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Carnosine (beta-alanyl-L-histidine) exhibits various biological effects underlying its potential therapeutic use. In ophthalmology carnosine was effective in treatment of corneal metabolic diseases, senile cataract. It accelerated cornea reepithelization after photorephraction ceratoectomia.
Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children.
The paper considers the armament development ultimately resulting in the predominance of using minor blasting assemblies and accordingly to a drastic prevalence (as high as 80%) of mine explosion injuries among other battle injuries to the eye. The particular severity of these injuries requires their efficient subdivision into types and severity, which is alleviated by the introduction of a new classification of mechanical injuries into the eyeball. It is obligatory for each ophthalmologist to know this classification. It is the ophthalomologist who may be the first specialist to start rendering an aid to the victim. In terms of the highest level of development of modern ophthalmological diagnosis and intraocular eye surgery, delivery of a patient to a specialized eye traumatological center where he/she will be given a comprehensive aid, including an intraocular one, in 3-7 days rather than the promptest surgical debridement (generally as just wound closure) is a master link in obviating the losses associated with eye injury. There is evidence that the same interregional centers as the army centers that have operated in Kabul and Rostov-on-Don should be set up preferably on the basis of multidisciplinary hospitals in the civil health care system. They could become an original testing area for researches of explosive injuries to the eye and a source of materials for making the centralized national register of eye injury.
Clinical practice guidelines represent the best current thinking on the management of acute and chronic medical conditions. Unfortunately, the implementation of such guidelines in clinical practice has been difficult and problematic. Electronic medical records represent an opportunity to implement guidelines. We have designed a system for incorporating guidelines for the management of glaucoma into an ophthalmology EMR.
PURPOSE: To define and discuss unnecessary clinical tests in ophthalmology, review the justifications commonly given by clinicians for obtaining unnecessary clinical tests, and suggest a more rational approach to clinical testing in the future. METHODS: The author defines an unnecessary clinical test as a test on a human subject that is unlikely to influence that patient's diagnosis, prognosis, or management or is performed exclusively, primarily, or in large part for research purposes. RESULTS: Examples of clinical tests the author categorizes as unnecessary are tests performed to evaluate a new or nonstandard diagnostic instrument or method; tests performed to evaluate sensitivity, specificity, and predictive value of a new instrument or method; tests obtained to provide images or data for future analysis, presentation, or publication; tests obtained routinely in patients of a certain class or category without regard to the individual's personal characteristics, recent clinical history, or clinical signs; and duplicate tests performed without retrieval and review of recent prior tests of the same types and determination of the quality of and findings revealed by those tests. Several justifications that are commonly given by clinicians for their ordering of unnecessary tests are presented, and each of these justifications is critiqued. The principal problems with unnecessary testing are increased costs of medical care, worsening rather than improvement in patient outcomes, and unethical practice. CONCLUSION: Unnecessary testing is perhaps an unavoidable aspect of current clinical ophthalmic practice in the United States. In spite of this, clinicians (especially academic ophthalmologists) need to be aware of this issue and take appropriate steps to minimize such testing.
The management of pituitary tumors requires a multidisciplinary approach involving neurosurgeons, endocrinologists, and ophthalmologists. Patients symptomatic from a pituitary tumor often are first evaluated by an ophthalmologist. This review discusses key issues regarding both the topographic diagnosis as well as the neuro-ophthalmologic manifestations of pituitary disease. Knowledge of the medical, surgical, and radiation treatment options for pituitary tumors is also important in coordinating patient care. The goals of such treatment include the control of tumor growth, normalization of pituitary function, and preservation or restoration of visual function.
A system for estimating labor consumption in, and quality of the therapeutic and diagnostic process, based on the medicosocial and economic analysis of the current ocular morbidity structure in Russia, is suggested. This estimation system may be useful in condition of cost accounting relations introduction in research institutions of ophthalmologic profile.
The authors evaluate the questionnaire programme "Ambulatory ophthalmology". They draw attention to working problems of the ambulatory doctor and submit some suggestions to improve the position. They try to activate ophthalmologists for collaboration and more rapid essential changes.
