Innovative Techniques in Ophthalmology Ashok Garg, I Howard Fine, Ioannis G Pallikaris, Hiroshi Tsuneoka
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1INNOVATIVE TECHNIQUES IN OPHTHALMOLOGY
2
3INNOVATIVE TECHNIQUES IN OPHTHALMOLOGY
Editors Ashok Garg MS PhD FIAO (Bel) FRSM ADM FAIMS FICA International and National Gold Medalist Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk Hisar 125 005, India Ioannis G Pallikaris MD Professor and Head Deptt. of Ophthalmology University of Crete, VEIC, PO Box 2208 Heraklion 71003, Crete, Greece Hiroshi Tsuneoka MD Associate Professor Department of Ophthalmology Jikei University School of Medicine 4-11-1 Izumihonchou, Komae-shi Tokyo, 201-8601, Japan I Howard Fine MD Clinical Professor of Ophthalmology Oregon Health and Science University Chief Consultant Drs Fine, Hoffman and Packer, LLC 1550-Oak St, Ste 5, Eugene OR 97401, USA David F Chang MD Clinical Professor of Ophthalmology University of California, San Francisco Private Practice, 762, Altos Oaks Drive Los Altos, CA-94024, USA Jerome Jean-Phillippe Bovet MD Consultant Ophthalmic Surgeon FMH Clinique de L'oeil 15, Avenyue Du Bois-de-law Chapelle CH-1213, Onex Switzerland Foreword: Jorge L Alio
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
Fax: +91-11-23276490, +91-11-23245683
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Branches
Innovative Techniques in Ophthalmology
© 2006, Ashok Garg, I Howard Fine, Ioannis G Pallikaris, David F Chang, Hiroshi Tsuneoka, Jerome Jean-Phillippe Bovet
All rights reserved. No part of this publication and Interactive DVD ROM 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 editors and the publisher.
First Edition: 2006
9788180617546
Typeset at JPBMP typesetting unit
Printed at Raplika
5Dedicated to
— Ashok Garg
— I Howard Fine
— Ioannis G Pallikaris
— David F Chang
— Hisoshi Tsuneoka
— Jerome Bovet
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7Contributors 11Foreword
Among the many progresses that surgical medicine has made in the last decades, one of the most relevant and acknowledged ones in the human surgical science is indeed ocular surgery. Progresses in cataract surgery were considered by the US Academy of Sciences as the most important progress in a single surgical procedure in human surgery that took place during the 20th century. Now, in the 21st century, we are facing major changes in our practice as ocular surgeons and indeed innovative techniques like the ones that are gathered in this book are to be not only important, but fostering others in the future that will lead us to a complete transformation in our surgical practice.
Cross-hybridisation between science and technology has been the driving force in the progress of ocular surgery. Ophthalmology has brought a tremendous attraction for scientists of all kinds that has introduced us in concepts such as neurophysiology, neurosciences, regenerative medicine, applied optics to human vision, lasers and other pieces of high technology that are, at this moment, creating a progressive change in our everyday approach to eye disease.
The most recent progress has been made in cataract surgery among others, but indeed not the only one. Microincisional surgical techniques (all of them gathered with the acronym, MICS), new intraocular lenses that are capable to suppress or decrease eye aberrations after surgery, new knowledge in applied optics that is creating a new environment for cataract surgery are addressed in this book. Refractive surgery indeed is part of the progress as well, as today the practice of refractive surgery has to be considered not only related to relieve from spectacle use our patients, but rather to improve their vision by using different innovative techniques and devices that are creating not only a new perspective of visual quality, but also a new hope to many patients with eye disease such as keratoconus. Glaucoma is another area of interest of this book. Glaucoma, one of the most frequent blinding conditions of the human being, is now being approached not only with new pharmacology, but also with new surgery. New approaches made glaucoma surgery to be able to face these cases with an armamentarium that improves their performance and speeds up the surgical process. New examination techniques are indeed of major relevance for our practice, as they bring us the information that is needed to make a correct diagnosis and to define the best approach to solve an ocular problem. Among these examination techniques, those that are based on diagnostic imaging are the most relevant at this moment in the decision making process of anterior segment and posterior segment surgery. New lasers are approaching lacrimal surgery, one of the least developed in the last 40 years of our practice, with a new perspective of conservative procedures that can solve the problems of chronic tearing without creating any external scar in the patient with reliable outcomes. The book ends with the perspectives of something that might be considered today utopia: artificial vision. Nobody can really predict what will be in the next 20 years our perspective for visually impaired people, but indeed the progress in this area, coming from serious research in neuroprocessing and neuroscience, is bringing hope to those who have none.
Dr Ashok Garg has made with this book a commitment with ocular surgery. He is aware of the fact that the progress in ocular surgery is based on these innovative techniques that at this moment 12are leading the most important surgeons in the world to face old problems with new tools, hopeless conditions with new positive perspectives and leading a generation of ocular surgeons who are going to transform the practice of ocular surgery in the coming years.
We welcome this important book of Dr. Ashok Garg that will open the minds of many of us to many new technologies that at this moments are emerging in different parts of the world. The important and most relevant social issue that are witnessing in this century is globalisation. Ocular surgery is global and Dr Ashok Garg has been approaching this book on innovations in ocular surgery under the most modern global approach, in which science and knowledge may be created and developed elsewhere around the world. I would like to thank Dr. Ashok Garg and Co-editors for this great effort and all the contributors of the different chapters for their creativity, work and understanding of the philosophy of excellence in their approach to ocular surgery.
Dr Jorge L Alio
md phd
Professor and Chairman of Ophthalmology
Medical Director
VISSUM, Instituto Oftalmologico de Alicante
Alicante, Spain
Tel. 34-965-150-025
13Preface
Ophthalmology has come of age specially in the last decade with the evolution of various innovative high-tech procedures and medical management. Today ophthalmic surgery is state-of-art surgery for the management of various anterior and posterior segment diseases. Minimally invasive cataract surgery, glaucoma surgery, refractive and retinal surgery, etc have improved the visual outcome dramatically to the patient satisfaction.
In this book a number of leading international ophthalmologists have shared their experiences in form of chapters for the benefit of ophthalmologists covering all aspects of ophthalmology. A wide array of Modern Surgical Techniques are covered in this book.
Our special gratitude extends to Shri JP Vij, Chairman and Managing Director, Mr Tarun Duneja (GM Publishing) and all staff of M/s Jaypee Brothers Medical Publishers Pvt. Ltd. who gave prompt attention and active support in the publication of this useful book.
We hope this book on New Innovative Techniques will be a useful companion to ophthalmologists worldwide in their day-to-day practice.
Editors