bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study Between 0.125% Bupivacaine and 0.2% Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block Using a Perineural Catheter for Postoperative Analgesia in Upper Limb Surgeries
Authors: Ahmed Syed Arafath , Desingh Dilip Chandar , Kuppusamy Suresh Kumar , Lazarus Suneeth P.
Published: December 2023

Introduction:

Regional anesthesia offers the anesthesiologist, the surgeon, as well as the patient with better advantages over general anesthesia such as being conscious throughout the surgery, avoiding multiple drugs, better hemodynamic stability, excellent postoperative analgesia, and faster per oral consumption after surgery. Compared with the axillary approach, brachial plexus block at the level of clavicle can anesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. The aim of the study was to assess the duration of postoperative analgesia using visual analog scale and onset of motor blockade in two groups – bupivacaine group and ropivacaine group.

Materials and Methods:

A single-blinded, randomized, prospective experimental study was conducted in the Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital a Tertiary Care Teaching Hospital in South India from November 2019 to May 2021. Sixty patients undergoing upper limb surgeries were randomized into two groups – bupivacaine and ropivacaine. All patients were administered 25 mL of 0.5% bupivacaine as the standard intraoperative drug and at the end of 3 h study drug was administered accordingly. We assessed onset of sensory and motor blockade, duration of block, hemodynamic parameters, and duration for first rescue analgesia. The duration of postoperative analgesia was the primary outcome, and onset of motor blockade and time of first rescue analgesia required were the secondary outcomes. The statistical significance between the groups was analyzed using the Chi-square test for categorical variables, and ANOVA test for continuous variables a P < 0.05 was considered statistically significant.

Results:

We observed that 0.125% bupivacaine group had prolonged duration of action (25 h) than 0.2% ropivacaine group (16.9 h) with P < 0.001. The onset of motor block of both drugs was found to be similar in both groups, but it was not found to be statistically significant (P = 0.786).

Conclusion:

0.125% bupivacaine provides longer duration for postoperative analgesia given through perineural catheter than 0.2% ropivacaine in ultrasound-guided supraclavicular blocks for upper limb surgeries.
Role of Morphology and Immunohistochemistry in the Diagnosis of Incidental Cancers in Gallstone Disease
Authors: Saxena Mohiny , Bohara Sangita , Gupta Vivek , Goel Vijay Kumar
Published: December 2023

Introduction:

The majority of gallbladder adenocarcinomas have been known to develop from dysplasia or carcinoma in situ, without pre-existing adenomas, hence observation of these non-neoplastic or preneoplastic lesions is important as it may underlie an occult malignancy. To study the role of morphology and immunohistochemistry in the diagnosis of incidental cancers in cases of gall stone disease by adopting a universal histopathological screening policy for all the gallstone disease cases operated at our tertiary care center.

Material and Methods:

The present study was designed as an observational cross sectional study completed over a time period of 14 months. A total of 176 cases were included in the study including all the patients of gall stone disease in the adult age group. All the indeterminate and frankly malignant cases were subjected to immunohistochemistry with a panel of antibody markers including p53, CEA and Ki-67 using Streptavidin Biotin immunoperoxidase method Fisher-exact test was used to compare the data taking‘p’ value less than 0.05 as statistically significant.

Results:

Mean age of patients was 40.55±13.25 years. Majority of patients (n=141; 80.1%) were females. The final diagnosis revealed a dominance of non-neoplastic inflammatory (n=168; 95.5%) pathology. There were 8 (4.5%) of malignancy, of these 7 were adenocarcinoma and 1 was adenosquamous carcinoma. Atypia was seen in 5 (2.8%) cases and 3 (1.7%) cases were of dysplasia. Histopathology detected carcinoma in 7 (4%) cases whereas addition of immunohistochemistry helped to find out one more unidentified case, thus the diagnostic yield increased to 8 (4.5%) cases. Out of three dysplasia cases, one (33.3%) was found positive on immunohistochemistry, which was later confirmed to be malignant. None of the cases of atypia were positive on p53, Ki-67 and CEA immunohistochemistry. On comparison between the three groups, the results were statistically significant (p=0.00062).

Conclusion:

Immunohistochemistry has a useful role in detection of incidental gallbladder carcinoma when morphology is limited by indeterminate results. A panel of immunohistochemical markers including p53, Ki-67 and CEA may prove very useful to pick up cases of malignancy in such cases of diagnostic dilemma.
Histopathology of Endoscopic Biopsies of Gastrointestinal Tract Lesions with Clinical Correlation
Authors: Rastogi Gaurav , Chawhan Sanjay Madhukar.
Published: December 2023

Introduction:

Because of limited anatomical space and certain unusual clinicopathological features, gastrointestinal tract lesions causes problem in their diagnosis, prognosis, and management. The primary objective of the study is to know the utility of endoscopic biopsy in diagnosing gastrointestinal lesions, and the secondary objective is to correlate the histopathological findings with the clinical symptoms and endoscopic appearance of the lesions.

