This document discusses various types of cataracts and examination findings related to cataracts. It begins with descriptions and images of different types of cataracts such as hypermature, morgagnian, rosette, lamellar, and posterior subcapsular cataracts. It then discusses examination considerations for cataracts in young patients. Other sections discuss findings related to diabetic cataracts, types of glaucoma that can result from cataracts, different intraocular lenses, and complications after cataract surgery.
This ppt describe about the incidence, diagnosis and management of maculopathy in caaes of pathological myopia.
Data collected and created by Vivek Chaudhary
For queries : vivek977optom@gmail.com
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.[
Clinical and dermographics profile of glaucoma patients in Hebron - Palestin...Riyad Banayot
ABSTRACT
BACKGROUND: The purpose of the study was to describe the clinical profile of glaucoma types, treatment modalities, visual outcomes, and intraocular pressure (IOP) control for patients in Palestine.MATERIAL AND METHODS: Data collection was done through the hospital record review, which included basic demographics including file number, age, sex, family history of glaucoma, history of anti-glaucoma and steroid medication, history of ocular trauma or surgery, etiology of secondary glaucoma and history of systemic illness. All the patients had a comprehensive eye examination, including visual acuity, intraocular pressure, vertical cup-disc ratio, and gonioscopy. Data were obtained, tabulated, and organized using Microsoft Excel, and statistical analyses were done using Wizard Version 1.9.49 by Evan Miller.RESULTS: There were 100 females with a mean age of 53 and 101 males with a mean age of 67. Primary open-angle glaucoma and its variants represented 45.3% of all patients, while secondary glaucoma represented 40.3% and primary angle closure glaucoma represented 10.4%. The prevalence of glaucoma increased with age, and the last visual acuity (VA) showed that 39.2% of eyes had Normal/near normal VA. The highest average IOP of 25 mm Hg was recorded among secondary glaucoma patients. Of all glaucoma eyes studied, 64% were on one or two medications, and the most common surgical procedures performed were peripheral iridectomy 18.2% followed by trabeculectomy 15.5%. CONCLUSION: Primary open-angle glaucoma (POAG) was the predominant glaucoma. Glaucoma increased significantly with advancing age. Pseudoexfoliation and neovascular glaucoma comprised the majority of secondary glaucoma.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Use of digital retinal camera to detect prevalence and severity of diabetic ...Riyad Banayot
ABStrAct
BAckGround: The purpose of this study was to determine the prevalence of diabetic retinopathy among Palestinian
refugees serviced by the Diabetic Retinopathy Screening Program in the Occupied Palestinian Territories (DRS-
-OPT).
MAterIAl And MethodS: This is a retrospective study of retinal images of 1891 diabetic patients in 15 urban
UNRWA clinics participating in the DRS-OPT program in Palestine over 12 months. A nonmydriatic Canon CR-2
fundus retinal camera was used to capture two 450 non-stereo fundus images for each eye. Qualified graders (nurses)
performed the grading based on the DRS-OPT grading system.
reSultS: Out of the 1891 diabetic patients screened, 1694 had at least one gradable eye. 16% of patients had
diabetic retinopathy (5.7% had mild nonproliferative diabetic retinopathy, 4.3% had moderate nonproliferative
diabetic retinopathy, 1.1% had severe, moderate nonproliferative diabetic retinopathy, and 1.7% had proliferative
diabetic retinopathy. Maculopathy without retinopathy amounted to 3%. Other findings included the identification
of blinding diseases such as age-related macular degeneration and optic disc glaucomatous cupping.
concluSIonS: The retinopathy screening program using a nonmydriatic fundus camera identified diabetic retino-
pathy in 16% of diabetic Palestinian refugees. A total of 72% of these patients were diabetics with nonproliferative
retinopathy. This program can be used to prevent progression by facilitating the education of patients and early
intervention.
