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Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science


Since this protection can only be effective if they can be identified and (a) vessels described in Articles 22 herbolax 100caps free shipping zee herbals, 24 best buy herbolax herbals for erectile dysfunction, 25 and recognized as medical ships or craft generic 100 caps herbolax otc herbs de provence substitute, such 27 of the Second Convention, vessels should be marked with the distinctive emblem and as far as possible comply with the second paragraph of Article 43 of the Second (b) their lifeboats and small craft, Convention. The ships and craft referred to in paragraph 1 shall remain subject to the laws of war. Any (d) the wounded; sick and shipwrecked on warship on the surface able immediately to board, enforce its command may order them to stop, order them off, or make them take a certain shall also apply where these vessels carry course, and they shall obey every such civilian wounded, sick and shipwrecked who command. Such ships and craft may not in any do not belong to any of the categories other way be diverted from their medical mentioned in Article 13 of the Second mission so long as they are needed for the Convention. The protection provided in paragraph 1 shall notify the adverse Party, as provided in Article cease only under the conditions set out in 29, in particular when such aircraft are making Articles 34 and 35 of the Second Convention. Convention shall apply to medical and religious personnel in such ships and craft. The provisions of the Second Convention are in contact with each other, especially where shall apply to the wounded, sick and they are exposed to direct fire from the ground. Medical aircraft in areas controlled Convention and in Article 44 of this Protocol by an adverse Party who may be on board such medical ships and craft. Wounded, sick and shipwrecked civilians who do not belong to any or the categories 1. The medical aircraft of a Party to the conflict mentioned in Article 13 of the Second shall continue to be protected while flying over Convention shall not be subject, at sea, either land or sea areas physically controlled by an to surrender to any Party which is not their adverse Party, provided that prior agreement to own, or to removal from such ships or craft; if such flights has been obtained from the they find themselves in the power of a Party to competent authority of that adverse Party. Protection of medical Aircraft agreement provided for in paragraph 1, either through navigational error or because of an emergency affecting the safety of the flight, Medical aircraft shall be respected and shall make every effort to identify itself and to protected, subject to the provisions of this Part. Medical aircraft in areas not recognized by the adverse Party, that Party controlled by an adverse Party shall make all reasonable efforts to give the order to land or to alight on water, referred to In and over land areas physically controlled by in Article 30, paragraph 1, or to take other friendly forces, or in and over sea areas not measures to safeguard its own interests, and, in physically controlled by an adverse Party, the either case, to allow the aircraft time for respect and protection of medical aircraft of a compliance, before resorting to an attack Party to the conflict is not dependent on any against the aircraft. For greater safety, however, a Party to the conflict operating its medical aircraft in these areas may 340 Art 28. Restrictions on operations of medical (b) that the request is denied; or aircraft (c) of reasonable alternative proposals to the 1. It may also propose prohibition or from using their medical aircraft to attempt to restriction of other flights in the area during the acquire any military advantage over an adverse time involved. The presence of medical aircraft shall request accepts the alternative proposals, it not be used in an attempt to render military shall notify the other Party of such acceptance. Medical aircraft shall not be used to collect to ensure that notifications and agreements can or transmit intelligence data and shall not carry be made rapidly. The Parties shall also take the necessary or cargo not included within the definition in measures to disseminate rapidly the substance Article 8 (6). The carrying on board of the of any such notifications and agreements to the personal effects of the occupants or of military units concerned and shall instruct equipment intended solely to facilitate those units regarding the means of navigation, communication or identification identification that will be used by the medical shall not be considered as prohibited, aircraft in question. Landing and inspection of medical armament except small arms and ammunition aircraft taken from