Anterior vitrectomy
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Tips for performing efficient unplanned vitrectomy after posterior capsule rupture during phacoemulsification
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Surgical induced astigmatism
This document discusses surgical induced astigmatism following cataract surgery. It notes that astigmatism has a significant impact on vision and is influenced by surgical technique and incision size and type. Various factors can induce astigmatism including incision location and size, suture type and placement, and wound compression or gape. Evaluating astigmatism involves tools like retinoscopy, keratometry and corneal topography. Managing astigmatism may involve selective suture removal to reduce cylindrical error over time.
Posterior capsular rupture
This document discusses signs, predisposing factors, timing, and management of a posterior capsule tear during cataract surgery. A posterior capsule tear can be identified by sudden pupil dilation, a falling away nucleus, or visible vitreous or capsule in the phaco tip. Risk factors include surgeon hand position, poor visibility from fluid, globe torsion, or underlying pathology. Tears often occur late in surgery during nucleus removal or capsule polishing. Management involves injecting viscoelastic to cover the tear and prevent vitreous prolapse, removing any lens fragments, and determining if an anterior or sulcus IOL placement is possible depending on tear size.
Retinoscopy
Dr. Pushkar Dhir gave a seminar on retinoscopy. He discussed how retinoscopy works by illuminating the retina and observing the light reflex. It can be used to objectively measure refractive error in infants and others who cannot communicate. Both dry and wet retinoscopy were explained. Challenges like an unclear red reflex due to media opacity or high refractive error were addressed. Subjective refinement using techniques like the Jackson Cross Cylinder was also covered. The seminar provided an in-depth overview of the retinoscopy procedure and techniques.
Ophthalmic Viscoelastic devices
This document discusses ophthalmic viscosurgical devices (OVDs), including their history, properties, composition, classification, and uses. It begins by describing the introduction of sodium hyaluronate as the first OVD used in ophthalmic surgery in 1972. It then covers the ideal properties of an OVD and the rheological properties of viscosity, elasticity, coatability, and others. OVDs are classified as cohesive, dispersive, or viscoadaptive based on their molecular structure and behavior. The document discusses the advantages and uses of OVDs in cataract surgery, glaucoma surgery, keratoplasty, and other ophthalmic procedures. It concludes by outlining complications like
Biometry & Iol calculations
1) Biometry is the process of measuring the eye to determine the ideal intraocular lens power for cataract surgery. It involves measuring the corneal power and axial length of the eye.
2) Traditional A-scan ultrasound biometry measures axial length using sound waves, but has limitations like variable corneal compression. Newer devices like the IOL Master use optical interferometry and are non-contact.
3) Proper technique and accounting for factors like intraocular lens material are important for accurate biometry and intraocular lens power calculation. Inaccuracies can result in postoperative refractive surprises.
Phakic iol ppt
1) Phakic IOLs are artificial lenses implanted in the eye to correct refractive errors while leaving the natural lens intact. They are classified as angle-supported, iris-fixated, or posterior chamber IOLs.
2) The first phakic IOLs date back to the 1950s but modern designs from the 1980s/90s include the Artisan iris-claw lens and posterior chamber lenses like the ICL.
3) Ideal phakic IOL candidates have a stable refraction and meet endothelial cell and anterior chamber depth requirements. Assessments include VA, biometry, and endothelial cell counts.
IOL power calculation special situations
IOL power calculation is challenging in eyes with prior refractive surgery or other special situations. In eyes with prior radial keratotomy, standard keratometry overestimates corneal power due to flattening outside the central optical zone. Multiple methods of IOL power calculation should be used, including topography to measure the flattest central corneal power. A study comparing methods in eyes with prior RK found IOL power calculation using topographic keratometry was least accurate compared to formulas from the ESCRS calculator. No single method provided reliable results, highlighting the difficulty in IOL power calculation for eyes with prior refractive surgery.
Phacodynamics
Phacodynamics refers to the fundamental principles of inflow, outflow, vacuum, and phaco power modulation during cataract surgery. Understanding these principles helps optimize machine settings for different surgical techniques. The foot pedal controls irrigation, aspiration, and ultrasound energy. Position 1 provides irrigation only, position 2 adds aspiration, and position 3 engages ultrasound. Peristaltic and venturi pumps differ in how they create vacuum. Peristaltic pumps require tip occlusion while venturi pumps create vacuum instantly. Factors like compliance, surge, and vent type impact fluidics and safety. Mastering phacodynamics leads to independent surgical skill.
Recommended
Surgical induced astigmatism
This document discusses surgical induced astigmatism following cataract surgery. It notes that astigmatism has a significant impact on vision and is influenced by surgical technique and incision size and type. Various factors can induce astigmatism including incision location and size, suture type and placement, and wound compression or gape. Evaluating astigmatism involves tools like retinoscopy, keratometry and corneal topography. Managing astigmatism may involve selective suture removal to reduce cylindrical error over time.
Posterior capsular rupture
This document discusses signs, predisposing factors, timing, and management of a posterior capsule tear during cataract surgery. A posterior capsule tear can be identified by sudden pupil dilation, a falling away nucleus, or visible vitreous or capsule in the phaco tip. Risk factors include surgeon hand position, poor visibility from fluid, globe torsion, or underlying pathology. Tears often occur late in surgery during nucleus removal or capsule polishing. Management involves injecting viscoelastic to cover the tear and prevent vitreous prolapse, removing any lens fragments, and determining if an anterior or sulcus IOL placement is possible depending on tear size.
Retinoscopy
Dr. Pushkar Dhir gave a seminar on retinoscopy. He discussed how retinoscopy works by illuminating the retina and observing the light reflex. It can be used to objectively measure refractive error in infants and others who cannot communicate. Both dry and wet retinoscopy were explained. Challenges like an unclear red reflex due to media opacity or high refractive error were addressed. Subjective refinement using techniques like the Jackson Cross Cylinder was also covered. The seminar provided an in-depth overview of the retinoscopy procedure and techniques.
