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What to Expect After Your Retinal Detachment Surgery

Posted on February 10, 2012 by FCI

The retina is the light-sensing membrane that captures and transmits images to the brain. Most retinal detachments experienced by individuals are originally caused by a small tear or hole in this sensitive retina wall. Often due to thinning of the retina or shrinking of the vitreous gel within the eye over time, retinal detachments cause vision loss that may become permanent if not treated quickly and effectively.  Often affecting those individuals who are middle-aged or older, retinal tears and detachments are most common in nearsighted individuals and those with a genetic predisposition.

Prompt treatment of a retinal detachment is vital to the prevention of permanent vision loss. Scleral buckling, pneumatic retinopexy and vitrectomies are the most common treatments of retinal detachment. These treatments help press the retina against the wall of the eye and hold the tissues in place so that they can heal. Surgical retinal reattachment surgery is conducted through a quick one-and-a-half to two-hour surgery.

Complications

Although every surgery comes with its risk of complications, most retinal detachments come with infrequent and treatable complications, which include: bleeding under the retina, cataracts, recurrence, or infection.

Going Home after Surgery

Retinal detachment surgery is normally followed by a short recovery at the hospital before returning home. Patients can often return to normal activity one to two weeks after surgery. Traveling should be avoided for some time, and increases in altitude should be avoided until cleared by the surgeon.

Pain and Eye Protection

After a retinal detachment surgery is performed the eye may be inflamed, sore, and swollen for some time. Although very little pain is expected after surgery, pain medications are often sent home with the patient to aid in post-surgical pain control. Eye drops and an eye patch may be necessary aftercare to keep the eye moist, sanitized, and protected. A shield may also be used to avoid accidental pressure on the eye during sleep. Follow-up visits will be scheduled for the day after surgery and again for regular checkups over the next two to three months depending on patient progress. Some discharge is expected during the healing process, but the eye should be monitored for unusual drainage.

Care will need to be taken when showering not to get soap in the eye. Some procedures require a gas bubble to be placed in the eye during surgery to help keep the retina pressed up against the inner wall of the eye. Patients may be asked to position their head facing down to aid in the effect of this pressure bubble. This positioning may be necessary for one to two weeks after surgery.

Activity

The first week after surgery should be reserved for rest and slow movement. Excessive close concentration or TV watching should be avoided to prevent eye strain and further discomfort. Some patients may experience sensitivity to light after surgery. Activity can often be resumed after a month, but heavy lifting over 20 pounds and strenuous activities should be avoided while the eye heals.

Driving should also be avoided until vision improves and stabilizes. Initial depth perception and field of view is compromised after surgery and care should be taken before patients get back behind the wheel. Sedentary jobs may be returned to between ten and fourteen days after surgery, but more active jobs should be cleared by the surgeon before resumed.

Outlook

Surgical treatment for retinal detachment is successful in over 90 percent of cases. If the retinal reattachment is a success, the patient will have some degree of vision restored. Depending on the condition of the retina, a varying degree of reading and traveling vision may be restored, and oftentimes patients can expect a full recovery of their vision.

A period of healing is necessary after surgery before patients will begin to see an improvement in their vision. This improvement should be expected to begin two weeks after surgery, and within six weeks postoperative vision improvement should be complete. The retina may continue to heal for a year or more, and it may take months for vision to stabilize after surgery.

Retinal detachment procedures are highly successful, come with few complications, and are imminent when a detachment occurs to help restore vision before blindness becomes permanent. Recovery is quick and requires a short period of rest and care while the retina heals and vision improves.

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FCI Ophthalmics Welcomes Jim Perez as National Sales Manager

Posted on February 8, 2012 by FCI

Jim FCI Ophthalmics Welcomes Jim Perez as National Sales Manager

FCI Ophthalmics is pleased to announce the appointment of Jim Perez as our new National Sales Manager, as of February 7, 2012.

Jim has over 20 years experience in medical sales, business development and sales management.  Most recently, Jim was Director of Sales at Porex Surgical for 7 years before it was acquired by the Stryker Corporation in 2010.  At Stryker, Jim was responsible for helping to integrate the sales team into the new business unit as Director of Strategic Accounts.

Jim brings experience, knowledge and skills that will enhance our capabilities and help propel us to the next level of growth.  He came up the old fashioned way, starting as a sales rep for seven years then District Manager, Region Sales Manager, Distribution Manager, Business Development Leader, US Segment and Market Manager and eventually US Sales Director.  While at Porex Surgical Jim learned to wear many hats and developed key relationships within the Oculoplastic community across the Nation.

