bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective, randomized, parallel group, double blind, multicenter study to compare the efficacy, safety and immunogenicity of Lupin’s Ranibizumab with Lucentis® in patients with neovascular age-related macular degeneration
Authors: Singh Ramandeep , Chauhan Rohan , Saxena Ashish , Shah Anup , Mondal Laxshmi , Bakhle Dhananjay , Shah Chirag , Shah Arpit , Deoghare Shashank , Krishnan Neelakant , Godse Neelima
Published: August 2022

Purpose:

The present study compares the efficacy, safety, and immunogenicity of Lupin’s biosimilar ranibizumab with that of Lucentis® in patients with neovascular age-related macular degeneration.

Methods:

This prospective, double-blind, multi-centric phase-III study was conducted across 19 centers in India. A total of 202 patients with neovascular age-related macular degeneration were randomized (1:1) to receive either Lupin’s biosimilar ranibizumab or Lucentis®, 0.5 mg, as an intravitreous injection once every month for 3 months. The primary efficacy endpoint was the proportion of patients who lost fewer than 15 letters from baseline in best-corrected visual acuity. The safety profile included assessment of adverse events, ophthalmic examination, physical and systemic examination, and vital parameters. The immunogenicity assessment was based on evaluation of anti-drug antibodies.

Results:

Overall, 174 patients (87 [86.14%] in each group) completed the study. The demographics and baseline characteristics were comparable between the treatment groups. The proportion of patients losing fewer than 15 letters from baseline best corrected visual acuity score in the study eye was comparable between two groups. The difference between Lupin’s ranibizumab and Lucentis® for the proportion of patients who lost fewer than 15 letters was within the predefined equivalence margin (intention-to-treat population: 1.0%; 95% confidence interval [CI], −3.3% to 5.4% and per protocol population: 1.2%; 95% CI, −3.2% to 6.4%). The incidence of treatment-emergent adverse events was comparable, and 11 (10.89%) patients in Lupin’s ranibizumab and 19 (18.81%) patients in Lucentis® group had at least one treatment-emergent adverse event. The immunogenicity incidence as assessed by proportion of patients with positive anti-drug antibodies was numerically lower in Lupin’s ranibizumab (4.95%) than Lucentis® (12.87%).

Conclusion:

Lupin’s biosimilar ranibizumab demonstrated therapeutic equivalence, desirable safety, and favorable immunogenicity profile compared to Lucentis®.
The Gimbalscope – A novel smartphone-assisted retinoscopy technique
Authors: Chandrakanth Prithvi , Gosalia Hirika , Verghese Shishir , Narendran Kalpana , Narendran Venkatapathy
Published: August 2022

The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.
A graded approach in East Asian personalized lower blepharoplasty: A retrospective study spanning 12 years
Authors: Liu Jiaxi , Huang Chen , Song Baoqiang
Published: August 2022

Purpose:

The aim of the study was to describe a graded approach for assessment and specific treatment, which can achieve satisfactory postoperative result in East Asian personalized lower blepharoplasty.

Methods:

We reviewed 913 patients who underwent lower blepharoplasty from 2008 to 2020. We preoperatively classified patients with different characteristics to provide personalized treatment.

Results:

There were 163 patients with fat herniation but no lower eyelid skin laxity, 259 patients with lower eyelid skin laxity accompanied by mild fat herniation, 313 patients with sagging lower eyelid skin accompanied by mild fat herniation and tear troughs, and a total of 178 patients with sagging skin accompanied by moderate to severe fat herniation and tear troughs. The overall success rate was 97.81%. Postoperative complications included the following: conjunctival chemosis, dry eye symptoms, and more.

Conclusion:

For East Asian patients with different characteristics, we achieved satisfactory postoperative results through accurate preoperative clinical grading and personalized surgical plans. The success of the operation not only depends on correct manipulation during the procedure but also on the surgeon’s accurate assessment and full grasp of the anatomy of each patient preoperatively.
Analysis on the completeness of case records of patients with penetrating ocular trauma following a multimodal intervention
Authors: Vaghmare Sanira , Rahul Ramesh , Prajna N Venkatesh , Radhakrishnan Naveen
Published: August 2022

Purpose:

To describe the process development of a multimodal intervention and the pre- and postintervention results on the completeness of case records of patients with penetrating ocular trauma in a high-volume tertiary eye care hospital in south India.

Methods:

A multimodal intervention including an objective-validated case sheet template, an education program, a physical template case record reminder, a continuous near-real time audit process, and a feedback system was developed. Analysis on the completeness of the case records of patients with ocular trauma from October 2020 to December 2020 (preintervention) and from January 2021 to March 2021 (postintervention) was performed. These case records and the personnel involved in the documentation, were given scores based on the scores assigned to the subsections of the validated template case sheet. The mean total score of the case records and of the personnel involved were analyzed.

