bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal pessary treatment in women with symptomatic pelvic organ prolapse: a long-term prospective study
Authors: Ma Congcong , Zhou Ying , Kang Jia , Zhang Ye , Ma Yidi , Wang Yuan , Tian Weijie , Xu Tao , Liang Shuo , Fan Guorong , Cui Yiran , Zhu Lan
Published: February 2021

Objective:

To evaluate the 5-year pessary continuation rate and identify clinical risk factors associated with discontinuation in patients with symptomatic pelvic organ prolapse (POP).

Methods:

In this prospective observational study, 312 women with symptomatic POP received pessary treatment between November 2013 and July 2015 in Peking Union Medical College Hospital, China, a tertiary referral center. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted and continued to use the pessary 2 weeks later. Patients with successful pessary fitting were followed for 5 years. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression.

Results:

In total, 265 patients (84.9%) had successful pessary fitting. After 5 years, 180 of 239 patients continued pessary use (75.3% continuation rate), with 26 lost to follow-up. The discontinuation rates decreased over time, from 8.7% at 1 year to 2.7% at 5 years. Total vaginal length < 7.5 cm (TVL, OR = 2.7, 95% CI 1.3-5.7, P = 0.007), improvement in Urinary Impact Questionnaire-7 scores < 50% at 3 months (OR = 2.1, 95% CI 1.1-4.2, P = 0.025), and incapability of self-care (OR = 2.6, 95% CI 1.3-5.1, P = 0.008) were potential discontinuation risk factors.

Conclusion:

Three-quarters of patients with symptomatic POP had successful pessary treatment at 5-year follow-up. TVL < 7.5 cm, poor urinary symptom relief at 3 months, and incapability of self-care were potential discontinuation risk factors.
Lymphovenous Anastomoses and Microscopic Lymphatic Ligations for the Treatment of Persistent Lymphocele
Authors: Uyulmaz Semra , Planegger Andrea , Grünherz Lisanne , Giovanoli Pietro , Lindenblatt Nicole
Published: February 2021

Background:

Numerous approaches have been employed to treat chronic lymphocele and cutaneous lymphatic fistulas (LFs) with little success. Given a high incidence and substantial consequences for patients, there is an ongoing demand for effective therapeutic and preventive strategies. The aim of this study was to evaluate the results after microscopic lymphatic ligation (MLL) and lymphovenous anastomosis (LVA) as a therapeutic and preventive approach in this context.

Methods:

Demographic data, surgical characteristics, complications, and the overall outcome of all patients undergoing surgery for postoperative LF from 2014 to 2019 were collected retrospectively. Patients were categorized in accordance with predefined inclusion/exclusion criteria and with their treatment. Statistical analysis was conducted using descriptive, summary statistics to identify a central tendency.

Results:

Thirty-four patients underwent indocyanine-green-lymphangiography guided revision surgery for LF. Two patients were lost to follow-up at 6 months. LF was successfully treated in all patients (n = 32) with a multimodal approach. Only MLL was performed in 22 patients and MLL/LVA in 10 patients. LF resolved in 78% of all patients with MLL only or MLL/LVA. In the remaining 22%, LF resolved after additional sclerotherapy within 3 months.

Conclusions:

Treatment of LF should follow a standardized staged surgical approach to optimize outcome. LF was treated successfully in all our patients. We therefore propose a multimodal interdisciplinary approach to this common clinical problem that includes adjunctive sclerotherapy.
Post-mastectomy Breast Reconstruction with Autologous Tissue: Current Methods and Techniques
Authors: Garza Ramon , Ochoa Oscar , Chrysopoulo Minas
Published: February 2021

Breast reconstruction is an option that should be considered for any patient facing a mastectomy. Autologous breast reconstruction provides the benefits of excellent longterm results, natural appearance, natural feel, and the best opportunity for sensory restoration. These factors lead many patients to choose autologous tissue over implant-based reconstruction. With improved anatomic and technical knowledge, the donor site morbidity previously associated with abdominally based autologous reconstruction has been significantly reduced. Today, the DIEP flap is the preferred autologous method allowing restoration of a “natural,” aesthetic breast with potential for sensation while simultaneously minimizing abdominal donor site morbidity. Alternative flaps and adjunctive procedures provide options when dealing with patients who present with challenging clinical scenarios because of an inadequate abdominal donor site. This paper reviews current methods employed by a high volume breast reconstruction practice to achieve these goals.
The Negative Impact of COVID-19 on Medical Education amongst Medical Students Interested in Plastic Surgery: A Cross-sectional Survey Study
Authors: Haley Caleb , Lee Jasmine , Xun Helen , Yesantharao Pooja , Nolan Ian T. , Harirah Muhammad , Crowe Christopher S. , Lopez Joseph , Morrison Shane D. , Drolet Brian C. , Janis Jeffrey E.
Published: February 2021

Background:

The COVID-19 pandemic has resulted in unpreceded changes to medical education. Medical students interested in urology and neurosurgery have reported concerns regarding COVID-19’s effects on clinical experience and the residency application process; however, the impact amongst students interested in plastic surgery is unknown. We hypothesized that students applying into plastic surgery may experience much distress as a result of the COVID-19 pandemic.

