ince 1985, it has been my privilege to be the Director of The - ciety of Byron Smith Fellows. During the years in which Byron SSmith was with us, his former fellows would meet at the Ame- can Academy of Ophthalmology's annual meeting. They would present to him, and to one another, interesting cases of their own compli- tions that had occurred or cases that had been sent to them that were complications to be repaired. This forum provided the fellows with an excellent format for evaluating their own problems and also for d- cussing how to treat extremely difficult cases. Shortly after Dr. Brian Brazzo completed his fellowship with me in 1998, he asked if I thought it would be appropriate for him to edit a new book on complications of ophthalmic plastic surgery. Certainly, during his fellowship, it became apparent that Dr. Brazzo was pr- ably the most gifted academician and writer that I had ever had the pleasure of training and meeting. I could think of no one more - propriate to continue the work initiated by Dr. Byron Smith and c- ried on by his students.

The sellar region and paranasal sinuses constitute the anatomical sections of the skull base in which pathological entities warrant interdisciplinary management. Processes originating in the paranasal sinuses can reach and involve the skull base in and around the sella, sometimes not respecting the natural dural boundary. On the other hand, lesions involving the sellar block, such as pituitary adenomas and meningiomas, can also extend downwards into the paranasal sinuses. The orbit and cavernous sinus may be subject to involvement and infiltration by both paranasal and sellar pathology. The advancement and new achievements of modern diagnostic procedures, such as high-resolution CT, three-dimensional reconstruc tion, MRI, and MRI angiography, as well as the detailed selective angiographic protocols and endovascular techniques, have increased the possibilities for surgical management of this type of pathology with extra- and intracranial involvement. Long-standing and intense inter disciplinary work has led to sophisticated operative approaches which for benign tumors allow total excision with preservation of structures and function, and for some malignant lesions permit an en bloc resec tion via a combined intracranial-extracranial approach. This volume reflects the work and scientific exchange which took place during the IV International Congress of the Skull Base Study Group, held in Hanover. Leading authorities in the basic sciences including anatomy joined with diagnosticians, clinicians, and surgeons from different fields to evaluate the state of the art of this topic in skull base surgery."

The history of the use of ultrasound in medicine has been one of evolution of technology and innovative methods of applying this technology to imaging body structures. Many scientists and clinicians have contributed to this evolution. Ophthalmic ultrasound has become an indispensible tool in ophthalmic practice, with its own instrumentation and techniques. Ultrasound frequencies used in ophthalmology have generally been higher than those used in general medicine because of a requirement for higher resolution and a lesser need for deep penetration. Most ophthalmic diagnostic equipment uses frequencies in the 10 MHz range. The use of ultrasound frequencies in the 50-100 MHz range is a relatively new development in ultrasound imaging of the eye. This technique has been developed in our laboratories over the past several years. We have progressed from the theoretical description of the basic science required, past the first in-vitro experiments in eye bank eyes, to the construction of an instrument capable of clinical application. We have gained broad clinical experience with this instrument in normal patients and patients with ocular disease. A commercial instrument based on our original clinical scanner has recently become available, allowing other clinicians to apply this tool to ophthalmic research and clinical practice. We have applied the term ultrasound biomicroscopy to this new imaging technique because of similarities to optical biomicroscopy, i. e. , the observation of living tissue at microscopic resolution.

Retinal and choroidal vasculatures are easily affected by various systemic diseases, and changes in the retina can easily be observed with various procedures such as direct and indirect ophthalmoscopy, scanning laser ophthalmoscopy, fluorescein fundus angiography, and indocyanin green fundus angiography. Vascular changes are the major, most prominent, and most important fundus changes. The above-mentioned procedures can reveal vascular changes clearly, but mainly reveal changes in the superficial layer of the retina. In addition, these procedures cannot show the three-dimensional architecture of the retina. Usually we can barely obtain the view of that three dimensional architecture. At the same time, pathological findings are well described, but most of them are based on histological and cytological methods. Thus, three-dimensional description of pathology is rare. Vascular corrosion cast scanning electron microscopy can provide a very useful three-dimensional view of the microvasculature and can demonstrate the fine structural architecture of the capillary network. However, the application of this method to the retinal and choroidal vasculature is very difficult, especially in small eyes. We succeeded in making good corrosion casts of retinal and choroidal vessels in the rat. Using this method during the past 10 years we have examined the retinal and choroidal vascular architecture of rats with various systemic diseases such as aging, hypertension, diabetes mellitus, and arteriosclerosis."

