bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Moisture Migration in Schirmer Test Strips: Exploring Brand-Specific Variations and Introducing Calibration and Conversion Methods
Authors: Magone M. Teresa , Schuck Peter 
Published: November 2023

Purpose:
Schirmer test results are widely used for ocular surface disease assessment, but Schirmer strips are not standardized. We compare the characteristics and tear volume with millimeter moisture migration in different brands of Schirmer strips and introduce methods for volume-based, brand-independent calibration.

Methods:
Physical parameters of Haag-Streit, EagleVision, TearFlo, Contacare, and MIPL/A6 Schirmer strip brands were compared. Schirmer strip millimeter moisture migration distances were assessed 5 minutes after application of incremental microliter volumes of human tears. Linear regression analysis of data points from each Schirmer strip brand was performed, and the root-mean-square deviation of data points to the best-fit linear regression was calculated. Calibration correction was performed by converting migration distance to the corresponding tear volume. A reference table and calibration method formulas were created.

Results:
Schirmer strips differed in design, shape, and manufacturing precision. Strip width, weight, and length were different between the 5 brands (P < 0.05). A wide range of Schirmer strip moisture migration values for identical tear volumes was observed among brands. Statistical measurement resulted in a root-mean-square deviation of 2.9 mm for all data points from all brands. Millimeter to volume and weight to volume-based calibration correction methods resulted in a 2.2- and 3.1-fold measurement error reduction, respectively.

Conclusions:
Our findings highlight the lack of standardization among different brands of Schirmer strips, raising concerns about potential sources of unintentional measurement errors. We propose volume-based Schirmer strip calibration methods and conversion of millimeter to microliter results to achieve brand-independent results and improve Schirmer test accuracy.
Early Outcomes of an Artificial Endothelial Replacement Membrane Implantation After Failed Repeat Endothelial Keratoplasty
Authors: Fontana Luigi , di Geronimo Natalie , Cennamo Michela , Mencucci Rita , Versura Piera , Moramarco Antonio 
Published: November 2023

Purpose:
The purpose of this study was to report the outcomes of a novel artificial endothelial replacement membrane implant for treating corneal edema after failed repeat endothelial keratoplasty (EK).

Design:
This was a retrospective interventional case series.

Methods:
Patients with chronic corneal edema underwent removal of the EK graft and implantation of an artificial endothelial replacement membrane (EndoArt, EyeYon Medical, Israel) several months after 2 or more Descemet stripping endothelial keratoplasty procedures. The implant was secured to the posterior corneal surface using an air–gas bubble. Outcome measures included corrected distance visual acuity (logMAR), central corneal thickness, device-related complications, and ocular discomfort.

Results:
Five eyes of 5 patients underwent EndoArt implantation. Six months after surgery, the synthetic endothelial replacement membrane was well-centered and adherent to the posterior corneal surface, with improvement in central corneal transparency in all patients. Corrected distance visual acuity increased from mean 1.26 ± 0.25 (logMAR) preoperatively to 0.74 ± 0.44 (logMAR) postoperatively (P = 0.06). Central corneal thickness significantly decreased from a mean of 805 ± 135 μm (excluding the EK graft) preoperatively to 588 ± 60 μm (excluding the EndoArt) postoperatively (P = 0.015). No severe device-related complications developed after surgery, although most patients required more than 1 air–gas bubble injection to achieve complete implant adhesion. All patients experienced preoperative reduction in subjective ocular pain.

Conclusions:
Synthetic endothelial replacement membrane implantation improves central corneal transparency and visual acuity in patients with failed EK and guarded prognosis for repeat keratoplasty. No significant implant-related adverse events occurred after surgery.
Outcomes of Flap Amputation After Laser In Situ Keratomileusis
Authors: Castillejo Becerra Clara M. , Maguire Leo J. , Salomao Diva R. , Patel Sanjay V. 
Published: November 2023

Purpose:
The aim of this study was to describe the indications and outcomes of flap amputation after laser in situ keratomileusis (LASIK) at a referral-based institution.

Methods:
In this retrospective consecutive case series, medical records of patients who underwent LASIK flap amputation at Mayo Clinic, Rochester, MN, between January 1, 1998, and January 31, 2023, were reviewed.

