A Simple & Novel AC Paracentesis Device for safe intravitreal injection
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Intravitreal injection of triamcinolone, Anti VEGF & antibiotics are given in various retinal conditions. It may be a single or multiple injections at one time depending on the retinal condition. It was found that during injection increased IOP may lead to compromised optic disc perfusion & vitreous incarceration in needle track after its removal & subconjunctival vitreous.To have a safe intravitreal injection we have devised a simple but very helpful technique to lessen the IOP.One or many intravitreal medicines can be injected without any rise in IOP or vitreous incarceration or any subconjunctival vitreous.A 26 or 30 G needle hub is mounted on sterile ear bud to obstruct its inner hole, then it is pierced horizontally into the anterior chamber till its bevel is half in AC & not surpassing pupil border so that lens touch is avoided.Now intravitreal injection one or many drugs are given without any fear of rise in IOP.As soon as the medicine is injected,the extrafluid (aqueous) comes out through needle & soaked in the sterile ear bud. After removal of intravitreal needle no vit incarceration or subconjunctival vitreous were noted,IOP remains stable. Dramatically less pain was noted. At the end you find stable AC & IOP without any complications.
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2) 46 eyes of 41 patients underwent punch trabeculectomy surgery after a trial of medical treatment. The mean baseline IOP, surgical technique, and post-operative follow up and complications are described.
3) The results show that punch trabeculectomy was more effective than medical treatment in lowering IOP, with a mean IOP reduction of over 50% achieved surgically. Surgical intervention was found to provide consistent and substantial IOP lowering compared to medical management.
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intravitrealinjection-160805031133.pptx
This document provides information on intravitreal injections, including:
- Intravitreal injections allow targeted delivery of medication to the eye with minimal systemic absorption. They are commonly used to treat retinal diseases like age-related macular degeneration.
- Anti-VEGF agents have significantly increased the number of intravitreal injections performed each year in the US, from under 5,000 in 2001 to over 2.3 million in 2012.
- Proper injection technique involves sterilizing the injection site, using a 30-gauge needle 3-4mm posterior to the limbus, and injecting the medication slowly to minimize risks like endophthalmitis.
MIGS
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2. It can be classified as infectious (exogenous or endogenous) or non-infectious. The most common type is exogenous endophthalmitis, which accounts for over 85% of cases.
3. Treatment depends on the type and severity of endophthalmitis. For acute postoperative endophthalmitis with vision of light perception or worse, immediate pars plana vitrectomy and intravitreal antibiotics is recommended. For vision of hand motions or better, a tap and inject of intravitreal antibiotics is recommended initially.
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This study compared the efficacy and safety of standard trabeculectomy versus the Ex-PRESS miniature glaucoma shunt implantation using a retrospective review of 100 eyes that underwent either procedure. No significant differences were found in IOP reduction, success rates, failure rates, or hypotony between the two procedures. The study concluded that there were no differences in efficacy or safety between the Ex-PRESS shunt and standard trabeculectomy for lowering IOP in glaucoma patients.
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1. Post-operative endophthalmitis is an intraocular inflammation that can occur after eye surgery or trauma as a complication. It involves inflammation in the anterior and posterior segments of the eye.
2. It is classified as infectious or non-infectious. Infectious endophthalmitis can be exogenous from surgery or trauma, or endogenous from hematogenous spread. Acute infectious endophthalmitis typically occurs within 6 weeks of surgery.
3. Management involves medical therapy including intravitreal and systemic antibiotics, as well as vitrectomy in some cases depending on visual acuity. The Endophthalmitis Vitrectomy Study showed vitrectomy is beneficial for patients
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This document discusses endophthalmitis, a potentially devastating eye infection, and its various causes and risk factors. It covers exogenous endophthalmitis resulting from trauma or surgery and endogenous endophthalmitis from bacteremia or fungemia. Specific surgical procedures like cataract extraction, glaucoma filtration, and intravitreal injections are examined in terms of their associated endophthalmitis rates and common causative organisms. Patient symptoms and the importance of differentiating infectious versus sterile postoperative inflammation are also mentioned.
