Management Of Pcu

MANAGEMENT OF

PERFORATED COR NE AL UL CE R Under Supervision Of :

Dr. Mahmoud Yousif

DEFINITION • Corneal ulcer is discontuity of the anterior corneal surface.

CAUSATIVE AGENT • • • • •

Bacterial : staph.,Strept.,Pneumococci Viral : H.S.Virus Fungi : Candida albican Protozoal : Acanthamoeba Chlamydial : Chlamydia trachomatis

Bacterial culture

DIAGNOSIS • Slit lamp revealing the ulcer on the cornea.

DIAGNOSIS • fluorescein stain helps in defining the margins of the corneal ulcer, and can reveal additional details of the surrounding epithelium

DIAGNOSIS • Rose-Bengal dye : used for supra-vital staining purposes, but it may be very irritating to the eyes.

DIAGNOSIS

DIAGNOSIS

COMPLICATIONS

COMPLICATIONS

COMPLICATIONS

COMPLICATIONS

COMPLICATIONS

COMPLICATIONS

1-MEDICAL TREATMENT • 2. 3. 4. 5.

Local treatment : Atropine sulphate Bandage Antibiotics Hot fomentation

1-MEDICAL TREATMENT •

General treatment :

2. Systemic Antibiotics 3. Vitamins 4. Rest in bed 5. Avoid straining : By laxatives and anti tussives

2-SURGICAL TREATMENT 1. Conjunctival flaps or graft Principle: All types of conjunctival flaps consist of thin conjunctival tissue transposed onto the cornea to cover the lesion. Value: Conjunctival flaps provide corneal support, fibrovascular tissue to fill corneal defects, and bring blood supply

3-SURGICAL TREATMENT •

Conjunctival flaps or graft

2-SURGICAL TREATMENT •

Amniotic membrane grafts

Principle: Separate amniotic membranes were transplanted as material to fill the stromal layer (amniotic membrane filling), as a basement membrane (amniotic membrane graft), and as a wound cover (amniotic membrane patch

2-SURGICAL TREATMENT •

Amniotic membrane grafts

2-SURGICAL TREATMENT 1. Penetrating Keratoplasty : Objectives Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes

2-SURGICAL TREATMENT 1. Penetrating Keratoplasty :

2-SURGICAL TREATMENT 4. Deep lamellar keratoplasty Objectives : an alternative option to PK in inflamed eyes owing to its potential for a lower incidence of rejection

2-SURGICAL TREATMENT 4. Deep lamellar keratoplasty

2-SURGICAL TREATMENT 1. Human Fibrin Glue Princible: similar to those of the coagulation cascade, with final formation of a fibrin clot

3-SURGICAL TREATMENT •

Human Fibrin Glue

3-CAUSAL TREATMENT 1. Treat the predisposing factors : e.g.: - Epilation of rubbing lashes - Removal of P.T.D.s - Control D.M.

5. Treat the precipitating Factors : e.g.:- blepharitits - conjunctivivtis - Chronic dacryocystits

‫‪Presented By :‬‬ ‫‪ -608‬مروة وجيه طه فرج‬ ‫‪ -602‬مروة محمد أحمد مليحة‬ ‫‪ -609‬مريم ماهر حليم‬ ‫‪ -603‬مروة محمد شتا‬ ‫‪ -610‬مريم نشأت المحلوي‬ ‫‪ -604‬مروة محمد صبحي‬ ‫‪ -611‬مريهان عبد العليم‬ ‫‪ -605‬مروة محمود الطويل‬ ‫‪ -612‬مسلم ابراهيم نعيم‬ ‫‪ -606‬مروة مصطفى الشوح‬ ‫‪ -607‬مروة مصطفى زكي حراز ‪ -613‬مشيرة اسماعيل‬ ‫‪ -614‬مصطفى أحمد أحمد‬ ‫عبدالقادروالى‬