Fine I / Mojon Minimally Invasive Ophthalmic Surgery

1. Auflage 2010
ISBN: 978-3-642-02602-7
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 241 Seiten

Many minimally invasive procedures have been developed over the past decades, leading to a great improvement in eye surgery. This unique textbook and reference guide provides a complete up-to-date overview of minimally invasive surgical techniques in ophthalmology. Lavishly illustrated with superb illustrations and video clips, it presents the state of the art of minimally invasive ophthalmic procedures. It serves as an invaluable resource for all ophthalmic surgeons with widely varying levels of experience, from the resident to the experienced surgeon.

Autoren/Hrsg.

Fine I, Howard

Mojon, Daniel

Inhaltsverzeichnis

1;Dedication;5
2;Preface;6
3;Acknowledgements;7
4;Contents;8
5;Contributors;9
6;Chapter 1;11
6.1;Minimally Invasive Oculoplastic Surgery;11
6.1.1;1.1 General Points;11
6.1.2;1.2 Lower Lid Entropion;11
6.1.2.1;1.2.1 Introduction;11
6.1.2.2;1.2.2 Lower Lid Entropion Sutures;12
6.1.2.3;1.2.3 Lower Lid Entropion Botulinum Toxin;13
6.1.3;1.3 Lower Lid Ectropion;14
6.1.3.1;1.3.1 Introduction;14
6.1.3.2;1.3.2 The Royce Johnson Suture;15
6.1.3.3;1.3.3 The Pillar Tarsorrhaphy;15
6.1.4;1.4 Distichiasis;18
6.1.4.1;1.4.1 Introduction;18
6.1.4.2;1.4.2 Direct Excision of Lashes;19
6.1.5;1.5 Ptosis;19
6.1.5.1;1.5.1 Introduction;19
6.1.5.2;1.5.2 Posterior Approach Muller’s Muscle-Conjunctival Resection;19
6.1.5.3;1.5.3 Anterior Approach – One Stitch Aponeurosis Repair;20
6.1.5.4;1.5.4 Supramid Brow Suspension;22
6.1.6;1.6 Lid Retraction;23
6.1.6.1;1.6.1 Introduction;23
6.1.6.2;1.6.2 Koornneef Blepharotomy;23
6.1.6.3;1.6.3 Botulinum Toxin;25
6.1.7;1.7 Lid Tumours;25
6.1.7.1;1.7.1 Mohs’ Micrographic Surgery;25
6.1.7.2;1.7.2 Lamella Sparing Tumour Excision;28
6.1.8;References;29
7;Chapter 2;32
7.1;Minimally Invasive Conjunctival Surgery;32
7.1.1;2.1 Conjunctival Surgery;32
7.1.2;2.2 Conjunctivochalasis;32
7.1.2.1;2.2.1 Background of the Disease;32
7.1.2.2;2.2.2 Indication for Surgery;33
7.1.2.3;2.2.3 Basic Concept of Surgery;33
7.1.2.4;2.2.4 Surgical Procedure;33
7.1.2.5;2.2.5 Postoperative Follow-Up;35
7.1.3;2.3 Pterygium;35
7.1.3.1;2.3.1 Background of the Disease and the Concept of Minimally Invasive Surgery;35
7.1.3.2;2.3.2 Indication for Surgery;37
7.1.3.3;2.3.3 Basic Concept of Surgery;37
7.1.3.4;2.3.4 Surgical Procedures;37
7.1.3.5;2.3.5 A Biologic Adhesive for Sutureless Pterygium Surgery;38
7.1.3.6;2.3.6 Postoperative Follow-Up;38
7.1.4;2.4 Limbal and Conjuntival Dermoids;39
