Isotretinoin is a retinoid and derivative of vitamin A used to treat severe recalcitrant acne vulgaris. By affecting the cell cycle, cell differentiation, survival, and apoptosis it reduces sebum production, prevents the blockage of pores, and growth of acne-causing bacteria. Additionally, isotretinoin may interact with FoxO1, which may explain a substantial number of isotretinoin's unexplained actions.
The Duke Elder Examination is an annual prize examination run by the Royal College of Ophthalmologists, targeted to undergraduate medical students with a special interest in Ophthalmology. It is a prestigious award, one of only two Ophthalmology awards which can only be achieved as an undergraduate: The Duke Elder exam, and The Patrick Trever-Roper Undergraduate Travel Award. It is a great opportunity for medical students to add valuable points to their portfolio, while simultaneously expanding their knowledge in an area not well covered in most undergraduate curriculums.
Idiopathic Intracranial Hypertension is a neurological disorder caused by raised cerebrospinal fluid (CSF) pressure without any known intracranial abnormalities or secondary causes of intracranial hypertension. In this review, we consider the pathophysiology/aetiology, risk factors, how it presents and the general management of the condition.
The femtolaser has emerged as a novel method to conduct anterior segment surgery in ophthalmology, including deep anterior lamellar keratoplasty (DALK) surgery. There are certain advantages the femtolaser may have, as compared to manual/conventional methods for DALK corneal transplant surgery. This literature review aims to identify both observational and interventional studies within femto-DALK literature, and as such, discuss indications, surgical techniques, outcomes and scope for further research in the area. Studies were identified via thorough online database text word searching.
Although most medical students are taught the ‘SBAR’ framework and similar tools for making referrals, referring to specialists like ophthalmologists can be still daunting. Part of it is because of how little non-specialists know about ophthalmology, the lack of equipment to examine the eyes, and fear of being laughed at for a lack of a differential diagnosis! However, we spoke to an ophthalmologist and got some tips that will help any A&E, GP or ward doctor make a better referral to ophthalmology.
Posterior uveitis is an uncommon cause of severe visual loss in the paediatric population, usually secondary to macular scarring or secondary glaucoma (1-3). Infectious aetiologies, such as toxoplasma and toxocara, are the most common and are usually associated with classical fundal examination findings (1, 3). Non-infectious causes are less common and can be a diagnostic challenge. We report an atypical presentation of an uncommon disease, particularly so in a paediatric population, with the potential for severe visual impairment if not diagnosed early and managed aggressively.
This review aims to elucidate the key mechanisms behind the formation of corneal scars, and to give some consideration to the strength of the evidence behind those mechanisms identified. The review will firstly discuss the process of normal wound healing within the cornea that may precede scarring, and then examine three key factors within this process that have been suggested to contribute to corneal scarring: keratocytes and their activation by growth factors, collagen fibril organisation, and the role of neutrophils. Examination of the literature suggests that keratocyte activation by growth factors to their repair phenotype was found to be the most important factor in the formation of scars, while the disorganised deposition of collagen is a more contentious factor, and neutrophils have only relatively recently been thought to play a role and consequently little supporting evidence currently exists. This knowledge has allowed the development of targeted treatments, and perhaps further progress will be made in the future as our understanding of corneal scarring mechanisms improves.
I was never that person who came into medical school knowing exactly what sort of specialist I wanted to be. I began this journey knowing that the feeling I got in knowing exactly what to do during someone’s time of illness, was something I could chase all my life. On first entering medical university, I was overwhelmed by the sheer number of specialties to which one could dedicate their entire life. This concern of mine had to take a backseat though, as the demands of basic sciences studies took over my entire time soon thereafter. At my university, the first 2 years were dedicated to covering Basic Medical Sciences like Anatomy, Physiology, and Pharmacology, among others. Even though these 2 years did give me a good idea about what sort of basic sciences are involved in specialties like Cardiology, Neurology, or Pulmonology, I did not find myself gravitating towards any specialty.
Glaucoma-filtering procedures (e.g., trabeculectomy) is a standard surgical procedure commonly done when maximally tolerated medical therapy or laser trabeculoplasty fails to adequately control intraocular pressure (IOP). The filtering procedure creates a fistula between the anterior chamber and the subconjunctival space, covered with thin sclera and conjunctiva that allows excess aqueous humour to be absorbed into the systemic circulation. Thus, the presence of a filtering bleb poses an enduring risk of a bleb related infection (BRI) over the patient’s lifetime (1). To improve the success of these procedures, it has now become routine to use intraoperative antifibrotic agents (e.g., mitomycin and fluorouracil) as an adjunct to standard trabeculectomy (2). Although these agents have improved the chances of long-term IOP control they have further predisposed to an increased incidence of postoperative complications including late-onset filtering bleb-related infections (1).
Having fortunately passed the FRCOphth part 1 in my first attempt, the aim herein is to detail exactly how I used one of the main foundational texts- ‘Clinical Optics’ by Elkington and Frank. Out of 174 multiple choice questions in the April 2022 FRCOphth Part 1 exam, 47 questions were dedicated to Optics; comprising the most number of questions of any topic. Optics generally has formed the majority of questions in previous sittings too, although since its conversion to a pure MCQ exam, there appears to be increasing emphasis in this area.