Therapies in ophthalmology

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  • Ocular pharmacotherapeutics can be delivered by
  • Therapies in ophthalmology

    1. 1. Special therapies inOphthalmology Gauri S. Shrestha, M.Optom, FIACLE Lecturer
    2. 2. What are they?  Optical  Medical  Surgical  Laser  Cryotherapy  Vision therapy
    3. 3. Optical therapy  Refractive errors  Hypermetropia  (long sightedness)  Light rays coming from infinity is focused behind the retina when accommodation is at rest  Myopia  (short sightedness)  Light rays coming from infinity is focused in front of the retina when accommodation is at rest
    4. 4. Optical therapy  Refractive errors  Astigmatism  Refraction varies in different meridians  The rays of light entering in the eye can not converge to a point focus
    5. 5. Optical therapy  Anomalies of accommodation  Paralysis of accommodation  Presbyopia  Physiological insufficiency of accommodation  Normal phenomenon according to age  Insufficiency of accommodation  Abnormal insufficiency of accommodation
    6. 6. Optical therapy  Strabismus  Accommodative esotropia  Esotropia caused by excessive abnormal accommodation  Esotropia more at near than distance  Intermittent exotropia  Extotropia manifests at certain point of time only
    7. 7. Optical therapy  Amblyopia  Reduction of vision in one or both eyes without with out obvious pathological cause and vision can’t be restored to normal by any optical, medical and surgical therapy  Occupational optics  Protect the eye from hazard or external environment
    8. 8. Identify the anomalies
    9. 9. Optical therapy  Method of correction  Spectacle glass  Contact lenses  Laser refractive therapy
    10. 10. Optical therapy  Method of correction  Intra corneal ring  Phakic IOL  Corneal refractive therapy
    11. 11. What are they?  Optical Medical  Surgical  Laser  Cryotherapy  Vision therapy
    12. 12. Ocular pharmacotherapy  four methods of delivery A. Topical instillation in to conjunctival sac B. Periocular injection, C. Intraocular injection D. Systemic administration
    13. 13. A. Topical instillation in to conjunctivalsac  Administered in the form of  Eye drops  Specially day time use  Immediate action  Ointments  Increase bioavailability of the drug  Prevent dilution and quick absorption  Bed time use  Gels  Prolong contact time
    14. 14. A. Topical instillation in to conjunctivalsac  Ocuserts  Form of system of drug delivery through a membrane  Release drug in constant rate  Soft contact lens  Deliver high concentration of drug in emergency treatment
    15. 15. B. Periocular injection  Subconjunctival injection  Use to achieve high concentration of drugs  Penetrate large sized molecules  Subtenon injection  Prefer over subconjunctival  Anterior subtenon is used to administer steroids  Posterior subtenons is used for intermediate and posterior uveitis
    16. 16. B. Periocular injection  Retrobulbar injection  Deliver drug for optic neuritis, papillitis, retorbulbar block  Peribulbar injection  now a days a frequent use as anesthetic agents
    17. 17. C. Intraocular injection  Made in desperate cases  Intracameral injection (anterior chambers)  Intravtreal injection
    18. 18. D. Systemic administration  Route  Oral  Intramuscular  Intravenous  Medicine should cross the blood aqueous barrier  Low molecular weight and lipid soluble (sulphonamide) drugs readily penetrate the barrier
    19. 19. What are they?  Optical  Medical Surgical  Laser  Cryotherapy  Vision therapy
    20. 20. Surgical therapy  Surgery for lid  Chalazion  Chronic non-infective granulomatous inflammation of meibomian gland  Ectropion  Entropion Tarsoraphy done  Lagophthalmos in Right eye  Incomplete closure of eye lids  Ptosis
    21. 21. Surgical therapy  Surgery of conjunctiva  Pterygium  Conjuctival cysts  Conjunctival dermoid  symblepharon
    22. 22. Surgical therapy  Cornea  keratoplasty  Refractive surgery  Laser in situ keratomileusis (LASIK)  Sclera  Staphyloma  Scleral buckling
    23. 23. Surgical therapy  Surgery for Uvea  Melanoma of choroid, iris and ciliary body  A malignant tumour of melanocytes  Hemangioma of choroid  a malignant self-involuting tumour of endothelial cells, lining blood vessels
    24. 24. Surgical therapy  Surgery for cataract  Extra Capsular cataract extraction with posterior capsular intraocular lens implant (ECCE PC IOL)  Small incision cataract surgery (SICS)  Phacoemulsification (Phaco)  Surgical Aphakia  AC IOL
    25. 25. Surgical therapy  Surgery for glaucoma  Goniotomy  a surgical procedure in which a goniolens is used to see the structures of anterior chamber  An opening is made in the trabecular meshwork located in the drainage angle, where fluid leaves the eye.  Goniotomy is a surgery for congenital glaucoma only
