ABOUT THE DISEASE
It is an inflammatory bowel disease (IBD) causing long lasting swelling and inflammation of the colon (large intestine). There are tiny ulcers and small abscesses in the colon and rectum that flare up periodically producing symptoms, with periods of remission in between. It is closely related to another condition of inflammation of the intestines called Crohn’s disease. But unlike Crohn’s disease, it does not affect the esophagus, stomach or small intestine. It is a disease that can last years to decades. Men and women are affected equally. It most commonly begins during adolescence and early adulthood.

Ulcerative Colitis:

SYMPTOMS
• Rectal bleeding
• Abdominal pain or cramping
• Diarrhea
• Fever
• Tiredness
• Weight loss
• Night sweats
• Rectal pain
• Feeling the immediate need to have a bowel movement -Rectal urgency
• Joint pain or swelling

CAUSES:

The exact cause of ulcerative colitis is unknown, but it is likely caused by an abnormal response of the immune system in the gastrointestinal tract to something in the gut — food or bacteria in the intestines, or even the lining of the bowel — that causes uncontrolled inflammation. Risk factors include a family history of ulcerative colitis.

DIAGNOSIS:

– Endoscopy, such as colonoscopy or proctosigmoidoscopy
– Blood tests
– Stool samples
– Barium X-ray
– Other X-ray procedures, such as magnetic resonance imaging (MRI), or computed tomography (CT scan).
Colonoscopy needs to be repeated after every 1-2 years just to rule out colon cancer as the chances for the same increase in patients suffering from IBD.

TREATMENT METHODS:

There is no cure for this disease, medicines / immunomodulators / corticosteroids are used to control the immune system and reduce the inflammation. Hospitalisation might be required after every serious attack.
Dietary restrictions – small helpings, proper water intake (spread throughout the day) and stress management go a long way in containing the disease.
Surgery to remove the entire large intestine (colectomy), or both the colon and rectum (proctocolectomy) removes the threat of colon cancer. Surgery is usually recommended if you have:
– Colitis that does not respond to complete medical therapy
– Changes in the lining of the colon that are thought to be precancerous
– Serious complications such as rupture (perforation) of the colon, severe bleeding (hemorrhage)
If the entire colon is removed, the operation may create an opening, or stoma, in the abdominal wall, to which a bag is attached (permanent ileostomy). The tip of the lower small intestine is brought through the stoma. Stools pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times.

PEDIATRIC RETINA SERVICE:

Pediatric Retina is a nascent subspecialty in Ophthalmology world over. Truly, it is Ophthalmology’s newest ‘baby’. In the current scenario in India today, this niche specialty is evolving and only a handful of institutes have awarded it the status of a stand-alone department.

Over half of the world’s blind children live in India alone. Approximately 24% of childhood blindness in India is attributable to retinal causes. Whereas cataract and malnutrition related blindness have received the attention of both governmental and non-governmental eye-care providers, retinal causes are not a priority issue. This is despite the fact that perhaps the most devastating causes of blindness stems from retinal diseases.
The growing numbers of premature infants surviving in India today have resulted in an epidemic rise of diseases such as Retinopathy of Prematurity (ROP).This needs urgent attention.

The key focus area of this service has been the KIDROP project. In addition, the department has active clinical and research projects in retinal vascular diseases, surgical retinal disorders of the infant retina and retinal imaging using high end OCT, FFA and ICG.

CLINICAL SERVICES:

Pediatric-Retina-Service3 Reaching the correct diagnosis is not always easy in pediatric retinal disorders. The department uses a combination of advanced imaging techniques using the RETCAM Shuttle (Clarity MSI, USA), electrophysiological testing (Electro-Retinogram and Visual Evoked Potential), India’s first hand held SD-OCT (Bioptigen) and a specially developed method to convert the Spectralis (Heidelberg) to perform multi-modal imaging to arrive at the appropriate diagnosis. Appropriate genetic and family counseling is administered in cases of inherited conditions while cases that would gain from surgical intervention are appropriately operated.

SURGICAL TREATMENT:

The department uses the latest micro-surgical instrumentation that makes advanced surgery for retinal detachment and other conditions in infants possible. Internationally trained surgeons perform surgical procedures using the latest techniques. The department is ably aided by an expert pediatric anesthesia team that is capable of providing safe and effective anesthetic care for infants only a few weeks old.

