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http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-12-18T11:58:29+01:00http://www.webmedcentral.com/Dr. Udo A UbaniClinical Features Of Epidemic Adenovirus Ocular Infection- A Case Report In Eket Coastal Town In Nigeria
http://www.webmedcentral.com/article_view/1349
BackgroundAdenovirus cause most cases of viral infections of the eyes, which are highly contagious with the tendency to occur as epidemics.MethodAn 8year old school girl presented to the clinic with complains of difficulty to open her eyes while she woke in the morning, gritty sensations and watery discharges on both eyes; with clinical features of multiple petechial hemorrhages seen within the injected conjunctivas, a bilateral inferior palpebral folliculitis, left eye more severe and a conjunctival pseudomembrane.ResultPalpation of the left preauricular area showed lymphadenopathy. Serological test implicated adenovirus type 8. Patient was subsequently treated as outpatient; in the office both eyes were thoroughly lavaged with a sterile saline rinse and the pseudomenbrane was peeled. 2 drop 0.5% lotprednol etabonate ophthalmic suspension was applied to minimize bleeding. 2 drop 0.5% Visine ophthalmic preparation, a vasoconstrictor was prescribed q.i.d. OU along side GenTeal artificial tears q.2h. OU. In addition, cold compresses were recommended p.r.n. There was complete resolution of the conjunctiva by the 5th day of check-up.ConclusionBetter hygiene such as frequent hand wash and furlough help control spread.text/html2013-04-15T05:49:25+01:00http://www.webmedcentral.com/Mr. Shrikant D PawarInvestigating Emerging Trends of Intraocular Lens (IOL\'s) Implantation in Rural India for Cataract
http://www.webmedcentral.com/article_view/4197
Purpose: Investigating emerging trends of intraocular lens (IOL's) implantation in Dr. Manohar Dole Medical Foundation, Narayangaon, India, for Cataract from April 2003 till March 2011.
Materials and Methods: Survey was conducted at Dr. Manohar Dole Medical Foundation, Narayangaon, India, where patients were categorized by Intraocular lens (IOL's) implantations and conservative methods of treatment. The Parametric T test was calculated between number of patients operated for cataract with IOL and the conservative method of treatment to find if there is any significant difference between these two groups.
Result: The significant Parametric P value of 3.60833076940971E-36 was obtained stating that the occurrence of observed difference just by chance is very much unlikely.
Conclusion: We found a significant increase in IOL implantation compared to conservative treatment in the patients at Dr. Manohar Dole Medical Foundation, Narayangaon, India, for 9 subsequent years stating an emerging trend of operative procedures in rural parts of India.text/html2010-11-20T16:26:06+01:00http://www.webmedcentral.com/Dr. Shveta J BaliCorneal Graft Rejection: A Review Of Literature And Recent Advances
http://www.webmedcentral.com/article_view/1199
Immune rejections remain one of the most common causes of failure of penetrating keratoplasty. Epithelial rejection, chronic stromal rejection, hyperacute rejection and endothelial rejection constitute the different types of corneal graft rejection that might occur in isolation or conjunction. Various risk factors have been identified to increase the risk of graft rejections. With a recent advent in lamellar and endothelial keratoplasties, it is important to identify the patterns of rejection in these grafts. Corticosteroids remain the mainstay of prophylaxis and treatment of corneal graft rejection. The role of various immunosuppressive agents, systemic and topical, is being investigated and preliminary reports have shown some benefit. The successful management of corneal graft rejection involves understanding the immunopathogenesis of the same, prevention, early detection and prompt management.text/html2011-02-24T21:24:17+01:00http://www.webmedcentral.com/Dr. Shveta J BaliEpithelial And Subepithelial Corneal Dystrophies
http://www.webmedcentral.com/article_view/1598
Corneal dystrophies are a heterogenous group of rare, inherited corneal diseases that are typically bilateral, symmetric, non-inflammatory, slowly progressive, and usually bear no relationship to environmental or systemic factors. The word dystrophy is derived from Greek literature (dys = wrong, difficult; trophe = nourishment). Clinically, the corneal dystrophies are divided into three groups based on the principal anatomical location of the abnormalities. Some affect primarily the corneal epithelium and its basement membrane or Bowman layer and the superficial corneal stroma (anterior corneal dystrophies), the corneal stroma (stromal corneal dystrophies), or Descemet membrane and the corneal endothelium (posterior corneal dystrophies). Most corneal dystrophies have no systemic manifestations and present with variable shaped corneal opacities in a clear or cloudy cornea and they affect visual acuity to different degrees.text/html2011-04-08T19:47:36+01:00http://www.webmedcentral.com/Dr. Tan Aik KahA Systemic Approach to Facial Nerve Paralysis
