This document summarizes various retinal considerations for refractive surgery patients. It discusses vitreoretinal alterations that can occur during refractive surgery and various macular and peripheral retinal disorders. Specifically, it examines disorders like epiretinal membranes, vitreomacular traction, myopic foveoschisis, cystoid macular edema and peripheral lesions that can predispose patients to retinal detachment. It emphasizes the importance of thorough pre-operative and post-operative retinal exams to identify any high-risk lesions that may require referral to a retinal specialist. Complications after refractive surgery are generally rare but complications of the myopic eye will persist.
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...parkavenuelasek
Dr. Chynn graduated from Harvard's ophthalmology program, which is probably the most famous in the world.
As the only member of his graduating class to specialize in Refractive Surgery, and now an recognized authority, Dr. Chynn is frequently invited back to Harvard to give updates on the State of the Art in Refractive Surgery.
This slide show presentation was given to 100 eye surgeons who flew in from across the country to learn the latest advances in glaucoma, retina, cataract surgery--and laser vision correction (from Dr. Chynn).
The title of his talk reflects the movement in the US and worldwide from leading surgeons that is called "Back to the Surface." This means that surgeons are moving away from LASIK and IntraLase, to avoid flap complications and the # 1 problem causing lawsuits (iatrogenic keratoconus, or KC), and back to the surface.
For some doctors, this means going back to the original procedure, PRK, which has a lot of pain, delayed healing, and scarring.
For Dr. Chynn, this means performing an Advanced Surface Ablation, which is either a LASEK or epiLASEK. These are more advanced than PRK because they do not hurt, healing and recovery is quick, and there is no haze or scarring.
For example, Dr. Chynn performs over 1,000 LASEKs and epiLASEKs per year--he performed his last PRK in 1999.
Obviously, he moved away from PRK to LASIK, then to IntraLase, and now back to the safer LASEK and epiLASEK procedures.
View the following slide show to find out more, and call us with your questions--better yet, come in and meet with our MDs!
Vinayak Hospital , a unit of Dr Agarwals Eye Hospital – A Super Specialty Eye Hospital in Indore, providing eye care services of national standards is situated in Indore. It is an NABH- National Board of Hospitals & Healthcare Providers accredited hospital with a vision to become the premier eye care organisation by achieving excellence in patient care through latest medical technology and quality health care services. Eyes are among the most sensitive organs in the body, and therefore they need the best possible care in a top-quality environment and under the supervision of expert ophthalmologists. At Vinayak Hospital, all services related to Eye care which includes outpatient & Inpatient services, Diagnostics, Laboratory, Opticals & Pharmacy are available under one roof.
https://vinayaknetralaya.org/
https://www.dragarwal.com/
This is a video about eye laser treatment, particularly LASIK. It was made to inform you about the procedure as well as what to look for when choosing clinics and doctors.
Watch the video and learn all the vital information about this life-changing treatment in 4 minutes!
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...parkavenuelasek
Dr. Chynn graduated from Harvard's ophthalmology program, which is probably the most famous in the world.
As the only member of his graduating class to specialize in Refractive Surgery, and now an recognized authority, Dr. Chynn is frequently invited back to Harvard to give updates on the State of the Art in Refractive Surgery.
This slide show presentation was given to 100 eye surgeons who flew in from across the country to learn the latest advances in glaucoma, retina, cataract surgery--and laser vision correction (from Dr. Chynn).
The title of his talk reflects the movement in the US and worldwide from leading surgeons that is called "Back to the Surface." This means that surgeons are moving away from LASIK and IntraLase, to avoid flap complications and the # 1 problem causing lawsuits (iatrogenic keratoconus, or KC), and back to the surface.
For some doctors, this means going back to the original procedure, PRK, which has a lot of pain, delayed healing, and scarring.
For Dr. Chynn, this means performing an Advanced Surface Ablation, which is either a LASEK or epiLASEK. These are more advanced than PRK because they do not hurt, healing and recovery is quick, and there is no haze or scarring.
For example, Dr. Chynn performs over 1,000 LASEKs and epiLASEKs per year--he performed his last PRK in 1999.
Obviously, he moved away from PRK to LASIK, then to IntraLase, and now back to the safer LASEK and epiLASEK procedures.
View the following slide show to find out more, and call us with your questions--better yet, come in and meet with our MDs!
