROCEDURE
Krupin-Denver Valve Implant
Joseph-Hitchings Valve Implant
INDICATIONS FOR USE
RESULTS
COMPLICATIONS
SUMMARY
SECTION 6: DISEASES OF ORBIT
CHAPTER 82:
Applied Anatomy of the Orbit
BONY ORBIT
Size, Shape, and Relations
Walls of the Orbit
Medial Wall
Inferior Orbital Wall (Floor)
Lateral Wall
Roof
Base of the Orbit
Apex of the Orbit
PERIORBITA
ORBITAL FASCIA
Fascia Bulbi
Fascial Sheaths of Extraocular Muscles
Fascial Expansions of Extraocular Muscles
Intermuscular Septa/Membrane
SURGICAL SPACES IN THE ORBIT
Subperiosteal Space
Peripheral Orbital Space (Anterior Space)
Central Space
SubTenon's Space
ORBITAL FAT AND RETICULAR TISSUE
APERTURES AT THE BASE OF THE ORBIT
CHAPTER 83:
Investigation of Orbital Space Occupying Lesions
INTRODUCTION
CLINICAL EVALUATION
History
Clinical Examination
Systemic Examination
LABORATORY INVESTIGATIONS
SPECIAL INVESTIGATIONS
PLAIN X-RAY EXAMINATION
Computerized Tomography Scanning (CT Scan)
Ultrasonography
Normal Echo Pattern
Echo Pattern in Mass Lesions
Ultrasonography in Graves’ Ophthalmopathy
Ultrasonic Features of Orbital Foreign Bodies
Magnetic Resonance Imaging (MRI)
Contrast Orbitography
HISTOPATHOLOGIC STUDIES
Fine Needle Aspiration Biopsy (FNAB)
Incisional Biopsy
Excisional Biopsy
CORE BIPOSY
ENDOSCOPIC BIOPSY
IMMUNOHISTOCHEMISTRY
SUMMARY
CHAPTER 84:
Lymphoproliferative, Leukemic and Histiocytic Lesions of the Orbit
INTRODUCTION
CLASSIFICATION
Lymphocytic Lesions
Reactive Lymphoid Hyperplasia
Small B cell lymphomas
Diffuse Large B Cell Lymphomas
Burkitt's Lymphoma
T Cell Lymphomas
Leukemic Lesions
Leukemia
Granulocytic sarcoma
PLASMA CELL TUMORS
Solitary Plasma Cell Tumors
Multiple Myeloma
HODGKIN'S LYMPHOMA
HISTIOCYTOSES
Langerhans’ Cell Histiocytoses
Eosinophilic Granuloma
Hand-Schuller-Christian Disease
Letterer-Siwe Disease
Malignant Histiocytosis
MISCELLANEOUS LESIONS
CHAPTER 85:
Ultrasonography-guided Fine Needle Aspiration Cytology in Orbital Lesions
INTRODUCTION
HISTORICAL BACKGROUND
TECHNIQUE
Anterior Orbital and Palpable Lesions
Posterior Orbital and Nonpalpable Lesions
Ultrasound-guided FNAB for Posterior Orbital and Non-palpable Lesions
Guidelines
CYTOLOGICAL INTERPRETATION
INDICATIONS
COMPLICATIONS
Local Dissemination of Tumor Cells
LIMITATIONS
CONCLUSION
CHAPTER 86:
Phakomatosis
CLASSICAL FEATURES OF PHAKOMATOSES
TUBEROUS SCLEROSIS (BOURNEVILLE DISEASE)
Clinical Features
Cutaneous Involvement
Central Nervous System
Visceral Involvement
Ocular Involvement
Differential Diagnosis of Astrocytic Hamartomas4
NEUROFIBROMATOSIS (VON RECKLINGHAUSEN'S DISEASE)
Ocular Involvement
Uveal Tract
Retinal and Optic Nerve Lesions
Eyelid and Orbital Lesions
Glaucoma
Systemic Manifestations6
Pathology
Treatment
ANGIOMATOSIS RETINAE (VON HIPPEL-LINDAU DISEASE)
Clinical Picture
Systemic Features
Pathology
Fundus Fluorescein Angiography (FFA)
Treatment
ENCEPHALOFACIAL ANGIOMATOSIS (STURGE-WEBER SYNDROME)
Clinical Features
Ocular Involvement
Cutaneous Involvement
Visceral Involvement
Central Nervous System Involvement
Treatment
KLIPPEL-TRENAUNAY-WEBER SYNDROME
DIFFUSE CONGENITAL HEMANGIOMATOSIS
BASAL CELL NEVUS SYNDROME
WYBURN-MASON SYNDROME
Ocular Features
Treatment
OCULODERMAL MELANOCYTOSIS
ATAXIA-TELANGIECTASIA (LOUIS-BAR SYNDROME)
CHAPTER 87:
Orbital Involvement in Diseases of the Paranasal Sinuses
ORBITAL MANIFESTATIONS OF PARANASAL SINUS DISEASES
Orbital Cellulitis and Abscess
Mode of Spread of Infection
Clinical Features
Treatment
Proptosis
Mechanism of Proptosis
Lesions of Paranasal Sinuses Causing Proptosis
Treatment
Outline of Treatment
Surgical Approaches
Enophthalmos
A Mass in the Orbit
Superior Orbital Fissure Syndrome
Miscellaneous Associated Features
Orbital Neuralgia
Lid Swelling
Optic Neuritis
Periosteitis and Osteomyelitis
CHAPTER 88:
Metastatic Tumors to the Orbit
PRIMARY TUMOR SITES
BEHAVIOR OF DIFFERENT METASTATIC TUMORS
Presentation (Fig. 88.1)
Factors Facilitating Metastasis16
Diagnostic Modalities (Table 88.1)
Physical Examination
Metastatic Cancer of Unknown Origin
Treatment
Radiotherapy
Hormonal Therapy
Chemotherapy
Surgery
CHAPTER 89:
Orbital Blow-out Fractures
INCIDENCE OF BLOW-OUT FRACTURES
MECHANISM OF BLOW-OUT FRACTURE
CLASSIFICATIONS OF BLOW-OUT FRACTURE OF ORBITAL FLOOR
Depending upon the Fractured Bones
Depending upon the Extent of Fracture
Depending upon the Location of Fracture
CLINICAL FEATURES
ROENTGEN EXAMINATION
Plain X-rays
Computerized Tomography Scanning
MANAGEMENT
Time for Treatment
Aims of Treatment
Indications of Surgical Intervention
Surgical Technique
MANAGEMENT OF BLOW-OUT FRACTURES: AN ALTERNATIVE VIEW
MEDIAL BLOW-OUT FRACTURES
Clinical Features
Imaging Studies
CT Scan
MANAGEMENT
Medical Therapy
Surgical Therapy
Indications
CHAPTER 90:
Orbital Cellulitis
INTRODUCTION
ETIOPATHOGENESIS
Predisposing Factors
Routes of Infection
Extension of the Infection from the Periorbital and Intraocular Structures
Direct Inoculation of the Orbit
Embolic Source
Pathophysiology
Microbiology
Bacteria
Fungi
Parasites
CLINICAL FEATURES
Symptoms
Signs
COMPLICATIONS
DIFFERENTIAL DIAGNOSIS
LABORATORY AND IMAGING STUDIES
Laboratory Studies
Imaging Studies
Ultrasound
CT Scan
Magnetic Resonance Imaging (MRI)
Other Tests
MANAGEMENT
Surgical Intervention
Procedures
MORTALITY/MORBIDITY
MEDICAL/LEGAL PIT FALLS
CHAPTER 91:
Painful Ophthalmoplegia
NASOPHARYNGEAL TUMORS
Clinical Features
TOLOSA-HUNT SYNDROME
GRADENIGO'S SYNDROME
GIANT CELL ARTERITIS
Clinical Features
Pathology
Diagnosis
Treatment
RAEDER'S PARATRIGEMINAL SYNDROME
OPHTHALMOPLEGIC MIGRAINE
PARASELLAR SYNDROME (PITUITARY APOPLEXY)
Carotid Cavernous Aneurysm
ANEURYSM OF POSTERIOR COMMUNICATING ARTERY OF CIRCLE OF WILLIS
CHAPTER 92:
Thyroid Ophthalmopathy
BASIC PHYSIOLOGY OF THYROID HORMONE
GRAVES’ DISEASE (THYROID ASSOCIATED OPHTHALMOPATHY)
Epidemiology
Ocular Manifestations in Thyroid Ophthalmopathy
Lid Signs
Lid Retraction (Dalrymple Sign)
Lid Edema or Fullness
Superior Limbic Keratoconjunctivitis
Thyroid Myopathy
Exophthalmos
LABORATORY INVESTIGATIONS AND ORBITAL IMAGING
THYROID FUNCTION TESTS
Orbital Imaging
Computed Tomography
Magnetic Resonance Imaging (MRI)
Ultrasonography
Treatment
Treatment for Eye Lid Retraction
Treatment for Thyroid Myopathy
Orbital Decompression
Medical Decompression
Surgical Decompression
CHAPTER 93:
Anatomy, Physiology and Diseases of the Lacrimal System
ANATOMY OF LACRIMAL SYSTEM
Lacrimal Gland
Nerve Supply
Secretomotor Fibers
Sympathetic Fibers
Nasolacrimal Duct
Development of the Lacrimal Apparatus
PHYSIOLOGY OF LACRIMAL SYSTEM
Secretion of Tears
Drainage of Tears (Fig. 93.2)
SYMPTOMS OF LACRIMAL SYSTEM DYSFUNCTION
INVESTIGATING THE LACRIMAL SYSTEM
Tests of Lacrimal Secretion
Schirmer Test
Tear Break-up Time (TBUT)
Tear Lysozyme Assay
Tests of Lacrimal Excretion
Saccharin Test
Jones’ Dye Tests
Fluorescein Dye Disappearance Test
Syringing of Lacrimal Passages
Probing
Dacryocystography
Newer Investigative Modalities
DISEASES OF THE LACRIMAL GLAND
Infection
Non-infective Chronic Inflammations
Benign Lymphoepithelial Lesion
CONGENITAL ANOMALIES OF LACRIMAL EXCRETORY SYSTEM
Congenital Nasolacrimal Duct (NLD) Block
Technique of Probing
Infracture of the Inferior Turbinate
Silicone Intubation
Balloon Catheter Dilatation
Congenital Lacrimal Fistula (Lacrimal Anlage Duct)
Punctal Atresia
ACQUIRED DISORDERS OF LACRIMAL EXCRETORY SYSTEM
Punctal Stenosis
Punctal Ectropion
Canalicular Laceration
Repair of Single Canalicular Laceration
Repair of Both Upper and Lower Canalicular Laceration
Canalicular Obstruction
Dacryocystitis
Management of Acute Dacryocystitis
Management of Chronic Dacryocystitis
Conventional Dacryocystorhinostomy
Preoperative Evaluation
Type of Anesthesia
Surgical Technique
Results of DCR
Complications of DCR
Causes of Failure in DCR Surgery
Management of Failed DCR
OBSTRUCTION OF COMMON CANALICULUS
Dacryocystectomy
CHAPTER 94:
Radiographic Study of Lacrimal Passage
SURGICAL ANATOMY OF LACRIMAL PASSAGE
DACRYOCYSTOGRAPHY (DCG)
Types of Dacryocystography
Radiopaque Dyes Used for Dacryocystography
Techniques
Plain DCG
Distention DCG
Macrodacryocystography
Cinematography of Lacrimal System
Dacryoscintigraphy (DSG)
Radiography in Operated Cases of Sac
CHAPTER 95:
Lacrimal Gland Tumors
ANATOMY OF THE LACRIMAL GLAND
Space Occupying Lesions of the Lacrimal Fossa
Inflammatory Lesions
EPITHELIAL LACRIMAL GLAND TUMORS
Dacryops or Ductal Cyst
Pleomorphic Adenoma (Originally called Benign Mixed Tumor)
Treatment
Malignant Epithelial Lacrimal Gland Tumors
Lymphoma
Differential Diagnosis of Malignant Lacrimal Tumors
Management and Prognosis of Lacrimal Gland Tumor
SECTION 7: PEDIATRIC OPHTHALMOLOGY INCLUDING STRABISMUS
CHAPTER 96:
Neonatal Conjunctivitis
ETIOPATHOGENESIS
CLINICAL FEATURES
Chemical Conjunctivitis
Chlamydial Neonatal Conjunctivitis
Gonococcal Neonatal Conjunctivitis
Neonatal Conjunctivitis due to Other Bacteria
Herpes Simplex Neonatal Conjunctivitis
Laboratory Diagnosis
TREATMENT
Prevention of Neonatal Conjunctivitis
CHAPTER 97:
Amblyopia
CHAPTER 98:
Nutritional Blindness: Vitamin A Deficiency Disorders
ASSESSMENT OF VITAMIN A DEFICIENCY (VAD) STATUS
Treatment
Treatment Schedule for Xerophthalmia
Vitamin A Prophylaxis
Increased Intake of Dietary Vitamin A
Sources of Vitamin A
Daily Requirements
Functions of Vitamin A
VISUAL CYCLE AND VITAMIN A
Hypervitaminosis A (Vitamin A Toxicity)
Periodic Supplementation
Fortification of Dietary Items
New Plant Breeding and Genetic Modification
Ocular Findings in other Vitamin Deficiencies
CHAPTER 99:
Congenital Glaucoma
SYMPTOMS AND SIGNS
EXAMINATION TECHNIQUES IN CHILDREN
Examination Under Anesthesia
External Examination
IOP Measurement
Corneal Diameter Measurement
Gonioscopy
Ophthalmoscopy
CLINICAL TYPES OF CONGENITAL GLAUCOMA
Primary Congenital Glaucoma
Pathogenesis
Glaucoma Associated with Ocular Anomalies
Glaucoma Associated with Systemic Anomalies
Differential Diagnosis
Treatment
External Trabeculotomy
Procedure
Direct Goniotomy
Other Procedures
Follow-up
Other Types of Congenital Glaucoma
Sturge-Weber Syndrome
CHAPTER 100:
Glaucomas Associated with Developmental and Congenital Anomalies
INTRODUCTION
ANIRIDIA
Clinical Findings
Corneal Abnormalities
Iris Anomalies
Lens Abnormalities
Ptosis
Posterior Segment Abnormalities
Glaucoma
Management
AXENFELD-RIEGER SYNDROME
Ocular Features
Cornea
Anterior Chamber Angle
Iris
Extraocular Features
Dental Anomalies
Maxillary Hypoplasia
Histopathological Features and Mechanism
Management
PETER'S ANOMALY
Clinical Features
Other Ocular Abnormalities
Pathogenesis
Mechanism of Glaucoma
Management
GLAUCOMA IN PHAKOMATOSiS
Sturge-Weber Syndrome
Systemic Involvement
Ocular Involvement
Management
Neurofibromatosis
Systemic Involvement
Ocular Involvement
Management
Klippel-Trenaunay-Weber Syndrome
von Hippel-Lindau Syndrome
Tuberous Sclerosis
Oculodermal Melanocytosis
GLAUCOMA ASSOCIATED WITH CONGENITAL DISORDERS
Glaucoma Associated with Systemic Congenital Syndromes with known Chromosomal Abnormalities
Glaucoma Associated with Systemic Congenital Disorders of Unknown Etiology
Pierre-Robin Syndrome
Lowe's Syndrome (Oculocerebrorenal Syndrome)
Rubinstein-Taybi Syndrome (Broad Thumb Syndrome)
Glaucoma Associated with Ocular Congenital Disorders
Microphthalmos
Microcornea
Persistent Hyperplastic Primary Vitreous
Retinopathy of Prematurity
CHAPTER 101:
Childhood Cataract and Other Abnormalities of the Crystalline Lens
CONGENITAL ABNORMALITIES OF THE LENS
Congenital Aphakia
Persistent Hyaloid System
Epicapsular Star
Pigments over the Anterior Lens Capsule
Coloboma
Lenticonus
Spontaneous Displacement of the Lens
Marfan's Syndrome
Weill-Marchesani Syndrome (Brachimorphis Spherophakia)
Homocystinuria
CONGENITAL OR DEVELOPMENTAL CATARACT
Congenital Cataract
Blue Dot Cataract (Punctiform Opacity)
Coronary Cataract
Anterior Polar Cataract
Posterior Polar Cataract
Zonular Cataract
Virus Induced Cataract
Lowe's Oculocerebral Syndrome
Alport's Syndrome
Turner's Syndrome
Myotonic dystrophy
CHAPTER 102:
Management of Infantile-Pediatric Cataract
DIAGNOSIS OF PEDIATRIC CATARACTS
Indications for Treatment
Optical Rehabilitation
Aphakic Glasses
Contact Lenses
Epikeratophakia
Intraocular Lens Implantation
IS IOL IMPLANTATION FEASIBLE FOR INFANTILE CATARACTS?
