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Pediatric Cardiac Surgery

Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.


Blepharoplasty, also known as an eyelift, removes excess skin and fat in the upper eyelids and excess fat in the lower lids. The procedure can also be done on just the upper or lower eyelids. It may be accompanied by an eyebrow lift and cheek lift as well. This procedure is also done for cosmetic beautification but is commonly done for treatment of Ptosis.

Ptosis is the abnormal drooping of the upper eyelid to a level such that it covers part of the eye, restricting or obscuring vision. It is also called as ‘drooping eyelid’ or ‘blepharoptosis’.

Droopy eyelids interfere with vision and can lead to headaches from straining to elevate the eyelids. It is very important that the disorder is treated as soon as possible, before it begins to interfere with one’s vision. This is especially important in children, whose vision is still developing.

There are two types of ptosis: acquired and congenital.

Acquired ptosis is the most common type, and is usually due to the muscles that elevate the eyelid becoming weak, thin, or stretched. Congenital ptosis is present at birth and is usually due to the lack of development of the eyelid muscles called levators.

Symptoms of a Droopy Eyelid
The most obvious symptom of ptosis is the drooping eyelid itself. Other symptoms include difficulty shutting or opening the eye, extra skin on or around the eyelid, or the need to tilt your head back in order to see better. Eye fatigue, misaligned eyes, or double vision can also accompany ptosis. Many experts recommend that you compare a photo of yourself from ten years ago to a recent one to see if there is a difference in your eyelids.

Risk Factors for Ptosis
A variety of factors may increase your risk for developing ptosis or passing it on to your children. They include:

  1.  Aging
  2.  Family history of condition
  3.  Birth injury
  4.  Eye surgery such as cataract
  5.  Paralysis of nerve fibres in eyelids
  6.  Diabetes
  7.  Stroke
  8.  Horner’s syndrome
  9.  Head or eyelid trauma
  10.  Tumor in the upper lobe of a lung
  11.  Brain tumor
  12.  Muscular dystrophy
  13.  Myasthenia gravis

Treating a Droopy Eyelid
If symptoms of ptosis are mild, treatment may not be necessary. Specific treatment is usually directed towards the underlying cause. In some mild cases, eye exercises may strengthen weak muscles and correct the problem. Other times, special glasses may be used. These glasses have a crutch attached to hold up the eyelid. In moderate to severe cases surgery may be the only option to correct the eyelid. This may be done with a surgical procedure called blepharoplasty.


Cataract is the clouding of the lens of the eye. Though it can occur at any age but it is the leading cause of vision loss in people over age 55. More than half of people over age 65 have some degree of cataract development.

Other reasons may be prolonged use of steroids, exposure to ultra violet and associated health problems like diabetes and eye injuries. Person with diabetes, smoke, or have a family history of cataract, excessive exposure to sunlight, serious eye injury or inflammation, prolonged use of steroids have increased risk of cataract.

When cataract develops person feels blurry vision, faded colors, glare, difficulty in seeing at night and double vision, eye strain, headache and frequent change of glasses. One should not ignore the early symptoms and get a check-up of the eyes by eye specialist. Ignorance may lead to complication.

At early stage of cataract, new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses may help but if these measures don’t improve your symptoms, the only effective treatment is surgery, which involves removing the cloudy lens and replacing it with an artificial lens.

Surgery is the only known effective treatment for cataract removal and is one of the safest and most effective types of surgery, with a success rate of about 90 percent. All cataract surgeries are aimed at removal of the cloudy natural lens and replacing it with an Intra Ocular Lens (IOL). These lenses can be inserted through a small 1.8 to 2.8 mm opening. With this small incision foldable lenses are implanted into the eyes. Thus there is no need of full day admission, injection, stitch and patching of the eye. One can go for surgery in any season and resume once duties on a very next day.

With the technological advancement today we have a great choice of lens. Aspheric lens work like a natural human lens, cylinder number can be corrected by

Toric IOL and a person will be glass free with Multifocal lenses. They are explained in detail as below:
Aberration free/ Aspheric IOLS
These IOLs gives good quality of vision post-operative due to the lens design, it also improves the contrast sensitivity of the patient and good night vision. These lenses also filter the harmful UV light and blue light which are said to be harmful to the retina.

Toric IOLS
These IOLs correct the pre-existing corneal astigmatism there by reducing the possibility of spectacle wear for distant vision post operatively.

Multifocal IOLs
These IOLs provide clear vision for all distances hence almost 90% of the day-to-day activities can be performed without the need for additional glasses. Rarely the patient may experience glare during nights post operatively but usually gets adapted within a few months.

Accommodating IOLs
These IOLs have flexible hinges that enables them to change focus for different distances hence providing clear distance, intermediate and near vision without glasses.


