Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Clinical Ophthalmology: Medical and Surgical Approach
Sandeep Saxena
SECTION 1: CORNEAL AND EXTERNAL DISEASES
CHAPTER 1:
Investigations for Corneal and External Diseases
INTRODUCTION
DIAGNOSIS IN INFECTIOUS KERATITIS
Types of Samples
Sample Collection Gadgets
Corneal Scraping
Transport of Sample
Corneal Biopsy
Microbiological Investigations
Potassium Hydroxide Wet Mount Preparation
Gram Staining
Giemsa Staining
Special Stains
Fluorochromatic Stains
Culture Specimens
Serological Investigations
Role of Corneal Staining in Infectious Keratitis
DIAGNOSIS IN DRY EYE
Tests of Tear Stability
Invasive Tear Break-up Time (Fluorescein Break-up Time)
Disadvantages
Noninvasive Tests of Tear Film Stability
Invasive Test for Tear Volume
Schirmer Test
Disadvantages
Phenol Red Impregnated Cotton Thread Test
Slit-lamp Fluorophotometry
Interpretation
Noninvasive Test for Tear Volume
Tear Meniscus Height and Curvature
Ocular protection index
Assessment of Tear Quality
Slit Lamp
Nonroutine Tests in Dry Eye
Meibomiometry
Lactoplate Test
Refractometry
Tear Ferning
Osmolality
Laboratory Diagnosis
Impression Cytology
Technique of Specimen Collection
Specimen Staining Technique
Applications of impression cytology
Corneal Aesthesiometer
DIAGNOSTIC MODALITIES IN KERATOPLASTY WORK-UP
Specular Microscopy
Optical Principles of Specular Microscopy
Methods of Evaluation of Corneal Endothelium
Clinical Indications for Specular Microscopy
Advantages
Disadvantages
Eye Bank Specular Microscopy
Anterior Segment Optical Coherence Tomography and its Application in Corneal Diseases
Applications in Cornea
Advantages
Confocal Microscopy
Indications of Confocal Microscopy
Advantages
Disadvantages
Corneal Topography
Projection Device Systems
Scanning Slit Imaging
Current Applications of Corneal Topography
Pachymetry
Corneal Thickness in Normal Eyes
Indications
Correction Factor
Techniques of Pachymetric Measurements
Methods of Measurements
Ultrasonic Pachymetry
Principle
Disadvantages
Advantages
Ultrasound Biomicroscopy
Advantages
Disadvantages
Slit-Scanning Pachymetry
Principle
Advantages
Disadvantages
Pentacam
Principle
Advantages
Disadvantages
Pachycam
Principle
Advantages
CHAPTER 2:
External Eye Diseases
DISORDERS OF EYELASHES
Trichiasis
Introduction
Diagnosis
Treatment
Madarosis
Introduction
Treatment
Poliosis
Introduction
Causes
Treatment
Blepharitis
Introduction
Types
Treatment
Blepharoconjunctivitis
Introduction
Diagnosis
Treatment
BENIGN NODULES
Chalazion
Introduction
Diagnosis
Treatment
Incision and Curettage
Internal Hordeolum (Infected Chalazion)
Introduction
Treatment
BACTERIAL INFECTIONS
External Hordeolum (Stye)
Introduction
Diagnosis
Treatment
VIRAL INFECTIONS
Herpes Zoster Ophthalmicus
Introduction
Diagnosis
Treatment
Molluscum Contagiosum
Introduction
Diagnosis
Treatment
CONJUNCTIVA
Bacterial Conjunctivitis
Introduction
Diagnosis
Treatment
Gonococcal Keratoconjunctivitis
Introduction
Diagnosis
Treatment
Ophthalmia Neonatorum
Introduction
Types
Diagnosis
Complications
Treatment
Chlamydial Conjunctivitis
Introduction
Diagnosis
Treatment
Trachoma
Introduction
Classification
Diagnosis
Treatment
Prevention
Surgery
Antibiotic Therapy
Cleanliness
Environmental Improvement
Viral Conjunctivitis
Adenoviral Keratoconjunctivitis
Acute Hemorrhagic Conjunctivitis
Introduction
Diagnosis
Treatment
Allergic Conjunctivitis
Acute Allergic Conjunctivitis
Vernal Keratoconjunctivitis
Introduction
Types
Treatment
Atopic Conjunctivitis
Introduction
Diagnosis
Treatment
Giant Papillary Conjunctivitis
Introduction
Diagnosis
Treatment
Stevens-Johnson Syndrome
Introduction
Diagnosis
Treatment
Miscellaneous Conjunctivitis
Membranous Conjunctivitis
Angular Conjunctivitis
DEGENERATIONS
Pinguecula
Introduction
Diagnosis
Treatment
Pterygium
Introduction
Types
Treatment
Surgical Steps of Pterygium Excision Surgery
Benign Pigmented Lesions
Flat Superficial Pigmentation
Benign Epithelial Melanosis
Benign Subepithelial Melanocytosis
Simple Nevus
Melanocytoma
Malignant Lesions
Precancerous Melanosis
Malignant Melanoma
DRY EYE
Investigations
Treatment
EPISCLERA AND SCLERA
Episcleritis
Introduction
Types
Treatment
Scleritis
Introduction
Types
Treatment
Posterior Scleritis
Scleral Discoloration
Blue Sclera
Causes
Other Types of Discoloration
Causes
Treatment
CHAPTER 3:
Diseases of Cornea
BACTERIAL KERATITIS
Introduction
Pathogens
Risk Factors
Pathophysiology
History
Examination
Microbiological Examination
Corneal Biopsy
Histological Findings
Imaging
Management
Medical
• Antibiotics
• Topical corticosteroids
Surgical
Complications
Prognosis
FUNGAL KERATITIS
Introduction
Structural Characteristics of Fungi
Classification
Clinical Features
Diagnosis
Management
Management
HERPES SIMPLEX VIRUS KERATITIS
Introduction
Latency and Reactivation
Primary Infection
Recurrent Infection
Corneal Epithelial Disease
Stromal Keratitis
Metaherpetic Ulcer
Herpes Simplex Virus Endotheliitis
Herpes Simplex Virus Iridocyclitis
Trabeculitis
Laboratory Diagnosis
Management
Antiviral agents
Corticosteroids
Systemic treatment
Specific treatment: Primary infection
Specific treatment: Recurrent infection
Surgical Procedures
ACANTHAMOEBA KERATITIS
Introduction
Predisposing Factors
Clinical Features
Laboratory Diagnosis
Management
Corticosteroids
Keratoplasty
NOCARDIA KERATITIS
Introduction
Predisposing Factors
Clinical Features
Diagnosis
Management
MICROSPORIDIA KERATITIS
Introduction
Clinical Features
Laboratory Diagnosis
Management
NEUROTROPHIC KERATITIS
Introduction
Pathogenesis
Clinical Features
Management
PHLYCTENULAR KERATOCONJUNCTIVITIS
Introduction
Clinical Features
Treatment
STAPHYLOCOCCAL MARGINAL KERATITIS
Introduction
Clinical Features
Management
PERIPHERAL ULCERATIVE KERATITIS
Introduction
Pathogenesis
Mooren's Ulcer
Watson's criteria
Pathogenesis
Management
Collagen Vascular Disease-related Peripheral Ulcerative Keratitis
Management
INFECTIOUS CRYSTALLINE KERATOPATHY
Introduction
Pathogenesis
Management
FILAMENTARY KERATITIS
Introduction
Theory of Filament Formation
Causes
Treatment
METABOLIC KERATOPATHY
Systemic Mucopolysaccharidosis
Hurler Syndrome
Scheie Syndrome
Hunter Syndrome
Sanfilippo Syndrome
Morquio Syndrome
Maroteaux-Lamy Syndrome
Sly Syndrome
Cystinosis
Wilson's Disease
DRUG-INDUCED KERATOPATHIES
Introduction
Chloroquine
Amiodarone
Other Agents
KERATOCONUS
Introduction
Pathophysiology
Clinical Features
Diagnosis
Imaging Studies
Histologic Findings
Management
DOCUMENTATION OF CLINICAL SIGNS THROUGH CLINICAL DIAGRAMS
CHAPTER 4:
Corneal Surgeries
CORNEAL TRAUMA
Assessment of the Eye
Surgical Principles
Penetrating Trauma—Management
Perforating Trauma—Management
Outcomes of Corneal Trauma Management
PTERYGIUM SURGERY
Indications for Surgery
Bare Sclera Excision
Adjuncts to Bare Sclera Excision
Conjunctival and Amniotic Membrane Grafting
PENETRATING KERATOPLASTY
Indications and Patient Assessment
Contraindications
Surgical Technique
Postoperative Care
Therapeutic Penetrating Keratoplasty
Total Corneoscleral Transplantation
Future Directions
ANTERIOR LAMELLAR CORNEAL REPLACEMENT
Rationale
Direct Surgical Dissection
Injection to Separate Descemet's Membrane
Closed Dissection Using Spatulated Dissectors
Donor Preparation
DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY
Microkeratome Flap-Assisted Deep Lamellar Endothelial Keratoplasty
Large Incision Deep Lamellar Endothelial Keratoplasty
Small Incision Deep Lamellar Endothelial Keratoplasty
Results
CORNEAL TRANSPLANTATION—AUTOGRAFTS
Rationale
Types
Ipsilateral Nonrotational Autografts
Ipsilateral Rotational Autografts
Contralateral Autografts
LIMBAL STEM CELL TRANSPLANTATION
Limbal Stem Cell
Stem Cell Dysfunction
Correction of Limbal Stem Cell Dysfunction
Surgical Procedures
Limbal Autografting
Live-related Limbal Allograft
Cadaver Limbal Allografting
Experience With Ex Vivo Stem Cell Cultivation
Future Directions
AMNIOTIC MEMBRANE TRANSPLANTATION
History of Amniotic Membrane Use
Properties of the Membrane
Preparation and Storage
Surgical Technique
Review of Current Indications
Cornea
Conjunctiva
Sclera
Eyelid
OCULAR SURFACE RECONSTRUCTION
Ocular Surface
Lid and Tear Function
Conjunctiva and Sclera
Corneal Surface
Keratoprosthesis
Future Prospects
PUNCTAL OCCLUSION
Tear Function and Drainage
Indications
Approaches
Surgical Technique
Complications
TECTONIC CORNEAL SURGERY
Limbal Fistula and Bleb Repair
Corneal Perforations
Band-Shaped Keratopathy
Anterior Stromal Puncture
Conjunctival Hooding
CHAPTER 5:
Refractive Surgeries
INTRODUCTION
Relevant Anatomy and Corneal Biomechanics
Corneal Topography
Placido-Disc Topography Systems
Slit-Imaging Systems
Pachymetry
Scheimpflug Imaging: The Oculus Pentacam
Corneal Biomechanics
Wavefront Analysis
What is Fourier Analysis?