NEURO OPHTHALMOLOGY & ELECTROPHYSILOGY:

Neuro-ophthalmology is an ophthalmic subspeciality that addresses the relationship between the eye and the brain, specifically disorders of the optic nerve, orbit and brain associated with visual symptoms.

NEUROLOGICAL DISORDERS PRESENT WITH A VARIETY OF VISUAL SYMPTOMS INCLUDING:

1. Decrease in central vision.
2. Disorder of the visual field.
3. Double vision (seeing double due to misalignment of the eye with abnormal eye movements).
4. Abnormal drooping of the eyelids.
5. Severe headache, which may or may not be associated intermittent blurring of vision and vomiting.

The Neuro-ophthalmologists provide comprehensive clinical care to a broad spectrum of cases including optic neuritis, ischemic optic neuropathy, compressive optic neuropathy (including pituitary tumors), papilledema, inflammatory and infectious optic neuropathies, cerebrovascular disorder or tumors involving vision, ocular motor disorders (including cranial nerve palsies), hereditary and traumatic optic neuropathies and patients who have unexplained visual loss.

THE FACILITIES PROVIDED INCLUDE:

1. ELECTRORETINOGRAPHY (ERG).
2. MULTIFOCAL ERG
3. ELECTROOCULOGRAPHY (EOG)
4. VISUALLY EVOKED POTENTIAL (VEP)

What is Collagen Cross Linking?

Although many current treatments can improve vision in keratoconus, they do not treat the underlying cause of the corneal weakness and distortion i.e they do not stop the progression of keratoconus. Collagen cross linking with riboflavin (commonly known as C3R) is one such treatment modality which stops propressive weakening of the cornea that occurs in keratoconus.

The one hour C3-R treatment is performed in the hospital. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet A light(370nm). This amazingly simple process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In published European studies, such treatments were proven safe and effective in patients.

A pilot clinical study in humans evaluated the effect of the new cross-linking method in patients with keratoconus and showed that, in all treated eyes, progression of the condition was halted. To date there are over 700 patients with more than 5 years follow-up after cross-linking treatment and some eyes have been followed for 7 years with encouraging results.

HOW IS THE TREATMENT DONE?
The treatment involves removing the superficial layer (epithelium) from the surface of the cornea and then applying Riboflavin eye drops to the eye for 30 minutes. The eye is then exposed to UVA light for another 30 minutes. After the treatment, a bandage contact lens is worn for 1-3 days until the surface of the eye has healed. Antibiotic and steroid eye drops are also prescribed for a few weeks.

WHO CAN BENEFIT FROM THIS TREATMENT?
It is important to understand that collagen cross-linking treatment is not a cure for keratoconus. Rather, it aims to slow or even halt the progression of the condition. After the treatment, it is expected that it will continue to be necessary to wear spectacles or contact lenses (although a change in the prescription may be required). However, it is hoped that the treatment will prevent further deterioration in vision and the need for corneal transplantation.

Thus initially the treatment would be offered only to patients in whom there is clear evidence of progression of their keratoconus. A person whose keratoconus is already so bad that it cannot be corrected by contact lenses is unlikely to gain any benefit from this treatment. In this situation a corneal transplant is usually required.

WHAT ARE THE RISKS?
There are a number of potential risks associated with this treatment although very few complications have been reported so far.

Ultraviolet light is potentially harmful to the eye .However, the dose used is designed to prevent observable damage to the sensitive cells that line the back of the cornea (endothelium) or the other delicate structures within the eye eg lens and retina. No lens opacities (cataracts) have been attributed to this treatment in European trials.

The treatment involves the scraping away of the outer layer (skin or epithelium) of the cornea. There is therefore a risk that the surface of the cornea will be slow to heal. Infection may occur which could lead to the development of corneal scarring. Antibiotics are routinely used to prevent this complication. Corneal scarring might necessitate further surgical procedures (including corneal transplantation)though this is extremely rare.

