bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of prostaglandin analogues on central corneal thickness in patients with glaucoma: A systematic review and meta-analysis with trial sequential analysis
Authors: Kadri Rajani , Shetty Akansha , Parameshwar Devika , Kudva Ajay A , Achar Asha , Shetty Jayaram
Published: May 2022

The objective of this meta-analysis was to evaluate the effect of prostaglandin analogues (PGA) on central corneal thickness (CCT) in patients with glaucoma. Key electronic databases were searched for randomized controlled trials (RCTs) involving the CCT effects of prostaglandin use for glaucoma. Primary outcome measures were the mean difference in the CCT measurement from baseline to the last available assessment. Intraocular pressure and other corneal changes were recorded as secondary. Efficacy estimates were measured by their weighted mean difference (WMD) with 95% confidence intervals (CI’s) by using the random-effects model for primary and secondary outcomes Trial sequential analysis was used to determine if the current evidence was sufficient and conclusive. Eight RCTs met our inclusion criteria. A total of 879 patients were included. The overall effect showed that PGA’s had a significant CCT lowering effect (WMD = −7.04, 95%CI: −10.07 to −4.00, P < 0.00001). We pooled results of 5 RCT’s on Travoprost (WMD = −10.44, 95%CI: −16.80 to −4.08, P = 0.001), seven trials on Latanoprost (WMD = −4.73, 95% CI: −9.70 to 0.25, P = 0.06), and three trials on Bimatoprost (WMD = −11.88, 95%CI: −21.03 to −2.73, P = 0.01). The WMD across groups in >6 months of PGA use was −11.37 (95%CI: −17.17 to −5.58, P = 0.0001), and in <6 months of PGAs group was −8.35 (95% CI: −12.01 to −4.69, P < 0.00001), suggesting a longitudinal effect of PGAs on CCT. In conclusion, Bimatoprost and Travoprost caused a statistically significant reduction in the thickness of central cornea. Though only a few studies were included, the narrow confidence intervals and adequate sample size suggest that these findings are valid.
Population-based assessment of barriers for uptake of eye care services among elderly people: Findings from rapid assessment of visual impairment studies from Telangana, India
Authors: Marmamula Srinivas , Yelagondula Vijay K , Kumbham Thirupathi R , Modepalli Satyabrahmanandam , Yellapragada Ratnakar , Avula Sanjana , Keeffe Jill
Published: May 2022

Purpose:

To report the barriers for seeking eye care among the elderly population aged ≥60 years with avoidable vision impairment (VI) in the South Indian state of Telangana.

Methods:

A total of 3640 participants aged ≥60 years were recruited using cluster-random sampling. Demographic information, including presenting visual acuity, was measured using the standard Rapid Assessment of Visual Impairment (RAVI) protocol. “Avoidable VI” was considered if the VI was due to cataract or uncorrected refractive error (URE). A detailed interview was conducted using a validated questionnaire to report the barriers for not seeking eye care. Data were analyzed using the Stata statistical software version 14.

Results:

Prevalence of avoidable VI was 30.2% (95% CI: 28.02–31.06; n = 1102). Among those who noticed decreased vision (n = 1074), only 392 participants (36.4%) reported that they felt the need for seeking eye care. The major barriers for not seeking eye care were: cannot afford the consultation fee and services (42.0%) and no escort (25.7%). Overall, the personal barriers (57.9%) were the major reason for not seeking care, followed by economic barriers (42.0%). No significant difference was reported in barriers between the participants with unilateral and bilateral VI (>0.05).

Conclusion:

Overall, among the elderly people, personal and economic barriers were the major reason for not seeking eye care. Health care providers and policymakers should focus on newer models of eye care delivery to ensure better accessibility and uptake of care by the elderly people.
Evaluation of macular and choroidal thickness in healthy residents living at high altitude
Authors: Gok Mustafa , Karaman Suleyman , Erdem Burak
Published: May 2022

Purpose:

Assessment of long-term effects of high altitude on choroidal thickness.

Methods:

This prospective cross-sectional study included 88 and 79 age- and sex-matched healthy individuals who were living at sea-level (SL group) and high-altitude (HA group), respectively. Participants were required to have resided in the same place for at least 10 years. Spectral-domain optical coherence tomography (SD-OCT) scans were conducted in two different and were performed within the same time (08:00 am to 10:00 am). Central macular thickness (CMT) and choroidal thickness were measured at five different points (i.e., at the central fovea and 1 mm and 2 mm temporal and nasal of the fovea). Blood hemoglobin (Hb), red blood cell (RBC), hematocrit (Htc) levels, blood oxygen saturation, heart rate, and body mass index (BMI) were compared between groups statistically.

Results:

The HA group had a mean age of 47.5 ± 13.3 years, whereas the SL group was 48.7 ± 13.4 years (P = 0.57). There was no significant difference between the groups in terms of CMT. Subfoveal choroidal thickness (SCFT) was 282.73 ± 87.82 mm in the HA group and 310.49 ± 74.73 in the SL group (P = 0.02). The choroid was found to be thinner at all the measured locations in the HA group except the 2 mm nasal point of the fovea. However, only the difference at an SFCT was statistically significant. Furthermore compared with the SL group statistically significant higher Hb, RBC, Htc levels were determined in the HA group. In the multiple linear regression model analysis, age was found an only effective confounder factor for SCFT (P = 0.001, 95% CI 4.132–2.476).

