Ophthalmic Surgery—The Cutting Edge Sandeep Saxena
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1Ophthalmic Surgery: The Cutting Edge2
3Ophthalmic Surgery: The Cutting Edge
Sandeep Saxena MS MAMS Associate Professor, Department of Ophthalmology Member, KGMC Institute of Clinical Epidemiology King George's Medical University Lucknow, India Member, National Academy of Medical Sciences, India Fellow, Barnes Retina Institute and Anheuser Busch Eye Institute, St Louis, USA Fellow, New York-Presbyterian Hospital, New York, USA Visiting Professor, University of North Carolina at Chapel Hill, Chapel Hill, USA
4Published by
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Jaypee Brothers Medical Publishers (P) Ltd
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Ophthalmic Surgery—The Cutting Edge
© 2006, Sandeep Saxena
All rights reserved. No part of this publication and Interactive DVD Roms should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2006
9788180616341
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5“When you were born, you cried while the world rejoiced.
Live your life in such a way that when you die, the world cries while you rejoice.”
— Ancient Sanskrit saying
To
My Parents
Dr RC Saxena and Mrs Madhu Saxena
and my family
Sangeeta, Shreeya and Aishwarya
“The tragedy of life is not death, but what we let die inside of us while we live.”
— Norman Cousins6
7Global Contributors
FOR BOOK CHAPTERS AND SURGICAL VIDEOS
8
9
10
11Foreword
Ophthalmology is one of the most technology driven disciplines of medicine. Rapid technological advances in related areas have had dramatic impacts in terms of improvements in the diagnostic and surgical armamentaria of the ophthalmologist. They have also led to greater understanding of the pathogenetic mechanisms and, thereby, to better management of common ophthalmic disorders. Treatment modalities are now more innovative and more sharply focused on the causative mechanisms.
This book aims at updating knowledge of the reader on modern diagnostic practices and the contemporary ‘state of the art’ in ophthalmic surgery. It is a comprehensive text combined with visual references (figures and videos), of important surgical procedures. Chapters on corneal and refractive surgery, advances in intraocular lens materials and designs, diagnostic tests for glaucoma and vitreoretinal diseases and bimanual microphacoemulsification are excellent. Well written topics on small incision cataract surgery, pediatric cataract surgery, laser photocoagulation, photodynamic therapy, transpupillary thermotherapy, vitreoretinal surgeries and macular and submacular surgeries including macular translocation add to the value of this book. Diagnostic tests aiding orbital surgeries, together with, surgical strategies in uveitis, are innovative additions.
Dr Sandeep Saxena has compiled an excellent collection of chapters, all written by experts in their respective fields. I am certain this book will make its space on the tables of all postgraduate students and ophthalmic surgeons.
 
Dipak Kumar ms
Professor and Head
Department of Ophthalmology
King George's Medical University
Lucknow
India
12
13Foreword
Ophthalmic surgery is a continuously advancing field as new technologies are being introduced at a rapid rate. As new lasers and instruments are introduced, the ophthalmic surgeon must learn their intricacies as he begins to apply them to treatment of ocular disease. In turn, the adoption of new technology brings with it the need to learn new skills and develop new treatment algorithms. Advancing capabilities furthermore allow intervention for new indications. As techniques, indications, and equipment evolve, better outcomes result but may also be accompanied by new sets of complications. Keeping up with these changes is a major imperative throughout the ophthalmologist's career.
New technology and surgical approaches must be adapted to the specific socioeconomic conditions and disease presentations in different parts of the world. One area or country may see different diseases or disease manifestations than another, and may have different systems for financing new technology.
No one ophthalmologist can be highly expert in all facets of ophthalmic surgery. In this challenging intellectual environment a text bringing together respected authors from multiple subspecialties is welcome. Dr Sandeep Saxena has gathered a distinguished group of experts to address the current status of eye surgery. The subjects include new diagnostic instruments and have multiple chapters on individual surgical problems. This text has an excellent compilation of lucid color figures and surgical videos. This book has contributors from around the globe. This is in fact the first complete ophthalmic surgery textbook from Southeast Asia for practicing ophthalmologists and residents.
Dr Saxena is an extraordinarily gifted and energetic surgeon and academician who, along with his fellow authors, has produced a book, which is an important contribution to contemporary ophthalmic education. Dr. Saxena and his colleagues are to be congratulated for an exemplary effort which will be of great value to the readers. I heartedly congratulate them all on their success.
 
Travis A Meredith md
Sterling A Barrett Distinguished Professor
Chairman, Department of Ophthalmology
University of North Carolina
Chapel Hill
USA
14
15Preface
Ophthalmology is a dynamic specialty and one of the most advancing disciplines of medicine. With the evolution of new diagnostic and therapeutic modalities, the ophthalmologist has become more involved in decision-making for patients. The challenge facing the ophthalmologist lies in maintaining an up-to-date practical knowledge.
The earliest attempts to record and describe techniques of ophthalmic surgery date back centuries before Hippocrates. They include the Sanskrit texts of Susruta and Baghbata on cataract and the Egyptian papyri on epilation. Old concepts change and new ideas are plentiful. Everything is difficult before it becomes easy.
Ophthalmic Surgery: The Cutting Edge provides a comprehensive text combined with integrated visual reference, in the form of black and white and colored figures and numerous surgical videos, of the important surgical subspecialties of ophthalmology. This book attempts to update the state of art in ophthalmic surgery in a lucid, authoritative and well-illustrated manner. Most of the techniques described have been accepted and form the background of modern ophthalmic surgery.
The value of this book lies in the quality and expertise of the text chapters and surgical video contributors from around the globe. State-of-the-art anterior segment surgeries such as corneal and refractive surgeries, glaucoma surgeries, phacoemulsification, bimanual microphacoemulsification, small incision cataract surgery and pediatric cataract surgery have been included. Posterior segment surgeries such as laser photocoagulation, photodynamic therapy, transpupillary thermotherapy, vitreoretinal surgeries and macular and submacular surgeries including macular translocation have also been included. Surgical strategies in uveitis, strabismus, lid, orbit and intraocular tumors have also been presented. Advances in phacoemulsification technology including cold phaco, intraocular lens material and designs, plasma blade, and vitreoretinal surgery add further to this text. Diagnostic tests aiding glaucoma surgery and vitreoretinal surgery are novel additions.
This book is intended for the experienced ophthalmologists, postgraduates as well as those in training. It is hoped that this book will be sufficiently comprehensive to aid the ophthalmic surgeon in performing competent surgery and in the management of complications. This pragmatic book provides an understanding of surgical techniques so important to the everyday practice of ophthalmology.
 
Sandeep Saxena