bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of mitral regurgitation
Authors: Lawrie Gerald M. 
Published: August 2020

Purpose of review
Mitral repair is the best treatment for degenerative mitral regurgitation. Many patients are referred too late for optimal outcomes. The US repair vs. replacement rate is only 60–80%, at a time when the inferiority of replacement has been established. Therefore, widely used traditional techniques of repair are being reappraised.

Recent findings
Identification of risk factors predictive of poor early and late outcome have improved timing for surgical referral. Composite risk scores have been developed. Novel echocardiographic, cardiac MRI, and molecular level risk factors could improve timing. Analysis of factors contributing to low repair rates is also of critical importance. The role of institutional and surgeon volumes have been identified. More detailed data on the importance of dynamic function of the mitral valve have led to improved repair techniques such as intraoperative simulation of end diastole and early systole, use of expanded polytetrafluoroethylene neochords instead of leaflet resection, and dynamic instead of rigid annuloplasty.

Summary
Our perception of mitral regurgitation has changed from a seemingly simple condition to one of considerable complexity at multiple levels. National guidelines should be studied and followed.
Revascularization strategies for left main coronary artery disease: current perspectives
Authors: Elbatarny Malak , Cheema Asim N. , Mazine Amine , Verma Subodh , Yanagawa Bobby 
Published: August 2020

Purpose of review
Left main coronary artery disease (LMCAD) represents a high-risk subset of coronary artery disease with significant morbidity and mortality if not treated in a timely manner. In this review, we survey the contemporary evidence on the management of LMCAD, highlight advances, and provide in-depth review of data comparing surgical and percutaneous approaches.

Recent findings
LMCAD represents a heterogeneous condition and management should be guided by key clinical and anatomic factors. In recent years, there has been a wealth of published prospective data including results of the EXCEL and NOBLE trials. Coronary artery bypass graft (CABG), remains the gold standard for optimal long-term outcomes and the greatest benefit seen in patients with higher anatomic complexity and longer life expectancy. Percutaneous coronary intervention (PCI) offers a less-invasive approach with rapid recovery. PCI is optimal in situations when surgery cannot be offered in a timely manner due to hemodynamic instability, for high-risk surgical patients, or those with limited life expectancy, if LMCAD is anatomically simple. As a result of continued technological and procedural improvements in both PCI and CABG, cardiovascular specialists possess a growing armamentarium of approaches to treat LMCAD. Thus, center specialization and use of a heart team approach are increasingly vital, though barriers remain.

Summary
Emerging evidence continues to support CABG as the gold standard for achieving optimal long-term outcomes in patients with LMCAD. PCI offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected candidates.
Influence of Sodium Hyaluronate Concentration in Tear Meniscus Height: 10-min Dynamic Profile After Single Instillation
Authors: Rocha-de-Lossada Carlos , Sánchez-González José-María , Zamorano-Martín Francisco , Rachwani-Anil Rahul , Torras-Sanvicens Josep , Peraza-Nieves Jorge 
Published: August 2020

Purpose:
To assess the height, area, and density of tear meniscus throughout 10 min after instillation of sodium hyaluronate (SH) of equal molecular weight at two different concentrations.

Methods:
Thirty-four eyes from 17 patients were enrolled in this longitudinal, nonrandomized, interventional and contralateral eye study. Tear meniscus height (TMH), corneal meniscus junction (CMJ), lower-lid meniscus junction (LLMJ), and tear meniscus area (TMA) images were obtained with the anterior segment module of the deep range imaging ocular coherence tomography ([DRI-OCT] Triton Swept-Source). Tear meniscus density (TMD) was calculated using the image processing and analysis software by Java (ImageJ program). Sodium hyaluronate artificial tears at 0.1% and 0.2% concentrations were instilled into all right and left eyes, respectively.

Results:
Patients' mean age was 61.05±11.43 years. Tear meniscus height, CMJ, LLMJ, and TMA measured at 1-, 5-, 7- and 10-min postinstillation of 0.1% SH proved significant differences among them (P<0.05). Sodium hyaluronate 0.2% instillation obtained similar findings, although no significant differences were found between 1- and 3-min postinstillation measurements (P>0.05). Fewer differences were found in TMD 0.2% SH group due to a lower baseline densitometry compared to the 0.1% group.

