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Fung AT, Yang Y, Kam AW. Central serous chorioretinopathy: A review. Clin Exp Ophthalmol 2023; 51:243-270. [PMID: 36597282 DOI: 10.1111/ceo.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 01/05/2023]
Abstract
Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.
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Affiliation(s)
- Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Yang
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
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2
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Gunasekaran N, Lee KR, Kam AW, McCall D, Waring D, Yeung S, Fung AT. Glomerella cingulata endophthalmitis. Am J Ophthalmol Case Rep 2022; 28:101744. [DOI: 10.1016/j.ajoc.2022.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022] Open
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Abstract
A 67-year-old Caucasian male presented with severe contraction of socket lining 8 years after enucleation, dermis fat graft and successful ocular prosthesis fitting. Following two failed attempts at using amniotic membrane grafts to reform the socket lining, a total socket reconstruction was attempted using a novel nasal turbinate mucosal graft technique. This was performed in a staged fashion with lower fornix reconstruction followed by upper fornix reconstruction 3 months later. The patient was stable at 12 months review, with a satisfactory cosmetic outcome. Nasal turbinate mucosa was used as it was surgically accessible, provided natural socket lubrication due to its mucosal surface, and avoided oral mucosa and its associated morbidity. This case report suggests that nasal turbinate mucosa is a suitable autologous grafting material for total socket reconstruction in contracted anophthalmic sockets.
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Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Christopher Zq Go
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - George He
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - David Veivers
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Brett O'Donnell
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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4
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Kam AW, Wells M, White AJ. Hypotony Maculopathy Secondary to Traumatic Cyclodialysis Cleft. Asia Pac J Ophthalmol (Phila) 2021; 10:595. [PMID: 34789672 PMCID: PMC8673842 DOI: 10.1097/apo.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Andrew W. Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Wells
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J.R. White
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
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5
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Wen Q, Kam AW, Fung AT. The Omega Sign Is Not Distinct to Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Asia Pac J Ophthalmol (Phila) 2021; 10:499-500. [PMID: 34524143 DOI: 10.1097/apo.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Qingyun Wen
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
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Kam AW, King N, Sharma A, Phillips N, Nayyar V, Shaban RZ. Short research paper: Personal protective equipment for the care of suspected and confirmed COVID-19 patients - Modelling requirements and burn rate. Infect Dis Health 2021; 26:214-217. [PMID: 33972186 PMCID: PMC8064831 DOI: 10.1016/j.idh.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
Background The COVID-19 pandemic has caused unprecedented global demand for personal protective equipment (PPE). A paucity of data on PPE burn rate (PPE consumption over time) in pandemic situations exacerbated these issues as there was little historic research to indicate volumes of PPE required to care for surges in infective patients and thus plan procurement requirements. Methods To better understand PPE requirements for care of suspected or confirmed COVID-19 patients in our Australian quaternary referral hospital, the number of staff-to-patient interactions in a 24-h period for three patient groups (ward-based COVID suspect, ward-based COVID confirmed, intensive care COVID confirmed) was audited prospectively from 1st to 30th April 2020. Results The average number of staff-to-patient interactions in a 24-h period was: 13.1 ± 5.0 (mean ± SD) for stable ward-managed COVID-19 suspect patients; 11.9 ± 3.8 for stable ward-managed confirmed COVID-19 patients; and 30.0 ± 5.3 for stable, mechanically ventilated, ICU-managed COVID-19 patients. This data can be used in PPE demand simulation modelling for COVID-19 and potentially other respiratory illnesses. Conclusion Data on the average number of staff-to-patient interactions needed for the care of COVID-19 patients is presented. This data can be used for PPE demand simulation modelling.
