Cataract. Diagnostic errors at referring patients to surgery

2020 ◽  
Author(s):  
V.V. Egorov ◽  
◽  
E.L. Sorokin ◽  
G.P. Smoliakova ◽  
O. V. Kolenko ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Diagnostic Errors ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Critical View ◽  
Optical Media

The textbook examines the most common diagnostic errors of ophthalmologists when making a clinical diagnosis of "cataract". Clinical examples point to a more critical view of the cataract diagnosis. Due to the fact that most of the errors are based on a superficial examination of the eye, clear recommendations are given for conducting a clinical ophthalmological examination of cataracts. At the same time, special attention is paid to the types of examination of the lens with the help of a slit lamp, to the peculiarities of performing various types of ophthalmoscopy with moderate opacity of optical media.

Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Robert M. McFadzean ◽  
David Doyle ◽  
Roy Rampling ◽  
Evelyn Teasdale ◽  
Graham Teasdale
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Visual Function ◽  
Pituitary Apoplexy ◽  
Diagnostic Errors ◽  
Large Series ◽  
Ocular Motility ◽  
Pathological Findings ◽  
Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

scholarly journals Anterior Chamber Angle Assessment Techniques: A Review

2020 ◽  
Vol 9 (12) ◽  
pp. 3814
Author(s):  
Ivano Riva ◽  
Eleonora Micheletti ◽  
Francesco Oddone ◽  
Carlo Bruttini ◽  
Silvia Montescani ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Anterior Chamber ◽  
Imaging Techniques ◽  
Anterior Segment ◽  
Standard Technique ◽  
Qualitative Assessment ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Anterior Chamber Angle ◽  
Chamber Angle

Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.

scholarly journals Genetic testing for familial exudative vitreoretinopathy

2017 ◽  
Vol 1 (s1) ◽  
pp. 51-53 ◽  
Author(s):  
Andi Abeshi ◽  
Carla Marinelli ◽  
Tommaso Beccari ◽  
Munis Dundar ◽  
Leonardo Colombo ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Clinical Utility ◽  
Autosomal Dominant ◽  
Scientific Literature ◽  
Genetic Test ◽  
Clinical Findings ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Dominant Inheritance ◽  
Familial Exudative Vitreoretinopathy

Abstract We studied the scientific literature and disease guidelines in order to summarize the clinical utility of genetic testing for familial exudative vitreoretinopathy (FEVR). There is insufficient data to determine the prevalence of FEVR. Variations in the FZD4 (OMIM gene: 604579; OMIM disease: 133780), TSPAN12 (OMIM gene: 613138; OMIM disease: 613310) and ZNF408 (OMIM gene: 616454; OMIM disease: 616468) genes have autosomal dominant inheritance, whereas variations in LRP5 (OMIM gene: 603506; OMIM disease: 601813) have autosomal dominant or recessive inheritance and variations in NDP (OMIM gene: 300658; OMIM disease: 305390) have X-linked inheritance. Clinical diagnosis is based on clinical findings, family history, ophthalmological examination, fundoscopy, slit-lamp examination and fluorescein angiography. The genetic test is useful for confirming diagnosis and for differential diagnosis, couple risk assessment and access to clinical trials.

scholarly journals Diagnosis and Treatment of Pityriasis Rubra Pilaris

2014 ◽  
Vol 6 (4) ◽  
pp. 167-173
Author(s):  
Alexey Kubanov ◽  
Yulia Gallyamova
Keyword(s):  
Clinical Study ◽  
Literature Review ◽  
Clinical Diagnosis ◽  
Histological Analysis ◽  
Diagnostic Errors ◽  
Symptomatic Improvement ◽  
Substantial Improvement ◽  
Diagnosis And Treatment ◽  
Diagnostic Features ◽  
Pityriasis Rubra Pilaris

AbstractThe article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP). The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2%) patients, 6 (26%) patients received treatment for toxic exanthema, and only 2 (8.8%) patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.

scholarly journals Uveitis Among Children Living with HIV / AIDS in Kinshasa, RD Congo: A Case Series

