Diabetic Macular Edema
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A concise and brief description of basics and pathophysiology of maculopathy in diabetes mellitus and its management
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DIABETIC MACULAR EDEMA
GENERAL INFORMATION ABOUT DIABETIC MACULAR EDEMA WITH 2 PATIENT CASES, TREATED WITH 2 DIFFERENT TREATMENT TECHNIQUES.
CLASSIFICATION (CSME)
RISK FACTORS
CAUSES
SIGNS AND SYMPTOMS
MANAGEMENT AND TREATMENT OPTIONS
DIAGNISTIC TESTS, BLOOD AND URINE TEST
SCORING SYSTEM
PATHOLOGY
DIFFERENTIAL DIAGNOSIS
PROGNOSIS
EPIDEMIOLOGY
DESCRIPTION OF 2 CASES, THEIR DIAGNOSTIC RESULT AND DETAILS ABOUT TREATMENTS PERFORMED.
Diabetic macular edema-Current treatment Modalities
Diabetic macular edema-Current treatment ModalitiesCentral Park Medical College and WAPDA Teaching Hospital Lahore
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Anti VEGF in Ophthalmology
Anti-VEGF agents such as bevacizumab, ranibizumab, pegaptanib, and aflibercept are used to treat retinal diseases caused by abnormal blood vessel growth due to VEGF overexpression. They work by inhibiting VEGF to prevent new blood vessel proliferation and leakage. Common uses include treating wet age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and retinopathy of prematurity. Ranibizumab and aflibercept are approved by the FDA, while bevacizumab is commonly used off-label. Monthly intravitreal injections are typically required initially, then treatments are extended based on disease response. Adverse events include inflammation, increased intraocular pressure, and
Choroidal neovascular membranes (CNVM)
Choroidal neovascularization (CNV) involves the abnormal growth of new blood vessels from the choroid layer of the eye through Bruch's membrane. This can cause vision loss and is a common cause of wet macular degeneration. CNV occurs due to alterations in Bruch's membrane and high levels of vascular endothelial growth factor. It is classified based on its location relative to the retinal pigment epithelium and fovea. Symptoms include sudden vision loss and visual distortions. CNV is diagnosed through imaging like optical coherence tomography and fluorescein angiography and treated with injections of anti-VEGF drugs to inhibit blood vessel growth.
Peripheral fundus & its disorders
Peripheral fundus & its disorders
Presented by Dr Rohit Rao
This document summarizes the key anatomical structures and pathologies of the peripheral retina. It describes the ora serrata, pars plana, vitreous base, dentate processes, meridional folds, and other peripheral features. It then discusses various degenerative conditions like lattice degeneration, retinoschisis, and pavingstone degeneration. Treatment options for retinal breaks including cryopexy and laser photocoagulation are also summarized.
Diabetic macula edema
This document provides an overview of diabetic macular edema (DME) and its treatment. It discusses the results of major clinical trials that established standards of care. The Early Treatment Diabetic Retinopathy Study (ETDRS) first demonstrated that focal laser photocoagulation can reduce vision loss from DME. However, many patients still lose vision with laser alone. Recent studies show anti-VEGF agents like ranibizumab are now the standard treatment, providing better outcomes than laser. Clinical trials found ranibizumab improves vision in DME and fewer injections are needed over time using PRN regimens. While laser remains an option, anti-VEGF agents lead to greater vision gains and have replaced laser
Tractional RD
Tractional retinal detachment occurs when fibrovascular membranes exert traction on the retina, most commonly due to proliferative diabetic retinopathy or posterior segment trauma. Static traction from these membranes causes the retina to detach in a shallow, concave configuration without visible retinal breaks. Diagnosis is based on finding reduced retinal mobility and the absence of breaks, with traction visible from fibrovascular tissue. Ultrasound can help diagnose tractional detachments when the media is opaque.
Branch retinal vein occlusion (BRVO)
This document discusses branch retinal vein occlusion (BRVO), including its pathogenesis, clinical features, complications, investigations, and management. BRVO is caused by obstruction of one of the retinal veins, usually at the arteriovenous crossing point. It can lead to macular edema, neovascularization, vitreous hemorrhage, and retinal detachment. Treatment involves anti-VEGF injections, steroids, laser photocoagulation, and occasionally surgery. Several clinical trials have evaluated therapies for BRVO, finding that anti-VEGF drugs and steroids reduce macular edema but laser provides little additional benefit when combined with anti-VEGF treatment.
Recommended
DIABETIC MACULAR EDEMA
GENERAL INFORMATION ABOUT DIABETIC MACULAR EDEMA WITH 2 PATIENT CASES, TREATED WITH 2 DIFFERENT TREATMENT TECHNIQUES.
CLASSIFICATION (CSME)
RISK FACTORS
CAUSES
SIGNS AND SYMPTOMS
MANAGEMENT AND TREATMENT OPTIONS
DIAGNISTIC TESTS, BLOOD AND URINE TEST
SCORING SYSTEM
PATHOLOGY
DIFFERENTIAL DIAGNOSIS
PROGNOSIS
EPIDEMIOLOGY
DESCRIPTION OF 2 CASES, THEIR DIAGNOSTIC RESULT AND DETAILS ABOUT TREATMENTS PERFORMED.
Diabetic macular edema-Current treatment Modalities
Diabetic macular edema-Current treatment ModalitiesCentral Park Medical College and WAPDA Teaching Hospital Lahore
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Anti VEGF in Ophthalmology
Anti-VEGF agents such as bevacizumab, ranibizumab, pegaptanib, and aflibercept are used to treat retinal diseases caused by abnormal blood vessel growth due to VEGF overexpression. They work by inhibiting VEGF to prevent new blood vessel proliferation and leakage. Common uses include treating wet age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and retinopathy of prematurity. Ranibizumab and aflibercept are approved by the FDA, while bevacizumab is commonly used off-label. Monthly intravitreal injections are typically required initially, then treatments are extended based on disease response. Adverse events include inflammation, increased intraocular pressure, and
Choroidal neovascular membranes (CNVM)
Choroidal neovascularization (CNV) involves the abnormal growth of new blood vessels from the choroid layer of the eye through Bruch's membrane. This can cause vision loss and is a common cause of wet macular degeneration. CNV occurs due to alterations in Bruch's membrane and high levels of vascular endothelial growth factor. It is classified based on its location relative to the retinal pigment epithelium and fovea. Symptoms include sudden vision loss and visual distortions. CNV is diagnosed through imaging like optical coherence tomography and fluorescein angiography and treated with injections of anti-VEGF drugs to inhibit blood vessel growth.
