Cornea: Fundamentals, Diagnosis and Management

Front Cover
Front Matter
Copyright
Contents
Video Table of Contents
Preface
Acknowledgments
Dedication
Acknowledgments to the Founding Editors
List of Contributors
PART I Basic Science: Cornea, Sclera, Ocular Adnexa Anatomy, Physiology, and Pathophysiologic Responses
1 - Cornea and Sclera: Anatomy and Physiology
INTRODUCTION
Anatomy and Physiology
Structure of the Cornea and Sclera
Dimensions and Optical Properties of the Cornea
Corneal Epithelium
Limbal Stem Cells and Lineage of Corneal Epithelial Cells
Layered Structure of the Corneal Epithelium
Physiology of the Corneal Epithelium
Stroma of the Cornea and Sclera
Bowman Layer
Structure of the Stroma
Physiology of the Stroma
Endothelium
Descemet Membrane
Endothelial Cells
Physiology of the Endothelium
Innervation
Vascular System
Oxygen and Nutrient Supply
Development of the Anterior Eye Segment
References
2 - The Conjunctiva: Anatomy and Physiology
EMBRYOLOGY
Anatomy
Histology
Mucocutaneous Junction
Palpebral and Forniceal Conjunctiva
Bulbar Conjunctiva
The Corneoscleral Limbus
Conjunctival Goblet Cells
Substantia Propria
Vascular Supply
Lymphatic Drainage
Nerve Supply
Normal Flora
Physiology of the Conjunctiva
References
3 - Tear Film
MACROSTRUCTURE AND FUNCTION
Mucoaqueous Component
Lipid Component
Evaluation of the Tear Film
Optical Coherence Tomography
Tear Film Osmolarity
Tear Film Break-up Time
Tear Production Measurement
Microstructure
Lipidome
Mucins
Proteome
Tear Production
References
4 - Eyelids and the Corneal Surface
Introduction
Anatomy
Eyelid Skin
Eyelid Muscles: Protractors
Orbicularis Oculi
Eyelid Muscles: Retractors
Upper Lid Retractor: Levator Palpebrae Superioris
Upper Lid Retractor: Müller Muscle
Upper Lid Retractor: Frontalis
Lower Lid Retractors
Orbital Septum
Orbital Fat
Tarsus
Meibomian Glands
Conjunctiva
Lacrimal Glands
Eyelid Margin
Canthal Tendons
Lacrimal Drainage System
Vascular Supply
Lymphatic Drainage
Nerves
Blink Reflex and Tear Flow
REFERENCES
5 - A Matrix of Pathologic Responses in the Cornea
ANATOMIC REGIONS OF THE CORNEA
GENERAL PATHOLOGIC RESPONSES OF THE CORNEA
1. Defects and Their Repair
2. Fibrosis and Vascularization
3. Edema and Cysts
4. Inflammation and Immune Responses
5. Deposits
6. Proliferation
Specific Pathologic Responses of the Cornea
1. Defects and Their Repair
2. Fibrosis and Vascularization
3. Edema and Cysts
Epithelial Edema
4. Inflammation and Immune Responses
5. Deposits
Elements
Drugs5
Corneal Dystrophies and Degenerations
6. Proliferation
1. Defects and Their Repair
2. Fibrosis and Vascularization
Subepithelial Avascular Fibrosis
Subepithelial Vascular Fibrosis
3. Edema and Cysts
4. Inflammation and Immune Responses
5. Deposits
6. Proliferation of the Epithelial Basement Membrane
Pathologic Responses of the Corneal Stroma
1. Defects and Their Repair
2. Fibrosis and Vascularization
Stromal Fibrosis
Stromal Vascularization
3. Edema and Cysts
4. Inflammation and Immune Responses
5. Deposits
Topical and Systemic Drugs
Ocular Diseases
Systemic Diseases
Deposits from Dystrophies and Degenerations of the Stroma
6. Proliferation
1. Defects (and Their Repair)
Defects in the Endothelium
Defects in Descemet Membrane
2. Fibrosis and Vascularization Posterior to Descemet Membrane
Posterior Collagenous Layer
Using the Posterior Collagenous Layer to Date the Onset of Endothelial or Descemet Membrane Disease with Transmission Electron M...
3. Edema and Cysts
4. Inflammation and Immune Responses
5. Deposits
Topical and Systemic Drugs
Ocular and Systemic Diseases
Corneal Dystrophies and Degenerations
6. Proliferation
Overview
Cells of Inflammation and the Immune Response
Cells of the Lymphoid System
B Lymphocytes
T Lymphocytes
Null Lymphocytes
Cells of the Myeloid System
Macrophages and the Mononuclear Phagocytic System
Dendritic Cells
Langerhans Cells
Other Cells of the Myeloid System
Polymorphonuclear Leukocytes
Eosinophils
Basophils
Mast Cells
Adhesion Molecules
Cytokines
Chemokines
Complement
Mucosa-Associated Immune System
Lacrimal Functional Unit
Cell-Mediated Immune Response
Major Histocompatibility Complex40
Antigen Presentation and T-Cell Activation40
Cell-Mediated Immune Response
Humoral (Antibody-Mediated) Immune Response
Immunoglobulins
Characteristics of Immunoglobulins40
Anterior Chamber–Associated Immune Deviation
Immune Hypersensitivity Reactions
Type I Hypersensitivity Response (Atopic, Allergic Reactions)
Type II (Cytotoxic) Hypersensitivity Response
Type III Hypersensitivity Response (Immune Complex)
Type IV (Delayed-Type Hypersensitivity) Response
References
PART II Examining and Imaging the Cornea and External Eye
SECTION 1 Basic Evaluation of the Cornea and External Eye
6 - Examination of the Lids
General Principles
History of the Patient
Dermatologic Examination
Eyelid Position
Tear Meniscus and Puncta
Anterior Eyelid
Posterior Eyelid
Meibomian Gland Expression
Mucocutaneous Junction
Meibomian Gland Imaging
References
7 - Slit Lamp Examination and Photography
SECTION I: EXAMINATION
The Instrument
Forms of Illumination
Direct Illumination
Diffuse Illumination
Indirect Illumination
Proximal Illumination
Sclerotic Scatter
Direct and Indirect Retroillumination from the Iris
Retroillumination from the fundus
Transillumination of the Iris
The Peripheral Cornea (Gonioscopy)
Vital Dyes
Section II: Photography
The Instrument
Preparing for Photography
Focus
The Photographic Format
Centration
Control of Artifacts
The Final Image
Color Balance and Sensitivity
. Subject reflectivity is an element of great influence. In recording conditions by direct illumination, levels of subject refle...
. When an electronic flash is used, the duration of exposure is dictated by the 1-ms duration of the flash. The intensity and sh...
Direct Illumination
Diffuse Illumination
Broad-beam Illumination
Optical Section
Combined Direct Focal and Diffused Illumination
Tyndall Light/Anterior Chamber Cells and Flare
Specular Reflection
Indirect Illumination
Proximal Illumination
Sclerotic Scatter
Direct Retroillumination from the Iris
Indirect Retroillumination from the Iris
Retroillumination from the Fundus
Transillumination of the Iris
The Peripheral Cornea
Vital Dyes
. To produce photographs of this technique, the blue filter is placed over the light source, which is set to produce full broad-...
Techniques Specific to Keratoconus
. The Fleischer ring may be documented by using the blue filter described earlier for exciting fluorescein. In this case, the bl...
. This sign is a simple, graphic means of demonstrating the abnormal corneal outline. By asking the patient to look down, the li...
Further Reading
References
8 - Tear Film and Corneal Diagnostic Techniques
INTRODUCTION
Dry Eye Questionnaires
General Inspection
Slit Lamp Examination
Tear Stability
Corneal Staining
Tear Production and Volume
Meibomian Gland Health
Tear Clearance Tests
Point-of-Care Tests
Tear Osmolarity
Inflammatory Biomarkers
Lactoferrin
Devices Used in the Assessment of Dry Eye Disease
Tests of Visual Function
Corneal Imaging
Aesthesiometry
Confocal Microscopy
Conclusion
References
SECTION 2 Laboratory Investigations
9 - Practical Ophthalmic Microbiology for the Detection of Corneal Pathogens
Introduction
Corneal Specimen Collection
Transport Media
Mailing of Diagnostic Specimens
Stains and Cytology Specimens
Bacterial Laboratory Diagnosis
Mycobacteria
Nocardia and Actinomyces
Antibiotic Susceptibility Testing
Laboratory Diagnosis of Fungal Infection
Laboratory Testing for Chlamydia
Laboratory Diagnosis: Unusual Requests
Summary
References
10 - Molecular Genetics of Corneal Disease
REVIEW OF GENETICS AND HUMAN DISEASE
Techniques Used to Identify Disease-Causing Genes
Disease-Causing Mutations Versus Non–Disease-Causing Sequence Variations
Terminology
Epithelial Basement Membrane Dystrophy
Epithelial Recurrent Erosion Dystrophies
Subepithelial Mucinous Corneal Dystrophy
Meesmann Corneal Dystrophy
Lisch Epithelial Corneal Dystrophy
Gelatinous Drop-Like Corneal Dystrophy (GDLD)
Epithelial-Stromal Tgfbi Dystrophies
TGFBI Dystrophies
Reis-Bücklers Corneal Dystrophy
Thiel-Behnke Corneal Dystrophy
Lattice Corneal Dystrophy Type 1
Granular Corneal Dystrophy Type 1
Granular Corneal Dystrophy Type 2
Stromal Dystrophies
Macular Corneal Dystrophy
Schnyder Corneal Dystrophy
Congenital Stromal Corneal Dystrophy
Fleck Corneal Dystrophy
Posterior Amorphous Corneal Dystrophy
Central Cloudy Dystrophy of François
Pre-Descemet Corneal Dystrophy
Endothelial Dystrophies
Fuchs Dystrophy
Posterior Polymorphous Corneal Dystrophy
Congenital Hereditary Endothelial Dystrophy
X-Linked Endothelial Corneal Dystrophy
Other Conditions
Keratoconus
X-Linked Megalocornea
Cornea Plana
EDICT Syndrome
Familial Amyloidosis, Gelosin Type
Conclusion
References
SECTION 3 Imaging Techniques of the Cornea
11 - Keratometry and Topography
Keratometry
Corneal Topography
Placido Disk-based Topography
Grid-Style Reflection Topography
Slit Scanning Tomography
Scheimpflug Tomography
Optical Coherence Tomography
Topographic Maps
Axial Curvature Map
Instantaneous or Tangential Curvature Map
Refractive Power Map
Elevation Map
Pachymetric Map
Difference Map
Quantitative Indices
Screening With Topographic and Tomographic Indices
Applications
Cataract Surgery
Refractive Surgery
Corneal Surgery
Conclusion
References
12 - Corneal Shape Analysis and Biomechanical Assessment
Scheimpflug Principle
Three-Dimensional Image—Cornea and Lens Densitometry (Backscatter)
Elevation Maps—Enhanced Elevation
Cone Location
Displaced Apex Syndrome
Enhanced Reference Surface
Comprehensive Corneal Thickness Evaluation
Spatial Variation of Corneal Thickness
Segmental Tomography
Corneal Biomechanical Assessment
Conclusion
References
13 - Specular Microscopy
Optical Principles of Specular Microscopy
Patient Preparation
Standardization of Imaging Techniques
INSTRUMENTATION
Qualitative Specular Microscopy
Epithelium
Endothelium: Miscellaneous Bright and Dark Structures
Endothelium: Morphometry
Quantitative Specular Microscopy
Specular Microscopy in Clinical Trials and the Value of a Reading Center
Clinical Applications for Specular Microscopy
Cataract Extraction With Intraocular Lens Implantation
Refractive Surgery and Collagen Crosslinking
Photorefractive Keratectomy and Laser in Situ Keratomileusis
Phakic Intraocular Lenses
Intrastromal Devices
Collagen Crosslinking
Donor Corneas
Penetrating Keratoplasty
Endothelial Keratoplasty
Descemet Stripping Automated Endothelial Keratoplasty
Descemet Membrane Endothelial Keratoplasty
Summary
References
14 - Confocal Microscopy
Background
Historical Overview
Current Confocal Systems in Clinical Use
In Vivo Confocal Imaging
Normal Corneal Structures
Confocal Microscopy Through-Focusing
Applications
Conclusion
References
15 - Clinical Applications of Confocal Microscopy
Introduction
Normal Exam
Infectious Keratitis
Acanthamoeba Keratitis
Fungal Keratitis
Corneal Dystrophies
Keratoconus
Endothelium Evaluation
Corneal Surgery and Wound Healing
Corneal Disease
Corneal Nerves
Dry Eye
Corneal/Conjunctival Intraepithelial Neoplasia
Systemic Diseases
Conclusion
Declaration of Interests
References
16 - High-Resolution Ultrasound
ULTRASOUND BIOMICROSCOPY: HIGH-RESOLUTION ULTRASOUND
Examination Techniques With Ultrasound Biomicroscopy
Normal Cornea
Uveal Melanoma
Idiopathic Iris Cyst
Malignant Neoplasm of the Conjunctiva
Scleral Staphyloma
Pigmented Iris Lesion
Shallow Anterior Chamber
Iris Stromal Cyst
Hyphema
Low Intraocular Pressure
Imaging Through Corneal Opacities
Summary
References
17 - Anterior Segment Optical Coherence Tomography
INTRODUCTION
Dewarping of Anterior Segment Optical Coherence Tomography Images
Detection and Classification of Keratoconus and Other Corneal Irregularities
Refractive Surgery Evaluation
LASIK Flap Evaluation
Refractive Enhancement
LASIK Complications
Small-Incision Lenticule Extraction
Corneal Power Measurement and Intraocular Lens Power Calculation
Corneal Opacities
