Refractive keratotomy for myopia and astigmatism

목차 (Table of Contents)

• CONTENTS
• SECTION Ⅰ Myopia
• 1 Myopia : A Brief Overview / George O. Waring Ⅲ = 3
• Terminology = 3
• Sociologic aspects of myopia = 4
• Prevalence of myopia = 4
• Effect of age = 4
• Visual disability and blindness from myopia = 5
• Economic aspects of myopia = 6
• Cause of myopia = 6
• Germinal dysgenesis theories = 6
• Heredity = 6
• Genealogic studies = 6
• Myopia associated with systemic and ophthalmic disorders = 7
• Myopia as a disorder of growth = 7
• Effect of environment on myopia = 7
• Ocular response to visual input = 7
• Effect of near work on myopia = 7
• Application to radial keratotomy = 7
• Classification of myopia = 7
• Clinical characteristics of simple and intermediate myopia = 9
• Visual acuity = 9
• Motility and the accommodative convergence／accommodation ratio = 9
• Intraocular pressure = 10
• Changes in the vitreous body = 10
• Myopic crescent = 11
• Lattice retinal degeneration and retinal detachment = 11
• Axial length = 11
• Onset and progression of physiologic and intermediate myopia = 11
• Man$$\mathord{\buildrel{\lower3pt\hbox{$\scriptscriptstyle\frown$}}\over a} $$gement of physiologic and intermediate myopia = 13
• Pathologic mypia = 13
• Unfinished business = 14
• 2 Corneal Anatomy and Physiology as Applied to Refractive Keratotomy / George O.Waring Ⅲ = 17
• Functions of the cornea = 17
• Corneal epithelium = 18
• Functions of the epithelium = 18
• Structure of the epithelium = 19
• Epithelial-tear film interaction = 19
• Epithelial squamous cells = 20
• Polygonal wing cells = 20
• Basal epithelial cells = 22
• Epithelial basement membrane and attachment complexes = 22
• Metabolism of the corneal epithelium = 22
• Bowman's layer = 24
• Cellular corneal stroma = 25
• Structural components of the stroma = 25
• Cells in the corneal stroma = 25
• Collagen in the stroma = 26
• Proteog1ycans in the stroma = 28
• Mechanical properties of the cornea = 28
• Corneal transparency = 29
• Corneal endothelicm and Descemet's membrane = 29
• Structure of the endothelium = 29
• Function of the endothelium = 30
• Descemet's membrance and the posterior collagenous layer = 31
• Corneal thickness = 32
• Species differences in corneal structure = 33
• Unfinished business = 33
• 3 Optics and Topography of Radial Keratotomy / Jack T.Holladay ; George O. Waring Ⅲ = 37
• The optics of myopia = 38
• Correlation and component ametropia = 38
• Role of the cornea in myopia = 39
• Optical and surgical correction of myopia = 45
• Terminology of corneal optics and topography = 46
• Shape of the cornea-radius of curvature and power = 47
• Corneal asphericity = 48
• Anatomic Surface Zones of the cornea = 48
• Directions on the cornea : meridians and axes = 51
• Central corneal curvature, refractive power, and corneal topography = 54
• Terminology of instruments used to measure corneal curvature and topography = 55
• Principles of keratomerty and keratoscopy = 58
• Keratometry-sampling the central cornea = 60
• Keratoscopy and keratography : measuring the corneal surface = 66
• Comparison of keratometry, photokeratogra-phy, and videokeratography = 83
• Corneal modeling : measuring corneal toptgraphy and thickness = 83
• Rasterstereography : measuring the ocular surface = 88
• Interference fringe techniques : measuring with high resolution = 89
• Practical considerations about topography instruments = 91
• Normal corneal topography and aspheric optics = 91
• Corneal asphericity and asymmetry = 91
• Normal corneal topography = 92
• Influence of pupil size = 97
• Corneal topography and visual function = 99
• Optics and corneal topography after radial keratotomy = 100
• Changes induced in corneal shape by radial keratotomy = 101
• Keratometric measurements after radial keratotomy = 107
• Corneal topography after radial keratotomy = 109
• Relationship of refractive error, visual acuity, and corneal topography = 125
• Refractive error and visual acuity in normal eyes = 125
• Refractive error, visual acuity, and corneal topography after radial keratotomy = 127
• Refraction after radial keratotomy = 134
• Unfinished business = 136
• SECTION Ⅱ Development of Refractive Keratotomy
• Background and acknowledgments = 142
• 4 Development and Classification of Refractive Surgical Procedures / George O. Waring Ⅲ = 145
• Sources of information about refractive surgery = 145
• Colloquial sources = 145
• Formal trials = 146
• Need for formal clinical trials = 146
• Current controlled clinical trials = 147
• Stages in the development and evaluation of keratotomy = 147
• Initial creativity = 149
• Trial-and-error refinement = 150
• Informal testing = 151
• Formal trials = 152
• Randomized controlled clinical trial = 153
• Different characteristics along the continuum of development = 154
• Clinical use of the fice developmental stages = 154
• Rate of progress along the continuum of development = 154
• Stages of development in the laboratory = 155
• Small mammals = 155
• Rabbits = 156
• Cats = 156
• Dogs = 156
• Monkeys = 156
• Blind human eyes = 155
• Sighted human eyes with ocular pathology = 155
• Ametropic sighted human eyes = 156
