Marian S. Macsai (Ed.) Ophthalmic Microsurgical Suturing Techniques

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Marian S. Macsai (Ed.)

Ophthalmic Microsurgical Suturing Techniques

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Marian S. Macsai (Ed.)

Ophthalmic

Microsurgical

Suturing Techniques

With 289 Figures, mostly in Color

123

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Marian S. Macsai, MD

Professor and Vice Chair Ophthalmology Northwestern University

Chief, Division of Ophtho

Evanston Northwestern Healthcare 2050 Pfi ngsten Rd.

Glenview, Il 60025 USA

ISBN-10 3-540-28069-3 Springer Berlin Heidelberg New York ISBN-13 978-3-540-28069-9 Springer Berlin Heidelberg New York

Library of Congress Control Number: 2006935423

Th is work is subject to copyright. All rights are reserved, whether the whole or part of the material is con- cerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, repro- duction on microfi lms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9th, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under German Copyright Law.

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Th e use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from relevant protective laws and regu- lations an therefore free general use.

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Editor: Marion Philipp, Heidelberg, Germany Desk Editor: Martina Himberger, Heidelberg, Germany

Production: LE-T_EX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany

Illustrations: Albert R. Gattung + Regine Gattung-Petith, Edingen-Neckarhausen, Germany Typesetting: Arnold & Domnick, Leipzig, Germany

Cover Design: Frido Steinen-Broo, EStudio Calamar, Spain

Printed on acid-free paper 24/3100/YL 5 4 3 2 1 0

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Dedication

For my husband, Jack,

and his never ending support and love.

For Ezra, Max and Emma, my continued sources of inspiration and joy.

For my parents who taught me

to learn, to teach and to enjoy life.

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Preface

In any surgical fi eld, the importance of suturing is self- evident. In eye surgery, due to the lack of elasticity of the tissues and the infl uence of sutures on the visual outcome, proper microsurgical suturing technique is paramount. Inappropriate or careless suture placement and knot tying can impact visual function. If wound construction and closure are not astigmatically neutral, the visual outcome will be altered and further surgical intervention may be required. Wound related complications are more severe in the eye than in the skin. Th e close proximity of tissues allows for rapid spread of in- fection and the limited blood supply inhibits treatment.

Th e same limited blood supply alters wound healing.

Th e translation of hand tying techniques, intro- duced in every medical school curriculum, to microsurgical instrument tying is not obvious. Essential dif- ferences exist in all aspects of ophthalmic microsurgical suturing techniques, from the use of the microscope itself to the instrumentation, tissue tactics, suture material and knot construction. Th e experienced surgeon shares the challenges that face surgeons in training, as they attempt to master new skills and handle more complicated cases. Th e role of wound closure and suturing techniques are basic building blocks for every ophthalmic surgical procedure. Breaking down the

complexity of microsurgical suturing to each of the numerous components required for tissue apposition that does not alter the function of the eye or impair the surgical outcome is the goal of this text.

Expert surgeons from diff erent specialties have contributed their time and knowledge to the creation of this text. Th e uniform layout with key points identifi ed at the beginning of each chapter allows the reader to quickly locate a particular technique. Th e authors have made great eff orts to describe each technique in a step- by-step fashion, so that the reader can reproduce the technique on their own. Accompanying digital video clips of surgical footage clarify and demonstrate the diff erent techniques. Mastery of basic and advanced ophthalmic microsurgical suturing techniques will fa- cilitate expansion of any surgeon’s armamentarium.

As ophthalmic surgery advances, a variety of skills are needed for the surgeon to stay current. Th is text off ers the reader ophthalmic microsurgical suturing techniques that decrease the risk of postoperative in- fection and result in astigmatically neutral wound closure. Equipped with the knowledge of alternative techniques, when complications arise, the reader can decrease the need for further surgical intervention and improve their surgical outcomes.

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Acknowledgements

A text of this diversity is not possible without the input and help of many authors. I thank each of the authors who have freely contributed their expertise on an ex- tremely tight schedule. Each was patient with the con- tinuous revisions, illustrations, and video issues. Your continued help and support made this idea a reality. I could not have assembled all this material without Peggy Dow, who kept me organized and on track. A special thanks goes to all the people at Springer who gave so much to this project, especially Marion Philipp and Martina Himberger. I thank Renee Gattung for her expert illustrations, and Patrick Waltemate at LE-TeX for his patience.

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List of Contributors

Larry Benjamin

Department of Ophthalmology Stoke Mandeville Hospital Mandeville Road

Aylesbury, Bucks HP21 8AL, UK

E-mail: [email protected]

Victoria Casas

Ocular Surface Center, P.A.

