bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction of Deep Learning in Thermographic Monitoring of Cultural Heritage and Improvement by Automatic Thermogram Pre-Processing Algorithms
Authors: Garrido Iván , Erazo-Aux Jorge , Lagüela Susana , Sfarra Stefano , Ibarra-Castanedo Clemente , Pivarčiová Elena , Gargiulo Gianfranco , Maldague Xavier , Arias Pedro
Published: January 2021

The monitoring of heritage objects is necessary due to their continuous deterioration over time. Therefore, the joint use of the most up-to-date inspection techniques with the most innovative data processing algorithms plays an important role to apply the required prevention and conservation tasks in each case study. InfraRed Thermography (IRT) is one of the most used Non-Destructive Testing (NDT) techniques in the cultural heritage field due to its advantages in the analysis of delicate objects (i.e., undisturbed, non-contact and fast inspection of large surfaces) and its continuous evolution in both the acquisition and the processing of the data acquired. Despite the good qualitative and quantitative results obtained so far, the lack of automation in the IRT data interpretation predominates, with few automatic analyses that are limited to specific conditions and the technology of the thermographic camera. Deep Learning (DL) is a data processor with a versatile solution for highly automated analysis. Then, this paper introduces the latest state-of-the-art DL model for instance segmentation, Mask Region-Convolution Neural Network (Mask R-CNN), for the automatic detection and segmentation of the position and area of different surface and subsurface defects, respectively, in two different artistic objects belonging to the same family: Marquetry. For that, active IRT experiments are applied to each marquetry. The thermal image sequences acquired are used as input dataset in the Mask R-CNN learning process. Previously, two automatic thermal image pre-processing algorithms based on thermal fundamentals are applied to the acquired data in order to improve the contrast between defective and sound areas. Good detection and segmentation results are obtained regarding state-of-the-art IRT data processing algorithms, which experience difficulty in identifying the deepest defects in the tests. In addition, the performance of the Mask R-CNN is improved by the prior application of the proposed pre-processing algorithms.
The Figure of the Teacher-Prosumer for the Development of an Innovative, Sustainable, and Committed Education in Times of COVID-19
Authors: Triviño-Cabrera Laura , Chaves-Guerrero Elisa Isabel , Alejo-Lozano Laura
Published: January 2021

Studies on the adaptation from face-to-face to online teaching during lockdown show the before and after in education that faces the double challenge of promoting digital skills and public access to connectivity and electronic devices in the post-COVID-19 era. Therefore, this article contributes to these new emerging lines of educational research by presenting an educational innovation project called “Teachers Versus COVID-19”. This project aimed to verify whether the figure of teacher-prosumer, that is, consumers of media culture and creators of their own educational resources, favors the initial training of teachers during the pandemic. To this end, the following objectives were proposed: firstly, test whether the figure of the teacher-prosumer contributes to improving the adaptation of face-to-face teaching to the virtual modality of the Didactics of Social Sciences in the Degree in Primary Education during lockdown; secondly, analyze the production of content on social networks by the students in the Degree in Primary Education, according to the objectives of sustainable development. To validate our teacher-prosumer proposal, we chose the design-based research (DBR) qualitative methodology. For this, 240 students from the course in Didactics of Social Sciences of the Degree in Primary Education at the University of Malaga created 37 educational videos that teach the social sciences curriculum to children between 6 and 12 years of age from the perspective of relevant social problems and the Sustainable Development Goals. These videos were disseminated through the project’s YouTube channel. The results of this study corroborate the effectiveness of turning students into teachers-prosumers, generating the development of critical, creative, digital, and socio-emotional skills so that they feel committed to playing an active role in social changes for a sustainable world.
Assessment of International Trade-Related Transport CO2 Emissions—A Logistics Responsibility Perspective
Authors: Stojanović Đurđica , Ivetić Jelena , Veličković Marko
Published: January 2021

International supply chains generate substantial amounts of CO2 emissions. However, established methodologies for national freight transport emission assessments do not consider such international perspectives sufficiently. This research aims to show how logistic responsibility may be used in ex post transport CO2 emission assessments, for macrologistic or supply chain levels. We propose an original approach to estimate and allocate CO2 emissions generated by international freight transport between trade countries. The proposed method relies on the applied Incoterms® rules in sales contracts. A new indicator, the index of responsibility for transport emissions (RTE-index), is introduced to allocate bilateral trade-related transport CO2 emissions. This is the first time that the Incoterms® clauses are used for macrologistic assessments of international trade-related transport CO2 emissions. Our approach is exemplified using bilateral trade-related transport flows between Serbia and other European countries. The introduced RTE-index is expected to help visualise average national trade-related transport CO2 emission responsibilities; increase awareness regarding environmental considerations among trade parties, logistics companies, and national organisations; and provide new perspectives for environmental transport policy actions.
The Competitiveness of Manufacturing and Its Driving Factors: A Case Study of G20 Participating Countries
Authors: Dou Zixin , Wu BeiBei , Sun Yanming , Wang Tao
Published: January 2021

