Impact of preoperative posterior segment evaluation on surgical intervention in camp patients: A retrospective analysis

Purpose: To retrospectively study impact of preoperative posterior segment evaluation on surgical intervention in camp patients recruited for cataract surgery in Gujarat India. Methods: Retrospective analysis of six months data collected from hospital electronic medical record (EMR) system of 9820 admitted patients recruited from screening camp for cataract surgery from 1/10/2019 to 31/3/2020 in Tertiary Eye Hospital in Gujarat, India, has been done. Comprehensive clinical evaluation, of both anterior and posterior segment which included detailed history; best corrected visual acuity (BCVA); intraocular pressure measurement with non?contact tonometer (NCT) and when required with Goldman applanation tonometer; slit lamp examination; and fundus examination with + 90 diopter lens as well as indirect ophthalmoscope as and when indicated. In case there was no view of retina, a B?scan ultrasound was done to rule out any posterior segment pathology. Immediate surgical intervention done was assessed and results analyzed in percentage. Results: Cataract surgery was advised for 8390 patients (85.43%). Surgical intervention for management of glaucoma was done for 68 patients (0.692%). Retina intervention was done for 86 patients. Posterior segment evaluation changed immediate surgical plane of management for 154 (1.57%) patients. Conclusion: Comprehensive clinical evaluation is economical and should be mandatory especially in community services as comorbid conditions like glaucoma, diabetic retinopathy, retinal vein occlusion, and other varied posterior segment diseases contribute significantly to visual disability in elderly age group. It is difficult to follow these patients later if manageable comorbidity is not informed about and if indicated dealt simultaneously for visual rehabilitation of patient.

O ensino do exame de fundo de olho: vivências e percepções de estudantes de medicina / The teaching of ocular fundus exam: experiences and perceptions of medicine students

Resumo: Introdução: O ensino médico vem passando por transformações nas últimas décadas. Objetivos educacionais tendem a se alterar com os avanços tecnológicos recentes, em especial na área de tecnologias de informação. Objetivo: Esta pesquisa aborda o exame do fundo de olho explorando e analisando as dificuldades dos estudantes de Medicina na execução desse componente do exame clínico e busca propor diretrizes para seu ensino na graduação médica. Métodos: Trata-se de uma pesquisa qualitativa com técnicas de observação direta e entrevistas com análise de conteúdo em uma população de estudantes do internato da Universidade do Estado do Pará (Uepa), na cidade de Marabá. Na avaliação de conteúdo utilizaram-se recursos do programa livre de análise de texto Iramuteq. Resultados: Dos 21 estudantes voluntários participantes da pesquisa, apenas dois relataram experiência anterior com oftalmoscópio direto (9,52%) e um aluno havia participado de campanha com uso de dispositivo portátil para registro da imagem do fundo de olho (4,8%). As atividades da pesquisa incluiram discussão de casos clínicos, realização de oftalmoscopias diretas em pacientes voluntários e análise de retinografias. Na análise dos textos correspondentes às entrevistas foram categorizadas quatro classes geradas pelo programa Iramuteq, realçando-se o valor da integração de teoria e prática no depoimento dos alunos. Conclusão: Programas de treinamento com integração de teoria e prática e valendo-se de princípios de aprendizagem significativa podem contribuir para prover competência ao estudante de Medicina para o exame de fundo de olho, adequando-se ao surgimento de novas tecnologias.

Abstract: Introduction: Medical education has undergone changes in recent decades. Educational objectives tend to change with recent technological advances, especially in the area of information technologies. Objective: This research addresses the examination of ocular fundus by exploring and analyzing the difficulties medical students encounter in relation to this component of the clinical examination and seeks to propose guidelines for its teaching in undergraduate medical training. Method: Qualitative research with direct observation techniques and interviews with content analysis with a population of students at the University of the State of Pará (UEPA), in the city of Marabá. Content analysis used resources from the free text analysis program Iramuteq. Results: Of the 21 volunteer students participating in the research, only two reported previous experience with direct ophthalmoscope (9.52%) and one student had participated in a campaign using a portable device to record the fundus image (4.8%). Research activities included discussion of clinical cases, performing direct ophthalmoscopies in volunteer patients and retinography analysis. In the analysis of the texts corresponding to the interviews, four classes generated by the Iramuteq program were categorized, highlighting the value of theoretical and practical integration in the students' testimony. Conclusion: Training programs with theoretical and practical integration using meaningful learning concepts can help qualify medical students in the ocular fundus exam, adapting to the emergence of new technologies.