Results:

One hundred and eleven case records of patients with ocular trauma who underwent primary wound repair were included in the study. Of these 111 case records, 46 belonged to preintervention group and 65 belonged to postintervention group. The mean total score for preintervention group during the study period was 57.93 ± 24 out of 100 and for postintervention group was 99.07 ± 4.49 out of 100. The temporal trend of postintervention group showed a consistent improvement every month (97.14, 100,100) during the 3-month study period. Postintervention improvement was noted in all the sections of case records completed by both fellows and consultants.

Conclusion:

A sustained improvement in ocular trauma case record documentation among all levels of medical professionals was noted following the five-component multimodal intervention.
Preferred practice pattern for Descemet membrane endothelial keratoplasty surgeries: A survey of Indian corneal surgeons
Authors: Sahay Pranita , Fogla Rajesh , Sharma Namrata
Published: August 2022

Purpose:

This study aims to assess the preferred surgical technique of Descemet membrane endothelial keratoplasty (DMEK) among corneal surgeons in India, and barriers in performing DMEK surgeries amongst the non-DMEK surgeons.

Methods:

An online, questionnaire-based, cross-sectional survey was conducted among members of the Cornea Society of India (CSI) (n = 500). Responses on their surgical experience, preferred technique, complications, and outcome of DMEK were collected and analyzed. Barriers in performing DMEK surgeries were assessed amongst the non-DMEK surgeons.

Results:

A total of 100 responses were obtained and response rate for the survey was 20%. DMEK was performed by 55% of the participants of whom only 40% had formal training in this technique. Surgical video-based learning was the most often used self-training method for others. Lack of training was the most common reason for not performing DMEK by the non-DMEK surgeons. Descemet stripping endothelial keratoplasty (DSEK) was the most common endothelial keratoplasty (EK) performed by both DMEK and non-DMEK surgeons. High volume (>50 cases) DMEK surgeries were reported by limited surgeons (n = 6). Nearly all the DMEK surgeons prepared the donor tissue by themselves on the day of the surgery, and majority felt that unrolling the graft in the anterior chamber was the most difficult surgical step. Nearly 80% of the DMEK surgeons were more comfortable with DSEK or Descemet stripping automated endothelial keratoplasty (DSAEK) when compared to DMEK.

Conclusion:

DMEK practice in India needs improvement with increased accessibility to DMEK training programs, wet lab facilities, and better support from eye banks.
Clinical, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment implantations in duck-type keratoconus
Authors: Coskunseven Efekan , Kayhan Belma
Published: August 2022

Purpose:

To evaluate the visual, refractive, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment (PT-ICRS) implantation in duck-type keratoconus.

Methods:

This retrospective study included eyes with oval (duck-type) keratoconus treated with PT-ICRS implantation. After the femtosecond laser tunnel creation, one PT-ICRS (Keraring AS 5 with 160° arc length) was implanted along the ectatic, inferior half of the cornea. Data of uncorrected and corrected distance visual acuity (UDVA and CDVA), refraction, asphericity (Q value), and keratometry (K) were compared pre- and postoperatively. Additionally, changes in the topometric indices of corneal irregularity were also evaluated after PT-ICRS implantation.

Results:

Thirty-one eyes of 30 patients were included in the study with a mean follow-up time of 9.06 months (ranging between 6 and 18 months). UDVA improved from 0.85 ± 0.36 to 0.27 ± 0.14 logMAR (P = 0.001), and CDVA improved from 0.37 ± 0.22 to 0.13 ± 0.11 logMAR (P = 0.001). The mean spherical error decreased from −3.66 ± 2.60 to −1.60 ± 1.42 D (P = 0.001), and the mean cylindrical error decreased from −4.91 ± 2.65 to − 1.41 ± 1.31 D (P = 0.001). All topographic parameters measured from the anterior cornea demonstrated statistically significant improvements after PT-ICRS implantation (P = 0.001). K mean, K maximum, corneal astigmatism, and Q value showed a significant decrease. Besides the index of height asymmetry, all topometric indices were significantly reduced after PT-ICRS implantation. There were no loss of lines and no complications.

Conclusion:

PT-ICRS implantation in duck-type keratoconus is an effective and safe treatment. This intervention improves the visual acuity, refractive error, topographical, and topometric parameters significantly by decreasing both eccentricity and steepness of the cone.
Accelerated corneal collagen cross-linking in progressive keratoconus: Five-year results and predictors of visual and topographic outcomes
Authors: Chan Tommy C Y , Tsui Rachel W Y , Chow Vanissa W S , Lam Jasmine K M , Wong Victoria W Y , Wan Kelvin H
Published: August 2022

Purpose:

To analyze the 5-year results of accelerated corneal collagen crosslinking (CXL) for progressive keratoconus and identify preoperative characteristics predictive of visual and topographic outcomes.

Methods:

A prospective interventional case series. Nineteen eyes of 19 patients receiving accelerated CXL with settings of 18 mW/cm2 for 5 min were included. Clinical and topographic parameters were assessed. Linear regression and logistic regression were used to compare the R2 and odds ratio (OR), respectively, between baseline characteristics and postoperative outcomes.

