Struggling With Pain After Breast Cancer Surgery? Learn More About Post Mastectomy Pain

 Breast Cancer Surgery

Breast cancer is a common cancer among women worldwide. A variety of problems can occur during treatment, and persisting pain after surgery is one such issue. It can affect 20% to 50% of women after mastectomy (operation involving removal of breast) and is defined as pain in the chest, armpit, upper arm, and shoulder persisting for more than 3 months post-surgery. Treating this pain is important as persisting pain besides causing suffering, can negatively impact on mood, sleep, activities of daily living, social interactions, and overall quality of life. Reduced working ability and financial implications are obvious consequences as shown in one study where 54% of individuals reported reducing their workload to part-time as a direct result of pain. As the survivorship is increasing, enabled by the technological advancements in medicine, the focus needs to be equally on quality of life and reducing suffering. Phantom breast sensation (where one feels that the removed breast is still present) has an even higher incidence (60-80% of patients). The actual problem and pain may be underreported due to reasons such as worries about cancer reoccurrence, barriers in discussing personal issues, fear of being misconstrued etc.

Another subgroup of patients undergoing mastectomy are those who want to reduce their risk of developing breast cancer such as those with gene mutations (e.g., BRCA1, BRCA2) and a strong family history. Advances in surgical treatment like breast-conserving approaches have enabled patients to realistically consider this option.

Who are at risk of developing persisting pain ?

Some factors associated with increased risk of persisting pain include:

Type of surgery: Nerve preservation approaches are associated with reduced incidence of sensory deficits (53 % vs. 84 %) but may not be possible in all cases.

Different breast cancer surgery options include

• Radical mastectomy – involves removing the breast, skin, fat, chest muscles (pectoralis major and minor), and all the lymph nodes of the affected side.
• Modified radical mastectomy spares the chest (pectoral) muscles when compared to the surgery mentioned previously.
• Lumpectomy with axillary node dissection involves removal of the tumour with surrounding margin of normal tissue and the axillary (armpit) lymph nodes.
• Breast-conserving surgery (lumpectomy) also known as breast preservation, conservative breast surgery, wide local excision, partial mastectomy is generally used in early breast cancer  and involves removal of the tumour and a margin of normal tissue.
• Lumpectomy with sentinel lymph node biopsy involves removal and examination of the first axillary node (sentinel node) receiving drainage from the breast. The node is identified by injection of a special dye/ radiolabeled substance prior to the operation. If this node is free of disease, axillary dissection is not required.

Axillary nodes dissection leads to increased chances of lymphedema (arm swelling due to inadequate drainage) and poses risks to one of the nerves (intercostobrachial nerve) which is responsible for the sensation of the inner aspect of the upper arm. Both of these factors can become a source of persisting pain. The wide variation in the size, location, and branching patterns of the nerve make it more vulnerable to injury. Damage may occur as a result of stretching during surgery or direct nerve injury, presenting with numbness and pain in the area supplied by the nerve. As per one study women with axillary node dissection are 3.1 times more likely to experience moderate-to-severe pain at rest.

Other nerves in the area are also at risk of injury and can become a source of persisting pain. These include 

• Medial cutaneous nerve of the arm (provides sensation to the lower medial skin of the upper arm (damaged during section of the tributaries of the axillary vein)
• Medial and lateral pectoral nerves (control the chest wall or pectoral muscles)
• Long thoracic nerve (controls the serratus anterior muscle present along the side of chest wall close to armpit)
• Thoracodorsal nerve (controls the latissimus dorsi muscle)

Other treatments like radiation therapy administered in conjunction with surgery increase risk of persisting pain. This may be due to increased tissue fibrosis, neural entrapment, and impaired shoulder movement. Moreover, radiotherapy also increases risk for lymphedema which is another reason for persisting pain. Later-stage disease also is likely to require more aggressive treatment (i.e., chemotherapy) and may be associated with higher rates of pain. Regardless these are necessary treatments and when indicated should be pursued. 

Pre-existing pain prior to surgery is one of the most consistent factors related to increased risk of persisting pain after surgery. Even those patients with unrelated pain conditions such as headaches or low back pain are more likely to develop chronic pain after surgery. 