KERATOREFRACTIVE PROCEDURES
Incisional Corneal Surgery
Radial Keratotomy for Myopia
Patient Selection
Surgical Technique
Prospective Evaluation of Radial Keratotomy (PERK)
Complications
Hexagonal Keratotomy for Hyperopia
Incisional Correction of Astigmatism
LASER-based Photoablative Procedures
Surface Ablation Procedures
Contraindications
Femtosecond Laser: A Breakthrough in Creation of the Stromal Flap for LASIK
LASIK in Myopia
Preoperative Examination
Ophthalmic Examination
Performing the Laser Procedure
Lasik in Hyperopia
Enhancement Procedures
Flap-Related Complications
Interface debris
Epithelial Defect
Incomplete Cap
Buttonhole/Partial/Thin Cap
Free Cap
Dislodged Flap
Striae
Perforation
Epithelial Ingrowth
Diffuse Lamellar Keratitis
Laser-Related Complications
Infectious Keratitis
Ectasia
Dry Eye
Corneal Haze
Thermokeratoplasty
Laser Thermokeratoplasty
Conductive Keratoplasty
INTACS (Intrastromal Corneal Ring Segments)
Newer Innovations
Femtosecond Lenticule Extraction
Corneal Inlays for Correction of Presbyopia
LENTICULAR REFRACTIVE SURGERY
Phakic Intraocular Lenses
Types of Phakic IOL
Angle-supported Phakic Intraocular Lenses
Iris-fixated Phakic Intraocular Lens
Surgical Technique
Posterior Chamber Phakic Intraocular Lenses
Clear Lens Extraction
Bioptics
SECTION 2: GLAUCOMA
CHAPTER 6:
Automated Visual Field Assessment, Optic Nerve and Nerve Fiber Layer Imaging
AUTOMATED VISUAL FIELD ASSESSMENT
Introduction
Test Algorithms
Full Threshold Program
Evaluation of a Single Test
General Information
Reliability Indices
Raw Data and Gray Scale
Total Deviation
Pattern Deviation
Global Indices
Mean Deviation (MD)
Pattern Standard Deviation (PSD)
Short-term Fluctuation (SF)
Corrected Pattern Standard Deviation (CPSD)
Glaucoma Hemifield Test
Common Factors Influencing Automated Perimetry
Fatigue Related Artifacts
Patient Behavior—Moderate and Extreme
Criteria for Progression of Visual Field
Advanced Analysis
Alternative Strategies and New Programs
Swedish Interactive Thresholding Algorithms (SITA)
Short Wavelength Automated Perimetry
Frequency Doubling Technology Perimetry
OPTIC NERVE AND NERVE FIBER LAYER IMAGING
Heidelberg Retinal Tomograph
Introduction
Definition
Scanning Laser Polarimetry
Introduction
Definition
Optical Coherence Tomography
Introduction
Definition
CHAPTER 7:
Optic Disc Assessment
INTRODUCTION
Methods of Optic Disc Examination
Features of Glaucomatous Optic Disc Damage
Cup Disc Ratio
Asymmetry of Optic Disc Cupping
Neuroretinal Rim Evaluation
Vascular Changes
Configuration of Vessels
Peripapillary Atrophy
Retinal Nerve Fiber Layer Abnormalities
Myopic Changes versus Glaucoma
Differential Diagnosis
Physiological Cupping
Optic Nerve Coloboma
Congenital Optic Disc Pit
Anterior Ischemic Optic Neuropathy
Neurological Causes
Optic Nerve Imaging in Glaucoma
CHAPTER 8:
Primary Congenital Glaucoma
INTRODUCTION
Epidemiology
Inheritance
Genetic Defects
Structural Defects and Clinical Features
Management
Tonometry
Corneal Diameter
Gonioscopy
Fundoscopy
CHAPTER 9:
Primary Angle-Closure Glaucoma
INTRODUCTION
Epidemiology
Risk Factors for Primary Angle-Closure Glaucoma
Family History
Age
Gender
History of Symptoms
Refractive Error
Race
Pathogenesis and Pathophysiology
Plateau Iris
Controversies in Definition
Chronic Angle-Closure Glaucoma
Combined Mechanism versus Mixed Mechanism
Creeping Angle-Closure Glaucoma
Clinical Presentation of Angle-Closure Glaucoma
MANAGEMENT OF ANGLE-CLOSURE GLAUCOMAS
Medical Treatment
Laser Treatment
Laser iridotomy
Argon Laser Peripheral Iridoplasty
Filtration Surgery
CHAPTER 10:
Primary Open-Angle Glaucoma
INTRODUCTION
DIAGNOSIS
Primary Open-Angle Glaucoma
Ocular Hypertension
ETIOPATHOGENESIS
Causes of Elevated Intraocular Pressure
Changes in the Optic Nerve Head
Mechanical and Vascular Theories
Genetics and Glaucoma
Autoimmunity–Does it have a role?
APPROACH TO DIAGNOSIS AND TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMA
Risk Factors
Elevated IOP as a Risk Factor
History
Symptoms
Signs
Clinical Examinations
Intraocular Pressure Assessment
Pupillary Evaluation
Biomicroscopy
Gonioscopy
Optic Nerve and Nerve Fiber Layer Imaging
Visual Field Changes
Flicker Perimetry
Motion Perimetry
Detection and Resolution Perimetry
MANAGEMENT OF GLAUCOMA – PRINCIPLES
Principles of Medical Therapy for Glaucoma
Laser Therapy
Argon Laser Trabeculoplasty (ALT)
Selective Laser Trabeculoplasty (SLT)
Other Laser Procedures
Surgery
Phacotrabeculectomy
Newer Surgical Techniques: Non-penetrating Filtering Procedures
CHAPTER 11:
Secondary Glaucoma
PSEUDOEXFOLIATION SYNDROME
Introduction
Etiopathogenesis
Clinical Features
Treatment
PIGMENTARY GLAUCOMA
Introduction
Etiopathogenesis
Clinical Features
Differential Diagnosis
Treatment
Prognosis
LENS-RELAUCOMA
Phacomorphic Glaucoma
Clinical Features
Treatment
Phacolytic Glaucoma
Clinical Features
Etiopathogenesis
Treatment
Phacoantigenic/Phacoanaphylactic Uveitis
Ectopia Lentis Glaucoma
Ocular Features
Treatment
PSEUDOPHAKIC/APHAKIC GLAUCOMA
Post Congenital Cataract Surgery
Treatment
Epithelial and Fibrous Ingrowth
Complicated Cataract Surgery
Etiopathogenesis
Treatment
NEOVASCULAR GLAUCOMA
Etiopathogenesis
Ocular Features
Treatment
Medications
Surgical Intervention
UVEITIC/INFLAMMATORY GLAUCOMA
Etiopathogenesis
Ocular Features
Some Specific Entities
Acute Anterior Uveitis
Juvenile Rheumatoid Arthritis/ Juvenile Idiopathic Arthritis
Pars Planitis
Glaucomatocyclitic Crisis (Posner Schlossman Syndrome)
Fuchs Heterochromic Cyclitis
Treatment
STEROID-INDUCED GLAUCOMA
Etiopathogenesis
Ocular Features
Treatment
RETINAL CONDITIONS CAUSING GLAUCOMA
Retinopathy of Prematurity
Treatment
Nanophthalmos
Retinal Detachment /Surgery
Pars Plana Vitrectomy
Treatment and Prophylaxis
Post Photocoagulation
POST-TRAUMATIC GLAUCOMA
Penetrating Injury
Chemical Burn
Ocular Manifestations
Treatment
Raised Episcleral Venous Pressure
Etiopathogenesis
Clinical Features
Systemic Associations
Treatment
MALIGNANT GLAUCOMA
Etiopathogenesis
Clinical Features
Treatment
GLAUCOMA ASSOCIATED WITH CORNEAL AND UVEAL CONDITIONS
Iridocorneal Endothelial Syndrome
Clinical Features
Treatment
Fuchs Endothelial Dystrophy
Treatment
Axenfeld-Rieger Anomaly
Ocular Features
Systemic Associations
Peter's Anomaly
Aniridia
Ocular Manifestations
Treatment
Postkeratoplasty Glaucoma
Ocular Manifestations
Treatment
Corneal Infections
Corneal Ulcer with Glaucoma
Pseudophakic Bullous Keratopathy
Ocular Tumors
Neurofibromatosis (von Recklinghausen's Disease)
Ocular Features
Treatment
Ocular Manifestations
Treatment
CHAPTER 12:
Investigative Techniques Helpful in Glaucoma Surgeries
INTRODUCTION
ULTRASOUND BIOMICROSCOPY
Principle
Uses of Ultrasound Biomicroscopy in Glaucoma Surgery
Preoperative Applications
Postoperative Applications
Non-penetrating Deep Sclerectomy
Evaluation of Postoperative Complications after Trabeculectomy
Laser Iridotomy
OPTICAL COHERENCE TOMOGRAPHY
Principle
Uses of Optical Coherence Tomography in Glaucoma Surgery
Hypotonous Maculopathy
Cystoid Macular Edema
Retinal Nerve Fiber Layer Thickness Measurements
Optic Nerve Head Analysis
High-Speed Corneal and Anterior Segment Optical Coherence Tomography
SCANNING LASER POLARIMETER
CONFOCAL SCANNING LASER OPHTHALMOSCOPY
VISUAL FIELDS
CHAPTER 13:
Glaucoma Surgeries
APPLIED ANATOMY FOR GLAUCOMA SURGERY
Corneolimbal Junction
Sclerolimbal Junction
Blue Zone Transition
SURGICAL INSTRUMENTS FOR GLAUCOMA SURGERY
Kelly-Descemet Membrane Punch
Harms Trabeculotome
TRABECULECTOMY
Exposure of the Surgical Site
Conjunctival Flap Dissection
Limbus-based Flap
Fornix-based Flap
Use of Antimetabolites
Fashioning Scleral Flap