IOL Power Selection
IOL Size
SURGICAL TECHNIQUES
Historical Perspective
Anesthesia
Wound Construction
Viscoelastic Substances
ANTERIOR CAPSULE MANAGEMENT
Manual Continuous Curvilinear Capsulorhexis
Can-opener Anterior Capsulotomy (Figs 102.13A to C)
Vitrector-cut Anterior Capsulectomy (Vitrectorhexis)
Vitrectorhexis in Pediatric Eyes (Figs 102.14A to D)
Bipolar Radiofrequency Capsulotomy
Fugo Plasma Blade” Anterior 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
Options for Primary Posterior Capsulotomy
DYE-ENHANCED PEDIATRIC CATARACT SURGERY
PERIOPERATIVE AND POSTOPERATIVE MEDICATIONS
POSTOPERATIVE COMPLICATIONS AND MANAGEMENT
Noninfectious Inflammation
POSTOPERATIVE COMPLICATIONS 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
PIGGY-BACK FOLDABLE INTRAOCULAR LENSES IN INFANTS
Management of Amblyopia
SUMMARY AND CONCLUSIONS
CHAPTER 103:
Lens Subluxation and its Management
ETIOPATHOGENESIS
HERITABLE ECTOPIA LENTIS
HERITABLE ECTOPIA LENTIS ASSOCIATED WITH SYSTEMIC ANOMALIES
Marfan's Syndrome
Homocystinuria
Weill-Marchesani Syndrome
Hyperlysinemia
Sulfite Oxidase Deficiency
Ehlers-Danlos Syndrome
Sturge-Weber Syndrome
Crouzon's Syndrome
Mandibulofacial Dysostosis
Refsum's Syndrome
Conradi Syndrome
Pierre Robin Syndrome
Wildervanck Syndrome
Aniridia
Isolated Ectopia Lentis
Ectopia lentis et Pupillae
ACQUIRED ECTOPIA LENTIS
TRAUMATIC ECTOPIA LENTIS
Management of Ectopia Lentis
Surgical Technique
CHAPTER 104:
Ophthalmic Manifestations of Inborn Errors of Metabolism
GALACTOSEMIA
Treatment
ALBINISM
Clinical Classification of Albinism
Causes of Visual Disability in Albinism
Chediak Higashi Syndrome
Heredity of Albinism
Management
CYSTINOSIS (CYSTINE-STORAGE DISEASE; LIGNAC-FANCONI DISEASE)
Classification
PROGRESSIVE HEPATOLENTICULAR DISEASE (WILSON'S DISEASE)
ALKAPTONURIA (OCHRONOSIS, OCULAR OCHRONOSIS)
HOMOCYSTINURIA
Biochemical Tests for Homocystinuria
Abnormality in Collagen Metabolism
Marfan's Syndrome
Stickler's Syndrome
Ehlers-Danlos Syndrome
CHAPTER 105:
Pediatric Orbital Space Occupying Lesions
CYSTIC TUMORS
Dermoid/Epidermoid Cyst
Microphthalmos with Cyst
Teratoma
Cephalocele, Encephalocele, Meningoencephalocele, Meningocele
Differential Diagnosis
Treatment
Optic Nerve Tumors
Differential Diagnosis
Treatment
Prognosis
Rhabdomyosarcoma
Pathology
Diagnosis
Differential Diagnosis
Treatment
Prognosis
METASTATIC TUMORS
Neuroblastoma
Ewing's Tumor
Wilms’ Tumor
Leukemia and Lymphoproliferative Conditions
Orbital Varix
Lymphangioma
Treatment
ORBITAL PSEUDOTUMOR
SECONDARY TUMOR
CHAPTER 106:
Pediatric Posterior Uveitis
TOXOCARA
Life Cycle
Clinical Presentation
Chronic Endophthalmitis
Posterior Pole Granuloma
Peripheral Granuloma
Atypical Presentations
Differential Diagnosis
Retinoblastoma
Retinopathy of Prematurity (ROP)
Coats’ Disease
PHPV
Familial Exudative Vitreoretinopathy (FEVR)
Pars Planitis
Pathology
Laboratory Tests
ELISA Test
Cytology
Treatment
Medical
Surgical
Laser
MASQUERADE SYNDROMES
Malignant
Leukemia
Nonmalignant Diseases
CHAPTER 107:
Retinopathy of Prematurity
DEFINITION
INTRODUCTION
Normal Vasculogenesis in ROP
Abnormal Vasculogenesis in ROP
CLASSIFICATION
Location of the Disease
Zone I
Zone II
Zone III
Stages of the Disease
Stage 1 (Demarcation line)
Stage 2
Stage 3 (Ridge with Extraretinal Fibrovascular Proliferation)
Stage 4 (Partial Retinal Detachment)
Stage 5 (Total Retinal Detachment)
Regressed ROP
Plus Disease
Threshold ROP
RISK FACTORS FOR ROP
Birthweight and Gestational Age
Delicate Balance
Prolonged Intubation and Multiple Gestation
EXAMINATION FOR ROP
Time of Examination
Technique of Examination
Mild Acute ROP
Severe Acute ROP
Rush Disease
Cicatrization
PREVENTION AND TREATMENT
Decreasing Risk Factors
Vitamin E
Surfactant
TREATMENT
Cryotherapy
Technique
Effect
Complications
Multicentric Cryotherapy Trial for ROP
Design of Study
Laser Photocoagulation
Vitreoretinal Surgery
Vitrectomy in Stages 4 and 5
Surgical Technique
Complications During Surgery
Results
RECENT ADVANCES REGARDING ROP
SUMMARY
CHAPTER 108:
Retinoblastoma
HISTORY
EPIDEMIOLOGY
AGE AT DIAGNOSIS
PATHOGENESIS
GENETICS
CLINICAL FEATURES
Early Lesions
Moderately Advanced Lesions
Advanced Lesions
Retinocytoma
PATHOLOGY
Gross
Microscopy
Low Power
High Power
DIFFERENTIAL DIAGNOSIS OF RETINOBLASTOMA
Classification14
Hereditary
Developmental Abnormalities
Inflammatory Conditions
Tumors
Miscellaneous Conditions
HEREDITARY CONDITIONS
DEVELOPMENTAL ABNORMALITIES
INFLAMMATORY CONDITIONS
TUMORS
MISCELLANEOUS
Diagnosis
History
Clinical Features
External Ocular Examination
Examination under Anesthesia
Investigations
Management
CRYOTHERAPY
LASER PHOTOCOAGULATION
THERMOTHERAPY
PLAQUE BRACHYTHERAPY
EXTERNAL BEAM RADIOTHERAPY (EBRT)
ENUCLEATION
ORBITAL EXENTERATION
CHEMOTHERAPY (Fig. 108.6)
Systemic Chemotherapy
Periocular Chemotherapy
Follow up Schedule
Genetic Counseling
CHAPTER 109:
Infantile Nystagmus
ELECTRO-NYSTAGMOGRAPHY (ENG)
SENSORY DEFECT NYSTAGMUS
CATARACT
CORNEAL OPACITY
CONGENITAL IDIOPATHIC NYSTAGMUS (CIN)
Typical Congenital Idiopathic Nystagmus
Atypical Congenital Idiopathic Nystagmus
Neurological Nystagmus
Nystagmus Compensatory Mechanism
Latent Nystagmus
SPASMUS NUTANS
MANIFEST CONGENITAL NYSTAGMUS
MANAGEMENT
CHAPTER 110:
Nystagmus Surgery: Current Concepts
COMPENSATORY HEAD POSTURE
Principle of Nystagmus Surgery
History of Nystagmus Surgery
Current Concept
Measurement of Torticollis
Surgical Result (Figs 110.6 and 110.7)
CHAPTER 111:
Evaluation of Strabismus
HISTORY TAKING
VISUAL ACUITY ESTIMATION
MONOCULAR VS BINOCULAR VISION
DUCTIONS AND VERSIONS
Limbus Test of Motility of Kestenbaum
Oblique Dysfunction (Fig. 111.1)
MEASUREMENT OF VERGENCE
Measurement of Nearpoint of Convergence
MEASUREMENT OF ANGLE OF DEVIATION AND FACE TURN
Hirschberg's Light Reflex Test (Fig. 111.2)
Krimsky Test (Figs 111.3A and B)
Angle Kappa
Measurement of Incomitant Deviations
Face Turn and Head Tilt
SENSORY TESTS
Stereoacuity Estimation
Lang's Two-pencil Test
Titmus Stereo Test
Diplopia Tests
Red Filter Test (Figs 111.6A and B)
Worth 4-Dot (Fig. 111.7)
Bagolini Lens (Fig. 111.8)
Maddox Rod Test
Haploscopic Test
Hess Chart (Fig. 111.10)
Normal and Anomalous Retinal Correspondence
Amblyoscope (Figs 111.11 to 111.13)
After Image Test (Fig. 111.14)
SPECIAL TESTS
AC/A Ratio
The Lens Gradient Method
Four Base-out Test (Fig. 111.15)
Forced Duction Test
Muscle Force Generation Test
Cycloplegic Refraction
FUNDUS EVALUATION
CHAPTER 112:
Sensory Adaptation in Concomitant Squints
DIPLOPIA
SUPPRESSION
Facultative Inhibition
Obligatory Inhibition
ABNORMAL/ANOMALOUS RETINAL CORRESPONDENCE
Harmonious ARC
Unharmonious ARC
Detection of ARC
Treatment of ARC
AMBLYOPIA
Straight-Eye Amblyopia
Amblyopia with Squint
Diagnostic Criteria
Fixation Pattern of Amblyopic Eye
Treatments
Occlusion in Squinting Eye with Eccentric Fixation
CAM Treatment for Amblyopia
CHAPTER 113:
Introduction to Heterophoria
ETIOLOGY
Mechanical
Innervational
Refraction Errors
AC/A Ratio
Position of Macula
Weakness of Muscles
Psychic Patients
Brain Trauma
Genetic Factors
CLASSIFICATION
Exophoria
Esophoria
Hyperphoria
SYMPTOMS
EXAMINATION OF PHORIA
Refraction
Ocular Movements
Cover Test
Convergence Test
Maddox Rod Test
Maddox Wing
MANAGEMENT
Orthoptics
Surgery
Prisms
Relieving Prisms
Exercising Prisms
CHAPTER 114:
Esodeviations
ACCOMMODATIVE ESOTROPIA
Refractive Accommodative Esotropia (Normal AC/A Ratio)
Clinical Characters
Treatment
Prognosis
Nonrefractive Accommodative Esotropia (High AC/A ratio)
Clinical Characters
Hypoaccommodative Esotropia5
Clinical Characters
Treatment
Partial Accommodative Esotropia
Clinical Characteristics
Treatment
ESSENTIAL INFANTILE ESOTROPIA
Clinical Features
Treatment
Timing of Surgery and Treatment Goal
ACQUIRED NONACCOMMODATIVE ESOTROPIA
Basic Esotropia
Nonaccommodative Convergence Excess
Clinical Characteristics
Treatment
Microtropia
Diagnosis
Treatment
CHAPTER 115:
Exodeviation
INTRODUCTION
DEFINITION
ETIOLOGY
CLASSIFICATION
PREVALENCE
Age of Onset and Natural History
OCCLUSION TEST
Aims
Treatment
Indications for Surgery
Age for Surgery
CHAPTER 116:
A and V Syndrome
ETIOLOGY
The Horizontal School of Urist3-5 (1951-58)
The Vertical School
Combined Patterns
Anomalies of Muscle Insertion
CLINICAL FEATURES AND DIAGNOSIS
TREATMENT
CHAPTER 117:
Management of Double Elevator Palsy
CLASSIFICATION
CLINICAL CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
CHAPTER 118:
Vertical Strabismus
DISSOCIATED VERTICAL DEVIATION (DVD)
Etiology
Examination
Differential Diagnosis
Treatment
STRABISMUS SURSOADDUCTORIOUS
NONCOMITANT VERTICAL DEVIATIONS
The Secondary Vertical Strabismus
Treatment
Double Elevator Palsy
Special Group
Blow-out Fracture
CHAPTER 119:
Special Forms of Strabismus
DUANE'S RETRACTION SYNDROME (STILLING-TURK-DUANE'S SYNDROME)
Bilateral DRS
Pseudo-Duane's Syndrome (Acquired Retraction Syndrome)
Treatment of DRS
Types of Surgery
BROWN SYNDROME (SUPERIOR OBLIQUE MUSCLE SHEATH SYNDROME)
Clinical Features
Differential Diagnosis
Management of Brown Syndrome
MYASTHENIA GRAVIS
Diagnosis
Pharmacological Test (Tensilon Test)
Tensilon Test (Negative)
Electromyography (EMG)
Ocular Tonography
Treatment of Myasthenia
Cyclic Strabismus
CHAPTER 120:
Nonsurgical Treatment of Squint
REFRACTIVE CORRECTION
BIFOCALS
How to Determine Power of Bifocals
Mechanism of Action
MIOTICS
Prisms
Convergence Excercise
Treatment of Heterophoria
Palliative
BOTULINUM TOXIN
Mechanism of Action
Indications
Contraindications (Relative)
ORTHOPTICS
Heterophoria
Convergence Insufficiency
Antisuppression Training
MANAGEMENT OF AMBLYOPIA
Occlusion Treatment
Occlusion-induced Amblyopia
Penalization Therapy
Types of Penalization
Pleoptics
CAM Visual Stimulator
CHAPTER 121:
Surgical Treatment of Strabismus
INTRODUCTION
AIMS OF STRABISMUS SURGERY
INDICATIONS FOR SURGERY
