Biomedical subjects
I Beiran
Publications and source records attributed to I Beiran.
Multiple retinal arteriolar occlusions associated with coexisting primary antiphospholipid syndrome and factor V Leiden mutation.
PURPOSE: To investigate a case of a young woman with both primary antiphospholipid syndrome and factor V Leiden mutation who developed multiple retinal arteriolar occlusions. METHOD: Case report of a 25-year-old woman with history and laboratory tests confirming the diagnosis of both primary antiphospholipid syndrome and factor V Leiden mutation who presented with blurred vision in both eyes. RESULTS: Multiple retinal arteriolar occlusions were observed in both of her eyes. The patient was treated first with heparin and then with warfarin. CONCLUSIONS: Primary antiphospholipid syndrome and factor V Leiden mutation, as well as other forms of thrombophilia, should be considered in the differential diagnosis of unexplained retinal vascular occlusions. The coexistence of several thrombophilic disorders may carry a particularly high risk for thrombotic manifestations.
Paediatric chiasmal neuritis--typical of post-Epstein-Barr virus infection?
A case of chiasmal neuritis with bilateral, asymmetric optic nerve involvement is presented. Association with recent Epstein-Barr virus infection is suggested. The clinical picture, possible aetiological factors, and causative relation to Epstein-Barr virus are presented.
Long-term results of transscleral Nd:YAG cyclophotocoagulation for refractory glaucoma postpenetrating keratoplasty.
PURPOSE: To determine the effects of noncontact transscleral Nd:YAG cyclophotocoagulation (NCTY) in the treatment of refractory glaucoma postpenetrating keratoplasty (PKP) with respect to intraocular pressure (IOP), corneal graft survival, and reduction of glaucoma medications. METHODS: The records of all patients treated with NCTY for refractory glaucoma after PKP at the authors' institution over an 11-year interval were reviewed. The LASAG noncontact Nd:YAG laser (Lasag AG; Thun, Switzerland) was used. Approximately 40 laser applications were delivered per eye. Visual acuity, IOP, glaucoma medications, and corneal graft clarity were evaluated. RESULTS: Fifty-two eyes met the inclusion criterion. The mean pretreatment IOP was 38.7+/-11.9 mm Hg. The mean posttreatment IOP was 15.8+/-9.7 mm Hg. From life table analysis, the probability of having a posttreatment IOP of 21 mm Hg or less with or without medication was 70% at 1 year and 63% at 5 years. The probability of a graft remaining clear was 79% at 1 year and 56% at 5 years. In 85% of patients the visual acuity remained stable, in 11% the visual acuity improved, and in 4% the visual acuity deteriorated after treatment. One patient developed hypotony. Twenty patients (36.5%) were able to discontinue one or more glaucoma medications posttreatment. CONCLUSION: In this group of patients with PKP glaucoma, NCTY effectively lowered IOP over the long term, with 36.5% of patients discontinuing one or more glaucoma medications. There was, however, a significant incidence of graft failure at 5 years.
[Traumatic hyphema].
Traumatic hyphema usually occurs in young men at the rate of 17-20/1000,000. Major complications include secondary hemorrhage, glaucoma, corneal staining and disturbances in visual acuity. Final visual acuity is predominantly the outcome of all the ocular injuries occurring during the trauma, mainly to the posterior segment of the eye. We describe all cases of traumatic hyphema treated in our department over a period of 3.5 years. Antifibrinolytic treatment is recommended in the literature in traumatic hyphema to prevent secondary hemorrhage. Our findings differ from those in the literature in that they show a lower prevalence of more severe hemorrhages and of secondary hemorrhage. In light of these differences, and with regard to possible side effects of such treatment, we suggest that antifibrinolytic treatment not be used in our population. We recommend that treatment for traumatic hyphema should include restricted activity, local corti-costeroidal preparations, frequent follow-up visits and vigorous diagnostic work-up in order to find any additional eye damage. We strongly recommend the use of preventive measures (eye-shields) in high risk activities such as sports, house-hold work and military training.
The efficacy of calcium gluconate in ocular hydrofluoric acid burns.