Removal of the Inner Block: Sclerectomy
Inner Block Removal with Scissors
Inner Block Removal with Descemet's Punch
Peripheral Iridectomy
Closure of the Scleral Flap
Conjunctival Closure
Limbus-based Flap
Fornix-based Flap
Technique
COMBINED CATARACT AND GLAUCOMA SURGERY: TECHNIQUES
Extracapsular Cataract Extraction Combined with Trabeculectomy
Preoperative Precautions
Intraoperative Procedure
Precaution
Extracapsular Cataract Extraction: Variations
Phacoemulsification Combined with Trabeculectomy
Phacoemulsification Combined with Trabeculectomy: Variations
Blumenthal Surgery Combined with Trabeculectomy
WOUND MODULATION
Antimetabolites
Mitomycin-C
Complications
Dose and Duration of Mitomycin-C Application
Subconjunctival Injection
5-Fluorouracil
Fluorouracil Filtering Surgery Study
Releasable Sutures
Technique
Modifications
Argon Laser Suture Lysis
GLAUCOMA IMPLANTS
Indications
Choice of Implant
Surgical Technique
(Mainly for the Ahmed Glaucoma Valve Implant)
Other Modifications in Implant Surgery for Glaucoma
Implant Specific Instructions
Molteno Implant
Baerveldt Implant
Postoperative Care for Modification of Intraocular Pressure in Implant Surgery
Complications
External Trabeculotomy
Conjunctival Flap
Partial-thickness Scleral Flap
Exposing Schlemm's Canal
Trabeculotomy
Complications
PROCEDURES RELATED TO COMPLICATIONS FOLLOWING TRABECULECTOMY
Prevention of Complications
Intraoperative Complications
Anesthesia Related
Traction Sutures
Conjunctival Complications
Scleral Flap Complications
Suprachoroidal Hemorrhage
Hyphema
Early Postoperative Complications (Day 2–6th Week)
Low Intraocular Pressure with Shallow Anterior Chamber
Anterior Chamber Reformation (Fig. 13.70)
Choroidal Drainage (Figs 13.71 and 13.72)
Elevated Intraocular Pressure with Shallow Anterior Chamber
Elevated Intraocular Pressure with Normal Anterior Chamber
Technique of Needling of Bleb:
Late Complications
Bleb Leak
Autologous Blood Injection (Figs 13.80A to F)
Bleb-related Ocular Infection
Blebesthesia
Viscocanalostomy
SUCCESS RATES FOR GLAUCOMA SURGERY
CHAPTER 14:
Non-Penetrating Glaucoma Surgeries
INTRODUCTION
Non-penetrating Deep Sclerectomy (NPDS)
How Does it Work?
Status of this Surgery
Contraindications
Need for an Implant
Absorbable
Nonabsorbable
Adjunctive Use of Antifibrotics
Technique
Postoperative Course and Need for Goniopuncture
Longevity of Non-Penetrating Deep Sclerectomy
Combined with Cataract Surgery
Modifications
Viscocanalostomy
Complications
CHAPTER 15:
Nd: YAG Laser Iridotomy, Selective Laser Trabeculoplasty and Cyclophotocoagulation
Nd:YAG LASER IRIDOTOMY
Introduction
Indications
Procedure
Complications
SELECTIVE LASER TRABECULOPLASTY
Introduction
Indications
Principle
Mechanism of Action
Instrumentation
Procedure
Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty
Complications
CYCLOPHOTOCOAGULATION
Introduction
Indications
Mechanism of Action
Current Cyclophotocoagulation Techniques
Transscleral Cyclophotocoagulation (TSCPC)
Semiconductor diode laser
Principle and Technique
Limitation of Transscleral Cyclophotocoagulation
Complications
SECTION 3: CATARACT
CHAPTER 16:
Technological Advances in Intraocular Lenses and Instrumentation
INTRAOCULAR LENS MATERIALS AND DESIGNS
Square Edge Effect
Intraocular Lens Haptics
Intraocular Lens Materials
Acrylate/Methacrylate Polymer
Rigid Polymethylmethacrylate Intraocular Lenses
Foldable Intraocular Lenses
Silicone Elastomers
IOL IMPLANTATION TECHNIQUES
Implantation of Rigid IOLs
Foldable Lens Delivery Systems
Cartridge Injector System
BASICS OF PHACOEMULSIFICATION
Ultrasonic Handpiece
Mechanism of Phacoemulsification
Irrigation Aspiration Handpiece
Aspiration Pump
Peristaltic Pump
Venturi Pump
Diaphragmatic Pump
Concentrix Pump
Foot Pedal
SPECIFICATION OF A BASIC MODEL PHACO MACHINE
Burst and Pulse Mode Phaco
Power Modulations in Phacoemulsification
Cold Phacoemulsification
Torsional Phacoemulsification
Instruments used for Incisions
Phaco Choppers
Phaco Tips
Endocapsular Ring
VISCOELASTIC SUBSTANCES
Toxicity of Viscoelastics
Types of Viscoelastics
Viscoanesthesia
CHAPTER 17:
Phacoemulsification
INTRODUCTION
LENS HARDNESS GRADING SYSTEM IN CATARACT
Lens Opacities Classification Systems
ANESTHESIA
Topical Anesthesia
Intracameral Anesthesia
Technique
Bloomberg Supernumb Anesthetic Ring
Deep Topical Nerve Block Anesthesia
Lignocaine Jelly
CATARACT INCISION
Side Port Entry
Scleral Flap Incisions
Different Types of Scleral Incisions
Corneal Valve Incision
Technique
Limbal Incision
Wound Architecture
Temporal Limbal Incision
Hinge Incisions
CAPSULORHEXIS
Mechanics
Tearing by Stretching
Tearing by Shearing
Special Circumstances
Intumescent Cataract
Milky White Cataract
HYDROPROCEDURES
Terminology and Classification
Technique of Hydrodissection and Hydrodelineation
Hydrodissection
Hydrodelineation
NUCLEOFRACTIS TECHNIQUES
Principles of Phacoemulsification
Isolation of Phacoemulsification Tip into Manipulation, Cutting and Suction
Nuclear Rotation
Nuclear Segmentation
Nuclear Fragment Removal
ENDOCAPSULAR PHACOEMULSIFICATION
Endocapsular Phacoemulsification without Nuclear Cleavage
Endocapsular Phacoemulsification with Nucleus Cleavage
Chip and Flip Phacoemulsification
Spring Surgery
ENDOCAPSULAR EMULSIFICATION TECHNIQUES WITH NUCLEUS CRACKING
Phacoemulsification by Divide and Conquer
Four-Quadrant Cracking
Technique
Fractional 2:4 Phaco
Cracking the Nucleus
Crater Divide and Conquer
V-Style
Down Slope Sculpting
Phaco-sweep
Multidirectional Divide and Conquer Technique
Phaco-chop
Stop and Chop
Modification of Stop and Chop
Quick Chop
Prerequisite
Autocrack Chop
Choo-Choo Chop and Flip Phacoemulsification
Petalloid Phacoemulsification
Akahoshi Pre-Chopping Technique
EPINUCLEUS MANAGEMENT
CORTICAL CLEAN UP
FOLDABLE LENS INSERTION
Technique
COMPLICATIONS AND MANAGEMENT
Wound Construction
Hyphema
Anterior Capsulotomy
Corneal Complications
Iris Injury
Vitreous Loss
Conversion to Extracapsular Cataract Extraction
CHALLENGING SITUATIONS
Intraocular Lens Power Calculation after Refractive Surgery
Clinical History Method
Contact Lens Method
Intraocular Lens Power Calculation in Corneal Transplant Eyes
Hard Nucleus
The Central Flip
Other Technique
Phaco in White and Black Cataracts
White Cataract
Black Cataract
Subluxated Lens
Preoperative Evaluation
Anesthesia
Incision
Capsulorhexis
Hydrodissection
Implantation of the Capsular Ring
Phacoemulsification Technique
Cortical Aspiration
Implantation of Intraocular Lenses
Small Pupil
Postvitreoretinal Surgery
SECONDARY INTRAOCULAR LENS IMPLANTATION
CHAPTER 18:
Microincision Cataract Surgery
INTRODUCTION
BIMANUAL MICROPHACOEMULSIFICATION
Advantages of Bimanual Phacoemulsification
Advantages of Bimanual MICS in Difficult Situations
Disadvantages of Bimanual MICS
Intraocular Lenses for MICS
Advantages of Ultrathin Lenses
Technical Challenges for Bimanual MICS Lenses
Acri.Tec Intraocular Lenses
ThinOptx Rollable Intraocular Lenses
ThinLens Optics
Tips to Transition to Bimanual MICS
CHAPTER 19:
Multifocal Intraocular Lenses
INTRODUCTION
Types of Multifocal Intraocular Lenses
Refractive Multifocal Intraocular Lens
Diffractive Multifocal Intraocular Lens
Comparison of Multifocal Intraocular Lenses
Multifocal Intraocular Lens Selection and Mixing and Matching of Intraocular Lenses for Spectacle Independence
Special Considerations
CHAPTER 20:
Small Incision Cataract Surgery
INTRODUCTION
ADVANCES IN CATARACT SURGERY
Lens Removal Techniques
Intraocular Lens Designs
Incision Site, Design and Size
Site
Design
Size
THE TECHNIQUE OF SMALL INCISION CATARACT SURGERY
The Incision
Problems During Wound Construction
