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Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)
Ashok Garg, Jorge L Alio
SECTION 1: ANTERIOR SEGMENT
CHAPTER 1:
Congenital Lens Anomalies
LENTICONUS POSTERIOR
Key Facts
Clinical Findings
Ancillary Testing
Differential Diagnosis
Treatment
Prognosis
LENTIGLOBUS
Key Facts
Clinical Findings
Ancillary Testing
Differential Diagnosis
Treatment
Prognosis
LENS COLOBOMA
Key Facts
Clinical Findings
Ancillary Testing
Differential Diagnosis
Treatment
Prognosis
MITTENDORF DOT
Key Facts
Clinical Findings
Ancillary Testing
Differential Diagnosis
Treatment
Prognosis
CHAPTER 2:
Management of Congenital Cataract
INTRODUCTION
Pathophysiology
Mortality/Morbidity
Age
SYMPTOMS AND SIGNS
Symptoms
Signs
Etiology
Differential Diagnosis
Other Problems to be Considered
Other Differential Diagnosis
Lab Studies
Imaging Studies
Other Tests
Treatment
Medical Care
Surgical Care
FURTHER CONSIDERATION
COMPLICATIONS OF SURGICAL TREATMENT
PROGNOSIS
PATIENT EDUCATION
CHAPTER 3:
Congenital Cataract Surgery
INTRODUCTION
TREATMENT IN CONGENITAL CATARACT
IOL Power in Congenital Cataract
Surgical Technique
Postoperative Management
CHAPTER 4:
Techniques and Development in Pediatric Cataract Surgery Procedures
INTRODUCTION
SURGICAL TREATMENT
THE CATARACT PROCEDURE
Pupil Dilatation
Patient Preparation
Cataract Surgery, without Placement of an Intraocular Lens
Cataract Surgery with Lens Implantation
Patient Selection
Lens Style
Implantation of an Intraocular Lens
Surgical Technique of Congenital Lens Subluxation
SECONDARY IOL IMPLANTATION IN CHILDREN
Secondary Intraocular Lens, Placement without a Capsular Support
CHAPTER 5:
Pediatric Cataract Surgery: The Biaxial Approach
INTRODUCTION
CLINICAL FEATURES OF THE PEDIATRIC CATARACT, PREOPERATIVE EVALUATION AND SURGICAL INDICATIONS
Evaluation
Causes and Investigations
Surgical Indications
ADVANTAGES AND SURGICAL TECHNIQUE OF MICROBIAXIAL TECHNOLOGY FOR REMOVAL OF PEDIATRIC CATARACTS
Anesthesia
Incisions
Anterior Capsule Management
Nuclear and Cortical Particles Removal; Mastering the Fluidics Management and Anterior Chamber Stability
Posterior Capsule Management
Microbiaxial Anterior Vitrectomy
CONCLUSION
CHAPTER 6:
Simultaneous Bilateral Surgery for Pediatric Cataract
CHAPTER 7:
Management of the IOL Power Calculation when Performing Pediatric Cataract Surgery
INTRODUCTION
ANATOMY OF THE CHILD'S EYE
CATARACT SURGERY WITH LENS IMPLANTATION
Patient Selection
Lens Style and Power
Lens Power
SECONDARY IOL IMPLANTATION IN CHILDREN
Secondary Intraocular Lens, Placement without Capsular Support
FOLLOW-UP CARE
CONCLUSION
CHAPTER 8:
Cataracta Juvenilis and Congenital Lens Subluxation Surgical Procedures
INTRODUCTION
THE CATARACT PROCEDURE
CATARACT SURGERY, WITHOUT PLACEMENT OF AN INTRAOCULAR LENS
CATARACT SURGERY WITH LENS IMPLANTATION
IMPLANTATION OF AN INTRAOCULAR LENS
SURGICAL TECHNIQUE OF CONGENITAL LENS SUBLUXATION
CONCLUSION
CHAPTER 9:
Bimanual Microcataract Surgery in Children
INTRODUCTION
HISTORY
History of Bimanual Phaco
Bimanual Microphacoemulsification Technique
ANESTHESIA
Paracentesis11(Fig. 3)
Dye of the Capsule12–14 (Fig. 4)
Viscous
Capsulorhexis15
Hydrodelineation-hydrodissection
Phacoemulsification of the Nucleus (Fig. 7)
Epinucleus Removal if Exist
Irrigation/Aspiration—the Cortex
Lens
CONCLUSION
CHAPTER 10:
Management of Infantile Cataract Using Removable Piggyback IOLs
BIOMETRY
IOL FORMULAS
THE GROWTH OF THE EYE
EXTENDING THE REFRACTIVE GROWTH MODEL TO EARLY INFANCY
PRACTICAL CONSIDERATIONS IN IOL POWER CHOICE
What are the Options?
Two Surgical Approaches
Which Lens?
