This document summarizes corneal collagen shrinkage and collagen crosslinking techniques. It discusses how collagen shrinkage was initially used to treat keratoconus through heating methods but had limitations due to necrosis. Collagen crosslinking was developed to strengthen corneal collagen through riboflavin and UV light exposure based on the Dresden Protocol. Variations including accelerated and customized protocols aim to treat thinner corneas and focal disease. While generally safe and effective for keratoconus, complications can include haze, infection, and continued progression requiring proper technique. New applications investigate refractive corrections and other corneal conditions.
Manajemen Komplikasi Silicone Oil Post VitrektomiMeironi Waimir
Silicone oil (Polydimethylsiloxanes) is an artificial liquid that injected into the vitreous cavity with the aim of restoring intraocular pressure and provides intraocular tamponade in vitreoretinal surgery.
Silicone oil has a combination of physical and chemical properties. Physical parameters which affects the function of silicone oil, namely specific gravity, buoyancy, surface tension, and viscosity.
Indications of using silicone oil are retinal detachment with proliferative vitreoretinopathy, giant retinal tears, severe proliferative diabetic retinopathy, macular hole, retinal detachment due to viral retinitis, complicated pediatric retinal detachment, retinal detachment associated with choroidal coloboma, retinal detachment due to trauma, and endophthalmitis.
Complications of using silicone oil are silicone oil entry in subconjunctival space and anterior chamber, glaucoma, chronic hypotony, cataract formation, recurrent retinal detachment, emulsification, and keratopathy.
Management of complications using silicone oil depends on the types of complications that occur.
This journal club discussed a study that evaluated the visual outcomes of binocular implantation of a new extended depth of focus intraocular lens called the Supraphob Infocus IOL. The study aimed to assess the safety and efficacy of this lower cost IOL in patients undergoing cataract surgery compared to the FDA approved TECNIS Symfony IOL. The study found that the Supraphob Infocus IOL provided good visual acuity, contrast sensitivity, and stereoacuity outcomes comparable to the TECNIS Symfony IOL. It also induced less ocular aberrations. Based on its safety, efficacy and lower cost, the study concluded that the Supraphob Infocus IOL can
This document provides an overview of corneal collagen cross-linking (CXL) treatment for keratoconus. It discusses that CXL induces collagen cross-linking through riboflavin and UV light application, increasing corneal biomechanical rigidity. The document outlines indications for CXL including keratoconus, iatrogenic keratectasia, and infectious keratitis. Potential complications are also summarized, such as corneal haze, infection, endothelial damage, herpes reactivation, and treatment failure. The technique of CXL is described involving epithelial removal, riboflavin application, and UVA irradiation.
This document outlines several new treatments and technologies for dry eye disease. It discusses increased expenditures on dry eye medications from 2001-2006 driven by Restasis. Six new tools to treat dry eyes are described, including anterior segment OCT, osmolarity testing, LipiFlow, Inflammadry, Ziena eyewear, and intraductal meibomian gland probes. New artificial tear formulations and the use of diquafosol and cyclosporine for dry eyes are also covered.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
This document discusses potential complications of trabeculectomy, both intraoperative and postoperative. Intraoperative complications include buttonholing of the conjunctiva, scleral flap tears, lens injury, vitreous prolapse, hyphema, and suprachoroidal hemorrhage. Postoperative complications can be early such as hypotony, elevated intraocular pressure, choroidal effusions or late such as thin blebs, infections, and cataracts. Management strategies are provided for addressing complications depending on the specific issue.
Ocular surface disease (OSD), commonly known as dry eye, affects 25 million people in the US and costs $3.8 billion annually. It causes ocular discomfort and vision problems. The main causes include aging, climate, genetics, medications, LASIK, and work environment. Secondary OSD can be caused by conditions like Sjogren's syndrome, rheumatoid arthritis, thyroid dysfunction, and diabetes. Diagnosis involves questionnaires, dye tests, meibomian gland expression, and newer tests of tear osmolarity, meibography, and biomarkers. Treatment depends on whether the dry eye is aqueous deficient or due to meibomian gland dysfunction (MGD). For MGD, treatments focus on lid
This document summarizes corneal collagen shrinkage and collagen crosslinking techniques. It discusses how collagen shrinkage was initially used to treat keratoconus through heating methods but had limitations due to necrosis. Collagen crosslinking was developed to strengthen corneal collagen through riboflavin and UV light exposure based on the Dresden Protocol. Variations including accelerated and customized protocols aim to treat thinner corneas and focal disease. While generally safe and effective for keratoconus, complications can include haze, infection, and continued progression requiring proper technique. New applications investigate refractive corrections and other corneal conditions.