Results:

Corrected distance visual acuity (CDVA) remained stable from 0.28 ± 0.21 to 0.25 ± 0.18 logMAR (P = 0.486). The mean cylindrical refraction was stable (P = 0.119). The maximal keratometry (Kmax) decreased from 61.99 ± 10.37 to 59.25 ± 7.75 D (P < 0.001), flattening in the flattest and steepest meridians and mean keratometry were also observed (P ≤ 0.040). The mean anterior elevation at the apex reduced from 21.42 ± 16.69 to 18.53 ± 12.74 mm (P = 0.013) and changes in posterior elevation were non-significant (P = 0.629). Preoperative Kmax best predicted the postoperative change in Kmax (R2 = 0.55, P < 0.001) compared to the other baseline characteristics (P ≤ 0.028), whereas preoperative CDVA was the only significant predictor of postoperative change in CDVA (R2 = 0.41, P = 0.003). Accelerated CXL is less likely to fail in eyes with a steeper preoperative Kmax (OR = 0.74, P = 0.040) or greater posterior elevation at the apex (OR = 0.91, P = 0.042).

Conclusion:

Kmax significantly decreased following accelerated CXL. Eyes with worse preoperative CDVA and higher Kmax were more likely to have an improvement in visual acuity and corneal flattening.
Choriocapillaris flow deficits in polypoidal choroidal vasculopathy using swept source optical coherence tomography angiography
Authors: Mahalingam Maanasi , Sachidanandam Ramya , Verma Aditya , Alagorie Ahmed Roshdy , Sen Parveen
Published: August 2022

Purpose:

To evaluate the choriocapillaris flow deficits (CCFD) on swept-source optical coherence tomography angiography (SS-OCTA) in eyes with unilateral polypoidal choroidal vasculopathy (PCV), fellow unaffected eyes, and to compare them with age-matched healthy controls.

Methods:

This study was a cross-sectional study which included treatment-naïve eyes with unilateral PCV (group 1), fellow unaffected eyes of patients with PCV (group 2), and normal eyes (group 3). Using the SS-OCTA, the Choriocapillaris (CC) slab was segmented from the structural optical coherence tomography (OCT) and the corresponding flow map was multiplied after signal compensation. The resultant image was evaluated for CCFD in equidistant squares measuring 1 × 1 mm, 1.5 × 1.5 mm, 2 × 2 mm, 2.5 × 2.5 mm, 3 × 3 mm, and 6 × 6 mm centered on the fovea.

Results:

The percentage of flow deficits were significantly increased (one-way ANOVA, P = 0.003 and P = 0.049) in the eyes with PCV as compared to the fellow eyes, and age-matched healthy controls. In the multiple pairwise comparison using post hoc Bonferroni, CCFD of 1 mm in group 1 and 2 (P = 0.019), group 1 and 3 (P = 0.003), and CCFD of 1.5 mm in group 1 and 3 (P = 0.044) were statistically significant. Correlation analysis showed no significant correlation between CCFD, age, Best corrected visual acuity (BCVA), foveal thickness (FT), and subfoveal choroidal thickness (SFCT) in our study. Linear regression analysis showed that the CCFD was negatively correlated with the distance from the foveal center in group 1 (b = −0.613, P = 0.046).

Conclusion:

Eyes with PCV demonstrated a significant flow impairment in the choriocapillaris layer as compared to the fellow unaffected eyes and age-matched healthy eyes.
A comparison of lens parameters in patients with various subtypes of primary angle-closure disease and the normal population: A prospective study
Authors: Chakrabarti Keya , Samant Swati , Mohapatra Ramesh , Mishra Suchismita , Das Suprava , Chakrabarti Meena
Published: August 2022

Purpose:

To assess the role of lens parameters in the detection and progression of primary angle-closure disease (PACD) by combining A-scan and A-scan optical coherence tomography (AS-OCT) parameters.

Methods:

A cross-sectional study was conducted in a tertiary health-care center in eastern India. A total of 91 study subjects including cases and controls were included in the study. The parameters studied were lens thickness (LT), lens axial factor (LAF), relative lens position (RLP), and lens vault (LV). Anterior chamber depth (ACD) and axial length (AL) were also analyzed using A-scan.

Results:

The LT was significantly more in all subtypes of PACD (from 4.24 ± 0.84 to 5.02 ± 0.18 mm) than in controls (4.04 ± 0.46 mm; P < 0.01). Similarly, LAF was significantly less among all subtypes of PACD compared to controls (P < 0.001). The RLP, calculated using the formula (ACD + 0.5 LT)/AL × 10, showed no significant difference (P > 0.05) between various study groups. The LV in acute angle-closure glaucoma (AcCG) patients was significantly higher compared to the control population (P < 0.01). Ocular parameters like ACD decreased, whereas LT and LAF increased from normal through primary angle closure (PAC) to primary angle-closure glaucoma (PACG). Logistic regression analysis found a significant association between a decrease in ACD and an increased risk of PACG (P-value was 0.0001) and an increase in LT and LAF with increased risk of PACG (P = 0.040 and P = 0.006, respectively).

