Keratoprosthesis
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This document reviews a study of 55 keratoprosthesis insertions in 35 patients over periods ranging from 1 month to 15 years. Keratoprosthesis is a surgical procedure that replaces a severely damaged cornea with an artificial cornea to restore vision. There are two main types - Type 1 is a collar button shaped device that perforates the cornea, while Type 2 is a through-the-lid design with an anterior nub to penetrate a tarsorrhaphy. Indications for each type are described. Complications can include rejection, infections, and extrusion. The aim of the study was to review visual outcomes, retention time, and complications of keratoprosthesis surgery.
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This document provides information about artificial cornea or keratoprosthesis surgery. It discusses the history and indications for the procedure, describes common designs for artificial corneas including biointegrated and non-biointegrated options, and outlines some of the major keratoprosthesis designs including the Boston KPro, AlphaCor KPro, and modified osteo-odonto keratoprosthesis. It also covers the preoperative evaluation, surgical procedure, postoperative management, prognosis, and complications for keratoprosthesis surgery.
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Keratoprosthesis is a surgical procedure where an artificial cornea replaces a severely damaged or diseased natural cornea. It involves implanting an artificial optical cylinder made of clear plastic materials inside the eye with a supporting flange or skirt outside the eye. The Boston KPro is the most commonly used keratoprosthesis device and comes in Type 1 and Type 2 models for different clinical situations. The Osteo-Odonto KPro is a more complex multi-stage procedure that uses the patient's own tooth and surrounding bone to support an artificial cornea for patients with severe dry eye conditions. Keratoprosthesis surgery aims to restore sight for patients with corneal blindness when traditional corneal transplant is not possible or
Keratoprosthesis
Keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea to restore vision. The most commonly used procedure is the Boston Keratoprosthesis, which uses a donor corneal graft sandwiched between a front and back plate. Complications include melts and extrusion of the graft, infectious endophthalmitis, glaucoma, and retroprosthetic membranes. Close follow up is required after surgery to monitor for and manage any complications.
keratoprosthesis
Keratoprosthesis is a surgical procedure that replaces a severely damaged or diseased cornea with an artificial cornea to restore vision. The first attempts at keratoprosthesis in humans date back to the mid-19th century, but most implants failed. Modern keratoprosthesis designs like the Boston KPro and AlphaCor KPro sandwich a donor corneal graft between plastic plates. Complications can include melting/extrusion of the implant, infection, glaucoma, retinal detachment, and formation of membranes behind the implant. Close post-operative monitoring is required to manage complications and maintain vision with keratoprosthesis implants.
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Keratoprosthesis
Keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea to restore vision. The most commonly used procedure is the Boston Keratoprosthesis, which uses a donor corneal graft sandwiched between a front and back plate. Complications include melts and extrusion of the graft, infectious endophthalmitis, glaucoma, and retroprosthetic membranes. Close follow up is required after surgery to monitor for and manage any complications.
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Keratoprosthesis is a surgical procedure that replaces a severely damaged or diseased cornea with an artificial cornea to restore vision. The first attempts at keratoprosthesis in humans date back to the mid-19th century, but most implants failed. Modern keratoprosthesis designs like the Boston KPro and AlphaCor KPro sandwich a donor corneal graft between plastic plates. Complications can include melting/extrusion of the implant, infection, glaucoma, retinal detachment, and formation of membranes behind the implant. Close post-operative monitoring is required to manage complications and maintain vision with keratoprosthesis implants.
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This document discusses keratoplasty surgery, which involves replacing diseased corneal tissue with healthy donor cornea. It has been performed for over 100 years and is one of the most common and successful transplant procedures. The document describes the structure and function of the cornea, indications for keratoplasty surgery, different types of procedures including penetrating keratoplasty and endothelial keratoplasty, the surgical process, expected vision outcomes, and potential complications.