Conclusion:

The systemic adaptive changes due to chronic high altitude exposure may cause structural changes in the choroidal vascular network. The current study results revealed significant thinning only at SFCT. Large-scale longitudinal studies are needed to obtain more definitive data on this subject.
Prevalence and risk factors for cataracts in the Lao People’s Democratic Republic: The Vientiane Eye Study
Authors: Guo Brad , Tan Yiran , Nygaard Stephen , Carrillo Cesar , Nouansavanh Kham Od , Souksamone Kitar , J Casson Robert
Published: May 2022

Purpose:

To determine the prevalence and risk factors for cataracts in the Vientiane Province.

Methods:

We conducted a population-based study of 1264 participants aged ≥40 years of age from urban and rural areas of Vientiane Province. Data collection included demographic information, smoking history, body mass index, blood pressure, history of trauma and dilated lens examination using the World Health Organization WHO Simplified Cataract Grading System. Aphakic and pseudophakic eyes were included as operated cataracts for statistical analysis.

Results:

The mean age of the 1264 participants was 57.6 years. The prevalence of any cataract including operated eyes was 46.8% (95% CI: 44.1 – 49.6%): 36.9% nuclear, 21.7% cortical and 10.1% posterior subcapsular cataracts.

Conclusion:

The prevalence of cataract in the Vientiane Eye Study is similar compared to the prevalence reported in other studies from Asian regions; however, the median age in this study was low, reflecting the age group of the population and the rapid urbanisation occurring in the Lao People’s Democratic Republic. A significant association for any cataract was found with elevated blood pressure >148mmHg (OR2.48, 95%CI:1.55 - 3.97, P < 0.01), increasing age (OR1.19, 95%CI:1.17 - 1.22, P < 0.001) and rural inhabitants for cortical cataract (OR1.99, 95%CI:1.37 - 2.90, P < 0.001). An inverse relationship between rural inhabitants with any cataract and nuclear cataract was found (OR 0.63, 95%CI: 0.45 – 0.89, P < 0.01 and OR 0.42, 95%CI: 0.31 - 0.59, P < 0.001) respectively.Nevertheless, cataract remains a high prevalence disease in this population.
Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging
Authors: Duan Miao , Xu Dong-Dong , Zhou Hai-Long , Fang Hong-Ying , Meng Wei , Wang Yi-Ning , Jin Zheng-Yu , Chen Yu , Zhang Zhu-Hua
Published: May 2022

Purpose:

To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment.

Methods:

Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2-weighted, fat-suppressed fast spin echo imaging (T2WI-fs) and T1-weighted, fat-suppressed, contrast-enhanced fast spin echo imaging (T1WI-fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non-effective group. Independent t-test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t-test was used to compare SIR and T of LPS muscle before and after treatment. Then cut-off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed.

Results:

Sixty-two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non-effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI-fs and T1WI-fs + C decreased after treatment in the effective group (P
T2 < 0.001, P
T1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non-effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non-effective treatment group on T1WI-fs + C (P < 0.001). SIR of LPS muscle on T1WI-fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840).

Conclusion:

In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy.
Noninvasive ocular surface analyzer as an adjunct in diagnosis and estimating prevalence of meibomian gland dysfunction: Hospital-based comparative study
Authors: Yadav Saumya , Gupta Noopur , Makwana Tarjani , Vanathi Murugesan , Tandon Radhika
Published: May 2022

Purpose:

To assess the role of noninvasive ocular surface analyzer (OSA) in workup of meibomian gland dysfunction (MGD) and to estimate hospital-based prevalence of MGD using this objective device.

Methods:

The study recruited 113 consecutive participants attending the ophthalmology outpatient department of a tertiary care hospital. All participants were administered a symptom questionnaire. Participants underwent a comprehensive ocular examination, including slit-lamp biomicroscopy and meibomian gland expression. Lipid layer thickness (LLT), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and meibomian gland loss (MGL) were assessed using OSA. The presence of either or both reduced/absent meibum secretion and cloudy to toothpaste-like secretion was diagnosed as MGD.

Results:

Prevalence of total MGD was 57.52% (95% confidence interval [95% CI]: 48.3%–66.8%) and that of symptomatic MGD was 42.5% (95% CI: 33.2%–51.7%). Prevalence of total and symptomatic MGD was highest in those aged ≥50 years (P < 0.001 and P = 0.004, respectively). Computer vision syndrome increased the odds of symptomatic MGD (odds ratio [OR]: 4.3). NIBUT and MGL significantly differed in MGD and non-MGD groups (P = 0.023 and P < 0.001, respectively). LLT significantly differed between asymptomatic and symptomatic cases (P = 0.033). MGL >25% increased the odds of having MGD (OR: 19.1). Significant negative correlations were observed between MGL and NIBUT (P = 0.04) and between MGL and LLT (P = 0.02). MGL demonstrated the highest diagnostic accuracy for MGD (AUC = 0.827, sensitivity = 75.4%, specificity = 85.4%, cut-off value: ≥26%).