Advantages
Disadvantages
The Answer
Material of the Hema Domed Implant
Hema Intraocular Domed IOL
Specification of the Domed IOL
Criteria for Selection of IOL
Criteria for Removal of IOL
Anesthesia Requirements
PERIOPERATIVE ROUTINE AND SELECTION OF ANESTHETIC AGENTS
OCULOCARDIAC REFLEX
Surgical Technique
Criteria for Selection of IOL
Criteria for Removal of IOL
CHAPTER 11:
Surgical Management of Traumatic Cataract in Children
EPIDEMIOLOGY
PATHOPHYSIOLOGY
PREOPERATIVE EVALUATION
EXAMINATION
Before Dilation
After Dilation
TIMING OF SURGERY
SURGICAL DETAILS
POSTOPERATIVE MEDICATION
POSTOPERATIVE COMPLICATIONS
VISUAL OUTCOME
SUMMARY
CHAPTER 12:
Pediatric Aphakia Treatment
INTRODUCTION
CLINICAL FINDINGS
INVESTIGATION
DIFFERENTIAL DIAGNOSIS
TREATMENT
PROGNOSIS
Monocular Aphakia
Binocular Aphakia
CHAPTER 13:
Tips and Pearls for Achieving the Optical Results when Managing Cataract in a Child
INTRODUCTION
DIAGNOSIS OF CATARACTS IN CHILDREN
Inheritance
CLASSIFICATION OF CATARACTS
Laterality
Age of Onset
The Extent and Location of Cataract
Cataract Size and Density
Progression
Evaluation of the Child
Associated Ocular Defects
Nonsurgical Treatment
SURGICAL TREATMENT
Congenital Cataracts
OPTICAL REHABILITATION
THE CORRECTION AFTER CATARACT PROCEDURE
Contact Lense Correction for Aphakic and Pseudophakic Eyes
Optical Supply of an Aphakic Eye
Soft Contact Lenses versus Rigid Contact Lenses
FOLLOW-UP CARE
CONCLUSION
CHAPTER 14:
Posterior Capsule Management in Pediatric Cataract Surgery
TECHNIQUE
CHAPTER 15:
Management of Persistent Pupillary Membrane
ASSOCIATED ANOMALIES
CLINICAL FEATURES
Symptoms
Signs
CAUSES OF Persistent pupillary Membrane
CLASSIFICATION OF PERSISTENT PUPILLARY MEMBRANE
DEVELOPMENT AND REGRESSION OF PUPILLARY MEMBRANE
STRUCTURE OF PERSISTENT PUPILLARY MEMBRANE6
TREATMENT
Conservative Management
Indications for Removal of Persistent Pupillary Membrane
Laser Management
Indications
Advantages of Laser Treatment
Complications of Laser Treatment
Contraindications to Laser Treatment
Laser Technique
Surgical Treatment
Indications
Complications of Removal
DIFFERENT SURGICAL TECHNIQUES
Technique Described by Tsai et al (Fig. 8)14
Advantages of this Technique
Precautions to be Taken During Surgery
Surgery with Vitreous Scissors
Advantages of this Technique
One More Variant of the Surgical Technique for Removing a Unilateral Persistent Pupillary Membrane in a 3 year-old-girl (Figs 11A to K)
CHAPTER 16:
Cataract Surgery in Complex Situations
IRIS DISORDERS
Congenital Iris Anomalies
CAPSULOZONULAR AFFECTIONS
CHAPTER 17:
Toric Bag-in-the-Lens (BIL) Implantation: Why and How to Implant?
INTRODUCTION
CHAPTER 18:
Refractive Surgery in Children: When and How?—An Overview
INTRODUCTION
REFRACTIVE SURGERy IN CHILDREN—WHEN?
Anisometropia
Accommodative Esotropia
REFRACTIVE SURGERY IN CHILDREN—HOW?
Corneal Refractive Surgery
Literature Review
Comments and Personal Experience
Phakic IOLs
Literature Review
Comments and Personal Experience
CONCLUSION
CHAPTER 19:
An Update on Multifocal IOLs in Children
PEDIATRIC CATARACT SURGERY
Can Children and Infants Manage Multifocality?
Multifocal IOL's in Children
PERIOPERATIVE ROUTINE AND SELECTION OF ANESTHETIC AGENTS
OCULOCARDIAC REFLEX
Surgical Technique
Posterior Rhexis and Vitrectomy
Statistics
CHAPTER 20:
Pediatric and Adolescent Refractive Surgery—An Update
INTRODUCTION
Clinical Signs and Symptoms
Conventional Treatment for Anisometropia
Investigations
Excimer Laser Refractive Surgery
Refractive Surgery in Children
Our Personal Experience
Discussion
CHAPTER 21:
Evaluation of Childhood Glaucomas
BASIC PRINCIPLES FOR MANAGEMENT OF GLAUCOMA IN CHILDREN
DIAGNOSING A CASE OF PEDIATRIC GLAUCOMA
Symptoms
Signs
EXAMINATION UNDER ANESTHESIA (EUA)
WHAT NEEDS TO TESTED WHEN A CHILD IS UNDER ANESTHESIA?