Materials and Methods:

The present study is a simple retrospective observational study. Upper and lower gastrointestinal lesions in the form of ulcer, polyp, and growth were biopsied by biopsy forceps using flexible fiberoptic endoscopes. Only adequate biopsies were included in the study. The exact site of the biopsy with clinical data was provided by the endoscopist. Routine histopathological examination was done on the specimens submitted in 10% formalin. The use of special stains was done wherever needed.

Results:

A total of 100 cases were categorized as nonneoplastic and neoplastic. Friedman and Osborn classification was used for nonneoplastic lesions. The maximum number of cases was seen in 5th–6th decade with male predominance with equal distribution of cases as far as anatomical site is concerned.

Conclusion:

Targeted biopsies are possible with definitive diagnosis in 90% of cases with safe use of endoscopy. 17% of cases diagnosed on endoscopy were confirmed on histopathology. In 73% of cases, histopathology was essential for further subtyping. Histopathology was mandatory in 8% of the cases. Recommended combined use of endoscopy and histopathology can offer a definitive diagnosis in 98% of cases.
A narrative review of potential neural repair poststroke: Decoction of Chinese angelica and peony in regulating microglia polarization through the neurosteroid pathway
Authors: Qin Linhui , Kamash Peter , Yang Yong , Ding Yuchuan , Ren Changhong
Published: December 2023

Ischemic stroke is a major global health crisis, characterized by high morbidity and mortality rates. Although there have been significant advancements in treating the acute phase of this condition, there remains a pressing need for effective treatments that can facilitate the recovery of neurological functions. Danggui-Shaoyao-San (DSS), also known as the Decoction of Chinese Angelica and Peony, is a traditional Chinese herbal formula. It has demonstrated promising results in the regulation of microglial polarization and modulation of neurosteroid receptor expression, which may make it a potent strategy for promoting the recovery of neurological functions. Microglia, which plays a crucial role in neuroplasticity and functional reconstruction poststroke, is regulated by neurosteroids. This review posits that DSS could facilitate the recovery of neuronal function poststroke by influencing microglial polarization through the neurosteroid receptor pathway. We will further discuss the potential mechanisms by which DSS could enhance neural function in stroke, including the regulation of microglial activation, neurosteroid regulation, and other potential mechanisms.
Association of Central serous chorioretinopathy with type of personality, anxiety and depression
Authors: Mukherji Sushmita , Karmakar Soumen , Dasgupta Sibaji
Published: December 2023

Purpose:

Central serous chorioretinopathy (CSCR) a relatively common cause of visual impairment, which is characterized by subretinal fluid accumulation in the macula and is more common in middle-aged males. Various risk factors have been reported in literature, among which substantial role of psychological factors is cited. Our aim was to look for the prevalence and association of the psychiatric factors in CSCR patients and to compare them with other non-chorioretinal ocular pathologies.

Methods:

A cross-sectional correlational study was undertaken involving 91 CSCR patients, along with 91 patients with other non-chorioretinal diseases. Their risk factors, clinical history, ocular examination, and psychiatric assessments were done using standardized tools, and the groups were compared in terms of scoring of Framingham Type A scale (FTAS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HDRS).

Results:

CSCR patients had a male:female ratio of 8:1. Chronic, bilateral, and recurrent diseases were found in 15%, 20%, and 23% cases, respectively. Anxiety disorder had a prevalence of 40%, followed by major depression with a prevalence of 24%, and these were significantly higher than non-chorioretinal disease patients (odds ratios 14.18 and 5.30, respectively). Also, these psychiatric disorders were significantly associated with an overall lower visual acuity and greater central macular thickness due to subretinal fluid accumulation.

Conclusion:

Psychiatric comorbidities like Type A personality trait and depression and anxiety disorders were significantly more prevalent in CSCR patients, compared to non-chorioretinal pathologies. Focus on psychological health would certainly benefit these patients in terms of better management of not only CSCR, but their psychiatric morbidity as well.
Optimization of biometry for best refractive outcome in cataract surgery
Authors: Gupta Vinita , Pal Himani , Sawhney Saurabh , Aggarwal Aashima , Vanathi Murugesan , Luthra Gaurav
Published: December 2023

High-precision biometry and accurate intraocular lens (IOL) power calculation have become essential components of cataract surgery. In clinical practice, IOL power calculation involves measuring parameters such as corneal power and axial length and then applying a power calculation formula. The importance of posterior corneal curvature in determining the true power of the cornea is increasingly being recognized, and newer investigative modalities that can estimate both the anterior and posterior corneal power are becoming the standard of care. Optical biometry, especially using swept-source biometers, with an accuracy of 0.01–0.02 mm, has become the state-of-the-art method in biometry. With the evolution of IOL formulas, the ultimate goal of achieving a given target refraction has also moved closer to accuracy. However, despite these technological efforts to standardize and calibrate methods of IOL power calculation, achieving a mean absolute error of zero for every patient undergoing cataract surgery may not be possible. This is due to inherent consistent bias and systematic errors in the measurement devices, IOL formulas, and the individual bias of the surgeon. Optimization and personalization of lens constants allow for the incorporation of these systematic errors as well as individual bias, thereby further improving IOL power prediction accuracy. Our review provides a comprehensive overview of parameters for accurate biometry, along with considerations to enhance IOL power prediction accuracy through optimization and personalization. We conducted a detailed search in PubMed and Google Scholar by using a combination of MeSH terms and specific keywords such as “ocular biometry,” “IOL power calculations,” “prediction accuracy of refractive outcome in cataract surgery,” “effective lens position,” “intraocular lens calculation formulas,” and “optimization of A-constants” to find relevant literature. We identified and analyzed 121 relevant articles, and their findings were included.
Gender- and age-related differences in foveal pit morphology
Authors: Liu Yen-Ting , Ma I-Hsin , Hsieh Yi-Ting
Published: December 2023

Aims:

To measure the foveal pit morphology parameters and evaluate their correlations with age and sex.