Conclusion:

Inclusion of lens parameter assessment in the workup of a patient with PACD helps in detection and close monitoring of the progression from suspected to disease state.
Effect of immediate shallow anterior chamber after Ahmed glaucoma valve implantation on intermediate-term intraocular pressure control
Authors: Patil Trupti Sudhir , Mani Baskaran , Balekudaru Shantha , George Ronnie J , Lingam Vijaya
Published: August 2022

Purpose:

To evaluate the incidence of shallow anterior chamber in the early postoperative period following Ahmed glaucoma valve (AGV) implantation and its effect on the hypertensive phase (HP), intermediate-term intraocular pressure (IOP) control, and success rate.

Methods:

A retrospective analysis of 369 eyes of 360 patients who underwent AGV implantation between January 2005 and January 2020 with a minimum follow-up of 2 months was performed. Twenty-six patients developed shallow anterior chamber (AC) within 8 weeks following surgery (cases). They were compared with 39 randomly selected controls (no shallow AC post AGV). HP (IOP spike >21 mmHg), use of ocular hypotensive medications, and other associations were compared.

Results:

Incidence of shallow AC post AGV was 7% (95% confidence interval [CI] 4, 9). The onset of shallow AC was 3 ± 2.1 days and resolved within 6 ± 4.7 days. Hypotony (12 [47%] vs. 1 [2.5%], P 0.0001) and choroidal detachment (CD; 7 [27%] vs. 3 [8%], P 0.03) were more common in cases compared to controls. The HP occurred in 11 (43%) cases versus 13 (34%) controls (P 0.4). Cases required more ocular hypotensive medications than controls at the end of 8 weeks (1.1 ± 1 vs. 0.5 ± 0.5, P 0.01). There was no significant difference in the qualified success between the groups at 1 year.

Conclusion:

The development of postoperative shallow AC post AGV implantation was not detrimental to IOP control at 1 year. However, there is a need to monitor the occurrence of HP in these eyes.
Raman Spectroscopy of six explanted acrylic hydrophobic foldable intraocular lenses with glistening
Authors: Bhattacharjee Harsha , Bhattacharjee Kasturi , Das Dipankar , Javeri Henal , Buragohain Suklengmung
Published: August 2022

Purpose:

To study and interpret Raman spectra of six explanted acrylic hydrophobic foldable intraocular lenses (HFIOLs) with grade six microvacuoles and to understand the possible mechanism for microvacuole formation.

Methods:

Clinical data, slit-lamp photographs, and optical microphotographs of the explanted analytes were obtained. RS of the analytes were registered using a confocal Raman microscope (Lab RAM HR Evolution, Horiba Jobin Yvon) and Horiba Lab Space 6 Spectroscopy Suite software. Data were interpreted by identifying the functional group and fingerprint region of the spectra about the available literature.

Results:

IOLs were explanted for visual impairment after an average interval of 11.2 years following implantation. Each of the HFIOLs exhibited distinctive and identical Raman bands at the frequency range of 200–1,800, 2,600–3,000, and 3,200–3,700 cm-1 which were identified with those reported in the literature. The unique bands and peaks of the spectra were specific to the functional groups, its ring and other stretching variations, hydroxyl group, and water molecule. A spike at 1,640 cm-1 revealed the presence of monomer and indicated material bioincompatibility of the samples.

Conclusion:

Raman spectroscopy (RS) was found specific and an effective tool to detect the material change in the HFIOL and constituents of polymer biomaterial about microvacuole formation and also suggested modification and development of a more biocompatible and non-biodegradable polymer blend where RS could be a monitoring tool.
Red cell distribution width levels in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma
Authors: Bashir Jasiya , Beg Danish T , Beigh Arshid A , Wani Ejaz A
Published: August 2022

Purpose:

The purpose of this study was to assess the levels of red cell distribution width (RDW) in patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliation glaucoma (PEXG), and to compare their RDW values with healthy controls.

Methods:

40 patients with PEX, 40 with PEXG, and 80 control subjects were enrolled in this study. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within one hour of blood collection.

Results:

RDW levels were significantly higher in patients with PEX and PEXG than in controls (P = 0.027 and P < 0.001, respectively). Furthermore, a significant difference was found in RDW values between PEXG and PEX groups (P = 0.016). RDW levels were gradually increased from control group to PEXG group (P < 0.001). Multivariate logistic regression analysis revealed that RDW was independently associated with the presence of PEX/PEXG (odds ratio 1.765, 95% confidence interval (CI) 1.095–2.867, P = 0.013).

Conclusion:

We conclude that RDW may be a useful marker for predicting the presence of PEX and progression to PEXG.
Intensive topical interferon therapy in uveitic macular edema
Authors: Kawali Ankush , Sanjay Srinivasan , Mohan Ashwin , Mahendradas Padmamalini , Shroff Sujani , Shetty Rohit
Published: August 2022

Purpose:

To evaluate the efficacy of intensive topical interferon alfa-2b (IFN) therapy in uveitic macular edema (UME).