Peripheral fundus & its disorders
Peripheral fundus & its disorders
Presented by Dr Rohit Rao
This document summarizes the key anatomical structures and pathologies of the peripheral retina. It describes the ora serrata, pars plana, vitreous base, dentate processes, meridional folds, and other peripheral features. It then discusses various degenerative conditions like lattice degeneration, retinoschisis, and pavingstone degeneration. Treatment options for retinal breaks including cryopexy and laser photocoagulation are also summarized.
Diabetic macula edema
This document provides an overview of diabetic macular edema (DME) and its treatment. It discusses the results of major clinical trials that established standards of care. The Early Treatment Diabetic Retinopathy Study (ETDRS) first demonstrated that focal laser photocoagulation can reduce vision loss from DME. However, many patients still lose vision with laser alone. Recent studies show anti-VEGF agents like ranibizumab are now the standard treatment, providing better outcomes than laser. Clinical trials found ranibizumab improves vision in DME and fewer injections are needed over time using PRN regimens. While laser remains an option, anti-VEGF agents lead to greater vision gains and have replaced laser
Tractional RD
Tractional retinal detachment occurs when fibrovascular membranes exert traction on the retina, most commonly due to proliferative diabetic retinopathy or posterior segment trauma. Static traction from these membranes causes the retina to detach in a shallow, concave configuration without visible retinal breaks. Diagnosis is based on finding reduced retinal mobility and the absence of breaks, with traction visible from fibrovascular tissue. Ultrasound can help diagnose tractional detachments when the media is opaque.
Branch retinal vein occlusion (BRVO)
This document discusses branch retinal vein occlusion (BRVO), including its pathogenesis, clinical features, complications, investigations, and management. BRVO is caused by obstruction of one of the retinal veins, usually at the arteriovenous crossing point. It can lead to macular edema, neovascularization, vitreous hemorrhage, and retinal detachment. Treatment involves anti-VEGF injections, steroids, laser photocoagulation, and occasionally surgery. Several clinical trials have evaluated therapies for BRVO, finding that anti-VEGF drugs and steroids reduce macular edema but laser provides little additional benefit when combined with anti-VEGF treatment.
DME Management Guidelines
This document provides guidelines for screening, monitoring, classifying severity, and treating diabetic macular edema (DME). It recommends annual screening of diabetic patients aged 15+ for retinopathy and treating any sight-threatening cases found. For DME treatment, it discusses traditional laser photocoagulation as well as newer options like intravitreal corticosteroids and anti-VEGF drugs. Intravitreal injections of anti-VEGF agents are considered first-line therapy for center-involving DME, with laser as an option for non-center cases or if thickening persists after anti-VEGF treatment. Strict control of modifiable risk factors like glycemia, blood pressure, and lipids can also help prevent
Diabetic macular edema
1. Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes and can be focal or diffuse.
2. Clinically significant macular edema is defined by retinal thickening within 500 μm of the macula or hard exudates associated with thickening.
3. Optical coherence tomography and fluorescein angiography are used to diagnose and characterize DME by detecting retinal thickening and leakage patterns.
Acute retinal necrosis
This document summarizes acute retinal necrosis (ARN), a rare viral infection of the retina. It begins by describing the initial 1971 case report and clinical features of ARN, which include anterior uveitis, vitritis, and characteristic retinal lesions. The document then discusses the epidemiology, diagnostic criteria, etiology as herpes virus, and treatment with antivirals like acyclovir. It also briefly mentions a more severe variant, progressive outer retinal necrosis (PORN), which mostly affects immunocompromised patients and has a poor prognosis.
MANAGEMENT OF DIABETIC MACULOPATHY
The document discusses diabetic retinopathy (DR) and diabetic macular edema (DME). Some key points:
- DR is a leading cause of vision loss and its prevalence is increasing in India. Effective screening and treatment is needed.
- DR stages include non-proliferative DR and proliferative DR. DME can occur and is a major cause of vision loss.
- Treatments include controlling blood sugar and blood pressure, laser therapy, intravitreal anti-VEGF drugs, and steroids. Anti-VEGF drugs and steroids have largely replaced laser as first-line treatment for DME.
- Optical coherence tomography is important for diagnosing and monitoring DME and treatment response.
Diabetic macular edema studies
This document provides a review of literature on diabetic macular edema (DME). It summarizes key studies on the pathophysiology and treatment of DME, including the Early Treatment Diabetic Retinopathy Study (ETDRS), trials of intravitreal corticosteroids, anti-VEGF drugs, and combination therapies. Major studies discussed include DRCR.net, PACORES, RESOLVE, BOLT, RIDE, and RESTORE trials which evaluated laser photocoagulation, corticosteroids, ranibizumab, bevacizumab, and combination therapies for treating DME. The document concludes anti-VEGF drugs like ranibizumab and bevacizumab
Malignant Glaucoma
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
Differential Diagnosis of Disc Edema
1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
Proliferative vitreoretinopathy
This document provides an overview of proliferative vitreoretinopathy (PVR). It defines PVR as a fibrotic wound healing response involving proliferation of cells that can cause retinal traction and detachment. The pathophysiology involves epithelial-mesenchymal transition of retinal pigment epithelium cells and proliferation of glial cells, which secrete extracellular matrix proteins. Growth factors and cytokines promote proliferation and contraction of fibrocellular membranes. Risk factors include retinal detachment, inflammation, and previous vitreoretinal surgery. Early diagnosis and timely surgery aiming to relieve traction and reattach the retina are important for treatment.
Diseases of the Orbit
1) The document discusses diseases of the orbit including anatomy, causes of proptosis, orbital infections like cellulitis, dysthyroid ophthalmopathy, and orbital inflammatory pseudotumors.
2) Evaluation of proptosis involves taking history of onset and symptoms, examining for signs of inflammation, restricted eye movement, and proptosis measurement. Investigations include imaging and biopsy.
