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Surgical and Medical Management of Pediatric Ophthalmology
Ashok Garg, Rajvardhan Azad, Keiki R Mehta, Ashok K Grover
SECTION 1: PEDIATRIC OCULAR DEVELOPEMENT AND PRELIMINARY CONSIDERATIONS
1:
Embryology and Development of the Eye
INTRODUCTION
FERTILIZED OVUM
TWO-CELL STAGE
CLEAVAGE
MORULA
FUNCTION OF THE ZONA PELLUCIDA
BILAMINAR GERM DISK
EXTRAEMBRYONIC MESODERM
FORMATION OF CHORION AND AMNION
PROCHORDAL PLATE
PRIMITIVE STREAK
TRILAMINAR GERM DISK
INTRODUCTION
DEVELOPMENT OF THE BRAIN
FORMATION OF OPTIC VESICLE AND OPTIC STALK
FORMATION OF THE LENS
FORMATION OF THE OPTIC CUP
CHOROIDAL FISSURE
MESODERM
DEVELOPMENT OF THE LENS
DEVELOPMENT OF THE LENS VESICLE
PRIMARY LENS FIBERS
SECONDARY LENS FIBERS
LENS NUCLEI
LENS SUTURES
LENS CAPSULE
CORTEX
DEVELOPMENT OF THE ZONULAR FIBERS
DEVELOPMENT OF THE CORNEA
BASICS
EPITHELIUM
ENDOTHELIUM AND DESCEMET'S MEMBRANE
STROMA AND BOWMAN'S LAYER
DEVELOPMENT OF THE SCLERA
DEVELOPMENT OF THE UVEAL TRACT
BASICS
CHOROID
BRUCH'S MEMBRANE
CILIARY BODY
CILIARY MUSCLE
IRIS
DEVELOPMENT OF THE ANGLE OF THE ANTERIOR CHAMBER
TRABECULAR MESHWORK
SCHLEMM'S CANAL
IRIDOCORNEAL ANGLE
DEVELOPMENT OF THE RETINA
BASICS
PIGMENT EPITHELIUM
NEUROSENSORY RETINA
MACULA
DEVELOPMENT OF THE OPTIC NERVE
OPTIC NERVE
DEVELOPMENT OF THE VASCULATURE OF OPTIC NERVE AND RETINA
DEVELOPMENT OF THE VITREOUS
VITREOUS BODY
PRIMARY VITREOUS
SECONDARY VITREOUS
TERTIARY VITREOUS
DEVELOPMENT OF THE LIDS, CONJUNCTIVAL SAC AND LACRIMAL GLAND
LID AND CONJUNCTIVA
LACRIMAL AND CONJUNCTIVAL GLANDS
DEVELOPMENT OF THE NASOLACRIMAL DUCT
2:
Pediatric Visual Electrophysiology Tests
INTRODUCTION
ELECTRORETINOGRAM
TYPES
ORIGINS OF ERG
Retinal Response to Light
Component Origins
SCOTOPIC THRESHOLD RESPONSE (STR)
PATTERN ERGs (PERGs)
ERG RECORDING METHODS
Electrodes
TECHNICAL EQUIPMENT
Amplification
Averaging
ELECTRO-OCULOGRAM
VISUAL EVOKED POTENTIAL
TYPES OF VEP
CORTICAL ORIGINS OF THE VEP
Flash VEPs
Pattern Reversal VEPs
Pattern-onset VEPs
RECORDING VEPs IN CHILDREN
STANDARDS AND GUIDELINES
ISCEV ERG STANDARDS
Dark-adapted Responses
Light-adapted Responses
RECORDING FROM YOUNG CHILDREN
ISCEV APPROACH
COMBINED ERG/VEP RECORDING
RESPONSE MATURATION
MATURATION OF THE ERG
MATURATION OF THE VEP
DELAYED VISUAL MATURATION (DVM)
DIAGNOSTIC APPLICATIONS
BOTH ROD AND CONE FUNCTION ARE MARKEDLY ABNORMAL
RETINAL CONDITIONS IN WHICH ROD FUNCTION IS PREDOMINANTLY ABNORMAL
ROD DYSFUNCTION ASSOCIATED WITH SYSTEMIC DISEASE, SYNDROMES AND INBORN ERRORS OF METABOLISM
ABETALIPOPROTEINEMIA
PEROXISOMAL DISEASE
BARDET-BIEDL SYNDROME
JOURBET SYNDROME
MUCOPOLYSACCHARIDOSIS AND NEUROLIPIDOSIS
MITOCHONDRIAL DISEASE
RETINAL CONDITIONS PREDOMINANTLY AFFECTING CONES
Rod Monochromatism (Achromatopsia)
Alstrom's Disease
MACULOPATHIES
INNER RETINAL DYSFUNCTION AND THE “NEGATIVE” ERG
CONGENITAL STATIONARY NIGHT BLINDNESS (CSNB)
X-LINKED RETINOSCHISIS
DUCHENNE'S MUSCULAR DYSTROPHY
NEURONAL CEROID LIPOFUSCINOSIS (NCL OR BATTEN'S DISEASE)
VITREORETINAL DISORDERS
GOLDMANN FAVRE SYNDROME
WAGNER'S VITREORETINAL DEGENERATION AND EROSIVE VITREORETINOPATHY
STICKLER'S SYNDROME
DIAGNOSTIC APPLICATIONS OF PERG
DIAGNOSTIC APPLICATIONS OF EOG
DIAGNOSTIC APPLICATION OF VEP
OCULAR OPACITIES
CORNEAL OPACITY
CONGENITAL HEREDITARY ENDOTHELIAL DYSTROPHY (CHED)
LENS OPACITY
VITREOUS OPACITY
MACULOPATHY
OPTIC NERVE DISORDERS
OPTIC NEURITIS
OPTIC NERVE HYPOPLASIA (ONH)
OPTIC NERVE COMPRESSION
VITAMIN DEFICIENCY
Vitamin B12 Deficiency
Vitamin E Deficiency
CHIASMAL ABNORMALITIES
POSTCHIASMAL DYSFUNCTION
Generalized
PERINATAL HYPOXIA
HYDROCEPHALUS
NEURODEGENERATIVE CONDITIONS
TAY-SACHS DISEASE
COMBINED ERG/VEP IN INFANTS WITH NYSTAGMUS
THE VEP IN ACUITY TESTING AND AMBLYOPIA
AMBLYOPIA
HYSTERICAL (OR FUNCTIONAL) VISUAL LOSS
IN SUMMARY
3:
Ocular Genetics in Pediatric Ophthalmology
INTRODUCTION
GENES AND PHENOTYPE
AUTOSOMAL DOMINANT
AUTOSOMAL RECESSIVE
LOSS OF HETEROZYGOSITY
SEX-LINKED INHERITANCE
X-LINKED DOMINANT INHERITANCE
X-LINKED RECESSIVE INHERITANCE
Y-LINKED INHERITANCE
MITOCHONDRIAL INHERITANCE
CHROMOSOMAL DISORDERS
CONCLUSION
4:
Pediatric Eye Examination
INTRODUCTION
HISTORY6
CLINICAL EXAMINATION6
OCULAR FIXATION6
CSM NOTATION4, 6
ASSESSMENT OF VISUAL ACUITY5, 6
HOTV TEST (MATCHING TEST)6
ALLEN CARDS8
LH SYMBOLS (LEA SYMBOLS)5, 6, 8
ASSESSING VISUAL ACUITY IN INFANTS5
OPTIKO KINETIC NYSTAGMUS (OKN)4–6
PREFERENTIAL LOOKING (PL)
VISUAL EVOKED RESPONSE (VER)
VISUAL FIELD ANALYSIS
COLOR VISION6
EYE MOVEMENTS AND STRABISMUS4–6
SIMULTANEOUS RED REFLEX TEST (BRUCKNER TEST)8
Krimsky's Test
Cover Test4, 5
Uncover Test4, 5
Alternate Cover Test
Prism Bar Cover Test4, 5
Krimsky's Test4, 5
Hirschberg Test
OCULAR MOVEMENTS
Duction/Monocular Movement
Versions/Binocular Eye Movements
STEREOPSIS/ STEREOACUITY
Tests for Central Suppression
ADDITIONAL TESTS
SLIT LAMP EXAMINATION6
TONOMETRY5, 6
REFRACTION
CONCLUSION
5:
Pediatric Vision Screening: Guidelines and Techniques
INTRODUCTION
VISION SCREENING AND OCULAR EXAMINATION
NEWBORN SCREENING
EVALUATION OF VISION WITHIN THE FIRST 4 MONTHS OF LIFE
SCREENING AT 6 MONTHS
SCREENING AT 3 YEARS OF AGE
SCREENING AND EYE EXAMINATIONS AT AGE 5 AND OLDER
SPECIAL SCREENING GROUPS
HISTORY AS A SCREENING TOOL
IMPORTANCE OF THE FAMILY HISTORY
TESTING VISUAL ACUITY
STEREOSCOPIC AND PHOTOREFRACTIVE TESTS
SCREENING FOR STRABISMUS AND AMBLYOPIA
CONCLUSION
6:
Visual Acuity Assessment in Children
INTRODUCTION
WHAT IS VISUAL ACUITY?
MINIMUM VISIBLES
MINIMUM DISCRIMINABLE (HYPERACUITY)
MINIMUM RESOLVABLE/RECOGNIZABLE
VISUAL DEVELOPMENT IN HUMANS (TABLE 6.1)
VARIOUS FACTORS TO BE ENSURED BEFORE TESTING
METHODS OF VISUAL ACUITY TESTING
TAC (TELLER'S ACUITY CARDS) (FIG. 6.2)
Responses
Drawbacks
CARDIFF ACUITY CARDS (CAC) (FIG. 6.3)
OPTOKINETIC NYSTAGMUS (OKN) E.G. CATFORD DRUM
CATFORD DRUM
VISUAL EVOKED POTENTIAL (VEP) (FIG. 6.4)
Responses
Clinical Uses in Children
DIFFERENT TESTS USEFUL ACCORDING TO AGE
1–2 YEARS OF AGE
2–3 YEARS
3–5 YEARS OF AGE
> 6 YEARS
For distance
For near
7:
Refraction and Refractive Errors in Children
INTRODUCTION
NATURAL HISTORY
REFRACTION IN CHILDREN
Post-natal Development of the Eye
EMMETROPISATION
CLASSIFICATION OF REFRACTIVE ERRORS
REFRACTIVE STATUS OF THE EYE
EMMETROPIA
AMETROPIA
Axial Ametropia
Refractive Ametropia
MYOPIA
JUVENILE ONSET MYOPIA
Associated Risk Factors
ADULT ONSET MYOPIA
MYOPIA IN CHILDREN
Presentation
Fundus Picture
HYPEROPIA
ASTIGMATISM
FORMS
Regular Astigmatism
Irregular Astigmatism
RATIONAL FOR TREATMENT
MANAGEMENT
Measurement of Visual Acuity
Amount of Refractive Error
ASSESSMENT OF REFRACTIVE ERROR IN CHILDREN
CYCLOPLEGIC REFRACTION
Side Effects
Systemic effects:
AUTOREFRACTION
PHOTO REFRACTION
Method
TREATMENT
Hyperopia
Myopia
Astigmatism
Use of Glasses
Refractive Surgery
8:
Theoretical Predictor and Mechanisms of Pediatric Myopia
INTRODUCTION
THE NEW CRITERIA FOR EMMETROPIA
THE DOUBLE-RATIO THEORY
THE DYNAMIC DOUBLE-RATE GROWTH THEORY
PREDICTION OF ONSET OF MYOPIA
MECHANISMS OF MYOPIA
THE DYNAMIC REFRACTIVE ERROR
CONCLUSION
9:
Emmetropization Theory of Human Eyes: From Neonatal to Age 15
INTRODUCTION
REFRACTIVE ERROR EQUATION
THE IMAGE EQUATION
A NEW STANDARD FOR REFRACTIVE STATE
GROWTH FACTORS
CALCULATION PROCEDURES
COMPETING GROWTH FACTORS
EXAMPLE # 1
EXAMPLE # 2
EXAMPLE # 3
EMMETROPIZATION PROCESS
THE ROLE OF AXIAL LENGTH GROWTH
STRATEGIES OF REFRACTIVE ERROR DEVELOPMENT
MECHANISMS OF OCULAR COMPONENT GROWTH
THE DEVELOPMENT OF MYOPIA
THE SORSBY CRITERIA
PRE-BORN DEVELOPMENT
THE LIN'S HYPOTHESIS
THE POWER CHANGE (AGE −40 TO 0 WEEK)
DISCUSSIONS OF PRE-BORN STAGE
CONCLUSION
10:
Learning Disabilities and Vision
INTRODUCTION
OVERVIEW OF READING AND ROLE OF THE VISUAL SYSTEM
NON-OCULAR DISORDERS ASSOCIATED WITH READING DIFFICULTIES
DYSLEXIA
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
OCULAR DISORDERS ASSOCIATED WITH READING DIFFICULTIES
CONVERGENCE INSUFFICIENCY
ACCOMMODATIVE INSUFFICIENCY
SPASM OF THE NEAR REFLEX
ROLE OF THE OPHTHALMOLOGIST
TREATMENT OPTIONS
ALTERNATIVE OPTIONS
VISION THERAPY
TINTED LENSES AND OVERLAYS
SUMMARY
11:
Neonatal Eye Structure and Function in Comparison to Adults
INTRODUCTION
CHANGES IN STRUCTURE
AXIAL LENGTH
CORNEAL CURVATURE
GROWTH OF CRYSTALLINE LENS
CHANGES IN RETINA AND CILIARY BODY
CHANGES IN FUNCTION OF THE EYE AFTER BIRTH
TEAR PRODUCTION
REFRACTIVE ERRORS
DEVELOPMENT OF VISUAL FUNCTION
SUMMARY
SECTION 2: PEDIATRIC LENS DISEASES
12:
Etiology and Pathogenesis of Infantile Cataracts
INTRODUCTION
ASPECTS OF LENS EMBRYOLOGY, PHYSIOLOGY AND METABOLISM PERTAINING TO PATHOGENESIS OF CATARACT FORMATION
CATARACT MORPHOLOGY
DISCUSSION OF ETIOLOGY
IDIOPATHIC
HEREDITARY CATARACTS
METABOLIC
INFECTIOUS
ASSOCIATED OCULAR ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
TRAUMA
MEDICATIONS
OTHER SYNDROMES
AN APPROACH TO THE WORK-UP OF A CONGENITAL CATARACT PATIENT
13:
Primary Intraocular Lens Implantation in Infantile Cataract Surgery
INTRODUCTION
WHY AND WHY NOT?
LITERATURE REVIEW
IOL USE PATTERN AND OPINIONS
SHOULD I IMPLANT IN THIS EYE OR NOT?
SPECIFIC ISSUES
PREOPERATIVE
Preoperative Counseling
Timing of Surgery
IOL Power Calculation
INTRAOPERATIVE
Incision
Capsulorhexis
IOL Material and Site of Fixation
Posterior Capsulectomy and Vitrectomy
POSTOPERATIVE
Management of Residual Refractive Error
Complications and Visual Acuity Outcomes
SUMMARY
14:
Secondary Intraocular Lens Implantation in Children
INTRODUCTION
PREOPERATIVE EVALUATION
CAPSULAR SUPPORT
IOL POWER CALCULATION
SITE OF FIXATION OF AN IOL
IN THE PRESENCE OF SUFFICIENT CAPSULAR SUPPORT
ABSENCE OF SUFFICIENT CAPSULAR SUPPORT
OUTCOME OF SECONDARY IOL IMPLANTATION
IN THE PRESENCE OF SUFFICIENT CAPSULAR SUPPORT
IN THE ABSENCE OF SUFFICIENT CAPSULAR SUPPORT
SUMMARY
15:
Designs and Types of Intraocular Lens for Children
INTRODUCTION
AcrySof® IOL
INTRAOPERATIVE PERFORMANCE OF AcrySof® IOL
POSTOPERATIVE OUTCOME OF AcrySof® IOL USE
SPECIAL LENSES
BLUE FILTRATION HYDROPHOBIC IOL
ANTERIOR CHAMBER IOL, SUTURED IOL, AND IRIS-FIXATED IOL
MULTIFOCAL AND ACCOMMODATING IOL IMPLANTATION
THE LIGHT-ADJUSTABLE LENS (LAL) AND ITS APPLICATION IN PEDIATRIC CATARACT SURGERY
BAG-IN-THE LENS IOL
SUMMARY
16:
Operative Techniques in Pediatric Cataract Surgery
INTRODUCTION
TIMING OF SURGERY
PRIMARY IOL IMPLANTATION IN CHILDREN YOUNGER THAN 1 YEAR
PREOPERATIVE EVALUATION
OPERATIVE TECHNIQUES IN PEDIATRIC CATARACT SURGERY WITHOUT IOL IMPLANTATION
OPERATIVE TECHNIQUES IN PEDIATRIC CATARACT SURGERY WITH IOL IMPLANTATION
THE CHOICE OF IOL FOR IMPLANTATION IN CHILDREN
Size of Haptics
Size of Optics
Haptic Angulations
Optic Configuration
IOL Material
IOL Design
IOL Filters
Implantation Method
Conclusion
IOL POWER CALCULATIONS
TECHNIQUE OF SURGERY
Incision Construction
Anterior Capsule Surgery
Multiquadrant, Cortical-cleaving Hydrodissection
Aspiration of Lens Substance
Posterior Capsule Surgery and Anterior Vitrectomy
IOL Implantation
Bimanual Aspiration/Irrigation of Viscoelastic Agent
Wound Suturing
SECONDARY IOL IMPLANTATION
TIMING OF SURGERY
TECHNIQUE OF IMPLANTATION
In-the bag-fixation
Ciliary Sulcus fixation
Optic Capture
Scleral Fixation
Iris Fixation
Anterior Chamber Fixation
CHOICE OF IOL
17:
Management of Pediatric Cataract
INTRODUCTION
THE MAGNITUDE OF PROBLEM
CAUSES
EXAMINATION
MANAGEMENT
THE PEDIATRIC EYE
VISUALLY SIGNIFICANT CATARACTS
TIME OF SURGERY
IOL IMPLANTATION
Size of IOL
Material of IOL
Design of IOL
Power of IOL
Type of IOL
TYPE OF SURGERY
Lens Aspiration and IOL Implantation
Primary Posterior Capsulectomy and Anterior Vitrectomy
Optic Capture
TECHNIQUE OF SURGERY
Anterior Approach
Posterior Approach
STEPS OF SURGERY
Incision
Anterior Capsulorhexis
Lens Aspiration
Posterior Capsulorhexis
Anterior Vitrectomy
IOL Implantation
CONCLUSION
18:
Microphakonit: Cataract Surgery with a 0.7 mm Tip
HISTORY
MICROPHAKONIT (0.7 MM) NEEDLE TIP
MICROPHAKONIT (0.7 MM) IRRIGATING CHOPPER
AIR PUMP AND GAS FORCED INFUSION
BIMANUAL 0.7 MM IRRIGATION ASPIRATION SYSTEM
DUET HANDLES
TECHNIQUE
Incision
Rhexis
Hydrodissection
Microphakonit
SUMMARY
19:
Bimanual Microphaco in Children
INTRODUCTION
HISTORY
HISTORY BIMANUAL PHACO
BIMANUAL MICROPHACOEMULSIFICATION TECHNIQUE
ANESTHESIA
PARACENTHESIS11 (FIG. 19.3)
DYE OF THE CAPSULE12–14 (FIG. 19.4)
VISCOUS
CAPSULORHEXIS15
HYDRODELINEATION-HYDRODISSECTION
PHACOEMULSIFICATION OF THE NUCLEUS (FIG. 19.7)
EPINUCLEUS REMOVAL IF EXIST
IRRIGATION–ASPIRATION THE CORTEX
LENS
CONCLUSION
20:
Phakonit and Microphakonit in Pediatric Cataract Surgery
INTRODUCTION
SURGICAL TECHNIQUE
PHAKONIT
MICROPHAKONIT
CONCLUSION
21:
Posterior Capsulotomy and Vitrectomy using Bimanual Microphaco before Implantation in Young Children
INTRODUCTION
HISTORY
PRIMARY CAPSULOTOMY/SECONDARY CAPSULOTOMY
BIMANUAL MICROPHACO TECHNIQUE CAPSULOTOMY POSTERIOR VITRECTOMY
CONCLUSION
22:
Implantation of an Acrylic Lens on a Microincision in Children
INTRODUCTION
IOL SIZING IN CHILDREN
IOL POWER CALCULATION
TYPE OF LENS
TECHNIQUE
CONCLUSION
23:
Pearls and Tricks in Congenital Cataract Surgery
INTRODUCTION
DIAGNOSIS
PREOPERATIVE PEARLS
PUPIL DILATION
IOL IMPLANTATION
IOL POWER CALCULATION
GENERAL ANESTHESIA
SURGICAL PEARLS AND TRICKS
24:
Age-dependent IOL Power after Pediatric Cataract Surgery
INTRODUCTION
AGE DEPENDENCE (IN PHAKIC EYES)
AGE 3 AND UP
AGE 0 TO 6
PSEUDOPHAKIC EYE (AGE 0 TO 3)
THE LIN'S DOUBLE-RATE (M AND N)
CUSTOMIZED IOL POWER
THE DOUBLE-RATE THEORY
THE ADJUSTED IOL-POWER
ADJUSTED FACTORS
CONCLUSION
25:
Negative Accommodating IOL for Eyes after Congenital Cataract Surgery
INTRODUCTION
BASIC PRINCIPLES
SINGLE-OPTICS IOL (FIG. 25.2)
BASICS OF ACCOMMODATION
DUAL-OPTICS IOL (REFERRED TO FIG. 25.3)
AXIAL GROWTH
IOL ACCOMMODATION
DESIGN OF NEGATIVE AA IOL
SPECIAL FEATURES
CONCLUSION
26:
Intraocular Lens Power Calculation for Children
INTRODUCTION
AXIAL LENGTH AND KERATOMETRY
IOL POWER CALCULATION FORMULAS
DESIRED IMMEDIATE POSTOPERATIVE REFRACTION
LITERATURE REVIEW
OUR CURRENT APPROACH
AGE AT CATARACT SURGERY
STATUS OF FELLOW EYE
VISUAL ACUITY
EXPECTED COMPLIANCE OF CHILD/FAMILY TO THE GLASSES/CONTACT LENS/OCCLUSION THERAPY
PARENT'S REFRACTIVE ERROR
IOL POWER
IMPLANTATION IN-THE-BAG, SULCUS, OR IN THE ANTERIOR CHAMBER
SPECIAL SITUATIONS
TRAUMATIC CATARACT
SECONDARY IOL IMPLANTATION
REFRACTIVE SURPRISES
INSTRUMENTATION ERROR
FORMULA ERROR
EYE GROWTH
SUMMARY
27:
SICS in Pediatric Cataracts
INTRODUCTION
WHY SICS AND IOL IN A CHILD?
