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Similar a Selected Ocular Disorders & Procedures
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Más de John R. Martinelli, MD, OD
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Selected Ocular Disorders & Procedures
- 1. Common Ocular Conditions Diagnosis & Treatment John R. Martinelli, OD, FAAO SGUSOM Term 3/4
- 2. U.S. Stats (2008) Physicians & Surgeons: 661,400 Dentists: 141,900 Optometrists: 34,800 Ophthalmologists: 15,000 U.S. Bureau of Labor Statistics | Office of Occupational Statistics and Employment Projections, PSB Suite 2135, 2 Massachusetts Avenue, NE Washington, DC 20212-0001 www.bls.gov/OCO | Telephone: 1-202-691-5700 | Contact OCO
- 3. Corneal Abrasion - Dx VA 1st!!! Pain? Unilateral? History? Stain?
- 4. Corneal Abrasion – Tx 1-2gtts Proparacaine 1-2gtts Homatropine 5% Bandage CL vs. Pressure Patch Topical Antibiotic TID Fluroquinolone Topical NSAID TID (PRN) Keterolac PO Analgesic?
- 5. Corneal Foreign Body - Dx VA 1st!!! Pain? Unilateral? History? Inspection Cornea Lid Eversion Retroilluminate Stain
- 6. Corneal Foreign Body - Tx 1-2gtts Proparacaine 1-2gtts Homatropine 5% BSS Irrigation Cotton Swab? 22 gauge syringe/needle BCL Fluroquinolone TID NSAID TID (PRN) PO Analgesic? RTC 24 – 48 hrs & 1 wk
- 8. Corneal Foreign Body - Tx Rust Ring Can be Asymptomatic Monitor?
- 9. Conjunctival FB FB Tracking Conjunctival FB
- 10. Conjunctival FB – Cul-du-Sac
- 11. Important! REFER to Corneal Specialist if Central FB! NEVER patch if suspect infectious component! (-) Staining or Corneal Infiltrates present NEVER dispense or Rx a Topical Anesthetic! Hide – Px’s will steal! ONLY Rx minimum # Analgesic Tabs (if Narcotic) And…NEVER patch both eyes!
- 12. Cataract - Dx
- 13. Cataract - Variations Posterior Subcapsular Steroid, Diabetes, Trauma Cortical Sorbitol/Diabetes, Trauma Nuclear Age/UV Anterior Subcapsular Meds, Trauma, P. Synechia Epicapsular Congenital, P. Synechia
- 14. What will YOU actually see? Retro-Illumination Slit-Lamp
- 15. Posterior Subcapsular Cataract (PSC) Retro-Illumination Slit-Lamp
- 16. Cortical Cataract Retro-Illumination Slit-Lamp
- 17. Nuclear Cataract Retro-Illumination Slit-Lamp
- 18. Hope it’s a Cataract…
- 19. Cataract Surgery Phacoemulsification IOL Placement Coffee Blender & Vacuum Cleaner – All in One Temporal “Clear Corneal” Small Incision 12mm <-> 3mm! “N0 Stitch”
- 20. Phacoemulsification – aka “PHACO”
- 23. Intraocular Lenses (IOL) MANY Options! Materials PMMA Silicon Optics Aspheric HD Toric Multifocal ReZOOM ReSTOR
- 24. IOL Insertion & Placement How do we get this through a 3mm incision? VERY carefully! Make it a Taco!
- 25. IOL Insertion & Placement
- 26. IOL Insertion & Placement
- 27. “Complications” (ALL RARE) Subluxation of IOL Posterior Corneal Injury Corneal Decompensation/Rejection Endophthalmitis Phacoanaphalaxis Wound Leak Chronic Uveitis Secondary Ocular Hypertension -> Glaucoma Cystoid Macular Edema (CME) Retinal Detachment Induced Astigmatism Anisocoria Posterior Capsular Opacity
- 28. Post-Op Tx Topical Antibiotic QID Topical Steroid QID Topical NSAID Sun Protection F/U 1 Day, 1 Week, 3 Weeks Refraction @ ~ 3 Weeks YAG? > 1 month
- 30. Diabetic Retinopathy Normal Retina Background DR
- 31. Diabetic Retinopathy - Tx Proliferative DR PRP Tx
- 32. Diabetic Retinopathy - Tx Additional Tx CME Focal/Grid Laser Anti-VEGF injections Avastin Lucentis Anti-Inflammatory injections Steroid Injection Kenalog
- 33. Age-Related Macular Degeneration Dry AMD Wet AMD
- 34. AMD Tx Dry vs Wet Grid Laser Tx Dry UV Protection/Sunglasses Nutrition Vitamin Tx Amsler Grid Monitor ≤ 6 mo. Wet Grid Laser Anti-VEGF injections Avastin Lucentis Anti-Inflammatory injections Kenalog
- 35. THANK YOU! Q&A