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Ocular surgeries BY DR GEORGE DEOGRATIAS

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Ocular surgeries BY DR GEORGE DEOGRATIAS

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Beschreibung

PREPARED BE DR GEORGE DEOGRATIAS FROM TANZANIA

Transkript

  1. 1. OCULAR SURGERIES Prepared by George deogratias MD5 student. Archbishop James university college the constitute of st.augustine university of Tanzania. (biziriko1991@gmail.com) +255656592079
  2. 2. SURGICAL PROCEDURES • EVISCERATION • ENUCLEATION • EXENTERATION
  3. 3. EVISCERATION • Removal of the contents of the globe leaves the sclera ,fat,EOM, and other adjacent structures of the eye intact and sometimes the cornea in place.
  4. 4. CONT… INDICATIONS • Pan ophthalmitis, Endophthalmitis • Penetrating ocular trauma • Blind, painful eye • Expulsive Choroidal hemorrhage • Bleeding Anterior Staphyloma
  5. 5. CONT… Contraindications • Known or suspected intraocular malignancy Relative Contraindications • Phthisis bulbi • Microphthalmia
  6. 6. CONT… Surgical Technique • A 360-degree conjunctival peritomy is then made at the • limbus utilizing Wescott scissors undermine the conjunctiva and Tenon’s capsule • A full-thickness incision is then made at the limbus so that scissors may be introduced to excise the cornea in a circumferential manner. • All intraocular contents, including uveal tract, crystalline lens,
  7. 7. CONT… • vitreous humor, and retina are then removed by using an • evisceration spoon, spatula, suction. • • These contents are sent for histopathologic examination. • • Sclera is swabbed with Absolute Alcohol to denature adherent • uveal remnants and irrigated properly to remove alcohol • • Hemostasis of the nerve and vortex veins may then • be achieved with cautery and direct pressure.
  8. 8. CONT… • In some cases, a posterior sclerotomy or radial scleral relaxing incisions to allow for a larger implant to be placed. • The best implant size to restore orbital volume is selected while ensuring appropriate position. • Implant material is made of different materials like
  9. 9. CONT… • acrylic, PMMA, silicone, and hydroxyapatite. • • The implant may be placed directly into the scleral shell • • The anterior sclera, Tenon’s capsule, and conjunctiva is then • carefully closed in a layered approach before placement of a conformer.
  10. 10. CONT… • Sclera is sutured with interrupted 6-0 Vicryl • Conjunctiva with running mattress 6-0 Vicryl • A temporary tarsorrhaphy may be performed to help the • conformer remain in place to maintain the fornices till • prosthesis can be placed
  11. 11. CONT… • ADVADVANTAGES OF EVISCERATION OVER ENUCLEATION • 1. Shorter operative time • 2. More cost efficient • 3. A technically simpler procedure • 4. A less invasive procedure (important in cases when GA is • contraindicated or in bleeding disorders)
  12. 12. CONT… 5. Less disruption of orbital tissues – chance of injury to EOM ,nerves and fat atrophy is reduced – Relationships between the muscles, globe, eyelids, and fornices remain undisturbed – Less chance of spread of infection to nervous system 6. Less painful 7. Better cosmetic 8. Good motility of the prosthesis- EOM remain attached to the sclera
  13. 13. CONT… 9.Lower rate of migration, extrusion, reoperation and socket complications 10.Preferred by some surgeons in cases of endophthalmitis as drainage of the ocular contents can be done without invasion of the orbit. • The chance of contamination of the orbit with orbital cellulitis or intracranial extension is therefore theoretically reduced.NTAGES
