bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bibliometric and visualized analysis of diabetic macular edema
Authors: Wei Jin , Shu Yiyang , Wang Yimin , Liu Haiyun 
Published: December 2023

Purpose:
Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors.

Methods:
We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends.

Results:
A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. “Diabetic macular edema,” “retinopathy,” “ranibizumab,” and “optical coherence tomography angiography” were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, “deep learning” (AAY:2020.83), “optical coherence tomography angiography” (AAY:2019.59), “intravitreal Aflibercept” (AAY:2019.29), and “dexamethasone implant” (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run.

Conclusion:
In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots.
Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes – A randomized controlled trial (InFlap Study)
Authors: Baskaran Prabu , Sindal Manavi D , Ganne Pratyusha , Madanagopalan VG , Krishnappa Nagesha C , Rajendran Anand , Dhoble Pankaja , Ratna Bholesh , Ghondale Harshal , Mani Iswarya 
Published: December 2023

Purpose:
To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH).

Methods:
A consecutive 99 eyes of 99 patients were enrolled {45 – conventional group and 54 – inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed.

Results:
At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group.

Conclusion:
The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.
Research on an artificial intelligence-based myopic maculopathy grading method using EfficientNet
Authors: Zheng Bo , Zhang Maotao , Zhu Shaojun , Wu Maonian , Chen Lu , Zhang Shaochong , Yang Weihua 
Published: December 2023

Purpose:
We aimed to develop an artificial intelligence-based myopic maculopathy grading method using EfficientNet to overcome the delayed grading and diagnosis of different myopic maculopathy degrees.

Methods:
The cooperative hospital provided 4642 healthy and myopic maculopathy color fundus photographs, comprising the four degrees of myopic maculopathy and healthy fundi. The myopic maculopathy grading models were trained using EfficientNet-B0 to EfficientNet-B7 models. The diagnostic results were compared with those of the VGG16 and ResNet50 classification models. The leading evaluation indicators were sensitivity, specificity, F1 score, area under the receiver operating characteristic (ROC) curve area under curve (AUC), 95% confidence interval, kappa value, and accuracy. The ROC curves of the ten grading models were also compared.

Results:
We used 1199 color fundus photographs to evaluate the myopic maculopathy grading models. The size of the EfficientNet-B0 myopic maculopathy grading model was 15.6 MB, and it had the highest kappa value (88.32%) and accuracy (83.58%). The model's sensitivities to diagnose tessellated fundus (TF), diffuse chorioretinal atrophy (DCA), patchy chorioretinal atrophy (PCA), and macular atrophy (MA) were 96.86%, 75.98%, 64.67%, and 88.75%, respectively. The specificity was above 93%, and the AUCs were 0.992, 0.960, 0.964, and 0.989, respectively.

Conclusion:
The EfficientNet models were used to design grading diagnostic models for myopic maculopathy. Based on the collected fundus images, the models could diagnose a healthy fundus and four types of myopic maculopathy. The models might help ophthalmologists to make preliminary diagnoses of different degrees of myopic maculopathy.
Digital eye strain among medical students associated with shifting to e-learning during COVID-19 pandemic: An online survey
Authors: Bhatnagar Kavita R , Dixit Shilpi G , Pandey Latika , Prakash Sujeet , Shiromani Sakshi , Singh Kuldeep 
Published: December 2023

Purpose:
This study aimed to determine the prevalence, risk factors, symptoms, and awareness of computer vision syndrome (CVS) among medical students during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:
A cross-sectional observational study was conducted among 283 undergraduate medical students at a tertiary healthcare center. An electronic survey was conducted to collect the data. Data were analyzed using Statistical Package for Social Sciences (SPSS version 23). The Chi-square test (Fisher’s exact test when required) was used to study the significance of associations. A P value <0.05 was considered statistically significant.

Results:
A high prevalence of CVS was observed in which 92% reported at least one symptom while using a digital device, the most frequent being eye strain (49%). Among extraocular complaints, joint pain in the wrist and fingers was most frequent. Significant association (P < 0.05) of CVS was found with increased duration of digital device usage, refractive error, use of glasses or contact lens, preexisting dry eye disease, and use of topical eye drops. 37% of the participants were aware of the 20-20-20 rule, while only 11% followed it.

