Additional Information
Book Details
Abstract
Cornea, edited by Drs. Krachmer, Mannis & Holland, is the only truly comprehensive clinical reference available that covers external disease, anterior uveitis, and the expanding range of contemporary corneal surgery. In this Third Edition, state-of-the-art coverage, 25 brand-new chapters, and 45 new videos provide expert guidance on performing femtosecond-assisted penetrating keratoplasty, DSAEK, deep anterior lamellar keratoplasty, and many other cutting-edge techniques. Plus, you’ll have easy access to the complete contents and illustrations online at expertconsult.
- Overcome any clinical challenge related to the cornea, external disease, anterior uveitis, and the expanding range of contemporary corneal surgery with the most complete, authoritative guidance source available.
- Get superb visual guidance with exceptionally clear illustrations, diagnostic images, and step-by-step surgical photographs.
- Access the complete contents and illustrations online at expertconsult.
- Make optimal use of Anterior Segment OCT to plan and choose treatment options and assess post-operative recovery.
- Master the latest surgical techniques—including femtosecond-assisted penetrating keratoplasty, DSAEK, and deep anterior lamellar keratoplasty—thanks to 25 brand-new chapters and 45 new videos on DVD (a total of 3 hours running time).
- Understand the full spectrum of corneal diseases with coverage of the new corneal dystrophy classification that incoporates current genetic, clinical, and pathologic information.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Cornea, 3/e | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| DVD Table of contents | xi | ||
| Preface | xiii | ||
| Acknowledgments | xiv | ||
| Dedication | xv | ||
| Contributors | xvi | ||
| I Basic Science: Cornea, Sclera, Ocular Adnexa Anatomy, Physiology and Pathophysiologic Responses | 1 | ||
| 1 Cornea and Sclera: | 3 | ||
| Introduction | 3 | ||
| Anatomy and Physiology | 3 | ||
| Structure of the cornea and sclera | 3 | ||
| Optical properties of the cornea | 4 | ||
| Innervation | 4 | ||
| Vascular system | 5 | ||
| Oxygen and nutrient supply | 5 | ||
| Tear fluid | 5 | ||
| Histology and Biochemistry | 6 | ||
| Corneal epithelium | 7 | ||
| Superficial cells | 7 | ||
| Wing cells | 9 | ||
| Basal cells | 10 | ||
| Basement membrane | 10 | ||
| Bowman’s layer | 11 | ||
| Stroma of the cornea and sclera | 12 | ||
| Overview | 12 | ||
| Cells | 12 | ||
| Collagen | 13 | ||
| Proteoglycans | 13 | ||
| Descemet’s membrane | 15 | ||
| Endothelium | 15 | ||
| Maintenance of Normal Corneal Integrity | 16 | ||
| Overview | 16 | ||
| Epithelial maintenance | 16 | ||
| Role of limbal stem cells | 16 | ||
| Epithelial movement | 17 | ||
| Fibronectin–integrin system | 17 | ||
| Hyaluronan | 18 | ||
| Proteolytic enzymes | 18 | ||
| Cytokines and growth factors | 18 | ||
| Epidermal growth factor | 18 | ||
| Transforming growth factor-β | 18 | ||
| Basic fibroblast growth factor and platelet-derived growth factor | 18 | ||
| Interleukins | 18 | ||
| Neural regulation | 18 | ||
| Stromal maintenance | 19 | ||
| Extracellular matrix and stromal repair | 19 | ||
| Cytokines and growth factors | 19 | ||
| Neovascularization in the corneal stroma | 19 | ||
| Development of the Anterior Eye Segment | 19 | ||
| References | 21 | ||
| 2 The Conjunctiva: | 25 | ||
| Embryology | 25 | ||
| Anatomy | 25 | ||
| Histology | 26 | ||
| Palpebral and forniceal conjunctiva | 27 | ||
| Bulbar conjunctiva | 27 | ||
| The corneoscleral limbus | 27 | ||
| Conjunctival goblet cells | 27 | ||
| Substantia propria | 28 | ||
| Vascular Supply | 29 | ||
| Lymphatic Drainage | 29 | ||
| Nerve Supply | 29 | ||
| Normal Flora | 30 | ||
| Physiology of the Conjunctiva | 30 | ||
| References | 31 | ||
| 3 Tear Film | 33 | ||
| Overview and Function | 33 | ||
| Control of Tear Secretion | 33 | ||
| Tear Layer Thickness | 34 | ||
| Analytical Methods | 35 | ||
| Peptide Components of Tears | 36 | ||
| Acknowledgments | 38 | ||
| References | 38 | ||
| 4 The Eyelids | 41 | ||
| Introduction | 41 | ||
| Embryology | 41 | ||
| Anatomy | 42 | ||
| Epithelium | 42 | ||
| Orbicularis oculi | 42 | ||
| Orbital septum | 43 | ||
| Retractors | 43 | ||
| Levator palpebrae superioris | 43 | ||
| Müller’s muscle | 43 | ||
| Capsulopalpebral fascia and inferior retractors | 43 | ||
| Tarsal plates | 43 | ||
| Conjunctiva | 43 | ||
| Eyelid margin | 44 | ||
| The suspensory system of the eyelids | 44 | ||
| Orbital fat compartments | 45 | ||
| Vascular supply | 45 | ||
| Lymphatic drainage | 45 | ||
| Sensory innervation | 45 | ||
| Blink reflex | 45 | ||
| References | 45 | ||
| 5 A Matrix of Pathologic Responses in the Cornea | 47 | ||
| Anatomical Regions of the Cornea | 47 | ||
| General Pathologic Responses of the Cornea | 47 | ||
| 1. Defects and their repair | 47 | ||
| 2. Fibrosis and vascularization | 47 | ||
| 3. Edema and cysts | 47 | ||
| 4. Inflammation and immune responses | 47 | ||
| 5. Deposits | 48 | ||
| 6. Proliferation | 48 | ||
| Specific Pathologic Responses of the Cornea | 50 | ||
| Pathologic Responses of the Corneal Epithelium | 51 | ||
| 1. Defects (and their repair) | 51 | ||
| 2. Fibrosis and vascularization | 51 | ||
| 3. Edema and cysts | 51 | ||
| Epithelial edema | 51 | ||
| Epithelial hypoxia and trauma | 51 | ||
| Changes in epithelial maturation | 51 | ||
| 4. Inflammation and immune response | 51 | ||
| 5. Deposits | 52 | ||
| Elements: iron deposits | 52 | ||
| Drugs: topical and systemic | 52 | ||
| Systemic diseases | 52 | ||
| Corneal dystrophies and degenerations | 53 | ||
| 6. Proliferation | 53 | ||
| The Pathologic Responses of the Subepithelial Zone | 54 | ||
| 1. Defects (and their repair) | 54 | ||
| 2. Fibrosis and vascularization | 54 | ||
| Subepithelial avascular fibrosis | 54 | ||
| Subepithelial vascular fibrosis | 55 | ||
| 3. Edema and cysts | 55 | ||
| 4. Inflammation and immune responses | 55 | ||
| 5. Deposits | 55 | ||
| 6. Proliferation of the epithelial basement membrane | 55 | ||
| Pathologic Responses of the Corneal Stroma | 55 | ||
| 1. Defects (and their repair) | 55 | ||
| 2. Fibrosis and vascularization | 58 | ||
| Stromal fibrosis | 58 | ||
| Stromal vascularization | 59 | ||
| 3. Edema and cysts | 60 | ||
| 4. Inflammation and immune responses | 60 | ||
| 5. Deposits | 60 | ||
| Topical and systemic drugs | 60 | ||
| Ocular diseases | 60 | ||
| Systemic diseases | 61 | ||
| Deposits from dystrophies and degenerations of the stroma | 62 | ||
| 6. Proliferation | 62 | ||
| Pathologic Responses of the Corneal Endothelium and Descemet’s Membrane | 62 | ||
| 1. Defects (and their repair) | 62 | ||
| Defects in the endothelium | 63 | ||
| Defects in Descemet’s membrane | 63 | ||
| 2. Fibrosis and vascularization posterior to Descemet’s membrane | 63 | ||
| Posterior collagenous layer | 63 | ||
| Using the posterior collagenous layer to date the onset of endothelial or Descemet’s membrane disease with transmission electron microscopy | 64 | ||
| 3. Edema and cysts | 64 | ||
| 4. Inflammation and immune responses | 64 | ||
| 5. Deposits | 65 | ||
| Topical and systemic drugs | 65 | ||
| Ocular and systemic diseases | 65 | ||
| Corneal dystrophies and degenerations | 65 | ||
| 6. Proliferation | 65 | ||
| The Immune Response: Components and Reactions in the Eye | 66 | ||
| Overview | 66 | ||
| Cells of inflammation and the immune response | 66 | ||
| Cells of the lymphoid system | 67 | ||
| B lymphocytes | 67 | ||
| T lymphocytes | 67 | ||
| Null lymphocytes | 72 | ||
| Cells of the myeloid system | 73 | ||
| Macrophages and the mononuclear phagocytic system | 73 | ||
| Dendritic cells | 73 | ||
| Langerhans cells | 73 | ||
| Other cells of the myeloid system | 73 | ||
| Polymorphonuclear leukocytes | 73 | ||
| Eosinophils | 73 | ||
| Basophils | 73 | ||
| Mast cells | 73 | ||
| Soluble Mediators/Receptors of Inflammation | 74 | ||
| Adhesion molecules | 74 | ||
| Cytokines | 74 | ||
| Chemokines | 74 | ||
| Complement | 74 | ||
| Tissue Components of the Ocular Immune System | 75 | ||
| Mucosa-associated immune system (MALT) | 75 | ||
| The lacrimal functional unit (LFU) | 75 | ||
| The Cell-Mediated Immune (CMI) Response | 75 | ||
| Major histocompatibility complex | 75 | ||
| Antigen presentation and T-cell activation | 75 | ||
| Cell-mediated immune response | 76 | ||
| The Humoral (Antibody-Mediated) Immune Response | 76 | ||
| Immunoglobulins | 76 | ||
| Characteristics of immunoglobulins | 76 | ||
| Anterior Chamber Associated Immune Deviation (ACAID) | 76 | ||
| Immune Hypersensitivity Reactions | 77 | ||
| Type I hypersensitivity response (atopic, allergic reactions) | 77 | ||
| Type II (cytotoxic) hypersensitivity response | 77 | ||
| Type III hypersensitivity response (immune complex) | 78 | ||
| Type IV (delayed-type hypersensitivity [DTH]) response | 78 | ||
| References | 78 | ||
| II Examining and Imaging the Cornea and External Eye | 81 | ||
| 1 Basic Evaluation of the Cornea and External Eye | 83 | ||
| 6 Examination of the Lids | 83 | ||
| General Principles | 83 | ||
| History of Patient | 83 | ||
| Dermatologic Examination | 83 | ||
| Eyelid Position | 83 | ||
| Tear Meniscus and Puncta | 84 | ||
| Anterior Eyelid | 84 | ||
| Posterior Eyelid | 85 | ||
| Meibomian Gland Expression | 85 | ||
| Mucocutaneous Junction | 86 | ||
| Meibomian Gland Imagery | 87 | ||
| References | 87 | ||
| 7 Slit Lamp Examination and Photography | 89 | ||
| The Instrument: Examination and Photography | 89 | ||
| The Instrument: Photography | 89 | ||
| Preparing for Photography | 90 | ||
| Focus | 91 | ||
| The 35-mm format | 91 | ||
| Magnification | 91 | ||
| Centration | 91 | ||
| Control of artifacts | 92 | ||
| Exposure | 92 | ||
| Color balance and sensitivity | 92 | ||
| Intensity of illumination | 92 | ||
| Subject reflectivity | 92 | ||
| Duration of exposure | 92 | ||
| Forms of Illumination: Examination and Photography | 92 | ||
| Direct Illumination | 92 | ||
| Diffuse illumination: examination | 92 | ||
| Diffuse illumination: photography | 94 | ||
| Focal illumination | 94 | ||
| Broad-beam illumination: examination | 94 | ||
| Broad-beam illumination: photography | 96 | ||
| Optic section: examination | 96 | ||
| Optic section: photography | 98 | ||
| Combined direct focal and diffused illumination: photography | 99 | ||
| Tyndall’s light/anterior chamber cells and flare: examination | 103 | ||
| Tyndall’s light/anterior chamber cells and flare: photography | 103 | ||
| Specular reflection: examination | 103 | ||
| Specular reflection: photography | 104 | ||
| Indirect Illumination | 106 | ||
| Proximal illumination: examination | 106 | ||
| Proximal illumination: photography | 107 | ||
| Sclerotic scatter: examination | 107 | ||
| Sclerotic scatter: photography | 108 | ||
| Direct and indirect retroillumination from the iris: examination | 109 | ||
| Direct retroillumination from the iris: photography | 110 | ||
| Indirect retroillumination from the iris: photography | 111 | ||
| Retroillumination from the fundus: examination | 112 | ||
| Retroillumination from the fundus: photography | 112 | ||
| Transillumination of the iris: examination | 113 | ||
| Transillumination of the iris: photography | 113 | ||
| The peripheral cornea (gonioscopy): examination | 113 | ||
| The peripheral cornea: photography | 113 | ||
| Vital dyes: examination | 113 | ||
| The Seidel test: examination | 115 | ||
| Vital dyes: photography | 115 | ||
| The Seidel test: photography | 117 | ||
| Techniques specific to keratoconus: photography | 117 | ||
| Documenting the Fleischer ring | 117 | ||
| Munson’s sign | 117 | ||
| The Examination | 117 | ||
| Further reading | 118 | ||
| References | 118 | ||
| 8 Tear Film Evaluation | 119 | ||
| General Inspection | 119 | ||
| Slit Lamp Examination | 119 | ||
| Tear Stability | 120 | ||
| Tear Production | 120 | ||
| Tear Composition and Characteristics | 121 | ||
| Tear ferning | 121 | ||
| Tear osmolarity | 121 | ||
| Meibomian Gland Structure and Excreta | 121 | ||
| Tear Clearance Tests | 122 | ||
| Staining of the Ocular Surface | 122 | ||
| Tests of visual function | 122 | ||
| Conclusion | 123 | ||
| References | 123 | ||
| 9 Refraction of the Abnormal Cornea | 125 | ||
| Instrumentation | 125 | ||
| Retinoscopy | 125 | ||
| Keratometry | 125 | ||
| Computer-assisted topographic analysis | 127 | ||
| Trial frame | 127 | ||
| Refracting the Patient | 128 | ||
| Conclusion | 129 | ||
| References | 129 | ||
| 10 Corneal Diagnostic Techniques | 131 | ||
| Corneal Staining | 131 | ||
| Pachymetry | 134 | ||
| Aesthesiometry | 135 | ||
| Osmolarity | 136 | ||
| Summary | 136 | ||
| References | 136 | ||
| 2 Laboratory Investigations | 139 | ||
| 11 Practical Ophthalmic Microbiology for the Detection of Corneal Pathogens | 139 | ||
| Introduction | 139 | ||
| Central Laboratory versus In-office Testing | 139 | ||
| Communication: Ophthalmologist and Laboratory | 139 | ||
| Corneal Specimen Collection | 139 | ||
| Transport media | 140 | ||
| Mailing of diagnostic specimens | 140 | ||