PATIENT EVALUATION
ANATOMICAL CONSIDERATIONS
Extraocular Muscles
Fascial Coverings
Tenon's Capsule
Intermuscular Septum
Muscle Capsule
Check Ligaments
The Orbital Fat
Capsulopalpebral Fascia and Ligament of Lockwood
SURGICAL TECHNIQUES
Anesthesia
Exposure of the Muscle
SURGICAL PROCEDURES
Weakening Operations
Recession (Figs 121.8A to C)
Marginal Myotomy
Tenotomy or Myectomy
Posterior Fixation Suture (Faden Operation)
Botulinum Toxin to Weaken the Action of a Muscle
Strengthening Operations
Resection Operation
Combined Weakening-Strengthening Operations
Adjustable Sutures
Operations to Modify the Action of an Extraocular Muscle (Muscle Transposition Operations)
Paralytic Strabismus
Correction of A/V Patterns
Anteroplacement of Obliques
Use of Plastic Materials
AMOUNT OF OPERATION
Horizontal Deviations
Cyclovertical Deviations
Paralytic Squint
Special Forms of Strabismus
Suturing the Muscle to the Sclera
Closure of the Wound
Postoperative Care
COMPLICATIONS
Preoperative
Postoperative
RESULT
SECTION 8: NEUROOPHTHALMOLOGY
CHAPTER 122:
Anatomy of Visual Sensory System
RETINA
OPTIC DISK
Optic Nerve
OPTIC CHIASM
OPTIC TRACTS
LATERAL GENICULATE BODY (LGB)
OPTIC RADIATIONS
OCCIPITAL CORTEX
BLOOD SUPPLY OF THE VISUAL PATHWAYS
CHAPTER 123:
Neuroophthalmological Evaluation
HISTORY TAKING
Visual Deficit
Diplopia
History about Sensory Disturbances
TESTING OF VISUAL FUNCTION
PHOTOSTRESS TEST
FUNCTIONAL VISUAL LOSS
EXTERNAL EXAMINATION OF THE EYE
Ocular Motility
Gaze Palsy: Abnormality of Conjugate Movements of the Eye
COVER TEST
PUPILS AND PUPILLARY REACTIONS
PUPILLARY DILATOR PATHWAY
PUPILLOCONSTRICTOR PATHWAY (Figs 123.2 and 123.3)
ADIE'S SYNDROME
ARGYLL ROBERTSON PUPIL (ARP) (Argyll Robertson)
Hutchinson's Pupil
WERNICKE'S HEMIANOPIC PUPIL: HOMONYMOUS HEMIANOPIC PUPILLARY RIGIDITY
MARCUS GUNN PUPILLARY SIGN
Pupil in Horner's Syndrome
CORNEAL SENSITIVITY
OPHTHALMOSCOPY
CHAPTER 124:
Normal and Abnormal Pupils
PUPILLARY PATHWAYS
Afferent Limb
Parasympathetic Pathway
Sympathetic Pathway
Accommodation
AFFERENT PUPILLARY DEFECTS
Argyll Robertson Pupils
Parinaud's Dorsal Midbrain Syndrome
Pretectal Afferent Pupillary Defects
LESIONS OF THE PARASYMPATHETIC SYSTEM
Third Nerve Palsy
Traumatic Mydriasis
Pharmacologic Mydriasis
LESIONS OF THE SYMPATHETIC SYSTEM
Simple Anisocoria
CHAPTER 125:
Chiasmal Lesions: Chiasmal Syndromes
CHAPTER 126:
Visual Field Defects
OPTIC NERVE
Central Scotoma
Cecocentral Scotoma
Arcuate Scotoma
Altitudinal Visual Field Defect
Optic Chiasm
OPTIC TRACT
RETROGENICULATE LESIONS
CHAPTER 127:
Optic N euritis: Optic Neuropathies Demyelinating Diseases
STRUCTURE OF THE OPTIC NERVE HEAD
Papillitis or Anterior Optic Neuritis
Retrobulbar Neuritis
DEMYELINATING DISEASES AS ETIOLOGY OF OPTIC NEURITIS
Multiple Sclerosis (Disseminated Sclerosis)
Ocular Features of Multiple Sclerosis
Optic Atrophy
Ocular Motor Paralysis
Diagnosis
Acute Disseminated Encephalomyelitis
Neuromyelitis Optica (Devic's Disease)
Encephalitis Periaxialis diffusa: Diffuse Cerebral Sclerosis: Diffuse Periaxial Encephalitis: Schilder's Disease
Leber's Hereditary Optic Atrophy
Pathology
Treatment
Alzheimer's Syndrome: Ophthalmic Manifestations of Alzheimer's Disease: Alzheimer's Type of Dementia
Classification of Optic Atrophy
CHAPTER 128:
Ocular Motor Palsies
OCULOMOTOR NERVE
Nucleus
Fasciculus
Peripheral Nerve
Subarachnoid Space
Intracavernosus Space
Orbital Space
Special Syndromes Related to the Third Nerve
Aberrant Regeneration
Ophthalmoplegic Migraine
Cyclic Oculomotor Palsy
CLINICAL APPROACH TO ISOLATED OCULOMOTOR PALSY
TROCHLEAR (FOURTH CRANIAL) NERVE
Fasciculus
Peripheral
Superior Oblique Myokymia
Clinical Approach to Isolated Trochlear Nerve Palsy
ABDUCENS (SIXTH CRANIAL) NERVE
Fasciculus
Peripheral Nerve (Subarachnoid)
Peripheral Nerve (Petrous)
Peripheral Nerve (Cavernosus Sinus and Orbit)
Special Syndromes of the Sixth Nerve
Abducens Palsy of Childhood
Mobius’ Syndrome
Duane's Retraction Syndrome
Clinical Approach to Isolated Sixth Nerve Palsies
Multiple Ocular Motor Nerve Palsies
Brainstem
Subarachnoid Space
Cavernosus Sinus
CHAPTER 129:
Supranuclear Disorders of the Eye Movements and Visual Integration
SUPRANUCLEAR DISORDERS OF EYE MOVEMENTS
CLINICAL DISORDERS AFFECTING THE INITIATION OF EYE MOVEMENTS
Oculomotor Apraxia
Congenital Ocular Motor Apraxiaa (Cogan's Syndrome)
Frontal Gaze Palsy
Clinical Disorders Affecting the Calibration of Saccadic Eye Movementss
Ocular Motor Dysmetria
Ocular Flutter
Opsoclonus
Clinical Disorders Affecting the Size and Velocity of Saccades
Progressive Supranuclear Palsy
Olivopontocerebellar Atrophy
Other Degenerative Conditions of CNS
GAZE PARESIS
Clinical Disorders Affecting the Conjugacy of Gaze
Internuclear Ophthalmoplegia
One and a Half Syndrome (Fisher's)
CLINICAL DISORDERS OF VERTICAL EYE MOVEMENTS
Paralysis of Upgaze
Skew Deviation
NYSTAGMUS AND OTHER OCULAR MOTOR OSCILLATIONS
Physiologic Nystagmus
Endpoint Nystagmus
Optokinetic Nystagmus (OKN)
Vestibular Jerk Nystagmus
Sensory Deprivation Nystagmus
Congenital Motor Nystagmus
Monocular Forms of Nystagmus
Acquired Monocular Nystagmus
Blind Eye
Acquired Forms of Horizontal Nystagmus
Gaze-evoked Nystagmus
Rebound Nystagmus
Periodic Alternating Nystagmus
ACQUIRED FORMS OF VERTICAL NYSTAGMUS
VERGENCE SYSTEM
DISORDERS OF VISUAL INTEGRATION
CHAPTER 130:
Papilledema
PATHOGENESIS OF PAPILLEDEMA
PATHOLOGY OF PAPILLEDEMA
OPHTHALMOSCOPIC APPEARANCE OF PAPILLEDEMA
SYMPTOMATOLOGY OF PAPILLEDEMA
FLUORESCEIN ANGIOGRAPHY IN PAPILLEDEMA
DIFFERENTIAL DIAGNOSIS OF UNILATERAL OPTIC DISK EDEMA
Congenital Abnormalities
Local Condition of the Orbit and the Disk
Orbitocranial Diseases
Unilateral papilledema
CHAPTER 131:
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
SYNONYMS
DEFINITION
CIRCULATION OF CSF
ETIOLOGY OF IIH
PATHOLOGY
SYMPTOMS OF IIH
DIAGNOSIS
TREATMENT
Surgical Treatment
Lumbar Puncture
Optic Nerve Sheath Decompression
Lumbar-Peritoneal Shunt
CHAPTER 132:
Abnormalities of Optic Disk and Optic Nerve
OPTIC NERVE DRUSEN
TILTED OPTIC DISK
OPTIC NERVE DYSPLASIA
Aplasia
Coloboma
Pit
Morning Glory Disk
Hypoplasia
INFILTRATIVE OPTIC NEUROPATHY
TOXIC/NUTRITIONAL OPTIC NEUROPATHY
DOMINANT BEHR OPTIC NEUROPATHY
OPTIC NERVE TRAUMA
OPTIC DISK VASCULITIS (PAPILLOPHLEBITIS)
COMPRESSIVE OPTIC NEUROPATHY
OPTIC NERVE GLIOMA
OPTIC NERVE MENINGIOMA
CHAPTER 133:
Intracranial Space Occupying Lesions of Ophthalmic Importance
ANEURYSMS
Aneurysm of Internal Carotid Artery within the Cavernous Sinus
Intrasellar Aneurysm of the Internal Carotid Artery
Aneurysm of Intracranial Portion of Ophthalmic Artery
Aneurysm of the Circle of Willis
Anteriovenous Aneurysms: Caroticocavernous Fistula
SUBDURAL HEMATOMA
CLIVUS RIDGE SYNDROME
TUMORS OF CEREBELLOPONTINE ANGLE
TUMORS OF IIIRD VENTRICLE AND INTERNAL HYDROCEPHALUS
TUMORS OF PINEAL BODY AND MIDBRAIN
SECTION 9: MISCELLANEOUS TOPICS
CHAPTER 134:
Applied Anatomy of the Eye and Adnexa
COMMUNICATIONS WITH THE ORBIT
OCULAR APPENDAGES
Eyelids
Lid Margins
Gross Structure of Lids
Lacrimal Apparatus
Eyeball
Size of Eyeball
Structure of the Eyeball
OUTER TUNIC
Cornea
Sclera
Uveal Tract
Choroid
Structure of the Choroid
Ciliary Body
Structure of Ciliary Body
RETINA
The Lens
Vitreous Humor
EMBRYOLOGY OF EYEBALL
CHAPTER 135:
Introduction to Computed Tomography and Magnetic Resonance Imaging in Ophthalmic Practice
COMPUTERIZED TOMOGRAPHY (CT)
Spiral CT
Multislice (Multidetector) CT
Scanning Protocols
MAGNETIC RESONANCE (MR) IMAGING
The Basics of MRI
MR Protocols for Orbits
NORMAL ANATOMY
Globe
Retrobulbar Space
CHAPTER 136:
Computed Tomography and Magnetic Resonance Imaging of the Eye and Orbit
OCULAR LESIONS IN CHILDREN
Retinoblastoma and its Mimics
Retinoblastoma
Persistent Hyperplastic Primary Vitreous (PHPV)
Coats’ Disease
Ocular Toxocariasis (Sclerosing Endophthalmitis)
Retinopathy of Prematurity (ROP)
Medulloepithelioma
CONGENITAL LESIONS OF THE EYEBALL
Coloboma
Macrophthalmos/Buphthalmos
Anophthalmos/Microphthalmos
OCULAR LESIONS IN ADULTS
Ocular Detachment
Malignant Uveal Melanoma
Choroidal Hemangioma
Optic Disk Drusen
EXTRAOCULAR LESIONS OF THE ORBIT
Congenital and Developmental Conditions
Dermoid/Epidermoid
Cephaloceles
Neurocutaneous Syndromes with Ocular Manifestations
Inflammatory Conditions
Orbital Pseudotumor
Graves’ Disease
Optic Neuritis
Neoplasms
Lymphoproliferative Disease of the Orbit
Metastatic Lesions
Tumors of Neural Origin
Neoplasms of the Optic Nerve
Rhabdomyosarcoma
INFECTIONS/INFESTATIONS OF THE ORBIT
Orbital and Periorbtial Cellulitis
Orbital Cysticercosis
Mucocele
VASCULAR LESIONS
Hemangioma
Cavernous Hemangioma
Capillary Hemangioma
Lymphangioma
Venous Varix
Carotid Cavernous Fistula
Orbital Trauma
Orbital Fractures
Soft Tissue Injuries
Foreign Bodies
LACRIMAL GLAND PATHOLOGY
Lesions of the Lacrimal Sac and Duct
LESIONS OF THE BONY ORBIT
IMAGING EVALUATION OF THE INTRACRANIAL VISUAL PATHWAY
CHAPTER 137:
Applications of Ultrasound Biomicroscopy
ULTRASOUND BIOMICROSCOPY (UBM): INTRODUCTION
Principle
Instrumentation
Technique
CLINICAL APPLICATIONS (Table 137.1)
Cornea and Ocular Surface Disorders
Glaucoma
Lens
Uvea
Vitreoretinal Disorders
Mass Lesions of Anterior Segment
Research Aspects
Future
CHAPTER 138:
Laboratory Techniques in Ophthalmic Pathology
INTRODUCTION
HISTOLOPATHOLOGY
Tissue Fixation
Grossing
Corneal Button
Lid Biopsy
Grossing an Eye
Exenterated Specimen
Tissue Processing
Tissue Embedding and Cutting
Staining
Special Stains
Electron Microscopy
Immunologic and Molecular Techniques
Molecular Diagnostic Tools
Principle of Polymerase Chain Reaction
Flow Cytometry
Tissue Culture and Karyotyping
SPECIAL PROCEDURES IN OPHTHALMIC PATHOLOGY
Preoperative Diagnosis
Fine-Needle Aspiration/Sampling Technique
Intraoperative Diagnosis
Frozen Sections
Squash or Imprint Cytology