7.1.4.1;2.4.1 Background of the Disease;39
7.1.4.2;2.4.2 Basic Concept of Surgery;39
7.1.4.3;2.4.3 Surgical Procedure;39
7.1.4.4;2.4.4 Postoperative Follow-Up;39
7.1.5;2.5 Strabismus Surgery;39
7.1.6;2.6 Conclusion;39
7.1.7;References;41
8;Chapter 3;42
8.1;Minimally Invasive Lacrimal Surgery;42
8.1.1;3.1 Introduction;42
8.1.1.1;3.1.1 Causes of Stenoses of the Lacrimal Drainage System;42
8.1.1.2;3.1.2 Diagnosis of Stenoses of the Lacrimal Drainage System;42
8.1.1.3;3.1.3 General Remarks Regarding Surgical Management;43
8.1.2;3.2 Endonasal Endoscopic (Microscopic) Dacryocystorhinostomy (EDCR);44
8.1.2.1;3.2.1 Indication for EDCR;44
8.1.2.2;3.2.2 Surgical Technique;44
8.1.2.3;3.2.3 Silicone Stenting for EDCR;47
8.1.2.3.1;3.2.2.1 Silicone “Cones” (Lacrimal Duct Stent, Bess, Berlin);48
8.1.2.4;3.2.4 Use of Mitomycin C for EDCR;48
8.1.2.5;3.2.5 Post-Operative Care After EDCR;49
8.1.2.6;3.2.6 Results of EDCR;49
8.1.3;3.3 Endonasal Endoscopic Laser Dacryocystorhinostomy (ELDCR);50
8.1.3.1;3.3.1 Indications for ELDCR;51
8.1.3.2;3.3.2 Contraindications for ELDCR;51
8.1.3.3;3.3.3 Surgical Technique for ELDCR;52
8.1.3.4;3.3.4 Potential Problems with ELDCR;53
8.1.3.5;3.3.5 Post-Operative Care After ELDCR;54
8.1.3.6;3.3.6 Results of ELDCR;54
8.1.3.7;3.3.7 Post-Operative Complications After ELDCR;54
8.1.4;3.4 Dacryoendoscopy with Transcanalicular Laserdacryoplasty (TLDP);55
8.1.4.1;3.4.1 Indication for TLDP;55
8.1.4.2;3.4.2 Contraindication for TLDP;56
8.1.4.3;3.4.3 Surgical Technique for TLDP;56
8.1.4.4;3.4.4 Results of TLDP;56
8.1.4.5;3.4.5 Post-Operative Care and Complications of TLDP;56
8.1.5;3.5 Microdrill Dacryoplasty (MDP);56
8.1.5.1;3.5.1 Indication for MDP;57
8.1.5.2;3.5.2 Contraindication for MDP;57
8.1.5.3;3.5.3 MDP Procedure;57
8.1.5.4;3.5.4 Results of MDP;57
8.1.5.5;3.5.5 Post-Operative Care and Complications of MDP;57
8.1.6;3.6 Balloon Dilatation;57
8.1.6.1;3.6.1 Indications for Balloon Dilatation;58
8.1.6.2;3.6.2 Anaesthesia for Balloon Dilatation;58
8.1.6.3;3.6.3 Surgical Technique with 2 mm or 3 mm Balloon for Incomplete Stenosis;58
8.1.6.3.1;3.6.3.1 Post-Operative Care;60
8.1.6.3.2;3.6.3.2 Complications;60
8.1.6.3.3;3.6.3.3 Results;60
8.1.6.4;3.6.4 Surgical Technique with 5 mm Balloon for Complete Stenosis or Revision Cases of DCR According to Ref.;60
8.1.6.4.1;3.6.4.1 Post-Operative Care;61
8.1.6.4.2;3.6.4.2 Results;61
8.1.6.4.3;3.6.4.3 Complications;62
8.1.7;3.7 Stent Placement;62
8.1.7.1;3.7.1 Indications for Stent Placement;62
8.1.7.2;3.7.3 Surgical Technique for Stent Placement;62