Methods:

An electronic survey was developed by 3 plastic surgery residents and 2 academic plastic surgeons and later refined by 4 fourth-year medical students. Questions focused on medical education curricular changes, perceived impact on medical education, and demographics. From April–May 2020 the survey was distributed to medical students who were interested in plastic surgery. Participants were identified through plastic surgery residency program personnel and social media platforms.

Results: In total,

130 of the 140 respondents reported interest in plastic surgery careers. An estimated 67% were in their clinical years or completing research year(s) before residency applications. Of the respondents, 80% believed that the COVID-19 pandemic had a negative impact on their medical education. Clinical-level students compared with preclinical-level students, and students applying to residency during the 2020–2021 match cycle compared with students not applying during the 2020–2021 match cycle were significantly more likely to perceive the COVID-19 pandemic as having a negative impact on their medical education (P = 0.04 and 0.03, respectively).

Conclusion:

Medical students interested in plastic surgery perceive the COVID-19 pandemic as having a negative impact on their education, likely due to a reduction in clinical exposure.
Implementing a New Service Line Model to Support Growth and Serve Patients
Authors: Fine Peter S. , Kuhlenbeck Kathy
Published: February 2021

Many healthcare organizations are reinvesting in clinical service lines to differentiate themselves, standardize evidence-based care, and add value. Typically, service line structures are built around hospital-based procedures and are accountable solely to local operations. That can be a blueprint for missed growth and lost value.

Banner Health, based in Phoenix, Arizona, with operations in six southwestern states, has pivoted to a systemwide service line strategy to foster growth and support value-based care. Service lines are now organized to maximize both revenue and quality across the continuum of care, to the benefit of both the system and its patients. The new, team-based structure allows Banner Health to respond nimbly to changes in the healthcare environment because it is based on the ways patients access the system. In 2021, just two years into this complex transition, the results have demonstrated that this service line model can achieve measurable benefits that include growth; improved financial performance, safety, and clinical outcomes; and increased collaboration in value-based payment models—all helping the system to realize its mission of making healthcare easier so that life can be better for our patients.
The genetics of left ventricular noncompaction
Authors: Cannie Douglas , Elliott Perry
Published: February 2021

Purpose of review

This article summarises current understanding of the genetic architecture underpinning left ventricular noncompaction (LVNC) and highlights the difficulty in differentiating LVNC from hypertrabeculation seen in normal, healthy individuals, that caused by physiological adaptation or that seen in association with cardiomyopathy phenotypes.

Recent findings

Progress has been made in better defining the LVNC phenotype and those patients who may benefit from genetic testing. Yield of diagnostic genetic testing may be low in the absence of syndromic features, systolic dysfunction and a family history of cardiomyopathy. Sarcomeric gene variants are most commonly identified but a wide-range of genes are implicated, emphasising the high degree of heterogeneity of studied cohorts.

More accurate phenotyping and genotype–phenotype correlation are required to better characterise the genetic architecture of LVNC.
Identification of Ferroptosis Biomarker in AHH-1 Lymphocytes Associated with Low Dose Radiation
Authors: Yin Jie , Hu Nan , Yi Lan , Zhao Weichao , Cheng Xinjie , Li Guoqing , Yang Nanyang , Li Guangyue , Ding Dexin
Published: February 2021

The impact of long-term low-dose radiation on human health has always been a concern. Long-term low-dose gamma radiation causes cells continuous injury and causes chromosomal mutations to greatly increase the chance of cancer. Because it is significant to identify biomarkers for long-term low-dose gamma radiation, we investigate the influence of low dose rate on the gene expressions in the AHH-1 lymphocytes cell line (AHH-1 cells) for long-term irradiation. Different dose rates (7, 14, 26, 34, and 43 μGy h−1) of irradiation from gamma radiation in uranium tailings powder were used to irradiate AHH-1 lymphocytes. We used flow cytometry to test the apoptosis of AHH-1 lymphocytes at different dose rates and irradiation times (7-84 d). It was found that 14 μGy h−1 is the most sensitive dose rate of AHH-1 lymphocyte irradiation. The 7-, 14-, and 21-d (2.4, 4.8, and 7.2 mGy) irradiation groups were sensitive, and the 84-d (28.8 mGy) irradiation group was insensitive to low dose gamma radiation. Microarray analysis was conducted on the significantly differentially expressed genes (p<0.05) in the 2.4, 4.8, 7.2, and 28.8 mGy irradiation groups. We found that TFRC1, SLC3A2, SLC39A8, FTH1, ACSL4, and GPX4 are significant genes with low-dose radiation and were constituents of the ferroptosis signaling pathway. In the range of 0–4.8 mGy radiation dose, the expressions of these genes were downregulated with increasing radiation dose, while in the range of 4.8–28.8 mGy, its expression increased with increasing radiation dose. RT-PCR and Western blot were used to detect the mRNA and protein expression of these genes. The results were consistent with those from microarray analysis. Our findings indicate that expression of the TFRC, SLC3A2, SLC39A, FTH1, ACSL4, and GPX4 genes is sensitive to low-dose radiation, and they are main members of the ferroptosis signaling pathway. Therefore, there is a very important connection between ferroptosis and low-dose radiation, which has become a hot topic in international research. These results can provide reference to the effect of ferroptosis on human health with low-dose radiation.
Are X-ray Safety Glasses Alone Enough for Adequate Ocular Protection in Complex Radiological Interventions?
Authors: Grau Mathias , Eldergash Osama , Amin Sandeep Sunder , Kowald Tobias , Schnabel Johannes , Wißmann Anika , Simka Sebastian , Chavan Ajay , Mathys Christian , Poppe Björn , Schmuck Bernhard , Thomas Rohit Philip
Published: February 2021

