bluuebunny/crossref_metadata_2025_split huggingface dataset:
MULTIMODAL IMAGING OF RECURRENT CYSTOID MACULAR EDEMA ASSOCIATED WITH POEMS SYNDROME RESPONSIVE TO INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: Pole Cameron , Hosseini Hamid , Prasad Pradeep 
Published: September 2020

Purpose:
To describe the multimodal imaging findings of cystoid macular edema (CME) in POEMS syndrome and to demonstrate the effectiveness of the dexamethasone intravitreal implant in this condition.

Methods:
A case report of a patient with POEMS syndrome. Multimodal imaging, including optical coherence tomography and ultra-wide field fluorescein angiography, was used to evaluate the CME and its response to treatment.

Results:
A 66-year-old man with a history of POEMS syndrome in clinical remission after chemotherapy presented with blurry vision in the left eye. Vitreomacular traction and CME were noted on optical coherence tomography. After pars plana vitrectomy, the patient had persistent CME in the left eye and developed new CME in the right eye, which worsened over the next year. Visual acuities at this time were 20 of 60 in both eyes. The CME was unresponsive to topical ketorolac and prednisolone acetate and intravitreal bevacizumab but partially response to intravitreal and sub-Tenon's triamcinolone acetate injections. Intravitreal dexamethasone implant was given bilaterally with full resolution and visual acuities improvement to 20 of 40 in the right eye and 20 of 30 in the left eye. However, CME recurred after 3 months. Ultra-wide field fluorescein angiography demonstrated bilateral CME and diffuse peripheral vascular leakage. Serum vascular endothelial growth factor levels were normal.

Conclusion:
Cystoid macular edema may develop in POEMS syndrome in the absence of systemic findings, elevated serum vascular endothelial growth factor, or optic nerve edema. Previously unreported peripheral vascular leakage was demonstrated on ultra-wide field fluorescein angiography. Dexamethasone implant was the most effective of used therapies to treat CME.
Neuro-ophthalmic manifestations of coronavirus disease 19
Authors: Tisdale Alanna K. , Chwalisz Bart K. 
Published: September 2020

Purpose of review
To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19), documented in the literature thus far.

Recent findings
A small but growing literature documents cases of new onset neuro-ophthalmic disease, in the setting of COVID-19 infection. Patients with COVID-19 have experienced acute onset vision loss, optic neuritis, cranial neuropathies, and Miller Fisher syndrome. In addition, COVID-19 increases the risk of cerebrovascular diseases that can impact the visual system.

Summary
The literature on COVID-19 continues to evolve. Although COVID-19 primarily impacts the respiratory system, there are several reports of new onset neuro-ophthalmic conditions in COVID-infected patients. When patients present with new onset neuro-ophthalmic issues, COVID-19 should be kept on the differential. Testing for COVID-19 should be considered, especially when fever or respiratory symptoms are also present. When screening general patients for COVID-19-associated symptoms, frontline physicians can consider including questions about diplopia, eye pain, pain with extraocular movements, decreased vision, gait issues, and other neurologic symptoms. The presence of these symptoms may increase the overall probability of viral infection, especially when fever or respiratory symptoms are present. More research is needed to establish a causal relationship between COVID-19 and neuro-ophthalmic disease, and better understand pathogenesis.
Retinal manifestations of the neurocutaneous disorders
Authors: Engelhard Stephanie B. , Kiss Szilard , Gupta Mrinali P. 
Published: September 2020

Purpose of reviewThe neurocutaneous disorders are a genetically and phenotypically diverse group of congenital syndromes characterized by cutaneous, ocular, and central nervous system manifestations. This review provides an overview of the clinical features and retinal findings in selected neurocutaneous disorders.Recent findingsAdvances in genetics and diagnostic retinal and neuroimaging allow for the recognition of retinal features of common neurocutaneous syndromes and for improved characterization of rarer entities based on previously underdiagnosed or unrecognized retinal findings.SummaryBetter characterization of the neurocutaneous disorders allows for earlier recognition and the potential for expeditious vision-saving and life-saving treatment.
Neuro-ophthalmic manifestations of Susac syndrome
Authors: Redler Yael , Chwalisz Bart K. 
Published: September 2020

Purpose of review
This review discusses general features and organ-specific presentations of Susac syndrome as well as diagnosis and treatment.

