bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term result of combined ab externo Schlemm’s canal surgery and phacoemulsification in management of open angle glaucoma in cataract patients
Authors: Dushina Galina , Kumar Vinod , Frolov Mikhail , Bezzabotnov Andrej , Shradqa Ahmad , Lukyanenko Viktoriya
Published: January 2022

Purpose

To evaluate the effectiveness of segmental Schlemm’s canal (SC) distension using Kumar’s Schlemm’s canal expander (SCE) in decreasing intraocular pressure (IOP) in cataract patients suffering from open angle glaucoma (OAG).

Methods

Between October, 2012 and March, 2020 in a prospective interventional case series study. SCE device, made from 0.04 mm thick medical grade stainless steel wire, having inner lumen diameter of 0.12 mm and outer – 0.2 mm, 4–5 mm long was implanted into SC ab externo after completion of cataract surgery of 59 patients (38 male and 21 female; average age – 75.47 ± 6.2 years) suffering from OAG. Outcome measures were IOP change, number of glaucoma medications pre‐ and postoperatively and complications. Success rates were evaluated using World Glaucoma Association guidelines. A paired t‐test was used for analysis. Results were significant when p less than 0.05.

Results

Mean preoperative IOP was 28+/–4.7mmHg and mean number of medications – 2.4 ± 0.8. At 4 years mean IOP reduced by 27%+/–15.5% and was 20,4+/–4,9 (n=59; p=.0000006) use of medications reduced to 1 ± 1.2 (p = 0.0000001). Complete success was achieved in 24% (14/59) cases and partial – in 49% (29/59) respectively. Intraoperatively, microperforation occurred in 5 cases (8.5%). Postoperatively, 6 cases (10%) required YAG laser trabeculopuncture to control IOP. In these cases, one end of SCE was lying in anterior chamber angle without contact with intraocular structures. Postoperatively, specific complications related to SCE were rare. In one case the body of SCE ruptured TM because of extra pressure put on eye ball while inserting goniolens. Both ends of the expander were embedded in SC. Patient’s IOP was under control with one medication.

Conclusions

Combined surgery phacoemulsification with intraocular lens implantation and SCE implantation in surgical management of OAG in cataract patients show significant reduction in IOP from the baseline and in hypotensive medication(s) use in long‐term period.
Influence of sex on neuroretinal degeneration: 6 month follow‐up in rats with chronic glaucoma
Authors: Rodrigo Maria Jesus , Perié Manuel Subías , Martinez‐Rincon Teresa , Campo Lorena Arias , Altabás María José Vicente , Tello Alvaro , Castro‐Roger Luisa , Palomar Elisa Viladés , Ciordia Beatriz Cordón , Garcia‐Herranz David , Garcia‐Martin Elena
Published: January 2022

Purpose

To evaluate differences by sex in the neuroretina of rats with chronic glaucoma (CG) induced by two different methods of increased ocular hypertension (OHT) vs healthy animals (HA).

Methods

Forty‐six Long Evans rats (18 males, 28 females) with CG and paired HA were analyzed. Glaucoma was achieved by sclerosing the episcleral veins or by injecting microspheres into the anterior chamber. Intraocular pressure was measured every week by Tonolab® tonometer, neuroretinal function was recorded by dark/light‐adapted RETIanimal® electroretinography (ERG) at 0, 12 and 24 weeks; and structure was analyzed by Spectralis high definition Heidelberg® optical coherence tomography (OCT), using the Retina, Retinal Nerve Fiber Layer (RNFL) and Ganglion Cell Layer (GCL) protocols at 0, 8, 12, 18 and 24 weeks.

Results

Males showed statistically significant higher IOP in both CG models and HA (p < 0.05). Greater differences were found in the episcleral model at early stages. Males with episclerally induced glaucoma showed higher increase (p < 0.05) in retinal thickness in OCT recordings than its females, microspheres model and HA. CG rats showed bigger thickness loss of RNFL and GCL (p < 0.05) comparing HA. Males showed a higher percentage of RNFL thickness loss (p < 0.05) in both models and HA. No differences by sex were observed in GCL thickness in the episcleral model, but comparison in microspheres model and HA showed differences. Males exhibited worse dark/light‐adapted functionality in CG models (p < 0.05), with worsened in the episcleral model at 12 weeks, than paired females and HA.

Conclusions

Male rats experienced higher IOP, structural loss and worse neurorretinal functionality than females under physiological and glaucomatous conditions. Sex and the OHT‐inducing method influenced neuroretinal degeneration.
Has the use of optical coherence tomography in community optometrists’ referrals improved diagnostic accuracy for glaucoma?
Authors: Yang Yingjia , Thornton Richard , Lockwood Alastair , Kirwan James
Published: January 2022

Purpose

In recent years, community optometry practices have begun to use optical coherence tomography (OCT) as part of glaucoma assessment, the result of which is increasingly cited as a reason for referral into hospital glaucoma clinics. We aim to assess whether the addition of OCT scanning has improved diagnostic accuracy of glaucoma referrals from community optometry practices.

Methods

A prospective observational study was conducted, which includes all glaucoma referrals from community optometrists to the Portsmouth Glaucoma Referral Refinement (GRR) scheme from July 2019 until February 2020. Patient demographics, tests performed, reasons for referral, and the final diagnosis from glaucoma clinic were collated. A positive diagnosis includes open angle glaucoma, ocular hypertension, glaucoma suspect and narrow angle glaucoma.