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1) Trabeculectomy is the most common glaucoma surgery but scarring can lead to bleb failure. OloGen collagen implant may help control wound healing to maintain drainage.
2) This study compares outcomes of trabeculectomy with and without OloGen implant in 60 eyes over 6 months. Success rates and complications were similar between groups with no significant differences.
3) While OloGen did not provide clear advantages in this pilot study, larger trials with longer follow up are needed to fully evaluate its safety and efficacy in trabeculectomy.
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This document provides guidelines for managing postoperative endophthalmitis. It recommends that if a patient has hand motion or better vision, an immediate tap or biopsy should be performed along with intravitreal antibiotic injection. For patients with light perception vision or less, an immediate vitrectomy with tap and biopsy is recommended. Intravitreal, subconjunctival, and topical fortified antibiotic therapies are outlined. Close follow up is important to monitor for signs of worsening infection requiring additional procedures.
Prevention of endophthalmitis
This document discusses measures to prevent endophthalmitis following cataract surgery. It recommends preoperative measures like applying povidone-iodine drops and topical antibiotics prior to surgery. Intracameral antibiotics like cefuroxime or moxifloxacin injected at the end of surgery can significantly reduce the risk of endophthalmitis. Fourth generation quinolones are more effective than vancomycin. Proper surgical asepsis and attention to wound closure are also important peroperative measures. Postoperative topical antibiotics are recommended for one to two weeks depending on wound type.
Five year experience in the treatment of Endophthalmitis
This document summarizes a retrospective study analyzing 84 cases of post-operative endophthalmitis following cataract surgery over 5 years. The study evaluated the effectiveness of the "Abou Shousha Triple Procedure" with and without vitrectomy. The Triple Procedure involves intravitreal and intracameral antibiotic injection along with removal of anterior chamber membranes. For patients presenting with light perception or worse, vitrectomy was also performed. The majority of cases saw visual improvement. The study concluded the Triple Procedure, with or without vitrectomy based on initial vision, is an effective treatment for post-operative endophthalmitis.
Efficacy of Punch Trabeculectomy
1) The document discusses a study comparing the efficacy of medical treatment versus standardized punch trabeculectomy surgery in lowering intraocular pressure (IOP) in patients with different types of glaucoma.
2) 46 eyes of 41 patients underwent punch trabeculectomy surgery after a trial of medical treatment. The mean baseline IOP, surgical technique, and post-operative follow up and complications are described.
3) The results show that punch trabeculectomy was more effective than medical treatment in lowering IOP, with a mean IOP reduction of over 50% achieved surgically. Surgical intervention was found to provide consistent and substantial IOP lowering compared to medical management.
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This document summarizes a study on the management of postoperative endophthalmitis following cataract surgery over a 5-year period. 74 eyes were treated with either the Triple Procedure alone or along with vitrectomy depending on visual acuity. The Triple Procedure involves intravitreal and intracameral antibiotics along with membrane removal. Positive cultures were obtained in 64.7% of cases, most commonly coagulase-negative staphylococci. Visual acuity outcomes varied by treatment, with the Triple Procedure plus vitrectomy showing better results for patients with light perception vision. The study supports using the Abou Shousha Triple Procedure, with or without vitrectomy, as essential treatments for post-catar
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Endophthalmitis management
1. Early recognition and treatment of endophthalmitis is critical to prevent further spread and vision loss. Diagnosis involves a thorough ocular exam, microbiological investigations including aqueous or vitreous taps and cultures, as well as systemic workup to identify the source of infection.
2. Treatment involves prompt administration of broad-spectrum intravitreal antibiotics targeting both gram-positive and gram-negative organisms. Vitrectomy may improve outcomes in cases with initial light perception vision or suspected fungal infection. Close monitoring is needed as repeat injections or surgery may be required if the infection persists or vision declines.
3. Risk factors like older age, diabetes, and poor initial vision portend worse visual outcomes,
Fnac of breast
FNAC of breast - definition, history, purpose, preparations, basic equipment, procedure, smear preparation, fixatives, staining solutions, rapid stains - toluidine blue, difference between air dried and wet fixed slides, complications and contraindications, advantages, general criteris for malignancy, nuclear size and pleomorphism, nuclear membrane, irregularity and extranuclear chromatin, nuclear fragility and mitotic figures, types of breast carcinoma.
