Shekhar eye care and Laser centre

06/10/2023

https://youtu.be/qCbCDk5ENyY?si=qs2xnqwONiwUhYe-

My surgical video of phaco with BANG surgery

Another option for cataract patients who also have glaucoma is to perform a form of MIGS where we are performing a procedure in the angle of the eye with vis...

28/04/2023

In any ophthalmological examination it is not considered complete without indirect ophthalmological examination. Usually after slit lamp examination in routine

15/12/2022

02/12/2022

Humphrey field analyser or visual field test

It is an important tool in ophthalmology. It asses the functional quality and quantity of vision or field of vision.

A normal human eye can see upto 90 degree temporaly ( I.e laterally outside ), upto 50 degrees superiorly and nasally and upto 60 degrees inferiorly.

In glaucoma the optic nerve damage is damaged gradually and progressively due the raised intraocular pressure or poor perfusion or nutrition to optic nerves. The damage to the optic nerve fibre occurs to the peripheral portions of the nerve first. So accordingly the loss of vision in glaucoma happens to the peripheral portion first which leads to shrinkage of field of vision.

As the damage of peripheral field of vision happens first the patient is unable to pick it up. This test help to pick up the loss of peripheral field of vision. So it's very important test for early detection of glaucoma.
Other tests like OCT RNFL or ganglion cell density also help in supporting the diagnosis.

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02/12/2022

Shekhar eye care and laser centre serving patients of various eye disorders for last 12 years. Our journey started from small clinic in rajabazar , near magal market in 2010.
We are great full to our patients for their continuous support and love.
Now we have almost all facilities at our starting from cataract, cornea - keratoplasty, surgical and medical retina,occuloplasty and glaucoma.

10/11/2022

Smart toric IOLs
These IOL s are customised according to the cylindrical axis in patient eye.
Higher cylindrical power for which readymade toric are not available in market. Really sometimes feel proud of Indian companies like care group who have made these IOL available in our basket.
In these IOLs the lens need to be implanted and put at 180 degree .

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04/11/2022

विजन चार्ट:

जब भी आप किसी आंखो के डॉक्टर के पास जाएं होंगे तो आपको विजन चार्ट देखने को मिलता है। विजन चार्ट पर कई तरह के अक्षर बड़े और क्रमश छोटे आकार के अक्षर होते है। इस चार्ट की मदद के आपके आंखो की रोशनी की जांच की जाती है।

आपके नजर जांच करने के बाद आपके नजर को ६/६ ,६/९, ६/१२ इत्यादि जैसे पैमाने पर दर्शाया जाता है।
क्या आप जानते है ये ६/६ या ६/१२ क्या दर्शाता है?
६/१२ में पहला अक्षर दर्शाता है कि आप कितने दूर से उस चार्ट को पढ़ रहे है और बाद वाला अंक दर्शाता है कि उस लाइन के अक्षर को १२ मीटर की दूरी से भी एक नॉर्मल माना जाने वाला इंसान पढ़ सकता है पर आपने उसे ६ मीटर की दूरी से पढ़ा है।
६/६ की नजर को नॉर्मल माना जाता है । बाद वाला अंक जितना ज्यादा होगा आपकी नजर उतनी ही कमजोर मानी जायेगी। उद्धरण के लिए ६/६० की नजर ६/२४ से कमजोर होगी।

आधुनिक काल में कोई जरूरी नहीं की आपको चार्ट ६ मीटर की दूरी से ही पढ़ने को मिले । कंप्यूटर के इस्तेमाल के कारण ये दूरी ३ या २ मीटर भी हो सकती है। नजर को कभी कभी २०/२० ,२०/३० जैसे भी मापा जाता है , जिसमे २०/२० के नजर को नॉर्मल माना जाता है।

म्योपिया में आपकी नजर दूर के लिए काम होती है और हाइपरोपिया में आपको दूर और नजदीक दोनो देखने में तकलीफ होती है। Presbyopia ४० वर्ष के बाद लोगो में नजदीक डेकने की परेशानी को बोलते है।

03/11/2022

A case of serous PED in 68 year ,male, showed good results post- injection of anti-VEGF molecules. The injections used in this particular case was Indian biosimilar , it gave equivalent results compared to original molecule in this case.

29/10/2022

मोतियाबिंद ऑपरेशन के बाद लगने वाले लेंस

मोतियाबिंद के ऑपरेशन में आंखो में प्राकृतिक रूप से पाए जाने वाले लेंस जो की मोतियाबिंद होने से खराब अथवा अपारदर्शी हो जाता है उसे निकाल कर कृत्रिम पारदर्शी लेंस ( IOL) उसके स्थान पर लगाया जाता है।
यह लेंस मुख्यत: दो प्रकार के होते है :
१) Rigid IOL जो सख्त होते है और बड़े चीरे के द्वारा आंखो में डाले जाते है ।
चूंकि इन लेंस को डालने के लिए बड़े चीरे की आवश्यकता होती है , आपरेशन के बाद बड़े चीरे को भरने में समय लग सकता है, इन्फेक्शन होने की संभावना ज्यादा रहती है, और ऑपरेशन के बाद asigmatism यानी कि सिलेंड्रिकल पावर के आने की ज्यादा संभावना रहती है।

