bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives of physicians regarding the role of webinars on medical education during the COVID-19 pandemic
Authors: Odayappan Annamalai , Venkatesh Rengaraj , Tammineni Raveendra , Nachiappan Sivagami , Iswarya Mani 
Published: May 2021

Purpose:
To understand the perspectives of physicians regarding the role of webinars on continuing medical education.

Methods:
An online survey comprising of 34 questions in nine sections was conducted using Google Forms. The link for the questionnaire was shared via e-mail and social media to practicing physicians. The survey accepted responses from September 10, 2020, to September 30, 2020.

Results:
In total, 509 ophthalmologists and 91 physicians from other specialties participated in the survey. The physicians were predominantly employed in nongovernmental institutes (25%) or were in private practice (33.2%). The preference was to attend a weekend webinar (62.8%), in the evening (52.8%), not extending more than 2 hours (97.7%), by ≤3 reputed national speakers (89.8%), each given 15 to 30 minutes for their presentation, and the topic being clinical or surgical skill demonstration (47.5%) or recent advances (39.5%). The residents were perceived to be the most benefited (65.3%). There was an equal preference for watching a webinar live or recorded (50.7% vs. 49.3%). Zoom Video Communications, Inc., was described as the platform that offers the best experience (43.8%). Webinars were considered to be better than conferences or continuing medical education (CME) activities (55.8%). The majority (43.8%) also preferred to get CME credit points by attending paid webinars. However, the broad consensus was that webinars should not completely replace the conferences (42.5%).

Conclusion:
Our survey evaluated the participants’ perspective and the advantages and the disadvantages of a webinar and provides suggestions for the conduct of an ideal webinar with maximum active participation. Future programs would greatly be benefited by this survey.
Orbital and adnexal amyloidosis: Thirty years experience at a tertiary eye care center
Authors: Banerjee Prabrisha , Alam Md. Shahid , Subramanian Nirmala , Kundu Debi , Koka Kirthi , Poonam Nisar Sonam , Mukherjee Bipasha 
Published: May 2021

Purpose:
The aim of this work was to study the clinical presentation, management and outcomes of orbital and adnexal amyloidosis.

Methods:
This retrospective analysis included all the patients diagnosed with orbital and adnexal amyloidosis between January 1990 and December 2019. Positive staining with Congo Red and apple-green birefringence on polarized light microscopy established the diagnosis. Data analyzed included demographic profile, varied presentations, management, and outcome.

Results:
Thirty-three eyes of 26 patients were included. The male:female ratio was 1:1. The mean age of the study population was 42.6 ± 16 years. The median duration of symptoms was two years. Unilateral involvement was seen in 19 eyes (right = 11, left = 8). The most common presenting feature was acquired ptosis. Eyelid was the most commonly affected site followed by orbit and conjunctiva. Two patients had systemic involvement in the form of multiple myeloma and lymphoplasmacytic lymphoma. Complete excision was done in seven (26.9%) cases while 19 (73.1%) cases underwent debulking. Three patients underwent ptosis surgery. The median duration of follow-up was 1.5 years. Three cases had recurrence and underwent repeat surgery.

Conclusion:
Orbit and adnexa is a rare site for amyloidosis. It is usually localized; however it can occur as a part of systemic amyloidosis. Eyelid is the most common site of involvement and patients usually present as eyelid mass or ptosis. Complete excision is difficult and most of the patients usually undergo debulking surgery. All patients should undergo screening for systemic amyloidosis
Drug reservoir function of voriconazole impregnated human amniotic membrane: An in vitro study
Authors: Hazarika Manali , Prajna Namperumalsamy Venkatesh , Senthilkumari Srinivasan 
Published: May 2021

Purpose:
Earlier our group has demonstrated the drug reservoir function of the human amniotic membrane (HAM) using stable moxifloxacin and fortified cefazolin ophthalmic formulations and found it as a suitable tool to deliver drugs for an extended duration. The purpose of this study was to evaluate the extended-release kinetics of voriconazole from the impregnated human amniotic membrane (HAM) in vitro.

