This document discusses approaches to treating paediatric cataracts. It notes that paediatric cataract accounts for 7.4-15.3% of paediatric blindness worldwide. Etiologies include genetic factors, intrauterine infections, metabolic disorders, trauma, and prematurity. A thorough history, ocular exam, and laboratory tests are required to evaluate the cataract and check for associated ocular or systemic abnormalities. Surgical removal is indicated for visually significant cataracts. Challenges of paediatric cataract surgery include performing accurate biometry and intraocular lens power calculations due to the developing eye, achieving a stable anterior chamber, and addressing post-operative aphakia or amblyopia management.
Here are 3 options for very difficult post-graft cases when standard lenses are not working:
1. Try a scleral lens with a large optic zone to vault over the irregularity. This can improve comfort and vision.
2. Consider corneal collagen cross-linking (CXL) to strengthen the cornea followed by intracorneal ring segments (Intacs) to help regularize the shape.
3. As a last resort, a second corneal transplant may be needed to obtain an adequate surface for contact lens wear or improve vision. However, the success rate decreases with subsequent grafts.
The key is finding the best option to improve vision and comfort while protecting the ocular surface long-term. A
MYOPIA , basics , causes , types and treatmentssuserde6356
Myopia, also known as near-sightedness and short-sightedness, is an eye disease[5][6][7] where light from distant objects focuses in front of, instead of on, the retina.[1][2][6] As a result, distant objects appear blurry while close objects appear normal.[1] Other symptoms may include headaches and eye strain.[1][8] Severe myopia is associated with an increased risk of macular degeneration, retinal detachment, cataracts, and glaucoma.[2][9]
Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong.[1][10] It is a type of refractive error.[1] Diagnosis is by the use of cycloplegics during eye examination.[11]
Tentative evidence indicates that the risk of myopia can be decreased by having young children spend more time outside.[12][13] This decrease in risk may be related to natural light exposure.[14] Myopia can be corrected with eyeglasses, contact lenses, or by refractive surgery.[1][15] Eyeglasses are the simplest and safest method of correction.[1] Contact lenses can provide a relatively wider corrected field of vision, but are associated with an increased risk of infection.[1][16] Refractive surgeries like LASIK and PRK permanently change the shape of the cornea. Surgeries like Implantable Collamer Lens (ICL) implant a lens inside the anterior chamber in front of the natural eye lens. ICL doesn't affect the cornea.[
This document discusses myopia (nearsightedness), including its definition, types, causes, signs and symptoms, complications, and treatment options. The main types of myopia are axial, curvatural, and index myopia. Causes include genetics, excessive eye growth, and changes in the eye's shape or refractive index. Signs include prominent eyeballs and myopic degeneration in advanced cases. Treatments include glasses, contact lenses, refractive surgery such LASIK, and low vision aids for severe vision loss.
congenital cataract for undergraduate MBBS Students.
Also covers salient points for PGMEE.
Aetiology, clinical features and management discussed in detail.
The document discusses various topics related to contact lenses and corneal treatments including:
1) Edge lift and edge clearance in contact lens design and their effects on tear exchange and lens movement.
2) Corneal topography, its uses in evaluating conditions like keratoconus and fitting contact lenses. Different topography devices are also mentioned.
3) Corneal cross-linking for progressive corneal conditions like keratoconus to strengthen the cornea using riboflavin and UV light. Various techniques and the procedure are outlined.
- Aphakia is the absence of the crystalline lens from the eye. It can be congenital or caused by surgery or trauma.
- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
IOL implantation in the absence of capsular bagcrisnemato
This document discusses options for intraocular lens (IOL) implantation when the eye's natural capsular support is absent. It reviews causes of ectopia lentis and traumatic/surgical aphakia. Three main IOL options are described: scleral fixation, iris-claw fixation, and iris suturing of the IOL. Each option is evaluated based on surgical techniques, published studies, outcomes, complications, and patient factors. The document concludes by proposing protocols for IOL implantation based on individual patient and ocular characteristics to provide the best visual outcomes while minimizing risks of complications requiring long-term follow-up.
This document provides an overview of cataracts in dogs, including:
- The anatomy of the lens and different types of cataracts such as nuclear sclerosis and stages of cataract development.
- Common causes of cataracts like age, diabetes, trauma, and genetics.
- Guidelines for when to refer a cataract case for surgery based on the stage of development.
- Details of the cataract surgery procedure and important aspects of pre- and post-operative care to monitor patients and manage complications.
Here are 3 options for very difficult post-graft cases when standard lenses are not working:
1. Try a scleral lens with a large optic zone to vault over the irregularity. This can improve comfort and vision.
2. Consider corneal collagen cross-linking (CXL) to strengthen the cornea followed by intracorneal ring segments (Intacs) to help regularize the shape.
3. As a last resort, a second corneal transplant may be needed to obtain an adequate surface for contact lens wear or improve vision. However, the success rate decreases with subsequent grafts.
