Endophthalmitis is one of the most devastating complications
of intraocular surgeries, leaving patients with permanently
poor vision. Since cataract surgery consists of a large part of
ophthalmic operations, the majority of literature reports about the endophthalmitis is focused on cataract surgery [1]. Chronic post cataract endophthalmitis generally caused by propionibacterium acnes, and this entity is an indolent form of endophthalmitis usually presented 6 weeks or more after cataract surgery [2]. We display a post traumatic cataract endophthalmitic case.
— Man is the intermediate host in the life cycle of the pork tapeworm Taenia solium. Its larval form Cysticercus cellulosae is the causative agent of cysticercosis. Both intraocular and extra ocular cysticercosis are observed in tropical countries like India. A case of extra ocular cysticercosis is reported here. An eight year old female patient who was brought to emergency department with pain and swelling around peri-orbital region, diminution of vision along with ptosis in left eye. CT scan showed scolex of Taenia solium in left medial rectus muscle. The patient recovered completely with oral albendazole steroids for four weeks. So a case with pain and swelling around peri-orbital region, diminution of vision along with ptosis in left eye should be investigated for cysticercosis.
Pseudophakic bullous keratopathy (PBK) is a post-operative condition that can occur as a complication of cataract extraction surgery and intraocular lens placement.
May be manifest in the immediate post-operative period or symptoms may not present for many years.
— Man is the intermediate host in the life cycle of the pork tapeworm Taenia solium. Its larval form Cysticercus cellulosae is the causative agent of cysticercosis. Both intraocular and extra ocular cysticercosis are observed in tropical countries like India. A case of extra ocular cysticercosis is reported here. An eight year old female patient who was brought to emergency department with pain and swelling around peri-orbital region, diminution of vision along with ptosis in left eye. CT scan showed scolex of Taenia solium in left medial rectus muscle. The patient recovered completely with oral albendazole steroids for four weeks. So a case with pain and swelling around peri-orbital region, diminution of vision along with ptosis in left eye should be investigated for cysticercosis.
Pseudophakic bullous keratopathy (PBK) is a post-operative condition that can occur as a complication of cataract extraction surgery and intraocular lens placement.
May be manifest in the immediate post-operative period or symptoms may not present for many years.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Recent Management of Double Pterygium: A Hospital Based Study
Abstract: Purpose: To describe a recent management of conjunctivo-limbal autografting (CLA) for double pterygium in single eye & to evaluate post surgical outcome on follow up. Method: A total 6 months prospective short study in which fifteen (15) patients were selected who had double pterygium in one eye & serial analysis of 15 eyes of surgically managed double pterygium was done. The conjunctivo-limbal autograft from Nasal & Temporal pterygium in same eye was taken from the neck-body of pterygium on either side & the harvested conjunctivo-limbal autograft from the neck-body of the nasal pterygium was transferred to temporal pterygium & similarly temporal autograft nasally with minimal loss of limbal stem cells. The patients were followed up per month to check for any recurrence or complications. Result: No recurrence or other complications was noted in any patient. Conclusion: Transferring conjunctival autograft harvested from neck- body of nasal & temporal pterygia in the same eye to utilize for autografting in temporal & nasal pterygium in double pterygium is less complicated & useful procedure for double headed pterygium .
Presbyopia ( Part 1 / lenticular approach )..Types of MFIOLDiyarAlzubaidy
Ophthalmology Lectures: Presbyopia Management can be done through the cornea or the lens or sclera ..in part 1 we discuss lenticular part & types of MFIOL
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Recent Management of Double Pterygium: A Hospital Based Study
Abstract: Purpose: To describe a recent management of conjunctivo-limbal autografting (CLA) for double pterygium in single eye & to evaluate post surgical outcome on follow up. Method: A total 6 months prospective short study in which fifteen (15) patients were selected who had double pterygium in one eye & serial analysis of 15 eyes of surgically managed double pterygium was done. The conjunctivo-limbal autograft from Nasal & Temporal pterygium in same eye was taken from the neck-body of pterygium on either side & the harvested conjunctivo-limbal autograft from the neck-body of the nasal pterygium was transferred to temporal pterygium & similarly temporal autograft nasally with minimal loss of limbal stem cells. The patients were followed up per month to check for any recurrence or complications. Result: No recurrence or other complications was noted in any patient. Conclusion: Transferring conjunctival autograft harvested from neck- body of nasal & temporal pterygia in the same eye to utilize for autografting in temporal & nasal pterygium in double pterygium is less complicated & useful procedure for double headed pterygium .