FLUID (VITREOUS, AQUEOUS OR OTHER FLUIDS) CYTOLOGY
CONJUNCTIVAL IMPRESSION CYTOLOGY
Method
OPHTHALMIC PHOTOGRAPHY
CHAPTER 139:
Viscoelastic Substances in Ophthalmology
CRITERIA FOR SELECTION OF MATERIAL
Physical Properties
Chemical Properties
Preparations
Sodium Hyaluronate
Chondroitin Sulfate
Hydroxy Propyl Methyl Cellulose
Ocugel
Collagen
Cellugel
Newer Viscoelastics
CLINICAL USE OF VISCOELASTIC SUBSTANCES16
Cataract Surgery
Protection of Corneal Epithelium
Control of Capillary Oozing
Anterior Chamber Maintenance During Incision Making
ECCE
ICCE
Miscellaneous
Glaucoma
Keratoplasty17
Donor Eye
Recipient Eye
Retinal Surgery
Trauma
Membrane Surgery
Vitreous Loss
Extraocular Surgery
Postoperative Period
CONCLUSION
CHAPTER 140:
Principles of Biostatistics
WHAT ARE VARIABLES
Qualitative Variables
Quantitative Variables
Continuous Variable
Discrete Variable or Discontinuous
SCALE OF MEASUREMENT
MEASURES OF CENTRAL TENDENCY
ARITHMETIC MEAN OR AVERAGE
MEDIAN
MODE
MEASURES OF DISPERSION
Range
Standard Deviation
Applications of Standard Deviation
Coefficient of Variation (CV)
CORRELATION
Importance of Studying the Relationship between two Variables
Scatter Diagram
Correlation Coefficient
Assumptions
Interpretation of the Values of Correlation
Regression Analysis
Simple Regression
Multiple Regression Analysis
Difference between Correlation and Regression Analysis
STATISTICAL AND CLINICAL SIGNIFICANCE
Inferential Statistics
Sampling Distribution
Estimation
Testing of Hypothesis
Null Hypothesis
Statistical Significance
CLINICAL SIGNIFICANCE
Clinical vs Statistical Significance
Level of Significance
Power
Type II Error
Tests of Significance
Large Sample Tests
Small Sample Tests
Student's ‘t’-test
Paired ‘t’ test
χ2 - test
Analysis of Variance (ANOVA)
Non-parametric Tests
Statistical Methods and Computer Programs
CHAPTER 141:
Genetics in Ophthalmology
INTRODUCTION
TYPES OF VARIATION IN DNA
DNA Testing
Polymorphisms
MENDELIAN INHERITANCE
NON-TRADITIONAL MODES OF INHERITANCE
Mitochondrial Inheritance
USES OF GENETIC INFORMATION
Genetic Counseling
Family History and Pedigree Analysis
Genetic Testing
PROBLEMS WITH DIAGNOSIS OF DISORDERS AS HEREDITARY
Variable Penetrance and Expressivity
Sporadic Cases
Mosaicism
SUMMARY AND FUTURE PROSPECTS
GLOSSARY
CHAPTER 142:
Molecular Genetics in Clinical Ophthalmology*
INTRODUCTION
TECHNIQUES OF MOLECULAR BIOLOGY
Basic Concepts
Southern Blotting
Probes
Preparation of Probes
Linkage
Pulsed Field Gel Electrophoresis (PFGE)
Polymerase Chain Reaction (PCR)
Chromosome Walking and Jumping
THE X CHROMOSOME AND THE EYE
X-linked Retinitis Pigmentosa (XLRP)
Congenital Stationary Night Blindness (CSNB)
Norrie's Disease
Choroideremia
Color Vision and its Defects
Blue Cone Monochromatism
LEBER'S HEREDITARY OPTIC NEUROPATHY (LHON)
RETINOBLASTOMA
CONCLUSIONS
CHAPTER 143:
Infection Control Practices for Ophthalmologists
INFECTION CONTROL PRACTICES IN PATIENT CARE AREAS
Handwashing
Universal Body Substance Precautions (UBSP)
Care of Instruments/Sterile Supplies/Drugs
Tonometers and Gonioscopes
A-scan and Pachymetry Probes
Ophthalmic Drops and Ointments
Sterile Instruments and Other Accessories
Disposal
Infection Control Manuals
INFECTION CONTROL PRACTICES IN THE OPERATING ROOM (OR)
Design of the OR
Personnel of the OR
Decontamination of OR Surfaces
The OR Environment
Surgical Scrub and Skin Preparation
Gowning and Gloving
Record Keeping
CHAPTER 144:
Acquired Immunodeficiency Syndrome and the Eye
HUMAN IMMUNODEFICIENCY VIRUSES (HIV)
POSTERIOR SEGMENT LESIONS
Non-infectious Retinopathy (HIV Retinopathy)
Opportunistic Infections
Cytomegalovirus (CMV) Retinitis
Retinal Detachment in CMV Retinitis
VARICELLA ZOSTER VIRUS DISEASE
Acute Retinal Necrosis (ARN)
Progressive Outer Retinal Necrosis (PORN)
Frosted Branch Angiitis
TREATMENT OF VIRAL RETINITIS
Ganciclovir
Foscarnet
Acyclovir
Catheter-less Therapy
Oral Ganciclovir
Intravenous Cidofovir
Ganciclovir Intraocular Implant
Intravitreal Medications
INVESTIGATIONAL AGENTS
Ocular Toxoplasmosis
Ocular Syphilis
Mycobacterial Infection
Fungal Infection
Pneumocystis Carinii Choroidopathy
Adnexal and Anterior Segment Lesions in AIDS
HERPES ZOSTER OPHTHALMICUS (HZO)
Molluscum Contagiosum
Lid Infections
Conjunctival Squamous Cell Carcinoma
Keratoconjunctivitis Sicca
Infectious Keratitis
Anterior Uveitis
ORBITAL INFECTIONS (Table 144.9)
NEUROOPHTHALMIC LESIONS
NEOPLASMS
Ophthalmic Kaposi's Sarcoma
Lymphoma
MANAGEMENT
The Impact of HAART on the Clinical Spectrum of Ocular Lesions in AIDS
GUIDELINES FOR DISCONTINUATION OF ANTI-CMV THERAPY IN PATIENTS WITH IMMUNE RECONSTITUTION FROM HAART
Level of CD4+ T Cell Count Prior to Discontinuation of Anti-CMV Therapy
HIV Viral Load Estimation
Immune Recovery Uveitis (IRU)
Has HAART Resulted in Improved Visual Outcome in CMV Retinitis?
Management of HIV Infections and Opportunistic Infections
ANTIRETROVIRAL THERAPY
Indications for Antiretroviral Therapy
Investigations
When to Change Therapy
Antiretroviral therapy in Patients with Tuberculosis
CHAPTER 145:
Color Vision and Color Blindness
FACTORS AFFECTING COLOR VISION
Lens
RETINAL DISTRIBUTION OF COLOR VISION
Wavelength Discrimination
Hue, Saturation and Lightness
Illumination
Bezold-Burcke Effect
Color Constancy: Aperture Colors and Surface Colors
Complementary Wavelengths
Simultaneous Color Contrast
Successive Color Contrast
Stiles-Crawford Effect
Color Triangle
THEORIES OF COLOR VISION
Young-Helmholtz Theory
Fundamental Sensations
Granit's Theory of Color Vision
Herring's Theory of Color Vision
ANATOMY OF COLOR VISION
Cones
Color Coded Cells
Opponent Color Cells
Double Opponent Color Cells
Simple, Complex and Hypercomplex Cells
TESTING OF COLOR VISION
Lantern Tests
Pseudoisochromatic Color Plates
Farnsworth 100-hue Test
Farnsworth D-15
City University Color Vision Test
Anomaloscope
Electroretinography (ERG)
Microspectrophotometry
ANOMALIES OF COLOR VISION
Congenital Color Vision Deficiency
DISORDERS OF COLOR VISION
Genetics of Congenital Color Deficiencies
Acquired Deficiency of Color Vision
Ocular Disease Causing Deficiency of Color Vision
Squint Amblyopia
Glaucoma
Diabetic Retinopathy
Retinal Disorders
Optic Nerve Disorders
Color Vision after Lasers
DRUGS CAUSING DEFICIENCY IN COLOR VISION25
SYSTEMIC DISORDERS CAUSING DEFICIENCY IN COLOR VISION
Cardiovascular Disease
Turner's Syndrome
CHAPTER 146:
Indocyanine Green Angiography in Neovascular Age-related Macular Degeneration
INTRODUCTION
INDOCYANINE GREEN ANGIOGRAPHY
Properties of Indocyanine Green Dye
INDOCYANINE GREEN ANGIOGRAPHY IMAGING
Focal Spots
Plaques
Combined Lesions
Marginal Spot
Combination Spot
Remote Spot
IMAGING OF CHOROIDAL NEOVASCULARIZATION
Classic Choroidal Neovascularization
Occult Choroidal Neovascularization
Occult CNV without Serous Pigment Epithelial Detachment
Occult CNV with Serous Pigment Epithelial Detachment
Combined Choroidal Neovascularization
Polypoidal Choroidal Vasculopathy (PCV)
Retinal Angiomatous Proliferation (RAP)
ADDITIONAL CONSIDERATIONS
IMAGING OF RECURRENT CHOROIDAL NEOVASCULARIZATION
Recurrent Classic CNV
Recurrent Occult CNV
ICG-GUIDED LASER PHOTOCOAGULATION OF PRIMARY OCCULT CNV
Direct ICG-guided Laser Treatment
Dye-enhanced Laser Treatment
ICG-guided Feeder Vessel Photocoagulation
When to use Indocyanine Green Angiography
CHAPTER 147:
Low Vision Devices
INTRODUCTION
DEFINING LOW VISION
FUNCTIONAL VISION
IMPACT OF OCULAR DISEASE ON THE PATIENT
CAUSES OF LOW VISION
Diseases of the Optical Media
Diseases of the Macula
Diseases of the Peripheral Retina and Visual Pathways
ENHANCING IMPAIRED VISION
Types of Magnification
SYSTEMATIC SEQUENCE FOR SELECTING LOW VISION DEVICE
Please Note
LOW VISION DEVICES
Optical Devices for Near Vision Tasks
Spectacle Devices23-26
Magnifiers24, 26-28
Hand-held Magnifiers
Stand Magnifier
Optical Devices for Distance Vision-Telescopes23-24,26
Telescopes are Available in two Optical Designs
Uses
Disadvantages
Glare Control Devices
Points to be Stressed for using High Plus Reading Glasses
Points to be Noticed in using Hand Magnifier
When using Stand Magnifier one should
Using Monocular Telescope
Nonoptical Devices (Supplementary Devices)
Writing Guide
Signature Guide
Reading Lamp
Notex: Money/Currency Identifying Strip
Needle Threader
Assistive and Adaptive Devices
Video Magnifiers—Closed-circuit Television (CCTV) Fig. 147.6
Computer Systems
Field Utilization Device
Night Vision Devices
Concluding Remark
Equipment Required for Low Vision Clinic
CHAPTER 148:
Amniotic Membrane Transplantation in Ophthalmic Disorders
BACKGROUND
EMBRYOLOGY, ANATOMY, PHYSIOLOGY AND HISTOPATHOLOGY OF AM
FUNCTIONS OF AM
TISSUE HARVESTING AND USE
PROCEDURE FOR OF HUMAN AM PREPARATION AND PRESERVATION40
Procedure I
Procedure II
Procedure III
CLINICAL USES OF AMT (Table 148.1)
Situation I
Situation II
Situation III
INDICATIONS AND SURGICAL PROCEDURES FOLLOWING ARE THE POSSIBLE SURGICAL PROCEDURES
SURGICAL TECHNIQUE
IDENTIFICATION OF EPITHELIAL SURFACE
Simple AMT
Indications (Table 148.1)
Persistent Epithelial Defect 33,66,67
LT + AMT28,35,83 (LT = Limbal autograft transplantation)
LT + LK/PK + AMT 28,35,83
AMT with Glue Application84,85
Miscellaneous
For Repair of Leaking Filtering Bleb37,80
During Trabeculectomy36
During Entropion Surgery
Ocular Surface Disorders58,67
AM in Persistent Epithelial Defect (PED)
AMT in Corneal Ulcers
Pterygium Surgery
Pseudophakic Bullous Keratopathy (PBK)
Following Management of Band Shaped Keratopathy (BSK)
Acute Chemical Burns
In Stem Cell Deficiency
Total Limbal Stem Cell Deficiency
Following Removal of OSSN
Following Keratorefractive Surgery
In Glaucoma Surgery
As Epithelial Cell Carrier
CHAPTER 149:
Limbal Stem Cells of Corneal Epithelium: Concepts, Disease and Management
OCULAR SURFACE
Ocular Surface Epithelia
WHAT IS A STEM CELL?