Planning of Phototherapeutic Keratectomy
Cornea Transplant
Endothelial Keratoplasty
Femtosecond Enabled Keratoplasty
Refractive Implants
Corneal Implants
Phakic Intraocular Lenses
Ocular Surface and Iris Tumors
Ocular Surface Tumor
Iris Tumors
Other Anterior Segment Optical Coherence Tomography Applications
Financial Disclosure
References
PART III Differential Diagnosis of Selected Problems in Cornea and External Eye Disease
18 - Congenital Corneal Opacities: Diagnosis and Management
BACKGROUND
HISTORY AND PHYSICAL EXAMINATION
SCLEROCORNEA (S TUMPED)
TEARS IN THE ENDOTHELIUM AND DESCEMET MEMBRANE (S T UMPED)
Congenital Glaucoma
Birth Trauma
CORNEAL ULCERS AND INFLAMMATION(ST U MPED)
Infectious Diseases
METABOLIC DISEASES (STU M PED)
Mucopolysaccharidosis
Gangliosidoses
Fabry disease
Mucolipidosis
Cystinosis
Tyrosinemia
MISCELLANEOUS SYNDROMES
Fetal Alcohol Syndrome
POSTERIOR CORNEAL DEFECTS (STUM P ED)
Peters Anomaly
Posterior Keratoconus
Congenital Anterior Staphyloma
ENDOTHELIAL DYSTROPHY (STUMP E D)
Congenital Hereditary Endothelial Dystrophy
Posterior Polymorphous Corneal Dystrophy
Congenital Stromal Corneal Dystrophy
Other Dystrophies
DERMOIDS (STUMPE D)
CORNEAL KELOIDS
REFERENCES
19 - Peripheral Corneal Disease
THE PERIPHERAL CORNEA: SUSCEPTIBILITY AND RESPONSE TO DISEASE
Congenital/Developmental/Inherited Disorders of the Peripheral Cornea
Inflammatory/Autoimmune Disorders of the Peripheral Cornea
Neoplastic Disorders of the Peripheral Cornea
Degenerative Disorders of the Peripheral Cornea
Infectious Disorders of the Peripheral Cornea
References
20 - Evaluation of the Corneal Ulcer
History
Clinical Exam
Testing—Corneal Smears and Cultures
Treatment
Conclusion
References
21 - Evaluation of Recurrent Corneal Erosions
Introduction
Presentation
Pathophysiology
Diagnosis
Ancillary Diagnostic Testing
References
22 - Corneal Deposits
Superficial Deposits
Pigmented Deposits
Cornea Verticillata
Striate Melanokeratosis
Epithelial Iron Lines
Spheroidal Degeneration
Adrenochrome Deposition
Nonpigmented Deposits
Subepithelial Mucinous Corneal Dystrophy
Coat’s White Ring
Calcific Band Keratopathy
Fluoroquinolone Deposits
Mucin Balls
Refractile/Crystalline Deposits
Meesmann Dystrophy
Gelatinous Drop-like Dystrophy
Tyrosinemia II (Richner−Hanhart Syndrome)
Intraepithelial Ointment
Gout (Urate)
Stromal Deposits
Pigmented Deposits
Phenothiazines
Corneal Blood Staining
Bilirubin
Siderosis
Nonpigmented Deposits
Granular Dystrophy
Macular Corneal Dystrophy
Fleck Corneal Dystrophy
Lipid Deposition
Mucopolysaccharidoses
Refractile/Crystalline Deposits
Lattice Dystrophy
Schnyder Central Crystalline Dystrophy
Bietti Crystalline Dystrophy
Immunoglobulin Deposition
Cystinosis
Deep Stromal Deposits
Pigmented Deposits
Copper Deposition Associated With Wilson Disease
Chalcosis
Ocular Chrysiasis
Mottled Cyan Opacification of the Posterior Cornea
Deep Blue Dot Degeneration
Nonpigmented Deposits
Cornea Farinata
Pre-Descemet Corneal Dystrophy
X-linked Ichthyosis
Ocular Argyrosis
Refractile/Crystalline Deposits
Polymorphic Amyloid Degeneration
References
23 - The Red Eye
HISTORY
Identify the Risk Factors
Onset and Duration of Disease
Laterality
Pain
Vision Loss
Identifying Abnormalities in the Ocular Structures
General Appearance
Skin
Eyelids
Periorbital Masses and Globe Position
Recognizing Distinctive Ocular Signs
Eyelid Margins
Tear Film and Tear Volume
Discharge
Findings of the Palpebral and Tarsal Conjunctiva
Findings of the Bulbar Conjunctiva
Corneal Findings
Additional Testing
Constructing a Differential Diagnosis
Classification Schemes
Conclusion
References
PART IV Eye Banking
24 - Eye Banking: Structure and Function
Eye Banking: Past and Present
Tissue Acquisition
Donor Screening and Authorization
Recovery
Tissue Preservation and Storage
Tissue Evaluation and Suitability
Donor Eligibility
Tissue Processing and Distribution
Facilities, Equipment, Instruments, and Supplies
Quality Assurance
Future Considerations
References
25 - Medical Standards for Eye Banking
Eye Bank Association of America Medical Standards
Federal and State Regulations
Standards Relating to Safety of Tissue
Dystrophies and Degenerations
Endophthalmitis and Microbial Keratitis
Rabies
Hepatitis B
Hepatitis C
Human Immunodeficiency Virus I and II
Other Infectious Agents
Prion Disease
Malignancies
Recalls and Market Withdrawals
Primary Graft Failure
Mechanical and Optical Integrity
Future Challenges and Opportunities
References
PART V The Ocular Adnexa
SECTION 1 Diseases of the Lid: Anatomic Abnormalities
26 - Malposition of the Eyelids
ENTROPION
Congenital Entropion
Involutional Entropion
Cicatricial Entropion
Acute Spastic Entropion
Differential Diagnosis
Medical Management
Surgical Management
Congenital Entropion
Involutional Entropion
Cicatricial Entropion
Ectropion
Congenital Ectropion
Involutional Ectropion
Cicatricial Ectropion
Paralytic Ectropion
Mechanical Ectropion
Inflammatory Ectropion
Medical Management
Surgical Management
Involutional Ectropion
Congenital Ectropion
Paralytic Ectropion
Cicatricial Ectropion
Complications
Trichiasis and Distichiasis
Management of Trichiasis
Management of Distichiasis
Floppy Eyelid Syndrome
Treatment
Giant Fornix Syndrome
Lid Imbrication Syndrome
Treatment
Lagophthalmos
Treatment
Eyelid Retraction
Treatment
References
SECTION 2 Diseases of the Lid: Tumors, Inflammation, and Infection
27 - Benign Lid Tumors
Histology of the Eyelid Skin
Approach to Diagnosis and Management
Benign Tumors of the Epidermis
Acrochordon
Epidermal Inclusion Cyst
Seborrheic Keratosis
Milia
Keratoacanthoma
Inverted Follicular Keratosis
Cutaneous Horn
Linear Epidermal Nevus
Nodular Elastosis With Cysts and Comedones (Favre-Racouchot Syndrome)
Actinic Keratosis (Solar Keratosis)
Dermoid and Epidermoid Cysts
Oncocytoma
Phakomatous Choristoma
Benign Tumors of the Dermis
Tumors Derived From Neural Tissue
Neurofibroma
Neurilemoma
Neuroma
Granular Cell Tumor
Tumors Derived From Smooth Muscle
Leiomyoma
Tumors Derived From Vascular Tissue
Nevus Flammeus
Capillary Hemangioma
Cherry Hemangioma
Cavernous Hemangioma
Varix
Lymphatic Malformation
Arteriovenous Malformation
Pyogenic Granuloma
Glomus Tumor
Intravascular Papillary Endothelial Hyperplasia
Angiolymphoid Hyperplasia With Eosinophilia
Tumors Derived From Histiocytes
Xanthelasma
Xanthoma
Juvenile Xanthogranuloma
Tumors Derived From Fibrous Tissue
Dermatofibroma
Benign Tumors of the Eyelid Adnexa
Tumors of Sweat Gland Origin
Tumors of Eccrine Sweat Gland Origin
. Syringomas are benign eccrine sweat gland tumors found most commonly in young females. Clinically, they usually appear as mult...
. The eccrine spiradenoma shows differentiation toward the secretory portion of the eccrine gland. This benign tumor is an uncom...
. The eccrine acrospiroma (clear cell hidradenoma) shows differentiation toward both ductal and secretory portions of the eccrin...
. These cystic lesions tend to be small (1–3 mm in diameter) and multiple; commonly they occur clustered around the eyelids and ...
. The pleomorphic adenoma (mixed tumor of skin, chondroid syringoma) occurs most commonly in the head and neck region and may in...
Tumors of Apocrine Sweat Gland Origin
. The apocrine type of hidrocystoma (cyst of Moll) is a true adenoma of the secretory cells of the glands of Moll rather than a ...
. Although recognized as a tumor of sweat gland origin, the exact origin is uncertain. Solitary or multiple lesions can occur. C...
. Appearing at birth or during early childhood, syringocystadenoma papilliferum occurs most commonly on the scalp or face. The l...
Tumors of Hair Follicle Origin
Trichoepithelioma
Trichoadenoma
Trichofolliculoma
Trichilemmoma
Pilomatricoma
Tumors of Sebaceous Gland Origin
Sebaceous Gland Hyperplasia
Sebaceous Adenoma
Benign Melanocytic Lesions
Nevocellular Nevi
Junctional Nevi
Compound Nevi
Melanoma
Intradermal Nevi
Variants of Nevocellular Nevi
Congenital Nevus
Blue Nevus
Nevus of Ota
Freckle
Lentigo Simplex
Lentigo Senilis
Lentigo Maligna
Conclusion
References
28 - Malignant Eyelid Tumors
Basal Cell Carcinoma
Clinical Appearance
Biologic Behavior
Clinical Diagnosis
Treatment
Mohs Micrographic Surgery
Frozen Section Control
Ionizing Radiation Therapy
Chemotherapy
Recurrence
Squamous Cell Carcinoma
Premalignant Lesions
Actinic Keratosis
Bowen Disease
Epidemiology and Differential Diagnosis
Squamous Cell Carcinoma
Clinical Presentation
Biologic Behavior
Treatment
Sebaceous Cell Carcinoma
Etiology
Clinical Presentation
Treatment
Prognosis
Merkel Cell Carcinoma (Trabecular Carcinoma)
Normal Merkel Cell
Merkel Cell Carcinomas
Clinical Presentation
Histopathology
Treatment
. Localized disease requires prompt and aggressive initial treatment for potential favorable outcome. Wide surgical excision of ...
. Chemotherapy using a combination of drugs that are active against small cell carcinoma of the lung is recommended for patients...
Malignant Melanoma
Lentigo Maligna Melanoma
Superficial Spreading Melanoma
Nodular Melanoma
Treatment
Basal Cell Nevus Syndrome (Gorlin-Goltz Syndrome)
Systemic Manifestations
Ophthalmic Manifestations
Treatment
Xeroderma Pigmentosum
Cutaneous Abnormalities
Ocular Abnormalities
Neurologic Abnormalities
Treatment
Muir-Torre Syndrome
Summary
References
29 - Blepharitis: Overview and Classification
Classification
Differential Diagnosis
Management
References
30 - Eyelid Infections
Viral Infections
Herpes Simplex Virus
Varicella-Zoster Virus
Molluscum Contagiosum
Human Papillomavirus
Bacterial Infections
Hordeolum
Preseptal Cellulitis
Impetigo Contagiosa
Rare Bacterial Infections
Anthrax
Syphilis
Mycobacterial Infections
Actinomyces Canaliculitis
Fungal Infections
Blastomycosis
Coccidiomycosis
Cryptococcosis
Dermatophytosis/Tinea Palpebrum
Sporotrichosis
Mucormycosis
Parasitic Eyelid Infections
Demodicosis
Phthiriasis and Pediculosis Palpebrarum
Leishmaniasis
Ophthalmomyiasis Externa
References
SECTION 3 Disorders of Tear Production and the Lacrimal System
31 - Dry Eye Overview: Classification and Treatment Algorithm
DEFINITION
Pathophysiology
Classification Scheme
Aqueous Tear-Deficient Dry Eye
Sjögren Syndrome Dry Eye
Non-Sjögren Syndrome Dry Eye
Evaporative Dry Eye
TFOS DEWS II DED Diagnostic Algorithm (Fig. 31.2)
Step 1
Education
Tear Supplementation
Essential Fatty Acid Supplementation
Step 2
Tear Conservation
. Punctal occlusion is one of the most useful and practical therapies for conserving tears in patients with aqueous-deficient DE...
. Moisture-conserving spectacles reduce tear evaporation by increasing humidity around the eye and can be worn during the day or...
In Office Procedures
. These devices have proven efficacious in the treatment of MGD and may offer benefit in patients with poor compliance of lid hy...
. Microblepharoexfoliation (MBE) is an in-office procedure for mechanically debriding the lid margin of scurf, collarettes, kera...
. Intense pulsed light (IPL) is effective in patients with prominent features of ocular rosacea and MGD. The mechanism of action...
. Topical cyclosporine A (CsA), a calcineurin inhibitor, reduces proinflammatory cytokines (e.g., conjunctival IL-6 levels), act...
. This topical immunomodulator inhibits binding between LFA-1 and ICAM-1 (intercellular adhesion molecule 1) on epithelial cells...
. Corticosteroids exert their immuno
Oral Macrolide or Tetracycline Antibiotic
Step 3
Therapeutic Contact Lens Options
Oral Secretagogues
Autologous/Allogenic Serum
Step 4
Other Surgical Approaches
. A partial tarsorrhaphy is reserved for severe or refractory DED.35 This surgical approach reduces the area of exposed ocular s...
. Salivary submandibular gland transplantation is capable of replacing deficient mucin and aqueous tears. This minimal-risk surg...
. Topical acetylcysteine is mentioned in the literature as a DED treatment as early as the 1960s and is still occasionally used ...
. Amniotic membrane grafts in the acute stage of Stevens-Johnson syndrome56 and ocular surface burns57 has been shown to reduce ...