http://www.webmedcentral.com/article_view/1856
Purpose. To present systemic approach and recognition of red flags in facial nerve paralysis. Background. Patients with facial nerve paralysis commonly present themselves to the primary care physicians. Misdiagnosis of other causes of facial nerve paralysis as Bell’s palsy is not uncommon. Occult malignancy can present with acute facial paralysis resembling Bell’s palsy; with no other clinical findings and normal imaging findings. A systematic diagnostic approach and recognition of red flags is important.Conclusion. A careful search for the etiology of facial paralysis will avoid misdiagnosis and medicolegal complications. Bell’s palsy should always remain a diagnosis of exclusion.text/html2012-04-26T15:00:42+01:00http://www.webmedcentral.com/Dr. Karandeep RishiReversible Blindness in Severe Pre eclampsia
http://www.webmedcentral.com/article_view/3302
Sudden and complete loss of vision in patients with severe pre eclampsia and eclampsia is a rare occurrence. It is usually due to involvement of the occipital cortex or the retina. Though distressing and alarming it is generally reversible with complete recovery of blindness in one week. We report a rare case of patient with severe preeclampsia who underwent caesarean section, had complete loss of vision in the post-operative period. Vision started improving within 24 hours and completely recovered in one week.text/html2012-04-27T17:48:34+01:00http://www.webmedcentral.com/Dr. Karandeep RishiPosterior Ischaemic Optic Neuropathy Following Vaginal Delivery
http://www.webmedcentral.com/article_view/3307
Sudden hypotension complicated with anaemia can lead to acute bilateral simultaneous posterior ischaemic optic neuropathy (PION). Such cases have been described in the perioperative period; however PION developing after normal vaginal delivery is a very rare occurrence. We report a case of 32 years old para 3 who presented to us on the second post-partum day after a normal vaginal delivery with bilateral vision loss and had no visual recovery even 8 weeks post-partum.text/html2012-05-10T18:41:32+01:00http://www.webmedcentral.com/Mr. Muhammed R SiddiquiCorneal Collagen Cross Linking in Keratoconus
http://www.webmedcentral.com/article_view/3351
Keratoconus is a non-inflammatory degenerative acquired condition affecting the shape of the cornea. The cornea begins to protrude like a cone and this eventually results in distortion, apical thinning and scarring (1).
Keratoconus usually begins during puberty and progresses through adolescence and beyond (3). It may progress for up to 10-20 years before slowing down or stabilising. Most cases affect both eyes with each eye being affected differently but it can be unilateral (2). It is associated with eye rubbing (3). The incidence of keratoconus is approximately 1 in 20 000 (4).
Although the cause of keratoconus is unknown, there are many theories which indicate that there may be environmental (allergies and eye rubbing), endocrine or genetic elements that play a part (6). Some studies have shown that keratoconus affected corneas lack important anchoring fibrils that structurally stabilise the cornea and that this extra flexibility allows the cornea to protrude forward into a cone like shape (2).
Histological features include thinning of the stroma, iron deposits in the epithelial basement membrane and breaks within the bowman’s layer (3).
Patients present initially with vision deterioration often in one eye due to progressive myopia and astigmatism (4). This may be described by patients as blurred vision, increased sensitivity to light, difficult night time driving, haloes, headaches or eye strain (2).
Diagnosing keratoconus may be difficult in the early stages but may be done by identifying many of the subtle changes by using a slit lamp microscope (4). Some signs that may be visualised on the slit lamp may include corneal thinning, apical scarring, Fleischer’s rings (yellow-brown iron deposits in the peripheral cornea) and vogt’s striae (vertical stress lines in the stroma and descemet’s membrane) (2,5). Following diagnosis, ophthalmologists would often like to measure the curvature of the cornea which is done by keratometry and computed corneal topography. Keratometry measures the central anterior curvature and measures corneal astigmatism (2). Corneal topography makes three dimensional maps of the cornea and has been the main way to diagnose keratoconus earlier and monitor progression accurately (2).
