This document discusses the anatomy, histology, classification, symptoms, signs, and treatment of cataracts. It begins with describing the structure of the human crystalline lens and then classifies cataracts based on etiology, morphology, and maturity. The key signs of immature and mature cataracts are outlined. Surgical treatment options for cataract extraction are discussed including extracapsular cataract extraction and phacoemulsification. Preoperative investigations like biometry and sac patency tests are also summarized. Local anesthesia techniques for cataract surgery including retrobulbar and peribulbar blocks are explained.
The document discusses different types of reduced eye models, including Donders' reduced eye model. It provides details on Donders' model, which treats the eye as a single refracting surface located 2mm behind the cornea with a radius of curvature of 5mm. The principal point is located 2mm behind the cornea, the nodal point is 5mm behind the principal point, the anterior focal length is 15mm, and the posterior focal length is 20mm. The refractive index is given as 1.336 and the total power of the model is +60D.
A prism is defined as a portion of a refracting medium bordered by two plane surfaces which are inclined at a finite angle. It deviates light toward its base and causes objects to appear displaced toward its apex. Prisms are used diagnostically to measure ocular alignment and fusional reserves, and therapeutically to treat conditions like convergence insufficiency by strengthening the convergence reflex through base-out prism exercises.
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
For this slide, i have done very hard work. This anatomy has been presented in a very simple way. The video of this slide is available on youtube as well. You can search with my name in utube. Thank u.
This document describes various illumination techniques used with a slit lamp to examine different parts of the eye. It discusses diffuse, direct, tangential, and specular illumination techniques as well as indirect, retroillumination, and Van Herrick techniques. Each technique is used to illuminate a specific area of the eye in order to observe different structures like the cornea, iris, lens, anterior chamber angle, and detect any pathologies present. Proper illumination angles and magnifications are outlined for visualizing various eye tissues and evaluating properties like surface texture and integrity.
This document discusses prisms, their properties, and uses in optometry. It defines key prism terminology like apex, base, axis, and apical angle. It explains how prisms refract light and cause deviation according to Snell's law. Prisms are used clinically for diagnosing and managing eye alignment conditions like esotropia. They help measure deviation angles and correct angles of deviation. Prisms are also used in ophthalmic instruments like slit lamps and microscopes due to their light reflecting properties.
This document discusses various classes of antibiotics used in ophthalmology, including their mechanisms of action, spectra of activity, therapeutic uses, and adverse effects. It covers beta-lactam antibiotics like penicillins, cephalosporins, carbapenems, and monobactams. It also discusses non-beta lactam antibiotics like chloramphenicol. Common ocular infections treated include conjunctivitis, keratitis, endophthalmitis, and blepharitis, with treatment depending on the causative organism. While effective against many bacteria, antibiotics require careful use due to potential adverse reactions and development of resistance.
The cornea is the transparent front part of the eye that transmits and focuses light. It has 3 main layers - an outer epithelial layer, a thick middle stromal layer made of collagen, and an inner single-cell endothelial layer. The cornea derives its strength and curvature from the orderly arrangement of collagen in the stroma. It remains transparent due to its regular structure without blood vessels and the deturgescent properties maintained by the endothelial pump. The cornea has a high metabolic rate powered by glucose and oxygen and is innervated by nerves for vision and protection.
The document discusses different types of reduced eye models, including Donders' reduced eye model. It provides details on Donders' model, which treats the eye as a single refracting surface located 2mm behind the cornea with a radius of curvature of 5mm. The principal point is located 2mm behind the cornea, the nodal point is 5mm behind the principal point, the anterior focal length is 15mm, and the posterior focal length is 20mm. The refractive index is given as 1.336 and the total power of the model is +60D.
A prism is defined as a portion of a refracting medium bordered by two plane surfaces which are inclined at a finite angle. It deviates light toward its base and causes objects to appear displaced toward its apex. Prisms are used diagnostically to measure ocular alignment and fusional reserves, and therapeutically to treat conditions like convergence insufficiency by strengthening the convergence reflex through base-out prism exercises.
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
For this slide, i have done very hard work. This anatomy has been presented in a very simple way. The video of this slide is available on youtube as well. You can search with my name in utube. Thank u.
This document describes various illumination techniques used with a slit lamp to examine different parts of the eye. It discusses diffuse, direct, tangential, and specular illumination techniques as well as indirect, retroillumination, and Van Herrick techniques. Each technique is used to illuminate a specific area of the eye in order to observe different structures like the cornea, iris, lens, anterior chamber angle, and detect any pathologies present. Proper illumination angles and magnifications are outlined for visualizing various eye tissues and evaluating properties like surface texture and integrity.
This document discusses prisms, their properties, and uses in optometry. It defines key prism terminology like apex, base, axis, and apical angle. It explains how prisms refract light and cause deviation according to Snell's law. Prisms are used clinically for diagnosing and managing eye alignment conditions like esotropia. They help measure deviation angles and correct angles of deviation. Prisms are also used in ophthalmic instruments like slit lamps and microscopes due to their light reflecting properties.
This document discusses various classes of antibiotics used in ophthalmology, including their mechanisms of action, spectra of activity, therapeutic uses, and adverse effects. It covers beta-lactam antibiotics like penicillins, cephalosporins, carbapenems, and monobactams. It also discusses non-beta lactam antibiotics like chloramphenicol. Common ocular infections treated include conjunctivitis, keratitis, endophthalmitis, and blepharitis, with treatment depending on the causative organism. While effective against many bacteria, antibiotics require careful use due to potential adverse reactions and development of resistance.
The cornea is the transparent front part of the eye that transmits and focuses light. It has 3 main layers - an outer epithelial layer, a thick middle stromal layer made of collagen, and an inner single-cell endothelial layer. The cornea derives its strength and curvature from the orderly arrangement of collagen in the stroma. It remains transparent due to its regular structure without blood vessels and the deturgescent properties maintained by the endothelial pump. The cornea has a high metabolic rate powered by glucose and oxygen and is innervated by nerves for vision and protection.
Accommodation is the mechanism by which the eye changes refractive power to focus on objects at different distances. It involves changes in the shape of the elastic lens, controlled by the ciliary muscle. The amplitude of accommodation declines with age as the lens loses elasticity, causing presbyopia. Accommodation is measured using methods like push-up and minus lens, which determine the near and far points of clear vision. The range between these points indicates how much accommodation is available. Accommodation abilities normally decline with age according to established formulas.
The document provides information on the anatomy, physiology, and diseases of the lens. It discusses the lens's biconvex shape and ability to change shape to accommodate. The lens is divided into an anterior and posterior epithelium, cortex, and nucleus. It maintains transparency through organized fiber structure, hydration, and antioxidants. The lens focuses light and accommodates through changes in shape mediated by the ciliary body and zonules. Aging and various diseases can impact the lens's structure and function.
Irregular astigmatism is an irregular change in refractive power caused by conditions like extensive corneal scarring from keratoconus or post-surgical changes. It results in defective vision, distortion of objects, and polyopia. Examinations show an irregular pupillary reflex and placido disc test, as well as irregular corneal curvature on photokeratoscopy. Treatment options include contact lenses, excimer laser surgery for superficial scarring, or penetrating keratoplasty for extensive corneal scarring.