With the rapid development of high quality industries, it is particularly important to study the sustainable competitiveness of manufacturing and its driving factors. The aim of this paper is to build the whole competitiveness index to analyze the recent development trends of manufacturing in G20 participating countries from 2008 to 2018. Meanwhile, based on the diamond theory, this paper adopted a panel regression model to conduct an empirical analysis on various factors that affect the sustainable competitiveness of manufacturing. These results showed the following: (1) Transport services have the most significant effect on manufacturing in developing countries. (2) Intellectual property only has a positive and significant effect on manufacturing in developed countries. (3) Information technology plays a significant role in all countries, but it is more effective in developed countries. Finally, this paper puts forward some suggestions for the sustainable development of manufacturing.
Social Aspects of Electric Vehicles Research—Trends and Relations to Sustainable Development Goals
Authors: Omahne Vasja , Knez Matjaz , Obrecht Matevz
Published: January 2021

E-mobility sustainability assessment is becoming more comprehensive with research integrating social aspects without focusing only on technical, economic, and/or environmental perspectives. The transportation sector is indeed one of the leading and most challenging greenhouse gas polluters, and e-mobility is seen as one of the potential solutions; however, a social perspective must be further investigated to improve the perception of and acceptance of electric vehicles. This could consequently lead to the European Green Deal’s holy grail: faster decarbonization of the transportation sector. Another way to achieve it is by promoting more comprehensive sustainable development goals. Therefore, this paper combines a systematic review of recent research with research emphasis focused on social aspects of electric vehicles and their interconnection with specific UN Sustainable Development Goals. By knowing the current research focus mainly related with “perception” of electric vehicles and assessing their social “impact” as well as an emerging area of “user experience” and their relations with UN Sustainable Development Goals enables better insight on the current and future directions of electric vehicle social sustainability research. The current priority is identified as “climate actions”. Increasingly important “sustainable cities and communities” shows potential for becoming one of the future research, policy, and community priorities.
On Linear and Quadratic Two-Stage Transportation Problem
Authors: Stetsyuk P. , Lykhovyd O. , Suprun A.
Published: January 2021

Introduction. When formulating the classical two-stage transportation problem, it is assumed that the product is transported from suppliers to consumers through intermediate points. Intermediary firms and various kinds of storage facilities (warehouses) can act as intermediate points.

The article discusses two mathematical models for two-stage transportation problem (linear programming problem and quadratic programming problem) and a fairly universal way to solve them using modern software. It uses the description of the problem in the modeling language AMPL (A Mathematical Programming Language) and depends on which of the known programs is chosen to solve the problem of linear or quadratic programming.

The purpose of the article is to propose the use of AMPL code for solving a linear programming two-stage transportation problem using modern software for linear programming problems, to formulate a mathematical model of a quadratic programming two-stage transportation problem and to investigate its properties.

Results. The properties of two variants of a two-stage transportation problem are described: a linear programming problem and a quadratic programming problem. An AMPL code for solving a linear programming two-stage transportation problem using modern software for linear programming problems is given. The results of the calculation using Gurobi program for a linear programming two-stage transportation problem, which has many solutions, are presented and analyzed. A quadratic programming two-stage transportation problem was formulated and conditions were found under which it has unique solution.

Conclusions. The developed AMPL-code for a linear programming two-stage transportation problem and its modification for a quadratic programming two-stage transportation problem can be used to solve various logistics transportation problems using modern software for solving mathematical programming problems. The developed AMPL code can be easily adapted to take into account the lower and upper bounds for the quantity of products transported from suppliers to intermediate points and from intermediate points to consumers.

Keywords: transportation problem, linear programming problem, AMPL modeling language, Gurobi program, quadratic programming problem.
About Structure of Graph Obstructions for Klein Surface with 9 Vertices
Authors: Petrenjuk V.I. , Petrenjuk D.A.
Published: January 2021

The structure of the 9 vertex obstructive graphs for the nonorientable surface of the genus 2 is established by the method of j-transformations of the graphs. The problem of establishing the structural properties of 9 vertex obstruction graphs for the surface of the undirected genus 2 by the method of j-transformation of graphs is considered. The article has an introduction and 5 sections. The introduction contains the main definitions, which are illustrated, to some extent, in Section 1, which provides several statements about their properties. Sections 2 – 4 investigate the structural properties of 9 vertex obstruction graphs for an undirected surface by presenting as a j-image of several graphs homeomorphic to one of the Kuratovsky graphs and at least one planar or projective-planar graph. Section 5 contains a new version of the proof of the statement about the peculiarities of the minimal embeddings of finite graphs in nonorientable surfaces, namely, that, in contrast to oriented surfaces, cell boundaries do not contain repeated edges. Also in section 5 the other properties peculiar to embeddings of graphs to non-oriented surfaces and the main result are given. The main result is Theorem 1. Each obstruction graph H for a non-oriented surface N2 of genus 2 satisfies the following. 1. An arbitrary edge u,u = (a,b) is placed on the Mebius strip by some minimal embedding of the graph H in N3 and there exists a locally projective-planar subgraph K of the graph H \ u which satisfies the condition: (tK({a,b},N3)=1)˄(tK\u({a,b},N2)=2), where tK({a,b},N) is the number of reachability of the set {a,b} on the nonorientable surface N; 2. There exists the smallest inclusion of many different subgraphs Ki of a 2-connected graph H homeomorphic to the graph K+e, where K is a locally planar subgraph of the graph H (at least K+e is homemorphic to K5 or K3,3), which covers the set of edges of the graph H. Keywords: graph, Klein surface, graph structure, graph obstruction, non-oriented surface, Möbius strip.
Visual outcomes in Patients with Diabetic Macular Oedema undergoing Cataract Surgery with or without Intravitreal Bevacizumab
Authors: Hassan Mazhar Hassan , Rehman Aziz Ur , Qidwai Umair , Alvi Rashid , Bhatti Nasir , Dawood Ashraf
Published: January 2021