Jim will take on the overall leadership of the sales team and business development activities at FCI Ophthalmics.

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Causes of Watery Eyes and Their Solutions

Posted on February 1, 2012 by FCI

The human tear is made in a gland under the skin of the eyelid that flows over the surface of the eyeball and drains into the naso-lacrimal ducts into the nose. Necessary for normal lubrication of the eye and to wash away foreign substances and allergens, normal tear production is rarely something one thinks much about. But when natural function goes awry, it can cause something called epiphora, or more simply put, excessive tearing.

Epiphora occurs when your body makes more tears than it can remove by way of drainage or evaporation. Although temporary excessive watering can occur as a result of emotions, allergies, or the elements, other issues can cause a more longstanding and concerning issue. In adults, this can be commonly caused by diseases, disorders, or aging. In children, epiphora is most often caused by a blocked or incompletely opened tear duct.

Causes of Epiphora

Epiphora can be caused by many passing and chronic conditions. If the condition persists, an ophthalmologist can best identify the cause of epiphora and decide the best route of treatment.

Epiphora can be attributed to any of the following causes:

  • Ingrown eye lashes
  • Dry eye
  • Foreign substances
  • Blepharitis or eyelid laxity
  • Naso-lacrimal duct blockages
  • The common cold, hay fever, or eye/tear duct infections
  • Pink eye
  • A blow to the face
  • Allergies or chronic sinusitis
  • Congenital or early-onset glaucoma infants
  • Granulamatosis, rheumatoid arthritis, or sarcoidosis
  • Radiation therapy
  • Seventh nerve palsy or Sjögren’s syndrome
  • Eye or nose surgery
  • Thyroid disorders
  • Tear drainage tumors
  • Antihistamines, beta blockers, diuretics, pain relievers, or sleeping pills
  • Blockage of the tear duct
  • Eyestrain

Often epiphora resolves and intervention is not necessary. Although not usually cause for emergency, this issue should be addressed if it becomes more than a transient discomfort. If prolonged and unexplained tearing or excess discharge, redness, and pain occur, it’s important to locate the cause of the discomfort and assess proper treatment by a professional.

Epiphora Solutions

Artificial tears can help manage watery eyes due to irritation, dry eye, or foreign objects, and antihistamines can help solve this issue if watery eyes are the symptom of allergies. If symptoms persist, visiting an ophthalmologist can help you determine the underlying cause of your symptoms. Ophthalmologists can perform tests to determine whether your issue is due to problems with your naso-lacrimal ducts or improper eyelid or eye lash positioning, and whether your issue can be solved permanently through a surgical procedure. Many causes of chronic epiphora can be quickly remedied through a minor surgical procedure with little or no necessary recovery time.

Dacryostenosis

Children and infants often experience epiphora due to a poorly developed or narrow tear duct. This condition, called dacryostenosis, can be resolved by a painless procedure in which these ducts are probed to help open up the tear drainage system. If a simple probing procedure does not completely resolve the issue, stents and tubes can be placed to help open up this drainage system.

Improper Eyelid or Eyelash Positioning

Watery eyes can also be due to improper eyelid or eyelash positioning. Minor surgery can fix improper eyelid positioning. Often times this improper positioning can cause dry eye, and this condition results in the body reacting by overproducing tears. In-growing eyelashes, called trichiasis, can also irritate the eye and cause watering. This may be remedied by removing the lashes, although the issue may reoccur.

Poor Eyelid Function

Another cause of watery eyes can be poor eyelid function. The eye must close correctly in order to properly spread the tear film over the eye, and poor eyelid function may prevent proper closing of the eyelids. A condition called ectropion can cause a drooping and pulling away of the lower eyelid, which is often seen in older individuals. This issue can be easily remedied with a minor eyelid surgery to tighten the drooping eyelid.

Persistent eye watering should be examined by an ophthalmologist and a proper treatment plan executed in order to aid in better vision and a healthier eye. Epiphora can be caused by a multitude of issues, many of which are transient or easily resolved by a simple surgical procedure. Ectropion, trichiasis, and dacryostenosis can all be resolved with simple procedures that involve painless probing, eyelash removal, or eyelid tightening.

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Non-Cosmetic Reasons to get Lid Ptosis Surgery

Posted on January 16, 2012 by FCI

Ptosis is the technical term for the drooping of an eyelid. Ptosis can occur in one or both lids, and can often cause vision obstruction. The causes of this condition can be credited to the aging process, prior surgery, or may be congenital in nature.

