The document discusses glaucoma drainage device (GDD) surgery. It describes the physiology of drainage implants, which involve a silicone tube extending from the anterior chamber to a plate beneath the conjunctiva. A fibrous capsule forms around the external portion of the implant. The document discusses various GDD designs including open-tube devices like the Baerveldt implant, flow-restricted devices like the Ahmed Glaucoma Valve, and newer devices like the iStent. Complications of GDD surgery and the indications for the procedure are also outlined.
This is a power point presentation prepared by Dr Robin Goh Chon Han. He is a Ophthalmology Postgraduate Student from University Malaya, Malaysia.
This presentation reviewed the challenges and overcome measures for cataract surgery in silicone oil filled post-vitrectomized eye.
This is a power point presentation prepared by Dr Robin Goh Chon Han. He is a Ophthalmology Postgraduate Student from University Malaya, Malaysia.
This presentation reviewed the challenges and overcome measures for cataract surgery in silicone oil filled post-vitrectomized eye.
A case of dense nuclear cataract has undergone phacoemulsificaton by horizontal chop technique. the pupil was small so Iris retractor was utilized. Intraocular lens was implanted.
A case of dense nuclear cataract has undergone phacoemulsificaton by horizontal chop technique. the pupil was small so Iris retractor was utilized. Intraocular lens was implanted.
Minimally Invasive Glaucoma Surgery (MIGS)Meironi Waimir
Minimally invasive glaucoma surgery (MIGS) is a group of procedures that minimizes the invasive rate of glaucoma with five characteristics: ab interno microincision, minimal trauma, more effective, high safety profile, and quick recovery.
MIGS is a surgery that uses an incision in a clear cornea and is indicated in patients with mild to moderate open angle glaucoma.
The technique of MIGS is based on several mechanisms, namely trabecular meshwork bypass stents including iStent, trabectome, and Hydrus microstent; Suprachoroidal implant using Cypass microstent; And subconjungtiva filtration using XEN gel stent.
MIGS technology has potential advantages in glaucoma management by reducing the burden of treatment, improving patients quality of life, and cutting or delaying more invasive surgeries.
Casting procedures/cosmetic dentistry course by Indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
Clinical management of edentulous maxillectomy /prosthodontic coursesIndian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Physiology of Drainage Implants
• A silicone tube that extends from the AC to a plate, disc, or encircling
element beneath the conjunctiva and tenon capsule. External plate has a
ridge through which the tube enters on to its surface.The ridge decreases
the risk of obstruction with the surrounding tissue and fibrous capsule and
forms a filtering bleb posteriorly near the equator.
• A fibrous capsule forms a filtering bleb around the external portion of the
draining device.
• After insertion, a thin collagenous capsule, surrounded by granulomatous
reaction is present which subsides after 4 months.The capsule thickness
remains stable and collagen stroma becomes less compact.
• There is a direct relation between surface area of the implants and the
filtering capacity of their surrounding capsule.
• Reduction in bleb diameter decreases surface tension, capsular fibrosis and
thickness thus increasing the effectiveness of the filtering surface.
3. • All drainage devices develop an elevated IOP weeks to months after
implantation due to capsule formation.This is termed as Hypertensive Phase
The indications for GDD implantation include the following:
• Neovascular glaucoma
• PKP with glaucoma
• Retinal detachment surgery with glaucoma
• ICE syndrome
• Traumatic glaucoma
• Uveitic glaucoma
• Open-angle glaucoma with failed trabeculectomy
• Epithelial downgrowth
• Refractory infantile glaucoma
• Contact lens wearers who need glaucoma filtration surgery
4. Implant designs:
A) Open-Tube Drainage Devices
-Baerveldt Implant:a) 250 mm2 area
b) 350 mm2 area
c) 500 mm2 area
d) 35o mm2 area pars plana
-Molteno Implant
-SchocketTube Shunt
B) Flow Restricted/Valved Devices
-Ahmed GlaucomaValve
-Krupin Implants.
C) Newer Devices
-iStent
-Ex-PRESS Device
-SolxGold Shunt
-OptiMed glaucoma Pressure
Regulator
-SusannaGlaucoma Implant
5. A) Baerveldt Implant:
-Non valved drainage implant.
-Designed for single quadrant conjunctival insertion.
-Material: Medical grade silicon plate (soft barium impregnated
silicon plate) with a silicon tubing.
