bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Smoking Environment and Associations With Cardiac Rehabilitation Attendance
Authors: Bolívar Hypatia A. , Elliott Rebecca J. , Middleton William , Yoon Jin H. , Okoli Chizimuzo T. C. , Haliwa Ilana , Miller Charles C. , Ades Philip A. , Gaalema Diann E.
Published: September 2020

Purpose:

Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients.

Methods:

Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking (“None-Few” vs “Some-Most”). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up.

Results:

Compared with the “None-Few” group, participants in the “Some-Most” group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the “Some-Most” group tended to be less likely to quit smoking, but this difference was not statistically significant.

Conclusion:

Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.
Oxygen Indications and Utilization in a Diverse, Urban Community Setting
Authors: Karki Apurwa , Morante Joaquin , Cervellione Kelly L. , Ullah Tofura , Patel Viral , Fein Alan M.
Published: September 2020

Purpose:

Long-term oxygen therapy (LTOT) is widely used to treat chronic obstructive pulmonary disease (COPD) and other conditions with severe hypoxemia, imposing a large financial burden on the American health care system.

Methods:

To better understand oxygen prescription and its use in a multiethnic community hospital, we completed a prospective, observational study with a survey design in our multicultural population to better recognize patient understanding of oxygen indications and utilization.

Results:

The survey was conducted at three outpatient pulmonary clinics. Among the 94 respondents (42% men and 58% women; age 71.8 ± 13 yr), 64% were current or former smokers. Sixty-one percent had primary diagnoses other than COPD, most commonly interstitial lung disease and congestive heart failure. One-third used oxygen for <12 hr daily. Oxygen use was variable among those to whom it was prescribed. Thirty-two percent of patients described themselves as noncompliant with their prescribed therapy due to poor equipment ergonomics, burdensome machine weight, and negative self-image and social stigma when using oxygen.

Conclusions:

Chronic obstructive pulmonary disease represented <50% of LTOT patients who were surveyed. Our data suggest that more structured prescribing practices and patient education should be studied if compliance is to be increased.
Hypertension awareness, treatment and control among ethnic minority populations in Europe: a systematic review and meta-analysis
Authors: van der Linden Eva L. , Couwenhoven Brandon N. , Beune Erik J.A.J. , Daams Joost G. , van den Born Bert-Jan H. , Agyemang Charles
Published: September 2020

Objective:

Ethnic minority populations (EMPs) are disproportionally affected by hypertension-mediated complications compared with European host populations (EHPs), which might be due to disparities in hypertension awareness, treatment and control. We conducted a systematic review and meta-analysis to compare awareness, treatment and control rates among EMPs with EHPs.

Methods:

MEDLINE, EMBASE and Web of Science were searched from inception to 29 January 2020. Critical appraisal was performed according to methods of Hoy et al. Pooled odds ratios with corresponding 95% confidence intervals were calculated for these rates, stratified by ethnic group, using either random or fixed effect meta-analysis based on I
2-statistics. Study was registered in PROSPRO (CRD42020107897).

Results:

A total of 3532 records were screened of which 16 were included in the analysis with data on 26 800 EMP and 57 000 EHP individuals. Compared with EHPs, African origin populations were more likely to be aware (odds ratio 1.26, 95% confidence interval 1.02–1.56) and treated (1.49, 1.18–1.88) for hypertension, but were less likely to have their blood pressure controlled (0.56, 0.40–0.78), whereas South Asian populations were more likely to be aware (1.15, 1.02–1.30), but had similar treatment and control rates. In Moroccan populations, hypertension awareness (0.79, 0.62–1.00) and treatment levels (0.77, 0.60–0.97) were lower compared with EHPs, while in Turkish populations awareness was lower (0.81, 0.65–1.00).

Conclusion:

Levels of hypertension awareness, treatment and control differ between EMPs and EHPs. Effort should be made to improve these suboptimal rates in EMPs, aiming to reduce ethnic inequalities in hypertension-mediated complications.
SHORT-TERM MODIFICATIONS OF ELLIPSOID ZONE IN BEST VITELLIFORM MACULAR DYSTROPHY
Authors: Romano Francesco , Arrigo Alessandro , Leone Pier Pasquale , Bandello Francesco , Battaglia Parodi Maurizio
Published: September 2020

Purpose:

To assess ellipsoid zone (EZ) alterations in Best vitelliform macular dystrophy using spectral-domain optical coherence tomography.

Methods:

Prospective, observational case series. Forty-three patients (43 eyes) underwent complete ophthalmological examination at baseline and at 24 months: best-corrected visual acuity (BCVA), biomicroscopy, fundus photography, and spectral-domain optical coherence tomography were performed. Acquisition protocol included 19-line raster scan. Alterations in EZ were marked on spectral-domain optical coherence tomography, and the area was manually calculated on a near-infrared reflectance image. Three patterns were identified: A (decrease >0.25 mm2), B (±0.25 mm2), and C (increase >0.25 mm2). Primary outcome was to describe different patterns of EZ alteration. Secondary outcomes included their correlation with BCVA and the description of a central optically preserved islet.

