bluuebunny/crossref_metadata_2025 huggingface dataset:
An experimental study to evaluate Gunasankarya (combination of properties)
Authors: Nair Jiji U. , Vyas Hitesh A. , Nariya Mukesh B.
Published: May 2023

Introduction:

Gunasankarya implies the combination or admixture of different Guna (properties) in a Dravya (substance). Every Dravya in this world is composed of different Guna varying in their quantity and potency. The final resultant action of the Dravya depends on the combination of Guna and their interaction with each other.

Aim:

The present study was aimed to explain the manifestation of Karma (action) of a Dravya through its Guna (properties) and to evaluate the effect of the combination of Sheeta Guna (cool property) with different other Guna on digestion and metabolism in an animal model.

Materials and methods:

The test drugs Usheera (Vetiveria zizanioides Linn.) and Bala (Sida cordifolia Linn.) were dried and powdered. A total of 18 adult healthy male and female Wistar strain albino rats were grouped randomly into three groups out of which the first was the control group and administered with distilled water. The second and third groups were fed with powder of Usheera and Bala, respectively, in the suspended form in distilled water. Test drugs were administered daily for 12 consecutive days. During the experimental phase, relative food intake, relative water intake, relative urine output, relative stool output, and food conversion ratio were recorded on the 3rd, 6th, 9th, and 12th day among which the 3rd day was considered as the initial day for the assessment, whereas body weight was measured from the 1st day of the study. Throughout the study, the main focus was on how these parameters change in Usheera and Bala-treated rats which are having different combinations of Guna with reference to the control group.

Results:

Both Usheera and Bala groups showed a nonsignificant increase in relative food and water intake, nonsignificant increase in relative urine output, significant decrease in relative stool output, and significant increase in food conversion ratio. Body weight was nonsignificantly increased in Usheera group, whereas it was nonsignificantly decreased in Bala group. This study aimed to show how the Guna are interacting and resulting in Karma either by dominating or suppressing or giving a combined effect of Guna. This study provides initial data regarding the concept of Gunasankarya (combination of properties).

Conclusion:

The study concludes that all the Guna in a Dravya interact and exhibit their resultant action, i.e., Karma based on Gunasankarya, with emphasis on example of assessment of the effects of Sheeta Guna Dravya, namely, Usheera and Bala on physiological parameters (digestion and metabolism) have been assessed experimentally in animal models to evaluation of the combination of Guna.
Agnikarma with Kshaudra (honey) along with adjuvant Ayurveda therapy in the management of trigger finger- A single case report
Authors: Ganatra Riddhi Jitendrakumar , Dudhamal Tukaram S.
Published: May 2023

Trigger finger (TF) mechanical ailment results from a stenotic A1 pulley that has lost its gliding surface, producing friction and nodular change in the tendon. This results in pain and tenderness at the site of the A1 pulley which further progresses into catching and then locking of the finger. A definite cure of TF in the current mainstream is the surgical release of the A1 pulley. A 71-year-old male patient with a TF presented with pain, swelling, and locking of the left hand's middle finger. The patient was considered as suffering from Snayugata Vata as an Ayurveda diagnosis and treated with Kshaudra Agnikarma (therapeutic burn with honey) on daily basis at the morning for 30 days and Bandhana (bandages) for 2 months along with Dashmoola Kwatha orally 20 mL empty stomach twice a day and Haritaki Churna 5 g at night with lukewarm water orally for 2 months. The patient was clinically assessed and Green's Severity Scores of TF showed remarkable improvement after the completion of treatment. This single case report demonstrates that the case of TF can be successfully managed with Kshaudra Agnikarma – A minimally invasive nonsurgical therapeutic intervention using Ayurveda principles.
Modified FOLFIRINOX compared to Gemcitabine & nab-Paclitaxel in advanced pancreatic ductal adenocarcinoma - results of a match-pair analysis
Authors: Ramaswamy Anant , Shah Darshit , Bhargava Prabhat , Srinivas Sujay , Kannan Sadhana , Shah Minit , Suman Mannavi , Das Shasanka , Trikha Mehak , Ostwal Vikas
Published: May 2023

Background & objectives:

FOLFIRINOX and gemcitabine plus nab-paclitaxel (GN) are the most commonly used regimens in advanced pancreatic ductal adenocarcinomas (PDACs). As there is limited data on comparison of these two regimens, the present study was aimed to compare survivals and tolerance for both regimens through a match-pair analysis.

