BOOK REVIEW

[caption id='attachment_2773' align='alignright' width='195' caption='Oculoplasty: Innovative Simple Techniques

Author: Hemant Mehta'][/caption]

In a few months' time, I will begin the oculoplastics and orbital disease rotation within my ophthalmology residency, so it was with great interest that I read Dr Hemant Mehta's Oculoplasty: Innovative Simpler Techniques. This practical surgical guide is richly illustrated with pre-, peri- and postoperative photographs, surgical diagrams, and detailed anatomical sketches. A surgical technique DVD is included in order to deepen both the reader's knowledge and his or her confidence in the operating room.

Dr Mehta, who has 32 years of experience as an ophthalmic surgeon in Wales, begins his text with fundamental techniques and summation of what he terms the 5 basic & fundamental procedures of oculoplasty:

1. Excision of lesions; 
2.  Skin grafting & skin flaps; 
3. Multi-layer suturing; 
4.  Exploiting the tarso-conjunctival flap; 
5. Spontaneous repair. 

This list gives the young surgeon the comforting feeling that developing an overview of this complex sub-specialty is possible without having to practise for 32 years.
The text continues in Chapter 2 with a discussion of ‘minor' common procedures, such as entropion and ectropion correction, trichiasis treatment, and blepharoplasty. These are the techniques of most use to the general ophthalmologist, particularly those who are interested in treating these conditions themselves rather than referring them to oculoplastic sub-specialists.

With the trend towards increased sub-specialisation in ophthalmology, there is a growing tendency to refer all surgical procedures to the sub-specialists. However, many common procedures, such as blepharoplasty, can be competently performed by non-specialists. Particularly useful are the descriptions of local and regional anaesthetic techniques, a crucial topic that is frequently overlooked in surgical manuals.

What is missing from the text, however, is any mention of Mohs' surgery. Considering the very small and highly complex periocular cutaneous anatomy, a statement like, 'For malignant or suspected malignant lesions, an excision with at least 5mm clinical clearance is implemented,' seems outdated. Mohs' surgery is maybe at its most useful in this field, and this technique should at least be referred to, even if not covered in this book.

Despite that, the book reads smoothly and is peppered with fun little anecdotes. Dr Mehta relates how a would-be American president, Abraham Lincoln, performed temporary tarsorrhaphy on pigs to make them easier to control back in 1831. Each chapter begins with the sort of insight that only a senior and experienced physician would have. For example, Chapter 9 begins: 'The serious and at times tragic consequences that follow inexpertly repaired wounds…occur too frequently to be ignored.' He makes the case that these wounds should not be quickly treated in the emergency room, but should instead be planned for treatment under optimal operating conditions up to 48 hours later.

Another type of statement frequently seen in this text is one that repudiates what might have previously been common wisdom. For example: 'One further ritual that needs to be abandoned is the Frost suture (which is) quite unnecessary.' Indeed, Dr Mehta seems to be in essence a minimalist, whose self-described modus operandi is 'Perfection is achieved not when there is nothing more to add, but when there is nothing more to take away.' This occasionally gives the text a pleasantly philosophical tone.

But besides the beginners' introduction and the colourful stories, Dr Mehta discusses serious oculoplastic topics such as severe eyelid injuries and blowout fractures. This book can be recommended to ophthalmology residents looking to brush up on their knowledge, fellows in oculoplasty seeking new insights, general ophthalmologists, and even oculoplastic specialists looking to read the advice of an experienced fellow surgeon.