the wounded, sick and shipwrecked on board and not yet handed to the proper service, and such light individual weapons as 1. Medical aircraft flying over areas which are may be necessary to enable the medical physically controlled by an adverse Party, or personnel on board to defend themselves and over areas the physical control of which is not the wounded, sick and shipwrecked in their clearly established, may be ordered to land or charge. Articles 26 and 27, medical aircraft shall not, except by prior agreement with the adverse Party, be used to search for the wounded, sick 2. Any such inspection shall be concerning medical aircraft commenced without delay and shall be conducted expeditiously. Notifications under Article 25, or requests shall not require the wounded and sick to be for prior agreement under Articles 26, 27, 28, removed from the aircraft unless their removal paragraph 4, or 31 shall state the proposed is essential for the inspection. That Party shall number of medical aircraft, their flight plans in any event ensure that the condition of the and means of identification, and shall be wounded and sick is not adversely affected by understood to mean that every flight will be the inspection or by the removal. A Party which receives a notification given under Article 25 shall at once acknowledge (a) is a medical aircraft within the meaning of receipt of such notification. A Party which Article 8, sub-paragraph j), receives a request for prior agreement under Articles 25, 27, 28, paragraph 4, or 31 shall, as rapidly as possible, notify the requesting Party: (b) is not in violation of the conditions prescribed in Article 28, and (a) that the request is agreed to; 341 (c) has not flown without or in breach of a prior 3. If a medical aircraft, either by agreement or agreement where such agreement is required, in the circumstances mentioned in paragraph 2, lands or alights on water in the territory of a the aircraft and those of its occupants who neutral or other State not Party to the conflict, belong to the adverse Party or to a neutral or whether ordered to do so or for other reasons, other State not a Party to the conflict shall be the aircraft shall be subject to inspection for the authorized to continue the flight without delay. The inspecting Party shall not require the wounded and sick of the (a) is not a medical aircraft within the meaning Party operating the aircraft to be removed from of Article 8, sub-paragraph j), it unless their removal is essential for the inspection. The inspecting Party shall in any event ensure that the condition of the wounded (b) is in violation or the conditions prescribed and sick is not adversely affected by the in Article 28, or inspection or the removal. If the inspection discloses that the aircraft is in fact a medical (c) has flown without or in breach of a prior aircraft, the aircraft with its occupants, other agreement where such agreement is required, than those who must be detained in accordance with the rules of international law applicable in the aircraft may be seized. Its occupants shall armed conflict, shall be allowed to resume its be treated in conformity with the relevant flight, and reasonable facilities shall be given provisions of the Conventions and of this for the continuation of the flight. Any aircraft seized which had been inspection discloses that the aircraft is not a assigned as a permanent medical aircraft may medical aircraft, it shall be seized and the be used thereafter only as a medical aircraft. The wounded, sick and shipwrecked disembarked, otherwise than temporarily, from a medical aircraft with the consent of the local 1. Except by prior agreement, medical aircraft authorities in the territory of a neutral or other shall not fly over or land in the territory of a State not a Party to the conflict shall, unless neutral or other State not a Party to the conflict. The cost of hospital treatment and internment shall be borne by the State to which 2. Neutral or other States not Parties to the or other State not a Party to the conflict, either conflict shall apply any conditions and through navigational error or because of an restrictions on the passage of medical aircraft emergency affecting the safety of the flight, it over, or on the landing of medical aircraft in, shall make every effort to give notice of the their territory equally to all Parties to the flight and to identify itself. In the implementation of this Section, the activities of the High Contracting Parties, of 342 the Parties to the conflict and of the for such teams to be accompanied by personnel international humanitarian organizations of the adverse Party while carrying out these mentioned in the Conventions and in this missions in areas controlled by the adverse Protocol shall be prompted mainly by the right Party.