Aims: To evaluate the efficacy of a single intravitreal bevacizumab injection after cataract surgery for the management of postoperative decrease in vision in patients with diabetic macular oedema.Methods: In this randomised controlled open-label parallel group study of 60 patients with diabetic macular oedema and lens opacity (grade ≥3), 30 eyes received a single intravitreal bevacizumab injection after cataract surgery, and 30 control eyes did not receive bevacizumab. The primary endpoint was change in best-corrected visual acuity 6 weeks after operation compared with that at baseline using the Snellen visual acuity chart.Results: Postoperative visual acuity was significantly different between the group receiving bevacizumab and the control group (p<0.005). All patients in the bevacizumab group had postoperative visual acuities above 6/18 with 27 patients having visual acuities of 6/12 or better compared with 6 patients in the control group. None of the patients in the bevacizumab group had visual acuities less than 6/18 compared with 11 patients in the control group.Conclusion: Intravitreal bevacizumab after cataract surgery appears to be beneficial for preventing postoperative visual loss in eyes with diabetic retinopathy by reducing the risk of macular thickening.
Evaluation of the Clinical Profile and Treatment Outcomes of Ocular and Adnexal Rhinosporidiosis in a Tertiary Eye Care Centre
Authors: Agarwal Prateek , Kim Usha , Arora Vipul
Published: January 2021

Aim: To describe the demographics, histopathology, treatment modalities, outcomes, and recurrence rates for patients diagnosed with ocular and adnexal rhinosporidiosis.Methods: This prospective descriptive study was conducted at the Department of Orbit, Oculoplasty, and Oncology at a tertiary eye care centre in South India. Fifty patients with a clinical diagnosis of ocular and adnexal rhinosporidiosis who presented from March 2005 to October 2007 were included. All patients underwent complete conjunctival and lid mass excision with cautery, and all patients with rhinosporidiosis of the lacrimal system underwent dacryocystectomy.Results: The mean age at presentation was 30.42 years (SD, 16.89 years; range, 1-70 years). The mean follow-up was 14.2 months (range, 12-18 months). The most common site was the conjunctiva (n = 26; 52%), followed by the lacrimal sac (n = 13; 26%) and the eyelids (n = 11; 22%). There was a single recurrence (2%) involving the lacrimal sac. Endonasal polypectomy and exploration of the sac region was done. There were no further recurrences during subsequent follow-up. The diagnosis was confirmed histopathologically for all patients.Conclusions: Rhinosporidiosis is an ocular disorder with high recurrence rates. Histopathological examination following excision biopsy is recommended for all patients for a conclusive diagnosis. Recurrence rates can be low if complete meticulous excision is performed coupled with cauterization of the lesion.
Optical Coherence Tomography as a Useful Adjunct for Diagnosis and Management of Acute Zonal Occult Outer Retinopathy
Authors: Lim Lik Thai , Shankar Vikas , Blum Robert
Published: January 2021

Acute zonal occult outer retinopathy is a rare condition that has traditionally  been diagnosed by perimetry and electroretinogram. This report is of a 48-year-old man with acute zonal occult outer retinopathy, for which optical coherence tomography aided the diagnosis. Optical coherence tomography can be a useful adjunct for diagnosis and management of acute zonal occult outer retinopathy.
Central Corneal Thickness in Congenital Aniridia and its Role in Glaucoma in an Indian Population
Authors: Agarwal Prateek , Devendra Gopal Gaurav , Shetty Shashikant , Das Krishna , Vijayalakshmi Perumalsamy , Muralidhar Rajamani
Published: January 2021

Aim: To determine the range and distribution of central corneal thickness in patients with aniridia and compare with age- and sex-matched controls.Methods: This was a prospective cross-sectional observational case-control study performed at a tertiary eyecare hospital. All patients diagnosed with aniridia from June 2006 to April 2008 were enrolled. Patients were excluded if they had corneal oedema, central corneal scars, central aniridic keratopathy, or any history or signs suggestive of previous surgery or injury. Central corneal thickness was measured by ultrasoundpachymetry and the mean of 5 measurements per eye was used as the study measurement. The results were compared with those of age- and sex-matched controls.Results: The mean central corneal thickness in the aniridia group was 0.603 mm compared with 0.566 mm in the control group (p = 0.0083).Conclusions: This study has determined the range and distribution of CCT in Indian patients with aniridia and substantiates the fact that patients with aniridia in an Indian cohort also have significantly thicker corneas. This needs to be considered for making accurate IOP measurements in these patients to ascertain the appropriate management.
The use of intravenous pulse-steroid therapy in optic neuropathy from nasopharyngeal carcinoma
Authors: Reyes Karen B. , Goh Kong Yong
Published: January 2021