Esclerite posterior / Posterior scleritis

Resumo Esclerite Posterior (EP) é uma inflamação do segmento escleral posterior, de etiologia inflamatória ou infecciosa, pouco diagnosticada, com evolução rápida, progressiva e irreversível com severo comprometimento visual, principalmente se o diagnóstico e o tratamento da (EP) não forem realizados a tempo hábil. A dor ocular, dor à movimentação ocular, cefaléia e embaçamento visual são os principais sinais e sintomas. Pode ser de causa Idiopática ou associada a doença sistêmica em até 45% dos caso. A Artrite Reumatoide é descrita como a associação mais comum. Causas infecciosas podem estar presente tais como: Herpes Simples, Herpes Zoster Oftálmico, Sífilis e Tuberculose. A bilateralidade pode ocorrer em até 35% dos casos sendo mais prevalente em mulheres a partir da quinta década de vida.

Abstract Posterior Scleritis (PS) is an inflammation of the posterior scleral segment, of low inflammatory or infectious etiology, with a rapid, progressive and irreversible evolution with severe visual impairment, especially if the diagnosis and treatment of (PS) are not performed in time skillful. Ocular pain, eye movement pain, headache and visual haze are the main signs and symptoms. It can be of idiopathic cause or associated with systemic disease in up to 45% of the cases. Rheumatoid arthritis is described as the most common association. Infectious causes may be present such as: Simple Herpes, Ophthalmic Herpes Zoster, Syphilis and Tuberculosis. Bilaterality can occur in up to 35% of cases being more prevalent in women from the fifth decade of life.

Posterior segment eye diseases in Ijebu, Southwestern Nigeria

Background: To review cases of posterior segment eye diseases (PSEDs) seen at the Eye Foundation Centre Ijebu, Nigeria in a 5 year period for planning purposes.Methods: Data was collected from patients’ case notes from January 2006 to December 2011. A systematic sampling of 468 patients from 1173 case notes of patient with (PSEDs) was done. Information retrieved was: age, sex, state of residence and diagnosis. All patients were examined by the glaucoma and the vitroretinal specialist as the case may be. They had visual acuity, refraction, slit lamp examination (including intraocular pressure (IOP) with Goldman applanation tonometer), and dilated fundoscopy with (bilateral indirect ophthalmoscopy) BIO, slit lamp using 20 D, 78 D and 90 D respectively. The glaucoma patients in addition had central visual field (CVF), Central cornea thickness (CCT), fundus photograph and in some cases optical coherence tomography (OCT) done in addition to the above.Results: The mean age was 59.98 years (SD 17.67) and the age range is 5-95 years. Males outnumbered females by 63% to 37%. The diseases were more common in age group 61 to 80. Patients’ attendances were mostly from Ijebu division of Ogun state (57%). Glaucoma is the commonest cause of attendance 262 (56%) followed by diabetic retinopathy 29 (6.2%) and age-related macular degeneration (ARMD) 28 (6.0%).Conclusions: Glaucoma, diabetic retinopathy and ARMD were noted as the commonest PSEDs in Ijebu division in Southweste

Proptosis ocular a causa de la infección-enfermedad por VIH-sida / Ocular proptosis caused by HIV-AIDS infection-disease

RESUMEN Se presenta a un paciente que ingresó en el antiguo Hospital Provincial Clínico Quirúrgico Docente "José Ramón López Tabrane", de Matanzas. El motivo del ingreso fue una proptosis ocular derecha de instauración súbita en el curso de la infección-enfermedad por VIH-sida. Se le realizaron múltiples estudios para poder definir la causa, y, pese a imponer tratamiento oportuno, falleció a los 15 días del mismo. La epidemia de sida continúa creciendo mundialmente. El conocimiento de las manifestaciones oculares; tanto las alteraciones del segmento anterior como las del posterior, y las infecciones asociadas, permiten mayor posibilidad de preservar la función visual en estos pacientes (AU).