| Stains and Cytologic Specimens | 140 | ||
| Bacterial Laboratory Diagnosis | 141 | ||
| Mycobacteria | 142 | ||
| Nocardia and Actinomyces | 142 | ||
| Antibiotic Susceptibility Testing | 143 | ||
| Laboratory Diagnosis of Fungal Infection | 143 | ||
| Laboratory Detection of Acanthamoeba and Microsporidia | 143 | ||
| Laboratory Diagnosis of Adenovirus Infection | 143 | ||
| Laboratory Testing for Herpes Simplex Virus | 145 | ||
| Laboratory Testing for Varicella-Zoster Virus and Epstein–Barr Virus | 145 | ||
| Laboratory Testing for Chlamydia | 146 | ||
| Laboratory Diagnosis: Unusual Requests | 146 | ||
| Summary | 146 | ||
| References | 146 | ||
| 12 Molecular Genetics of Corneal Disease | 149 | ||
| The Value of Molecular Genetics Study of Disease | 149 | ||
| Review of Genetics and Human Disease | 149 | ||
| Techniques Used to Identify Disease-causing Genes | 150 | ||
| Disease-causing Mutations versus Nondisease-causing Sequence Variations | 151 | ||
| Epithelial and Subepithelial Corneal Dystrophies | 151 | ||
| Epithelial basement membrane dystrophy (EBMD, MIM | 151 | ||
| Epithelial recurrent erosion dystrophy (ERED, MIM | 151 | ||
| Subepithelial mucinous corneal dystrophy (SMCD) | 151 | ||
| Meesmann corneal dystrophy (MCD, MIM | 152 | ||
| Lisch epithelial corneal dystrophy (LECD) | 152 | ||
| Bowman Layer Dystrophies | 152 | ||
| Reis-Bücklers corneal dystrophy (RBCD, MIM | 152 | ||
| Thiel-Behnke corneal dystrophy (TBCD, MIM | 152 | ||
| Grayson-Wilbrandt (GWD) | 152 | ||
| Stromal Dystrophies | 152 | ||
| TGFBI Dystrophies | 152 | ||
| Classic lattice corneal dystrophy (LCD1, MIM | 153 | ||
| Lattice corneal dystrophy, gelosin type (LCD2, MIM | 153 | ||
| Granular corneal dystrophy, type 1 (GCD1, MIM | 154 | ||
| Granular-lattice (Avellino) corneal dystrophy (GCD2, MIM | 154 | ||
| Macular corneal dystrophy (MCD, OMIM | 155 | ||
| Schnyder corneal dystophy (SCD, MIM | 156 | ||
| Congenital stromal corneal dystrophy (CSCD, MIM | 156 | ||
| Fleck corneal dystrophy (FCD, MIM | 156 | ||
| Posterior amorphous corneal dystrophy (PACD) | 156 | ||
| Central cloudy dystrophy of Francois (CCDF, MIM | 156 | ||
| Pre-Descemet’s corneal dystrophy (PDCD) | 156 | ||
| Descemet’s Membrane and Endothelial Dystrophies | 156 | ||
| Fuchs’ endothelial corneal dystrophy (FECD, MIM | 156 | ||
| Posterior polymorphous corneal dystrophy (PPCD, MIM | 157 | ||
| Congenital hereditary endothelial dystrophy (CHED) | 157 | ||
| Autosomal dominant congenital hereditary endothelial dystrophy (CHED1, MIM | 157 | ||
| Autosomal recessive congenital hereditary endothelial dystrophy (CHED2, OMIM 217700) | 157 | ||
| X-linked endothelial corneal dystrophy (XECD) | 157 | ||
| Keratoconus (OMIM 148300) | 158 | ||
| X-linked megalocornea (MGC1, OMIM | 158 | ||
| Cornea plana (CNA2, OMIM | 158 | ||
| Conclusion | 158 | ||
| References | 158 | ||
| 3 Imaging Techniques of the Cornea | 161 | ||
| 13 Keratometry and Topography | 161 | ||
| Keratometry | 161 | ||
| Corneal Topography | 162 | ||
| Placido disk-based topographers | 163 | ||
| Slit scanning tomography | 163 | ||
| Calculations and Surface Reconstruction | 164 | ||
| Placido disk | 164 | ||
| Slit scanning technology | 164 | ||
| Presentation Methods | 164 | ||
| Color-coded maps | 164 | ||
| The Normal Cornea | 164 | ||
| Axial Curvature Maps | 165 | ||
| Refractive Power Map | 165 | ||
| Instantaneous or Tangential Power Map | 167 | ||
| Difference Maps | 167 | ||
| Elevation Maps | 167 | ||
| Pachymetric Maps | 169 | ||
| Quantitative indices | 169 | ||
| Corneal topography indices and screening methods | 170 | ||
| Conclusion | 173 | ||
| References | 175 | ||
| 14 Specular Microscopy | 177 | ||
| Optical Principles of Specular Microscopy | 177 | ||
| Patient Preparation | 178 | ||
| Standardization of Imaging Techniques | 180 | ||
| Instrumentation | 180 | ||
| Qualitative Specular Microscopy | 180 | ||
| Epithelium | 180 | ||
| Endothelium: miscellaneous bright and dark structures | 183 | ||
| Endothelium: morphometry | 184 | ||
| Quantitative Specular Microscopy | 185 | ||
| Specular Microscopy in Clinical Trials and the Value of a Reading Center | 187 | ||
| Clinical Applications for Specular Microscopy | 188 | ||
| Aging | 189 | ||
| Corneal guttae | 189 | ||
| Fuchs’ endothelial corneal dystrophy | 189 | ||
| Lattice corneal dystrophy | 190 | ||
| Iridocorneal endothelial syndrome | 190 | ||
| Posterior polymorphous corneal dystrophy | 190 | ||
| Keratoconus | 191 | ||
| Glaucoma | 191 | ||
| Intraocular inflammation | 192 | ||
| Cataract extraction with intraocular lens implantation | 192 | ||
| Refractive surgery | 192 | ||
| Penetrating keratoplasty | 193 | ||
| Endothelial keratoplasty | 195 | ||
| Donor corneas | 196 | ||
| Intraocular irrigating solutions | 196 | ||
| Vitreocorneal contact | 196 | ||
| Epithelialization of the anterior chamber | 196 | ||
| Blunt trauma | 197 | ||
| Contact lens wear | 197 | ||
| Diabetes | 197 | ||
| References | 197 | ||
| 15 Confocal Microscopy | 205 | ||
| Background | 205 | ||
| Historical overview | 205 | ||
| Current confocal systems in clinical use | 205 | ||
| In Vivo Confocal Imaging Techniques | 207 | ||
| Normal corneal structures | 207 | ||
| Confocal microscopy through-focusing | 208 | ||
| Clinical Applications | 210 | ||
| Wound healing following refractive surgery | 210 | ||
| Infectious keratitis | 212 | ||
| Imaging Corneal Collagen Using Second Harmonic Generated Signals | 213 | ||
| Normal human corneal stromal collagen organization | 214 | ||
| Collagen organization in keratoconus corneas | 216 | ||
| Conclusions | 217 | ||
| References | 217 | ||
| 16 High-Resolution Ultrasound | 221 | ||
| Instrumentation | 221 | ||
| Image resolution | 221 | ||
| Examination Techniques | 222 | ||
| The Normal Cornea | 222 | ||
| Corneal Disease | 224 | ||
| Corneal edema | 224 | ||
| Descemet’s membrane detachment | 224 | ||
| Intraocular lens malposition | 224 | ||
| Imaging the anterior segment behind corneal opacities | 224 | ||
| Corneal dystrophies | 224 | ||
| Peripheral corneal degenerations | 224 | ||
| Keratoconus | 225 | ||
| Corneal Tumors | 225 | ||
| Corneal Surgery | 226 | ||
| Keratoplasty | 226 | ||
| Penetrating | 226 | ||
| Lamellar | 227 | ||
| Refractive surgery | 227 | ||
| Excimer laser keratectomy | 227 | ||
| Laser-associated in situ keratomileusis | 227 | ||
| Summary | 227 | ||
| Acknowledgments | 227 | ||
| References | 228 | ||
| 17 Anterior Segment Optical Coherence Tomography | 231 | ||
| Introduction | 231 | ||
| Keratoconus Screening | 231 | ||
| Refractive Surgery Evaluation | 232 | ||
| LASIK flap evaluation | 232 | ||
| Refractive enhancement | 232 | ||
| LASIK complications | 233 | ||
| Corneal Power Calculation | 233 | ||
| Corneal Opacities | 233 | ||
| Cornea Transplant | 233 | ||
| Posterior lamellar keratoplasty | 233 | ||
| Femtosecond-enabled keratoplasty | 234 | ||
| Refractive Implants | 234 | ||
| Corneal implants | 234 | ||
| Phakic Intraocular Lenses | 235 | ||
| Financial interests | 236 | ||
| References | 236 | ||
| III Differential Diagnosis of Selected Problems in Corneal and External Eye Disease | 237 | ||
| 18 Congenital Corneal Opacities: | 239 | ||
| Differential Diagnosis | 239 | ||
| History and Physical Examination | 239 | ||
| Sclerocornea (S TUMPED) | 241 | ||
| Tears in the Endothelium and Descemet’s Membrane (S T UMPED) | 242 | ||
| Congenital glaucoma | 242 | ||
| Birth trauma | 243 | ||
| Corneal Ulcers and Inflammation (ST U MPED) | 244 | ||
| Viral diseases | 245 | ||
| Herpes simplex virus infection | 245 | ||
| Congenital rubella | 246 | ||
| Bacterial diseases | 246 | ||
| Neurotrophic keratitis | 247 | ||
| Metabolic diseases (STU M PED) | 247 | ||
| Mucopolysaccharidosis | 247 | ||
| Mucolipidosis | 250 | ||
| Other metabolic diseases | 250 | ||
| Cystinosis | 250 | ||
| Fabry’s disease | 250 | ||
| Tyrosinemia | 251 | ||
| Gangliosidoses | 251 | ||
| Miscellaneous Syndromes | 251 | ||
| Fetal alcohol syndrome | 251 | ||
| Fryns syndrome | 251 | ||
| Cerebro-oculofacio-skeletal syndrome | 251 | ||
| Posterior Corneal Defect (STUM P ED) | 251 | ||
| Peters’ anomaly (STUM P ED) | 252 | ||
| Posterior keratoconus (STUM P ED) | 254 | ||
| Congenital anterior staphyloma (STUM P ED) | 255 | ||
| Endothelial Dystrophy (STUMP E D) | 255 | ||
| Congenital hereditary endothelial dystrophy | 255 | ||
| Posterior polymorphous corneal dystrophy (PPCD) | 256 | ||
| Congenital stromal corneal dystrophy (CSCD) | 258 | ||
| Other dystrophies | 259 | ||
| Congenital Dermoids (STUMPE D) | 259 | ||
| Corneal Keloids | 262 | ||
| References | 262 | ||
| 19 Peripheral Corneal Disease | 267 | ||
| The Peripheral Cornea: Its Susceptibility and Response to Disease | 267 | ||
| Congenital/Developmental/Inherited Disorders of the Peripheral Cornea | 267 | ||
| Inflammatory/Autoimmune Disorders of the Peripheral Cornea | 268 | ||
| Neoplastic Disorders of the Peripheral Cornea | 271 | ||
| Degenerative Disorders of the Peripheral Cornea | 272 | ||
| Infectious Disorders of the Peripheral Cornea | 274 | ||
| References | 275 | ||
| 20 The Corneal Ulcer | 277 | ||
| Diagnosis | 277 | ||
| Treatment | 281 | ||
| References | 281 | ||
| 21 Corneal Edema | 283 | ||
| Physiology | 283 | ||
| Epithelial and endothelial barriers | 283 | ||
| Tear evaporation | 283 | ||
| Intraocular pressure | 283 | ||
| Metabolically active mechanisms | 283 | ||
| Diagnosis | 283 | ||
| Clinical history | 283 | ||
| Examination | 284 | ||
| Ancillary tests | 285 | ||
| Pachymetry | 285 | ||
| Specular microscopy | 285 | ||
| In vivo confocal microscopy | 285 | ||
| Anterior segment optical coherence tomography | 285 | ||
| Treatment | 285 | ||
| Control of associated abnormalities | 285 | ||
| Inflammation | 285 | ||
| Intraocular pressure | 286 | ||
| Management of epithelial and stromal edema | 286 | ||
| Hypertonic agents | 286 | ||
| Bandage contact lens | 286 | ||
| Anterior stromal cautery | 286 | ||
| Conjunctival flap | 286 | ||
| Amniotic membrane | 286 | ||
| Excimer laser | 286 | ||
| Penetrating keratoplasty | 286 | ||
| Endothelial keratoplasty | 286 | ||
| Collagen Cross-linking | 287 | ||
| References | 287 | ||
| 22 Corneal Deposits | 289 | ||
| Superficial Deposits | 289 | ||
| Pigmented deposits | 289 | ||
| Cornea verticillata | 289 | ||
| Striate melanokeratosis | 289 | ||
| Epithelial iron lines | 289 | ||
| Spheroidal degeneration | 289 | ||
| Adrenochrome deposition | 289 | ||
| Nonpigmented deposits | 290 | ||
| Subepithelial mucinous corneal dystrophy | 290 | ||
| Coat’s white ring | 290 | ||
| Calcific band keratopathy | 290 | ||
| Fluoroquinolone deposits | 291 | ||
| Mucin balls | 292 | ||
| Refractile/crystalline deposits | 292 | ||
| Meesmann’s dystrophy | 292 | ||
| Gelatinous droplike dystrophy | 293 | ||
| Tyrosinemia II (Richner-Hanhart syndrome) | 293 | ||
| Intraepithelial ointment | 293 | ||
| Gout (urate) | 294 | ||
| Stromal Deposits | 294 | ||
| Pigmented Deposits | 294 | ||
| Phenothiazines | 294 | ||
| Corneal blood staining | 294 | ||
| Bilirubin | 294 | ||
| Siderosis | 294 | ||
| Nonpigmented deposits | 295 | ||
| Granular dystrophy | 295 | ||
| Macular dystrophy | 295 | ||
| Fleck dystrophy | 295 | ||
| Lipid deposition | 296 | ||
| Mucopolysaccharidoses | 296 | ||
| Refractile/crystalline deposits | 296 | ||
| Lattice dystrophy | 296 | ||
| Schnyder’s central crystalline dystrophy | 297 | ||
| Bietti’s crystalline dystrophy | 297 | ||
| Systemic diseases with immunoglobulin deposition | 298 | ||
| Cystinosis | 298 | ||
| Deep Stromal Deposits | 298 | ||
| Pigmented deposits | 298 | ||
| Copper deposition associated with Wilson’s disease | 298 | ||
| Chalcosis | 299 | ||
| Ocular chrysiasis | 299 | ||
| Mottled cyan opacification in contact lens wearers | 299 | ||
| Nonpigmented deposits | 299 | ||
| Cornea farinata | 299 | ||
| Pre-Descemet’s corneal dystrophy | 300 | ||
| X-linked ichthyosis | 300 | ||
| Ocular argyrosis | 300 | ||
| Refractile/crystalline deposits | 301 | ||
| Polymorphic amyloid degeneration | 301 | ||
| References | 301 | ||
| 23 Corneal Infiltrates in the Contact Lens Patient | 303 | ||
| History | 303 | ||
| Pain | 303 | ||
| Type of contact lens and pattern of wear | 303 | ||
| Contact lens solutions and hygeine | 303 | ||
| Slit Lamp Examination | 304 | ||
| Diagnosis | 304 | ||
| Treatment | 306 | ||
| Follow-up | 306 | ||
| Case Examples | 306 | ||
| Case 1 | 306 | ||
| Case 2 | 307 | ||
| Case 3 | 307 | ||
| Case 4 | 307 | ||
| Case 5 | 307 | ||
| Case 6 | 307 | ||
| References | 307 | ||
| 24 The Red Eye | 309 | ||
| Defining a Red Eye | 309 | ||
| Approaching the Patient | 309 | ||
| Subconjunctival Hemorrhages and Telephone Triage of a Red Eye | 309 | ||
| Redness due to Inflammation | 311 | ||
| Red Eyes due to Vascular Abnormalities | 311 | ||
| The Medical History and Case Examples | 311 | ||
| Physical Examination | 312 | ||
| Conclusion | 314 | ||
| 25 Minimal Visual Loss: | 315 | ||
| History | 315 | ||
| Examination Techniques | 315 | ||
| Visual acuity | 315 | ||
| Pinhole aperture | 315 | ||
| Contrast sensitivity function (CSF) | 315 | ||