EQUIPMENT REQUIRED IN EUA
STEPS TO CONDUCT AN EUA
CHAPTER 22:
Management of Congenital Glaucoma
DEFINITION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
INVESTIGATIONS
SIGNS AND SYMPTOMS
DIAGNOSIS
MEDICAL AND SURGICAL TREATMENTS
GONIOTOMY
Trabeculotomy
TRABECULECTOMY
GLAUCOMA VALVES
CYCLODESTRUCTIVE PROCEDURES
MEDICAL TREATMENT
PROGNOSIS
CHAPTER 23:
Aniridia Rings: Surgery for Advanced Congenital Glaucoma
CHAPTER 24:
Surgical Management of Congenital and Developmental Glaucoma
SURGICAL MANAGEMENT
Trabeculectomy
Deep Sclerectomy
Aqueous Shunt Implantation
Goniotomy versus Trabeculotomy
Goniotomy
Trabeculotomy
CHAPTER 25:
Pediatric Glaucoma
INTRODUCTION
CLINICAL PRESENTATION
Primary Congenital Glaucoma (PCG) and Primary Infantile Glaucoma (PIG)
Secondary Developmental Glaucomas and Secondary Pediatric Glaucomas
DIFFERENTIAL DIAGNOSIS
Epiphora
Corneal Edema or Opacification
Enlarged Cornea
Enlarged Optic Nerve Cupping
MANAGEMENT
General
Surgical Intervention Options
Medical Treatment Options
Follow-up
PROGNOSIS
CHAPTER 26:
Surgical Management of Primary Infantile Glaucoma
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
SURGICAL TREATMENT
Introduction
Preoperative Management
Angle Surgery
Goniotomy
Trabeculotomy
Combined Trabeculotomy—Trabeculectomy
Trabeculectomy
Synthetic Drainage Implants
Cyclodestructive Procedures
Cyclocryotherapy
Transscleral Cyclophotocoagulation
Neodymium:YAG Lasers
Semiconductor Diode Lasers
LONG-TERM FOLLOW-UP
PROGNOSTIC FACTORS
CHAPTER 27:
Nonperforated Transcameral Deep Sclerotomy—Surgical Procedure with a Fast Rehabilitation for Glaucoma Juvenilis
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
HIGH-FREQUENCY DIATHERMIC PROBE
SURGICAL PROCEDURE
EVALUATION OF THE RESULTS
Results
Discussion
CHAPTER 28:
Glaucoma Implants in the Treatment of Pediatric Glaucoma
INTRODUCTION
CHOICE OF IMPLANT
OPERATION TECHNIQUE OF BAERVELDT IMPLANT
COMPLICATIONS
CONCLUSION
CHAPTER 29:
Managing Aphakic Glaucoma in Children with AGV Valves
SURGICAL PROCEDURE
SURGICAL TECHNIQUE INVOLVED
Results
DISCUSSION
CONCLUSION
CHAPTER 30:
Anterior Segment Lymphaticsand Glaucoma Surgery
IMPORTANCE OF CONJUNCTIVAL LYMPHATICS IN GLAUCOMA SURGERY
MINIMALLY INVASIVE TECHNIQUESTO PROTECT LYMPHATICS
SINGH MICROTRACK FILTRATION
SINGH TRANSCONJUNCTIVAL TRANSCILIARY FILTRATION
BLEBS AFTER LYMPHOPROTECTIVESURGERY
FUTURE OF GLAUCOMA SURGERY
CHAPTER 31:
Surgical Muscle Anatomy
ANATOMY OF THE EXTRAOCULAR MUSCLES
RECTUS MUSCLES
Medial Rectus Muscle
Lateral Rectus Muscle
Superior Rectus Muscle
Inferior Rectus Muscle
OBLIQUE MUSCLES
Superior Oblique Muscle
Inferior Oblique Muscle
VASCULARIZATION OF THE EXTRAOCULAR MUSCLES
INNERVATION OF EXTRAOCULAR MUSCLES
ORBIT: FACIAE, TENDONS AND SURROUNDING TISSUES
CHAPTER 32:
Diagnosis and Treatment of Amblyopia
INTRODUCTION
Concept and Terminology
History of Amblyopia
The Concept of Amblyopia
Critical Period
Epidemiological Aspects and Social Importance
Classification
Prognostic Classification32,33
Etiological Classification42
Semiological Classification32,33
Smith-Kettlewell Institute Classification94,95
Medical History
Exploration
Prognostic Factors
Treating Amblyopia and New Therapeutic Perspectives
Optical Correction
Occlusive Therapy
Penalizations
Other Forms of Treatment; Past and Future—New Therapeutic Perspectives
History of Amblyopia
CHAPTER 33:
Strengthening Procedures of Rectus Muscle
RECTUS MUSCLE RESECTION
Indications
Surgical Technique
ANTEPOSITION
Indications
Surgical Technique
MUSCLE-SCLERAL TUCK
Indications
Surgical Technique
CHAPTER 34:
Weakening Procedures of Rectus Muscle
RECTUS MUSCLES RECESSION
Indications
Surgical Technique
HANG-BACK TECHNIQUE OF RECESSION
Indications
Surgical Technique
ELONGATION OF THE MUSCLE
Indications
Surgical Technique
CHAPTER 35:
Management of Concomitant Strabismus
TYPES OF STRABISMUS
Pseudostrabismus
Heterophoria
Concomitant Strabismus
ESOTROPIA
Congenital Esotropia
Ocular Manifestation and Diagnosis
Differential Diagnosis
Treatment
Accommodative Esotropia
Ocular Manifestations and Diagnosis
Treatment
Cyclic Esotropia
EXOTROPIA
Congenital Exotropia
Intermittent Exotropia
Ocular Manifestations and Treatment
Treatment
OBLIQUE MUSCLE DYSFUNCTION
ALPHABET PATTERN STRABISMUS
Treatment
VERTICAL STRABISMUS FORMS
CONCOMITANT STRABISMUS MANAGEMENT
NONSURGICAL STRABISMUS MANAGEMENT
Correction of Refraction Errors
Amblyopia
Penalization Method
Pleoptics
Prisms
Orthoptics
Botulinum Toxin
SURGICAL MANAGEMENT
Preoperative Evaluation and Diagnostic Approach
How to Establish the Extend of Surgery?
