bluuebunny/crossref_metadata_2025_split huggingface dataset:
MULTIMODAL IMAGING IN HELLP-RELATED CHORIORETINOPATHY
Authors: Van Rysselberge Camille , Balikova Irina , Judice Lia , Makhoul Dorine , Postelmans Laurence 
Published: February 2020

Purpose:
To illustrate with multimodal imaging a case of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) complicated by bilateral multifocal serous retinal detachments, subretinal exudation, and papilledema.

Methods:
Case report. Fundus photography, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography were performed at presentation and the day after. We also present the SD-OCT follow-up at 8 days, 1 year, and 4 years.

Results:
A 25-year-old 5-month-pregnant Guinean woman complained about decreased visual acuity in the right eye. Eye fundus and multimodal imaging were abnormal in both eyes. Spectral domain optical coherence tomography showed the presence of multifocal serous retinal detachments, subretinal deposits, and intraretinal cysts. Indocyanin green angiography revealed an irregular choroidal perfusion and localized choroidal ischemia. Spectral domain optical coherence tomography also provided assessment of retinal changes during the long-term follow-up, showing tissue damage in the outer retina.

Conclusion:
Serous retinal detachments during pregnancy can be the leading sign of HELLP syndrome—a potentially life-threatening condition. Spectral domain optical coherence tomography is a noninvasive and useful tool for its diagnosis and follow-up. ICG is important to confirm the choroidal ischemia and choroidal vascular abnormalities, underlying conditions leading to main sign of HELLP syndrome in the eye.
AUTOFLUORESCENT TIMELINE OF SPOTS AND DOTS IN MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Scharf Jackson M. , Hilely Assaf , Freund K. Bailey , Sarraf David 
Published: February 2020

Purpose:
To describe the recovery timeline of spots and dots in multiple evanescent white dot syndrome.

Methods:
Sequential multimodal retinal imaging including fundus autofluorescence and cross-sectional and en face optical coherence tomography was performed to track the development and resolution of spots and dots in a case of multiple evanescent white dot syndrome.

Results:
En face optical coherence tomography showed that the spots are the result of ellipsoid zone loss and are hyperautofluorescent due to unmasking of the underlying retinal pigment epithelium autofluorescence. Conversely, the dots are hyperreflective with cross-sectional and en face optical coherence tomography and hyperautofluorescent, which we propose may be due to accumulation of degenerated photoreceptor material including fluorophores with autofluorescent capability such as precursors of A2E. The earlier resolution of the hyperautofluorescent spots allowed for later detection of the hyperautofluorescent dots.

Conclusion:
This case report illustrates the different recovery timelines of spots and dots in multiple evanescent white dot syndrome. Although both lesion types are hyperautofluorescent, the mechanism of autofluorescence is distinctive and may be explained by their contrasting pathoanatomy.
Clinical and Morphologic Outcomes of Minimally Invasive Direct Corneal Neurotization
Authors: Wisely C. Ellis , Rafailov Leon , Cypen Sanja , Proia Alan D. , Boehlke Christopher S. , Leyngold Ilya M. 
Published: February 2020

Purpose:
To describe clinical outcomes of a minimally invasive technique for direct corneal neurotization to treat neurotrophic keratopathy.

Methods:
All cases of corneal neurotization for neurotrophic keratopathy performed by a single surgeon using minimally invasive direct corneal neurotization were reviewed. The supraorbital donor nerve was directly transferred to the cornea through an upper eyelid crease incision using either a combination of endoscopic and direct visualization or direct visualization alone. Detailed ocular and adnexal examinations as well as Cochet–Bonnet esthesiometry of the affected cornea were performed. Corneal histopathology and in vivo confocal microscopy after minimally invasive direct corneal neurotization were reviewed in one patient who underwent simultaneous penetrating keratoplasty.

Results:
Five consecutive cases in 4 patients were included, with a mean follow up of 15.8 months (range: 11–23 months). Average denervation time was 17.8 months (range: 6–24 months). Baseline corneal conditions were Mackie stage 1 (20%), Mackie stage 2 (40%), and Mackie stage 3 (40%). All patients demonstrated improvements in corneal sensibility and appearance postoperatively. All patients demonstrated stable or improved visual acuity. No patients developed persistent epithelial defects postoperatively, and all achieved return of tactile skin sensation in the donor nerve sensory distribution. In vivo confocal microscopy after minimally invasive direct corneal neurotization and simultaneous penetrating keratoplasty demonstrated regeneration of corneal nerves. Complications included an asymptomatic small bony excrescence lateral to the supraorbital notch in one patient and cataract progression in the patient who underwent penetrating keratoplasty.

