Consent Forms in Ophthalmic Practice in Hindi & English

Transcription

1 Consent Forms in Ophthalmic Practice in Hindi & English EDITORS English Edition Dr. Bhavna Chawla Dr. Namrata Sharma Dr. Lalit Verma Hindi Edition Dr. P.S. Negi Dr. Y.C. Gupta Published By: Dr. Amit Khosla Secretary, DOS Room No.2225, 2nd Floor New Building Sir Ganga Ram Hospital Rajinder Nagar, New Delhi Disclaimer This manual is for educational purpose only and is not intended to constitute legal advice. Hence it should not be relied upon as a source for legal advice.

2 Contents RETINA 1. Cryosurgery Retinal Detachment Vitreo Retinal Surgery Macular Hole Surgery Avastin tm Intravitreal Injection Macugen tm Intravitreal Injection Lucentis tm Intravitreal Injection ROP Laser Laser Indirect Ophthalmoscopy Laser Photocoagulation for Diabetic Retinopathy Laser Photocoagulation for Proliferative Retinopathy Laser Photocoagulation for Maculopathy Fundus Fluorescein Angiography / Ophthalmoscopy/ Indocyanine Green Angiography Photodynamic Therapy (PDT) Trans Pupillary Thermotherapy (TTT) Intravitreal Injection for Endophthalmitis Electrophysiological Tests OCULOPLASTY & ORBIT 1. Enucleation Evisceration Orbitotomy Entropion Ectropion Ptosis Syringing and Probing Punctal Plugs Dacryocystorhinostomy (DCR) Contracted Socket OCULAR SURFACE, CORNEA & REFRACTIVE SURGERY 1. Optical Penetrating Keratoplasty Therapeutic Keratoplasty Automated Lamellar Therapeutic Keratoplasty (ALTK) Deep Anterior Lamellar Keratoplasty (DALK)

3 5. Descemet s Stripping Endothelial Keratoplasty (DSEK/DSAEK) Phototherapeutic Keratectomy (PTK) Photorefractive Keratectomy (PRK) LASIK Astigmatic Keratotomy (AK) Intacs Phakic IOL Conductive Keratoplasty Pterygium Surgery Corneal Scraping Fibrin Glue Adhesive for Corneal Perforation Symblepharon Release Amniotic Membrane Transplantation (AMT) Limbal Stem Cell Transplantation (LSCT) Osteo-odonto Keratoprosthesis (OOKP) SQUINT 1. Squint Surgery Botox (Botulinum Toxin) Injection GLAUCOMA 1. Trabeculectomy With / Without Anti-Fibroblastic Agents Diode Laser Cyclo-photocoagulation (DLCP) Argon Laser Trabeculoplasty (ALT) Laser Iridotomy CATARACT 1. Cataract Surgery With / Without Implantation of Intraocular Lens Pediatric Cataract YAG Capsulotomy MISCELLANEOUS 1. Examination Under Anesthesia (EUA) Optical Iridectomy

4 RETINA

5 Cryosurgery Bipul Baishya, Atul Kumar Name of Patient... Age/Sex... Patient ID... Date... Son / Daughter of... Address... Tel... Proposed Treatment The doctor has explained that I, (name of patient. ), have a retinal lesion in my..eye which is a risk factor for development of and Cryosurgery is proposed. Risks These are the commoner risks. There may be other unusual risks that have not been listed here. I understand there are risks associated with any anesthetic agent (in case of children). I may have side effects from any of the drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation. I understand the procedure has the following specific risks and limitations: 1. Although most retinal lesions can be treated, it is not 100% effective. In some cases, more than two sittings may be required. 2. Corneal burns 3. Retinal detachment or macular puckering that may require additional surgery 4. Inflammation 5. Pigmentary disturbances 6. Bleeding in eye Local complications of anesthesia injections around the eye include: 1. Perforation of eyeball 2. Destruction of optic nerve 3. Interference with circulation of retina 4. Possible drooping of eyelid 5. Respiratory depression 6. Hypotension Individual Risks I understand the following are possible significant risks and complications specific to my individual circumstances, that I have considered in deciding to have this operation: Declaration by Patient I acknowledge doctors from the ophthalmic team have informed me about the procedure, alternative treatments and answered my specific queries and concerns about this matter. I acknowledge that I have discussed with the surgical team any significant risks and complications specific to my individual circumstances that I have considered in deciding to have this operation. I understand that a doctor other than the specialist surgeon may perform the procedure. ( 1 )

6 I have received no guarantee the operation will be successful. I have received a copy of this form to take home with me. If a needle stick/sharps injury occurs to staff during any operation I give my permission for blood to be taken and tested for HIV and other blood borne disorders. I understand I will be advised and counselled as soon as practicable after the operation if this has been necessary. Signature / Thumb Impression of Patient/ Parent / Guardian:... Name:... Relationship... Date... Address:... Phone (Off)... (Res)... (Mob)... Declaration by Doctor I declare that I have explained the nature and consequences of the procedure to be performed, and discussed the risks that particularly concern the patient. I have given the patient an opportunity to ask questions and I have answered these. Doctor s signature Doctor s name Date Witness 1 Witness 2 Signature:... Signature:... Name:... Name:... Address:... Address:... Tel:... Tel:... ( 2 )

