Ординатура / Офтальмология / Учебные материалы / Uveitis Text and Imaging Text and Imaging Text and Imaging 2009

Foreword

Since new imaging techniques have fundamentally changed our approach to ophthalmology in general and to uveitis in particular, this comprehensive book appears as an essential to improve our management of ocular inflammatory disorders. This book will help the clinician to easily get updated on new possibilities for diagnosis as well as for modern treatment and follow-up of uveitis. It presents techniques such as laser flare photometry, indocyanine green angiography and others that cannot be ignored any more if state-of-the-art management of the uveitis patient is to be performed.

It is an honour and it gives me great pleasure to share the foreword with distinguished and renowned scientists such as Narsing Rao and Denis Wakefield who taught me a lot along all these years.

The pleasure also comes from the fact that the editors and the authors who gathered for this reference book are not only outstanding clinical researchers that contributed themselves to these recent developments that changed uveitis practice, but also a group of friends among whom there is clearly a productive complicity as well as deep bonds.

The mix of competence of the editors and their will to address some of the uveitis issues in a more innovative fashion may influence uveitis practice in future. The second part of the textbook has been written by contributors coming from nearly all continents with different clinical backgrounds and expertise which translates into a more diversified approach of uveitis. The information and the large number of illustrations included make it a very useful book both for students and general ophthalmologists as well as for uveitis specialists.

Considering the current rapid progress of new techniques in the field of imaging which not only produce beautiful and clear pictures but also give sometimes functional evaluation of tissues and organs, there is no doubt that the editors will again have to gather a team very soon to update us in the second edition of this “must have” reference book.

I am certain that the readers will enjoy the very substance of this work.

Phuc LeHoang MD, PhD

Professor and Chairman

Department of Ophthalmology

Université Pierre et Marie Curie

Hôpital de la Pitié-Salpêtrière

Paris, France

Foreword

The editors of this well-illustrated volume on uveitis are to be congratulated. Written by a roster of international experts on various aspects of intraocular inflammation/uveitis, this book highlights the current knowledge on imaging techniques, the use of such techniques to support the clinical diagnosis of uveitis entities, and the detection and documentation of the complications of uveitis and their management by medical and surgical interventions. The authors and the editors present topics in an orderly fashion, enabling the reader to understand the features of the technology and the clinically relevant details. The authors provide a well-established approach to the use of highly relevant imaging techniques to support clinical impressions or differentiate one uveitis entity from others for appropriate management. The superb, high-quality color illustrations of fundus changes, fluorescein and indocyanine green angiograms, and optical coherence tomography findings show relevant details of various uveitis entities. The fundus color illustrations throughout the book are particularly vibrant.

The editors have met their goal of providing a comprehensive treatise with superb illustrations showing the importance of modern imaging techniques in the clinical diagnosis and management of common and exotic uveitis entities. They present a logical layout of the topics with an anatomic/histologic basis for the proper interpretation of images, followed by classic and current imaging techniques, including slit-lamp, laser flare photometry, fundus photography, fluorescein and indocyanine green angiography, ultrasonography, and optical coherence tomography. Subsequent chapters discuss these and other systemic imaging techniques for defining uveitis entities in conjunction with diagnostic criteria, pathogenesis, differential diagnosis, treatment, and prognosis of various uveitis entities. The contributing authors, all experts in the subspeciality of uveitis, hail from different continents. These authors, representing both developed and developing countries, provide a global perspective on endemic and emerging infectious uveitis in different parts of the world. The contributions of these experts enrich the book.

The field of uveitis diagnosis and treatment has grown rapidly in part because of the introduction of new imaging techniques and novel biological agents for the management of recalcitrant disease. The text and images contained in this book are extremely useful as a reference book and as a practical resource for general ophthalmologists, retinal/vitreous surgeons, and uveitis experts. Ophthalmology residents and fellows will find the images very helpful in their training and for patient care.

