Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
Congenital Glaucoma is one of the most common causes of irreversible childhood blindness. This presentation covers this topic in detail that can aid physicians in effective patient care.
PS: The slides in the preview look skewed, download the presentation to view the font used in Office 2012 and upwards.
www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. The clinical feature of each of the disease entities is explained with the help of case studies.
businessinarts.org
unitedsmallbusiness.org
minoritybusinesssolutions.org
businesstheory.org
You have the capacity to slow all the way down the mediation at any point that. When you decide to do this, other side is going to react. Their reply will explain to you a lot about its situation. They can start so that you can complain the fact that negotiation is already taking too much.
www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. The clinical feature of each of the disease entities is explained with the help of case studies.
businessinarts.org
unitedsmallbusiness.org
minoritybusinesssolutions.org
businesstheory.org
You have the capacity to slow all the way down the mediation at any point that. When you decide to do this, other side is going to react. Their reply will explain to you a lot about its situation. They can start so that you can complain the fact that negotiation is already taking too much.
The global economy is entering a business cycle focused on customer experience and engagement. Our flexible integration platform provides IT with a responsive framework to quickly integrate customer-focused systems and applications.
www.mypetshop.org
www.petsspark.org Deciding to allow your son or daughter to obtain his very first pet could be a tough 1. Adding the pet towards the family is really a huge task, requiring period and obligation on each yours as well as your child's component. When you are feeling it's about time and your son or daughter is older enough to begin caring for any pet of their own, you'll have to teach him how you can properly take care of it.
www.select4pets.org
sportrabbit.org
sportindustryjobs.org
betterfootball.org
Soccer players need a great degree of stamina. Amongst various elements, concentration is it is important. Even a little distraction could make you lose the overall game. Thus, players may increase their own concentration spans with this particular game.
R A Longhorn Presentation at Taiwan Open Data Forum, Taipei, 9 July 2014GSDI Association
Big Data Meets Open Data: Challenges and Issues presentation of Roger Longhorn, Operations & Communications Manager, GSDI Association, delivered at the Taiwan Open Data Forum, 9 July 2014 in Taipei
healthynchospitals.org
crphealth.org
coimbrahealth.org
broadhealth.org
Kidneys tend to be vital entire body organs which filter waste in the blood as well as aid your body in getting rid of them via urine manufacturing. Kidney wellness is imperative for that overall homeostasis from the body. Whether you've suffered from the kidney condition previously or simply wish to prevent long term problems, there are a number of natural techniques to maintain kidney wellness.
This presentation deals with information regarding a minor disorder of pregnancy i.e hyperemesis gravidarum, its manifestations, causes, diagnostic evaluation,complications, management, nursing interventions etc.Though its a minor disorder, delayed treatment can be fatal.
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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
It’s work is regulated by androgens which are responsible for male sex characteristics
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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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.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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 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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. INTRODUCTION
• Pregnancy causes major changes in all the systems of the body.
• Visual Impairment and other ocular changes are rare in pregnancy.
• Ocular changes in pregnancy are categorised as :-
1. Physiological
2. Pathological
3. INTRODUCTION
• Pregnancy related pathological changes may present as:-
• 1. New ocular changes
• 2. Changes in existing ocular pathology
• 3. Ocular complications of systemic diseases.
4. Physiological Changes in Pregnancy
S No. STRUCTURE PHYSIOLOGICAL CHANGE
1. IOP Low IOP
2. Lid Chloasma (5-70%)
3. Conjunctiva Hyposphagma (10%)
4. Tear Film Tear film composition alterations (14%)
5. Cornea Decreased Sensations
Krukenberg’s Spindles
Increased Thickness (14%)
Alteration in refractive power
6. Lens Increased Thickness (14%)
Refractive change
7. Optic Nerve Pituitary gland enlargement.
Sharma S RW, Sharma T, Downey G.: Refractive issues in pregnancy.
Aust N Z J Obstet Gynaecol 2006; 46: 186–8.
6. Pathological Changes
S no. STRUCTURE PATHOLOGICAL CHANGE
1. Orbit Growth of hemangiomas
Carotid-cavernous fistula
2. Lid Ptosis
Horner’s Syndrome
Facial nerve palsy
3. Conjunctiva Vasospasm in pre-eclampsia
4. Retina Worsening of Diabetic retinopathy
Vascular changes in Pre-eclampsia (40-100%)
Serous Retinal Detachment (0.005%)
Central serous chorioretinopathy
Growth of melanomas
5. Optic nerve Ischemic optic neuropathy
Papilloedema
6. Optic Pathway Cortical Blindness in eclampsia (0.06%)
Reddy SC NS, George S Ra, Who TS: Fundus changes in pregnancy induced hypertension.
Int J Ophthalmol 2012; 5: 694–7.
Achanna S, Monga D, Sivagnanam: Transient blindness in pregnancy induced hypertension.
Asia-Oceania Journal of Obstetrics and Gynaecology/AOFOG 1994; 20: 49–52.
7. Physiological Ocular Changes
• Increased pigmentation around eyes.