7 Økvks ltzjh fciqy cs';] vrqy dqekj jksxh dk uke %.... %.... jksxh dh vkbzmh %.... rkjh[k %... dk irk %.... VsyhQksu ua %.... izlrkfor mipkj MkWDVj us Li"V fd;k gs fd esjh ¼jksxh dk uke½ vka[k esa jsfvuk ls tqm+k t[e gs tks fd ds fodkl ds fy, tksf[ke dk dkjd gs vksj Øk;ks ltzjh izlrkfor dh gsa tksf[ke ;s lk/kkj.k tksf[ke gsaa nwljs vlkeku; tksf[ke Hkh gks ldrs gsa ftugsa fd ;gka lwphc) ugha fd;k x;k gsa esa le>rk gwa fd fdlh Hkh laosnukgkjh dkjd ds lkfk ¼cPpksa ds ekeys esa½ tksf[ke tqm+s gksrs gsaa eq>s mi;ksx esa yk;h x;h nokvksa esa ls fdlh ds Hkh dkj.k ik'oz&izhkko mriuu gks ldrs gsaa vke ik'oz&izhkkoksa esa pddj vkuk] feryh] Ropk ij nnksjs vksj dct 'kkfey gsa esa le>rk gwa fd fpfdrldh; izfø;k ds fueufyf[kr [kkl tksf[ke vksj lhek,a gsa % 1- gkykafd jsfvuk ds vf/kdrj t[eksa dk bykt gks ldrk gs ysfdu ;g 'kr&izfr'kr izhkkoh ugha gsa dqn ekeyksa esa nks ls T;knk csbd dh t:jr im+ ldrh gsa 2- dkuhzy dk tyuk 3- jsfvuk dk vyx gksuk ;k esdqyj fldqm+u ftlds fy, vfrfjdr ltzjh dh t:jr im+ ldrh gs 4- tyu 5- jax fn[kus esa ijs'kkuh 6- vka[kksa esa jdrlzko vk[kksa ds bnzfxnz laosnukgkjh batsd'kuksa dh LFkkfud ijs'kkfu;ksa esa 'kkfey gsa % 1- vka[k dh iqryh ds Nsn 2- izdkf'kd ul dk fouk'k 3- jsfvuk ds lapj.k ds lkfk O;o/kku 4- iyd dh lahkkfor yvdu 5- 'olu ls tqm+k ncko 6- vlkeku; :i ls fueu jdrpki O;fDrxr tksf[ke esa le>rk gwa fd fo'ks"k :i ls esjh ifjflfkfr;ksa ls tqm+s lahkkfor egriw.kz tksf[ke vksj tfvyrk,a fueufyf[kr gsa] ftu ij fd es aus bl vkwijs'ku dks djokus dk fu.kz; djrs le; fopkj fd;k gs % jksxh }kjk?kks"k.kk esa bl ckr dh iqf"v djrk gwa fd us= fo'ks"kkksa dh Vhe ds MkWDVjksa us fpfdrldh; izfø;k] osdfyid mipkjksa ds ckjs esa eq>s tkudkjh iznku dh gs vksj bl ekeys esa esjs fof'k"v iz'uksa vksj fparkvksa dk tokc fn;k gsa esa bl ckr dh iqf"v djrk gwa fd esaus ltzjh djus okys MkWDVjksa dh Vhe ds lkfk fdugha egroiw.kz tksf[keksa vksj viuh O;fDrxr ifjflfkfr;ksa ds fy, [kkl tfvyrkvksa ij ppkz dh gs] ftu ij fd esaus bl vkwijs'ku dks djokrs le; fopkj fd;k gsa esa le>rk gwa fd fo'ks"kk ltzu ds vykok nwljk MkWDVj bl vkwijs'ku dks dj ldrk gsa ( 3 )

8 vkwijs'ku lqy gksxk eq>s bldh dksbz xkjavh ugha nh x;h gsa eq>s vius lkfk?kj ys tkus ds fy, bl izi= dh,d izfr izkir gqbz gsa vxj fdlh phm+&qkm+ ds nksjku LVkQ dks lqbz ;k /kkjnkj vkstkj ls pksv vkrh gs rks esa,pvkbzoh vksj jdr ls gksus okys nwljs fodkjksa ds fy, jdr ysus vksj mldk ijh{k.k djus dh vuqefr iznku djrk gwaa esa le>rk gwa fd vkwijs'ku ds ckn vko';drk im+us ij tsls gh eqefdu gksxk eq>s lykg vksj ijke'kz iznku fd;k tk,xka dk dk fu'kku %... uke %.... fj'rk %... rkjh[k %.... irk %... Qksu % ¼vkfQl½.... ¼/kj½.... eksckby%.... MkWDVj }kjk?kks"k.kk esa?kks"k.kk djrk gwa fd esaus laiuu dh tkus okyh dk;zfof/k dh izñfr vksj mlds ifj.kkeksa dks le>k fn;k gs vksj mu tksf[keksa dh ppkz dh gs tks fd fo'ks"k :i ls jksxh ls lacaf/kr gsa esaus jksxh dks iz'u iwnus dk volj iznku fd;k gs vksj mudk mùkj fn;k gsa MkWDVj dk glrk{kj % MkWDVj dk uke % rkjh[k % xokg 1 xokg 2 glrk{kj %.... glrk{kj %... uke %.... uke %.... irk %... irk %.... Qksu %.... Qksu %.... ( 4 )

9 Retinal Detachment Bipul Baishya, Y.R. Sharma Name of Patient... Age/Sex... Patient ID... Date... Son / Daughter of... Address... Tel... Proposed Treatment The doctor has explained that I, (name of patient.... ),have a retinal detachment in my.....eye and that is proposed: Risks These are the commoner risks. There may be other unusual risks that have not been listed here. I understand there are risks associated with any anesthetic agent. I may have side effects from any of the drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation. I understand the procedure has the following specific risks and limitations: 1. Although most retina detachments can be treated, a small proportion (5%) may be inoperable and blindness cannot be prevented. 2. Failure to accomplish intent of surgery 3. More than one surgery may be required. Like if Scleral buckling surgery fails, Vitrectomy may be required with Silicone Oil or Gas tamponade. 4. In case of Silicone Oil or Gas injection, I have to maintain position depending upon the surgery. 5. If Gas is injected, I have to restrict air travel until gas is absorbed. 6. If Silicone oil is injected, then resurgery will be required to remove the oil. 7. It may take up to 18 months before the final outcome of the surgery is known. Although many cases achieve a good result, this depends on several factors including how long the detachment had been present. 8. It may not be possible to predict before the operation which cases will do well. 9. There is a chance I may develop further retina detachments in future in the same eye or in the opposite eye. 10. In some cases, more than one operation may be required 11. Though rare, I may develop complications like vitreous hemorrhage, infection, elevated eye pressure (glaucoma), poorly healing or non-healing corneal defects, corneal clouding and scarring, cataract, which might require eventual or immediate removal of lens, double vision, eyelid droop, and loss of circulation to vital tissues in the eye, resulting in decrease or loss of vision There is an extremely small risk (1:17000 cases) that the opposite eye to the one having surgery may become inflamed, especially if complications occur after the operation. This is called sympathetic ophthalmia.although this can be treated, in some cases, eyesight may be lost. I understand some of the above risks are more likely if I smoke, am overweight, diabetic, have high blood pressure or have had previous heart disease. Individual Risks I understand the following are possible significant risks and complications specific to my individual circumstances, that I have considered in deciding to have this operation: ( 5 )

10 Declaration By Patient I acknowledge doctors from the ophthalmic team have informed me about the procedure, alternative treatments and answered my specific queries and concerns about this matter. I acknowledge that I have discussed with the surgical team any significant risks and complications specific to my individual circumstances that I have considered in deciding to have this operation. I agree to any other additional procedures considered necessary in the judgment of my surgeon during this operation. I have received no guarantee the operation will be successful. I have received a copy of this form to take home with me. If a needle stick/sharps injury occurs to staff during any operation I give my permission for blood to be taken and tested for HIV and other blood borne disorders. I understand I will be advised and counselled as soon as practicable after the operation if this has been necessary. Signature / Thumb Impression of Patient/ Parent / Guardian:... Name:... Relationship... Date... Address:... Phone (Off)... (Res)... (Mob)... Declaration by Doctor I declare that I have explained the nature and consequences of the procedure to be performed, and discussed the risks that particularly concern the patient. I have given the patient an opportunity to ask questions and I have answered these. Doctor s signature Doctor s name Date Witness 1 Witness 2 Signature:... Signature:... Name:... Name:... Address:... Address:... Tel:... Tel:... ( 6 )