Methods:

The data of 350 patients with metastatic and locally advanced PDAC, treated between January 2013 and December 2019, were retrieved. A 1:1 matching, using age and performance status, without replacement was performed by using nearest neighbour matching method.

Results:

A total of 260 patients (130 modified FOLFIRINOX and 130 GN) were matched. The median overall survival (OS) was 12.98 months [95% confidence interval (CI) 7.257-8.776 months] in modifications of FOLFIRINOX (mFOLFIRINOX) cohort and 12.06 months (95% CI 6.690-8.88 months) in GN group (P=0.080). The incidence of grade 3 and 4 infections, diarrhoea, oral mucositis, and fatigue was higher with mFOLFIRINOX. Patients who received second line therapy had improved OS as compared to those who did not (14.06 vs. 9.07 months, P<0.001).

Interpretation & conclusions:

GN and mFOLFIRINOX appear to have similar survival outcomes in an unselected match paired patient population with advanced PDAC. A markedly increased incidence of non-myelosuppressive grade 3 and grade 4 side-effects and lack of survival improvements suggest a need for nuanced use of the mFOLFIRINOX regimen. Administration of second-line chemotherapy improves OS in patients with advanced PDAC.
30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure
Authors: Singhal Deepali , Narde Harpreet Kaur , Maharana Prafulla Kumar
Published: May 2023

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.
Outcomes of accelerated collagen cross linking in progressive paediatric keratoconus
Authors: Preethi B , Kumar Kiran K , Babu G Suresh , Sridhar Sriya , Srinivasa K H
Published: May 2023

Purpose:

To determine the efficacy and safety of pediatric accelerated cross linking (CXL).

Methods:

A prospective study on progressive keratoconus (KC) cases under ≤18 years of age. Sixty four eyes of thirty nine cases underwent epithelium-off accelerated CXL protocol. Visual acuity (VA), slit-lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th-month post procedure.

Results:

Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4–70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46–68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze.

Conclusion:

Accelerated CXL is effective and efficacious in pediatric KC.
Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique
Authors: Sharma Ashok , Sharma Rajan , Kulshreshta Ashish , Nirankari Verinder S
Published: May 2023

A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet’s membrane (DM) could be visualized. We performed a novel surgical approach, “double-bubble pneumo-descemetopexy.” The surgical procedure included unrolling of DM with “small air bubble” and descemetopexy with “big bubble.” No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet’s stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.
Efficacy and safety analysis of intravitreal bio-similar products of bevacizumab in patients with macular edema because of retinal diseases
Authors: Agarwal Ruchi , Gupta Sanjiv K , Agrawal Siddharth
Published: May 2023

Purpose:

The purpose of this study was to evaluate retrospectively the efficacy and safety profile of intravitreal injection of bevacizumab bio-similar product Zybev(Z) for macular edema because of retinal diseases.

Methods:

A retrospective analysis was conducted on patients with macular edema because of retinal diseases, who had been administered intravitreal injections of bio-similar bevacizumab at a tertiary eye care center. Changes in the retinal thickness and visual acuity were evaluated to judge the efficacy, and adverse events were noted for the safety profile over a period of 6 weeks.

Results:

A total of 104 patients were included in the study. The mean age of the patients was 53 ± 13.5 years. The mean pre-injection best corrected visual acuity (BCVA) was 1.32 ± 0.70 log minimum angle of resolution (logMAR) with a central subfield thickness (CST) of 429.26 ± 204.30 μm, and the post-injection BCVA at 6 weeks was 1.13 ± 0.71 logMAR with a CST of 302.26 ± 104.50 μm; this change was statistically significant (P < 0.05) for all groups. The mean average cube thickness (μm) decreased from 11.85 ± 1.96 pre-injection to 10.52 ± 1.75 post-injection, and the mean average cube volume (mm3) decreased from 329.30 ± 54.35 to 302.23 ± 49.56 (P < 0.05). During the follow-up period after injection, no patient had inflammation, endophthalmitis, an increase in intra-ocular pressure, or systemic side effects.

