This document discusses diabetic retinopathy and its management. It notes that diabetic retinopathy is a leading cause of blindness and consists of complications like macular edema, cataracts, and proliferative retinopathy. Proliferative retinopathy involves the growth of weak, abnormal blood vessels in the retina. Risk factors include the duration of diabetes and poor blood sugar control. Treatment involves good blood sugar control, laser therapy to destroy abnormal blood vessels or reduce macular edema, and anti-VEGF drugs to inhibit vascular growth. Vitrectomy may also be used to treat severe complications like retinal detachment. Regular eye exams are important for early detection and treatment of diabetic retinopathy.
GENERAL INFORMATION ABOUT DIABETIC MACULAR EDEMA WITH 2 PATIENT CASES, TREATED WITH 2 DIFFERENT TREATMENT TECHNIQUES.
CLASSIFICATION (CSME)
RISK FACTORS
CAUSES
SIGNS AND SYMPTOMS
MANAGEMENT AND TREATMENT OPTIONS
DIAGNISTIC TESTS, BLOOD AND URINE TEST
SCORING SYSTEM
PATHOLOGY
DIFFERENTIAL DIAGNOSIS
PROGNOSIS
EPIDEMIOLOGY
DESCRIPTION OF 2 CASES, THEIR DIAGNOSTIC RESULT AND DETAILS ABOUT TREATMENTS PERFORMED.
GENERAL INFORMATION ABOUT DIABETIC MACULAR EDEMA WITH 2 PATIENT CASES, TREATED WITH 2 DIFFERENT TREATMENT TECHNIQUES.
CLASSIFICATION (CSME)
RISK FACTORS
CAUSES
SIGNS AND SYMPTOMS
MANAGEMENT AND TREATMENT OPTIONS
DIAGNISTIC TESTS, BLOOD AND URINE TEST
SCORING SYSTEM
PATHOLOGY
DIFFERENTIAL DIAGNOSIS
PROGNOSIS
EPIDEMIOLOGY
DESCRIPTION OF 2 CASES, THEIR DIAGNOSTIC RESULT AND DETAILS ABOUT TREATMENTS PERFORMED.
Ischemic condition affecting the eye.
The ischemia can occur secondary to systemically problem [or] particulary the eye.
Many retinal vascular disorders {like CRAO,CRVO,Diabetic retinopathy,Hypertensive Retinopathy} shows ischemic signs.
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
This presentation describes all clinical aspects of primary angle closure glaucoma in a concentrated and simplified manner....you can watch the illustrated presentation at the following link:
Retinal vasculitis refers to the inflammation of the retinal vessel resulting in evident clinical manifestations i.e. vascular sheathing, leakage and occlusion. This presentation covers the etiology, pathogenesis, clinical features, diagnosis and management of this spectrum of retinal disease.
Ischemic condition affecting the eye.
The ischemia can occur secondary to systemically problem [or] particulary the eye.
Many retinal vascular disorders {like CRAO,CRVO,Diabetic retinopathy,Hypertensive Retinopathy} shows ischemic signs.
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
This presentation describes all clinical aspects of primary angle closure glaucoma in a concentrated and simplified manner....you can watch the illustrated presentation at the following link:
Retinal vasculitis refers to the inflammation of the retinal vessel resulting in evident clinical manifestations i.e. vascular sheathing, leakage and occlusion. This presentation covers the etiology, pathogenesis, clinical features, diagnosis and management of this spectrum of retinal disease.
www.ophthalclass.blogspot.com has the complete class on uveitis for undergraduate medical students. This presentation is the second part of the introductory class in the series and deals with the clinical features of uveitis.
This ppt describe about the incidence, diagnosis and management of maculopathy in caaes of pathological myopia.
Data collected and created by Vivek Chaudhary
For queries : vivek977optom@gmail.com
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.
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.
