this talk is for MBBS STUDENTS
It gives a summary of diabetic retinopahty including epidemiology, signs and symptoms, pathogenesis , diagnosis, investigations and treatment .
it is fairly brief lecture to make UGs aware of the entity of DR
with lot of images it is a good teaching presentation.
DR WANI'S TALK ON DIABETIC RETINOPATHY PART I FOR KLE RESIDENTS.pptxvbwani
part I of detailed talk on diabetic retinopathy
covers epidemilogy , risk factors pathogenesis , classification, clinical features in detail
The presentation has lot of pictures
The presentation is based on studies published regaring each topic
It deatls with each clinical sign in detail
It also deals with risk factors for DR with examples of studies conducted
Retinal Complications in Indians with Type 2 Diabeticsijtsrd
Diabetic retinopathy is the disease that affects diabetics the most often DR . The duration of the disease, ineffective control of blood sugar, and the presence of hypertensive are the key causes. Yet, large inter individual differences in risk indicate that other factors, like as genetic inheritance or insulin variability, are critical in explaining susceptibility to DR development. It is also important to recognise that DR can predict both microvascular and macrovascular issues independently. Hence, DR needs to be factored in when determining the cardiovascular risk of a diabetic. Even if dementia is becoming more prevalent in people with type 2 diabetes, evaluating retina neurodegeneration could help in spotting those at risk. The therapeutic implications of DR awareness in the assessment of a diabetic patient cannot be overstated. It follows that DR may worsen despite a rapid decrease in blood sugar. To wrap up, this article provides a critical evaluation of DRs function within entire care of diabetic patients. Dr. Dhruv Kundu "Retinal Complications in Indians with Type 2 Diabetics" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd53983.pdf Paper URL: https://www.ijtsrd.com.com/medicine/other/53983/retinal-complications-in-indians-with-type-2-diabetics/dr-dhruv-kundu
DR WANI'S TALK ON CRVO FOR RESIDENTS KLE 14 JAN 2023.pptxvbwani
This detailed talk about central retinal vein occlusion deals with all aspects of the disease
It deals with incidence and prevalence, risk factors and clinical features
It also deals with classification, importance of recognizing the ischemic type and the means to recognize it .
It deals with historical studies that gave nformation abour natural course and treatment options
sEveral studies that were conducted to treat CRVO are dealt with in which emphasis is given to anti VEGF drugs
Detection of Diabetic Retinopathy in Retinal Image Early Identification using...ijtsrd
Diabetic Retinopathy, the most common reason of vision loss, is caused by damage to the small blood vessels in the retina. If untreated, it may result in varying degrees of vision loss and even blindness. Since Diabetic Retinopathy is a silent disease that may cause no symptoms or only mild vision problems, annual eye exams are crucial for early detection to improve the chances of effective treatment where fundus cameras are used to capture the retinal images. However, fundus cameras are too big and heavy to be transported easily and too costly to be purchased by every health clinic, so fundus cameras are an inconvenient tool for widespread screening. Recent technological developments have enabled using smartphones in designing small sized, low power, and affordable retinal imaging systems to perform Diabetic Retinopathy screening and automated Diabetic Retinopathy detection using machine learning and image processing methods. However, Diabetic Retinopathy detection accuracy depends on the image quality and it is negatively affected by several factors such as Field of View. Since smartphone based retinal imaging systems have much more compact designs than the traditional fundus cameras, the retina images captured are likely to be low quality with smaller Field of View As a result, the smartphone based retina imaging systems can be used as an alternative to the direct ophthalmoscope once it tested in the clinical settings. However, the Field of View of the smartphone based retina imaging systems plays an important role in determining the automatic Diabetic Retinopathy detection accuracy. M. Mukesh Krishnan | J. Diofrin | M. Vadivel "Detection of Diabetic Retinopathy in Retinal Image Early Identification using Deep CNN" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd55047.pdf Paper URL: https://www.ijtsrd.com.com/computer-science/other/55047/detection-of-diabetic-retinopathy-in-retinal-image-early-identification-using-deep-cnn/m-mukesh-krishnan
DR WANI'S TALK ON DIABETIC RETINOPATHY PART I FOR KLE RESIDENTS.pptxvbwani
part I of detailed talk on diabetic retinopathy
covers epidemilogy , risk factors pathogenesis , classification, clinical features in detail
The presentation has lot of pictures
The presentation is based on studies published regaring each topic
It deatls with each clinical sign in detail
It also deals with risk factors for DR with examples of studies conducted
Retinal Complications in Indians with Type 2 Diabeticsijtsrd
Diabetic retinopathy is the disease that affects diabetics the most often DR . The duration of the disease, ineffective control of blood sugar, and the presence of hypertensive are the key causes. Yet, large inter individual differences in risk indicate that other factors, like as genetic inheritance or insulin variability, are critical in explaining susceptibility to DR development. It is also important to recognise that DR can predict both microvascular and macrovascular issues independently. Hence, DR needs to be factored in when determining the cardiovascular risk of a diabetic. Even if dementia is becoming more prevalent in people with type 2 diabetes, evaluating retina neurodegeneration could help in spotting those at risk. The therapeutic implications of DR awareness in the assessment of a diabetic patient cannot be overstated. It follows that DR may worsen despite a rapid decrease in blood sugar. To wrap up, this article provides a critical evaluation of DRs function within entire care of diabetic patients. Dr. Dhruv Kundu "Retinal Complications in Indians with Type 2 Diabetics" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd53983.pdf Paper URL: https://www.ijtsrd.com.com/medicine/other/53983/retinal-complications-in-indians-with-type-2-diabetics/dr-dhruv-kundu
DR WANI'S TALK ON CRVO FOR RESIDENTS KLE 14 JAN 2023.pptxvbwani
This detailed talk about central retinal vein occlusion deals with all aspects of the disease
It deals with incidence and prevalence, risk factors and clinical features
It also deals with classification, importance of recognizing the ischemic type and the means to recognize it .
