Current Advances in Ocular Surgery (Current Practices in Ophthalmology)

Description

​The book discusses innovations in surgical techniques and procedures in multiple ophthalmic subspecialties with an evidence based approach.With the rapid development of the field of ophthalmology over the last 10 years, from the development of ever more sophisticated ocular diagnostic technology, to the development of novel medical therapies, ophthalmologists have seen dramatic advancements in the care of their patients.The book highlights various ophthalmic surgical techniques that have been devised, modified, and refined over the last decade, allowing ophthalmic surgeons to achieve surgical perfection. It includes illustrations, clinical photos, videos of surgical procedure. It includes easy to follow salient points in each chapter.This volume of the Current Practices in Ophthalmology book series serves as a valuable resource for post graduate residents in ophthalmology, practicing ophthalmologists, subspecialty fellows, vision science researchers, and general ophthalmologists. Preface Contents About the Editors Part I: Surgical Innovations for Adnexal and Oculoplastics 1: Injectables: Aesthetics and Cosmetics 1.1 Soft Tissue Filler 1.1.1 Introduction 1.1.2 Clinical Applications 1.1.3 Categories of Dermal Filler 1.1.3.1 Non-biodegradable Fillers Poly-Methyl Methacrylate (PMMA) Silicone Polyalkylimide 1.1.3.2 Biodegradable Fillers Collagen Calcium Hydroxyapatite (CaHA) Poly-l-Lactic Acid (PLLA) Hyaluronic Acid Fillers (HA) Patient Selection and Evaluation Contraindications 1.1.4 Preparation and Post-Operative Care 1.1.4.1 Antiseptic Technique 1.1.4.2 Post-Procedural Care 1.1.5 Injection Techniques 1.1.5.1 Linear Threading (Anterograde and Retrograde) 1.1.5.2 Serial Puncture and Depot Injections 1.1.5.3 Fanning and Cross Hatching 1.1.6 Anatomical Considerations and Techniques 1.1.6.1 Forehead and Glabellar Furrows 1.1.6.2 Forehead and Temporal Fossa 1.1.7 Periorbital Region 1.1.7.1 Eyebrows 1.1.7.2 Superior Sulcus 1.1.7.3 Tear Troughs 1.1.8 Midface and Nasolabial Folds 1.1.8.1 Cheek 1.1.8.2 Nasolabial Folds Augmentation 1.1.8.3 Nose 1.1.9 Lower Face 1.1.9.1 Perioral Region 1.1.9.2 Marionette Lines and the Oral Commissure 1.1.9.3 Labiomental Fold and the Chin Apex 1.1.9.4 Jawline 1.1.10 Soft Tissue Filler Complications 1.1.10.1 Technique for Reversal 1.1.10.2 Ecchymosis 1.1.10.3 Infection and Biofilm Production 1.1.10.4 Granulomas 1.1.10.5 Improper Filler Placement or Migrated Filler 1.1.10.6 Skin Necrosis 1.1.10.7 Ophthalmic Complications 1.2 Botulinum Toxins 1.2.1 Introduction 1.2.2 Clinical Applications 1.2.3 Mechanism of Action 1.2.4 Patient Selection and Evaluation 1.2.5 Contraindications 1.2.6 Preparation and Post-Operative Care 1.2.6.1 Preparation and Storage 1.2.6.2 Post-Procedural Care 1.2.7 Injection Techniques 1.2.8 Anatomical Considerations and Techniques 1.2.8.1 Frontalis 1.2.8.2 Glabella 1.2.8.3 Orbicularis Oculi 1.2.8.4 