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Aspects cliniques des modifications de la tension oculaire
VOL. 81, NO. 5
BOOK REVIEWS
extracapsular extraction with phacoemulsification, and have already spent the time and money required to introduce them to the subject. For them this book is an ideal mechanism for refreshing their memories concerning procedural detail, and re minding them of the difficulties that can arise with this demanding technique. Su perb drawings illustrate both of these points, and the text material compliments the drawings nicely. The introductory chapters deal with the history of phacoemulsification and the selection of patients. This is followed by a detailed description of the technique. One is impressed with the author's con servatism in that his most frequent ad monition when a variance occurs in the standard procedure is "convert to a rou tine extracapsular." This is obviously the crux of learning to use this technique properly since it is.only useful when every step goes perfectly. In addition to becom ing skilled with the use of the micro scope, the operator must indeed become a mechanic and devote himself to the va garies and dispositions of a fairly compli cated piece of equipment. Indeed a whole chapter is devoted to equipment and instrumentation difficulties. It is obvious from a perusal of this book that standard experience in either intracapsular or extracapsular cataract surgery does not prepare one for phacoemulsifi cation. Specialized maneuvers must be learned that are not part of any other technique. Even the most conservative ophthalmologist will admit that the tech nique is worthwhile in children and young patients with readily aspiratable lenses. Whether it is worth doing in older patients is still debatable but this book obviously assumes that it is. The book is highly recommended to those who have committed themselves to phacoemulsification as their standard technique for cataract extractions since this will review for them many of the
695
points made in the formal course and will point out some of the errors and pitfalls. Those who have not taken the course should look at a friend's copy since they will find it interesting. They may also find it somewhat difficult to understand since there is a specialized vocabulary for phacoemulsification. For example, one does not make a triangular opening in the anterior lens capsule, one "Christmas trees it." There is even a "fallen Christ mas tree" tear in the capsule. Further, instead of using a spatula to lever the lens nucleus into the anterior chamber, one "tire irons" it, and this maneuver results in a "bedsheet tuck" of the iris under the lens. The metaphor here is a bit strained since a bedsheet covers the mattress while the iris does not cover the lens. Neverthe less, these colorful descriptions do make the author's points more memorable and that of course is the purpose of pedagogy. The last few chapters are on anesthesia for phacoemulsification, the instruction of the nurse who circulates in the oper ating room, and animal surgery. One is impressed that patients get seven differ ent medications systemically and four topically preoperatively for surgery done under local anesthesia. A small computer would be handy to tabulate the possible drug cross reactions and indeed Dr. Kelman has one. He is called the standby anesthesiologist. DAVID SHOCH
Aspects cliniques des modifications de la tension oculaire. By E. Bessiere. Masson et Cie, 1975. Clothbound, 219 pages, table of contents, index, 45 black and white figures. $33.28 This monograph is the clinical sequel to the author's "Aspects physiopathologiques des modifications de la tension ocu laire" and represents the fifth in a series of monographs on ophthalmologic sub-
696
AMERICAN JOURNAL OF OPHTHALMOLOGY
jects to be published in French by Masson et Cie. Topics covered have been divided into three major subcategories: primary glaucoma (including pseudoexfoliation syndromes and angle-closure mechanisms), secondary glaucoma (in cluding congenital forms as well as medi cation related increases in intraocular pressure), and ocular hypotony. The author has chosen a careful and relevant set of references to support ma terial presented in this extensive work. To the extent that all major aspects of each subtopic are presented, the book is a success. Unfortunately, a point of view is lacking which would afford a glimpse into either the author's mode of glaucoma therapy or current concepts utilized in France. The section on primary glauco mas suffers especially from this ap proach; in an effort to be as fair as possi ble, the author frequently presents conflicting statements side-by-side with no qualification. In the sections on secondary glaucomas and on ocular hypotony, both areas of minimal therapeutic controversy but in volving complex diagnostic problems, the author's thorough search for only the rele vant yields a lucid summary of the major important features. Of particular interest is the section on hypotony, summarizing an entity too often confined to pathology texts. This volume is an interesting text for those versed in the French language. The available English texts cover their materi al in greater depth or with more clinically useful suggestions. RICHARD BENSINGER
Manual for Eye Examinations and Diagnosis. By Mark M. Leitman, Samuel Gartner, and Paul Henkind. Oradell, New Jersey, Medical Economics Com pany, 1975. Paperbound, 68 pages, table of contents, 68 black and white figures, 7 color plates.