Although commonly fixed for cosmetic purposes, ptosis surgery is also indicated to resolve many non-cosmetic issues. This condition can often obstruct vision and affect a person’s ability to drive, read, or otherwise perform daily activities. Children with severe ptosis are at risk of altered development, and adults may experience a lesser quality of life due to a limited field of vision.

The need for ptosis surgery is examined by reviewing the symmetry of the middle part of the patient’s face. Eyelids are measured and photographs are taken of the position of the eyelids. Lids are carefully examined and often the patient’s field of vision is reviewed to determine the best treatment option.

Levator Tightening

In most individuals who have acquired ptosis from aging, the condition is caused by the gradual stretching of the upper eyelid tissue that slowly causes the eyelid to droop. This type of ptosis can be corrected by tightening the levator muscle that is responsible for raising the eyelid. An incision is placed in the normal crease of the upper eyelid and the levator muscle is then resectioned. This tightens the muscle and restores normal function to the eyelid, allowing it to lift to a proper level.

Frontalis Suspension

If a stretching of the tissue is not the cause, then a weak levator muscle may be to blame. This is often the case in congenital cases, but can occur both in early childhood and later in life. Early childhood cases of ptosis are often caused by improper development or muscular dystrophy. Other causes include eyelid tumors, muscular diseases or neurological disorders. If the levator muscle is weak, then tightening the muscle will not sufficiently remedy the issue, and a frontalis suspension is necessary to lift the eyelid to an appropriate position and restore normal function.

A frontalis suspension uses small strands of fibrous tissue that are surgically affixed to the eyelid and the eyebrow. This biological fibrous tissue can be taken from the individual’s own body (common in children), or from a donor. After the strands are placed, they are tightened to lift the eyelid into the correct position. When the patient lifts their eyebrow, the suspension will result in a lifting of the eyelid, restoring a normal field of vision.

Blepharoplasty

Blepharoplasties are best known as a cosmetic repair and are a very common procedure performed by plastic surgeons. This procedure removes the loose or baggy skin and fatty tissue around the eye that results from aging. When these folds of skin hang down or fatty tissue impedes lid lifting, it not only creates an aged appearance, but can also obstruct one’s field of vision. The issue of aging eyes and loss of vision due to baggy eyelids has become better recognized in recent years, and this procedure is much more commonly covered by insurance carriers.

These baggy eyelids are considered pseudoptosis, or false ptosis. The name comes from the fact that the patient has no issues with the strength or tightness of their levator muscle, but simply has too much skin or fat above the eyelid and therefore suffers from tissue overhang or impaired lifting abilities that restricts their field of vision. Some cases also result in eyelashes folding inward or outward, which irritates the eye itself.

Surgically removing this overhanging skin can improve a patient’s field of vision and also the function of their upper eyelid. Although this removal also causes a cosmetic improvement and an “awakening” of the eyes, the procedure to remove excess tissue around the eyes helps many individuals regain better vision.

Ptosis surgery is performed in different ways depending on the cause and severity of the condition. The specific surgery performed depends on the strength of the levator (lifting) muscle, the severity of the condition, the patient’s age, and if there is interference with the individual’s field of vision. Incidences of acquired ptosis are often treated with a different surgical procedure than congenital ptosis. Levator tightening, frontalis suspension, and blepharoplasties are all non-cosmetic cures for conditions that cause visual impairment.

Posted in Droopy Eyelids, Ptosis | Tagged , , , , | 1 Comment

Things You Didn’t Know about the Eye

Posted on October 14, 2011 by FCI

Your eyes are a valuable, physiologically complex component of your senses. Of all of those senses, the eyes are one of the most important for everyday living. Vision is credited for the way we understand our surroundings, and is an integral part of almost every moment of every waking minute. Vision is a sense that many people take for granted. Unless you wear glasses or contacts, you most likely go through your day thinking very little about your eyes and how they are helping you navigate your surroundings. Here we’ll explore some interesting facts about the eyes and how they function, age, communicate with our body, and alert us of disease.

The Decline of Every Eye

Even if you have perfect vision, you are not exempt from the natural aging process. The vision abilities of every eye are bound to decline over time, and nearly every individual will eventually need reading glasses as their bodies age. The need for reading glasses usually arises between 40 and 50 years of age as the lenses in your eyes slowly lose their focusing abilities. The flexibility of this lens becomes limited, and the ability of your eye to focus and change shape will begin to deteriorate—therefore, so will your vision.

