bluuebunny/crossref_metadata_2025 huggingface dataset:
Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury
Authors: Loyd Brian J. , Dibble Leland E. , Weightman Margaret M. , Pelo Ryan , Hoppes Carrie W. , Lester Mark , King Laurie A. , Fino Peter C.
Published: February 2023

Objective:

Unconstrained head motion is necessary to scan for visual cues during navigation, for minimizing threats, and to allow regulation of balance. Following mild traumatic brain injury (mTBI) people may experience alterations in head movement kinematics, which may be pronounced during gait tasks. Gait speed may also be impacted by the need to turn the head while walking in these individuals. The aim of this study was to examine head kinematics during dynamic gait tasks and the interaction between kinematics and gait speed in people with persistent symptoms after mTBI.

Setting:

A clinical assessment laboratory.

Design:

A cross-sectional, matched-cohort study.

Participants:

Forty-five individuals with a history of mTBI and 46 age-matched control individuals.

Main Measures:

All participants were tested at a single time point and completed the Functional Gait Assessment (FGA) while wearing a suite of body-mounted inertial measurement units (IMUs). Data collected from the IMUs were gait speed, and peak head rotation speed and amplitude in the yaw and pitch planes during the FGA-1, -3, and -4 tasks.

Results:

Participants with mTBI demonstrated significantly slower head rotations in the yaw (P = .0008) and pitch (P = .002) planes. They also demonstrated significantly reduced amplitude of yaw plane head rotations (P < .0001), but not pitch plane head rotations (P = .84). Participants with mTBI had significantly slower gait speed during normal gait (FGA-1) (P < .001) and experienced a significantly greater percent decrease in gait speed than healthy controls when walking with yaw plane head rotations (FGA-3) (P = .02), but not pitch plane head rotations (FGA-4) (P = .11).

Conclusions:

Participants with mTBI demonstrated smaller amplitudes and slower speeds of yaw plane head rotations and slower speeds of pitch plane head rotations during gait. Additionally, people with mTBI walked slower during normal gait and demonstrated a greater reduction in gait speed while walking with yaw plane head rotations compared with healthy controls.
Return to School After Traumatic Brain Injury: Description of Implementation Settings
Authors: Haarbauer-Krupa Juliet , Thigpen Sally , Glang Ann , Eagan-Johnson Brenda , McAvoy Karen , Brunken Cindy , Chininis Maria , Kurowski Brad G. , Suskauer Stacy , Crowley Maria , Denslow Paula
Published: February 2023

Objective:

Children who experience traumatic brain injury (TBI) of any severity may need accommodations when they return to school—the setting that manages academic achievement and learning. However, variations exist in current return to school (RTS) programs that address a child's transition to school following TBI. This article describes some of these return to school (RTS) programs and how they vary by setting.

Design:

This article provides insights from a modified evaluability assessment that examined RTS programs and their readiness for rigorous evaluation. A secondary analysis was conducted to better describe the types and location of programs examined.

Results:

Differences exist in program structure, access, and how care for children is monitored over time. RTS programs that serve children following TBI are located in healthcare settings, schools, and state agencies and vary in models of care due to their location and organizational structure.

Conclusions:

Children who experience TBI benefit from a healthcare assessment and follow-up upon RTS that includes parental involvement. Models of care for this process vary based on program location and organizational structure. Further research and program evaluation are needed to better understand effectiveness and how to optimally monitor and care for children returning to school after a concussion or TBI.
INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR PHARMACEUTICAL UTILIZATION AND FINANCIAL IMPACT IN A VALUE-BASED CARE PROGRAM
Authors: Daruwalla Cyrus , Andrieni Julia , Hsu Enshuo , Uzair Sidra , Wykoff Charles C. , Lee Andrew G.
Published: February 2023

Purpose:

To investigate trends and the potential impact of the COVID-19 pandemic on the utilization of intravitreal antivascular endothelial growth factor (anti-VEGF) pharmaceuticals in an accountable care organization (ACO).

Methods:

We retrospectively analyzed the Centers for Medicare and Medicaid Services beneficiary claims for all patients in the Houston Methodist Coordinated Care ACO registry during the years 2018, 2019, and 2020.

Results:

Across the 3 years studied, a mean of 708 patients received anti-VEGF injections per year. The percentage of patients who received anti-VEGF injections decreased in each sequential year, with a steeper decline during the COVID-19 pandemic in the year 2020 (decrease by 0.4% from 2019 to 2020, P < 0.001; decrease by 0.2% from 2018 to 2019, P = 0.1453). The percentage of patients receiving bevacizumab of the total number of patients receiving any anti-VEGF treatment decreased (bevacizumab decreased by 6% from 2019 to 2020, P = 0.0174; decreased by 7% from 2018 to 2019, P = 0.0074). The COVID-19 pandemic did not seem to correlate with a change in the distribution of the specific anti-VEGF injection used.

Conclusion:

Despite the lower price which may correlate with value-based care, bevacizumab was the least used anti-VEGF treatment. COVID-19 correlated with a larger decrease in the utilization of all three anti-VEGF drugs.
LONGITUDINAL STUDY OF CHANGES IN INNER SCLERAL CURVATURE PATTERNS AND DEVELOPMENT OF POSTERIOR STAPHYLOMAS IN HIGHLY MYOPIC EYES OF CHILDREN AND ADOLESCENTS
Authors: Chen Changyu , Du Ran , Xie Shiqi , Lu Hongshuang , Xiong Jianping , Wang Yining , Nakao Noriko , Takahashi Hiroyuki , Igarashi-Yokoi Tae , Kamoi Koju , Uramoto Kengo , Ohno-Matsui Kyoko
Published: February 2023

Purpose:

To determine the longitudinal changes in patterns of inner scleral curvature and development of posterior staphylomas in the eyes of highly myopic youths.