Manajemen Komplikasi Silicone Oil Post VitrektomiMeironi Waimir
Silicone oil (Polydimethylsiloxanes) is an artificial liquid that injected into the vitreous cavity with the aim of restoring intraocular pressure and provides intraocular tamponade in vitreoretinal surgery.
Silicone oil has a combination of physical and chemical properties. Physical parameters which affects the function of silicone oil, namely specific gravity, buoyancy, surface tension, and viscosity.
Indications of using silicone oil are retinal detachment with proliferative vitreoretinopathy, giant retinal tears, severe proliferative diabetic retinopathy, macular hole, retinal detachment due to viral retinitis, complicated pediatric retinal detachment, retinal detachment associated with choroidal coloboma, retinal detachment due to trauma, and endophthalmitis.
Complications of using silicone oil are silicone oil entry in subconjunctival space and anterior chamber, glaucoma, chronic hypotony, cataract formation, recurrent retinal detachment, emulsification, and keratopathy.
Management of complications using silicone oil depends on the types of complications that occur.
This journal club discussed a study that evaluated the visual outcomes of binocular implantation of a new extended depth of focus intraocular lens called the Supraphob Infocus IOL. The study aimed to assess the safety and efficacy of this lower cost IOL in patients undergoing cataract surgery compared to the FDA approved TECNIS Symfony IOL. The study found that the Supraphob Infocus IOL provided good visual acuity, contrast sensitivity, and stereoacuity outcomes comparable to the TECNIS Symfony IOL. It also induced less ocular aberrations. Based on its safety, efficacy and lower cost, the study concluded that the Supraphob Infocus IOL can
This document provides an overview of corneal collagen cross-linking (CXL) treatment for keratoconus. It discusses that CXL induces collagen cross-linking through riboflavin and UV light application, increasing corneal biomechanical rigidity. The document outlines indications for CXL including keratoconus, iatrogenic keratectasia, and infectious keratitis. Potential complications are also summarized, such as corneal haze, infection, endothelial damage, herpes reactivation, and treatment failure. The technique of CXL is described involving epithelial removal, riboflavin application, and UVA irradiation.
This document outlines several new treatments and technologies for dry eye disease. It discusses increased expenditures on dry eye medications from 2001-2006 driven by Restasis. Six new tools to treat dry eyes are described, including anterior segment OCT, osmolarity testing, LipiFlow, Inflammadry, Ziena eyewear, and intraductal meibomian gland probes. New artificial tear formulations and the use of diquafosol and cyclosporine for dry eyes are also covered.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
This document discusses potential complications of trabeculectomy, both intraoperative and postoperative. Intraoperative complications include buttonholing of the conjunctiva, scleral flap tears, lens injury, vitreous prolapse, hyphema, and suprachoroidal hemorrhage. Postoperative complications can be early such as hypotony, elevated intraocular pressure, choroidal effusions or late such as thin blebs, infections, and cataracts. Management strategies are provided for addressing complications depending on the specific issue.
Ocular surface disease (OSD), commonly known as dry eye, affects 25 million people in the US and costs $3.8 billion annually. It causes ocular discomfort and vision problems. The main causes include aging, climate, genetics, medications, LASIK, and work environment. Secondary OSD can be caused by conditions like Sjogren's syndrome, rheumatoid arthritis, thyroid dysfunction, and diabetes. Diagnosis involves questionnaires, dye tests, meibomian gland expression, and newer tests of tear osmolarity, meibography, and biomarkers. Treatment depends on whether the dry eye is aqueous deficient or due to meibomian gland dysfunction (MGD). For MGD, treatments focus on lid
This document discusses various techniques for corneal collagen crosslinking (CXL), a procedure to strengthen the cornea using riboflavin and UV light. It describes the pathogenesis of keratoconus and history of CXL. The standard Dresden protocol involves epithelial removal followed by riboflavin drops and 30 minutes of UV light exposure. Variations discussed include accelerated CXL, hypo-osmolar CXL for thin corneas, transepithelial CXL, and contact lens-assisted CXL. The document provides details on riboflavin solutions, irradiation parameters, and indications and contraindications for CXL.