Results

A total of 248 eligible referrals were analysed. Overall, the positive predictive rate was 20% (n = 50), which is similar to previous audits of glaucoma referrals in Portsmouth (1). 25 subjects had an OCT scan as part of their referral, and the OCT given as a reason for referral in 24 of these cases. 25% (n = 6) resulted in a positive diagnosis; however, all these patients had at least 2 other abnormal tests at initial assessment (from IOP, disc appearance, and visual field testing) which were also reasons for referral, suggesting they would have been referred regardless of the OCT. In six cases, the only reason for referral was OCT findings, none resulted in a positive diagnosis after clinic review. The highest PPV (75%, n = 6) was achieved when all three of IOP, disc, and visual field were given as reasons for referral.

Conclusions

The use of OCT in glaucoma assessment at community optometry practices is still not very widespread. This early evidence suggests OCT performed by community optometrists does not improve diagnostic accuracy of referrals into hospital eye services.

Reference

1. Lockwood, A., Kirwan, J. and Ashleigh, Z., 2010. Optometrists referrals for glaucoma assessment: a prospective survey of clinical data and outcomes. Eye, 24(9), pp. 1515–1519.
Evaluation of OCT parameters in the patients with pseudo exfoliation and normal IOP: an OCT angiography study
Authors: Halkiadakis Ioannis , Tzimis Vasillis , Vernikou Anna , Kollia Elpida , Markopoulos Ioannis , Tzakos Michalis
Published: January 2022

Purpose

To compare peripapillary retinal nerve fiber layer thickness (RNFL), ganglion cell complex (GCC) optic nerve head vessel density (VD) results measured using optical coherence tomography angiography (OCTA) in the patients with pseudoexfoliative syndrome (PEXS) with aged‐matched healthy individuals.

Methods

The RNFL, GCC and papillary VD of 40 eyes of patients with PEXS and 40 eyes of aged‐matched normal controls were examined using OCTA (AngioVue™). Patients with increased IOP and or signs of glaucoma were excluded from the study. The VD was measured with a 4.5 × 4.5 mm papillary scan. VD was calculated by an automated density measuring tool in the AngioVue™ software.

Results

Mean age of PEXS patients was 76.5 ± 6.6 and of healthy controls was 72.4 ± 9.2 (p = 0.18). There were no significant differences in RNFL and VD values of all regions in eyes compared to control eyes (p < 0.05 for all comparisons).

Conclusions

There is no difference in RNFL and peripapillary VD between healthy eyes and PEXS eyes with normal IOP.
Surgical management of ophthalmic abnormalities in Peters plus syndrome: case report
Authors: Monia Cheour , Fehmy Nafaa , Meriem Ouederni , Maamouri Rym , Hela Sassi , Chelly Zied
Published: January 2022

Purpose

To report a case of a patient with Peters plus syndrome (PPS) who underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy.

Methods

A four‐year‐old female with bilateral central opacified cornea was referred to our department for corneal transplantation. Slit‐lamp examination demonstrated horizontal nystagmus, bilateral central corneal opacity and iridocorneal adhesion without lenticular involvement, which is characteristic of type I Peters anomaly. Intraocular pressure was 22 mmHg in the right eye and 26 mmHg in the left eye. Posterior segment ultrasonography showed no vitreous or retinal abnormalities. General and systemic examination revealed short stature and developmental delay without any other abnormality. The diagnosis of PPS was clinically made. The patient underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy of her left eye that was more affected.

Results

Six months postoperatively, corneal graft was clear with normal depth anterior chamber and normal intraocular pressure. For the right eye, the patient was put on antiglaucomatous eye drops while waiting for corneal transplantation

Conclusions

Glaucoma was proven to be a significant risk factor for graft failure and rejection after penetrating keratoplasty for Peters anomaly(1). In this case, combined surgeries were performed to allow better visual outcome and intraocular pressure control.

Bibliography

1. Dolezal KA, Besirli CG, Mian SI, Sugar A, Moroi SE, Bohnsack BL. Glaucoma and Cornea Surgery Outcomes in Peters Anomaly. Am J Ophthalmol 2019;208: 367–375.
Oxygenation in glaucoma patients: Influence of age and oxidative stress
Authors: Türksever Cengiz , Todorova Margarita G.
Published: January 2022

Purpose

To evaluate retinal oxygenation in glaucoma patients and to compare it with that of healthy controls.

Methods

Retinal vessel oxygen saturation was measured in 46 eyes of 34 Caucasian individuals with primary open angle glaucoma (POAG) and in 21 eyes of 17 age‐matched controls using the oximetry tool of Retinal Vessel Analyser (RVA: IMEDOS Systems UG, Jena, Germany). The mean oxygen saturation of the major arterioles (A‐SO2) and venules (V‐SO2), as well as the corresponding arterio‐venular difference (A‐V SO2), were calculated. Glaucomatous damage was assessed by Optical Coherence Tomography (Carl Zeiss Meditec, Dublin, CA, USA) and static automated perimetry (Octopus, program G2/ standard strategy: Haag‐Streit International, Köniz, Switzerland). In addition, we calculated the mean retinal oxygen extraction (O2‐E) per micron of nerve fibre layer thickness, O2‐E [µm/%] by dividing the mean retinal nerve fibre layer (RNFL) thickness with the mean A‐V SO2.

