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Lasers in ophthalmology

Basic, Diagnostics and Surgical Aspects

edited by: F. Fankhauser & S. Kwasniewska

Price: € 110.00 / US $ 137.50

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Publication details: Book. 2003. vii and 452 pages. Publication date: 2003-06-30. 392 figures, of which 165 in full color, and 36 tables. Hardbound. A4 (8.3x11.7 in).

ISBN: 978-90-6299-189-1 (ISBN 10: 90-6299-189-0; Kugler Publications)

Also available as ebook



It is impossible to imagine ophthalmology today without lasers, so ubiquitously and thoroughly do they dominate the field. Just 25 years ago, virtually all of what we rely upon today was in its infancy. Not only were lasers new on the scene, but also computers, intraocular lenses, and microsurgical instrumentation. Intracapsular cataract extraction was the standard, and ocular imaging devices, gene therapy, and stem cells had not yet even been conceptualized.

A rapid explosion of argon laser techniques occurred in the late 1970s and early 1980s, and during this time, laser iridotomy, peripheral iridoplasty, and trabeculoplasty brought revolutionary changes to the approach of both angle-closure and open-angle glaucoma, while panretinal photocoagulation did the same for diabetic retinopathy. Neodymium:YAG laser capsulotomy and iridotomy were developed in the early 1980s. In the 1990s, another explosion occurred in the treatment of posterior segment disorders, including macular degeneration and intraocular tumors. The development of lasers for plastic surgery, cataract extraction, and ocular imaging is progressing rapidly and is expected to find much greater use and usefulness in the coming years.

Professors Fankhauser and Kwasniewska have brought together many leading experts from different subspecialties in ophthalmology and laser physics to provide a comprehensive overview of the status of the broad range of laser applications at the present time. Professor Fankhauser has investigated the uses of laser in ophthalmology for over 30 years. Professor Kwasniewska joined him as a collaborator in the 1980s.

After a brief history of laser applications, the first section of this book deals with the fundamentals of laser optics and principles of various imaging devices. The theory and clinical applications of lasers in corneal surgery, glaucoma, tumors, and vitreoretinal disease receive extensive coverage. Newer uses of the laser for cataract surgery, strabismus, plastic surgery, and lacrimal surgery are discussed in the final chapters.

Ten years ago, the fundamentals of many of the chapters in this book had not yet been formulated. It will be interesting to see where we will stand ten years hence.

Robert Ritch, MD

Table of Contents

Table of Contents

R. Ritch

F. Fankhauser and S. Kwasniewska

Ophthalmic Laser Safety
D.H. Sliney

The Purposes of Surgery
G.L. Spaeth

Contact Lenses for Ophthalmic Laser Treatment
E. Stefánsson and F. Fankhauser

Fundamentals of Optical Fibers
M.J. Poulain

On the Application of Optical Fibers in Ophthalmology
P.F. Niederer

Laser Speckle
T. Halldórsson

Laser Doppler Techniques in Ophthalmology. Principles and Applications
Ch.E. Riva and B.L. Petrig

Principles of Optical Coherence Tomography
C.K. Hitzenberger

From Physical Energy to Biological Effect: How Retinal Laser Treatment Affects Diabetic Retinopathy
E. Stefánsson

High-Resolution Multiphon Imaging and Nanosurgery of the Cornea Using Femtosecond Laser Pulses
K. König

Selective Absorption by Melanin Granules and Selective Cell Targeting
C.P. Lin

Mechanisms of Short-Pulsed Plasma-Mediated Laser Ablation and Disruption
A. Vogel

The First Clinical Application of the Laser
C.J. Koester and C.J. Campbell

Selective Retinal Pigment Epithelium Laser Treatment
J. Roider, R. Brinkmann and R. Birngruber

Confocal Microscopy of the Eye
C.J. Koester

Imaging in Ophthalmology
J.S. Schuman, Z.Y. Williams, J.G. Fujimoto and L.A. Paunescu

Different Methods of Refractive Surgery. The Advantages and Risks, and Their Relationship to Professional Ethics and Morals
B.M. Tengroth

Corneal Laser Surgery for Refractive Corrections
M. Mrochen, M. Bueeler and T. Seiler

Selective Laser Trabeculoplasty
M.A. Latina and D.H. Gosiengfiao

Photocoagulation, Transpupillary Thermotherapy and Photodynamic Therapy for Choroidal Neovascularization
R.S.B. Newsom, A.H. Rogers and E. Reichel

Photodynamic Therapy: Basic Principles and Mechanisms
H. Van den Bergh and J.-P. Ballini