Definition
Characteristics of Stem Cells
CORNEAL EPITHELIAL STEM CELLS
LIMBAL STEM CELLS DEFICIENCY (LSCD)
Introduction
Classification and Etiology
Clinical Features of LSCD
Diagnosis of LSCD
Management of Limbal Stem Cell Deficiency
Limbal Stem Cells Transplantation
SURGICAL TECHNIQUES OF LIMBAL TRANSPLANTATION
Management of Partial LSCD
Preparation of the Bed
AMNIOTIC MEMBRANE TRANSPLANTATION (AMT)
Introduction
Surgical Procedure
Current Status
CONJUNCTIVAL LIMBAL AUTOGRAFT (CLAG)
Indication
Surgical Procedure
Current Status
KERATOLIMBAL ALLOGRAFT (KLAL)
Introduction
Indication
Surgical Procedure
Donor Tissue
Donor Tissue Preparation
Donor Tissue Transplantation
Current Status
LIVE RELATED DIRECT CONJUNCTIVAL LIMBAL ALLOGRAFT (Lr-CLAL)
Introduction
Indications
Surgical Procedure
Current Status
CULTIVATED LIMBAL EPITHELIUM TRANSPLANTATION
Introduction
Indications
Surgical Procedure
Cultivation of Epithelia
Transplantation
Immunosuppression
Current status
CORNEAL TRANSPLANTATION FOLLOWING LIMBAL TRANSPLANTATION
Immunosuppression
COMPLICATIONS
Immunological Rejection
KLAL Rejection
Lr-CLAL Rejection
Cultivated Limbal Transplant Rejection
Glaucoma
Infection
RECENT ADVANCES
Co-cultivated Limbal and Conjunctival Epithelium
Cultivated Oral Mucosal Epithelium Transplantation
Stem Cell Plasticity
CHAPTER 150:
Miscellaneous Aspects of Conjunctiva
FLOPPY EYELID SYNDROME
Pathology
Management
GIANT PAPILLARY CONJUNCTIVITIS (GPC)
Pathology of GPC
D/D from Vernal Conjunctivitis
Management
OCULAR CICATRICIAL PEMPHIGOID
Differential Diagnosis
Pathology
Treatment
Symptomatic Treatment
LABORATORY DIAGNOSIS OF OCULAR INFECTIVE ORGANISMS
Standard Methods
Cytological Tests
Direct Detection Tests
Culture and Isolation Test
Serological Tests
Test for Rapid Identification of Organisms
Fungus Identification
Fluorescein Conjugated Lectin
Affinity Membrane Test for Superficial Corneal Herpes
Limulus Amebocyte Lysate Assay
Use of Monoclonal Antibody
Nucelic Acid Hybridization Reactions
Electron Microscopy
Immunofluorescent Staining
CHAPTER 151:
Neoplasms of Conjunctiva and Cornea
INTRODUCTION
CLASSIFICATION OF TUMORS OF CONJUNCTIVA AND CORNEA (DUKE ELDER)1
Benign
Dermoid and Dermolipoma
Mesenchymal Tumors
Fibrous Histiocytoma
Squamous Epithelial Neoplasms of Cornea and Conjunctiva2,3
Benign Squamous Neoplasia
Premalignant and Malignant Lesions
Primary Corneal Epithelial Dysplasia
Precancerous Lesions
Intraepithelial Neoplasia
Invasive Squamous Cell Carcinoma
Mucoepidermoid Carcinoma
Melanocytic Tumors
Melanosis
Invasive Malignant Melanoma
Pagetoid Sebaceous Cell Carcinoma
INCIDENCE
AGE AND SEX DISTRIBUTION
ETIOLOGY
MANAGEMENT
Investigations
Exfoliative Cytology6
Impression Cytology7
Immunohistology
Frozen Section Guided Excision8-10
Histopathology1-4
Electron Microscopy
Treatment
Surgery
Radiotherapy
Cryotherapy
Immunotherapy and Chemotherapy
Recurrence
Metastasis
CHAPTER 152:
Management of Corneal Epithelial Defects
MICROANATOMY OF CORNEAL EPITHELIUM
FUNCTIONS OF THE CORNEAL EPITHELIUM
EXAMINATION
Slit Lamp Examination
Planimetry
NORMAL CORNEAL EPITHELIAL HEALING
CLINICAL PATTERNS OF HEALING PROCESS
MANAGEMENT OF ACUTE EPITHELIAL DEFECT
Medical
Topical Medications
Double Eye Pads and Bandage (with Antibiotic Ointment, with/without Cycloplegics)
Contact Lens/Capping
Soft Bandage Contact Lens (BCL) with Topical Antibiotic Drops
Collagen Shield
Surgical
Tissue Adhesive
Conjunctival Graft
Conjunctival Flap
Limbal Allograft Stem Cell Transplantation
Surgical Procedure
Tarsorrhaphy
Amniotic Membrane Transplantation
CHAPTER 153:
Ocular Manifestations in Tropical Diseases
CHAPTER 154:
Eye in Connective Tissue Disorders
VARIOUS TYPES OF CONNECTIVE TISSUE DISORDERS
OCULAR MANIFESTATIONS OF CONNECTIVE TISSUE
Scleritis and Episcleritis
Cornea
Anterior Uveitis
Keratoconjunctivitis Sicca
Sicca
Juvenile Chronic Polyarteritis (Still's disease)
Ocular Involvement
Ankylosing Spondylitis
Ocular Manifestations
Reiter's Disease
Ocular Involvements
Behcet's Syndrome
Ocular Involvements
Systemic Lupus Erythematosus (SLE)
Ocular Manifestations
Dermatomyositis and Polymyositis
Scleroderma Progressiva Systemica
Ocular Involvements
Polyarteritis Nodosa
Ocular Involvements
Temporal Arteritis (Cranial Arteritis, Giant Cell Arteritis and Polymyalgia Rheumatica)
Ocular Manifestations
Treatment
Takayasu Disease (Pulseless Disease, Aortic Arch Aortitis)
Cogan's Syndrome
Allergic Granulomatous Angiitis: Wegener's Granulomatosis
Ocular Complication
ACQUIRED GENERALIZED DISORDERS OF CONNECTIVE TISSUE SOMETIMES ASSOCIATED WITH JOINT DISEASE
Relapsing Polychondritis
Sarcoidosis
Ocular Involvement
Amyloidosis
Ocular Manifestations
Erythema Nodosum
ACQUIRED SYSTEMIC METABOLIC DISORDER AFFECTING CONNECTIVE TISSUE AND THE EYE
Gout
Ocular Manifestations
Chronic Gout
Ocular Manifestations
HEREDITARY GENERALIZED DISORDER OF CONNECTIVE TISSUE WHICH ALSO AFFECTS THE EYE
Marfan's Syndrome
Ectopia Lentis
Marchesani Syndrome
Homocystinuria
Osteogenesis Imperfecta
Ehlers-Danlos Syndrome
Pseudoxanthoma Elasticum
CHAPTER 155:
Oxidative Stress and Antioxidants in Ophthalmology
FREE RADICALS
DEFENCE AGAINST FREE RADICALS
PATHOPHYSIOLOGY
Carotenoids and Tocopherol
Ascorbic Acid
Glutathione
The Last Word
CHAPTER 156:
Contact Lenses
BRIEF HISTORY
OPTICAL PRINCIPLES OF CONTACT LENS
MATERIALS USED FOR CONTACT LENSES
Polymethyl Methacrylate (PMMA)
Other Materials
Soft Hydrophilic Materials
HEMA Cross-linked with EGDMA
Glyceryl Methacrylate (GMA) Polymers
HEMA-PGMA Copolymers
Others
INDICATIONS FOR CONTACT LENS
Optical
Therapeutic
Soft and Silicone Lens
Hard Gas Permeable Lens
Scleral Lens
Corneal Burns/Indolent Ulcers
Chemical Burns
Cosmetic
Cosmetic Lenses
Occupational
Contact Lenses as a Low Vision Aid
Diagnostic
CONTRAINDICATIONS
FITTING OF CONTACT LENS
History
External Examination
Visual Function
Keratometry
Peripheral Keratometry
Corneal and Pupillary Diameter
Additional Tests
Patient Consultation
Fitting Procedures
Fitting of Hard and Gas Permeable Contact Lenses
Insertion and Removal of Lens
Wearing Schedule
Bifocal Lenses
Soft Contact Lenses
Advantages
Disadvantages
Methods of Fitting
Evaluation of the Fit
Oxygen Permeability through Contact Lens
Rigid Gas Permeable Scleral Contact Lenses
Care of Worn Lenses
Care of Lens Cases
Care of Trial Lenses
Undesirable Effects of Contact Lens Wear
Pathogenesis of Ulcer Formation
Acanthameba Keratitis
Giant Papillary Conjunctivitis
Disposable Contact Lens
Extended Wear Lenses
SECTION 10: DISEASES OF THE UVEAL TRACT
CHAPTER 157:
Anatomy of the Uveal Tract
GROSS AND MICROANATOMY1
Iris
Anterior Border Layer
Stroma and Sphincter Muscles
Anterior Epithelium and Dilator Muscles
Posterior Pigment Epithelium
Ciliary Body
Important Functions
Histology
Blood Supply
Choroid
Vascular Supply
CONGENITAL AND DEVELOPMENTAL DEFECTS OF UVEAL TRACT
Persistent Pupillary Membrane
Persistent Tunica Vasculosa Lentis
Heterochromia Iridis
Involved Iris—Darker (Hyperchromia)
Involved Iris—Lighter (Hypochromia)
Hypoplasia of Iris
Coloboma of Choroid
Iris and Ciliary Body Cysts2
Primary Cysts
Secondary Cysts
CHAPTER 158:
Uveitis: Classification, History-Taking, Examination and Incidence
DEFINITION
CLASSIFICATION
Basic Mechanism of Ocular Inflammation and Signs of Uveitis
Symptoms of Uveitis
HISTORY-TAKING
Geographic History
Family History
Demographic History
Age
Sex
Race
Personal History
History of Systemic Disease and Treatment for the same
Ocular History
Laterality
Onset
Severity
Pattern
Duration
Treatment Taken
EXAMINATION
Local Examination
Visual Acuity
Anterior Segment Examination2
Anterior Chamber
Depth of Anterior Chamber
Posterior Segment Examination3,4
Posterior Vitreous Detachment
Exudative Retinal Detachment
General Examination
Systemic Findings in Uveitis
INCIDENCE
Etiology of Uveitis (in percentage)
CHAPTER 159:
Clinical Approach to a Patient with Uveitis
INTRODUCTION
HISTORY TAKING
Examination of Patients with Uveitis
Slit Lamp Biomicroscopy
Other Corneal Findings
Laboratory Evaluations
Summary and Conclusion
APPENDIX: SAMPLE UVEITIS QUESTIONNAIRE
Family History
Social History
Personal Medical History
Medical History
CHAPTER 160:
Anterior Uveitis: Diagnosis and Management
DEFINITION
DIFFERENTIAL DIAGNOSIS
IDIOPATHIC ANTERIOR UVEITIS
HLA-B27: Related Iridocyclitis
Clinical Features
ANKYLOSING SPONDYLITIS (AS)
REITER'S SYNDROME
PSORIATIC ARTHRITIS
INFLAMMATORY BOWEL DISEASE
Course and Prognosis
Laboratory Investigations
Therapy
JUVENILE RHEUMATOID ARTHRITIS (JRA)
Clinical Features
Course and Prognosis
Laboratory Investigations
Treatment
FUCH'S HETEROCHROMIC IRIDOCYCLITIS (FHI)
Clinical Features
Course and Prognosis
Differential Diagnosis
Laboratory Investigations
Treatment
HERPETIC IRIDOCYCLITIS
HSV KERATOUVEITIS
HERPES ZOSTER
Laboratory Investigations
Treatment
SYPHILIS
Clinical Features
Course and Prognosis
Laboratory Investigations
Treatment
TUBERCULOSIS
Clinical Features
Course and Prognosis
Laboratory Investigations
Treatment
GLAUCOMATOCYCLITIC CRISIS
Clinical Features
Course and Prognosis
Treatment
TRAUMATIC IRIDOCYCLITIS
LENS: ASSOCIATED UVEITIS
Signs and Symptoms
Treatment
Postoperative Uveitis
TUBULAR INTERSTITIAL NEPHRITIS AND UVEITIS (TINU)
MASQUERADE SYNDROMES
SUMMARY AND CONCLUSION
CHAPTER 161:
Intermediate Uveitis: Pars Planitis
ANATOMY
NOMENCLATURE
EPIDEMIOLOGY
CLINICAL FEATURES
NATURAL COURSE, COMPLICATION, AND PROGNOSIS
DIFFERENTIAL DIAGNOSIS
Systemic Association
Ancillary Tests
Ultrasonography
Electrophysiological
Laboratory Investigations
PATHOLOGY29,30
IMMUNOLOGY
HEREDITY
PATHOGENESIS
TREATMENT
Step 1
Step 2
Step 3
Step 4
CATARACT EXTRACTION IN PARS PLANITIS
CONCLUSION
CHAPTER 162:
Posterior Uveitis
DEFINITION
DIFFERENTIAL DIAGNOSIS
INFECTIOUS POSTERIOR UVEITIS
NON-INFECTIOUS POSTERIOR UVEITIS
INFECTIOUS POSTERIOR UVEITIS
Ocular Toxoplasmosis
Toxoplasmosis in Acquired Immunodeficiency Syndrome (AIDS)
Diagnostic Tests for Ocular Toxoplasmosis
Treatment
Ocular Tuberculosis
Treatment
Ocular Toxocariasis
Chronic Endophthalmitis
Posterior Pole Granuloma
Peripheral Granuloma
Atypical Presentations
Differential diagnosis
Diagnostic tests
Ocular Cysticercosis
Acute Retinal Necrosis (ARN) Syndrome
Clinical Features
Etiology
Differential Diagnosis
Treatment
Progressive Outer Retinal Necrosis (PORN)
Treatment
Posterior Uveitis in Acquired Immunodeficiency Syndrome
CMV Retinitis
Visual Loss in CMV Retinitis can be due to following Causes
Management
Endogenous Fungal Endophthalmitis
Treatment
NON-INFECTIOUS POSTERIOR UVEITIS
Birdshot Retinochoroidopathy
Treatment
Multifocal Choroiditis with Panuveitis
Treatment
Diffuse Subretinal Fibrosis
Treatment
Punctate Inner Choroidopathy (PIC)
Treatment
Multiple Evanescent White Dot Syndrome (MEWDS)
Treatment
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE)
Treatment
Serpiginous Choroiditis
Treatment
Acute Retinal Pigment Epithelitis
