- •Dedication
- •Preface
- •Acknowledgements
- •Contributors
- •Contents
- •1. Minimally Invasive Oculoplastic Surgery
- •1.1 General Points
- •1.2 Lower Lid Entropion
- •1.2.1 Introduction
- •1.2.2 Lower Lid Entropion Sutures
- •1.2.3 Lower Lid Entropion Botulinum Toxin
- •1.3 Lower Lid Ectropion
- •1.3.1 Introduction
- •1.3.2 The Royce Johnson Suture
- •1.3.3 The Pillar Tarsorrhaphy
- •1.4 Distichiasis
- •1.4.1 Introduction
- •1.4.2 Direct Excision of Lashes
- •1.5 Ptosis
- •1.5.1 Introduction
- •1.5.3 Anterior Approach – One Stitch Aponeurosis Repair
- •1.5.4 Supramid Brow Suspension
- •1.6 Lid Retraction
- •1.6.1 Introduction
- •1.6.2 Koornneef Blepharotomy
- •1.6.3 Botulinum Toxin
- •1.7 Lid Tumours
- •1.7.1 Mohs’ Micrographic Surgery
- •1.7.2 Lamella Sparing Tumour Excision
- •References
- •2. Minimally Invasive Conjunctival Surgery
- •2.1 Conjunctival Surgery
- •2.2 Conjunctivochalasis
- •2.2.1 Background of the Disease
- •2.2.2 Indication for Surgery
- •2.2.3 Basic Concept of Surgery
- •2.2.4 Surgical Procedure
- •2.2.5 Postoperative Follow-Up
- •2.3 Pterygium
- •2.3.1 Background of the Disease and the Concept of Minimally Invasive Surgery
- •2.3.2 Indication for Surgery
- •2.3.3 Basic Concept of Surgery
- •2.3.4 Surgical Procedures
- •2.3.5 A Biologic Adhesive for Sutureless Pterygium Surgery
- •2.3.6 Postoperative Follow-Up
- •2.4 Limbal and Conjuntival Dermoids
- •2.4.1 Background of the Disease
- •2.4.2 Basic Concept of Surgery
- •2.4.3 Surgical Procedure
- •2.4.4 Postoperative Follow-Up
- •2.5 Strabismus Surgery
- •2.6 Conclusion
- •References
- •3. Minimally Invasive Lacrimal Surgery
- •3.1 Introduction
- •3.1.1 Causes of Stenoses of the Lacrimal Drainage System
- •3.1.3 General Remarks Regarding Surgical Management
- •3.2 Endonasal Endoscopic (Microscopic) Dacryocystorhinostomy (EDCR)
- •3.2.1 Indication for EDCR
- •3.2.2 Surgical Technique
- •3.2.3 Silicone Stenting for EDCR
- •3.2.2.1 Silicone “Cones” (Lacrimal Duct Stent, Bess, Berlin)
- •3.2.4 Use of Mitomycin C for EDCR
- •3.2.5 Post-Operative Care After EDCR
- •3.2.6 Results of EDCR
- •3.3 Endonasal Endoscopic Laser Dacryocystorhinostomy (ELDCR)
- •3.3.1 Indications for ELDCR
- •3.3.2 Contraindications for ELDCR
- •3.3.3 Surgical Technique for ELDCR
- •3.3.4 Potential Problems with ELDCR
- •3.3.5 Post-Operative Care After ELDCR
- •3.3.6 Results of ELDCR
- •3.4 Dacryoendoscopy with Transcanalicular Laserdacryoplasty (TLDP)
- •3.4.1 Indication for TLDP
- •3.4.2 Contraindication for TLDP
- •3.4.3 Surgical Technique for TLDP
- •3.4.4 Results of TLDP
- •3.5 Microdrill Dacryoplasty (MDP)
- •3.5.1 Indication for MDP
- •3.5.2 Contraindication for MDP
- •3.5.3 MDP Procedure
- •3.5.4 Results of MDP
- •3.6 Balloon Dilatation
- •3.6.1 Indications for Balloon Dilatation
- •3.6.2 Anaesthesia for Balloon Dilatation
- •3.6.3 Surgical Technique with 2 mm or 3 mm Balloon for Incomplete Stenosis
- •3.6.3.1 Post-Operative Care
- •3.6.3.2 Complications
- •3.6.3.3 Results
- •3.6.4.1 Post-Operative Care
- •3.6.4.2 Results
- •3.6.4.3 Complications
- •3.7 Stent Placement
- •3.7.1 Indications for Stent Placement
- •3.7.3 Surgical Technique for Stent Placement
- •3.7.5 Results of Stent Placement
- •References