3) Orbital cellulitis is a serious infection behind the orbital septum treated with intravenous antibiotics and possibly surgery. Dysthyroid ophthalmopathy causes eye changes like proptosis and diplopia managed initially with oral steroids.
Diabetic macular edema
This document discusses macular edema in diabetic retinopathy and its treatment. It explains that macular edema is caused by chronic hyperactivity of the polyol pathway and increased vascular endothelial growth factor, which leads to increased vascular permeability. Laser photocoagulation and intravitreal anti-VEGF injections are effective treatments that work by reducing hypoxia and VEGF levels in the retina. Several studies found that treatments with drugs like ranibizumab and aflibercept were more effective at improving vision outcomes than laser alone in patients with diabetic macular edema.
Scleral buckling for rhegmatogenous retinal detachment
Scleral buckling surgery involves suturing a silicone implant or explant to the outer layer of the eye (sclera) to push the retina back into contact with the retinal pigment epithelium. This is done by creating an inward indentation of the sclera. The implant seals retinal breaks by approximating the retina and RPE over the buckle. Key steps include identifying retinal breaks, treating the breaks with cryotherapy or laser, placing scleral sutures, and sometimes draining subretinal fluid. The goal is to close breaks and reduce traction on the retina to allow it to reattach.
Normal tension glaucoma
This document summarizes a presentation on normal tension glaucoma (NTG). It begins with an introduction defining NTG as open-angle glaucoma with characteristic optic nerve damage and visual field defects in patients with consistently low intraocular pressure (IOP) below 21 mmHg. It then describes a case presentation of a 47-year-old female patient. The remainder of the document discusses the history, examination, investigations, differential diagnosis, management, pathogenesis involving both IOP-dependent and independent factors, and epidemiology of NTG. Key points are that lowering IOP through medication or surgery can help prevent progression even in NTG, and that NTG may have an underlying vascular component involving low ocular perfusion pressure
Lamellar keratoplasty
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
Retinal diagram dr sabin sahu
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Optic disc evaluation
This document provides terminology and descriptions related to evaluation of the optic disc. It describes normal anatomy and features of the optic disc including size, shape, color, zones, and vessels. It also summarizes various congenital and acquired optic disc anomalies including glaucoma, papilledema, optic neuropathies, tumors, and other conditions. Key features are described for different stages and types of each condition.
Diabetic retinopathy- Management
This document discusses diabetic retinopathy, including:
- DR is a major cause of blindness and is classified as non-proliferative or proliferative.
- Tight control of blood glucose, blood pressure, and lipids can slow progression of DR.
- Laser photocoagulation is effective for treating diabetic macular edema and proliferative DR. Focal laser is used for edema localized to the macula, while panretinal photocoagulation scatters wider burns throughout the retina to induce regression of new vessels.
- Imaging like OCT and fluorescein angiography help diagnose and monitor DR and guide treatment.
Corneal degenerations
This document discusses various types of corneal degenerations and dystrophies. It provides descriptions of conditions such as arcus senilis, band keratopathy, corneal dystrophies, and corneal depositions. The causes, characteristics, associated systemic diseases, histopathological features, and treatments are summarized for each condition.
Papilloedema
Papilloedema is swelling of the optic disc caused by increased intracranial pressure. It is defined as disc swelling associated with raised ICP and is nearly always bilateral. The document discusses the anatomy of the optic disc, causes of papilloedema including tumors and idiopathic intracranial hypertension, pathogenesis related to alterations in pressure gradients, clinical features such as headache and diplopia, and epidemiology showing highest rates in obese women of childbearing age.
Cystoid macular oedema
Cystoid macular edema is a pathological accumulation of fluid in the macula that can be caused by conditions like diabetic retinopathy, retinal vein occlusions, or following cataract surgery. It is diagnosed using optical coherence tomography or fluorescein angiography and treated initially with anti-inflammatory eye drops, corticosteroid injections, or anti-VEGF drugs to reduce fluid accumulation. Laser therapy or vitrectomy may also be used in some cases to treat underlying causes like vitreomacular traction.
CENTRAL SEROUS CHORIO RETINOPATHY
This document provides an overview of central serous chorioretinopathy (CSC), including its pathogenesis, clinical presentation, diagnosis, course and treatment. CSC is characterized by a localized serous retinal detachment in the macula due to leakage of fluid from the choroid. It typically affects men ages 30-50 and can be associated with stress, corticosteroid use, hypertension and type A personality. Diagnosis is usually clinical but can be confirmed with fluorescein angiography showing characteristic leakage patterns or optical coherence tomography identifying subretinal fluid. While most cases resolve spontaneously, laser photocoagulation or photodynamic therapy may be used in persistent or recurrent cases to seal leaking sites and accelerate resolution.
Diabetic macular odema update 2016
This document discusses diabetic macular edema (DME), including its prevalence, evaluation, treatment options, and intravitreal injection technique. DME is a leading cause of vision loss in diabetic retinopathy. Evaluation involves visual acuity testing, slit lamp examination, and imaging like OCT and FA. Treatment includes tight blood sugar and blood pressure control, as well as therapies like anti-VEGF agents, corticosteroids, and laser photocoagulation. Intravitreal injections are a common method to deliver these medications, with 30-gauge needles typically used for anti-VEGF drugs and 27-gauge for corticosteroids like triamcinolone.
Diabetic macular edema 2011 (1)
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
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DME Management Guidelines
This document provides guidelines for screening, monitoring, classifying severity, and treating diabetic macular edema (DME). It recommends annual screening of diabetic patients aged 15+ for retinopathy and treating any sight-threatening cases found. For DME treatment, it discusses traditional laser photocoagulation as well as newer options like intravitreal corticosteroids and anti-VEGF drugs. Intravitreal injections of anti-VEGF agents are considered first-line therapy for center-involving DME, with laser as an option for non-center cases or if thickening persists after anti-VEGF treatment. Strict control of modifiable risk factors like glycemia, blood pressure, and lipids can also help prevent
Diabetic macular edema
1. Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes and can be focal or diffuse.
2. Clinically significant macular edema is defined by retinal thickening within 500 μm of the macula or hard exudates associated with thickening.
