1. Special therapies in
Ophthalmology
Gauri S. Shrestha, M.Optom, FIACLE
Lecturer

2. What are they?
 Optical
 Medical
 Surgical
 Laser
 Cryotherapy
 Vision therapy

3. Optical therapy
 Refractive errors
 Hypermetropia
 (long sightedness)
 Light rays coming from infinity
is focused behind the retina
when accommodation is at rest
 Myopia
 (short sightedness)
 Light rays coming from infinity
is focused in front of the retina
when accommodation is at rest

4. Optical therapy
 Refractive errors
 Astigmatism
 Refraction varies in different
meridians
 The rays of light entering in
the eye can not converge to a
point focus

5. Optical therapy
 Anomalies of accommodation
 Paralysis of accommodation
 Presbyopia
 Physiological insufficiency of accommodation
 Normal phenomenon according to age
 Insufficiency of accommodation
 Abnormal insufficiency of accommodation

6. Optical therapy
 Strabismus
 Accommodative esotropia
 Esotropia caused by
excessive abnormal
accommodation
 Esotropia more at near than
distance
 Intermittent exotropia
 Extotropia manifests at
certain point of time only

7. Optical therapy
 Amblyopia
 Reduction of vision in one or both eyes without
with out obvious pathological cause and vision
can’t be restored to normal by any optical,
medical and surgical therapy
 Occupational optics
 Protect the eye from hazard or external
environment

8. Identify the anomalies

9. Optical therapy
 Method of
correction
 Spectacle glass
 Contact lenses
 Laser refractive
therapy

10. Optical therapy
 Method of
correction
 Intra corneal ring
 Phakic IOL
 Corneal refractive
therapy

11. What are they?
 Optical
Medical
 Surgical
 Laser
 Cryotherapy
 Vision therapy

12. Ocular pharmacotherapy
 four methods of
delivery
A. Topical instillation in
to conjunctival sac
B. Periocular injection,
C. Intraocular injection
D. Systemic
administration

13. A. Topical instillation in to conjunctival
sac
 Administered in the form of
 Eye drops
 Specially day time use
 Immediate action
 Ointments
 Increase bioavailability of the drug
 Prevent dilution and quick absorption
 Bed time use
 Gels
 Prolong contact time

14. A. Topical instillation in to conjunctival
sac
 Ocuserts
 Form of system of drug delivery
through a membrane
 Release drug in constant rate
 Soft contact lens
 Deliver high concentration of drug
in emergency treatment

15. B. Periocular injection
 Subconjunctival injection
 Use to achieve high concentration of
drugs
 Penetrate large sized molecules
 Subtenon injection
 Prefer over subconjunctival
 Anterior subtenon is used to
administer steroids
 Posterior subtenons is used for
intermediate and posterior uveitis

16. B. Periocular injection
 Retrobulbar injection
 Deliver drug for optic neuritis,
papillitis, retorbulbar block
 Peribulbar injection
 now a days a frequent use as
anesthetic agents

17. C. Intraocular injection
 Made in desperate cases
 Intracameral injection
(anterior chambers)
 Intravtreal injection

18. D. Systemic administration
 Route
 Oral
 Intramuscular
 Intravenous
 Medicine should cross the blood aqueous
barrier
 Low molecular weight and lipid soluble
(sulphonamide) drugs readily penetrate the
barrier

19. What are they?
 Optical
 Medical
Surgical
 Laser
 Cryotherapy
 Vision therapy

20. Surgical therapy
 Surgery for lid
 Chalazion
 Chronic non-infective
granulomatous inflammation of
meibomian gland
 Ectropion
 Entropion
Tarsoraphy done
 Lagophthalmos
in Right eye
 Incomplete closure of eye lids
 Ptosis

21. Surgical therapy
 Surgery of conjunctiva
 Pterygium
 Conjuctival cysts
 Conjunctival dermoid
 symblepharon

22. Surgical therapy
 Cornea
 keratoplasty
 Refractive surgery
 Laser in situ keratomileusis
(LASIK)
 Sclera
 Staphyloma
 Scleral buckling

23. Surgical therapy
 Surgery for Uvea
 Melanoma of choroid, iris and
ciliary body
 A malignant tumour of melanocytes
 Hemangioma of choroid
 a malignant self-involuting tumour
of endothelial cells, lining blood
vessels

24. Surgical therapy
 Surgery for cataract
 Extra Capsular cataract extraction
with posterior capsular intraocular
lens implant (ECCE PC IOL)
 Small incision cataract surgery
(SICS)
 Phacoemulsification (Phaco)
 Surgical Aphakia
 AC IOL

25. Surgical therapy
 Surgery for glaucoma
 Goniotomy
 a surgical procedure in which a
goniolens is used to see the
structures of anterior chamber
 An opening is made in the
trabecular meshwork located in
the drainage angle, where fluid
leaves the eye.
 Goniotomy is a surgery for
congenital glaucoma only

