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Book Details
Abstract
Get the quick answers you need on every aspect of clinical ophthalmology and apply them in your day-to-day practice. The latest edition of Ophthalmology by Drs. Yanoff and Duker presents practical, expert, concise guidance on nearly every ophthalmic condition and procedure, equipping you to efficiently overcome whatever clinical challenges you may face.
- Consult this title on your favorite e-reader , conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
- Focus on the clinically actionable information you need thanks to a more streamlined format.
- Make optimal use of the newest drug therapies, including Anti-VEGF treatment for wet ARMD and bevacizumab treatment for complications of diabetes.
- Get authoritative guidance on the newest treatment options for cornea disorders, including evolving ocular surface reconstruction techniques and new cornea procedures such as DSEK.
- Take it with you anywhere. Access the full text, video clips, and more online at Expert Consult.
- Apply the latest advances in the diagnosis and treatment of ocular disease, including new drug therapies for retinal disorders; today’s expanded uses of optical coherence tomography (OCT) and high-resolution imaging modalities; new corneal, cataract and refractive surgical approaches; and new developments in molecular biology and genetics, ocular surface disease, glaucoma testing, neuro-ophthalmology, uveitis, ocular tumors, and much more.
- Visualize how to proceed by viewing more than 2200 illustrations (1,900 in full color) depicting the complete range of clinical disorders, imaging methods, and surgical techniques.
- Hone and expand your surgical skills by watching 40 brand-new videos demonstrating key techniques in cornea, cataract, refractive, retina and glaucoma surgery.
- Spend less time searching thanks to a user-friendly visual format designed for quick, "easy-in easy-out" reference and an instant understanding on any topic.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Ophthalmology | i | ||
| Copyright Page | iv | ||
| User Guide | v | ||
| Color Coding | v | ||
| ExpertConsult.com Website | v | ||
| Video Contents | vi | ||
| Table Of Contents | vii | ||
| Preface | xii | ||
| Preface to First Edition | xiii | ||
| List of Contributors | xiv | ||
| Acknowledgments | xxiii | ||
| Dedication | xxiii | ||
| 1 Genetics | 1 | ||
| 1.1 Fundamentals of Human Genetics | 1 | ||
| DNA and the Central Dogma of Human Genetics | 1 | ||
| Human Genome | 1 | ||
| Mitosis and Meiosis | 2 | ||
| Basic Mendelian Principles | 2 | ||
| Mutations | 3 | ||
| Genes and Phenotypes | 4 | ||
| Patterns of Human Inheritance | 4 | ||
| Autosomal Dominant | 4 | ||
| Autosomal Recessive | 5 | ||
| X-Linked Recessive | 5 | ||
| Mitochondrial Inheritance | 6 | ||
| Pseudodominance | 6 | ||
| X-Linked Dominant Inheritance | 6 | ||
| Digenic Inheritance and Polygenic Inheritance | 6 | ||
| Imprinting | 6 | ||
| Molecular Mechanisms of Disease | 7 | ||
| Autosomal Dominant | 7 | ||
| Haploinsufficiency | 7 | ||
| Gain-of-function dominant negative effect | 7 | ||
| Autosomal and X-Linked Recessive | 7 | ||
| Gene Therapy | 7 | ||
| References | 8.e1 | ||
| Key References | 8 | ||
| 1.2 Molecular Genetics of Selected Ocular Disorders | 9 | ||
| Introduction | 9 | ||
| Dominant Corneal Dystrophies | 9 | ||
| Aniridia, Peter’s Anomaly, Autosomal Dominant Keratitis | 9 | ||
| Rieger’s Syndrome | 10 | ||
| Juvenile Glaucoma | 10 | ||
| Congenital Glaucoma | 11 | ||
| Nonsyndromic Congenital Cataract | 11 | ||
| Retinitis Pigmentosa | 11 | ||
| Stargardt’s Disease | 12 | ||
| X-Linked Juvenile Retinoschisis | 12 | ||
| Norrie’s Disease | 12 | ||
| Sorsby’s Macular Dystrophy | 12 | ||
| Gyrate Atrophy | 12 | ||
| Color Vision | 12 | ||
| Retinoblastoma | 12 | ||
| Albinism | 12 | ||
| Leber’s Optic Neuropathy | 13 | ||
| Congenital Fibrosis Syndromes and Disorders of Axon Guidance | 13 | ||
| Autosomal Dominant Optic Atrophy | 13 | ||
| Complex Traits | 14 | ||
| References | 14.e1 | ||
| Key References | 14 | ||
| 1.3 Genetic Testing and Genetic Counseling | 15 | ||
| Genetic Testing | 15 | ||
| Role of Genetic Testing in the Clinic | 15 | ||
| Methods for DNA-based Genetic Testing | 15 | ||
| Current Recommendations for Genetic Testing for Ophthalmic Diseases | 16 | ||
| CLIA Laboratories | 16 | ||
| Genetic Reports | 16 | ||
| Genetic Counseling | 16 | ||
| Clinical Evaluation and Family History | 16 | ||
| Risk Prediction Based on Inheritance | 16 | ||
| Indications to Refer for Genetic Counseling | 17 | ||
| Known inherited condition | 17 | ||
| Ocular and systemic congenital anomalies | 17 | ||
| Specific eye diseases | 17 | ||
| Ocular defects associated with genetic diseases | 17 | ||
| Confidentiality | 17 | ||
| References | 17.e1 | ||
| Key References | 17 | ||
| 2 Optics and Refraction | 19 | ||
| 2.1 Visible Light | 19 | ||
| Origin of Visible Light | 19 | ||
| Source | 19 | ||
| Effect of Earth’s Atmosphere | 19 | ||
| Visible Light Sensing | 19 | ||
| Visible Light Receptors and the Ocular Media | 20 | ||
| Receptors | 20 | ||
| Receptor size and shape | 20 | ||
| Light sensitivity | 21 | ||
| Receptor shape | 21 | ||
| Receptor as a light guide | 21 | ||
| Dioptric Media | 22 | ||
| Photonics | 22 | ||
| Summary | 22 | ||
| Key References | 22 | ||
| References | 22.e1 | ||
| 2.2 Physical Optics for Clinicians | 23 | ||
| Overview | 23 | ||
| Electromagnetic and Scalar Waves | 23 | ||
| Polarization | 23 | ||
| Diffraction and Interference | 24 | ||
| The Speed of Light and Dispersion | 25 | ||
| Quantum Model of Light | 26 | ||
| Fluorescence and Phosphorescence | 26 | ||
| Laser Fundamentals | 26 | ||
| Light–Tissue Interactions | 26 | ||
| Light Scattering | 27 | ||
| Key References | 27 | ||
| References | 27.e1 | ||
| 2.3 Light Damage to the Eye | 28 | ||
| Ultraviolet Filtration | 28 | ||
| Ultraviolet Profile | 28 | ||
| Ultraviolet Vulnerability | 28 | ||
| Older Individuals | 28 | ||
| Lightly Pigmented Individuals | 29 | ||
| Aphakia | 29 | ||
| Use of Photosensitizing Drugs | 29 | ||
| Outer Segment Turnover | 29 | ||
| Biochemical Mechanism of UV Radiation Damage | 30 | ||
| Molecular Fragmentation | 30 | ||
| Free Radical Generation | 30 | ||
| Light Protection | 30 | ||
| During Surgery | 30 | ||
| Ultraviolet Filters in Intraocular Lenses | 30 | ||
| Absorptive Lenses | 30 | ||
| Improvement of Contrast Sensitivity | 30 | ||
| Improvement of Dark Adaptation | 30 | ||
| Reduction of Glare Sensitivity | 30 | ||
| Improvement of Color Contrast | 30 | ||
| Use of Photochromic Lenses | 30 | ||
| Ultraviolet-Absorbing Lenses | 31 | ||
| Key References | 31 | ||
| References | 31.e1 | ||
| 2.4 Principles of Lasers | 32 | ||
| Introduction | 32 | ||
| How Lasers Work | 32 | ||
| Continuous and Pulsed Lasers | 33 | ||
| What Color is Your Laser? | 33 | ||
| Clinical Use of Lasers | 33 | ||
| Clinical Use of Laser Photocoagulation | 34 | ||
| Clinical Use of Photodisruption | 34 | ||
| Clinical Use of Laser Photoablation | 34 | ||
| Photodynamic Therapy | 35 | ||
| Diagnostic Use of Lasers | 35 | ||
| Scanning Laser Ophthalmoscopy | 35 | ||
| Optical Coherence Tomography | 35 | ||
| Wavefront Analysis and Photorefractive Keratectomy | 35 | ||
| Conclusion | 36 | ||
| Key References | 37 | ||
| References | 37.e1 | ||
| 2.5 Optics of the Normal Eye | 38 | ||
| Introduction | 38 | ||
| Individual Optical Elements of the Eye | 38 | ||
| Corneal Factors | 38 | ||
| Pupillary Factors | 38 | ||
| Crystalline Lens Factors | 39 | ||
| Ocular Aberrations | 39 | ||
| Chromatic aberration | 39 | ||
| Higher-order aberrations | 39 | ||
| Coma | 39 | ||
| Light scattering | 39 | ||
| Retinal Factors | 39 | ||
| Resolution and Focal Length Factors | 40 | ||
| Depth of Focus | 40 | ||
| Pinhole Optics | 41 | ||
| Visual Acuity Testing | 42 | ||
| Testing Distance | 42 | ||
| Other Considerations | 42 | ||
| Contrast Sensitivity Testing | 43 | ||
| Contrast | 43 | ||
| Contrast Sensitivity | 43 | ||
| Targets | 43 | ||
| Sine Waves | 43 | ||
| Recording Contrast Sensitivity | 44 | ||
| Modulation Transfer Function Testing | 44 | ||
| Wavefront Testing | 45 | ||
| Retina–Brain Image Processing | 45 | ||
| Vernier Acuity | 45 | ||
| Fast-Moving Objects | 45 | ||
| Flicker | 45 | ||
| Dark Adaptation | 45 | ||
| Key References | 45 | ||
| References | 45.e1 | ||
| 2.6 Testing of Refraction | 46 | ||
| Introduction | 46 | ||
| Historical Review | 46 | ||
| Purpose of the Test | 46 | ||
| Utility of the Test | 46 | ||
| Procedure | 46 | ||
| Instrumentation | 47 | ||
| Monocular Subjective Refraction | 47 | ||
| Binocular Balance | 49 | ||
| Near Refraction | 50 | ||
| Alternative Tests | 51 | ||
| Key References | 51 | ||
| References | 51.e1 | ||