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Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Executive Unit, Westmead Hospital, Westmead, New South Wales, Australia.
| | - Nicole King
- Intensive Care Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Ashima Sharma
- Intensive Care Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Nicole Phillips
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Executive Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Department of Anaesthetics, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Vineet Nayyar
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Intensive Care Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Ramon Z Shaban
- New South Wales Biocontainment Centre & Division of Infectious Diseases and Sexual Health, Western Sydney Local Health District, Westmead, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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7
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Kam AW, Gunasekaran N, Chaudhry SG, Vukasovic M, White AJR, Fung AT. Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture? Clin Ophthalmol 2021; 15:341-346. [PMID: 33542617 PMCID: PMC7853628 DOI: 10.2147/opth.s289467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine changing patterns of ophthalmic presentations to emergency departments (EDs) during the lockdowns associated with the first wave of the COVID-19 pandemic in Australia and the two months immediately following lockdown relaxation. Patients and Methods This was a retrospective audit of triage coding and ICD-10-AM coding for all patient presentations to four Australian EDs from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and the corresponding period in 2019), and from June 1 to July 31 in 2019 and 2020 (the post-lockdown period and the corresponding period in 2019). Number of ophthalmic presentations triaged per day and number of seven common and/or time-sensitive, vision threatening ophthalmic diagnoses were examined. Differences in mean daily presentation numbers were assessed with non-paired Student’s t-test with Bonferroni correction. Results Total ophthalmic presentations per day during COVID-19 lockdowns fell by 16% compared to the corresponding period in 2019 (13.0 ± 4.0 in 2019 vs 10.8 ± 3.3 in 2020, mean ± standard deviation; p=0.01). There was also a significant decrease in presentations of atraumatic retinal detachment, conjunctivitis, and eye pain. In the two months following easing of lockdown restrictions, total ophthalmic presentations per day returned to the same level as that of the corresponding period in 2019 (12.2 ± 4.3 in 2019 vs 12.3 ± 4.1 in 2020, p=0.97). Conclusion Total ophthalmic presentations and presentations of atraumatic retinal detachment, conjunctivitis and, eye pain to EDs fell during the lockdowns associated with the first wave of COVID-19 in Australia. These may represent delays in patients seeking appropriate medical attention and may have implications on patient morbidity long after the COVID-19 pandemic.
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Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Executive Unit, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nathan Gunasekaran
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah G Chaudhry
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew J R White
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
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8
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Affiliation(s)
- Elissa J Zhang
- Westmead Hospital, Westmead, NSW, Australia
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Lucy P Aitchison
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Nicole Phillips
- Concord Repatriation General Hospital, Concord, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Ramon Z Shaban
- Westmead Hospital, Westmead, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Andrew W Kam
- Westmead Hospital, Westmead, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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9
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Kam AW, Collins S, Park T, Mihail M, Stanaway FF, Lewis NL, Polya D, Fraser-Bell S, Roberts TV, Smith JEH. Using Lean Six Sigma techniques to improve efficiency in outpatient ophthalmology clinics. BMC Health Serv Res 2021; 21:38. [PMID: 33413381 PMCID: PMC7792026 DOI: 10.1186/s12913-020-06034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Increasing patient numbers, complexity of patient management, and healthcare resource limitations have resulted in prolonged patient wait times, decreased quality of service, and decreased patient satisfaction in many outpatient services worldwide. This study investigated the impact of Lean Six Sigma, a service improvement methodology originally from manufacturing, in reducing patient wait times and increasing service capacity in a publicly-funded, tertiary referral outpatient ophthalmology clinic. Methods This quality improvement study compared results from two five-months audits of operational data pre- and post-implementation of Lean Six Sigma. A baseline audit was conducted to determine duration and variability of patient in-clinic time and number of patients seen per clinic session. Staff interviews and a time-in-motion study were conducted to identify issues reducing clinic service efficiency. Solutions were developed to address these root causes including: clinic schedule amendments, creation of dedicated postoperative clinics, and clear documentation templates. A post-implementation audit was conducted, and the results compared with baseline audit data. Significant differences in patient in-clinic time pre- and post-solution implementation were assessed using Mann-Whitney test. Differences in variability of patient in-clinic times were assessed using Brown-Forsythe test. Differences in numbers of patients seen per clinic session were assessed using Student’s t-test. Results During the baseline audit period, 19.4 patients were seen per 240-minute clinic session. Median patient in-clinic time was 131 minutes with an interquartile range of 133 minutes (84–217 minutes, quartile 1- quartile 3). Targeted low/negligible cost solutions were implemented to reduce in-clinic times. During the post-implementation audit period, the number of patients seen per session increased 9% to 21.1 (p = 0.016). There was significant reduction in duration (p < 0.001) and variability (p < 0.001) of patient in-clinic time (median 107 minutes, interquartile range 91 minutes [71–162 minutes]). Conclusions Lean Six Sigma techniques may be used to reduce duration and variability of patient in-clinic time and increase service capacity in outpatient ophthalmology clinics without additional resource input.