Ophthalmic Viscoelastic devices
This document discusses ophthalmic viscosurgical devices (OVDs), including their history, properties, composition, classification, and uses. It begins by describing the introduction of sodium hyaluronate as the first OVD used in ophthalmic surgery in 1972. It then covers the ideal properties of an OVD and the rheological properties of viscosity, elasticity, coatability, and others. OVDs are classified as cohesive, dispersive, or viscoadaptive based on their molecular structure and behavior. The document discusses the advantages and uses of OVDs in cataract surgery, glaucoma surgery, keratoplasty, and other ophthalmic procedures. It concludes by outlining complications like
Biometry & Iol calculations
1) Biometry is the process of measuring the eye to determine the ideal intraocular lens power for cataract surgery. It involves measuring the corneal power and axial length of the eye.
2) Traditional A-scan ultrasound biometry measures axial length using sound waves, but has limitations like variable corneal compression. Newer devices like the IOL Master use optical interferometry and are non-contact.
3) Proper technique and accounting for factors like intraocular lens material are important for accurate biometry and intraocular lens power calculation. Inaccuracies can result in postoperative refractive surprises.
Phakic iol ppt
1) Phakic IOLs are artificial lenses implanted in the eye to correct refractive errors while leaving the natural lens intact. They are classified as angle-supported, iris-fixated, or posterior chamber IOLs.
2) The first phakic IOLs date back to the 1950s but modern designs from the 1980s/90s include the Artisan iris-claw lens and posterior chamber lenses like the ICL.
3) Ideal phakic IOL candidates have a stable refraction and meet endothelial cell and anterior chamber depth requirements. Assessments include VA, biometry, and endothelial cell counts.
IOL power calculation special situations
IOL power calculation is challenging in eyes with prior refractive surgery or other special situations. In eyes with prior radial keratotomy, standard keratometry overestimates corneal power due to flattening outside the central optical zone. Multiple methods of IOL power calculation should be used, including topography to measure the flattest central corneal power. A study comparing methods in eyes with prior RK found IOL power calculation using topographic keratometry was least accurate compared to formulas from the ESCRS calculator. No single method provided reliable results, highlighting the difficulty in IOL power calculation for eyes with prior refractive surgery.
Phacodynamics
Phacodynamics refers to the fundamental principles of inflow, outflow, vacuum, and phaco power modulation during cataract surgery. Understanding these principles helps optimize machine settings for different surgical techniques. The foot pedal controls irrigation, aspiration, and ultrasound energy. Position 1 provides irrigation only, position 2 adds aspiration, and position 3 engages ultrasound. Peristaltic and venturi pumps differ in how they create vacuum. Peristaltic pumps require tip occlusion while venturi pumps create vacuum instantly. Factors like compliance, surge, and vent type impact fluidics and safety. Mastering phacodynamics leads to independent surgical skill.
Vitreous substitutes
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
Glaucoma drainage devices
Glaucoma drainage devices (GDDs) work by creating an alternate pathway for aqueous outflow from the anterior chamber through a silicone tube to a plate under the conjunctiva where fluid is absorbed. The Ahmed valve and Baerveldt implant are two commonly used valved and non-valved devices, respectively. The Ahmed valve uses silicone leaflets to allow one-way flow above a certain pressure threshold, while the Baerveldt implant relies on a fibrous capsule formation around its plate for resistance to outflow. GDDs are indicated for refractory glaucoma when other surgeries have failed.
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Dr Somdutt Prasad also known as Dr Som Prasad shows the process of conducting anterior vitrectomy during APACRS 2015.
Mgmt of pcr
This document discusses posterior capsule tears that can occur during cataract surgery. It covers the predisposing factors, mechanisms, identification, and management strategies for posterior capsule tears with or without vitreous loss. Key points include identifying tears early, stabilizing the anterior chamber with viscoelastic, deciding whether to continue phacoemulsification or convert to extracapsular extraction based on the situation, performing anterior vitrectomy when needed with caution to minimize further vitreous disturbance, and properly placing an IOL. The goal is to remove all lens material and prevent further complications while minimizing additional surgery.
Nucleus drop
1) A nucleus drop occurs when part or all of the lens nucleus falls into the vitreous cavity during cataract surgery. It has a low incidence rate of around 0.3%.
2) Risk factors include preexisting conditions like pseudoexfoliation or zonular weakness, as well as complications during surgery such as tears in the posterior capsule or zonules.
3) Definitive management involves a pars plana vitrectomy to remove the dropped nucleus and any remaining vitreous gel. This helps minimize complications like uveitis, glaucoma, or retinal detachment.
Lamellar keratoplasty
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
Multifocal iols
Multifocal IOLs provide both near and distance vision without glasses by utilizing concentric zones of different optical powers (refractive MFIOLs) or diffractive properties to split light between two focal points. While eliminating need for glasses, they can cause visual side effects like glare and reduced contrast sensitivity. Careful patient selection and counseling, accurate biometry and surgical technique are important for successful multifocal IOL implantation outcomes.
Biometry
This document discusses biometry, which involves measuring the eye to determine the ideal intraocular lens power for cataract surgery. It notes that biometry errors are the second most common cause of claims in cataract malpractice cases. It describes various techniques for measuring the corneal curvature and axial length of the eye, including manual and automated keratometry, ultrasound A-scan, and optical biometers. It also discusses considerations for biometry in special cases and different intraocular lens calculation formulas.
MIVS
This document summarizes information about different gauge vitrectomy systems including 20 gauge, 23 gauge, and 25 gauge. It provides details on the instrumentation, techniques, advantages and disadvantages of each system as well as indications for microincision vitrectomy surgery. Key points include that 23 gauge combines benefits of 20 and 25 gauge, has better flow rates and maneuverability than 25 gauge, and is considered a potential future gold standard. Smaller gauge systems allow for reduced trauma, faster recovery, and greater flexibility for complex procedures.