ABSTRACT We present the case of a patient who entered the former Provincial Teaching Clinical Surgical Hospital "José Ramón López Tabrane", of Matanzas. The cause of admission was a sudden right ocular proptosis in the course of an HIV-AIDS infection-disease. Many different studies were carried out to define the cause, and although he was timely treated, he died 15 days after the treatment. The AIDS epidemic is still growing around the world. The knowledge of ocular manifestations, the alterations of the anterior segment as much as the alterations of the posterior one, and the associated infections allow a higher possibility of preserving the visual function in these patients (AU).

Ultrasonographic assessment of paediatric ocular emergencies: A tertiary eye hospital based observation / 世界急诊医学杂志（英文）

BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies. METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57％) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19％), retinal detachment (6.55％), choroidal detachment (4.91％), posteriorly dislocated clear lens (0.81％) and retained intraocular foreign body (5.73％). Non-traumatic cases constituted around 42 (34.42％) eyes, which included corneal ulcer (7.37％), retinoblastoma (6.55％), endophthalmitis (4.91％), extraocular muscle cysticercosis (4.91％), orbital cellulitis (4.09％), periocular haemorrhage (2.45％), proptosis(1.63％), paediatric cataract (1.63％) and cryptophthalmos (0.81％). No adverse events of performing the ultrasound was noted. CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.

Characterization of the parasite‑induced lesions in the posterior segment of the eye.

Ocular lesions are frequently associated with different parasitic infections. The classes of infection include protozoa, nematodes, cestodes, and ectoparasites. Ocular parasitic infections can manifest in any part of the eye; the disease manifestations are frequently characterized as either posterior or anterior eye disease. Parasite‑induced lesions may be due to damage directly caused by the parasite, indirect pathology caused by toxic products or the immune response initiated by infectious parasitism. This review characterized the parasite‑induced lesions in the posterior segment of the eye. Prompt diagnosis and early treatment of these lesions can reduce ocular morbidity. The method of the literature search was conducted on PubMed, Elsevier Scopus database, and Google Scholar with no limitation on the year of publication databases. It was limited to English articles published for ocular lesions in clinical studies and was focused on parasitic infections of the eye.

Determination of craniofacial relation among the subethnic Indian population: A modified approach - (Sagittal relation).

Aim : To measure the linear cephalometric dimensions of anterior and posterior segments of the craniofacial complex sagittally, to establish ratios between different linear dimensions of sagittal segments and check for dimensional balance among the various segments in subjects with normal occlusion, pleasing profile and facial harmony. Setting and Sample Population : Department of Orthodontics, Saveetha University. Lateral cephalograms of 120 subjects of both sexes in the age group of 17-28 years with normal occlusion belonging to Chennai, India Materials and Methods : Linear dimensions of anterior and posterior segments of the craniofacial complex were measured sagittally with the posterior maxillary plane as a key reference plane. Ratios were established between the various parameters in the anterior and posterior region. Results : A ratio of 1:1 was found to exist between the individual and aggregate sagittal segments of the craniofacial complex in both sexes. There was a statistically significant sexual dimorphism in the aggregate lengths(P=0.028,P=0.005).However, the ratio between the anterior cranial floor and effective maxillary length was 2:3 and 5:8 and that between anterior cranial floor to effective mandibular length was 5:8 and 3:5 in females and males respectively. The difference in the above values was not statistically significant. Conclusion : A dimensional balance was found to exist between the maxilla and mandible both at the dentoalveolar and skeletal level with a ratio of 1:1. There was also a dimensional balance between the posterior cranial floor and ramus width. However, there was no architectural balance between the anterior cranial floor and maxilla and mandible.

