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Retinopathy of Prematurity
BOOK REVIEWS Edited by H. Stanley Thompson, M.D.
different pathogenetic mechanism involved in the much lower arterial P0 2 levels currently used in comparison with the 1950s. The recent spindle cell gap-junction theory in the pathogenesis and the role of vitamin E in this process are reviewed and updated. The newer methods of continuous monitoring of blood gases with transcutaneous measurements are discussed. It is important to recognize that these methods still have not been documented to reduce the incidence of retinopathy of prematurity, the author points out. The discussion on the epidemiology of retinopathy of prematurity clarifies many of the problems in understanding the confusing biostatistics on retinopathy of prematurity and the limitations of published studies. These data are important in laying the groundwork for consideration of therapeutic trials. The chapter on the sequelae of regressed retinopathy of prematurity provides new information. Most importantly, the author calls our attention to the not infrequent complication of narrow-angle glaucoma in eyes with mild to moderate degrees of cicatricial retinopathy of prematurity. The author points that out these patients should be alerted to this risk and should have periodic examinations. The management of retinal detachment in active retinopathy of prematurity is discussed and the controversial nature of current management is carefully described. The discussion of the pathogenesis of retinal detachment provides the rationale for the newer vitrectomy techniques used in selected cases. There have been many reports on the use of photocoagulation and cyrotherapy for active retinopathy of prematurity. This topic is updated and the background of the current national trial on cryotherapy is presented. Ophthalmologists with patients showing stage III retinopathy of prematurity are encouraged to refer these patients to participating centers where feasible. The discussions of the efficacy of vitamin E in the prophylaxis of retinopathy of prematurity from different investigators show conflicting results. Yet it is important for the reader to recognize that controversy still exists on the role of vitamin E. The final chapter, on developmental issues in
Retinopathy of Prematurity. Edited by William A. Silverman and John T. Flynn. Boston, Blackwell Scientific Publications, 1985. 303 pages, index, illustrated. $35
Reviewed by ARNALL PATZ
Baltimore, Maryland
Since the epidemic of retinopathy of prematurity in the early 1950s, there has been a major increase in the survival of extremely low birthweight infants. These infants who are at greatest risk of retinopathy of prematurity would not have survived long enough in the 1950s to develop retinopathy of prematurity. Probably because of the improved survival, we are now seeing a significant number of new cases. It is therefore timely for a published update to elucidate key factors thought to be involved. This multicontributor volume takes a major step toward this goal. The Table of Contents (abbreviated titles) includes: Overview (W. A. Silverman and J. T. Flynn), International Classification 0. T. Flynn), Pathology of Retinopathy of Prematurity (A. Garner), Animal Models (G. A. Gole), Perinatal Vascular Physiology (R. W. Flower), Initiating Events in Development of Retinopathy of Prematurity (F. L. Kretzer and H. M. Hittner), Monitoring and Controlling Oxygen (J. D. Horbar), Vitamin E and Retinopathy of Prematurity (D. L. Phelps), Retinal Ablative Therapy (E. A. Palmer, A. W. Biglan, and R. J. Hardy), Retinal Detachment (W. Tasman), Sequelae of Regressed Retinopathy of Prematurity (B. J. Kushner), Epidemiology (E. D. Alberman), Developmental Issues in Blind Infants (S. W. Teplin). The new international classification is presented with good-quality color photographs considering the difficulties in photographing the peripheral retina of the premature infant. The classification provides a method to standarize the retinal findings, a vital tool for collaborative studies. The discussions on the pathology of retinopathy of prematurity and on perinatal retinal vascular physiology give a useful update on these fundamental topics. In the chapter on animal models, the interesting concept is presented that we may be seeing a 625
626
AMERICAN JOURNAL OF OPHTHALMOLOGY
blind children with retinopathy of prematurity, addresses an important topic that many of us dealing with the problem of retinopathy of prematurity have overlooked. This monograph is highly recommended for ophthalmologists, pediatricians, psychologists, and educators dealing with this problem of the premature infant.