Acute hydrops may occur in some cases of keratoconus. This occurs when aqueous humour flows through a split descemet’s membrane and into the corneal stroma causing oedema and haziness which may cause severe pain and deteriorate vision further (4,6).
Management of keratoconus is aimed at correcting refractive errors and this is achieved initially by wearing glasses or soft contact lenses. Rigid gas permeable contact lenses may be worn if there is progression of keratoconus (2). A variety of surgical options exist if glasses or contacts prove unsuccessful. These can include insertion of intracorneal rings, however this does not affect progression. Severe cases of keratoconus in which the refractive error is too large to be treated by optical means or when there is substantial scarring may require corneal transplantation (penetrating keratoplasty) in order to improve vision (7). This applies to 10-20% of keratoconus patients who after a long recovery period after the corneal transplantation may still need to wear contact lenses (6). Although the prognosis after transplantation is good, there is still a chance of transplant rejection (6).
Riboflavin ultraviolet light induced corneal collagen crosslinking (CXL) has been a new promising method of treating keratoconus. It was developed in 1998 in Germany and is the only form of treatment that aims to treat the underlying cause of keratoconus by increasing collagen cross-links within the cornea which subsequently strengthens it (6). However this treatment is not curative, it aims to halt any further progression and glasses or contact lens may still be required (2). Early on in this procedure, the epithelium needs to be removed which is done by instilling alcohol onto the corneal for a short period and then scraping it off. Although removal of the epithelium may cause some discomfort and increase the risk for infection, studies have found that cross-linking does not occur in the presence of the epithelium as it acts like a barrier (8).
The aim of this audit is to look the outcomes of patients who have had corneal collagen cross linking (CXL) at the Royal Liverpool University Hospital (RLUH) Ophthalmology Department and compare this to other available literature.text/html2012-05-14T12:22:14+01:00http://www.webmedcentral.com/Dr. Pankaj LambaA Case of Bilateral Optic Neuritis
http://www.webmedcentral.com/article_view/3373
A 22 year male patient presented with headache fever and vomiting since 3 days duration and was initial managed as a case of meningitis or suspected brain abscess. He developed painful blurred vision in the right eye 2 days after his admission.
On ocular examination the vision in Right eye was reduced to counting fingers close to face with presence of colour de-saturation in right eye. The vision in the left eye was 6/6. There was a presence of relative afferent pupillary defect in the right eye. Examination of the fundus showed presence of disc oedema with surrounding parapapillary oedema in the right eye. A provisional diagnosis of optic neuritis secondary to demyelination was made as MRI showed demyelinating plaques. Patient was started on IV Methylprednisiolone and oral steroids as per ONTT (Optic Neuritis treatment trial) guidelines Patient vision improved to 6/15 in the right eye and the oral steroids were tapered.
After 2 weeks of stopping steroid therapy patient visited the outpatient clinic with painful blurring of the vision of the left eye. On examination the visual acuity in the Left eye was hand movements close to face with colour desatuartion and presence of relative afferent pupillary defect in the left eye. Patient was put on IV methyl prednisolone and oral steroids. Visual acuity at the end of treatment was 6/9p in Right eye and 6/12 in the left eye. On follow up MRI at 3 months there was resolution of the demyelinating changes on MRI and the final visual acuity was 6/9 in Right eye and 6/9P in Left eye. This patient needs to be followed up to detect development of demyelinating diseases later in life.text/html2013-07-10T04:25:56+01:00http://www.webmedcentral.com/Dr. Ken-ichi SatoTips to Create Smooth Scleral Beds under Scleral Flaps: Theory and Preliminary Results
http://www.webmedcentral.com/article_view/4325
A surgical technique using a round-tip scarifier to create smooth scleral bed surfaces was postulated and performed on patients. During dissection in the right-handed direction, the blade should be rotated approximately 15° counter-clockwise around the axis of its handle from the bed-surface plane; the blade is then rotated clockwise for incision in the opposite direction. The handle is simultaneously set at approximately 15° from the scleral bed surface. When a thicker scleral flap is required during undermining, the blade is again relocated just posterior to the flap-bed angle, and dissection is resumed while the back edge of the blade is pushed into the bed more firmly. In each of 12 consecutive trabeculotomies performed by two surgeons, Schlemm’s canal was successfully identified using this technique.