Severe pain after the operation requiring high doses of painkillers increases the likelihood of persisting pain.

Age: In several studies, younger age was seen to be associated with greater likelihood of persistent pain. Although the exact reason is not known, some postulated factors include presence of more aggressive cancers requiring more aggressive treatment, higher preoperative anxiety, and the need for adjuvant chemotherapy in this group.

Psychosocial distress can be both a risk factor for and a consequence of chronic pain. Preoperative anxiety has been found to be related with immediate postoperative pain levels. Numerous studies have found correlations between persisting pain after surgery and depression, stress, and psychological vulnerability. 

What are the symptoms of postmastectomy pain syndrome?

Postmastectomy pain syndrome may cause persistent or intermittent burning, shooting, stabbing, pulling, tightness, heaviness sensation or aching pain in

• Chest
• Axilla (armpit)
• Arm
• Shoulder

Other symptoms in addition to pain may include

• Numbness
• Tingling or prickling pain 
• Increased sensitivity in the area
• Spasms
• Severe itching 
• Phantom breast sensation & pain

What are the causes and different types of pains found after breast surgery?

Pain may persist after surgery due to numerous reasons such as surgical injury- nerve or muscle damage, nerve entrapment, lymphedema, mechanical causes, radiotherapy and chemotherapy, post-surgical scarring, recurrence of tumour, etc. Nerve injury pain has been further divided into the following types

Phantom Breast Pain

Phantom pain is seen after amputations where the absent body part (phantom) hurts. The patient may experience sensation as if the removed breast is still present and is painful. Often patients are confused and reluctant in sharing this with others as they feel unsure if this is actually real and possible, but phantom pain is real and not just in one’s head. Controlling this can be challenging and requires a multi-modality (using many treatment options in combination) approach.

Nerve Injury & Neuroma pain

Nerve injuries can lead to the formation of neuromas which in simple language can be explained as swelling at the end of the injured nerve. These neuromas can generate spontaneous or provoked tingling, electric shock like sensation with increased sensitivity in the area. Neuroma pain may be more common following lumpectomy than mastectomy. I have come across a few cases where the patient experienced pain as if she was having a heart attack requiring multiple visits to hospital emergency whilst the actual problem was injured pectoral nerves and the pain responded to nerve blocks. 

Post-Mastectomy Pain Syndrome (PMPS)

These patients present with persisting pain and sensory abnormalities following surgery. It is more common after operations involving the upper outer portion of the breast or the underarm area. Pain may be felt in axilla, inner side of upper arm, chest wall, shoulder or the surgical scar. Intercostobrachial nerve damage which can occur with axillary node dissection is considered as a common cause. 

Mastectomy patients are also at increased risk for pain in the shoulder and/or scapulothoracic area (upper back and back of shoulder area). In one study approximately 27% of patients reported such problems even after 6 months of surgery and the possible causes can include 

• Axillary web syndrome
• Adhesive capsulitis
• Myofascial dysfunction
• Brachial plexopathy 
• Rotator cuff injury

Reduced movements and guarding can lead to further decline in function, reduced lymphatic drainage and increase in pain.

What is the prognosis of post breast cancer surgery pain and what are the treatment options?

There is paucity of good quality evidence regarding the long-term outcomes in post mastectomy pain with some studies suggesting reduction in chronic pain /sensation abnormalities whereas others reporting long term persisting pain in a significant proportion of patients. Persisting pain after surgery can be multifactorial and hence besides pain management, addressing psychosocial and functional disruption, using a multimodal approach, is equally important. Some of the options used in the treatment include

Medications: These may include different classes of medications such as special types of painkillers used for nerve pain called anti neuropathic medications. These include the anticonvulsants and antidepressants which are well known painkillers.

Before starting painkillers, an assessment to identify the likely pain generators is carried out and the therapy is tailored accordingly. Sometimes even the side effects of medications are utilised to our advantage like the sedative side effect to improve sleep. There are numerous other painkillers which can be utilised like opioids, anti-inflammatory agents, topical agents (e.g. capsaicin), numbing patches, painkiller patches, oral tablets, pain relieving nasal sprays and lollipops etc. 