Astigmatism is a refractive error where the eye does not focus light properly due to an irregularly shaped cornea. There are different types of astigmatism depending on the orientation of the steeper and flatter corneal meridians. Astigmatism can be caused by the cornea or lens and is assessed using retinoscopy, keratometry, and other tests. Treatment options include eyeglasses, contact lenses, refractive surgery procedures like astigmatic keratotomy or LASIK.
Anatomy of crystalline lens by Dr. Aayush Tandon Aayush Tandon
The document summarizes the anatomy of the crystalline lens. It discusses the lens's structure, composition, dimensions, and surgical anatomy. Key points include:
- The lens is a transparent biconvex structure composed mainly of specialized cells and proteins. It helps focus light onto the retina to allow vision.
- Structurally, it has an outer lens capsule enclosing lens epithelium cells and elongated lens fibers in concentric layers. The fibers are arranged in a nucleus and surrounding cortex.
- Dimensions vary with age but the lens is roughly 10mm in diameter and weighs around 258mg in adults. It provides around 16-17 diopters of refractive power and accommodates vision changes.
- Surgically
The document summarizes key aspects of corneal physiology:
1. It describes the structure and optical properties of the cornea, including its thickness, curvature, and role in refractive power.
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.
This document discusses the uses of prisms in optometry. It begins by defining prisms and their basic properties, such as how they deviate light. It then covers prism terminology including apex, base, refracting angle, angle of deviation, and power. The document discusses how prisms cause eye movements and the resultant effects of combining prisms. It also covers induced prism from lenses, prentice's rule, and the major reference point. Finally, the summary discusses the diagnostic and therapeutic uses of prisms for conditions like convergence insufficiency and strabismus. Prisms are also used in instruments like the slit lamp and keratometer.
Prism is a portion of a refractive medium with two plane surfaces inclined at an angle. It causes light to deviate due to refraction. Prisms are used in ophthalmology to diagnose and manage eye alignment issues like strabismus. Key diagnostic uses include measuring the angle of deviation using prism alternate cover test and investigating binocular single vision through tests like the prism reflex test and prism vergence testing. Prisms are also used therapeutically to correct angles of deviation in conditions like esotropia and exotropia.
The document summarizes the anatomy and physiology of the retina. It describes the three main regions of the retina - optic disc, macula lutea, and peripheral retina. It details the microscopic layers of the retina and the cells within each layer. It discusses the visual pigments rhodopsin and cone pigments, and how light induces photochemical changes in these pigments to initiate the visual process. Finally, it briefly outlines the pathway of visual signal transmission from the retina to the visual cortex.
This document describes different visual acuity tests used for different age groups. For infants, the Optokinetic Nystagmus Drum and Lea Paddle are used, which test eye movements in response to moving black and white stripes or changing picture cards. For preschoolers, tests include the Landolt C, Tumbling E, Sheridan Gardiner, Stycar, Lea Symbol, Kay Picture, and Cardiff charts which present letters, shapes or pictures at decreasing sizes. For school-aged children and adults, the Snellen and LogMAR charts are used, with LogMAR providing more precise measurements of low vision.
1) Photochromic lenses are lenses that darken when exposed to UV light and fade back to clear when removed from the light. They help the eyes adapt to changing light conditions both indoors and outdoors.
2) There are two main types of photochromic lenses - glass and plastic. Glass uses silver halide crystals while plastic uses spiroxazine molecules. Both darken when activated by UV rays and fade when the UV exposure is removed.
3) Factors like temperature, thickness, intensity of UV light, and exposure history affect how quickly and darkly the lenses change color. Photochromic lenses provide eye comfort in varying light but have some limitations like delayed response time and gradual loss of darkening ability over
Astigmatism is a refractive error where the refraction varies in different meridians. There are two types: regular and irregular. Regular astigmatism has two principal meridians and can be with-the-rule, against-the-rule, oblique, or bi-oblique depending on the axis. Irregular astigmatism has an irregular change in refractive power. Both cause blurred vision and symptoms. Regular astigmatism is treated with cylindrical lenses, contact lenses, or LASIK while irregular astigmatism may require contact lenses, phototherapeutic keratectomy, or surgery.
The Maddox Rod is used to detect heterophoria and heterotropia. It consists of a series of cylindrical lenses mounted in a trial frame that produces an elongated streak of light. When viewed through the Maddox Rod, a spot of light will appear as a streak. This allows detection of deviations by assessing whether the streak is to the left or right of the spot for horizontal deviations, or above or below for vertical deviations. Prisms of increasing strength are used to measure the degree of deviation.
This document discusses the classification and terminology used for strabismus (eye misalignment). It defines different types of strabismus such as phoria, tropia, and heterophoria based on the presence of fusion. It also classifies strabismus based on factors like deviation direction, variation with gaze, age of onset, and etiology. Various types of strabismus deviations and causes like paralytic, mechanical, and orbital are described. References for further information on strabismus classification are provided.
This document discusses various parasitic infections that can affect the eye. It begins by describing how parasites can cause eye lesions through direct damage, toxic products, immune responses, ectopic infection, or drug treatments. It then lists and describes specific protozoan, helminthic, and ectoparasitic infections that can involve the eye. Several infections are discussed in more depth, including Acanthamoeba keratitis, Chagas' disease, leishmaniasis, toxoplasmosis, malaria, and others. For each, the causative agent, transmission, clinical manifestations, diagnosis, and treatment are outlined. A wide range of parasites are shown to have the potential to infect the eye.
A trial box, also known as a trial case or trial set, contains lenses and other devices used to test vision and diagnose refractive errors and eye pathology. It includes trial lenses in various prescriptions, prisms, filters, occluders, and other accessories. Trial lenses are arranged in pairs ranging from -20D to +20D in steps, and cylinders from -6D to +6D. The trial frame holds the lenses and allows adjustment for pupil distance and lens height. A trial box is used for objective and subjective refraction, diplopia testing, diagnosing strabismus, and assessing binocular vision.
Pseudostrabismus is the clinical impression of ocular deviation
when no squint is present.
• Epicanthic folds may simulate an esotropia
• Abnormal interpupillary distance, if short may simulate an esotropia and if wide an exotropia
• Angle kappa is the angle between the visual and anatomical
(pupillary) axes.
○ Normally, the fovea is situated temporal to the
anatomical centre of the posterior pole. The eyes are
therefore slightly abducted to achieve bifoveal fixation
and a light shone onto the cornea will therefore cause a
reflex just nasal to the centre of the cornea in both eyes. This is termed a positive angle kappa.
○ A large positive angle kappa (e.g. temporally displaced
macula) may give a pseudoexotropia
○ A negative angle kappa occurs when the fovea is situated
nasal to the posterior pole (e.g. high myopia). In this
situation, the corneal reflex is situated temporally to the
centre of the cornea and it may simulate an esotropia.