Treatment
Acute Zonal Occult Outer Retinopathy (AZOOR)
Treatment
Masquerade Syndromes
Malignant Conditions
Non-malignant Conditions
Diagnosis
Treatment
SUMMARY
CHAPTER 163:
Common Panuveitic Entities
INFECTIOUS CAUSES OF PANUVEITIS
SYPHILIS
Introduction
Clinical Features
Uveitis in Syphilis3-6
Diagnosis
Investigations
Treatment
Prognosis
HIV and Syphilis
FUNGAL PANUVEITIS
Introduction
Clinical Features
Etiological Organisms
Symptoms and Signs
Diagnosis
Differential Diagnosis
Treatment
Other Causes of Fungal Panuveitis
Prognosis of Fungal Endophthalmitis
Endogenous Endophthalmitis
POSTSURGICAL UVEITIS
Introduction
Flare-up of Pre-existing Uveitis
ACUTE BACTERIAL ENDOPHTHALMITIS
Clinical Features
Diagnosis
Management
CHRONIC BACTERIAL ENDOPHTHALMITIS
Clinical Features
Diagnosis
Management
FUNGAL ENDOPHTHALMITIS (POST-SURGICAL)
Clinical Features
Diagnosis
Management
Outcome
Lens-induced Uveitis
Clinical Features
Diagnosis
Management
SARCOIDOSIS
Etiology
Clinical Features
Systemic Symptoms
Ocular Manifestations (Table 163.5)
Posterior Segment Findings
Vitreous Involvement
Vascular Involvement
Choroidal Findings
Retinal Findings
Optic Disk Involvement
Causes of Poor Vision
Sarcoidosis in Children
Systemic Involvement (Table 163.6)
Pathology
Diagnosis
Investigations (Table 163.7)
Differential Diagnosis
Tuberculosis
Lyme Disease
Treatment
Anterior Uveitis
Posterior Uveitis
Outcome
SYMPATHETIC OPHTHALMIA
Clinical Features2,34-37
Symptoms
Signs
Diagnosis
Histopathology
Dalen-Fuchs Nodules
Differential Diagnosis
Treatment
Role of Enucleation
Corticosteroids
Other Immunomodulators
Outcome
Vogt-Koyanagi-Harada (VKH) Syndrome
Epidemiology
Clinical Features
Prodromal Stage
Acute Uveitic Stage
Chronic or Convalescent Phase
Chronic Recurrent Phase
Extraocular Signs
Etiology
ANCILLARY INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
Treatment
Prognosis
ADAMANTIADES-BEHçET'S DISEASE (ABD)
Clinical Manifestations
ORAL APHTHOUS ULCERS
Skin Lesions
GENITAL ULCERS
OCULAR DISEASE
Clinical Features
Anterior Uveitis
Retinal Disease
Complications
Differential Diagnosis
Etiopathogenesis
Therapy
CHAPTER 164:
Viral and Rickettsial Uveitis
GENERAL CHARACTERISTICS OF VIRUS
Pathogenesis of Viral Infection
Protection of the Eye against Viruses
ACUTE RETINAL NECROSIS (ARN) SYNDROME
Clinical Features
Complication and Sequelae
Systemic Findings
Differential Diagnosis
Investigations for Diagnosis
Ancillary Tests
Fundus Fluorescein Angiogram (FFA)
Ultrasound
Etiology
Laboratory Tests
Aqueous, Vitreous and Endoretinal Biopsy
Histopathology
Treatment
Medical Therapy
CYTOMEGALOVIRUS
Route of Transmission
Congenital
Acquired
Clinical Features
Symptoms
Signs
Differential Diagnosis
Histopathology
Laboratory Investigations
Treatment
HERPES SIMPLEX VIRUS
Congenital
Aquired
Investigations
Treatment
HERPES ZOSTER VIRUS (HZV) OR VARICELLA ZOSTER VIRUS (VZV)
CHICKENPOX
HERPES ZOSTER OPHTHALMICUS (HZO)
DERMATOME
OCULAR
UVEITIS
HZV RETINITIS
Diagnosis
Treatment
RUBELLA
Differential Diagnosis
Ancillary Tests for Diagnosis
Laboratory Tests
Treatment
EPSTEIN-BARR VIRUS (EBV)
PROGRESSIVE OUTER RETINAL NECROSIS (PORN)
HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNODEFICIENCY SYNDROME
Laboratory Test
Treatment
PRECAUTION AGAINST TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS (HIV)62,63
HUMAN T LYMPHOTROPIC VIRUS TYPE I ASSOCIATED UVEITIS
RIFT VALLEY FEVER RETINITIS
OTHER VIRUSES
RICKETTSIAL UVEITIS
EPIDEMIC TYPHUS
SCRUB TYPHUS
MURINE TYPHUS
BOUTONNEUSE (MARSEILLES) FEVER
Q FEVER
Laboratory Diagnosis
Serological Tests
Prevention
Treatment
CHAPTER 165:
Ocular Toxoplasmosis
LIFE CYCLE
Definitive Hosts
Intermediate Hosts
OCULAR TOXOPLASMOSIS: CONGENITAL VS ACQUIRED
CLINICAL FEATURES
COMPLICATIONS
TOXOPLASMOSIS IN AIDS
DIAGNOSTIC TESTS
Laboratory Tests
Radiologic Investigations
CT Scan and MRI
TREATMENT
Additional Therapeutic Approaches
Cryotherapy
Photocoagulation
Vitrectomy and Lensectomy
CHAPTER 166:
Ciliochoroidal Detachment
ANATOMY
PATHOGENESIS
ETIOLOGY
Conditions Causing Choroidal Detachment
Associated with Ocular Trauma
Associated with Specific Ocular Disease
Associated with Inflammatory Disorders
Associated with Systemic Disease
CLINICAL FEATURES
Choroidal Detachment Due to Filtering Surgery
Choroidal Detachment Following Retinal Detachment Surgery
Uveal Effusion Syndrome
INVESTIGATIONS
Ultrasonography
Ultrasound Biomicroscopy (UBM)
TREATMENT
CHAPTER 167:
Presumed Ocular Tuberculosis
DIAGNOSIS OF PRESUMED OCULAR TUBERCULOSIS (POT)
TUBERCULIN SKIN TEST
ISONIAZID SKIN TEST
Presumed Choroidal Tuberculosis: Secondary Central Serous Chorioretinitis (CSC)
FLUORESCEIN ANGIOGRAPHY
CHAPTER 168:
Fuchs’ Heterochromic Uveitis
HISTORY
TERMINOLOGY
DEFINITION
CLINICAL FEATURES
ETIOLOGY
PATHOLOGY
ROLE OF GENETICS
HLA ASSOCIATION
OCULAR FEATURES
Cornea
Iris
DIFFERENTIAL DIAGNOSIS
INVESTIGATIVE PROCEDURES
Light Microscopy
Electron Microscopy
IMMUNOPATHOLOGY
MANAGEMENT
Management of the Uveitis
Management of the Cataract
Management of Glaucoma
CHAPTER 169:
Serpiginous Choroiditis
CLINICAL FEATURES
Signs
Variations
ANCILLARY INVESTIGATIONS
Fundus Fluorescein Angiography (FFA)
Indocyanine Green Angiography
Electrophysiology
Visual Field
Optical Coherence Tomography
COMPLICATIONS
PATHOGENESIS
DIFFERENTIAL DIAGNOSIS
TREATMENT
CHAPTER 170:
Anterior Uveitis and Arthritis
INTRODUCTION
ANTERIOR UVEITIS
Classification
Specific Entities
HLA-B27 Associated Diseases
Ankylosing Spondylitis
Reiter's Syndrome
Psoriatic Arthritis
Inflammatory Bowel Disease
Management of Uveitis
JUVENILE ARTHRITIS
Classification of Juvenile Arthritis
Juvenile Rheumatoid Arthritis
Juvenile Rheumotoid Arthritis (JRA)
Characteristics of Uveitis in JRA
Risk Factors for Uveitis
Visual Prognosis14
Ocular Complications
Management of Uveitis in JRA
Management of Complications
MISCELLANEOUS DISEASES
RECENT ADVANCES
CHAPTER 171:
Sympathetic Ophthalmia
INCIDENCE
TIME OF ONSET
CLINICAL FEATURES
PATHOLOGY
Immunopathology
Pathogenesis
Granulomatous Inflammations of the Uvea
Tissue Injury
Preservation of Choriocapillaris and Retina
LABORATORY INVESTIGATIONS
MANAGEMENT
Surgical
Medical
OCULAR COMPLICATIONS
CONCLUSION
CHAPTER 172:
Investigational Approach in Uveitis
Investigations in Uveitis1,2
Steps of Approach
Skin Tests
Purified Protein Derivative (PPD) of Tuberculin (Mantoux Test)
Kveim Test
Serological Tests
Antinuclear Antibodies (ANA)
Rheumatoid Factor (RF)
Serum Angiotensin Converting Enzyme (ACE)
Human Leukocyte Antigens (HLA)3
Enzyme-linked Immunosorbent Assay (ELISA) for Infectious Agents
Serological Tests for Toxoplasmosis
Serological Tests for Syphilis
Pathologic Study of Ocular Tissue/Fluid Specimens
Anterior Chamber Paracentesis
Vitreous Aspiration/biopsy4,5
Retinal/retinochoroidal Biopsy
Nonlaboratory Investigations
Uveitic Entities which Usually do not Require Laboratory Investigations
Laboratory Tests for New Uveitic Entities
Lyme Disease
Cytomegalovirus (CMV) Retinitis
Suggested Investigations in Various Types of Uveitic Lesions
Iridocyclitis in a Child (Less than 15 years)
Iridocyclitis in an Adult
Retinitis or Chorioretinitis in a Child (Less than 15 years)
Retinitis or Chorioretinitis in an Adult
CHAPTER 173:
Management of Endogenous Non-infectious Uveitis
INTRODUCTION
INFECTIOUS VERSUS NON-INFECTIOUS UVEITIS
ASSESSMENT OF NON-INFECTIOUS UVEITIS
Degree of Inflammation
Duration of Inflammation
History of Previous Uveitis and its Response to Treatment
Risk of Structural Damage
Response to Initial Treatment
Uveitis Active or Inactive
STEROIDS (TOPICAL, REGIONAL, INTRAVITREAL, AND SYSTEMIC)
NEWER TOPICAL STEROID PREPARATIONS
PERIOCULAR DRUGS
INTRAVITREAL STEROIDS
SYSTEMIC STEROIDS
ADVERSE EFFECTS AND TOXICITY
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
PERIPHERAL RETINAL CRYOPEXY
CYTOTOXIC AND IMMUNOSUPPRESSIVE CHEMOTHERAPY
PARS PLANA VITRECTOMY
ANCILLARY TREATMENT
FUTURE DEVELOPMENTS
SUMMARY AND CONCLUSIONS
CHAPTER 174:
Uveal Malignant Melanoma
CLINICAL PRESENTATION
Complaints
Clinical Appearance
DIAGNOSIS
Clinical Appearance
Differential Diagnosis (Pseudomelanoma)3
Fundus Fluorescein Angiography (FFA)4
Ultrasonography5
Transillumination
Invasive Technique
New Diagnostic Tests
PATHOLOGY7
Pigmentation
Growth Pattern
Histologic Characteristic of Uveal Melanoma Cells
Other Histologic Features Related to Prognosis
TREATMENT MODALITIES
Periodic Observation
Photocoagulation
Sources
Radiotherapy
Local Resection
Enucleation
Exenteration
Chemotherapy and Immunotherapy
New Modalities of Treatment
Ferromagnetic Hyperthermia
SYSTEMIC EVALUATION
Sites of Metastasis
Evaluation for Metastasis
Research
CHAPTER 175:
Intraocular Metastatic Tumors
RETINAL METASTASIS
Ophthalmoscopic Examination
Diagnosis
Differential Diagnosis
MALIGNANT MELANOMA/MELANOCYTOMA
CHOROIDAL NEVI
Localized Choroidal Hemorrhage
MELANOCYTOMA (Figs 175.6A and B)
IRIS NODULES
LEIOMYOMA OF IRIS
Treatment of Metastatic Lesion
PROGNOSIS
CONCLUSION
ACKNOWLEDGEMENT
CHAPTER 176:
Vascular Tumors of the Choroid and Retina
CHOROIDAL HEMANGIOMA
CIRCUMSCRIBED CHOROIDAL HEMANGIOMA
Clinical Features
Diagnosis
Fluorescein Angiography
Indocyanine Green Angiography6
Ultrasonography
Computed Tomography1
Magnetic Resonance Imaging (MRI)
Radioactive Phosphorus uptake Test (The P-32 test)
Pathology
Differential Diagnosis
Amelanotic Choroidal Melanoma
Choroidal Metastasis
Central Serous Retinopathy
Posterior Scleritis16
Management
Photocoagulation
DIFFUSE CHOROIDAL HEMANGIOMA
Clinical Features
Diagnosis
Pathology5
Management
VASCULAR TUMORS OF THE RETINA
CAPILLARY HEMANGIOMA OF THE RETINA
Clinical Findings1
Differential Diagnosis
Pathology33
Diagnosis
Treatment
Systemic Features40
CAVERNOUS HEMANGIOMA OF THE RETINA
Ocular Features1
RACEMOSE HEMANGIOMA
VASOPROLIFERATIVE TUMOR OF THE RETINA
CHAPTER 177:
Intraocular Biopsy Techniques
PREREQUISITES
Indications
Contraindications
Biopsy Techniques
AQUEOUS TAP1
Indications
Procedure
Complications
VITREOUS TAP1(Fig. 177.2)
Indications
Procedure
Vitreous Tap
Diagnostic Vitrectomy (Fig. 177.4)
SPECIMEN HANDLING AND PROCESSING
Complications
FINE NEEDLE ASPIRATION BIOPSY (FNAB)1,5
Indications
Prerequisites
Materials
Procedure
PARS PLANA APPROACH (Fig. 177.5)
CLEAR CORNEAL APPROACH (FIG. 177.9)
TRANSSCLERAL APPROACH
Complications—(Posterior Segment FNAB)
LIMBAL APPROACH (FIG. 177.12)
Complications (Anterior Segment FNAB)
Specimen Handling
CHORIORETINAL BIOPSY1,10
Indications
Prerequisites
Procedure
EXTERNAL APPROACH
Peyman et al1,2
Martin et al10
INTERNAL/ENDORETINAL APPROACH
Freeman et al9
Complications
Excision Biopsy1,11
ANTERIOR SEGMENT TUMORS
External Approach
Internal Approach
POSTERIOR SEGMENT TUMORS
External Approach
Internal Approach
INTERNAL RETINOCHOROIDOTOMY1
RETINA SPARING INTERNAL RESECTION
COMPLICATIONS
HYPOTONY
CHAPTER 178:
Controversies and Preferred Treatment of Malignant Melanoma of the Choroid
