CONTENTS CHAPTER 25 CATARACT SURGERY Its Evolution And Progress The Unique Innovative and Transforming Events Anatomic Highlights of the Lens in Three Dimensions How Cataracts Respond Differently Cataract Surgery in its Different Stages 1. The Period of Extracapsulars with Coaching Jaques Daviel 2. Precursor of Intracapsulars 3. The 50 Year Era of Intracapsulars 4. The Development of Enzymatic Zonulolysis Cryoextraction Helmholtz s Invention of Ophthalmoscope Detecting Changes in Claude Monet s Color of Cataracts Intraocular Lenses in the Horizon Harold Ridley s Fight for Sight Design and Creativity for the First IOL Saint Thomas Hospital and the First IOL Implanted Successfully First IOL Implant in the United States Historical Personalities Related to Harold Ridley s Development of his Intraocular Lens and Landmark Operation Key Developments in Cataract Surgery Over the Last 60 Years Cataract Surgery- Problems Pending Solutions CHAPTER 26 CATARACT INCISIONS PART I Small Incision and Fluidics In Cataract Surgery Surgical Incisions for Phaco Limbal Incision and Scleral Tunnel Incisions Corneal Sutureless Incision Scleral Tunnel Sutureless Cataract Wound xxiv 3 5 6 7 7 7 8 9 11 13 13 15 17 17 19 20 21 21 25 26 33 35 36 37 38
Mechanism of Valve-Type Self Sealing Cataract Wound Combining Tunnel Incision with Opening in Anterior Capsule The Significant Role of Dr. Howard Fine Capsulorhexis Jack Dodick s Technique Gimbel s Concepts Malbran s CCC Technique Hydro Processes Related to Phacoemulsification Hydrodelineation, Hydrosonics and Hydrolysis CATARACT INCISIONS PART II The Evolution of Cataract Surgery Incisions Fine s Original Technique Self Sealing Scleral Tunnel Incision Increased Incidence of Infectious Endophthalmitis Following Cataract Surgery with CCI Endophthalmitis Prophylaxis The Need for 4th Generation Fluoroquinolones The Architecture of a Different Clear Corneal Incision Grooved Incision Routinely Constructed Side-Port Incisions Phaco Handpiece Paracentesis Irrigating Chopper Paracentesis CHAPTER 27 CATARACT SURGERY PART I Phacoemulsification Charles Kelman s Remarkable Development Initial Struggles and Hurdles The Importance of the American Academy s KPE Statistically Equal in Results Major and Additional Important Changes xxv 39 39 40 41 41 43 44 46 47 53 53 55 56 57 58 59 60 61 61 62 69 71 72 74 75
The Evolution of Surgical Techniques Sinskey s and Kratz s Methods Highlights in Development of Surgical Instrumentation for Phacoemulsification Charles Kelman, A Life Changing Experience Phacotechnology and Phacotechniques During the Past 60 Years The Role of Engineering in Development of Phacoemulsification CATARACT SURGERY PART II Rationale Behind The Phaco Machine Mechanism of the Phaco Machine The Principles of How the Phaco Machine Works Phacodynamics The Phaco Handpiece Mechanism of Action of Phaco Probe Tip Basic Phaco Foot Pedal Functions Irrigating Bottle Height Related to Flow Rate Varying Ultrasonic Settings While Proceeding Through a Nucleus Of Varying Density During the Creation of a Furrow of Groove How to Program the Machine for Optimal Use Fluid Dynamics During Phaco Fluidics and Physics of Phacoemulsification Importance of the Surge Phenomenon CHAPTER 28 INTRAOCULAR LENSES PART I PMMA IOL s, Posterior Chamber Lenses and Foldable IOL s Nature of Intraocular Lenses The First Intraocular Lens Implants Summary of Research and its Results Providing Haptic Support Posterior Chamber Lenses Major Problems Looking for a Solution for Posterior Chamber Lenses Foldable Intraocular Lenses Effect of IOL Implantation on Incision Size Materials and Optics xxvi 76 77 78 81 82 84 89 91 92 93 94 95 96 97 98 99 101 104 104 111 113 114 117 118 118 119 120 120 121