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
- 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
3. Diabetic Eye DiseaseDiabetic Eye Disease
significancesignificance
►10% of blind registrations are due to DR
►Commonest cause in 20-65 year old age
group
►Most cases of blindness can be prevented
with implementation of existing technology
4. Risk factorsRisk factors
►Duration of diabetes is the principle
determinant of the presence of diabetes
related retinopathy
►Poor glycemic control is the most critical risk
factor for the development and progression
of diabetes associated retinopathy
6. Classification of DRClassification of DR
► Non proliferative diabetic retinopathyNon proliferative diabetic retinopathy (NPDR)/ BDR(NPDR)/ BDR
MicroaneurysmsMicroaneurysms
Dot and blot haemorrhagesDot and blot haemorrhages
Hard ( intra-retinal ) exudatesHard ( intra-retinal ) exudates
► PreproliferativePreproliferative diabetic retinopathydiabetic retinopathy
- CWSCWS
- IRMAIRMA
- Venous dilationVenous dilation
- Dark blot haemorrhagesDark blot haemorrhages
► Proliferative diabetic retinopathyProliferative diabetic retinopathy
Neovascularization of the retina, optic disc or irisNeovascularization of the retina, optic disc or iris
Late DR-fibrovascular proliferationLate DR-fibrovascular proliferation
► MaculopathyMaculopathy
Clinically significant macular oedema (CSME )Clinically significant macular oedema (CSME )
Ischaemic MaculopathyIschaemic Maculopathy
Diffuse maculopathyDiffuse maculopathy
► MACULOPATHY IS LEADING CAUSE OF BLINDNESSMACULOPATHY IS LEADING CAUSE OF BLINDNESS
7. MicroaneurysmsMicroaneurysms
► Retinal microaneurysms are focal dilatations of retinal capillariesRetinal microaneurysms are focal dilatations of retinal capillaries
► appear as red dots.appear as red dots.
► They are usually seen at the posterior pole, especially temporal to theThey are usually seen at the posterior pole, especially temporal to the
fovea.fovea.
8. Retinal HaemorrhagesRetinal Haemorrhages
► When the wall of a capillary or microaneurysm is sufficientlyWhen the wall of a capillary or microaneurysm is sufficiently
weakened, it may rupture, giving rise to an intraretinal hemorrhage.weakened, it may rupture, giving rise to an intraretinal hemorrhage.
► If the hemorrhage is deep (i.e., in the inner nuclear layer or outerIf the hemorrhage is deep (i.e., in the inner nuclear layer or outer
plexiform layer), it usually is round or oval ("dot or blot")plexiform layer), it usually is round or oval ("dot or blot")
► Dot haemorrhages appear as bright red dots and are the same size asDot haemorrhages appear as bright red dots and are the same size as
large microaneurysmslarge microaneurysms
► Blot haemorrhages are larger lesions they are located within the midBlot haemorrhages are larger lesions they are located within the mid
retina and often within or surrounding areas of ischaemia.retina and often within or surrounding areas of ischaemia.
9. Hard exudatesHard exudates
(Intra retinal lipid exudates)(Intra retinal lipid exudates)
Hard exudates (Intra retinal lipid exudates) are yellowHard exudates (Intra retinal lipid exudates) are yellow
deposits of lipid and protein within the sensory retina.deposits of lipid and protein within the sensory retina.
Accumulations of lipids leak from surrounding capillariesAccumulations of lipids leak from surrounding capillaries
and microaneurysms, they may form a circinate pattern.and microaneurysms, they may form a circinate pattern.
10. Cotton Wool SpotsCotton Wool Spots
Cotton wool spots result from occlusion of retinalCotton wool spots result from occlusion of retinal
pre-capillary arterioles supplying the nerve fiberpre-capillary arterioles supplying the nerve fiber
layer with concomitant swelling of local nerve fiberlayer with concomitant swelling of local nerve fiber
axons.axons.
Also called "soft exudates" or "nerve fiber layerAlso called "soft exudates" or "nerve fiber layer
infarctions" they are white, fluffy lesions in theinfarctions" they are white, fluffy lesions in the
nerve fiber layer.nerve fiber layer.
11. Proliferative diabeticProliferative diabetic
retinopathyretinopathy
Retinal ischaemia due toRetinal ischaemia due to
widespread capillary nonwidespread capillary non
perfusion results in theperfusion results in the
production ofproduction of
vasoproliferative substancesvasoproliferative substances
and to the development ofand to the development of
neovascularizationneovascularization
Neovascularization canNeovascularization can
involve the retina, optic discinvolve the retina, optic disc
or the iris (or the iris (rubeosis iridis)rubeosis iridis)
12. Proliferative diabeticProliferative diabetic
retinopathyretinopathy
► Rubeosis iridisRubeosis iridis is a sign of severeis a sign of severe
proliferative disease, it may causeproliferative disease, it may cause
intractable glaucoma.intractable glaucoma.
