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61. Anterior capsule staining using micronized triamcinolone in the absence of red reflex. (Abstract)

Anterior capsule staining using micronized triamcinolone in the absence of red reflex. We describe a technique to stain the anterior lens capsule with micronized triamcinolone to perform a continuous curvilinear capsulorhexis (CCC) during phacoemulsification in the absence of a red reflex due to vitreous hemorrhage. After a self-sealing clear corneal tunnel incision is performed using a 2.75 mm blade, a dispersive ophthalmic viscosurgical device (OVD) is injected to protect the iridocorneal (...) angle. An air bubble as large as possible is injected into the center of the anterior chamber, and a small amount of micronized triamcinolone is then injected as needed to stain the anterior lens capsule. The OVD injection permits the removal of excessive triamcinolone and protects the corneal endothelium from damage during phacoemulsification. A capsulorhexis forceps is used to perform the CCC.No author has a financial or proprietary interest in any material or method mentioned.Copyright © 2011

2011 Journal of cataract and refractive surgery

62. Organ donation with the use of normothermic regional perfusion in patients who die after cardiac and respiratory arrest after withdrawal of life-sustaining treatment

also have additional criteria in the form of specific neurological tests to confirm death. These criteria are defined by "Academy of Medical Royal Collages, United Kingdom 2008" as: Lack of pupillary reflex on light stimulation Lack of corneal reflex Lack of motor response to supra-orbital pressure Law In § 10 (see above - "Death criteria ...") the law states that death can be determined in several ways. The wording in § 10, subsection 3 states that "If ..." death is confirmed after cessation (...) . The neurological tests may be similar to the tests described in the English guidelines for cDCD: Lack of pupillary reflex on light stimulation Lack of corneal reflex Lack of motor response to supra-orbital pressure Point 3 An update and quality assurance of the cDCD procedure Conclusion Efficacy and safety The results of our included clinical studies suggest, admittedly on a weak basis, that the organ quality after cDCD with normothermic regional perfusion is not significantly different from DBD. Law

2020 Norwegian Institute of Public Health

63. Influence of topical anesthetics on oculocardiac reflex and corneal healing in rabbits Full Text available with Trip Pro

Influence of topical anesthetics on oculocardiac reflex and corneal healing in rabbits To investigate the incidence of oculocardiac reflex (OCR) with two anesthetic regimens and its prevention using topical anesthetics in a rabbit model, and to explore the effect of topical anesthetics on corneal healing.Forty-eight clinically healthy adult New Zealand white rabbits of either sex were divided into two groups (Group A and B) and anesthetized with either ketamine (Group A, n =24) or propofol (...) (Group B, n =24). he incidence of OCR was recorded in each group with a variety of ocular manipulation with or without the use of topical anesthetics (40g/L lignocaine, 5g/L proparacain, 5g/L bupivacaine). Corneal toxicity and healing following the use of each topical anesthetic was assessed one day after surgery and up to 7 days postoperatively by clinical examination of the eye, histopathology and collagen staining and transmission electron microscopy.No incidence of OCR was recorded with ocular

2010 International journal of ophthalmology

64. Computer vision syndrome: a growing issue in a digital world

]. However, the blink rate for [5]. This decreased blink rate leads to an increase in exposed ocular surface area and a reduction in tear fluid integrity, thereby accelerating eye desiccation [6]. Increased corneal exposure can also occur when an electronic screen is viewed in primary gaze with eyes looking straight ahead, as opposed to viewing at a downward angle. A cross-sectional study published in JAMA Ophthalmology found that prolonged use of digital devices is associated with decreased (...) concentrations of MUC5AC, [7]. These results illustrate the close physiologic relationship between CVS and dry eye disease. Extended use of digital devices at closer viewing distances and more upward gaze angles can increase visual demands on appropriate vergence responses. Blurred vision may be a result from “an inaccurate accommodative response or the failure to fully relax the accommodative reflex” following a sustained near-vision task [4]. As opposed to reading printed materials, reading from a digital

2020 Clinical Correlations

66. Amblyopia

://www.ncbi.nlm.nih.gov/pubmed/5498493?tool=bestpractice.com History and exam presence of risk factors infant not tracking parent's face abnormal red reflex asymptomatic subnormal visual acuity for age in 1 or both eyes asymmetric corneal light reflex unequal behavioural response to alternate eye occlusion abnormal cover/uncover testing blurred vision eye strain congenital nystagmus abnormal pupil exam abnormal external eye exam age <9 years prematurity FHx of amblyopia or strabismus strabismus (misalignment (...) Amblyopia Amblyopia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Amblyopia Last reviewed: February 2019 Last updated: February 2018 Summary A visual impairment resulting from abnormal visual stimulation during early childhood, the prevalence of which ranges from 1% to 4%. Can result from strabismus, form deprivation (e.g., due to congenital cataracts or corneal opacities), and various types of refractive error

