Nihal Kenawy - Academia.edu (original) (raw)

Papers by Nihal Kenawy

Indian Journal of Ophthalmology, 2008

ABSTRACT We present a two-generation family with Brown syndrome. The proband was a six and a half... more ABSTRACT We present a two-generation family with Brown syndrome. The proband was a six and a half-year-old female who presented with a history of failure of dextro-elevation of her left eye. A full ophthalmic evaluation was consistent with a left Brown syndrome. Family history revealed that her mother was operated on as a child for left Brown syndrome and examination of her four and a half-year-old sibling showed similar affection in the left eye. Autosomal dominant inheritance has been postulated in this condition. To our knowledge this is the first report of three members of a two-generation family with left-sided Brown syndrome. Genetic counseling of Brown syndrome cases is advised; nevertheless, identification of the responsible gene should shed more light on its genetics.

British Journal of Ophthalmology, Apr 1, 2003

Eye, Apr 20, 2012

Purpose To describe the design and implementation of a nurse-led clinic in a tertiary adult ocula... more Purpose To describe the design and implementation of a nurse-led clinic in a tertiary adult ocular oncology service and to assess its feasibility and patient satisfaction. Methods Patients with a melanocytic uveal tumour attending for review during an initial 6-month trial period were assessed in a dedicated ocular oncology clinic by an ophthalmic nurse practitioner. These were: (1) patients who would have been discharged back to the referring hospital but whose ophthalmologist refused to continue their follow-up; (2) patients who preferred to be reviewed in our clinic; and (3) patients with a risk of metastatic disease that was increased but not enough for them to be referred to our medical oncologist. Quality assurance mechanisms were established to ensure safe practice. Patient satisfaction was assessed by means of anonymised questionnaires. Results A total of 65 patients were seen between 1 November 2011 and 31 May 2011. The mean age was 58 years (range 16-82 years). Most lesions seen were choroidal suspicious naevi (54%) and treated choroidal malignant melanomas (20%). Nine (14%) patients with an increased risk of metastatic disease attended the clinic. Nine patients (14%) were referred back to the ophthalmologist's ocular oncology clinic, because of tumour growth in two patients, macular oedema in one, cataract in five, and conjunctival melanosis at the plaque site in one. Questionnaires showed high levels of satisfaction with the service. Conclusion A nurse-led adult ocular oncology clinic is feasible, thanks to developments in ocular photography. It is well accepted by patients.

Graefes Archive for Clinical and Experimental Ophthalmology, Nov 16, 2014

To report the outcome of patients with conjunctival squamous cell neoplasia (CSCN)--including con... more To report the outcome of patients with conjunctival squamous cell neoplasia (CSCN)--including conjunctival squamous cell carcinoma (SCC), conjunctival squamous intraepithelial neoplasia (C-SIN) and carcinoma in situ (CIS)-treated at the Liverpool Ocular Oncology Centre (LOOC). Patients treated between January 1993 and September 2011 were identified and categorised as having 'primary' or 'salvage' treatment, according to whether they had undergone a surgical procedure before referral to our centre. Invasive SCC was treated by excision with adjunctive ruthenium plaque radiotherapy. C-SIN or CIS was treated with topical 5-fluorouracil (5-FU), and in a few cases, cryotherapy. Primary treatment was administered to 20 patients (16 males, four females). Mean age was 62 years (range, 33-85). Histological examination revealed C-SIN/CIS in ten patients and invasive SCC in nine. Median follow-up was 69 months (range, 34-168). Three patients required further topical chemotherapy for persistent/recurrent C-SIN. Salvage therapy was administered to 21 patients (15 males, six females). Mean age was 63 years (range, 26-82). Histology showed C-SIN/CIS in 11 patients and invasive SCC in ten. Median follow-up was 54.5 months (range, 36-120). At the close of this audit, there was no recurrence of invasive or metastatic disease in either the primary or salvage groups. Our established protocol for treatment of CSCN has proven successful in local tumour control, and avoids ocular complications. We advocate adjunctive radiotherapy in patients with invasive SCC and chemotherapy in C-SIN/CIS. For improved patient outcome, prompt referral to a specialist centre is encouraged.