► Bleeding from fragile new vesselsBleeding from fragile new vessels
involving the retina or optic disc caninvolving the retina or optic disc can
result inresult in vitreous or retinal hemorrhagevitreous or retinal hemorrhage..
Retinal damage can result fromRetinal damage can result from
persistent vitreous hemorrhage.persistent vitreous hemorrhage.
► Pre retinal haemorrhages are oftenPre retinal haemorrhages are often
associated with retinalassociated with retinal
neovascularization, they mayneovascularization, they may
dramatically reduce vision within a fewdramatically reduce vision within a few
minutes.minutes.
14. Late DiseaseLate Disease
Contraction ofContraction of
associated fibrousassociated fibrous
tissue formed bytissue formed by
proliferative diseaseproliferative disease
tissue can result intissue can result in
deformation of thedeformation of the
retina and tractionalretina and tractional
retinal detachmentretinal detachment
15. Macular OedemaMacular Oedema
► Macular oedema is an important manifestation ofMacular oedema is an important manifestation of
DR because it is now the leading cause of legalDR because it is now the leading cause of legal
blindness in diabetics.blindness in diabetics.
► The intercellular fluid comes from leakingThe intercellular fluid comes from leaking
microaneurysms or from diffuse capillary leakagemicroaneurysms or from diffuse capillary leakage
20. Laser TherapyLaser Therapy
► LaserLaser
photocoagulationphotocoagulation
causes a retinal burncauses a retinal burn
which is visible onwhich is visible on
fundoscopy.fundoscopy.
► Retinal and optic discRetinal and optic disc
neovascularization canneovascularization can
regress with the use ofregress with the use of
retinal laserretinal laser
photocoagulationphotocoagulation
21. Panretinal laser photocoagulationPanretinal laser photocoagulation
for proliferative DRfor proliferative DR
► The mainstay of treatment ofThe mainstay of treatment of
diabetic retinopathy is retinaldiabetic retinopathy is retinal
laser photocoagulation.laser photocoagulation.
► Laser therapy is highlyLaser therapy is highly
effective; the rate of severeeffective; the rate of severe
visual loss at 2 years due tovisual loss at 2 years due to
proliferative disease can beproliferative disease can be
reduced by 60%.reduced by 60%.
► Rubeosis iridis requiresRubeosis iridis requires
urgent panretinalurgent panretinal
photocoagulation to preventphotocoagulation to prevent
ocular pain and blindnessocular pain and blindness
from glaucoma.from glaucoma.
23. Macular laser therapyMacular laser therapy
► The indications for laser therapy now include CSME whichThe indications for laser therapy now include CSME which
is treated with a macular laser grid or treatment of focalis treated with a macular laser grid or treatment of focal
lesions such as microaneurysms.lesions such as microaneurysms.
► Early referral and detection of disease is important asEarly referral and detection of disease is important as
treatment of maculopathy is far more successful iftreatment of maculopathy is far more successful if
undertaken at an early stage of the disease processundertaken at an early stage of the disease process
24. Anti VEGFAnti VEGF
Vascular endothelial growth factor (VEGF)
► A protein called vascular endothelial growth factor (VEGF)A protein called vascular endothelial growth factor (VEGF)
is one reason why weak abnormal blood vessels may growis one reason why weak abnormal blood vessels may grow
under the retina and lead to vision loss.under the retina and lead to vision loss.
► Anti-VEGF medicines block the effects of VEGF.Anti-VEGF medicines block the effects of VEGF.
► Treatment of macular oedeme, PDRTreatment of macular oedeme, PDR
► Treatment of ARMDTreatment of ARMD
25. VITRECTOMY IN DIABETICVITRECTOMY IN DIABETIC
PATIENTSPATIENTS
► Vitrectomy, plays a vitalVitrectomy, plays a vital
role in the management ofrole in the management of
severe complications ofsevere complications of
diabetic retinopathy.diabetic retinopathy.
► The major indications areThe major indications are
non-clearing vitreousnon-clearing vitreous
hemorrhage, tractionhemorrhage, traction
retinal detachment, andretinal detachment, and
combined tractioncombined traction
/rhegmatogenous retinal/rhegmatogenous retinal
detachment.detachment.