| 2.7 Contact Lenses | 52 | ||
| Introduction | 52 | ||
| Lens Types and Usage | 52 | ||
| Lens Categories | 52 | ||
| Disposable Contact Lenses | 52 | ||
| Colored Lenses | 53 | ||
| Contact Lenses for Astigmatism | 53 | ||
| Contact Lens Asphericity | 53 | ||
| Contact Lenses for Presbyopia | 53 | ||
| Unusual Surface Configuration | 53 | ||
| Initial Fitting | 53 | ||
| Follow-Up Care | 54 | ||
| Corneal and Conjunctival Tissue Problems | 54 | ||
| Superficial punctate keratopathy (also called punctate epithelial erosion) | 55 | ||
| Edema | 55 | ||
| Microcysts | 55 | ||
| Infiltrates | 55 | ||
| Hyperemia and neovascularization | 55 | ||
| Polymegathism and blebs | 55 | ||
| Giant papillary conjunctivitis | 56 | ||
| Silicone Hydrogel Lenses | 56 | ||
| Spectacle Blur | 56 | ||
| Mechanical or Physical Problems | 56 | ||
| Key References | 56 | ||
| References | 56.e1 | ||
| 2.8 Ophthalmic Instrumentation | 57 | ||
| Introduction | 57 | ||
| Keratometer and Corneal Topographer | 57 | ||
| Slit-Lamp Biomicroscope | 58 | ||
| Illumination | 58 | ||
| Improving Tissue Contrast | 58 | ||
| Observation System | 58 | ||
| Slit-Lamp Fundus Lenses | 58 | ||
| Goldmann Applanation Tonometer | 59 | ||
| Optical Pachymeter | 61 | ||
| Specular Microscope | 62 | ||
| Optics of Endothelial Microscopy | 63 | ||
| Operating Microscope | 64 | ||
| Retinoscope | 64 | ||
| Optics of Retinoscopy | 65 | ||
| Neutrality | 65 | ||
| With and Against Motion | 65 | ||
| Other Clues | 66 | ||
| Enhancement | 66 | ||
| Myopia Estimation | 66 | ||
| Astigmatism | 66 | ||
| Automated Objective Refractometer | 66 | ||
| Characteristics of Contemporary Objective Refractors | 67 | ||
| Possible Problems | 68 | ||
| Lensmeter | 68 | ||
| Binocular Indirect Ophthalmoscope | 69 | ||
| Illumination System | 69 | ||
| Observation System | 69 | ||
| Contrast | 69 | ||
| Inverted image | 69 | ||
| Field of view | 69 | ||
| Magnification | 69 | ||
| Stereopsis | 69 | ||
| Direct Ophthalmoscope | 69 | ||
| Important Considerations when Using the Direct Ophthalmoscope | 70 | ||
| Bulb color temperature | 70 | ||
| Green filter | 70 | ||
| High astigmatism | 70 | ||
| Nerve fiber layer status | 70 | ||
| Looking through a cataract | 70 | ||
| Corneal reflection | 70 | ||
| Light Safety | 70 | ||
| Fundus Camera | 70 | ||
| Lighting | 70 | ||
| Reducing Reflections from the Cornea and Instrument | 71 | ||
| The Observation System | 71 | ||
| Field of View | 71 | ||
| Fluorescein Angiography | 71 | ||
| Magnifying Devices | 71 | ||
| Angular Magnification | 71 | ||
| Magnifying Glass | 71 | ||
| Galilean Telescope | 72 | ||
| Simple Microscope (Operating Loupe) | 72 | ||
| Effects of Lens Aberrations | 73 | ||
| Optical Coherence Tomography | 73 | ||
| Wavefront Aberrometers | 73 | ||
| Wavefront Analysis | 73 | ||
| Hartmann–Shack Aberrometry | 73 | ||
| Tscherning Aberrometry | 75 | ||
| Retinal Raytracing Technique | 75 | ||
| Key References | 75 | ||
| References | 75.e1 | ||
| 2.9 Perspectives on Aberrations of the Eye | 76 | ||
| Introduction | 76 | ||
| The Wavefront Approach to Aberrations | 76 | ||
| Defocus | 77 | ||
| Regular Astigmatism (RA) | 77 | ||
| Spherical Aberration (SA) | 77 | ||
| Distortion | 78 | ||
| Coma | 78 | ||
| Astigmatism of Oblique Incidence | 78 | ||
| Piston Error | 78 | ||
| Higher-Order Aberrations | 78 | ||
| Mathematical Considerations | 79 | ||
| Chromatic Aberration | 79 | ||
| Clinical Measurement of Aberrations | 79 | ||
| Clinical Application of Aberration Theory | 80 | ||
| An Overall Perspective on Aberration Theory | 80 | ||
| Key References | 80 | ||
| References | 80.e1 | ||
| 3 Refractive Surgery | 81 | ||
| 3.1 Current Concepts, Classification, and History of Refractive Surgery | 81 | ||
| Introduction | 81 | ||
| Excimer Laser and Ablation Profiles | 81 | ||
| Laser Ablation Profiles | 81 | ||
| Munnerlyn’s Formula | 82 | ||
| Wavefront-Guided Ablation | 82 | ||
| Topography-Guided Ablation | 83 | ||
| Wavefront-Optimized/Aspheric/ Q-Factor-Adjusted Laser Profiles | 83 | ||
| Presbyopia Correction | 83 | ||
| Concepts in Development and Optical Ray-Tracing | 83 | ||
| Classification of Refractive Procedures | 84 | ||
| Cornea | 84 | ||
| Central cornea | 84 | ||
| Corneal surface: addition | 84 | ||
| Epikeratophakia | 84 | ||
| Corneal surface: subtraction | 84 | ||
| Photorefractive keratectomy (PRK) | 85 | ||
| Laser subepithelial keratomileusis | 85 | ||
| EpiLASIK | 85 | ||
| Corneal stroma: subtraction | 85 | ||
| Keratomileusis | 85 | ||
| Laser-assisted in situ keratomileusis (LASIK) | 85 | ||
| Femto-LASIK | 86 | ||
| Intrastromal laser ablation | 86 | ||
| Intrastromal lenticule extraction | 86 | ||
| Corneal stroma: addition | 86 | ||
| Keratophakia | 86 | ||
| Intracorneal inlays | 86 | ||
| Corneal stroma: relaxation | 86 | ||
| Lamellar keratotomy (hyperopic automated lamellar keratoplasty) | 86 | ||
| Peripheral cornea | 86 | ||
| Peripheral cornea: addition | 86 | ||
| Intracorneal rings | 86 | ||
| Intracorneal ring segments | 87 | ||
| Peripheral cornea: subtraction | 87 | ||
| Wedge resection | 87 | ||
| Peripheral cornea: relaxation | 87 | ||
| Radial keratotomy | 87 | ||
| Hexagonal keratotomy | 87 | ||
| Astigmatic keratotomy | 87 | ||
| Peripheral cornea: coagulation-compression | 87 | ||
| Thermokeratoplasty | 87 | ||
| Microwave-induced thermokeratoplasty: Keraflex® procedure | 88 | ||
| Circular keratorrhaphy | 88 | ||
| Peripheral cornea: oppression | 88 | ||
| Orthokeratology | 88 | ||
| Intraocular Lenses and Refractive Lensectomy | 88 | ||
| Refractive lens exchange | 88 | ||
| Toric intraocular lenses | 88 | ||
| Multifocal intraocular lenses | 88 | ||
| The potentially accommodative intraocular lenses | 88 | ||
| Light-adjustable intraocular lenses | 88 | ||
| Phakic intraocular lenses | 89 | ||
| Add-on intraocular lenses in pseudophakic eyes | 89 | ||
| Electronic IOLS | 89 | ||
| New or Alternative Approaches | 89 | ||
| Corneal collagen cross-linking | 89 | ||
| LASIK extra | 89 | ||
| Prophylactic | 89 | ||
| In combination with keratoplasty | 90 | ||
| IntraCor | 90 | ||
| Ciliary muscle–zonular complex | 90 | ||
| Axial length | 90 | ||
| Refractive indexes | 90 | ||
| Summary | 90 | ||
| Key References | 90 | ||
| References | 90.e1 | ||
| 3.2 Preoperative Evaluation for Refractive Surgery | 91 | ||
| Introduction | 91 | ||
| Systemic Contraindications for Keratorefractive Surgery | 91 | ||
| Ophthalmic Contraindications | 91 | ||
| Ophthalmic Examination | 92 | ||
| Ancillary Testing | 93 | ||
| Wavefront Measurement (Aberrometry) | 93 | ||
| Computerized Videokeratography | 93 | ||
| Pachymetry | 93 | ||
| Counseling | 93 | ||
| Key References | 94 | ||
| References | 94.e1 | ||
| 3.3 Excimer Laser Photorefractive Keratectomy | 95 | ||
| Introduction | 95 | ||
| History and Fundamentals of the Excimer Laser | 95 | ||
| Excimer Laser Keratomileusis | 95 | ||
| Surface ablation | 95 | ||
| Ablation Profiles | 95 | ||
| Tracking Systems | 96 | ||
| Iris Registration (IR) System | 96 | ||
| Preoperative Evaluation | 96 | ||
| Surgical Treatment | 97 | ||
| Patient Preparation and Epithelial Removal | 97 | ||
| Stromal Ablation | 97 | ||
| Postoperative Management | 98 | ||
| Photorefractive Keratectomy with Mitomycin-C | 99 | ||
| Wavefront-Guided PRK | 99 | ||
| Results | 99 | ||
| Photorefractive Keratectomy for Myopia and Astigmatism | 99 | ||
| Photorefractive Keratectomy for Hyperopia | 100 | ||
| Photorefractive Keratectomy Following Previous Refractive Surgery | 100 | ||
| Wavefront-Guided PRK | 100 | ||
| Complications | 100 | ||
| Undercorrection or Overcorrection | 100 | ||
| Epithelial Problems | 100 | ||
| Corneal Haze/Scar Formation | 100 | ||
| Dry Eyes | 101 | ||
| Infectious Keratitis | 101 | ||
| Conclusions | 101 | ||
| Key References | 101 | ||
| References | 101.e1 | ||
| 3.4 Laser Subepithelial Keratomileusis (LASEK) and Epi-LASIK | 102 | ||
| Introduction | 102 | ||
| Indications | 102 | ||
| Advantages | 102 | ||
| LASEK and Epi-LASIK Surgical Techniques | 102 | ||
| Preoperative Evaluation | 102 | ||
| LASEK Surgical Technique (see Fig. 3-4-1) | 102 | ||
| Epi-LASIK Surgical Technique (Fig. 3-4-2) | 104 | ||
| Postoperative Management | 104 | ||
| Complications | 104 | ||
| LASEK-Related Intraoperative Complications | 104 | ||
| Alcohol leakage during surgery | 104 | ||
| Incomplete epithelial detachment | 104 | ||
| Epi-LASIK-Related Intraoperative Complications | 104 | ||
| Early Postoperative Complications of LASEK and Epi-LASIK | 104 | ||
| Epithelial Healing | 104 | ||
| Pain | 104 | ||
| Infiltrates and Infection | 104 | ||
| Dry Eye | 104 | ||
| Long-Term Postoperative Complications | 104 | ||
| Corneal Haze | 104 | ||
| Laser-Related Complications | 104 | ||
| Clinical Outcomes | 105 | ||