2018 BMJ Best Practice

67. Assessment of cranial nerve mononeuropathy

cortex. Efferent motor fibres originate in the motor nucleus of the trigeminal nerve in the mid-pons and travel with V3 through the foramen ovale to supply the muscles of mastication (masseter, temporalis, mylohyoid, medial and lateral pterygoid, and anterior belly of the digastric), as well as the tensor tympani and tensor veli palatini. The trigeminal nerve and its branches also mediate the afferent limbs of the corneal blink and lacrimal reflexes, and both afferent and efferent limbs of the jaw (...) -jerk reflex. Function and disorders The trigeminal nerve is the biggest cranial nerve. It carries sensation from the face and mucosal surfaces, cornea, and supratentorial dura, as well as providing motor innervations to the muscles of mastication. The differential for a trigeminal neuropathy is very broad. Intra-axial pathology, particularly of the pons, can result in trigeminal dysfunction, but only rarely does this result in a mononeuropathy. Extra-axial lesions are more likely to affect

2018 BMJ Best Practice

68. Cataracts

or acquired), medications, or congenital problems. This topic mainly addresses acquired cataract. History and exam presence of risk factors subjective decrease in vision blurred or cloudy vision glare washed-out colour vision reduced visual acuity defects in the red reflex inadequate glasses prescription disruption in activities of daily living age >65 years smoking long-term UV exposure diabetes mellitus other metabolic or hereditary conditions eye trauma long-term ocular corticosteroid use FHx (...) of cataract surgery equipment, but has no contractual agreement. Dr Robert T. Chang would like to gratefully acknowledge Dr Creig Hoyt, Dr Leela V. Raju, and Dr M. Bowes Hamill, previous contributors to this topic. CH, LVR, and MBH declare that they have no competing interests. Peer reviewers Assistant Professor of Ophthalmology Cornea External Disease and Refractive Surgery Local Director Long Island College Hospital Eye Center Brooklyn NY Disclosures MPE declares that he has no competing interests

2018 BMJ Best Practice

69. Diabetic neuropathy

B12 electrolytes, urea, creatinine serum lipid profile LFTs FBC and erythrocyte sedimentation rate serum/urine immunoelectrophoresis corneal confocal microscopy oral glucose tolerance test nerve conduction studies (nerve conduction velocity, NCV) electromyography (EMG) quantitative sensory testing (QST) skin biopsy cardiovascular reflex testing heart rate variability (HRV) gastric emptying studies gastroduodenoscopy surface electrogastrography barium meal GI manometry hydrogen breath tests gastric (...) , people with DN are asymptomatic. History and exam presence of risk factors asymptomatic pain (peripheral) loss of sensation (peripheral) dysaesthesia (peripheral) reduced or absent ankle reflexes (peripheral) painless injuries (peripheral) resting tachycardia (autonomic) impaired heart rate variability (autonomic) urinary frequency, urgency, nocturia, incontinence, hesitancy, weak stream, or retention (autonomic) erectile dysfunction (autonomic) decreased sexual desire and increased pain during

2018 BMJ Best Practice

70. Tropical sprue

]. History and exam prolonged exposure to an endemic area constitutional symptoms diarrhoea bloating foul-smelling, greasy stools swollen/sore tongue and lips glossitis numbness of fingers and toes abdominal cramping fever leg swelling hair loss cheilitis/angular stomatitis pedal oedema hyperactive bowel sounds/borborygmi hyperpigmentation/eczematous rash pallor dry eyes corneal xerosis night blindness decreased deep tendon reflexes/decreased vibratory sensation prolonged exposure to an endemic area HLA

2018 BMJ Best Practice

72. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association

key brainstem areas such as the cranial nerve (Cn) III nucleus in the midbrain, resulting in the absence of pupillary light reflex, and the trigeminal nerve nucleus, injury to which leads to the loss of the corneal reflex. In preterm infants, the lack of pupillary reflexes may be developmental and should not be used for prognosis. In those with widespread cerebral cortical injury but with preservation of the brainstem, the patient may at best achieve an unresponsive wakefulness syndrome (formerly (...) known as the vegetative state). These patients remain unresponsive but with preserved brainstem reflexes. Patients with some injury to the cerebral cortex but with preservation of subcortical and brainstem areas may present with varying cognitive and motor deficits. In the very young, cortical plasticity is mediated by surviving subplate neurons, and injury to subcortical areas may inhibit recovery through plasticity and cortical reassignment. Neuroimaging is an evolving modality that may be able