Conclusion:

MGD is a common disorder in adults attending the ophthalmology outpatient services of a tertiary eye care hospital. Incorporating noninvasive OSA in clinical practice can aid in rapid and reliable measurements of MGD-related parameters.
Vision centre helps reduce blindness and vision impairment. Proof of concept in a four-year longitudinal study in an urban area in India
Authors: Gogate Parikshit M , Phadke Supriya P , Das Taraprasad , Sane Shrivallabh , Moosa Soumya , Dhangar Ashok , Inamdar Minhaj , Khandekar Rajiv , Magdum Renu , Bhawalkar Jitendra S , Bhoosnurmath Kashinath
Published: May 2022

Purpose:

To estimate the prevalence of blindness and severe visual impairment (SVI) by using a door-to-door screening and vision center (VC) examination strategy in an urban area in western Maharashtra (Pune), India and repeat the exercise after 4 years to study its impact.

Methods:

Four trained community health workers measured the visual acuity and performed an external ocular examination in patients’ homes. People with vision <6/18 were requested to visit the VC for a comprehensive eye examination by an optometrist. An ophthalmologist examined people whose vision did not improve to 6/12. A home examination was done for people who did not visit the VC despite two requests. The same population was examined twice in an interval of 4 years.

Results:

In the study, 44,535 people in 2015–16 and 98.14% (n = 43,708) of them in 2018–19 were examined. Blindness (vision < 3/60 in better eye), and moderate-to-severe visual impairment (MSVI, vision 6/18–6/60 in better eye) were 0.26% and 1.3%, respectively, in the first cohort, and 0.16% and 1.1%, respectively, in the second cohort (P < 0.001). When the worse eye was considered, the prevalence of blindness reduced from 0.72% to 0.44%, SVI reduced from 0.1% to 0.07%, and MVI decreased from 1.7% to 1.49% between 2015 and 2019 (P < 0.001). Females (P < 0.001) and older individuals (P < 0.001) were more likely to have blindness or SVI. In the VC, 8211 people were examined in 4 years.

Conclusion:

The reduction of blindness and MSVI in the urban area of Pune can be partly ascribed to the presence of a VC and attendant screening in this locality.
Evaluation of retinal microvasculature according to stable chronic obstructive pulmonary disease severity and the correlation of pulmonary parameters with optical coherence tomography angiography findings
Authors: Kurtul Bengi Ece , Cakmak Ayse Idil , Kasapoglu Dilek Ezgi , Dikmen Nursel
Published: May 2022

Purpose:

To evaluate the retinal and optic disc microvascular changes according to disease severity in patients with stable chronic obstructive pulmonary disease (COPD), and the correlation of pulmonary parameters with optical coherence tomography angiography (OCTA) findings.

Methods:

Forty patients with COPD and 30 age- and sex-matched subjects (control group) were included in this cross-sectional prospective study. The COPD group was then divided into two subgroups according to GOLD classification and disease severity as mild-to-moderate COPD group (group 1) and severe COPD group (group 2). OCTA was performed with 6 mm × 6 mm sections for the macula and 4.5 mm × 4.5 mm sections for the optic disc. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, and vessel density in different sections of the retina and optic disc were analyzed.

Results:

The mean ages, gender, intraocular pressures, peripapillary RNFL thickness, FRT, and optic disc vessel densities were similar among the groups. Compared to the control group and group 1, group 2 showed significantly lower mean foveal vessel density measurements in superficial and deep capillary plexus (P = 0.014 and P = 0.007, respectively). Cigarette packets/year, exacerbation per year, and Modified Medical Research Council showed significant negative correlations, whereas forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity showed significant positive correlations with foveal vessel densities.

Conclusion:

COPD severity seems to have a negative effect on OCTA measurements. OCTA may reflect the severity of inflammation and hypoxia in COPD and may provide useful detailed information on the role of retinal vascular changes in the follow-up and progression of patients with COPD.
Comparison of ocular biometry and refractive outcome between ANTERION and IOL Master 700
Authors: Panda Amita , Nanda Ashok , Sahoo Kalyani
Published: May 2022

Purpose:

To assess the comparability of ocular biometry measurements and refractive outcomes between ANTERION and IOL Master 700.

Methods:

This comparative prospective study was conducted from December 2020 to February 2021. A total of 225 patients who had cataracts were enrolled for the study and different parameters such as anterior keratometry (Steep K, Flat K) with axis, Sim K, central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), and axial length (AL), white-to-white (WTW) were evaluated in IOL master 700 first and then with ANTERION. Finally, 203 patients completed the 6-week follow-up and the postoperative refraction was done at the 6th week. To assess the agreement between the devices, intraclass coefficient (ICC) and Bland–Altman analysis with 95% limits of agreement (LoA) were used. To analyze the agreement for postoperative residual refractive error between the two devices, Kappa statistics were used.