Conclusion
References
32 - Aqueous Deficiency Dry Eye Syndrome
PATHOPHYSIOLOGY
Sjögren Syndrome Dry Eye
Non-Sjögren Syndrome Dry Eye
Secondary Lacrimal Gland Deficiencies
Lacrimal Gland Infiltration
Graft-Versus-Host Disease
Obstruction of the Lacrimal Gland Ducts
Reflex Hyposecretion
Systemic Medications
Diagnosis
History
Physical Examination
Diagnostic Tests
Systemic Work-Up
Management
References
33 - Meibomian Gland Dysfunction and Evaporative Dry Eye
Normal Anatomy of the Meibomian Glands
Terminology
Physiology/Pathophysiology
Classification of Meibomian Gland Dysfunction
Diagnosis of Meibomian Gland Dysfunction
Associated Conditions
Animal Models of Meibomian Gland Dysfunction
Lipid Composition and Behavior of Human Meibomian Secretion
Role of Microorganisms
Treatment
Conclusion
References
34 - Dacryoadenitis, Dacryocystitis, and Canaliculitis
DACRYOADENITIS
Dacryocystitis
Canaliculitis
References
35 - Epiphora
Introduction
Etiology
Overproduction
Outflow Obstruction
Lacrimal Pump Failure
Differential Diagnosis
Evaluation
Treatment
Overproduction
Outflow Obstruction
Lacrimal Pump Failure
Summary
References
PART VI The Conjunctiva
SECTION 1 Conjunctivitis
36 - Conjunctivitis: An Overview and Classification
Conjunctival Injection
Conjunctivitis
Morphologic Responses
Papillae
Follicles
Membranes
Cicatrizing Changes
Granulomas
Type of Exudate
Anatomic Localization
Acute Conjunctivitis
Acute Papillary Conjunctivitis
Acute Follicular Conjunctivitis
Adenovirus
Inclusion Conjunctivitis
Ocular Herpes Infections
RNA-Containing Viruses
Poxviruses
Acute Membranous Conjunctivitis
Chronic Conjunctivitis
Giant Papillary Conjunctivitis
Vernal Keratoconjunctivitis
Atopic Keratoconjunctivitis
Secondary Giant Papillary Conjunctivitis
Chronic Papillary Conjunctivitis
Masquerade Syndrome
Lacrimal Drainage System Infection
Superior Limbic Keratoconjunctivitis
Floppy Eyelid Syndrome
Blepharoconjunctivitis
Aqueous Tear Deficiency Dry Eye
Mucus-Fishing Syndrome
Toxic Papillary Keratoconjunctivitis
Chronic Follicular Conjunctivitis
Moraxella
Molluscum Contagiosum
Toxic Follicular Conjunctivitis
Lyme Disease
Chronic Membranous Conjunctivitis
Giant Fornix Syndrome
Cicatrizing and Granulomatous Conjunctivitis
References
37 - Bacterial Conjunctivitis
Introduction
Incidence
Risk Factors
Categories of Bacterial Conjunctivitis
Acute Conjunctivitis
Pathogens
Signs and Symptoms
Associated Extraocular Manifestations
Diagnosis
Management
Monitoring for Resistance and Emerging Alternative Therapy
Hyperacute Bacterial Conjunctivitis
Neisseria gonorrhoeae
Clinical Manifestations
Management
Microbiologic Confirmation
Other Considerations in Management of Gonococcal Conjunctivitis
Neisseria meningitidis
Management
Chronic Conjunctivitis
Staphylococcal Infections
Moraxella
Chlamydial Infections
Trachoma
Inclusion Conjunctivitis
Ophthalmia Neonatorum
Other
Conclusion
References
38 - Viral Conjunctivitis
DNA VIRUSES
Adenoviruses
Pharyngoconjunctival Fever
Epidemic Keratoconjunctivitis
Acute Nonspecific Follicular Conjunctivitis
Chronic Conjunctivitis
Laboratory Diagnosis
Treatment
Herpes Simplex Virus
Varicella Zoster Virus
Epstein-Barr Virus
Cytomegalovirus
Variola and Vaccinia Virus
Molluscum Contagiosum Virus
RNA Viruses
Picornaviruses
Paramyxoviruses
Togaviruses
Flaviviruses
Filoviruses
References
39 - Chlamydial Infections
Introduction
Biology
Laboratory Tests for Chlamydia
Trachoma
Epidemiology
Clinical Manifestations
Pathophysiology
Treatment
Public Health Efforts
Neonatal Inclusion Conjunctivitis
Adult Inclusion Conjunctivitis
Lymphogranuloma Venereum
Chlamydia Psittaci and Chlamydia Pneumoniae
Conclusion
References
40 - Ophthalmia Neonatorum
Pathogenesis and Assessment of Risk
The Role of Sexually Transmitted Diseases
Causes of Neonatal Conjunctivitis
Chemical
Bacterial
Chlamydial
Viral
Fungal
Laboratory Diagnosis
Laboratory Diagnosis
Treatment
Ocular Prophylaxis
References
41 - Parinaud Oculoglandular Syndrome
History
Directed Work-Up
Individual Etiologies
Cat-Scratch Disease
Tularemia
Tuberculosis
Sporotrichosis
Syphilis
Other Causes
References
42 - Seasonal and Perennial Allergic Conjunctivitis
INTRODUCTION
Clinical Findings
Pathophysiology
Local Treatments
Systemic Treatments
Future Developments
Conclusion
References
43 - Vernal and Atopic Keratoconjunctivitis
VERNAL KERATOCONJUNCTIVITIS
Definition
Demographics
Symptoms
Signs
Pathophysiology
Diagnosis
Treatment
Atopic Keratoconjunctivitis
Definition
Demographics
Symptoms
Signs
Pathophysiology
Diagnosis
Treatment
References
44 - Giant Papillary Conjunctivitis
SYMPTOMS AND SIGNS
Histopathology and Immunopathology
Pathophysiology
Differential Diagnosis
Treatment
Prognosis
References
45 - Mucous Membrane Pemphigoid
INTRODUCTION
Epidemiology
Pathogenesis
Diagnosis
Ocular Manifestations
Management of Ocular Mucous Membrane Pemphigoid
Medical Management
Dry Eye Disease
Chronic Blepharitis and Meibomitis
Immunomodulatory
Surgical Treatment
Epilation
Lid Surgery
Fornix Reconstruction
Corneal Surgery
Conclusion
References
46 - Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis
INTRODUCTION
History
Classification
Incidence
Clinical Findings
Initial Presentation
Eye Findings
Acute Eye Findings
Chronic Eye Findings
Nonocular Findings
Recurrent Disease
Incidence of Ocular Complications
Differential Diagnosis
Ocular Disorders
Dermatologic Manifestations
Etiology
Pathogenesis
Histopathology
Skin
Eye
Management
Systemic Disease
Ophthalmic Disease
Acute Stage
Chronic Stage
Conclusion
References
47 - Toxic Conjunctivitis
Introduction
Toxicity Versus Allergy
Cellular Mechanisms
Signs and Symptoms
Diagnostic Testing
Toxic Keratoconjunctivitis Related to Topical Medications
Methods of Assessing Toxicity
Toxicity of Specific Agents
Antivirals
Glaucoma Medications
Antibiotics and Antifungals
Anesthetics
Preservatives
Follicular Conjunctivitis
Hurricane Keratitis
Drug-induced Mucous Membrane Pemphigoid
Other Causes of Toxic Keratoconjunctivitis
Cosmetics and Skin Care Products
Hair Care Products
Tear Gas Weapons and Lacrimating Agents
Therapeutic Considerations
References
48 - Superior Limbic Keratoconjunctivitis
Introduction and Epidemiology
Clinical Presentation
Etiology
Histopathology
Treatment Modalities
Medical Treatment
Surgery
Differential Diagnosis
Summary
References
49 - Ligneous Conjunctivitis
Clinical Findings
EPIDEMIOLOGY
Pathophysiology/Histopathology
Etiology
Treatment
References
50 - Conjunctivochalasis
INTRODUCTION
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Management
Medical Treatment
Surgical Treatment
Conjunctival Cauterization
Conjunctival Excision
Other
Conclusion
References
SECTION 2 Conjunctival Disease: Tumors
51 - Epithelial Tumors of the Conjunctiva
Benign Tumefactions
Benign Hereditary Intraepithelial Dyskeratosis
Pseudoepitheliomatous Hyperplasia, Large Cell
Conjunctival Squamous Papilloma
Inverted Conjunctival Papillomas
Dacryoadenoma
Sebaceous Adenoma
Pterygia and Pingueculae
Malignant Tumefactions
Noninvasive Ocular Surface Squamous Neoplasia/Conjunctival Intraepithelial Neoplasia
Invasive Ocular Surface Squamous Neoplasia
Corneal Epithelial Dysmaturation and Epithelial
Mucoepidermoid Carcinoma
Spindle Cell Carcinoma
Adenoid Squamous Carcinoma
Clear Cell Squamous Cell Carcinoma
Transitional Cell Carcinoma
Sebaceous Cell Carcinoma
Basal Cell Carcinoma
References
52 - Medical and Surgical Management of Ocular Surface Squamous Neoplasia
INITIAL CONSIDERATIONS
Role of Optical Coherence Tomography in Diagnosis and Management of Ocular Surface Squamous Neoplasia
Choice of Treatment Modality for Ocular Surface Squamous Neoplasia
Medical Management of Ocular Surface Squamous Neoplasia
Topical Immunomodulatory and Chemotherapeutic Agents
Immunomodulators
. IFN is an endogenous immunomodulatory glycoprotein released by various immune cells with antiviral, antimicrobial, and antineo...
Antimetabolites
. 5-FU is a pyrimidine analog that blocks DNA and RNA synthesis by inhibiting thymidylate synthase. Long used as systemic therap...
. MMC is an alkylating agent derived from the actinobacterium Streptomyces caespitosus and exerts its antineoplastic effect by c...
Radiotherapy
Anti-Vascular Endothelial Growth Factor
Surgical Management of Ocular Surface Squamous Neoplasia
“No-Touch” Technique
Intraoperative Adjunctive Treatments
Mitomycin C
Amniotic Membrane Transplant
Postoperative Management and Complications
Standard Postoperative Regimen
Neoadjuvant Treatments
Complications of Surgical Resection
Role of Optical Coherence Tomography During Treatment and Surveillance of Ocular Surface Squamous Neoplasia
References
53 - Melanocytic Neoplasms of the Conjunctiva
INTRODUCTION
CLINICAL AND HISTOPATHOLOGIC FEATURES OF CONJUNCTIVAL MELANOCYTIC LESIONS
Conjunctival Nevus
Conjunctival Melanosis
Epithelial Congenital Melanosis
Subepithelial Congenital Melanosis
Secondary Acquired Melanosis
Primary Acquired Melanosis
Malignant Melanoma
Management of Conjunctival Melanocytic Lesions
Diagnosis
Treatment
Financial Support
References
54 - Subepithelial Tumors of the Conjunctiva
Congenital Lesions
Choristomas
Dermoid and Dermolipoma
Ectopic Lacrimal Gland; Simple and Complex Choristomas
Epibulbar Osseous and Neuroglial Choristomas
Hamartomas
Conjunctival Cysts
Pyogenic Granuloma/Lobular Capillary Hemangioma
Pinguecula/Pterygium
Elastofibroma Oculi
Nodular Fasciitis
Granulomatous and Histiocytic Lesions
Epibulbar Molluscum Contagiosum
Keloid
Amyloid
Hematic Cyst
Neoplastic Lesions
Fibrous Histiocytoma
Kaposi Sarcoma
Oncocytoma (Oxyphilic Adenoma)
Basal Cell Carcinoma
Malignant Melanoma
Lymphoid Lesions
Other Subconjunctival Neoplastic Lesions
References
PART VII Diseases of the Cornea
SECTION 1 Developmental Abnormalities of Cornea
55 - Developmental Corneal Anomalies of Size and Shape
Absence of the Cornea
Anomalies of Size
Megalocornea
Microcornea
Anomalies of Shape
Oval Cornea
Astigmatism
Sclerocornea (Cornea Plana)
Posterior Keratoconus
Keratoglobus
Congenital Anterior Staphyloma and Keratectasia
References
56 - Axenfeld-Rieger Syndrome
Axenfeld-Rieger Syndrome
History
Clinical Features
Cornea
Iridocorneal Angle
Iris
Glaucoma
Other Ocular Findings
Nonocular Findings
Face
Teeth
Umbilical
Genital
Others
Differential Diagnosis
Pathogenesis
Genetics
Chromosome 4q, RIEG1, PITX2
Chromosome 13q, RIEG2
Chromosome 6p, FOXC1
Genotype-Phenotype Correlations
Natural History
Treatment
References
57 - Peters Anomaly
Peters Anomaly
Peters Anomaly
History
Clinical Features
Cornea
Anterior Chamber
Lens
Glaucoma
Other Ocular Findings
Nonocular Findings
Differential Diagnosis
Pathogenesis
Genetics
Natural History
Treatment
References
SECTION 2 Corneal Manifestations of Systemic Disease and Therapies
58 - Corneal Manifestations of Metabolic Diseases
INTRODUCTION
Disorders of Carbohydrate Metabolism
Diabetes Mellitus: Diabetic Keratopathy
Lysosomal Storage Disorders
Introduction
Mucopolysaccharidoses
Mucopolysaccharidoses I
Hurler Syndrome (Mucopolysaccharidoses I-H)
Scheie Syndrome (Mucopolysaccharidoses IS)
Hurler Scheie (Mucopolysaccharidoses I H/S)
Hunter Syndrome (Mucopolysaccharidoses II)
Sanfilippo Syndrome (Mucopolysaccharidoses III)
Morquio Syndrome (Mucopolysaccharidoses IV)
Maroteaux-Lamy Syndrome (Mucopolysaccharidoses VI)
Sly Syndrome (Mucopolysaccharidoses VII)
Natowicz Syndrome (Mucopolysaccharidoses IX)
Corneal Histopathology in Mucopolysaccharidoses
Dyslipoproteinemias
Hyperlipoproteinemias and Schnyder Corneal Dystrophy
Hypolipoproteinemias
Lipidoses
Fabry Disease
Multiple Sulfatase Deficiency
Generalized Gangliosidoses
Drug-induced lipidoses
Chloroquine
Amiodarone
Other Agents
Mucolipidoses
Galactosialidosis
Cystinosis
Tyrosinemia II
Alkaptonuria
Amyloidosis
Gout
Porphyria
References
59 - Skeletal and Connective Tissue Disorders With Anterior Segment Manifestations
Classification of Skeletal Disorders
Craniofacial Dysostosis Syndromes
Crouzon Syndrome
Apert Syndrome
Saethre-Chotzen Syndrome
Goldenhar Syndrome
Ehlers-Danlos Syndrome
Osteogenesis Imperfecta
Kniest Dysplasia
Marfan Syndrome
Oculo-dento-osseous Dysplasia
Sotos Syndrome (Cerebral Gigantism)
Dermo-chondro-corneal Dystrophy of François
Werner Syndrome
Hypophosphatasia
Treatment of Ocular and Corneal Abnormalities in Skeletal Disorders
References
60 - Granulomatosis With Polyangiitis and Other Systemic Inflammatory Diseases
Granulomatosis With Polyangiitis
Epidemiology, Etiology, and Pathogenesis
Systemic Manifestations
60
Ocular Manifestations
Management
Inflammatory Bowel Disease
Epidemiology, Etiology, and Pathogenesis
Systemic Manifestations
Ocular Manifestations
Management
Whipple Disease
Epidemiology, Etiology, and Pathogenesis
Systemic Manifestations
Ocular Manifestations
Management
Chronic Granulomatous Disease
Epidemiology, Etiology, and Pathogenesis
Systemic Manifestations
Ocular Manifestations
Management
Kawasaki Disease
Epidemiology, Etiology, and Pathogenesis
Systemic Manifestations
Ocular Manifestations
Management
References
61 - Nutritional Disorders
METABOLISM OF VITAMIN A
Historical Considerations
Classification and Clinical Manifestations of Xerophthalmia
Night Blindness (XN)
Conjunctival Xerosis (X1A) and Bitot Spots (X1B)
Corneal Xerosis (X2)
Corneal Ulceration/Keratomalacia (X3A/X3B)
Pathogenesis of Corneal Ulceration
Interactions With Other Factors
Epidemiology
Treatment
Other Nutritional Deficiencies
Vitamin B (Riboflavin)
Vitamin C
Other Nutrients
Discrete Colliquative Keratopathy
Summary
References
62 - Hematologic Diseases and Malignancies
Basics of Hematology
Anemia
Iron Deficiency Anemia
Systemic Manifestations
Ophthalmic Manifestations
Thalassemia
Systemic Manifestations
Ophthalmic Manifestations
Sickle Cell Disease
Systemic Manifestations
Ophthalmic Manifestations
Leukemia
Acute Leukemia: Acute Myeloid Leukemia
Systemic Manifestations
Ophthalmic Manifestations
Acute Leukemia: Acute Lymphoblastic Leukemia
Systemic Manifestations
Ophthalmic Manifestations
Chronic Leukemia: Chronic Myeloid Leukemia
Systemic Manifestations
Ophthalmic Manifestations
Chronic Leukemia: Chronic Lymphocytic Leukemia
Systemic Manifestations
Ophthalmic Manifestations
Infectious Complications of Leukemia
Ocular Toxicity of Leukemia Treatment
Ophthalmic Diagnostic Techniques in Leukemia
Ocular Treatment in Leukemia
Bruton Agammaglobulinemia
Plasma Cell Disorders
Multiple Myeloma
Systemic Manifestations
Ophthalmic Manifestations
Waldenström Macroglobulinemia
Systemic Manifestations
Ophthalmic Manifestations
Monoclonal Gammopathy of Undetermined Significance
Systemic Manifestations
Ophthalmic Manifestations
Cryoglobulinemia
Systemic Manifestations
Ophthalmic Manifestations
Differential Diagnosis of the Crystalline Keratopathies
References
63 - Endocrine Disease and the Cornea
DIABETES MELLITUS
Biochemistry
Animal Studies
Morphology
Clinical Correlations
Parathyroid Disease
Hypoparathyroidism
Hyperparathyroidism
Thyroid Disease
Multiple Endocrine Neoplasia
References
64 - Dermatologic Disorders and the Cornea
Psoriasis
Seborrheic Dermatitis
Rosacea
Contact Dermatitis
Atopic Dermatitis
Pityriasis Rubra Pilaris
Impetigo
Immunobullous Disorders
Pemphigus
Pemphigus Vulgaris
Pemphigus Foliaceus
Paraneoplastic Pemphigus
Pemphigoid
Bullous Pemphigoid
Mucous Membrane Pemphigoid
Drug-Induced Ocular Pemphigoid
Linear IgA Bullous Dermatosis
Epidermolysis Bullosa Acquisita
Genetic Disorders
Acrodermatitis Enteropathica
Darier Disease (Keratosis Follicularis)
Dyskeratosis Congenita
Ectodermal Dysplasias
Ehlers-Danlos Syndrome
Epidermolysis Bullosa
Focal Dermal Hypoplasia (Goltz Syndrome)
Ichthyosis
Incontinentia Pigmenti (Bloch-Sulzberger Syndrome)
Keratosis Follicularis Spinulosa Decalvans
Melkersson-Rosenthal Syndrome
Richner-Hanhart Syndrome
Rothmund-Thomson Syndrome
Werner Syndrome
Xeroderma Pigmentosum
Miscellaneous Disorders
Acanthosis Nigricans
Epidermal Nevus Syndrome
Hydroa Vacciniforme
Juvenile Xanthogranuloma
Kaposi Sarcoma
Malignant Atrophic Papulosis (Degos Disease)
Summary
References
65 - Infectious Disease: Ocular Manifestations
EMERGING INFECTIONS
Ebola Virus Disease
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
Chikungunya
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
West Nile Virus
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
Zika Virus Disease
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
Established Infections
Hansen Disease (Leprosy)
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
. Nerve involvement is more common in the tuberculoid group, and one of the principal nerves affected is the facial nerve on one...
