Lamellar keratoplasty has evolved since 1886 to address the disadvantages of penetrating keratoplasty such as unpredictable astigmatism and long visual recovery. It involves replacing diseased corneal layers while leaving healthy tissue intact. Anterior lamellar keratoplasty techniques like deep anterior lamellar keratoplasty remove the corneal stroma, while posterior techniques like Descemet's stripping endothelial keratoplasty replace the posterior layers and endothelium. Outcomes are generally better than penetrating keratoplasty with less rejection risk and faster visual recovery, though techniques like Descemet's membrane endothelial keratoplasty remain surgically challenging.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
corneal-surgery
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Indication, contraindication, advantage, disadvantage, types of keratoplasty, complication of keratoplasty and management, corneal graft rejection and failure
M.S ophthalmology, sarojini devi eye hospital, regional institute of ophthalmology, osmania medical college, hyderabad, telangana
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
corneal-surgery
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced
Using a diamond knife, set at 90% of corneal thickness at (90 degrees meridian), at 8 mm optic zone, a radial incision was done and corneal pockets were created. A 6.0 nylon preloaded spatula was then inserted into the corneal pocket and in a counterclockwise direction rotated in 3600 to create a deep stromal tunnel
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
3. Why lamellar keratoplasty??
Unpredictable post op
astigmatism
Loose suture can induce
epithelial breakdown,
ulceration, infection,
vascularisation .
Long post operative visual
recovery
Dramatic shift in corneal
topography can occur
following suture removal
resulting in irregular
astigmatism
corneal wound relatively
fragile, with poor tectonic
strength, making eye
susceptible to minor
even several years
surgery
Increased risk of all open
procedure like RD,
choroidal haemorrage.
4. ANATOMY
LAYERS THICKNESS(µm) COMPOSITION
Epithelium 50 Stratified
squamous
Bowman’s
membrane
8-14 Compact layer of
unorganized
collagen fiber
Stroma 500 Orderly arranged
collagen lamellae
with keratocyte
Dua’s layer 10-15 Consists of typ 1
collagen
Descemet’s
membrane
10-12 Consist of
basement
membrane
Endothelium 5 Single layer of
simple squamous
epithelium
5. surgical anatomy of stroma
Collagen
fibrils in
Ant. 1/3 Post 2/3
Orientation to
corneal
surface
oblique parallel
arrangement Branching
present
lamella
interweave
Less loosely
placed
Thickness of
stroma- 478-500
microns
The deeper in
the stroma the
surgeon is, the
easier it is to
dissect between
the lamellae
i.e Easier to do
LK, The deeper
we go
10. ADVANTAGE
I. Non-penetrating
surgery
II. Reduced risk of
endothelial graft
rejection
III. Does not require good
endothelial quality
donor tissue
IV. Technically achieves a
stronger corneal wound
V. Suture related
astigmatism is lesser
DISADVANTAGE
I. Technically more demanding
and time consuming
II. Suboptimal visual acuity
compared to PK due to
Interface problems
Lamellar dissection
regularity
Residual scarring
11. Optical ALK- for visual
rehabilitation
Congenital dermoid Post chem. scar Post trauma scar
Healed SPKS Band keratopathy Salzmann nodule
12. Tectonic ALK- for re-establishing
structural integrity of the cornea
Mooren’s ulcer
Pellucid marginal
degeneration
Terrin’s marginal degeneration
14. ANTERIOR LAMELLAR
KERATOPLASTY
Superficial Anterior
Lamellar Keratoplasty
(SALK)
anterior 30 to 50% of
cornea
stroma-to-stroma
interfaces can degrade
visual acuity over time
Deep Anterior
Lamellar Keratoplasty
(DALK)
corneal stroma is
completely excised up to
DM
stroma-to-DM interface
provides higher quality
vision
15. Preoperativ
e
assessment
Slit lamp: depth
of stroma
involved
Lid and
adnexa, tear
film,infection/i
nflammation,
posterior
segment, IOP,
general
systemic exam
Pachymetry
Anterior
segment
OCT
16. Surgical technique
Globe exposure
Host cornea marking: optical axis is marked using gentian violet
marking pen.
