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New Investigations in Ophthalmology
Tanuj Dada, Subrata Mandal
SECTION 1: CORNEA
1:
Confocal Microscopy of the Cornea
INTRODUCTION
Optics
CONFOCAL MICROSCOPY OF NORMAL CORNEA
Epithelium
SUBEPITHELIAL NERVE PLEXUS
STROMA
ENDOTHELIUM
CONFOCAL MICROSCOPY IN CORNEAL PATHOLOGIES
Keratoconus
CORNEAL DYSTROPHIES
Granular Dystrophy
POSTERIOR POLYMORPHOUS DYSTROPHY
FUCH'S ENDOTHELIAL DYSTROPHY
LASIK
MEASUREMENT OF FLAP THICKNESS IN LASIK
CORNEAL GRAFTS
INTRACORNEAL DEPOSITS
Vortex Keratopathy
CONCLUSION
ACKNOWLEDGEMENT
2:
Corneal Topography
INTRODUCTION
Working Principles of Computerized Videokeratography
Interpretation of the Maps
Limitations of the Placido-based Computerized Videokeratoscopy
Orbscan System
Indications (Orbscan II)
Interpretation of Orbscan Maps
Pachymetry
Screening Eye-Bank Corneas
Detection of Keratoconus and Suspects
Postrefractive Surgery Screening
SECTION 2: LENS
3:
IOL Master
INTRODUCTION
PRINCIPLE
INSTRUMENT
PROCEDURE
Axial Length Measurement Mode
Interpretation of Displays
Interpretation of Signal Curves
Keratometry
White-to-white Measurement
Anterior Chamber Depth Mode
IOL Power Calculation
ADVANTAGES
Precise Measurements
Takes Minimum Time
Improved Refractive Results Through Specific IOL Constants
Gentle to Patients
User-friendly Operation
LIMITATIONS
CLINICAL STUDIES IN LITERATURE
CONCLUSIONS
4:
Wavefront Technology
INTRODUCTION
Image Blur
Zernike Polynomials
Measuring Aberration
Wavefront a berration and visual a cuity
Wavefront and visual symptoms
PRINCIPLES OF WAVEFRONT MEASUREMENT
WAVEFRONT MEASUREMENTS AND VISION
Age
Pupil Size
PATHOLOGY AND SURGERY
Keratoconus
Cataract Surgery
Corneal refractive surgery
SURGICAL CORRECTION OF HOA
Spot size
Wavefront guided correction of HOA
Limitations
SECTION 3: GLAUCOMA
5:
Clinical Utility of OCT in Glaucoma
BASIC PRINCIPLE
RNFL EVALUATION ON OCT
RNFL IMAGE ACQUISITION
Clinical Interpretation of RNFL Thickness Average
CLINICAL STUDIES
Reproducibility and Repeatability
Correlation with Visual Field Indices
Sensitivity and Specificity
Role in Detecting Progression
Role in Pre-perimetric Diagnosis
OCT Comparison with Other Imaging Modalities
Optic Nerve Head Evaluation on OCT
Image acquisition
Interpretation of Optic Disk Scan and Optic Nerve Head Analysis
CLINICAL STUDIES
Macular Thickness and Macular Retinal Nerve Fiber Layer Thickness Evaluation on OCT in Glaucoma Eyes
Comparative Evaluation of Role of Retinal Nerve Fiber Layer, Optic Nerve Head and the Macular Thickness in Glaucoma Diagnosis
Uses of OCT in Glaucoma Surgery
Hypotonous Maculopathy
Cystoid Macular Edema
Retinal Nerve Fiber Layer Thickness Measurements after Glaucoma Surgery
High Speed Corneal and Anterior Segment (CAS) Optical Coherence Tomography (OCT)
ADVANTAGES
DISADVANTAGES
SUMMARY
6:
Retinal Nerve Fiber Layer Analysis Using Scanning Laser Polarimetry
INTRODUCTION
PRINCIPLE OF SCANNING LASER POLARIMETRY
ANTERIOR SEGMENT BIREFRINGENCE