SURGICAL PROCEDURE
SURGERY
ANESTHESIA
TUNNEL INCISIONS
VISCOELASTICS
ANTERIOR CAPSULECTOMY
REMOVAL OF LENS MATTER
PRIMARY IOL IMPLANTATION
MANAGEMENT OF POSTERIOR CAPSULE
SELECTION OF IOL POWER
POSTOPERATIVE MEDICATIONS
FOLLOW-UPS
28:
Features of Refractogenesis and Eyeballs Growth in Children with Cataract of Various Etiology
INTRODUCTION
INFLUENCE OF THE CATARACT ETIOLOGY TO THE OCULAR REFRACTOGENESIS IN CHILDREN
GROWTH OF THE PSEUDOPHAKIC EYES IN CHILDREN AFTER REMOVAL OF VARIOUS ETIOLOGY CATARACTS
29:
Management of Pediatric Cataract and Novel Surgery Procedures
INTRODUCTION
ANATOMY OF THE CHILD'S EYE
DIAGNOSIS OF CATARACTS IN CHILDREN
INHERITANCE
CLASSIFICATION OF CATARACTS
LATERALITY
AGE OF ONSET
THE EXTENT AND LOCATION OF CATARACT
CATARACT SIZE AND DENSITY
PROGRESSION
EVALUATION OF THE CHILD
ASSOCIATED OCULAR DEFECTS
NONSURGICAL TREATMENT
SURGICAL TREATMENT
CONGENITAL CATARACTS
OPTICAL REHABILITATION
THE CATARACT PROCEDURE
PUPIL DILATATION
PATIENT PREPARATION
CATARACT SURGERY, WITHOUT PLACEMENT OF AN INTRAOCULAR LENS
CONTACT LENS CORRECTION FOR APHAKIC AND PSEUDOPHAKIC EYES
Optical Supply of an Aphake Eye
Soft Contact Lenses – Rigid contact lenses
CATARACT SURGERY WITH LENS IMPLANTATION
Patient Selection
Lens Style and Power
Lens Power
Implantation of an Intraocular Lens
SUGICAL TECHNIQUE OF CONGENITAL LENS SUBLUXATION
SECONDARY IOL IMPLANTATION IN CHILDREN
SECONDARY INTRAOCULAR LENS, PLACEMENT WITHOUT CAPSULAR SUPPORT
FOLLOW-UP CARE
CONCLUSION
30:
Intraocular Lens Implantation with One Loop Haptic Amputated for Congenital Subluxation Lens Surgical Treatment
INTRODUCTION
SURGICAL TREATMENT
INTRAOCULAR LENS IMPLANTATION WITH ONE LOOP HAPTIC AMPUTATED
SURGICAL TECHNIQUE
PERSONAL EXPERIENCE
31:
Pediatric Aphakia Treatment
INTRODUCTION
OPTICAL CORRECTION
APHAKIC GLASSES
EPIKERATOPHAKIA
CONTACT LENSES
Types of Contact Lenses
INTRAOCULAR LENS (IOL)
MONOCULAR AND BINOCULAR APHAKIA TREATMENT
32:
Management of Ectopia Lentis
INTRODUCTION
ETIOLOGY
CLINICAL SYMPTOMS AND SIGNS
MANAGEMENT
CONSERVATIVE MANAGEMENT
SURGICAL MANAGEMENT
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE
LENSECTOMY AND ANTERIOR STABILISATION OF CAPSULAR BAG WITH INTRAOCULAR LENS (IOL) IMPLANT
VITREOLENSECTOMY AND SULCUS SCLERAL SUTURED IOL/IRIS CLIPPED LENS
Sulcus Scleral Sutured IOL
Iris Clipped IOLs
COMPLICATIONS
33:
Management of Postoperative Complications after Pediatric Cataract Surgery
INTRODUCTION
VISUAL AXIS OPACIFICATION
PREVENTION
TREATMENT
IOL OPACIFICATION
INTRAOCULAR PRESSURE SPIKE DUE TO RESIDUAL OPHTHALMIC VISCOSURGICAL DEVICES
POSTOPERATIVE GLAUCOMA
TREATMENT
ASTIGMATISM
POSTOPERATIVE ANTERIOR UVEITIS
PREVENTION
TREATMENT
IOL DEPOSITS AND SYNECHIAE
HETEROCHROMIA IRIDIS
PUPILLARY CAPTURE
CORNEAL COMPLICATION
ENDOPHTHALMITIS
IOL MALPOSITION
RETINAL DETACHMENT
TREATMENT
CYSTOID MACULAR EDEMA
PREVENTION
TREATMENT
HEMORRHAGIC RETINOPATHY
MYOPIC SHIFT OF REFRACTION
STRABISMUS
SUMMARY
SECTION 3: EXTERNAL EYE DISEASES (LID, ORBIT AND LACRIMAL SYSTEM)
34:
Pediatric Eyelid Abnormalities
INTRODUCTION
EMBRYOLOGY OF THE EYELID
CONGENITAL ABNORMALITIES
CRYPTOPHTHALMOS
Management
COLOBOMA
MANAGEMENT
ANKYLOBLEPHARON
Management
CONGENITAL ECTROPION
Management
CONGENITAL ENTROPION
Management
EPIBLEPHARON
Management
EURYBLEPHARON
Management
EPICANTHUS
Types of Epicanthus
Management
TELECANTHUS
Management
CONGENITAL PTOSIS
Management
CHOICE OF SURGICAL PROCEDURE
Commonly Performed Surgeries
Indications for the Choice of Different Surgical Procedures
CONGENITAL TUMORS
Pigmented lesions
Management
Naevus of Ota (Oculodermal melanocytosis)
ANGIOMATOUS TUMORS
Management
Dermoid and Epidermoid Cyst
Plexiform Neurofibroma
ACQUIRED DISORDERS
EYELID TRAUMA IN CHILDREN
Management
INFLAMMATOMY DISORDERS
Blepharitis
Stye
Chalazion
Internal hordeolum
Molluscum Contagiosum
Management
35:
Congenital Ptosis: Evaluation and Management
INTRODUCTION
SURGICAL ANATOMY OF THE UPPER EYELID AND EYEBROW
CLASSIFICATION OF CONGENITAL PTOSIS
CLINICAL EVALUATION
HISTORY
OCULAR EXAMINATION
Visual Acuity
Palpebral Aperture
Margin Reflex Distance (Fig. 35.2)
Levator function
ASSESSMENT IN CHILDREN
Iliff Test
Margin Crease Distance (MCD)
Bell's Phenomenon
Corneal Sensation
Ocular Motility
Tensilon Test
Phenylephrine Test
ASSOCIATIONS
SURGICAL APPROACH DEPENDS ON
COMMONLY PERFORMED SURGERIES
BILATERAL PTOSIS
SURGICAL TECHNIQUES
MODIFIED FASANELLA SERVAT SURGERY
Surgical steps (Figs 35.9A to E)
Comolications of Fasanella Servat Surgery
LEVATOR RESECTION
Surgical Steps
Complications of Levator Surgery
BROW SUSPENSION REPAIR
TEMPORARY SLING
FASCIA LATA SLING
Harvesting of fascia lata
Fascia Lata Sling Suspension
COMPLICATIONS OF FRONTALIS SLING
Unavoidable Complications
Avoidable Complications
MANAGEMENT OF COMPLICATED PTOSIS
PTOSIS WITH OCULOMOTOR ABNORMALITIES
Congenital Ptosis with Superior Rectus Weakness
Ptosis Associated with Double Elevator Palsy
BLEPHAROPHIMOSIS SYNDROME
Double Z Olasty or Y to V Plasty with Transnasal Wiring
LATERAL CANTHOPLASTY
Stage II
MARCUS GUNN PTOSIS
MISDIRECTED THIRD NERVE PTOSIS
36:
Frontalis Muscle Flap Advancement for Correction of Blepharoptosis with Poor Levator Function
INTRODUCTION
MECHANISM OF LID ELEVATION AFTER BROW SUSPENSION
ANATOMY OF THE OCCIPITOFRONTALIS
EVALUATION OF THE PATIENT
SURGICAL TECHNIQUE
COMPLICATIONS
37:
Anatomy of the Lacrimal Apparatus
INTRODUCTION
LACRIMAL GLANDS
BLOOD SUPPLY OF THE LACRIMAL GLAND
NERVE SUPPLY OF THE LACRIMAL GLAND
Secretomotor Supply to Lacrimal Gland
LACRIMAL PASSAGE
LACRIMAL PUNCTA
LACRIMAL CANALICULI
LACRIMAL SAC
NASOLACRIMAL DUCT
BLOOD SUPPLY OF THE LACRIMAL PASSAGE
NERVE SUPPLY OF THE LACRIMAL PASSAGE
38:
Pediatric Epiphora
INTRODUCTION
EMBRYOLOGY OF THE LACRIMAL SYSTEM
SECRETORY SYSTEM
EXCRETORY SYSTEM
DEVELOPMENTAL ABNORMALITIES
ANATOMY OF EXCRETORY SYSTEM
IMPORTANT POINTS TO REMEMBER IN INFANTS
PHYSIOLOGY
EVALUATION
HISTORY
EXAMINATION
Eyelid Margin
Medial Canthal Area
INVESTIGATIONS
MANAGEMENT
PUNCTAL AND CANALICULAR ABNORMALITIES
Punctal Agenesis
LACRIMAL SAC ABNORMALITIES
Dacryocystocele
Congenital Naso-lacrimal obstruction (CNLDO)
CONSERVATIVE MANAGEMENT
Syringing and Probing
Failure
Inferior Turbinate Infracture
Silicone Intubation
BALLON DACRYOPLASTY
DACRYOCYSTORHINOSTOMY (DCR)
ENDONASAL DCR
SUMMARY
39:
Lacrimal Gland Tumors
ANATOMY
TYPES
SYMPTOMS
INVESTIGATIONS
TREATMENT
EPITHELIAL LACRIMAL GLAND TUMORS
PLEOMORPHIC ADENOMA (BENIGN MIXED TUMOR)
MALIGNANT MIXED TUMOR
ADENOID CYSTIC CARCINOMA
OTHER EPITHELIAL TUMORS
NONEPITHELIAL LACRIMAL GLAND TUMORS
INFLAMMATORY MASSES
LYMPHOIDAL TUMORS
OTHER LACRIMAL GLAND LESIONS
40:
Dacryocystitis
INTRODUCTION
EPIDEMIOLOGY
ANATOMY
CLINICAL MANIFESTATIONS
ETIOLOGY
HISTOLOGY
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
TREATMENT
ANESTHESIA
SURGERY
POSTOPERATIVE CARE
CONTRAINDICATIONS FOR SURGERY
COMPLICATIONS OF SURGERY
PROGNOSIS
41:
Endoscopic Conjunctivo-dacryocystorhinostomy
INTRODUCTION
ENDOSCOPIC SURGERY
INDICATIONS AND CONTRAINDICATIONS FOR CDRC AND THE ALTERNATIVES AVAILABLE
PREOPERATIVE WORK-UP
POSTOPERATIVE WORK-UP
COMPLICATIONS
UNBREAKABLE TUBE AND INJECTOR
WHY USE ENDOSCOPIC CDRC?
