bluuebunny/crossref_metadata_2025_split huggingface dataset:
Topical 0.1% Adapalene Gel Versus 0.1% Adapalene and 2.5% Benzoyl Peroxide Combination Gel in the Treatment of Mild-to-Moderate Acne Vulgaris
Authors: Amrutha Madai Puthiyaveedu , Bifi Joy , Anoop Thyvalappil , Ajayakumar Sreenivasan , Radhakrishnan K. , Rajiv Sridharan 
Published: June 2021

Introduction:
The combination of adapalene (ADA) benzoyl peroxide (BPO) offers a safe and effective alternative avoiding long-term antibiotic use in the management of acne vulgaris.

Aims:
The aim of this study was is to compare the clinical efficacy and tolerability of 0.1% ADA with combination of 0.1% ADA and 2.5% BPO in the treatment of mild-to-moderate acne vulgaris.

Methods:
All patients were instructed to apply the given topical medications to whole face, excluding lips and eyelids, once a day at night after washing and moistening the facial skin. Follow-up was done once every 4 weeks up to 12 weeks from the start of treatment. Efficacy of treatment arms was assessed by 4 parameters, namely percentage change of total lesion counts (TLCs), Acne severity index, success rate, and response rate. Statistical analysis was performed using the SPSS software version 16.0. Data were analyzed using the Chi-square test, Fisher's exact test, and Mann–Whitney U test. P < 0.05 was considered to indicate statistical significance.

Results:
Thirty-eight patients were in Group A (ADA-BPO) and 38 patients in Group B (ADA alone). At the end of 12 weeks, Group A had significantly less TLC as well as significant percentage change in total lesions than Group B. Group A was significantly better than Group B in TLC response rate also.

Conclusions:
The combination gel of 0.1% ADA and 2.5% BPO was superior to 0.1% ADA gel in terms of efficacy. Tolerability was comparable for both the drugs.
Optic disc morphology in primary open-angle glaucoma versus primary angle-closure glaucoma in South India
Authors: Parikh Rajul , Kitnarong Naris , Jonas Jost B , Parikh Shefali R , Thomas Ravi 
Published: June 2021

Purpose:
The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians.

Methods:
A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs.

Results:
The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20).

Conclusion:
In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG.
Is the high contrast visual acuity chart a good predictor of improvement in visual acuity with low vision aids?
Authors: Sahu Anupam , Agrawal Deepshikha , Bhatia Priyavrat 
Published: June 2021

Purpose:
To assess whether the objective improvement seen with HCVA chart using LVAs correlates with subjective improvement in the quality of life as measured on low vision quality of life (LVQOL) questionnaire of such patients.

Methods:
This was a prospective, consecutive, observational study. Objective improvement in visual function was assessed using LVAs with high contrast LogMAR visual acuity chart for near and distance. Subjective improvement for distance was assessed using LVQOL score for “distance mobility and lighting”, whereas for near it was assessed using the LVQOL score for “near and fine work”. A total of 46 patients completed one follow-up after low vision trial and were included in the study.

Results:
Improvement in objective visual acuity was highly significant for both near and distance (P < 0.001) with LVAs. LVQOL score improved from 65.85 to 76.83 after one of using low vision aids (P < 0.001). The improvement in LVQOL score for distance and mobility was also highly significant (2.55; P < 0.001); and so was for near and fine work (5.89; P < 0.001). However, Spearman rank correlation coefficient showed no correlation between improvement in visual acuity for distance and LVQOL score improvement for distance (r
s = –.086; P = 0.57). For near also, improvement in acuity did not correlate with the LVQOL score improvement for near and fine work (r
s = 0.036; P = 0.81).

Conclusion:
No statistical correlation was observed between the improvements measured by objective HCVA charts and subjective improved as perceived by the patient after use of low vision devices.
High power custom toric intraocular lens for correcting high corneal astigmatism in post-keratoplasty and keratoconus patients with cataract
Authors: Reddy J K , Pooja C M , Prabhakar G V 
Published: June 2021

Purpose:
To analyze the outcomes of phacoemulsification with high power customized toric intraocular lens implantation (IOL) in patients with high corneal astigmatism (6-10 D Cyl) post keratoplasty and keratoconus eyes with cataract.

Methods:
Five eyes post keratoplasty with clear graft, four eyes with stable keratoconus, one eye with pterygium excision scar with visually significant cataract were included in this retrospective study. Phacoemulsification was done followed by implantation of custom made high power toric IOL in all patients. Outcomes included uncorrected and best-corrected distance visual acuity (UDVA, BCVA), pre-operative astigmatism at the corneal plane and IOL plane, post-operative residual astigmatism, mean torus of all IOLs used were calculated.