. Superciliary and ciliary madarosis are common and a contributory finding for diagnosis as they usually occur relatively early ...
. Scleritis, episcleritis, and uveitis can be a presenting complaint in perhaps as many as one out of five patients. These can b...
. Intraocular inflammation can be seen in those (especially lepromatous) patients who have recently been treated or sometimes wi...
Diagnosis
Treatment and Prevention
Brucellosis
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
Onchocerciasis
Background
Epidemiology
Transmission
Ocular Disease
. Microfilariae can and do enter the cornea, probably via the conjunctiva, corneal nerves, or perhaps the sclera. The organism c...
. There are at least two forms of uveitis including anterior iridocyclitis and a posterior chorioretinitis. The microfilariae ca...
. The second form of uveitis is a chorioretinitis, although there are many potential presentations of this form. The organism pr...
Diagnosis
Treatment and Prevention
. Although ivermectin is a relatively safe drug, there can be some problems with coinfecting organisms that should be recognized...
Lyme Disease
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
Tuberculosis
Background
Epidemiology
Transmission
Systemic Disease
Ocular Disease
Diagnosis
Treatment and Prevention
References
66 - Corneal and External Ocular Infections in Acquired Immunodeficiency Syndrome
Viral Infections
Human Immunodeficiency Virus
Cytomegalovirus
Varicella-Zoster Virus
Herpes Zoster Ophthalmicus
Varicella-Zoster Virus Keratitis
Herpes Simplex Virus
Molluscum Contagiosum Virus
Other Viruses
Bacterial Infections
Fungal Infections
Parasitic Infections
Summary
References
67 - Ocular Graft-Versus-Host Disease
INTRODUCTION
Pathophysiology of Acute and Chronic Graft-Versus-Host Disease
Ocular Graft-Versus-Host Disease
Conjunctival Disease
Keratoconjunctivitis Sicca/Dry Eye Syndrome
Meibomian Gland Dysfunction
Other Findings of Ocular Graft-Versus-Host Disease
Diagnostic Criteria of Ocular Graft-Versus-Host Disease
Increase Lubrication
Control and Immunomodulate Inflammation
Manage Meibomian Gland Dysfunction
Protect the Ocular Surface
Consider Surgery (With Caution)
References
68 - Corneal Manifestations of Local and Systemic Therapies
Topical Ophthalmic Medications
Topical Preservatives
Topical Anesthetics
Topical Antimicrobials
Topical Antiinflammatories
Antiglaucoma Medications
Surgical Solutions
Surgical Antiseptics
Irrigating Solutions, Viscoelastics, Intracameral Injections, Capsular Dyes
Topical Chemotherapeutic Agents
Systemic Therapies
Systemic Chemotherapeutics
Other Systemic Medications
Corneal Deposits
Conclusion
References
SECTION 3 Corneal Dystrophies, Ectatic Disorders, and Degenerations
69 - Corneal Dystrophy Classification
History
Corneal Dystrophy Definition
Corneal Dystrophy Classification in the Literature
Shortcomings of Corneal Dystrophy Nomenclature and Classification
The Impact of Genotyping on Corneal Dystrophy Nomenclature
The International Committee for Classification of Corneal Dystrophies
The IC3D Classification—an Anatomically Based Classification System
The IC3D Category System to Denote the Evolution of a Corneal Dystrophy
The IC3D Templates
Changes from 2008 to 2015 IC3D
Summary
References
70 - Anterior Corneal Dystrophies
EPITHELIAL CORNEAL DYSTROPHIES
Meesmann Corneal Dystrophy (IC3D, MECD, Category 1)
Lisch Epithelial Corneal Dystrophy (IC3D, LECD, Category 2)
Gelatinous Drop-Like Corneal Dystrophy (IC3D, GDLD, Category 1)
Epithelial Basement Membrane Dystrophy (IC3D, EBMD, Some Category 1)
Corneal Dystrophies of Bowman Layer
References
71 - The Stromal Dystrophies
Granular Corneal Dystrophy
Granular Corneal Dystrophy, Type 1
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Granular Corneal Dystrophy, Type 2
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Lattice Corneal Dystrophy
Lattice Corneal Dystrophy: Classic and Variant
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Macular Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Schnyder Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Fleck Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Central Cloudy Dystrophy of François
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Posterior Amorphous Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Congenital Stromal Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
Pre-Descemet Corneal Dystrophy
Clinical Features
Epidemiology and Heritability
Histopathology
Management
References
72 - Descemet Membrane and Endothelial Dystrophies
Posterior Polymorphous Corneal Dystrophy
Introduction
Molecular Genetics
Clinical Presentation and Course
Differential Diagnosis
Prognosis and Management
Light Microscopy
Electron Microscopy
Fuchs Endothelial Corneal Dystrophy
Introduction
Molecular Genetics
Early-Onset FECD
Late-Onset FECD
Clinical Presentation and Course
Nonguttate Endothelial Dystrophy
Differential Diagnosis
Prognosis and Management
Histopathology
Light Microscopy
Electron Microscopy
Congenital Hereditary Endothelial Dystrophy
Molecular Genetics
Differential Diagnosis
Clinical Presentation and Course
Prognosis and Management
Electron Microscopy
X-Linked Endothelial Corneal Dystrophy
Molecular Genetics
Clinical Presentation and Course
Differential Diagnosis
Prognosis and Management
Microscopy
References
73 - Noninflammatory Ectatic Disorders
KERATOCONUS
Definition
Prevalence, Distribution, and Course
Associated Disease
Systemic Disease
Ocular Disease
Etiology
Biochemistry
Heredity
Pathology
Diagnosis
Corneal Imaging Overview
Corneal Power
Corneal Elevation and Thickness
Biomechanical Measurement
Treatment
Contact Lens
Intrastromal Ring Segments
Corneal Crosslinking
Keratoplasty
Bowman Layer Transplantation
Post-Keratorefractive Surgery Corneal Ectasia
Pellucid Marginal Degeneration
Keratoglobus
Posterior Keratoconus
References
74 - Iridocorneal Endothelial Syndrome
HISTORY AND BACKGROUND
Clinical Features
Essential Iris Atrophy
Chandler Syndrome
Cogan-Reese Syndrome
Iris Nevus Syndrome
Etiology
Clinical Course
Differential Diagnosis
Management
Summary
References
75 - Corneal and Conjunctival Degenerations
Corneal Degenerations
Arcus Senilis
Limbal Girdle (of Vogt)
Iron Deposits
Calcific Degeneration
Crocodile Shagreen
Cornea Farinata
Senile Furrow
Hassall-Henle Bodies
Lipid Degeneration
Spheroidal Degeneration (Climatic Droplet Keratopathy)
Climatic Proteoglycan Stromal Keratopathy
Amyloid Degeneration
Salzmann Nodular Degeneration
Peripheral Hypertrophic Subepithelial Corneal Degeneration
Corneal Keloids
Terrien Marginal Corneal Degeneration
Epithelial Basement Membrane Degeneration
Conjunctival Degenerations
Pingueculae
Pterygium
Concretions
References
SECTION 4 Corneal Infections
76 - Bacterial Keratitis
INTRODUCTION
EPIDEMIOLOGY
HOST DEFENSE AND RISK FACTORS
Defense of the Ocular Surface
External Risk Factors
Contact Lens Use
Ocular Surface Abnormalities
PATHOGENESIS
Bacterial Adherence
Bacterial Invasion
Corneal Inflammation and Tissue Damage
NATURAL HISTORY
PRESENTATION
DIFFERENTIAL DIAGNOSIS
CLINICAL EXAMINATION
SPECIFIC BACTERIAL ULCERS
Staphylococci
Streptococci
Nocardia
Nontuberculous Mycobacteria
Pseudomonas
Neisseria
Bacillus
Infectious Crystalline Keratopathy
LABORATORY INVESTIGATION
Cultures and Smears
Cultures
Indications for Re-Culture
Stains
Antimicrobial Susceptibility Testing
OTHER DIAGNOSTIC TOOLS
Corneal Biopsy
Impression Cytology
SPECIFIC THERAPEUTIC AGENTS AND RESISTANCE PATTERNS
Cephalosporins
Glycopeptides
Aminoglycosides
Macrolides
Fluoroquinolones
Sulfonamide and Trimethoprim
Anti-Collagenase
Antiseptics
STRATEGIES FOR INITIAL MANAGEMENT
Culture-Guided Approach
Empiric Approach
Case-Based Approach
MODIFICATION OF THERAPY
Review After 1 Week
Corticosteroid Therapy
THERAPY FOR COMPLICATED CASES
Cyanoacrylate Tissue Adhesives
Therapeutic Contact Lenses
Amniotic Membrane
SURGICAL MANAGEMENT
Conjunctival Flap
Keratoplasty
Collagen Crosslinking
PREVENTION AND EARLY DETECTION
COUNSELING AND REFERRAL
REFERENCES
77 - Nontuberculous Mycobacteria Keratitis
OVERVIEW
Classification
Risk Factors
Clinical Features
Laboratory Diagnosis
Medical Treatment
Surgical Treatment
References
78 - Herpes Simplex Keratitis
Viral Structure and Classification
Epidemiology
Pathogenesis
Latency and Reactivation
Immune Defense Mechanisms
Clinical Manifestations
Congenital and Neonatal Ocular Herpes
Primary Ocular Herpes
Recurrent Ocular Herpes
Blepharitis
Conjunctivitis
Keratitis
Iridocyclitis
Diagnosis
Management
Herpetic Eye Disease Study
Medical Management
Antiviral Agents
Corticosteroids
Recommendations for Clinical Manifestations
Antiviral Prophylaxis
Surgical Therapy
References
79 - Herpes Zoster Keratitis
EPIDEMIOLOGY
Clinical Disorders
Herpes Zoster Ophthalmicus
Ophthalmic Manifestations
Neurologic Manifestations
Diagnosis of Herpes Zoster Ophthalmicus
Therapy of Varicella-Zoster Virus Infection
Medical Treatment
Surgical Treatment
Varicella-Zoster Virus Vaccination
References
80 - Less Common Viral Corneal Infections
DNA VIRUSES
Poxviridae
Variola (Smallpox)
Vaccinia
Herpesviridae
Cytomegalovirus
RNA Viruses
Picornaviridae
Acute Hemorrhagic Conjunctivitis
Togaviridae
Rubella (German Measles) Virus
Acquired Rubella
Congenital Rubella
Chikungunya
Flaviviridae
Zika
West Nile
Paramyxoviridae
Rubeola (Measles)
Mumps
Newcastle Disease
Orthomyxoviridae
Influenza
Filoviridae
Ebola
References
81 - Fungal Keratitis
Introduction
Pathogenesis
Epidemiology
Risk Factors
Clinical Features
Laboratory Diagnosis
Medical Therapy
Polyenes
Azoles
Echinocandins
Crosslinking
Surgical Therapy
Prognosis
Conclusion
Acknowledgment
References
82 - Acanthamoeba and Other Parasitic Corneal Infections
Acanthamoeba Keratitis
Introduction
Incidence
Risk Factors
Pathogenesis
Clinical Features
Diagnosis
Treatment
Medical
Surgical
Role of Corticosteroids
Other Parasitic Corneal Infections
Non-Acanthamoeba Amoebic Keratitis
Microsporidia
Parasitic Keratitis of Primarily Endogenous Origin
Onchocerciasis
Leishmaniasis
Trypanosomiasis
Pythium Insidiosum
References
83 - Corneal Diseases in the Developing World
GLOBAL DATA ON CORNEAL BLINDNESS
Causes of Corneal Blindness
Xerophthalmia
Clinical Features
Management
Trachoma
Clinical Diagnosis
Management
Onchocerciasis
Clinical Features
Management
Leprosy
Clinical Features
Management
Ophthalmia Neonatorum
Corneal Trauma
Infectious Keratitis
Traditional Eye Medicines
Keratoconus
Corneal Dystrophies
Keratoplasty
Models for TACKLING Corneal Blindness
Conclusion
References
SECTION 5 Interstitial Keratitis
84 - Syphilitic Keratitis
EPIDEMIOLOGY
Pathogenesis
Ocular Infection in Early Syphilis
Corneal Immunity During Late Syphilis
Stromal Keratitis of Congenital Syphilis
Context
Corneal Inflammation
Corneal Neovascularization
Bilateral Keratitis
Anterior Uveitis
Posterior Uveitis
Recurrent Ocular Inflammation
Otosyphilis and Neurosyphilis
Stromal Keratitis of Acquired Syphilis
Context
Corneal Inflammation
Syphilitic Keratopathy
Corneal Opacity
Ghost Vessels
Thickened Descemet Membrane
Iris Atrophy and Secondary Glaucoma
Laboratory Investigation
Serologic Testing of Stromal Keratitis
Serologic Testing of Stromal Keratopathy
Serologic Screening of Corneal Donors
Management
Antiinflammatory Therapy
Antibacterial Therapy
Keratoplasty
References
85 - Nonsyphilitic Interstitial Keratitis
NONSYPHILITIC BACTERIAL INFECTIONS ASSOCIATED WITH INTERSTITIAL KERATITIS
Mycobacteria Infections
Tuberculosis
Other Bacterial Infections
Lyme Disease (Borreliosis)
Acanthamoeba Keratitis
Onchocerciasis
Leishmaniasis
Trypanosomiasis
Microsporidiosis
Viral Infections
Herpes Simplex Virus Infection
Varicella-Zoster Virus Infection
Other Viral Infections
Cogan Syndrome
Background
Typical Cogan Syndrome
Atypical Cogan Syndrome
Epidemiology
Clinical Manifestations
Etiology and Pathogenesis
Differential Diagnosis
Laboratory Findings
Treatment
References
SECTION 6 Noninfectious Keratopathy
86 - Filamentary Keratitis
INTRODUCTION
BACKGROUND
PATHOPHYSIOLOGY
ASSOCIATED CONDITIONS
CLINICAL MANIFESTATIONS
TREATMENT
SUMMARY
REFERENCES
87 - Superficial Punctate Keratitis of Thygeson
History
Epidemiology
Disease Course and Clinical Manifestations
Differential Diagnosis
Treatment
Pathogenesis
References
88 - Neurotrophic Keratitis
Clinical Causes
Biochemical Basis
Clinical Findings
Histopathologic Findings
Clinical Evaluation
Management
Summary
References
89 - Factitious Keratoconjunctivitis
Introduction
Factitious Disorders Defined
Munchausen Syndrome (Chronic Factitious Disorder)
Diagnosis of Factitious Keratoconjunctivitis
Treatment of Factitious Disease
Malingering
Mucus Fishing Syndrome
Inadvertent or Unintentionally Self-Induced Trauma
Self-Induced Trauma and Psychosis
Neurologic Disorders
Self-Inflicted Injuries in Children
Topical Anesthetic Abuse
History
Local Effects on the Corneal Surface
Clinical Presentation
Diagnosis
Treatment
Conclusion
References
SECTION 7 Immunologic Disorders of the Cornea
90 - Corneal Disease in Rheumatoid Arthritis
Introduction
Pathogenesis
Clinical Manifestations
Articular Manifestations
Extra articular Manifestations
Rheumatoid Nodules
Vasculitis
Ocular Manifestations
Keratoconjunctivitis Sicca
Scleritis
Keratitis
Additional Ocular Disease
Treatment
Systemic Disease
Ocular Disease
Keratoconjunctivitis Sicca
Keratitis
Scleritis
. Systemic medical therapy for RA-associated nonnecrotizing scleritis and keratitis is successful in most cases.45 Initial treat...