Conclusions:
Minimally invasive direct corneal neurotization is a safe and effective treatment of neurotrophic keratopathy.
Müller Muscle Conjunctiva Resection for Revision of Residual Ptosis After External Levator Advancement Surgery
Authors: Ozturk Karabulut Gamze , Fazil Korhan , Karaagac Gunaydin Zehra , Serefoglu Cabuk Kubra , Onmez Funda Ebru , Taskapili Muhittin 
Published: February 2020

Purpose:
To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis.

Methods:
A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour.

Results:
The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection.

Conclusions:
In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.
Thickness of Retro- and Sub-Orbicularis Oculi Fat in Thyroid Eye Disease: Comparison With Controls and Its Influential Factors
Authors: Valencia Ma. Regina Paula , Miyazaki Hidetaka , Kakizaki Hirohiko , Takahashi Yasuhiro 
Published: February 2020

Purpose:
To compare the thickness of the retro- and sub-orbicularis oculi fat (ROOF and SOOF) between patients with thyroid eye disease (TED) and controls via MRI and to determine factors influencing fat thickness.

Methods:
This retrospective, comparative, case-control study included 136 patients (272 sides) with TED and 50 control patients (50 sides). The thickness of the ROOF and SOOF was measured on the quasi-sagittal plane through the optic nerve (the central plane) and 6 mm lateral and medial to the central plane at the level through the superior orbital rim and at the level just below the orbital septum in the lower eyelid, respectively.

Results:
The ROOF and SOOF were thickest on the lateral plane (p < 0.050; Tukey Kramer post hoc test) and were significantly thicker in patients with TED than controls on all planes (p < 0.050; Student t test). Multivariate stepwise analysis showed that age, sex, clinical activity score, Hertel exophthalmometric values, and number of enlarged extraocular muscles are significant predictors of the ROOF and SOOF thickness in patients with TED (p < 0.050).

Conclusions:
Patients with TED had thicker ROOF and SOOF on all planes than controls with various factors influencing the thickness. These results may be helpful in planning rehabilitative blepharoplasty with removal of the ROOF and SOOF for correction of eyelid fullness in TED.
Visual outcome, optical quality, and patient satisfaction with a new monofocal IOL, enhanced for intermediate vision: preliminary results
Authors: Mencucci Rita , Cennamo Michela , Venturi Daniel , Vignapiano Roberto , Favuzza Eleonora 
Published: February 2020

Purpose:
To compare visual outcomes, contrast sensitivity, optical quality, spectacle independence, and visual disturbances in patients implanted with 2 models of monofocal intraocular lenses (IOLs).

Setting:
Eye Clinic, Department of NEUROFARBA, University of Florence, Italy.

Design:
Prospective case series

Methods:
Patients without ocular comorbidities and corneal astigmatism less than 0.75 diopters (D) had cataract surgery with bilateral implantation of either of 2 monofocal IOLs, the Tecnis ZCB00 or the Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc.). Six months postoperatively, monocular and binocular uncorrected and corrected (at 4 m) distance visual acuities, as well as uncorrected (UIVA), distance corrected, and corrected intermediate (at 66 cm) and near (at 40 cm) visual acuities were measured. Photopic contrast sensitivity, binocular defocus curve, objective scatter index (OSI), Strehl ratio, modulation transfer function (MTF) cutoff, halo and glare perception, and spectacle independence were also evaluated.

Results:
A total of 80 eyes of 40 patients were evaluated in this study. Although monocular and binocular uncorrected and corrected distance and near visual acuities were similar between groups, monocular and binocular UIVA were significantly higher in the Eyhance group. There were no statistically significant differences between the 2 groups in terms of photopic contrast sensitivity, OSI, MTF cutoff, Strehl ratio, and glare and halo perception. The ICB00 IOL provided better spectacle independence than the ZCB00 IOL for intermediate distance.

Conclusions:
In patients without ocular comorbidities, the Eyhance ICB00 IOL provided better UIVA and higher intermediate spectacle independence without impairment of far vision and visual quality, compared with the ZCB00 IOL.
Rate of pseudophakic cystoid macular edema using intraoperative and topical nonsteroidal antiinflammatory drugs alone without steroids
Authors: Walter Keith , Kauffman Levi , Hess Justin 
Published: February 2020

Purpose:
To determine the rate of postoperative cystoid macular edema (CME) in patients undergoing cataract surgery treated with intraoperative intracameral and postoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) without steroids.

Setting:
Academic outpatient surgery center Wake Forest Baptist Health in Bermuda Run, NC.

Design:
Retrospective cohort study.

Methods:
A retrospective chart review was performed. Patients were identified through a medical record search tool using criteria of the Current Procedural Terminology code (66984), a single surgeon, and a date range from January 1, 2016, through December 31, 2017. Medical records were reviewed to determine intraoperative and postoperative medication regimen, visual outcome, and development of postoperative CME. Patients with a history of uveitis, diabetic macular edema, retinal vein occlusions, epiretinal membranes, vitreomacular traction, or any prior macular edema were excluded. In addition, any patients with less than 6 weeks of postoperative follow-up were excluded.