Methods:
HAM buttons were incubated with freshly prepared 1% topical ophthalmic formulation of voriconazole for 5 different exposure time to investigate the ideal exposure time for the extended-release of voriconazole from HAM. The drug release kinetics was studied in simulated tear fluid for 5 weeks and the amount of voriconazole released at different intervals was estimated using high-performance liquid chromatography (HPLC) with photodiode array (PDA) detector.

Results:
There was a marginal increase in drug entrapment efficiency with increased drug exposure time but neither the drug entrapment nor the drug release was found to be statistically significant (P ≥ 0.5). Voriconazole was detectable even at 5 weeks.

Conclusion:
A sustained release of voriconazole was achieved up to 5 weeks, when voriconazole was incubated with amniotic membrane for all the studied drug soaking times. Thus, voriconazole impregnated amniotic membrane can be considered for the sustained delivery for its in fungal keratitis.
Perforating ocular trauma due to shotgun pellet - Clinical profile and visual outcome
Authors: Shah Faisal Qayoom , Asif Jasmine , Syed Tariq Qureshi 
Published: May 2021

Purpose:
The aim of this study was to determine visual and anatomical outcome of perforating injuries due to shotgun pellet.

Methods:
This was a prospective observational study carried out between July 2016 and Jan 2019 at a tertiary care referral center in Srinagar, Jammu and Kashmir. A total of 172 eyes with perforating injuries of 170 patients were included in the study and were followed up for 6 months with best-corrected visual acuity, slit-lamp examination for status of anterior chamber and lens, fundus examination for status of retina and media, intraocular pressure measurements, and OCT (optical coherence tomography) and FFA (fundus fluoresceine angiography) in selected cases. The relative improvement of visual acuity after treatment was interpreted by applying paired two-tailed t tests. Prognostic significance of other variables was calculated using Chi-square and Chi-square for linear trend tests, for two dependent outcome variables of good outcome and poor outcome.

Results:
WHO category 4 visual impairment was found in 66 (38.4%) eyes, whereas category 0 was found in 24 (14%) of eyes. Retina was found to be attached 99 (57.6%) of study eyes.

Conclusion:
Perforating injury is a severe form of ocular trauma with grave consequences in terms of functional and anatomical outcome.
Ocular manifestation of rickettsial disease in South Indian population
Authors: Ganekal Sunil , Singnal Kruthika , Rajappa Suresha , Hegde Sharat 
Published: May 2021

Purpose:
The aim of this work was to study the ocular manifestations and its management in spotted fever and typhus group of rickettsial disease.

Methods:
A retrospective analysis of 50 patients with serologically confirmed Rickettsial disease. In all patients, relevant history, investigations and treatment details were collected and they underwent complete ophthalmic evaluation including measurement of best-corrected visual acuity, anterior segment examination and dilated fundus examination.

Results:
Mean age was 12.5 ± 8.99 years. Of the 50 patients, 40 patients were ≤18 years of age and 27 (54%) had ocular involvement. Out of 27 patients, bilateral involvement was seen in 10 patients. Most of the patients had no ocular symptoms. Ocular findings included, Retinal vasculitis 6 (22.22%); macular edema 4 (14.81%); vasculitis with macular edema 1 (3.7%); Retinitis 7 (25.92%); Papilloedema 6 (22.22%); Papilloedema with 6th cranial nerve palsy 1 (3.7%); Isolated 6th cranial nerve palsy 1 (3.7%) and optic neuritis 1 (3.7%). Ocular involvement was more common in double antigen group (68%) than spotted fever group (50%) or Scrub typhus group (21%) (P = 0.01). Ocular involvement was seen in 94% of the patients with CNS involvement. Cases with bilateral involvement (P = 0.01), pediatric age group (P = 0.01) and CNS involvement (P = 0.02) had poor visual outcome.

Conclusion:
Rickettsioses patients can have ocular manifestations with predominant posterior segment involvement during acute phase of illness. Ocular involvement was more common in the double antigen group. For any patient who presents with fever and rash living in endemic area, ophthalmic evaluation should be part of routine checkup during the acute phase of illness associated with less frequent ocular symptoms.
Delayed postoperative opacification of three hydrophobic acrylic intraocular lens: A scanning electron microscopic and energy dispersive spectroscopic study
Authors: Bhattacharjee Harsha , Buragohain Suklengmung , Javeri Henal , Das Dipankar , Bhattacharjee Kasturi 
Published: May 2021

Purpose:
The aim of this study was to report scanning electron microscopic (SEM) and energy dispersive spectroscopic (EDS) findings of three specimens of opaque hydrophobic acrylic intraocular lens (IOL) explanted in delayed postoperative period for visual indications.

