Recent Advances in Ophthalmology—9 HV Nema, Nitin Nema
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Editors HV Nema MS Former Professor and Head Department of Ophthalmology Banaras Hindu University Varanasi, UP, India Nitin Nema MS DNB Assistant Professor Department of Ophthalmology Sri Aurobindo Institute of Medical Sciences Indore, MP, India Editorial Board Jorge L Alió MD PhD Alicante, Spain Frank Goes MD Antwerp, Belgium Lingam Gopal MS FRCS Chennai, India Devindra Sood MD New Delhi, India Suresh Chandra MD Madison, USA
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Recent Advances in Ophthalmology—9
© 2010, HV Nema, Nitin Nema
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.
First Edition: 2010
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5Contributors 7Preface
During the past three decades, ophthalmology has made remarkable progress. It is difficult to keep abreast with all new developments. Therefore, in the present volume of Recent Advances in Ophthalmology—9 only some selected topics such as orbital tumors, refractive surgery, glaucoma imaging, age-related macular degeneration, ocular and adnexal injuries in warfare, genetic in ophthalmology, etc. have been included.
Orbit is a complex structure. Besides eyeball, it contains extraocular muscles, blood vessels, glands, nerves, fat, and connective tissues. Hence, a wide variety of benign and malignant neoplasms may arise from it. Secondary orbital involvement may occur from the malignancies of neighboring structures and distant organs. Incidence, type and mode of presentations of orbital tumors differ between adult and pediatric age groups. Gündüz and colleagues presented a well illustrated and detail account of orbital tumors in adults and childhood in the first two chapters. An elaborate description of clinical features, characteristic histopathological findings, CT and MR images, and treatment modalities makes these chapters a useful reference manual on orbital malignant tumors for ophthalmologists.
A surgical refractive correction of anisometropia or bilateral ametropia is relatively a new and controversial concept. Proponents of the concept claim that the deprivation amblyopia can be prevented by normalization of high refractive error. The surgery is highly recommended to those children who reject glasses and contact lenses, and/or who suffer from neurobehavioral disorders. However, those who oppose the refractive surgery in children plead that surgery is not going to treat amblyopia, it is just going to treat the refractive error. The current available data on the usefulness of refractive surgery in children is insufficient. Corneal regression, haze, and possibility of iatrogenic keratoconus are potential issues to be resolved before the surgery in pediatric patients can be recommended for widespread adaptation.
Mendez discovered conductive keratoplasty to correct small degree of hyperopia, and presbyopia. Radiofrequency is used to heat and reshape the cornea. The procedure has convincing advantages over hyperopic LASIK and hyperopic LTK but is not free from side effects such as glare, halos, vision fluctuations and overcorrection.
Ultrasound biomicroscopy (UBM) is a valuable tool in the diagnosis of angle-closure glaucoma. It helps to understand pathophysiology of various types of angle closures such as relative pupillary block, phacomorphic glaucoma, plateau iris syndrome, and chronic traumatic glaucoma. A high degree of agreement is found between gonioscopy and UBM when both are performed in a completely darkroom. UBM is useful in the management of the angle-closure glaucoma because it can determine the opening of pupillary block following laser iridotomy.8
Age-related macular degeneration (AMD) is one of the leading causes of blindness in elderly population. It is a late onset complex disorder wherein both genetic and environmental factors contribute to its pathogenesis. There is a growing evidence to suggest that AMD has genetic basis. Perhaps genetic typing of AMD patients would permit identification of subjects at risk of developing the disease, and timely intervention. Several treatment strategies: Antioxidants, anecortave acetate, laser photocoagulation, photodynamic therapy, vascular endothelial growth factor inhibitors, and macular translocation have been evaluated in the management of AMD. None of the treatment modalities had shown promising results on long-term basis. It is reported that a combination of anti-VEGF with photodynamic therapy has a synergetic long-term effect and it may reduce the frequency of retreatment. Hussain and colleagues have comprehensively reviewed the present status of management of age-related macular degeneration.
The pattern of ocular injuries in war has grossly changed due to deployment of more sophisticated weapons. The wartime incidence of ocular injuries is surging. The Society of Ocular Trauma reported about a six-fold increase in the number of ocular injuries in recent conflicts in Iraq, Afghanistan, and Lebanon as compared to the World War I and II. Blast fragments are the most common cause of ocular and adnexal injuries. Improvized explosive devices (IEDs) produce devastating open globe injuries. The rupture of the globe is an ophthalmic emergency and always requires immediate surgical intervention. Almost 50% of casualties with penetrating eye wounds eventually lose their vision in the injured eye. The loss of vision often causes profound emotional trauma to the patients and their families. Sabri Shuker presented a well-illustrated and vivid account of mechanism of blast eye injuries, their effect on ocular tissues, and various techniques of repair.
The reader may find chapters on Phacomorphic Glaucoma, Management of Subluxated Lenses, Phacoemulsification in Vitrectomized Eyes, and Management of Rhegmatogenous Retinal Detachment by Vitreoretinal Techniques Innovative, Informative and Practical. The adaptation of modified surgical technique is likely to provide sufficient confidence to the operating surgeon to tackle difficult situation and restore reasonable vision to the patients. Idiopathic polypoidal choroidal vasculopathy and retinal cysts are of great clinical importance because both can cause serious visual impairment. Classical features, diagnosis and management of both diseases are briefly covered.
Craniopharyngioma is of immense clinical interest to ophthalmologist, neurologist, neurosurgeon, endocrinologist, oncologist, and radiologist. Perhaps ophthalmologist is often the first to diagnose the tumor because it presents a wide array of visual symptoms. Stefko and Kassam have presented a concise account of origin, diagnosis, and surgical treatment of cranio–pharyngioma.
Genetic testing and genetic counseling in ophthalmology are well- established procedures to prevent occurrence and recurrence of genetic eye 9diseases. However, gene therapy is a novel concept and still in its infancy. Several clinical trials are ongoing for the treatment of hereditary eye diseases due to mutation of gene. Two basic approaches are followed: Replacement of the gene which is responsible for defective production of an enzyme or protein, and gene addition for the treatment of acquired diseases. Viral or nonviral vector may be used for gene transfer. Advances in the management of ocular genetic disorders are critically analyzed by Kuldeep Singh in the last chapter.
Recent developments and innovations in ophthalmology have revolutionized the care and treatment of eye patients. We hope that this volume of Recent Advances in Ophthalmology—9 will provide the readers, especially postgraduate students and researchers in ophthalmology, and practicing ophthalmologists, an insight into recent development and trends in the subject which may help improve their day-to-day patient care and quality of life.
The contributing authors of chapters included in the present volume of Recent Advances in Ophthalmology—9 were selected for their widely acknowledged expertise in their respective field. We are indeed grateful to all authors for their timely and outstanding contributions.
Shri Jitendar P Vij (Chairman and Managing Director) Jaypee Brothers Medical Publishers (P) Ltd. and staff especially Mr Tarun Duneja (Director- Publishing) deserve our sincere thanks for their continued interest in the publication of the Recent Advances in Ophthalmology Series.
HV Nema
Nitin Nema