Following are some of the other surgeries performed by Dr. Kshipra Aphale

Glaucoma Surgery

Glaucoma means increased eye pressure. As we have some normal range of our blood pressure, we have safe range of our eye pressure also. The normal eye pressure should be between 10.2 and 20.6 mm of Hg. Increased eye pressure is harmful to the optic nerve and causes permanent damage to the optic nerve. and hence to the vision. This high eye pressure causes slow and painless damage to the optic nerve, which may not be noticed by the patient for a long time. Hence is it a slow killer of vision. It is detected by the eye surgeon on routine eye checking which includes checking of eye pressure. As it causes permanent blindness it is important to prevent the damage to optic nerve by early detection. It is common after the age of 40 years, so every person above this age must get his eye pressure checked at least once a year.

The pressure can be reduced with the help of various drops and surgery is rarely needed now-a-days. Surgery involves alternate filtering passage for the fluid in the eye. It can be done either with a laser or surgically at Dr. Aphale's Eye Hospital.

Squint surgery

The two eye balls are normally parallel to one another. The imaginary lines passing through the centres of both the eyeballs are all the time parallel in any position of our gaze. there are 6 muscles on the eyeball which move synchronously and move and maintain the eyeballs in parallel position. If they cease to be parallel in primary position, i.e. looking straight ahead, or while looking in any other direction that condition is called squint.

Squint can happen because of difference in spectacle number in both the eyes or due to incurable long standing blinding problem in one eye ,or perhaps due to paralysis of any of the eye muscles responsible for movement of eyes; or by birth or after fever.

The treatment of squint depends on the cause. The squint due to difference in spectacle number can usually be corrected by giving specs of proper numbers. Squint due to some incurable blinding disease usually can be corrected only temporarily, cosmetically.

Squint due to paralysis of muscles by birth can be operated successfully so as to get parallelism between the two eyes. Decision of surgery should be taken after a detailed eye examination.Squint surgery involves cutting or repositioning of either of eye muscles out of six muscles responsible for the movement of eyes. Field of surgery is strictly out of the eye and vision or internal parts of the eyes are not likely to be damaged because of this surgery.

There are chances of under correction or over correction of squint but that can be overcome by newer techniques of adjustable stitches which allows subsequent adjustments.

Correction of abnormalities of lids

Ptosis is drooping of an eyelid. It could be in one eye or in both eyes. The patient is unable to lift the eyelids totally or partially. It is because of paralysis of the muscle in the eye lid which is responsible for lifting the eye lid. (called levator palpebri superiasis - LPS).

The correction of this is possible. This is done by shortening of LPS muscle or when it is totally paralysed, a forehead muscle can be attached to the lid from inside (frontalis sling). This attachment is achieved by using natural material like that from thigh muscle or artificial decron mesh.

The results are rewarding though achieving nature's beauty and symmetry is not always possible.

Probing- for constant watering in children - for correcting watering of eye in a new born baby.

There is a tear passage tube in nose which is normally open at the time of birth. In some babies it remains unopened and in these babies excess tears flow out of the eyes and there is constant discharge. Normally the tube - nasolocrymal tube, opens up within a year, so no surgical intervention is needed. It may cause an infection and that has to be treated with proper drugs( eye drops) and massage from above to down along the tear passage to facilitate the opening of the passage. If the passage remains unopened even after a year, it needs to be opened by an operation.

It is a simple procedure to open the passage. It involves use of a thin metallic probe along the passage under light general anesthesia. Usually it solves the problem, but in some cases it needs repetition and if there is a bony obstruction in the passage, a surgery like DCR as given below may be needed.

Dacryocystorhinostomy (DCR) that is correction surgery for constant watering of eye

It is an operation to create alternate passage for the tears from eye to nose for those patients who have constant watering of eye because of blockage of the natural passage. It is a major operation involving creation of hole in the nasal bone and suturing together tiny flaps of tear sac and nasal skin. It demands high skill, but the results are quite rewarding in Dr. Aphale's Eye Hospital. The operation does not leave any facial scar.

There is a minor operation commonly done for this problem which is called dacryocystectomy which though reduces watering can not completely stop it, as the tear sac is totally removed in this operation. A short cut method for DCR is done through the nose which does not involve suturing of the flaps, hence its results are not very rewarding, especially in the long run.