Results:

At baseline, altered EZ was identified in 40 eyes. Worse BCVA significantly correlated with larger EZ alterations but not with lesion extension on fundus photograph. Only “pattern-C” eyes unveiled BCVA worsening at follow-up. Optically preserved islet was detected in 16 eyes (37%), disclosing significantly better vision; its disappearance at follow-up (n = 7; 44% of 16 eyes) correlated with a decrease in BCVA.

Conclusion:

The assessment of EZ status might represent a valuable functional marker in Best vitelliform macular dystrophy because stable alterations and the maintenance of a central optically preserved islet are associated with better visual acuity.
Short-term Interim Results of Clinical Outcomes and Complications After Implantation of Boston Keratoprosthesis in Japanese Patients
Authors: Ono Takashi , Mori Yosai , Nejima Ryohei , Iwasaki Takuya , Fukuda Masahiko , Minami Keiichiro , Miyata Kazunori
Published: September 2020

Keratoprosthesis is used for corneal transplantation in high-risk patients who require penetrating keratoplasty (PKP). Boston keratoprosthesis (BKpro) is a representative type of keratoprosthesis used worldwide. In Japan, the first BKpro was implanted in an eye after multiple corneal graft failures in 2008, but its use remains limited. A recent patient survey revealed that among the Japanese patients who had previously undergone multiple PKPs, the retention rate of BKpro was significantly higher than that of PKP at 5 years postoperatively (100% vs. 26%; P < 0.01). Patients with implanted BKpro also had better best corrected visual acuity of 20/200 or higher than those with PKP at 5 years postoperatively (80.0% vs. 17.6%; P = 0.03). Regarding the postoperative complications, retroprosthetic membrane formation was observed in 88.9%, infectious keratitis in 33.3%, and glaucoma progression in 11.1% of cases. Another retrospective analysis showed that fungal keratitis occurred in 0.09 patients per year and severely affected visual acuity. Furthermore, because it is difficult to accurately examine intraocular pressure after BKpro implantation, the intraocular pressure of patients with implanted BKpro was prospectively estimated using a transpalpebral tonometer (Diaton). In conclusion, BKpro implantation is effective and safe for Japanese patients, given the reported improvements in visual acuity and low rates of complications.
Severe Corneal Hydrops With Suspected Posterior Stromal Rupture Managed With Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty
Authors: Blitzer Andrea L. , Liles Caleb A. , Harocopos George J. , Reidy James J. , Farooq Asim V.
Published: September 2020

Purpose:

To describe severe acute corneal hydrops in a patient with previously undiagnosed keratoconus, in which anterior segment optical coherence tomography (AS-OCT) revealed a protruding ridge of tissue on either side of Descemet membrane (DM) break, treated successfully with ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK).

Methods:

A case report.

Results:

A 32-year-old man presented with severe corneal hydrops in OS. He was treated conservatively with hypertonic saline. Serial AS-OCT revealed persistent edema and haze overlying a break in DM, with a ridge of protruding tissue on either side. Based on these findings, UT-DSAEK was performed. Intraoperatively, the ridge of tissue remained firmly adhered after DM removal and was felt to possibly represent posterior stroma. The patient's uncorrected visual acuity improved to 20/80. Literature review revealed 1 case with similar AS-OCT findings who underwent penetrating keratoplasty; histopathology was reported to show Descemet scrolls on either side of the break, but our analysis of this and other reports suggest that an additional layer of tissue is contained within the scroll along with DM.

Conclusions:

This case demonstrates severe corneal hydrops in the setting of keratoconus, in which AS-OCT revealed a ridge of protruding tissue on either side of a break in DM. UT-DSAEK led to resolution of corneal edema and improvement in stromal haze and visual acuity. Further research is required to determine the precise role of endothelial keratoplasty and potential role of posterior stromal rupture in some cases of acute corneal hydrops.
Treatment of Progressive Scleromalacia Perforans by Tectonic Enhancement With Lyophilized Equine Pericardium
Authors: Droutsas Konstantinos , Giachos Ioannis , Katsiampoula Vasiliki , Kourti Persefoni , Kymionis Georgios , Petrou Petros
Published: September 2020

Purpose:

To describe the off-label use of lyophilized equine pericardium for tectonic enhancement of the sclera in a case of progressive scleromalacia perforans.

Methods:

An 82-year-old woman with a history of varicella zoster virus sclerokeratitis presented with a progressively expanding scleral thinning at the superonasal quadrant of the anterior sclera of her left eye. The eye was blind because of intractable glaucoma. To avoid perforation of the exposed choroid, a single layer of lyophilized equine pericardium was sutured over the scleral perforation. After performing a conjunctival peritomy in the involved superonasal area, the pericardium was trimmed, fixated on the anterior sclera with 4 Nylon 9 to 0 interrupted sutures, and tucked underneath the conjunctival pocket. The conjunctiva was adapted with 6 Vicryl 8 to 0 interrupted sutures.