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Intrastromal Corneal Ring Segment (ICRSs)
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Corneal opacity is a loss of normal transparency of the cornea due to scarring. It can be caused by healed corneal wounds, ulcers, or congenital defects. Risk factors include vitamin A deficiency, measles, eye injuries, infections, contact lens overwear, and cold sores. Symptoms are reduced or lost vision, pain, redness, photophobia, and cloudy appearances in parts of the eye. Types of opacity include nebula, macula, leukoma, and anterior staphyloma. Treatment options are phototherapeutic keratectomy using excimer laser for nebula, optical iridectomy for central opacities, and keratoplasty.
Corneal physiology
The document summarizes key aspects of corneal physiology:
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2. The functions of the cornea are outlined as providing refractive power, protecting intraocular structures, and allowing images to reach the retina.
3. Factors like transparency, curvature regularity, and smoothness are described as affecting corneal function. Measurement techniques for analyzing the cornea's optical properties are also discussed.
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Dr. Karan Bhatia provides an overview of keratoplasty (corneal transplantation). There are different types including penetrating keratoplasty (replacing the full thickness of the diseased cornea), partial thickness lamellar keratoplasty, and rotational keratoplasty. Penetrating keratoplasty has been the standard procedure but carries risks. The history and techniques of penetrating keratoplasty are described in detail including pre-operative evaluation, donor cornea excision, recipient cornea trephination, suturing, and post-operative management. Potential complications are also reviewed. Lamellar keratoplasty is introduced as an alternative to penetrating keratoplasty to reduce risks
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1. Keratoplasty, or corneal transplantation, involves replacing part or all of a damaged cornea with donor corneal tissue.
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3. Keratoplasty is indicated for conditions such as corneal opacity, dystrophy, infection, trauma, ectasia, and refractive errors. Careful donor preparation, surgical technique, and postoperative management are required for successful outcomes. Complications can include rejection, infection, and recurrence of the underlying condition.
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1. Pediatric keratoplasty involves replacing part or all of a damaged or diseased cornea in children through surgical procedures like penetrating keratoplasty or lamellar keratoplasty.
2. It is indicated for conditions like congenital corneal opacities, trauma, infections, keratoconus, and corneal scars. Challenges include the small eye size, elastic sclera, and difficulty with examination and cooperation in young patients.
3. Complications can include graft rejection, scarring, glaucoma, cataracts, wound issues, and amblyopia. Careful pre-operative evaluation and long-term post-operative management are important for successful outcomes in
PENETRATING KERATOPLASTY - Cmmmmopy.pptx
The document discusses the history and evolution of corneal transplantation (keratoplasty) from early experiments in the 18th-19th centuries to modern techniques. Some key events include the first successful human corneal transplant being performed by Eduard Zirm in 1906, the introduction of antibiotics and steroids improving outcomes in the 1940s, and recent advances with femtosecond lasers and other technologies. The document also reviews the various surgical techniques used for corneal transplantation and postoperative care considerations.
Full Thickness Skin Graft In Cicatricial Ectropion
This case report describes the successful treatment of a 30-year-old female patient who presented with cicatricial ectropion of the left lower eyelid secondary to thermal injury from a hot wooden stick one month prior. She complained of pain, redness, and watering of the left eye. The cicatricial ectropion was repaired by releasing skin contractures and covering the defect with a full thickness skin graft from the post auricular region. The graft took well with early wound healing and good cosmetic results. The patient's symptoms were relieved.
Osteo odonto kerato prosthesis
This document discusses the osteo-odonto-keratoprosthesis (OOKP), a surgical procedure used to treat corneal blindness. It involves implanting an artificial cornea attached to a patient's tooth and bone. The OOKP provides the best option for restoring vision in severe corneal disease. The procedure is complex, involving both ophthalmological and oral surgeons. It has high success rates but also risks like infection. Lifelong follow up is required as it is a two-stage surgery. Overall, the OOKP offers a successful method of visual rehabilitation for corneal blindness.