| Diagnostic rigid contact lens refraction | 315 | ||
| Technique | 315 | ||
| Potential acuity meter | 316 | ||
| Retinoscopy | 316 | ||
| Slit lamp examination | 316 | ||
| Fluorescein evaluation | 316 | ||
| Keratometry | 316 | ||
| Computerized corneal topography | 316 | ||
| Wavefront analysis | 317 | ||
| Selected Conditions Causing Minimal Visual Loss | 318 | ||
| Dry eyes | 318 | ||
| Ectatic disorders | 318 | ||
| Keratoconus | 318 | ||
| Ectasia following refractive surgery | 319 | ||
| Pellucid marginal degeneration | 319 | ||
| Terrien’s marginal degeneration | 319 | ||
| Punctate epithelial keratitis | 319 | ||
| Corneal scars | 319 | ||
| Corneal dystrophies | 319 | ||
| Anterior corneal dytrophies | 319 | ||
| Meesmann’s dystrophy | 319 | ||
| Reis-Bücklers’ dystrophy | 320 | ||
| Stromal corneal dystrophies | 320 | ||
| Granular dystrophy | 320 | ||
| Lattice dystrophy | 320 | ||
| Macular dystrophy | 320 | ||
| Endothelial disorders | 320 | ||
| Fuchs’ endothelial dystrophy | 320 | ||
| Posterior polymorphous dystrophy (PPMD) | 320 | ||
| Iridocorneal endothelial syndrome | 320 | ||
| Corneal degenerations | 321 | ||
| Pterygium | 321 | ||
| Corneal warpage | 321 | ||
| Keratorefractive surgery | 321 | ||
| References | 321 | ||
| 26 The Approach to a Patient with Itching and Burning | 323 | ||
| The Primary Symptom | 323 | ||
| Onset | 323 | ||
| Past medical history | 323 | ||
| Contact lens wear | 323 | ||
| Review of systems | 323 | ||
| The Examination | 324 | ||
| External examination | 324 | ||
| Lids and lashes | 325 | ||
| The Ocular Surface | 325 | ||
| Conjunctiva | 325 | ||
| Tear film analysis | 326 | ||
| Cornea | 326 | ||
| References | 326 | ||
| IV Eye Banking | 329 | ||
| 27 Eye Banking: | 331 | ||
| Eye Banking: Patient Services and Regulatory Concerns | 331 | ||
| Tissue Acquisition | 331 | ||
| Screening | 331 | ||
| Retrieval or Recovery | 332 | ||
| Tissue Preservation/Storage | 332 | ||
| Donor Eligibility and Tissue Suitability | 332 | ||
| Tissue Evaluation | 332 | ||
| Quality Assurance | 332 | ||
| Facilities, Equipment, Instruments, and Supplies | 333 | ||
| Distribution | 333 | ||
| Further Reading | 333 | ||
| 28 Medical Standards for Eye Banking | 335 | ||
| Eye Bank Association of America Medical Standards | 335 | ||
| Federal and State Regulations | 335 | ||
| Standards Relating to Safety of Tissue | 336 | ||
| Dystrophies and degenerations | 337 | ||
| Endophthalmitis and microbial keratitis | 337 | ||
| Rabies | 338 | ||
| Hepatitis B | 338 | ||
| Hepatitis C | 339 | ||
| HIV I and II | 339 | ||
| Other infectious agents | 339 | ||
| Prion disease | 340 | ||
| Malignancies | 341 | ||
| Recalls and Market Withdrawals | 341 | ||
| Primary Graft Failure | 342 | ||
| Mechanical and Optical Integrity | 342 | ||
| References | 343 | ||
| V The Ocular Adnexa | 345 | ||
| 1 Diseases of the Lid: Anatomic Abnormalities | 347 | ||
| 29 Eyelid Disorders: | 347 | ||
| Entropion | 347 | ||
| Congenital entropion | 347 | ||
| Involutional entropion | 347 | ||
| Cicatricial entropion | 348 | ||
| Acute spastic entropion | 348 | ||
| Differential diagnosis | 349 | ||
| Medical management | 349 | ||
| Surgical management | 349 | ||
| Congenital entropion | 349 | ||
| Involutional entropion | 349 | ||
| Cicatricial entropion | 352 | ||
| Complications | 352 | ||
| Ectropion | 352 | ||
| Congenital ectropion | 352 | ||
| Involutional ectropion | 352 | ||
| Cicatricial ectropion | 352 | ||
| Paralytic ectropion | 352 | ||
| Mechanical ectropion | 353 | ||
| Inflammatory ectropion | 353 | ||
| Differential diagnosis | 353 | ||
| Medical management | 353 | ||
| Surgical management | 353 | ||
| Involutional ectropion | 353 | ||
| Congenital ectropion | 354 | ||
| Paralytic ectropion | 354 | ||
| Cicatricial ectropion | 354 | ||
| Complications | 354 | ||
| Trichiasis and Distichiasis | 355 | ||
| Management of trichiasis | 355 | ||
| Management of distichiasis | 356 | ||
| References | 356 | ||
| 30 Lagophthalmos and Other Malpositions of the Lid | 357 | ||
| Floppy Eyelid Syndrome | 357 | ||
| Treatment | 359 | ||
| Lid Imbrication Syndrome | 359 | ||
| Treatment | 360 | ||
| Lagophthalmos | 360 | ||
| Treatment | 362 | ||
| Eyelid Retraction | 364 | ||
| Treatment | 364 | ||
| References | 365 | ||
| 2 Diseases of the Lid: Tumors | 367 | ||
| 31 Benign Lid Tumors | 367 | ||
| Histology of the Eyelid Skin | 367 | ||
| Approach to Diagnosis and Management | 368 | ||
| Benign Tumors of the Epidermis | 368 | ||
| Acrochordon | 368 | ||
| Milia | 369 | ||
| Seborrheic keratosis | 369 | ||
| Keratoacanthoma | 369 | ||
| Inverted follicular keratosis | 370 | ||
| Cutaneous horn | 370 | ||
| Epidermal inclusion cyst | 370 | ||
| Linear epidermal nevus | 370 | ||
| Nodular elastosis with cysts and comedones (Favre-Racouchot syndrome) | 371 | ||
| Actinic keratosis (solar keratosis) | 371 | ||
| Dermoid and epidermoid cysts | 371 | ||
| Oncocytoma | 372 | ||
| Phakomatous choristoma | 372 | ||
| Benign Tumors of the Dermis | 372 | ||
| Tumors derived from neural tissue | 372 | ||
| Neurofibroma | 372 | ||
| Neurilemoma | 373 | ||
| Neuroma | 373 | ||
| Granular cell tumor | 373 | ||
| Tumors derived from smooth muscle | 373 | ||
| Leiomyoma | 373 | ||
| Tumors derived from vascular tissue | 373 | ||
| Nevus flammeus | 373 | ||
| Capillary hemangioma | 374 | ||
| Cherry hemangioma | 374 | ||
| Cavernous hemangioma | 374 | ||
| Varix | 375 | ||
| Lymphangioma | 375 | ||
| Arteriovenous malformation | 375 | ||
| Pyogenic granuloma | 376 | ||
| Glomus tumor | 376 | ||
| Intravascular papillary endothelial hyperplasia | 376 | ||
| Angiolymphoid hyperplasia with eosinophilia | 376 | ||
| Tumors derived from histiocytes | 377 | ||
| Xanthelasma | 377 | ||
| Xanthoma | 377 | ||
| Juvenile xanthogranuloma | 377 | ||
| Tumors derived from fibrous tissue | 378 | ||
| Dermatofibroma | 378 | ||
| Benign Tumors of the Eyelid Adnexa | 378 | ||
| Tumors of sweat gland origin | 378 | ||
| Tumors of eccrine sweat gland origin | 378 | ||
| Syringoma | 378 | ||
| Eccrine spiradenoma | 378 | ||
| Eccrine acrospiroma | 378 | ||
| Eccrine hidrocystoma | 379 | ||
| Pleomorphic adenoma | 379 | ||
| Tumors of apocrine sweat gland origin | 379 | ||
| Apocrine hidrocystoma | 379 | ||
| Cylindroma | 379 | ||
| Syringocystadenoma papilliferum | 380 | ||
| Tumors of hair follicle origin | 380 | ||
| Trichoepithelioma | 380 | ||
| Trichoadenoma | 381 | ||
| Trichofolliculoma | 381 | ||
| Trichilemmoma | 381 | ||
| Pilomatricoma | 381 | ||
| Tumors of sebaceous gland origin | 382 | ||
| Sebaceous gland hyperplasia | 382 | ||
| Sebaceous adenoma | 382 | ||
| Benign Melanocytic Lesions | 382 | ||
| Nevocellular nevi | 382 | ||
| Junctional nevi | 382 | ||
| Compound nevi | 382 | ||
| Melanoma | 382 | ||
| Intradermal nevi | 382 | ||
| Variants of nevocellular nevi | 383 | ||
| Congenital nevus | 383 | ||
| Blue nevus | 383 | ||
| Nevus of Ota | 383 | ||
| Freckle | 384 | ||
| Lentigo simplex | 384 | ||
| Lentigo senilis | 384 | ||
| Lentigo maligna | 384 | ||
| Conclusion | 384 | ||
| References | 384 | ||
| 32 Malignant Eyelid Tumors | 387 | ||
| Basal Cell Carcinoma | 387 | ||
| Clinical appearance | 387 | ||
| Biologic behavior | 389 | ||
| Clinical diagnosis | 389 | ||
| Treatment | 389 | ||
| Mohs’ micrographic surgery | 389 | ||
| Frozen section control | 390 | ||
| Ionizing radiation therapy | 390 | ||
| Cryosurgery | 390 | ||
| Chemotherapy | 390 | ||
| Recurrence | 390 | ||
| Squamous Cell Carcinoma | 390 | ||
| Premalignant Lesions | 391 | ||
| Actinic keratosis | 391 | ||
| Bowen’s disease | 391 | ||
| Epidemiology and Differential Diagnosis | 392 | ||
| Squamous cell carcinoma | 392 | ||
| Clinical presentation | 392 | ||
| Biologic behavior | 392 | ||
| Treatment | 392 | ||
| Sebaceous cell carcinoma | 392 | ||
| Etiology | 393 | ||
| Clinical presentation | 393 | ||
| Treatment | 393 | ||
| Prognosis | 394 | ||
| Merkel cell carcinoma (trabecular carcinoma) | 394 | ||
| Normal Merkel cell | 394 | ||
| Merkel cell carcinomas | 394 | ||
| Clinical presentation | 394 | ||
| Histopathology | 394 | ||
| Treatment | 395 | ||
| Localized disease | 395 | ||
| Extraregional disease | 395 | ||
| Malignant melanoma | 395 | ||
| Lentigo maligna melanoma | 395 | ||
| Superficial spreading melanoma | 396 | ||
| Nodular melanoma | 396 | ||
| Treatment | 396 | ||
| Kaposi’s sarcoma | 397 | ||
| Clinical presentation | 397 | ||
| Histopathology | 397 | ||
| Treatment | 397 | ||
| Systemic Associations | 398 | ||
| Basal cell nevus syndrome (Gorlin-Goltz syndrome) | 398 | ||
| Systemic manifestations | 398 | ||
| Ophthalmic manifestations | 398 | ||
| Treatment | 398 | ||
| Xeroderma Pigmentosum | 398 | ||
| Cutaneous abnormalities | 399 | ||
| Ocular abnormalities | 399 | ||
| Neurologic abnormalities | 399 | ||
| Treatment | 399 | ||
| Muir-Torre Syndrome | 399 | ||
| Summary | 399 | ||
| References | 399 | ||
| 3 Diseases of the Lid: Inflammation and Infections | 403 | ||
| 33 Blepharitis: | 403 | ||
| Classification | 403 | ||
| Differential Diagnosis | 405 | ||
| Management | 405 | ||
| References | 405 | ||
| 34 Meibomian Gland Dysfunction and Seborrhea | 407 | ||
| Normal Anatomy of the Meibomian Glands | 407 | ||
| Terminology | 407 | ||
| Physiology | 407 | ||
| Classification of Meibomian Gland Dysfunction | 409 | ||
| Diagnosis of Meibomian Gland Dysfunction | 409 | ||
| Associated Conditions | 410 | ||
| Associated sequelae | 411 | ||
| Histopathology | 411 | ||
| Models of Meibomian Gland Dysfunction | 411 | ||
| Lipid Composition and Behavior of Human Meibomian Secretion | 411 | ||
| Role of Microorganisms | 411 | ||
| Treatment | 412 | ||
| Conclusion | 412 | ||
| References | 412 | ||
| 35 Eyelid Infections | 415 | ||
| Viral Infections | 415 | ||
| Herpes simplex virus | 415 | ||
| Clinical manifestations | 415 | ||
| Treatment | 415 | ||
| Varicella-zoster virus | 415 | ||
| Clinical manifestations of primary VZV infection | 415 | ||
| Clinical manifestations of reactivated VZV | 416 | ||
| Diagnosis | 416 | ||
| Treatment of primary VZV infection | 416 | ||
| Treatment of reactivated VZV | 417 | ||
| Molluscum contagiosum | 417 | ||
| Verruca vulgaris | 418 | ||
| Treatment | 418 | ||
| Bacterial Infections | 418 | ||
| Hordeolum | 418 | ||
| Preseptal cellulitis | 418 | ||
| Post-traumatic suppurative preseptal cellulitis | 418 | ||
| Nonsuppurative preseptal cellulitis in children | 419 | ||
| Erysipelas | 419 | ||
| Impetigo contagiosa | 419 | ||
| Rare bacterial infections | 419 | ||
| Anthrax | 419 | ||
| Syphilis | 419 | ||
| Mycobacterial Infections | 419 | ||
| Actinomycosis | 420 | ||
| Fungal Infections | 420 | ||
| Blastomycosis | 420 | ||
| Coccidiomycosis | 420 | ||
| Cryptococcosis | 420 | ||
| Dermatophytosis/tinea palpebrum | 420 | ||
| Sporotrichosis | 421 | ||
| Mucormycosis | 421 | ||
| Parasitic Eyelid Infections | 421 | ||
| Demodicosis | 421 | ||
| Phthiriasis/pediculosis | 421 | ||
| Onchocerciasis | 422 | ||
| References | 422 | ||
| 4 Disorders of Tear Production and the Lacrimal System | 425 | ||
| 36 Dry Eye | 425 | ||
| Definition | 425 | ||
| Lacrimal Functional Unit: Anatomy and Physiology | 425 | ||
| Pathophysiology | 425 | ||
| Etiopathogenic Classification | 426 | ||
| Aqueous tear-deficient dry eye (ADDE, tear-deficient dry eye; lacrimal tear deficiency) | 426 | ||
| Sjögren’s syndrome dry eye | 427 | ||
| Non-Sjögren’s syndrome dry eye | 428 | ||
| Primary lacrimal gland deficiencies | 428 | ||
| Secondary lacrimal gland deficiencies | 429 | ||
| Obstruction of the lacrimal gland ducts | 429 | ||
| Reflex hyposecretion | 429 | ||
| Reflex sensory block | 429 | ||
| Diabetes mellitus: | 429 | ||
| Neurotrophic keratitis: | 429 | ||
| Reflex motor block | 430 | ||
| Evaporative dry eye | 430 | ||
| Intrinsic causes | 430 | ||
| Meibomian gland dysfunction | 430 | ||
| Disorders of lid aperture and lid/globe congruity or dynamic | 430 | ||
| Low blink rate | 430 | ||
| Extrinsic causes | 430 | ||
| Ocular surface disease | 430 | ||
| Contact lens wear | 430 | ||
| Diagnosis of Dry Eye | 430 | ||
| History | 430 | ||
| Physical examination | 431 | ||
| Diagnostic tests | 431 | ||
| Tear film stability | 431 | ||
| Diagnostic dye staining: ocular surface health | 431 | ||
| Corneal sensation | 433 | ||
| Tear film composition | 433 | ||
| Osmolarity | 433 | ||
| Tear protein analysis | 433 | ||
| Aqueous tear flow and turnover | 433 | ||
| Schirmer test | 433 | ||
| Delayed tear clearance | 434 | ||
| Other noninvasive methods for assessing the tear film | 434 | ||
| Systemic Work-Up | 435 | ||
| Management of Dry Eyes | 435 | ||
| Tear supplementation: lubricants | 435 | ||
| Tear retention | 436 | ||
| Punctal occlusion | 436 | ||
| Moisture chamber spectacles | 436 | ||
| Contact lenses | 436 | ||
| Tarsorrhaphy | 436 | ||
| Tear stimulation: secretagogues | 437 | ||
| Biological tear substitutes | 437 | ||
| Serum | 437 | ||
| Salivary gland autotransplantation | 437 | ||
| Anti-inflammatory therapy | 437 | ||
| Ciclosporin | 437 | ||
| Corticosteroids | 438 | ||
