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Ophthalmology
846
BOOK REVIEWS
pect of the thesis, from embryologie and anatomic considerations to indications, prep aration of the patient, organization of the surgical theatre (here the old visitor to Barraquer's clinic will refresh his memory of a most remarkable and efficient setup), an esthesia, incisions, sutures, iridectomy, tech niques of the operation, including, of course, the use of alpha chymotrypsin, in cidents, accidents and complications, the shallow anterior chamber, normal and com plicated postoperative phenomena and, fin ally, tables of the author's results. These are Barraquer's conclusions at the end of his book : 1. The systematic use of potentialized general anesthesia reduces the complica tions of the operation and does not increase the postoperative ones. 2. The incision and subconjunctival su tures provide for the greatest security in the closure of the anterior chamber. 3. Enzymatic zonulolysis extraordinarily facilitates the intracapsular extraction. 4. The loss of vitreous is less frequent, thanks to the techniques of hypotinization and security. The correct employment of chymotrypsin increases the facility of the extraction. The pupil maintains its rotun dity in the majority of cases, thanks to the "toilet" and replacement of the iris. 5. Striped keratitis is much more frequent and grave with corneal incision. 6. Hyphema is somewhat more frequent with the sclerocorneal incision. Neverthe less, the percentage is minimal (in the neigh borhood of one percent). 7. Pupillary block was a little-known complication for us before 1958. Its fre quency in the cases in which alpha chymo trypsin was used is 2.1 percent, whereas its frequency was 0.94 percent in cases in which it was not used. It is fundamental to diagnose and treat it early. 8. The use of alpha chymostrypsin re quires the practice of a sclerocorneal inci sion with complete conjunctival flap. The corneal incision cicatrizes slowly and can gape in the late postoperative period.
9. Secondary glaucoma is a rare compli cation, thanks to the secure closure of the incision and to early treatment of the pupil lary block and the delayed formation and collapse of the anterior chamber. 10. Zonulolysis enzymatica notably re duces the total percentage of retinal detach ment and still more the cases not cured. Practically every page reveals the meticu lous skill and surgical artistry of the au thor. His results, frankly and honestly pre sented, are most impressive regarding the many advantages and some complications or disadvantages of the use of alpha chymo trypsin. The book is handsomely printed and illus trated and a credit to its author and publish ers. Naturally, we wish that it were in Eng lish, as well as in Spanish. Let us hope that this wish is realized, for every eye surgeon should enjoy, relish and appreciate this fine work. Derrick Vail. OPHTHALMOLOGY. By Patrick D. TrevorRoper, M.A., M.D., B.Chir., F.R.C.S., D.O.M.S. London, Lloyd-Luke, Ltd., edi tion 2, 1962. Distributed in the U.S., South America, and Canada by Year Book Medical Publishers, Chicago. 648 pages and index. Price : $18.00. Conceived as a textbook of ophthalmol ogy for the student preparing for the Lon don "Diploma in Ophthalmology" this mon umental work, now in its second edition, makes an excellent literary nucleus about which the ophthalmologic neophyte can build his library. Containing less than 10 percent of the number of pages to be found in DukeElder's classical Textbook it does not have the reference value of the latter's encyclo pedic scope but is more like Fuchs' Text book, the ophthalmological "Bible" of the past generation. Within the pages of this book is com pressed an enormous amount of information presented in a palatable form and in the usual divisions of anatomy, physiology,
BOOK REVIEWS optics, diseases of the outer eye and diseases of the inner eye. Illustrations, many bor rowed, are numerous and excellent, and ma terial has been brought up to date with dele tion of obsolete matter, in order, as the author states to avoid "that middle-age spread which so often disfigures textbooks as they pass through succeeding editions." It should be emphasized that this book is excellent for the postgraduate student or be ginning ophthalmologic resident and would be a valued addition to any ophthalmolo gist's library but it is much too complete and comprehensive for the undergraduate medical student unless he be one of those rare individuals who has already "received the call" for ophthalmology. William A. Mann.
