bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of age-related macular degeneration on diabetic retinopathy: An electronic health record based big data analysis from a tertiary eye centre in South India
Authors: Sahoo Niroj K , Mehta Mehul C , Rani Padmaja K , Khanna Rohit C , Raman Rajiv , Bhattacharya Jayanta , Das Anthony V , Murthy Gudlavalleti VS , Narayanan Raja 
Published: November 2021

Purpose:
To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy.

Methods:
This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD.

Results:
Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = −0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = −0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = −0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR.

Conclusion:
The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.
Calculation of intraocular lens power and to determine the relationship between ocular biometry and severity of diabetic retinopathy in patients with type II diabetes mellitus
Authors: Adlakha Neha , Kaur Manpreet , Singh Anurag A , Sharma Vaibhav 
Published: November 2021

Purpose:
To calculate the intraocular lens power and to determine the relationship between ocular biometry and severity of diabetic retinopathy (DR) in patients with type II diabetes mellitus.

Methods:
The study group included 150 type II diabetic subjects with DR. The control group consisted of 150 type II diabetic subjects having no DR. Axial length (AL), corneal power, and anterior chamber depth were measured using LenStar. DR and diabetic macular edema were classified according to International DR Classification. Crystalline lens power was calculated using Barrett Universal II formula. AL to corneal radius ratio was calculated. Chi-square test was used for categorical variables.

Results:
In multivariate logistic models adjusting for age, sex, glycosylated hemoglobin, duration of diabetes, Mean age of patients in the study group was 62.45 ± 4.85 years, whereas in the control group, it was 63.37 ± 7.29 years. Of the eyes with DR, 117, 76, 69, and 38 had mild NPDR, moderate NPDR, severe NPDR, and PDR, respectively. The difference in the mean duration of diabetes mellitus and glycosylated hemoglobin in both study and control groups was found to be statistically significant. A progressive decrease in the mean AL and the anterior chamber depth was observed with increasing severity of DR, and difference was statistically significant. There was a progressive increase in intraocular lens power with increasing severity of DR, and difference was found to be statistically significant.

Conclusion:
In persons with diabetes mellitus, globe elongation plays quite an important role in protective effects against DR, with contribution from intraocular lens power and other refractive components.
A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India
Authors: Sengupta Sabyasachi , Sindal Manavi D , Shanmugam P Mahesh , Bhende Pramod , Ratra Dhanashree , Nagpal Manish , Narayanan Raja , Rajendran Anand , Saravanan Veerappan , Kelkar Aditya , Maiti Aniruddha , Chakraborty Debdulal , Dogra Mohit , Behera Sourabh 
Published: November 2021

Purpose:
To derive consensus statements for surgical management of proliferative diabetic retinopathy (PDR) for vitreoretinal (VR) surgeons.

Methods:
Thirteen prolific VR surgeons representing all regions of India were invited to participate in a 42-point questionnaire based on the Delphi methodology describing various surgical scenarios commonly encountered in PDR. Consensus was derived using predefined robust analytics. Scenarios that returned a moderate consensus in round 1 were taken to round 2 as per the Delphi methodology. After considering all inputs, the final consensus criteria were developed.

Results:
A strong consensus was derived about waiting for 4 weeks before considering vitrectomy. In treatment-naïve eyes with fresh vitreous hemorrhage (VH), the wait time was slightly shorter for extramacular tractional retinal detachment (2–4 weeks) and longer (4–6 weeks) for eyes treated previously with laser or anti-VEGF agents. The expert panel recommended using preoperative anti-VEGF only in eyes with large membranes requiring extensive dissection. For post vitrectomy VH, while a conservative approach was recommended for the first episode of VH, experts recommended immediate vitreous lavage for recurrent episodes of VH. In eyes with iris neovascularization, the panel recommended immediate anti-VEGF injection followed by early vitreous lavage in nonresponsive eyes. A strong consensus was derived for stopping antiplatelet agents before surgery, while there was only a moderate consensus for performing vitrectomy for recalcitrant macular edema unresponsive to anti-VEGF injections in the absence of traction.