- •4. Minimally Invasive Corneal Surgery
- •4.1 Penetrating Keratoplasty
- •4.1.1 Introduction
- •4.1.2 Indications
- •4.1.3 Preoperative Evaluation of the Keratoplasty Patient
- •4.1.4 Preparation for Penetrating Keratoplasty
- •4.1.4.1 Eyelid Speculum
- •4.1.4.2 Scleral Fixation Rings
- •4.1.4.3 Large and Fine-Tipped Needle Holder
- •4.1.4.4 Toothed Forceps
- •4.1.4.5 Trephine Blades
- •4.1.4.6 Radial Marker
- •4.1.4.7 Cornea Punch
- •4.1.4.8 Cutting Block
- •4.1.4.9 Scissors
- •4.1.4.10 Cannulas and Blades
- •4.1.5 Preoperative Medications
- •4.1.6 Penetrating Keratoplasty Surgical Procedure
- •4.1.6.1 Placement of the Scleral Fixation Ring
- •4.1.6.2 Marking of the Host Cornea
- •4.1.6.3 Sizing of the Trephine
- •4.1.6.4 Trephination of the Host Cornea
- •4.1.6.5 Trephination of the Donor Cornea
- •4.1.6.6 Removal of the Host Cornea
- •4.1.6.7 Placement of the Donor Cornea Tissue in the Host Stromal Bed
- •4.1.6.8 Placement of the Cardinal Sutures
- •4.1.6.9 Completion of Suturing
- •4.1.6.10 Suture Techniques
- •4.1.6.11 Subconjunctival Medications
- •4.1.7 Intraoperative Complications
- •4.1.7.1 Scleral Perforation
- •4.1.7.2 Damage to the Donor Button
- •4.1.7.4 Posterior Capsule Rupture
- •4.1.7.5 Vitreous Loss
- •4.1.7.6 Anterior Chamber Hemorrhage
- •4.1.7.7 Choroidal Hemorrhage
- •4.1.8 Postoperative Management
- •4.1.8.1 Postoperative Immunosuppressive Regimen
- •4.1.9 Postoperative Complications
- •4.1.9.1 Wound Leaks
- •4.1.9.2 Epithelial Defects
- •4.1.9.3 Suture-Related Problems
- •4.1.9.4 Increased Intraocular Pressure
- •4.1.9.5 Post-Keratoplasty Astigmatism
- •4.1.10.1 Wedge Resections and Compression Sutures
- •4.1.10.2 Relaxing Incisions
- •4.1.10.3 LASIK
- •4.1.10.4 Photorefractive Keratectomy with Mitomycin C
- •4.1.11 Corneal Allograft Rejection
- •4.1.11.1 Host Risk Factors
- •4.1.11.2 Vascularized Corneas
- •4.1.11.3 Prior Graft Loss
- •4.1.11.4 Graft Diameter
- •4.1.11.5 Anterior Synechiae
- •4.1.11.6 Previous Intraocular Surgery
- •4.1.11.7 Herpes Simplex
- •4.1.12 Treatment of Allograft Rejection
- •4.1.13 Large Diameter Penetrating Keratoplasty
- •4.1.14 Summary
- •References
- •4.2 Descemet’s Stripping Endothelial Keratoplasty
- •4.2.1 Introduction
- •4.2.2 Descemet’s Stripping Endothelial Keratoplasty Surgical Technique
- •4.2.2.1 Donor Cornea Preparation
- •4.2.2.2 Host Cornea Preparation
- •4.2.2.3 Insertion of the Donor Cornea
- •4.2.3 Postoperative Medications
- •4.2.4 Donor Dislocation Risks
- •4.2.5 Repositioning Donor Tissue
- •4.2.6 Treatment of Rejection Episodes
- •4.2.7 Visual and Refractive Outcomes
- •4.2.8 Other Complications
- •4.2.9 Summary
- •References
- •4.3 Pterygium
- •4.3.1 Introduction
- •4.3.2 Treatment of Pterygium
- •4.3.3 Surgical Technique
- •4.3.3.1 Removal of the Pterygium
- •4.3.3.2 Harvesting the Conjunctival Autograft
- •4.3.3.3 Securing the Conjunctival Autograft
- •4.3.3.4 Fibrin Glue vs. Nylon Sutures
- •4.3.4 Postoperative Management
- •4.3.5 Recurrent Pterygium
- •4.3.6 Other Techniques in Pterygium Removal
- •4.3.6.1 Bare Scleral Technique
- •4.3.6.2 Adjunctive Agents
- •Mitomycin C
- •Beta-Irradiation
- •4.3.6.3 Amniotic Membrane Transplantation
- •4.3.7 Complications in Pterygium Removal
