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Copeland and Afshari's Principles and Practice of Cornea (2 Volumes)
Robert A Copeland Jr, Natalie A Afshari
PART 1: FUNDAMENTALS: SECTION 1: BASIC SCIENCE
CHAPTER 1:
Basic Structure and Function of the Human Cornea and Adnexal Structures
INTRODUCTION
GROSS ANATOMY OF THE CORNEA
EPITHELIUM
THE TEAR FILM
BOWMAN'S MEMBRANE
STROMA
DESCEMET'S MEMBRANE
ENDOTHELIUM
LIMBUS
SCLERA
CONJUNCTIVA
EYELIDS
CHAPTER 2:
Corneal Embryology
INTRODUCTION AND OVERVIEW
HISTOLOGY
Corneal Epithelium
Bowman's Membrane
Corneal Stroma [Figs 2(3) and 3(1)]
Descemet's Membrane
Corneal Endothelium
EMBRYOLOGY
Introduction
Development of the Eye (Overview)
Development of the Cornea
ACKNOWLEDGMENTS
CHAPTER 3:
The Human Cornea: Basic Structure and Function
CORNEAL EPITHELIUM
Epithelial Injury and Wound Healing
Electrophysiology and Ion Transport
Epithelial Metabolism
The Effect of Contact Lenses on Corneal Epithelial Metabolism
Corneal Epithelium Antiangiogenic Effect
BOWMAN'S MEMBRANE
CORNEAL STROMA
Stromal Wound Healing
Corneal Transparency
DESCEMET'S MEMBRANE
Corneal Endothelium
Endothelial Ions Transport
Endothelial Wound Healing
Endothelial Function and Intraocular Irrigating Solution
Relation to Temperature
Corneal Response to Injury
Corneal Vasculature
Corneal Innervation and Sensitivity
CORNEAL PHARMACOLOGY
ACKNOWLEDGMENTS
CHAPTER 4:
Basic Immunology
OVERVIEW OF IMMUNE RESPONSE
CELLULAR COMPONENTS OF THE IMMUNE RESPONSE
Cells of the Myeloid System
Polymorphonuclear Leukocytes
Antigen-Presenting Cells
Macrophages and the Mononuclear Phagocytic System
Dendritic Cells
Langerhans Cells
Cells of the Lymphoid System
B Lymphocytes
T Lymphocytes
Helper T Cells
Cytotoxic T Cells
Natural Killer Cells
SOLUBLE MEDIATORS/RECEPTORS OF INFLAMMATION
Immunoglobulins
Cytokines
Complement
CELL-MEDIATED IMMUNE RESPONSE
Major Histocompatibility Complex
Antigen Presentation and T-cell Activation
Cell-Mediated Immune Response
HUMORAL IMMUNE RESPONSE
Antibody-Mediated Immune Response
HYPERSENSITIVITY REACTIONS
Type I: Hypersensitivity Response
Type II: (Cytotoxic) Hypersensitivity Response
Type III: Hypersensitivity Response (Immune Complex)
Type IV: Delayed Type Hypersensitivity Response
THE OCULAR IMMUNE RESPONSE
Immune Privilege and Anterior Chamber Associated Immune Deviation
IMMUNOLOGY OF CORNEAL GRAFT REJECTION
Allograft Rejection
CHAPTER 5:
Morphology and Pathologic Response of Corneal and Conjunctival Disease
INTRODUCTION
EPITHELIUM
Pathologic Responses
Keratinization
Epithelial Defect
Infection
STROMA AND KERATOCYTES
Pathologic Responses
Stromal Reaction to Injury
Ulceration
Neovascularization
ENDOTHELIUM
Pathologic Responses
Penetrating Injury
Endothelial Stressors
Rupture of Descemet's Membrane
CORNEAL LIMBUS
STEM CELL DEFICIENCY
CONJUNCTIVA
Pathologic Responses of the Conjunctiva
CHAPTER 6:
Corneal Angiogenesis
INTRODUCTION
ANGIOGENIC PRIVILEGE OF THE CORNEA
Receptor Decoy Mechanisms
ENDOGENOUS INHIBITORS OF ANGIOGENESIS IN THE CORNEA AND AQUEOUS HUMOR
Angiostatin
Endostatin
Pigment Epithelium-Derived Factor
Thrombospondin
ANGIOGENESIS AND LYMPHANGIOGENESIS IN THE CORNEA
CLINICAL CONSEQUENCES OF LOSS OF CORNEAL ANGIOGENIC PRIVILEGE
EXOGENOUS INHIBITORS OF ANGIOGENESIS
Antisense-Oligonucleotide against the Insulin Receptor Substrate-1 (IRS-1)
Topical Cortisone and Cyclosporin A
CONCLUSION
CHAPTER 7:
Limbal Stem Cells of the Corneal Epithelium
STEM CELLS
LIMBAL EPITHELIAL STEM CELLS
The Evidence: Clinical Studies
The Evidence: Laboratory Studies
SECTION 2: EXAMINATION AND EVALUATION TECHNIQUES
CHAPTER 8:
The Fine Art of Slit-Lamp Biomicroscopy with Applications to Anterior Segment Photography
INTRODUCTION
HISTORICAL BACKGROUND
Historical Names for Developments in Instrumentation
Illuminating System
Stereoscopic Microscope
ELEMENTS THAT CONTRIBUTE TO A SUCCESSFUL EXAMINATION
OPTICAL CONSIDERATIONS
Methods of Illumination
Diffuse Illumination
Direct Focal Illumination
Indirect Retroillumination
Direct Retroillumination
Scleral Scatter
Specular Reflection
SUMMARY
CHAPTER 9:
Corneal Pachymetry
INTRODUCTION
APPLICATIONS
Endothelial Cell Function and Corneal Edema
Glaucoma and Intraocular Pressure
Refractive Surgery
DEMOGRAPHICS
Normal Values
Age, Ethnicity and Diurnal Fluctuations
DIAGNOSTIC METHODS
Optical Pachymetry
Ultrasound Pachymetry
Ultrasound Biomicroscopy
OrbScan Scanning Slit Tomography
Pentacam Scheimpflug Tomography
Optical Coherence Tomography
Partial Coherence Interferometry and Optical Low-Coherence Reflectometry
Specular Microscopy
Confocal Microscopy
CONCLUSION
CHAPTER 10:
Corneal Keratometry
INTRODUCTION
HISTORY OF KERATOMETRY
EYE OPTICAL SYSTEM
KERATOMETRY
KERATOMETRIC REFRACTIVE INDEX
ASSUMPTIONS AND LIMITATIONS
SUMMARY
CHAPTER 11:
Corneal Topography: Topography Overview
INTRODUCTION
TOPOGRAPHY OVERVIEW
Placido Disk Corneal Topography
3D Corneal Topography
Tomography-based Corneal Topography
Scanning Slit—Orbscan
Scheimpflug Image-based—Pentacam
Wavefront Maps
TOPOGRAPHY IMAGES FOR REVIEW AND CLINICAL APPLICATIONS
Normal and Variations of Normal
Posthyperopic Refractive Surgery
Postmyopic/Postradial Keratotomy Refractive Surgery
Keratoconus/Forme Fruste Keratoconus
Masqueraders
CONCLUSION
CHAPTER 12:
Corneal Imaging
INTRODUCTION
ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY
Principles of Optical Coherence Tomography
Time-Domain versus Fourier-Domain Optical Coherence Tomography
Clinical Applications of Anterior Segment Optical Coherence Tomography in Corneal Disease
Refractive Surgery
Corneal Pachymetric Mapping
Anterior Chamber Biometry
Corneal Transplantation
Corneal Implants
Corneal Pathology
Anterior Segment Tumors
Iridocorneal Angle
ULTRASOUND BIOMICROSCOPY
Technology
Imaging Normal Corneal Structures
Clinical Applications of Ultrasound Biomicroscopy in Corneal Disease
Keratoconus
Corneal Dystrophies
Corneal Scars
Peripheral Corneal Degenerations
Corneal Edema
Descemet's Membrane Detachment
Imaging Beyond an Opaque Cornea
Corneal Dermoids and Malignancies
Position of Intraocular Lenses
Trauma
Imaging Following Keratoplasty and Refractive Surgery
CONCLUSION
CHAPTER 13:
Confocal Microscopy
INTRODUCTION
HISTORY
PRINCIPLES OF CONFOCAL MICROSCOPY
CONFOCAL MICROSCOPY SYSTEMS IN CLINICAL USE
Tandem Scanning Confocal Microscope
Scanning Slit Confocal Microscope
Laser Scanning Confocal Microscope
CONFOCAL MICROSCOPY THROUGH FOCUSING
CLINICAL APPLICATIONS
Infectious Keratitis
Acanthamoeba Keratitis
Fungal Keratitis
Bacterial and Viral Keratitis
Evaluation of Corneal Endothelial Disorders
Evaluation of Corneal Nerves
Wound Healing Following Refractive Surgery
RESEARCH APPLICATIONS
Corneal Collagen Cross-Linking
Cellular Morphology of Keratic Precipitates
LIMITATIONS
CONCLUSION
CHAPTER 14:
Specular Microscopy
INTRODUCTION
OPTICAL PRINCIPLES OF SPECULAR MICROSCOPY
IMPROVeMENTS IN INSTRUMENTATION AND METHODS
PRACTICAL USE OF SPECULAR MICROSCOPY
Qualitative Interpretation
Cell Borders
Cell Shape
Intraendothelial Changes
Interendothelial Changes
Quantitative Interpretation
Fixed Frame Analysis
Variable Frame Analysis of Cell Size
Errors Associated with Quantitative Analysis
CLINICAL FINDINGS OF SPECULAR MICROSCOPY
Changes in the Corneal Endothelium as a Function of Age
Fuchs' Endothelial Dystrophy
Posterior Polymorphous Dystrophy
Iridocorneal Endothelial Syndrome
Cataract Extraction and Intraocular Lens Implantation
Penetrating Keratoplasty/Endothelial Keratoplasty
Contact Lens Wear
Diabetes
Glaucoma
Trauma
SUMMARY
CHAPTER 15:
Corneal Biomechanics
INTRODUCTION
A BRIEF PHYSICS OVERVIEW
Elastic, Viscous and Viscoelastic Materials
OPERATION OF THE OCULAR RESPONSE ANALYZER
Corneal Hysteresis: A New Ocular Parameter
Corneal Resistance Factor and Corneal-Compensated IOP
Ocular Response Analyzer Waveform Score
Relevant Clinical Findings
Ocular Response Analyzer in Normal Eyes
Ocular Response Analyzer in Corneal Pathologies and Refractive Surgery
Waveform Analysis and the Keratoconus Match Index
Ocular Response Analyzer beyond the Cornea
Ocular Response Analyzer in Glaucoma
SUMMARY
SECTION 3: EPIDEMIOLOGY OF CORNEA AND EXTERNAL DISEASES
CHAPTER 16:
Epidemiology of the Major Cornea and External Diseases
INTRODUCTION
EPIDEMIOLOGY OF BLINDING CORNEA AND EXTERNAL DISEASES IN THE DEVELOPING WORLD