3. Optical coherence tomography and fluorescein angiography are used to diagnose and characterize DME by detecting retinal thickening and leakage patterns.
Acute retinal necrosis
This document summarizes acute retinal necrosis (ARN), a rare viral infection of the retina. It begins by describing the initial 1971 case report and clinical features of ARN, which include anterior uveitis, vitritis, and characteristic retinal lesions. The document then discusses the epidemiology, diagnostic criteria, etiology as herpes virus, and treatment with antivirals like acyclovir. It also briefly mentions a more severe variant, progressive outer retinal necrosis (PORN), which mostly affects immunocompromised patients and has a poor prognosis.
MANAGEMENT OF DIABETIC MACULOPATHY
The document discusses diabetic retinopathy (DR) and diabetic macular edema (DME). Some key points:
- DR is a leading cause of vision loss and its prevalence is increasing in India. Effective screening and treatment is needed.
- DR stages include non-proliferative DR and proliferative DR. DME can occur and is a major cause of vision loss.
- Treatments include controlling blood sugar and blood pressure, laser therapy, intravitreal anti-VEGF drugs, and steroids. Anti-VEGF drugs and steroids have largely replaced laser as first-line treatment for DME.
- Optical coherence tomography is important for diagnosing and monitoring DME and treatment response.
Diabetic macular edema studies
This document provides a review of literature on diabetic macular edema (DME). It summarizes key studies on the pathophysiology and treatment of DME, including the Early Treatment Diabetic Retinopathy Study (ETDRS), trials of intravitreal corticosteroids, anti-VEGF drugs, and combination therapies. Major studies discussed include DRCR.net, PACORES, RESOLVE, BOLT, RIDE, and RESTORE trials which evaluated laser photocoagulation, corticosteroids, ranibizumab, bevacizumab, and combination therapies for treating DME. The document concludes anti-VEGF drugs like ranibizumab and bevacizumab
Malignant Glaucoma
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
Differential Diagnosis of Disc Edema
1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
Proliferative vitreoretinopathy
This document provides an overview of proliferative vitreoretinopathy (PVR). It defines PVR as a fibrotic wound healing response involving proliferation of cells that can cause retinal traction and detachment. The pathophysiology involves epithelial-mesenchymal transition of retinal pigment epithelium cells and proliferation of glial cells, which secrete extracellular matrix proteins. Growth factors and cytokines promote proliferation and contraction of fibrocellular membranes. Risk factors include retinal detachment, inflammation, and previous vitreoretinal surgery. Early diagnosis and timely surgery aiming to relieve traction and reattach the retina are important for treatment.
Diseases of the Orbit
1) The document discusses diseases of the orbit including anatomy, causes of proptosis, orbital infections like cellulitis, dysthyroid ophthalmopathy, and orbital inflammatory pseudotumors.
2) Evaluation of proptosis involves taking history of onset and symptoms, examining for signs of inflammation, restricted eye movement, and proptosis measurement. Investigations include imaging and biopsy.
3) Orbital cellulitis is a serious infection behind the orbital septum treated with intravenous antibiotics and possibly surgery. Dysthyroid ophthalmopathy causes eye changes like proptosis and diplopia managed initially with oral steroids.
Diabetic macular edema
This document discusses macular edema in diabetic retinopathy and its treatment. It explains that macular edema is caused by chronic hyperactivity of the polyol pathway and increased vascular endothelial growth factor, which leads to increased vascular permeability. Laser photocoagulation and intravitreal anti-VEGF injections are effective treatments that work by reducing hypoxia and VEGF levels in the retina. Several studies found that treatments with drugs like ranibizumab and aflibercept were more effective at improving vision outcomes than laser alone in patients with diabetic macular edema.
Scleral buckling for rhegmatogenous retinal detachment
Scleral buckling surgery involves suturing a silicone implant or explant to the outer layer of the eye (sclera) to push the retina back into contact with the retinal pigment epithelium. This is done by creating an inward indentation of the sclera. The implant seals retinal breaks by approximating the retina and RPE over the buckle. Key steps include identifying retinal breaks, treating the breaks with cryotherapy or laser, placing scleral sutures, and sometimes draining subretinal fluid. The goal is to close breaks and reduce traction on the retina to allow it to reattach.
Normal tension glaucoma
This document summarizes a presentation on normal tension glaucoma (NTG). It begins with an introduction defining NTG as open-angle glaucoma with characteristic optic nerve damage and visual field defects in patients with consistently low intraocular pressure (IOP) below 21 mmHg. It then describes a case presentation of a 47-year-old female patient. The remainder of the document discusses the history, examination, investigations, differential diagnosis, management, pathogenesis involving both IOP-dependent and independent factors, and epidemiology of NTG. Key points are that lowering IOP through medication or surgery can help prevent progression even in NTG, and that NTG may have an underlying vascular component involving low ocular perfusion pressure
Lamellar keratoplasty
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
Retinal diagram dr sabin sahu
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Optic disc evaluation
This document provides terminology and descriptions related to evaluation of the optic disc. It describes normal anatomy and features of the optic disc including size, shape, color, zones, and vessels. It also summarizes various congenital and acquired optic disc anomalies including glaucoma, papilledema, optic neuropathies, tumors, and other conditions. Key features are described for different stages and types of each condition.
Diabetic retinopathy- Management
This document discusses diabetic retinopathy, including:
- DR is a major cause of blindness and is classified as non-proliferative or proliferative.
- Tight control of blood glucose, blood pressure, and lipids can slow progression of DR.
- Laser photocoagulation is effective for treating diabetic macular edema and proliferative DR. Focal laser is used for edema localized to the macula, while panretinal photocoagulation scatters wider burns throughout the retina to induce regression of new vessels.
- Imaging like OCT and fluorescein angiography help diagnose and monitor DR and guide treatment.
Corneal degenerations
This document discusses various types of corneal degenerations and dystrophies. It provides descriptions of conditions such as arcus senilis, band keratopathy, corneal dystrophies, and corneal depositions. The causes, characteristics, associated systemic diseases, histopathological features, and treatments are summarized for each condition.