Results:
Overall, 824 patient records were reviewed, and the analysis included 504 eyes. Of these, 2 eyes developed postoperative CME (rate = 0.40%, 95% CI 0.0005 to 0.0143).

Conclusions:
The rate of CME in patients treated with intraoperative and postoperative NSAIDs without steroids was low and below the historical rates derived from a literature review of CME development with the use of steroids.
Changes in angle kappa and angle alpha before and after cataract surgery
Authors: Wang Rui , Long Tan , Gu Xin , Ma Ting 
Published: February 2020

Purpose:
To observe the distributions and changes in angle kappa and angle alpha preoperatively and postoperatively in patients with cataract who were implanted with a multifocal intraocular lens (mIOL).

Setting:
The First Affiliated Hospital of Northwest University, Shaanxi, China.

Design:
Prospective nonrandomized noncomparative case series.

Methods:
Eyes that underwent phacoemulsification were included. The magnitudes and orientations of angle kappa and angle alpha preoperatively and postoperatively were compared, respectively.

Results:
The study comprised 81 eyes of 70 patients. The magnitude of angle kappa significantly decreased after phacoemulsification. No significant differences were observed between preoperative and postoperative angle kappa in orientation, as well as between preoperative and postoperative angle alpha. The correlations between preoperative and postoperative angle kappa and angle alpha were significant. There were displacement vectors for angle kappa (0.15 ± 0.10) and angle alpha (0.12 ± 0.12) after phacoemulsification. Locations of angle kappa of right and left eyes were scattered mostly in the temporal side of corneal light reflection, whereas locations of angle alpha were well organized in the horizontal position on temporal sides of corneal light reflection.

Conclusions:
The distribution of angle alpha was more organized compared with angle kappa. Angle kappa may change after phacoemulsification. During preoperative evaluation for patients with cataract planning for mIOLs implanted angle alpha may be a more reliable and stable factor compared with angle kappa.
European study of the efficacy of a cross-linked gel stent for the treatment of glaucoma
Authors: Fea Antonio M. , Bron Alain M. , Economou Mario A. , Laffi Gianluca , Martini Enrico , Figus Michele , Oddone Francesco 
Published: February 2020

Purpose:
To investigate the efficacy and safety of a cross-linked gel stent (XEN45) with or without cataract surgery in the treatment of glaucoma patients.

Setting:
Five university hospitals.

Design:
Prospective multicenter clinical trial.

Methods:
Patients with glaucoma inadequately controlled by treatment or poor compliance or intolerance to topical therapy were included. Patients were divided into those who had an implant only (Solo Group; phakic and pseudophakic patients) and those who had an implant combined with cataract surgery (Combo Group). Differences in mean intraocular pressure (IOP) and number of medications between the baseline preoperative visit and study end (12 months), and the rate of qualified and complete success, were evaluated.

Results:
The Solo Group comprised 115 glaucoma patients (43 phakic and 72 pseudophakic) and the Combo Group comprised 56 patients. Compared with baseline, mean IOP (23.9 ± 7.6 to 15.5 ± 3.9) and number of medications (3.0 ± 1.1 to 0.5 ± 1.0) decreased significantly at 12-month follow-up (P < .001 for both). A >20% and >30% reduction in IOP from baseline was achieved by 72.3% and 52.6% of patients, respectively. IOP at 1 week postoperatively was a predictor of success, and the needling rate was inversely correlated with early postoperative IOP. The number of preoperative medications and patient age were not significantly associated with failure.

Conclusions:
Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in IOP and number of medications.
Development of low laser energy levels in small-incision lenticule extraction: clinical results, black area, and ultrastructural evaluation
Authors: Lin Limian , Weng Shengbei , Liu Fang , Lin Haiqin , Xu Jiping , Xie Yi , Liu Quan 
Published: February 2020

Purpose:
To evaluate the outcomes of 4 low laser energy levels after small-incision lenticule extraction (SMILE) surgery.

Setting:
Zhongshan Ophthalmic Center, Guangzhou, China.

Design:
Prospective randomized clinical trial.

Methods:
This study evaluated consecutive patients who had SMILE to correct myopia or myopia with astigmatism. Eyes were placed into groups based on the laser energy used during surgery (ie, 105 nJ, 110 nJ, 115 nJ, or 120 nJ). All patients had a thorough ophthalmic examination preoperative and at 4 timepoints over 3 months postoperatively. Black areas and surface regularity of the extracted lenticules were observed and evaluated qualitatively and quantitatively.