| Clinical Results of LASEK and Epi-LASIK | 105 | ||
| LASEK and Epi-LASIK Versus PRK and LASIK | 106 | ||
| Key References | 106 | ||
| References | 106.e1 | ||
| 3.5 LASIK | 107 | ||
| Historical Review | 107 | ||
| LASIK | 107 | ||
| Excimer Lasers | 108 | ||
| Wavefront-Guided Technology and Custom Ablations | 109 | ||
| Wavefront-Optimized Technology and Ablations | 110 | ||
| Topography-Guided LASIK | 110 | ||
| Patient Selection | 110 | ||
| Preoperative evaluation and diagnostic approach | 110 | ||
| Limitations and contraindications | 110 | ||
| Microkeratomes and Femtosecond Lasers | 111 | ||
| Operative Technique | 111 | ||
| Microkeratome surgical technique | 112 | ||
| Femtosecond laser flap creation | 112 | ||
| Excimer laser ablation | 112 | ||
| Postoperative Care | 113 | ||
| Complications | 113 | ||
| Intraoperative complications | 113 | ||
| Ablation complications | 114 | ||
| Postoperative complications | 115 | ||
| Keratectasia | 116 | ||
| Results | 116 | ||
| LASIK Enhancements | 117 | ||
| LASIK in Complex Cases | 118 | ||
| LASIK after Radial Keratotomy | 118 | ||
| LASIK after Photorefractive Keratectomy | 118 | ||
| LASIK after Penetrating Keratoplasty | 118 | ||
| Intraocular Lens Calculations after LASIK | 119 | ||
| Bioptics | 119 | ||
| Summary | 119 | ||
| Key References | 119 | ||
| References | 119.e1 | ||
| 3.6 Wavefront-Based Excimer Laser Refractive Surgery | 120 | ||
| Introduction | 120 | ||
| Wavefront Optics | 120 | ||
| Higher-Order Aberrations | 120 | ||
| Ideal Corneal Shape | 120 | ||
| Measurements of Wavefront Aberrations | 120 | ||
| Quality of Vision and Measures of Optical Quality | 123 | ||
| Wavefront-Measuring Devices | 123 | ||
| Wavefront-Based Surgery | 125 | ||
| Results | 125 | ||
| Wavefront Platforms (Table 3-6-1) | 125 | ||
| Conclusion | 126 | ||
| Key References | 126 | ||
| References | 126.e1 | ||
| 3.7 Phakic Intraocular Lenses | 127 | ||
| Introduction | 127 | ||
| History of Phakic Lenses | 127 | ||
| Indications of Phakic Lenses | 128 | ||
| High Myopia | 128 | ||
| High Hyperopia | 128 | ||
| High Astigmatism | 129 | ||
| Advantages and Disadvantages of Phakic IOLs | 129 | ||
| Intraocular Lens Power Calculation | 129 | ||
| Ancillary Tests | 129 | ||
| Sizing the Anterior Chamber Angle-Supported Phakic IOLs | 130 | ||
| Sizing the Anterior Chamber Iris-Fixated Phakic IOLs | 130 | ||
| Sizing the Posterior Chamber Phakic IOLs | 130 | ||
| Visual Outcomes (Table 3-7-3) | 130 | ||
| Anterior Chamber Angle-Supported Phakic Intraocular Lenses | 131 | ||
| Surgical Procedure for the AcrySof Cachet | 132 | ||
| Complications | 133 | ||
| Halos and glare | 133 | ||
| Pupillary ovalization | 133 | ||
| Endothelial damage | 134 | ||
| Elevation of intraocular pressure | 134 | ||
| Uveitis | 135 | ||
| Cataract | 135 | ||
| Retinal detachment | 135 | ||
| Other complications | 135 | ||
| Iris-Fixated Phakic Intraocular Lenses | 135 | ||
| Surgical Procedure | 136 | ||
| Complications | 137 | ||
| Glare and halos | 137 | ||
| Anterior chamber inflammation/pigment dispersion | 137 | ||
| Endothelial cell loss | 138 | ||
| Glaucoma | 138 | ||
| Iris atrophy or dislocation | 138 | ||
| Cataract | 138 | ||
| Other complications | 138 | ||
| Posterior Chamber Phakic Intraocular Lenses | 138 | ||
| Surgical Technique | 138 | ||
| Complications | 138 | ||
| Glare and halos | 138 | ||
| Cataract | 139 | ||
| Pigmentary dispersion and elevated intraocular pressure | 139 | ||
| Decentration | 140 | ||
| Endothelial cell damage | 140 | ||
| Bioptics | 140 | ||
| Conclusion | 140 | ||
| Key References | 140 | ||
| References | 140.e1 | ||
| 3.8 Astigmatic and Radial Incisional Keratotomy | 141 | ||
| Historical Review | 141 | ||
| Incisional Keratotomy | 141 | ||
| Corneal Wound Healing after Incisional Keratotomy | 141 | ||
| Phases of Normal Epithelial and Stromal Wound Healing | 141 | ||
| Epithelial phase | 141 | ||
| Stromal phase | 141 | ||
| Cross-linking and initial stabilization phase | 141 | ||
| Remodeling and strengthening phase | 141 | ||
| Postoperative Side-Effects Related to Wound Healing | 142 | ||
| Surgical Techniques for Astigmatic and Radial Keratotomy | 142 | ||
| Preoperative Considerations | 142 | ||
| Patient selection | 142 | ||
| Age | 143 | ||
| Visual axis determination and marking | 143 | ||
| Intraoperative corneal pachymetry | 143 | ||
| Diamond knife calibration and adjustment | 143 | ||
| Femtosecond laser AK | 143 | ||
| Incision Technique | 143 | ||
| Femtosecond AK and laser arcuate resection (LAR) | 143 | ||
| Surgical Protocol | 143 | ||
| Axis of astigmatism | 143 | ||
| Postoperative Protocol | 144 | ||
| Complications of Astigmatic and Radial Incisional Keratotomy | 144 | ||
| Complications Related to Corneal Incisions | 144 | ||
| Incision beyond clear cornea | 144 | ||
| Optical zone invasion | 144 | ||
| Intersecting incisions | 144 | ||
| Complications Related to Corneal Perforations | 144 | ||
| Postoperative Complications | 145 | ||
| Progressive hyperopia | 145 | ||
| Induced astigmatism | 145 | ||
| Contact lens intolerance | 145 | ||
| Sight-Threatening Complications | 145 | ||
| Stromal melting | 145 | ||
| Infectious keratitis | 146 | ||
| Complications Associated with Adjunctive Therapy | 146 | ||
| Conclusions | 146 | ||
| Key References | 146 | ||
| References | 146.e1 | ||
| 3.9 Intrastromal Corneal Ring Segments and Collagen Crosslinking | 147 | ||
| Introduction | 147 | ||
| Surgical Technique | 148 | ||
| ICRS Channel Formation | 148 | ||
| ICRS Channeling with Femtosecond Laser | 148 | ||
| Segment Insertion | 148 | ||
| Injection Adjustable Keratoplasty | 148 | ||
| Corneal Collagen Crosslinking (CXL) | 148 | ||
| Clinical Outcome | 149 | ||
| Wound Healing | 149 | ||
| Postoperative Care and Management | 149 | ||
| ICRS for Keratoconus and after LASIK | 149 | ||
| Combination Treatment with Corneal Collagen Crosslinking | 150 | ||
| Conclusions | 150 | ||
| Key References | 150 | ||
| References | 150.e1 | ||
| 3.10 Surgical Correction of Presbyopia | 151 | ||
| Introduction | 151 | ||
| Corneal Surgery | 151 | ||
| Excimer Laser Correction of Presbyopia Using the Concept of Multifocal Cornea | 151 | ||
| Historical Background | 151 | ||
| Patient Selection | 152 | ||
| Types of Multifocal Corneal Excimer Laser Profiles | 152 | ||
| Presby-LASIK by transitional multifocality | 152 | ||
| Peripheral presby-LASIK techniques | 152 | ||
| Central presby-LASIK techniques | 152 | ||
| Limitations of Corneal Multifocality | 153 | ||
| Intrastromal Correction of Presbyopia Using a Femtosecond Laser System (INTRACOR Procedure) | 153 | ||
| Historical Background | 153 | ||
| Surgical Technique | 153 | ||
| Advantages and Disadvantages of the INTRACOR procedure | 154 | ||
| Surgical Correction of Presbyopia with Intracorneal Inlay | 155 | ||
| Historical Background | 155 | ||
| The AcuFocus KAMRA Small Aperture Inlay: Optical Principle | 155 | ||
| Surgical Technique | 156 | ||
| Advantages and Limitations of the Small Aperture Corneal Inlay | 156 | ||
| Hydrogel Refractive Presbyopic Implants | 157 | ||
| Lens Surgery | 157 | ||
| Pseudophakic Presbyopia Correction with Multifocal IOLs | 157 | ||
| Important Issues Associated with the Indication for Multifocal IOLs | 157 | ||
| The Perfect Multifocal IOL | 157 | ||
| Different Types of Multifocal IOL | 157 | ||
| Clinical Studies | 158 | ||
| Presbyopic Pseudophakic Correction with Accommodative Iols | 160 | ||
| Clinical Study | 160 | ||
| Scleral Surgery for the Correction of Presbyopia | 160 | ||
| Conclusion | 161 | ||
| References | 161.e1 | ||
| Key References | 161 | ||
| 4 Cornea and Ocular Surface Diseases | 163 | ||
| 1 Basic Principles | 163 | ||
| 4.1 Corneal Anatomy, Physiology, and Wound Healing | 163 | ||
| Introduction | 163 | ||
| Embryology, Anatomy, and Physiology of the Cornea | 163 | ||
| Epithelium | 163 | ||
| Stroma | 164 | ||
| Endothelium | 164 | ||
| Endothelial Responses to Stress | 165 | ||
| Corneal Wound Healing | 166 | ||
| Epithelial Injury | 166 | ||
| Stromal Injury | 166 | ||
| Endothelial Injury | 167 | ||
| Key References | 167 | ||
| References | 167.e1 | ||
| 4.2 Corneal Topography and Wavefront Imaging | 168 | ||
| Corneal Topography | 168 | ||
| Wavefront Analysis | 168 | ||
| Summary | 172 | ||
| Key References | 172 | ||
| References | 172.e1 | ||
| 2 Congenital Abnormailities | 173 | ||
| 4.3 Congenital Corneal Anomalies | 173 | ||
| Introduction | 173 | ||
| Size and Shape Anomalies | 173 | ||
| Microcornea | 173 | ||
| 5 The Lens | 329 | ||
| 5.1 Basic Science of the Lens | 329 | ||
| References | 330.e1 | ||
| Key References | 330 | ||
| 5.1 Basic Science of the Lens | e1 | ||
| Introduction | e1 | ||
| Anatomy of the Lens | e1 | ||
| Capsule | e1 | ||
| Epithelial Cells | e1 | ||