Capsulotomy
The Hydroprocedures
Hydrodissection
Hydrodelineation
Nucleus Prolapse
Nucleus Delivery
Other Options for Nucleus Delivery
Problems in Nucleus Delivery
Delivery of the Epinucleus and Cortex Aspiration
Intraocular Lens Implantation
Wound Closure
PRACTICAL TIPS FOR BEGINNERS
THE FUTURE
Advantages of Small Incision Cataract Surgery
Advantages of Small Incision Cataract Surgery over Extracapsular Cataract Surgery
Advantages of Small Incision Cataract Surgery over Phacoemulsification
Advantages of Phacoemulsification
Disadvantages of Phacoemulsification
SMALL INCISION CATARACT SURGERY: THE FISHHOOK TECHNIQUE
Small Incision Cataract Surgical Techniques
The Fishhook Technique
Tunnel Construction
Capsulotomy
Hydrodissection and Nucleus Extraction
Completing the Surgery
Outcome
Transition from Sutured to Sutureless Cataract Surgery
Stepwise Approach
CHAPTER 21:
Pediatric Cataract Surgery and Intraocular Lens Implantation
INTRODUCTION
Childhood Cataract
Etiology of Childhood Cataract
Morphology
Ocular Examination
Laboratory Work-up
Cataract Surgery in Children
Options in the Management of Pediatric Aphakia
Aphakic Glasses, Contact Lenses and Epikeratophakia
Intraocular Lens Implantation in Children
Why is there an Increase in the Use of IOLs in Pediatric Cataract Surgery?
How Does Pediatric Cataract Surgery Differ from Adult?
SURGICAL PROCEDURE
IOL Power Calculation
IOL Selection
Current Surgical Techniques
The Lensectomy and Anterior Vitrectomy Technique
Primary Posterior Capsulectomy, Anterior Vitrectomy with Intraocular Lens Implantation
Posterior Circular Curvilinear Capsulorhexis with Optic Capture
Secondary Intraocular Lens Implantation
Operative Problems and Complications in Pediatric Cataract Surgery
Postoperative Management
Postoperative Complications in Pediatric Cataract Surgery
Uveitis
Posterior Capsular Opacification
Pupillary Capture
Decentration of IOL
Glaucoma
Secondary Membrane Formation
Retinal Complications
Amblyopia
Change in the Axial Length of the Globe and Refractive Errors
Visual Outcome
SECTION 4: UVEITIS
CHAPTER 22:
Uveitis
INTRODUCTION
CLASSIFICATION
Anatomical Classification
Clinical Classification
Etiological Classification
PATHOGENESIS
Immune Response
Cells of the Immune System
Lymphocytes
Major Histocompatibility Complex
HLA Association of Certain Uveitic Conditions
Amplifiers of the Immune System
Sequence of Events in an Immune Response
Eye: A Site of Immune Privilege
Mechanisms of Immune System Failure
Hypersensitivity Reactions
Autoimmunity
Tolerance
Mechanisms of Tolerance
CLINICAL FEATURES
Symptoms
Signs
Lid
Conjunctiva
Cornea
Anterior Chamber Reaction
Iris
INVESTIGATIONS
Clinical Diagnosis
Reason for Ordering a Test
Skin Tests
Serology
Syphilis
Imaging
Fluorescein Angiography
Indocyanine Green Angiography
Ultrasonography
Optical Coherence Tomography
Biopsy
Polymerase Chain Reaction
TREATMENT
Medical Management
Mydriatic and Cycloplegic Agents
Corticosteroids
Side Effects of Corticosteroids
Immunosuppressive Agents
Azathioprine
Methotrexate
Mycophenolate Mofetil
Cyclosporine
Cyclophosphamide
UVEITIS IN SPONDYLOARTHROPATHIES
HLA-B27 Association
Pathogenesis
Molecular Mimicry
Arthritogenic Peptide
Clinical Features
ANKYLOSING SPONDYLITIS
Clinical Features
Investigations
REACTIVE ARTHRITIS AND REITER'S SYNDROME
Pathogenesis
Clinical Features
Investigations
Inflammatory Bowel Disease
PSORIATIC ARTHRITIS
MISCELLANEOUS ANTERIOR UVEITIS
Fuchs Uveitis Syndrome
Pathogenesis
Clinical Features
Posner Schlossman Syndrome (Glaucomatocyclitic Crisis)
Pathogenesis
Clinical Features
Symptoms
Signs:
LENS-ASSOCIATED UVEITIS
Pathogenesis
Clinical Features
INTERMEDIATE UVEITIS
Pathogenesis
Associations
Clinical Features
Complications
Investigations
Histopathology
Differential Diagnosis
Management
Periocular Steroid
Oral Steroids
Immunosuppressive Agents
Topical Steroids
Prognosis
WHITE DOT SYNDROMES
Acute Posterior Multifocal Placoid Pigment Epitheliopathy
Pathogenesis
Clinical Features
Investigations
Prognosis
Treatment
Pathogenesis
Clinical Features
Investigations
Prognosis
Treatment
Birdshot Retinochoroidopathy
Introduction
Clinical Features
Investigations
Prognosis
Treatment
Multifocal Choroiditis with Panuveitis
Pathogenesis
Clinical Features
Complications
Investigations
Prognosis
Treatment
Punctate Inner Choroidopathy
Pathogenesis
Clinical Features
Investigations
Prognosis
Treatment
PANUVEITIS CONDITIONS
Behçet's Syndrome
Pathogenesis
Clinical Features
International Study Group Criteria
Ocular Features
Treatment
SARCOIDOSIS
Pathogenesis
Proposed Antigens
Infectious
Clinical Features
Symptoms
Signs
Investigations
Treatment
VOGT-KOYANAGI-HARADA'S SYNDROME
Pathogenesis
Clinical Features
Pathology
Differential Diagnosis
Prognosis
Treatment
SYMPATHETIC OPHTHALMIA
Pathogenesis
Clinical Features
Symptoms
Signs
Complications
Investigations
Fluorescein Angiography
Indocyanine Green Angiography
Histopathology
Differential Diagnosis
Management
UVEITIS ASSOCIATED WITH OTHER SYSTEMIC DISEASES
Juvenile Rheumatoid Arthritis
Classification
Clinical Features
Symptoms
Signs
Management
Management of Cataract
PARASITIC UVEITIS
Toxoplasma Retinitis
Classification
Congenital Toxoplasmosis
Acquired Toxoplasmosis
Pathogenesis
Clinical Features
Complications
Investigations
Differential Diagnosis
Management
Toxocariasis
Pathogenesis
Clinical Features
Treatment
Onchocerciasis
Pathogenesis
Clinical Features
Investigations
Treatment
Cysticercosis
Pathogenesis
Clinical Features
Treatment
Diffuse Unilateral Subacute Neuroretinitis
Pathogenesis
Clinical Features
Management
VIRAL UVEITIS
HIV Microangiopathy
Pathogenesis
Clinical Features
Cytomegalovirus Retinitis
Clinical Features
Differential Diagnosis
Investigations
Management
Antiviral Agents
Acute Retinal Necrosis
Clinical Features
Treatment
Progressive Outer Retinal Necrosis
Clinical Features
Management
Prognosis
FUNGAL UVEITIS
Candida
Introduction
Pathogenesis
Clinical Features
Investigations
Management
Presumed Ocular Histoplasmosis
Introduction
Pathogenesis
Clinical Features
Investigations
Management
Cryptococcosis
Aspergillosis
Introduction
Pathogenesis
Clinical Features
Investigations
Differential Diagnosis
Management
Ocular Coccidiomycosis
BACTERIAL UVEITIS
Tuberculosis
Introduction
Pathogenesis
Clinical Features
Investigations
X-ray Chest and Sputum Culture
Mantoux Test (Fig. 22.11)
False Negatives
QuantiFERON-TB Gold Test
Polymerase Chain Reaction, Culture, Biopsy
Histopathology
Culture
Management
Syphilis
Introduction
Pathogenesis
Clinical Features
Pupil
Investigations
Management
Lyme's Disease
Introduction
Investigation
Management
Endophthalmitis
Classification of Endophthalmitis
Classification of Endophthalmitis by Etiology
Clinical Features
Investigations
Management
Endophthalmitis Vitrectomy Study (EVS)
Purpose
Description
Patient Eligibility
Results
Vitrectomy
Conclusions
MISCELLANEOUS UVEAL ABNORMALITIES
Uveal Masquerade Syndromes
Introduction
Primary Central Nervous System Lymphoma
Introduction
Clinical Features
Investigations
Management
CHAPTER 23:
Surgery in Uveitis: Diagnostic and Therapeutic
INTRODUCTION
CATARACT SURGERY IN UVEITIS
Indications for Cataract Surgery
Preoperative Evaluation
Preoperative Management
Surgical Considerations
Phacoemulsification Versus Extracapsular Cataract Extraction
Pars Plana approach
Problems Specific to the Uveitic Patient and their Management
Selection of the Intraocular Lens
Patient Selection
Intraocular Lens Material and Biocompatibility
Current Concept
Postoperative Care
Postoperative Complications
Excessive Inflammation
Intraocular Pressure
Cystoid Macular Edema
