State Consumer Disputes Redressal Commission
Bawar Singh vs Dr.Ranjeet Singh on 5 February, 2021
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bl lac/a k esa [1957] 1 WLR 582 Bolam V Friern
Hospital Management Committee esa fuEu fu/kkZfjr fd;k gS%&
Mr Bolam was a voluntary patient at Friern Hospital, a
mental health institution run by the Friern Hospital
Management Committee. He agreed to undergo electro-
convulsive therapy. He was not given any muscle relaxant, and
his body was not restrained during the procedure. He flailed
about violently before the procedure was stopped, and he
suffered some serious injuries, including fractures of
the acetabula. He sued the committee for compensation. He
argued they were negligent for:
1.not issuing relaxants
2. not restraining him
3. not warning him about the risks involved.
At this time, juries were still being used for tort cases in England and Wales, so the judge's role would be to sum up the law and then leave it for the jury to hold the defendant liable or not.
McNair J at the first instance noted that expert witnesses had confirmed, much medical opinion was opposed to the use of relaxant drugs, and that manual restraints could sometimes increase the risk of fracture. Moreover, it was the common practice of the profession to not warn patients of the risk of treatment (when it is small) unless they are asked. He held that what was common practice in a particular profession was highly relevant to the standard of care required. A person falls below the appropriate standard, and is negligent, if he fails to do what a reasonable person would in the circumstances. But when a person professes to have professional skills, as doctors do, the 5 standard of care must be higher. "It is just a question of expression", said McNair J.
"I myself would prefer to put it this way, that he is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. I do not think there is much difference in sense. It is just a different way of expressing the same thought. Putting it the other way round, a man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view. At the same time, that does not mean that a medical man can obstinately and pig-headedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion. Otherwise you might get men today saying: "I do not believe in anaesthetics. I do not believe in antiseptics. I am going to continue to do my surgery in the way it was done in the eighteenth century." That clearly would be wrong."[2] In this case, the jury delivered a verdict in favour of the defendant hospital. Given the general medical opinions about what was acceptable electro-shock practice, they had not been negligent in the way they carried out the treatment. That passage is quoted very frequently, and has served as the basic rule for professional negligence over the last fifty years.
bl lac/a k esa (2005) 6 Supreme Court Cases 1 JACOB MATHEW Vs STATE OF PUNJAB AND AN OTHER esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS %& J. Tort -Negligence - Medical Negligence -When actionable - Test for Approach to be taken in dealing with cases of - Rationable for differential treatment of medical profession, discussed in extenso - Duties undertaken by doctors enumerated - Held, in a claim of medical negligence, it is enough for defendant to show that standard of care and skill attained was that of the ordinary competent medical practitioner exercising an ordinary degree of professional skill - Test for medical negligence laid down in Balam case, (1957) 2 All ER 118, 121 D-F [set out in para 19 herein], held, applicable in india -Further explained in detail when deviation from normal 6 medical practice would amount to evidence of medical negligence - various issues clarified as to (1) state of knowledge by which standard of care is to be determined, (2) Standard of care in case of charge of failure (a) to use some particular equipment, or (b) to take some precaution, (3) enquiry to be made when alleged negligence is (a) due to an accident, or (b) due to an error of judgment in choice of a procedure or its execution--Considerations to be kept in mind by any forum trying issue of medical negligence, specified - Medical Practitioners K. Tort -Negligence - Professional negligence--when actionable--Test for--Held, a professional may be held liable for negligence either (1) wnen he was not possessed of the requisite skill which he professed to have possessed, or (2) when he did not exercise, with reasonable competence in the given case, the skill which he did possess--Standard to be applied would be that of an ordinary competent person exercising ordinary skill in that profession--Test for professional negligence laid down in Bolam case, (1957) 2 All ER 118, 121 D-F [set out in para 19 herein], held, applicable in India - Professional negligence distinguished from occupational negligence.