• Survey of refractive corneal surgical procedures = 157
• Keratomileusis = 157
• Epikeratoplasty = 159
• Intracorneal lenses = 161
• Lamellar keratoplasty = 162
• Radial deratotomy for myopia = 162
• Keratotomy for astigmatism = 162
• Circunlferential keratotomy for hyperopia = 163
• Laser photorefractive keratectomy = 163
• Crescentic lamellar keratoplasty = 164
• Penetrating keratoplasty = 164
• Thermokeratoplasty = 164
• Crystalline lens and intraocular lens surgery = 166
• Unfinished business = 166
• 5 Development of Refractive Keratotomy in the Nineteenth Century / Bernd H. Schimmelpfennig ; George O. Waring Ⅲ = 171
• Optics and refractive surgery = 171
• Early clinical keratotomy for astigmatism = 173
• Early laboratory study of keratotomy = 174
• Early twentieth century : a latent period = 176
• Unfinished business = 177
• 6 Development of Redial Keratotomy in Japan(1939-1960) / Koichiro Akiyama ; Hirohiko Shibata ; Atsushi Kanai ; Shuichi Akiyama ; Tatsuo Yamaguchi ; Akira Nakajima ; George O. Waring Ⅲ = 179
• Development of anterior-posterior keratotomy = 179
• Anterior and posterior keratotomy in rabbits = 187
• General laboratory methods = 187
• Anterior and posterior keratotomy in humans = 197
• General surgical plan = 197
• Tangential posterior half-corneal incision for astigmatism = 199
• Anteroposterior corneal incisions for astigmatism = 199
• Comb-type posterior corneal incision for astigmatism = 200
• Corneal interlayer separation and posterior tangential incision for high astigmatism = 201
• Radial posterior incisions for myopia = 202
• Radial anterior and posterior corneal incisions for myopia = 204
• Radial incisions for myopic astigmatism = 208
• Central posterior keratotomy for keratoconus = 208
• Clinical course after posterior keratotomy = 208
• Sato's hypothetical biomechanical explanation of the effect of corneal incisions = 209
• Long-term follow-up in humans = 212
• Histopathologic findings = 215
• Anterior and posterior keratotomy in monkeys = 217
• Unfinished business = 219
• 7 Development of Refractive Keratotomy in the Soviet Union(1960-1990) / George O. Waring Ⅲ = 221
• Sato's anterior and posterior keratotomy in the Soviet Union = 221
• Anterior keratotomy in the Soviet Union = 222
• Fyodorov's individualized anterior radial keratotomy = 222
• Optical clear zone diampeter = 224
• Biomechanics of keratotomy = 224
• Individualized prediction formula = 224
• Clinical results = 224
• Surgery for astigmatism = 229
• Surgical instruments and technique = 229
• Reports of Avetisov and Krasnov = 234
• Anterior refractive keratotomy in the East = 234
• Anterior refractive keratotomy in the West = 234
• Unfinished business = 234
• 8 Development of Rdfractive Keratotomy in the United States(1978-1990) / George O. Waring Ⅲ = 237
• Introduction of refractive keratotomy in the United States = 238
• Refractive keratotomy organizations = 238
• The National Radial Keratotomy Study Group = 238
• The Keratorefractive Society = 239
• The National Eye Instiute and the Prospective Evaluation of Radial Keratotomy(PERK) Study = 240
• Analysis of Radial Keratotomy(ARK) Study = 246
• International Society of Refractive Keratoplasty(ISRK) = 246
• Other professional organizations = 246
• Ophthalmic practitioners and the public = 247
• Clinical development of keratotomy = 250
• Development of keratotomy outside the United States = 256
• Unfinished business = 256
• 9 Radial Keratotomy on Trial : New Surgical Procedures and the Antitrust Laws / Wiliiam S. Duffey, Jr. = 259
• Sherman Antitrust Act and two radial keratotomy cases = 260
• Conspiracies and monopolies-a cursory review = 260
• Two radial keratotomy antitrust lawsuits = 260
• Vest v. Waring = 260
• Schachar v. the Vest and Schachar cases = 261
• Resolutiono of the Vest and Schachar cases = 262
• Alleged antitrust conspiracy in radial keratotomy = 262
• "Concerted action" = 263
• The defendants' view of the "concerted action" alleged = 266
• The "experimental" designation = 267
• The defendants' view of the "experimental" designation = 267
• Call for "restraint," = 268
• The alleged section 2 monopoly = 269
• Permissible conduct : can a line be drawn? = 270
• Section Ⅰ and the "rule of reason" = 270
• The risk analysis : a basic "rule of reason" approach = 271
• Medical considerations in applying the rule of reason = 271
• Economic considerations = 272
• Practical considerations = 272
• Alternatives and their relative risks = 272
• Clinical and laboratory studies = 273
• Personal opinions = 273
• Lobbying against technokogy = 273
• Requests to a professional organization = 274
• Criticism of individuals who advocate the use of the new procedure = 274
• Communications with insurance companies = 274
• The fundamental issue : can it be resolved? = 275
• Unfinished business = 276
• SECTION Ⅲ Patient Selection and Planning for Refractive Keratotomy
• 10 Patient educational Materials for Refractive Keratotomy / Pamela Edwards Klein ; Jan A. Markowiz = 281
• Roll of mass media in health education = 282
• Planned and unplanned information = 282
• Advertising health care = 283
• Physician's role as information provider = 287