Art20196664 ijsr pterygium
Recent Management of Double Pterygium: A Hospital Based Study
Abstract: Purpose: To describe a recent management of conjunctivo-limbal autografting (CLA) for double pterygium in single eye & to evaluate post surgical outcome on follow up. Method: A total 6 months prospective short study in which fifteen (15) patients were selected who had double pterygium in one eye & serial analysis of 15 eyes of surgically managed double pterygium was done. The conjunctivo-limbal autograft from Nasal & Temporal pterygium in same eye was taken from the neck-body of pterygium on either side & the harvested conjunctivo-limbal autograft from the neck-body of the nasal pterygium was transferred to temporal pterygium & similarly temporal autograft nasally with minimal loss of limbal stem cells. The patients were followed up per month to check for any recurrence or complications. Result: No recurrence or other complications was noted in any patient. Conclusion: Transferring conjunctival autograft harvested from neck- body of nasal & temporal pterygia in the same eye to utilize for autografting in temporal & nasal pterygium in double pterygium is less complicated & useful procedure for double headed pterygium .
Ceratopatia bolhosa tratamento
This case report describes the treatment of bullous keratopathy in a 2-year-old male Pinscher. The dog presented with discomfort and vision loss in the right eye. Surgery was performed in two steps: 1) a superficial keratectomy and 360 degree conjunctival flap to remove the corneal edema and provide trophic support to heal the cornea, and 2) a second superficial keratectomy 120 days later to restore corneal transparency. This resulted in restoration of a transparent visual axis and return of vision. The conjunctival flap and repeated keratectomies helped resolve the bullous keratopathy without recurrence of endothelial decompensation.
CORNEA
This document summarizes a case presentation on corneal anatomy and physiology and two patient cases involving corneal injuries or conditions.
[1] The first section reviews corneal anatomy including the epithelium, Bowman's layer, stroma, Descemet's membrane, endothelium, and tear film.
[2] The first case involves a 43-year-old female who struck her eye with a lampshade, resulting in a corneal abrasion. Her initial treatment with a pressure patch and medications is summarized.
[3] The second case involves a 22-year-old male who underwent LASIK surgery two years prior and now has blurry vision after being struck in the eye. He is diagnosed with diffuse lamell
CORNEA
This document summarizes a case presentation on corneal anatomy and physiology and two patient cases involving corneal injuries or conditions.
[1] The first section reviews corneal anatomy including the epithelium, Bowman's layer, stroma, Descemet's membrane, endothelium, and tear film.
[2] The first case involves a 43-year-old female who struck her eye with a lampshade, resulting in a corneal abrasion. Her initial treatment with a pressure patch and medications is summarized.
[3] The second case involves a 22-year-old male who underwent LASIK surgery two years prior and now has blurry vision after being struck in the eye. He is diagnosed with diffuse lamell
Corneal transplantation
Corneal transplantation has evolved significantly since the first attempts in the early 1800s. Today, it is one of the most common and successful organ transplant procedures. The document traces the key developments in corneal grafting surgery, from the first suggestions of replacing opaque corneas to modern techniques like Descemet's membrane endothelial keratoplasty. It provides details on procedures like penetrating keratoplasty and deep anterior lamellar keratoplasty, including indications, surgical steps, potential complications, and post-operative management. The success of corneal transplantation techniques has expanded treatment options for corneal diseases and visual rehabilitation.
Comparison of Corneal Endothelial Cell Counts in Patients with Controlled Dia...
Comparison of Corneal Endothelial Cell Counts in Patients with Controlled Dia...International Multispeciality Journal of Health
Abstract—Cataract is the main cause of blinding and Diabetes Mallitus (DM) is the one of major cause of early cataract. Patents of DM has poor So this study is aimed to assess the corneal endothelial cell count in patients of DM (Type 2)after phecoemulsification and intra-ocular lens implantation. This study was conducted on 66 patients of cataract, out of which 33 patients with and 33 without DM (Type 2). Both groups underwent pre operative investigation and ophthalmological assessment and then undergo phacoemulsification done by same surgeon. After phacoemulsification all cases were followed up on 1st day ,1st week,1 month and 3 months and Uncorrected visual acquity (UCVA), Best corrected visual acquity (BCVA),corneal thickness, endothelial cell count and morphometric analysis were recorded. Both groups parameters were compared with unpaired 't' test. At the end of 3 months it was found that the mean endothelial cell loss in Group A(Diabetic) was 6.9% ± 0.6 and in Group B (control) was 2.4% ± 0.3 suggesting that the corneal endothelium in diabetic patients is under metabolic stress, and weaker against mechanical loads, such as phacoemulsification, than that in non-diabetic subjects. Despite good glycemic control and no corneal abnormalities before surgery. Endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the process of repair. These findings should be considered when planning cataract surgery in patients with diabetes.Bilateral Spontaneous Anterior Dislocation Of Intraocular Lens With The Capsu...
