The impact of heat source and chemical reaction on MHD blood flow through permeable bifurcated arteries with tilted magnetic field in tumor treatments.

In this research work, we investigate the influence of heat source and chemical reaction on electro-magneto-hydrodynamic (EMHD) blood flow through bifurcated arteries with external tilted magnetic field for treating tumor. The potential electric field applied along the bifurcated arterial wall, accurately described the Poisson-Boltzmann equation. We modeled the EMHD blood flow to obtain the non-dimensionalized form of the equations. We converted the modeled equations to ordinary differential equations by the use of suitable variables. Exact solutions of the converted equations are calculated by the method of undetermined coefficients and the results obtained with the aid of Mathcad software were simulated and presented graphically. From the graphical representation of results, we observed that increase in Joule heating and Eckert number, increases the temperature distribution in the affected tumor cells which prevent high thermal radiation exposure from killing the healthy cells within the tumor region. The curves of the wall shear stress seem to be greater in the converging region in comparison to the diverging region, but when the strength of magnetic field and thermal radiation parameters increase the wall shear stress decreases at the bifurcated wall where blockage may likely occur due to the development of boundary layers on the inner walls of the bifurcated region. By increasing the heat radiation parameter, we observed that the curves representing both velocity and temperature profiles increase rapidly from the origin and the velocity of blood flow varies directly for the converging, diverging and the tumor regions of the bifurcated arteries. Thus, thermal radiation effect is a result of the higher rate of heat transfer at the vessel walls. Further, combining the electromagnetic field and the heat radiation together gives new insights of the physical properties of blood flow in the body system network which is essential for health practitioners and clinicians.

Penetrating Ocular Fish-Hook Injury.

Penetrating ocular injuries caused by fish hooks, although rare, present unique challenges and significant risks to ocular structures and vision. We report a case of a 36-year-old male who presented with a fish hook embedded in his right eye. Clinical examination revealed a fish hook perforating the cornea, entering at the nasal cornea at 3 o'clock and exiting at the temporal cornea at 7 o'clock. Despite initial attempts to employ the advance-and-cut technique, the unsuccessful utilization of a wire cutter led to a shift in the removal approach. The modified backout method was successfully employed, allowing the safe extraction of the fish hook while minimizing iatrogenic damage. Follow-up appointments showed a gradual improvement in visual acuity despite early cataract formation and significant central scarring. To optimize the patient's visual outcome, a triple procedure involving penetrating keratoplasty (PKP), extra-capsular cataract extraction (ECCE), and intraocular lens (IOL) implantation has been scheduled. This case highlights the importance of prompt and adaptable management in ocular fish-hook injuries, emphasizing the need for comprehensive follow-up care. It also underscores the value of preventive measures, including the use of protective eyewear, to reduce the incidence of such injuries, given that the majority of ocular traumas are preventable.

Diffractive Trifocal Intraocular Lens Implantation in Stable Subclinical and Forme Fruste Keratoconus: A Case Series.

In this retrospective case series, we examine the outcomes of diffractive trifocal intraocular lens implantation after cataract surgery, in patients with subclinical and forme fruste keratoconus. Eight eyes of four patients (aged between 47 and 64) were included in the study and underwent phacoemulsification with implantation of AT LISA tri 839MP or AT LISA tri-toric 939MP intraocular lenses (Carl Zeiss Meditec AG, Jena, Germany). Post-operative evaluation included a visual acuity test at three distances (6m, 80cm, and 40cm), a visual acuity test at three low contrast levels (25%, 12.5%, and 6%), and a questionnaire about the patients' experience with photic phenomena and overall satisfaction with the achieved quality of vision. Our results show that spectacle freedom was achieved in all cases with a high satisfaction rate among participants. We hope our results would encourage surgeons to offer this technology to carefully selected candidates with stable subclinical and forme fruste keratoconus undergoing cataract surgery, giving them the possibility of achieving spectacle independence.

Localized Choroidal Melanoma Managed by Pars Plana Endoresection, Endodiathermy, and Endolaser.

Choroidal melanoma, although rare, is the most common primary intraocular malignancy among adults, with an incidence ranging from 6 to 7.5 cases per million per year globally. This tumor originates from the uveal tract's melanocytes in the eye. Melanomas usually arise from the sixth decade of age with increasing incidence with progressive age. A 60-year-old male presented with a right-sided sudden painless decrease in vision due to a grade 4 vitreous hemorrhage. B-scan ultrasonography and CT scan of the orbits revealed a mushroom-shaped choroidal mass highly suggestive of choroidal melanoma, which was managed surgically with pars plana endoresection, endodiathermy, and endolaser. Endoresection can be an effective method for the management of solitary non-metastasized choroidal tumors, especially those that have become symptomatic. Pre and post-surgical imaging are necessary, along with careful follow-up to detect any recurrence.

Sutureless Amniotic Membrane (ProKera®) and Intravenous Immunoglobulin in the Management of Ocular Complications of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis Overlap.

