Ординатура / Офтальмология / Английские материалы / Strabismus Surgery and Its Complications_Coats, Olitsky_2007

Strabismus Surgery and its Complications is divided into two distinct sections. Part I outlines the surgical management of strabismus in 17 chapters. A full range of topics is covered including basic anatomy and physiology, surgical planning, preoperative and postoperative management, and surgical techniques. Surgical techniques are described in dedicated chapters, each richly illustrated with figures and photographs. Detailed descriptions of the basic steps of surgery as well as surgical nuances are provided. The figures and figure legends are designed to stand alone as basic surgical instruction for the surgeon who has experience with the surgical management of strabismus. More detailed instruction is available in the text for those wanting elaboration. Chapters on the use of botulinum toxin in the management of strabismus and on the medical management of strabismus conclude Part I of the textbook.

Part II reviews a wide range of surgical complications, both common and uncommon, in 15 chapters. Most published reports on complications related to strabismus surgery consist of case reports or small case series. An attempt has been made to compile these numerous reports into the concise pages of this textbook in a user-friendly format, to create a single source reference on strabismus surgery complications. Advice on how to avoid and how to manage complications of strabismus surgery

is provided based on evidence-based medicine where available. Consensus and/or common sense advice is provided where ev- idence-based medicine is not available. A chapter on managing patients with atypical and unexpected anatomical features and a chapter on the medicolegal aspects of strabismus surgery are included. The textbook is extensively referenced and indexed to facilitate rapid identification and review of desired information. Cross-reference is made throughout each chapter to other chapters containing related information.

A DVD is provided containing video footage of basic surgical techniques to compliment the information on surgical techniques provided in Part I of the textbook. The DVD also contains electronic copies of all photographs and illustrations that are unique to this textbook, divided by chapters. The owner of this textbook and DVD is free to use these photographs and illustrations in lectures and other nonpermanent teaching mediums provided that this textbook is cited as their source. Materials that were used with the permission of others has not been included on the DVD as the publisher does not have the right to authorize use of materials provided by others for use exclusively in this textbook.

David K. Coats and Scott E. Olitsky

Two well-known strabismologists present in this book their combined experience and philosophy of the surgical treatment of strabismus. In doing so they have, whenever possible, shied away from unfounded hypotheses and speculation, and relied on clinical evidence instead. If such is unavailable, a common sense approach is taught. Certain variations notwithstanding, the surgical techniques demonstrated in this volume represent the current state of the art. The reader will welcome this information and enjoy the clear illustrations.

However, it is the second part, dealing with surgical complications, that sets this book apart from other recently published texts. Instructions on how to manage a complication effectively

and, more importantly, how to prevent some by avoiding certain pitfalls during the preoperative work-up of a patient are widely dispersed in the literature and not always easily located. The authors have succeeded in collecting this information and presenting it comprehensively and in an easily accessible format. This book fills a void and is a welcomed addition to the ophthalmic literature.

Gunter K. von Noorden, MD

Professor of Ophthalmology and Pediatrics

Baylor College of Medicine

Houston, Texas

1.4.2Function of Tenon’s Capsule and Orbital

Connective Tissues  .. . . . . . . . . . . . . . . . . . . . . . .   9 1.5 The Rectus Muscle Pulley System  .. . . . . . . .   10

1.6Gross Anatomy of the Extraocular Muscles    12

1.6.1 Rectus Muscles   .. . . . . . . . . . . . . . . . . . . . . . . .   12 1.7 Innervation of the Extraocular Muscles   .. .   15 1.8 Blood Supply to Extraocular Muscles  . . . . .   15

1.9Surgically Important Anatomy

of Individual Extraocular Muscles  . . . . . . . .   16 1.9.1 Medial Rectus Muscle  . . . . . . . . . . . . . . . . . . .   16 1.9.2 Lateral Rectus Muscle  . . . . . . . . . . . . . . . . . . .   16 1.9.3 Inferior Rectus Muscle  .. . . . . . . . . . . . . . . . . .   17 1.9.4 Superior Rectus Muscle  .. . . . . . . . . . . . . . . . .   17 1.9.5 Superior Oblique Muscle/Tendon  .. . . . . . . .   18 1.9.6 Inferior Oblique Muscle  . . . . . . . . . . . . . . . . .   18