Bilateral Spontaneous Anterior Dislocation Of Intraocular Lens With The Capsu...Dr. Jagannath Boramani
Presenting Author- Dr Sumit Chatterjee, Co Author- Dr Mrunal Patil, Dr vasantrao pawar medical college, nashik, maharashtra
Ocular trauma
This document provides an overview of ocular trauma, including classifications, signs, symptoms, and management approaches. It discusses various types of trauma such as blunt trauma, penetrating trauma, chemical injuries, and orbital fractures. Key points include:
- Ocular trauma can be caused by physical injury, chemicals, heat, or radiation. It is a leading cause of monocular blindness.
- Trauma is classified based on etiology (accidental, self-inflicted, occupational) and nature (physical, chemical, thermal, radiation). Physical trauma includes perforating, non-perforating, and blunt injuries.
- Complications depend on the type and location of trauma but can include corneal abrasions,
Non ectatic problems causing corneal astigmatism
Non ectactic corneal disease causing corneal astigmatism including herpes and many other eye diseases are discussed
Ocular emergencies
This document discusses various types of ocular emergencies and injuries including mechanical, chemical, thermal and radiational injuries. It provides details on extraocular foreign bodies, contusional or blunt injuries, perforating or penetrating injuries, and retained intraocular foreign bodies. Signs, symptoms, and treatment approaches are described for each type of injury. Acute congestive glaucoma is also covered, outlining its clinical course and treatments during an acute congestive attack which involve medical approaches like pilocarpine and timolol as well as surgical options like iridectomy or trabeculectomy.
Ocular injuries for undergraduate students
This document discusses ocular injuries, including their causes, types, signs and symptoms, examination techniques, and treatment approaches. It covers topics such as protective eye mechanisms, common causes of injuries, how to examine for foreign bodies, blunt trauma, penetrating injuries, chemical injuries, hyphaema, and treatments for various injuries including corneal abrasions, hyphaema, and orbital fractures. The goal is to educate fourth year medical students on evaluating and managing different types of eye trauma.
Ocular Injuries 1-2-3Class_01-08-23.pptxt
1. Open-globe injuries involve full-thickness wounds of the eye wall caused by blunt or sharp trauma and can allow infection.
2. Penetrating injuries create a single wound while perforating injuries make two wounds from entry and exit of an object.
3. Retained intraocular foreign bodies can cause mechanical damage, introduce infection, and elicit reactions from inorganic materials like iron or copper alloys. Precise localization is needed before removal.
кольцевая
1. Fragmentary-circular keratoplasty (FCK) is a surgical technique to correct high myopia involving implantation of circular corneal transplant fragments.
2. The technique involves splitting a donor cornea into layers and making parallel sections to create 4 implant fragments which are inserted into a circular tunnel in the recipient cornea to form a closed interlamellar ring.
3. Initial clinical results on 11 eyes of 8 patients found the technique provided stable correction of 9-13 diopters of myopia with good vision outcomes in most cases and no major complications.
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Optical aberrations
The document discusses optical aberrations in the eye, including monochromatic and chromatic aberrations. It describes how aberrations can be measured using wavefront analysis techniques like the Shack-Hartman test. Common aberrations discussed include defocus, astigmatism, coma, and spherical aberration. The document explains how these aberrations affect image quality and discusses techniques to measure and correct for aberrations.
B scan
B-scan ultrasonography provides two-dimensional images of the eye that can reveal information about the shape, location, extension, mobility, and thickness of tissues. It uses high frequency sound waves reflected off structures in the eye. The transducer sends pulses and receives echoes to build an image. B-scan is useful when the ocular media is opaque and for evaluating conditions like tumors, detachments, inflammation and measuring the eye's dimensions. Pathological features seen on B-scan include vitreous hemorrhage, asteroid hyalosis, retinoschisis, choroidal detachment, retinal detachment in various configurations, cysticercosis, choroidal melanoma and more.