Results

In glaucoma patients, A‐SO2 and V‐SO2 values were significantly increased and their difference decreased, when compared to controls (p < 0.017; linear mixed‐effects model). Whereas V‐SO2 and A‐V SO2 were not influenced by age, the A‐SO2 was severely reduced and the O2‐E significantly increased in elderly glaucoma patients, than in younger glaucoma patients (p = 0.003, correspondingly p = 0.004). Also, higher O2‐E in glaucoma patients correlated negatively with the neuroretinal rim area (p < 0.019), and positively with the mean defect of the visual field (p = 0.012)

Conclusions

The presented structure‐metabolic approach supposes that ganglion cells axons in glaucomatous eyes are influenced by aging and are probaly more exposed to oxidative stress, which seems to contribute to progression of glaucomatous damage.
Neuroimaging in normal tension glaucoma: to scan or not to scan?
Authors: Szymanska Maja , Capellan Pamela , Yap Timothy , Cordeiro Maria F.
Published: January 2022

Purpose

To determine the frequency, yield and possible cost implications of brain imaging in patients with normal tension glaucoma (NTG).

Methods

Retrospective case series of patients from a single centre in West London who underwent brain imaging as part of diagnostic workup for NTG between January 2018 and May 2021. The main outcome measures included the frequency of requests, and diagnostic yield for relevant and incidental findings. Secondarily, we examined the prevalence of NTG risk factors and whether they were documented in patient notes.

Results

Notes from 496 patients with NTG were analysed. Among them, 47 (9%) had an imaging scan requested by their ophthalmologist. Only 1 patient (2%) was found to have an intracranial lesion compressing the optic chiasm. Other incidental findings included 1 meningioma (2%), 1 pituitary cyst (2%), and 12 patients showing small vessel disease (26%). The number needed to test for one positive finding was 50 (assuming no tumours were missed). The estimated cost of the scans requested was £64 719. However, the costs of treating a brain tumour can range from £13 200 to £180 000 annually, depending on the grade1. Based on these findings and the literature review, we propose a new guideline based to help clinicians in the evaluation of NTG patients to improve diagnostic yield.

Conclusions

Intracranial compressive lesions are an important differential diagnosis to NTG. However, a more judicious approach to the use of neuroimaging is required.

Bibliography

1. Macmillan Cancer Support. Routes from Diagnosis: The most detailed map of cancer survivorship yet (2014), Pg 46 available at: https://www. macmillan.org.uk/_images/Routesfromdiagnosisreport_tcm9‐265651.pdf.
Automatic segmentation of the waist of the nerve fiber layer at the ONH with AI
Authors: Kisonaite Konstancija , Raeme Faisal , Yu Zhaohua , Sandberg Melin Camilla , Brusini Irene , Bendazzoli Simone , Wang Chunliang , Söderberg Per
Published: January 2022

Purpose

To evaluate a machine learning AI‐tool for automatic segmentation of the waist of the nerve fiber layer at the optic nerve head (ONH).

Methods

OCT‐volumes of the ONH were captured from eyes with early to manifest glaucoma (OCT‐2000) and eyes without glaucoma (OCT‐Triton). The angularly resolved segmentation consisted of first detecting the inner limit of the retina in the OCT volume with AI‐model I. Subsequently, the OCT volume was resampled into 500 radial images distributed at equidistant angles in the frontal plane. In each radial image, the Optic nerve head Pigment epithelium Central Limit (OPCL) was identified manually with a specially developed tool and automatically with AI‐model II. Model II was trained for OPCL location on a training set of radial images. Ground truth was provided as manual annotations. Finally, the Pigment‐epithelium‐Inner‐limit of the retina‐Minimal Distance (PIMD) was estimated at each angle as the shortest distance between OPCL and the closest point on the inner limit of the retina. PIMD estimated both automatically and based on manual annotation of OPCL were compared in a test data set. All radial images in the test data set were manually annotated by three different annotators.

Results

For both groups of eyes examined, the automatic and manual estimates of the angular distribution of PIMD overlapped. The eyes without glaucoma expressed the expected peak thickness of the waist of the nerve fiber layer inferiorly and superiorly, while the glaucomatous eyes lost most of this angular dependence. A 95% confidence interval for the mean difference of automatically estimated PIMD between eyes without glaucoma and glaucomatous eyes was 220 ± 85 μm. An analysis of interobserver variability in PIMD‐estimates demonstrated minor differences.

Conclusions

AI‐based estimation of the waist of the nerve fiber layer at the ONH angularly resolved is reliable and precise enough to detect a difference between early to manifest glaucoma and non‐glaucoma.
Impact of the COVID‐19 pandemic on the glaucoma surgical waiting list
Authors: Cardeñosa Nuria Cuenca , Blazquez Javier Guzman , Martinez Teresa Perez , Fernandez Gonzalez Maria Carmen , Ortega Campos Maria Pilar , Martin Carmen Pizzamiglio , de Paz Sergio Perez , Reina Alfonso Rubio , Diaz Oier Perez
Published: January 2022

Purpose

The purpose is to study the impact caused by the pandemic situation (COVID‐19) on the waiting time for glaucoma surgery and to study the differences between the severity of glaucoma according to the affectation of the visual field in patients included in this surgical waiting list.

Methods

For this, a retrospective random sampling analytical study has been carried out. The cases are the patients included in the glaucoma surgical waiting list of the Toledo Hospital Complex in the pandemic period, from January 2020 to May 2021; and controls are the patients included from July 2018 to December 2019. A total of 99 patients have been recruited. The variables that have been calculated are: the surgical waiting time, the severity of the glaucoma based on the affectation of the visual field through the Modified glaucoma Staging System, age, gender, type of glaucoma, affected eye, need for reoperation and the number of active ingredients needed pre‐ and post‐surgery.

