Table Of ContentSurgical
Ophthal
Edited by
F. C. Blodi, G. Mackensen and H. Neubauer
With Contributions by
F. Bigar, 1. Draeger, H. Hanselmayer, F. Hoffmann
H. Hofmann, M. Kirchner, G. Kommerell, O.-E. Lund
G. Mackensen, N. Mtiller-Stolzenburg, G. O. H. Naumann
H. Neubauer, W. Rtissmann, H. Sautter, R. Sundmacher
K. Ullerich
With 446 Figures in 941 Separate Illustrations
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo Hong Kong Barcelona
Translator: Prof. Dr. F. C. BLODI, Iowa City, IA (USA)
Title of the Gennan Edition: Augeniirztliche Operationen 1
(Volume IV, Part 1 of Kirschnersche allgemeine und spezielle Operationslehre, edited by G. Mackensen
and H. Neubauer)
© Springer-Verlag Berlin Heidelberg 1988
ISBN-13:978-3-642-75387-9 e-ISBN-13:978-3-642-75385-5
DOl: 10.1007/978-3-642-75385-5
Library of Congress Cataloging-in-Publication Data. Augeniirztliche Operationen. English. Surgical ophthal
mology 1 edited by F. C. Blodi, G. Mackensen, and H. Neubauer; with contributions by F. Bigar ... let al.;
translator, F. C. Blodi]. p. em. Translation of: Augeniirztliche Operationen. Includes index.
ISBN-13:978-3-642-75387-9 1. Eye-Surgery. I. Blodi, Frederick
C. (Frederick Christopher), 1917- . II. Mackensen, G. (Giinter) III. Neubauer, Hellmut. IV. Bigar, F.
(Francis) V. Title. IDNLM: 1. Eye-surgery. WW 168 A919] RE80.A9413 1990 617.71-dc20 DNLMI
DLC for Library of Congress 90-10403 CIP
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© Springer-Verlag Berlin Heidelberg 1991
Softcover reprint of the hardcover 1st edition 1991
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2122/3130-543210 - Printed on acid-free paper
List of Editors and Contributors
EDITORS
F. C. BLODI, Prof. (em.) Dr. Dr. h. c., The University of Iowa, Department of
Ophthalmology, University of Iowa, Hospitals and Clinics, Iowa City, IA 52242
(USA)
G. MACKEN SEN, Prof. (em.) Dr. Dr. sc. h. c., UniversiHits-Augenklinik,
KillianstraBe 5, D-7S00 Freiburg
H. NEUBAUER, Prof. (em.) Dr., Universitats-Augenklinik,
losef-Stelzmann-StraBe 9, D-5000 Kaln 41
CONTRIBUTORS
F. BIGAR, Prof. Dr., Hopital Ophtalmique Universitaire, 15, Avenue de France,
CH-1004 Lausanne
1. DRAEGER, Prof. Dr., Universitats-Augenklinik, MartinistraBe 52,
D-2000 Hamburg 20
H. HANSELMAYER, Prof. Dr., Universitats-Augenklinik, Auenbruggerplatz 4,
A-S036 Graz
F. HOFFMANN, Prof. Dr., Universitats-Augenklinik, Klinikum Steglitz,
Hindenburgdamm 30, D-1000 Berlin 45
H. HOFMANN, Prof. (em.) Dr., Universitats-Augenklinik, Auenbruggerplatz 4,
A-S036 Graz
M. KiRCHNER, Architekt, Rothenbaumchaussee 79, D-2000 Hamburg 13
G. KOMMERELL, Prof. Dr., Universitats-Augenklinik, Abteilung Neuro
ophthalmologie und Schielbehandlung, KillianstraBe 5, D-7S00 Freiburg
O.-E. LUND, Prof. Dr., Universitats-Augenklinik, MathildenstraBe S,
D-SOOO Munchen 2
G. MACKENSEN, Prof. (em.) Dr. Dr. sc. h. c., Universitats-Augenklinik,
KillianstraBe 5, D-7S00 Freiburg
N. MOLLER-STOLZENBURG, Dr. Dr., Universitatsklinikum Steglitz, Augenklinik
und Poliklinik, Hindenburgdamm 30, D-1000 Berlin 45
G. O. H. NAUMANN, Prof. Dr., Universitats-Augenklinik, Schwabachanlage 6,
D-S520 Erlangen
H. NEUBAUER, Prof. (em.) Dr., Universitats-Augenklinik,
losef-Stelzmann-StraBe 9, D-5000 Katn 41
VI List of Editors and Contributors
W. ROSSMANN, Prof. Dr., Universitats-Augenklinik, Abteilung fUr Okulare
Motilitatsstorungen und Neuroophthalmologie, Josef-Stelzmann-Stra13e 9,
D-5000 Koln 41
H. SAUTTER t, Prof. (em.) Dr. Dr. med. h. c., Universitats-Augenklinik,
Martinistra13e 52, D-2000 Hamburg 20
R. SUNDMACHER, Prof. Dr., Universitats-Augenklinik, Moorenstra13e 5,
D-4000 Dusseldorf
K. ULLERICH, Prof. Dr., ehem. Direktor der Augenklinik der Stadtischen
Krankenanstalten, Beurhausstra13e 40, D-4600 Dortmund 1
Preface to the English Edition
These two volumes of "Surgical Ophthalmology" represent the fruits of a long
standing cooperation among a number of experts in the various subspecialties of