8.1.7.3;3.7.4 Post-Operative Care and Complications After Stent Placement;63
8.1.7.4;3.7.5 Results of Stent Placement;63
8.1.8;References;64
9;Chapter 4;67
9.1;Minimally Invasive Corneal Surgery;67
9.1.1;4.1 Penetrating Keratoplasty;67
9.1.1.1;4.1.1 Introduction;67
9.1.1.2;4.1.2 Indications;67
9.1.1.3;4.1.3 Preoperative Evaluation of the Keratoplasty Patient;68
9.1.1.4;4.1.4 Preparation for Penetrating Keratoplasty;70
9.1.1.4.1;4.1.4.1 Eyelid Speculum;70
9.1.1.4.2;4.1.4.2 Scleral Fixation Rings;70
9.1.1.4.3;4.1.4.3 Large and Fine-Tipped Needle Holder;70
9.1.1.4.4;4.1.4.4 Toothed Forceps;70
9.1.1.4.5;4.1.4.5 Trephine Blades;71
9.1.1.4.6;4.1.4.6 Radial Marker;71
9.1.1.4.7;4.1.4.7 Cornea Punch;72
9.1.1.4.8;4.1.4.8 Cutting Block;72
9.1.1.4.9;4.1.4.9 Scissors;72
9.1.1.4.10;4.1.4.10 Cannulas and Blades;72
9.1.1.5;4.1.5 Preoperative Medications;73
9.1.1.6;4.1.6 Penetrating Keratoplasty Surgical Procedure;73
9.1.1.6.1;4.1.6.1 Placement of the Scleral Fixation Ring;74
9.1.1.6.2;4.1.6.2 Marking of the Host Cornea;74
9.1.1.6.3;4.1.6.3 Sizing of the Trephine;74
9.1.1.6.4;4.1.6.4 Trephination of the Host Cornea;74
9.1.1.6.5;4.1.6.5 Trephination of the Donor Cornea;75
9.1.1.6.6;4.1.6.6 Removal of the Host Cornea;75
9.1.1.6.7;4.1.6.7 Placement of the Donor Cornea Tissue in the Host Stromal Bed;75
9.1.1.6.8;4.1.6.8 Placement of the Cardinal Sutures;75
9.1.1.6.9;4.1.6.9 Completion of Suturing;76
9.1.1.6.10;4.1.6.10 Suture Techniques;76
9.1.1.6.11;4.1.6.11 Subconjunctival Medications;76
9.1.1.7;4.1.7 Intraoperative Complications;76
9.1.1.7.1;4.1.7.1 Scleral Perforation;77
9.1.1.7.2;4.1.7.2 Damage to the Donor Button;77
9.1.1.7.3;4.1.7.4 Posterior Capsule Rupture;77
9.1.1.7.4;4.1.7.5 Vitreous Loss;77
9.1.1.7.5;4.1.7.6 Anterior Chamber Hemorrhage;78
9.1.1.7.6;4.1.7.7 Choroidal Hemorrhage;78
9.1.1.8;4.1.8 Postoperative Management;78
9.1.1.8.1;4.1.8.1 Postoperative Immunosuppressive Regimen;79
9.1.1.9;4.1.9 Postoperative Complications;79
9.1.1.9.1;4.1.9.1 Wound Leaks;79
9.1.1.9.2;4.1.9.2 Epithelial Defects;79
9.1.1.9.3;4.1.9.3 Suture-Related Problems;80
9.1.1.9.4;4.1.9.4 Increased Intraocular Pressure;80
9.1.1.9.5;4.1.9.5 Post-Keratoplasty Astigmatism;81
9.1.1.10;4.1.10 Correction of Post-keratoplasty Astigmatism;82
9.1.1.10.1;4.1.10.1 Wedge Resections and Compression Sutures;82
9.1.1.10.2;4.1.10.2 Relaxing Incisions;82
9.1.1.10.3;4.1.10.3 LASIK;82
9.1.1.10.4;4.1.10.4 Photorefractive Keratectomy with Mitomycin C;83
9.1.1.11;4.1.11 Corneal Allograft Rejection;83
9.1.1.11.1;4.1.11.1 Host Risk Factors;84
9.1.1.11.2;4.1.11.2 Vascularized Corneas;84