The maximum annual radiation ocular dose limit for medical staff has been reduced to 20 mSv in the current European directive 2013/59/Euratom. This multi-centric study aims at reporting the protected and unprotected eye lens doses in different fluoroscopically guided interventions and to evaluate any other factors that could influence the ocular dose. From July 2018 to July 2019, ocular radiation doses of six interventionists of four departments during complex interventions were recorded with a thermoluminescent dosimeter in front of and behind radiation protection glasses to measure the protected and unprotected doses. The position of personnel, intervention type, fluoroscopy time, total body dose and use of pre-installed protection devices like lead acrylic shields were also systematically recorded. Linear regression analysis was used to estimate the doses at 2 y and 5 y. The annual unprotected/protected ocular doses of six interventionists were 67/21, 32.7/3.3, 27.4/5.1, 7/0, 21.8/2.2, and 0/0 mSv, respectively. The unprotected dose crossed the 20-mSv annual limits for four interventionists and protected dose for one less experienced interventionist. The estimated 5-y protected ocular dose of this interventionist was 101.318 mSv (95%CI 96.066-106.57), also crossing the 5-y limit. The use of a lead acrylic shield was observed to have a significant effect in reducing ocular doses. The annual unprotected and protected ocular doses for interventionists dealing with complex interventions could cross the present permitted yearly limit. The measurement of significant protected ocular dose behind the radiation protection glasses emphasizes the additional indispensable role of pre-installed radiation protection devices and training in reducing radiation doses for complex procedures.
Inhalation of Soluble Plutonium: 53-year Follow-up of Manhattan Project Worker
Authors: Šefl Martin , Avtandilashvili Maia , Tolmachev Sergei Y.
Published: February 2021

This whole-body tissue donor to the United States Transuranium and Uranium Registries was occupationally exposed to plutonium nitrate-dioxide mixture via chronic inhalation. This individual was involved in the Manhattan Project operations and later participated in medical follow-up studies. Soft tissues and bones collected at autopsy were analyzed for 238Pu, 239+240Pu, and 241Am. Fifty-three years post-intake, 700±2 Bq of 239+240Pu were still retained in the skeleton, 661±11 Bq in the liver, and 282±3 Bq in the respiratory tract. Bioassay measurements and organ activities at the time of death were used to estimate the intake and radiation doses using the TAURUS internal dosimetry software. For this individual, an ICRP Publication 130 Human Respiratory Tract Model with case-specific particle size of 0.3 μm, ICRP Publication 100 Human Alimentary Tract Model, and ICRP Publication 141 Plutonium Systemic Model adequately described long-term plutonium retention and excretion. The total cumulative 239+240Pu intake of 31,716 Bq was estimated, of which 24,853 Bq (78.4%) were contributed by inhalation of plutonium nitrate and 6,863 Bq (21.6%) of plutonium dioxide. The committed equivalent doses to the red bone marrow, bone surface, liver, lungs, and brain were 0.71 Sv, 6.5 Sv, 8.3 Sv, 3.8 Sv, and 0.068 Sv, respectively. The committed effective dose was 1.22 Sv.
CORRELATION OF OUTER RETINAL TUBULATIONS AND CHORIOCAPILLARIS FLOW SIGNAL DEFICITS SURROUNDING GEOGRAPHIC ATROPHY
Authors: Haensli Christof , Sugiura Yoshimi , Freund K Bailey , Zweifel Sandrine A.
Published: February 2021

Purpose:

To evaluate and compare paralesional and perilesional choriocapillaris vascular impairment in eyes with geographic atrophy with and without outer retinal tubulations (ORT).

Methods:

Using swept-source optical coherence tomography angiography, 6 × 6 mm scans of eyes with geographic atrophy with and without ORT were acquired. Choriocapillaris en-face flow and structural images were binarized, before flow signal deficit (FD) analysis in the paraatrophy zone (a 500-µm-wide band adjacent to the geographic atrophy) and the periatrophy zone (a 500-µm-wide band adjacent to the latter).