Methods:

A retrospective, longitudinal study. Ultra-widefield optic coherence tomographic (UWF-OCT) images from 47 eyes of 24 highly myopic patients with a follow-up period of 2 to 4 years were analyzed. Patients were divided into two groups, the children group younger than 10 years and the adolescents group aged 11 to 19 years.

Results:

During the follow-up period, the scleral curvature patterns changed in either the horizontal or vertical optical coherence tomographic sections in 27 of the 46 eyes (58.7%) of both groups. The changes were significantly more frequent in children than adolescents. The change in the vertical section from symmetrical to asymmetrical in almost of children was correlated with an increase in the axial length and myopia. Four eyes had a staphyloma at the baseline. The staphyloma developed in six eyes of the remaining 43 eyes (14%). All staphyloma edges were found at or around the optic disc and were oriented in the horizontal direction.

Conclusion:

Our results showed that UWF-OCT images can be used to determine the process of new staphyloma formation and concurrent changes in scleral curvature patterns.
QUANTIFIED ANASTOMOTIC AREAS OF NEOVASCULARIZATION AS FACTORS ASSOCIATED WITH FREQUENT RECURRENCE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Lee Hyungwoo , Kim SoHyeon , Kim Myung Ae , Chung Hyewon , Kim Hyung Chan
Published: February 2023

Purpose:

To investigate the quantitative characteristics of anastomoses of macular neovascularization (MNV) in neovascular age-related macular degeneration using optical coherence tomography angiography according to the frequency of intravitreal injections.

Methods:

Eighty-six eyes of 86 patients treated for neovascular age-related macular degeneration were classified into two groups based on the number of intravitreal injections administered over 12 months: stable (<3) and unstable (≥3). Anastomotic areas were defined as areas surrounded by neighboring vessels in the MNV; their total number, mean area, maximal and minimal diameters (i.e., maximal and minimum Feret diameters), and ratio (Feret aspect ratio) were analyzed in the inner and outer areas of the MNV.

Results:

Forty-four and 42 eyes were classified into the stable and unstable groups, respectively. The eyes in the unstable group had larger anastomotic areas with longer minimum Feret diameters and longer perimeters in the outer MNV. In the logistic regression analysis, instability was associated with a larger anastomotic area and a longer minimum Feret diameter in the outer MNV. Multivariate analysis revealed that a longer minimum Feret diameter in the outer MNV was the most significant factor (P = 0.03).

Conclusion:

The quantitative characteristics of the anastomotic areas in the MNV might indicate the need for intravitreal injections in patients with neovascular age-related macular degeneration.
OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT REPAIR FOLLOWING INFECTIOUS ENDOPHTHALMITIS
Authors: Wu Frances , Kim Leo A.
Published: February 2023

Purpose:

To determine the incidence of and identify risk factors for redetachment in eyes that underwent rhegmatogenous retinal detachment (RRD) repair after infectious endophthalmitis.

Methods:

Retrospective chart review of patients who had RRD surgery following a diagnosis of endophthalmitis from 2008 to 2021 at a tertiary referral center. Demographic and clinical characteristics as well as operative details were collected. Subjects with prior RRD, trauma, keratoprosthesis, or less than 3 months of postoperative follow-up were excluded. Univariate logistic regression analyses were performed.

Results:

Thirty-four eyes of 34 patients were included. Most subjects were male with a mean age of 60.1 years. Exogenous (58.8%) was more common than endogenous (41.2%) sources of endophthalmitis. Seventeen of 34 eyes (50.0%) experienced redetachment. Significant risk factors were infection with virulent organisms, hypotony, and postoperative proliferative vitreoretinopathy. Initial management with vitreous tap or vitrectomy, exogenous versus endogenous source, and surgical procedure were not associated with recurrent RRD. At the final follow-up, 32 of 34 eyes (91.2%) were attached, although more than one third of these had silicone oil.

Conclusion:

Redetachment occurred in half of eyes that underwent surgical repair of RRD after endophthalmitis. Early vitrectomy, with or without prior vitreous tap, was not associated with a higher risk of redetachment and improved the likelihood of a positive culture result. Culture data can aid in risk stratification because organism virulence was a risk factor for recurrent RRD. Although visual outcomes were generally poor, most retinas remained attached at the final visit.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MORPHOLOGY AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Melo Isabela M. , Francisconi Carolina L. M. , Marafon Samara B. , Figueiredo Natalia A. , Juncal Verena R. , Bhambra Nishaant , Ta Kim David T. , Brosh Koby , Berger Alan R. , Giavedoni Louis R. , Wong David T. , Altomare Filiberto , Chow David R. , Hillier Roxane J. , Muni Rajeev H.
Published: February 2023

Purpose:

To compare foveal avascular zone (FAZ) geometric indices using optical coherence tomography angiography (OCTA) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). FAZ morphology was assessed as a possible imaging feature of retinal displacement.

Methods:

This ALIGN post hoc analysis included primary fovea-off RRDs that underwent successful PnR or PPV, and performed OCTA, and fundus autofluorescence at (FAF) 3 months postoperatively at St. Michael's Hospital, Toronto, Canada. FAZ area (mm2), axial ratio, circularity, and roundness were measured, and FAF images were assessed for retinal displacement.