Physical therapy. Early initiation of physical therapy with gradual increase from range of motion exercises to active stretching, followed by strengthening is recommended. The aim is to preserve glenohumeral and scapulothoracic movement, strength, and to minimise arm dysfunction. Early initiation of physical therapy is supported by research evidence demonstrating  better range of motion at 2 years post axillary node dissection surgery.

Another subgroup that can benefit from early therapy is those experiencing pain secondary to lymphedema. Apart from physical therapy other interventions such as occupational therapy, compression garments, manual lymph drainage, lymph-reducing exercises, skin care and weight loss may also be required. 

Psychological treatments these may include options such as cognitive behavioural therapy (CBT), hypnosis, mindfulness-based therapies, meditation, self-management programs (individual vs. group) etc. Self-management programs focus on education, cognitive restructuring  to modify thought processes and reduce distress, coping skills training (e.g., pacing, communication) and relaxation training (e.g., hypnosis, mindfulness).

Interventions/ Injections– these are discussed in the next section

What other interventions can be performed for postmastectomy pain?

The most appropriate intervention is decided keeping in mind the likely pain generator. Some of the options include

Trigger point injections Muscles ability to contract and relax plays an important role in body functioning. When muscles fail to relax, they form knots or tight bands known as trigger points. Common causes include inflammation, injury of the muscle or the neighbouring structures. Injection of local anaesthetic and steroid at the points of maximal tenderness can relieve chronic post mastectomy pain. The local anaesthetic blocks the pain sensations and the steroids help in reducing the inflammation, swelling. I prefer to perform these injections under ultrasound guidance as it improves the accuracy and reduces the chances of complications. Post injection physiotherapy is essential to prevent recurrence and maximise the benefits. 

Nerve Blocks & Pulsed Radiofrequency – Intercostal, Pectoral Nerves 
Intercostal nerves run in between two ribs to supply the chest wall. They carry messages from the chest wall to the brain and vice versa. Indications for intercostal block can be diagnostic or therapeutic. The procedure involves injecting a mixture of local anaesthetic and a small amount of steroid under ultrasound guidance. Using ultrasound helps to visualise the spread of drugs and reduce the chances of complications as the needle can be kept away from important structures such as lungs. Pulsed radiofrequency treatment can be performed to prolong the effects of the injections.

Cryoablation of Nerves The primary aim in cryoablation is deactivation of the nerves transmitting the pain signals and this is achieved by freezing the nerves in a controlled fashion to temperatures as low as minus 80 degrees. The procedure is performed using a special probe called cryoprobe, which is guided to the correct location using ultrasound, x-rays and nerve stimulators. The extremely low temperatures achieved at the tip of the cryoprobe results in formation of an ice ball which freezes the nearby nerves thereby reducing pain. This technology is a minimally invasive pain-relieving alternative that does not require any cuts or incisions. It is a safe, day care procedure with the potential of providing quick and lasting relief.

Plane Blocks – Ultrasound guided Serratus Plane Block (SPB) & PECS Block
These injections are commonly used during anaesthesia for breast surgery and can sometimes be useful in chronic pain situations. They involve injection of local anaesthetics and steroids, using ultrasound guidance, in specific planes between the muscles ensuring blockage of multiple nerves with a single injection. Serratus plane block can also block the intercostobrachial nerve, which is implicated in chronic post-mastectomy pain. In chronic pain conditions they are often used to break the pain cycle enabling patients to start physiotherapy.

Botox injections
Botox injections can help in situations where muscles are the source of pain and their spasm is an issue. They can also be useful when muscle pain is produced by the temporary expander as a part of the breast reconstruction. They work by temporarily paralysing the muscles thereby producing relief. Injections are best performed under ultrasound guidance to ensure accuracy and may need to be repeated after a few months if the problem persists. 

Pulsed radiofrequency (PRF) of dorsal root ganglion (DRG)
DRG can be looked at as the modulator of the pain signals being transmitted from the periphery to the brain. By performing a block and pulsed radiofrequency procedure the pain impulses reaching the brain can be modulated/ reduced and this can produce pain relief. PRF of the DRG is considered for patients with inadequate response to other treatments discussed previously. 