| Tetracyclines | 439 | ||
| Essential fatty acids | 439 | ||
| Topical vitamin A (retinol) | 439 | ||
| Mucolytics | 439 | ||
| Treatment Guidelines | 439 | ||
| References | 440 | ||
| 37 Dacryoadenitis, Dacryocystitis, and Canaliculitis | 445 | ||
| Dacryoadenitis | 445 | ||
| Dacryocystitis | 446 | ||
| Canaliculitis | 448 | ||
| References | 450 | ||
| 38 Epiphora | 451 | ||
| Introduction | 451 | ||
| Etiology | 451 | ||
| Overproduction | 451 | ||
| Outflow obstruction | 451 | ||
| Lacrimal pump failure | 453 | ||
| Differential Diagnosis | 453 | ||
| Evaluation | 453 | ||
| Treatment | 454 | ||
| Overproduction | 454 | ||
| Outflow obstruction | 455 | ||
| Lacrimal pump failure | 456 | ||
| Summary | 456 | ||
| References | 456 | ||
| VI The Conjunctiva | 459 | ||
| 1 Conjunctival Disease: Tumors | 1 | ||
| 39 Squamous Neoplasms of the Conjunctiva | 1 | ||
| Benign Tumefactions | 1 | ||
| Benign hereditary intraepithelial dyskeratosis | 1 | ||
| Pseudoepitheliomatous hyperplasia and keratoacanthoma | 1 | ||
| Conjunctival squamous papilloma | 2 | ||
| Inverted conjunctival papillomas | 3 | ||
| Dacryoadenoma | 3 | ||
| Pterygia and pingueculae | 3 | ||
| Malignant Tumefactions | 4 | ||
| Conjunctival intraepithelial neoplasia | 4 | ||
| Invasive squamous cell carcinoma | 6 | ||
| Corneal epithelial dysmaturation and epithelial dysplasia | 9 | ||
| Mucoepidermoid carcinoma | 9 | ||
| Spindle cell carcinoma | 9 | ||
| Adenoid squamous carcinoma | 9 | ||
| Clear cell carcinoma | 9 | ||
| Sebaceous cell carcinoma | 10 | ||
| Basal cell carcinoma | 13 | ||
| References | 13 | ||
| 40 Melanocytic Neoplasms of the Conjunctiva | 477 | ||
| Introduction | 477 | ||
| Conjunctival Nevus | 477 | ||
| Conjunctival Melanosis | 478 | ||
| Epithelial congenital melanosis | 478 | ||
| Subepithelial congential melanosis | 479 | ||
| Secondary acquired melanosis | 479 | ||
| Primary acquired melanosis | 479 | ||
| Malignant Melanoma | 481 | ||
| References | 483 | ||
| 41 Subepithelial Neoplasms of the Conjunctiva | 485 | ||
| Congenital Lesions | 485 | ||
| Choristomas | 485 | ||
| Dermoid and dermolipoma | 485 | ||
| Ectopic lacrimal gland; simple and complex choristomas | 486 | ||
| Epibulbar osseous and neuroglial choristomas | 487 | ||
| Hamartomas | 488 | ||
| Conjunctival cysts | 488 | ||
| Reactive, Degenerative, and Inflammatory Lesions | 489 | ||
| Pyogenic granuloma/capillary hemangioma | 489 | ||
| Pinguecula/pterygium | 491 | ||
| Elastofibroma oculi | 491 | ||
| Nodular fasciitis | 491 | ||
| Granulomatous and histiocytic lesions | 491 | ||
| Epibulbar molluscum contagiosum | 492 | ||
| Keloid | 492 | ||
| Amyloid | 493 | ||
| Hematic cyst | 493 | ||
| Neoplastic Lesions | 493 | ||
| Fibrous histiocytoma | 493 | ||
| Kaposi’s sarcoma | 494 | ||
| Oncocytoma (oxyphilic adenoma) | 498 | ||
| Basal cell carcinoma | 499 | ||
| Malignant melanoma | 499 | ||
| Lymphoid lesions | 499 | ||
| Other Subconjunctival Neoplastic Lesions | 501 | ||
| References | 504 | ||
| 2 Conjunctivitis | 509 | ||
| 42 Conjunctivitis: | 509 | ||
| Conjunctival Injection | 509 | ||
| Conjunctivitis | 509 | ||
| Morphologic responses | 510 | ||
| Papillae | 510 | ||
| Follicles | 510 | ||
| Membranes | 510 | ||
| Cicatrizing changes | 512 | ||
| Granulomas | 512 | ||
| Type of exudate | 513 | ||
| Anatomic localization | 513 | ||
| Acute Conjunctivitis | 513 | ||
| Acute papillary conjunctivitis | 513 | ||
| Acute follicular conjunctivitis | 514 | ||
| Adenovirus | 514 | ||
| Inclusion conjunctivitis | 514 | ||
| Ocular herpes infections | 514 | ||
| RNA-containing viruses | 515 | ||
| Poxviruses | 515 | ||
| Acute membranous conjunctivitis | 515 | ||
| Chronic Conjunctivitis | 515 | ||
| Giant papillary conjunctivitis | 516 | ||
| Vernal keratoconjunctivitis | 516 | ||
| Atopic keratoconjunctivitis | 516 | ||
| Secondary giant papillary conjunctivitis | 516 | ||
| Chronic papillary conjunctivitis | 516 | ||
| Masquerade syndrome | 517 | ||
| Intraepithelial neoplasia | 517 | ||
| Malignant melanoma | 517 | ||
| Sebaceous cell carcinoma | 517 | ||
| Lacrimal drainage system infection | 517 | ||
| Chronic dacryocystitis | 517 | ||
| Chronic canaliculitis | 517 | ||
| Superior limbic keratoconjunctivitis | 517 | ||
| Floppy eyelid syndrome | 517 | ||
| Blepharoconjunctivitis | 518 | ||
| Staphylococcal and seborrheic | 518 | ||
| Meibomian gland dysfunction | 518 | ||
| Keratoconjunctivitis sicca | 518 | ||
| Mucus-fishing syndrome | 518 | ||
| Toxic papillary keratoconjunctivitis | 518 | ||
| Chronic follicular conjunctivitis | 519 | ||
| Chlamydial | 519 | ||
| Trachoma | 519 | ||
| Inclusion conjunctivitis | 519 | ||
| Moraxella | 519 | ||
| Molluscum contagiosum | 519 | ||
| Toxic follicular conjunctivitis | 519 | ||
| Lyme disease | 519 | ||
| Chronic membranous conjunctivitis | 520 | ||
| Cicatrizing and granulomatous conjunctivitis | 520 | ||
| References | 520 | ||
| 43 Bacterial Conjunctivitis | 521 | ||
| Nonspecific and Specific Natural Defenses | 521 | ||
| Manifestations of Conjunctivitis | 522 | ||
| Discharge | 522 | ||
| Membranes and pseudomembranes | 522 | ||
| Papillae and follicles | 522 | ||
| Classification | 523 | ||
| Hyperacute bacterial conjunctivitis | 523 | ||
| Associated ocular and systemic complications | 524 | ||
| Diagnosis | 524 | ||
| Treatment | 524 | ||
| Acute conjunctivitis | 525 | ||
| Associated ocular and systemic complications | 527 | ||
| Diagnosis | 527 | ||
| Treatment | 527 | ||
| Chronic conjunctivitis | 529 | ||
| Associated ocular complications | 530 | ||
| Diagnosis | 530 | ||
| Treatment | 530 | ||
| Unusual Causes of Bacterial Conjunctivitis | 530 | ||
| Immunodeficiency and AIDS | 531 | ||
| References | 531 | ||
| 44 Viral Conjunctivitis | 535 | ||
| DNA Viruses | 535 | ||
| Adenoviruses | 535 | ||
| Treatment | 538 | ||
| Herpes simplex virus (HSV) | 540 | ||
| Varicella-zoster virus (VZV) | 540 | ||
| Epstein-Barr virus (EBV) | 541 | ||
| Cytomegalovirus (CMV) | 541 | ||
| Variola and vaccinia virus | 541 | ||
| Molluscum contagiosum virus (MC) | 541 | ||
| RNA Viruses | 541 | ||
| Picornaviruses | 541 | ||
| Paramyxoviruses | 542 | ||
| Togaviruses | 542 | ||
| Flaviviruses | 542 | ||
| References | 542 | ||
| 45 Chlamydial Infections | 545 | ||
| Introduction | 545 | ||
| Basic Science | 545 | ||
| Trachoma | 545 | ||
| Epidemiology | 545 | ||
| Clinical manifestations | 546 | ||
| Pathophysiology | 547 | ||
| Treatment | 547 | ||
| Neonatal Inclusion Conjunctivitis | 548 | ||
| Adult Inclusion Conjunctivitis | 549 | ||
| Lymphogranuloma Venereum | 550 | ||
| Chlamydia psittaci | 551 | ||
| Conclusion | 551 | ||
| References | 551 | ||
| 46 Ophthalmia Neonatorum | 553 | ||
| Pathogenesis | 553 | ||
| The Role of Sexually Transmitted Diseases | 553 | ||
| Causes of Neonatal Conjunctivitis | 554 | ||
| Chemical | 554 | ||
| Bacterial | 554 | ||
| Chlamydial | 555 | ||
| Viral | 555 | ||
| Fungal | 556 | ||
| Laboratory Diagnosis | 556 | ||
| Treatment | 556 | ||
| Ocular Prophylaxis | 557 | ||
| References | 558 | ||
| 47 Parinaud’s Oculoglandular Syndrome | 559 | ||
| History | 559 | ||
| Directed Work-up | 559 | ||
| Individual Etiologies | 560 | ||
| Cat-scratch disease | 560 | ||
| Tularemia | 562 | ||
| Tuberculosis | 563 | ||
| Sporotrichosis | 563 | ||
| Syphilis | 564 | ||
| Other causes | 564 | ||
| References | 564 | ||
| 48 Seasonal and Perennial Allergic Conjunctivitis | 567 | ||
| Immunopathophysiology | 567 | ||
| Clinical Features of Seasonal Allergic Conjunctivitis | 568 | ||
| Clinical Features of Perennial Allergic Conjunctivitis | 569 | ||
| Treatment of Seasonal and Perennial Allergic Conjunctivitis | 570 | ||
| Advisory interventions | 570 | ||
| Medical therapy | 570 | ||
| Contact Lens Wearers | 571 | ||
| Research in Diagnosis and Treatment | 571 | ||
| References | 571 | ||
| 49 Vernal and Atopic Keratoconjunctivitis | 573 | ||
| Vernal Keratoconjunctivitis | 573 | ||
| Definition | 573 | ||
| Demographics | 573 | ||
| Symptoms | 573 | ||
| Signs | 573 | ||
| Pathophysiology | 574 | ||
| Diagnosis | 575 | ||
| Treatment | 575 | ||
| Atopic Keratoconjunctivitis | 576 | ||
| Definition | 576 | ||
| Demographics | 576 | ||
| Symptoms | 576 | ||
| Signs | 576 | ||
| Pathophysiology | 577 | ||
| Diagnosis | 578 | ||
| Treatment | 578 | ||
| References | 579 | ||
| 50 Giant Papillary Conjunctivitis | 583 | ||
| Symptoms and Signs | 583 | ||
| Histopathology and Immunopathology | 585 | ||
| Pathophysiology | 586 | ||
| Differential Diagnosis | 586 | ||
| Treatment | 587 | ||
| Prognosis | 588 | ||
| References | 588 | ||
| 51 Cicatricial Pemphigoid | 591 | ||
| Definition | 591 | ||
| Epidemiology | 591 | ||
| Pathogenesis | 592 | ||
| Diagnosis | 593 | ||
| Ocular Manifestations | 593 | ||
| Therapy | 594 | ||
| Current Status of Medical Therapy Program for Ocular Cicatricial Pemphigoid | 594 | ||
| References | 596 | ||
| 52 Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis | 599 | ||
| History | 599 | ||
| Incidence and Prevalence | 599 | ||
| Clinical Findings | 600 | ||
| Initial presentation | 600 | ||
| Eye findings | 600 | ||
| Acute eye findings | 600 | ||
| Chronic eye findings | 600 | ||
| Nonocular findings | 601 | ||
| Recurrent Disease | 602 | ||
| Incidence of ocular complications | 602 | ||
| Differential Diagnosis | 603 | ||
| Ocular disorders | 603 | ||
| Dermatologic manifestations | 603 | ||
| Etiology | 603 | ||
| Pathogenesis | 603 | ||
| Histopathology | 604 | ||
| Skin | 604 | ||
| Eye | 605 | ||
| Management | 605 | ||
| Systemic disease | 605 | ||
| Ophthalmic disease | 605 | ||
| Acute stage | 605 | ||
| Chronic stage | 606 | ||
| Prognosis | 607 | ||
| References | 607 | ||
| 53 Toxic Conjunctivitis | 613 | ||
| Introduction | 613 | ||
| Toxicity versus Allergy | 613 | ||
| Cellular mechanisms | 613 | ||
| Signs and symptoms | 613 | ||
| Diagnostic testing | 615 | ||
| Toxic Keratoconjunctivitis Related to Topical Medications | 615 | ||
| Methods of assessing toxicity | 615 | ||
| Toxicity of specific agents | 615 | ||
| Antivirals | 615 | ||
| Glaucoma medications | 615 | ||
| Antibiotics and antifungals | 616 | ||
| Anesthetics | 617 | ||
| Preservatives | 617 | ||
| Follicular conjunctivitis | 618 | ||
| Hurricane keratitis | 618 | ||
| Drug-induced cicatricial pemphigoid | 618 | ||
| Others Causes of Toxic Keratoconjunctivitis | 618 | ||
| Cosmetics and skin care products | 618 | ||
| Hair care products | 619 | ||
| Tear gas weapons and lacrimating agents | 619 | ||
| Therapeutic Considerations | 620 | ||
| References | 620 | ||
| 54 Superior Limbic Keratoconjunctivitis | 623 | ||
| Historical Perspective and Epidemiology | 623 | ||
| Clinical Presentation | 623 | ||
| Histopathology | 623 | ||
| Origin and Pathogenesis | 624 | ||
| Treatment Options | 625 | ||
| Differential Diagnosis | 626 | ||
| Summary | 627 | ||
| References | 627 | ||
| 55 Ligneous Conjunctivitis | 629 | ||
| Epidemiology | 629 | ||
| Clinical Findings | 629 | ||
| Pathophysiology/Histopathology | 629 | ||
| Etiology | 630 | ||
| Treatment | 631 | ||
| References | 633 | ||
| 56 Conjunctivochalasis | 635 | ||
| Introduction | 635 | ||
| Epidemiology | 635 | ||
| Histopathology | 635 | ||
| Symptoms and Clinical Presentation | 636 | ||
| Diagnosis | 636 | ||
| Treatment | 637 | ||
| Conclusion | 638 | ||
| References | 639 | ||
| VII Diseases of the Cornea | 641 | ||
| 1 Developmental Abnormalities of Cornea | 643 | ||
| 57 Developmental Corneal Anomalies of Size and Shape | 643 | ||
| Absence of the Cornea | 643 | ||
| Anomalies of Size | 644 | ||
| Megalocornea | 645 | ||
| Microcornea | 646 | ||
| Anomalies of Shape | 647 | ||
| Oval cornea | 647 | ||
| Astigmatism | 647 | ||
| Sclerocornea (cornea plana) | 647 | ||
| Posterior keratoconus | 649 | ||
| Keratoglobus | 650 | ||
| Congenital Anterior Staphyloma and Keratectasia | 650 | ||
| References | 651 | ||
| 58 Axenfeld-Rieger Syndrome and Peters’ Anomaly | 655 | ||
| Terminology | 655 | ||
| Axenfeld-Rieger Syndrome | 655 | ||
| History | 655 | ||
| Clinical features | 656 | ||
| Cornea | 656 | ||
| Iridocorneal angle | 657 | ||
| Iris | 657 | ||
| Glaucoma | 658 | ||
| Other ocular findings | 658 | ||
| Nonocular findings | 658 | ||
| Face | 658 | ||
| Teeth | 658 | ||
| Umbilical | 658 | ||
| Genital | 659 | ||
| Others | 659 | ||
| Differential diagnosis | 659 | ||
| Pathogenesis | 660 | ||
| Genetics | 660 | ||
| Chromosome 4q, RIEG1, PITX2 | 660 | ||
| Chromosome 13q, RIEG2 | 660 | ||
| Chromosome 6p, FOXC1 | 660 | ||
| Natural history | 661 | ||
| Treatment | 661 | ||
| Peters’ Anomaly | 661 | ||
| History | 661 | ||
| Clinical features | 661 | ||
| Cornea | 661 | ||
| Anterior chamber | 661 | ||
| Lens | 661 | ||
| Glaucoma | 662 | ||
| Other ocular findings | 662 | ||
| Nonocular findings | 662 | ||
| Differential diagnosis | 662 | ||
| Pathogenesis | 662 | ||
| Genetics | 662 | ||
| Natural history | 663 | ||
| Treatment | 663 | ||
| References | 663 | ||
| 2 Corneal Manifestations of Systemic Disease and Therapies | 665 | ||
| 59 Corneal Manifestations of Metabolic Diseases | 665 | ||
| Introduction | 665 | ||