Results:

Seventy-two patients were included, 78% (56/72) were male mean age was 60 ± 9 years, and 60% (43/72) were phakic. Sixty-five percent (47/72) and 35% (25/72) underwent PnR and PPV, respectively. The mean baseline logarithm of the minimum angle of resolution visual acuity was 1.49 ± 0.76. FAZ circularity was lower after PPV (0.629 ± 0.120) versus PnR (0.703 ± 0.122); P = 0.016. Sixty-six patients had gradable FAF images. Retinal displacement was present in 29% (19/66), 84.2% (16/19) of which had displacement in the macula. FAZ circularity was lower in eyes with displacement in the macula (0.613 ± 0.110) versus those without displacement (0.700 ± 0.124); P = 0.015. There was a moderate negative correlation between 12-month aniseikonia and FAZ circularity(r = −0.262; P = 0.041).

Conclusion:

FAZ circularity was lower after PPV and in eyes with retinal displacement in the macula. Circularity was negatively correlated with 12-month aniseikonia scores. FAZ circularity may be another imaging feature to consider postoperatively after RRD repair.
PREDICTING VISUAL OUTCOME AFTER SURGERY IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANE USING A NOVEL CONVOLUTIONAL NEURAL NETWORK
Authors: Yeh Tsai-Chu , Chen Shih-Jen , Chou Yu-Bai , Luo An-Chun , Deng Yu-Shan , Lee Yu-Hsien , Chang Po-Han , Lin Chun-Ju , Tai Ming-Chi , Chen Ying-Chi , Ko Yu-Chieh
Published: February 2023

Purpose:

To develop a deep convolutional neural network that enables the prediction of postoperative visual outcomes after epiretinal membrane surgery based on preoperative optical coherence tomography images and clinical parameters to refine surgical decision making.

Methods:

A total of 529 patients with idiopathic epiretinal membrane who underwent standard vitrectomy with epiretinal membrane peeling surgery by two surgeons between January 1, 2014, and June 1, 2020, were enrolled. The newly developed Heterogeneous Data Fusion Net was introduced to predict postoperative visual acuity outcomes (improvement ≥2 lines in Snellen chart) 12 months after surgery based on preoperative cross-sectional optical coherence tomography images and clinical factors, including age, sex, and preoperative visual acuity. The predictive accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the convolutional neural network model were evaluated.

Results:

The developed model demonstrated an overall accuracy for visual outcome prediction of 88.68% (95% CI, 79.0%–95.7%) with an area under the receiver operating characteristic curve of 97.8% (95% CI, 86.8%–98.0%), sensitivity of 87.0% (95% CI, 67.9%–95.5%), specificity of 92.9% (95% CI, 77.4%–98.0%), precision of 0.909, recall of 0.870, and F1 score of 0.889. The heatmaps identified the critical area for prediction as the ellipsoid zone of photoreceptors and the superficial retina, which was subjected to tangential traction of the proliferative membrane.

Conclusion:

The novel Heterogeneous Data Fusion Net demonstrated high accuracy in the automated prediction of visual outcomes after weighing and leveraging multiple clinical parameters, including optical coherence tomography images. This approach may be helpful in establishing personalized therapeutic strategies for epiretinal membrane management.
QUANTITATIVE ANALYSIS OF CHOROIDAL MORPHOLOGY USING MULTIMODAL IMAGING IN ACUTE AND PERSISTENT CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Phil-kyu , Ra Ho , Han Su Yeon , Baek Jiwon
Published: February 2023

Purpose:

To analyze quantitative differences in choroidal morphology between acute and persistent central serous chorioretinopathy using multimodal images.

Methods:

Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography images of 72 eyes of 72 patients with acute (32 eyes) and persistent (40 eyes) central serous chorioretinopathy were collected. Choroidal thickness, area, vessel density, symmetry, and intervortex anastomosis were assessed.

Results:

The choroidal area on optical coherence tomography B-scan images was smaller and the choroidal vessel density on UWICGA images was lower in the persistent group (P < 0.001 and P = 0.028, respectively). Choroidal vessel density on UWICGA showed positive correlation with that of vortex ampullae (all P ≤ 0.046). The constitution of the intervortex anastomosis and dominant vessels in the macular area showed differences between the groups (P = 0.014 and P = 0.010, respectively), with greater inferonasal vessel participation in the anastomosis and combined superotemporal and inferotemporal vessels as dominant vessels in the persistent groups.

Conclusion:

Acute and persistent central serous chorioretinopathy differed in subfoveal choroidal area, choroidal vessel density, and intervortex anastomosis constitution on UWICGA images. Choroidal vessel density on UWICGA images correlated with that of vortex ampullae. These findings enhance our understanding of the pathophysiology of central serous chorioretinopathy subtypes.
USE OF OPTICAL COHERENCE TOMOGRAPHY IN DETECTING RETINAL TEARS IN ACUTE, SYMPTOMATIC POSTERIOR VITREOUS DETACHMENT
Authors: Rao Aishwarya V. , Shah Ankoor R. , Nguyen Vy T. , Pearce William , Wong Tien P. , Brown David M. , Wykoff Charles C. , Patel Sagar B.
Published: February 2023

Purpose:

To evaluate the association of posterior vitreous opacities (PVOs) on optical coherence tomography with retinal tears identified on examination in patients with acute, symptomatic posterior vitreous detachment (PVD).

Methods:

Data were retrospectively collected from the medical records of 388 patients with acute, symptomatic PVD between January 1, 2021, and June 30, 2021. Included patients had received a primary diagnosis of PVD and presented with flashes and/or floaters. Optical coherence tomography scans were reviewed by two separate readers for the presence of PVOs. The primary outcome was the presence of retinal tear on fundus photograph and on examination.