Trauma ocular contuso y afecciones de vítreo-retina / Blunt ocular trauma and vitreous and retinal disorders

Se consultó la bibliografía actualizada para ofrecer una orientación práctica sobre el manejo de las afecciones vítreorretinales más frecuentes provocadas por los traumas oculares contusos. Estos se encuentran presentes en 31 % de los casos y presentan como complicación seria más frecuente el desprendimiento de retina en 44 %. Se explicó la importancia de la creación de un registro nacional de trauma como herramienta inicial para la prevención de esta enfermedad. Finalmente se expuso algunas consideraciones y un flujograma orientador para el manejo de esta urgencia.

Current papers were reviewed to provide practical managing guidelines in most frequent vitreous and retinal disorders infringed by blunt ocular trauma. They are present in 31 % of traumas, with retinal detachment in 44 % of cases as the most frequent serious complication. The importance of the creation of a national eye injury registry as an initial tool to prevent this disease was explained. Finally, some considerations and a guiding flowchart for the management of this visual problem were included.

Inflammatory choroidal neovascular membrane in posterior uveitis—pathogenesis and treatment.

Choroidal neovascular membrane (CNVM) formation is a well-documented sight-threatening complication of posterior segment intraocular inflammation (PSII). The aim of this article is to review the basic and clinical science literature on the pathogenesis of CNVM formation in PSII and to present results of a case series. We searched the literature using the mesh terms- inflammation, CNVM, age-related macular degeneration, immunosuppression, photodynamic therapy, steroids, vascular endothelial growth factors and posterior uveitis. Additionally, we evaluated the visual outcome of and clinical response to our standard treatment protocol involving a combination treatment for young patients with inflammatory CNVM. The development of CNVM in PSII is promulgated by infiltrating myeloid cells as well as choroidal and retinal myeloid cell activation, subsequent vascular endothelial growth factors, cytokine and chemokine production and complement activation acting in consort to mediate angiogenic responses. No clear standard of care currently exists for the treatment of inflammatory CNVM and various combinations have been tried. Using our combination treatment, visual acuity improved in four, stabilized in one and worsened in four patients. Though significant advances have occurred in the understanding of the pathogenesis and management of this condition, optimizing therapeutic regimens will require further well-constructed prospective cohort series.

A long-term follow-up after successful posterior segment intraocular foreign body removal / 中国医师进修杂志

Objective To follow-up the patients with successful posterior segment intraocular foreign body removal.Methods Medical records of consecutive cases with posterior segment intraocular foreign body that were successfully removed between June 2005 and June 2008 were retrospectively reviewed.Twenty-three patients(23 eyes)were included in the series.Results Followed up 3-36 months All the patients underwent pars plana vitrectomy for posterior segment intraocular foreign body removsl,4 patients (4 eyes)experienced rhegmatogenous retinal detachments that were managed with good long-term visual outcomes.Conclusions Rhegmatogenous retinal detachments may occur following successful removal of posterior segment intraocular foreign body in several months after initial management.These rhegmatogenous retinal detachments can be successfully managed with a variety of methods,depending upon the extent and location of the detachments and causative break.Therefore,it is clinically important to perform a long-term follow-up in patients after successful posterior segment intraocular foreign body removal.

A severe penetrating eye injury with a fish hook / 国际眼科杂志(Guoji Yanke Zazhi)

An interventional case-report about a rare case of penetrating eye injury caused by a fish hook. A 34-year old man was brought to the emergency department with a fish hook embedded in the eye. The fish hook occupied the whole globe with part of it penetrated into the posterior part of the sclera. It was extracted under general anaesthesia using the back-out method.The back-out method is the best option for the removal of the fish hook that penetrated the globe till to the posterior part of the sclera

Ultrasonographic findings in patients examined in cataract detection-andtreatment campaigns: a retrospective study