Stellate Ganglion Block this can be helpful in some cases in reducing pain and improving range of shoulder movements. These injections target special nerves called the sympathetic nerves, that can get involved in transmitting the pain signals to the brain.  Sometimes a series of injections may be required to produce lasting relief. 

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Sport Injury Treatment in Delhi

  

Sports Injuries Prevention

 

Overuse and trauma are two common factors responsible for sports injuries. Both intrinsic (such as age, fitness level, muscle strength etc) and extrinsic factors (such as equipment, environment, type of activity etc) play a role in injuries.

Prevention of injuries may involve changing of training schedule, gear, training, practicing environment and style and many other factors. Primary prevention deals with prevention of an injury whereas secondary prevention is about prevention of re occurrence of injury. As "Prevention is better than cure," here are some tips that can help you prevent sports injuries. Whilst most of these may seem like common knowledge, you would be surprised by how many injuries can be avoided by following these tips.

Tip 1: Understand the importance of physical conditioning and know your limits

This factor is often overlooked by amateurs who easily succumb to temptation and overindulge.  It is easy to get carried away when you return to sports after a long time. Knowing ones limits, gradually increasing the intensity and duration of training can help in injury prevention. Regular exercise is an effective way to energize your body and keep fit.  On the other hand aggressive training beyond ones capabilities and the resulting overuse, fatigue, poor judgment makes injuries more likely.

Be mindful of old injuries and listen to your body. Warning signs such as joint pain, tenderness, and swelling are reasons to re-evaluate your technique and routine.

Tip 2: Invest in the right sporting gear

This includes every essential bit of equipment required for playing a particular sport, starting from the right shoes to the protective equipment such as helmets, gloves, protective pads etc. Right gear not only protects you from injuries but can also enhance your performance.

Tip 3: Warm and stretch your muscles

Warmed up muscles are less prone to injuries and overlooking warm-up sessions can cost one dearly. Warm up raises the core body temperature and gears up the body for the intended exercise.  It helps by increasing the blood flow to muscles improving the muscle efficiency, range of motion and stretching the muscles being used in particular sports. Stretching to the point of tension (not pain) helps to reduce stiffness and improve flexibility, thereby reducing the chances of injury.

Warm up may be general or specific to the intended sport.  The right exercises would vary depending on the sports. Starting the sport at a slow pace can be helpful. If you closely observe your sporting idols, you will always see them warm up prior to any game.

Tip 4: Use the right technique and follow the rules of the game

Correct techniques to play a sport are defined to minimize the chances of injuries and maximize your performance. The same can be said about the rules of the game. Incorrect overzealous manoeuvre can predispose one to injuries and hence the importance of concentrating on the precise technique. One example which I can quote as I commonly see this in my clinic is back injuries due to incorrect dead lift technique. Often that temptation to add the extra 5kgs compromises the technique predisposing one to injuries.

Selecting the appropriate surface for sports is equally important especially for repetitive activities such as running, jumping where the impact force on the body is magnified by 3- 12 times. Impact force on hard surfaces is much higher increasing the injury chances. 

Tip 5: Cool down

Cooling down is another injury prevention technique that helps to return the heart rate, breathing, and blood pressure to the pre-training levels. It can also help to limit the post exercise muscle soreness and flush out toxins produced during the training.

Tip 6: Adequate recovery

Adequate recovery is essential no only for avoiding injuries but also for the full training effect. Inadequate recovery can lead to tiredness, lethargy, mental fatigue and impaired performance. Adequate recovery includes warm down sessions, re stand sleep, psychological and nutritional advices.

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About Hysterectomies And The Different Types of Hysterectomies

Surgery to remove the uterus (womb) is called a hysterectomy. You won’t menstruate (have periods) or be able to become pregnant after a hysterectomy. A common procedure for different disorders affecting a woman’s reproductive organs is uterus removal.

What is a hysterectomy?

The uterus is removed during a hysterectomy, along with the ovaries and fallopian tubes sometimes. Your choice of hysterectomy will be based on your medical condition.

