Intravitreal Injection of Vancomycin & Ceftazidime for Postop Endothalmitis Dr Suresh Pandey.mpg скачать в хорошем качестве

Intravitreal Injection of Vancomycin & Ceftazidime for Postop Endothalmitis Dr Suresh Pandey.mpg

In this video, we describe pearls for preparing intravitreal Injection of Vancomycin & Ceftazidime for Postoperative Endophthalmitis. The commonly recommended 1 mg vancomycin dose. Use of sterile surgical gloves and sterile drappings sheets are a must. It is essential to obtain informed written consent for intravitreal therapy. Scrub hands thoroughly and wear sterile surgical gloves. Prepare intravitreal injection in three tuberculin syringes based on which drugs option has chosen. The pupil should be dilated prior to intravitreal therapy. Topical anaesthetic agents such as xylocaine or proparacaine are necessary for intravitreal therapy. However, many ophthalmologists additionally use subconjunctival anaesthetic injections at the proposed site of intravitreal injection. In endophthalmitis peribulbar anaesthetic injection is very useful, as it provides post intravitreal injection analgesia for many hours. The most critical step pre-operatively, is to use 10% povidone iodine to clean the Eyelids and to irrigate the ocular surface and conjunctival sac. It is necessary to use a lid speculum to ensure that the eyelashes and margins of the Eyelids do not contaminate the syringe and needle during injection. Sterile gloves should be worn. Tuberculin syringes with 26 or 30 gauge needle are very useful for giving intravitreal injections. It is recommended that the conjunctiva be displaced slightly with a cotton bud prior to beginning the injection so that the conjunctival entry point is slightly separated from the scleral entry point. This allows a better wound seal post injection. The injection should be given 3.5mm from the limbus in a pseudophakic eye. An attempt may be made to aspirate by gentle suction some vitreous fluid through pars plana for bacteriological analysis. Often one is likely to fail to get fluid. The the needle must be withdrawn slowly letting the vitreous collagen clogging the needle to escape back without causing traction retinal tears. Take the syringe with 0.1ml drugs. Puncture the globe at pars plana ( 3.5-4mm behind the limbus). Slowly inject the content. Withdraw. Repeat same procedure with the with remaining two syringes with 0.1 ml of the solution. Please note, though it is possible to mix an antibiotic and dexamethasone, it is not advisable to mix two antibiotics in the syringe. In order that concentrated antibiotics do not settle on the Macula, one may use a Pillow during the procedure and Turn the head to the opposite side, immediately after the injections. After the injection the patient may maintain a Face down position for 10 to 15 mts for the antibiotics to move towards the anterior segment. Put a pad and bandage for at least an hour. Analgesic and a tablet of acetazolamide is optional. If improvement noted but not impressive: Repeat antibiotics & dexamethasone after 48 hours. Definition of Improvement: Improvement of vision, however small it may appear Reduction or disapperance of hypopyon after sitting up of 1 hour or more. Clearing of the AC,Consolidation of the fibrin exudates or shrinking of the pupillary membrane,Better red reflex, Reduction of pain , Decrease in lid edema & chemosis, if it was present, If No Improvement or Worsening in 48-72 hours.A repeat vitreous tap and injection of antibiotics plus a pars plana vitrectomy (if this was not originally done) should be considered. Complications of an intravitreal injection include Retinal detachment (0.0 -- 1.0% per patient); Significant vitreous haemorrhage (0.4% per patient). Contact details: Dr Suresh K Pandey, MS (PGIMER), ASF (USA) SuVi Eye Institute, Kota, INDIA, [email protected] For Eye Doctors/Ophthalmologists: We offer various hand-on training courses at SuVi Eye Institute, C 13 Talwandi, Kota, Rajasthan, India. For details please contact [email protected] Website: www.suvieye.com; phacolasiktraining.com; Phone +91 9351412449, Phaco Training India, Lasik Laser Training India, Hand on Basic and Advanced Phaco Training India, Customized Lasik Refractive Surgery Training India, Training in Oculoplastic Surgery India, Retinal Lasers Training India, Dr Suresh K Pandey Kota India, Dr Vidushi Sharma Kota India, SuVi Eye Institute Lasik Laser Center Kota India, Medical Retina Training India, Dacryo-Cysto-Rhinostomy (DCR) Training India, C3R (Corneal Collagen Cross Linking with Riboflavin) for Keratoconus Training India, Suture-less Glue Free Pterigium Surgery Training India, Botulinum Toxin Training India, Pediatric Cataract Surgery Training India, Intravitreal Injection Training India, Glaucoma Surgery Training India, Strabismus Surgery Training India, SICS (Small Incision Cataract Surgery)Training India, Manual Phaco Training India, Training in Premium IOL (Multifocal, Toric, Accommodative) India, Phakic IOL, Implantable Contact Lens (ICL) Training India, Keratoprosthesis training India.