2019 American Heart Association

74. The Utility and Practice of Electrodiagnostic Testing in the Pediatric Population: An AANEM Consensus Statement

subjects: (1) indications for EDX testing; (2) sedation and consent issues, parental presence during needle electromyography (EMG); (3) technical issues including stimulator size; (4) normative data including late responses; (5) specialized nerve conduction studies (NCSs), including repetitive stimulation and blink reflexes; (6) needle EMG issues; (7) single fiber EMG; (8) small nerve fiber testing; (9) evoked potentials. The literature searches included the keywords “pediatric” or “children (...) throughout the world, thus it is critically important to match appropriate patients with the ideal pain-minimizing procedure. In addition, the ages between 18 months and 5 years are frequently ones when non-compliant behavior is at its peak. In consideration of the above, conscious sedation and/or general anesthesia are used in some centers to facilitate neurophysiologic testing at these ages. While many anesthetic agents depress central activity and reflexes (e.g., electroencephalographic background

2019 American Association of Neuromuscular & Electrodiagnostic Medicine

75. European Academy of Neurology guideline on trigeminal neuralgia Full Text available with Trip Pro

accuracy of trigeminal reflex testing and evoked potentials for distinguishing secondary TN from primary TN were sought. Also papers addressing the role of laboratory tests in detecting trigeminal afferent damage in other neuropathic facial pain conditions were sought. Eight studies reported the trigeminal reflex findings in patients with TN , - (Table ). The diagnostic accuracy of trigeminal reflexes for identifying secondary TN patients was relatively high with sensitivity 59%–100% and specificity 93 (...) %–100%; pooled sensitivity 94%; pooled specificity 88%. Six studies reported the evoked potential findings in patients with TN , , - (Table ). In contrast to the trigeminal reflexes, evoked potentials may be altered even in idiopathic or classical TN. A pooled sensitivity of 84% and a pooled specificity of 52% were found. Table 2. Diagnostic accuracy of trigeminal reflex testing for distinguishing secondary TN (STN) from primary TN (PTN) First author Year STN A/T PTN A/T P assoc Spe (CI) Sen (CI

2019 European Academy of Neurology

76. Cavernous sinus thrombosis

, ears, teeth, or mouth), affecting the cavernous sinus and its structures. Aseptic CST is usually a thrombotic process that is a result of trauma, iatrogenic injuries, or prothrombotic conditions. History and exam presence of risk factors rapid onset of signs and symptoms (acute septic CST) headache fever peri-orbital oedema chemosis and proptosis lateral gaze palsy ophthalmoplegia profound sepsis (acute septic CST) ptosis and mydriasis papilloedema and/or retinal-vein dilatation decreased corneal (...) reflex hypo- or hyper-aesthesia in the distribution of the ophthalmic and maxillary nerves mental state changes (e.g., confusion, drowsiness, coma) clinically detectable primary infection site meningismus (nuchal rigidity, photophobia, and headache) positive Kernig's or Brudzinski's signs seizures loss of visual acuity recent hx of acute sinusitis hx of facial infections hx of peri-orbital infection hx of otitis media, mastoiditis, or petrositis hx of dental or oral infection hx of sepsis

2017 BMJ Best Practice

77. Astigmatism

is incapable of generating a clear image. Benjamin WJ. Borish's clinical refraction, 1st ed. Philadelphia, PA: W.B. Saunders; 1998. History and exam presence of risk factors blurred vision asthenopia (eye strain) distorted retinal reflex Munson's sign positive family history presence of myopia East Asian, Hispanic, Native American, or indigenous Brazilian ethnicity eye trauma or surgery genetic syndromes eyelid pathology Diagnostic investigations retinoscopy keratometry corneal topography wavefront (...) in the dioptric power of the eye from one meridian to another. Instead of having a spherical cross-section, the cornea and/or lens is cylindrical, with different focal power depending on the plane in which the light travels (the meridian). The meridians that have the greatest and the least dioptric power are known as the principal meridians. Astigmatism is termed regular when the principal meridians are at 90° to each other; otherwise, it is termed irregular. When astigmatism is present, the optical system

2017 BMJ Best Practice

78. UV crosslinking with riboflavin in keratoconus

), stromal thinning and corneal scars as the consequence of spontaneous corneal hydrops [4,13]. Furthermore, distorted reflex images of a placido disc or a keratometer lead to a diagnosis. Corneal computer topography can also be used for specific diagnosis; in this procedure, computer-monitored measurement of the corneal surface and structure is performed and the protrusion is displayed as a 3- dimensional coloured image [1,3,4]. So far there is no causally targeted treatment for keratoconus. The limited (...) transplantation (keratoplasty) is indicated [1-4]. Through UV cross-linking with riboflavin (synonym: corneal collagen cross-linking, CXL), for the first time a potential treatment option is available that aims to prevent or slow down disease progression [16,17]. The original CXL procedure according to the so-called Dresden protocol is performed on an outpatient basis under local anaesthetics and includes mechanical removal of the corneal epithelium [17]. The exposed cornea is initially instilled

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

79. Tests for detecting strabismus in children aged 1 to 6 years in the community. Full Text available with Trip Pro

Tests for detecting strabismus in children aged 1 to 6 years in the community. Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect

2017 Cochrane

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