Methods:
Clinical data and photographs from each subject were obtained. Explanted IOLs were examined under gross and light microscopy followed by SEM coupled with EDS.

Results:
All three subjects underwent IOL implantation following senile cataract extraction at an average age of 64.3 ± 0.3 years, and the IOLs were in situ for a duration of 11.3 ± 4.04 years. The IOL explantation and exchange were done due to late postoperative opacification of the IOL and significant visual deterioration. The milky iridescent opacity affected the full thickness of IOL optics in the first two specimens and in the third only two surfaces were involved. SEM detected surface cracks in the first specimen, typical conglumated surface, pores and accumulation of crystals with surface deposit of nano-particles on the second specimen and uneven surface erosion in the third specimen. SEM detected mainly sodium (Na) and chloride (Cl) spikes. All patients recovered normal vision following IOL exchange.

Conclusion:
SEM features of the IOL optics and absence of calcium and phosphate spikes in EDS and other findings were consistent and suggestive of hydrolytic biodegradation of hydrophobic acrylic IOL polymer in ocular media and was responsible for delayed postoperative opacification of the hydrophobic IOLs and visual loss.
Overcoming challenges in implementing measures across multiple centers of a chain of hospitals to combat COVID-19 pandemic
Authors: Singh Mandeep J , Verma Deepika , Banerjee Tirtha B , Singh Ankita , Bhatt Kanika 
Published: May 2021

Purpose:
Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Post declaration, India announced lockdown and various guidelines were issued by Health authorities worldwide for the organizations to function in this emergency aeon. Different organizations strategized differently to respond to COVID 19 pandemic. The aim was to implement COVID 19 guidelines across all the centres of a chain of Eye hospitals in India in short span of time overcoming the challenges.

Methods:
A SMART strategy was confabulated within the team. There were numerous challenges like lack of time, rapidly changing guidelines, no travelling scenarios, training and educating the staff in huge numbers, rapidly evolving situation, change management, need of increased vigilance, and language barrier at certain centres, sustaining quality assurance and motivating the staff in stressful times. The challenges were surpassed using a power packed strategy, dedicated efforts and team work grasping the available tools and technology from a single location. This template can serve us and other hospitals to respond in a better way for similar future challenges.

Results:
The COVID 19 protocols were implemented across all the centres successfully. The entire Quality assurance system drifted to online platform and education and awareness methods took the digital thread. Teamwork synergized with the aforementioned things and we came out with flying colours achieving the goals in short span of time overcoming all the barriers.

Conclusion:
Difficult times bring challenges and challenges teach us the innovative ways to convert them into opportunities. A well planned strategy, best utilization of available resources, team work and continuous monitoring can bring the best outcomes forward.
Retinoblastoma in twins: Risk assessment of genotypic variants
Authors: Raval Vishal , DeBenedictis Meghan , Bowen Randy , Soto Hansell , Davanzo Jacquelyn , Singh Arun 
Published: May 2021

Purpose:
To describe methods of risk assessment in twins with retinoblastoma (RB).

Methods:
A case series of four RB probands with a twin sibling. Family status, clinical presentation, and RB1 germline status-based risk assessment were analyzed.

Results:
Two pairs had a positive family history (unilateral and bilateral RB in one of the parents (#1 and #2, respectively) and two pairs (#3 and #4) were sporadic. One of the familial twins (#1) had a high risk (90%) of manifesting RB in the twin. The other case (#2) with an absent RB1 germline mutation in the twin had a 0% risk of developing RB. Among sporadic cases of twins (#3), genetic testing did not identify a germline mutation (tumor sample unavailable) in the proband which downgraded the risk of germline mutation from 15% to <1%. The twin never developed RB (5 years of age at last follow-up). Pathogenic mosaicism for germline RB1 mutation (c.1723C>T) could be identified (tumor tissue available) in the proband (# 4). Identical germline mutation (and RB tumor) was also noted in the twin. In each case, there was concordance between the assessed risk and manifestation of RB.