The development of cataracts is also a normal part of eye aging. At some point in time, an individual will begin to develop this clouding in the lens of the eye. The average age that most individuals begin to develop cataracts is between 70 and 80 years old. Luckily cataracts are a treatable condition and cataract surgery is a common treatment for individuals of every age suffering from this condition.

Fast Focus

Your eye’s natural lens focuses at a speed that is nearly instant. If you think about how fast you can move from viewing an object near you to one further away, imagine how quickly the lens of your eye must be adjusting in order to make that happen. Faster than a camera lens, your eye is quick to make these changes with seemingly effortless adjustments.

Swiftly Aging Eyes

By the age of seven, your eyes have already hit their own level of adulthood. The physiological shape of the eye and its capabilities are fully developed after these first years of life. For this reason, improvements in vision at a young age are vitally important to correct. A lazy eye or poor vision diagnosed later in life has a much lower chance of being remedied due to this swift aging.

15,000 Blinks per Day

Considered partially involuntary, blinking is an automatic and on-demand function of the body. Blinking helps clear debris, keep eyes moist, and spread this moisture across the surface of the eye. As the eye’s camera shutter, blinking is an important part of maintaining the eye’s health and moisture and ridding it of dirt and bacteria.

Eye Tests Can Reveal Medical Conditions

Diabetic retinopathy is often one of the first signs that lead to a diagnosis of diabetes. Type II diabetes often does not show blatant symptoms, and many individuals do not even realize they have the condition. This type of diabetes is often revealed during an eye exam and presents as small hemorrhages in the eye.

Your Eyes Gather, but Your Brain Interprets

Your eyes collect information, but your brain receives this information through the optic nerve and then uses it to create the visual picture and interpretation of the world around you. Your eyes can even adapt to gaps in vision and essentially ‘fill in’ the missing spaces in your eyesight.

Perfect Vision Is Far from Perfect

20/20 vision is often known as perfect vision. But many animals have much better eyesight than this. Birds such as eagles, hawks and buzzards have vision that is 3-4 times sharper than ours. Eagles can spot prey from miles away while hawks and buzzards can spot prey anywhere from a few feet to hundreds of feet away.

Eyes are amazing gadgets of the human body. With many separate components that work together to feed information to the brain, eyes are one of the body’s most valuable assets and are an integral part of our everyday living. Try your best to not take vision for granted.

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Cataract CTRs: A Look at the Eyejet CTR

Posted on September 30, 2011 by FCI

Cataract surgery is recommended for patients who have developed cataracts that severely impair their ability to see. These cloudy areas in the lens of the eye can cause impaired, fuzzy vision as well as sensitivity to glare. Although most cataracts develop in the elderly, some do also occur in infants and younger adults. Fortunately, cataracts are treatable through surgery and lens correction.

Cataract surgery involves removal of the natural, occluded lens of the eye, which is replaced with an artificial lens. Capsular tension rings are used most often in cases where the eye’s capsular bag encasing the lens demonstrates weaknesses in the zonules. These are fibrous strands that help hold the lens in place and assist the eye in focusing on objects.

Two to five percent of all cataract surgeries are performed on patients with compromised or partially absent zonules. These capsular tension rings increase the success of cataract surgery by mitigating the risks for patients with compromised zonules. The ring works by placing centrifugal forces on existing zonules to support areas of zonular weakness, and allows redistribution of the existing zonules. Compromised zonules can often be attributed to:

  • Congenital, metabolic, and endocrine disorders such as Marfan’s syndrome, Marchesani’s, scleroderma, homocystinuria, spherophakia, porphyria, hyperlysinemia, and sulfite oxidase deficiency
  • Pseudoexfoliation
  • Extreme myopia
  • Cataracts that have suffered significant trauma
  • Postvitrectomy patients
  • Patients with previous glaucoma filtration surgery
  • Patients who have had radial keratotomy surgery with more than eight incisions.

The success of capsular tensions rings is credited to the fact that their diameter is larger than the capsular bag, there are three sizes to choose from, and when inserted into the capsular bag, they provide pressure against the equatorial region. Focal forces are then transmitted circumferentially to the entire zonule apparatus, thereby removing the pressure from the compromised zonular areas.

Dating back to 1991, the Morcher company has created rings designed to stabilize the lens capsule in patients with weak or partially absent zonules. Beginning in 1996, these Morcher rings went under study, with the Morcher study investigator Roger F. Steinert, M.D., associate clinical professor at Harvard Medical School and Ophthalmic Consultants of Boston stating, “It does exactly what it is supposed to do, and there are no complications.”