9.1.1.11.3;4.1.11.3 Prior Graft Loss;84
9.1.1.11.4;4.1.11.4 Graft Diameter;84
9.1.1.11.5;4.1.11.5 Anterior Synechiae;85
9.1.1.11.6;4.1.11.6 Previous Intraocular Surgery;85
9.1.1.11.7;4.1.11.7 Herpes Simplex;85
9.1.1.12;4.1.12 Treatment of Allograft Rejection;86
9.1.1.13;4.1.13 Large Diameter Penetrating Keratoplasty;87
9.1.1.14;4.1.14 Summary;88
9.1.1.15;References;89
10;Chapter 5;91
10.1;4.2 Descemet’s Stripping Endothelial Keratoplasty;91
10.1.1;4.2.1 Introduction;91
10.1.2;4.2.2 Descemet’s Stripping Endothelial Keratoplasty Surgical Technique;92
10.1.2.1;4.2.2.1 Donor Cornea Preparation;93
10.1.2.2;4.2.2.2 Host Cornea Preparation;93
10.1.2.3;4.2.2.3 Insertion of the Donor Cornea;93
10.1.3;4.2.3 Postoperative Medications;93
10.1.4;4.2.4 Donor Dislocation Risks;94
10.1.5;4.2.5 Repositioning Donor Tissue;94
10.1.6;4.2.6 Treatment of Rejection Episodes;94
10.1.7;4.2.7 Visual and Refractive Outcomes;95
10.1.8;4.2.8 Other Complications;95
10.1.9;4.2.9 Summary;95
10.1.10;References;96
11;Chapter 6;97
11.1;4.3 Pterygium;97
11.1.1;4.3.1 Introduction;97
11.1.2;4.3.2 Treatment of Pterygium;97
11.1.3;4.3.3 Surgical Technique;98
11.1.3.1;4.3.3.1 Removal of the Pterygium;98
11.1.3.2;4.3.3.2 Harvesting the Conjunctival Autograft;98
11.1.3.3;4.3.3.3 Securing the Conjunctival Autograft;99
11.1.3.4;4.3.3.4 Fibrin Glue vs. Nylon Sutures;99
11.1.4;4.3.4 Postoperative Management;99
11.1.5;4.3.5 Recurrent Pterygium;101
11.1.6;4.3.6 Other Techniques in Pterygium Removal;101
11.1.6.1;4.3.6.1 Bare Scleral Technique;101
11.1.6.2;4.3.6.2 Adjunctive Agents;101
11.1.6.2.1;Mitomycin C;101
11.1.6.2.2;Beta-Irradiation;102
11.1.6.3;4.3.6.3 Amniotic Membrane Transplantation;102
11.1.6.4;4.3.6.4 Various Techniques in Conjunctival Autografting;102
11.1.7;4.3.7 Complications in Pterygium Removal;103
11.1.8;4.3.8 Summary;103
11.1.9;References;104
12;Chapter 7;105
12.1;Minimally Invasive Refractive Surgery;105
12.1.1;5.1 Trends in Refractive Surgery;105
12.1.2;5.2 Introduction;105
12.1.3;5.3 Cornea Refractive Surgery;106
12.1.3.1;5.3.1 Laser In Situ Keratomileusis (LASIK);106
12.1.3.1.1;5.3.1.1 Advances in Flap Creation Technology;106
12.1.3.1.1.1;Microkeratomes;106
12.1.3.1.1.2;Femtosecond Laser;107
12.1.3.1.2;5.3.1.2 Technological Advances in Laser Delivery Platforms;110
12.1.3.1.3;5.3.1.3 Faster Excimer Lasers;110
12.1.3.1.4;5.3.1.4 Reduction of Collateral Thermal Tissue Damage;111
12.1.3.1.5;5.3.1.5 Advanced Eye Trackers;112
12.1.3.1.6;5.3.1.6 Newer Ablation Profi les;114
12.1.3.2;5.3.2 PRK and Advanced Surface Ablations (ASA);114
12.1.3.2.1;5.3.2.1 Decrease Thermal Load on the Cornea;114