Presbyopia ( Part 1 / lenticular approach )..Types of MFIOLDiyarAlzubaidy
Ophthalmology Lectures: Presbyopia Management can be done through the cornea or the lens or sclera ..in part 1 we discuss lenticular part & types of MFIOL
Bilateral Corneal Thinning Post-Photorefractive Keratectomy Secondary to Untr...semualkaira
Photorefractive keratectomy (PRK) has been shown to be an effective surgical treatment for ametropic conditions. However, PRK is
associated with potential side effects which include glare, halos,
dry eye, haze, and corneal infection. This report focused on the
continued management and documentation of an unusual presentation of infectious keratitis secondary to previously untreated
blepharitis in a 29-year-old healthy Caucasian male
Bilateral Corneal Thinning Post-Photorefractive Keratectomy Secondary to Untr...semualkaira
Photorefractive keratectomy (PRK) has been shown to be an effective surgical treatment for ametropic conditions. However, PRK is
associated with potential side effects which include glare, halos,
dry eye, haze, and corneal infection. This report focused on the
continued management and documentation of an unusual presentation of infectious keratitis secondary to previously untreated
blepharitis in a 29-year-old healthy Caucasian male. He underwent
bilateral PRK one month prior and was formally diagnosed with
non-resistant staphylococcus aureus keratitis in both eyes. His uncorrected visual acuity was in the normal range in both eyes (OU).
Examination revealed inferior arc-shaped corneal thinning. Anterior segment photography and corneal topography were performed
on both eyes, and he was diagnosed with resolving staphylococcus
keratitis with persistent inferior thinning OU. The present report
documents the management and, more importantly, unusual appearance of peripheral arc-shaped corneal thinning secondary to
PRK treatment of eyes with previously undetected and untreated
staphylococcus blepharitis.
Purtscher’s Retinopathy after Airbag Injury, Six month Progression and Sequel...CrimsonpublishersMSOR
Purtscher’s retinopathy is a microvasculopathy that has been
well documented but poorly understood. The earliest case was
reported by Otmar Purtscher in 1910, which described a man
who suffered cranial trauma after falling out of a tree. The current incidence of Purtscher’s retinopathy is estimated at 0.24 persons per million per year [1]. When identified, Purtscher’s is most commonly seen in young men in the setting of trauma [2]. Seat belt trauma associated with motor vehicle accidents leading to Purtscher’s retinopathy has been reported in several papers. However, only one previous case of Purtscher’s retinopathy associated with traumatic optic neuropathy has been attributed to airbag injury [3-7].
A Case Report of Sub Periosteal Abscess by Munish Kumar Saroch in Crimson Publishers: International Journal of Medical Sciences
Acute and chronic rhino sinusitis are amongst the most frequently encountered conditions by the otolaryngologist in dayto- day practice. These are usually easily manageable with proper and effective antibiotic therapy and decongestants. However, despite widely available appropriate antibiotics, the otolaryngologist often finds himself face-to-face with complications of sinusitis especially in the pediatric population. These may affect the soft tissues, bones, the orbit and even the brain with a possible fatal or functionally impairing outcome (visual loss) at times. Here we present a case of orbital complication secondary to frontoethmoidal sinusitis.
Homework IX - Biomaterials Science.
Many pathologies arise from deficiencies in diffracting the light due to abnormal morphologies of cornea; lens opacity (due to aging, most of the times) ...
Two practical cases are now studied deeply in a patient and biocompatibility scope.
IST - 4th Year - 2nd Semester - Biomedical Engineering.
Presented By- Dr. Hardik Jain, Co-Authors- Dr. Mrunal Patil, Dr. Dhiraj Balwir( Disclosure: Author Has No Financial Interest ), Dr. Vasantrao Pawar Medical College, Nashik
Similar to A Chronic Post Cataract Surgery Endophthalmitis with Suspended Intraocular Lens: A Case Report | Crimson Publishers (20)
Can Blackcurrant (Ribes Nigrum L) Help in Control of Ligneous Conjunctivitis?...CrimsonpublishersMSOR
Can Blackcurrant (Ribes Nigrum L) Help in Control of Ligneous Conjunctivitis? by Mariana Granito Ponte de Oliveira in Medical & Surgical Ophthalmology Research
Right Sided Optic Meningioma in a Young Girl _Crimson PublishersCrimsonpublishersMSOR
ONSMs are rare tumors of anterior visual pathway [1]. ONSMs arise from meningoepithelial cap cells of the arachnoids villi and can develop at any location along the entire course of the optic nerve sheath [2,3]. We received a case of right sided optic tumor completely involving the eyeball requiring exentration surgery and were sent to our department for analysis. On cut opening a firm whicte tumor surface was seen and on microscopy a diagnosis og meningothelial meningioma was made. The diagnosis was confirmed by EMA positivity.