TRACHOMA
ONCHOCERCIASIS
CHILDHOOD BLINDNESS
OCULAR TRAUMA AND CORNEAL ULCERATION
EPIDEMIOLOGY OF BLINDING CORNEA AND EXTERNAL DISEASES IN THE DEVELOPED WORLD
CONCLUSION
PART 2: CLINICAL TOPICS: SECTION 4: INFECTIOUS DISEASES
CHAPTER 17:
Corneal Microbiology
INTRODUCTION
REACTION OF THE CORNEA TO INFECTIOUS PROCESS
ASSOCIATED FACTORS
LABORATORY DIAGNOSIS
Specimen Collection
Staining
Culture
Culture Media
Antimicrobial Susceptibility Testing
Viral Diagnostic Testing
Other Diagnostic Tests
BACTERIOLOGY
Staphylococci
Streptococci
Pseudomonas
Enterobacteriaceae
Nocardia
VIROLOGY
MYCOLOGY
PARASITOLOGY
CHAPTER 18:
Ophthalmia Neonatorum
INTRODUCTION
DIFFERENTIAL DIAGNOSIS OF OPHTHALMIA NEONATORUM (TABLE 1)
Chemical Conjunctivitis
Bacterial Conjunctivitis
Chlamydial Conjunctivitis
Herpes Simplex
DIAGNOSTIC TECHNIQUES (TABLE 2)
PROPHYLAXIS AND PREVENTION
CHAPTER 19:
Bacterial Conjunctivitis
INTRODUCTION
EPIDEMIOLOGY
HOST DEFENSES
ACUTE CONJUNCTIVITIS
HYPERACUTE CONJUNCTIVITIS
CHRONIC CONJUNCTIVITIS
CHAPTER 20:
Bacterial Keratitis
INTRODUCTION
CLINICAL FEATURES
DIAGNOSTIC TECHNIQUES
TREATMENT
Routes of Administration
Empiric Therapy
Adjunctive Therapy
CHAPTER 21:
Ocular Antibiotics
INTRODUCTION
BRIEF HISTORY OF ANTIBIOTICS
The Beginning: The Road to Fleming (1928)
The Golden Age of Antibiotic Class Discovery (1928–1962)
Antibiotic Analog Discovery (1962–2000)
Recent Antibiotics Developed (2000–Present)
INDICATIONS FOR OCULAR ANTIBIOTICS
Blepharitis
Bacterial Conjunctivitis
Bacterial Keratitis
Endophthalmitis Prophylaxis
CLASSES OF OCULAR ANTIBIOTICS
Aminoglycosides
Sulfonamides
Polypeptides
Fluoroquinolones
Macrolides
Combination Antibiotics
Combination Antibiotics (Corticosteroids)
Fortified Antibiotics
ANTIBIOTIC RESISTANCE
ANTIBACTERIAL CONCEPTS
Minimum Inhibitory Concentration
Pharmacokinetics and Pharmacodynamics
Kill Time
CONCLUSION
CHAPTER 22:
Viral Conjunctivitis
INTRODUCTION
ADENOVIRUSES
Structure
Pharyngoconjunctival Fever (PCF)
Acute Nonspecific Follicular Conjunctivitis
Chronic Conjunctivitis
Epidemic Keratoconjunctivitis
Transmission
Signs and Symptoms
Adenoviral Morbidity
Immunity
Differential Diagnosis
Diagnosis
Diagnostic Tests
Infection Control
Treatment
Adenoviral Infections and Phototherapeutic Laser Treatments
EPSTEIN BARR VIRUS
CYTOMEGALOVIRUS
POXVIRIDAE
Variola and Vaccinia Viruses
MOLLUSCUM CONTAGIOSUM
RNA VIRUSES
Picornaviruses
Paramyxoviruses
Measles (Rubeola)
Mumps
Newcastle Disease
Togaviruses
Flaviviruses
CHAPTER 23:
Viral Keratitis
VIRAL KERATITIS
HERPES VIRUS
Structure
Herpes Simplex Virus
Pathogenesis
Clinical Presentations
CONGENITAL AND NEONATAL OCULAR HERPES SIMPLEX
PRIMARY OCULAR HERPES SIMPLEX INFECTIONS
Clinical Presentation
Laboratory Testing
Treatment (Table 4)
RECURRENT OCULAR HERPES INFECTION
Herpes Simplex Virus Reactivation Factors37–42 (Table 5)
Clinical Presentations
BLEPHAROCONJUNCTIVITIS
EPISCLERITIS AND SCLERITIS
EPITHELIAL KERATITIS: DENdRITIC AND GEOGRAPHICAL
Clinical Presentation
Laboratory Testing
Treatment (See Table 4)
Prognosis
EPITHELIAL TROPHIC (METAHERPETIC) ULCERATION
Presentation
Clinical Presentation
Treatment
STROMAL KERATITIS
Presentation
Ocular Morbidity
Pathogenesis and Categories
Limbal Vasculitis and Wessley Immune Rings
Treatment
Necrotizing Stromal Keratitis
Non-necrotizing Stromal Keratitis or Disciform Keratitis
Treatment (See Table 4)
Endotheliitis with or without Trabeculitis and Secondary Glaucoma
Treatment
HERPES SIMPLEX VIRUS IRIDOCYCLITIS
Treatment
Surgical Treatment after Herpes Virus Infections
Prognostic Factors
VARICELLA-ZOSTER VIRUS
Herpes Zoster Ophthalmicus
IRIDOCYCLITIS
POSTHERPETIC NEURALGIA (PHN)
Treatment
Pain Management
Ocular Management
ADENOVIRAL KERATOCONJUNCTIVITIS
Treatment
MOLLUSCUM CONTAGIOSUM
Epstein-Barr Virus
ENTEROVIRUS AND COXSACKIEVIRUS CONJUNCTIVITIS
Clinical Presentation
PARAMYXOVIRUS
Measles
Mumps
Newcastle Disease
TOGAVIRUS
Dengue Fever
Congenital Rubella Syndrome
CHAPTER 24:
Antiviral Medications in the Treatment of Corneal Disease
INTRODUCTION
VIRAL REPLICATION
ANTIVIRAL MEDICATIONS IN THE TREATMENT OF CORNEAL DISEASE
Idoxuridine
Mechanism of Action
Efficacy, Toxicity and Clinical Indications
Vidarabine
Mechanism of Action
Efficacy, Toxicity and Therapeutic Indications
Trifluridine
Mechanism of Action
Efficacy and Therapeutic Indications
Toxicity
Acyclovir
Mechanism of Action
Metabolism, Dosing and Toxicity
Efficacy and Therapeutic Indications
Resistance
Valacyclovir
Mechanism of Action, Dosing and Metabolism
Valacyclovir versus Acyclovir
Toxicity and Side Effects
Ganciclovir
Mechanism of Action
Efficacy and Therapeutic Indications
Toxicity
Resistance
OTHER ANTIVIRAL MEDICATIONS
Interferon α
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 25:
Fungal Keratitis
INTRODUCTION
CLASSIFICATION
PATHOGENESIS
Risk Factors
EPIDEMIOLOGY
CLINICAL FEATURES AND DIAGNOSIS
MEDICAL TREATMENT
Surgical Treatment
CONCLUSION
WEB SITES
CHAPTER 26:
Parasitic Keratitis and Conjunctivitis
INTRODUCTION
INFECTIONS CAUSED BY PROTOZOA
Acanthamoeba
Diagnosis
Treatment
Entamoeba Histolytica Infections
Microsporidiosis
Hemoflagellate Infections
Trypanosomes
Leishmaniasis
Giardiasis
INFECTIONS CAUSED BY NEMATODES
Wuchereria Bancrofti and Brugia Malayi Infections
Onchocerciasis
Loiasis
Dirofilariasis
Dracunculus Medinensis Infections
Thelaziasis
Gnathostomiasis
Angiostrongyliasis
Macacanema Formosana
INFECTIONS CAUSED BY CESTODES
Cysticercosis
INFECTIONS CAUSED BY TREMATODES
Schistosomiasis
Ophthalmia Nodosa and Insect Stings
INFECTIONS ASSOCIATED WITH ARTHROPODS
Phthiriasis
External Ophthalmomyiasis
ACKNOWLEDGMENTS
CHAPTER 27:
Chlamydial Keratitis and Conjunctivitis
MICROBIOLOGY
Laboratory Diagnosis
CLINICAL SYNDROMES
Trachoma
Epidemiology
Clinical Manifestations
Differential Diagnosis
Pathophysiology
Diagnosis
Treatment
Surgery
Antibiotics
Facial Cleanliness
Environmental Improvement
Adult Inclusion Conjunctivitis
Epidemiology
Clinical Manifestations
Differential Diagnosis
Pathophysiology
Diagnosis
Treatment
Infant Inclusion Conjunctivitis
Epidemiology
Clinical Manifestations
Differential Diagnosis
Pathophysiology
Diagnosis
Treatment
Lymphogranuloma Venereum
Epidemiology
Clinical Manifestations
Differential Diagnosis
Pathophysiology
Diagnosis
Treatment
Nontrachomatis Chlamydial Conjunctivitis
Epidemiology
Clinical Manifestations
Differential Diagnosis
Pathophysiology
Diagnosis
Treatment
CHAPTER 28:
Interstitial Keratitis
INTRODUCTION
CLINICAL FINDINGS
Pathology
CAUSES OF INTERSTITIAL KERATITIS
BACTERIAL INTERSTITIAL KERATITIS
Spirochetes
Syphilis
Syphilis Serology5
Treatment
Surgery for Interstitial Keratitis
Lyme disease
Mycobacteria
Viral Interstitial Keratitis
Herpes Simplex Virus
Varicella-Zoster Virus
Epstein-Barr Virus
Paramyxoviruses
Poxviruses
Orthomyxoviruses
Togaviruses
Parasitic Interstitial Keratitis
Helminthic Interstitial Keratitis
Protozoan Interstitial Keratitis
Trypanosomiasis
Malaria
Leishmaniasis
Microsporidia
Acanthamoeba
Unknown Interstitial Keratitis
Cogan's Syndrome
Clinical Findings
Laboratory
Pathology
Differential Diagnosis
Etiology
Treatment
SECTION 5: IMMUNOLOGIC DISEASE
CHAPTER 29:
Ocular Allergy
INTRODUCTION
IMMUNOLOGIC MECHANISMS
Differential Diagnosis (Tables 1 and 2)
Types of Ocular Allergy
Seasonal and Perennial Allergic Conjunctivitis
Vernal Keratoconjunctivitis
Atopic Keratoconjunctivitis
Contact Allergy
Giant Papillary Conjunctivitis
Diagnostic Tests
Treatment
CONCLUSION
CHAPTER 30:
Cicatrizing Conjunctivitis
INTRODUCTION
MUCOUS MEMBRANE PEMPHIGOID OVERVIEW
OCULAR CICATRICIAL PEMPHIGOID
IMMUNOPATHOGENESIS
Clinical Features
Diagnosis
Management
Medical Therapy
Surgical Management
Eyelids/Lashes
Conjunctiva
Cornea
Cataract Surgery
Supportive Therapy
STEVENS JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS OVERVIEW
IMMUNOPATHOGENESIS
Clinical Features
Diagnosis
Differential Diagnosis
Management
Systemic Treatment
Management of Ocular Manifestations
Acute Phase
Late Phase
PARANEOPLASTIC CONJUNCTIVAL CICATRIZATION
PSEUDOPEMPHIGOID
CONCLUSION
CHAPTER 31:
Phlyctenular keratoconjunctivitis
INTRODUCTION AND BACKGROUND
ETIOLOGY
CLINICAL PRESENTATION
DIFFERENTIAL DIAGNOSIS
HISTOLOGY
MANAGEMENT
SUMMARY
CHAPTER 32:
Peripheral Ulcerative Keratitis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL SIGNS AND SYMPTOMS
