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Atlas of Cataract Surgery
VOL. 76, NO. 1
BOOK REVIEWS
Fig. S (Khuri). Pigmented membrane covering the pupillary opening following trauma.
Fig, 6 (Khuri). Same pupil in Figure 5, after "cutting" the membrane edges with argon laser photocoagulation. This photograph was taken six weeks after treatment.
epithelial hypoxia. For many years, we have recommended that lenses not be worn in air craft. The studies Dr. Jagerman suggests would certainly be in order. John M. Corboy, M.D. James C. Tannehill Kaiser Foundation Hospitals Honolulu, Hawaii XENON ARC AND ARGON LASER PHOTOCOAGULATION
Editor, American Journal of Ophthalmology: Xenon arc and argon laser photocoagulation have been used mainly for retinal pathol
167
ogy. There also have been some reports on photocoagulation of the anterior segment.1 Recently we have found argon laser photocoagulation valuable in dilating refractory miotic pupils prior to retinal detachment sur gery. Two such âphakic patients had better visualization of the fundus after treatment (Figs. 1-4). Another patient presenting with pupillary membrane secondary to trauma was treated with argon laser. The iris was photocoagulated directly after retrobulbàr anesthesia. Using a large spot (500-1,000 μ), exposure time of 0.1 seconds, and moderately low intensity (250-350 milli watts), 30 to 50 applications were put circumferentially 2 mm away from the pupillary edge. The pupil increased in size immediately, and iritis was minimal. In the pupillary mem brane case, the membrane was detached from the pupillary edges (Figs. 5 and 6). As we develop more clinical experience with this technique, we will report further details and follow-up of a larger series of patients. However, we would like to use this column to inform others of this potentially valuable technique. Charles H. Khuri, M.D. University of Iowa Hospitals Iowa City, Iowa R E F E R E N CE
1. Zweng, H. C, Paus, G. L., Bassihadis, A., Rose, H., and Hayes, J. Laser photocoagulation of the iris. Arch. Ophth. 84:193, 1970.
BOOK R E V I E W S By William H. Havener and Sallie L. Gloeckner. St. Louis, C. V. Mosby Co., 1972. Clothbound, 180 pages, table of contents, 75 black and white figures. $27.50 Cataract surgery can be compared to gour met cooking in that every chef has his own secret ingredients that account for his suc cess. In the first part of this handsomely il lustrated atlas, Dr. Havener, in the course of describing his own routines for cataract exATLAS OF CATARACT SURGERY.
168
AMERICAN JOURNAL OF OPHTHALMOLOGY
traction, gives us some of his "secrets for success." These include large volumes of retrobulbar anesthetic, prolonged massage of the globe, and double-armed, preplaced su tures. However, it is obvious that the real se cret is Dr. Havener's meticulous attention to detail and thoroughgoing evaluation of each step of his surgical procedure. For example, such seemingly minor points as eversion of the eyelids for scrubbing, and arrangement of the head drape are described in detail. Further, at the end of each chapter there is a series of checkpoints which determine whether the operation is "go" or "no go." As Dr. Havener appropriately points out, ignor ing or failing to note a negative clue may foredoom the operation to complications no matter how carefully the procedure itself is performed. A smaller second section reviews some of these complications, again in a sen sible, orderly fashion. Every surgeon will find points of proce dure with which he disagrees, or omissions, in this atlas, but these are minor variations on a theme and do not need comment. However, a reasonable point might be made for the in clusion of a discussion on the use of the op erating microscope for cataract surgery or at least for inspection of the eye at the comple tion of surgery. Certainly most ophthalmic surgeons do not use the microscope for rou tine cataract surgery, yet there is no gainsay ing the fact that courses in microsurgery are ever more popular and that there is wide spread interest in this field by those now in residency programs. One feels that the inclu sion of the pros and cons of microsurgery in the next edition of this book would be use ful. Finally, a word must bè said about the drawings which face each page of text. They are not merely an adjunct but an integral part of the book. Their importance was obvi ously apparent to Dr. Havener, since he ap propriately listed Sallie Gloeckner as a co author. She certainly deserves this recogni tion for a superb job of illustration. All ac tive and potential cataract surgeons will ben
JULY, 1973
efit from this book. The experienced surgeon will find himself forced to appraise critically his current techniques and the novice will find an excellent base oh which to develop his own variations. David Shoch T H E BASIC ASPECTS OF THE GLAUCOMAS. By
Adnan H. Halasa. Springfield, 111., Charles C Thomas, 1972. Clothbound, 226 pages, table of contents, index, references, two color plates. 68 black and white figures. $14.50 This book has as its goal the presentation of basic concepts of glaucoma in the context of current information. This is indeed a for midable task, but the author has been fairly successful in this regard. The book is divided into, four sections. The first contains a chapter on glaucoma his tory and classification. This chapter is well done, as is the short chapter oh the historical background of tonometry and tonography which heads the second section of the book. Four chapters follow pertaining to tonome try and scierai rigidity. The latter material is quite exhaustive and, despite lengthy mathe matical derivation, only partially succeeds in providing a practical explanation of scierai rigidity. A chapter on tonography is also laden with formulas, while many practical points are not mentioned. In the third section of the book, the pri mary glaucomas are covered. Seven chapters make up this section, including one on con genital glaucoma. The fourth section dis cusses the secondary glaucomas. The last two sections are well written and informative. The clinical information is abundant and quite current, although one might quarrel with the exclusive use of brand names of carbonic anhydrase inhibi tors, particularly in a book with "basic con cepts" in its title. A short chapter on the genetics of glau coma in section three is now historic in light of the recent twin study of Schwartz and as sociates.
