Ophthalmologists may be the first to consider the diagnosis of Alport’s Syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery during which time IOP should be monitored closely. Results of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport’s Syndrome.
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Use of digital retinal camera to detect prevalence and severity of diabetic ...Riyad Banayot
ABStrAct
BAckGround: The purpose of this study was to determine the prevalence of diabetic retinopathy among Palestinian
refugees serviced by the Diabetic Retinopathy Screening Program in the Occupied Palestinian Territories (DRS-
-OPT).
MAterIAl And MethodS: This is a retrospective study of retinal images of 1891 diabetic patients in 15 urban
UNRWA clinics participating in the DRS-OPT program in Palestine over 12 months. A nonmydriatic Canon CR-2
fundus retinal camera was used to capture two 450 non-stereo fundus images for each eye. Qualified graders (nurses)
performed the grading based on the DRS-OPT grading system.
reSultS: Out of the 1891 diabetic patients screened, 1694 had at least one gradable eye. 16% of patients had
diabetic retinopathy (5.7% had mild nonproliferative diabetic retinopathy, 4.3% had moderate nonproliferative
diabetic retinopathy, 1.1% had severe, moderate nonproliferative diabetic retinopathy, and 1.7% had proliferative
diabetic retinopathy. Maculopathy without retinopathy amounted to 3%. Other findings included the identification
of blinding diseases such as age-related macular degeneration and optic disc glaucomatous cupping.
concluSIonS: The retinopathy screening program using a nonmydriatic fundus camera identified diabetic retino-
pathy in 16% of diabetic Palestinian refugees. A total of 72% of these patients were diabetics with nonproliferative
retinopathy. This program can be used to prevent progression by facilitating the education of patients and early
intervention.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify
the prognostic factors associated with profound visual loss.
Materia l and methods: The current study is a retrospective review of hospital files for 83 consecutive patients
with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic
details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group
was used for wound location, classification, and scoring for each case.
Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and
21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%),
followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes
occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic
impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that
were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar,
vitreous hemorrhage.
Conclusi on: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III
injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic
factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury
and its prognosis.
Use of digital retinal camera to detect prevalence and severity of diabetic ...Riyad Banayot
ABStrAct
BAckGround: The purpose of this study was to determine the prevalence of diabetic retinopathy among Palestinian
refugees serviced by the Diabetic Retinopathy Screening Program in the Occupied Palestinian Territories (DRS-
-OPT).
MAterIAl And MethodS: This is a retrospective study of retinal images of 1891 diabetic patients in 15 urban
UNRWA clinics participating in the DRS-OPT program in Palestine over 12 months. A nonmydriatic Canon CR-2
fundus retinal camera was used to capture two 450 non-stereo fundus images for each eye. Qualified graders (nurses)
performed the grading based on the DRS-OPT grading system.
reSultS: Out of the 1891 diabetic patients screened, 1694 had at least one gradable eye. 16% of patients had
diabetic retinopathy (5.7% had mild nonproliferative diabetic retinopathy, 4.3% had moderate nonproliferative
diabetic retinopathy, 1.1% had severe, moderate nonproliferative diabetic retinopathy, and 1.7% had proliferative
diabetic retinopathy. Maculopathy without retinopathy amounted to 3%. Other findings included the identification
of blinding diseases such as age-related macular degeneration and optic disc glaucomatous cupping.
concluSIonS: The retinopathy screening program using a nonmydriatic fundus camera identified diabetic retino-
pathy in 16% of diabetic Palestinian refugees. A total of 72% of these patients were diabetics with nonproliferative
retinopathy. This program can be used to prevent progression by facilitating the education of patients and early
intervention.
Acute ocular chemical injury: a descriptive assessment and management review ...Riyad Banayot
Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for
chemical injury at St. John Eye Hospital, Jerusalem.
Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital,
Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included:
Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and
medications given. Data were stored and analysed using Excel.
Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of
injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50%
of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented
in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the
condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were
prescribed in 92.5% of cases.
Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters.
Several recommendations were formulated:
1. Emphasize to caregivers that irrigation must be done first.
2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be
documented.
3. It is important to document and record limbus details, iris details, and IOP in all cases.
Lecture on Management of Cataract Surgery and Diabetes Mellitus. 2010 World Congress, American Society of Cataract & Refractive Surgery. Boston, MA 2010
Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
Lecture on Management of Cataract Surgery and Diabetes Mellitus. 2010 World Congress, American Society of Cataract & Refractive Surgery. Boston, MA 2010
Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
Rare Case Of Right Eye Persistent Fetal Vasculature With Left Eye Optic Nerve...Dr. Jagannath Boramani
Sayli Gavaskar - Jr.Resident, V H Karambelkar - Professor, D K Sindal - Professor, and HOD , Department of Ophthalmology KRISHNA INSTITUTE OF MEDICAL SCIENCES AND DEEMED UNIVERSITY, KARAD, MAHARASHTRA.
