Sandeep
Saxena
MS MAMS
Member, National Academy of Medical Sciences,
India
Visiting Professor, UNC-Chapel Hill, Chapel Hill,
USA
Fellow, Barnes Retina Institute and Anheuser-Busch Eye Institute, St. Louis,
USA
Fellow, New York-Presbyterian Hospital,
New York,
USA
Professor Department of Ophthalmology King George's Medical University
Lucknow,
India
11Foreword
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 e-mail: jaypee@jaypeebrothers.com
Visit our website: www.jaypeebrothers.com
Branches
- 2/B Akruti Society, Jodhpur Gam Road, SatelliteAhmedabad 380 015, Phone: +91-079-30988717, +91-079-26926233
- 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park EastBangalore 560 001, Phones: +91-80-22285971, +91-80-22382956, +91-80-30614073Tele Fax: +91-80-22281761 e-mail: jaypeemedpubbgl@eth.net
- 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon RoadChennai 600 008, Phones: +91-44-28262665, +91-44-28269897Fax: +91-44-28262331 e-mail: jpchen@eth.net
- 4-2-1067/1-3, Ist Floor, Balaji Building, Ramkote, Cross RoadHyderabad 500 095, Phones: +91-40-55610020, +91-40-24758498Fax: +91-40-24758499 e-mail: jpmedpub@rediffmail.com
- “KURUVI BUILDING”, 1st Floor, Plot/Door No. 41/3098-B &B1, St. Vincent RoadKochi 682 018, Ph: +91-0484-4036109 e-mail: jaypeekochi@rediffmail.com
- 1A Indian Mirror Street, Wellington SquareKolkata 700 013, Phones: +91-33-22456075, +91-33-22451926Fax: +91-33-22456075 e-mail: jpbcal@cal.vsnl.net.in
- 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, ParelMumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, +91-22-30926896Fax: +91-22-24160828 e-mail: jpmedpub@bom7.vsnl.net.in
- “KAMALPUSHPA”, 38 Reshimbag, Opp. Mohota Science College, Umred RoadNagpur 440 009, Phones: +91-712-3945220, +91-712-2704275 e-mail: jpnagpur@rediffmail.com
Focus on Macular Diseases
© 2007, Sandeep Saxena
All rights reserved. No part of this publication and 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 author and the publisher.
First Edition: 2007
9788180619533
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
My Parents
Dr RC Saxena and Mrs Madhu Saxena
Travis A Meredith MD, Matthew A Thomas MD, Harvey Lincoff MD,
Maurice B Landers III MD, Lawrence A Yannuzzi MD and Stanley Chang MD
for showing me the new horizons in Macula
and my family
Sangeeta, Shreeya and Aishwarya
5Preface
Diagnosis and treatment of macular diseases is a continuously advancing field as new technologies are being introduced at a rapid rate. As new medications, lasers and instruments are introduced, one must learn their intricacies for applying them to the treatment of macular diseases. In turn, the adoption of new technology brings with it the need to learn new skills and develop new treatment algorithms. Advancing capabilities furthermore allows intervention for new indications.
As techniques, indications, and equipment evolve, better outcomes result but may also be accompanied by new sets of complications. Coping up with these changes is vital. New technology and surgical approaches must be adapted to the specific socioeconomic conditions and disease presentations in different parts of the world.
Focus on Macular Diseases provides a comprehensive text combined with integrated visual reference, in the form of black and white and colored figures and surgical videos of treatable macular disorders. This book attempts to update the state-of-the-art diagnostic and treatment modalities in macular diseases in a lucid, authoritative and well-illustrated manner.
The value of this book lies in the quality and expertise of the text chapters and surgical video contributors.
The book is intended for the experienced ophthalmologists, postgraduates as well as those in training. This pragmatic book provides an understanding of the diagnosis and management of treatable macular diseases which are so important in the everyday practice.