Good practice points [] Recommended best practice based on the clinical experience of the guideline development group buy discount herbolax line herbs used for anxiety. Withdrawal of the drugs in these circumstances may lead to purchase herbolax 100 caps visa herbs de provence walmart dangerous thromboembolic events order herbolax mastercard herbs for depression. In particular, a recommendation for sub-Tenon‘s block over needle block cannot be supported by weight of evidence at this time [B]. If appropriate, topical-intracameral local anaesthetic or topical alone is a safer alternative than needle or subtenon‘s block by cannula with regards to haemorrhagic complications related to anaesthetic technique. For operations on patients unsuitable for topical or topical-intracameral anaesthesia, the risk/benefit of a needle or cannula technique vs. Serious complications of local anaesthesia for cataract surgery: a one year national survey in the United Kingdom. Haemorrhage and risk factors associated with retrobulbar/peribulbar block : a prospective study in 1383 patients. The Cataract National Dataset Electronic Multi-centre Audit of 55 567 operations: anaesthetic techniques and complications. The Cataract National Dataset Electronic Multi-centre Audit of 55 567 operations: antiplatelet and anticoagulant medications. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Perioperative bleeding and thromboembolic risk during non-cardiac surgery in patients with mechanical prosthetic valves: An institutional review. Central retinal artery closure during orbital haemorrhage from retrobulbar injection. Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation. Appendix Anticoagulation and vitreoretinal, glaucoma and oculoplastic surgery In recent years there has been an expansion of rather complex and invasive vitreoretinal glaucoma and oculoplastic surgery being done under local anaesthesia. Unfortunately, there is a paucity of firm evidence in the literature looking at the issues of anticoagulation and local anaesthesia for these types of procedures. There is however a risk that the guidelines for routine ambulatory cataract surgery‘ may be applied to what is much more intricate work. What follows is a review of the literature for overall care of patients on anticoagulant and antiplatelet therapy (rather than just local anaesthesia) for these procedures. A Vitreoretinal surgery Although anticoagulant therapy may safely be continued for patients scheduled for vitreoretinal surgery, the literature does report complications. Subretinal haemorrhage is one such complication associated with external drainage during scleral buckling procedures. This patient had an intraoperative subretinal haemorrhage associated with scleral buckling and the drainage procedure. One patient who underwent a major procedure for a complicated retinal detachment had an intraoperative subretinal haemorrhage requiring retinectomy. Two of the seven suffered hemorrhagic complications, including one postoperative hemorrhagic choroidal detachment and one recurrent vitreous haemorrhage. The authors concluded that warfarin anticoagulation was associated with an increased risk of haemorrhagic complications. Degree of anticoagulation this may have a bearing on the overall outcome of the procedure. A retrospective 5 study of 1737 patients undergoing pars plana vitrectomy identified 54 patients on warfarin who underwent 57 vitreoretinal surgical procedures. Herbert et al have reported four cases of intraocular haemorrhage associated with these combinations. Massive subretinal bleed in a patient with background diabetic retinopathy and on treatment with warfarin. The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery. Maintenance of warfarin anticoagulation for patients undergoing vireoretinal surgery. Haemorrhagic vitreoretinal complications associated with combined antiplatelet agents. B Glaucoma surgery Chronic anticoagulant and antiplatelet therapy are associated with a statistically significant increase in the rate of hemorrhagic complications in patients undergoing glaucoma surgery. Perioperative anticoagulation and a high preoperative intraocular pressure are potential risk factors for hemorrhagic complications in these patients. The haemorrhagic complications were higher in this group than 347 control patients (10. Currently there is no definitive evidence or guideline available for management of patients on anticoagulant or antiplatelet therapy undergoing glaucoma surgery. In a 2 questionnaire survey of glaucoma surgeons in England, diversity was observed with regard to continuation of anticoagulation therapy. The majority of surgeons do not stop warfarin or aspirin prior to glaucoma surgery. Hemorrhagic Complications from Glaucoma Surgery in Patients on Anticoagulation Therapy or Antiplatelet Therapy. C Oculoplastic Surgery Serious haemorrhagic complications have been reported with oculoplastic procedures. In a prospective study in patients undergoing 1 oculoplastic surgery intraoperative bleeding prolonging surgery was reported in 9.