VISUAL PROBLEMS IN AVIATION MEDICINE.
Edited by Armand Mercier, M.D. New York, Pergamon Press, 1962. 120 pages, chapter bibliographies. Price: $6.00. This symposium of the Aero Space Medi cal Panel, NATO, comprises 14 contribu tions—five from France (in French) and four each from England and United States. It deals exclusively with the visual problems of military aviation. For protection against dazzle in high altitudes, goggles should ab sorb at least five percent of the light. Except for flight above the ozone layer at 120,000 feet, ultraviolet light is not hazardous. In high performance aircraft requiring oxygen masks, pilots must have unaided perfect vi
847
sion, as spectacles then cause distortion and limitation of visual field. Sixty percent of men between the ages of 17 and 27 years were found to meet the required visual standard. Experiments with 22 aviators in dicated that corneal contact lenses, though advantageous in some respects, are not en tirely practicable. In general, little correla tion was noted between heterophoria and depth perception, between depth perception and landing ability and between stereoscopic vision and flying skill. However, the correc tion of refractive errors is considered im perative for helicopter pilots as they must have perfect stereopsis to estimate correctly the altitude, relief and slope of the ground. Over half of major aircraft accidents result from pilot error. To reduce this hazard, the design, location and action of cockpit con trols are being standardized. The mainte nance of good night vision requires mini mum illumination of the instrument panel— not more than 0.02 foot-lamberts. The pi lot's basic acuity is reduced by anoxia and vibration. In the positive acceleration pro duced in a precipitous dive, blackout, ocu lar immobility and pupillary dilatation oc cur because of decreased retinal and cere bral circulation. Pilots, presented with an empty visual field having no detail upon which the eye can focus, suffer from a fluctuating accommodation that reduces pickup range by half and are uncertain in the determination of the relative movements, distance and size of a target. James E. Lebensohn.
BOOK REVIEWS
pect of the thesis, from embryologie and anatomic considerations to indications, prep aration of the patient, organization of the surgical theatre (here the old visitor to Barraquer's clinic will refresh his memory of a most remarkable and efficient setup), an esthesia, incisions, sutures, iridectomy, tech niques of the operation, including, of course, the use of alpha chymotrypsin, in cidents, accidents and complications, the shallow anterior chamber, normal and com plicated postoperative phenomena and, fin ally, tables of the author's results. These are Barraquer's conclusions at the end of his book : 1. The systematic use of potentialized general anesthesia reduces the complica tions of the operation and does not increase the postoperative ones. 2. The incision and subconjunctival su tures provide for the greatest security in the closure of the anterior chamber. 3. Enzymatic zonulolysis extraordinarily facilitates the intracapsular extraction. 4. The loss of vitreous is less frequent, thanks to the techniques of hypotinization and security. The correct employment of chymotrypsin increases the facility of the extraction. The pupil maintains its rotun dity in the majority of cases, thanks to the "toilet" and replacement of the iris. 5. Striped keratitis is much more frequent and grave with corneal incision. 6. Hyphema is somewhat more frequent with the sclerocorneal incision. Neverthe less, the percentage is minimal (in the neigh borhood of one percent). 7. Pupillary block was a little-known complication for us before 1958. Its fre quency in the cases in which alpha chymo trypsin was used is 2.1 percent, whereas its frequency was 0.94 percent in cases in which it was not used. It is fundamental to diagnose and treat it early. 8. The use of alpha chymostrypsin re quires the practice of a sclerocorneal inci sion with complete conjunctival flap. The corneal incision cicatrizes slowly and can gape in the late postoperative period.
