Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery) Ashok Garg, Jorge L Alio
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1SURGICAL TECHNIQUES IN OPHTHALMOLOGY PEDIATRIC OPHTHALMIC SURGERY
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3SURGICAL TECHNIQUES IN OPHTHALMOLOGY PEDIATRIC OPHTHALMIC SURGERY
Editors-in-Chief
Ashok Garg MS PhD FIAO (Bel) FRSM ADM FAIMS FICA International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre Hisar, Haryana, India
Jorge L Alió MD PhD Professor and Chairman of Ophthalmology Medical Director VISSUM, Instituto Oftalmologico de Alicante, Avda de Denia S/n 03016 Alicante, Spain Foreword M Edward Wilson
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Editors
Laura Elena Campos-Campos MD Chairman Department of Pediatric Ophthalmology General Hospital National Medical Centre, “La Raza” National Institute of Social Security Mexico
Bojan Pajic MD Chairman Swiss Eye Research Foundation Eye Clinic ORASIS Titlisstrasse 44, 5734 Reinach, AG, Switzerland
Ewa Oleszczynska Prost MD PhD Director Center for Pediatric Ophthalmology Hertza 9, 04-603 Warsaw, Poland
Arturo Pérez-Arteaga MD Medical Director Centro Oftalmologico Tlalnepantla Perez-Arteaga Vallarta No. 42 Tlelnepantla, Centro Estado de Mexico 54000, Mexico
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CS Dhull MS PhD FIAO Senior Professor and Head Regional Institute of Ophthalmology and Director, PGIMS Rohtak, India
Rupal H Trivedi MD PhD Research Assistant Professor Storm Eye Institute Medical University of South Carolina (MUSC) Charleston USA
6Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
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Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2011
9789350251485
Typeset at JPBMP typesetting unit
Printed at
7Dedicated to
• My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Insa Ji for his blessings and motivation
• My Respected Parents, teachers, my wife Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work
• My dear friend Dr Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise.
—Ashok Garg
• To Mayca, Jorge, Fernando and Maria Lucia and most especially to my beloved wife Maria, for the hours that were taken from our family life to make this book possible.
—Jorge L Alió
• To God my guide, my husband and my kids, I love you and all little patients because they are open book.
—Laura Elena Campos-Campos
• My parents, husband and son for patience and understanding.
—Ewa Oleszczynska Prost
• To my son Valentin Aleksandar.
—Bojan Pajic
• I dedicate my work to all the people in the world with ophthalmic diseases, with the best wish that we can improve with this kind of material our quality of care. I also dedicate this opus to Professor Ashok Garg, because he has trusted in my work many times.
—Arturo Pérez-Arteaga
• My dear wife Dr Indira Dhull and my children Tushar and Chirag.
—CS Dhull
• My mentor, Dr Abhay R Vasavada, in deep appreciation for his unending encouragement and direction of my academic and research career in ophthalmology.
—Rupal H Trivedi
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9Contributors
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13Foreword
Although it may sound cliche, children are not small adults. Nowhere is that more true than when eye surgery is planned and executed. Numerous special considerations are needed when innovation is applied to a growing and developing young child whose postoperative period may last a half century or longer.
When volume alone is considered, ophthalmology is mostly a geriatric specialty. However, the field must care and support eye development, growth and aging from “cradle to grave”. When I speak to surgeons about operating on children they invariably report an increased level of concern and report that their skills are put to the test in ways that do not occur during the care of the elderly. For this reason, textbooks like this one are valuable resources, allowing the surgeon to consult the experts each time they step into the operating room. I suspect that this volume will find a home near operating theaters and surgical suites around the globe and that many of these chapters will become worn from the many re-readings that will occur just before procedures begin.
Series editors Dr Ashok Garg and Dr Jorge Alio have selected editors for this volume on pediatric eye surgery who have international acclaim. They have written many of the chapters themselves but have also selected a special group of authors to write individual chapters in their areas of expertise. Seventy-two chapters cover the landscape in a very comprehensive way, giving the surgeon information about treatments that precede surgery as well as many different surgical approaches, some tried and true and others unproven but innovative and promising.
Cataract and intraocular lens considerations receive the most chapter titles but this edition is well-balanced with nearly as many chapters covering strabismus and oculoplastic procedures for children. Congenital and developmental glaucoma and corneal transplant are well-covered, as the varied posterior segment problems that pose unique challenges in the young patient.
My hat goes off to Dr Ashok Garg, Dr Jorge Alió (Chief Editors) the editors and the publisher for putting together a volume of work that gives the reader many different approaches to these special problems. No attempt is made to promote one approach over another. Rather, innovators and those who prefer conservatism are each represented. All seek to promote the best visual outcome with the least amount of surgical trauma. Caring for children is a privilege that comes with a lot of responsibility. We each must learn something new every day, seek to provide the best care we can, innovate and evolve without applying unproven treatments too quickly. We should treat our patients, rich or poor, like we would want our own children treated. This book will help us meet those lofty goals.
M Edward Wilson md
Professor of Ophthalmology and Pediatrics
Chairman, Department of Ophthalmology
Director, Albert Florens Storm Eye Institute
Medical University of South Carolina
167 Ashley Avenue
Charleston, SC 29425
USA
E-mail: wilsonme@musc.edu
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15Preface
Ophthalmic surgery technology has undergone rapid advancements and innovations in last two decades. From modest and conventional surgical techniques in early eighties, now it has become high-tech surgery with least indoor stay and excellent visual outcomes. Microincision surgery in both anterior and posterior segments, corneal and lenticular refractive surgery, modern keratoplasty techniques, pediatric and strabismus surgery, oculoplastic and reconstructive surgery and stem cell transplantation have entirely changed the scenario in ophthalmic surgery today.
Modern ophthalmic surgery is a vast subject. It is important for ophthalmologists to master various surgical steps in the ophthalmic surgery procedures of their interest. There are very few quality international Surgical Techniques in Ophthalmic book which can teach and guide the ophthalmologists to master various surgical techniques properly. Keeping in view of this factor, we have conceptualized the present series of Surgical Techniques in Ophthalmology which shall contain eight volumes. These volumes shall cover all aspects of ophthalmic surgery in a comprehensive and easy-to-read format. These volumes shall focus on especially Cataract Surgery, Refractive Surgery, Oculoplasty and Reconstructive Surgery, Corneal Surgery, Glaucoma Surgery, Retinal Surgery, Strabismus Surgery, and Pediatric Ophthalmic Surgery. A panel of International Eminent Ophthalmologists are contributing chapters in these volumes for the benefit of ophthalmologists worldwide.
This volume is dedicated to Pediatric Ophthalmic Surgery—an important branch of ophthalmology. The clinically significant topics of pediatric ophthalmic surgery related to anterior and posterior segments have been included in this volume. Both conventional and high-tech surgeries specially related to Pediatric Cataract Surgery, Corneal Surgery, Strabismus Surgery, Glaucoma Surgery, Oculoplasty Surgery, Retinal Surgery and Pediatric Refractive Surgery are special features of this volume.
Our gratitudes are due to Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director- Publishing) and all staff members of our publisher M/s Jaypee Highlights Inc. who took keen interest in this project and for speedy completion of this mega task.
We expect that present series of Surgical Techniques in Ophthalmology shall serve as quick look reference book for ophthalmologists worldwide to sharpen their surgical skills.
Editors