Results:

The postoperative course was uneventful. At 12 months after surgery, slit-lamp biomicroscopy showed a stable subconjunctival sheet covering the staphyloma, whereas anterior segment optical coherence tomography demonstrated thickening of the ocular wall, suggesting successful integration of the pericardium.

Conclusions:

Suturing of equine pericardium over a scleral defect was feasible allowing successful reinforcement of the staphyloma in a case of severe scleromalacia perforans.
Glueless Simple Limbal Epithelial Transplantation: The Report of the First 2 Cases
Authors: Malyugin Boris E. , Gerasimov Maxim Y. , Borzenok Sergey A.
Published: September 2020

Purpose:

To assess the anatomic and visual results of the modified glueless simple limbal epithelial transplantation (G-SLET) in the treatment of unilateral limbal stem cell deficiency (LSCD).

Methods:

This is a retrospective analysis of 2 patients who received G-SLET for corneal reepithelization after unilateral eye burn. After the recipient bed preparation on the eye with LSCD, radial symmetrical superficial incisions were applied to the corneal periphery. Next, short (1 mm) slightly oblique or horizontal tunnels were formed in every incision. The precut limbal pieces from the healthy eye were inserted into the tunnels with a scleral portion forward. At the end of surgery, the amniotic membrane was sutured to the sclera outside the corneal limbus with a single running suture.

Results:

Slit lamp examination in the early postoperative period revealed that transplanted limbal pieces remained in place and were visible through the semitransparent amniotic membrane. The donor's eye had a small scar and light subconjunctival hemorrhage. Early and late postoperative periods were uneventful. Twelve months after surgery, the LSCD-affected cornea was entirely covered with tight and semitransparent epithelium. The donor's eye exhibited a small scar on the site of the biopsy. Visual improvement was achieved in case 2, but the vision did not improve due to the presence of a mature cataract in case 1.

Conclusions:

Modified G-SLET technique could be an option for LSCD treatment in patients with unilateral eye disease in cases when fibrin glue is not available for the surgeon.
The Descemet Membrane in Primary Congenital Glaucoma
Authors: Gupta Shikha , Chaurasia Abadh K. , Sen Seema , Bhardwaj Mansi , Mandal Sohini , Titiyal Jeewan S. , Gupta Viney
Published: September 2020

Purpose:

To evaluate Descemet membrane (DM) morphology in eyes with primary congenital glaucoma (PCG) in vivo using high-definition anterior segment optical coherence tomography (ASOCT) and on histopathology.

Methods:

Corneal scans of patients with PCG (22 eyes of 15 patients) were evaluated for DM morphology and anterior chamber angle using ASOCT. The DM thickness in PCG eyes was compared with fellow eyes (8 eyes) of unilateral patients with PCG and healthy controls (12 eyes) on ASOCT. The DM morphology was also compared on the histopathology of corneal tissues (9) obtained from PCG eyes after keratoplasty and enucleated eyes of retinoblastoma (6 controls) on light microscopy with immunostaining for collagen IV.

Results:

On ASOCT, all affected eyes showed the presence of either a thickened DM complex or a hyper-reflective double layer representing the thickened DM and pre-Descemet layer (PDL), unlike a single membrane in the controls and fellow eyes. On ASOCT, among patients with PCG, the DM showed significant thickening (32.0 ± 11.2 μm) versus fellow eyes (14.4 ± 3.3 μm) and controls (11.5 ± 1 μm) (P < 0.001; analysis of variance). The thickened DM complex continued peripherally into the trabecular meshwork as an abnormal membrane in 16/22 affected eyes. On histopathology, thickening of DM was also more among PCG eyes (median: 67.9 μm range: 27.2–214.9) versus controls (median: 27.7 μm, range: 22.1–36.1; P = 0.005) as also of PDL (median: 14 μm, range: 5.9–30.5) of PCG versus (median 3.5, range: 1.3–6.7 μm) in controls; P = 0.014.

Conclusions:

Thickening of DM and PDL occurs in eyes with PCG and is seen to have a peripheral extension upto the angle recess.
Ocular Phaeohyphomycosis Caused by Veronaea botryose: A Novel Fungal Infection in Human Beings
Authors: Davoudi Samaneh , Shah Nishi , Khurshid Gibran , Shah Ankit
Published: September 2020

Purpose:

To describe an aggressive, refractory case of Veronaea botryosa-associated mycokeratitis progressing to endophthalmitis.

Methods:

Observational case report and review of relevant literature.

Results:

An 80-year-old man with a history of lung cancer and diabetes mellitus type 2 presented as an emergent referral to the corneal service with a corneal ulcer and associated endothelial plaque that responded initially to topical steroid and antiviral therapy but subsequently progressed to fungal endophthalmitis. The patient underwent an emergent penetrating keratoplasty and pars plana vitrectomy. Despite multiple negative Grocott methenamine silver smears, gram stains, eye cultures (aerobic, anaerobic, and fungal), and inconclusive confocal microscopy, the host corneal tissue pathology revealed melanin-containing fungi (phaeohyphomycosis). Further speciation of the pathology specimen revealed mold and phenotypic characterization and DNA sequencing confirmed V. botryose.