| Lens Substance | e2 | ||
| Sutures | e2 | ||
| Growth | e2 | ||
| Mass | e2 | ||
| Dimensions | e2 | ||
| Physiology of the Lens | e2 | ||
| Permeability, Diffusion, and Transport | e2 | ||
| Transport of ions | e2 | ||
| Amino acid and sugar transport | e3 | ||
| Biophysics | e3 | ||
| Light Transmission | e3 | ||
| Transparency | e3 | ||
| Refractive Indices | e3 | ||
| Chromatic Aberration | e3 | ||
| Spherical Aberration | e3 | ||
| Accommodation | e4 | ||
| Biochemistry | e4 | ||
| Sugar Metabolism | e4 | ||
| Protein Metabolism | e4 | ||
| Glutathione | e5 | ||
| Amino acid transport | e5 | ||
| Antioxidant Mechanisms | e5 | ||
| Lens Crystallins | e6 | ||
| Crystallin Structure | e6 | ||
| Crystallin Gene Expression during Lens Growth | e6 | ||
| Crystallin Function | e7 | ||
| Age Changes | e7 | ||
| Morphology | e7 | ||
| Physiological Changes | e8 | ||
| Biophysical Changes | e8 | ||
| Accommodation Changes | e8 | ||
| Biochemical Changes | e9 | ||
| Crystallins | e9 | ||
| Secondary Cataract | e9 | ||
| Fibrosis-Type Posterior Capsule Opacification | e10 | ||
| Pearl-Type Posterior Capsule Opacification | e10 | ||
| Soemmerring’s Ring | e11 | ||
| Prevention and Treatment of Posterior Capsule Opacification | e11 | ||
| Key References | e11 | ||
| References | e11 | ||
| 5.2 Evolution of Intraocular Lens Implantation | 331 | ||
| Introduction | 331 | ||
| Lens Design and Fixation | 331 | ||
| Generation I (Original Ridley Posterior Chamber Lens) | 331 | ||
| Generation II (Early Anterior Chamber Lenses) | 331 | ||
| Generation III (Iris-Supported Lenses) | 331 | ||
| Generation IV (Intermediate Anterior Chamber Lenses) | 331 | ||
| Generation V (Improved Posterior Chamber Lenses) | 331 | ||
| Generation VI (Modern Capsular Lenses – Rigid PMMA, Soft Foldable, and Modern Anterior Chamber) | 332 | ||
| Recent Advances | 332 | ||
| References | 333.e1 | ||
| Key References | 333 | ||
| 5.2 Evolution of Intraocular Lens Implantation | e13 | ||
| Introduction | e13 | ||
| Lens Design and Fixation | e13 | ||
| Generation I (Original Ridley Posterior Chamber Lens) | e13 | ||
| Generation II (Early Anterior Chamber Lenses) | e14 | ||
| Generation III (Iris-Supported Lenses) | e14 | ||
| Generation IV (Intermediate Anterior Chamber Lenses) | e15 | ||
| Generation V (Improved Posterior Chamber Lenses) | e16 | ||
| Generation VI (Modern Capsular Lenses—Rigid PMMA, Soft Foldable, and Modern Anterior Chamber) | e17 | ||
| Recent Advances | e20 | ||
| Key References | e24 | ||
| References | e24 | ||
| 5.3 Patient Workup for Cataract Surgery | 334 | ||
| Introduction | 334 | ||
| Medical History and Current Therapeutic Regimen | 334 | ||
| General Ophthalmic History and Examination | 334 | ||
| Specific Ophthalmic Examination | 335 | ||
| Assessment of Lens Opacities | 335 | ||
| Introduction | 335 | ||
| Diagnosis of Lens Opacities | 335 | ||
| Classification of Lens Opacities | 335 | ||
| Nuclear Opacities | 335 | ||
| Cortical Opacities | 336 | ||
| Posterior Subcapsular Opacities | 336 | ||
| Advanced Cataracts | 336 | ||
| Grading of Lens Opacities | 336 | ||
| Lens Opacities Classification System III | 336 | ||
| Effects of Opacities on Vision | 336 | ||
| Visual Acuity Reduction | 336 | ||
| Contrast Sensitivity Reduction | 337 | ||
| Myopic Shift | 337 | ||
| Monocular Diplopia | 337 | ||
| Glare | 337 | ||
| Color Shift | 337 | ||
| Visual Field Loss | 337 | ||
| Measurements | 337 | ||
| Introduction | 337 | ||
| IOL Calculations That Require Axial Length | 337 | ||
| Theoretical Formulas | 337 | ||
| Normal Cornea with No Previous Keratorefractive Surgery | 338 | ||
| Refractive lens exchange (RLE) for high myopia and hyperopia | 338 | ||
| Myopia | 338 | ||
| Hyperopia | 338 | ||
| Methods to Determine Axial Length | 338 | ||
| Patients with Previous Keratorefractive Surgery | 339 | ||
| Background | 339 | ||
| Methods to determine corneal power | 339 | ||
| Calculation method | 339 | ||
| Trial hard contact lens method | 339 | ||
| Corneal topography | 339 | ||
| Automated keratometry | 339 | ||
| Manual keratometry | 340 | ||
| Special limitations of IOL power calculation formulas | 340 | ||
| IOL Calculations Using k Values and Preoperative Refraction | 340 | ||
| Formula and Rationale for Using Preoperative Refraction versus Axial Length | 340 | ||
| Cases in Which to Use the Calculation from Preoperative Refraction | 340 | ||
| Secondary Implant for Aphakia | 340 | ||
| Secondary Piggy-Back IOL for Pseudophakia | 340 | ||
| Primary Minus Anterior Chamber IOL in a High Myopic Phakic Patient | 341 | ||
| Investigations for Further Surgical Refinement | 341 | ||
| Corneal Topography | 341 | ||
| Preoperative Topography | 341 | ||
| Calculation of IOL Power | 341 | ||
| Planning the Incision | 341 | ||
| Good Clinical Practice (Social and Legal Aspects) | 341 | ||
| References | 342.e1 | ||
| Key References | 342 | ||
| 5.4 Indications for Lens Surgery/Indications for Application of Different Lens Surgery Techniques | 343 | ||
| Introduction | 343 | ||
| Medical Indications for Lens Surgery | 343 | ||
| Lenticular Opacification (Cataract) | 343 | ||
| Cataract in the presence of other ocular disorders | 343 | ||
| Lenticular Malposition | 344 | ||
| Lenticular Malformation | 344 | ||
| Lens-Induced Ocular Inflammation | 344 | ||
| Lens-Induced Glaucoma | 344 | ||
| Inflammatory glaucoma (phacolytic glaucoma) | 344 | ||
| Pupil block and angle closure (phacomorphic glaucoma) | 344 | ||
| Refractive Indications for Lens Surgery | 344 | ||
| Indications for Different Lens Surgery Techniques | 345 | ||
| Intracapsular Extraction | 345 | ||
| Extracapsular Extraction (Large-Incision Nuclear Expression Cataract Surgery) | 347 | ||
| Small-Incision Nuclear Expression Cataract Surgery (‘Mini-nuc’ and Other Techniques) | 347 | ||
| Phacoemulsification | 347 | ||
| Surgery of the Lens Capsule | 348 | ||
| Zonular Surgery | 348 | ||
| Surgery for Presbyopia | 349 | ||
| Monovision | 349 | ||
| Astigmatism | 349 | ||
| Acknowledgment | 350 | ||
| References | 350.e1 | ||
| Key References | 350 | ||
| 5.5 The Pharmacotherapy of Cataract Surgery | 351 | ||
| Introduction | 351 | ||
| Preoperative Medications | 351 | ||
| Pupil Dilatation | 351 | ||
| Anti-Infective Prophylaxis | 351 | ||
| Anesthetics | 352 | ||
| Intraoperative Medications | 352 | ||
| Additives to Irrigating Solutions, Intracameral Antibiotics, and Other Intraocular Drugs Used During the Surgical Procedure | 352 | ||
| Irrigating Solutions | 353 | ||
| Ophthalmic Viscosurgical Devices | 353 | ||
| Postoperative Medications | 354 | ||
| Antibiotics | 354 | ||
| Corticosteroids and Nonsteroidal Anti-Inflammatory Drugs | 354 | ||
| Late Postoperative Medications | 354 | ||
| Treatment of Endophthalmitis | 354 | ||
| Treatment of Cystoid Macular Edema | 354 | ||
| References | 355.e1 | ||
| Key References | 355 | ||
| 5.6 Anesthesia for Cataract Surgery | 356 | ||
| Introduction | 356 | ||
| Medical Aspects of Anesthesia for Cataract Surgery | 356 | ||
| Cataract Type and Associated Medical Conditions | 356 | ||
| Specific Conditions | 356 | ||
| Ischemic heart disease | 356 | ||
| Anticoagulants | 356 | ||
| Diabetes mellitus | 356 | ||
| Local Anesthesia | 356 | ||
| General Considerations | 356 | ||
| Topical Anesthesia (see Box 5-6-1) | 356 | ||
| Retrobulbar Block (see Box 5-6-2) | 357 | ||
| Peribulbar Block (see also Table 5-6-1) | 357 | ||
| Technique | 357 | ||
| Local anesthetic agent | 357 | ||
| Complications | 358 | ||
| Sub-Tenon’s Block (see also Table 5-6-1) | 358 | ||
| Anatomy | 358 | ||
| Technique | 358 | ||
| Sedative Agents | 359 | ||
| General Anesthesia | 360 | ||
| Technique | 360 | ||
| Spontaneous respiration | 360 | ||
| Ventilation | 360 | ||
| Conclusion | 360 | ||
| Postoperative Care | 360 | ||
| References | 360.e1 | ||
| Key References | 360 | ||
| 5.7 Phacoemulsification | 361 | ||
| Introduction | 361 | ||
| Historical Review | 361 | ||
| Handpieces and Tips | 361 | ||
| Power Modulation | 362 | ||
| Pumps and Fluidics | 362 | ||
| Flow-Based (Peristaltic) | 362 | ||
| Vacuum-Based | 362 | ||
| Anterior Chamber Hydrodynamics | 362 | ||
| Fluidics of Micro-incisional Phaco | 363 | ||
| Post-Occlusion Surge | 363 | ||
| References | 364.e1 | ||
| Key References | 364 | ||
| 5.8 Refractive Aspects of Cataract Surgery | 365 | ||
| Introduction | 365 | ||
| Value of Corneal Topography | 365 | ||
| Intra-Operative Management of Preoperative Corneal Astigmatism to Prevent Induction of Corneal Astigmatism | 366 | ||
| Corneal Incisions | 366 | ||
| To Treat Preoperative Corneal Astigmatism | 367 | ||
| Astigmatic Incisions | 367 | ||
| Limbal Relaxing Incisions | 367 | ||
| Opposite Clear Corneal Incisions (OCCIs) | 367 | ||
| Toric Intraocular Lens Implantation | 368 | ||
