bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification
Authors: Raja S Vidya , Ponnat Arvin Kurian , Balagiri K , Pallamparthy Srilekha 
Published: October 2021

Purpose:
To compare outcomes of laser assisted deep sclerectomy (LADS) and conventional trabeculectomy both combined with phacoemulsification.

Methods:
We divided 36 eyes into 2 groups, one group with LADS and the other Trabeculectomy. Patients were measured post operatively at 1, 3, 6, 9 months, 1, 2, 3 years for intraocular pressure (IOP), best corrected visual acuity (BCVA) and number of medications.

Results:
In the trabeculectomy group, after 3 year follow up, IOP was 14.67 ± 3.14, 15.27 ± 4.28 and 17.00 ± 7.79, BCVA improved to 0.17 ± 0.18, 0.24 ± 0.20 and 0.24 ± 0.27 and number of medications reduced to 0.6 ± 0.6, 1.1 ± 1.2, and 1.5 ± 1.5. Complete success rate after 3 years was 100%, 80.0% & 80.0% and Qualified success rate was 100%, 88.9% & 88.9%. In the LADS group, after 3 years follow up, IOP was 14.11 ± 3.91, 16.07 ± 5.51, 15.80 ± 6.07, BCVA improved to 0.13 ± 0.11, 0.10 ± 0.15, 0.11 ± 0.13 and medications reduced to 1 ± 1.1, 1.5 ± 1.0 and 1.8 ± 1.0. Complete success after 3 years was 85.7%, 57.1% & 57.1% whereas qualified success was 92.3%, 84.6% & 84.6%.

Conclusion:
Main limitations of our study were small sample size and lack of prospective comparison. However we were able to perfom the surgery comfortably due to the relatively shorter learning curve compared to conventional NPDS.
Subjective and objective assessment of the eye drop instillation technique: A hospital-based cross-sectional study
Authors: Usgaonkar Ugam , Zambaulicar Viraj , Shetty Aksha 
Published: October 2021

Purpose:
To objectively and subjectively evaluate eye drop technique and assess communicated instructions, and reported problems with eye drop instillation among tertiary care sample eye drop users.

Methods:
A cross-sectional, observational study was carried out among patients attending our outpatient clinic from June to September 2020. Eligible participants obtained through convenient sampling were assessed for their eye drop instillation performance. The objective evaluation was made using observation of a demonstration and subjective assessment through responses to an interview. Patient inclusion criteria were being aged ≥18 years and using eye drops for ≥ one month; excluded if having a disability in communication or physical barriers in using eye drops. The patient reported difficulties and previous education about the instillation were also obtained.

Results:
Participants (n = 84) had a mean age of 50.3 ± 14.0 years. During the demonstration, almost everyone (86.9%) successfully instilled at least one drop in the eye. None of the participants exhibited a perfect drop technique. The most common deviations were failing to close the eye (60.7%), touching the bottle to the eye or eyelid (36.9% of patients), and multiple blinks after drop instillation without nasolacrimal occlusion (25.0%). Forty percent of patients reported ≥1 problem and only a small sample recalled having had education in the eye drop instillation technique.

Conclusion:
Most participants failed to properly execute the eye drop technique. A proactive role of the prescribing practitioner to assess a patient’s ability to instill eye drops correctly could be helpful.
Short term changes in corneal stress-strain index and other corneal biomechanical parameters post-laser in situ keratomileusis
Authors: Kenia Vaishal P , Kenia Raj V , Pirdankar Onkar H 
Published: October 2021

Purpose:
To report the short-term changes in a corneal stress-strain index (SSI) and other corneal biomechanical parameters post-laser in situ keratomileusis (LASIK) surgery.

Methods:
A retrospective study was conducted at a tertiary eye care center wherein patients who had undergone LASIK (microkeratome blade and femtosecond bladeless LASIK) between July and December 2019 were enrolled. Patients of age group 20–40 years, best-corrected visual acuity of 20/20, intraocular pressure (IOP) <22 mmHg, pre-LASIK pachymetry >500 microns, and corneal astigmatism ≤3.00 D were included. Subjects with a prior history of refractive surgery, any other ocular or systemic disease, poor-quality scans, intraoperative complications, and missing data were excluded. Corneal biomechanical properties including SSI were analyzed using Corvis ST and compared using the Paired T-test for each group separately at pre-LASIK, and 1-month post-operatively.