INTRAOCULAR LENSES PART II ReSTOR Apodized Diffractive IOL s AcrySof ReSTOR Intraocular Lenses Main Characteristics of the Different AcrySof ReSTOR IOL s Visual Performance After AcrySof ReSTOR IOL Implantation Demographic Characteristics of Participants Visual Acuity Results for Distance, Intermediate and Near Vision Refractive Lens Exchange Performance CHAPTER 29 OCULAR TUMORS PART I Metastatic Cancer to The Eye Presentation, Ocular Manifestations Diagnosis and Supportive Evaluation Differential Diagnosis Management Systemic Evaluations Therapy Options Radiotherapy Side Effects of Radiotherapy Survival and Outcome 125 127 129 130 131 132 136 147 149 149 153 154 156 156 156 157 158 160 OCULAR TUMORS PART II Uveal Melanoma Collaborative Ocular Melanoma Study COMS Protocol Compliance COMS Small Choroidal Melanoma Observational Study COMS Medium Choroidal Melanoma Trial COMS Large Choroidal Melanoma Trial Choroidal Melanoma: Tumor Characteristics and Diagnosis Differential Diagnosis of Choroidal Melanoma Other Diagostic Considerations Therapeutic Approaches Observations xxvii 165 167 167 168 168 168 170 170 173 175 175 175
Brachytherapy Charged Particle Radiotherapy Transpupillary Thermotherapy (Small Choroidal Melanomas) Surgical Resection Enucleation Ciliary Body Melanoma Iris Melanoma Uveal Melanoma: Mortality Surveillance Following Intervention New Approaches to Managing Uveal Melanoma CHAPTER 30 OCULAR TRAUMA Ruptured Globe And Penetrating Injuries 176 180 181 181 181 182 183 184 184 184 191 Pathophysiology and Prognosis Main Pronostic Factors Other Key Factors Found to Correlate with Final Visual Prognosis Mechanism of Secondary Intraocular Complications Important Clinical Clues Initial History and Examination Diagnosis Imaging and Electrophysiological Examination Management of Anterior Segment Penetrating Wounds Corneal Lacerations Repair of Combined Corneal and Scleral Wounds Anterior Chamber Reformation Role of Viscoelastics in Penetrating Injuries of Anterior Segment 193 194 195 197 198 198 199 200 200 200 201 202 203 CHAPTER 31 OCULAR INFECTIOUS DISEASES PART I Bacterial, Fungal And Parasitic Keratitis 209 Contact Lens Wear and Keratitis Post-Refractive Surgery Infections Post-Keratoplasty Infections 211 211 212 213 xxviii
Keratitis Outbreaks Confocal Microscopy and Infectious Keratitis Standarization of Ophthalmic Laboratorial Diagnosis Conclusions OCULAR INFECTIOUS DISEASES PART II Blepharitis, Conjunctivitis And Trachoma Blepharitis Pathophysiological Mehanisms Role of Microorganisms Treatment Lid Hygiene, Antibiotics and Dietary Supplementation Bacterial Conjunctivitis Acute Bacterial Conjunctivitis Hyperacute Bacterial Conjunctivitis Chronic Bacterial Conjunctivitis Adenoviral Conjunctivitis Pharyngeal Conjunctival Fever Epidemic Keratoconjunctivitis Acute Hemorrhagic Conjunctivitis Herpes Simplex Conjunctivitis Ophthalmia Neonatorum Inclusion Conjunctivitis Neonatal Inclusion Conjunctivitis Inclusion Conjunctivitis in Adults Trachoma Parinaud Oculoglandular Syndrome Final Considerations CHAPTER 32 OCULAR INFECTIOUS DISEASES PART III Herpes Simplex Virus Keratitis Clinical Picture Infectious Epithelial Keratitis 214 215 216 217 221 223 225 226 227 227 228 228 229 230 230 231 231 232 232 233 234 234 235 236 238 238 245 247 247 247 xxix
Neurotrophic Keratopathy Stromal Keratitis Endothelitis Treatment Infectious Epithelial Keratitis Neurotrophic Keratopathy Stromal Keratitis and Endothelitis Necrotizing Stromal Keratitis Surgical Care and Prophylaxis Herpetic Keratitis, caused by Herpes Simplex Virus Type 1 OCULAR INFECTIOUS DISEASES PART IV Herpes Zoster Virus Keratitis Risk Factors Clinical Treatment 248 248 249 250 250 250 251 251 251 251 255 257 257 257 259 CHAPTER 33 OCULAR INFECTIOUS DISEASES PART V Infectious Endophthalmitis, Definition and Epidemiology Etiology, Clinical Findings, Classification and Laboratory Diagnosis Medical Therapy Systemic and Topical Application of Antiobiotics Intravitreal Injections of Antibiotics Surgical Therapy Vitrectomy Concepts in Prophylaxis Final Considerations xxx 267 269 269 271 272 272 273 274