  14. 14. CONT… Complications • Retrobulbar hemorrhage • Orbital edema • Dissemination of unexpected intraocular neoplasm • Extrusion of implant
  15. 15. CONT… Disadvantages of Evisceration over Enucleation • Risk of sympathetic ophthalmia • Risk of dissemination of intraocular tumors • Offers a less complete specimen for pathologic examinations.
  16. 16. ENUCLEATION • A surgical procedure that involves removal of the entire globe and its contents. • all other periorbital and orbital structures including parts of EOM and orbital fat preserved.
  17. 17. CONT… Indications • Eye donation • Intraocular malignancy or high suspicion for intraocular malignancy (most commonly uveal melanoma and retinoblastoma) • Trauma • Blind, painful eye
  18. 18. • Sympathetic ophthalmia • Microphthalmia • Phthisis bulbi • Endophthalmitis • Cosmetic deformity
  19. 19. CONT…  Advantages • Enucleation allows for histologic examination of an intact globe and optic nerve. • This is important in biopsy of proven or suspected intraocular malignancy, where it is essential to determine the margins of the malignancy and invasion of the optic nerve, if any. • Enucleation classically has been thought to decrease the risk of sympathetic ophthalmia as it avoids exposure to uveal antigens that may occur during an evisceration.
  20. 20. CONT… Disadvantages • A reduction in implant motility is often noted in enucleation.
  21. 21. EXENTRATION • A surgical procedure involving removal of the entire globe and its surrounding structures including muscles, fat, nerves, and eyelids (extent determined by disease being treated) • The goal is to remove all lesions along with appropriate margins of adjacent tissue while retaining as much healthy tissue as possible. • The technique selected depends on the pathologic process.
  22. 22. Varieties of orbital exenteration  Subtotal : • The eye and adjacent intraorbital tissues are removed such • that the lesion is locally excised (leaving the periorbita and • part or all of the eyelids). • This technique is used for some locally invasive tumors, for • debulking of disseminated tumors, or for partial treatment in selected patients.  Total: • All intraorbital soft tissues, including periorbita, are removed, with or without the skin of the eyelids.  Extended: • All intraorbital soft tissues are removed, together with • adjacent structures(usually bony walls and sinuses).
  23. 23.  Indications • Orbital malignancies Cutaneous tumours with orbital adnexa invasion including squamous cell carcinoma, basal cell carcinoma, and sebaceous cell carcinoma.Less common tumors include conjunctival malignant melanoma, adenoid cystic carcinoma of the lacrimal gland, and uveal melanoma with extrascleral extension,Intraocular melanomas or retinoblastomas • Painful or life-threatening orbital infections • Mucormycosis • Chronic orbital pain • Orbital deformities
  24. 24. COMPLICATIONS Intraoperative • Removal of the wrong eye • Damage to or loss of extra ocular muscles • Hemorrhage • Fracture of thin ethmoid bones during the surgery, leading to an opening between the orbit and the nasal cavity.
  25. 25. Postoperative • Infection • Hemorrhage • Wound dehiscence • Extrusion of the conformer • Contraction of the fornices • Exposure of the implant. • Sloughing of the skin graft. • Sino orbital fistula
  26. 26. AHSANTENI SANA

