bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a structured training program to enhance skills in phacoemulsification surgery
Authors: Bhatt Anuprita Gandhi , Dole Kuldeep S , Deshpande Madan , Bharucha Khurshed , Kalyani VKS 
Published: November 2021

Purpose:
The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases.

Methods:
This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done.

Results:
Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1.

Conclusion:
A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.
Does size of telangiectasia on optical coherence tomography angiography influence vision in eyes with type 2 macular telangiectasia?
Authors: Kelkar Aditya S , Kelkar Jai A , Tidke Sayali , Agarwal Aanchal , Bolisetty Mounika , Kelkar Shreekant 
Published: November 2021

Purpose:
To study the influence of dimensions of macular telangiectasia (MacTel) on enface optical coherence tomography angiography (OCTA) on vision and clinical parameters in eyes with MacTel type 2.

Methods:
MacTel was classified based on OCTA location, i.e. either temporal to the fovea (grade 1), or spread nasally (grade 2), or circumferentially (grade 3), or the presence of neovascular-like tissue in the outer retina–choriocapillary complex (ORCC) (grade 4). On enface images, the maximum dimensions of the MacTel in the deep plexus were noted using calipers by a single experienced observer.

Results:
Ninety-eight eyes of 49 patients with MacTel with a mean visual acuity was 0.46 + 0.26 logMAR and mean macular thickness of 202 ± 132 μ were included. Based on OCTA, grade 3 MacTel (n = 35, 36%) was the commonest followed by grade 4 (n = 28, 29%). The mean maximum vertical diameter of the MacTel was 2019 + 753 μ, and every 500 microns increment in vertical diameter of the MacTel was associated with a half-line drop in vision (95%CI = 0.005 to 0.08 logMAR, P = 0.03). Vision gradually reduced with increment in OCTA grades of MacTel from grade 1 to 3; however, the trend was not maintained in grade 4 MacTel, which showed better vision and lesser degenerative cysts.

Conclusion:
Larger telangiectasias were associated with significantly lower vision in MacTel. Eyes with deeper telangiectasia involving ORCC have better vision and evidence of far lesser neurodegeneration than type 3 disease, suggesting that this may not be part of the continuum and does not represent neovascularization.
Short tear film breakup time-type of dry eye in India
Authors: Chatterjee Samrat , Agrawal Deepshikha 
Published: November 2021

Purpose:
The aim of this study was to describe the clinical characteristics and risk factors of short tear film break-up time (TBUT) type of dry eye disease and compare it with other types of dry eye diseases.

Methods:
This cross-sectional study included 570 patients (≥ 20 years) from the outpatient department using systematic random sampling.

Results:
The age-adjusted prevalence of short TBUT type of dry eye disease was 5.4% (95% confidence interval: 3.2–6.8%). There was no difference (P > 0.05) between the total and subscale scores of the Ocular Surface Disease Index® questionnaire between patients with short TBUT and those with aqueous tear deficiency. Both these groups differed significantly (P < 0.05) in the findings of TBUT, Schirmer I test, and Lissamine green staining score. The common symptoms in patients with short TBUT type of dry eye disease were eye fatigue (25.4%), heaviness in the eye (19.7%), and an uncomfortable sensation (14.1%). The symptoms in the aqueous tear deficiency group were light sensitivity (28.2%), dryness (19.2%), burning (13.0%), foreign body sensation (12.8%), and blurring of vision (14.1%). The risk factors associated with short TBUT type of dry eye disease were the presence of meibomian gland dysfunction (odds ratio: 3.759 [95% confidence interval: 2.135–6.618], P < 0.0001) and female sex [odds ratio: 1.954 (95% confidence interval: 1.042–3.667), P = 0.037].

Conclusion:
Patients with short TBUT type of dry eye disease have symptom severity similar to aqueous tear-deficient dry eyes, but the pattern is different. The finding of this type of dry eye disease in India indicates its global presence, and ophthalmologists should consider it in their differential diagnoses.
Development and validation of competency framework for teaching management of refractive errors: A participatory Delphi approach
Authors: Rajhans Vidyut , Ve Ramesh S , Mohammad Ciraj Ali , Rege Sumita 
Published: November 2021

Purpose:
Competency-based education and assessment are globally trending, also embraced by recently announced National education policy 2020, India. Medical programs are rapidly transforming to produce competent health professionals, to satisfy public health requirements. This paper describes Delphi study with a participatory approach, to develop a competency matrix required for training of eye care professionals.

Methods:
Scoping review of literature formulated the baseline architecture of competency framework identifying two core competencies for management of refractive error, namely, “visual function assessment” and “optical technology management.” The Delphi technique was employed for the development of a competency matrix with detailed knowledge, skills, and attitude (KSA) definitions for all competency elements. A heterogeneous group including optometry practitioners, academicians, researchers, association representatives, and industry representatives accomplished the objective in four rounds.