Results:
Fifteen eyes (15 patients) underwent flap amputation during the study period. The median age was 45 years (range, 25–71 years), and 8 patients (53%) were men. The median uncorrected visual acuity before flap amputation was 20/200 (range 20/40-hand motions). Indications for flap amputation included epithelial ingrowth (n = 6, 40%), infectious keratitis (n = 6, 40%), diffuse lamellar keratitis (n = 1, 7%), vegetative foreign body (n = 1, 7%), and astigmatism from fixed flap striae (n = 1, 7%). The median duration of follow-up was 8 months (range 1–234 months). Subsequent corneal interventions included chelation of calcific band keratopathy (n = 1, 7%), lamellar keratoplasty (n = 1, 7%), penetrating keratoplasty (n = 2, 18%), keratoprosthesis (n = 1, 7%), and rigid contact lens wear (n = 4, 27%). The final median best visual acuity was 20/25 (range 20/20–20/200). Compared with noninfectious indications for flap amputation, eyes with infectious indications had worse baseline median uncorrected visual acuity (hand motions vs. 20/63, P < 0.001), were more likely to undergo major corneal surgical intervention (50% vs. 11%), and had worse final median best visual acuity (20/50 vs. 20/20, P = 0.018).

Conclusions:
LASIK flap amputation is sometimes necessary to control threatening corneal diseases. Excellent visual outcomes were achieved in most cases, albeit with additional intervention or rigid contact lens wear.
Deformable Biomechanics of DMEK Tissue Scrolls Traveling Through Narrow Lumens: The Inverse Relationships Between Fluid Velocity, Scroll Width, and Wall Contact and Their Clinical Implications for Preloading
Authors: Kigin Matthew , Revis Benjamin , Vigmostad Sarah , Sales Christopher 
Published: November 2023

Purpose:
The aim of this study was to evaluate Descemet membrane endothelial keratoplasty (DMEK) scroll width and length in relation to variable velocities as the tissue transits through wide and narrow lumen glass tubes.

Methods:
Sets of DMEK tissue were processed using the Iowa Lions Eye Bank standard DMEK protocol and were passed through 2 glass tube widths at variable speeds. Two hourglass-shaped glass tubes were created, one “wide” and one “narrow.” A syringe pump, valve, and pressure gauge were used to modulate tissue speed through each tube. For both tube sizes, DMEK tissue was passed through their lumens with incrementally increasing velocity and visualized with a high-speed camera at frame rates from 1000 to 8000 fps. Scroll width and length were measured using IDT Motion Studio software and digital calipers.

Results:
There was a significant, indirect correlation between scroll velocity and width in both the wide (R2 = −0.98, P < 0.001) and narrow (R2 = −0.84, P < 0.001) tubes. There was a significant, direct correlation between scroll velocity and length in both the wide (R2 = 0.84, P < 0.001) and narrow (R2 = 0.83, P < 0.001) tubes. The resting widths of the scrolls were 105% and 207% wider than the wide and narrow tubes, respectively. All transits recorded scroll widths that were equal to or smaller than their respective tube's internal diameter.

Conclusions:
There is a significant, inverse correlation between DMEK scroll velocity and width as well as a direct correlation between scroll velocity and length, allowing DMEK scrolls to transit through a tube that is narrower than its resting width without sustained lumen wall contact.
Corneal Superficial Plaque Formation After Recombinant Human Nerve Growth Factor Use in a Patient With Neurotrophic Keratopathy and Limbal Stem Cell Deficiency From Mucous Membrane Pemphigoid
Authors: Surico Pier Luigi , Kaufman Aaron R. , Lin Julie , Dehghani Shima , Dana Reza 
Published: November 2023

Purpose:
The aim of this study was to report a rare observation of corneal superficial plaque formation after topical recombinant human nerve growth factor (rhNGF) treatment for a nonhealing epithelial defect in a patient with advanced mucous membrane pemphigoid, limbal stem cell deficiency, and neurotrophic keratopathy.

Methods:
This study was a case report.

Results:
A 72-year-old man with a complex course of mucous membrane pemphigoid, leading to cicatrizing keratoconjunctivits, limbal stem cell deficiency, and neurotrophic keratopathy presented with a recurrent persistent epithelial defect in the right eye. After a long course of unsuccessful epithelial healing, despite various treatment modalities, he was administered topical rhNGF (cenegermin 0.002%; Oxervate, Dompé US Inc., Boston, MA) which successfully resolved the epithelial defect. However, on day 22 posttreatment, an unusual white, thick, adherent corneal superficial plaque formed. rhNGF was stopped and the plaque was carefully removed. Subsequently, there was no recurrence, and the patient's epithelial healing remained stable.