• Darkening of face - Pregnancy Mask or Chloasma or Melasma
• Causes:-
1. Increased estrogen
2. Increased Progesterone
3. Increased melanocyte stimulating hormone (MSH)
8. Pathological Ocular Changes
• Unilateral Ptosis
• Cause:-
• Fluid and hormonal effects on the levator aponeurosis.
• Course:- It resolves post-partum.
• Check the pupils and extra-ocular movements to differentiate it from
3rd nerve palsy.
Sanke RF. Blepharoptosis as a complication of pregnancy.
Ann Ophthalmol. 1984;16:720-722.
9. Tear Film alterations
1. Increased immune reaction in lacrimal duct cells
2. The destruction of acinar cells by prolactin, transforming growth
factor beta-1 and epidermal growth factor.
• Dry eye Is further enhanced by dehydration caused by
1. Nausea and vomiting
2. Anti-emetic drugs
10. Corneal changes
• Corneal changes:-
1.Increased Thickness (14%)
• Due to corneal edema
2. Decreased Sensations
• Due to increased corneal thickness & Hormonal changes
3. Alteration in refractive power
4. Krukenberg’s Spindles- appear in first two trimesters.
• In last trimester- Increased aqueous outflow leads to spindle
shrinkage.
11. Corneal changes
5. Altered corneal curvature
6. Altered refractive index
• Clinical Importance:-
1. Contact lens intolerance due to corneal changes.
2. Avoid new spectacles prescription
3. Avoid new contact lens prescription
4. Refractive surgery is contra-indicated
12. Intra-Ocular Pressure (IOP)
Intra-Ocular Pressure (IOP)
• 19.6 % reduction – In person with normal IOP
• 24.4% reduction – Ocular hypertension pt.
Various proposed mechanisms:-
1. Increased Aqueous outflow
2. Lower epi-scleral venous pressure due to decreased systemic
vascular resistance
3. Lower scleral rigidity due to increased tissue elasticity
4. General acidosis in pregnancy
1. Horven I, Gjonnaess H. Corneal indentation pulseand intraocular pressure in pregnancy.
Arch Ophthalmol.1974;91:92-98.
2. Cantor LB, Harris A, Harris M. Glaucoma medications in pregnancy. Rev Ophthalmol. 2000:91-99.
3. Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy and lactation.
Surv Ophthalmol. 2001;45:449-454.
13. Changes in Lens and Accomodation
• 1. Increased lens curvature – causes Myopic Shift.
• 2. Temporary Accomodation insufficiency or loss.
14. Retinal Changes
• Diabetic Retinopathy
• Quick progression of Diabetic Retinopathy
• Cause:-
1. Haematological, hormonal, metabolic, cardio-vascular and
immunologic factors.
2. Increased retinal capillary blood flow – Increased endothelial cell
damage.
3. Progesterone elevates the production of VEGF and other angiogenic
factors
• Dependant on several factors:-
• 1. Degree of retinopathy at beginning of pregnancy
• 2. Time duration since diabetes
• 3. Glycemic contol
• 4. Associated hypertension.
15. Retinal Changes
• Gestational Diabetes – Low risk of developing retinopathy.
• 10% patients without DR at Beginning of pregnancy develop Non
proliferative changes.
• NPDR patients – 50% progression
• PDR patients – 45 % progression
• 5-20% NPDR patients – progress to PDR
• Clinical Importance :-
• Pre-pregnancy laser therapy – Recommended for pt. with PDR or
severe NPDR.
• Pre- pregnancy laser treatment – Risk of progression is decreased by
50%.
16. Retinal Changes
• Diabetic Macular edema:-
• Develop or worsen during pregnancy.
• Observed in pt. with proteinuria or associated hypertension.
• Treatment:-
• Observation.
• Spontaneous resolution postpartum.
• Laser treatment can be done in postpartum period.
17. Retinal Changes
• Pre-eclampsia related retinopathy:-
• Pre-eclampsia – BP> 140/90 mm hg, edema and proteinuria.
• Retinal findings:-
• Retinal arteriolar narrowing.(most common finding)
• Other findings - retinal haemmorrhages, exudates, RNFL defects,
retinal edema, vitreous haemmorrhage.
• Exudative RD – 1% in pre-eclampsic patients.
10% in eclampsic patients
• Optic nerve findings:- Papillary edema, Ischemic optic neuropathy
and optic atrophy.
Dinn RB, Harris A, Marcus PS. Ocular changes in pregnancy.
Obstet Gynecol Surv. 2003;58:137-144.
18. Hypertensive retinopathy with hemorrhages (solid white arrows), cotton-wool
spots (open arrow), and exudates (solid black arrows) in eclampsia.
19. Retinal Changes
• Central Serous Chorioretinopathy:-
• Most frequently seen in third trimester.
• Cause- High cortisol levels in pregnancy
• Fibrous subretinal exudates present.
• Diagnosis- OCT
• Spontaneous regression postpartum.
• Recurrence present in subsequent pregnancies.
20. Tumors
Pituitary Adenoma:-
• Micro-adenomas may grow during pregnancy.