Results:
Delphi study resulted in defining two competency clusters (CC): “CC1: Refraction” with 10 units and 43 elements and “CC2: Dispensing optics” with 8 units and 54 elements. KSA components of each of competency elements were identified and mapped with applied optics curriculum in the optometry program.

Conclusion:
Participation of all stakeholders of the educational system is essential and beneficial for nurturing of the competent workforce in healthcare. It helps build a curriculum not only having theoretical knowledge and skills but also the attitude and behavioral component of measurable competencies that satisfies the needs of the local healthcare system. This study has evolved a comprehensive competency matrix highlighting essential competencies required for the effective management of refractive error.
Modified posterior drainage of post-operative suprachoroidal hemorrhage
Authors: Boral Subhendu Kumar , Agarwal Deepak 
Published: November 2021

Purpose:
To study the anatomical and functional outcomes of trans-conjunctival 23G or 25G cannula-guided modified posterior passive drainage of post-operative suprachoroidal hemorrhage (SCH).

Methods:
A retrospective study was done on 15 eyes in the last nine years. Vitrectomy with perfluorocarbon liquid injection to push SCH from inside along with 23G or 25G cannula-guided passive drainage of SCH was performed by making multiple sutureless posterior sclerotomies at 10–15 mm behind the limbus. Postoperatively, best corrected visual acuity (BCVA), intraocular pressure (IOP), and posterior segment findings were compared from pre-operative findings.

Results:
Mean age at presentation was 64.93 ± 7.62 years. Complete resolution of SCH with attached retina was achieved in 60% (9/15) of cases. Mean pre-operative BCVA of Log MAR 2.82 ± 0.21 improved to mean post-operative BCVA Log MAR 1.04 ± 0.53 (P < 0.001). Mean pre-operative IOP of 27.87 ± 8.67 mmHg improved significantly to post-operative IOP of 10.2 ± 5.16 mmHg (P < 0.001). Silicone oil removal was possible in 11/15 (73.33%) cases.

Conclusion:
Posterior passive drainage of post-operative SCH by multiple sclerotomies using 23G or 25G cannulas can salvage these eyes with both anatomical and functional recovery.
Short-term changes of cornea and tear film after ruthenium-106 plaque therapy for intraocular tumors
Authors: Aghaei Hossein , Sedaghat Ahad , Abolfathzadeh Navid , Mirshahi Reza , Manafi Navid , Afshar Reza Kiaee , Naseripour Masood 
Published: November 2021

Purpose:
Plaque therapy is a well-recognized treatment for intraocular tumors. In current study, we aimed to prospectively investigate the short-term effects of ruthenium 106 (Ru-106) plaque therapy on the cornea and ocular surface parameters.

Methods:
Twenty-five patients diagnosed with choroidal melanoma which undergone Ru-106 plaque therapy from 2016 to 2018 were included. Tear osmolarity, tear film break-up time, Schirmer test I, fluorescein dye staining based on Oxford staining method; Ocular Surface Disease Index (OSDI) questionnaire and corneal specular microscopy were performed. These tests were assessed preoperatively and then 3 months postoperatively.

Results:
The mean (±SD) age of subjects was 48.52 ± 15.18 years. The patients were followed for a mean(±SD) period of 3.64 ± 2.40 months. Total mean (+SD) delivered radiation dose to the tumor apex and total received radiation by the sclera was 83.20 ± 26.31 and 640.65 ± 472.69 Gray (Gy), respectively. In longitudinal analysis, OSDI score and Oxford staining score increased significantly (P = 0.002 for both variables) and the prevalence of dry eye disease (DED) increased from 20% preoperatively to 72% at 3 months postoperatively (P = 0.001).The changes in the all specular microscopy parameters were statistically nonsignificant (all P values > 0.05).

Conclusion:
There is a considerable increase in the rate of DED following plaque therapy for the treatment of choroidal melanoma in short-term follow-up. The OSDI questionnaire and fluorescein staining test are valuable tools for early detection of DED postoperatively.
Evolution of corneal epithelial remodeling after myopic laser in situ keratomileusis surgery measured by anterior segment optical coherence tomography combined with Placido disk
Authors: Díaz-Bernal José , García-Basterra Ignacio , Mora-Castilla José , Nguyen Annie , Fernández-Barrientos Yolanda , Guerrero Antonio M 
Published: November 2021

Purpose:
To investigate patterns of short- and long-term variations in corneal epithelial thickness (CET) after myopic laser in situ keratomileusis (LASIK) using anterior segment optical coherence tomography (AS-OCT) combined with Placido disk-based topography.

