Index

Surgical Techniques in Ophthalmology: Corneal Surgery Ashok Garg, Boris Malyugin, Bojan Pajic, Jorge L Alio, Belquiz A Nassaralla, Mahipal S Sachdev, Keiki R Mehta, Roberto Pinelli, A John Kanellopoulos, Carlo F Lovisolo, Jes N Mortensen, Francisco Sánchez León, Frederic Hehn, Arun C Gulani, Quresh B Maskati

SECTION I: SURGICAL TECHNIQUES FOR CORNEAL RESHAPING (KERATOCONUS—KCN) AND OTHER CORNEAL DISEASES
CHAPTER 1:Intracorneal Ring Segments for Keratoconus
- AN INTRODUCTION
CHAPTER 2:Asymmetric Intacs for Keratoconus
- AN INTRODUCTION
CHAPTER 3:Factors Influencing Flap and Intacs Decentration after Femtolaser Application in Normal and Keratoconic Eyes
- INTRODUCTION
- STATISTICAL ANALYSIS
CHAPTER 4:Simultaneous Collagen Cross-linking (CXL) and Topography-guided PRK (tPRK) for Keratoconus (KCN)
- INTRODUCTION
- DIAGNOSIS OF KERATOCONUS
- CLINICAL EXAMINATION
- SURGICAL STEPS
  - Step 1: The (partial, in regard to refractive error corrected) Topography-guided PRK Technique
  - Step 2: Collagen Cross-linking (CXL) Procedure
CHAPTER 5:Laser PRK for Keratoconus
- AN INTRODUCTION
CHAPTER 6:Corneal Collagen Cross-linking in Keratoconus
- INTRODUCTION
- THE SURGICAL PROCEDURE
- FOLLOW-UP
- CLINICAL RESULTS
- RISKS AND SIDE EFFECTS
CHAPTER 7:Surgical Treatment of Keratoconus and LASIK Ectasia with Intrastromal Corneal Ring Segments (Keraring®)—Custom Keraring Implantation Using Intralase
- INTRODUCTION
- ADVANTAGES
- INDICATIONS2,3, 5
- CONTRAINDICATIONS
- MECHANISM OF ACTION2,5,6 (figures 7.4 and 7.8)
- SURGICAL TECHNIQUE AND SPECIFICATIONS
  - Surgical Technique
  - Keraring IntraLase Technique Advantages
- KERARING INTRALASE PROCEDURE STEP BY STEP
- NOMOGRAMS AND CONSULTANCY
- KERARING SPECIFICATIONS (Figure 7.16)
- COMPLICATIONS
  - Postoperative Complications
- KERARING AND INTRALASE CONCLUSION ORTHOPEDIC OR REFRACTIVE PROCEDURE
CHAPTER 8:Lamellar Keratoplasty for Keratoconus
- INTRODUCTION
- METHODS AND PATIENTS
- RESULTS
- DISCUSSION
CHAPTER 9:Transepithelial Cross-linking Treatment in Eyes with Intacs
- INTACS EFFECT ON KERATOCONIC EYES
  - Cross-linking Effect in Eyes with Intacs
- EPITHELIUM AND CORNEA PERMEABILITY
  - R Cornea: R epithelium + R stroma + R endothelium
- SURGICAL TECHNIQUE
- STATISTICAL ANALYSIS
- RESULTS
- CONCLUSION
CHAPTER 10:Management of Corneal Injuries
- TERMINOLOGY IN OCULAR TRAUMA
- OPEN-GLOBE INJURY CLASSIFICATION
- MANAGEMENT OF ACUTE CORNEAL INJURY
- MANAGEMENT OF INJURY TO LENS
  - Type of Sutures
- POSTOPERATIVE TREATMENT
  - Traumatic Wound Dehiscence Following Penetrating Keratoplasty
- COMPLICATIONS OF CORNEAL INJURY
- VISUAL REHABILITATION
- WAR RELATED INJURIES
- PREVENTION OF EYE INJURIES
CHAPTER 11:Corneal Cross-linking (CXL) for Keratitis
- INTRODUCTION
  - History
  - How does it Function
- CORNEAL CROSS-LINKING IN TREATMENT OF KERATITIS
- SEVERAL CASES
- PREVENTING CORNEAL MELTING
- CONCLUSION
CHAPTER 12:Role of PTK Today
- INTRODUCTION
