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 |