DIFFERENTIAL DIAGNOSIS
EVALUATION
TREATMENT
CHAPTER 33:
Scleritis and Episcleritis
INTRODUCTION
ANATOMIC BACKGROUND
CLASSIFICATION OF SCLERAL INFLAMMATORY DISORDERS
EPIDEMIOLOGY
CLINICAL PRESENTATION
Episcleritis
Scleritis
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
IMMUNOPATHOLOGY
TREATMENT
PROGNOSIS
SECTION 6: OCULAR SURFACE DISEASE
CHAPTER 34:
Limbal Stem Cells, Biology and Pathogenesis in Ocular Surface Disease
LIMBAL STEM CELLS
LIMBAL STEM CELL MARKERS
LIMBAL STEM CELL REGULATION
LIMBAL STEM CELL DEFICIENCY
Etiology and Classification
Presentation of Limbal Stem Cell Deficiency
Diagnosis of Limbal Stem Cell Deficiency
Treatments of Limbal Stem Cell Deficiency
Partial Stem Cell Deficiency
Total Stem Cell Deficiency
CHAPTER 35:
Dry Eye
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
Systemic Associations
Sjögren's Syndrome
Vitamin A Deficiency
Rheumatoid Arthritis
Graft-Versus-Host Disease
Ocular Associations
Environmental Risk Factors
Iatrogenic Causes
Medications
Dry Eye and Ocular Surgery
SYMPTOMS
DIAGNOSIS
Slit-Lamp Examination
Tear Break-up Time
Schirmer Test
Tear Osmolarity Measurement
Lactoferrin and Lysozyme
Additional Testing
CLASSIFICATION
PATHOPHYSIOLOGY
TREATMENT
Topical Lubrication
Anti-inflammatory Drugs
Mechanism of Action
Systemic Therapy
Punctal Occlusion
Environmental Modification
Other Therapies
Future Treatment Modalities
COMPLICATIONS
CONCLUSION
CHAPTER 36:
Nutritional Factors and the Ocular Surface
INTRODUCTION
VITAMIN A AND GLOBAL CONSEQUENCES OF VITAMIN A DEFICIENCY
DIETARY INTAKE AND STORAGE OF VITAMIN A
SOURCES OF VITAMIN A
Animal Sources
Plant Sources
Synthetic Vitamin A Supplementation
CAUSES AND EPIDEMIOLOGY OF VITAMIN A DEFICIENCY IN LOW INCOME VERSUS HIGH INCOME POPULATIONS
Fat Malabsorption Syndromes as Etiologies for Hypovitaminosis A
Stages and Progression of Xerophthalmia and Keratomalacia
Treatment of Vitamin A Deficiency Xerophthalmia
Surgical Intervention in Keratomalacia and Perforation
Suspicion and Diagnosis of Vitamin A Deficiency in the Developed World
THE ROLE OF OTHER VITAMINS IN DRY EYE
Riboflavin
Vitamin C
Zinc and Magnesium
LIPIDS AND OCULAR SURFACE HEALTH
Lipid Composition of the Cornea and Tear Film
MEIBOMIAN GLAND DYSFUNCTION AND EVAPORATIVE DRY EYE
Meibomian Lipid Abnormalities and Relationship to Meibomian Gland Dysfunction
ROLE OF LIPIDS IN DRY EYE, OCULAR SURFACE INJURY, CORNEAL NERVE INJURY AND REPAIR
Linolenic Acid
Resolvins
Neuroprotectins
CLASSIFICATION OF FATTY ACIDS—A BRIEF REVIEW
OMEGA-3 FATTY ACID SUPPLEMENTATION
Omega-3 Fatty Acids from Fish Oil (EPA/DHA)
Flaxseed Oil (Omega-3 ALA)
OTHER FATTY ACID SUPPLEMENTS
Olive Oil (Omega-9 Oleic Acid)
Evening Primrose Oil and Borage Oil (Omega-6 Gamma-Linoleic Acid)
Sea Buckthorn Oil
Dosages
CONCLUSION
CHAPTER 37:
Sjögren's Syndrome
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
DIAGNOSIS
OCULAR MANIFESTATIONS
EXTRAOCULAR MANIFESTATIONS
MANAGEMENT
CHAPTER 38:
Ocular Surface Disease in Glaucoma
INTRODUCTION
OCULAR SURFACE DISEASE IN GLAUCOMA PATIENTS
USE OF PRESERVATIVES IN OCULAR MEDICATIONS
BIMOLECULAR CHANGES ASSOCIATED WITH PRESERVATIVES
CELLULAR CHANGES ASSOCIATED WITH PRESERVATIVES
ADVERSE EVENTS FROM ACTIVE AGENTS THEMSELVES
IMPACT OF OCULAR SURFACE DISEASE ON TREATMENT AND COMPLIANCE
PRESERVED VERSUS PRESERVATIVE-FREE THERAPY
CONCLUSION
CHAPTER 39:
Blepharitis and Meibomian Gland Dysfunction
INTRODUCTION
CLASSIFICATION
ANTERIOR BLEPHARITIS: STAPHYLOCOCCAL DISEASE
Clinical Features
Pathophysiology
Treatment
POSTERIOR BLEPHARITIS: MEIBOMIAN GLAND DYSFUNCTION
Clinical Features
Pathophysiology and Functional Consequences
Treatment
CONCLUSION
CHAPTER 40:
Recurrent Corneal Erosion Syndrome
INTRODUCTION
PATHOPHYSIOLOGY
DIAGNOSIS
MEDICAL TREATMENT
SURGICAL TREATMENT
CHAPTER 41:
Superior Limbic Keratoconjunctivitis
INTRODUCTION
HISTORY
EPIDEMIOLOGY
CLINICAL FINDINGS
Symptoms
Signs
Tests
DIAGNOSIS
Differential Diagnosis
Contact Lens Associations
PATHOGENESIS
TREATMENT
Medical Treatment
Surgical Treatment
SUMMARY
CHAPTER 42:
Ligneous Conjunctivitis
INTRODUCTION
ETIOLOGY, PATHOGENESIS AND HISTOPATHOLOGY
EPIDEMIOLOGY
CLINICAL FINDINGS
DIFFERENTIAL DIAGNOSIS
TREATMENT
CONCLUSION
CHAPTER 43:
Eye Disorders Associated with Dermatological Diseases
INTRODUCTION
BULLOUS DERMATOSES
HYPERSENSITIVITY DISORDERS
Rosacea
ECZEMATOUS DERMATOSES
HISTIOCYTIC AND GRANULOMATOUS DISORDERS
NEOPLASTIC CUTANEOUS DISEASES AND PROLIFERATIONS
Ocular Melanoma
ERRORS IN METABOLISM
Vasculitides
CONNECTIVE TISSUE DISORDERS
PIGMENTARY/MELANOCYTIC DISORDERS
GENODERMATOSES
CHAPTER 44:
Thygeson's Superficial Punctate Keratitis
INTRODUCTION
HISTORY
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS
PATHOGENESIS AND LABORATORY
TREATMENT
APPENDIX A
CHAPTER 45:
Filamentary Keratitis
OVERVIEW
HISTOPATHOLOGY/PATHOGENESIS
MANAGEMENT
RECENT MANAGEMENT RESEARCH
CHAPTER 46:
Climatic Droplet Keratopathy
INTRODUCTION
CLINICAL FINDINGS
HISTOPATHOLOGY AND ELECTRON MICROSCOPY
PROTEOMIC ANALYSIS AND PATHOGENESIS
Annexin and GAPDH
PREVENTION AND MANAGEMENT
CHAPTER 47:
Neurotrophic Keratitis
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
DIFFERENTIAL DIAGNOSIS
TREATMENT
CHAPTER 48:
Dacryoadenitis
INTRODUCTION
CHAPTER 49:
Immunotherapy for Ocular Surface Diseases and Graft Rejection
INTRODUCTION
OCULAR SURFACE DISEASE
Dry Eye Disease
Immunotherapy for Dry Eye Disease
Cyclosporine
Corticosteroids
Tetracyclines
ALLERGIC CONJUNCTIVITIS
Immunotherapy for Allergic Conjunctivitis
Corticosteroids
Cyclosporine
Tacrolimus
Systemic Immunosuppression
STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS
Ocular Manifestation
Immunotherapy for SJS/TEN
Amniotic Membrane Transplantation
OCULAR CICATRICIAL PEMPHIGOID
Immunotherapy
Cyclophosphamide
Azathioprine
Methotrexate
Stepladder Therapy
CORNEAL GRAFT REJECTION
Immunotherapy
Corticosteroids
Cyclosporine
Tacrolimus
Mycophenolate Mofetil
Rapamycin
SECTION 7: METABOLIC AND CONGENITAL DISEASE
CHAPTER 50:
Metabolic Diseases and Congenital Abnormalities Affecting the Ocular Surface
INTRODUCTION
CYSTINOSIS
Corneal and Conjunctival Findings
Treatment
TYROSINEMIA
Corneal and Conjunctival Findings
Treatment
ALKAPTONURIA
Corneal and Conjunctival Findings
Treatment
AMYLOIDOSIS
Corneal and Conjunctival Findings
Treatment
GOUT
Corneal and Conjunctival Findings
Treatment
XERODERMA PIGMENTOSUM
Corneal and Conjunctival Findings
Treatment
SYSTEMIC MUCOPOLYSACCHARIDOSES
Corneal and Conjunctival Findings
Treatment
MUCOLIPIDOSES
Corneal and Conjunctival Findings
Treatment
CHAPTER 51:
Metabolic Disorders of the Cornea
DIABETES MELLITUS
Cellular Signaling
Central Corneal Thickness
Blurry Vision
Diabetic Peripheral Neuropathy of the Cornea
Management of Diabetic Keratopathy
MUCOPOLYSACCHARIDOSES
Mucopolysaccharidoses I
Mucopolysaccharidoses IH
Mucopolysaccharidoses IS
Mucopolysaccharidoses IH/S
Mucopolysaccharidoses II
Mucopolysaccharidoses III
Mucopolysaccharidoses IV
Mucopolysaccharidoses VI
Macular Corneal Dystrophy
Mucopolysaccharidoses VII
Mucopolysaccharidoses IX
Management Options
Bone Marrow Transplant
Enzyme Replacement Therapy
Gene Therapy
LIPIDOSES
Sphingolipidosis
Sphingomyelinoses
Gaucher's Disease (Glucocerebrocidosis)
Gaucher'sType I
Gaucher's Type II
Gaucher's Type III
Globosidosis
Fabry's Disease
Systemic
Ocular
Treatment
Gangliosidoses
GM1 Gangliosidosis
GM2 Gangliosidosis
Sulfatidoses
Metachromatic Leukodystrophy
Multiple Sulfatase Deficiency
Krabbe's Disease (Galactocerebrocidosis)
Ceramidoses
Farber's Disease
Drug-Associated Lipidoses
Neuronal Ceroid Lipofuscinoses
Early Infantile NCL
Late Infantile NCL
Juvenile NCL
Adult NCL
DYSLIPOPROTEINEMIA
Familial Hypercholesterolemia
Tangier Disease
Lecithin Cholesterol Acyl-Transferase (LCAT) Deficiency
Fish Eye Disease
Familial LCAT Deficiency
PORPHYRIA
Systemic
Ocular
Diagnosis
Treatment
CYSTINOSIS
Richner-Hanhart Syndrome (Tyrosinemia Type II)
Systemic Manifestations
Ocular Manifestations
Diagnosis
Treatment
ALKAPTONURIA
Systemic
Ocular
Diagnosis
Treatment
AMYLOIDOSES
SERUM COPPER ABNORMALITIES
CALCIUM
Band Keratopathy
Secondary Hypercalcemia
Chronic Glaucoma
Instrumentation
Trauma
Pharmacological
Neoplasms
Dystrophies/Familial
Autoimmune and Inflammatory Conditions
Diagnosis
Treatment
GOLD
CHAPTER 52:
