Survey of ophthalmology
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Survey of ophthalmology · May 2014
ReviewUrrets-Zavalia syndrome (fixed and dilated pupil following penetrating keratoplasty for keratoconus) and its variants.
Urrets-Zavalia Syndrome (UZS) was described 50 years ago as the appearance of a fixed and dilated pupil following penetrating keratoplasty for keratoconus in patients receiving atropine. The mechanism of UZS has still not been fully determined, but an acute increase in intraocular pressure and ischemia of the iris most probably play a major role. ⋯ Some have questioned the existence of this syndrome, as well as the linkage to keratoconus and use of mydriatics. We review the pathophysiology, etiology, and clinical presentation of fixed and dilated pupils following ophthalmic procedures.
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Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. ⋯ We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.
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The ACGME is moving towards the next generation of accreditation in the USA called the Next Accreditation System (NAS). The NAS is anticipated to reduce the burden on programs to comply with accreditation requirements; to produce meaningful, innovative, and continuous benchmark outcomes data; to use ongoing individual and programmatic milestones to judge performance; and ultimately to produce better trained residents, to improve the quality of care, to reduce health care costs and health care disparities, and to provide objective evidence to the public and other external stakeholders of the quality of graduate medical education across the specialties of medicine. We describe the ACGME milestone development process for ophthalmology. If successful, the NAS will benefit all programs by reducing the programmatic burden and paperwork; increasing accreditation cycle length; and improving all programs through formative and summative feedback.