• Realistic patient expectations = 287
• Patient education = 287
• Informational materials for refractive keratotomy patients = 289
• Informed consent = 290
• Review of available refractive keratotomy patient materials = 290
• Informational booklets = 290
• Informational video presentations = 294
• Conclusion = 297
• Unfinished business = 297
• 11 Refractive Keratotomy, the Law of Informed Consent, and Medical Malpractice / william S. Duffey, Jr. ; Michael P. Kennedy = 299
• Law of medical consent = 300
• Law of consent = 300
• Law of informed consent = 300
• Obtaining informed consent = 300
• Standards for intormed consent = 300
• What information to communicate = 301
• Consent for new procedures = 302
• Form of consent = 302
• Refractive keratotomy and informed consent : observations and recommendations = 302
• Disclosure = 302
• Documentation = 303
• Study of malpractice cases involving refractive keratotomy = 305
• Conclusion = 306
• Unfinished business = 306
• 12 Examonation and Selection of Patients for Refractive Keratotomy / George O. Waring Ⅲ = 309
• Philosophic attitudes that affect patient selection = 309
• Elective surgery = 310
• Structurally normal eye = 310
• Patient as partner = 310
• Quality of life = 310
• Commercialized medicine = 311
• Demographic characteristics and motivations of cadidates for refractive keratotomy = 311
• Demographic characteristics = 311
• Self-perceived visual ability = 312
• Psychologic characteristics = 312
• Patient motivation for surgery = 313
• Overall patient motivation = 316
• Preoperative clinical examinations = 317
• Refraction = 317
• Age of the patient and stability of refraction = 319
• visual acuity = 321
• Slit-lamp microscopy = 325
• Intraocular pressure = 325
• Central keratometry = 326
• Keratography = 327
• Measurement of corneal thickness = 327
• Fundus examination = 328
• Ocular dominance = 328
• Ocular rigidity = 328
• Corneal diameter = 328
• Specular microscopy of the endothelium = 328
• Axial length of the globe = 239
• Corneal sensation = 329
• Detailed studies of the accommodative convergence／accommodation ratio = 329
• Consulting with patients about refractive keratotomy = 330
• Preexising attitudes of patients = 330
• Preexising attitudes of surgeous = 330
• Consultation with an individual patient = 331
• Surgery on the second eye = 332
• Timing of surgery on the second eye = 332
• Management of the unoperated second eye = 334
• Surgery on the second eye in the PERK study = 335
• Economics of refractive keratotomy = 336
• Surgeon's fees = 336
• Operating room cost = 336
• Insurance coverage = 336
• Cost of refractive keratotomy versus spectacles and contact lenses = 337
• Cost of spectacles and contact lenses = 337
• Impact of economics on patient selection = 337
• Unfinished busimess = 338
• 13 Predictability of Refractive Keratotomy / Michael J. Lynn ; George O. Waring Ⅲ ; Michael H. Kutner = 341
• The search for predictability = 341
• Definition and measurement of predictability = 342
• Basis for predictability = 342
• Regression analysis and prediction intervals = 342
• Standard deviation and standard error of the mean = 343
• Predicted versus actual change in refraction = 344
• Identification of important factors = 344
• Regression analysis in laboratory studies = 345
• Regression analysis in clinical trials = 345
• Predictability in the PERK studies = 347
• Identification of important factors = 348
• Interpretation of regression coefficients in PERK = 349
• Individual predictive favtors in refractive keratotomy = 349
• Diameter of central Clear zone(optical zone) = 349
• Baseline refractive error and clear zone diameter = 352
• Length of incisions = 353
• Patient age-clinical studies = 355
• Depth of incision in refractive keratotomy = 357
• Number of incisions = 361
• Intraocular pressure = 365
• Central corneal curvature = 368
• Corneal thickness and corneal hydration = 370
• Ocular rigidity = 372
• Corneal diameter = 372
• Intraoperative keratoscopy and keratometry = 372
• Predictability for repeated operations = 372
• Clinical applications = 372
• Prediction interval = 373
• Example from the PERK study = 373
• Calculation of the prediction interval = 374
• Effect of age on predictalbility = 374
• Clinical use of the statistical analysis = 376
• Unfinished business = 379
• 14 Computerized Predictability Formulas for Refractive Keratotomy / Donald R. sanders = 381
• Assessment of refrartive keraltotomy formulas = 382
• Components of refractive keraltotomy formulas = 382
• Descriptions of individual formulas = 383
• DRS formulas = 383
• Thornton guide = 387
• RK Data Master formula = 388
• AMark formula = 389
• Kremer formula = 391
• RK predictor formula = 392
• RK Stat program = 393
• Comparison of variables in five software formulas = 393
• Incision depth = 393
• Diameter of clear zone(optical zone) = 393
• Age and sex = 394
• Evaluation of two directly comparable programs : DRS and AMark = 395
• Observation on comparison of formulas = 398
• Noncompyterized refractive keratotomy nomograms = 399
• Unfinished busimess = 404
• SECTION Ⅳ Surgery
• 15 Surgical Instruments Used in Refractive Keratotomy / Spencer P. Thornton ; Susanne K. Gardner ; George O. Waring Ⅲ = 407
