Ординатура / Офтальмология / Английские материалы / Ophthalmic Microsurgical Suturing Techniques_Macsai_2007
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Marian S. Macsai (Ed.)
Ophthalmic Microsurgical Suturing Techniques
Marian S. Macsai (Ed.)
Ophthalmic
Microsurgical
Suturing Techniques
With 289 Figures, mostly in Color
123
This eBook does not include ancillary media that was packaged with the printed version of the book.
Marian S. Macsai, MD
Professor and Vice Chair Ophthalmology
Northwestern University
Chief, Division of Ophtho
Evanston Northwestern Healthcare
2050 Pfingsten Rd.
Glenview, Il 60025
USA
ISBN-10 |
3-540-28069-3 Springer Berlin Heidelberg New York |
ISBN-13 |
978-3-540-28069-9 Springer Berlin Heidelberg New York |
Library of Congress Control Number: 2006935423
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9th, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under German Copyright Law.
Springer is part of Springer Science+Business Media.
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© Springer-Verlag Berlin Heidelberg 2007
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from relevant protective laws and regulations an therefore free general use.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.
Editor: Marion Philipp, Heidelberg, Germany
Desk Editor: Martina Himberger, Heidelberg, Germany
Production: LE-TEX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany
Illustrations: Albert R. Gattung + Regine Gattung-Petith, Edingen-Neckarhausen, Germany Typesetting: Arnold & Domnick, Leipzig, Germany
Cover Design: Frido Steinen-Broo, EStudio Calamar, Spain
Printed on acid-free paper |
24/3100/YL |
5 4 3 2 1 0 |
Dedication
For my husband, Jack,
and his never ending support and love. For Ezra, Max and Emma,
my continued sources of inspiration and joy.
For my parents who taught me
to learn, to teach and to enjoy life.
Preface
In any surgical field, the importance of suturing is selfevident. In eye surgery, due to the lack of elasticity of the tissues and the influence of sutures on the visual outcome, proper microsurgical suturing technique is paramount. Inappropriate or careless suture placement and knot tying can impact visual function. If wound construction and closure are not astigmatically neutral, the visual outcome will be altered and further surgical intervention may be required. Wound related complications are more severe in the eye than in the skin. The close proximity of tissues allows for rapid spread of infection and the limited blood supply inhibits treatment. The same limited blood supply alters wound healing.
The translation of hand tying techniques, introduced in every medical school curriculum, to microsurgical instrument tying is not obvious. Essential differences exist in all aspects of ophthalmic microsurgical suturing techniques, from the use of the microscope itself to the instrumentation, tissue tactics, suture material and knot construction. The experienced surgeon shares the challenges that face surgeons in training, as they attempt to master new skills and handle more complicated cases. The role of wound closure and suturing techniques are basic building blocks for every ophthalmic surgical procedure. Breaking down the
complexity of microsurgical suturing to each of the numerous components required for tissue apposition that does not alter the function of the eye or impair the surgical outcome is the goal of this text.
Expert surgeons from different specialties have contributed their time and knowledge to the creation of this text. The uniform layout with key points identified at the beginning of each chapter allows the reader to quickly locate a particular technique. The authors have made great efforts to describe each technique in a step- by-step fashion, so that the reader can reproduce the technique on their own. Accompanying digital video clips of surgical footage clarify and demonstrate the different techniques. Mastery of basic and advanced ophthalmic microsurgical suturing techniques will facilitate expansion of any surgeon’s armamentarium.
As ophthalmic surgery advances, a variety of skills are needed for the surgeon to stay current. This text offers the reader ophthalmic microsurgical suturing techniques that decrease the risk of postoperative infection and result in astigmatically neutral wound closure. Equipped with the knowledge of alternative techniques, when complications arise, the reader can decrease the need for further surgical intervention and improve their surgical outcomes.
Acknowledgements
A text of this diversity is not possible without the input and help of many authors. I thank each of the authors who have freely contributed their expertise on an extremely tight schedule. Each was patient with the continuous revisions, illustrations, and video issues. Your continued help and support made this idea a reality. I could not have assembled all this material without Peggy Dow, who kept me organized and on track. A special thanks goes to all the people at Springer who gave so much to this project, especially Marion Philipp and Martina Himberger. I thank Renee Gattung for her expert illustrations, and Patrick Waltemate at LE-TeX for his patience.
