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Ulcus Rodens! Part 2

๐Œ๐จ๐จ๐ซ๐ž๐งโ€™๐ฌ ๐”๐ฅ๐œ๐ž๐ซ ๐Œ๐š๐ง๐š๐ ๐ž๐ฆ๐ž๐ง๐ญโฃโฃโฃ โฃโฃโฃ ๐’๐ญ๐ž๐ฉ๐ฐ๐ข๐ฌ๐ž ๐€๐ฉ๐ฉ๐ซ๐จ๐š๐œ๐กโฃโฃโฃ โฃโฃโฃ The goal of therapy is to โ€‹arrest the destructive process and to promote healing and reepithelialization of the corneal surfaceโฃโฃโฃ โฃโฃโฃ 1. ๐˜›๐˜ฐ๐˜ฑ๐˜ช๐˜ค๐˜ข๐˜ญ ๐˜ค๐˜ฐ๐˜ณ๐˜ต๐˜ช๐˜ค๐˜ฐ๐˜ด๐˜ต๐˜ฆ๐˜ณ๐˜ฐ๐˜ช๐˜ฅ๐˜ด to control the inflammationโฃโฃโฃ โฃโฃโฃ 2. ๐˜Š๐˜ฐ๐˜ฏ๐˜ซ๐˜ถ๐˜ฏ๐˜ค๐˜ต๐˜ช๐˜ท๐˜ข๐˜ญ ๐˜ณ๐˜ฆ๐˜ด๐˜ฆ๐˜ค๐˜ต๐˜ช๐˜ฐ๐˜ฏโฃโฃโฃ โ— Conjunctiva adjacent to the ulcer contains inflammatory cells that may be producing antibodies against the cornea and cytokines which amplify the inflammation and recruit additional inflammatory cells.โฃโฃโฃ โ— Conjunctival excision to bare sclera extending at least 2 clock hours to either side of the peripheral ulcer, and approximately 4 mm posterior to the corneoscleral limbus and parallel to the ulcer. The overhanging lip of the ulcerating cornea can also be removed.โฃโฃโฃ โฃโฃโฃ 3. ๐˜š๐˜บ๐˜ด๐˜ต๐˜ฆ๐˜ฎ๐˜ช๐˜ค ๐˜ช๐˜ฎ๐˜ฎ๐˜ถ๐˜ฏ๐˜ฐ๐˜ด๐˜ถ๐˜ฑ๐˜ฑ๐˜ณ๐˜ฆ๐˜ด๐˜ด๐˜ช๐˜ฐ๐˜ฏโฃโฃโฃ โ— Those cases of bilateral or progressive Mooren's ulcer that fail the preceding therapeutic attempts will require systemic chemotherapy.โฃโฃโฃ 4. ๐˜ˆ๐˜ฅ๐˜ฅ๐˜ช๐˜ต๐˜ช๐˜ฐ๐˜ฏ๐˜ข๐˜ญ ๐˜ด๐˜ถ๐˜ณ๐˜จ๐˜ช๐˜ค๐˜ข๐˜ญ ๐˜ฑ๐˜ณ๐˜ฐ๐˜ค๐˜ฆ๐˜ฅ๐˜ถ๐˜ณ๐˜ฆ๐˜ดโฃโฃโฃ โ— Superfical lamellar keratectomy โฃ โ— Application of tissue adhesive (cyanoacrylate glue) creates a biological barrier between the host cornea and re-epithelializing conjunctiva and the immune components it carriesโฃโฃโฃ โ— Amniotic membrane transplantation allows for rapid healing of epithelial defectโฃโฃโฃ โ— Small perforations can be sealed with glue and bandage contact lensโฃโฃโฃ โ— Patch graft/ Partial penetrating keratoplasty in larger perforationsโฃโฃโฃ โฃโฃโฃ 5. ๐˜™๐˜ฆ๐˜ฉ๐˜ข๐˜ฃ๐˜ช๐˜ญ๐˜ช๐˜ต๐˜ข๐˜ต๐˜ช๐˜ฐ๐˜ฏโฃโฃโฃ โ— Two stage surgical therapy โ†’ Initial lamellar tectonic grafting in the quiescent stage of disease followed by central PK in advanced cases.โฃโฃโฃ โ— Lamellar Keratoplasty is widely done - to remove necrotic cornea and to reconstruct the anatomical structure of the corneaโฃโฃ.โฃ โฃ The video shows conjunctival resection being done in the area of the ulcer and tissue adhesive being applied to create a barrier followed by application of a BCL.โฃโฃโฃ



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