DLK is an uncommon complication after lasik. Various etiological agents have been implicated. Responds well to aggressive treatment and early diagnosis
Intracorneal ring segments, such as INTACS, are thin plastic rings that are implanted into the corneal stroma to flatten the cornea and reduce myopia. They are placed in a lamellar channel using either a mechanical or laser procedure. Thicker rings provide greater flattening and myopia correction. Potential risks include visual disturbances and complications requiring removal. Intracorneal rings have been used off-label to treat conditions like post-LASIK ectasia and keratectasia with some success in improving vision.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
This presentation describes indications of intrastromal corneal rings implantation in keratoconus cases and how they are beneficial even in advanced cases.
This document discusses tear film dysfunction and dry eye. It begins with an introduction to the tear film, its components and functions. Various tests to evaluate tear film such as tear film breakup time, Schirmer's test, Rose Bengal staining, and Phenol Red thread test are described. Causes of tear film instability and diseases related to tear film dysfunction including evaporative dry eye and obstructive epiphoria are explained. Early signs of tear dysfunction and methods to check the tear outflow mechanism like Jones tests are also summarized.
This document discusses various biological agents used to treat uveitis, including tumor necrosis factor inhibitors like infliximab, adalimumab, etanercept, golimumab, and certolizumab. It provides dosing information and potential adverse effects for each drug. Anti-interleukin therapies like daclizumab, anakinra, tocilizumab, rituximab, gevokizumab, and secukinumab are also summarized. Key points are provided on initiating and monitoring patients on biological therapies to help maximize efficacy and safety. Biologics are described as potent treatments for uveitis when conventional therapies have failed or been poorly tolerated.
Botulinum toxin type A is produced by Clostridium botulinum and is used commercially as Botox. It works by inhibiting the release of acetylcholine at neuromuscular junctions, causing localized muscle weakness. In ophthalmology, it is used to treat blepharospasm, hemifacial spasm, strabismus, dry eye, and for cosmetic purposes to reduce wrinkles. Complications are usually minor and transient.
This document discusses femtosecond laser cataract surgery and compares it to traditional manual cataract surgery. It summarizes the key claims made by femtosecond laser companies regarding improved capsulotomy precision and intraocular lens positioning with their technology. It then reviews several studies that have investigated the impact of capsulotomy centration, circularity, and intraocular lens positioning on postoperative refractive outcomes and visual quality. The studies found no significant correlations between capsulotomy characteristics and refractive error or cylinder. Capsulotomy centration and overlap were found to play a small role in refractive stability but not the average postoperative refractive result. The document questions whether improved capsulotomy characteristics would translate to better visual quality, as claimed by fem
La chirurgie de la presbytie n'est pas toujours possible avec le laser. Il faut alors envisager une chirurgie du cristallin claire avec des implants multi-focaux. Ceux-ci permettent de corriger la vision de loin et près de manière définitive.
Estudio de la asfericidad corneal y compensación de la aberración esférica mediante el uso de lente intraocular asférica, esférica o neutra
Study of corneal asphericity and compensation of spherical aberration by the usage of aspherical, spherical or neutral intraocular lens
This document discusses different types of multifocal intraocular lenses (IOLs) used in cataract surgery. There are three main types: refractive, diffractive, and a combination. Refractive IOLs use concentric rings of different optical powers while diffractive IOLs use diffraction optics to create two focal points. Combination IOLs can provide the advantages of both refractive and diffractive technologies. The document also covers specific multifocal IOL models and considerations for patient selection.
Topic- ''Eyelid/Meibomian Gland Evaluation''
Speaker: Dr Christine W. Sindt
Hello Everyone, Namaste!!
We would like to notify you all that Mero Eye Foundation is going to conduct an "EYE TALKS-Webinar", and we will be having our session live broadcasted on YouTube (Session No. 90)
DATE – Thurs, 08:00 p.m NPT, 07:45 p.m IST,
July 23th, 2020
YouTube LIVE : https://youtu.be/FBwoRQuDYlU
a review of use of AMT in ocular diseases.
i sincerely thank all the authors of various articles that helped me with this information and also for the images, videos borrowed.
no financial interests.
Dry eye is a multifactorial disease characterized by loss of tear film homeostasis and accompanied by ocular symptoms. It involves tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities. It can be caused by aqueous deficiency, evaporative loss, or external diseases like Sjogren's syndrome. Diagnosis involves assessing risk factors, tear film parameters, ocular staining, and questionnaires. Treatment is staged based on disease severity and may include lifestyle modifications, lubricants, anti-inflammatories, punctal plugs, and in severe cases amniotic membrane grafts or surgery.
Dry eye syndrome is characterized by ocular irritation and visual disturbance caused by alterations to the tear film and ocular surface. It can range from minor inconvenience to sight-threatening complications. While traditionally focused on inadequate tear secretion, the tear film depends on normal function of multiple components. Current treatment targets tear supplementation but often ignores multiple deficiency states, resulting in treatment failure. There is a need for improved treatment options.