A resident was performing phacoemulsification surgery on an uncomplicated cataract case. The lens was inappropriately manipulated, causing it to break up into pieces and fall into the vitreous cavity. To detect this, the surgeon would check for a tilted or eccentric lens, phacodonesis, an interval between the iris and lens margins, vitreous prolapse into the anterior chamber, sudden deepening of the anterior chamber, focal iridodonesis, and an iridolenticular gap. To complete the surgery, the surgeon would use a capsular tension ring. Settings on the machine that would need to be changed include lowering the flow rate, vacuum, and bottle height.
Accommodation is the mechanism by which the eye changes refractive power to focus on objects at different distances. It involves changes in the shape of the elastic lens, controlled by the ciliary muscle. The amplitude of accommodation declines with age as the lens loses elasticity, causing presbyopia. Accommodation is measured using methods like push-up and minus lens, which determine the near and far points of clear vision. The range between these points indicates how much accommodation is available. Accommodation abilities normally decline with age according to established formulas.
The document provides information on the anatomy, physiology, and diseases of the lens. It discusses the lens's biconvex shape and ability to change shape to accommodate. The lens is divided into an anterior and posterior epithelium, cortex, and nucleus. It maintains transparency through organized fiber structure, hydration, and antioxidants. The lens focuses light and accommodates through changes in shape mediated by the ciliary body and zonules. Aging and various diseases can impact the lens's structure and function.
Irregular astigmatism is an irregular change in refractive power caused by conditions like extensive corneal scarring from keratoconus or post-surgical changes. It results in defective vision, distortion of objects, and polyopia. Examinations show an irregular pupillary reflex and placido disc test, as well as irregular corneal curvature on photokeratoscopy. Treatment options include contact lenses, excimer laser surgery for superficial scarring, or penetrating keratoplasty for extensive corneal scarring.
Astigmatism is a refractive error where the eye does not focus light properly due to an irregularly shaped cornea. There are different types of astigmatism depending on the orientation of the steeper and flatter corneal meridians. Astigmatism can be caused by the cornea or lens and is assessed using retinoscopy, keratometry, and other tests. Treatment options include eyeglasses, contact lenses, refractive surgery procedures like astigmatic keratotomy or LASIK.
Anatomy of crystalline lens by Dr. Aayush Tandon Aayush Tandon
The document summarizes the anatomy of the crystalline lens. It discusses the lens's structure, composition, dimensions, and surgical anatomy. Key points include:
- The lens is a transparent biconvex structure composed mainly of specialized cells and proteins. It helps focus light onto the retina to allow vision.
- Structurally, it has an outer lens capsule enclosing lens epithelium cells and elongated lens fibers in concentric layers. The fibers are arranged in a nucleus and surrounding cortex.
- Dimensions vary with age but the lens is roughly 10mm in diameter and weighs around 258mg in adults. It provides around 16-17 diopters of refractive power and accommodates vision changes.
- Surgically
The document summarizes key aspects of corneal physiology:
1. It describes the structure and optical properties of the cornea, including its thickness, curvature, and role in refractive power.
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.
This document discusses the uses of prisms in optometry. It begins by defining prisms and their basic properties, such as how they deviate light. It then covers prism terminology including apex, base, refracting angle, angle of deviation, and power. The document discusses how prisms cause eye movements and the resultant effects of combining prisms. It also covers induced prism from lenses, prentice's rule, and the major reference point. Finally, the summary discusses the diagnostic and therapeutic uses of prisms for conditions like convergence insufficiency and strabismus. Prisms are also used in instruments like the slit lamp and keratometer.
Prism is a portion of a refractive medium with two plane surfaces inclined at an angle. It causes light to deviate due to refraction. Prisms are used in ophthalmology to diagnose and manage eye alignment issues like strabismus. Key diagnostic uses include measuring the angle of deviation using prism alternate cover test and investigating binocular single vision through tests like the prism reflex test and prism vergence testing. Prisms are also used therapeutically to correct angles of deviation in conditions like esotropia and exotropia.
The document summarizes the anatomy and physiology of the retina. It describes the three main regions of the retina - optic disc, macula lutea, and peripheral retina. It details the microscopic layers of the retina and the cells within each layer. It discusses the visual pigments rhodopsin and cone pigments, and how light induces photochemical changes in these pigments to initiate the visual process. Finally, it briefly outlines the pathway of visual signal transmission from the retina to the visual cortex.
This document describes different visual acuity tests used for different age groups. For infants, the Optokinetic Nystagmus Drum and Lea Paddle are used, which test eye movements in response to moving black and white stripes or changing picture cards. For preschoolers, tests include the Landolt C, Tumbling E, Sheridan Gardiner, Stycar, Lea Symbol, Kay Picture, and Cardiff charts which present letters, shapes or pictures at decreasing sizes. For school-aged children and adults, the Snellen and LogMAR charts are used, with LogMAR providing more precise measurements of low vision.
1) Photochromic lenses are lenses that darken when exposed to UV light and fade back to clear when removed from the light. They help the eyes adapt to changing light conditions both indoors and outdoors.
2) There are two main types of photochromic lenses - glass and plastic. Glass uses silver halide crystals while plastic uses spiroxazine molecules. Both darken when activated by UV rays and fade when the UV exposure is removed.
3) Factors like temperature, thickness, intensity of UV light, and exposure history affect how quickly and darkly the lenses change color. Photochromic lenses provide eye comfort in varying light but have some limitations like delayed response time and gradual loss of darkening ability over
Astigmatism is a refractive error where the refraction varies in different meridians. There are two types: regular and irregular. Regular astigmatism has two principal meridians and can be with-the-rule, against-the-rule, oblique, or bi-oblique depending on the axis. Irregular astigmatism has an irregular change in refractive power. Both cause blurred vision and symptoms. Regular astigmatism is treated with cylindrical lenses, contact lenses, or LASIK while irregular astigmatism may require contact lenses, phototherapeutic keratectomy, or surgery.
The Maddox Rod is used to detect heterophoria and heterotropia. It consists of a series of cylindrical lenses mounted in a trial frame that produces an elongated streak of light. When viewed through the Maddox Rod, a spot of light will appear as a streak. This allows detection of deviations by assessing whether the streak is to the left or right of the spot for horizontal deviations, or above or below for vertical deviations. Prisms of increasing strength are used to measure the degree of deviation.
This document discusses the classification and terminology used for strabismus (eye misalignment). It defines different types of strabismus such as phoria, tropia, and heterophoria based on the presence of fusion. It also classifies strabismus based on factors like deviation direction, variation with gaze, age of onset, and etiology. Various types of strabismus deviations and causes like paralytic, mechanical, and orbital are described. References for further information on strabismus classification are provided.
This document discusses various parasitic infections that can affect the eye. It begins by describing how parasites can cause eye lesions through direct damage, toxic products, immune responses, ectopic infection, or drug treatments. It then lists and describes specific protozoan, helminthic, and ectoparasitic infections that can involve the eye. Several infections are discussed in more depth, including Acanthamoeba keratitis, Chagas' disease, leishmaniasis, toxoplasmosis, malaria, and others. For each, the causative agent, transmission, clinical manifestations, diagnosis, and treatment are outlined. A wide range of parasites are shown to have the potential to infect the eye.
