This condensed guide to surgical practices outlines the dangers in the field of refractive, cataract, and corneal surgery. Focusing on the practical aspects of surgery, Melki (director, Boston Cornea Center; and chief surgeon, Boston Laser Eye Center) and Azar (corneal and refractive surgery, Harvard Medical School) offer advice on improving outcomes, reducing time in the operating room, minimizing complications, and simplifying procedures. Black-and-white and color graphics illustrate key points. Annotation c. Book News, Inc., Portland, OR (booknews.com)
101 Pearls in Refractive, Cataract, and Corneal Surgery has invaluable tips for both the beginning and advanced surgeons. Unlike other texts on this topic, this resource summarizes the key pearls and pitfalls of many challenging procedures.
This book serves as a condensed summary of surgical tips acquired from the personal experiences of Drs. Melki and Azar, as well as interactions with many other well-known colleagues in the field of refractive, cataract, and corneal surgery. It teaches you how to enhance surgical outcomes, reduce surgical time, minimize complications, or simplify a complicated step. The focus is on practical points, rather than the theoretical aspects of the procedures.
There is no other book on ophthalmic surgical techniques that follows this unique format. There are excellent illustrations allowing for a quick and thorough understanding of each technique. Each pearl includes an "always remember" section, with statements at the end of each pearl to remind the reader of the most important points.
101 Pearls in Refractive, Cataract, and Corneal Surgery includes chapters on: LASIK Complications; PRK; PTK; PARK; Hyperopia Treatment; Topography; Corneal Lacerations Repair; Posterior Vitreous Pressure During Keratoplasty; and Pterygium Excision, among others.
Dedication iii Acknowledgments viii About the Editors ix Contributing Authors x Forward xiv Section 1: Refractive Surgery Six Pearls for Surgical Planning with Videokeratography 3(10) Michael J. Endl Stephen D. Klyce Keratoconus---Whos the Suspect? 3(1) Orbscan for a Posterior Perspective 4(2) You Can Prevent Decentration 6(1) A Plan for Astigmatic Keratectomy 7(1) The Difference Map---What Good Is It? 8(1) So Many Maps, So Little Time 8(5) Nine Pearls in LASIK Technique 13(10) Elizabeth A. Davis David R. Hardten Richard L. Lindstrom Counsel the Patient 13(1) Achieve Adequate Exposure 13(1) Achieve and Confirm Adequate Suction 14(1) Create a Complete Flap 15(1) Consistent Hydration 16(1) Perform the Appropriate Ablation 17(1) Prevent and Remove Debris 18(1) Attain Good Flap Alignment and Adhesion 18(1) Avoid and Treat Loose Epithelium 19(4) Eight Pearls in Prevention and Management of LASIK Complications 23(10) Samir A. Melki Dimitri T. Azar The Sliding Suction Ring 23(1) The Mid-Cut Jam 23(1) Flap Buttonholes 24(1) The Free Cap 25(1) The Aborted LASIK 26(1) LASIK Retreatment: Flap Lift Techniques 26(3) Epithelial Ingrowth...Leave or Lift? 29(1) Flattening the Recalcitrant LASIK Flap Fold 29(4) Five PRK and LASEK Pearls 33(10) Eric Dudenhoefer Dimitri T. Azar Methods of Epithelial Debridement in PRK 33(1) Laser Epithelial Keratomileusis (LASEK): Surgical Technique of Flap PRK 34(1) Handling Haze with Mitomycin C 35(2) PRK for Residual Myopia after Radial Keratotomy 37(1) Treatment Decentration: Shift versus Drift 38(5) Four PTK Pearls 43(8) Shahzad Mian Dimitri T. Azar Location, Location, Location: Depth, Diameter, and Position 43(2) Best Preoperative Refraction for Better Postoperative Vision 45(1) Masking Agents for Smoother Ablation 46(2) PTK and the Recurrent Erosion Ladder 48(3) Four Pearls in Excimer Laser Correction of Hyperopia 51(4) Nada S. Jabbur Samir A. Melki Dimitri T. Azar Latent Hyperopia and Spasm of Accommodation 51(1) Hyperopic LASIK: Meticulous Flap Management 51(1) Hyperopic PRK: The Epithelial Challenge 52(2) On Hyperopia and Regression 54(1) Five Pearls in Holmium-YAG Laser Thermokeratoplasty (LTK) 55(8) Guillermo Rocha Proper Patient Selection 55(1) Ho:Yag LTK: The Procedure 56(1) How to Avoid Treatment Decentration 57(1) Unilateral Treatments: A Preferable Option 58(1) Postoperative Considerations 59(4) Six Pearls in Phakic IOL Implantation 63(10) Thanh Hoang-Xuan Jean-Louis Arne Georges Baikoff Phakic IOLs: What Size? 63(2) Iris Visco-Stretch Prevents Mydriasis and Iris Prolapse 65(1) Artisan Lens: Iris Enclavation 65(2) ICL: Prevent Pigment Dispersion 67(1) The Inverted ICL 68(1) Removal of the Viscoelastic Agent 68(5) Section 2: Cataract Surgery Four Pearls for Successful Cataract Surgery Using Topical Anesthesia 73(4) H. John Shammas Anesthesia without Akinesia: What If the Eye Moves? 