OTHER LESSER BUT MORE COMMON RISKS INCLUDE:
Inability to wear contact lenses for several weeks after the treatment.
Changes in the shape of the cornea necessitating a refitting of a contact lens or a change in the spectacle correction.
As is the case with any experimental treatment, there may also be long-term risks that have not yet been identified.
The increased corneal rigidity induced by exposure to UVA and riboflavin may wear off over time and further periodic treatments may be required, raising the possibility of other side effects from repeat doses of the treatment.
A NEW FORM OF COMBINATION TREATMENT HAS BEEN INTRODUCED WHICH INVOLVES COLLAGEN CROSSLINKING AND INTACS AFTER 3-6 MONTHS. THIS TREATMENT IS KNOWN TO HALT THE PROGRESSION AND ALSO STABILIZES THE CORNEA.

The contact lens department at Narayana Nethralaya is well equipped to cater the requirements of all eye conditions.We provide basic and various speciality contact lenses. The basic contact lenses like Spherical soft lenses, Rigid Gas Permeable lenses and Toric lenses are available which can be given in patient’s who wish to avoid glasses due to cosmetic purpose or due to the profession itself. Also, the Cosmetic contact lenses, which enables one to enhance or change the eye colour are available with us.

The prosthetic Contact lenses, which can be used in patient’s who have corneal scarring(white spot) or abnormalities like loss of iris, large/ irregular pupil can be given these lenses which will mask the scars/other deformities at the same time will reduce glare and photophobia. The patient’s who require glasses for near and distance can be prescribed with Multi focal contact lenses, which will keep them free from glasses.

The patient’s who cannot tolerate RGP contact lenses, have an option of Hybrid lenses which provide comfort of Soft lens and vision clarity of RGP lens. We also have Refractive Surgery Specific(RSS) Contact lenses for patient’s who complaints of glare, distortions and ghosting of images/shadows after the refractive surgery. . Orthokeratology that uses contact lenses at night to provide a spectacle free day is also available with us.

The special focus of this department is on Keratoconus and all the currently available contact lenses for the management of this progressive condition such as Rose K lenses, Kerasoft contact lenses, Scleral and miniscleral lenses are provided here. Keratoconus is managed by many different contact lens designs. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the practitioner carefully evaluates the needs of the individual to find the lens that offers the best combination of visual acuity, comfort and corneal health.

Compliance is the key to long-term success for all contact lens wearers. It is even more important for keratoconus patients, since they are almost totally dependent upon contact lenses for all their visual tasks. After patients have been successfully fit with contact lenses, a high percentage of complications and adverse reactions are related to skipping or shortcutting the recommended procedure for cleaning, disinfecting, and storing their lenses. A study revealed that 27% of patients admitted that they don’t clean their lenses daily, and it is likely that an even higher percentage of lens wearers are non-compliant in some way. Some patients have used dishwashing liquid, baby shampoo, or even toothpaste instead of the recommended cleaners; stored their lenses dry, rather than in an FDA-approved disinfecting solution; and used saliva (which contains a host of sight-threatening microorganisms) instead of the sterile solutions that are readily available, to wet their lenses before inserting them in their eyes.

GLASSES:

In the early stages, vision can be corrected with glasses or regular soft contact but as KC progresses they are not able to correct the distortion caused by the irregular corneal surface and more complex contact lens designs are required.

SOFT LENSES:

Contact-Lens1The role of soft lenses in keratoconus is limited because the soft lens drapes over the irregular corneal surface and the front surface of the lens assumes the same irregular surface as the cornea without trapping a fluid reservoir so the effective refracting surface is no improvement over the original corneal surface. There are some specially designed thicker soft lenses retain more of a rigid shape and may contribute to the liquid lens effect to some extent. There are designs being used for keratoconus, and they are helpful in mild to moderate cases.

RGP CONTACT LENSES:

Rigid Gas Permeable (RGP or GP) contact lenses are primary option for correcting KC vision. The rigid lens masks the underlying irregular cornea and functions as the new refractive surface of the eye, with the tear film filling in the space between the back of the contact lens and the front of the eye. “Rigid” defines the type of lens. “Gas Permeable” describes the lens material. There are many different RGP lens designs.

Contact-Lens2
Contact-Lens3
“Piggy-backs”
This is a two system: an RGP lens worn on top of a soft lens. The RGP lens provides crisp vision and the soft lens acts as a cushion providing comfort.

Hybrid lenses
This is a lens combination that has an RGP center surrounded by a soft skirt.