A trial box, also known as a trial case or trial set, contains lenses and other devices used to test vision and diagnose refractive errors and eye pathology. It includes trial lenses in various prescriptions, prisms, filters, occluders, and other accessories. Trial lenses are arranged in pairs ranging from -20D to +20D in steps, and cylinders from -6D to +6D. The trial frame holds the lenses and allows adjustment for pupil distance and lens height. A trial box is used for objective and subjective refraction, diplopia testing, diagnosing strabismus, and assessing binocular vision.
Pseudostrabismus is the clinical impression of ocular deviation
when no squint is present.
• Epicanthic folds may simulate an esotropia
• Abnormal interpupillary distance, if short may simulate an esotropia and if wide an exotropia
• Angle kappa is the angle between the visual and anatomical
(pupillary) axes.
○ Normally, the fovea is situated temporal to the
anatomical centre of the posterior pole. The eyes are
therefore slightly abducted to achieve bifoveal fixation
and a light shone onto the cornea will therefore cause a
reflex just nasal to the centre of the cornea in both eyes. This is termed a positive angle kappa.
○ A large positive angle kappa (e.g. temporally displaced
macula) may give a pseudoexotropia
○ A negative angle kappa occurs when the fovea is situated
nasal to the posterior pole (e.g. high myopia). In this
situation, the corneal reflex is situated temporally to the
centre of the cornea and it may simulate an esotropia.
A resident was performing phacoemulsification surgery on an uncomplicated cataract case. The lens was inappropriately manipulated, causing it to break up into pieces and fall into the vitreous cavity. To detect this, the surgeon would check for a tilted or eccentric lens, phacodonesis, an interval between the iris and lens margins, vitreous prolapse into the anterior chamber, sudden deepening of the anterior chamber, focal iridodonesis, and an iridolenticular gap. To complete the surgery, the surgeon would use a capsular tension ring. Settings on the machine that would need to be changed include lowering the flow rate, vacuum, and bottle height.
I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to build there carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
Ospe (objective structured practical examination)Anisur Rahman
The document discusses OSPE (Objective Structured Practical Examination), which is used to evaluate trainees in a standardized way. During an OSPE, trainees see the same problems and perform the same tasks within a set time frame, similar to real clinical situations. The document provides examples of OSPE stations on history taking for congenital cataract and Retinitis Pigmentosa. It also includes sample questions and answers that may be used in an OSPE evaluation.
This module has prepared for the postgraduate medical students in any specialty. Last 10 questions are MCQ which is very important for FCPS part 1 (all subjects)
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
OSPE (Ophthalmology) for FCPS, FRCOphth, MS & DO Examinee.Anisur Rahman
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
The document discusses an intra capsular tension ring, a device used to expand the capsule following significant zonulolysis. It may be used to treat conditions like Marfan's syndrome and pseudo exfoliation syndrome that can cause zonulolysis and require increased capsular support. The document provides the name of the device, asks for two conditions where its use may increase, and gives the answer naming the device as an intra capsular tension ring and listing Marfan's syndrome and pseudo exfoliation syndrome as two conditions.
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
I am Dr Md Anisur Rahman Anjum working as associate professor at NIO Dhaka Bangladesh. These 10 OSPE were made by me for the MOCK test of FCPS examinee. I hope that these will be helpful for FCPS. MS. & DO students
How to write a scientific paper for publicationAnisur Rahman
I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. Now I am working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
When I was secretary of Bangladesh Academy in 2011-2012. During my tenure I had pulblished four academic journal. The ISSN of the journal is 1818-9423. I have seen that the format of original article was not maintained. though there was "GENERAL INFORMATION FOR CONTRIBUTORS" but many of the author did not follow that guideline. From that time I am trying to build up "HOW TO WRITE THE SCIENTIFIC MANUSCRIPT" among my students, colleague and senior fellows. and do two workshop about this topic.
I am hopeful if any of you write a scientific manuscript according to this format with correct statistics power and language it will be no longer rejected.
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
Objective structured practical question (ospe) for FCPS MS amd DO examinee of...Anisur Rahman
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to build their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
Dr A Rajendraprasad provides a summary of 20 ophthalmic conditions. For each condition, he provides short descriptions of key characteristics and histopathological findings. Some of the conditions discussed include Gorlin's syndrome, posterior polymorphous dystrophy, crystalline deposits in the conjunctiva, pterygium, keratoconjunctivitis sicca, and optic nerve glioma among others. He also provides short multiple choice questions to test understanding of each condition.
The document discusses stereo vision and depth perception, including how binocular vision allows for stereopsis through the use of cues like binocular disparity. It explores various monocular cues for depth perception such as linear perspective, size gradients, and motion parallax. Additionally, it examines techniques for simulating stereo vision like anaglyphs and stereoscopes as well as illusions that can occur when depth cues are ambiguous.
This document contains a series of multiple choice questions about various ophthalmic conditions and treatments. The questions cover topics like causes of blindness, types of entropion/ectropion, cranial nerve disorders, corneal diseases, conjunctivitis, pterygium, and treatments for conditions like ptosis, blepharitis and corneal ulcers. The questions are in a multiple choice format with 4 answer options for each.
1) The document discusses key concepts in optics, including geometrical optics, physical optics, and quantum optics.
2) Geometrical optics deals with light rays and concepts like reflection and refraction. Physical optics examines light as waves and topics such as interference and diffraction. Quantum optics views light as particles.
3) Images formed by a concave mirror depend on the object's location relative to the mirror's center of curvature and focal point. If beyond the center, the image is real, inverted, and smaller.
This document provides information on various ophthalmology topics including:
1. Optic nerve swelling and papilledema are summarized.
2. Instruments used in ophthalmology such as the ophthalmoscope, slit lamp, and tonometers are described.
3. Common eye conditions like retinal detachment, glaucoma, and trauma are discussed in terms of signs, diagnosis, and management by general physicians.
This document discusses various techniques for measuring eye dimensions needed for accurate intraocular lens (IOL) power calculations, including:
- Applanation A-scan, immersion A-scan, and immersion vector A/B-scan techniques
- Using the IOL Master, which utilizes partial coherence interferometry, to obtain highly precise measurements
- Factors that can affect IOL power calculations like axial length, corneal power, anterior chamber depth, prior refractive surgery, and placement of IOL in bag vs sulcus
- Recommendations for validating biometry measurements and identifying potential errors in IOL power calculations based on certain parameters outside of expected ranges.
This document discusses subchondral cysts in the hip joint. It provides the following key points:
1. Subchondral cysts can occur due to congenital factors, secondary bone damage, or fluid erosion through bone fractures.
2. Treatment options for cysts include improving the joint, temporary inactivity followed by surgery, removing the cyst, or removing the cyst and grafting the area.