High Frequency Deep Sclerotomy (HFDS)
This document provides information on High Frequency Deep Sclerotomy (HFDS) surgery for glaucoma. It describes HFDS as a minimally invasive glaucoma surgery that bypasses the trabecular meshwork by using a high frequency probe to create multiple sclerotomies, allowing aqueous humor to drain directly into Schlemm's canal. The document discusses the surgical procedure for HFDS and presents a case study demonstrating reduced intraocular pressure following the surgery. It also compares HFDS to other glaucoma surgeries such as trabeculectomy and reviews their respective success rates and complication profiles.
TASS AND ENDOPH.pptx
TASS
Toxic solution enters the anterior chamber
Produce severe intraocular inflammation as well as corneal edema
Form of sterile, noninfectious endophthalmitis
Endophthalmitis
Present in an acute form or in a more indolent or chronic form the latter is associated with organisms of lower pathogenicity
NW2008 Endopthalmitis
1. Endophthalmitis is an inflammatory reaction within the eye resulting from bacterial, fungal, or parasitic colonization. It can be exogenous (post-operative, post-traumatic) or endogenous.
2. Microbial endophthalmitis occurs in three phases - incubation, acceleration, and destructive. The incubation phase lasts at least 16-18 hours as bacteria multiply. The acceleration phase sees inflammation spread from the anterior chamber to the posterior chamber within 7 days. The destructive phase involves inflammatory mediators recruiting white blood cells to directly destroy ocular tissues.
3. Risk factors for post-cataract endophthalmitis include wound leakage, capsular defects, vitreous
Nasal Septal Hematoma Drainage
Nasal septal hematoma is a collection of blood under the mucoperichondrium or mucoperiosteum of the nasal septum caused by trauma or surgery. Symptoms include nasal obstruction, pain, rhinorrhea, and fever. Examination reveals asymmetry of the septum with bluish or reddish swelling. Treatment involves urgent drainage of the clot under local anesthesia to prevent complications like abscess or deformity. Late drainage can lead to issues like a saddle nose deformity or sinusitis. Proper technique involves incising the mucosa and suctioning out the clot while irrigating with saline.
Management of retinal detachment....
This document provides information on the management of retinal detachment. It begins with definitions of key terms like scleral buckling and the various surgical procedures used to reattach the retina like scleral buckling, vitrectomy, and pneumatic retinopexy. It then describes the surgical steps for procedures like scleral buckling in 3 sentences or less, including conjunctival peritomy, slinging the rectus muscles, cryotherapy or retinopexy, placement of explants and sutures, and drainage of subretinal fluid. The document also summarizes techniques for pneumatic retinopexy including use of gases like sulfur hexafluoride and properties of silicone oil used as an
CATARACT SURGERY COMPLICATIONS
Early complications of intraocular lens (IOL) surgery include corneal edema, wound leak, shallow anterior chamber, hyphaema, retained lens matter, and uveitis. Late complications include posterior capsular opacification, cystoid macular edema, endophthalmitis, and retinal detachment. Post-operative endophthalmitis is a vision-threatening complication that is treated with topical, systemic, and intravitreal antibiotics along with steroids. Posterior capsular opacification occurs in 10-50% of cases due to proliferation of lens epithelial cells.
Advances in glaucoma surgeries
This document discusses various minimally invasive glaucoma surgery (MIGS) procedures and devices. MIGS procedures are minimally traumatic, avoid complications of traditional glaucoma surgery, and provide rapid recovery with minimal impact on quality of life. Devices discussed include the Trabectome, iStent, CyPass microstent, Hydrus microstent, Aquasys stent, canaloplasty, Ex-PRESS shunt, and Gold Microshunt. Laser procedures like cyclophotocoagulation are also summarized.