The hereditary retinopathy, retinitis pigmentosa (RP), which affects 1 in 3,500 people worldwide, is the most common cause of registered visual handicap among those of the working age in developed countries. RP is a highly variable disorder where patients may develop symptomatic visual loss in early childhood, while others may remain asymptomatic until mid-adulthood. Most cases of RP segregate in autosomal dominant, recessive or X-linked recessive modes, with approximately 41 genes being implicated in disease pathology to date (RetNet). The extensive genetic heterogeneity associated with autosomal dominant RP (adRP) is an undisputed hindrance to the development of genetically based therapeutics.

As a garden is to a gardener, so a book is to its author. Nurtured out of love, both are a source of pride and hope. Microbiology, immunol ogy, infectious diseases, rheumatology, and ophthalmology are the seeds of this textbook on uveitis. Over the years, these branches of medicine have been cultivated and garnered to care for patients with inflammatory diseases of the eye, a most hardy species in the family of ocular maladies. The aim of this clinical manual is to give both a serviceable frame work and practical information on ocular inflammatory disease. The first section is devoted to general principles and commonly held sup positions in the field of uveitis. A system of diagnosis, based on the differential, is also offered. Traumatic uveitis is addressed in the sec ond section. The third part examines infectious diseases that have been identified with uveitis. These are frequently curable forms of ocular inflammation caused by replicating foreign antigens. The fourth section of this textbook considers inflammatory diseases of the eye with a presumed autoimmune mechanism. A disobedient, autoreactive immune response is postulated to playa role in these forms of uveitis. Masquerade and idiopathic conditions are dis cussed in the final chapters. Etiology, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, treatment, and prognosis are provided for each disease syndrome. As with most gardens, there are many styles and delightful entrances to the field of uveitis.

Das trockene Auge ist eine der schwerwiegendsten Komplikationen von Bindehauterkrankungen verschiedenster Genese, von Stellungs anomalien, Lahmungen und Narbenbildungen an Lidern und Binde haut. Fundierte Kenntnisse hierzu erbrachten erstmals die Unter suchungsergebnisse von Sjogren aus den dreifSiger Jahren, vorwie gend aber die wissenschaftlichen Ergebnisse zahlreicher Forscher gruppen der letzten zehn Jahre. Diese zu sichten, Zusammenhange, Gemeinsamkeiten und Verlaufe der zahlreichen Schadigungen und Entziindungen des Auges, die zum Syndrom des trockenen Auges fiihren, zu erarbeiten, urn eventuell neue Impulse fiir die Diagno stik, Klinik und Therapie zu geben und urn den Augenarzt Richt Iinien zum Erkennen und Behandeln derartiger Augenerkrankungen darzuIegen, wurde der Workshop "Chronische Conjunctivitis - Trockenes Auge" durchgefiihrt, an dem Ophthalmologen, Anatomen, AllergoIogen, Elektronenmikroskopiker und Biochemiker, die auf diesem Gebiet seit Jahren gearbeitet haben, teilnahmen. Allen diesen gilt mein Dank, nicht zuIetzt der Firma Dr. Mann, Berlin, welche die Durchfiihrung des Workshops iiberhaupt erst ermoglichte. UIm, im Mai 1982 Rolf Marquardt Inhaltsverzeichnis T eilnehmerliste des Workshops . . . . . . . . . . . . . . . . . . . . . . XI . . . . . . Einleitung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pathophysiologie Rohen, J. W., Steuhl, P., Arnold, W. H.: Zur funktionellen Morphologie der Conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Liitjen-Drecoll, E., Steuhl, P., Arnold, W. H.: Morphologische Besonderheiten der Conjunctiva bulbi . . . . . . . . . . . . . . . . . 25 . . . Brewitt, H., Honegger, H.: Morphologische Befunde des Horn hautepithels bei Starung des praecornealen Filmes und nach Applikation von Augenmedikamenten. Eine raster- und transmissionselektronenmikroskopische Untersuchung . . . . . . 35 Marquardt, R.: Untersuchungen zur Tranenfilmstabilitat . . . . . 58 Janssen, P. T., van Bijsterveld, O. P.: Pathophysiology of the Tear Film: Protein Patterns in Health and Disease. . . . . . . . ."

