Ординатура / Офтальмология / Английские материалы / Basic Principles of Ophthalmic Surgery_Arnold_2006

t:I~ AMERICANACADEMY

~OFOPHTHALMOLOGY

The EyeM.D. Association

Dear Ophthalmology Residentand ProgramDirector:

As part of the American Academy of Ophthalmology's ongoing commitment to residenteducation,we are underwriting the cost!)f BasicPrinciplesof Ophthalmic Surgery,edited by Anthony C. Arnold, MD, so that it canbeprovided free of chargeto first-year ophthalmology residentsaspart of the BasicClinicaland ScienceCourse.

I hope that you will find the knowledge provided in thesepagesa useful adjunct to your educationand that it will help you becomea safeand proficient eye surgeonduring your training overthe next three years.

On behalf of the American Academy of Ophthalmology, I wish you success during your ophthalmology training and in your chosencareer.

Sincerely,

H. DunbarHoskins,Jr.,MD

ExecutiveVice-President

AmericanAcademyof Ophthalmology

Maria M. Aaron, MD

The performance of surgeryinvolves much more than the procedureitself. The beginning surgeonoften focuseson the successfulcompletion of the technical procedure-merely getting from point A to point B-without complications.

Successfulsurgery,however,alsorequires careful patient selection,preoperativeevaluation,and postoperativecare.This chapterfocuseson issuesof patient selection,including criteria for surgicalintervention, factors affecting surgicalrisk, ethicalconsiderationsincluding informed consentand advertising, and the implications of the surgeon'sexperience.

CRITERIA FOR SURGICAL INTERVENTION

The surgeonmust carefully assessthe patient'scomplaints and expectations for surgery.Upon reviewing the clinical pathology, he or shemust determine if the surgicalprocedure will accomplishthe desiredoutcome. For example, the patient with mild to moderatemaculardegenerationundergoing cataract extraction might be expectinga 20/20 result similar to that of others who have had the procedure; consequently,the surgeonmust communicatea teasonable expectationof more limited visual acuity in this situation. Moreover, in a patient with severemaculardegeneration,the surgicalprocedure might not be expectedto benefit vision enoughto justify cataractextraction at all.

In addition to understandingthe patient's expectations,the surgeonmust carefully review the clinical findings in order to accuratelyassessrisk, evaluate whether surgeryis justified, and communicatethe risk-benefit ratio clearly