Strabismus Surgery Techniques
Rectus Muscles
Rectus Muscle Recession
Rectus Muscles Resection
Horizontal Muscle Transpositions for Alphabet Pattern Strabismus
Posterior Fixation Suture
Inferior Oblique Muscle
Recession
Myectomy
Superior Oblique Muscle
Superior Oblique Tendon Plication
Superior Oblique Tenotomy
Complications
Outcomes
CHAPTER 36:
Superior Oblique Surgery—Indications, Approach and Management
WEAKENING PROCEDURES OF THE SUPERIOR OBLIQUE
Generalized Weakening
Tenotomy/Tenectomy (Fig. 1)
Disinsertion (Fig. 2)
Recession of the Superior Oblique
Loop Tenectomy
Translational Recession (Fig. 3)
Superior Oblique Tendon Expander (Fig. 4)
The ‘Chicken’ Suture (Fig. 5)
Z or L-Tenotomy (Fig. 6)
Selective Weakening
Posterior Tenectomy of Superior Oblique (PTSO) (Figs 7A and B)
Anterior Tenectomy of Superior Oblique
STRENGTHENING PROCEDURES FOR THE SUPERIOR OBLIQUE
Indications for Strengthening Superior Oblique
Sagittalization of the Superior Oblique (Harada-Ito Procedure)
Superior Oblique Tuck at the Insertion (Figs 8A to D)
Superior Oblique Resection and Advancement
Transposition of the Superior Oblique Tendon
COMPLICATIONS OF SUPERIOR OBLIQUE SURGERY
CHAPTER 37:
Management of Paralytic Squint
CLASSIFICATION OF PARALYTIC SQUINT
CLINICAL FEATURES OF PARALYTIC SQUINT
Investigations
Nonsurgical Management
Occlusion
Prisms
Botulinum Toxin
Surgical Management
THIRD NERVE PALSY
Complete III Nerve Palsy
LR Recession and MR Resection
Transposition of SO Oblique Tendon to MR
Anchoring of the Globe on Medial Wall Periosteum
Periosteal Fixation of Lateral Rectus Muscle
Partial/Isolated Muscle Paralysis
Medial Rectus Muscle Palsy
Horizontal Muscle Surgery
Transposition Surgery
Superior Rectus Muscle Palsy
Inferior Rectus Recession
Knapp's Procedure
Inferior Rectus Muscle Palsy
Inferior Oblique Muscle Palsy
Aberrant Regeneration
Fourth Nerve Palsy
Inferior Oblique Weakening Procedure
Inferior Oblique Myotomy and Myectomy
Inferior Oblique Recession and Anterior Positioning
Fink's Method
Park's Method
Elliot and Nankin's
Superior Oblique Strengthening
Superior Oblique Tucking
Harada Ito's Advancement of Superior Oblique
SIXTH NERVE PALSY
Horizontal Muscle Surgery
Vertical Rectus Transposition
Technique
Acknowledgment
CHAPTER 38:
Update on Strabismus Surgery in Children
INFANTILE ESOTROPIA
Congenital Esotropia
Preoperative Evaluation
Timing for Congenital Esotropia Surgery
Surgical Approach for Congenital Esotropia
Infantile Accommodative Esotropia
Esotropia Fully Corrected for Distance and Near
Distance Corrected, but there is Residual Esotropia at Near (High AC/A Ratio)
Residual Esotropia for Distance and Near, Partially Accommodative Esotropia
LATE ONSET STRABISMUS
Normosensory Strabismus
Nonaccommodative Acquired Esotropia
EXOTROPIA
Intermittent Exotropia
Surgical Treatment
Postoperative Management
Sensory Exotropia
Congenital Exotropia
MAXIMAL DOSAGE OF THE RECTUS EYE MUSCLES IN STRABOLOGICAL SURGERY
CHAPTER 39:
Sutureless Closure in Strabismus Surgery
CHAPTER 40:
New Methods for the Analysis of Ocular Motility: 3D Video-oculography
3D VIDEO-OCULOGRAPHY: A NEW TECHNIQUE FOR THE ANALYSIS OF THE OCULAR MOTILITY
Anatomophysiological Bases
Extraocular Muscles
The Spiral of Tillaux
Ocular Movements
Individual Action of the Ocular Musculature
Homo-lateral Synergists and Antagonists
Classification of Ocular Movements
Ocular Motility Laws
Exploratory Techniques: 3D Video-oculography (VOG-3D) SensoMotoric Instrument®
Technical Characteristics of 3D-VOG
Measures and Resolution
VOG Goggles
Visual Stimulus (VisualLabTM)
Analysis
VOG Workstation
Practical Application of Video-oculography to Ocular Motility
Analysis of Different Types of Strabismus
Analysis of Dissociated Strabismus; Dissociated Vertical Divergence (DVD)
Diplopia Analysis
Analysis of Muscular Paralysis
III Nerve Paralysis
Analysis of Duanne's Retraction Syndrome
Nystagmography
CHAPTER 41:
Surgical Procedures in Strabismus Surgery
NEWER INFERIOR OBLIQUE WEAKENING PROCEDURES
PERIOSTEAL ANCHORING OF LATERAL RECTUS
Surgical Procedure
VERTICAL RECTUS TRANSPOSITIONS
Physiology and Mechanics
Surgical Technique
PERIOSTEAL FIXATION OF THE GLOBE IN THIRD NERVE PALSY
Surgical Procedure
