OFTALMOLOGIA EM MOVIMENTO

Foreword por Dr. Miguel Ângelo Padilha.

José Barraquer, regarded as the forefather of refractive surgery may not have foreseen in the early sixties that his keratomileusis was the beginning of so long a chain of consequences responsible for the tremendous development of the armamentarium of refractive solutions by means of manipulation of the cornea.

Barraquer was followed in continuous movement by Fyodorov's anterior radial keratotomy in 1977 and its introduction into the United States by Leo Bores in 1978, by Kaufman & McDonald's epikeratophakia in 1980, by the advent of Trokel & Seller's excimer laser radiation removing corneal tissues in animal experiments in 1983 and by the introduction of Ruiz's keratomileusis-in-situ in 1987, all of them fostering the tremendous development in research, technique, methods and management of complications in refractive surgery in the last forty years.

This ongoing evolutionary process has overcome new challenges and has so drastically and speedily changed this area of ophthalmic surgery that most surgeons find it hard to follow closely and quickly absorb all the innovations. Exploring and manipulating areas previously undreamed of in ophthalmology, the 21st. century surgeon perplexes at the thought that, not too long ago, so much was ignored about the embryology, histology, anatomy and physiology of the cornea.

Today, such delicate structure has been unveiled by researchers, who irrepressibly seek ways to reshape it and bring light beams to meet the retina. Such encounter is the perfect conjunction of the external environment with the visual phenomenon which is processed inside, granting the brain with the best vision possible.

The search for refractive surgical solutions is clearly not restricted to the reshaping of the cornea. The other advances are the refractive lensectomy and its replacement by monofocal, bifocal, multifocal or accommodative intra-ocular lenses and the implantation of IOLs in phakic eyes. All of these options have advantages and disadvantages, but we know that the unyielding quest for the vision that is as nearly perfect as possible will never cease. As men attempt to achieve immortality and resemblance to their creator, ophthalmologists strive at a breathtaking pace to correct the defects of the visual device, amazed at the power they now bear in their own hands.

Mastering the Techinques in Corneal Refractive Surgery derives from a mighty concentrated effort by Garg, Pallikaris, Hoyos, Avalos, Pinelli and Piovella to bring together a select group of exponents in the field of refractive surgery in order to discuss techniques and procedures constantly questioned in contemporary ophthalmology. It is mandatory to speak of contemporaneousness once the evolution of means and methods for the practice of our specialty involves technology in continuous and overwhelming velocity of transformation.

In sixty-two chapters divided in four sections, the work exposes the essence of what present-day refractive surgeons consider important and indicates the direction of their thinking.

The first section provides knowledge of how to deal with the different technology at our disposal, not only to treat but, most importantly, to precisely and correctly evaluate perspective candidates to refractive surgery. A comprehensive knowledge of the available technology and sound surgical indications are major requirements to avoid complications.

The second section exposes the reader to various techniques by thoroughly describing the main approaches to refractive surgery which have proven most effective in the hands of experienced surgeons. The third section focus on how to prevent and manage complications. The authors share valuable information and insights leading the attentive reader to improvement in results.

The fourth and last section is an enticing journey through new perspectives of corneal refractive surgery, anticipating what may well be a reality in the near future.

Three to two decades ago a skeptic and frightened but also curious and inquisitive ophthalmic community watched the raids of intrepid surgeons on the cornea, cutting it, burning it and excising tissue from its surface with lasers. These are but remote images, now replaced by state of the art technology which provides detailed exams of the corneal structure as well as sophisticated evaluation of aberrations.

Most of us have witnessed already strides in ophthalmology which have perplexed us but the full impact of successful evolution has yet to be realized - the day will come when limitations to visual potentiality will no longer exist.

I heartily congratulate my prestigious colleagues Dr. Ashok Garg and co-editors who collaborated in the devising, elaboration and execution of this encompassing work which provides a substantial and opportune update in corneal refractive surgery and grants us the means to meet with the challenge of keeping abreast of the dynamic changes we can already envisage.