Retina Atlas: A Global Perspective Sandeep Saxena, RC Saxena
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1RETINA ATLAS A Global Perspective
2RETINA ATLAS A Global Perspective
Sandeep Saxena MS, MAMS Member, National Academy of Medical Sciences, India Visiting Professor, UNC-Chapel Hill, Chapel Hill, USA Fellow, Barnes Retina Institute and Anheuser-Busch Eye Institute, St. Louis, USA Fellow, New York-Presbyterian Hospital, New York, USA Professor Department of Ophthalmology King George's Medical University Lucknow, India RC Saxena MS DAAD Fellow, Augenklinik, Essen, Germany Commonwealth Medical Fellow, Institute of Ophthalmology and Moorfields Eye Hospital, London, UK Indo-FRG Fellow, Augenklinik, Essen, Germany Formerly, Professor and Head Department of Ophthalmology King George's Medical College Lucknow, India
3Published by
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Retina Atlas: A Global Perspective
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2008
9788184482195
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4“The whole world steps aside for the man who knows where he is going.”
—Anon
To
My mother
Mrs Madhu Saxena
Travis A Meredith MD, Matthew A Thomas MD, Harvey Lincoff MD,
Maurice B Landers III MD, Lawrence A Yannuzzi MD, Stanley Chang MD,
and
Dipak Kumar MS
for showing me the colors of retina
and my family
Sangeeta, Shreeya and Aishwarya
Sandeep Saxena
5Contributors 9Foreword
Retina is a continuously advancing field as new technologies are being introduced at a rapid rate. As new diagnostic instruments, lasers and anti-VEGF therapies are introduced; the retinal specialist must learn their intricacies as one begins to apply them to treatment of vitreoretinal diseases. In turn, the adoption of new technology brings with it the need to learn new skills and develop new treatment algorithms. Advancing capabilities furthermore allows intervention for new indications. As techniques, indications, and equipment evolve, better outcomes result but may also be accompanied by new sets of complications. Keeping up with these changes is a major imperative throughout the retinal specialist's career.
In this challenging intellectual environment an atlas on medical and surgical diseases of retina is welcome. Dr Saxena has gathered a distinguished group of experts from around the globe to bring out a Retina Atlas, presenting a global perspective. This atlas has an excellent compilation of more than 100 chapters with around 2300 lucid images of the fundus, fluorescein angiography, and indocyanine green angiography, optical coherence tomography including the latest spectral-domain high resolution optical coherence tomography, microperimetry, B-scan ultrasonography and multifocal electroretinogram. Step-by-step macular surgeries have also been depicted. This is in fact the first retina atlas presenting the medical and surgical aspects of vitreoretinal diseases, in a comprehensive manner, for practicing ophthalmologists. Videos of spectral-domain high resolution optical coherence tomography of various macular disorders have also been included.
Dr Saxena is an energetic physician and academician who, along with his fellow contributors, have produced a book, which is an important contribution to contemporary ophthalmic education. Dr Saxena and his colleagues are to be congratulated for an exemplary effort, which will be of great value to the readers.
Travis A Meredith MD
Sterling A Barrett Distinguished Professor
Chairman, Department of Ophthalmology
University of North Carolina
Chapel Hill, USA
10Foreword
The world grows smaller everyday. One of the benefits of this is the improving level of knowledge of vitreoretinal diseases available to the physicians and patients everywhere.
Dr Saxena has compiled a remarkable new Retina Atlas, presenting a truly global perspective of retinal diseases for the first time. Each chapter comprises of an overview of the disease and management and numerous images. Various figures in the atlas have been contributed from around the world, including: USA, Brazil, Germany, France, Austria, Switzerland, Spain, Turkey, Hong Kong, Japan, India, Australia and New Zealand.
Fundus photographs, fluorescein angiograms, indocyanine green angiograms, optical coherence tomography images, microperimetry, multifocal electroretinograms and B-scans have been presented together for the first time to give comprehensive knowledge about a particular retinal disease. Multiple figures of each disease are included to show the spectrum of a particular disease presentation.
While the majority of the optical coherence tomography images are of the time-domain type, there are also a number of the newer spectral-domain high-resolution images of a several major diseases including diabetic retinopathy, age-related macular degeneration, choroidal neovascularization, myopia, central serous chorioretinopathy, venous occlusion, Best's disease and rod-cone degeneration. The 3D optical coherence tomography figures have been presented in epiretinal membrane and macular hole cases.
In addition to medical diseases, surgical disease cases are presented, including figures of the step-by-step surgical treatment of epiretinal membrane, macular hole, diabetic macular edema, retinal vein sheathotomy, radial optic neurotomy, and myopic foveoschisis; the latter included for the first time in a Retina Atlas.
Several videos of spectral-domain high-resolution optical coherence tomography have been included, covering several macular diseases.
Dr Saxena has compiled an extremely timely, thorough, and well integrated Retina Atlas, valuable to the active vitreoretinal specialist and also to the comprehensive ophthalmologist alike, both as a learning aid and as an exhaustive reference resource.
Maurice B Landers III, MD
Professor of Ophthalmology
Director, Vitreoretinal Service
Department of Ophthalmology
University of North Carolina
Chapel Hill, USA
11Preface
Sandeep Saxena
RC Saxena
Ophthalmology is one of the most technology driven disciplines of medicine. Rapid technological advances in the diagnosis and management of vitreoretinal disorders have had dramatic impacts. Evidence-based medicine is a reality today. Treatment modalities are now more innovative and more sharply focused on the causative mechanisms.
Retina Atlas aims at updating knowledge of the reader on the current status of various vitreoretinal disorders. Medical and surgical diseases of the retina have been included. Fluorescein angiography, indocyanine green angiography, time-domain as well as spectral-domain high-resolution optical coherence tomography, microperimetry, electroretinography, and B-scan ultrasonography have been included together for the first time to provide wide-ranging knowledge about various diseases. An effort has been made to present a global perspective with over 100 contributors, of repute, from across the globe.
The atlas contains 102 chapters featuring around 2300 images.
Section 1 includes the basics of fluorescein angiography, indocyanine green angiography, scanning laser ophthalmoscope-based angiography, time-domain and spectral-domain high-resolution optical coherence tomography, microperimetry and multifocal electroretinography.
Section 2 includes sections on retinal vascular disorders, macular disorders, vitreoretinal surgical disorders, inflammatory disorders, infectious disorders, traumatic disorders, hereditary chorioretinal disorders, tumors, optic nerve disorders, and various miscellaneous disorders. Each chapter includes an overview of the disease. Classification systems for various diseases have been included. Each photograph or set of photographs include an expressive legend. Diagnostic features of various diseases as well as the effect of various treatment modalities, including medical therapy, laser photocoagulation, photodynamic therapy, anti-VEGF therapies and vitreoretinal surgery have been shown in an extremely lucid manner.
Step-by-step surgeries for epiretinal membrane, macular hole, diabetic macular edema, arteriovenous sheathotomy, radial optic neurotomy and myopic foveoschisis have been shown in the form of sequential images for the first time in an atlas.
Fifteen videos of spectral-domain high-resolution optical coherence tomography of several macular diseases have also been included for the first time.
The aim of this book is to provide a better understanding of vitreoretinal diseases. We are certain that this atlas will be useful to all postgraduate students, vitreoretinal specialists and practicing ophthalmologists.
Sandeep Saxena
RC Saxena