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DEPARTMENT OF INPATIENT

DEPARTMENT OF INPATIENT. POST OPERATIVE COMPLICATION. AIM. The MLOP shall identify the early post operative complications in the ward and shall help in the effective management of the same. Objectives. The MLOP shall

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DEPARTMENT OF INPATIENT

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  1. DEPARTMENT OF INPATIENT POST OPERATIVE COMPLICATION

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

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

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

  10. Lid edema 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 -3wks

  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 : • 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. • 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. 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 : • BacteriaFungal • Staphylococcus Aspergillus • Staphylococcus Candida • Streptococcus Fusarium • Pseudomonas

  33. THANK YOU

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