Settings and Design:

A retrospective cross-sectional matched comparison study in a tertiary center.

Methods and Materials:

Forty men and 40 age-matched women who had normal macular structures and foveal contours were enrolled. Foveal pit parameters including top width, base width, nasal width, temporal width, minimal thickness, nasal thickness, temporal thickness, nasal height, temporal height, nasal slope, and temporal slope were measured on horizontal B-scan macular optical coherence tomography and compared between men and women.

Statistical Analysis Used:

Paired t-tests and Pearson's correlation analysis.

Results:

The average patient age was 51.4 ± 17.5 (21–84) years. Women had a wider base width (313.1 ± 68.0 μm vs 266.8 ± 70.9 μm, P = 0.006), wider temporal width (1043.1 ± 245.6 μm vs 968.9 ± 261.0 μm, P = 0.006), thinner nasal thickness (345.6 ± 36.2 μm vs 359.7 ± 35.8 μm, P = 0.048), and flatter temporal slope (11.60 ± 2.52° vs 12.98 ± 2.68°, P = 0.016) than men. With age, the base width (r = 0.35, P = 0.025) and temporal width (r = 0.54, P = 0.0003) tended to be wider and the temporal slope was flatter (r = -0.45, P = 0.003) in women but not men. The minimal thickness tended to be thinner in the elderly group (r = 0.038, P = 0.015).

Conclusions:

Women had a significantly wider base width, wider temporal width, thinner nasal thickness, and flatter temporal slope of the foveal pit than age-matched men. The base width and temporal width were wider and the temporal slope was flatter with age in women but not men.
Proximal nailfold videocapillaroscopy findings of patients with idiopathic macular telangiectasia type 2
Authors: Gedik Birumut , Erol Muhammet K , Bulut Mehmet , Dogan Berna , Bozdogan Yigit C , Ekinci Rojbin , Ayan Ayse
Published: December 2023

Purpose:

Idiopathic macular telangiectasia type 2 (IMT) is a neurodegenerative disease characterized by bilateral, idiopathic, and perifoveal retinal telangiectatic vessel formations. We aimed to compare proximal nailfold videocapillaroscopy (NV) findings between patients with IMT and healthy individuals and evaluate the optical coherence tomography angiography (OCTA) parameters of the patients with IMT according to their NV findings.

Methods:

The study included 43 patients with IMT and 92 healthy controls of similar age and gender without any additional diseases. The OCTA and NV findings of the patients and controls were examined.

Results:

The mean age was 59.76 ± 5.73 years in the IMT group and 58.23 ± 4.96 years in the control group. Of the 43 patients with IMT, 19 were found to have increased capillary tortuosity, six had microhemorrhage, and 18 had bizarre capillaries (P < 0.001). In the IMT group, the total vascular density value of the superficial capillary plexus was higher among the patients with capillary microhemorrhage (P = 0.001), and the subfoveal choroidal thickness was lower among those with increased capillary tortuosity and bizarre capillaries (P = 0.04 and P = 0.07, respectively).

Conclusion:

This is the first study in which the NV findings of patients with IMT were compared with those of a control group. We found higher rates of increased capillary tortuosity, microhemorrhage, and bizarre capillaries in the IMT group compared to the controls. We consider that this situation is caused by microvascular damage. We also think that IMT is a systemic disease that affects both proximal nailfold capillaries and eye vessels.
Patient adherence to therapy after switch to aflibercept from bevacizumab or ranibizumab for treatment-refractory neovascular age-related macular degeneration
Authors: Archambault Simon D , Nichols Megan M , McCullum James C , Zhang Yubo , Steinberger Elise E , Ramsey David J
Published: December 2023

Purpose:

Clinical trials have demonstrated that switching patients from intravitreal bevacizumab (IVB) or ranibizumab (IVR) to aflibercept (IVA) for treatment-refractory neovascular age-related macular degeneration (nAMD) can decrease the injection frequency. This study evaluated whether there was a difference in the rate of injections or nonadherent events after switching therapies.

Methods:

The study comprised a retrospective, cross-sectional analysis of patients treated for nAMD from 2010 to 2018 who received ≥3 intravitreal injections of IVB/IVR prior to switching to IVA because of treatment-refractory nAMD. The treatment index, outcomes, and adherence to treatment were compared between both treatment regimens.