- EXAMPLE OF REGENERATIVE WOUND HEALING AFTER SEVERE INJURY TO THE CORNEA
- DIAGNOSES
- CONCLUSION
CHAPTER 13:Chemical Burns of the Eye
- INTRODUCTION
- PATHOGENESIS
- CLASSIFICATION
- MANAGEMENT − GENERAL PRINCIPLES
- RECENT ADVANCES IN THERAPY
- CONCLUSION
CHAPTER 14:Phototherapeutic Keratectomy on Recurrent Corneal Erosions
- INTRODUCTION
CHAPTER 15:Excimer Laser PRK and Corneal Scars: Refractive Surgery to the Rescue
- INTRODUCTION
- SURGICAL TECHNIQUE
  - Anesthesia: Topical Anesthesia
  - Surgical Steps
- PEARLS
CHAPTER 16:Keratoprosthesis
- INTRODUCTION
- THE PBIKP
- THE DKP (TYPE 1)
  - Surgical Technique
  - Postoperative Treatment
- REASON FOR SUCCESS
SECTION II: SURGICAL TECHNIQUES FOR CORNEAL TRANSPLANTATION
CHAPTER 17:Penetrating Keratoplasty
- INTRODUCTION
- IMMUNOLOGY OF THE EYE
- KERATOPLASTY AT PRESENT
- HOW WE PERFORM PKP TODAY
- POSTOPERATIVE TREATMENT AND FOLLOW-UP
- COMPLICATIONS
- THE FUTURE
- CONCLUSION
CHAPTER 18:Corneoplastique™—An Update
- INTRODUCTION
- CORNEOPLASTIQUE™ IN ACTION
CHAPTER 19:Aphakic Epikeratophakia with Decentered Scarred Epilenticle
- INTRODUCTION
CHAPTER 20:Pediatric Keratoplasty
- INTRODUCTION
- VISUAL ASSESSMENT (FIGURES 20.2 TO 20.13)
  - Direct
  - Indirect
- OCULAR EXAMINATION
- SURGICAL PROCEDURES
- INDICATIONS
- SURGICAL MANAGEMENT
  - Penetrating Keratoplasty
    - Disadvantages of Smaller Graft
  - Concomitant Procedures
- POSTOPERATIVE CARE
  - Immediate Postoperative Period
  - Early Postoperative Care
- POSTOPERATIVE MEDICATIONS
- SUTURE REMOVAL
- OPTICAL CORRECTION AND AMBLYOPIA THERAPY
- CONCLUSION
CHAPTER 21:Deep Posterior Lamellar Keratoplasty
- INTRODUCTION
- METHODS AND PATIENTS
- RESULTS
- DISCUSSION
CHAPTER 22:Lamellar Keratoplasty
- INTRODUCTION
- IMMUNOLOGY OF THE EYE
- THE REINTRODUCTION OF LAMELLAR KERATOPLASTY
- MY OWN EXPERIENCE OF LAMELLAR TECHNIQUE
- FUTURE
- CONCLUSION
CHAPTER 23:Endothelial Graft
- INTRODUCTION
- SUBJECT
- CONCLUSION
CHAPTER 24:Amnio Keratoplasty for Band-shaped Keratopathy
- AN INTRODUCTION
CHAPTER 25:Key Hole Corneal Transplant
- ADVANTAGES
- STEPS SEEN IN IMAGES
- LASER VISION SURGERY FOLLOWING DSEK (KEY HOLE TRANSPLANT)
CHAPTER 26:Excimer Laser Assisted Descemet Stripping Endothelial Keratoplasty
- INTRODUCTION
- CASE REPORTS
- SUMMARY
CHAPTER 27:Therapeutic Deep Anterior Lamellar Karatoplasty: Surgical Steps
- SURGICAL STEP
CHAPTER 28:Stem Cell Transplantation
- INTRODUCTION
- DIAGNOSIS OF LIMBAL STEM CELL DEFICIENCY
- INCLUSION CRITERIA
- LATERALITY OF THE DISEASE
- PRE-OPERATIVE TESTS
  - Limbal Biopsy
  - Limbal Stem Cell Culture
- CULTIVATED LIMBAL STEM CELL TRANSPLANTATION
- POST-OPERATIVE TREATMENT AND FOLLOW-UP
  - Early Results
- CONCLUSION
CHAPTER 29:Amniotic Membrane Graft for Non-healing Corneal Ulcers
- INTRODUCTION
- PREPARATION OF PRESERVEDHUMAN AMNIOTIC MEMBRANE
CHAPTER 30:Cultured Limbal Stem Cell Transplant: Surgical Technique
- INTRODUCTION
- ADJUNCT TREATMENT
- OCULAR SURFACE RECONSTRUCTION
- NEWER SURGICAL PROCEDURES