Posterior Capsular Opacification
Anterior Capsular Opacification
Summary of Present Recommendations for Cataract Surgery in Patients of Uveitis
Vitrectomy for Uveitis
Diagnostic Pars Plana Vitrectomy
Indications:
Preoperative Preparation
Preoperative Counseling
Surgical Techniques
Anterior Segment Tap/ Paracentesis
Vitreous Tap/ Aspiration
Vitreous Biopsy
Flow Cytometry and Immunohistochemistry
Antibody Production in Vitreous
Cytokines in Vitreous
Chorioretinal Biopsy
SECTION 5: VITREORETINAL DISEASES
CHAPTER 24:
Investigations in Retinal Diseases
INTRODUCTION
FLUORESCEIN ANGIOGRAPHY
INDOCYANINE GREEN ANGIOGRAPHY
SCANNING LASER OPHTHALMOSCOPE-BASED ANGIOGRAPHY
OPTICAL COHERENCE TOMOGRAPHY
B-SCAN ULTRASONOGRAPHY
MICROPERIMETRY
MULTIFOCAL ELECTRORETINOGRAM
COLOR CODING FOR RETINAL LESIONS
CHAPTER 25:
Spectral-Domain Optical Coherence Tomography in Macular Diseases
INTRODUCTION
SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND THREE-DIMENSIONAL RETINAL IMAGING
Spectral-Domain vs Time-Domain
3-D Retinal Imaging
AGE-RELATED MACULAR DEGENERATION
DIABETIC MACULAR EDEMA
RETINAL VEIN OCCLUSION
RETINAL ARTERY OCCLUSION
IDIOPATHIC MACULAR HOLE
EPIRETINAL MEMBRANE AND VITREOMACULAR TRACTION SYNDROME
MACULAR DYSTROPHY
HEALED TOXOPLASMOSIS
CHAPTER 26:
Macular and Allied Disorders
AGE-RELATED MACULAR DEGENERATION
Non-Neovascular Age-Related Macular Degeneration
Introduction
Diagnosis
NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Introduction
Diagnosis
Management
Macular Photocoagulation Study (MPS)
External Beam Radiation (Teletherapy)
Plaque Radiotherapy (Brachytherapy)
Photodynamic Therapy
Transpupillary Thermotherapy
Submacular Surgery
Foveal Translocation
Pharmacological Therapy
Retinal Pigment Epithelial Transplantation
Gene Therapy
CENTRAL SEROUS CHORIORETINOPATHY
Introduction
Diagnosis
Differential Diagnosis
Etiopathogenesis
Management
POSTSURGICAL CYSTOID MACULAR EDEMA
Introduction
Diagnosis
Differential Diagnosis
Etiopathogenesis
Management
MYOPIA
Introduction
Diagnosis
Clinical Features
Differential Diagnosis
Etiopathogenesis
Management
PARAFOVEAL TELANGIECTASIS
Introduction
Diagnosis
Differential Diagnosis
Management
RETINAL ARTERY MACROANEURYSM
Introduction
Diagnosis
Management
PHOTIC RETINOPATHY
Introduction
Diagnosis
Etiopathogenesis
Management
RADIATION RETINOPATHY
Introduction
Diagnosis
Etiopathogenesis
Management
CHAPTER 27:
Retinal Vascular Disorders
INTRODUCTION
DIABETIC RETINOPATHY
Nonproliferative Diabetic Retinopathy
Proliferative Diabetic Retinopathy
Visual Loss in Diabetic Retinopathy
Management
Medical Management
Laser Photocoagulation
Laser treatment techniques
Surgery
New Management Strategies
Enzymatic Manipulation of the Posterior Hyaloid in Diabetic Retinopathy
HYPERTENSIVE RETINOPATHY
Pathogenesis of Ocular Changes
Grading
Clinical Features
Pathophysiology
Management
HYPERTENSIVE CHOROIDOPATHY AND OPTIC NEUROPATHY
ARTERIAL OCCLUSIONS
Cotton-Wool Spots
Branch Retinal Artery Obstruction
Clinical Features
Treatment
Central Retinal Artery Occlusion
Clinical Features
Ancilliary Tests
Systemic Association
Management
Ophthalmic Artery Obstruction
Cilioretinal Artery Obstruction
Ocular Ischemic Syndrome
VENOUS OCCLUSIVE DISEASES OF RETINA
Central Retinal Vein Occlusion
Pathogenesis
Clinical Features
Natural Course and Complications
Management
Medical Therapy
Systemic Corticosteroids
Laser Photocoagulation
Surgery
Branch Retinal Vein Occlusion
Clinical Features
Complications
Management
Laser Photocoagulation
Surgery
Hemicentral Retinal Vein Occlusion
Clinical Features
Management
EALES' DISEASE
CHAPTER 28:
Laser Treatment in Posterior Segment Disorders
INTRODUCTION
LASER TREATMENT IN CHOROIDAL NEOVASCULAR MEMBRANES
Choroidal Neovascularization in Age-Related Macular Degeneration
Conventional (Direct) Laser Treatment
Photodynamic Therapy
Transpupillary Thermotherapy
Feeder Vessel Treatment
Transscleral Diode Laser Photocoagulation
Choroidal Neovascularization from Non-Age-Related Macular Degeneration
Etiology
PROPHYLACTIC LASER FOR DRUSEN
LASERS IN DIABETIC RETINOPATHY
Introduction
Focal and Grid Laser in Diabetic Maculopathy
Technique
Subthreshold Diode Laser in Diabetic Macular Edema
Scatter Laser in Diabetic Retinopathy
Technique
LASERS IN RETINAL VEIN OCCLUSION
Introduction
Management of Branch Retinal Vein Occlusion (Branch Vein Occlusion Study Recommendations)
Management of Central Retinal Vein Occlusion (Central Vein Occlusion Study Recommendations)
Laser-Induced Chorioretinal Anastomosis
LASER IN CENTRAL SEROUS CHORIORETINOPATHY
Introduction
Laser Photocoagulation
LASERS IN RETINAL LESIONS PREDISPOSING TO DETACHMENT AND RETINAL TEARS
Introduction
Why Should We Aim at Treating Peripheral Retinal Lesions Predisposing to retinal detachment?
What Are the High-Risk Characteristics One Has to Look for Before Contemplating Treatment in Cases of Peripheral Retinal Lesions?
Laser Photocoagulation
LASERS IN RETINAL DETACHMENT: PROPHYLACTIC/DELIMITING
Introduction
Technique
LASERS IN INFLAMMATORY DISEASES
Post-vasculitis Retinal Proliferation
Laser in Intermediate Uveitis
Laser in Idiopathic Retinal Vasculitis, Aneurysms and Neuroretinitis
Laser in Diffuse Unilateral Subacute Neuroretinitis
LASER IN RETINAL VASCULAR ANOMALIES
Retinal Artery Macroaneurysm
Coats' Disease
Retinal Capillary Hemangioma
LASER IN CHOROIDAL TUMORS
Choroidal Hemangioma
Laser Photocoagulation for Choroidal Melanomas
LASER IN RETINOPATHY OF PREMATURITY
MISCELLANEOUS PROCEDURES
YAG Laser Hyaloidotomy
PROCEDURES TO IMPROVE POSTERIOR SEGMENT VISUALIZATION
YAG Laser Capsulotomy
Neodymium:YAG Sweeping
Coreoplasty
Technique
Nd:YAG Vitreolysis
CHAPTER 29:
Anti-Vascular Endothelial Growth Factor Therapy
INTRODUCTION
Angiogenesis
Vascular Endothelial Growth Factor
Role of Vascular Endothelial Growth Factor in Angiogenesis
ANTI-VEGF THERAPY IN WET AGE-RELATED MACULAR DEGENERATION
ANTI-VEGF THERAPY IN DIABETIC RETINOPATHY
ANTI-VEGF THERAPY IN DIABETIC MACULAR EDEMA
ANTI-VEGF TREATMENT FOR PROLIFERATIVE DIABETIC RETINOPATHY
Adjunct Role of Intravitreal Bevacizumab in Surgery for Proliferative Diabetic Retinopathy
ANTI-VEGF THERAPY IN RETINAL VEIN OCCLUSION
Anti-VEGF Therapy in Central Retinal Vein Occlusion
Anti-VEGF Therapy for Macular Edema
Anti-VEGF Therapy for Neovascular Complications
Anti-VEGF Therapy in Branch Retinal Vein Occlusion
CHAPTER 30:
Vitreoretinal Surgeries
RHEGMATOGENOUS RETINAL DETACHMENT
Introduction
Symptomatology
Clinical Features
Retinal Break
Traction–related tears
Other Features
Evaluation
Identifying the Retinal Break
Rules
Diagnosis
Differential Diagnosis
Management
Common Method of Retinal Reattachment
Scleral Buckling
Localization of the Retinal Break
The Buckle
Subretinal Fluid Drainage
Complications of Scleral Buckling
Early Postoperative Complications
Late Postoperative Complications
ALTERNATE METHODS OF RETINAL REATTACHMENT
Pneumatic Retinopexy
Principle
Indications
Contraindications
Surgical Technique
Follow-Up
Complications
Balloon Buckle
Absorbable Buckling Materials
Primary Vitrectomy for Rhegmatogenous Retinal Detachment
Revision Surgery
Approach to Management of Recurrent/Persistent Retinal Detachment
RESULTS OF SCLERAL BUCKLING AND PNEUMATIC RETINOPEXY
Scleral Buckling
Anatomical Results
Visual Results
Pneumatic Retinopexy
PROLIFERATIVE VITREORETINOPATHY
Definition
Classification
Pathogenesis
Information from Clinical Studies
Information from Basic Studies
Pathology
Management
Surgical Management of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy
Do All the Cases of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy Need Vitrectomy?