12.1.3.2.2;5.3.2.2 Use of Wound-Healing Modulators;115
12.1.3.2.3;5.3.2.3 Trend Towards EPI-LASIK;115
12.1.3.3;5.3.3 Summary;116
12.1.4;5.4 Intraocular Refractive Surgery;116
12.1.4.1;5.4.1 Phakic Intraocular Lens Surgery;116
12.1.4.1.1;5.4.1.1 Advances in Diagnostic Equipment;117
12.1.4.1.2;5.4.1.2 Types of Phakic Intraocular Lens;118
12.1.4.1.3;5.4.1.3 Kelman-Duet Phakic Intraocular Lens;118
12.1.4.1.3.1;Lens Design;118
12.1.4.1.3.2;Surgical Technique;118
12.1.4.1.3.2.1;Pre-Operative Preparation;118
12.1.4.1.3.3;Operative Procedure;119
12.1.4.1.3.3.1;Post-Operative Care;119
12.1.4.1.3.4;Results;119
12.1.4.1.3.4.1;Refractive Outcomes;119
12.1.4.1.3.4.2;Corneal Endothelium;119
12.1.4.1.4;5.4.1.4 Visian Implantable Collamer Lens;122
12.1.4.1.4.1;Lens Design;122
12.1.4.1.4.2;Surgical Technique;122
12.1.4.1.4.2.1;Pre-Operative Preparation;122
12.1.4.1.4.2.2;Operative Procedure;122
12.1.4.1.4.2.3;Post-Operative Care;123
12.1.4.1.5;5.4.1.5 Results;123
12.1.4.2;5.4.2 Summary;123
12.1.5;5.5 Lens and Cataract Surgery;123
12.1.5.1;5.5.1 Surgery: Micro-Incisional Cataract Surgery (MICS);124
12.1.5.2;5.5.2 The Ideal MICS Intraocular Lens;125
12.1.5.2.1;5.5.2.1 Aspheric Intraocular Lenses;125
12.1.5.2.2;5.5.2.2 Toric Intraocular Lenses;125
12.1.5.2.3;5.5.2.3 ACRI.LISA 366D and ACRI.LISA TORIC 466TD;126
12.1.5.2.3.1;Lens Design;126
12.1.5.2.4;5.5.2.4 Surgical Technique;126
12.1.5.2.4.1;Operative Procedure;126
12.1.5.2.4.2;Post-Operative Care;127
12.1.5.2.5;5.5.2.5 Results;127
12.1.5.3;5.5.3 Summary;127
12.1.6;5.6 The Future: Beyond the Horizon of Refractive Surgery Today;127
12.1.7;Reference;128
13;Chapter 8;131
13.1;Minimally Invasive Strabismus Surgery;131
13.1.1;6.1 Introduction;131
13.1.2;6.2 Nonsurgical Treatment;131
13.1.3;6.3 Types and Classifi cation of Conjunctival Openings;132
13.1.4;6.4 Rectus Muscle Procedures;132
13.1.4.1;6.4.1 MISS Rectus Muscle Recession;134
13.1.4.2;6.4.2 MISS Rectus Muscle Plication;137
13.1.4.3;6.4.3 Parks’ Rectus Muscle Recession;137
13.1.4.4;6.4.4 Parks’ Rectus Muscle Plication;137
13.1.4.5;6.4.5 MISS Rectus Muscle Posterior Fixation Suture;139
13.1.4.6;6.4.6 Priglinger’s Rectus Muscle Y-Split Recession;140
13.1.4.7;6.4.7 MISS Rectus Muscle Repeat Surgery;140
13.1.4.8;6.4.8 MISS Rectus Muscle Transposition Surgery;145
13.1.5;6.5 Oblique Muscle Procedures;147
13.1.5.1;6.5.1 MISS Inferior Oblique Muscle Recession;149
13.1.5.2;6.5.2 MISS Inferior Oblique Muscle Plication;150
13.1.5.3;6.5.3 MISS Superior Oblique Muscle Recession;150
13.1.5.4;6.5.4 MISS Superior Oblique Muscle Plication;151