N. Tort -Negligence-Definition and meaning (jurisprudential and forensic), discussed in estenso -Words and phrases The jurisprudential concept of negligence defies any precise definition. In current forensic speech, negligence has three meanings. They are: (i) a state of mind, in which it is apposed to intention; (ii) careless conduct; and (iii) the breach of a duty to take care that is imposed by either common or stature law. All three meanings are aplicable in different circumstances but any one of them does not necessarily exclude the other meanings. (paras 10 and 11 ) Negligence is the breach of a duty caused by omission to do domething which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Negligence becomes actionable on account of injury resulting from the act or omission 7 amounting to negligence attributable to the person sued. The essential components of negligence, as recognised, are three:
"duty", "breach" and "resulting damage", that is to say:
(1) the existence of a duty to take care, which is owed by the defendant to the complainant;
(2) the failure to attain that standard of care, prescribed by the law, thereby committing a breach of such duty; and (3) damage, which is both causally connected with such breach and recognised by the law, has been suffered by the complainant.
If the Claimant satisfies the court on the evidence that these three ingredients are made out, the defendant should be held liable in negligence.
ifjoknh jsyos esa dkaVsokyk , ds in ij rSukr Fkk fnukad 25-07-2012 dks esMhdy pSdvi gqvk ml le; ifjoknh dh vkWa[kksa dh T;ksfr lgh ik;h x;hA fnukad 23-07-2014 dks jsyos gkWfLiVy] ykyx< esa fn[kk;k rks ogkWa MkWa0 nkl ls pSd djok;k mUgksusa foi{kh la[;k 1 MkWa0 j.kthr flag dks jSQj dj fn;k fnukad 23-07-2014 dks gh foi{kh la[;k 1 us tkWap dh rks vkWa[k dh T;ksfr de ik;h rFkk dgk fd ckbZ vkWa[k esa eksfr;kfcUn id jgk gS] vHkh dPpk gS 6 eghus yxsxsa okfil MkWa0 nkl ds ikl Hkst fn;k MkWa0 nkl us fQV nsus ls badkj dj fn;kA foi{kh la[;k 1 ls iqu% feyk rks mlus foi{kh la[;k 2 ds ;gkWa Hkst fn;k] foi{kh la[;k 2 ds ikl x;k rks p'esa dk uacj ns fn;k iqu% MkWa0 nkl ds ikl x;k rks fQV nsus ls badkj dj fn;k iqu% foi{kh la[;k 1 ds ikl Hkst fn;kA foi{kh la[;k 1 us dgk fd 18]000@&:- yxsxsa ySal yxk nwWaxk p'ek gV tk;sxkA foi{kh la[;k 1 us ykijokgh o vlko/kkuh ls vkWijs'ku fd;k vkW[k dh iqryh ij vkW ijs'ku ds nkSjku vkStkj yx x;k ftlls vkWa[k esa lQsn /kCck cu x;k] vkWa[k dh iqryh [kjkc gks x;hA foi{kh la[;k 1 us 18]000@&:- dk fcy ugha fn;k ckbZ vkWa[k dh jks'kuh pyh x;h 27-10-2014 dks jsyos gkWfLiVy esa pSd djok;k rks t;iqj jSQj dj fn;k jsyos gkWfLiVy esa pSd djok;k rks 15 fnu dh nokbZ;kWa nhA 15- 11-2014 dks iqu% jsyos gkWfLiVy x;k rks ckbZ vkWa[k dh iqryh [kjkc gksuk crk;h] vkSj ,El fnYyh jSQj dj fn;k 20-11-2014 dks ,El fnYyh fn[kkus x;k] ogkWa tkWap dh rks crk;k fd iqryh cnyus yk;d ugha gS dbZ izdkj dh nokbW;kwa nh 7 eghus bZykt pyk bl nkSjku MkWa0 nkl us ifjoknh dks vufQV ?kksf"kr dj fn;k 8 ftlds dkj.k mls uhps okyh xszM esa Mky fn;k x;k mls 2400 ds LFkku ij 1800 okyh is&xzsM nh tk jgh gSA bl izdkj ifjokn esa tks rF; vk;s gS mlds vuqlkj jsyos deZpkjh dk :Vhu pSdvi gksrk gS ftlesa vkWa[kksa dk pSdvi Hkh gksrk gS foi{kh la[;k 1 us ckbZ vkWa[k detksj crk;h rFkk eksfr;kfcUn dPpk crk;k ijUrq MkW nkl us iqu% foi{kh la[;k 1 ds ikl Hkst fn;k foi{kh la[;k 1 us foi{kh la[;k 2 ds ikl Hkst fn;k foi{kh la[;k 2 us p'ek ns fn;k fQj Hkh MkWa0 nkl us fQV nsus ls badkj dj fn;k fQj foi{kh la[;k 1 ds ikl x;k mlus vkWijs'ku fd;k] blls ;g izrhr gksrk gS fd ifjoknh dh vkWa[ksa detksj Fkh eksfr;kfcUn idk gqvk ugha Fkk igys flQZ p'ek fn;k x;k fQj Hkh mls fQV djkj ugha fn;k x;k rFkk mls vkWijs'ku ds fy, etcwj fd;k x;k tc fd eksfr;kfcUn dPpk Fkk] eksfr;kfcUn dk vkWijs'ku dc fd;k tkuk pkfg,A bl laca/k esa fpfdRlh; foKku fuEu izdkj gS%& When to have cataract surgery Cataract surgery is the most frequently performed surgical procedure worldwide. During surgery, the eye's clouded lens (the cataract) is removed and replaced with an artificial lens, which restores clear vision. Cataracts develop gradually over many years. Most people find that changing their glasses prescription is enough to manage their blurred vision in the initial stages. But as cataracts progress, they cause deteriorating vision and, in parts of the world where treatment is not accessible, blindness.