Conclusions:
Although the successful resolution of the persistent epithelial defect with rhNGF administration was notable, the development of the unusual epithelial overgrowth emphasizes the importance of vigilant monitoring and evaluation when using rhNGF in complex ocular conditions. Making informed decisions on the timing of discontinuing rhNGF can lead to desirable effects of the drug while mitigating additional side effects when managing such challenging cases.
Comparison of long-term outcomes of simultaneous accelerated corneal crosslinking combined with intracorneal ring segment or topography-guided PRK
Authors: Cohen Eyal , Ong Tone Stephan , Mimouni Michael , Stein Raymond , Chan Clara C. , Chew Hall F. , Rabinovitch Theodore , Rootman David S. , Slomovic Allan R. , Hatch Wendy V. , Singal Neera 
Published: November 2023

Purpose:
To compare long-term outcomes of simultaneous accelerated corneal crosslinking (CXL) with intrastromal corneal ring segments (CXL-ICRS) with simultaneous accelerated CXL with topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus (KC).

Setting:
Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada.

Design:
Prospective nonrandomized interventional study.

Methods:
The change in visual and topographical outcomes of CXL-ICRS and CXL-TG-PRK 4 to 5 years postoperatively were compared using linear regression models adjusted for preoperative corrected distance visual acuity (CDVA) and maximum keratometry (Kmax).

Results:
57 eyes of 43 patients with progressive KC who underwent simultaneous accelerated (9 mW/cm2, 10 minutes) CXL-ICRS (n = 32) and CXL-TG-PRK (n = 25) were included. Mean follow-up duration was 51.28 (9.58) and 54.57 (5.81) months for the CXL-ICRS and CXL-TG-PRK groups, respectively. Initial mean Kmax was higher in the CXL-ICRS group compared with the CXL-TG-PRK group (60.68 ± 6.81 diopters [D] vs 57.15 ± 4.19 D, P = .02). At the last follow-up, change (improvement) in logMAR uncorrected distance visual acuity (UDVA) compared with that preoperatively was significant with CXL-ICRS (−0.31 ± 0.27, P < .001, which is equivalent to approximately 3 lines) and not significant with CXL-TG-PRK (−0.06 ± 0.42, P = .43). The logMAR CDVA improved significantly with CXL-ICRS (−0.22 ± 0.20, P < .001), but not with CXL-TG-PRK (−0.05 ± 0.22, P = .25). Adjusting for baseline Kmax and CDVA, the improvement in UDVA was significantly greater with CXL-ICRS than with CXL-TG-PRK (−0.27, 95% CI, 0.06-0.47, P = .01). Improvement in CDVA was not significantly different.

Conclusions:
In this cohort of progressive KC with long-term follow-up, UDVA showed more improvement with accelerated CXL-ICRS than with CXL-TG-PRK.
Safety and efficacy of kidney transplantation in patients with aortoiliac stenosis: a retrospective cohort study
Authors: Fang Yitian , Hamm Julie J.M. , den Hartog Floris P.J. , Kimenai Hendrikus J.A.N. , de Bruin Ron W.F. , Minnee Robert C. 
Published: November 2023

Background:
The impact of aortoiliac occlusive disease on kidney transplantation remains unclear. This study aims to investigate the clinical outcomes of kidney transplant patients with aortoiliac atherosclerotic stenosis.

Methods:
Retrospective data from our transplant center were used to identify patients undergoing kidney transplantation between January 2010 and December 2020. Aortoiliac atherosclerotic stenosis was screened and stratified by the Trans-Atlantic Inter-Society Consensus (TASC) II classification. The primary outcome was patient survival. Secondary outcomes were 90-day mortality, death-censored graft survival, graft function and arterial complications. Propensity score matching was used to match all patients in the stenosis group with patients without stenosis sharing similar characteristics.