  - Rationale of Newer Surgical Options
- SURGICAL TECHNIQUE
CHAPTER 31:DALK in Corneal Perforations: A New Option
- INTRODUCTION
- SURGICAL PROCEDURE
CHAPTER 32:Intracorneal and Intracameral Amphotericin B in Fungal Corneal Ulcers
- AN INTRODUCTION
CHAPTER 33:Amniotic Membrane Transplantation
- PREPARATION AND STORAGE
- SURGICAL TECHNIQUE
CHAPTER 34:Anterior Lamellar Corneal Replacement
- INTRODUCTION
- DIRECT SURGICAL DISSECTION
- INJECTION TO SEPARATE DESCEMET'S MEMBRANE
- CLOSED DISSECTION USINGSPATULATED DISSECTORS
- DONOR PREPARATION
SECTION III: RECENT ADVANCES AND INNOVATIVE TECHNIQUES IN CORNEAL SURGERY
CHAPTER 35:Update on Keratoprosthesis Surgery
- INTRODUCTION
- HISTORY OF KERATOPROSTHESIS
- KERATOPROSTHESES IN CURRENT USE
- KERATOPROSTHESIS SURGERYIN THE NEW MILLENNIUM
CHAPTER 36:Evolution of Keratoplasty Through Centuries
- INTRODUCTION
- REVIEW
- EYE BANKING AND CORNEAL STORAGE
- LAMELLAR KERATOPLASTY
- LIMBAL STEM CELL TRANSPLANTATION
- CORNEAL COLLAGEN CROSS-LINKING
- NEW TECHNOLOGY
- EVOLUTION OF NEW NOMENCLATURE IN CORNEAL TRANSPLANT SURGERY
- EVOLUTION OF KERATOPLASTY: INDIAN SCENARIO
CHAPTER 37:LASIK after Perforated Keratoplasty
- AIM
- PATIENTS AND METHODS
- RESULTS
- CONCLUSION
CHAPTER 38:Corneal Wavefront LASIK after Penetrating Keratoplasty
- INTRODUCTION
- TIMING OF LASIK AFTER KERATOPLASTY
- TECHNIQUE
- CASE STUDY
- CONCLUSION
CHAPTER 39:An Update on Surgical Techniques for DSEK
- INTRODUCTION
- CONCLUSIONS
CHAPTER 40:Deep Anterior Lamellar Keratoplasty in Keratoconus
- INTRODUCTION
  - History
  - Indications
- PERSONAL SURGICAL TECHNIQUE: AIR-VISCO BUBBLE EXCHANGE
- CONCLUSIONS
CHAPTER 41:Artificial Cornea Technique
- STAGE I: ARTIFICIAL CORNEAL TRANSPLANT
- STAGE II: ARTIFICIAL CORNEAL TRANSPLANT
CHAPTER 42:Management of Acute Chemical Eye Injuries
- INTRODUCTION
- EMERGENCY TREATMENT
- DIAGNOSIS
- VISUAL REHABILITATION
CHAPTER 43:Management of Mooren's Ulcer
- INTRODUCTION
- DIFFERENTIAL DIAGNOSIS
- TREATMENT
CHAPTER 44:Cultured Limbal Stem Cell Transplants in Ocular Surface Diseases: Our Experience and Review of Literature
- INTRODUCTION
- LIMBAL STEM CELLS
- LIMBAL STEM CELLS IN OCULAR SURFACE HEALING
- LIMBAL STEM CELL DEFICIENCY DISORDERS
- DIAGNOSIS OF LIMBAL STEM CELL DEFICIENCY
- SURGICAL TREATMENT OF LIMBAL STEM CELL DEFICIENCY
- CULTURED LIMBAL STEM CELL TRANSPLANTS
CHAPTER 45: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
- OUTCOME
- SUMMARY AND CONCLUSIONS
CHAPTER 46:Update on Other Refractive Procedures
- CORNEAL COLLAGEN CROSS-LINKAGE WITH RIBOFLAVIN (C3R)
- PROCEDURAL DETAILS
- IMPLANTABLE CONTACT LENS (ICL)
CHAPTER 47:Deep Lamellar Endothelial Keratoplasty
- INTRODUCTION
- LARGE INCISION DLEK
- SMALL INCISION DLEK
- DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY
CHAPTER 48:Management of Corneal Laceration
- INTRODUCTION
- INJURY ASSESSMENT
- PERFORATING OR NON-PERFORATING CORNEAL LACERATION
- MEDICAL MANAGEMENT
- SURGICAL MANAGEMENT
- CONCLUSION