Conclusions:

Veronaea botryose is a rare fungal infection with previously reported human cutaneous, subcutaneous, and submucosal infections. This is the first documented case of phaeohyphomycosis caused by V. botryosa infection in human ocular tissue.
Ocular rosacea
Authors: Redd Travis K. , Seitzman Gerami D.
Published: September 2020

Purpose of review

To revisit ocular rosacea as an underappreciated condition which can cause permanent blindness if inadequately treated, and to review data supporting improved diagnostic and treatment strategies.

Recent findings

Ocular rosacea has an underrecognized prevalence in children and individuals with darker skin tone. Rosacea has several associations with other significant systemic diseases. Variations in local and systemic microbiome, including demodex infestation, may play a role in pathogenesis, severity, and in explaining the different phenotypes of rosacea. The National Rosacea Society Expert Committee established an updated classification system of rosacea in 2017. New treatment algorithms based on these clinical subtypes are suggested.

With continued advancements in the understanding of the epidemiology and pathogenesis of rosacea, randomized controlled trials specific for ocular rosacea remain lacking. There is overall consensus that rosacea and ocular rosacea require chronic maintenance treatment strategies involving combination topical and systemic therapies.
Mupirocin and Chlorhexidine Genotypic Resistance Found in Staphylococcus aureus Isolated From Young Infants Below 90 Days Old: A Genetic Basis for Eradication Failure
Authors: Kang Hyun Mi , Park Ki Cheol , Park Joonhong , Park Sun Hee , Lee Dong-Gun , Kim Jong-Hyun
Published: September 2020

Objectives:

To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old.

Methods:

S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin.

Results:

During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072).

Conclusions:

Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.
Epidemiology of Coronavirus Infection in Children and Their Impact on Lung Health: Finding From a Birth Cohort Study
Authors: Kumar Prawin , Mukherjee Aparna , Randev Shivani , Medigeshi Guruprasad R. , Jat Kana Ram , Kapil Arti , Lodha Rakesh , Kabra Sushil K.
Published: September 2020

In this birth cohort, coronavirus acute respiratory infection was detected in 6.5% of the episodes; the commonest strain was OC43, followed by NL63, HKU1, and 229E. Children with coronavirus acute respiratory infection during infancy had significantly decreased forced expiratory volume in 0.5 seconds, forced expiratory flow between 25% and 75% of forced vital capacity, and peak expiratory flow at 3 years of age.
A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection
Authors: Kaushik Ashlesha , Gupta Sandeep , Sood Mangla , Sharma Seema , Verma Shikha
Published: September 2020

Background:

Recently, severe manifestations associated with coronavirus disease 2019 (COVID-19) called multisystem inflammatory syndrome in children (MIS-C) have been recognized. Analysis of studies for this novel syndrome is needed for a better understanding of effective management among affected children.

Methods:

An extensive search strategy was conducted by combining the terms multisystem inflammatory syndrome in children and coronavirus infection or using the term multisystem inflammatory syndrome in children in bibliographic electronic databases (PubMed, EMBASE, and CINAHL) and in preprint servers (BioRxiv.org and MedRxiv.org) following the Preferred Reporting Items for Systematic Reviews and Metaanalyses guidelines to retrieve all articles published from January 1, 2020, to July 31, 2020. Observational cross-sectional, cohort, case series, and case reports were included.

Results:

A total of 328 articles were identified. Sixteen studies with 655 participants (3 months–20 years of age) were included in the final analysis. Most of the children in reported studies presented with fever, gastrointestinal symptoms, and Kawasaki Disease-like symptoms. Sixty-eight percent of the patients required critical care; 40% needed inotropes; 34% received anticoagulation; and 15% required mechanical ventilation. More than two-thirds of the patients received intravenous immunoglobulin and 49% received corticosteroids. Remdesivir and convalescent plasma were the least commonly utilized therapies. Left ventricular dysfunction was reported in 32% of patients. Among patients presenting with KD-like symptoms, 23% developed coronary abnormalities and 26% had circulatory shock. The majority recovered; 11 (1.7%) children died.

Conclusions:

This systematic review delineates and summarizes clinical features, management, and outcomes of MIS-C associated with SARS-CoV-2 infection. Although most children required intensive care and immunomodulatory therapies, favorable outcomes were reported in the majority with low-mortality rates.
Plasmapheresis for Rescue in Severe Encephalopathy and Multiorgan Failure from Fulminant Influenza (H3N2) Infection
Authors: Jha Prashant , Gebhard Daniel
Published: September 2020

We are presenting a case of 4-years-old previously healthy male with coma, severe acute hepatitis and multiorgan failure in presence of Influenza infection. Literature review highlighted an immune-mediated pathophysiology for such presentations so the child underwent a trial of plasmapheresis which resulted in a rapid clinical improvement and child was discharge in his baseline neurologic status by day 14.
Treatment of Chronic Hepatitis C in Adolescent Patients With Positive HBsAg or With Occult Hepatitis B: Is the Risk of Hepatitis B Reactivation Significant?
Authors: El-Khayat Hesham , Yakoot Mostafa , El-Shabrawi Mortada , Fouad Yasser , Attia Dina , Kamal Enas M.
Published: September 2020

Background:

Reactivation of hepatitis B virus (HBV) infection in patients treated for chronic hepatitis C (HCV) with direct-acting antiviral agents has emerged recently as an important safety issue; however, it has not been adequately studied in pediatric age groups. We aimed to evaluate this risk in adolescent patients infected with chronic HCV and positive for HBsAg and HBcAbs.