Conclusion:
Assessment of risk of RB in a twin presents with a unique challenge. Depending upon the genotype variant, the risk of developing RB can vary from 0% to 90%. In addition to family history, clinical manifestation in the proband, zygosity status, and RB1 germline status are critical in formulating risk-appropriate surveillance guidelines.
Assessment of a software guided system to reduce pre-existing astigmatism in cataract surgery
Authors: Raut Rajeev M , Jeswani Kumud D , Raut Madhuri R , Raut Bhargav R 
Published: May 2021

The aim of this pilot study was to assess the astigmatism after small incision cataract surgery by use of a novel software guided surgical technique. The software system guides the surgeon toward a hypothetical shape of the cornea. When this shape is achieved, the vertical meridian is relaxed and the incision does not produce any astigmatism. How that hypothetical shape is to be achieved by the surgeon is described. If preoperative astigmatism exists, the hypothetical shape calculated by the system takes that into account. This enables the surgeon to reduce preexisting astigmatism, without having to change the site or size of the standard 6 mm 12 o clock incision of SICS.

Results:
Results indicated that preoperative astigmatism reduced in 11 out of 14 cases at the end of 8 weeks, remained unchanged in one, and increased by less than 0.5D in two cases. This proves the hypothesis that the vertical corneal meridian is under higher tension and relaxing it by flattening the perpendicular meridian has a reducing effect on postoperative astigmatism.
Fundus evaluation in COVID-19 positives with non-severe disease
Authors: Bypareddy Ravi , Rathod B L Sujatha , D Shilpa Y , R Hithashree H , Nagaraj Kalpana Badami , C Hemalatha B , Basumatary Jessica , Bekal Deeksha , R Niranjan , G Anusha P 
Published: May 2021

Purpose:
The aim of this work was to study and document retinal changes in coronavirus disease-2019 (COVID-19) positive patients with nonsevere disease using a nonmydriatic handheld fundus camera.

Methods:
A cross-sectional observational study was conducted on patients affected by COVID-19 who were admitted at our center. Our study included patients with no, mild, and moderate symptoms (nonsevere cases). Intensive care unit (ICU)-admitted patients were excluded considering the difficulty in procuring the fundus image by the handheld camera due to patients positioning. Patients with systemic conditions (diabetes, hypertension, and severe anemia) known to cause retinopathy were also excluded. Bedside anterior segment examination, fundus examination using indirect ophthalmoscopy and fundus imaging of each patient using a nonmydriatic handheld fundus camera was done by a trained ophthalmologist posted for COVID duty.

Results:
In a cohort of 138 patients, 94 (68.1%) were men and 44 (31.9%) were women. A total of 276 eyes were evaluated. The mean age of the patients was 38.51 ± 14.4 years. Anterior segment evaluation showed no abnormality in any of the eyes. On fundus screening using nonmydriatic handheld camera, a single streak of superficial retinal hemorrhage was noted at the posterior pole of the fundus in the left eye of one patient (0.72%), which was away from fovea. Laboratory tests revealed low hemoglobin (between 10 and 10.9 g/dL falling under mild Anemia) in 12 patients, elevated total leucocyte count in 6 patients, raised LDH in majority of patients (323 ± 101 Units/L) and elevated CRP (14.6 ± 30.99 mg/L). Rest of the lab parameters were within the normal range.

Conclusion:
In our study, COVID patients with mild-to-moderate symptoms did not show any inflammatory/infective or vaso-occlusive lesions in the retina attributable to COVID-19 infection, except one patient who had a single streak hemorrhage in the macula away from fovea, probably incidental.
COVID-19 and ophthalmology: A scientometric analysis
Authors: Kalra Gagan , Kaur Rishemjit , Ichhpujani Parul , Chahal Rutvi , Kumar Suresh 
Published: May 2021

Purpose:
Coronavirus disease pandemic has impacted global healthcare tremendously and ophthalmology is one of the high-hit specialties. An increasing number of research items are upcoming with COVID-19-related research in ophthalmology and this report aims at performing a scientometric analysis of all the available research pertaining to COVID-19 and ophthalmology.

