Thursday, August 9, 2018

Complication of Small Incision Cataract Surgery (SICS)



Though SICS is a popular and cheap method of cataract extraction and posterior chamber intra ocular lens implantation in the developing and under developed countries, it’s not free of complication. Actually, no surgical procedure  is free of complications.
The possible complications of SICS are as below:
Per operative complications of SICS:
a)     Endothelial injury
b)    Injury to iris and iris prolapse
c)     Hyphaema
d)    Posterior capsular tear

SICS Complication

Post operative complications of SICS:
a)     Raised IOP (Intra Ocular Pressure)
b)    Iris prolapse
c)     Wound leak
d)    Acute bacterial endopthalmitis

Steps of small incision cataract surgery (SICS)



SICS also known as small incision cataract surgery, is a popular method of cataract extraction in under developed country. Every year through the world many people suffer from cataract. Many of them are from under developed country. SICS is a solution for them as because this method of cataract extraction is very cheap. The steps of cataract extraction and posterior chamber intra ocular lens implantation are as below;
a)     Superior rectus suture is passed to fix the eye in downward gaze
b)    Conjunctival flap and exposure of sclera
c)     Homeostasis is achieved by applying gentle and just adequate field cautery
d)    Sclero corneal tunnel incision

SICS

e)     Side port entry of about 1.5mm valvular corneal incision is made at 9 o’ clock position
f)      Anterior capsulotomy
g)     Hydrodissection
h)    Nuclear management – Prolapse and delivery of the nucleus outside
i)       Aspiration of the cortex
j)       IOL (Intra Ocular Lens ) implantation
k)    Removal of the viscoelastic material
l)       Wound closure



Thursday, February 2, 2017

Hepato Renal Syndrome

Hepato Renal Syndrome:

Hepato Renal syndrome is a severe condition usually occurring in chronic liver disease patient. Actually Hepato Renal syndrome occurs at the very end stage of chronic liver disease and the mortality rate of the patients, when hepato renal syndrome developed is very high. In short we can describe hepato renal syndrome as detoriation of the renal function at the late statage of chronic liver disease or fulminant liver failure.

Mechanism of Hepato Renal Syndrome (HRS) development:

The actual mechanism of the development of hepato renal syndrome is not so clear. It is thought that multiple factors play role inn the development of hepato renall syndrome. Constriction of the renal blood veasels is the main of them. Why the constriction of the renal blood vessels occur? The answer is not so clear. It is believed that activation of systemic vaso constrictor agents and the inactivation of the systemic vaso dilator agents are responsible for this. Though the renal blood vessels are constricted, there are no changes are seen in renal parenchyma.


The histological findings of the renal parenchyma appears to be normal where the histological picture of liver shows total loss of normal architecture.
In hepato renal syndrome there is a complete inverse relationship is seen between renal plasma flow and glomerular filtration rate. Though renal plasma flow is decreased, Glomerular filtration rate is still increasing. This is may be due to a very minimal and microscopic damage to glomerular basement membrane.