Signs and Symptoms
Comma sign: Comma shaped vessels in the bulbar conjunctiva is due to vascular occlusion of conjunctival vessels. Vitreoretinal traction or retinal detachment cause flashes, floaters or dark shadows. Sudden loss of vision may occur due to retinal artery occlusion, vitreous hemorrhage or retinal detachment. Intravascular occlusions may be seen in optic disc vessels. Cause
Normal adult hemoglobin A molecule comprises two α and two β globin chains associated with a heme ring. Mutation at the 6th position of the beta chain is the cause of sickle cell disease. Due to sickle cell disease, vascular occlusion may occur in the conjunctiva, iris, retina, or choroid. Retinal changes occur due to blockage of retinal blood vessels by abnormal RBCs. Diagnosis
Diagnostic Techniques
Diagnosis is conducted in a multidisciplinary manner. The diagnosis of sickle cell disease can be confirmed by cation high performance liquid chromatography, haemoglobin electrophoresis in adolescents and adults and molecular genetic diagnosis in prenatal and neonatal populations. Anterior segment signs including the conjunctival sign and iris atrophy are ocular manifestations that are strongly indicative of sickle cell disease. Early stages of sickle cell retinopathy are asymptomatic. However, retinal changes that are diagnostic of sickle cell retinopathy can be visualized using fundoscopic examinations, retinography, fluorescein angiography and coherence tomography. Ultra Widefield Fluorescein Angiography is the gold standard for diagnosis of proliferative sickle cell retinopathy. It is an invasive method that assesses both anterior and posterior segment structures. Spectral Domain Optical Coherence Tomography and Coherence Tomography Angiography are non invasive methods of diagnosing proliferative retinopathy.
Ibuprofen/famotidine, sold under the brand name Duexis, is a fixed-dose combination medication used for the treatment of rheumatoid arthritis and osteoarthritis. It contains ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) and famotidine, a histamine H2-receptor antagonist. References
Further reading
Deeks ED (September 2013). "Fixed-dose ibuprofen/famotidine: a review of its use to reduce the risk of gastric and duodenal ulcers in patients requiring NSAID therapy". Clin Drug Investig. 33 (9): 689–97. doi:10.1007/s40261-013-0113-x. PMID 23881568. S2CID 24972423. Schiff M, Peura D (February 2012). "HZT-501 (Duexis; ibuprofen 800 mg/famotidine 26.6 mg) gastrointestinal protection in the treatment of the signs and symptoms of rheumatoid arthritis and osteoarthritis". Expert Rev Gastroenterol Hepatol. 6 (1): 25–35. doi:10.1586/egh.11.88. PMID 22149579. S2CID 46369253. External links
"Famotidine mixture with ibuprofen". Drug Information Portal. U.S. National Library of Medicine.