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Anthony C. Arnold, MO, Executive Editor

tJ~ AMERICANACADEMY

~ OFOPHTHALMOLOGY

, TheEye M.D. Association

tJ~

AMERICAN ACADEMY

\V

OF OPHTHALMOLOGY

 

The Eye M.D. Association

Box 7424

SanFrancisco,CA 94120-7424

Clinical Education Secretaries

ThomasJ. Liesegang,MD,

SeniorSecretaryfor

Clinical Education

GregoryL. Skuta,MD,

Secretaryfor Ophthalmic

Knowledge

Academy Staff

Richard A. Zorab, VicePresident,

Ophthalmic Knowledge,

Clinical EducationDivision

Hal Straus,Director of Publications

Kimberly Torgerson,Publications

Manager

Ruth Modric, Production Manager

Denise Evenson,Design

Nate Grant, ExecutiveAssistant

Debra Marchi, Administrative

Assistant

The Academy provides this material for educationalpurposesonly. It is not intendedto representthe only or bestmethod or procedure in every case,nor to replaceaphysician'sown judgment or give specificadvicefor casemanagement. Including all indications, contraindications, sideeffects,and alternativeagents for eachdrug or treatmentis beyond the scopeof this material. All information and recommendationsshould beverified, prior to use,with current information included in the manufacturers'packageinserts or other independentsources, and consideredin light of the patient'scondition andhistory. Referenceto certain drugs,instruments,and other products in this publication is madefor illustrative purposesonly andis not intended to constitute an endorsementof such. Somematerialsmay include information on applicationsthat arenot consideredcommunity standard,that reflect indications not included in approved FDA labeling,or that areapprovedfor useonly in restricted researchsettings. The FDA hasstated that it is the responsibility of the physician to determinethe FDA statusof eachdrug or deviceheor~e wishesto use,andtQ usethem with appropriatepatient consentin compliancewith applicablelaw. The Academy specifically disclaimsany and all liability for injury or other damagesof any

kind, from negligenceor otherwise,for any andall claims that may arisefrom the useof any recommendationsor other information containedherein.

The authors disclosethe following financialrelationships:

Anthony J. Aldave,MD: consultant fees,AlIergan; grant support, National Eye Institute

Anthony C. Arnold, MD: consultant and lecture fees,Pfizer Ophthalmics StevenJ. Gedde,MD: lecture fees,Merck U.S. Human Health and Pfizer

Ophthalmics

JayM. Lustbader,MD: grant support, Alcon Laboratories,Inc; equity ownership/stock options, LCA Vision

PeterA. Quiros, MD: lecture fees,AlIergan, Inc. NicholasJ. Volpe,MD: consultant fees,Pfizer Ophthalmics Norman Zabriskie,MD: lecture fees,Pfizer Ophthalmics

The other authors do not statesignificant financial interest or other relationship with the manufacturerof any commercialproduct discussedin the chaptersthat they contributed to this publication or with the manufacturerof any competing commercialproduct: MariaM. Aaron, MD; Keith D. Carter,MD; Madhuri Chilakapati,MD; JackA. Cohen, MD, FACS; OscarA. Cruz, MD; J. Paul Dunn, MD; Eric R. Holz, MD; Aaleya Koreishi, MD; PaulD. Langer,MD; Jennifer Lee,MD; Andrew G. Lee,MD; YunheeLee,MD, MPH; Casey Mickler, MS; FrankJ. Moya, MD; EnsaK. Pillow, MD; Scott Sigler,MD;

David K. Wallace,MD; EdwardJ. Wladis,MD.

Copyright @2006American Academy of Ophthalmology@. All rights reserved.

Library of CongressCataloging-in-Publication Data Basicprinciples of ophthalmic surgery / Anthony C. Arnold, executiveeditor.

p.;cm.

.Includesbibliographical referencesandindex. ISBN 1-56055-629-3(soft cover)

1. Eye--Surgery. I. Arnold, Anthony C.

[DNLM: 1. Ophthalmologic SurgicalJ'rocedures.2. EyeDiseases-surgery.

WW 168B3112006]

 

RE80.B372006

 

617.7'1-dc22

2006005983

P.O.

contents

Practical

 

 

 

Considerations

189

CornealWound

 

 

Healing

190

 

 

Practical

 

 

 

Considerations

192

ScleralWound Healing

193

Practical

 

 

 

Considerations

193

Uveal Wound Healing

194

Modifying Wound

 

 

Healing

195

 

 

SutureMaterials

195

Anti-Inflammatories 196

Antiproliferative

 

 

Agents

196

 

 

The Ultimate Goal

197

Chapter 15

 

 

 

 

Dressings

201

 

 

David K. Wallace,

MD

 

 

Advantagesand

Disadvantagesof

PostoperativeDressings 201

Indications 202

Supplies 203

Techniquefor Dressing

Placement 205

Nonpressure DressingWith

a Shield 205

PressureDressing 207

PostoperativeInstructions 208

Chapter 16

Postoperative

Management 211

Nicholas J. Volpe, MD

Timing of Postoperative

Care 213

Anterior Segment

Surgery 214

StrabismusSurgery 214

Eyelid and Orbital

Surgery 215

Retinovitreous Surgery 215

LaserSurgery

215

 

Focus of r;xamination

216

Anterior Segment

 

Surgery 216

 

StrabismusSurgery

216

Eyelid and Orbital

 

Surgery 216

 

Retinovitreous

 

 

Surgery 217

 

LaserSurgery

217

 

Pain Management

217

 

Managementof

 

 

Complications

218

 

Complications of

Retrobulbar or Peribulbar

AnestheticInjections 218

Anterior Segment

Surgery 219

StrabismusSurgery 220

Eyelid and Orbital

Surgery 220

Retinovitreous

Surgery 220

LaserSurgery 221

Appendix A:

Preferred Responses, Chapter

Self-Assessment Tests 223

Index 225

PostoperativeInstructions 212