This document discusses various posterior segment complications that can occur after refractive eye surgery procedures like LASIK and lens-based refractive surgeries. It describes complications such as retinal detachments, macular hemorrhages, macular holes, choroidal neovascular membranes that have been reported after LASIK. It also discusses complications for lens-based refractive surgeries like perforated globe, suprachoroidal hemorrhage, dropped nucleus, cystoid macular edema, macular phototoxicity, retinal detachment, and endophthalmitis. Risk factors and management strategies for many of these complications are provided. The document concludes with recommendations for refractive surgeons to help prevent or properly manage some of these complications.
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
Diabetic maculopathy is a form of damage to the eye causing by diabetic macular oedema where fluids build up on the macula. It can be cured by laser surgeries.
After the tunnel has been dissected with crescent knife
Entry is made into the anterior chamber at 10 O’ Clock
position with MVR/V-Lance 20G blade
Viscoelastic is injected to make the eyeball hypertensive
Diabetic maculopathy is a form of damage to the eye causing by diabetic macular oedema where fluids build up on the macula. It can be cured by laser surgeries.
After the tunnel has been dissected with crescent knife
Entry is made into the anterior chamber at 10 O’ Clock
position with MVR/V-Lance 20G blade
Viscoelastic is injected to make the eyeball hypertensive
The basic concepts about refractive errors and their corrective options are explained in this lecture. It was taken at Central Park Medical College Lahore Pakistan for fourth year medical students
DIAGNOSTICS-IMPACT ON THE PREMIUM CHANNEL - AlconHealthegy
Presentation from OIS@ASCRS 2016
Seba Leoni, VP & Global Head, Surgical Suite
Video Presentation:
https://www.youtube.com/watch?v=hidfQJsrV4o&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=24
Age related macular degeneration - a glimpse into the future by Jaheed KhanJaheed Khan
This presentation on age related macular degeneration was given by Jaheed Khan on the 12th April 2016 as part of a series of talks given to optometrists and general practitioners at Clinica London, 140 Harley Street, London.
Secondary Piggyback Iol Implantation For Correction Of Residual Refractive Er...Dr. Jagannath Boramani
Presented by- Dr. Hardik Jain, Co-authors- Dr. Mrunal Patil, Dr. Dhiraj Balwir ( Disclosure: Author has no financial interest ) Dr. Vasantrao Pawar Medical College, Nashik
Light - Reflection and Refraction, Class X, CBSE, ScienceDevesh Saini
PowerPoint Presentation covering all the concepts and topics of the chapter : Light- Reflection and Refraction of class X (CBSE).
This is exactly what you are looking for.
Don't forget to comment and give feedback.
Ocular Disorders-Insight Pharma ReportsDaniel Miller
Available to Insight Pharma Reports is Ocular Disorders: Rising Therapeutics, Technologies, and Devices Report. This report begins with outlining Age-related macular degeneration (both wet and dry) and delving into Anti-VEGF therapies in chapter 2. Further providing substantial weight to this report, several companies were interviewed on their approach to targeting wet and dry AMD, their strategies for seeking alternative therapeutic options, and the hardships they have encountered in their research and product execution.
Trabeculectomy is an incisional procedure in which a fistula is created between the anterior chamber and the subconjunctival space, bypassing the normal aqueous outflow pathway.
Initially performed as a full-thickness (“unguarded”) procedure.
High complication rates related to hypotony led to a major evolution in the surgical technique.
The fistula is now created under a partial-thickness flap of sclera (“guarding” the flow of aqueous) as a means of providing some resistance to aqueous flow through the fistula.
PCR- breach in the posterior capsule of the crystalline lens during cataract surgery
Common complication
Lead to sub-optimal visual outcomes if not recognized early or managed appropriately
Complication varies with the stage at which it occurred or was recognized
Consequent Vitreous loss -major determinant of post-operative outcomes
This ppt describe about the incidence, diagnosis and management of maculopathy in caaes of pathological myopia.
Data collected and created by Vivek Chaudhary
For queries : vivek977optom@gmail.com
Femtosecond lasers are being touted as the next great leap forward in cataract surgery but, as with any radical change to our practices, many questions remain: Does this technology truly improve cataract surgery? Is the refractive accuracy better? Is the safety profile significantly elevated compared to existing technologies? Are there additional complications or issues with using this laser?
