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Fundamentals of Clinical Ophthalmology: Scleritis
  1. ANDREW DICK

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    Fundamentals of Clinical Ophthalmology: Scleritis. By Peter McCluskey. (Series editor: Susan Lightman.) £40; pp 130. London: BMJ Books, 2001. ISBN 072791586X.

    Scleritis is part of a book seriesFundamentals of Clinical Ophthalmology to update general ophthalmologists in specific areas and also, most probably, for ophthalmologists in training. Each book has been edited by a specialist, in this case Peter McCluskey in Australia, with expertise in each chapter from individual authors.

    Overall, I think the book is good and achieves its aim if directed to the ophthalmic trainee as an introduction to scleritis and its differential diagnosis. However, as a result, a frequent collating problem of multiauthor books, it does not read fluently and is sometimes frustrating. This, however, should not discourage any trainee reading this book. It takes the reader logically through the anatomy and biochemistry of the sclera, highlighting reasonably up to date knowledge on cellular components and extracellular matrix and their steady state in relation to matrix metalloprotease and corresponding tissue inhibitors. If we were then to read chapter 3, which is the pathology of scleritis, it would have been more rewarding to have some link between the basic cell biology and the pathology. That is the relation of the inflammatory response to the breakdown of the steady state and the extracellular matrix. As it stands both chapters are excellent in their own right, but do fail to be linked.

    The rest of the book is clinical with good figure representation of both anterior segment and posterior segment disease. The reading is easy and encourages constant thinking of the differential diagnosis.

    There are also chapters on the investigation and management of scleritis. Again these chapters might have been more informative if they were linked to the overall cell biology, biochemistry, and pathology so as to educate us in why we may be undertaking such investigations. There is a lack of explanation as to the serology assays performed to look for antinuclear antibodies or ANCA and its specific antigenic components. I think this slightly disjointed approach may still leave the ophthalmic trainee confused despite the information being present. The section on treatment is well presented and highlights the requirement for pretreatment assessment, prevention of side effects, and overall management of patients on immunosuppression.

    Overall, the book is an enjoyable read and certainly useful for the trainee. For a small book it would have benefited from greater editorial licence to merge the information in all the chapters more coherently.

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