26. Surgical therapy
 Surgery for glaucoma
 Trabeculotomy
 A surgical procedure in which a
piece of tissue in the eye’s
drainage angle is removed to
create an opening.
 This new opening allows fluid to
drain out of the eye
 Congenital glaucoma

27. Surgical therapy
 Surgery for glaucoma
 Peripheral iridectomy
 Treatment in ACG and
prophylaxis in fellow eye
 A procedure in which a
small section of peripheral
iris is excised through a
limbal incision
 Neodynium:YAG and/or
argon laser

28. Surgical therapy
 Surgery for glaucoma
 Filtration surgery (trabeculectomy)
 Partial thickness filtering surgery in which a new
channel is created around the margin of scleral
flap through which aqueous flows from Anterior
chamber into the subconjunctival space

29. Surgical therapy
 Surgery for vitreous
 Vitrectomy (vitreous
hemorrhage, and vitreous
opacity)
 Vitrectomy is a surgery to
remove some or all of the
vitreous humor from the eye

30. Surgical therapy
 Surgery for retina
 Sealing of retinal break (high myopia)
 photocoagulation
 Scleral buckling
 Procedure that can be used to repair a
retinal detachment
 Thin silicone band is used

31. Surgical therapy
 Surgery for retina
 Pars plana vitrectomy
 Procedure to remove clouded
vitreous with blood or vitreous opacities

32. Surgical therapy
 Strabismus and nystagmus
 Muscle weaking procedures
(recession, myotomy)
 Muscle strengthening procedure
(resection)
 Procedure that changes the
direction
 Surgery for dacryocystitis
 Dacryocystorhinostomy

33. What are they?
 Optical
 Medical
 Surgical
Laser
 Cryotherapy
 Vision therapy

34. Laser therapy
 Laser: light amplification by stimulated
emission of radiation
 a mechanism for emitting electromagnetic
radiation, via the process of stimulated emission
 Properties of laser
 Monochromatic
 Coherent
 No scattering

35. Production of laser beam
Gas/Liquid
filled
Semi-transparent +++++++++++++++++++++++
mirror
chamber
M M
M M
Opaque
M M M
Emission of laser mirror
------------
Release the excessive energy in the form of light
which is amplified to an appropriate wavelength

36. Lasers used in ophthalmology
Type Atomic environment Effect produced
Argon Argon gas photocoagulation
Krypton Krypton gas Photocoagulation
Diode Diode crystal Photocoagulation
Nd: YAG A liquid dry or a solid Photodisruption
compound of Yt-Al
garnet+neodymium,
Excimer Helium and fluorine Photoablation
Diode pumped Diode and Nd: YAG Photocoagulation
Nd YAG crystal

37. Lasers used in ophthalmology
 Definitions
 Photocoagulation: The coagulation (clotting) of tissue using
a laser which produces light in the visible green wavelength
that is selectively absorbed by hemoglobin, in order to seal
off bleeding blood vessels
 Photoablation: volatilization of tissue by ultraviolet rays
emitted by a laser for remodeling
 Photodisruption: exert a cutting incision upon the tissue by
laser application for breakage of layer of structure

38. Mechanism of laser effect and their
therapeutic applications
 Photocoagulation:
Raise temp of
Absorption of laser Conversion of
target tissue
light by tissues Light to heat
Denature and
Coagulate cellular
Treat ocular diseases by elements
Production of scar,
occlusion of vessels, Application
tissue atrophy Peripheral iridectomy
tissue contraction Argon laser trabeculoplasty
Pan retinal photocoagulation
Focal or grid retinal photocoagulation

39. Mechanism of laser effect and their
therapeutic applications
 Photodisruption
Produce the physical
Nd: YAG Ionize the electrons State of momentarily
laser of target tissue expanding pressure
Exert a cutting/ incision
Application effect upon the tissue
Capsulotomy
Membranectomy
phacolysis

40. Mechanism of laser effect and their
therapeutic applications
 Photoablation
Exited dimer laser Break chemical bonds
(Excimer laser) of biological materials
UV 192nm
Convert them into small
Tissue modeling molecules that diffuse away
Application
PRK
LASIK
PTK

41. What are they?
 Optical
 Medical
 Surgical
 Laser
Cryotherapy
 Vision therapy

42. Cryotherapy in Ophthalmology
 Cryopexy means to produce tissue injury by
application of intense cold (-40º to 100 ºC)
 Cryounit uses freon, nitrous oxide or carbon
dioxide gas as a cooling agent
 Its goal is to decrease cellular metabolism, increase
cellular survival, decrease inflammation, decrease
pain and spasm, promote vasoconstriction, and
when using extreme temperatures, to destroy cells
by crystallizing the cytosol

43. Cryotherapy in Ophthalmology
 Mode of action
 Therapeutic effect by tissue necrosis (tumor)
 Adhesion of tissues (seal retinal and choroidal
detachment: cryopexy)
 Cryolysis of trichiasis
 Cryoextraction of lens

44. Thank you