Purpose Peripapillary retinal nerve fiber layer (pRNFL) thickness is subject to high variability. Normative values of pRNFL thickness remain undocumented in the Middle East. The aim of our study is to assess the normative values of pRNFL thickness in a Middle Eastern population. Methods A retrospective chart review of 74 patients was conducted. Outpatients who had presented to the ophthalmology clinic at the Jordan University Hospital between January 2016 and July 2018 were consecutively sampled. Measurements had been recorded using Fourier-domain optical coherence tomography. Multivariable regression models were developed to generate predicted normative values with adjustments to candidate confounders. Results The mean global pRNFL thickness was 99 ± 11 μm. The mean quadrantic pRNFL thickness increased from the nasal quadrant (75 ± 16 μm) to the temporal (82 ± 20 μm), superior (114 ± 20 μm), and inferior (125 ± 20 μm) quadrants. Gender and eye sidedness did not contribute to the variability in pRNFL thickness. The relationship between aging and pRNFL thinning is independent of diabetes mellitus type 2 and systemic hypertension. Both systemic conditions significantly predicted pRNFL changes despite negative fundoscopic findings. Conclusions Our set of predicted normative data may be used to interpret measurements of pRNFL thickness in Middle Eastern patients. Our findings suggest that systemic conditions with potential ocular manifestations may require consideration in predictive models of pRNFL thickness, even in the absence of gross fundoscopic findings. Normative data from additional Middle Eastern populations are required to appraise our models, which adjust for common clinical confounders.
Bacterial keratitis can lead to severe vision loss and corneal scarring, and possibly perforation. Early and appropriate management is a key factor in decreasing and preventing complication.Pubmed and Medline were searched for articles related to Pseudomonas keratitis between year 2000 and 2017 to get current guidelines about the management of Pseudomonas keratitis. These articles are reviewed in this article and information related to management is summarized.The most used agents to treat Pseudomonas are either aminoglycosides (usually gentamicin) fortified with a cephalosporin or mono therapy with a fluoroquinolones usually ciprofloxacin. In most areas, most strains of Pseudomonas were susceptible to ciprofloxacin. The role of topical steroids is discussed, as well as, available options for treatment of multidrug resistant Pseudomonas species.
This is a case of young patient presented with granulomatous anterior and posterior uveitis, which turned to be fungal endophthalmitis after penetrating keratoplasty. Her symptoms were undetected because she was on systemic and topical steroids. The patient is a 25 years old Caucasian female, previously medically free of any disease, who was admitted to the Eye Clinic at the Jordan University Hospital, Amman, Jordan, for left penetrating keratoplasty and severe keratoconus. After an initial improvement in her vision and a smooth postoperative course, she presented with drop of vision, photophobia, and non-specific eye pain. On examination she was found to have anterior granulomatous uveitis. She was started on systemic steroids and the topical steroids were increased in intensity. The initial systemic workup for granulomatous anterior uveitis was negative. However, culture of the aqueous was positive for Candida galibrata, but the donor rim was negative. Later the patient developed vitritis despite being on systemic fluconazole and topical amphotericin B. She was treated with intravitreal amphotericin B. The vitritis improved, but vitreous opacities developed which deteriorated her vision. A parsplana vitetrectony was done. Her final visual acuity remained poor because of opacified graft. The patient's unfortunate case represents a Candida endophthalmitis after penetrating keratoplasty despite being medically a healthy person.
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