The key is finding the best option to improve vision and comfort while protecting the ocular surface long-term. A
MYOPIA , basics , causes , types and treatmentssuserde6356
Myopia, also known as near-sightedness and short-sightedness, is an eye disease[5][6][7] where light from distant objects focuses in front of, instead of on, the retina.[1][2][6] As a result, distant objects appear blurry while close objects appear normal.[1] Other symptoms may include headaches and eye strain.[1][8] Severe myopia is associated with an increased risk of macular degeneration, retinal detachment, cataracts, and glaucoma.[2][9]
Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong.[1][10] It is a type of refractive error.[1] Diagnosis is by the use of cycloplegics during eye examination.[11]
Tentative evidence indicates that the risk of myopia can be decreased by having young children spend more time outside.[12][13] This decrease in risk may be related to natural light exposure.[14] Myopia can be corrected with eyeglasses, contact lenses, or by refractive surgery.[1][15] Eyeglasses are the simplest and safest method of correction.[1] Contact lenses can provide a relatively wider corrected field of vision, but are associated with an increased risk of infection.[1][16] Refractive surgeries like LASIK and PRK permanently change the shape of the cornea. Surgeries like Implantable Collamer Lens (ICL) implant a lens inside the anterior chamber in front of the natural eye lens. ICL doesn't affect the cornea.[
This document discusses myopia (nearsightedness), including its definition, types, causes, signs and symptoms, complications, and treatment options. The main types of myopia are axial, curvatural, and index myopia. Causes include genetics, excessive eye growth, and changes in the eye's shape or refractive index. Signs include prominent eyeballs and myopic degeneration in advanced cases. Treatments include glasses, contact lenses, refractive surgery such LASIK, and low vision aids for severe vision loss.
congenital cataract for undergraduate MBBS Students.
Also covers salient points for PGMEE.
Aetiology, clinical features and management discussed in detail.
The document discusses various topics related to contact lenses and corneal treatments including:
1) Edge lift and edge clearance in contact lens design and their effects on tear exchange and lens movement.
2) Corneal topography, its uses in evaluating conditions like keratoconus and fitting contact lenses. Different topography devices are also mentioned.
3) Corneal cross-linking for progressive corneal conditions like keratoconus to strengthen the cornea using riboflavin and UV light. Various techniques and the procedure are outlined.
- Aphakia is the absence of the crystalline lens from the eye. It can be congenital or caused by surgery or trauma.
- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
IOL implantation in the absence of capsular bagcrisnemato
This document discusses options for intraocular lens (IOL) implantation when the eye's natural capsular support is absent. It reviews causes of ectopia lentis and traumatic/surgical aphakia. Three main IOL options are described: scleral fixation, iris-claw fixation, and iris suturing of the IOL. Each option is evaluated based on surgical techniques, published studies, outcomes, complications, and patient factors. The document concludes by proposing protocols for IOL implantation based on individual patient and ocular characteristics to provide the best visual outcomes while minimizing risks of complications requiring long-term follow-up.
This document provides an overview of cataracts in dogs, including:
- The anatomy of the lens and different types of cataracts such as nuclear sclerosis and stages of cataract development.
- Common causes of cataracts like age, diabetes, trauma, and genetics.
- Guidelines for when to refer a cataract case for surgery based on the stage of development.
- Details of the cataract surgery procedure and important aspects of pre- and post-operative care to monitor patients and manage complications.
Complex cases in Cataract surgery and its management.pptxMadhumitaBooks
Complex case scenarios in Cataract surgery. Small pupil , hard Cataract, posterior polar Cataract, Fuch's endothelial dystrophy, run away rhexis. Management of complicated Cataract.
The document discusses the pre and post operative management of cataract surgery. It covers preoperative assessment including biometry and lens power calculation. It also discusses anesthesia options and postoperative care including expected visual recovery timelines and managing complications. Key steps in the preoperative, operative, and postoperative periods are outlined to maximize outcomes and identify issues needing attention.
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.
This document provides information about pediatric cataract examination, investigation, treatment and intraocular lens implantation techniques. It discusses:
1. Examination techniques including visual acuity tests, ocular imaging and determining refractive status.
2. Common investigations like blood tests, urine analysis and imaging based on whether the cataract is unilateral or bilateral.
3. Non-surgical treatment options like pupil dilation and occlusion therapy for partial cataracts.
4. Surgical techniques for cataract extraction including limbal and pars plana approaches and considerations for intraocular lens implantation based on the age of the child.
Complex cases in Cataract surgery and its management.pptxDrMadhumita Prasad
In ophthalmology the clinical management of patients is constantly evolving and complication rate is getting low.
Although routine cataract surgery considered as low-risk surgery for both patients and the surgeon, some eyes have higher risk of complications.
It is extremely important to recognize when eyes are at greater risk, and manage accordingly to reduce the complications.
The common goal is to completely remove the cataract while preserving the zonules and capsular bag for the placement of an IOL.
Fuchs’ endothelial corneal dystrophy (FECD) is a condition that affects the corneal endothelium, resulting in a reduction in the number of Na+/K+ ATPase pumps [1]. Clinically, this manifests as corneal edema, which can lead to symptomatic glare and halos, and ultimately decreased visual acuity.
Presentation- blurring of vision (more in the morning hours), glare.
Detection- guttae
Dr. Om Patel presented on myopia (nearsightedness). There are several types and causes of myopia, including axial myopia caused by an elongated eyeball, curvatural myopia from increased corneal or lens curvature, and pathological myopia associated with degenerative changes. Treatment options discussed included optical correction with glasses or contacts, as well as surgical procedures like LASIK, PRK, and phakic intraocular lenses for high myopia. The goal of treatment is to slow progression and provide clear vision.
A 47-year-old male presented with a right lower eyelid lesion for two years that had recently become red and watery. Examination found a 2.7x1.6cm ulcerated, everted lesion of the right lower eyelid. Biopsy found basal cell carcinoma (BCC). The BCC was excised with frozen section-confirmed margins. This created a 30-40% full-thickness eyelid defect that was reconstructed using lateral canthotomy, Tenzel semi-circular flap, and a periosteal flap to reconstruct the posterior lamella. The periosteal flap provided a reliable, vascularized tissue that reduced the risk of ectropion and matched the native eyelid contour.