Pharmacologic Brow Contouring 1.2.8.5 Nasal Rhytids 1.2.8.6 Perioral Region 1.2.8.7 Masseter 1.2.8.8 Mentalis 1.2.8.9 Platysma 1.2.9 Botulinum Toxins Complications 1.2.10 Injection Site Reactions 1.2.11 Under-Correction 1.2.12 Ptosis 1.2.13 Brow Ptosis 1.2.14 Brow Asymmetry 1.2.15 Diplopia, Lagophthalmos, and Dry Eyes 1.2.16 Lip Ptosis 1.2.17 Dysphagia 1.2.18 Systemic Complications 1.2.19 Future Directions References 2: Fornix Reconstruction 2.1 Mucous Membrane Substitution 2.1.1 Contralateral Conjunctiva 2.1.2 Buccal or Labial Mucous Membrane 2.1.3 Nasal Mucosa Graft 2.1.4 Hard Palate Graft 2.1.5 Dermis Fat Graft 2.1.6 Temporoparietal Fascial Flap 2.1.7 Tarsoconjunctival Flap 2.1.8 Amniotic Membrane Graft 2.2 Forniceal Deepening 2.3 Maintaining Separation of Healing Surfaces 2.4 Summary References Part II: Surgical Innovations for Cataract 3: Capsulotomy and Lens Fragmentation 3.1 Anterior Capsulotomy: Manual Curvilinear Capsulorhexis, Femtosecond Laser Capsulotomy, and Precision Pulse Capsulotomy 3.1.1 Historical Perspective 3.1.2 Adequacy of Capsulotomy for Successful Cataract Surgery 3.1.3 Introduction to Femtosecond Laser Capsulotomy (FSLC) 3.1.4 Applications of Femtosecond Laser Capsulotomy (FLSC) 3.1.5 Introduction to Precision Pulse Capsulotomy (Zepto) 3.1.6 Applications of Precision Pulse Capsulotomy 3.2 Lens Fragmentation: Femtosecond Laser-Assisted and Micro-Interventional Lens Fragmentation 3.2.1 Historical Perspective 3.2.2 Introduction to Femtosecond Laser (FSL) for Cataract Lens Fragmentation 3.2.3 Applications for Femtosecond Laser Lens Fragmentation 3.2.4 Introduction to Micro-Interventional Lens Fragmentation 3.2.5 Applications of the miLOOP 3.2.6 Conclusion and Future Directions References 4: Scleral-Fixated Intraocular Lenses 4.1 Introduction 4.2 Background 4.3 Indications and Risk Factors 4.3.1 Subluxation/Dislocation of the Lens 4.3.2 Inadequate Capsular Support 4.4 Glued Intrascleral Haptic Fixation of an IOL (Glued IOL) 4.4.1 Lens and Suture Selection 4.4.2 Surgical Technique 4.4.3 Modifications to the Surgical Technique 4.4.4 Outcomes 4.5 Flanged Intrascleral IOL Fixation with Double-Needle Technique (Yamane Technique) 4.5.1 Lens and Suture Selection 4.5.2 Surgical Technique 4.5.3 Outcomes 4.6 Canabrava Four-Flanged Scleral Fixation Technique 4.6.1 Lens and Suture Selection 4.6.2 Four-Flanged Scleral Fixation of a Two-Eyelet Non-Foldable IOL 4.6.3 Four-Flanged Scleral Fixation of a Four-Eyelet Foldable IOL 4.6.4 Outcomes 4.7 McCabe Belt Loop Technique for Scleral Fixation 4.7.1 Lens and Suture Selection 4.7.2 Surgical Technique 4.7.3 Outcomes 4.8 Complications 4.8.1 Complications in Glued SFIOL 4.8.2 Complications in Flanged, Double-Needle SFIOL 4.8.3 Complications in Canabrava and McCabe Belt Loop SFIOL 4.9 Comparisons between Scleral Fixation Techniques 4.10 Conclusion References 5: Iris Implants 5.1 Indications for Artificial Iris Device Implantation 5.2 Types and Manufacturers of Iris