bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up
Authors: Monteiro Tiago , Correia Fernando Faria , Franqueira Nuno , Mendes José Carlos , Pinto Christophe , Vaz Fernando 
Published: September 2020

Purpose:
To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up.

Setting:
Ophthalmology Department, Hospital Braga, Portugal.

Design:
Retrospective cohort study.

Methods:
Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed.

Results:
A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from −9.50 ± 2.93 diopters (D) to −0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD.

Conclusions:
The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.
Neural effects of placebo analgesia in fibromyalgia patients and healthy individuals
Authors: Frangos Eleni , Čeko Marta , Wang Binquan , Richards Emily A. , Gracely John L. , Colloca Luana , Schweinhardt Petra , Bushnell M. Catherine 
Published: September 2020

Abstract
Placebo analgesia is hypothesized to involve top-down engagement of prefrontal regions that access endogenous pain inhibiting opioid pathways. Fibromyalgia (FM) patients have neuroanatomical and neurochemical alterations in pathways relevant to placebo analgesia. Thus, it remains unclear whether placebo analgesic mechanisms would differ in FM patients compared to healthy controls (HCs). Here, using placebo-analgesia-inducing paradigms that included verbal suggestions and conditioning manipulations, we examined whether behavioral and neural placebo analgesic responses differed between 32 FM patients and 46 age- and sex-matched HCs. Participants underwent a manipulation scan, where noxious high and low heat were paired with the control and placebo cream, respectively, and a placebo experimental scan with equal noxious heat temperatures. Before the experimental scan, each participant received saline or naloxone, an opioid receptor antagonist. Across all participants, the placebo condition decreased pain intensity and unpleasantness ratings, decreased activity within the right insula and bilateral secondary somatosensory cortex, and modulated the neurologic pain signature. There were no differences between HCs and FM patients in pain intensity ratings or neural responses during the placebo condition. Despite the perceptual and neural effects of the placebo manipulation, prefrontal circuitry was not activated during the expectation period and the placebo analgesia was unaltered by naloxone, suggesting placebo effects were driven more by conditioning than expectation. Together, these findings suggest that placebo analgesia can occur in both HCs and chronic pain FM patients, without the involvement of opioidergic prefrontal modulatory networks.
Not as “blurred” as expected? Acuity and spatial summation in the pain system
Authors: Adamczyk Wacław M. , Szikszay Tibor M. , Kung Tiffany , Carvalho Gabriela F. , Luedtke Kerstin 
Published: September 2020

Abstract
Spatial acuity measured by 2-point discrimination (2PD) threshold and spatial summation of pain (SSp) are useful paradigms to probe the pain system in humans. Whether the results of these paradigms are influenced by different stimulus modalities and intensities is unclear. The aim of this study was to test 2PD controlling the stimulus modality and the intensity and to investigate the effect of modality on SSp. Thirty-seven healthy volunteers were tested for 2PDs with 2 stimulus modalities (electrocutaneous and mechanical) and intensity (noxious and innocuous). For each condition, participants received stimuli to either 1 or 2 points on their lower back with different distances (2-14 cm, steps of 2 cm). It was found that 2PDs were significantly smaller for noxious stimuli for both modalities. By contrast, between-modality comparison reproduced previous reports of impaired acuity for noxious stimulation. Higher pain intensities were reported when a larger area was stimulated (SSp), independent of the modality. Furthermore, reported pain intensities were higher when the distance between 2 stimulated areas was increased from 2 to 6 cm (P < 0.001), 8 cm (P < 0.01), and 14 cm (P < 0.01). 2PDs determined by mechanical and electrocutaneous stimuli were significantly correlated within both stimulus intensities, ie, innocuous (r = 0.34, P < 0.05) and noxious (r = 0.35, P < 0.05). The current results show 3 novel findings: (1) the precision of the pain system might be higher than in the innocuous (tactile) system when mechanical and electrocutaneous modalities are used, (2) the pattern of distance-based and area-based SSp seems to be comparable irrespective of the modality applied (mechanical and electrocutaneous), and (3) both modalities are moderately correlated.