Anterior segment OCT & UBM
UBM and ASOCT provide high-resolution cross-sectional images of the anterior segment including the cornea, anterior chamber, angle, and iris. ASOCT uses optical coherence tomography with a wavelength of 1310nm for improved penetration and reduced retinal damage compared to posterior segment OCT. It allows high-speed imaging of dynamic structures. ASOCT has applications in assessing corneal diseases and procedures, glaucoma (including angle anatomy and iridotomy evaluation), and intraocular lens implantation. Measurements of angle width parameters help evaluate angle closure risk. While valuable for objective angle assessment, ASOCT cannot image all anatomical structures involved in glaucoma.
Wound construction For Cataract Surgery
This document discusses different types of astigmatism and incision techniques for cataract surgery. It describes with-the-rule (WTR) astigmatism as having the steepest meridian vertical, against-the-rule (ATR) as having the steepest meridian horizontal, and oblique astigmatism as having the steepest meridian between 120-150 or 30-60 degrees. Temporal and clear corneal incisions are discussed in terms of location, shape, length and their effects on astigmatism. Creating scleral and clear corneal incisions is described step-by-step. On-axis cataract incisions and opposite clear corneal incisions can
Newer IOLs
This document discusses the evolution of intraocular lenses (IOLs) from early generations implanted in the 1950s to newer IOL designs. It covers generations I-VI of IOLs and their complications. Newer IOL designs discussed in more detail include aspheric, multifocal, accommodative, toric, phakic and aniridia IOLs. The benefits and limitations of different IOL materials and designs are presented.
AS OCT & UBM - Dr Shylesh B Dabke
This document compares and contrasts AS-OCT (anterior segment optical coherence tomography) and ultrasound biomicroscopy (UBM) imaging techniques for evaluating the anterior eye segment.
It discusses that AS-OCT provides non-contact, high resolution cross-sectional imaging of the anterior segment structures without touching the eye. UBM uses high frequency ultrasound to generate detailed 2D images of the anterior segment, allowing visualization of structures like the iris and angle.
While both techniques allow qualitative and quantitative assessment of the anterior chamber angle and structures, AS-OCT has advantages of being non-contact, faster imaging, and less operator dependency compared to UBM. However, UBM can image deeper into the posterior iris and has greater penetration than
Nonpenetrating glaucoma surgery
This document discusses non-penetrating glaucoma surgery techniques that facilitate the drainage of aqueous humor through the trabecular meshwork and Schlemm's canal without opening the anterior chamber. It describes several procedures including deep sclerectomy, viscocanalostomy, canaloplasty, ab-externo trabeculectomy, and laser trabecular ablation. The goal is to bypass the highest resistance point to outflow in the juxtacanalicular meshwork. Advantages include lower risks of complications like hypotony compared to penetrating surgeries. Indications and contraindications are provided for various non-penetrating glaucoma procedures.
Diagnosis of pre perimetric glaucoma
This document discusses the diagnosis of pre-perimetric glaucoma. It begins by defining pre-perimetric glaucoma as optic nerve abnormalities seen on structural tests with normal visual fields. It then discusses the need for early diagnosis before functional changes occur. Various functional tests are described like standard automated perimetry, short wavelength automated perimetry, frequency doubling technology, and others. Structural tests like confocal scanning laser ophthalmoscopy, optical coherence tomography, and their principles are summarized.
RECENT ADVANCES IN INTRAOCULAR LENS
1) Intraocular lenses (IOLs) are artificial lenses implanted during cataract surgery to replace the clouded natural lens and correct vision. 2) IOLs have evolved over generations from rigid PMMA lenses to modern foldable designs made of silicone, acrylic, or hydrogel materials. 3) IOLs can be mono-focal, providing a single vision correction, or multi-focal, attempting to provide both near and distance vision without glasses. Accommodating IOL designs also aim to restore the eye's ability to focus at different distances.
Corneal topography
The cornea is the main refractive element of the eye, contributing 70% of the eye's refractive power. Even minor changes to its shape can significantly alter the image formed on the retina. The cornea has an elliptical anterior surface and a circular posterior surface. It varies in thickness from center to periphery. Corneal topography is used to map the shape of the cornea using various techniques such as Placido disk, elevation-based, and Scheimpflug imaging. Topography provides quantitative data on corneal curvature, thickness, and irregularities that aid in diagnosing conditions like keratoconus.
Intra Ocular lens
The document provides an overview of intraocular lenses (IOLs). It discusses the history and definition of IOLs, the generations of IOLs, parts of an IOL, IOL designs, materials, and properties. It also covers IOL placement sites, power calculation, complications like posterior capsular opacification, and recent advances in premium IOLs including multifocal, accommodative, and toric lenses.
Iol power And IOL power calculation
Detailed and to the point seminar on Optical biometry and IOL power calculation-very useful for ophthalmologists
Keratoconus
Keratoconus is a non-inflammatory thinning of the cornea that causes it to take on a conical shape. It typically develops in adolescence and causes vision impairment due to irregular astigmatism. It is classified into four stages based on refractive error, corneal thickness and shape. While the exact cause is unknown, theories include genetic and enzymatic factors. It is often associated with eye rubbing and connective tissue disorders. Clinical features include corneal thinning, Fleischer's ring, Munson's sign, and scarring in advanced cases. Diagnosis involves topography, pachymetry and biomicroscopy to detect corneal shape changes.
Types of vitrectomy ,indication s and complications
The document discusses types of vitrectomy, including pars plana vitrectomy and minimally invasive transconjunctival vitrectomy. It also covers indications for vitrectomy such as macular diseases, complications of anterior segment surgery, diabetic retinal detachment, and complex retinal detachment. Complications of vitrectomy include postoperative cataract, glaucoma, retinal breaks and detachment, vitreous hemorrhage, and endophthalmitis.
Vitrectomy
Here we oresent in short the basics of vitrectomy, machine and procedure, indications and complications.