The hypothesis contrast test used for ordinal qualitative variables was the Mann‐Whitney Test, for continuous quantitative variables the Student's t Test for independent data, and the Chi2 Test for dichotomous qualitative variables.

Results

As a result, there are statistically significant differences (p = 0.045) in the degree of severity of glaucoma measured with the Modified glaucoma Staging System, glaucoma being less severe in the group affected by the pandemic. Significant differences have also been found in age, the 2020–2021 group being younger (72.33 ± 10.8 years versus 67.64 ± 11.26 years). There are no statistically significant differences about the need of post‐surgery needling (19.2% in 2018–2019 group versus 17% in 2020–2021 group (p = 0.776)). There are no statistically significant differences in the waiting time for gluacoma surgery between the two groups (68 ± 40.4 days in 2018–2019 versus 78.47 ± 74.35 days in 2020–2021 (p = 0.380).

Conclusions

The impact of the COVID‐19 pandemic seems to have caused that younger patients and patients with less visual field involvement undergo earlier surgery, but it is possible that the onset of progression and the difficulty in check‐ups have led to the need for surgery. On the other hand, it has been possible to maintain the waiting time for surgery similar to the period without a pandemic.
Delayed follow‐up of glaucoma patients due to COVID‐19 pandemic – impact on disease progression
Authors: Szymanska Maja , Normando Eduardo , Cordeiro Maria F.
Published: January 2022

Purpose

To determine the impact of delayed follow‐up on the disease course in patients with glaucoma.

Methods

A retrospective case series of 224 glaucoma patients. Data analysis from the hospital electronic medical record was performed on patients attending the glaucoma clinic between April and May 2021 at Charing Cross Hospital, London, United Kingdom, after easing of the national lockdown due to COVID‐19 pandemic. The main outcome measures included increased intraocular pressure (IOP), worsening of visual field (VF) defect, thinning of retinal nerve fibre layer (RNFL) and the posterior pole using spectral domain Optical Coherence Tomography (OCT).

Results

Notes from 224 patients were analysed. Among them, 24 patients were identified to develop a progression of glaucoma. Majority of patients (10, 42%) had open angle glaucoma, 6 (25%) had normal tension glaucoma, 5 (21%) were glaucoma suspects, 2 (8%) had narrow angle glaucoma and 1 (4%) had angle closure glaucoma. The mean IOP (±SD) pre‐lockdown was 15.4 ± 3.8 mmHg and post‐lockdown was 16.7 ± 5.4 mmHg (p < 0.05). The average RNFL thickness pre‐lockdown was 79.7 ± 15.7 µm and post‐lockdown was 78.8 ± 15.6 µm (p > 0.05). Of the 24 patients who developed progression, 16 had an increase in IOP (mean ∆ IOP was 3.8 ± 1.8 mmHg; p < 0.05), 19 patients had a clinically significant RNFL thinning (mean ∆ was 3.3 ± 1.4 µm; p < 0.05) and 9 patients had worsening of VF. The average timing between pre‐ and post‐lockdown visit was 15.1 months (SD ± 7.6).

Conclusions

These results confirm that a proportion of patients developed glaucoma progression during the COVID Lockdown which could be attributed to delayed follow‐up. Further analyses of these data will be needed to confirm how the results of this study could help to guide future decisions making and guidance on prioritising and managing glaucoma patients if disruption to standard of care occurs.
Glaucoma rose plots: redesigning circumpapillary progression analysis
Authors: Yap Timothy , Davis Benjamin Michael , Bloom Philip , Cordeiro M. Francesca , Normando Eduardo
Published: January 2022

Purpose

To evaluate glaucoma rose plot analysis (RPA), a novel display of circumpapillary optical coherence tomography (OCT) progression data.

Methods

A novel RPA protocol was developed to automatically analyse and display progression analysis of circumpapillary retinal nerve fibre layer (cRNFL) OCT data. A clustering technique was employed to allow circumferential statistical determination of progressing regions of varying widths, without the use of predefined sectors. Results were presented in the form of an angular histogram for each eye. RPA was evaluated using data from primary open‐angle glaucoma (POAG) or POAG suspect eyes and compared to a gold‐standard determined by three clinicians’ assessment of OCT series and linear regression plots. Each eye was graded as ‘progressing’ or ‘stable/unaffected’. Rose plots were assessed using objective and subjective methods to confirm their relevance and practical application. Objectively, the area of red rose petals was compared. Subjectively, rose plots were assessed by three masked assessors as suspicious of progression or not.

Results

A total of 743 scans making up registered series from 98 eyes were analysed. The mean ± SD number of visits was 8.5 ± 3.8 μm in the progressing eyes, and 7.1 ± 2.8 μm in the stable or unaffected eyes (p = 0.06). Rose plots were able to distinguish progressing eyes from stable or unaffected eyes with area under receiver‐operating characteristic curve (AUROC) of 0.968 (95% CI: 0.92–1.00) compared to 0.706 (95% CI: 0.585–0.826) using global cRNFL thickness. Furthermore, agreement on progression status between clinician graders using RPA was greater than when assessing OCT scans and linear regression plots (Fleiss’ kappa = 0.86, 95% CI: 0.81–0.91 compared with 0.66, 95% CI: 0.54–0.77).