Results:
The study comprised 124 eyes of 62 patients (40 women, 22 men), with 31 eyes in each laser energy group. The incidence of black areas was 45.16% (14 of 31 eyes), 12.90% (4 of 31 eyes), 16.13% (5 of 31 eyes), and 12.90% (4 of 31 eyes) for 105 nJ, 110 nJ, 115 nJ, and 120 nJ, respectively. The mean time for lenticule creation was the longest in the 105 nJ group (P = .015). The greatest increase in corneal thickness postoperatively occurred with 105 nJ (P < .05). Regression was highest in the 105 nJ group at 3 months (P < .01). However, corneal horizontal coma (C8) was lowest in the 105 nJ group at 1 week (P = .032). The lenticular surface in the 110 nJ group was the smoothest (P = .011). All contrast sensitivity values varied with time and recovered to preoperative levels by 1 week or 1 month. In all eyes, the uncorrected distance visual acuity and corrected distance visual acuity were good, with no statistically significant differences between the 4 energy groups.

Conclusions:
The 105 nJ group, in which the lowest energy was used, had the highest risk for black areas, serious postoperative corneal edema, and a significant healing response.
Corneal aberrations measured with a high-resolution Scheimpflug tomographer: repeatability and reproducibility
Authors: McAlinden Colm , Schwiegerling Jim , Khadka Jyoti , Pesudovs Konrad 
Published: February 2020

Purpose:
To evaluate the precision of elevation and wavefront aberration measurements with the Pentacam HR (Oculus Optikgeräte GmbH).

Setting:
Flinders University, Australia.

Design:
Instrument evaluation study.

Methods:
A randomly selected eye of 100 participants was scanned twice with the Pentacam HR by 1 observer on the 3 measurement modes: 25-picture, 50-picture, and cornea fine. A second observer performed 2 scans on the same random eye with the 25-picture mode. Repeatability and reproducibility were assessed using the within-subject SD (Sw) statistic from a 1-way analysis of variance.

Results:
From the 100 scanned eyes, the higher-order aberration root mean square (RMS) repeatability limit

for both elevation and wavefront, and anterior and posterior measurements was 0.03 μm for all 3 measurement modes. Anterior, posterior, and total corneal wavefront Zernike terms were highly precise, with most Zernike terms displaying a repeatability limit of 0.03 μm. The least repeatable measurement was the posterior elevation Zernike term

with the 25-picture scan (repeatability limit 1.50 μm). The cornea fine measurement mode provided the most precise measurements. Reproducibility limits (second observer) were similar to repeatability limits with the 25-picture scan mode.

Conclusions:
The Pentacam HR provided highly precise aberration outputs. The most precise measurements are achievable with the cornea fine measurement mode and wavefront aberrations. One should be cognizant of posterior elevation aberration precision, particularly for lower radial order and higher azimuthal frequency terms. Accounting for tilt and misalignment of aberrations, all RMS and Zernike aberrations were extremely precise (repeatability and reproducibility limit less than 0.000001 μm).
Influence of stereopsis on the ability to perform simulated microsurgery
Authors: Dutton James , Watkins Alice , Henderson Jack , Burgess Frederick R. , Tint Naing L. , Dhillon Baljean , Tatham Andrew J. 
Published: February 2020

Purpose:
To determine whether impaired or absent stereopsis affects the ability to perform simulated microsurgical tasks.

Setting:
University of Edinburgh, United Kingdom.

Design:
Prospective randomized cross-over study.

Methods:
Visual acuity and stereoacuity were measured. A band-pass filter was placed over the nondominant eye to reduce stereoacuity to 150 seconds of an arc (partial stereopsis), or the nondominant eye was completely occluded (absent stereopsis). Participants completed a computerized surgical simulator task 3 times with a randomized testing order (normal stereopsis, absent stereopsis, and partial stereopsis). The task involved using forceps to grasp and position objects in the anterior chamber. Outcomes included area of ocular injury, time to task completion, and overall score.

Results:
Ocular damage area was significantly worse with partial stereopsis (P = .002) and worse still when stereopsis was absent (P < .001 for normal vs absent stereopsis and P = .005 for partial vs absent stereopsis). The median ocular damage area was 3.55 mm2 (interquartile range [IQR], 1.21-5.88 mm2) with normal stereopsis, increasing to 6.10 mm2 (IQR, 3.96-12.47 mm2) with stereopsis reduced to 150 seconds of an arc and to 9.25 mm2 (IQR, 4.93-18.70 mm2) with no stereopsis. Time taken to complete the task increased and overall score decreased as stereopsis was reduced. The overall score decreased from 53% (IQR, 22.5-82%) under normal stereopsis to 0% (IQR, 0-43.5%) with absent stereopsis.

Conclusions:
Impaired stereopsis was associated with worse microsurgical performance, which may have implications for surgical training. The absence of stereopsis resulted in worse performance than partial reduction in stereopsis.