3. The best outcome is achieved by removing the cause of damage, clearing the cyst, removing the cyst wall, and grafting the area. Restoring normal joint mechanics also helps.
https://telecombcn-dl.github.io/2018-dlcv/
Deep learning technologies are at the core of the current revolution in artificial intelligence for multimedia data analysis. The convergence of large-scale annotated datasets and affordable GPU hardware has allowed the training of neural networks for data analysis tasks which were previously addressed with hand-crafted features. Architectures such as convolutional neural networks, recurrent neural networks and Q-nets for reinforcement learning have shaped a brand new scenario in signal processing. This course will cover the basic principles and applications of deep learning to computer vision problems, such as image classification, object detection or image captioning.
Microplastics - an incomplete but potentially frightening pictureStefanBarot
Microplastics are an increasing threat to health by their presence in seafood. Due to a lack of sufficient statistically relevant data their presence and impact is still difficult to estimate, however the origin of microplastics seems to be firming up.
This document discusses cataracts, including their definition, types, causes, symptoms, diagnostic evaluation, management, nursing care, and complications. Specifically, it defines cataract as an opacification or cloudiness of the normally transparent crystalline lens resulting in visual disturbance. It notes that aging, genetics, diabetes, smoking, and exposure to ultraviolet light or ionizing radiation are common causes. Symptoms include clouded vision, glare, blurred vision, and difficulty seeing at night. Diagnostic evaluation involves visual acuity tests, slit lamp examination, and fundoscopy. Surgical management includes phacoemulsification, extracapsular extraction, and intraocular lens implantation. Nursing care focuses on managing anxiety, ensuring safety, providing
1. Keratoplasty, or corneal transplantation, involves replacing part or all of a damaged cornea with donor corneal tissue.
2. There are several types of keratoplasty procedures including penetrating keratoplasty (full thickness), lamellar keratoplasty (partial thickness), DSAEK, and DMEK.
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.
Multiple Choice Questions (MCQs) for Masters of Optometry Entrance Examinatio...RabindraAdhikary
Multiple Choice Questions (MCQs) for Masters of Optometry Entrance Examination, Pokhara University NEPAL
MCQs Optometry Nepal
Here we have included syllabus of entrance examinations for Master of Optometry in Pokhara University, entry requirements of candidate for the master of optometry course and multiple choice questions that appeared in the entrance examinations of 2019.
Prepared by: Rabindra Adhikary
for more MCQs:
http://ravinems.blogspot.com/2019/05/multiple-choice-questions-mcqs-for.html
Three-dimensional imaging techniques: A literature review By; Orhan Hakki Ka...Dr. Yahya Alogaibi
This literature review discusses various 3D imaging techniques used in dentistry and orthodontics. It begins by providing background on the development of 3D imaging since the discovery of X-rays. It then discusses disadvantages of traditional 2D cephalometry. The bulk of the review covers different 3D imaging modalities including CT, CBCT, MCT, 3D laser scanning, and their uses and advantages/disadvantages in orthodontics. Key applications discussed are impacted teeth detection, airway analysis, TMJ evaluation, and cleft lip/palate treatment planning.
Microendo courses| Advanced Endodontic courses in delhi| Micro-Endodontic Cou...Dr. Rajat Sachdeva
Endodontics related to cleaning of canals, prevention of tooth from loss due to infection Surgical operating of teeth through microscope envoloves:-
1. Which enhances visibility helps in finding calcified canals, missed canals accessory canal.
2. Apicectomy
3. Removal of broken instrument, retreatment.
4. treats perforation ledges.
Dr. Sachdeva's Dental Institute made it easy for Dentist to handle microscope availing them hands-on on extracted teeth,live-patient's treatment.
Experience a magic of advanced endodontics at Dr. Sachdeva's Dental Institute.
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https://www.facebook.com/sachdevadental/
You tube Link:
https://www.youtube.com/user/drrajatsachdeva
Linkedin link:
https://www.linkedin.com/in/drrajatsachdeva/
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https://www.slideshare.net/drrajatsachdeva
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Cervical arthroplasty a non fusion technique for daws in dogs - power point...Filippo Adamo
This document summarizes a study on cervical disc arthroplasty using an artificial disc to treat disc-associated wobbler syndrome in 33 dogs. The key findings were:
1) 91% of dogs showed improvement in neurological grade after surgery, with 30 dogs having satisfactory to excellent outcomes.
2) Complications included vertebral fractures during surgery in 2 dogs, immediate subsidence in 1 dog, and subsidence in 7 disc spaces.
3) Poor outcomes occurred in 2 dogs with severe, long-standing neurological signs that did not improve after surgery.
DEVELOPING CRYO-ELECTRON MICROSCOPY OF BIOMOLECULES IN WATERGuttiPavan
Cryo-electron microscopy (Cryo-EM) is a type of transmission electron microscopy that allows for the specimen of interest to be viewed at cryogenic temperatures (-150°C)
Following years of improvement, the cryo-electron microscope has become a valuable tool for viewing and studying the 3D structures of various biological molecules in water.
This document summarizes recent advancements in optometry. It discusses developments such as antimicrobial coatings for contact lenses, advancements in treating diabetic eye diseases using scatter laser treatment, stem cell therapy for retinal and optic nerve problems, Optiwave refractive analysis technology that allows surgeons to analyze eyes during cataract surgery, and Optos retinal scanning that eliminates the need for dilating drops and allows viewing of the entire retina. It also mentions visual prosthetics, advances in ocular drug delivery systems, and orthokeratology. Overall, the document outlines several important technological innovations that have improved eye care and vision correction.
Irregular Astigmatism after DSAEK in case of Congenital Hereditary Endothelial Distrophy with Intrastromal Vacuolization - L. Avoni, L. Cappuccini, M. Busin
This document contains 60 multiple choice questions testing knowledge of various topics in ophthalmology. It addresses topics like retinal layers, causes of blindness in HIV patients, pseudophakia, treatments for myopia, signs of past optic neuritis, definitions of emmetropia and more. The questions cover a wide range of ophthalmic topics including glaucoma, cataracts, retinal detachment, strabismus and others.
This lecture is based on medical students those are preparing for postgraduate degree namely FCPS/MS/MD/ any any subject coz hypertension is a systemic disease and by seeing the ocular fundus we can asses the general condition of blood vessels in major organ.
This lecture is based on post-graduate students of Ophthalmology (DO, DCO, MCPS, FCPS, MS) and optical principle of LASER, construction of laser and laser tissue interaction has cover the lecture
This lecture is based on post-graduate students of Ophthalmology (DO, DCO, MCPS, FCPS, MS) and optical principle of GAT has to know for a student to use the instrument friendly
This lecture is based on post-graduate medical students of all subject those who are students MS/MD/FCPS of different subject on Central Tendency and Dispersion.
The document discusses various topics related to spherical mirrors, including:
1) Spherical mirrors can be concave or convex depending on whether the silvering is on the outside or inside of the curved glass surface.
2) Key parts of spherical mirrors include the pole, center of curvature, radius of curvature, and principal axis.
3) Images formed by a concave mirror depend on the location of the object, which can be divided into five cases based on whether the object is beyond, at, or between the center of curvature and focal point, or at the focal point itself.