2020 ◽  
pp. 1-4
Author(s):  
Nadine Nsiangani Lusambo ◽  
Nadine Nsiangani Lusambo ◽  
Dieudonné Kaimbo Wa Kaimbo
Keyword(s):  
Immune Deficiency ◽  
Immune Status ◽  
Retinal Vasculitis ◽  
Case Series ◽  
Peripheral Retina ◽  
Unknown Etiology ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Living With Hiv ◽  
Hiv Aids

Purpose: To report the clinical features of a series of children living with HIV / AIDS (CLWHA) with uveitis. Methods: This was a case series of CLWHA and who had a diagnosis of uveitis examined from November 2010 to April 2011 in five sanitary structures in Kinshasa. For each child, anamnestic elements were collected. Each child underwent an ophthalmological examination including visual acuity measurement, slit lamp examination and fundus examination after dilation. Results: 15 CLWAH presented with uveitis out of a series of 100 CLWHA examined. Fourteen of the children with uveitis were already on treatment and had normal immune status, the only child who had not yet started treatment had a severe immune deficiency. Retinal vasculitis was the most common disorder in 8 children. It was asymptomatic and mainly concerned the veins on the peripheral retina. Four children presented with chorioretinal scars of unknown etiology. HIV-related microangiopathy was found in 2 children. Unilateral anterior uveitis was the only symptomatic involvement, found in the child who were not on treatment. Conclusion: Uveitis is common in African CLWHA. Retinal vasculitis of unknown etiology appears to be the most common clinical manifestation in this population. Antiretroviral therapy seems to decrease the frequency of sight-threatening conditions.

scholarly journals Bilateral Persistent Pupillary Membrane with Tetralogy of Fallot: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
A. Altun ◽  
S. A. Kurna ◽  
E. Bozkurt ◽  
G. Erdogan ◽  
G. Altun ◽  
...  
Keyword(s):  
Case Report ◽  
Tetralogy Of Fallot ◽  
Congenital Heart ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Review Of The Literature ◽  
Slit Lamp Examination ◽  
Uncorrected Visual Acuity ◽  
The Right ◽  
Congenital Heart Anomaly

Case Report. A 15-year-old boy presented to the Fatih Sultan Mehmet Education and Research Hospital with the complain of bilateral vision blurring associated with severe glare and photophobia. On ophthalmological examination, uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left eye, and there was no improvement with pinhole testing. The slit-lamp examination showed persistent pupillary membranes (PPM) in both eyes. According to the history obtained from his parents, he had received cardiac surgery for tetralogy of Fallot (TOF) 8 years ago.Conclusion. This patient is unique because this is the first reported case of bilateral PPM with congenital heart anomaly in the literature. Bilaterality of the eye anomaly strengthens the possibility of an uncommon association between PPM and TOF, rather than local failure in embryonic development.

scholarly journals A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Sameh S. Mandour ◽  
Khaled E. Said-Ahmed ◽  
Hany A. Khairy ◽  
Moataz F. Elsawy ◽  
Marwa A. Zaky
Keyword(s):  
Nasolacrimal Duct ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
University Hospitals ◽  
Silicone Tube ◽  
Significant Difference ◽  
Fluorescein Dye ◽  
The Difference ◽  
One Year ◽  
Punctal Stenosis

Purpose. Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation. Study design. A prospective nonrandomized clinical study. Methods. The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery. Results. One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3–5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results. Conclusion. Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143.

scholarly journals The Effect of Multiple Sclerosis on Nerve Fiber Layer of the Retina

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A A Mohamed ◽  
A M Saad ◽  
T H Mohamed ◽  
Y A Elzanklony
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Neuritis ◽  
Control Group ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
University Hospitals ◽  
Rnfl Thickness ◽  
Study Results ◽  
Significant Difference

