Background In recent years, there was a rise in ocular injuries secondary to cosmetic laser‐assisted hair removal. Purpose To assess the level of adherence to optical safety guidelines during laser‐assisted hair removal performed by nurses or physicians in private practice. Methods A cross‐sectional study was conducted at thirty‐one private laser‐assisted hair removal clinics. An electronic random number generator using a cluster random sampling technique was used to select the clinics. The Alexlazr™ (Candela Corp.) device operator's manual checklist was modified to collect data from laser device operators and patients by surveying the laser rooms, interviewing the patients, and observing the treatments. Results Ninety‐four patients treated by different service providers were included from 31 private centers. All treatment sessions were delivered by trained nurses. Only 9.5% had acceptable adherence to optical safety guidelines during hair removal treatment, while the majority (90.5%) of service providers were poorly adherent. None of the providers achieved excellent adherence to optical safety guidelines. The item with the least adherence was the lack of non‐reflective floors inside laser rooms in 72.3% of centers. All service providers were familiar with the laser system controls and emergency shutdown (100% adherence). Conclusion There is a significant deficiency in the safety precautions at laser‐assisted hair removal centers that can result in devastating ophthalmic injuries. Companies providing laser‐assisted hair removal machines should be involved in aiding these centers to implement safety procedures.
Isotretinoin is one of the most effective drugs for the treatment of all forms of acne vulgaris. It has been suspected of causing alterations in lipids and liver enzymes. The aim of this retrospective study was to determine the prevalence of laboratory changes among 371 patients with acne receiving isotretinoin therapy. Each patient's medical records were evaluated to determine baseline alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol, and triglycerides (TGs) compared to levels recorded at 2 later readings following initiation of treatment with oral isotretinoin. Results indicated that isotretinoin can be administered with minimal concern regarding changes in serum transaminase and lipid profiles. Nevertheless, physicians should be cautious when administering isotretinoin in patients with a history of abnormal findings.
In this paper, we measured the impact of a full COVID-19 lockdown on ophthalmic patients after a period of lockdown in Saudi Arabia, from March to September 2020. A cross-sectional analytical study was carried out on 180 patients who had their appointments delayed or canceled due to the lockdown. Data was collected from electronic medical records and patients via voice calls using a validated questionnaire that were analyzed using a multivariable binary regression analysis. The results show no statistically significant mean difference in visual acuity when comparing pre- and post-lockdown measurements. The median number of appointment cancellations/delays per patient was two, and the estimated delay for the first canceled appointments was equal to 178.8 days. Of the cohort studied, 15.4% of patients faced delays in necessary surgical and therapeutic interventions; 22.1% of patients sought eye care at other institutions due to the delay, and 15% of those were seen by doctors unspecialized in ophthalmology. The odds of dissatisfaction with care were higher in patients who experienced cancellations in a surgical procedure and patients who experienced difficulty in obtaining medications. In conclusion, the pandemic hampered ophthalmic patients’ access to medications. Subjective visual outcomes of patients were also negatively affected; however, the change in objective visual parameters was not statistically significant.
We report a case of atypical posterior scleritis mimicking amelanotic choroidal melanoma. A 30-year-old healthy Filipino man, with a history of painless subacute loss of vision in his left eye over 5 months, was referred to our institute for further workup and management. On examination, visual acuity of the left eye was 20/200. Anterior segment examination yielded unremarkable results, with injected conjunctiva and quiet episcleral blood vessels, while fundus examination revealed non-pigmented nasal choroidal mass, with significant subretinal fluid resembling amelanotic choroidal melanoma. Right eye examination yielded unremarkable results. The patient was diagnosed with atypical posterior scleritis, and treated with oral steroids for 2 weeks, with no improvement. A periocular steroid was then injected to the left eye, causing dramatic reduction in choroidal mass size, and complete resolution of subretinal fluid. The visual acuity improved to 20/28.5 one month after the injection. Timely treatment was crucial for minimizing vision-threatening complications.
Introduction and importance Primary mucinous adenocarcinoma (PMA) of the skin is a rare condition that is usually seen in elderly patients, most commonly involves the periorbital region as a slow growing mass. Histopathological and immunohistochemical (IHC) stains are of paramount importance for the diagnosis of these lesions, which are usually misdiagnosed either as benign or metastatic mucinous adenocarcinomas. Case presentation We herein report a rare presentation of PMA in a 70-year-old male patient who presented with an upper eyelid residual lesion after being incompletely excised elsewhere as an epidermal cyst and was successfully managed by complete surgical excision with frozen section control of the margins and no evidence of recurrence. Discussion PMA is a rare sweat gland malignancy that involves the eyelid in 41.9% in the head and neck area and is a disease of the elderly with median age of 60 years and variable reported racial and gender predilection. Diagnosis of PMA is challenging both clinically and histopathologically, which was the case in our patient's initial incomplete excision with the presumed diagnosis of a benign epidermal cyst. Proper final tissue diagnosis and surgical management in our patient ensured his favorable outcome. Conclusion Accurate diagnosis of PMA requires a high index of clinical suspicion and accurate histopathological diagnosis aided by proper IHC markers.
Retinoblastoma (RB) is the most common intraocular tumor in children. It arises from the nuclear layer of the retina, with different growth patterns: endophytic, exophytic, and mixed. Retinoblastoma also has characteristic histopathological appearance with areas of viable tumor, necrosis, and calcifications. The tumor differentiation can be determined by the presence of rosettes-Flexner-Wintersteiner rosettes as well as fleurettes-and tends to become less differentiated with age. Histopathological risk factors are used as prognostic indicators and will be discussed in this chapter together with the typical tissue diagnostic features. These will include optic nerve/choroidal invasion, extraocular extension, and anterior segment involvement. Other prognostic factors with less impact will be discussed as well including the amount of necrosis, mitotic figures, and grading of anaplasia. Furthermore, we will briefly discuss different regression patterns and posttreatment findings in enucleated globes.
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