Patients and methods:

One hundred and fifteen adolescent patients from 12 to 17 years of age, infected with chronic HCV and positive for HBcAbs with or without HBsAg were included in this study. All patients were treated with 1 tablet daily of the fixed-dose combination sofosbuvir/ledipasvir for 12 weeks. Patients were closely monitored throughout the study for virus load, liver functions, and other safety and efficacy outcome measures.

Results:

The sustained virologic response 12 (SVR12) rates were 96.7% (95% confidence interval: 88.6–99.1%) in HBsAg positive group and 98.2% (95% confidence interval: 90.4–99.7%) in HBsAg negative with HBcAbs positive group. Throughout the treatment period and the 12 weeks follow-up after treatment, there has been no single case in both HBsAg negative or positive that showed any manifestation of reactivation of hepatitis B, detected levels of HBV-DNA, or deterioration of liver functions.

Conclusion:

No HBV reactivation was observed in adolescents treated for chronic HCV with direct-acting antiviral agents in our study, in both HBsAg positive or occult hepatitis B. Although results are reassuring, we still recommend close monitoring of liver functions to not miss even rare cases of such a potentially serious condition.
Human Herpes Virus 6 Detection in Children With Suspected Central Nervous System Infection
Authors: Cosme Isabella , Ramírez María Alejandra , Peñata Carlos Adrian , Beltrán-Arroyave Claudia , Florez Ivan D.
Published: September 2020

Human herpes virus 6 (HHV-6) infection is considered a self-limited disease in immunocompetent children. However, HHV-6 could be associated with various neurologic diseases. We describe 8 children with suspected central nervous system infection and detection of HHV-6 in cerebrospinal fluid. The clinical significance of HHV-6 detection is controversial because it may be caused by primary infection, reactivation or latency.
Low Pretreatment Viral Loads in Infants With HIV in an Era of High-maternal Antiretroviral Therapy Coverage
Authors: Patel Faeezah , Shiau Stephanie , Strehlau Renate , Shen Yanhan , Burke Megan , Paximadis Maria , Shalekoff Sharon , Schramm Diana , Technau Karl-Günter , Sherman Gayle G. , Coovadia Ashraf , Tiemessen Caroline T. , Abrams Elaine J. , Kuhn Louise
Published: September 2020

Background:

With expansion of antiretroviral therapy (ART) programs, transmission rates are low but new infant infections still occur. We investigated predictors of pre-ART viral load (VL) and CD4+ T-cell counts and percentages in infants diagnosed with HIV at birth in a setting with high coverage of maternal ART and infant prophylaxis.

Methods:

As part of an early treatment study, 97 infants with confirmed HIV-infection were identified at a hospital in Johannesburg, South Africa. Infant VL and CD4+ T-cell parameters were measured before ART initiation. Data were collected on maternal characteristics, including VL, CD4+ T-cell counts and ART, and infant characteristics, including sex, birth weight, and mode of delivery.

Results:

Pre-ART, median infant VL was 28,405 copies/mL [interquartile range (IQR): 2515–218,150], CD4+ T-cell count 1914 cells/mm3 (IQR: 1474–2639) and percentage 40.8% (IQR: 32.2–51.2). Most (80.4%) infants were born to mothers who received ART during pregnancy and 97.9% of infants received daily nevirapine prophylaxis until ART initiation at median of 2 days of age (IQR: 1−7). Infant pre-ART VL was more likely to be ≥1000 copies/mL when their mothers had VL ≥1000 copies/mL [Odds Ratio (OR): 6.88, 95% confidence interval (CI): 2.32–20.41] and was higher in boys than girls (OR: 3.29, 95% CI: 1.07–9.95). Lower maternal CD4+ T-cell count (<350 cells/mm3) was associated with lower infant CD4+ T-cell count (<1500 cells/mm3) (OR: 3.59, 95% CI: 1.24–10.43).

Conclusions:

Pre-ART VL and CD4+ T-cell parameters of intrauterine-infected infants were associated with VL and CD4+ T-cell counts of their mothers. Maternal ART during pregnancy may begin treatment of intrauterine infection and may mask the severity of disease in infected infants identified in the current era with high-maternal ART coverage.
Predictors of Virologic Failure Among a Cohort of HIV-infected Children in Southern Ethiopia
Authors: Tadesse Birkneh Tilahun , Foster Byron Alexander , Latour Emile , Lim Jeong Youn , Jerene Degu , Ruff Andrea , Aklillu Eleni
Published: September 2020

Background:

Optimal care for children with HIV infection includes timely assessment of treatment failure. Using HIV viral load to define treatment failure remains a challenge in resource-limited settings.