Conclusions

Glaucoma RPA is a representative and intuitive progression analysis tool that can improve the reproducibility of clinical decision making. As RPA is a statistical (deterministic) technique not dependent on deep learning, this should facilitate rapid clinical translation.
A comparative study of difluprednate 0.05% nanoemulsion vs prednisolone acetate 1% + phenylephrine 0.12% suspension on postoperative inflammation treatment following cataract surgery
Authors: Valvecchia Gerardo , Kaufer Robert , Ferroni Carlos , Zaldívar Roger , Masseroni Manuela , Idiart Cecilia , Ferroni Valeria , Marino Flavia , Nuñez Myriam , del Papa Melina Sol , Passerini María Silvia
Published: January 2022

Purpose

To investigate if Difluprednate 0.05% nanoemulsion (DIFL) administered once a day (BID) is non‐inferior than Prednisolone acetate 1% + Phenylephrine hydrochloride 0.12% (P+P) administered four times a day (QID), on post‐operative inflammation treatment following cataract surgery.

Methods

A multicentric, randomized, double‐masked, parallel‐group, non‐inferiority study was performed in 259 patients who underwent phacoemulsification. Primary endpoint was corneal thickness. Non‐inferior anti‐inflammatory efficacy was considered if the difference in corneal thickness between baseline and Day 4 did not differ beyond 17 µm between treatments. Secondary endpoints were cell & flare, best‐corrected visual acuity (BCVA), endothelial cell count, OCT‐central macular thickness, and intraocular pressure (IOP). All outcomes were evaluated at baseline, day 1, 4, and 28 after surgery.

Results

225 patients finished the study. The difference in corneal thickness at baseline and Day 4 did not differ beyond 17 µm between treatments (IC95% −2.78 µm – 14.84 µm), with no statistically significant differences between treatments (p = 0.523). There were no statistically significant differences between groups in flare & cells at all study times (p > 0.05). No statistically significant differences were reported between treatments in BCVA (p = 0.455), although BCVA logMAR improved in DIFL group at Day 1 (from 0.198 to 0.177), while P+P group did not improve (from 0.219 to 0.234). No statistically significant differences were reported in endothelial cell count (p = 0.811), OCT‐central macular thickness (p = 0.869), and in intraocular pressure outcome (p = 0.316). At Day 28, four patients reported elevated IOP (>21 mmHg), three of which belonged to P+P.

Conclusions

Difluprednate 0.05% ophthalmic nanoemulsion administered BID is at least as effective as Prednisolone acetate 1% + Phenylephrine 0.12% suspension administered QID on anti‐inflammatory treatment following cataract surgery.
Accommodative and convergence anomalies in patients with opioid use disorder
Authors: Yekta Abbas Ali , Khabazkhoob Mehdi , Ghobadi Mohaddeseh , Hashemi Hassan , Ali Talaee , Fathi Hamidreza , Yekta Yegane , Nabovati Payam , Ostadimoghaddam Hadi , Shandiz Javad Heravian
Published: January 2022

Purpose

To determine the prevalence of accommodative and convergence anomalies and their related factors in a population of young adults with opioid use disorder (OUD).

Methods

This cross‐sectional study was conducted using a convenience sampling method. The study sample included male young adults with OUD who referred to a specialized drug‐dependence rehabilitation center in Mashhad, Iran. The diagnosis of OUD was made by a psychologist based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) criteria. All patients underwent complete optometric examinations.

Results

Eighty male young adults with OUD were included in this study. The mean age of participants was 30.5 ± 3.9 years (age range = 19 to 35 years). The prevalence of accommodative and convergence disorders was 33.75% (95% CI: 23.55–45.19) and 25.00 (95% CI: 15.99–35.94), respectively. Accommodative insufficiency (22.5%, 95% CI: 13.91‐ 33.21) had a higher prevalence than accommodative excess (3.75%, 95% CI: 0.78–10.57) and accommodative infacility (7.50%, 95% CI: 2.80–15.61). Convergence insufficiency (18.75%, 95% CI: 10.89–29.03) had a higher prevalence compared to convergence excess (3.75%, 95% URL: https://mc.manuscriptcentral.com/ceoptom Email: TCEO-peerreview@journals.tandf.co.uk Clinical and Experimental Optometry For Review CI: 0.78–10.57) and basic exophoria (2.50%, 95% CI: 0.30–8.74). According to the multiple logistic regression, a significant inverse relationship was observed between pupil size with accommodative insufficiency (OR = 0.45), accommodative infacility (OR = 0.67), and convergence insufficiency (OR = 0.55).

Conclusions

The results of the present study showed a higher prevalence of accommodative and convergence disorders in OUD patients compared to the prevalence reported in previous studies conducted on the normal populations with a similar age range.
The impact of COVID‐19 on intravitreal injections of anti‐vascular endothelial growth factor (VEGF): experience of a tertiary center in Tunisia
Authors: Aoun Safa Ben , Maamouri Rym , Ouederni Meriem , Nefaa Fehmy , Nabi Wijden , Cheour Monia
Published: January 2022

Purpose

To report the clinical experience of intravitreal injections of anti‐VEGF at a tertiary center of ophthalmology department in Tunisia during the COVID‐19 pandemic.

Methods

Retrospective comparative cross‐sectional study describing the clinical experience of the ophthalmology department in Habib Thameur Hospital in Tunis, Tunisia from the 1st of March 2019 to the 1st of March 2021. Diagnosis, intravitreal injection history, medical history, ophthalmic examinations data were collected and analyzed.