Papilloedema
Papilloedema is swelling of the optic disc caused by increased intracranial pressure. It is defined as disc swelling associated with raised ICP and is nearly always bilateral. The document discusses the anatomy of the optic disc, causes of papilloedema including tumors and idiopathic intracranial hypertension, pathogenesis related to alterations in pressure gradients, clinical features such as headache and diplopia, and epidemiology showing highest rates in obese women of childbearing age.
Cystoid macular oedema
Cystoid macular edema is a pathological accumulation of fluid in the macula that can be caused by conditions like diabetic retinopathy, retinal vein occlusions, or following cataract surgery. It is diagnosed using optical coherence tomography or fluorescein angiography and treated initially with anti-inflammatory eye drops, corticosteroid injections, or anti-VEGF drugs to reduce fluid accumulation. Laser therapy or vitrectomy may also be used in some cases to treat underlying causes like vitreomacular traction.
CENTRAL SEROUS CHORIO RETINOPATHY
This document provides an overview of central serous chorioretinopathy (CSC), including its pathogenesis, clinical presentation, diagnosis, course and treatment. CSC is characterized by a localized serous retinal detachment in the macula due to leakage of fluid from the choroid. It typically affects men ages 30-50 and can be associated with stress, corticosteroid use, hypertension and type A personality. Diagnosis is usually clinical but can be confirmed with fluorescein angiography showing characteristic leakage patterns or optical coherence tomography identifying subretinal fluid. While most cases resolve spontaneously, laser photocoagulation or photodynamic therapy may be used in persistent or recurrent cases to seal leaking sites and accelerate resolution.
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Diabetic macular odema update 2016
This document discusses diabetic macular edema (DME), including its prevalence, evaluation, treatment options, and intravitreal injection technique. DME is a leading cause of vision loss in diabetic retinopathy. Evaluation involves visual acuity testing, slit lamp examination, and imaging like OCT and FA. Treatment includes tight blood sugar and blood pressure control, as well as therapies like anti-VEGF agents, corticosteroids, and laser photocoagulation. Intravitreal injections are a common method to deliver these medications, with 30-gauge needles typically used for anti-VEGF drugs and 27-gauge for corticosteroids like triamcinolone.
Diabetic macular edema 2011 (1)
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
Nw2014 Diabetic Macular Edema Treatment Options
This document summarizes current treatment options for diabetic macular edema (DME), including laser therapy, anti-VEGF drugs like ranibizumab and aflibercept, and steroid implants. Laser monotherapy is no longer considered the best practice, as evidence shows anti-VEGF drugs alone or with laser provide better visual outcomes than laser alone. While the optimal anti-VEGF injection protocol is still unclear, monthly injections may not be necessary. Newer treatments like dexamethasone and fluocinolone implants provide sustained drug delivery over months and show promise, but more research is still needed on their long-term safety and efficacy.
Diabetic retinopathy
Diabetic retinopathy is a leading cause of blindness worldwide. Prolonged hyperglycemia can damage retinal blood vessels and neurons. Over time, this can lead to vision loss through retinal edema, hemorrhage, fibrosis or neovascularization. Risk factors include duration and control of diabetes, hypertension, and nephropathy. Treatment focuses on laser photocoagulation and intravitreal injections to reduce edema or abnormal blood vessels, along with glycemic control to prevent progression. Regular screening is important to detect diabetic retinopathy early when treatment is most effective.
Anti vegf intravitreal injections
VEGF is a growth factor that promotes abnormal blood vessel growth in the retina and causes vision loss. Anti-VEGF drugs like ranibizumab (Lucentis), bevacizumab (Avastin), and pegaptanib (Macugen) work by blocking VEGF and stopping this blood vessel growth. Ranibizumab was designed specifically for eye injections and has a short half-life, while bevacizumab was designed for cancer but is also used "off-label" in the eye. Clinical trials found that both drugs are effective in treating wet AMD, diabetic retinopathy, and other retinal diseases, but ranibizumab may have a slightly lower risk of rare side effects due to its shorter exposure in
DIABETIC RETINOPATHY DEMYSTIFIED
This document provides an overview of diabetic retinopathy and its management. It begins by defining diabetic retinopathy and diabetic macular edema as microvascular complications of diabetes that can cause vision loss. It then describes the signs and stages of diabetic retinopathy from mild nonproliferative to proliferative, and discusses evaluation and classification using techniques like OCT, FA and clinical examination. Management approaches covered include control of systemic risk factors, laser photocoagulation protocols for proliferative retinopathy and macular edema, and intravitreal injections of anti-VEGF agents or steroids. The document concludes by outlining treatment protocols from studies like ETDRS and DRCR.net.
THE ROLE OF ANTI-VEGF THERAPY IN RETINA DISEASES ASSOCIATED WITH MACULAR EDEMA
1. Neovascular AMD and DME are two major retinal diseases associated with macular edema. While they share upregulation of VEGF as a driver of pathology, neovascular AMD primarily affects the outer BRB and choroid, while DME primarily affects the inner BRB and retinal layers.
2. Ranibizumab is an anti-VEGF drug that was shown to be superior to sham injections in treating neovascular AMD based on the MARINA trial. Patients receiving monthly ranibizumab injections experienced significantly less vision loss and greater gains in visual acuity compared to sham at 12 and 24 months.
Anti vegf' s in Ophthalmology
This document provides information on anti-VEGF drugs used in ophthalmology. It discusses the role of VEGF in various eye diseases and conditions. It summarizes the properties, mechanisms of action, administration, and safety profiles of major anti-VEGF drugs including bevacizumab, pegaptanib, and ranibizumab which are used to treat wet age-related macular degeneration, diabetic retinopathy, and other retinal diseases by inhibiting abnormal blood vessel growth and leakage caused by VEGF.
Diabetic Retinopathy
The document discusses diabetic retinopathy, including its definition, signs and symptoms, causes, risk factors, stages, treatments including laser photocoagulation and intravitreal injections, and importance of glycemic and blood pressure control. It emphasizes the need for regular eye exams in people with diabetes to screen for and treat diabetic eye diseases early.
