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
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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
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A 14, Sector 60, Noida
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.”
7Global Contributors
FOR BOOK CHAPTERS AND SURGICAL VIDEOS
- Amar Agarwal ms frcs frcophth
- Eye Research Center and
- Dr Agarwal's Group of Eye Hospitals
- Chennai, Bangalore, Trichy, India and
- Dubai, United Arab Emirates
- Athiya Agarwal md frsh do
- Eye Research Center and
- Dr Agarwal's Group of Eye Hospitals
- Chennai, Bangalore, Trichy, India and
- Dubai, United Arab Emirates
- Sunita Agarwal ms fsvh do
- Eye Research Center and
- Dr Agarwal's Group of Eye Hospitals
- Chennai, Bangalore, Trichy, India and
- Dubai, United Arab Emirates
- Levent Akduman md
- Assistant Professor
- St Louis University Eye Institute
- St Louis University
- St Louis, USA
- David J Apple md
- Professor of Ophthalmology and Pathology
- Director, David J Apple, MD Laboratories
- for Ophthalmic Device Research
- John A. Moran Eye Center
- Department of Ophthalmology and
- Visual Sciences, University of Utah
- Salt Lake City, USA
- M Baskaran do dnb
- Consultant
- Glaucoma Service
- Sankara Nethralaya
- Chennai, India
- Sudhank Bharti md
- Chief, Cornea Services and Medical Director
- Bharti Eye Foundation
- New Delhi, India
- Shashi K Bhasker ms
- Assistant Professor
- Department of Ophthalmology
- King George's Medical University
- Lucknow, India
- Frank A Billson ao mbbs franzco fracs frcs (edin) frcophth frcs facs
- Founding Professor of Ophthalmology
- Founding Director Save Sight Institute
- Head of Discipline of Ophthalmology and
- Visual Sciences, University of Sydney
- Campus of Sydney Hospital and
- Sydney Eye Hospital
- Sydney, Australia
- Gagandeep S Brar ms
- Assistant Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh, India
- David F Chang md
- Clinical Professor of Ophthalmology
- University of California, Altos Eye Physicians
- Los Altos, USA
- Sanjay Chaudhary ms
- Chaudhary Eye Center
- New Delhi, India
- Rohan Chawla md
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Robert J Cionni md
- Medical Director
- Cincinnati Eye Institute
- Cincinnati, USA
- Minas T Coroneo md franzco
- Professor and Chairman
- Department of Ophthalmology
- University of New South Wales
- Prince of Wales Hospital
- Randwick, Australia
- Tanuj Dada md
- Assistant Professor
- Glaucoma Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Sachi Devi ms
- Glaucoma Service, Sankara Nethralaya
- Chennai, India
- Kumar J Doctor ms
- Doctor Eye Institute
- Mumbai, India
- Satpal Garg md
- Professor
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Ronnie George ms do dnb
- Consultant
- Glaucoma Service, Sankara Nethralaya
- Chennai, India.