The Concept and Experimental Validation of Photodynamic Therapy in Neovascular Structures in the Eye
R. Birngruber

Photodynamic Therapy: Clinical Status
U. Schmidt-Erfurth and S. Michels

Controversial Aspects of Photodynamic Therapy
K. Mori, D.M. Moshfeghi, G.A. Peyman and S. Yoneya

Lasers in Diabetes
R.A. Stolz and A.J. Brucker

Retinal Photocoagulation with Diode Lasers
R. Brancato, P.G. Gobbi, R. Lattanzio

Central Serous Chorioretinopathy
A.P. Ciardella, S.J. Huang, D.L.L. Costa, I.M. Donsoff and L.A. Yannuzzi

Scanning Laser Polarimetry of the Retinal Nerve Fiber Layer in the Detection and Monitoring of Glaucoma
C. Bowd, L.M. Zangwill and R.N. Weinreb

The Glaucomatous Optic Nerve Staging System with Confocal Tomography
R. Sampaolesi and J.R. Sampaolesi

Principles of Photodisruption
J.M. Krauss

Ultrastructual Effects of Laser Irradiation at the Anterior Chamber Angle
E. Van der Zypen

Erbium:YAG Laser Trabecular Ablation
T.S. Dietlein and G.K. Krieglstein

Laser Cyclodestructive Procedures of the Ciliary Body
G.P. Schwartz, L.W. Schwartz and G.L. Spaeth

Laser Uveoscleroplasty: Basic Mechanisms and Clinical Experience
S. Okisaka, K. Miyazaki, K. Morimoto, A. Mizukawa and Y. Sai

Transpupillary Laser Phototherapy for Retinal and Choroidal Tumors. A Rational Approach
P. Rol(†)

Lasers in Intraocular Tumors
G. Anastassiou and N. Bornfeld

Erbium:YAG Laser Vitrectomy
M. Mrochen and T. Seiler

Lasers in Small-Incision Cataract Surgery
J.M. Dodick and I.A. Pahlavi

Some Applications of the Neodymium:YAG Laser Operating in the Thermal and Photodisruptive Modes. Vitreolysis
S. Kwasniewska

The Neodymium:YAG Laser in Strabismus and Plastic Surgery of the Face. Wound Repair
F. Fankhauser

Hemostasis, Hemodynamics, Photodynamic Therapy, Transpupillary Thermotherapy: Controversial Aspects
F. Fankhauser and S. Kwasniewska

Lasers in Lacrimal Surgery
K. Müllner, T. Hofmann, G. Lackner and G. Wolf 




  • Arch Ophthalmol vol 122: 1094-1095

George L Spaeth, MD & Louis J. Esposito
Correspondence: Dr Spaeth, Glaucoma Service, Wills Eye Hospital, 894
Walnut St, Philadelphia, PA 19107.

This text is a feast for the eyes and the mind. The senior editor, Franz Fankhauser, has been personally involved with a great deal of both the theory and the practice of what is covered in Lasers in Ophthalmology Basic, Diagnostic and Surgical Aspects: A Review. Professor Fankhauser and his latest publication are in, many ways metaphors for each other, they are both theoretically brilliant and clinically relevant.

The authors' approach to their subjects is comprehensive and authoritative. Subjects range from philosophical consideration of the purposes of surgery through the physics of laser imaging, the biophysics of laser effects, and clinical applications-both well established and more experimental-in a wide variety of conditions. Most of the 42 chapters are written by the individuals who have been the pioneers, the investigators, and the practitioners most involved in the field.

The first chapter, by David Sliney, PhD, of the US Army, Aberdeen Proving Ground, Md, deals with safety considerations, followed by a chapter by Einar Stefánsson, MD, PhD; Marcel Poulain, MD; and Peter Niederer, PhD, on the physics of laser energy. The chapters by Thorsteinn Halldórsson, PhD; Charles Riva, DSc; and Benno Petrig, PhD; Christoph Hitzenberger, MD, PhD; Charles Koester, PhD; and Joel Schulman, MD; Zinnaria Williams, MD; James Fujimoto, PhD; and Lelia Paunescu, PhD, provide a comprehensive and highly graphic discussion of laser imaging, including laser speckle, laser Doppler, optical coherence tomography, and confocal biomicroscopy. Scanning laser polarimetry is well covered by Christopher Bowd, PhD; Linda Zangwill, PhD; and Robert Weinreb, MD, from San Diego, Calif, and confocal tomography using the Heidelberg Retina Tomograph by Roberto Sampaolesi, MD, and Juan Roberto Sampaolesi, MD, a father and son from Buenos Aires, Argentina. Additionally, Karsten Konig, PhD, from Jena, Germany, has a fascinating chapter on high-resolution multiphon imaging and nanosurgery of the cornea using femtosecond laser pulses