Methods:
In this retrospective study, 36 subjects (72 eyes) who underwent LASIK myopic surgery and 53 healthy subjects (106 eyes) who served as controls were enrolled. AS-OCT (MS-39) was performed in all patients before, 1 day, 1 month, and 6 months after surgery. Statistical analysis was performed to analyze CET changes over time after LASIK and to detect patterns of definitive CET remodeling compared to healthy subjects. Multivariate analysis was performed to look for possible predictors of final CET.

Results:
There was no statistically significant difference between groups in terms of demographic and anterior segment parameters (all P > 0.05). After LASIK, all sectors and rings got thicker over time (1.62–8.32 μm; P < 0.01). Except for the central sector, all areas achieved the thickest CET value one day after surgery with a progressive epithelial thinning between 1 and 6 months of follow-up. Changes on CET occurred independently of the grade of myopia before LASIK or final refraction (P > 0.05). None of the clinical variables studied, including diopters corrected, were found to be correlated with final CET (P > 0.05).

Conclusion:
Independent of anterior segment parameters and diopters corrected, CET becomes thicker after LASIK surgery. Central and inner ring sectors thicken more than those more peripheral. CET remodeling after myopic LASIK should be taken into consideration when planning refractive surgery.
Peripapillary changes after vitrectomy and silicone oil tamponade for rhegmatogenous retinal detachment
Authors: Jiang Jian , Li Rui , Zhou Jin-Xiu , Li Rui-Mei , Wang Rui-Hua , Wang Xia-Ping , Dou Ran , Jia Ya-Ding , Li Shuang-Nong , Chen Song 
Published: November 2021

Purpose:
To evaluate the peripapillary changes after vitrectomy and silicone oil (SO) tamponade in eyes with rhegmatogenous retinal detachment (RRD).

Methods:
In this study, 25-gauge vitrectomy with SO tamponade was performed in 22 eyes with RRD. The radial peripapillary capillary (RPC) vessel density (VD) and retinal nerve fiber layer thickness (RNFLT) were assessed by optical coherence tomography angiography at 2, 4, 8, and 12 weeks postoperatively. The values of healthy fellow eyes were used as controls.

Results:
The global RPC VDs were significantly lower in the eyes with RRD than in fellow healthy eyes at 2 weeks (P < 0.001), and increased at 4 weeks, then decreased over time after surgery (F = 1.046, P = 0.377). The RPC VDs in the superior-hemifield were lower than those in the inferior-hemifield at 12 weeks postoperatively (t = −2.844, P = 0.010). The global RNFLTs decreased gradually after vitrectomy in the eyes with RRD (F = 1.312, P = 0.276). The RNFLTs in the superior-hemifield were thinner than those in the inferior-hemifield at 12 weeks postoperatively (t = −2.222, P = 0.037). The global, superior, and inferior RNFLTs were correlated with corresponding RPC VDs in the eyes with RRD at all time-points postoperatively (P < 0.05).

Conclusion:
RRD resulted in the decrease of RPC VDs. The RPC VDs recovered in the early postoperative period but were still lower than the normal level. Long-term application of SO tamponade resulted in the reduction of peripapillary VDs secondary to loss of RNFLTs.
Clinical profile and demographic distribution of pellucid marginal corneal degeneration in India: A study of 559 patients
Authors: Das Anthony V , Pillutla Lalitha N , Chaurasia Sunita 
Published: November 2021

Purpose:
The aim of this study was to describe the clinical profile and demographic distribution of pellucid marginal corneal degeneration (PMD) in patients presenting to a multitier ophthalmology hospital network in India.

Methods:
This cross-sectional hospital-based study included 2,470,793 new patients presenting between September 2012 and September 2020 (~8 years period). Patients with a clinical diagnosis of PMD in at least one eye were included as cases. The data were collected using an electronic medical record system.

Results:
Overall, 559 (0.02%) new patients were diagnosed with PMD. The prevalence rates were 0.004% in children (age <16 years) and 0.03% in adults. The majority of patients were males (70.13%) with the bilateral affliction (77.1%). The mean age of the patients was 37.91 ± 13.19 years. The majority (30.23%) of the patients were between 31 and 40 years of age. A significant number of patients were from higher socioeconomic status (93.74%) and from the urban region (45.08%). Of the 990 eyes, the most common clinical signs were ectasia/thinning (58.99%), corneal scar (17.47%), and corneal hydrops (1.01%). The majority of the eyes (87.97%) were managed with either spectacles or contact lenses. Among those who had surgical intervention, collagen cross-linking was the most performed procedure (5.25%) followed by cataract surgery (4.14%).