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Vitreous substitutes
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
Glaucoma drainage devices
Glaucoma drainage devices (GDDs) work by creating an alternate pathway for aqueous outflow from the anterior chamber through a silicone tube to a plate under the conjunctiva where fluid is absorbed. The Ahmed valve and Baerveldt implant are two commonly used valved and non-valved devices, respectively. The Ahmed valve uses silicone leaflets to allow one-way flow above a certain pressure threshold, while the Baerveldt implant relies on a fibrous capsule formation around its plate for resistance to outflow. GDDs are indicated for refractory glaucoma when other surgeries have failed.
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Dr Somdutt Prasad also known as Dr Som Prasad shows the process of conducting anterior vitrectomy during APACRS 2015.
Mgmt of pcr
This document discusses posterior capsule tears that can occur during cataract surgery. It covers the predisposing factors, mechanisms, identification, and management strategies for posterior capsule tears with or without vitreous loss. Key points include identifying tears early, stabilizing the anterior chamber with viscoelastic, deciding whether to continue phacoemulsification or convert to extracapsular extraction based on the situation, performing anterior vitrectomy when needed with caution to minimize further vitreous disturbance, and properly placing an IOL. The goal is to remove all lens material and prevent further complications while minimizing additional surgery.
Nucleus drop
1) A nucleus drop occurs when part or all of the lens nucleus falls into the vitreous cavity during cataract surgery. It has a low incidence rate of around 0.3%.
2) Risk factors include preexisting conditions like pseudoexfoliation or zonular weakness, as well as complications during surgery such as tears in the posterior capsule or zonules.
3) Definitive management involves a pars plana vitrectomy to remove the dropped nucleus and any remaining vitreous gel. This helps minimize complications like uveitis, glaucoma, or retinal detachment.
Lamellar keratoplasty
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
Multifocal iols
Multifocal IOLs provide both near and distance vision without glasses by utilizing concentric zones of different optical powers (refractive MFIOLs) or diffractive properties to split light between two focal points. While eliminating need for glasses, they can cause visual side effects like glare and reduced contrast sensitivity. Careful patient selection and counseling, accurate biometry and surgical technique are important for successful multifocal IOL implantation outcomes.
Biometry
This document discusses biometry, which involves measuring the eye to determine the ideal intraocular lens power for cataract surgery. It notes that biometry errors are the second most common cause of claims in cataract malpractice cases. It describes various techniques for measuring the corneal curvature and axial length of the eye, including manual and automated keratometry, ultrasound A-scan, and optical biometers. It also discusses considerations for biometry in special cases and different intraocular lens calculation formulas.
MIVS
This document summarizes information about different gauge vitrectomy systems including 20 gauge, 23 gauge, and 25 gauge. It provides details on the instrumentation, techniques, advantages and disadvantages of each system as well as indications for microincision vitrectomy surgery. Key points include that 23 gauge combines benefits of 20 and 25 gauge, has better flow rates and maneuverability than 25 gauge, and is considered a potential future gold standard. Smaller gauge systems allow for reduced trauma, faster recovery, and greater flexibility for complex procedures.
Anterior segment OCT & UBM
UBM and ASOCT provide high-resolution cross-sectional images of the anterior segment including the cornea, anterior chamber, angle, and iris. ASOCT uses optical coherence tomography with a wavelength of 1310nm for improved penetration and reduced retinal damage compared to posterior segment OCT. It allows high-speed imaging of dynamic structures. ASOCT has applications in assessing corneal diseases and procedures, glaucoma (including angle anatomy and iridotomy evaluation), and intraocular lens implantation. Measurements of angle width parameters help evaluate angle closure risk. While valuable for objective angle assessment, ASOCT cannot image all anatomical structures involved in glaucoma.
Wound construction For Cataract Surgery
This document discusses different types of astigmatism and incision techniques for cataract surgery. It describes with-the-rule (WTR) astigmatism as having the steepest meridian vertical, against-the-rule (ATR) as having the steepest meridian horizontal, and oblique astigmatism as having the steepest meridian between 120-150 or 30-60 degrees. Temporal and clear corneal incisions are discussed in terms of location, shape, length and their effects on astigmatism. Creating scleral and clear corneal incisions is described step-by-step. On-axis cataract incisions and opposite clear corneal incisions can
Newer IOLs
This document discusses the evolution of intraocular lenses (IOLs) from early generations implanted in the 1950s to newer IOL designs. It covers generations I-VI of IOLs and their complications. Newer IOL designs discussed in more detail include aspheric, multifocal, accommodative, toric, phakic and aniridia IOLs. The benefits and limitations of different IOL materials and designs are presented.
AS OCT & UBM - Dr Shylesh B Dabke
This document compares and contrasts AS-OCT (anterior segment optical coherence tomography) and ultrasound biomicroscopy (UBM) imaging techniques for evaluating the anterior eye segment.
It discusses that AS-OCT provides non-contact, high resolution cross-sectional imaging of the anterior segment structures without touching the eye. UBM uses high frequency ultrasound to generate detailed 2D images of the anterior segment, allowing visualization of structures like the iris and angle.
While both techniques allow qualitative and quantitative assessment of the anterior chamber angle and structures, AS-OCT has advantages of being non-contact, faster imaging, and less operator dependency compared to UBM. However, UBM can image deeper into the posterior iris and has greater penetration than
Nonpenetrating glaucoma surgery
This document discusses non-penetrating glaucoma surgery techniques that facilitate the drainage of aqueous humor through the trabecular meshwork and Schlemm's canal without opening the anterior chamber. It describes several procedures including deep sclerectomy, viscocanalostomy, canaloplasty, ab-externo trabeculectomy, and laser trabecular ablation. The goal is to bypass the highest resistance point to outflow in the juxtacanalicular meshwork. Advantages include lower risks of complications like hypotony compared to penetrating surgeries. Indications and contraindications are provided for various non-penetrating glaucoma procedures.