Methods:

Children with HIV infection who were already on or starting first-line antiretroviral therapy were enrolled and followed over time. We examined clinical and immunologic predictors of virologic failure (VF), defined as consecutive viral load measurements > 1000 copies/mL (VF). Children were followed every 6 months with clinical assessments, immunologic assays and viral load testing until treatment failure or up to 18 months.

Results:

Of the 484 children with complete data, we observed a prevalence of 15% who had VF at enrollment, and 18 who developed VF over 10.5 person-years of follow-up for an incidence of 4.97 [95% CI: 3.04–7.70) per 100 person-years. Lower adherence, lower CD4 T-cell count, lower white blood cells count, lower platelets and a lower glomerular filtration rate were all associated with increased VF. However, in a multivariable analysis, renal function (estimated glomerular filtration rate < 90 mL/min), odds ratio: 11.5 (95% CI: 1.5–63.7), and lower adherence, odds ratio: 3.9 (95% CI: 1.1–13.4), were the only factors associated with development of VF.

Conclusions:

We identified a significant risk of VF in children with HIV infection in a prospective cohort study in southern Ethiopia and limited predictive value of clinical variables for VF. This provides further evidence that rapid and reliable viral load testing is needed to adequately address the HIV epidemic, along with implementation of adherence interventions in sub-Saharan Africa.
Impact of reduced elective ophthalmic surgical volume on U.S. hospitals during the early coronavirus disease 2019 pandemic
Authors: Fliotsos Michael J. , Best Matthew J. , Field Matthew G. , Srikumaran Uma , Repka Michael X. , Woreta Fasika A. , Srikumaran Divya
Published: September 2020

Purpose:

To estimate the financial impact of coronavirus disease 2019 (COVID-19)–related shutdowns on ophthalmic surgery performed at hospital outpatient departments (HOPDs) in the United States.

Setting:

Nationally representative sample of U.S. hospital payment and cost data.

Design:

Retrospective review and economic impact analysis.

Methods:

The Nationwide Ambulatory Surgery Sample (NASS) was used to identify ophthalmic surgical procedures and associated charges, which were performed at HOPDs. The highest volume elective ophthalmic procedures were identified. The total hospital cost and payment amount was calculated for each procedure using the Hospital Outpatient Prospective Payment System (OPPS) maintained by the Centers for Medicare & Medicaid Services. Net facility income (estimated payments less OPPS rates) was determined for each elective surgical procedure category and stratified by hospital teaching status.

Results:

In 2017, elective cataract, strabismus, and keratoplasty surgeries were performed 1 230 992 times at HOPDs. The total cost of these elective surgeries was 2350 million U.S. dollars (USD), with a total hospital payment of 3624 to 3786 million USD. This led to an estimated net income of 1278 to 1440 million USD overall to U.S. hospitals in the NASS dataset from elective ophthalmic surgery (approximately 107 to 120 million USD per month), with a larger proportion performed in teaching hospitals.

Conclusions:

The cessation of elective ophthalmic surgeries at HOPDs during COVID-19 resulted in a significant loss of income for hospitals in the United States and teaching experiences for trainees at academic medical centers.
Management of common iatrogenic iris defects induced by cataract surgery
Authors: Foster Gary J.L. , Ayres Brandon , Fram Nicole , Khandewal Sumitra , Ogawa Gregory S.H. , MacDonald Susan M. , Miller Kevin M. , Snyder Michael E. , Vasavada Abhay R.
Published: September 2020

The proximity of the iris to the instruments and currents of cataract surgery makes iatrogenic damage to the iris a common complication of cataract surgery. This article discusses techniques to prevent or minimize this damage. When damage does occur, the surgeon must decide if, when, and how to repair the damage. Principles governing these decisions and techniques for repair are discussed. Figures and videos, included as online Supplemental Data files, illustrate cases of iatrogenic damage and repair techniques.
Outcomes of secondary intraocular lens implantation in the Infant Aphakia Treatment Study
Authors: VanderVeen Deborah K. , Drews-Botsch Carolyn D. , Nizam Azhar , Bothun Erick D. , Wilson Lorri B. , Wilson M. Edward , Lambert Scott R. ,   for the Infant Aphakia Treatment Study
Published: September 2020

Purpose:

To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS).

Setting:

Multicenter clinical practice.

Design:

Secondary analysis of patients enrolled in a randomized clinical trial.

Methods:

Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. Visual outcomes, refractive outcomes, and adverse events at the age of 10½ years were evaluated. Comparisons were made with eyes that remained aphakic and with eyes randomized to primary IOL placement.

Results:

The study included 114 infants, 57 in the aphakic group and 57 in the primary IOL group; 55 of 57 patients randomized to aphakia with contact lens correction were seen for the 10½-year study visit; 24 (44%) of 55 eyes had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.00 ± 0.70 diopters (D). At age 10½ years, the median logarithm of the minimum angle of resolution visual acuity (VA) was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4½-year and 10½-year study visits was also similar (78% secondary IOL eyes; 84% aphakic eyes). For eyes undergoing IOL implantation after the 4½-year study visit (n = 22), the mean refraction at age 10½ years was −3.20 ± 2.70 D (range −9.90 to 1.10 D), compared with −5.50 ± 6.60 D (n = 53, range −26.50 to 3.00 D) in eyes with primary IOL (P = .03).