CHAPTER 49:IOL Power Calculation for Cornea Triple and Penetrating Keratoplasty with IOL Exchange
- INTRODUCTION
CHAPTER 50:The Use of Orbscan for Monitoring Corneal Changes Following Collagen Cross-linking Treatment for Keratoconus
- TREATMENTS FOR KERATOCONUS
- CXL
  - Previous Studies
- A NOVEL USE OF ORBSCAN
CHAPTER 51:Corneal Collagen Cross-linking with Riboflavin (C3-R) Combined with Intrastromal Ring Segment Implantation and Overnight Contact Lens Molding in Keratoconus
- INTRODUCTION
- PURPOSE, METHODS AND MATERIALS
- RESULTS
- DISCUSSION AND CONCLUSION
CHAPTER 52:Transepithelial Cross-linking for the Treatment of Keratoconus
- INTRODUCTION
- CORNEAL COLLAGEN NETWORKS
- PHOTOCHEMICAL CROSS-LINKING
- RIBOFLAVIN-UVA TREATMENT
- CORNEAL EPITHELIUM
CHAPTER 53:Corneoplastics Using Corneal Collagen Cross-linking and Intracorneal Rings for Keratoconus and LASIK Ectasia
- INTRODUCTION
- COMBINING NEW AND OLD TECHNIQUES
- UNFINISHED BUSINESS
- WHEN IS THE BEST TIME TO APPROACH FOR COMBINE CROSS-LINKING AND INTRACORNEAL RINGS AND FOR KERATOCONUS?
- COMBINING TREATMENTS EXPERIENCES
- CROSS-LINKING AND PRK
CHAPTER 54:Re-shaping Keratoconus: Laser PRK Followed by Corneal Cross-linking
- INTRODUCTION
- GULANI CLASSIFICATION SYSTEM FOR LASER SURGERY IN KERATOCONUS
- DISCUSSION AND RESULTS
CHAPTER 55:Corneal Collagen Cross-linking (CXL): Current Scenario and Future Prospects
- INTRODUCTION
- WHAT IS CROSS-LINKING?
- PHYSIOLOGY OF COLLAGEN CORNEAL CROSS-LINKING
- INDICATIONS FOR C3-R TREATMENT
- EXCLUSION CRITERIA
- PARAMETERS FOR C3-R TREATMENT
- PRE-OPERATIVE WORK UP FOR C3-R TREATMENT
- STEPS OF C3-R TECHNIQUE (Figure 55.4)
- POSTOPERATIVE FOLLOW-UP
- FUTURE PROSPECTS
CHAPTER 56:Instrumentation in Lamellar Corneal Procedures
- INTRODUCTION
- HISTORY
- ANTERIOR LAMELLAR PROCEDURES
  - Indications
- CONVENTIONAL MANUAL ALK SURGERY (PREDESCEMETIC ALK)
- DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) (DESCEMETIC ALK)
- MICROKERATOME ASSISTED ALK (AUTOMATED LAMELLAR THERAPEUTIC KERATOPLASTY (ALTK))
- FEMTOSECOND LASER ASSISTED ALK
- DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK)
  - Surgical Technique3
    - Procedure
- ADVANTAGES OF ANTERIOR LAMELLAR PROCEDURES
- DISADVANTAGES OF ANTERIOR LAMELLAR PROCEDURES
- POSTERIOR LAMELLAR PROCEDURES
  - Indications
- POSTERIOR LAMELLAR KERATOPLASTY (PLK)
- DEEP LAMELLAR ENDOTHELIALKERATOPLASTY (DLEK)
- DESCEMET STRIPPING ENDOTHELIAL KERATOPLASTY (DSEK)
- DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY (DSAEK)
- FEMTOSECOND DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY (FS-DSEK)
- DESCEMET'S MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK)
- SURGICAL TECHNIQUE
  - Deep Lamellar Endothelial Keratoplasty (DLEK)4
- DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY (DSEK)
- DESCEMET'S STRIPPING AUTOMATEDENDOTHELIAL KERATOPLASTY
  - Graft Preparation
- ADVANTAGES OF POSTERIOR LAMELLAR PROCEDURES
- DISADVANTAGES OF POSTERIORLAMELLAR PROCEDURES