Results:
The minimum follow-up time was 12 months. At the last follow-up visit, there was a significant improvement (pre-operative vs post-operative) of UDVA (1.5 ± 0.47 vs 0.28 ± 0.14 logMAR; P < 0.05), cylindrical refraction (-9.0 ± 1.80 D vs - 1.1 ± 0.45 vs ; P < 0.05). Range of IOL powers used was 1.0-26.50 DSph and 9.0-15.5 DCyl. Post-operative mean residual spherical equivalent was 0.75 ± 0.5.

Conclusion:
This novel study describes the effectiveness of custom toric IOLs in high astigmatism in the range of 9.0-15.5 DCyl. Phacoemulsification with implantation of a customized high power toric IOL was effective in correcting high astigmatism in complex cases in our study.
Capsular tension ring assisted phacoemulsification of morgagnian cataract
Authors: Bardoloi Narayan , Sarkar Sandip , Burgute Pankaj Suresh , Ghosh Debaruna , Deb Amit Kumar 
Published: June 2021

Purpose:
To describe a novel technique of phacoemulsification in morgagnian cataract using capsular tension ring (CTR).

Methods:
This was a retrospective, non-comparative, clinical interventional study. Patients with hypermature morgagnian cataract who had undergone CTR-assisted phacoemulsification were included in the study. After capsulorhexis, CTR was inserted in a clockwise manner to stabilize the capsular bag in each case. Phacoemulsification was then performed using either horizontal chopping or vertical chopping. We have used the CTR in these cases without any obvious lens subluxation in order to perform safe emulsification of the nuclear pieces in the capsular bag. We have performed the procedure successfully in eleven eyes with hypermature morgagnian cataract.

Results:
The mean corrected distance visual acuity (CDVA) improved from 2.62 ± 0.25 Log MAR to 0.35 ± 0.28 Log MAR at 3 months postoperatively (P = 0.00008). Total nine out of 11 patients gained CDVA of 20/40 or better at 3 months postoperatively. No intraoperative complications such as posterior capsular rupture, zonular dialysis, iris trauma, vitreous loss were noted. The mean endothelial cell loss was 148.82 ± 41.52 cells/mm2 after 3 months of surgery.

Conclusion:
The main culprit for intraoperative complications during phacoemulsification in a morgagnian cataract is the vulnerable capsular bag. Following insertion of a CTR after capsulorhexis, the bag becomes stable and the subsequent steps of the surgery become uneventful, thereby, preventing any further complications.
Assessment of precision of astigmatism measurements taken by a swept-source optical coherence tomography biometer - IOLMaster 700
Authors: Sharma Ajay , Batra Akanksha 
Published: June 2021

Purpose:
To assess the repeatability of ocular measurements, particularly astigmatism, taken using the latest version of an swept-source optical coherence tomography (SS-OCT) device, IOLMaster 700.

Methods:
This prospective observational study done in a private eye care centre. Study included 213 eyes of 152 patients diagnosed with cataract. Axial length (AL), Anterior corneal astigmatism (ΔK), Total corneal astigmatism (ΔTK), Aqueous depth (AD), Lens thickness (LT), Iris barycentre distance (IBD) and White to white distance (WTW) were analysed; three measurements were taken for each patient in the same sitting by the same examiner in an undilated state using the SS-OCT device. Repeatability was analysed using intraclass coefficient (ICC) and coefficient of variation (CV) measures, and astigmatism values were transformed into vector components (J0/J45) and categorised based on magnitude.

Results:
Astigmatism vector components (J0/J45) showed poor repeatability (ICC < 0.5 and CV > 0), while iris coordinates (IBD) and astigmatism magnitude had good correlation (ICC > 0.9) but more variations between the readings which was least for magnitude ≥ 1.5D; however, rest of the parameters demonstrated excellent repeatability (ICC > 0.9 with P value < 0.05).

Conclusion:
IOLMaster 700 demonstrated good reliability for the parameters measured, although, for astigmatism and iris barycentre distance, more number of readings and cross reference with other devices may be required to get clinically accurate results.
Effect of myopia and optic disc area on ganglion cell-inner plexiform layer and retinal nerve fiber layer thickness
Authors: Ganekal Sunil , MH Sadhwini , Kagathur Shivanna 
Published: June 2021

Purpose:
The aim of this work was to study the impact of myopia and different optic disc areas on ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) thickness profiles in myopic patients by spectral-domain optical coherence tomography (SD-OCT).

Methods:
This was a cross-sectional study of 100 eyes of 50 myopic individuals. All patients underwent complete ophthalmic evaluation and SD-OCT examination. According to spherical equivalent (SE), patients were divided into M1, M2, and M3 (low, moderate, and high myopia group). According to optic disc area values, patients were divided into D1, D2 and D3 (small, medium and large disc groups). Average GCIPL and RNFL thickness recorded globally and separately for all quadrants and also according to 12 clock hours and analyzed with respect to different myopic groups, optic disc area groups, and axial length.