Diabetic retinopathy
This document discusses diabetic retinopathy, its causes, stages, treatments, and prevention. It is progressive retinal vessel dysfunction caused by long-term hyperglycemia. Key factors that contribute to its development include hypertension, hyperlipidemia, female sex, pregnancy, smoking, obesity, and poor metabolic control. Stages include non-proliferative and proliferative retinopathy. Treatments include anti-VEGF drugs, laser photocoagulation, vitrectomy, and strict control of blood sugar and blood pressure to prevent its progression.
Leser treartment
This study analyzed clinical outcomes for patients in the UK undergoing laser treatment for diabetic retinopathy. For eyes treated for maculopathy:
- 9.2% had a deterioration in visual acuity equivalent to doubling the visual angle.
- Poorer outcomes were related to worse baseline visual acuity, diffuse (vs focal) maculopathy, and grid (vs focal) laser treatment.
- For eyes treated for proliferative retinopathy, the neovascularization fully regressed in 50.8% and visual acuity was less than 6/60 in 8.6%. Poorer outcomes were related to high-risk characteristics and coexisting maculopathy at baseline. Improvement was related to larger areas of
Nikolakopoulos vitrectomy or microplasmin in dme with vitreomacular traction
Nikolakopoulos vitrectomy or microplasmin in dme with vitreomacular tractionThessaloniki International Vitreo-Retinal Summer School
Diabetic macular edema (DME) is a major cause of vision loss in people with diabetes. DME affects up to 25% of people after 10 years of diabetes diagnosis and over 40% of people with type 1 diabetes in their lifetime. Current treatment options for DME include laser photocoagulation, anti-VEGF agents, and combined therapy of laser photocoagulation and anti-VEGF agents. Vitrectomy may improve outcomes for DME when there is also macular traction present. A new potential treatment, ocriplasmin, is an enzyme designed to cleave the vitreoretinal interface and has shown promise in resolving vitreomacular adhesion in early clinical trials without requiringMacular Degeneration
Nicholas J. Silvestros, OD
Clinical Instructor
Department of Ophthalmology and Vision Sciences
Washington University St. Louis
School of Medicine
Age related macular degeneration - a glimpse into the future
This short presentation by Jaheed Khan was given on 12th April 2016 as part of a series of talks at Clinica London given to a group of optometrists and general practitioners.
Choosing amongst current modalities to manage diabetic retinopathy
Choosing amongst current modalities to manage diabetic retinopathyCentral Park Medical College and WAPDA Teaching Hospital Lahore
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Macular Degeneration
This document discusses macular degeneration (AMD), including its causes, types (dry and wet), investigations like OCT and fluorescein angiography, symptoms, signs, and treatments. It notes that dry AMD accounts for 80-90% of cases and involves drusen and retinal pigment epithelium changes, while wet AMD involves choroidal neovascularization, leakage, and vision loss. Treatments discussed include nutritional supplementation based on AREDS trials, regular anti-VEGF injections for wet AMD, and monitoring for dry AMD.
How 3 d oct enhances amd & dme treatment
This document discusses age-related macular degeneration (AMD), its two types (dry and wet), risk factors, epidemiology, and treatments. It defines AMD as a disease that gradually destroys central vision. Dry AMD involves breakdown of light-sensitive cells in the macula, while wet AMD occurs when abnormal blood vessels grow behind the retina. Epidemiology studies find 30% of those over 75 have some form of AMD. Treatments discussed include antioxidants to delay dry AMD progression, and laser therapy, photodynamic therapy, and anti-VEGF injections to treat wet AMD. Several case studies demonstrate treatment outcomes.
VEGF (Vascular endothelial growth factors )
you can find out all types of VEGF in this ppt and it is about physiological and path-physiological significance of VEGF and its possible targeting manoeuvering
Preventing Vision Loss in Diabetic Retinopathy
This document discusses diabetic retinopathy and methods for preventing vision loss. It describes the stages of diabetic retinopathy from background retinopathy to proliferative retinopathy. It emphasizes that glycemic control through strict management of blood sugar levels is the most effective treatment for preventing and reducing the risk of diabetic retinopathy. Later stages may require laser therapy or angiogenesis inhibitors. Maintaining optimal blood pressure and cholesterol levels also helps prevent vision loss from diabetic retinopathy.
Advances in Amd And Oct
This document discusses age-related macular degeneration (AMD) and its treatment. It defines dry and wet AMD and their stages. Dry AMD involves breakdown of light-sensitive cells causing blurred vision. Wet AMD occurs when abnormal blood vessels leak fluid causing rapid vision loss. Treatments for wet AMD include laser, photodynamic therapy, and injections of anti-VEGF drugs like Avastin to block abnormal blood vessel growth. The document presents several case studies demonstrating treatment outcomes and uses imaging to show changes pre- and post-treatment. It also discusses epidemiology and risk factors for AMD and a newly defined condition called age-related choroidal atrophy.
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THE ROLE OF ANTI-VEGF THERAPY IN RETINA DISEASES ASSOCIATED WITH MACULAR EDEMA
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Nikolakopoulos vitrectomy or microplasmin in dme with vitreomacular traction
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Age related macular degeneration - a glimpse into the future
Age related macular degeneration - a glimpse into the future
Choosing amongst current modalities to manage diabetic retinopathy
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Similar to Diabetic Macular Edema
Diabetic Maculopathy
Diabetic maculopathy is a form of damage to the eye causing by diabetic macular oedema where fluids build up on the macula. It can be cured by laser surgeries.
Management of dr
This document provides information on various techniques for managing diabetic retinopathy (DR), including:
1. Fundus fluorescein angiography (FFA) examines retinal and choroidal circulation using fluorescent dye and specialized camera.
2. Optical coherence tomography (OCT) captures high-resolution 3D retinal images, and is highly sensitive in detecting diabetic macular edema (DME).
3. Photocoagulation techniques like pan-retinal photocoagulation (PRP), grid laser, and focal/modified grid laser are used to treat proliferative DR and DME based on lesion location and extent.
4. Intravitreal injections of steroids like triamcinolone or
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE MI...
DIABETIC MACULAR EDEMA
The more common cause of visual loss (10 times as much as PDR)
Occurs in about 1/3 of diabetics usually after 8 - 10 years
Diabetic retinopathy
This document discusses diabetic retinopathy, including its classification, risk factors, and evidence from studies on the importance of glycemic control. It covers different classification systems based on features, fluorescein angiography, and OCT. National screening programs are outlined that use digital retinal photography to detect retinopathy and sight-threatening diabetic retinopathy. Guidelines recommend annual eye exams for those with diabetes to monitor for retinopathy and referrals for proliferative retinopathy or other complications.