Results:

Twenty-four eyes of 19 patients with ORT and 18 eyes of 15 patients without ORT were analyzed. With and without ORT, mean percental area of FD (%FD) was greater in para- than in periatrophy zone. The difference of %FD between para- and periatrophy zone (deltaFD) was lower in eyes with ORT (mean 1.8477%, 95% confidence interval 0.8607–2.8346) than without ORT (mean 4.0018%, 95% confidence interval 2.8622–5.1414).

Conclusion:

In eyes with geographic atrophy caused by non–neovascular age-related macular degeneration, smaller reductions in FDs were found between the para- and periatrophy zone in eyes with ORT. In both cohorts, the paraatrophy zone had more FD than the periatrophy zone.
BACILLARY LAYER DETACHMENT BECAUSE OF MACULAR NEOVASCULARIZATION
Authors: Jung Jesse J. , Soh Yu Qiang , Yu Daryle Jason G. , Rofagha Soraya , Lee Scott S. , Freund K. Bailey , Hoang Quan V.
Published: February 2021

Purpose:

To describe the clinical and multimodal imaging features of bacillary layer detachment (BD), and its response to intravitreal anti-vascular endothelial growth factor therapy, in eyes with macular neovascularization.

Methods:

Retrospective, observational case series of 14 eyes (14 patients, 7 men) imaged with eyes (14 patients, 7 men) were imaged with spectral-domain optical coherence tomography, and either fluorescein angiography or optical coherence tomography angiography. Therapeutic response was monitored with serial imaging and best-corrected visual acuity assessments.

Results:

The mean age was 75 ± 13 (range: 45–96) years, with mean follow-up duration of 27 ± 21 (range: 1–56) months. Neovascular age-related macular degeneration was found in 71% (10/14) eyes. Type 2 macular neovascularization lesions were associated with BD in all 14 eyes. Subretinal hemorrhage was noted in 79% (11/14) eyes. BD promptly resolved after intravitreal antivascular endothelial growth factor therapy in all eyes. The baseline best-corrected visual acuity improved from logarithm of the minimum angle of resolution 0.84 ± 0.32 (Snellen equivalent 20/138) to logarithm of the minimum angle of resolution 0.48 ± 0.31 (Snellen equivalent 20/60) at the last follow-up, with treatment of the macular neovascularization.

Conclusion:

Type 2 macular neovascularization and subretinal hemorrhage are associated with BDs, which may be due to a rapid influx of exudative fluid into the potential space between the external limiting membrane and ellipsoid zone. Intravitreal antivascular endothelial growth factor therapy results in rapid resolution of BDs and visual improvement in most eyes.
“IRIS SHELF” TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES
Authors: Soliman Wael , Tawfik Mohamed A. , Abdelazeem Khaled , Kedwany Salma M.
Published: February 2021

Purpose:

To describe “iris shelf” technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes.

Methods:

Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision.

Results:

Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1–8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes).

Conclusion:

The “iris shelf” technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.
CHOROIDAL IMAGING BIOMARKERS TO PREDICT HIGHLY RESPONSIVE AND RESISTANT CASES TREATED WITH STANDARDIZED ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR REGIMEN IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Jhingan Mahima , Cavichini Melina , Amador Manuel , Dans Kunny , Bartsch Dirk-Uwe , Cheng Lingyun , Chhablani Jay , Freeman William R.
Published: February 2021

Purpose:

To determine structural predictors of treatment response in neovascular age-related macular degeneration analyzing optical coherence tomography (OCT)–related biomarkers.

Methods:

A retrospective review of patients undergoing treatment for neovascular age-related macular degeneration at a tertiary institute was performed at presentation. High-intensity regimen included eyes on long-term anti–vascular endothelial growth factor treatment with the inability to extend beyond a month without a relapse and needed double the dose of medication (n = 25). Low-intensity regimen had eyes that went into long-term remission after at least three injections and remained dry for more than a year until the last visit (n = 20). Multimodal imaging including fluorescein angiogram, OCT, and comprehensive ocular evaluation were done. Choroidal vascularity index, total choroidal area, luminal area, subfoveal choroidal thickness, choriocapillaris thickness and Haller and Sattler layer thickness were analyzed for statistical significance.

Results:

The groups had no significant difference at baseline in age, gender, incidence of reticular pseudodrusen, polypoidal choroidal vasculopathy feature on OCT, type of choroidal neovascular membrane, and geographic atrophy. Multinomial logistic regression revealed that thicker subfoveal choroidal thickness and larger total choroidal area were the significant predictors of poor response to anti–vascular endothelial growth factor treatment (E = 0.02; P = 0.02; E = 1.82; P = 0.0075).