Corneal Conditions Associated with Glaucoma
INTRODUCTION
CONGENITAL CONDITIONS AFFECTING CORNEAL DIMENSIONS
Megalocornea
Microcornea
Cornea Plana
Sclerocornea
Corneal Opacification
Anterior Segment Dysgenesis (ASD) Disorders
Axenfeld's Anomaly
Reiger's Anomaly
Axenfeld-Reiger's Anomaly and Syndrome
Peters' Anomaly
Iridocorneal Endothelial (ICE) Syndromes
Iris Nevus Syndrome (Cogan-Reese) Syndrome
Chandler's Syndrome
Essential Iris Atrophy
Corneal Dystrophies
Posterior Polymorphous Dystrophy
Congenital Hereditary Endothelial Dystrophy
Epithelial Downgrowth and Fibrous Ingrowth
Keratitis and Keratouveitis
Inborn Errors in Metabolism
SECTION 8: CONJUNCTIVAL CORNEAL DYSPLASIA AND MALIGNANCY
CHAPTER 53:
Conjunctival and Corneal Neoplasms
PRELIMINARY
SECTION 1: PREMALIGNANT AND MALIGNANT TUMORS OF EPITHELIUM
RISK FACTORS
Solar Ultraviolet Light Exposure
Oncogenic Infections
Human Papillomavirus
Human Immunodeficiency Virus
Genetic Predisposition
CONJUNCTIVAL INTRAEPITHELIAL NEOPLASIA
SQUAMOUS CELL CARCINOMA
OTHER CONJUNCTIVAL EPITHELIAL TUMORS
CORNEAL EPITHELIAL TUMORS
PIGMENTED CONJUNCTIVAL EPITHELIAL TUMORS
SECTION 2: MELANOCYTIC TUMORS OF CONJUNCTIVAL EPITHELIUM
CONJUNCTIVAL MELANOCYTIC NEVUS
PRIMARY ACQUIRED MELANOSIS
MALIGNANT MELANOMA
MASQUERADING LESIONS
SECTION 3: LYMPHOPROLIFERATIVE CONJUNCTIVAL LESIONS
REACTIVE LYMPHOID HYPERPLASIA
MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA
OTHER TYPES OF LYMPHOMA
EVALUATION OF CONJUNCTIVAL LYMPHOPROLIFERATIVE LESIONS
CLASSIFICATION OF LYMPHOPROLIFERATIVE LESIONS
MANAGEMENT OF CONJUNCTIVAL LYMPHOMA
SECTION 4: OTHER LYMPHOID, LEUKEMIC AND HISTIOCYTIC CONJUNCTIVAL LESIONS
LEUKEMIA
HISTIOCYTIC TUMORS
SECTION 5: SECONDARY AND METASTATIC LESIONS
SEBACEOUS CELL CARCINOMA
METASTATIC TUMORS
SECTION 6: ADNEXAL LESIONS
Rhabdomyosarcoma
Liposarcoma
Hemangiopericytoma
Kaposi Sarcoma
SECTION 7: MANAGEMENT OF CONJUNCTIVAL TUMORS
DIAGNOSIS
Ultrasonography
In Vivo Confocal Microscopy
Exfoliative Cytopathology
Neuroimaging
Sentinel Lymph Node Biopsy
SURGICAL TREATMENT OF CONJUNCTIVAL TUMORS
Excision of Conjunctival Tumors without Corneoscleral Involvement
Excision of Conjunctival Tumors with Corneal or Scleral Penetration
MAP BIOPSY TECHNIQUE
Tumors with Intraocular Extension
Tumors with Regional Metastatic Spread
NONSURGICAL TREATMENT OF CONJUNCTIVAL TUMORS
Topical Chemotherapy
Radiation Treatment
SECTION 9: TRAUMA
CHAPTER 54:
Chemical Trauma
INTRODUCTION
EPIDEMIOLOGY
CLASSIFICATION OF INJURIES
MAJOR CHEMICAL DIFFERENCES BETWEEN ALKALI, ACID AND TOXIC INJURY OF THE EYE
Alkaline
Ammonia
Lye
Other Hydroxides
Lime
Methyl Ethyl Ketone Peroxide
Acids
Sulfuric Acid
Sulfurous Acid
Hydrofluoric Acid
Other Acids
Toxic
Clinical Grading of Chemical Injuries
Repair Processes
Epithelium
Stroma
Endothelium
Emergency Treatment
Treatment from Weeks to Months
Epithelium
Inflammation and Corneal Ulceration
Glaucoma
Surgical Treatment
Tenonplasty
Amniotic Membrane
Corneal Epithelial Stem Cell Replacement
Rehabilitation of Vision
Research in Chemical Injuries
Ascorbate Treatment
Citrate Treatment
Combination Ascorbate and Citrate Treatment
Other Treatments
CHAPTER 55:
Trauma of the Anterior Segment
INTRODUCTION
CLINICAL EVALUATION
GENERAL PRECAUTIONS
ANESTHESIA
IRIS REPAIR AND RECONSTRUCTION
Indications
Nonsurgical Approaches
Surgical Approaches
Instruments
Techniques
IRIDODIALYSIS REPAIR
Closed System Ab Interno (Cross-Pupil) Approach (Fig. 4A)
Closed System Ab Externo (Peripheral) Approach (Fig. 5)
Nonappositional ‘Hang-Back’ Technique
Sutureless Technique
IRIS OR PUPIL REPAIR (PUPILLOPLASTY)
Intracameral Knot-Tying Techniques
McCannel Technique7
Modified McCannel Techniques
Siepser Technique
Modified Siepser Technique
Approaches for Various Iris Defects
Iris Defect Involving Iris Base/Midperiphery
Iris Defect Involving Pupil Edge
Displaced Pupil without Significant Tissue Loss
Displaced Pupil with Significant Tissue Loss
Atonic Mydriatic Pupil
Combined with Penetrating Keratoplasty (PKP)
IRIS PROSTHESIS
CILIARY BODY TRAUMA AND RECONSTRUCTION
Indications
Nonsurgical Approaches
Surgical Approaches
Instruments
Techniques
LENS AND ZONULE TRAUMA AND SURGICAL APPROACHES
Indication
Instruments
Techniques
APPROACH FOR TRAUMATIC CATARACTS
Capsular Tension Devices (CTD)38
Types of CTDs
Location of IOL Placement
Timing of IOL Insertion
APPROACH FOR SUBLUXED CRYSTALLINE LENS
APPROACH FOR IOL SUBLUXATION
Scleral-Fixated IOL
Ab Externo (Outside-In) Approach
Ab Interno (Inside-Out) Approach
Iris-Fixated IOL
Standard ACIOL
Aphakic Iris-Claw IOL (Artisan, Ophtec, Netherlands)
SUMMARY
CHAPTER 56:
Physical Trauma of the Cornea
INTRODUCTION AND BACKGROUND
PATHOPHYSIOLOGY AND MICROSCOPY
MANAGEMENT
Evaluation
Corneal Abrasions
Lacerations of the Cornea
Surgical Management
PROGNOSIS
Procedural Steps for the Repair of Corneal Lacerations (Figs 6 and 7)
SECTION 10: CORNEAL DYSTROPHIES AND DEGENERATIONS
CHAPTER 57:
Anterior Corneal Dystrophies: Dystrophies of the Epithelium, Epithelial Basement Membrane and Bowman's Layer
EPITHELIAL BASEMENT MEMBRANE DYSTROPHY
EPITHELIAL RECURRENT EROSION DYSTROPHY
SUBEPITHELIAL MUCINOUS CORNEAL DYSTROPHY (SMCD)
MEESMANN CORNEAL DYSTROPHY
LISCH EPITHELIAL CORNEAL DYSTROPHY
GELATINOUS DROP-LIKE CORNEAL DYSTROPHY
REIS-BUCKLER'S CORNEAL DYSTROPHY
THIEL-BEHNKE CORNEAL DYSTROPHY
GRAYSON-WILBRANDT CORNEAL DYSTROPHY
CHAPTER 58:
Stromal Corneal Dystrophies
INTRODUCTION
THE IC3D AND TGFBI CORNEAL DYSTROPHIES
Lattice Corneal Dystrophy (MIM #122200)
Lattice Corneal Dystrophy (LCD1), TGFBI Type and Variants
Alternate Names
Epidemiology and Inheritance
Clinical Course
Histopathology
Other Subtypes of Lattice Corneal Dystrophy
Confocal Microscopy
Treatment
Lattice Corneal Dystrophy, Gelsolin Type (LCD2), Lattice Corneal Dystrophy Type 2 (MIM #105120)
Notation
Alternative Names
Epidemiology/Inheritance/Pathogenesis
Clinical Course
Histopathology
Confocal Microscopy
Treatment
GRANULAR CORNEAL DYSTROPHY
Granular Corneal Dystrophy Type 1 (MIM #12900)
Alternate Names
Epidemiology and Inheritance
Clinical Course
Histopathology
Confocal Microscopy
Treatment
Granular Corneal Dystrophy Type 2 (GCD2)(Granular-Lattice) (MIM #121900)
Alternative Names
Epidemiology/Inheritance
Clinical Course
Histopathology
Confocal Microscopy
Treatment
Macular Corneal Dystrophy (MIM #217800)
Alternate Names
Epidemiology and Inheritance
Clinical Course
Macular Corneal Dystrophy Subtypes
Histopathology and Pathogenesis
Treatment
Schnyder Corneal Dystrophy (MIM #21800)
Alternate Names
Epidemiology and Inheritance
Clinical Course
Corneal Crystals in SCD
Histopathology
Confocal Microscopy
Treatment
Central Cloudy Corneal Dystrophy of François (MIM #217600)
Alternate Names
Epidemiology and Inheritance
Clinical Course
Histopathology
Confocal Microscopy
Treatment
Fleck Corneal Dystrophy (MIM #121850)
Alternate Names
Epidemiology and Inheritance
Clinical Findings
Histopathology
Confocal Microscopy
Treatment
Posterior Amorphous Corneal Dystrophy (MIM None)
Alternate Names
Epidemiology and Inheritance
Clinical Course
Histopathology
Confocal Microscopy
Ultrasound Biomicroscopy
Treatment
Pre-Descemet Corneal Dystrophy (MIM None)
Alternate Names
Inheritance and Genetics
Clinical Course
Histopathology
Confocal Microscopy
Treatment
Congenital Stromal Corneal Dystrophy (MIM #610048)
Alternative Names
Epidemiology and Inheritance
Clinical Course
Histopathology
Treatment
CHAPTER 59:
Posterior Corneal Dystrophies
INTRODUCTION
FUCHS ENDOTHELIAL CORNEAL DYSTROPHY
Epidemiology and Pathogenesis
Clinical Presentation
Differential Diagnosis
Histopathology and Electron Microscopy
Pathophysiology and Genetics
Treatment and Prognosis
POSTERIOR POLYMORPHOUS CORNEAL DYSTROPHY
Epidemiology and Pathogenesis
Clinical Presentation
Differential Diagnosis
Pathophysiology
Genetics
Treatment and Prognosis
CONGENITAL HEREDITARY ENDOTHELIAL DYSTROPHY
Epidemiology and Pathogenesis
Clinical Presentation
Differential Diagnosis
Pathophysiology
Treatment and Prognosis
X-LINKED ENDOTHELIAL CORNEAL DYSTROPHY
Clinical Presentation
Histopathology
CHAPTER 60:
Corneal and Conjunctival Degenerations
INTRODUCTION
CONJUNCTIVA
Conjunctival Concretions
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Management
Pinguecula
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Management