1. Although calcium gluconate (CG) is recommended in the treatment of hydrofluoric acid (HF) eye burn its efficacy seems to be controversial, and controlled human or animal studies are limited. The study's objective is to compare the efficacy of 1% CG and normal saline irrigation for the treatment of HF eye injury in animals. 2. 0.05 ml 2% HF was instilled to anesthetized rabbit's eyes. One minute later, four treatment groups were studies: (1) irrigation with normal saline followed by topical antibiotics, corticosteroids and cycloplegics for 48 h (n = 10); (2) irrigation with 1% CG followed by the same topical treatment (n = 9); (3) as group 1 and 1% CG drops over 48 h (n = 10); (4) as group 3, and injection of 1% CG subconjunctivally after irrigation (n = 9). 3. Corneal erosion area, corneal haziness, conjunctival status, vascularization (pannus) and acidity were assessed before injury, immediately after initial treatment and 1, 2, 7 and 14 days thereafter by slit lamp aided by fluorescein staining. 4. Conjunctival pH dropped from 6.0-6.5 to 2.5-3 after injury and increased to 6-6.5 after irrigation. Corneal erosion: smaller in groups 2, 3, significantly so at 2 days, but not different at 14 days. Corneal haziness: more severe in group 4, at 14 days, insignificant. Conjunctival damage: significantly worse in group 4 at 2, 7 and 14 days. Pannus appeared in 2-4 eyes in each group. 5. It seems that for HF injury 1% CG did not have any significant advantage over saline irrigation and topical treatment only. It might have some initial and temporary effect on healing process especially that involving erosion. Given subconjunctivally, 1% CG may be toxic and worsens clinical outcome.
Recurrent retinal artery obstruction as a presenting symptom of ophthalmic artery aneurysm: a case report.
BACKGROUND: Retinal artery obstruction is an ophthalmic emergency requiring immediate treatment. Recurrent episodes are the result of thromboembolic seeding and necessitate diagnostic efforts to find a possible source for this seeding. The most common sources of such seeding are the valves of the heart and the carotid arteries. CASE REPORT: We describe a case of a 25-year-old man who had recurrent episodes of retinal artery obstruction due to embolic spread. DISCUSSION: We suggest the origin of the embolic spread to be a post-traumatic ophthalmic artery aneurysm. The immediate and long-term treatment given to the patient are described, the present case is compared to earlier reports, and the unusual clinical picture and suggested treatment are discussed.
Meningitis as a complication of dacryocystorhinostomy.
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Influence of systemic diseases and environmental factors on age at appearance, location and type of acquired cataract.
We studied 257 patients scheduled for cataract surgery for possible correlation with systemic diseases, blood chemistry, and environmental exposure. We found that posterior subcapsular cataract appeared in patients 10 years younger on average than those with other types of cataract. Nuclear cataract patients had higher blood levels of uric acid and creatinine and lower blood levels of calcium. We suggest capsular insult as a possible pathophysiological explanation for cataract formation in young age groups (as well as diabetes) and a toxic effect of blood metabolites in patients with renal failure, resulting in earlier and more prevalent sclerosis of lens fibers. No effect of smoking or of exposure to sunlight on the distribution of various types of cataracts was noted.
Excessive water drinking and cataract formation: a case report.
We report a case of a 46-year-old man who developed mature cataract in one eye and nearly mature cataract in his other eye over a 14-month period. No genetic, traumatic, or toxic etiology or intraocular pathology or history of irradiation were present. The patient had intentionally been drinking 15 liters of water a day for 11 months, up until 3 months prior to his admission, and 5 liters a day thereafter, until his admission. During his hospitalization he was found to suffer from insulin-dependent diabetes mellitus. The rest of his medical work-up was found to be normal. We suggest that the huge water overload put on his lens played a role in the premature and rapid cataract formation.
Mortality trends among Jewish and non-Jewish women in Israel, 1960-82.