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Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Scott Collins
- Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Tae Park
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Michael Mihail
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Fiona F Stanaway
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Noni L Lewis
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel Polya
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Timothy V Roberts
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - James E H Smith
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, New South Wales, Australia. .,Northern Sydney Local Health District, St Leonards, New South Wales, Australia. .,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia. .,Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia. .,Department of Ophthalmology, Macquarie University Hospital, North Ryde, New South Wales, Australia.
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Kam AW, Chaudhry SG, Gunasekaran N, White AJ, Vukasovic M, Fung AT. Fewer presentations to metropolitan emergency departments during the COVID-19 pandemic. Med J Aust 2020; 213:370-371. [PMID: 32946589 PMCID: PMC7537075 DOI: 10.5694/mja2.50769] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Andrew W Kam
- Westmead Hospital, Sydney, NSW.,The University of Sydney, Sydney, NSW
| | | | | | - Andrew Jr White
- Westmead Hospital, Sydney, NSW.,The University of Sydney, Sydney, NSW
| | | | - Adrian T Fung
- Westmead Hospital, Sydney, NSW.,The University of Sydney, Sydney, NSW
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Jain NS, Kam AW, Chong C, Bobba S, Waldie A, Newey AY, Agar A, Kalani MYS, Francis IC. Intracranial Arterial Compression of the Anterior Visual Pathway. Neuroophthalmology 2019; 43:295-304. [DOI: 10.1080/01658107.2019.1566383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Neeranjali S. Jain
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
| | - Andrew W. Kam
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
| | - Calum Chong
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
| | - Samantha Bobba
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
| | - Anna Waldie
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Allison Y. Newey
- Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Ashish Agar
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - M. Yashar S. Kalani
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Ian C. Francis
- Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
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12
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Kam AW, Galvin J, Cherepanoff S, Miller AA, Fung AT. Primary Choroidal Lymphoma Diagnosed with 27-Gauge Pars Plana Vitrectomy Choroidal Biopsy. Case Rep Ophthalmol 2019; 10:213-220. [PMID: 31692619 PMCID: PMC6760356 DOI: 10.1159/000500238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Currently, transvitreal fine-needle aspiration biopsy is the most widely used tissue biopsy technique in cases of suspected intraocular lymphoma due to its relative simplicity and low trauma. The small sample produced, however, may be inadequate for diagnostic and prognostic analyses due to mechanical artefacts, insufficient material, or sampling errors. Small case series have demonstrated choroidal biopsy via vitrectomy to be safe and effective. With smaller-gauge vitrectomy instruments, visual recovery is rapid, and post-operative inflammation and conjunctival scarring is minimised. Furthermore, smaller-gauge instrumentation does not appear to affect the diagnostic yield of biopsies for intraocular lymphoma in vitro. We report a case of primary choroidal lymphoma successfully diagnosed with 27-gauge pars plana vitrectomy choroidal biopsy. Case Presentation A 72-year-old female presented with a 6-month history of painless blurred vision in her right eye. Fundus examination revealed a large pale choroidal mass centred on the posterior pole with overlying exudative retinal detachment. Enhanced depth imaging optical coherence tomography revealed a markedly thickened choroid with an undulating appearance. B-scan ultrasonography demonstrated diffuse, smooth thickening of the choroid, and retrobulbar extrascleral hypoechoic nodules. A 27-gauge pars plana vitrectomy was performed and choroidal biopsy taken. Histopathologic, immunohistochemical, and flow cytometry studies confirmed a diagnosis of extranodal marginal zone B-cell lymphoma. Systemic workup found no evidence of systemic lymphoma. As such, the patient was diagnosed with primary choroidal lymphoma. She underwent intensity-modulated external beam radiotherapy with subsequent resolution of disease. Conclusions Primary choroidal lymphoma can be safely and effectively diagnosed via 27-gauge vitrectomy choroidal biopsy.