Results:

Sixty-two patients (67 eyes) met inclusion criteria. There was no change in the treatment index (0.65 versus 0.66, P = 0.650) or the number of nonadherent events (33 versus 36, P = 0.760) after the switch from IVB/IVR to IVA. Central macular thickness (CMT) increased 7.7%±13.8% in eyes that had a nonadherent event (283±69 µm to 304±75 µm after resuming care, P = 0.039). There was no short-term impact on visual acuity (VA) for this subset of eyes (0.387±0.202 LogMAR versus 0.365±0.156 LogMAR, P = 0.636). Patients who had nonadherent events ended the study with similar VA compared with patients who had no treatment lapses (0.370±0.616 LogMAR versus 0.337±0.638 LogMAR, P = 0.843).

Conclusion:

Switching from IVB/ IVR to IVA for treatment-refractory nAMD in a real-world setting does not reduce the treatment index or increase adherence to treatment. Although there were short-term anatomical effects resulting from missed treatments, VA remained stable.
Toxic anterior segment syndrome (TASS): A review and update
Authors: Verma Lalit , Malik Anu , Maharana Prafulla K , Dada Tanuj , Sharma Namrata
Published: December 2023

Toxic anterior segment syndrome (TASS) is an acute, sterile, postoperative inflammatory reaction of the anterior segment without vitreous involvement, following an uncomplicated and uneventful ocular surgery, having broad and multiple etiologies. The symptoms of decreased visual acuity and ocular discomfort generally occur within the first 12–48 h after intraocular surgery. The clinical signs include prominent limbus-to-limbus corneal edema, anterior chamber cells, aqueous flare, fibrinous inflammation, and/or keratic precipitates. There can be sight-threatening complications of TASS, such as permanent corneal decompensation, intractable glaucoma, and cystoid macular edema. The causes of TASS are emerging and being reported, so are the newer treatment options for managing the inflammation and its complications. Prevention guidelines for TASS are being updated, and a traceability system for surgical instruments and intraocular fluids used during the surgery is being perpetually developed. It is important to recognize TASS and start treatment on an immediate effect. Hereby, we review the literature on TASS, emphasizing its etiology, pathophysiology, management, prognosis, complications, and the importance of prevention as well as prompt recognition.
Characterization of retinal hemorrhages delimited by the internal limiting membrane
Authors: Brar Anand Singh , Ramachandran Sivaranjan , Takkar Brijesh , Narayanan Raja , Mandal Sohini , Padhy Srikanta Kumar
Published: December 2023

Clinically, hemorrhages at the vitreoretinal interface have been termed as ‘pre-retinal’ in location. However, there is a careful distinction to be made between sub-hyaloid and sub-internal limiting membrane (ILM) planes of blood collection. In the past half-century, a body of literature has accrued on sub-internal limiting membrane hemorrhage. We characterize the etiopathological, clinical, anatomical, and imaging characteristics of this entity (often misconstrued as sub-hyaloid hemorrhage). Management decisions are briefly described, and a unifying term of sub-internal limiting membrane macular hemorrhage is proposed to aid in further research.
Evaluation of retinal and peripapillary vessel density and subfoveal choroidal thickness changes in patients undergoing cardiopulmonary bypass: An OCTA study
Authors: Şimdivar Göksu Hande Naz , İncekalan Tuğba Kurumoğlu , Gündüz Akif
Published: December 2023

Purpose:

We aimed to investigate hemodynamic changes in the retina, peripapillary area, and choroid in patients undergoing coronary artery bypass grafting (CABG).

Methods:

This prospective case series included 35 eyes of 35 patients. Vessel density (VD) of superficial capillary plexus, deep capillary plexus, radial peripapillary capillary, foveal avascular zone area, and subfoveal choroidal thickness changes were evaluated using optical coherence tomography angiography (OCTA) 1 day before and 2 weeks after surgery. The correlation of these parameters with aortic cross-clamp (ACC) duration and cardiopulmonary bypass (CPB) duration was evaluated.

Results:

There were no differences in the OCTA measurements of the patients after CABG compared to before surgery (P > 0.05). Inside-disc VD showed a negative correlation with both ACC (P = 0.036) and CPB duration (P = 0.048); peripapillary inferior hernia showed a negative correlation with both ACC (P = 0.042) and CPB duration (P = 0.027). Another negative correlation was observed between mean peripapillary VD and CPB duration (P = 0.039).

Conclusion:

The CPB procedure had no permanent effect on retinal choroid and optic disc blood flow postoperatively. Prolonged ACC and CPB times seem to be important in terms of optic nerve blood flow. Clinicians should be alert for postoperative ocular complications after long surgeries.
A double-blinded study for quantifiable assessment of the diagnostic accuracy of AI tool “ADVEN-i” in identifying diseased fundus images including diabetic retinopathy on a retrospective data
Authors: Acharyya Mausumi , Moharana Bruttendu , Jain Sahil , Tandon Manjari
Published: December 2023

Purpose:

To quantifiably assess the diagnostic accuracy of Adven-I, a proprietary artificial intelligence (AI)-driven diagnostic system that automatically detects diseases from fundus images. The purpose is to quantify the performance of Adven-i in differentiating a nonreferable (within normal limits) image from a referable (diseased fundus) image and further segregating diabetic retinopathy (DR) from the rest of the abnormalities (non-DR) encompassing the wide spectrum of abnormal pathologies. The assessment is carried out in comparison to manual reading as the reference gold standard. Adven-i is the only AI system classifying retinal abnormalities into DR and non-DR classes separately, apart from predicting nonreferable fundus, while most existing systems classify fundus images into referable and nonreferable DR.