Conclusion:

This short-term retrospective analysis provides evidence regarding the efficacy and safety of intravitreal injection of bio-similar products of bevacizumab for the treatment of macular edema because of retinal diseases.
Reutilization of disposable rebound tonometer probes: Risk or return?
Authors: Enders Christian , Klante Pia , Hessling Martin , Wolf Armin , Werner Jens Ulrich
Published: May 2023

Purpose:

An advantage of rebound tonometry (RT) is its ease of use so that it can also be operated by health care technicians. However, the cost of the disposable measuring probes is high and their reuse carries the risk of infection. Therefore, this study aims to objectify the potential risk of bacterial transmission by RT.

Methods:

Our experimental setting consisted of two experiments. The first aimed to quantify the number of bacteria on a tonometer probe after immersion in a bacterial suspension in vitro. The experiment was carried out with two different bacteria and compared with results from a Goldmann tonometer probe. The second experiment tested whether bacteria could be transmitted by simulating reuse of a nondisinfected rebound tonometer probe.

Results:

First experiment: After immersion of the rebound tonometer probe, we measured a bacterial count of 2.43 × 106
Escherichia coli (EC) and 1.12 × 106
Pseudomonas fluorescens. In total, 1.09 × 107 bacteria for EC and 2.61 × 106 for Pseudomonas fluorescens (PF) were measured on the Goldmann tonometer probe. Second experiment: A bacterial transmission could be detected in 36% of cases in which reuse of nondisinfected tonometer probes was simulated.

Conclusion:

These results show that despite the small surface of the rebound tonometer probe, there is a clear risk of bacterial transmission. Thorough disinfection according to general standards should be mandatory if the tonometer probes are to be reused.
A novel iridoplasty suture technique to repair iris defects and traumatic mydriasis
Authors: Karabaş V. Levent , Seyyar Sevim Ayça , Tokuc Ecem Onder , Şahin Özlem
Published: May 2023

A new iridoplasty method is described, which uses the U-suture technique to repair traumatic mydriasis and large iris defects. Two 0.9 mm opposing corneal incisions were made. The needle was inserted through the first incision, passed through the iris leaflets, and removed through the second incision. The needle was reinserted through the second incision and removed through the first incision by re-passing the needle through the iris leaflets to form a U-shaped suture. The modified Siepser technique was applied to fix the suture. Thus, with a single knot, the iris leaflets were brought closer (shrinking like a pack), fewer sutures were used and fewer gaps were left. Satisfactory aesthetic and functional results were obtained in all cases in which the technique was applied. There was no suture erosion, hypotonia, iris atrophy, or chronic inflammation during the follow-up.
Role of corneal collagen cross-linking in bullous keratopathy: A systematic review
Authors: Singh Mamta , Sinha Bibhuti Prassan , Mishra Deepak , Deokar Kunal , Bhatia Gayatri , Upreti Garima
Published: May 2023

Corneal cross-linking (CXL), a corneal strengthening procedure, is known to alter anterior stroma swelling behavior and is one of the treatment modalities of bullous keratopathy (BK). There are multiple studies published on the role of CXL in the treatment of BK. These articles had heterogeneous study population, different protocols used, and variable conclusions. This systematic review aimed to determine the role of CXL in the treatment of BK. The primary outcomes considered were changes in central corneal thickness (CCT) after 1, 3, and 6 months of CXL. The secondary outcome measures were changes in visual acuity, corneal clarity, subjective symptoms, and complications after CXL. We included randomized control trials (RCTs), observational and interventional studies, and case series with reports of more than 10 cases in this review. In RCTs, the mean pre-CXL CCT (794.0 ± 178.5 μm) in the intervention group (n = 37), decreased at 1 month (750.9 ± 154.3 μm) followed by a subsequent increase, but this difference was not significant during the 6-month follow-up (P- value 0.28, 0.82, and 0.82 at 1, 3, and 6 months, respectively). In noncomparative clinical studies (n = 188), the mean pre-CXL CCT (794.0 ± 178.5 μm) decreased at 1 month (710.9 ± 127.2 μm, P < 0.0001). Seven of the 11 articles included in the review reported no significant improvement in vision with CXL. The initial improvement in corneal clarity and clinical symptoms was not sustained. Current evidence suggests that CXL has short-term efficacy in the treatment of BK. More RCTs with high-quality evidence are needed.
Impact of color vision deficiency on the quality of life in a sample of Indian population: Application of the CVD-QoL tool
Authors: Male Shiva Ram , Shamanna BR , Bhardwaj Rishi , Gandhi Rashmin , Bhagvati Chakravarthy , Theagarayan Baskar
Published: May 2023

Purpose:

To investigate the quality of life (QoL) in a sample of color vision deficit (CVD) patients in India and how color vision deficiency affects them psychologically, economically, and in productivity related to their work and occupation.