This document compares and contrasts AS-OCT (anterior segment optical coherence tomography) and ultrasound biomicroscopy (UBM) imaging techniques for evaluating the anterior eye segment.
It discusses that AS-OCT provides non-contact, high resolution cross-sectional imaging of the anterior segment structures without touching the eye. UBM uses high frequency ultrasound to generate detailed 2D images of the anterior segment, allowing visualization of structures like the iris and angle.
While both techniques allow qualitative and quantitative assessment of the anterior chamber angle and structures, AS-OCT has advantages of being non-contact, faster imaging, and less operator dependency compared to UBM. However, UBM can image deeper into the posterior iris and has greater penetration than
This document discusses LASIK complications and their management. It describes potential intraoperative complications such as incomplete cuts, thin cuts, and free caps. Early postoperative complications include flap-related issues like displacement, wrinkling, and striations. Late complications include epithelial ingrowth, diffuse lamellar keratitis, microbial keratitis, and corneal ectasia. Refractive complications like irregular astigmatism, undercorrection, overcorrection, regression, and ectasia are also reviewed. Prevention and management strategies are provided for each complication.
This document provides guidance on managing failing blebs after glaucoma surgery. It discusses risk factors for bleb failure, the histology of functioning vs failed blebs, typical appearances of failed blebs, identifying the cause of failure as internal or external blockage, and various management techniques. These include increasing digital pressure, medications, laser suture lysis, and bleb needling with or without anti-metabolites like mitomycin C or 5-fluorouracil to restore bleb function and control intraocular pressure. Complications of bleb needling are also reviewed.
This document summarizes information about different gauge vitrectomy systems including 20 gauge, 23 gauge, and 25 gauge. It provides details on the instrumentation, techniques, advantages and disadvantages of each system as well as indications for microincision vitrectomy surgery. Key points include that 23 gauge combines benefits of 20 and 25 gauge, has better flow rates and maneuverability than 25 gauge, and is considered a potential future gold standard. Smaller gauge systems allow for reduced trauma, faster recovery, and greater flexibility for complex procedures.
This document discusses various techniques for corneal collagen crosslinking (CXL), a procedure to strengthen the cornea using riboflavin and UV light. It describes the pathogenesis of keratoconus and history of CXL. The standard Dresden protocol involves epithelial removal followed by riboflavin drops and 30 minutes of UV light exposure. Variations discussed include accelerated CXL, hypo-osmolar CXL for thin corneas, transepithelial CXL, and contact lens-assisted CXL. The document provides details on riboflavin solutions, irradiation parameters, and indications and contraindications for CXL.
DLK is an uncommon complication after lasik. Various etiological agents have been implicated. Responds well to aggressive treatment and early diagnosis
Intracorneal ring segments, such as INTACS, are thin plastic rings that are implanted into the corneal stroma to flatten the cornea and reduce myopia. They are placed in a lamellar channel using either a mechanical or laser procedure. Thicker rings provide greater flattening and myopia correction. Potential risks include visual disturbances and complications requiring removal. Intracorneal rings have been used off-label to treat conditions like post-LASIK ectasia and keratectasia with some success in improving vision.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
This presentation describes indications of intrastromal corneal rings implantation in keratoconus cases and how they are beneficial even in advanced cases.
This document discusses tear film dysfunction and dry eye. It begins with an introduction to the tear film, its components and functions. Various tests to evaluate tear film such as tear film breakup time, Schirmer's test, Rose Bengal staining, and Phenol Red thread test are described. Causes of tear film instability and diseases related to tear film dysfunction including evaporative dry eye and obstructive epiphoria are explained. Early signs of tear dysfunction and methods to check the tear outflow mechanism like Jones tests are also summarized.
This document discusses various biological agents used to treat uveitis, including tumor necrosis factor inhibitors like infliximab, adalimumab, etanercept, golimumab, and certolizumab. It provides dosing information and potential adverse effects for each drug. Anti-interleukin therapies like daclizumab, anakinra, tocilizumab, rituximab, gevokizumab, and secukinumab are also summarized. Key points are provided on initiating and monitoring patients on biological therapies to help maximize efficacy and safety. Biologics are described as potent treatments for uveitis when conventional therapies have failed or been poorly tolerated.