Results

From the1st of March 2019 to the 1st of March 2021, 2463 intravitreal injections of anti‐VEGF were made. The main etiologies were diabetic macular edema in 2003 eyes (82%), age‐related macular degeneration in 284 eyes (12%), retinal vein occlusion in 127 eyes (5%), and other macular diseases in 49 Eyes (1%). Before the Covid‐19 pandemic, from Mars 2019 till February 2020, we made 78 injections per month with only three cases of neovascular glaucoma (NVG) and two cases of vitreous hemorrhage. During the two months of national Covid lockdown, the total number of injections decreased to 39 injections per month. After the lockdown, the number of injections monthly had increased to 138 injections per month. There were no changes in the prevalence of responsible diseases (p = 0.29). Therefore, despite the increase of the number of injections, from May 2020 till March 2021, the number of NVG had risen to 16 and the vitreous hemorrhage to 27 (p = 0.03).

Conclusions

COVID‐19 pandemic has dramatically affected the management and the treatment of eye diseases, and has resulted in a significantly worse short‐term outcomes and more severe ocular impairment.
Establishing intranasal administration as an alternative to intravitreal delivery of fluorescent annexin
Authors: Hill Daniel , Luong Vy , Guo Li , Cordeiro M. Francesca
Published: January 2022

Purpose

DARC (detection of apoptosing retinal cells) facilitates in vivo assessment of retinal pathology using a confocal laser scanning ophthalmoscope. The technology uses fluorescent annexin to mark unhealthy cells in the retina. In vivo imaging of intravitreally administered DARC allows for a unique assessment of neuronal health, applicable to a broad range of neurodegenerative pathologies. To avoid both the potential complications and discomfort arising from intravitreal administration, intranasal delivery of DARC was investigated as an alternative route of delivery.

Methods

5 female 3xTg transgenic Alzheimer’s disease (3xTg‐AD) model mice were used as a model of retinal cell death and 5 C57 mice were used as healthy controls (all animals from The Jackson Laboratory). Intranasal DARC administration involved restraining the animal and applying 5 µL of DARC to each nostril. Retinas were imaged in vivo at baseline and 2 hours after DARC administration a Multiline Spectralis OCT. Animals were then sacrificed, and the retinas were extracted, fixed, and imaged with fluorescent microscopy. Spots were counted using an automated image analysis script for in vivo images.

Results

Intranasal DARC demonstrated discrimination between healthy and diseased eyes in vivo (significantly more spots in disease; p < 0.05) and produced images of similar quality to those acquired from animals receiving intravitreal DARC. A higher intranasal DARC dose was required compared to intravitreal administration (approximately 10‐fold increase).

Conclusions

Intranasal DARC has been shown as a viable alternative to intravitreal administration, thus helping to refine animal procedures. Optimisation of an intranasal buffer to enhance delivery and reduce dose, followed by expansion to rat models are to be established in future work. In the long term, standardisation of administration route to intranasal across animal and human applications may help to improve the applicability of DARC‐based research.
Corneal biomechanics in a pediatric population
Authors: Corbu Cătălina Gabriela , Potop Vasile , Coviltir Valeria , Constantin Mihaela Monica , Dăscălescu Dana‐Margareta Cornelia , Burcel Miruna Gabriela , Ionescu Cătălina Ioana , Corbu Maria‐Cristina
Published: January 2022

Purpose

The purpose of the study is to explore the relationship between biomechanical corneal parameters and axial length in a pediatric population.

Methods

We conducted a prospective study that included 82 eyes from 41 pediatric patients. All patients were submitted to a complete ophthalmologic examination that included autorefractometry (before and after pharmacological cycloplegia), slit lamp and fundus examination, ocular tonometry. Additionally, the patients underwent examination with Ocular Response Analyzer (Reichert Ophthalmic Instruments Inc., Depew, NY) to determine corneal hysteresis (CH), corneal resistance factor (CRF) and with Aladdin biometer (Topcon, Tokyo, Japan) to determine axial length (AL) and central corneal thickness (CCT). Statistical analysis was performed using IBM

SPSS Statistics 26.

Results

Our study included 82 eyes, from 41 patients (63.41% female, 36.59% male). The average age was 13.29 years old (12.92 in females, 13.93 in males). Average CH, CRF, and spherical power, respectively, were similar between sexes: 12.30 mmHg, 12.47 mmHg, −0.70 D respectively in females, 12.89 mmHg, 13.31 mmHg and −1.27 D respectively in males. Mean AL and CCT are larger in males than in females, in a statistically significant

manner. Average AL is 23.69 mm in females, 24.52 mm in males (p = 0.007) and average CCT is 0.558 mm in females and 0.583 mm in males (p = 0.003). We also found a statistically significant moderate negative correlation between CH and AL in the pediatric population (Pearson’s r of −0.350, p = 0.001), and also in both sexes (Pearson’s r of −0.419, p = 0.002 in females and −0.437, p = 0.016 in males).

Conclusions

Our study reveals that in the pediatric population, at similar age, males have a thicker central cornea and longer axial length. Furthermore, in these patients, a high axial length is correlated to a low corneal hysteresis. Further studies are needed to explore these data and to confirm these findings in adults.
Full‐thickness central corneal grafts in tectonic lamellar sclerokeratoplasty for malformative, invasive and inflammatory limbal insufficiency treatment
Authors: Amatu Jean‐Baptiste , Wei Leo Seo , Nathalia Bellon , Christine Bodemer , Bremond‐Gignac Dominique
Published: January 2022

Purpose

To describe the surgical technique and to assess the outcomes in pediatric patients who underwent tectonic lamellar sclerokeratoplasty using full‐thickness central corneal grafts to treat malformative, invasive and inflammatory limbal insufficiency.