Prostheses 5.2.1 Morcher 5.2.2 Ophtec 5.2.3 HumanOptics 5.2.4 Reper-NN 5.3 Selecting an Appropriate Device 5.4 Surgical Technique 5.5 Complications of Artificial Iris Implantation 5.6 Device Availability 5.7 Future Directions References 6: New Lenses 6.1 Introduction 6.2 Terminology 6.3 New Classification 6.3.1 Small-Aperture IOLs 6.3.1.1 The IC8-IOL (Acufocus Inc.) 6.3.2 Wavefront-Correcting IOLs 6.3.2.1 The Mini Well IOL (Sifi Medtech) 6.3.2.2 The Vivity IOL DFT015 (Alcon) 6.4 Full Range of Focus Lenses 6.4.1 RAYNER Sulcoflex Trifocal® References Part III: Surgical Innovations for Refractive Procedures 7: Laser Surface Ablation Procedures 7.1 Introduction 7.2 Surface Ablation 7.2.1 Photorefractive Keratectomy 7.2.2 Transepithelial PRK 7.2.3 Phototherapeutic Keratectomy 7.2.4 Conclusion References 8: Small Incision Lenticule Extraction 8.1 Indications of SMILE Surgery 8.2 Preoperative Preparations 8.2.1 Patient Preparations 8.2.2 Instrument Preparation 8.3 Surgical Design and Procedure 8.3.1 Surgical Design 8.3.1.1 Corneal Cap 8.3.1.2 Lenticule 8.3.1.3 Incision 8.3.1.4 Energy Setting 8.3.1.5 Nomogram Adjustment 8.4 Surgical Procedures 8.4.1 Anesthesia 8.4.2 Docking 8.4.3 Centration 8.4.4 Lenticule Creation 8.4.5 Lenticule Separation and Extraction 8.4.6 Surgical Sequence Selection 8.4.7 Incision Management 8.4.8 Postoperative Management 8.5 Complications and Managements 8.5.1 Intraoperative Complications 8.5.1.1 Suction Loss 8.5.1.2 Opaque Bubble Layer (OBL) 8.5.1.3 Appearance of “Black Areas” in the Scanned Area 8.5.1.4 Difficulties in Identifying the Stromal Lenticule 8.5.1.5 Difficulties in Lenticule Separation 8.5.1.6 Tears at the Incision or Cap 8.5.1.7 Lenticular Tear or Remnant 8.5.1.8 Decentered Lenticule 8.5.1.9 Foreign Body Beneath the Cap (Interface Debris) 8.5.1.10 Bleeding 8.5.2 Postoperative Complications 8.5.2.1 Diffuse Lamellar Keratitis (DLK) 8.5.2.2 Corneal Stromal Haze 8.5.2.3 Corneal Striae or Folds 8.5.2.4 Epithelial Island or Epithelial Ingrowth 8.5.2.5 Infection 8.5.2.6 Corneal Sterile Infiltrates 8.5.2.7 Dry Eye 8.5.2.8 Symptoms of Poor Vision: Cloudy Vision, Glare, and Halo 8.5.2.9 Regression or Under-Correction 8.6 Refractive Outcomes of SMILE 8.6.1 Long-Term Outcomes 8.6.2 Outcomes of High Myopia 8.6.3 Outcomes of Myopic Astigmatism 8.6.4 Outcomes of Higher-Order Aberrations 8.7 Advantages of SMILE 8.7.1 Stability of Corneal Biomechanics 8.7.2 Less Corneal Damage and Faster Corneal Nerve Recovery 8.7.3 Wound Healing 8.8 Lenticule Tissue Applications 8.9 Future Directions References 9: Phakic Intraocular and Implantable Collamer Lenses 9.1 Introduction 9.2 Types of PIOL 9.3 Indications and Contraindications 9.4 Preoperative Evaluation 9.5 Sizing of the ICL 9.6 Surgical Technique 9.7 Outcomes 9.8 Complications 9.8.1 Endothelial Cell Loss 9.8.2 Glaucoma 9.8.3 Cataract 9.9 Future Directions References 10: Corneal Cross-Linking 10.1 Background 10.2 Indications 10.3 Contraindications 10.4 Procedure 