PURPOSE: To report a case of Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, with severe acute ocular manifestations successfully managed with sutureless Amniotic Membrane device ProKera® (Bio-Tissue, Inc., Miami, FL) and topical steroids, followed by late complications that were successfully managed with intravenous immunoglobulin (IVIG) therapy. OBSERVATIONS: A 24-year-old lady, known case of epilepsy, admitted to the burn unit with SJS-TEN overlap attributed to a recent change of her anti-convulsant therapy, with severe ocular manifestations, inability to open both eyes, and poor visual acuity. Early management included intensive topical steroids and lubrication, in addition to the application of a ProKera® device. Despite achieving full epithelialization within two weeks with the improvement of ocular manifestations, the patient presented three weeks later with recurrence of conjunctival epithelial defects, partial ankyloblepharon, and severely dry corneas. These late sequelae were managed with bandage contact lens (BCL) application, intensive topical steroid, and lubrication in addition to IVIG therapy. After six cycles of IVIG therapy, ocular manifestations improved significantly and the patient achieved uncorrected visual acuity of 6/9 in both eyes. Conclusion and importance: Existing evidence suggests that the use of IVIG in combination with systemic steroids in the early phase of SJS-TEN can reduce mortality, without affecting the final visual outcome in patients with ocular manifestations. This case highlights the possible role of IVIG therapy alone - without systemic steroids - in managing and preventing long-term ocular complications of SJS-TEN.

Unexplained Bilateral Simultaneous Corneal Graft Rejection in a Healthy 18-Year-Old Male.

PURPOSE: To report a rare case of unexplained bilateral corneal graft rejection one year after penetrating keratoplasty (PK) in an otherwise healthy individual, who was compliant with topical fluorometholone maintenance therapy. OBSERVATIONS: An 18-year-old gentleman, who underwent successful, sequential, non-simultaneous, bilateral PK for advanced keratoconus, presented one year later with an acute endothelial rejection episode involving both eyes simultaneously. The rejection episode was reversed with a high dose of intravenous (IV) methylprednisolone pulse therapy over three days, topical cyclosporine-A 1%, and prednisolone acetate 1%, and then maintained on cyclosporine-A 1% eye drops, as the patient was a steroid responder. Conclusion and importance: Bilateral corneal graft rejection, although rare, can occur even several months after successful PK. Prompt management is crucial for the successful reversal of an acute corneal graft rejection episode. In steroid responders, Cyclosporine-A 1% can play a role in reducing the need for, or frequency of, potent steroid eye drops in the acute phase, and as a long-term steroid-sparing agent for maintenance.

Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre.

PURPOSE: To study the changing indications for Penetrating keratoplasty in Bahrain and to compare them with published data. PATIENTS AND METHODS: A Retrospective review of available records of patients who underwent penetrating keratoplasty at a tertiary center in Bahrain (1996-2015). The trend of each indication was analyzed. The study was subdivided into three periods for correlation purposes. Pearson Coefficient r and the p values were used for interpretation of data. The results were compared with similar studies. RESULTS: A total of 298 patients underwent keratoplasty in the study period, which is from 1996 until 2015 (missing data 2009-2011). Keratoconus was found to be the leading indication, accounting for 33% of the total cases, followed by trachoma 27%, followed by aphakic and pseudophakic bullous keratopathies 13%. Trachoma showed a statistically significant decreasing trend (p < 0.001), Keratoconus had an increasing trend (p<0.001). Bullous keratopathy showed an increasing trend (p = 0.001) with an abrupt rise after 2012. CONCLUSION: Corneal scarring due to old trachoma was the leading indication for keratoplasty 20 years ago in Bahrain. However, due to improvement of health awareness, hygiene, and the socioeconomic status, this has regressed with keratoconus becoming the leading indication from 2002 onwards. A surge of bullous keratopathy was noted after 2012, placing it as the second commonest indication. This may be due to the introduction of phacoemulsification technique for cataract surgery, and perhaps because the nature of the institute being a teaching hospital. Keratoconus is the leading indication and showed an increasing trend. It is recommended to perform a keratoconus screening program for early detection and prevention.

Four-flanged prolene fixation for a toric trifocal intraocular lens of the double C-Loop design in an eye with severe capsular phimosis.

PURPOSE: To report a rare case of severe capsular phimosis after toric trifocal intraocular lens implantation, in a patient who was already on systemic immunosuppression and to present a modified fixation technique, based on the four-flanged prolene technique, which could be adapted for fixation of intraocular lenses of the double-C-loop design. OBSERVATIONS: A 33 year old gentleman, who underwent uneventful, sequential, bilateral phacoemulsification with implantation of toric trifocal intraocular lenses, presented 6 weeks post-operatively, with severe capsular phimosis, causing decentration of the IOL and deformation of the haptics in both eyes. The left eye was successfully managed by Nd-YAG laser anterior capsulotomy, while the right eye required surgical intervention. CONCLUSION AND IMPORTANCE: In the present case report, we describe a novel technique to successfully reposition and realign a decentered toric trifocal intraocular lens of the double C-loop haptic design, after severe capsule phimosis.