Conclusion:
CVS is a common health concern among medical students. Hence, to increase the productivity of work, significant risk factors need to be addressed and awareness must be raised.
Relevance of multicolor imaging, its component channels, and fundus autofluorescence in describing macular telangiectasia type-2 (MacTel) lesion characteristics
Authors: Chandran Kiran , Giridhar Anantharaman , Desai Sachin , Gopalakrishnan Mahesh , Indu VP , Sivaprasad Sobha 
Published: December 2023

Purpose:
The aim of the study was to describe imaging characteristics and detection rates of phenotypic features in macular telangiectasia type-2 (MacTel) on multicolor (MC), blue reflectance (BR), green reflectance (GR), infrared reflectance (IR), and fundus autofluorescence (FAF) and to evaluate sensitivity, specificity, and predictive values across modalities.

Methods:
In this monocentric observational study, 282 eyes of 148 patients with MacTel underwent color fundus photograph, MC, BR, GR, IR, FAF, spectral-domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A), and fundus fluorescein angiography (FFA). Grading was done by two graders qualitatively and quantitatively for the presence of the following prespecified MacTel findings [crystals, right-angle vessels (RAVs), plaques, subretinal neovascularization (SRNV), and MacTel area]. Across each imaging modality, the detection rate of RAVs and SRNV was compared with reference standard OCT-A (RAVs and SRNV) and FFA (SRNV), whereas that of plaques was compared with reference standard SD-OCT.

Results:
MC identified overall MacTel characteristics in 92.7% of eyes. Regarding the presence, number, and quadrants of RAVs and the presence and number of crystals, MC and GR had superior detection rates as well as the highest sensitivity and negative predictive value. Retinal plaques were better detected using FAF (97%), followed by MC (88%). In proliferative MacTel, SRNV was identified in 86% and 79% of eyes on MC and IR, respectively. While BR clearly delineated MacTel area in 100% eyes, FAF was able to ascertain a larger area of involvement in proliferative MacTel.

Conclusion:
The findings demonstrate the ability of MC, its component channels, and FAF to describe MacTel characteristics qualitatively and quantitatively.
Pupil vignetting artifact on optical coherence tomography angiography
Authors: Bhattacharyya Sampurna , D'souza Zubin , Ramanadhane Raghulnadhan , Maitra Debalina , Goel Nikita , Sen Ahana , Majumder Bristi , Gupta Shamayita , Chowdhury Maitreyi , Chattree Surabhi , Saurabh Kumar , Roy Rupak 
Published: December 2023

Purpose:
To discuss the features of an artifact on optical coherence tomography angiography (OCTA), termed “pupil vignetting artifact,” and describe how it may masquerade as true chorioretinal pathology.

Design:
This was a retrospective, observational case series.

Methods:
The authors studied 12 eyes at a vitreoretinal clinic in Eastern India, reviewing a dark shadow such as an artifact on OCTA images.

Results:
In all 12 eyes, there was an appearance of a dark shadow on OCTA imaging, located at the macula, superior, superotemporal, or superonasal to the fovea, which did not correspond to any ischemic area responsible for flow-void or any media opacity casting a posterior shadow. It was believed to be an artifact caused by the vignetting effect of the pupil as the incident OCT beam clips the iris during OCTA scanning, and therefore reduces the amount of total light incident on the retina. The variability in the size, shape, and location of the artifact is contributed by a few factors such as variable angle of incident light on the pupil, pupillary dynamics, and curvature of the retinal surface.

Conclusion:
Pupil vignetting artifact is a unique undescribed phenomenon appearing at the macula on OCTA imaging that can masquerade as numerous true chorioretinal pathologies. This article aims to describe this artifact to avoid misinterpretation and further confusion in real-life clinical practice.
Predicting visual outcomes following anti-vascular endothelial growth factor treatment for diabetic macular edema
Authors: Rana Vipin , Agarwal Aniruddha , Arora Atul , Bansal Reema , Dogra Mohit , Bhadada Sanjay Kumar , Singh Nirbhai , Gupta Vishali 
Published: December 2023

Purpose:
To assess the utility of pre-defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME) following anti-vascular endothelial growth factor (anti-VEGF) therapy in determining visual and anatomical outcomes.

Methods:
In this prospective, non-randomized, and interventional study, 17 patients with treatment-naive DME were included. OCT biomarkers [size/reflectivity of cysts, disorganization of retinal inner layers, integrity of ellipsoid zone or external limiting membrane, subfoveal serous retinal detachment, hyper-reflective foci (HRF)] and OCTA [vascular density (VD), foveal avascular zone (FAZ), and total micro-aneurysms in superficial capillary plexus and deep capillary plexus (DCP)] were analyzed at baseline and after three monthly intravitreal anti-VEGF injections. Response was defined as a decrease of 10% or more in central macular thickness from the baseline after three injections.