• Mveasurement of corneal thickness = 409
• Terminology = 409
• Methods of measuring corneal thickness = 410
• Normal corneal thickness = 410
• Ultrasonic pachometry = 411
• Opticalpachometry = 430
• Knife blades and handles used for refractive keratotomy = 431
• Knife blades = 431
• Assessment of knife blades = 449
• Attachment of crystal blade to knife handle = 449
• Maintenance and cleaning of crystal knife blades = 450
• Knife footplates = 453
• Knife handle = 461
• Mechanized knife systems = 465
• Gauge blocks = 466
• Purpose and development = 466
• Accuracy of gauges = 466
• Types of gauge blocks = 469
• Care of gauge blocks = 475
• Zone and incision markers = 475
• Purpose and design of markers = 475
• Blades on markers = 476
• Centering of markers = 476
• Clircular zone markers = 476
• Radial incision markers = 479
• Astigmatism markers = 480
• Fixation instrument = 480
• Single-pronged forceps = 482
• Double-pronged fixation forceps = 482
• Compression rings = 482
• Suction fixation rings = 482
• Other instruments used for radial keratotomy = 485
• Eyelid speculums = 485
• Depth gauges = 485
• Wound openers = 486
• Irrigating cannulas = 486
• Accuracy in manufacture and use of instruments for keratotomy = 486
• Pachometers = 486
• Knife blades = 486
• Micrometer handles = 486
• Knife footplaters = 486
• Gauge blocks = 487
• Clear zone markers = 487
• Centering mark = 487
• Unfinished business = 487
• 16 Centering Corneal Surgical Procedures / Hiroshi Uozato ; David L. Guyton ; George O. Waring Ⅲ = 491
• Entrance pupil and line of sight = 491
• Corneal light reflex = 495
• Axes of the eye = 496
• Current methods of centering corneal surgery = 498
• PERK technique = 498
• Osher's optical centering device = 499
• Fixation tauget between microscope viewing tubes = 501
• Weck and Zeiss light reflex target = 501
• Thornton's fixation target = 502
• Binocular sighting = 503
• Optimal centering for refractive keratotomy = 503
• Unfinished business = 505
• 17 Atals of Surgical Techniques of Radial Keratotomy / George O. Waring Ⅲ = 507
• Steps in keratotomy surgery = 510
• Orientation of drawings = 518
• Preoperative preparation of the patient and surgeon = 519
• Preparation in the operating room = 522
• Anesthetizing the eye = 525
• Preparation, draping, and eyelid speculum = 531
• Manipulation of the microscope = 533
• Marking the center of the optical clear zone = 536
• Marking the central zone and location of incisions on the epithelial surface = 539
• Measurement of corneal thickness = 543
• Setting the length of the knife blade = 552
• Verifying the length of the knife blade = 556
• Moistening the ocular surface = 562
• Fixation of the globe = 566
• Number and orientation of incisions = 574
• Sequence of incisions = 579
• Direction and depth of incisions = 583
• Holding the knife and starting the incision = 590
• Execution of the incisions = 597
• Pressure on the knife and depth of the incision = 603
• Length and termination of incisions = 606
• Deepening of incisions = 612
• Corneal perforations = 620
• Verification of incision length and contour = 628
• Care of the diamond knife = 630
• Cleaning the incisions = 632
• Concluding the operation = 636
• 18 Repeated Surgery for Residual Myopia and Huperopia after Refractive Corneal Surgery / George O. WaringⅢ = 641
• Classification and terminology = 642
• Role of repeated keratotomy in clinical series = 642
• Staging keratotomy surgery = 642
• Patient selection = 462
• Timing of additional surgery = 643
• Timing of repeated keratotomy for residual myopia or astigmatism = 643
• Timing of wound revision for induced hyperopia = 643
• Timing of lamellar and penetrating keratoplasty = 643
• Surgical plan for repeated operations = 643
• Diameter of clear zone = 644
• Number of incisions = 644
• Depth and profile of initial incisions = 644
• Directionof incision = 645
• Overall guidelines for repeated keratotomy for residual myopia or astigmatism = 645
• Techniques of repeated keratotomy for residual myopia = 645
• Repeated incisions between initial incisions = 646
• Recutting initial incisions = 653
• Recutting the paracentral part of incision = 654
• Opening and recutting the wounds = 656
• Correction of hyperopia after radial keratotomy = 659
• Purse-string suture = 659
• Interrupted sutures = 659
• Penetrating and lamellar keratoplasty after radial keratectomy = 661
• Penetrating keratotomy = 662
• Epikeratoplasty = 665
• Myopic keratomileusis = 666
• Generalities about repeated surgery after radial keratotomy = 667
• Unfinished business = 667
• 19 Laser Corneal Surgery / Theo Seiler ; Francisco E. Fantes ; George O. Waring Ⅲ ; Khalil D. Hanna = 669
• Termimology for laser corneal surgery = 670
• Priniciples of lasers = 672
• Specific characteristics of laser light as applied to corneal surgery = 672
• Creatuib if kaser kuggt = 672
• Interaction of laser light with the cornea = 676
• Absorption of laser light by the cormea = 676
• Lasers used for corneal surgery = 679
• Excimer lasers = 679
• Carbon dioxide laser = 679
• Hydrogen fluorde lasers = 681
• Erbium : YAG lasers = 681