Results:
Overall, 202 eyes were reviewed, and 79 eyes fulfilled the inclusion criteria. Forty-three and 36 eyes had undergone Microkeratome Blade LASIK (Group I) and Femto LASIK (Group II), respectively. Overall, 29 and 26 corneal biomechanical parameters out of 33 changed significantly post-Microkeratome Blade LASIK and Femto LASIK, respectively. Statistically significant changes were noted in all the parameters at A1, maximum and Vinciguerra screening parameters (P < 0.001), however, no changes were noted in SSI in both the groups when compared with the pre-surgery data.

Conclusion:
Though the reduction in SSI was not statistically significant, other biomechanical parameters showed significant biomechanical changes pre- and post-LASIK surgeries in both the groups. However, a long-term study with a larger sample size would be required to understand the changes and stability in SSI post-refractive surgery.
Efficacy of blink software in improving the blink rate and dry eye symptoms in visual display terminal users – A single-blinded randomized control trial
Authors: Ashwini D L , Ve Ramesh S , Nosch Daniela , Wilmot Natoya 
Published: October 2021

Purpose:
Dry eye disease (DED) is a multifactorial disease, more prevalent among visual display terminal users. Reduced blink rate is a risk factor to dry eye disorder, innovative means to remind to blink while using computers can be helpful.

Methods:
Single-blinded Randomized Control Trial enrolled computer users with dry eye. Allocation concealment was done using opaque envelope and principal investigator was blinded. After baseline examination, eligible participants were randomized to intervention group (appearance of bars is 8 times/min) and control group (appearance of bars is 1 time/min). Participants from both groups used the software for 15 days, came for first follow up, and did not use the software for next 15 days until second follow-up examination. During each visit, detailed eye examination was done including blink rate, tear film break up time, and Ocular Surface Disease Index score.

Results:
Forty-six participants (women n = 31; men n = 15) with a mean age of 28.02 (±6.295) years completed the study. Four participants were excluded from analysis because of early dropout. In the intervention group (n = 23) and control group (n = 23), participants were allocated. At the end of first phase, there was statistically significant difference in OSDI score (P = 0.021). Statistically significant difference was noticed in OSDI (P = 0.014) and blink rate (P = 0.049) as baseline, and final visit data were compared.

Conclusion:
“Blink–Blink” software with 8 reminders/min improved DED-related symptoms by increasing the blink rate. The carry-over effect after cessation of Blink-Blink software in improving blink rate was maintained even after 1 month.

Trial Registration
: Clinical Trials Registry-India (CTRI): CTRI/2018/08/015176
Clinical implications of energy used in Neodymium: Yttrium Aluminum Garnet posterior capsulotomy on intraocular pressure
Authors: Chawla Harshika , Singh Manav Deep , Vohra Vishal 
Published: October 2021

Purpose:
To study the trend of the rise of intraocular pressure (IOP), with the energy used during Neodymium: Yttrium Aluminum Garnet (Nd: YAG) posterior capsulotomy.

Methods:
This is a prospective interventional study undertaken at a tertiary care center. The study was conducted on 221 non-glaucomatous eyes that underwent Nd: YAG posterior capsulotomy, of which 181 patients completed the study. IOP was recorded before laser and at 1, 2, 3, 4 hours, one day, one week, and one month during the post-laser period. Patients were grouped, depending on the amount of energy used, into Group 1 (≤ 40 mJ), Group 2 (40–80 mJ), and Group 3 (>80 mJ).

Results:
Raised IOPs were noted in all the groups at various time points; however, such cases were more in Group 3 (P = <0.001). IOP was noted to peak at the fourth hour and declined to reach baseline by one week in Group 2 and by one month in Group 3.

Conclusion:
There exists a relationship between the quantum of energy used and the amount of rising of IOP following Nd: YAG laser capsulotomy. In uncomplicated cases without preexisting glaucoma, if the amount of energy for posterior capsulotomy is limited to 40 mJ, routine use of ocular hypotensive medication can be avoided.
Comparison of bleb morphology by anterior segment optical coherence tomography and clinical outcome after phacotrabeculectomy with mitomycin C or Ologen implant
Authors: Chelerkar Vidya J , Agrawal Dishi , Kalyani V K S , Deshpande Madan 
Published: October 2021

Purpose:
To compare the bleb morphology by Anterior Segment Optical Coherence Tomography (ASOCT) and clinical outcome after Phacotrabeculectomy with either mitomycin C or Ologen implant.