ACKNOWLEDGMENTS
CHAPTER 42:
Tips for an Easier Strabismus Surgery
INTRODUCTION
RECESSION OF A RECTUS MUSCLE
RESECTION OF A RECTUS MUSCLE
THE VERTICAL MUSCLES
THE OBLIQUE MUSCLES
THE TIGHT MUSCLE
CONCLUSION
CHAPTER 43:
Chemodenervation in Strabismus Management
BOTULINUM TOXIN—MODE OF ACTION
INDICATIONS
Diagnostic Uses
Therapeutic Uses
INJECTION TECHNIQUE
Technique
COMPLICATIONS
CHAPTER 44:
Posterior Fixation Suture (Faden Operation)
INDICATIONS
TECHNIQUE (NO RECESSION)
TECHNIQUE WITH RECTUS MUSCLE RECESSION
POSTOPERATIVE CONSIDERATIONS
CHAPTER 45:
Accommodative Esotropia
DEFINITION AND INITIAL CONSIDERATIONS
EPIDEMIOLOGY
SIGNS AND SYMPTOMS
DIFFERENTIAL DIAGNOSIS
TREATMENT
PROGNOSIS AND FOLLOW-UP
CHAPTER 46:
Dissociated Deviations
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT AND PROGNOSIS
CHAPTER 47:
Surgical Management of Anterior Segment Congenital Anomalies
ANOPHTHALMOS AND MICROPHTHALMOS
Etiology
Ocular and Systemic Associations
Management
Management of Anophthalmos
Orbital Surgery
Eyelid Surgery
Management of Microphthalmos
ANTERIOR SEGMENT DYSGENESIS
Posterior Embyotoxon
Axenfeld-Rieger Syndrome
Peter's Anomaly
Histopathology
Differential Diagnosis
Ultrasound Biomicroscopy (UBM)
SCLEROCORNEA
CHAPTER 48:
Congenital Eyelid Abnormalities and their Surgical Management
INTRODUCTION
EMBRYOLOGY OF THE EYELID
CONGENITAL DISORDERS
Cryptophthalmos
Management
Coloboma
Management
Ankyloblepharon
Management
Congenital Ectropion
Management
Congenital Entropion
Management
Epiblepharon
Management
Euryblepharon
Management
Epicanthus
Management
Telecanthus
Management
Congenital Ptosis
Management
Choice of Surgical Procedure
Commonly Performed Surgeries
Indications for the Choice of Different Surgical Procedures
Congenital Tumors
Pigmented Lesions
Management
Naevus of Ota (Oculodermal Melanocytosis)
Management
Angiomatous Tumors
Portwine Stain (Naevus Flammeus)
Strawberry (Capillary) Hemangioma (Fig. 16)
Dermoid and Epidermoid Cyst
Management
Plexiform Neurofibroma
Management
ACQUIRED DISORDERS
Eyelid Trauma in Children
Management
Inflammatory Disorders
Blepharitis
Stye
Chalazion
Management
Internal Hordeolum
Management
Molluscum Contagiosum
CHAPTER 49:
Management of Eyelid Injuries
INTRODUCTION
EVALUATION OF LID INJURY
History
Examination
PRINCIPLES OF WOUND REPAIR
Wounds with No or Minimal Tissue Loss
Superficial Lacerations
Deep Lacerations Involving the Levator Complex
Marginal Wounds
Wounds with Significant Tissue Loss
Wounds Associated with Canalicular Injuries
Wounds Associated with Canthal Tendon Injuries
Medial Canthal Tendon
Lateral Canthal Tendon
LID BURNS
CHAPTER 50:
Surgical Management of Eyelid Disorders
ENTROPION
Introduction
Clinical Picture of Entropion
Classification of Entropion
Congenital Entropion
Pathophysiology
Treatment
Differential Diagnosis
Spastic Entropion
Causes
Pathophysiology
Treatment
Prognosis
Cicatricial Entropion
Pathophysiology
Causes
Clinical Picture
Treatment of Cicatrizing Entropion
Involutional Entropion
Medical Treatment
Sugical Treatment
Three Suture Technique
Direct Anatomic Surgical Approach
Direct Anatomic Approach
Weiss Procedure
Weiss Procedure with Lateral Tarsal Strip
Lateral Tarsal Strip Procedure
ECTROPION
Introduction
Pathophysiology
Note
Clinical Signs and Symptoms
History
Examination
Treatment of Ectropion
Prognosis
CHAPTER 51:
Congenital Ptosis: Evaluation and Surgical Management
CLINICAL EVALUATION
HISTORY
OCULAR EXAMINATION
Visual Acuity
Palpebral Aperture
Margin Reflex Distance (Fig. 2)
Amount of Ptosis may be Classified as:
Levator Function
Berke's Method (Lid Excursion)
The Levator Function is Classified as:
Putterman's Method
Assessment in Children
Iliff Test
Margin Crease Distance
Bell's Phenomenon
Corneal Sensation
Ocular Motility
Tensilon Test
Phenylephrine Test
Associations
Surgical Approach Depends On
COMMONLY PERFORMED SURGERIES
INDICATIONS FOR THE CHOICE OF DIFFERENT SURGICAL PROCEDURES
Bilateral Ptosis
SURGICAL TECHNIQUES
Modified Fasanella Servat Surgery
Surgical Steps (Figs 9A to E)
COMPLICATIONS OF FASANELLA SERVAT SURGERY
Levator Resection
Surgical Steps
COMPLICATIONS OF LEVATOR SURGERY
Undercorrection
Overcorrection
Lagophthalmos
Entropion
Ectropion
Lid Fold
Lid Lag