Different Types of Hysterectomies

Hysterectomies are of several types.  Your health doctor will go over the drawbacks, advantages, and possible side effects of each operation. It’s crucial to find out whether your doctor recommends removing your fallopian tubes and ovaries during your hysterectomy. Types of hysterectomy include:

• In a total hysterectomy, the uterus and cervix are both removed (most common type).
• The cervix is not removed during partial hysterectomy, also known as supracervical hysterectomy, which only removes the upper portion of the uterus.
• In a radical hysterectomy, the uterus, cervix, and upper vaginal wall are removed (usually for cancer treatment).

How long is the hysterectomy procedure?

It might take one to four hours to perform a hysterectomy. The kind of surgery you undergo and how it is done will determine how long it takes.

Reasons for a hysterectomy

Your doctor may suggest a hysterectomy for a variety of reasons such as:

• Adenomyosis.
• Endometriosis.
• gynaecological cancers, such as those of the cervix, uterus, ovary, or endometrium.
• heavy or persistent period bleeding (menorrhagia).
• Fibroids.
• bladder repair may be paired with uterine prolapse.

Abdominal Hysterectomy

Through an incision (cut) in your belly, a surgeon conducts an abdominal, or open, hysterectomy. Typically, the belly incision is low and horizontal, right above the pubic bone. If your uterus is very big, a surgeon could occasionally make a longer vertical incision.

What to expect with an abdominal hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: two to three.
• Size of incision: Longer for vertical incisions; 6 to 12 inches for horizontal incisions.
• One to two hours for the procedure.
• Four to six weeks for recovery.

Robotic or laparoscopic hysterectomy

Hysterectomy procedures can frequently be carried out with less invasive methods. Instead of one major incision, a laparoscopic hysterectomy is performed through numerous tiny abdominal incisions.

Through one incision, a surgeon inserts a laparoscope, a small, flexible tube with a video camera. The surgeon can see your pelvic organs on a video monitor due to the laparoscope. Your uterus may be removed whole or in pieces by using tiny surgical tools.

Another kind of less invasive uterine removal is a robotic hysterectomy. Through tiny abdominal incisions, your surgeon removes your uterus with the help of a robotic arm.

What to expect with a Robotic or laparoscopic hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: One to Two.
• Size of incision: 5 to 12 millimetres.
• One to three hours for the procedure.
• Three to four weeks for recovery.

Hysteroscopic Hysterectomy

The least invasive method of removing the uterus is a hysteroscopic (vaginal) hysterectomy. There are no visible scars since the uterus is removed through a surgical incision at the top of the vagina.

You may be a candidate for a hysteroscopic hysterectomy depending on a number of circumstances, such as:

• Need for ovary and fallopian tube removal due to conditions that might restrict vaginal access to the uterus, such as severe endometriosis or adhesions (scar tissue).
• History of vaginal births
• The size and form of your uterus and vagina

What to expect with a Robotic or laparoscopic hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: One to Two.
• Size of incision: 5 to 12 millimetres.
• One to three hours for the procedure.
• Three to four weeks for recovery.

Side Effects and Risks of Hysterectomy

A hysterectomy often has high success rates and is safe. However, following are some possible risks and adverse effects of the procedure:

• The removal of the ovaries might cause early menopause with symptoms including hot flashes or insomnia. 
• The removal of the ovaries might cause early menopause with symptoms including hot flashes or insomnia. 
• Bladder or bowel damage-related incontinence
• Anesthesia-related reactions
• Vaginal prolapse
• Wound infection

Recovery from Hysterectomy

Your level of recovery following a hysterectomy will vary depending on the treatment. You should anticipate a four to six-week recovery period following an abdominal hysterectomy. Three to four weeks are needed for recovery following a robotic, laparoscopic, or minimally invasive hysterectomy. Avoid intense exertion and heavy lifting at this time. When you can resume daily activities including employment, exercise, and sexual activity will be determined by your doctor.

Treatment at Department of Gynaecology, Orchid Medical Centre, Ranchi

Your general health, your preferences about fertility and your capacity to carry a pregnancy or parent biologically, as well as other factors, may all influence the procedure or procedures that you and your gynaecologist may ultimately choose. If you want to get your uterus removed, you can consult one of the best gynaecologists in Ranchi, Jharkhand at Orchid Medical Centre.