• Pulsed holmium : YAG laser = 681
• Dye lasers = 681
• Excimer lasers = 682
• Physics of excimer lasers = 683
• Excimer laser variables = 683
• Excimer laser delivery systems = 698
• Optical elements = 701
• Control of beam uniformity = 701
• Shaping the beam for refractive ablation = 701
• Delivery of the beam to the eye = 708
• Measuring the beam = 708
• Systems to couple laser and eye = 708
• Position of the patient = 708
• Observation of the cornea = 709
• Aiming the laser = 709
• Stabilization of the eye = 709
• Environment over area of ablation = 710
• Excimer laser interactions with the cornea = 710
• Ablative photodecomposition = 710
• Ablation of corneal epithelium and stroma = 710
• Thermal effects = 712
• Mutagenesis induced by excimer lasers = 712
• Excimer laser keratectomy = 712
• Limear radial myopia and astigmatism = 712
• Lear radial keratectomy in humans = 713
• Transverse linear keratectomy for astigmatism in humans = 715
• Clinical usefulness of linear keratectomy = 718
• Photorefractive keratectomy = 718
• Optical calculations = 719
• Laboratory studies of photorefractive keratotomy = 719
• Photorecractive keratectomy in humans = 721
• Corneal trephination = 725
• Effect of corneal wound healing on photorefractive keratectomy = 727
• Time course of corneal wound healing = 730
• Epithelial wound healing = 720
• Response of Bowman's layer = 730
• Anterior stromal wound healing = 730
• Endotheliun and Descemet's membrane = 734
• Repeated photorefractive keratectomy = 739
• Laser-adjustable synthetic epikeratoplasty(LASE) = 739
• Intrastomal laser surgery = 739
• Scope of laser corneal surgery = 740
• Unfinished business = 742
• SECTION Ⅴ Results
• 20 Corneal Wound Healing and Its Pharmacolohic Modification after Refractive Keratotomy / Gregorv S. Schultz ; Robert E. Nordquist ; George O. Waring III = 749
• Normal healing of corneal wounds-laboratory studies = 750
• Epithelial wound healing = 750
• Stromal wound healing = 750
• Normal endothelial wound healing = 753
• Wound healing after radial keratomy-laboratory studies = 753
• Healing of keratotomy in rabbits = 753
• Healing of keratotomy in monkeys = 753
• Wound healing after refractive keratotomy in humans = 755
• Clinical observations in uncomplicated case = 755
• Clinical observations in complicated cases = 755
• Clinical observations of excimer laser excisions = 757
• Histology of human refractive keratotomy wounds = 757
• Traumatic rupture of the cornea after radial keratotomy = 764
• Pharmacologic manipulation of corneal wound healing = 766
• Growth factors = 766
• Fibronectins = 772
• Corneal mortar = 774
• Drugs that decrease corneal wound healing = 776
• Role of corneal wound healing in refractive keratotomy = 777
• Unfinished business = 777
• 21 Results of Refractive Keratotomy / George O. Waring Ⅲ ; Katherine K. Lindstrom = 781
• Two groups of studies = 781
• Selection criteria for reported series = 782
• Types of reports not published = 783
• Need for standards for reporting = 783
• Detailed summary of three major studies of refractive keratotomy = 786
• Summary of published studies of refractive keratotomy in chronological order = 800
• 22 Bilateral Results of Radial Keratotomy / Azhar Nizam ; Michael J. Lynn ; Michael H. Kutner ; Genrge O. Waring Ⅲ = 849
• Termlnology : anisometropia and aniseikoniar = 849
• Limits for clinically acceptable anisomertropia = 850
• Symmetry of outcome after radial keratotomy in the PERK study = 851
• Surgical protocol = 851
• Methods of analysis = 851
• Study population = 851
• Symmetry of spherical equivalent refraction at baseline and at I year = 852
• Change in symmetry of spherical equivalent refraction from baseline to Iyear = 852
• Spherical equivalent refractive error in both eyes of each patient = 853
• Symmetry of astigmatic refractive power in vertival meridian at baseline and at I year = 853
• Change in symmetry of astigmatic refractive power in vertical meridian from baseline to I year = 853
• Interpretation of results = 853
• Symmetry of uncorrected visual acuity at baseline and at I year = 854
• Characterization of uncorrected visual acuity in highly asymmetric patients = 854
• Symmetry of change in retraction after radial keratotomy in the PERK study = 855
• Patients with one eye operated in the PERK study = 856
• Motivations for having unilateral surgery = 856
• Timing of examinations = 856
• Symmetry of spherical equivalent refraction = 856
• Symmetry of astigmatic refractive power in vertical meridian = 857
• Symmetry of uncorrected visual acuity = 857
• Optical correction for monocularly treated patients = 857
• Observations about anisometropia after radial keratotomy = 857
• Intentional monovision after radial keratotomy = 859
• Other reports of anisometropia after radial keratotomy = 859
• Unnnished business = 860
• 23 Complications of Refractive Keratotomy / Edward R. Rashid ; Genrge O. Waring Ⅲ = 863
• Sources of infomation on complications of keratotomy = 865
• Complications resulting form errors before surgery = 866
• Inaccurate refraction = 866
• Incorrect surgical plan = 867
• Complications or anesthesia = 867
• Uncooperative patient = 867