Narsing A Rao MD

Stieger Professor of Vision Research

Doheny Eye Institute

Professor of Ophthalmology and Pathology

Director of Uveitis and Ophthalmic Pathology Laboratory

Keck School of Medicine

University of Southern California

Los Angeles, California

USA

Foreword

Careful observation is the cornerstone of Science and Medicine. Bringing greater objectivity to such observation has resulted in major advances in our understanding of human diseases. Inflammatory eye diseases, particularly uveitis, are a disparate group of diseases, which can be defined to a large extent by careful observation of their clinical features. Attempts have been made to develop grading systems for the extent of inflammation in the anterior chamber and vitreous humor, often relying on careful observation to find characteristic features of specific types of uveitis. The advent of fluorescence angiography was a great step forward in further defining the nature of vascular changes that occur in ocular inflammation. Recently new developments in the field of ICG angiography and OCT have once again focused attention on the importance of careful observation and accurate measurement in the assessment of patients with uveitis. The editors have brought together leading authorities in the area of inflammatory eye diseases to summarize the current state of knowledge of imaging techniques useful for the evaluation of patients with sight threatening inflammatory eye diseases and in the investigation and treatment of these conditions. This text represents a major advance in helping to unravel the clinical features and complications that occur in patients with ocular inflammation and will be a valuable compendium to all those interested in treating patients with significant inflammatory eye diseases.

Denis Wakefield MD, DSc

Professor of Medicine and

Director, Ocular Inflammation Laboratory

University of New South Wales

Sydney, Australia

Preface

Imaging techniques in ophthalmology have played a major role in better understanding of the clinical disease processes and their responses to therapeutic interventions. Several uveitic entities display fairly characteristic features on conventional imaging techniques including slit lamp imaging, fundus fluorescein angiography and ultrasonography. Last few years have seen emergence of several new imaging tools such as indocyanine green angiography, laser flare photometry, ultrasound biomicroscopy, optical coherence tomography, microperimetry, autofluoresence, confocal specular microscopy and electrophysiology, etc. While these tools have existed for some time now, trainees as well comprehensive ophthalmologists practising uveitis, do not have a single source document to help them acquire, interpret and apply judicious information obtained from such images in the management of their patients. Further, the indocyanine green angiography has brought about a new insight to our understanding of the choroidal inflammations, their classifications, prognostication and monitoring. An objective monitoring of the uveitis is now possible with the use of laser flare photometer and has resulted in better management decisions. Part one of the book provides detailed description of the techniques, equipment required including the hardware and the acquisition protocols as applicable to patients with uveitis with due emphasis on the analysis and interpretation of these images in clinical practice.

Part two of the book deals with a number of common specific uveitic entities including the emerging and rare diseases. Each disease has been profusely illustrated to clearly depict the various clinical signs and the use of various imaging tools appropriate for the disease. Part three deals with the complications of uveitis and their surgical management.

This book is not an attempt to replace the existing standard textbooks on the subject that deal with the fundamentals, pathology, immunology, diagnosis or management of the intraocular inflammations and infections. Leading authorities from across the world, who have made significant contributions in their respective fields, have contributed to this book. All the authors have been pivotal in understanding of the various imaging techniques and their interpretations. They have generously contributed their finest illustrations to make it ‘a first of its kind document’ for use globally in the uveitis clinics. The unique format of the book has been designed to facilitate recall by the trainees when they encounter a similar patient in their clinical setting.

We acknowledge Carl Zeiss, India and the ‘Eye Research Foundation’ Chandigarh for their generous support. We highly appreciate the ever-efficient editorial staff at the Jaypee Brothers who worked untiringly to bring out this book. We would like to specially mention Mrs Yashu Kapoor, Mr Manoj Pahuja, Mrs Samina Khan and Mr Tarun Duneja (Director Publishing) among others who made this book possible. Last but not the least, we are grateful to Shri Jitendar P Vij, Chairman and Managing Director, for allowing us unrestricted use of the color illustrations.

Amod Gupta

Vishali Gupta

Carl P Herbort

Moncef Khairallah

Contents

PART ONE: IMAGING TECHNIQUES