Contents
1 |
The Physics of Wound Closure, |
8 |
Iris Reconstruction. . . . . . . . . . . . . . . . . . . . . . . . . |
. 71 |
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Including Tissue Tactics . . . . . . . . . . . . . . . . . . . . . |
. 1 |
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Larry Benjamin |
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Steven P. Dunn and Lori Stec |
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9 |
Sclera and Retina Suturing Techniques |
85 |
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2 |
Needles, Sutures, and Instruments . . . . . . . . . . . . |
9 |
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Jennifer H. Smith and Marian S. Macsai |
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Kirk H. Packo and Sohail J. Hasan |
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10 |
Glaucoma Surgery Suturing Techniques |
101 |
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3 |
Knot-Tying Principles and Techniques . . . . . . . . |
21 |
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Anthony J. Johnson and R. Doyle Stulting |
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Joanna D. Lumba and Anne L. Coleman |
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11 |
Amniotic Membrane Suturing Techniques |
107 |
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4Microsurgical Suturing Techniques:
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Closure of the Cataract Wound. . . . . . . . . . . . . . . |
29 |
Scheffer C. G. Tseng, Antonio Elizondo, |
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Scott A. Uttley and Steven S. Lane |
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and Victoria Casas |
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12 |
Strabismus |
117 |
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5 Suturing an Intraocular Lens . . . . . . . . . . . . . . . . |
37 |
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Julie H. Tsai and Edward J. Holland |
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Mark J. Greenwald |
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13 Refractive Surgery Suturing Techniques |
129 |
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6 |
Corneal Suturing Techniques . . . . . . . . . . . . . . . . |
49 |
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W. Barry Lee and Mark J. Mannis |
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Gaston O. Lacayo III and Parag A. Majmudar |
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14 Pterygium, Tissue Glue, and the Future |
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7 |
Trauma Suturing Techniques . . . . . . . . . . . . . . . . |
61 |
of Wound Closure . . . . . . . . . . . . . . . . . . . . . . . . . . |
135 |
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Marian S. Macsai and Bruno Machado Fontes |
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Sadeer B. Hannush |
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Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
141 |
List of Contributors
Larry Benjamin
Department of Ophthalmology Stoke Mandeville Hospital
Mandeville Road
Aylesbury, Bucks HP21 8AL, UK
E-mail: larry.benjamin@btopenworld.com
Victoria Casas
Ocular Surface Center, P.A. 7000 SW 97th Ave., Ste. 213 Miami, FL 33173-1492, USA
E-mail: vcasas@ocularsurface.com
Anne L. Coleman
Jules Stein Eye Institute
100 Stein Plaza, #2118
Los Angeles, CA 90095-7065, USA E-mail: colemana@ucla.edu
Steven P. Dunn
Michigan Cornea Consultants
29201 Telegraph Rd., Ste. 101
Southfield, MI 48034-7630, USA
E-mail: StevenPDunn@ameritech.net
Antonio Elizondo
Ocular Surface Center, P.A.
7000 SW 97th Ave., Ste. 213
Miami, FL 33173-1492, USA
Bruno Machado Fontes
Av. des Americas 2300 / B, cs 27 Rio de Janeiro, RJ, Brazil 22640-101
E-mail: brunofontes@openlink.com.br; brunofontes@oftalmo.epm.br
Mark J. Greenwald
Department of Ophthalmology and Visual Science
University of Chicago
5841 S. Maryland Avenue, M/C 2114 Chicago, IL 60637, USA
E-mail: mgreenwa@uchicago.edu
Sadeer B. Hannush
Cornea Service, Wills Eye Hospital
Jefferson Medical College, Philadelphia, PA
Correspondence:
400 Middletown Blvd. Suite 110
Langhorne, PA 19047, USA
E-mail: SBHannush@comcast.net
Sohail J. Hasan
Ingalls Hospital Professional Bldg.
71 West 156th St., Ste. 400
Harvey, IL 60426, USA
Edward J. Holland
CEI-NKY
580 South Loop Rd., Ste. 200 Edgewood, KY 41017, USA E-mail: eholland@fuse.net
Anthony Johnson
Cornea/Refractive Surgery
SAUSHEC Ophthalmology
3851 Roger Brooke Drive
Fort Sam Houston, Tx 78234, USA
E-Mail: Anthony.Johnson2@amedd.army.mil
Gaston O. Lacayo III
Rush University Medical Center
Department of Ophthalmology
1725 W. Harrison St., Ste. 928
Chicago, IL 60612, USA
E-mail: Gaston_O_Lacayo@rush.edu
Stephen S. Lane
280 N. Smith Ave., Ste. 840
St. Paul, MN 55102, USA
E-mail: sslane@associatedeyecare.com
W. Barry Lee
Eye Consultants of Atlanta
95 Collier Rd., Ste. 3000
Atlanta, GA 30309, USA
E-mail: Lee0003@aol.com
XIV
Joanna Lumba |
Lori Stec |
1101 Welch Road, Suite B2 |
Beaumont Eye Institute |
Palo Alto, CA 94304, USA |
3601 W. Thirteen Mile Road |
E-mail: lumbajo@yahoo.com |
Royal Oak, Michigan 48073, USA |
Marian S. Macsai |
R. Doyle Stulting |
Professor and Vice Chair Ophthalmology |
Emory Vision |
Northwestern University |
875 Johnson Ferry Road |
Chief, Division of Ophtho |
Atlanta, GA 30342, USA |
Evanston Northwestern Healthcare |
E-mail: ophtrds@emory.edu |
2050 Pfingsten Rd. |
|
Glenview, Il 60025, USA |
Julie H. Tsai |
|
University of South Carolina School of Medicine |
Parag A. Majmudar |
Dept of Ophthalmology |
Rush University Medical Center |
Four Medical Park, Suite 300 |
Department of Ophthalmology |
Columbia, SC 29203, USA |
1725 W. Harrison St., Ste. 928 |
E-mail: tsaij3@gmail.com |
Chicago, IL 60612, USA |
|
E-mail: pamajmudar@chicagocornea.com |
Sche er C. G. Tseng |
|
Ocular Surface Center, P.A. |
Mark J. Mannis |
7000 SW 97th Ave., Ste. 213 |
Department of Ophthalmology |
Miami, FL 33173-1492, USA |
University of California |
E-mail: stseng@ocularsurface.com |
4860 Y St., Suite 2400 |
|
Sacramento, CA 95817, USA |
Scott A. Uttley |
|
St. Paul Eye Clinic |
Kirk H. Packo |
2080 Woodwinds Dr. |
Rush University Medical Center |
Woodbury, MN 55125-2523, USA |
Department of Ophthalmology |
E-mail: uttle001@tc.umn.edu |
1725 W. Harrison St., Ste. 945 |
|
Chicago, IL 60612, USA |
|
E-mail: kirk_packo@rush.edu |
|
Jennifer Hasenyager Smith |
|
2032 Valor Ct. |
|
Glenview, IL 60026, USA |
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E-mail: Jhsmith2020@yahoo.com |
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