- •4.3.8 Summary
- •References
- •5. Minimally Invasive Refractive Surgery
- •5.1 Trends in Refractive Surgery
- •5.2 Introduction
- •5.3 Cornea Refractive Surgery
- •5.3.1 Laser In Situ Keratomileusis (LASIK)
- •5.3.1.1 Advances in Flap Creation Technology
- •Microkeratomes
- •Femtosecond Laser
- •5.3.1.2 Technological Advances in Laser Delivery Platforms
- •5.3.1.3 Faster Excimer Lasers
- •5.3.1.4 Reduction of Collateral Thermal Tissue Damage
- •5.3.1.5 Advanced Eye Trackers
- •5.3.2 PRK and Advanced Surface Ablations (ASA)
- •5.3.2.1 Decrease Thermal Load on the Cornea
- •5.3.2.2 Use of Wound-Healing Modulators
- •5.3.2.3 Trend Towards EPI-LASIK
- •5.3.3 Summary
- •5.4 Intraocular Refractive Surgery
- •5.4.1 Phakic Intraocular Lens Surgery
- •5.4.1.1 Advances in Diagnostic Equipment
- •5.4.1.2 Types of Phakic Intraocular Lens
- •5.4.1.3 Kelman-Duet Phakic Intraocular Lens
- •Lens Design
- •Surgical Technique
- •Pre-Operative Preparation
- •Operative Procedure
- •Post-Operative Care
- •Results
- •Refractive Outcomes
- •Corneal Endothelium
- •5.4.1.4 Visian Implantable Collamer Lens
- •Lens Design
- •Surgical Technique
- •Pre-Operative Preparation
- •Operative Procedure
- •Post-Operative Care
- •5.4.1.5 Results
- •5.4.2 Summary
- •5.5 Lens and Cataract Surgery
- •5.5.2 The Ideal MICS Intraocular Lens
- •5.5.2.1 Aspheric Intraocular Lenses
- •5.5.2.2 Toric Intraocular Lenses
- •5.5.2.3 ACRI.LISA 366D and ACRI.LISA TORIC 466TD
- •Lens Design
- •5.5.2.4 Surgical Technique
- •Operative Procedure
- •Post-Operative Care
- •5.5.2.5 Results
- •5.5.3 Summary
- •5.6 The Future: Beyond the Horizon of Refractive Surgery Today
- •Reference
- •6. Minimally Invasive Strabismus Surgery
- •6.1 Introduction
- •6.2 Nonsurgical Treatment
- •6.4 Rectus Muscle Procedures
- •6.4.1 MISS Rectus Muscle Recession
- •6.4.2 MISS Rectus Muscle Plication
- •6.4.3 Parks’ Rectus Muscle Recession
- •6.4.4 Parks’ Rectus Muscle Plication
- •6.4.5 MISS Rectus Muscle Posterior Fixation Suture
- •6.4.7 MISS Rectus Muscle Repeat Surgery
- •6.4.8 MISS Rectus Muscle Transposition Surgery
- •6.5 Oblique Muscle Procedures
- •6.5.1 MISS Inferior Oblique Muscle Recession
- •6.5.2 MISS Inferior Oblique Muscle Plication
- •6.5.3 MISS Superior Oblique Muscle Recession
- •6.5.4 MISS Superior Oblique Muscle Plication
- •6.5.6 Mühlendyck’s Partial Posterior Superior Oblique Tenectomy for Congenital Brown’s Syndrome
- •6.6 Postoperative Handling
- •6.7.1 Intraoperative Complications
- •6.7.2 Postoperative Complications
- •6.8 Suggestions on How to Start Doing MISS
- •6.8.1 Instruments Suitable for MISS
- •6.8.2 Suture Materials Used for MISS
- •6.8.3 General Remarks Regarding MISS Procedures
- •6.8.4 MISS Dose–Response Relationships
- •References
- •7. Minimally Invasive Iris Surgery
- •7.1 Instrumentation
- •7.2 Sutures
- •7.3 Surgical Principles of Iris Suturing
- •7.3.1 Mobilization
- •7.3.2 Intraocular Suturing and Knot Tying
- •7.3.3 Reattachment of Iris to Sclera
- •7.3.4 Pupil Repair
- •7.3.5 Adjunctive Pupil Repair Techniques
- •References
- •8. Minimally Invasive Glaucoma Surgery
- •Introduction
- •8.1.1 Introduction to Deep Sclerectomy
- •8.1.2 Anesthesia
- •8.1.3 Surgical Technique
- •8.1.3.1 Preparation