This document summarizes a case of keratectasia that developed in a patient's right eye following LASIK surgery. Initially, the patient's vision was good in both eyes after bilateral LASIK, but over three years her vision deteriorated in the right eye. Examination revealed irregular corneal contour with inferior thinning and steepening in the right eye resembling keratoconus. This is a case of keratectasia, a serious complication where the cornea bulges out due to weakening from refractive surgery.
This document provides information on keratoconus, a noninflammatory corneal ectasia characterized by progressive corneal thinning and protrusion. It discusses the etiology, pathophysiology, clinical features, diagnosis, and treatment modalities for keratoconus. Treatment options include spectacle correction, contact lenses, intrastromal corneal ring segments, collagen cross-linking, and corneal transplantation if visual correction is no longer possible due to excessive thinning or scarring.
Retinal complications of LASIK- DR AJAY DUDANIAjayDudani1
This document discusses retinal complications that can occur after LASIK surgery. It reports on several cases of retinal detachment and breaks seen after LASIK. Retinal detachments occurred in 0.08-0.25% of cases. The distribution of retinal breaks was primarily in the inferotemporal quadrant. Rare cases of macular hemorrhage were also reported. Choroidal neovascular membranes are related to high myopia itself rather than LASIK. Careful pre-operative examination is important to identify risks like lattice degeneration or lacquer cracks. Proper patient counseling on risks of both LASIK and underlying retinal conditions is concluded to be important.
This document discusses various ocular pathologies and how they affect A-scan biometry readings. It describes how conditions like dense cataracts, posterior staphylomas, macular lesions, retinal detachments, asteroid hyalosis, intraocular foreign bodies, exudative retinal detachment, microphthalmia, post-buckle procedures, and pseudophakia with intraocular air can impact the visualization and measurement of spikes from ocular interfaces. In many cases, these pathologies can make it difficult to distinguish spikes, potentially leading to inaccurate axial length measurements if not accounted for. The document illustrates examples of A-scan readings from patients with several of these conditions.
This document discusses retinal detachment, including the different types (rhegmatogenous, tractional, exudative), symptoms, risk factors, examination findings, diagnosis, treatment options including pneumatic retinopexy, scleral buckling, vitrectomy, and prevention techniques. It also covers traction retinal detachment and exudative retinal detachment, their causes, presentations, signs, and management approaches.
This case report discusses the management of keratoconus in a 24-year-old male. He was referred for contact lens fitting for keratoconus diagnosed 5 years prior in his right eye, which had previously undergone C3R procedure. Topography showed inferior thinning in the right eye. Rose K2 and soft toric lens trials produced good centration and vision. The lenses were ordered and the patient was asked to return for collection. The conclusion discusses recent advances in keratoconus treatment including collagen cross-linking, excimer laser, phakic IOLs, and intrastromal corneal ring segments.
This document provides information on cataract surgery and intraocular lens implantation in dogs. It discusses the structure of the normal eye, different types and classifications of cataracts. It describes various surgical techniques for cataract removal including discission and aspiration, extracapsular extraction, and phacoemulsification. It also covers patient selection, pre-operative care, anesthesia, intraocular lenses, and post-operative care and complications. The goal of cataract surgery is to remove the opaque lens and restore vision through implantation of an intraocular lens.
This document provides information about keratoconus, a non-inflammatory thinning of the cornea that causes a cone-shaped bulge. It is most common in teenagers and young adults. The document discusses the definition, stages, etiology, associations, clinical features, investigations, and management of keratoconus. Keratoconus is typically managed initially with glasses or contact lenses, and more advanced cases may require collagen cross-linking, intracorneal ring segments, deep anterior lamellar keratoplasty, or penetrating keratoplasty to correct vision and stop further thinning. Differential diagnoses include keratoglobus and pellucid marginal degeneration.
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
Complex cases in Cataract surgery and its management.pptxMadhumitaBooks
Complex case scenarios in Cataract surgery. Small pupil , hard Cataract, posterior polar Cataract, Fuch's endothelial dystrophy, run away rhexis. Management of complicated Cataract.
The document discusses the pre and post operative management of cataract surgery. It covers preoperative assessment including biometry and lens power calculation. It also discusses anesthesia options and postoperative care including expected visual recovery timelines and managing complications. Key steps in the preoperative, operative, and postoperative periods are outlined to maximize outcomes and identify issues needing attention.
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.
This document provides information about pediatric cataract examination, investigation, treatment and intraocular lens implantation techniques. It discusses:
1. Examination techniques including visual acuity tests, ocular imaging and determining refractive status.
2. Common investigations like blood tests, urine analysis and imaging based on whether the cataract is unilateral or bilateral.
3. Non-surgical treatment options like pupil dilation and occlusion therapy for partial cataracts.
4. Surgical techniques for cataract extraction including limbal and pars plana approaches and considerations for intraocular lens implantation based on the age of the child.
Complex cases in Cataract surgery and its management.pptxDrMadhumita Prasad
In ophthalmology the clinical management of patients is constantly evolving and complication rate is getting low.
Although routine cataract surgery considered as low-risk surgery for both patients and the surgeon, some eyes have higher risk of complications.
It is extremely important to recognize when eyes are at greater risk, and manage accordingly to reduce the complications.
The common goal is to completely remove the cataract while preserving the zonules and capsular bag for the placement of an IOL.
Fuchs’ endothelial corneal dystrophy (FECD) is a condition that affects the corneal endothelium, resulting in a reduction in the number of Na+/K+ ATPase pumps [1]. Clinically, this manifests as corneal edema, which can lead to symptomatic glare and halos, and ultimately decreased visual acuity.
Presentation- blurring of vision (more in the morning hours), glare.
