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Recent Advances in Ophthalmology—8
HV Nema, Nitin Nema
1:
Past, Present and Future of Refractive Surgery
INTRODUCTION
HISTORY OF REFRACTIVE SURGERY1, 2
Historical Refractive Surgery
Modern Refractive Surgery
Today Refractive Surgery
COMPLICATIONS AND LIMITATIONS OF LASIK3,4
Preoperative Sources of Complications
Intraoperative LASIK Complications
Lasik Flap
Decentration of the Ablation
Central Island
Epithelial Defect
Postoperative Complications
Microstriae
Shifting Sands of the Sahara
Infection
Dry Eye
Epithelial Ingrowth
Ectasia
Scotopic Glare Halos
Enhancement
Future Developments
Femtosecond Laser Technology
Improved Laser Algorithms
PHAKIC INTRAOCULAR LENSES
Introduction
Anterior Chamber IOLs
Angle Fixation Compared to Iris Fixation9, 10
Flexible Implants
Assessment of the Anterior Chamber
Indications
SURGICAL CORRECTION OF HYPEROPIA
Steepening the Central Cornea with Collagen Shrinkage
LTK
CK
Adding a Lens of Particular Power within the Cornea or inside the Eye
Phakic Intraocular Lenses
Different Designs of PIOLs have their Own Intrinsic Problems
Exchanging the Patient's Crystalline Lens with One of Different Power14,15
Accurate Selection of IOL Power
Choice of Treatment
Hyperopic Surgery as an Enhancement
Overcorrected Myopic LASIK
Overcorrected Radial Keratotomy
Hyperopia after Previous Cataract and Implant Surgery
SURGICAL CORRECTION OF MYOPIA
Refractive Lensectomy for Myopia
Lensectomy Replacement Requires Accurate Lens Power
SURGICAL CORRECTION OF PRESBYOPIA
Several Approaches
Intraocular Lenses with a Corneal Approach
Off-axis Ablation
Anterior Ciliary Sclerotomy27
Scleral Expansion Inserts
Laser Presbyopia Reversal
CK
Laser Modifications
Accommodative IOL28,29
Refractive Lensectomy with Implantation of Bifocal or Diffractive or Multifocal IOLs
LASER EPITHELIAL KERATOMILEUSIS
Clinical Application
Technique
Indications
Advantages and Drawbacks
NEAR VISION RESTORATION WITH REFRACTIVE LENS EXCHANGE14 AND PSEUDOACCOMMODATING AND MULTI FOCAL REFRACTIVE AND DIFFRACTIVE INTRAOCULAR LENESES
Accommodative IOLs32, 34–37
Restor Lens
Tecnis Lens
Comparative Clinical Study
IOL POWER CALCULATION AFTER KERATOREFRACTIVE SURGERY
NEW DEVELOPMENTS—NEW TRENDS
Intralase
Light Adjustable Lens
Wavefront Technology in IOLs
2:
LASIK in Hyperopia
INTRODUCTION
SURFACE ABLATIVE PROCEDURES
LASIK IN HYPEROPIA
COMPLICATIONS OF HYPEROPIC LASIK3
Flap Complications
Ablation-related Complications3
Management of Complications
HYPEROPIC LASIK IN SPECIAL SITUATIONS3
Undercorrected Hyperopic LASIK
Overcorrected Myopic LASIK5
Overcorrected Radial Keratotomy
Hyperopia After Previous Cataract and Implant Surgery
CONCLUSION
3:
Surgical Management of Presbyopia
INTRODUCTION
ACCOMMODATION
Initial Concepts and Definitions1
Definition Accommodation2
Amplitude of Accommodation
Near Point in Different Refractive Conditions
Range of Accommodation
Theory of Accommodation
Anatomical Basis of Accommodation
The Ciliary Muscle
Effects of Contraction
The Nervous Mechanism
Changes in the Lens
The Excised Lens
The Lens Capsule
The Change in Accommodation with Age3
Accommodation and Age
Testing Accommodation
Methods to Measure the Amplitude of Accommodation5
Donder's Push-Up Method
Minus Lens Method
Negative Relative Accommodation Test
Positive Relative Accommodation Test
Interpretation of NRA/PRA Tests
Accommodative Facility Testing
Objective Accommodation Measurements
Monocular Versus Binocular Testing
The Development of Presbyopia4
Lenticular Sclerosis
Changes in Capsular Elasticity
Geometric Theory of Presbyopia
The “Disaccommodation” Theory of Presbyopia
Schachar's Theory of Presbyopia
The Catenary Theory
Multifactorial Theory of Presbyopia
Preoperative Examinations For Presbyopic Correction6
Data from Presbyopic Correction Technologies
SURGICAL CORRECTION OF PRESBYOPIA
Scleral Ciliary Surgery
Corneal Multifocal Surgery PresbyLASIK
Intracorneal Lenses
Intraocular Phakic Multifocal Lenses
Intraocular Pseudoaccommodative Lenses
Intraocular Multifocal Lenses
Monovision
“Real” Accommodative Intraocular Lenses
4:
Peripapillary Atrophy in Glaucoma
INTRODUCTION
WHAT IS PERIPAPILLARY ATROPHY?
