pars plana vitrectomy for lens nucleus drop with video demonstration. Vitreo retinal surgery, ophthalmology, residency training presentation, cataract surgery commplications,
oECCE with posterior chamber intraocula lens implantation achieves results equal to phacemulsification in expert hands and has been an accepted method of cataract surgery.
strabismus , gaze , ocular movements , classification etc
presented by senior optometrist & orthoptician at Sagarmatha Choudhary Eye Hospital, SCEH, LAHAN (NEPAL )
He explain details about the binocular gaze , EOMs, etc & work up of a patient of squint etc.
visual acuity testing in children is challenging
VEP, OKN,PLT etc
CARDIFF, BOEK CANDY, WORTH IVORY BAAL, STYCAR
HOTV , MINIACTURE TOY TEST
SHEREDN GARED
SNELLEN CHART
ETDRS CHART
LOGMAR CHART
these are charts used in ophthalmology in pediatric age group
cover test
uncover test
alternate cover
hirschburg corneal light reflex test
10 D verticle prism bar test
Cscr ( central serous chorioretinopathy )Vinitkumar MJ
What is the difference between disc odema & papillodema ?
Enumerate causes of papillodema ? & management of that ?
what is macular hole
what is CSCR
WHAT IS macular odema ?
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
2. TYPES OF CATARACT SURGERY
• Intra Capsular Cataract Extraction (ICCE)
• Extra Capsular Cataract Extraction (ECCE)
• Small Incision Cataract Surgery (SCIS)
• Phacoemulsification
ECCE
ICCE
7. DETAILS OF EACH TECHNIQUE
• ICCE
• ECCE
• SICS
• PHACO
• PHACONIT
• FEMTO LASER CATARACT EXTRACTION
8. Intra capsular cataract extraction (ICCE)
ICCE
ICCE evolved into a very successful operation
Preferred surgical technique before the refinement of modern ECCE surgery
However there remained 5% rate of potentially blinding complications including:
Infection
Hemorrhage
RD
CME
9. ECCE has replaced ICCE, almost entirely in most parts of the world:
1. Better operating microscopes
2. More sophisticated surgical aspiration systems
3. More sophisticated IOL implants
Intra capsular cataract extraction (ICCE)
10. Techniques (ICCE)
Smith’s method
Arruga’s method
Erysiphakes
Cryo surgery
Chemical dissolution of zonular fibers
11. Smith’s technique
Smith used external pressure with muscle hook to mechanically break the inferior
zonules
Expelled the lens through the limbal incision
The lens would “Tumble”, I.e. the inferior pole would exit the eye before the
superior pole
12. Arruga’s method
Toothless forceps (Arruga’s) used to grasp the lens capsule and
then gently pulled from the eye using side-to-side motion that
broke the zonules
14. Cryo surgery
Cryprobe: Hollow metal-tipped probe, cooled by liquid nitrogen, that is touched
to the lens surface
As the temperature of the probe tip falls below freezing, an ice ball forms and the
lens adheres to it
This instrument forms an ice ball, fusing the lens capsule, cortex, and nucleus
Lessening the risk of capsular rupture as the cataract is removed
15. Extra capsular cataract extraction (ECCE)
Shift from ICCE to modern ECCE
To decrease the rate of potentially blinding:
Complications
To facilitate the placement of PC IOLs
By leaving the PC intact, the surgeon could decrease the risk of:
Vitreous loss and
Complications like RD, CME, and Bullous Keratopathy
16. Extra capsular cataract extraction (ECCE)
Key to the development of modern ECCE technique were the
growing use of:
Operating microscopes for increased magnification &
Improved methods of cortical removal
17. Extra capsular cataract extraction (ECCE)
Charles Kelman in 1967 developed phacoemulsification
This new type of ECCE:
Ultrasonically emulsified the lens nucleus,
Allowing the operation to be performed through a small incision
This method has continued to grow in popularity as:
Techniques &
Instrumentation
18. Indications of ICCE
Operating microscopes not available
Unstable / luxated cataracts
Week zonular support
19. Advantages of ICCE
Cryoprobes
Capsular forceps
Erysiphakes
Allow this procedure
To be performed
Under most conditions
• Entire lens removed with no capsule left behind to:
• Opacify or
• Require additional surgery
• Less sophisticated instrumentation required
• Non automated extraction devices:
20. Disadvantages of ICCE
Delayed healing
Iris incarceration
Delayed visual rehabilitation
Vitreous incarceration
• Large ICCE incision 12 – 14 mm (160 - 180)
• Postoperative wound leaks with inadvertent filteration
• Endothelial cell loss > following ICCE than ECCE
• Corneal / endothelial cell trauma from lifting / folding
of the cornea (lens delivery / cryprobe)
• Cystoid macular edema (transient 50%, persistent 2%
- 4%)
21. Vitreous complications:
In young patients PC is firmly adherent to anterior
hyaloid; attempted ICCE will usually result in vitreous loss
Intact vitreous face may opacify and vision
Adherence to corneal endothelium (corneal edema)
Adherence to iris (pupillary block glaucoma)
Broken vitreous face may incarcerate in the wound with vitreous traction
causing:
RD
CME
Vitreous in AC causing open angle glaucoma
Disadvantages of ICCE (cont’d)