Conclusion:
This study provides valuable consensus on managing the different scenarios encountered during surgical management of PDR and should help guide the VR surgeons in clinical decision-making.
Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients
Authors: Vikas S J , Agarwal Divya , Seth Sankalp , Kumar Aman , Kumar Atul 
Published: November 2021

Purpose:
To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction.

Methods:
A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication.

Results:
The mean CMT improved significantly from 540.6 and 490.2 μm at the baseline to 292.5 and 270.6 μm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2–5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group.

Conclusion:
PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.
Association of metformin use among diabetics and the incidence of primary open-angle glaucoma – The Chennai Eye Disease Incidence Study
Authors: George Ronnie , Asokan Rashima , Vijaya Lingam 
Published: November 2021

Purpose:
Studies have reported the usage of metformin being associated with the reduced risk of progression of glaucoma. The current study aims to determine the association of metformin usage among subjects with diabetes mellitus and the six-year incidence of primary open-angle glaucoma (POAG).

Methods:
In this prospective cohort study, subjects who did not have glaucoma at the baseline and had a follow-up after a six-year interval were included. Details such as medical and drug history, applanation tonometry, gonioscopy, pachymetry, optic disc evaluation, and automated perimetry were collected. Incident POAG was defined as subjects who do not have glaucoma at baseline and developed glaucoma as classified International Society of Geographical and Epidemiological Ophthalmology Classification at the follow-up. The association between the subjects who were on metformin for treatment of diabetes mellitus and development of incident POAG was assessed.

Results:
Among the 4302 eligible participants, 128 (3%) had incident POAG. There were 905 (21.0%) subjects who had diabetes mellitus of which 142 (15.7%) were using metformin. Of the subjects with POAG, 92 (71.9%) were nondiabetics and 36 were diabetics (28.1%). Among the diabetics, the incidence of POAG among those on metformin was 5.6% (8 participants) and those not on metformin was 3.6% (28 participants). There was no difference in the incidence of POAG in subjects with diabetes mellitus, with and without metformin use (P = 0.25). Logistic regression showed no association of metformin use with the incidence of POAG (OR: 1.33, 95 CI: 0.58–3.04, P = 0.49) after adjusting for age, gender, and place of residence.

Conclusion:
The current study did not find any association between the effects of metformin on the incidence of POAG.
Clinical profile and magnitude of diabetic retinopathy: An electronic medical record–driven big data analytics from an eye care network in India
Authors: Das Anthony Vipin , Prashanthi Gumpili Sai , Das Taraprasad , Narayanan Raja , Rani Padmaja Kumari 
Published: November 2021

Purpose:
This study aimed to describe the clinical profile and magnitude of diabetic retinopathy (DR) in patients presenting to a multitier eye hospital network in India.

Methods:
This cross-sectional hospital-based study included 263,419 individuals with diabetes mellitus (DM) presenting between February 2012 and February 2021 (9-year period). The data were collected using an electronic medical record (EMR). Patients with a clinical diagnosis of DR in at least one eye were included in the analysis. Severe nonproliferative DR/proliferative DR/diabetic macular edema (DME) were considered sight-threatening DR (STDR).

Results:
In the study period, 25% (n = 66,913) were new patients diagnosed with DR. The majority of patients were males (70%). The mean age of the patients was 57 ± 10 years. The risk factors for DR were increased age: 30 to 50 years (odds ratio [OR] = 2.42), and 51 to 70 years (OR = 3.02), increased duration of DM: 6 to 10 years (OR = 2.88) and >10 years (OR = 6.52), blindness (OR = 2.42), male gender (OR = 1.36), lower socioeconomic status (OR = 1.43), and rural habitation (OR = 1.09). STDR was seen in 58% (n = 38,538) of examined patients. Risk factors for STDR were increased age 31 to 50 years (OR = 3.51), increased duration of DM: 6 to 10 years (OR = 1.23) and >10 years (OR = 1.68), blindness (OR = 3.68), male gender (OR = 1.12), and higher socioeconomic status (OR = 1.09).