VARIABLE CORNEAL COMPENSATION (VCC)
COMPARISON OF VCC TECHNOLOGY WITH FCC TECHNOLOGY
RNFL MEASUREMENTS
Measurement Technique
Clinical Interpretation of the GDx VCC Printout
The Thickness Map
The Deviation Map
The TSNIT Map
The Parameter Table
Abnormal Scan
Additional Diagnostic Parameters
Detecting Progression of RNFL Loss: Serial Analysis
Clinical Studies Using GDx VCC Technology
CONCLUSIONS
7:
Heidelberg Retinal Tomography
PRINCIPLE
HRT III
OPERATION OF THE HEIDELBERG RETINAL TOMOGRAPH II
Image Acquisition
THE REFERENCE PLANE
MARKING THE DISC CONTOUR
THE MOORFIELD'S REGRESSION ANALYSIS AND OTHER DISCRIMINANT FORMULAS
Moorfields Regression Analysis
Others Discriminant Formulas
CURRENT ROLE IN DIAGNOSIS
ADVANTAGES
DISADVANTAGES
TYPES OF PRINTOUT
NEW HRT PRINTOUT
INTERPRETATION OF THE PRINTOUT
Topography Image (Fig. 7.13)
Horizontal Height Profile
Vertical Height Profile
Reflection Image
Mean Height Contour Graph
Moorfield's Regression Analysis
Stereometric Parameters
Detection of Damage
Location of Damage
Comparison between Two Eyes
Comparison of Structural and Functional Damage
INTERPRETATION OF A SINGLE PRINTOUT
MONITORING PROGRESSION
Topographic Change Analysis
SUMMARY OF HRT LITERATURE
Detection of Glaucomatous Damage
Progression by HRT
CONCLUSIONS
8:
Short Wavelength Automated Perimetry
INTRODUCTION
PRINCIPLE
TECHNIQUE
INDICATIONS
INTERPRETATION OF PRINTOUT
CLINICAL STUDIES
SITA SWAP
Advantages of SWAP
Limitations
CONCLUSIONS
9:
Frequency Doubling Perimetry
INTRODUCTION
FREQUENCY DOUBLING THEORY
METHODOLOGY
TESTING MODES
Full Threshold Strategy
Custom 24-2 FDT Perimetry
Matrix FDT Perimetry
Advantages of FDP
Disadvantages
CLINICAL STUDIES
CONCLUSIONS
10:
Ultrasound Biomicroscopy in Glaucoma
INTRODUCTION
PRINCIPLE
TECHNIQUE
CLINICAL USES OF UBM IN GLAUCOMA SURGERY QUALITATIVE ULTRASOUND BIOMICROSCOPY
Other surgeries
Evaluation of Postoperative Complications after Trabeculectomy
Quantitative Ultrasound Biomicroscopy
CLINICAL APPLICATIONS OF QUANTITATIVE ULTRASOUND BIOMICROSCOPY
Quantification of the anterior chamber angle
Effects of Drugs
Effects of Surgery
CONCLUSIONS
11:
Anterior Segment Optical Coherence Tomography
INTRODUCTION
APPLICATIONS IN CORNEAL IMAGING
APPLICATIONS IN ANGLE CLOSURE GLAUCOMA
APPLICATION IN IMAGING TRABECULECTOMY BLEBS
COMPARISON OF AS-OCT VERSUS UBM
Advantages of the AS-OCT
Disadvantages of the AS-OCT
12:
Dynamic Contour Tonometry
INTRODUCTION
ROLE OF CENTRAL CORNEAL THICKNESS IN GLAUCOMA
INSTRUMENT DESIGN
EFFECT OF CENTRAL CORNEAL THICKNESS ON DCT
PRINCIPLE OF CONTOUR TONOMETRY
METHODOLOGY
DCT vs GAT
DCT after LASIK
ADVANTAGES OF DCT
CONCLUSIONS
13:
New Perimetric Techniques
INTRODUCTION
MOTION PERIMETRY
Principle
Procedure
Sensitivity and Specificity
Advantages
Limitations
Clinical Studies
Conclusions
HIGH-PASS RESOLUTION PERIMETRY
Principle
Procedure
Interpretation of printout and Indices
Simple Analysis
Calculation of decibel scores
Ordered deviation plot
Advanced Analysis
Global Deviation (GD)
Local Deviation (LD)