11 jsfvuk dk vyxko fciqy cs';] okbz- vkj- 'kekz jksxh dk uke %.... %.... jksxh dh vkbzmh %.... rkjh[k %... dk irk %.... VsyhQksu ua %.... izlrkfor mipkj MkWDVj us Li"V fd;k gs fd esjh ¼jksxh dk uke½ vka[k esa jsfvuk dk vyxko gs vksj ;g fd izlrkfor gs % tksf[ke dqn lkeku; tksf[ke gsaa nwljs vlkeku; tksf[ke Hkh gks ldrs gsa] ftugsa fd ;gka ij lwphc) ugha fd;k x;k gsa esa le>rk gwa fd fdlh Hkh laosnukgkjh dkjd ds lkfk tksf[ke tqm+s gq, gksrs gsaa eq>s mi;ksx esa yk;h x;h nokvksa esa ls fdlh ds Hkh dkj.k ik'oz&izhkko mriuu gks ldrs gsaa vke ik'oz&izhkkoksa esa pddj vkuk] feryh] Ropk ij nnksjs vksj dct 'kkfey gsa esa le>rk gwa fd fpfdrldh; izfø;k ds fueufyf[kr [kkl tksf[ke vksj lhek,a gsa % 1- gkykafd jsfvuk ds vf/kdrj vyxkoksa dk mipkj fd;k tk ldrk gs ij,d NksVk vuqikr ¼5 izfr'kr½ gks ldrk gs fd vkwijs'ku ds yk;d ugha gks vksj va/ksiu dks jksdk ugha tk ldsa 2- ltzjh ds iz;kstu dks iwjk djus esa foqyrk 3-,d ls vf/kd ltzjh dh vko';drk im+ ldrh gsa tsls fd vxj lsjy cdfyax ltzjh foqy gksrh gs rks flfydkwu vkw;y ;k xsl VSEiksusM ds lkfk fovjsdvkweh dh vko';drk im+ ldrh gsa 4- flfydkwu vkw;y ;k xsl batsd'ku dh n'kk esa ltzjh ds vk/kkj ij flfkfr dks cuk;s j[kuk gsa 5- vxj xsl dk batsd'ku fn;k tkrk gs rks eq>s ml le; rd gokbz ;k=k ls cpuk gksxh tc rd fd xsl vo'kksf"kr ugha gks tkrh- 6- vxj flfydkwu vkw;y dk batsd'ku fn;k tkrk gs rks rsy dks fudkyus ds fy, nksckjk ltzjh vko';d gksxha 7- ltjh ds vafre ifj.kke dk irk pyus esa 18 eghuksa rd dk le; yx ldrk gsa gkykafd cgqr ls ekeyksa esa vpnk ifj.kke vkrk gs ij ;g blds lesr dbz dkjdksa ij fuhkzj djrk gs fd vyxko fdrus le; ls ekstwn FkkA 8- fdu ekeyksa esa vpns ifj.kke vk,axs budk vkwijs'ku ls igys vuqeku yxkuk gks ldrk gs fd lahko ugha gksa 9- bl ckr dk [krjk gksrk gs fd eq>s Hkfo"; esa mlh vka[k esa ;k nwljh okyh esa jsfvuk dk vkxs Hkh vyxko fodflr gks tk;sa 10- dqn ekeyksa esa],d ls vf/kd vkwijs'ku dh t:jr im+ ldrh gsa 11- gkykafd eqf'dy ls gh,slk gksrk gs ysfdu esjs Hkhrj okbvfjvl jdrlzko] laøe.k] vka[k dk aåapk ncko ¼Xywdksek½] dkwuhzy dh [kjkfc;ksa ds?kko ds eqf'dy ls Hkjus ;k ugha Hkjus] dkwuhzy DykmfMax vksj LdSfjax] eksfr;kfcan] ftlds fy, ysalksa dks varr% ;k QkSju fudkyus dh t:jr im+ ldrh gs] Mcy fotu] iydksa ds yvduk vksj vka[kksa ds egroiw.kz Årdksa esa ifjlapj.k ds ugha gksus tslh tfvyrk,a fodflr gks ldrh gsa] ftlds QyLo:i utj esa deh ;k mldk [kkrek gks ldrk gsa bl ckr dk cgqr gh de tksf[ke ¼1%17000 ekeys½ gksrk gs fd ftl vka[k dh ltzjh dh x;h gs mlds cxy okyh vka[k yky gks ldrh gs] fo'ks"kdj ml le; tcfd tfvyrk,a vkwijs'ku ds ckn isnk gksrh gsaa gkykafd bldk mipkj fd;k tk ldrk gs ij dqn ekeyksa esa vka[kksa dh n`f"v tk ldrh gsa esa le>rk gwa fd Åij crk;s x;s tksf[keksa esa ls dqn ds vklkj ml le; T;knk gksrs gsa tcfd esa /kweziku djrk gwa] esjk otu T;knk gs] e/kqesg ls ihfm+r gwa] mpp jdrpki gs ;k igys fny dh chekjh gks pqdh gsa O;fDrxr tksf[ke esa le>rk gwa fd fo'ks"k :i ls esjh ifjflfkfr;ksa ls tqm+s lahkkfor egriw.kz tksf[ke vksj tfvyrk,a fueufyf[kr gsa] ftu ij fd es aus bl vkwijs'ku dks djokus dk fu.kz; djrs le; fopkj fd;k gs % ( 7 )

12 jksxh }kjk?kks"k.kk esa bl ckr dh iqf"v djrk gwa fd us= fo'ks"kkksa dh Vhe ds MkWDVjksa us fpfdrldh; izfø;k] osdfyid mipkjksa ds ckjs esa eq>s tkudkjh iznku dh gs vksj bl ekeys esa esjs fof'k"v iz'uksa vksj fparkvksa dk tokc fn;k gsa esa bl ckr dh iqf"v djrk gwa fd esaus ltzjh djus okys MkWDVjksa dh Vhe ds lkfk fdugha egroiw.kz tksf[keksa vksj viuh O;fDrxr ifjflfkfr;ksa ds fy, [kkl tfvyrkvksa ij ppkz dh gs] ftu ij fd esaus bl vkwijs'ku dks djokrs le; fopkj fd;k gsa esa,slh vu; dk;zfof/k;ksa dks viuk, tkus ij lger gwa tks fd bl vkwijs'ku ds nksjku esjs ltzu dh jk; esa vko';d gksaxha vkwijs'ku lqy gh gksxk bldh eq>s dksbz xkjavh ugha nh x;h gsa eq>s?kj ys tkus ds fy, bl izi= dh,d izfr izkir gqbz gsa vxj fdlh phm+&qkm+ ds nksjku LVkQ dks lqbz ;k /kkjnkj vkstkj ls pksv vkrh gs rks esa,pvkbzoh vksj jdr ls gksus okys nwljs fodkjksa ds fy, jdr ysus vksj mldk ijh{k.k djus dh vuqefr iznku djrk gwaa esa le>rk gwa fd vkwijs'ku ds ckn vko';drk im+us ij tsls gh eqefdu gksxk eq>s lykg vksj ijke'kz iznku fd;k tk,xka dk dk fu'kku %... uke %.... fj'rk %... rkjh[k %.... irk %... Qksu % ¼vkfQl½.... ¼/kj½.... eksckby%.... MkWDVj }kjk?kks"k.kk esa?kks"k.kk djrk gwa fd esaus laiuu dh tkus okyh dk;zfof/k dh izñfr vksj mlds ifj.kkeksa dks le>k fn;k gs vksj mu tksf[keksa dh ppkz dh gs tks fd fo'ks"k :i ls jksxh ls lacaf/kr gsa esaus jksxh dks iz'u iwnus dk volj iznku fd;k gs vksj mudk mùkj fn;k gsa MkWDVj dk glrk{kj % MkWDVj dk uke % rkjh[k % xokg 1 xokg 2 glrk{kj %.... glrk{kj %... uke %.... uke %.... irk %... irk %.... Qksu %.... Qksu %.... ( 8 )