Results:

The mean difference for steep K, flat K, and Sim K between ANTERION and IOL Master 700 were − 0.18 +/−0.26 D, −0.13+/− 0.28D, −0.15 +/−0.23, respectively. The CCT, ACD, and LT also showed excellent agreement (ICC > 0.9) but the similarity for the keratometry axis was not up to the mark (ICC = 0.794). For postoperative refractive outcomes, the Kappa value was 0.437, indicating moderate agreement.

Conclusion:

ANTERION showed a good agreement for the majority of parameters with IOLMaster 700 in measuring ocular biometry, except for the keratometry. The accuracy of the intraocular lens power calculations was clinically acceptable with both biometers though the IOL power given by ANTERION remained slightly on the hypermetropic side.
Clinicopathological study of parasitic lesions of the eye and ocular adnexa in a tertiary care ophthalmic center in South India
Authors: Mahesh Meenakshi , Pauly Marian , Krishna Shruthi M , Raman M , Biswas Jyotirmay
Published: May 2022

Purpose:

To study clinical and pathological features of parasitic lesions in the ocular adnexa in a tertiary care ophthalmic center in south India.

Methods:

43 cases of ocular parasitosis were analysed clinically and correlated with the pathological findings (gross morphology and histopathology) over a period of five years (2015–2020).

Results:

Among the 43 cases, the age group ranged from 9 months to 78 years (mean age of 41.6 years). Female patients were more common than male patients, with a percentage of 63% (27) and 37% (16) respectively. Cystic lesion in the lid or orbit was seen in 23 cases (53.4%); solid mass lesions were seen in 17 cases (39.5%); subconjunctival worms in three cases; and subretinal parasite in one. Gross examination and histopathologic study showed Dirofilaria in 23 cases (53.5%), followed by Cysticercus in six cases (14%) and Microfilariae in four cases (9.3%). Exact species identification was not possible in ten cases (23.25%). Correlation between the type of lesion and type of inflammatory cells with the specific parasite was done.

Conclusion:

Our study showed that important clinicopathological correlations can be made from the parasitic lesions in the eye and adnexa, which can aid in definitive diagnosis and prompt identification of the parasite for patient management.
Emerging antimicrobial resistance and need for antimicrobial stewardship for ocular infections in India: A narrative review
Authors: Biswas Partha , Batra Sneha , Gurha Neha , Maksane Nitin
Published: May 2022

Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.
Clinical profile and demographic distribution of band shaped keratopathy in India: A study of 8801 patients
Authors: Das Anthony V , Pillutla Lalitha N , Chaurasia Sunita
Published: May 2022

Purpose:

To describe the clinical profile and demographic distribution of band-shaped keratopathy (BSK) in patients presenting to a multitier ophthalmology hospital network in India.

Methods:

This cross-sectional hospital-based study included 2,664,906 new patients presenting between January 2011 and January 2021 (10-year period). Patients with a clinical diagnosis of BSK in at least one eye were included as cases. The data were collected using an electronic medical record system.

Results:

Overall, 8801 (0.33%) patients were diagnosed with BSK. The prevalence rates were 0.47% in children (age: <16 years) and 0.31% in adults. The majority of patients were males (62.87%) with unilateral affliction (85.21%). The mean age of the patients was 40.43 ± 23.14 years. The majority (16.93%) of the patients were in the age bracket of 11–20 years. A larger proportion of the patients were from higher socioeconomic status (60.46%) and the urban region (45.9%). Of the 10,103 eyes affected with BSK, the common ocular comorbidities were status post-vitreoretinal surgery (20.55%) and uveitis (12.7%) in children and corneal scar (41.23%) and spheroidal degeneration (13.7%) in adults. Most of the eyes had mild or no visual impairment (24.74%). Among the eyes that needed surgical intervention, chelation with ethylenediaminetetraacetic acid (EDTA) was the most performed surgical procedure (1.68%) along with phototherapeutic keratectomy (0.32%).

Conclusion:

BSK commonly affects adult males and is unilateral in nature. The majority of the patients in this cohort belonged to higher socioeconomic strata and urban geography. At initial presentation, visual impairment was mild to moderate in a vast majority of the patients, and the most common surgical intervention performed was chelation with EDTA during the study period.
Changes in ocular surface after withdrawal of anti-glaucoma medications following non-penetrating deep sclerectomy
Authors: Fuente-García Carlota , Muñoz-Negrete Francisco José , de Dompablo Elisabet , Moreno-Montañés Javier , Rebolleda Gema
Published: May 2022

Purpose:

To analyze the ocular surface changes in eyes after the withdrawal of anti-glaucomatous drugs when non-penetrating deep sclerectomy (NPDS) is performed.