MAY, 1976
This useful text provides a concise, practical, and accessible introduction to ophthalmology that will be of benefit for those about to begin clinical rotation on an ophthalmology service. Similarly, it will be useful to general medical practi tioners reviewing the subject or requiring information concerning the routine oph thalmic problems they are likely to en counter. The book's value is limited, however, for students or physicians en gaged exclusively in the care of the eye. Beginning with the history, the text outlines the complaints that most fre quently bring the patient to an ophthal mologist and the areas of enquiry most likely to yield information leading to diagnosis.Refractive errors and refraction are discussed; a brief but adequate theo retical background is followed by an ex planation of the technique involved. This latter section could probably be omitted since the information is better conveyed by demonstration. The well-written, concise sections deal ing with lymph nodes, eyelids, lashes, lacrimal glands, and the pupil contain helpful diagrams and tables. The normal anatomy and common pathology of these structures are well integrated and provide the student with an approach to correlat ing physical findings with clinical enti ties. The section on strabismus would bene fit from diagrams of the extraocular mus cles and their insertions, to promote bet ter understanding of their actions and of the mechanisms of the various tropias. A section added on neuro-ophthalmology would also be valuable. The cornea and uveal tract both receive excellent coverage; the abbreviated sec tion on the lens should contain more information on lens structure. An outline on the various causes of the three patterns of cataracts is conspicuously absent. The chapter dealing with glaucoma covers the subject well, although the section on to-
BOOK REVIEWS
extracapsular extraction with phacoemulsification, and have already spent the time and money required to introduce them to the subject. For them this book is an ideal mechanism for refreshing their memories concerning procedural detail, and re minding them of the difficulties that can arise with this demanding technique. Su perb drawings illustrate both of these points, and the text material compliments the drawings nicely. The introductory chapters deal with the history of phacoemulsification and the selection of patients. This is followed by a detailed description of the technique. One is impressed with the author's con servatism in that his most frequent ad monition when a variance occurs in the standard procedure is "convert to a rou tine extracapsular." This is obviously the crux of learning to use this technique properly since it is.only useful when every step goes perfectly. In addition to becom ing skilled with the use of the micro scope, the operator must indeed become a mechanic and devote himself to the va garies and dispositions of a fairly compli cated piece of equipment. Indeed a whole chapter is devoted to equipment and instrumentation difficulties. It is obvious from a perusal of this book that standard experience in either intracapsular or extracapsular cataract surgery does not prepare one for phacoemulsifi cation. Specialized maneuvers must be learned that are not part of any other technique. Even the most conservative ophthalmologist will admit that the tech nique is worthwhile in children and young patients with readily aspiratable lenses. Whether it is worth doing in older patients is still debatable but this book obviously assumes that it is. The book is highly recommended to those who have committed themselves to phacoemulsification as their standard technique for cataract extractions since this will review for them many of the
695
points made in the formal course and will point out some of the errors and pitfalls. Those who have not taken the course should look at a friend's copy since they will find it interesting. They may also find it somewhat difficult to understand since there is a specialized vocabulary for phacoemulsification. For example, one does not make a triangular opening in the anterior lens capsule, one "Christmas trees it." There is even a "fallen Christ mas tree" tear in the capsule. Further, instead of using a spatula to lever the lens nucleus into the anterior chamber, one "tire irons" it, and this maneuver results in a "bedsheet tuck" of the iris under the lens. The metaphor here is a bit strained since a bedsheet covers the mattress while the iris does not cover the lens. Neverthe less, these colorful descriptions do make the author's points more memorable and that of course is the purpose of pedagogy. The last few chapters are on anesthesia for phacoemulsification, the instruction of the nurse who circulates in the oper ating room, and animal surgery. One is impressed that patients get seven differ ent medications systemically and four topically preoperatively for surgery done under local anesthesia. A small computer would be handy to tabulate the possible drug cross reactions and indeed Dr. Kelman has one. He is called the standby anesthesiologist. DAVID SHOCH