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Ear (Otology) Doctor In Delhi - Dr. Ameet Kishore

Your ear problems need advice from an expert. You can now consult to the Best Otology Doctor In India for any issue related to Otology. A right advice after a complete diagnosisfrom an experienced professional can help you to achieve the necessary relief with the hearing issues. An experienced and qualified specialist is now available in your city.

Tympanoplasty

A tympanoplasty is an operation that is aimed to remove infection from your ear and close a hole in your eardrum. The aim of thisoperation is to prevent repeated ear infections and if repair certain types of hearing losses. With the perfect diagnosis from Best Octology Doctor in India you can gain your hearing back. With the availability of modern equipment and state-of-the-art facilities, our staff will extend you the best service.

Stapedotomy

A stapedotomy (or stapedectomy) is an operation to help improve hearing in those patients who suffer from a condition called otosclerosis. In this delicate operation a part of the fixed stapes bone is removed and replaced with an artificial piston. Performed by Best Otology Doctor In India to enhance the transmission of sound to the internal ear, stapedectomy treats dynamic hearing loss brought on by otosclerosis, a condition in which bone solidifies around the base of the stapes.

Ossiculoplasty

An ossiculoplasty is an operation to help improve hearing in those patients where hearing loss is due to damage to the ossicles (tiny hearing bones) following chronic ear infection. In this operation we may either use your own residual ossicle or an artificial ossicle to achieve the desired result. In a few sorts of ear surgery that incorporates an ossicular chain repair, the surgical approach is through the ear canal (outside sound-related channel) and this is called an endaural approach.

Mastoidectomy

A mastoidectomy is an operation that is aimed to remove any pocket of dead skin and infection in your ear and mastoid bone (ear bone) and thus stop ear discharge. The infection in the ear can spread to the temporal / mastoid bone. Your ENT specialist may need to evacuate parts of the temporal bone if this happens. This can cause hearing loss. You can expect some hearing distress from a radical and modified radical mastoidectomy. This operation isn't as common as it used to be. These days the expert Ear Surgeon can reconstruct the defects caused by the disease or the surgery at the same time as the primary operation. Antibiotics ordinarily treat infections, yet surgery is an alternative if antibiotics are not effective.

We provide to all aspects of ENT surgeries and ENT treatments, from the very elementary to the most exceptional, with the association of our ENT Specialist, Consultants, Onco-Surgeons, Plastic Surgeons, therapists, practitioners, rehabilitators, and assistance staff. Guided by the extensive knowledge, excellent expertise, and clear vision, we are providingthe best ENT health care in the Capital city. 

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About Doctor - https://medicalcaree.blogspot.com/p/ent-specialist.html

Lasik Surgery in Ghatkopar By the Best Eye Specialist Dr. Jatin Ashar

  

Mumbai Eye Care Utilizes The Latest And The Most Advanced Technology To Perform Lasik Surgery In Ghatkopar

The eye specialist in Ghatkopar, Mumbai Eye Care, introduces LASIK (laser-assisted in situ keratomileusis) surgery with the most advanced technology. Lasik surgery by Mumbai Eye Care is performed by Dr. Jatin Ashar, an India’s cornea transplant specialist.

Ghatkopar, Mumbai – Mumbai Eye Care is pleased to announce Lasik Surgery in Ghatkopar with the latest and most advanced technology. Laser-assisted in situ keratomileusis (LASIK) eye surgery can be a better alternative and a safer procedure to improve vision besides using glasses or contact lenses. Lasik eye surgery was performed for the first time in 1988 and approved in the US in 1999. Today, LASIK eye surgery is widely recognized as a solution for eye defects such as Astigmatism (blurred distance & near vision), Hyperopia (farsightedness), and Myopia (nearsightedness). Mumbai Eye Care Clinic, with Dr. Jatin Ashar, as an ophthalmologist, provides the best eye treatments for various eye problems, including eye correction with a bladeless procedure.