| Postoperative Management of Residual or Induced Corneal Astigmatism | 369 | ||
| Corneal Laser Ablative Techniques | 369 | ||
| Post-Cataract Piggyback IOLS | 370 | ||
| Light Adjustable Intraocular Lens Implant (LAL) | 370 | ||
| References | 370.e1 | ||
| Key References | 370 | ||
| 5.9 Small Incision and Femtosecond Laser Cataract Surgery | 371 | ||
| Introduction | 371 | ||
| Incision Construction and Architecture | 371 | ||
| Continuous Curvilinear Capsulorrhexis | 372 | ||
| Hydrodissection and Hydrodelineation | 372 | ||
| Nucleofractis Techniques | 372 | ||
| Divide and Conquer | 373 | ||
| Phaco Chop | 373 | ||
| Power Modulations | 373 | ||
| Biaxial Micro-Incision Cataract Surgery | 374 | ||
| B-MICS Vertical Chop Technique | 375 | ||
| Femtosecond Laser-Assisted Cataract Surgery | 375 | ||
| Anterior Capsulectomy | 375 | ||
| Lens Fragmentation | 376 | ||
| Corneal Incisions | 377 | ||
| Conclusion | 377 | ||
| References | 377.e1 | ||
| Key References | 377 | ||
| 5.10 Manual Cataract Extraction | 378 | ||
| Introduction | 378 | ||
| Historical Issues | 378 | ||
| Manual (Large Incision) Cataract Surgery | 378 | ||
| Incision | 378 | ||
| Wound Closure | 378 | ||
| Intracapsular Cataract Extraction | 379 | ||
| General Comments | 379 | ||
| Specific Techniques | 379 | ||
| Iris management | 379 | ||
| Vitreous presentation or prolapse | 379 | ||
| Intraocular lenses | 379 | ||
| Extracapsular Cataract Extraction | 379 | ||
| Anterior Capsulectomy | 379 | ||
| ‘Can-opener’ capsulectomy | 379 | ||
| Linear capsulectomy and intercapsular techniques | 379 | ||
| 6 Retina and Vitreous | 419 | ||
| 1 Anatomy | 419 | ||
| 6.1 Structure of the Neural Retina | 419 | ||
| Introduction | 419 | ||
| Center of the Macula: Umbo | 420 | ||
| Foveola | 421 | ||
| Fovea | 421 | ||
| Parafovea | 421 | ||
| Perifovea | 421 | ||
| Macula, or Central Area | 421 | ||
| Extra-Areal Periphery | 421 | ||
| Layers of the Neural Retina | 421 | ||
| References | 422.e1 | ||
| Key References | 422 | ||
| 6.2 Retinal Pigment Epithelium | 423 | ||
| Introduction | 423 | ||
| Structure | 423 | ||
| Cellular Architecture and Blood-Retinal Barrier | 423 | ||
| Pigments | 423 | ||
| Metabolism and Growth Factors | 423 | ||
| Membrane Properties and Fluid Transport | 423 | ||
| Electrical Activity | 424 | ||
| Photoreceptor-Retinal Pigment Epithelium Interactions | 424 | ||
| Visual Pigment Regeneration | 424 | ||
| Photoreceptor Renewal and Phagocytosis | 424 | ||
| Interphotoreceptor Matrix and Retinal Adhesion | 424 | ||
| Repair and Regeneration | 425 | ||
| Key References | 425 | ||
| References | 425.e1 | ||
| 6.3 Retinal and Choroidal Circulation | 426 | ||
| Introduction | 426 | ||
| Posterior Segment Vascular Anatomy | 426 | ||
| Retinal Vascular Anatomy | 426 | ||
| Choroidal Vascular Anatomy | 426 | ||
| Blood-Retinal Barrier | 426 | ||
| Retinal and Choroidal Blood Flow | 428 | ||
| Future Perspectives for Retinal and Choroidal Assessment | 429 | ||
| Regulation of Retinal and Choroidal Blood Flows | 429 | ||
| Key References | 429 | ||
| References | 429.e1 | ||
| 6.4 Vitreous Anatomy and Pathology | 430 | ||
| Introduction | 430 | ||
| Molecular Morphology | 430 | ||
| Supramolecular Organization | 430 | ||
| Vitreous Anatomy | 431 | ||
| Macroscopic Morphology | 431 | ||
| Microscopic Morphology | 431 | ||
| Age-Related Changes | 433 | ||
| Embryology and Postnatal Development | 433 | ||
| Developmental Anomalies | 433 | ||
| Aging of the Vitreous | 433 | ||
| Posterior Vitreous Detachment | 434 | ||
| Anomalous Posterior Vitreous Detachment | 434 | ||
| Epiretinal membrane/macular pucker | 435 | ||
| Macular holes | 435 | ||
| Metabolic Disorders of Vitreous | 435 | ||
| Diabetic Vitreopathy | 435 | ||
| Synchysis Scintillans | 435 | ||
| Asteroid Hyalosis | 436 | ||
| Amyloidosis | 436 | ||
| References | 436.e1 | ||
| Key References | 436 | ||
| 2 Ancillary Tests | 437 | ||
| 6.5 Contact B-Scan Ultrasonography | 437 | ||
| Introduction | 437 | ||
| Devices | 437 | ||
| Technique of Examination | 437 | ||
| Concepts of B-Scan Interpretation | 437 | ||
| Real Time | 437 | ||
| Gray Scale | 437 | ||
| Three-Dimensional Analysis | 437 | ||
| Display Presentation and Documentation | 437 | ||
| Normal Vitreous Cavity | 438 | ||
| Vitreous Hemorrhage | 438 | ||
| Retinal Detachment | 438 | ||
| Choroidal Detachment | 438 | ||
| Tumors | 438 | ||
| Digital Contact Ultrasound | 438 | ||
| Summary | 439 | ||
| Key References | 439 | ||
| References | 439.e1 | ||
| 6.6 Fluorescein Angiography and Indocyanine Green Angiography | 440 | ||
| 7 Uveitis and Other Intraocular Inflammations | 687 | ||
| 1 Basic Principles | 687 | ||
| 7.1 Anatomy of the Uvea | 687 | ||
| Introduction | 687 | ||
| Iris | 687 | ||
| Ciliary Body | 687 | ||
| Choroid | 688 | ||
| References | 689.e1 | ||
| Key References | 689 | ||
| 7.2 Mechanisms of Uveitis | 690 | ||
| Introduction | 690 | ||
| Innate and Adaptive Immunities | 690 | ||
| Cells of the Immune System | 690 | ||
| Non-Lymphocytic Leukocytes | 690 | ||
| B Cells | 690 | ||
| T Cells | 691 | ||
| Mast Cells | 691 | ||
| NK and NK T Cells | 691 | ||
| Antigen Presenting Cells (APC) | 691 | ||
| Molecules of the Immune System Involved in Uveitis | 691 | ||
| Antibodies | 691 | ||
| Cytokines | 691 | ||
| Chemokines and Chemokine Receptors | 691 | ||
| Adhesion Molecules | 691 | ||
| Other Molecules | 691 | ||
| Tolerance and Autoimmunity | 691 | ||
| Central Tolerance | 691 | ||
| Peripheral Tolerance | 692 | ||
| Ignorance | 692 | ||
| Mechanisms That Trigger and Promote Uveitogenic Processes | 692 | ||
| Genetic Background | 692 | ||
| Trauma | 692 | ||
| Microbial Infection | 692 | ||
| Mechanisms of Inflammation | 692 | ||
| Types of Immunopathogenic Processes | 692 | ||
| Immunopathogenic Processes of Uveitis in Humans | 693 | ||
| Mechanisms That Inhibit Inflammation in the Eye | 693 | ||
| References | 693.e1 | ||
| Key References | 693 | ||
| 7.3 General Approach to the Uveitis Patient and Treatment Strategies | 694 | ||
| Introduction | 694 | ||
| Classification | 694 | ||
| Epidemiology | 694 | ||
| Ocular Manifestations | 694 | ||
| Diagnosis and Ancillary Testing | 696 | ||
| Differential Diagnosis | 696 | ||
| Treatment | 697 | ||
| Mydriatic and Cycloplegic Agents | 697 | ||
| Nonsteroidal Anti-Inflammatory Drugs | 697 | ||
| Corticosteroids | 697 | ||
| Topical | 697 | ||
| Periocular | 697 | ||
| Intravitreal | 697 | ||
| Systemic | 697 | ||
| Immunosuppressive Therapy | 697 | ||
| Course and Outcome | 699 | ||
| References | 699.e1 | ||
| Key References | 699 | ||
| 2 Infectious Causes of Uveitis–Viral | 700 | ||
| 7.4 Herpes and Other Viral Infections | 700 | ||
| Varicella-Zoster and Herpes Simplex Virus-Induced Acute Retinal Necrosis | 700 | ||
| Progressive Outer Retinal Necrosis | 700 | ||
| Varicella-Zoster and Herpes Simplex Virus | 700 | ||
| Introduction | 700 | ||
| Epidemiology and Pathogenesis | 700 | ||
| Ocular Manifestations | 700 | ||
| Diagnosis | 701 | ||
| 8 Intraocular Tumors | 793 | ||
| 1 Malignant and Intraocular Tumors | 793 | ||
| 8.1 Retinoblastoma | 793 | ||
| Introduction | 793 | ||
| Epidemiology and Pathogenesis | 793 | ||
| Ocular Manifestations | 794 | ||
| Diagnosis and Ancillary Testing | 795 | ||
| Differential Diagnosis | 795 | ||
| Systemic Associations | 795 | ||
| Baseline Systemic Evaluation | 795 | ||
| Pathology | 796 | ||
| Treatment | 796 | ||
| Enucleation | 796 | ||
| Intravenous Chemotherapy | 796 | ||
| Ophthalmic Artery Infusion Chemotherapy | 797 | ||
| External Beam Radiation Therapy | 797 | ||
| Plaque Radiation Therapy | 798 | ||
| Laser Therapy | 798 | ||
| Cryotherapy | 798 | ||
| Periocular Chemotherapy | 798 | ||
| Intravitreal Chemotherapy | 799 | ||
| Multimodality Therapy | 799 | ||
| Observation | 799 | ||
| Course and Outcome | 799 | ||
| References | 800.e1 | ||
| Key References | 800 | ||
| 8.2 Uveal Melanoma | 801 | ||
| Introduction | 801 | ||
| Epidemiology and Pathogenesis | 801 | ||
| Iris Melanomas | 801 | ||
| Ocular Manifestations | 801 | ||
| Diagnosis and Ancillary Testing | 802 | ||
| Baseline Systemic Evaluation | 802 | ||
| Differential Diagnosis | 802 | ||
| Pathology | 802 | ||
| Treatment | 803 | ||
| Course and Outcome | 803 | ||
| Choroidal and Ciliary Body Melanomas | 803 | ||
| Ocular Manifestations | 803 | ||
| Diagnosis and Ancillary Testing | 804 | ||
| Baseline Systemic Evaluation | 805 | ||
| Differential Diagnosis | 805 | ||
| Pathology | 805 | ||
| Treatment | 806 | ||
| Enucleation | 806 | ||
| Radiation Therapy | 807 | ||
| Observation | 808 | ||
| Laser Therapy | 808 | ||
| Cryotherapy | 808 | ||
| Microsurgical Resection | 808 | ||
| Exenteration | 809 | ||
| Systemic Chemotherapy | 809 | ||
| Multimodal Therapy | 809 | ||
| Course and Outcome | 809 | ||