    26. 26. Surgical therapy  Surgery for glaucoma  Trabeculotomy  A surgical procedure in which a piece of tissue in the eye’s drainage angle is removed to create an opening.  This new opening allows fluid to drain out of the eye  Congenital glaucoma
    27. 27. Surgical therapy  Surgery for glaucoma  Peripheral iridectomy  Treatment in ACG and prophylaxis in fellow eye  A procedure in which a small section of peripheral iris is excised through a limbal incision  Neodynium:YAG and/or argon laser
    28. 28. Surgical therapy  Surgery for glaucoma  Filtration surgery (trabeculectomy)  Partial thickness filtering surgery in which a new channel is created around the margin of scleral flap through which aqueous flows from Anterior chamber into the subconjunctival space
    29. 29. Surgical therapy  Surgery for vitreous  Vitrectomy (vitreous hemorrhage, and vitreous opacity)  Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye
    30. 30. Surgical therapy  Surgery for retina  Sealing of retinal break (high myopia)  photocoagulation  Scleral buckling  Procedure that can be used to repair a retinal detachment  Thin silicone band is used
    31. 31. Surgical therapy  Surgery for retina  Pars plana vitrectomy  Procedure to remove clouded vitreous with blood or vitreous opacities
    32. 32. Surgical therapy  Strabismus and nystagmus  Muscle weaking procedures (recession, myotomy)  Muscle strengthening procedure (resection)  Procedure that changes the direction  Surgery for dacryocystitis  Dacryocystorhinostomy
    33. 33. What are they?  Optical  Medical  Surgical Laser  Cryotherapy  Vision therapy
    34. 34. Laser therapy  Laser: light amplification by stimulated emission of radiation  a mechanism for emitting electromagnetic radiation, via the process of stimulated emission  Properties of laser  Monochromatic  Coherent  No scattering
    35. 35. Production of laser beam Gas/Liquid filled Semi-transparent +++++++++++++++++++++++ mirror chamber M M M M Opaque M M M Emission of laser mirror ------------ Release the excessive energy in the form of light which is amplified to an appropriate wavelength
    36. 36. Lasers used in ophthalmology Type Atomic environment Effect produced Argon Argon gas photocoagulation Krypton Krypton gas Photocoagulation Diode Diode crystal Photocoagulation Nd: YAG A liquid dry or a solid Photodisruption compound of Yt-Al garnet+neodymium, Excimer Helium and fluorine Photoablation Diode pumped Diode and Nd: YAG Photocoagulation Nd YAG crystal
    37. 37. Lasers used in ophthalmology  Definitions  Photocoagulation: The coagulation (clotting) of tissue using a laser which produces light in the visible green wavelength that is selectively absorbed by hemoglobin, in order to seal off bleeding blood vessels  Photoablation: volatilization of tissue by ultraviolet rays emitted by a laser for remodeling  Photodisruption: exert a cutting incision upon the tissue by laser application for breakage of layer of structure
    38. 38. Mechanism of laser effect and theirtherapeutic applications  Photocoagulation: Raise temp ofAbsorption of laser Conversion of target tissue light by tissues Light to heat Denature and Coagulate cellular Treat ocular diseases by elements Production of scar, occlusion of vessels, Application tissue atrophy Peripheral iridectomy tissue contraction Argon laser trabeculoplasty Pan retinal photocoagulation Focal or grid retinal photocoagulation
    39. 39. Mechanism of laser effect and theirtherapeutic applications  Photodisruption Produce the physical Nd: YAG Ionize the electrons State of momentarily laser of target tissue expanding pressure Exert a cutting/ incision Application effect upon the tissue Capsulotomy Membranectomy phacolysis
    40. 40. Mechanism of laser effect and theirtherapeutic applications  Photoablation Exited dimer laser Break chemical bonds (Excimer laser) of biological materials UV 192nm Convert them into small Tissue modeling molecules that diffuse away Application PRK LASIK PTK
    41. 41. What are they?  Optical  Medical  Surgical  Laser Cryotherapy  Vision therapy
    42. 42. Cryotherapy in Ophthalmology  Cryopexy means to produce tissue injury by application of intense cold (-40º to 100 ºC)  Cryounit uses freon, nitrous oxide or carbon dioxide gas as a cooling agent  Its goal is to decrease cellular metabolism, increase cellular survival, decrease inflammation, decrease pain and spasm, promote vasoconstriction, and when using extreme temperatures, to destroy cells by crystallizing the cytosol
    43. 43. Cryotherapy in Ophthalmology  Mode of action  Therapeutic effect by tissue necrosis (tumor)  Adhesion of tissues (seal retinal and choroidal detachment: cryopexy)  Cryolysis of trichiasis  Cryoextraction of lens
    44. 44. Thank you

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