4) Depending on the object location, the image characteristics such as position, orientation, size and whether it is real
This is the 5 th lecture on "Research Methodology through zoom. The lecture was based on postgraduate Medical students those are different courses of FCPS/MS/MD/PhD (any Specialty)
This document discusses various conditions that affect the pupil, including Adie's tonic pupil, Argyll Robertson pupils, and pituitary adenomas. Adie's tonic pupil is caused by damage to the ciliary ganglion and results in a dilated, poorly reactive pupil. Argyll Robertson pupils are caused by neurosyphilis and show a dissociation between the light and near reflexes. Pituitary adenomas are tumors of the pituitary gland that can compress the optic chiasm and cause visual field defects such as bitemporal hemianopia. MRI is useful for evaluating these conditions.
Sample and Sampling Technique 3rd LectureAnisur Rahman
Cluster sampling is a sampling technique where the population is divided into naturally occurring groups or clusters, and then a sample of clusters is selected for analysis. The key aspects are that the population is divided into clusters first before sampling, and that sampling is done at the cluster level rather than individually. There are two main types of cluster sampling: one-stage, where all individuals in selected clusters are surveyed; and two-stage, where a random sample of individuals is selected from each cluster. Cluster sampling aims to reduce costs compared to simple random sampling while still achieving representation. However, it can result in larger sampling errors if clusters are not sufficiently heterogeneous.
Light can be defined as energy that the human eye can see. There are three broad subfields of optics: geometrical optics which studies light as rays, physical optics which studies light as waves, and quantum optics which studies light as particles. Geometrical optics includes the laws of reflection and refraction. Physical optics demonstrates that light exhibits wave properties through interference and diffraction. Quantum optics examines light at the quantum scale. Polarization and dispersion are also properties of light discussed in the document. Visual field loss in glaucoma can be detected earlier using blue light stimuli on a yellow background due to the eye's sensitivity to different wavelengths.
The document provides guidelines for writing a thesis protocol, including covering formatting requirements, sections to include such as objectives, methodology, and references, and tips for writing effective introductions, research questions/hypotheses, and objectives. It emphasizes following the guidelines of one's institution and writing concisely, clearly, and with appropriate references. Sample text is provided to demonstrate proper structure and formatting for each section of a thesis protocol.
The document discusses 15 different ophthalmic instruments used in various eye examinations and surgeries. For each instrument, the name, relevant procedure (e.g. cataract surgery), and potential complications are provided. The instruments include the Nettleship punctum dilator, trial frame, Schiotz tonometer, wire vectis, Simcoe cannula, phacoemulsification device, chalazion clamp, chalazion scoop, Barraquer needle holder, evisceration scoop, and instruments used in DCR surgery. Differences between immature and mature cataract and measurement of visual acuity with Snellen's chart are also summarized.
The document discusses neovascular glaucoma, noting the positive findings of neovascularization along the pupillary margin and diagnosing it as such. It states that the primary pathology is in the retina and lists common causes as ischemic central retinal vein occlusion, diabetes mellitus, central retinal artery occlusion, and ocular ischemic syndrome. The document advises that miotics should be avoided as medical treatment for neovascular glaucoma, instead recommending topical atropine, steroids if inflammation is present, and apraclonidine or oral acetazolamide.
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. LECTURE: 1 LENS
Prof Md Anisur Rahman
Head of the department (Eye)
Dhaka Medical College. Dhaka
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3. Monday, March 20, 2017 anjumk38dmc@gmail.com 3
Cross section of human crystalline lens
4. Human Crystalline Lens: (Applied anatomy)
The lens is a transparent, biconvex, crystalline structure placed
between iris and the vitreous in a saucer shaped depression.
Diameter is 9-10 mm
It has got 2 surfaces: the anterior surface is less convex (radius
of curvature is 10 mm) than the posterior (radius of curvature
6 mm) The two surfaces meet at the equator.
Its refractive index is 1.39 and total power is 15-16.
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5. Human Crystalline Lens (Histopathology)
Structure
1) Lens capsule: It is a thin, transparent, hyaline membrane
surrounding the lens which is thicker over the anterior than
the posterior surface. The lens capsule is thickest at pre-
equator regions and thinnest at the posterior pole.
2) Anterior epithelium: It is a single layer of cuboidal cells
which lies deep to the anterior capsule. In the equatorial
region these cells become columnar, are actively dividing and
elongating to form new lens fiber throughout the life.
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6. Human Crystalline Lens (Histopathology)
Structure
• 3) Lens fiber: The epithelial cells elongated to form lens fiber.
It form throughout the life, the older fiber resides in the centre
and form the nucleus and the peripheral called cortex.
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7. What is cataract?
• Opacity of the human crystalline lens and its
capsule is called cataract.
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8. Classification of cataract
A. Etiological classification
I. Congenital & developmental cataract
II. Acquired cataract
1. Senile cataract
2. Traumatic cataract
3. Complicated cataract
4. Metabolic cataract
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9. Classification of cataract
5. Radiation cataract
6. Toxic cataract
7. Cataract associated with skin diseases
8. Cataract associated with miscellaneous syndromes
i. Dystrophic myotonic
ii. Down’s syndrome
iii. Lowe’s syndrome
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10. Classification of cataract
B. Morphological classification: It involves the capsule & may be
1) Capsular cataract
i. Anterior capsular cataract
ii. Posterior capsular cataract
2) Subcapsular cataract: It involves the superficial part of the
cortex (just below the capsule) and includes:
Anterior subcapsular cataract & Posterior subcapsular cataract
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11. Classification of cataract
3) Cortical cataract: It involves the major part of the cortex
4) Supranuclear cataract: It involves only the deeper part of the
cortex
5) Nuclear cataract: It involves the nucleus of the crystalline
lens.
6) Polar cataract: It involves the capsule and superficial part of
the cortex in the polar region only. It may be:
Anterior polar cataract & Posterior polar cataract
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12. Cataract maturity (This classification is only for
Age related cataract)
1. Immature cataract: is one in which the lens is partially
opaque.
2. Mature cataract: when lens is completely opaque.
3. Hyper mature cataract: has a shrunken and wrinkled anterior
capsule due to leakage of water out of the lens.