Conclusion:
Every fourth person with DM was found to have DR, and every second person with DR had STDR in this study cohort. These real-world big data might provide greater insight into the current status of DR. Additional big data from similar EMR-based sources will help in planning and resource allocation.
Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure
Authors: Senthil Sirisha , Chary Raghava , Ali Mohammed Hasnat , Cherukuri Jhansi R , Rani Padmaja K , Krishnamurthy Rashmi , Choudhari Nikhil , Garudadri Chandrasekhar 
Published: November 2021

Purpose:
To evaluate the outcomes of trabeculectomy in the eyes with neovascular glaucoma (NVG), caused by proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO), and ocular ischemic syndrome (OIS).

Methods:
A retrospective review of NVG eyes that underwent trabeculectomy between 1991 and 2019. Complete success was defined as intraocular pressure (IOP) between 6 and 21 mmHg without antiglaucoma medications (AGM). The risk factors were analyzed by Cox’s proportional hazard model.

Results:
The study included 100 eyes of 100 subjects with a mean age of 58 ± 9.8 years and a median follow-up of 1.27 years (interquartile range: 0.63, 2.27). The cause of NVG was PDR in 59 eyes (59%), CRVO in 25 eyes (25%), and OIS in 16 eyes (16%). Trabeculectomy with mitomycin-C was performed in 88 eyes and trabeculectomy in 12 eyes. The cumulative complete success probability of trabeculectomy in PDR was 50% (95% confidence interval [CI]: 38, 65) at 1 year, 8% (1, 46) at 3–5 years. In OIS, it was 64% (43, 96) from 1 to 5 years. In CRVO, it was 75% (59, 94) at 1 year, 45% (23, 86) from 2 to 5 years. The PDR was associated with a higher risk of surgical failure compared to OIS (P = 0.04) and CRVO (P = 0.004). Other significant risk factors were increasing age (P = 0.02), persistent neovascularization of iris (NVI) (P = 0.03), higher number of anti-vascular endothelial growth factor (VEGF) injections prior to trabeculectomy (P = 0.02), and delay in performing trabeculectomy (P = 0.02).

Conclusion:
Compared to CRVO and OIS, the eyes with NVG secondary to PDR had poor success with trabeculectomy. Older age, persistent NVI, need for a higher number of anti-VEGF injections, and delayed surgery were associated with a higher risk for trabeculectomy failure.
Identification of risk factors for targeted diabetic retinopathy screening to urgently decrease the rate of blindness in people with diabetes in India
Authors: Sen Sagnik , Ramasamy Kim , Vignesh TP , Kannan Naresh B , Sivaprasad Sobha , Rajalakshmi Ramachandran , Raman Rajiv , Mohan Viswanathan , Das Taraprasad , Mani Iswarya 
Published: November 2021

Purpose:
There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screening for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment.

Methods:
We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM.

Results:
The prevalence of DR in 44,599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR.

Conclusion:
In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.
Profile of sight-threatening diabetic retinopathy and its awareness among patients with diabetes mellitus attending a tertiary care center in Kashmir, India
Authors: Kaushik Madhurima , Nawaz Shah , Qureshi Tariq Syed 
Published: November 2021

Purpose:
To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir.

Methods:
In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema.

Results:
The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all).