Vinayak Hospital , a unit of Dr Agarwals Eye Hospital – A Super Specialty Eye Hospital in Indore, providing eye care services of national standards is situated in Indore. It is an NABH- National Board of Hospitals & Healthcare Providers accredited hospital with a vision to become the premier eye care organisation by achieving excellence in patient care through latest medical technology and quality health care services. Eyes are among the most sensitive organs in the body, and therefore they need the best possible care in a top-quality environment and under the supervision of expert ophthalmologists. At Vinayak Hospital, all services related to Eye care which includes outpatient & Inpatient services, Diagnostics, Laboratory, Opticals & Pharmacy are available under one roof.
https://vinayaknetralaya.org/
https://www.dragarwal.com/
This is a video about eye laser treatment, particularly LASIK. It was made to inform you about the procedure as well as what to look for when choosing clinics and doctors.
Watch the video and learn all the vital information about this life-changing treatment in 4 minutes!
Autodesk - Gamification in customer engagement - Manu Melwin Joymanumelwin
For software company Autodesk, the 30-day software trial period offered to customers is critical.Trials are a key part of the customer’s purchase decision and account for a significant percentage of the company’s website traffic.
Ionopolis - Gamification in customer engagement - Manu Melwin Joymanumelwin
Japanese soft drink Pocari Sweat launched an electrolyte drink in Indonesia with a game called Ionopolis. Over 94,000 signed up to defeat comic book monsters who wanted to dehydrate a city.
KEI PULSE Workshop Presentation - Year of the Monkey by Stefanie Kuhnhen-Stei...Grabarz & Partner
AN INTUITIVE TOOL
FOR SHAPING
COLLABORATIVE
CULTURES.
Year of the Monkey Digital and Innovation Festival
Workshop Session with Stefanie and Imran
Munich, 21 April 2016
Club Psyche - Gamification in customer engagement - Manu Melwin Joymanumelwin
NBC Universal's USA Network enlisted the help of gamification startup San Jose, Calif.-based Bunchball in July 2010 to increase engagement on the website for Psych, one of its TV shows.
in these slides the organization of processor has been discussed in detail. as a processor is the main unit of computer a good understanding of this topic is very necessary for understanding the computer architecture.
Leukocoria ( or white pupillary reflex) is an abnormal white reflection from the eye.
Leukocoria is a medical sign for a number of several conditions.
- this presentation at annual conference of the Ophthalmic department, faculty of medicine - Al-Azhar University in association with DOS & EOS Cairo, Egypt January 2017
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
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Telehealth Psychology Building Trust with Clients.pptx
Focus Co Management 2016 Dr Dolin
1. 6/17/2016
1
Retinal considerations for
refractive surgery
Michael Dollin, MD, FRCSC
Assistant Professor
University of Ottawa Eye Institute
Ottawa, Ontario, Canada
June 2, 2016
Outline
• Vitreoretinal alterations during refractive surgery
• Disorders of the macula
• Disorders of the peripheral retina
2. 6/17/2016
2
Outline
• Vitreoretinal alterations during refractive surgery
• Disorders of the macula
– Epiretinal membrane
– Vitreomacular traction
– Myopic foveoschisis
– Myopic macular hole
– Cystoid macular edema
• Disorders of the peripheral retina
– Lesions predisposing to retinal detachment
– Retinal detachment
– Retinoschisis
Homer Simpson
“Eye crusts” after laser eye surgery
4. 6/17/2016
4
Vitreoretinal alterations during
refractive surgery
• Corneal refractive surgery (CRS)
– Suction ring changes in eye shape power vectors
relayed to the macula and/or vitreous base
– Effect of the excimer laser shock wave appears negligible
5. 6/17/2016
5
Vitreoretinal alterations during
refractive surgery
• Refractive lens exchange (RLE)
– VR alterations similar to those induced during
cataract surgery (PC trampolining, PC rupture)
Thorough pre-operative dilated fundus
examination is key
7. 6/17/2016
7
MACULA
Epiretinal membrane (ERM)
• Glial cells and laminocytes that attach to a scaffold of vitreous
cortex on the inner retinal surface, typically after PVD
• ERM contracture causes macular traction distorting the
underlying foveal structure thickening +/- CME
8. 6/17/2016
8
Epiretinal membrane (ERM)
• Incidence increases with age
– Seen in 7% of patients ≥50 years old
