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ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute.

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Presentation on theme: "ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute."— Presentation transcript:

1 ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology DEPARTMENT OF INPATIENT POST OPERATIVE COMPLICATION

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

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

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

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

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

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

8  Open Angle CortexCellsBlood Suture infiltration Suture infiltration Iris Prolapse Iris Prolapse Uveitis Uveitis Late post – op endophthalmitis Late post – op endophthalmitis

9 Cystoid macular edema (CME)Cystoid macular edema (CME) Pseudophakic R.DPseudophakic R.D PCO ( Posterior capsule opacifications)PCO ( Posterior capsule opacifications) Dislocated IOL/ Decentered IOLDislocated IOL/ Decentered IOL Vitreous HaemorrhageVitreous Haemorrhage EndophthalmitisEndophthalmitis POSTERIOR SEGMENT COMPLICATIONS

10 Lid edema Swelling of the Lid Swelling of the Lid Causes :  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  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 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  Rupture of epithelium Predisposing Factors :  Injury (Instrument, Pad / Cotton )  During anaesthesia eye is open Treatment :  Only antibiotic ointment pad / bandage. pad / bandage.

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

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

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

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

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

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

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

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

29 ENDOPHALMITIS (Dreadful complication, follows infection ) (Dreadful complication, follows infection )Sources:  Contamination in O.T (Staffs & Instruments) (Staffs & Instruments)  Patients Lids and conjunctival poor hygiene. 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 : ORGANISMS : Bacteria FungalBacteria Fungal Staphylococcus AspergillusStaphylococcus Aspergillus Staphylococcus CandidaStaphylococcus Candida Streptococcus FusariumStreptococcus Fusarium PseudomonasPseudomonas

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