22. IOL implantation problematic since posterior capsular support missing
IOL choices include:
ACL /Sutured PC IOL (Iris fixation IOLs no longer available)
These significant disadvantages and risks led to loss of popularity of ICCE
Disadvantages of ICCE (cont’d)
23. Patient preparation
Pharmacologic pupillary dilation with topical mydriatic and cycloplegic
agents to facilitate lens removal (iris retractors intraoperatively)
Anaesthesia
24. Patient preparation
Orbital massage / osmotic agents (manitol, glycerine, isosorbide) before surgery
1. Intermittent digital pressure on closed eye lids or
2. Occulopressive device (honann baloon, mercury bag, sponge ball, strap)
3. Massage helps to:
Distribute the anaesthetic agent within orbit
Orbital volume
Pressure on the globe
IOP
(cont’d)
25. Patient preparation
Orbital massage (cont’d)
4. Minimizes vitreous prolapse during cataract extraction and facilitates an angle supported IOL
5. Osmotic agents are used less frequently:
Volume load in patients with heart and kidney failure
Nausea (Occasional)
Urinary urgency during surgery
(cont’d)
26. Procedure
Postoperative course
VA should be consistent with:
1. Refractive state of the eye
2. Clarity of the cornea
3. Clarity of the media
4. Visual potential of the retina and optic nerve
Patient preparation (cont’d)
27. ECCE
ECCE involves removal of the nucleus and cortex through an opening in the
anterior capsule (anterior capsulotomy), leaving the posterior capsule in
place.
Patient preparation (cont’d)
29. ECCE (cont’d)
Methods
Preferred method of routine cataract surgery
Selection of technique for nucleus removal depends upon:
Instrumentation available
Surgeon’s level of experience with each technique
Patient preparation (cont’d)
30. Advantages of ECCE surgery
Smaller incision
Less traumatic to corneal endothelium
Eliminates complications (short and long term) associated with
vitreous adherent to:
Incision wound
Iris
Cornea
(cont’d)
31. Advantages of ECCE surgery
Intact posterior capsule allows better anatomical position for IOL fixation
Intact posterior capsule incidence of:
CME
RD
Corneal edema
(cont’d)
32. Advantages of ECCE surgery
Intact posterior capsule ability of bacteria, introduced into eye, to gain access to vitreous cavity and
cause endophthalmitis
2ndry IOL implantation
Filtration surgery
Corneal Transplantation
Wound rapair
Technically easier and safer when
intact PC is present
(cont’d)
33. Contraindications (ECCE)
Zonular weakness
ECCE requires zonular integrity for selective removal of nucleus and cortical material
Therefore when zonular support appears insufficient to allow safe removal of the
cataract through ECCE surgery, ICCE or Pars Plana Lensectomy should be considered
34. Instrumentation (ECCE)
A wide range of instruments is available for each step of ECCE:
Opening the anterior capsule
Dissecting and removing the nucleus
Removing the lens cortex
Polishing PC
35. Cystotome
Used for anterior capsulotomy (opening in the anterior of the lens)
Fashioned from 25 gauge needles by bending at its hub and beveled tip
Prefabricated cystotomes also commercially available
The needle tip is used to puncture and tear the anterior capsule
36. Irrigation and aspiration system coaxial, double-lumen
blunt cannulas
One lumen irrigates BSS into the AC
Second lumen aspirates lens material out of the AC
Irrigation is gravity fed from a solution bottle
Fluid flow is regulated with adjustment of bottle height
The flow may be constant, or the surgeon can employ a foot control connected to
a pinch valve
37. Irrigation and aspiration system coaxial, double-lumen blunt
cannulas (cont’d)
Aspiration:
Syringe connected to the cannula
Elaborate pump system controlled by a foot switch
38. Lens nucleus
Removed by a variety of techniques, each
with its own set of instruments:
Lens expressor
Lens loop
Spoon, Vectis
39. Procedure ECCE
Pupillary dilation
Critical to the success of ECCE esp. phacoemulsification
Cycloplegic / mydriatic drops
NSAID (topical/oral) these agents help to maintain dialation during surgery
40. Procedure ECCE
Incision
Incision: Mid limbal, chord length 8 – 12 mm, which is smaller than for ICCE
The initial incision consists of a limbal groove
Some surgeons prefer more posterior incision with anterior dissection creating a flap of tunnel
A stab incision is made into AC
AC depth stabilized by viscoelastic agents, air bubble, or continuous fluid irrigation
Cystotome is inserted for anterior capsulotomy
(cont’d)
42. Procedure ECCE
Capsulotomy (cont’d)
Christmas tree
With cystotome anterior capsule punctured inferiorly and
The flap of the capsule drawn toward the wound and cut with scissors
(cont’d)
44. Procedure ECCE
Capsulorrhexis
Continuous tear anterior capsulotomy popular in phacoemulsification, can be performed with either:
Csytotome or
Capsulorrhexis forceps
First a small tear is created,
The edge this tear is then grasped with cytotome tip/forceps, and
A smooth tear is created, removing a circular portion of anterior capsule
(cont’d)
45.