Beschreibung

PREPARED BE DR GEORGE DEOGRATIAS FROM TANZANIA

Transkript

  1. 1. OCULAR SURGERIES Prepared by George deogratias MD5 student. Archbishop James university college the constitute of st.augustine university of Tanzania. (biziriko1991@gmail.com) +255656592079
  2. 2. SURGICAL PROCEDURES • EVISCERATION • ENUCLEATION • EXENTERATION
  3. 3. EVISCERATION • Removal of the contents of the globe leaves the sclera ,fat,EOM, and other adjacent structures of the eye intact and sometimes the cornea in place.
  4. 4. CONT… INDICATIONS • Pan ophthalmitis, Endophthalmitis • Penetrating ocular trauma • Blind, painful eye • Expulsive Choroidal hemorrhage • Bleeding Anterior Staphyloma
  5. 5. CONT… Contraindications • Known or suspected intraocular malignancy Relative Contraindications • Phthisis bulbi • Microphthalmia
  6. 6. CONT… Surgical Technique • A 360-degree conjunctival peritomy is then made at the • limbus utilizing Wescott scissors undermine the conjunctiva and Tenon’s capsule • A full-thickness incision is then made at the limbus so that scissors may be introduced to excise the cornea in a circumferential manner. • All intraocular contents, including uveal tract, crystalline lens,
  7. 7. CONT… • vitreous humor, and retina are then removed by using an • evisceration spoon, spatula, suction. • • These contents are sent for histopathologic examination. • • Sclera is swabbed with Absolute Alcohol to denature adherent • uveal remnants and irrigated properly to remove alcohol • • Hemostasis of the nerve and vortex veins may then • be achieved with cautery and direct pressure.
  8. 8. CONT… • In some cases, a posterior sclerotomy or radial scleral relaxing incisions to allow for a larger implant to be placed. • The best implant size to restore orbital volume is selected while ensuring appropriate position. • Implant material is made of different materials like
  9. 9. CONT… • acrylic, PMMA, silicone, and hydroxyapatite. • • The implant may be placed directly into the scleral shell • • The anterior sclera, Tenon’s capsule, and conjunctiva is then • carefully closed in a layered approach before placement of a conformer.
  10. 10. CONT… • Sclera is sutured with interrupted 6-0 Vicryl • Conjunctiva with running mattress 6-0 Vicryl • A temporary tarsorrhaphy may be performed to help the • conformer remain in place to maintain the fornices till • prosthesis can be placed
  11. 11. CONT… • ADVADVANTAGES OF EVISCERATION OVER ENUCLEATION • 1. Shorter operative time • 2. More cost efficient • 3. A technically simpler procedure • 4. A less invasive procedure (important in cases when GA is • contraindicated or in bleeding disorders)
  12. 12. CONT… 5. Less disruption of orbital tissues – chance of injury to EOM ,nerves and fat atrophy is reduced – Relationships between the muscles, globe, eyelids, and fornices remain undisturbed – Less chance of spread of infection to nervous system 6. Less painful 7. Better cosmetic 8. Good motility of the prosthesis- EOM remain attached to the sclera
  13. 13. CONT… 9.Lower rate of migration, extrusion, reoperation and socket complications 10.Preferred by some surgeons in cases of endophthalmitis as drainage of the ocular contents can be done without invasion of the orbit. • The chance of contamination of the orbit with orbital cellulitis or intracranial extension is therefore theoretically reduced.NTAGES
  14. 14. CONT… Complications • Retrobulbar hemorrhage • Orbital edema • Dissemination of unexpected intraocular neoplasm • Extrusion of implant
  15. 15. CONT… Disadvantages of Evisceration over Enucleation • Risk of sympathetic ophthalmia • Risk of dissemination of intraocular tumors • Offers a less complete specimen for pathologic examinations.
  16. 16. ENUCLEATION • A surgical procedure that involves removal of the entire globe and its contents. • all other periorbital and orbital structures including parts of EOM and orbital fat preserved.
  17. 17. CONT… Indications • Eye donation • Intraocular malignancy or high suspicion for intraocular malignancy (most commonly uveal melanoma and retinoblastoma) • Trauma • Blind, painful eye
  18. 18. • Sympathetic ophthalmia • Microphthalmia • Phthisis bulbi • Endophthalmitis • Cosmetic deformity
  19. 19. CONT…  Advantages • Enucleation allows for histologic examination of an intact globe and optic nerve. • This is important in biopsy of proven or suspected intraocular malignancy, where it is essential to determine the margins of the malignancy and invasion of the optic nerve, if any. • Enucleation classically has been thought to decrease the risk of sympathetic ophthalmia as it avoids exposure to uveal antigens that may occur during an evisceration.
  20. 20. CONT… Disadvantages • A reduction in implant motility is often noted in enucleation.
  21. 21. EXENTRATION • A surgical procedure involving removal of the entire globe and its surrounding structures including muscles, fat, nerves, and eyelids (extent determined by disease being treated) • The goal is to remove all lesions along with appropriate margins of adjacent tissue while retaining as much healthy tissue as possible. • The technique selected depends on the pathologic process.
  22. 22. Varieties of orbital exenteration  Subtotal : • The eye and adjacent intraorbital tissues are removed such • that the lesion is locally excised (leaving the periorbita and • part or all of the eyelids). • This technique is used for some locally invasive tumors, for • debulking of disseminated tumors, or for partial treatment in selected patients.  Total: • All intraorbital soft tissues, including periorbita, are removed, with or without the skin of the eyelids.  Extended: • All intraorbital soft tissues are removed, together with • adjacent structures(usually bony walls and sinuses).
  23. 23.  Indications • Orbital malignancies Cutaneous tumours with orbital adnexa invasion including squamous cell carcinoma, basal cell carcinoma, and sebaceous cell carcinoma.Less common tumors include conjunctival malignant melanoma, adenoid cystic carcinoma of the lacrimal gland, and uveal melanoma with extrascleral extension,Intraocular melanomas or retinoblastomas • Painful or life-threatening orbital infections • Mucormycosis • Chronic orbital pain • Orbital deformities
  24. 24. COMPLICATIONS Intraoperative • Removal of the wrong eye • Damage to or loss of extra ocular muscles • Hemorrhage • Fracture of thin ethmoid bones during the surgery, leading to an opening between the orbit and the nasal cavity.
  25. 25. Postoperative • Infection • Hemorrhage • Wound dehiscence • Extrusion of the conformer • Contraction of the fornices • Exposure of the implant. • Sloughing of the skin graft. • Sino orbital fistula
  26. 26. AHSANTENI SANA

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