Results:

Of 388 patients who presented with acute PVD symptoms, 90 (23.2%) were found to have a retinal tear on dilated fundus examination. Among these patients, 78 (86.7%) were found to have PVOs on optical coherence tomography. Statistical analysis demonstrated a significant relationship between the presence of PVOs and retinal tear (P < 0.01). The sensitivity and specificity of this finding was 86.7% and 72.5%, respectively. Further analysis included area under the curve from receiver operating characteristic curve which was found to be 0.80.

Conclusion:

The presence of PVOs on optical coherence tomography is suggestive of a retinal tear in patients with acute, symptomatic PVD.
Alternative Techniques To Remove Retained Silicone Oil Droplets On IOLs
Authors: Cherkas Elliot , Sivalingam Meera D. , Klufas Timothy , Klufas Michael A.
Published: February 2023

Background/Purpose:

To describe several modified approaches to remove retained silicone oil droplets on intraocular lens (IOLs).

Methods:

Four novel techniques for removing retained silicone oil droplets on IOLs were described.

Results:

All four techniques led to an improved IOL with a good view to the posterior segment. No intraoperative or long-term postoperative complications have been seen in any of these eyes. These modified approaches are safe, efficient, low cost, and use existing vitreoretinal operating room supplies to add to the vitreoretinal surgeon's armamentarium to clear retained IOL silicone droplets.

Conclusion:

It is advocated for having multiple techniques at the disposal of the vitreoretinal surgeon to address retained silicone oil on IOLs. Being able to use multiple techniques may not be superior than a single approach but is often necessary to accomplish the surgical goal of removing these adherent droplets.
SUSTAINED BIWEEKLY AFLIBERCEPT FOR REFRACTORY NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Schneider Eric W. , Thomas Mridul K. , Recchia Franco M. , Reichstein David A. , Awh Carl C.
Published: February 2023

Purpose:

To assess the safety and efficacy of biweekly (every 2 weeks) intravitreal aflibercept injections (IAI) 2 mg in eyes with refractory neovascular age-related macular degeneration (NVAMD).

Methods:

A prospective, single-arm, interventional study was conducted. Eyes with refractory NVAMD received six biweekly IAIs through week 12, followed by a 4-week treatment pause until week 16. Eyes with residual subretinal fluid (SRF) at week 16 were randomized 1:1 to either four additional biweekly IAIs or to 4-week (q4W) IAI dosing through week 24. All eyes were subsequently treated q4W through week 52.

Results:

Enrolled eyes (n = 22) had persistent SRF despite a mean of 11.8 injections over the prior 12 months. One patient developed endophthalmitis at week 12. There were no additional drug/procedure-related adverse events. Best-corrected visual acuity (BCVA) improved significantly from baseline to week 14 (2.52 letters, P < 0.001). The mean central subfield thickness (CST) was also significantly improved at week 14 (−31.9 µm, P < 0.001) with eight of 22 eyes achieving complete SRF resolution. Only two of eight eyes remained free of SRF at week 16, with a corresponding increase in mean CST of 26.7 µm compared with week 14. By week 52, improvements in BCVA and CST were lost.

Conclusion:

In patients with refractory NVAMD-related SRF, sustained biweekly IAIs resulted in significant functional and anatomical improvements during biweekly dosing. These gains, however, were lost on return to monthly dosing. These findings suggest that efforts to reduce refractory SRF in NVAMD with biweekly dosing may provide added benefit compared with standard of care treatment if biweekly dosing is sustained.
VITRECTOMY RESULTS FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH CONCOMITANT MACULAR HOLE IN NONMYOPIC PATIENTS
Authors: Iros Mariano , Sallam Ahmed B. , Lopez Juan Manuel , Glacet-Bernard Agnes , Seknazi Daniel , Souied Eric H.
Published: February 2023

Purpose:

To report on results of pars plana vitrectomy with ILM peeling in patients with rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) and to assess for preoperative associated conditions related to this type of RRD.

Methods:

Patients undergoing surgical repair for RRD between 2014 and 2021 were reviewed, and subjects with concomitant, non-causal, macular hole were identified. We studied post-operative macular status, retinal reattachment rate and visual acuity.

Results:

Over 532 eyes operated on for RRD, 11 (2.06%) had a concurrent non-causal macular hole. Preoperative PVR B or superior was recorded in 86 eyes (16.6%) of the entire cohort and in 6 eyes (54.54 %) with RRD and concomitant MH (p=0.00001). Severe hypotony with choroidal detachment was present in 15 eyes (2.81%) of the entire cohort and in 3 eyes (27.27%) with RRD and concomitant MH (p=<0.00001).

Conclusions:

RRD with concomitant MH is an infrequent association. Retinal reattachment and anatomical hole closure can be achieved in most of cases but despite this fact, functional recovery is usually not good. Preoperative PVR is a more frequent finding in this group of patients, as well as severe hypotony with choroidal detachment.
CLINICAL OUTCOMES OF ACUTE ENDOPHTHALMITIS AFTER INTRAVITREAL DELIVERY OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS VERSUS STEROIDS
Authors: Adams Olufemi E. , Sodhi Guneet S. , Vagaggini Tommaso , Haq Zeeshan , Curran Christian D. , Prairie Michael L. , Montezuma Sandra R. , Koozekanani Dara D. , Ryan Edwin H. , Parke DAVID WILKIN , Mittra Robert A. , Tang Peter H.
Published: February 2023

Purpose:

To compare patients with acute endophthalmitis after intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors vs. steroids.

