Pediatric Retina: Medical and Surgical Approaches
http://www.100md.com
《新英格兰医药杂志》
"Invisible by design, vitreous was long unseen as an important participant in the physiology and pathology of the eye." Thus begins an early chapter in this exhaustive and often eloquent textbook on pediatric retinal development, disease, and surgery. Devoting an entire chapter to an invisible structure, and making it imaginable and vital, is just one of the accomplishments of this essential book.
Section through the Retina Showing Rods and Cones in the Photoreceptor Layer of an Adult.
Chris Guerin/Wellcome Photo Library.
Why ophthalmologists are superspecialized becomes apparent in a book such as Pediatric Retina. The eye is a world, and each structure in it is distinct. The transparent, avascular cornea and lens focus images onto the tissue-paper-thin yet multilayered retina through the vitreous, a clear gel that gradually liquefies with age. Then there are the extraocular muscles, eyelids, orbits, and finally, the optic nerve, which connects the eye to the visual cortex in the brain. Each structure has its own genetics, metabolism, and surgical idiosyncrasies, which can be fully understood only by single-minded study and practice.
Is a textbook on the pediatric retina necessary? The answer is yes. To adapt a mantra from general pediatrics, infant eyes are not simply small adult eyes. This book conveys that idea beautifully, from the chapters on embryology, with the accompanying clinical correlations with disordered development, to the final section on visual rehabilitation by the internationally respected pediatric specialist in low vision Lea Hyv?rinen. Although in children two years of age the eye is 95 percent of adult size, important differences in the vitreous make some adult surgical techniques difficult and others impossible in such children. Many retinal surgeons avoid children's eyes; others dive into such work. This book is by and for the latter group and for their colleagues in related fields.
Far more than a surgical textbook, this book includes chapters by noted experts on such topics as genetic counseling, anesthesia in children, tumors, uveitis, and posterior pole imaging. There are important chapters on the clinical assessment and management of retinal diseases requiring surgery in infants and children. Many of these chapters are coauthored by two of the editors, Michael Trese and Antonio Capone, Jr., both of whom are pioneers in pediatric retinal surgery and have singular insights into special techniques for young eyes. The descriptions and images of surgical approaches will be invaluable to anyone who performs pediatric retinal surgery. Specialized instruments are pictured, with vendors listed, and excellent drawings depict the ocular entry sites for and uses of these instruments.
Retinopathy of prematurity is a leading cause of blindness among children in the United States. An authoritative chapter discusses the major clinical trials, which are summarized in a table, and how each has advanced our understanding of the disease. Another chapter describes how retinopathy of prematurity progresses to blind an eye and the complex treatments that can be tried to halt or reverse blindness. This chapter should be required reading for anyone taking on the mission of fighting this devastating disease.
Despite advances, many retinal disorders are still blinding. Hope — a necessity for physicians, parents, and patients — features prominently in the chapters on gene therapy, retinal transplantation, and visual prostheses (also called "retinal microchips"). Subretinal, epiretinal, optic-nerve, and cortical implants can electrically stimulate the remaining components of damaged visual pathways to create artificial vision. Clinical trials are under way, and "vision" has been demonstrated. Gene therapy to replace defective genes or gene products has already shown some success in dogs with a form of congenital retinitis pigmentosa. An innovative table in the book lists pediatric retinal disorders that might be amenable to gene therapy, as well as potential strategies.
The book ends with a bonus: the Appendixes. The first one contains a list of genes that cause retinal diseases, and this is followed by eight others dedicated to several retinal disorders that are illustrated in beautiful color photographs. Ophthalmology is a supremely visual field, in that it requires the physician's direct sight, rather than hearing or touch, for diagnosis and treatment, including surgery. Arguably, retina is its most visual subspecialty. The editors conclude the book with a worthy tribute to their field, which will be of great value to medical students, residents, and practicing ophthalmologists.
Among retinal specialists and pediatric ophthalmologists, this book is likely to become a classic. It will be most appreciated, however, by those few daring souls who combine these two fields to pursue this highly specialized, risky, and rewarding subsubspecialty, pediatric retina.