• Systemic sedation = 868
• Topical anesthesia = 868
• Retrobulbar anesthesia = 868
• Operative complications = 870
• Corneal perforations = 870
• Decentered clear zone = 872
• Incisions across the visual axis = 873
• Incorrect number of incisions = 874
• Incorrect orientation of incisions = 874
• Curvillinear incisions = 875
• Incisions across the limbus = 875
• Early postoperative sequelae = 876
• Pain = 876
• Photophobia = 876
• Epithelial defects = 877
• Fluctuating vision and corneal edema = 877
• Reduced best spectacle-corrected visual acuity = 877
• Refractive complications = 878
• Overcorrection = 878
• Undercorrection = 881
• Anisometropia = 882
• Astigmatism = 883
• Prematire Presbyopia = 886
• Visual acuity problems = 886
• Unstable visual acuity = 886
• Glare = 887
• Changes in contrast sensitivity = 465
• Color vision after refractive keratotomy = 892
• Diminshed night vision = 892
• Monocular diplopia = 895
• Corneal complications = 897
• Bacterial or fungal keratitis = 897
• Early postoperative keratitis = 897
• Delayed bacterial and fungal keratitis = 900
• Nonhealing sterile norneal defects = 901
• Herpes simplex keratitis = 901
• Endothelial cell loss = 901
• Stellate epithlial iron lines = 904
• Epithelial basement membrame changes and epithelial erosions = 905
• Abnormal incisions and scars = 907
• Intraocular complications = 912
• Endophthalmitis = 912
• Cataract = 913
• Traumatic rupture of keratotomy scars = 915
• Epithelial ingrowth = 918
• Iridocyclitis = 919
• Elevated intraocular pressure = 919
• Glaucoma = 921
• Retinal detavhment and maculopathy = 922
• Ptosis = 922
• Ocular surgery after refrctive keratotomy = 924
• Cataract surgery = 924
• Retinal detavhment／vitrecotomy = 924
• Contact lens fitting problems after keratotomy = 925
• Anatomic and physiologic problems in contact lens fitting = 925
• History and examination of the contact lens candidate = 926
• Fitting problems = 926
• Techniques of contact lens fiting = 927
• Therapeutic uses of contct lenses after keratotoomy = 927
• Results of contact lens fitting after keratotomy = 927
• Complications of contact lens wear after keratotomy = 928
• Unnnished business = 930
• 24 Stabilith of Refrction after Recractive Keratotomy / George O. Waring Ⅲ ; Michael J. Lynn ; Michael H. Kutner = 937
• Terminology of stability = 937
• Refractive change in unoperated eyes of patients with physiologic and intermediate myopia = 938
• Time intervals for measurement of changes in refraction = 940
• 1 day to 3 months : postoperative adjustment = 942
• 1 day to 2 weeks : immediate postoperative course = 942
• 2 weeks to 3 months : early postoperative course = 946
• 3 months to 5 years : intermediate term = 948
• Average change in refraction for all eyes = 948
• Change in refraction for individual eyes = 948
• Stability of refraction in individual eyes = 952
• Rate of change and duration of instability of refraction = 956
• Practical aspects of refractive instability = 957
• Effect on daily living = 957
• Cumulative effect = 958
• Early symptomatic presbyopia = 958
• Effect of predictability of refractive keratotomy = 958
• Intentional undercorrection = 958
• Characterization of patients with unstable refraction = 959
• Stability of refraction after repeated keratotomy = 959
• Stability of uncorrected visual acuity = 960
• Changes in refractionand keratomertic power = 960
• Mechanisms of refractived visual acuity = 960
• Morning-to-evening(diurnal) variation = 961
• Teminology = 961
• Diurnal variation in the PERK study = 961
• Diurnal variation reported by ophthalmologists = 963
• Mechanism of diural variation = 963
• Parctical aspects of daily fluctuation = 964
• Stability of refraction after astigmatic keratotomy = 966
• Unfinished business = 966
• 25 The Patient Speaks : Testimonials after Refractive Keratotomy / Mary C. Gemmill ; George O. Waring III = 969
• Lifelong wish come true = 969
• Clinical background = 969
• The patient speaks = 970
• Editorial observation = 971
• A 6-year delay of second eye surgery = 971
• Clinical background = 971
• The patient speaks = 971
• Editorial observation = 972
• Happy swap of distance g1asses for reading glasses = 972
• Clinical background = 972
• The patient speaks = 971
• Editorial observation = 973
• Decreased visual acuity but less dependence on glasses = 974
• Clinical background = 974
• The patient speaks = 974
• Editorial observation = 974
• Asymmetric results and a return to contact lenses = 974
• Clinical background = 974
• The patient speaks = 975
• Editorial observation = 975
• High expectations, poor results, and a lawsuit = 975
• Clinical background = 975
• The patient speaks = 976
• Editorial observation = 977
• Radial keratotomy as seen through operated eyes = 977
• The patient speaks = 977
• Methods of examination = 977
• Initial operations-both eyes = 979
• Repeated operations-right eye = 979
• Postoperative course = 980
• Fluctuation of refraction = 982
• Suturing incisions for overcorrection = 983
• Hyperbaric oxygen treatment = 984
• Conclusions = 984
• Measurement of subjective satisfaction = 984
• Determinants of satisfaction-refraction and visual acuity = 985