13 Vitreo Retinal Surgery Bipul Baishya, R.V. Azad Name of Patient... Age/Sex... Patient ID... Date... Son / Daughter of... Address... Tel... Proposed Treatment The doctor has explained that I, (name of patient. ), have... in my... Eye and that is proposed. Risks These are the commoner risks. There may be other unusual risks that have not been listed here. I understand there are risks associated with any anesthetic agent. I may have side effects from any of the drugs used. The commoner side effects include light-headedness, nausea, skin rash and constipation. I understand the procedure has the following specific risks and limitations: 1. Failure to accomplish intent of surgery 2. Retinal detachments that may require additional surgery or may be inoperable 3. Depending upon the surgery, Silicone Oil or Gas may be required for tamponade. 4. In case of Silicone Oil or Gas injection, I have to maintain position depending upon the surgery. 5. If Gas is injected, I have to restrict air travel until gas is absorbed. 6. If Silicone oil is injected then resurgery will be required to remove the oil. 7. It may take up to 18 months before the final outcome of the surgery is known. 8. In a few cases, the underlying condition cannot be treated and blindness cannot be prevented. 9. It may not be possible to predict before the operation which cases will do well. 10. There is a chance I may develop further retina detachments in future in the same eye or in the opposite eye. 11. In some cases, more than one operation may be required 12. Though rare I may develop complications like vitreous hemorrhage, infection, elevated eye pressure (glaucoma), poorly healing or non-healing corneal defects, corneal clouding and scarring, cataract, which might require eventual or immediate removal of lens, double vision, eyelid droop, and loss of circulation to vital tissues in the eye, resulting in decrease or loss of vision There is an extremely small risk (1:17000 cases) that the opposite eye to the one having surgery may become inflamed, especially if complications occur after the operation. This is called sympathetic ophthalmia.although this can be treated, in some cases, eyesight may be lost. I understand some of the above risks are more likely if I smoke, am overweight, diabetic, have high blood pressure or have had previous heart disease. Individual Risks I understand the following are possible significant risks and complications specific to my individual circumstances, that I have considered in deciding to have this operation: ( 9 )

14 Declaration by Patient I acknowledge doctors from the ophthalmic team have informed me about the procedure, alternative treatments and answered my specific queries and concerns about this matter. I acknowledge that I have discussed with the surgical team any significant risks and complications specific to my individual circumstances that I have considered in deciding to have this operation. I agree to any other additional procedures considered necessary in the judgment of my surgeon during this operation. I agree to the disposal by the hospital authorities of any tissues that may be removed during the procedure. I understand that some tissues or samples may be kept as part of my hospital records. I have received no guarantee the operation will be successful. I have received a copy of this form to take home with me. If a needle stick/sharps injury occurs to staff during any operation I give my permission for blood to be taken and tested for HIV and other blood borne disorders. I understand I will be advised and counselled as soon as practicable after the operation if this has been necessary. Signature / Thumb Impression of Patient/ Parent / Guardian:... Name:... Relationship... Date... Address:... Phone (Off)... (Res)... (Mob)... Declaration by Doctor I declare that I have explained the nature and consequences of the procedure to be performed, and discussed the risks that particularly concern the patient. I have given the patient an opportunity to ask questions and I have answered these. Doctor s signature Doctor s name Date Witness 1 Witness 2 Signature:... Signature:... Name:... Name:... Address:... Address:... Tel:... Tel:... ( 10 )

15 fovsfjvks jsfvuy ltzjh fciqy cs';] vkj- oh- vktkn jksxh dk uke %.... %.... jksxh dh vkbzmh %.... rkjh[k %... dk irk %.... VsyhQksu ua %.... izlrkfor mipkj MkWDVj us Li"V fd;k gs fd esjh ¼jksxh dk uke½ vka[k esa gs vksj ;g fd izlrkfor gs % tksf[ke dqn lkeku; tksf[ke gsaa nwljs vlkeku; tksf[ke Hkh gks ldrs gsa] ftugsa fd ;gka ij lwphc) ugha fd;k x;k gsa esa le>rk gwa fd fdlh Hkh laosnukgkjh dkjd ds lkfk tksf[ke tqm+s gq, gksrs gsaa eq>s mi;ksx esa yk;h x;h nokvksa esa ls fdlh ds Hkh dkj.k ik'oz&izhkko mriuu gks ldrs gsaa vke ik'oz&izhkkoksa esa pddj vkuk] feryh] Ropk ij nnksjs vksj dct 'kkfey gsa esa le>rk gwa fd fpfdrldh; izfø;k ds fueufyf[kr [kkl tksf[ke vksj lhek,a gsa % 1- ltzjh ds iz;kstu dks iwjk djus esa foqyrk 2- jsfvuk dk vyxko ftlds fy, vfrfjdr ltzjh dh vko';drk im+ ldrh gs ;k gks ldrk gs fd mldk vkwijs'ku gh u fd;k tk ldsa 3- ltzjh ds vk/kkj ij VSEiksusM ds fy, flfydkwu vkw;y ;k xsl dh vko';drk im+ ldrh gsa 4- flfydkwu vkw;y ;k xsl batsd'ku dh n'kk esa eq>s ltzjh ds vk/kkj ij flfkfr dks cuk;s j[kuk gsa 5- vxj xsl dk batsd'ku fn;k tkrk gs rks eq>s ml le; rd gokbz ;k=k ls cpuk gksxh tc rd fd xsl vo'kksf"kr ugha gks tkrh- 6- vxj flfydkwu vkw;y dk batsd'ku fn;k tkrk gs rks rsy dks fudkyus ds fy, nksckjk ltzjh vko';d gksxha 7- ltjh ds vafre ifj.kke dk irk pyus esa 18 eghuksa rd dk le; yx ldrk gsa 8- dqn ekeyksa esa varjfufgr n'kk dk mipkj ugha gks ldrk vksj n`f"vghurk dks jksdk ugha tk ldrka 9- fdu ekeyksa esa vpns ifj.kke vk,axs budk vkwijs'ku ls igys vuqeku yxkuk gks ldrk gs fd lahko ugha gksa 10- bl ckr dk [krjk gksrk gs fd eq>s Hkfo"; esa mlh vka[k esa ;k nwljh okyh esa jsfvuk dk vkxs Hkh vyxko fodflr gks tk;sa 11- dqn ekeyksa esa],d ls vf/kd vkwijs'ku dh t:jr im+ ldrh gsa 12- gkykafd eqf'dy ls gh,slk gksrk gs ysfdu esjs Hkhrj okbvfjvl jdrlzko] laøe.k] vka[k dk aåapk ncko ¼Xywdksek½] dkwuhzy dh [kjkfc;ksa ds?kko ds eqf'dy ls Hkjus ;k ugha Hkjus] dkwuhzy DykmfMax vksj LdSfjax] eksfr;kfcan] ftlds fy, ysalksa dks varr% ;k QkSju fudkyus dh t:jr im+ ldrh gs] Mcy fotu] iydksa ds yvduk vksj vka[kksa ds egroiw.kz Årdksa esa ifjlapj.k ds ugha gksus tslh tfvyrk,a fodflr gks ldrh gsa] ftlds QyLo:i utj esa deh ;k mldk [kkrek gks ldrk gsa bl ckr dk cgqr gh de tksf[ke ¼1%17000 ekeys½ gksrk gs fd ftl vka[k dh ltzjh dh x;h gs mlds cxy okyh vka[k yky gks ldrh gs] fo'ks"kdj ml le; tcfd tfvyrk,a vkwijs'ku ds ckn isnk gksrh gsaa bls fleisfksfvd vkfksyfe;k dgk tkrk gsa gkykafd bldk mipkj fd;k tk ldrk gs ij dqn ekeyksa esa vka[kksa dh n`f"v tk ldrh gsa esa le>rk gwa fd Åij crk;s x;s tksf[keksa esa ls dqn ds vklkj ml le; T;knk gksrs gsa tcfd esa /kweziku djrk gwa] esjk otu T;knk gs] e/kqesg ls ihfm+r gwa] mpp jdrpki gs ;k igys fny dh chekjh gks pqdh gsa O;fDrxr tksf[ke esa le>rk gwa fd fo'ks"k :i ls esjh ifjflfkfr;ksa ls tqm+s lahkkfor egriw.kz tksf[ke vksj tfvyrk,a fueufyf[kr gsa] ftu ij fd es aus bl vkwijs'ku dks djokus dk fu.kz; djrs le; fopkj fd;k gs % ( 11 )