Rigid IOL मुख्यतः ECCE या SICS सर्जरी के बाद डाला जाता है।

२) फोल्डेबल IOL : Pahcoemulsification सर्जरी आने के बाद से फोल्डेबल IOL का चलन काफी बढ़ गया है। ये लेंस आसानी से मुड़ जाती है और छोटे चीरे से आंखो के अंदर डाला जा सकता है।
Phacoemulsifcation या फेको सर्जरी में चीरे का साइज १.८ मिलीमीटर से २.८ मिलीमीटर तक होता है। ये चीरे इतने छोटे होने के कारण ऑपरेशन के बाद घाव जल्दी भर जाता है, इन्फेक्शन की संभावना कम हो जाती है तथा asigmatism भी बहुत ही कम रहता है।

फोल्डेबल IOL ke प्रकार :
i) Monofocal ( मोनोफोकल) लेंस: जैसा कि नाम से ही पता चल रहा है मोनोफॉकल लेंस से एक जगह पर ही अच्छे से फोकस हो पता है। यदि दूर की दृष्टि अच्छी हो जाती है तो मरीज को नजदीक के लिए चश्में की आवश्यकता होती है और यदि नजदीक की दृष्टि अच्छी होती है तो दूर के लिए चश्में की आवश्यकता होती है।
ii) मल्टीफोकल या बाइफोकल लेंस : इन लेंस से दूर और नजदीक दोनो दृष्टि साफ दिखती है। इन लेंस में diffractive रिंग्स अथवा रिफ्रेक्टिव रिंग्स का इस्तेमाल लाइट को नजदीक फोकस करने के लिए किया जाता है। इन रिंग्स के चलते इन लेंस में कुछ मरीजों को चमक या सप्तरंगी गोला प्रकाश के साथ दिखता है। उन्हें कार ड्राइव करने में परेशानी आ सकती है।

iii) Trifocals ( ट्राईफोकल ) लेंस : ट्राईफोकल लेंस से मरीज को दूर, नजदीक और इनरमीडिएट दूरी के वस्तु को ठीक से देखा जा सकता है।

iv) Extended depth of focus लेंस (EDOF) : EDOF लेंस से दूर तथा इंटरमीडिएट दूरी ( यानी एक हाथ की दूरी या कंप्यूटर / डेस्क टॉप की दूरी ,मतलब ३३ सेंटीमीटर की दूरी) पर साफ से दिखाई देता है। इन लेंस में मल्टीफॉकल या ट्राईफोकल लेंस की तरह डाइफ्रेक्टिव रिंग्स नही होते है इस लिए रिंग्स के चलते होने वाली चमक और सप्तरंगी गोला नही के बराबर दिखता है।


iv) Toric ( टोरिक) IOL : कुछ लोगो के कॉर्निया में astigmatism या सिलेंड्रकल पावर होता है। ऐसे मरीज में सर्जरी के बाद toric टोरिक लेंस लगाया जाता है । इस लेंस के वजह से astigmatism को कम करने में सफलता मिलती है। Astigmatism ठीक होने के दृष्टि की क्वालिटी बहुत अच्छी हो जाती है।

टॉरिक लेंस मोनोफोकल, मल्टीफोकल ,ट्राईफोकल और EDOF सभी प्रकार के लेंस में उपलब्ध होता है।

11/10/2022

Intravitreal injection of anti- vascular endothelial growth factor has now become a routine treatment modality for Neo-vascular AMD , diabetic macular edema and vascular occlusion involving macula.

All anti- vascular endothelial growth factor injection are aimed to reduce the intravitreal concentration of vascular endothelial growth factor (VGEF). VEGF is the main culprit molecule with is responsible for retinal edema and abnormal growth of blood vessels in the retina.

Injection of anti-VEGF is a simple 2 minutes procedure. It can be done as a OPD or indoor procedure.

First the eyes are anesthetized with topical drops like proparacaine . Once the eye become numb then the drug is injected in eyes taking all sterile precautions. Usually there are no complications except minor subconjuctival hemorrhage wich usually subside by 2 weeks.
Patients are advised to avoid taking head bath for 10 days after the procedure.

Usually the injections are repeated at interval of 4 - 6 weeks . The number of injection depends on the response,so, regular follow up is what is most important in such cases.

Commonly available anti-VEGF are - bevacezumab , ranibizumab, aflibercept .
Some of new arrivals with promising results are brolucizumab. In case of aflibercept and brolucizumab repeat injections are required after gap of 12 weeks.

Port delivery system PDS are also in phase of development where continuous delivery of drug is tried to maintain adequate level of drug in vitreous for longer duration preferably for more than a year.

Intravitreal drug delivery has become the gold standard for treatment of many retinal diseases, including neovascular age-related macular degeneration (AMD),...