Until 1975 in Israel mortality rates in women aged greater than or equal to 25 years old were higher among Jewish women than non-Jewish women. Since then the relationship has been reversed with higher rates in the non-Jewish group. The three main causes of death in the two groups were heart disease, cancer and cerebrovascular disease (CVA). The proportional mortality and death rates from total heart diseases rose in the non-Jewish population during 1970-82, whereas in Jewish women there were only slight changes. With regard to cancer, the proportional mortality and death rates were higher in the Jewish group. However, from 1970 to 1982 cancer mortality in the Jewish population declined continuously, while in the non-Jewish group it rose. Mortality from CVA rose in both Jewish and non-Jewish women until 1974, but then declined. Since then, the rates remained considerably higher in the non-Jewish population. Death from heart disease, cancer and CVA can partially explain the reversal in total mortality rates in 1975.
Mortality trends among Jewish and non-Jewish men in Israel, 1960-82.
Until 1975 in Israel the mortality rates in men greater than or equal to 25 years old were higher in Jews than non-Jews. Since then the relationship has been reversed with higher rates in the non-Jewish group. The three main causes of death in the two groups were heart disease, cancer and cerebrovascular disease (CVA). Death rates from total heart diseases rose in the non-Jewish population during 1970-82, whereas in the Jewish men there were only slight changes. With regard to cancer, death rates were higher in the Jewish group, but from 1970 to 1978 it increased in both groups, the change being relatively higher in non-Jews. Mortality from CVA was higher among Jews at the beginning of the study period, but since 1978 the rates remained higher in the non-Jewish population. Death from heart disease, cancer and CVA can partially explain the reversal in total mortality rates in 1975. A comparison of the data of Israeli men with those of Israeli women shows that the mortality rates of the non-Jewish population of both sexes have changed dramatically over the last decade. These findings have important implications for the planning of further research and for priority determination in health care planning.
A quality management project in Israeli navy primary care clinics.
The objective of this project was to establish a measurable process of continuous quality improvement of health care services in the Israeli naval primary care clinics. All navy clinics were surveyed at 6-month intervals. The quality of medical recording was evaluated, and instructive workshops were given on the matter. Real-time physician-patient interactions were evaluated, and immediate feedback was given to the examining physician. Complementary medical services were evaluated and steps toward improvement were taken. A total of 1043 medical records were examined. A general improvement in medical-record documentation (from a score of 6.0 +/- 2.5 to a score of 7.4 +/- 1.9, P < .001) was demonstrated during the first 3 years of the project. No significant change was noticed in the physician-patient interaction score. Complementary medical services improved from a score of 4.9 +/- 1.5 in 1994 to a score of 7.4 +/- 0.9 3 years later (P < .02). This project achieved a significant improvement in the quality of medical recording and of complementary medical services.
Hyperbaric oxygenation combined with nifedipine treatment for recent-onset retinal artery occlusion.
We describe the results of early hyperbaric oxygenation combined with nifedipine treatment for central retinal artery occlusion, and explain the results pathophysiologically. We report four cases in which hyperbaric oxygenation therapy was applied in combination with nifedipine, eyeball massage, and glycerol for the treatment of central retinal artery occlusion. In two of the cases in which therapy was started less than 100 minutes after the acute onset of visual loss and one case in which therapy was started during the course of central arterial occlusion, considerable improvement in visual acuity was observed, while in the fourth case in which therapy was started six hours after the acute onset of visual loss, no improvement appeared. We conclude from these results that hyperbaric oxygenation therapy has a beneficial effect on the final visual outcome of central retinal artery occlusion, provided it is applied early enough. Further investigation is needed to fully define the nature and terms of this beneficial effect.
A change in ocular involvement in a patient suffering from ankylosing spondylitis and Behçet's disease.
We report a case of a young man suffering from both ankylosing spondylitis and Behçet's disease in whom the character of the ocular involvement changed according to the predominant disease at a given time. When the clinical picture was one of ankylosing spondylitis, only anterior uveitis was observed, while the clinical picture of Behçet's disease occurred with panuveitis and retinal vasculitis. To the best of our knowledge, this is the first report in the English literature of two different patterns of ocular involvement in the same patient with two seronegative arthritides.
Hyperbaric oxygenation therapy for ischemic optic neuropathy.
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