Botulinum toxin type A is produced by Clostridium botulinum and is used commercially as Botox. It works by inhibiting the release of acetylcholine at neuromuscular junctions, causing localized muscle weakness. In ophthalmology, it is used to treat blepharospasm, hemifacial spasm, strabismus, dry eye, and for cosmetic purposes to reduce wrinkles. Complications are usually minor and transient.
This document discusses femtosecond laser cataract surgery and compares it to traditional manual cataract surgery. It summarizes the key claims made by femtosecond laser companies regarding improved capsulotomy precision and intraocular lens positioning with their technology. It then reviews several studies that have investigated the impact of capsulotomy centration, circularity, and intraocular lens positioning on postoperative refractive outcomes and visual quality. The studies found no significant correlations between capsulotomy characteristics and refractive error or cylinder. Capsulotomy centration and overlap were found to play a small role in refractive stability but not the average postoperative refractive result. The document questions whether improved capsulotomy characteristics would translate to better visual quality, as claimed by fem
La chirurgie de la presbytie n'est pas toujours possible avec le laser. Il faut alors envisager une chirurgie du cristallin claire avec des implants multi-focaux. Ceux-ci permettent de corriger la vision de loin et près de manière définitive.
Estudio de la asfericidad corneal y compensación de la aberración esférica mediante el uso de lente intraocular asférica, esférica o neutra
Study of corneal asphericity and compensation of spherical aberration by the usage of aspherical, spherical or neutral intraocular lens
This document discusses different types of multifocal intraocular lenses (IOLs) used in cataract surgery. There are three main types: refractive, diffractive, and a combination. Refractive IOLs use concentric rings of different optical powers while diffractive IOLs use diffraction optics to create two focal points. Combination IOLs can provide the advantages of both refractive and diffractive technologies. The document also covers specific multifocal IOL models and considerations for patient selection.
Topic- ''Eyelid/Meibomian Gland Evaluation''
Speaker: Dr Christine W. Sindt
Hello Everyone, Namaste!!
We would like to notify you all that Mero Eye Foundation is going to conduct an "EYE TALKS-Webinar", and we will be having our session live broadcasted on YouTube (Session No. 90)
DATE – Thurs, 08:00 p.m NPT, 07:45 p.m IST,
July 23th, 2020
YouTube LIVE : https://youtu.be/FBwoRQuDYlU
a review of use of AMT in ocular diseases.
i sincerely thank all the authors of various articles that helped me with this information and also for the images, videos borrowed.
no financial interests.
Dry eye is a multifactorial disease characterized by loss of tear film homeostasis and accompanied by ocular symptoms. It involves tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities. It can be caused by aqueous deficiency, evaporative loss, or external diseases like Sjogren's syndrome. Diagnosis involves assessing risk factors, tear film parameters, ocular staining, and questionnaires. Treatment is staged based on disease severity and may include lifestyle modifications, lubricants, anti-inflammatories, punctal plugs, and in severe cases amniotic membrane grafts or surgery.
Dry eye syndrome is characterized by ocular irritation and visual disturbance caused by alterations to the tear film and ocular surface. It can range from minor inconvenience to sight-threatening complications. While traditionally focused on inadequate tear secretion, the tear film depends on normal function of multiple components. Current treatment targets tear supplementation but often ignores multiple deficiency states, resulting in treatment failure. There is a need for improved treatment options.
This document compares and contrasts AS-OCT (anterior segment optical coherence tomography) and ultrasound biomicroscopy (UBM) imaging techniques for evaluating the anterior eye segment.
It discusses that AS-OCT provides non-contact, high resolution cross-sectional imaging of the anterior segment structures without touching the eye. UBM uses high frequency ultrasound to generate detailed 2D images of the anterior segment, allowing visualization of structures like the iris and angle.
While both techniques allow qualitative and quantitative assessment of the anterior chamber angle and structures, AS-OCT has advantages of being non-contact, faster imaging, and less operator dependency compared to UBM. However, UBM can image deeper into the posterior iris and has greater penetration than
This document discusses LASIK complications and their management. It describes potential intraoperative complications such as incomplete cuts, thin cuts, and free caps. Early postoperative complications include flap-related issues like displacement, wrinkling, and striations. Late complications include epithelial ingrowth, diffuse lamellar keratitis, microbial keratitis, and corneal ectasia. Refractive complications like irregular astigmatism, undercorrection, overcorrection, regression, and ectasia are also reviewed. Prevention and management strategies are provided for each complication.