-Size: Plate surface area a) 250 mm2 (20 x 13 mm)
b) 350 mm2 (32 x 14 mm)
c) 500 mm2
-Position: Under the rectus muscle insertion usually in the
superotemporal quadrant.
-Features: 4 fenestrastions that allow growth of fibrous tissue through
the plate, serving to reduce the height of the BLEB thus reducing
the risk of dislocation of the implant and diplopia.
3-4 weeks post op fibrous capsule forms over the implant,
therefore full efficacy of the implant is achieved after that.
Open drainage devices
9. B) Molteno Implant:
-Non valved drainage implant introduced in 1969.
-Original design had a single plate ( 13 mm diameter and 135mm2
surface area ).To increase the efficacy second plate was added.
3Rd generation plate was developed, it has a bowl shaped
structure ( it is designed to function as a biological valve by l
imiting the available area of filtration during times of low
aqueous production.)
-Material:Acrylic plate with silicon tubing
-Size: Surface area of single plate is 135mm2 and 13 mm diameter
Double plate is 270 mm2 , 175 mm2 and 230 mm2.
Silicon tubing had an external diameter of 0.62mm and internal
diameter of 0.30mm.
-Position: Under the rectus muscle insertion usually in the
superotemporal quadrant.
-Features:V-shaped pressure ridge on the upper surface encases
10.5mm2 around the tube opening to deal with the problem of
Hypotony and excessive filtration in post op period.
10.
11.
12. C) SchocketTube Shunt:
-Non valved drainage implant.
-A Silicon or Silastic tube is extended from the AC to a 360 degree
encircling silicon band which functioned in developing the
reservoir for aqueous drainage.
-Material: Silicon or Silastic tubing.
-Position: 90 degree insertion of the silicon tube originating from
the AC to the encircling band beneath 2 or more rectus muscles
-Features: Its provides a larger surface area of reservoir compared
to molteno implant.
-Procedure: A 30-mm long silastic lacrimal tube with an internal
diameter of 0.30 mm is sutured inside the groove of a #20 silicone band,
leaving 15 mm of the tube extending from the band.The encircling band
is circumferentially sutured to the sclera, 10–12 mm from the limbus
beneath the four rectus muscles, with 5-0 Supramid sutures.A square 3–
4mm scleral flap hinged at the limbus is elevated, and a slightly beveled
puncture wound is made into the anterior chamber.The end of the tube is
beveled and inserted into the anterior cham- ber so that a 3-mm length is
suspended between the iris and cor- nea with the bevel facing anteriorly.
The scleral flap is closed with 10-0 nylon, and the conjunctival flap is
sutured with 8-0Vicryl.
13.
14. Flow restricted /Valved Devices:
A) Ahmed GlaucomaValve (AGV) implant
-Valved implant design
-Design and material: Silicone tube is connected to a silicone sheath
valve held in a polypropylene / silicone body.
For pars plana insertion , a pars plana clip can be used .
-Models: most commonly used model is S2 ,
flexible siliconeAGV FP7 (0.9 mm thick).
Adult and pediatic (96 mm2 surface area)AGV are also available.
-Valve mechanism:
-2 thin silicone elastomer membranes , 8 mm long and 7 mm
wide I is used which allows 1-way regulation.
-Inlet cross section is wider than the outlet , so small pressure
differentials between the AC and the subconj space , enabling
the valve to function even at small pressure differences.
8 to 10 mmHg in early post op period
15. -Venturi effect of the valve can be explained by Bernoulli’s equation of fluid
dynamics.
( flow rate of a fluid is inversely proportional to the pressure of the fluid)
-The aqueous humor flows slowly into the trapezoid chamber and increases
the pressure.On reaching the pre-set threshold value , the valve opens thus
decreasing the pressure.
-The fluid velocity has to increase as it leaves the chamber (due to rise in
pressure) through the drainage tube .The tension in the silicone membranes
helps reduce hypotony as the valves closes as pressure decreases.
-No-touch zone on the AVG is area of the chamber with silicone leaflets.
If the implant is grasped with the forceps along the centre line, it may separate
the valve cover from the implant leading to failure due to adhesion of the valve
membrane.
18. B) Krupin Implants
-Valved implant with multiple leaflets.
-The original design of krupin was without a disc , similar to
Schocket type of implant.
-Present design consists of the krupin valve with a disc, a silastic
tube is attached to an oval silastic disc, conformed to the curvature
of the globe (360 degrees), 13mm x 18mm , with side walls 1.75
mm high.