Methods:

Retrospective single-center, nonrandomized interventional study from 2013 to 2021.

Patients underwent vitreous biopsy before initiating treatment and were divided into the following cohorts: (1) anti-VEGF managed medically (T&I–anti-VEGF), (2) anti-VEGF managed by immediate pars plana vitrectomy (PPV–anti-VEGF), and (3) steroid therapy and managed medically or by pars plana vitrectomy (steroid).

Results:

A total of 141 patients were analyzed. The steroid cohort demonstrated significantly worse presenting (median = 2.80 logarithm of the minimum angle of resolution [logMAR]; P ≤ 0.01) and final (median = 2.30 logMAR) best-corrected visual acuity compared with T&I–anti-VEGF (presenting: median = 2.00 logMAR; final: median = 0.40 logMAR) and pars plana vitrectomy–anti-VEGF cohorts (presenting: median = 2.30 logMAR; final: median = 0.48 logMAR). There was no significant (P = 0.33) difference in the final best-corrected visual acuity between T&I–anti-VEGF and pars plana vitrectomy–anti-VEGF cohorts. There were no significant (P ≥ 0.63) differences among cohorts in best-corrected visual acuity before acute endophthalmitis diagnosis (T&I–anti-VEGF: median = 0.40 logMAR; pars plana vitrectomy–anti-VEGF: median = 0.40 logMAR; steroid: median = 0.44 logMAR). Microbial cultures revealed similar profiles for all cohorts.

Conclusion:

Acute endophthalmitis after intravitreal injection steroid therapy had worse outcomes compared with anti-VEGF therapy.
RECURRENCE OF ACUTE RETINOPATHY IN PSEUDOXANTHOMA ELASTICUM
Authors: Ramtohul Prithvi , Cabral Diogo , Cicinelli Maria Vittoria , Freund K. Bailey
Published: February 2023

Purpose:

To report a case of recurrent acute retinopathy associated with pseudoxanthoma elasticum (PXE) and to propose a reappraisal of this entity based on multimodal imaging analysis.

Methods:

Retrospective case report. High-resolution optical coherence tomography (High-Res OCT), ultra-widefield imaging, and widefield swept-source OCT-angiography (OCTA) and en face OCT were performed.

Results:

A man in his 40s diagnosed with PXE and angioid streaks presented with two distinct episodes of acute retinopathy in his right eye during a one-year follow-up period. Acute retinopathy was characterized by rapid vision loss. High-Res OCT showed multifocal hyperreflective lesions splitting the retinal pigment epithelium/Bruch’s membrane complex and associated with focal choroidal thickening. After the first episode, OCTA confirmed the development of macular neovascularization at the site of a prior inflammatory lesion. During the second episode, multimodal images showed findings consistent with epiphenomenon multiple evanescent white dot syndrome (EpiMEWDS). On en face widefield OCT, acute retinopathy was characterized by multiple hyperreflective spots scattered at the posterior pole.

Conclusion:

Recurrence of acute retinopathy can be observed in patients with PXE and angioid streaks. Multimodal imaging shows that some lesions of PXE-associated acute retinopathy closely resemble those of punctate inner choroidopathy/idiopathic multifocal choroiditis.
Descemet Stripping Without Endothelial Keratoplasty in Early-Stage Central Fuchs Endothelial Dystrophy: Long-term Results
Authors: Vieira Rita , Castro Catarina , Coelho João , Mesquita Neves Miguel , Gomes Miguel , Oliveira Luís
Published: February 2023

Purpose:

The purpose of this study was to report long-term results of Descemet stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification in patients with early-stage central Fuchs endothelial corneal dystrophy.

Methods:

This is a retrospective study, including all patients submitted to DWEK associated with cataract surgery with a minimum follow-up of 24 months. Included patients had central confluent guttae confirmed with specular microscopy, a clear peripheral endothelium (with a peripheral endothelial count >1500 cells/mm2), and a central pachymetry <600 μm. The main end points were the presence of a clear cornea and time that was needed to achieve transparency, best-corrected visual acuity in logMAR, endothelial central cell count (ECC), and central pachymetry.

Results:

A total of 22 eyes were included with a mean follow-up of 40.8 ± 10.5 months. At baseline, mean central pachymetry was 536 ± 34 mm and 6 eyes had countable ECC (mean 1138 ± 190 cells/mm2). Twenty eyes (90.9%) achieved good corneal transparency 3.2 ± 1.1 months after surgery. There was a significant improvement in logMAR best-corrected visual acuity compared with baseline (0.13 ± 0.10 vs. 0.48 ± 0.24, respectively, P < 0.001). Endothelial central repopulation was observed in all successful cases. Twelve months after DWEK, ECC was 1449 ± 344 cells/mm2 and 1393 ± 450 cells/mm2 at the end of follow-up, without a significant decrease between this period (P = 0.081). Only 2 eyes (9.1%) did not achieve corneal transparency and were submitted to an endothelial keratoplasty.

Conclusions:

According to our results, DWEK is a safe and effective procedure in selected cases of early-stage central Fuchs endothelial corneal dystrophy. This seems to be a promising technique, delaying or avoiding endothelial transplantation.
Recurrent Keratoconus: Corneal Transplants for Keratoconus Develop Tomographic Ectatic Changes
Authors: Miura Maria , Leon Pia , Nahum Yoav , Böhm Myriam S. , Mimouni Michael , Belin Michael W. , Johns Lynette , Ciolino Joseph B.
Published: February 2023

Purpose:

The purpose of this study was to evaluate postoperative Scheimpflug imaging changes during the first 5 years after penetrating keratoplasty (PK) in patients with keratoconus (KC).