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
Ophthalmologists may be the first to consider the diagnosis of Alport’s Syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery during which time IOP should be monitored closely. Results of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport’s Syndrome.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
9. In a young patient
With bilateral cataract. Look for:
Atopic dermatitis (examine the face)
Diabetic mellitus (examine fundus for DR)
Retinitis pigmentosa (examine fundi for
pigmentary changes)
Myotonic dystrophy (note the typical facies of
frontal balding, bilateral ptosis and delayed
muscle relaxation)
With unilateral cataract. Look for:
Fuch's heterochromic uveitis
Trauma
Chronic uveitis
Retinal detachment
10. There is a significant shift in the fluid
content of the normal lens probably
related to the accumulation of sorbitol
inside the diabetic lens.
The result is:
Myopia or
Rapid formation of subcapsular granular
cataract also called the snowstorm cataract.
11. Nuclear sclerotic cataract.
The increased density of the nucleus
increases the refractive index, and as a
result the patient develop myopia.
As a result, patients who previously
needed plus lenses for reading, find that
they can now read without glasses.
12. Phacomorphic glaucoma: Cataract can
increase the lens size causing shallowing of
the anterior chamber and angle closure
Phacolytic glaucoma: Lens protein leaks
form the lens and elicits a macrophagic
response. The inflammatory material blocks
the flow of aqueous through the trabecular
meshwork
Phacoantigenic uveitis: This is caused by
lens protein released through a ruptured
lens capsule causing a granulomatous
inflammation
13. A posterior chamber
lens showing
YAG capsulotomy
An anterior chamber
lens in an eye with
complicated cataract
operation showing
hazy cornea. This is
pseudophakic
bullous keratopathy
An iris clip lens (Binkhorst
lens). This lens is not
longer favored due to the
risk of iritis, lens
dislodgement and
corneal decompensation
14. Capsulorrhexis provides a stronger edge
and allows phacoemulsification to be
carried out safely.
The implant can be held more securely
and gives a better centration.
15. Ideally, if the lens were to be placed in
the sulcus, the power of the lens (with
the same A constant) is reduced by 1/2 D
from that calculated pre-operatively.
In this case, the focal point is moved
anteriorly, and the patient becomes
myopic.
16. Cystoid macular edema = Irvine-Gass syndrome.
Typically seen 4-8 weeks following the cataract
extraction.
More common after
intracapsular than extracapsular cataract extraction.
vitreous loss
presence of iris or vitreous incarceration.
Treatment is controversial and the great majority
improves without treatment.
Treatment options include:
Topical steroid or non-steroidal anti-inflammatory medications.
Acetazolamide is often given and is believed to reduce the macular
edema.
Predisposing factors:
Iris or vitreous incarceration
Freeing the iris and vitrectomy can improve the edema.
17. • There is a circular
imprint of pigment
on the anterior
capsule from
the iris.
• This may result
from previous
posterior
synechiae or
trauma (Vossiu's
ring).
• It is of no visual
significance.
18. • Rosette cataract.
• This is typical of
traumatic cataract
resulting from blunt
injury.
• The cataract begins
in the subcapsular
region and with time
become buried in
the cortex.
• Vision is usually
reduced.
19. • There is a star
shaped opacity in
the anterior
subcapsular area.
• This is seen in
patient on
chlorpromazine for
more than 2 years.
• Vision may be
normal as this type
of cataract seldom
causes significant
visual impairment.
20. An aphakic eye with broad
iridectomy and peripheral
iridectomy.
An aphakic eye with
corneal edema as a
result of vitreous touch.
21. The patient may be wearing thick lenses or
contact lenses.
In intracapsular cataract extraction, there is
usually iridectomy and the presence of vitreous
in the anterior chamber (examine the cornea for
any decompensation due to vitreous touch).
Some patients may have extracapsular cataract
extraction without implant (for example in clear
lens extraction for high myopia).
In young children with aphakia, consider:
Lens dislocation such as Marfan's syndrome
Cataract extraction in juvenile chronic arthritis, look for
cells and flare in the anterior chamber and band
keratopathy.
Direct ophthalmoscopy on a high myopic patient
with aphakia requires relatively low minus
(concave) power on the ophthalmoscope.
22. Image magnification
Spherical aberration
A “jack-in-the-box”
ring scotoma
Reduced visual field
Physical inconvenience
Cosmetic appearance
30%
Pin cushion effect
Prismatic effect
Weight of glasses
Eyes appear large
23. An phakic eye which is myopic with an
axial length of 31mm is equal to -21D.