| Disorders of Carbohydrate Metabolism | 665 | ||
| Diabetes mellitus – diabetic keratopathy | 665 | ||
| Lysosomal storage disorders | 667 | ||
| Introduction | 667 | ||
| Mucopolysaccharidoses | 667 | ||
| MPS I | 668 | ||
| Hurler’s syndrome (MPS I-H) | 671 | ||
| Scheie’s syndrome (MPS I-S) | 672 | ||
| Hurler-Scheie (MPS I-HS) | 673 | ||
| Hunter’s syndrome (MPS II) | 673 | ||
| Sanfilippo’s syndrome (MPS III) | 673 | ||
| Morquio’s syndrome (MPS IV) | 673 | ||
| Maroteaux-Lamy syndrome (MPS VI) | 673 | ||
| Sly’s syndrome (MPS VII) | 674 | ||
| Natowicz’s syndrome (MPS IX) | 674 | ||
| Corneal histopathology in MPS | 674 | ||
| Disorders of Lipid and Lipoprotein Metabolism | 675 | ||
| Dyslipoproteinemias | 675 | ||
| Hyperlipoproteinemias and Schnyder crystalline dystrophy | 676 | ||
| Hypolipoproteinemias | 676 | ||
| Lipidoses | 677 | ||
| Fabry’s disease | 677 | ||
| Multiple sulfatase deficiency | 678 | ||
| Generalized gangliosidoses | 678 | ||
| Drug-induced lipidoses | 678 | ||
| Chloroquine | 678 | ||
| Amiodarone | 679 | ||
| Other agents | 680 | ||
| Disorders of Glycosaminoglycan and Lipid Metabolism | 680 | ||
| Mucolipidoses | 680 | ||
| Galactosialidosis | 681 | ||
| Disorders of Amino Acid, Nucleic Acid, and Protein Metabolism | 681 | ||
| Cystinosis | 681 | ||
| Tyrosinemia II | 682 | ||
| Alkaptonuria | 683 | ||
| Amyloidosis | 683 | ||
| Gout | 684 | ||
| Porphyria | 685 | ||
| References | 685 | ||
| 60 Skeletal and Connective Tissue Disorders with Anterior Segment Manifestations | 691 | ||
| Classification of Skeletal Disorders | 692 | ||
| Craniofacial dysostosis syndromes | 692 | ||
| Goldenhar syndrome | 695 | ||
| Hallermann-Streiff syndrome (oculomandibulodyscephaly, Francois dyscephalic syndrome) | 696 | ||
| Treacher Collins syndrome (mandibulofacial dysostosis; Franceschetti syndrome) | 696 | ||
| Ehlers-Danlos syndrome | 696 | ||
| Osteogenesis imperfecta | 700 | ||
| Stickler syndrome (hereditary progressive arthro-ophthalmopathy), Wagner syndrome, and Marshall syndrome | 701 | ||
| Kniest dysplasia | 702 | ||
| Marfan syndrome | 702 | ||
| Oculo-dento-osseous dysplasia | 704 | ||
| Sotos syndrome | 705 | ||
| Dermo-chondro-corneal dystrophy of Francois | 705 | ||
| Werner syndrome | 705 | ||
| Syndrome of acromegaly, cutis verticis gyrata, and corneal leukoma of Rosenthal and Kloepfer | 706 | ||
| Hypophosphatasia | 706 | ||
| Treatment of Ocular and Corneal Abnormalities in Skeletal Disorders | 706 | ||
| References | 707 | ||
| 61 Inflammatory Bowel Disease and Other Systemic Inflammatory Diseases | 711 | ||
| Inflammatory Bowel Disease | 711 | ||
| Etiology and pathogenesis | 711 | ||
| Pathology and clinical manifestations | 711 | ||
| Ocular manifestations | 711 | ||
| Treatment | 712 | ||
| Whipple’s Disease | 712 | ||
| Systemic manifestations | 713 | ||
| Etiology and pathogenesis | 713 | ||
| Ocular manifestations | 713 | ||
| Treatment | 713 | ||
| Chronic Granulomatous Disease | 714 | ||
| Systemic manifestations | 714 | ||
| Ocular manifestations | 714 | ||
| Wegener’s Granulomatosis | 714 | ||
| Systemic manifestations | 715 | ||
| Classic Wegener’s granulomatosis | 715 | ||
| Limited Wegener’s granulomatosis | 715 | ||
| Pathogenesis | 715 | ||
| Ocular manifestations | 715 | ||
| Management | 716 | ||
| Kawasaki disease | 716 | ||
| Epidemiology | 716 | ||
| Etiology and pathogenesis | 716 | ||
| Systemic manifestations | 716 | ||
| Ocular manifestations | 717 | ||
| Management | 717 | ||
| References | 717 | ||
| 62 Nutritional Disorders | 721 | ||
| Metabolism of Vitamin A | 721 | ||
| Historical Considerations | 721 | ||
| Classification and Clinical Manifestations of Xerophthalmia | 722 | ||
| Night blindness (XN) | 722 | ||
| Conjunctival xerosis (X1A) and Bitot’s spots (X1B) | 722 | ||
| Corneal xerosis (X2) | 723 | ||
| Corneal ulceration/keratomalacia (X3A/X3B) | 724 | ||
| Pathogenesis of corneal ulceration | 724 | ||
| Interactions with Other Factors | 726 | ||
| Epidemiology | 727 | ||
| Treatment | 728 | ||
| Other Nutritional Deficiencies | 729 | ||
| Vitamin B (riboflavin) | 729 | ||
| Vitamin C | 729 | ||
| Other nutrients | 729 | ||
| Discrete colliquative keratopathy | 729 | ||
| Summary | 729 | ||
| References | 729 | ||
| 63 Hematologic Disorders | 733 | ||
| Hematopoiesis | 733 | ||
| Miscellaneous Disorders of the Erythroid Line | 733 | ||
| Iron deficiency anemia | 733 | ||
| Systemic manifestations | 733 | ||
| Ophthalmic manifestations | 733 | ||
| Iron overload | 733 | ||
| VIII The Sclera and Anterior Uvea | 1243 | ||
| 1 Disorders of the Sclera | 1245 | ||
| 103 Episcleritis | 1245 | ||
| Anatomy | 1245 | ||
| Incidence | 1245 | ||
| Clinical Manifestations | 1245 | ||
| History | 1245 | ||
| Physical examination | 1246 | ||
| Course | 1247 | ||
| Differential Diagnosis | 1247 | ||
| Pathology | 1247 | ||
| Angiography | 1247 | ||
| Complications | 1247 | ||
| Etiology | 1248 | ||
| Laboratory Evaluation | 1249 | ||
| Treatment | 1249 | ||
| References | 1250 | ||
| 104 Scleritis | 1253 | ||
| Immune-mediated Scleritis | 1253 | ||
| Epidemiology | 1253 | ||
| Pathogenesis and risk factors | 1253 | ||
| Clinical findings | 1254 | ||
| Associated systemic diseases | 1255 | ||
| Complications | 1256 | ||
| Signs aiding in differential diagnosis | 1257 | ||
| Laboratory investigations | 1257 | ||
| Therapy | 1258 | ||
| Infectious Scleritis | 1259 | ||
| Clinical Findings | 1260 | ||
| Keratoscleritis | 1260 | ||
| Panophthalmitis | 1261 | ||
| Scleritis after scleral buckling surgery, | 1261 | ||
| Post-pterygium excision scleritis | 1261 | ||
| Other postsurgical infectious scleritis | 1261 | ||
| Herpetic scleritis | 1261 | ||
| Syphilitic scleritis | 1261 | ||
| Mycobacterium tuberculosis scleritis | 1262 | ||
| Signs aiding in differential diagnosis | 1262 | ||
| Laboratory investigations | 1262 | ||
| Therapy | 1262 | ||
| References | 1263 | ||
| 2 Anterior Uveitis | 1267 | ||
| 105 Classification and Diagnosis of Anterior Uveitis | 1267 | ||
| Diagnosis | 1267 | ||
| Symptoms of Anterior Uveitis | 1267 | ||
| History | 1267 | ||
| Demographic Information | 1267 | ||
| Past Medical History and Review of Systems | 1268 | ||
| Social and Family History | 1268 | ||
| Physical Examination | 1268 | ||
| External | 1268 | ||
| Pupils | 1268 | ||
| Sclera and conjunctiva | 1268 | ||
| Cornea | 1269 | ||
| Anterior chamber, anterior chamber angle, and iris | 1270 | ||
| Lens and anterior vitreous | 1272 | ||
| Intraocular pressure | 1272 | ||
| Retina and optic nerve | 1272 | ||
| Classification | 1272 | ||
| Response to Therapy | 1272 | ||
| Diagnostic Evaluation | 1273 | ||
| Treatment | 1273 | ||
| Summary | 1275 | ||
| References | 1275 | ||
| 106 Idiopathic Uveitis | 1277 | ||
| Uveitis Classification | 1277 | ||
| Uveitis History | 1277 | ||
| Physical Examination | 1277 | ||
| Laboratory Evaluation | 1279 | ||
| Consultation | 1279 | ||
| Nonspecific Treatment of Uvetis | 1279 | ||
| What to treat | 1279 | ||
| Principles of treatment | 1280 | ||
| Nonsteroidal antiinflammatory agents | 1280 | ||
| Corticosteroids | 1281 | ||
| Immunosuppressive agents | 1282 | ||
| Summary | 1283 | ||
| References | 1283 | ||
| 107 HLA-B27-Related Uveitis | 1285 | ||
| HLA-B27 and Pathogenesis of Disease | 1285 | ||
| Acute Anterior Uveitis | 1286 | ||
| Complications and Posterior Pole Involvement in HLA-B27-Positive Patients | 1286 | ||
| Other Associated Conditions | 1287 | ||
| Ankylosing spondylitis | 1287 | ||
| Psoriatic arthritis | 1287 | ||
| Idiopathic inflammatory bowel disease | 1287 | ||
| Reactive arthritis | 1288 | ||
| Summary | 1290 | ||
| References | 1290 | ||
| 108 Sarcoidosis | 1293 | ||
| Ocular Manifestations | 1293 | ||
| Eyelids | 1293 | ||
| Lacrimal gland | 1293 | ||
| Lacrimal drainage system | 1293 | ||
| Orbit | 1293 | ||
| Conjunctiva | 1294 | ||
| Cornea | 1294 | ||
| Iris | 1294 | ||
| Anterior uveitis | 1294 | ||
| Posterior uveitis | 1295 | ||
| Optic nerve | 1296 | ||
| Diagnosis | 1296 | ||
| Course and Management | 1297 | ||
| References | 1297 | ||
| 109 Behçet’s Disease | 1299 | ||
| Etiology of Behçet’s Disease | 1299 | ||
| Clinical Manifestations of Behçet’s’s Disease | 1299 | ||
| Mucocutaneous | 1299 | ||
| Eye disease | 1300 | ||
| Vascular findings | 1302 | ||
| Central nervous system | 1302 | ||
| Treatment of Behçet’s Disease | 1302 | ||
| Azathioprine | 1302 | ||
| Ciclosporin | 1302 | ||
| Corticosteroids | 1303 | ||
| Interferon-α | 1303 | ||
| Antitumor necrosis factor medications | 1303 | ||
| Mycophenolate mofetil | 1303 | ||
| Other medications | 1303 | ||
| Surgical Therapy in Behçet’s Disease | 1303 | ||
| Summary | 1304 | ||
| References | 1304 | ||
| 110 Fuchs’ Heterochromic Iridocyclitis | 1307 | ||
| Clinical Features | 1307 | ||
| Pathology | 1308 | ||
| Differential Diagnosis | 1308 | ||
| Treatment | 1309 | ||
| Prognosis | 1309 | ||
| References | 1309 | ||
| 111 Juvenile Idiopathic Arthritis | 1311 | ||
| Epidemiology | 1311 | ||
| Clinical Features | 1311 | ||
| Ocular Clinical Features | 1312 | ||
| Etiology | 1313 | ||
| Treatment of Systemic Disease | 1314 | ||
| Treatment of Ocular Disease | 1315 | ||
| Prognosis | 1315 | ||
| Conclusion | 1316 | ||
| References | 1316 | ||
| IX Keratoplasty | 1319 | ||
| 1 Overview | 1321 | ||
| 112 The Evolution of Contemporary Keratoplasty | 1321 | ||
| Early Contributions to Corneal Transplantation | 1321 | ||
| Modern Techniques of Corneal Transplantation | 1321 | ||
| The Evolution from Penetrating Keratoplasty Back to Lamellar Keratoplasty | 1322 | ||
| Descemet Stripping Automated Endothelial Keratoplasty | 1322 | ||
| Deep Anterior Lamellar Keratoplasty | 1323 | ||
| Use of the Femtosecond Laser | 1323 | ||
| Conclusions | 1323 | ||
| References | 1324 | ||
| 113 Preoperative Considerations and Decision-Making in Keratoplasty | 1327 | ||
| General Considerations | 1327 | ||
| Ocular surface reconstruction procedures | 1327 | ||
| Anterior lamellar keratoplasty procedures | 1327 | ||
| Indications | 1327 | ||
| Contraindications | 1328 | ||
| Advantages of anterior lamellar keratoplasty | 1328 | ||
| Disadvantages of anterior lamellar keratoplasty | 1328 | ||
| Surgical techniques | 1328 | ||
| Lamellar keratectomy (LK) | 1328 | ||
| Tectonic, reconstructive, and excisional anterior lamellar keratoplasty | 1328 | ||
| Automated lamellar therapeutic keratoplasty | 1328 | ||
| Deep anterior lamellar keratoplasty | 1328 | ||
| Femtosecond laser-assisted lamellar keratoplasty | 1330 | ||
| Posterior lamellar keratoplasty procedures | 1330 | ||
| Indications | 1330 | ||
| Contraindications | 1330 | ||
| Advantages of endothelial keratoplasty (EK) | 1330 | ||
| Disadvantages of endothelial keratoplasty (EK) | 1330 | ||
| Surgical technique | 1330 | ||
| Penetrating keratoplasty procedures | 1330 | ||
| Indications | 1332 | ||
| Relative contraindications | 1332 | ||
| Advantages of penetrating keratoplasty | 1332 | ||
| Disadvantages of penetrating keratoplasty | 1332 | ||
| Surgical techniques | 1332 | ||
| Penetrating keratoplasty | 1332 | ||
| Femtosecond laser-assisted penetrating keratoplasty | 1333 | ||
| Permanent keratoprosthesis surgery | 1333 | ||
| Indications | 1333 | ||
| Relative contraindications | 1333 | ||
| Advantages of permanent keratoprosthesis surgery (KPro) | 1333 | ||
| Disadvantages of permanent keratoprosthesis (KPro) | 1333 | ||
| Surgical technique | 1333 | ||
| Summary | 1333 | ||
| References | 1333 | ||
| 2 Penetrating Keratoplasty Procedures | 1335 | ||
| 114 Penetrating Keratoplasty | 1335 | ||
| History | 1335 | ||
| Patient Selection | 1336 | ||
| Age | 1336 | ||
| Mental impairment | 1336 | ||
| Coexisting ocular disease | 1336 | ||
| Establish Realistic Expectations | 1336 | ||
| Surgical Setting and Anesthesia | 1336 | ||
| Preoperative Preparations | 1336 | ||
| Infection control | 1336 | ||
| Intraocular pressure control | 1337 | ||
| Lens management | 1337 | ||
| Donor corneal tissue management | 1337 | ||
| Anticipate suprachoroidal hemorrhage | 1337 | ||
| Surgical Steps in Phakic Penetrating Keratoplasty | 1337 | ||
| Insertion of lid speculum | 1338 | ||
| Placement of scleral fixation ring | 1338 | ||
| Marking of host cornea | 1338 | ||
| Trephination of donor cornea | 1339 | ||
| Trephination of host cornea | 1339 | ||
| Placement of viscoelastic material in the anterior chamber | 1340 | ||
| Placement of the donor corneal tissue in the host bed | 1340 | ||
| Placement of four interrupted radial 10/0 nylon cardinal sutures | 1340 | ||
| Complete suturing | 1340 | ||
| Readjustment of sutures to minimize astigmatism | 1343 | ||
| Administering medications | 1343 | ||
| Special Circumstances | 1344 | ||
| The postrefractive surgery patient | 1344 | ||
| Rotating autograft | 1344 | ||
| Maximizing penetrating keratoplasty outcome | 1344 | ||
| References | 1345 | ||
| 115 Femtosecond Laser-assisted Penetrating Keratoplasty | 1349 | ||
| Introduction | 1349 | ||
| Evaluation and Surgery | 1349 | ||
| Outcomes | 1351 | ||
| Femtosecond Laser-assisted Deep Anterior Lamellar Keratoplasty | 1352 | ||