42:
Orbital Lesions and Tumors
CLINICAL EVALUATION OF ORBITAL DISEASE
ORBITAL DIAGNOSIS
SYMPTOMS
Pain
Vision Loss
Associated Systemic Disease
INNERVATION
Motor
Sensory
MUSCLE INVOLVEMENT
PROGRESSION
LOCATION
EXTERNAL SIGNS
Globe Pulsation
Eyelid Position
Exophthalmometry
RADIOLOGY
Plain Radiographs
Computed Tomography (CT)
Magnetic Resonance Imaging
ORBITAL INFECTIONS AND INFLAMMATORY DISEASES
ORBITAL INFECTIONS
Bacterial Infection
PEDIATRIC BACTERIAL INFECTION
ADULT BACTERIAL INFECTION
TOLOSA-HUNT SYNDROME (CAVERNOUS SINUS THROMBOSIS)
FUNGAL INFECTION
ORBITAL PHYCOMYCOSIS
ORBITAL ASCOMYCOSIS
PARASITIC INFECTIONS
PSEUDOTUMOR (IDIOPATHIC ORBITAL INFLAMMATION)
CYSTIC LESIONS
DERMOID CYST
Treatment
MUCOCELE
Treatment
HEMATOCELE
Treatment
VASCULAR LESIONS (TABLE 42.7)
CAPILLARY HEMANGIOMA
Treatment
CAVERNOUS HEMANGIOMA (FIGS 42.20A AND B)
Treatment
LYMPHANGIOMA
Treatment
ORBITAL VARIX
Treatment
CAROTID-CAVERNOUS FISTULA
Treatment
ORBITAL MALIGNANCIES
RHABDOMYOSARCOMA
Clinical Presentation
Differential Diagnosis
Histological Types
Treatment
Prognosis
Systemic Prognosis
ORBITAL METASTATIC TUMORS
Incidence and Prevalence
Pathogenesis
Clinical Characteristics
PEDIATRIC METASTATIC ORBITAL TUMORS
PRIMARY OPTIC NERVE TUMORS
OPTIC NERVE GLIOMA
Treatment
OPTIC NERVE SHEATH MENINGIOMA
Treatment
SECONDARY ORBITAL TUMORS
PARANASAL SINUS TUMORS
BENIGN TUMORS
OSTEOMA
Treatment
MUCOCELE
MALIGNANT TUMORS
MAXILLARY CARCINOMA
ETHMOID CARCINOMA
LACRIMAL FOSSA MASSES
LYMPHOMA
PERIPHERAL NERVE SHEATH TUMORS
NEURILEMMOMA (SCHWANNOMA)
Treatment
NEUROFIBROMA
43:
Preseptal Cellulitis
DEFINITION
PRESEPTUM CELLULITIS
CAUSES
PATHOGENESIS
CLINICAL FEATURES
MANAGEMENT
DIAGNOSIS
TREATMENT
COMPLICATION
PROGNOSIS
ORBITAL CELLULITIS
PATHOPHYSIOLOGY
CLINICAL FEATURES
CAUSES
COMPLICATION
DIAGNOSIS
TREATMENT
Indications of Surgery
44:
Orbital Fractures
INTRODUCTION
ORBITAL ANATOMY
INJURY PATTERNS
ASSOCIATED OCULAR INJURIES
LOSS OF VISION
HYPHEMA
CORNEOSCLERAL LACERATION
POSTERIOR SEGMENT INJURIES
OCULAR MUSCLE INJURY
SURGICAL TIMING
RADIOLOGIC EVALUATION
CLINICAL SIGNS AND SYMPTOMS
INDICATIONS FOR SURGERY
CONTRAINDICATIONS FOR SURGERY
SURGERY
ORBITAL ROOF FRACTURES
ORBITAL FLOOR FRACTURES
MEDIAL WALL FRACTURES
LATERAL ORBITAL WALL FRACTURES
ORBITAL IMPLANT MATERIALS
COMPLICATIONS (FIG. 44.18)
45:
Orbitotomies
INTRODUCTION
GENERAL ASPECTS OF ORBITAL SURGERY
SURGICAL ANATOMY
APPROACHES TO THE ORBIT
LATERAL ORBITOTOMY
Skin Muscle Incision
Periosteal Incision
Bone Cuts
Incision in the Periorbita
Removal of Tumor
Wound Closure
ANTERIOR ORBITOTOMY
Skin Muscle Incision
Periosteal Incision
Removal of Tumor
Closure of Periosteum
Skin Closure and Dressing
TRANSCONJUNCTIVAL ORBITOTOMY
TRANSFRONTAL CRANIOTOMY
ORBITAL DECOMPRESSION
COMPLICATIONS OF ORBITAL SURGERY
SECTION 4: ANTERIOR SEGMENT DISEASES
46:
Congenital Anomalies of the Anterior Segment
ANOPHTHALMOS/MICROPHTHALMOS
PREVALENCE
DIFFERENTIAL DIAGNOSIS
ETIOLOGY
OCULAR AND SYSTEMIC ASSOCIATIONS
MANAGEMENT
Management of Anophthalmos
Management of Microphthalmos
ANTERIOR SEGMENT DYSGENESIS
POSTERIOR EMBYOTOXON
AXENFELD-RIEGER SYNDROME
PETER'S ANOMALY
Histopathology
Differential Diagnosis
Ultrasound Biomicroscopy
SCLEROCORNEA
ULTRASOUND BIOMICROSCOPY
DIFFERENTIAL DIAGNOSIS
47:
Hyphema
INTRODUCTION
HISTORY
EXAMINATION (FIGS 47.1 TO 47.9)
ASSOCIATED EXAM FINDINGS
PROGNOSIS AND TREATMENT OF HYPHEMA
48:
Ophthalmic Medications in Pediatric Age Group
INTRODUCTION
PRECAUTIONS
MYDRIATIC AGENTS
ADRENERGIC AGONIST
Phenylephrine Hydrochloride
CYCLOPLEGIC AGENTS/ PARASYMPATHOLYTICS
Indications in Children
Atropine Sulphate
Homatropine
Cyclopentolate
Toxicity
Tropicamide
GLAUCOMA MEDICATIONS
BETA BLOCKERS
Mechanism
Potential Side Effects
Contraindications and Toxicity
CARBONIC ANHYDRASE INHIBITORS
Mechanism of Action
Dosage and Preparations
Potential Side Effects
ALPHA ADRENERGIC AGONISTS
Mechanism of Action
Dosage and Preparation
Potential Side Effects
ADRENERGIC AGONIST (SYMPATHOMIMETIC)
Mechanism of Action
Dosage and Preparation
Potential Side Effects
Contraindication
PARASYMPATHOMIMETICS
Mechanism of Action
Indications
Dosage and Preparation
Potential Side Effects
Contraindications
PROSTAGLANDIN ANALOGS
Mechanism of Action
Dosage and Preparations
Potential Side Effects
ANTI-INFLAMMATORY DRUGS
STEROIDS
Mechanism of Action
Indications
Dosage and Preparations
Potential Side Effects
Relative Potential Side effects of Various Corticosteroids
Precautions
NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS)
Mechanism of Action
Indications
Dosage and preparations
ANTI-ALLERGY MEDICATIONS
MAST CELL INHIBITORS
Mechanism of Action
Indications
Dosage and Preparations
Potential Side Effects
DECONGESTANTS(ANTIHISTAMINICS AND SYMPATHOMIMETICS)
Mechanism of Action
Preparation and Dosage
Potential Side Effects
DUAL AGENTS
Mechanism of Action
Indication
Dosage and Preparation
Potential Side Effects
ANTIBIOTIC
INDICATIONS
Prophylaxis
Treatment
DOSAGE
BETA-LACTAMS
Mechanism of Action
Preparations
Dosage and Routes of Administration
Side Effects and Safety
SULPHONAMIDES
Mechanism of Action
Indications
Effectivity
Resistance
Preparation and Dosage
Side Effects and Safety
AMINOGLYCOSIDES
Mechanism of Action
Effectivity
Resistance
Preparation and Dosage
Side Effects and Safety
MACROLIDES
Mechanism of Action
Effectivity
Preparation and Dosage
Side Effects and Safety
TETRACYCLINES
Mechanism of Action
Effectivity
Resistance
Preparation
Side Effects and Safety
CHLORAMPHENICOL
Mechanism of Action
Effectivity
Resistance
Preparation and Dosage
Side Effects and Safety
FLUROQUINOLONES
Mechanism of Action
Effectivity
Preparation
Side Effects and Safety
ANTIVIRALS
ANTI FUNGALS
POLYENES
Mechanism of action
Preparation and Dosage
Side Effects and Safety
IMIDAZOLE DERIVATIVES
Mechanism of Action
Preparations and Dosage
Side effects and Safety
FLUORINATED PYRIMIDINES-FLUCYTOSINE
Mechanism of Action
Dosage and Preparation
Side Effects and Safety
CONCLUSION
49:
Surgery in Pediatric Age Group
INTRODUCTION
SURGICAL ANATOMY
EXTERNAL
LACRIMAL SYSTEM
ORBIT
EYEBALL
FUNDUS
IOL IMPLANT IN CHILDREN
INSTRUMENTS IN PEDIATRIC SURGERY
INSTRUMENTATION
50:
Pediatric Corneal Diseases: Current Concepts and Management
INTRODUCTION
SCLEROCORNEA
DEVELOPMENT OF CORNEA AND ANTERIOR SEGMENT
ABSENCE OF THE CORNEA
CRYPTOPHTHALMOS
PSEUDOCRYPTOPHTHALMOS
ABNORMALITIES OF SIZE
MEGALOCORNEA
MICROCORNEA
PETER'S ANOMALY
CORNEAL INVOLVEMENT IN CHROMOSOMAL ABERRATIONS
CORNEAL INVOLVEMENT IN CHROMOSOMAL DISORDERS
CORNEAL INVOLVEMENT IN MUCOPOLYSACCHARIDOSIS
CYSTINOSIS
ALKAPTONURIA
TYROSINEMIA TYPE II (TYROSINOSIS, RICHNER-HANHART SYNDROME)
WILSON DISEASE
CORNEAL INVOLVEMENT IN ASSOCIATION WITH CRANIOFACIAL MALFORMATION SYNDROMES
CROUZON AND APERT SYNDROME
HALLERMANN-STERIFF SYNDROME
MEYER-SCHWICKERATH SYNDROME (OCULODENTODIGITAL DYSPLASIA)
GOLDENHAR SYNDROME (OCULOAURICULOVERTEBRAL DYSPLASIA)
OCULAR INVOLVEMENT IN INHERITED CONNECTIVE TISSUE DISORDERS
MARFAN SYNDROME
OSTEOGENEIS IMPERFECTA
EHLERS-DANLOS SYNDROME TYPE VIA
CONGENITAL CORNEAL DYSTROPHIES
CONGENITAL HEREDITARY ENDOTHELIAL DYSTROPHY (CHED)
Clinical Features
Differential Diagnosis
Pathogenesis
Treatment
POSTERIOR POLYMORPHOUS DYSTROPHY
Diagnosis
Differential Diagnosis
Pathology
Treatment
CONGENITAL HEREDITARY STROMAL DYSTROPHY
Causes of Congenital Corneal Opacities
INFECTIONS
OPHTHALMIA NEONATORUM
Management of Ophthalmia Neonatorum
Prophylaxis
Prevention
CONJUNCTIVITIS
A. Bacterial Conjunctivitis
B. Viral Conjunctivitis
C. Infective Keratitis
Clinical Diagnosis
Treatment
HERPES SIMPLEX INFECTION
Recurrences and Latency
Clinical Presentation
Treatment
HERPES SIMPLEX ZOSTER OPHTHALMICUS
Clinical Presentation
Complications
Treatment
INTERSTITIAL KERATITIS
Keratitis in Association with Acne Rosacea
ALLERGIC DISORDERS
ALLERGIC CONJUNCTIVITIS
A. Atopic Conjunctivitis
B. Vernal Conjunctivitis
Clinical Presentation
Treatment
VERNAL KERATOPATHY AND SHIELD ULCERS
Etiology
Clinical Features
Treatment
CORNEAL INJURIES
MANAGEMENT OF CORNEAL INJURIES
EPIDEMIOLOGY
CLINICAL EXAMINATION
TYPE OF ANESTHESIA
PRINCIPLES OF SURGICAL REPAIR
VISCOELASTIC MATERIALS
MANAGEMENT OF INJURY TO LENS
TYPE OF SUTURES
POSTOPERATIVE TREATMENT
COMPLICATIONS
Corneal Abrasion
Corneal Foreign Bodies
Corneal Edema
TREATMENT
CORNEAL ECTASIA
KERATOCONUS
Clinical Presentation
Pathogenesis
Treatment
NUTRITIONAL DEFICIENCY DISORDER
XEROPHTHALMIA : VIT. A DEFICIENCY
Definition of Xerophthalmia, Keratomalacia
Pathophysiology
Ocular Manifestation
Diagnosis
Treatment
Prevention
DRY EYE AND OCULAR SURFACE DISEASE
DRY EYE IN CHILDREN
LIMBAL STEM CELL DEFICIENCY IN CHILDREN
STEVENS-JOHNSON SYNDROME
ANIRIDIA RELATED OCULAR SURFACE DISEASE
CHEMICAL EYE INJURY
Clinical Presentation
Diagnosis
Treatment
Gene Therapy in Corneal Diseases
BLINDNESS IN CHILDHOOD
Etiology of Childhood Blindness
51:
Pediatric Keratoplasty
INTRODUCTION
VISUAL ASSESSMENT (FIGS 51.2 TO 51.13)
DIRECT
INDIRECT
OCULAR EXAMINATION
SURGICAL PROCEDURES
INDICATIONS
Congenital
Acquired, Non-traumatic
Acquired, traumatic (Fig. 51.17)
SURGICAL MANAGEMENT
PENETRATING KERATOPLASTY
CONCOMITANT PROCEDURES
Iris Procedures
Indications
Pupilloplasty (Fig. 51.18)
Lensectomy and Anterior vitrectomy
Concomitant Retinal Surgery
Postoperative Care
Early Postoperative Care
Postoperative Medications
Suture Removal
OPTICAL CORRECTION AND AMBLYOPIA THERAPY
CONCLUSION
52:
Nonviral Pediatric Keratitis
INTRODUCTION
PREDISPOSING FACTORS
MICROBIOLOGY
BACTERIA
Gram-positive Cocci
Gram-negative Bacilli
FUNGUS
PROTOZOA
Contact Lens Use
CELLULAR MECHANISM
CLINICAL ASSESSMENT
CLINICAL SIGNS AND SYMPTOMS
Bacterial
Fungal
Acanthamoeba
Contact Lens Induced Keratitis
CORNEAL SCRAPING AND MICROBIOLOGICAL EVALUATIONS
MANAGEMENT
MEDICAL
Antibacterials
Systemic Antibiotic
HEALING CRITERIA
SURGICAL
PREVENTION
EARLY DIAGNOSIS
VITAMIN A DEFICIENCY DISORDERS
CLINICAL FEATURES
PREVENTION
TREATMENT
NON-INFECTIVE CORNEAL INFILTRATES33
CLINICAL FEATURE
TREATMENT
MISCELLANEOUS TYPES OF KERATITIS
BLEPHAROKERATITIS/ BLEPHAROKERATOCONJUNCTIVITIS
Treatment
FASCICULAR KERATITIS
SHIELD'S ULCER
Management
ACNE ROSEA KERATITIS39
EYE EXPOSURE AND CORNEAL INFECTION
COMMENTS
DEMOGRAPHIES (GENERAL EPIDEMIOLOGY)
MICROBIOLOGICAL EVALUATION
MICROBES ISOLATION
MEDICAL THERAPY
SURGICAL THERAPY
CONCLUSIONS
53:
Disorders of the Conjunctiva
PATHOLOGIC RESPONSES OF THE CONJUNCTIVA
CONJUNCTIVAL HYPEREMIA
CONJUNCTIVAL VESSELS TORTUOSITY
TELANGIECTASIA
CONJUNCTIVAL HEMORRHAGES
EDEMA
PAPILLAE
GIANT PAPILLAE
FOLLICLES
MEMBRANES OR PSEUDOMEMBRANES
MICRO-PANNUS
GROSS-PANNUS
CONJUNCTIVAL SCARRING
INFECTIONS
NEONATAL CONJUNCTIVITIS (OPHTHALMIA NEONATORUM)
Chemical conjunctivitis
Gonococcal hyperacute conjunctivitis
Other Bacterial Conjunctivitis
Chlamydial Conjunctivitis
Viral Conjunctivitis
PEDIATRIC CONJUNCTIVITIS
Bacterial Conjunctivitis
Diagnosis of bacterial conjunctivitis
Treatment of bacterial conjunctivitis
Viral Conjunctivitis
Adenoviral Infections
Chlamydial Conjunctivitis
Trachoma
Adult Inclusion Conjunctivitis
Diagnosis of Trachoma
Treatment of Trachoma
Acanthamoeba Kertaoconjunctivitis
Fungal Keratoconjunctivitis
BLEPHAROCONJUNCTIVITIS
DIAGNOSIS OF CONJUNCTIVAL INFECTIONS
Slide Stains of Smears or Scrapings
Cultures
Cytology
Immunological Tests
TOXIC CONJUNCTIVITIS
LIGNEOUS CONJUNCTIVITIS
FOLLICULOSIS
ERYTHEMA MULTIFORME (EM), STEVENS-JOHNSON SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN)
CONJUNCTIVAL MELANOCYTIC LESIONS
TUMORS OF THE CONJUNCTIVA
CAPILLARY HEMANGIOMA
LYMPHANGIOMA
LEUKEMIC INFILTRATION OF THE CONJUNCTIVA
CHORISTOMAS
OTHER CONJUNCTIVAL LESIONS
PINGUECULUM AND PTERYGIUM
PAPILLOMA
XERODERMA PIGMENTOSUM
EPITHELIAL CYSTS
AVITAMINOSIS A
CONJUNCTIVAL MANIFESTATIONS OF SYSTEMIC DISEASES
54:
Pediatric Conjunctivitis
INTRODUCTION
BACTERIAL CONJUNCTIVITIS1, 5
CLINICAL FEATURES
SIGNS
DIAGNOSIS
CONJUNCTIVAL SWAB
TREATMENT
NEONATAL CONJUNCTIVITIS/ OPHTHALMIA NEONATORUM1,3,4,6,11
RISK FACTORS
CAUSES
Chemical Conjunctivitis:
Gonococcal Conjunctivitis
Clinical Features
DIAGNOSIS
TREATMENT
CHLAMYDIA CONJUNCTIVITIS
CLINICAL PRESENTATION
DIAGNOSIS
TRACHOMA
Clinical Features
HERPES SIMPLEX CONJUNCTIVITIS
PROPHYLACTIC AGENTS
VIRAL CONJUNCTIVITIS1, 3, 6, 10
ADENOVIRAL
ACUTE FOLLICULAR CONJUNCTIVITIS
Epidemic Keratoconjunctivitis (EKC)
Pharyngeal Conjunctival Fever(PCF)
Hemorrhagic Conjunctivitis
SUB ACUTE AND CHRONIC FOLLICULAR CONJUNCTIVITIS
Normal Childhood Folliculosis
Moraxella Conjunctivitis
Herpes Simplex
Chicken Pox
NON INFECTIOUS CONJUNCTIVITIS
Phylectenular Conjunctivitis 3
Ligneous Conjunctivitis3
Chronic Papillary Conjunctivitis1, 3, 6
Vernal Conjunctivitis
Keratopathy
Atopy Conjunctivitis
Allergic Conjunctivitis
KAWASAKI'S DISEASE
CONCLUSION
55:
Pediatric Iris Abnormalities
ANIRIDIA2
ADDITIONAL ABNORMALITIES
TYPICAL CLINICAL PRESENTATION
CAUSE
Sporadic or Familial
Familial
Sporadic
COLOBOMA IRIS
TYPICAL
ATYPICAL
COMMON ASSOCIATION
HETEROCHROMIA IRIDIS1, 2
CONGENITAL
Involved Iris Dark
Involved Iris Light in Color
Waardenburg Syndrome
ACQUIRED
Involved Iris Dark
Involved Iris Light
William Syndrome
IRIS NODULES
LISCH NODULE
JUVENILE XANTHOGRANULOMA(JXG)
PRIMARY IRIS CYSTS1, 2
IRIS PIGMENT EPITHELIUM CYSTS
CENTRAL CYSTS (PUPILLARY) 1,2
CYST IRIS STROMA1, 2
BRUSH FIELD SPOTS(WOFFLIN NODULES)2
PERSISTENT PUPILLARY MEMBRANE (PPM)1,2
PRIMARY IRIS ABNORMALITIES
REIGER'S ANOMALY2
REIGER'S SYNDROME2
56:
Pediatric Dry Eye
INTRODUCTION
CLASSIFICATION AND TREATMENTS
DIAGNOSIS OF PEDIATRIC DRY EYE
ETIOLOGY OF PEDIATRIC DRY EYE
RILEY-DAY SYNDROME (FAMILIAL DYSAUTONOMIA)
MANAGEMENT OF SEVERE DRY EYE
MULTIPLE CONCOMMITANT THERAPIES
PEDIATRIC REFRACTIVE SURGERY
TREATMENT PERSISTENCE
57:
Pediatric Ocular Allergy
INTRODUCTION
OCULAR ALLERGY DIAGNOSIS
ACUTE ALLERGIC CONJUNCTIVITIS (AAC)
SEASONAL ALLERGIC CONJUNCTIVITIS (SAC) AND PERENNIAL ALLERGIC CONJUNCTIVITIS (PAC)
VERNAL KERATOCONJUNCTIVITIS (VKC)
ATOPIC KERATOCONJUNCTIVITIS
GIANT PAPILLARY CONJUNCTIVITIS
DIFFERENTIAL DIAGNOSIS
ANALYSIS OF THE PEDIATRIC ALLERGIC PATIENT
EVALUATING THE HISTORY
EXAMINING THE OCULAR SURFACE
NON-PHARMACOLOGIC TREATMENT STRATEGIES
PREVENTING EYE CONTAMINATION
AVOIDING OR REMOVING THE ALLERGEN
ENCOURAGING FAMILY AND PARENTAL ASSISTANCE
USING ARTIFICIAL TEARS
COOLING THE EYES
TOPICAL ALLERGY MEDICATIONS
FINE TUNING TOPICAL THERAPY
MAKE SURE DROPS ARE APPLIED CORRECTLY
PRESCRIBE HIGHER POTENCY, LOWER FREQUENCY
HAVE THE PATIENT CHILL THE DROPS
RECOMMEND PRESERVATIVE-FREE MEDICATION DROPS
CONTROLLING VASCULAR PERMEABILITY
STRATEGIC AVOIDANCE OF SYSTEMIC ALLERGY MEDICATIONS
SPECIFIC MEDICAL THERAPEUTIC OPTIONS
CONTROLLING SERIOUS COMPLICATIONS
KERATOCONJUNCTIVITIS
INFLAMMATION
CHRONIC CYSTOID MACULAR EDEMA
SPECIALTY CONSULTATIONS FOR DIFFICULT CASES
ALLERGISTS
DERMATOLOGISTS
PEDIATRICIANS
PATIENT AND PARENT ACCEPTANCE OF CHRONICITY AND RECURRENCE WITHOUT CURE
58:
Corneal Dystrophies
INTRODUCTION
ANTERIOR DYSTROPHIES
MEESMANN'S CORNEAL DYSTROPHY
EPITHELIAL BASEMENT MEMBRANE DYSTROPHY
CORNEAL DYSTROPHIES OF BOWMAN'S LAYER AND THE SUPERFICIAL STROMA TYPE I AND II
CDB Type I (“True” Reis-Bucklers’ Dystrophy)
CDB Type II (Thiel-Behnke Dystrophy)
STROMAL DYSTROPHIES
GRANULAR CORNEAL DYSTROPHY
GRANULAR-LATTICE (AVELLINO) CORNEAL DYSTROPHY
LATTICE CORNEAL DYSTROPHY
LCD Type I (LCD I)
LCD Type II (LCD II)
LCD Type III (LCD III)
LCD Type IIIA (LCD IIIA)
Treatment
MACULAR CORNEAL DYSTROPHY
SCHNYDER'S CORNEAL DYSTROPHY
GELATINOUS DROP-LIKE CORNEAL DYSTROPHY
FLECK DYSTROPHY
CENTRAL CLOUDY DYSTROPHY OF FRANCOIS
BIETTI'S CRYSTALLINE DYSTROPHY
CONGENITAL HEREDITARY STROMAL DYSTROPHY
PRE-DESCEMET'S DYSTROPHIES
POSTERIOR AMORPHOUS CORNEAL DYSTROPHY
ENDOTHELIAL DYSTROPHIES
CONGENITAL HEREDITARY ENDOTHELIAL DYSTROPHY
POSTERIOR POLYMORPHOUS DYSTROPHY
FUCHS’ DYSTROPHY
59:
Anterior Segment Tumors
INTRODUCTION
IRIS NEVUS
INTRODUCTION
DIAGNOSIS
SPECIAL FORMS OF IRIS NEVUS
Iris Freckles
Lisch Nodules
Cogan-Reese Syndrome
Nevus of Ota (Oculodermal Syndrome)
TREATMENT
PROGNOSIS
CILIARY BODY NEVUS
INTRODUCTION
DIAGNOSIS
TREATMENT AND PROGNOSIS
IRIS MELANOMA
INTRODUCTION
DIAGNOSIS
TREATMENT
PROGNOSIS
CILIARY BODY MELANOMA
INTRODUCTION
DIAGNOSIS
TREATMENT
PROGNOSIS
ANTERIOR SEGMENT CYSTS
INTRODUCTION
DIAGNOSIS
TREATMENT
METASTASIS
INTRODUCTION
DIAGNOSIS
TREATMENT
PROGNOSIS
MEDULLOEPITHELIOMA
INTRODUCTION
DIAGNOSIS
FUCHS’ ADENOMA (PSEUDOEPITHELIOMATOUS HYPERPLASIA)
INTRODUCTION
DIAGNOSIS
OTHER TUMORS OF THE NONPIGMENTED CILIARY BODY EPITHELIUM
LEIOMYOMA
NEURILEMMOMA (SCHWANNOMA)