It deals with historical studies that gave nformation abour natural course and treatment options
sEveral studies that were conducted to treat CRVO are dealt with in which emphasis is given to anti VEGF drugs
Detection of Diabetic Retinopathy in Retinal Image Early Identification using...ijtsrd
Diabetic Retinopathy, the most common reason of vision loss, is caused by damage to the small blood vessels in the retina. If untreated, it may result in varying degrees of vision loss and even blindness. Since Diabetic Retinopathy is a silent disease that may cause no symptoms or only mild vision problems, annual eye exams are crucial for early detection to improve the chances of effective treatment where fundus cameras are used to capture the retinal images. However, fundus cameras are too big and heavy to be transported easily and too costly to be purchased by every health clinic, so fundus cameras are an inconvenient tool for widespread screening. Recent technological developments have enabled using smartphones in designing small sized, low power, and affordable retinal imaging systems to perform Diabetic Retinopathy screening and automated Diabetic Retinopathy detection using machine learning and image processing methods. However, Diabetic Retinopathy detection accuracy depends on the image quality and it is negatively affected by several factors such as Field of View. Since smartphone based retinal imaging systems have much more compact designs than the traditional fundus cameras, the retina images captured are likely to be low quality with smaller Field of View As a result, the smartphone based retina imaging systems can be used as an alternative to the direct ophthalmoscope once it tested in the clinical settings. However, the Field of View of the smartphone based retina imaging systems plays an important role in determining the automatic Diabetic Retinopathy detection accuracy. M. Mukesh Krishnan | J. Diofrin | M. Vadivel "Detection of Diabetic Retinopathy in Retinal Image Early Identification using Deep CNN" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd55047.pdf Paper URL: https://www.ijtsrd.com.com/computer-science/other/55047/detection-of-diabetic-retinopathy-in-retinal-image-early-identification-using-deep-cnn/m-mukesh-krishnan
RETINOPATHY OF PREMATURITY FOR PEDIATRICIANSvbwani
A TALK on Retinopathy of Prematurity (ROP) mainly for pediatricians
THE POWERPOINT presentation describes the important diseaee ofROP KEEPING in view teh responsibilities of neonatologists and pediatricians.
Which babies are to be screened and when should they be referred for ROP screening are described.
It describes the criteria for screening for ROP, screening regimen, when to treat what are the complications, different methods of treatment an their rationale is described .
Diabetic Retinopathy Detection System from Retinal Imagesijtsrd
Diabetes Mellitus is a disorder in metabolism of carbohydrates, and due to lack of the pancreatic hormone insulin sugars in the body are not oxidized to produce energy. Diabetic Retinopathy is a disorder of the retina resulting in impairment or vision loss. Improper blood sugar control is the main cause of diabetic retinopathy. That is the reason why early detection of retinopathy is crucial to prevent vision loss. Appearance of exudates, microaneurysms and hemorrhages are the early indications. In this study, we propose an algorithm for detection and classification of diabetic retinopathy. The proposed algorithm is based on the combination of various image processing techniques, which includes Contrast Limited Adaptive Histogram Equalization, Green channelization, Filtering and Thresholding. The objective measurements such as homogeneity, entropy, contrast, energy, dissimilarity, asm, correlation, mean and standard deviation are computed from processed images. These measurements are finally fed to Support Vector Machine and k Nearest Neighbors classifiers for classification and their results were analysed and compared. Aditi Devanand Lotliker | Amit Patil "Diabetic Retinopathy Detection System from Retinal Images" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38353.pdf Paper Url: https://www.ijtsrd.com/engineering/computer-engineering/38353/diabetic-retinopathy-detection-system-from-retinal-images/aditi-devanand-lotliker
DR WANI'S TALK ON Diabetic Retinopathy Part II december 31 2022 for KLE RES...vbwani
This part iI of DR deals with DME, investigations, treatment options and prognosis in detail
DME also deals with treatment protocols and regimen.
This along with part I is meant for those who want to have in depth knowledge about DR
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Automatic detection Non-proliferative Diabetic Retinopathy using image proces...IJERA Editor
Diabetes is a chronic disease that is reaching epidemic proportions worldwide. There are currently more than
190 million people with diabetes worldwide. The World Health Organization (WHO) estimates that this will rise
to 221 million by the year 2010, largely due to population growth, ageing, urbanization and a sedentary lifestyle.