It used to be that cataract surgery was only performed when the cataract had matured and was causing vision loss. These days, you can have a cataract removed in the early stages of development, when it is causing subtle changes to vision, such as loss of colour perception, glare and loss of contrast, but not necessarily severe sight loss.
Although it's never too late to have a cataract removed, it is better to have cataracts removed while they are immature, as this reduces the length of surgery and the recovery time. Earlier removal also means that you avoid the significant visual impairment associated with very mature (hypermature) cataracts.
When deciding on the right time to have cataract surgery, you'll also need to take into account the recovery process, making sure you can avoid certain tasks, such as strenuous activity and swimming, usually for the first month after surgery.
Cataract Surgery Overview 9 Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear. A cataract causes the lens to become cloudy, which eventually affects your vision.
Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don't have to stay in the hospital after the surgery. Cataract surgery is very common and is generally a safe procedure.
Why it's done Cataract surgery is performed to treat cataracts. Cataracts can cause blurry vision and increase the glare from lights. If a cataract makes it difficult for you to carry out your normal activities, your doctor may suggest cataract surgery.
When a cataract interferes with the treatment of another eye problem, cataract surgery may be recommended. For example, doctors may recommend cataract surgery if a cataract makes it difficult for your eye doctor to examine the back of your eye to monitor or treat other eye problems, such as age-related macular degeneration or diabetic retinopathy.
In most cases, waiting to have cataract surgery won't harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever.
When considering cataract surgery, keep these questions in mind:
Can you see to safely do your job and to drive? Do you have problems reading or watching television? Is it difficult to cook, shop, do yardwork, climb stairs or take medications?
Do vision problems affect your level of independence? Do bright lights make it more difficult to see?
Risks Complications after cataract surgery are uncommon, and most can be treated successfully.
Cataract surgery risks include:
Inflammation Infection Bleeding Swelling Drooping eyelid 10 Dislocation of artificial lens Retinal detachment Glaucoma Secondary cataract Loss of vision Your risk of complications is greater if you have another eye disease or a serious medical condition. Occasionally, cataract surgery fails to improve vision because of underlying eye damage from other conditions, such as glaucoma or macular degeneration. If possible, it may be beneficial to evaluate and treat other eye problems before making the decision to have cataract surgery.
Before the procedure A week or so before your surgery, your doctor performs a painless ultrasound test to measure the size and shape of your eye. This helps determine the right type of lens implant (intraocular lens, or IOL).
Nearly everyone who has cataract surgery will be given IOLs. These lenses improve your vision by focusing light on the back of your eye. You won't be able to see or feel the lens. It requires no care and becomes a permanent part of your eye.
A variety of IOLs with different features are available. Before surgery, you and your eye doctor will discuss which type of IOL might work best for you and your lifestyle. Cost may also be a factor, as insurance companies may not pay for all types of lenses.
IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close.
However, many IOLs are flexible, allowing a smaller incision that requires few or no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.