| References | 1353 | ||
| 116 Keratoplasty Suturing Techniques | 1355 | ||
| Fundamentals of Wound Closure | 1355 | ||
| Penetrating Keratoplasty | 1355 | ||
| Single Interrupted Sutures | 1357 | ||
| Combined Continuous and Interrupted Suture Technique | 1358 | ||
| Single Continuous Suture | 1359 | ||
| Double Continuous Suture | 1360 | ||
| Suture Adjustment | 1361 | ||
| Suture removal | 1361 | ||
| Single interrupted sutures | 1361 | ||
| Combined continuous and interrupted sutures | 1362 | ||
| Single continuous suture | 1362 | ||
| Double continuous suture | 1364 | ||
| Lamellar Procedures | 1364 | ||
| Summary of suture adjustment | 1365 | ||
| Conclusions | 1365 | ||
| References | 1365 | ||
| 117 Intraoperative Complications of Penetrating Keratoplasty | 1367 | ||
| Technical Complications of Penetrating Keratoplasty | 1367 | ||
| Scleral perforation with fixation sutures | 1367 | ||
| Improper trephination | 1367 | ||
| Eccentric trephination | 1367 | ||
| Damaged donor button | 1367 | ||
| Retained Descemet’s membrane | 1368 | ||
| Iris–lens damage | 1368 | ||
| Torn posterior capsule | 1369 | ||
| Vitreous loss with pseudophakic bullous keratopathy and posterior chamber intraocular lenses | 1369 | ||
| Anterior chamber hemorrhage | 1369 | ||
| Nontechnical Complications | 1370 | ||
| Expulsive choroidal hemorrhage | 1370 | ||
| References | 1371 | ||
| 3 Penetrating Keratoplasty: Postoperative Management | 1373 | ||
| 118 Routine Management | 1373 | ||
| Immediate Postoperative Care | 1373 | ||
| First 24 hours | 1373 | ||
| Early Postoperative Care | 1374 | ||
| 1 to 7 days | 1374 | ||
| Postoperative Care | 1376 | ||
| 1 to 12 weeks | 1376 | ||
| Postoperative Care | 1381 | ||
| After 3 months | 1381 | ||
| Postoperative Care in Infants and Children | 1382 | ||
| References | 1383 | ||
| 119 Early Postoperative Complications | 1385 | ||
| Wound Leaks and Wound Displacement | 1385 | ||
| Persistent Epithelial Defects | 1386 | ||
| Filamentary Keratitis | 1388 | ||
| Suture-related Complications | 1389 | ||
| Suture exposure | 1389 | ||
| Suture-related infection | 1389 | ||
| Suture-related immune infiltrates | 1389 | ||
| Kaye dots | 1390 | ||
| Elevated Intraocular Pressure | 1390 | ||
| Postoperative Inflammation | 1391 | ||
| Anterior Synechia Formation | 1391 | ||
| Pupillary Block | 1392 | ||
| Choroidal Detachment and Choroidal Hemorrhage | 1392 | ||
| Hyphema | 1393 | ||
| Fixed Dilated Pupil | 1393 | ||
| Postoperative Infection | 1393 | ||
| Primary Donor Failure | 1394 | ||
| Conclusion | 1394 | ||
| References | 1395 | ||
| 120 Management of Postkeratoplasty Astigmatism | 1397 | ||
| Preoperative Factors | 1397 | ||
| Intraoperative Factors | 1397 | ||
| Graft diameter | 1397 | ||
| Tissue alignment | 1399 | ||
| Trephination factors | 1400 | ||
| Scleral support ring | 1401 | ||
| Suture technique | 1401 | ||
| Postoperative Factors | 1402 | ||
| Relaxing incisions | 1402 | ||
| Astigmatic keratotomy | 1404 | ||
| Wedge resections | 1405 | ||
| Laser in situ keratomileusis | 1405 | ||
| Photorefractive keratectomy | 1406 | ||
| Summary | 1406 | ||
| References | 1407 | ||
| 121 Diagnosis and Management of Corneal Allograft Rejection | 1409 | ||
| Clinical Aspects of Corneal Allograft Rejection | 1409 | ||
| Historical Perspective | 1409 | ||
| Recognition of Risk Factors | 1409 | ||
| Clinical Features of Corneal Allograft Rejection | 1410 | ||
| Differential Diagnosis of Corneal Allograft Rejection | 1413 | ||
| Treatment of Corneal Allograft Rejection | 1414 | ||
| Prevention of Corneal Allograft Rejection | 1415 | ||
| Management Strategy | 1415 | ||
| References | 1415 | ||
| 122 Infections after Penetrating Keratoplasty | 1417 | ||
| Microbial Keratitis | 1417 | ||
| Pathogenesis | 1417 | ||
| Pathogens | 1418 | ||
| Clinical approach | 1419 | ||
| Therapeutic approach | 1419 | ||
| Outcomes | 1420 | ||
| Suture Abscess | 1420 | ||
| Pathogenesis | 1420 | ||
| Clinical approach | 1421 | ||
| Therapeutic approach | 1421 | ||
| Infectious Crystalline Keratopathy | 1422 | ||
| Historical background | 1422 | ||
| Pathogenesis | 1422 | ||
| Microscopy | 1422 | ||
| Clinical approach | 1423 | ||
| Therapeutic approach | 1423 | ||
| Outcomes | 1423 | ||
| Endophthalmitis | 1423 | ||
| Incidence | 1423 | ||
| Pathogenesis | 1423 | ||
| Pathogens | 1424 | ||
| Clinical approach | 1424 | ||
| Therapeutic approach | 1425 | ||
| Outcomes | 1425 | ||
| Herpetic Keratitis after Keratoplasty | 1425 | ||
| Recurrence | 1425 | ||
| Newly acquired | 1426 | ||
| Transmission of Unusual Infections | 1426 | ||
| Rabies | 1426 | ||
| Creutzfeldt-Jakob disease | 1427 | ||
| Hepatitis virus | 1427 | ||
| Human immunodeficiency virus | 1427 | ||
| Conclusion | 1427 | ||
| References | 1427 | ||
| 123 Retrocorneal Membranes | 1431 | ||
| Epithelial Downgrowth | 1431 | ||
| History | 1431 | ||
| Incidence and etiology | 1431 | ||
| Pathogenesis | 1432 | ||
| Diagnosis | 1432 | ||
| Glaucoma and epithelial downgrowth | 1434 | ||
| Treatment | 1434 | ||
| Fibrous Ingrowth | 1435 | ||
| Incidence and etiology | 1435 | ||
| Pathogenesis | 1435 | ||
| Diagnosis | 1436 | ||
| Treatment | 1436 | ||
| Differential Diagnosis | 1437 | ||
| Conclusion | 1437 | ||
| References | 1437 | ||
| 124 Glaucoma after Penetrating Keratoplasty | 1441 | ||
| Incidence | 1441 | ||
| Risk Factors | 1442 | ||
| The Pre-Keratoplasty Evaluation | 1444 | ||
| Clinical Presentation | 1444 | ||
| Glaucoma and Graft Failure | 1444 | ||
| Mechanisms | 1445 | ||
| Management of Postkeratoplasty Glaucoma | 1446 | ||
| Medical management | 1447 | ||
| Surgical management | 1448 | ||
| Laser iridoplasty and trabeculoplasty | 1448 | ||
| Filtering surgery | 1448 | ||
| Glaucoma Drainage Devices | 1448 | ||
| Cyclodestructive Procedures | 1450 | ||
| Summary | 1451 | ||
| References | 1452 | ||
| 4 Complex Penetrating Keratoplasty | 1455 | ||
| 125 Pediatric Penetrating Keratoplasty | 1455 | ||
| Introduction | 1455 | ||
| Review of the Literature | 1455 | ||
| Indications | 1457 | ||
| Graft Survival | 1458 | ||
| Visual Outcome | 1459 | ||
| Complications | 1461 | ||
| Future Studies | 1461 | ||
| Preoperative Evaluation, Counseling, and Preparation | 1462 | ||
| The initial evaluation | 1462 | ||
| The decision to perform penetrating keratoplasty | 1462 | ||
| What are the chances that penetrating keratoplasty will improve the patient’s vision and quality of life? | 1462 | ||
| What are the risks and costs to the patient and family of performing a penetrating keratoplasty? | 1463 | ||
| What are the benefits, risks, and costs of delayed treatment, no treatment, or alternative treatment? | 1463 | ||
| Counseling the parents and informed consent | 1463 | ||
| Timing and preparation for penetrating keratoplasty | 1464 | ||
| Bilateral opacities | 1464 | ||
| Unilateral opacities | 1464 | ||
| Repeat grafting | 1464 | ||
| The donor tissue | 1464 | ||
| Surgical Management | 1464 | ||
| Preoperative considerations | 1464 | ||
| Surgical technique | 1465 | ||
| Concomitant operative procedures | 1466 | ||
| Postoperative Care | 1467 | ||
| Postoperative Instructions | 1467 | ||
| Examination of Patients | 1467 | ||
| Examination schedule | 1467 | ||
| Early Postoperative Complications | 1468 | ||
| Suture Removal | 1468 | ||
| Graft Rejection | 1469 | ||
| Glaucoma | 1469 | ||
| Optical Correction and Amblyopia Therapy | 1470 | ||
| Advances in Pediatric Corneal Surgery | 1470 | ||
| Conclusions | 1470 | ||
| References | 1471 | ||
| 126 Large-Diameter Corneal Grafts | 1473 | ||
| Indications | 1473 | ||
| Surgical Technique | 1473 | ||
| Large-diameter penetrating keratoplasty | 1473 | ||
| Total penetrating keratoplasty | 1476 | ||
| Large-diameter lamellar grafts | 1476 | ||
| Postoperative Management | 1476 | ||
| Complications | 1476 | ||
| Outcomes | 1478 | ||
| References | 1478 | ||
| 127 Penetrating Keratoplasty in Herpes Simplex Disease | 1481 | ||
| Indications and Timing for Corneal Grafting | 1481 | ||
| Preoperative Measures | 1482 | ||
| Control of inflammation | 1482 | ||
| Vascularization | 1483 | ||
| Corneal sensation | 1484 | ||
| Antiviral prophylaxis | 1484 | ||
| Donor tissue requirements | 1485 | ||
| Operative Technique | 1485 | ||
| Graft size | 1485 | ||
| Perforated eyes | 1485 | ||
| Suture | 1486 | ||
| ‘Triple procedure’ | 1486 | ||
| Anterior lamellar keratoplasty | 1486 | ||
| Femtosecond laser | 1486 | ||
| Boston keratoprosthesis | 1486 | ||
| Postoperative Management | 1486 | ||
| Use of corticosteroids | 1486 | ||
| Suture removal | 1487 | ||
| Persistent epithelial defects | 1487 | ||
| Recurrence of HSV keratitis | 1487 | ||
| The allograft rejection | 1489 | ||
| Herpes simplex virus in corneas for transplantation | 1490 | ||
| Secondary graft failure | 1490 | ||
| Glaucoma | 1491 | ||
| Wound dehiscence | 1491 | ||
| Secondary infections | 1491 | ||
| References | 1492 | ||
| 128 Immunologically High-Risk Penetrating Keratoplasty | 1495 | ||
| Introduction | 1495 | ||
| Immunology of Graft Rejection | 1495 | ||
| Current view of the immune response | 1495 | ||
| Histocompatibility antigens | 1495 | ||
| Immune privilege | 1495 | ||
| Allograft rejection | 1496 | ||
| Risk Factors for Immune Rejection (Box 128.1) | 1497 | ||
| Vascularized corneas | 1497 | ||
| Prior graft loss | 1498 | ||
| Graft diameter and eccentric grafts | 1498 | ||
| Anterior synechiae | 1498 | ||
| Previous intraocular surgery | 1498 | ||
| Herpes simplex | 1499 | ||
| History of anterior segment inflammatory disease | 1499 | ||
| Ocular surface disease | 1499 | ||
| Young age | 1499 | ||
| Clinical Management of Immunologically High-Risk Penetrating Keratoplasty | 1499 | ||
| Preoperative considerations | 1499 | ||
| Controlling ocular inflammation | 1499 | ||
| Rehabilitating the ocular surface | 1500 | ||
| Operative considerations | 1500 | ||
| Tissue matching | 1500 | ||
| Surgical technique | 1500 | ||
| Postoperative considerations | 1501 | ||
| Immunosuppression | 1501 | ||
| Corticosteroids | 1501 | ||
| Calcineurin inhibitors | 1501 | ||
| Ciclosporin A | 1501 | ||
| Topical CsA | 1501 | ||
| Systemic CsA | 1502 | ||
| Tacrolimus | 1503 | ||
| Topical tacrolimus | 1503 | ||
| Systemic tacrolimus | 1503 | ||
| Antimetabolites | 1503 | ||
| Azathioprine | 1503 | ||
| Mycophenolate mofetil | 1503 | ||
| Rapamycin | 1504 | ||
| Monoclonal antibodies | 1504 | ||
| Experimental Approaches to Immunomodulation | 1505 | ||
| Inhibiting antigen-presenting cells | 1505 | ||
| Blocking the activation and action of T cells | 1505 | ||
| Monoclonal antibodies to T-cell antigens | 1505 | ||
| Costimulatory blockade | 1505 | ||
| Modulating the immune response with cytokines and peptides | 1505 | ||
| Inhibiting immune access to the graft | 1505 | ||
| Inhibition of adhesion molecules | 1505 | ||
| Reduction of corneal neovascularization | 1505 | ||
| Inhibition of chemokines | 1506 | ||
| Inducing allospecific tolerance | 1506 | ||
| Oral immunization with donor-specific alloantigens | 1506 | ||
| Lymphadenectomy | 1506 | ||
| References | 1506 | ||
| 5 Anterior Lamellar Keratoplasty | 1511 | ||
| 129 Indications for Anterior Lamellar Keratoplasty | 1511 | ||
| Indications | 1511 | ||
| Contraindications | 1511 | ||
| Keratoconus | 1512 | ||
| Scars | 1513 | ||
| Microkeratome-assisted technique | 1513 | ||
| Keratoglobus | 1514 | ||
| Macular corneal dystrophy | 1514 | ||
| Descemetocele | 1514 | ||
| Pellucid marginal degeneration | 1515 | ||
| References | 1515 | ||
| 130 Techniques of Anterior Lamellar Keratoplasty | 1517 | ||
| Introduction | 1517 | ||
| ALK Techniques | 1517 | ||
| Layer-by-layer dissection | 1517 | ||
| Stromal delamination (VIDEO 1) | 1518 | ||
| Automated therapeutic lamellar keratoplasty (VIDEOS 2 and 3) | 1519 | ||
| Intrastromal dissection | 1519 | ||
| Cleavage separation (VIDEO 4) | 1519 | ||
| Donor preparation (VIDEO 5) | 1520 | ||
| References | 1520 | ||
| 131 Intraoperative and Postoperative Complications of Anterior Lamellar Keratoplasty | 1523 | ||
| Indications for Anterior Lamellar Keratoplasty | 1523 | ||
| Surgical Instruments and Preoperative Treatment | 1523 | ||
| Intraoperative Complications | 1524 | ||
| Perforations and ruptures of Descemet’s membrane | 1524 | ||
| Trephination | 1524 | ||
| Stromal dissection | 1524 | ||
| Suture needles | 1525 | ||
| Management of Descemet’s membrane ruptures | 1525 | ||
| Postoperative Complications | 1525 | ||
| Pseudoanterior chambers | 1525 | ||
| Pupillary block and fixed dilated pupil (Urrets-Zavalia syndrome) | 1525 | ||
| Sclerocorneal inflammation | 1525 | ||
| Conclusion | 1526 | ||
| References | 1526 | ||
| 132 Outcomes of Anterior Lamellar Keratoplasty | 1527 | ||
| Visual Outcomes | 1527 | ||
| Refractive Outcomes | 1528 | ||
| Graft Survival | 1528 | ||
| Suture Management | 1529 | ||
| Resistance to Trauma | 1529 | ||
| Surgical Planning | 1529 | ||
| Summary | 1529 | ||
| References | 1529 | ||
| 6 Endothelial Keratoplasty | 1531 | ||
| 133 Indications for Endothelial Keratoplasty | 1531 | ||
| Patient Selection | 1531 | ||
| Age | 1531 | ||