Scleral lenses
These are large diameter lenses that rest on the white part of the eye, called the sclera, and vaults over the cornea. The size can be a scary prospect for some, but scleral lenses have many advantages. Because of their size, they do not fall out, dust or dirt particles cannot get behind them during wear. They are surprisingly comfortable to wear because the edges of the lens rests above and below the eye lid margins so there is no lens awareness. The introduction of rigid gas permeable (RGP) materials has made this design more readily available.

Contact Lenses
Eye infections, while infrequent, can be devastating, preventing patients from wearing their contact lenses for days or weeks and sometimes resulting in permanent corneal scarring and loss of vision. A thorough understanding of the role played by each of the rigid lens care products will help to keep lenses clean and eyes healthy.

CARE SYSTEM FOR RIGID LENSES:

They consist of:
A daily cleaner, to remove tear film oils, mucus, cosmetics, and other debris from lens surfaces. Cleaning solution containers have a red tip to warn patients that the solution should not be put in the eyes. If cleaner is accidentally instilled in the eyes, it should be flushed out immediately, preferably by dunking the entire face into a sink filled with water.
A combination wetting/soaking solution for lens storage and reinsertion in the eye, which kills bacteria and other microorganisms, keeps lenses from warping, and acts as a “cushioning agent” when the lenses are placed in the eyes.
An optional enzymatic cleaner (in either liquid or tablet form), for patients who build up a lot of protein on their lenses. Not all rigid lens wearers need an enzymatic cleaner.
A lubricating and rewetting drop, to instill in the eye while you are wearing lenses. This will help to flush debris from under the lenses and help the lenses to glide more smoothly and comfortably in the eyes.
Rub the lens between your fingers! It may warp or crack! If the lens curvature is too steep for your index finger to clean the inner lens surface, try using your pinkie or a cotton swab.
Rinse the lens with cool or lukewarm water. Hot water will warp the lens. Do not rinse your lenses over an open drain!
Replace the right lens in the case and repeat the steps for your left lens.
Soak lenses overnight or for at least 4 hours.
In the morning, wash your hands and insert your lenses directly from the wetting/soaking or conditioning solution. Do not rinse first! The solution will help to cushion the lenses as you insert them. In addition, if the lenses are rinsed with water after they have been disinfected, there is a chance that they may become contaminated from impurities in the water supply.

ABNORMAL SYMPTOMS

Pain: when placing lenses on the eyes, while wearing the lenses, or after removing them
Burning, a sensation of heat, redness, excessive tearing, or discharge
Inability to keep the eyes open
Extreme sensitivity to light
Severe or persistent haze, fog, or rainbows around lights
Severe irritation
White spots on the cornea.

DO’S AND DON’TS FOR RIGID LENS WEARERS

Clean your lenses at night, immediately after you remove them from your eyes. Leaving them in the soaking solution without cleaning until morning reduces the effectiveness of the disinfecting chemicals. In addition, rinsing the cleaner off with tap water just prior to replacing the lenses in your eyes might introduce bacteria or other microorganisms that would ordinarily have been killed while the lenses soaked overnight.

If your lenses ever dry out, soak them for at least 4 hours before you wear them again, since they may have warped or flattened in curvature when the liquid evaporated.
Do not mix and match solutions made by different manufacturers. Doing so may cloud your lenses, cause them to become gummy, or irritate your eyes. Make sure that the cleaning, soaking, disinfecting, and wetting/rewetting products you buy are all part of the same care system.

Always store your lenses in a case with ridges on the bottom. Lenses tend to suction onto smooth-bottomed cases and may chip if you try to pry them up at the edges.
Replace your case each time you buy a new bottle of wetting/soaking or cleaning/soaking solution. Cases tend to become contaminated. You can clean case with your contact lens cleaner using a brand new inexpensive toothbrush. Be sure to rinse the case well before using it again.

If the skin on your hands is rough, ask your contact lens fitter if you can use a manually-agitated device such as the Allergan Hydramat or a mechanical device such as the Clensatron. These devices work like miniature washing machines and may protect the lenses from becoming scratched from your rough skin.

If you remove your lenses with a suction cup make sure you know exactly where the lens is before placing the suction cup on the eye. Suction cups should be cleaned with contact lens cleaner and rinsed after each use. They can also be soaked in wetting/soaking or cleaning/soaking solution.
If you drop a lens, do not drag it along a surface. Wet your finger with wetting/soaking or rewetting solution and touch it gently to the lens to lift it.