Purpose: We report a rare case of a 2 - year-old child with ectopia lentis and potential Marfan syndrome (MFS) and discuss her management.
Methods: A 2 - year - old female with no signifi cant past medical history was brought in by her mother after complaints that the child has recently been holding everything close to her eyes while simultaneously shifting her head down. Her mother reported no history of pain or trauma. The child’s family history was negative for ectopia lentis or MFS.
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Clinical and dermographics profile of glaucoma patients in Hebron - Palestin...Riyad Banayot
ABSTRACT
BACKGROUND: The purpose of the study was to describe the clinical profile of glaucoma types, treatment modalities, visual outcomes, and intraocular pressure (IOP) control for patients in Palestine.MATERIAL AND METHODS: Data collection was done through the hospital record review, which included basic demographics including file number, age, sex, family history of glaucoma, history of anti-glaucoma and steroid medication, history of ocular trauma or surgery, etiology of secondary glaucoma and history of systemic illness. All the patients had a comprehensive eye examination, including visual acuity, intraocular pressure, vertical cup-disc ratio, and gonioscopy. Data were obtained, tabulated, and organized using Microsoft Excel, and statistical analyses were done using Wizard Version 1.9.49 by Evan Miller.RESULTS: There were 100 females with a mean age of 53 and 101 males with a mean age of 67. Primary open-angle glaucoma and its variants represented 45.3% of all patients, while secondary glaucoma represented 40.3% and primary angle closure glaucoma represented 10.4%. The prevalence of glaucoma increased with age, and the last visual acuity (VA) showed that 39.2% of eyes had Normal/near normal VA. The highest average IOP of 25 mm Hg was recorded among secondary glaucoma patients. Of all glaucoma eyes studied, 64% were on one or two medications, and the most common surgical procedures performed were peripheral iridectomy 18.2% followed by trabeculectomy 15.5%. CONCLUSION: Primary open-angle glaucoma (POAG) was the predominant glaucoma. Glaucoma increased significantly with advancing age. Pseudoexfoliation and neovascular glaucoma comprised the majority of secondary glaucoma.
Evaluating the optic nerve head in glaucomaRiyad Banayot
The best method readily available to the clinician for performing this examination is high plus lens fundus biomicroscopy. Optimal magnification can be achieved by using a +60D lens which provides 1.5 times the magnification of a 90D lens. During this examination the patient's pupils must be maximally dilated with a combination of mydriatic agents such as 1% Tropicamide and 2.5% Phenylephrine.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
2. Ophthalmology Journal 2021, Vol. 6
58 www.journals.viamedica.pl/ophthalmology_journal
85% of males with XLAS, and anterior lenticonus
(pathognomonic), which occurs in 25% of patients
with XLAS. Although anterior lenticonus is com-
mon, rupture of the anterior capsule is not.
Case report
A 12-years-old boy was presented to St. John
Eye Hospital with complaints of reduced vision
in the left eye lasting for five days. The patient
had a history of trauma by his brother using his
hand. There was no history of systemic diseas-
es. Slit-lamp examination revealed: normal test
results in the right eye and ruptured anterior
lens capsule with opaque lens (assumed to be
trauma-related) in the left eye. The child was ad-
mitted to the hospital. Left lensectomy and pos-
terior chamber intraocular lens (PCIOL) under
general anaesthesia was performed the next day.
Blood pressure was 100/60 mm Hg preopera-
tively. Six weeks follow-up showed: visual acuity
6/6 with –3.00 DS in the right eye and 6/6 with
Plano/–0.75 X 45 in the left eye.
Two years later, the same child was referred to
our hospital for right cataract surgery. Physical
examination revealed that the child was clinically
anaemic and had neurosensory deafness (patient
produced a report from otolaryngologist showing
a history of deafness of 3 years duration). Family
history revealed eight healthy older siblings. Oph-
thalmic examination revealed the right eye had rup-
tured anterior capsule and cataractous lens (Fig. 1).
A paediatric consultation was conducted regarding
the patient’s general condition. The child was diag-
nosed with Alport’s syndrome and end-stage renal
disease. He underwent haemodialysis and blood
transfusions and was started on anti-hypertensive
medication (atenolol).
Three months later, the assessment of the right
eye cataract extraction was performed. Examina-
tion revealed: blood pressure (BP): 240/140 mm
Hg, haemoglobin: 10.8 g/dL, right eye was catarac-
tous with intraocular pressure (IOP) of 30 mm Hg.
Surgery was postponed due to poorly controlled
systemic hypertension (despite being on atenolol
and hemodialysis three times/week). The patient
was started on timolol and dorzolamide drops and
was referred urgently to his physician, who added
nifedipine systemically.
The child was re-admitted to our hospital three
weeks later for surgery, but the right eye IOP was
48 mm Hg, and his BP was 190/125 mm Hg. Oral
acetazolamide (Diamox) was added to his medica-
tion regimen. Three days later, right eye IOP was
23 mm Hg, and BP was 166/113 mm Hg. The
child underwent a right lensectomy with foldable
PCIOL under general anesthesia.