Conclusion:
STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.
Tensões entre transformação e reprodução de discursos socioambientais:
Authors: Nunes Carvalho Yasmim , Lima de Oliveira Nepomuceno Aline 
Published: November 2021

A Comissão Interinstitucional de Educação Ambiental de Sergipe (CIEASE) foi criada em 1999, pelo decreto estadual 18.509. A CIEASE é formada por representantes de órgãos estatais de Meio Ambiente, Educação, Cultura e Esporte, universidades, de ONGs e da sociedade civil. A principal responsabilidade desta comissão é a definição, implementação e o acompanhamento da Política Estadual de Educação Ambiental. A pesquisa teve como objetivo buscar respostas para alguns desafios enfrentados na implementação da Educação Ambiental no Estado de Sergipe, especificamente em relação à CIEASE para a formação de educadores(as) socioambientais. Utilizou-se uma metodologia com abordagem qualitativa, na qual foi feita uma análise, baseada em Análise Textual Discursiva, dos documentos cedidos pela Comissão e das entrevistas semiestruturadas. Conclui-se que a formação dos membros da CIEASE como educador(a) socioambiental não está alinhada à EA Crítica, o que possivelmente limita os interesses políticos e a atuação desta comissão.
correntes da Geografia e da Educação Ambiental presentes na BNCC e nas DCNEA
Authors: Andrade de Jesus Lelis Diego , Saheb Pedroso Daniele 
Published: November 2021

A Geografia e a Educação Ambiental-EA são campos do conhecimento que, através de seus referenciais, possibilitam aos seres humanos diversas formas de interpretação e de interação com o espaço. Assim, esta pesquisa tem o objetivo de investigar quais correntes do pensamento geográfico e da EA estão presentes na Base Nacional Comum Curricular-BNCC e nas Diretrizes Curriculares Nacionais para a Educação Ambiental-DCNEA. Para isso, foi realizado um estudo qualitativo do tipo crítico analítico nos referidos documentos, com auxílio do software de análise de dados qualitativos ATLAS.ti, a partir dos ciclos de codificação do Saldaña (2013). Os principais resultados apontam que, na BNCC, se apresentam enfaticamente as correntes crítica, humanista e socioambiental da Geografia e as correntes denominadas de moral/ética, naturalista, crítica, conservacionista e de sustentabilidade da EA. Nas DCNEA aparecem as correntes regional, humanista, socioambiental e a crítica da Geografia e as correntes moral/ética, crítica, sistêmica, humanista, científica, de ecoeducação, sustentabilidade e práxica.
RE-ENGINEERING STRATEGY AND PERFORMANCE OF LARGE MANUFACTURING FIRMS IN KENYA
Authors: Kithinji Jacob , Rotich Gladys , Kihara Allan 
Published: November 2021

Purpose: Most of the large manufacturing firms in Kenya have been experiencing declining performance in terms of revenue, sales and the profit margins for more than a decade. This has seen some of the large manufacturing firms in the country consider strategies such as relocating or restructuring their operations, opting to serve the local market through importing from low-cost manufacturing areas instead of adopting turnaround strategies. This therefore prompted a question on whether turnaround strategies such as reengineering strategy are effective for the manufacturing firms; hence the motivation of this study.
Methodology: This study was informed by theory of constraints. A descriptive research design was adopted while 708 large manufacturing firms in Kenya registered under the Kenya Association of Manufacturers were targeted. The sample size for the study was 249 firms selected randomly from all the 14 sectors of the manufacturing industry in Kenya. The data collection instrument was a questionnaire, while mean, frequencies and percentages were used to describe the data. Correlation and regression analysis were done to show direction, magnitude and significance of the association between the variables.
Findings: The findings revealed that re-engineering strategy had significant and positive influence on the performance of large manufacturing firms in Kenya. The findings further revealed that organizational culture had significant moderating effect on the relationship between reengineering strategy and performance of large manufacturing companies. The study concluded that reengineering strategy as one of the turnaround strategies positively influenced the performance of large manufacturing companies.
Unique Contribution to Theory, Practice and Policy: It is therefore recommended that the management of large manufacturing firms uphold reengineering strategy in order to enhance performance.