Diagnosis of pre perimetric glaucoma
This document discusses the diagnosis of pre-perimetric glaucoma. It begins by defining pre-perimetric glaucoma as optic nerve abnormalities seen on structural tests with normal visual fields. It then discusses the need for early diagnosis before functional changes occur. Various functional tests are described like standard automated perimetry, short wavelength automated perimetry, frequency doubling technology, and others. Structural tests like confocal scanning laser ophthalmoscopy, optical coherence tomography, and their principles are summarized.
RECENT ADVANCES IN INTRAOCULAR LENS
1) Intraocular lenses (IOLs) are artificial lenses implanted during cataract surgery to replace the clouded natural lens and correct vision. 2) IOLs have evolved over generations from rigid PMMA lenses to modern foldable designs made of silicone, acrylic, or hydrogel materials. 3) IOLs can be mono-focal, providing a single vision correction, or multi-focal, attempting to provide both near and distance vision without glasses. Accommodating IOL designs also aim to restore the eye's ability to focus at different distances.
Corneal topography
The cornea is the main refractive element of the eye, contributing 70% of the eye's refractive power. Even minor changes to its shape can significantly alter the image formed on the retina. The cornea has an elliptical anterior surface and a circular posterior surface. It varies in thickness from center to periphery. Corneal topography is used to map the shape of the cornea using various techniques such as Placido disk, elevation-based, and Scheimpflug imaging. Topography provides quantitative data on corneal curvature, thickness, and irregularities that aid in diagnosing conditions like keratoconus.
Intra Ocular lens
The document provides an overview of intraocular lenses (IOLs). It discusses the history and definition of IOLs, the generations of IOLs, parts of an IOL, IOL designs, materials, and properties. It also covers IOL placement sites, power calculation, complications like posterior capsular opacification, and recent advances in premium IOLs including multifocal, accommodative, and toric lenses.
Iol power And IOL power calculation
Detailed and to the point seminar on Optical biometry and IOL power calculation-very useful for ophthalmologists
Keratoconus
Keratoconus is a non-inflammatory thinning of the cornea that causes it to take on a conical shape. It typically develops in adolescence and causes vision impairment due to irregular astigmatism. It is classified into four stages based on refractive error, corneal thickness and shape. While the exact cause is unknown, theories include genetic and enzymatic factors. It is often associated with eye rubbing and connective tissue disorders. Clinical features include corneal thinning, Fleischer's ring, Munson's sign, and scarring in advanced cases. Diagnosis involves topography, pachymetry and biomicroscopy to detect corneal shape changes.
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Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
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Vitreous
This document provides information on the anatomy and diseases of the vitreous humor. It discusses that the vitreous humor is a jelly-like structure that fills the back of the eye and provides support. Common diseases include vitreous liquefaction, detachment, hemorrhage, and opacities. Vitreous liquefaction is the most common degenerative change and causes floaters. Posterior vitreous detachment often occurs in older individuals and may lead to retinal tears or breaks. Vitreous opacities can result from inflammatory cells, aggregates, tumors or hemorrhages. Vitreous hemorrhage usually stems from retinal vessels and can cause vision loss.
Mivs
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Aaberg jr surgical management for diabetic retinopathy 2014
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This document summarizes key aspects of chandelier endoillumination techniques for vitrectomy surgery. It discusses refinements in surgical instruments, wide-angle viewing systems, and endoillumination systems that have driven increased use of minimally invasive vitrectomy surgery (MIVS). Specific chandelier fibers and instrumentation from various manufacturers are presented. Tips for optimizing chandelier illumination settings are provided from literature references. Enhancements in tissue visualization through dye staining, gas/oil use, and color filters are discussed. The evolution of higher resolution probes and need for adequate illumination with smaller gauges is summarized. Considerations for patient selection with ocriplasmin treatment are highlighted.Treatment of retinal detachment
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Final Vitrectomy gray group
A 39-year-old woman with a 10-year history of bilateral uveitis and vision loss in her right eye was taking medications including Humira, Durezol, and Timolol drops. A review study assessed whether pars plana vitrectomy improved vision, reduced disease, or ameliorated cystoid macular edema in 1575 uveitis patients. The study found that 68% of patients experienced improved vision, 20% unchanged, and 12% worsened after vitrectomy. Vitrectomy may also reduce systemic medication use and inflammation, but methodological weaknesses prevent conclusions about its effectiveness. Further randomized studies are needed.
Malignant glaucoma
Classic malignant glaucoma is a rare complication of incisional surgery for angle-closure glaucoma where the anterior chamber shallows due to forward movement of the iris-lens diaphragm despite increased intraocular pressure. It can occur in eyes with or without glaucoma and may be triggered by laser treatment, miotics, or trabeculectomy. Treatment involves reducing pressure and vitreous volume medically or surgically with vitrectomy. Definitive management is phacoemulsification, intraocular lens implantation, and removal of the posterior capsule during vitrectomy.
Pentacam and topography
The document discusses corneal tomography parameters and their significance in evaluating post-refractive surgery eyes and detecting ectatic disorders. It provides normal values and characteristics for pachymetry, keratometry, sagittal and elevation maps, and other Pentacam parameters. Abnormal findings that may indicate conditions like keratoconus and pellucid marginal degeneration are also described.
Posterior segment complications of refractive surgery
This document discusses various posterior segment complications that can occur after refractive eye surgery procedures like LASIK and lens-based refractive surgeries. It describes complications such as retinal detachments, macular hemorrhages, macular holes, choroidal neovascular membranes that have been reported after LASIK. It also discusses complications for lens-based refractive surgeries like perforated globe, suprachoroidal hemorrhage, dropped nucleus, cystoid macular edema, macular phototoxicity, retinal detachment, and endophthalmitis. Risk factors and management strategies for many of these complications are provided. The document concludes with recommendations for refractive surgeons to help prevent or properly manage some of these complications.
Vitreous
This document summarizes the development and structure of the vitreous humor in the eye. It discusses how the vitreous develops in three stages - primitive, secondary, and tertiary vitreous - beginning in the first month of gestation. It describes the layers and parts of the vitreous, including the hyaloid layer, cortical vitreous, and central vitreous. It also outlines the attachments and zones of the vitreous within the eye.