Notching of the Lid Margin
Exposure Keratitis
Conjunctival Prolapse (Fig. 21)
Brow Suspension Repair
Temporary Sling
Fascia Lata Sling
HARVESTING OF FASCIA LATA
Fascia Lata Sling Suspension
COMPLICATIONS OF FRONTALIS SLING
Unavoidable Complications
Lid Lag
Lagophthalmos
Avoidable Complications
Undercorrection
Overcorrection
Notching or Tenting
Recurrence
Ectropion
Exposure Keratitis
Granuloma Formation
Infection
MANAGEMENT OF COMPLICATED PTOSIS
Ptosis with Oculomotor Abnormalities
Congenital Ptosis with Superior Rectus Weakness
Ptosis Associated with Double Elevator Palsy
Blepharophimosis Syndrome
Double Z Plasty or Y to V Plasty with Transnasal Wiring
Lateral Canthoplasty
Stage II
Marcus Gunn Ptosis
CHAPTER 52:
Lacrimal Surgery
INTRODUCTION
SYRINGING AND PROBING
Steps of Surgery (Figs 1 to 11)
DACRYOCYSTORHINOSTOMY (DCR)
Steps of Surgery (Figs 12 to 29)
ENDOSCOPIC DCR
CHAPTER 53:
Levator Muscle Resection: Anterior Approach
INTRODUCTION
SURGICAL TECHNIQUE
CHAPTER 54:
Laser-assisted (Ho:YAG) Lacrimal Bypass Surgery
INTRODUCTION
SURGICAL TECHNIQUE
COMPLICATIONS
POSTOPERATIVE CARE
CHAPTER 55:
Frontalis Muscle Suspension with Silicone Rod for Ptosis
INTRODUCTION
SURGICAL TECHNIQUE
COMPLICATION
CHAPTER 56:
An Evidence-based Update on Pediatric Oculoplasty
INTRODUCTION
Congenital Dacryocystitis Update
SYNDROMES
Lacrimo-auriculo-dento-digital syndrome (LADD)1
MICROBIOLOGICAL SPECTRUM AND SENSITIVITIES
TREATMENT
Probing
Timing
Endonasal probing and retrograde irrigation of lacrimal ducts
Balloon Dilatation of nasolacrimal Duct
Monocanalicular Stenting
Step Wise Approach
CONGENITAL PTOSIS
MOREKER'S CLASSIFICATION OF CHILDHOOD PTOSIS
Congenital
Acquired
DIAGNOSIS—DIFFERENTIATING CONGENITAL FROM APONEUROTIC PTOSIS
Upgaze eyelid Position13
Ultrasound Biomicroscopy
UNCONVENTIONAL PTOSIS
Childhood Myasthenia
Types
Mutations16
Treatment
WARG Syndrome and Ptosis
Partial trisomy and Ptosis
MANAGEMENT
Recent Concepts from evidences in Terms of Management
Refractive Changes
Synkinetic Ptosis—Oculomotor Abducens
Role of Steroids in Childhood Myasthenia
Comparison of Silastic and banked Fascia lata in pediatric frontalis suspension
Frontalis lobe Suspension
Advancement of Whitnall's ligament—Conjunctival Approach
Autogenous palmaris longus frontalis Sling in Children with Congenital Ptosis
Complication of Surgery—Inverse Bell's phenomenon
ORBITAL IMPLANTATION IN CHILDREN
SIZE OF IMPLANT30
PRIMARY ORBITAL IMPLANTS IN CHILDREN—HYDROXYAPATITE
POROUS POLYETHYLENE IMPLANT IN A CHILD
AUTOGENOUS DERMIS—FAT GRAFT ORBITAL IMPLANT
MOREKER'S EXPANDABLE BALLOON IMPLANTS
ORBITAL FRACTURES IN CHILDREN
Endoscopic Fracture Reduction and Mesh Implantation with Tissue Glue
LID AND ORBITAL TUMORS
Shields Classification of orbital Cysts40
Endoscopic Management of orbital Diseases
Nd: YAG Laser and Corticosteroids
CONGENITAL EYELID RETRACTION AND CHILDHOOD THYROID
EYELID MALPOSITIONS
Ruban's Classification
Static
Dynamic
CONGENITAL ENTROPION
Surgical Correction of entropion in Congenital cutis laxa50
CONGENITAL ECTROPION
CRYPTOPHTHALMOS
Parental Age
Known Risk Factors
Pathogenesis
Classification
Nouby's Classification of Congenital Upper eyelid coloboma and cryptophthalmos
Moreker-Agashe Classification
Treatment
Complete Cryptophthalmos
Incomplete Cryptophthalmos
Role of Amniotic membrane
Prenatal Diagnosis57–59
CHAPTER 57:
Congenital Dacryostenosis
DEFINITION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
SYMPTOMS AND SIGNS
INVESTIGATIONS
DIAGNOSIS
MEDICAL AND SURGICAL TREATMENT
Lacrimal Probe
Intubation of the lacrimal pathway
Dacryocystorhinostomy
Endoscopic dacryocystorhinostomy
LASER ASSISTED DACRYOCYSTORHINOSTOMY
PROGNOSIS
CHAPTER 58:
Pediatric Orbital Vascular Tumors
INTRODUCTION
EPIDEMIOLOGY
NATURAL HISTORY
CLINICAL SIGNS
MOREKER-KATARIA-LALA CLASSIFICATION OF PERIOCULAR HEMANGIOMAS
CASES WITH SUDDEN INCREASE IN SIZE
CT SCAN CRITERIA
INVESTIGATIONS
TREATMENT
Factors affecting treatment
Timing of Surgery
Approaches
CAVERNOUS SINUS HEMANGIOMAS
Types
Approach
Extradural Transcavernous Approach to Cavernous Sinus Hemangiomas24
Adjunct Therapy
ACKNOWLEDGMENTS
CHAPTER 59:
Congenital Nasolacrimal Duct Obstruction and its Management
PATHOPHYSIOLOGY
FREQUENCY