Methods

Retrospective, multicenter, non‐comparative analysis of a consecutive interventional case series including five pediatric cases of progressive limbal insufficiency from various severe malformative and inflammatory cause. All patients underwent tectonic lamellar sclerokeratoplasty using full‐thickness central corneal grafts under general anesthesia. Progression of limbal insufficiency after surgery, preoperative and postoperative visual acuity and perioperative complications were recorded retrospectively from patient medical records and external eye imaging.

Minimum post‐operative follow‐up was 6 months for each patient.

Results

In total, 5 children with severe limbal insufficiency from various etiologies were included. Mean age at surgery was 5.6 yo (range 5 w to 11 yo). Four (80%) had severe progressive and invasive choristomas and one (20%) presented a severe case of epidermolysis bullosa.

Two cases (40%) showed a stabilization of the postoperative visual acuity, other cases had non‐quantifiable visual acuity due to various reasons. Four cases (80%) presented a stabilization of the limbal insufficiency and corneal opacification. Two cases (40%) of corneal graft opacification without consequences on visual acuity were noted. One case (20%) of corneal graft infection was followed by limbal insufficiency recurrence. A second procedure for recurrence was performed in one case (20%).

Conclusions

Using full‐thickness central corneal grafts in lamellar sclerokeratoplasty for severe malformative, invasive and inflammatory limbal insufficiency cases seems to help reducing progression. In most of the cases, stable visual acuity was maintained or visual axis preserved, with limited postoperative complications.
Evaluation of retinal nerve fiber and ganglion cell layers in patients with multiple sclerosis and fibromyalgia
Authors: Palomar Elisa Viladés , Ciordia Beatriz Cordón , Rodrigo Maria Jesus , Perié Manuel Subías , Campo Lorena Arias , Altabás María José Vicente , Tello Alvaro , Castro‐Roger Luisa , Garcia‐Martin Elena
Published: January 2022

Purpose

To assess the differences in the retinal nerve fiber layer (RNFL) and ganglion cells (GCL) between patients with multiple sclerosis versus fibromyalgia. Likewise, to evaluate the ability of the Posterior Pole protocol from Spectralis Optical Coherence Tomography (OCT) to detect clusters with differences between these groups.

Methods

We analyzed 100 eyes of healthy subjects (CS), 100 eyes of patients with relapsing‐remitting multiple sclerosis (RR‐MS) and 55 eyes of patients with fibromyalgia (FB). The thickness of the RNFL and the GCL between these groups were evaluated in the 64 cells of the macular grid analyzed by the Posterior Pole protocol and later the thickness maps and cluster detection were reproduced thanks to the matrix analysis using Matlab (Mathworks,USA). Additionally, the RR‐MS group was compared with the different fibromyalgia phenotypes (atypical, biological and depressive).

Results

Both pathologies present a very similar significant thinning (p < 0.05) of both layers compared to healthy subjects. Compared with healthy controls, significant differences were found for the RNFL in the papillomacular bundle area and for the GCL in the macular area in RR‐MS group and fibromyalgia patients. Additionally, no significant differences were observed between patients with RR‐MS and those with fibromyalgia.

Conclusions

For the last years, the GCL has been postulated as a potential biomarker of neurodegenerative processes. Both RR‐MS and fibromyalgia present a similar thinning of the RNFL and GCL, although it is greater in patients with RR‐MS. Observed alterations are more significant in the GCL, thus suggesting that fibromyalgia might be a neurodegenerative process, with results similar to those observed in other well studied degenerative processes.
Early and late effects of botulinum toxin in infantile esotropia
Authors: Ciftci Suleyman
Published: January 2022

Purpose

To observe the short‐ and long‐term effects of botulinum toxin in infantile esotropia.

Methods

Between February 26th of 2013 and January 27th of 2015, botulinum toxin was injected transconjunctival to bimedial rectus of 5 patients. Following, one patient was checked regularly until their 8th year, one 9th month, one 7th month, one 3rd month, one 1st month. During their regular follow‐up parents were instructed to patch the dominant eye either in consecutive exotropia or esotropia phases. And also, they were assisted on glass prescription. Further, patients were seen again between their 78th and 96th months to find out their current visual acuity and to observe if they had any late term accompanying squints.

Results

Based on our observation derived from the follow‐ups: After the 3rd month on the horizontal plan, orthophoria on 2 patients, monocular esotropia on 2 patients and orthophoria with dissociated horizontal deviation (DHD) developed on 1 patient. On exotropia stage, for 3 hours a day patching was applied on the dominant eye. Inferior oblique muscle hyperfuction (IOHF) developed on all the patients at the earliest 2nd month and at the latest 7.5th year. Dissociated vertical deviation (DVD) and latentnystagmus did not develop on any patient, DHD developed on 1 patient. On the last examination, patients’ visual acuities were determined. On the orthophoric ones who had IOHF development: on his 7.5th year had 1.0/1.0 visual acuity, on her 9th month had 0.4/0.6 visual acuity, and on her 2nd month had 0.2/0.2 visual acuity. In this state, there seems to be an inverse proportion between visual acuity and IOHF development. Monocular esotropia ones: on the strabismic eye 0.1, on the dominant eye full vision was described. These patients were not compliant on their follow‐ups so when IOHF development happened was not determined.