Methods:

A descriptive and case–control study design using a questionnaire was conducted on N = 120 participants, of whom 60 were patients of CVD (52 male and eight female) who visited two eye facilities in Hyderabad between 2020 and 2021 and 60 were age-matched normal color vision participants who served as controls. We validated English–Telugu adapted version of CVD-QoL, developed by Barry et al. in 2017 (CB-QoL). The CVD-QoL consists of 27 Likert-scale items with factors (lifestyle, emotions, and work). Color vision was assessed using the Ishihara and Cambridge Mollen color vision tests. A six-point Likert scale was used, with lower scores indicating poor QoL (from 1 = severe issue to 6 = no problem).

Results:

The CVD-QoL questionnaire’s reliability and internal consistency were measured, including Cronbach’s a (a =0.70–0.90). There was no significance between the group in age (t = −1.2, P = 0.67) whereas the Ishihara colour vision test, scores showed a significant difference (t = 4.50, P < 0.001). The QoL scores showed a significant difference towards lifestyle, emotions and work (P = 0.001). The CVD group had a poorer QoL score than the normal color vision group odds ratio [OR] =0.31, 95% confidence interval [CI], (P = 0.002, CI = 0.14–0.65, Z = 3.0) . In this analysis, a low CI indicated that the OR was more precise.

Conclusion:

Color vision deficiency affects Indians’ QoL, according to this study. The mean scores of lifestyle, emotions, and work were lower than the UK sample.Since CVD is underreported and possibly affects developing countries more, advocacy for a new health care plan on CVD is essential. Increasing public understanding and awareness could also help diagnosing the CVD population.
A new intraocular lens marker to guide the implantation of toric intraocular lenses in small and mid-dilating pupils
Authors: Ganesh Sri , Brar Sheetal , Chakma Anwesha
Published: May 2023

Insufficient pupillary dilatation is a significant challenge during cataract surgery, as it increases the risk of various intraoperative complications. Implantation of toric intraocular lenses (TIOL) is particularly difficult in eyes with small pupils, as the toric marks are provided in the periphery of the IOL optic, making the visualization of the same difficult for proper alignment. Attempts at visualizing these marks using a second instrument such as a dialler or iris retractor lead to additional manipulations in the anterior chamber resulting in increased chances of postoperative inflammation and intraocular pressure rise. A new intraocular lens (IOL) marker to guide the implantation of TIOLs in eyes with small pupils is described, which can potentially be beneficial in achieving accurate alignment of toric IOLs in small pupils, without the need for additional manipulations, thus improving safety, efficacy, and success rates of TIOL implantation in these eyes.
Age-related cataract - Prevalence, epidemiological pattern and emerging risk factors in a cross-sectional study from Central India
Authors: Sarkar Deepayan , Sharma Ria , Singh Priti , Verma Vidhya , Karkhur Samendra , Verma Sunil , Soni Deepak , Sharma Bhavana
Published: May 2023

Purpose:

To study the epidemiological pattern, prevalence, types, and correlates of age-related cataracts in a tertiary care center in central India.

Methods:

This hospital-based single-center cross-sectional study was conducted on 2,621 patients diagnosed with cataracts for 3 years. Data pertaining to demography, socio-economic profile, cataract grading, cataract types, and associated risk factors were evaluated. Statistical analysis using unadjusted odds ratio (OR) and multivariate logistic regression was performed, with P-value <0.05 considered significant with the power of the study being 95%.

Results:

The commonest age group affected was 60–79 years, closely followed by the 40–59 years age group. The prevalence of nuclear sclerosis (NS), cortical (CC), and posterior subcapsular cataract (PSC) was found to be 65.2% (3,418), 24.6% (1,289), and 43.4% (2,276), respectively. Among mixed cataracts, (NS + PSC) had the highest prevalence of 39.8%. Smokers were found to have 1.17 times higher odds of developing NS than non-smokers. Diabetics had 1.12 times higher odds of developing NS cataracts and 1.04 times higher odds of developing CC. Patients with hypertension showed 1.27 times higher odds of developing NS and 1.32 times higher odds of developing CC.