Detection- guttae
Dr. Om Patel presented on myopia (nearsightedness). There are several types and causes of myopia, including axial myopia caused by an elongated eyeball, curvatural myopia from increased corneal or lens curvature, and pathological myopia associated with degenerative changes. Treatment options discussed included optical correction with glasses or contacts, as well as surgical procedures like LASIK, PRK, and phakic intraocular lenses for high myopia. The goal of treatment is to slow progression and provide clear vision.
A 47-year-old male presented with a right lower eyelid lesion for two years that had recently become red and watery. Examination found a 2.7x1.6cm ulcerated, everted lesion of the right lower eyelid. Biopsy found basal cell carcinoma (BCC). The BCC was excised with frozen section-confirmed margins. This created a 30-40% full-thickness eyelid defect that was reconstructed using lateral canthotomy, Tenzel semi-circular flap, and a periosteal flap to reconstruct the posterior lamella. The periosteal flap provided a reliable, vascularized tissue that reduced the risk of ectropion and matched the native eyelid contour.
This document summarizes a case of keratectasia that developed in a patient's right eye following LASIK surgery. Initially, the patient's vision was good in both eyes after bilateral LASIK, but over three years her vision deteriorated in the right eye. Examination revealed irregular corneal contour with inferior thinning and steepening in the right eye resembling keratoconus. This is a case of keratectasia, a serious complication where the cornea bulges out due to weakening from refractive surgery.
This document provides information on keratoconus, a noninflammatory corneal ectasia characterized by progressive corneal thinning and protrusion. It discusses the etiology, pathophysiology, clinical features, diagnosis, and treatment modalities for keratoconus. Treatment options include spectacle correction, contact lenses, intrastromal corneal ring segments, collagen cross-linking, and corneal transplantation if visual correction is no longer possible due to excessive thinning or scarring.
Retinal complications of LASIK- DR AJAY DUDANIAjayDudani1
This document discusses retinal complications that can occur after LASIK surgery. It reports on several cases of retinal detachment and breaks seen after LASIK. Retinal detachments occurred in 0.08-0.25% of cases. The distribution of retinal breaks was primarily in the inferotemporal quadrant. Rare cases of macular hemorrhage were also reported. Choroidal neovascular membranes are related to high myopia itself rather than LASIK. Careful pre-operative examination is important to identify risks like lattice degeneration or lacquer cracks. Proper patient counseling on risks of both LASIK and underlying retinal conditions is concluded to be important.
This document discusses various ocular pathologies and how they affect A-scan biometry readings. It describes how conditions like dense cataracts, posterior staphylomas, macular lesions, retinal detachments, asteroid hyalosis, intraocular foreign bodies, exudative retinal detachment, microphthalmia, post-buckle procedures, and pseudophakia with intraocular air can impact the visualization and measurement of spikes from ocular interfaces. In many cases, these pathologies can make it difficult to distinguish spikes, potentially leading to inaccurate axial length measurements if not accounted for. The document illustrates examples of A-scan readings from patients with several of these conditions.
This document discusses retinal detachment, including the different types (rhegmatogenous, tractional, exudative), symptoms, risk factors, examination findings, diagnosis, treatment options including pneumatic retinopexy, scleral buckling, vitrectomy, and prevention techniques. It also covers traction retinal detachment and exudative retinal detachment, their causes, presentations, signs, and management approaches.
This case report discusses the management of keratoconus in a 24-year-old male. He was referred for contact lens fitting for keratoconus diagnosed 5 years prior in his right eye, which had previously undergone C3R procedure. Topography showed inferior thinning in the right eye. Rose K2 and soft toric lens trials produced good centration and vision. The lenses were ordered and the patient was asked to return for collection. The conclusion discusses recent advances in keratoconus treatment including collagen cross-linking, excimer laser, phakic IOLs, and intrastromal corneal ring segments.
This document provides information on cataract surgery and intraocular lens implantation in dogs. It discusses the structure of the normal eye, different types and classifications of cataracts. It describes various surgical techniques for cataract removal including discission and aspiration, extracapsular extraction, and phacoemulsification. It also covers patient selection, pre-operative care, anesthesia, intraocular lenses, and post-operative care and complications. The goal of cataract surgery is to remove the opaque lens and restore vision through implantation of an intraocular lens.
This document provides information about keratoconus, a non-inflammatory thinning of the cornea that causes a cone-shaped bulge. It is most common in teenagers and young adults. The document discusses the definition, stages, etiology, associations, clinical features, investigations, and management of keratoconus. Keratoconus is typically managed initially with glasses or contact lenses, and more advanced cases may require collagen cross-linking, intracorneal ring segments, deep anterior lamellar keratoplasty, or penetrating keratoplasty to correct vision and stop further thinning. Differential diagnoses include keratoglobus and pellucid marginal degeneration.
Similar to approach to padiatric cataract 2.pptx (20)
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
ECTROPION^JENTROPION AND THEIR MANAGEMENT 2.pptxHarshika Malik
This document discusses ectropion and entropion of the eyelids, including their causes, types, clinical evaluation, and management. Ectropion is the outward turning of the eyelid margin, while entropion is the inward turning. Involutional ectropion most commonly affects the lower eyelids in elderly patients due to gravitational changes. Management depends on the type but may include procedures to shorten the eyelid or correct underlying issues like laxity of the medial or lateral canthal tendons. Prompt treatment is important to prevent complications such as dry eye or corneal damage.
This document discusses episcleritis and scleritis. Episcleritis involves inflammation of the episclera and is typically benign and self-limiting. Scleritis involves inflammation of the sclera and can be more serious, potentially causing vision loss if untreated. Scleritis is classified as anterior (non-necrotizing or necrotizing) or posterior. Treatment involves topical steroids and NSAIDs for mild cases and systemic steroids and immunosuppressants for more severe or necrotizing forms. Both conditions require treatment of any underlying systemic diseases.
