Corneal Astigmatism, Etiology, Prevention, and Management. By R.C. Troutman and K. A. Buzard. St Louis, Mo: Mosby Year Book Publishers; 1992; 506 pages; $110.
Forgetting the title for a moment, which only reflects a portion of the contents, the book can be seen to represent the genuine dilemma of a pioneer surgeon in his later years. In this case, we have Richard Troutman, a man who spent his career creatively applying an engineering approach to corneal surgery. Now, he wants to remind us of his contributions as well as share many of his unique observations. How to proceed? A memoir or autobiography perhaps? But such vehicles require a level of writing skill that very few surgeons possess. In fact, what the authors have done is to produce a highly personalized surgical atlas which could have easily been entitled, "Corneal Surgery, My Way." Under such a banner, the unending references to the "Troutman corneal scissors," the "Troutman keratometer," the "Troutman punch," or procedures like the "Troutman relaxing incision" or the "Troutman corneal wedge resection," etc might not have been necessary. In keeping with the autobiographical approach, the authors talk of their results as successful in their hands rather than justifying their techniques with controlled studies and statistics. Of course, in their defense, surgery is a very individual endeavor, where statistics are not easily transferable from surgeon to surgeon.
The book contains a basic science section on corneal physiology, biomechanics, and wound healing. This section demonstrates a great deal of courage on the part of the authors. In today's world of statistical documentation, the authors choose to go their own way. Anecdotal impressions and imaginative reasoning give these chapters a different spin from the usual surgical basic science chapters.
However, the most important and really invaluable portion of the book are the practical surgical and postoperative tips, as well as the indepth descriptions of certain instruments. For example, correction of astigmatism after cataract or corneal surgery should always be done "in or inside the incision." In my opinion, this advice should be tattooed to the corneal surgeon's forehead. The description of the different diamond blades and corneal trephines as well as the strengths and weaknesses of each design is another unique and memorable feature of the book. Incidentally, each explanation or description is lucidly illustrated by Virginia HoytCantavella. Her black and white drawings appear adjacent to the relevant paragraph which enhances the readers' learning experience.
In summary, this book is a very personal presentation of corneal surgical topics by a recognized authority and his disciple.