Necrotizing Scleritis and Peripheral Ulcerative Keratitis
Effectiveness of Systemic Immunosuppressive Therapy in Ocular Inflammation
Surgical Management
Conclusion
References
91 - Corneal Disease Associated With Nonrheumatoid Collagen-Vascular Disease
The Collagenoses
Systemic Lupus Erythematosus
Systemic Sclerosis
Mixed Connective Tissue Disease
Polymyositis and Dermatomyositis
Relapsing Polychondritis
The Vasculitides
Granulomatosis With Polyangiitis
Polyarteritis Nodosa
Churg-Strauss Syndrome
Cogan Syndrome
Behçet Disease
Giant Cell Arteritis
Conclusion
References
92 - Phlyctenular Keratoconjunctivitis and Marginal Staphylococcal Keratitis
Phlyctenular Keratoconjunctivitis
Background and History
Etiology and Epidemiology
Pathogenesis
Clinical Features
Differential Diagnosis
Diagnostic Evaluation
Treatment
Staphylococcal Marginal Keratitis
Background
Pathogenesis
Clinical Features
Differential Diagnosis
Diagnostic Evaluation
Treatment
References
93 - Mooren Ulcer
Introduction
Epidemiology
Etiology
Pathogenesis
Clinical Features
Symptoms
Signs
Differential Diagnosis
Diagnosis
Treatment
Systemic Immunosuppression
Other Agents
Additional Surgery
Prognosis
Summary
References
SECTION 8 Corneal Trauma
94 - Mechanical Injury
History
Examination
Abrading Injuries
Epithelial Abrasions
Etiology
Clinical Signs and Findings
Treatment
Healing
Complications
Stromal Abrasions
Etiology
Clinical Signs and Findings
Treatment
Complications
Blunt Trauma
Contusion Injuries
Clinical Signs and Findings
Diffuse Endotheliopathy
Endothelial Rings
Stromal Injuries and Fractures
Obstetric Injuries
Pathogenesis
Clinical Signs
Management
Injuries Caused by Radiant Energy
Ultraviolet Radiation
Corneal Effects of Ultraviolet Irradiation
Clinical Signs and Findings
Infrared Radiation
Thermal Burns
Clinical Signs and Findings
Management
Foreign Body Injuries
Clinical Signs and Findings
Stings
Bee and Wasp Stings
Jellyfish Stings
References
95 - Chemical and Thermal Injuries of the Eye
Introduction
Epidemiology of Chemical Eye Injuries
Etiology of Chemical Injury: Causative Agents
Sequelae
Classification
Emergency Management
Irrigation
Aqueous Humor Replacement
Acute Management
Control of Inflammation
Topical Corticosteroids
Prevention of Stromal Breakdown
Tetracyclines
Ascorbate
Citrate
Promotion of Reepithelialization and Repair
Amniotic Membrane Transplant
Tenonplasty Flaps
Preservative-Free Lubricants
Biologic Fluids
Preservative-Free Antibiotics
Management of Ocular Exposure
Management of Intraocular Pressure
Antihypertensives
Miscellaneous
Cycloplegic Agents
Management of Symblepharon Formation
Emergency Surgery
Tissue Glue and Tectonic Keratoplasty
Chronic Phase
Rehabilitation of the Ocular Surface
Reconstruction of the Adnexa
Management of Limbal Stem Cell Deficiency
Unilateral Stem Cell Deficiency
. In conjunctival limbal autograft (CLAU), a relatively large free conjunctival limbal lenticule is harvested from the donor eye...
. Pellegrini et al. first described the technique of treating unilateral LSCD with an ex vivo autologous cultured limbal epithel...
. Simple limbal epithelial transplantation (SLET) is a recently developed technique for the treatment of unilateral LSCD.45 Brie...
Bilateral Limbal Deficiency
. Bilateral limbal deficiency secondary to ocular chemical burns pose a unique set of challenges due to the lack of a source of ...
. The risk of allograft rejection and the requirement for systemic immunosuppression in allogenic LSCT inspired the development ...
Limbal Stem Cell Transplantation and Keratoplasty
Keratoprosthesis
Glaucoma Management
Future Therapies
Vascular Endothelial Growth Factor Inhibitors
Stem Cell–Based Therapies
Ocular Thermal Burns
Pathophysiology
Clinical Evaluation
Clinical Management
Conclusion
Acknowledgments
References
96 - Corneal Complications of Intraocular Surgery
Epithelial Complications
Thermal Burns
Descemet Membrane Tear/Detachment
Infectious Keratitis
Endothelial Injury
Incidence
Pathogenesis
Brown-Mclean Syndrome
Toxic Anterior Segment Syndrome
Specific Etiologic Factors in Aphakic Bullous Keratopathy and Pseudophakic Bullous Keratopathy
Preoperative Factors: Preexisting Disease
Intraoperative Factors
Postoperative Causes of Corneal Edema
Treatment
Future Considerations
References
97 - External Eye Manifestations of Biological and Chemical Warfare
BACKGROUND
MECHANISM OF ATTACK
WARNING SIGNS
BIOLOGICAL DISEASES
Anthrax
Microbiology/Epidemiology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Botulism
Microbiology
Clinical Manifestations
Diagnosis
Treatment
Smallpox
Microbiology
Epidemiology
Clinical Manifestations
Diagnosis
Treatment and vaccination
Tularemia
Microbiology and Epidemiology
Clinical Manifestations
Diagnosis
Treatment
Viral Hemorrhagic Fever
Microbiology and Epidemiology
Clinical Manifestations
Diagnosis
Treatment
CHEMICAL AGENTS
Nerve Agents
Ophthalmic Manifestations
Vesicants
Clinical Manifestations
Treatment
REFERENCES
SECTION 9 Contact Lenses
98 - Contact Lens Applications in Corneal Disease
Introduction
Soft Lens Innovations
Hydrogel Lenses
Silicone Hydrogel Lenses
Rigid Lens Innovations
Contact Lenses As Bandage Lenses
Collagen Shields
Therapeutic Uses for Contact Lenses
Contact Lenses for Drug Delivery
Irregular Cornea and Ectasia
Conventional Soft Spherical and Soft Toric Lenses
Keratoconus Design Specialty Soft Lenses
Conventional RGP Lenses
Keratoconus Design Specialty RGP Lenses
Ultralarge and Intralimbal RGP Designs
Hybrid Lenses
Piggyback Lenses
Mini-scleral Lenses, Scleral Lenses, and Prosthetic Replacement of the Ocular Surface Ecosystem Treatment
Scleral Lens and Prosthetic Replacement of the Ocular Surface Ecosystem Treatment as Alternative to Keratoplasty
Wavefront Customized Contact Lens Designs
Contact Lens Correction for Vision Correction After Surgery
Contact Lenses After Corneal Collagen Crosslinking for Keratoconus
Contact Lens Correction After Corneal RING Segments
Contact Lens Correction After Penetrating Keratoplasty
Contact Lens Correction After Refractive Surgery
Radial Keratotomy
Photorefractive Keratectomy and Laser In Situ Keratomileusis
Prosthetic Contact Lenses
Tinted Contact Lenses
Summary
References
99 - Complications of Contact Lens Wear
INTRODUCTION
Patient History
Abrasions
Infiltrates
Infections
Fungal Infections
Acanthamoeba
Contact Lens-Induced Keratopathy
Giant Papillary Conjunctivitis and Other Allergies
Ocular Allergies
Ptosis
Dry Eyes
Meibomian Gland Dysfunction
Hypoxia
Corneal Warpage
Conclusion
References
PART VIII The Sclera and Anterior Uvea
SECTION 1 Disorders of the Sclera
100 - Episcleritis
ANATOMY
Incidence
Clinical Manifestations
History
Physical Examination
Course
Differential Diagnosis
Pathology
Imaging
Angiography
Complications
Etiology
Laboratory Evaluation
Treatment
References
101 - Scleritis
Immune-Mediated Scleritis
Epidemiology
Pathogenesis and Risk Factors
Clinical Findings
Associated Systemic Diseases
Complications
Signs Aiding in Differential Diagnosis
Laboratory Investigations
Therapy
Infectious Scleritis
Clinical Findings
Sclerokeratitis
Panophthalmitis
Scleritis After Scleral Buckling Surgery132,133
Post-pterygium Excision Scleritis
Other Postsurgical Infectious Scleritis
Herpetic Scleritis
Syphilitic Scleritis
Mycobacterium Tuberculosis Scleritis108,155–157
Signs Aiding in Differential Diagnosis
Laboratory Investigations
Therapy
References
SECTION 2 Anterior Uveitis
102 - Classification and Diagnosis of Anterior Uveitis
DIAGNOSIS
Symptoms of Anterior Uveitis
History
Demographic Information
Past Medical History and Review of Systems
Social and Family History
Physical Examination
External
Pupils
Sclera and Conjunctiva
Cornea
Anterior Chamber, Anterior Chamber Angle, and Iris
Lens and Anterior Vitreous
Intraocular Pressure
Retina and Optic Nerve
Classification
Response to Therapy
Diagnostic Evaluation
Treatment
Summary
References
103 - Idiopathic Anterior Uveitis
Classification of Uveitis
History of Uveitis
Ocular Examination
Differential Diagnoses of Anterior Uveitis
Laboratory Evaluation
Treatment Of Anterior Uveitis
Topical Corticosteroids
Topical Cycloplegics
Systemic Corticosteroids
Systemic Immunosuppressive Drugs
Biologic Agents
Treatment Of Complications
summary
References
104 - HLA-B27–Associated Uveitis
EPIDEMIOLOGY
Clinical Features
Etiology
Hla-B27 and its Association With Spondyloarthropathies
Treatment
Complications and Prognosis
References
105 - Sarcoidosis
Ocular Manifestations
Eyelids
Lacrimal Gland
Lacrimal Drainage System
Orbit
Conjunctiva
Cornea
Iris
Anterior Uveitis
Intermediate and Posterior Uveitis
Optic Nerve
Diagnosis
Course and Management
References
106 - Behçet Disease
Systemic Manifestations of Behçet Disease
Ocular Manifestations of Behçet Disease
Anterior Segment Findings
Posterior Segment Findings
Conventional Therapy
Biologic Therapy
References
107 - Fuchs Uveitis Syndrome
Clinical Features
Etiology
Differential Diagnosis
Treatment
Prognosis
References
108 - Juvenile Idiopathic Arthritis-Associated Uveitis
Epidemiology
Clinical Features
Ocular Clinical Features
Etiology
Treatment of Ocular Disease
Screening
Conclusion
References
PART IX Keratoplasty
SECTION 1 Overview
109 - The Evolution of Contemporary Keratoplasty
EARLY CONTRIBUTIONS TO CORNEAL TRANSPLANTATION
Modern Techniques of Corneal Transplantation
The Evolution From Penetrating Keratoplasty Back to Lamellar Keratoplasty
Ultrathin Descemet Stripping Automated Endothelial Keratoplasty
Nanothin Descemet Stripping Automated Endothelial Keratoplasty
Deep Anterior Lamellar Keratoplasty
Use of the Femtosecond Laser
Ocular Surface Transplantation
Conclusion
References
110 - Preoperative Considerations and Decision-Making in Keratoplasty
GENERAL CONSIDERATIONS
Ocular Surface Reconstruction Procedures
Anterior Lamellar Keratoplasty Procedures
Indications
Contraindications
Advantages of Anterior Lamellar Keratoplasty
Disadvantages of Anterior Lamellar Keratoplasty
Surgical Techniques
Posterior Lamellar Keratoplasty Procedures
Indications
Contraindications
Advantages of Endothelial Keratoplasty Compared to Penetrating Keratoplasty
Disadvantages of Endothelial Keratoplasty
Surgical Technique
Penetrating Keratoplasty Procedures
Indications for Penetrating Keratoplasty
Relative Contraindications for Penetrating Keratoplasty
Advantages of Penetrating Keratoplasty
Disadvantages of Penetrating Keratoplasty
Surgical Techniques
Permanent Keratoprosthesis Surgery
Indications
Relative Contraindications
Advantages of Permanent Keratoprosthesis Surgery (KPro)
Disadvantages of Permanent Keratoprosthesis (KPro)
Surgical Technique
Summary
References
SECTION 2 Penetrating Keratoplasty Procedures
111 - Penetrating Keratoplasty: The Fundamentals
Introduction
Factors in Patient Selection
Age
Mental Impairment
Coexisting Ocular Disease
Establish Realistic Expectations
Surgical Setting and Anesthesia
Preoperative Preparations
Infection Control
Intraocular Pressure Control
Lens Management
Donor Corneal Tissue Management
Anticipated Suprachoroidal Hemorrhage
Insertion of Lid Speculum
Placement of Scleral Fixation Ring
Marking of Host Cornea
Trephination of Donor Cornea
Trephination of Host Cornea
Placement of Viscoelastic Material in the Anterior Chamber
Placement of the Donor Corneal Tissue in the Host Bed
Placement of Four Interrupted Radial 10-0 Nylon Cardinal Sutures
Complete Suturing
Surgical Tips on Wound Closure
Readjustment of Sutures to Minimize Astigmatism
Administering Medications
Postoperative Suture Adjustment
Special Circumstances
The Postrefractive Surgery Patient
Rotating Autograft
Autologous Contralateral Autograft
Maximizing Penetrating Keratoplasty Outcomes
References
112 - Intraoperative Complications of Penetrating Keratoplasty
Complications Related to Anesthesia
Scleral Perforation with Fixation Sutures
Complications Related to Trephination
Improper Trephination Size
Eccentric Trephination
Damaged Donor Button
Retained Descemet Membrane
Iris–lens Damage
Torn Posterior Capsule
Expulsive Suprachoroidal Hemorrhage
References
113 - Femtosecond-Assisted Penetrating Keratoplasty
Introduction
History
Laboratory Research
Laser Platforms
Preoperative Evaluation
Posterior Side Bridge
Trephination Geometry
Surgical Methodology
Early Outcomes
Deep Anterior Lamellar Keratoplasty
Anterior Lamellar Keratoplasty
Endothelial Keratoplasty
References
SECTION 3 Penetrating Keratoplasty: Postoperative Management
114 - Postoperative Management
IMMEDIATE POSTOPERATIVE CARE
First 24 Hours
EARLY POSTOPERATIVE CARE
