Cystoid macular edema (CME) is a common cause of vision loss following uncomplicated cataract surgery. It involves the accumulation of fluid in the macula and is usually associated with a breakdown of the inner blood-retinal barrier. Risk factors include surgical complications, diabetes, and use of prostaglandin analogs. Symptoms include blurred vision appearing 5-10 weeks post-op. Diagnosis is typically made through optical coherence tomography showing cystic changes in the macula. Mild cases are often treated with topical NSAIDs, while more severe cases may require intravitreal steroids or anti-VEGF injections to resolve fluid and improve vision. Refractory CME could potentially be treated
Coats' disease, (also known as exudative retinitis or retinal telangiectasis, sometimes spelled Coates' disease), is a rare congenital, nonhereditary eye disorder, causing full or partial blindness, characterized by abnormal development of blood vessels behind the retina.
Coats' disease, (also known as exudative retinitis or retinal telangiectasis, sometimes spelled Coates' disease), is a rare congenital, nonhereditary eye disorder, causing full or partial blindness, characterized by abnormal development of blood vessels behind the retina.
MANAGEMENT OF MACULAR HOLE, Ophthalmology presentation, eye care in the elderly , macular hole as a consequence of trauma, Vitreoretinal surgical cases, ,
An important instrument in every day job of critical ill patients . This work shop has been performed to help clinicians to understand how to deal with direct ophthalmoscope and organize diagnostic and life saving fundoscopy findings .
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
irvine gass syndrome
1. Cystoid Macular Edema
Post cataract surgery non resolving C.M.E.
Dr Himanshu Shukla,
T. N. SHUKLA EYE HOSPITAL
2. Definition
• Accumulation of Fluid in the Outer Plexiform
and the Inner Nuclear layer of the retina.
• There is formation of Fluid filled cyst like
spaces in the central macula.
• Usually associated with breach in the Inner
Blood Retinal Barrier.
7. IRVINE-GASS SYNDROME
• In 1955 Prof. Irvine described “ Macular changes
occurring in patients after cataract surgery with loss
of Best corrected visual acuity”
• In 1966 Dr. Gass and Norton described “ These
changes are Cystic spaces in macula” and termed
“Irvine- Gass Syndrome”.
• Later through studies it was described as the most
common cause of Visual loss after an uneventful
cataract surgery.
8. Post Operative C.M.E
• Event following an Uncomplicated Cataract Surgery.
• Spontaneous resolution does occur.
• Peak incidence are at 5-10 weeks postop.
9. RISK FACTOR ASSOCIATED WITH
IRVINE GASS SYNDROME
• P.C.R. (With more chances with
Vitreous loss).
• Vitreous in A/C.
• Aphakia.
• Unstable diabetic maculopathy.
• H/O CME in contra lateral eye.
• Secondary IOL’s
• Early YAG ( < 6 Months Post op).
• Topical Prostaglandin Analogs
12. Fundus Examination (90D or Fundus Photo)
• Loss of Foveal reflex in an otherwise normal looking
macula.
• Retinal Thickening
• Yellow Spot at fovea
• “Cystic spaces seen at macula”
13. Extra macula Finding in Chronic Severe
Irvine Gass
• Some Degree of Optic nerve head swelling with
mild congestion reduced cup size.
• Changes are best appreciated when compared with
the other eye disc findings.
• Media Haze with Vitritis like picture
15. Fundus Fluorescein Angiography
• Pre-OCT era: Test of choice in cases post op.
with reduced visual acuity and no clear
Fundus findings.
• Also helped in finding any other etiological
cause associated with C.M.E
• “Angiographic macular edema”, macular
edema visible only angiographically.
21. Points Regarding FFA
• According to “Gass . Et al”
– There is significant correlation between visual
acuity and area found with Cystoid changes.
– There is no correlation between V/A and distance
the cyst from FAZ.
30. Points Regarding Ketorolac
• Prophylactic use of Ketorolac 0.5% after cataract
surgery reduces chances of Pseudophakic CME.
• Most of the Multicenter R.C.C.T. are on 0.5%
Ketorolac.
• Although it has been shown that 0.4% is as effective
as 0.5% drug in Q.I.D dosage schedule.
31. Topical KETOROLAC
• Many Pilot studies and Multicentre studies show
Ketorolac to be:
– Effective in reducing post operative CME.