NEUROFIBROMA
HEMANGIOMA AND LYMPHOID TUMORS
SECTION 5: STRABISMUS AND AMBLYOPIA
60:
Development of the Extraocular Muscles
INTRODUCTION
ORGANIZERS
BILAMINAR GERM DISK
TRILAMINAR GERM DISK
MESODERM
EXTRAOCULAR MUSCLES
SUMMARY
61:
Binocular Vision
DEFINITION
INTRODUCTION
DIAGNOSIS OF BINOCULAR DISORDERS
ACCOMMODATIVE PERFORMANCE
COVER TEST
SUBJECTIVE TESTS TO ESTIMATE THE PRESENCE, DIRECTION AND MAGNITUDE OF PHORIAS
FIXATION DISPARITY TEST
EVALUATION OF POSITIVE AND NEGATIVE FUSIONAL VERGENCE
MEASUREMENT OF THE NEAR POINT OF CONVERGENCE
CONVERGENCE JUMP TEST
EXTERNAL OPHTHALMOLOGICAL EXAMINATION
RETINOSCOPY AND REFRACTION
MEASUREMENT AND EVALUATION OF DEVIATION
SENSORY STATE
WORTH'S FOUR DOT TEST
ESTIMATION OF THE LEVEL OF SUPPRESSION
STEREOPSIS
EVALUATION OF STEREOPSIS
ACCOMMODATION
PUPILLARY REFLEXES
EYE MOVEMENTS
BINOCULAR VISION ANOMALIES
BINOCULAR ANOMALIES
ACCOMMODATIVE ANOMALIES
OCULOMOTOR ANOMALIES
BINOCULAR ANOMALIES
CONVERGENCE INSUFFICIENCY
Treatment
FALSE CONVERGENCE INSUFFICIENCY
DIVERGENCE INSUFFICIENCY
Diagnosis
Treatment
CONVERGENCE EXCESS
DIVERGENCE EXCESS
Treatment
BASIC EXOPHORIA
BASIC ESOPHORIA
HYPERPHORIAS
ACCOMMODATIVE ANOMALIES
ACCOMMODATIVE INSUFFICIENCY
ACCOMMODATIVE EXCESS
ACCOMMODATIVE INFLEXIBILITY
OCULOMOTOR ANOMALIES
62:
Pediatric Strabismus Examination
INTRODUCTION
HISTORY
VISUAL ACUITY AND REFRACTION
EXAMINATION OF THE EYE
CHECK FOR PSEUDOSTRABISMUS
OCULAR MOVEMENTS
UNIOCULAR MOVEMENTS
BINOCULAR MOVEMENTS
VERSIONS
VERGENCES
HERING'S LAW
SHERRINGTON'S LAW
HEAD POSTURES
INTRODUCTION
BASICS
INDIVIDUAL MUSCLES INVOLVED
RIGHT LR PALSY
RIGHT MR PALSY
RIGHT SR PALSY
HIRSCHBERG'S CORNEAL REFLECTION TEST
TEST
COVER TEST
PARTS
Simple Cover Test
Cover-Uncover Test
Alternate Cover Test
PRIMARY AND SECONDARY DEVIATION
FALLACIES OF THE COVER TEST
PRISM BAR COVER TEST
TEST
KRIMSKY'S TEST
SYNAPTOPHORE (MAJOR AMBLYOSCOPE)
BASICS
USAGE OF THE INSTRUMENT
Interpupillary Distance (IPD)
Simultaneous Macular Perception
Fusion
Stereopsis
After Images
MADDOX ROD
PRINCIPLE
APPARATUS
DISTANCE
RESULTS
MADDOX WING TEST
INSTRUMENT
CLINICALLY IMPORTANT POINTS
DIPLOPIA
DIPLOPIA DEFINITION
TYPES OF DIPLOPIA
Physiological Diplopia (Fixation disparity)
Physical Uniocular Diplopia
Projectional Uniocular Diplopia
Central Uniocular Diplopia
Binocular Diplopia
Uncrossed Diplopia
Crossed Diplopia
Paradoxical Diplopia
Congruous Diplopia
Incongruous Diplopia
Overcoming Diplopia
SWAN'S SYNDROME
DIPLOPIA TESTING
INTRODUCTION
PROCEDURE
HESS CHARTING
INSTRUMENT
TEST
RESULTS
WORTH'S 4 DOT TEST
BAGOLINI'S STRIATED GLASSES TEST
TESTS FOR STEREOPSIS
DEFINITION OF STEREOPSIS
DIFFERENCE BETWEEN STEREOPSIS AND FUSION
TESTS
AFTER IMAGES TEST
63:
Signs, Symptoms and Adaptations in Strabismus
INTRODUCTION
CONFUSION
DEFINITION
INTRODUCTION
COMPARISON WITH DIPLOPIA
DIPLOPIA
SUPPRESSION
DEFINITION
DIFFERENCE FROM AMBLYOPIA
TESTS TO DETECT SUPPRESSION
Worth's Four Dot Test
FRIEND Test
Bagolini's Striated Glasses
Synaptophore
AMBLYOPIA
DEFINITION
INCIDENCE
TYPES
Amblyopia Ex Anopsia
Organic (Congenital) Amblyopia
Anisometropic Amblyopia
Aniseikonic Amblyopia
Ametropic Amblyopia
Strabismic Amblyopia
CLINICAL FEATURES
TREATMENT
ECCENTRIC FIXATION
INTRODUCTION
TYPES
PARADOXICAL FIXATION
Remember
INVESTIGATIONS
Corneal Reflection Test
Ophthalmoscope
Others
TREATMENT
ABNORMAL RETINAL CORRESPONDENCE
DEFINITION
ANGLES
PERVERSION QUOTIENT
EXPLANATION
FACTORS WHICH FAVOR THE DEVELOPMENT OF ARC
CASES OF SQUINT IN WHICH ARC IS UNLIKELY TO OCCUR
ADVANTAGES OF ARC
DISADVANTAGE OF ARC
TESTS TO DETECT ARC
Worth's Four Dot Test
Synaptophore
Bagolini's Striated Glasses
After-images Test
Others
TREATMENT
64:
Sensory Adaptations in Strabismus
INTRODUCTION
TYPES OF SENSORY ADAPTATIONS
SUPPRESSION
Mechanism
Requirements
Types
Tests for Suppression
ANOMALOUS RETINAL CORRESPONDENCE
FACTORS AFFECTING THE DEVELOPMENT OF ARC
Objective Angle of Deviation
ANGLE OF ANOMALY
THEORIES OF DEVELOPMENT
DETERMINATION OF TYPE OF RETINAL CORRESPONDENCE
Bielscowsky Afterimage (AI) Test
Red Filter Test
Bagolini Striated Lenses
Synaptophore Test
Worth 4-dot Test
AMBLYOPIA
PREVALENCE
PATHOPHYSIOLOGY
SENSITIVE PERIOD
CLASSIFICATION
Strabismic Amblyopia
Clinical features of the strabismic amblyopia
Anisometropic Amblyopia
Visual Deprivation Amblyopia (amblyopia ex anopsia)
Amblyopia with Nystagmus
Organic Amblyopia
Idiopathic Amblyopia
DIAGNOSTIC TESTS
Visual Acuity Testing
Neutral Density Filters
Pattern of Fixation
Examination of Fixation
Electrophysiological Studies
Screening Tests
65:
Cyclovertical Deviations
INTRODUCTION
DIFFERENCE FROM HORIZONTAL DEVIATIONS
CLASSIFICATION
COMITANT VERTICAL DEVIATIONS (Associated Vertical Deviation)
FEATURES
DIFFERENTIAL DIAGNOSIS
TREATMENT
PARETIC VERTICAL DEVIATIONS
THIRD NERVE PARESIS
Introduction
Etiology
Features
Differential Diagnosis
Management
FOURTH NERVE PARALYSIS
Types
Clinical Manifestation
Other Features
Management
STRABISMUS SURSOADDUCTORIUS (Syn: Overaction of the Inferior Oblique)
ETIOLOGY
INTRODUCTION
CLINICAL CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Recession of the IO
Myectomy of the IO
DISSOCIATED VERTICAL DEVIATION (DVD) (Syn: Alternating Hypertropia, Double Hypertropia, Alternating Sursumduction)
INTRODUCTION
THEORIES
CLINICAL CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMBINATIONS
FADEN'S OPERATION (Syn: Posterior Fixation Suture Operation. Retroequatorial Myopexy)
66:
Nonsurgical Treatment of Squint
INTRODUCTION
OPTICAL TREATMENT
PHARMACOLOGICAL TREATMENT
ORTHOPTICS
DEFINITION
AIM
INTRODUCTION
CLASSIFICATION
Antisuppression Treatment
TREATMENT OF FUNCTIONAL AMBLYOPIA
Occlusion
Red Filter Treatment
Prisms
Pleoptics
TREATMENT OF ABNORMAL RETINAL CORRESPONDENCE
Fusion Training
TREATMENT OF CONVERGENCE INSUFFICIENCY
67:
Ophthalmic Prisms and Orthoptics
INTRODUCTION
PRISMS
FRESNEL PRISMS
INVESTIGATION
VERGENCE (PRISM) ADAPTATION IN NORMAL BSV
INVESTIGATING BSV WITH PRISMS
Prism Reflex Test
The 4∆ Prism Test
Prism Fusion Range
Vertical Fusion Range
Vergence Facility
MEASURING THE ANGLE OF DEVIATION
PRISM COVER TEST
Measurement in 9 Positions of Gaze
SIMULTANEOUS PRISM COVER TEST
MADDOX ROD
PRISM REFLECTION TEST/KRIMSKY TEST
MEASUREMENT ERRORS
Measurements taken on Near Fixation
Large Angles of Deviation
ASSESSMENT OF TORSION
MADDOX DOUBLE PRISM
DOUBLE MADDOX ROD
CORRECTION OF DEVIATIONS: DIAGNOSTIC TESTS
TO ASSESS IF SYMPTOMS ARE OCULAR
TO ASSESS IF POTENTIAL BSV IS PRESENT
PRISM ADAPTATION TEST
PROGRESSIVE PRISM COMPENSATION TEST
PREOPERATIVE PRISM ADAPTATION
Correction of Vertical Angle
TESTS FOR RETINAL CORRESPONDENCE
INVESTIGATION OF SUPPRESSION
POSTOPERATIVE DIPLOPIA TEST
MANAGEMENT
EXERCISES
Improving Fusion Range/Fusional Vergences
Teaching Diplopia
HETEROPHORIA
ESOTROPIA
EXOTROPIA
Decompensated Strabismus
Convergence Problems
Divergence Paralysis
APHAKIA AND PSEUDOPHAKIA FOLLOWING CATARACT SURGERY
INCOMITANT STRABISMUS
INCORPORATION OF PRISMS
PRISM OF NO HELP
OTHER USES OF PRISMS IN INVESTIGATION AND MANAGEMENT
AMBLYOPIA
10∆ Fixation Test
Treatment of Amblyopia with Eccentric Fixation
NYSTAGMUS
MALINGERERS
FIELD DEFECTS
DISPLACEMENT OR MIRROR EFFECTS
SUMMARY
68:
Amblyopia: Prevention and Management
INTRODUCTION
PREVALENCE
CLASSIFICATION OF AMBLYOPIA
ANISOMETROPIC, DEPRIVATION, AND STRABISMIC
FUNCTIONAL AMBLYOPIA
ORGANIC AMBYLOPIA
CAUSES
PATHOPHYSIOLOGY
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT
RULE OUT THE ORGANIC CAUSE
AMELIORATION OF THE AMBLYOGENIC FACTOR
OCCLUSION THERAPY
Types of Occlusion
Maintenance Occlusion
Guidelines for Occlusion Therapy
Penalization
CAM Vision Stimulator
Pleoptics Therapy
PHARMACOLOGICAL MODALITIES
SURGICAL TREATMENT
PREVENTION
PROGNOSIS
PARENTAL EDUCATION
69:
Esotropia
INTRODUCTION
CLASSIFICATION
ESSENTIAL INFANTILE ESOTROPIA
Clinical Features
Treatment
ACCOMMODATIVE ESOTROPIA
Clinical Features
REFRACTIVE ACCOMMODATIVE ESOTROPIA
Treatment
70:
Exotropia
INTRODUCTION
ETIOLOGY
FORMS
CLASSIFICATION
PRIMARY EXODEVIATION
CLINICAL CHARACTERISTICS
EXAMINATION
NONSURGICAL TREATMENT
Glasses
Prisms
Exercises
Chemodenervation
Surgical Treatment
SURGICAL PROCEDURES
SECONDARY EXODEVIATIONS
71:
Strabismus Surgery
INTRODUCTION
SURGICAL ANATOMY OF THE MUSCLES
RECTI MUSCLES
SUPERIOR OBLIQUE MUSCLE
INFERIOR OBLIQUE MUSCLE
BASIC PRINCIPLES OF STRABISMUS SURGERY
TECHNIQUES OF MUSCLE EXPOSURE
Swan's Technique
Park's Cul-de-sac Incision
von Noorden's Limbal Incision in the Palpebral Aperture Area
Prem Prakash's Technique of Para Limbal Incision
WEAKENING PROCEDURES OF THE RECTI
Recession
Fadenoperation (Retroequatorial myopexy)
Marginal Myotomy
Myectomy and Free Tenectomy or the Recti Muscles
STRENGTHENING PROCEDURES OF THE RECTI MUSCLES
Resection of Recti
Tuck or Placation
Advancement
Cinching
RESECTION-RECESSION PROCEDURES ON HORIZONTAL MUSCLES AND THEIR MODIFICATIONS (FIG. 71.8)
Recession and Resection (R and R)
Vertical Displacement of Horizontal Muscles
Slanted Recession-resection Procedure
INFERIOR OBLIQUE SURGERY
WEAKENING PROCEDURES OF INFERIOR OBLIQUE MUSCLE
Technique of Muscle Exposure
Myotomy
Myectomy
Denervation
Extirpation of the Muscle
Pure Recession, Recession with Anterior Positioning and Pure Anterior Positioning of Inferior Oblique
STRENGTHENING PROCEDURES OF INFERIOR OBLIQUE
Inferior Oblique Tuck
Resection with Advancement of Inferior Oblique
SUPERIOR OBLIQUE SURGERIES
WEAKENING PROCEDURES FOR SUPERIOR OBLIQUE
Superior Oblique Tenectomy and Tenotomy
Recession of Superior Oblique
Posterior Tenectomy of Superior Oblique Muscle
Superior Oblique Expander
STRENGTHENING PROCEDURES OF SUPERIOR OBLIQUE
Superior Oblique Tuck
Harada-Ito Procedure
COMPLICATIONS OF STRABISMUS SURGERY
COMPLICATIONS DUE TO GENERAL ANESTHESIA AND LOCAL ANESTHESIA
Bradycardia
Toxicity of Local Anesthetic Agents
INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS
Operating the Wrong Eye
Loss of Vision
Scleral Perforation
Lost or Slipped Muscle and Muscle Tendon Rupture
Hyphema
Posterior Chamber Hemorrhage
Undercorrection and Overcorrection
Anterior Segment Ischemia
72:
Diagnostic Methods in Concomitant Squint
INTRODUCTION
INCIDENCE
CAUSES
CONCOMITANT STRABISMUS
TYPES OF CONCOMITANT STRABISMUS
EXAMINATION OF A CASE OF SQUINT
EXAMINATION OF MOTOR STATUS
HEAD POSTURE
Measurement of Interpupillary Distance
OCULAR DEVIATION
Pseudostrabismus
Angle Kappa
Detection of a Squint
Cover Test
Alternate Cover Test
Prerequisites of Cover—Uncover test
Information from Cover Uncover Test
Measurement of Ocular Deviation
Prism Bar Cover Test (PBCT)
Prism Bar under Cover test: Measurement of Dissociated Vertical Deviations (DVD)
Effect of High Plus or Minus Glasses on Measuring Squint Deviations
Different Aspects of Measurement
Examination of Eyes in Nine Gaze Positions
Synoptophore
Uses of Synoptophore
Precautions for PBCT
Corneal Reflection Test
Subjective Tests of Deviation
Diplopia Testing
Hess and Lees Screen
Measurement of Cyclodeviations
LIMITATIONS OF MOVEMENTS
Grading Oblique Overactions
MEASUREMENT OF VERGENCES
HORIZONTAL VERGENCES
Near Point of Convergence
Convergence Sustenance
Measurement of Vergences with Prisms
EXAMINATION OF THE SENSORY STATUS
BINOCULARITY AND DIPLOPIA
SUPPRESSION
Tests for Suppression
Interpretation of responses
Measurement of Suppression Scotoma
Depth of Scotoma
RETINAL CORRESPONDENCE
Prerequistes for ARC
Diagnosis of ARC
Bagolini's Striated Glasses
Worth's Four Dot Test
Synoptophore
After Image Test
AMBLYOPIA
CLASSIFICATION OF AMBLYOPIA
CLINICAL FEATURES
Stereoacuity
Stereoacuity Tests
Randot Stereotest
TNO Test
Frisby Test
Distance Stereopsis Tests
Normal Stereoacuity
Gross Stereopsis: Lang's Two Pencil Test
Fixation Disparity
Fixation Disparity Curves
Disparometer
Wesson's Card
73:
Concomitant Strabismus
ANATOMY OF THE EXTRAOCULAR MUSCLES
RECTUS MUSCLES
Medial Rectus Muscle
Lateral Rectus Muscle
Superior Rectus Muscle
Inferior Rectus Muscle
OBLIQUE MUSCLES
Superior Oblique Muscle
Inferior Oblique Muscle
LAWS OF THE EYEBALLS MOTILITY
Binocular movements are called:
Sherrington's Law
Hering's Law
BINOCULAR ROTATIONS
Versions
VERGENCES
Convergence
Divergence
REFLEX EYEBALLS MOVEMENTS
Optometric Reflexes
Postural Eyeball Reflexes
Optokinetic Nystagmus
BINOCULAR VISION PHYSIOLOGY
VISUAL DEVELOPMENT
BINOCULAR VISION
Good binocular vision acquired:
PATHOPHYSIOLOGY OF BINOCULAR VISION
Amblyopia
Anomalous Retinal Correspondence (ARC)
STRABISMUS EXAMINATION
History
Inspection
VISUAL ACUITY
Observational Techniques
Optokinetic Nystagmus
Visual Evoked Potentials
Forced Choice Preferential Looking
Graded Optotypes
Monocular Fixation
REFRACTION
OCULAR-MOTOR-EXAMINATION
OCULAR MOVEMENTS EXAMINATION
OCULAR DEVIATION MEASUREMENTS
Hirschberg Method
Krimsky test
Cover Tests
Cover-uncover Test
Alternate Cover Test
Prism-alternate Cover Test
Synoptophore
Red Filter Test
Maddox Rod test
Forced Duction Test
Hess Screening
SENSORY EXAMINATION
Synoptophore Examination
Anomalous Retinal Correspondence Examination with Prism
Possible Worth Four-dot Test
Bagolini Lenses
Stereopsis Tests
TYPES OF STRABISMUS
PSEUDOSTRABISMUS
HETEROPHORIA
CONCOMITANT STRABISMUS
ESOTROPIA
Congenital Esotropia
Accommodative Esotropia
Cyclic Esotropia
EXOTROPIA
Congenital Exotropia
Intermittent Exotropia
OBLIQUE MUSCLE DYSFUNCTION
ALPHABET PATTERN STRABISMUS
Treatment
Surgical Treatment
VERTICAL STRABISMUS FORMS
CONCOMITANT STRABISMUS MANAGEMENT
NONSURGICAL STRABISMUS MANAGEMENT
Correction of Refraction Errors
Amblyopia
Penalization Method
Pleoptics
Prisms
Orthoptics
Botulinum Toxin
SURGICAL MANAGEMENT
Preoperative Evaluation and Diagnostic Approach
How to establish the extend of surgery
STRABISMUS SURGERY TECHNIQUES
Rectus Muscles
Horizontal Muscle Transpositions for Alphabet Pattern Strabismus
Posterior Fixation Suture
Inferior Oblique Muscle
Superior Oblique Muscle
74:
A and V Patterns in Strabismus
INTRODUCTION
PREVALENCE
ETIOLOGY
HORIZONTAL FACTORS
Vertical School
Oblique School
STRUCTURAL FACTORS (ORBITAL/CRANIOFACIAL ANOMALIES)
ANOMALIES OF MUSCLE INSERTIONS
EFFECT OF THE PULLEY SYSTEMS
CLINICAL FINDINGS AND DIAGNOSIS
TREATMENT
CONCLUSION
75:
Cranial Nerve Palsies and their Management
DEFINITION
TYPES
CLINICAL FEATURES
CLASSIFICATION OF PARALYTIC SQUINT (FLOW CHART 75.1)
THIRD NERVE PALSY
ANATOMY
ETIOLOGY
Congenital Third Nerve Palsy (Fig. 75.1)
Acquired Third Nerve Palsy
CLINICAL PRESENTATION
Complete Third Nerve Palsy
Partial Third Nerve Palsy
Isolated Muscle Palsy
EVALUATION
DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF THIRD NERVE PALSY
During the Acute Phase
Definitive/Surgical Management
Isolated Muscle Paralysis
Complete Third Nerve Paralysis
FOURTH NERVE PALSY
ANATOMY
ETIOLOGY
Congenital Fourth Nerve Palsy
Acquired Fourth Nerve Palsy
CLINICAL PRESENTATION
Bilateral SO Palsy
DIFFERENTIAL DIAGNOSIS
Primary IO Overaction
Brown Syndrome
Pseudoparalysis
Myasthenia Gravis
MANAGEMENT OF FOURTH NERVE PALSY
Nonsurgical Management
Surgical Management
SIXTH NERVE PALSY
ANATOMY
ETIOLOGY
Congenital Sixth Nerve Palsy
Acquired Sixth Nerve Palsy
CLINICAL PRESENTATION
DIFFERENTIAL DIAGNOSIS
Myasthenia Gravis
Graves’ Ophthalmopathy
Duane Rectraction Syndrome
Infantile Esotropia
MANAGEMENT OF SIXTH NERVE PALSY
Nonsurgical Management
Surgical Management
76:
Special Forms of Strabismus
INTRODUCTION
DUANE'S RETRACTION SYNDROME
DEFINITION
ETIOLOGY
Structural Anomalies
Abnormal Innervation
CLINICAL FEATURES
Classification
Variations in Clinical Pattern
MANAGEMENT
Medial Rectus Recession
Medial Rectus and Lateral Rectus Recession
Transposition of Vertical Recti
Management of Upshoots and Downshoots
BROWN SYNDROME
DEFINITION
ETIOLOGY
Congenital Abnormality
Acquired Brown Syndrome
Causes of Acquired Brown Syndrome
CLINICAL FEATURES
Characteristics
Other Variable Features
Classification
MANAGEMENT
Nonsurgical
Surgical Management
Complications of Surgery
CHRONIC PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA
CONGENITAL FIBROSIS OF EXTRAOCULAR MUSCLES (CFEOM)
DIFFERENTIAL DIAGNOSIS
TREATMENT
THYROID OPHTHALMOPATHY
DEFINITION
ETIOPATHOGENESIS
CLINICAL FEATURES
Classification
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Nonsurgical
Surgical
77:
Anomalies of Disjunctive Fixation
INTRODUCTION
CONVERGENCE INSUFFICIENCY
INCIDENCE
INTRODUCTION
TYPES
CLINICAL FEATURES
TREATMENT
CONVERGENCE EXCESS
DIVERGENCE EXCESS
DIVERGENCE INSUFFICIENCY
78:
Strategies for Amblyopia: Rehabilitation Orthoptics and Refractive Surgery
INTRODUCTION
HOW DOES AMBLYOPIA ARISE?