OCULAR INFECTIOUS DISEASES PART VI Uveitis 279 Definition, Concepts of Disease, Pathogenesis and Classification Diagnostic Testing Examination of the Patient with Uveitis in the Past and New Technologies Ophthalmoscope and Slit Lamp Exam Laser flare-cell Photometry Fluorescein Angiography and Indocyanine Green Angiography Optical Coherence Tomography (OCT) Molecular Biology Techniques Invasive Diagnostic Testing for Uveitis Infectious Causes of Uveitis Toxoplasmosis Viral Retinitis Syphilis Tuberculosis Specific Treatment Surgical Advances in the Last Decade 281 282 283 283 283 284 285 287 287 288 288 289 291 292 293 296 CHAPTER 34 OPTICAL COHERENCE TOMOGRAPHY (OCT) PART I Indications And Interpretations 303 Principles of Operation Color Coding in OCT Interpretation of OCT Scanning Protocols Quantitative Analysis Algorithms Time Domain vs Fourier (Spectral) OCT Anterior Segment Application (AS-OCT) OCT Benefits in the Diagnosis of Retinal Diseases xxxi 305 306 306 307 308 309 309 310 311
OPTICAL COHERENCE TOMOGRAPHY (OCT) PART II Its Applications The Development and Clinical Impact of OCT Clinical Use Healthy Most Common Ophthalmic Applications Macular Degeneration Glaucoma Macular Hole Non-Proliferative Diabetic Retinopathy Epiretinal Membrane Additional OCT Applications OPTICAL COHERENCE TOMOGRAPHY (OCT) PART III Its Evolution Brief History of OCT Importance of OCT in Ophthalmology Understanding and Better Evaluating Retinal Diseases Time Domain and Spectral / Fourier Domain OCT: How Do They Work and What Are the Differences? Clinical Advantages of Spectral / Fourier Domain OCT Other Applications in Ophthalmology Ultrahigh Resolution OCT New Directions in Future OCT CHAPTER 35 EVOLUTION OF STRABISMUS IN THE PAST 60 YEARS The Most Important Developments in Strabismus and Their Evolution in the Last 60 Years The Management of Amblyopia xxxii 317 319 321 322 322 322 322 326 326 327 328 333 335 335 336 338 339 340 342 342 351 353 353
Causes of Irreversible Amblyopia Refractive Surgery for Prevention of Amblyopia in the Young Child Intraocular Lenses in Aphakic Babies Bilateral Congenital Cataract Congenital and Very Early Onset Strabismus Improvement in Anesthesia and Early Surgery in Children The Three Most Important Advances in Strabismus of the 1970 s Prismotheraphy Presurgical Treartment Botulinum Oculinum Toxin Microscope Posterior Fixation Suture Procedure Muscle Procedures Introduced Close to or After 1950 Adjustable Sutures Alphabetic Patterns Brown s Superior Oblique Tendon Sheath Syndrome Overcorrections, not a New Occurrence but a New Approach Instrumentation Past, Present, Future Influence of Radiology on Strabismology Factors Important to Developments in Strabismus, the Last 60 Years Specialty Clinics Fellowship Training Information Explosion CHAPTER 36 - A COSMETIC AND FUNCTIONAL OPHTHALMIC PLASTIC SURGERY Cosmetic Applications of Botulinum Toxin The Use of Botulinum Toxin Basic Supplies Required for BOTOX Reconstitution and Dilution Botulinum Endotoxin in Paralytic Strabismus Mechanism of Action of Botulinum Endotoxin Preoperative Patient Preparation Injection Technique xxxiii 354 354 354 356 356 358 358 358 359 360 360 361 362 362 363 364 365 365 365 366 366 366 367 367 373 375 375 377 378 380 381 382 382
Variabilities in Injection Technique Indications for Botulinum Toxin Contraindications and Complications Surgical Techniques on the Rectus Muscles Surgical Techniques on the Oblique Muscles Surgical Management of Dry Eye Description of Each Technique Dacryodeposits Parotid Duct Derivation Salivary Gland Transplantation Without Vascular Anastomosis Salivary Gland Transplantation With Vascular Anastomosis Mucosal Transplant Occlusion of the Canaliculi Blepharorraphy Cisternoplasty Inducing Blepharoptosis Lid / Eye Congruence CHAPTER 36 - B THE ROLE OF OPHTHALMIC FOUNDATIONS IN THE WESTERN HEMISPHERE Prevention of Blindness in Mexico Why Did I Start Assisting Labor in Ophthalmology? Prevention of Blindness in Peru Social Responsibility and Ophthalmological Institutions Prevention of Blindness in Colombia A Social and Communitarian Outreach Program xxxiv 382 383 384 385 386 387 388 388 388 388 390 392 392 393 396 397 397 403 405 405 411 411 416 416