Methods:

The double-blinded study was conducted on retrospective data collected over the course of a year in the ophthalmology outpatient department (OPD) at a top Tier II eyecare hospital in Chandigarh, India. Three vitreoretina specialists who were blinded to one another read the images. The ground-truth was generated on the basis of majority agreement among the readers. An arbitrator's decision was regarded final if all three readers disagreed.

Results:

2261 fundus images were analyzed by Adven-i. The sensitivity and specificity of Adven-i in diagnosing images with abnormalities were 95.12% and 85.77%, respectively, and for segregating DR from rest of the retinal abnormalities were 91.87% and 85.12%, respectively.

Conclusions and Relevance:

Adven-i shows definite promise in automated screening for early diagnosis of referable fundus images including DR. Adven-i can be adopted to scale for mass screening in resource-limited settings.
Quantitative measurement of retinal nerve fiber layer thickness and its correlation with optical coherence tomography angiography vascular biomarker changes in preclinical diabetic retinopathy
Authors: Verma Shweta , Singh Vinod Kumar , Rana Jagriti , Kumar Santosh , Singh Kamaljeet , Srivastava Ratnapriya
Published: December 2023

Purpose:

The present study was done to assess the use of optical coherence tomography angiography (OCTA) in detecting earlier stages of diabetic retinopathy and for the early management and effective blood glucose control in preclinical diabetic patients for preventing retinal nerve fiber layer (RNFL) thinning.

Methods:

A tertiary care center–based prospective observational study was conducted from the year 2021 to 2022 in the Department of Ophthalmology. The study included 50 cases and 50 controls. The parameters analyzed by using OCTA (Topcon 3D OCT-1 Maestro2) were RNFL thickness and peripapillary vessel density.

Results:

We found that the RNFL thickness in the temporal and superior disc in patients with preclinical diabetic retinopathy was significantly (0.041 and 0.044, respectively) decreased. The duration of diabetes and glycated hemoglobin (HbA1c) were the risk factors for peripapillary vessel density reduction in patients with preclinical diabetic retinopathy (P < 0.001).

Conclusion:

RNFL thinning is an early sign of retinal neurodegeneration and is associated with peripapillary vessel density reduction. Early management and effective blood glucose control in diabetes patients may be beneficial for preventing RNFL thinning in superior and temporal disc.
Bibliometric and visualized analysis of diabetic macular edema
Authors: Wei Jin , Shu Yiyang , Wang Yimin , Liu Haiyun
Published: December 2023

Purpose:

Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors.

Methods:

We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends.

Results:

A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. “Diabetic macular edema,” “retinopathy,” “ranibizumab,” and “optical coherence tomography angiography” were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, “deep learning” (AAY:2020.83), “optical coherence tomography angiography” (AAY:2019.59), “intravitreal Aflibercept” (AAY:2019.29), and “dexamethasone implant” (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run.

Conclusion:

In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots.
Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes – A randomized controlled trial (InFlap Study)
Authors: Baskaran Prabu , Sindal Manavi D , Ganne Pratyusha , Madanagopalan VG , Krishnappa Nagesha C , Rajendran Anand , Dhoble Pankaja , Ratna Bholesh , Ghondale Harshal , Mani Iswarya
Published: December 2023

Purpose:

To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH).

Methods:

A consecutive 99 eyes of 99 patients were enrolled {45 – conventional group and 54 – inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed.

Results:

At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group.

Conclusion:

The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.
Research on an artificial intelligence-based myopic maculopathy grading method using EfficientNet
Authors: Zheng Bo , Zhang Maotao , Zhu Shaojun , Wu Maonian , Chen Lu , Zhang Shaochong , Yang Weihua
Published: December 2023

Purpose:

We aimed to develop an artificial intelligence-based myopic maculopathy grading method using EfficientNet to overcome the delayed grading and diagnosis of different myopic maculopathy degrees.

Methods:

The cooperative hospital provided 4642 healthy and myopic maculopathy color fundus photographs, comprising the four degrees of myopic maculopathy and healthy fundi. The myopic maculopathy grading models were trained using EfficientNet-B0 to EfficientNet-B7 models. The diagnostic results were compared with those of the VGG16 and ResNet50 classification models. The leading evaluation indicators were sensitivity, specificity, F1 score, area under the receiver operating characteristic (ROC) curve area under curve (AUC), 95% confidence interval, kappa value, and accuracy. The ROC curves of the ten grading models were also compared.

Results:

We used 1199 color fundus photographs to evaluate the myopic maculopathy grading models. The size of the EfficientNet-B0 myopic maculopathy grading model was 15.6 MB, and it had the highest kappa value (88.32%) and accuracy (83.58%). The model's sensitivities to diagnose tessellated fundus (TF), diffuse chorioretinal atrophy (DCA), patchy chorioretinal atrophy (PCA), and macular atrophy (MA) were 96.86%, 75.98%, 64.67%, and 88.75%, respectively. The specificity was above 93%, and the AUCs were 0.992, 0.960, 0.964, and 0.989, respectively.