Conclusions:

Delayed IOL implantation allows a more predictable refractive outcome at age 10½ years, although the range of refractive error is still large.
Diffuse lamellar keratitis after LASIK with low-energy femtosecond laser
Authors: Leccisotti Antonio , Fields Stefania V.
Published: September 2020

Purpose:

To evaluate the incidence, evolution, and prognosis of diffuse lamellar keratitis (DLK) in a large series of laser in situ keratomileusis (LASIK) with low-energy femtosecond laser.

Setting:

Private practice, Siena, Italy.

Design:

Retrospective, consecutive, noncomparative case series study.

Methods:

Single-use instruments, powder-free gloves, and no corneal marking were used. Flap was created by a low-energy femtosecond laser (Ziemer Z2 and Z4).

Results:

A total of 37 315 eyes of 19 602 patients were reviewed. DLK was observed in 236 eyes (0.63%) of 149 patients (0.76%). Grade 1 DLK was observed in 231 eyes of 142 patients, grade 2 in 1 eye: when treated with topical steroids, they had no visual consequences. Three patients had bilateral grade 3 to 4 DLK: one of them, with bilateral grade 3, despite flap lifting and irrigation worsened to stage 4 (central stroma thinning and flattening), partially recovered in 2 years, and underwent repeat femtosecond laser–assisted LASIK for hyperopic shift in 1 eye. In all the 5 eyes that developed grade 4 DLK, corneal thickness decreased until the first month and then partially recovered; mean final tissue loss at 1 to 2 years was 35 µm. Compensatory epithelial thickening was observed.

Conclusions:

DLK after low-energy femtosecond laser–assisted LASIK is rare; severe DLK (stages 3 and 4) was found in only 6 eyes (0.016%). Flap lifting and irrigation might not prevent progression. Spontaneous reformation of stromal tissue and epithelial thickening improve visual acuity in the long term; residual hyperopic shift can be corrected by repeat femtosecond laser–assisted LASIK.
Safety and efficacy of nepafenac punctal plug delivery system in controlling postoperative ocular pain and inflammation after cataract surgery
Authors: Donnenfeld Eric D. , Holland Edward J. , Solomon Kerry D.
Published: September 2020

Purpose:

To evaluate the safety and efficacy of a nepafenac punctal plug delivery system (N-PPDS) after cataract surgery.

Setting:

Three U.S. clinical sites.

Design:

Prospective, multicenter, randomized (2:1), parallel-arm, double-masked, placebo-controlled, phase II pilot study.

Methods:

Fifty-six subjects (aged older than 22 years) with expected postcataract correctable distance vision of 20/30 or better and lower puncta allowing dilation up to 1.0 mm received either the nepafenac (N-PPDS group; n = 38 eyes) or a placebo punctal plug delivery system (p-PPDS group; n = 18 eyes). All eyes underwent routine unilateral cataract surgery with intraocular lens implantation. The primary and secondary efficacy measures were postoperative ocular pain and inflammation, respectively.

Results:

There were 38 patients in the experimental N-PPDS group and 18 patients in the control group. The N-PPDS group had a significantly higher percentage of pain-free patients than that in the p-PPDS group (22/32 [69%] vs 6/16 [38%] at 3 days, P = .038; and 24/36 [67%] vs 5/16 [31%] at 7 days, P = .018). A higher percentage of patients in the N-PPDS group (15/29 [52%] vs 0/14 [0%] in p-PPDS) was pain free at all visits (P = .001). Anterior chamber cell scores were better in the N-PPDS group (patients with no anterior chamber cells: 18/36 [50%] vs 3/16 [19%] in p-PPDS; P = .034) at 7 days. The plug retention rate was 98% (55/56) at 14 days. Adverse events having a suspected relationship with the punctal plug treatment occurred in 1 case of the N-PPDS group having to do with placement and zero in the p-PPDS group.

Conclusions:

The N-PPDS was safe and effective for the management of ocular pain and inflammation after cataract surgery.
Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs
Authors: Haripriya Aravind , GK Sweekruthi , Mani Iswarya , Chang David F.
Published: September 2020

Purpose:

To evaluate the comparative rotational stability and the repositioning rates and outcomes of a hydrophilic and hydrophobic acrylic monofocal toric intraocular lens (IOLs).

Setting:

Single center, Aravind Eye Hospital in Madurai, India.

Design:

Retrospective cohort study.

Methods:

All patients had either an Auroflex hydrophilic acrylic toric IOL (n = 4603) or AcrySof hydrophobic acrylic toric IOL (n = 926) implanted between January 2015 and April 2019. Surgical repositioning was offered if the toric IOL was 15 degrees or greater misaligned or there was a 2-line or greater improvement in uncorrected distance visual acuity (UDVA) predicted with repositioning.