– 31% bilateral
• May occur during any stage of vitreous
separation (vitreoschisis)
– In younger patients, often present in absence of PVD
• Refer for Retina opinion
Case
• 36 year old male
• Referred for macular evaluation prior to CRS
• C/O mild blur OD, no distortion
• High myope (-9 OU)
• BCVA 20/25 OD, 20/20 OS
10. 6/17/2016
10
Vitreomacular adhesion (VMA)
• Perifoveal vitreous
separation with
remaining vitreomacular
attachment
• Unperturbed foveal
morphologic features
• May or may not lead to
pathologic conditions
Vitreomacular traction (VMT)
• Anomalous PVD accompanied by
anatomic distortion of the fovea
– Pseudocysts, macular schisis, cystoid
macular edema, and subretinal fluid
• Focal (≤ 1500μ) vs. broad (> 1500μ)
• Concurrent = associated with other
macular disease (e.g. ERM)
• Variably symptomatic
– Decreased vision, metamorphopsia,
central scotoma
11. 6/17/2016
11
OCT essential in the diagnosis
Distinguish from vitreomacular adhesion
(VMA)
• Unperturbed foveal morphologic features
12. 6/17/2016
12
VMT
• Management
– Observation
• 1/3 will release spontaneously
– Ocriplasmin (Jetrea)
– Vitrectomy
• 5% will require surgery due to
bothersome symptoms or
progression to full thickness
macular hole
• Refer for Retina opinion
Myopic foveoschisis
• Increasingly recognized entity with advent of OCT
– Prevalence 9-33% of myopic eyes with staphyloma
• Mechanism is mixture of tractional forces
– Abnormal vitreomacular interface pulling inward
– Abnormal scleral alterations pulling outward
13. 6/17/2016
13
• Despite often impressive anatomic findings, most
patients may be relatively asymptomatic
– Visual loss often eventually attributed to foveal
detachment and/or macular holes
• Choroidal thinning often an associated feature
– May reduce vision independent of schisis
• Refer for Retina opinion
Case
• 32 yo female
• Interested in CRS
• Myope (-6 OU)
• BCVA 20/20 OD, CF OS
14. 6/17/2016
14
20/20 CF
Macular hole
• Foveal lesion with interruption of
all retinal layers from ILM to RPE
• Primary (due to VMT) or
secondary (e.g. traumatic)
• Small ≤ 250 μ
• Medium > 250 μ – 400 μ
• Large > 400 μ
• Status of vitreous:
– With VMT
– Without VMT
15. 6/17/2016
15
Macular hole in high myopes
• Can be extremely subtle, if not impossible, to
detect clinically
– Particularly in the setting of posterior staphyloma
• Obtain an OCT
• Refer for Retina opinion
Case
• 48 year old female
• Referred for retina check prior to RLE
• High myope (-12 OU)
• BCVA 20/30-2 OD, 20/25 OS
17. 6/17/2016
17
Cystoid macular edema
• Various etiologies
– Vein occlusion, diabetes, radiation, uveitis, CNV, etc
• Presumed inflammatory etiology post RLE
Cystoid macular edema
• Presumed inflammatory etiology post RLE
– Stepwise approach to treatment beginning with
topical therapy:
– Prednisolone (e.g. Pred forte QID)
– NSAID (e.g. Acular QID, Nevanac TID)
– Taper slowly once CME has resolved
• Refer to Retina
– If not improving after 4-6 weeks of topical therapy
– May require sub-Tenon’s or intravitreal steroid
18. 6/17/2016
18
A note about diabetic macular edema
• Refer to Retina if DME is
detected on pre-op
exam
• In patients receiving
anti-VEGF for DME and
wishing to undergo RLE,
ideal to time surgery 1
week after an injection
Disorders of the peripheral retina
• Lesions not predisposing to retinal detachment
• Lesions predisposing to retinal detachment
• Posterior vitreous detachment
• Retinal detachment
• Retinoschisis
19. 6/17/2016
19
Lesions NOT predisposing to RD
• Pavingstone (cobblestone) degeneration
• RPE hyperplasia and hypertrophy
• Peripheral cystoid degeneration
• White without pressure
20. 6/17/2016
20
Pavingstone (cobblestone) degeneration
• Small, discrete areas of
ischemic atrophy of outer
retina
• 22% of patients over 20
years of age, 38% bilateral
• May be single or multiple
and confluent
• Most commonly inferior
(5-7 o’clock) and anterior
to the equator
22. 6/17/2016
22
Peripheral cystoid degeneration
• Zones of microcysts with bubbly
appearance posterior to the ora
• Present in virtually all adults over 20
years old
• Holes may form but rarely lead to RD
• Coalescence and extension of
cavities can progress to retinoschisis
23. 6/17/2016
23
White without pressure
• White appearance of the equator and/or peripheral
retina seen without scleral indentation
• Margins often sharply demarcated from normal retina
25. 6/17/2016
25
Lattice degeneration
• Crisscrossing lattice work of white lines (hyalinized blood
vessels)
– Typically parallels the ora seratta
