::Departments : Clinical : Department of Ophthalmology
                     
          Our First Ophthalmic ward was opened by Sri K. KAMARAJ NADAR, Chief Minister on 20-10-1956.        
Our Hospital is the tertiary care centre for the surrounding 4 districts.      
 
           The Ophthalmology department functions in a separate block accommodating the Outpatient/Inpatient and Operation Theatres. We have 2 Major operation theatres and one Minor operation theatre.
 
           We see around 35,000 outpatients per year and operate on more than 4000 patients per year.
 
            We have trained faculty for Cornea, Oculoplasty, vitreo retinal surgery, low vision aids, and Medical Retina.
 
            We perform surgeries on all 6 days a week. The surgeries performed are for Cataract (SICS /Phacoemulsification), Keratoplasty, Oculoplasty, Anti glaucoma Surgeries and Surgeries for Peadiatric cataract, and Retina.
 
           We have Special Clinics for Glaucoma and Nd YAG Laser for doing laser iridotomy and capsulotomy. We screen for Retinopathy of Prematurity for infants in NICU and screen for diabetic retinopathy in the diabetic outpatient department.
 
We have Green Laser to treat for retinal diseases (ROP and DR). Being a tertiary care centre with super specialty hospital we attend to number of Trauma and Neuro-Ophthalmology patients.    




 
Services Offered :  
Number of units in the Dept. One
OP Days and Timings Monday to Saturday 8 AM to 12 Noon
IP Unit and Admission Day Single Unit in all days
Bed Strength of Department 60 Beds.
Average OP Statistics 150 / day
Average IP Statistics 750 / Month
Type of Surgeries Performed Emergency :
1.Corneal Tear Suturing
2.Ruptured Globe Suturing
3.Lid Tear Suturing
 
Elective :
1.Cataract Surgery
2.Glaucoma Surgery
3.Keratoplasty
4.Dacryocystectomy
5.Incision & Curretage for chalazian
6.Oculoplasty –Lid reconstruction, tumor Excision
7.Intravitreal Injection
8.Pterygium excision
9.Ectropion ,Entropion—Correction
10.Tarsorrhaphy
11.Enucleation
12.Evisceration
13.Amniotic membrane grafting
14.Orbitotomy
 
 
 
 
 
 
Special clinics Conducted  Glaucoma clinic / Cornea clinic
List of lab test done Keratometry, A-scan biometry,
B-scan, Indirect,
Ophthalmoscope,Tonometry
 
Other Special test or Modalities of Treatment  B Scan, Automated perimetry
Objective, Eligibility, procedure to get the facility and list of Surgeries covered under CM Health Insurance Scheme The List is Enclosed
Management  team  Categorization of waste and training on Bio Medical Waste
Management
All the Assistans,CRRI’S, Staff nurses and Student nurses
 
 
Surgeries Covered Under CMCHIS
CORNEA PROCEDURES
1.Therapeutic  Penetrating Keratoplasty
2.Lamellar Keratoplasty
3.Cornea Patch Graft
4.Scleral Patch Graft
5.Penetrating Keratoplasty
6.Collagen Cross Linking For Keratoconus
OCULOPLASTY PROCEDURES
1.Double Z-Plasty
2.Amniotic Membrane Graft
3.Sockt Reconstruction
4.Dermis Fat Graft
5.Orbitotomy
6.Enucleation With Orbital Implant
7.Lid Reconstruction Surgery
VITREORETINAL PROCEDURES
1.Removal Of Silicon Oil Gas
2.Vitrectomy
3.Vitrectomy-Membrane Peeling-Endolaser
4.Monthly Intravitreal Anti-Vegf.Injection For Macular Degeneration-(Maximum 6)
5.Vitrectomy-Membrane Peeling-Endolaser,Silicon Oil
6.Scleral Buckle For Retinal Detachment
7.Photocoaogulation For Diabetic Retinopathy Per Sitting
8.Vitrectomy Plus Silicon Oil Or Gas
SQUINT PROCEDURES
1.Rectus Muscle Surgery (Single)
2.Rectus Muscle Surgery (Two/Three)
3.Oblique Muscle
PAEDIATRIC PROCEDURES
1.Peadiatric Cataract Surgery (Phacoemulisification-IOL)
2.Photocoagulation For Retinopathy Of Prematurity
3.Glaucoma Filtering Surgery For Pediatric Glaucoma
ADULT GLAUCOMA PROCEDURE
4.Adult Glaucoma Surgery,Trabeculectomy,Implant Surgery


Academic Activities

75 days clinical posting & 100 hrs of theory classes for prefinal year MBBS Students are
handled by Department faculty.
1. 100 hours of theory class.
2. 75 days clinical classes
                    a. students are taught to examine the patients and make clinical diagnosis and to       
                        present the case. 
                    b. Observe surgeries in operation theatre.
3. GROUP DISCUSSION on every Friday.
4. We are conducting 3 Symposium for pre-final year students.
CME: Our department conducted CME on Comprehensive Ophthalmology on 22-6-2016.
We conducted quiz programme for undergraduates and gave prizes to first three team winners.
C.R.R.I:
     All undergraduate students undergo training in Ophthalmology during their internship for 15 days. Once in a week we have group clinical discussion about interesting case .
NURSING STUDENTS:
     Diploma & Bsc nursing students attend eye OP for their clinical Posting.
     Theory classes are also taken by department faculty.
LIBRARY:
     A spacious and furnished library with books and journals are available in our department.