This document provides guidance on managing failing blebs after glaucoma surgery. It discusses risk factors for bleb failure, the histology of functioning vs failed blebs, typical appearances of failed blebs, identifying the cause of failure as internal or external blockage, and various management techniques. These include increasing digital pressure, medications, laser suture lysis, and bleb needling with or without anti-metabolites like mitomycin C or 5-fluorouracil to restore bleb function and control intraocular pressure. Complications of bleb needling are also reviewed.
This document summarizes information about different gauge vitrectomy systems including 20 gauge, 23 gauge, and 25 gauge. It provides details on the instrumentation, techniques, advantages and disadvantages of each system as well as indications for microincision vitrectomy surgery. Key points include that 23 gauge combines benefits of 20 and 25 gauge, has better flow rates and maneuverability than 25 gauge, and is considered a potential future gold standard. Smaller gauge systems allow for reduced trauma, faster recovery, and greater flexibility for complex procedures.
Il Cheratocono è una patologia degenerativa non infiammatoria della cornea, ad eziologia incerta, che compare generalmente nell’età della pubertà. Il Cross-Linking corneale è una tecnica parachirurgica che consiste nella foto-polimerizzazione delle fibre del collagene stromale della cornea grazie all’effetto combinato di una sostanza fotosensibile (Ribloflavina o Vitamina B2) irradiata con radiazioni UV-A1 previa asportazione dell’epitelio corneale. Documento a cura del Dott. Luca Avoni, Medico Chirurgo Oculista, e Edoardo Marani, Optometrista.
Preserflow microshunt per chirurgia filtrante sottocongiuntivale nel glaucoma. DrCanali. Lezione tenutasi il 20marzo2024 a Brescia.
Preserflow microshunt for subconjunctival filtering surgery in glaucoma. DrCanali. Lecture held on 20th March 2024 in Brescia.
Presentazione del lavoro sulla "Miopia" da parte di alcuni corsisti iscritti al Corso di Specializzazione sull'Attività di Sostegno Polivalente 400H presso l'Università degli Studi del Molise di Campobasso, a.a. 2007-2008. Esame: Fisiopatologia dell'apparato visivo - Prof. Ciro Costagliola
THE CHALLENGE OF DIABETIC VITREORETINAL INTERFACE ITA DrCanali 20 Aprile23 ...Nicola Canali
A lesson presented in Lugano on the 20 april 2023 at the ESASO vitreoretinal master. Focused on vitreoretinal surgery in diabetic retinopathy and the vitreo retinale interface
La terapia per il cheratocono ieri e oggi: indicazioni per il cross-linking corneale, modificazioni istologiche. Documento a cura del Dr. Luca Avoni. http://lucaavoni.com/default.aspx
Correzione astigmatismo post cheratoplastica (PK, DALK)Luca Avoni
L’astigmatismo (cornea con due diverse curvature e quindi l’immagine con due diversi fuochi) è una condizione molto frequente dopo trapianto di cornea sia perforante (PK) che lamellare (DALK) e per consentire una corretta visione del paziente si deve tendere alla correzione di questo vizio refrattivo.
Le possibilità di correzione sono varie e possono essere utilizzate a seconda dell’entità dell’astigmatismo e della fase post chirurgica nella quale ci troviamo.
Si può correggere con occhiali, lenti a contatto, ridistribuendo la tensione delle suture, con incisioni chirurgiche sulla cornea, col laser ad eccimeri, con l’utilizzo di lenti intraoculari toriche.