Atypical Presentation of Orbital Natural Killer cell Lymphoma | Crimson Publi...CrimsonpublishersMSOR
Natural killer (NK)/T-cell lymphoma is a rare malignancy accounting for less than 1 percent of all lymphomas in North America and Europe. Ocular manifestations frequently presented as orbital cellulites that does not improve with adequate antibiotics. We report a case of NK/T cell lymphoma with rare ocular manifestation that was initially confused with orbital cellulites and chronic sinusitis due to multiple negative biopsies. 92-year-old female presented with right eye vision loss, and ipsi lateral orbital swelling for four weeks. MRI demonstrated right intra-orbital extension to the orbital apex. Workups for infection and vasculitis were negative. Multiple biopsies with histopathology and flow cytology were unrevealing for malignancy. Patient failed to improve on antibiotics and steroids. Five months after the initial presentation, patient presented with the same complaint; however, the orbital mass had grown in size and involved the maxillary sinus and contra lateral side. Re-biopsy revealed positive CD 56 for NK lymphoma.
Macular Abnormality after Successful Surgery for Idiopathic Macular Hole Asse...CrimsonpublishersMSOR
Purpose: Macular changes following Internal Limiting Membrane peeling after successful Macular hole closure using optical coherence tomography.
Methods: 5 eyes of 5 patients were included in the study. The inclusion criteria were idiopathic full thickness macular hole and completed at least 6 months follow up. All patients underwent optical coherence tomography assessment before and after surgery until 6 months. Macular thickness and morphology map was analyzed before and after surgery.
Results: There were 3 males and 2 females. The age range from 45 to 59 years. Conspicuous irregular surface of the inner retina on Optical Coherence Tomography surface topography was evident in all eyes at 6 months. This was also associated with downward slope of the temporal macula seen on surface topography. There was trend towards decrease in subfield thickness especially in the T1, S1, I1 and N1 6 months after surgery. The average decrease was -60.4 microns in T1, -20.4 microns in S1, -13.0 microns in I1 and -23.4 microns in N1.
Conclusion: In this small case series brilliant blue assisted ILM peeling after successful macular whole closure showed evidence of decrease in macular thickness in all first subfield quadrant and downward slope of the temporal macula as well as conspicuous irregularity of the inner retina.
Choroidal Neovascular Membrane Association with Tumoral Calcinosis, a Case Re...CrimsonpublishersMSOR
To report a case of Choroidal neovascular membrane in a tumoral calcinosis patient, 2 eyes from 1 patient with choroidal neovascular membrane in one eye, a 40-year-old male with a history of Tumoral calcinosis presented with a choroidal neovascular membrane in his right eye, with his medical work up consisting of elevated levels of phosphorus and normal levels of calcium, with radiological imaging consistent with the diagnosis of tumoral calcinosis. We describe a case of choroidal neovascular membrane in tumoral calcinosis, and its response to Intravitreal anti-VEGF injections.
Case Report of Bilateral Medial Rectii Recessions as a Surgical Modality in C...CrimsonpublishersMSOR
Squint or strabismus is an ocular condition in which an eye deviated from its normal position of parallelism we have different forms of squints 1 con 2 acquires one of the most important things while dealing with a squint is to do the following things
1. Visual assessment
2. Refraction mydriatic
3. Fundus examination
Why funds as in children retinoblastoma and coats disease can present as squint urge we have got various forms of squint
1. Accommodate
2. Non Accommodative
11 paralytic non paralytic 11 concomitant non concomitant squint can be esotopia, exotropia, hypertropia, hypotripia, pseudotropia, hertrotropia, microtropia and cyclotropia.