Glaucoma is an eye disease that causes damage to the optic nerve. In this disease, eye pressure causes damage to the optic nerve fibres that leads to gradual loss of peripheral visual field, finally leading to blindness. Glaucoma is the second leading cause of blindness throughout the world. Vision loss caused by glaucoma is irreversible. It is estimated that half of the population affected by glaucoma may not know that they have the disease.

Although, high pressure within the eye also known as intra-ocular pressure (IOP) is one of the most important risk factor for development of glaucoma, but other risk factors must also be involved because even people with normal IOP can have the disease. It is well known now that glaucoma has to do something with the mechanical compression of the optic nerve or reduced blood flow to the nerve.

Glaucoma is also called as ‘Sneak Thief of Sight’ since there are no warning signs of the disease. Vision loss routinely begins in the periphery. You may compensate for this unconsciously by turning your head on the side of vision loss and may not notice anything until significant central vision is lost.

Sometimes patients may experience mild to severe headache, eye pain, and fuzzy vision and may see rainbow colours around light. These symptoms may indicate increase IOP. People who have frequent changes in glass power should also get checked themselves for glaucoma.

There are various risk factors for development of glaucoma which include increasing age, family history of glaucoma, myopia, use of steroids, injury to the eye and uncontrolled diabetes and high blood pressure.

Early detection of the disease through regular and complete eye check-ups is the key to protect you vision from glaucoma. Various eye tests which are done to diagnose glaucoma include following:

  1.  Tonometry to check the pressure within the eye. Applanation tonometer is the most reliable instrument for glaucoma patients.
  2.  Perimetry to check the visual fields
  3.  Gonioscopy to test if the angle inside the eye is open or closed
  4.  Dilated fundus evaluation to see the characteristic glaucomatous changes in the optic nerve head. Sterioscopic fundus photographs can also be done to monitor the changes in optic nerve over years
  5.  Higher imaging modalaties like OCT, GDx, HRT which help in the diagnosis of preperimetric glaucoma
  6.  Pachymetry to measure central thickness of the cornea

Once diagnosed as glaucoma patient, you require lifelong treatment. If detected early, the disease can be successfully controlled, thereby preventing any vision loss. Treatment modalities for glaucoma include eyedrops, lasers and surgeries. Even when medications have successfully controlled the IOP, it is important to monitor the condition by periodical checkups and visual field testings. If despite the medical treatment, glaucoma is not coming under control, surgery can be done to control the pressure, where a new channel is formed in the eye through which the fluid from inside the eye is drained out. Use of antimetabolites during surgery and glaucoma drainage devices (Ahmed glaucoma valve, Express shunt) are the newer advances, which increase the success rate of glaucoma surgery.

Refractive Surgery

For clear vision, the eye’s cornea and lens must bend (refract) light rays properly, so that images are focused on the retina. If the light rays aren’t clearly focused on the retina, the images you see are blurry. This blurriness or refractive error is caused by an imperfectly shaped eyeball, cornea, or lens. LASIK is a surgical procedure that can eliminate a person’s dependency on glasses or contact lenses by permanently changing the shape of the cornea of the eye. It uses an ultraviolet laser to precisely remove corneal tissue to correct the shape for better focusing.

LASIK (laser-assisted in-situ keratomileusis) is today’s most popular surgical procedure for correcting vision problems caused by refractive error, the failure of the eye to properly focus light. Laser vision correction can correct myopia (short sight) upto -9.00 D, Hyperopia (long sight) upto +6.00 D, and astigmatism upto 6.00 D.

Indian Hospitals are equipped with the advanced software system for laser vision correction in which the treatment can be personalized for each eye of the patient.

A personalized zyoptix treatment (Customized LASIK) corrects the refractive errors to great accuracy and provides best quality of vision by additionally correcting the optical aberration of the eye. A tissue saving zyoptix, as the name suggests, corrects the required power using lesser amount of corneal tissue, thus can correct more refractive error in thin corneas. An Aspheric Zyoptix has the double advantage of correcting spherical aberration of the eye as well as maintaining natural corneal shape.

Intra Ocular Surgeries
Implantable Contact Lens (ICL) – ICL corrects higher degree of refractive error which cannot be done by laser treatments. Implantable contact lenses (ICL Spherical / Toric) is surgically implanted in the eye between the iris and the natural crystalline lens through a small corneal incision.

Refractive lens exchange – In refractive lens exchange surgery the natural crystalline lens of the eye is replaced with an artificial Intra ocular lens (IOL) to achieve sharper focus, rarely it is opted for young people with very high powers. The surgical procedure is almost the same as cataract surgery and is done under local/topical anaesthesia.

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