9. Secondary glaucoma is a rare compli cation, thanks to the secure closure of the incision and to early treatment of the pupil lary block and the delayed formation and collapse of the anterior chamber. 10. Zonulolysis enzymatica notably re duces the total percentage of retinal detach ment and still more the cases not cured. Practically every page reveals the meticu lous skill and surgical artistry of the au thor. His results, frankly and honestly pre sented, are most impressive regarding the many advantages and some complications or disadvantages of the use of alpha chymo trypsin. The book is handsomely printed and illus trated and a credit to its author and publish ers. Naturally, we wish that it were in Eng lish, as well as in Spanish. Let us hope that this wish is realized, for every eye surgeon should enjoy, relish and appreciate this fine work. Derrick Vail. OPHTHALMOLOGY. By Patrick D. TrevorRoper, M.A., M.D., B.Chir., F.R.C.S., D.O.M.S. London, Lloyd-Luke, Ltd., edi tion 2, 1962. Distributed in the U.S., South America, and Canada by Year Book Medical Publishers, Chicago. 648 pages and index. Price : $18.00. Conceived as a textbook of ophthalmol ogy for the student preparing for the Lon don "Diploma in Ophthalmology" this mon umental work, now in its second edition, makes an excellent literary nucleus about which the ophthalmologic neophyte can build his library. Containing less than 10 percent of the number of pages to be found in DukeElder's classical Textbook it does not have the reference value of the latter's encyclo pedic scope but is more like Fuchs' Text book, the ophthalmological "Bible" of the past generation. Within the pages of this book is com pressed an enormous amount of information presented in a palatable form and in the usual divisions of anatomy, physiology,
BOOK REVIEWS optics, diseases of the outer eye and diseases of the inner eye. Illustrations, many bor rowed, are numerous and excellent, and ma terial has been brought up to date with dele tion of obsolete matter, in order, as the author states to avoid "that middle-age spread which so often disfigures textbooks as they pass through succeeding editions." It should be emphasized that this book is excellent for the postgraduate student or be ginning ophthalmologic resident and would be a valued addition to any ophthalmolo gist's library but it is much too complete and comprehensive for the undergraduate medical student unless he be one of those rare individuals who has already "received the call" for ophthalmology. William A. Mann.
VISUAL PROBLEMS IN AVIATION MEDICINE.
Edited by Armand Mercier, M.D. New York, Pergamon Press, 1962. 120 pages, chapter bibliographies. Price: $6.00. This symposium of the Aero Space Medi cal Panel, NATO, comprises 14 contribu tions—five from France (in French) and four each from England and United States. It deals exclusively with the visual problems of military aviation. For protection against dazzle in high altitudes, goggles should ab sorb at least five percent of the light. Except for flight above the ozone layer at 120,000 feet, ultraviolet light is not hazardous. In high performance aircraft requiring oxygen masks, pilots must have unaided perfect vi
847
sion, as spectacles then cause distortion and limitation of visual field. Sixty percent of men between the ages of 17 and 27 years were found to meet the required visual standard. Experiments with 22 aviators in dicated that corneal contact lenses, though advantageous in some respects, are not en tirely practicable. In general, little correla tion was noted between heterophoria and depth perception, between depth perception and landing ability and between stereoscopic vision and flying skill. However, the correc tion of refractive errors is considered im perative for helicopter pilots as they must have perfect stereopsis to estimate correctly the altitude, relief and slope of the ground. Over half of major aircraft accidents result from pilot error. To reduce this hazard, the design, location and action of cockpit con trols are being standardized. The mainte nance of good night vision requires mini mum illumination of the instrument panel— not more than 0.02 foot-lamberts. The pi lot's basic acuity is reduced by anoxia and vibration. In the positive acceleration pro duced in a precipitous dive, blackout, ocu lar immobility and pupillary dilatation oc cur because of decreased retinal and cere bral circulation. Pilots, presented with an empty visual field having no detail upon which the eye can focus, suffer from a fluctuating accommodation that reduces pickup range by half and are uncertain in the determination of the relative movements, distance and size of a target. James E. Lebensohn.