Methods:

This is a prospective, interventional case study of eyes with UME. Commercially available injection IFN for subcutaneous use was reconstituted to form eye drops and a dose of 6 times/day for 2 weeks, 5 times/day for next 2 weeks, followed by 4, 3, 2, 1 taper per month was prescribed. Optical coherence tomography (OCT) and clinical examination was done at 0, 2, 4, 8 weeks, and further as required.

Results:

Nine eyes of 9 patients with UME were studied. Mean central macular thickness (CMT) at presentation was 522.2 mm (range: 408–803 mm). At 2-week, 1-month, and 2-month follow-up, mean CMT decreased to 451.6 mm (range: 322–524 mm), 375.8 mm (range: 287–480 mm), and 360.3 mm (range: 260–485 mm), respectively. Four eyes which showed inadequate response to previous topical IFN therapy (4 times/day) showed significant improvement with intensive therapy at 1 month follow-up. In 4 eyes, UME resolved completely with mean CMT 285.5 mm (range: 260–312 mm) at 7.5 weeks (range: 4–12 weeks). Study exit was seen in 2 cases due to inadequate response and relapse of uveitis. Mean follow up was 3.38 months (range: 1–5 months).

Conclusion:

Intensive topical IFN therapy can be an alternative therapeutic option in the treatment of UME. Study of intraocular penetration, combination with other drugs, and the efficacy of IFN separately for different uveitic entities may explore new avenues in treatment of UME.
To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes
Authors: Dhami Abhinav , Sharma Pragya , Dhami Nimrata B , Dhami Gobinder S
Published: August 2022

Purpose:

To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Methods:

This is a retrospective study analyzing medical records of consecutive patients with refractory macular hole (at least 1 prior surgery) and eyes with retinal detachment with coexisting macular holes (MH). Optical coherence tomography (OCT) of the macula was performed before and after surgery. The primary study outcome evaluated were the functional and anatomic macular hole closure, and secondary outcomes were improvement in visual acuity and restoration of the outer retinal bands, external limiting membrane, and ellipsoid zone in eyes with acquisition of autologous retinal transplant using Finesse Loop.

Results:

The study included eight eyes of eight patients; retinal autograft was performed in six (75.0%) and autologous retinal transplantation (ART) with rhegmatogenous retinal detachment (RRD) was performed in two (25.0%) eyes. The average MH basal diameter in the study was 1310.88 ± 138.63 µm. The successful hole closure rate was observed to be 75% (6 eyes) and 100% retinal reattachment was observed in ART with RRD. Statistically significant (P = 0.001) improvement was noted for preop and postop visual acuity gain for ART acquisition and postop macular hole closure. The restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) was observed in 37.5% (3 eyes) of patients.

Conclusion:

Finesse™ Flex Loop can be used to harvest retinal tissue and it provides good anatomical and functional outcomes for failed macular hole.
Association of keratoconus with serum levels of 25-hydroxyvitamin D and antioxidant trace elements: A systematic review and meta-analysis
Authors: Gupta Parul C , Pathak Mona , Thakur Bhaskar , Fogla Rajesh , Agarwal Aniruddha , Ram Jagat
Published: August 2022

The aim of this systematic review and meta-analysis was to summarize and compare the available evidence on the level of vitamin D and antioxidant trace elements between the keratoconus (KC) patients and healthy controls. Seven case–control studies with 830 subjects were found eligible with a systematic search using PubMed, SCOPUS, Web of Science, and EMBASE till November 21, 2021. Data were synthesized with a DerSimonian and Laird random-effects method of meta-analysis. The mean serum vitamin D level was significantly lower in the patients with KC [standardized mean difference (SMD): −0.71;P< 0.001] as compared with the control group. The mean serum vitamin D level decreased more in the progressive patients (SMD: −0.80;P= 0.016) than in the stable patients (SMD: −0.66;P< 0.001) when compared with the control group. The mean serum zinc level was found significantly lower in the patients with KC compared with the control group (SMD: −1.98;P= 0.005). Pooled analysis based on the two studies showed significantly lower mean selenium levels in the KC patients (SMD: −0.34;P= 0.003). Regular evaluation of serum vitamin D, zinc, and selenium levels among the patients with KC at disease onset and future follow-ups could be promising in predicting the progressive disease and disease severity.
Virtual bedside clinics in pediatric ophthalmology and strabismus – An innovation in education and learning
Authors: Kekunnaya Ramesh , Deshmukh Ajinkya V , Sheth Jenil , Chattannavar Goura , Sachadeva Virender
Published: August 2022