FREQUENCY AND SIZE OF PERIPAPILLARY ATROPHY
HOW TO DETECT AND MEASURE PERIPAPILLARY ATROPHY?
CLINICAL SIGNIFICANCE OF PERIPAPILLARY ATROPHY
PERIPAPILLARY ATROPHY AND GLAUCOMA PROGRESSION
PERIPAPILLARY ATROPHY IN DIFFERENT TYPES OF GLAUCOMA
PERIPAPILLARY ATROPHY AND OPTIC NERVE DAMAGE
SUMMARY
5:
Advances in the Management of Developmental Glaucoma
INTRODUCTION
FACTORS INFLUENCING THERAPEUTIC DECISIONS
Structural Defects
Age
Systemic Syndromes
In Sturge-Weber Syndrome
Oculocerebrorenal Syndrome of Lowe
Homocysteinuria
Trisomy13
Corneal Clarity
Severity of Glaucoma
Corneal Diameter
MEDICAL TREATMENT
Beta Blockers
Carbonic Anhydrase Inhibitors
Prostaglandin-Related Drugs
Alpha-2 Agonists
Other Adrenergic Agonists
Cholinergic Drugs
Osmotic Drugs
INITIAL SURGICAL THERAPY
Goniotomy
Trabeculotomy Ab externo
Primary Trabeculectomy
Ab externo Combined Trabeculotomy-Trabeculectomy
SIMULTANEOUS BILATERAL SURGERY FOR DEVELOPMENTAL GLAUCOMA
MANAGEMENT OF REFRACTORY PEDIATRIC GLAUCOMA
Filtration Surgery with Antifibrotic Drugs
Glaucoma Drainage Implants
Cyclodestructive Procedures
LONG-TERM FOLLOW-UP AND PROGNOSIS
CONCLUSION
6:
Advances in the Management of Primary Open-angle Glaucoma
INTRODUCTION
GENERAL PATIENT CONSIDERATIONS
Decision to Initiate Medical Therapy
Corneal Thickness and IOP Measurement
Patient Compliance/Adherence to Medication Therapy
MEDICATIONS FOR GLAUCOMA
Increasing Aqueous Humor Outflow
Decreasing Aqueous Humor Production
Beta-blockers
Prostaglandin Analogs
Alpha Agonists
Topical Carbonic Anhydrase Inhibitors
Combination Agents
Less Commonly Used Agents
Strategies in Medical Treatment
Setting Target IOP
Controlling Diurnal Variation in IOP
Efficacy at Trough Drug Concentrations
Efficacy and Tolerability
Unilateral Trials
Reducing Systemic Absorption of Topical Medications
Choice of Initial Medication
Maximum Tolerable Medical Therapy
Alternative Medicine
Future Hypotensive Agents
Neuroprotective Agents
Enhancing Ocular Blood Flow
Glaucoma Gene Therapy
Vaccination for Glaucoma
7:
Phacoemulsification in Uveitic Cataract
INTRODUCTION
PREOPERATIVE EVALUATION
Preoperative Examination
Investigations
Preoperative Treatment
SURGICAL TECHNIQUE
POSTOPERATIVE MANAGEMENT
COMPLICATIONS AND OUTCOME
8:
Ophthalmic Medications in Pediatric Patients
ABSTRACT AND INTRODUCTION
Abstract
Introduction
Dosage, Absorption, and Administration of Eye Drops in Children
Dilating Agents
Alpha-Adrenergic Agents
Cycloplegic Agents
Glaucoma Medications
Beta-Adrenergic Antagonists
Carbonic Anhydrase Inhibitors
Alpha-Adrenergic Agonists
Prostaglandin Analogs
Miotics and Sympathomimetics
ANTI-INFLAMMATORY MEDICATIONS
Corticosteroids
Nonsteroidal Anti-Inflammatory Drugs
Allergy Medications
Dual Agents
Mast Cell Inhibitors
Antibiotics
Antiviral Medications
CONCLUSION
9:
Chloroquine Retinopathy: Diagnosis
INTRODUCTION
STAGES OF CHLOROQUINE RETINOPATHY
Pre-maculopathy
Early Maculopathy
Established Maculopathy
Advanced Maculopathy
Final Stage Maculopathy
INCIDENCE AND DOSAGE
MECHANISMS OF CHLOROQUINE TOXICITY
CORNEAL DEPOSITS
DIAGNOSTIC TOOLS
Visual Field Testing
Color Vision
Electro-oculogram
Electroretinogram and Multifocal Electroretinogram
GUIDELINES FOR SCREENING
CONCLUSION
10:
