Preface

Intraocular inflammation comprises a wide variety of clinical entities. Its relative rarity makes diagnosis and therapy difficult. However, great progress has been made in the management of ocular inflammatory disorders as our knowledge has increased over the past decade, especially in the analysis of ocular specimens and in the use of immunosuppressive medication. We hope and expect that this is a prelude to even greater progress in this field.

Despite adequate medical therapy, ocular inflammatory diseases often cause secondary complications that require surgical intervention. The indications for surgical treatment, preoperative medical therapy, and intraoperative management require experience both as a surgeon and as a doctor managing ocular inflammatory disease in order to obtain successful outcomes with the best prognosis for the control of postoperative inflammation. We aim to improve the understanding of nonmedical therapy of ocular inflammatory disease so as to help the clinician who is faced with performing surgery on a patient with uveitis.

This book will provide the practitioner with practical information on planning surgical intervention in these difficult cases. It is designed to bridge the gap between primary research literature and daily practice. Although current and practical information is stressed, new research and trends are also highlighted. The book is designed to be user-friendly with numerous tables and illustrations. The “Core Messages” help the reader focus on the most important themes in each chapter. Finally, all procedures are explained in detail to facilitate their use by ophthalmologists in practice and in training.

In the first section, current thinking on the surgical treatment of uveitis is discussed in relation to invasive drug delivery and to surgery to modify uveitic activity. The emphasis is on drugs and devices used to influence inflammatory activity by local therapy.

The second section includes a wide variety of topics concerning the surgical treatment of uveitic complications, including general treatment strategies for uveitis. Diagnosis is discussed in relation to clinical decision making. Surgical procedures are comprehensively described.

The third section describes surgical biopsies for the diagnosis of ocular inflammatory disease and masquerades.

To our knowledge, this is the first book dealing with this topic. The book is accompanied by a DVD illustrating the various surgical procedures, making the book a “hands-on” experience. We hope to engage the reader’s interest and look forward to feedback that will enhance the next edition.

The editors gratefully acknowledge the effort of the contributing authors who, despite intensive clinical and research work, found time to assist in the completion of this project. More than 30 internationally recognized leaders in ophthalmology have made a significant contribution through these pages to state-of-the-art surgery for uveitis.

We are indebted to the editorial and production staff at Springer for their commitment to timely publication. We thank Marion Philipp and Martina Himberger, who helped design this book’s unique presentation.

We believe that the topics and authors that we have selected will improve understanding of the many facets of uveitis surgery and will contribute to better care for our patients. Our hope is that Surgical Management of Inflammatory Eye Disease will ultimately inspire clinicians to make further advances in this field.

Heidelberg, Miami

February 2008

Matthias D. Becker

Janet L. Davis

Part A

A Surgical Treatment of Uveitis

I  Invasive Drug Delivery

1Injectable Intraocular Corticosteroids  . .   5

Paul A. Kurz, Eric B. Suhler,

Christina J. Flaxel, James T. Rosenbaum

2Intraocular Corticosteroid Implants  . .   17

David Callanan

3Noncorticosteroid Intraocular Drug

Therapy  . . . . . . . . . .   23

Francine Behar-Cohen, Jean-Louis Bourges

II  Surgery to Modify Uveitic Activity

4Therapeutic Vitrectomy

for Noninfectious Uveitis  . . . . .   35

Kathrin Greiner, Andrew D. Dick

5Cryotherapy and Laser

for Intermediate Uveitis  . . . . .   47

Javier A. Montero, Jose M. Ruiz-Moreno

Part B

Surgical Treatment

of Uveitic Complications

I  Anterior Segment

Cornea

6Surgery for Band Keratopathy  . . . .   63

Ruth Lapid-Gortzak,

Jan Willem van der Linden, Ivanka J. E. van der Meulen, Carla P. Nieuwendaal

Lens

7Selection of Surgical Technique

for Complicated Cataract in Uveitis  . .   67

Mauricio Miranda, Jorge L. Alió

8Perioperative Medical Management   . . .   81

Manfred Zierhut, Peter Szurman

9Pars Plana Lensectomy  . . . . . .   85

Emilio Dodds

10Extracapsular Extraction

by Phacoemulsification  . . . . .   93

Antoine P. Brézin, Dominique Monnet

11Selection of Intraocular Lenses: Materials, Contraindications,

Secondary Implants  . . . . . .   103

Gerd U. Auffarth

12Management of Posterior Synechiae, Peripheral Anterior Synechiae,

Iridocorneal Adhesions, and Iridectomy    113

Yosuf El-Shabrawi

13Complications Post Cataract Surgery

in the Uveitic Eye  . . . . . . .   119

Marie-José Tassignon, Dimitrios Sakellaris

14Cataract Surgery in Childhood Uveitis  . .   127

Arnd Heiligenhaus, Carsten Heinz, Bahram Bodaghi

Glaucoma

15Surgical Management of Uveitis-Induced Angle-Closure Glaucoma  . . . . .   149

Kaweh Mansouri, Tarek Shaarawy

16Surgical Management of Open-Angle Glaucoma Associated with Uveitis  . . .   155