YAG laser

In some patients, a few months after cataract surgery, supporting capsule to the artificial lens can become opaque and cause blurring of vision. This capsule can be cut with YAG laser and patient can regain vision without further operation.

This procedure takes three to five minutes. It is done in sitting position under anesthetic eye drops. It is painless. Patient regains vision after 2 to 3 days. No special diet or movement restrictions are required.

Chalazion

- This is a localised swelling of lid which is firm in consistency and remain there for a long time without causing pain.There is a row of 11-12 glands inside the lid and they open at lid margins. These openings get blocked and the secretions of the glands remains inside the glands, as the outlet is blocked. The secretions get infected and both of them lead to swelling of the gland.

A very small, 5 minute surgery under local anesthesia can give relief to the patient without any significant pain. Surgery involves a tiny cut from the inner side of the lid which avoids external marks. The cut is exactly on the swollen gland and it is followed by curetting of the content of the gland. No tablets or drops can successfully treat this.

If chalazion is untreated, it can develop acute infection and start giving pain. It can burst from outside and leave an ugly scar. The infection can spread to adjacent glands and they also develop similar problems.

Pterigium

This is a vascularised whitish mass that grows from white part (conjunctiva) of the eye, on to the cornea.

This is usually slow growing and may not encroach much upon the cornea but sometimes it does encroach. If it does and starts approaching the centre of the eye, it can threaten the vision. It is more common in those geographical areas where there is more of sunlight, though its exact cause is not known. It is a degenerative condition of the conjunctiva.It is treated with excision of the this extra mass. High degree of skill is required to remove this white mass without making any scars, though it may not always be possible if the pterigium is deeply seated.

As this is a degenerative tendency of conjunctiva, it can recur. Various procedures are coming up to prevent recurrence .

Trauma

Sometimes a branch of a tree, nail, pencil tip ,a chip of metal during metal cutting, toy arrow, sharp object during accident, fight or sport; can lead to laceration of the cornea, prolapse of contents of the eye through it, cataract and hence danger to the vision.However grave the injury, a timely management of it with medicine and surgery can improve the chances of survival of the eye. Trauma of anterior chamber has better chances of recovery. Many patients with such injury along with corneal cut and cataract have been successfully managed at the Aphale Eye Hospital, with excellent results. Corneal wound stitching, vitrectomy, cataract removal with lens implant have been done with good results.

The trauma due to impact of a ball or a result of a heavy fight can lead to detachment of retina and needs attention of a retinal surgeon. immediate treatment should be sought of an ophthalmologist but the prognosis remains guarded.

Foreign Body on cornea is a very common condition especially while working on grinding or cutting machine, and driving two wheelers. The Foreign Body needs to be removed as soon as possible, by an ophthalmologist, under high magnification (slit lamp) so that there should be minimal trauma to the cornea. It needs to be followed by sterile pad application on eye till the wound heals. Entry of chemicals (gaseous or liquid) can lead to serious injury to the eye and may need hospitalisation and meticulous treatment, but the first aid treatment for this problem is very important. It will be useful to wash the eye thoroughly with saline water or by tap water., while rushing to the eye surgeon.

Keratoplasty (Cornea transplant)

Many people are blind because they have whitening of their front part of the eye called cornea. Some of the causes of such whitening are eye injury, infections, chemical burn, by birth, post cataract surgery. or some old age conditions.

These patients have bad ,opaque cornea which do not allow the light to pass through into the eye and hence have poor vision. But the other parts of the eye may be in good condition. This front part of the eye can be replaced with cornea of a some other dead person's (donor's) eye ball. The donor's eye ball is collected when a person has donated his eyes after death.

A circular button of the recipient's (the blind patient's) cornea is removed and replaced with the same size circular button of the donor's cornea . If the graft is taken up by the recipient's cornea. it remains clear and the patient can see clearly.There are chances of graft rejection though with the recent drugs and good follow up, the chances of rejection can be lowered.

Dr. Aphale Eye Hospital offers eye bank service and can accept eye donations. Interested people may download form or contact phone +91-22-2547 4995

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