CAUSES
PRESENTATION
Amniotocele
Dacryocystitis (Acute Mucocele or Pyocele)
Tearing
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT
Medical Care
Surgical Care
Probing
Nasolacrimal Intubation
Balloon Catheter Dilatation
Dacryocystorhinostomy with or without Intubation
Conjunctival Dacryocystorhinostomy
COMPLICATIONS AND PROGNOSIS
Bleeding
Surgical Failures
Silicone or Polyethylene Tubing Complications
Bypass Tube Complications
Anesthesia Complications
CHAPTER 60:
Orbital Disorders: Vascular Abnormalities
INTRODUCTION
CAPILLARY HEMANGIOMA
Symptoms and Signs
Investigations
Management
Prognosis
LYMPHANGIOMA
Symptoms and Signs
Investigations
Management
Prognosis
CAVERNOUS HEMANGIOMA
Symptoms and Signs
Investigations
Management
Prognosis
ORBITAL VARICES
Symptoms and Signs
Investigations
Management
Prognosis
CHAPTER 61:
Orbital Tumors in Pediatric Patients
QUISTIC LESIONS
Dermoid Cyst
Mucocele
VASCULAR LESION
Capillary Hemangioma
Lymphangiomas
BONE LESIONS
Fibrotic dysplasia
PERIPHERAL NERVE LESIONS
Plexiform Neurofibroma
INFLAMMATORY LESIONS
Inflammatory Pseudotumor
MALIGNANT TUMORS
Retinoblastoma
Rhabdomyosarcoma
Neuroblastoma
CHAPTER 62:
Management of Congenital Tumors
PIGMENTED LESIONS
Nevi (Fig. 1)
Management
Nevus of Ota (Oculodermal Melanocytosis)
Management
ANGIOMATOUS TUMORS
Portwine Stain (Nevus Flammeus)
Strawberry (Capillary) Hemangioma (Fig. 2)
Symptoms and Signs
Prognosis
Management
DERMOID AND EPIDERMOID CYST
PLEXIFORM NEUROFIBROMA
CHAPTER 63:
Pediatric Corneal Transplant Surgery—An Overview
CURRENT CONCEPTS IN PEDIATRIC CORNEAL TRANSPLANT SURGERY
INDICATIONS OF PENETRATING KERATOPLASTY
AGE AT THE TIME OF PENETRATING KERATOPLASTY
EVALUATION OF INFANTS OR NEONATES WITH CONGENITAL CORNEAL OPACITIES
INVESTIGATIONS
PEDIATRIC KERATOPLASTY CONSTRAINTS
PREPARATION BEFORE CORNEAL TRANSPLANT SURGERY
DONOR TISSUE
SURGERY
SIZE OF THE GRAFT
ALTERNATIVES TO PENETRATING KERATOPLASTY
HIGH-RISK PENETRATING KERATOPLASTY
PERIOPERATIVE CARE
COMPLICATIONS
Early
INTERMEDIATE
LATE COMPLICATIONS
ALLOGRAFT REJECTION
GLAUCOMA
TREATMENT OF AMBLYOPIA
OUTCOME
REPEAT CORNEAL GRAFT
KERATOPROSTHESIS
REHABILITATION OF BLINDS DUE TO CORNEAL DISEASE
CONCLUSION
CHAPTER 64:
An Update on Pediatric Keratoplasty
INTRODUCTION
VISUAL ASSESSMENT (FIGS 2 TO 13)
Direct
Indirect
OCULAR EXAMINATION
SURGICAL PROCEDURES
Indications
Congenital
Acquired, Nontraumatic
Acquired, Traumatic
SURGICAL MANAGEMENT
Penetrating Keratoplasty
Disadvantages of Smaller Graft
Concomitant Procedures
Postoperative Care
Immediate Postoperative Period
Early Postoperative Care
Postoperative Medications
Suture Removal
OPTICAL CORRECTION AND AMBLYOPIA THERAPY
CONCLUSION
SECTION 2: POSTERIOR SEGMENT
CHAPTER 65:
Management of Retinoblastoma
DEFINITION
EPIDEMIOLOGY
PHYSIOPATHOLOGY
SIGNS AND SYMPTOMS
INVESTIGATIONS
DIAGNOSIS
MEDICAL AND SURGICAL TREATMENT
PROGNOSIS
CHAPTER 66:
Management of Pediatric Retinal Detachment
SPECIFIC CLINICAL SITUATIONS
Retinopathy of Prematurity
Familial Exudative Vitreoretinopathy (FEVR) (Figs 5 to 7)
PHPV/PFV SYNDROME12,13
Management
Retinoschisis14
Clinical Features
Management
Surgical Management
Gene Therapy
Surgery in Older Children
Indications
Rhegmatogenous Retinal Detachment (RRD)
Vitreous Hemorrhage
Endophthalmitis
Specific Concerns in Pediatric Vitreoretinal Surgery
Decision Making for Prophylactic Treatment in Pediatric Retinal Disorders
Specific Conditions in Pediatric Cases treated Prophylactically
Postoperative Management
CHAPTER 67:
Management of Retinal Tumors
RETINAL CAPILLARY HEMANGIOMA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
RETINAL CAVERNOUS HEMANGIOMA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
VASOPROLIFERATIVE TUMOR OF THE RETINA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
RETINAL ASTROCYTOMA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
CHOROIDAL MELANOMA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
SOLITARY CHOROIDAL HEMANGIOMA
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
RETINOBLASTOMA
Clinical Signs and Symptoms
Differential Diagnosis
Investigations
Treatment
Cryotherapy
Laser Photocoagulation
Transpupillary Thermotherapy (TTT)
Brachytherapy Plaque
External Beam Radiotherapy (EBRT)