16 jksxh }kjk?kks"k.kk esa bl ckr dh iqf"v djrk gwa fd us= fo'ks"kkksa dh Vhe ds MkWDVjksa us fpfdrldh; izfø;k] osdfyid mipkjksa ds ckjs esa eq>s tkudkjh iznku dh gs vksj bl ekeys esa esjs fof'k"v iz'uksa vksj fparkvksa dk tokc fn;k gsa esa bl ckr dh iqf"v djrk gwa fd esaus ltzjh djus okys MkWDVjksa dh Vhe ds lkfk fdugha egroiw.kz tksf[keksa vksj viuh O;fDrxr ifjflfkfr;ksa ds fy, [kkl tfvyrkvksa ij ppkz dh gs] ftu ij fd esaus bl vkwijs'ku dks djokrs le; fopkj fd;k gsa esa,slh vu; dk;zfof/k;ksa dks viuk, tkus ij lger gwa tks fd bl vkwijs'ku ds nksjku esjs ltzu dh jk; esa vko';d gksaxha esa vlirky ds vf/kdkfj;ksa }kjk,slh fdugha Hkh Årdksa ds fuivku ds fy, lger gwa ftugsa fd dk;zfof/k ds nksjku fudkyk tk ldrk gsa esa le>rk gwa fd dqn Årdksa vksj uewuksa dks vlirky ds esjs fjdkmksza ds fglls ds :i esa j[kk tk ldrk gsa vkwijs'ku lqy gh gksxk bldh eq>s dksbz xkjavh ugha nh x;h gsa eq>s?kj ys tkus ds fy, bl izi= dh,d izfr izkir gqbz gsa vxj fdlh phm+&qkm+ ds nksjku LVkQ dks lqbz ;k /kkjnkj vkstkj ls pksv vkrh gs rks esa,pvkbzoh vksj jdr ls gksus okys nwljs fodkjksa ds fy, jdr ysus vksj mldk ijh{k.k djus dh vuqefr iznku djrk gwaa esa le>rk gwa fd vkwijs'ku ds ckn vko';drk im+us ij tsls gh eqefdu gksxk eq>s lykg vksj ijke'kz iznku fd;k tk,xka dk dk fu'kku %... uke %.... fj'rk %... rkjh[k %.... irk %... Qksu % ¼vkfQl½.... ¼/kj½.... eksckby%.... MkWDVj }kjk?kks"k.kk esa?kks"k.kk djrk gwa fd esaus laiuu dh tkus okyh dk;zfof/k dh izñfr vksj mlds ifj.kkeksa dks le>k fn;k gs vksj mu tksf[keksa dh ppkz dh gs tks fd fo'ks"k :i ls jksxh ls lacaf/kr gsa esaus jksxh dks iz'u iwnus dk volj iznku fd;k gs vksj mudk mùkj fn;k gsa MkWDVj dk glrk{kj % MkWDVj dk uke % rkjh[k % xokg 1 xokg 2 glrk{kj %.... glrk{kj %... uke %.... uke %.... irk %... irk %.... Qksu %.... Qksu %.... ( 12 )

17 Macular Hole Surgery Ritesh Gupta Name of Patient... Age/Sex... Patient ID... Date... Son / Daughter of... Address... Tel... Indications and Benefits Your doctor has diagnosed you with macular hole and informed you that if it is left untreated, it is likely that you will have gradual central vision deterioration but you will not lose all of the vision in your eye. Your doctor has informed you that a procedure involving pars plana vitrectomy with/without internal limiting membrane removal and gas injection will be performed in your eye under local/general anesthesia. The important factors in predicting whether the hole closes as a result of surgery is the duration for which the hole has been present and the size of the hole. The success rate for holes that have been present for less than six months is about 90%. However, this reduces to around 60% for a hole which has been present for a year or more. Your doctor has told you that a successful macular hole closure does not guarantee complete visual recovery and that a 2-line improvement is usually the measure of success of the surgery. You have been told that postoperative positioning also has an important role to play for closure of macular hole and that a good majority of the failures stem from incomplete and inconsistent postoperative positioning. Complications As with any surgical procedure, there are risks associated with macular hole surgery. Not every conceivable complication can be covered in this form but the following are examples of risk encountered with macular hole surgery. These complications can occur days, weeks, months, or years later. They can result in loss of vision or blindness. Careful follow-up is required after surgery. Complications of the surgery 1. Failure to accomplish closure of the hole(10-40% depending primarily on the duration and size) 2. Retinal detachments that may require additional surgery or may be inoperable (1-2%) 3. Vitreous hemorrhage 4. Infection (0.02%-0.1%) 5. Elevated eye pressure (glaucoma) 6. Cataract, which might require eventual or immediate removal of lens 7. Poorly healing or non-healing corneal defects 8 Corneal clouding and scarring Complications of anesthesia injections around the eye 1. Perforation of eyeball 2. Needle damage to the optic nerve, which could destroy vision 3. Retrobulbar hemorrhage 4. Possible drooping of eyelid 5. Systemic effects that have the potential for life-threatening complications and death Patient Consent In spite of the risks noted above, I understand that there is more risk to my vision if I do not have the operation than if I do. I have read and understand the consent form, I have had my questions answered, and I authorize my surgeon to proceed with the operation on my... (indicate right or left eye). ( 13 )