Conclusion:

The prevalence of cataracts in the pre-senile age group (<60 years) was found to have increased significantly (35.7%). A higher prevalence of PSC (43.4%) was found in studied subjects, as compared to the data of previous studies. Smoking, diabetes, and hypertension were found to have a positive association with a higher prevalence of cataracts.
Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis
Authors: Chetry Dipak , Singh Jayvindra , Chhetri Archana , Katiyar Vinod Kumar , Singh Daya Shankar
Published: May 2023

Glaucoma is the second leading cause of blindness in the world, with an estimated 57.5 million people suffering from glaucoma globally. Treatment of glaucoma focuses on lowering intra-ocular pressure to prevent progression of visual field defects, which is the only proven method for treating this disease. Yoga practices are believed to lower intra-ocular pressure in the eyes and prevent further damage in patients with glaucoma. Therefore, this systematic review was planned to explore the available scientific studies on yoga and intra-ocular pressure in glaucoma patients. PubMed, Cochrane Library, and Google Scholar were the basis for the investigation of the literature. The Jadad Scale was used to assess the quality of included clinical trials, and the JBI Critical Appraisal Checklist was used to assess the quality of included case studies. Based on the quality assessment and eligibility, six studies on yoga and intra-ocular pressure in glaucoma patients carried out between 2007 and 2021 were included in the final review. The results showed a reduction in intra-ocular pressure in patients with glaucoma through Jyoti-trataka (gazing steadily on a point or candle flame) and some other slow yogic breathing techniques, whereas studies on inversion Asanas (yoga postures) showed a rapid increase in intra-ocular pressure soon after starting. The three high-quality RCTs included in the meta-analysis showed a greater improvement in intra-ocular pressure in the yoga groups in both eyes than in the control groups; however, there were some limitations related to a small sample size, study quality, a long-term follow-up period, and variations in the yoga practices. Therefore, further studies with larger sample sizes and long-term follow-up are needed to overcome the limitations for a better understanding.
Comparative evaluation of intraoperative aberrometry and Barrett’s toric calculator in toric intraocular lens implantation
Authors: Mukhija Ritika , Vanathi Murugesan , Verma Meena , Raj Nimmy , Gupta Noopur , Tandon Radhika
Published: May 2023

Purpose:

Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real-time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation.

Methods:

This was an institution-based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar-LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version-21 was used; P < 0.05 considered significant.

Results:

Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (−0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (-0.14 ± 0.32D) than IA (0.001 ± 0.33D) (−0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one-month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, -0.57 ± 0.26D, and -0.18 ± 0.27D, respectively.

Conclusion:

Both IA and BTC give reliable and comparable refractive results for tIOL implantation.
Choroidal lesions in varicella zoster virus uveitis
Authors: Kawali Ankush , Khanum Aayesha , Mahendradas Padmamalini , Sanjay Srinivasan , Mishra Sai-Bhakti , Shetty Rohit
Published: May 2023

Purpose:

To evaluate choroidal lesions with spectral domain optical coherence tomography (SD-OCT) scan in varicella zoster virus (VZV) uveitis.

Methods:

VZV-uveitis cases which underwent OCT scan for choroidal lesions were studied. SD-OCT scan passing through these lesions was studied in detail. Subfoveal choroidal thickness (SFCT) during active and resolved stages was studied. Angiogaphic features were studied where available.

Results:

Thirteen out of 15 cases had same-sided herpes zoster ophthalmicus skin rashes. All except three patients had old or active kerato-uveitis. All eyes demonstrated clear vitreous and a single or multiple hypopigmented orangish-yellow choroidal lesions. The number of lesions remained unchanged during the follow-up on clinical examination. SD-OCT over lesions (n = 11) showed choroidal thinning (n = 5), hyporeflective choroidal elevation during active inflammation (n = 3), transmission effects (n = 4), and ellipsoid zone disruption (n = 7). The mean change in SFCT (n = 9) after resolution of the inflammation was 26.3 μm (range: 3–90 μm). Fundus fluorescein angiography showed iso-fluorescence over lesions in all (n = 5), but indocyanine green angiography (n = 3) showed hypofluorescence at lesions. Mean follow-up was 1.38 years (range: 3 months–7 years). De-novo appearance of choroidal lesion during the first relapse of VZV-uveitis was captured in one case.