Herbert P. Fechter, Richard K. Parrish II

17 Cyclodestructive Procedures  . . . .   175

Torsten Schlote

II  Posterior Segment

18 Macular Surgery for Posterior Segment Complications of Uveitis  . . . . .   185

Janet L. Davis

19Surgical Treatment of Retinal Vasculitis with Occlusion, Neovascularization or

Traction  . . . . . . . . . .   191

Jose M. Ruiz-Moreno, Javier A. Montero

20Surgical Treatment of Uveitic

Complications: Retinal Detachment  . .   201

Heinrich Heimann

21 Surgical Management of Ocular Hypotony  213

Mark Hammer, W. Sanderson Grizzard

Part C

Surgery for Diagnosis of Uveitis

22 Anterior Chamber Tap and Aqueous

Humor Analysis  . . . . . . . .   221

Uwe Pleyer, Justus G. Garweg

23Surgery for the Diagnosis of Uveitis

– Anterior Segment Biopsy  . . . . .   227

Bahram Bodaghi

24 Diagnostic Vitrectomy  . . . . . .   237

Christoph M.E. Deuter, Sabine Biester, Karl Ulrich Bartz-Schmidt

25 Choroidal Biopsy  . . . . . . .   249

Christoph M.E. Deuter, Sabine Biester, Karl Ulrich Bartz-Schmidt

26 Retinal Biopsy  . . . . . . . .   253

Janet L. Davis

Subject Index   . . . . . . .   259

Yosuf El-Shabrawi, Prof. Dr.

University of Graz Department of Ophthalmology Auenbruggerplatz 4

8036 Graz, Austria yosuf.elshabrawi@meduni-graz.at

Herbert P. Fechter, Dr. M.D.

Ophthalmology Service

Walter Reed Army Medical Center

Washington, DC, USA

Christina J. Flaxel, M.D., Ass. Prof.

Casey Eye Institute

3375 SW Terwilliger Blvd.

Portland, Oregon 97239-4197

USA

Justus G. Garweg, Prof. Dr.

Swiss Eye Institute

Bern, Switzerland

Kathrin Greiner, M.D., Ph.D.

St. Johns Eye Hospital PO Box 19960 Sheikh Jarrah

Jerusalem 97200, Israel greiner@doctors.org.uk

W. Sanderson Grizzard, M.D.

Retina Associates of Florida

Tampa, Florida, USA

Mark Hammer, M.D.

Retina Associates of Florida Tampa, Florida, USA

drhammer@retinaassociatesflorida.com

Arnd Heiligenhaus, Prof. Dr.

Department of Ophthalmology St. Franziskus Hospital Hohenzollernring 74

48145 Muenster, Germany arnd.heiligenhaus@uveitis-Zentrum.de

Heinrich Heimann, Prof. Dr.

Consultant Ophthalmic Surgeon St. Paul’s Eye Unit

Royal Liverpool University Hospital Liverpool, UK heinrichheimann@yahoo.de

Carsten Heinz, Dr.

St. Franziskus Hospital

Department of Ophthalmology

Hohenzollernring 74

48145 Muenster

Germany

Paul A. Kurz, M.D.

Casey Eye Institute

3375 SW Terwilliger Blvd.

Portland, Oregon 97239-4197

USA

Ruth Lapid-Gortzak, M.D.

Academic Medical Centre, University of Amsterdam Amsterdam, the Netherlands

Cornea, External Diseases, and Cataract Service Department of Ophthalmology

Retina Total Eye Care—Refractive Surgery Clinic Driebergen, The Netherlands r.lapid@amc.uva.nl

Jan Willem van der Linden, B.Optom.

Retina Total Eye Care – Refractive Surgery Clinic Traay 42

3971 GP Driebergen The Netherlands

Kaweh Mansouri, M.D., M.P.H.

University of Geneva Glaucoma Sector Ophthalmology Service

Department of Clinical Neurosciences Geneva, Switzerland kaweh.mansouri@ophtal.vd.ch

Ivanka J.E. van der Meulen, M.D.

Academic Medical Centre, University of Amsterdam Cornea, External Diseases, and Cataract Service Department of Ophthalmology

Amsterdam, The Netherlands

Mauricio Miranda, M.D., M.Sc.

Instituto de Ojos Oftalmosalud Avenida Javier Prado Este 1142 Lima 27 San Isidro, Peru mauricio_mvfmd@hotmail.com

Dominique Monnet, M.D.

Université Paris 5, Faculté de Médecine Service d’Ophtalmologie, Hôpital Cochin Paris, France