Wide angle viewing field systems in vr surgery
Wide angle viewing systems provide panoramic views of the retina during vitreous surgery. There are contact and non-contact systems. Contact systems include vitreous panfundoscopes, contact wide field lenses, advanced visual instrument systems, and reinverting operating lens systems. These provide good image resolution but require an inverter due to the inverted image and have risks of corneal trauma. Non-contact systems like the BIOM and Resight provide upright images without inversion but have poorer image quality. Newer non-contact systems aim to provide wide fields of view with upright high resolution images.
A scan ultrasonography
Ultrasonography uses ultrasound to image tissues within the body. A-scan ultrasonography provides a one-dimensional view of the eye by measuring the echoes of ultrasound waves. It can be used to detect and measure tumors, assess eye structures for IOL calculation, and interpret pathology. The ultrasound is reflected at interfaces between tissues, appearing as spikes on the display. Immersion techniques provide more accurate measurements than contact techniques by avoiding compression artifacts. Limitations include artifacts, small lesions, missed foreign bodies, and misalignment issues.
Macular hole
The macula is a round yellow area at the back of the eye that is responsible for central vision. A macular hole is a break or defect in the macula that can cause vision loss. Macular holes are classified into four stages based on their size and severity. Stage 1 holes are subtle with little vision impact, while stage 4 holes are large with complete detachment of the vitreous gel from the retina. Surgery involving vitrectomy and gas or oil tamponade is often used to treat more advanced macular holes and works by relieving traction on the retina. Post-operative care involves keeping face down for up to two weeks to aid in hole closure.
Nyctalopia & retinitis pigmentosa
Rods contain the visual pigment rhodopsin, which consists of the protein opsin bound to the chromophore retinal. Rhodopsin absorbs blue light at 500nm and allows rods to function in low light conditions. Rods are more numerous and sensitive to light than cones, allowing vision in dim environments. When shifting from light to dark, the processes of pigment regeneration and phototransduction take place over 30 minutes to restore night vision through the visual pigment rhodopsin in rods. Nyctalopia, or night blindness, can result from vitamin A deficiency or other causes that impair rod function.
Corneal drawings
This document provides guidance on drawing corneal pathology as a method for standardized documentation, follow-up, teaching, and lower cost compared to photography. It outlines color-coding conventions for different corneal features and structures: black for scars, sutures, etc.; blue for edema; yellow for infiltrates; green for defects and staining; red for blood vessels; and brown for pigments. Detailed instructions are given for depicting the frontal and slit views of the cornea, including dimensions, landmarks, and representations of specific conditions. Following a systematic clock-hour approach is emphasized for accurate drawings.
Dark room
This document describes various instruments used in ophthalmic examinations including retinoscopes, trial frames, Placido's disc, Maddox wing and rod, lenses, occluders, pin holes, and stenopic slits. It provides details on how each instrument is constructed and its purpose in examining patients, determining refractive error, and testing for conditions like keratoconus and heterophoria.
Congenital anophthalmia
This document discusses congenital anophthalmia and recent advances in its management. It describes how the introduction of hydrogel socket expanders and orbital expanders has modified the rehabilitation approach. The goals of treatment are to simultaneously expand soft tissues and orbital bones to replace lost volume, maintain orbital structure, and allow prosthesis motility. Various types of orbital implants and expanders are discussed, including advantages and disadvantages. Guidelines for successful socket reconstruction with adequate volume, fornices, eyelid tone and prosthesis motility and comfort are provided.
A case of atypical disc edema
This document presents a case study of a 42-year-old female who presented with sudden loss of vision in her left eye and headache for one week. Her ocular examination revealed blurry margins, peripapillary edema, and serous detachment of the macula in her left eye. A B-scan showed edema around the optic nerve head. Differential diagnoses included posterior scleritis and optic neuritis. Treatment with oral steroids and antibiotics improved her vision. She was later readmitted due to congestion from frequent steroid use.