Conclusion:

VZV-uveitis can cause focal or multifocal hypopigmented choroidal lesions with thickening or scarring of choroidal tissue, depending on the disease activity.
Psychiatric aspects of ophthalmic disorders: A narrative review
Authors: Mamtani Nidhi H , Mamtani Harkishan Gurmukh , Chaturvedi Santosh K
Published: May 2023

Ophthalmic disorders have psychiatric aspects associated with them at various levels. Psychological factors have a well-documented role in the causation, aggravation, and maintenance of various ophthalmic conditions, including glaucoma, central serous retinopathy, dry eye disease, and retinitis pigmentosa. Many ophthalmic conditions, including blindness, have psychological manifestations as well, which need to be addressed, in addition to the ophthalmic pathology. There is also significant overlap in the treatment of the two disciplines in many ways. For instance, many ophthalmic drugs have psychiatric side effects. Even ophthalmological surgeries have psychiatric aspects associated with them, which primarily include black patch psychosis and anxiety in the operation theater. This review will be useful for psychiatrists and ophthalmologists, for their clinical practice and research. Future research should focus on this interface to give it its well-deserved attention.
Medical student competence in ophthalmology assessed using the Objective Standardized Clinical Examination
Authors: Patil Nikhil S , Bal Manpartap , Khan Yasser
Published: May 2023

Purpose:

To assess pre-clerkship and clerkship medical student performance in an ophthalmology Objective Standardized Clinical Examination (OSCE) station.

Methods:

One hundred pre-clerkship medical students and 98 clerkship medical students were included in this study. The OSCE station consisted of a common ocular complaint – blurry vision with decreased visual acuity – and students were asked to take an appropriate history, provide two or three differential diagnoses to explain the symptoms, and perform a basic ophthalmic examination.

Results:

Generally, clerks performed better than pre-clerks in the history taking (P < 0.01) and ophthalmic examination (P < 0.05) sections, with few specific exceptions. In the history-taking section, more pre-clerkship students asked about patient age and past medical history (P < 0.00001) and for the ophthalmic examination, more pre-clerkship students performed the anterior segment examination (P < 0.01). Interestingly, more pre-clerkship students were also able to provide two or three differential diagnoses (P < 0.05), specifically diabetic retinopathy (P < 0.00001) and hypertensive retinopathy (P < 0.00001).

Conclusion:

The performance of both groups was generally satisfactory; however, many students in both groups had scores that were unsatisfactory. Notably, pre-clerks also outperformed clerks in certain areas, which emphasizes the importance of revisiting ophthalmology content through clerkship. Awareness of such knowledge can allow medical educators to incorporate focused programs into the curriculum.
An observational study on the presence of perilimbal conjunctival pigmentation in vernal keratoconjunctivitis
Authors: Dubbaka Srujana , Agrawal Mohini , Sati Alok , Vats Sumedha , Mahajan Saurabh
Published: May 2023

Purpose:

To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC).

Methods:

A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon–Mann–Whitney U test and Chi square test.

Results:

Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%–61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (Χ2 = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12).

Conclusion:

Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/limbal signs are elusive.
The impact of COVID-19 on compliance to amblyopia treatment in a tertiary eye care center
Authors: Hegde Namratha , Vidya C , Bandamwar Kalika , Murali Kaushik , Murthy Sowmya Raveendra
Published: May 2023

Purpose:

To investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children.

Methods:

The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID-19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open-ended questions for 15 min. The questions were related to patients’ compliance toward amblyopia treatment and the date of follow-up with their practitioners. The data collected were entered on Excel sheets in the participant’s own words and later converted to a transcript for analysis.

Results:

A total of 217 parents of children with amblyopia who were due for follow-up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia.

Conclusion:

In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow-up with the eye care practitioner.
Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism
Authors: Chatterjee Debapriya , Mittal Vikas
Published: May 2023

We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.
Evaluation of optical coherence tomography angiography changes in nonarteritic anterior ischemic optic neuropathy
Authors: Phuljhele Swati , Sharma Sumant , Chawla Rohan , Saxena Rohit , Sharma Pradeep
Published: May 2023

Purpose:

To study the long-term microvasculature changes at the macula and the optic disk in eyes with nonarteritic anterior ischemic optic neuropathy (NAION).

Methods:

Patients with acute NAION of less than 6 weeks duration were included. Optical coherence tomography angiography (OCTA) of the macula and the optic disk was performed at baseline, 3 and 6 months and compared with the controls.