There have been greater advances in our knowledge of the visual function and its disabilities in the past 50 years than had accumulated in all of the previous years. This applies not only to the basic science of biochemistry, physiology, physiopathology, and cytopathology but also to the diagnosis and treatment of visual dysfunction and ocular disease. These advances have been aided by a proliferation of ingenious instruments. When I began my residency in ophthalmology at The Wilmer Institute in 1938, one was supposed to learn not only the physiology of vision but also how to diagnose and treat all phases of ophthalmology including disabilities of the orbit, sclera, retina, lens, and cornea. In addition he or she was supposed to understand neuro-ophthalmology, ophthalmic genetics, and so-called uveitis. It soon became evident that no one could adequately comprehend all of these areas and, therefore, most young trainees today take a year or two of fel lowship in a specialized area following their three-to five-year residency train ing. Following this they join a group of other ophthalmologists and specialize. Thus, they become more expert in the diagnosis and treatment in a limited area in ophthalmology. When I returned to The Wilmer Institute in 1955 as Head of the Department I was the only full-time member of the staff. To date we have some 28 full-time ophthalmologists working in highly specialized areas of our institution.

When seen from an outsider's vantage point, the development of knowledge in the sensory sciences must appear massive and the result of some carefully followed master plan. In reality, it is the result of numerous relatively independent human endeavors shaped by application of the scientific method. The comprehensive construction of quantitative theories of sense organ function has occurred only recently -but at an explosive rate prefaced by centuries of expansion in the physical sciences. Predicated on this growth, the twentieth century may become known as the age of the biological sciences. With the exception of a modest number of intellectual giants, there were few contributors to the foundations of the sensory sciences before the dawn of this century. At least 90% of existing knowledge has been produced by scientists working in laboratories founded since 1920. If any single scientist and his laboratory may be identified with the growth in the sensory sciences, it is EDGAR DOUGLAS ADRIAN, First Baron of Cambridge and leader of the Physiological Laboratory at Cambridge University, England. Lord ADRIAN'S influence upon the sensory sciences was great, not only in terms of his contribution to knowledge itself but also through the influence which he exerted upon numerous young scientists who spent weeks or years at the Cambridge laboratory and who later returned to their homelands and colleagues with the seeds of vigorous research and quantitative inquiry firmly implanted.

While chopping techniques are particularly advantageous for complicated cataracts, they must be integrated with other devices and strategies. Phaco Chop, the best-selling cataract surgery book, has been revised and updated into a Second Edition to reflect the many advances over the past few years. More than half of the 30 total chapters are new. These detail strategies for complicated cases and introduce femtosecond laser nuclear fragmentation techniques. Dr. David F. Chang is widely acknowledged as one of the best cataract surgical teachers. His video instruction courses for phaco chop and complicated cataracts have consistently ranked among the best attended and top rated at the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgeons meetings for over a decade. The Four Main Sections inside the Second Edition: * Phaco Chop Techniques * Phacodynamics of Chopping * Femtosecond Laser Nuclear Pre-Chopping * Complicated Cases and Complications - Strategies and Management Section One is a detailed guide for learning phaco chop. The faculty from Dr. Chang's popular phaco chop course outlines their pearls based upon extensive experience teaching residents and transitioning surgeons. Section Two provides the general principles of instrumentation and configuring machine parameters. Separate chapters specifically address optimizing the Infiniti, Signature, and Stellaris platforms for chopping. Section Three introduces femtosecond laser nuclear pre chopping with separate chapters on the LenSx, LensAR, and Optimedica platforms. Section Four covers small pupils and IFIS, rock hard and white mature cataracts, weak zonules, and extremely long and short eyes with an emphasis on managing posterior capsule rupture, advanced IOL fixation strategies, and avoiding and managing capsulorrhexis complications. Bonus Video Material! Phaco Chop and Advanced Phaco Techniques, Second Edition includes instructional video that complements and supplements the content of the book. With your book purchase, you will receive a DVD that contains 26 surgical videos in high definition 3D format. With the enclosed 3D glasses-learning intraocular surgical techniques is taken to a new level. Additionally, you will receive access to a website that includes additional companion surgical videos narrated by Dr. Chang in 2D format-watch, listen, view repeatedly, and learn the techniques! The narrated videos produced by Dr. Chang illustrate advanced surgical techniques and technologies. Together with over 400 high-resolution operative photographs, this paired format overcomes the limitations of learning new and advanced surgical techniques from written text alone. With its comprehensive and integrated emphasis on advanced surgical techniques, optimizing phaco technology, and complication management, Phaco Chop and Advanced Phaco Techniques: Strategies for Complicated Cataracts, Second Edition will appeal to residents and transitioning surgeons as well as high volume surgeons interested in honing their most advanced phaco skills.