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The overuse of antibiotics and the underuse of diagnostics occur within the entire breadth of healthcare: primary care buy 100caps herbolax amex bajaj herbals, as well as hospitals with acute care herbolax 100caps cheap yucatan herbals, rehabilitation facilities and long-term care facilities purchase 100caps herbolax visa herbals aps pvt ltd, where most of the emerging antibiotic-resistant pathogens can be found. It is also well-described that the largest volume of antibiotics for human use is prescribed in the community setting. Better diagnostic capabilities and more aggressive antimicrobial stewardship are amongst the top five unmet medical needs in strategies to combat antibiotic-resistant infections. One of the most convincing means of demonstrating the value of diagnostics is to conduct prospective clinical trials and data collection which evaluate their impact in real-life patient-care settings. Due to the need for large numbers of patients in such analyses, a network of well-defined patient-care settings is necessary to carry out the type and extent of studies needed to demonstrate the value of diagnostics. The goal for setting up a network of clinical sites is to assess the impact of ‘standardised care and management algorithms’ using well defined diagnostics in a proscribed manner in a well-defined and common infectious syndrome, compared to ‘usual care’. Possible outcomes which could be measured include, among others: i) doses or days of antibiotics prescribed, ii) proportion of patients not receiving antibiotics, iii) development of antibiotic resistant colonisation post antibiotic therapy, iv) selection of pathogens with a resistant phenotype during or post therapy, v) emergence of antibiotic resistance among ‘normal’ intestinal flora during or after therapy. There is currently a dearth of studies which can provide the evidence of the value of diagnostics in well characterised situations, and the lack of such evidence has been a hindrance for diagnostic innovation. The current in vitro diagnostic business model focused on technology used, lab activity measures, and complexity indicators – is antiquated, and should change to focus on patient outcomes and health-economic 171 benefits to incentivise the creation and utilisation of high-medical-value diagnostics. Moreover, regulatory approval has historically been based on analytical performance, rather than on clinical effectiveness. Inserting patient-based benefits into the regulatory process would advantage diagnostics which confer the most benefit to individuals and the healthcare system. More background information is available in the following list of publications: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][ 33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. Need and opportunity for public-private collaborative research the urgent action to address the escalating problem of antibiotic resistance requires cooperation amongst industry, academia, patients and patient groups, policymakers, public health experts and healthcare decision makers in order to implement critical solutions, including impactful diagnostics, which will allow preserving the efficacy of the antibiotics currently available or in development. Multiple diagnostics already exist which can be used to accurately and efficiently guide and improve antibiotic prescribing, but they are under-utilised across Europe. A public-private project is required to address the barriers which prevent the uptake and development of diagnostics for antimicrobial stewardship, which include studies, policy development, funding and reimbursement formulae and schemes, physician education and patient awareness, psychosocial factors, appropriate and innovative assessment. The overuse of antibiotics and the underuse of diagnostics occur within the entire breadth of healthcare. It is crucial to demonstrate both the economic and clinical value of diagnostics to health systems and purchasers. Health economic models for the use of diagnostics must be developed to: address the costs and benefits of the use of diagnostics and their impact on antibiotic prescribing; propose funding models. Four objectives need to be addressed in this project: Objective 1 172 the first objective is to establish a health-economic framework to assess and demonstrate the impact for individual patients and public health in general of increasing the use of diagnostics to reduce or optimise antibiotic prescription and ultimately combat the development of antibiotic resistance. The framework should build on existing evidence from extensive research work and literature in the field as well as experiential knowledge and expertise from key stakeholders in, for example, traditional