46. Procedure ECCE
Capsulorrhexis (cont’d)
This technique provides:
Structural integrity for the lens capsule
Maintain implant stability
Centeration
(cont’d)
49. Posterior capsular polishing
Abrasive tipped irrigation cannula / low vacuum clean using low
aspiration remove epithelial and cortical particles from the capsular
surface
50. IOL implantation
AC filled with viscoelastic / BBS / air
Viscoelastic most reliable AC maintainer
It also protects corneal endothelial
IOL inserted in the ciliary sulcus / capsular bag
Sulcus fixation:
Requires greater IOL diameter (>12.5 mm)
Large diameter optic (6 mm)
More forgiving in case of postoperative decentration
Bag fixation:
IOL diameter <12.5 mm
Optic diameter 5.00 mm
52. Postoperative course ECCE
As with ICCE, VA on the first postoperative day should be consistent
with:
Refractive state of the eye
Clarity of the cornea
Clarity of the media
Visual potential of the retina and optic nerve
53. Postoperative course ECCE
Lid: Mild eye lid edema and erythema may occur
Conjunctiva: May be injected and boggy
Cornea: Should be clear and free of striate / edema
AC: Should be of normal depth and mild cellular
reaction typical
54. Postoperative course ECCE (cont’d)
Posterior capsule: Should be clear and intact
Implant: Should be well positioned and stable
Red reflex: Should be strong and clear
IOP: Elevations may be associated with retained
viscoelastic
55. Postoperative course ECCE
Antibiotics and Corticosteroids:
Topical antibiotic and corticosteroids are used for first few weeks
Vision:
Steady improvement in vision and comfort, as inflammation subsides
56. Postoperative course ECCE (Cont’d)
Refraction:
Refraction stable by 6th – 8th weeks,
Glasses may then be prescribed
Astigmatism:
If significant astigmatism along the axis of incision, selective sutures removed by 6th week, according to
keratometry corneal topography
57. Phacoemulsification
Phacoemulsification is an ECCE technique that differs from “standard ECCE
with nuclear expression” by the:
1. Size of incision required
2. Method of nucleus removal
This technique uses ultrasonically driven needle (phaco tip) to fragment the
nucleus and aspirate the lens substance through a needle port
58. Phacoemulsification (cont’d)
Advantages
Lower incidence of wound related complications
Faster healing
Rapid visual rehabilitation
AC depth controlled during surgery and providing safeguards against positive vitreous pressure and
choroidal haemorrhage (closed system)
60. Phacoemulsification (cont’d)
Ultrasound
The phacoemulsification hand piece contains a piezoelectic crystal that vibrates at frequency
of 24000 – 56000 Hz
The vibration is transmitted to the head which is attached to the phaco tip
61. Phacoemulsification(cont’d)
Aspiration
The aspiration system of phacoemulsification machine varies according to the pump design:
1. Peristaltic Pump
2. Diaphragm Pump
3. Venture Pump
62. Phacoemulsification(cont’d)
Aspiration (cont’d)
Peristaltic Pump
Consists of set of rollers that move along a flexible tubing, forcing fluid through the tubing
and creating a relative vacuum at the aspiration port of phacoemulsification needle
65. Phacoemulsification
Irrigation
Fluid dynamics of phacoemulsification requires constant
irrigation through the irrigation sleeve around the
ultrasound tip
Constant irrigation:
Maintains AC depth
Cools the phacoemulsification probe
Prevents heat buildup and adjacent tissue damage