One to Seven Days
POSTOPERATIVE CARE
One to Twelve Weeks
Beyond 3 Months
POSTOPERATIVE CARE IN INFANTS AND CHILDREN
EARLY POSTOPERATIVE COMPLICATIONS
WOUND LEAKS AND WOUND DISPLACEMENT
PERSISTENT EPITHELIAL DEFECTS
FILAMENTARY KERATITIS
SUTURE-RELATED COMPLICATIONS
Suture Exposure
Suture-Related Infection
Suture-Related Immune Infiltrates
Kaye Dots
ELEVATED INTRAOCULAR PRESSURE
POSTOPERATIVE INFLAMMATION
ANTERIOR SYNECHIA
PUPILLARY BLOCK
CHOROIDAL DETACHMENT AND CHOROIDAL HEMORRHAGE
HYPHEMA
FIXED DILATED PUPIL
POSTOPERATIVE INFECTION
PRIMARY GRAFT FAILURE
EPITHELIAL DOWNGROWTH
History
Incidence and Etiology
Pathogenesis
Diagnosis
Glaucoma and Epithelial Downgrowth
Treatment
FIBROUS INGROWTH
Incidence and Etiology
Pathogenesis
Diagnosis
Treatment
DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF POSTKERATOPLASTY ASTIGMATISM
PREOPERATIVE FACTORS
INTRAOPERATIVE FACTORS
Graft Diameter
Tissue Alignment
Trephination Factors
Scleral Support Ring
POSTOPERATIVE FACTORS
Relaxing Incisions
Astigmatic Keratotomy
Wedge Resections
Laser In Situ Keratomileusis
Photorefractive Keratectomy
CONCLUSION
REFERENCES
115 - Diagnosis and Management of Corneal Allograft Rejection
CLINICAL ASPECTS OF CORNEAL ALLOGRAFT REJECTION
HISTORICAL PERSPECTIVE
Recognition of Risk Factors
Differential Diagnosis of Corneal Allograft Rejection
Treatment of Corneal Allograft Rejection
Prevention of Corneal Allograft Rejection
Management Strategy
References
116 - Infections After Penetrating Keratoplasty
MICROBIAL KERATITIS
Pathogenesis
Pathogens
Clinical Approach
Therapeutic Approach
Outcomes
Suture Abscess
Pathogenesis
Clinical Approach
Therapeutic Approach
Infectious Crystalline Keratopathy
Historical Background
Pathogenesis
Clinical Approach
Therapeutic Approach
Outcomes
Endophthalmitis
Incidence
Pathogenesis
Pathogens
Clinical Approach
Therapeutic Approach
Outcomes
Factors Associated With Recurrence
Herpes Simplex Virus
Fungal
Acanthamoeba
Newly Acquired Herpetic Keratitis After Keratoplasty
Transmission of Unusual Infections
Rabies
Creutzfeldt-Jakob Disease
Hepatitis Virus
Human Immunodeficiency Virus
Conclusion
References
117 - Glaucoma After Corneal Transplantation
Incidence
Risk Factors
The Prekeratoplasty Evaluation
Clinical Presentation
Glaucoma and Graft Failure
Mechanisms for Glaucoma
Post Penetrating Keratoplasty
Deep Anterior Lamellar Keratoplasty
Endothelial Keratoplasty
Keratoprosthesis
Management of Postkeratoplasty Glaucoma
Medical Management
Surgical Management
Laser Iridoplasty and Trabeculoplasty
. The adjunctive use of mitomycin C (MMC) during trabeculectomy to suppress episcleral fibrosis appears to increase the success ...
. Many keratoplasty patients have comorbid conditions that preclude trabeculectomy. For example, chemical injury, ocular surface...
. Comorbidities, including the presence of cicatricial disease or conjunctival scarring from prior procedures, may make some ker...
Summary
References
SECTION 4 Anterior Lamellar Keratoplasty
118 - Indications for Anterior Lamellar Keratoplasty
Introduction
Epikeratophakia
Anterior Lamellar Keratoplasty
Superficial Anterior Lamellar Keratoplasty
Deep Anterior Lamellar Keratoplasty
Deep Anterior Lamellar Keratoplasty Indications
Keratoconus
Keratoglobus
Pellucid Marginal Degeneration
Herpes Simplex Virus-Related Scar
Leukoma Resulting From Thermal/Chemical Injury
Corneal Perforating Wounds
References
119 - Historical Development of Anterior Lamellar Keratoplasty
References
120 - Techniques of Anterior Lamellar Keratoplasty
Introduction
Surgical Anatomy of the Corneal Stroma
Descemetic DALK and Predescemetic DALK Classification
Pre-Descemet Layer, Big Bubble Type 1, Type 2, and Type 3
Clinical and Surgical Implications
New Acronyms: Deep Anterior Lamellar Keratoplasty, Subtotal Anterior Lamellar Keratoplasty, and Total Anterior Lamellar Keratopl...
Dalk Surgical Techniques
Most Prevalent Techniques
Peeling Off27,28
Layer-By-Layer Manual Dissection29
Hydrodissection32
Viscoelastic Dissection11,12,33
Air Big Bubble13
?Bubble Test (See Video 120.6)34
New Opening of the Bubble35,36
?Cannula Big Bubble (See Video 120.6)37,38
Air-Visco Bubble Technique7,37–39
Donor Preparation
Suturing Techniques
New Devices
References
121 - Intraoperative and Postoperative Complications of Anterior Lamellar Keratoplasty
INDICATIONS FOR ANTERIOR LAMELLAR KERATOPLASTY
SURGICAL INSTRUMENTS TO PREVENT INTRAOPERATIVE COMPLICATIONS
Intraoperative Complications
Perforations and Ruptures of Descemet Membrane
Trephination
Stromal Dissection
Suture Needles
Management of Descemet Membrane Ruptures
Postoperative Complications
Pseudo-Anterior Chambers
Pupillary Block and Fixed Dilated Pupil (Urrets-Zavalia Syndrome)
Sclerocorneal Inflammation
Stromal Rejection
Postoperative Astigmatism
References
122 - Recovery Techniques in Deep Anterior Lamellar Keratoplasty
INTRODUCTION
Standard Techniques And Learning Curves
Repeated Air Injections
Air-Visco Bubble Technique
Manual Dissection (See Videos 120.2 and 120.3)
Avoidance of Descemet Membrane Ruptures
Cannula Versus Needle Big Bubble
Bubble Test (See Video 120.6)
New Opening of the Bubble
Repair of Descemet Membrane Ruptures
Descemet Membrane Ruptures in Total Anterior Lamellar Keratoplasty
Descemet Membrane Ruptures in Subtotal Anterior Lamellar Keratoplasty (Video 122.1)
Descemet Membrane Ruptures in Deep Anterior Lamellar Keratoplasty
Excessive trephination and perforation
Postoperative Traumatic Descemet Membrane Disinsertion (Video 122.5)
References
123 - Outcomes of Anterior Lamellar Keratoplasty
INTRODUCTION
Visual Outcomes
Refractive Outcomes
Graft Survival
Resistance to Trauma
Surgical Planning
Summary
References
SECTION 5 Complex Keratoplasty
124 - Pediatric Keratoplasty
INTRODUCTION
Corneal Grafts and the Pediatric Patient
Amblyopia and Neural Plasticity
Infant and Toddler Development
Emmetropization
Indications
Preoperative Evaluation
Ocular
Management Options
Pediatric Keratoplasty
Counseling Parents and Grandparents
Scheduling Surgery
Operative Technique
Anesthesia
Penetrating Keratoplasty
Rotational Penetrating Autokeratoplasty
Deep Anterior Lamellar Keratoplasty
Endothelial Keratoplasty
Selective Endothelial Removal
Concomitant Procedures
Postoperative Evaluation
Early Postoperative Complications
Suture Removal
Graft Rejection
Glaucoma
Strabismus
Optical Correction and Amblyopia Therapy
Graft Survival
Risk Factors for Failure
Visual Outcome
The Future
References
125 - Keratoplasty in Herpes Simplex Infection
INDICATIONS AND TIMING FOR CORNEAL GRAFTING
PREOPERATIVE MEASURES
Control of Inflammation
Vascularization
Corneal Sensation
Antiviral Prophylaxis
Donor Tissue Requirements
Operative Technique
Graft Size
Perforated Eyes
Suture
The Triple Procedure
Anterior Lamellar Keratoplasty
Femtosecond Laser
Boston Keratoprosthesis
Postoperative Management
Use of Corticosteroids
Suture Removal
Persistent Epithelial Defects
Recurrence of Herpes Simplex Virus Keratitis
Allograft Rejection
Secondary Graft Failure
Glaucoma
Wound Dehiscence
Secondary Infections
Postkeratoplasty Refractive Errors
References
126 - Immunologically High-Risk Penetrating Keratoplasty and Large-Diameter Corneal Grafts
INTRODUCTION
Immunology of Graft Rejection
Current View of the Immune Response
Histocompatibility Antigens
Immune Status of the Cornea
Allograft Rejection
RISK FACTORS FOR IMMUNEREJECTION
Corneal Vascularization
Prior Graft Rejection and Graft Loss
Graft Diameter and Eccentric Grafts
Anterior Synechiae
Previous Intraocular Surgery
Herpes Simplex and Herpes Zoster Keratitis
History of Anterior Segment Inflammatory Disease
Ocular Surface Disease
Young Age
Glaucoma
Preoperative Considerations
Controlling Ocular Inflammation
Rehabilitating the Ocular Surface
Operative Considerations
Tissue Matching
Surgical Technique
Postoperative Considerations
Immunosuppression
Corticosteroids
Calcineurin Inhibitors
Antimetabolites
Monoclonal Antibodies
Blocking the Activation and Action of T-Cells
Monoclonal Antibodies to T-cell Antigens
Co-stimulatory Blockade
Inhibiting the Antigen-Presenting Cells
Inhibiting Immune Access to the Graft
Reduction of Corneal Neovascularization
References
SECTION 6 Endothelial Keratoplasty
127 - Historical Development of Endothelial Keratoplasty
INTRODUCTION
Early Posterior Lamellar Keratoplasty
THE FLAP TECHNIQUE OF POSTERIOR LAMELLAR KERATOPLASTY
THE LIMBAL APPROACH TO ENDOTHELIAL REPLACEMENT
Deep Lamellar Endothelial Keratoplasty
Advances in Eye Bank Tissue Preparation
References
128 - Indications and Decision-Making for Endothelial Keratoplasty
Indications for Endothelial Keratoplasty
Advantages of Endothelial Keratoplasty
Patient Selection
Vision
Age
Duration of Corneal Edema
Lens Considerations
Considerations in Complex Eyes
Conclusion
References
129 - Eye Bank Preparation of Tissue for Endothelial Keratoplasty
INTRODUCTION
Issues to Consider
Techniques
Summary
References
130 - Surgical Techniques for Descemet Stripping Automated Endothelial Keratoplasty
INTRAOPERATIVE CONSIDERATIONS
Wound Creation
Recipient Preparation
Techniques to Improve Donor Adherence
Donor Insertion Techniques
Donor Apposition Techniques
Early Postoperative Management
Summary
References
131 - Ultrathin Descemet Membrane Endothelial Keratoplasty
INTRODUCTION
Indications
Preoperative Planning
Surgical Technique
Donor Preparation
Recipient Preparation and Graft Delivery
Postoperative Care
Results
Visual Outcomes
Refractive Outcomes
Endothelial Cell Density
Graft Thickness
Graft Survival
Complications
Conclusion
References
132 - Nanothin Descemet Stripping Automated Endothelial Keratoplasty
Introduction
ULTRATHIN DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY AND ITS OUTCOMES
NANOTHIN DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY
NANOTHIN DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY OUTCOMES
ADVANTAGES OF NANOTHIN DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY
References
133 - Intraoperative and Postoperative Complications of Descemet Stripping Automated Endothelial Keratoplasty
COMPLICATIONS OF DONOR TISSUE PREPARATION
Intraoperative Complications
Donor Lenticule Problems
Air Management
Bleeding
Lens or Lens Implant Problems
Postoperative Complications
Graft Complications
Air-Related Complications
Interface Problems
Infectious Complications
Iatrogenic Glaucoma
Persistent Corneal Edema
References
134 - Outcomes of Descemet Stripping Automated Endothelial Keratoplasty
INTRODUCTION
Results
Descemet Stripping Automated Endothelial Keratoplasty Complications
Visual Recovery After Descemet Stripping Automated Endothelial Keratoplasty
Astigmatism
Spherical Equivalent
Donor Endothelial Survival
Summary
References
135 - Surgical Technique for Descemet Membrane Endothelial Keratoplasty
Introduction
Injectors
Recipient Preparation
Wound Creation
Endothelium–Descemet Membrane Resection
Pupillary Modulation
Peripheral Iridotomy
Graft Orientation
Orientation Before Insertion
Orientation After Insertion
Changing Orientation After Insertion
Unscrolling and Centering
Fluid-Assisted Unscrolling
Bubble-Assisted Unscrolling
Chamber-Assisted Unscrolling
Centering and Centration
Sulfur Hexafluoride Versus Room Air
References
136 - Intraoperative and Postoperative Complications of Descemet Membrane Endothelial Keratoplasty
INTRODUCTION
Intraoperative Complications
Donor Tissue Damage During Graft Preparation
Poor Visualization of Donor Tissue
Difficulty Handling and Unfolding Donor Tissue
Upside-Down Donor Graft
Other Complications
Postoperative Complications
Donor Dislocation
Primary Graft Failure
Graft Rejection
Pupillary Block Glaucoma
Endothelial Cell Loss
Other Complications
Conclusion
References
137 - Outcomes of Descemet Membrane Endothelial Keratoplasty
Introduction
Descemet Membrane Endothelial Keratoplasty After Vitrectomy
VISUAL FUNCTION AFTER DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY
Visual Acuity
Hyperopic Shift
MORPHOLOGY AFTER DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY
Restoration of the Normal Anatomy
Morphology and Optical Properties of the Anterior Corneal Surface
Optical Properties of the Posterior Corneal Surface
Morphology and Function of the Corneal Endothelium
DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY OUTCOMES: PREOPERATIVE CONSIDERATIONS
Graft Preparation
Donor Tissue Selection
Donor Preparation
Surgeon Prepared Descemet Membrane Endothelial Keratoplasty Tissue
Descemet Membrane Endothelial Keratoplasty With Precut Tissue
Descemet Membrane Endothelial Keratoplasty With Preloaded Tissue