Although nasopharyngeal carcinoma (NPC) is commonly seen in patients from Asia, optic neuropathy is a rare initial presenting symptom of this disease. This is an interventional case report discussing the clinical response of NPC-related optic neuropathy to pulse-steroid therapy. We discuss two patients who initially presented with signs of optic neuropathy. On imaging, a skull-base tumor was noted infiltrating the area of the affected optic nerve. An excision biopsy of the tumor revealed nasopharyngeal carcinoma. Both patients were pulsed with intravenous (IV) methlyprednisolone one gm/day for three days, followed by oral steroids (one mg/kg/BW) with gradual tapering. After two weeks, both showed visual improvement and chemo- and radiation therapy commenced at this time. In these two cases, pulse-steroid therapy did not hinder the chemo- and radiation therapy for nasopharyngeal carcinoma. Steroid therapy brought immediate visual recovery and gradual oral tapering could assist in optimizing visual outcomes for patients with compressive optic neuropathy from nasopharyngeal carcinoma.
Epidemiology of ocular trauma hospital presentations in Sydney, Australia: insights for management and prevention
Authors: Clark Georgina C , Sandercoe Trent M , Lertsumitkul Somsak , Guzowski Magdalena , McCluskey Peter J
Published: January 2021

Aim: To facilitate care delivery and injury prevention by investigating the nature and outcomes of ocular trauma presentations to a tertiary care center serving an estimated 1.3 million people. Patients and methods: This is an observational case series, retrospectively analyzed, of all patients that presented to the tertiary care center for management of ocular trauma between 01/01/2006-31/12/2006. Data collected included: patient’s clinical findings, major diagnoses, initial and final visual acuity, whether the injury was work related, whether protective eyewear was worn, and whether the patient required surgery or admission to hospital. A final BCVA < 6/12 was defined as significant visual deficit. Eligible patients were identified prospectively by researchers. Patients underwent standardized clinical assessment. De-identified clinical data was entered into a Microsoft Access database retrospectively and analyzed by separate, blinded researchers. Descriptive statistical analysis was then performed in Microsoft Excel. Analysis based on an ordinal regression model and risk factor analysis was performed in SAS.Results: There were 214 cases of ocular trauma in 197 individuals (17 bilateral injuries). Patients were mostly male (83%) with average age 35. The majority of cases were closed globe injuries (92.1%) with no significant final visual deficit (88.3%). Open globe injuries (7.9%) were more likely to have visual deficit (i.e., 47% with final BCVA < 6/12) (p < 0.01). In total, 13.1% required surgery and 12.1% required admission to hospital. Eye protection was worn in 7.9% of all cases, and 19.1% of work related cases. Nearly one quarter of cases (22.4%) were work related. Open globe injuries were more likely to occur at work. Open globe injuries at work were caused by a metal projectile in 85.7% of cases. Thirty percent of workers suffered a burn, with final BCVA < 6/12 in 10% of burns.Conclusions: While the vast majority of ocular trauma is superficial with low morbidity, trauma persists as a significant cause of visual impairment. Most vision impairing injuries occur at work, where metal projectiles and burns are common, preventable causes of significant vision loss, which could be targeted in prevention efforts.
A novel method to convert bicanalicular intubation into monocanalicular intubation in endoscopic dacryocystorhinostomy
Authors: Li Emmy Y , Chen Andy C , Yuen Hunter KL
Published: January 2021

Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is an effective treatmentfor acquired nasolacrimal duct obstruction. Although the exact role of siliconeintubation remains controversial, it is routinely performed to increase the success rate ofthe procedure. Occasionally, difficulty may be encountered during silicone tube intubationcommonly when one end of the bicanalicular stent has been successfully passed intothe nasal cavity but the other end fails. In which case either this has to be converted toa monocanalicular stent or leave without stenting. We hereby report a novel method totackle this situation by converting a bicanalicular stent into a monocanalicular stent usingsimple knotting steps. From our experience with three patients, the end-results were safeand well-tolerated. This modified lacrimal intubation stent may also be used when thestandard Monoka monocanalicular stent is not available.
Ocular metastasis from a rare thyroid carcinoma
Authors: Agahan Archimedes Lee , Carrillo Ryner Jose , Chao Peter Mark , Lising Ramil
Published: January 2021