• Determinants of satisfaction-subjective glare, fluctuation in Vision, and personal apperarance = 987
• Determinats of satisfaction-regression analysis = 957
• Unfinished business = 989
• 26 Summary of Factors Thar Affect the Outcome of Refractive Keratotomy / George O. Waring Ⅲ = 991
• Surgical instruments = 992
• Surgical plan and technique = 993
• Patient factors = 996
• Examination conditions = 998
• Unfinished business = 999
• Section Ⅵ Corneal Biomechanics and Computer modeling of Refractive Keratotomy Background and acknowledgments = 1002
• 27 Biomechanics : A Primer for Corneal Surgeons / Raymond p. vito = 1003
• Continuum = 1004
• Homogeneity = 1004
• Displacement = 1004
• Stress = 1004
• Definition = 1004
• Stress in three dimensions = 1005
• Stress calculations = 1007
• Strain = 1008
• Definition = 1008
• Strain in three dimensions = 1009
• Strain measurement = 1010
• Constitutive law = 1010
• Tension test = 1010
• Kinds of material behavior = 1012
• Other tests = 1012
• Hooke's law = 1013
• Soft tissues = 1014
• Material symmetry = 1014
• Boundary conditions = 1014
• Conclusion = 1015
• Unfinished business = 1016
• 28 A Finite Element Model of Radial Keratotomy Surgery / Raymond P. Vito ; Jung-woog shin = 1017
• Description of the finite element model = 1018
• Software = 1018
• Brick elements = 1018
• Material properties of the cornea = 1019
• Boundary conditions at the limbus = 1020
• Loading of ghe cornea = 1021
• Radial incisions = 1021
• Calculations of anterior corneal curvature = 1021
• Baseline model = 1022
• Application and interpretation of the model = 1023
• Effect of variables on conrneal curvature = 1023
• Effect of Young's elasic modulus = 1023
• Effect of intraocular pressure = 1024
• Effect of corneal thickness = 1025
• Effect of incision depth = 1025
• Effect of the clear zone diameter = 1025
• Effect of number of incisions = 1026
• Effect of errors in incision length, depth, and offset = 1026
• Effect of clear zone offset = 1026
• Directions for refinement of the model = 1028
• Unfinished business = 1028
• 29 Preliminart Computer Simulation of Radial Keratotomy / Khalil D. Hanna ; Francois E. Jouve = 1031
• Computer modeling in refractive surgery = 1031
• Computer simulation of refractive surgery = 1032
• Assumptions in biomechanical models of cornea and sclera = 1032
• Assumptions about constitutive properties = 1032
• Assumptions about mechanical behavior = 1033
• Assumptions about distribution of physical properties in tissues = 1033
• Assumptions about extent of simulation and boundary conditions = 1034
• A nonlinear, finite element model of radiol keratotomy = 1034
• Numerical fintie element model of radial analysis = 1034
• Geometric definition = 1034
• Mathematical laws and definitions of coefficients = 1036
• Idealized simulated surgical technique = 1037
• Optical calculations = 0137
• Simulation of baseline conditions in low myopia = 1037
• Stress along a meridian(meridional stress, σ_1) = 1038
• Stress perpendicular to surface(normal stress, σ_2) = 1038
• Stress around a circumference(circular or σ_3) = 1038
• Stress transverse to thickness(shear stresses) = 1041
• Simulation of radial incisions = 1041
• Preliminary simulation = 1041
• Change in corneal shape = 1041
• Distribution of stress after radial incisions = 1041
• Effect of number of incisions = 1046
• Effect of intraocular pressure = 1050
• Effect of length of incisions = 1050
• Effort of depth of incisions = 1050
• Effort of baseline corneal curvature = 1050
• Effect of Young's modulus = 1051
• Multilayered model = 1051
• Summary of changes in stress distribution = 1052
• Computer simulation and clinical observations = 1053
• Unfinished business = 1054
• SECTION Ⅶ Keratotomy for Astigmatism
• 30 Optics and Topogrphy of Corneal Astigmntism / George O. Waring Ⅲ ; Jack T. Holladay = 1059
• Definitions of astigmatism = 1059
• Regular astigmatism = 1059
• Irregular astigmatism = 1070
• History of astigmatism = 1073
• Causes of corneal astigmatism = 1074
• Prevalence of astigmatism = 1075
• Measurement of astigmatism = 1075
• Astigmatism measurement as a guide to surgery = 1076
• Measurement of change in astigmatism = 1077
• Correcton of astigmatism = 1079
• Unnnished business = 1084
• 31 Keratotomy for Astigmatism / Perry S. Binder ; George O. Waring Ⅲ = 1085
• Selection of patients = 1087
• Principles of astigmatic keratotomy = 1087
• Classification of astigmatic kertottomy = 1090
• Transverse of incisions perpendicular to the steep meridian = 1092
• Combined transverse and radial or semiradial incisions = 1094
• Grouped radial incisions and oval clear zone = 1098
• Circular and delimiting kertotomy = 1098
• Scleral surgery = 1098
• Comparative studies or techniques of astigmatic keratotomy = 1100
• Evaluation of astigmatic keratotomy = 1100
• The coupling effect : relationship between incised and unincised meridians = 1101
• Minus cylinder refraction = 1101
• Definition of coupling effect = 1101
• Effect of coupling ratio on astigmatic surgery = 1102
• Factors that affect the coupling ratio = 1102
• Reports of coupling ratios = 1104
• Variables that determine the effect of transverse incisions = 1105