When to Operate in an Eye with Proliferative Vitreoretinopathy?
Role of Buckle along with Vitrectomy
Role of Lens Sacrifice
Advantages of Lens Removal
Disadvantages of Lens Removal
Procedure of Lens Removal
Role of Intraocular Lens Sacrifice
Extent of Vitrectomy
Membrane Peeling Techniques
Subretinal Band Removal
Role of Retinotomies and Retinectomies
Retinal Reattachment
Uses of Perfluorocarbon Liquids
Retinopexy
Choice of Tamponade
Silicone Oil Removal
Results
RECENT INNOVATIONS IN THE MANAGEMENT OF PROLIFERATIVE VITREORETINOPATHY
Endoscopic Surgery
Erbium:YAG Laser Vitrectomy
Pharmacological Modulation
GIANT RETINAL TEAR
Introduction
Etiology
Clinical Presentation
Variables
Management
Technique of Scleral Buckling
Vitreoretinal Surgery
Management of Inverted Flap
Present Technique Choice of visualization system
Surgical Technique
Lens Management
Intraocular Lens Management
Management of Edge of Tear
Management of the Anterior Flap
Management of Proliferative Vitreoretinopathy
Role of Perfluorocarbon Liquids
Retinal Reattachment
Technique of Air Fluid/Air Perfluorocarbon Liquid and Silicone Oil Fluid/Silicone Oil Perfluorocarbon Liquid Exchange
Retinopexy
Role of Peripheral Buckle
Iridectomy
Postoperative Positioning
Recurrent Retinal Detachment
Silicone Oil Removal
Fellow Eyes with Giant Retinal Tear
MANAGEMENT OF DISLOCATED LENS AND INTRAOCULAR LENS
Introduction
Clinical Scenario
Dislocated Crystalline Lens
Clinical evaluation
Management options
Dislocated Nucleus/Lens Fragments/Cortex
Subsequent management
Surgical management
Dislocated Intraocular Lens
Management
ENDOPHTHALMITIS
Introduction
Clinical Presentation
Postoperative Endophthalmitis
Endogenous Endophthalmitis
Traumatic Endophthalmitis
Bleb-Related Endophthalmitis
Corneal Involvement with Endophthalmitis
Panophthalmitis
Ultrasonographic Features of Endophthalmitis
Management
Diagnosis
Microbiological Investigations
Specimens for processing
Collection of specimens
Processing of the specimens
Interpretation
Medical Therapy
Route of administration
Choice of antibiotics
Vitrectomy
Indication for Vitrectomy
Surgical Procedure
Management of the Intraocular Lens
Procedure for the Removal of Intraocular Lens
Management in the Presence of Corneal Involvement
Cases with Retinal Detachment on Ultrasonography
Second Intervention
Complications
Prognosis
Routine Antiseptic Measures that can Reduce the Occurrence of Postoperative Infections
Intravitreal Drug Dosage and Formulation
Important Messages from the Endophthalmitis Vitrectomy Study
RETINOPATHY OF PREMATURITY
Introduction
Etiopathogenesis
International Classification of Retinopathy of Prematurity
Stages
Stage 1: Demarcation Line
Stage 2: Ridge Formation
Stage 3: Extra Retinal Proliferation
Stage 4: Partial Retinal Detachment
Stage 5: Total Retinal Detachment
Examination Protocol
Examination Procedure
Treatment
Treatment of Threshold Disease
Technique of Laser Therapy
Technique of Cryotherapy
Effect of the Treatment
Sequelae of Regressed Retinopathy of Prematurity
Treatment of Retinal Detachment
Scleral Buckling
Vitreoretinal Surgery
Results
SURGERY FOR THE COMPLICATIONS OF DIABETIC RETINOPATHY
Introduction
Pathology
Configurations
The Concept of Vitreoschisis and Second Membrane
Tractional Retinoschisis
Other Factors
Surgical Management
Indications for Vitrectomy
Contraindications
Surgical Procedure
Intraoperative Complications
Postoperative Complications
Results
SURGICAL TREATMENT OF VEIN OCCLUSIONS
Introduction
Central Retinal Vein Occlusion
Radial Optic Neurotomy
Branch Retinal Vein Occlusion
Sheathotomy
SURGICAL TREATMENT OF INTRAOCULAR FOREIGN BODY
Introduction
Clinical Picture
Evaluation
Ultrasonography
Radiology
Management
Decision Regarding the Removal of the Intraocular Foreign Body
Decision Regarding the Timing of Surgery
Decision Regarding the Approach to Remove the Intraocular Foreign Body
Surgical Procedure
Initial Steps
Management of the Lens
Vitrectomy
Role of Encircling Band
Difficulties
Results
CHAPTER 31:
Macular Surgeries
EPIRETINAL MEMBRANE
Etiopathogenesis
Clinical Features
Surgical Case Selection
Surgical Technique
Dye-Assisted Epiretinal Membrane Removal Surgery
Complications
Role of Optical Coherence Tomography
VITREOMACULAR TRACTION SYNDROME
Etiopathogenesis
Clinical Features
Surgical Case Selection
Surgical Technique
Complications
Role of Optical Coherence Tomography
IDIOPATHIC MACULAR HOLE
Etiopathogenesis
Clinical Features
Surgical Case Selection
Surgical Technique
Internal Limiting Membrane Peeling
Surgical Technique
Internal Limiting Membrane Peeling
Indocyanine Green-Assisted Internal Limiting Membrane Peeling
Internal limiting membrane peeling can be done as follows:
Infracyanine Green-Assisted Internal Limiting Membrane Peeling
Trypan Blue-Assisted Internal Limiting Membrane Peeling
Triamcinolone-Assisted Vitrectomy
Tamponade
Complications
Miscellaneous
Role of Optical Coherence Tomography
SUBMACULAR SURGERY
Subfoveal Choroidal Neovascularization
Management
Case Selection
Surgical Technique
Complications
SUBMACULAR HEMORRHAGE
Mechanism of Retinal Injury
Management
Case Selection
Observation
Vitrectomy With Mechanical Clot Extraction, Without Tissue Plasminogen Activator (tPA)
Vitrectomy With Clot Removal Following Subretinal Tissue Plasminogen Activator Injection
Pneumatic Displacement With or Without Tissue Plasminogen Activator
Vitrectomy, Subretinal Injection of tPA and Fluid-Gas Exchange
Special Considerations
Complications
VITRECTOMY FOR DIABETIC MACULAR EDEMA
Clinical Characteristics
Rationale
Surgical Technique
Complications
Role of Optical Coherence Tomography
MACULAR TRANSLOCATION
Rationale
Macular Translocation with 360-Degree Retinotomy
Limited Macular Translocation
Complications
MYOPIC FOVEOSCHISIS
Surgical Technique
Role of Optical Coherence Tomography
EPIRETINAL MEMBRANE REMOVAL
TRIAMCINOLONE-ASSISTED EPIRETINAL MEMBRANE REMOVAL
POSTERIOR HYALOID REMOVAL USING TRIAMCINOLONE ACETONIDE
MACULAR HOLE SURGERY
CHAPTER 32:
Hereditary Vitreoretinal Diseases
INTRODUCTION
NERVE FIBER LAYER
X-Linked Retinoschisis
Introduction
Clinical Presentation
Investigations
Treatment
PHOTORECEPTOR LAYER
Retinitis Pigmentosa
Introduction
Clinical Presentation
Investigations
Treatment
Atypical Forms of Retinitis Pigmentosa
Central Retinitis Pigmentosa
Retinitis Punctata Albescence
Retinitis Pigmentosa with Coats' Response
Pigmented Para Venous Chorioretinal Atrophy
Ocular Associations of Retinitis Pigmentosa
Systemic Associations of Retinitis Pigmentosa
Leber's Congenital Amaurosis
Other Genetic Disorders Associated With Night Blindness
Congenital Stationary Night Blindness
Progressive Cone Dystrophy
Introduction
Clinical Presentation
Investigations
Cone Rod Dystrophy
Introduction
Clinical Presentation
Investigations
RETINAL PIGMENT EPITHELIUM
Stargardt's Dystrophy
Introduction
Clinical Presentation
Investigations
Fundus Flavimaculatus
Introduction
Clinical Presentation
Investigations
Benign Fleck Retina Syndrome
Best's Disease or Vitelliform Dystrophy
Introduction
Clinical Presentation
Investigations
Pattern Dystrophy
Introduction
Clinical Presentation
Investigations
Dominant Cystoid Macular Dystrophy
Introduction
Clinical Presentation
Investigations
Dominant Drusen
Introduction
Clinical Presentation
Investigations
BRUCH'S MEMBRANE
Sorsby Pseudoinflammatory Dystrophy
Introduction
Clinical Presentation
Investigations
Angioid Streaks
Introduction
Clinical Presentation
Investigations
CHOROID
Central Areolar Choroidal Dystrophy
Introduction
Clinical Presentation
Investigations
Bietti's Crystalline Retinopathy
Introduction
Clinical Presentation
Investigations
Choroideremia
Introduction
Clinical Presentation
Investigations
Gyrate Atrophy
Introduction
Clinical Presentation
Investigations
Ocular Albinism
Introduction
Clinical Presentation
HEREDITARY VITREORETINOPATHIES
Goldmann-Favre's Vitreoretinal Degeneration
Clinical Presentation
Investigations
Stickler's Syndrome
Clinical Presentation
Investigations
Wagner Syndrome
Clinical Presentation
Investigations
Familial Exudative Vitreoretinopathy
Clinical Presentation
DRUG TOXICITIES
Chloroquine Toxicity
Introduction
Clinical Presentation
Hydroxychloroquine Toxicity
Introduction
Clinical Presentation
Investigations