Diabetes is currently the fourth main cause of death in most developed countries. In Singapore, the prevalence
of diabetes in our population is 8.2% according to the 2004 National Health Survey. This is expected to grow as
our population age.
Diabetic Retinopathy, if not well managed and controlled, can progress steadily to devastating
complications like blindness. At present, various analyses on complicated interaction between hereditary and
environmental factors are being undertaken regarding the onset of diabetes. The development of diabetic
complication has become a major concern regarding the prognosis of diabetic patients.
Diabetes Retinopathy is one of the most common diseases that people get affected by over the years. By doing
this paper, we hope to detect the stages of Diabetic Retinopathy as early as possible so as to prevent and cure
more Singaporeans from falling prey to this disease
Automatic detection Non-proliferative Diabetic Retinopathy using image proces...IJERA Editor
Diabetes is a chronic disease that is reaching epidemic proportions worldwide. There are currently more than
190 million people with diabetes worldwide. The World Health Organization (WHO) estimates that this will rise
to 221 million by the year 2010, largely due to population growth, ageing, urbanization and a sedentary lifestyle.
Diabetes is currently the fourth main cause of death in most developed countries. In Singapore, the prevalence
of diabetes in our population is 8.2% according to the 2004 National Health Survey. This is expected to grow as
our population age.
Diabetic Retinopathy, if not well managed and controlled, can progress steadily to devastating
complications like blindness. At present, various analyses on complicated interaction between hereditary and
environmental factors are being undertaken regarding the onset of diabetes. The development of diabetic
complication has become a major concern regarding the prognosis of diabetic patients.
Diabetes Retinopathy is one of the most common diseases that people get affected by over the years. By doing
this paper, we hope to detect the stages of Diabetic Retinopathy as early as possible so as to prevent and cure
more Singaporeans from falling prey to this disease
Detection of Diabetic Retinopathy using Kirsch Edge Detection and Watershed T...IJARIIT
Diabetic retinopathy (DR) is a common retinal complication associated with diabetics. A complication of diabetes is that it can also affect various parts of the body. When the small blood vessels have a high level of glucose in the retina, the vision will be blurred and can cause blindness eventually, which is known as diabetic retinopathy. However, if symptoms are identified in the early stage then proper treatment can be provided to prevent blindness. Usually the retinal images obtained from the fundus camera are examined directly and diagnosed. Due to this certain abnormalities due to diabetic retinopathy are not directly visible through the naked eye .Hence by using the image processing techniques these abnormalities can be extracted accurately and required treatments and precautions can be taken. And this also reduces the time for the ophthalmologists to detect the disease and give accurate treatments.
DR WANI'S TALK ON AMD FOR RESIDENTS 30 March 2020.pptxvbwani
This contains a detailed talk on AMD given in 2020 So slightly old But basic facts remain same It deals with epedemilogy, pathogenesis, risk factors, clincial features, investigations, treatment studies on treatment etc
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RETINOPATHY OF PREMATURITY FOR PEDIATRICIANSvbwani
A TALK on Retinopathy of Prematurity (ROP) mainly for pediatricians
THE POWERPOINT presentation describes the important diseaee ofROP KEEPING in view teh responsibilities of neonatologists and pediatricians.
Which babies are to be screened and when should they be referred for ROP screening are described.
It describes the criteria for screening for ROP, screening regimen, when to treat what are the complications, different methods of treatment an their rationale is described .
Diabetic Retinopathy Detection System from Retinal Imagesijtsrd
Diabetes Mellitus is a disorder in metabolism of carbohydrates, and due to lack of the pancreatic hormone insulin sugars in the body are not oxidized to produce energy. Diabetic Retinopathy is a disorder of the retina resulting in impairment or vision loss. Improper blood sugar control is the main cause of diabetic retinopathy. That is the reason why early detection of retinopathy is crucial to prevent vision loss. Appearance of exudates, microaneurysms and hemorrhages are the early indications. In this study, we propose an algorithm for detection and classification of diabetic retinopathy. The proposed algorithm is based on the combination of various image processing techniques, which includes Contrast Limited Adaptive Histogram Equalization, Green channelization, Filtering and Thresholding. The objective measurements such as homogeneity, entropy, contrast, energy, dissimilarity, asm, correlation, mean and standard deviation are computed from processed images. These measurements are finally fed to Support Vector Machine and k Nearest Neighbors classifiers for classification and their results were analysed and compared. Aditi Devanand Lotliker | Amit Patil "Diabetic Retinopathy Detection System from Retinal Images" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38353.pdf Paper Url: https://www.ijtsrd.com/engineering/computer-engineering/38353/diabetic-retinopathy-detection-system-from-retinal-images/aditi-devanand-lotliker
DR WANI'S TALK ON Diabetic Retinopathy Part II december 31 2022 for KLE RES...vbwani
This part iI of DR deals with DME, investigations, treatment options and prognosis in detail
DME also deals with treatment protocols and regimen.