References  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .   19

2.1Axes of Ocular Rotation and Listing’s Plane    21

2.2 Duction Movements  .. . . . . . . . . . . . . . . . . . . .   22 2.3 Version Movements  . . . . . . . . . . . . . . . . . . . . .   22 2.4 Vergence Movements  .. . . . . . . . . . . . . . . . . . .   22 2.5 Basic Laws Governing Eye Movements  .. . .   22

2.6Sherrington’s Law of Reciprocal

3.9Expansion of the Field of Vision in Patients

with Esotropia  . . . . . . . . . . . . . . . . . . . . . . . . . .   30 3.10 Psychosocial and Vocational Indications  . .   31 References  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .   32

6.5.1Modification of Surgical Technique

7.3Arrangement of the Operating Room

8.1What to do Prior to Making

a Conjunctival Incision for Strabismus

Surgery  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   67

8.1.1Visual Inspection of the Patient’s

Conjunctival Anatomical Landmarks  . . . . .   67

8.1.2Visual and Tactile Identification

8.1.3.1Technique for Rectus Muscle Traction

Testing  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   69

8.1.4Oblique Muscle/Tendon Forced Traction

Testing  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   69

8.1.4.1Technique for Forced Traction Testing

of the Superior Oblique Muscle/Tendon  .. .   69

8.1.4.2Technique for Forced Traction Testing

of the Inferior Oblique Muscle  .. . . . . . . . . . .   71

8.1.5Spring Back Test for Slipped or Lost

Muscle  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   71

8.2Conjunctival Incisions for Rectus Muscle

8.2.1.1 Fornix Incision Technique  . . . . . . . . . . . . . . .   73 8.2.1.1.1 Initial Incision  . . . . . . . . . . . . . . . . . . . . . . . . . .   74 8.2.1.1.2 Isolation of a Rectus Muscle  .. . . . . . . . . . . . .   75 8.2.1.1.3 Heel or Toe Maneuver  .. . . . . . . . . . . . . . . . . .   76 8.2.1.1.4 Exposure of the Muscle Insertion  .. . . . . . . .   76 8.2.1.1.5 The Pole Test  .. . . . . . . . . . . . . . . . . . . . . . . . . . .   76 8.2.1.1.6 Dissection of the Muscle Fascia  .. . . . . . . . . .   76 8.2.1.1.7 Closure of a Fornix Incision  .. . . . . . . . . . . . .   79 8.2.2 Limbal Incision  . . . . . . . . . . . . . . . . . . . . . . . . .   79 8.2.2.1 Limbal Incision Technique  .. . . . . . . . . . . . . .   80 8.2.2.1.1 Initial Incision  . . . . . . . . . . . . . . . . . . . . . . . . . .   80 8.2.2.1.2 Isolation of the Muscle and Dissection

of the Muscle Fascia  .. . . . . . . . . . . . . . . . . . . .   80 8.2.2.1.3 Closure of a Limbal Incision  . . . . . . . . . . . . .   81 8.2.2.1.4 Modified Limbal Incision  .. . . . . . . . . . . . . . .   82 8.2.2.1.5 Conjunctival Recession  .. . . . . . . . . . . . . . . . .   82

8.2.3Converting a Fornix Incision into a Limbal

Incision  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   83

8.2.3.1 Technique  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   83

8.2.4 Swan “Over the Muscle” Incision  . . . . . . . . .   84

8.2.4.1 Technique   .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .   84

8.3Conjunctival Incisions for Oblique Surgery    86

References  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .   86

9.1General Principles for Recession

9.3Specific Considerations for Surgery

on Individual Rectus Muscles  . . . . . . . . . . . .   88 9.3.1 Medial Rectus Muscle  . . . . . . . . . . . . . . . . . . .   88 9.3.2 Inferior Rectus Muscle  .. . . . . . . . . . . . . . . . . .   88 9.3.3 Lateral Rectus Muscle  . . . . . . . . . . . . . . . . . . .   89 9.3.4 Superior Rectus Muscle  .. . . . . . . . . . . . . . . . .   89 9.4 Rectus Muscle Recession Techniques  .. . . . .   89

9.4.1Standard Rectus Muscle Recession

9.4.1.3Securing the Muscle to the Sclera at its

9.5.2Recession Following Scleral Buckling

9.5.5Recession with Fixation to the Adjacent

Orbital Wall  . . . . . . . . . . . . . . . . . . . . . . . . . . . .   97 9.5.6 Y Splitting of the Lateral Rectus   .. . . . . . . . .   97 References  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .   97