18 Signature / Thumb Impression of Patient/ Parent / Guardian:... Name:... Relationship... Date... Address:... Phone (Off)... (Res)... (Mob)... Declaration by Doctor I declare that I have explained the nature and consequences of the procedure to be performed, and discussed the risks that particularly concern the patient. I have given the patient an opportunity to ask questions and I have answered these. Doctor s signature Doctor s name Date Witness 1 Witness 2 Signature:... Signature:... Name:... Name:... Address:... Address:... Tel:... Tel:... ( 14 )

19 esdqyj gksy ltzjh fjrs'k xqirk jksxh dk uke %.... %.... jksxh dh vkbzmh %.... rkjh[k %... dk irk %.... VsyhQksu ua %.... lq>ko vksj ykhk vkids MkWDVj dh tkap ds vuqlkj vkidh vka[k esa esdqyj Nsn gs vksj vkidks crk;k gs fd vxj bldk bykt ugha fd;k x;k rks bl ckr ds vklkj gsa fd vkidh e/;orhz utj /khjs&/khjs [kjkc gksrh tk,xh ysfdu vkidh vka[k dh iwjh jks'kuh ugha tk,xha vkids MkWDVj us vkidks crk;k gs fd csgks'kh dh flfkfr esa vkidh vka[k esa vkarfjd :i ls lhfer djus okyh f>yyh fudklh vksj xsl batsd'ku ds fcuk iklz Iykuk fovjsdvkseh ls tqm+h fø;kfof/k viuk;h tk,xha D;k ltzjh ds QyLo:i Nsn can gks tk,xk bldk iwokzuqeku yxkus esa egroiw.kz dkjd Nsn ds ekstwn jgus dh vof/k vksj Nsn dk vkdkj gsa Ng eghuksa ls de le; le; ls ekstwn jgus okys Nsnksa ds fy, lqyrk dh nj yxhkx 90 izfr'kr gsa fqj Hkh],d lky ;k vf/kd ls ekstwn jgus okys Nsn ds fy, ;g?kvdj yxhkx 60 izfr'kr gks tkrh gsa vkids MkWDVj us vkidks crk;k gs fd esdqyj Nsn dk lqyrkiwozd can gksuk n`f"v dh iw.kz:is.k HkjikbZ dh xkjavh ugha djrk vksj ;g fd 2&ykbu lq/kkj izk;% ltzjh dh lqyrk dk isekuk gksrk gsa vkidks crk;k x;k gs fd vkwijs'ku ds ckn dk LFkkiu Hkh esdqyj ds Nsn dks can djus esa egroiw.kz Hkfedk vnk djrk gs vksj foqyrkvksa ds dkqh cms+ fglls dk dkj.k vkwijs'ku ds ckn dk v/kwjk vksj vlaxr LFkkiu gksrk gsa tfvyrk,a 'ky;fø;k ls tqm+h fdlh Hkh dk;zfof/k dh Hkkafr gh esdqyj Nsn dh ltzjh ls Hkh tksf[ke tqm+s gq, gksrs gsaa bl :i esa gjsd dyiuh; tfvyrk dks 'kkfey ugha fd;k tk ldrk ysfdu esdqyj Nsn ltzjh ls tqm+s tksf[keksa ds mnkgj.k fueufyf[kr gsaa ;s tfvyrk,a fnuksa] grksa] eghuksa ;k lkyksa ckn isnk gks ldrh gsaa budh otg ls n`f"v dk pys tkuk ;k va/kkiu isnk gks ldrk gsa ltzjh ds ckn lko/kkuh Hkjs QkWyks&vi dh t:jr gksrh gsa ltzjh dh tfvyrk,a 1- Nsn dh canh dks iwjk djus esa foqyrk ¼10&40 izfr'kr eq[;r;k vof/k vksj vkdkj ij fuhkjz½ 2- jsfvuk dk vyxko ftlds fy, vfrfjdr ltzjh dh t:jr im+ ldrh gs ;k gks ldrk gs fd mldk vkwijs'ku gh u gks ik;s ¼1&2 izfr'kr½ 3- fovfjvl jdrlzko 4- laøe.k ¼0-02 izfr'kr&0-1 izfr'kr½ 5- vka[k dk c<+k gqvk ncko ¼Xywdksek½ 6- eksfr;kfcan] tks fd ysalksa dh varr% ;k QkSju fudklh dks vko';d cuk ldrk gs 7- dkwuhzy dh [kjkfc;ksa dk cgqr gh /khes Bhd gksuk ;k ugha Bhd gksuk 8- dkwuhzy DykmfMax ;k LdSfjax vka[kksa ds bnzfxnz laosnukgkjh batsd'kuksa dh tfvyrk,a 1- us=xksyd dk [ksn 2- izdkf'kd ul dks lqbz ls {kfr] tks fd n`f"v dks u"v dj nsrh gs 3- jsvªkscqyckj jdrlzko 4- iydksa dh lahko Mªwfiax 5- lokzaxh izhkko ftlesa fd thou dks [krjs esa Mkyus okyh tfvyrkvksa vksj eksr dh lahkko;rk gksrh gs jksxh dh lgefr Åij crk;s x;s tksf[keksa ds ckotwn] esa le>rk gwa fd vxj esa vkwijs'ku ugha djokrk gwa rks esjh n`f"v dks vksj Hkh vf/kd [krjk gsa esaus lgefr izi= dks i<+ vksj le> fy;k gs] esjs iz'uksa ds mùkj fn;s tk pqds gsa] vksj esa vius ltzu dks viuh ¼^^nk;ha** ;k ^^ck;ha** vka[k lq>k,a½ dk vkwijs'ku djus ds fy, vkxs c<+us gsrq vf/kñr djrk gwaa ( 15 )

20 dk dk fu'kku %... uke %.... fj'rk %... rkjh[k %.... irk %... Qksu % ¼vkfQl½.... ¼/kj½.... eksckby%.... MkWDVj }kjk?kks"k.kk esa?kks"k.kk djrk gwa fd esaus laiuu dh tkus okyh dk;zfof/k dh izñfr vksj mlds ifj.kkeksa dks le>k fn;k gs vksj mu tksf[keksa dh ppkz dh gs tks fd fo'ks"k :i ls jksxh ls lacaf/kr gsa esaus jksxh dks iz'u iwnus dk volj iznku fd;k gs vksj mudk mùkj fn;k gsa MkWDVj dk glrk{kj % MkWDVj dk uke % rkjh[k % xokg 1 xokg 2 glrk{kj %.... glrk{kj %... uke %.... uke %.... irk %... irk %.... Qksu %.... Qksu %. ( 16 )