The document discusses the history and evolution of corneal transplantation (keratoplasty) from early experiments in the 18th-19th centuries to modern techniques. Some key events include the first successful human corneal transplant being performed by Eduard Zirm in 1906, the introduction of antibiotics and steroids improving outcomes in the 1940s, and recent advances with femtosecond lasers and other technologies. The document also reviews the various surgical techniques used for corneal transplantation and postoperative care considerations.
The document discusses lamellar keratoplasty, which involves replacing diseased corneal tissue while retaining normal tissue. It describes anterior lamellar keratoplasty (ALKP) and posterior lamellar keratoplasty (PLKP). ALKP replaces varying amounts of anterior corneal tissue, while PLKP replaces the Descemet's membrane and endothelium. The document also discusses indications, surgical techniques like the Anwar bubble technique, and complications for anterior lamellar keratoplasty. Posterior lamellar keratoplasty techniques like DSAEK are described to replace dysfunctional endothelium.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a disorder of the developing retina in premature infants that can lead to blindness if left untreated. It occurs when the retina is incompletely developed and blood vessels grow abnormally.
2) Risk factors include prematurity, low birth weight, excess oxygen exposure, and other medical complications. The pathogenesis involves abnormal vasoproliferation and retinal neovascularization due to disrupted retinal vascular development.
3) ROP is classified based on location within zones of the retina, stage of disease progression from mild to severe, and presence of "plus disease" indicating worse prognosis. Timely screening and treatment can
This document provides an overview of thyroid ophthalmopathy (TED), also known as Graves' ophthalmopathy. It discusses the epidemiology, etiology, risk factors, pathogenesis, clinical signs and symptoms, diagnosis, and management of the autoimmune disease. TED is caused by inflammation and accumulation of fluids in the orbit, raising pressure and causing enlargement of the extraocular muscles and adipose tissue. Symptoms include eye bulging, double vision, and dryness. Management involves treating any thyroid abnormalities, using corticosteroids, radiation, or surgery to address eye involvement and symptoms.
The orbit is a pyramidal space located between the anterior cranial fossa and the maxillary sinuses. It is formed by seven bones and contains the eyeball as well as nerves, blood vessels and extraocular muscles. Proptosis refers to forward displacement of the eyeball. It can be caused by infections, inflammation, vascular abnormalities, tumors or trauma based on characteristics like age of onset and laterality. Evaluation involves inspection of periorbital region and eye examination along with imaging studies and biopsy as needed to identify the cause which guides treatment.
Mechanical ocular trauma can cause a wide range of eye injuries from relatively minor to vision threatening. The document defines standard terminology for different types of eye injuries using the Birmingham Eye Trauma Terminology (BETT) system. It describes closed globe injuries which involve no penetration of the eyewall, open globe injuries which involve penetration of the eyewall, and different types of open globe injuries including globe rupture, penetrating injuries, and perforating injuries. It provides details on mechanisms of injury, clinical findings, examination techniques, and treatment approaches for different injury types.
Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. There are three main types: rhegmatogenous retinal detachment caused by a retinal break, tractional retinal detachment caused by vitreous traction, and exudative retinal detachment caused by fluid accumulation beneath the retina. Rhegmatogenous retinal detachment is usually associated with a retinal break and treated surgically by sealing the break with photocoagulation or cryotherapy and using scleral buckling or vitrectomy to reattach the retina. Tractional and exudative retinal detachments are generally treated with vitrectomy but may also be treated medically or with laser in some cases
The document discusses the anatomy and physiology of ocular muscles. It describes:
1. The intrinsic and extrinsic muscles that control eye movement and pupil size/lens shape.
2. The origins, insertions, innervation and actions of individual muscles.
3. Principles of binocular vision including fusion, stereopsis, prerequisites for development and anomalies like suppression and amblyopia.
4. Types of strabismus like tropia, phoria, pseudostrabismus and their characteristics. Heterophoria is defined and compensated vs decompensated types discussed.
Diabetic retinopathy is a progressive dysfunction of the retinal blood vessels caused by chronic hyperglycemia. It can cause vision loss and blindness if not treated. The risk and severity of retinopathy increases with the duration of diabetes and poor blood sugar control. Early stages are characterized by microaneurysms and hemorrhages, while proliferative stages involve new blood vessel growth. Macular edema can occur at any stage and is a leading cause of vision loss. Treatment includes laser photocoagulation, anti-VEGF injections, and vitrectomy surgery depending on the severity of retinopathy and presence of macular edema. Strict blood sugar and blood pressure control can help prevent and slow the progression of diabetic ret
Optic Neuritis, Papilledema document discusses optic nerve conditions. It defines optic neuritis as inflammation of the optic nerve impairing nerve conduction that can be caused by demyelination, infection, or autoimmunity. Papilledema is defined as bilateral, non-inflammatory swelling of the optic disc due to increased intracranial pressure. The document covers causes, signs, symptoms, diagnostic tests, treatment, and prognosis for both conditions.
The retina is the innermost layer of the eye that contains photoreceptor cells. Retinoblastoma is a malignant tumor that arises from these photoreceptor cells in the retina, most commonly affecting young children under 5 years old. It can be hereditary if caused by a mutation in the RB1 gene, resulting in bilateral and multifocal tumors, or non-hereditary if caused by somatic mutations, usually presenting as a unilateral tumor. Treatment depends on tumor size and extent but may include chemotherapy, local therapies like cryotherapy or brachytherapy, and enucleation of the eye for advanced cases. Early diagnosis and treatment can help preserve vision and life.