Donor Insertion and Manipulation
Descemetorhexis Sizing
DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY OUTCOMES: PERIOPERATIVE CONSIDERATIONS
Descemetorhexis Sizing
Air Versus Gas Tamponade
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
Incomplete Graft Adhesion: Rebubbling
Pupillary Block
Cystoid Macular Edema
Cataract Progression
Graft Failure
Graft Rejection
Steroid-Induced Secondary Glaucoma After Descemet Membrane Endothelial Keratoplasty
DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY OUTCOMES: COMPARISON WITH OTHER TECHNIQUES OF POSTERIOR LAMELLAR SURGERY
Ultrathin (UT)-DSAEK Versus DMEK
DMEK Versus Nanothin (NT)- DSAEK
DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY IN SPECIAL SITUATIONS
Descemet Membrane Endothelial Keratoplasty as a Combined Procedure
Phakic Descemet Membrane Endothelial Keratoplasty
DMEK Under Failed PK
Repeat DMEK After Failed DMEK
DMEK After Failed DSAEK
Descemet Membrane Endothelial Keratoplasty in Complex Eyes (Posttrabeculectomy/Filtering Tubes Postvitrectomy)
Descemet Membrane Endothelial Keratoplasty After Glaucoma Filtration Surgery
References
138 - Complex Endothelial Keratoplasty
INTRODUCTION
Lens Abnormalities
Aphakia
Dislocated Intraocular Lens
Anterior Chamber Abnormalities
Excessively Shallow or Crowded
Excessively Deep Anterior Chamber
Iris Abnormalities
Pupillary Abnormalities and Large Iris Defects
Traumatic Aniridia
Irido-Corneal Endothelial Syndrome
Previous Glaucoma Surgery
Previous Failed Graft
Penetrating Keratoplasty
Failed Descemet Stripping Endothelial Keratoplasty
Failed Descemet Membrane Endothelial Keratoplasty
Summary
References
139 - Cultivated Corneal Endothelial Cell Transplantation
Concept
Corneal Endothelial Cell Biology
Cultured Human Corneal Endothelial Cells-Sheet Transplantation
Cultured Human Corneal Endothelial Cells-Injection Therapy
Topical Treatment of Corneal Endothelial Disease
References
PART X Therapeutic Procedures
SECTION 1 Corneal Surgery
140 - Management of Corneal Perforations
Etiology
Terminology
Preoperative Management
Treatment Options
Tissue Adhesives
Cyanoacrylate Glue
Method of Application
Postoperative Management
Complications
Penetrating Keratoplasty
Patch Graft
Amniotic Membrane Transplantation
Medical and Nonconventional Management
Prevention of Corneal Perforation
Bandage Soft Contact Lens
Conjunctival Flap
Tarsorrhaphy
Amniotic Membrane Transplantation
Miscellaneous
Conclusion
References
141 - Therapeutic Keratoplasty
THERAPEUTIC KERATOPLASTY FOR INFECTIOUS KERATITIS
Therapeutic Keratoplasty for Bacterial Infections
Therapeutic Keratoplasty for Fungal Keratitis
Therapeutic Keratoplasty for Acanthamoeba Keratitis
Therapeutic Keratoplasty for Viral Keratitis
Presurgical Evaluation
Antimicrobial Therapy
Donor Material
Surgical Technique
Therapeutic Penetrating Keratoplasty
Therapeutic Lamellar Keratoplasty
References
142 - Surgical Management of Superficial Corneal and Conjunctival Disease
INTRODUCTION
Superficial Corneal Diseases
Recurrent Corneal Erosions
Anterior Stromal Micropuncture
Epithelial Debridement (Superficial Keratectomy,Diamond Burr, PTK)
Band Keratopathy
Partial Limbal Stem Cell Deficiency
Salzmann Nodular Degeneration
Superficial Conjunctival Diseases
Superior Limbic Keratoconjunctivitis
Conjunctivochalasis
Molluscum Contagiosum
Conclusion
References
143 - Excimer Laser Phototherapeutic Keratectomy
INTRODUCTION
INDICATIONS FOR PHOTOTHERAPEUTIC KERATECTOMY
Contraindications
Preoperative Evaluation
Ophthalmic History
Medical History
Examination
Ancillary Testing
Patient Selection
Techniques
General
Smooth Opacities
Rough or Elevated Opacities
Deep Irregular Opacities
Recurrent Erosions
Antihyperopia Treatment
Masking Agents
Mitomycin C
Postoperative Management
Results
Side Effects and Complications
Future Directions
Summary
References
SECTION 2 Conjunctival Surgery
144 - Management of Primary Pterygium
INTRODUCTION
DEFINITION AND MORPHOLOGY
EPIDEMIOLOGY OF PTERYGIUM
Risk Factors
Environmental Factors
Genetic Factors
PATHOGENESIS OF PTERYGIUM
Degenerative Versus Proliferative Disorder
Limbal Stem Cell Deficiency and Epithelial Abnormalities in Pterygium
THERAPEUTIC OPTIONS FOR PTERYGIUM
Bare Sclera Excision
Excision With Conjunctival Closure/Transposition
Bare Scleral Excision With Adjunctive Medical Therapies
Ocular Surface Transplantation Techniques
Conjunctival Autografting
Other Adjuvants in Pterygium Management
Tissue Adhesives in Pterygium Surgery
Surgical Technique of Pterygium Excision and Conjunctival Autografting
Conjunctival-limbal Autograft Transplantation
COMPLICATIONS OF CONJUNCTIVAL AUTOGRAFTING
Causes of Recurrence After Conjunctival Autografting
Amniotic Membrane Transplantation
Surgical Technique of Amniotic Membrane Transplantation
Lamellar Keratoplasty
CONCLUSION
REFERENCES
145 - Management of Recurrent Pterygium
Introduction
Aims and Definitions
Risk Factors for Pterygium Recurrence
Dry Eye Syndrome
Timing of Surgery
Surgical Technique
Previous Surgical Procedures
Other Considerations
Medial Rectus
Author’s Technique
Femtosecond Laser-Assisted Pterygium Surgery
FURTHER Considerations
Conclusion
References
146 - Conjunctival Flaps
INTRODUCTION
Indications
Persistent Corneal Epithelial Defect
Unresponsive Ulcerative Microbial Keratitis
Corneal Thinning and Perforation
Corneal Limbal Disease
Scleral Necrosis
Glaucoma Surgery Complications
Surface Preparation for a Cosmetic Scleral Shell
Lacrimal Punctal Occlusion
Disadvantages
Surgical Techniques
Total Conjunctival Flap
Removal of Corneal Epithelium
Mobilization of the Conjunctival Flap
Conjunctival Flap Suture
Bipedicle Bridge Flap
Single Pedicle Flap
Advancement Flap
Complications
Intraoperative Complications
Buttonhole Formation
Dissection of an Inadequate Flap
Excessive Hemorrhage
Postoperative Complications
Retraction of the Flap
Ptosis
Cystic Flap
Opacification and Vascularization
References
147 - Indications for and Uses of Amniotic Membrane: Clinic
THE AMNIOTIC MEMBRANE: HISTOLOGY, BIOLOGIC PROPERTIES, AND CLINICAL EFFECTS
Preserving The Amniotic Membrane
Sutureless, Cryopreserved Amniotic Membrane
Dehydrated Amniotic Membrane
Amniotic Membrane as a Patch in Corneal Surface Disease
Amniotic Membrane and Limbal Stem Cell Deficiency
Complications
References
148 - Indications for and Uses of Amniotic Membrane: Operating Room
THE AMNIOTIC MEMBRANE: HISTOLOGY, BIOLOGIC PROPERTIES, AND CLINICAL EFFECTS
PRESERVATION METHODS OF AMNIOTIC MEMBRANE: TISSUE BANK
TECHNIQUES FOR AMNIOTIC MEMBRANE IMPLANTATION IN THE OPERATING ROOM (VIDEO 148.1)
AMNIOTIC MEMBRANE TRANSPLANTATION IN OCULAR SURFACE DISEASES
?Amniotic Membrane Grafts in Conjunctival Reconstruction (Video 148.2)
?Amniotic Membrane Grafts in Corneal Surface Reconstruction (See Video 148.2)
?Amniotic Membrane Patch in Corneal Surface Reconstruction (See Video 148.2)
?Amniotic Membrane and Limbal Stem Cell Deficiency (See Videos 148.2 and 148.7)
Amniotic Membrane as a Substrate for Culturing Epithelial Stem Cell of the Sclero-corneal Limbus
Complications
References
SECTION 3 Anterior Segment Surgery
149 - Surgical Management and Rehabilitation of Anterior Segment Trauma
Patient Evaluation
History
Examination
Slit Lamp Examination
Imaging
Tissue Adhesive
Acute Surgical Management
Anesthesia and Preparation of the Eye
Surgical Timing and Goals
Corneal Laceration Repair
. In closing a jagged incision, each linear aspect of the incision is closed individually. It is important to avoid closing the ...
. A variation of the mattress suture technique has been suggested by Eisner to close a stellate laceration (Fig. 149.12). A purs...
. In the face of tissue loss that cannot be sealed with tissue glue, a lamellar corneal autograft may be used (Fig. 149.13).49–5...
Corneoscleral Lacerations
Iris Trauma
Iridodialysis
Traumatic Iris Defects
Lens Trauma, Dislocation
Anterior Segment Intraocular Foreign Bodies
Postoperative Care
Suture Removal
Postoperative Complications
Visual Rehabilitation
Conclusion
References
150 - Iris Reconstruction Surgery
Iris Suture Techniques
Sliding Knot Intracameral Suture
Pupil Cerclage Procedure
Iridodialysis Repair
Iris Relaxing Incisions
Iris Oversewing of Transillumination Defects
Scissors Sculpting
Vitrector Sculpting
Iris Cautery Sculpting
Iris Prostheses
Large-incision, Rigid Diaphragm Devices
Rigid Small-incision Devices
Flexible Small-incision Iris Prostheses
Pupillary Aperture: Pupil Versus Entrance Pupil
Complications
Summary
References
151 - Management of Scleral Perforation
GENERAL MANAGEMENT STRATEGIES
Anesthesia for Scleral Perforations
Surgical Repair of Scleral Perforations
Preoperative Considerations
Operative Considerations
Conjunctiva and Tenon Capsule
Tarsoconjunctival Flap
Autologous Sclera
Homologous Sclera
Donor Cornea
Fascia lata
Periosteum
Split-Thickness Dermal Graft
Amniotic Membrane
Other Materials
Summary
References
PART XI Collagen Crosslinking
152 - Collagen Crosslinking for Keratoconus
INTRODUCTION
Mechanism of Action
Indications
Contraindications
Surgical Procedure
Dresden Protocol
Alternative Crosslinking Techniques
Transepithelial Crosslinking
High Fluence Crosslinking
Crosslinking Combined With Topography-Guided Photorefractive Keratectomy
Crosslinking With Riboflavin Placed Through a Corneal Pocket
Typical Postoperative Findings
Cellular and Ultrastructural Findings After Crosslinking
Biomechanical Changes
Complications
Clinical Outcomes
Standard Crosslinking
Transepithelial Collagen Crosslinking
High Fluence Crosslinking
Crosslinking Combined With Topography-Guided Photorefractive Keratectomy
Future Directions
Conclusion
References
153 - Collagen Crosslinking for Postrefractive Ectasia
INTRODUCTION
Pathophysiology
The Crosslinking Procedure
Clinical Outcomes
Visual Acuity
Topographic Outcomes
Postoperative Timecourse
Biomechanical Effects of Corneal Collagen Crosslinking
Complications
Postoperative Haze
Corneal Pachymetry
Predictors of Outcomes
Future of Corneal Collagen Crosslinking
Financial Disclosure
References
154 - Collagen Crosslinking for Infectious Keratitis
BACTERIAL SUSCEPTIBILITY
In Vitro Experimental Assays
Fungal Susceptibility
Candida albicans
Fusarium solani
In Vitro Experimental Essays
In Vivo Experimental Studies
Acanthamoeba Susceptibility
In Vitro Experimental Essays
In Vivo Experimental Studies
PACK-Corneal Crosslinking
Technique
Irradiation Zone
Special Conditions
Safety
Indications
Outcomes
Conclusion
References
PART XII Keratoprosthesis
155 - Indications for Keratoprosthesis
Introduction
Boston Keratoprosthesis
Osteo-Odonto-Keratoprosthesis
Other Keratoprosthesis Devices
Moscow Eye Microsurgery Complex in Russia Keratoprosthesis
KeraKlear, Pintucci, AlphaCor, Auro Keratoprosthesis
Summary
References
156 - Boston Keratoprosthesis Type 1 Surgical Technique
Preoperative Evaluation
Design
Postoperative Management
References
157 - Postoperative Management of Boston Keratoprosthesis Type 1
AVOIDANCE OF COMPLICATIONS
Postoperative Patient Evaluation
Postoperative Treatment
Antibiotics
Corticosteroids
Glaucoma Management
Soft Contact Lens
Conclusion
References
158 - Complications of Boston Keratoprosthesis Type 1
RETROPROSTHETIC MEMBRANE
Glaucoma
Endophthalmitis
Posterior Segment Complications
Infectious Keratitis
Keratolysis or Corneal Melt
Extrusion or Keratoprosthesis Loss
References
159 - Outcomes of Boston Keratoprosthesis Type 1
Introduction
Visual Acuity and Prosthesis Retention
Postoperative Complications
Retroprosthetic Membranes
Glaucoma
Infectious Keratitis
Endophthalmitis
Sterile Vitritis
Retinal Detachment
Corneal Melt
Primary Implantation of Keratoprosthesis
Conclusion
References
160 - Boston Keratoprosthesis Type 2 Surgical Techniques, Complications, and Outcomes
Background and Design
Surgical Planning
Surgical Technique
Eyelid and Ocular Surface Preparation
Assembly of the Boston Keratoprosthesis Type 2
Implantation of the Keratoprosthesis
Closure of Eyelids
Postoperative Care
Outcomes and Complications
Conclusion
References
161 - Osteo-Odonto-Keratoprosthesis
Introduction
Preoperative Assessment
Indications for Osteo-odonto-keratoprosthesis
Preoperative Evaluation
Surgical Technique
Results and Complications
Visual Results and Stability
Complications
Conclusion
References
162 - Contemporary Approaches to the Biosynthetic Cornea: Overview and Classification
ALPHACOR
Keraklear
Tissue Engineering
Future Directions
Conclusion
References
PART XIII Ocular Surface Transplantation
163 - Classification and Staging of Ocular Surface Disease