CLASSIFICATION OF AMBLYOPIAS
ETIOLOGICAL CLASSIFICATION
Sensory Deprivation Amblyopia
Strabismus Amblyopia
Mixed or Combined Amblyopia
PROGNOSIS OF AMBLYOPIA
DIAGNOSIS
EXAMINATION OF THE CHILD
HOW TO TREAT AMBLYOPIA
TREATMENT FROM A SURGICAL VIEWPOINT
79:
Unique Forms of Strabismus
INTRODUCTION
DUANE'S RETRACTION SYNDROME
INTRODUCTION
ETIOLOGY
Structural Anomalies
Innervational Anomalies
CLASSIFICATION
CLINICAL CHARACTERISTICS
Explanation
VARIANTS
DIFFERENTIAL DIAGNOSIS
TREATMENT
BROWN'S SYNDROME
INTRODUCTION
ETIOLOGY
CLINICAL CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
TREATMENT
DOUBLE ELEVATOR PALSY
INTRODUCTION
ETIOLOGY
CLINICAL CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
TREATMENT
STRABISMUS FIXUS
INTRODUCTION
FEATURES
JOHNSON'S SYNDROME
DEFINITION
CLINICAL FEATURES
80:
Correction of Strabismus with Botulinum Toxin
THE BOTULINUM TOXIN TYPE A
HISTORY AND INITIAL INDICATIONS IN STRABISMUS SURGERY
TECHNIQUE OF INJECTION
INDICATIONS
INFANTILE ESSENTIAL ESOTROPIA
POSTSURGICAL ADJUSTMENT
ADULT ESOTROPIA
OCULOMOTOR NERVE PALSIES
SIXTH CRANIAL NERVE
FOURTH CRANIAL NERVE
THIRD CRANIAL NERVE
ADJUNCT TO SURGERY
SUMMARY
81:
Refractive Accommodative Esotropia Correction with LASIK
INTRODUCTION
TREATMENT OF REFRACTIVE ACCOMMODATIVE ESOTROPIA
PATIENT SELECTION
PREOPERATIVE EXAMINATION
HYPEROPIC-LASIK TECHNIQUE
CASE REPORT
CONCLUSION
82:
Adjustable Sutures in Pediatric Strabismus Surgery
INTRODUCTION
INTRAOPERATIVE ADJUSTMENTS
POSTOPERATIVE ADJUSTMENTS
SUMMARY
83:
Diagnosis and Treatment of Amblyopia
INTRODUCTION
CONCEPT AND TERMINOLOGY
HISTORY OF AMBLYOPIA
THE CONCEPT OF AMBLYOPIA
CRITICAL PERIOD
EPIDEMIOLOGICAL ASPECTS AND SOCIAL IMPORTANCE
CLASSIFICATION
PROGNOSTIC CLASSIFICATION32,33
ETIOLOGICAL CLASSIFICATION42
Strabismic Amblyopia
Anisometropic Amblyopia
Amblyopia due to Deprivation or Ex Anopsia
Idiopathic Amblyopia
Organic Amblyopia
Amblyopia Secondary to Nystagmus
SEMIOLOGICAL CLASSIFICATION32,33.
According to the Level of Visual Acuity
According to the Sum of the Amblyogenic Factors
According to the Loss of the Specific Functions of the Fovea
SMITH-KETTLEWELL INSTITUTE CLASSIFICATION94,95
ANATOMICAL AND NEUROPHYSIOLOGIC BASIS
DIAGNOSIS
MEDICAL HISTORY
EXPLORATION
Assessment of Stereopsis
Cover Test5
Measuring Visual Acuity
Biomicroscopic Exploration
Refractive Study Under Cycloplegia
Fixation Study
Eye Fundus examination
PROGNOSTIC FACTORS
TREATING AMBLYOPIA AND NEW THERAPEUTIC PERSPECTIVES
OPTICAL CORRECTION
Prescription in Hypermetropia
Prescription in Myopia
Prescription in Astigmatism
Aphakia Glasses
Contact Lenses
Intraocular Lenses
Refractive Surgery
OCCLUSIVE THERAPY
Form of Occlusion
Type of Occlusion
Timings
Occlusion Regimen
PENALIZATIONS
Total Penalization
Distance Penalization
Near Penalization
Mild Penalization
OTHER FORMS OF TREATMENT; PAST AND FUTURE; NEW THERAPEUTIC PERSPECTIVES
Pleoptics32
Prisms32
Pharmacologic Treatment
Sensory Neurostimulation
HISTORY OF AMBLYOPIA
SECTION 6: NEURO-OPHTHALMOLOGY
84:
Visual Pathway
INTRODUCTION
RETINA
OPTIC NERVE
OPTIC CHIASMA
Definition
Dimensions
Types
Anatomy
Relations
OPTIC TRACT
Definition
Course
Relations
Roots
Terminations
LATERAL GENICULATE BODY
Definition
Shape
Situation
Development
Parts
Relations
Superior Brachium
OPTIC RADIATIONS
Definition
Course
Meyer's Loop
Further Course
Other Fibers
THE VISUAL CORTEX
Calcarine Sulcus
Cuneus
Histology of the Visual Cortex
Parastriate Cortex
Peristriate Cortex
LOCALIZATION IN THE VISUAL PATHWAY
RETINA
OPTIC NERVE
OPTIC CHIASMA
The Nasal Fibers
The Temporal Fibers
The Macular Fibers
OPTIC TRACT
LATERAL GENICULATE BODY
OPTIC RADIATION
VISUAL CORTEX
BLOOD SUPPLY OF THE VISUAL PATHWAY
INTRODUCTION
OPTIC NERVE
OPTIC CHIASMA
OPTIC TRACT
LATERAL GENICULATE BODY
OPTIC RADIATIONS
VISUAL CORTEX
LESIONS OF THE VISUAL PATHWAY AND FIELD DEFECTS
OPTIC NERVE TYPE FIELD DEFECTS
Papillomacular Bundle
Arcuate Nerve Fiber Bundle
Nasal Nerve Fiber Bundle Defects
OPTIC CHIASMA LESIONS
Bitemporal Hemianopia
Central Bitemporal Hemianopia
Junctional Scotoma
Upper Temporal Quadrantic Defects
Lower Temporal Quadrantic Defects
OPTIC TRACT LESIONS
LATERAL GENICULATE BODY LESIONS
OPTIC RADIATIONS AND VISUAL CORTEX LESIONS
Temporal Lobe Lesions
Parietal Lobe Lesions
Occipital Lobe Lesions
85:
The Pupil
NORMAL PUPIL
PUPILLARY PATHWAYS
INTRODUCTION
PUPILLOCONSTRICTOR LIGHT REFLEX PATHWAY
Afferent
Efferent
Functions of the Light Reflex
CONVERGENCE NEAR REFLEX PATHWAY
Afferent
Efferent
ACCOMMODATION REFLEX PATHWAY
Afferent
Efferent
PUPILLARY DILATATION PATHWAY
DARKNESS REFLEX
PSYCHOSENSORY REFLEX
PUPIL CYCLE TIME
LESIONS OF THE PUPIL
AMAUROTIC PUPIL
MARCUS GUNN PUPIL
Swinging Flashlight Test
Grades
Lesion
Important Points
WERNICKE'S HEMIANOPIC PUPIL
ARGYLL ROBERTSON PUPIL
Lesion
Features
Light-Near Dissociation
Pseudo-Argyll Robertson Pupil
How to Test for a Pupillary Near Response
TONIC PUPIL
HUTCHINSON'S PUPIL
HORNER'S SYNDROME
Introduction
Central Horner's Syndrome
Preganglionic Horner's Syndrome
Postganglionic Horner's Syndrome
Pharmacological Tests for Horner's Syndrome
Reader's Syndrome
PHARMACOLOGY OF THE PUPIL
PUPIL ABNORMALITIES
HIPPUS
PARADOXICAL PUPILLARY REACTION
IRREGULARITY OF THE PUPIL
POLYCORIA
86:
Supranuclear Pathways for Eye Movements
INTRODUCTION
SUPRANUCLEAR AND INFRANUCLEAR PATHWAYS
SUPRANUCLEAR EYE MOVEMENT SYSTEMS
SACCADIC SYSTEM
HORIZONTAL SACCADES
VERTICAL SACCADES
CHARACTERISTIC OF THE SACCADE
PURSUIT SYSTEM
HORIZONTAL PURSUIT SYSTEM PATHWAY
CORRECTIVE SACCADE
PARIETAL LOBE LESION
VERTICAL PURSUIT SYSTEM
VERGENCE SYSTEM
VOLUNTARY VERGENCE
PURSUIT OR REFLEX VERGENCE
NON-OPTIC REFLEX SYSTEM
SEMICIRCULAR CANALS
NECK RECEPTORS
CEREBELLUM
POSITION MAINTENANCE SYSTEM
SUMMARY
87:
Pediatric Neuro-ophthalmology Examination
INTRODUCTION
HISTORY
VISUAL DEVELOPMENT
VISUAL ACUITY
HEAD POSTURE
PUPILLARY EXAMINATION
ANISOCORIA
IRIS DEFECTS
MOTILITY
REFRACTION
COLOR VISION
NYSTAGMUS
CONFRONTATIONAL VISUAL FIELDS
FUNDOSCOPIC EXAMINATION
GENERAL NEUROLOGICAL EVALUATION
88:
Laws of Ocular Motility
INTRODUCTION
DONDER'S LAW
LISTING'S LAW
HERING'S LAW OF MOTOR CORRESPONDENCE
CLINICAL SIGNIFICANCE
SHERRINGTON'S LAW OF RECIPROCAL INNERVATION
CLINICAL SIGNIFICANCE
89:
Nystagmus
DEFINITION
GENERAL CONSIDERATIONS
TERMINOLOGY
PENDULAR NYSTAGMUS
JERKY NYSTAGMUS
MICRONYSTAGMUS
NULL ZONE
NEUTRAL ZONE
ALEXANDER'S LAW
GRADES
EXAMINATION OF A CASE OF NYSTAGMUS
CLASSIFICATION
OCULAR NYSTAGMUS
DEVIATIONAL NYSTAGMUS
OPTOKINETIC NYSTAGMUS
Introduction
Clinical Test
Kestenbaum's Newspaper Method
Barrie's Ruler Test
Optokinetic Nystagmus Drum
Pathway
Parietal Lobe Lesion
Type of OKN Abnormalities
Inverse OKN
PATHOLOGICAL OCULAR NYSTAGMUS
Amaurotic Nystagmus
Amblyopic Nystagmus
Spasmus Nystagmus
Miner's Nystagmus
Latent Nystagmus
VESTIBULAR NYSTAGMUS
VESTIBULAR APPARATUS
CALORIC TEST
VERTICAL VESTIBULAR NYSTAGMUS
LESIONS
Canal Paresis (Peripheral Lesion)
Directional Preponderance (Central Lesion)
ROTATIONAL NYSTAGMUS
DOLL'S HEAD PHENOMENON
CEREBELLAR NYSTAGMUS
CENTRAL NYSTAGMUS
MISCELLANEOUS
VOLUNTARY NYSTAGMUS
HYSTERICAL NYSTAGMUS
IDIOPATHIC CONGENITAL NYSTAGMUS
NYSTAGMUS BLOCKAGE SYNDROME
SYMPTOMS
TREATMENT
90:
Lesions of the Oculomotor Nerve
ANATOMY
ETIOLOGY
GENETICS
CLINICAL FEATURES
NUCLEAR THIRD NERVE PARESIS
THIRD NERVE FASCICLE SYNDROMES
NOTHNAGEL'S SYNDROME
BENEDICT'S SYNDROME
CLAUDE'S SYNDROME
WEBER'S SYNDROME
UNCAL HERNIATION SYNDROME
POSTERIOR COMMUNICATING ARTERY ANEURYSM
CAVERNOUS SINUS SYNDROME
ORBITAL SYNDROME
PUPIL-SPARING ISOLATED THIRD NERVE PARESIS
MANAGEMENT
OCCLUSION
MEDICAL TREATMENT
SURGICAL TREATMENT
91:
Visual Impairment in Cortical Lesions
INTRODUCTION
TEMPORAL LOBE
PARIETAL LOBE
OCCIPITAL LOBE
CORTICAL BLINDNESS
INTRODUCTION
DEFINITION
ETIOPATHOGENESIS
Hypoxic or Anoxic Brain Damage
Causes
Vascular Spasm
CLINICAL FEATURES OF CORTICAL BLINDNESS
Visual Evoked Potentials
Other Investigations
SPECIAL FORMS OF CORTICAL BLINDNESS
Anton's Syndrome (Anosagnosia, Cortical Blindness with Denial)
Transient Cortical Blindness
Incomplete Forms of Cortical Blindness
Balint's Syndrome
Visual Agnosias
Achromatopsia
Akinetopsia
RECOVERY
92:
Ophthalmic Manifestations of Intracranial Lesions
INTRODUCTION
CLASSIFICATION
Infection
Neoplasms
Cysts
Vascular
Trauma
Demyelinating Disorders
SIGNS AND SYMPTOMS
GENERAL OPHTHALMIC SIGNS
PAPILLEDEMA
Clinical Features
ABNORMAL HEAD POSTURE
VISUAL HALLUCINATIONS
PROPTOSIS
AMAUROSIS FUGAX
FALSE-LOCALIZING SIGNS
HYDROCEPHALUS
NERVE DYSFUNCTION
Optic Nerve Dysfunction
VI (Abducens) Nerve Dysfunction
Oculomotion (III) Nerve Dysfunction
Trochlear IV Nerve Dysfunction
TRUE LOCALIZING SIGNS
TUMORS OF THE ORBIT
Gaze Evoked Amaurosis
Proptosis
Endophthalmos
Optic Disk Swelling
Choroidal Folds
Optociliary Shunts
Others
TUMORS OF THE SUPERIOR ORBITAL FISSURE AND CAVERNOUS SIGNS
TUMORS IN THE SUPRASELLAR REGION
Optic Nerve Lesions
Optic Chiasma Lesions
Optic Tract Lesions
PITUITARY TUMORS
TUMORS INVOLVING THE LATERAL GENICULATE BODY
TUMORS INVOLVING THE FRONTIAL LOBE
Neurophthalmic Signs
TUMORS OF THE TEMPORAL LOBE
Neuro-ophthalmic Signs and Symptoms
TUMORS OF THE PARIETAL LOBE
Neuro-ophthalmic Manifestations
TUMORS INVOLVING THE OCCIPITAL LOBE
Neuro-ophthalmic Manifestations
TUMORS OF THE LATERAL VENTRICLE
TUMORS OF THE THIRD VENTRICLE
TUMORS OF THE FOURTH VENTRICLE
TUMORS OF THE PINEAL GLAND
TUMORS OF THE BRAINSTEM
Midbrain (mesencephalon)
Lesions affecting Dorsal Midbrain
Lesions Affecting Ventral Midbrain
TUMORS OF THE PONS
TUMORS OF THE MEDULLA
TUMORS OF THE CEREBELLUM
HEMORRHAGE
INFECTIONS
DEMYELINATING DISORDERS
93:
Supranuclear Disorders of Eye Movements
INTRODUCTION
PSEUDO-OPHTHALMOPLEGIA
CLASSIFICATION
SACCADIC DISORDERS
CONJUGATE PALSIES
LESIONS OF THE FRONTAL CORTEX
Overactivity
Unilateral Underactivity
Bilateral Underactivity
LESIONS OF THE BASAL GANGLIA
Overactivity
Underactivity: Progressive Supranuclear Palsy
LESIONS OF THE COLLICULAR AREA
Parinaud's Syndrome
DISSOCIATED PALSIES
INTERNUCLEAR OPHTHALMOPLEGIA
Introduction
Etiology
Classification
ONE AND ONE-HALF SYNDROME
DISSOCIATED VERTICAL PALSIES
PURSUIT DISORDERS
OVERACTIVITY
UNDERACTIVITY
VERGENCE DISORDERS
PARALYSIS OF CONVERGENCE
PARALYSIS OF DIVERGENCE
NON-OPTIC REFLEX SYSTEM DISORDERS
VESTIBULAR SYSTEM DISORDERS
CEREBELLAR DISORDER