21 Avastin TM Intraivtreal Injection Zahir Abbas, Gunjan Prakash Name of Patient... Age/Sex... Patient ID... Date... Son / Daughter of... Address... Tel... Possible Benefits and Off-Label Status Avastin TM was not initially developed to treat your eye condition. Based upon the results of clinical trials that demonstrated its safety and effectiveness, Avastin TM was approved by the Food and Drug Administration (FDA) for the treatment of metastatic colorectal cancer. Once a device or medication is approved by the FDA, physicians may use it off-label for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using Avastin TM off-label to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin TM had less fluid and more normal-appearing maculas, and their vision improved. Avastin TM is also used, therefore, to treat macular edema, or swelling of the macula. Recently, a medication similar in function and designed for intravitreal administration was approved by the FDA for the treatment of AMD. Possible Limitations The goal of treatment is to prevent further loss of vision. Although some patients have regained vision, the medication may not restore vision that has already been lost, and may not ultimately prevent further loss of vision caused by the disease. Alternatives You do not have to receive treatment for your condition, although without treatment, these diseases can lead to further vision loss and blindness, sometimes very quickly. Other forms of treatment are available. At present, there are three FDA-approved treatments for neovascular age-related macular degeneration. The first two are photodynamic therapy with a drug called Visudyne TM and injection into the eye of a drug called Macugen TM. The third medication, Lucentis TM is similar to Avastin TM. In addition to the FDA-approved medications, some ophthalmologists use intravitreal triamcinolone off-label to treat eye conditions like yours. Complications when Avastin TM is given to patients with cancer When Avastin TM is given to patients with metastatic colorectal cancer, some patients experienced gastrointestinal perforations or wound healing complications, hemorrhage, arterial thromboembolic events (such as stroke or heart attack), hypertension, proteinuria, and congestive heart failure. Patients who experienced these complications not only had metastatic colon cancer, but were also given 400 times the dose you will be given, at more frequent intervals, and in a way (through an intravenous infusion) that spread the drug throughout their bodies. Risk when Avastin TM is given to treat patients with eye conditions The risk of these complications for patients with eye conditions is low. Patients receiving Avastin TM for eye conditions are healthier than the cancer patients, and receive a significantly small dose, delivered only to the cavity of their eye. While there are no FDA-approved studies about the use of Avastin TM in the eye that prove it is safe and effective, Lucentis TM, a similar drug, was recently approved for AMD. One study of patients who received Avastin TM through an intravenous infusion reported only a mild elevation in blood pressure. Another study of patients treated like you will be with intravitreal Avastin TM did not have these elevations or the other serious problems seen in the patients with cancer. However, the benefits and risks of intravitreal Avastin TM for eye conditions are not yet fully known. In addition, whenever a medication is used in a large number of patients, a small number of coincidental life-threatening problems may occur that have no relationship to the treatment. For example, patients with diabetes are already at increased risk for heart attacks and strokes. If one of these patients being treated with Avastin TM suffers a heart attack or stroke, it may be caused by the diabetes and not the Avastin TM treatment. Known risks of intravitreal eye injections Your condition may not get better or may become worse. Any or all of these complications may cause decreased vision and/or have a ( 17 )

22 possibility of causing blindness. Additional procedures may be needed to treat these complications. Possible complications and side effects of the procedure and administration of Avastin TM include but are not limited to retinal detachment, cataract formation, glaucoma, hypotony (reduced pressure in the eye), damage to the retina or cornea, and bleeding. There is also the possibility of an eye infection (endophthalmitis). Any of these rare complications may lead to severe, permanent loss of vision. Patient Responsibilities I will immediately contact my doctor if any of the following signs of infection or other complications develop : pain, blurry or decreased vision, sensitivity to light, redness of the eye, or discharge from the eye. I will keep all post-injection appointments so my doctor can check for complications. Although the likelihood of serious complications affecting other organs of my body is low, I will immediately contact my physician if I experience abdominal pain associated with constipation & vomiting, abnormal bleeding, chest pain, severe headache, slurred speech, or weakness on one side of the body. As soon as possible, I will also notify the treating ophthalmologist of these problems. I will inform any other surgeon that I am on a medication that needs to be stopped before I can have surgery. Patient Consent The above explanation has been read by/to me. The nature of my eye condition has been explained to me and the proposed treatment has been described. The risks, benefits, alternatives, and limitations of the treatment have been discussed with me. All my questions have been answered. I understand that Avastin TM was approved by the FDA for the treatment of metastatic colorectal cancer, and has not been approved for the treatment of eye conditions. Nevertheless, I wish to be treated with Avastin TM, and I am willing to accept the potential risks that my physician has discussed with me. I hereby authorize the treating eye-surgeon to administer the intravitreal Avastin TM in my affected eye as needed. This consent will be valid until I revoke it or my condition changes to the point that the risks and benefits of this medication for me are significantly different. Signature / Thumb Impression of Patient/ Parent / Guardian:... Name:... Relationship... Date... Address:... Phone (Off)... (Res)... (Mob)... Declaration by Doctor I declare that I have explained the nature and consequences of the procedure to be performed, and discussed the risks that particularly concern the patient. I have given the patient an opportunity to ask questions and I have answered these. Doctor s signature Doctor s name Date Witness 1 Witness 2 Signature:... Signature:... Name:... Name:... Address:... Address:... Tel:... Tel:... ( 18 )

