Retinal Detachment

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AMERICAN JOURNAL OF OPHTHALMOLOGY

chemical, physiologic, anatomic, pharmacologic, and immunologic interactions of biologic tissues as they relate to the clinical practice of cosmetic surgery. Unlike many other texts on the subject, this volume is dedicated largely to basic science considerations of normal tissue structure, physiology, and biochemistry in relation to wound healing that can affect the final surgical outcome. Understanding the biologic basis for surgical approaches to aesthetic reconstruction can only lead to better cosmetic surgery. The first seven chapters deal with aspects of wound healing. Epidermal cell kinetics and the effects of local tissue environments on the reparative process are discussed along with the mechanisms of wound contraction under a variety of clinical and experimental conditions. The discussion of the biomechanical properties of skin in relation to scar formation provides an enlightening understanding of the surgeon's control over the final cosmetic result as well as the inherent limitations. The chapter on healing in compromised tissues includes a discussion of smoking and of systemic diseases, the influence of drugs, and the role of hyperbaric oxygen in the survival of tissue flaps. An understanding of the effects of nictoine, hypertension, and infection is essential for achieving acceptable results. A chapter on skin grafts and hair transplants contains excellent material on the mechanisms of vascularization, dermal and epidermal interactions, pigmentation problems, and graft contraction. In a chapter on keloids and hypertrophic scar formation, the value of various treatments is discussed. Cosmetic surgeons are well aware of differences between young and elderly patients with regard to wound repair. A chapter on aging of skin discusses the anatomic and physiologic changes associated with aging and evaluation the implications of changes in cellular proliferation and repair with respect to wound healing. Age-related changes in epidermis, dermal fibroblasts, and vasculature, skin appendages, and melanocytes as well as changes in response to injury, chemical clearance, and immune responsiveness all have implications for the cosmetic surgeon. The last several chapters are devoted to the clinical uses of dermabrasion and chemical peels on the face, and the use of lasers in the treatment of port-wine stain hemangiomas. A chapter on cosmetics and skin preparations provides the cosmetic surgeon with a guide for educating patients about nor-

September, 1986

mal skin care and methods to prevent premature aging of skin. This volume provides the basic data on which to make therapeutic decisions. It is well written, carefully organized, and provides a very welcome and much needed reference source for the cosmetic surgeon.

Retinal Detachment. By Jack J. Kanski. Stoneham, Butterworth Publishers, 1986. 162 pages, index, illustrated. $75

Reviewed by THOMAS M. AABERG Milwaukee, Wisconsin This book is intended for general ophthalmologists and ophthalmologists in training. In the opening chapters the author describes examination techniques and the disorders tending to produce retinal tears and holes with a brief discussion of the probability of various retina-weakening (rhegmatogenic) degenerations progressing to actual retinal detachment. The illustrations, done by Terry Tarrant, are excellent. Mr. Tarrant is known for his ability to draw retinal abnormalities, particularly those associated with retinal detachment. The early chapters provide a checklist of procedures necessary for diagnosing the nature of the detachment, finding the cause, and performing the necessary preoperative steps (dilation of the pupil, prophylactic antibiotics, cutting eyelashes, and the like). The section on surgical principles is confined to exoplant surgery. The stepby-step description of technique provides the details necessary to achieve the goal stated in the preface: "enabling the reader to manage in a safe manner uncomplicated cases of retinal detachment." The description of complicated cases is confined to the American Retina Society's classification of proliferative vitreoretinopathy and a subsequent definition of air, balanced salt solution, and silicone oil injection into the vitreous. A unique approach in this text is the author's format of listing errors and complications followed by ways of preventing them. First, he informs the reader of the possible problems the surgeon may encounter and then he shows how these errors can be avoided. By doing this for each step in the procedure, he provides information not found in other texts.

Vol. 102, No. 3

Obituary

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This text has a place in the library of general ophthalmologists and ophthalmologists in training. The ophthalmologist who does only occasional retinal detachment surgery will find this useful. Surgeons performing complicated retinal detachment procedures will need more detailed texts.

Obituary PAUL HENKIND, M.D. 1932-1986 Each generation of ophthalmologists looks back at the previous generation and reflects, "There were giants in the earth in those days" (Genesis 6:4). The exception to this observation was Paul Henkind, who was our own generation's giant in every sense of the word. He was large in size, large in appetite, prodigious in ability, and spectacular in performance. It was with sadness that we learned that this commanding figure died June 24, 1986. Paul Henkind was born on Dec. 12, 1932, in New York, New York. Except for a brief interval for internship at the Henry Ford Hospital in Detroit and two years at the Institute of Ophthalmology in London, he spent his life in the city of his birth. He began his scholastic career in the grade schools of New York and from his education at the Bronx High School of Science, that mother of Nobel Prize winners, we can deduce that even at an early age he showed outstanding promise and not solely as a future scientist. He also demonstrated athletic ability, earning a varsity letter in basketball; so it seems likely that even in high school Paul towered above his classmates. He continued his scholarly and athletic career at Columbia University, making both the Dean's list and the varsity basketball team. In 1955, after graduation from Columbia, he .matriculated at the Medical School of New York University and here a new talent emerged. He became photographic editor of the Medical School magazine, "Violet." While in medical school, he received a National Council to Combat Blindness Student Fellowship and also a Fight for Sight Fellowship. After internship Paul returned to New York in 1960 to start a residency in ophthalmology at New York University. On completion of his residency he received a fellowship from the National Institutes of Health that allowed him

Figure (Shoch). Paul Henkind, M.D.

to spend the next two years at the Institute of Ophthalmology of the University of London where he earned a Ph.D. in pathology. (Twenty years later the same institution awarded him a Doctor of Science degree.) In 1965 Dr. Henkind returned to New York to a teaching and research career at New York University. In 1970 he was recruited by the Albert Einstein College of Medicine of Yeshiva University and became the Frances Dejur Professor and Chairman of the Department of Ophthalmology. By the time he became chairman he had already published some 70 papers, but during the next 15 years he published some 200 papers, book chapters, and textbooks. He served on numerous advisory boards and he was invited to give named lectures all over the world: the G. Victor Simpson Lecture in Washington, D.C., the University of Chicago Alex Krill Lecture, the Royal College of Surgeons of Canada Lecture, the Paul Chandler Lecture at Harvard University, the Alan Firmin Lecture in England, the Abraham Ticho Lecture in Israel, and many others. But in my opinion, Dr. Henkind's primary contribution to ophthalmology was not as a