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Affiliation(s)
- Andrew W Kam
- Royal North Shore Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | | | - Svetlana Cherepanoff
- St Vincent's Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - A Andrew Miller
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, New South Wales, Australia.,Centre for Oncology Informatics, University of Wollongong, Gwynneville, New South Wales, Australia
| | - Adrian T Fung
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
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13
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Kam AW, Hui M, Cherepanoff S, Fung AT. Rapid "epiretinal membrane" development following intravitreal bevacizumab for Coats' disease. Am J Ophthalmol Case Rep 2018; 11:75-77. [PMID: 29942874 PMCID: PMC6010952 DOI: 10.1016/j.ajoc.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of rapid "epiretinal membrane" ("ERM") development following intravitreal bevacizumab for juvenile Coats' disease. Observations A 7-year old boy was followed for four years with asymptomatic stage 2 Coats' disease in his left eye. At age 11, he developed symptomatic cystoid macular edema. Argon laser photocoagulation to the leaking aneurysms failed to improve his vision, which had symptomatically declined to 20/30. Four-months after laser, a single injection of intravitreal bevacizumab was given. Rapid development of an "ERM" was noticed on his first post-injection follow-up at 4 weeks. By 8-weeks post-injection the visual acuity had deteriorated to 20/400. 25 + gauge pars plana vitrectomy with "ERM" peeling was performed, with recovery of vision to 20/30 at the 4 months post-operative visit. Conclusions and importance Intravitreal bevacizumab may induce rapidly progressive "ERM" in patients with juvenile Coats' disease.
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Affiliation(s)
- Andrew W Kam
- Royal North Shore Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Hui
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia
| | - Svetlana Cherepanoff
- St Vincent's Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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14
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Kam AW, Lam PH, Haen PSWA, Tan M, Shamsudin A, Murrell GAC. Preventing brachial plexus injury during shoulder surgery: a real-time cadaveric study. J Shoulder Elbow Surg 2018; 27:912-922. [PMID: 29370965 DOI: 10.1016/j.jse.2017.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachial plexopathy is not uncommon after shoulder surgery. Although thought to be due to stretch neuropathy, its etiology is poorly understood. This study aimed to identify arm positions and maneuvers that may risk causing brachial plexopathy during shoulder arthroplasty. METHODS Tensions in the cords of the brachial plexuses of 6 human cadaveric upper limbs were measured using load cells while each limb was placed in different arm positions and while they underwent shoulder hemiarthroplasty and revision reverse arthroplasty. Arthroplasty procedures in 4 specimens were performed with standard limb positioning (unsupported), and 2 specimens were supported from under the elbow (supported). Each cord then underwent biomechanical testing to identify tension corresponding to 10% strain (the stretch neuropathy threshold in animal models). RESULTS Tensions exceeding 15 N, 11 N, and 9 N in the lateral, medial, and posterior cords, respectively, produced 10% strain. Shoulder abduction >70° and combined external rotation >60° with extension >50° increased medial cord tension above the 10% strain threshold. Medial cord tensions (mean ± standard error of the mean) in unsupported specimens increased over baseline during hemiarthroplasty (sounder insertion [4.7 ± 0.6 N, P = .04], prosthesis impaction [6.1 ± 0.8 N, P = .04], and arthroplasty reduction [5.0 ± 0.7 N, P = .04]) and revision reverse arthroplasty (retractor positioning [7.2 ± 0.8 N, P = .02]). Supported specimens experienced lower tensions than unsupported specimens. CONCLUSIONS Shoulder abduction >70°, combined external rotation >60° with extension >50°, and downward forces on the humeral shaft may risk causing brachial plexopathy. Retractor placement, sounder insertion, humeral prosthesis impaction, and arthroplasty reduction increase medial cord tensions during shoulder arthroplasty. Supporting the arm from under the elbow protected the brachial plexus in this cadaveric model.