Objective: To report a case of primary thyroid carcinoma with ocular metastasis.Methods: This is a case report of a 39-year-old male, who initially presented with a sudden painless loss of vision in the left eye and an anterior neck mass. He was initially diagnosed to have retinal detachment with vitreous hemorrhage based on ocular ultrasound. Fine Needle Aspiration Biopsy of the neck mass initially revealed medullary thyroid carcinoma. Computed topography of the chest and abdominal ultrasound revealed lung and liver metastasis. Whole body bone scintigraphy also revealed bone metastasis.Results: Patient underwent total thyroidectomy with bilateral modified radical neck dissection of the neck mass and vitreous biopsy of the left eye. Histopathology report revealed malignant carcinoma of the thyroid, medullary type while vitreous showed malignant cells from the thyroid. Patient was scheduled to undergo chemotherapy for the widespread metastasis.Conclusions: Ocular malignancy can present in many ways, thus it is necessary to consider it as a differential for cases of retinal detachment and vitreous hemorrhage. Choroidal metastasis from malignant thyroid carcinoma is rare, more so the medullary type.
Foreign-body conjunctival granuloma secondary to finger-nail trauma
Authors: Sowmya V. , Nazareth Nelly E.P. , Kamath Vijna B.
Published: January 2021

A foreign body lodged in the conjunctiva can trigger a granuloma formation. In the past, cilia, caterpillar hair, insect wing and fibers have been reported to incite foreignbody granuloma formation in the eye. Trauma to the eye with finger nail is frequently encountered but goes unnoticed among the pediatric population. Finger-nail trauma to the eye leading to a mass has not been reported in literature. We hereby report a case of conjunctival foreign-body granuloma in a seven-year-old child following finger-nail trauma. Excision biopsy and histopathology of the mass affirmed the diagnosis.
Dietary intake and retinal microvasculature: a systematic review
Authors: Keel Stuart , Koklanis Connie , Vukicevic Meri , Itsiopoulos Catherine , Brazionis Laima
Published: January 2021

Aims: To summarise the available findings from published research that has focussed on the effect of diet on retinal microvascular characteristics. Design: Systematic review.Methods: A systematic Medline, EMBASE and PubMed search of relevant articles was conducted with coverage from the January 1, 1970 up to the January 10, 2013. Search terms were pilot tested for accuracy and modified. Articles were systematically excluded if the title and abstract were not relevant and full text manuscripts were obtained for all studies that were potentially relevant.Results: After combining all searches, 5370 abstracts were identified and screened. Of  these 20 were considered potentially relevant and full articles were retrieved for further evaluation. Eleven of these studies did not meet the inclusion/exclusion criteria, leaving 9 studies to be included in the review.Conclusions: To date, it has been suggested that a low glycemic Index (GI) diet, high dietary fibre intake and regular fish consumption attenuate retinal arteriolar narrowing and retinal venular widening which has been associated with adverse cardiovascular outcomes. Conversely, it has been suggested that a high GI diet may predispose an individual to adverse retinal microvascular changes.
Long term outcome of 5-Fluorouracil(5-FU) augmented bleb needling revision of failed and failing filtration blebs.
Authors: Mitra Arijit , Ramakrishnan R. , Kader Mohideen Abdul
Published: January 2021

Purpose: To evaluate the long term outcome of 5-Fluorouracil (5-FU) augmented bleb needling revision of failed and failing filtration blebs based on survival analysis and to identify risk factors for failure, indicators for success and complications.Methods: This was a prospective, interventional case series with survival analysis. 32 eyes of 32 patients underwent bleb needling augmented with 5-FU and were then followed up. Statistical analysis was done to assess the association between study factors and time to failure. Main outcome measures were reduction in IOP (<21 mm of Hg), number of antiglaucoma medications (AGM’s), complications and factors associated with outcome including indicators for success. Results: At one year followup 9 (28. 13%) eyes had IOP <21 mmHg without the use of any antiglaucoma medications. 13 eyes (40. 63%) had qualified success with mean IOP <21 mm Hg after 1 or multiple needlings but with the help of one or more AGM’s (1. 2±0. 4). 10 cases (31. 25%) failed and had to undergo repeat Trabeculectomy or shunt surgery. In the cases which achieved overall success, complete and qualified together (n = 22) the baseline IOP pre needling was 26. 7±8. 2 mmHg which was reduced to 13. 6±4. 6 mmHg at the end of the minimum follow up period of 1 year. The median interval between the “index” filtration surgery and the first (or only) needling procedure was 7. 5 months (Range 3 months to 4 years). Overall reduction in mean number of topical AGM’s was from 2. 68±0. 82 to 0. 82±0. 34. Overall cross sectional success rate at 1 year follow up (complete and qualified) was 68. 76%(n=32) and the overall cross-sectional success rate (complete and qualified) at the 3 year follow up period was 66. 91%(n=24) and 65. 82%(n=16) at 5 year follow up. Strong evidence was found for association between pre needling IOP >28 mm of Hg and failure and immediate attainment of low IOP <11 mmHg and longer survival. None of the other proposed factors were identified as having statistically significant effect. Conclusions: This long term study shows that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued. Attaining an immediate reduction in IOP <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy.
Managing Suspected Temporal Arteritis without a Temporal Artery Biopsy
Authors: ONG Keith Soo Keat , ONG Lawrence Tsng Chze , ONG Lillian Beatrice
Published: January 2021

