Elevated intraocular pressure (IOP) causes structural changes in the optic nerve head in glaucoma... more Elevated intraocular pressure (IOP) causes structural changes in the optic nerve head in glaucoma patients. IOP reduction is clearly the only available treatment that has been proved to decrease both the risk of disease onset and its progression. Glaucoma surgery is indicated when maximal tolerated medical or laser therapy has failed to lower IOP. Anesthesia techniques for glaucoma surgery include general, retrobulbar, peribulbar, sub-Tenon's, subconjunctival, and topical anesthesia. General anesthesia may be advantageous for glaucoma surgery by avoiding the risks of regional anesthesia besides the total immobility of the patient, possibility to control the intraocular pressure, and the facility to fixate the operated eye. Anesthesiologists should be aware of the systemic side-effects and drug interactions of topical or systemic glaucoma medications. In addition, the effects of the anesthetic manoeuvers and drugs on IOP must be taken into consideration.
Aim: To detect Alphasynuclein and Lewy bodies in the retina of patients with Lewy Body Dementia (... more Aim: To detect Alphasynuclein and Lewy bodies in the retina of patients with Lewy Body Dementia (LBD). Methods: 5 patients with probable LBD were examined with fundus autofluorescein (FAF) and optical coherence tomography (OCT). FAF revealed hypo and hyperfluorescent lesions. OCT was performed through these lesions to detect abnormal accumulations. Also, 5 age-matched healthy controls were examined. Results: Alphasynuclein and Lewy bodies were detected in 4 patients. No lesions were observed in the control group. Conclusion: Retina examination by OCT and FAF reveals aggregations exactly similar to the histopathological images of Alphasynuclein and Lewy bodies in live patients with LBD.
A 63-year-old woman with metastatic breast carcinoma presented to the ophthalmology clinic with d... more A 63-year-old woman with metastatic breast carcinoma presented to the ophthalmology clinic with diplopia and right abduction deficit. Magnetic resonance imaging showed isolated enlargement of the right medial rectus muscle. Biopsy of the enlarged muscle revealed metastasis of breast carcinoma. Ocular motility deficit in a patient with breast carcinoma should raise suspicion of metastasis to the orbit involving the extraocular muscles. Orbital imaging and biopsy are necessary for diagnosis and appropriate treatment.
The secondary objective is to validate the accuracy of different parts of the CDAI and DAS-28. Co... more The secondary objective is to validate the accuracy of different parts of the CDAI and DAS-28. Comparison with the patient's joint count is done as well. Methods: The trial was conducted in a private clinic. The patient was examined at first by the physician and afterward by the nurse. The 2 nurses participating to the trial were trained for joint count during a 14 hours course. Finally, a brief training was given to the patient who performed a self-evaluation. The study consisted of one visit where all the different information was collected. The different data collected concerned: the patient's medical history, medication, diagnostic, joint count by the nurse and the physician, VAS by nurse and physician. The patient's selfjoint count was done for a subgroup of the patients. The Rho of Spearman was used for the correlation analysis. Results: The overall correlation between the patient DAS-28 and physician DAS-28 was good (r=0,701) and it was very good between the nurse and the physician (r=0,846).The correlation between the nurse CDAI and the physician CDAI was also very good (r=0,765). The correlation between the different parts of the DAS-28 was less impressive. But in the same way, the correlation was better between the nurse (nr) and the physician, than between the patient (pt) and the physician (MD) and the least between the patient and the nurse. Respectively the correlation for TJC pt-nr is r=0,452, pt-MD is r=0,537, nr-MD is r=0,693, for the SJC the correlation is with pt-nr=0,390, pt-MD=0,414, nr-MD=0,699. The VAS-pt correlates poorly with both the nurse and the doctor VAS, respectively r=0,428 and r=0,392.No significant difference was found between the two nurses. Conclusion: The primary end point is attained. There is a very good correlation between the nurse and the physician's evaluation. These results are congruent with those of previous studies 3. So, this study is another argument to work with a nurse assistant and to use DAS-28 or CDAI in order to save time as we can be confident that the results of the nurse examination is accurate and valuable. This team work is a way to improve patient care following the guidelines. Treat to Target is possible even in remote areas lacking of resources.
We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After init... more We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After initiation of total androgen blockade, the visual complaints, pain and periorbital swelling regressed dramatically within 2 months of treatment. However, the disease subsequently progressed and the patient died 12 months after diagnosis.
A 63-year-old woman with metastatic breast carcinoma presented to the ophthalmology clinic with d... more A 63-year-old woman with metastatic breast carcinoma presented to the ophthalmology clinic with diplopia and right abduction deficit. Magnetic resonance imaging showed isolated enlargement of the right medial rectus muscle. Biopsy of the enlarged muscle revealed metastasis of breast carcinoma. Ocular motility deficit in a patient with breast carcinoma should raise suspicion of metastasis to the orbit involving the extraocular muscles. Orbital imaging and biopsy are necessary for diagnosis and appropriate treatment.
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Papers by Melike Gedar