73(1) Enhancing Topical Anesthesia with Adjunctive Measures 73(1) Intracameral Lidocaine 74(1) The Unsuitable Candidate for Topical Anesthesia 74(3) Four Pearls to Conquer the Difficult Iris 77(6) Pierre G. Mardelli Samir A. Melki Small Pupil, Big Challenge 77(1) The Hidden Capsulorrhexis 78(2) The Exuberant Iris Prolapse 80(1) Tips for Iris Sutures 80(3) Four Pearls in Avoiding Phacoemulsification Corneal Burns 83(4) James J. Reidy Proper Hand Positioning 83(1) Appropriate Irrigation Flow 84(1) Debulk the Viscoelastic in the Anterior Chamber 85(1) Minimize the Use of Ultrasound Power 86(1) Five Pearls in the Management of Crystalline and Artificial Intraocular Lens Dislocation 87(10) Ammar N. Safar Nasrin A. Afshari Alexandre Assi Posterior Assisted Levitation (PAL) 87(3) The Sheath Glide Maneuver 90(1) McCannel Sutures for Dislocated IOLs 90(2) Double-Knot Transscleral Suture Fixation Technique for Sunset and Sunrise Syndromes 92(2) Double-Knot Technique for Iris Fixation of Decentered, Dislocated, or Subluxated Silicone Plate Haptic IOLs 94(3) Seven Pearls for Challenging Cases in Cataract Extraction 97(14) Richard Mackool Capsular Dyes 97(1) The Runaway Rhexis 98(1) Pseudoexfoliation Quandry 98(3) The Shallow Anterior Chamber 101(2) Infusion Misdirection Syndrome 103(1) Techniques for Reattachment of Descemets Membrane 104(1) Upright Phacoemulsification 105(6) Section 3: Corneal Surgery Five Pearls in Limbal Stem Cell Transplantation 111(10) Kimberly C. Sippel C. Stephen Foster How is Limbal Stem Cell Deficiency Identified? 111(1) Approach to the Management of Ocular Surface Disorders 111(2) Limbal Stem Cell Autografting: Make Sure the Contralateral Eye is Normal 113(2) Limbal Stem Cell Allografting: HLA Typing and Postsurgical Immunosuppression 115(4) Combining Limbal Stem Cell Transplantation and Corneal Grafting: At the Same Time or Spaced Apart? 119(2) Two Pearls for Successful Pterygium Excision 121(4) Rasik Vajpayee Mitomycin C: Pros and Cons 121(1) Cosmetic Autografts 121(4) Three Pearls in Amniotic Membrane Grafting 125(6) Kimberly C. Sippel C. Stephen Foster Amniotic Membrane Grafting: When Would One Consider Using It? 125(1) Amniotic Membrane Grafting: Where Does One Obtain It? 126(1) Inlay or Overlay? 127(4) Four Pearls for Suturing Corneal Incisions and Lacerations 131(8) Roberto Pineda II Head On or Shelve It 131(1) The Compression Factor 132(1) Wound Override: Splitting the Difference 132(2) The Sutureless Repair of Corneal Lacerations 134(5) Four Pearls in Successful Application of Cyanoacrylate Glue to the Cornea 139(10) Jonathan D. Primack Indications: To Glue or Not to Glue? 139(3) Tips on Glue and Patient Preparation 142(1) Avoid Sticky Situations 143(2) Maintenance of Glue on the Ocular Surface 145(4) Six Pearls in Challenging Corneal Surgery 149(12) Esen Karamursel Akpek Rana Altan-Yaycioglu Walter J. Stark The Neurotrophic Cornea 149(1) The Vascularized Cornea 150(1) Enhancing Regrafting Success 151(2) Epithelial Downgrowth 153(1) Contralateral Corneas in Monocular Patients (Autokeratoplasty) 153(1) Lamellar Keratoplasty 154(7) Three Pearls to Minimize Postkeratoplasty Astigmatism 161(4) Rasik Vajpayee Samir A. Melki Better Choices in Graft Size 161(1) Avoid Oval Trephination 161(1) Running versus Interrupted Sutures 162(3) Three Pearls in Managing Posterior Vitreous Pressure During Penetrating Keratoplasty 165(4) Sadeer B. Hannush Avoid Posterior Vitreous Pressure: Using Physics to Your Advantage 165(1) Closed Chamber or Open-Sky Phaco-assisted Cataract Extraction 165(1) Vitrectomy in Keratoplasty 166(3) Index 169