Five weeks post-operatively, examination re-
vealed: visual acuity 6/6 with –3.00 DS in the right
eye and 6/6 with –2.75/–1.00 X 110 in the left
eye (Fig. 2). Fundus examination of the right eye
showed perimacular exudates/flecks (Fig. 3).
Figure 3. Right ye — perimacular exudates: flecks two weeks
post-operative
Figure 1. Right eye ruptured anterior capsule and cataractous
lens
Figure 2. Right eye — 2 weeks post-operative
3. Riyad G. Banayot, Nicholas Sargent Anterior lens capsule rupture in undiagnosed Alport’s
59
www.journals.viamedica.pl/ophthalmology_journal
Discussion
Dr. Cecil Alport, in 1927 was the first to iden-
tify an association between nephritis and deafness
[1]. Arnott et al. [2] in 1966 reported anterior
lenticonus as a specific sign of Alport’s syndrome.
Nielsen in 1978 stated that reported cases of ante-
rior lenticonus were only described in patients with
Alport’s syndrome [3].
Anterior lenticonus may not be distinguished at
birth but develops progressively over the years. The
average age for lenticonus diagnosis is the second
decade. The condition is bilateral, where the ante-
rior surface of the lens protrudes centrally, causing
high myopia. Vision deteriorates gradually over the
years and, and there is no noticeable improvement
of visual acuity with optical correction.
Perimacular flecks do not hinder vision and are
linked to renal deterioration. Flecks and pigment ep-
ithelial lesions are identified with Alport’s syndrome.
With slit-lamp examination, the lenticonus is
seen as a transparent, local, tapering bulge of the
lens capsule and cortex, located axially. Lenticonus
is seen with retro-illumination as an ‘oil droplet’
shape in its early stages. Swan and Patel [4] em-
phasized that anterior lenticonus may be difficult
to observe with the slit-lamp. However, an altered
retinoscopic reflex should alert the practitioner to
look more closely at the ocular media.
Ruotsalainen and Tarkanan [5] reported mean
thickness values of 8.2 ± 3.2 µm for the central
anterior capsule. Ohkubo et al. [6] reported a 3 µm
thickness for the central portion of the anterior cap-
sule of a patient with Alport’s syndrome (controls
had a thickness of 20 µm). Factors that eventually
cause the capsule to rupture include histological
changes of the anterior capsule, stressed structures
during accommodation, and anterior lens curvature
becoming more convex centrally.
The diagnosis of Alport’s syndrome is suspected
with the following findings: persistent glomerular
hematuria, positive family history for Alport’s syn-
drome or renal failure, or characteristic clinical fea-
tures (progressive neurosensory deafness, lenticonus,
or retinopathy), or glomerular basement membrane
(GBM) with an abnormal collagen IV. Diagnosis
is confirmed by using kidney biopsy (lamellated
GBM) or genetic testing (mutations in COL4A5 or
COL4A3 or COL4A4).
A literature review showed few anterior lens cap-
sule/lenticonus rupture cases associated with Al-
port’s syndrome [7– 10].
Our case represents a spontaneous rupture
in a patient not known to have anterior lenti-
conus. With a history of trauma and the lack of
findings in the unaffected eye, clinically significant
anterior lenticonus was most likely not present in the
traumatized eye. However, a sub-clinical abnormal-
ity of the anterior capsule must have been present
to allow the anterior capsule to rupture secondary
to a traumatic event that was not severe enough to
affect the rest of the anterior segment. We suspect an
early stage of Alport’s syndrome was present.
The majority of males with Alport’s syndrome
have hematuria and high tone hearing loss by the
age of 10 years. The progression of renal failure
varies among patients. Many males develop failure
in their teens, but some do not develop it until the
fourth decade of life.
We report a case of bilateral anterior lens capsule
rupture in a child who was not previously diagnosed
with Alport’s syndrome. A search of the literature
revealed one case similar to ours [11].
Our patient did not show any typical signs of
renal failure or hearing loss on his first presen-
tation, and the attending physician assumed his
condition to be trauma-related. When the patient
presented to the hospital two years later, he had
been diagnosed with neurosensory deafness but
not nephropathy.
Limitations of the study include the lack of regu-
lar follow-up, and lack of genetic testing.
Early diagnosis may prevent amblyopia, cataract,
and strabismus. Also, optical devices can correct len-
ticular myopia, and hearing aids can reduce sensory
neural hearing loss. In our case, the ophthalmologist
was the first physician to evaluate the patient before
serious systemic complications occurred.
Conclusions
Ophthalmologists may be the first to consider
the diagnosis of Alport’s syndrome based on lens
changes. Uncontrolled blood pressure can delay sur-
gery, during which time IOP should be monitored
closely. Results of lensectomies with foldable IOL
implantation are successful.
Acknowledgments
NIL.
Competing interests
NIL.
4. Ophthalmology Journal 2021, Vol. 6
60 www.journals.viamedica.pl/ophthalmology_journal
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