Presentation is loading. Please wait.

Presentation is loading. Please wait.


Similar presentations

Presentation on theme: "DEPARTMENT OF INPATIENT"— Presentation transcript:


2 AIM The MLOP shall identify the early post
operative complications in the ward and shall help in the effective management of the same.

3 Objectives The MLOP shall
Develop wide range of basic knowledge of immediate post surgical complications In early identification of post operative complications Helping doctors in prompt remedial measures In explaining and reassuring patients in a proper way about their complications.

4 Theory The ocular post surgical complications can broadly be divided into Anterior segment complications Posterior segment complications Early post operative complications Late post operative complications

5 Early Post - Operative Anterior segment complications
Lid Oedema; ptosis Conjunctiva - Chemosis, Subconjunctival haemorrhage Cornea Oedema, Striate Keratopathy, Epi. defect Ant. Chamber - Shallow, Cortex, Hyphaema, Hypopyon Cont…

6 Iris - Iritis, Iris prolapse
Pupil - Fibrin Membrane , Pupilary capture Lens - Decentred IOL, Haptic in AC, Panophthalmitis

7 Late post-operative Ant. segment complications
Bullous Keratopathy Vitreous touch syndrome Vitreous wick syndrome Secondary Glaucoma - Angle closure Severe iritis, Pupillary block, Irisbombe, Peripheral anterior synechiae Cont…

8 Cortex Suture infiltration Iris Prolapse Uveitis
Open Angle Cortex Cells Blood Suture infiltration Iris Prolapse Uveitis Late post – op endophthalmitis

Cystoid macular edema (CME) Pseudophakic R.D PCO ( Posterior capsule opacifications) Dislocated IOL/ Decentered IOL Vitreous Haemorrhage Endophthalmitis

10 Swelling of the Lid Lid edema Causes : Treatment :
Injury with instruments Inflammation ( Iritis) Allergy to medications Treatment : Anti - Inflammatory drugs Steroids Anti histamines in case of allergy

11 Chemosis Congestion and collection of fluid Causes : Allergy
Subconjunctival Injections Iritis Endophthalmitis Treatment : Observation Anti Inflammatory drug

12 Subconjunctival Haemorrhage
Collection of blood beneath the conjunctiva Causes : Injury Retrobulbar Haemorrhage Hypertension Bleeding disorders Treatment : Observation Absorbs spontaneously – 2 -3 wks

13 Corneal Oedema Corneal Oedema
Increase in corneal thickness epithelial edema Causes: Increased IOP – 40 mmHg and more Iritis Descemets membrane stripping Endothelial damage Treatment: Timolol eyedrops Tab. Diamox Oral glycerol Injection Mannitol 20% Hypertonic Saline drops

14 Striate Keratitis Causes : Severe endothelium damage Tight suture
Treatment : Steroid eye drops Timolol eye drops Cycloplegic eye drops

15 Descemets Membrane Stripping
The stroma and thus allowing easy separation from stroma Causes: Entry in to the globe Faulty instrumentation Fluid is injected between the descemet’s membrane and stroma If small – Air Bubble left in anterior chamber If larger – Needs surgical repair

16 Epithelial defect Epithelial defect Rupture of epithelium
Predisposing Factors : Injury (Instrument, Pad / Cotton ) During anaesthesia eye is open Treatment : Only antibiotic ointment pad / bandage.

17 A.C Shallow Shallow Anterior Chamber Causes : Wound leak
Pupilary block Choroidal detachment Malignant glaucoma

18 Wound leak : Treatment : Size of the section is larger than the normal
Loose suture wound gape Trauma Inadequate and improper suturing of the wound Treatment : Pressure pad / bandage / mydriatic If AC does not form within 24 – 48 hrs Needs AC reforming / resuturing

19 Pupilary Block Causes : AC IOL without PI Severe Iritis – 360 deg PS
Vitreous touching the PUPIL IOL capture Treatment : Inj. mannitol 20% Tab. diamox 1st Laser PI. If not possible Needs surgical PI.

20 Fibrin Membrane Appear as a dense fibrin net in pupillary area Causes:
Prolonged Irrigation with balance – salt solution Unsterile IOL Treatment: Antibiotic drops hourly Steriods drops hourly Cycloplegic drops TDS If needed oral steriods to be given (1mg /1kg)

21 Cortex Residual cortex Predisposing Conditions : Treatment :
Small pupil Pseudo exfoliation Diabetic mellitus Positive pressure during surgery PC rent Treatment : Small piece of loose cortex will get absorbed – steroids E/D Large clumps of cortex not getting absorbed – needs AC wash.

22 Bed rest, bandage both eyes.
Treatment : Bed rest, bandage both eyes. Steroid eye drops. Cycloplegic eye drops. Timolol eye drops. Tab. Diamox. Tab. Vit C. Observation for 2 days. If not responding needs AC wash.

23 Hypopyon Predisposing conditions : Complicated cat
Phacolytic / Phacomorphic glaucoma Infection. Treatment : Antibiotic Steroids Cycloplegic.

24 SYMPTOMS Pain , Redness , Defective vision.
Lid edema , conjunctival chemosis Corneal edema, corneal Infiltration AC cells, Hypopyon Infiltrate in suture / section Wound gape or weak wound.

25 TREATMENT: No steroids Topical antibiotics AC tap. Vit-tap Intravitreal antibiotics

26 IRITIS Inflammation of the iris. Flare and cells Fibrin membrane.
Treatment : Antibiotic drops hourly Steroids drops hourly Cycloplegic drops TDS If needed oral steroids to be given (1mg/1kg)

27 Iris Prolapse IRIS PROLAPSE Causes : Loose suture Wound gape Injury
Positive pressure. Treatment : Hourly antibiotic drops Iris prolapse excision and resuturing < 24 hrs – Reposition > 24 hrs – Excision.

28 HAPTIC IN AC : One Haptic in AC Treatment : IOL reposition ( or ) Redialing

29 (Dreadful complication, follows infection )
ENDOPHALMITIS (Dreadful complication, follows infection ) Sources: Contamination in O.T (Staffs & Instruments) Patients Lids and conjunctival poor hygiene.

30 TREATMENT: No steroids Topical antibiotics AC tap. Vit - tap Intravitreal antibiotics Anti inflammatory drug

31 RISK FACTOR : Poor hygiene Immune suppressed patient Debilatet patient - (diabetic, cancer & weak ) Suture abscess or suture removal

32 ORGANISMS : Bacteria Fungal Staphylococcus Aspergillus Staphylococcus Candida Streptococcus Fusarium Pseudomonas



Similar presentations

Ads by Google