Interpretation of fields
This document provides guidance on interpreting visual field tests. It outlines the key steps which include checking patient and test data, obtaining a general impression, observing defects and curves, and reviewing statistics. Various plots and indices are described that analyze retinal sensitivity values, compare them to normal values, and evaluate for abnormalities. Global indices like mean deviation and pattern standard deviation reduce the field data into single numbers. The reliability and quality of the test are also important to evaluate. Factors like eye conditions, testing procedures, and artifacts can influence results.
Perimetry 1
The document discusses principles of perimetry, which is the measurement of visual functions across the visual field. It describes the history of automated perimeters beginning in 1970. Static perimetry uses computerized testing to determine contrast sensitivity thresholds at preset locations, while kinetic perimetry manually maps sensitivity points along meridians. Both methods are used to identify decreases in retinal sensitivity indicative of conditions like glaucoma. Automated static perimetry provides quantifiable and reproducible data but is time-consuming, while kinetic perimetry rapidly defines field contours but requires more operator skill.
Rhegmatogenous retinal detachment
This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
Angle closure glaucoma
This document provides information on angle closure glaucoma, including its causes, risk factors, stages, clinical presentation, diagnostic tests, and treatment options. Angle closure glaucoma results from obstruction of the aqueous outflow pathway due to apposition or adhesion of the iris to the trabecular meshwork. It is more common in individuals with anatomically narrow anterior chamber angles and certain ethnic groups. Treatment involves lowering intraocular pressure through medications, laser procedures such as peripheral iridotomy or iridoplasty, or incisional surgeries like goniosynechialysis or trabeculectomy if needed.
Implantable collamer lens(ICL)
The Implantable Collamer Lens (ICL) is a soft, flexible, posterior chamber phakic intraocular lens made of collagen-copolymer material called Collamer. Studies have shown ICL implantation is safe and effective for correcting myopia between -3 to -25 diopters and astigmatism up to -6 diopters. It provides stable refractive results with few complications over 4 years. Toric ICL models were found to be superior to LASIK in safety, efficacy, predictability and stability for high myopic astigmatism. The procedure is reversible and preserves corneal tissue, reducing risks compared to LASIK.
Neovascular glaucoma
Neovascular glaucoma is a secondary glaucoma caused by the growth of new blood vessels on the iris and in the anterior chamber angle due to underlying retinal ischemia or disease. The new vessels are stimulated by hypoxic factors and can contract, pulling the iris forward and occluding the drainage angle. This leads to increased eye pressure and vision loss if not treated. Treatment options aim to reduce the stimulus for new vessel growth such as panretinal photocoagulation laser or anti-VEGF injections, lower eye pressure through filtration surgeries or cyclodestructive procedures, and manage pain.
Post operative endophthalmitis
1. Post-operative endophthalmitis is an intraocular inflammation that can occur after eye surgery or trauma as a complication. It involves inflammation in the anterior and posterior segments of the eye.
2. It is classified as infectious or non-infectious. Infectious endophthalmitis can be exogenous from surgery or trauma, or endogenous from hematogenous spread. Acute infectious endophthalmitis typically occurs within 6 weeks of surgery.
3. Management involves medical therapy including intravitreal and systemic antibiotics, as well as vitrectomy in some cases depending on visual acuity. The Endophthalmitis Vitrectomy Study showed vitrectomy is beneficial for patients
Malignant melanoma
This document discusses melanoma and its characteristics. It notes that pigmentation is a hallmark of melanoma. Features suggestive of melanoma include changes in existing pigmented lesions or presence of irregular, asymmetrical, or multiple colored lesions over 6mm in diameter. Risk factors include white race, older age, and intense sunlight exposure. Pathology shows anaplastic malignant melanocytic cells. Types include lesions arising from nevi or de novo. Diagnosis and treatment options are also summarized.