Conclusion:
0.2% sodium hyaluronate achieved better TMH and TMA in 1 and 3 min after instillation than 0.1% concentration. However, there were no statistically significant differences between 0.1% and 0.2% sodium hyaluronate throughout a ten-minute longitudinal profile measurement using DRI-OCT.
Precision Pulse Capsulotomy During Combined Penetrating Keratoplasty With Cataract Surgery and Intraocular Lens in Small Nondilating Pupil
Authors: Singh Bhupesh , Sharma Sourabh , Bharti Neha , Bharti Sudhank 
Published: August 2020

Objective:
To demonstrate precision pulse capsulotomy (PPC) in an open-sky procedure and to evaluate its use during triple procedure keratoplasty in small nondilating pupils.

Methods:
This single-center retrospective case series study included 10 eyes (from 10 patients) with corneal opacity and poorly dilated pupils who were scheduled to undergo triple procedure keratoplasty. The main outcome measures were capsulotomy performance of the PPC device and intraoperative complications. Secondary outcome measures included postoperative best-corrected visual acuity, intraocular pressure, and other postoperative complications.

Results:
Complete free-floating capsulotomy was achieved in all 10 eyes. There were no cases of anterior capsule tears or tags. There were no postoperative complications that occurred in association with the PPC device.

Conclusions:
The PPC device facilitates creation of a smooth, round, and appropriately sized anterior capsulotomy in open-sky surgeries, particularly in presence of small nondilating pupils.
Axial Length Elongation in Japanese Youth With Myopia
Authors: Itoi Motohiro , Itoi Motozumi 
Published: August 2020

Objectives:
To investigate the correlation between the annual axial length (AL) elongation and associated factors in Japanese youth with myopia.

Methods:
This retrospective study enrolled patients aged 7 to 21 years with myopia. Axial length was measured using ocular biometry. Refractive errors and curvature radius (CR) were measured using an open-field Binocular Auto Ref/Keratometer without cycloplegia. Subjects were divided into five groups using 3-year age intervals, and the relationship between annual AL elongation and age, spherical equivalent (SE), corneal CR, and sex was evaluated.

Results:
Four hundred and eighty-two patients (184 male and 298 female subjects) with a mean age of 15.55±4.09 years were included. The annual AL elongation was largest in the youngest group (0.47±0.19) and decreased with age to 0.03±0.04 in the oldest group. The annual change in AL was associated with age and SE (P<0.01) but not with sex or CR (P>0.05). Axial length elongation stratified by age was significantly correlated with SE in the 15 to 18-year-old (R
2=0.20, P<0.01) and 19 to 21-year-old (R
2=0.37, P=0.01) groups, whereas there was no significant correlation in the 7 to 9-year-old group (R
2=0.04, P=0.14), the 10 to 12-year-old group (R
2=0.05, P=0.07), and the 13 to 15-year-old group (R
2=0.01, P=0.14).

Conclusions:
In Japanese youth with myopia, AL elongation was largest in the youngest group, decreased with age, especially in the group older than 15 years.
Heads-up Descemet Membrane Endothelial Keratoplasty Surgery: Feasibility, Surgical Duration, Complication Rates, and Comparison With a Conventional Microscope
Authors: Panthier Christophe , Courtin Romain , Moran Sarah , Gatinel Damien 
Published: August 2020

Purpose:
To assess the feasibility of Descemet membrane endothelial keratoplasty (DMEK) surgery using the glasses-assisted 3-dimensional (3D) display system NGENUITY (Alcon Laboratories, Fort Worth, TX) and to compare with standard DMEK surgery by using a conventional operating microscope.

Methods:
Twelve consecutive cases of DMEK surgery were performed using the glasses-assisted 3D display system NGENUITY (Alcon) and matched with similar cases performed by using the OPMI-Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) in this prospective cross-sectional study realized at the Rothschild Foundation, Paris, France. DMEK graft preparation time, graft unfolding time, time to perform the descemetorhexis (DM), and overall surgical time were recorded. Best corrected visual acuity, endothelial cell density of the donor tissue measured by specular microscopy, and the recipient's central corneal thickness were recorded preoperatively and again at 1 and 3 months postoperatively.