Abstract Background Multiple Sclerosis is a chronic idiopathic inflammatory demyelinating disease involving Central Nervous System white matter with relapsing-remitting nature. Optic neuritis is a common initial manifestation. Multiple Sclerosis is characterized by dual pathological process of inflammation and neurodegeneration. It causes prominent retinal neural ganglion cell layer loss in addition to related axonal loss which can be identified by thinning of RNFL seen in OCT. Patients and Methods This case control study was carried out at Ain Shams University Hospitals in MS clinic of neurology department and Ophthalmology outpatient clinics. with a total of 100 eyes, from 50 subjects, Group A (10 patients, 20 eyes): normal persons with normal eyes as a Control group and 40 patients (80 eyes) having multiple sclerosis who satisfied the inclusion and exclusion criteria subdivided into 2 groups,(group B) 20 patients having previous attack of Optic Neuritis & (group C) 20 patients not having previous Optic Neuritis. Informed consents were obtained from all subjects and ethics approval were obtained from Ain Shams University Hospitals Ethical Commitee: A complete ophthalmic history and ophthalmological examination were done for each subject. Visual acuity assessment using Auto Refractometer, refraction, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) assessment using Snellen chart and also calculated in Logarithm of Minimum Angle of Resolution (LogMAR).Pupil reaction. Color vision assessment. Anterior segment detailed Slit Lamp examination. Posterior segment examination (ONH examination) using Slit lamp biomicroscopy, Volk +90 Diopter lens. Intraocular tension measured by Goldmann applanation tonometry. OCT to evaluate RNF layer thickness and c/d ratio. Results Our study results demonstrated that: VA & BCVA were statistically significant lower in MS group than the control group (P = 0.011, 0.006 respectively). Total, superior, inferior and temporal RNFL thickness were statistically significant lower in MS group than the control group(P = 0.003, 0.004, 0.028, 0.018 respectively), while there was no statistically significant difference between the two studied groups regarding nasal RNFL thickness. Total, all the four quadrants superior, inferior, temporal and nasal RNFL thickness were statistically significant lower in MS group with previous attack of ON compared with the MS group not having previous ON (P = 0.000, 0.000, 0.004, 0.004, 0.024 respectively). Conclusion This study also suggests a great role of ocular imaging techniques such as OCT as an effective noninvasive, high-resolution, non contact tool in mapping of subclinical retinal changes (GCIP layer) in MS patients. It may also serve as a diagnostic adjunct for monitoring disease activity and responses to neuroprotective drugs.

Clinical Diagnoses and Autopsy Findings: A Retrospective Analysis of 252 Cases in Greece

2005 ◽  
Vol 129 (2) ◽  
pp. 210-214
Author(s):  
Chaido Spiliopoulou ◽  
Stavroula Papadodima ◽  
Nikolaos Kotakidis ◽  
Antonios Koutselinis
Keyword(s):  
Retrospective Analysis ◽  
Clinical Diagnosis ◽  
Cause Of Death ◽  
Diagnostic Errors ◽  
Postmortem Diagnosis ◽  
Autopsy Findings ◽  
Quality Of Patient Care ◽  
Clinical Diagnoses ◽  
Unexpected Findings

Abstract Context.—Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science. Objective.—To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies. Design.—Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999–2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient. Results.—In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 105 cases (42%), the autopsy requests did not include any suggestion about the cause of the patient's death. In 7 cases (3%), several diagnoses were suggested by the clinicians, and in 16 cases (6%), the comparison between clinical and postmortem diagnosis was not possible. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism. Conclusions.—It is concluded from this study that autopsies may reveal unexpected findings that are of critical importance and that a continued emphasis on autopsy evaluation is necessary to improve the quality of patient care.

scholarly journals Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 498-504
Author(s):  
Henrique Soares Silva ◽  
Fernanda Kelly Fraga Oliveira ◽  
Lourivania Oliveira Melo Prado ◽  
Marcos Almeida-Santos ◽  
Francisco Prado Reis
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Emergency Room ◽  
Clinical Diagnosis ◽  
Obstructive Uropathy ◽  
Hospital Costs ◽  
Diagnostic Errors ◽  
Urgent Care ◽  
Cross Sectional ◽  
Abdominal Computed Tomography

ABSTRACT The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

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