LASIK eye surgery in Mumbai Eye Care Clinic is performed by Dr. Jatin Ashar, an eye specialist in Ghatkopar with a high success rate in performing various eye treatments, including LASIK surgery. A representative from Mumbai Eye Care said, “Dr. Jatin Ashar is an ophthalmologist in Ghatkopar, Mumbai, India. He specializes in performing treatment for Cataract, Cornea, Lasik and Refractive Surgery. Dr. Jatin Ashar and Mumbai Eye Care staff have years of experience in eye treatments and corneal surgery in Ghatkopar. Patients can get an appointment with Dr. Jatin at Mumbai Eye Care and please call at +91 8451045935, +91-8451045934 to schedule an appointment with Dr. Jatin Ashar.”

LASIK eye surgery at Mumbai Eye Care Clinic is performed under local anesthesia and takes only 30-40 minutes of procedures. According to the clinic representative, LASIK surgery at Mumbai Eye Care is performed with the latest femtosecond / bladeless technology from Alcon, USA. The LASIK procedure with Dr. Jatin Ashar is safe as it provides many advantages. It utilizes a bladeless procedure and uses only barcoded single-use cones to deliver the laser. The results are accurate, predictable, and customizable.

About Mumbai Eye Care

Mumbai Eye Care is a leading eye clinic in Ghatkopar. The clinic provides various eye treatments under one roof. Their services include eye treatment for cataracts, glaucoma, cornea, retina, Lasik eye surgery, Ocular Aesthetics, Pediatric Ophthalmology, Oculoplastics, Retina, and many more. For more information about Mumbai Eye Care, the best eye clinic in Ghatkopar, or make a scheduled consultation with Dr. Jatin Ashar, please visit their official website at www.mumbaieyecare.com.

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Keratoconus Treatment In Ghatkopar

 Keratoconus is a vision disorder that occurs when the normally round cornea (the front part of the eye) becomes thin and irregular (cone) shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision. It is characterized by para-central corneal thinning and ectasia so that the cornea takes the shape of a cone. Visual loss occurs primarily from myopia and irregular astigmatism and secondarily from corneal scarring. Keratoconus often begins at puberty and most often is seen in teenagers or young adults.

Keratoconus causes distorted vision that cannot be corrected with eyeglasses. Tiny fibers of protein in your eye called collagen help hold your cornea in place. When these fibers get weak, they can’t hold their shape. Your cornea gets more and more cone-like.

It happens when you don’t have enough protective antioxidants in your cornea. Its cells produce harmful byproducts, the same way a car puts out exhaust. Normally, antioxidants get rid of them and protect the collagen fibers. But if levels are low, the collagen weakens and the cornea bulges.

Symptoms

Signs and symptoms of keratoconus may change as the disease progresses. They include:

• Blurred or distorted vision
• Increased sensitivity to bright light and glare, which can cause problems with night driving
• A need for frequent changes in eyeglass prescriptions
• Sudden worsening or clouding of vision
• The swelling occurs when the strain of the cornea's protruding cone-like shape causes a tiny crack to develop. The swelling may last for weeks or months as the crack heals and is gradually replaced by scar tissue.
• Monocular polyopia (perception of multiple ‘ghost’ images in the eye).
• Streaking and flaring distortion around light sources.
• Marked anisometropia (difference in vision of two eyes).
• Photophobia (increased sensitivity to light).
• Eyestrain, in order to read clearly.

Risk factors

• Heredity. One in 10 keratoconus sufferers has a close family relative with the disorder.
• Frequent eye rubbing, especially aggressive “knuckling” eye rubbing.
• Having a history of asthma, allergies, Ehlos Danlers syndrome, Down’s syndrome

Keratoconus is categorised clinically as:

Latent stage: Latent stage was recognisable by placido disc only.
Early stage: Early stages were subdivided into two categories as:

• Keratoconus fruste, which entailed 1- to 4-degree deviation of horizontal axis of the placido disc.
• Early or mild keratoconus, which entailed 5- to 8-degree deviation of horizontal axis.

Causes

A family history of keratoconus has been established in some cases. Most researchers believe that multiple, complex factors are required for the development of keratoconus including both genetic and environmental factors.

With the advent of videokeratography to assess family members, however, pedigrees have been analysed. These studies show corneal changes consistent with keratoconus in some family members, which suggest an autosomal dominant pattern of inheritance.