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Similar to Anterior vitrectomy
Manual small incision cataract surgery
Manual small incision cataract surgery (MSICS) is presented as a lower cost alternative to phacoemulsification for cataract removal. MSICS involves making a 5.5mm scleral incision and using manual techniques to express the nucleus through the incision without ultrasound. The procedure is described in 18 steps, including continuous curvilinear capsulorrhexis, hydrodissection, and expression of the nucleus. MSICS provides many advantages of modern cataract surgery like rapid recovery time and minimal induced astigmatism at a lower cost than phacoemulsification by using simpler equipment and techniques.
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This document discusses posterior capsule tears that can occur during cataract surgery. It covers the predisposing factors, mechanisms, identification, and management strategies for posterior capsule tears with or without vitreous loss. Key points include identifying tears early, stabilizing the anterior chamber with viscoelastic, deciding whether to continue phacoemulsification or convert to extracapsular extraction based on the situation, performing anterior vitrectomy when needed with caution to minimize further vitreous disturbance, and properly placing an IOL. The goal is to remove all lens material and prevent further complications while minimizing additional surgery like vitrectomy.
CCC.pptx
The document discusses key steps in phacoemulsification surgery including wound construction, continuous curvilinear capsulorhexis (CCC), and hydrodissection. It describes how the incision location and size determines outcomes like maintenance of the anterior chamber and risk of astigmatism. For CCC, it outlines using trypan blue, grasping capsule flaps with forceps, and completing a centered circular tear. Hydrodissection involves lifting the anterior capsule, injecting balanced salt solution to separate the lens from the capsule, and tapping the lens to release trapped fluid.
Vitrectomy: Development And Steps
This document provides an overview of vitrectomy, including a brief history, the key steps in a simple vitrectomy procedure, and descriptions of the equipment used. It discusses trocars and cannulas, sclerotomies, illumination sources, viewing systems, vitreous cutters, and vitreous removal. Advantages of smaller gauge vitrectomy instruments are also summarized.
Phacoemulsification part 3
This document provides information on various techniques for phacoemulsification cataract surgery. It discusses wound construction including clear corneal, limbal, and scleral incisions. It also covers capsulorhexis, hydrodissection, hydrodelineation, and different techniques for phacoemulsification of the nucleus including divide and conquer, shear, and prechop methods. The key steps and advantages of different intraocular procedures are outlined in detail.
Nucleus drop - SN
This document discusses management of complications that can occur during cataract surgery including posterior capsule tears and dropped nuclear fragments. It notes that early intervention by a vitreoretinal surgeon is important to achieve a good visual outcome. The vitreoretinal surgeon should perform an anterior vitrectomy to clear the wound and place an IOL if possible. Delaying surgery risks higher complications so intervention within 2 weeks is recommended when possible.
Intracapsular Cataract extraction
This document describes the intracapsular cataract extraction (ICCE) technique. It was widely used for about 100 years before modern extracapsular techniques. ICCE involves rupturing the zonules to remove the entire lens and capsule through the corneal incision. It is now rarely used as it has been replaced by extracapsular techniques. The document outlines the steps of ICCE including conjunctival flap preparation, corneoscleral incision, lens delivery methods like cryoextraction, and closure. Postoperative care and potential complications are also discussed.
Traumatic Cataract.pptx
Traumatic cataracts are caused by blunt or penetrating ocular trauma and can form immediately or years later. The majority require surgery. Factors like mechanism of injury, lens morphology, integrity of structures like the capsule and zonules, and presence of other ocular injuries must be considered for surgical planning. Cataract extraction techniques may include phacoemulsification, extracapsular extraction, or lensectomy depending on the case. Postoperative care involves managing complications and determining appropriate intraocular lens placement. Prognosis depends on initial findings and injuries per the Ocular Trauma Score.
Vitreoretinal complications during transition to flacs
This document discusses femtosecond laser-assisted cataract surgery (FLACS). It describes how femtosecond lasers work using ultrashort pulses to precisely cut tissue with minimal collateral damage. The major advantages of FLACS include reduced ultrasound energy needed for phacoemulsification and more precise capsulotomies and incisions. However, risks include increased anterior capsule tears due to the learning curve. The document also discusses techniques for managing complications like posterior capsule rupture, including performing limited anterior vitrectomy through the capsular opening or pars plana vitrectomy ports.
Vitreoretinal complications during transition to FLACS
This document discusses femtosecond laser-assisted cataract surgery (FLACS). It describes how femtosecond lasers work using ultrashort pulses to precisely cut tissue with minimal collateral damage. The major advantages of FLACS include reduced ultrasound energy needed for phacoemulsification and more precise capsulotomies and incisions. However, risks include increased anterior capsule tears due to the learning curve. The document also discusses techniques for managing complications like posterior capsule rupture, including performing limited anterior vitrectomy while maintaining a closed system to minimize vitreous loss.
EVISCERATION, ENUCLEATION, EXENTRATION, CYCLODESTRUCTIVE PROCEDURES
The document discusses four surgical procedures for removing an eye: evisceration, enucleation, exenteration, and cyclodestructive procedures. Evisceration involves removing the contents of the eye while leaving surrounding structures intact. Enucleation is the removal of the entire eye while leaving surrounding orbital contents intact. Exenteration is the removal of the entire orbital contents, including extraocular muscles. The document provides details on indications, techniques, advantages, and disadvantages of each procedure.
MIVS 2018
This document discusses microincision vitrectomy surgery (MIVS) using smaller gauge instruments for vitreoretinal surgery. It describes the historical development of vitrectomy from larger 20 gauge systems to newer 23, 25, and 27 gauge systems. Key aspects of MIVS instrumentation and techniques are summarized, including trocar/cannula systems, self-sealing wound construction, challenges with smaller gauges, and advances in vitrectomy machines and illumination systems to improve efficiency and safety with MIVS.