Results:
13/17 (76.47%) patients were categorized as responders to anti-VEGF therapy. Non-responders had significantly greater hyper-reflectivity of cysts (P = 0.015), larger cystic spaces (P = 0.023), and an increased number of HRF (P = 0.04) at baseline. On OCTA, non-responders showed larger FAZ in DCP (1.35 ± 0.21 versus 1.14 ± 0.28 mm2) (P = 0.042) and lower VD (61.17 ± 0.45 versus 62.73 ± 3.32) in DCP at baseline. At 3 months, the VD increased in responders (63.10 ± 3.42) compared to a decrease in non-responders (60.82 ± 1.13) (P = 0.032).

Conclusions:
Non-responders show a higher number of micro-aneurysms, larger FAZ, and lower VD in the DCP on OCTA and higher cyst hyper-reflectivity and HRF and larger cystic spaces on OCT imaging.
Brolucizumab in age-related macular neovascularization (BRAIN study): Efficacy, optical coherence tomography biomarkers, and safety profile
Authors: Dabir Supriya , Mohankumar Arthi , Khatri Manoj G , Rajan Mohan 
Published: December 2023

Background:
Brolucizumab is a new anti-vascular endothelial growth factor (anti-VEGF) in the treatment of neovascular age-related macular degeneration (nAMD) and idiopathic polypoidal choroidal vasculopathy (IPCV).

Materials and Methods:
A retrospective, consecutive, interventional study was conducted from a tertiary eye hospital, in which treatment-naïve and treatment-switch patients were included. They underwent an intravitreal injection of brolucizumab. The decision to reinject was made based on the presence of fluid on spectral domain optical coherence tomography (SD-OCT) or worsening of vision at follow-up. Outcome measures were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), fluid (subretinal/intraretinal/sub-retinal pigment epithelium fluid) levels, and OCT biomarkers and safety analysis.

Results:
A total of 59 eyes of 50 patients with a total of 132 intravitreal injections were included. There was a statistically significant improvement (P < 0.05) in BCVA from baseline in logMAR treatment-naïve patients (mean BCVA at baseline 0.6 ± 0.41 and 0.37 ± 0.56). The mean baseline CST of all patients significantly reduced from 582.92 ± 233.11 µm at baseline to 474.06 ± 252.89 µm at the final treatment visit. Thirty-eight percent of patients showed complete resolution of SHRM after a single injection. The interval between each subsequent injection increased from a mean of 67 to 96 days in treatment-switch patients and from 47 to 151 days in treatment-naïve patients.

Conclusion:
Brolucizumab promises reduced number of injections with longer treatment intervals.
Histopathology and electron microscopy evaluation of the sildenafil effect on diabetic rats' retinae
Authors: Tadros Dina , Abdelhalim Tamer I , Sarhan Naglaa , El-Anwar Noha , Elkholy Reem A. , Tahoon Dina , Sorour Osama A 
Published: December 2023

Purpose:
Although there is increasing evidence that phosphodiesterase-5 (PDE-5) inhibitors modify the effect of diabetes on different tissues, its effect on diabetic retinopathy is not well studied.

Methods:
Forty male Sprague–Dawley (SD) rats were divided into four groups: group I = control group that received no treatment; group II (diabetic group), in which diabetes was induced by a single streptozotocin injection; group III (sildenafil small dose, SSD), in which diabetes was similarly introduced (however, rats received daily oral 1 mg/kg sildenafil citrate (SC) for 3 months); and group IV (sildenafil large dose, SLD), which was as in group 3, but SC was 2.5 mg/kg. After 3 months, globes were removed and retinae were dissected; one globe from each rat was examined by light microscopy (LM), and the other by electron microscopy (EM).

Results:
In contrast to the control group, diabetic rats in group II demonstrated well-established diabetic changes in the form of capillary congestion, decreased cell population, hyaline changes of capillary walls, and degenerated nerve fiber layer by LM. Similarly, EM demonstrated photoreceptor degeneration, mitochondrial cristolysis, and vacuolated depleted cells among other features in group II. These diabetic features were less prominent in group III and nearly absent in group IV.