Keratoconus may be associated with wide variety of systemic and ocular conditions.

Systemic associations:

• Atopy (a genetic predisposition to develop an allergic reaction): Eye rubbing seen in systemic atopy may play a role in the development of keratoconus.
• Down syndrome (Trisomy 21): In Down syndrome (Trisomy 21), frequency of acute hydrops is higher, perhaps because of eye rubbing and/or these patients are treated infrequently with keratoplasty and their disease is allowed to progress further.
• Ehlers-Danlos syndrome.
• Marfan syndrome.

Ocular associations:

• Retinitis pigmentosa.
• Retinopathy of prematurity.
• Fuchs’ corneal endothelial dystrophy.
• Posterior polymorphous dystrophy.

Contributory factors such as:

• Enzyme abnormalities in corneal epithelium: Enzyme abnormalities such as increased expression of lysosomal enzymes (catalase and cathepsin) and decreased levels of inhibitors of proteolytic enzymes (tissue inhibitor matrix metalloproteinases), may play a role in corneal stromal degradation.
• Differentially expressed corneal epithelium: Differentially expressed corneal epithelium between keratoconus and myopes (as controls) in both genetic expression and protein expression.
• Molecular defect: Molecular defect producing unusual absence of water channel protein aquaporin 5 in keratoconus as compared to normal corneal epithelium.
• Gelatinolytic activity: Gelatinolytic activity in stroma has been described, which may be due to decreased function of enzyme inhibitors.
• Abnormalities in corneal collagen and its cross-linking: Abnormalities in corneal collagen and its cross-linking may be the cause of keratoconus.
• Hard contact lens wear.

Pathophysiology:

First is thinning of the corneal stroma then fragmentation of the Bowman layer and the deposition of iron in the basal epithelial cells, forming the Fleischer ring. Folds and breaks in the Descemet’s membrane result in acute hydrops and striae, which produces variable amount of diffuse scarring.

How diagnosis is made?

Certain tests like refraction, keratometry, corneal topography/Computerised videokeratography, ultrasound pachymetry and slit lamp microscopy help in reaching final conclusion.

Computerized videokeratography, which takes pictures of your cornea so a map can be made of the surface while also measuring the thickness of your cornea

Severity of keratoconus depends on shape of cone:

• Nipple cones
• Oval cones
• Globus cones

Treatment

If your keratoconus is progressing, corneal collagen cross-linking might be indicated to slow or stop the progression. Contact lenses can be used to correct astigmatism and mild near-sightedness. Improving your vision depends on the severity of keratoconus. Mild to moderate keratoconus can be treated with eyeglasses or contact lenses.

Lenses

• Hard contact lenses. Hard lenses may feel uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. This type of lens can be made to fit your corneas.
• Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend "piggybacking" a hard contact lens on top of a soft one.
• Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
• Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can't tolerate hard contact lenses may prefer hybrid lenses.
• Scleral lenses. These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of resting on the cornea like traditional contact lenses do, scleral lenses sit on the white part of the eye (sclera) and vault over the cornea without touching it.

Surgical Interventions

Some form of surgery may become necessary if the cornea progresses in its shape-changing until it is so steep that contacts cannot be tolerated at all.

• INTACS are described as arc-like and plastic. These pieces are inserted into the center of the cornea to flatten it, thereby making the eye more contact lens-tolerant.
• Collagen crosslinking (CXL) with UVA is a complex surgery that involves removing the topmost layer of your cornea, adding vitamin drops and then exposing the eye to a special UV lamp that helps the cornea fibers multiply, strengthening the cornea.
• Corneal transplant surgery is the last resort for most doctors. In this procedure cornea would be removed and replaced with a healthy, normal-shaped cornea. This surgery has a long recovery time, a year or more in some cases, for clear vision.
• Penetrating keratoplasty. If you have corneal scarring or extreme thinning, you'll likely need a cornea transplant (keratoplasty). Penetrating keratoplasty is a full-cornea transplant. In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue
• Deep anterior lamellar keratoplasty (DALK). The DALK procedure preserves the inside lining of the cornea (endothelium). This helps avoid the rejection of this critical inside lining that can occur with a full-thickness transplant.

Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

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