| References | 809.e1 | ||
| Key References | 809 | ||
| 8.3 Metastatic Cancer to the Eye | 810 | ||
| Introduction | 810 | ||
| Epidemiology and Pathogenesis | 810 | ||
| Ocular Manifestations | 810 | ||
| Diagnosis and Ancillary Testing | 811 | ||
| Differential Diagnosis | 811 | ||
| Systemic Associations | 812 | ||
| Baseline Systemic Evaluation | 812 | ||
| Pathology | 812 | ||
| Treatment | 812 | ||
| Course and Outcome | 814 | ||
| References | 814.e1 | ||
| Key References | 814 | ||
| 8.4 Lymphoma and Leukemia | 815 | ||
| 9 Neuro-Ophthalmology | 851 | ||
| 1 Imaging in Neuro–Ophthalmology | 851 | ||
| 9.1 Principles of Imaging in Neuro-Ophthalmology | 851 | ||
| Introduction | 851 | ||
| Ophthalmologist’s Role in Neuroimaging | 851 | ||
| Computed Tomography | 851 | ||
| 10 Glaucoma | 1001 | ||
| 1 Epidemiology and Mechanisms of Glaucoma | 1001 | ||
| 10.1 Epidemiology of Glaucoma | 1001 | ||
| Introduction | 1001 | ||
| Prevalence and Rates of Associated Blindness | 1001 | ||
| Primary Open-Angle Glaucoma | 1001 | ||
| Demographic Risk Factors for POAG | 1001 | ||
| Race | 1001 | ||
| Age | 1002 | ||
| Gender | 1002 | ||
| Family history | 1002 | ||
| Ocular Risk Factors for POAG | 1002 | ||
| Intraocular pressure | 1002 | ||
| Optic nerve parameters | 1003 | ||
| Nerve fiber layer | 1003 | ||
| Myopia | 1003 | ||
| Peripapillary atrophy | 1003 | ||
| Central corneal thickness | 1003 | ||
| Systemic Risk Factors for POAG | 1003 | ||
| Diabetes | 1003 | ||
| Hypertension | 1003 | ||
| Cigarette smoking, alcohol use, and caffeine consumption | 1003 | ||
| Primary Angle-Closure Glaucoma | 1004 | ||
| Demographic Risk Factors for PACG | 1004 | ||
| Race | 1004 | ||
| Gender | 1004 | ||
| Family history | 1004 | ||
| Ocular Risk Factors for PACG | 1004 | ||
| Anterior chamber depth | 1004 | ||
| Limbal anterior chamber depth | 1005 | ||
| Axial length/refractive error | 1005 | ||
| Lens thickness | 1005 | ||
| Radius of corneal curvature | 1005 | ||
| Systemic Risk Factors for PACG | 1005 | ||
| Secondary Glaucomas | 1005 | ||
| Ocular Hypertension | 1005 | ||
| Glaucoma Suspects | 1005 | ||
| Key References | 1006 | ||
| References | 1006.e1 | ||
| 10.2 Screening for Glaucoma | 1007 | ||
| Introduction | 1007 | ||
| Historical Review | 1007 | ||
| Screening Programs | 1007 | ||
| Prior Glaucoma Screening Efforts | 1007 | ||
| Current Definition of Open-Angle Glaucoma | 1007 | ||
| Purpose of the Test | 1008 | ||
| Utility of the Test and Interpretation of Results | 1008 | ||
| Procedure | 1009 | ||
| Complications | 1010 | ||
| Alternative Tests | 1010 | ||
| Analysis of Tests | 1010 | ||
| Telemedicine and Glaucoma Screening | 1010 | ||
| Marker Testing for Glaucoma | 1010 | ||
| Future Direction of Glaucoma Screening | 1010 | ||
| Key References | 1011 | ||
| References | 1011.e1 | ||
| 10.3 Mechanisms of Glaucoma | 1012 | ||
| Introduction | 1012 | ||
| Glaucomatous Damage to the Aqueous Humor Outflow Pathway | 1012 | ||
| IOP as a Causative Risk Factor | 1012 | ||
| The Aqueous Humor Outflow Pathway | 1012 | ||
| Pathologic Damage to the Outflow Pathway | 1013 | ||
| Conclusions and Future Directions | 1013 | ||
| Physiology of Inflow | 1013 | ||
| Importance | 1013 | ||
| Structural Basis for Aqueous Humor Formation | 1013 | ||
| Functional Overview of Aqueous Humor Formation | 1014 | ||
| First Step in Secretion: Uptake of Fluid from the Stroma | 1014 | ||
| Transport mechanisms | 1014 | ||
| Potential solute recycling | 1014 | ||
| Second Step in Secretion: Fluid Transfer through Gap Junctions | 1014 | ||
| Third Step in Secretion: Fluid Transfer into the Aqueous Humor | 1015 | ||
| Transport mechanisms | 1015 | ||
| Regulation | 1015 | ||
| Complexities of Aqueous Humor Formation | 1015 | ||
| Potential reabsorption of aqueous humor | 1015 | ||
| Topography of net aqueous humor formation | 1015 | ||
| Regulation of net aqueous humor formation | 1015 | ||
| In vivo tests of conclusions from in vitro data | 1015 | ||
| Summary | 1015 | ||
| Pathophysiology of Glaucomatous Optic Neuropathy | 1016 | ||
| Glaucomatous Neuropathy Occurs in Response to Increased Cell Stress Conditions | 1016 | ||
| Mechanical Hypothesis | 1016 | ||
| Vascular Hypothesis | 1017 | ||
| Excitotoxicity Due to Excessive Glutamate | 1017 | ||
| Oxidative Stress and Free Radical Damage | 1017 | ||
| Inflammatory Cytokines | 1017 | ||
| Aberrant Immunity | 1017 | ||
| Cellular Mechanisms of Apoptosis in Glaucoma | 1017 | ||
| Conclusion | 1018 | ||
| Key References | 1018 | ||
| References | 1018.e1 | ||
| 2 Evaluation and Diagnosis | 1019 | ||
| 10.4 Clinical Examination of Glaucoma | 1019 | ||
| Introduction | 1019 | ||
| Obtaining Clinically Relevant Information | 1019 | ||
| Assessing the Patient’s Functional Status | 1019 | ||
| Obtaining the Patient’s History | 1019 | ||
| Medical history | 1019 | ||
| Ocular history | 1019 | ||
| Family history | 1019 | ||
| Ethnicity | 1019 | ||
| Examination Techniques | 1020 | ||
| Visual Acuity Testing | 1020 | ||
| Pupillary Response Testing | 1020 | ||
| Tonometry | 1020 | ||
| The role of intraocular pressure in glaucoma | 1020 | ||
| Applanation tonometry | 1020 | ||
| Pachymetry | 1020 | ||
| External Examination | 1021 | ||
| Slit-lamp Examination | 1022 | ||
| Conjunctiva, sclera, and episclera | 1022 | ||
| Cornea | 1022 | ||
| Anterior chamber | 1024 | ||
| Iris | 1024 | ||
| Lens | 1024 | ||
| Gonioscopy | 1024 | ||
| Estimation of the peripheral anterior chamber angle | 1024 | ||
| Principles of gonioscopy | 1024 | ||
| Direct gonioscopy | 1025 | ||
| Indirect gonioscopy | 1025 | ||
| Gonioscopic grading systems | 1025 | ||
| Gonioscopic anatomy of the angle | 1025 | ||
| Shaffer system | 1025 | ||
| Spaeth system | 1025 | ||
| Occludable angles | 1026 | ||
| Specific findings of the anterior chamber angle | 1026 | ||
| Optic Nerve Examination | 1026 | ||
| Testing for Glaucoma | 1028 | ||
| Key References | 1028 | ||
| References | 1028.e1 | ||
| 10.5 Visual Field Testing in Glaucoma | 1029 | ||
| Introduction | 1029 | ||
| Standard Automated Perimetry | 1029 | ||
| Testing Algorithms in Standard Automated Perimetry | 1029 | ||
| Visual Field Testing and Glaucoma Diagnosis | 1029 | ||
| Visual Field and Assessing the Severity of Glaucoma | 1030 | ||
| Visual Field and Assessing Progression in Glaucoma | 1031 | ||
| Key References | 1035 | ||
| References | 1035.e1 | ||
| 10.6 Advanced Psychophysical Tests for Glaucoma | 1036 | ||
| Introduction | 1036 | ||
| New Test Strategies | 1036 | ||
| New Test Procedures | 1036 | ||
| New Analysis Methods | 1037 | ||
| Conclusion | 1038 | ||
| Key References | 1039 | ||
| References | 1039.e1 | ||
| 10.7 Optic Nerve Analysis | 1040 | ||
| Introduction | 1040 | ||
| Normal Anatomy | 1040 | ||
| Clinical Examination: Glaucomatous Features | 1041 | ||
| Disc Cup | 1041 | ||
| Blood Vessels | 1041 | ||
| Peripapillary Atrophy | 1041 | ||
| Imaging | 1041 | ||
| Optic Disc Photographs | 1041 | ||
| Confocal Scanning Laser Ophthalmoscopy | 1041 | ||
| Optical Coherence Tomography | 1043 | ||
| Conclusion | 1044 | ||
| Key References | 1046 | ||
| References | 1046.e1 | ||
| 10.8 Optic Nerve Blood Flow Measurement | 1047 | ||
| Introduction | 1047 | ||
| Applied Anatomy | 1047 | ||
| Physiology | 1048 | ||
| Experimental Investigations | 1048 | ||
| Clinical Studies | 1048 | ||
| Angiography | 1048 | ||
| Color Doppler Imaging | 1048 | ||
| Laser Doppler Flowmetry | 1048 | ||
| Doppler Optical Coherence Tomography | 1048 | ||
| Retinal Oximetry | 1048 | ||
| Ocular Blood Flow and Visual Field Loss | 1048 | ||
| Systemic Vascular Disease and Glaucoma | 1049 | ||
| Pharmacology | 1049 | ||
| Key References | 1049 | ||
| References | 1049.e1 | ||
| 10.9 Ocular Hypertension | 1050 | ||
| Introduction | 1050 | ||
| Epidemiology and Pathogenesis | 1050 | ||
| Predictive Factors for Conversion of OHT to POAG | 1050 | ||
| Central Corneal Thickness | 1050 | ||
| IOP | 1050 | ||
| Age | 1050 | ||
| Pattern Standard Deviation | 1051 | ||
| Optic Nerve | 1051 | ||
| Other Predictive Factors | 1051 | ||
| Diagnosis | 1051 | ||
| Differential Diagnosis | 1051 | ||
| Treatment | 1051 | ||
| Course and Outcome | 1051 | ||
| Key References | 1051 | ||
| References | 1051.e1 | ||
| 3 Specific Types of Glaucoma | 1052 | ||
| 10.10 Primary Open-Angle Glaucoma | 1052 | ||
| Definition and Classification | 1052 | ||
| Intraocular Pressure and Other Risk Factors for POAG | 1052 | ||
| Diagnosis | 1052 | ||
| Nature of Progressive Visual Loss | 1053 | ||
| Pre-perimetric | 1053 | ||
| Threshold and Conversion | 1053 | ||
| Critical Phase | 1054 | ||
| Blindness | 1054 | ||
| Treatment and Monitoring | 1054 | ||
| Key References | 1056 | ||
| References | 1056.e1 | ||
| 10.11 Normal-Tension Glaucoma | 1057 | ||
| Introduction | 1057 | ||