We piloted an innovation in teaching by conducting live virtual bedside clinics and evaluated the effectiveness compared to conventional bedside clinics. The purpose is to report the methodology and survey results of this innovation in teaching. A virtual bedside clinic was set up utilizing multiple audio-visual aids at a tertiary eye care facility. The bedside clinic was conducted and streamed live to pre-registered participants across the globe using the Zoom platform. The online survey was conducted comparing its effectiveness with conventional bedside clinics. A total of five sessions were conducted. A total of 2058 participants registered (411/session), of which 938 (45.57%) attended (187/session). A total of 287 participants (30.6%) responded to the survey. The respondents included ophthalmology residents (43.4%), fellows (19%), sub-specialty ophthalmologists (15.4%), general ophthalmologists (12%), and optometrists (9%). More than 95% of the respondents felt that these clinics were equally effective/better in imparting the following: physical examination 97%, clinical knowledge 99.3%, clinical reasoning 98.3%, procedural skills 95%, and communication skills 96.5%. Respondents suggested that these clinics were better/equally effective in the following techniques: general examination (96%), ocular motility (93.3%), nystagmus evaluation (93.3%), and anterior (80%) and posterior segment examination (73.3%). The hybrid mode presentation (97.3%) and discussion with the panel (100%) were reported to be equally effective/much better. Live virtual bedside clinics are a novel and effective way of continuing quality teaching and impactful learning. Most of the bedside manners, procedural skills, and examination techniques can be effectively taught through this virtual platform with a scope to improve anterior and posterior segment examination skills.
Steep increase in myopia among public school-going children in South India after COVID-19 home confinement
Authors: Saara Krishnamurthy , Swetha Saravanan , Subhiksha Rangavittal , Amirthaa Murali , Anuradha Narayanan
Published: August 2022

Purpose:

Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India.

Methods:

This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables.

Results:

From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day.

Conclusion:

Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India.
Uncontrolled diabetes mellitus exacerbated by COVID-19–induced inflammation is the risk factor for COVID-19–associated rhino-orbito-cerebral mucormycosis: A matched pair case–control study
Authors: Karat Shubashree , Lobo Aaron C , Satish Deepthi , Devaraj Rincy , Manjooran Riya R , Nithyanandam Suneetha
Published: August 2022

Purpose:

Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19–associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19–associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM.

Methods:

This case–control study included all COVID-19–associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients.

Results:

The study included 69 patients with COVID-19–associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19–associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03–1.78), blood glucose (OR = 1.008, 95% CI: 1.003–1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02–1.17) were associated with increased odds of developing COVID-19–associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30–9.02) and blood glucose (OR = 1.02, 95% CI: 1.005–1.03) (P = 0.02) had a higher probability of developing COVID-19–associated ROCM than patients with established DM.

Conclusion:

Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19–induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19–associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
Clinical and imaging characteristics of outer retinal folds in eyes with retinitis
Authors: Dhewale Saurabh , Kelgaonkar Anup , Khalsa Ashish , Padhy Srikanta Kumar , Behera Umesh Chandra , Padhi Tapas Ranjan , Basu Soumyava
Published: August 2022

Purpose:

To describe clinical and imaging characteristics of the outer retinal folds (ORF) in cases of retinitis, retinochoroiditis, and chorioretinitis.

Methods:

Retrospective review of retinitis cases with presence of ORFs either at presentation or during follow up.

Results:

ORFs were seen adjacent to retinitis lesions in 16 eyes of 14 cases (retinitis post-febrile illness n = 10, toxoplasma retinochoroiditis n = 2, fungal chorioretinitis n = 2) either at presentation (n = 2) or during follow up (n = 14). Optical coherence tomography (OCT) appearance was outer retinal vertical stout lesions involving ellipsoid, external limiting membrane, and outer nuclear layer. All the cases had a presence of past or concurrent subretinal fluid and/or subretinal hyperreflective material when ORF was seen. ORF resolved with variable outer retinal atrophy over a mean period of 2.86 months.

Conclusion:

ORF is observed in cases of retinitis with subretinal fluid either at presentation or during resolution. It is not specific to any etiological disease. Differentiation of this sign from vertical outer retinal stripes in viral retinitis on OCT is important to avoid misinterpretation.
Innovation Urrets-Zavalia syndrome
Authors: Narang Priya , Narang Rhea
Published: August 2022

Background:

Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing Urrets-Zavalia syndrome (UZS). The authors have previously documented the results of surgical pupilloplasty and have outlined this modality of treatment for cases with UZS.

Purpose:

To highlight the aspect of development of UZS post-operatively in the eyes following an intra-ocular surgery.

Synopsis:

The video highlights the aspect of prevalence of the persistently dilated pupil that is non-responsive to topical miotics. Apart from associated glare, these cases often have raised intra-ocular pressure because of appositional closure of the anterior chamber angle. Surgical pupilloplasty pulls the iris tissue centrally, eventually releasing the mechanical blockage and often breakage of the peripheral anterior synechias as demonstrated by intra-operative gonioscopy and anterior segment optical coherence tomography.

Highlights:

Performing a surgical pupilloplasty can resolve the UZS, and timely intervention can also prevent the development of secondary glaucoma because of fallback of the iris tissue on the structures of the anterior chamber angle.