Conclusion:

The EfficientNet models were used to design grading diagnostic models for myopic maculopathy. Based on the collected fundus images, the models could diagnose a healthy fundus and four types of myopic maculopathy. The models might help ophthalmologists to make preliminary diagnoses of different degrees of myopic maculopathy.
Digital eye strain among medical students associated with shifting to e-learning during COVID-19 pandemic: An online survey
Authors: Bhatnagar Kavita R , Dixit Shilpi G , Pandey Latika , Prakash Sujeet , Shiromani Sakshi , Singh Kuldeep
Published: December 2023

Purpose:

This study aimed to determine the prevalence, risk factors, symptoms, and awareness of computer vision syndrome (CVS) among medical students during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

A cross-sectional observational study was conducted among 283 undergraduate medical students at a tertiary healthcare center. An electronic survey was conducted to collect the data. Data were analyzed using Statistical Package for Social Sciences (SPSS version 23). The Chi-square test (Fisher’s exact test when required) was used to study the significance of associations. A P value <0.05 was considered statistically significant.

Results:

A high prevalence of CVS was observed in which 92% reported at least one symptom while using a digital device, the most frequent being eye strain (49%). Among extraocular complaints, joint pain in the wrist and fingers was most frequent. Significant association (P < 0.05) of CVS was found with increased duration of digital device usage, refractive error, use of glasses or contact lens, preexisting dry eye disease, and use of topical eye drops. 37% of the participants were aware of the 20-20-20 rule, while only 11% followed it.

Conclusion:

CVS is a common health concern among medical students. Hence, to increase the productivity of work, significant risk factors need to be addressed and awareness must be raised.
Relevance of multicolor imaging, its component channels, and fundus autofluorescence in describing macular telangiectasia type-2 (MacTel) lesion characteristics
Authors: Chandran Kiran , Giridhar Anantharaman , Desai Sachin , Gopalakrishnan Mahesh , Indu VP , Sivaprasad Sobha
Published: December 2023

Purpose:

The aim of the study was to describe imaging characteristics and detection rates of phenotypic features in macular telangiectasia type-2 (MacTel) on multicolor (MC), blue reflectance (BR), green reflectance (GR), infrared reflectance (IR), and fundus autofluorescence (FAF) and to evaluate sensitivity, specificity, and predictive values across modalities.

Methods:

In this monocentric observational study, 282 eyes of 148 patients with MacTel underwent color fundus photograph, MC, BR, GR, IR, FAF, spectral-domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A), and fundus fluorescein angiography (FFA). Grading was done by two graders qualitatively and quantitatively for the presence of the following prespecified MacTel findings [crystals, right-angle vessels (RAVs), plaques, subretinal neovascularization (SRNV), and MacTel area]. Across each imaging modality, the detection rate of RAVs and SRNV was compared with reference standard OCT-A (RAVs and SRNV) and FFA (SRNV), whereas that of plaques was compared with reference standard SD-OCT.

Results:

MC identified overall MacTel characteristics in 92.7% of eyes. Regarding the presence, number, and quadrants of RAVs and the presence and number of crystals, MC and GR had superior detection rates as well as the highest sensitivity and negative predictive value. Retinal plaques were better detected using FAF (97%), followed by MC (88%). In proliferative MacTel, SRNV was identified in 86% and 79% of eyes on MC and IR, respectively. While BR clearly delineated MacTel area in 100% eyes, FAF was able to ascertain a larger area of involvement in proliferative MacTel.

Conclusion:

The findings demonstrate the ability of MC, its component channels, and FAF to describe MacTel characteristics qualitatively and quantitatively.
Pupil vignetting artifact on optical coherence tomography angiography
Authors: Bhattacharyya Sampurna , D'souza Zubin , Ramanadhane Raghulnadhan , Maitra Debalina , Goel Nikita , Sen Ahana , Majumder Bristi , Gupta Shamayita , Chowdhury Maitreyi , Chattree Surabhi , Saurabh Kumar , Roy Rupak
Published: December 2023

Purpose:

To discuss the features of an artifact on optical coherence tomography angiography (OCTA), termed “pupil vignetting artifact,” and describe how it may masquerade as true chorioretinal pathology.

Design:

This was a retrospective, observational case series.

Methods:

The authors studied 12 eyes at a vitreoretinal clinic in Eastern India, reviewing a dark shadow such as an artifact on OCTA images.

Results:

In all 12 eyes, there was an appearance of a dark shadow on OCTA imaging, located at the macula, superior, superotemporal, or superonasal to the fovea, which did not correspond to any ischemic area responsible for flow-void or any media opacity casting a posterior shadow. It was believed to be an artifact caused by the vignetting effect of the pupil as the incident OCT beam clips the iris during OCTA scanning, and therefore reduces the amount of total light incident on the retina. The variability in the size, shape, and location of the artifact is contributed by a few factors such as variable angle of incident light on the pupil, pupillary dynamics, and curvature of the retinal surface.