Some of the types of lenses available include:
Fixed-focus monofocal. This type of lens has a single focus strength for distance vision. Reading will generally require the use of reading glasses.11
Accommodating-focus monofocal. Although these lenses only have a single focusing strength, they can respond to eye muscle movements and shift focus to near or distant objects. Multifocal. These lenses are similar to glasses with bifocal or progressive lenses. Different areas of the lens have different focusing strengths, allowing for near, medium and far vision. Astigmatism correction (toric). If you have a significant astigmatism, a toric lens can help correct your vision.
Discuss the benefits and risks of the different types of IOLs with your eye surgeon to determine what's best for you.
During the procedure Cataract surgery, usually an outpatient procedure, takes an hour or less to perform.
First, your doctor will place eyedrops in your eye to dilate your pupil. You'll receive local anesthetics to numb the area, and you may be given a sedative to help you relax. If you're given a sedative, you may remain awake, but groggy, during surgery.
During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.
Surgical methods used to remove cataracts include:
Using an ultrasound probe to break up the lens for removal. During a procedure called phacoemulsification (fak-o-e- mul-sih-fih-KAY-shun), your surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed. Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The very back of your lens (the lens capsule) is left intact to serve as a place for the artificial lens to rest. Stitches may be used to close the tiny incision in your cornea at the completion of the procedure.
Making an incision in the eye and removing the lens in one piece. A less frequently used procedure called extracapsular cataract extraction requires a larger incision than that used for phacoemulsification. Through this larger incision your surgeon uses surgical tools to remove the front capsule of the lens and the cloudy lens comprising the cataract. The very back capsule of your lens is left in place to serve as a place for the artificial lens to rest.
This procedure may be performed if you have certain eye complications. With the larger incision, stitches are required.12
Once the cataract has been removed by either phacoemulsification or extracapsular extraction, the artificial lens is implanted into the empty lens capsule.
` After the procedure After cataract surgery, expect your vision to begin improving within a few days. Your vision may be blurry at first as your eye heals and adjusts.
Colors may seem brighter after your surgery because you are looking through a new, clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting the look of colors.
You'll usually see your eye doctor a day or two after your surgery, the following week, and then again after about a month to monitor healing.
It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pushing on your eye.
Your doctor may ask you to wear an eye patch or protective shield the day of surgery. Your doctor may also recommend wearing the eye patch for a few days after your surgery and the protective shield when you sleep during the recovery period.
Your doctor may prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure. Sometimes, these medications can be injected into the eye at the time of surgery.
After a couple of days, most of the discomfort should disappear. Often, complete healing occurs within eight weeks.
Contact your doctor immediately if you experience any of the following:
Vision loss Pain that persists despite the use of over-the-counter pain medications Increased eye redness Eyelid swelling Light flashes or multiple new spots (floaters) in front of your eye Most people need glasses, at least some of the time, after cataract surgery. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for 13 eyeglasses. This is usually between one and three months after surgery.