Clear lens extraction can fully correct a
myopic eye measuring -21D.
24. A subluxated lens in the
superior nasal direction.
(Marfan's syndrome)
Arachnodactyly (long
fingers) in a Marfan's
patient
High arch palate in a
Marfan's patient
25. If the eye is not dilated:
Iridodonesis (abnormal tremor of the iris)
Phacodonesis (abnormal movement of the lens)
Deep AC depth or vitreous herniation into AC.
Signs of Marfan's syndrome
Superior nasal subluxation of the lens; Arachnodactyly;
High arch palate; Arm span longer than height
In homocystinuria:
Downward subluxation of lens; Same features as
Marfan's syndrome; Patient tends to be mentally
subnormal and may have fair hair.
In Weill-Marchesani's syndrome:
Mental retardation; short stature; stubby fingers
look for pseudoexfoliation syndrome
look for signs of trauma which is the most
common cause of subluxated lens.
30. The patient has hyper-extensibility of the joint. This is a sign of Ehler-Danlos's
syndrome.
The patient is at risk of lens subluxation.
31. This patient has physical signs of ankylosing
spondylitis (stiff back and kyphosis).
The problems encountered will include:
- Posturing of the patient during operation
- Poorly dilated pupil due to anterior synechiae
32. Right Eye
K1 = 42.75
K2 = 42.50
AL = 21.75 mm
Refraction = - 8.25 D
VA = 6/24
Left EYE
K1 = 42.25
K2 = 42.50
AL = 22.00 mm
Refraction = - 7.55 D
VA = 6/24
• This patient's biometry shows average keratometry readings and axial
lengths but high minus refraction.
• These changes are seen in patients with significant nuclear sclerosis. The
lenses are likely to be large and hard.
• A large lens will give a shallow anterior chamber making capsulorrhexis
difficult for the inexperienced surgeon.
• A hard nucleus increases the phaco time and in the hand of inexperienced
surgeon complications such as corneal edema is increased.
lens
33.
34. Cystic bleb indicating a
functioning trabeculectomy
Adrenochrome pigments on the lower
lid tarsal conjunctiva seen with topical
adrenaline use
35. Physical signs of the treatment the patient is
receiving
Physical signs for possible causes (e.g. PDS,
PXF)
Physical signs indicating the severity of the
condition
Surgery (Traby, tube, iridectomy)
Poor drainage is suggested by an absence of
bleb or a dome-shaped vascularized bleb caused
by subconjunctival fibrosis
Constricted pupil (Pilocarpine)
Heterochromia iridis (Latanoprost)
Adrenochrome (adrenaline)
36. Most common cases of 2ry
OAG
with anterior physical signs are:
Pigment dispersion syndrome
Pseudoexfoliation syndrome
Iridocorneal endothelial (ICE) syndrome
Fuch's heterochromic cyclitis.
37. Advantages:
Reduced post-operative
leakage
Less trauma to the
cornea
Disadvantages:
Smaller bleb
Poorer scleral exposure
Higher chance of button
holes
Advantages:
Better exposure of limbus
More diffuse bleb due to
the lack of a posterior scar
line to limit the extension
of the bleb
Easier technique & less
time
Disadvantages:
Frequent wound leaks
Risk of corneal trauma
38. Low IOPLow IOP
Wound leakage
Patching.
Re-suturing is needed if
leakage fails to stop after
24-48 hours
Excessive drainage
No leakage
Patching may be useful.
Choroidal effusion
Persistent marked
shallowing of AC with
hypotony
If it persists for 10-14
days post-op, surgical
drainage is needed plus
AC reformation.
High IOPHigh IOP
Angle closure glaucoma
Non-patent iridectomy
YAG iridotomy is needed.
Aqueous misdirection
Patent iridectomy
Most cases respond to
medical Rx (cycloplegic,
B-blockers and systemic
Acetazolamide.
failure to Med Rx:
Nd:YAG laser to disrupt
the posterior or anterior
hyaloid if the eye is
phakic or aphakic.
Alternatively, par plana
vitrectomy is useful.