Conclusion:

Pupil vignetting artifact is a unique undescribed phenomenon appearing at the macula on OCTA imaging that can masquerade as numerous true chorioretinal pathologies. This article aims to describe this artifact to avoid misinterpretation and further confusion in real-life clinical practice.
Predicting visual outcomes following anti-vascular endothelial growth factor treatment for diabetic macular edema
Authors: Rana Vipin , Agarwal Aniruddha , Arora Atul , Bansal Reema , Dogra Mohit , Bhadada Sanjay Kumar , Singh Nirbhai , Gupta Vishali
Published: December 2023

Purpose:

To assess the utility of pre-defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME) following anti-vascular endothelial growth factor (anti-VEGF) therapy in determining visual and anatomical outcomes.

Methods:

In this prospective, non-randomized, and interventional study, 17 patients with treatment-naive DME were included. OCT biomarkers [size/reflectivity of cysts, disorganization of retinal inner layers, integrity of ellipsoid zone or external limiting membrane, subfoveal serous retinal detachment, hyper-reflective foci (HRF)] and OCTA [vascular density (VD), foveal avascular zone (FAZ), and total micro-aneurysms in superficial capillary plexus and deep capillary plexus (DCP)] were analyzed at baseline and after three monthly intravitreal anti-VEGF injections. Response was defined as a decrease of 10% or more in central macular thickness from the baseline after three injections.

Results:

13/17 (76.47%) patients were categorized as responders to anti-VEGF therapy. Non-responders had significantly greater hyper-reflectivity of cysts (P = 0.015), larger cystic spaces (P = 0.023), and an increased number of HRF (P = 0.04) at baseline. On OCTA, non-responders showed larger FAZ in DCP (1.35 ± 0.21 versus 1.14 ± 0.28 mm2) (P = 0.042) and lower VD (61.17 ± 0.45 versus 62.73 ± 3.32) in DCP at baseline. At 3 months, the VD increased in responders (63.10 ± 3.42) compared to a decrease in non-responders (60.82 ± 1.13) (P = 0.032).

Conclusions:

Non-responders show a higher number of micro-aneurysms, larger FAZ, and lower VD in the DCP on OCTA and higher cyst hyper-reflectivity and HRF and larger cystic spaces on OCT imaging.
Brolucizumab in age-related macular neovascularization (BRAIN study): Efficacy, optical coherence tomography biomarkers, and safety profile
Authors: Dabir Supriya , Mohankumar Arthi , Khatri Manoj G , Rajan Mohan
Published: December 2023

Background:

Brolucizumab is a new anti-vascular endothelial growth factor (anti-VEGF) in the treatment of neovascular age-related macular degeneration (nAMD) and idiopathic polypoidal choroidal vasculopathy (IPCV).

Materials and Methods:

A retrospective, consecutive, interventional study was conducted from a tertiary eye hospital, in which treatment-naïve and treatment-switch patients were included. They underwent an intravitreal injection of brolucizumab. The decision to reinject was made based on the presence of fluid on spectral domain optical coherence tomography (SD-OCT) or worsening of vision at follow-up. Outcome measures were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), fluid (subretinal/intraretinal/sub-retinal pigment epithelium fluid) levels, and OCT biomarkers and safety analysis.

Results:

A total of 59 eyes of 50 patients with a total of 132 intravitreal injections were included. There was a statistically significant improvement (P < 0.05) in BCVA from baseline in logMAR treatment-naïve patients (mean BCVA at baseline 0.6 ± 0.41 and 0.37 ± 0.56). The mean baseline CST of all patients significantly reduced from 582.92 ± 233.11 µm at baseline to 474.06 ± 252.89 µm at the final treatment visit. Thirty-eight percent of patients showed complete resolution of SHRM after a single injection. The interval between each subsequent injection increased from a mean of 67 to 96 days in treatment-switch patients and from 47 to 151 days in treatment-naïve patients.

Conclusion:

Brolucizumab promises reduced number of injections with longer treatment intervals.
Customized therapeutic deep anterior lamellar keratoplasty in perforated Mooren’s ulcer: A novel technique
Authors: Sharma Ashok , Sharma Rajan
Published: December 2023

We describe customized therapeutic deep anterior lamellar keratoplasty (DALK) for treating a perforated Mooren’s ulcer. Slit-lamp biomicroscopy revealed corneal perforation (3.5 mm × 3.0 mm) with iris prolapse. The corneal melt extended from 9.0 o’clock to 4.0 o’clock. The peripheral edge of the ulcer was sloping, whereas the medial edge showed undermining. Immunological tests did not reveal any evidence of systemic autoimmune disease. In view of extensive peripheral corneal melt with large corneal perforation, the patient needed tectonic keratoplasty. The penetrating graft is not only technically demanding but also results in a poor visual outcome. We advised customized tectonic DALK. We used two different-sized trephines to obtain appropriate-sized donor tissue and avoided manual dissection. The post-surgery period was uneventful. He was prescribed topical steroids and oral methotrexate. He achieved 6/9 aided visual acuity at 4 months and maintained it until the last follow-up at 36 months.
Histopathology and electron microscopy evaluation of the sildenafil effect on diabetic rats' retinae
Authors: Tadros Dina , Abdelhalim Tamer I , Sarhan Naglaa , El-Anwar Noha , Elkholy Reem A. , Tahoon Dina , Sorour Osama A
Published: December 2023

Purpose:

Although there is increasing evidence that phosphodiesterase-5 (PDE-5) inhibitors modify the effect of diabetes on different tissues, its effect on diabetic retinopathy is not well studied.