CURRENT MANAGEMENT
PERIODIC OBSERVATION
ENUCLEATION
LOCAL RESECTION
INTERNAL RESECTION
Photocoagulation11
Complications
Photochemotherapy13
Radiotherapy
Brachytherapy
SECTION 11: RETINA-VITREOUS
CHAPTER 179:
Anatomy of Retina and Vitreous
EMBRYOLOGY
Retina
Vitreous
ANATOMY OF RETINA
Central Retina
Peripheral Fundus
Structure of Retina
Retinal Pigment Epithelium (RPE)
Photoreceptors
Bipolar Cells
Horizontal Cells
Amacrine Cells
Ganglion Cells
Supporting Structure of Retina
Blood Supply of Retina
ANATOMY OF VITREOUS
Optical Anatomy
BLOOD-RETINAL BARRIER
CHAPTER 180:
Retinal Viewing System: The Diagnostic, Laser and Surgical Lenses
DIRECT OPHTHALMOSCOPY
PROCEDURE
BINOCULAR INDIRECT OPHTHALMOSCOPY
OPTICS OF INDIRECT OPHTHALMOSCOPY
FIELD OF VIEW
MAGNIFICATION
COMPENSATION FOR REFRACTIVE ERROR
EXAMINATION TECHNIQUE
Condensing Lenses
SCLERAL DEPRESSION
FUNDUS EXAMINATION DOCUMENTATION
BIOMICROSCOPY OF THE RETINA
NON-CONTACT LENSES FOR BIOMICROSCOPY
Negative Lens
Positive Aspheric Lenses
CONTACT LENSES FOR BIOMICROSCOPY
Goldmann Three-Mirror Lens
Goldmann Posterior Fundus Contact Lens
LASER LENSES
Panfundoscopic Lens
Mainster Lens
Karichkoff Lens
SURGICAL LENSES
Introduction
CONTACT SYSTEM
Conventional Lenses
OPTICAL PRINCIPLE
Wide-Angle System
NON-CONTACT SYSTEM
Optical Principle of Wide-Angle Lens
BIOM
SDI
CHAPTER 181:
Electrophysiological Tests of the Eye
OCULAR ELECTROPHYSIOLOGY TESTS
THE RATIONALE
TESTING METHODS
Side Effects
THE ELECTROOCULOGRAM (EOG)
Clinical Measurement
Clinical Uses
Limitations of EOG Recording
Fast Oscillations of EOG
ELECTRORETINOGRAM (ERG)
Recording Electrodes (Fig. 181.4)
Reference Electrodes
Ground Electrodes
Flash Stimulus Characteristics10
Precaution
CLINICAL PROTOCOL9,10
ERG Measurements and Recording
Oscillatory Potentials9,10
Normal Values
Reporting the ERG
Pediatric ERG Recording9,10
Origin of 5 Basic ERG Waveforms
Clinical Uses
The Pattern Electroretinogram (PERG)
Recordings and Measurements (Fig. 181.15)
Clinical Uses
Primary Evaluation of Macular Function
Ganglion Cell Dysfunction
VISUAL EVOKED POTENTIAL (VEP)
Recording and Measurement
Normal Waveforms39
Clinical Uses41
MULTIFOCAL ERG AND MULTIFOCAL VEP
FOCAL MACULAR ERG
CONCLUSION
CHAPTER 182:
Clinical Application of Optical Coherence Tomography
PRINCIPLES
PRACTICE
CLINICAL APPLICATIONS
Macular Hole (Table 182.1)
Epiretinal Membrane
Macular Edema
Vitreomacular Traction Syndrome
IDIOPATHIC CENTRAL SEROUS CHOROIDORETINOPATHY
Age-related Macular Degeneration
SUMMARY
CHAPTER 183:
Fluorescein Angiography
PHARMACOLOGY
Characteristics and Uses
Technique
Fluorescein Solution
Injecting the Fluorescein
Monochromatic Fundus Photography
Stereoscopic Fundus Photography
Fluorescein Angiographic Sequence
Normal Fluorescein Angiogram
Anatomic and Clinical Considerations
Angiographic Characteristics
Fluorescein Angiographic Characteristics of Optic Disk
Interpretation of Fluorescein Angiography
Autofluorescence
Pseudofluorescence
Transmission or Window Defect
Leakage
Staining
Filling Defects
Blocked Fluorescence
Retrofluorescence
Hypofluorescence
Hyperfluorescence
Conclusion and Applications
CHAPTER 184:
Indocyanine Green Angiography (ICGA)
HISTORY
PHYSICAL AND PHARMACOLOGIC PROPERTIES
DOSAGE
CLINICAL INTERPRETATION
CLINICAL APPLICATIONS
Age-related Macular Degeneration
POSTERIOR UVEITIS
IDIOPATHIC POLYPOIDAL CHOROIDAL VASCULOPATHY
CENTRAL SEROUS CHORIORETINOPATHY
CONCLUSION
CHAPTER 185:
Peripheral Retina, Pars Plana and Vitreous Base
INTRODUCTION
PERIPHERAL RETINA
Developmental Anatomy
Applied Anatomy
Microanatomy
Lesions of the Peripheral Retina
Development of the Peripheral Retina
Degenerative Lesions
DEGENERATIVE LESIONS PREDISPOSING TO RETINAL DETACHMENT
Lattice Degeneration
Snail Track Degeneration
Degenerative Retinoschisis and Peripheral Cystoid Degeneration
White with Pressure and White without Pressure
Retinal Tuft
Cystic and Non-cystic Retinal Tuft
Zonular Tractional Retinal Tuft
Partial Thickness Retina Tear
Full Thickness Retina Tear
Retinal Hole
DEGENERATIVE LESIONS NOT PREDISPOSING TO RETINAL DETACHMENTS
Pavingstone Degeneration
PARS PLANA
Developmental Anatomy
Applied Anatomy
Microanatomy
SURGICAL ANATOMY
LESIONS OF PARS PLANA
Pars Plana Cysts
VITREOUS BASE
Developmental Anatomy
Applied Anatomy
Microanatomy
CLINICAL EXAMINATION TECHNIQUE
Scleral Depression and Indirect Ophthalmoscopy
TECHNIQUE OF SCLERAL DEPRESSION
DOCUMENTATION
Fundus Drawing
Color Codes Used for Documentation
Video Indirect Ophthalmoscopy
SLIT LAMP EXAMINATION OF FUNDUS PERIPHERY
Slit Lamp Indirect Ophthalmoscopy
Technique
Goldmann Three Mirror Examination
Technique
ACKNOWLEDGEMENT
CHAPTER 186:
Retinal Telangiectasis
GROUP 1
GROUP 2
Group 2A
Natural Course
Differential Diagnosis
Pathogenesis
Treatment
Group 2B
GROUP 3
Group 3A
Group 3B
SUMMARY
CHAPTER 187:
Age-related Macular Degeneration
PREVALENCE
RISK FACTORS
Demographic Factors
Lifestyle Factors
Cardiovascular Factors
Ocular Risk Factors
AGING CHANGES IN RPE AND BRUCH'S MEMBRANE
Classification
Clinical Features
Indocyanine Green (ICG) and Fluorescein Fundus Angiography (FFA)
Classic CNV
Occult CNV
TREATMENT OF DRY AMD AND PREVENTION OF EXUDATIVE CNV
Nutritional Supplements
AREDS Findings
Laser Photocoagulation of Eyes with Drusen
TREATMENT OF EXUDATIVE AMD
Thermal Laser Treatment
Photodynamic Therapy (PDT)
Alternative Treatments
Transpupillary Thermotherapy (TTT)
Radiation Therapy
Submacular Surgery
Retinal Translocation
Feeder Vessel Photocoagulation
Pharmacologic Intervention
Low Vision Aids
FUTURE DIRECTIONS
RPE Transplantation
Photoreceptor Cell Transplantation
Gene Therapy
MICROELECTRONIC VISUAL IMPLANTS
Subretinal Implants
Epiretinal Implants
Cortical Implants
Perspectives
Molecular Basis of AMD
Genetic Basis of AMD
Proteomics111,112
Animal Models
CHAPTER 188:
Endophthalmitis
CLASSIFICATION
Acute Postoperative Endophthalmitis
Bleb-associated Endophthalmitis
Chronic Endophthalmitis
Traumatic Endophthalmitis
Endogenous Endophthalmitis
DIAGNOSIS
Clinical Diagnosis
Microbiological Diagnosis
Microscopy
Culture
Antimicrobial Susceptibility Testing
Molecular Diagnosis
MANAGEMENT
Principles
History of Endophthalmitis Treatment
Antibiotics
Intraocular Antibiotics
Systemic Antibiotics
Corticosteroids
Vitrectomy
COMPLICATIONS
OUTCOME
PROPHYLAXIS
SUMMARY
Endophthalmitis Vitrectomy Study
TREATMENT
Treatment Assignment
Study Medications
Major Results
Treatment Recommendations
Vitrectomy Vs Vitreous Tap
Systemic Antibiotics
CHAPTER 189:
Etiopathogenesis of Retinal Detachment
HISTORY OF RETINAL DETACHMENT SURGERY
EXAMINATION OF THE PATIENT
INDIRECT OPHTHALMOSCOPY
Principle
Instrumentation
Patient Preparation
Method
CONDENSING LENSES
SCLERAL DEPRESSION
Types of Scleral Depressors
NORMAL RETINAL PERIPHERY AND PERIPHERAL LESIONS
Lesions of the Peripheral Retina
Vitreoretinal Adhesions Predisposing to Retinal Breaks
RETINAL DETACHMENT
Pathogenesis of Nontraumatic Rhegmatogenous Retinal Detachment
Formation of Retinal Breaks
Precipitating Factors of Retinal Detachment
Myopia
Epiretinal Membrane
Vitreous Hemorrhage
Chorioretinal Inflammation
Trauma
Penetrating Injuries
Predisposing Factors
Sex and Race
Heredity
Congenital Eye Anomalies
Miscellaneous
Clinical Features of Retinal Detachment
Symptoms
Signs
Differential Diagnosis
Acquired Retinoschisis
Congenital Retinoschisis
Nonrhegmatogenous Retinal Detachment
Retinal Detachment Accompanying Choroidal Detachment
Retinal Edema
Retinal Detachment Due to Concomitant Disease
Vitreous Changes Mimicking Retinal Detachment
Characteristics of the Types of Retinal Detachment
Aphakic and Pseudophakic Retinal Detachment
Retinal Dialysis
Giant Retinal Tears
Macular Holes
Choroidal Coloboma and Retinal Detachment
Exudative Retinal Detachment
Etiology
Clinical Features and Diagnosis
Management of Exudative RD
Some Rare Entities of Exudative RD
Idiopathic Uveal Effusion Syndrome
Nanophthalmos
Familial Exudative Vitreoretinopathy (FEVR)
Traction Retinal Detachment (TRD)
Important Causes
Pathogenesis of TRD
Management of TRD
CHAPTER 190:
Principles and Alternative Surgical Techniques for Retinal Detachment
HISTORICAL REVIEW
RATIONALE AND GOALS OF RETINAL SURGERY
ANESTHESIA FOR SCLERAL BUCKLING
PREPARATION OF THE OPERATIVE FIELD
SURGICAL EXPOSURE
LOCALIZATION OF RETINAL BREAKS
TREATMENT OF RETINAL BREAKS
CLOSURE OF RETINAL BREAKS
Buckling Materials
Configuration of Buckle
Intrascleral Implants
Episcleral Exoplants
MANAGEMENT OF SUBRETINAL FLUID
Nondrainage Technique
Drainage Technique
INTRAOPERATIVE COMPLICATIONS
Drainage Complications
ALTERNATIVE TECHNIQUES
Orbital/Episcleral (Lincoff) Balloon
Pneumatic Retinopexy
Suprachoroidal Implantation
DACE (Drainage, Air, Cryo, and Exoplant) Technique50
Primary Vitrectomy for Uncomplicated Rhegmatogenous Retinal Detachment
SUMMARY
CHAPTER 191:
Ocular Ischemic Syndrome and Retinal Arterial Obstruction
OCULAR ISCHEMIC SYNDROME
Symptoms and Signs
Investigations
Fundus Fluorescein Angiography (FFA)
Electroretinography
Carotid Angiography
Differential Diagnosis
Systemic Associations
Treatment
CENTRAL RETINAL ARTERY OCCLUSION
Signs
Ocular Investigations in CRAO
Pathophysiologic Mechanisms
Associated Diseases
Management
OPHTHALMIC ARTERY OBSTRUCTION
BRANCH RETINAL ARTERY OCCLUSION
CILIORETINAL ARTERY OCCLUSION
COTTON-WOOL SPOTS
CHAPTER 192:
Retinal Venous Occlusive Diseases
CENTRAL RETINAL VEIN OCCLUSION (CRVO)
Demographic Characteristics
Pathogenesis of CRVO
Clinical Characteristics of Nonischemic and Ischemic CRVO (Figs 192.1 and 192.2)
Visual Acuity
Perimetry
Relative Afferent Pupillary Defect (RAPD)
Ophthalmoscopy
Fundus Fluorescein Angiography (FFA)
Electroretinography (ERG)
Ocular Neovascularization
Newer Techniques
Natural Course and Complications
Macular Edema
Ocular Neovascularization (NVZ)
Vitreous Hemorrhage
Cilioretinal Artery Occlusion
Systemic Diseases and CRVO
Evaluation of Systemic Disease Risk Factors in the Presence of CRVO
Management
Medical Therapies
Laser Photocoagulation
Technique
Complications
Other Therapies
CONCLUSION
BRANCH RETINAL VEIN OCCLUSION (BRVO)
Clinical Features of BRVO (Fig. 192.9)
Ophthalmoscopic Features and Fluoroscein Angiography (Fig. 192.10)
Complications of BRVO
Macular Changes
Neovascularization
Retinal Detachment
Associations of BRVO
Ocular Associations
Systemic Associations
Management of BRVO
Medical Management
Laser Photocoagulation
HEMICENTRAL RETINAL VEIN OCCLUSION (HRVO) (Fig. 192.13)
CHAPTER 193:
Ocular Manifestations in Systemic Hypertension
ARTERIOSCLEROSIS
PATHOGENESIS OF OCULAR CHANGES IN HYPERTENSION
CLINICAL FINDINGS
Hypertensive Choroidopathy
Pathophysiology
Hypertensive Retinopathy
Vasoconstrictive Phase
Sclerotic Phase
Exudative Phase
Complications of Sclerotic Phase
Pathophysiology
Hypertensive Optic Neuropathy
Pathophysiology
Grading of Hypertensive Retinopathy
Management of Patients with Hypertensive Retinopathy