MANAGING SUSPECTED TEMPORAL ARTERITIS WITHOUT A TEMPORAL ARTERY BIOPSY   Keith Ong, Ophthalmologist, University of Sydney, RNSH, Ryde Hospital, Dalcross Adventist Hospital Lawrence Tsng Chze Ong, Immunology Registrar, Westmead Hospital Lillian Beatrice Ong, JMO, Prince of Wales Hospital  We would like to report 2 cases of suspected temporal arteritis which were managed without routine temporal artery biopsy.   The gold standard diagnostic test for temporal arteritis, the temporal artery biopsy (TAB), is highly specific for a diagnosis of temporal arteritis, but is only positive in up to 82% of temporal arteritis cases (with sensitivities reported as low as 20%). This figure has been shown to decrease even further (12%) following corticosteroid therapy.   Although it is a relatively minor procedure, the risks of TAB are not trivial and include facial nerve injury, infection, haemorrhage, incisional alopecia, scar widening and foreign body reaction to entrapped hairs. Furthermore, the need for theatre time and skilled personnel in a procedure with a significant number of false negatives makes TAB questionable.   Even if TAB were performed, a high index of suspicion would have led to commencement of corticosteroid therapy regardless of the biopsy result. The only drawback in not conducting a TAB appears to be the lack of additional conclusive evidence supporting temporal arteritis.   The two cases presented here illustrate how a trial of corticosteroid therapy is a reasonable and practical option for patients who elect not to have TAB. The strength and duration of corticosteroid therapy will still be guided by clinical progress as well as biochemical markers such as ESR and CRP.
Diabetic Macular Edema Estimation Using Slit Lamp Biomicroscopy Versus That Using Oct.
Authors: Sharma Trisha , DSouza Susan , Kamath Manjunath
Published: January 2021

Purpose: Comparison of Diabetic macular edema estimation using slit lamp biomicroscopy versus that using OCT.Materials and Methods: We performed a retrospective analysis of 121 patients (154 eyes) with established Type 2 diabetes mellitus, divided into three groups. Group I consisted of 62 eyes with NPDR, Group II ,27 eyes with PDR and  Group III ,66 eyes with CSME. Diagnosis of CSME was made as per ETDRS protocol, using slit lamp stereoscopic biomicroscopy. DME was defined on OCT as central foveal thickness greater than 250µm .OCT scanning was performed through the macula of each eye after pupillary dilatation. Results: The mean age of patients included was 60.70 ± 9.20years and 61.98% were males. Only 66 eyes were classified as having DME clinically as opposed to 109 eyes by OCT, leading to a significant sub-estimation of 39.44% eyes. The mean macular thickness in the CSME patients identified by slit lamp biomicroscopy was 399.59±105.31µm.The mean central macular thickness in the sub-estimated cases was 290.58 ±28.92 µm overall, 290.10±26.19 µm in the PDR group and 290.95± 31.46µm amongst NPDR patients.Conclusion: Mild macular thickening on OCT may not correspond to overt edema clinically and has been termed sub-clinical macular edema by some authors. We report a sub- estimation of DME in 39.44% eyes in our study. The emerging importance of monitoring of these vulnerable patients and early detection of their conversion to overt CSME must be realised. In conclusion, assessment of diabetic macular edema with OCT is probably more objective and reliable.
Comparasion of efficacy and safety of Difluprednate 0.05% and Nepafenac 0.1% in reducing macular thickness and volume after cataract surgery
Authors: Katiyar Vishal , Yadav Ankur , Gupta Sanjiv , Kishore Poonam , Phadikar Prateep
Published: January 2021

Objective- To evaluate and compare efficacy and safety of topical Difluprednate ophthalmic emulsion 0.05% with Nepafenac ophthalmic suspension 0.1% in patients of uneventful cataract surgery with respect to postoperative macular thickness and volume.

Design- A prospective, single centric, tertiary care centre based, comparative, interventional study from August 2013 to July 2014

Subjects- Total 206 ( Group N=106, Group D=100) patients were followed up who completed their 12 weeks follow up

Methodology- Surgery was performed by phacoemulsification technique by clear corneal incision with foldable PCIOL implantation by a single surgeon having 10 years of surgical experience. Post operative patients were divided into 2 groups. Group N were given topical treatment with Nepafenac ophthalmic suspension  0.1% TID starting 24 hours before surgery  and continued post-op 4 weeks. Group D were given Difluprednate ophthalmic emulsion 0.05% QID post surgery for 2 weeks followed by BID for 2 weeks. 

Main outcome measures: Postoperative assessment of patients were done on 1st day and on 1st, 8th and12th  weeks  after the surgery for best corrected visual acuity (BCVA) by logMAR, intraocular pressure by Applanation tonometry and macular thickness and volume by SD-OCT. Statistical test used was sample Unpaired and paired ‘t’ test  and statistical analysis was done with SPSS 20.0 ( IBM, USA).