Conclusion:

Thicker subfoveal choroidal thickness and higher total choroidal area are useful variables to predict a poor treatment response.
RESPONSE OF CHOROIDAL ABNORMALITIES TO PHOTODYNAMIC THERAPY VERSUS MICROPULSE LASER IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: van Rijssen Thomas J. , Hahn Leo C. , van Dijk Elon H.C. , Tsonaka Roula , Scholz Paula , Breukink Myrte B. , Blanco-Garavito Rocio , Souied Eric H. , Keunen Jan E.E. , MacLaren Robert E. , Querques Giuseppe , Fauser Sascha , Downes Susan M. , Hoyng Carel B. , Boon Camiel J.F.
Published: February 2021

Purpose:

To compare the effects of half-dose photodynamic therapy (PDT) and high-density subthreshold micropulse laser on choroidal dysfunction evaluated by degree and extent of hyperfluorescence on indocyanine green angiography (ICGA) in chronic central serous chorioretinopathy.

Methods:

Data from the multicenter, randomized, controlled PLACE trial were used in this study. Hyperfluorescent and hypofluorescent areas on ICGA, their association with subretinal fluid and visual function were assessed.

Results:

In total, 146 patients were included (72 in the PDT and 74 in the high-density subthreshold micropulse laser treatment arm). A significantly greater decrease in the size of hyperfluorescent areas on ICGA at first visit after treatment was seen after PDT compared with high-density subthreshold micropulse laser (mean, −1.41 ± 2.40 mm2 vs. −0.04 ± 0.73 mm2, respectively; P < 0.001). A reduction in the degree of hyperfluorescence on ICGA decreased the odds of having persistent subretinal fluid on optical coherence tomography at first visit after treatment (B = 0.295; P = 0.019). There were no significant differences in best-corrected visual acuity and retinal sensitivity between the subgroup with novel hypofluorescence (n = 20, 28%) on ICGA at first visit post PDT, compared with the subgroup without novel hypofluorescence on ICGA after PDT.

Conclusion:

Choroidal abnormalities in chronic central serous chorioretinopathy can be effectively treated by ICGA-guided half-dose PDT but not with high-density subthreshold micropulse laser application.
Progression From Soft Lens to Piggyback Soft-Scleral Contact Lens System to Facilitate Scleral Lens Use in a Pediatric Patient
Authors: Murphy David A. , Samples Jeffrey S. , Zepeda Emily M. , Riaz Kamran M.
Published: February 2021

Traumatic injury in the pediatric population often results in significant refractive errors that if left untreated can lead to amblyopia. Scleral contact lenses (ScCLs) have recently gained popularity in this population for efficacy in treatment of significant refractive errors, including irregularity astigmatism and corneal abnormalities. Scleral contact lens intolerance may limit the ability of practitioners to use this modality. Although a soft contact lens (SCL) is generally well tolerated, it cannot treat refractive error as effectively as an ScCL. We recently used an SCL followed by an SCL–ScCL combination (“piggyback” system) sequence in a pediatric patient to facilitate use of an ScCL alone. We hope that our results may provide practitioners with an additional option when treating this challenging patient population.
Polymicrobial Keratitis: Risk Factors, Clinical Characteristics, Bacterial Profile, and Antimicrobial Resistance
Authors: González-Dibildox Laura A. , Oyervidez-Alvarado José A. , Vazquez-Romo Kristian A. , Ramos-Betancourt Nallely , Hernandez-Quintela Everardo , Beltran Francisco , Garza-Leon Manuel
Published: February 2021

Objective:

To describe clinical characteristics, complications, and the most prevalent microorganisms causing polymicrobial keratitis and their antibiotic sensitivities.

Methods:

A cross-sectional study including a consecutive analysis of patient's records with a diagnosis of bacterial keratitis with a positive culture and antibiogram report were included. Patients were grouped into those having monomicrobial and polymicrobial infection. Features studied included demographic and clinical characteristics, risk factors, Gram stain, cultures, and antibiotic sensitivity.

Results:

We included 656 patients; in 31.5% more than one microorganism was found. Seven hundred and twenty-three gram-positive bacteria were isolated, and 336 (46.5%) had polymicrobial keratitis. One hundred sixty-one gram-negative bacteria were isolated, and 99 (61.5%) from polymicrobial keratitis. Fourteen (0.60%) patients presented ring infiltrate, and 10 (71.42%) of those patients had polymicrobial keratitis (X
2 10.654, P=0.001). Multivariate analysis showed that patients with history of contact lens use (odds ratio [OR] of 1.78, P=0.042), coexistent autoimmune disease (OR 4.64, P=0.03), irregular edges of the infiltrate (OR 2.06, P=0.005), and ring infiltrate (OR 6.034, P=0.005) have a higher risk for developing polymicrobial infection. In the polymicrobial group, gram-positive and gram-negative organisms showed a high sensitivity to Netilmicin.