13.1.5.5;6.5.5 Boergen’s Modifi ed Harada-Ito Operation;151
13.1.5.6;6.5.6 Mühlendyck’s Partial Posterior Superior Oblique Tenectomy for Congenital Brown’s Syndrome;151
13.1.6;6.6 Postoperative Handling;154
13.1.7;6.7 Specifi c Complications of MISS;154
13.1.7.1;6.7.1 Intraoperative Complications;154
13.1.7.2;6.7.2 Postoperative Complications;156
13.1.8;6.8 Suggestions on How to Start Doing MISS;157
13.1.8.1;6.8.1 Instruments Suitable for MISS;157
13.1.8.2;6.8.2 Suture Materials Used for MISS;158
13.1.8.3;6.8.3 General Remarks Regarding MISS Procedures;159
13.1.8.4;6.8.4 MISS Dose–Response Relationships;159
13.1.9;References;160
14;Chapter 9;161
14.1;Minimally Invasive Iris Surgery;161
14.1.1;7.1 Instrumentation;161
14.1.2;7.2 Sutures;161
14.1.3;7.3 Surgical Principles of Iris Suturing;161
14.1.3.1;7.3.1 Mobilization;161
14.1.3.2;7.3.2 Intraocular Suturing and Knot Tying;162
14.1.3.3;7.3.3 Reattachment of Iris to Sclera;163
14.1.3.4;7.3.4 Pupil Repair;165
14.1.3.5;7.3.5 Adjunctive Pupil Repair Techniques;167
14.1.4;References;167
15;Chapter 10;168
15.1;Minimally Invasive Glaucoma Surgery;168
15.1.1;Introduction;168
15.1.2;8.1 Deep Sclerectomy: A Nonpenetrating Filtering Surgery;168
15.1.2.1;8.1.1 Introduction to Deep Sclerectomy;168
15.1.2.2;8.1.2 Anesthesia;169
15.1.2.3;8.1.3 Surgical Technique;169
15.1.2.3.1;8.1.3.1 Preparation;169
15.1.2.3.2;8.1.3.2 Superfi cial Flap Preparation;170
15.1.2.3.3;8.1.3.3 Deep Flap Preparation;170
15.1.2.3.4;8.1.3.4 Dissection of the Trabeculo-Descemet’s Membrane;171
15.1.2.3.5;8.1.3.5 Peeling of Schlemm’s Canal and Juxtacanalicular Meshwork;172
15.1.2.3.6;8.1.3.6 Drainage Device;173
15.1.2.3.7;8.1.3.7 Wound Closure;173
15.1.2.4;8.1.4 Postoperative Management and Medication;174
15.1.2.4.1;8.1.4.1 Medication;174
15.1.2.4.2;8.1.4.2 Management;174
15.1.2.5;8.1.5 Adjunctive Treatments;175
15.1.2.5.1;8.1.5.1 Bleb Needling;175
15.1.2.5.2;8.1.5.2 Nd:YAG Goniopuncture;175
15.1.2.6;8.1.6 Complications and Management;175
15.1.2.6.1;8.1.6.1 General;175
15.1.2.6.2;8.1.6.2 Perioperative Complications;176
15.1.2.6.3;8.1.6.3 Early Postoperative Complications;176
15.1.2.6.4;8.1.6.4 Late Postoperative Complications;177
15.1.3;References;178
16;Chapter 11;179
16.1;8.2 Minimally Penetrating Glaucoma Surgery with the Ex-PRESS™ Miniature Shunt;179
16.1.1;8.2.1 Introduction to Glaucoma Surgery with the Ex-PRESS™;179
16.1.1.1;8.2.1.1 Indications for MPGS with the Ex-PRESS™ Mini-Shunt Under a Scleral Flap;180
16.1.1.1.1;Open-Angle Glaucoma;180
16.1.1.1.2;Pigmentary Glaucoma;180