The HF A is a computerized perimeter with a very comprehensive set of test point patterns, strategies and custom tests. The instrument employs several solutions which have proved useful in earlier computerized perimeters and several new concepts. The construction with stimulus generation through a projection system, input through a CRT, programmes stored in PROMs and a double disc drive for storage of test results makes it simple to adapt the instrument to future needs, whether these are new test algorithms or point patterns, different input or display screens or new statistical analysis programmes. All these changes could be made without modification of actual instrument hardware. REFERENCES 1. Dannheim, F. and Drance, S.M. Psycho visual disturbances in glaucoma. A study of temporal and spatial summation. Arch. Ophthalmol. 91: 463 -468 (1974). 2. Fankhauser, F. and Hiiberlin, H. Dynamic range and stray light. An estimate of the falsifying effect of stray light in perimetry. Documenta Ophthalmol. 50: 143-167 (1980). 3. Fankhauser, F., Hiiberlin, H. and Jenni, A. Octopus programs SAPRO and F. Two new principles for the analyses of the visual field. Graefes Arch. Klin. exp Ophthal- mo1216: 155-165 (1981). 4. Gramer, E. and Krieglstein, G.K. Zur Spezifitiit der iiberschwelligen Computer- perimetrie. Klin. Mbl. Augenheilk. 181; 373-375 (1982). 5. Gramer, E., Kontic, D. and Krieglstein, G.K. Die computerperimetrische Dar- stellung glaukomatoser Gesichtsfelddefekte in Abhangigkeit von der Stimulus- grosse. Ophthalmologica 183: 162-167 (1981).

It is with great pleasure that I write this Foreword to the Proceedings of the International Conference on Behcet's Disease which was held in Berlin in June 2002. This was the first International Conference held under the auspices of the International Society for Behcet's Disease which was founded in 2000 in Seoul. First, I congratulate our colleagues in Berlin, led by Professor Christos Zouboulis of the Department of Dermatology at the Free University of Berlin, for having organised a most successful conference and for having compiled these proceedings so rapidly. It will be realised immediately on scanning the contents of this book that the conference was truly international with 210 participants from 26 countries, as Professor Zouboulis has noted in his preface. These included basic scientists, epidemiologists, pathologists, clinicians and, importantly, representatives from patient organisations. The latter held their own conference alongside the scientific-medical conference to mutual benefit. The combined session of patients and doctors (abstracts on pp 601 - 626) gave the opportunity for an exchange of information and fruitful discussion. The wide ranging scope of the communications is evident from the index and it was most encouraging to see their origin - from all parts of the world, from senior and junior colleagues and, from many different disciplines. Many communications may be regarded as preliminary reports of research in progress and we look forward to seeing the definitive publications in appropriate journals in due course."

Cataract Surgery in Complicated Cases offers the latest techniques in treating complicated cases as faced by today's surgeons performing cataract surgery. Dr. Lucio Buratto; Dr. Stephen Brint; and Dr. Luigi Caretti provide step-by-step approach to facilitate how to assess the patient, perform the technique, and manager the most challenging cataract surgery complicated cases facing both beginning and experienced surgeons. Cataract Surgery in Complicated Cases covers a wide variety of topics including cataract in high myopia, floppy iris syndrome, traumatic cataract, phacoemulsification with a small pupil, and IOL explanation and replacement. Supplemented by more than 250 colour illustrations, diagrams, a glossary, and references, all surgeons, from beginner to expert will want this unique resource by their side.