Conclusions:

We found a high incidence of polymicrobial keratitis. Our results suggest that it should be suspected in patients with a history of contact lens use, coexistent autoimmune disease, infiltrates with indistinct edges, and ring infiltrates. Sensitivities to moxifloxacin are lower than those reported in previous studies, but sensitivity to Netilmicin is higher.
Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation
Authors: Clerici Riccardo , Ceccuzzi Roberto , Fausto Riccardo , Tinelli Carmine , Di Palma Maria Rosaria , Mantegna Giuseppe , Riva Ivano , Busin Massimo , De Angelis Giovanni , Quaranta Luciano
Published: February 2021

Purpose:

To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation.

Methods:

A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 μm. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians).

Results:

Of the 265 UT-DSAEK grafts, ACP achieved the target “CGT ≤ 100 μm” in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was −3.9 μm (SD: 2.3), whereas predictability of the conventional technique was −54.6 μm (SD: 3.7) (P < 0.001). Thickness increased similarly (P = 0.212); CP ratio was better with ACP for only 2 mm diameter (P = 0.001); graft thickness uniformity was comparable (P > 0.05).

Conclusions:

Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 μm with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent.
Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation
Authors: Ghaffari Reza , Bonnet Clemence , Yung Madeline , Bostan Cristina , Harissi-Dagher Mona , Aldave Anthony J.
Published: February 2021

Purpose:

To identify the incidence, risk factors, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (kpro) implantation.

Methods:

Retrospective case series of kpro procedures at the Stein Eye Institute and the Centre Hospitalier de l'Université de Montréal between May 1, 2004, and December 31, 2018. Data were collected regarding ocular history, operative details, postoperative management, microbiologic profile, treatment, and outcomes. Log-rank test and Cox proportional hazard ratio (HR) were used to evaluate for an association between risk factors and outcomes.

Results:

A total of 349 kpro procedures were performed in 295 eyes of 268 patients. Fifty-seven cases of presumed infectious keratitis were identified after 53 procedures (15.2%) in 50 eyes (16.9%) of 49 patients (18.3%). The incidences of culture-positive bacterial and fungal keratitis were 0.014 and 0.004 per eye-year, respectively. Persistent corneal epithelial defect formation (P < 0.001) and cicatricial disease (HR: 1.98, 95% confidence interval, 1.02–3.83) were associated with a significantly higher incidence of infectious keratitis. For the 53 cases with a known outcome, medical therapy achieved resolution of infection in 34 cases (64.2%), whereas kpro explantation was required in 19 cases (35.8%). Infectious keratitis was associated with an increased risk for kpro explantation (HR: 3.09, 95% confidence interval, 1.92–4.79).

Conclusions:

Infectious keratitis develops in approximately 17% of eyes after kpro implantation, with a higher rate of culture-positive bacterial than fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis in eyes at higher risk, such as those with preexisting cicatricial disease or postoperative persistent corneal epithelial defect formation.
The Aotearoa Research Into Keratoconus Study: Geographic Distribution, Demographics, and Clinical Characteristics of Keratoconus in New Zealand
Authors: Gokul Akilesh , Ziaei Mohammed , Mathan Jeremy J. , Han Jina V. , Misra Stuti L. , Patel Dipika V. , McGhee Charles N. J.
Published: February 2021

Purpose:

To investigate the epidemiologic, demographic, and basic clinical characteristics of individuals with keratoconus managed by optometrists in New Zealand (NZ)/Aotearoa.

Methods:

A prospective, longitudinal, nationwide, survey protocol was completed for every patient with keratoconus who underwent a consultation with participating optometrists in a 2-year period. Data for each patient included date of birth, sex, self-reported ethnicity, new or previous diagnosis, uncorrected (UCVA) and best-corrected visual acuity (BCVA), type of refractive correction required to obtain BCVA and keratometric readings obtained using keratometry or computerized topography.

Results:

One thousand eight hundred sixty-nine cases were identified, with a mean age of 41.0 ± 15.7 years, 56.4% being men, and 87.3% with previous diagnosis. The distribution of cases was skewed toward Auckland (41.6%), Waikato (21.3%), Wellington (16.8%), and Bay of Plenty (13.3%). Self-reported ethnicities were predominantly NZ European (54.4%), Māori (24.7%), and Pacific Peoples (15.5%), disproportionate to the general population profile (74.0%, 14.9%, and 7.4% respectively). Most eyes (64.3%) were managed with rigid contact lenses (corneal lens in 34.2%). The mean K-mean was 49.0 ± 5.7 D. The mean UCVA was 6/42 and BCVA was 6/9. Māori and Pacific Peoples had both the highest K-mean and proportions of eyes graded stage IV on the Amsler–Krumeich scale.

Conclusions:

The results indicate that keratoconus is relatively common in NZ with at least 1869 patients managed by optometrists in 2 years. Most eyes had mild to moderate disease; however, Māori and Pacific Peoples seem to have greater disease severity. An ethnic predilection is apparent, with Māori and Pacific Peoples overrepresented relative to their population proportions, reinforcing a long-held clinical suspicion.
Uveal melanoma: laboratory advances and new frontiers in patient care
Authors: Xu Timothy T. , Moser Justin C. , Dalvin Lauren A.
Published: February 2021

Purpose of review

To review recent advancements in the genetic understanding, diagnosis, prognosis, and treatment of uveal melanoma (UM).