| Epidemiology and Pathogenesis | 1057 | ||
| Ocular Manifestations | 1057 | ||
| Diagnosis | 1057 | ||
| Differential Diagnosis | 1058 | ||
| Systemic Associations | 1058 | ||
| Treatment | 1058 | ||
| Lower Intraocular Pressure | 1058 | ||
| Reversal of Circulatory Deficiencies at the Optic Nerve Head | 1058 | ||
| Vasospasm | 1058 | ||
| Nocturnal hypotension | 1058 | ||
| Monitoring for Progression | 1058 | ||
| Therapeutic Intervention | 1058 | ||
| Course and Outcome | 1059 | ||
| Key References | 1059 | ||
| References | 1059.e1 | ||
| 10.12 Angle-Closure Glaucoma | 1060 | ||
| Introduction | 1060 | ||
| Epidemiology and Pathogenesis | 1060 | ||
| Prevalence | 1060 | ||
| Incidence | 1060 | ||
| Risk Factors | 1060 | ||
| Pupillary Block | 1061 | ||
| Non-Pupillary Block Mechanisms | 1061 | ||
| Plateau Iris Configuration | 1061 | ||
| Aqueous Misdirection | 1061 | ||
| Diagnosis | 1063 | ||
| External Examination | 1063 | ||
| Penlight Examination | 1063 | ||
| Slit-Lamp Examination | 1064 | ||
| Gonioscopy | 1064 | ||
| Other Imaging Techniques | 1065 | ||
| Scheimpflug photography | 1065 | ||
| Ultrasound biomicroscopy (UBM) | 1065 | ||
| Anterior segment optical coherence tomography (AS-OCT) | 1065 | ||
| Scanning peripheral anterior chamber depth analyzer (SPAC) | 1065 | ||
| Provocative tests | 1065 | ||
| Differential Diagnosis | 1065 | ||
| Management of Acute Angle Closure | 1065 | ||
| After 1–2 Hours | 1066 | ||
| Later | 1066 | ||
| Even Later | 1066 | ||
| Management of Chronic ACG | 1066 | ||
| Management of Angle-Closure Glaucoma | 1066 | ||
| Medical Treatment | 1066 | ||
| Laser Treatment | 1066 | ||
| Surgical Treatment | 1066 | ||
| Surgical Iridectomy | 1066 | ||
| Lens extraction | 1068 | ||
| Goniosynechialysis | 1068 | ||
| Trabeculectomy | 1068 | ||
| Glaucoma drainage implant | 1069 | ||
| Cyclodestructive procedures | 1069 | ||
| Prognosis | 1069 | ||
| Key References | 1069 | ||
| References | 1069.e1 | ||
| 10.13 Glaucoma Associated with Pseudoexfoliation Syndrome | 1070 | ||
| Introduction | 1070 | ||
| Epidemiology and Genetics | 1070 | ||
| Systemic Manifestations | 1070 | ||
| Clinical Presentation and Ocular Manifestations | 1070 | ||
| Differential Diagnosis | 1071 | ||
| Treatment and Outcome | 1071 | ||
| Key References | 1072 | ||
| References | 1072.e1 | ||
| 10.14 Pigmentary Glaucoma | 1073 | ||
| Introduction | 1073 | ||
| Epidemiology and Pathogenesis | 1073 | ||
| Ocular Manifestations | 1073 | ||
| Differential Diagnosis | 1074 | ||
| Treatment | 1074 | ||
| Course and Outcome | 1075 | ||
| Key References | 1075 | ||
| References | 1075.e1 | ||
| 10.15 Neovascular Glaucoma | 1076 | ||
| Introduction | 1076 | ||
| Epidemiology and Pathogenesis | 1076 | ||
| Ocular Manifestations | 1076 | ||
| Diagnosis | 1077 | ||
| Differential Diagnosis | 1077 | ||
| Treatment | 1078 | ||
| Course and Outcome | 1078 | ||
| Emerging Treatments | 1078 | ||
| Key References | 1079 | ||
| References | 1079.e1 | ||
| 10.16 Inflammatory and Corticosteroid-Induced Glaucoma | 1080 | ||
| Introduction | 1080 | ||
| Pathophysiology | 1080 | ||
| Mechanisms of Elevated IOP | 1080 | ||
| Secondary Open-Angle Glaucoma | 1080 | ||
| Pre-Existing Open-Angle Glaucoma | 1081 | ||
| Secondary Angle-Closure Glaucoma | 1081 | ||
| Pre-existing Disposition to Primary Angle Closure | 1081 | ||
| Combined-Mechanism Glaucoma | 1081 | ||
| Principles of Management | 1081 | ||
| Uveitis | 1081 | ||
| Diagnosis | 1081 | ||
| Management | 1082 | ||
| Mydriasis and Cycloplegia | 1082 | ||
| Glaucoma | 1082 | ||
| Medical Management | 1082 | ||
| Surgical Management | 1082 | ||
| Specific Entities | 1083 | ||
| Glaucomatocyclitic Crisis (Posner–Schlossman Syndrome) | 1083 | ||
| Fuchs’ Uveitis Syndrome (Fuchs’ Heterochromic Iridocyclitis) | 1083 | ||
| Key References | 1083 | ||
| References | 1083.e1 | ||
| 10.17 Glaucoma Associated with Ocular Trauma | 1084 | ||
| Introduction | 1084 | ||
| Immediate or Early-Onset Glaucoma after Ocular Trauma | 1084 | ||
| Contusion | 1084 | ||
| Trabecular Disruption | 1084 | ||
| Hyphema | 1085 | ||
| Massive Choroidal Hemorrhage | 1085 | ||
| Chemical Trauma | 1086 | ||
| Late-Onset Glaucoma after Ocular Trauma | 1086 | ||
| Angle Recession | 1086 | ||
| Peripheral Anterior Synechiae | 1087 | ||
| Ghost Cell (Hemolytic) Glaucoma | 1087 | ||
| Lens-Induced Glaucoma | 1088 | ||
| Lens dislocation | 1088 | ||
| Lens swelling | 1088 | ||
| Phacolytic glaucoma | 1088 | ||
| Lens particle glaucoma | 1088 | ||
| Delayed Closure of a Cyclodialysis Cleft | 1088 | ||
| Epithelial Downgrowth | 1088 | ||
| Retained Intraocular Foreign Body | 1088 | ||
| Rhegmatogenous Retinal Detachment | 1088 | ||
| Key References | 1089 | ||
| References | 1089.e1 | ||
| 10.18 Glaucoma with Raised Episcleral Venous Pressure | 1090 | ||
| Introduction | 1090 | ||
| Epidemiology and Pathogenesis | 1090 | ||
| Ocular Manifestations | 1090 | ||
| Diagnosis | 1091 | ||
| Differential Diagnosis | 1091 | ||
| Systemic Associations | 1091 | ||
| Treatment | 1091 | ||
| Course and Outcome | 1091 | ||
| Key References | 1091 | ||
| References | 1091.e1 | ||
| 10.19 Aqueous Misdirection Syndrome | 1092 | ||
| Introduction | 1092 | ||
| Epidemiology and Pathogenesis | 1092 | ||
| Ocular Manifestations | 1092 | ||
| Diagnosis | 1093 | ||
| Differential Diagnosis | 1093 | ||
| Treatment | 1093 | ||
| Medical | 1093 | ||
| Laser | 1093 | ||
| Surgery | 1093 | ||
| Fellow Eye | 1093 | ||
| Key References | 1093 | ||
| References | 1093.e1 | ||
| 10.20 Glaucomas Secondary to Abnormalities of the Cornea, Iris, Retina, and Intraocular Tumors | 1094 | ||
| Ghost Cell Hemolytic Glaucoma | 1094 | ||
| Introduction | 1094 | ||
| Epidemiology and Pathogenesis | 1094 | ||
| Ocular Manifestations | 1094 | ||
| Pathology | 1094 | ||
| Treatment | 1094 | ||
| Schwartz’s Syndrome | 1094 | ||
| Iridocorneal Endothelial Syndrome | 1095 | ||
| Introduction | 1095 | ||
| Epidemiology and Pathogenesis | 1095 | ||
| Ocular Manifestations | 1095 | ||
| Progressive (Essential) Iris Atrophy | 1095 | ||
| Chandler’s Syndrome | 1095 | ||
| Iris–Nevus Syndrome (Cogan–Reese Syndrome) | 1095 | ||
| Pathology | 1095 | ||
| 11 Pediatric and Adult Strabismus | 1181 | ||
| 1 Basic Science | 1181 | ||
| 11.1 Anatomy and Physiology of the Extraocular Muscles and Surrounding Tissues | 1181 | ||
| Embryology | 1181 | ||
| Gross Anatomy of the Extraocular Muscles | 1181 | ||
| Origin of the Extraocular Muscles | 1181 | ||
| Insertion of the Extraocular Muscles | 1181 | ||
| Course and Action of the Extraocular Muscles | 1182 | ||
| Innervation | 1183 | ||
| Blood Supply | 1184 | ||
| The Orbital Infrastructure and Anatomy | 1184 | ||
| Clinical Correlates | 1185 | ||
| Extraocular Muscle Physiology | 1186 | ||
| Hering and Sherrington Laws | 1186 | ||
| Key References | 1187 | ||
| References | 1187.e1 | ||
| 2 Evaluation and Diagnosis | 1188 | ||
| 11.2 Evaluating Vision in Preverbal and Preliterate Infants and Children | 1188 | ||
| Introduction | 1188 | ||
| Historical and Observational Techniques | 1188 | ||
| Fixation Targets | 1188 | ||
| Opticokinetic Nystagmus | 1188 | ||
| Visual Evoked Potentials | 1189 | ||
| Forced-Choice Preferential Looking | 1189 | ||
| Graded Optotypes | 1190 | ||
| Maturation of Visual Acuity | 1190 | ||
| Key References | 1191 | ||
| References | 1191.e1 | ||
| 11.3 Examination of Ocular Alignment and Eye Movements | 1192 | ||
| Evaluation of Ocular Alignment | 1192 | ||
| Introduction | 1192 | ||
| Laboratory Methods | 1192 | ||
| Clinical Methods | 1192 | ||
| Objective Clinical Methods | 1193 | ||
| Corneal Light Reflex Tests | 1193 | ||
| Cover Tests | 1193 | ||
| Subjective Clinical Methods | 1195 | ||
| Eye Movement Examinations | 1195 | ||
| Introduction | 1195 | ||
| Mechanical Tests of Eye Movement Limitation | 1196 | ||
| Forced Duction Test | 1196 | ||
| Active Force Generation Test | 1196 | ||
| Key References | 1196 | ||
| References | 1196.e1 | ||
| 11.4 Sensory Adaptations in Strabismus | 1197 | ||
| Visual Confusion and Diplopia | 1197 | ||
| 12 Orbit and Oculoplastics | 1255 | ||
| 1 Orbital Anatomy and Imaging | 1255 | ||
| 12.1 Clinical Anatomy of the Eyelids | 1255 | ||
| Introduction | 1255 | ||
| Anatomy of the Eyelids | 1255 | ||
| Orbicularis Muscle | 1255 | ||
| Orbital Septum | 1255 | ||
| Preaponeurotic Fat Pockets | 1256 | ||
| Major Eyelid Retractors | 1256 | ||
| Sympathetic Accessory Retractors | 1256 | ||
| Tarsal Plates | 1256 | ||
| Canthal Tendons | 1256 | ||
| Conjunctiva | 1256 | ||
| Nerves to the Eyelids | 1256 | ||
| Vascular Supply to the Eyelids | 1257 | ||
| References | 1257.e1 | ||
| Key References | 1257 | ||
| 12.2 Clinical Anatomy of the Orbit | 1258 | ||
| Introduction | 1258 | ||
| General Organization | 1258 | ||