Methods:
In a prospective interventional active controlled study, 93 patients aged 18 years and above underwent phacotrabeculectomy with either mitomycin C (53 eyes) or ologen implant (40 eyes), followed up for 12 months. The primary outcome measure was to note the evolution of bleb morphology by ASOCT in the two groups over 12 months. Secondary outcome measures were mean IOP, reduction in the need for anti-glaucoma medications, and complications seen in the two groups.

Results:
All parameters in the two groups were comparable preoperatively (P>0.05). Best corrected visual acuity at 12 months was 0.38±0.27 in mitomycin group and 0.31±0.23 in ologen group (P=0.151). Post-operative IOP at 12 months was 14.09±3.1mmHg (95%CI 13.22-14.97) in mitomycin group, and 13.25±2.5 mmHg (95%CI 12.40-14.30) in ologen group (P=0.254).The mean number of medications was 0.36±0.68 in mitomycin group and 0.38+/-0.70 in ologen group at 12 months (P=0.91). Overall success was achieved in 98.1 % of patients in mitomycin group and 90 % of patients in ologen group at 12 months. No major sight-threatening complications were noted in any group. AS-OCT imaging at 12 months showed multiform reflectivity with multiple large cystic spaces in both groups, with good IOP control.

Conclusion:
Phacotrabeculectomy using Mitomycin C and Ologen implant resulted in similar morphologic and functioning blebs at one year with comparable efficacy in controlling intraocular pressure.
Multimodal imaging of eyes with metamorphopsia after vitrectomy for rhegmatogenous retinal detachment
Authors: Kumar Vinod , Naik Anand , Kumawat Devesh , Sundar Dheepak , Chawla Rohan , Chandra Parijat , Kumar Atul 
Published: October 2021

Purpose:
To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI).

Methods:
In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI).

Results:
Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM.

Conclusion:
POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.
Periorbital aesthetic concerns in patients seeking corneal refractive surgery
Authors: Naik Milind N , Khader Mohammed A , Murthy Somasheila I 
Published: October 2021

Purpose:
To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon.

Methods:
Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference.

Results:
The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01).

Conclusion:
Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.
Ophthalmic presentations and long-term outcomes of subconjunctival and atypical orbital myocysticercosis
Authors: Singh Manpreet , Sharma Manjula , Chaurasia Shweta , Grewal Aditi Mehta , Kaur Savleen , Kaur Manpreet , Yadav Deepti , Gupta Pankaj 
Published: October 2021

Purpose:
To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.

Methods:
Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of “post-treatment” follow-up of 12 months was observed.

Results:
Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane’s and pseudo-Brown’s syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery).

Conclusion:
In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.
Use of predictive models to identify patients who are likely to benefit from refraction at a follow-up visit after cataract surgery
Authors: Gupta Sachin , Schneider Matthew J , Vardhan S Ashok , Ravilla Thulasiraj 
Published: October 2021

Purpose:
To develop predictive models to identify cataract surgery patients who are more likely to benefit from refraction at a four-week postoperative exam.

Methods:
In this retrospective study, we used data of all 86,776 cataract surgeries performed in 2015 at a large tertiary-care eye hospital in India. The outcome variable was a binary indicator of whether the difference between corrected distance visual acuity and uncorrected visual acuity at the four-week postoperative exam was at least two lines on the Snellen chart. We examined the following statistical models: logistic regression, decision tree, pruned decision tree, random forest, weighted k-nearest neighbor, and a neural network. Predictor variables included in each model were patient sex and age, source eye (left or right), preoperative visual acuity, first-day postoperative visual acuity, intraoperative and immediate postoperative complications, and combined surgeries. We compared the predictive performance of models and assessed their clinical impact in test samples.

Results:
All models demonstrated predictive accuracy better than chance based on area under the receiver operating characteristic curve. In a targeting exercise with a fixed intervention budget, we found that gains from predictive models in identifying patients who would benefit from refraction ranged from 7.8% (increase from 1500 to 1617 patients) to 74% (increase from 250 to 435 patients).