If you have cataracts in both eyes, your doctor usually schedules the second surgery after the first eye has healed.
blls ;g izrhr gksrk gS fd eksfr;kfcUn dk vkWijs'ku rc gh fd;k tkuk pkfg,] tc eksfr;kfcUn id pqdk gks rFkk vkWijs'ku ds yk;d gks x;k gks] blls igys vkWijs'ku ugha fd;k tkuk pkfg, ijUrq ifjoknh dks esMhdy fQV ds uke ls Hkstk tkrk jgk rFkk esMhdy fQVusl izek.k&i= ugha fn;kA ifjoknh dks eksfr;kfcUn dk vkWijs'ku djkus ds fy, etcwj fd;k tc fd bl vkWijs'ku nks fnu igys ;g dgk x;k Fkk fd eksfr;kfcUn dPpk gS 6 eghus ckn vkWijs'ku fd;k tk;sxk ijurq tkWap ds rhljs fnu vkWijs'ku dj fn;k x;k ifjoknh ls jkf'k olwy dj yhA ;g foi{kh la[;k 1 o 2 rFkk MkWa0 nkl dh feyhHkxr gSA MkW0a nkl dks blesa i{kdkj ugha cuk;k x;k gSA flQZ MkWa0 j.kthr flag o MkWa0 Jo.k dqekj] uS= fpfdRlky; dks i{kdkj cuk;k x;k gS] budh ;g vuQs;j VªsM izsfDVl Fkh fd fdlh jsyos deZpkjh ftldks lsok ds fy, esMhdy fQVusl tkjh gksrk gS ftlesa vkW[ksa Hkh 'kkfey gksrh gS mldks fQV dk izek.k&i= ugha fn;k tkosa rFkk vkWijs'ku djds jkf'k olwy dj yh tkosaA bl izdkj ;g nksuksa fpfdRld vuQs;j VªsM izsfDVl ds ftEesnkj gSA ifjoknh dk vkWijs'ku foi{kh la[;k 1 }kjk fd;k x;k eksfr;kfcUn iwjk idk gqvk ugha Fkk] ;fn eksfr;kfcUn iwjk idk gqvk rks rks ;g ,d izdkj ls tkyk lk gksrk gS tks vkjke ls fudkyk tk ldrk gS ijUrq tkyk idk gqvk ugha Fkk fuf'pr :i ls tcjnLrh v/kidk tkyk fudkyus dh dksf'k'k dh ftl le; ifjoknh dh vkWa[k esa vkStkj yx x;k ftl dkj.k lQsn /kCck dk;e gks x;k vkWa[k dh iqryh [kjkc gks x;hA ifjoknh ds Cloudy Cornea gks tkus ds dkj.k ckbZ vkWa[k ls fn[kuk can gks x;kA bl lac/a k esa fpfdRlh; foKku fuEu izdkj gS%& A cloudy cornea is a loss of transparency of the cornea.
Causes The cornea makes up the front wall of the eye. It is normally clear. It helps focus the light entering the eye.
Causes of cloudy cornea include:14
Inflammation
Sensitivity to non-infectious bacteria or toxins
Infection
Keratitis
Trachoma
River blindness
Corneal ulcers
Swelling (edema)
Acute glaucoma
Birth injury
Fuchs dystrophy
Dryness of the eye due to Sjogren syndrome, vitamin
A deficiency, or LASIK eye surgery
Dystrophy (inherited metabolic disease)
Keratoconus
Injury to the eye, including chemical burns and
welding injury
Tumors or growths on the eye
Pterygium
Bowen disease
Clouding may affect all or part of the cornea. It leads to different amounts of vision loss. You may not have any symptoms in the early stages.
Bullous Keratopathy Bullous keratopathy is caused by edema of the cornea, resulting from failure of the corneal endothelium to maintain the normally dehydrated state of the cornea. Most frequently, it is due to Fuchs corneal endothelial dystrophy or corneal endothelial trauma. Fuchs dystrophy is a genetic disorder that causes bilateral, progressive corneal endothelial cell loss, sometimes leading to symptomatic bullous keratopathy by age 50 to 60. Fuchs dystrophy may be autosomal dominant with incomplete penetrance. Another frequent cause of bullous keratopathy is corneal endothelial trauma, which can occur during intraocular surgery (eg, cataract removal) or after placement of a poorly designed or malpositioned intraocular lens implant. Bullous keratopathy after cataract removal is called pseudophakic (if an intraocular lens implant is present) or aphakic (if no intraocular lens implant is present) bullous keratopathy ifjoknh ds Corneal Edema gks x;k bldk iksLV vkWijsfVo /;ku j[kuk pkfg, tks fuEu izdkj gS%& Pseudophakic bullous keratopathy (PBK) and aphakic bullous keratopathy (ABK) refer to the development of irreversible corneal edema as a complication of cataract surgery.[1] As corneal edema progresses and worsens, first stromal and then intercellular epithelial edema develops.15
Epithelial edema is associated with the development of bullae; hence, the name bullous keratopathy. See the image below.
Pseudophakic bullous keratopathy. Large multiple bullae, such as depicted here, are associated with moderate to severe pain and discomfort.