| Osteology of the Orbit | 1258 | ||
| Orbital Roof | 1258 | ||
| Lateral Orbital Wall | 1258 | ||
| Orbital Floor | 1259 | ||
| Medial Orbital Wall | 1259 | ||
| Connective Tissue System | 1259 | ||
| Periorbita | 1259 | ||
| Orbital Septal System | 1259 | ||
| Tenon’s Capsule | 1260 | ||
| Muscles of Ocular Motility | 1260 | ||
| Motor Nerves of the Orbit | 1261 | ||
| Sensory Nerves of the Orbit | 1261 | ||
| Arterial Supply to the Orbit | 1261 | ||
| Venous Drainage From the Orbit | 1262 | ||
| Key References | 1263 | ||
| References | 1263.e1 | ||
| 12.3 Orbital Imaging Techniques | 1264 | ||
| Introduction | 1264 | ||
| Normal Orbital Anatomy in the Axial Plane | 1264 | ||
| Axial Section Through the Lowermost Orbit | 1264 | ||
| Axial Section Through the Inferior Orbit | 1264 | ||
| Axial Section Through the Midorbit | 1265 | ||
| Axial Section Through the Superior Orbit | 1265 | ||
| Axial Section Through the Orbital Roof | 1265 | ||
| Normal Orbital Anatomy in the Coronal Plane | 1265 | ||
| Coronal Section Through the Anteriormost Orbit | 1265 | ||
| Coronal Section Through the Anterior Orbit | 1265 | ||
| Coronal Section Through the Central Orbit | 1265 | ||
| Coronal Section Through the Anterior Orbital Apex | 1266 | ||
| Coronal Section Through the Posterior Orbital Apex | 1266 | ||
| Orbital Echography | 1266 | ||
| A-Scan Echography | 1266 | ||
| B-Scan Echography | 1267 | ||
| Key References | 1267 | ||
| References | 1267.e1 | ||
| 2 Eyelids | 1268 | ||
| 12.4 Eyelid Retraction | 1268 | ||
| Introduction | 1268 | ||
| Preoperative Evaluation and Diagnostic Approach | 1268 | ||
| The Ophthalmic History | 1268 | ||
| The Ophthalmic Examination | 1268 | ||
| Ancillary Tests | 1268 | ||
| Differential Diagnosis | 1268 | ||
| Neurogenic Retraction | 1268 | ||
| Myogenic Retraction | 1269 | ||
| Mechanistic Retraction | 1269 | ||
| Miscellaneous Causes of Retraction | 1269 | ||
| Alternatives to Surgery | 1269 | ||
| Anesthesia | 1270 | ||
| Surgical Techniques | 1270 | ||
| Levator Aponeurosis Recession with Excision of Müller’s Muscle | 1270 | ||
| Lower Eyelid Recession with Spacer Graft | 1270 | ||
| Complications | 1271 | ||
| Outcome | 1271 | ||
| Key References | 1271 | ||
| References | 1271.e1 | ||
| 12.5 Blepharoptosis | 1272 | ||
| Introduction | 1272 | ||
| Preoperative Evaluation and Diagnostic Approach | 1272 | ||
| The Ocular and Medical History | 1272 | ||
| Hering’s law | 1272 | ||
| Levator Muscle Function | 1272 | ||
| Differential Diagnosis | 1272 | ||
| Congenital Ptosis | 1272 | ||
| Simple congenital (myopathic) ptosis | 1272 | ||
| Blepharophimosis syndrome | 1273 | ||
| Marcus Gunn jaw-winking syndrome | 1273 | ||
| Acquired Ptosis | 1273 | ||
| Third cranial nerve palsy | 1273 | ||
| Horner’s syndrome | 1274 | ||
| Myasthenia gravis | 1274 | ||
| Chronic progressive external ophthalmoplegia | 1274 | ||
| Aponeurotic redundancy or dehiscence | 1274 | ||
| Mechanical ptosis | 1275 | ||
| Ptosis Repair | 1275 | ||
| Anesthesia | 1275 | ||
| General Techniques | 1275 | ||
| Specific Techniques | 1276 | ||
| Anterior Levator Aponeurosis Advancement | 1276 | ||
| Frontalis Suspension | 1276 | ||
| Complications | 1276 | ||
| Undercorrection | 1277 | ||
| Overcorrection | 1277 | ||
| Eyelid Crease Abnormalities | 1277 | ||
| Lagophthalmos and Exposure Keratitis | 1277 | ||
| Changes in Astigmatism | 1277 | ||
| Outcome | 1277 | ||
| Key References | 1277 | ||
| References | 1277.e1 | ||
| 12.6 Entropion | 1278 | ||
| Introduction | 1278 | ||
| Preoperative Evaluation and Diagnostic Approach | 1278 | ||
| The Capsulopalpebral Fascia | 1278 | ||
| The Tarsus and Canthal Tendons | 1279 | ||
| Enophthalmos | 1279 | ||
| Orbicularis Muscle | 1279 | ||
| The Posterior Lamella | 1279 | ||
| Other Factors | 1279 | ||
| Differential Diagnosis | 1279 | ||
| Epiblepharon | 1279 | ||
| Trichiasis | 1279 | ||
| Congenital Entropion | 1279 | ||
| Alternatives to Surgery | 1279 | ||
| Quickert–Rathbun Sutures | 1280 | ||
| Botulinum Toxin | 1280 | ||
| Anesthesia | 1280 | ||
| General Technique | 1280 | ||
| Specific Techniques | 1280 | ||
| Retractor Reattachment | 1280 | ||
| Lateral Tarsal Strip Procedure | 1281 | ||
| Transverse Tarsotomy | 1282 | ||
| Hard Palate Mucosal Graft | 1282 | ||
| Complications | 1282 | ||
| Overcorrection | 1283 | ||
| Hematoma | 1283 | ||
| Eyelid Retraction | 1283 | ||
| Exposure Keratopathy | 1283 | ||
| Ptosis | 1283 | ||
| Outcome | 1283 | ||
| Key References | 1283 | ||
| References | 1283.e1 | ||
| 12.7 Ectropion | 1284 | ||
| Introduction | 1284 | ||
| Historical Review | 1284 | ||
| Preoperative Evaluation and Diagnostic Approach | 1284 | ||
| Eyelid Laxity | 1285 | ||
| Medial Canthal Tendon Laxity | 1285 | ||
| Lateral Canthal Tendon Laxity | 1285 | ||
| Position of the Lacrimal Puncta | 1285 | ||
| Cicatricial Skin Changes | 1285 | ||
| Orbicularis Muscle Weakness | 1285 | ||
| Lid Masses | 1285 | ||
| Inferior Lid Retractor Laxity | 1285 | ||
| Alternatives to Surgery | 1286 | ||
| Anesthesia | 1286 | ||
| General Techniques | 1286 | ||
| Specific Techniques | 1286 | ||
| Plication of the Anterior Limb of the Medial Canthal Tendon | 1286 | ||
| Medial Canthal Resection | 1286 | ||
| Excision of a Diamond of Tarsoconjunctiva | 1286 | ||
| Medial Diamond Excision Plus Horizontal Lid Shortening (‘Lazy-T’) | 1287 | ||
| Lateral Tarsal Strip Procedure | 1287 | ||
| Horizontal Lid Shortening by Full-Thickness Wedge Excision | 1288 | ||
| Horizontal Lid Shortening Plus Blepharoplasty (Kuhnt–Symanowski Procedure) | 1288 | ||
| Z-Plasty | 1288 | ||
| Pedicle Transposition Flap | 1288 | ||
| Skin Graft | 1289 | ||
| Medial Canthoplasty | 1289 | ||
| Lateral Tarsorrhaphy | 1290 | ||
| Complications | 1290 | ||
| Outcome | 1291 | ||
| Key References | 1291 | ||
| References | 1291.e1 | ||
| 12.8 Essential Blepharospasm | 1292 | ||
| Introduction | 1292 | ||
| Ocular Manifestations | 1292 | ||
| Diagnosis | 1292 | ||
| Differential Diagnosis | 1293 | ||
| Pathology | 1293 | ||
| Treatment | 1293 | ||
| Myectomy | 1293 | ||
| Pharmacological Agents | 1293 | ||
| Chemodenervation | 1293 | ||
| Course and Outcome | 1294 | ||
| Key References | 1294 | ||
| References | 1294.e1 | ||
| 12.9 Benign Eyelid Lesions | 1295 | ||
| Introduction | 1295 | ||
| Epithelial Tumors | 1295 | ||
| Squamous Papilloma | 1295 | ||
| Cutaneous Horn | 1295 | ||
| Seborrheic Keratosis | 1296 | ||
| Inverted Follicular Keratosis | 1296 | ||
| Keratoacanthoma | 1296 | ||
| Actinic Keratosis | 1296 | ||
| Epidermal Inclusion Cyst | 1297 | ||
| Pilar Cyst | 1297 | ||
| Epidermoid and Dermoid Cysts | 1297 | ||
| Adnexal Tumors | 1297 | ||
| Benign Lesions of Sebaceous Origin | 1298 | ||
| Milia | 1298 | ||
| Sebaceous adenoma | 1298 | ||
| Benign Lesions of Eccrine Origin | 1298 | ||
| Eccrine hidrocystoma | 1298 | ||
| Syringoma | 1298 | ||
| Chondroid syringoma | 1298 | ||
| Benign Lesions of Apocrine Origin | 1298 | ||
| Apocrine hidrocystoma | 1298 | ||
| Cylindroma | 1298 | ||
| Benign Lesions of Hair Follicle Origin | 1299 | ||
| Trichoepithelioma | 1299 | ||
| Trichofolliculoma | 1299 | ||
| Trichilemmoma | 1299 | ||
| Pilomatrixoma | 1299 | ||
| Vascular Tumors | 1299 | ||
| Capillary Hemangioma | 1299 | ||
| Cavernous Hemangioma | 1300 | ||
| Lymphangioma | 1300 | ||
| Nevus Flammeus | 1300 | ||
| Pyogenic Granuloma | 1300 | ||
| Tumors of Neural Origin | 1301 | ||
| Neurofibroma | 1301 | ||
| Xanthomatous Lesions | 1301 | ||
| Xanthelasma | 1302 | ||
| Juvenile Xanthogranuloma | 1302 | ||
| Pigmented Lesions of Melanocytic Origin | 1302 | ||
| Freckles | 1302 | ||
| Lentigo Simplex | 1302 | ||
| Solar Lentigo | 1302 | ||
| Melanocytic Nevi | 1303 | ||
| Congenital Melanocytic Nevus | 1303 | ||
| Nevus of Ota | 1303 | ||
| Blue Nevus | 1303 | ||
| Inflammatory Lesions | 1304 | ||
| Chalazion | 1304 | ||
| Hordeolum | 1304 | ||
| Infectious Lesions | 1304 | ||
| Molluscum Contagiosum | 1304 | ||
| Verruca Vulgaris | 1305 | ||
| Conclusion | 1305 | ||
| Outcomes | 1305 | ||
| Key References | 1305 | ||
| References | 1305.e1 | ||
| 12.10 Eyelid Malignancies | 1306 | ||
| Introduction | 1306 | ||
| Basal Cell Carcinoma | 1306 | ||
| Epidemiology and Pathogenesis | 1306 | ||
| Ocular Manifestations | 1306 | ||
| Diagnosis | 1307 | ||
| Differential Diagnosis | 1307 | ||
| Systemic Associations | 1307 | ||
| Pathology | 1307 | ||
| Index | 1367 | ||
| A | 1367 | ||
| B | 1370 | ||
| C | 1371 | ||
| D | 1375 | ||
| E | 1376 | ||
| F | 1378 | ||
| G | 1379 | ||
| H | 1380 | ||
| I | 1382 | ||
| J | 1384 | ||
| K | 1384 | ||
| L | 1385 | ||
| M | 1386 | ||
| N | 1388 | ||
| O | 1389 | ||
| P | 1391 | ||
| Q | 1394 | ||
| R | 1394 | ||
| S | 1396 | ||
| T | 1400 | ||
| U | 1401 | ||
| V | 1402 | ||
| W | 1403 | ||
| X | 1404 | ||
| Y | 1404 | ||
| Z | 1404 |