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Clinical Gonioscopy. a Text and Stereoscopic Atlas
904
AMERICAN JOURNAL OF OPHTHALMOLOGY
This is an era when we are willing to dis cuss complications rather than hide them. This book (a result of this philosophy) con tains 574 pages and 40 chapters by 54 differ ent authors on the causes, prevention, and treatment of unfavorable results in plastic surgery. Most of the authors are plastic sur geons with teaching appointments. Other specialties with related interests are repre sented; but strangely, not ophthalmology. The 15 chapters on "Cosmetic Surgery and Personality Change," "Local and Re gional Anesthesia," "Flaps," "Grafts," "Synthetic Implants," "Dressings," "Scars and Keloids," "Revision of Linear Scars," "Treatment of Facial Lesions," "Treatment of Facial Fractures," "Eyelid Plasty," "Transformation of the Oriental Eye into the Western Eye," "Rhytidectomy," "Chemical Face Peeling," and "Dermabrasion" will be of interst to the ophthalmolo gist who performs plastic surgery. The last two chapters, "Malpractice from the View point of the Trial Attorney," should be of interest to all surgeons. The chapters vary in completeness and quality. Most of them are well done and will be of interest to the surgeon who treats the conditions discussed. I found Dr. Milton Alper's chapter on local anesthesia to be one that should be of value to all surgeons. The chapters by Dr. Sanford Gifford on "Cos metic Surgery and Personality Change" and Drs. William Grabb and Carl Berner on "Facial Fractures" are the most extensive. Dr. Gifford is a psychiatrist and a member of a famous ophthalmic family, too. Especial praise should go to the editor, Dr. Robert M. Goldwyn for the introduction, "Ingredients for Failure," and for a section termed "The Consultant and the Unfavor able Result." These thought-provoking few pages alone are worth the price of this vol ume to any physician practicing medicine, let alone surgery. It will aid all who read it in self-assessment. I would like to see these pages reprinted in a well-read journal in edi torial form.
MAY, 1973
At a time when many new books are being produced at high prices, it is difficult to pick the ones that we wish to have in our personal libraries. This one is recommended for oph thalmic plastic surgeons and for others who prize valuable and interesting reading in the field discussed. Crowell Beard
CLINICAL GONIOSCOPY. A TEXT AND STE
By Stanley C. Becker. St. Louis, C. V. Mosby, 1972. Clothbound, 256 pages, table of contents, index, 240 black and white figures and 112 color fig ures. $53.50 Gonioscopy in the past two decades has become almost routine in ocular examina tions, and is essential in the diagnosis of glaucoma. The recognition of anomalies of the anterior chamber angle, however, is diffi cult to teach during a clinical examination. The student will have difficulty in visualizing the subtleties of the anterior chamber angle, and the teacher's ability to instruct is limited by the fact that only one person at a time can view this site. Recently, this problem has been overcome by the use of stereoscopic photography; this method provides lifelike reproductions of the gonioscopic view. We must be grateful to Stanley C. Becker, there fore, for this magnificent collection of ste reoscopic photographs of the anterior cham ber angle, complemented by an instructive text and a foreword written by Hans Goldmann. REOSCOPIC ATLAS.
The first few chapters consist of a review of the history of gonioscopy and the develop ment, anatomy, and normal appearance of the anterior chamber angle. Histologie sec tions, scanning electron micrographs, and gonioscopic views provide a picture of the normal anatomy. In the sections following this review, the author focuses attention on artifacts and false diagnoses resulting from technical imperfections of currently avail able gonioprisms. He then describes his own instrument, which allegedly prevents such
VOL. 75, NO. S
BOOK REVIEWS
artifacts. Direct contact between the gonioprism and the cornea is avoided by means of an interface maintained by a continuous flow of saline. Becker also introduces his classifi cation for grading the width of the angle, and the results are recorded on a goniogram as a reference for future observations. Time will tell whether Becker's instrument is truly superior to others that are already so well ac cepted and whether his classification will re place those of Scheie or Shaffer. The author then leads the reader on a fas cinating and instructive journey through the anterior chamber angles of eyes with various forms of glaucoma, tumors, and trauma of the anterior segment, developmental anoma lies, and postoperative complications. With few exceptions, the quality of the stereo scopic photography is superb, and the high lights of each are emphasized in the legends. More than 400 references are cited at the end of the text. From a critical point of view, only a few remarks need to be made. In the illustrations more emphasis should have been placed on identifying Schwalbe's line and the anterior border of the trabecular meshwork by show ing the point of juncture of the anterior and posterior portions of the slit beam. This is an invaluable landmark, especially for the beginner, who may find it difficult to distin
90S
guish between a broad ciliary body band and heavily pigmented trabeculae or to judge the extent of apposition of the iris on the trabec ular meshwork in cases of glaucoma. I was annoyed, from an etymologic point of view, by the frequent use of the word "trabeculum." The correct term, of course, is "tra beculae" (pleural of trabecula), or in En glish, the more suitable "trabecular mesh work." While this is a common error in the ophthalmic literature, it was distressing to see a prominent ring of Schwalbe referred to consistently as a posterior "embryotoxin." Finally—and the publisher must take the blame for this—the shoddy quality of the stereoscopic viewer supplied with this book contrasts with the excellence of the binding, the printing, and the reproductions. This ex traordinarily flimsy contrivance is oddly held together with adhesive tape and a rubber band. Fortunately, it did not disintergrate to tally until the last picture of this volume was inspected. Surely, considering the price of this book, a more durable collapsible viewer could be designed. In spite of these minor criticisms, Stanley C. Becker has given us the most instructive book on gonioscopy presently available. I recommend it highly for learning, teaching, and review purposes. Gunter K. von Noorden