SECTION 7: PEDIATRIC GLAUCOMA AND UVEITIS
94:
Congenital Glaucoma (Early Onset Developmental Glaucoma)
INTRODUCTION
EARLY ONSET DEVELOPMENTAL GLAUCOMA (EODG)
LATE ONSET DEVELOPMENTAL GLAUCOMA
DEVELOPMENTAL GLAUCOMA WITH OTHER CONGENITAL ANOMALIES
PATHOPHYSIOLOGY OF EARLY ONSET DEVELOPMENTAL GLAUCOMA (CONGENITAL GLAUCOMA)
INCIDENCE AND GENETICS
PRESENTATION AND DIFFERENTIAL DIAGNOSIS
EXAMINATION
THE NORMAL INFANT EYE
CORNEAL DIAMETER MEASUREMENT AND EVALUATION OF CORNEAL EDEMA
MEASURING THE IOP
AYA PIC face, corneal edema
THE OPTIC NERVE HEAD
GONIOSCOPY
AXIAL LENGTH MEASUREMENTS
CYCLOPLEGIC REFRACTION
MANAGEMENT
SURGICAL MANAGEMENT
Deep Sclerectomy
Aqueous Shunt Implantation
Goniotomy Versus Trabeculotomy
Technique (Figs 94.18A to D)
MEDICAL TREATMENT
OUTCOME PARAMETERS
FOLLOW-UP
95:
Primary Infantile Glaucoma
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
SURGICAL TREATMENT
INTRODUCTION
PREOPERATIVE MANAGEMENT
ANGLE SURGERY
Goniotomy
Trabeculotomy
Combined Trabeculotomy-Trabeculectomy
Trabeculectomy
SYNTHETIC DRAINAGE IMPLANTS
CYCLODESTRUCTIVE PROCEDURES
Cyclocryotherapy
TRANS-SCLERAL CYCLOPHOTOCOAGULATION
Neodymium: YAG Lasers
Semiconductor Diode Lasers
LONG-TERM FOLLOW-UP
PROGNOSTIC FACTORS
96:
Developmental Glaucoma
INTRODUCTION
DEVELOPMENT
AXENFELD-RIEGER SYNDROME
PATHOPHYSIOLOGY
GENETICS
Axenfeld's Anomaly
Rieger's Anomaly
Rieger's Syndrome
DIFFERENTIAL DIAGNOSIS
TREATMENT
FAMILIAL HYPOPLASIA OF THE IRIS WITH GLAUCOMA
PETER'S ANOMALY
TREATMENT
ANIRIDIA
PATHOPHYSIOLOGY
GENETICS
CLINICAL FEATURES
DIAGNOSIS
TREATMENT OF GLAUCOMA
PHAKOMATOSES
STURGE-WEBER SYNDROME (ENCEPHALOTRIGEMINAL ANGIOMATOSIS)
CLINICAL FEATURE
PATHOPHYSIOLOGY
TREATMENT
NEUROFIBROMATOSIS
NEUROFIBROMATOSIS I
Clinical Features
Management
OCULODERMAL MEIANOCYTOSIS (NEVUS OF OTA)
LOWE SYNDROME (OCULOCEREBRORENAL SYNDROME OF LOWE)
CLINICAL FEATURES
TREATMENT
OTHER DISORDERS
PERSISTENT HYPERPLASTIC PRIMARY VITREOUS
RETINOPATHY OF PREMATURITY
MEGALOCORNEA
MARSHALL-SMITH SYNDROME
PHACE SYNDROME
SUMMARY
97:
Managing Aphakic Glaucoma in Children with AGV Valves
INTRODUCTION
SURGICAL PROCEDURE
THE SURGICAL TECHNIQUE INVOLVED
RESULTS
DISCUSSION
CONCLUSION
98:
Sclerothalamotomy ab interno (STT ab interno) a Novel Minimal Surgical Procedure for Juvenile Glaucoma
INTRODUCTION
PATIENTS AND METHODS
EVALUATION OF THE RESULTS
RESULTS
DISCUSSION
99:
Glaucoma Implants in the Treatment of Pediatric Glaucoma
INTRODUCTION
CHOICE OF IMPLANT
OPERATION TECHNIQUE OF BAERVELDT IMPLANT
COMPLICATIONS
CONCLUSION
100:
Uveitis in Children and its Management
INTRODUCTION
JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS
DIAGNOSIS
MANAGEMENT
FUCH'S HETEROCHROMIC UVEITIS
MANAGEMENT
INTERMEDIATE UVEITIS
DIAGNOSIS
MANAGEMENT
BEHçET'S DISEASE
MANAGEMENT
TOXOPLASMOSIS
CLINICAL FEATURES
MANAGEMENT
TOXOCARIASIS
SUMMARY
SECTION 8: PEDIATRIC REFRACTIVE SURGERY
101:
Pediatric Refractive Surgery
INTRODUCTION
TYPES OF REFRACTIVE PROCEDURE
PREOPERATIVE ISSUES
INFORMED CONSENT
REFRACTIVE SURGERY AND STRABISMUS
NOMOGRAM
ANESTHETIC CONSIDERATIONS FOR LASER REFRACTIVE SURGERY
OUTCOME OF REFRACTIVE SURGERY
PRK
LASIK
LASEK
CLEAR LENS EXTRACTION
PHAKIC IOL
102:
Implantation of Phakic Refractive Lenses (PRL) in Pediatric Myopic Eyes Associated with Scleral Reinforcement Surgery
INTRODUCTION
PATIENTS AND METHODS
PATIENTS
PREOPERATIVE EVALUATION
SURGICAL PROCEDURE
RESULTS
DISCUSSION
103:
Refractive Surgery in Children: When and How
INTRODUCTION
REFRACTIVE SURGERY IN CHILDREN— WHEN ?
ANISOMETROPIA
ACCOMMODATIVE ESOTROPIA
REFRACTIVE SURGERY IN CHILDREN— HOW ?
CORNEAL REFRACTIVE SURGERY
Literature Review
Comments and Personal Experience
PHAKIC IOLs
Literature Review
Comments and Personal Experience
CONCLUSIONS
104:
Pediatric Refractive Surgery
REFRACTIVE SURGERY AS AN OPPORTUNITY FOR THE TREATMENT OF AMBLYOPIA
REFRACTIVE SURGERY EXAMINATION TECHNIQUES IN THE PEDIATRIC EYE
ANESTHESIA TECHNIQUE
SURGICAL ALTERNATIVES
LASIK
PRK
Phakic Anterior Chamber Intraocular Lenses
Phakic Posterior Chamber Intraocular Lenses
INDICATIONS IN PEDIATRIC REFRACTIVE SURGERY
RESULTS
PSEUDOPHAKIC ANTERIOR CHAMBER LENS
IS PEDIATRIC REFRACTIVE SURGERY A SOLUTION FOR ACCOMMODATIVE ESOTROPIA?
COMPLICATIONS IN PEDIATRIC REFRACTIVE SURGERY
REGRESSION
DECENTRATION
VISUAL ACUITY DECREASE
HAZE
ANESTHETIC COMPLICATIONS
SUMMARY
SECTION 9: PEDIATRIC RETINAL DISEASE
105:
Management of Retinopathy of Prematurity
INTRODUCTION
PREVENTION OF ROP
ROLE OF OXYGEN
Correctional of Nutritional Factors and Anemia
Encouraging Normal Delivery/Not Caesarian
Good Screening Protocol
PRIMARY MANAGEMENT OF ROP: LASER/CRYO
TECHNIQUES OF LASER PHOTOCOAGULATION
Required Personnel and Equipment
Neonatology Clearance for Laser Procedure
Dilatation of Pupil
Treatment Strategy
Post Laser Medication, Follow up and Management:
Complications from Laser Photocoagulation
Outcome of Laser Photocoagulation
LASER VS CRYOTHERAPY
ARGON VS DIODE LASER
SECONDARY MANAGEMENT OF ROP: SURGERY FOR STAGE IV AND STAGE V
PREOPERATIVE EVALUATION
SURGERY FOR RETINAL DETACHMENT
Scleral Buckling
Lens Sparing Vitrectomy for Stage IV A and IV B
Lensectomy, Pars Plicata Vitrectomy and Membrane Peeling for Stage V ROP
25 Guage Vitrectomy for RD in ROP
SUMMARY
106:
Pediatric Retinal Detachment
INTRODUCTION
CLASSIFICATION
RETINAL DETACHMENT WITHOUT SYSTEMIC ASSOCIATIONS
Persistent Hyperplastic Primary Vitreous (PHPV)
Familial Exudative Vitreoretinopathy (FEVR)
Coat's Disease
Retinopathy of Prematurity (ROP)
Juvenile Retinoschisis
Goldmann-Favre Syndrome
RETINAL DETACHMENT WITH SYSTEMIC ASSOCIATIONS
Patau’ Syndrome
Walker-Warburg Syndrome
Norrie's Disease
Meckel's Syndrome
Incontinentia Pigmenti
Heredofamilial Vitreoretinopathies
Wagner's Syndrome, Jansen's Syndrome and Erosive Vitreoretinopathy
RETINAL DETACHMENT ASSOCIATED WITH OPTIC NERVE ANOMALIES
Morning Glory Disc Anomaly
Optic Disc Coloboma
MISCELLANEOUS SYNDROMES
Infantile Giant Retinal Tear Associated with Lenticular Abnormalities
Aicardi's Syndrome
107:
Retinitis Pigmentosa and Allied Disorders
INTRODUCTION
CLINICAL FEATURES
NYCTALOPIA
VISUAL FIELD LOSS
PHOTOPSIA
FUNDUS FINDINGS
PSYCHOPHYSICAL FINDINGS
PERIMETRY
DARK ADAPTOMETRY
RETINAL DENSITOMETRY
ELECTROPHYSIOLOGY
CLASSIFICATION
SUBDIVISION BY MODE OF INHERITANCE
SUBDIVISION BY AGE OF ONSET
SUBDIVISION BY MOLECULAR DEFECT
SUBDIVISION BASED ON DISTRIBUTION OF RETINAL INVOLVEMENT AND FUNDUS APPEARENCE
Retinitis Pigmentosa Sine Pigmento
Retinitis Punctata Albescens
Sector and Sectorial Retinitis Pigmentosa
Retinitis Pigmentosa Inversus (pericentral and central retinitis pigmentosa)
COMPLICATED RETINITIS PIGMENTOSA
USHER'S SYNDROME
LEBER'S CONGENITAL AMAUROSIS
BARDET-BIEDL SYNDROME
NEURONAL CEROID LIPOFUSCINOSIS (BATTEN DISEASE, AMAUROTIC IDIOCY)
BASSEN- KORNZWEIG SYNDROME (ABETALIPOPROTEINEMIA)
REFSUMS DISEASE
MITOCHONDRIAL MYOPATHY [Chronic Progressive External Ophthalmoplegia, (Kearns-Sayre Syndrome)]
PSEUDORETINITIS PIGMENTOSA
Retinal Inflammatory Diseases
Autoimmune Paraneoplastic Retinopathy
Drug Toxicity
Pigmented Paravenous Retinochoroidal Atrophy
Unilateral Pigmentary Retinopathy (Unilateral RP)
TREATMENT AND MANAGEMENT
COUNSELLING
CATARACT SURGERY
MACULAR EDEMA AND SEROUS RETINAL DETACHMENT
VITAMIN A SUPPLEMENTS
LUTEIN SUPPLEMENTS
MEDICATIONS WITH POTENTIAL ADVERSE REACTION WITH RP
Isoretinoin(13-cis-retinoic acid)
Sildenafil (Viagra)
ADVANCES IN THERAPEUTICS
Gene Therapy
Retinal Transplantation
Electronic Prosthesis (Artificial Retina)
108:
Retinoblastoma
INTRODUCTION
EPIDEMIOLOGY
INDIAN SCENARIO
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS OF LEUKOKORIA (WHITE PUPILLARY REFLEX)
RETINOBLASTOMA
ORBITAL RETINOBLASTOMA
CLASSIFICATION
REESE-ELLSWORTH CLASSIFICATION FOR INTRAOCULAR TUMORS (OLD)17
INTERNATIONAL CLASSIFICATION
PATHOLOGY
VARIANTS
GENETIC COUNSELING
MANAGEMENT
CRYOTHERAPY
LASER PHOTOCOAGULATION
THERMOTHERAPY
BRACHYTHERAPY PLAQUE
EXTERNAL BEAM RADIOTHERAPY (EBRT)
ENUCLEATION
ORBITAL EXENTERATION
CHEMOTHERAPY
Systemic Chemotherapy
Systemic Chemotherapy Drugs and Dose Schedules
Standard chemotherapy
High-dose chemotherapy
Periocular Chemotherapy
Follow-up Schedule
GENETIC COUNSELING
ACKNOWLEDGMENTS
109:
Retinal Vascular Disorders
RETINOPATHY OF PREMATURITY
DEFINITION
INTRODUCTION
NORMAL VASCULOGENESIS IN ROP
ABNORMAL VASCULOGENESIS IN ROP
CLASSIFICATION
LOCATION OF THE DISEASE
Zone I
Zone II
Zone III
STAGES OF THE DISEASE
Stage 1 (Demarcation line)
Stage 2 (Ridge)
Stage 3 (Ridge with Extraretinal Fibrovascular Proliferation)
Stage 4 (Partial Retinal Detachment)
Stage 5
REGRESSED ROP
PLUS DISEASE
THRESHOLD ROP
RISK FACTORS FOR ROP
Birthweight and Gestational Age
Delicate Balance
Prolonged Intubation and Multiple Gestation
EXAMINATION FOR ROP
TIME OF EXAMINATION
METHOD OF EXAMINATION
Mild Acute ROP
Severe Acute ROP
Rush Disease
Cicatrization
PREVENTION AND TREATMENT
Decreasing Risk Factors
Vitamin E
Surfactant
TREATMENT
Cryotherapy
Technique
Effect
Complications
Multicentric Cryotherapy Trial for ROP
Design of Study
LASER PHOTOCOAGULATION
VITREORETINAL SURGERY
Vitrectomy in Stages 4 and 5
Surgical Technique
Complications During Surgery
RESULTS
RECENT ADVANCES REGARDING ROP
SUMMARY
COATS’ DISEASE
DEFINITION
INTRODUCTION
HISTORICAL BACKGROUND
CLASSIFICATION
CLINICAL PRESENTATION AND APPEARANCE
DEMOGRAPHICS
PRESENTATION
Ocular Findings
Systemic Findings
DIAGNOSTIC TESTS
FLUORESCEIN ANGIOGRAPHY
Indication
Characteristic Appearance
IMAGING STUDIES
PATHOLOGY AND PATHOGENESIS
HYPOTHESES
DIFFERENTIAL DIAGNOSIS
NATURAL HISTORY
TREATMENT AND PROGNOSIS
PRIMARY OBJECTIVE
SUMMARY
PERSISTENT HYALOID ARTERY
FAMILIAL EXUDATIVE VITREORETINOPATHY
LEBER'S MILIARY ANEURYSMS
RETINAL ARTERIOVENOUS MALFORMATIONS AND WYBURN-MASON SYNDROME
WYBURN-MASON'S FIRST DESCRIBED THIS CONDITION IN 1943 THAT LED TO THE EPONYM
CLASSIFICATION AND CLINICAL FEATURES
TREATMENT
FAMILIAL RETINAL ARTERIAL TORTUOSITY
INHERITED RETINAL VENOUS BEADING
CILIORETINAL ARTERIES
OPTICOCILIARY VEINS
SHAKEN BABY SYNDROME
DEFINITION
KEY FEATURES
ASSOCIATED FEATURES
DIABETIC RETINOPATHY
MISCELLANEOUS
CENTRAL RETINAL ARTERY OBSTRUCTION
CAUSES IN CHILDREN
HYPERVISCOSITY SYNDROMES
AORTIC ARCH SYNDROMES AND OCULAR ISCHEMIC SYNDROMES.
CAROTID–CAVERNOUS FISTULA.
VASCULITIS RESULTING FROM INFECTION
HEMOGLOBINOPATHIES
INCONTINENTIA PIGMENTI.