Results:
Quadrantic RNFL thickness profiles and their average RNFL thickness were significantly thinner in high myopic group compared to low myopic group, except for the temporal quadrant (P < 0.05). Average RNFL and RNFL thickness of all quadrants were significantly thicker in the large disc group than in the small disc group (P < 0.05). Average GCIPL and GCIPL thicknesses of all sectors were significantly thinner in high myopic group compared to low myopic group (P < 0.05). No significant correlation was observed between GCIPL and disc area changes. Average RNFL thickness correlated significantly with SE (3.667 μm/diopter), axial length (–5.3805 μm/mm) and optic disc area (9.4617 μm/mm2). Also, average GCIPL thickness correlated statistically significantly with SE (1.6807 μm/diopter) and axial length (–2.626 μm/mm).

Conclusion:
Myopia and axial length significantly reduce RNFL and GCIPL thickness profiles but the optic disc area significantly increases RNFL thickness, but not GCIPL thickness.
The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography
Authors: Bhutia Pinkila , Sen Snigdha , Nath Tirupati , Shamshad Mohammad Abid 
Published: June 2021

Purpose:
Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers.

Methods:
In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer’s II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT).

Results:
The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer’s score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06).

Conclusion:
Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis.
The relationship between corneal subbasal nerve density and corneal sensitivity in patients with Fuchs endothelial corneal dystrophy
Authors: Dikmetas Ozlem , Kocabeyoglu Sibel , Mocan Mehmet Cem , Karahan Sevilay , İrkec Murat 
Published: June 2021

Purpose:
The aim of this study was to investigate the association between alterations in corneal subbasal nerve plexus and tactile corneal sensitivity in patients with Fuchs’ endothelial corneal dystrophy (FECD).

Methods:
This retrospective, cross-sectional study included 24 (10 M/14 F) patients with FECD and 25 age- and sex-matched (10 M/15 F) healthy subjects as controls. Subjects with FECD were classified as having early (grades 1 and 2) and late (grades 3 and 4) disease. All subjects underwent central corneal tactile sensitivity measurements with the Cochet–Bonnet esthesiometer (Luneau Ophthalmologie, Chartres, France) and subbasal nerve density evaluation using in vivo confocal microscopy (IVCM). Association between corneal nerve plexus density and corneal sensitivity alterations were evaluated using the Mann–Whitney U test and the Spearman correlation test.

Results:
Compared to healthy subjects (mean age = 60.4 ± 7.5 years), patients with FECD (mean age = 60.6 ± 8.0 years) had worse central corneal sensitivity scores (5.9 ± 0.1 cm vs. 4.2 ± 0.8 cm; P < 0.001), reduced corneal nerve fibers (3.4 ± 1.3 nerves/frame vs. 5.0 ± 0.9 nerves/frame; P < 0.001) and lower corneal subbasal nerve plexus densities (2229.4 ± 364.3 μm/mm2 vs. 1901.6 ± 486.8 μm/mm2; P = 0.050). Patients with late stage FECD demonstrated lower subbasal nerve densities as compared to those with early disease (2204.3 ± 313.1 μm/mm2 (range = 1523–2552 μm/mm2); 1397.1 ± 227.4 μm/mm2 (range = 1120-1834 μm/mm2); P < 0.001). In the FECD group, subbasal nerve density was found to be directly correlated with corneal sensitivity scores (r = 0.457, P = 0.025).

Conclusion:
Progressive loss of the corneal subbasal nerve plexus appears to be a consistent feature of FECD. Reduction of the corneal nerve plexus parallels the decrease in corneal sensitivity in this patient population.
Subjective outcome and quality of life following external dacryocystorhinostomy
Authors: Dani Koshal , Yadalla Dayakar , Joy Anupama , Wu Annie M , R Jayagayathri 
Published: June 2021

Purpose:
To assess the patient reported outcome and quality of life in post external dacryocystorhinostomy operated patients.

Methods:
A prospective questionnaire based study was carried out on 112 patients diagnosed with chronic dacryocystitis who underwent external dacryocystorhinostomy in the department of Orbit and Oculoplasty at a tertiary eye hospital in South India.

Results:
We included 112 cases in our study. Mean (SD) of the age of patients was 48.03 (12.79) years and ranged from 7 to 72 years of age. 44 (39.3%) patients were males and 68 (60.7%) were females. All cases had subjective symptoms of tearing, pain and swelling at baseline which were relieved by post-operative 3 in all cases. The mean (SD) best corrected visual acuity was 0.28 (0.39) at baseline and 0.25 (0.37) at postoperative 3 (p < 0.001). All four parameters studied in the GBI questionnaire - total mean GBI (32.22 vs 48.86, P < 0.001), general subscale (31.21 vs 44.08, P < 0.001), social health (46.28 vs 61.01, P < 0.001), physical outcome (22.17 vs 55.80, P = 0.0001) scores showed significant improvement from 1 vs 3 months post DCR.