7000 SW 97th Ave., Ste. 213 Miami, FL 33173-1492, USA E-mail: [email protected]

Anne L. Coleman Jules Stein Eye Institute 100 Stein Plaza, #2118

Los Angeles, CA 90095-7065, USA E-mail: [email protected]

Steven P. Dunn

Michigan Cornea Consultants 29201 Telegraph Rd., Ste. 101 Southfi eld, MI 48034-7630, USA E-mail: [email protected]

Antonio Elizondo

Ocular Surface Center, P.A.

7000 SW 97th Ave., Ste. 213 Miami, FL 33173-1492, USA

Bruno Machado Fontes

Av. des Americas 2300 / B, cs 27 Rio de Janeiro, RJ, Brazil 22640-101 E-mail: [email protected];

brunofontes@oft almo.epm.br

Mark J. Greenwald

Department of Ophthalmology and Visual Science University of Chicago

5841 S. Maryland Avenue, M/C 2114 Chicago, IL 60637, USA

Sadeer B. Hannush

Cornea Service, Wills Eye Hospital

Jeff erson Medical College, Philadelphia, PA Correspondence:

400 Middletown Blvd. Suite 110 Langhorne, PA 19047, USA E-mail: [email protected]

Sohail J. Hasan

Ingalls Hospital Professional Bldg.

71 West 156th St., Ste. 400 Harvey, IL 60426, USA

Edward J. Holland CEI-NKY

580 South Loop Rd., Ste. 200 Edgewood, KY 41017, USA E-mail: [email protected]

Anthony Johnson

Cornea/Refractive Surgery SAUSHEC Ophthalmology 3851 Roger Brooke Drive

Fort Sam Houston, Tx 78234, USA

E-Mail: [email protected]

Gaston O. Lacayo III

Rush University Medical Center Department of Ophthalmology 1725 W. Harrison St., Ste. 928 Chicago, IL 60612, USA

Stephen S. Lane

280 N. Smith Ave., Ste. 840 St. Paul, MN 55102, USA

W. Barry Lee

Eye Consultants of Atlanta 95 Collier Rd., Ste. 3000 Atlanta, GA 30309, USA E-mail: [email protected]

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XIV

Joanna Lumba

1101 Welch Road, Suite B2 Palo Alto, CA 94304, USA E-mail: [email protected]

Marian S. Macsai

Professor and Vice Chair Ophthalmology Northwestern University

Chief, Division of Ophtho

Evanston Northwestern Healthcare 2050 Pfi ngsten Rd.

Glenview, Il 60025, USA

Parag A. Majmudar

Rush University Medical Center Department of Ophthalmology 1725 W. Harrison St., Ste. 928 Chicago, IL 60612, USA

Mark J. Mannis

Department of Ophthalmology University of California 4860 Y St., Suite 2400 Sacramento, CA 95817, USA

Kirk H. Packo

Rush University Medical Center Department of Ophthalmology 1725 W. Harrison St., Ste. 945 Chicago, IL 60612, USA E-mail: [email protected]

Jennifer Hasenyager Smith 2032 Valor Ct.

Glenview, IL 60026, USA E-mail: [email protected]

Lori Stec

Beaumont Eye Institute 3601 W. Th irteen Mile Road Royal Oak, Michigan 48073, USA

R. Doyle Stulting Emory Vision

875 Johnson Ferry Road Atlanta, GA 30342, USA E-mail: [email protected]

Julie H. Tsai

University of South Carolina School of Medicine Dept of Ophthalmology

Four Medical Park, Suite 300 Columbia, SC 29203, USA E-mail: [email protected]

Scheﬀ er C. G. Tseng Ocular Surface Center, P.A.

7000 SW 97th Ave., Ste. 213 Miami, FL 33173-1492, USA E-mail: [email protected]

Scott A. Uttley St. Paul Eye Clinic 2080 Woodwinds Dr.

Woodbury, MN 55125-2523, USA E-mail: [email protected]

Marian S. Macsai (Ed.) Ophthalmic Microsurgical Suturing Techniques

Marian S. Macsai (Ed.)

Ophthalmic

Microsurgical

Suturing Techniques

123

Dedication

For my husband, Jack,

and his never ending support and love.

For Ezra, Max and Emma, my continued sources of inspiration and joy.

For my parents who taught me

to learn, to teach and to enjoy life.

Preface

Acknowledgements

Contents

List of Contributors