16.1.1.1.3;Pseudoexfoliation Glaucoma;181
16.1.1.1.4;Aphakic Glaucoma;181
16.1.1.1.5;Sturge–Weber Syndrome;181
16.1.1.1.6;Glaucoma Secondary to Uveitis;181
16.1.1.2;8.2.1.2 Relative Contraindications for MPGS with the Ex-PRESS™ Mini-Shunt Under a Scleral Flap;181
16.1.1.2.1;Congenital and Juvenile Glaucoma;181
16.1.1.2.2;Aniridia and Anterior Segment Dysgenesis Syndromes;182
16.1.1.2.3;Narrow-Angle Glaucoma;182
16.1.1.2.4;Posttrauma Angle-Recession Glaucoma;182
16.1.1.2.5;Neovascular Glaucoma;182
16.1.1.3;8.2.1.3 Absolute Contraindications for MPGS with the Ex-PRESS™ Mini-Shunt Under a Scleral Flap;182
16.1.1.3.1;Narrow-Angle Glaucoma in a Young Patient;182
16.1.1.3.2;Pseudophakic Glaucoma with an A/C IOL;182
16.1.1.4;8.2.1.4 Preoperative Considerations;182
16.1.2;8.2.2 Anesthesia;183
16.1.3;8.2.3 Surgical Technique and Potential Modifications;183
16.1.4;8.2.4 Postoperative Management and Medication;186
16.1.5;8.2.5 Outcomes and Comparison with Other Techniques;186
16.1.6;8.2.6 Complications and Management;186
16.1.6.1;8.2.6.1 General;186
16.1.6.2;8.2.6.2 Specifi c to the Technique;187
16.1.6.3;8.2.6.3 Several Characteristics of the Ex-PRESS™ Are Unique;187
16.1.6.4;8.2.6.4 Summary and Key Points;188
16.1.7;References;188
17;Chapter 12;190
17.1;8.3 New Minimally Invasive, Sclerothalamotomy Ab Interno Surgical Technique;190
17.1.1;8.3.1 Introduction to the Sclerothalamotomy Ab Interno;190
17.1.1.1;8.3.1.1 Indications for the Sclerothalamotomy Ab Interno;190
17.1.2;8.3.2 Anesthesia;190
17.1.3;8.3.3 Surgical Technique;190
17.1.3.1;8.3.3.1 Preparation;191
17.1.3.2;8.3.3.2 Diathermy Probe Insertion;191
17.1.4;8.3.4 Postoperative Management and Medication;192
17.1.5;8.3.5 Outcomes and Comparison with Other Techniques;192
17.1.6;8.3.6 Complications and Management;193
17.1.6.1;8.3.6.1 General;193
17.1.6.2;8.3.6.2 Specifi c to the Technique;193
17.1.6.3;8.3.6.3 Conclusions;195
17.1.7;References;196
18;Chapter 13;198
18.1;8.4 Glaukos® iStent® Trabecular Micro-Bypass Implant;198
18.1.1;8.4.1 Introduction to Glaucoma Surgery with a Micro-Bypass Implant;198
18.1.1.1;8.4.1.1 Indications for Implantation of Glaukos® iStent® Micro-Bypass Implant;199
18.1.1.1.1;Type of Glaucoma;199
18.1.1.1.2;Stage of Glaucoma;199
18.1.1.1.3;Combined Surgery;199
18.1.1.2;8.4.2 Anesthesia;200
18.1.1.3;8.4.3 Surgical Technique;200
18.1.1.3.1;8.4.3.1 Preparation;200
18.1.1.3.2;8.4.3.2 Implantation of the Micro-Bypass Stent;200
18.1.1.4;8.4.4 Postoperative Management and Medication;201
18.1.1.5;8.4.5 Outcomes and Combination with Other Techniques;201