Conclusion:
The GBI questionnaire is an effective tool for assessing patients’ quality of life following DCR. External DCR can not only produce a successful anatomical outcome but also bring about a measurable improvement in subjective symptoms and quality of life among patients with symptomatic NLDO.
Corneal endothelial morphology and central corneal thickness in type 2 diabetes mellitus patients
Authors: Chowdhury Bithi , Bhadra Sangeeta , Mittal Pramod , Shyam Kishore 
Published: June 2021

Purpose:
This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls.

Methods:
This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher’s exact test, and Spearman’s rho correlation analysis were used as appropriate.

Results:
Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM.

Conclusion:
Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities.
Ten-year outcomes of uveal melanoma based on The Cancer Genome Atlas (TCGA) classification in 1001 cases
Authors: Shields Carol L , Mayro Eileen L , Bas Zeynep , Dockery Philip W , Yaghy Antonio , Lally Sara E , Ganguly Arupa , Shields Jerry A 
Published: June 2021

Purpose:
To understand the prognostic value of The Cancer Genome Atlas (TCGA) for uveal melanoma metastasis, using a simplified 4-category classification, based on tumor DNA.

Methods:
A retrospective cohort study of 1001 eyes with uveal melanoma at a single center, categorized according to TCGA as Group A, B, C, or D (by fine-needle aspiration biopsy for DNA analysis), and treated with standard methods, was studied for melanoma-related metastasis at 5 and 10 years.

Results:
Of 1001 eyes with uveal melanoma, the TCGA categories included Group A (n = 486, 49%), B (n = 141, 14%), C (n = 260, 26%), and D (n = 114, 11%). By comparison, increasing category (A vs. B vs. C vs. D) was associated with features of older age at presentation (56.8 vs. 52.8 vs. 61.1 vs. 63.5 years, P < 0.001), less often visual acuity of 20/20–20/50 (80% vs. 67% vs. 70% vs. 65%, P = 0.001), tumor location further from the optic disc (P < 0.001) and foveola (P < 0.001), and greater median tumor basal diameter (10.0 vs. 13.0 vs. 14.0 vs. 16.0 mm, P < 0.001) and tumor thickness (3.5 vs. 5.2 vs. 6.0 vs. 7.1 mm, P < 0.001). The Kaplan–Meier (5-year/10-year) rate of metastasis was 4%/6% for Group A, 12%/20% for Group B, 33%/49% for Group C, and 60%/not available for Group D.

Conclusion:
A simplified 4-category classification of uveal melanoma using TCGA, based on tumor DNA, is highly predictive of risk for metastatic disease.
Prescription of near addition and its relation to accommodative reserve in presbyopia - The dichotomy between theory and practice
Authors: Deepu Susmi , Kujur Evon Selina , Horo Saban , Priyanka Nancy , Selvin Satheesh Solomon T , Kuriakose Thomas 
Published: June 2021

Purpose:
To study the relationship between the amplitude of accommodation (AA) measured by the Royal Air Force (RAF) rule and near addition (NA) prescribed in presbyopic patients to assess how far practice is different from theoretical recommendations.

Methods:
Patients, aged 40 to 60 years with best corrected vision of 6/6 N5 were included in this cross sectional observational study. AA was measured using the RAF rule. Refined with near Duochrome chart, the NA was given with the chart at 40 cm. Accommodative reserve was calculated from the measured AA, NA required and the calculated additional accommodation expended by the patient for reading. The percentage of reserve was calculated with and without the correction for depth-of-field.

Results:
A total of 130 patients were studied. In the patients above 50 years of age, the negative correlation of AA with age was - 0.298 (P = 0.065) and AA and NA was - 0.365 (P = 0.002) was weak. Among the patients aged between 40 and 50 years, the negative correlation of AA with Age and NA were strong; - 0.853 (P < 0.0001) and - 0.823 (P < 0.0001) respectively. When prescribing glasses, 62.01% (CI 58.78 to 65.23) and 90.93% (CI 62.50 to 119.37) of the AA was found to be kept in reserve for patients below and above 50 years of age respectively.

Conclusion:
Accommodative reserve kept in our study patients when prescribing NA was two to three times the theoretical recommendation. High percentage of accommodation kept in reserve suggest that the measured AA is not activated normally and require higher NA and one should not rely on patient’s ability to generate accommodative power especially in patients over 50 years.