4. Morgagnian cataract: is a hyper mature cataract in which
liquefaction of the cortex has allowed the nucleus to sink
inferiorly
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13. Classification of cataract (Congenital &
Development cataract)
A. Hereditary: About one third of the congenital cataract is
hereditary. Mode of inheritance is autosomal dominant
B. Maternal factor:
1) Malnutrition
2) Infection
3) Drugs ingestion
4) Radiation
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14. Classification of cataract (Congenital &
Development cataract). Aetiological
C. Fetal or Infantile factors:
i. Deficient of oxygenation: Owing to placental haemorrhage
ii. Metabolic disorder: Galactosemia, galactokinase deficiency
iii. Cataract associated with other congenital anomalies: Lowe’s
syndrome, myotonica dystrophica
iv. Birth trauma
v. Malnutrition
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15. Classification of cataract (Congenital &
Development cataract)
• D. Idiopathic
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18. Morphological classification of
congenital/Developmental Cataract
6) Generalized cataract
Coronary cataract
Blue dot cataract
Total congenital cataract
Congenital membranous cataract
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19. Difference between immature & mature cataract
Immature cataract
1) Considerable vision present
2) Colour of the lens is
grayish white
3) Iris shadow present
4) Fundal glow present
Mature cataract
1) Vision is reduced to CF
2) Colour of the lens is pearly
white
3) Iris shadow absent
4) Fundal glow absent
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20. How the visual acuity measure with Snellen’s
chart
1) 6/60
2) 6/36
3) 6/24
4) 6/18
5) 6/12
6) 6/9
7) 6/6
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21. Reversible blindness
1) Cataract is most common
2) Refractive error
3) Corneal opacity due to trauma, ulcer etc
4) Diabetic retinopathy
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22. Irreversible blindness
1) Primary open angle glaucoma (POAG)
2) Age related macular degeneration (ARMD)
3) Some retinal dystrophy or degeneration
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23. LECTURE: 2. Lens
Prof Md Anisur Rahman
Head of the department (Eye)
Dhaka Medical College. Dhaka
Monday, March 20, 2017 23anjumk38dmc@gmail.com
24. Symptoms of cataract
1) Gradual dimness of vision
2) Sometimes mono ocular diplopia in early
stage
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25. Signs of Immature cataract
1) Considerable vision present
2) Colour of the lens is grayish white
3) Iris shadow present
4) Fundal glow present
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26. Signs of Mature cataract
1) Vision is reduced to CF
2) Colour of the lens is pearly white
3) Iris shadow absent
4) Fundal glow absent
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27. Treatment of cataract
In early stage, change of spectacle
But the surgical treatment depends upon the
patient choice and profession of the patient.
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28. What are the surgical treatment of cataract
There are two types of cataract surgery
1) ICCE (Intracapsular cataract extraction) Now
obsolete
2) ECCE: (Extra capsular cataract extraction)
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29. The basic difference between the two
surgeries are:
• In ICCE the lens is extracted along with total
capsule of the lens, so no IOL can be
implanted in posterior chamber
• But in ECCE the posterior capsule of the lens
is remain intact so IOL can be implanted in
posterior chamber
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30. Various types of Extracapsular Capsular Cataract
Extraction
1) Extra capsular cataract extraction with
posterior chamber intra ocular lens
implantation (ECCE with PC IOL)
2) Small incision cataract surgery with posterior
chamber intra ocular lens implantation (SICS
with PC IOL)
3) Phacoemulsification with posterior chamber
intra ocular lens implantation (Phaco with PC
IOL)
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31. Among these 3, SICS with PC IOL & Phaco
with PC IOL is the treatment of choice
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32. What investigation will you do before
cataract surgery?
Systemic investigations:
Blood sugar: Cataract surgery will not perform if
blood sugar is above 10 two hours ABF.
ECG: Not always
Ocular investigation:
IOP
SPT
Biometry
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33. What is SPT?
SPT: Sac patency test. It is done to check whether the
lacrimal passage is open or not. If the draining
passage is blocked cataract surgery will not perform.
We have to clear the passage by doing surgery.
We have to do DCR/DCT according to patient
condition.
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34. What is biometry?
Biometry is the procedure by which we detect the
intra ocular lens power before surgery.
How to perform biometry?
To calculate the IOL power which we put inside the
eye during surgery
Two instruments are needed to calculate the IOL
power.
Keratometer
A scan ultra sonogram
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35. Biometry
There is a formula to calculate the IOL power.
P = A – {(2.5xAL) + (0.9 x K)}
Here,
P = Power of the IOL
A = Constant (which is printed over the lens box)
AL = Axial length of the globe
K = Keratometer reading (Diopter power of cornea)
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36. Biometry
• With the help of A-Scan we measure the axial
length of the globe
• We the help of kerato meter we measure the
diopter power of the cornea.
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37. Anaesthesia used in cataract surgery
Cataract surgery usually perform with local
anaesthesia
There are 2 types of block
1) Retrobulbar
2) Peribulbar
In some cases, such as children & non cooperative
patient we use G/A.
Some surgeons prefer topical Oxybuprocaine 0.4%
in phaco surgery.
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38. ANAESTHETIC SOLUTIONS:
Lignocaine (lidocaine) 2%: Fast onset of action and
effects last for an hour.
Bupivacaine 0.5% : slow onset of action but lasts for
3-4hrs
Hyaluronidase (7.5 units/ml): Spreading agent
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39. Retrobulbar block
The globe should be in primary gaze, looking straight
up towards the ceiling. The inferior orbital rim is
palpated through the lower eyelid.
The needle should be oriented with the bevel facing
up towards the globe. This further protects the globe
from penetration during injection.
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40. Retrobulbar block
• The needle is then inserted through the lower eyelid,
just superior to the lateral third of the inferior orbital
rim. The temporal limbus is used as a guide, as shown
in the image below.
• The needle is advanced posteriorly parallel to the
orbital floor, which has an approximate incline of 15
degrees.
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41. Retrobulbar block
• When the needle is approximately 50% passed (at this
point the tip of the needle will have passed the
equator of the globe), the angle of injection is shifted
medially and further superiorly to 45 degrees
allowing the needle to enter the intraconal space.
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46. Peribulbar block
Peribulbar block is very similar to the retrobulbar block.
Anesthetic is injected into the orbit; however, it is
administered outside of the muscle cone. Because of
this fact, this technique is lower risk than the
retrobulbar block, but achieves a lesser degree of
anesthesia and especially akinesia
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47. Peribulbar block
• Peribulbar block should be given in upper and lower
Upper one should be given at the junction of medial
1/3 and lateral 2/3 of the superior orbital rim
Lower one should be given at the junction of lateral
1/3 and medial 2/3 of the inferior orbital rim
• (5ml should be given in each time)
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49. Complication of block
Complication due to anaesthetic agent:
• Hypersensitivity reaction
• Syncope
Complication due to faulty technique
• Retrobulbar hemorrhage
• Perforation of the globe
• Optic N injury
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50. Pre operative preparation of cataract surgery
I. Topical antibiotic hourly from the day before surgery (except
sleeping time)
II. Sedative (night before surgery) according to patient choice.
III. Tab Acetazolamide & Tab Potassium supplement at C/M.
IV. Phenylephrine + Tropicamide eye drop 15 minute interval for
3 to 4 times before surgery to dilate the pupil.
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51. Solve the problem
A patient 65 year old came to you for cataract surgery
(R/E) and he desires to do phaco surgery with PC
IOL, O/E you got visual acuity of R/E is 6/36. L/E is
aphakic but with glass of +10 D his visual acuity is
6/9.
Now how you manage/counsel the patient?
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52. Lecture: 3
17 May 2016
Prof Md Anisur Rahman
Head of the department (Ophthalmology)
Dhaka Medical College, Dhaka
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53. Steps of SICS.