This along with part I is meant for those who want to have in depth knowledge about DR
Title:
Choosing amongst current modalities to manage Diabetic Retinopathy
At Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore
Objective:
1. To review the current management options for DR
2. To share author’s four years follow up from Jan 2008 to Nov 2011 at Medical Retina Clinic, Eye Department WAPDA Teaching Hospital Complex Lahore.
3. Discussion on future Trends in management of DR.
Synopsis:
Diabetic retinopathy is the leading cause of new blindness in the world,
Argon LASER treatment has established itself as a gold standard in the management of DR. Intravitreal therapies in the form anti VEGF agents and steroids are also being widely used nationally and internationally. These therapies do not replace but complement each other.
Author will share his four years experience at Medical Retina clinic WAPDA hospital complex Lahore. 125 patients with DR were enrolled during this period. Treatment modalities used, included Argon Green Laser, Intravitreal Anti VEGF (Bevacizumab), Intravitreal Triamcinolone and subtenon Triamcinolone. Staging and severity of the disease as well as response to the offered therapy were the parameters used to tailor the treatment options.
Dr. Zia ul Mazhry
FRCS (Edin), FRCS (Glasgow), FCPS, CICOphth (UK)
Asstt Professor Central Park Medical College Lahore.
Consultant Eye Surgeon and Head of Eye Department
Wapda Teaching Hospital Complex
210 Feroz Pur Road Lahore.
Website: www.EyeAcuity.com
mazhry@yahoo.com
03004401151
Automatic detection Non-proliferative Diabetic Retinopathy using image proces...IJERA Editor
Diabetes is a chronic disease that is reaching epidemic proportions worldwide. There are currently more than
190 million people with diabetes worldwide. The World Health Organization (WHO) estimates that this will rise
to 221 million by the year 2010, largely due to population growth, ageing, urbanization and a sedentary lifestyle.
Diabetes is currently the fourth main cause of death in most developed countries. In Singapore, the prevalence
of diabetes in our population is 8.2% according to the 2004 National Health Survey. This is expected to grow as
our population age.
Diabetic Retinopathy, if not well managed and controlled, can progress steadily to devastating
complications like blindness. At present, various analyses on complicated interaction between hereditary and
environmental factors are being undertaken regarding the onset of diabetes. The development of diabetic
complication has become a major concern regarding the prognosis of diabetic patients.
Diabetes Retinopathy is one of the most common diseases that people get affected by over the years. By doing
this paper, we hope to detect the stages of Diabetic Retinopathy as early as possible so as to prevent and cure
more Singaporeans from falling prey to this disease
Automatic detection Non-proliferative Diabetic Retinopathy using image proces...IJERA Editor
Diabetes is a chronic disease that is reaching epidemic proportions worldwide. There are currently more than
190 million people with diabetes worldwide. The World Health Organization (WHO) estimates that this will rise
to 221 million by the year 2010, largely due to population growth, ageing, urbanization and a sedentary lifestyle.
Diabetes is currently the fourth main cause of death in most developed countries. In Singapore, the prevalence
of diabetes in our population is 8.2% according to the 2004 National Health Survey. This is expected to grow as
our population age.
Diabetic Retinopathy, if not well managed and controlled, can progress steadily to devastating
complications like blindness. At present, various analyses on complicated interaction between hereditary and
environmental factors are being undertaken regarding the onset of diabetes. The development of diabetic
complication has become a major concern regarding the prognosis of diabetic patients.
Diabetes Retinopathy is one of the most common diseases that people get affected by over the years. By doing
this paper, we hope to detect the stages of Diabetic Retinopathy as early as possible so as to prevent and cure
more Singaporeans from falling prey to this disease
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Diabetic retinopathy (DR) is a common retinal complication associated with diabetics. A complication of diabetes is that it can also affect various parts of the body. When the small blood vessels have a high level of glucose in the retina, the vision will be blurred and can cause blindness eventually, which is known as diabetic retinopathy. However, if symptoms are identified in the early stage then proper treatment can be provided to prevent blindness. Usually the retinal images obtained from the fundus camera are examined directly and diagnosed. Due to this certain abnormalities due to diabetic retinopathy are not directly visible through the naked eye .Hence by using the image processing techniques these abnormalities can be extracted accurately and required treatments and precautions can be taken. And this also reduces the time for the ophthalmologists to detect the disease and give accurate treatments.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
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Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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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