Results:
In the 3D group, time to perform the graft preparation, DM, and global surgical time were significantly higher in the 3D group than in the conventional groups (17 minutes 36 seconds ± 3 minutes 13 seconds and 14 minutes 50 seconds ± 1 minutes 28 seconds, P = 0.04; 6 minutes 18 seconds ± 2 minutes 30 seconds vs. 3 minutes 50 seconds ± 2 minutes 8 seconds, P = 0.03; and 31 minutes 30 seconds ± 6 minutes 10 seconds vs. 24 minutes 10 seconds ± 3 minutes 26 seconds, respectively, P = 0.05). The time to unfold the graft was higher, although not significantly so, in the 3D group compared with the conventional group (5 minutes 15 seconds ± 2 minutes 40 seconds vs. 4 minutes 40 seconds ± 2 minutes 25 seconds, P = 0.89). Mean central corneal thickness decreased about 168 ± 82 μm at 3 months after surgery in the 3D group and about 228 ± 123 μm in the conventional group without significant difference (P = 0.60). Best corrected visual acuity in the 3D group was 0.33 ± 0.32 LogMAR at 3 months after surgery with no significant differences found when compared with conventional surgery. The percent endothelial cell loss from preoperative at 3 months was 35% in the 3D group and 26% in the conventional group, respectively, with no significant difference (P > 0.05).

Conclusions:
Performing DMEK surgery using a 3D display system is feasible; however, it is more challenging and the total surgical time is longer. This method would certainly be useful for instructional courses.
Keratoconus in Children: A Literature Review
Authors: Buzzonetti Luca , Bohringer Daniel , Liskova Petra , Lang Stefan , Valente Paola 
Published: August 2020

Purpose:This review discusses the main aspects of pediatric keratoconus (KC) based on the current evidence to propose a guideline for helping early diagnosis and improving efficacy in treatment.Methods:This literature review was performed using PubMed, Ovid, and Elsevier databases. For the database search, the primary entered term included “pediatric keratoconus,” connected to descriptors such as “keratoconus,” “screening,” “corneal cross-linking” (CXL), and “keratoplasty.” Peer-reviewed and scholarly resources including original scientific articles and review articles were included.Results:The prevalence of KC changes among populations. The greatest incidence has been reported in Middle-Eastern populations, an estimate of incidence of 1/2,000 individuals per year. Scheimpflug imaging, optical coherence tomography, and slit-scan tomography are commonly used to detect early diagnosis. Epithelium-off CXL is the treatment that should be discussed as soon as there is evidence for disease progression. Actually, penetrating keratoplasty represents the more common technique of pediatric keratoplasty; however, deep anterior lamellar keratoplasty probably seems as the best surgical option because of healthy endothelium. Options to increase visual acuity thereafter include contact lens fitting and corneal implants.Conclusions:The review of the literature confirms that KC in children is more aggressive than that in adults. In the attempt to preserve a good visual acuity, guidelines for improving early diagnosis and appropriate treatment seem crucial.
Descemet Stripping Only Supplemented With Topical Ripasudil for Fuchs Endothelial Dystrophy 12-Month Outcomes of the Sydney Eye Hospital Study
Authors: Moloney Gregory , Garcerant Congote Daniel , Hirnschall Nino , Arsiwalla Tasneem , Luiza Mylla Boso Ana , Toalster Nicholas , D'Souza Mario , Devasahayam Raj N. 
Published: August 2020

Purpose:
To report early safety and efficacy of Descemet stripping only (DSO) supplemented with ripasudil.