The Eyejet is a unique disposable injector that is preloaded with one of the three available sizes of cataract tension rings. The standard diameter of the Eyejet is 12 mm. Available in left or right versions to accommodate insertion preference (The left model used for implantation in a counter-clockwise direction, the right model for clockwise), the Eyejet is pre-loaded and packaged in a sterile, peel-open container and is ready for immediate use by the surgeon with no preparation necessary.

The Eyejet poses many benefits for surgeons looking to improve the surgical outcome of their special cataract cases. Benefits of the Eyejet capsular tension ring include:

4 Eyejet5 300x225 Cataract CTRs: A Look at the Eyejet CTR

  • Easy insertion into the capsular bag
  • Circular expansion of the capsular bag
  • Stabilization of the capsular bag on small zonular damages with no sclera fixation necessary
  • Reduced risk of damaging the capsule or zonules during surgery
  • Better centration of the intraocular lens, including cases of future capsular bag shrinkage
  • Capsular bag distortion
  • Simplification of the implantation of foldable intraocular lenses

The easily operated Eyejet unit comes with a capsular tension ring affixed to the hook of the injector with a clamp. After the sterile package is opened for use, the clamp is pulled backwards to load the ring into the injector. The clamp is then removed, leaving the ring prepared for insertion into the capsular bag.

Although a capsular tension ring is best to have on-hand in every case of suspected zonular weakness, the least aggressive surgical procedure is always advised. Although capsular tension rings are very safe, they should only be used when necessary to avoid the small chance of a problem occuring.

Capsular tension rings have many advantages, with documentation of these benefits dating back since the Morcher company first introduced them over 15 years ago. With availability in three sizes, easy implantation and other proven benefits, the Eyejet system offers notable advantage for surgeons performing cataract operations on patients with zonular damages, pseudoexfoliation, and other capsular bag irregularities.

 

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The Aging Eye

Posted on September 21, 2011 by FCI

Age-related vision impairment champions the leaderboards as the main cause of vision impairment and blindness in the United States. Cataracts, one of the most prevalent age-related eye diseases, affect over 20 million Americans over 65 years of age. Glaucoma, macular degeneration, and diabetic retinopathy also sit high on the list of these diseases. Each age-related eye disease comes with its own cause and complications. Eye diseases that have been closely tied to the aging process include:

senioreye 300x157 The Aging Eye

  • Cataracts

Cataracts are most often age-related. A cataract is a clouding of the transparent lens structure behind the iris. Cataracts may form as early as age 40 and then become advanced enough to limit vision by age 60. Fortunately, cataract surgery can restore this vision loss.

  • Macular degeneration

This condition destroys the macula, a group of cells in the central retina that are responsible for sharp vision and fine detail. It is essential to diagnose and monitor macular degeneration to help preserve vision over time.

  • Glaucoma

Older adults are at an increased risk of glaucoma. Glaucoma is the result of excessive fluid buildup within the eyeball that places pressure on the optic nerve. Over time, the optic nerve can gradually suffer major damage.

  • Diabetic retinopathy

In patients with diabetic retinopathy, high blood glucose causes fragile blood vessels to overgrow. These fragile vessels burst, leaking fluid behind the retina that causes inflammation and scarring. Age and the length of time an individual has had diabetes are both factors in the development of diabetic retinopathy.

  • Dry or watery eyes

Dry eye is a common occurrence in older individuals. Dry eye can be caused by tear evaporation, underproduction of the tear film, abnormal pH, or ptosis.

Watery eyes can be caused by the weakening of the structures that support your eyelids, causing them to lose the ability to properly sweep tear film towards tear ducts.

  • Presbyopia

Farsightedness develops as the lens of the eye loses elasticity and the ability to focus the lens becomes increasingly limited. This age-related eye condition is so prevalent that reading glasses of varying prescriptions are often found on racks in pharmacies and grocery stores.

  •  Blepharitis

This condition can cause redness, swelling, and crusting and can be caused by bacterial overgrowth in the oil glands of the eyelashes.

As the eye ages, anatomical and physiological processes also gradually decline. This results in a natural decline in vision quality. Areas of natural degeneration in the eye that contribute to a loss of vision include:

  • Pupil changes

The most significant of these natural changes occurs in the pupil. A reduction in pupil size, the loss of focusing, and the lesser extent of pupil dilation reduces the amount of light that can reach the retina. This is often apparent in older people as they tend to use additional lighting for illumination where younger individuals do not have trouble seeing.

 

  • Color and Contrast

Color and contrast sensitivity is also affected. The lens of the eye yellows over time, causing a reduction in the ability to discriminate between certain colors such as blue and green.