and innovative value-based evaluation methods, reimbursement schemes, research incentives, evaluation models, policies etc. Results should be disseminated in an adapted way to all stakeholders, including policymakers, clinicians and patients. Objective 2 the second objective is to establish a Standardised Care Network (pre-existing or new) in order to conduct clinical trials evaluating the value of diagnostics. This network should include high-, medium and low antibiotic-use countries in Europe with an antibiotic stewardship programme in place. In addition, within this network, a bank of appropriate clinical specimens – properly annotated and curated – must be kept for the duration of the project and a model proposed to sustain the biobank a posteriori in cooperation with the diagnostics industry. The study must use combinations of ‘host-based’ and ‘pathogen-based’ diagnostic tests in order to determine the optimal testing algorithm for reducing inappropriate antibiotic use and the subsequent development of antibiotic resistant bacteria (colonisation and/or infection). Objective 4 the fourth objective is to explore, define and attempt to resolve the many aspects which prevent the more widespread adoption of diagnostics when delivering healthcare to the population. Focus will be necessary on patient and healthcare provider education, psychological, ethical, organisational and social barriers in order to understand and address this complex issue. It requires a precise and shared methodology agreed and defined with main stakeholders to: 1. It should be adapted according to national/regional requirements and maintained based on a sustainable business model beyond the proposed funding period. A decrease of antibiotic-prescribing rates should further happen in countries involved in the study. Economic models will illustrate to governments, third-party payers and healthcare providers the economic feasibility and benefits of utilising diagnostics to guide appropriate antibiotic prescribing in various healthcare settings. This evidence should then be published, disseminated, and adopted in order to sensitise the medical, political, regulatory and patient communities to the value of diagnostics in the targeted condition, and promote adoption of the diagnostic tests and testing algorithms into national and international guidelines. Additionally, it is expected that interactions will occur with European (and other) regulatory bodies to assist in the timely approval of diagnostic tests for quick introduction into routine clinical practice. Potential synergies with existing consortia Applicants should take into consideration, while preparing their short proposal, relevant national, European (both research projects as well as research infrastructure initiatives), and non-European initiatives. This evaluation can serve as the evidence base to inform a coordinated international advocacy. The industry consortium will provide financial and/or in-kind contributions that altogether address the following area: pathogen and host-based assays and equipment clinical design and medical affairs expertise point-of-care data connectivity solutions, software and expertise data analytics. The applicant consortium is expected to address all the objectives and make key contributions to the defined deliverables in synergy with the industry consortium which will join the selected applicant consortium in preparation of the full proposal for stage 2. Applicant consortia will be expected to include experts and sites in a ‘community’ setting such as non-hospital clinics, private physician offices, para-medical clinics, etc. The consortium is expected to have a strategy on the translation of the relevant project outputs into policy, regulatory, clinical and healthcare practice. A plan for interactions with decision makers, regulatory agencies/health technology assessment bodies with relevant milestones and allocated resources should be proposed to ensure this.

Rectus Muscles the four rectus muscles originate at a common ring tendon (annulus of Zinn) surrounding the optic nerve at the posterior apex of the orbit (Figure 1–3) discount 100caps herbolax herbals to lower blood pressure. They are named according to order herbolax 100 caps otc herbals weight loss their insertion into the sclera on the medial buy herbolax 100 caps lowest price herbals 2015, lateral, inferior, and superior surfaces of the eye. The principal action of the respective muscles is thus to adduct, abduct, depress, and elevate the globe (see Chapter 12). The muscles are about 40-mm long, becoming tendinous 4–8 mm from the point of insertion, where they are about 10 mm wide. The approximate distances of the points of insertion from the corneal limbus are: medial rectus, 5. With the