Surgical Techniques in Ophthalmology Pediatric Ophthalmic Surgery

Dr M Edward Wilson states in the forward to this book: “Children are not small adults.†He understands that paediatric ocular surgeons operate in an entirely different domain than general ophthalmologists. After all, Dr Wilson notes, the “postoperative period may last a half century or longer.†These are sobering words for those who might consider themselves unprepared, but they are also encouraging for those surgeons looking for another excellent reason to spend some more time reading up on the latest developments in the field of paediatric ophthalmic surgery.

Drs Ashok Garg and Jorge Alió have brought together a large group of sub-specialists to write “Paediatric Ophthalmic Surgery†for the Surgical Techniques in Ophthalmology series published by Jaypee Brothers Medical Publishers.

This book is a detailed surgical instruction manual and atlas that covers everything from standard procedures like strabismus correction and cataract surgery to more complex glaucoma surgery, laser-assisted lacrimal bypass surgery, and paediatric keratoplasty.

Although children are not simply miniature versions of adults, the techniques employed in the treatment of their ocular pathology increasingly borrow from those developed for adults. Indeed, removable piggyback IOLs, toric bag-in-the-lens implantation, multifocal IOLs, and paediatric refractive surgery are all discussed.

The atlas is divided into two sections: the first 500 pages are devoted to the anterior segment, including strabismus surgery, orbital and eyelid procedures; the last 100 pages cover the surgical treatment of posterior segment disease such as paediatric retinal detachment and retinal tumors. Very little space is “wasted†on the theoretical background, on the assumption that readers who are interested in the details of surgical technique already have a solid understanding of the etiology, pathophysiology and natural history of the disease they are seeking to treat. However, a discussion of the potential complications and their management follows each outline of surgical technique. This is very welcome, as we are all interested in reading not only how the experts’ surgical precision allows them to avoid problems, but also how they solve the problems that inevitably arise from time to time, even in their hands.

A fun addition is the inclusion of “tips†chapters, which provide the sort of surgical pearls that a mentor might suggest while assisting a fellow in the operating room. These are very specific and practical, aiming not to teach a surgical method but to help aim for an easier, less traumatic surgery.

In Chapter 13, “Tips and Pearls for Achieving Good Optical Results when Managing Cataract in a Child,†details are covered that everyone wants to know but might have been afraid to ask. Which contact lenses are best for aphakic children, and why? What are other surgeons using? What are the precise indications for use of an IOL? And the contra-indications?

What might have been interesting to include in this volume is information on the preoperative preparation of the paediatric patient, as well as the ins and outs of paediatric anaesthesia. After all, general anaesthesia is required for nearly all paediatric ophthalmic procedures, and although surgeons will usually not be administering the anaesthesia, they are well served by having some insight into how it works and what to discuss with the anaesthesiologist and anaesthetic nurse before, during and after surgery.

This book is ideal for paediatric ophthalmology fellows, who have, in one single volume, detailed instruction for each operation they might be asked to perform. Ophthalmology residents might also want to read specific chapters to prepare for upcoming time in the operating room. Operations are far more interesting to watch when you know the indications and have memorised the steps ahead of time. Paediatric ophthalmologists might be interested in learning the variations in technique – “How do others do it?†– of the operations they perform. And, of course, general ophthalmologists are likely to benefit from keeping abreast of recent developments in this rapidly evolving surgical sub-specialty.