 

  • Lens Elasticity

The lens of the eye begins to lose its elasticity and makes it more difficult for the lens to bend and focus on close objects. This results in the common farsightedness of older individuals known as presbyopia.

As one ages, regular eye exams are critical to maintaining vision and eye health. Although age-related eye conditions usually present gradually, individuals should be careful to seek immediate medical assistance if they experience:

  • Flashing lights, floaters, or a gray creeping curtain moving across the field of vision. This sudden onset may indicate a retinal detachment. Unless treated immediately, retinal detachment can lead to blindness.
  • Any sudden loss of vision. Sudden vision loss can be related to macular degeneration, glaucoma, or other conditions that require immediate attention.
  • Eye pain can be caused by many of the common age-related eye diseases, but should be assessed immediately.
  • Blurred vision can often be a sign of glaucoma, uveitis, a retinal tear, macular degeneration, or a blocked blood supply to the eye.

Although many age-related changes are not preventable, close monitoring and routine examinations can help minimize the complications of an aging eye and keep eyesight at its best throughout the lifetime of every individual.

 

Posted in Cataracts, Dry Eyes | Leave a comment

Using Vitrectomy Lenses and Scleral Buckling for Retinal Detachment Cases

Posted on August 31, 2011 by FCI

Common in midlife through the golden years, but possible at any age, retinal detachment occurs when the retina is separated from its position on the back wall of the eye. Affixed to this wall like a sheet of wallpaper, the retina is responsible for taking images through a physical and chemical reaction and sending this imagery to the brain through the optic nerve.

Retinal detachment can occur when the vitreous gel separates from the retina, causing tension and pulling the retina away from its location or causing tears in its surface. Vitreous gel can seep through these tears and pool behind the retina, exerting pressure and detaching the retina from the wall of the eye. When retinal detachment occurs, the result is visual loss or blindness.

Surgery is the prescribed treatment to return the retina back to its original location on the inner wall of the eye;  thus restoring its image-capturing capabilities and returning vision to the patient.

Conditions

Conditions that increase the chances of retinal detachment include nearsightedness, cataract surgery, glaucoma, trauma, family history, or retinal weakness.

Symptoms

Symptoms of retinal detachment can include floaters or flashing lights in the periphery of a patient’s vision. A gray veil moving across the field of vision or a sudden reduction in peripheral vision can also be symptoms of retinal detachment.

Treatment

Treatment for retinal tears includes laser surgery or cryotherapy, but detachments most often require surgery to return the retina to its original location. These treatments include pneumatic retinopexy, scleral buckling, and vitrectomy.

Pneumatic retinopexy

A pneumatic retinopexy involves injecting a gas bubble into the vitreous space via an intravitreal injection to push the retina back to its original position against the wall of the eye. The patient is often instructed to maintain a certain head position for several days after this procedure. The injected gas bubble will gradually dissipate and be replaced by the body’s own fluids.

Medications are sometimes injected into the eye with the help of an intravitreal injection assistant such as the disposable Invitria®  which ensures a predictable procedure without the need for usual instruments such as the speculum, calibrator or pressure plate. This instrument allows the physician to insert the injection into the eye with ease, making it a surgical solution that is user, budget, and patient-friendly.

Scleral buckle

Scleral buckling is the most common retinal surgery and an effective way to close large breaks and reunite layers of the retina. A scleral buckle can be placed around the equator of the eye to counter the traction pulling the retina from its position. The fluid under the detached retina is removed so that the retina can return to the wall of the eye and then the scleral buckle is positioned to keep it in place. Usually permanent, this buckle is sewn to the outer layer of the eye and pushes the sclera toward the middle of the eye, relieving traction on the retina and allowing it to heal.

Vitrectomy

A vitrectomy is used to remove vitreous gel that is applying traction to the retina and pulling it out of place, along with any other tissues that are tugging at the retina. Vitrectomies are also used to remove vitreous gel before performing a pneumatic retinopexy or combined with scleral buckling. Disposable vitrectomy lenses offer a highly effective solution that allows the physician to efficiently view the retinal surface during retinal surgery. These lenses are available in 30 degree prismatic lenses and planoconcave silicone options.

Risks

Risks of surgery are low and include infection, bleeding, raised eye pressure, or cataracts. Sometimes a second surgery is necessary, but the risks of surgery are far outweighed by the guaranteed loss of vision resulting from lack of treatment.

Outlook

Vision may take months to fully improve, and may not return entirely. An eye patch is necessary and often a change of prescription lenses is needed after surgery. The longer and more severe the initial detachment is, the lower the vision recovery, which can be expected after surgery.