- •8.1.3.3 Deep Flap Preparation
- •8.1.3.5 Peeling of Schlemm’s Canal and Juxtacanalicular Meshwork
- •8.1.3.6 Drainage Device
- •8.1.3.7 Wound Closure
- •8.1.4 Postoperative Management and Medication
- •8.1.4.1 Medication
- •8.1.4.2 Management
- •8.1.5 Adjunctive Treatments
- •8.1.5.1 Bleb Needling
- •8.1.5.2 Nd:YAG Goniopuncture
- •8.1.6 Complications and Management
- •8.1.6.1 General
- •8.1.6.2 Perioperative Complications
- •8.1.6.3 Early Postoperative Complications
- •8.1.6.4 Late Postoperative Complications
- •Open-Angle Glaucoma
- •Pigmentary Glaucoma
- •Pseudoexfoliation Glaucoma
- •Aphakic Glaucoma
- •Sturge–Weber Syndrome
- •Glaucoma Secondary to Uveitis
- •Congenital and Juvenile Glaucoma
- •Narrow-Angle Glaucoma
- •Posttrauma Angle-Recession Glaucoma
- •Neovascular Glaucoma
- •Narrow-Angle Glaucoma in a Young Patient
- •Pseudophakic Glaucoma with an A/C IOL
- •8.2.1.4 Preoperative Considerations
- •8.2.2 Anesthesia
- •8.2.4 Postoperative Management and Medication
- •8.2.5 Outcomes and Comparison with Other Techniques
- •8.2.6 Complications and Management
- •8.2.6.1 General
- •8.2.6.4 Summary and Key Points
- •References
- •8.3 New Minimally Invasive, Sclerothalamotomy Ab Interno Surgical Technique
- •8.3.1 Introduction to the Sclerothalamotomy Ab Interno
- •8.3.1.1 Indications for the Sclerothalamotomy Ab Interno
- •8.3.2 Anesthesia
- •8.3.3 Surgical Technique
- •8.3.3.1 Preparation
- •8.3.3.2 Diathermy Probe Insertion
- •8.3.4 Postoperative Management and Medication
- •8.3.5 Outcomes and Comparison with Other Techniques
- •8.3.6 Complications and Management
- •8.3.6.1 General
- •8.3.6.3 Conclusions
- •References
- •Type of Glaucoma
- •Stage of Glaucoma
- •Combined Surgery
- •8.4.2 Anesthesia
- •8.4.3 Surgical Technique
- •8.4.3.1 Preparation
- •8.4.3.2 Implantation of the Micro-Bypass Stent
- •8.4.4 Postoperative Management and Medication
- •8.4.5 Outcomes and Combination with Other Techniques
- •8.4.5.1 Trabecular Implant in Refractory Glaucoma Patients
- •8.4.6 Conclusions
- •References
- •9. Minimally Invasive Cataract Surgery
- •10. Minimally Invasive Vitreoretinal Surgery
- •10.1 Introduction
- •10.2 Microincision Vitrectomy
- •10.2.1 Models of Wound Architecture
- •10.2.2 Vitrectomy
- •10.2.3 Adjuncts
- •10.2.4 Common Surgical Techniques
- •10.2.4.1 Macular Surgery
- •10.2.4.2 Proliferative Diabetic Retinopathy
- •10.2.4.3 Retinal Detachment
- •10.2.4.4 Pediatric Vitreoretinal Surgery
- •10.2.5 Complications
- •10.2.6 Future Developments in Minimally Invasive Vitrectomy
- •10.3 Endoscopic Vitreoretinal Surgery
- •10.3.1 Introduction
- •10.3.2 History and Development of Endoscopic Ophthalmic Surgery
- •10.3.3 The Endoscope
- •10.3.4 Applications of Intraocular Endoscopy
- •10.3.4.1 Media Opacity
- •10.3.4.3 PVR and Subretinal Surgery
- •10.3.4.4 Retained Lens Fragments
- •10.3.4.5 Anterior and Retrolental Vitrectomy in Malignant Glaucoma
- •10.3.4.5 Sutured IOL and ECP
- •10.3.5 Limitations and Challenges
- •10.4 Future Directions of Minimally Invasive Vitreoretinal Surgery
- •References
- •INDEX
48 |
R. K. Weber |
drill was powered by a foot pedal and connected to a Vitroptic T, which is an endoscopic system where the endoscope has already been installed in the probe. In the meantime, we have a much more powerful drill with a frequency up to 3,000 Hz.