Correlation between Corneal Endothelial Cell Characteristics and Dry Eye Dise...CrimsonpublishersMSOR
In this cross-sectional study, a total of 150 eyes of 75 female students aged 19-25 years who did not have any history of eye injuries or eye disease affecting the corneal endothelium cell density, were recruited from KSU Female Campus. They were divided into groups based on their dry eye disease severity. All subjects undergone full ophthalmic examinations assessing their endothelium cell count using specular microscope and dryness level using Non-invasive Break up Time (NIBUT) using Keratograph.
Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glauco...CrimsonpublishersMSOR
The aim of this study was to investigate the long-term effect of selective laser trabeculoplasty in open angle glaucoma patients as a replacement for medical therapy. 64 eyes of 64 primary open angle glaucoma (POAG) patients under therapy with glaucoma drugs and controlled Intra Ocular Pressure (IOP) were reviewed for 36 months. 360o selective laser therapy (SLT) sessions were performed in two sessions and the medical therapy was stopped. The patients were controlled and evaluated postoperatively 1, 3, 6, 12, 24 and 36 months after surgery for glaucoma progression. In 36 (56.3%) of the 64 patients SLT was successful and there was no need to medical treatment at 36th month. In 28 patients (43.7%) medical treatment was started due to IOP rising. In Logistic regression analysis baseline IOP was found to be significantly effective on success rate of SLT (R2: 0.718, p<0.001).
The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic ...CrimsonpublishersMSOR
Women with idiopathic anterior uveitis do not appear to relapse while pregnant. Relapses are reported more frequently and more intensely during premenstrual and menstrual stages. These observations suggest that uveitis may be related to fluctuations of sex steroid hormones.
Histoplasmosis is a systemic mycosis present in an endemic state in many tropical or temperate regions. It is a pathology induced by Histoplasma capsulatum, dimorphic fungus thriving in wetlands and at moderate temperatures. In immunocompetent subjects, 95% of clinical forms are asymptomatic. The preferred sites for this dissemination are pulmonary, medullary, hepatic, splenic and ganglionic. Exceptionally, the fungus can reach the eye.
Epidemiology of Cataract in the Mexican Population, by 2020 | Crimson PublishersCrimsonpublishersMSOR
The objective of this study is to describe, in a retrospective and prospective manner, statistical data on the revalence and incidence of cataract in the Mexican population from data generated by INEGI (Instituto Nacional de Estadísticas Geografica e Informatica - National Institute of Statistics, Geographical and Informatics) and The CONAPO (Consejo Nacional de Poblacion-National Population Council). The OPS (Organizacion Panamericana de Salud) (PAHO (Pan American Health Organization)) has determined 5 priority eye diseases in Latin America, Cases of which CATARATA causes 50% - 60% of reversible blindness. 20% of the population is above 50 years of age and 65% have visual disability.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. How to cite this article: Shuting L, Xianru H, Mingwu L, Wenzhen Y. A Chronic Post Cataract Surgery Endophthalmitis with Suspended Intraocular Lens: A Case
Report. Med Surg Ophthal Res. 1(1): MSOR.000504. 2017. DOI: 10.31031/MSOR.2017.01.000504
Medical & Surgical Ophthalmology Research Med Surg Ophthal Res
2/3
Volume 1 - Issue - 1
Slip-lamp examination revealed severe congestion in the right eye,
with an infratemporal knot at a distence of 3 mm from the limbus,
untransparent cornea with a scarring, numerous dust keratic
precipitates (KPs), anterior cells 4+, aqueous flare (++), no obvious
hypopyon and a PC-IOL. The fundus could not be visualized (Figure
1). B scan showed dispersed dot echoes throughout the vitreous
cavitywithlowtomediumreflectivityandaposterior-temporalband
with high reflectivity (Figure 2). So, a diagnosis of endophthalmitis
was presumed and aqueous humor (AH) samples were immediately
obtained for pathogenic identification. At the same time, empirically
vancomycin (2mg) combined with dexamethasone (0.4mg) was
injected intravitreally and topical 0.5% levofloxacin eye drops 4
times one day were administered. AH smears were subjected to
Gram’s stain for detection of bacteria and showed Gram-possitive
cocci.On the 2th
day, the anterior and posterior inflammation
was not improved. The conventional cultures characterized the
bacterium as a staphylococcus epidermidis on the basis of colony
morphology and convetional biochemical reactions. Meanwhile
genechip arrays verified Staphylococci in aqueous humor at genetic
level. Therefore, a complete pars plana vitrectomy combined with
intraviteous injection of vancomycin (2mg) and ceftazidime (2mg)
was performed. Massive white purulent clusters in the vitreous
body and on the posterior retinal surface were found during the
surgery (Figure 3). Neither retinal breaks nor retinal detachment
were found after the purulent clusters had been completely
removed. Unexpectedly, we found the infratemporal suture knot
was loose which was used to fix the suspended IOL (Figure 4).