Conclusion:
SC use in the early stages of DR may prevent/delay diabetic retinopathy development or progression in diabetic rat models, an effect that seems to be dose-related.
Use of Lung Ultrasound versus Chest X-ray in Diagnosing Heart Failure in the Emergency Care Setting: A Systematic Review
Authors: Haridas Rushikesh S. , Shelke Sheetal , Patrike Girish , Patil Deepak , Dhumal Sainath 
Published: December 2023

Background:Acute heart failure (HF) is initially diagnosed and managed in the large part in the emergency care setting. Lung ultrasound (LUS) and chest X-ray (CXR) are the most common diagnostic and prognostic techniques for people with HF. It has been observed that lung ultrasonography has a higher sensitivity for diagnosing HF than CXR. In this review, we assess the comparison between the use of LUS and CXR in diagnosing HF.Methods:An extended search was done in the databases of PubMed, Medline, Wiley library, and Google Scholar between 2012 and 2022. Fifteen studies were included in this systematic review. Studies, in which the sensitivity of LUS and CXR was noted, were included.Results:Fifteen studies were included. The majority of the studies showed that LUS had high sensitivity and accuracy for detecting HF.Conclusion:The result of the present review shows that the sensitivity of the LUS was higher than those of the CXR in detecting HF. Ultrasound has certain advantages over CXR.
Prevalence of Quality of Life and Physical Activity in Patients with Different Stages of Heart Failure – An Observational Cross-Sectional Study
Authors: Shah Purvi , Mehta Mihir , Oza Falak , Makwana Priya 
Published: December 2023

Background:
Heart failure (HF) is an escalating health problem around the world. HF is a highly prevalent disorder worldwide, with a high morbidity and mortality rate. Maintaining a good quality of life (QOL) and physical activity are as important as survival to patients living with HF. Individuals with HF have markedly impaired QOL compared with other chronic diseases and healthy population. Different stages of HF in physical activity and QOL have not been studied in India. Hence, aim of the study was to find out the prevalence of physical activity and QOL patients with HF.

Methodology:
After calculating the sample size, 301 patients diagnosed with HF who were managed medically were selected for this study with fulfilling criteria. The Minnesota Living with Heart Failure Questionnaire and International PhysicalActivity Questionnaire were used to screen the patients. Outcome measures were QOL, physical activity, ejection fraction (EF), Heart Failure Classification (HFC) New York Heart Association and American Heart Association (AHA) Stages.

Results:
The mean age of the patients was 53 ± 13.56, including 53.82% males and 45.84% females. Among them, occupation data show 58.13% have labourer work, socioeconomical data show 28.30% of patients have upper middle class. Co-morbidity data shows 13.28% patients have hypertension (HTN), 39.20% have diabetes mellitus (DM), and 22.25% patients have both. Among 301, 30.23% of patients have HFC 3 and 38.53% of patients have AHA Stages B. This study shows 19.60%, 46.17%, and 34.21% good, moderate, and poor QOL, respectively. The prevalence of physical Activity was found to be 81.06% low, 15.61% moderate, and 3.32% high. According to EF prevalence, 79.73% have a reduced EF.

Conclusion:
Patients with different HF stages experienced impaired QOL and lowest physical activity. Low physical activity and moderate QOL can be improved by early rehabilitation.
Prevalence of Anxiety, Depression, Kinesiophobia, and Impaired Shoulder Function in Patients following Coronary Artery Bypass Grafting: An Observational Study
Authors: Ratnoo Bhumika , Mulla Ayesha , Oza Falak , Vyas Miral 
Published: December 2023

Background:
Coronary artery bypass grafting (CABG) is an effective coronary revascularization technique. Anxiety and depression are associated with risks of re-hospitalization, heart failure, stroke, myocardial infarction, and death after CABG. Kinesiophobia and impaired shoulder function are associated with impaired physical performance and self-reported disability. Hence, early identification is essential for initiating supportive or preventive measures. This study aimed to find out the prevalence of anxiety, depression, kinesiophobia, and impaired shoulder function in patients following CABG.

Materials and Methods:
A cross-sectional study was carried out on 300 patients who underwent CABG in a tertiary cardiac care hospital. After obtaining informed consent, this study assessed the following patient-reported outcome measures – demographic information, Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 scale for anxiety, Tampa Scale for Kinesiophobia-17, and Shoulder Pain and Disability Index for shoulder impairments.

Results:
Analysis was done using SPSS software (version 20.0). The prevalence of anxiety in this study was minimum (33%), mild (32%), moderate (34%), and severe (2%) out of total population. Prevalence of depression was minimum (15.33%), mild (35%), moderate (39.33%), and moderately severe (10%) out of total population. Prevalence of kinesiophobia was mild (15%), moderate (84%), and severe (1%) out of total population. Shoulder impairments were up to 20% in 55% of the population, 40% in 30%, and 0% in 16% of the total population.

Conclusions:
From the entire population, 34% had moderate anxiety, 40% had moderate depression, 84% had moderate kinesiophobia, and 30% had shoulder impairments. This prevalence study helps identify these risk factors and could guide the secondary complications after CABG.