With Surface Ablation: Techniques for Optimum Results, refractive surgeons will learn efficient pre- and post-op routines that optimize chair time and lead to improved safety and excellent results for patients. Inside Surface Ablation: Techniques for Optimum Results by Dr. Ellen Anderson Penno is joined by 9 contributors who offer a practical approach with clinically useful tips including patient counseling and post-operative care that will improve patient satisfaction. This up-to-date book is an excellent resource for patient assessment of candidacy for refractive surgery or in post- operative co-management. In addition to chapters with information on patient selection, surgical techniques, post-op care, and prevention and management of complications, Surface Ablation: Techniques for Optimum Results includes several articles, contributed by leaders in the refractive surgery field, covering a variety of topics including surface ablation in keratoconus patients, corneal cross-linking, and ectasia. Surface Ablation: Techniques for Optimum Results is a clinically- oriented resource for residents and new refractive surgeons as well as the many seasoned refractive surgeons, general ophthalmologists following the increasing trend of transitioning away from LASIK towards surface ablation for many of their patients.

Evoked potentials are potentials that are derived from the peripheral or central nervous system. They are time locked with an external stimulus and can be influenced by subjective intentions. Evoked potentials have become increasingly popular for clinical diagnosis over the last few years. Evoked potentials from the visual system are used by ophthalmologists in order to localize the abnormalities in the visual pathway. The otologists are mainly involved in brainstem auditory evoked potentials, while the pediatricians, neonatologists, neurologists and clinical neurophysiologists make use of multimodal stimulation. The psychiatrists and psychologists, generally, examine the slow potentials such as P300 and CNV. Anesthesiologists use short latency somatosensory and visual evoked potentials in order to monitor the effectiveness of the anesthesia. Pharmaco evoked potentials are very promising measures for the quan tification of the effectiveness of drug action on the cerebral cortex. Urologists are more and more involved in pudendal somatosensory evoked potentials and in the intensive care unit evoked potentials are used in order to monitor the functional state of the central nervous system of the patient. This overwhelming number of examinations and exam ina tors clearly demonstrates the need for guidelines and standardization of the methods used. The evoked potential metholody is restricted by the relative poor signal to noise ratio. In many diseases this signal to noise ratio decrease rapidly during the progression of the illness. Optimal technical equipment and methodology are therefore essential."

Retinopathy of Prematurity presents a review of the current knowledge of this disease, which tragically renders many premature infants blind. First, the volume covers the natural history, classification and histopathology of ROP, followed by examination techniques, recommendations for follow-up and therapy and finally a panel discussion providing answers to frequent questions and areas of legal concern.

Progress in vitreo-retinal surgery is mercurial. Since this series is dedicated to new developments the reader is presented with a motley list of topics. The advancements described here may represent generally accepted progress in the field: New instruments, Macular hole surgery, Tumor biopsy. New ideas are set out to be tested for their benefit, for example: AMD surgery, Adjunctive pharmacotherapy. Reflections on incessant clinical problems in vitreo-retina surgery require superior scrutinization of established surgical techniques and indications: Posterior slippage, Inferior breaks, Subclinical retinal detachments. The editors will expand this list in future editions with topics like: new support for buckling surgery, enzyme assisted vitrectomy, new tamponades and other yet unknown fields of progress.

The nature, control, and disorders of eye movements are topics which draw together scientists from many diverse fields. On October 29-30, 1976, a Symposium on Eye Movements was held at The University of Texas Health Science Center at San Antonio. The Symposium constituted the Southern Sectional Meeting of the Association for Research in Vision and Ophthalmology. The Program Coordinators, Drs. Frank Bajandas and Barbara Brooks invited an outstanding group of participants to give presentations on a variety of aspects of this subject. This volume contains all of the invited presentations delivered at that meeting. It does not include the excellent free papers, nor the enthusiastic and fruitful discussions that the participants and the audience enjoyed as well. The editorial work for this book was performed by Dr. Brooks and Dr. Bajandas with great care and efficiency. They have made special efforts together with the Publisher, Plenum Press, to bring this information to you in the shortest possible time, so as to retain the currency of its contents. This effort would not have been even considered without the tireless and always dependable assistance of Mrs. Catherine Arocha and Mrs. Louise Whelan. We are also indebted to the ~exas State Commission for the Blind for its help in defraying the expenses ever attendant at significant symposia. George W. Weinstein, M.D.