Step: 1Expose the eyeball
• After draping the field is ready to surgery
• Step: 1
Expose the eye ball with the help of universal
speculum & superior rectus bridle suture with 4/0 or
5/0 atraumatic silk
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54. Steps of SICS.
Step: 1Expose the eyeball
Fig: 1. Superior Rectus hold
with Tooth forcep and needle of
the atraumatic silk hold with
Silcock's needle holder
Fig: 2. Now the eyeball is
exposed with Universal eye
speculum & Superior Rectus
bridle suture
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55. Steps of SICS.
Step: 2. Construction of scleral tunnel
Give incision to the conjunctiva and expose
the sclera about 1.5 to 2 mm above the sup limbus.
Give incision (crescent
shaped or straight)
to the sclera (half or
2/3 thickness) with
crescent
knife. FIG: 3
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56. Steps of SICS.
Step: 2. Construction of scleral tunnel
Monday, March 20, 2017 56FIG: 4m
Then make a tunnel with
the crescent knife upto 1.5
to 2 mm of the cornea.
Then enter into A/C with
the help of keratome.
FIG
57. Steps of SICS
Step: 3. Anterior capsulotomy
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Crescent knife Keratome
58. Steps of SICS
Step: 3. Anterior capsulotomy
Before Anterior capsulotomy stain the capsule with
bluerex
Wash A/C with Ringer’s/Basal Salt Solution (BSS)
Insert visco elastic substance (Methyl Cellulose) into
A/C to maintain the A/C depth.
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F
Capsule is
stained
with
bluerex
FIG: 5
59. Steps of SICS
Step: 3. Anterior capsulotomy
• There are 3 types of anterior capsulotomy
1) Can opener
2) CCC (Continuous Curvilinear Capsulorhexis)
3) Envelope type
Capsulotomy is done with the help of Cystitome
(Cystitome is nothing but the double bent
hypodermic needle)
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60. Steps of SICS
Step: 3. Anterior capsulotomy
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FIG: 6. CCC FIG: 7. Can Opener
61. Steps of SICS
Step: 4 hydrodissection & hydrodelination
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• This step is not mandatory for SICS but phaco.
FIG: 8. If hydrodissection is
complete there will appear a Golden
Ring Surrounded the nucleus
FIG: 8. Golden ring is
seen.
62. Steps of SICS
Step: 5 & 6. Removal of the nucleus
• Step: 5. The nucleus will be prolapse into the A/C
with the help Sinsky hook or Cystitome needle.
• Step: 6. The nucleus will be delivered with the help of
Vectis loop (many surgeons use different instrument
for nucleus delivery) FIG: 9
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63. Steps of SICS
Step: 6 Removal of the nucleus
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FIG: 9 Removal of the nucleus with the help
of wire loop vectis
64. Steps of SICS
Step: 7. Cortical matter clean up
• Step: 7. When nucleus is delivered only cortical
matter is there. So cortical matter has to removed.
This step is called irrigation & aspiration.
• It is clean up with the help of Simcoe cannula. It is
also called two-way cannula
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65. Monday, March 20, 2017 anjumk38dmc@gmail.com 65
FIG: 10. Irrigation & Aspiration
cannula (I & A cannula)
66. Steps of SICS
Step: 7. How cortical matter clean up with I/A cannula?
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The 2-way cannula is
attached one side with 5 cc
syringe & the other end with
the saline set.
When the saline is on fluid
enter into the A/C.
The syringe which is
attached with other end will
aspirate cortical matter from
A/C.
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Intraocular lens made
by Polymethylmeth
Acrylic Refractive
index is 1.49
Intraocular lens has two parts.
1) Two haptic for anchoring
2) Optical part. Lens power is in
optical part
71. • After insertion of the lens the anterior chamber
washed with Ringer’s/BSS.
• Check whether A/C is normal depth or shallow. If
A/C is shallow give a bite with 10/0 monofilament
nylon.
• Lastly, apply pad for 24 hours
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72. Lecture: 4
Prof Md Anisur Rahman
Head of the department (Ophthalmology)
Dhaka Medical College, Dhaka
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73. After cataract surgery what advice should you
give to the patient?
1) Do not use water in your eyes
2) Use dark black sun glass
3) Do not lean forward
4) Use medicine regularly
5) Come after 7 days or before if any problem
Abide by these rules for 4 weeks (for SICS) 2 weeks for
phaco surgery
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74. Post operative order (oral medication)
1) Systemic antibiotic: Usually Tab Ciprofloxacin (500
mg) for 7 days
2) Analgesic (Paracetamol preferably) if pain along
with anti ulcerant.
3) Tab Acetazolamide (250) and potassium supplement
If IOP is raised
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75. Post operative order (eye drop)
1) Antibiotic eye drop (Moxifloxacin/Levofloxacin):
1 drop 4 to 6 hourly for 1 month
2) Steroid eye drop (Dexamethason/Prednisolone)
I drop 2 hourly for 7 days
1 drop 4 hourly for 15 days
Then tapper (total dose will be 6-8 weeks)
3) Tropicamide 1% eye drop 8 hourly for 2 weeks
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76. Complications of cataract surgery
• In broad heading we can divided complications of
cataract surgery into 3 stages:
1) Pre operative complications: due to anaesthetic
agent
2) Per operative complications: During surgery
3) Post operative complications: We can divided it into
two groups:
a) Early post operative
b) Late post operative
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78. Per-operative complications of SICS
Per operative: According to stages of surgery
Step: 2. Construction of scleral tunnel
a) Improper tunnel construction.
b) Early entry into A/C
c) Anterior capsular tear during entry into A/C
Step: 3. Anterior capsulotomy: In SICS usually no
complication, but in phaco there may be radial tear
into capsule & phaco may be turn into SICS
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79. Complications of SICS
• Step: 6. Removal of the nucleus:
a) There is high risk, to corneal endothelial injury
which may ultimately causes bullous keratopathy.
b) Iris injury & iridodialysis.
c) There is chance of PCT (posterior capsular tear)
d) Vitreous loss (VL)
e) There is chance of nucleus drop into vitreous
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80. • Step: 7. Cortical clean up
• During cortical clean up there is chance of PCT &
VL
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81. Early postoperative complications
1) Wound related:
i. Wound leak
ii. Iris prolapse
2) Cornea:
i. Corneal striate
ii. Corneal oedema
3) Anterior chamber:
i. A/C reaction
ii. Hyphaema
iii. TASS (Toxic Anterior Segment Syndrome)
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82. Early postoperative complications
4) IOP related:
i. Raised
ii. Low
5) IOL related
i. Decentered
ii. Dislocated
iii. Tilted
iv. Pupil capture
6) The most devastating: Acute endophthalmitis
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83. Late postoperative complications
1) Delayed-onset endophthalmitis following cataract
surgery develops when an organism of low virulence
such as P. acnes, becomes trapped within the capsular
bag (saccular endophthalmitis).
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84. Late postoperative complications
2) Visually significant posterior lens capsular
opacification (PCO), also known as ‘after cataract’,
is the most common late complication of
uncomplicated cataract surgery, historically
occurring
3) contraction of the anterior capsular opening
(capsulophimosis)
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