10.5 Postoperative Care 10.6 Complications 10.7 Variations of Standard Technique 10.7.1 Modifications to Riboflavin Delivery 10.7.2 Modifications to UV Exposure 10.7.3 Modifications to Oxygen Availability 10.8 Treatment Outcomes 10.9 CXL-Plus (“Refractive-Plus”) 10.9.1 Conductive Keratoplasty 10.9.2 Surface Ablation 10.9.3 Phakic IOLs 10.9.4 LASIKxtra 10.10 Future Directions/Novel Uses References Part IV: Surgical Innovations for Cornea and External Diseases 11: Simple Limbal Epithelial Transplantation 11.1 Introduction and History 11.2 Indications 11.3 Contraindications and Poor Prognostic Factors 11.4 Surgical Technique 11.5 Postoperative Care and Follow-Up 11.6 Advantages 11.7 Complications 11.8 Modifications and Recent Advances 11.9 Outcomes 11.10 Concluding Remarks and Future Directions References 12: Updates on Therapy for Cornea Edema References 13: Corneal Neurotization 13.1 Introduction 13.2 Neurotrophic Keratopathy 13.2.1 Anatomy and Pathophysiology 13.2.2 Diagnosis and Clinical Presentation 13.2.3 Management 13.3 Development and Physiology of Corneal Neurotization 13.3.1 History 13.3.2 Corneal Nerve Regeneration and Functionality 13.4 Modern Corneal Neurotization Techniques 13.4.1 Anatomy of Donor Nerves and Coaptation 13.4.2 Direct Approaches (Table 13.1) 13.4.3 Nerve Graft-Based (“Indirect”) Approaches (Table 13.2) 13.4.4 Comparative Analysis and Outcomes 13.5 Current Limitations and Controversies 13.6 Future Directions References 14: Keratoprosthesis 14.1 Introduction 14.2 Design 14.3 Indications 14.3.1 Inclusion and Exclusion Criteria 14.3.2 Implications of the Underlying Indication on Outcomes 14.3.3 Specific Indications and Considerations for Keratoprosthesis Implantation 14.3.3.1 Prior Graft Failure 14.3.3.2 Limbal Stem Cell Deficiency 14.3.3.3 Primary Keratoprosthesis Implantation Chronic Hypotony and Pre-Phthisis 14.3.3.4 Pediatric Keratoprosthesis Implantation 14.3.3.5 Bilateral Keratoprosthesis Implantation 14.4 Preoperative Evaluation 14.4.1 Eyelid and Blink Function Assessment 14.4.2 Ocular Surface and Anterior Segment Examination 14.4.3 Evaluation of Glaucoma Status 14.4.4 Posterior Segment Evaluation and Assessment of Potential for Vision 14.5 Surgical Technique and Intraoperative Considerations 14.6 Postoperative Management 14.6.1 Antimicrobial Prophylaxis 14.6.2 Bandage Contact Lens 14.6.3 Glaucoma Management 14.6.3.1 Other Considerations 14.7 Outcomes 14.7.1 Visual Outcomes 14.7.2 Retention Outcomes 14.8 Complications 14.8.1 Retroprosthetic Membrane 14.8.2 Glaucoma 14.8.3 Sterile Corneal Necrosis 14.8.4 Infectious Keratitis 14.8.5 Endophthalmitis 14.8.6 Idiopathic Vitritis 14.8.7 Other Posterior Segment Complications 14.8.7.1 Hypotony 14.9 Future Directions References Part V: Surgical Innovations for Glaucoma 15: Microinvasive Glaucoma Surgery 15.1 Introduction 15.2 Schlemm’s Canal Devices/Procedures 15.2.1 Trabectome 15.2.2 iStent and iStent Inject 15.2.3 Kahook Dual Blade 15.2.4 