Conclusion:
PMD is a rare disease affecting patients seeking eye care in India. It commonly affects adult males and is bilateral in nature. The disease progression is slow and usually occurs beyond 3 years. Conservative management is more common than surgical intervention.
Prevalence of chronic disease in older adults in multitier eye-care facilities in South India: Electronic medical records-driven big data analytics report
Authors: Behera Umesh Chandra , Salzman Brooke , Das Anthony Vipin , Prashanthi Gumpili Sai , Lalakia Parth , Derman Richard , Panigrahy Bharat 
Published: November 2021

Purpose:
To study the prevalence of systemic conditions in older adults, either self-reported or discovered during routine eye examinations, at multitier eye-care facilities over the past decade, and to explore their association with vision and common ocular disorders, including cataract, glaucoma, and retinopathy.

Methods:
Retrospective review of a large data set compiled from the electronic medical records of patients older than 60 years who presented to an eye facility of a multitier ophthalmology network located in 200 different geographical locations that included urban and rural eye-care centers spread across four states in India over a 10-year period.

Results:
618,096 subjects aged 60 or older were identified as visiting an eye facility over the 10-year study period. The mean age of the study individuals was 67·28 (±6·14) years. A majority of older adults (66·96%) reported being free of systemic illnesses. Patients from lower socioeconomic status had a lower prevalence of chronic systemic disease, but the presenting vision was poorer. Hypertension (21·62%) and diabetes (18·77%) were the most commonly reported chronic conditions in patients who had concomitant systemic illness with visual concerns.

Conclusion:
The prevalence of chronic systemic illnesses in older adults presenting to multitier eye-care facilities is relatively low, except in those with diabetic retinopathy. These observations suggest a need to include active screening for common chronic diseases in standalone eye-care facilities to achieve a more accurate assessment of chronic disease burden in the older population.
Outcome of large angle exotropia treated by single stage adjustable strabismus surgery with monitored conscious anesthesia
Authors: Asafali Fasna , Rajamani Muralidhar , Periannan Chidambaram , Michael Sekar , Dandapani Ramamurthy 
Published: November 2021

Purpose:
To evaluate the outcomes of large-angle exotropia by single-stage adjustable strabismus surgery (SSASS) under monitored conscious anesthesia.

Methods:
A prospective study was done in 33 patients above 14 years with ≥40 prism diopters (PD) of exotropia. All patients underwent SSASS under monitored conscious anesthesia (topical anesthesia plus intravenous sedation). For deviations of ≤55 PD, two horizontal rectus muscles, and for >55 PD, three rectus muscles were operated and a decision on adjustment/operating on an additional rectus muscle was taken after assessing the alignment. Monitored conscious anesthesia allowed us to check our results after surgery and plan further surgery/adjustment to achieve the desired alignment.

Results:
Mean preoperative deviation for distance was 52 ± 11.1 PD. The target alignment was achieved with the initial surgical plan in 10/21 patients with <55 PD exotropia and 4/12 patients with >55 PD exotropia, and one patient in each group needed adjustment. The remaining patients needed additional rectus muscle surgery. One patient with >55 PD exotropia needed both adjustment and additional rectus surgery. The success rate for distance correction was 85% at 6 months and 1 year. The overall success rate was 71% at 6 months. Percentage of patients with binocular single vision improved from 31% preoperatively to 78% by 6 months. Incidence of oculocardiac reflex was 6.1%.

Conclusion:
SSASS under monitored conscious anesthesia is a viable option for large-angle strabismus correction with good patient comfort and safety.
Role of Maternal Nutritional Supplementation on the Hormonal Profile and Immunohistochemical Analysis of Testicular Development of Fetal Rats
Authors: Kusemiju Taiwo O. , Afolayan Olasunmbo O. , Ogunlade Babatunde 
Published: November 2021

Introduction:
This study elucidated the role of maternal microelement supplementation on fetal testicular development.

Materials and Methods:
Twenty-eight Wistar rats (21 females and 7 males) were randomly divided into seven groups comprising three females to one male: Group A – standard feed and water; Group B – diet deficient in all the micronutrients (Fe, Cu, Se) and water; Group C – diet fortified with 0.2 mg/kg of selenium and water; Group D – diet enriched with 40 mg/kg of iron and water; Group E – diet fortified with 8 mg/kg of copper and water; and Group F – diet enriched with all nutrients and water. All administration was via oral gavage; thereafter, animals were sacrificed at day 20 of pregnancy. Placenta measurements, testes, and blood serum were obtained for analysis.

Results:
The results showed statically a significant decrease (p<0.05) in placental and fetal weight (WPF), the distance between fetus and mother (DFM), the concentration of trace elements; FSH and LH levels among chaff only group when compared to the Control group. Testicular histomorphology and immunohistochemical studies of the animals in the chaff alone diet showed mild fetal Leydig cells in the interstitium, primitive germ cells in the testicular cord, pre-Sertoli cell necrosis, and decreased positive expression compared with the control.

Conclusion:
Administration of single and combined doses of nutritional supplements diet significantly preserved the fetal parameters, hormone profile, and histochemical analysis of the testis.