EPITHELIUM AND SUBEPITHELIUM
CENTRAL STROMA
Mosaic (crocodile) Shagreen
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Cornea Farinata
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Polymorphic Amyloid Degeneration
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
PERIPHERAL STROMA
White Limbal Girdle of Vogt Type I
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
White Limbal Girdle of Vogt Type II
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Corneal Arcus
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Senile Furrow Degeneration
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Terrien's Marginal Degeneration
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
POSTINFLAMMATION
Band-shaped Keratopathy
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Removal with Chelating
Salzmann's Nodular Degeneration
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Amyloid Degeneration
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Lipid Keratopathy
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
ENDOTHELIAL
Hassall-Henle Bodies
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
IRON LINES
Coats's White Ring
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Hudson-Stähli Line
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Fleisher's Ring
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Stocker's Line
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
Ferry's Line
Clinical Findings
Etiology and Risk Factors
Histology and Electron Microscopy
Prevention and Treatment
CONCLUSION
CHAPTER 61:
Ectatic Diseases of the Cornea: Keratoconus, Pellucid Marginal Degeneration and Keratoglobus
INTRODUCTION
KERATOCONUS
Background
Epidemiology
Family Studies
Clinical Presentation and Diagnosis
Clinical Signs
Topography
PELLUCID MARGINAL DEGENERATION
KERATOGLOBUS
SECTION 11: CORNEAL AND CONJUNCTIVAL MANIFESTATIONS OF DIETARY DEFICIENCIES
CHAPTER 62:
Nutritional Deficiencies Affecting the Cornea and Conjunctiva
INTRODUCTION
PREVALENCE, MORTALITY AND MORBIDITY
PHYSIOLOGY and METABOLISM OF VITAMIN A
PATHOGENESIS OF CONJUNCTIVAL AND CORNEAL DISEASE
NIGHT BLINDNESS (XN)
CONJUNCTIVAL XEROSIS (X1A)
BITOT'S SPOTS (X1B)
CORNEAL XEROSIS (X2) (Fig. 5)
KERATOMALACIA (X3)
CORNEAL SCAR (XS)
PREVENTION AND TREATMENT OF VAD
OTHER NUTRIENT DEFICIENCIES
CONCLUSION
SECTION 12: CONTACT LENSES
CHAPTER 63:
Contact Lenses in the Treatment of Corneal Disease
INTRODUCTION
INDICATIONS
CORNEAL EPITHELIAL DISORDERS
Corneal Abrasions
Recurrent Erosion
Persistent Epithelial Defect
Filamentary Keratitis
Aqueous Deficient Dry Eye
Thygeson's Superficial Punctate Keratitis
Superior Limbic Keratoconjunctivitis
CORNEAL ULCERATIONS/ PERFORATIONS/LACERATIONS
CORNEAL EDEMA
SURGICAL INDICATIONS
Lid Abnormalities
DISORDERS OF THE OCULAR SURFACE
IRREGULAR CORNEAL SURFACE
PROSTHETIC SOFT CONTACT LENSES
Fitting Soft Therapeutic Contact Lenses
DRUG DELIVERY
NEW DEVELOPMENTS
COMPLICATIONS OF THERAPEUTIC CONTACT LENSES
CONCLUSION
CHAPTER 64:
PROSE Treatment for Ocular Surface Disease
INTRODUCTION
HISTORY OF SCLERAL LENSES AND PRINCIPLES OF DESIGN FOR PHYSIOLOGICAL TOLERANCE
DEFINITION OF A SCLERAL LENS
PROSE TREATMENT
Steps in PROSE Treatment
Age and PROSE Treatment
PROSE Treatment for Ocular Surface Disease
PROSE Treatment for Ocular Chronic Graft-Versus-Host Disease
PROSE Treatment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
PROSE Treatment for Limbal Stem Cell Deficiency
PROSE Treatment for Neurotrophic Keratopathy
PROSE Treatment for Atopic Keratoconjunctivitis
PROSE Treatment Exposure Keratitis (Lagophthalmos)
PROSE Treatment for Persistent Epithelial Defects
Frontiers and Innovations in PROSE Treatment
CONCLUSION
SECTION 13: EMERGING INNOVATION
CHAPTER 65:
Gene Therapy in the Cornea: Principles and Promise
INTRODUCTION
HISTORY OF GENE THERAPY
ADVANTAGES OF GENE THERAPY OVER CONVENTIONAL DRUG THERAPY
THE CORNEA: AN IDEAL TISSUE FOR GENE THERAPY
GENE THERAPY VECTORS
Adenovirus Vectors
Retrovirus Vectors
Lentivirus Vectors
Adeno-associated Virus Vectors
Nonviral Vectors
Nanoparticle Vectors
CELL AND TISSUE TARGETING
AN OVERVIEW OF CORNEAL GENE THERAPY STUDIES
Corneal Grafts
Corneal Scarring and Wound Healing
Corneal Alkali Burn
Corneal Neovascularization
Other Common Corneal Disorders
Corneal Dystrophies
CONCLUSION AND PROSPECTIVE
ACKNOWLEDGMENTS
CHAPTER 66:
Biosynthetic Alternatives to Human Donor Tissue
INTRODUCTION
THE CASE FOR REGENERATIVE MEDICINE APPROACHES FOR CORNEAL TRANSPLANTATION
THE CORNEA AS A RESEARCH MODEL
KERATOPROSTHESES WITH REGENERATIVE CAPACITY
CELL-FREE SCAFFOLDS FOR PROMOTING CORNEAL REGENERATION
Decellularized Corneas as Scaffolds
Collagen and Other Extracellular Matrix Mimetics
Biosynthetic Collagen ECM Mimics Induce Regeneration in Human Corneas
Collagen-Based Interpenetrating Networks
Scaffolds for Use in Cell-based Therapies
CONCLUSION
SECTION 14: CORNEA SURGERY
CHAPTER 67:
History of Cornea Surgery
INTRODUCTION
HISTORY OF KERATOPLASTY
Corneal Grafting Envisioners and Initial Studies
Era of Heteroplasty (1800–1900)
Era of Homoplasty (1900–Present)
History of the Eye Banks
Later Stages of Homoplasty Era
Current Evolution in Keratoplasty
Deep Anterior Lamellar Keratoplasty
Automated Lamellar Therapeutic Keratoplasty
Posterior Lamellar Keratoplasty
Phototherapeutic Keratectomy
Keratoprostheses and Xenotransplants
Laser-assisted Penetrating Keratoplasty
Different Trephination Configurations
HISTORY OF REFRACTIVE SURGERY
Incisional Corneal Refractive Surgery
Collagen Alteration Surgery
Thermokeratoplasty
Laser Thermal Keratoplasty
Conductive Keratoplasty
Keratomileusis
Laser Assisted Surgery
Excimer Laser Assisted
Femtosecond Laser Assisted
Intrastromal Implants
Rings
CORNEAL COLLAGEN CROSSLINKING
APPENDIX
ACKNOWLEDGMENT
SECTION 15: CORNEAL, SCLERAL AND CONJUNCTIVAL SURGERY: SUPPORTIVE AND PROTECTIVE
CHAPTER 68:
Ophthalmic Applications of Tissue Adhesives in Anterior Segment Surgery
INTRODUCTION
CYANOACRYLATE- AND FIBRIN-BASED ADHESIVES
Cyanoacrylate-based Adhesive
Fibrin-based Adhesive
OPHTHALMIC USES OF CYANOACRYLATE- AND FIBRIN-BASED TISSUE ADHESIVES
Pterygium
Cornea
Cataract Surgery
Glaucoma
Other
NOVEL TISSUE ADHESIVES
Biodendrimer-based Adhesives
Polyethylene Glycol-based Adhesives
Chondroitin Sulfate-based Adhesive
Acrylic Copolymer-based Adhesives
CONCLUSION
CHAPTER 69:
Conjunctival Flaps
INTRODUCTION
INDICATIONS
Blind Painful Eye
Nonhealing Epithelial Defect
Recalcitrant Microbial Keratitis
Corneal Descemetocele and Perforation
PERIPHERAL CORNEAL DISEASE
DISADVANTAGES
TECHNIQUE
Total Flap
Partial Flap
POSTOPERATIVE CARE
COMPLICATIONS
Buttonholes
Flap Retraction
Hemorrhage
Epithelial Inclusion Cyst
Ptosis
CHAPTER 70:
Scleral Transplantation: Supportive and Protective
INTRODUCTION
SCLERAL GRAFT
ANESTHESIA OPTIONS
SCLERAL GRAFT TECHNIQUES
Scleral Perforation Repair
Glaucoma Surgery
Corneal Surgery
Retinal Surgery
Dental Surgery
AMNIOTIC MEMBRANE
FASCIA LATA
PERIOSTEUM
PERICARDIUM
DURA MATER
SPLIT THICKNESS DERMAL GRAFT
OTHER MATERIALS
Biologic
Synthetic
Conclusion
SECTION 16: OCULAR SURFACE REHABILITATION
CHAPTER 71:
Corneal and Conjunctival Foreign Bodies
BACKGROUND
CLINICAL FINDINGS AND EVALUATION
PATHOGENESIS
MANAGEMENT
RUST RINGS
REMOVAL OF CORNEAL FOREIGN BODIES IN LASIK PATIENTS
REMOVAL OF CORNEAL FOREIGN BODY THROUGH A LAMELLAR CORNEAL POCKET
TREATMENT
FOLLOW-UP
COMPLICATIONS
PROGNOSIS
CHAPTER 72:
Superficial Keratectomy and Epithelial Debridement
HISTORY
INDICATIONS
Anterior Dystrophies6,9
Recurrent Erosion Syndrome
TECHNIQUE
Preoperative Procedure
Instrumentation
Procedure
COMPLICATIONS
CHAPTER 73:
Limbal Dermoid
INTRODUCTION And OVERVIEW
EPIDEMIOLOGY
CLINICAL FEATURES
Classification
Grade I
Grade II
Grade III
Associated Abnormalities
Ocular
Systemic
HISTOPATHOLOGY
ETIOLOGY/PATHOGENESIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
CHAPTER 74:
Evaluation and Management of Eyelid and Eyelash Malposition for the Anterior Segment Surgeon
INTRODUCTION
KERATOPATHY DUE TO EYELID MALPOSITION
Ectropion
Entropion
KERATOPATHY DUE TO EYELASH MALPOSITION
CHAPTER 75:
Pterygium Surgery
INTRODUCTION
PATHOGENESIS
PATHOLOGY
PREVENTION
SURGERY
Suggested Surgical Techniques
Conjunctival Flaps
Conjunctival Autograft
Amniotic Membrane Graft
Comparison of Techniques