Results:
The analysis included 655 patients, 524 without stenosis, and 131 with aortoiliac stenosis (95 with TASC A/B stenosis, 36 with TASC C/D stenosis). Recipient age (median [IQR], 66 [60-70] vs. 66 [59-71] years; P=0.47), gender (male: 87 [66%] vs. 355 [68%], P=0.85), and comorbidities were comparable between the stenosis and no-stenosis groups. Forty-six (35%) patients with stenosis were symptomatic. Patient survival was significantly lower in the stenosis group compared to the no-stenosis group (TASC A/B: 30.6% vs. no-stenosis: 44.1%, P=0.013; TASC C/D: 11.4% vs. no-stenosis: 44.1%, P<0.001). The incidence rates of artery dissection, lower extremity ischemia and acute thrombosis were significantly higher in the stenosis group (P<0.001). However, death-censored graft survival (TASC A/B: 73.6% vs. no-stenosis: 72.9%, P=0.62; TASC C/D: 58.1% vs. no-stenosis: 72.9%, P=0.16) and graft function were comparable between the groups.

Conclusions:
Aortoiliac atherosclerotic stenosis significantly impacts patient survival but not graft survival. Our analyses suggest that patients with TASC A/B stenosis have prolonged survival and enhanced quality of life through kidney transplantation. However, for patients with TASC C/D stenosis, kidney transplantation improves quality of life without bringing survival benefits.
Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study
Authors: Wang Juan , Lin Fa , Zeng Min , Liu Minying , Zheng Maoyao , Ren Yue , Li Shu , Yang Xiaodong , Chen Yiqiang , Chen Xiaolin , Sessler Daniel I. , Peng Yuming 
Published: November 2023

Background:
Previous studies report that intraoperative hypotension worsens outcomes after aneurysmal subarachnoid hemorrhage (aSAH). However, the hypotensive harm threshold for major adverse cardiovascular events remains unclear.

Methods:
We included aSAH patients who had general anaesthesia for aneurysmal clipping/coiling. Major adverse cardiovascular events (MACE) were defined by a composite of acute myocardial injury, acute myocardial infarction, and other cardiovascular complications identified by electrocardiogram and echocardiography. We initially used logistic regression and change-point analysis based on the second derivative to identify mean arterial pressure (MAP) of 75 mmHg as the best threshold. Thereafter, our major exposure was MAP below 75 mmHg characterized by area, duration, and time-weighted average. The area below 75 mmHg represents the severity and duration of exposure and was defined as the sum of all areas below a specified threshold using the trapezoid rule. Time-weighted average MAP was derived by dividing area below the threshold by the duration of anaesthesia. All analyses were adjusted for baseline risk factors including age >70 years, female sex, severity of intracerebral haemorrhage, history of cardiovascular disease, and preoperative elevated myocardial enzymes.

Results:
Among 1029 patients enrolled, 254 (25%) developed postoperative MACE. Patients who experienced MACE were slightly older (59±11 vs. 54±11 y), were slightly more often women (69% vs. 58%), and had a higher prevalence of cardiovascular history (65% vs. 47%). Adjusted cardiovascular risk increased nearly linearly over the entire range of observed MAP. However, there was a slight inflexion at MAP of 75 mmHg. MACE was significantly associated with area (adjusted odds ratios [aOR] 1.004 per 10 mmHg.min, 95% confidence interval [CI]: 1.001-1.007, P=0.002), duration (aOR 1.031 per 10 min, 95%CI: 1.009-1.054, P=0.006), and time-weighted average (aOR 3.516 per 10 mmHg, 95%CI: 1.818-6.804, P<0.001) of MAP <75 mmHg.

Conclusions:
Lower blood pressures were associated with cardiovascular complications over the entire observed range, but worsened when MAP was <75 mmHg. Pending trial data to establish causality, it may be prudent to keep MAP above 75 mmHg in patients having surgical aSAH repairs to reduce the risk of major adverse cardiovascular events.
Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?
Authors: Kaul Vivian F. , Dzubara Bryce P.G. , Munjal Vikas , Katta Juhi , Adunka Oliver F. , Ren Yin 
Published: November 2023

ObjectiveEvaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors.Study DesignRetrospective cohort study.SettingTertiary referral center.PatientsFour hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data.InterventionsDiagnostic.Main Outcome MeasuresAge, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county.ResultsOf the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11–0.68];p= 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009–0.25];p= 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94–0.98];p< 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12–3.15];p= 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. Aχ2test of independence showed no association between receiving CIs and living in medically underserved counties (χ2= 2; N = 493; 0.3891;p= 0.53).ConclusionsNot infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.
Characterization of Vestibular Perception in Patients with Persistent Postural-Perceptual Dizziness
Authors: Kobel Megan J. , Wagner Andrew R. , Oas John G. , Merfeld Daniel M. 
Published: November 2023

Objective
To assess vestibular (i.e., passive self-motion) perception in patients diagnosed with persistent postural-perceptual dizziness (PPPD).