The history of PBK parallels the history of the development of the intraocular lens. As surgical techniques and lens design have improved, the incidence of this complication has decreased dramatically. However, it still represents an important cause of visual disability following routine and complicated cataract surgery.
ifjoknh dh tks vkWs[kksa esa chekjh gks x;h og fuEu izdkj gS%& Corneal endothelial cell dysfunction: etiologies and management A transparent cornea is essential for the formation of a clear image on the retina. The human cornea is arranged into well-organized layers, and each layer plays a significant role in maintaining the transparency and viability of the tissue. The endothelium has both barrier and pump functions, which are important for the maintenance of corneal clarity. Many etiologies, including Fuchs' endothelial corneal dystrophy, surgical trauma, and congenital hereditary endothelial dystrophy, lead to endothelial cell dysfunction. The main treatment for corneal decompensation is replacement of the abnormal corneal layers with normal donor tissue. Nowadays, the trend is to perform selective endothelial keratoplasty, including Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty, to manage corneal endothelial dysfunction. This selective approach has several advantages over penetrating keratoplasty, including rapid recovery of visual acuity, less likelihood of graft rejection, and better patient satisfaction. However, the global limitation in the supply of donor corneas is becoming an increasing challenge, necessitating alternatives to reduce this demand. Consequently, in vitro expansion of human corneal endothelial cells is evolving as a sustainable choice. This method is intended to prepare corneal endothelial cells in vitro that can be transferred to the eye. Herein, we describe the etiologies and manifestations of human corneal endothelial cell dysfunction. We also summarize the available options for as well as recent developments in the management of corneal endothelial dysfunction.
Pseudophakic bullous keratopathy Disease Pseudophakic bullous keratopathy (PBK) or pseudophakic corneal edema (PCE) traditionally refers to the development of irreversible corneal edema after cataract surgery and intraocular lens (IOL) implantation.
Etiology 16 The corneal endothelium is important in maintaining corneal transparency. Loss of corneal endothelial cells pre- operatively, intra-operatively, and post-operatively are all thought to contribute to the development of irreversible corneal edema in PBK.
Pre-operatively, low endothelial cell counts increase the risk of PBK in these eyes. Intra-operatively, surgical trauma is an important cause of endothelial loss. This can include direct damage of the corneal endothelium from instrumentation and the IOL, excess use of phaco power, toxicity of irrigating solutions, and posterior capsular rupture with vitreous prolapse into the anterior chamber. Post-operatively, various entities can increase risk of developing post-operative corneal edema including but not limited to inflammation and glaucoma.
The average time to the development or PBK after cataract surgery ranges from 8 months to 7 years.
Eyes that are at risk for having lower pre-operative endothelial cell counts are at increased risk of developing PBK.
Advanced age
Pre-existing Fuch's corneal dystrophy
Insertion of anterior chamber intraocular lens (ACIOL)
Previous intraocular surgery
Shallow anterior chamber
Glaucom.
Previous ocular trauma
Systemic conditions (diabetes, chronic obstructive
pulmonary disease)
Surgery
Corneal transplantation is the definitive treatment for PBK as it restores the normal structure and function of endothelial cells. It can be done in the form of penetrating keratoplasty (PK), Descemet membrane endothelial keratoplasty (DMEK) or Descemet stripping automated endothelial keratoplasty (DSAEK). [4][5] DMEK has shown to have better graft survival and lower rejection rates for cases of PBK when compared to PK or DSAEK. [5] Other surgical options such as corneal collagen cross linking (CXL), amniotic membrane transplant (AMT), anterior stromal puncture (ASP) and phototherapeutic keratectomy (PTK), all can be used to relieve pain and/or improve corneal edema temporarily while awaiting corneal transplantation. [6][7] CXL with riboflavin and ultraviolet A is thought to induce stromal compaction with thinning and less water influx into the cornea and consequently less fluid in the subepithelial space (bullae formation). Therefore, it helps in both improving vision and in managing pain. [6] AMT on the other hand helps in pain control by its composition of various growth factors and protease inhibitors which promote epithelial cells migration and adhesion to the underlying basement membrane. [7] ASP is thought to work similarly by increasing the formation of various extracellular matrix proteins that increase the adhesion of the epithelial cells to the underlying stroma. It also induces subepithelial fibrosis 17 which acts as physical barrier limiting fluid migration to the subepithelial space. Lastly, PTK can help in decreasing pain perception by ablations the subepithelial nerve plexus. It also strengthens the adhesions between the epithelial cells and underlying stroma.
ifjoknh dk bZykt Corneal transplantation Fkk tks fuEu izdkj gS%& Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.