COMPLICATIONS
ADJUVANT THERAPIES
COMMENTS
CHAPTER 76:
Amniotic Membrane Transplantation
EMBRYOLOGY
ANATOMY OF THE AMNIOTIC MEMBRANE
PHYSIOLOGY OF AMNIOTIC MEMBRANE
PREPARATION OF AMNIOTIC MEMBRANE
ROLE OF AMNIOTIC MEMBRANE IN OPHTHALMOLOGY
CORNEAL USES
Persistent Epithelial Defect(s)
Corneal/Scleral Melts
Bullous Keratopathy
Limbal Stem Cell Deficiency
Partial Limbal Stem Cell Deficiency
Total Limbal Stem Cell Deficiency
CONJUNCTIVAL USES
Pterygium Excision
Fornix Reconstruction
Surface Reconstruction
Acute Corneal and Conjunctival Insults
Bleb Leaks and Overfiltering Blebs
TISSUE CULTURED HUMAN AMNIOTIC EPITHELIAL CELLS
AMNIOTIC MEMBRANE SUBSTRATE FOR EX VIVO EXPANSION OF LIMBAL STEM CELLS
CONCLUSION
CHAPTER 77:
Limbal Stem Cell Transplantation
INTRODUCTION
REMOVAL OF ABNORMAL TISSUE BY SUPERFICIAL KERATECTOMY
Restoration of Ocular Surface Substrate by Mucous Membrane Transplantation
Conjunctival Transplantation
Oral Mucosa Transplantation
Amniotic Membrane Transplantation
Restoration of Corneal Stem Cells by Limbal Transplantation
Conjunctival Limbal Autograft
Cadaveric Conjunctival Limbal Allograft
Living-related Conjunctival Limbal Allograft
Keratolimbal Allograft
Ex Vivo Expansion of Limbal Stem Cell (EVEL)
OTHER SURGICAL TECHNIQUES FOR OCULAR SURFACE RECONSTRUCTION
MANAGEMENT OF LIMBAL STEM CELL TRANSPLANTS
SUMMARY
CHAPTER 78:
Autologous Ex Vivo Cultivated Limbal Epithelial Transplantation
OCULAR BURNS, LIMBUS, STEM CELLS AND THERAPY
Advantages of Ex Vivo Cultivated Limbal Epithelial Transplantation
INDICATIONS FOR AUTOLOGOUS LIMBAL TRANSPLANTATION
PREOPERATIVE CLINICAL ASSESSMENT AND COUNSELING
TECHNIQUE OF LIMBAL BIOPSY
TECHNIQUE OF LIMBAL CULTURE
TECHNIQUE OF LIMBAL TRANSPLANTATION
POSTOPERATIVE MANAGEMENT
CLINICAL OUTCOMES OF CULTIVATED LIMBAL TRANSPLANTATION
CONCLUSIONS
CHAPTER 79:
Modern Eye Banking: Advances and Challenges
HISTORY OF EYE BANKING
GROWTH AND TRENDS IN TISSUE UTILIZATION
DONOR TISSUE SELECTION
Donor Age
Infectious Diseases
Viruses
Prions
Bacteria
Fungi
Protozoan (Acanthamoeba)
Noninfectious Corneal Pathology
Neoplastic Disease
Local Corneal Diseases
TISSUE RETRIEVAL
Pre-removal Measures
Donor Evaluation and Physical Inspection
Blood Sample
Enucleation
Donor Reconstruction
Corneoscleral Rim Excision
TISSUE EVALUATION
Gross Examination
Slit-Lamp Examination
Specular Microscopy
Histocompatibility Matching
TISSUE PREPARATION FOR DESCEMET STRIPPING ENDOTHELIAL KERATOPLASTY
STORAGE MEDIA
Short-Term Storage
McCarey and Kaufman Medium
Intermediate-Term Storage
Chondroitin Sulfate-based Media: K-Sol, DexSol, Optisol and Optisol GS
Eusol-C
Long-Term Storage
Organ Culture
Cryopreservation
OTHER TISSUE PREPARATIONS
Amniotic Membrane
Materials Required
Recovery of Human Placenta
Processing of Amniotic Membrane from Placenta
Preservation Medium
Quality Assurance
Scleral Tissue
Processing of Sclera
Materials Required
Preservation Medium
Processing
INTERNATIONAL EYE BANKING
Corneal Blindness as an Important Cause of Blindness
Causes of Corneal Blindness
International Eye Banking Concerns
Meeting the Challenges
FINANCIAL AND LEGAL CONSIDERATIONS IN EYE BANKING
Financial
Countries with National Health Systems
Eye Bank Funding in Developing Countries
Organization of Eye Banks
Tissue Acceptance Criteria
Processing Fee Variations
Costs of Donor Eye Tissues for Research and Teaching
Legal
FUTURE THREATS IN EYE BANKING
ACKNOWLEDGMENTS
CHAPTER 80:
Penetrating Keratoplasty: Surgical Techniques and Pre- and Postoperative Care
INTRODUCTION
INDICATIONS FOR PENETRATING KERATOPLASTY
DONOR TISSUE
DISCUSSING PENETRATING KERATOPLASTY WITH THE PATIENT
THE OPERATIVE PROCEDURE
Preparation of the Patient
Donor Tissue Preparation
RECIPIENT PROCEDURE
Suturing the Donor Cornea in Place
POSTOPERATIVE CARE
COMBINED PROCEDURES WITH PENETRATING KERATOPLASTY
Cataract Surgery
Triple Procedure: Penetrating Keratoplasty, Cataract Extraction and Intraocular Lens Implant
Uncontrolled Glaucoma
Iris Procedures
Oculoplastic Surgery
Strabismus Surgery
INTRAOPERATIVE COMPLICATIONS
EARLY POSTOPERATIVE COMPLICATIONS
Primary Graft Failure
Glaucoma
Epithelial Defect
Endophthalmitis
LATE COMPLICATIONS
Corneal Graft Rejection
Wound Dehiscence at Suture Removal
Astigmatism
MAKING THE DECISION TO PERFORM REPEAT PENETRATING KERATOPLASTY
ACKNOWLEDGMENTS
CHAPTER 81:
Management of Postkeratoplasty Astigmatism
INTRODUCTION
PREOPERATIVE FACTORS
INTRAOPERATIVE FACTORS
POSTOPERATIVE CONSIDERATIONS
Topographical Evaluation
Treatment of Postpenetrating Keratoplasty Astigmatism
Suture Tension Adjustment
Techniques of Suture Adjustment
Suture Removal
Corrective Wear—Spectacles/Contact Lenses
Incisional Techniques
Effects on Deep Anterior Lamellar Keratoplasty
Laser Refractive Surgery
Combining Methods
Repeat Keratoplasty
CHAPTER 82:
Glaucoma Surgery in Penetrating and Nonpenetrating Keratoplasty Patients
INTRODUCTION
PENETRATING KERATOPLASTY
DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY
KERATOPROSTHESIS
REFRACTIVE SURGERY
SURGICAL APPROACH
Trabeculectomy
Glaucoma Drainage Device
Cyclophotocoagulation
Laser Trabeculoplasty
Other Surgical Procedures
SUMMARY
CHAPTER 83:
Pediatric Corneal Transplant Surgery
INTRODUCTION
INDICATIONS
SURGERY
Preoperative Evaluation
Timing
SURGICAL TECHNIQUE
POSTOPERATIVE MANAGEMENT
RESULTS
CONCLUSION
CHAPTER 84:
DLEK, DSAEK, DSEK, DMEK
INTRODUCTION
INDICATIONS AND CONTRAINDICATIONS
DESCEMET'S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY/ DESCEMET'S STRIPPING ENDOTHELIAL KERATOPLASTY
Surgical Technique
Visual Acuity and Refractive Outcomes
Endothelial Cell Density
Graft Survival
Complications
DESCEMET'S MEMBRANE ENDOTHELIAL KERATOPLASTY
Surgical Technique
Visual and Refractive Outcomes
Endothelial Cell Loss
Complications
DESCEMET'S MEMBRANE AUTOMATED ENDOTHELIAL KERATOPLASTY
Surgical Technique
Visual and Refractive Outcomes
Complications and Endothelial Cell Loss
CONCLUSION
CHAPTER 85:
Descemet's Membrane Endothelial Keratoplasty (DMEK)
INTRODUCTION
PREOPERATIVE PREPARATION OF THE DMEK GRAFT
DESCEMET's MEMBRANE ENDOTHELIAL KERATOPLASTY SURGICAL TECHNIQUE
Obtaining a Soft Eye
Incisions and Descemetorhexis
Intraoperative Preparation of the DMEK Graft
Implantation of the DMEK Graft
Orientating the DMEK Graft
Unfolding the DMEK Graft
Centering the DMEK Graft
Appositioning the DMEK Graft
Fixating the DMEK Graft
VISUAL REHABILITATION RATE AND REFRACTIVE OUTCOME
Visual Acuity
Refractive Change and Stability
Hyperopic Shift in DMEK and Lens Power Calculation for Cataract Surgery
ENDOTHELIAL CELL DENSITY AND GRAFT SURVIVAL
COMPLICATIONS
Graft Detachment
Graft Detachment Rate
Graft Detachment Diagnosis
Graft Detachment Management
Secondary Glaucoma
Exacerbation of pre-existing glaucoma (2.5%)
De novo glaucoma or surgically-induced ocular hypertension (4%)
Allograft Rejection
DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY AND CATARACT
FUTURE PERSPECTIVES
CHAPTER 86:
Deep Anterior Lamellar Keratoplasty
INTRODUCTION
HISTORY
PATIENT AND PROCEDURE SELECTION
ESTABLISH REALISTIC EXPECTATIONS
DONOR TISSUE SELECTION
SURGICAL VENUE AND ANESTHESIA
SURGICAL STEPS IN DALK: BIG-BUBBLE TECHNIQUE
Determination of Size and Centration of Lamellar Bed and Graft
Trephination
Big-Bubble Formation (Figs 5A to D)
(Optional) Double-Bubble Technique to Confirm Presence of the Big-Bubble (Figs 5A to D)
Debulking/Lamellar Dissection of Recipient Anterior Stroma (Figs 6A to C)
Fluid Release from Anterior Chamber to Lower Intraocular Pressure
Brave Slash
Baring of Descemet's Membrane/Posterior Stromal Dissection (Figs 8A to D)
Donor Tissue Preparation
Placement of Donor Tissue in Recipient Lamellar Bed
ALTERNATIVE TECHNIQUE TO BIG-BUBBLE DALK: MANUAL DISSECTION
POSTOPERATIVE CARE
Medications
Follow-up Visits
Anticipate Corneal Surface Problems
Suture Removal
Rejection
Refractive Error
LONG-TERM PROGNOSIS
CHAPTER 87:
Intacs Intracorneal Ring Segments and Keratoconus
INTRODUCTION
INTACS IN CORNEAS WITH SUSPECTED KERATOCONUS
INTACS AND KERATOCONUS
Indications for Corneal Rings in Keratoconus
Poor Candidates for Intacs
OPERATION TECHNIQUES
The Mechanical Technique
The Femtosecond Laser Technique
For Intacs
Incision, Ring Position and Nomograms
Results and Long-Term Follow-Up
Mechanical versus Intralase
Reposition and Reimplantation of Intacs