7Contributors- Levent Akduman MD
- Assistant Professor
- St Louis University Eye Institute
- St Louis University
- St Louis, USA
- Shashank Bidaye MS
- Retina Foundation
- Ahmedabad, India
- Muna Bhende MS
- Senior Vitreoretinal Consultant
- Sankara Nethralaya
- Chennai, India
- Jyotirmay Biswas MS
- Director, Uveitis Department
- Sankara Nethralaya
- Chennai, India
- Wai-Man Chan FRCP, FRCS
- Consultant Ophthalmologist
- Hong Kong Hospital
- Hong Kong, PRC
- Robert F Degenring MD
- Vitreoretinal Associate
- Department of Ophthalmology
- Cologne Hospitals
- Cologne, Germany
- Satpal Garg MD
- Professor
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Amod Gupta MS
- Professor and Head
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and
- Research
- Chandigarh, India
- Vishali Gupta MS
- Associate Professor
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and
- Research
- Chandigarh, India
- Murali M Gurran MS
- Retina Foundation
- Ahmedabad, India
- Nancy M Holekamp MD
- Barnes Retina Institute
- Washington University School of Medicine
- St Louis, USA
- Nazimul Hussain MS
- Vitreoretinal Consultant
- L.V. Prasad Eye Institute
- Hyderabad, India
- Michael Jones MD
- St Louis University Eye Institute
- St Louis University
- St Louis, USA
- Vinay K. Khanna PhD
- Scientist
- Industrial Toxicology Research Center
- Lucknow, India
- Teresa TY Lau MRCS
- Clinical Fellow
- Prince of Wales Hospital
- Hong Kong, PRC
- David TL Liu MRCS
- Ophthalmology Specialist
- Prince of Wales Hospital
- Hong Kong, PRC
- Asheesh Mehrotra MD
- Childrens Hospital of Wisconsin
- Milwaukee, USA
- Travis A Meredith MD
- Professor and Chairman
- Department of Ophthalmology
- University of North Carolina at Chapel Hill
- Chapel Hill, USA
- Carsten H Meyer MD
- Assistant Professor
- Department of Ophthalmology
- Phillips-University
- Marburg, Germany
- Amit Nagpal DNB
- Associate Consultant, Vitreoretinal and Oncology Services
- Sankara Nethralaya
- Chennai, India
- Kamal Nagpal MS
- Retina Foundation
- Ahmedabad, India
- Manish Nagpal MS, DOMS, FRCS
- Retina Foundation
- Ahmedabad, India
- Bijoy K Nair MPhil
- Electrodiagnostic Department
- Sankara Nethralaya
- Chennai, India
- Narendra GV MS
- Retina Foundation
- Ahmedabad, India
- Masahito Ohji MD
- Professor and Chairman
- Shiga University of Medical Science
- Seta Tsukinowa-cho
- Otsu, Japan
- Aditya B. Pant PhD
- Scientist
- Industrial Toxicology Research Center
- Lucknow, India
- Priya Ravi BS
- Electrodiagnostic Department
- Sankara Nethralaya
- Chennai, India
- Parveen Sen MS
- Consultant, Vitreoretinal service
- Sankara Nethralaya
- Chennai, India
- P Mahesh Shanmugam DO, PhD, FRCS
- Associate Professor
- Department of Ophthalmology and Visual Sciences
- The Chinese University of Hong Kong, Hong Kong Eye
- Hospital
- Hong Kong, PRC
- Sandeep Saxena MS, MAMS
- Professor
- Department of Ophthalmology
- King George's Medical University
- Lucknow, India
- Osamu Sawada MD
- Assistant Professor
- Shiga University of Medical Science
- Seta Tsukinowa-cho, Otsu, Japan
- Ramandeep Singh MS
- Department of Ophthalmology
- Post Graduate Institute of Medical Education and
- Research
- Chandigarh, India
- S Sudharshan DO
- Consultant, Uveitis Department
- Sankara Nethralaya
- Chennai, India
- Matthew A Thomas MD
- Barnes Retina Institute
- Washington University School of Medicine
- St Louis, USA
- Pradeep Venkatesh MD
- Associate Professor
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences
- New Delhi, India
- Arun Bhargava MS
- Sankara Nethralaya
- Chennai, India
The world grows smaller every day. One of the benefits of this is the improving level of medical knowledge and care available to physicians and patients everywhere.
In Focus on Macular Diseases, Dr Saxena and a group of colleagues from around the world have produced a timely and highly informative text, further demonstrating how rapidly the information revolution is making available the expertise of the best doctors to patients in all corners of the globe.
The first five chapters of the book deal with contemporary techniques of detailed evaluation of the macula, covering the optical coherence tomography examination, microperimetry, the multifocal electroretinogram, the scanning laser ophthalmoscope and Heidelberg retina angiograph, along with fluorescein angiography and indocyanine green angiography. These chapters are extremely valuable to modern retinologists, particularly the sections on the optical coherence tomography and the multifocal electroretinogram.
The next five chapters deal with the outpatient treatment of macular diseases, and cover laser treatment for diabetic macular edema, laser treatment of other macular diseases, the use of intravitreal triamcinolone in macular diseases, photodynamic therapy treatment, and interestingly, an optimistic chapter detailing the use of transpupillary thermotherapy in cases of age-related macular degeneration with choroidal neovascularization.
Next is an excellent survey chapter on vascular endothelial growth factor, and the currently available anti-vascular endothelial growth factor drugs, and their use in treating age-related macular degeneration.
The final discussion of the medical management of age-related macular degeneration is covered in a wellwritten chapter on antioxidants and age-related macular degeneration.
A remarkably inclusive and exhaustively referenced chapter on surgery of the macula; written by internationally acclaimed experts, is clearly one of the highlights of the book.
The chapter on surgery for retinal vein occlusion presents an extensive review of radial optic neurotomy for central retinal vein occlusion, and sheathotomy for branch retinal vein occlusion. The authors’ summary states that neither of these procedures, on their own, have been clearly proven to offer any therapeutic benefit, and that any benefit they may offer in combination with other procedures, including vitrectomy, intravenous thrombolysis with tissue plasminogen activator, etc. await the results of controlled clinical trials.
An overview of macular involvement in posterior uveitis is succinct, as one might expect in a book of this nature. The discussions of conditions affecting macular function are good.
12Macular involvement in intraocular tumors is again an extensively referenced presentation on ocular oncology seen from the point of view from the retinologist examining the macula for an explanation of a patient's decreased central vision.
In summary, this is a timely, well written and exhaustively referenced book, combined with visual references (figures and surgical videos), which will be a welcome addition to the library of retinologists around the world.
Maurice B Landers III MD
Professor
Department of Ophthalmology
University of North Carolina at Chapel Hill