Results:

A total of 5529 single-piece toric IOLs were implanted during the study period. There was no statistically significant difference between the hydrophilic and hydrophobic acrylic toric IOL groups in need for surgical repositioning (2.5% vs 1.9%; P = .34) or actual surgical repositioning rate (1.8% vs 1.5%; P = .59). A higher rate of surgical toric IOL repositioning was associated with younger age (62.7 vs 67.2 years; P < .0001), higher presurgical astigmatism (2.32 vs 1.99 diopters [D]; P < .0001), and with-the-rule astigmatism (4.7% vs 2.1% against-the-rule astigmatism; P = .002). In 95 eyes that underwent toric IOL repositioning, there was significant preoperative to postoperative improvement in UDVA (0.48 vs 0.12 logarithm of the minimum angle of resolution; P < .001), mean residual cylinder (1.79 vs 0.7 D; P < .001), and mean toric IOL misalignment (49.7 vs 5.4 degrees; P < .001). The repositioning outcomes were statistically similar with both toric IOL models. There were no major complications or recurrent toric IOL rotation after surgical repositioning.

Conclusions:

The hydrophilic acrylic toric IOL had comparable rates of postoperative misalignment and surgical repositioning with the hydrophobic acrylic toric IOL. Early postoperative surgical repositioning was both safe and effective with both toric IOLs.
Glued intraocular lens in eyes with deficient capsules: retrospective analysis of long-term effects
Authors: Kumar Dhivya Ashok , Agarwal Amar , Dhawan Atul , Thambusamy Vijay Anand , Sivangnanam Soundari , Venktesh Triveni , Chandrasekar Radhika
Published: September 2020

Purpose:

To assess the long-term (6-12 years) results and complications of glued transscleral-fixated intraocular lens (IOL).

Setting:

Dr. Agarwal's Eye Center, Chennai, India.

Design:

Retrospective case series.

Methods:

Eyes with glued IOL of more than 5-year follow-up were evaluated. Visual acuity (logarithm of the minimum angle of resolution [logMAR]), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness, central foveal thickness, and ocular residual astigmatism (ORA) were evaluated.

Results:

Overall, 91 eyes (63 patients) with mean postoperative 8.2 ± 2.3 years were analyzed. The duration was 10 to 12 years in 31 eyes (34%), 9 years in 14 eyes (15.3%), and 6 to 9 years in 46 eyes (50.5%). No subscleral haptic was visible in 50% eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The corrected distance visual acuity (CDVA) was 0.50 ± 0.50 logMAR. Clinically, no tilt was seen in 87 eyes (95.6%), whereas detectable tilt was seen in 4 eyes (4.3%). The optical coherence tomography microtilt was 0.8 ± 1.7 and 0.4 ± 1.2 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.10 ± 1.00 diopter. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%), and uveitis–glaucoma–hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%) keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries performed.

Conclusions:

Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long-term.
Comparison of clinical outcomes of implantable collamer lens implantation with and without use of an ophthalmic viscosurgical device
Authors: Kim Bu Ki , Chung Young Taek
Published: September 2020

Purpose:

To compare the clinical efficacy of posterior chamber phakic implantable collamer lens (ICL) implantation with and without the use of an ophthalmic viscosurgical device (OVD).

Setting:

Onnuri Eye Hospital, Jeonju, Jeollabuk-do, South Korea.

Design:

Retrospective case series.

Methods:

Included were patients who underwent ICL implantation with the use of an OVD (OVD group) and patients who underwent ICL implantation without the use of an OVD (hydro group). Refractive error, endothelial cell density (ECD), intraocular pressure (IOP), vault, and adverse events were evaluated at 1 day, 1 week, 1 month, and 3 months postoperatively. The IOP and vault were checked 1 hour postoperatively, and the surgical time was recorded.

Results:

The OVD group comprised 54 eyes of 27 patients and the hydro group 49 eyes of 25 patients. There were no significant preoperative differences between the 2 groups. At 1 hour postoperatively, the IOP was significantly higher in the OVD group (P < .001); however, there was no significant difference in IOP between the 2 groups at other follow-up timepoints. Surgical time was significantly shorter for the hydro group (P = .032). There was no statistically significant difference in vault, ECD, or refractive error between the 2 groups during the 3-month follow-up period. No adverse events were observed.

Conclusions:

ICL implantation without the use of an OVD was safe and effective. The advantages of this technique included a short surgical time, prevention of early postoperative IOP spikes, and cost savings due to OVD elimination.
Comparative study of small-incision lenticule extraction and phakic intraocular lens implantation for the correction of high myopia: 6-year results
Authors: Yildirim Yusuf , Çakmak Semih , Sucu Mehmet Emin , Kepez Yildiz Burcin , Kirgiz Ahmet , Akbas Yusuf Berk , Yasa Dilek , Demirok Ahmet
Published: September 2020

Purpose:

To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia.

Setting:

University of Health Science Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey.

Design:

Retrospective comparative case series.

Methods:

Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from −6.00 to −10.00 diopters (D) were included in the study.

Results:

There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss.

Conclusions:

In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.