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
DR VIVEK WANI TALK ON DIABETIC RETINOPATHY FOR KLE MBBS STUDENTS UG KAHER.pptx
1. Diabetic Retinopathy
Dr. Vivek B Wani MS FRCSEd
Asst Prof JNMC
Consultant Vitreoretina surgeon
KLES Dr. Prabhakar Kore Hospital and MRC
Belagavi
2. OBJECTIVES OF THIS TALK
• Give a brief account of various aspects of
diabetic retinopathy
• At the end of talk the students should be able
to recognize DR as an important cause of
visual impairment
• Should be aware of referral protocols
• Also be aware of treatments available
10th August 2023 DR.Wani on DR for UGs KAHER 2
4. What is DR?
• It is a microangiopathy , affects retinal
vessels and results in typical clinical features
called DR
• DR is the most common retinal vascular
disease
• Most common cause of visual impairment in
persons aged 20-64 years
• If detected in time it can be treated to
improve or preserve the vision
10th August 2023 DR.Wani on DR for UGs KAHER 4
6. DM affects several OTHER organs
10th August 2023 DR.Wani on DR for UGs KAHER 6
7. Diabetic retinopathy
I) Epidemiology and the burden of Diabetic
Retinopathy(DR)
II) Risk factors for DR
III) Pathogenesis
IV) Clinical features
V) Classification of DR
VI) Investigations
VII)Treatment of Diabetic macular edema(DME)
and Diabetic retinopathy
10th August 2023 DR.Wani on DR for UGs KAHER 7
8. Burden of DM (epidemiology)
• Nearly 8.5% of adults above 18
years have DM in the world
https://www.who.int/news-room/fact-sheets/detail/diabetes
• In India 7.3% of population aged
>20 years have DM
RM Anjana et al. Lancet diabetes endocrinology. 2017 online
• An estimated 6.5 crore people are
diabetic in India
10th August 2023 DR.Wani on DR for UGs KAHER 8
9. How many DM patients have Diabetic
Retinopathy(DR)-prevalence?
• 34% of DM patients had DR and 10% of them
had sight threatening DR –world statistics
Yau et al Diabetes Care. 2012 Mar; 35(3):556-64.
• In India about 18% DM patients had
DR and 4% had sight threatening DR
Jotheeshwaran et al Indian J Endocr Metob 2016;20:51-8
PK Rani et al Middle East Afr J Ophthalmol .2012;19(1):129-34
10th August 2023 DR.Wani on DR for UGs KAHER 9
10. II) What are the risk factors for
development of DR in diabetics?
• Duration of DM- longer the duration more DR
• Control of DM –persistent hyperglycemia is a risk
factor for DR
• Hypertension- Higher the BP more the risk of DR
• Pregnancy –if a DM lady becomes pregnant
• Hyperlipidaemia
• h/o Cataract surgery-worsens DR
• M<F –not very strong factor
• Genetic factors – clustering of cases is seen
10th August 2023 DR.Wani on DR for UGs KAHER 10
11. a) Duration of DM and DR in Type I DM
Duration
of DM
ANY DR PDR DME
<5 YEARS 2% 0 0
>15 YEARS 97% 67% 23%
10th August 2023 DR.Wani on DR for UGs KAHER 11
Klein et al Diabetes in America, 2nd ed. Bethesda, Maryland: National Institute of Health.
1995;293-338
Klein R et al Arch Ophthalmol. 1984;102:520-52
12. 10th August 2023 DR.Wani on DR for UGs KAHER 12
DR Insulin takers Non insulin
takers
DM>15 years
Any DR 87% 57%
10 years incidence
of PDR
24% 10%
10years incidence
DME
18% 9%
Klein R et al Arch Ophthalmol. 1984;102:527-532
Klein R et al Arch Ophthalmol. 1994;112:1217-1228, Klein R et al Ophthalmol. 1995;102:7-16)
Duration of Type II DM And Incidence of DR
13. b) Control of DM –applies to MD of both
type I and II
UKPDS study (United Kingdom
Prospective Diabetes Study)of type
II DM patients
• If we reduce HbA1C by 1% the
risk of DR was reduced by 37%
Stratton IM, Adler AI, Neil HA, et al BMJ 2000 Aug 12;321(7258):405-12)
10th August 2023 DR.Wani on DR for UGs KAHER 13
14. c) Hypertension in DM of type 2
• In patients with hypertension and DM if we
reduce BP by 10 mm of Hg(154/97 to 144/82)
Progression of DR reduced by 34%
Reduced VA deterioration by 47%
Reduced need of laser by 35%
UKPDS group BMJ. 1998;317:703-713.
10th August 2023 DR.Wani on DR for UGs KAHER 14
15. 10th August 2023 DR.Wani on DR for UGs KAHER 15
How does hyperglycemia
cause Diabetic retinopathy?