| Duration of Corneal Edema | 1531 | ||
| Lens Considerations | 1532 | ||
| Tips for Successful Application of EK in Challenging Eyes | 1532 | ||
| Failed penetrating grafts | 1532 | ||
| Glaucoma tubes | 1532 | ||
| Shallow anterior chambers | 1533 | ||
| ACIOLs | 1533 | ||
| Iris abnormalities, aniridia and aphakia | 1533 | ||
| Conclusions | 1533 | ||
| References | 1533 | ||
| 134 Donor Preparation for Endothelial Keratoplasty | 1535 | ||
| Introduction | 1535 | ||
| Issues to Consider | 1535 | ||
| Methods | 1536 | ||
| Techniques | 1536 | ||
| Summary | 1540 | ||
| References | 1540 | ||
| 135 Surgical Techniques of Endothelial Keratoplasty | 1543 | ||
| Donor Tissue Preparation | 1543 | ||
| Anesthesia Considerations | 1543 | ||
| Intraoperative Techniques | 1544 | ||
| Wound creation | 1544 | ||
| Recipient preparation | 1544 | ||
| Techniques to Improve Donor Adherence | 1545 | ||
| Donor Insertion Techniques | 1545 | ||
| Donor Apposition Techniques | 1547 | ||
| Early Postoperative Management | 1548 | ||
| Special Considerations for Endothelial Keratoplasty | 1549 | ||
| New Developments in Endothelial Keratoplasty | 1549 | ||
| Summary | 1550 | ||
| References | 1550 | ||
| 136 Phacoemulsification and Endothelial Keratoplasty: | 1553 | ||
| Preoperative Planning | 1554 | ||
| Intraoperative Issues | 1554 | ||
| Postoperative Results | 1555 | ||
| Future Trends | 1556 | ||
| References | 1556 | ||
| 137 Intraoperative and Postoperative Complications of Endothelial Keratoplasty | 1559 | ||
| Introduction | 1559 | ||
| Intraoperative Complications | 1559 | ||
| Complications with donor tissue preparation | 1559 | ||
| Damaged donor tissue | 1559 | ||
| Eccentric trephination | 1559 | ||
| Thin donor tissue | 1559 | ||
| Retained Descemet’s membrane | 1559 | ||
| Air management | 1559 | ||
| Others complications | 1561 | ||
| Postoperative Complications | 1561 | ||
| Donor dislocation | 1561 | ||
| Primary graft failure | 1562 | ||
| Graft rejection | 1562 | ||
| Pupillary block – glaucoma | 1562 | ||
| Endothelial cell loss | 1563 | ||
| Refractive change | 1563 | ||
| Interface deposits and epithelial ingrowth | 1563 | ||
| Retinal complications | 1564 | ||
| References | 1564 | ||
| 138 Outcomes of Endothelial Keratoplasty | 1565 | ||
| Introduction | 1565 | ||
| Results | 1565 | ||
| Endothelial keratoplasty complications | 1565 | ||
| Visual recovery after DSAEK | 1565 | ||
| Astigmatism | 1567 | ||
| Spherical equivalent | 1567 | ||
| Donor endothelial survival | 1567 | ||
| Summary | 1568 | ||
| References | 1568 | ||
| X Therapeutic Procedures | 1569 | ||
| 1 Corneal Surgery | 1571 | ||
| 139 Management of Corneal Perforations | 1571 | ||
| Etiology | 1571 | ||
| Terminology | 1572 | ||
| Signs and Symptoms of Descemetocele and Perforation | 1572 | ||
| Preoperative Management | 1574 | ||
| Treatment Options | 1574 | ||
| Tissue adhesives | 1574 | ||
| Cyanoacrylate glue | 1574 | ||
| Method of application | 1575 | ||
| Postoperative management | 1578 | ||
| Complications | 1579 | ||
| Penetrating keratoplasty | 1579 | ||
| Patch graft | 1580 | ||
| Amniotic membrane transplantation | 1581 | ||
| Medical management | 1581 | ||
| Prevention of Corneal Perforation | 1583 | ||
| Bandage soft contact lens | 1583 | ||
| Conjunctival flap | 1583 | ||
| Tarsorrhaphy | 1584 | ||
| Amniotic membrane transplantation | 1584 | ||
| Miscellaneous | 1584 | ||
| Conclusion | 1584 | ||
| References | 1584 | ||
| 140 Therapeutic Lamellar Keratoplasty | 1587 | ||
| Optical Indications | 1587 | ||
| Tectonic Indications | 1587 | ||
| Peripheral noninflammatory corneal thinning disorders | 1587 | ||
| Peripheral inflammatory corneal disease | 1587 | ||
| Central thinning and ectasia | 1587 | ||
| Limitations of Lamellar Grafts | 1587 | ||
| Mechanical Surgical Technique | 1589 | ||
| Laser-Assisted Anterior Lamellar Keratoplasty | 1589 | ||
| The Future of Lamellar Keratoplasty | 1589 | ||
| References | 1591 | ||
| 141 Therapeutic Keratoplasty | 1593 | ||
| Therapeutic Keratoplasty for Infectious Keratitis | 1593 | ||
| Therapeutic keratoplasty for bacterial infections | 1594 | ||
| Therapeutic keratoplasty for fungal keratitis | 1594 | ||
| Therapeutic keratoplasty for Acanthamoeba keratitis | 1596 | ||
| Therapeutic keratoplasty for herpetic keratitis | 1596 | ||
| Therapeutic keratoplasty for persistent epithelial defects and sterile melts | 1596 | ||
| Presurgical Evaluation | 1599 | ||
| Antimicrobial Therapy | 1599 | ||
| Donor Material | 1599 | ||
| Surgical Technique | 1599 | ||
| Postoperative Management of Therapeutic Penetrating Keratoplasties | 1601 | ||
| Visual Prognosis for Therapeutic Keratoplasty | 1601 | ||
| References | 1602 | ||
| 142 Surgical Management of Superficial Corneal and Conjunctival Disease | 1605 | ||
| Introduction | 1605 | ||
| Molluscum Contagiosum | 1605 | ||
| Superior Limbic Keratoconjunctivitis | 1605 | ||
| Conjunctivochalasis | 1606 | ||
| Recurrent Corneal Erosions | 1607 | ||
| Band Keratopathy | 1608 | ||
| Partial Limbal Stem Cell Deficiency | 1608 | ||
| Conclusion | 1610 | ||
| References | 1610 | ||
| 143 Excimer Laser Phototherapeutic Keratectomy | 1613 | ||
| Introduction | 1613 | ||
| Indications for PTK | 1613 | ||
| Contraindications | 1613 | ||
| Preoperative Evaluation | 1614 | ||
| Ophthalmic history | 1614 | ||
| Medical history | 1614 | ||
| Examination | 1614 | ||
| Ancillary testing | 1614 | ||
| Patient Selection | 1615 | ||
| Techniques | 1615 | ||
| General | 1615 | ||
| Smooth opacities | 1615 | ||
| Rough or elevated opacities | 1616 | ||
| Deep irregular opacities | 1616 | ||
| Recurrent erosions | 1617 | ||
| Antihyperopia treatment | 1617 | ||
| Masking agents | 1617 | ||
| Mitomycin-C | 1618 | ||
| Postoperative Management | 1618 | ||
| Results | 1619 | ||
| Side Effects and Complications | 1621 | ||
| Future Directions | 1621 | ||
| Summary | 1622 | ||
| References | 1622 | ||
| 2 Conjunctival Surgery | 1625 | ||
| 144 Management of Pterygium | 1625 | ||
| Introduction | 1625 | ||
| Definition and Morphology | 1625 | ||
| Epidemiology of Pterygium | 1625 | ||
| Risk Factors | 1625 | ||
| Ultraviolet radiation | 1626 | ||
| Genetic factors | 1626 | ||
| Other risk factors | 1626 | ||
| Pathogenesis of Pterygium | 1626 | ||
| Degenerative vs proliferative disorder | 1626 | ||
| Limbal stem cell deficiency and epithelial abnormalities in pterygium | 1627 | ||
| The Role of the Fibrovascular Component in Corneal Invasion and Pterygium Recurrence | 1627 | ||
| Therapeutic Options for Pterygium | 1627 | ||
| Bare sclera excision | 1627 | ||
| Excision with conjunctival closure/transposition | 1627 | ||
| Excision with adjunctive medical therapy | 1628 | ||
| Beta irradiation | 1628 | ||
| Mitomycin C | 1628 | ||
| Ocular surface transplantation techniques | 1629 | ||
| Conjunctival autografting | 1629 | ||
| Surgical technique of pterygium excision and conjunctival autografting | 1629 | ||
| Pterygium excision technique | 1629 | ||
| Anesthesia | 1629 | ||
| Exposure/stabilization of the globe | 1629 | ||
| Excision of pterygium tissue | 1629 | ||
| Recurrent pterygium excision | 1630 | ||
| Harvesting of the conjunctival autograft | 1630 | ||
| Harvesting site | 1630 | ||
| Superficial dissection technique | 1630 | ||
| Size of conjunctival autograft | 1630 | ||
| Orientation of conjunctival autograft | 1630 | ||
| Securing the conjunctival autograft | 1631 | ||
| Additional techniques | 1631 | ||
| Postoperative regimen | 1631 | ||
| Complications of Conjunctival Autografting | 1631 | ||
| Causes of recurrence of conjunctival autografting | 1631 | ||
| Conjunctival rotational autografting | 1631 | ||
| Annular conjunctival autografting | 1632 | ||
| Cultivated conjunctival transplantation | 1632 | ||
| Conjunctival–limbal autograft transplantation | 1633 | ||
| Amniotic membrane transplantation (AMT) | 1633 | ||
| Surgical technique of amniotic membrane transplantation | 1634 | ||
| Size of amniotic membrane graft | 1634 | ||
| Scleral bed preparation | 1634 | ||
| Amniotic membrane application | 1634 | ||
| Postoperative management | 1634 | ||
| The role of fibrin glue in pterygium surgery | 1634 | ||
| Lamellar keratoplasty | 1635 | ||
| Potential Future Therapeutic Options | 1635 | ||
| Conclusion | 1635 | ||
| References | 1635 | ||
| 145 Conjunctival Flaps | 1639 | ||
| Introduction | 1639 | ||
| Indications | 1639 | ||
| Persistent corneal epithelial defect | 1639 | ||
| Unresponsive ulcerative microbial keratitis | 1639 | ||
| Corneal thinning and perforation | 1640 | ||
| Corneal limbal disease | 1640 | ||
| Scleral necrosis | 1640 | ||
| Glaucoma surgery complications | 1640 | ||
| Surface preparation for a cosmetic scleral shell | 1640 | ||
| Disadvantages | 1640 | ||
| Surgical Techniques | 1640 | ||
| Total conjunctival flap | 1640 | ||
| Removal of corneal epithelium | 1641 | ||
| Mobilization of the conjunctival flap | 1641 | ||
| Conjunctival flap suture | 1642 | ||
| Bipedicle bridge flap | 1643 | ||
| Single pedicle flap | 1643 | ||
| Advancement flap | 1643 | ||
| Complications | 1643 | ||
| Intraoperative complications | 1643 | ||
| Buttonhole formation | 1643 | ||
| Dissection of an inadequate flap | 1645 | ||
| Excessive hemorrhage | 1645 | ||
| Postoperative complications | 1645 | ||
| Retraction of the flap | 1645 | ||
| Ptosis | 1645 | ||
| Cystic flap | 1645 | ||
| Opacification and vascularization | 1645 | ||
| References | 1645 | ||
| 146 Indications for and Uses of Amniotic Membrane | 1647 | ||
| The Amniotic Membrane: Histology, Biological Properties, and Clinical Effects | 1647 | ||
| Obtaining and Preserving the Amniotic Membrane | 1647 | ||
| Methods for Amniotic Membrane Transplantation | 1647 | ||
| Indications for Amniotic Membrane Transplantation in Ocular Surface Diseases | 1648 | ||
| Amniotic membrane as a graft in conjunctival reconstruction | 1648 | ||
| Amniotic membrane as a graft in corneal surface reconstruction | 1648 | ||
| Amniotic membrane as a patch in corneal surface reconstruction | 1650 | ||
| Amniotic membrane and limbal stem cells deficiencies | 1652 | ||
| Amniotic membrane as a substrate for culturing epithelial stem cells of the sclerocorneal limbus | 1652 | ||
| Limitations of Amniotic Membrane Transplantation in Ocular Surface Diseases | 1653 | ||
| Complications | 1653 | ||
| References | 1653 | ||
| 3 Anterior Segment Surgery | 1655 | ||
| 147 Surgical Management and Rehabilitation of Anterior Segment Trauma | 1655 | ||
| Patient Evaluation | 1655 | ||
| History | 1655 | ||
| Examination | 1655 | ||
| Slit lamp examination | 1656 | ||
| Tissue Adhesive | 1658 | ||
| Management of Penetrating and Perforating Trauma | 1658 | ||
| Anesthesia and preparation of the eye | 1658 | ||
| Acute Surgical Management | 1659 | ||
| Corneal laceration repair | 1659 | ||
| Suturing the zig-zag incision | 1660 | ||
| Stellate lacerations | 1660 | ||
| Management of tissue loss | 1660 | ||
| Corneoscleral lacerations | 1661 | ||
| Iris trauma | 1662 | ||
| Iridodialysis | 1663 | ||
| Lens trauma, dislocation | 1664 | ||
| Anterior segment intraocular foreign bodies | 1665 | ||
| Postoperative Care | 1665 | ||
| Suture Removal | 1666 | ||
| Visual Rehabilitation | 1666 | ||
| Optical correction | 1666 | ||
| Postoperative complications | 1667 | ||
| Surgical rehabilitation after primary trauma repair | 1667 | ||
| Conclusion | 1667 | ||
| References | 1667 | ||
| 148 Iris Reconstruction Surgery | 1671 | ||
| Iris Suture Techniques | 1671 | ||
| The sliding knot intracameral suture | 1671 | ||
| Pupil cerclage procedure | 1671 | ||
| Iridodialysis Repair | 1672 | ||
| Iris Relaxing Incisions | 1673 | ||
| Scissors Sculpting | 1673 | ||
| Vitrector Sculpting | 1673 | ||
| Iris Prostheses | 1673 | ||
| Large-incision, rigid diaphragm devices | 1674 | ||
| Rigid small-incision devices | 1675 | ||
| Flexible small-incision iris prostheses | 1675 | ||
| Pupillary aperture: pupil versus entrance pupil | 1676 | ||
| Complications | 1676 | ||
| Summary | 1677 | ||
| References | 1677 | ||
| 149 Management of Scleral Perforation | 1679 | ||
| General Management Strategies | 1679 | ||
| Anesthesia for Scleral Perforations | 1679 | ||
| Surgical Repair of Scleral Perforations | 1680 | ||
| Preoperative considerations | 1680 | ||
| Operative considerations | 1680 | ||
| Conjunctiva and Tenon’s capsule | 1680 | ||
| Tarsoconjunctival flap | 1680 | ||
| Autologous sclera | 1681 | ||
| Homologous sclera | 1682 | ||
| Fascia lata | 1683 | ||
| Periosteum | 1684 | ||
| Split-thickness dermal graft | 1684 | ||
| Amniotic membrane | 1684 | ||
| Other materials | 1685 | ||
| Summary | 1685 | ||
| References | 1685 | ||
| XI Keratoprosthesis | 1687 | ||
| 150 Indications for Keratoprosthesis | 1689 | ||
| Keratoprosthesis Designs Currently in Wide Use and Their Indications | 1689 | ||
| Other Keratoprosthesis Designs | 1690 | ||
| Summary | 1691 | ||
| References | 1691 | ||
| 151 Types and Techniques of Keratoprosthesis | 1693 | ||
| Boston Keratoprosthesis Type 1 | 1693 | ||
| AlphaCor | 1694 | ||
| OOKP (Osteo-odonto-keratoprosthesis) | 1696 | ||