COMPLICATIONS
Intraoperative Complications
Postoperative Complications
Extrusion
Keratitis Post Intacs
Pain after Intacs
Infiltrates
HISTOLOGY AND DEPOSITS
Anterior Channel Fibrosis and Increased Scattering
Corneal Biomechanics and Intacs
ADDITIONAL PROCEDURES TO ENHANCE INTACS' EFFECTS
Intacs Combined with Intraocular Lenses
Photorefractive Keratectomy Following Intacs
Intacs and Collagen Corneal Crosslinking
Contact Lenses after Intacs
Kerarings Post Intacs
INTACS COMPARED WITH OTHER SURGICAL PROCEDURES
Intacs versus Kerarings
Intacs versus Penetrating Keratoplasty
Sample Case Report 1
NEW DESIGN OF INTACS: INTACS SK
Sample Case Report 2
Sample Case Report 3
INTACS AND OTHER ECTATIC DISEASES OF THE CORNEA
Intacs and Pellucid Marginal Corneal Degeneration
Intacs and Post-LASIK Ectasia
CONCLUSION
CHAPTER 88:
UVA-light and Riboflavin Mediated Corneal Collagen Crosslinking
BACKGROUND
UVA-LIGHT AND RIBOFLAVIN
Clinical Application of Corneal Collagen Crosslinking
Keratoconus
Post-LASIK Ectasia
Other Indications for Corneal Collagen Crosslinking
Complications
SUMMARY
CHAPTER 89:
Phototherapeutic Keratectomy
INTRODUCTION
CANDIDACY
CLINICAL USES
RESULTS
CONTRAINDICATIONS AND COMPLICATIONS
SURGICAL TECHNIQUE
FUTURE TRENDS
CONCLUSION
CHAPTER 90:
Keratoprosthesis Surgery
INTRODUCTION
PREOPERATIVE EVALUATION
TYPES OF KERATOPROSTHESIS
Boston Keratoprosthesis
AlphaCor™
Osteo-Odonto-Keratoprosthesis
OUTCOMES OF KERATOPROSTHESES
COMPLICATIONS AND CONSIDERATIONS
Tissue Necrosis, Melt, and Extrusion
Inflammation
Glaucoma
Posterior Segment Complications
Retroprosthetic Membranes
Retinal Detachment
Vitreous Hemorrhage
Vitreous Inflammation/Sterile Uveitis-Vitritis
Epiretinal Membrane and Cystoid Macular Edema
Infectious Endophthalmitis
CONCLUSION
CHAPTER 91:
Infant Keratoprosthesis
INTRODUCTION
HISTORICAL PERSPECTIVE
OUR TEAM
SURGICAL PROCEDURE
DEVICE ASSEMBLY
POSTOPERATIVE CARE
COMPLICATIONS
RESULTS
CONCLUSION
CHAPTER 92:
Boston Keratoprosthesis in the Management of Limbal Stem Cell Failure
BACKGROUND
LIMBAL STEM CELL FAILURE AND OCULAR SURFACE DISEASE
KERATOPROSTHESIS IMPLANTATION FOR SEVERE LIMBAL STEM CELL DEFICIENCY
POSTOPERATIVE CARE FOLLOWING BOSTON KERATOPROSTHESIS IN LIMBAL STEM CELL DEFICIENCY
COMPLICATIONS
VISUAL OUTCOMES AFTER BOSTON KERATOPROSTHESIS IN LIMBAL STEM CELL DEFICIENCY
Retention of the Boston Keratoprosthesis
CONCLUSION
CHAPTER 93:
Preoperative Considerations: Patient Selection and Evaluation
INTRODUCTION
SELECTING THE RIGHT KERATOREFRACTIVE PROCEDURE
SYSTEMIC CONSIDERATIONS
Diabetes Mellitus
Hormonal Fluctuations
HIV/Immunocompromised Patients
Autoimmune Conditions
Keloid Formation
Psoriasis
OCULAR CONSIDERATIONS
Refractive Stability
Refractive Error and Corneal Curvature Limitations
Orbital Anatomy
Phorias/Tropias
Large Pupils
Herpes Simplex Virus/Corneal Scars
Blepharitis and Rosacea
Dry Eyes
Corneal Dystrophies
Corneal Ectasia
Corneal Warpage
Retinal Holes or Myopic Degeneration
Glaucoma
Cataracts
REFRACTIVE INTRAOCULAR LENSES
CHAPTER 94:
Preoperative Considerations: Corneal Topography
INTRODUCTION
DEVELOPMENT OF THE CORNEAL TOPOGRAPHER
Myth: Photorefractive Keratectomy is Safe and Effective in Corneas with Abnormal Topography
CORNEAL TOPOGRAPHY DISPLAYS AND SCALES
CORNEAL TOPOGRAPHER DISPLAYS
Photokeratoscope View
Axial Map
Refractive Power Map
Tangential Power Map
Elevation Map
Difference Map
QUANTITATIVE DESCRIPTORS OF CORNEAL TOPOGRAPHY
CORNEAL TOPOGRAPHY AND TEAR FILM
NORMAL CORNEAL TOPOGRAPHIC PARAMETERS AND DEVIATION FROM THE NORMAL
Contact Lens-Induced Corneal Warpage
Topographic Findings in Ectatic Disorders and Refractive Surgery Screening
Keratoconus
Pellucid Marginal Degeneration
ADJUNCT SCREENING TOOLS
Pachymetry
Pupil Diameter
CORNEAL TOPOGRAPHERS AND CORNEAL TOMOGRAPHERS
TOMOGRAPHY ELEVATION MAPS
CONCLUSION
CHAPTER 95:
Radial Keratotomy
INTRODUCTION
HISTORY
TECHNIQUE
RESULTS
PREDICTABILITY
PERK STUDY
OTHER RK STUDIES
RETREATMENTS
CONCLUSION
CHAPTER 96:
Conductive Keratoplasty
INTRODUCTION
CONDUCTIVE KERATOPLASTY
HISTOLOGY
CONDUCTIVE KERATOPLASTY TREATMENT
Patient Selection
Procedure
Efficacy
Safety
Predictability
Stability
SURGICALLY-INDUCED ASTIGMATISM
Complications
Patient Evaluation
CONCLUSION
CHAPTER 97:
Incisional Surgery for Natural and Surgically-Induced Astigmatism
INTRODUCTION
PATIENT SELECTION
PREOPERATIVE MEASUREMENTS
NOMOGRAMS
TECHNIQUE
COMPLICATIONS
Infection
Bleeding
Full-thickness Perforation
Ectasia
Weakening of the Globe
Decreased Corneal Sensation
Misalignment or Wrong Axis Surgery
FUTURE DIRECTIONS
CONCLUSION
CHAPTER 98:
Shaping the Future and Reshaping the Past: The Art of Vision Surgery
HISTORY OF LAMELLAR REFRACTIVE SURGERY (KERATOMILEUSIfoif]ooS AND AUTOMATED LAMELLAR KERATOPLASTY)
GULANI CARDINAL RULES FOR REFRACTIVE SURGEONS
GULANI CLASSIFICATION FOR PREVIOUS REFRACTIVE SURGERY
Primary Visual Factors
Quantitative
Qualitative
Secondary (Associated) Visual Factors
ACKNOWLEDGMENT
CHAPTER 99:
Intrastromal Corneal Implants for the Treatment of Presbyopia
INTRODUCTION
BACKGROUND
KAMRA™ SMALL APERTURE INLAY
VUE+ SPACE OCCUPYING INLAY
FLEXIVUE MICROLENS ANNULAR ADD LENTICULE
IMPLANTING CORNEAL INLAYS
POTENTIAL COMPLICATIONS AND MANAGEMENT
CONCLUSION
CHAPTER 100:
Excimer Laser Surface Ablation: Photorefractive Keratectomy and Laser Subepithelial Keratomileusis
HISTORY
EXCIMER LASER
PRK, LASIK AND LASEK
PREOPERATIVE MANAGEMENT
TECHNIQUE
POSTOPERATIVE MANAGEMENT
OUTCOMES
MITOMYCIN C
MONOVISION
PHOTOREFRACTIVE KERATECTOMY AFTER PREVIOUS CORNEAL SURGERY
COMPLICATIONS
Haze
Infectious Keratitis
Decentered Ablation
Dry Eyes
CHAPTER 101:
LASIK Instrumentation: Microkeratomes, Excimer Lasers and Wavefront Analyzers
INTRODUCTION
MICROKERATOMES
Historical Background
Components of the Microkeratome
Hansatome (Bausch & Lomb)
Zyoptix XP Microkeratome (Technolas Perfect Vision)
Summit-Krumeich-Barraquer Microkeratome (Alcon)
Amadeus II (Abott Medical Optics)
MK-2000 (Nidek)
Corriazo-Barraquer Microkeratome (Moria)
Corriazo-Pendular Microkeratome (SCHWIND eye-tech-solutions)
FEMTOSECOND LASER
IntraLase (Abott Medical Optics)
Technolas 520F (Technolas Perfect Vision)
VisuMax Femtosecond Laser (Carl Zeiss Meditec)
Femto LDV Femtosecond Laser (Ziemer Ophthalmic Systems)
Wavelight FS 2000 Laser (Alcon)
EXCIMER LASER
Zytopix Technolas Platform (Technolas Perfect Vision)
LADARVision 4000 System (Alcon)
EC-5000 Excimer Laser (Nidek)
VISX STAR S4 Excimer Laser (AMO)
Mel 80 Excimer Laser System (Carl Zeiss Meditec)
WaveLight Allegretto Wave System
SCHWIND AMARIS Excimer Laser (SCHWIND eye-tech-solutions)
Wavefront Analyzers
CHAPTER 102:
LASIK Techniques and Outcomes
ABSTRACT
INTRODUCTION: HISTORY
TECHNIQUES: MECHANICAL MICROKERATOME VERSUS LASER KERATOME
Mechanical Microkeratome
Laser Keratome
OUTCOMES
Flap Thickness and Flap Diameter
Epithelial Preservation
Stromal Wound Healing and Inflammation
Aberrations
Refraction Predictability and Visual Acuity
Biomechanics
Dry Eye
CONCLUSION
CHAPTER 103:
LASIK Outcomes in Astigmatism
INTRODUCTION
DEFINITIONS
HISTORY
LASIK TREATMENT OF ASTIGMATISM
ASTIGMATIC AXIS OF CORRECTION
LASIK IN IRREGULAR ASTIGMATISM
LASIK AFTER PENETRATING KERATOPLASTY
LASIK COMPARED TO PHAKIC TORIC IMPLANTED COLLAMER LENS
EXCIMER LASER OUTCOMES IN CORRECTION OF ASTIGMATISM
CONCLUSION
CHAPTER 104:
LASIK Combined with Other Procedures
INTRODUCTION
ON-FLAP PHOTOREFRACTIVE KERATECTOMY
PHAKIC INTRAOCULAR LENSES
POSTERIOR CHAMBER INTRAOCULAR LENS
PENETRATING KERATOPLASTY
CHAPTER 105:
Wavefront-Guided Custom LASIK and LASEK: Techniques and Outcomes
INTRODUCTION
OPTICAL CONSIDERATIONS
Visual Quality and Visual Acuity
Limits of Vision: The Root Mean Square
Basic Optics of Refractive Surgery
WAVEFRONT BASICS
Premeasurement Considerations
Wavefront Acquisition
Wavefront Aberrometry
Wavefront Images and Measurements
INTERPRETING WAVEFRONTS
Zernike Coefficients and Other Methods of Analysis
Coma
Trefoil
Spherical Aberration
Point Spread Function
Wavefront with Iris Registration
Special Cases
Flap Creation
Custom Wavefront as Enhancement
CONCLUSION
CHAPTER 106:
LASIK Complications
INTRODUCTION
LASIK PREOPERATIVE COMPLICATIONS
Red Light
Yellow Light
Green Light
LASIK OPERATIVE COMPLICATIONS
Use of Machines
Excimer Laser
Flap Makers
Microkeratome12–15
Femtosecond Laser Flaps