Methods:

This retrospective, interventional case series includes 31 eyes of 31 patients who underwent their first PK with a history of KC. Postoperative Scheimpflug imaging was performed 3 months after the removal of the last suture (baseline) and then repeated 3 and 5 years after the PK. Demographic data, donor and host trephination diameter, and Scheimpflug imaging (Pentacam HR, Oculus, Germany) parameters indicative of ectasia were analyzed to evaluate postoperative graft changes that occur after PK.

Results:

The maximal keratometry (Kmax) progressed significantly between baseline (53.5 ± 6.1 D) and postoperative year 3 and year 5 [56.5 ± 6.1 diopter (D) and 58.8 ± 7.9 D, P < 0.001]. Significant changes were also observed for the anterior best fit sphere and posterior best fit sphere (P < 0.001 for 3 and 5 years compared with baseline). Kmax increased by at least 2 Ds for 74.2% of patients and up to 7 Ds or more for 25.8% of the patients. A significant inverse correlation was observed for host trephine size and progression of Kmax (r = −0.52, P = 0.01), which indicated that larger host trephination size was associated with a smaller increase in postoperative Kmax.

Conclusions:

Tomographic graft changes indicative of ectasia were observed within 3 to 5 years after PK in patients with KC. These changes were observed more frequently and sooner after corneal transplants than previously reported.
Corneal Densitometry to Assess the Corneal Cystine Deposits in Patients With Cystinosis
Authors: Biswas Susmito , Alzahrani Khaled , Radhakrishnan Hema
Published: February 2023

Purpose:

The purpose of this study was to assess the suitability of corneal densitometry measurements obtained with Scheimpflug imaging in estimating the corneal changes caused by cystine deposits in the cornea in patients with cystinosis.

Methods:

Scheimpflug imaging (Pentacam) was performed for 14 patients with cystinosis and 16 age-matched controls. Pentacam data were used for analysis of the corneal densitometry at different zones in the cornea for patients with cystinosis and controls. Densitometry measurements were compared with the corneal crystal scores obtained from the slitlamp images for patients with cystinosis.

Results:

There was no statistically significant difference in keratometry measurements between the 2 groups (P > 0.05). Corneal thickness was found to be significantly higher in the control group when compared with the cystinosis group (P = 0.0004). The mean corneal densitometry was significantly higher in patients with cystinosis when compared with controls at most of the corneal layers and zones. The corneal densitometry readings for the right and left eyes showed moderate positive correlation with the corneal crystal score with a ceiling effect being reached at the maximum corneal crystal score of 3.

Conclusions:

Corneal densitometry obtained through Pentacam can be used as an objective estimate of the level of cystine crystals present in patients with cystinosis. The clinical estimate of corneal crystal score, although effective at low levels of crystal deposition, does not allow for accurate estimates of change when the level of crystal deposition is high leading to limited utility when assessing treatment effects. Hence, densitometry measurements can potentially be used to assess treatment efficacy of cystinosis treatments in clinical settings.
Distribution of Corneal Volume and Its Associated Factors in an Elderly Population: Tehran Geriatric Eye Study
Authors: Hashemi Hassan , Valadkhan Mehrnaz , Nabovati Payam , Yekta Abbasali , Aghamirsalim Mohamadreza , Khabazkhoob Mehdi
Published: February 2023

Purpose:

The aim of this study was to determine the distribution of corneal volume (CV) using Pentacam and its relationship with demographic and ocular factors in an elderly population older than 60 years.

Methods:

The present report is a part of the Tehran Geriatric Eye Study. The sampling was performed using the multistage stratified random cluster sampling method. The preliminary ocular examinations were performed for all individuals including visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Finally, study participants underwent anterior segment imaging and ocular biometry using Pentacam AXL.

Results:

The mean CV was 57.92 mm3 [95% confidence interval (CI): 57.76–58.08] in the whole sample. The mean CV was 57.69 mm3 (95% CI: 57.52–57.87) after excluding diabetic patients. The mean CV was 57.79 mm3 (95% CI: 57.57–58.01) and 58.04 mm3 (95% CI: 57.83–58.26) in men and women, respectively. The mean CV was 57.96 mm3 (95% CI: 57.71–58.21), 57.84 mm3 (95% CI: 57.49–58.19), and 57.92 mm3 (95% CI: 57.7–58.13) in individuals with emmetropia, myopia, and hyperopia, respectively. The CV decreased significantly with advancing age. Moreover, the anterior chamber depth, central corneal thickness, mean keratometry, anterior corneal asphericity (Q value), and posterior corneal astigmatism were significantly directly related to CV, whereas axial length and white-to-white distance had a statistically significant inverse association with the CV.

Conclusions:

Aging is one of the important factors in reducing CV that should be considered. Some other topographic and biometric indices also have a significant relationship with CV.
Mustard Gas–Induced Ocular Surface Disorders: An Update on the Pathogenesis, Clinical Manifestations, and Management
Authors: Soleimani Mohammad , Momenaei Bita , Baradaran-Rafii Alireza , Cheraqpour Kasra , An Seungwon , Ashraf Mohammad Javad , Abedi Farshad , Javadi Mohammad Ali , Djalilian Ali R.
Published: February 2023

Purpose:

Mustard gas (MG) is a potent blistering and alkylating agent that has been used for military and terrorism purposes. Ocular surface injuries are common after exposure to MG. This review provides an update on the pathophysiology, ocular surface complications, and treatment options for MG-related ocular injuries.