Secondary glaucoma is caused by an underlying ocular or systemic disease that leads to increased intraocular pressure and potential vision loss. It can be classified based on the mechanism of pressure rise into open-angle or angle-closure glaucoma. Common causes include lens-induced glaucoma, pigmentary glaucoma, neovascular glaucoma due to retinal ischemia, inflammatory glaucoma, traumatic glaucoma, steroid-induced glaucoma, pseudoexfoliative glaucoma, and glaucoma following cataract surgery. Treatment depends on the underlying cause but may include medications, laser treatment, or surgery to lower pressure and prevent further optic nerve damage.
This document discusses various types of ischemic optic neuropathies including anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). It describes the differences between arteritic AION (caused by giant cell arteritis) and non-arteritic AION, with the former affecting older patients and often causing bilateral simultaneous vision loss. Risk factors for NAION include hypertension, diabetes, and sleep apnea. The document provides details on clinical evaluation, imaging, and management of these vision-threatening conditions.
This document provides information on diseases of the lacrimal apparatus. It describes the anatomy of the lacrimal gland and drainage system. It discusses conditions such as dacryocystitis, which is inflammation of the lacrimal sac. Dacryocystitis can be congenital in infants due to blockage, or adult onset due to infection. Chronic dacryocystitis is more common and can lead to a lacrimal mucocele or pyocoele if left untreated. Surgical treatments like dacryocystorhinostomy are described to repair blockages and restore tear drainage.
The document discusses diseases of the lens, including its anatomy, transparency mechanisms, and types of cataracts. It describes the lens's structure and functions. For cataracts, it covers the differential diagnosis, etiological classification including congenital vs acquired cataracts, and morphological classification. Evaluation, indications for surgery, timing of surgery, intraocular lens power calculation and material selection, surgical techniques, and post-operative rehabilitation are summarized.
The document provides information on diseases of the uveal tract, which includes the iris, ciliary body, and choroid. It describes the anatomy, microscopic structure, blood supply, and functions of each part of the uveal tract. Uveitis, or inflammation of the uveal tract, is also discussed. The signs, symptoms, classifications, complications, and investigations for uveitis are summarized.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
2. PREVALENCE
◦ 1.5 million children blind worldwide.
◦ Paediatric cataract accounts for 7.4%-15.3% of paediatric
blindness.
◦ The prevalence of childhood cataract is about 1.03/10,000
children.
◦ Approx. 40,000 children with cataract in india
3. ETIOLOGY AND ASSOCIATIONS OF
PAEDIATRIC CATARACT
◦ Congenital cataract is associated with
- ocular abnormalities in 27% of cases
- systemic abnormalities in 22% of cases
◦ Most unilateral and a significant number of bilateral
cataracts are idiopathic in nature.
◦ Crystallin and connexin gene mutations are the most
commonly described non-syndromic inherited cataracts.
4. ETIOLOGY OF PAEDIATRIC CATARACT
◦ Idiopathic –M/C
◦ Genetic-congenital cataract is hereditary in 8.3-25% of cases,with 75% being AD in inheritance.
◦ Intra-uterine infections-10-15%(rubella,varicella,toxoplasmosis,herpes simplex).
◦ Metabolic-8-10%(galactosemia,hypocalcemia,hypoglycemia,dehydration)
◦ Trauma-20-30%
◦ Prematurity
◦ Syndromic
7. HISTORY
Parents of child come with following complaints-
1.Failure of response to visual targets
2.White pupillary reflex
3.Lack of fixation
4.Deviated eye
5.Nystagmus
8. HISTORY
Age of onset, duration of symptoms
Maternal history (infection,rash,drug use)
Developmental history, milestones
History of LBW and pre-term delivery
Any history suggestive of any associated systemic
abnormality
Trauma, Previous treatment, or surgery
Family history of congenital cataract and consanguinity
9. VISUAL ASSESSMENT
• PREVERBAL CHILDREN
#Fixation Behavior-fix and follow light,
CSM method
#Preferential looking test
-Teller acuity cards
-Visual evoked potential (VEP)
#Optokinetic nystagmus drum
11. Anterior segment
examination
Slit-lamp Exam / Torch light
Morphology-size,density,location and its laterality
Associated anomalies of cornea,iris and anterior
chamber,pupil
Intraocular pressure/squint/nystagmus
12. Examination of
The Red Reflex
◦ k/c/o Bruckner test
◦ For detection of visual axis
opacities,strabismus,refractive errors and
retinal abnormalities.
◦ Done by DDO
◦ To assess density and morphology of
cataract.
13. Posterior segment
examination
Dilated fundus examination-to look for any post
segment anomaly
R/O vitreous haemorrhage,RD,persistent foetal
vasculature or any intraocular mass in the post
segment
Ultrasound B-scan-if fundus is not visible by IO
14. Visually significant cataract
◦ Centrally or posteriorly located
◦ Size >3mm
◦ Visual acuity < 20/60
◦ Decrease in contrast sensitivity
◦ Increased glare
◦ Loss of stereo acuity
◦ Not able to observe the disc and macula with direct ophthalmoscope,especially on dilated pupil
◦ Congenital sensory nystagmus,strabismus
15.
16. Laboratory Investigations
Complete hemogram
Blood sugar
Urine routine microscopy
Serum calcium and phosphate levels for hyper or hypoparathyroidism.
VDRL for syphilis
Antibody titer for TORCH.