Arlene Drack, M.D.
University of Colorado Health Sciences Center
Denver, CO 80045(Edited by Mary Elizabeth )
Section through the Retina Showing Rods and Cones in the Photoreceptor Layer of an Adult.
Chris Guerin/Wellcome Photo Library.
Why ophthalmologists are superspecialized becomes apparent in a book such as Pediatric Retina. The eye is a world, and each structure in it is distinct. The transparent, avascular cornea and lens focus images onto the tissue-paper-thin yet multilayered retina through the vitreous, a clear gel that gradually liquefies with age. Then there are the extraocular muscles, eyelids, orbits, and finally, the optic nerve, which connects the eye to the visual cortex in the brain. Each structure has its own genetics, metabolism, and surgical idiosyncrasies, which can be fully understood only by single-minded study and practice.
Is a textbook on the pediatric retina necessary? The answer is yes. To adapt a mantra from general pediatrics, infant eyes are not simply small adult eyes. This book conveys that idea beautifully, from the chapters on embryology, with the accompanying clinical correlations with disordered development, to the final section on visual rehabilitation by the internationally respected pediatric specialist in low vision Lea Hyv?rinen. Although in children two years of age the eye is 95 percent of adult size, important differences in the vitreous make some adult surgical techniques difficult and others impossible in such children. Many retinal surgeons avoid children's eyes; others dive into such work. This book is by and for the latter group and for their colleagues in related fields.
Far more than a surgical textbook, this book includes chapters by noted experts on such topics as genetic counseling, anesthesia in children, tumors, uveitis, and posterior pole imaging. There are important chapters on the clinical assessment and management of retinal diseases requiring surgery in infants and children. Many of these chapters are coauthored by two of the editors, Michael Trese and Antonio Capone, Jr., both of whom are pioneers in pediatric retinal surgery and have singular insights into special techniques for young eyes. The descriptions and images of surgical approaches will be invaluable to anyone who performs pediatric retinal surgery. Specialized instruments are pictured, with vendors listed, and excellent drawings depict the ocular entry sites for and uses of these instruments.
Retinopathy of prematurity is a leading cause of blindness among children in the United States. An authoritative chapter discusses the major clinical trials, which are summarized in a table, and how each has advanced our understanding of the disease. Another chapter describes how retinopathy of prematurity progresses to blind an eye and the complex treatments that can be tried to halt or reverse blindness. This chapter should be required reading for anyone taking on the mission of fighting this devastating disease.
Despite advances, many retinal disorders are still blinding. Hope — a necessity for physicians, parents, and patients — features prominently in the chapters on gene therapy, retinal transplantation, and visual prostheses (also called "retinal microchips"). Subretinal, epiretinal, optic-nerve, and cortical implants can electrically stimulate the remaining components of damaged visual pathways to create artificial vision. Clinical trials are under way, and "vision" has been demonstrated. Gene therapy to replace defective genes or gene products has already shown some success in dogs with a form of congenital retinitis pigmentosa. An innovative table in the book lists pediatric retinal disorders that might be amenable to gene therapy, as well as potential strategies.
The book ends with a bonus: the Appendixes. The first one contains a list of genes that cause retinal diseases, and this is followed by eight others dedicated to several retinal disorders that are illustrated in beautiful color photographs. Ophthalmology is a supremely visual field, in that it requires the physician's direct sight, rather than hearing or touch, for diagnosis and treatment, including surgery. Arguably, retina is its most visual subspecialty. The editors conclude the book with a worthy tribute to their field, which will be of great value to medical students, residents, and practicing ophthalmologists.
Among retinal specialists and pediatric ophthalmologists, this book is likely to become a classic. It will be most appreciated, however, by those few daring souls who combine these two fields to pursue this highly specialized, risky, and rewarding subsubspecialty, pediatric retina.
Arlene Drack, M.D.
University of Colorado Health Sciences Center
Denver, CO 80045(Edited by Mary Elizabeth )