Nodule at the limbus
The limbus is the transitional zone between the sclera and cornea. Lesions of the limbus can be classified as congenital, inflammatory, allergic, vascular, traumatic, degenerative, nutritional, neoplastic, or miscellaneous. Common limbal lesions include dermoids, dermolipomas, raised nevi, episcleritis, scleritis, phlyctenules, vernal catarrh, ophthalmia nodosa, hemangiomas, granulomas, implantation cysts, pinguecula, cystic pterygium, papillomas, squamous cell carcinoma, and primary melanoma. The document provides details on characteristics, causes, and treatment of various limbal
Diabetic retinopathy
This document summarizes diabetic retinopathy, including its risk factors, pathogenesis, classification, signs, investigations, and treatments. It notes that diabetic retinopathy is caused by damage to the small blood vessels in the retina from high blood sugar levels over time. The main risk factors are duration of diabetes, poor blood sugar control, pregnancy, and other systemic diseases. The document describes the classification of diabetic retinopathy from mild non-proliferative to more severe proliferative stages. Key signs and investigations are also outlined, along with medical, laser, and surgical therapy options.
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Keratoprosthesis
- 1. Keratoprosthesis – A Long term review Br J Ophthalmol, 1983 July ; 67 (7) 468 -474 JJ Barnham and MJ Roper Hall
- 2. AIM of the study The aim of this study was to review the 35 patients with 55 KP insertions with regard to visual outcome, length of time vision maintained,retention time and complications
- 3. Patients and methods Thirty five patients were reviewed with a total of 55 KP insertions of which 39 were 1 st timers, 8 were 2 nd, 4 were 3 rd, 3 were 4 th 1 was 5 th in a single eye. Follow up time ranged from 1 month to 15 yrs with only 4 patients been followed up for less than 6 months. A preoperative diagnosis of Bullous keratopathy was made in 20 patients of which 16 followed cataract extraction, 1 followed lens dislocation,3 had fuch’s dystrophy - surgery unrelated.
- 4. Of remaining 15 pts ,3 had corneal damage following perforating injury , 2 followed explosion, 1 followed lime burn, 1 had thermal burn sustained in road accident . 4 had herpetic keratitis , 1 interstitial keratitis, 2 had band keratopathy following iridocyclitis , 1 had SJ syndrome. 49 underwent penetrating KP and 6 underwent Intralamellar KP.
- 10. References 1.DeVoe AG . A current evaluation of Corneal prosthetic devices. Arch Ophthalmol 1967;78:269-71 2. Giles CL. Henderson JW . Keratoprosthesis : current status.Am J Med Sci 1967 ; 253:239-42 3.Girard IJ . Hawkin RS. Nieves R, et al. Keratoprosthesis : a 12 – year follow up.Trans Am Acad Ophthalmol Otolaryngol 1977;83:25267
- 11. Keratoprosthesis is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea to restore useful vision or to make the eye comfortable in painful keratopathy
- 12. It is a double plated PMMA device with a central rigid optic that perforates Cornea . Type 1 is a collar button shaped device with front plate ,central optic stem, back plate . Type 2 is a through – the – lid design with a 2 mm anterior nub designed to penetrate through a tarsorrhaphy
- 13. When use a Boston type 1 Keratoprosthesis ? When corneal transplant carries a particular poor prognosis 1. Multiple corneal transplant rejection & failures 2. Tear deficiency syndromes 3.Eyelid contour irregularities 4.Aniridia 5.Chemical /thermal injury
- 14. When use a Boston type 2 Keratoprosthesis ? Severe Cicatrical ocular surface diseases 1.Steven Johnson syndrome/ Toxic epidermal necrolysis 2.Severe Alkali burn 3. Mucous membrane pemphigoid 4. Severe Aqueous tear deficiency
- 15. Indications of Type 2 Boston Keratoprothesis: When not likely to successful type 1 keratoprosthesis - Symblepharon and loss of conjunctival fornices - Severe keratinizing dry eye
- 18. Threaded design Snap in design
- 19. MOOKP – Eye tooth Originally described by Strampelli later it was Giancario Falcinelli who modified the technique. This technique uses a composite bone-tooth lamina to help anchor a polymethyl methacrylate cylinder to the cornea.
- 20. Proble ms Need for atleast two lengthy surgeries Need for oral surgery [minimum tooth size & good dental health] Cosmetic result unacceptable [tooth loss, protuding eye, prosthetic shell help]