Graefes Archive for Clinical and Experimental Ophthalmology, Jan 12, 2007

Dear Editor: Exposure of scleral explants is not an uncommon postoperative complication [2]. It c... more Dear Editor: Exposure of scleral explants is not an uncommon postoperative complication [2]. It can lead to acute or acute-onchronic infection that is resistant to antibiotic treatment [3]. The symptoms are chronic discharge and discomfort. Early removal of the explant leads to resolution of the infection and symptoms in most patients. Whilst it is safe to do so in the majority of patients, recurrent re-detachment can occur in between 4 and 47% of patients following explant removal [10]. Particularly at risk are patients with a history of multiple detachment procedures, those with residual vitreoretinal traction, patients with proliferative vitreoretinopathy, those with multiple small post-oral breaks and those in whom the retinal break was not identified at the time of retinal surgery [7]. In these patients, retaining the explant in situ may be the safer option. Simply re-suturing the conjunctiva leads to recurrent breakdown of the wound. We report on the use of sclera and amniotic membrane (AM) to deal with exposed surgical explants. A 68-year-old woman (Case 1) was referred with discomfort in the left eye. Five years ago she had two retinal detachment operations involving pars plana vitrectomies and at her last operation a 276 encircling explant was applied. Her recent symptom was due to a breakdown of the conjunctiva in the inferonasal quadrant (INQ) where the explant was exposed. We applied a donor scleral patch graft to cover and secure the explant. There was a large epithelial defect and the surrounding conjunctiva and Tenon could not be sufficiently mobilised. We used AM and sutured it over the scleral graft using 10/0 Vicryl. At the end of surgery a lid suture was applied and the eye was kept shut for 1 week. At the 12-month follow-up the scleral explant was well covered and the retina was attached. A 36-year-old woman (Case 2) was referred with discomfort in the right eye. Six years ago the patient was treated for a retinal detachment with scleral buckling procedure plus a segmental 276 circumferential explant in the superotemporal quadrant (STQ) as well as a 40-band encirclement. On examination, the 276 scleral explant was exposed in STQ (Fig. 1a) and a Watzke sleeve was found to be prominent over the explant. We performed a scleral graft to cover the explant, replaced the Watzke sleeve with a 5/0 mattress suture and mobilised the conjunctiva and Tenon to cover the scleral graft. A tarsorrhaphy suture was applied for 1 week (Fig. 1b). At the 12-month follow-up the area was well healed (Fig. 1c). Neither of the patients had clinical evidence of infection (significant conjunctival hyperaemia or purulent conjunctival discharge) and both had culture-negative preoperative conjunctival swabs. Postoperatively, both patients were given topical preservative-free chloramphenicol 0.5% and prednisolone 0.5% four times a day for 4 weeks. Neither of the patients were receiving sub-conjunctival antibiotics or steroids at the time of surgery. Biomaterial such as temporalis fascia, fascia lata and preserved pericardium have been used to cover exposed explants [1, 10]. There are also several reports of the use of donor sclera [5, 9]. Irrespective of the material used, recurrent wound dehiscence and breakdown occurred in a Graefe`s Arch Clin Exp Ophthalmol (2007) 245:915–916 DOI 10.1007/s00417-006-0502-4

Clinical and Experimental Ophthalmology, Sep 2, 2011

as a laser in situ keratomileusis’s (LASIK)-related complication and traumatic surgeries. It gene... more as a laser in situ keratomileusis’s (LASIK)-related complication and traumatic surgeries. It generally occurs in the early times after the procedure, the longest reported interval being 20 months. This case illustrates the possibility to have an epithelial ingrowth following other surgeries than LASIK and trauma, even in the absence of risk factors. Another peculiarity of our case is that the abnormal growth of epithelial cells created an over 300-mm-thick opacity, which expanded to the centre of the cornea, differently from the typical post-LASIK ingrowth. We suggest that a possible risk factor is the construction and the size of the tunnel. A wide and irregular incision may create a breach for epithelial cells, leading to the ingrowth. Even if epithelial ingrowth is an uncommon complication after cataract surgery, it must be promptly recognized and treated to avoid serious consequences.