CONCLUSION
CHAPTER 194:
Diabetic Retinopathy
RISK FACTORS
Duration of Diabetes
Age
Control of Blood Glucose Levels
Promptness of Referral
SYSTEMIC FACTORS
Nephropathy
Systemic Hypertension
Pregnancy
GENETIC FACTORS
CLINICAL FEATURES OF DIABETIC RETINOPATHY
Nonproliferative Diabetic Retinopathy (Figs 194.1A and B)
Macular Edema in Diabetic Retinopathy
Proliferative Diabetic Retinopathy (PDR) (Figs 194.2A and B and 194.3A to C)
Pathogenesis
Clinical Features of PDR
MANAGEMENT OF DIABETIC RETINOPATHY
Medical Treatment
Diabetes Control and Complications Trial (DCCT) 21-27, 59,60
Antiplatelet Therapy
Lipid Reduction
Laser Photocoagulation in Diabetic Retinopathy
Panretinal Photocoagulation (PRP) (Figs 194.4A and B and 194.5A and B)
Treatment Techniques
Focal Photocoagulation (Figs 194.6A and B)
Complications of Laser Treatment
Peripheral Retinal Cryoablation
Technique
Vitrectomy in Proliferative Diabetic Retinopathy
Surgical Objectives and Techniques
Outcome
CONCLUSION
CHAPTER 195:
Vitreous Hemorrhage
TYPES OF VITREOUS HEMORRHAGE
Intravitreal Hemorrhage
Subvitreal Hemorrhage
CAUSES OF VITREOUS HEMORRHAGE
ETIOPATHOLOGY OF VITREOUS HEMORRHAGE
Vitreous Barriers
FATE OF VITREOUS HEMORRHAGE
DIAGNOSIS and INVESTIGATIONS
Diagnostic Ultrasound
MRI
TREATMENT
COMPLICATIONS OF VITREOUS HEMORRHAGE
VITREOUS HEMORRHAGE IN VITRECTOMIZED EYES
CHAPTER 196:
Proliferative Vitreoretinopathy
PATHOGENESIS
TERMINOLOGY AND CLASSIFICATION
Risk Factors
Clinical Features
Investigations
MANAGEMENT
Prophylaxis
Surgical Management
Adjuvant Therapy
CHAPTER 197:
Retinitis Pigmentosa and Associated Retinal Degenerations
EPIDEMIOLOGY
SYMPTOMS1,2
SIGNS
Evaluation and Investigations
Variants
MANAGEMENT
MOLECULAR GENETICS
Current State of Research to Treat and Cure Retinal Degenerative Diseases Like RP
Vitamin and Other Nutritional Supplemental Therapy in RP and Related Disorders
CHAPTER 198:
Familial Exudative Vitreoretinopathy
HISTORY
EPIDEMIOLOGY
ETIOLOGY
HISTOPATHOLOGY
PLATELET ABNORMALITIES
INHERITANCE
ATTEMPTS AT GRADING FEVR
CLINICAL FEATURES AND NATURAL HISTORY
Stage 1 (Mild FEVR)
Stage 2 (Moderate FEVR)
Stage 3 (Severe/Advanced FEVR)
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Family Screening
Observation
Cryotherapy and Photocoagulation
Scleral Buckling and Vitrectomy
SUMMARY
CHAPTER 199:
Degenerative Myopia
PATHOGENESIS
HISTOPATHOLOGY
Ocular Manifestations
TREATMENT
CHAPTER 200:
CMV Retinitis
CLINICAL FEATURES
Management of CMV Retinitis
Treatment of Active Retinitis
Anti-CMV Therapy
Immune Reconstitution Therapy
Toxic Effects of Anti-CMV Therapy
Prophylaxis
Progression and Recurrence
Treatment of Retinal Detachment
Immune Recovery Uveitis
CHAPTER 201:
Eales’ Disease
CLINICAL FEATURES
Epidemiology
Symptoms
Signs
Inflammation
Nonperfusion
Neovascularization
Other Abnormalities
Classification and Natural Course
ETIOPATHOGENESIS
Immunological Studies
Pathology
MANAGEMENT
Corticosteroids
Anterior Retinal Cryotherapy (ARC)
Photocoagulation
Vitrectomy
FUTURE RESEARCH
CHAPTER 202:
Coats’ Disease
INTRODUCTION AND HISTORY
ETIOLOGY AND PATHOPHYSIOLOGY
DEMOGRAPHICS
CLINICAL PRESENTATION
Fundus Fluorescein Angiography
HISTOPATHOLOGY
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS AND ANCILLARY TESTING
SYSTEMIC ASSOCIATION
MANAGEMENT
PROGNOSIS
CHAPTER 203:
Surgery for Macular Diseases
EPIMACULAR PROLIFERATION
Etiology
Clinical Features
Pathology
Management
Surgical Technique
Results
Complications
VITREOMACULAR TRACTION SYNDROME
MACULAR HOLE
PATHOGENESIS AND PATHOLOGY
Classification
Clinical Examination
Natural History
Management
Indications
Basic Surgical Technique
Use of Adjuvants
Postoperative Follow-up
Alternative Techniques
Complications
SUBMACULAR HEMORRHAGE
Indications for Surgical Intervention
Alternative Techniques
Results
SUBRETINAL NEOVASCULARIZATION (Figs 203.10 to 203.13)
Indications
Surgical Technique
SUBMACULAR CYSTICERCOSIS
CHAPTER 204:
Perfluorocarbon Liquids and Silicone Oil in Vitreoretinal Surgery
PERFLUOROCARBON LIQUIDS (PFCL)
Applications of PFCL
Proliferative Vitreoretinopathy (PVR)
Proliferative Diabetic Retinopathy
Giant Retinal Tears
Trauma
Retinal Detachment in Acquired Immunodeficiency Syndrome
Posteriorly Dislocated Crystalline Lens and Intraocular Lens
Surgical Excision of Subretinal Membrane
Retinal Incarceration
Endophthalmitis
Massive Subretinal Hemorrhage
Retinopathy of Prematurity
Retinal Detachments Associated with Choroidal Coloboma
Retinal Detachments Associated with Posterior Retinal Breaks
Suprachoroidal Hemorrhage
Complications of PFCL
SILICONE OIL
Applications of Silicone Oil
Proliferative Vitreoretinopathy (PVR)
Proliferative Diabetic Retinopathy
Gaint Retinal Tears
Trauma
Retinal Detachment in Acquired Immunodeficiency Syndrome
Silicone Oil and Fluorosilicone as intraoperative Tool
Complications of Silicone Oil
Combination of PFCL and Silicone Oil
CHAPTER 205:
Management of Giant Retinal Tears
CLINICAL EVALUATION
SURGICAL MANAGEMENT
Scleral Buckling
Lensectomy
Vitrectomy
Perfluorocarbon Liquid (PFCL)
Retinectomy
Endolaser
Fluid-Gas Exchange
PFCL-Silicone Oil Exchange
Choice of Retinal Tamponade
Surgical Management of GRT with PVR
Results
FELLOW EYES OF GRT
Photocoagulation
Scleral Buckling
Prophylactic Scleral Buckling in High Risk Fellow Eyes
SUMMARY
CHAPTER 206:
Principles and Techniques of Internal Tamponade for Retinal Detachment
INTERNAL TAMPONADE
Surface Tension
How a Bubble Works?
Clinical Application of Intraocular Tamponade
Fluid-Air Exchange and Internal Drainage
Gas Mixtures
Silicone Oil
CONCLUSION
CHAPTER 207:
Retinotomy and Retinectomy
INTRODUCTION
INDICATIONS FOR RETINOTOMY
Indications for Relaxing Retinotomy and Retinectomy
TECHNIQUES OF RETINOTOMY
Technique of Relaxing Retinotomy and Retinectomy
COMPLICATIONS OF RETINOTOMY AND RETINECTOMY
CHAPTER 208:
Subretinal Surgery
SUBFOVEAL CHOROIDAL NEOVASCULARIZATION
Management
Case Selection
Instrumentation
Surgical Technique
Complications
Postoperative Management
Adjuncts to Surgery
Results
Feasibility of Surgical Excision of Subfoveal Neovascular Membranes
Retinotomy and Foveal Translocation for Surgical Management of Subfoveal Choroidal Neovascular Membranes
SUBMACULAR HEMORRHAGE
Management
Case Selection
Surgical Technique
Results
Complications
Submacular Surgery Trial
SUBRETINAL STRANDS IN PROLIFERATIVE VITREORETINOPATHY
Management
Complications
CHAPTER 209:
Scleral Buckling: Concepts, Materials and Techniques
INTRODUCTION
TYPES AND CLASSIFICATIONS OF SCLERAL BUCKLING
Material of the Buckle
Materials Used in the Past
Currently Used Materials
Newer Materials
Length of the Buckle
Orientation of the Buckle
Placement of the Buckle
Life of the Buckling Effect
Shape of the Buckle
Techniques of Scleral Buckling
Exoplant Technique
Implant Techniques
Microsurgery of Retinal Detachment
ALTERNATIVE TECHNIQUES OF BUCKLING
ALTERNATIVES OF SCLERAL BUCKLING
FATE OF THE BUCKLE
COMPLICATIONS OF SCLERAL BUCKLING
Intraoperative Complications
Postoperative Complications
CHAPTER 210:
Pars Plana Surgery
PRINCIPLES OF VITREOUS SURGERY
INDICATIONS OF VITREOUS SURGERY
TYPES OF VITRECTOMY
INSTRUMENTATION
Illumination
Infusion
Suction
Cutting
FULL FUNCTION SYSTEM: PEYMAN VITREOPHAGE
ACCESSORY INSTRUMENTATION
VITREOUS SUBSTITUTES (Also see Chapter 211)
INDICATIONS FOR VITRECTOMY
Clinical Guidelines
VITRECTOMY TECHNIQUES
THE MANAGEMENT OF EPIRETINAL MEMBRANES
Vitrectomy for Vitreous Hemorrhage
Vitrectomy for Diabetic Retinopathy
Vitrectomy for Eales’ Disease
Vitrectomy for Retinal Detachment
Giant Retinal Breaks
Proliferative Vitreoretinopathy (PVR)
Vitrectomy for Ocular Trauma
Vitrectomy for Intraocular Foreign Bodies
Vitrectomy for Endophthalmitis (Refer to Ch. 188)
Vitrectomy for Macular Holes
Submacular Surgery
Vitrectomy for Anterior Segment Disorders
VITREOUS COMPLICATIONS IN THE ANTERIOR SEGMENT
COMPLICATIONS OF PARS PLANA SURGERY
Intraoperative Complications
Postoperative Complications
CHAPTER 211:
Vitreous Substitutes
INTRAOCULAR GASES
Characteristics of Gases
Indications10,11
Postoperative Care
Complications
Contraindications
SILICONE OIL
Chemical Properties of Silicone Oil14
Mode of Action15
Change in Optics16
Indications for Use of Silicone Oils
Complications23
PERFLUOROCARBON LIQUIDS (PFCL)
Available Compounds
Uses of PFCL
Complications
Miscellaneous Vitreous Substitutes
CHAPTER 212:
Laser Application in Retinal Disorders
TYPES OF LASER-TISSUE INTERACTIONS
Photodisruptive
Photochemical
Photoablative
Photocoagulative
Selecting Wavelength for Retinal Disorders3-5
Types of Lasers
Delivery Systems
Factors Affecting the Energy Delivered (Slit Lamp Delivery)
Types of Lenses to be Used in Slit Lamp Delivery System
LASER IN POSTERIOR SEGMENT DISORDERS
Diabetic Retinopathy
CSME as defined by ETDRS10,11
Central Retinal Vein Occlusion (CRVO)
Branch Retinal Vein Occlusion (BRVO)
Eales'Disease
Central Serous Retinopathy (CSR)
Age-related Macular Degeneration (AMD)
Fundal Vascular Lesions
Choroidal Melanoma31
Retinoblastoma32
Retinal Breaks33
MISCELLANEOUS APPLICATIONS
CHAPTER 213:
Retinoschisis
DEGENERATIVE OR SENILE RETINOSCHISIS
X-LINKED OR JUVENILE RETINOSCHISIS
CLINICAL FEATURES AND NATURAL COURSE
TREATMENT
CHAPTER 214:
Central Serous Chorioretinopathy
INDOCYANINE GREEN ANGIOGRAPHY
Bullous Central Serous Chorioretinopathy
Associated Fundus Finding
CSC in Older Adults
CSC in Women
Pathogenesis
Differential Diagnosis
Choroidal Neovascular Membrane
VKH
Optic Disc Pit
Posterior Scleritis
Rhegmatogenous Retinal Detachment
Natural History
TREATMENT
CHAPTER 215:
Epiretinal Membrane
TYPES AND CAUSES
TREATMENT
CHAPTER 216:
Ocular Ischemic Syndrome
ETIOLOGY
PATHOGENESIS
CLINICAL FEATURES
SYMPTOMS
Visual Loss
Pain
Visual Acuity
Anterior Segment
Posterior Segment
ANCILLARY STUDIES
Fluorescein Fundus Angiography (FFA)
Electroretinography (ERG)
Carotid Artery Imaging
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Aims of Management
CHAPTER 217:
Management of Dislocated Nucleus
INCIDENCE OF DISLOCATED LENS FRAGMENTS
RISK FACTORS FOR POSTERIOR DISLOCATION OF LENS FRAGMENTS
PROBLEMS OF RETAINED LENS MATTER
Intraocular Inflammation
Glaucoma
Corneal Edema
Retinal Tear and Detachment
Vitreous Hemorrhage
Cystoid Macular Edema
ROLE OF THE PRIMARY SURGEON
TIMING OF PARS PLANA VITRECTOMY
Technique of Pars Plana Vitrectomy
Perfluorocarbon Liquids
Complications of Pars Plana Vitrectomy
Retinal Damage
Glaucoma
Corneal Edema
OUTCOME
RECOMMENDATIONS
Do's
Don'ts
CHAPTER 218:
Laser Tissue Interactions
LIGHT ABSORPTION
THERMAL EFFECTS
Grading of Photocoagulation Burns
Chorioretinal Photocoagulation
Vascular Photocoagulation
Photodynamic Therapy (PDT)— The Non-thermal Laser
CHAPTER 219:
Principles of Lasers in Retinal Diseases
PRINCIPLES
LASER OUTPUT MODES
Laser Media
Delivery Systems
APPENDIX:
Some Ophthalmological Eponyms
INDEX
TOC
Index
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