Recent findings
Latest literature regarding demographics, new diagnostic modalities such as optical coherence tomography and treatment options for Susac syndrome are discussed in detail in this review, summarizing the most recent updated information.

Summary
Susac syndrome is a rare, underdiagnosed, and often misdiagnosed disease that can lead to severe complications such as deafness, vision loss, dementia, and death. It involves the central nervous system and may mimic other neurological and neuro-ophthalmological diseases.
Effect of Nylon Wick Technique on Early Intraocular Pressure Control in Nonvalved Aqueous Shunt Surgery
Authors: Swaminathan Swarup S. , Quist Michael S. , Dawson Lindsay E. , Rothman Adam L. , Herndon Leon W. 
Published: September 2020

Precis:
The use of nylon wicks with fenestrations in nonvalved aqueous shunt surgery significantly reduces intraocular pressure (IOP) and glaucoma medication usage in the immediate postoperative period compared with the use of fenestrations alone.

Purpose:
To compare early postoperative IOP and medication usage in patients undergoing implantation of a nonvalved aqueous shunt device with fenestrations only or fenestrations with nylon wicks.

Methods:
A retrospective review of all nonvalved aqueous shunt insertions completed by one surgeon (L.W.H.) was completed using current procedure terminology. Patients undergoing Baerveldt or ClearPath 350 mm2 aqueous shunt insertion with fenestrations only (n=37) or fenestrations with 2 nylon wicks were identified (n=92). All devices were ligated with 7-0 Vicryl (polyglactin) suture, and either 4 fenestrations or 2 fenestrations and two 9-0 nylon wicks were placed anterior to the ligature. Data regarding visual acuity (VA), IOP, number of glaucoma medications, and complications were collected from the preoperative visit just before surgery, postoperative day 1, week 3 (POW3), week 5, and month 2 (POM2). The main outcome measures were VA, IOP, number of glaucoma medications, and complications at all postoperative time points.

Results:
There was no difference in logMAR VA between the 2 groups at any time point. At POW3, IOP was significantly lower in the wick group (14.6±7.7 vs. 18.1±8.7 mm Hg, P=0.03). Number of glaucoma medications used was significantly reduced in the wick group at POW3 (0.5±0.9 vs. 1.0±1.2, P=0.02) and POM2 (0.7±1.0 vs. 1.4±1.3, P=0.02). There was no significant increase in the overall rate of complications in the wick group, but there was a higher rate of transient hyphema (28% vs. 8%, P=0.02).

Conclusions:
The use of 2 nylon wicks with fenestrations in nonvalved aqueous shunt device implantation can significantly lower IOP and medication burden while awaiting the dissolution of the ligature suture.
Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment
Authors: Halkiadakis Ioannis , Vernikou Anna , Tzimis Vasilis , Markopoulos Ioannis , Popeskou Korina , Konstadinidou Vasiliki 
Published: September 2020

Precis:
Patients with glaucoma have reduced and irregular corneal epithelial thickness (CET) even if they do not report symptoms of dry eyes. The reduction of corneal epithelium affects equally the superior and inferior areas of the cornea.

Purpose:
To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls.

Methods:
This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed.

Results:
Mean age of the patients was 68±11.9 years in the glaucoma group and 65.5±8.5, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±33.3 in the glaucoma group and 550.8±33.7 in the control group, respectively (P=0.028). The central CET was 48.8.±3.7 μm in the glaucoma group and 53.5±3.7 μm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±4 vs. 49.6±3.3 μm, P<0.001 and 49±3.9 vs 53.5±3.7, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters.

Conclusions:
Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.
Association of Nailfold Capillary Abnormalities With Primary Open-angle Glaucoma and Glaucomatous Visual Field Loss
Authors: Goh Hilary , Kersten Hannah M. , Yoon Jinny J. , Gossage Lisa , Danesh-Meyer Helen V. 
Published: September 2020

Precis:
Nailfold capillary abnormalities are associated with primary open-angle glaucoma (POAG) and increased severity of global and central glaucomatous visual field (VF) loss.

Purpose:
The purpose of this study was to investigate whether nailfold capillary abnormalities are associated with POAG and the severity of glaucomatous VF loss.