LASIK POSTOPERATIVE COMPLICATIONS
Overcorrection/Undercorrection20,21
Epithelial (Epi) Ingrowth16,9,23
Epithelial Ingrowth Cell Removal16,9
Foreign Bodies Beneath Flaps
Dislodged Flap16,9
Microstriae9,25
Treatment of Microstriae9
Postoperative Inflammation26
Central Toxic Keratopathy27
Pressure-Induced Stromal Keratitis (PISK)9,28
Superficial Punctate Keratitis/Dry Eyes9
Infection9
Glare/Halo29,30
Ectasia33,34
CHAPTER 107:
Corneal Applications of Ultrashort Pulse Laser
INTRODUCTION
ULTRASHORT PULSE LASER TECHNOLOGY AND LASER-TISSUE INTERACTION
FEMTOSECOND LASER LASIK FLAP CREATION
PENETRATING KERATOPLASTY
ANTERIOR LAMELLAR KERATOPLASTY
ENDOTHELIAL KERATOPLASTY
ASTIGMATIC KERATECTOMY
FEMTOSECOND LASER-ASSISTED PLACEMENT OF INTRASTROMAL CORNEAL RING SEGMENT
FEMTOSECOND LENTICULE EXTRACTION AND SMALL INCISION LENTICULE EXTRACTION
OTHER NOVEL FEMTOSECOND LASER APPLICATIONS IN CORNEAL SURGERIES
CONCLUSION
CHAPTER 108:
Lens Power Calculations in the Postkeratorefractive Eye
INTRODUCTION
SOURCES OF ERROR IN CALCULATIONS
Axial Length
Keratometric Power
Effective Lens Position
METHODS FOR ESTIMATING EFFECTIVE CENTRAL CORNEAL POWER
Preoperative Data Required: Keratometry
Clinical History Method
Aramberri Double K Method17
Walter Cornea Bypass Method19
Feiz-Mannis Method14
Preoperative Data Required: Refractive Error
Koch-Wang Formula10,18
Modified Masket Formula20,21
Latkany Flat K, or Average K Method22
Preoperative Data not Required
Contact Lens Over-Refraction Method
Adjusting Postrefractive Keratometry: Regression Formulas
Geggel Pachymetric Ratio Method28
APHAKIC CALCULATION METHODS
Mackool Aphakic Refraction Technique29,30
Intraoperative Aphakic Autorefraction Technique31
INTRAOCULAR LENS CHOICE CONSIDERATIONS
CONCLUSION
INTERNET RESOURCES
CHAPTER 109:
Light-Adjustable Lenses Postcorneal Refractive Surgery
INTRODUCTION
BASIC CONCEPTS IN IOL CALCULATION
IOL CALCULATION AFTER CORNEAL REFRACTIVE SURGERY
LIGHT-ADJUSTABLE LENS TECHNOLOGY
LIGHT-ADJUSTABLE LENS POSTREFRACTIVE SURGERY
Case 1–RE
Case 2–RS
ACKNOWLEDGMENT
SECTION 17: FEMTOSECOND LASER APPLICATIONS IN ANTERIOR SEGMENT SURGERY
CHAPTER 110:
Femtosecond Continuous Curvilinear Capsulorhexis
INTRODUCTION
HISTORY OF CONTINUOUS CURVILINEAR CAPSULORHEXIS
FEMTOSECOND CONTINUOUS CURVILINEAR CAPSULORHEXIS
Femtosecond Capsulotomy Creation
Capsule Precision
Capsule Size
Capsule Centration
Effective Lens Position
Capsule Tears
Complex Cases
ADVANCED IOLS
ADVANTAGES TO SURGEONS
POSTOPERATIVE OUTCOMES
FUTURE OF FEMTOSECOND CONTINUOUS CURVILINEAR CAPSULORHEXIS
SUMMARY
CHAPTER 111:
Femtosecond Laser Lens Fragmentation
INTRODUCTION AND CONCEPT OF LENS FRAGMENTATION
Origin of the Nucleus Fragmentation Concept
Lens Anatomic Features
HISTORY AND TECHNIQUES OF PHACOEMULSIFICATION ULTRASOUND FRAGMENTATION
Divide and Conquer Sculpting
Choo-choo Chop and Flip Technique
Phaco Chop Technique
CURRENT LIMITATIONS OF ULTRASOUND FRAGMENTATION
INTRODUCTION OF LASER LENS FRAGMENTATION
The Beginning of Lens Photodisruption with the Nd:YAG Laser
Nd:YAG Laser Shock Waves Production for Lens Photolysis
Femtosecond Laser Lens Fragmentation
TECHNICAL CONSIDERATIONS FOR LASER-ASSISTED FRAGMENTATION
Technical Requirements
Imaging System
Treatment Algorithms
Advantages of Laser Lens Fragmentation
EARLY CLINICAL RESULTS
CONCLUSION
CHAPTER 112:
Femtosecond Laser Presbyopia Correction
INTRODUCTION
THE INTRACORá PROCEDURE
EVALUATION OF THE INTRACORá PROCEDURE—2-YEAR FOLLOW-UP DATA
STEPS FOR PERFORMING THE INTRACORá PROCEDURE
Preoperative Measurements
INTRACORá Procedure
RESULTS
WORKING PRINCIPLE
PATIENT SELECTION AND MANAGING EXPECTATIONS
SUMMARY
CHAPTER 113:
Wound Creation
THE SCIENCE OF THE FEMTOSECOND LASER
APPLICATION OF FEMTOSECOND TECHNOLOGY IN OPHTHALMOLOGY
Laser in situ Keratomileusis (LASIK)
Penetrating Keratoplasty (PKP)
LASER SETTINGS AND TECHNIQUES
TOP-HAT-SHAPED GRAFTS
ZIGZAG-SHAPED GRAFTS
MUSHROOM-SHAPED GRAFTS
Additional Corneal Procedures
HISTORICAL CORNEAL INCISIONS FOR CATARACT SURGERY
BENEFIT OF USING THE FS LASER FOR WOUND CREATION
CHAPTER 114:
Femtosecond Refractive Lenticule Extraction and Small Incision Lenticule Extraction
INTRODUCTION
FEMTOSECOND LASER
INDICATIONS
PREOPERATIVE ASSESSMENT AND FOLLOW-UP
SURGICAL PROCEDURE
Common ReLEx, FLEx and SMILE Steps (First Half Shared Steps)
Femtosecond Lenticule Extraction Specific Steps (Second Half Steps)
Pseudo-SMILE
Small Incision Lenticule Extraction Specific Steps (Second Half Steps)
BASIC SCIENCE
Surface Regularity of Stromal Bed and Lenticule
Early Inflammation, Cell Proliferation and Wound Healing
Cell Death, Keratocyte Viability after Refractive Lenticule Extraction
Topographic and Keratometric Changes
CLINICAL OUTCOMES
Femtosecond Lenticule Extraction
Small Incision Lenticule Extraction
REFRACTIVE LENTICULE EXTRACTION (FLEX AND SMILE)
Early Visual Acuity, Stability of Refraction and Regression of Refractive Error
Topographic Changes
Higher Order Aberrations
Contrast Sensitivity
Quality of Life Questionnaires
Different Laser Scanning Patterns and Visual Outcomes
Intraocular Pressure
SIDE EFFECTS
ADVANTAGES AND DISADVANTAGES OF RELEX OVER LASIK
FUTURE PROSPECTS AND DEVELOPMENTS
Lenticule Long-Term Storage
Lenticule Reimplantation
Enhancement Procedures for Small Incision Lenticule Extraction
Hyperopic Correction
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 115:
Femtosecond Laser Keratoplasty
INTRODUCTION
PATIENT SELECTION AND PREOPERATIVE EVALUATION
GRAFT CUTTING AND SURGERY
REVIEW OF RECENT OUTCOMES
FEMTOSECOND LASER ASSISTED LAMELLAR KERATOPLASTY
CHAPTER 116:
Femtosecond Laser Enabled Correction of Postkeratoplasty Astigmatism
INTRODUCTION
THE PRINCIPLES OF ASTIGMATIC KERATOTOMY POSTKERATOPLASTY
FEMTOSECOND ENABLED ASTIGMATIC KERATOTOMY (FEAK) POST KERATOPLASTY
Surgical Assessment
Surgical Technique
RESULTS
COMPLICATIONS
Discussion
CHAPTER 117:
Complications of Femtosecond Laser Procedures
INTRODUCTION
COMPLICATIONS
Cavitation Bubble Related Complications
Opaque Bubble Layer
Vertical Gas Breakthrough
Air Bubble in the Anterior Chamber
Transient Light Sensitivity Syndrome
Rainbow Glare Phenomenon
Lamellar Keratitis
Other Complications
Decentered Flap
Suction Loss and Partial Flap
Interface Haze
Unintended Epithelial Flap
Interface Stromal Irregularities
Air Under Conjunctiva
Macular Hemorrhage
CONCLUSION
Financial Support: None
SECTION 18: CORNEAL INSTRUMENTATION
CHAPTER 118:
Corneal Instrumentation
INTRODUCTION
PENETRATING KERATOPLASTY
DEEP ANTERIOR LAMELLAR KERATOPLASTY
DESCEMET's STRIPPING ENDOTHELIAL KERATOPLASTY
DESCEMET's MEMBRANE ENDOTHELIAL KERATOPLASTY
FEMTOSECOND LASER ASSISTED CORNEAL SURGERY
SUMMARY
SECTION 19: APPENDICES
CHAPTER::
SURGICAL PROCEDURE GUIDELINES
PROCEDURAL STEPS FOR THE REPAIR OF CORNEAL LACERATIONS
SUTURELESS REPAIR OF CONJUNCTIVAL EROSION ASSOCIATED WITH SCLERAL RESORPTION FOLLOWING TUBE SHUNT SURGERY
INSTRUMENTATION
PROCEDURE TECHNIQUE
CONJUNCTIVAL FLAPS PROCEDURE FOR PTERYGIUM SURGERY
Preoperative
Conjunctival Flaps Procedure: Five Steps
Postoperative
TECHNIQUE OF LIMBAL BIOPSY
TECHNIQUE OF LIMBAL CULTURE
TECHNIQUE OF LIMBAL TRANSPLANTATION
POSTOPERATIVE MANAGEMENT
PENETRATING KERATOPLASTY: SUMMARY OF OPERATION
TRABECULECTOMY (FORNIX-BASED APPROACH)
TRABECULECTOMY (LIMBUS-BASED APPROACH)
GLAUCOMA DRAINAGE DEVICES
SURGICAL TECHNIQUE
DESCEMET's MEMBRANE ENDOTHELIAL KERATOPLASTY SURGICAL STEPS
Obtaining a Soft Eye
Incisions and Descemetorhexis
Intraoperative Preparation of the Descemet's Membrane Endothelial Keratoplasty (DMEK) Graft
Donor Implantation and Unfolding
PHOTOTHERAPEUTIC KERATECTOMY PROCEDURE
BOSTON KERATOPROSTHESIS TYPE I SURGERY: STEP BY STEP SURGICAL PREPARATION
LIGHT ADJUSTABLE LENS TECHNOLOGY
Device Description
Light Adjustable Intraocular Lens
Light Delivery Device
Indications for Use
Patients
Light Adjustable Lens Implantation and Refractive Adjustment
Surgical Procedure
Power Adjustment Procedure
Lock-in Irradiation Procedure
COMMON RELEX, FLEX AND SMILE STEPS (FIRST-HALF SHARED STEPS)
FLEX SPECIFIC STEPS (SECOND-HALF STEPS)
SMILE SPECIFIC STEPS (SECOND-HALF STEPS)
GRAFT CUTTING AND SURGERY
DONOR CORNEA LASER RESECTION WITH FEMTOSECOND LASER*
RECIPIENT CORNEA LASER RESECTION WITH FEMTOSECOND LASER
INDEX
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