18.1.1.5.1;8.4.5.1 Trabecular Implant in Refractory Glaucoma Patients;201
18.1.1.5.2;8.4.5.2 Phacoemulsifi cation Cataract Surgery Combined with Implantation of a Trabecular Stent;202
18.1.1.5.3;8.4.5.3 Phacoemulsifi cation Cataract Surgery Combined with Implantation of Two Trabecular Implants;203
18.1.1.6;8.4.6 Conclusions;203
18.1.1.7;References;203
19;Chapter 14;205
19.1;Minimally Invasive Cataract Surgery;205
19.1.1;9.1 Instrument List;205
19.1.2;9.2 Topical Anesthesia Protocol;207
19.1.2.1;9.2.1 Topical Technique;207
19.1.2.1.1;9.2.1.1 Materials;207
19.1.2.1.2;9.2.1.2 Procedures;207
19.1.2.1.3;9.2.3.3 Operating Room;207
19.1.2.1.4;9.2.3.4 Helpful Hints;209
19.1.3;9.3 Surgical Procedure;209
19.1.3.1;9.3.1 Incision Construction;209
19.1.3.2;9.3.2 Capsulorhexis;211
19.1.3.3;9.3.3 Hydrodissection and Hydrodelineation;212
19.1.3.4;9.3.4 Chopping and Phacoemulsifi cation;214
19.1.3.5;9.3.5 Cortical Clean-up;217
19.1.3.6;9.3.6 Limbal Relaxing Incisions;217
19.1.3.7;9.3.7 IOL Implantation;217
19.1.3.8;9.3.8 Stromal Hydration and Testing of Incisions;217
19.1.4;9.4 Postoperative Management;218
19.1.5;References;218
19.1.6;Appendix 1;220
19.1.7;Appendix 2;221
19.1.8;Appendix 3;222
19.1.9;Appendix 4;223
19.1.10;Appendix 5;224
20;Chapter 15;225
20.1;Minimally Invasive Vitreoretinal Surgery;225
20.1.1;10.1 Introduction;225
20.1.2;10.2 Microincision Vitrectomy;225
20.1.2.1;10.2.1 Models of Wound Architecture;227
20.1.2.2;10.2.2 Vitrectomy;227
20.1.2.3;10.2.3 Adjuncts;228
20.1.2.4;10.2.4 Common Surgical Techniques;229
20.1.2.4.1;10.2.4.1 Macular Surgery;230
20.1.2.4.2;10.2.4.2 Proliferative Diabetic Retinopathy;231
20.1.2.4.3;10.2.4.3 Retinal Detachment;231
20.1.2.4.4;10.2.4.4 Pediatric Vitreoretinal Surgery;232
20.1.2.5;10.2.5 Complications;232
20.1.2.6;10.2.6 Future Developments in Minimally Invasive Vitrectomy;232
20.1.3;10.3 Endoscopic Vitreoretinal Surgery;233
20.1.3.1;10.3.1 Introduction;233
20.1.3.2;10.3.2 History and Development of Endoscopic Ophthalmic Surgery;233
20.1.3.3;10.3.3 The Endoscope;233
20.1.3.4;10.3.4 Applications of Intraocular Endoscopy;234
20.1.3.4.1;10.3.4.1 Media Opacity;234
20.1.3.4.2;10.3.4.2 Subretinal Fluid Drainage and Fluid–Gas Exchange;234
20.1.3.4.3;10.3.4.3 PVR and Subretinal Surgery;235
20.1.3.4.4;10.3.4.4 Retained Lens Fragments;235
20.1.3.4.5;10.3.4.5 Anterior and Retrolental Vitrectomy in Malignant Glaucoma;235
20.1.3.4.6;10.3.4.5 Sutured IOL and ECP;235
20.1.3.5;10.3.5 Limitations and Challenges;235
20.1.4;10.4 Future Directions of Minimally Invasive Vitreoretinal Surgery;236
20.1.5;References;236
21;Index;240