MACULAR_HOLE presentation dhir hospital bhiwani.pptx
- A macular hole is a full-thickness opening in the neurosensory retina at the foveal center that causes metamorphopsia and central vision loss.
- Macular holes form due to vitreomacular traction or cystoid macular edema and are classified into stages based on size and morphology on OCT imaging.
- Surgical repair via pars plana vitrectomy and gas tamponade is effective for most macular holes, especially smaller and newer ones, leading to hole closure and vision improvement in many cases.
Diabetic retinopathy
This document provides an overview of diabetic eye disease and its treatment. It begins with an introduction and discusses pathogenesis, classification, signs, and advanced complications such as retinopathy and macular edema. Risk factors for progression are described, including duration of diabetes, glycemic control, hypertension, and nephropathy. Treatment focuses on glycemic and blood pressure control as well as laser photocoagulation, intravitreal anti-VEGF agents, and steroids to treat macular edema. Several major clinical trials are summarized that demonstrate the benefits of tighter glucose and blood pressure control, as well as anti-VEGF therapies, on slowing progression of diabetic retinopathy and vision outcomes.
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Sarcoidosis is a chronic multisystem inflammatory disorder characterized by non-caseating granulomas in affected tissues. Common organs involved are the lungs, lymph nodes, eyes, skin and heart. Ocular involvement occurs in 40% of sarcoidosis patients, most commonly presenting as uveitis. Uveitis manifestations include anterior uveitis, intermediate uveitis, posterior uveitis, scleritis, conjunctivitis, keratopathy and optic nerve involvement. Treatment involves topical, periocular or intraocular corticosteroids. Systemic corticosteroids or immunosuppressive drugs are used for more severe or treatment resistant disease.
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This document provides information about uveitis, including:
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- Uveitis is classified anatomically based on the primary site of inflammation - anterior, intermediate, posterior or panuveitis. It is also classified clinically based on infectious vs non-infectious causes.
- Anterior uveitis is inflammation in the anterior chamber and causes pain, redness, photophobia, tearing and decreased vision. Workup and treatment depends on identified cause but may include topical steroids, cycloplegics, and systemic immunosKeratoconus
This document discusses various corneal ectasias such as keratoconus. It describes the structure of the cornea and the pathophysiology of keratoconus. Symptoms include decreasing vision, irregular astigmatism. Diagnosis involves corneal tomography and biomechanical testing. Management includes contact lenses, corneal collagen cross-linking, and intrastromal corneal ring segments. The Dresden protocol is described for corneal collagen cross-linking using riboflavin and UV light.
RETINA-retinal detatchment powerpoint presentation
This document summarizes various retinal conditions including retinal detachment, retinoblastoma, and retinitis pigmentosa. It describes the classification, causes, clinical features, investigations, and treatments of these conditions. Retinal detachment can be rhegmatogenous, tractional, or exudative in nature. Retinoblastoma is a malignant tumor of childhood that may appear as a white pupil reflex and is typically treated with chemotherapy, radiation, or enucleation. Retinitis pigmentosa is a genetic retinal dystrophy characterized by night blindness and bony spicule pigmentation.
DR management
Diabetic retinopathy is managed through modification of systemic risk factors like blood sugar and blood pressure control, as well as ocular treatments. Laser photocoagulation and intravitreal anti-VEGF injections are primary treatment modalities. Laser photocoagulation through panretinal or macular grid lasers is effective for proliferative diabetic retinopathy and diabetic macular edema respectively. Intravitreal anti-VEGF drugs like ranibizumab, aflibercept and bevacizumab are effective treatments for center-involving diabetic macular edema and can be alternatives to laser in some cases. The choice of treatment depends on the severity and location of retinopathy and macular edema.
Cornea dr. feba mary george
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Macular hole
Macular hole is a defect in the macula involving its full thickness. It was first described in 1869. Idiopathic macular holes are the most common type and affect people over age 55. Staging of macular holes ranges from stage 1 to 4 based on size and pathology. Symptoms include decreased vision and metamorphopsia. Diagnosis involves examination, OCT, and sometimes FA. Treatment is usually vitrectomy surgery for stages 2-4 to relieve traction on the macula. Prognosis depends on pre-op vision and hole size/duration, with most patients gaining vision after surgery.
OCT For Everyone..
OCT is a great technology,Many ophthalmologist find very difficult to understand it ,SO I have tired to simplify it as much as possible .Hope everyone can understand now onwards the basic about OCT .
Every feedback s most welcomed sothat i can improve further in coming days
Please email your feedback to me in the following address
yourgyanu@gmail.com
Corneal Ectasias
Corneal ectasias are disorders affecting the shape of the cornea. The main types are inflammatory and non-inflammatory. Keratoconus is a non-inflammatory ectasia with progressive thinning and protrusion of the cornea leading to irregular astigmatism. Diagnosis involves corneal topography showing an asymmetric bowtie pattern. Treatments include rigid contact lenses, collagen cross-linking to strengthen the cornea, and keratoplasty for severe cases. INTACS inserts are also used to flatten the cornea in mild to moderate keratoconus.
KERATOCONUS
This document provides information about keratoconus, a non-inflammatory thinning of the cornea that causes a cone-shaped bulge. It is most common in teenagers and young adults. The document discusses the definition, stages, etiology, associations, clinical features, investigations, and management of keratoconus. Keratoconus is typically managed initially with glasses or contact lenses, and more advanced cases may require collagen cross-linking, intracorneal ring segments, deep anterior lamellar keratoplasty, or penetrating keratoplasty to correct vision and stop further thinning. Differential diagnoses include keratoglobus and pellucid marginal degeneration.
Retina for undergraduate students
The document discusses the retina and macula. It begins by describing the layers of the retina and macula, including the fovea. It then discusses the cell types found in each layer, such as photoreceptors, bipolar cells, and ganglion cells. The document goes on to explain retinal vasculature and how the retina is supplied by the central retinal artery. It concludes by briefly mentioning common imaging techniques used to examine the retina and macula.
