Surgical Management of Inflammatory Eye Disease

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If the number of jokes is any indication, surgeons and internists have a natural antipathy. Every first-year medical student should know the answer to: “How does a surgeon stop an elevator door from closing?” Only slightly fewer students are taught: “What do you call two ophthalmologists reading an electrocardiogram?” The answer is: a double blind study.

As an internist whose stomach becomes queasy at the sight of a suture, who better to comment on Matthias Becker’s and Janet Davis’ edited volume, Surgical Treatment of Ocular Inflammation? It is my pleasure to have this privilege.

While surgeons and internists do in general have different personalities and differing approaches to disease (internists halt the elevator doors with their hands; surgeons use their heads), their roles are ultimately complementary and the whole that results is truly greater than the sum of the parts. The morbidity of an operation can be avoided often by proper medical management, while the direction and ultimate success of medical therapy may need the assistance of a skillful surgeon.

In this internationally represented collection, Becker and Davis have approached a critical topic that has never been the subject of a single volume before. Their

effort is richly illustrated, logically organized, and eminently practical. The accompanying 44 videos will prove a resource to many practitioners and to every training program.

Education, of course, prepares us for the future. One could argue that the rapidly expanding understanding of the immune response will markedly diminish the role of the surgeon in the care of patients with uveitis. I would argue the opposite. Although local therapy with intraocular corticosteroids is fraught with complications, mainly due to the medication’s effect on the lens and trabecular meshwork, future, more targeted intraocular therapies have the potential for greater efficacy and less toxicity. And while biopsy now yields a specific diagnosis in the minority of instances, evolving molecular and surgical techniques could eventually make this approach routine.

I am sure that readers will find this volume to be timely and practical. I will read it wishing that my hand could be extricated from the elevator door, but grateful that my surgical colleagues are nearby to rescue me.

James T. Rosenbaum

Oregon Health & Science University