Stained 8 or 12 prong radial marker used to aid in suture
placement
Sizing & trephination: size of opacity measured with measuring
caliper
Trephine is preset to requisite depth in accordance with depth of
stromal involvement
Partial thickness trephination of host cornea is done
Stromal dissection:
Manual or automated
17. MANUAL DISSECTION
CLOSED DISSECTION-
After desired depth trephination, stromal pocket is made with
paufique knife at incision site
Introduce lamellar dissector through the pocket while lifting
up the anterior lip of the flap
Dissection continued by gentle side to side movement and
parallel to posterior stroma
Smoother preparation but no direct visualisation possible
18. Open dissection
Here the edge of the separated anterior lamellar tissue
is held retracted with the help of forceps during the
dissection enabling direct visualization of the area of
separation.
AUTOMATED LAMELLAR KERATOPLASTY-
Microkeratome used Allows for superior smooth
surface
Not suitable for thin & irregular corneas as in
advanced keratoconus
Indications:
Stromal lesions limited to anterior stromal layers
Moderate keratoconus
Post PRK haze
19. In DALK
Entire corneal stroma is removed baring the Descemet’s
membrane .
Adv –
elimination of the graft host stromal interface, scarring,
irregularity
Various methodes used to seprate DM from stroma-
1. Air dissection- ANWAR BIG BUBBLE TECHNIQUE most commonly
used
2. Viscodissection –
3. Hydrodelamination –saline solution is used
22. DONOR CORNEA
The donor tissue is prepared by
punching an appropriate sized CS
button with a trephine.
Trypan blue can be used to stain
the endothelium to improve
visualization in order to facilitate
the removal to DM and
endothelium from donor tissue.
Donor tissue is then sutured with
host tissue using 10-0 nylon sutures
in a contineuos or interrupted
fashion.
23.
24. INTRAOP COMPLICATION
Descemet membrane perforation-
Microperforation –self sealing or inject air to AC
Large perforation from rim to rim- suture (10-0 nylon)it with
donor stroma. If not possible convert it to PK
Pseudoanterior chamber-
Due to occult break
Due to retained visco
Treatment-
Shallow double chamber-self limiting, resolve in few week,
long standing one required surgical intervention by injecting
air to AC
Irregular lamellar bed-
Causes astigmatism, significant interface haze
Can be avoided by big bubble technique or automated
microkeratome assisted anterior lamellar keratoplasty
25. Graft-host malapposition/edge irregularity-
due to improper sizing of tissue
Adopt hemi-automated anterior lamellar procedure in
which the trephine is used to cut grafts of appropriate
size after the donor automated cuts on the donor cornea
and the host corneal lamellar dissection is performed
manually.
Interface debris-
due to fibers, bleeding
Wash thoroughly after procedure
26. POST OP COMPLICATION
Persistent epithelial defect
Infection: Graft infection due to various causes such as
suture related, lid adnexal abnormalities, poor ocular
surface, prolonged topical steroid, poor hygiene
Recurrence of the primary pathology- ex HSV, corneal
dystrophy
Graft Rejection- less common
Graft vascularization-can be seen in ocular surface
pathologies such as trachomatous keratopathy,
chemical burns and Stevens-Johnson syndrome.
31. DEEP LAMELLAR ENDOTHELIAL
KERATOPLSTY (DLEK)
It is a surgical method of endothelial replacement that
is performed through a limbal scleral incision that
leave the surface of the recipient cornea untouched.
33. Surgical procedure
Marking of host cornea
5mm scleral incision with diamond knife, 350 micron depth,
5mm temporal to limbus
Sclero corneal tunnel by cresent knife, 75% depth into clear
cornea
Straight devers dissector – to initiate from deep lamellar
stromal pocket
Dissect upto mid pupillary zone
34. A curved dissector is used to complete the stromal dissection
Enter AC with diamond knife at scler ocorneal tunnel
Healon inserted to AC
Cindy scissor used to dissect posterior stroma, DM, endothelium
Dissected tissue removed
Placed upon cornea to check its uniformity and smooth interface
35. Preparation of donor tissue
CS button is placed on AAC with epithelium side up
Suction trephine is used to achive 70% of depth
Cresent knife is used to dissect it
Then cs button is placed on a punch with
endothelium side up
a/c to host size punch is made
36. Healon is removed from AC
Graft is folded and inserted into AC
It made flatten inside the AC
Sclerocorneal tunnel then sutured with 3 interrupted suture
Air bubble is injected to ac to fix the graft in place
37.