Phototherapeutic keratectomy
Phototherapeutic keratectomy (PTK) can be used to treat corneal dystrophies by removing corneal opacity and smoothing the corneal surface. Key points:
- PTK removes superficial corneal opacity using an excimer laser, ablating dystrophic tissue while preserving as much healthy tissue as possible.
- It can improve vision and reduce irregular astigmatism in corneal dystrophies that involve superficial layers such as map-dot-fingerprint, granular, and lattice dystrophies.
- Complications include delayed epithelial healing, refractive changes like hyperopic shift, stromal haze, and recurrence of disease. Success varies by dystrophy type, with recurrent erosions and opacification more
Peripheral Ulcerative Keratitis.Dr Ferdous
This document discusses peripheral ulcerative keratitis (PUK), a group of inflammatory diseases that cause thinning and ulceration of the peripheral cornea. It describes several types of PUK including Mooren's ulcer, marginal keratitis, Terrien's marginal degeneration, and PUK associated with autoimmune diseases. Mooren's ulcer is a rare autoimmune disease characterized by progressive, peripheral, circumferential ulceration. Marginal keratitis is caused by a hypersensitivity reaction to Staphylococcus exotoxins. Terrien's marginal degeneration causes thinning of the peripheral cornea. PUK associated with autoimmune diseases like rheumatoid arthritis is linked to immune complex deposition in the peripheral cornea. Management involves topical
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Intraocular lenses
Intraocular lenses have evolved significantly from the early rigid lens designs implanted in the 1950s. Modern intraocular lenses are classified based on location, design, and material. Premium lens options include multifocal lenses that provide multiple focal points for both distance and near vision, toric lenses that correct astigmatism, and accommodating lenses designed to restore the eye's ability to focus on near objects. Proper patient selection is important for multifocal lenses, considering an individual's lifestyle and visual needs.
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Diabetic Macular Edema
- 2. OVERVIEW • Most common cause of visual loss in DM • Prevelance 11.1% (2-10%) • Incidence (10 year rate: 20.1%; 25.4%; 13.9%)
- 3. CLINICAL ASSOCIATONS • • • • • • • • Severity of DR Duration of diabetes and glycemic control Proteinuria, Hypertension, Dyslipidemia Pregnancy, Intraocular surgery Pan retinal photocoagulation
- 4. ANATOMY
- 5. ANATOMY
- 6. PATHOPHYSIOLOGY • ALDOSE REDUCTASE • VASOPROLFERATIVE FACTORS • PLATELET DYSFUNCTION
- 7. PATHOPHYSIOLOGY • Capillary damage and raised permeability (breakdown of inner blood retinal barrier) – Pericyte loss (oxidative damage and AGEs) – Disorganisation of tight junctions – Increased transcelluar endocytosis – VEGF – Protein kinase cβ • Microaneurysms • IRMAs
- 9. PATHOPHYSIOLOGY • • • • • Extracellular fluid accumulation Cystoid spaces in the outer plexiform layer May occupy entire thickness Tissue disorganisation Atrophic changes
- 10. PATHOPHYSIOLOGY • Hard exudates (HE): – Lipoproteinaceous deposits – Transudation – Outer plexiform layer • Subretinal fluid • Subretinal fibrosis
- 11. PRESENTATION • Depends on central macular involvement – Paracentral scotomas – Gradual progressive loss of vision (weeks to months) – Color vision loss – Metamorphopsia – Fluctuation of vision – Contrast sensitivity – Prolonged adaptation
- 12. EXAMINATION • • • • Clinically best detected by 60 D, 78 D lenses Decreased translucency Loss of foveolar reflex Patterns : – Diffuse – Focal; circinate pattern – Ischemic – Mixed
- 14. EXAMINATION • Stereoscopic fundus photography • Fluorescein angiography – Macular perfusion – Extent and location of capillary leakage • OCT – Documenting macular thickness – Monitoring progression
- 15. CSME • Retinal thickening at the center of macula • Retinal thickening and/or adjacent hard exudates at or within 500 u of center of macula • Retinal thickening ≥ 1 disc area, any part of which is within 1 DD of the center of macula
- 16. THERAPY • • • • • • Medical LASER photocoagulation Triancinolone acetonide Anti-VEGF therapy Protein kinase c inhibtion Vitrectomy
- 17. LASER photocoagulation • ETDRS gave conclusive supporting proof • Focal laser for leaking microaneurysm atleast 500 u from the fovea – (aim : closure of leak) • Grid laser for diffuse retinal thickening/ areas of ischemia – (aim : stimulate retinochoroidal pump)
- 18. Treatable lesions • Focal leaks >500 u from center of macula causing thickening/exudation • Focal leaks 300-500 u from center if t/t is not likely to damage perifoveal capillary network • Areas of diffuse leakage • Abnormal avasular zone
- 19. ETDRS protocol Focal Spot size Exposure time Grid 50-100 u <200u 0.05 – 0.1 s Intensity Whitening/darkening of microaneurysms (80 - 120 mW) 80 – 180 mW Number of burns Coagulate all leaking foci All zones of diffuse leakage Placement 500 – 3000 u from center sparing papillomacular bundle Sessions 1 Argon green laser (514 nm) and Goldmann 3 mirror lens Avoid argon blue-green (488 nm) Follow up after 4 weeks, if lesions missed then treat after 4 months Spacing is one burn width apart
- 20. LASER photocoagulation • Adverse effects – Foveal burns – Subretinal hemorrhage – Vitreous hemorrhage – RPE creep – CNV – Paradoxically increased HE
- 21. TRIANCINOLONE ACETONIDE • • • • Intravitreal route Needs repeated injections Duration of effect : 2-3 months with 4mg Complications – Raised iop – Endophthalmitis – Cataracts • Peribulbar route
- 22. ANTI-VEGF therapy • Bevacizumab (Avastin) • Ranibizumab (Lucentis) – – – – Fusion proteins with human antibody backbone Bind all VEGF subtypes Intravitreal route No definite schedule • Pegaptinib (Macugen) – Engineered RNA fragment – Specific sites for VEGF binding
- 23. PROTEIN KINASE C Inhibitors • PKCβ – Ruboxistaurin – Oral administration