Discussions by Charles Lin, PhD, of Massachusetts General Hospital, Boston; Alfred Vogel, PhD, from Lubeck, Germany; and Johann Roider, MD; Ralf Brinkmann, MS; and Reginald Birngruber, MD, PhD, from Kiel, Germany, provide the biological basis for treatment of the trabecular meshwork and retinal pigment epithelium, leading into the clinical aspects of the text, introduced by a short comment by Charles Koester, PhD, and Charles Campbell on the first clinical application of lasers in 1962. Mark Latina, MD, and David Gosiengfiao, MD, provide clinical information regarding selective laser trabeculoplasty. Bjorn Tengroth, MD, from Stockholm, Sweden, and Michael Mrochen, PhD; Michael Bueeler, MSE; and Theo Seiler, MD, PhD, from Zurich, Switzerland, explore different methods of refractive surgery; advantages, risks, and ethical considerations; and photorefractive correction.

Coverage of laser treatment of retinal conditions and neovascularization is extensive, including basic material by Reginald Birngruber, MD. PhD, ("The concept and experimental validation of photodynamic therapy in neovascular structures in the eye") and an interesting chapter by Hubert Van den Bergh, PhD, and Jean-Pierre Ballini from Lausanne, Switzerland, on the basic principles and mechanisms of photodynamic therapy. The clinical usefulness of laser treatment in diseases of the retina is discussed in detail by Richard Newsom, MD; Adam Rogers, MD; and Elias Reichel, MD, from Tufts, Medford, Mass. and photodynamic therapy is covered in derail by Ursula Schmidt-Erfurth, MD, and Stephan Michels from Lubeck and Keisuke Mori, MD; Darius Moshfeghi, MD; Gholam Peyman, MD; and Shin Yoneya, MD, from Tulane, New Orleans, La. Antonio Ciardella, MD; Sheau Huang, MD; Danielle Costa, MD; Irene Donsoff, MD; and Lawrence Yanuzzi, MD, from New York, NY, have an excellent chapter on the diagnosis and management of central serous chorioretinopathy, with marvelous, extensive, and remarkably helpful illustrations- Similarly, the chapter by Robert Stoles, MD, PhD, and Alexander Brucker, MD, from the Scheie Eye Institute, Philadelphia, Pa, on the use of lasers in diabetic retinopathy is thorough and clinically useful. Rosario Brancato, MD; Pier Giorgio Gobbi, PhD; and Rosangela Lattanzio, from Milan, Italy, discuss diode laser retinal photocoagulation in an extensively referenced chapter.

The basic biophysical principles of laser-tissue interactions are well covered in an interesting chapter by Joel Krauss, MD, of Bell Atlantic Laboratories. Pathological effects are brilliantly discussed by E. Van der Zypen, MD, the world's expert in that field Up-to-dare chapters on the use of laser treatment for glaucoma are provided by Thomas Dietlein, MD, and Granter Krieglstein, MD, from Cologne, Germany; Geoffrey P. Schwartz, Louis W. Schwartz, MD; and George Spaeth, MD, from Wills Eye Hospital, Philadelphia; and Shigekuni Okisaka, MD, Kohji Miyazaki, Kenj, Morimoto, Atsushi Mizukawa, ant Yumi Sai, from the National Defense Medical College in Tokorozawa, Japan.

The final 8 chapters deal will a miscellany of important issues, in eluding laser treatment for tumors vitrectomy, vitreolysis, strabismus plastic surgery, hemostasis, and lacrimal surgery.

The publisher is to be congratulated on a beautiful presentation o the authors' work and illustrations The format is clear, and the book is a delight to read.

This book is highly recommended for the individual interested in the theoretical basis of laser treatment of ophthalmic disease for the investigator, for those becoming familial with using lasers it ophthalmology, and for the advanced practitioner as well.

  • Ophthalmologica
    Tarek Shaarawy, Josef Flammer, Basel
    © 2004 S. Karger AG, Basel

Beyond any shadow of doubt, Franz Fankhauser has been a beacon of scientific research and innovation in ophthalmology for the last 50 years. Lest new generations of ophthalmologists forget, it is worth mentioning that much of the technology that we enjoy and take for granted nowadays is, at least partly, his brain child. His last text book where he co-edits with another brilliant scientist, Sylvia Kwasniewska, is a masterpiece and a `must have' for ophthalmic centres' libraries as well as for the advanced practising ophthalmologist.