Recent findings

UM is a molecularly distinct melanocytic malignancy driven by mutations in GNAQ or GNA11, with mitogen-activated protein kinase pathway upregulation. Earlier diagnosis and treatment are important factors for improving life prognosis. These goals can be aided by more objective multimodal imaging risk factors for the prediction of malignant nevus transformation and novel treatment strategies such as customized radiation fields and nanoparticle therapy to reduce vision-threatening treatment side effects. The risk for metastatic disease can be reliably predicted through gene expression profiling or the Cancer Genome Atlas project classification, and combined use of clinical tumor features with molecular data allows for highly individualized patient prognosis. Patients with high-risk UM should be considered for clinical trials of adjuvant therapy to prevent metastatic disease. For patients with clinically evident metastasis, combination immunotherapy regimens, T cell-based therapies, and focal adhesion kinase inhibitors offer hope for improved clinical response rates.

Improved understanding of UM molecular pathogenesis and clinical trials of targeted therapy for prevention and treatment of metastatic disease may improve patient survival for this challenging disease.
Rho kinase (ROCK) inhibitors in the management of corneal endothelial disease
Authors: Syed Zeba A. , Rapuano Christopher J.
Published: February 2021

Purpose of review

Rho kinase (ROCK) inhibitors are growing increasingly relevant in ophthalmology, and the goal of this review is to summarize their mechanisms of action and potential applications in the subspecialties of glaucoma, retina, and cornea. We will focus specifically on corneal endothelial wound healing, for which ROCK inhibition demonstrates particular promise.

Recent findings

ROCK inhibition has been shown to promote corneal endothelial cell proliferation, increase intercellular adhesion, and suppress apoptosis. Topical ROCK inhibitor treatment has exhibited potential use in Fuchs endothelial dystrophy, corneal edema from acute surgical trauma and other etiologies, and tissue engineering therapy for the endothelial disease. Ripasudil and netarsudil, the two ROCK inhibitors available for ophthalmic use, are generally very well tolerated with mild and transient local side effects.

ROCK inhibitors are revolutionizing the subspecialty of cornea, and further research is needed to compare long-term outcomes of ROCK inhibitor therapy to those of conventional endothelial keratoplasty, including visual acuity and endothelial cell density. Other possible avenues include the use of ROCK inhibitors to prolong corneal graft survival, and early data appears promising.
Is Coaching Home Visitors an Evidence-Based Professional Development Approach? A Review of the Literature
Authors: McLeod Ragan H. , Akemoglu Yusuf , Tomeny Kimberly R.
Published: February 2021

Coaching is becoming a common professional development strategy to support early childhood (EC) professionals to use evidence-based practices. However, most of the research on coaching professionals in EC settings has been conducted in classroom or center-based EC settings. The authors of this review sought to summarize the current empirical literature on coaching of EC home visitors. Seven studies were identified and coded to determine common factors. Additional research is greatly needed to identify whether coaching home visitors is an evidence-based professional development strategy and the effective components of coaching in home-based programs.
Results of corneal crosslinking in adolescents with progressive keratoconus: prospective study
Authors: Gaster Ronald N. , Margines J. Ben , Li Xiaohui , Canedo Ana C. , Rabinowitz Yaron S.
Published: February 2021

Purpose:

To evaluate the safety and efficacy of epithelium-off (epi-off) corneal crosslinking (CXL) in adolescents with progressive keratoconus (KC).

Setting:

Private clinical practice.

Design:

Nonrandomized prospective clinical trial.

Methods:

230 adolescent patients aged 10 to 19 years with progressive KC (increasing maximum keratometry [Kmax] or astigmatism of 1.00 diopter or greater associated with decreased corrected distance visual acuity [CDVA]) underwent CXL. Exclusion criteria were age at time of CXL younger than 10 years or older than 19 years, corneas that were thinner than 400 μm or demonstrated central corneal scarring, history of herpetic eye disease, or pregnancy or nursing. Follow-up examinations of uncorrected distance visual acuity (UDVA), CDVA, Kmax, and minimum pachymetry occurred on 130 eyes at 1 year, 77 eyes at 2 years, and 55 eyes at 3 years post-CXL.

Results:

In this study, 230 eyes of adolescent patients were evaluated. UDVA significantly improved from preoperatively to 1 year, 2 years, and 3 years post-CXL. CDVA values significantly improved from preoperatively to 1 year, 2 years, and 3 years post-CXL. Kmax values significantly reduced (improved) from preoperatively to 1 year and 3 years post-CXL and reduced (improved) (P = .22) from preoperatively to 2 years post-CXL. Minimum pachymetry decreased significantly from preoperatively to 1 year, 2 years, and 3 years post-CXL.