23 vokflvu Vh,e bavªsofvª;y btsd'ku tghj vcckl] xqatu izdk'k jksxh dk uke %.... %.... jksxh dh vkbzmh %.... rkjh[k %... dk irk %.... VsyhQksu ua %.... lahkkfor ykhk vksj ^^vkq&yscy** flfkfr vokflvu Vh,e dks 'kq:&'kq: esa vkidh vka[k dh n'kk dks Bhd djus ds fy, ugha fodflr fd;k x;k FkkA bldh lqj{kk vksj izhkkfork dks iznf'kzr djus okys fpfdrldh; ijh{k.kksa ds ifj.kkeksa ds vk/kkj ij vokflvu Vh,e dks esvklvsfvd dksyksjsdvy dsalj ds mipkj ds fy, [kk,oa vks"kf/k iz'kklu ¼,QMh,½ dh eatwjh izkir gqbza,d ckj tc fdlh fmokbl ;k nok dks,qmh, dh eatwjh fey tkrh gs rks MkWDVj vxj mrikn ds ckjs esa iwjh tkudkjh j[krs gsa rks os vu; mís';ksa ds fy, mldk ^^vkq&yscy** mi;ksx dj ldrs gsa] mlds mi;ksx dks n`<+ oskkfud rjhds vksj Bksl fpfdrldh; lk{; ij vk/kkfjr dj ldrs gsa vksj mlds mi;ksx vksj izhkkoksa ds fjdkmksza dks cuk;s j[k ldrs gsaa us= fo'ks"kk,,emh vksj leku n'kkvksa ds mipkj ds fy, vokflvu Vh,e ^^vkq yscy** dk mi;ksx dj jgs gsa D;ksafd vuqla/kku crkrs gsa fd ohbzth,q vlkeku; ulksa ds fodkl ds dkj.kksa esa ls,d gs tks fd bu n'kkvksa dks mriuu djrs gsaa vokflvu Vh,e ls mipkj ikus okys jksfx;ksa esa de rjy inkfkz vksj T;knk lkeku; fn[kus okys esdqys Fks vksj mudh n`f"v lq/kjh gqbz FkhA fygktk] vokflvu Vh,e dk mi;ksx esdqyj,fmek ;k esdqyk dh lwtu dks Bhd djus ds fy, Hkh fd;k tkrk gsa gky gh esa] izdk;z esa,d leku vksj bavªkfovfj;y izca/k ds fy, rs;kj dh x;h nok dks,,emh ds mipkj ds fy,,qmh, }kjk eatwjh iznku dh x;ha lahkkfor lhek,a mipkj dk y{; n`f"v dh vksj vf/kd gkfu dks jksduk gsa gkykafd dqn jksfx;ksa us n`f"v dks fqj ls izkir fd;k gs ij gks ldrk gs fd nok ml n`f"v dks cgky ugha dj ik;s tks fd igys gh tk pqdh gs vksj chekjh ds dkj.k vkxs n`f"v ds tkus dks varr% ugha jksd ik;sa fodyi vki viuh n'kk dk mipkj ugha Hkh djok ldrs gsa] gkykafd mipkj ds fcuk ;s chekfj;ka n`f"v dh vksj Hkh gkfu vksj va/ksiu dh vksj ys tk,axh] dbz ckj cgqr gh tynha mipkj ds nwljs :i miyc/k gsaa orzeku esa] fu;ksosldwyj mez ls tqm+s esdqyj fodkj ds fy,,qmh, ls eatwjh izkir rhu mipkj gsaa izfke nks folqmkbu Vh,e uked nok ds lkfk QksVksMk;kufed mipkj vksj esdqtsu Vh,e uked nok dk vka[k esa batsd'ku gsaa rhljh nok] yqlsafvl Vh,e vokflvu Vh,e ds leku gksrh gsa,qmh, ls eatwjh izkir nokvksa ds vfrfjdr dqn us=&fo'ks"kk vkidh rjg dh vka[kksa dh n'kkvksa ds mipkj ds fy, bavªkfovfj;y fvª;kefluksyku & ^^vkq&yscy** dks mi;ksx esa ykrs gsaa dsalj ds jksfx;ksa dks vokflvu Vh,e fn;s tkus ij mriuu gksus okyh tfvyrk,a tc esvklvsfvd dksyksjsdvy dsalj okys jksfx;ksa dks vokflvu Vh,e nh x;h rks dqn jksfx;ksa us tbjkaf=; Nsnksa ;k?kko Hkjus esa ijs'kkfu;ksa] /keuh; FkzksEcks,Ecksfyd?kVukvksa ¼tSls fd nksjk ;k ân;k?kkr½] mpp jdrpki] izksvhuqfj;k vksj dkatsflvo gkvz QsY;ksj dk lkeuk fd;ka bu ijs'kkfu;ksa dks eglwl djus okys jksfx;ksa dks u dsoy esvklvsfvd dksyksu dsalj Fkk cfyd mugsa vkids eqdkcys 400 xquk [kqjkd T;knk fu;fer varjkyksa ij vksj bl izdkj ls ¼var%f'kjk esa nzo dks Mkyus ds tfj;s½ nh x;h Fkh ftlus fd muds iwjs 'kjhj esa nok dks QSyk fn;k FkkA vka[k dh chekfj;ksa okys jksfx;ksa ds mipkj ds fy, vokflvu Vh,e dks fn;s tkus ds le; ds tksf[ke vka[k dh chekjh okys jksfx;ksa ds fy, bu ijs'kkfu;ksa ds tksf[ke de gsaa vka[kksa dh chekfj;ksa ds fy, vokflvu Vh,e izkir djus okys jksxh dsalj jksfx;ksa ds eqdkcys T;knk LoLFk gksrs gsa vksj dsoy mudh vka[kksa dh dsfovh esa Mkyh tkus okyh myys[kuh; :i ls de ek=k izkir djrs gsaa tgkavka[kksa esa vokflvu Vh,e ds mi;ksx ds ckjs esa,qmh, ls eatwjh izkir,sls dksbz v/;;u ugha gsa tks fd ;g lkfcr djrs gksa fd ;g lqjf{kr vksj izhkkoh gs] ogha blh izdkj dh nok yqlsafvl Vh,e dks gky gh esa,,emh ds fy, eatwjh iznku dh x;ha ul ds vanj nzo Mkydj vokflvu Vh,e izkir djus okys jksfx;ksa ds,d v/;;u esa dsoy jdrpki esa gydh o`f) ns[kh x;ha vkidh rjg bavªkfovfj;y vokflvu Vh,e ls mipkj ikus okys jksfx;ksa ds,d nwljs v/;;u esa bu o`f);ksa ;k vu; xahkhj lel;kvksa dks ugha ns[kk x;k gs ftugsa fd dsalj ds jksfx;ksa esa ns[kk x;k FkkA fqj Hkh] vka[k dh chekfj;ksa ds fy, bavªkfovfj;y vokflvu Vh,e ds ykhkksa vksj tksf[keksa dk vhkh iwjh rjg ls irk ugha pyk gsa blds vfrfjdr] tc jksfx;ksa dh cm+h la[;k esa nok dk mi;ksx fd;k tkrk gs rks,d NksVh la[;k esa tkuysok lel;kvksa dk la;ksx isnk gks ldrk gs ftldk fd mipkj ds lkfk dksbz fj'rk ugha gksrk gsa mnkgj.k ds fy, e/kqesg dks jksfx;ksa dks fny ds nksjs ;k vk?kkr dk tksf[ke igys ls gh c<+k gqvk gksrk gsa vxj vokflvu Vh,e ls mipkj ik jgs jksfx;ksa esa ls dksbz fny ds nksjs ;k vk?kkr ls =Lr gksrk gs rks gks ldrk gs fd mldk dkj.k e/kqesg gks u fd vokflvu Vh,e ds lkfk mipkja vka[kksa ds bavªkfovfj;y batsd'kuksa ds Kkr tksf[ke vkidh chekjh esa gks ldrk gs fd lq/kkj ugha vk;s ;k og cnrj gks ldrh gsa bu ijs'kkfu;ksa esa ls dksbz ;k lhkh?kvh gqbz n`f"v vksj@;k va/kro isnk djus ( 19 )