Advances in Retinopathy of Prematurity
INTRODUCTION
RISK FACTORS AND ROP
CLASSIFICATION OF ROP
Stages of ROP (Figs 10.1A to E)
Zones of ROP (Fig. 10.2)
Plus Disease
Threshold Disease
Prethreshold Disease
SCREENING GUIDELINES FOR ROP
Screening Procedure
RETCAM AND ROP DOCUMENTATION
TREATMENT OF ROP
Laser/Cryotherapy
Early Treatment of ROP
Surgical Management of ROP
CONCLUSION
11:
Intravitreal Triamcinolone Acetonide
INTRODUCTION
MECHANISM OF ACTION
INDICATIONS OF USES
Diabetic Macular Edema
Central Retinal Vein Occlusion
Branch Retinal Vein Occlusion
Pseudophakic Macular Edema
Uveitis
Age Related Macular Degeneration
PREPARATION OF DRUG AND PROCEDURE
Ocular Hypertension
Cataract
Endophthalmitis
12:
Dry Eye Disease
INTRODUCTION
THE SCALE OF PROBLEM OF DRY EYE DISEASE
DEFINITION OF DRY EYE DISEASE
PREVALENCE
OCULAR SURFACE AND TEAR FILM
TEAR FILM REGULATION
COMPOSITION OF TEAR FILM
DYSFUNCTION OF THE OCULAR SURFACE AND TEAR FILM
The Vicious Cycle of Increased Evaporation and Ocular Surface Damage
CHRONIC INFLAMMATION AND DRY EYE DISEASE
Inflammation and Dry Eye
Sjögren's Syndrome
Dry Eye Disease and Allergies
Dry Eye Disease and Conjunctivitis
Dry Eye Disease and Blepharitis
Dry Eye Disease and Eyedrops
DIAGNOSIS OF DRY EYE
System Questionnaires
Ocular Surface Staining
Fluorescein
Rose Bengal
Other Dyes
ASSESSMENT OF TEAR FILM STABILITY
Noninvasive Tear Breakup Time
Interblink Interval and Ocular Protection Index
Tear Meniscus Height
Fluorescein Tear Breakup Test
Assessment of Aqueous Tear Production
Schirmer Test
Assessment of Oil Glands
TREATMENT OF DRYEYE
Tear Substitution
What's Inside the Bottle
Preservatives in Artificial Tears
Nonpreserved Drugs
Tear Preservation
Occlusion of the Tear Drainage System
Methods of Occlusion
Treatment of Underlying Causes of Dry Eye Disease
Cyclosporin A
Topical Corticosteroids
Systemic Tetracyclines
Sexual Hormones
Topical Autologous Serum
13:
Advances in Lacrimal Surgery
INTRODUCTION
ANATOMY OF LACRIMAL APPARATUS1,2
Developmental Abnormalities3,4
PHYSIOLOGY OF LACRIMAL DRAINAGE
EVALUATION OF WATERING7–9
EVALUATION OF CONGENITAL WATERING7,8
Outflow Abnormalities in Children
NLD Block
Complications
Complications
Punctal Agenesis and Dysgenesis
Congenital Dacryocystocele
Congenital Lacrimal Cutaneous Fistula (Anlage Duct)
EVALUATION OF ACQUIRED WATERING
Evaluation of Outflow Obstruction
Dye Disappearance Test
Jones I and Jones II Tests
Microreflux Test26
Syringing
Complete block
Partial block
Functional block
Probing
Causes of True Watering
Syringing Patent
Syringing Blocked
Complete block
INVESTIGATIVE MODALITIES
SURGICLA MANAGEMENT FOR NLDO
Dacryocystorhinostomy
Conventional DCR
Indications
Contraindications
Preoperative workup and investigations
Preoperative preparation
Complications of DCR
Causes of failed DCR34–35
Complications of stents
Endonasal DCR
Advantages
Disadvantages
Laser Assisted DCR38
Transcanalicular Laser DCR
Advantages
Surgical Management for Common Canalicular Block
Surgical Management for Canalicular Obstruction
Canaliculo-DCR (CDCR)
Conjunctivo-DCR (CJ DCR)
Endoscopy Assisted Procedure using Modified Jones Tube39
Post Traumatic Repair of Lacrimal System
INDEX
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