Aspects cliniques des modifications de la tension oculaire. By E. Bessiere. Masson et Cie, 1975. Clothbound, 219 pages, table of contents, index, 45 black and white figures. $33.28 This monograph is the clinical sequel to the author's "Aspects physiopathologiques des modifications de la tension ocu laire" and represents the fifth in a series of monographs on ophthalmologic sub-
696
AMERICAN JOURNAL OF OPHTHALMOLOGY
jects to be published in French by Masson et Cie. Topics covered have been divided into three major subcategories: primary glaucoma (including pseudoexfoliation syndromes and angle-closure mechanisms), secondary glaucoma (in cluding congenital forms as well as medi cation related increases in intraocular pressure), and ocular hypotony. The author has chosen a careful and relevant set of references to support ma terial presented in this extensive work. To the extent that all major aspects of each subtopic are presented, the book is a success. Unfortunately, a point of view is lacking which would afford a glimpse into either the author's mode of glaucoma therapy or current concepts utilized in France. The section on primary glauco mas suffers especially from this ap proach; in an effort to be as fair as possi ble, the author frequently presents conflicting statements side-by-side with no qualification. In the sections on secondary glaucomas and on ocular hypotony, both areas of minimal therapeutic controversy but in volving complex diagnostic problems, the author's thorough search for only the rele vant yields a lucid summary of the major important features. Of particular interest is the section on hypotony, summarizing an entity too often confined to pathology texts. This volume is an interesting text for those versed in the French language. The available English texts cover their materi al in greater depth or with more clinically useful suggestions. RICHARD BENSINGER
Manual for Eye Examinations and Diagnosis. By Mark M. Leitman, Samuel Gartner, and Paul Henkind. Oradell, New Jersey, Medical Economics Com pany, 1975. Paperbound, 68 pages, table of contents, 68 black and white figures, 7 color plates.
MAY, 1976
This useful text provides a concise, practical, and accessible introduction to ophthalmology that will be of benefit for those about to begin clinical rotation on an ophthalmology service. Similarly, it will be useful to general medical practi tioners reviewing the subject or requiring information concerning the routine oph thalmic problems they are likely to en counter. The book's value is limited, however, for students or physicians en gaged exclusively in the care of the eye. Beginning with the history, the text outlines the complaints that most fre quently bring the patient to an ophthal mologist and the areas of enquiry most likely to yield information leading to diagnosis.Refractive errors and refraction are discussed; a brief but adequate theo retical background is followed by an ex planation of the technique involved. This latter section could probably be omitted since the information is better conveyed by demonstration. The well-written, concise sections deal ing with lymph nodes, eyelids, lashes, lacrimal glands, and the pupil contain helpful diagrams and tables. The normal anatomy and common pathology of these structures are well integrated and provide the student with an approach to correlat ing physical findings with clinical enti ties. The section on strabismus would bene fit from diagrams of the extraocular mus cles and their insertions, to promote bet ter understanding of their actions and of the mechanisms of the various tropias. A section added on neuro-ophthalmology would also be valuable. The cornea and uveal tract both receive excellent coverage; the abbreviated sec tion on the lens should contain more information on lens structure. An outline on the various causes of the three patterns of cataracts is conspicuously absent. The chapter dealing with glaucoma covers the subject well, although the section on to-