Enucleation
Orbital Exenteration
Chemotherapy
Systemic Chemotherapy Drugs and Disk Schedules
Follow-up Schedule
Prognosis
International Classification (New)
CHAPTER 68:
Management of Juvenile Diabetic Retinopathy
EPIDEMIOLOGY
DURATION OF DIABETES AND THE DEVELOPMENT OF DIABETIC RETINOPATHY
SYSTEMIC FACTORS THAT MAY AFFECT DIABETIC RETINOPATHY
OCULAR FACTORS
RETINOPATHY IN DIFFERENT FORMS OF DIABETES
TECHNIQUES TO STUDY RETINAL BLOOD FLOW
ANATOMIC LESIONS AND THE PATHOGENESIS OF DIABETIC RETINOPATHY
Capillary Basement Membrane Thickening
Loss of Microvascular Intramural Pericytes
Microaneurysms
Capillary Acellularity
Breakdown of the Blood-retinal Barrier
Clinical Signs of Diabetic Retinopathy
SIGNS
Microaneurysms
Dot and Blot Hemorrhages
Cotton-Wool Spots
Venous Loops, Venous Beading
Intraretinal Microvascular Abnormalities
Diabetic Macular Edema
Classification of Diabetic Retinopathy
DEFINITIONS13
RISK FACTORS FOR DIABETIC RETINOPATHY
Duration of the Diabetes
Glucose Control
Lab Studies
Imaging Studies
Medical Care
Further Outpatient Care
Management of Diabetic Macular Edema
ETDRS Guidelines for Management of Diabetic Macular Edema (ETDRS: Report no. 2 1987):
ETDRS Guidelines for Laser Photocoagulation
Prognosis
INVESTIGATIONS AND CURRENT MANAGEMENT OF DME
MANAGEMENT
INTRAVITREAL TRIAMCINOLONE
MACULAR GRID PHOTOCOAGULATION
VITRECTOMY
Proliferative Diabetic Retinopathy: Surgical Management
Indications for Surgical Interventation
Severe Nonclearing Vitreous Hemorrhage
Traction Retinal Detachment Recently Involving Macula
Combined Tractional and Rhegmatogenous Retinal Detachment
Dense Fibrovascular Proliferation
Dense Premacular Hemorrhage
Diabetic Macular Edema Associated with Posterior Hyaloid Traction
Ghost Cell/ Hemolytic Glaucoma
Role of Avastin
Surgical Steps in Diabetic Vitrectomy
CHAPTER 69:
Management of Retinitis Pigmentosa and other Disorders
CLINICAL FEATURES
Nyctalopia
VISUAL FIELD LOSS
PHOTOPSIA
FUNDUS FINDINGS
FUNDUS FLUORESCEIN ANGIOGRAPHY
ANTERIOR SEGMENT ABNORMALITIES
VITREOUS ABNORMALITIES
REFRACTIVE STATUS
OTHER ASSOCIATED FEATURES
PSYCHOPHYSICAL FINDINGS
Perimetry
Dark Adaptometry
Retinal Densitometry
Electrophysiology
CLASSIFICATION
SUBDIVISION BY MODE OF INHERITANCE
SUBDIVISION BY AGE OF ONSET
Subdivision by Molecular Defect
Subdivision-based on Distribution of Retinal Involvement and Fundus Appearance
Retinitis Pigmentosa Inversus (Pericentral and Central Retinitis Pigmentosa)
COMPLICATED RETINITIS PIGMENTOSA
Usher's Syndrome
LEBER'S CONGENITAL AMAUROSIS
Bardet-Biedl Syndrome
Neuronal Ceroid Lipofuscinosis (Batten Disease, Amaurotic Idiocy)
Bassen-Kornzweig Syndrome (Abetalipoproteinemia)
Refsum's Disease
Pseudoretinitis Pigmentosa
RETINAL INFLAMMATORY DISEASES
Drug Toxicity
Thioridazine
Chloroquine
Quinine
Pigmented Paravenous Retinochoroidal Atrophy
Unilateral Pigmentary Retinopathy (Unilateral RP)
Traumatic Retinopathy
Diffuse Unilateral Subacute Neuroretinitis
TREATMENT AND MANAGEMENT
Counseling
Cataract Surgery
Macular Edema and Serous Retinal Detachment
Vitamin A Supplements
Lutein Supplements
Medications with Potential Adverse Reaction with RP
Isoretinoin (13-cis-retinoic acid)
Sildenafil (Viagra)
Advances in Therapeutics
CHAPTER 70:
Management of Retinopathy of Prematurity
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
Investigations
Differential Diagnosis
Prognosis
CHAPTER 71:
Management of Pediatric Retinal Diseases
RETINOPATHY OF PREMATURITY
Introduction
Classification and Clinical Signs
Location of the Disease (Zones)
Extent of the Disease (Clock Hours)
Plus Disease
Stages of the Disease (Severity)
RUSH DISEASE
SCREENING FOR ROP (INVESTIGATIONS)
TIME FOR SCREENING THE INFANTS AT RISK
Differential Diagnosis
Treatment
Inferences
BEST'S DISEASE OR BEST'S VITELLIFORM MACULAR DYSTROPHY
Introduction
Classification and Clinical Features
Investigations
Differential Diagnosis
Management
Inference
GYRATE ATROPHY
Introduction
Clinical Features
Investigations
Treatment
Differential Diagnosis
Inference
CHAPTER 72:
Management of Uveitis in Children
UVEITIS
Introduction
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
INDEX
TOC
Index
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