Methods:
A pre-post clinical trial with a historical control group for time to heal and cell count parameters. The study received ethics approval and was conducted with oversight of a data safety monitoring board. All enrolled patients had a superior endothelial cell count of >1000 cells/mm2 and were symptomatic from the presence of central guttata degrading vision and/or producing glare. DSO was carried out with a peeling technique and not combined with any other intervention. Ripasudil 0.4% was applied topically from day 1 postoperatively at a dose of 6 times/d until corneal clearance. Cases with relapse of edema were permitted to restart on ripasudil at a reduced dose of 2 drops/d for a further 2 weeks. Stopping rules with progression to a corneal graft were established. Baseline ocular and systemic investigations were carried out and repeated at varying intervals to monitor for local and systemic adverse events.

Results:
Twenty-three eyes of 23 patients met the inclusion criteria and underwent DSO. Twenty-two of 23 eyes achieved corneal clearance at a mean time of 4.1 weeks. In all patients achieving clearance, improvement in vision was recorded. Improvement in mean uncorrected visual acuity was 0.20 Logarithm of the minimum angle of resolution (LogMar), and improvement in mean best spectacle corrected visual acuity was 0.156 LogMar. One patient failed to clear and underwent Descemet membrane endothelial keratoplasty at week 12. Twenty-one of 22 patients achieving corneal clearance expressed satisfaction with the procedure. The commonest systemic side effect of topical ripasudil was gastrointestinal upset (24%), and the commonest local side effect was ocular irritation (43%). No patient experienced a serious adverse event in the course of the trial. Thirty-nine percent of patients experienced a relapse of edema on ceasing ripasudil, with clearance again on recommencing.

Conclusions:
This trial of DSO supplemented with ripasudil included local and systemic safety analysis. We judge that this treatment option is emerging as a reliable intervention for select patients with Fuchs' Endothelial Corneal Dystrophy (FECD) with an acceptable safety profile. The observation of relapse edema is strong evidence of a drug effect. The longevity of these results remains unknown.
Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center
Authors: Dalvin Lauren A. , Yaghy Antonio , Vaidya Sarangdev , Pacheco Richard R. , Perez Alejandro L. , Lally Sara E. , Shields Jerry A. , Shields Carol L. 
Published: August 2020

Purpose:
To investigate the clinical features and outcomes for conjunctival melanoma based on patient age.

Methods:
A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young ≤45 years, middle-aged 46–69 years, and older ≥70 years), with Kaplan–Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)].

Results:
There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan–Meier outcomes, older patients had more frequent visual acuity loss ≥3 lines (11% vs. 28% vs. 64%, P < 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P < 0.001). Hazard ratio for the oldest age group (age ≥70) revealed a 7.76-fold (3.33–18.09) increased risk for visual acuity loss (P < 0.001), and a 2.08-fold (1.32–3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death.

Conclusions:
Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence.
Evaluation of Densitometric Analysis for Early Detection of Corneal Blood Staining in Hyphema
Authors: Kiziltoprak Hasan , Atesoglu Halil İbrahim , Tekin Kemal , Yetkin Esat , Koc Mustafa 
Published: August 2020

Purpose:
To investigate the possibility of detecting presumed corneal blood staining after traumatic hyphema with corneal densitometry and to evaluate corneal transparency after hyphema resolution.

Methods:
Twenty-eight patients with uniocular nonpenetrating ocular trauma with hyphema were included in the study. Corneal densitometry measurements were performed at the first week and the first month after full resolution of blood in the anterior chamber and discontinuation of medication. The uninjured eyes were accepted as the control group.

Results:
The corneal densitometry values at all zones of the posterior layer in the study eyes were significantly higher at the first week compared with the first month (P < 0.05 for all). Comparison of the corneal densitometry values of the study eyes at the first week with the fellow eyes showed significantly higher values at all zones of the posterior corneal layer (P < 0.05 for all). Comparison of the study eyes at the first month with the fellow eyes was significantly higher at the posterior 0- to 2-, 2- to 6-, and 6- to 10-mm zones (P = 0.030, P = 0.044, and P = 0.035, respectively). Although corneal densitometry values at the posterior 10- to 12-mm and posterior total zones were higher at the first month compared with those of the fellow eyes, these differences were not statistically significant (P = 0.197 and P = 0.085, respectively).

