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Biomedical subjects

Ronit Nesher

Publications and source records attributed to Ronit Nesher.

7 recordsLinked to original sources

Headaches as the main presenting symptom of subacute angle closure glaucoma.

The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocular, or periocular pain. However, some patients may present with headaches in the absence of significant ocular discomfort, which often leads to misdiagnosis and delay in specific therapy. The clinical features of 9 such patients are described. Subacute angle closure glaucoma should always be considered in the differential diagnosis of adult-onset headaches.

Adult↗

Frequency doubling technology threshold testing in the pediatric age group.

PURPOSE: To evaluate the feasibility of performing visual field with the Frequency Doubling Technology (FDT) in children aged 5 to 10 years. PATIENTS AND METHODS: Forty healthy children and fifteen healthy adults, all with no previous experience with visual field testing, underwent visual field testing with the C20 threshold test of the Carl Zeiss Meditec FDT analyzer in both eyes. The subjects were divided into three groups. Group A (age 5-7), group B (age 8-10), and group C (adults). RESULTS: The mean explanation time for the test was 83 +/- 43 seconds for group A, 68 +/- 31 seconds for group B, and 37 +/- 15 seconds for group C (P < 0.001 for the difference between group C and groups A and B). Test performance time for the right eye was 347 +/- 57 seconds, 301 +/- 21 seconds, and 298 +/- 35 seconds for groups A to C, respectively (P < 0.001 for the difference between group A and groups B and C). Forty percent of the children, but none of the adults required two demonstrations prior to initiation of the test. In children fixation losses for the right and left eye were 10% and 37% respectively. No fixation losses occurred in adults. In both eyes a mean deviation <0.5% occurred significantly more often in group A than in group C (P = 0.013). CONCLUSION: Visual field testing with FDT in the young age group is feasible. Test reliability was similar between children aged 5 to 7 and 8 to 10. Pre-selection of children is suggested to achieve reliable results.

Adult↗

Risk factors for cranial ischemic complications in giant cell arteritis.

Cranial ischemic complications (CICs) are among the presenting manifestations of giant cell arteritis (GCA). Yet patients with GCA may develop CICs at a later stage, despite steroid therapy. In the current report we delineate risk factors for CICs, both at presentation and during follow-up, and review the relevant literature. We reviewed charts of 175 patients with GCA. Follow-up data were available for 166 patients. CICs at presentation or developing within 2 weeks of GCA diagnosis were considered GCA related. CICs developing later were considered GCA related only when associated with other GCA-related manifestations or acute-phase reactions. Associations between CICs and other variables were tested by multivariate analysis. At presentation, 43 patients (24.6%) had CICs. Risk factors were transient cerebro-ophthalmic ischemic episodes (COIEs) (odds ratio [OR] 4.3) and male sex (OR 2.5), while the presence of systemic symptoms was "protective" (OR 0.3). During follow-up 8.4% of patients with GCA developed new CICs. Risk factors in these cases were previous CICs at presentation (OR 5.6) and transient COIEs developing during follow-up (OR 14.8). The use of low-dose aspirin was protective (OR 0.2). These data, together with data from the literature review, suggest that GCA patients with transient COIEs and without fever or other systemic symptoms are at increased risk of presenting with CICs. Risk factors for late-developing CICs were CICs at presentation and late-developing transient COIEs.

Aged↗

Switching from systemic to the topical carbonic anhydrase inhibitor dorzolamide: effect on the quality of life of glaucoma patients with drug-related side effects.

BACKGROUND: The frequent systemic side effects associated with the use of systemic carbonic anhydrase inhibitors have adversely affected the compliance to treatment in glaucoma patients, obviating their long-term use. The introduction of the topical CAI dorzolamide has further reduced their use. However, the tolerability of dorzolamide in patients who have been intolerant to systemic CAIs has not been evaluated prospectively. OBJECTIVES: To study the tolerability and efficacy of dorzolamide (a topical CAI) in a selected group of glaucoma and ocular hypertensive patients who have been intolerant to systemic CAI. METHODS: A 3 month prospective study was conducted in 39 patients. Following recruitment, patients were evaluated on the day of switching from systemic CAI to dorzolamide and for five more visits. The SF-36 health assessment questionnaire was used to evaluate changes in well-being and quality of life, and the intraocular pressure was measured periodically. RESULTS: Within 4 weeks of switching from systemic CAI to dorzolamide, the mean health assessment scores improved significantly in seven of the eight categories of the SF-36, and remained generally unchanged for the rest of the study. No significant differences were noted between the mean IOP on day 0 and the following measurements throughout the 84 days of dorzolamide therapy. CONCLUSION: In glaucoma patients who were intolerant to systemic CAI, topical CAI dorzolamide offers a similar efficacy and better tolerability.

Aged↗

[Bilateral acute angle closure glaucoma following topiramate treatment].

We describe a case of bilateral acute angle closure glaucoma associated with oral topiramate therapy. A 64 year old woman developed bilateral acute angle closure glaucoma two weeks after beginning topiramate therapy for peripheral diabetic neuropathy. A topical and systemic anti-glaucomatous treatment were given and laser peripheral iridotomies were performed and, the intraocular pressure were stabilized. However, the anterior chambers remained very shallow and peripheral ciliochoroidal detachment was observed and confirmed echographically. Assuming that the mechanism of acute bilateral simultaneous angle closure glaucoma differs from the common pupillary block, and is related to external cause, the topiramate therapy was discontinued, and the patient was treated with cycloplegic agent and steroids. A gradual deepening of the anterior chamber and resolution of the choroidal edema were accompanied by improvement of visual acuity and corneal clarity. The presumed mechanism of drug related acute bilateral angle closure glaucoma is choroidal effusion and detachment associated with forward budging of the iris-lens diaphragm. This, in turn, causes a shallow anterior chamber and blockage of the ocular draining system.

Cornea↗

Digitizing stereoscopic optic nerve head photographs for storage and viewing using a personal computer.

Careful examination and monitoring of optic nerve head changes is essential in the treatment of patients with glaucoma. This often results in accumulation of numerous photographs and required appropriate storage space. A simple, inexpensive, and efficient means of storing and viewing stereoscopic optic nerve head photographs is described. Images were acquired with a fundus camera, on a color slide film. Slides were then scanned and digitized. A handheld stereoscope was used for stereoscopic viewing on a computer monitor. A scanning resolution of 300 dpi appeared optimal. At this resolution, the storage utilization was 16 kilobytes and the scanning time was 160 seconds per patient.

Computer Storage Devices↗