Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the elderly population. AMD is characterized in its late form by neovascularization (wet type) or geographic atrophy of the retinal pigment epithelium cell layer (dry type). Regarding the latter type, there is growing evidence supporting an association between the pathophysiology of dry AMD and key proteins in the complement cascade. The complement cascade works as a central part of the innate immune system by defending against foreign pathogens and modified self-tissues. Through three distinct pathways, a series of plasma and membrane-associated serum proteins are activated upon identification of a foreign entity. Several of these proteins have been implicated in the development and progression of dry AMD. Potential therapeutic targets include C1q, C3, C5, complement factors (B, D, H, I), membrane attack complex, and properdin. In this review, we provide an understanding of the role of the complement system in dry AMD and discuss the emerging therapies in early phase clinical trials. The tentative hope is that these drugs may offer the potential to intervene at earlier stages in dry AMD pathogenesis, thereby preventing progression to late disease.
Orbital emphysema refers to the infiltration of air or gas within the orbital soft tissue space. It is most commonly associated with a history of trauma or orbital wall fracture. [1][2][3] However, other mechanisms have been reported including infection, pulmonary barotrauma, and iatrogenic factors such as dental surgery. 4 Signs and symptoms include proptosis, crepitus, and diplopia presenting acutely or over the course of days to weeks. 5,6 Although orbital emphysema typically follows a benign course and is self-limiting, in severe cases, it can cause vision loss and require immediate intervention to prevent complications associated with orbital compartment syndrome. 2,7 Herein, we present a case report of bilateral orbital emphysema in a single individual after chest tube placement for spontaneous pneumothorax. This case illustrates the potential for dramatic complications of such a procedure
With the increasing prevalence of diabetic retinopathy (DR), screening is of the utmost importance to prevent vision loss for patients and reduce financial costs for the healthcare system. Unfortunately, it appears that the capacity of optometrists and ophthalmologists to adequately perform in-person screenings of DR will be insufficient within the coming years. Telemedicine offers the opportunity to expand access to screening while reducing the economic and temporal burden associated with current in-person protocols. The present literature review summarizes the latest developments in telemedicine for DR screening, considerations for stakeholders, barriers to implementation, and future directions in this area. As the role of telemedicine in DR screening continues to expand, further work will be necessary to continually optimize practices and improve long-term patient outcomes.
Millikans recorded an "Affidavit In Support Of Vesting Interest in Abandoned Railroad Right Of Way" which was stamped by the Hamilton County Recorder's Officer as "duly entered for taxation." 11 Though Noblesville paid drainage assessments on the Disputed Property which were payable in 2010-2016, there were no special assessments payable for the years 2000-2009, no evidence presented as to assessments prior to 2000, and no property taxes ever assessed on the Disputed Property. 12 The court cited the 1991 recorded affidavit as evidence that "[t]he Millikans believed that [the affidavit] put the taxation authorities on notice that [the Millikans] were taking responsibility for taxation of the Disputed Property." 13 "'[W]here no taxes are assessed none need be paid,'" and adverse claimants are found to have satisfied the statutory requirements. 14 The court concluded that because no taxes or assessments were assessed or due on the Disputed Property for the period of adverse possession, the Millikans had a reasonable and good faith belief that they were paying the taxes for the Disputed Property and therefore substantially complied with the statutory requirement. 15 Title by adverse possession automatically vests "at the conclusion of the ten-year possessory period" and such title "may not be lost, abandoned, or forfeited." 16 Title to the Disputed Property therefore vested with the Millikans upon substantially complying with the taxation requirement and the other elements of adverse possession for at least a ten-year period, and the Millikans were entitled to summary judgment in their favor. 17
Iatrogenic orbital emphysema from chest tube insertion is a rare but potentially serious complication due to potential optic neuropathy from orbital compartment syndrome. Herein, we present a rare case of orbital emphysema in the setting of pneumothorax and chest tube insertion.
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