Materials and Methods:
A cross-sectional study of 83 POAG cases and 40 controls was conducted. Nailfold capillaroscopy images were assessed by masked graders for dilated capillaries >50 μm, crossed capillaries, tortuous capillaries, hemorrhages, avascular zones >100 μm, capillary density, and capillary distribution. VF loss in glaucoma cases was quantified using mean deviation and mean central pattern standard deviation (PSD) from the worst-affected eye.

Results:
Logistic regression analyses of cases and controls showed that avascular zones [odds ratio (OR)=1.24; 95% confidence interval (CI): 1.06, 1.47; P=0.005], capillary density (OR=0.63; 95% CI: 0.46, 0.83; P<0.001), and capillary distribution (OR=7.88; 95% 95% CI: 2.53, 28.40; P=0.001) were associated with POAG. Simple linear regression analysis of cases only showed that nailfold hemorrhages were associated with mean deviation (β=−5.10; 95% CI: −9.20, −1.01; P=0.015) and mean central PSD (β=−4.37; 95% CI: −8.18, −0.57; P=0.025), and this remained significant in the multiple linear regressions. After controlling for demographic and clinical factors, avascular zones were associated with both mean deviation (β=−0.76; 95% CI: −1.48, −0.04; P=0.040) and mean central PSD (β=−0.78; 95% CI: −1.45, −0.10; P=0.024), whereas capillary distribution was only associated with mean deviation (β=−4.67; 95% CI: −7.92, −1.43; P=0.017).

Conclusion:
Nailfold capillary abnormalities are associated with POAG as well as increased global and central vision loss.
Management Patterns and Visual Outcomes of Endophthalmitis After Glaucoma Drainage Device Placement: A Case Series
Authors: Robbins Cason B. , Feng Henry L. , Fekrat Sharon 
Published: September 2020

Purpose:
To describe clinical presentation, management, and outcomes of eyes with endophthalmitis related to glaucoma drainage device (GDD) placement.

Patients and Methods:
Retrospective chart review of patients diagnosed with GDD-related endophthalmitis at Duke Eye Center from 2009 to 2018.

Results:
Six eyes of 6 patients had endophthalmitis related to a GDD (2 Ahmed, 4 Baerveldt). The mean time from surgery to presentation was 22.7 months. Five of 6 cases (83%) had culture-proven infectious endophthalmitis. Eyes undergoing GDD explantation (n=2) had better visual acuity at 6 months compared with those without hardware removal (20/11,314 vs. 20/358). Visual acuity at 6 months was hand motion (20/8000) or worse in 3 of 6 cases (50%).

Conclusions:
GDD-related endophthalmitis often leads to poor visual outcomes. Hardware removal may lead to improved visual outcomes; a multicenter prospective study assessing the benefit of hardware removal may be warranted.
Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction
Authors: Gouda Jylan , Tomairek Reham H. , Elhusseiny Abdelrahman M. , El-Fayoumi Dina , Awadein Ahmed , Gawdat Ghada , Elhilali Hala 
Published: September 2020

Precis:
Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months.

Purpose:
The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes.

Patients and Methods:
A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed.

Results:
Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively).

Conclusions:
Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.
Tube-Shunt Bleb Pathophysiology, the Cytokine Story
Authors: Freedman Jeffrey 
Published: September 2020

Purpose:
To define tube bleb-pathophysiology, outlining factors that may play a major role in the ultimate success or failure of the bleb. Methods that may be used to advance success of these blebs are discussed.

Materials and Methods:
The study describes the importance of tube shunt bleb pathophysiology, including the role of cytokines, relating to bleb failure or success. Methods to influence these outcomes, are outlined.

Results:
Understanding the various parameters involved with the pathophysiology of tube shunt blebs, especially intraocular pressure (IOP), and cytokine content of aqueous. The production of cytokines by tube shunt blebs, and the possible adverse results of this action on a second tube shunt in a different quadrant of the eye.