Desferrioxamine Toxicity
CHAPTER 33:
Ocular Oncology
INTRODUCTION
RETINOBLASTOMA
Introduction
Incidence
Genetics
Hereditary Cases
Nonhereditary Cases
Chromosome 13q14 Deletions and Esterase D
Age at Diagnosis
Clinical Features
Endophytic Tumors
Exophytic Tumors
Mixed Tumors
Differential Diagnosis
Evaluation of a Case of Retinoblastoma
Ancillary Tests
Ultrasonography
Computed Tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Metastatic Work-up
Examination of Parents and Siblings
Pathogenesis
Histopathology
Management
Enucleation
Cryotherapy
Photocoagulation
External Beam Radiotherapy
Brachytherapy
Chemoreduction
Transpupillary Thermotherapy
Thermochemotherapy
Prognosis
Clinical Staging Systems in Retinoblastoma
Second Tumors in Retinoblastoma
Trilateral Retinoblastoma
Follow-up
RETINOCYTOMA OR RETINOMA
Introduction
UVEAL MELANOMA
Introduction
Melanoma of Iris
Diagnosis
Management
Ciliary Body and Choroidal Melanomas
Ciliary Body Melanoma
Clinical Features
Differential Diagnosis of Ciliary Body Melanomas
Choroidal Melanoma
Differential Diagnosis
Pathophysiology and Prognosis of Uveal Melanoma
Diagnosis
Ultrasonography
Management
Treatment Modalities
Periodic Observation
Enucleation
Local Resection
Indications
Internal Resection
Photocoagulation
Photodynamic Therapy
Radiotherapy
External Beam Radiotherapy
External Beam Particle Radiotherapy
Brachytherapy
Transpupillary Thermotherapy
VASCULAR TUMORS OF CHOROID
Introduction
Choroidal Hemangioma
Circumscribed Choroidal Hemangioma
Clinical Features
Diagnosis
Pathology
Differential Diagnosis
Management
Diffuse Choroidal Hemangioma
Clinical Features
Diagnosis
Pathology
Management
VASCULAR TUMORS OF RETINA
Introduction
Capillary Hemangioma of the Retina
Ocular Features
Differential Diagnosis
Pathology
Diagnosis
Management
Systemic Features
Cavernous Hemangioma of the Retina
Ocular Features
Racemose Hemangioma
Vasoproliferative Tumor of the Retina
OCULAR METASTASIS
Introduction
Investigations
Fluorescein Angiography
Ultrasonography
Fine Needle Aspiration Biopsy
Differential Diagnosis
Management
PRIMARY INTRAOCULAR LYMPHOMA
Introduction
Differential Diagnosis
Management
INTRAOCULAR LEUKEMIA
Introduction
CHOROIDAL OSTEOMA
Introduction
Diagnosis
Differential Diagnosis
Management
MEDULLOEPITHELIOMA
Introduction
Investigations
Differential Diagnosis
Management
RETINAL ASTROCYTOMA
Introduction
Systemic Associations
Ancillary Tests
Ultrasonography
Fluorescein Angiography
Management
SECTION 6: DISEASES OF OPTIC NERVE
CHAPTER 34:
Optic Nerve Disorders
INTRODUCTION
DIAGNOSIS OF OPTIC NERVE DISORDERS
OPTIC NEURITIS
Clinical Symptoms
Clinical Signs
Differential Diagnoses
Prognosis
Conversion to Multiple Sclerosis
Treatment
Optic Neuritis in Children
Neuroretinitis
Infectious and Parainfectious Optic Neuritis
Postvaccination Optic Neuritis
Inflammatory Optic Neuritis
NEUROMYELITIS OPTICA (DEVIC'S DISEASE)
Clinical Features
Diagnosis
Treatment
PAPILLEDEMA
Pathogenesis
Symptoms and Signs
Ophthalmoscopic Appearance of Papilledema
Diagnosis
Treatment
ISCHEMIC OPTIC NEUROPATHY
Clinical Features
Management
Medical
Surgical
OPTIC ATROPHY
LEBER'S HEREDITARY OPTIC NEUROPATHY
RADIATION OPTIC NEUROPATHY
TOXIC OPTIC NEUROPATHY
COMPRESSIVE OPTIC NEUROPATHY
DRUG-INDUCED TOXICITY
TRAUMATIC OPTIC NEUROPATHY
UNCOMMON AND MISCELLANEOUS OPTIC NEUROPATHIES
Papillophlebitis
Partial Central Vein Occlusion
Diabetic Papillopathy
Parasitic Infestation of the Optic Nerve
Thyroid-Related Optic Neuropathy
Sarcoid Optic Neuropathy
Shock Optic Neuropathy
CONGENITAL ANOMALIES OF THE OPTIC DISC
Optic Disc Pit
SECTION 7: DISEASES OF LID, ORBIT AND LACRIMAL SYSTEM
CHAPTER 35:
Orbital Imaging
INTRODUCTION
B-SCAN ULTRASONOGRAPHY
CT SCAN
MAGNETIC RESONANCE IMAGING (MRI)
CHAPTER 36:
Diseases of the Eyelid and Orbit
PTOSIS
Evaluation of Ptosis
Management of Ptosis
TUMORS OF THE EYELID
Sebaceous Carcinoma
Incidence
Clinical Presentation
Management
Histopathology
Prognosis
Conclusion
Squamous Cell Carcinoma
Basal Cell Carcinoma
Clinical Appearance and Histopathology
Management
Micrographic (Mohs) Surgery
Excision with Frozen Section or Permanent Section Control
Radiotherapy and Electron Beam Therapy
Chemotherapy
Cryotherapy
Photodynamic Therapy
Carbon-dioxide Laser Treatment
PROPTOSIS
Classification of Proptosis
Evaluation of a Case of Proptosis
Diagnosis
ORBITAL CELLULITIS
Bacterial Infection
Fungal Infection
Parasitic Infection
CYSTS
Dermoid and Epidermoid Cysts
Teratomas
Meningoencephalocele
Microphthalmos with Cyst and Congenital Cystic Eye
Mucocele
CYSTS OF THE OPTIC NERVE SHEATH
Dacryocele
Hematic Cysts
Simple Cysts
VASCULAR LESIONS
Capillary Hemangioma
Lymphangioma
Cavernous Hemangioma
Carotid-Cavernous Fistula
Orbital Varix
NERVE SHEATH TUMORS
Neurofibroma
Schwannoma (Neurilemmoma)
LACRIMAL GLAND LESIONS
Epithelial Cyst (Dacryops)
Pleomorphic Adenoma
Primary Carcinoma
METASTASES
CHAPTER 37:
Diseases of Lacrimal Drainage System
INTRODUCTION
CONGENITAL ANOMALIES
CONGENITAL DACRYOCYSTITIS
Causes
Management
Medical
Surgical
CANALICULITIS
Introduction
Clinical Features
Causes
Treatment
INFLAMMATORY DISORDERS OF THE LACRIMAL SYSTEM
Acute Dacryocystitis
Clinical Features
Causes
Investigations
Complications
Treatment
Chronic Dacryocystitis
Introduction
Pathophysiology
Causes
Clinical Features
Imaging Studies
Other Tests
Histologic Findings
Management
LACRIMAL SAC TUMORS
CHAPTER 38:
Eyelid and Lacrimal Surgeries
INTRODUCTION
EYELID SURGERY
Ptosis Surgery
Timing of Ptosis Surgery
Choice of Surgery for Congenital Ptosis
Choice of Surgery for Acquired Ptosis
Surgical Techniques for Ptosis Correction
Fasanella-Servat Procedure
Levator Resection
Tarsofrontal Sling
Complications
EYELID RECONSTRUCTION
Anterior Lamellar Defects
Healing by Granulation
Primary Closure
Free Skin Graft
Myocutaneous Flaps
Full Thickness Eyelid Defects
Small Defects (Pentagon Excision)
Moderate Defects (Tenzel's Semicircular Flap)
Large Defects (Cutler-Beard Procedure)
Stage I
stage II
Complications
ECTROPION
Choice of Surgery
Surgical Techniques
Full Thickness Skin Grafting
Lateral Tarsal Strip Procedure
Kuhnt-Szymanowski Procedure
Complications
ENTROPION
Congenital Entropion
Involutional Entropion
Cicatricial Entropion
Complications
LACRIMAL SURGERY
Congenital Lacrimal Disorders
Abnormalities of the Puncta and Canaliculi (Upper System Block)
Abnormalities of the Lacrimal Sac
Congenital Lacrimal Fistulas
Congenital Dacryocystocele (Amniotocele)
Neonatal Acute Dacryocystitis (Lacrimal Abscess)
Congenital Lacrimal Disorders in Craniofacial Anomalies
Congenital Nasolacrimal Duct Obstruction
Acquired Lacrimal Disorders
Puncta and Canalicular Stenosis
Nasolacrimal Duct Stenosis
CHAPTER 39:
Periorbital Rejuvenation
INTRODUCTION
BOTULINUM TOXIN
Pharmacology
Toxin Reconstitution
Treatment of Dynamic Facial Wrinkles
Glabellar Frown Lines
Horizontal Forehead Wrinkles
Periocular Crow's Feet
Lower Eyelid Injection
Chemical Brow Lift
Soft Tissue Fillers
Hyaluronic Acid Fillers (Restylane)
Glabellar Furrows
Crow's Feet
Brow Injection
Periorbital Hollows
Complications
CHAPTER 40:
Orbital Surgeries
INTRODUCTION
ORBITAL BIOPSY
OPERATIVE PRINCIPLES
Bloodless Field
Adequate Exposure and Visualization
Proper Instrumentation
Atraumatic Tissue Manipulation
Types of Orbitotomy
Anterior Orbitotomy
Lateral Orbitotomy
Superior Orbitotomy
SURGICAL TECHNIQUE
Approach to the Anterior Orbit (Anterior Orbitotomy Techniques)
Transseptal Approach
Extraperiosteal Approach
Transconjunctival Approach
Approach to the Deep Medial Orbit
Vertical Upper Eyelid Split Anterior Orbitotomy
Transcaruncular Anterior Orbitotomy
Transcutaneous Frontoethmoidal Anterior Orbitotomy (Lynch Incision)
Approach to the Deep Lateral Orbit(Lateral Orbitotomy)
Approach to the Orbital Apex(Transcranial Orbitotomy)
Combined Approach
Lateral and Medial Orbitotomy
Orbital Decompression for Thyroid Orbitopathy
COMPLICATIONS
SECTION 8: STRABISMUS
CHAPTER 41:
Strabismus
AMBLYOPIA
Types of Amblyopia
Strabismic Amblyopia
Anisometropic Amblyopia
Stimulus Deprivation Amblyopia
Isoametropic (Refractive) Amblyopia
Meridional Amblyopia
Idiopathic Amblyopia
Pathomechanism of Amblyopia
Clinical Characteristics
Diagnosis of Amblyopia
Treatment
Occlusion Therapy
Type of Occluder
Follow-up
When to Stop Full-time Occlusion?