In phakic eye, pars plana
vitrectomy and
lensectomy
39. Age of patient: young more than old
Race of patient: black more than other
races
Type of glaucoma: traumatic, uveitic &
neovascular are more likely to fail
Previous failed surgery
Use of certain topical medication such as
topical adrenaline
40. • The iris and the lens
show dandruff-like flakes.
• The flakes on the lens are
arranged in a bull-eye
fashion with an
intermediate clear zone.
• The corneal endothelium
shows pigment
deposition.
• Retroillumination shows
peripupillary iris
transillumination.
• Look for:
• Traby, OD cupping,
phacodenesis, lens
sublaxation
Pseudoexfoliation syndrome
41. The exact source is unknown.
It may be produced by the epithelium of
the lens and other tissues because the
material is not confined to the eyes.
The condition is thought to be a
generalized disorder of the basement
membrane.
Bio-chemically, the material is made up of
proteoglycan materials and has features of
basement membrane.
Cataract operation does not stop its
production.
42. About 60% of patients with
pseudoexfoliation syndrome develop
secondary open angle glaucoma.
Compared with primary open angle
glaucoma, this type is less responsive to
medical therapy.
Argon laser trabeculoplasty is useful
initially to control the pressure but this is
eventually lost (sometimes abruptly).
Trabeculectomy is useful and has the
same success rate as POAG.
44. Poor pupillary dilatation.
Weak zonules predisposes to zonular
dehiscence. This risk is increased with
vigorous hydrodissection or excessive nucleus
manipulation during Phacoemulsification.
Increased risk of posterior capsular
rupture.
45. Glaucoflecken
Opacities behind anterior
lens capsule resulting from
anterior epithelium necrosis
Laser peripheral
iridotomy usually
situated peripherally &
superiorly
Surgical iridectomy
Eye with previous acute
glaucoma (irregular pupil)
The AC is usually shallow but may be normal in pseudophakia.
The lens contains white opacities anteriorly.
The iris may show atrophy from ischemic changes with irregular pupil which
may react poorly to light.
Peripheral iridotomy is usually present. Assess patency.
46. Not all cases of acute glaucoma are
treated with laser iridotomies.
You may have patients who had had
surgical iridectomies. With a casual
examination, this may be mistaken for
trabeculectomy without a functioning
bleb. The clue to this is the absence of a
scleral flap, glaucoflecken and iris
changes
Examine the opposite eye for
prophylactic treatment whether laser or
surgical.
47. Primary angle closure glaucoma:
The mechanism is due to pupillary block.
The AC is shallow both centrally and peripherally.
Plateau iris syndrome:
The main mechanism is caused by occlusion of the
trabecular meshwork by the anteriorly positioned
peripheral iris.
Patients are younger (fourth or fifth decade of life).
The AC is deep centrally.
Patients with plateau iris syndrome may not respond to
laser iridotomy like primary angle closure glaucoma.
Laser peripheral iridoplasty or miotic therapy may be
needed.
48. Shallow anterior chamber
Hypermetropia
Small corneal diameter
Short axial length of globe
Large crystalline lens
49. Patients with narrow angle may develop
AACG when the pupil is dilated due to
pupillary block.
Provocative tests may be used to identify
the latent cases; the result is positive if
there is 8 mmHg pressure rise in the first
hour.
The provocative test may be:
Physiological: for example the dark room test
in which the pressure of the test is checked
when the pupil becomes dilated in the dark or
Pharmacological with 10% phenylephrine
(which is reversible with thymoxamine)
50. Radial transillumination of the iris in
the midperiphery region. This is seen
with retroillumination. Each area
represents area devoid of pigment
epithelium
Krukenberg's
spindle with diffuse
illumination
Krukenberg's
spindle with
retroillumination
The corneal endothelium contains
vertically orientated deposition of
pigments (Krukenberg's spindle).
The pigment may also be seen on the
iris, lens and the trabecular meshwork
51. Pigment in the trabecular meshwork by
performing gonioscopy
Any peripheral iridoctomies which may be
performed in an attempt to reduce the
production of pigment
look at the patient's glasses, most of this
patients has myopia
Examine the optic disc for cupping
What percentage of patients with PDS
develop glaucoma ? 30%30%
52. Patients with PDS typically shows wide
fluctuation of the intraocular pressures.