– Probable Synergistic with Topical Steroids.
– Also working Effectively in combination with antibiotic.
– More effective in Acute CME than in Chronic once.
32. Nepafenac and Bromfenac
• Prophylactic use of Nepafenac 0.1% TDS reduces
chances of Clinical Pseudophakic CME.
• Still, Nepafenac and Bromfenac are FDA approved
for Postoperative Inflammation control but not
Prophylactically for Pseudophakic CME.
• Effective in Secondary CME’s in venous occlusions
and DME.
33. Nepafenac and Bromfenac
• There is no current R.C.C.T to show Superiority
of any one over the other.
• The advantage of the above Quoted drugs:
– lesser dosage schedule
– Comparatively better patients response
35. Severe OR Refractive Pseudophakic CME &
Intravitreal Triamcinolone
• IVTA leads to visual improvement in these patients.
• The improvement is usually:
– Visual improvement with BCVA > 2 ETDRS lines
– OCT : reduced CFT and normal Contour
– Resolved Angiographic CME
• Dosage:
– 4mg in 0.1ml.
– Currently used: 2mg in 0.05 ml
• Rarely these patients require repeat injection after
6-8 months.
36. Intravitreal Triamcinolone Technique
• Aseptic precautions.
• 2mg in 0.05 ml taken in
1ml syringe.
• 26/30 Gauge needle.
• Carefully stabilize globe
• Injected 3.5 to 4 mm from
limbus.
• Needle is withdrawn
• Area pressed with cotton
bud.
37. Literature Reported Complication of
Intravitreal Triamcinolone
• Raised IOP. ( seen more with high dose).
• Floater ( since particle are appreciated)
• Lens Touch.
• Cataract Formation (Not to worry in Pseudophakic).
• Pain after injection
• Endophthalmitis
• Vitreous Hemorrhage
• Retinal detachment
38. Severe or Refractive CME and PST
• Their have been reports that:
– Posterior Subtenon injection of Triamcinolone improves
vision and reduces CFT in patient with Chronic non resolving
Pseudophakic CME.
– Most of the studies now take into consideration Intravitreal
injection of steroids for treatment of Chronic Non resolving
CME.
• Complication:
– Globe perforation.
– Raised IOP.
– Improper injection module.
– Concern for dosage.
39. Ozurdex Implant
• Long acting
• Dexamethasone 0.7mg.
• Good for conditions
requiring repeated
IVSteroid.
• Effect need to be
proven
45. Improved
• BCVA 20/100 on day 1
improved to 20/30 day
26.
• CFT decreased by
572um.
• Normal Foveal
Morphology achieved.
46. Topical Medication post injection
• We continued either Combination drops with
Ketorolac 0.4% OR Bromfenac 0.09% OR
Nepafenac 0.1% in all cases of Refractive CME
who where treated with IVTA.
• Mostly the drops where preferred based on what
medication patient already had with him.
• Most cases showed improvement on serial OCT
and visual recovery. The former occurring before
in time.
47. Pars Plana Vitrectomy for Refractory
Pseudophakic CME
• Improvement occurs in selected cases.
• Indications:
– Taut posterior Hyaloid.
– E.R.M.
– Complicated Pseudophakic.
48. Other Treatment Tried
• Oral Acetazolamide:
– Risk of adverse effect are more.
– Non of the trails show their benefit
• Oral Steroid:
– Effective in Uveitis CME’s.
– Primary Pseudophakic CME: No role
• Intravitreal Bevacizumab (Avastin):
– Few R.C.C.T show their benefit in Refractory CME.
– Not Proven
49. Summary
• Pseudophakic CME occur even in uneventful
Cataract surgery. Although incidence increase with
intraoperative complication.
• Usually these occur 5-10 weeks postop. Thus the
patient has good vision immediate postoperatively
followed by reduced vision later.
• Most of these cases respond to topical NSAID’s. The
choice of drugs are multiple and NO superiority has
been proven of any available drug type.
• Cases should be investigated and treated depending
upon their pathological status.
50. • Intravitreal injection of Triamcinolone does
improve visual acuity and anatomic recovery is
seen even in chronic cases. Rarely, repeat
injections 6-8 months later.
• Intravitreal injection of Anti VEGF : May be
useful in co-existing pathologies or refractory
CME.
• Pars Plana Vitrectomy with or without
Membrane peeling, in indicated case.