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EDITORIAL
Year : 1989  |  Volume : 37  |  Issue : 2  |  Page : 53

Latrogenesis in ophthalmology


Udaipur, India

Correspondence Address:
M R Jain
Udaipur
India
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Source of Support: None, Conflict of Interest: None


PMID: 2583776

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How to cite this article:
Jain M R. Latrogenesis in ophthalmology. Indian J Ophthalmol 1989;37:53

How to cite this URL:
Jain M R. Latrogenesis in ophthalmology. Indian J Ophthalmol [serial online] 1989 [cited 2022 Oct 3];37:53. Available from: https://www.ijo.in/text.asp?1989/37/2/53/26095

The explosive advance in the field of medical and surgical management of ophthalmic problems has sizeably increased the incidence of iatrogenesis which has to be reckoned by every conscientious ophthalmic scientist. Preferably these problems must be avoided by sound knowledge of medical formulary and when they do occur, they must be tackled ef­fectively, urgently and with judicious knowledge of their identification and management so that the blessings of the development in medical science are not turned into a curse.

An ophthalmologist seizes to be a competent doctor if he segregates the eyes from the body or vice versa. The age, the sex, the presenting health and the nutritional status of the patient should not be overlooked whilst treating the eyes. Most of the iatrogenic problems arise when the doctor neglects these factors. More dangerous is the mere knowledge of the proprietary names of the drugs but an ignorance of their constituents, their precise dosage schedule and their proper indications and contraindications. Atropine drops in a child's eyes, phenylepherine in hypertensives, beta blockers in car­diac and asthmatic patients, miotics in myopia, frequent in­stillation of steroid drops in glaucoma prone patients or its prolonged use even in a normal young individual, systemic steroids and aspirin on empty stomach specially in gastric ulcer cases, diuretics at night, teratogenic drugs to the preg­nant lady and ketamine anaesthesia to a child during in­traocular surgery are a few glaring examples of iatrogenesis which could be easily avoided.

How often a treating ophthalmologist realizes that the mental disorientation of an old individual, a libidoless life of his young patient, watering and hyperaemia, or dryness of the eye, is the gift to the patient due to his prescription of betablockers.

A marathon race is on to pump into the market more potent antibiotics; may it be penicillins, ariminoglycosides, cephalosporines or fluroquinolones. To a major extent the aim is commercial partly to provide prompt and effective relief to the patient. Drug trials are most often biased and some times the results are blown out of proportions with the sole inten­tion of boosting up the sales. A cautious doctor should train his eyes to read carefully the side effects and contraindica­tions, so frequently, printed inconspicuously.

There is no doubt that better medical care has been born out of animal experiments and clinical trials. A decade back could anybody imagine of salvaging an eye with advanced endoph­thalmitis without the advent of vitrectomy and intravitreal therapy. However, if these sight saving intravitreal antibiotics are injected in dosages larger by a fraction of a milligram, they may cause iatrogenic blindness due to effect on the neurosen­sory epithelium of the retina. Simultaneous use of two potent antagonistic antibiotics may also lead to disastrous conse­quences. An increased incidence of ocular fungal infection is undoubtedly due to nonjudicious use of steroids and potent antibiotics.

Coming to surgery, microsurgical procedures with coaxial il­lumination and zoom system have undoubtedly revolutionised the surgical results but at the same time has also given rise to the annoying entity of aphakic macular cys­tic oedema due to prolonged exposure of the sensitive macula to ultraviolet rays. A lens implant is certainly a boon to a cataract patient, but it has at the same time promoted pseudo­phakic induced decompensation cornea as the number one in­dication for keratoplasty.

Radical keratotomy is another important surgical procedure which apart from its intraoperative complications, is known to seriously affect the endothelial cell counts. The fate of these young people in a decade or two, is just a matter of imagina­tion.

Some of the adverse consequences of an over enthusiastic ap­proach to parsplana lensectomy has cautioned eye surgeons to respect the virginity of the vitreous. An intact healthy young vitreous has probably something more than what we know and understand till date. Surgeons should ponder over the fact that if it was not so, why the creator did not fill both the chambers with aqueous only.

latrogenesis is most often avoidable and seems to be born out of poor knowledge, inadequate training and over enthusiasm in medical and surgical approach. Let us try to remedy these and the reward shall be most gratifying to your professional reputation as well as to the one who needs your sincere atten­tion.




 

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