- Lingam Gopal ms dnb frcs
- Assistant Director and
- Head, Vitreoretinal Service
- Sankara Nethralaya
- Chennai, India
- Amod Gupta ms
- Professor and Head
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh, India
- Vishali Gupta ms
- Assistant Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh, India
- Albrecht Hennig md
- Program Director
- Sangarmatha Choudhary Eye Hospital
- Lahan, Nepal
- Nancy M Holekamp md
- Clinical Assistant Professor of Ophthalmology
- Barnes Retina Institute
- Washington University School of Medicine
- St. Louis, USA
- Santosh G Honavar md facs
- Director, Ophthalmic Plastic Surgery
- Orbital Diseases and Ocular Oncology
- LV Prasad Eye Institute
- Hyderabad, India
- Nazimul Hussain ms
- Consultant
- Smt. Kannuri Santhamma Retina
- Vitreous Center
- LV Prasad Eye Institute
- Hyderabad, India
- Andrea M Izak md
- Formerly, Instructor
- David J Apple, MD Laboratories for Ophthalmic Device Research
- John A Moran Eye Center
- Department of Ophthalmology and
- Visual Sciences, University of Utah
- Salt Lake City, USA
- Mahmout Kaskaloglu md
- Professor of Ophthalmology
- Department of Ophthalmology
- Ege University
- Izmir, Turkey
- Sushmita Kaushik ms
- Assistant Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh, India
- Poonam Kishore ms
- Associate Professor
- Department of Ophthalmology
- King George's Medical University
- Lucknow, India
- Atul Kumar md
- Additional Professor
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Maurice B Landers III md
- Professor
- Department of Ophthalmology
- University of North Carolina at Chapel Hill
- Chapel Hill, USA
- Kenneth K Li, mbchb mrcs
- Department of Ophthalmology and
- Visual Sciences
- The Chinese University of Hong Kong
- Hong Kong Eye Hospital
- Kowloon, Hong Kong
- Formerly, Consultant Vitreo-retinal Surgeon
- St Paul's Eye Unit
- Royal Liverpool University Hospital
- UK
- Dennis SC Lam md frcs frcophth
- Professor and Chairman
- Department of Ophthalmology and
- Visual Sciences
- Chinese University of Hong Kong
- Hong Kong, PRC
- Tamer A Macky md frcsed
- Formerly Fellow, Center for Research for Ocular Therapeutics and Biomedical Devices
- Storm Eye Institute
- Medical University of South Carolina
- Charleston, USA
- Anthony J Maloof mbbs mbiomede franzco fracs
- Director of Ophthalmic Surgery
- Western Sydney Eye Hospital
- Westmead Hospital
- Westmead, Australia, and
- Member, Intraocular Implant Unit
- Sydney Hospital and Sydney Eye Hospital
- Sydney, Australia
- Nick Mamalis md
- Professor of Ophthalmology
- Director of Ophthalmic Pathology and Intermountain Research Center
- John A Moran Eye Center
- Department of Ophthalmology and
- Visual Sciences, University of Utah
- Salt Lake City, USA
- John W McAvoy phd
- Professor of Experimental Ophthalmology
- Save Sight Institute Research Laboratories
- Save Sight Institute
- University of Sydney
- Sydney, Australia
- E John Milverton mbbs do franzco frcophth
- Chairman, Intraocular Implant Unit
- Sydney Hospital and
- Sydney Eye Hospital
- Sydney, Australia
- Nishank Mittal ms
- Vitreoretinal Service
- Sankara Nethralaya
- Chennai, India
- Manish Nagpal ms do frcs
- Retina Foundation
- Ahmedabad, India
- Milind N Naik ms
- Faculty, Ophthalmic Plastic Surgery
- Orbital Diseases and Ocular Oncology
- LV Prasad Eye Institute
- Hyderabad, India
- Arun Narayanasamy do dnb
- Consultant
- Glaucoma Service
- Sankara Nethralaya
- Chennai, India
- Rajiv Nath ms dnb m med sci
- Professor
- Department of Ophthalmology and
- Member, KGMC Institute of Clinical Epidemiology
- King George's Medical University
- Lucknow, India
- Aditya Neog do dnb
- Glaucoma Service
- Sankara Nethralaya
- Chennai, India
- Masahito Ohji md
- Professor and Chairman
- Department of Ophthalmology
- Shiga University of Medical Science
- Seta Tsukinowa-cho
- Otsu, Japan
- Randall J Olson md
- The John A Moran Presidential Professor
- and Chair of Ophthalmology and Visual Sciences
- Director, John A Moran Eye Center
- University of Utah
- Salt Lake City, USA
- Robert J Osher md
- Professor of Ophthalmology