Methods:

Thirty-one patients (33 eyes) diagnosed with glaucoma that underwent NPDS were included in this prospective study. The control group included 33 eyes. Four variables were studied using Keratograph 5M (K5M): ocular hyperemia (OH), non-invasive tear film break-up time (NI-BUT), lower tear meniscus height (LTMH), and meibography. LTMH was also measured using the anterior segment module of a Spectralis Fourier-domain optical coherence tomography (FD-OCT) instrument. Moreover, an evaluation of corneal and conjunctival staining was performed. In the glaucoma group, five visits were carried out: pre-surgery, 1 week after surgery, and 1 month, 3 months, and 6 months after surgery. In control groups, examinations were performed in only one visit. In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and 6 months after surgery.

Results:

Before NPDS, eyes showed worse objective data than healthy control subjects (P ≤ 0.049). In this group, a significant improvement was observed in questionnaire responses (P < 0.001), LTMH-FD-OCT (P = 0.037), LTMH-K5M (P = 0.025), K5M-OH (P = 0.003), NI-BUT (P = 0.022), and conjunctival and corneal staining (P < 0.001). No significant differences were observed between groups in FD-OCT and K5M LTMH, NI-BUT, corneal-conjunctival staining, nor in the most OH sector values at 6 months (P ≥ 0.62).

Conclusion:

A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawal of the topical anti-glaucomatous treatment had a beneficial effect on the subjects.
Photo-activated chromophore for infectious keratitis cross-linking and its efficacy as a treatment modality in managing microbial keratitis
Authors: Saini Sanchita , Singh Satyaprakash , Dwivedi Kshama , Singh Sanskriti , Kumar Santosh , Rana Jagriti
Published: May 2022

Purpose:

To assess Photo Activated Chromophore for Infective Keratitis-Cross Linking (PACK-CXL) and its efficacy as a treatment modality in managing microbial keratitis.

Methods:

Single Centre prospective interventional study in infectious keratitis. A total of eleven patients were taken who had corneal thickness (CT) more than 400µm. PACK-CXL was performed according to Dresden’s protocol. The response was assessed by slit lamp examination, BCVA and AS-OCT at the time of complete healing.

Results:

The mean visual acuity at presentation was 1.207logMAR (0.3-3) which improved to mean value of 0.53logMAR (0.3-1). Mean time taken for complete epithelization was 17.45 days (14- 30 days) and that for complete healing was 33.72 days (21- 60 days). Mean CT at the baseline was 650.5± 108µm which reduced on consecutive follow up visits. There was reduction in the symptoms in nine patients except in two. One case reported increase in symptoms with worsening increase in endoexudates and hypopyon, and the other developed drug toxicity due to topical medications.

Conclusion:

Patients who underwent PACK-CXL showed good and early healing, good remodelling of cornea and improved visual acuity. The recalcitrant cases became responders to the same medications after PACK-CXL. Thus, PACK-CXL works well for both fungal and bacterial keratitis.
Corneal densitometry in patients with arcus senilis and its correlation with serum lipid levels
Authors: Yilmaz Yusuf Cem , Ipek Sefik Can , Ozer Muhammet Derda , Celebi Tugba
Published: May 2022

Purpose:

To evaluate corneal densitometry (CD) of patients with arcus senilis (AS) and its association with the serum lipid markers.

Methods:

This is a cross-sectional, case-control study. The AS diagnosis was made clinically. Forty-five eyes of 45 patients with AS and 38 eyes of 38 age-matched control subjects with no noticeable AS were enrolled in the study. All participants underwent detailed ophthalmologic examination along with corneal Scheimpflug imaging with CD measurement. The evaluated serum lipid markers of the participants included total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL). The Spearman correlation analysis was used to correlate the serum lipid values and the CD. P < 0.05 was defined as statistically significant.

Results:

The male to female ratio was 26/19 and 14/24 in the study and control groups, respectively (P = 0.057). The mean age was 59.56 ± 8.7 and 56.47 ± 8.6 years in the study and control groups, respectively (P = 0.117). The mean total CD values in the zones extending from 2 to 12 mm were higher in the study group than in the control group (P < 0.001). The serum HDL level was found to be significantly decreased in the study group compared to the control group (P = 0.048 and Z = −1.976). There was a significant positive correlation between the serum triglyceride level and the CD value of the outermost zone (10–12 mm) (r = 0.334 and P = 0.025).

Conclusion:

The CD of patients with AS was found to increase not only in the peripheral zone but also in the cornea’s paracentral zone compared to the healthy controls. The serum triglyceride level should give an insight into the intensity of arcus senilis. The serum HDL levels were decreased in patients with AS.
Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts
Authors: Kodavoor Shreesha K , Tamilarasi S , Dandapani Ramamurthy , Ramamurthy Chitra , Sachdev Gitansha S
Published: May 2022

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26-G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25-G flat-tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.
The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project “Fixing the missing link”: Prevalence data from Madhya Pradesh and Chhattisgarh
Authors: Biswas Partha , Batra Sneha , Porwal Amit C , Prasad R Krishna , Bawankule Prashant , Saxena Rohit , Sinha Satyajit , Ghosh Prajjwal
Published: May 2022

Purpose:

To determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in the states of Madhya Pradesh (MP) and Chhattisgarh (CG).