Combined Deviation
Mean Retest Change
Retest Standard Deviation
Relative Criterion Level (C)
Relative Dispersion
Blur Index
Neural Capacity (NC)
Advantages
Limitations
Clinical Studies
Conclusions
PATTERN DISCRIMINATION PERIMETRY
Principle
Procedure
Advantage
Limitations
Clinical Studies
Conclusions
FLICKER PERIMETRY
Procedure
Advantages
Limitations
Clinical Studies
Conclusions
RAREBIT PERIMETRY
Principle
Procedure
Advantages
Limitation
Clinical Studies
Conclusions
OBJECTIVE PERIMETRY
AccuMap
Procedure
Clinical Studies
PUPIL PERIMETRY
SECTION 4: RETINA
14:
Optical Coherence Tomography in Macular Disorders
INTRODUCTION
Macular Hole
Epiretinal Membrane (ERM)
Vitreomacular traction syndrome (VMTS)
Cystoid Macular Edema (CME)
Diabetic Macular Edema
Central serous chorioretinopathy (CSR)
Age-related macular degeneration (ARMD)
Post-retinal Detachment Surgery
Retinal vein occlusion
Limitations/Drawbacks
Retinal Image Processing Protocols
Ultra-high Resolution OCT (UHR-OCT)
15:
Multifocal Electroretinogram(M-ERG)
INTRODUCTION
PRINCIPLE
PROCEDURE
Indications/Utility
Advantages
Conclusion
SUGGESTED READING
16:
RetCam
INTRODUCTION
PRINCIPLE
PROCEDURE
INDICATIONS/UTILITY
PATIENT EXAMPLES (FIGS 16.3 TO 16.8)
Advantages
Disadvantages
RETCAM II
CONCLUSION
BIBLIOGRAPHY
17:
Heidelberg Retinal Angiography
INTRODUCTION
PRINCIPLE
Indications/Utility
Advantages of HRA-2
Autofluorescence
Staurenghi Lens
SUGGESTED READING
SECTION 5: RADIOLOGY
18:
Clinical Applications of Ultrasound Biomicroscopy
INTRODUCTION
PRINCIPLE
TECHNIQUE
CLINICAL USES OF ULTRASOUND BIOMICROSCOPY
Eyelid, Conjunctiva and Adnexa
Canaliculi
Corneal and Anterior Segment Disorders
Intraocular Lens
Uveitis
Trauma
Ocular Oncology
Retina
CONCLUSIONS
19:
Newer Cross-sectional Imaging Techniques in Ophthalmology
INTRODUCTION
COMPUTED TOMOGRAPHY (CT)
ULTRASOUND
Doppler Ultrasonography
MAGNETIC RESONANCE IMAGING (MRI)
Dacryocystography
20:
Cross-sectional Orbital Imagingin Various Pathological Conditions
INTRODUCTION
INTRACONAL
Optic Nerve Glioma
Meningioma
Optic Neuritis
Hemangioma
MUSCLE CONE
Pseudotumor (Idiopathic Orbital Inflammation)
Thyroid Eye Disease
Rhabdomyosarcoma
EXTRACONAL SPACE
Schwannoma/Neurofibroma
Lymphoma
Metastases
Lacrimal Gland
Benign Mixed Tumor (Pleomorphic Adenoma)
Malignant Tumors
Dermoid Cyst
Infection
Lymphangioma
Vascular Lesions
Carotico-cavernous Fistula
Orbital Varices
Osseous Lesions
GLOBE
Retinoblastoma
Persistent Hyperplastic Primary Vitreous (PHPV)
Coats’ Disease
Uveal Malignant Melanoma
Choroidal Metastases
CHOROIDAL HEMANGIOMA
Foreign Body
Parasitic Infestation
CONGENITAL ANOMALIES
CONCLUSION
SECTION 6: OCULAR BLOOD FLOW
21:
Measurement of Ocular Blood Flow
INTRODUCTION
Blood Supply to the Optic Nerve Head
Importance of Measuring of Ocular Blood Flow
Pulsatile Ocular Blood Flow
Methodology
Factors Affecting Pulsatile Ocular Blood Flow
Color Doppler Imaging
Laser Doppler Flowmetry
INDEX
TOC
Index
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