• Configuration = 1105
• Length = 1106
• Distance of incision from center of cornea-zone diameter = 1111
• Number of transverse incisions = 1114
• Depth of transverse incision = 1116
• Variables thar after radial or semiradial incisions = 1119
• Effect of other variables on transverse keratotomy = 1121
• Clinical results of keratotomy for naturally occurring astigmatism = 1121
• Isolated transverse and radial nonintersecting incisions = 1122
• Combined transverse and radial nonintersecting incisions = 1122
• Grouped radial incisioons = 1133
• Oval clear zone = 1133
• Deep circular trephination = 1134
• Scleral surgery for astigmatism = 1134
• Astigmatism after cataract surgery = 1134
• Development of techniques to control astigmatism = 1136
• Cataract surgery as refractive surgery = 1136
• Effect of cataract wound on astigmatism = 1137
• Intraoperative keratoscopy and keratometry = 1141
• Intraoperative adjustment of cataract wound to modity astigmatlsm = 1144
• Trarlsverse keratotomy during cataract surgery = 1146
• Natural course of astigmatism after cataract surgery = 1150
• Surgical management of astigmatism after cataract surgery = 1151
• Astigmatism after penetrating keratoplasty = 1157
• Causes of astigmatism after penetrating keratoplasty = 1157
• Changes in astigmatism after removal of all sutures = 1168
• Nonkeratotomy surgery for astigmatism after penetrating keratoplasty = 1169
• Transverse relaxing keratotomy for astigmatism after penetrating keratoplasty = 1171
• Corneal toptgraphy and astigmatism after penetrating keratoplasty = 1182
• Preopeiative planning = 1185
• Astigmatism after lamellar refractive surgery = 1186
• Astigmatism after refractive keratotomy surgery = 1187
• Preoperative planning for astigmatism surgery = 1187
• Complications = 1193
• Unfinished business = 1193
• 32 Atlas of Astigmatic Keratotomy / Georgr O. Waring Ⅲ ; Perry S. Binder = 1199
• Transverse keratotomy and the steep corneal meridian = 1200
• Variables used for planning astigmatic keratotomy = 1204
• Marking transverse and radial incisions = 1213
• Making transverse and radial incisions = 1222
• Trapezoidal keratotomy = 1227
• Astigmatism after cataract surgery = 1233
• Astigmatism after penetrating keratoplasty = 1235
• Unfinished business = 1242
• 33 Biomechanics of transverse incisions of the Cornea / Theo Seiler = 1243
• General concepts = 1243
• Biomechanical computations = 1243
• Comparison of biomechanical theory and published studies = 1247
• Limitationns of the biomechanical model = 1248
• 34 Computer Simulation of Arcuate Keratotomy for Astigmatism / Khalil D. Hanna ; Francois E. Jouve ; George O. Waring Ill ; Philippe G. Ciarlet = 1249
• Stages in development of mathematic models of keratotomy = 1248
• Description of the mathematic model = 1250
• Assumptions concerning geometry and properties of the eye = 1250
• Anisotropy of the corna and sclera = 1251
• Macroscopic model of stromal lamellae = 1251
• Transversely isotropic model of cornea and sclera = 1253
• Finite element computer program = 1253
• Graphic representation of finite element model = 1256
• Simulatio of effects of arcuate transverse incisions = 1256
• Correlation of incision length and arc length = 1256
• Change in overall curvature = 1256
• Graphic representation of change in curvature = 1258
• Effect of preexisting corneal curvature and astigmatism = 1260
• Effect of depth of incision = 1260
• Effect of length of incisions = 1260
• Effect of clear zone diameter = 1263
• Number of incisions = 1264
• Effect of intraocular pressure = 1265
• Refractive change in incised vs. uninciscd meridians-coupling effect = 1267
• Meaning and applications of computer simulation = 1271
• Appendices = 1272
• Appendix A : Homogenizalition in elasticity = 1272
• Appendix B : Transverse isotropy = 1273
• Appendix C : Homogenization of a stratified material with periodic structure = 1274
• APPENDICES
• Appendix 1 Propective Evaluation of Radial Keratotomy(PERK) Study : Design and Surgical Technique = 1281
• Eligibility criteria = 1281
• Operative procedure = 1282
• Appendix 2 Statements on Radial Keratotomy = 1287
• Statment on Radial Keratotomy in 1988 by the Board of Directors of the International Society of Refractive Keratoplasty = 1288
• History of ra1 al keratotomy = 1288
• Alternative for management of myopia = 1289
• Spectacles and contact lenses = 1289
• Refractive surgery = 1289
• Keratotomy for astigmatism = 1290
• Patient motivation = 1290
• Criteria for patient selection and informed consent = 1290
• Radial keratotomy suruerv = 1291
• Training of surgeons in radial keratotomy = 1291
• Surgical techniques and factors that affect outcome = 1291
• Reoperations = 1292
• Results = 1292
• Published studies = 1292
• Predictability of results = 1292
• Complications or side effects = 1292
• Temporary sequelae = 1292
• Complications or side effects that do not reduce corrected visual acuity = 1292
• Complications that potentially reduce visual function = 1295
• Ocular surgery after radial keratotomy = 1295
• Stability of refraction after radial keratotomy = 1295
• Patient satisfaction = 1296
• Summary = 1296