Conclusions:
Corneal densitometry at all zones of the posterior corneal layer significantly changed after traumatic hyphema. Corneal densitometry analysis could be used in clinically normal cases for possible early corneal blood staining detection.
Effect of Intravenous Dexmedetomidine on Intraocular Pressure in Patients Undergoing Glaucoma Surgery Under Local Anesthesia: A Pilot Study
Authors: Senthil Sirisha , Burugupally Keerthi , Rout Umashankar , Rao Harsha L. , Krishnamurthy Rashmi , Badakere Swathi , Choudhari Nikhil , Garudadri Chandrasekhar 
Published: August 2020

Precis:
Preoperative intravenous (IV) dexmedetomidine produced a 33% reduction in intraocular pressure (IOP) within 15 minutes of administration in patients with glaucoma.

Purpose:
To evaluate the effect of preoperative IV dexmedetomidine on IOP in adult patients undergoing glaucoma surgery under local anesthesia.

Methods:
In a prospective interventional case series, 12 patients with uncontrolled IOP (IOP>24 mm Hg in both the eyes) with the systemic status of American Society of Anesthesiologists (ASA) classification I-II, received IV dexmedetomidine 0.6 µg/kg 30 minutes preoperatively. The IOP of the nonsurgical eye (measured with Perkins tonometer), the heart rate (HR), and blood pressure (BP) were recorded 5 minutes prior, 15 minutes and 2 hours after IV dexmedetomidine administration, and were compared using analysis of variance and Tukey honestly significant difference tests.

Results:
There were 4 women and 8 men with a mean age (±SD) of 60.6±10.4 years. The mean number of antiglaucoma medications was 4.3±1.3. The mean pre-dexmedetomidine IOP was 31.5±5.6 mm Hg. At 15 minutes post-dexmedetomidine administration, the mean and percentage drop in IOP were 10.2±3.2 mm Hg (P=0.001) and 33%±11%, respectively. The mean and percentage drop in systolic BP were 18±20 mm Hg (P=0.01) and 12%±14%, and drop in diastolic BP were 6.5±10 mm Hg (P=0.05) and 7%±11%, respectively. The mean and percentage drop in HR were 2±0.6 bpm (P=0.48) and 2%±13%, respectively. None of the subjects experienced any medication-related adverse effects. At 2 hours, the mean and percentage drop in IOP were 5.3±3 mm Hg and 17%±11%, respectively.

Conclusion:
In the small sample of (ASA I-II) patients studied, preoperative dexmedetomidine produced a significant drop in IOP (33%) within 15 minutes of IV administration in patients with glaucoma that was reversing at 2 hours, with a good safety profile.
Knowledge, Attitudes, and Perceptions of Young Adults About Electronic Nicotine Delivery Systems in the United States
Authors: Tremblay Beth , Turk Melanie T. , Cooper Maria R. , Zoucha Richard 
Published: August 2020

Background
The causal link between cigarettes and cardiovascular disease is well known. The long-term effects of e-cigarettes are yet unknown, although early studies show biomarkers indicating inflammation and damage to endothelial cells associated with later development of cardiovascular disease. With the rapid rise in e-cigarette use, especially in young adults, it is imperative that health professionals understand the knowledge, perceptions, and motivations for use among young adults.

Objectives
The purpose of this integrative review is to explore existing literature on young adults' knowledge, attitudes, values, and perceptions about e-cigarettes, as well as the social norms they experience.

Methods
The Whittemore and Knafl model for integrative review guided the methodology. Three databases were searched from January 2010 through December 2018. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion and exclusion criteria were applied. Studies were evaluated for quality and strength. Key themes were extracted, coded, and synthesized.

Results
Seventy-one full-text studies were assessed for inclusion criteria; 15 articles were included, coded, and analyzed for quality and thematic content. Current e-cigarette users represented just 3% to 35% of study participants. Three themes arose from a synthesis of the literature: “Is it bad for me?,” “I just like it,” and “Is it cool or not?”

Conclusions
Young adults are not armed with the accurate knowledge to make informed choices about using e-cigarettes. E-cigarette users are understudied and tend to value appearance and physical sensation over health. Social norms related to e-cigarette use are linked to perception of identity and the current technology-focused culture.