Methods:

Forty male Sprague–Dawley (SD) rats were divided into four groups: group I = control group that received no treatment; group II (diabetic group), in which diabetes was induced by a single streptozotocin injection; group III (sildenafil small dose, SSD), in which diabetes was similarly introduced (however, rats received daily oral 1 mg/kg sildenafil citrate (SC) for 3 months); and group IV (sildenafil large dose, SLD), which was as in group 3, but SC was 2.5 mg/kg. After 3 months, globes were removed and retinae were dissected; one globe from each rat was examined by light microscopy (LM), and the other by electron microscopy (EM).

Results:

In contrast to the control group, diabetic rats in group II demonstrated well-established diabetic changes in the form of capillary congestion, decreased cell population, hyaline changes of capillary walls, and degenerated nerve fiber layer by LM. Similarly, EM demonstrated photoreceptor degeneration, mitochondrial cristolysis, and vacuolated depleted cells among other features in group II. These diabetic features were less prominent in group III and nearly absent in group IV.

Conclusion:

SC use in the early stages of DR may prevent/delay diabetic retinopathy development or progression in diabetic rat models, an effect that seems to be dose-related.
Use of Lung Ultrasound versus Chest X-ray in Diagnosing Heart Failure in the Emergency Care Setting: A Systematic Review
Authors: Haridas Rushikesh S. , Shelke Sheetal , Patrike Girish , Patil Deepak , Dhumal Sainath
Published: December 2023

Background:

Acute heart failure (HF) is initially diagnosed and managed in the large part in the emergency care setting. Lung ultrasound (LUS) and chest X-ray (CXR) are the most common diagnostic and prognostic techniques for people with HF. It has been observed that lung ultrasonography has a higher sensitivity for diagnosing HF than CXR. In this review, we assess the comparison between the use of LUS and CXR in diagnosing HF.

Methods:

An extended search was done in the databases of PubMed, Medline, Wiley library, and Google Scholar between 2012 and 2022. Fifteen studies were included in this systematic review. Studies, in which the sensitivity of LUS and CXR was noted, were included.

Results:

Fifteen studies were included. The majority of the studies showed that LUS had high sensitivity and accuracy for detecting HF.

Conclusion:

The result of the present review shows that the sensitivity of the LUS was higher than those of the CXR in detecting HF. Ultrasound has certain advantages over CXR.
ST-elevation Myocardial Infarction in Acute Liver Failure? Or is it Something Else?
Authors: Bagchi Avishek
Published: December 2023

Here, we report an interesting case report of a young female presenting with acute liver failure, where the electrocardiogram (ECG) was initially confused as ST-elevation myocardial infarction (STEMI), which later turned out to be something else.
Prevalence of Quality of Life and Physical Activity in Patients with Different Stages of Heart Failure – An Observational Cross-Sectional Study
Authors: Shah Purvi , Mehta Mihir , Oza Falak , Makwana Priya
Published: December 2023

Background:

Heart failure (HF) is an escalating health problem around the world. HF is a highly prevalent disorder worldwide, with a high morbidity and mortality rate. Maintaining a good quality of life (QOL) and physical activity are as important as survival to patients living with HF. Individuals with HF have markedly impaired QOL compared with other chronic diseases and healthy population. Different stages of HF in physical activity and QOL have not been studied in India. Hence, aim of the study was to find out the prevalence of physical activity and QOL patients with HF.

Methodology:

After calculating the sample size, 301 patients diagnosed with HF who were managed medically were selected for this study with fulfilling criteria. The Minnesota Living with Heart Failure Questionnaire and International PhysicalActivity Questionnaire were used to screen the patients. Outcome measures were QOL, physical activity, ejection fraction (EF), Heart Failure Classification (HFC) New York Heart Association and American Heart Association (AHA) Stages.

Results:

The mean age of the patients was 53 ± 13.56, including 53.82% males and 45.84% females. Among them, occupation data show 58.13% have labourer work, socioeconomical data show 28.30% of patients have upper middle class. Co-morbidity data shows 13.28% patients have hypertension (HTN), 39.20% have diabetes mellitus (DM), and 22.25% patients have both. Among 301, 30.23% of patients have HFC 3 and 38.53% of patients have AHA Stages B. This study shows 19.60%, 46.17%, and 34.21% good, moderate, and poor QOL, respectively. The prevalence of physical Activity was found to be 81.06% low, 15.61% moderate, and 3.32% high. According to EF prevalence, 79.73% have a reduced EF.

Conclusion:

Patients with different HF stages experienced impaired QOL and lowest physical activity. Low physical activity and moderate QOL can be improved by early rehabilitation.