Methods:

Required information was obtained by reviewing various databases such as Cochrane Library, Google Scholar, and PubMed until March 2022. Data were collected by using keywords: “mustard gas” OR “sulfur mustard” AND “eye” OR “cornea” OR “ocular complication” OR “keratitis” OR “keratopathy” OR “limbal stem cell deficiency” OR “dry eye.”

Results:

Chronic intracellular toxicity, inflammation, and ischemia have been shown to play an essential role in the pathogenesis of MG injury. Ocular surface injuries can have acute, chronic, and most distinctly a delayed-onset presentation leading to various degrees of limbal stem cell deficiency. To date, no treatment has been agreed on as the standard treatment for chronic/delayed-onset MG keratopathy. Based on the authors’ experience, we propose a management algorithm for MG-related ocular surface injuries involving optimization of ocular health, anti-inflammatory therapy, and if needed surgical interventions. The management of chronic and delayed-onset presentation remains challenging.

Conclusions:

MG keratopathy is a unique form of chemical injury which can lead to a range of ocular surface pathologies. Long-term anti-inflammatory therapy even in patients with seemingly mild disease may potentially reduce the likelihood of the development of more severe delayed-onset disease.
Glaucoma management in patients with penetrating keratoplasty or keratoprosthesis
Authors: Sun Jessica A. , Manz Sarah N. , Shen Lucy Q.
Published: February 2023

Purpose of review

Advances in surgical techniques and postoperative care have significantly improved rates of short-term complications following keratoplasty; however, glaucoma remains a highly prevalent long-term and potentially devastating complication for postkeratoplasty patients. In this review, we provide an overview of recent literature on glaucoma management in patients who have undergone penetrating keratoplasty or the Boston keratoprosthesis type I (KPro) implantation.

Recent findings

New research suggests an inflammatory cause underlying glaucoma following KPro. Accurate IOP measurement is difficult in patients postkeratoplasty; study of objective techniques such as PDCT or Tono-Pen in penetrating keratoplasty eyes and trans-palpebral Diaton tonometry in KPro eyes have shown promising results. Early glaucoma surgical intervention should be considered for patients undergoing penetrating keratoplasty and KPro.

Patients who have undergone penetrating keratoplasty or implantation of the Boston keratoprosthesis type I should be monitored frequently for elevated intraocular pressure and for other signs of glaucomatous optic nerve damage. Intraocular pressure elevation should be treated promptly either medically or surgically while minimizing risk to the corneal graft. Further research into inflammatory causes and other treatment modalities is promising for the long-term visual success in these patients.
“Hot Tub Lung” With M. avium complex in an Immunocompetent Adolescent
Authors: Waletzko Benjamin , Lin Philana Ling , Lopez Santiago M.C.
Published: February 2023

We describe a case of pulmonary Mycobacterium avium complex (MAC) infection in an immunocompetent pediatric patient after a hot tub near drowning event with a literature review of pediatric MAC-associated disease after hot tub exposure.
Maternal, Infant, and Breast Milk Antibody Response Following COVID-19 Infection in Early Versus Late Gestation
Authors: Wachman Elisha M. , Snyder-Cappione Jennifer , Devera Jean , Boateng Jeffery , Dhole Yashoda , Clarke Katherine , Yuen Rachel R. , Parker Samantha E. , Hunnewell Jessica , Ferraro Renee , Jean-Sicard Sigride , Woodard Elizabeth , Cruikshank Alice , Sinha Bharati , Bartolome Ruby , Barnett Elizabeth D. , Yarrington Christina , Taglauer Elizabeth S. , Sabharwal Vishakha
Published: February 2023

Background:

Coronavirus disease 2019 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] infection at varying time points during the pregnancy can influence antibody levels after delivery. We aimed to examine SARS-CoV-2 IgG, IgM and IgA receptor binding domain of the spike protein and nucleocapsid protein (N-protein) reactive antibody concentrations in maternal blood, infant blood and breastmilk at birth and 6 weeks after SARS-CoV-2 infection in early versus late gestation.

Methods:

Mothers with SARS-CoV-2 infection during pregnancy were enrolled between July 2020 and May 2021. Maternal blood, infant blood and breast milk samples were collected at delivery and 6 weeks postpartum. Samples were analyzed for SARS-CoV-2 spike and N-protein reactive IgG, IgM and IgA antibodies. Antibody concentrations were compared at the 2 time points and based on trimester of infection (“early” 1st/2nd vs. “late” 3rd).

Results:

Dyads from 20 early and 11 late trimester infections were analyzed. For the entire cohort, there were no significant differences in antibody levels at delivery versus 6 weeks with the exception of breast milk levels which declined over time. Early gestation infections were associated with higher levels of breastmilk IgA to spike protein (P = 0.04). Infant IgG levels to spike protein were higher at 6 weeks after late infections (P = 0.04). There were strong correlations between maternal and infant IgG levels at delivery (P < 0.01), and between breastmilk and infant IgG levels.

Conclusions:

SARS-CoV-2 infection in early versus late gestation leads to a persistent antibody response in maternal blood, infant blood and breast milk over the first 6 weeks after delivery.
Trends and Changes in Influenza-associated Hospitalizations in Children During 25 Years in Finland, 1993–2018
Authors: Mattila Janna-Maija , Vuorinen Tytti , Heikkinen Terho
Published: February 2023

Background:

Limited long-term data are available on potential changes in the demographics and management of children hospitalized with influenza.