Results:

The mean age of 15 patients was 52.25 (±9.06) years. The whole image superficial peripapillary density (42.49 ± 5.28) was significantly low when compared to that of control eyes (46.36 ± 2.09); similarly, radial peripapillary capillary density (49.35 ± 5.64) was also significantly reduced when compared to controls (53.45 ± 1.96, P < 0.05). These parameters showed significant progressive decrease at 3 and 6 months (P < 0.05). At the macula, both superficial (41.83 ± 3.64) and deep macular vasculature densities (47.30 ± 2.04) were significantly reduced when compared to control eyes (52.15 ± 4.84 and 55.13 ± 1.81, respectively). The vascular density at the macula remained stable at 3- and 6-months period.

Conclusion:

The study shows that the microvasculature in case of NAION is significantly reduced both in peripapillary area and in macular area.
Prevalence of hypertensive phase and outcomes in patients with Ahmed valve implantation at one year of follow-up and evaluation of associated risk factors
Authors: Neaves-Mendez Jorge , Hernandez-Oteyza Alejandra , Alvarez-Ascencio Daniela , Campos-Martinez Giselle , Jimenez-Roman Jesus
Published: May 2023

Purpose:

To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure.

Methods:

A cross-sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow-up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors.

Results:

A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found.

Conclusion:

A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group.
Solar retinopathy in India: Clinical presentation and demographic distribution in 253 patients (349 eyes)
Authors: Das Anthony Vipin , Tyagi Mudit , Kadam Yogita , Belenje Akash
Published: May 2023

Purpose:

To describe the demographics, clinical characteristics, and presentation of solar retinopathy in patients who presented to a multi-tier ophthalmology hospital network in India.

Methods:

This cross-sectional, hospital-based study included 3,082,727 new patients presenting to the hospital between August 2010 and December 2021. Patients with a clinical diagnosis of solar retinopathy in at least one eye were included in the study. All the data was collected using an electronic medical record system.

Results:

Three hundred and forty-nine eyes of 253 (0.01%) patients were diagnosed with solar retinopathy and included in the study, and 157 patients (62.06%) had a unilateral affliction. Solar retinopathy was noted to be significantly more common in males (73.12%) and adults (98.81%). The most common age group at presentation was during the sixth decade of life with 56 (22.13%) patients. They were more commonly from the rural geography (41.9%). Among the 349 eyes, 275 (78.8%) eyes had mild or no visual impairment (<20/70), which was followed by moderate visual impairment (>20/70–20/200) found in 45 (12.89%) eyes. The most commonly associated ocular comorbidity was cataract in 48 (13.75%) eyes, followed by epiretinal membrane in 38 (10.89%) eyes. The most common retinal damage seen was interdigitation zone (IZ) disruption (38.68%), followed by inner segment–outer segment (IS–OS) disruption (33.52%). Foveal atrophy was seen in 105 (30.09%) eyes.

Conclusion:

Solar retinopathy is predominantly unilateral and is more common in males. It usually presents during the sixth decade of life and rarely causes significant visual impairment. The most common retinal damage seen was disruption of the outer retinal layers.
Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia: Transepithelial flap-on 30 minute and flap-lift 4 minute protocol
Authors: Zheng Yaru , Yu Marco , Zhang Jia , Wang Yu Meng , Ding Ping , Jhanji Vishal , Chen Shihao
Published: May 2023

Purpose:

To evaluate the outcomes of transepithelial corneal collagen crosslinking (CXL) for management of corneal ectasia after laser-assisted in situ keratomileusis (LASIK).

Methods:

CXL was performed on 18 eyes of 16 patients either with LASIK flap lift (n = 9; 365 nm, 30 mW/cm2, 4 minutes, pulse) or with transepithelial flap-on (n = 9 eyes; 365 nm, 3 mW/cm2, 30 minutes) technique. Postoperative change in maximum keratometry (Kmax), anterior elevation, posterior elevation, spherical equivalent (SE), logMAR uncorrected distance visual acuity (UDVA), aberrations, and central corneal thickness (CCT) were evaluated at 12 months postoperatively.

