The Cornea edited by H.E. Kaufman, BA Barron, M.B. McDonald, S. R. Waltman, New York, NY, Churchill Livingston ine, 1988. 952 pages.
This text was designed to provide the clinical practitioner with a comprehensive understanding of the pathogenesis, course, and treatment of corneal disease. Although an arduous undertaking, this goal has been met remarkably well thanks to the contributions of 37 distinguished authors, logical organization, high-quality photographs, tables, and diagrams, and careful editing.
Organizationally, the 933 pages of text are broken down into 122 pages of basic science, the balance devoted to clinical science. The first chapter, "Structure and Function of the Cornea," is particularly good. It is a concise, up-to-date treatise on corneal embryology, anatomy, and physiology. Importantly, it is very readable, since, as with any organ system, a thorough knowledge of structure and function is essential to understanding disease mechanisms. A short chapter on conjunctiva and eyelids follows; it is a bit out of context and nonessential. Mechanisms of inflammation, and rationale for the use of steroids and nonsteroidal anti-inflammatory drugs are adequately dealt with in the next brief chapter.
The basic science portion concludes with a section entitled "Basic Ocular Immunology." This chapter sticks to basic tenets of "classical" immunology. Although there is an attempt to categorize a few ocular conditions by the presumed immune mechanism involved, the word "ocular" might better be left out of this title. It is the type of chapter found in introductory immunology texts, but by virtue of its simplicity will not quickly become outmoded.
The clinical section covers the majority of pathologic processes that affect the cornea, and, because of their intimate relationship with the cornea, also touches on the eyelids and conjunctiva. Some chapters are primarily medical, others surgical, and the rest integrate the two. I found the chapters on bacterial and fungal keratitis, corneal dystrophies, and corneal tumors to be exceptionally good. I am aware of no other text where these areas are as thoroughly handled. Congenital and metabolic diseases and degenerative corneal and conjunctival disorders are admirably discussed in five chapters. Immunologic disorders of the conjunctiva and cornea are dealt with in a single chapter, but the coverage is good, ranging from atopic disorders to marginal ulcerative keratitis. A description of each entity is followed by what is known about pathogenesis, and finally by rational and acceptable modes of therapy, both medical and surgical.
A well written section on corneal trauma covers the medical and surgical management of trauma ranging from radiant and chemical injury to penetrating trauma. It should serve admirably for those not commonly confronted with these problems. A section devoted to corneal transplantation encompasses four chapters, and discussions include corneal preservation, surgical technique, and management of allograft rejection. Basic keratoplasty techniques are well described. More complicated techniques of anterior segment reconstruction, including intraocular lens removal and exchange, are not detailed enough. Readers interested in these maneuvers designed to be comprehensive, no such text could hope to cover everything. For example, readers interested in a treatise on Thygeson's superficial punctate keratopathy or Theodore's superior limbic keratoconjunctivitis will be disappointed to find only passing reference to these entities.
This is a useful and highly comprehensive text that has admirably met its goal of presenting a practical, integrated medical and surgical approach to the management of corneal disease. It is to be recommended to residents, fellows, and clinicians as a state-of-the-art reference text.