Article by

Narayana Netralaya

DACRYOCYSTORHINOSTOMY (DCR):

What is DCR?

Each eye has a fine pipe which drains the tears from the eye. This is a nasolacrimal duct (drain-pipe of the eye). If it gets blocked, the tears and stickiness come out of the eye. The treatment is by dacryocystorhinostomy (DCR). This is a technique by which a new passage is created from the eye into the nose, and the tears can drain out.

Is it necessary to undergo DCR?

When a nasolacrimal duct is blocked, the dirt and discharge accumulate in the lacrimal sac next to the eye. There is the risk of severe eye infection if the condition is left untreated. There may be swelling, pain, and watering. If a cataract surgery is planned, a blocked nasolacrimal duct increases the risk of dangerous infection; a DCR should be done before the cataract surgery.

How is DCR performed? What are the outcomes?

DCR can be performed in three ways- externally, through a small (less than half inch) line next to the nose; endonasally- through the nose; and trans-canalicular using Laser DCR.

The external DCR leaves a fine mark near the eye; it has the highest success rates, more than 95 out of 100 patients have the problem completely solved after external DCR. An endo nasal DCR is done through the nose, so there is no mark outside. The success rates are a little lower; all nose space inside is not suitable for endonasal surgery, and it can be done well in selected patients only. Trans-canalicular Laser DCR is a very rapid procedure, with hardly any pain and swelling. However, some of the DCR done with laser may close down again.

I have had a DCR done already. The eye is still watering. Why?
As mentioned, about 5 out of 100 patients find that their DCR has closed down again. This may particularly happen in a patient who had multiple attacked of infection earlier, with a history of injury near the nose, or a patient who has frequent nasal allergies and colds. The DCR can be repeated, with addition of silicone intubation to prop the passage open. A typical oculoplastic surgeon will often see patients sent over from elsewhere after the DCR did not work; most such patients can be re-operated successfully.

Article by

Narayana Nethralaya

PTOSIS
What is ptosis?
Ptosis is drooping of the eyelid. The eye appears smaller, there is difficulty opening th e eye. Ptosis may occur in one eye or both eye. There is obstruction of vision and a sleepy and tired appearance.

Why does ptosis occur?
There is a muscle in the upper lid, called the levator- the function the levator is the lift the eyelid open. If the levator is not working well, the eyelid droops.
In many patients who have ptosis since birth, the levator muscle is weak since birth.
In patients where ptosis starts later in life, there may be multiple causes : injury, age, use of contact lens for many years, some neurological diseases.

Do we need to consult a neurologist?
A small proportion of ptosis stems from neurologic diseases. Usually the oculoplasty surgeon is able to differentiate these on examination. They will then refer you to a neurologist.

How important is it to correct ptosis?
For an adult, a ptosis can block part of the visual field, obstructing the vision. There can be strain by lifting the brow muscles to compensate. More and more people opt for ptosis correction to avoid looking tired, sleepy and unhappy.

In a child, the ptosis may cause delay in the development of vision, and a lazy eye (amblyopia). This has to be corrected at a young age, and appropriate glasses and exercise started. Once the patient is older, vision correction cannot be achieved. It is extremely important to have an accurate assessment of vision in a child with ptosis.

What are the methods of correction of ptosis?
The oculoplasty surgeon assesses the measurements of the eye. If the natural muscle can be strengthened with stitches, that is the method of choice. If the natural muscle levator is too weak for correction, an implant (most commonly silicone) is places to connect the forehead muscles and the eyelids. The patient can then effectively use the forehead muscle to lift the eyelid.
Some neurologic diseases such as myasthenia can be treated by oral medicines.
Rarely, there are some ptosis patients where it is not safe to do surgery. These patients are recommended crutch glasses, spectacles which prop the eye open.

What are the outcomes with ptosis surgery?
After ptosis surgery, the final outcome is known at 6 weeks .This is because each person’s body heals in a slightly different way, and a small percentage of uncertainty remains. Eight of ten patients have the eyelid set exactly at the correct height, two may be little higher or lower.