Study Design
Case-controlled, cross-sectional, observational investigation.

Setting
Single-center laboratory-based study.

Patients
Thirteen patients with PPPD, 13 age-matched healthy control volunteers. Of those with PPPD, eight had co-occurring vestibular migraine (VM).

Interventions
All participants completed a vestibular threshold test battery reflecting perception with predominant inputs from (a) the otoliths (1-Hz interaural y-axis translation, 1-Hz superior-inferior z-axis translation), (b) the semicircular canals (2-Hz yaw rotation, 2-Hz tilts in the planes of the vertical canal pairs), and (c) and canal-otolith integration (0.5-Hz roll tilt).

Main Outcome Measures
Direction-recognition thresholds for each vestibular threshold test condition.

Results
Across all patients with PPPD, higher thresholds for superior-inferior z-translations thresholds in comparison to age-matched healthy control participants were identified (p < 0.001). Those patients with co-occurring VM and PPPD (PPPD/+VM) displayed significantly higher z-translation thresholds (p = 0.006), whereas patients with PPPD without VM (PPPD/−VM) displayed significantly higher roll tilt thresholds (p = 0.029).

Conclusions
Patients with PPPD did not display a global worsening of passive self-motion perception as quantified by vestibular perceptual thresholds. Instead, patients with PPPD displayed elevated thresholds for only roll tilt and z-translation thresholds, with the relative change in each threshold impacted by the co-occurrence of VM. Because both z-translation and roll tilt motions are reliant on accurate gravity perception, our data suggest that patients with PPPD may exhibit impaired processing of graviceptive cues.
Comparison of Speech Recognition and Hearing Preservation Outcomes Between the Mid-Scala and Lateral Wall Electrode Arrays
Authors: Patro Ankita , Lindquist Nathan R. , Schauwecker Natalie , Holder Jourdan T. , Perkins Elizabeth L. , Haynes David S. , Tawfik Kareem O. 
Published: November 2023

ObjectiveTo assess speech recognition and hearing preservation (HP) outcomes with the Advanced Bionics Mid-Scala and SlimJ electrodes.Study DesignRetrospective cohort.SettingTertiary referral center.PatientsA total of 237 adult patients implanted between 2013 and 2020 (Mid-Scala, n = 136; SlimJ, n = 101).Main Outcome MeasuresConsonant-nucleus-consonant (CNC) and AzBio (Arizona Biomedical) scores at 6 and 12 months; postoperative HP, defined as low-frequency pure-tone average ≤ 80 dB HL; scalar position.ResultsMean CNC scores did not significantly differ between Mid-Scala and SlimJ recipients at 6 (45.8% versus 46.0%,p= 0.962) and 12 (51.9% versus 48.8%,p= 0.363) months. Similarly, mean AzBio in quiet scores were equivalent for both groups at 6 (55.1% versus 59.2%,p= 0.334) and 12 (60.6% versus 62.3%,p= 0.684) months. HP rates were significantly higher with the SlimJ (48.4%) than the Mid-Scala (30.8%;p= 0.033). Scalar translocations were 34.8 and 16.1% for the Mid-Scala and SlimJ groups, respectively (p= 0.019). Ears with postoperative HP had significantly fewer scalar translocations (16.7% versus 37.2%,p= 0.048), and postoperative HP was associated with higher AzBio in noise scores at the most recent follow-up interval (38.7% versus 25.1%,p= 0.042). CNC, AzBio in quiet and noise, low-frequency pure-tone average shifts, and PTA at 6 and 12 months were not significantly different between patients with scala tympani insertions of the SlimJ versus the Mid-Scala (p> 0.05).ConclusionsCompared with the Mid-Scala, the lateral wall electrode has superior HP rates and fewer scalar translocations, whereas speech recognition scores are equivalent between both electrode arrays. These findings can help providers with electrode selection and patient counseling.