How to Maintain the Improved Vision?
Penalization
Pleoptics
CAM Vision Stimulator
Pharmacological Agents
Role of Patient Compliance
Prognosis
STRABISMUS IN CHILDHOOD
Convergent Squint in a Child
Infantile Esotropia
Accommodative Esotropia
Refractive Accommodative Esotropia
Nonrefractive Accommodative Esotropia
Partially Accommodative Esotropia
Acquired Nonaccommodative or Basic Esotropia
Other Conditions Which May Be Present with Esotropia
Clinical Evaluation
Treatment
Correction of the Refractive Error
Role of Surgery
Divergent Squint in a Child
Infantile Exotropia
Intermittent Exotropia
Clinical Evaluation
Occlusion Test
Lateral Incomitance
Vertical Deviation
Sensory Adaptations
Refractive Errors
Treatment
Surgical Treatment
Indications for Surgery
Choice of Surgical Procedure
Where to Overcorrect?
Where to Undercorrect ?
Results of Surgery
Factors Affecting Surgical Results
ADULT STRABISMUS
Special Points in Clinical Presentation
Asthenopia
Symptomatic Alternation
Special Points in Assessing Adults with Strabismus
Surgery for Adult Strabismus
Restoration of Binocular Fusion and Elimination of Diplopia
Expansion of Binocular Visual Fields in Patients with Esotropia
Improvement in Psychosocial Functioning
Postoperative Diplopia in Adult Strabismus
Surgical Overcorrection for Intermittent Exotropia in Adults
Stability of Strabismus Surgery in Adults
Central Fusion Disruption
BOTULINUM TOXIN IN THE MANAGEMENT OF STRABISMUS
Mechanism of Action
Preparation of Type A Toxin
Technique of Injection
Onset and Duration of Action of Botulinum Toxin
Side Effects
Uses of Botulinum Toxin in Squint Management
Sixth Nerve Palsy
Adult Strabismus
Childhood Strabismus
Nystagmus
Current Status of Botulinum Toxin in Strabismus Management
CHAPTER 42:
Surgical Treatment of Strabismus
AIMS OF STRABISMUS SURGERY
Indications for Surgery
Patient Evaluation
ANATOMICAL CONSIDERATIONS
Extraocular Muscles
Fascial Coverings
Tenon's Capsule
Intermuscular Septum
Muscle Capsule
Check Ligaments
The Orbital Fat
Capsulopalpebral Fascia and Ligament of Lockwood
SURGICAL TECHNIQUES
Anesthesia
Exposure of the Muscle
Recti
Inferior Oblique (Figs 42.9A to H)
Superior Oblique
SURGICAL PROCEDURES
Weakening Operations
Recession
Marginal Myotomy
Tenotomy or Myectomy
Posterior Fixation Suture (Faden Operation)
Botulinum Toxin to Weaken the Action of a Muscle
Strengthening Operations
Resection Operation
Combined Weakening-Strengthening Operations
Adjustable Sutures
Operations to Modify the Action of an Extraocular Muscle (Muscle Transposition Operations)
Paralytic Strabismus
Correction of A/V Patterns
Anteroplacement of Obliques
Use of Plastic Materials
AMOUNT OF OPERATION
Horizontal Deviations
Cyclovertical Deviations
PARALYTIC SQUINT
SPECIAL FORMS OF STRABISMUS
Suturing the Muscle to the Sclera
Closure of the Wound
POSTOPERATIVE CARE
COMPLICATIONS
Preoperative
Postoperative
RESULTS
SECTION 9: TRAUMA
CHAPTER 43:
Ocular Trauma
INTRODUCTION
EVALUATION AND INITIAL MANAGEMENT
OCULAR TRAUMA CLASSIFICATION SYSTEM
Type of Injury
Grade of Injury
Relative Afferent Pupillary Defect
Zone of Injury
Zone I
Zone II
Zone III
Ancillary Testing
Electrophysiological Tests
X-ray
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
ANTERIOR SEGMENT TRAUMA
Conjunctival Injury
Blunt Trauma
Foreign Body
Laceration
Corneal Injury (Closed Globe Injury)
Contusion
Foreign Body
Abrasion
Corneoscleral Tears
Subconjunctival Hemorrhage
Suturing Technique
Stellated Corneal Lacerations
Scleral Tear Repair
Hyphema
Surgical Procedure
Angle Recession Glaucoma
Traumatic Cataract
Postoperative Management
CLOSED GLOBE POSTERIOR SEGMENT TRAUMA
Mechanism of Contusion
Traumatic Maculopathies
Commotio Retinae
Purtscher's Retinopathy
Choroidal Rupture
Retinitis Sclopetaria
Traumatic Macular Hole
Traumatic Retinal Tears and Detachment
Traumatic Endophthalmitis
Open Globe Posterior Segment Trauma
Vitrectomy and Penetrating Injury
Timing of Vitrectomy
Indications
Basic Steps
Special Situations in Vitrectomy
Retinal Incarceration
Subretinal Hemorrhage
Suprachoroidal Hemorrhage
Perforating (Double Penetrating Injury)
Intraocular Foreign Body
Siderosis
Chalcosis
Management of Dislocated Crystalline Lens
Post traumatic Posterior Dislocation of Posterior Chamber Intraocular Lens
MANAGEMENT OF RETAINED INTRAOCULAR FOREIGN BODY
Diagnosis and Localization
Surgical Technique
Magnetic Extraction
Vitrectomy
Chemical Injuries of the Eye: Alkali and Acid Burns
Alkali Burns
Acid Burns
Clinical Course and Evaluation
SECTION 10: PRACTICE MANAGEMENT
CHAPTER 44:
Ophthalmology Practice Management
SETTING SPECIFIC GOALS FOR SUCCESS
Making Resolutions
Focus on Your Goal
Determine Where You Are and Compare
Involve Others
Successful Practice
Make Great Decisions
Make Collective Business Decisions
Strive Daily to Increase Profitability
Leave Your Options Open
Remain Diversified
Cultivate Better Relationships
Be Disciplined
Work Harder and Smarter
Seize Opportunity
Review Every Major Business Decision
Office Planning and Procedures
Strategic Practice Plan
Situation Analysis
Analysis of Your Practice's Strengths, Weaknesses, Opportunities and Threats
Mission Statement
Goal Setting
Tactical Planning
Implementation
Positioning the Practice
Emphasize Specific Characteristic of Your Practice
Make Your Message Unique
Make Your Message Relevant
Convey Convincing Message
Competitive Practice Analysis
Marketing
Smart Marketing Plan
Budgeting the Marketing Plan
Price Issue
Market Share
Patient Service
Patient Care
Improving Referrals
Benchmarking Ophthalmology Practice
Embracing Efficiency
Adopting New Technology
Computers in Medical Practice
Impact of Information Technology
Doing Business on the World Wide Web
INDEX
TOC
Index
×
Chapter Notes
Save
Clear
