Vitreous Microsurgery

271 Pages·2010·17.924 MB·English

by  Steve Charles, Jorge Calzada, Byron Wood

Vitreou s Microsu rgery
FIFTH EDITION
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Vitreou s Micr osu r gery
FIFTH EDITION
Steve Charles, MD
Vitreoretinal Surgeon and Founder
Charles Retina Institute
Clinical Professor of Ophthalmology
University of Tennessee
Memphis, Tennessee
Adjunct Professor of Ophthalmology
Columbia College of Physicians and Surgeons
New York City, New York
Jorge Calzada, MD
Vitreoretinal Surgeon
Charles Retina Institute
Clinical Instructor in Ophthalmology
University of Tennessee
Memphis, Tennessee
Byron Wood, MS
Chief Photographer and Director of Graphics
Charles Retina Institute
Memphis, Tennessee
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All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including
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Printed in China
Library of Congress Cataloging-in-Publication Data
Charles, Steve.
Vitreous microsurgery / Steve Charles, Jorge Calzada, Byron Wood. —5th ed.
p. ; cm.
Includes bibliographical references and index.
Summary: “Written by a pioneering leader in the development of vitreoretinal surgical techniques and instruments, Vitreous Microsur-
gery is a comprehensive how-to guide to all vitreoretinal procedures. This thoroughly updated Fifth Edition describes many new techniques
and refi nements of established procedures and includes new chapters and new illustrations. More than 170 three-dimensional full-color
illustrations—many by the Charles Retina Institute’s resident medical artist, Byron Wood—enable surgeons to clearly visualize the tech-
niques. The focus of the text is on the decision making process a surgeon goes through in evaluating the best course of treatment for his/her
patient undergoing vitreous surgery. The book describes in detail clinically proven methods of managing the anterior and posterior segment
vitreous surgery patient in a systematic manner. The text is organized in a building block approach with general methodology preceding its
application to specifi c disease states. The book stresses algorithms for intra-operative decision making, relying on knowledge of physical
principles and performed in the order of ascending risk. A companion website included with purchase offers the fully searchable text and
an online image bank”—Provided by publisher.
ISBN 978-1-60831-503-1 (hardback)
1. Vitreous body—Surgery. 2. Microsurgery. I. Calzada, Jorge. II. Wood, Byron. III. Title.
[DNLM: 1. Vitreous Body—surgery. 2. Eye Diseases—surgery. 3. Microsurgery—methods. WW 250 C477v 2011]
RE501.C48 2011
617.7’46059—dc22
2010018076
Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the
authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in
this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the pub-
lication. Application of the information in a particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accor-
dance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government
regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert
for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for
use in their clinical practice.
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The Fifth Edition is dedicated to the quest to
better serve humankind.
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Pre fa ce
In keeping with the approach taken with perspective in collaboration with Gary Fanning, MD, and
previous editions, the fi fth edition is designed Jay Mattingly, MD, leading experts on this subject.
as a technology book rather than an academic Kenneth Fung, MD, MBA made a substantial contribu-
analysis of the literature, a statistical review of tion to the chapter on retinal vein occlusions.
outcomes, or a series of clinical cases and images. This edi- The retinopathy of prematurity chapter has been com-
tion is intended to be fi ne grained with emphasis on every pletely rewritten to address new examination, laser guide-
nuance of surgical technique and tool technology. lines, anti-VEGF therapy, and changing, more conservative
Surgical and medical retina strategies have under- indications for surgery.
gone signifi cant paradigm shifts since the fourth edition All chapters have been updated, and new references
was written. The fi fth edition includes new chapters on have been included. All illustrations have been updated; the
the Constellation vitrectomy system, uveitis, retinal com- majority of illustrations have been updated to a 25-gauge
plications of permanent keratoprosthesis, and anti-VEGF approach instead of a 20-gauge approach, and many new
therapy. illustrations have been included.
Many techniques and parameters unique to 25-gauge It is planned that this text will go forward with an update
sutureless vitrectomy are discussed in detail. The authors approximately every 5 years with my able coauthors, associates,
use 25-gauge sutureless technique for all cases, and micro- and great friends Byron Wood, MS and Jorge Calzada, MD.
incisional 23-, 25-, or 27-gauge vitrectomy is growing in
popularity on a worldwide basis. Steve Charles, MD
The section on anesthesia for vitreoretinal surgery
has been completely rewritten from an anesthesiologist’s
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Ackn o w le d g m e n t s
This book is made possible because Lippincott because of his input. It is a great pleasure to work with great
Williams & Wilkins invited us to write a fi fth friends who are dedicated to producing the highest quality
edition based, in part, on extensive sales of the work.
fourth edition as well as Chinese, Portuguese, I would also like to thank my wonderful, loyal, and
Turkish, and planned Spanish editions. I would like to thank hardworking offi ce and OR staff who provided clinical sup-
the many surgeons, libraries, and universities worldwide port, allowing me to perform over 700 vitrectomies per year
that purchased the previous edition. We are very fortunate for the last 30 years, which ultimately drove the concepts
to have worked with Jonathan Pine and Emily Moyer of described in this book.
Lippincott Williams & Wilkins to produce this larger and I would like to thank Alcon Laboratories for working
improved textbook. with me over the years to develop most of the wonderful
I would like to especially thank my incredible coau- tools and systems described in this text. The engineers, man-
thors, Byron Wood, MS and Jorge Calzada, MD. Byron Wood agers, and craftsmen have enabled surgeons to provide the
has created the illustrations, as he has for four previous edi- best possible care to the patients.
tions; these are even more detailed, anatomically and surgi- I would like to thank my three amazing daughters—
cally accurate, and beautiful to view as art. Jordi Calzada has Kelli Ross, MD, Kerri Charles, MD, JD, and Marci Charles—
done a superb job of restructuring all references as well as for their love and their patience with their often preoccupied
adding new ones. In addition, many concepts were refi ned father.
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