Methods:

We identified all children ≤15 years old hospitalized with virologically confirmed influenza at Turku University Hospital, Finland, during the 25-year period of July 1993–June 2018. Data on clinical variables, comorbidities and management were retrieved directly from the medical records. Population-based rates of hospitalization were calculated using official annual databases of children living in the hospital catchment area.

Results:

Between 1993–1998 and 2013–2018, the median age of children increased from 1.3 years to 3.3 years (P< 0.0001). The proportion of children <2 years of age decreased from 65.2% to 36.8%, whereas the proportion of children 6–15-year-old increased from 13.0% to 36.2% (P< 0.0001 for both). The population-based rates of hospitalization decreased by 49% in children 1 year of age (incidence rate ratio, 0.51; 95% confidence interval: 0.27–0.92;P= 0.018) and increased by 194% in children 6–15 years old (incidence rate ratio, 2.94; 95% confidence interval: 1.70–5.32;P< 0.0001). The median duration of hospitalization shortened from 2.0 days (interquartile range [IQR], 1.0–4.0) to 1.0 day (IQR, 1.0–2.0;P< 0.0001).

Conclusions:

During the 25 years, the median age of hospitalized children increased by 2 years, while the duration of hospitalization shortened.
Vaccine Responses in Congenital Cytomegalovirus Infection
Authors: Kokkola Eeva , Puhakka Laura , Saxén Harri , Nieminen Tea
Published: February 2023

There is limited information on vaccine responses in children with congenital cytomegalovirus infection (cCMV). We studied diphtheria, tetanus, measles, mumps and rubella vaccine responses in 6-year-old children with cCMV and controls. Protective antibody levels and geometric mean concentrations did not differ significantly between the study groups. Therefore, immunizations for children with cCMV should be administrated according to established national schedules.
Effect of Multimodal Preemptive Analgesia of Flurbiprofen Axetil, Nalbuphine, and Retrobulbar Block on Postoperative Pain and Enhanced Recovery in Patients Undergoing Oculoplastic Day Surgery: A Prospective, Randomized, Double-Blinded Study
Authors: Ye Zexi , Zhu Yanling , Zhang Rui , Wang Yongyi , Huang Jingxia , Gan Xiaoliang
Published: February 2023

Purpose:

To evaluate the effect of either flurbiprofen axetil or nalbuphine combined with retrobulbar block (RB) before surgery on postoperative pain control and enhanced recovery in day-care patients undergoing orbital implantation.

Methods:

A total of 45 patients undergoing orbital implantation with general anesthesia were randomly divided into three groups: flurbiprofen axetil (1 mg/kg) combined with RB (group F), nalbuphine (0.1 mg/kg) combined with RB (group N), and placebo as normal saline with RB (group C). The primary outcome was the average pain score (numeric rating scale: 0–10) within the first 24 hours. Other outcomes including the peak pain score, paracetamol requirement, quality of recovery (QoR)-15, and adverse effects (AEs) were assessed.

Results:

The average and peak pain scores within 24 hours after surgery in group F were significantly lower than in other groups (p < 0.0167). Compared with group C, the NRS scores were significantly decreased at 2 and 4 hours in group F, and 2 hours in group N after surgery (p < 0.0167), but without significant differences at other measured time points. The time to first paracetamol oral intake displayed a significant difference among the three groups (p < 0.0167).

Conclusion:

Preemptive use of flurbiprofen axetil 1 mg/kg combined with RB is an optimal choice for multimodal analgesia for day-care patients undergoing orbital implantation in terms of efficient acute pain control, without impeding patient-enhanced recovery.
Chorio-Retinal Folds Associated With Orbital Cavernous Venous Malformations
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: February 2023

Purpose:

To determine the incidence of clinically detectable chorio-retinal folds (CRFs) with orbital cavernous venous malformations (OCVMs) and their recovery.

Methods:

Retrospective case-note and imaging review, with estimation of odds ratios in relation to the position and volume of the mass.

Results:

Records for 402 patients were reviewed, 83 (21%) having CRFs. The mean logarithm of minimum angle of resolution acuity was similar with or without CRFs (0.37 and 0.31, respectively; p = 0.46), but induced hyperopia was commoner with CRFs (76% vs. 12%; p < 0.001), exophthalmos greater (4.52 mm vs. 2.97 mm; p < 0.001), eye movement restriction commoner (37% vs. 21%; p = 0.004), and disc swelling more prevalent (42%, vs. 17%; p < 0.001). Orbital cavernous venous malformations with CRFs were almost all intraconal (98%; odds ratio 9.96; p = 0.002), and 93% (77/83) midorbital (odds ratio 6.02; p < 0.001). The median size with CRFs was twice that of those without (3.85 ml vs. 1.92 ml; p < 0.001), and two-thirds OCVMs with folds had volumes >2.5 ml (p < 0.001). The OCVM was excised in 76 of 83 (92%) of CRF group and 213 of 319 (67%) of those without (p < 0.001). The postoperative acuity was improved or unchanged in 67 of 76 (88%) eyes with folds, and 184 of 213 (83%) without CRFs (p = 0.84). The proportion recovering an acuity within 1 Snellen line (or better than) the unaffected side was 80% with CRFs and 77% in their absence (p = 0.63). Induced hyperopia persisted in 39% of all patients, with the mean being higher with CRFs (2.22D vs. 1.02D; p = 0.017).

Conclusions:

CRFs occur in ~25% of mid-intraconal OCVMs. Despite OCVM excision, 39% of operated patients retain significant residual hyperopia (54% if CRFs present before surgery), and 41% of such CRFs remain clinically detectable after surgery (with variable visual impairment). Earlier surgery might, therefore, be advisable in patients with CRFs and/or induced hyperopia.