Acta Ophthalmologica, Sep 1, 2011

Purpose Retinal optic disc haemangioma are difficult to manage. Observation as well as therapeuti... more Purpose Retinal optic disc haemangioma are difficult to manage. Observation as well as therapeutical interventions may result in irreversible visual loss. We investigated verteporfin photodynamic therapy (PDT) as the initial treatment method for these tumours.

$Research paper thumbnail of Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis$

Graefes Archive for Clinical and Experimental Ophthalmology, Oct 5, 2010

Juvenile idiopathic arthritis (JIA) is the most common of all systemic conditions associated with... more Juvenile idiopathic arthritis (JIA) is the most common of all systemic conditions associated with childhood uveitis. Visual impairment has been shown to be as high as 40% of which 10% being blind (6/60 or worse). Due to the lack of well-designed randomized control trials for paediatric uveitis and arthritis there are limited comparative data regarding the efficacy of single or combination treatments. Recently, abatacept was shown to control ocular inflammation in a case of psoriatic arthritis- associated uveitis, seven cases of JIA- associated uveitis and in JIA. We present two cases with JIA-associated uveitis who have responded dramatically to abatacept therapy following unsuccessful therapy with other immunosuppressants. Control of arthritis still represents a challenge with this treatment. Prospective review of two patients with refractory JIA- associated uveitis not responding to maximum conventional treatment. Patients were regularly reviewed in the ophthalmology and rheumatology clinics. Assessment of their ocular condition was characterized according to the Standardization of Uveitis Nomenclature (SUN) group. In case 1, ocular inflammation was brought under control after repeated abatacept infusions. Case 2 showed complete resolution of cystoids macular edema CME and improvement of 5 Snellen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lines in best corrected visual acuity. After 9 months, the ocular condition of both patients remains in remission with steroid sparing. Joint disease was brought to clinical remission in case 2, but not in case 1. Abatacept is a promising alternative treatment in refractory cases of JIA uveitis but may not be as successful in controlling joint disease. Larger series with long term follow up of biological therapies in paediatric uveitis are essential to assess the efficacy and cost effectiveness.

Eye, Apr 21, 2020

Background Naevomelanocytic lesions comprise an increasing workload in ophthalmic secondary care ... more Background Naevomelanocytic lesions comprise an increasing workload in ophthalmic secondary care and, although largely benign, carry high risk of mortality in case of malignant transformation. Previous studies highlight the theoretical strength of virtual models in monitoring such lesions and the role of allied health professionals (AHPs). We aim to describe and validate a "real-world" functional clinical model utilising these particular resources. Methods New and existing follow-up patients from November 2016 to June 2019 with melanocytic lesions of the uveal tract and conjunctiva were directed into an optometrist-led, consultant-supported, clinic. Diagnostic tests included colour photography, autofluorescence, enhanced-depth imaging and ultrasound biomicroscopy. New patients were examined face-toface initially, then virtually on subsequent visits. Suspicious lesions were referred to the consultant, with tertiary oncology referrals made as necessary. Clinical concordance between optometrist and consultant, patient satisfaction and outcomes of second opinion requests were audited. Results Eight hundred and twenty-five patient episodes were encountered: 419 new and 406 follow-up. Between July 1st and August 31st 2018, 72 cases were audited. There was 98.6% concordance between AHP and consultant for diagnosis and management. Referral for consultant second opinion was requested in 18(2%) clinical encounters, with 4(0.5%) referred on to the oncology centre, of which 3 received treatment. Of 65 patients responding to a patient satisfaction survey, 100% were satisfied with their experience and 95% were happy to continue monitoring by the AHP. Conclusion With robust training and assessment, AHP-led service models are a highly efficient in busy units, without compromising patient safety.