Methods:
A Web of Science (https://webofknowledge.com) query TS = (“novel coronavirus 2019” OR “coronavirus 2019” OR “COVID 2019” OR “COVID 19” OR “nCOV” OR “SARS-CoV-2” OR “COVID-19”) AND WC = (“Ophthalmology”) was deployed on February 22, 2021, to retrieve all research items on the topics of interest. R software (v4.0.1) with Bibliometrix library was deployed to visualize metrics to quantify geographical distribution, source metrics, author metrics, document metrics, and keyword metrics.

Results:
A total of 616 research items appeared in our search results that were drafted by 2398 authors and published in 63 sources. India, USA, UK, and China had the greatest number of research items among others. Indian Journal of Ophthalmology, Eye, and Graefe’s Archive for Clinical and Experimental Ophthalmology were sources with greatest number of research items. Documents per author were 0.257 and authors per document were 3.89. The collaboration index was noted to be 4.28.

Conclusion:
Our scientometric analysis presents descriptive quantitative metrics for COVID-related research in the field of ophthalmology and provides evidence for the increased global collaboration that global researchers have fostered to fight this pandemic.
Pediatric cataract surgery practices in the COVID-19 era: Perspectives of a tertiary care institute in Northern India
Authors: Gupta Parul Chawla , Sukhija Jaspreet , Khurana Surbhi , Kaur Savleen , Korla Shagun , Valliappan Abinaya , Ram Jagat 
Published: May 2021

Purpose:
To discuss the impact of COVID-19 pandemic on the pediatric cataract surgery services in a tertiary care institute in India, as well as the protocol followed for these surgeries.

Methods:
COVID-19 has hampered outpatient and elective services and surgeries throughout the world. During the national lockdown imposed in March in India, outpatient services were suspended in our institute, leading to a tremendous backlog of pediatric patients with cataract. Since the delay in surgery in pediatric cataract can cause amblyopia, our institute had resumed pediatric cataract surgeries in June 2020 at the time of Unlock-1 in the country.

Results:
We have discussed the percentage of reduction in pediatric cataract surgeries in 2020 during the Unlock 1, 2, 3, and 4, as compared to the number of surgeries done by the pediatric ophthalmology unit in the same months last year. We had introduced triage and telemedicine in our department. We have discussed the preoperative, intraoperative, and postoperative protocol followed in our institute for children with pediatric cataract, and also the measures which can be taken for the safety of patients and staff.

Conclusion:
It is essential to ensure COVID-19 protocol, i.e., wearing a mask, social distancing, and frequent hand hygiene, among the patients and health care personnel. Redesigning pediatric cataract surgery practices is essential to ensure the safety of the health care workers and the patients.
A novel approach to anterior segment imaging with smartphones in the COVID-19 era
Authors: Dutt Sreetama , Vadivel Siva S , Nagarajan Shanmuganathan , Galagali Amrutha , Christy Josephine S , Sivaraman Anand , Rao Divya Parthasarathy 
Published: May 2021

Purpose:
To report a novel, telemedicine-friendly, smartphone-based, wireless anterior segment device with instant photo-documentation ability in the COVID-19 era.

Methods:
Anterior Imaging Module (AIM) was constructed based on a 50/50 beam splitter design, to match the magnification drum optics of slit-lamps with a three-step or higher level of magnification. The design fills the smartphone sensor fully at the lowest magnification and matches the fixed focus of the slit-lamp. It comes with a smartphone for instant photo-documentation, an in-built software application for data-management and secure HIPAA compliant cloud storage, and a Bluetooth trigger for a one-tap image capture. The construction of the device is explained, and the optical resolution measured using U.S. air-force resolution test. AIM’s performance was characterized with traceability to internationally relevant performance standards for digital slit-lamps after image quality assessment through a pilot study.

Results:
Clinically useful anterior segment images were obtained with both diffuse and slit illumination at different magnification settings with the highest magnification (40X) resolution of 359 lines per cm and the lowest magnification (16X) resolution of 113 lines per cm.

Conclusion:
AIM is a novel, wireless, telemedicine-enabled design that digitizes existing, analog slit lamps with at least three-step magnification. The settings ensure the focus is determined purely by the position of the slit-lamp. Hence, the image viewed and captured on the smartphone is exactly what the clinician sees through the eyepiece. This helps in maintaining distance from the patient in the ongoing COVID-19 pandemic, as well.