Red cell galactokinase or uridyl transferase for galactosemia
Urine protein for Alport syndrome
Urine amino acid for Lowe syndrome
Urine sodium nitroprusside/ plasma homocysteine for homocystinuria
Urine/serum copper for Wilson disease
Karyotyping for a genetic defect
GA work up
18. NON-SURGICAL
Cataracts not in visual axis
In visual axis but <3mm diameter
Rx-Mydriatrics with part time occlusion of the better eye
But prolonged cycloplegia causes amblyopia-early sx reqd
19. SURGICAL-INDICATIONS
Visually significant cataract-U/L or B/L
U/L dense cataracts
Central and >3mm
Cataract with Strabismus
Cataract with nystagmus or unsteady fixation
One eye operated in a binocular cataract
Poor retinoscopic reflex
20. Small eyes/low scleral
rigidity
Positive pressure/elastic
AC/difficult rhexis
Biometry IOL power
calculation
Increased inflammatory
response/constant
change in refractive error
Glaucoma/amblyopia/gla
sses
Post-op mx of
aphakia/amblyopia
CHALLENGES
21. TIMING OF
SURGERY
Dense visually significant B/L cataract-
6-8 weeks of age (Each eye one week
apart- to prevent amblyopia)
U/L visually significant cataract -4-6
weeks
B/L cataract detected later-surgery as
soon as possible.First on the worse
eye.
22. Techniques of biometry
◦ Hand-held keratometer- lack of fixation and centration
◦ Inaccurate keratometric values-error of 0.8-1.3 D in children
◦ Obtaining multiple readings of the same and recording the
average K reading
◦ K readings without speculum are preferred (causes globe
deformation and gives unreliable readings)
23. Techniques of biometry
◦ Inaccurate AL in paediatric eyes - 4-14 D of error for each
mm difference
◦ For contact A-Scan,the value with maximum AC depth
chosen to offset the inadvertent indentation of the cornea.
◦ Immersion A-Scan is considered gold standard
24. IOL formulae
AL <20mm- SRK/T and the
Holladay 2 formulae
OLDER CHILDREN(>2yrs)
AL<22 MM –Hoffer Q formula
AL>22 MM- Barrett and SRK/T
formulas are better
25. IOL POWER CALCULATION
Aim for moderately hypermetropic postoperative refractive
outcome to compensate for myopic shift which is expected
in children due to axial elongation of the globe.
IOL can be implanted in eyes with an AL >17mm and
corneal diameter >10mm
27. IOL SIZE
In children <2 yrs,smaller size (10-10.5mm)IOL
must be used
Adult size IOL (12-13.5mm) well tolerated in
children >2 yrs d/t elastic nature of the capsule
Optic size-5.5-6.5mm ensures adequate
pupillary coverage in case of decentration
28. IOL MATERIAL
Acrylic Hydrophobic foldable IOL’s – Increased uveal
biocompatibility,reduced post-op inflammation and
PCO rates
Single piece PMMA,preferably heparin coated-
reduce deposits on IOL surface
Children with juvenile rheumatoid
arthritis,microcornea,microphthalmos,severe
persistent foetal vasculature are left aphakic.
29. IOL implantation ??
• IOL IMPLANTATION BEFORE 1 YR OF AGE CONTROVERSIAL
• Difference in size of globe compared to adult eye & rapid growth(AL,corneal curvature,lens
diameter&sulcus size). Unpredictable refractive status
• Technical difficulty of implanting IOL in very small eyes
• Greater inflammatory response
• Secondary glaucoma
• VAO
• Most surgeons prefer implant after 18-24 months of age
• Most of the growth of eye has occurred by this time
• IOL power calculation is more predictable
30.
31. SURGICAL PRINCIPLES
General Anaesthesia and EUA
Lid speculum applied
Superior rectus suture
Wound construction
Anterior capsulorrhexis
Irrigation and aspiration
Primary posterior capsulorrhexis
Anterior vitrectomy
IOL implantation
Closure of wound with a suture
32. General Anaesthesia and
EUA
Systemic co-morbidities
Seizure disorders/developmental
disorders
Corneal diameter/biometry/IOP/IOL
power cal/gonioscopy/pachymetry
R/o NLD obstruction
33. WOUND CONSTRUCTION
◦ LENSECTOMY
◦ -Limbal route/pars plana route
◦ -limbal:preservation of bag/360 capsular
rim for secondary IOL
◦ -pars plana-2 side ports with MVR blade
◦ LENS ASPIRATION WITH PRIMARY IOL
◦ -clear corneal/scleral tunnel
◦ -2.8mm clear corneal main incision-
preferred-foldable IOLs
◦ -5.5mm scleral tunnel-rigid PMMA IOLs
34. Pre-
requisites for
ACC
Adequate pupillary dilatation
Improve visualization-use high
magnification and dim OT lights
Avoid positive vitreous pressure-
pre-op iv mannitol may be reqd
Viscolelastic-highly cohesive,use
liberally
35. Challenges –ACC
◦ A.)VERY ELASTIC CAPSULE-
◦ Deforms without tearing
◦ When it finally tears,the force of the rebound propagates the
tear rapidly and uncontrollably to the periphery
◦ B.)LOW SCLERAL RIGIDITY
◦ Positive vitreous pressure shallowing of ac anterior surface
of the lens becomes convex rhexis runs to periphery
36. C.)DIFFICULT TO USE CYSTITOME
Difficult to advance the everted capsular flap over soft cortex
Less control over rhexis tends to extend
D.)RHEXIS FORCEPS
Better control over rhexis
Utrata chances of AC shallowing as it is passed through main incision
Special end-gripping type of rhexis forceps
Introduced through side-port AC well-maintained
37. Technique-ACC
◦ INITIAL CENTRAL PERFORATION-forceps -bent 26 G needle
◦ REST OF RHEXIS
◦ Forceps only
◦ Centripetal force instead of usual tangential (ripping technique)
◦ Peformed slowly with repeated re-grasping of flap just adjacent to edge of tear to prevent
peripheral extension
◦ Always keep AC well-formed with visco-elastic
◦ Aim for small rhexis size as it enlarges due to elasticity
◦ Ideal size-5-5.5 mm
◦ ACC-smaller than the IOL optic diameter(6mm)
38. ◦ RHEXIS BY RIPPING
◦ Flap pulled perpendicular to rhexis edge(i.e.towards
centre)
◦ Only this method can tear the elastic capsule of children
39. Other options
◦ VITRECTORRHEXIS
◦ Cutting rate 150-300
◦ Aspiration rate 150-200cc/min
◦ 2 incision push-pull technique
◦ -2 small incisions superior & inferior
◦ -grasp the centre of flap of superior
incision & push towards centre-
semicircular tear
◦ -grasp the centre of flap of inferior incision
& pull towards centre-semicircular tear
RADIOFREQUENCY DIATHERMY
CAPSULOTOMY
High frequency current of 500khz
Platinum alloy tip probe heated to 160
F
41. Irrigation and
Aspiration
Nucleus is very soft - Hence NO PHACO ENERGY needed
Bimanual/co-axial probe-faster,maintains AC and prevents hypotony,hence
pupillary miosis.