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Affiliation(s)
- Andrew W Kam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Pieter S W A Haen
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Martin Tan
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Aminudin Shamsudin
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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Kam AW, Tong WWY, Christensen JM, Katelaris CH, Rimmer J, Harvey RJ. Microgeographic factors and patterns of aeroallergen sensitisation. Med J Aust 2016; 205:310-5. [DOI: 10.5694/mja16.00264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jenna M Christensen
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW
| | | | | | - Richard J Harvey
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW
- Macquarie University, Sydney, NSW
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16
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Kam AW, Chen TS, Wang SB, Jain NS, Goh AY, Douglas CP, McKelvie PA, Agar A, Osher RH, Francis IC. Materials in the vitreous demonstrated under the operating microscope during cataract surgery and confirmed histologically. Clin Exp Ophthalmol 2016; 45:206-207. [PMID: 27507551 DOI: 10.1111/ceo.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | - Tony S Chen
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Neeranjali S Jain
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | - Aaron Yj Goh
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Penny A McKelvie
- The University of Melbourne, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia
| | - Ashish Agar
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Ian C Francis
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia.,Chatswood Grove Eye Clinic, Ophthalmic Surgery Centre, Chatswood, Australia
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17
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Kam AW, Chen TS, Wang SB, Jain NS, Goh AYJ, Douglas CP, McKelvie PA, Agar A, Osher RH, Francis IC. Materials in the vitreous during cataract surgery: nature and incidence, with two cases of histological confirmation. Clin Exp Ophthalmol 2016; 44:797-802. [DOI: 10.1111/ceo.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
| | - Tony S Chen
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
| | - Sarah B Wang
- The University of Sydney; Sydney New South Wales Australia
| | - Neeranjali S Jain
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
| | - Aaron YJ Goh
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
| | | | - Penny A McKelvie
- The University of Melbourne; Melbourne Victoria Australia
- St Vincent's Hospital; Melbourne Victoria Australia
| | - Ashish Agar
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
| | | | - Ian C Francis
- Department of Ophthalmology; Prince of Wales Hospital; Sydney New South Wales Australia
- The University of New South Wales; Sydney New South Wales Australia
- Ophthalmic Surgery Centre; Sydney New South Wales Australia
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18
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Chen TS, Chong CWK, Kam AW, Abedi F, Francis IC. Re: Rudnisky et al.: antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis (Ophthalmology 2014;121:835-41). Ophthalmology 2015; 122:e12. [PMID: 25618428 DOI: 10.1016/j.ophtha.2014.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Tony S Chen
- The University of New South Wales, Sydney, Australia; The Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | | | - Andrew W Kam
- The University of New South Wales, Sydney, Australia
| | | | - Ian C Francis
- The University of New South Wales, Sydney, Australia; The Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.
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19
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McPherson ZE, Lau OCF, Chen TS, Kam AW, Amjadi S, Zhang MG, Playfair TJ, Agar A, Francis IC. High-speed cannula detachment into the eye during hydrodissection. Ophthalmic Surg Lasers Imaging Retina 2014; 45:347-9. [PMID: 24972389 DOI: 10.3928/23258160-20140624-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 02/12/2014] [Indexed: 11/20/2022]
Abstract
Detachment of a hydrodissection cannula during a phacoemulsification procedure appeared to produce no adverse sequelae during surgery. Day 1 postoperatively, two nonpenetrating hemorrhagic retinal lesions were identified; there was no evidence of posterior capsular perforation. Day 6 postoperatively, the pupil was temporally peaked by a fine vitreous strand running to the main-port incision in the superotemporal cornea. This was divided with Nd:YAG laser, and argon laser was applied to encircle the two retinal lesions. Postoperative uncorrected visual acuity remained 6/4 at day 1, day 6, and week 4 (3 weeks after laser application) follow-up visits. Surgeons must accept responsibility for confirming the integrity of the cannula and syringe connection before beginning hydrodissection, which can be highly destructive to intracameral structures.