Conclusions:

CXL in patients aged 10 to 19 years was safe and efficacious, halted progression of KC and could improve UCVA, CDVA, and Kmax. Minimum pachymetry decreased and stabilized post-CXL. Ophthalmologists should encourage adolescent patients with KC to obtain prompt evaluation and possible CXL to halt progression of the disease.
Pain phenotypes among adults living with cerebral palsy and spina bifida
Authors: Peterson Mark D. , Haapala Heidi , Kamdar Neil , Lin Paul , Hurvitz Edward A.
Published: February 2021

Chronic pain is the most commonly reported physical symptomology of cerebral palsy (CP) and spina bifida (SB) throughout the lifespan, and yet, pain is perhaps the least understood comorbidity in these populations. The objective of this study was to compare the prevalence and types of pain diagnosed among adults living with and without CP or SB. In this retrospective cohort study, we analyzed data from a nationwide commercial insurance claims database. Beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnosis code for CP or SB (n = 22,648). Adults without CP or SB were also included as controls (n = 931,623). Pain phenotypes (nociceptive, nociplastic, and neuropathic pain) and pain multimorbidity (≥2 conditions) were compared. We found that adults living with CP or SB had a higher prevalence of any pain disorders (55.9% vs 35.2%), nociceptive pain (44.0% vs 26.7%), nociplastic pain (26.1% vs 11.9%), neuropathic pain (9.6% vs 5.6%), and pain multimorbidity (21.1% vs 8.4%), as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Adjusted odds ratios of nociceptive pain (odds ratio [OR]: 2.20; 95% confidence interval [CI]: 2.15-2.24), nociplastic pain (OR: 2.47; 95% CI: 2.41-2.53), neuropathic pain (OR: 2.71; 95% CI: 2.54-2.89), and other pain (OR: 3.92; 95% CI: 3.67-4.19) were significantly higher for adults living with CP or SB. In conclusion, adults with CP or SB have a significantly higher prevalence and odds of common peripheral, central, and neuropathic pain disorders and pain multimorbidity, as compared to adults without CP or SB.
Consensus agreement to rename burning mouth syndrome and improve International Classification of Diseases-11 disease criteria: an international Delphi study
Authors: Chmieliauskaite Milda , Stelson Elisabeth A. , Epstein Joel B. , Klasser Gary D. , Farag Arwa , Carey Barbara , Albuquerque Rui , Mejia Lina , Ariyawardana Anura , Nasri-Heir Cibele , Sardella Andrea , Carlson Charles , Miller Craig S.
Published: February 2021

The International Classification of Diseases (ICD-11) proposes revisions in the nomenclature, disease definition, and diagnostic criteria for “burning mouth syndrome” (BMS). This process could benefit from additional systematically collected expert input. Thus, the purpose of this study was to use the Delphi method to (1) determine whether revision in nomenclature and alternative names for “BMS” are warranted and (2) identify areas of consensus among experts for changes to the disease description and proposed diagnostic criteria of “BMS,” as described in the ICD-11 (World Health Organization). From 31 international invited experts, 23 who expressed interest were sent the survey. The study used 4 iterative surveys, each with a response rate of ≥82%. Consensus was predefined as 70% of participants in agreement. Data were summarized using both descriptive statistics and qualitative thematic analysis. Consensus indicated that BMS should not be classified as a syndrome and recommended instead renaming to “burning mouth disorder.” Consensus included deletion of 2 diagnostic criteria: (1) emotional distress or functional disability and (2) the number of hours symptoms occur per day. Additional items that reached consensus clarified the disease definition and proposed more separate diagnostic criteria, including a list of local and systemic factors to evaluate as potential secondary causes of oral burning. Experts in this study recommended and came to consensus on select revisions to the proposed ICD-11 BMS nomenclature, diagnostic criteria, and disease definition. The revisions recommended have the potential to improve clarity, consistency, and accuracy of diagnosis for this disorder.
What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education
Authors: Leake Hayley B. , Moseley G. Lorimer , Stanton Tasha R. , O'Hagan Edel T. , Heathcote Lauren C.
Published: February 2021

Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as “improved” were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
Factors Associated With Smoking Behaviors Among Late Adolescents
Authors: Huang Hui-Wen , Huang Chih-Ling
Published: February 2021

This study examined factors associated with smoking behaviors among late adolescents in Taiwan. A cross-sectional survey was conducted with 377 adolescents from four high schools who answered self-report questionnaires. The results indicated that 10.8% (n = 41) of the participants were current smokers. Univariate analysis indicated that current smoking status was significantly associated with smoking social confidence, smoking social connection, friend smoking, and smoking policy in schools. Logistic regression showed smoking social confidence (adjusted odds ratio = 1.41, 95% CI [1.16, 1.72], p = .01) and friend smoking (adjusted odds ratio = 2.80, 95% CI [1.67, 4.70], p < .01) were significantly associated with being a current smoker. Health professionals should consider implementing school-based programs to reduce influence of friend smoking, through strategies for resisting peer pressure, to reduce smoking. Educating late adolescents on improving skills related to social confidence, such as increasing communication abilities, should also be a part of these programs.