- University of Cincinnati
- Cincinnati Eye Institute
- Cincinnati, USA
- Suresh K Pandey md
- Assistant Professor of Ophthalmology
- John A. Moran Eye Center
- Department of Ophthalmology and Visual Sciences, University of Utah
- Salt Lake City, USA
- Fellow
- Intraocular Implant Unit, Sydney Eye Hospital
- Sydney, Australia
- Scholar to the University of Sydney
- Save Sight Institute and Discipline of Ophthalmology
- Sydney, Australia
- Gunjan Prakash md
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- MR Praveen doms
- Ila Devi Cataract and Eye Research Center
- Raghudeep Eye Clinic
- Ahmedabad, India
- Shetal M Raj ms
- Ila Devi Cataract and Eye Research Center
- Raghudeep Eye Clinic
- Ahmedabad, India
- Jagat Ram ms
- Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and Research
- Chandigarh, India
- Srinivas K Rao do dnb frcsed
- Professor
- Department of Ophthalmology and Visual Sciences
- Chinese University of Hong Kong
- Hong Kong, PRC
- Formerly
- Consultant, Cornea Service
- Sankara Nethralaya
- Chennai, India
- Rajesh C Saxena ms
- Former Head
- Department of Ophthalmology
- King George's Medical College
- Lucknow, India
- Sandeep Saxena ms mams
- Associate Professor
- Department of Ophthalmology and
- Member, KGMC Institute of Clinical Epidemiology
- King George's Medical University
- Lucknow, India
- Norbert F Schrage md
- Professor of Ophthalmology
- Augenklinik des Universitatsklinikum
- Aachen, Germany
- Bernd Schroeder md
- Consultant
- Sangarmatha Choudhary Eye Hospital
- Lahan, Nepal
- Mahesh P Shanmugam do phd frcs
- Consultant, Vitreoretinal Service
- Sankara Nethralaya
- Chennai, India
- Michael E Snyder md
- Consultant Ophthalmologist
- Cincinnati Eye Institute
- Cincinnati, USA
- Indu Singh ms
- Daljit Singh Eye Hospital
- Amritsar, India
- Ravijit Singh ms
- Daljit Singh Eye Hospital
- Amritsar, India
- Vinita Singh ms
- Professor
- Department of Ophthalmology and
- Member, KGMC Institute of Clinical Epidemiology
- King George's Medical University
- Lucknow, India
- G Sitalakshmi do frcsed
- Director, Cornea Service
- Sankara Nethralaya
- Chennai, India
- Parul Sony md
- Senior Research Associate
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Matthew A Thomas md
- Clinical Associate Professor of Ophthalmology
- Barnes Retina Institute
- Washington University School of Medicine
- St. Louis, USA
- Rupal H Trivedi md
- Assistant Professor
- Albert Florens Storm Eye Institute
- Medical University of South Carolina
- Charleston, USA
- Abhay R Vasavada ms frcs
- Ila Devi Cataract and Eye Research Center
- Raghudeep Eye Clinic
- Ahmedabad, India
- Pradeep Venkatesh md
- Assistant Professor
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Lalit Verma md
- Consultant, Center for Sight
- New Delhi
- Formerly
- Additional Professor
- Vitreoretinal Service
- Dr RP Center for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Lingam Vijaya ms do
- Head
- Glaucoma Service
- Sankara Nethralaya
- Chennai, India
- Taketoshi Wakabayashi md
- Assistant Professor
- Department of Ophthalmology
- Graduate School of Comprehensive Human Sciences
- University of Tsukuba, Tennoudai
- Tsukuba, Ibaraki, Japan
- Andreas W Weinberger md
- Department of Ophthalmology
- Augenklinik des Universitatsklinikum
- Aachen, Germany
- Liliana Werner md phd
- Assistant Professor
- Director of Research
- David J Apple, MD Laboratories for Ophthalmic Device Research
- John A. Moran Eye Center
- Department of Ophthalmology and Visual Sciences
- University of Utah
- Salt Lake City, USA
- M Edward Wilson md
- Professor of Ophthalmology
- Director
- Albert Florens Storm Eye Institute
- Miles Center for Pediatric Ophthalmology
- Medical University of South Carolina
- Charleston, USA
- Narumichi Yamamoto md phd
- Assistant Professor
- Department of Ophthalmology
- Institute of Clinical Medicine
- University of Tsukuba
- Tsukuba, Ibaraki, Japan
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
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
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