Hydrus Microstent 15.3 Ab Interno Trabeculotomy Procedures and Devices 15.3.1 Gonioscopy-Assisted Transluminal Trabeculotomy 15.3.2 Omni 15.4 Suprachoroidal Devices 15.4.1 Cypass 15.4.2 iStent Supra 15.5 Subconjunctival Devices 15.5.1 XEN® Gel Stent 15.5.2 PRESERFLO (InnFocus) MicroShunt 15.6 Cycloablation Procedures 15.6.1 Endoscopic Cyclophotocoagulation 15.7 Economic and Quality of Life Considerations 15.8 Ethical Considerations 15.9 Quality of Evidence 15.10 Conclusion References 16: Ahmed ClearPath, PAUL Glaucoma Implant, and Aurolab Aqueous Drainage Implant 16.1 Glaucoma Drainage Devices 16.1.1 Preoperative Considerations 16.1.2 Surgical Technique and Pearls 16.1.3 Postoperative Management and Monitoring 16.2 Ahmed Clearpath Glaucoma Drainage Device 16.2.1 Introduction 16.2.2 Features of the Device 16.2.3 Advantages and Disadvantages 16.2.4 Clinical Studies 16.3 AUROLAB Aqueous Drainage Implant 16.3.1 Introduction 16.3.2 Features of the Device 16.3.3 Advantages and Disadvantages 16.3.3.1 Clinical Studies 16.4 PAUL Glaucoma Drainage Implant 16.4.1 Features of the Device 16.4.2 Advantages and Disadvantages 16.5 Clinical Studies 16.6 Special Populations and Considerations 16.7 Future Directions References Part VI: Surgical Innovations for Retina 17: Advances in Vitrectomy 17.1 Introduction 17.2 Advances in Gauge Size 17.3 Advances in Duty Cycle 17.4 Other Advances in Vitreous Cutters 17.5 Advances in Fluidics 17.6 Advances in Forceps and Adjunct Tools 17.7 Advances in Lighting 17.8 Conclusion References 18: Advancements in Visualization 18.1 Introduction 18.2 Addressing the Media 18.3 Wide-Angle Viewing Systems 18.4 Macula Flat Lenses 18.5 Chromovitrectomy 18.6 Endoillumination 18.7 Three-Dimensional Heads-Up Visualization 18.8 Endoscopic Vitrectomy 18.9 Intraoperative Optical Coherence Tomography 18.10 Conclusion 18.11 Future Directions References 19: New Avenues of Delivery (Subretinal Gene Therapy, Port Delivery, Suprachoroidal) 19.1 Introduction 19.2 Subretinal Delivery 19.2.1 Surgical Maneuvers 19.2.2 Gene Therapy 19.2.3 Stem Cell Transplantation 19.2.4 Retinal Implants 19.3 Surgically Implanted Extended-Release Therapeutic 19.3.1 Introduction 19.3.2 The Surgical Implantation of the Port Delivery Device 19.3.3 The Usage and Refill of the Port Delivery Device 19.3.3.1 Ranibizumab PDS System 19.3.4 The Results of the Port Delivery System 19.3.5 Discussion of the Port Delivery System 19.4 Suprachoroidal Delivery 19.5 Conclusion References Part VII: Surgical Innovations for Strabismus 20: Vessel-Sparing Strabismus Surgeries 20.1 Introduction 20.2 Partial Tenotomy 20.2.1 Surgical Technique 20.3 Plication 20.3.1 Surgical Technique 20.4 Vessel-Sparing Transposition Techniques 20.4.1 Surgical Technique 20.4.1.1 Nishida Procedure 20.4.1.2 Superior Rectus Transposition (SRT) 20.4.1.3 Inferior Rectus Transposition (IRT) 20.4.1.4 Vertical Rectus Transposition (VRT) with Adjustable Technique 20.5 Future Directions References