38. DESCEMET STRIPPING ENDOTHELIAL
KERATOPLASTY(DSEK)/DESCEMET’S MEMBRANE
STRIPPING AUTOMATED ENDOTHELIAL
KERATOPLASTY (DSAEK)
DSEK/DSAEK It is a method of posterior lamellar
keratoplasty in which the recipient bed is prepared by
stripping off the recipient’s Descemet's membrane.
Technique was popularized by Gerrit Melles in 2003
43. Methods of insertion of donor
lenticule
Taco fold technique
Donor tissue folded into 60:40
Insertion using non coapting
forceps
Busin glide
Catridge
Tan’s endoglide
44.
45. DSEK VS DSAEK
risk of donor tissue
perforation
does not yield a smooth
anterior surface of the
donor posterior lamella
More time consuming
Visual recovery is slower
Adhesion of the posterior
lamellar lenticule is better
due to the greater tissue
thickness and irregular
anterior surface
Donor lenticule dislocation
is lesser
Microkeratome dissection
reduces the risk of donor
tissue perforation
yields a posterior donor
lamellar of superior optical
quality
Less time consuming
Visual recovery is more
rapid
Adhesion of the posterior
lamellar lenticule is not as
easy as in DSEK, as the
donor posterior stromal
lenticule is thinner and has a
smooth anterior surface
Donor lenticule dislocation
is more
46. DESCEMET MEMBRANE
ENDOTHELIAL KERATOPLASTY
(DMEK)
Transplantation of isolated donor endothelium and
Descemet’s membrane.
Steps – Isolation of donor DM and endothelium ,
recipient descematorrhexis followed by donor
insertion and positioning
Donor preparation :DM isolated by direct peeling or
by injection of air to create a Big Bubble
Donor tissue over 40 years of age is preferred
Insertion – glass pipette or IOL catridge and injector,
through 2.8mm corneal incision—unwrapping--air fill
47.
48.
49. COMPLICATION
INTRAOP-Inversion of the donor lenticule
POST OP-
Increased handling of the posterior stromal donor tissue
Postoperative dislocation of the posterior lamellar disc
Air bubble tamponade- result in postoperative pupillary
block and secondary angle closure glaucoma.
Primary graft failure-
Posterior graft dislocation
Endothelial graft rejection
Iatrogenic glaucoma
50. Reduction of interface haze
Less incidence of graft dislocation
Larger donor surface provides more viable endothelial cells
Shorter visual recovery as total corneal thickness remains same
Less strong host graft apposition at interface allows easier removal of
failed/rejected donor lenticle
DMEK
52. SURGICAL OUT COME
Visual acuity-6/9 to 6/18 with DSEK
DMEK has faster and better visual recovery
DMEK – 6/9 or better vision
Refractive results- mean hyperopic shift of 0.75 to 1.5D
due to changes in posterior corneal curvature and
increase in thickness in DSEK
DMEK– 0.25 to 0.50 D hyperopic shift
Endothelial cell loss- at 6months- 18-35 % , 54% at
5years
Graft survival-55-100% in various studies
53. RECENT ADVANCES
FEMTOSECOND LASER DSAEK •
This laser is used to create flaps in LASIK and can be used
to perform keratoplasty with different shapes of stromal
cut.
The laser uses an infrared wavelength (1053nm) to deliver
closely spaced, 3 microns spots that can be focused to a
preset depth to photodisrupt the tissue within the corneal
stroma.
Femtosecond laser is used to create a dissection plane on
the donor cornea mounted on artificial anterior chamber.
Offers a potential advantage over microkeratome with
regards to
better sizing of the posterior lenticule.
Obtains a smooth surface and precise stromal cuts
54. Sutureless corneal adhesion
Bioadhesive (Fibrin glue)- Kaufman et al successfully
used fibrin glue in small series of lamellar keratoplasty
Photochemical keratodesmos is method of producing
sutureless adhesion by applying a photosensitizer to
wound surfaces followed by low energy laser
irradiation. Laser promotes cross linkage between
collagen molecules to produce tight seal without
thermal damage