Conclusion:
The use of predictive statistical models to identify patients who are likely to benefit from refraction at follow-up can improve the economic efficiency of interventions. Simpler models like logistic regression perform almost as well as more complex machine-learning models, but are easier to implement.
Determination of surgical outcomes with a novel formulation of intrastromal natamycin in recalcitrant fungal keratitis: A pilot study
Authors: Saluja Gunjan , Sharma Namrata , Agarwal Rinky , Sharma H P , Maharana Praful , Satpathy Gita , Titiyal Jeewan Singh , Velpandian T 
Published: October 2021

Purpose:
To evaluate the outcomes of water-soluble intrastromal natamycin (IS-NTM) as an adjunct therapy for recalcitrant fungal keratitis.

Methods:
This was a prospective interventional pilot study in the setting of a tertiary eye-care center. Twenty eyes of 20 consecutive patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50%, and not responding to topical NTM for 2 weeks) were recruited. The selected patients were injected with a novel composition of IS-NTM (10 ug/0.1 mL, soluble natamycin) prepared aseptically in the ocular pharmacology department. All the patients continued using topical NTM suspension 5% 4-hourly until the ulcer healed. Repeat injections were undertaken after 72 h depending on the clinical response and all the patients were followed till 6 months.

Results:
The mean age of the patients was 40.42 ± 10.09 years. The mean duration of the presentation was 20.8 ± 5.1 days. The most commonly isolated organisms were Aspergillus sp. (12/20, 60%) and Fusarium
sp. (8/20, 40%). No patient had iatrogenic perforation or precipitate formation after IS-NTM injection. The overall cure rate with IS-NTM was 95% (19/20 patients). The number of patients who healed with the 1st, 2nd, and 3rd injection was 13, 5, and 1, respectively. One (5%) had no response to treatment and was subjected to penetrating keratoplasty. The average time taken for the resolution of the epithelial defect, stromal infiltrates, and hypopyon was 34 ± 5.2 days, 35.3 ± 6.4 days, and 15 ± 2.5 days. Healing with deep vascularization and cataract was noted in 6/19 eyes (31%) and 13/19 eyes (68.42%), respectively.

Conclusion:
Intrastromal injection of a novel formulation of NTM holds a promising role as adjunctive therapy to topical NTM in the management of recalcitrant filamentous fungal keratitis. The preliminary results are encouraging and further studies are required to validate the results.
Incidence of ocular and systemic diseases affecting visual function among state bus drivers
Authors: Kohli Piyush , Babu Naresh , Mishra Chitaranjan , Damodaran Sourav , Bhavani S , Kumar Mahesh , Ramasamy Kim 
Published: October 2021

Purpose:
To evaluate the incidence of ocular and systemic disease affecting visual function among state transport corporation bus drivers in a south Indian district.

Methods:
This retrospective study analysed the records of all the drivers who presented to a south Indian tertiary-care eye hospital in 2019 for their mandatory annual ocular check-up. Details reviewed included demographic details; refraction; presence of systemic and ocular diseases with vision-threatening potential; presence of ocular conditions responsible for visual loss and the treatment administered.

Results:
3042 drivers (mean age, 47.0 ± 5.7 years) were evaluated. Visual function-threatening systemic diseases were present in 25.0% drivers, out of which diabetes mellitus (18.7%) was the most common pathology. The most common ocular problem was refractive error (45.0%). Visual function-threatening ocular diseases were present in 9.5% drivers. Diabetic retinopathy, visually-significant cataract, glaucoma and central serous chorioretinopathy were noted in 4.0%, 1.9%, 1.7% and 0.8% drivers. Surgical intervention was required in 2.2% drivers. Thirteen drivers were temporarily deemed unfit for driving heavy-weight vehicles.

Conclusion:
Several bus drivers suffer from vision-threatening systemic and ocular diseases. Some of them require surgical intervention to retain fitness. A complete ocular and systemic evaluation of diseases with vision-threatening potential should be performed at the time of renewal of the driving license. The drivers should be educated about the systemic diseases which can affect their driving skills and must be encouraged to seek medical help at an early stage.