EALES’ DISEASE
UVEITIS
RETINOSCHISIS
OTHER VASCULAR ANOMALIES
110:
Juvenile Diabetic Retinopathy
EPIDEMIOLOGY
DURATION OF DIABETES AND THE DEVELOPMENT OF DIABETIC RETINOPATHY
SYSTEMIC FACTORS THAT MAY AFFECT DIABETIC RETINOPATHY
OCULAR FACTORS
RETINOPATHY IN DIFFERENT FORMS OF DIABETES
TECHNIQUES TO STUDY RETINAL BLOOD FLOW
ANATOMIC LESIONS AND THE PATHOGENESIS OF DIABETIC RETINOPATHY
CAPILLARY BASEMENT MEMBRANE THICKENING
LOSS OF MICROVASCULAR INTRAMURAL PERICYTES
MICROANEURYSMS
CAPILLARY ACELLULARITY
BREAKDOWN OF THE BLOOD-RETINAL BARRIER
CLINICAL SIGNS OF DIABETIC RETINOPATHY
HISTORY
SIGNS
Microaneurysms
Dot and Blot Hemorrhages
Flame-shaped Hemorrhages
Retinal Edema and Hard Exudates
Cotton-wool Spots
Venous Loops, Venous Beading
Intraretinal Microvascular Abnormalities
Diabetic Macular Edema
CLASSIFICATION OF DIABETIC RETINOPATHY
GRADING OF DIABETIC RETINOPATHY ON FUNDUS PHOTOGRAPH/90D BY EARLY TREATMENT OF DIABETIC RETINOPATHY STUDY (ETDRS)
Nonproliferative Diabetic Retinopathy
Proliferative Diabetic Retinopathy
Maculopathy
DEFINITIONS13
Macular Edema
Clinically Significant Macular Edema
Mild Nonproliferative Retinopathy
Moderate Nonproliferative Retinopathy
Severe Nonproliferative Retinopathy
Early Proliferative Retinopathy
High-risk Proliferative Retinopathy
RISK FACTORS FOR DIABETIC RETINOPATHY
DURATION OF THE DIABETES
GLUCOSE CONTROL
DIAGNOSIS OF DIABETES
LAB STUDIES
IMAGING STUDIES
MEDICAL CARE
GLUCOSE CONTROL
Further Outpatient Care
MANAGEMENT OF DIABETIC MACULAR EDEMA
ETDRS GUIDELINES FOR MANAGEMENT OF DIABETIC MACULAR EDEMA (ETDRS: REPORT NO.2 1987)6
ETDRS Guidelines for Laser Photocoagulation
PROGNOSIS
INVESTIGATIONS AND CURRENT MANAGEMENT OF DME
MANAGEMENT
INTRAVITREAL TRIAMCINOLONE
MACULAR GRID PHOTOCOAGULATION
VITRECTOMY
PROLIFERATIVE DIABETIC RETINAOPATHY: SURGICAL MANAGEMENT
INDICATION FOR SURGICAL INTERVENTATION
SEVERE NONCLEARING VITREOUS HEMORRHAGE
TRACTION RETINAL DETACHMENT RECENTLY INVOLVING MACULA
COMBINED TRACTIONAL AND RHEGMATOGENOUS RETINAL DETACHMENT
DENSE FIBROVASCULAR PROLIFERATION
DENSE PREMACULAR HEMORRHAGE
DIABETIC MACULAR EDEMA ASSOCIATED WITH POSTERIOR HYALOID TRACTION
GHOST CELL/ HEMOLYTIC GLAUCOMA
ROLE OF AVASTIN
SURGICAL STEPS IN DIABETIC VITRECTOMY
111:
Retinal Vascular Tumors
INTRODUCTION
CAPILLARY HEMANGIOMA (Hemangioblastoma)
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
PERIPHERAL CAPILLARY HEMANGIOMA: THE VON HIPPEL TUMOR
DIAGNOSIS: OPHTHALMOSCOPY
DIFFERENTIAL DIAGNOSIS
JUXTAPAPILLARY CAPILLARY HEMANGIOMA
DIAGNOSIS: OPHTHALMOSCOPY
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC TESTS
Color Fundus Photography
Fluorescein Angiography
Ultrasonography
Optical Coherence Tomography
Magnetic Resonance Imaging and Computed Tomography
Blood Tests
Genetic Testing
VON HIPPEL-LINDAU DISEASE
MOLECULAR GENETICS
CLINICAL FEATURES
TREATMENT
PROGNOSIS
TREATMENT OF JUXTAPAPILLARY HEMANGIOMAS
PROGNOSIS
CAVERNOUS HEMANGIOMA
CLINICAL FINDINGS
DIFFERENTIAL DIAGNOSIS
ANCILLARY STUDIES
NATURAL HISTORY
TREATMENT
PATHOLOGY
SYSTEMIC INVOLVEMENT
GENETICS
RACEMOSE HEMANGIOMA
VASOPROLIFERATIVE TUMOR OF THE RETINA
112:
Infective and Inflammatory Disorders of Retina
INTRODUCTION
CLASSIFICATION
TOXOPLASMOSIS (FIG. 112.1)
Treatment of Ocular Toxoplasmosis (Pyrimethamine, Sulfadiazine and Predisone; Triple Drug Therapy)
TOXOCARIASIS
VOGT-KOYANAGI-HARADA SYNDROME (FIGS 112.2 TO 112.6)
SARCOIDOSIS (FIG. 112.7)
RUBELLA RETINOPATHY18
SYPHILITIC RETINAL INVOLVEMENT19
DIFFUSE UNILATERAL SUBACUTE NEURORETINITIS
NON-INFECTIOUS RETINOPATHY (HIV RETINOPATHY)23, 24
CMV RETINITIS23,24
VARICELLA ZOSTER VIRUS DISEASE
Acute Retinal Necrosis (ARN) (Fig. 112.10)
Progressive Outer Retinal Necrosis (Fig. 112.11)
FROSTED BRANCH ANGIITIS (FIG. 112.12)
TREATMENT OF VIRAL RETINITIS26–28 (FIGS 112.9A AND B)
Ganciclovir
Foscarnet
Acyclovir
Catheter-less Therapy
Oral Ganciclovir
Intravenous Cidofovir
Ganciclovir Intraocular Implant
Intravitreal Ganciclovir
Intravitreal Foscarnet
Intravitreal Cidofovir
Intravitreal Fomivirsen
Oral Valganciclovir
Retinal Detachment Secondary to CMV Retinitis
Ocular Tuberculosis29 (Fig. 112.13)
113:
Hereditary Vitreoretinal Degeneration
INTRODUCTION
LATTICE DEGENERATION
PATHOPHYSIOLOGY
HISTOLOGIC FINDINGS
CLINICAL FEATURES
Symptoms
Fundus Findings
CLINICAL COURSE
MANAGEMENT
WAGNER'S DISEASE, JANSEN'S DISEASE AND EROSIVE VITREORETINOPATHY
GENETICS
CLINICAL FEATURES
Vitreous and Retina
Lens
ELECTROPHYSIOLOGY
MANAGEMENT
STICKLER'S SYNDROME, HEREDITARY PROGRESSIVE ARTHRO-OPHTHALMOPATHY
GENETICS
OTHER CHONDRODYSPLASIAS ASSOCIATED WITH OCULAR CHANGES
Marshall Syndrome
Weissenbach-Zweymuller Syndrome
Kneist Dysplasia
CLINICAL FEATURES
Ocular
Nonocular
ELECTROPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
Wagner's Disease
Goldmann Favre Disease
Congenital Retinoschisis
Pathological High Myopia
MANAGEMENT
GOLDMANN-FAVRE DISEASE
CLINICAL FEATURES
Ocular Features
Retinal Lesions
ELECTROPHYSIOLOGY
ERG
EOG
MANAGEMENT
X LINKED JUVENILE RETINOSCHISIS (XJR)
GENETICS
RISK TO FAMILY MEMBERS
CLINICAL FEATURES
Ocular Features
ELECTROPHYSIOLOGY
Electroretinogram (ERG)
Fluorescein Angiography (FA)
Optical Coherence Tomography (OCT)
DIFFERENTIAL DIAGNOSIS
Goldmann-Favre Vitreoretinal Degeneration
Retinitis Pigmentosa (RP)
Stickler's Syndrome
MANAGEMENT
FAMILIAL EXUDATIVE VITREORETINOPATHY (FEVR)
PATHOGENESIS
GENETICS
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS
MANGEMENT
SNOWFLAKE VITREORETINAL DEGENERATION(SVD)
CLINICAL FEATURES
PERIMETRY
ELECTROPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
114:
Congenital Optic Disc Anomalies
INTRODUCTION
ENTITIES
OPTIC DISC DRUSEN
CLINICAL FEATURES
OPTIC NERVE HYPOPLASIA
CLINICAL FEATURES
OCULAR ASSOCIATIONS
SYSTEMIC ASSOCIATIONS
MORNING GLORY DISC ANOMALY
OPTIC DISC COLOBOMA
OPTIC DISC PIT
CONGENITAL TILTED DISC SYNDROME
CONGENITAL OPTIC DISC PIGMENTATION
AICARDI SYNDROME
115:
Optic Nerve Tumors
INTRODUCTION
OPTIC NERVE GLIOMAS
CLINICAL FEATURES
Age
Sex
Location
PRESENTING SIGNS AND SYMPTOMS
ASSOCIATION WITH NEUROFIBROMATOSIS
RADIOGRAPHIC FINDINGS
HISTOPATHOLOGY
Gross Appearance
Microscopic Findings
MANAGEMENT
MALIGNANT GLIOMAS OF THE OPTIC NERVE
CLINICAL FEATURES
RADIOLOGY
PATHOLOGY
PROGNOSIS
OPTIC NERVE MENINGIOMAS
CLINICAL FEATURES
SIGNS AND SYMPTOMS
RADIOLOGY
HISTOPATHOLOGY
MANAGEMENT
SECONDARY OPTIC NERVE TUMORS
EXTENSION FROM THE EYE
BLOOD-BORNE METASTASIS
EXTENSION FROM THE MENINGES AND BRAIN
EXTENSION FROM ADJACENT STRUCTURES
SECTION 10: MISCELLANEOUS
116:
Management of Pediatric Ocular Trauma
INTRODUCTION
EVALUATION
HISTORY
EXAMINATION
Visual Acuity
Ocular Examination
SPECIFIC EYE INJURIES
BIRTH TRAUMA
Periorbital Ecchymosis and Edema
Corneal Damage (Breaks in Descemet's Membrane)
Retinal Hemorrhages
EYELID LACERATIONS
CORNEAL AND CONJUNCTIVAL FOREIGN BODIES (FIGS 116.2 AND 116.3)
SUBCONJUNCTIVAL HEMORRHAGE
CORNEAL PENETRATION (FIG. 116.4)
TRAUMATIC HYPHEMA
TRAUMATIC CATARACT
VITREOUS AND RETINAL CONDITIONS THAT CAN BE CAUSED BY TRAUMA
Intraocular Foreign Body (IOFB)
Commotio Retinae
Choroidal Rupture
Retinitis Sclopeteria
Traumatic Macular Hole
CHILD ABUSE
EYE INJURY PREVENTION
SUMMARY
117:
Shaken Baby Syndrome
INTRODUCTION
DEMOGRAPHICS
ETIOLOGY AND PATHOGENESIS
CLINICAL CHARACTERISTICS AND COURSE
DIFFERENTIAL DIAGNOSIS
TREATMENT
SUMMARY
118:
Persistent Hyaloid Artery: Surgical Solution and Postoperative Management
INTRODUCTION
SURGICAL SOLUTION
POSTOPERATIVE MANAGEMENT
119:
Mesenchymal Dysgeneses
INTRODUCTION
PETERS’ ANOMALY
HISTOPATHOLOGY
PATHOGENESIS
GLAUCOMA
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
AXENFELD-RIEGER SYNDROME
GENERAL FEATURES
OCULAR FEATURES
Cornea
Anterior Chamber Angle
Iris
Other Ocular Features
GLAUCOMA
SYSTEMIC FEATURES
HISTOPATHOLOGIC FEATURES
PATHOGENESIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
120:
Ocular HIV in the Pediatric Population
INTRODUCTION
EPIDEMIOLOGY OF THE PEDIATRIC HIV EPIDEMIC
OCULAR MANIFESTATIONS OF HIV IN THE PEDIATRIC POPULATION
ANTERIOR SEGMENT CONDITIONS
Herpes Zoster
Molluscum Contagiosum
Conjunctival Xerosis
Reduced Tear Secretion
Strabismus
POSTERIOR SEGMENT CONDITIONS
Cytomegalovirus(CMV) Retinitis
Perivasculitis
Macular Edema
Isolated Retinal Cotton Wool Spots
Toxoplasmic Retinitis
ADDRESSING THE PEDIATRIC HIV EPIDEMIC
CONCLUSION
121:
Ocular Toxoplasmosis
DEFINITION
HISTORY AND CLASSIFICATION
CLINICAL CHARACTERISTICS
SYSTEMIC MANIFESTATION
OCULAR MANIFESTATIONS
PATHOGENESIS
PATHOLOGY
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
TREATMENT
PREVENTION
COMPLICATION
PROGNOSIS
CONCLUSION
ACKNOWLEDGMENT
122:
Ocular Complications after Pediatric Organ and Bone Marrow Transplantation
INTRODUCTION
INCIDENCE OF OCULAR COMPLICATIONS
TYPES OF OCULAR COMPLICATIONS
DIAGNOSIS OF COMPLICATIONS
MANAGEMENT AND PROGNOSIS
CONCLUSION
123:
Thyroid Eye Disease in Children
INTRODUCTION
THE EFFECT OF PASSIVE SMOKING
124:
Craniosynstosis
INTRODUCTION
CONSEQUENCES
ETIOLOGY
TYPES
OXYCEPHALY
PATHOGENESIS
OCULAR FEATURES
SYSTEMIC FEATURES
TREATMENT
BRACHYCEPHALY
SCAPHOCEPHALY
PLAGIOCEPHALY
PLATYCEPHALY
CROUZON'S DISEASE
INTRODUCTION
DIFFERENCES FROM OXYCEPHALY
OCULAR FEATURES
TREATMENT
APERT'S SYNDROME
HYPERTELORISM
INTRODUCTION
FORMULAE TO CALCULATE INTERPUPILLARY DISTANCE (IPD)
FEATURES
TREATMENT FOR HYPERTELORISM
SECTION 11: SYSTEMIC & INHERITED DISEASES WITH PEDIATRIC OCULAR INVOLVEMENT
125:
Ocular Manifestations of Inborn Metabolic Disorders
INTRODUCTION
MUCOPOLYSACCHARIDOSES (MPS)
MPS 1-H (HURLER'S SYNDROME)
MPS-I S (SCHEIE'S SYNDROME)
MPS II (HUNTER'S SYNDROME)
MPS-III (SANFILIPPO'S SYNDROME)
MPS IV (MORQUIO SYNDROME)
MPS VI (MAROTEAUX-LAMY SYNDROME)
MPS VII (SLY'S SYNDROME)
MACULAR CORNEAL DYSTROPHY
MUCOLIPIDOSES
MUCOLIPIDOSES (GM1 GANGLIOSIDOSIS)
MUCOLIPIDOSES 2 (METACHROMATIC LEUKODYSTROPHY)
SIALIDOSIS
GOLDBERG-COTLIER SYNDROME
LIPID AND LIPOPROTEIN ABNORMALITIES (DISORDERS)
REFSUM'S DISEASE
BASSEN-KORNZWEIG SYNDROME (ABETA LIPOPROTEINEMIA)
FAMILIAL LECITHIN-CHOLESTEROL ACYLTRANSFERASE DEFICIENCY (HYPOLIPOPROTEINEMIAS)
TANGIER DISEASE (ANALPHALIPOPROTEINEMIA)
CHOLESTANOLOSIS (CEREBROTENDINOUS XANTHOMATOSIS)
URBACH-WIETHE DISEASE (LIPOID PROTEINOSIS)
HYPERLIPOPROTEINEMIAS AND SCHNYDER'S CRYSTALLINE DYSTROPHY
DYSLIPOPROTEINEMIAS
SPHINGOLIPIDOSES
FARBER'S DISEASE
TYPE A (INFANTILE) NIEMANN-PICK DISEASE
GM1 TYPE I GANGLIOSIDOSIS (LANDING DISEASE)
JUVENILE GM1 TYPE 2 GANGLIOSIDOSIS (DERRY'S DISEASE)
GM2 TYPE 1 GANGLIOSIDOSIS (TAY-SACHS DISEASE)
GM2 TYPE 2 GANGLIOSIDOSIS (SANDHOFF'S DISEASE)
GM2 TYPE 3 GANGLIOSIDOSIS (BERNHEIMER-SEITELBERGER DISEASE)
GAUCHER'S DISEASE
KRABBE'S DISEASE (GLOBOID CELL LEUKODYSTROPHY)
FABRY'S DISEASE (ANGIOKERATOMA CORPORIS DIFFUSUM UNIVERSALE)
Ophthalmic Manifestations
METACHROMATIC LEUKODYSTROPHY
LACTOSYL CERAMIDOSIS
CARBOHYDRATE METABOLISM DISORDERS
GALACTOSEMIA (TRANSFERASE DEFICIENCY)
GALACTOSEMIA (KINASE DEFICIENCY)
DIABETES MELLITUS
GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
VON GIERKE'S DISEASE (GLYCOGENESIS)
HYPOGLYCEMIA
OXALOSIS
MANNOSIDOSIS
FUCOSIDOSIS
AMINOACIDURIAS AND RELATED DISORDERS
HOMOCYSTINURIA
CYSTINOSIS
MARFAN'S SYNDROME
EHLERS-DANLOS SYNDROME
HYPERLYSINEMIA
SULFITE OXIDASE DEFICIENCY
ALKAPTONURIA
ARGININOSUCCINASE DEFICIENCY
OCULOCEREBRORENAL SYNDROME (LOWE'S SYNDROME)
RICHNER-HANHART SYNDROME (TYROSINEMIA)
ALBINISM
Tyrosinase Negative Oculocutaneous Albinism
Tyrosinase Positive Oculocutaneous Albinism
Ocular Albinism
Chédiak-Higashi Syndrome
Waardenburg's Syndrome
CEREBROHEPATORENAL SYNDROME (ZELLWEGER'S SYNDROME)
AMYLOIDOSIS
Primary Corneal Amyloidosis
Secondary Corneal Amyloidosis
HYPERORNITHINEMIA (GYRATE ATROPHY OF THE CHOROID AND RETINA)
HOOFT'S DISEASE
FAMILIAL DYSAUTONOMIA (RILEY-DAY SYNDROME)
HARTNUP'S DISEASE
MAPLE SYRUP DISEASE
PHENYLKETONURIA
MINERAL METABOLIC DISORDERS
HEMOCHROMATOSIS
WILSON'S DISEASE (HEPATOLENTICULAR DEGENERATION)
MENKES KINKY HAIR DISEASE
CALCIUM DEPOSITION
GOLD DEPOSITION
MISCELLANEOUS INBORN DISORDERS
PORPHYRIA
GOUT
XERODERMA PIGMENTOSA
HYPOPHOSPHATASIA (LOW PHOSPHATE RICKETS)
NEURONAL CEROID LIPOFUSCINOSIS (BATTEN'S DISEASE)
ACHROMATOPSIA
PROTAN AND DEUTAN COLOR BLINDNESS
NORRIE'S DISEASE
INCONTINENTIA PIGMENTI
AICARDI'S SYNDROME
Diagnostic Techniques
126:
Ocular Manifestations of Systemic Diseases
INTRODUCTION
THERMAL, CHEMICAL AND ACID BURNS
ALKALI BURNS
UV RADIATION
INFRARED RADIATION
ATOMIC RADIATION
ATOPIC DERMATITIS
ATOPIC ECZEMA
HAY FEVER
ASTHMA
URTICARIA
ACNE ROSACEA
EPIDERMOLYSIS BULLOSA
CICATRICIAL PEMPHIGOID
ERYTHEMA MULTIFORME (STEVENS-JOHNSON SYNDROME)
ICHTHYOSIS
INCONTINENTIA PIGMENTII
PEMPHIGUS
PSORIASIS
VOGT-KOYANAGI-HARADA (VKH) SYNDROME
XERODERMA PIGMENTOSUM
VON HIPPEL'S DISEASE
ATAXIA TELANGIECTASIA
ENCEPHALO-TRIGEMINAL ANGIOMATOSIS
NEUROFIBROMATOSIS
WYBURN SYNDROME
ANKYLOSING SPONDYLITIS
DERMATOMYOSITIS
REITER'S SYNDROME
RHEUMATOID ARTHRITIS
SARCOIDOSIS
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
VARICELLA
RUBELLA (GERMAN MEASLES)
VACCINIA
HERPES SIMPLEX
HERPES ZOSTER
MUMPS
INFECTIOUS MONONUCLEOSIS