Results:

A total of 18 eyes of 16 patients (11 males, 5 females) were included. Overall, Kmax flattened more after flap-on CXL (P = 0.014) compared to flap-lift CXL. The endothelial cell density and posterior elevation were stable throughout the follow-up period. Index of vertical asymmetry (IVA), keratoconus index (KI), and central keratoconus index (CKI) decreased after flap-on CXL at 12 months, postoperatively (P < 0.05), whereas there were no statistically significant changes in these parameters after flap-off CXL group. The spherical aberrations and total root mean square decreased after flap-lift CXL at 12 months, postoperatively (P < 0.05).

Conclusion:

In our study, transepithelial collagen crosslinking was successfully used to halt disease progression in post-LASIK keratectasia. We recommend flap-on surgical technique for these cases.
Artificial intelligence–based stratification of demographic, ocular surface high-risk factors in progression of keratoconus
Authors: Kundu Gairik , Shetty Naren , Shetty Rohit , Khamar Pooja , D’Souza Sharon , Meda Tulasi R , Nuijts Rudy M M A , Narasimhan Raghav , Roy Abhijit Sinha
Published: May 2023

Purpose:

The purpose of this study was to identify and analyze the clinical and ocular surface risk factors influencing the progression of keratoconus (KC) using an artificial intelligence (AI) model.

Methods:

This was a prospective analysis in which 450 KC patients were included. We used the random forest (RF) classifier model from our previous study (which evaluated longitudinal changes in tomographic parameters to predict “progression” and “no progression”) to classify these patients. Clinical and ocular surface risk factors were determined through a questionnaire, which included presence of eye rubbing, duration of indoor activity, usage of lubricants and immunomodulator topical medications, duration of computer use, hormonal disturbances, use of hand sanitizers, immunoglobulin E (IgE), and vitamins D and B12 from blood investigations. An AI model was then built to assess whether these risk factors were linked to the future progression versus no progression of KC. The area under the curve (AUC) and other metrics were evaluated.

Results:

The tomographic AI model classified 322 eyes as progression and 128 eyes as no progression. Also, 76% of the cases that were classified as progression (from tomographic changes) were correctly predicted as progression and 67% of cases that were classified as no progression were predicted as no progression based on clinical risk factors at the first visit. IgE had the highest information gain, followed by presence of systemic allergies, vitamin D, and eye rubbing. The clinical risk factors AI model achieved an AUC of 0.812.

Conclusion:

This study demonstrated the importance of using AI for risk stratification and profiling of patients based on clinical risk factors, which could impact the progression in KC eyes and help manage them better.
Dacryocystectomy: A fibrin glue-assisted subfascial excision
Authors: Tong Jessica Y , Selva Dinesh
Published: May 2023

This article describes a technique of dacryocystectomy involving dissection within the subfascial plane, in which the lacrimal sac fascia is preserved and the orbital fat remains undisturbed. The lacrimal sac cavity was directly injected with Tisseel fibrin glue mixed with trypan blue. This led to sac distension and facilitated its separation from surrounding periosteal and fascial attachments. Staining the lacrimal sac epithelium improved definition of the mucosal lining. Transverse sections of the lacrimal sac specimen were histologically analyzed, which confirmed that dissection was completed within a subfascial plane. The technique herein described facilitates en bloc excision of the lacrimal sac without breaching the fascial plane that separates the sac from orbital fat.
Prostaglandin analogs in ophthalmology
Authors: Subbulakshmi S , Kavitha Srinivasan , Venkatesh Rengaraj
Published: May 2023

Glaucoma is a major cause of irreversible blindness worldwide. Reducing intraocular pressure (IOP) is currently the only approach to prevent further optic nerve head damage. Pharmacotherapy is the mainstay of treatment for glaucoma patients. In recent years, a significant milestone in glaucoma treatment has been a transition to prostaglandin analogs (PGAs) as the first line of drugs. The rapid shift from traditional β-blockers to PGAs is primarily due to their excellent efficacy, convenient once-a-day usage, better diurnal control of IOP, and systemic safety profiles. This review article aims to provide information regarding the various PGAs in practice and also the newer promising drugs.
Assessment of parental awareness about pediatric visual problems by Knowledge-Attitude-Practice survey in South India
Authors: Pawar Neelam , Ravindran Meenakshi , Fathima Allapitchai , Ramakrishnan K , Chakrabarthy Sabyasachi , Aparna K , Uduman Mohammed Sithiq
Published: May 2023

Purpose:

To find out parents’ knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP.

Methods:

A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications.

Results:

The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6–10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05).

Conclusion:

Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.