Quick surgical correction is of ultimate importance in cases of retinal detachment. Although treatment for retinal tears includes laser surgery or cryotherapy; detachments most often require surgery to return the retina to its original position through the use of vitrectomies, scleral buckling and pneumatic retinopexy. These procedures are most often performed using advanced surgical instruments, which include intravitreal injection assistants, disposable vitrectomy lenses, and scleral buckling components.

 

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Lacrimal Stents for Dacryostenosis

Posted on August 9, 2011 by FCI

The lacrimal system is a small and complex system that aids in sustaining an appropriate tear film in the eye. Anatomical conditions such as nasolacrimal duct obstruction, also known as dacryostenosis, can upset the delicate physiological balance between tear production and drainage. The most common symptom of dacryostenosis is epiphora, or the overflow of tears. Ranging from bothersome to chronic and affecting both children and adults, dacryostenosis may be cured easily with a simple outpatient procedure, or it may require additional assistance from lacrimal stents or tubes.

The first step in assessing the appropriate course of treatment is to assess the cause of dacryostenosis. Dacryostenosis can be congenital, or it can be acquired by a primary or secondary obstruction.

Congenital Cases – Affecting one eye or both, blocked tear ducts occur in up to 20% of newborns and may not be evident until after the first month, sometimes resolving on its own. If the condition does require intervention, a quick and highly successful outpatient probe and irrigation can be performed. This procedure is conducted under general anesthesia and employs a small metal instrument that is passed through the nasolacrimal duct to open the pathway and clear the obstruction.

Acquired Cases – Dacryostenosis can also be caused by infections, abnormal growth or injury of the facial bones or surrounding tissues, underdeveloped puncta (the openings in the corners of the eyelids), and thickening of the tear duct lining, sinus problems or tumors.

If the condition cannot be resolved by simple probing, stents can be inserted to open up these ducts. Commonly used types of stents include the Mini Monoka, the Crawford & Mono-Crawford, and the Ritleng & Self-Threading Monoka.

 

Mini Monoka

The Mini Monoka is used for patients who have suffered a canalicular injury or have a canalicular anomaly. The canaliculi are the mucosal ducts through which tears drain from the eye, and injuries and anomalies of the canaliculi are fairly common. The Mini Monoka is a silicone stent that can be securely anchored at the punctum with no need for sutures. Threaded through the punctum into the lacrimal system, the Mini Monoka recreates the passageway that is being interfered with by the compromised canalicula.

As the Mini Monoka does not feed all the way through the nasolacrimal system, it eliminates possible injury to the normal canaliculus and nasolacrimal duct.

 

Ritleng Probe and Self-Threading Monoka

The Self-Threading Monoka (Ritleng style) tube is designed for canalicular stenosis procedures, laceration, or imperforate nasolacrimal ducts and requires no sutures. This tube is attached to a thin thread-guide which is fed through a Ritleng probe and gently out the nose. The probe is then removed, and the thread-guide is pulled along with the silicone tubing into proper position in the nasolacrimal duct. The tube is securely anchored at the punctum by a small plug and requires no suturing.

Intubation can be a complicated process in infants and small children, as the nasal passages are compact and complicated in youths. The removal of a thin suture or thread-guide from the nose is easier and less traumatic than traditional metallic probes, facilitating canalicular procedures in young children.

 

Crawford

The Crawford Bicanaliculus Intubation is a highly effective tool for the treatment of canalicular system stenosis (narrowing of the canalicular system) or nasolacrimal duct obstruction. It attaches to a metallic glide with an olive tip that is fed through the system and retrieved below the inferior turbinate using a Crawford Hook.

 

Mono-Crawford

The Mono-Crawford can be used for both nasolacrimal duct obstruction or in a canalicular laceration repair. This stent feeds all the way down into the nasolacrimal duct, unlike the Mini Monoka, and is anchored at the punctum by a plug and then retrieved using a Crawford Hook.

Although choices for lacrimal stents and tubes are many, recent studies have demonstrated better success with silicone stents. Silicone stands as the most ideal material to date—as it is soft, pliable, inert, and stable.

Monocanalicular stents are also preferable over bicanalicular for a variety of reasons, including their ease of removal, quick office procedure, and no danger of punctum erosion (which can occur occasionally with bicanalicular stents). The most common issue with monocanalicular stents remains the chance of postoperative scarring, obstruction or stenosis from spontaneous dislodgement.

Dacryostenosis remains a common but curable condition. With the use of simple probing or further assistance by the use of stents, dacryostenosis can be effectively treated with minimal intrusion and an overwhelmingly positive outcome.