Methods:

Diabetic patients were screened in the treating diabetologist/physician’s clinic by a team that included an ophthalmologist, an optometrist, and a counselor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera.

Results:

In total, 602 subjects were screened across five selected locations of MP and CG. The prevalence of DR was 13.62%. No significant difference with gender was seen. The presence and grade of DR were related to age, diabetic age, and diabetic control.

Conclusion:

This study provides the prevalence data for DR among diabetic patients from the states of MP and CG and highlights important barriers to DR screening in our country.
Clinical profile and long term outcomes of eyes with choroidal detachment following trabeculectomy
Authors: Rao Sanjana , Maheshwari Devendra , Pawar Neelam , Kadar Mohideen A. , Ramakrishnan Rengappa , Uduman Mohammed S
Published: May 2022

Purpose:

To assess the long-term outcomes of choroidal detachments (CDs) in eyes following trabeculectomy.

Methods:

Retrospective comparative case series. Data of patients with CDs following trabeculectomy (5-year period) with or without cataract surgery with a minimum of 3 months of follow-up were included.

Results:

In total, 45 patients with CDs following trabeculectomy were included. The mean age was 63.27 ± 8.68 years, (M:F = 2:1); 29 of 45 eyes (64.4%) had a baseline IOP of >24 mm Hg. Patients had a median follow-up of 22.2 (IQR: 16.2–30.5) months. Further, 10 of 45 eyes (22.2%) had CDs following suture lysis. The median onset of choroidal detachment from the time of surgery was 16.0 (IQR: 11–36) days. The mean BCVA improved from 0.62 ± 0.28 to 0.24 ± 0.27 (P < 0.001) and mean IOP increased from 4.07 ± 2.66 to 11.20 ± 5.31 (P < 0.001) at last visit. The cumulative success rates were 76.4% (95% CI: 48.4–90.5) in POAG eyes and 79.3% (95% CI: 62.8–89.1) in PACG eyes (P = 0.547). Medical management was the mainstay in all patients. Four of 45 (8.88%) patients underwent subsequent choroidal drainage.

Conclusion:

Choroidal detachment following modern-day trabeculectomy has favorable long-term visual acuity and IOP outcomes. There was no difference in the long-term surgical success of trabeculectomy with choroidal detachments in primary angle-closure and open-angle glaucoma eyes. Long-term follow-up is essential to prevent chronic hypotony and trabeculectomy failure.
Rhinosporidiosis of the lacrimal sac in a tertiary care hospital of India - A retrospective case study
Authors: Behera Sharmistha , Chowdhury Ravindra Kumar , Dora Jayashree
Published: May 2022

Purpose:

Though rhinosporidiosis of the lacrimal sac is a rare disease across the globe, the frequency with which these patients come to the outpatient department in western Odisha is quite alarming. This study was undertaken to upgrade the knowledge about the clinical profile and management of rhinosporidiosis of the lacrimal sac.

Methods:

This is a retrospective study comprising 32 clinically diagnosed and histopathologically proved cases of lacrimal sac rhinosporidiosis who were managed with dacryocystectomy with meticulous excision. Intraoperative copious irrigation with 5% povidone–iodine for 5 min and postoperative dapsone therapy for 3–6 months had been administered to all the patients. The mean follow-up period was 16.7 months. The study was conducted over 5 years from August 2015 to July 2020.

Results:

Rhinosporidium seeberi, an aquatic protistan parasite, was found to be the causative agent. Males and females were affected equally. Children less than 10 years of age comprised 56.2% (18 cases). History of pond bathing was found in 100% of cases. The most common presentation was boggy swelling over the lacrimal sac. The involvement was unilateral in all the cases. None of the patients were found to have nasal involvement. In 65.6%, the lesion was limited within the sac. Recurrence was noted in 25% of cases.

Conclusion:

Rhinosporidiosis of the lacrimal sac should be excluded in all patients presenting with boggy swelling of the lacrimal sac with a history of pond bath. The recurrence can be minimized by meticulous excision, intraoperative betadine, and postoperative dapsone therapy.
Histopathological analysis of residual lens cells in capsular opacities after cataract surgery using objective software
Authors: Mastromonaco Christina , Balazsi Matthew , Coblentz Jacqueline , Toledo Dias Ana Beatriz , Zoroquiain Pablo , Burnier Miguel N
Published: May 2022

Purpose:

Remnant lens epithelial cells (LECs) within the capsular bag (CB) undergo epithelial-to-mesenchymal transition (EMT) and acquire a myofibroblast phenotype, depositing extracellular matrix (ECM) components, leading to posterior capsular opacification (PCO). This study histopathologically analyzes the LEC-to-myofibroblast transition and de novo ECM component deposition (i.e., smooth muscle actin (SMA) and fibronectin (FN) expression) and determines the intraocular lens (IOL) and patient factors associated with these changes.