eye in the primary position, the vertical rectus muscles make an angle of about 23° with the optic axis. Approximate distances of the rectus muscles from the limbus, and the approximate lengths of tendons. Oblique Muscles the two oblique muscles primarily control torsional movement and, to a lesser extent, upward and downward movements of the globe (see Chapter 12). It originates above and medial to the optic foramen and partially overlaps the origin of the levator palpebrae superioris muscle. The superior oblique has a thin, fusiform belly (30-mm long) and passes anteriorly in the form of a tendon (10 mm long) to its trochlea, or pulley. It is then reflected backward and downward as a further length of tendon to attach in a fan shape to the sclera beneath the superior rectus. The trochlea is a cartilaginous structure attached to the frontal bone 3 mm behind the orbital rim. The superior oblique tendon is enclosed in a synovial sheath as it passes through the trochlea. The inferior oblique muscle originates from the nasal side of the orbital wall just behind the inferior orbital rim and lateral to the nasolacrimal duct. It passes outside the inferior rectus and inside the lateral rectus muscle to insert with a short tendon into the posterolateral sclera just over the macular area. In the primary position, the muscle plane of the superior and inferior oblique muscles forms an angle of 51–54° with the optic axis. Near the points of insertion of these muscles, the fascia is continuous with Tenon’s capsule, and fascial condensations to adjacent orbital structures (check ligaments) act as the functional origins of the extraocular muscles (Figures 1–19 and 1–20). Blood Supply the blood supply to the extraocular muscles is derived from the muscular branches of the ophthalmic artery. The lateral rectus and inferior oblique muscles are also supplied by branches from the lacrimal artery and the infraorbital artery, respectively. Blinking helps spread the tear film, which protects the cornea and conjunctiva from dehydration. The lids consist of five layers: skin, striated muscle (orbicularis oculi), areolar tissue, fibrous tissue (tarsal plates), and mucous membrane (palpebral conjunctiva) (Figure 1–22). Skin 43 the skin of the lids differs from skin on most other areas of the body in that it is thin, loose, and elastic and possesses few hair follicles and no subcutaneous fat. Orbicularis Oculi Muscle the function of the orbicularis oculi muscle is to close the lids. Its muscle fibers surround the palpebral fissure in concentric fashion and spread for a short distance around the orbital margin. The portion of the muscle that is in the lids is known as its pretarsal portion; the portion over the orbital septum is the preseptal portion. Areolar Tissue the submuscular loose areolar tissue that lies deep to the orbicularis oculi muscle communicates with the subaponeurotic layer of the scalp. Tarsal Plates the main supporting structure of the lids is a dense fibrous tissue layer that— along with a small amount of elastic tissue—is called the tarsal plate. The lateral and medial angles and extensions of the tarsal plates are attached to the orbital margin by the lateral and medial palpebral ligaments. The upper and lower tarsal plates are also attached by a condensed, thin fascia to the upper and lower orbital margins. Palpebral Conjunctiva the lids are lined posteriorly by a layer of mucous membrane, the palpebral conjunctiva, which adheres firmly to the tarsal plates. A surgical incision through the gray line of the lid margin (see the next section) splits the lid into an anterior lamella (margin) of the skin and the orbicularis muscle and a posterior lamella (margin) of the tarsal plate and the palpebral conjunctiva. It is divided by 44 the gray line (mucocutaneous junction) into anterior and posterior margins. Lashes—The lashes project from the margins of the lids and are arranged irregularly. The upper lashes are longer and more numerous than the lower lashes and turn upward; the lower lashes turn downward. Glands of Zeis—These are small, modified sebaceous glands that open into the hair follicles at the base of the lashes. Glands of Moll—These are modified sweat glands that open in a row near the base of the lashes. Posterior Margin the posterior lid margin is in close contact with the globe, and along this margin are the small orifices of modified sebaceous glands (meibomian, or tarsal, glands). Lacrimal Punctum At the medial end of the posterior margin of each of the upper and lower lids is a small elevation with a central small opening (punctum) through which tears pass to the corresponding canaliculus and thence to the lacrimal sac. Palpebral Fissure the palpebral fissure is the elliptic space between the two open lids.

