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THE EXCHANGE | Newsletter March 2020

THE EXCHANGE | Newsletter March 2020

20/20 Vision Restored in a Young Lenticonus Patient using Femtolaser Assisted Cataract Surgery with Trifocal Lens

Femtolaser assisted cataract surgery  (FLACS) has brought unprecedented precision and accuracy in cataract surgery

FemtoLaser Assisted Cataract Surgery (FLACS) using LenSx

Evolution in the intraocular lenses (IOL) with the addition of trifocal lenses has made possible for patients to achieve a spectacle free vision after cataract surgery.

Recently, a patient with Alport syndrome wherein the patient had kidney problem, hearing loss and abnormal lens due to a genetic defect in production of a type of collagen came to Medanta - Gurugram. The abnormal lens had caused poor vision since childhood. The patient had lost any hope of vision despite consulting multiple centres.

This 28-year-old male patient had come to Medanta for his kidney biopsy for suspected Alport syndrome and was referred to the Division of Ophthalmology for his eye condition. On examination the patient was found to have abnormal lens capsule in the form of a cone – referred to as lenticonus in both eyes.

Slit lamp photograph of the eye showing central conical protrusion in anterior lens capsule

This was causing very high myopia with irregular cylindrical power in the eye and vision could not be corrected even with high powered spectacles. His best vision, even with glasses, was 20/200 (6/60) in both eyes. Since the abnormal lens with the central conical capsule was the cause for the vision loss, this patient was offered lens extraction using the FLACS technology. FLACS offered a significant advantage in this patient as a conventional phacoemulsification surgery would have complications with respect to capsulorrhexis.

7 Ways doctors can protect themselves

  • Compel patients with respiratory infections to wear a mask. Do not allow them to wait among other patients in the OPD.
  • Provide supplies for respiratory hygiene – 60-95% alcohol based hand sanitizer, tissues, facemasks in the OPD.
  • Suspected patients should be immediately referred to government authorized centres.
  • Regularly clean hands using alcohol based hand sanitizers or soap and water for 20 seconds.
  • Wear clean gloves, respirators and eye protection.
  • Use caution while examining patients with respiratory symptoms or performing procedures

that can make a patient cough.

  • Train OPD staff on personal protective equipment and respiratory hygiene.

Gear up your ER for Festive Season

Cannabis smoking and bhang drinking is a social norm in the month of March owing to extended Holi celebration. Lot of patients with symptoms of food poisoning report to emergency with altered mental status, abnormal behaviour and vomiting during the festival.

ER doctors are often faced with the dilemma of diagnosing whether the condition is a result of unhygienic food intake or due to intoxication caused by bhang or alcohol consumption. Triaging is done based on the symptoms wherein mostly fluids are given with antiemetics and anxiolytics. In some cases, intoxication does not get addressed properly and the condition of the patient worsens.

The proper approach to treat unknown intoxication or food poisoning caused due to ingestion of toxic substance as per the WHO guideline is acronymed as the DR ABCDE.

Danger to be identified to prevent further harm

Rescue call to toxicologist to investigate and intervene

Airway to be secured to prevent aspiration of vomitus

Breathing to be supported by bag and mask ventilation

Circulation to be maintained by intravenous fluids and
inotropic support

Decontamination of whole body and detoxification of stomach contents within one hour of ingestion

Exposure of whole body to identify missed out injuries or injection marks, venomous animal bites or stings

An important aspect of addressing intoxication is decontamination of the ingested toxin (bhang/alcohol) and detoxification by whole body bath. This can help in easy rescue in case of mass casualties during the festive season.


Medanta Medical Team
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