-The valves are designed to open at pressures of 10 to 12 mmHg.
Valve lies on the inside of the rim and comes in direct contact with
the subconj tissue.
-Designed to reduce post op hypotony and excessive drainage.
19. Newer Setons:
1) Glaukos iStent
-Light weightTitanium L-shaped device placed inside the
schlemm’s canal, to allow aqueous to bypass the inner wall
of schlemm’s canal and the juxtacanalicularTM
-1mm of the device sits in the SC and is shaped like a half
pipe.
-Small snorkel shaped tube 0.5 mm size sits in the peripheral
AC
-The device is designed to fit into the schlemm’s canal,
-The implant is heparin covered for thrombolytic activity and
prevent stenosis.
-The 3 barbed ridges are designed to prevent loosening and
secure placement.
-The device is placed in the nasal quadrant under
gonioscopic
guidance.
21. 2) Ex-PRESS mini shunt:
- 400 micron wide x 3 mm long , stainless steel device.
- It has a beveled sharpened rounded tip, disclike flange (<1 mm2) at the
proximal end and a spurlike projection that prevents its extrusion.
- Thickness corresponds to the scleral thickness, the external flange and
the inner spur are angled to conform to the scleral anatomy.
- Inner diameter is 125 microns and outer diameter is 250 micron, thin
enough to fit into the scleral spur.
- Sterilization: by gamma radiation , stored at 15-30 degree C
- Immediate bleb formation on 1st or 2nd post op day.
23. 3) Gold Micro-Shunt
- Deep Light Glaucoma tx:Titanium sapphire laser and photo titratable gold
micro shunt
- Laser emits microsecond infra red light pulses that passes through the
trabecular meshwork tissues to produce an opening for outflow.
- The 99.5% inert gold shunt is placed which have micro channels , which can
also be titrated post op using titanium sapphire laser.
- The biocompatible gold plate is 5.2 mm long, 2 mm wide and 60 micron thick
containing multiple microchannels
- It is implanted through a 3 mm clear corneal incision with a help of a pre
loaded injector.
- Thus the channels of the gold shunt form a bridge b/w AC and suprachoroidal
space.
24. 4) OptiMed glaucoma Pressure Regulator:
- Silicon tube with a PMMA plate.
- Inner diameter of the tube is 0.38 mm and outer diameter is 0.76 mm.
- 5 mm PMMA tube is inserted into the silicone base with dimensions of
1 x 2 x 3 x 4 mm , base contains 180 to 200 microtubules.
- It functions when the pressure exceeds 10 mmHg , through the capillary
action, it works on the principle of Poiseuille’s formula.
25. 5) Susanna Glaucoma Implant:
- A reservior body conforming to the shape of the globe at its equator and a
ridge in the end plate to protect the inner opening of the silicone tube from
blockage by fibrous tissue growth.
- Fenestrating end plate promotes fibrous tissue anchoring.(to avoid motion)
- The footplate measures 4 mm length allow easy fixation at 6 mm from the
limbus and yet allowing the plate to be placed at 10 mm from the limbus ( to
reduce extrusion)
26. COMPLICATIONS:
a) Intraoperative complications:
• Bleeding
• Misdirection of the silicone tube into the posterior chamber in
presence of peripheral anterior synechiae
• Loss ofAC: if port size is large
b) Early Post operative complication:
• Hypotony: maybe asso with Choroidal effusions.
use of valved implants or by occluding the tubing with a ligature
• Increased IOP: due to occlusion , with iris ,YAG ablation of the iris
• Tube-corneal contact: avoided by placing the tube properly
intraoperatively
• Early post op endophthalmitis
27. c) Late complications:
• Encysted bleb: in the hypertensive phase rise in IOP due to
development of a thick capsule around the plate 4 to 6 weeks postop
regimen consists of Diclofenac 75 mg , prednisolone 40 mg and
topical steroids.
1 cm3 can be deflated by needling
• Erosion of the silicon tube.
• Plate migration
• Eye movement limitations
• Endophthalmitis
• Epithelial ingrowth and invasion into the fibrous capsule
• Sterile hypopyon
• Irregular pupil due to adhesions of the iris roots
• Globe perforation
• RD, supra choroidal h’age,VH, choroidal effusion.
28.
29. Hyphema: POD 4 and POD 35
Hypotony POD 3
Hypotony with choroidal effusion