Conclusion

It seems botulinum toxin injection gives a chance for restoration of visual immaturity, and by this way infantile esotropia can be made to behave almost similarly to acquired esotropia.
Ophthalmologic Microvascular changes in Wolfram syndrome
Authors: Maria Cunha Ana , Barbosa‐Breda João , Grangeia Ana , Estrela‐Silva Sérgio , Carneiro Ângela , Falcão‐Reis Fernando , Faria Olinda
Published: January 2022

Purpose

To evaluate ophthalmic, systemic, genotype features and microvascular abnormalities of patients with Wolfram syndrome (WFS).

Methods

Cross‐sectional, prospective evaluation of consecutive patients with WFS and healthy subjects. WFS diagnosis was performed based on the clinical presentation and detection of biallelic pathogenic variants in the WFS1 gene. All patients underwent a complete ophthalmological examination and a retinal vasculature evaluation by OCT‐A. Quantitative analysis included: whole‐image vessel density (VD, %), inside disk VD and peripapillary VD of the ONH and peripapillary region, as well as, whole VD for parafoveal superficial capillary plexus (SCP) of the macula.

Results

Fifty‐eight eyes were included in this study, 26 eyes from patients with WFS and 32 eyes from healthy subjects. Seven families were included, twelve patients had biallelic pathogenic variants whereas one had one pathogenic variant in the WFS1 gene confirming the diagnosis of WFS type 1 and Wolfram‐like syndrome, respectively. Optic atrophy and diabetes mellitus were the most common systemic findings. The best corrected visual acuity (BCVA) ranged from light perception to 0.1 logMar. Quantitative evaluation demonstrated a significant difference between WFS and healthy subjects on whole‐image VD, inside disk VD, and peripapillary VD (p < 0.001 for all) and SCP perfusion density (p < 0.001). Ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness have significant decrease in WFS patients with BCVA more than 1 logMar compared to those with less than 1 logMar (p < 0.001 and p = 0.024, respectively).

Conclusions

WFS patients had a decreased of vessel density in ONH, peripapillary microvasculature and in macular microvascular networks. Microvasculature changes seem to occur before a severe decrease in visual acuity, and the decreased of the GCC and RNFL thickness.
Ocular biodistribution of once‐daily bilastine eye drops reveals highest levels in conjunctiva up to 24 hours post‐administration
Authors: Torrens Prat Inés , Gonzalo Ana , Ganza Álvaro , Hernández Gonzalo , Zazpe Arturo
Published: January 2022

Purpose

A novel effective, safe and well tolerated topical formulation of bilastine, a second‐generation H1‐antihistamine, has been developed for allergic conjunctivitis treatment. This in vivo biodistribution study aimed to determine the exposure to topical bilastine of different ocular tissues and verify if the evolution of conjunctival levels over time supports the intended once daily posology.

Methods

Twenty‐four Dutch‐Belted rabbits received 30 µl/eye of 6 mg/ml bilastine formulation (a preservative free artificial tear containing sodium hyaluronate). Blood samples were obtained through the ear artery. Three animals were sacrificed per time point, and aqueous and vitreous humor, cornea, conjunctiva, iris/ciliary body, crystalline lens and retina/choroid samples were collected from both eyes. Bilastine concentrations in matrices were determined by validated LC‐MS/MS methods and pharmacokinetic parameters were determined usin a non‐compartmental analysis.

Results

Bilastine Cmax was achieved from 30 min to 6 h after drug administration. Bilastine exposure was highest in conjunctiva (Cmax: 2545.04 ng/g, at 6 h post‐administration; AUCt: 11382.40 ng·h/g) and cornea (Cmax: 609.11 ng/g, at 1 h post‐administration; AUCt: 1993.88 ng·h/g), followed by the iris/ciliary body, retina/choroid, aqueous humor, plasma, vitreous humor, and crystalline lens. Quantifiable bilastine concentrations were observed up to 24 h post‐instillation in conjunctiva (388.45 ng/g), cornea (28.68 ng/g), iris/ciliary body (12.42 ng/g), retina/choroid (1.91 ng/g) and crystalline lens (0.12 ng/g). In plasma, aqueous and vitreous humor, bilastine was detected up to 12 h post‐administration.

Conclusions

The results show the preferential distribution of bilastine eye drops in the conjunctiva, the intended target tissue, while absorption is limited and potential for systemic side effects low. Significant levels of bilastine found in conjunctiva up to 24 h post‐dose support the once daily posology.
A smart phone app for individual risk assessment for progression of diabetic retinopathy
Authors: Scholtz Sibylle , Aspelund Thor , Einarsson Stefan , Gudmundsdottir Arna , Jonsdottir Sigurbjörg , Thor Steinasson Aegir , Stefansson Einar
Published: January 2022

Purpose

Creation of a smart phone application containing diabetic retinopathy risk calculator to empower individual diabetic patients to understand their personal risk factors and risk profile. Educate and motivate patients to influence these risk factors.

Methods

A previously validated and published diabetic retinopathy risk algorithm (Aspelund et al 2011; Lund et al 2016) was programmed as a smart phone application. Clinical data can be entered by hand or through the digi.me platform, which is available in an increasing number of countries for automatic transmission of clinical data.

Results

The app is available at no cost in app stores and can be found under search word “retinarisk”. User numbers and responses will be reported.

Conclusions

A smartphone app is now available at no cost for all diabetic patients. The app allows each patient to evaluate his/her personal risk for progression to sight threatening diabetic retinopathy. The app provides education about diabetic retinopathy and risk factors and motivates and informs the patient to modify and improve the risk profile. The app is a step in the direction to empower individual patients through validated interpretation of available clinical data: what these data mean for each individual, how the risk factors can be modified for risk reduction. It provides a personal prognosis for retinopathy progression.