Similar to Danni iatrogeni indiretti a carico della retina interna durante chirurgia vitreo retinica (20)
Correzione astigmatismo post cheratoplastica (PK, DALK)
Danni iatrogeni indiretti a carico della retina interna durante chirurgia vitreo retinica
1. Danni iatrogeni indiretti a carico
della retina interna durante
chirurgia vitreo-retinica
Vito De Molfetta
RETINA 2012
Vito De Molfetta
2. Non considerando le lesioni meccaniche dirette ai
danni della retina, le fasi dell’intervento
potenzialmente coinvolte sono:
– Utilizzo di fonti luminose
– Utilizzo di coloranti vitali
– Peeling della membrana limitante interna
(MLI)
– Mezzi di tamponamento
• Lesioni meccaniche
• Lesioni chimiche
• Lesioni da ipertono
Vito De Molfetta
3. Utilizzo di fonti luminose
• L’eccessiva esposizione alla luce utilizzata durante
l’intervento induce la formazione di radicali liberi che
ledono l’integrità delle membrane cellulari
– Sono interessati soprattutto i fotorecettori e l’epitelio
pigmentato
– Occlusione dei capillari retinici
– Lesioni focali dello strato delle fibre nervose retiniche
• L’incidenza della retinopatia fototossica clinicamente
significativa durante chirurgia vitreo-retinica raggiunge
l’1,75%
• Effetto combinato di microscopio e fibra ottica
Watson BD, Ann Neurol 1985
Khwarg SG, Am J Ophthalmol 1987
Michels M, Am J Ophthalmol 1992
Vito De Molfetta Wu J, Surv Ophthalmol 2006
4. Utilizzo di fonti luminose
• Fattori di rischio
– Intensità della sorgente luminosa
– Durata dell’intervento
– Lunghezza d’onda della luce
• Vicino ultravioletto e blu
• Prevenzione
– Minimizzare il tempo di esposizione e l’intensità della
fonte luminosa
– Utilizzare filtri
– Controllare distanza ed orientamento della fibra ottica
Vito De Molfetta
5. Caso 1
• Maculopatia fototossica dopo
vitrectomia e tamponamento con
aria per distacco di retina
• Prima del DR OSV 2/10 -1.75
-0.50/90
• 60 giorni dopo l’intervento
– OSV 1/20 -0.75 -1.00/90
– OSF retina piana
– Fluorangiografia: atrofia
maculare con effetto finestra
– OCT: assottigliamento del
neuroepitelio maculare con
deplezione delle cellule
ganglionari e dei fotorecettori
– SLO Microperimetria: scotoma
centrale assoluto, fissazione
instabile
Vito De Molfetta
6. Utilizzo di coloranti
• Verde di indocianina (ICG)
• Verde di infracianina (IfCG)
• Trypan Blue (TB)
• Brilliant Blue (BB)
• Triamcinolone acetonide (TA)
• Patent Blue
• Bromofenolo Blue
Vito De Molfetta
7. Utilizzo di coloranti
• Verde di indocianina (ICG)
– Lo staining con ICG può alterare il piano di clivaggio
tra MLI e strati retinici interni asportazione
accidentale di frammenti retinici
– Effetto di tipo fotodinamico a livello dell’interfacie
vitreo-retinica a causa delle sue proprietà di
assorbimento della luce
– Tossicità diretta dose-dipendente su fotorecettori e
cellule dell’EPR
• Trypan Blue
– Non sono segnalati danni retinici correlati
Gandorfer A, Am J Ophthalmol 2001
Hatitoglou C, Am J Ophthalmol 2002
Gandorfer, IOVS 2003
Weinberger AW, Arch Clin Exp Ophthtalmol 2003
Vito De Molfetta Ito T, IOVS 2004
8. Utilizzo di coloranti
• Lo staining con ICG può determinare un
peggioramento del risultato funzionale e
l’insorgenza di difetti del campo visivo
• Tuttavia, studi recenti sostengono la sicurezza
dell’applicazione del colorante a basso dosaggio
(0.05 mg/ml), in soluzione iso-osmolare e per un
tempo più limitato
Da Mata AP, Ophthalmology 2001
Kwok AK, Am J Ophthalmol 2003
Ferenez M, Am J Ophthalmol 2006
Hillenkamp J, Graefe Arch Exp Ophthalmol 2006
Beutel J, Arch Ophthalmol 2007
Lai MM, Retina 2007
Vito De Molfetta
9. Caso 2
• Schisi degli strati retinici interni
dopo vitrectomia con colorazione
ICG per pucker maculare
• Pre-operatorio
– OCT: membrana epiretinica
aderente, edema retinico di
tipo semplice
– ODV 4/10 +1.00 Amsler +
• 25 giorni dopo la vitrectomia
– OCT: irregolarità del profilo
retinico interno; schisi
maculare
– ODV 2/10 +0.75 +2.00/90
Amsler +
Vito De Molfetta
10. Peeling della MLI
• A fronte di numerosi report con risultati
anatomo-funzionali favorevoli, sono segnalati
danni a carico della retina interna conseguenti
all’asportazione della MLI
– Corioretinopatia puntata
– Fori retinici parafoveali (indebolimento