BOOK REVIEWS
Fig. S (Khuri). Pigmented membrane covering the pupillary opening following trauma.
Fig, 6 (Khuri). Same pupil in Figure 5, after "cutting" the membrane edges with argon laser photocoagulation. This photograph was taken six weeks after treatment.
epithelial hypoxia. For many years, we have recommended that lenses not be worn in air craft. The studies Dr. Jagerman suggests would certainly be in order. John M. Corboy, M.D. James C. Tannehill Kaiser Foundation Hospitals Honolulu, Hawaii XENON ARC AND ARGON LASER PHOTOCOAGULATION
Editor, American Journal of Ophthalmology: Xenon arc and argon laser photocoagulation have been used mainly for retinal pathol
167
ogy. There also have been some reports on photocoagulation of the anterior segment.1 Recently we have found argon laser photocoagulation valuable in dilating refractory miotic pupils prior to retinal detachment sur gery. Two such âphakic patients had better visualization of the fundus after treatment (Figs. 1-4). Another patient presenting with pupillary membrane secondary to trauma was treated with argon laser. The iris was photocoagulated directly after retrobulbàr anesthesia. Using a large spot (500-1,000 μ), exposure time of 0.1 seconds, and moderately low intensity (250-350 milli watts), 30 to 50 applications were put circumferentially 2 mm away from the pupillary edge. The pupil increased in size immediately, and iritis was minimal. In the pupillary mem brane case, the membrane was detached from the pupillary edges (Figs. 5 and 6). As we develop more clinical experience with this technique, we will report further details and follow-up of a larger series of patients. However, we would like to use this column to inform others of this potentially valuable technique. Charles H. Khuri, M.D. University of Iowa Hospitals Iowa City, Iowa R E F E R E N CE
1. Zweng, H. C, Paus, G. L., Bassihadis, A., Rose, H., and Hayes, J. Laser photocoagulation of the iris. Arch. Ophth. 84:193, 1970.
BOOK R E V I E W S By William H. Havener and Sallie L. Gloeckner. St. Louis, C. V. Mosby Co., 1972. Clothbound, 180 pages, table of contents, 75 black and white figures. $27.50 Cataract surgery can be compared to gour met cooking in that every chef has his own secret ingredients that account for his suc cess. In the first part of this handsomely il lustrated atlas, Dr. Havener, in the course of describing his own routines for cataract exATLAS OF CATARACT SURGERY.
168
AMERICAN JOURNAL OF OPHTHALMOLOGY
traction, gives us some of his "secrets for success." These include large volumes of retrobulbar anesthetic, prolonged massage of the globe, and double-armed, preplaced su tures. However, it is obvious that the real se cret is Dr. Havener's meticulous attention to detail and thoroughgoing evaluation of each step of his surgical procedure. For example, such seemingly minor points as eversion of the eyelids for scrubbing, and arrangement of the head drape are described in detail. Further, at the end of each chapter there is a series of checkpoints which determine whether the operation is "go" or "no go." As Dr. Havener appropriately points out, ignor ing or failing to note a negative clue may foredoom the operation to complications no matter how carefully the procedure itself is performed. A smaller second section reviews some of these complications, again in a sen sible, orderly fashion. Every surgeon will find points of proce dure with which he disagrees, or omissions, in this atlas, but these are minor variations on a theme and do not need comment. However, a reasonable point might be made for the in clusion of a discussion on the use of the op erating microscope for cataract surgery or at least for inspection of the eye at the comple tion of surgery. Certainly most ophthalmic surgeons do not use the microscope for rou tine cataract surgery, yet there is no gainsay ing the fact that courses in microsurgery are ever more popular and that there is wide spread interest in this field by those now in residency programs. One feels that the inclu sion of the pros and cons of microsurgery in the next edition of this book would be use ful. Finally, a word must bè said about the drawings which face each page of text. They are not merely an adjunct but an integral part of the book. Their importance was obvi ously apparent to Dr. Havener, since he ap propriately listed Sallie Gloeckner as a co author. She certainly deserves this recogni tion for a superb job of illustration. All ac tive and potential cataract surgeons will ben
JULY, 1973
efit from this book. The experienced surgeon will find himself forced to appraise critically his current techniques and the novice will find an excellent base oh which to develop his own variations. David Shoch T H E BASIC ASPECTS OF THE GLAUCOMAS. By
Adnan H. Halasa. Springfield, 111., Charles C Thomas, 1972. Clothbound, 226 pages, table of contents, index, references, two color plates. 68 black and white figures. $14.50 This book has as its goal the presentation of basic concepts of glaucoma in the context of current information. This is indeed a for midable task, but the author has been fairly successful in this regard. The book is divided into, four sections. The first contains a chapter on glaucoma his tory and classification. This chapter is well done, as is the short chapter oh the historical background of tonometry and tonography which heads the second section of the book. Four chapters follow pertaining to tonome try and scierai rigidity. The latter material is quite exhaustive and, despite lengthy mathe matical derivation, only partially succeeds in providing a practical explanation of scierai rigidity. A chapter on tonography is also laden with formulas, while many practical points are not mentioned. In the third section of the book, the pri mary glaucomas are covered. Seven chapters make up this section, including one on con genital glaucoma. The fourth section dis cusses the secondary glaucomas. The last two sections are well written and informative. The clinical information is abundant and quite current, although one might quarrel with the exclusive use of brand names of carbonic anhydrase inhibi tors, particularly in a book with "basic con cepts" in its title. A short chapter on the genetics of glau coma in section three is now historic in light of the recent twin study of Schwartz and as sociates.