For more than 30 years, the visual cortex has been the source of new theories and ideas about how the brain processes information. The visual cortex is easily accessible through a variety of recording and imagining techniques and allows mapping of high level behavior relatively directly to neural mechanisms. Understanding the computations in the visual cortex is therefore an important step toward a general theory of computational brain theory.

This volume discusses the background and various clinical applications of radiation therapy in the treatment of non-malignant diseases. It documents the radiobiological and physical principles of treatment and the rationale underlying the use of radiotherapy for various disorders of the CNS, head and neck, eye, skin and soft tissues, bone and joints, and vascular system. In so doing, it draws attention to and elucidates the scope for application of radiotherapy beyond the treatment of malignancies. Both the risks and the benefits of such treatment are fully considered, the former ranging from minor clinical problems to life-threatening diseases.

Aimed at students taking a course on visual perception, this textbook considers what it means for a man, a monkey and a computer to perceive the world. After an introduction and a discussion of methods, the book deals with how the environment produces a physical effect, how the resulting "image" is processed by the brain or by computer algorithms in order to produce a perception of "something out there." It also discusses color, form, motion, distance, and also the sensing of three dimensionality, before dealing with visual perception and its role in awareness and consciousness. The book concludes with discussions of perceptual development, blindness, and visual disorders. Visual perception is by its very nature an interdisciplinary subject that requires a basic understanding of a range of topics from diverse fields, and this is a very readable guide to all students whether they come from a neuroscience, psychology, cognitive science, robotics, or philosophy background.

Simplified Facial Rejuvenation is divided into sections that include anatomy and anesthesia, classifications, dermatologic procedures, suture lifts, surgical variations of the face, surgical variations of the eyes, brow, neck, lips, nose ear, and scalp, and medical legal aspects. The book presents multiple variations of suture lift procedures to allow the physician to decide which is best. Unique surgical procedures of the face are presented, many of which are techniques of minimal incision facelift. The book brings together the more popular procedures for patients that include simpler methods of facial rejuvenation with less pain, shorter recovery time, lower cost, and fewer complications.

A comprehensive survey on the use of bedside skills and perimetric devices to the test visual fields, and how to interpret the results. To develop the clinician's interpretative skills, the authors include a chapter on visual anatomy and an atlas of 100 real-life cases arranged in anatomic order from retina to striate cortex. By placing a brief clinical vignette with a visual field on one side of the page and a description of the field and its causal lesion on the opposite side, the reader will be able to learn interpretation in a simulated clinical setting. An additional quiz section of twenty randomly arranged visual fields provides readers with an opportunity to test their newly acquired skills.

This is a practical guide to using lasers in the Eye clinic and includes all commonly performed Lasers for a range of ocular conditions. It uses multiple illustrations of real-life fundus photographs, FFA images, OCT images and digitally modified retinal images to simplify learning the fundamentals of laser physics and physiology, laser safety and an overview of the variety of ophthalmic lasers in current use. It standardizes Laser procedures and serves as a reference guide for Ophthalmic trainees learning the technique that can be transferred to their clinical practice. The book simplifies understanding of Ophthalmic Lasers and answers common questions of how and why things are done. Key Features * Emphasizes on Nd-YAG Laser, Lasers in Glaucoma and Photothermal Lasers for Retinal Pathology, with clarity on techniques and pearls on dealing with common laser related issues that come with experience. * Provides content in a Q&A format which is ideal as a lesson from trainer to trainee and answers all the doubts and laser related questions a trainee may have and aids their learning and progression to performing Lasers safely and independently. * Uses digitally modified images with bullet points and reference text boxes, making the content user friendly and easy to understand.

1. Features recent developments like 3-D surgery, telescopic IOL, bionic implants and robotic surgery. 2. Highlights case selection and important precautions to be taken by vitreoretinal surgeons and senior residents. 3. Covers the controversies surrounding primary VR versus RD surgery in Phakic, fresh retinal detachments; Positioning after macular hole/ VR surgery; and to peel or not peel ILM in non-macular hole retinal surgery.