- INSTRUMENTS USED IN LAMELLAR CORNEAL SURGERY (SOME OF THE COMAPANIES LISTED)
- ARTIFICIAL ANTERIOR CHAMBERS (AAC)
  - Reusable ACC
- MORIA AAC
- BAUSCH AND LOMB AAC
- DISPOSABLE AAC
- BARRON AAC
  - AAC Base
- CORONET ARTIFICIAL ANTERIOR CHAMBER (AAC)
- FUNCTIONAL CHARACTERISTIC
- MICROKERATOMES
- THE AUTOMATED M2 MICROKERATOME
  - Features of the Instrument
  - Advantages of M2 Microkeratome
- MORIA CB MICROKERATOME
  - Features of the Instrument7
  - Advantages of CB Microkeratome
- TREPHINES AND PUNCHES USED IN LAMELLAR SURGERIES
- HANNA KERATOPLASTY TREPHINE AND SINGLE USE PUNCH BY MORIA
- CORONET PUNCH AND TREPHINES
  - Vacuum Punch
  - A. Manual Trephines
  - Functional Characteristics
  - B. Vacuum Trephines
  - Functional Characteristics
- INSTRUMENTS FOR LAMELLAR DISSECTION
  - Daya Forces
- DALK SPATULA SET BY DORC
- CORNEAL DISSECTORS—STRAIGHT, CURVED AND ANGLED BY KATENA
- DEVERS-TERRY CURVED AND STRAIGHT DISECTOR BY BAUSCH AND LOMB
- SCISSORS USED IN LAMELLAR PROCEDURES
  - Cindy Scissors by Katena
  - Rosewasser Scissors by Katena
- CURVED PLK SCISSORS BY DORC
- INSTRUMENTS FOR DESCEMET'SMEMBRANE SCORING
  - Price Hook by Moria
  - Corneal Markers by Baush and Lomb 8 and 8.5 mm
  - Reversed Sinskey Hook by Katena
- INSTRUMENTS FOR DESCEMET'SMEMBRANE STRIPPING
  - Moria Strippers
  - Rosenwasser Irrigating Stripper by Katena
  - Kim Feeling Forceps by Bausch and Lomb
  - Reverse Sinskey Hook by Bausch and Lomb
  - Snyder Forceps by Bausch and Lomb
  - Daya Scraper by Duck Worth and Kent
  - Melles Scrapper by Dorc
    - Style 1:
    - Style 2:
- STEINERT STRIPPER BY RHEIN MEDICALS
- INSTRUMENTS FOR DONOR LAMELLA INSERTION
  - Rosenwasser Forceps by Katena
  - Steinert Forceps by Rhein Medicals
  - Rosenwasser Shovel by Katena
  - Carlson Forceps by Bausch and Lomb
  - Charlie Forceps II by Bausch and Lomb
  - Ogawa Forceps by Moria
  - Daya Forceps by Duckworth and Kent
- INSTRUMENTS FOR SMOOTHENING THE INTERFACE
  - Rubenstein Corneal Roller by Katena
  - Carlson Smoother by Bausch and Lomb
  - IDE Cannula by Rhein Medicals
  - Cindy Sweeper by Bausch and Lomb
- NEWER INSTRUMENTS USED INLAMELLAR SURGERIES
  - The Endosaver™ Ek I Injector
- NEUSIDL CORNEAL INSERTER (NCI, FISHER SURGICAL)
  - Features of the Instrument
- TERRY IRRIGATING AND NON-IRRIGATING SCRAPER BY BAUSCH AND LOMB
- BUSIN GLIDE SPATULA
- BUSIN FORCEPS
- FEMTOSECOND LASER IN LAMELLAR KERATOPLASTY
  - FMS Laser Factoid
  - FMS Laser Effect
- ADVANTAGES OF FEMTO IN LAMELLAR PROCEDURES
- INTRALASE FS LASER (AMO)
- EVOLUTION OF INTRALASE LASER
- ADVANTAGES OF INTRALASE IN LKPs
- WOUND CONFIGURATIONS
- FEMTOSECOND LASER ASSISTED ANTERIOR LKP9
- FEMTOSECOND LASER ASSISTED DLEK AND DSAEK9
- COMPLICATIONS
- FUTURE OF LAMELLAR KERATOPLASTY
- FINANCIAL INTEREST
- ACKNOWLEDGEMENTS
CHAPTER 57:Cyanoacrylate Glue in the Management of Corneal Perforations

INDEX

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Index

Chapter Notes