| References | 1697 | ||
| 152 Postoperative Management of Keratoprosthesis | 1699 | ||
| Avoidance of Complications | 1699 | ||
| Postoperative Patient Evaluation | 1700 | ||
| Postoperative Treatment | 1701 | ||
| Antibiotics | 1701 | ||
| Corticosteroids | 1701 | ||
| Glaucoma management | 1702 | ||
| Soft contact lens | 1702 | ||
| Postoperative Complications and Management | 1702 | ||
| Retroprosthetic membrane | 1703 | ||
| Loss of the soft contact lens | 1703 | ||
| Sterile vitritis | 1703 | ||
| Elevated intraocular pressure | 1703 | ||
| Endophthalmitis | 1703 | ||
| Retinal detachment | 1703 | ||
| Corneal melts and keratoprosthesis extrusion | 1704 | ||
| Conclusion | 1704 | ||
| References | 1704 | ||
| 153 Outcomes of Keratoprosthesis Surgery | 1705 | ||
| Introduction | 1705 | ||
| Osteo-Odonto Keratoprosthesis | 1705 | ||
| AlphaCorâ„¢ | 1705 | ||
| Boston keratoprosthesis | 1706 | ||
| References | 1708 | ||
| XII Ocular Surface Transplantation | 1711 | ||
| 154 Classification and Staging of Ocular Surface Disease | 1713 | ||
| Classification of Ocular Surface Disease | 1713 | ||
| Eyelids and eyelashes | 1713 | ||
| Tear film | 1713 | ||
| Conjunctiva | 1714 | ||
| Limbal Stem Cell Deficiency | 1714 | ||
| Congenital | 1716 | ||
| Aniridia | 1716 | ||
| Dominantly inherited keratitis | 1717 | ||
| Ectodermal dysplasia | 1717 | ||
| Traumatic | 1717 | ||
| Alkali and acid injury | 1718 | ||
| Thermal injury | 1719 | ||
| Iatrogenic limbal stem cell deficiency | 1719 | ||
| Autoimmune Disorders | 1720 | ||
| Stevens–Johnson syndrome | 1720 | ||
| Ocular cicatricial pemphigoid | 1721 | ||
| Staging of Ocular Surface Disease | 1721 | ||
| References | 1724 | ||
| 155 Surgical Techniques for Ocular Surface Reconstruction | 1727 | ||
| Introduction | 1727 | ||
| Conjunctival Limbal Autograft (CLAU) | 1727 | ||
| Indications and contraindications | 1727 | ||
| Preoperative considerations | 1727 | ||
| Surgical technique | 1727 | ||
| Living Related Conjunctival Limbal Allograft (lr-CLAL) | 1729 | ||
| Indications and contraindications | 1729 | ||
| Preoperative considerations | 1730 | ||
| Surgical technique | 1730 | ||
| Keratolimbal Allograft (KLAL) | 1731 | ||
| Indications and contraindications | 1731 | ||
| Preoperative considerations | 1732 | ||
| Surgical techniques | 1733 | ||
| General considerations | 1733 | ||
| Preparation of the recipient eye | 1733 | ||
| Technique 1 | 1733 | ||
| Technique 2 | 1734 | ||
| Conjunctival limbal allograft (CLAL) | 1734 | ||
| Donor eyes | 1734 | ||
| Recipient eye | 1735 | ||
| Combined Conjunctival Limbal and Keratolimbal Allograft (C-KLAL) | 1735 | ||
| Indications and contraindications | 1735 | ||
| Preoperative considerations | 1736 | ||
| Surgical technique | 1736 | ||
| Ex Vivo Tissue Engineered Procedures | 1737 | ||
| Ex Vivo Cultivated Limbal Transplantation | 1739 | ||
| Ex Vivo Stem Cell Allografts | 1739 | ||
| Limbal epithelial culture | 1739 | ||
| Technique | 1739 | ||
| Operative procedure | 1739 | ||
| Ex Vivo Cultivated Conjunctival Transplantation | 1739 | ||
| Ex Vivo Cultivated Mucosal Transplantation | 1740 | ||
| Amniotic Membrane Transplantation (AMT) | 1740 | ||
| Mechanism of action | 1740 | ||
| Clinical applications | 1741 | ||
| Results of AMT in ocular surface disease management | 1741 | ||
| Recommended Treatment Algorithm | 1741 | ||
| Conclusions | 1742 | ||
| Future Directions | 1742 | ||
| References | 1742 | ||
| 156 Postoperative Management of Ocular Surface Reconstruction | 1745 | ||
| Introduction | 1745 | ||
| Ocular surface rehabilitation | 1745 | ||
| Immunosuppressive Therapy | 1745 | ||
| Overview | 1745 | ||
| Clinical signs of rejection | 1745 | ||
| Immunosuppressive agents | 1747 | ||
| Evaluation of patients prior to starting immunosuppression | 1747 | ||
| Glucocorticosteroids | 1747 | ||
| Mode of action | 1747 | ||
| Topical steroids | 1747 | ||
| Systemic steroids | 1748 | ||
| Calcineurin inhibitors | 1748 | ||
| Ciclosporin A | 1748 | ||
| Mode of action | 1748 | ||
| Topical ciclosporin | 1749 | ||
| Systemic ciclosporin | 1749 | ||
| Tacrolimus (FK-506) | 1749 | ||
| Antimetabolites | 1750 | ||
| Azathioprine | 1750 | ||
| Mycophenolate mofetil | 1750 | ||
| Other immunosuppressive agents | 1751 | ||
| Sirolimus (rapamycin) | 1751 | ||
| Biological drugs | 1751 | ||
| Prophylactic antimicrobial therapy | 1751 | ||
| General considerations for patients on immunosuppression | 1751 | ||
| Risk of malignancy | 1752 | ||
| Summary | 1752 | ||
| References | 1752 | ||
| 157 Corneal Transplantation in Ocular Surface Disease | 1755 | ||
| Introduction | 1755 | ||
| Review of the Literature | 1755 | ||
| Technique | 1757 | ||
| Summary | 1758 | ||
| References | 1758 | ||
| XIII Refractive Surgery | 1759 | ||
| 1 Preoperative Considerations | 1761 | ||
| 158 Decision Making in Refractive Surgery | 1761 | ||
| Excimer Laser Vision Correction | 1761 | ||
| Patient age | 1761 | ||
| Refractive error | 1761 | ||
| Corneal thickness | 1761 | ||
| Corneal topography | 1763 | ||
| Keratometry | 1763 | ||
| Pupil size | 1764 | ||
| Thin-flap LASIK | 1764 | ||
| Surface Ablation | 1764 | ||
| Conductive Keratoplasty | 1764 | ||
| Arcuate Transverse Keratotomy | 1764 | ||
| Phakic Intraocular Lenses | 1764 | ||
| Intraocular Lens after Phacoemulsification | 1765 | ||
| Retreatments and Sequential Procedures | 1765 | ||
| Intracorneal Inlays | 1765 | ||
| Treatment of Presbyopia | 1765 | ||
| References | 1765 | ||
| 159 Patient Evaluation and Selection in Refractive Surgery | 1767 | ||
| Introduction | 1767 | ||
| Evaluation Process | 1767 | ||
| History | 1767 | ||
| Ocular herpes simplex virus | 1767 | ||
| Previous radial keratotomy | 1767 | ||
| History of strabismus | 1768 | ||
| Monocular patients | 1768 | ||
| History of keloid formation | 1768 | ||
| Contact lens history | 1768 | ||
| Pregnancy | 1768 | ||
| Participation in high-risk activities | 1768 | ||
| Medicines | 1769 | ||
| Medical conditions | 1769 | ||
| Examination | 1769 | ||
| Visual acuity | 1769 | ||
| Refraction | 1769 | ||
| Contrast sensitivity | 1769 | ||
| Keratometery | 1769 | ||
| Computed topography | 1769 | ||
| Pupil examination | 1770 | ||
| Case study relating pupil size, patient complaints, and wavefront measurements | 1772 | ||
| Slit lamp examination | 1774 | ||
| Fundus examination | 1774 | ||
| Tonometry | 1774 | ||
| Pachymetry | 1775 | ||
| Endothelial cell evaluation | 1775 | ||
| Anterior chamber depth | 1775 | ||
| Dry eye testing: Schirmer’s test and tear breakup testing | 1775 | ||
| Monovision testing | 1775 | ||
| Ocular dominance determination | 1775 | ||
| Wavefront testing | 1775 | ||
| Informed Consent | 1776 | ||
| References | 1778 | ||
| 160 Topographic Analysis in Keratorefractive Surgery | 1781 | ||
| Introduction | 1781 | ||
| Historical Background | 1781 | ||
| Keratometry | 1781 | ||
| Keratoscopy | 1782 | ||
| Videokeratoscopy | 1782 | ||
| Placido-based computerized videokeratoscopes | 1782 | ||
| Elevation-based topography systems | 1782 | ||
| Clinical Applications | 1783 | ||
| Contact lens-induced warpage | 1786 | ||
| Keratoconus and keratoconus suspect | 1786 | ||
| Displaced apex syndrome | 1790 | ||
| Postoperative Evaluations | 1790 | ||
| Contoured ablation pattern | 1790 | ||
| Other Uses | 1791 | ||
| Photokeratoplasty suture removal and modification | 1791 | ||
| Cataract surgery | 1791 | ||
| Future Horizons | 1791 | ||
| References | 1791 | ||
| 2 Laser Vision Correction | 1793 | ||
| 161 Excimer Laser Surface Treatment: | 1793 | ||
| Excimer Laser Surface Treatment | 1793 | ||
| Indications for Excimer Laser Surface Treatment | 1793 | ||
| Patient Selection | 1794 | ||
| Preoperative Management of Excimer Laser Surface Treatment | 1796 | ||
| PRK surgical techniques | 1796 | ||
| Preoperative medications | 1797 | ||
| PRK Epithelial Removal | 1797 | ||
| Mechanical | 1797 | ||
| Chemical | 1798 | ||
| Laser | 1798 | ||
| Excimer laser | 1798 | ||
| Laser and scrape | 1798 | ||
| Transepithelial | 1798 | ||
| Stromal treatment | 1799 | ||
| Postoperative Management | 1800 | ||
| Medications | 1800 | ||
| Epithelial healing | 1801 | ||
| Results | 1801 | ||
| Myopic PRK | 1801 | ||
| Hyperopic PRK | 1803 | ||
| Wavefront-guided PRK | 1803 | ||
| PRK and monovision | 1805 | ||
| PRK for presbyopia | 1805 | ||
| PRK in children | 1805 | ||
| PRK after refractive surgery | 1806 | ||
| Complications | 1806 | ||
| Intraoperative | 1806 | ||
| Eccentric ablations and decentrations | 1806 | ||
| Postoperative Complications | 1807 | ||
| Epithelial problems | 1807 | ||
| Dry eyes | 1807 | ||
| Corneal infiltrates and infectious keratitis | 1807 | ||
| Central islands | 1808 | ||
| Irregular astigmatism | 1808 | ||
| Undercorrection | 1809 | ||
| Overcorrection | 1809 | ||
| Haze, scarring, and regression | 1809 | ||
| Treatment of haze and regression | 1810 | ||
| Quality of vision | 1812 | ||
| Other Complications | 1812 | ||
| References | 1813 | ||
| 162 LASIK Technique | 1817 | ||
| Introduction and Historical Perspective | 1817 | ||
| Microkeratomes | 1819 | ||
| Technique | 1820 | ||
| Calibration and programming of the excimer laser system | 1820 | ||
| Assembly and testing of the microkeratome | 1821 | ||
| Preparation and assembly of the motor group | 1821 | ||
| Preparation and assembly of the suction ring | 1821 | ||
| Preparation and assembly of the microkeratome | 1821 | ||
| Preparation of the patient, sedation, and topical medication instillation | 1822 | ||
| Draping of the eye | 1823 | ||
| Placement of the locking eyelid speculum | 1823 | ||
| Placement of alignment markings | 1823 | ||
| Application of the pneumatic suction ring | 1823 | ||
| Checking for adequate intraocular pressure | 1824 | ||
| Lubrication of the ocular surface prior to microkeratome passage | 1825 | ||
| Insertion of the microkeratome head and creation of the keratectomy | 1825 | ||
| Lifting of the corneal flap and preparation of the stromal bed | 1826 | ||
| Intrastromal ablation | 1826 | ||
| Reapproximation of the corneal flap | 1826 | ||
| Flap alignment | 1827 | ||
| Removing the eyelid speculum | 1827 | ||
| Femtosecond laser flap creation | 1828 | ||
| Conclusion | 1828 | ||
| References | 1829 | ||
| 163 LASIK for Myopia | 1831 | ||
| Introduction | 1831 | ||
| History | 1831 | ||
| Excimer lasers | 1831 | ||
| Patient selection | 1833 | ||
| Indications | 1833 | ||
| Limitations and contraindications | 1833 | ||
| Microkeratomes | 1834 | ||
| Operative technique | 1834 | ||
| Postoperative care | 1835 | ||
| Complications | 1836 | ||
| Intraoperative complications | 1836 | ||
| Ablation complications | 1836 | ||
| Postoperative complications | 1837 | ||
| Keratectasia | 1839 | ||
| Results | 1839 | ||
| LASIK enhancements | 1839 | ||
| LASIK in Complex Cases | 1839 | ||
| LASIK after radial keratotomy | 1839 | ||
| LASIK after photorefractive keratectomy | 1840 | ||
| LASIK after penetrating keratoplasty | 1840 | ||
| LASIK after Intraocular Lenses | 1840 | ||
| Intraocular Lens Calculations after LASIK | 1841 | ||
| Summary | 1841 | ||
| References | 1841 | ||
| 164 LASIK for Hyperopia | 1845 | ||
| Introduction | 1845 | ||
| Physiological Aspects of Hyperopia | 1845 | ||
| Corneal Surgery for Hyperopia | 1845 | ||
| Preoperative Considerations and Patients Selection | 1847 | ||
| Indications for LASIK for Hyperopia | 1848 | ||
| Primary hyperopia | 1848 | ||
| Secondary hyperopia | 1848 | ||
| Technique and Instrumentation for LASIK for Hyperopia | 1849 | ||
| Technique | 1849 | ||
| Results | 1849 | ||
| Complications | 1850 | ||
| Conclusion | 1851 | ||
| References | 1851 | ||
| 165 Surface Ablation: Techniques for Managing the Epithelial Layer | 1853 | ||
| Introduction | 1853 | ||
| Preoperative Evaluation | 1853 | ||
| Surgical Techniques | 1854 | ||
| Photorefractive keratectomy | 1854 | ||
| Laser assisted subepithelial keratomileusis | 1854 | ||
| Azar flap technique | 1854 | ||
| Camellin trephination technique | 1854 | ||
| Vinciguerra butterfly technique | 1854 | ||
| McDonald technique | 1855 | ||
| Brown technique | 1855 | ||
| Epipolis laser in situ keratomileusis (epi-LASIK), | 1856 | ||
| Comparison of Techniques | 1856 | ||
| Postoperative Management and Complications | 1858 | ||
| Conclusions | 1858 | ||
| References | 1858 | ||
| 166 LASIK Complications | 1861 | ||
| Introduction | 1861 | ||
| Intraoperative LASIK Complications | 1861 | ||
| Femtosecond laser flap complications | 1861 | ||
| Microkeratome complications | 1861 | ||
| Buttonhole and irregular flaps | 1862 | ||
| Clinical | 1862 | ||
| Management | 1862 | ||
| Prevention | 1862 | ||
| Thin flaps | 1862 | ||
| Index | 1915 | ||
| A | 1915 | ||
| B | 1919 | ||
| C | 1922 | ||
| D | 1927 | ||
| E | 1930 | ||
| F | 1934 | ||
| G | 1935 | ||
| H | 1937 | ||
| I | 1939 | ||
| J | 1942 | ||
| K | 1942 | ||
| L | 1944 | ||
| M | 1947 | ||
| N | 1950 | ||
| O | 1951 | ||
| P | 1952 | ||
| Q | 1957 | ||
| R | 1957 | ||
| S | 1959 | ||
| T | 1963 | ||
| U | 1966 | ||
| V | 1966 | ||
| W | 1968 | ||
| X | 1968 | ||
| Y | 1968 | ||
| Z | 1968 |