Conclusions:
Tube shunts are conduits transporting aqueous from within the eye to the subconjunctival space. The ultimate end result is to create a drainage bleb over the tube plate. The formation of the bleb is controlled by multifactorial components, including age of the patient, racial background, presurgical IOP, and thereby aqueous cytokine content, and patient’s individual reaction to the presence of a foreign body beneath the conjunctiva. Prolonged IOP within the bleb results in cytokine production by the bleb lining. Occluding the tube of a failed implant can prevent damage to a new implant in a different eye quadrant.
Living Related Liver Transplantation for Metabolic Liver Diseases in Children
Authors: Sood Vikrant , Squires James E. , Mazariegos George V. , Vockley Jerry , McKiernan Patrick J. 
Published: September 2020

ABSTRACTMetabolic liver diseases (MLDs) are a heterogeneous group of inherited conditions for which liver transplantation can provide definitive treatment. The limited availability of deceased donor organs means some who could benefit from transplant do not have this option. Living related liver transplant (LrLT) using relatives as donors has emerged as one solution to this problem. This technique is established worldwide, especially in Asian countries, with shorter waiting times and patient and graft survival rates equivalent to deceased donor liver transplantation. However, living donors are underutilized for MLDs in many western countries, possibly due to the fear of limited efficacy using heterozygous donors. We have reviewed the published literature and shown that the use of heterozygous donors for liver transplantation is safe for the majority of MLDs with excellent metabolic correction. The use of LrLT should be encouraged to complement deceased donor liver transplantation (DDLT) for treatment of MLDs.
Impact of a Medical Scribe Program on Outpatient Pediatric Gastroenterology Clinic
Authors: Rahhal Riad , Goad Lindsay , Bishop Warren 
Published: September 2020

ABSTRACTObjectives:Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap.Methods:Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups.Results:One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02).Conclusions:The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.
Syndrome of the Trephined Related to Inflation of a Scalp Tissue Expander
Authors: Stewart Christopher M. , Deibert Christopher P. , Thompson Peter W. 
Published: September 2020

Abstract
Syndrome of the Trephined (SoT) is a severe complication following decompressive craniectomy. Urgent cranioplasty fully reverses the neurologic symptoms of SoT. This article presents a recent case of SoT following inflation of a scalp tissue expander.
A review of the literature was performed and case details obtained from the electronic medical record. Our patient had a large craniectomy defect following traumatic brain injury. A scalp tissue expander was used before secondary cranioplasty. The patient suffered severe neurologic decline temporally related to tissue expander inflation, which was fully reversed following expander removal and urgent cranioplasty.
SoT can be a neurologically devastating complication which can resolve following urgent cranioplasty. To our knowledge, this is the first description of SoT resulting from inflation of a scalp tissue expander. Familiarity with this syndrome is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.
Evaluation of Velopharyngeal Closure Ratio by a New Semi-Automatic Detection Method Based on Nasopharyngoscopy With Image Processing Method
Authors: Mao Bochun , Fu Fangling , Chen Shengkai , Cheng Xu , Guo Chunli , Ma Huangshui , He Ling , Yin Heng 
Published: September 2020

Abstract
The goal of this study is to develop and validate a novel semi-automatic detection method (SADM) under nasopharyngoscopy based on the image processing technique, which can assist the evaluation of the velar closure ratio (VCR). After the development of the SADM, 72 patients were enrolled. The reliability of SADM was evaluated by repeated measurements. Velar closure ratio are given by conventional nasopharyngoscopy method and SADM were compared. Velar closure ratios given by SADM were further translated into a trichotomous classification for velopharyngeal function diagnosis, that is, velopharyngeal closure (VPC), marginal VPC (MVPC), and velopharyngeal incomplete. The 2 VCR-thresholds used for the translation were explored and validated. As results shown, SADM was proved to be reliable with an intraclass correlation coefficient of 0.996 (95% confidence interval: 0.993–0.997, P < 0.001). Intraclass correlation coefficient between conventional nasopharyngoscopy method and SADM was 0.954 (95% confidence interval: 0.927– 0.971, P < 0.001). Velar closure ratio-thresholds were set at 0.82 and 0.92 according to the ROC curve. Diagnostic sensitivity and specificity for velopharyngeal incomplete were 1.00 and 1.00. MVPC had 0.58 sensitivity and 0.96 specificities while VPC had 0.92 and 0.79, respectively. No statistically significant difference was found between the diagnosis of SADM and speech pathologists (P > 0.1). In conclusion, this study successfully developed an accurate and reliable semi-automatic method to evaluate VCR, which could help improve the efficacy of VCR evaluation and velopharyngeal function diagnosis.