NEET PG-Complications of Cataract-Ophthalmology скачать в хорошем качестве

NEET PG-Complications of Cataract-Ophthalmology

To view more masterclasses download our ophthalmology app at https://play.google.com/store/apps/de... Secondary Cataract:@0:10 Secondary cataract has multiple names Secondary/After cataract/Posterior capsular opacification Question: most common complication of cataract surgery Ans: secondary cataract (30-40%) Q 2: Younger the pt. Faster the occurrence(basing on this questions) 50-70% yrs. develop within 6-8 months 20-25 yrs. patients develop within 3 months 1 yr. child develops in 3 weeks. Why so?? Younger the pt. Faster the occurrence?? Lets look at the pathology Pathology Following Cataract Surgery@1:48 Secondary cataract has multiple names Secondary/After cataract/Posterior capsular opacification. Lets look at the pathology of secondary cataract Remember the first step we have done is Anterior capsulotomy, capsulorhexis, placed an IOL and sent the patient home. Now this capsule is lined with LEC’s(lens epithelial cells). While cutting the anterior capsule we might traumatize the Lens epithelial cells, this mechanical trauma stimulates Mitosis. And because of the mitosis, the cells multiply and proliferate climb up the anterior capsule and slide down the posterior capsule and reach the centre of posterior capsule and causes thickening of central part of posterior capsule and as a result the light is again blocked because of the secondary cataract. Lets look at the pathology of secondary cataract@3:05 Remember the first step we have done is Anterior capsulotomy, capsulorhexis, placed an IOL and sent the patient home. Now this capsule is lined with LEC’s(lens epithelial cells). While cutting the anterior capsule we might traumatize the Lens epithelial cells, this mechanical trauma stimulates Mitosis. And because of the mitosis, the cells multiply and proliferate climb up the anterior capsule and slide down the posterior capsule and reach the centre of posterior capsule and causes thickening of central part of posterior capsule and as a result the light is again blocked because of the secondary cataract. 1.Secondary cataract is nothing but the migration and proliferation of LEC’S ITSELF ***Now ICCE( INTRA CAPSULAR CATARACT EXTRACTION) CANT HAVE SECONDARY CATARACTS AS THE CAPSULE IS ALSO REMOVED ALONG THE LENS. 2.AND Y ARE THE SECONDARY CATARACTS SO COMMON, BECAUSE WE ARE EASILY BOUND TO TRAUMATIZE THE LEC’S WHILE CUTTING THE CAPSULE. 3. AND BECAUSE IN YOUNGER PATIENTS THE DIVISION AND PROLIFERATION OF THE LEC’S(MITOSIS) IS AT HIGHER RATE COMPARED TO THE OLDER PATIENTS, THE FASTER THE OCCURANCE OF SECONDARY CATARACTS LIKE WE DISCUSSED IN THE FIRST SLIDE. There are two types of secondary cataracts.@3:41 Elshnig’s pearls (more common) – pearls like thickenings of the posterior capsule behind the IOL. Sommer’s Ring – a ring like thickening behind the IOL less common So we can get any of the two types of secondary cataracts and we have to treat them. We need to treat them with Nd YAG laser. Laser Capsulotomy :@4:06 Nd YAG: 'Neodymium-doped Yttrium Aluminium Garnet’ (1064 nm) is used in the treatment of secondary cataracts. Laser Capsulotomy : Lot of Elshnig’s pearls that has formed behind IOL, disrupting the passive rays of light, complete opacification (B) After capsulotomy, part of the capsule is removed with rest of the capsule that is left intact & can support IOL. Now the light rays can pass through again and hence the patients vision is recovered again. Cystoid Macular Oedema (CME) : Endophthalmitis:@6:44 Endophthalmitis is a very serious complication In CME and secondary cataracts there is loss of vision, but in endophthalmitis one can loose the eye. Endophthalm - vitiritis , infection of the vitreous cavity. We classify into two types early, within 6vweeks and late onset, if after 6 weeks. We have to classify cause the causes and treatment of both early & late are different and by definition it says 6 weeks but usually it is 2-3 days. Early caused by Staph. Epidermidis (most common) followed by Staph. Aureus Late onset Endophthalmitis caused by Propionibacterium acnes (most common)** both are important mcq’s. We will move on to the clinical features. Endophthalmitis – Clinical Features:@8:01 Endophthalmitis - A ball of pus Immense pain Marked congestion/ Red Very dramatic/sudden loss of vision Treatment:@8:29 Posterior Capsular Rupture:@9:54 Anterior Chamber Intra Ocular Lens(ACIOL): Scleral Fixation IOL:@11:45 Exam Important:@12:18