Usually the eyelid height is equal when the patient looks forward, but some difference is seen when the patient looks upward or downward. In a few patients, when the patient sleeps after surgery, a small gap may remain open in the eyelids. A silicone sling when used, has greater flexibility, allows natural blinking, and can be re-adjusted if required.

Article by
Narayana nethralaya

WHAT IS GLAUCOMA?

Glaucoma is a disease of the nerve for vision (optic nerve) caused by increased pressure in the eye.

HOW DOES GLAUCOMA OCCUR?
Glaucoma : The inside of the eye contains a fluid, which is being produced and drained out of the eye constantly. It is drained through a sieve like structure situated at the angle between the transparent cornea and the brown coloured iris. When the drainage mechanism becomes ineffective, the pressure in the eye (intra-ocular pressure) increases leading to optic nerve damage.

WHAT ARE THE EFFECTS OF GLAUCOMA?
Glaucoma can lead to permanent loss of vision. Initially, the loss of vision starts from periphery and progressively affects the central vision. The central visual acuity is affected only in the advanced stage.

Progressive loss of visual field with corresponding loss optic nerve damage
Progressive loss of visual field with corresponding loss optic nerve damage

ARE ALL THE GLAUCOMAS SAME?
No, there are many types of glaucoma. Some of these are:

Open angle glaucoma, in which, despite of open drainage angle, the drainage does not occur
Angle closure (closed angle) glaucoma, in which, the angle itself is closed preventing fluid drainage
Secondary glaucoma, which occurs due to other eye disease or treatment
Glaucoma3

HOW DO I KNOW WHETHER I HAVE GLAUCOMA?
95% patients with glaucoma do not have any sypmtoms. Glaucoma is a silent disease that cannot be detected or felt by the patient since central vision remains unaffected till the late stages of the disease. Hence it is rightly called as the ‘sneak thief of sight’. It is usually detected during a routine eye checkup.

WHEN SHOULD I GO FOR EYE CHECKUP?
Everyone over the age of 40 years should have a detailed eye check up, at least when one needs reading glasses. Hence it is advisable to not stop with visiting an optician alone.
Those who have additional risk factors should undergo an early evaluation.

WHAT ARE THE RISK FACTORS ASSOCIATED WITH GLAUCOMA?
If you

have blood relatives with glaucoma
have diabetes mellitus, hypertension, or thyroid disease
are near sighted
are on treatment with steroids (in the form of tablets, skin ointments, inhalers, eye drops)
have a history of trauma
You will need an early check up if you have any of the above symptoms.

WHAT ARE THE TESTS I NEED TO UNDERGO?
Tests help in finding out the presence of glaucoma and also its progression in the subsequent follow ups.
These tests include;

Tonometry: To measure the pressure in the eye
Gonioscopy: To assess the drainage angle
Ophthalmoscopy: To view the optic nerve
Pachymetry: To check the thickness of cornea
Perimetry: To assess the field of vision
All these tests are painless.

WHAT IS THE TREATMENT?
Glaucoma is a treatable disease that needs early detection as the damage is not reversible. The treatment can include medicines, laser or surgery.
The medicines either decrease the production of the fluid or increase the drainage of the fluid so as to keep the eye pressure under control as determined by your doctor. You may need lifelong treatment as per the instructions given by doctor.
Lasers are used in the treatment of glaucoma to increase the flow of fluid.
When medical or laser treatment fails, you may need surgery.

DOES TREATMENT RESTORE THE LOST VISION?
Treatment of glaucoma aims at preserving the existing vision; it does not restore the vision that is already lost. Therefore, early detection and treatment are very important.

SPECIALIZED TESTS FOR GLAUCOMA
.

INSTRUMENTS USED FOR DIAGNOSIS OF GLAUCOMA
.

FLOWCHART FOR INITIAL EVALUATION OF A GLAUCOMA PATIENT
.

Department of Glaucoma at Narayana Nethralaya is equipped with the latest diagnostic facilities including,

Perimeters – Humphrey Visual Field Analyser, VFA Octopus and Humphrey Matrix.
Retinal Nerve Fiber Layer Analysers
– Optical Coherence Tomography (OCT)
– GDX
– Heidelberg Retinal Tomogram (HRT-3)
Ultrasound Pachymetry.
Ultrasound Biomicroscopy.
Anterior Segment OCT (AS-OCT).
Newer Tonometers – Tonopen, I-Care, Dynamic Contour Tonometer, ORA.