Methods:

In total, 190 CBs with IOLs were removed from donor eyes. Digital images were obtained, and PCO was graded using published software (ADOS, Medical Parachute). Automated immunohistochemistry was performed using anti-SMA to detect EMT and anti-FN to document ECM remodeling. Slides were digitized and analyzed using the Positive Pixel Count v9 algorithm. Linear regression and Poisson regression were performed (P < 0.05).

Results:

SMA positive expression decreased as the time of IOL implantation increased (P < 0.0001). Positivity of SMA and FN demonstrated a positive correlation (P = 0.0002). Controlling for confounding factors in Poisson regression, hydrophobic and hydrophilic materials showed higher FN and SMA expression when compared to silicone material lenses (FN; P = 0.018; P < 0.0001, SMA; P = 0.001; P = 0.003, respectively). The square optic design had 29% higher SMA positivity compared to the opti-edge design (P = 0.042). One-piece haptic lenses had higher SMA expression compared to three-piece haptic (P = 0.042). A higher risk of expression of SMA and FN was seen in patients with a history of smoking, hypertension, and glaucoma (P < 0.05).

Conclusion:

This study demonstrated that SMA and FN expression is different according to IOL design and patient factors, thus indicating that LEC changes depend on lens biocompatibility. Therefore, by analyzing the histopathological composition of PCO by using LECs, further insight into the characteristics of IOLs that are important for biocompatibility can be ascertained.
Necrosis of uveal melanoma post-COVID-19 vaccination
Authors: Wagle Ajeet M. , Wu Bing Cheng , Gopal Lingam , Sundar Gangadhara
Published: May 2022

A 49-year-old Indian male presented with rapidly progressive vision loss 1 day after receiving the second dose of BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine (Pfizer-BioNTech, NY, USA). The eye had secondary angle closure glaucoma, bullous retinal detachment, and massive intraocular hemorrhage. Ultrasound showed an ill-defined subretinal mass with moderate internal reflectivity. Magnetic resonance imaging (MRI) confirmed an enhancing heterogeneous subretinal mass. Histopathology showed a necrotic melanocytic lesion arising from the posterior edge of the ciliary body and choroid. Necrotic uveal melanoma was confirmed after expert histopathology opinion. Uveal melanomas can rarely present with tumor necrosis following mRNA COVID-19 vaccination.
Efficacy of nebulized magnesium sulfate in moderate bronchiolitis
Authors: Guruprasad N. , Gopalakrishna Mithra C. A. , Ratageri Vinod H.
Published: May 2022

Background:

Bronchiolitis is a common cause of illness and hospitalization in infants and young children. The effectiveness of various bronchodilators remains unclear. This study was conducted to assess the efficacy of nebulized magnesium sulfate in hospitalized children with moderate bronchiolitis in the age group of 1–24 months.

Subjects and Methods:

This was a prospective observational study done from December 2018 to June 2020. All children with moderate bronchiolitis (clinical severity score [CSS]-4–8) meeting inclusion/exclusion criteria were enrolled. A detailed history, demographic profile, CSS and oxygen saturation in room air, and heart rate were recorded. They were given two doses of magnesium sulfate in the form of nebulization for 10 min each, at 30 min apart. The children were assessed for CSS at 0 h, 1 h, and 4 h after nebulization. The children were considered improved if CSS <4 at the end of 4 h. The children were monitored for adverse reactions of magnesium sulfate.

Results:

Sixty children were enrolled. The mean age was 7.5 ± 6.47 months. Most children (51.7%) were in 1–6 months. The mean CSS scores at 0 h, 1 h, and 4 h were 6 ± 1.008, 2.95 ± 1.395, and 2.40 ± 1.564, respectively (P = < 0.001). Fifty-three (88.3%) children improved and seven (11.7%) children did not improve. In nonimproved group, subanalysis was done and found hypoxia (odds ratio − 12.6) as a significant risk factor. Flushing was the most common adverse effect noticed in eight (13.3%) children.

Conclusions:

Children with moderate bronchiolitis were improved with nebulized magnesium sulfate.
Non-Surgical Management Of Mild To Moderate Splenic Injuries In Blunt Abdominal Trauma
Authors: Aparna S. , Ragesh K. V.
Published: May 2022

Introduction:

The spleen is the most frequently injured solid organ following blunt abdominal trauma. Non-operative management (NOM), either medical or radiological intervention, is currently favoured in haemodynamically stable patients, while surgery is indicated in haemodynamic instability.

Objectives:

The objectives were as follows: (1) to study the outcome of non-surgical management of mild-to-moderate splenic injuries in blunt abdominal trauma and (2) to analyse factors affecting the outcome of NOM.

Materials and Methods:

An observational study was conducted in 63 patients with blunt splenic injury undergoing NOM in the department of general surgery from August 2019 to August 2020. All patients were monitored till discharge. Statistical analysis was done using SPSS software.