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.
PHACO STEP.pptx
The document outlines the key steps of phacoemulsification cataract surgery:
1. Site marking and time out are performed to identify the operative eye and review patient details.
2. A clear cornea incision and paracentesis are created to access the anterior chamber.
3. A continuous curvilinear capsulorrhexis is performed to remove the anterior capsule.
4. Hydrodissection and hydrodelination are used to separate the nucleus from surrounding tissue.
5. The nucleus is rotated, sculpted, cracked, chopped, grasped and emulsified using phacoemulsification.
6. Irrigation and aspiration are used to remove softer lens material and prepare for
Management of cataract
The document summarizes techniques for managing cataracts through both extracapsular and intracapsular lens extraction. Phacoemulsification using small incisions and foldable intraocular lenses is now the mainstay technique. Larger incision techniques are used for dense cataracts. Specific techniques are described for iris management, vitreous presentation, and intraocular lens implantation depending on whether the lens capsule is removed. Complicated cases involving zonular dehiscence, uveitis, or compromised epithelium require modified approaches to protect delicate eye tissues and structures.
Trabeculectomy
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
RETINAL DETACHMENT SURGERY 2.pptx
This document provides guidelines for the management of retinal detachment. It discusses various treatment options including scleral buckling, pneumatic retinopexy, and vitrectomy. Scleral buckling involves conjunctival dissection, muscle slinging, cryotherapy or laser retinopexy around retinal breaks, placement of explants or an encircling band, and drainage of subretinal fluid. Pneumatic retinopexy uses an intraocular gas bubble to reattach the retina in cases of uncomplicated retinal detachment from superior breaks. Vitrectomy allows visualization and treatment of all retinal breaks through a pars plana approach using microinstruments under microscope visualization.
The anophthalmic socket
This document discusses the anatomy and management of the anophthalmic socket. It begins by defining an anophthalmic socket as an orbit lacking an eye globe, usually due to enucleation. True anophthalmia can be congenital or acquired. The most common causes of acquired anophthalmia are enucleation, exenteration, or evisceration performed to treat painful, blind eyes or remove tumors. The document outlines techniques for each procedure and discusses complications that can arise like socket contracture and management strategies like grafting. It emphasizes the importance of socket maintenance with conformers and prosthetics to prevent complications. In summary, this document provides an overview of anophthalmic socket anatomy,
CATARACT-SURGERY.pdf
Cataract surgery involves removing the cloudy natural lens and replacing it with an artificial lens. The standard and most common method is phacoemulsification, which uses ultrasonic vibrations to emulsify and remove the lens. Other older methods include extracapsular extraction, which removes the lens through a larger incision, and intracapsular extraction, which removes the entire lens and capsule. Femtosecond laser-assisted cataract surgery uses a laser for some steps but outcomes are not clearly better than traditional surgery. The most common complication is posterior capsular opacification but it can be treated with a laser capsulotomy.
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
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Vitreoretinal complications during transition to flacs
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This document provides guidance on properly measuring and prescribing glasses prescriptions. It emphasizes the importance of accurately measuring the pupilary distance (IPD) to avoid issues like decentration, tilt and induced astigmatism. It also discusses evaluating and correcting for accommodation, prescribing readers and bifocals, managing anisometropia and presbyopia, and using glasses to treat strabismus and amblyopia. Key points are measuring IPD before trials, testing reading function, and advising patients on minimizing decentration through small frames.
Corneal laceration repair tips
This document provides 5 tips for improving visual outcomes after repair of a corneal laceration:
1. Use antibiotic prophylaxis by injecting antibiotics through the wound.
2. Use amniotic membrane overlay for severely lacerated wounds to promote healing and reduce inflammation.
3. For traumatic cataracts with an open anterior capsule, carefully remove lens material from the anterior chamber to avoid dropping lens fragments or vitreous prolapse.
4. Provide refractive correction and consider amblyopia therapy. Determine refractive error through trial lenses, topography, or binocular trials if there is corneal opacity.
5. Thank God for the advice and cases presented on improving outcomes after corneal laceration repair.
Keratoconus refraction
The document provides guidelines for determining the best glasses prescription for patients with keratoconus based on their topography patterns, including starting with the least minus sphere and small cylinder to maximize vision while minimizing distortion, using binocular trials to account for changes from torsion and accommodation, and considering anisometropia and ways to improve binocularity. It discusses different approaches for central cone, oval cone, snowman, and peripheral cone patterns identified on topography.
Ophthalmology Slides revision
This document provides a summary of key information from an ophthalmology slides review presentation, including:
1. Questions about patient presentations covering topics like right proptosis, dacryocystocele, xanthelasma, trachoma, stye, pterygium, glaucoma, congenital glaucoma, esotropia, anisocoria, leucocoria, ptosis, visual acuity testing, and refractive errors.
2. Images are included and questions ask about identifying features like central retinal artery occlusion and optic nerve damage.
3. Disease processes, signs, affected structures, and causative organisms are discussed for conditions like chalazion, corneal ulcer,
Simple uveitis 2
This document summarizes different types of posterior uveitis and retinal vasculitis, including their causes, signs, symptoms, investigations, and treatment. It discusses various white dot syndromes such as multifocal choroiditis, birdshot choroidopathy, and acute macular neuroretinitis. It also covers specific conditions like toxoplasmosis, tuberculosis, frosted branch angiitis, and viral retinitis. Treatment often involves corticosteroids, immunosuppressants, antivirals, and laser photocoagulation depending on the underlying etiology.
Simple uveitis 1
1) This document summarizes different types of uveitis including anterior uveitis, intermediate uveitis, and granulomatous anterior uveitis. It discusses various etiologies and presentations of each type.
2) Treatment recommendations are provided for each condition including topical and systemic medications as well as surgical interventions if needed. Conditions like tuberculosis, toxoplasmosis, sarcoidosis, Behcet's disease, and others are addressed.