Weak iodine solution was used to disinfect the knot and topical
area after exposing tropical sclera. Foreign sclera was applied to
cover the reinforced knot. Post-operative administration included
intravenous ceftazidime 1000mg once a day for three days, topical
0.5% levofloxacin and 1% prednisolone acetate eye drops 4 times
one day for two weeks. Medium intracameral inflammation was
observed three days after the operation, and BCVA improved to 0.1.
According to the drug sensitive test result, an intraviteous injection
of vancomycin (2mg) was performed again. A relatively normal
fundus with slight intracameral inflammation was observed two
days after the injection, and the BCVA recovered to 0.15.
Figure 2
Figure 3
Figure 4
Discussion
In the absence of capsular support, the IOL could be implanted
into the anterior chamber or sewn into the posterior chamber
ciliary sulcus. PC-IOL implantation is a more optimal choice
in eyes without capsular support, because of the long-term
postoperative complications of anterior chamber IOL such as
endothelial decompensation, secondary glaucoma and pupillary
ectopia [3]. Gram-positive bacteria are the most common cause of
postoperative endophthalmitis in the West [4]. Staphylococci was
the most frequent bacterial flora isolated from conjuctival sac of
patients prior to cataract surgery [5]. The conventional method is
transscleral fixation of PC-IOL in the ciliary sulcus with a scleral
flap. In this case, the patient underwent PC-IOL through pars plana
fixation with inferior knot buried in the conjunctiva. After eigtht
years, the knot was loose and exposed above the conjuctiva, and
bacteria invaded into eyeball from the underlying tunnel of suture.
Meanwhile, diabetes mellitus was proposed as patient-associated
risk factor for the occurrence of endophthalmitis [6]. Intravitreal
antibiotics, IOL extraction and vitrectomy are treatment options
based on clinical course [7]. Above all, we prefer the knot beneath
a scleral flap to burries in the conjunctiva when performing a
suspended PC-IOL, because the knot is easier to expose without
a scleral flap. The report was supported by National Science
Foundation of China (No. 2101000263).
Acknowledgement
The report was supported by National Science Foundation of
China (No. 2101000263).
3. How to cite this article: Shuting L, Xianru H, Mingwu L, Wenzhen Y. A Chronic Post Cataract Surgery Endophthalmitis with Suspended Intraocular Lens: A Case
Report. Med Surg Ophthal Res. 1(1): MSOR.000504. 2017. DOI: 10.31031/MSOR.2017.01.000504
3/3
Medical & Surgical Ophthalmology Research Med Surg Ophthal Res
Volume 1 - Issue - 1
References
1. Sandvig KU, Dannevig L (2003) Postoperative endophthalmitis:
establishment and results of a national registry. Journal of cataract and
refractive surgery 29(7): 1273-1280.
2. Roussel TJ, Culbertson WW, Jaffe NS (1987) Chronic postoperative
endophthalmitis associated with Propionibacterium acnes. Archives
of ophthalmology 105(9): 1199-1201.
3. Mandal AK, Bagga H (2002) Pupillary block glaucoma following
implantation of a posterior chamber pseudophakos in the anterior
chamber. Indian journal of ophthalmology 50(1): 54-56.
4. Packer M, Chang DF, Dewey SH, Little BC, Mamalis N, et al. (2011)
Prevention, diagnosis, and management of acute postoperative
bacterial endophthalmitis. Journal of cataract and refractive surgery
37(9): 1699-1714.
5. Suto C, Morinaga M, Yagi T, Tsuji C, Toshida H (2012) Conjunctival sac
bacterial flora isolated prior to cataract surgery. Infect Drug Resistm
5: 37-41.
6. Jabbarvand M, Hashemian H, Khodaparast M, Jouhari M, Tabatabaei
A, et al. (2016) Endophthalmitis Occurring after Cataract Surgery:
Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic
Features, and Risk Factors. Ophthalmology 123(2): 295-301.
7. Meisler DM, Mandelbaum S (1989)Propionibacterium-associated
endophthalmitis after extracapsular cataract extraction. Review of
reported cases. Ophthalmology 96(1): 54-61.