Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

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Purpose To determine the relationship between central corneal thickness (CCT), ganglionic cell-inner plexiform layer thickness and macular nerve fibre layer (RNFL) thickness as measured by optical coherence tomography in a cohort of healthy subjects. Methods Sixty healthy eyes from 60 subjects were included in this study. All subjects had a standard slit-lamp examination and optical coherence tomography. Central corneal thickness was measured using the Optopol spectral domain optical coherence tomography (SD OCT) machine (version 7.2.0). A linear mixed effects model was used to assess the relationship between central corneal thickness (CCT) and ganglionic cell-inner plexiform layer thickness and macular retinal nerve fibre layer thickness (RNFL). Results Sixty healthy eyes from 60 subjects were included in this study. The average age was 41.8 years (±20.6 years). There were 22 males (37%) and 38 females (63%). The average central corneal thickness was 525.2 ± 35.1 µm (451–601) µm. The average macular retinal nerve fiber layer thickness was 28.9 ± 2.5 µm (23–38µm), and the average ganglionic cell-inner plexiform layer thickness was 88.6 ± 6.3 µm (75–110 µm). We found no statistically significant relationship between central corneal thickness and ganglionic cell-inner plexiform layer thickness (p=0.983) nor with macular RNFL (p =0.285). Conclusion In this cohort of healthy subjects, there was no statistically significant relationship between central corneal thickness and ganglionic cell-inner plexiform layer thickness or with macular retinal nerve fibre layer thickness.

Background: Since the normative value of the retinal macular thickness is undocumented in the Middle East, the aim of this work is to assess the normative values of the macular thickness in healthy eyes in a Middle Eastern population and its relationship with age, sex, and laterality. Methods: One hundred sixteen individuals were randomly selected from volunteers visiting the Jordan University Hospital in Amman, Jordan. Measurements were obtained using the Fourier domain optical coherence tomography (OCT). Multivariate regression models were developed to obtain predicted normative values with adjustment to candidate variables. In addition, the effect of age, sex and laterality were evaluated. Results: The average central fovea macular thickness was 229.5 (±30.85) um. The quadratic value of the retinal macular thickness decreased from the superior value of 299.71 (±23.67) um (P = .001) to the inferior value of 296.46 (±28.85) um(P = .001) and a nasal figure of 93.63 (±26.86) um(P = .001). The temporal area has the thinnest value of 293.43 (±30.78) um (P = 0.001). Central thickness was higher in males with a mean variation of 11.67 um (95% CI, 2.41 to 20.93) (p = 0.003). The thickness was highest within 3 mm diameter from the center and decreased towards the periphery Eye sidedness didn't contribute to variability of the macular thickness. Furthermore, we found a significant difference between age and central macular thickness (p = 0.001), as age was a positive predictor for macular thickness. Conclusion: Our set of predicted normative data may be used to interrupt measurement of the macular thickness in Middle Eastern population. The average fovea macular thickness among Jordanians is consistent with previously reported values. Normative values from additional Middle Eastern. Population are required to appraise our model.

Background: Since the normative value of the retinal macular thickness is undocumented in the Middle East, the aim of this work is to assess the normative values of the macular thickness in healthy eyes in a Middle Eastern population and its relationship with age, sex, and laterality. Methods: 98 individuals were randomly selected from volunteers visiting the Jordan University Hospital in Amman, Jordan. Measurements were obtained using the Fourier domain optical coherence tomography (OCT). Multivariable regression models were developed to obtain predicted normative values with adjustment to candidate variables. In addition, the effect of age, sex and laterality were evaluated. Results: The average central fovea macular thickness was 232.1 (±30.85) um. The quadratic value of the retinal macular thickness decreased from the superior value of 299.71 (±23.67) um to the inferior value of 296.46 (±28.85) um and a nasal figure of 93.63 (±26.86) um. The temporal area has the thinnest value of 293.43 (±30.78) um. Central thickness was higher in males with a mean variation of 11.67 um (95% CI: 2.41 to 20.93) (p= 0.003). The thickness was highest within 3mm diameter from the center and decreased towards the periphery Eye sidedness didn’t contribute to variability of the macular thickness. Conclusion: Our set of predicted normative data may be used to interrupt measurement of the macular thickness in Middle Eastern population. The average fovea macular thickness among Jordanians is consistent with previously reported values. Normative values from additional Middle Eastern populations are required to appraise our module.

Backgrounds: To evaluate changes in the thickness of ganglion cell-inner plexiform layer and macular retinal nerve fiber layer using ocular coherence tomography in patients exposed to hydroxychloroquine . Methods: This was a retrospective, cross-sectional study of patients on hydroxychloroquine therapy. Ocular coherence tomography images showing ganglion cell-inner plexiform cell layer and macular retinal nerve fiber layer thickness were obtained and compared to controls. The relationship between the thickness of ganglion cell-inner plexiform and macular  retinal nerve fiber layer, duration and cumulative dose of hydroxychloroquine were evaluated. Results: In all, 219 subjects were included. The Thickness of the ganglion cell-inner plexiform thickness was significantly less than controls  (p = 0.006). The average  macular RNFL thickness was less in the study compared to the control groups, but not statistically significant (p = 0.389). There was no significant correlation between ganglionic cell-inner plexiform and macular retinal nerve fiber layer with duration, daily dose, or cumulative dose of hydroxychloroquine. Conclusion: Thinning of the ganglionic cell- inner plexiform  layer could be an early indicator of retinal toxicity before the appearance of clinical retinopathy.

Background: Since the normative value of the retinal macular thickness is undocumented in the Middle East, the aim of this work is to assess the normative values of the macular thickness in healthy eyes in a Middle Eastern population and its relationship with age, sex, and laterality. Methods:116 individuals were randomly selected from volunteers visiting the Jordan University Hospital in Amman, Jordan. Measurements were obtained using the Fourier domain optical coherence tomography (OCT). Multivariant regression models were developed to obtain predicted normative values with adjustment to candidate variables. In addition, the effect of age, sex and laterality were evaluated. Results: The average central fovea macular thickness was 229.5 (±30.85) um. The quadratic value of the retinal macular thickness decreased from the superior value of 299.71 (±23.67) um (P=.001)to the inferior value of 296.46 (±28.85) um(P=.001) and a nasal figure of 93.63 (±26.86) um(P=.001). The temporal area has the thinnest value of 293.43 (±30.78) um( P=0.001). Central thickness was higher in males with a mean variation of 11.67 um (95% CI: 2.41 to 20.93) (p= 0.003). The thickness was highest within 3mm diameter from the center and decreased towards the periphery Eye sidedness didn’t contribute to variability of the macular thickness. Furthermore, we found a significant difference between age and central macular thickness (p= 0.001) Conclusion: Our set of predicted normative data may be used to interpret measurement of the macular thickness in Middle Eastern population. The average fovea macular thickness among Jordanians is consistent with previously reported values. Normative values from additional Middle Eastern populations are required to appraise our module.

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.