Keratoplasty
Dr. Karan Bhatia provides an overview of keratoplasty (corneal transplantation). There are different types including penetrating keratoplasty (replacing the full thickness of the diseased cornea), partial thickness lamellar keratoplasty, and rotational keratoplasty. Penetrating keratoplasty has been the standard procedure but carries risks. The history and techniques of penetrating keratoplasty are described in detail including pre-operative evaluation, donor cornea excision, recipient cornea trephination, suturing, and post-operative management. Potential complications are also reviewed. Lamellar keratoplasty is introduced as an alternative to penetrating keratoplasty to reduce risks
What's New In Glaucoma Surgery [OD CE 2 credit hours] - PPT Slides and Videos
What's New In Glaucoma Surgery Presentation. A Continuing Education course for Optometrists presented by Patient-Focused Ophthalmologist, Dr. David Richardson.
At the end of the presentation audience participants became familiar with the main benefits and risks of currently available glaucoma treatments as well as had awareness of the most promising potential future surgical glaucoma treatments.
This OD CE Course was held at Green Street Tavern, Pasadena, CA last May 20, 2015.
=========================
[Glaucoma Surgeon, California] Dr. David Richardson is a board certified Ophthalmologist and Eye Surgeon in California specializing in the treatment of Cataract and Glaucoma. He is the Medical Director of San Marino Eye (Vision Center), located in San Marino, California. He’s the former Chief of Surgery and now Vice Chief of Staff at San Gabriel Valley Medical Center. Dr. Richardson has performed thousands of advanced cataract and Canaloplasty glaucoma procedures with excellent results.
More information about Dr. Richardson: http://David-Richardson-MD.com
New Glaucoma Treatments is a GLAUCOMA HealthHub maintained by David Richardson, M.D. It’s primary purpose is to provide valuable information to glaucoma patients and their caregivers worldwide about the latest developments and treatments for glaucoma, while providing answers to commonly asked questions about glaucoma, care and treatment options.
More information about new glaucoma treatments here: http://new-glaucoma-treatments.com
EMERGENCY PARS PLANA VITRECTOMY FOR ACUTE POST - CATARACT ENDOPHTHALMITIS WH...
Post Cataract Surgery Endophthalmitis
Endophthalmitis is the most devastating complication of cataract surgery
Immediate action should be taken once endophthalmitis is diagnosed
There should not be any time lost before diagnosis is made
Intervento del Dottor Luca Avoni a Sicsso 2018
Corneal scraping is an important diagnostic tool for infectious keratitis that allows identification of the infectious agent, such as bacteria, fungi, or Acanthamoeba. Identification of the agent guides selection of targeted antibiotic or antifungal treatment and improves recovery chances. Corneal scraping should be performed before starting antibiotic therapy, on central or deep ulcers, or in young or immunosuppressed patients. It has a high rate of positive results and identification of agents including Staphylococcus, Pseudomonas, Candida, and Fusarium. Targeted topical or systemic therapy is selected based on agent identified, with close follow-up of patients required.
Gdd & kpro
This document summarizes different types of glaucoma drainage devices (GDD) used to manage refractory glaucoma. It describes the history and evolution of GDDs from early seton implants to modern implants with resistance mechanisms to control aqueous outflow. The key GDD types discussed are Molteno, Baerveldt, Ahmed, and Krupin valves. Complications, indications, success rates, and outcomes are compared between devices. The document also reviews keratoprosthesis procedures used to replace severely damaged corneas.
Minimally Invasive Glaucoma Surgery (MIGS)
Minimally invasive glaucoma surgery (MIGS) is a group of procedures that minimizes the invasive rate of glaucoma with five characteristics: ab interno microincision, minimal trauma, more effective, high safety profile, and quick recovery.
MIGS is a surgery that uses an incision in a clear cornea and is indicated in patients with mild to moderate open angle glaucoma.
The technique of MIGS is based on several mechanisms, namely trabecular meshwork bypass stents including iStent, trabectome, and Hydrus microstent; Suprachoroidal implant using Cypass microstent; And subconjungtiva filtration using XEN gel stent.
MIGS technology has potential advantages in glaucoma management by reducing the burden of treatment, improving patients quality of life, and cutting or delaying more invasive surgeries.