The pressure may be normal in the clinic
but can rise quickly following exercise or
pupillary dilatation in the dark.
53. The iris is bowed posteriorly, causing it to
rub against the lens zonules.
This results in the loss of the pigment
epithelium resulting in transillumination
and the endothelium deposition of
pigment.
The vertical orientation of the pigment is
due to conventional current.
54. It equalizes the pressures between the
posterior and anterior chamber and
therefore corrects the posterior bowing of
the iris.
This reduces the rubbing and thus
decreased pigment loss.
55.
56. A tube which enters the anterior chamber through the limbus region. This is a seton
used for glaucoma operation. Molteno's tube is the most commonly used
57. Previous trabeculectomy
Presence of signs indicating the
underlying condition:
Rubeosis iridis
ICE syndrome
58. It is used for refractory glaucoma
Neovascular glaucoma
Previous multiple failed filtration procedures
Conjunctival scarring from previous failed
filtration (making the development of a filtration bleb
impossible)
Childhood glaucoma in which primary
procedures have failed
59. All setons contain a tube and a plate.
The tube is inserted into the anterior
chamber to drain the aqueous and is
made up of either silicone or silastic.
The plate forms the reservoir for the
drained aqueous and is made up of
plastic or silicone.
The main difference between different
setons is in the design of plates.
60. Excessive drainage leading to hypotony.
Modification through valve insertion has
been made to the tube and plate to make
the seton pressure-dependent.
61. There is iris atrophy with corectopia and polycoria
Iridocorneal endothelial syndrome (ICE)
62. The eye may have previous glaucoma
operation
The cornea may show signs of
decompensation with corneal edema.
The endothelium shows guttate-like
changes
A tube in the anterior chamber
Signs of glaucoma in posterior segment
63. The main abnormality is in the corneal
endothelium appears like the epithelium.
The endothelium becomes several layer
thick and spreading over the TM and iris
causing:
Glaucoma
Iris distortion
The cause is unknown.
64. Essential iris atrophy: There is progressive
angle closure by:
peripheral anterior synechiae
Corectopia, polycoria and iris atrophy. T
he changes are the results of pulling by the
endothelium.
Iris naevus syndrome (Cogan-Reese):
Angle changes are as above
Diffuse naevus covering the anterior iris.
Iris nodules may or may not be present. The
nodules are the results of iris stroma protruding
through the abnormal endothelium growing over the
iris.
Chandler's syndrome falls between the above
two entities.
66. Seton tube in the anterior chamber which
may be used to treat this condition
Examine the posterior segment;
Central retinal vein occlusion
Diabetic retinopathy
67. This is neovascular glaucoma secondary
to ischaemic central retinal vein
occlusion.
69. Small keratic precipitates scattered throughout the corneal endothelium (stellate
keratic precipitates). Fuch's heterochromic cyclitis
70. The iris may show:
Hhypochromia (best seen in the day light)
Iris transillumination due to iris atrophy
There may be irregular fine vessels on the iris
The patient may have posterior subcaspular
cataract
The anterior chamber may have flare or cells
The conjunctiva is white
NO Posterior synechiae
The iris may contain abnormal iris vessels
Check for the presence of trabeculectomy
71. Uveitis:
This tends to be chronic and not responsive to
steroid.
Steroid may increase the risk of glaucoma and
cataract
Glaucoma:
May respond initially to medical treatment
Trabeculectomy is usually needed.
Bleb failure is common. Antimetabolites is
recommended
Cataract:
Extraction and heparin surface-modified IOL is
usually successful.
72. Pre-operatively:
the pupil may not dilate well due to iris
atrophy
Peri-operatively
Hyphema from the abnormal iris vessels is
common (Amsler's sign)
What is the average refractive power of the lens ?
15 D
A radius of curvature of the cornea is 8 mm and refractive indices are 1 (air) and 1.33 (cornea, aqueous and vitreous).
An aphakic eye has an anterior focal distance of 23 mm, and the posterior focal distance of 31 mm.
The management depends on the underlying cause
Corectopia: distorted pupil
The anterior chamber may contain cells, flare or even hyphaema.