17. Cheung et al Lancet. 2010;367:124-136
10th August 2023 DR.Wani on DR for UGs KAHER 17
Leucocyte
Adhesion
Platelet
Aggregation
RBC roulex
Formation
PDGF
Vascular occlusion
Causes hypoxia-VEGF up-regulated
New vessels produced-PDR
Leakage from retinal capillaries causes hgs,
exudates and Diabetic macular edema n DV
III) Pathogenesis of DR
19. 10th August 2023 DR.Wani on DR for UGs KAHER 19
VEGF –VASCULAR ENDOTHELIAL
GROWTH FACTOR
20. IV) Clinical Features of DR
SYMPTOMS
AND SIGNS
10th August 2023 DR.Wani on DR for UGs KAHER 20
21. A)SYMPTOMS
May be asymptomatic even with advanced disease and
DR may be detected in routine screening
Decreased vision is the most common symptom
GRADUAL onset of DV in DME or slowly developing
tractional RD
Sudden DV –is usually due to vitreous hemorrhage
Floaters – due to small vitreous hemorrhages
Distorted vision-metamorphopsia –pulling of retina by
TRD
Pain and redness- sudden onset indicates
development of neovascular glaucoma –late stage
10th August 2023 DR.Wani on DR for UGs KAHER 21
22. B) Examination -Signs of DR
In the anterior segment-
i) We first measure visual acuity both eyes
ii) Slit lamp examination to look for
neovascularisation of iris (NVI) or rubeosis
iridis
Gonioscopy- look for neovascularisation of
angle ---NVA
10th August 2023 DR.Wani on DR for UGs KAHER 22
24. Dilated fundus examination is must for
detection of signs of DR
1. Microaneurysms
2. Retinal hemorrhages-dot and blot and flame shaped hgs
3. Cotton wool spots(CWS)
4. Hard exudates
5. Venous changes –venous dilatation, beading, looping,
doubling,
6. Arterial changes-closure
7. WHEN PDR sets in - Neovascularization and its complications
– vitreous hemorrhage, tractional RD
8. Diabetic Macular edema -DME –can be present both in NPDR
AND PDR
9. Diabetic papillopathy -disc swelling causing DV in diabetic
patients
10th August 2023 DR.Wani on DR for UGs KAHER 24
25. 1. Retinal microaneurysms
• Are the first sign of DR
• Seen as red dots of 10-
125 microns
• Out-pouching or
fusiform dilation of
capillaries
• They leak and cause
retinal hemorrhages,
hard exudates and
retinal edema
10th August 2023 DR.Wani on DR for UGs KAHER 25
Out pouching Fusiform dilation
26. 2. Retinal hemorrhages
Superficial hgs - flame
shaped-they are in
retinal nerve fiber layer
Deep hgs- dot and blot
hgs –present inner
plexiform, inner nuclear
layers
10th August 2023 DR.Wani on DR for UGs KAHER 26
Superficial hgs
Dot and blot hgs
28. 3. Cotton wool spots (CWS)
10th August 2023 DR.Wani on DR for UGs KAHER 28
White superficial lesions with
brush like borders
Located in retinal nerve fiber layer
(RNFL)
Are due to axoplasmic flow
stoppage in retinal nerve fibers
CWS
Dot and blot hgs
Superfical hgs
29. 10th August 2023 DR.Wani on DR for UGs KAHER 29
Multiple small
hard exudates in
ring shape
Note hgs and
microaneurysms
in the center
Retina in center
is thickened
4. Hard exudates are in middle layers
30. Hard Exudates
Waxy, yellow lesions arranged in clumps
and/or rings in the posterior pole-circinate
retinopathy
In the center of the ring are present leaking
MA or capillaries also retina shows edema
Hard exudates are made up of lipoproteins
and lipid ingested macrophages
10th August 2023 DR.Wani on DR for UGs KAHER 30
32. 5. Intra Retinal Microvascular abnormality
(IRMA)