Online Video Link:

https://youtu.be/IF_w8dVk5_w

Key words: Dilated pupil, SFT, single-pass four-throw, surgical pupilloplasty, Urrets-Zavalia, UZS
Visual outcomes of acute bacterial endophthalmitis treated with adjuvant intravitreal dexamethasone: A meta-analysis and systematic review
Authors: Soekamto Christa , Rosignoli Luca , Zhu Christopher , Johnson Daniel A , Sohn Jeong-Hyeon , Bahadorani Sepehr
Published: August 2022

Adjunctive treatment of bacterial endophthalmitis with intravitreal steroids is a topic of controversy among many ophthalmologists. The objective of this study is to evaluate the effects of intravitreal dexamethasone on the visual outcomes of patients with acute bacterial endophthalmitis through a systematic review and meta-analysis. A literature search of PubMed, Scopus, and Cochrane Library databases was performed to include studies on the visual outcomes of adjuvant intravitreal dexamethasone in patients with acute bacterial endophthalmitis. The review is based on the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) protocol. A total of 1545 articles met our search criteria and after further review, two randomized controlled trials and three retrospective case series were included in the final analysis. A total of 126 eyes were treated with intravitreal dexamethasone combined with antibiotics, and another 139 eyes were treated with antibiotics alone. All cases of endophthalmitis were post-operative or post-intravitreal injection, with pooled results demonstrating no visual benefit with supplementation of intravitreal dexamethasone. Our meta-analysis does not show any visual benefit from steroid supplementation and yet, considering a relatively small number of patients included in each study, larger randomized controlled trials are required to further clarify the role of steroids in the treatment of acute bacterial endophthalmitis.
Development of a Questionnaire on Awareness about Occupational Therapy among Health-Care Professionals
Authors: Bhardwaj Shivani , Sharma Raj Kumar , Sethuraman Lakshmanan , Dwivedi Amit
Published: August 2022

Background:

Occupational therapists are recognized as essential members of the health-care team. Occupational therapy treatments are required to deliver better services and to promote a comprehensive service approach. Occupational therapy awareness is critical for providing high-quality care to all patients. There is, however, a paucity of studies aimed at determining occupational therapy awareness and knowledge. This study aimed to develop a questionnaire to assess health-care professionals' (HP's) awareness and knowledge of occupational therapy.

Objectives:

This study aimed to develop a reliable questionnaire to assess HP's awareness and knowledge about occupational therapy.

Study Design:

This study was based on a cross-sectional design.

Methods:

The questionnaire was created in three stages. Initially, the first stage was to do a literature review for item generation. The second stage was to circulate a draft of the questionnaire among experts for face validity, and stage three was to test the reliability of items.

Results:

The generated items underwent face validity by ten experts. After face validation, the final questionnaire consisting of two sections (awareness and knowledge about OT and advocacy) were circulated to fifty health-care professionals. A statistical analysis (Cronbach's alpha) was done to analyze internal consistency, which indicates α = 0.78.

Conclusion:

This study concludes that the questionnaire is reliable for exploring awareness and knowledge about occupational therapy.
Gender Differences in Quality of Life and Subjective Happiness in Indian Elderly
Authors: Moirangthem Sarju , Ojha Gita Jyoti
Published: August 2022

Background:

As aging is associated with lower quality of life (QOL), it is important to determine overall QOL and its related factors among older adults. Studies have shown that gender plays an essential role in the perception of health across cultures. As very few studies has been conducted on gender disparity in the elderly in India. Thus, the study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly.

Objectives:

The study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly in India. Study

Design:

The study design involves a cross-sectional survey.

Methods:

The data were collected from community-dwelling elderly (>60 years of age) based on convenient sampling. QOL and subjective happiness were tested by World Health Organization QOL (WHOQOL)-BREF and the Subjective Happiness Questionnaire. Informed consent was taken before administering the study-specific questionnaire via mail, telephone, or in person. Only completed questionnaires were used. Data hence collected were analyzed.

Results:

The data were analyzed by descriptive analysis, whereas the differences between gender on QOL and happiness were computed using the t-test and Mann–Whitney test, respectively. Gender and educational qualification correlated with QOL measure WHOQOL (P = 0.05; 95% confidence interval [CI]: 0.014, 0.527). Furthermore, a positive correlation (P = 0.01; 95% CI: 0.994, 0.998) was found between WHOQOL-BREF and the Subjective Happiness Questionnaire. For the overall QOL and general health section in WHOQOL-BREF, males scored a mean ± standard deviation (SD) of 3.825 ± 0.71 and 3.275 ± 1.15, whereas females scored a mean ± SD of 3.875 ± 0.56 and 3.35 ± 1.21. For the four domains of WHOQOL-BREF except for domain 4 (t = 2.17; 95% CI: 26.13, 28.06), mean ± SD (27.10 ± 4.35), (P = 0.033), and Subjective Happiness questionnaire, the differences in the means of elderly males and females were nonsignificant on Mann–Whitney test.