Anterior scleritis Non-necrotizing : Nodular : Diffuse Necrotizing : with inflame : without inflame (Scleromalacia perforans) 8 @ Corneal dystrophies 1 buy genuine herbolax on line herbals dario bottineau. Ammonia colorless gas Fertilizers () cheap 100 caps herbolax with amex aasha herbals -, Gas + pressure = Liquid ammonia + Ammonium hydroxide 7% household cleaning 2 cheap herbolax 100 caps free shipping herbals in chennai. Calcium hydroxide cornea (epithelial form calcium soaps) Lime (), Plaster } Cement 5. C 2 g/day + Topical 10% 14 : 10%Sodium citrate chelate calcium 3. Interrupted suture 0, 3, 6 ( loose 0, 3, 6 ) 2. Single continuous suture McNeill manipulation flat steeper 2-3 wk. Double continuous suture 10-0 90%depth, 11-0 15-25%depth 10 0 2-3, 11-0 12 @ Cutting flap Keratomileusis 3 1. Anterior uveitis( nongranulomatous granulomatous 3 Sarcoidosis, Tb, Sy) 5 1. Infectious : Endogenous : Exogenous Postoperative, Posttrauma, Bleb-associated. Associated with other ocular & systemic disorder corneal endothelium, iris, lens, trauma, steroid 13 @ Glaucomatous optic morphology 3 1. Late postop 3 : Infection, Cataract, Late bleb failure 13,34 @ Post op filtering surgery Systemic disease 5 : Marfan’s syndrome (lens zonule ), Weill-Marchesani, Homocystinuria, Hyperlysinemia, Sulfite oxidase deficiency 11 @ Indication for cataract surgery 3 1. Medical indications: Phacolytic, Phacomorphic, Phacoantigenic, Dislocated into A/C 3. Inability to tolerate multiple operations 11 @ Cataract 1. Venturi pump Venturi principle vacuum rate gas flow Storz @ Nucleus removal techniques phacoemulsification 1. Clip and Flip technique Fine et al sculpting bowl soft nucleus 2. Divide and Conquer technique Gimbel groove crack hard nucleus 3. Classic chop Nakahara tip + chop instrument nucleus capsulorrhexis 5. Purtscher’s retinopathy trauma(chest compression) complement Leukoembolize 12 2. Purtscher’s like retinopathy Acute pancreatitis (complement-mediated leukoemboli), Collagen-vascular Dz. Abnormal fundus Fundus albipunctatus rhodopsin recovery Fleck retina of Kandori Oguchi disease (Mizuo-Nakamura phenomenon) @ Color dyschromatopsia Abnormal color vision This book has been published in good faith that the material provided by author is original. In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. The Bible the need for a textbook for undergraduate medical students in ophthalmology dealing with the basic concepts and recent advances has been felt for a long-time. Keeping in mind the changed curriculum this book is intended primarily as a first step in commencing and continuing the study for the fundamentals of ophthalmology which like all other branches of medical sciences, has taken giant strides in the recent past. While teaching the subject I have been struck by the avalanche of queries from the ever inquisitive students and my effort therefore has been to let them find the answers to all their interrogatories. In the competitive market of medical text publishing, only successful books survive. Any textbook, more so, a medical one such as this, needs to be updated and revised from time to time. Yet the very task of revising Basic Ophthalmology presents a dilemma: how does one preserve the fundamental simplicity of the work while incorporating crucial but complex material lucubrated from recent research, investigations and inquiries in this ever expanding field. In essence, Basic Ophthalmology is both a ‘textbook’ and a ‘notebook’ that might as well have been written in the student’s own hand. The idea is for the student to relate to the material; and not merely to memorize it mechanically for reproducing it during an examination. It is something I wish was available to me when I was an undergraduate student not too long ago. The past few years have witnessed not only an alarming multiplication of information in the field of ophthalmology, but more significantly, a definite paradigmatic shift in the focus and direction of ophthalmic research and study. The dominant causes of visual disabilities are no longer pathological or even genetic in nature, but instead a direct derivative and manifestation of contemporary changes in predominantly modern urban lifestyles. With posterior chamber intraocular lenses establishing themselves as the primary modality in the optical rehabilitation of patients undergoing cataract surgery, the emphasis has shifted from just visual rehabilitation to an early, perfect optical, occupational and psychological rehabilitation. When I initiated this project I scarcely realized that it only had toil, sweat and hard work to offer. Whenever anyone reminded me that I was working hard, my answer always was; I am trying to create something very enduring. In truth, it is a vivid reflection of my long lasting concern and affection for my students. All books are collaborative efforts and I would like to take this opportunity to thank all the people who have advised and encouraged me in this project: specially my husband Shri Ajit Jogi, my son Aishwarya, Amit and Dr Nidhi Pandey. By the grace of the Almighty God and with the continuing support of the teachers, I am happy to present the fourth updated edition of my book. A thickening appears on either side of the neural tube in its anterior part, known as the optic plate. The two eyes develop from these optic vesicles and the ectoderm and mesoderm coming in contact with the optic vesicles.


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