strutturale retinico secondario a lesione delle
cellule del Müller)
– Lesioni focali maculari dello strato delle fibre
nervose Karacorlu M, Am J Ophthalmol 2003
Steven P, Br J Ophthalmol 2006
Hasan J, IOVS 2012
Vito De Molfetta
11. Caso 3
• Lesione dello strato RNFL dopo
vitrectomia e peeling MLI per
pucker maculare
• 40 giorni post-operatorio
– OCT: irregolarità del profilo
retinico con assenza dello
strato RNFL in sede
iuxtafoveale inferiore;
riduzione dello spessore
RNFL con marcato
assottigliamento inferiore
– Perimetria: difetto fascicolare
assoluto nei 10° centrali
Vito De Molfetta
12. Caso 4
• Peeling di membrana epiretinica
e MLI per pucker maculare
– Visus preoperatorio 2/10
– Dopo 15 gg insorgenza di
foro retinico paramaculare a
tutto spessore
– Visus 5/10
– Dopo 3 mesi distacco di
retina da foro paramaculare
(Densiron)
– Dopo asportazione Densiron
retina piana, persistenza foro
retinico
– Visus 4/10
Vito De Molfetta
13. Scambio fluido-aria
• Infusione di aria o fluidi ad alta pressione
durante gli scambi
– Sbiancamento immediato della retina,
restringimento o occlusione dei capillari
retinici, disomogeneità dell’EPR
– Sviluppo di fori retinici atrofici e/o difetti del
campo visivo per danno delle fibre nervose
retiniche
Yonemura N, Ophthalmology 2001
Hirata A, Retina 2003
Yang SS, Retina 2006
Vito De Molfetta
14. Danni chimici da mezzi di tamponamento
• Olio di silicone e FSi penetrano nei tessuti oculari,
determinando reazioni infiammatorie e immunitarie locali
– Importanza della purificazione dalle componenti a
basso peso molecolare
• I tamponanti ad elevato peso molecolare (PFCL,
Densiron) determinano un danno diretto sulla retina
dimostrato istologicamente
– Il danno non sembra dovuto all’incremento pressorio,
ma all’esclusione del contatto retina-umore acqueo
– Tuttavia, lavori clinici hanno dimostrato la buona
tolleranza al tamponamento a breve termine
• Membranogenesi
– Accumulo di fattori proliferativi perNakamura K, IOVS 1991
compartimentazione Vito De Molfetta Stolba U, Graefe 2004
Wong D, Graefe 2005
Mackiewicz J, Graefe 2007
15. Ipertono secondario da mezzi di tamponamento
• PDMS/Tamponamenti pesanti
– Ipertono precoce
• Blocco pupillare con chiusura d’angolo
• Migrazione del tamponante in camera
anteriore
• Infiammazione
• Pre-esistente glaucoma
– Ipertono tardivo
• Infiltrazione del trabecolato da parte di
emulsione
• Infiammazione cronica
• Formazione di goniosinechie con
chiusura d’angolo
• Rubeosi iridea
• Migrazione di olio in camera anteriore
McCuen BW, Retina 1985
Han DP, Ophthalmology 1989
Vito De Molfetta
Ichhpujani P, Graefe 2009
16. Ipertono secondario da mezzi di tamponamento
• La prevalenza del glaucoma secondario dopo iniezione
di tamponanti a permanenza è del 18% (3%-56%)
– La maggior parte dei casi è da blocco trabecolare da
emulsione
• Fattori di rischio
– Pre-esistente ipertono oculare/glaucoma, diabete,
presenza di tamponante in camera anteriore,
associazione con cerchiaggio, nistagmo, lunga durata
del tamponamento
Barr CC, Ophthalmology 1993
Montanari P, Int Ohthalmol 1997
Vito De Molfetta
17. Ipertono secondario da mezzi di tamponamento
• Trattamento
– Ipertono da eccessivo riempimento: asportazione
precocissima di parte o tutto il tamponante
– Ipertono da blocco angolare: prevenzione mediante
iridectomia basale e impianto IOL (afachico)
– Ipertono tardivo: Chirurgia dell’angolo con approccio
ab interno (via limbare o pars plana) sotto guida
gonioscopica e con indentazione sclerale, Chirurgia
convenzionale filtrante o no, Tubi drenanti
Nguyen QH, Ophthalmology 1992
Senn P, Ophthalmic Surg 1994
Li SI, Chin J Ocu 2001
Vito De Molfetta
18. Ipertono secondario da mezzi di tamponamento
• Gas
– Ipertono precoce da chiusura d’angolo per
espansione della bolla di gas
– Trattamento: posizionamento del paziente,
aspirazione parziale della bolla
Gedde SJ, Curr Opin Ophthalmol 2002
Williamson TH, Br J Ophthalmol 2003
Vito De Molfetta
19. Caso 5
• Ipertono secondario da emulsione
di PDMS
– ODT 37 mmHg
– ODV Conta dita -2.00
• Dopo 4 mesi dall’asportazione
PDMS intervento di asportazione
dell’emulsione e riapertura
angolare per via limbare
– ODT 21 mmHg
– ODV 1/20 -2=-1/90
Vito De Molfetta