• 6-10% of general population
– Bilateral in 33%
• More common in myopes
• Familial predilection
• Atrophic holes within lattice present in 31%
Lattice degeneration
• Histopathology
– ILM discontinuity
– Inner retinal layer atrophy
– Liquefaction of overlying vitreous
– Condensation and adherence of vitreous at
margin
27. 6/17/2016
27
Lattice degeneration and RD
• Cause of 20-30% of RRDs (present in 41%)
• Due to tractional tear at lateral or posterior
margin (55-70%)
– 90% under 50 yo and 43% myopic
– Progress rapidly and demarcation lines less likely
• Due to atrophic hole within lattice (30-45%)
– 70% under 40 yo and 70% myopic
– Progress slowly and see demarcation lines, due to tear
28. 6/17/2016
28
Lattice degeneration and RD
• Lifetime risk (11-year study) of RD in all
patients with lattice is 1%
– Increases to 2% if atrophic holes present in lattice
• Presence of lattice, with or without atrophic
holes on routine exam, does not require
prophylactic treatment
Lattice with atrophic holes
29. 6/17/2016
29
• 2% risk of RD
• Lesion should not be treated prophylactically
Atrophic hole not associated with lattice
31. 6/17/2016
31
Vitreoretinal tufts
• Small, peripheral retinal elevations caused by
focal areas of vitreous or zonular traction
– +/- surrounding RPE hyperplasia
• 3 types of tufts:
– Non-cystic (do not predispose to RD)
– Cystic and Zonular traction (predispose to RD)
33. 6/17/2016
33
• Risk of a retinal detachment from cystic retinal
tuft is quite low and estimated to be only 0.28%
– Prophylactic treatment not necessary if detected on
routine exam
– Treat if recent flashes and floaters and break is
suspected
Meridional folds
• Folds of redundant retina
• Usually superonasal
• Meridional folds can be associated with retinal
breaks at the tip
34. 6/17/2016
34
• Prophylactic treatment of meridional folds not necessary if
detected on routine exam
• Treat if recent flashes and floaters and break is suspected
35. 6/17/2016
35
Posterior vitreous detachment
• May develop in 2-24% of eyes
following CRS
– Increasing incidence with
increasing myopia
• Patients with new onset flashes
and floaters following CRS
should be evaluated with DFE
– Rule out retinal break
• 10-15% will have a retinal tear
– With hemorrhage 70%
– Without hemorrhage 2-4%
Weiss ring
37. 6/17/2016
37
Rhegmatogenous retinal detachment
• Risk of RRD after CRS is
very low
– Particuarly with adequate
pre-operative screening for
high risk peripheral retinal
lesions
• Characteristics of RRD are
similar in patients having
undergone CRS compared
to patients who have not
– Myopia likely contributes
more to the risk of RRD
than the refractive surgery
itself
40. 6/17/2016
40
Retinoschisis
• Intraretinal degenerative process with splitting of retina in
periphery, accumulation of intraretinal fluid, and loss of visual
function
– Split of sensory retina into outer and inner layer
• Found in 5% of population over 20 years
• 70% are hypermetropes
• Generally nonprogressive
– Posterior extension 3.2%
– Lateral extension 6.4%
– New areas 10%
41. 6/17/2016
41
Retinoschisis-retinal detachment
• Responsible for 3.2% of full-thickness RD
• Expected incidence of progressive RD in patients with
retinoschisis 0.05%
• 2 types of RD:
– Hole in outer wall only: usually do not progress or do so
slowly (demarcation and RPE atrophy often present)
– Hole in outer and inner walls: may result in rapidly
progressive RD
43. 6/17/2016
43
Differentiating retinoschisis from
retinal detachment
CLINICAL FEATURE RD RS
High risk group
Symptoms
Location
Surface
Hgb or pigment (Shafer’s)
Scotoma
Reaction to photocoagulation
Shifting fluid
Myopia
F/F, VF loss
Superotemporal
Corrugated
Present
Relative
Absent
Variable
Hyperopia (70%)
Typically asymptomatic
Inferotemporal (70%)
Smooth, dome-shaped
Usually absent
Absolute
Present
Absent
44. 6/17/2016
44
• Chronic RRD
– Retina may appear smooth, thin and transparent
– May also show underlying RPE atrophy, demarcation lines,
and macrocysts -- not present in retinoschisis
45. 6/17/2016
45
Summary
• Retinal complications after LASIK are rare
• Complications of the myopic eye will persist
– Important to inform patients that refractive surgery only
corrects the refractive aspect of myopia
• Pre-op dilated fundus examination of the macula and
peripheral retina is very important to identify any high risk
lesions
– Also important post-op when vision is not as good as expected
• If high risk peripheral lesions or new macular lesions are
detected refer to Retina