Results:

Fifty-eight out of 63 patients (92.06%) were successfully managed non-operatively. Five (7.94%) patients underwent surgical management within 48 h following trauma due to haemodynamic instability. Age group (P = 0.804), gender (P = 0.773), history of coronary artery disease (CAD) (P = 0.187) and use of antiplatelet drugs (P = 0.083) had no significant association with the outcome of NOM. Tachycardia and hypotension at admission, quantity of haemoperitoneum and contrast-enhanced computed tomography (CECT) grade of splenic injuries significantly correlated failure of NOM (P < 0.00001). Hospital stay was longer in surgical patients.

Conclusions:

NOM is successful in majority of haemodynamically stable patients. Age, gender, history of CAD and use of antiplatelet drugs had no impact on the outcome. Haemodynamic instability, severity of splenic injury in CT scan and need for transfusions predicted the need for surgery. The amount of blood in the peritoneum was more with the use of antiplatelets and higher grade of splenic injury in the CECT scan.
Effect of Perioperative Immunonutrition Supplementation in Patients Undergoing Living Donor Liver Transplantation
Authors: Agarwal Jaya , Saju Ansa , Ravindran Greeshma C. , Sudhindran S.
Published: May 2022

Introduction:

It is pertinent to study the effect of perioperative immunonutrition (IMN) supplementation in adult patients undergoing living donor liver transplantation (LDLT).

Materials and Methods:

A randomised controlled pilot trial was conducted in 20 patients admitted at Amrita Institute of Medical Sciences, Kochi, between November 2018 and January 2019. By means of computer-generated random numbers, 20 patients were allocated to IMN (Pentasure Immunomax® containing omega-3 fatty acids, L-arginine and ribonucleic acid salts) or control (CON; Accumax Advance® which is a standard protein supplement) group in 1:1 ratio. The supplements were provided from pre-operative day 7 and restarted postoperatively as soon as oral intake was resumed for 2 weeks. The primary endpoint was the length of intensive care unit (ICU) and hospital stay. The secondary endpoints included anthropometric measurements (triceps skinfold thickness [TST], mid-upper arm circumference and weight measured on pre-operative day 1 and post-operative day [POD] 30), biochemical parameters (liver function test assessed on pre-operative day 1 and POD 9) and infectious complications.

Results:

Significant improvement in TST from pre-operative day 1 to POD 30 was seen in the IMN group (7.45 ± 5.45–9.20 ± 6.12, P = 0.049) but not in the CON group (5.40 ± 2.27–5.00 ± 3.02, P = 0.438). Weight loss percentage was also lower in IMN in comparison to CON (10.09 ± 6.01 vs. 15.56 ± 4.39, P = 0.050). However, the length of ICU and hospital stay, biochemical parameters and rate of infection were statistically similar in both the groups.

Conclusion:

In patients undergoing LDLT, perioperative IMN supplementation provided enhancement in the anthropometrical parameters, although this did not translate into lesser hospital or ICU stay. A larger sample size will help in providing more insight into the beneficial effects of the IMN supplementation.
Diagnostic Validity of X-rays in Detection of Hollow Viscus Perforation
Authors: Jose Ajay M. , Saanida M. P. , Gopi E. V.
Published: May 2022

Introduction:

Identification of a small amount of free intra-abdominal gas remains one of the most significant signs in a perforated viscus. This paper tried to evaluate the sensitivity of chest radiographs in the detection of hollow viscus perforation and to compare the sensitivity of left lateral decubitus view and chest radiograph posteroanterior (PA) view in the detection of pneumoperitoneum.

Methodology:

Diagnostic validation study was conducted in sixty patients with clinical signs of peritonitis and strongly suspected to have perforation were evaluated with chest radiograph PA view and left lateral decubitus view in search of pneumoperitoneum and confirmed during laparotomy.

Results:

Out of sixty patients, 54 had gastrointestinal (GI) perforation and 42 out of those 54 were diagnosed in plain chest radiograph. Rest 12 required contrast enhancement computerised tomogam for diagnosis. There was only one case reported with chest radiograph showing pneumoperitoneum and the patient without any breach in the GI tract. Thirty patients with perforation took a left lateral decubitus view which showed free air only in 23 cases.

Conclusion:

Sensitivity of left lateral decubitus was around 76.6%. Overall, the sensitivity of plain chest radiograph in diagnosing perforation was 77% with specificity 83%, positive predicative value 97.6%, negative predicative value 29.4% and an accuracy of 79.6%.
Complications after Total Thyroidectomy According to Clinical and Pathological Diagnosis
Authors: Jyothin C. , Oomen Alex
Published: May 2022

Introduction:

Total thyroidectomy carries risk of complications. Although mortality is rare, morbidity is still seen.

Objectives:

This study aimed to compare the immediate complications after total thyroidectomy in relation to pathological diagnosis.

Materials and Methods:

This paper studied 170 patients undergoing total thyroidectomy. Post-operative complications were compared according to histopathology.

Results:

Patients were grouped into benign (103), thyroiditis (13) and malignancy (47). Complications included post-operative hypocalcaemia (20%), seroma (2.4%), voice change (11.8%), dysphagia (17.6%) and post-operative haemorrhage (1.2%).

Conclusion:

There was no statistically significant difference in occurrence of complications after total thyroidectomy with respect to clinical and pathological diagnosis.