ophthalmology. The editors have attempted to harmonize the individual contribu
tions. The illustrations are of a more or less uniform character and present in di
dactic sketches the individual steps of the most important operations. This should
be of benefit not only for the neophyte, but also for the expert. The text has in a
similary way been integrated so that the whole work, though written by a number
of contributors, presents an organic unit and not a patchwork of different parts.
In addition, this work is a monument to the spirit of German-American collab
oration. The two German editors have since the end of WWII stressed the advan
tages of such collaborative efforts. They have established close personal contacts
with many American ophthalmologists. They have participated in and contributed
to many American congresses, meetings and symposia. The American editor, on
the other hand, as a product of the Viennese school, has always stressed the im
portant contributions by German-speaking ophthalmologists and the value of the
German literature.
For these reasons the editors suggested from the inception of this work that the
publishing company would also prepare an English edition. The German edition
(1988/89) has been well received not only in German-speaking countries, but also
in East Europe, and we hope the English edition will be welcome in a similar way
and will prove to be a useful guide and source of information for English-speak
ing ophthalmic surgeons.
Preparing the English edition has taken some time and the authors have at
tempted to update their chapters by incorporating important new developments
which occurred since the German edition was published. We would like to thank
all contributors for their cooperation and the publishing company for its help.
We would be grateful for any critical comments or suggestions from the
readers.
F.C. BLODI G. MACKENSEN H. NEUBAUER
Preface to the German Edition
The readers of a new textbook on ocular surgery expect a presentation of the state
of the arts in surgical techniques, their indications, results, and complications.
Such a book should guide the young surgeon in his operative procedures, should
give him standards for evaluating pre- and postoperative results, and should also
support the soundness of his decisions.
However, surgical treatment presents - as any other medical activity - a per
sonal achievement molded by the surgeon's knowledge, experience, skill, and con
science. Therefore, a textbook on ocular surgery should not only present binding
rules; it should also emphasize a certain freedom of decision in regard to indica
tions and techniques. The editors therefore encouraged the authors of the various
chapters to stress not only common didactic principles, but also to present their
own personal opinions and experiences, and then compare them with the litera
ture.
The quality of surgical activities is to a large extent not determined by the so
phistication of machinery, but mainly by the precision of preoperative analysis
and the development of a correct surgical plan. Increased knowledge on patho
genesis will often improve our surgical techniques. We therefore thought it neces
sary to discuss also the modem aspects of pathogenesis of the disease process
which we attempt to cure or improve.
We also did not want to present the readership with a static description of the
newest techniques as they are available at the present time. We wanted to describe
briefly the development and history of the procedures in order to emphasize the
dynamic aspect of this area.
The technical improvements grow with increasing speed. This allows us to
achieve new surgical goals. During the years of our professional career we have
recognized how quickly a revision might be necessary.
Establishing these goals we hope to be of some help and advantage not only to
the young, but also to the experienced surgeon.