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Refractive eye surgery
Is any eye surgery used to improve the refractive
state of the eye and decrease or eliminate
dependency on glasses or contact lenses. This can
include various methods of surgical remodeling of
the cornea or the lens. Successful refractive eye
surgery can reduce or cure common vision
disorders such as myopia, hyperopia and
astigmatism, as well as degenerative disorders
like keratoconus.
4. The most common methods today use excimer
lasers to reshape the curvature of the cornea
Clearly, LASIK is an anterior segment
procedure, but it could have posterior segment
consequences. Although
rare,
posterior
complications following LASIK have been
documented, and including retinal tears, retinal
detachments, retinal hemorrhages, macular holes,
and choroidal neovascular membranes
5. The relationship between the LASIK
procedure and vitreoretinal complications is
difficult to establish, since such complications
occur with a higher incidence in patients with
high myopia, being the majority of patients
undergoing refractive surgery.
There is also fact that vitreoretinal
complications observed share a common
pathophysiology, which is posterior vitreous
detachment (PVD)
6. The suction and the increase in pressure
induced by the suction ring used to fixate the eye
while the microkeratome creates the flap could
elongate the eye along the anteroposterior axis,
which in turn could cause a contraction in the
horizontal axis. This combination of events may
push the lens anteriorly and cause vitreoretinal
traction at the vitreous base and the posterior pole
and facilitate PVD.
7. Cutting the flap with a femtosecond laser rather
than a microkeratome requires lower suction but
longer duration. LASIK with the femtosecond
laser has been reported with rhegmatogenous
RD, macular hemorrhage and. Epi-LASIK, which
also requires relatively longer suction durations,
has been associated with optic neuropathy.
8. Retinal detachments
It is interesting that retinal detachments
occurred at approximately 9 months after LASIK.
Therefore, corneal refractive surgery probably
does not increase the rate of retinal detachment
any more than if the patient had not undergone
surgery.
9. When planning surgical treatment of RD following
LASIK, certain factors should be considered. Post-LASIK
patients may be dissatisfied with the myopic shift
following encircling scleral buckling, and alternative
techniques (such as segmental scleral buckling, PPV or
pneumatic retinopexy) may be considered. If scleral
buckling is performed, the vitreoretinal surgeon should
understand that the patient may desire future LASIK
enhancement if retinal reattachment is achieved and if
good central vision returns. Conjunctival scarring and
anterior placement of an encircling buckling element may
prevent proper placement of a microkeratome following
successful scleral buckling.
10. If PPV is chosen to treat RD, the surgeon should
attempt to protect the corneal flap during surgery
to avoid flap dislocation
12. Theoretically, when a break in Bruch’s membrane
occurs, it allows the progression of the
neovascularization under the retina. The increase
in intraocular pressure (IOP) to levels over 60 mm
Hg during suction with the microkeratome suction
ring up to 4 mm posterior to the limbus may exert
posterior traction. This mechanism may open the
gap in Bruch’s membrane even more. In patients
with high myopia and lacquer cracks, LASIK
should be considered contraindicated and some
other method of refractive surgery offered (i.e.
phakic IOL
18. Perforated globe
Accidental perforation of the globe is an
acknowledged complication of peribulbar,
retrobulbar anaesthesia. High myopia is a strong
risk factor for globe perforation in peribulbar
anaesthesia.
Signs and symptoms of perforation include intense
ocular pain, sudden loss of vision and hypotony.
Interestingly, in one review, about 50% of the
patients had no immediate symptoms or signs of
perforation
19. This injury could be avoided by minimizing
the number of injections, use of blunt needle,
noting negative aspiration before injection,
inspection of aspirate for blood or vitreous fluid
and to wiggle the syringe before injecting, to
ensure that the globe is not pierced by the needle
(although not universally accepted). It is also
recommended to discontinue the injection if
corneal edema or resistance to injection occur.
21. Risk factors: older age, taking at least one
cardiovascular medication, glaucoma, elevated
preoperative intraocular pressure, the lack of
orbital compression after LA , PC rupture, HTN,
axial myopia, retrobulber injections, coughing
and valsalva.