CENSUS 
                                 
YEAR                         OP CENSUS                   IP CENSUS
MALE FEMALE CH TOTAL MALE FEMALE CH TOTAL
2013 9667 9878 1575 21,120 1879 2808 17 4,704
 
2014
 
11,031 10,302 1435 22,768 1877 2851 54 4,782
2015 16804 15058 1736 33,628 1735 2472 17 4,224
2016-TILL
JUNE16
7080
 
6901
 
919
 
14900 808
 
1201
 
2
 
1982
 
 


 OT & LASER CENSUS – 2013 -2016- Till date
2014
 
4233 91 18 86
15  
4015
 
313 46 126
2016-TILL JULY,16 1890 154 55 181
 

 
 

















May
MONTH                         OP CENSUS                   IP CENSUS
MALE FEMALE CH TOTAL MALE FEMALE CH TOTAL
MAY 930 1031 147 2108 132 221 1 335


Ravindar Kashyap T., Prefinal year student got selected for the essay Competition for his write up on “Advancements in cataract surgery”.
The topic given to him in the final round was “The best way to eye Donation – your opinion” and he was appreciated for his language  and won the 1st  Place in K A P Vishwanathan Medical College, Trichy
held on 2014-2015.


INTERSTING CASE REPORT FOR THE MONTH OF MARCH- 2017         
                         Menaka, 27 years old lady reported to our department with complains of redness,
Swelling and pain in left eye for 2 weeks,  then developed headache, giddiness, weakness in right upper
and lower limb and deviation of angle of mouth towards left side. H/O low grade fever intermittent,
associated with chills present.
Her vision was: BE: 6/6
 On Ocularexamination, RE-Normal, LE shows proptosis, conjunctival congestion, bruit & thrill present
 extra ocular movements showed RE-full & LE abduction restricted, Fundus BE-Normal.
Diplopia charting shows horizontal uncrossed & lateral rectus palsy – left abduscent nerve palsy.
General examination showed angle of deviation of mouth towards left side, power 3/5 in upper and    
lower limb, tone increased in upper and lower limb.
                                 

Investigation showed blood investigations were normal. ECHO &ECG were normal
MRI and MRA & V Brain- medium sized acute infarct in Left ganglia capsular region,
                     Moderate to severe stenosis noted in the cervical segment & cavernous region – left ICA
                     Wall thickening intra orbital part of right ICA
                  
                                   
It’s a case of Carotico cavernous fistula with abduscent nerve palsy treatment given for stroke and patient is on regular ocular and neurological follow up.
CAROTICO CAVERNOUS FISTULA
Carotico cavernous fistula is an Abnormal communication between previously normal carotid artery and
cavernous sinus characterized as: Direct & Indirect, High & Low Flow and Traumatic & Spontaneous .
 
Causes are due to
1. Trauma in 75% of all cases
–        Basal skull fracture tears ICA within cavernous sinus
–        Traumatic fistulae-high flow rates, sudden and dramatic onset of symptoms
2. Spontaneous rupture of aneurysm or atherosclerotic artery in 25%
Neurofibromatosis, atherosclerotic disease and collagen vascular disease            
               3. Iatrogenic
Arterial blood passes directly through a defect in the wall of intracavernous portion of ICA Blood in vein becomes arterialized,Venous pressure increases and Arterial pressure and perfusion decreases
Ocular manifestation includes : Pulsatile Proptosis, Ptosis, Very red, chemotic congestion, Increased IOP from increased episcleral venous pressure. Anterior segment ischemia in 20% -Corneal edema, cell/flare, iris atrophy, rubeosis, cataract, Bruit and thrill, Muscle palsies, .Visual loss
Ophthalmic consequences of CCSF are caused by compression and ischemia related to increased venous pressure and reduced arterial pressure, flow reversal leads to engorged ophthalmic veins causing proptosis, conjunctival injection, chemosis.  Patients complain of retro-orbital headache, or a bruit.  Facial pain with V1 and V2 involvement
Angiography is the definitive diagnostic examination
CT and MRI may show
–        Enlarged superior ophthalmic vein
–        Enlarged muscles
–        Enlarged cavernous sinus with a convex shape to the lateral wall
Most are not life-threatening
–        Only involved eye is at risk typically
Main indicators for treatment
–        Glaucoma
–        Diplopia
–        Intolerable bruit or HA
–        Severe proptosis causing exposure keratopathy
–         
99% of treatment is done by interventional neuroradiologists -Intravascular approach-placement of thrombogenic materials, eg coils
Other therapies include:
-          carotid artery ligation
-          surgical exposure with clipping of the fistula
-          Transarterial embolization.
 
 
 

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