Penetrating Keratoplasty
The document discusses the history and techniques of penetrating keratoplasty (PK). It notes that the first successful PK was performed in 1905. Common indications for PK include corneal opacities, dystrophies, trauma, and graft failure. The preoperative evaluation, surgical steps such as trephination and suturing, and postoperative care are described. Complications during and after PK can include perforation, bleeding, and graft rejection. Tight control of inflammation and immunosuppression are important for managing high-risk grafts.
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A Simple & Novel AC Paracentesis Device for safe intravitreal injection
- 1. Intravitreal InjectionIntravitreal Injection --InnovativeInnovative TechniqueTechnique DR. SANTOSH AGRAWAL AURANGABAD, MAHARASHTRA MOB- 09325382000/09689360352 EMAIL-drsantoshagrawal@gmail.com
- 2. Intravit. Injection is now widely used to administerIntravit. Injection is now widely used to administer • Anti VEGF , Triamcinolone acetonide, Antibiotics,TPA etc. • Chances of iris or lens touch can be avoided by penetrating needle at limbus tangentially into AC just the bevel is partially inside the AC and not touching any intraocular structures IntroductionIntroduction
- 3. Risks of Intravit. Injection Technique Vitreous incarceration “Vitreous wick” through scleral tunnel A bleb formation Immediate increase IOP Transient CRA occlusion – sudden central black out Increse risk of endop. b/o bact. Entering through injection site RD because of vitreous traction
- 4. My Simple & Novel AC Paracentesis Device “Prior (Pre injection) paracentesis with a 26/30 G needle whose hub is mounted on a sterile Johnson bud”. It remains inside AC throughout the injection to drain out aqueous as the intraocular volume increases.
- 5. Advantages No immediate hypotony or AC collapse At the time of injection aqueous drained out slowly – soaked into the tip of bud. No immediate rise in IOP Multiple injections can be given. No vitreous or drug reflux at the site of injection No vitreous wick Less chances of endophthalmitis Practically no need to check fundus or vision (post injection) Less discomfort to patient as no sudden increase IOP
- 6. MATERIAL AND METHOD ETHICAL STANDERD OUTLINED BY MRC WERE FOLLOWEDETHICAL STANDERD OUTLINED BY MRC WERE FOLLOWED Informed comment was taken. Mean duration of follow up 48mts ±6. Main outcome measures studied Vit. incarceration , vit wick, vit reflex , bleb formation ERA pulsation,iop,ant.chamber complications, pain Duration of study – 5 years (From Feb 2011 to Feb 2016) Cases – 320
- 7. Intravit Injections AntiVEGF – Avastin 0.05 ml – 152 T.A. – 112 eyes Antibiotics for endophthalmitis – 54 Others – TPA – 2 Preop. betadine e/d In OT, painting & drapping Topical anaesthesia by paracain Caliper used : - 3-3.5 mm in pseudophakia - 3.5 to 4 mm in phakic eye 26 G or 30 G needle on tuberculin syringe Preinjection paracentesis by new device.
- 8. RESULT COMPLICATIONS PRESENT SDTUDIES BLEB FORMATION 0.80 % FUNDUS CRA PULSATION 1.61 % VIT . INCARERATION (VIT WICK) 0.40 % RD NIL PAIN DURING PROCEDURE 1.2 % ENDOOPTHALMITIS NIL
- 9. COMPLICATIONS PRESENT SDTUDIES OTHER SDTUDIES BLEB FORMATION 0.80 % 20 % FUNDUS CRA PULSATION 1.61 % 30 % VIT . INCARERATION (VIT WICK) 0.40 % 42.9 % RD NIL 0.8 % PAIN DURING PROCEDURE 1.2 % 80 % ENDOOPTHALMITIS NIL 0.5 to 3 % DISCUSSION
- 10. DISCUSSION Dramatic effect of the this new technique on intraoperative & postop complication were observed. There is hardly any bleb formation, vit. Incaration, Rise in IOP or CRA pulsation were notified as against other studies. Less or no pain was experienced may be due to no sudden increase in IOP
- 11. ConclusionConclusion This is the simple, inexpensive ACThis is the simple, inexpensive AC Paracentesis Device Which isParacentesis Device Which is found very safe for all types offound very safe for all types of intravitreal injections.intravitreal injections.