11/10/2022

Intravitreal injection of anti- vascular endothelial growth factor has now become a routine treatment modality for Neo-vascular AMD , diabetic macular edema and vascular occlusion involving macula.

All anti- vascular endothelial growth factor injection are aimed to reduce the intravitreal concentration of vascular endothelial growth factor (VGEF). VEGF is the main culprit molecule with is responsible for retinal edema and abnormal growth of blood vessels in the retina.

Injection of anti-VEGF is a simple 2 minutes procedure. It can be done as a OPD or indoor procedure.

First the eyes are anesthetized with topical drops like proparacaine . Once the eye become numb then the drug is injected in eyes taking all sterile precautions. Usually there are no complications except minor subconjuctival hemorrhage wich usually subside by 2 weeks.
Patients are advised to avoid taking head bath for 10 days after the procedure.

Usually the injections are repeated at interval of 4 - 6 weeks . The number of injection depends on the response,so, regular follow up is what is most important in such cases.

Commonly available anti-VEGF are - bevacezumab , ranibizumab, aflibercept .
Some of new arrivals with promising results are brolucizumab. In case of aflibercept and brolucizumab repeat injections are required after gap of 12 weeks.

Port delivery system PDS are also in phase of development where continuous delivery of drug is tried to maintain adequate level of drug in vitreous for longer duration preferably for more than a year.

07/10/2022

Solar Retinopathy

Solar retinopathy is a condition where the outer retina of our eye get damaged due to directly gazing sun during eclipse. As during the eclipse time there is darkness and sunlight comes after a period of darkness. During the dark phase our pupil remain in dialated state. As we gaze sunlight after dark phase during eclipse the light gets directly focussed over fovea ( the central part of retina which is responsible for maximum vision) and damages it.

So it is not advisable to view sun directly after eclipse. We should always take necessary precautions for sun viewing.

Below is an OCT scan - where the outer retinal tissue damage due to photo chemical reactions after solar eclipse is visible.

Usually there is some visual recovery within 3 - 6 months but usually there is incomplete recovery. The amount of recovery depends on the amount of damage.

Similar injury to retina can occur after viewings welding arch, so , we should be cautious during such situations also.

20/09/2022

Posterior polar look-alike cataract -
This is a case where on gross appearance the cataract looked like posterior polar cataract.
So care wer taken which normally we take for such cataract .
1) No hydro-dissection was done. BUT hydro-delineation was done and a beautiful golden ring was obtained.

2) During phacoemulsification the central neucleus was first chopped into a small pie and the other piece was removed out of bag with the help of suction -hold over the piece. As rotation of neucleus was avoided during hydro-procedure the phaco-suction was used to remove the piece out of bag.

3) Rest of procedures were as a routine. Shallowing of anterior chamber was avoided by filling viscoelastic in anterior chamber before removing phaco-tip.

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16/09/2022

Corneal Perforation

The anterior part of the eye which looks black in colour is called cornea. Cornea is the first surface through which light enters our eye and it passes through lens and finally image is formed over the sensory portion at the back of eyeball called retina.

Maximum refraction of light happens at cornea. So, for vision of any individual it plays very important role. Nature has also created eyelids and prominent forehead and cheek bone to protect it.

But sometimes during road traffic accident or during child play with sharp pointed object cornea get damaged. In this case child wae playing with sharp object and injured his brother's eye with it. The injured child was of 3 and half year old, so, surgery was performed under general anaesthesia on urgent basis.

Here in this video it shown how such perforated cornea should be repaired. 1) The sutures should be perpendicular to the line of perforation. 2) the sutures should align tissue
3) Iris tissue should not be included in the wound 4) Debris and the membrane formed over the iris tissue should be meticulously removed 5) Cutting and removing iris tissue should be avoided as much as possible 6) Side port entry should be made in such cases - it will be helpful in anterior chamber formation. 7) All sutures should be burried 8 ) At the end anterior chamber should be formed and it should be checked for leakage of air.

In post operative phase suture removal should be planned after 8 to 10 weeks and if possible visual rehabilitation should be done. Scleral contact lense would be specially helpful in such cases.

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15/09/2022

Retinal detachment is a condition where the image forming portion in back of our eye get detached from it normal position. This condition is a surgical emergency in eye department. Surgical reattached is planned as soon as possible. Retinal detachment is more common in patients having pre-existing weakness in retina which is usually associated with myopia , trauma etc.

There is no medical treatment for retinal detachment. Few conditions like exudative retinal detachment which are as a result of very rare disease of eye like VKH, Posterior uveitis or scleritis are only medically treatable. BUT most commonly rhegmatogenous retinal detachment occurs and urgent surgery is the only treatment option.

As seen in the video the given patient had HST ( horse shoe tear) and also lattice associated HST. Vitreous is removed meticulously from the eye. All tears and lattice are lasers and silicon oil is put in the eye to keep the retina attached.

After surgery patient is asked to lie in prone position till 1-2 weeks. He is prescribed some medications and kept in follow up.
In regular follow up retinal examination is done and IOP monitoring is laso done on regular basis. The silicon oil is removed from eye after 6weeks to 12 weeks.

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