Introduction of new economic principles in the activities of medical research institutions helps extend the rights and responsibilities of the institutes' stuff and make them economically interested in the results of their activity; these principles provide high quality of treatment and prophylaxis work and permit concentrating all the resources on the priority trends in medical research. The authors discuss the pressing problems in introducing the cost accounting system in the activity of a research institute in ophthalmology.
Intranasal midazolam was tested in pediatric patients undergoing ophthalmological examination. 15 children aged 3.5 months to 10 years received 0.35-0.5 mg.kg-1 intranasal midazolam in association with a corneal anesthesia. The onset of sedation was rapid and permitted adequate ocular examination in all cases. In 8 of 15 cases where surgery followed immediately, the induction of inhalational anesthesia was easier. No local or general adverse reaction was noted. This non-invasive method of anesthesia may be compared to the intrarectal administration of midazolam, but the rapid onset of sedation and a cleaner route seem more suitable in surgical environment.
Following logical step-by-step strategies, many ophthalmological examinations are based on relatively simple methods. Because of this modern computers are capable of monitoring many of these examinations and of measuring the data. The interpretation, however, must be done by an ophthalmologist who can then relate the results to the patient's vision.
The system of estimating the cost of care of ophthalmologic patients improves out- and inpatient registration and helps assess the medical aid rendered to the patients; it permits an effective exploitation of the resources of therapeutic institutions and helps coordinate the activities of various departments.
Diseases of the organ of vision are rather frequent in children living in rural districts. Experience gained by pediatric ophthalmologic service of the Talgar district shows that all forms of specialized care of children (specialized groups for children with strabismus and amblyopia, pioneer camp for schoolchildren with myopia, day-time hospital) are fit for rural districts. To render such care, a pediatric ophthalmologist should be included in the stuff of central regional hospitals whatever the number of children in this region.
Carl Gustav Carus is the most important personality in medicine in Dresden in the first half of the 19th century. He is well known for his manifold activity as a doctor, scientist and philosopher as well as a landscape painter of the romantic period. His literary output is estimated at about 25,000 printed pages. There is just one paper which touches ophthalmology and teratology: in 1842, Carus described the monstrous head of a pig with cyclopia. The discussion follows an idealistic line with comparative anatomical studies in fauna and flora.
Friedrich August von Ammon of Dresden took a considerable part in shaping ophthalmology into a scientifically and clinically independent part of medicine, thus inserting himself into the great development of the specialty during the first half of the 19th century. In particular, he investigated the ontogeny of the human eye as well as its pathological anatomy. He edited journals, published monographs, created a school of his own and gained in this way far-reaching influence. As a practitioner, a teacher and a physician-in-ordinary to the King of Saxony, he maintained the tradition of an earlier ophthalmologist of Dresden: Georg Bartisch.
There is a new trend in the US government's perception regarding health care today. It involves an increased awareness of how disease can be prevented and health promoted. The US government is supporting this concept with its Healthy People 2000 project. Specific pediatric concerns about health promotion and disease prevention in ophthalmology include amblyopia and strabismus, ophthalmia neonatorum, ocular trauma, radiation injury, xerophthalmia, herpes simplex, herpes zoster, infections and metabolic and genetic disorders. Adult health promotion/disease prevention priorities include glaucoma; trauma; diabetic retinopathy; corneal problems; iatrogenic infections; exposure keratitis; ocular toxicity from drugs, chemicals, and the environment; visual loss from neglect; and those mentioned in the pediatric area.
The author assessed by means of questionnaires organizational aspects of ophthalmological care of premature infants in departments for premature infants in type I and II hospitals. He discusses therapeutic possibilities of children with developing retinopathies of the premature in these departments. In the conclusion he emphasizes that from the organizational aspect consultant services at this level are ensured in a satisfactory way. The actual professional standard cannot be evaluated from questionnaires.
The paper presents data about the influence of presurgical preparation, a special tactics of management on the day of operation and the first postoperative days on the incidence of complications, visual acuity and the term of the patient's stay in a specialized bed after cataract extraction and antiglaucomatous operations in patients of elderly and senile age, suffering from diabetes mellitus. It is substantiated that specialized ophthalmological hospitals of a surgical profile should have a therapist on staff with obligatory endocrinologic preparation.