• Important signs of advancing disease
• They are intraretinal
• They are shunt vessels
• Fine, reddish, irregular blood vessels that run
from arterioles to venules
• They bypass the capillary bed
10th August 2023 DR.Wani on DR for UGs KAHER 32
33. 10th August 2023 DR.Wani on DR for UGs KAHER 33
Redfree photo showing multiple areas of IRMAs
34. 6. Venous changes
• Dilatation
• Venous beading
• Venous looping
Venous beading and looping
signify worsening DR
10th August 2023 DR.Wani on DR for UGs KAHER 34
Venous looping
35. 7. Arterial changes
• Arteriolar closure is main reason for hypoxia
of retina
10th August 2023 DR.Wani on DR for UGs KAHER 35
36. Signs of DR
• MA
• Retinal hgs –superficial and deep
• Cotton wool spots
• Hard exudates
• IRMA
• Venous changes
• Arterial changes
All the above changes occur in non Proliferative
DR -NPDR
There are no new vessels of fibrous tissue
10th August 2023 DR.Wani on DR for UGs KAHER 36
37. PDR
• When new blood vessels appear on the
surface of retina- we call it as PROLIFERATIVE
DIABETIC RETINOPATHY ------PDR
• All signs of NPDR may be present during PDR
• IN ADDITION TO THEM we will have --
10th August 2023 DR.Wani on DR for UGs KAHER 37
38. Signs of PDR include
• New vessels and fibrovascular membranes on
the retina
• Vitreous hemorrhage
In the vitreous gel
Subhyaloid hg -between retina and posterior
hyaloid
• Tractional RD
• Combined TRD with rhegmatogenous RD
10th August 2023 DR.Wani on DR for UGs KAHER 38
39. Neovascularization of disc or NVD
When new vessels grow on the disc or within ONE disc diameter
of the disc
10th August 2023 DR.Wani on DR for UGs KAHER 39
40. 2) NEOVASCULARIZATION ELSEWHERE-NVE -When new vessels
grow outside of ONE disc diameter from the disc
10th August 2023 DR.Wani on DR for UGs KAHER 40
41. What do the new vessels do?
• They are fragile and may break n bleed
Vitreous hg –sudden loss of vision
Subhyaloid Hg
• Later the new vessels undergo fibrosis and
cause contraction and lift retina-tractional
retinal detachment
10th August 2023 DR.Wani on DR for UGs KAHER 41
43. 10th August 2023 DR.Wani on DR for UGs KAHER 43
Tractional retinal detachment –TRD
44. 10th August 2023 DR.Wani on DR for UGs KAHER 44
Tractional retinal detachment –TRD
45. 10th August 2023 DR.Wani on DR for UGs KAHER 45
Tractional retinal detachment –TRD
46. PDR- New vessels on iris –NVI and/or in the angle - NVA
• Indicate severe ischemia in the retina and need urgent
attention and treatment
• May cause NVG - painful and blinding disease
10th August 2023 DR.Wani on DR for UGs KAHER 46
NVI
NVA
47. V) Classification of DR or stages of DR
DR
Non
proliferative
Proliferative
10th August 2023 DR.Wani on DR for UGs KAHER 47
48. NO DR
• Patient is diabetic but there are no changes of
DR
• Need annual follow ups
• Control BS and BP
10th August 2023 DR.Wani on DR for UGs KAHER 48
49. V) A. Classification of DR
NPDR
Mild
Very Severe
Moderate
Severe
10th August 2023 DR.Wani on DR for UGs KAHER 49
50. Mild NPDR
• Only microaneurysms are present - at least
one MA +
• No hgs, CWS, IRMAS, VB ETC
• Need follow up at 6-9months
10th August 2023 DR.Wani on DR for UGs KAHER 50
51. Moderate NPDR
• Some or all signs of NPDR may be present but
their degree is less than severe NPDR
--MAs, Hgs, IRMAs, H ex, venous beading, CWS
• Follow up -every 4 months if there is no
maculopathy
• If DME present then treat or FU 2-3 months
10th August 2023 DR.Wani on DR for UGs KAHER 51
52. Severe NPDR
• Is diagnosed by 4-2-1 Rule
• One of the 4-2-1 conditions present
• No new vessels, vitr or subhyaloid hg present
• Standard photos are from ETDRS study
10th August 2023 DR.Wani on DR for UGs KAHER 52
53. SEVERE NPDR RULE 4- hgs and MA =/>standard photo 2A in all 4
quadrants
10th August 2023 DR.Wani on DR for UGs KAHER 53
54. RULE 2- venous beading =/>standard photo 6A is present in 2 or
more quadrants
10th August 2023 DR.Wani on DR for UGs KAHER 54
55. RULE 1-
IRMA ≥ standard photo 8A in at least 1 quadrant
10th August 2023 DR.Wani on DR for UGs KAHER 55
56. Why it is important to recognize
Severe NPDR ?
• Severe NPDR is a sight threatening DR
• Nearly 50% progress to PDR in one year
• Follow ups are needed every 2-3 months
• Selected cases
LASER treatment pan retinal photocoagulation
Or intravitreal injection of anti vascular
endothelial growth factor
10th August 2023 DR.Wani on DR for UGs KAHER 56
57. VERY severe NPDR
• For very severe NPDR more than
one condition of the 4-2-1 rule is
present (for example- hgs plus VB or
VB &IRMA or hgs and IRMA )
10th August 2023 DR.Wani on DR for UGs KAHER 57
58. V) Classification of DR
DR
Non
proliferative
Proliferative
10th August 2023 DR.Wani on DR for UGs KAHER 58
59. PDR staging
i)Early PDR
ii) High Risk PDR
iii) Advanced PDR
Severe NPDR, PDR & diabetic macular edema
are SIGHT THREATENING DR
10th August 2023 DR.Wani on DR for UGs KAHER 59
60. i) Early PDR
• There are new vessels but their severity is less
than the next stage of PDR
• Treat or observe closely
10th August 2023 DR.Wani on DR for UGs KAHER 60
61. ii) High Risk Characteristic (HRC) PDR
• Size of NVD >/=1/4 disc area –disc
diameter(DD)
• Size of NVD <1/4 DD but is associated with
vitreous hemorrhage
• Size of NVE >1/2DD with vitreous hemorrhage
10th August 2023 DR.Wani on DR for UGs KAHER 61
62. Standard photograph 10A defines the lower border of moderate NVD. NVD covers approximately
one-third the area of the standard disc. This extent of NVD alone would constitute HR PDR