AMERICAN JOURNAL OF OPHTHALMOLOGY
This is an era when we are willing to dis cuss complications rather than hide them. This book (a result of this philosophy) con tains 574 pages and 40 chapters by 54 differ ent authors on the causes, prevention, and treatment of unfavorable results in plastic surgery. Most of the authors are plastic sur geons with teaching appointments. Other specialties with related interests are repre sented; but strangely, not ophthalmology. The 15 chapters on "Cosmetic Surgery and Personality Change," "Local and Re gional Anesthesia," "Flaps," "Grafts," "Synthetic Implants," "Dressings," "Scars and Keloids," "Revision of Linear Scars," "Treatment of Facial Lesions," "Treatment of Facial Fractures," "Eyelid Plasty," "Transformation of the Oriental Eye into the Western Eye," "Rhytidectomy," "Chemical Face Peeling," and "Dermabrasion" will be of interst to the ophthalmolo gist who performs plastic surgery. The last two chapters, "Malpractice from the View point of the Trial Attorney," should be of interest to all surgeons. The chapters vary in completeness and quality. Most of them are well done and will be of interest to the surgeon who treats the conditions discussed. I found Dr. Milton Alper's chapter on local anesthesia to be one that should be of value to all surgeons. The chapters by Dr. Sanford Gifford on "Cos metic Surgery and Personality Change" and Drs. William Grabb and Carl Berner on "Facial Fractures" are the most extensive. Dr. Gifford is a psychiatrist and a member of a famous ophthalmic family, too. Especial praise should go to the editor, Dr. Robert M. Goldwyn for the introduction, "Ingredients for Failure," and for a section termed "The Consultant and the Unfavor able Result." These thought-provoking few pages alone are worth the price of this vol ume to any physician practicing medicine, let alone surgery. It will aid all who read it in self-assessment. I would like to see these pages reprinted in a well-read journal in edi torial form.
MAY, 1973
At a time when many new books are being produced at high prices, it is difficult to pick the ones that we wish to have in our personal libraries. This one is recommended for oph thalmic plastic surgeons and for others who prize valuable and interesting reading in the field discussed. Crowell Beard
CLINICAL GONIOSCOPY. A TEXT AND STE
By Stanley C. Becker. St. Louis, C. V. Mosby, 1972. Clothbound, 256 pages, table of contents, index, 240 black and white figures and 112 color fig ures. $53.50 Gonioscopy in the past two decades has become almost routine in ocular examina tions, and is essential in the diagnosis of glaucoma. The recognition of anomalies of the anterior chamber angle, however, is diffi cult to teach during a clinical examination. The student will have difficulty in visualizing the subtleties of the anterior chamber angle, and the teacher's ability to instruct is limited by the fact that only one person at a time can view this site. Recently, this problem has been overcome by the use of stereoscopic photography; this method provides lifelike reproductions of the gonioscopic view. We must be grateful to Stanley C. Becker, there fore, for this magnificent collection of ste reoscopic photographs of the anterior cham ber angle, complemented by an instructive text and a foreword written by Hans Goldmann. REOSCOPIC ATLAS.
The first few chapters consist of a review of the history of gonioscopy and the develop ment, anatomy, and normal appearance of the anterior chamber angle. Histologie sec tions, scanning electron micrographs, and gonioscopic views provide a picture of the normal anatomy. In the sections following this review, the author focuses attention on artifacts and false diagnoses resulting from technical imperfections of currently avail able gonioprisms. He then describes his own instrument, which allegedly prevents such
VOL. 75, NO. S
BOOK REVIEWS
artifacts. Direct contact between the gonioprism and the cornea is avoided by means of an interface maintained by a continuous flow of saline. Becker also introduces his classifi cation for grading the width of the angle, and the results are recorded on a goniogram as a reference for future observations. Time will tell whether Becker's instrument is truly superior to others that are already so well ac cepted and whether his classification will re place those of Scheie or Shaffer. The author then leads the reader on a fas cinating and instructive journey through the anterior chamber angles of eyes with various forms of glaucoma, tumors, and trauma of the anterior segment, developmental anoma lies, and postoperative complications. With few exceptions, the quality of the stereo scopic photography is superb, and the high lights of each are emphasized in the legends. More than 400 references are cited at the end of the text. From a critical point of view, only a few remarks need to be made. In the illustrations more emphasis should have been placed on identifying Schwalbe's line and the anterior border of the trabecular meshwork by show ing the point of juncture of the anterior and posterior portions of the slit beam. This is an invaluable landmark, especially for the beginner, who may find it difficult to distin
90S
guish between a broad ciliary body band and heavily pigmented trabeculae or to judge the extent of apposition of the iris on the trabec ular meshwork in cases of glaucoma. I was annoyed, from an etymologic point of view, by the frequent use of the word "trabeculum." The correct term, of course, is "tra beculae" (pleural of trabecula), or in En glish, the more suitable "trabecular mesh work." While this is a common error in the ophthalmic literature, it was distressing to see a prominent ring of Schwalbe referred to consistently as a posterior "embryotoxin." Finally—and the publisher must take the blame for this—the shoddy quality of the stereoscopic viewer supplied with this book contrasts with the excellence of the binding, the printing, and the reproductions. This ex traordinarily flimsy contrivance is oddly held together with adhesive tape and a rubber band. Fortunately, it did not disintergrate to tally until the last picture of this volume was inspected. Surely, considering the price of this book, a more durable collapsible viewer could be designed. In spite of these minor criticisms, Stanley C. Becker has given us the most instructive book on gonioscopy presently available. I recommend it highly for learning, teaching, and review purposes. Gunter K. von Noorden