24. Post-operative SCH
Presentations:
Sudden pain
Loss of vision
Shallow AC
^IOP
Management:
Wound intact: medical to control IOP
Wound not intact: surgical closure
When to drain:
Persistant flat AC
Kissing choroidale
Uncontrolled IOP for one week
Persistant Choroidal detachment
28. CME is the result of accumulation of fluid in
the central macula in the outer plexiform layer
with the formation of cystoid spaces.
The term “cystoid macular edema” (CME)
applies when there is evidence by biomicroscopy,
fluorescein angiography (FA), and/or optical
coherence
tomography
(OCT)
of
fluid
accumulation into multiple cyst-like spaces within
the macula.
29.
30. Potentially toxic substances including PGs
normaly contained in the anterior segment may
diffuse posteriorly to the macula
Risk factors:
Surgical approach
Diabetic and HTN Patients
Iris incaceration in the wound
A ruptured posterior capsule
Retained lens fragment
31.
32. Prophylaxis: NSAIDS
Substantial subgroups of patients with refractory
macular oedema show interest in other treatment
modalities, including pars plana vitrectomy, medical
therapy with protein kinase C inhibitors , intravitreal
injection of corticosteroids or a sustained release
intravitreal corticosteroid implant
34. Operating microscope light induced foveal damage is a
well recognised occurrence following ocular surgery
PM is the result of a photochemical and thermal lesion
of the retina due to ultraviolet radiation from the operating
microscope, characterized by affecting the outermost
retinal layers. It is related to the intensity, exposure time
and wavelength of the light source, with blue and UV light
(wavelength below 300-350 nm) being the most damaging
for the eye
35. At the clinical level, it is characterized by a yellowish lesion at
the foveal level, a window defect in FA and a central or paracentral scotoma which diminishes with time. The initial yellowish
lesions are subsequently replaced by a dotting of the RPE or even
a lamellar hole.
These patients may notice a pericentral scotoma,
metamorphopsia or slight/moderate vision loss between one and
four hours after exposure. The scotoma may diminish after a few
months and the patient usually recovers part of the lost eyesight.
36.
37. Precautions against phototoxic lesions:
The use of ultraviolet filters on the microscope, air in the AC to
defocus the light from the retina.
Minimizing the time and power of coaxial illumination from the
microscope
Keeping the patient's body temperature low to reduce the
temperature within the eye, irrigation solutions may be cooled
relative to room temperature.
Lowering the inspired oxygen concentration for the patient during
the procedure as it has been shown that an increase in inspired
oxygen markedly enhances retinal phototoxicity.
Stop photosensitising treatment particularly for underlying potential
photosensitising systemic conditions before surgery and taking
appropriate surgical precautions (Manzouri et al., 2002).
39. Postoperative acute endophthalmitis is a
devastating complication after intraocular surgery
and can be seen as increased pain, redness, lid
edema, anterior chamber reaction, corneal haze,
vitreous haze, frank exudates in the vitreous or
absent red reflex. This condition needs to be
treated as an emergency with maximum medical
therapy and may sometimes require vitrectomy
40. Risk factors :
Increased operative time, low experienced
surgeon.
Posterior capsule rupture/vitreous loss.
Retained lens fragments.
Inadequate sterilization of the operative field.
Contamination of surgical instruments.
Inadequate wounds eg, leaky
41. Once infection occurs, damage to ocular tissues is believed to occur
due to direct effects of bacterial replication as well as initiation of a
fulminant cascade of inflammatory mediators. Endotoxins and other
bacterial products appear to cause direct cellular injury while
eliciting cytokines that attract neutrophils, which enhance the
inflammatory effect. Thus, recent efforts in controlling the damaging
effects of endophthalmitis in experimental models have focused on
identifying not only appropriate antibiotics for control of the
infectious agent but also on anti-inflammatory agents that might
disrupt the immunologic events that occur after infection
46. Final recommendations for refractive
surgeons to consider before performing
surgery in myopic patients
47. •Inform the patient that retinal detachments can
occur. If after refractive surgery he presents
symptoms suggesting retinal traction, break, or
detachment, explain the symptoms and see the
patient as soon as possible.
•When performing refractive lens exchange, use an
IOL with a low rate of PCO.
•Carefully examine the periphery of the fundus to
detect any breaks or lattice degeneration that may
require follow-up or laser treatment.