10th August 2023 DR.Wani on DR for UGs KAHER 62
NVD
64. iii) Advanced PDR
• Vitreous hemorrhage
• Sub-hyaloid hemorrhage
• Tractional RD
• Combined Tractional and rhegmatogenous RD
• These patients need treatment usually pars
plana vitrectomy
10th August 2023 DR.Wani on DR for UGs KAHER 64
67. DIABETIC MACULAR EDEMA
• Sight threatening DR
• It is the most common cause of visual
impairment
• So diagnose and treat promptly
• It can be present in both NPDR and PDR stages
10th August 2023 DR.Wani on DR for UGs KAHER 67
68. What is DME?
• Diabetic Macular edema is defined as retinal
thickening or hard exudates at or within 1 disc
diameter of the center of the macula
• Clinically Significant Macular edema -CSME is
1) Retinal thickening within 500 mu of the center of the
fovea OR
2) Hard exudates within 500 mu of the center of the fovea
with adjacent retinal thickening OR
3) Thickening of the retina of 1 DD size or more any part of
which falls within 1 DD of center of the macula
Early treatment diabetic retinopathy study group,” Archives of Ophthalmology;1985:
1796-1806
10th August 2023 DR.Wani on DR for UGs KAHER 68
69. Investigations for DR
1. Optical coherence tomography-OCT-mainly to
detect diabetic macular edema and its features
2. Fundus fluorescein angiography- FFA to look for
leaking areas, capillary non perfusion areas and
assess foveal avascular zone FAZ
3. OCT-angiography –OCT A -is a recent
investigation that studies vessels without
injection of any dye
4. US B scan in cases where cataract or vitreous
hemorrhage prevents view of retina –assess if
vitreous hg or TRD or RD are present
10th August 2023 DR.Wani on DR for UGs KAHER 69
70. 10th August 2023 DR.Wani on DR for UGs KAHER 70
center involving DME
center not involving DME
OCT-very useful in assessing DME, prognostic value, follow up of DME, effect of
treatment of DME
71. We can detect cystoid changes, subretinal fluid
and thickening of retina
10th August 2023 DR.Wani on DR for UGs KAHER 71
72. RE CSME-Diffuse n cystoid
10th August 2023 DR.Wani on DR for UGs KAHER 72
73. DME before and after anti VEGF
INJECTION
10th August 2023 DR.Wani on DR for UGs KAHER 73
74. FFA- Note VB, capillary drop out areas, leak from
disc, enlarged FAZ, microaneurysms
10th August 2023 DR.Wani on DR for UGs KAHER 74
Capillary drop out
areas
leak from disc –NVD
Enlarged FAZ
–macular
ischemia
75. Ultrasound B scan
• To assess the retina in cases where the media
is not clear
Cataract
Vitreous hemorrhage
Helps to diagnose V Hg, RD, TRD or PVD
10th August 2023 DR.Wani on DR for UGs KAHER 75
77. TREATMENT OF DR
• Control of DM, HT and other risk factors in
treatment of DR is important
• Treatable conditions are
• -DME
• -PDR
• Recently cases of severe NPDR are also being
treated
10th August 2023 DR.Wani on DR for UGs KAHER 77
78. 10th August 2023 DR.Wani on DR for UGs KAHER 78
VEGF –VASCULAR ENDOTHELIAL
GROWTH FACTOR
79. DME
• The leaking microaneurysms are responsible for
DME
• So treat them by
• Closing the MA by applying laser burns to MA
• VEGF is causing increased permeability and
leakage
• So give a anti VEGF drug intravitreally
• Stops leakage –may need repeated treatment
sessions
10th August 2023 DR.Wani on DR for UGs KAHER 79
80. Intravitreal drugs
Anti VEGF
• Bevacizumab
• Ranibizumab
• Brolucizumab
• Faricimab
Intravitreal steroid depot injection-
dexamethasone is also used
10th August 2023 DR.Wani on DR for UGs KAHER 80
82. Stop VEGF production
• ‘Kill’ all cells producing the VEGF by doing
laser ablation
• Just leave the macula for central vision
• Affects peripheral visual field but good results
• Or give anti VEGF injections
• Needed repeatedly
10th August 2023 DR.Wani on DR for UGs KAHER 82
87. Surgical treatment of PDR
• When vitreous hemorrhage does not resolve
for more than 2-3 months
• There is tractional RD involving or threatening
the macula
• Traction on retina has resulted in a break in
retina causing rhegmatogenous RD-combined
RD
WE PERFORM pars plana vitrectomy to treat all
the above conditions
10th August 2023 DR.Wani on DR for UGs KAHER 87
88. Treatment of DR
control of DM and BP are for all stages
Type Treatment Follow up Remarks
No D R Nil 1 year
Mild NPDR Nil 6-9 mo Look for DME
Moderate NPDR Nil or May give anti VEGF 3-4 mo Look for DME
Severe NPDR May consider PRP or anti VEGF INJ 2-3 mo Look for DME
Very severe NPDR May consider PRP or anti VEGF INJ 2-3 MO Look for DME
Mild PDR May consider PRP or anti VEGF INJ 1-2 mo Look for DME
HRC PDR PPPC laser or anti VEGF inj - Look for DME
Advanced PDR PRPC
May need vitrectomy
- Look for DME
DME
If center involving
(CI)
It not CI
Anti VEGF inj monthly x3 n then as needed or
regular inj
Focal laser treatment
1-2 mo
VA
OCT monitoring
10th August 2023 DR.Wani on DR for UGs KAHER 88