INTRODUCTION: A cataract is defined as an opacity of any portion of the lens, regardless of visual acuity. In some advanced cases of cataracts, in which good fundus visualization is not possible, an ultrasound examination provides better assessment of the posterior segment of the globe. OBJECTIVES: This study aims to evaluate the ultrasonographic records of patients with advanced cataracts who were examined during cataract campaigns.METHODS: The ultrasonographic findings obtained from 215 patients examined in cataract campaigns conducted by the Hospital das Clínicas Department of Ophthalmology of the Faculdade de Medicina da Universidade de São Paulo between the years of 2005 and 2007 were evaluated, and the utility of this exam in changing the treatment procedures was studied. RESULTS: A total of 289 eyes from 215 patients were examined. Of the eyes examined, 77.5% presented with findings in the vitreous cavity and the posterior pole. A posterior vitreous detachment with no other complications was observed in 47.4% of the eyes. The remaining 30.1% presented with eye diseases that could result in a reduced visual function after surgery. The most frequent eye diseases observed were diffuse vitreous opacity (12.1% of the eyes) and detachment of the retina (9.3% of the eyes). DISCUSSION: In many cases, the ultrasonographic evaluation of the posterior segment revealed significant anomalies that changed the original treatment plan or contra-indicated surgery. At the very least, the evaluation was useful for patient counseling. CONCLUSION: The ultrasonographic examination revealed and differentiated between eyes with cataracts and eyes with ocular abnormalities other than cataracts as the cause of poor vision, thereby indicating the importance of its use during ocular evaluation.

The Study of Prognostic Factors after Vitrectomy for Posterior Segment Metallic Foreign Bodies

PURPOSE: To evaluate the clinical results and prognostic factors that predict final visual outcome in eye with posterior segment metallic foreign body(FB) managed by primary pars plana vitrectomy. METHODS: Twenty-nine patients with posterior segment FBs managed by pars plana vitrectomy were reviewed retrospectively. To determine prognostic factors for visual outcomes, variables including ocular findings at presentation, initial visual acuity(VA), location, size and weight of FBs, site of entrance, location of intraretinal lesion, mechanisms of injury and FB removal time were compared with final visual acuity. RESULTS: After a mean follow up of 19.2 months, 15 eyes(52%) achieved VA of 20/40 or better and 5 eyes(17%) showed decreased VA compared to the initial VA. Prognostic factors for the final VA of 20/40 or better included the weight of FBs less than 20 mg, negative findings of retinal detachment and endophthalmitis. Prognostic factors for the final VA of 20/200 or less included the size of FBs more than 4mm, the weight of FBs more than 20 mg, intraretinal FBs, nonhammering as the mechanism of injury. CONCLUSIONS: The predictors of the final VA were the size, the weight and the location of FBs, mechanisms of injury, preoperative negative findings of retinal detachment and endophthalmitis. These factors will be helpful for planning surgery and predicting the prognosis.

Posterior Triple Surgery in Ocular Trauma Patients

Cataract extraction, intraocular lens implantation, and pars plana vitrectomy combined in a one-stage procedure(posterior segment triple surgery) are effective operation method for complications of diabetic retinopathy and uveitis. We performed posterior segment triple surgeries in 12 eyes(12 patients) with traumatic eye injuries. After a follow up of at least 3 months, eleven eyes(92%) had a visual acuity f 20/200 or more: seven eyes(58%), 20/40 or morel. The result suggest that posterior segment triple surgery is effective in traumatic eye injuries for the fast visual rehabilitation.

A Clinical Study of Posterior Segment Injuries of Non-penetrating Ocular Trauma

Posterior segment injuries due to non-penetrating ocular trauma have protean ocular manifestations. Vision may be unaffected or completely lost according to the injured area. Although most cases require no specific treatment, early accurate diagnosis and appropriate prophylactic treatment will prevent some patients from late visual loss. We analyzed retrospectively 36 eyes of 36 patients with non-penetrating posterior segment trauma who had visited our clinic from August, 1994 to February, 1997. Thirty two of the patients(88.8%) were male and the peak age group was in the third decade. Thirteen of the patients(21%) had Berlin`s edema, which was one of the most common findings seen in the posterior segment. The most common anterior segment finding associated with non-penetrating ocular trauma was hyphema(20%). The most common cause of non-penetrating trauma was violence(first, foot)(38.8%). Final visual acuity was better in eyes without the lesion involving the macula.