Article by

Narayana Hospitals
Bangalore

Bilio-pancreatic Diversion:

The DS is more effective in achieving excellent weight loss in the extremely obese. In the DS, a sleeve resection of the stomach is performed by removing about 2/3 of the stomach, maintaining continuity of the gastric lesser curve. The stomach remains attached the first segment of the small intestine, the duodenum, which allows pylorus, the valve that controls food drainage from the stomach, to be left intact. The 2nd part of duodenum is then separated from the rest of the small intestine. The duodenum is then attached to the lowest part of the small intestine, bypassing the majority of the second and third segments of the small intestine. The small intestines are arranged so that the section where the food mixes with the digestive juices is fairly short. No small intestine is defunctionalized.

Bilio Pancreatic
Who needs BPD-DS?

Same as Gastric bypassPeople who want to eat normally
Advantages

The primary advantage of duodenal switch (DS) surgery is that it results in a very high percentage of excess weight loss for obese individuals, with a very low risk of significant weight regain.Various clinical studies showed resolution of type 2 diabetes [90%], hyperlipidemia [95%], sleep apnea [90%], and hypertension [80%]. The results are so favorable that some surgeons are performing the “switch” or intestinal surgery on non-obese patients for the benefits of curing the diabetes.Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who’ve undergone the Roux-en-Y gastric bypass surgery.Diet following the DS is more normal and better tolerated than with other surgeries. The malabsorptive component is fully reversible.Liver problems are much less frequent and the procedure essentially eliminates stomal ulcer.
Risks and Complications:

The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of patients having the gastric bypass surgery.Like Gastric bypass patients, DS patients require lifelong and extensive blood tests to check for deficiencies in vitamins and minerals. Follow-up care is non-optional and must continue for as long as the patient lives.DS patients also have a higher occurrence of smelly flatus and diarrhea, although both can usually be mitigated through diet, including avoiding simple carbohydrates and fatty foods

Article by
Columbiaasia Hospitals
Bangalore

Gastro Esophageal Reflux Disease (GERD) is a condition in which the contents of the stomach are regurgitated into the esophagus (the tube that carries food from your mouth to your stomach). This is also called “Acid Reflux.” Gastroesophageal refers to the stomach and esophagus and Reflux refers to regurgitation or return of the contents. Therefore, gastroesophageal reflux is the regurgitaion of the stomach’s contents back up into the esophagus.

Many people, including pregnant women, suffer from various symptoms and indications of GERD such as heartburn or acid indigestion. Mostly, heartburn can be relieved through dietary and lifestyle changes. At times, heartburn is also believed to be caused by hiatal hernia. However, in many cases, it may require medication or surgery.

In the process of normal digestion, the Lower Esophageal Sphincter (LES) opens up and allows food to pass through to the stomach thus preventing food, acid and other juices to flow back into the esophagus.

A weak or inappropriately relaxed LES allows the stomach’s contents to flow up into the esophagus, thus causing gastroesophageal reflux.

The severity of GERD depends on level of LES dysfunction and on the type and amount of fluid brought up from the stomach and on the neutralizing effect of saliva.
Some factors that may cause GERD:

Dietary Factors
Shorter dinner to bed time
High fat diet
Obesity
Smoking
Lifestyle associated factors
Stress
Major life events and alcoholic events
Family history

Symptoms

Following are the most common symptoms for people with GERD:

Heartburn: Commonly after a meal.
Regurgitation: Regurgitation can produce a sour or bitter taste, and you may experience a “wet burp” or even vomit some contents of your stomach.
Stomach Pain
Abdominal bloating/Gas
Acidity
Excessive Burping
Nausea
Trouble Swallowing
Asthma: Refluxed acid can worsen asthma by irritating the airways and the medications used to treat it can make GERD worse.
Sore Throat: If acid reflux gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx), causing sore throat.
Excessive Night Cough/Excessive Dry Cough: Chronic dry cough, especially at night. GERD is a common cause of unexplained coughing. It is not clear how cough is caused or aggravated by GERD.
Sudden increase of saliva
Bad breath
Ear aches

Article By
Fortis Healthcare
Bangalore