We are indebted to the authors of the various chapters and their coauthors, to
Professor F. C. BLOm for preparing the English translation, to Professor J. ROHEN
for consultation in questions of morphology, to the artists Mr. R HENKEL, Mr.
A. GATTUNG and Mrs. G. KUKULA for the indefatigable precision of their draw
ings, to Mr. J. KUHN for technical consultation concerning the illustrations, and to
the Springer-Verlag, especially to Mr. W. BERGSTEDT, Mrs. TH.DEIGMOLLER, Mrs.
I. LEGNER, Mrs. E. SCHUHMACHER and Mr. E. KIRCHNER for frequent and patient
help concerning the organization of the book, for advice, and for the so satisfacto
ry production of the final result.
Freiburg i. Br. - Koln G. MACKENSEN and H. NEUBAUER
Contents Part 1
I. Equipping and Organizing an Ophthalmic Surgical Suite
J. DRAEGER and M. KIRCHNER. With the Cooperation of R. WINTER
With 21 Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1
II. Principles, Preparation, Local Anesthesia,
Postoperative Treatment
K. ULLERICH. With the Cooperation of M. SEVERIN
With 12 Figures . . . . . . . . . . . . . . . . . . . . . . . . . .. 27
The Position of the Surgeon and his Assistant
and the Orientation of the Illustrations . . . . . . . . . . . .. 55
III. Surgical Procedures on the Lids
H. NEUBAUER
With 95 Figures . . . . . . . . . . .................. 57
IV. Operations on the Lacrimal System
H. HOFMANN and H. HANSELMAYER
With 51 Figures . . . . . . . . . . . . ....... 225
V. Surgical Procedures on the Conjunctiva and the Sclera
R. SUNDMACHER and G. MACKENSEN
With 16 Figures .............................. 281
VI. Operations on the Extraocular Muscles
VI.A. The Mechanics of the Strabismus Operations
G. KOMMERELL
With 11 Figures . . . . . . . . . . . . . . . .. ........... 327
VI.B. Indications, Surgical Techniques, Complications
W.ROSSMANN
With 117 Figures ............................. 343
VII. Surgical Procedures on the Cornea
G. O. H. NAUMANN and H. SAUTTER t
With a Contribution by F. BIGAR: Donor Material
With 60 Figures .............................. 433
VILA. Keratoprosthesis
O.-E. LUND
With 11 Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
XII Contents Part I
VII.B. Refractive Corneal Surgery
F.HoFFMANN
With a Contribution by N. MOLLER-STOLZENBURG:
Refractive Corneal Surgery with Lasers
With 24 Figures . . . . . . . . . . . . . . . . . . . . . . . . . . 523
VIII. Operations on the Iris and the Ciliary Body
G. MACKENSEN
With 28 Figures . . . . . . . . . . . . . . . . .547
Subject Index . . . . . . .............. 595
Contents Part 2
IX. Operations on the Lens
W. BOKE. With the Cooperation of G. DUNCKER
With 41 Figures
IX.A. Intraocular Lens Implantation
K. W.JACOBI
With 16 Figures
X. Glaucoma Surgery
G. MACKENSEN and H. HARMS. With the Cooperation
of H. H. UNGER
With a Contribution by F. GREHN: Laser Surgery in Glaucoma
With 63 Figures
XI. Surgical Procedures for Retinochoroidal Diseases
XI.A. Treatment and Prophylaxis of Retinal Detachment
G. MEYER-SCHWICKERATH and E. GERKE
With 94 Figures
XI.B. The Treatment of Retinal Vascular Diseases
E. GERKE, A. WESSING and G. MEYER-SCHWICKERATH
With 18 Figures
XI.c. Surgical Procedures for Tumors of the Retina and Choroid
M. H. FOERSTER, N.BoRNFELD, A. WESSING
and G. MEYER-SCHWICKERATH
With 12 Figures
XII. Vitreous Surgery
R.Ku'hI
With 95 Figures
XIII. Surgical Procedures for Accidental Injuries of the Eyeball
H. NEUBAUER. With the Cooperation of H. PAULMANN
and B. KtRCHHOF
With 2 Figures
XIII.A. Surgical Procedures for Contusions and Perforations
TH. N. WAUBKE and K. B. MELLIN
With 30 Figures