Cataract Surgery and Visual Rehabilitation. Edited by A. E. Maumenee, W. J. Stark, and I. Esente. Amstelveen, Kugler Publications, 1985. 349 pages, illustrated. $60
Reviewed by JARED M. EMERY Houston, Texas This book contains the proceedings of the Third International Congress on Cataract Surgery and Visual Rehabilitation held in Florence, Italy, May 9 to 12, 1984. The presentations often maintain a conversational tone, which makes for pleasant reading. The subject matter includes the techniques of extracapsular cataract extraction, the use of anterior chamber and posterior chamber implants, complications of cataract-lens implant surgery, secondary implantation, and the use of the neodymium-YAG laser. Many of the 104 contributors are internationally recognized for their contributions to ophthalmology. Some of the presentations are succinct and well-organized reviews that will be useful to all. Among these are the preoperative evaluation of the cataract patient (Maumenee), the indications for intraocular lens implantation (Deutman and Jaffe), glaucoma in the implanted eye (Obstbaum), the correction of aphakia in infants (Rice), intraocular lens incompatibility (Cararnazza, Laschi, and Bertoluzza), and the use of extended-wear contact lenses for the correction of aphakia (Cavanagh). Discussions of surgical techniques are in many cases excellent, such as Barraquer's description of congenital cataract surgery and Binkhorst's description of ail-in-the-bag pseu-
May, 1986
dophakia. Both are comprehensive and beautifully illustrated. Management of selected intraocular lens complications is described by several authors; as is usual at these meetings, a number of authors presented material related to their own lens designs, such as Worst's single-claw lens, Binkhorst's moustache lens, Choyce's anterior chamber lens, and Galand's intracapsular lens. An original, useful, and well-illustrated study by Miyake demonstrates in a novel and effective way the intraoperative behavior of posterior chamber lens loops. Blodi gives an interesting and well-documented discussion on the pathology of intraocular lenses. Aron-Rosa and Aron present a succinct but thorough discussion of YAG lasers. Thus, this book contains much of interest and practical value. What, then, are the drawbacks of this book? It is not comprehensive. It is not a textbook, nor was it meant to be. It merely represents the then-current work, and in many cases the opinions, of some of the world's leading ophthalmologists in May 1984. As such, it also contains occasional statements based on preliminary data or opinions. The editors are to be commended for their success in taking material from 104 individual and diverse contributors and blending it into a unified whole that provides much useful and important information.
Books Received Cataract Surgery. Edited by Ira H. Abrahamson. New York, McGraw-Hili Book Co., 1986. 296 pages, index, illustrated. $50
Chapters from 40 contributors assembled into a compact, well-illustrated book.
Ocular Syndromes and Systemic Diseases. By F. !=loy Hampton. Orlando, Grune and Stratton, 1985. 379 pages. $44.50
different pathogenetic mechanism involved in the much lower arterial P0 2 levels currently used in comparison with the 1950s. The recent spindle cell gap-junction theory in the pathogenesis and the role of vitamin E in this process are reviewed and updated. The newer methods of continuous monitoring of blood gases with transcutaneous measurements are discussed. It is important to recognize that these methods still have not been documented to reduce the incidence of retinopathy of prematurity, the author points out. The discussion on the epidemiology of retinopathy of prematurity clarifies many of the problems in understanding the confusing biostatistics on retinopathy of prematurity and the limitations of published studies. These data are important in laying the groundwork for consideration of therapeutic trials. The chapter on the sequelae of regressed retinopathy of prematurity provides new information. Most importantly, the author calls our attention to the not infrequent complication of narrow-angle glaucoma in eyes with mild to moderate degrees of cicatricial retinopathy of prematurity. The author points that out these patients should be alerted to this risk and should have periodic examinations. The management of retinal detachment in active retinopathy of prematurity is discussed and the controversial nature of current management is carefully described. The discussion of the pathogenesis of retinal detachment provides the rationale for the newer vitrectomy techniques used in selected cases. There have been many reports on the use of photocoagulation and cyrotherapy for active retinopathy of prematurity. This topic is updated and the background of the current national trial on cryotherapy is presented. Ophthalmologists with patients showing stage III retinopathy of prematurity are encouraged to refer these patients to participating centers where feasible. The discussions of the efficacy of vitamin E in the prophylaxis of retinopathy of prematurity from different investigators show conflicting results. Yet it is important for the reader to recognize that controversy still exists on the role of vitamin E. The final chapter, on developmental issues in
Retinopathy of Prematurity. Edited by William A. Silverman and John T. Flynn. Boston, Blackwell Scientific Publications, 1985. 303 pages, index, illustrated. $35