3) The author argues that secularism does not answer existential questions about the meaning of life. While it promotes ideas of freedom and rationality, it does not provide spiritual guidance and can lead people to make wrong choices by thinking they have freedom
Ocular manifestations of multiple sclerosis
This document discusses optic neuritis (ON), a neurological disorder causing inflammation and degeneration of the central nervous system. ON is characterized by multifocal lesions that are disseminated in space and time, and can cause afferent and efferent lesions as well as uveitis. It affects females more than males on average at age 30 and in white individuals. Symptoms include diminished vision worsened by temperature, flashes, pain with eye movement, and variable visual acuity and color vision changes. Examinations may reveal retinal nerve fiber layer abnormalities, visual field defects, and MRI/OCT/VEP changes. Treatment involves steroids to accelerate recovery along with monitoring for risk of multiple sclerosis.
Pachychoroid
This document discusses various topics related to pachychoroid disease including:
1. Key findings on imaging include a thickened choroid, dilated choroidal vessels, and choroidal hyperpermeability. Common symptoms include blurred vision and metamorphopsia.
2. Potential causes include hypertension, tobacco use, corticosteroid use, and emotional stress. Treatment depends on severity but may include stopping exacerbating factors, observation, laser treatment, photodynamic therapy, or anti-VEGF injections.
3. The document describes several subtypes of pachychoroid disease including central serous chorioretinopathy (CSCR), pachychoroid pigment epitheliopathy, poly
Qual è la fine della nostra vita ?
Perché siamo stati creati? Cosa dobbiamo fare in questa vita? Siamo stati creati solo per mangiare, bere e divertirci? Perché dobbiamo morire? Dove andremo dopo la morte?
Keratotorus pellucid marginal degeneration
Pellucid marginal degeneration is a type of corneal ectasia that is different in diagnosis and treatment from keratoconus
What is Islam ?
This document summarizes some of the core beliefs and teachings of Islam:
1) Muslims believe in one God, Allah, who is the creator. Allah sent prophets like Abraham, Moses, Jesus, and Muhammad (who is considered the final prophet) to deliver his messages to humanity.
2) Other core beliefs include angels, holy books revealed by Allah, the Day of Judgment when humans will return to Allah, and that Allah controls all aspects of life.
3) The five pillars of Islam that Muslims follow are the shahadah (declaration of faith), salah (prayer), zakah (charity), sawm (fasting during Ramadan), and hajj (
Early Keratoconus detection
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Diabetic retinopathy
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Glasses prescription in children
Summary of guidelines to glasses prescription in children and difference between refraction and prescribing in children and in adult
Chest X ray in 10 seconds
1) To summarize a chest x-ray, check that the x-ray is in the proper position with anatomical markers on the left side. Evaluate the view (PA or AP), penetration, and degree of inspiration shown.
2) Examine the airway and mediastinum for width, the bones for abnormalities, and the cardiac shadow for size and position.
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Anterior vitrectomy
- 2. Anterior VitrectomyAnterior Vitrectomy · Mohamed Zaki (M.Sc) · Tanta University
- 3. Aim · Prevent intra/post-operative vitreous traction · Leave a clean anterior segment · IOL implantation
- 4. Event · * PCT · * Zonular dialysis
- 5. 1- Once you suspect Keep irrigation till inject methyl Vitreous flow from high to low pressure
- 6. 2- Keep the AC formed The anterior vitrectomy should be done through tight paracentesis (not the main wound) Make new paracentesis to fit bare vitrector shaft using original side-port for irrigation
- 7. 3- Don’t sweep vitreous from the wound Traction on the anterior vitreous is dangerous because of the strong, permanent vitreoretinal adherence at the vitreous base
- 8. · The vitreous cutter should be used to amputate any posterior connection to wound entrapped vitreous. · OVD can be used to reposit vitreous through the incision
- 9. 4- Adjust machine parameters · High cutting rate · Lowest effective flow and vacuum · Irrigation → cut → aspiration
- 10. Irrigation Cutting Vacuum Anterior vitrectomy Low bottle hight (to maintain normotension) High 600 - 2500 / min Low (150 – 250 mm Hg) Lensectomy Low 300 / min
- 12. 5- Technique 1. The irrigation is placed in the AC directed towards the AC angle 2. The vitrector is placed through the capsular tear directed to the optic nerve with the aspiration port facing up . 3. The cutter should be maintained in a central position and not moved peripherally to avoid stress on the vitreous base. 4. The vitreous is removed to a level just posterior to the capsule
- 13. 5 -the cutter is moved forward into the capsular bag. The remaining lens matter is removed with the cutter, reducing the cut rate to 300 cuts/min and increasing vacuum. 6- The cortex is then engaged, using the vacuum-only setting of the cutter, and stripped off the capsule..
- 14. · The cutter should be held stationary while suction is applied to reduce traction; · The cutter tip should always be in view when activated.
- 15. video
- 16. End point : no vitreous in the AC & no vitreous in the bag · * rounded pupil · * Clean incision · * Sweep infusion canula from angle to angle · *Instill air or triamcinolone and rinse away.
- 18. TAAC · Diluted 1 : 10 · Should be completely removed by end of case ( IOP )
- 20. Types of anterior vitrectomy Bi manual Coaxial Dry ( small amount of vitreous) Parsplana anterior vitrectomy (single pars plana port )
- 21. Coaxial · Easy but may increase the tear · Irrigation is directed to the vitreous lead to more prolapse.
- 22. Pars plana Anterior vitrectomy · More efficent particularly in extensive prolapse · Used also in traumatic lens sublaxation or angle closure glaucoma. · Cutter should be visualized , surgeon should be familial with the technique
- 24. Residual cortex · After completeing anterior vitrectomy · Dry technique · Or : with the vitrectomy cutter set to : · I / A / cut
- 25. Conclusion • Maintain a closed chamber • Separate the infusion from the cutter • Use a low bottle height • Use a high cut rate • Use low to moderate aspiration • Identify any vitreous remaining with triamcinolone stain • Preserve the capsule