 

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KITARO Kits: A Superior Way to Practice Cataract Surgery

Posted on July 12, 2011 by FCI

The KITARO© WetLab and DryLab kits are created with the learning surgeon in mind. With both wet and dry lab kits, the beginner can practice techniques repeatedly without the added complication of long preparation times and costly live tissue samples. These tools simulate the stages of cataract surgery using both a wet lab and dry lab environment to allow new surgeons the ability to train repeatedly on basic surgical techniques.

Beginners can learn instrument manipulation with the KITARO DryLab and then move on to the KITARO WetLab to learn the intricacies of machine operations before performing actual surgeries.

KITARO DryLab

Without the need for a microscope or a phaco machine, procedures such as continuous curvilinear capsulorhexis (CCC), nuclear dividing, IOL insertion, and wound construction can be practiced repeatedly in a low-cost, pressure-free environment. The DryLab also monitors eye movement upon instrument contact to mimic a real surgical environment.

Mastering the essential specialized techniques of cataract surgery can be difficult for a surgeon to practice using conventional methods. Precise instrument manipulations require repetitive rehearsal, and available lab provisions such as porcine models can be tough and costly to obtain. With the KITARO DryLab, these issues are abated by allowing the novice to practice techniques repeatedly at their own desk.

Necessary surgical skills can be quickly improved through DryLab technologies designed to simulate the multiple stages of cataract surgery.

Continuous Curvilinear Capsulorhexis

The DryLab polyester film has a 2-layer structure that mimics the ocular cortex. This technology can simulate the CCC procedure necessary to release the original cornea, and help surgeons learn the skills necessary to perform successful CCC in preparation for phacoemulsification. In practice, common mistakes can be encountered and resolved, and the polyester film can be quickly shifted to yield a brand new practice site for each rehearsal.

Nucleus Dividing

The nucleus dividing technique is the process of segmenting the pieces of the cataract nucleus in preparation for removal. The DryLab allows surgeons to perform the basic techniques for this segmentation with 3 artificial nuclei that provide divide & conquer, stop & chop, and phaco-chop techniques. The DryLab comes with three plastic pre-divided nuclei and CCC-processed film to aid in the practice of the three nucleus dividing techniques.

A polymer clay nucleus is also included that can be maneuvered and pierced for stop & chop and phaco-chop techniques just like a human nucleus.

Phacoemulsification

Phacoemulsification for emulsifying the eye’s internal lens and aspirating the nucleus is simulated using an artificial nucleus made of special resin clay. This clay mimics the consistency of a human nucleus and can be reused multiple times by simply hand-kneading back to its original shape and letting it set for a short period of time.

Wound Construction and IOL Insertion

Surgeons can practice construction of self-sealing wound incisions with the DryLab resin sheet. This sheet mimics the human sclerocornea, and effective practice can be performed using a keratome or crescent knife. The DryLab also allows the surgeon to practice IOL insertion with both forceps and an injector.

KITARO WetLab

The KITARO WetLab was constructed to replace the porcine wetlab, lowering the cost and setup of conventional labs. Surgical techniques, complication management, and common mistakes can all be mastered through repeated practice with this revolutionary learning tool.

The KITARO WetLab provides advantages over the usual porcine wet lab, including: easy preparation, a hygienic environment and high-quality, predictable materials for CCC and nuclear segmentation practice.

The WetLab comes with a high-quality artificial cornea and cataract lens. This artificial lens comes in three consistencies (medium-soft, medium-hard, and very hard) to represent natural consistency variations. The artificial cornea is 500 µm thick at the central part and 700 µm thick at the periphery to mimic the resistance experienced during an actual surgery.

With this equipment, a complete cataract surgery can be practiced that includes:

  • Creating appropriate incisions
  • Filling the anterior chamber with viscoelastic gel
  • Performing CCC
  • Executing hydrodissection and hydrodelineation
  • Grooving and splitting the nucleus
  • Emulsification and aspiration
  • Removing the cortex
  • IOL implantation

This training system is the future of cataract surgery practice for beginning surgeons. It can limit mistakes made in real surgical settings, and allows surgeons to master techniques and manage complications through a simulation that uses a realistic surgical environment without the lengthy preparation. The KITARO Wetlab and Drylab provide realistic eye movements and materials of comparable consistency to human eyes to assist the beginner surgeon in practicing the techniques necessary for successful cataract surgeries.

Posted in Cataracts, Eye Surgery, Industry News, KITARO Kits | 4 Comments