Remove entire lens matter/cortex
Polish the posterior capsule before PPC.
Membranous /calcified cataracts may require phacoemulsification
42. Primary
posterior
capsulorhexis
Indicated in children <6years
Planned posterior capsulotomy performed
-to prevent inevitable PCO formation
-to remove PC plaque
-to allow posterior capture of IOL optic
-to prevent radial extension when small PC rupture
occurs inadvertently
-to provide more tear resistant edge for anterior
vitrectomy and IOL implantation
44. Technique-PPC
◦ Viscoelastic injected in capsular bag
after cortical clean up-flattens PC by
countering vitreous pressure
◦ Central perforation with cystitome in
front of retrolental space of berger
45. ◦ Central perforation
◦ -26G cystitome descends at a slant
◦ -PC engaged and punctured
◦ -small flap created by pushing margin inferiorly
◦ Small amount of viscoelastic injected into capsular hole
◦ -separates PC from vitreous
◦ -should be done slowly to avoid extension of tear to
periphery
46. ◦ Rhexis commenced with either utrata or end-
gripping forceps
◦ -proceed slowly with repeated re-grasping of the
leading edge in manner similar to anterior rhexis
◦ Rhexis size-
◦ -1.5-2mm smaller than IOL optic to reconstitute
barrier between vitreous and anterior chamber
◦ -too small or too big will prevent IOL optic capture
47. Anterior vitrectomy
Intact anterior vitreous face(AVF) acts as scaffold for lens epithelial cells
to grow-chances of VAO higher
Mandatory in infants and younger children
Maybe deferred in children >7years
Limbal/transconjuctival pars plana approach
Rates of PCO decreases only after AV not PCCC alone in children<6 years
48. CURRENT RECOMMENDATION—
Primary PCCC with AV for children <6-7 yrs of age
Primary PCCC without AV for >7 yrs of age
PC left intact in children >9-10 yrs of age
49. IOL Implantation
o Standard care-over 1 yr of age;infants-controversial?
o Single piece hydrophobic acrylic IOL in the bag;inflate
bag well with healon GV
◦ 3 piece IOL in sulcus
◦ Optic capture
◦ Bag in the lens technique
50. IOL FIXATION SITES
◦ Haptics in bag & optic capture by PCCC
◦ Haptics & optic in bag (if PCCC too large or small for IOL
capture)
◦ Haptics in sulcus & optic capture by PCCC(if incomplete
anterior rhexis but complete PCCC)
◦ Haptics in sulcus & optic capture by anterior rhexis(if
completenanterior rhexis but incomplete PCCC)
◦ Haptic in sulcus & optic in front of anterior capsule (if
incomplete anterior rhexis & PCCC)
51. Wound closure
◦ Wash all viscoelastic!
◦ Look for any peeking of rhexis/pupil-cut vitreous before wound closure
◦ LMW heparin solution(5IU in 500ml) may be used for irrigation to reduce chances of
inflammation
◦ ALWAYS suture all the wounds (low scleral rigidity-not self-sealing wound)
◦ 10-0 vicryl/10-0 monofilament nylon suture
◦ Side ports may be left unsutured in older children if well constructed and no leak at the end of
the procedure
52. Post-op management
◦ Surgery is only the first and the easiest step!
◦ Topical steroids hourly doses tapered gradually
◦ Topical antibiotics broad spectrum
◦ Topical cycloplegics
◦ Oral steroids in special cases
53. Management of aphakia
◦ SPECTACLES
◦ -B/L aphakia
◦ -most children adapt well and develop
good visual responses
◦ -poor quality of vision;increased incidence
of strabismus
◦ Poor cosmesis
◦ CONTACT LENSES
◦ -U/L and B/L aphakia
◦ -RGP/Silicone/hydrogel
◦ -better optical correction;comparable
results to primary IOL implantation
◦ -difficult to insert/costly
◦ -risk of infection/intolerence
54. Management of pseudophakia
◦ Undercorrection-less chances for higher myopic shift
and IOL exchange at later date
◦ Spectacles-given as soon as surgery is done!
◦ Single vision correction for young infants;bifocals for
toddlers;progressive glasses may be considered for
older children
◦ Secondary IOL implantation in the sulcus-for
aphakic cases @ 4-5 yrs of age
56. Amblyopia
◦ U/L cases most difficult to manage
◦ Starts right after surgery-aggressive part time occlusion
◦ B/L cases-check for fixation preference/BCVA at follow up visit and decide for PTO