• Symptoms:-
• Headache
• Visual Field changes ( Bitemporal hemianopia)
• Decreased visual acuity
• Diplopia (rarely)
• After pregnancy – Adenomas shrink and no visual sequelae left.
• Known adenoma – Monthly ophthalmological examination and
visual field monitoring.
21. Tumors
• Meningioma –
• Pre-existing meningioma – vascularise and grow.
• Cause :- Elevated estrogen and progesterone
• Uveal melanoma-
• High incidence and reactivation in pregnancy.
23. Sheehan syndrome
• Ischemic necrosis of the pituitary gland due to severe postpartum
haemorrhage.
• Potentially visually-threatening disorder as a result of sudden increase
in pituitary size from infarction or haemorrhage.
Symptoms:-
1. Sudden onset of headache
2. Visual loss
3. Ophthalmoplegia
• VF defect - 64% of cases
• VA abnormalities - 52% of cases.
24. Sheehan syndrome
• Cause of VF defect:-
• Expansion of the tumor compresses the optic chiasm
• The classic VF defect is a bitemporal superior quadrantic defect.
• Ophthalmoplegia - 78% of cases.
• Cause:- Compression of the cavernous sinus makes cranial
nerves 3,4 & 6 vulnerable to injury.
• Oculomotor nerve - most commonly involved.
• Resolution of ophthalmoplegia and visual occurs to some extent in
post-partum period.
25. Grave's disease
• Hyperthyroidism occurs in 2/1000 pregnancies
• Most common cause (85%) – Grave’s disease
• Recognition of hyperthyroidism during pregnancy can be elusive
because signs overlap with pregnancy symptoms such as
1. Nausea and vomiting
2. Increased appetite
3. Heat intolerance
4. Fatigue
5. Irritable or anxious mood.
26. Grave's disease
• Symptoms uncommon in normal pregnancy, but found in
hyperthyroidism are:-
1. Weight loss or failed weight gain despite increased dietary intake
2. Resting tachycardia
3. Hypertension
4. Tremor
5. Thyroid enlargement or nodule
6. Ocular manifestations
Graves's disease is known to exacerbate in the first trimester and to
improve in the second and third trimesters of pregnancy.
27. Grave's disease
• Approach to Graves's disease in pregnancy should be
multidisciplinary and involve an obstetrician, an endocrinologist and
an ophthalmologist.
Management
• Observation in asymptomatic cases
• Anti-thyroid medications in symptomatic patients
• Propyl-thiouracil is drug of choice in such cases.
• Surgery for complicated cases.
28. Idiopathic Intracranial Hypertension (IIH)
• Unknown etiology
• Common in obese females of child-bearing age
• Three times higher incidence in obese females, 15-44 years old
• Symptoms:-
1. Headache is the most common symptom (92% of patients)
2. Nausea and vomiting
3. Obscuration of vision
4. Scotomata
5. Photopsias
6. Diplopia
7. Retrobulbar pain.
29. Idiopathic Intracranial Hypertension (IIH)
• Fundus Finding:- Papilledema
• Papilledema is typically B/L, but may be markedly asymmetric, U/L.
• 20% of IIH patients- Abducens nerve palsy, a false localizing sign
secondary to elevated intracranial pressure.
• Major goals of IIH treatment include:-
• Alleviation of symptoms and preservation of visual function.
• Once diagnosed, the decision to treat depends on VA and VF loss.
• Medical treatment and observation are usually effective.
30. Anti-phospholipid Antibody Syndrome
• Is an autoimmune disorder.
• Characterized by either a history of vascular thrombosis or in
association with the presence of anti-phospholipid antibodies.
• Ocular complications of APS involve both the anterior and posterior
segment of the eye.
Anteriorly there are
1. Conjunctival telangiectasia or conjunctival microaneurysms
2. Episcleritis
3. Filamentary keratitis
4. Iritis
31. Anti-phospholipid Antibody Syndrome
• Posteriorly, there can be
1. Vitritis
2. Retinal detachment
3. Posterior scleritis
4. Branch or central retinal vein occlusion
5. Bilateral choroidal infarction
6. Cilio-retinal artery occlusion
7. Venous tortuosity
8. Retinal haemorrhages
9. Cotton-wool spots
10. Central serous chorio-retinopathy
11. Ischemic optic neuropathy
12. Progressive optic nerve atrophy
32. Disseminated intravascular coagulation
• Is an acquired syndrome characterized by the systemic intravascular
activation of coagulation
• The common obstetric causes of DIC are:- Amniotic fluid embolism;
intrauterine fetal demise; pre-eclampsia / eclampsia; placental
abruption and placenta praevia.
• The choroid is the most common intraocular structure involved.
• Occlusion of the choriocapillaris by a thrombus lead to disruption of
the overlying RPE causing SRD.
33. Conclusion
• Visual disturbances are very common during pregnancy.
• A firm understanding of the various ocular conditions that might
appear during pregnancy or get modified by pregnancy is required.
• Prompt evaluation and management of the rare and serious
conditions that may occur in pregnant women with visual complaints.