Introduction
Classification of Ocular Surface Disease
Eyelids and Eyelashes
Tear Film
Conjunctiva
Limbal Stem Cell Deficiency
Congenital
Traumatic
Autoimmune Disorders
Staging of Ocular Surface Disease
References
164 - Conjunctival Limbal Autograft 1
INTRODUCTION
Indications and Patient Selection
PREOPERATIVE EVALUATION AND OCULAR SURFACE OPTIMIZATION
Surgical Procedure
Recipient Eye (Fig. 164.1A–C, Video 164.1)
Donor Eye (Fig. 164.2, Video 164.2)
Placement of the Donor Grafts (see Fig. 164.1D–F)
Postoperative Management
Outcomes and Complications
Donor Eyes Complications
Surgical Alternatives
Acknowledgment
References
165 - Living-Related Conjunctival Limbal Allograft
Introduction
Indications/Contraindications
Preoperative Considerations
Surgical Procedure
Harvesting the LR-CLAL Donor Segment (Figs. 165.1 and 165.2, Video 165.1
Preparation of the Recipient Eye (see Figs. 165.1 and 165.3, Video 165.2)
Placement of the Donor Tissue
Postoperative Management
Rejection and Failure
OCULAR SURFACE STABILITY AND VISUAL ACUITY OUTCOMES
References
166 - Keratolimbal Allograft
INDICATIONS AND CONTRAINDICATIONS
Preoperative Considerations
Surgical Technique
Preparation of the Recipient Eye
Donor Tissue Preparation Technique 1
Donor Tissue Preparation Technique 2
Postoperative Considerations
References
167 - Cultivated Limbal Epithelial Transplant
INTRODUCTION
Stem Cell Niche
History
Origin of Cells
Culture Process
Surgical Procedure
Clet in Children
Postoperative Medication
Follow Up
Results Table (LSCD Review)
Outcomes
Complications
Advantages and Disadvantages of Clet
Future Directions of Clet
References
168 - Simple Limbal Epithelial Transplantation
Introduction
Technique
Technique Modifications
Results
Complications and Risk Factors for Failure
Other Indications for Slet
Conclusion
References
169 - Postoperative Management of Ocular Surface Reconstruction
INTRODUCTION
PREOPERATIVE SCREENING AND DONOR SELECTION—THE CINCINNATI PROTOCOL
Donor Selection
Preoperative Screening
Preventing Immune Rejection
Overview
Definition and Clinical Signs of Rejection
Immunosuppressive Agents
Immunosuppression Regimen
Evaluation of Patients Prior to Starting Immunosuppression
Glucocorticosteroids
Mode of Action
Topical Steroids
Systemic Steroids
Calcineurin Inhibitors
Cyclosporine A
Tacrolimus (FK-506)
Antimetabolites
Azathioprine
Mycophenolate Mofetil
Other Immunosuppressive Agents
Sirolimus (Rapamycin)
Biologic Drugs
Prophylactic Antimicrobial Therapy
Risk of Malignancy
Ocular Surface Rehabilitation
Postoperative Infectious Keratitis
References
170 - Corneal Transplantation in Ocular Surface Disease
INTRODUCTION
Review of the Literature
TREATMENT PARADIGM FOR KERATOPLASTY IN PATIENTS WITH SEVERE OCULAR SURFACE DISEASE
Summary
References
171 - Outcomes of Ocular Surface Transplantation
INTRODUCTION
Outcome Measures
Autograft Outcomes
Allogeneic Outcomes
Keratoplasty Outcomes
Rejection Outcomes
Ocular Hypertension/Glaucoma
Infectious Keratitis (Fig. 171.2)
Conclusion
References
PART XIV Refractive Surgery
SECTION 1 Preoperative Considerations
172 - Decision-Making in Refractive Surgery
Excimer Laser Vision Correction
Patient Age
Refractive Error
Corneal Thickness
Corneal Topography
Keratometry
Pupil Size
Thin-Flap Lasik
Surface Ablation
Small-Incision Lenticule Extraction
Conductive Keratoplasty
Arcuate Transverse Keratotomy
Phakic Intraocular Lenses
Intraocular Lens After Phacoemulsification
Retreatments And Sequential Procedures
Intracorneal Inlays
Treatment of Presbyopia
References
173 - Patient Evaluation and Selection in Refractive Surgery
Introduction
History
Ocular Herpes Simplex Virus (HSV)
Radial Keratotomy
Strabismus
Monocular Patients
Keloid Formation
Contact Lenses, Presbyopia, and Monovision
Pregnancy
Participation in High-Risk Activities
Medicines
Medical Conditions
Examination
Visual Acuity
Refraction
Computed Tomography
Pupil Examination
Slit Lamp Examination
Fundus Examination
Tonometry
Pachymetry
Anterior Chamber Depth
Dry Eye Testing
Ocular Dominance Determination
Wavefront Testing
Informed Consent
References
174 - Topographic Analysis in Keratorefractive Surgery
Introduction
Background
Keratometry
Keratoscopy
Videokeratoscopy
Computer-Based Videokeratoscopes
Color LED Ray Tracing Topography
Elevation-Based Topography Systems
Clinical Applications
Contact Lens-Induced Warpage
Keratoconus and Keratoconus Suspects
Displaced Apex Syndrome
Postoperative Evaluations
Contoured Ablation Patterns
Future Horizons
References
SECTION 2 Laser Vision Correction
175 - Excimer Laser Surface Treatment: Photorefractive Keratectomy
Excimer Laser Surface Treatment
Photorefractive Keratectomy
Preoperative Medications
Stromal Ablation
Postoperative Management
Medications and Pain Management
Epithelial Healing
Dry Eye
Visual Recovery
Results
Myopic Photorefractive Keratectomy
Hyperopic Photorefractive Keratectomy
Ablation Profiles
Wavefront-Optimized Photorefractive Keratectomy
Wavefront-Guided Photorefractive Keratectomy
Topography-Guided Photorefractive Keratectomy
Epithelial Mapping
Complications
Haze
Background and Clinical Presentation
Risk Factors
Haze Prophylaxis
Treatment
Irregular Astigmatism
Decentered Ablation
Central Island
Ectatic Disorders
Management of Irregular Astigmatism
Delayed Epithelial Healing
Corneal Infiltrates and Infectious Keratitis
Regression of Treatment Effect
Conclusion
References
176 - LASIK Technique
INTRODUCTION
The Evolution of Lasik
Advantages of the Femtosecond Laser Flap Creation Versus the Microkeratome
Lasik Evaluation
LASIK Versus Photorefractive Keratectomy
Parameters for Treatment
Contact Lens Discontinuation Protocol
Medications
Dry eyes
Methicillin-Resistant Staphylococcus aureus (Donnenfeld) Protocol
Other Ocular Conditions
Preoperative Planning
Wavefront-Adjusted Manifest Refraction
Age Adjustments
Coupling
Monovision
Corneal Thickness
Flap Size
Flap Shape
Pocket Position
Preoperative Preparation
Sedation
Triage
Preoperative Ocular Medications
Technique
LASIK Psychology
Care of the Corneal Epithelium
Refractive Surgery Lasers for LASIK in the United States
Calibration
Single-Use Disposable Instruments
Sterile Versus Clean Procedure
Safety Checks
Laser Positioning
Eye Preparation
Iris Registration
Docking
Soft Docking and Gas Escape
Flap Position Refinement
Loss of Suction During Flap Creation
Gas Breakthrough
Lifting the Flap
Opaque Bubble Layer
Laser Ablation
Flap Replacement
Flap Alignment
Immediate Postoperative Care
Lasik Results
Lasik Enhancements
The Future of Lasik
LASIK Xtra
ReLEx SMILE
References
177 - LASIK for Myopia
HISTORY
Lasik
Excimer Lasers
Patient Selection, Indications, Limitations, and Contraindications
LASIK Contraindications
Microkeratomes and Femtosecond Lasers
Operative Technique
Postoperative Care
Intraoperative Complications
Complications
Ablation Complications
Keratectasia
Results
LASIK Enhancements
Lasik in Complex Cases
LASIK After Radial Keratotomy
LASIK After Photorefractive Keratectomy
LASIK After Penetrating Keratoplasty
Lasik After Smile
Lasik After Intraocular Lenses
Intraocular Lens Calculations After Lasik
Summary
References
178 - LASIK for Hyperopia
Introduction
Physiologic Aspects of Hyperopia
Corneal Surgery for Hyperopia
Preoperative Considerations and Patient Selection
Indications for Lasik for Hyperopia
Primary Hyperopia
Secondary Hyperopia
Technique and Instrumentation for LASIK for Hyperopia
Technique
Results
Complications
Conclusion
References
179 - LASIK Complications
INTRODUCTION
Intraoperative Lasik Complications
Femtosecond Laser Flap Complications
Suction Loss
Clinical
Management
Vertical Gas Breakthrough
Clinical
Management
Prevention
Anterior Chamber Gas Bubbles
Clinical
Management
Prevention
Opaque Bubble Layer
Clinical
Management
Prevention
Microkeratome Complications
Laser-Related Complications
Clinical
Management
Prevention
Early Postoperative Complications
Flap Striae
Clinical
Management
Prevention
Dislodged Flap
Clinical
Management
Prevention
Infection
Clinical
Management
Prevention
Diffuse Lamellar Keratitis
Clinical
Management
Prevention
Transient Light Sensitivity Syndrome
Rainbow Glare
Clinical
Management
Prevention
Late Postoperative Lasik Complications
Epithelial Ingrowth
Clinical
Management
Prevention
Pressure-Induced Stromal Keratitis
Clinical
Management
Prevention
Errors in Refractive Outcome
Clinical
Management
Prevention
Postoperative Keratectasia Following LASIK
Clinical
Management
Prevention
Night-Vision Disturbances: Halos and Glare
Clinical
Management
Prevention
Decentration
Clinical
Management
Prevention
Irregular Astigmatism
Clinical
Management
Prevention
Post-LASIK Dry Eyes and Neuropathic Pain
Management
Prevention
References
180 - Corneal Ectasia: Prevention, Detection, and Management
Prevention
Clinical Correlation
Detection
Topography
Tomography
Ocular Coherence Tomography
Wavefront Aberrometry
Corneal Hysteresis
Management
Contact Lenses
Intracorneal Ring Segments
Corneal Collagen Crosslinking
Clinical Correlation
Corneal Transplantation
References
181 - Small-Incision Lenticule Extraction
Introduction
Basic Science
Biomechanical Stability
Corneal Denervation
Wound Healing and Inflammatory Reactions
Clinical Assessments and Outcomes
Efficacy, Predictability, Stability, and Safety
Higher Order Aberrations
Contrast Sensitivity
Corneal Sensation
Visual Quality
Complications
Intraoperative Complications
Postoperative Complications
Conclusions and Future Prospects
References
SECTION 3 Additional Refractive Procedures
182 - Topography-Guided Photorefractive Keratectomy
Keratoconus, Pellucid Marginal Degeneration, Or Ectasia
After Radial Keratotomy
After Lasik, PRK, or Smile
Other Conditions
Caution In Interpreting Topographic Maps
Summary
References
183 - Intrastromal Corneal Ring Segments
A BRIEF HISTORY OF THE TECHNIQUE
Mechanism of Action
Market Availability
Indications and Contraindications
Indications
Contraindications
Surgical Planning
Surgical Procedure
Manual Dissection
Femtosecond Laser-Assisted Dissection
Intrastromal Segments and Combined Techniques
Complications
References
184 - Combined Corneal Refractive Techniques
Corneal Crosslinking in Combination With a Nonexcimer Laser Ablation Technique
Corneal Crosslinking and Intrastromal Corneal Rings
Corneal Crosslinking and Phakic Intraocular Lens
Intraocular Lenses and Corneal Relaxing Incision
Excimer Laser Ablation and Corneal Crosslinking
Photorefractive Keratectomy and Corneal Crosslinking
LASIK and Corneal Crosslinking
Excimer Laser Ablation and Intraocular Lenses
LASIK/Photorefractive Keratectomy and Phakic Intraocular Lenses
LASIK/Photorefractive Keratectomy and Pseudophakic Intraocular Lenses
Excimer Laser Ablation and Small-Incision Lenticule Extraction
LASIK/Photorefractive Keratectomy and SMILE
Triple Procedure
Intrastromal Corneal Rings, Corneal Crosslinking, and Phakic Intraocular Lenses
Intrastromal Corneal Rings, PhotorefractiveKeratectomy, and Corneal Crosslinking
Intrastromal Corneal Rings, Corneal Crosslinking, and Toric Phakic Intraocular Lenses
Four-Stage Procedure
Intrastromal Corneal Rings, Corneal Crosslinking, Phakic Intraocular Lenses, and Photorefractive Keratectomy
References
185 - Incisional Keratotomy
Introduction
Patient Selection
Preoperative Planning
Manual Peripheral Corneal Relaxing Incision Equipment
Manual Peripheral Corneal Relaxing Incision Results
Femtosecond Corneal Relaxing Incisions
Femtosecond Laser Corneal Relaxing Incisions Nomograms
Femtosecond Laser Corneal Relaxing Incisions Equipment and Surgical Techniques
Femtosecond Laser Corneal Relaxing Incisions Results
Femtosecond Laser Anterior Penetrating Corneal Relaxing Incisions
Femtosecond Laser Intrastromal Corneal Relaxing Incisions
Femtosecond Corneal Relaxing Incisions Complications
Overcorrection
Visual Loss
Anterior Gas Breakthrough
Suction Loss
Alignment
Manual Alignment
Imaging and Guidance System Alignment
Intraoperative Wavefront Aberrometry Alignment
Post-Penetrating Keratoplasty Astigmatism
After PRK or LASIK
Summary
References
186 - Phakic Intraocular Lenses
INTRODUCTION
ANGLE-SUPPORTED ANTERIOR CHAMBER PHAKIC INTRAOCULAR LENSES
ANTERIOR CHAMBER IRIS-FIXATED PHAKIC INTRAOCULAR LENSES
Posterior Chamber Phakic Intraocular Lenses
Bioptics
Acknowledgment
References
187 - Corneal Inlay Surgery for Presbyopia: Techniques and Complications
INTRODUCTION
Small-Aperture Inlays: Lessons Learned
Myopia
Ocular Surface
Deep Implantation
Surgical Techniques
Postoperative Management
Conclusion
Acknowledgments
References
Index