Reviewed by ARNALL PATZ
Baltimore, Maryland
Since the epidemic of retinopathy of prematurity in the early 1950s, there has been a major increase in the survival of extremely low birthweight infants. These infants who are at greatest risk of retinopathy of prematurity would not have survived long enough in the 1950s to develop retinopathy of prematurity. Probably because of the improved survival, we are now seeing a significant number of new cases. It is therefore timely for a published update to elucidate key factors thought to be involved. This multicontributor volume takes a major step toward this goal. The Table of Contents (abbreviated titles) includes: Overview (W. A. Silverman and J. T. Flynn), International Classification 0. T. Flynn), Pathology of Retinopathy of Prematurity (A. Garner), Animal Models (G. A. Gole), Perinatal Vascular Physiology (R. W. Flower), Initiating Events in Development of Retinopathy of Prematurity (F. L. Kretzer and H. M. Hittner), Monitoring and Controlling Oxygen (J. D. Horbar), Vitamin E and Retinopathy of Prematurity (D. L. Phelps), Retinal Ablative Therapy (E. A. Palmer, A. W. Biglan, and R. J. Hardy), Retinal Detachment (W. Tasman), Sequelae of Regressed Retinopathy of Prematurity (B. J. Kushner), Epidemiology (E. D. Alberman), Developmental Issues in Blind Infants (S. W. Teplin). The new international classification is presented with good-quality color photographs considering the difficulties in photographing the peripheral retina of the premature infant. The classification provides a method to standarize the retinal findings, a vital tool for collaborative studies. The discussions on the pathology of retinopathy of prematurity and on perinatal retinal vascular physiology give a useful update on these fundamental topics. In the chapter on animal models, the interesting concept is presented that we may be seeing a 625
626
AMERICAN JOURNAL OF OPHTHALMOLOGY
blind children with retinopathy of prematurity, addresses an important topic that many of us dealing with the problem of retinopathy of prematurity have overlooked. This monograph is highly recommended for ophthalmologists, pediatricians, psychologists, and educators dealing with this problem of the premature infant.
Cataract Surgery and Visual Rehabilitation. Edited by A. E. Maumenee, W. J. Stark, and I. Esente. Amstelveen, Kugler Publications, 1985. 349 pages, illustrated. $60
Reviewed by JARED M. EMERY Houston, Texas This book contains the proceedings of the Third International Congress on Cataract Surgery and Visual Rehabilitation held in Florence, Italy, May 9 to 12, 1984. The presentations often maintain a conversational tone, which makes for pleasant reading. The subject matter includes the techniques of extracapsular cataract extraction, the use of anterior chamber and posterior chamber implants, complications of cataract-lens implant surgery, secondary implantation, and the use of the neodymium-YAG laser. Many of the 104 contributors are internationally recognized for their contributions to ophthalmology. Some of the presentations are succinct and well-organized reviews that will be useful to all. Among these are the preoperative evaluation of the cataract patient (Maumenee), the indications for intraocular lens implantation (Deutman and Jaffe), glaucoma in the implanted eye (Obstbaum), the correction of aphakia in infants (Rice), intraocular lens incompatibility (Cararnazza, Laschi, and Bertoluzza), and the use of extended-wear contact lenses for the correction of aphakia (Cavanagh). Discussions of surgical techniques are in many cases excellent, such as Barraquer's description of congenital cataract surgery and Binkhorst's description of ail-in-the-bag pseu-
May, 1986
dophakia. Both are comprehensive and beautifully illustrated. Management of selected intraocular lens complications is described by several authors; as is usual at these meetings, a number of authors presented material related to their own lens designs, such as Worst's single-claw lens, Binkhorst's moustache lens, Choyce's anterior chamber lens, and Galand's intracapsular lens. An original, useful, and well-illustrated study by Miyake demonstrates in a novel and effective way the intraoperative behavior of posterior chamber lens loops. Blodi gives an interesting and well-documented discussion on the pathology of intraocular lenses. Aron-Rosa and Aron present a succinct but thorough discussion of YAG lasers. Thus, this book contains much of interest and practical value. What, then, are the drawbacks of this book? It is not comprehensive. It is not a textbook, nor was it meant to be. It merely represents the then-current work, and in many cases the opinions, of some of the world's leading ophthalmologists in May 1984. As such, it also contains occasional statements based on preliminary data or opinions. The editors are to be commended for their success in taking material from 104 individual and diverse contributors and blending it into a unified whole that provides much useful and important information.
Books Received Cataract Surgery. Edited by Ira H. Abrahamson. New York, McGraw-Hili Book Co., 1986. 296 pages, index, illustrated. $50
Chapters from 40 contributors assembled into a compact, well-illustrated book.
Ocular Syndromes and Systemic Diseases. By F. !=loy Hampton. Orlando, Grune and Stratton, 1985. 379 pages. $44.50