From a point of view of an authority in the field, the authors comprehensively approach the subject of their textbook. From chapters on basic background of laser technology to more clinically relevant chapters such as laser refractive surgery, photodynamic therapy and cyclodestructive procedures, the book successfully covers its topics and offers state-of-the art knowledge to readers looking from different standpoints.

The editors have obviously painstakingly hand-picked contributors to their textbook from authorities in the field, and this has resulted in focused and well-informative chapters. Many of the topics of these chapters have whole books dedicated to them, but aside from a handful of scientists totally focusing on a specific research point, the book sufficiently covers its topics for all interested parties. A brief history of laser applications is presented followed by fundamentals of laser optics and principles of various imaging devices. The theory and clinical applications of lasers in corneal surgery, glaucoma,
tumours and vitreoretinal diseases receive extensive coverage. Potential and newer modalities of laser therapy in cataract surgery, strabismus, plastic surgery and lacrimal surgery are discussed in the final chapters.

One thing though that we would suggest and that could be taken into consideration in future editions, which will undoubtedly materialize, is the possible classification of chapters according to more focused sections, say, on background, investigative and therapeutic themes.
The publisher is to be congratulated on the fruit of his efforts, the book is well presented and is a joy to read.

We can attest to the fact that in a rapidly changing field, and in a dynamically progressive technology, this textbook is indeed timely and up to date. It is perhaps a book that will not be read from cover to cover by every ophthalmologist who has a copy, but every ophthalmologist who will be fortunate enough to have a copy would find loads of information that borders on the mandatory, in a technology that is here to stay. As Bob Ritch observed in the foreword of this book 'ten years ago, the fundamentals of many of the chapters in this book had not yet been formulated', and as we speak, it is impossible to imagine ophthalmology today without lasers that reign supreme in our field.
It is indeed refreshing to see that after decades of achievements and dedicated efforts, Franz Fankhauser still has it in him to astonish us with yet another achievement. It is also worthy of our respect that this husband-wife team of Fankhauser-Kwasniewska have not only succeeded in nourishing their holy matrimony, but also maintained a high scientific standard for which they are well known and appreciated.

  • Optics & Photonics News February 2004

Review by Jay M. Enoch, professor of the Graduate School and Dean, Emeritus, School of Optometry, University of California at Berkeley.

This book is a marriage of physics, physical properties and applications of laser technology to ophthalmology. The editors, who have been at the very center of the development of modern technologies for vision testing and laser technology, have recruited contributors from throughout the world.

In modern practice, laser technologies have entered vision treatment and diagnostic technologies across an incredibly broad spectrum of applications. These are reviewed and discussed in 42 separate chapters by many (most) of the main players in the development of these techniques. Physical properties are addressed and laser selection and applied technologies are considered. Because of the breadth of current laser applications, individual topics could not be covered in their entirety, but ample references direct the interested reader to sources for more information. The index is not by authors or contributors but by laser type, physical technology applied and disorder treated.

The book is written for both the physicist/opticist and the eye practitioner. Each reader will find topics, issues and applications of interest, although depth of treatment and analyses were not possible within the confines of the compendium. Based on my attendance at the 2003 OSA Annual Meeting in Tucson, Ariz., I can attest to the fact that many topics, for example, ultrahigh resolution optical coherence tomography, are particularly timely.

One emerging topic of importance not found here is the development of micro-ophthalmoscopy as part of applied adaptive optics technologies. With increasing resolution of individual cells in the living eye in real time, and the growing ability to isolate individual retinal layers for study (effectively combining adaptive optics and coherent-scanning laser ophthalmoscopic techniques), it has become possible to study individual cells in each retinal layer for advanced diagnosis and/or highly local micro-treatment techniques (by reverse path optics for laser intervention and possible use of microelectromechanical systems). The Rochester group and their students have led the way in this emerging technology, and other centers have now joined in these efforts.

The coverage offered readers of this compendium is very broad indeed. I recommend the book highly to interested parties and believe it can be a useful resource for individuals interested in the many forms of laser applications in optics and ophthalmology.

  • Barry R. Masters in Graefe's Arch Clin Exp Ophthalmol

"Lasers in Ophthalmology provides a modern, comprehensive coverage of the field and achieves a good balance between theory, laser devices, and clinical procedures. The production quality is very good, as are the color illustrations and clinical photographs. An useful index is provided. A wide range of diagnostic and therapeutic measures are discussed and illustrated. 
I recommend this book both to ophthalmologists and to scientists who develop and work with ophthalmic lasers."


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