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McPherson ZE, Jung-Yeon Ku J, Chong E, Amjadi S, Francis KE, Lauschke JL, Kam AW, Tsang H, Francis IC. Fibres found in the eye during and after phacoemulsification cataract surgery. Eye (Lond) 2014; 28:958-61. [PMID: 24833183 DOI: 10.1038/eye.2014.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 02/03/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Fibres are regularly found within the delivery cartridge (DC) and in the anterior chamber (AC) during phacoemulsification cataract surgery (PCS) and postoperatively. The purpose of this study was to identify their frequency and possible significance. SETTING Dedicated ophthalmic day surgery. DESIGN Prospective, consecutive, single-surgeon, cohort study. METHODS In 639 eyes undergoing PCS, the presence of fibres was documented in or on both the DC and in the AC intraoperatively, and in the AC postoperatively. The intraoperative method of fibre removal was documented. Corrected distance visual acuity (CDVA) was recorded preoperatively, and at day 1, week 1, and week 4 postoperatively. The incidence of clinical cystoid macular oedema (CMO) and endophthalmitis in the retained fibre subcohort was compared with that of the non-fibre subcohort. RESULTS A total of 5.2% of the operated eyes had a fibre or fibres in or on the DC, which in all cases was removed with forceps intraoperatively. A total of 14.6% of operated eyes had a fibre or fibres in the AC intraoperatively; these were removed by irrigation/aspiration. Postoperatively, five eyes (0.78%) had a fibre in the AC. There was no significant difference in postoperative CDVA between the fibre and non-fibre subcohorts (P=0.26), and no clinically significant CMO or endophthalmitis in either subcohort. CONCLUSIONS Most fibres seen on the DC or in the eye are sterile and non-inflammatory. However, there have been reports of endophthalmitis attributed to retained fibres. In this study, there were no complications attributable to the fibres, but their removal may minimise any adverse potential.
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Affiliation(s)
- Z E McPherson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - J Jung-Yeon Ku
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - E Chong
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - S Amjadi
- Ophthalmic Surgical Centre, Sydney, New South Wales, Australia
| | - K E Francis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J L Lauschke
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - A W Kam
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - H Tsang
- 1] Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia [2] School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - I C Francis
- 1] Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia [2] School of Medicine, University of New South Wales, Sydney, New South Wales, Australia [3] Ophthalmic Surgical Centre, Sydney, New South Wales, Australia
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Affiliation(s)
- J M Hanson
- Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada.
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23
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Lindsay MD, Kam AW, Lawall JR, Zhao P, Pipkin FM, Eyler EE. Autoionization rates and energy levels of triplet nf, v=1 Rydberg states of H2. Phys Rev A 1990; 41:4974-4988. [PMID: 9903722 DOI: 10.1103/physreva.41.4974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Zhao P, Lawall JR, Kam AW, Lindsay MD, Pipkin FM, Lichten W. Direct laser measurement of the Lamb shift of 23S-2(3)P transitions in helium. Phys Rev Lett 1989; 63:1593-1596. [PMID: 10040619 DOI: 10.1103/physrevlett.63.1593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Kam AW, Lawall JR, Lindsay MD, Pipkin FM, Short RC, Zhao P. Precise spectroscopy and lifetime measurement of electron-impact-excited N2: The c4' 1 Sigma u+(v=3) Rydberg level. Phys Rev A Gen Phys 1989; 40:1279-1288. [PMID: 9902260 DOI: 10.1103/physreva.40.1279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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