3.5.1 Indication for MDP
The drill is not powerful enough to create bone holes to perform a direct anastomosis between the lacrimal system and the nasal cavity. However, in many cases, a clinically completely closed system appears endoscopically not to be completely closed and shows a buttonhole like closure with a partial lumen. In such cases a complete opening of the system is possible and can be performed by microdrill dacryoplasty.
Indications for performing a microdrill dacryoplasty are removal of membranes or fragmentation and removal of dacryoliths. The microdrill dacryoplasty is particularly useful in the type of stenosis which was Þrst described by transcanalicular endoscopic Þndings as the Òbutton-hole stenosisÓ.
3.5.2 Contraindication for MDP
¥Acute infections
¥Mucocele
¥Stenosis after midfacial fractures
intubation when possible, and standard post-operative medical treatment.
Some types of lacrimal obstruction demonstrate a complete obstruction in irrigation and even a complete cessation on X-ray Þndings. Nevertheless, by performing the endoscopy, a tight lumen at the end of the lacrimal sac located at the region of the Krause valve about 18Ð20mm behind the punctum, styled like a buttonhole, can often be seen. In these cases in particular, the obstruction can be removed with the microdrill performing a kind of mucosa curettage and enlarging the tight lumen.
3.5.4 Results of MDP
In a long-term study with a minimal post-operative follow-up period of more than 12 months, the success rate was almost 78% in reducing the symptom of epiphora [23].
3.5.5Post-Operative Care and Complications of MDP
¥Eye drops containing dexamethasone, polymyxin B and neomycin for 3 weeks and vasoconstrictive nose drops for 1 week.
¥In the case of dacryolithiasis and a concomitant infection with actinomyces or nocardia, eye drops with erythromycin and colistin for 6 weeks and erythromycin orally for 10 days.
3.5.3 MDP Procedure |
3.6 Balloon Dilatation |
The technique of microdrill dacryoplasty is similar to that of laser dacryoplasty. After a diagnostic endoscopy, the microdrill is brought up to the location of the stenosis and pulled forward in front of the endoscope.
A continuous irrigation is required to prevent lacerations and assess the success of the procedure.
After removing all the obstructions, success is again assessed by irrigation under endoscopic control.
It is possible to compare irrigation resistance with a special manometre. The post-operative regimen is the same as after laserdacryoplasty with bicanalicular
Advances in interventional techniques in the lacrimal drainage system have created novel procedures for the easy and safe treatment of epiphora. These methods are simple, safe and cost-effective and can be performed under local anaesthesia on an outpatient basis.
Fluoroscopically and endoscopically guided balloon dacryocystoplasty (balloon dilatation) is a feasible non-surgical therapy in nasolacrimal duct stenosis that may be used as Þrst line therapy. In cases that have initial success, a relatively high long-term success rate can be expected.