INFLUENZA
CYTOMEGALIC INCLUSION DISEASE
EPIDEMIC KERATOCONJUNCTIVITIS
GONORRHEA
DIPHTHERIA
SEPTICEMIA
LEPROSY
TUBERCULOSIS
LYMPHOGRANULOMA VENEREUM
TOXOPLASMOSIS
CANDIDA ALBICANS
HISTOPLASMOSIS
CRYPTOCOCCUS INFECTIONS
CYSTICERCOSIS
ECHINOCOCCUS (HYDATID CYST)
TOXOCARIASIS
TRICHINOSIS
ONCHOCERCIASIS
TURNER'S SYNDROME
ANEMIAS
LEUKEMIAS
LYMPHOMAS
MULTIPLE MYELOMAS
SICKLE CELL DISEASE
THALASSEMIA
THROMBOCYTOPENIA
ARTERIOSCLEROSIS
HYPERTENSION
TOXEMIA OF PREGNANCY
OCCLUSIVE VASCULAR DISEASES (SUDDEN)
OCCLUSIVE VASCULAR DISEASES (SLOW)
VENOUS OCCLUSIVE DISEASES
ENDOCARDITIS
AORTIC ARCH SYNDROME
ADRENALS CUSHING'S DISEASE
ADDISON'S DISEASE
DIABETES MELLITUS
HYPOPARATHYROIDISM
HYPERTHYROIDISM
ALCOHOLISM
LIVER DISEASE (NUTRITIONAL)
MALNUTRITION
PEPTIC ULCER DISEASES
PANCREATIC DISEASES
ULCERATIVE COLITIS
VITAMIN A DEFICIENCY
VITAMIN B DEFICIENCY
VITAMIN C DEFICIENCY
HYPERVITAMINOSIS A, B AND D
ALBINISM
AMYLOIDOSIS
GALACTOSEMIA
GOUT
MARFAN'S SYNDROME
NIEMANN-PICK DISEASE
WILSON'S DISEASE
CRANIOFACIAL SYNDROMES
FACIAL DEFORMITY SYNDROMES
MYASTHENIA GRAVIS
MUSCULAR DYSTROPHY DISORDERS
BRONCHIECTASIS
BRONCHOGENIC CARCINOMA
EMPHYSEMA
LOWE'S SYNDROME
NEPHROTIC SYNDROME
RENAL TRANSPLANTATION
WILMS’ TUMOR
BREAST CARCINOMA
PERIARTERITIS NODOSA
SCLERODERMA
INFLUENZA
MALARIA
LYMPHOMAS
THALASSEMIA
ENDOCARDITIS
MALNUTRITION
MUSCULAR DYSTROPHY DISORDERS
PNEUMONIA
RENAL TRANSPLANTATION
BREAST NEOPLASM
LUNG NEOPLASM
ALKAPTONURIA
127:
Common Ocular Syndromes
PREDOMINANTLY MESODERMAL SYNDROMES
MARFAN'S SYNDROME
WEILL-MARCHESANI SYNDROME (MARCHESANI SYNDROME)
VAN DER HOEVE'S SYNDROME (OSTEOGENESIS IMPERFECTA)
EHLERS-DANLOS SYNDROME (RUBBER SKIN DISEASE)
GRÖNBLAD-STRANDBERG SYNDROME (PSEUDOXANTHOMA ELASTICUM)
KLIPPEL-FEIL SYNDROME (CONGENITAL WEBBED-NECK SYNDROME)
ECTODERMAL SYNDROMES
ROTHMUND'S SYNDROME (POIKILODERMA CONGENITA)
WERNER'S SYNDROME (PROGERIA OF ADULT)
WAARDENBURG'S SYNDROME (EMBRYONIC FIXATION SYNDROME)
SJÖGREN'S SYNDROME (KERATOCONJUNCTIVITIS SICCA OR SICCA SYNDROME)
CONGENITAL ANHIDROTIC ECTODERMAL DYSPLASIA
NEUROECTODERMAL SYNDROMES
VON HIPPEL-LINDAU SYNDROME (RETINOCEREBELLAR ANGIOMATOSIS)
BOURNEVILLE'S SYNDROME (TUBEROUS SCLEROSIS)
VON RECKLINGHAUSEN'S SYNDROME (NEUROFIBROMATOSIS)
STURGE-WEBER SYNDROME (NEUROOCULOCUTANEOUS ANGIOMATOSIS)
DOWN SYNDROME (MONGOLISM)
MISCELLANEOUS SYNDROMES
RUBELLA SYNDROME (GREGG'S SYNDROME)
LAURENCE-MOON-BIEDL SYNDROME (LAURENCE-MOON SYNDROME)
GOLDENHAR'S SYNDROME (OCULOAURICULO-VERTEBRAL DYSPLASIA)
DUANE'S SYNDROME (RETRACTION SYNDROME)
FUCHS’ SYNDROME (FUCHS’ HETEROCHROMIC CYCLITIS)
128:
Ocular Manifestations of Musculoskeletal Disorders
INTRODUCTION
ALBRIGHT'S DISEASE (FIBROUS DYSPLASIA OF BONE)
CRANIOFACIAL DYSOSTOSIS
APERT'S DISEASE
CROUZON'S DISEASE
CONRADI'S SYNDROME (CHONDRODYSTROPHIA PUNCTATA)
LAURENCE-MOON-BIEDL SYNDROME
LOWE SYNDROME (OCULOCEREBRAL RENAL SYNDROME)
TRISOMY 18 (EDWARD'S SYNDROME)
WEILL-MARCHESANI SYNDROME
COCKAYNE SYNDROME
FACIAL DEFORMITY SYNDROMES
TREACHER-COLLINS SYNDROME (MANDIBULOFACIAL DYSOSTOSIS)
GOLDENHAR SYNDROME (OCULOAURICULOVERTEBRAL DYSPLASIA)
HALLERMANN-STREIFF-FRANCOIS SYNDROME
PAGET'S DISEASE
OSTEOGENESIS IMPERFECTA
NEUROFIBROMATOSIS (VON RECKLINGHAUSEN'S DISEASE)
OSTEOPETROSIS (MARBLE BONE DISEASE)
CRANIOMETAPHYSEAL DYSPLASIA
PIERRE-ROBIN ANOMALY
MYASTHENIA GRAVIS
MYOTONIC DYSTROPHY
MUSCULAR DYSTROPHY DISORDERS
OCULAR MUSCULAR DYSTROPHY
MYOTONIC DISORDERS
INFLAMMATORY DISORDERS OF MUSCLES
POLYMYOSITIS (DERMATOMYOSITIS)
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Ophthalmic Manifestations of SLE (Figs 128.9 and 128.10)
RHEUMATOID ARTHRITIS
JUVENILE RHEUMATOID ARTHRITIS (JRA)
ENDOCRINE MYOPATHIES
OPHTHALMIC GRAVES’ DISEASE (EXOPHTHALMIC OPHTHALMOPLEGIA) (FIGS 128.11 TO 128.13)
SCLERODERMA
POLYARTERITIS NODOSA
129:
Ocular Manifestations of Granulomatous and Rheumatological Disease
INTRODUCTION
OCULAR SARCOIDOSIS
OCULAR HISTOPLASMOSIS
INFLAMMATORY AND RHEUMATOLOGICAL OCULAR DISEASE
SYSTEMIC LUPUS ERYTHEMATOSUS
JUVENILE CHRONIC ARTHRITIS (JCA)
RHEUMATOID ARTHRITIS (RA) AND SJOGREN'S SYNDROME (SS)
VASCULITIC DISORDERS OF THE EYE
POLYARTERITIS NODOSA, MICROSCOPIC POLYANGIITIS AND CHURG-STRAUSS SYNDROME
WEGENER'S GRANULOMATOSIS
GIANT CELL ARTERITIS
BEHCET'S SYNDROME
OCULAR COMPLICATIONS OF ANTIRHEUMATIC DRUG THERAPY
CONCLUSION
130:
Paraneoplastic Ocular Syndromes
INTRODUCTION
CARCINOMA-ASSOCIATED RETINOPATHY (CAR)
CLINICAL PRESENTATION
PATHOGENESIS
TREATMENT
MELANOMA-ASSOCIATED RETINOPATHY (MAR)
CLINICAL PRESENTATION
PATHOGENESIS
TREATMENT
BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION (BDUMP) SYNDROME
CLINICAL FEATURES
PATHOGENESIS
TREATMENT
ACQUIRED CONE DYSFUNCTION
CLINICAL FEATURES
PATHOGENESIS
OPTIC NEURITIS
CENTRAL RETINAL ARTERY OCCLUSION
VOGT-KOYANAGI-HARADA LIKE (VKHL) SYNDROME
OPHTHALMOPLEGIA
SECTION 12: RECENT ADVANCES IN PEDIATRIC DISEASES MANAGEMENT
131:
Video-oculography: A New Perspective of Ocular Motility for Strabismology
INTRODUCTION
ANATOMOPHYSIOLOGICAL BASES
EXTRAOCULAR MUSCLES
THE SPIRAL OF TILLAUX
OCULAR MOVEMENTS
INDIVIDUAL ACTION OF THE OCULAR MUSCULATURE
HOMOLATERAL SYNERGISTS AND ANTAGONISTS
CLASSIFICATION OF OCULAR MOVEMENTS
OCULAR MOTILITY LAWS
EXPLORATORY TECHNIQUES: 3D VIDEO-OCULOGRAPHY (VOG-3D) SENSOMOTORIC INSTRUMENT®
TECHNICAL CHARACTERISTICS OF 3D-VOG
VOG GOGGLES
VISUAL STIMULUS (VISUAL LABTM)
ANALYSIS
VOG WORKSTATION
PRACTICAL APPLICATION OF VIDEO-OCULOGRAPHY TO STRABISMUS
NYSTAGMOGRAPHY
132:
Update on Pediatric Cataract Surgery
INTRODUCTION
SURGICAL TECHNIQUE (STEP BY STEP)
WOUND CONSTRUCTION
MANAGING THE ANTERIOR CAPSULE
Bimanual Capsulorhexis 4
Capsulorhexis with Vitreoretinal Forceps / Microcapsulorhexis Forceps
HYDRODISSECTION
LENS ASPIRATION
Bimanual IA
Co-Axial IA
Lens Aspiration with Vitrectomy Probe
MANAGING THE POSTERIOR CAPSULE
Optic Capture and Anterior Vitrectomy
Pars Plana Lensectomy
Epilenticular IOL Placement
IOL IMPLANTATION
Timing of IOL implantation
Secondary Posterior Chamber Intraocular Lens Implantation in Pediatric Patients
Piggy Back IOL (Polypseudophakia)
Multifocal IOL
NEWER TECHNIQUES AND DEVICES
Capsular Bending Ring (CBR)
Perfect Capsule and Sealed Capsule Irrigation (SCI)
Postage Stamp Multiple Anterior Capsulorhexisotomies
Heparin
Tissue Plasminogen Activator (t-PA)
OTHER IMPORTANT ISSUES IN THE MANAGEMENT OF PEDIATRIC CATARACT
IOL POWER CALCULATIONS
BIOMETRY
TYPE AND TIMING OF IOL IMPLANTATION
POSTOPERATIVE VISUAL REHABILITATION
Aphakic glasses
Contact lenses
STRABISMUS AND AMBLYOPIA
MANAGEMENT OF COMPLICATIONS
133:
Pediatric Oculoplasty: Evidence Based Update
INTRODUCTION
CONGENITAL DACRYOCYSTITIS UPDATE
SYNDROMES
Lacrimo-auriculo-dento-digital syndrome (LADD)1
MICROBIOLOGICAL SPECTRUM AND SENSITIVITIES
TREATMENT
Probing
Endonasal Probing and Retrograde Irrigation of Lacrimal Ducts
Balloon Dilatation of Nasolacrimal Duct
Monocanalicular Stenting
CONGENITAL PTOSIS
MOREKER'S CLASSIFICATION OF CHILDHOOD PTOSIS
Congenital
Acquired
DIAGNOSIS: DIFFERENTIATING CONGENITAL FROM APONEUROTIC PTOSIS
Upgaze Eyelid Position13
Ultrasound Biomicroscopy
UNCONVENTIONAL PTOSIS
Childhood Myasthenia
WARG Syndrome and Ptosis
Partial Trisomy and Ptosis
MANAGEMENT
Recent Concepts from Evidences in Terms of Management
ORBITAL IMPLANTATION IN CHILDREN
SIZE OF IMPLANT 30
PRIMARY ORBITAL IMPLANTS IN CHILDREN—HYDROXYAPATITE
POROUS POLYETHYLENE IMPLANT IN A CHILD
AUTOGENOUS DERMIS—FAT GRAFT ORBITAL IMPLANT
MOREKER'S EXPANDABLE BALLOON IMPLANTS
ORBITAL FRACTURES IN CHILDREN
ENDOSCOPIC FRACTURE REDUCTION AND MESH IMPLANTATION WITH TISSUE GLUE
LID AND ORBITAL TUMORS
SHIELDS CLASSIFICATION OF ORBITAL CYSTS40
ENDOSCOPIC MANAGEMENT OF ORBITAL DISEASES
Nd: YAG Laser and Corticosteroids
CONGENITAL EYELID RETRACTION AND CHILDHOOD THYROID
EYELID MALPOSITIONS
RUBAN'S CLASSIFICATION*
Static
Dynamic Disorders
CONGENITAL ENTROPION
Surgical correction of entropion in Congenital cutis laxa50
CONGENITAL ECTROPION
Congenital Ectropion in Congenital Ichthyosis52
CRYPTOPHTHALMOS
PARENTAL AGE
KNOWN RISK FACTORS
PATHOGENESIS
CLASSIFICATION
Nouby's Classification of Congenital Upper Eyelid Coloboma and Cryptophthalmos
Moreker-Agashe Classification
Treatment
Complete Cryptophthalmos
Incomplete Cryptophthalmos
Role of Amniotic Membrane
Prenatal Diagnosis 57–59
134:
Multifocal IOLs in Children: A Long-term Analysis
PEDIATRIC CATARACT SURGERY
CAN CHILDREN AND INFANTS MANAGE MULTIFOCALITY?
MULTIFOCAL IOLs IN CHILDREN
PERIOPERATIVE ROUTINE AND SELECTION OF ANESTHETIC AGENTS
OCULOCARDIAC REFLEX
SURGICAL TECHNIQUE
POSTERIOR RHEXIS AND VITRECTOMY
Statistics
135:
AquaLase Applications for Cataract Removal in Children: The Safest Option
INTRODUCTION
PROBLEMS TYPICAL TO CHILDREN
SURGICAL PROBLEMS IN CHILDREN
SURGICAL TECHNIQUE
CONCEPT OF PRESSURE WASHING.
RESULTS
136:
Removable Piggyback IOL in Managing Cataract in Infants
INTRODUCTION
CALCULATING THE INTRAOCULAR LENS POWER CALCULATION FOR CHILDREN
BIOMETRY
IOL FORMULAS
THE GROWTH OF THE EYE
EXTENDING THE REFRACTIVE GROWTH MODEL TO EARLY INFANCY
PRACTICAL CONSIDERATIONS IN IOL POWER CHOICE
WHAT THEN ARE THE OPTIONS
SURGICAL APPROACHES
WHICH LENS?
PIGGY BACKING : THE MOST FUNCTIONAL CONCEPT
Advantages
Disadvantages
Answer
MATERIAL OF THE HEMA DOMED IMPLANT
HEMA INTRAOCULAR DOMED IOL
Specification of the Domed IOL
Criteria for Selection of IOL
Criteria for Removal of IOL
Anesthesia Requirements
PERIOPERATIVE ROUTINE AND SELECTION OF ANESTHETIC AGENTS
OCULOCARDIAC REFLEX
SURGICAL TECHNIQUE
Criteria for Selection of IOL
Criteria for Removal of IOL
137:
Managing Amblyopia with Corneal Wavefront Guided Lasik in Children
INTRODUCTION
CAUSES OF AMBLYOPIA
STRABISMUS
OPTICAL DEFOCUS
RATIONALE FOR TREATMENT
HOW IS AMBLYOPIA TREATED IN CHILDREN?
Atropine
Patching
AMBLYOPIA TREATMENT STUDY
Results
PROBLEMS FOR EXCIMER LASER REFRACTIVE SURGERY WITH CHILDREN
STANDARD TREATMENT FOR ANISOMETROPIA AMBLYOPIA
OUR CRITERIA FOR LASIK IN CHILDREN
REFRACTIVE GOALS IN THE CHILD
FOLLOW UP SCHEDULE
Examination Schedule
Caution with our Study
Examination Protocol
Demographics
CONCLUSION
138:
Update on Strabismus Surgery in Children
INFANTILE ESOTROPIA
CONGENITAL ESOTROPIA
Preoperative Evaluation
Timing for Congenital Esotropia Surgery
Surgical Approach for Congenital Esotropia
INFANTILE ACCOMMODATIVE ESOTROPIA
LATE ONSET STRABISMUS
NORMO-SENSORY STRABISMUS
NON-ACCOMMODATIVE ACQUIRED ESOTROPIA
139:
Recent Advances in the Management of Pediatric Cataracts
INTRODUCTION
INDICATIONS FOR SURGERY
PREOPERATIVE EXAMINATION
CONSIDERATIONS IN PEDIATRIC CATARACT SURGERY
INCISIONS
ANTERIOR LENS CAPSULE MANAGEMENT
CORTEX AND NUCLEUS REMOVAL
POSTERIOR CAPSULE MANAGEMENT
IS ANTERIOR VITRECTOMY NECESSARY IN PEDIATRIC CATARACT SURGERY?
CURRENT RECOMMENDATIONS
IOL IMPLANTATION
IOL CHOICE
IS OPTIC CAPTURE NECESSARY?
CONCLUSION
140:
Bag-in-the Lens in Babies and Infants
INTRODUCTION
CONCLUSION
141:
PCO in Childhood Prevention and Management
INTRODUCTION
CHARACTERISTICS OF CATARACT SURGERY IN CHILDHOOD
MODERN CATARACT SURGERY IN CHILDHOOD
PREVENTING FACTORS OF PCO
BLOCK LEC MIGRATION
Square Edge
Capsular Ring: CBR and CTR Respective Actions Against PCO
PROPERTIES TO PREVENT PCO
A PEDIATRIC EXAMPLE OF CATARACT SURGERY WITH ACRYLIC IOL AND CTR
KILL THE LEC
Perfect Capsule™14
Aqualase®15
Phaco-laser
CBJ: Cleanbagjet®
CONCLUSION
142:
Current Concepts in Pediatric Corneal Transplant Surgery
INTRODUCTION
INDICATIONS OF PENETRATING KERATOPLASTY
AGE AT THE TIME OF PENETRATING KERATOPLASTY
EVALUATION OF INFANTS OR NEONATES WITH CONGENITAL CORNEAL OPACITIES
INVESTIGATIONS
PEDIATRIC KERATOPLASTY CONSTRAINTS
PREPARATION BEFORE CORNEAL TRANSPLANT SURGERY
DONOR TISSUE
SURGERY
SIZE OF THE GRAFT
ALTERNATIVES TO PENETRATING KERATOPLASTY
HIGH RISK PENETRATING KERATOPLASTY
PERIOPERATIVE CARE
COMPLICATIONS
EARLY
INTERMEDIATE
LATE COMPLICATIONS
ALLOGRAFT REJECTION
GLAUCOMA
TREATMENT OF AMBLYOPIA
OUTCOME
REPEAT CORNEAL GRAFT
KERATOPROSTHESIS
REHABILITATION OF BLINDS DUE TO CORNEAL DISEASE
SUMMARY AND CONCLUSION
143:
Role of Stem Cell in Pediatric Ophthalmology
INTRODUCTION
DEFINITION OF STEM CELLS
ROLE OF RETINAL STEM CELLS AND MÜLLER/GLIAL CELLS
ROLE OF RETINAL PIGMENT EPITHELIAL STEM CELLS
ROLE OF BONE MARROW-DERIVED STEM CELLS
BONE MARROW HEMATOPOIETIC STEM CELLS
ROLE OF ADULT BONE MARROW- DERIVED ENDOTHELIAL PROGENITOR [STEM] CELLS
BONE MARROW-DERIVED STEM CELLS CAN EXERT A NEUROTROPHIC RESCUE IN RETINAL DEGENERATION
BONE MARROW-DERIVED STEM CELLS CAN EXERT A VASCULOTROPHIC RESCUE EFFECT
ROLE OF BONE MARROW-DERIVED STEM CELLS IN RETINAL AND CHOROIDAL NEOVASCULARIZATION
RECENT ADVANCES
ROLE OF CORNEAL STEM CELL IN PEDIATRICS
OCULAR SURFACE STEM CELLS
HOPE OF STEM CELLS FOR UNTREATABLE EYE DISEASE
IDENTIFICATION OF STEM CELLS
DISEASE ARISING FROM STEM CELL DEFICIENCY DUE TO OCULAR SURFACE CAUSES
LIVE-RELATED VS CADAVERIC LIMBAL TRANSPLANTATION (LT)
CULTIVATED VS DIRECT LIMBAL TRANSPLANTATION
BIOENGINEERED OCULAR SURFACE EQUALENTS FOR TRANSPLANTATION
INDEX
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