The cornea is the transparent front part of the eye that covers the iris, pupil and anterior chamber. The surgical procedure is performed by ophthalmologists, physicians who specialize in eyes, and is often done on an outpatient basis. Donors can be of any age, as is shown in the case of Janis Babson, who donated her eyes at age 10. The corneal transplantation is performed when medicines, keratoconus conservative surgery and cross-linking can no longer heal the cornea.
ifjoknh dh ckWbZ vkWa[k ds vkWijs'ku esa vkStkj yxus ds dkj.k vkWa[k [kjkc gks x;h] iqryh MSest gksus ds dkj.k t;iqj pSdvi djok;k ijUrq dksbZ lQyrk ugha feyh] ,El fnYyh esa vkWijs'ku djok;k ijUrq dksbZ lQyrk ugha feyh ifjoknh dh ckWbZ vkWa[k [kjkc gksus dk ifj.kke ;g fudyk fd mls lsok esa fjoVZ dj fn;k ftldh ;kfpdk ekuuh; mPp U;k;ky; esa py jgh gS blfy, mlds xq.kkoxq.k ij fVIi.kh dh tkuk mfpr ugha gS] ijUrq tSlh Hkh fLFkfr gks ifjoknh ds vuqlkj mlds eksfr;kfcUn dPpk gksus ds ckotwn tcjnLrh eksfr;kfcUn dk vkWijs'ku djkus ds fy, etcwj fd;k x;k tc fd eksfr;kfcUn ds vkWijs'ku ds ifj.kkeLo:i ifjoknh dh vkWa[k [kjkc gks x;h rFkk vkStkj yxus ls vkWa[k esa lQsn /kCck gks x;k rFkk iqryh [kjkc gks x;h ftldk bZykt u rks jsyos gkWfLiVy] t;iqj esa gks ldk u gh ,El fnYyh esa gks ldkA foi{khx.k dk bl laca/k esa dksbZ [k.Mu ugha gS] muds f[kykQ dk;Zokgh ,d rjQk gSA fLFkfr esa ;g ckr lkfcr gS fd foi{kh la[;k 1 dh xQyr o ykijokgh ls ifjoknh dh ckWbZ vkWa[k [kjkc gks x;h foi{kh la[;k 1 ds fo:) fpfdRlh; ykijokgh dk rF; izekf.kr gSA tks fd miyC/k nLrkost 'kiFkl&i= o fpfdRlh; foKku ds vuqlkj lkfcr gSA foi{kh la[;k 1 bldk ftEesnkj gSa 18 mijksDr rF;ksa dh foospuk ds vk/kkj ij foi{kh la[;k 1 o 2 us feydj ifjoknh dks dPps eksfr;kfcUn dk vkWijs'ku djkus ds fy, etcwj fd;k rkfd jkf'k olwy dh tk ldsaA ;g nksuksa foi{khx.k dh vuQs;j VªsM izsfDVl gS ftlds fy, nksuksa foi{khx.k ftEesnkj gS rFkk nksuksa foi{kh 5]00]000@&:-
&5]00]000@&:- ¼v{kjs ikWap&ikWap yk[k :-½ ifjoknh dks nsus ds fy, mRrjnk;h gSA tgkWa rd foi{kh la[;k 1 dk iz'u gS mlus dPpk eksfr;kfcUn dk vkWijs'ku fd;k vkWa[k esa vkStkj yx x;k vkW[k esa lQsn /kCck gks x;k iqryh [kjkc gks x;h ckbZ vkWa[k ls fn[kuk can gks x;k tks ykijokgh dk ifj.kke gSA blds fy, foi{kh la[;k 1 rknknh 10]00]000@&:- ¼v{kjs nl yk[k :-½ {kfriwfrZ nsus ds fy, mRrjnk;h gSA vkns'k vr% ifjoknh dk ifjokn foi{khx.k ds fo:) Lohdkj dj] foi{kh la[;k 1 }kjk 15]00]000@&:- ¼ v{kjs iUnzg yk[k :- ½ rFkk foi{kh la[;k 2 }kjk 5]00]000@&:- ¼ ikWap yk[k :-½ ifjokn izLrqfr fnukad 27 tuojh 2016 ls 9 izfr'kr okf"kZd dh nj ls C;kt lfgr vnk djsAa vkns'k dh ikyuk nks ekg esa dh tkosaA ¼ 'kksHkk flag ½ ¼ dey dqekj ckxMh ½ lnL; lnL; ¼U;kf;d½ @ikBd@ 19 20