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LIMBS
& EYE VISION CAN BE SAVED
Omental Transplantation for limb salvage in Buergers, Diabeties gangrene,
Restoring vision in Retinitis Pigmentosa, Macular degeneration, optic atrophy
(World wide accepted - Telecast in
Living Pulse II series by Discovery Channel)
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Eye can be revascularized by
Pedical Omentopexy, improve vision
(Retina pigmentosa, Macular degen, Choroditis, Central
artery occlusion Optic atrophy)
Myocardium total revascularization by T.M.R.
with Omentopexy
Dr. V.K. Agarwal, Rt. Director Medical Education, Dean and
Prof. Emeritus Medical College, Indore, India |
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Omentum a primitive structure, hanging as a fatty apron in abdomen6”x9” with vast network of blood vessels and lymphatic. It is known for its angiogenic properties. We used omentum for revascularization of the ischemic limbs and developed a technique (Agarwal technique) to lengthen a meter and brought it up to the toes in legs*(1) for last 25 yrs. with 85% good results and to retina in Eyes.**. We feel that this type of transplantation is effective because of its angiogenic properties and neovascularisation of ischeamic tissues. Vineburg 2 experiments have shown that omental grafts would develop communication with the local circulation which is ischemic in 4-8 days after omentopexy, by biological capillary and arteriolar anastomosis wherever the vessels are patent. Recent studies have shown this due to stem cells (CD+34 and Ly-1+B) which has power to migrate. This promote angiogenesis and repair and revascularize injured tissue.
So Omentopexy would be effective in cases with multiple blocks without distal runoff where direct reconstructive surgery is not possible.we recommend the omentopexy as a choice of treatment to prevent amputation. We could save over 1000 patients from amputations with 85% good results in 16 years long term follow up. We have also used it with T.M.R. for Myocardial revascularisation with good results(3).
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 In eye blindness due to avascular diseases of retina like Retinitis Pigmetosa, Age related Macular degeneration and optic atrophy, currently has no treatment(4,5), and patients constantly loose vision and become blind in spite of all available treatment.
Using our 25 yrs. experience of limb revascularisation with omentum and with published experimental study ,that intact omentum can be transplanted in eye safely, with evidence of developing bypass between omental and retinal vessels(6), we modified Agarwal technique(7) of Pedicle Omental transplantation to eye by which stomach vessel supplies eye (retinal bypass surgery).
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It resulted a break through in medical science by restoring vision in blind. Follow up of over 100 cases have shown, in all cases further detoriation of vision ischecked in all cases. patient of retinitis pigmentosa with vision more than counting finger over 3 feet,restored vision, ICG angiogram have shown improvement of retinal circulation to normal limit in early cases. |
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ICG Angiogram |
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No
filling at vessels
Pre
Op. |
New
Blood Vessels with good flow after 3 month
Post
Op. |
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With our continue good results, Pedicle omental transfer offers new ray of hope in a-vascular diseases of retina Retinitis Pigmentosa to stop further detoration and
Improve vision. We recommend early operation as Post operative recovery is directly proportionate to pre-op. vision.
Generally asked questions.-
1. No. of cases done 150 cases in last 6 yrs.
2. Is it safe.-
1) yes no risk to life.
2) No damage to eye as eye ball not touched.
3. Results.-
1) Further loss of vision cheked in all cases.
2) Patients who can count finger more than 3 feet improve vision.
3) Restoration vision directly proportionate to Pre-op. vision more early
recovery. Cases with 6/18 restore 6/6 in 6 month.
4) Vision less than 3/60, do not improve though further loss checked, not
Recommended for operation. |
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Susanta
Sinha
7/B II Floor
Ganguly Paralane
Chitpur, Kolkata, India |
Pre-Op
ICG |
Post-Op
ICG Angiogram
BE Circulatory effect of Central Fundus Normal
(PN Nagpal, Ahmedabad) |
Case No. 137 Retina Pigmentosa, opinion of all opthalmologists.
No medical treatment available.
DR. SS Badrinath, Sankar Netralaya, Chennai Ref. SM/SSB/1145/11/01
Pre op on 7/11/2003 vision 6/18 B.E. Night Blindness
Post op on 7/01/2004 vision 6/9 B.E. Night Vision Normal |
What Patient says,
Miss Upasana 28 yrs. V/A Pre-op.RE 6/60,LE6/36 Tubular vision, night blindness TF.0731-4034630.
Post-op. 6/12, 6/9 3 months after, night blindness improved
6/6, 6/6 6 months after Field + 90 degree
Vikas Jain 26 yrs. V/A Pre-op B.E. 2/60, with glasses 6/18
TF.09370024465
Post-op 6/6 6 months after
Nagpur email: vikas_jain_vikas@yahoo.co.in MBA student comleted joined Tata consultancy General manager sales, married.
Jogindra Singh 49 yrs. V/A Pre-op RE 6/12 LE 6/18 night blindness, Tubular vision
Hyderabad
Post-op BE 6/6 after 6 month night blindness improved. TF. O9440010564 Field increase +90degree
Subhas Bandyapabhiya 37 yrs. V/A Pre-op 2/60 with glasses 6/9, Tubular
TF.09433507804
Post-op 6/18 with glasses 6/6 6months after field +
Durgapur (W.B.)
Makhanlal Verma 42 yrs. V/A RE 6/18 LE 6/24 Tubular
TF. 0942547796
6/9 6/18 6 months after, field over 90+
S.K.Neema 48 yrs. V/A RE 6/24 LE 6/18 Tubular
TF. 07692-223446
6/6 6/6 6 months after Field++ |
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References: |
| (1) |
Agarwal V.K Long term results of Omental Transplantation in Buergers Disease and Retinitis Pigmentosa. Int. Surg. 2007;92:174-183.
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| (2) |
Vineberg A. LwinMM. Fostering a natural artery bypass by per coronary omental strips Surg. Gynec. Obst.1973:137:565©
Elsevier Science Publishers BV.
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| (3) |
Agarwal V.K., Myocardial Revascularization by Pedicaled Omentopexy and Transmyocardial Acupuncture. An Exp. Study in Dogs; Saudi Heart Jr. Vol. 7 July 1966
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| (4) |
Currently no treatment is available for Retinities Pigmentosa (text book on R.P.) John R. Heckenlively
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| (5) |
Macular Degeneration now the leading cause of blindness in USA, D. Jackson Coleman, Jr. of American College of Surgeons, Vol. 197, No. 5, 2003.
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| (6) |
Harry S. Goldsmith, Wei-Fax Chen and Peter V. Palena. Intact omentum for Ocular vascularisation, Investigative ophthalmology 1975:163:14-20
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| (7) |
Agarwal VK Pedical Omental transplant to the eye, Jr. American College of Suergeons Vol 201 No. 3,2005,486.
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Dr. V.K. Agarwal
M.S., F.A.C.S.
Sanjeevni Nursing Home
1, A Phadnis Colony
AB Road, Indore-452009 (MP) INDIA
Tel.: (91 731) 2534346(R), 2430033, 2542020(C)
Email : dr_vkagarwal@rediffmail.com |
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Copyright © Dr. V.K. Agarwal. All
rights reserved.
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