Results- There was increase in the measured mean central subfield thickness( CST) at 8 and 12 weeks as compared to 1 week , in both the study groups (P<0.05). On comparing the volume (in mm3) and average thickness (in µm) at 1 week, it was observed that thickness of group N (266.82±25.06 µm) was statistically higher than that of group D (253.14±22.21µm) (P= 0.03). The comparison of best corrected visual acuity (LogMAR) and the intraocular pressure recordings showed no difference between the patients of two studied groups recorded at 1 week and 8 weeks and 12weeks.

Conclusion- Both Nepafenac ophthalmic suspension 0.1% and Difluprednate ophthalmic emulsion 0.05% are equally effective in controlling macular thickness change after uneventful cataract surgery.
Bilateral simultaneous acute angle closure in an adult Nepalese woman
Authors: Sahu Sabin , Puri Lila Raj
Published: January 2021

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause.
Methods: Observational case report.
Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes.
Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.
Prevalence of glaucoma in first-degree relatives of patients with primary open-angle glaucoma and normal-tension glaucoma
Authors: Gupta Preeti , Pai. H. Vijaya
Published: January 2021

Objective: To determine the prevalence of glaucoma in first-degree relatives of patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG).

Methods: Observational study of first-degree relatives of patients with POAG and NTG who were screened for glaucoma.

Results: A total of 66 first-degree relatives of patients with glaucoma (POAG/NTG) were included in the study. We found a prevalence rate of 16.6%: 13.6% were diagnosed to have the disease and 3% were newly detected to have glaucoma during the study. We found that although 66.7% of the subjects were aware of the family history of glaucoma, only 36.4% were aware that they were at increased risk of developing glaucoma.

Conclusion: In our study, we found high prevalence of glaucoma in first-degree relatives of patients with glaucoma. This highlights the importance of selective screening of high-risk groups such as first-degree relatives of patients with POAG/NTG.
Primary nasal pterygium excision with sutureless and glue-free technique of conjunctival autograft
Authors: Dhany Rini Kusumawar
Published: January 2021

Aim: To evaluate the efficacy and complication of sutureless and glue-free conjunctival autograft for the management of primary pterygium over a period of one year.

Methods: Prospective, interventional, hospital-based study. Twenty-four eyes of 24 patients with primary nasal pterygium were graded, and excision was performed by a single surgeon. To prevent recurrence, a free conjunctival autograft was taken from the superior quadrant from the same eye and the bare sclera was covered without the use of sutures or fibrin glue, allowing natural autologous coagulum of the recipient bed to act as a bioadhesive. The eye was patched for 24 hours. Postoperatively, patients were put on topical eye drops (polymixin 0.5%, neomycin 0.5%, and dexamethasone 1%) four times daily for four weeks, and oral antibiotics and methyl prednisolone 3x4 mg per day for 5 days. Patients were followed up postoperatively on day 1, 1 week, 6 weeks, 6 months, and 12 months. They were examined for haemorrhage, wound gape, graft shrinkage, granuloma, graft dehiscence, recurrence, or any other complication.

Results: The mean age of the patients was 56.96 ± 11.51 years (range 35-81 years). There were 18 females (75%) and 6 males (25%). The following complications were noted: granuloma in three eyes (12.5 %), overriding graft onto the cornea in three eyes (4.17%), and recurrence in one eye (4.17%). No other complications were noted. Average surgical time was 16 ± 2 minutes. 

Conclusion: Sutureless and glue-free limbal conjunctival autografting is a treatment modality for primary nasal pterygium with no additional cost and has only one recurrence case in 24 cases.
Difference in prevalence of diabetes and diabetic retinopathy among low-altitude dwellers vs. high-altitude dwellers in North India
Authors: Chauhan Anil , Verma Anil Kumar , Sharma Deepak , Gupta Lalit , Kumar Dinesh , Sharma Gaurav , Grover Ashoo
Published: January 2021

Background: Type-2 diabetes mellitus (DM) is one of the leading lifestyle-related chronic disease as its prevalence is expected to rise up to 24.0% in the world by 2025, which was only 6.3% in year 2003.

Objective: To understand the high-altitude and low-altitude differentials for DM and diabetic retinopathy (DR) prevalence in a sub-Himalayan state of North India.

Methods: The study was carried out in the Shahpur block of Kangra district (altitude 2,404 feet) and the Spiti block of Lahaul and Spiti district (altitude 12,500 feet) of Himachal Pradesh.

Results: Among diabetics, the prevalence of DR was observed to be high (18.1%) in low landers and low (5.0%) in high landers. DM was more of a problem among low landers with a prevalence of 12.3% when compared to high landers (7.2%). Overall, the odd ratio of DR was twice as high (2.2; 95% confidence interval [CI]: 1.1-2.3) among patients with an unsatisfactory level of HbA1c (>8.0%) adjusted for gender, age group, smoking status and hypertension.