Conclusion:

This study shows that gender-related factors influence specific areas of QOL, such as females scoring less in physical and psychological factors, whereas scoring better than males in social relationship and environment areas.
Reduction of Metal Artifacts Caused by Titanium Peduncular Screws in the Spine by Means of Monoenergetic Images and the Metal Artifact Reduction Software in Dual-Energy Computed Tomography
Authors: Ceccarelli Luca , Vara Giulio , Ponti Federico , Miceli Marco , Golfieri Rita , Facchini Giancarlo
Published: August 2022

Objectives:

To evaluate the reduction of metal artifacts in patients with titanium peduncular screws in the spine using (1) conventional images (CI), (2) virtual monoenergetic reconstructions (VMRs), and (3) VMR + Metal Artifact Reduction Software (VMR + MARS), with dual-energy computed tomography (DECT).

Materials and Methods:

Twenty-four patients with titanium peduncular screws in the spine were studied using a 64-channel DECT. During the postprocessing phase, the CI, the VMRs from 100 to 140 keV, and the VMR at 140 keV + MARS were synthesized. All the images were considered, and a quantitative evaluation was performed measuring the attenuation values (in terms of Hounsfield Units) with region of interest, in correspondence with the most hyperdense and hypodense artifacts. All the values were then compared. A qualitative evaluation, in terms of image quality and extent of artifacts, was also performed by two radiologists.

Results:

In quantitative terms, the 140 keV + MARS reconstruction was able to significantly reduce both bright and dark metal artifacts, compared to CI and to VMRs. The VMR was capable of significantly reducing both dark and bright artifacts, compared to CI. In qualitative terms, the VMR at 140 keV proved to be the best, compared to CI and VMR + MARS images.

Conclusions:

The VMR + MARS image reduces metal artifacts from titanium peduncular screws more than VMRs alone and CI. Furthermore, the VMR can decrease metal artifacts from a quantitative and a qualitative point of view. Combining information from VMRs and VMR + MARS images could be the best way to solve the issue of metal artifacts on computed tomography images.
Determination of Dose Distributions by Monte-Carlo Simulation of 6 MV Photon Beam of Varian VitalBeam Accelerator Using Geant4 Multithreaded Code
Authors: Chiuyo Julius S. , Lugendo Innocent J. , Muhogora Wilbroad E.
Published: August 2022

Background:

Accuracy of dose delivery in radiation therapy is a primary requirement for effective cancer treatment. In practice, dose delivery accuracy of ±5% is desired. To achieve this accuracy level, an accurate method for calculating the dose distributions in the tumor volume is required. Monte-Carlo method is one of the methods considered to be the most accurate for calculating dose distributions.

Materials and Methods:

G4 linac-MT code was used to simulate a 6 MV photon beam. The initial electron beam parameters were tuned to validate the beam modeling from depth doses and beam profile. The dose distributions measured in water phantom were compared to the calculated dose distributions based on gamma index criterion.

Results:

The beam tuning showed the initial electron energy, sigma and full width at half maximum of 6.2 MeV, 0.8 MeV, and 1.18 mm, respectively, best match the measured dose distributions. The gamma index tests showed the calculated depth doses and beam profile were generally comparable with measurements, passing the standard acceptance criterion of 2%/2 mm. The simulated photon beam was justified by the index of beam quality, which showed excellent agreement with measured doses with a discrepancy of 0.1%.

Conclusion:

The observed agreement confirm the accuracy of the simulated 6 MV photon beam. It can therefore be used as radiation source for calculating dose distributions and further investigations aimed at improving dose delivery and planning in cancer patients.
Biological Evaluation of Grid versus 3D Conformal Radiotherapy in Bulky Head and Neck Cancer
Authors: Alanizy Najah Abdulmuneem , Attalla Ehab Marouf , Abdelaal Ahmed Mosa , Yassen Mohamed Nabil , Shafaa Medhat Wahba
Published: August 2022

Grid radiotherapy is one of the treatment techniques applied to treat patients with advanced bulky tumors.

Purpose:

This study aims to estimate the difference in biological and dosimetric parameters of the grid radiotherapy technique for the treatment of bulky head and neck (H and N) tumors and compare it with conventional conformal radiotherapy.

Subjects and Methods:

Three-dimensional conformal and grid radiotherapy were designed by the Monaco treatment planning system (TPS). Eight bulky tumors of (H and N) cases were selected, using a single fraction 15–20 Gy. Dose-volume histogram of the tumors and organs at risk (OARs) used to calculate the equivalent uniform dose (EUD) (Gy) by Matlab program. Furthermore, dosimetric parameters of the tumors from the TPS were compared for two techniques (grid radiotherapy and the conventional conformal radiotherapy).

Results:

Grid attained a lower EUD (Gy) in tumors and OARs as compared to conformal therapy, as Grid principle protects about half of the tumor area from the radiation leads to less coverage of the tumor. Also, where OARs in closed with tumors and the shielding by multi-leaf (1 cm) were more effective than other techniques, lead to a decrease of radiobiological values according to its definition by Niemierko. Radiobiological results showed significant differences between the two methods, and dosimetric data obtained by the TPS for tumours for two plans were P < 0.05.

Conclusions:

The grid plan achieves lower values of EUDs than the conformal technique for OARs. Hence, it achieves more sparing and fewer complications for these organs.