Conclusion: Differential did exist, as DM and DR were significantly lower in high-altitude areas when compared to low-altitude areas.
Anterior segment optical coherence tomography of intrastromal corneal cysts
Authors: Mazumdar Deepmala , Lal Barsha , Asokan Rashima
Published: January 2021

We report a case of six-year-old boy who presented with a progressive intracorneal cyst in the left eye. Anterior segment optical coherence tomography (AS-OCT) was performed, and it showed the location of the cyst in the corneal stroma. Its dimension was measured to be 7.09 Å~ 2.12 mm. The cyst aspiration was successfully done. AS-OCT helped in the management and follow-up of the condition.
Prophylactic corneal cross-linking in LASIK surgery: effects on visual outcome and recovery time
Authors: Oh Dominique Clare , Chan Yiong Huak , Lee Sao Bing , See Jovina Li Shuen
Published: January 2021

Introduction: Collagen cross-linking is a useful adjunct in preventing corneal ectasia after laser-assisted in situ keratomileusis (LASIK). This study aimed to evaluate whether prophylactic cross-linking in IntraLase LASIK affects optimum visual outcome and recovery time in the immediate post-surgery period and is associated with any side effects.

Methods: This was a retrospective case study on the right eyes of 100 Chinese subjects aged 18 to 40 years who underwent IntraLase LASIK. Fifty subjects who underwentcross-linking after completing LASIK (Group A) were compared with 50 subjects who did not undergo LASIK (Group B). Cases were evaluated for pre- and post-operative spherical equivalent, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), recovery time and presence of side effects.

Results: At 1 week post-LASIK, mean (SD) UDVA of Group A subjects was poorer than Group B, at 1.05 (0.19) vs 1.17 (0.19) (p = 0.036); however, there was no significant difference in CDVA (p = 0.095). By 1 month post-LASIK, differences in both UDVA and CDVA were insignificant (p = 0.055, 0.106, respectively). Mean recovery time was 2.72 (95% confidence interval [CI] = 0.64-4.7) days longer in Group A (p = 0.010), although by 1 month post-LASIK, both groups were able to achieve CDVA equal to or better than that achieved pre-LASIK. Incidence of mild inflammation and dry eyes post-LASIK was similar in both groups (p = 1.00, 0.749, respectively); no other complications were observed.

Conclusion: No differences in visual outcomes at and occurrence of side effects at 1 month post-LASIK were observed between subjects who underwent cross-linking prior to refractive surgery and those who did not. However, the group that underwent cross-linking had a slightly longer mean recovery time. Our study supports prophylactic cross-linking as a safe procedure that does not affect immediate visual outcomes among the Chinese population when used in adjunct with LASIK surgery.
Intermediate-term outcome of placement of Baerveldt glaucoma implant for refractory glaucoma in a Malaysian population
Authors: Fang Clarissa Ern Hui , Fang Seng Kheong
Published: January 2021

Objective: To report baseline characteristics and surgical outcomes of placement of Baerveldt glaucoma implant (BGI) in Asian eyes with considerably elevated intraocular pressure (IOP) despite maximal medical therapy.

Design: Retrospective case series of surgical cases from a single surgeon. Retrospective review of medical records of last clinic visits.

Participants: One hundred and ninety-seven eyes of patients underwent placement of 350-mm2 Baerveldt implant.

Methods: The medical records of consecutive patients who underwent placement of a Baerveldt 350-mm2 glaucoma drainage device (GDD) at the International Specialist Eye Centre from 2007 to 2014 were reviewed. Patients with a minimum 1-year follow-up were included. Baseline characteristics, pre-operative and post-operative IOP, number of glaucoma medications, visual acuity (VA) and complications were recorded. The pre-operative IOP is compared with the IOP at 1, 2, 3 and 5 years.

Measures: The IOP, VA, supplemental medical therapy, complications and success and failures were recorded.

Results: One hundred and ninety-seven patients were followed up at 1-year post-operation, 157 patients at 2 years, 120 at 3 years and 37 at 5 years. The mean baseline IOP of 29.2 ± 10.6 mmHg was significantly reduced at all time points post-operatively. Mean number of glaucoma medications was significantly lower at last follow-up than pre-operatively (1.8 vs. 2.7).

Conclusions: Placement of GDDs effectively reduces IOP without much long-term complication and may be useful in glaucomatous eyes with considerably elevated pre-operative IOP not well controlled with maximal medical therapy in the Asian population.
Secondary glaucoma due to thrombosis of sigmoid and transverse sinus
Authors: Pai H. Vijaya , Reddy Matta Rudhira
Published: January 2021

An 88-year-old female presented with redness in the left eye of one-month duration. On examination, the left eye showed 3 mm of proptosis with dilated and tortuous episcleral vessels and relative afferent pupillary defect. Intraocular pressure was 60 mmHg and showed open angles on gonioscopy with cup disc ratio of 0.8 in OS. A diagnosis of secondary open-angle glaucoma due to elevated episcleral venous pressure (EVP) was made. Magnetic resonance venogram revealed thrombosis of transverse and sigmoid sinus on the left side. This is the first case report of secondary open-angle glaucoma due to elevated EVP following thrombosis of transverse and sigmoid sinus.