bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Biomechanical Changes After Accelerated Cross-Linking in Progressive Keratoconus: A Prospective Follow-Up Study
Authors: Herber Robert , Francis Mathew , Spoerl Eberhard , Pillunat Lutz E. , Raiskup Frederik , Roy Abhijit Sinha 
Published: February 2023

Purpose:
The aim of this study was to analyze the biomechanical effect of accelerated corneal cross-linking (9*10) in progressive keratoconus (KC) in comparison to untreated fellow eyes using Scheimpflug-based tonometry (Corvis ST, CVS).

Methods:
Forty-three eyes of 43 patients with KC showed progressive KC and were treated using accelerated corneal cross-linking. Twenty-five untreated fellow eyes were used as the control group. All eyes were examined biomechanically (CVS) and tomographically (Pentacam) at baseline, after 1-month, 6-month, and 12-month follow-up. Statistical analysis was performed using a linear mixed model. A logistic regression was performed to attribute the effects of changes in each parameter to treatment status (treated or untreated).

Results:
Maximum keratometry values decreased statistically significantly at 12 months by −1.1 D (95 confidence interval: −2.0 to −0.1, P = 0.025) compared with baseline. Thinnest corneal thickness decreased significantly after 1 month (P < 0.001) and recovered to baseline after 12 months (P = 0.752). In the corneal cross-linking (CXL) group, biomechanical changes were observed by an increased bIOP, a shorter A2 time, and a lower integrated radius after 1 month (all P < 0.05). No biomechanical and tomographical changes were observed in the control group (all P > 0.05). Logistic regression pointed out that treated eyes can be separated from untreated eyes by differences in bIOP, corneal thickness, A1 velocity, integrated radius, and Kc mean at 1, 6, and 12 months.

Conclusions:
The alterations in biomechanical parameters indicated a corneal stiffening effect after CXL treatment, which was mostly detectable 1 month after treatment, although corneal thickness was reduced. The logistic regression model showed an adequate separation between CXL-treated and untreated eyes.
Ocular Cicatricial Pemphigoid With IgM-Positive Biopsy
Authors: Philip Andrew M. , Stephenson Andrew , Al-Dabbagh Alaa , Ramezani Koosha , Fernandez-Santos Carla C. , Foster C. Stephen 
Published: February 2023

Purpose:
The aim of this study was to investigate the prevalence of IgM along the basement membrane zone (BMZ) of patients with ocular cicatricial pemphigoid (OCP) and the outcomes of these patients with immunomodulatory therapy.

Methods:
This study is a retrospective chart review of patients with conjunctival biopsy-proven OCP. Clinical data, including the presence of linear IgM deposition along the BMZ on either direct immunofluorescence or avidin–biotin complex immunohistochemistry, were recorded. Response to IMT was also recorded.

Results:
A total of 817 patients with documented conjunctival biopsies were identified, with 93 (11.4%) positive for OCP with linear IgM deposition along the BMZ. Forty-six patients with sufficient follow-up were evaluated for clinical outcomes, with 35 (76.1%) able to achieve durable remission an average of 24.3 months after initiation of IMT. Most of these patients, 82.9%, were able to achieve durable remission with first-line antimetabolite therapy. Three patients were identified with solely IgM-positive conjunctival biopsies.

Conclusions:
Our study suggests that IgM positivity is seen in a minority of patients with OCP and that outcomes are comparable for these patients to the general OCP patient population.
Management of Belantamab Mafodotin–Associated Keratopathy With Rigid Gas-Permeable Corneal Contact Lenses
Authors: Keye Philip , Engelhardt Monika , Wäsch Ralph , Böhringer Daniel , Reinhard Thomas 
Published: February 2023

Abstract:
Belantamab mafodotin is a relatively new drug used in the treatment of relapsed or refractory multiple myeloma. Clinical studies have shown promising responses, but ocular toxicity remains a major challenge with dose reduction or therapy discontinuation being the only available treatment option. We report a clinical case of a patient with severe keratopathy under therapy with belantamab. The use of rigid gas-permeable corneal contact lenses led to a major visual improvement and enabled therapy continuation at full dose over several months. Although this strategy may not be suitable for all patients, it provides an additional option for the treatment of ocular toxicity of this promising agent.
Anterior Segment Swept Source Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in a Case With Bleb-Like Epithelial Basal Membrane Dystrophy
Authors: Eker Serhat , Oflaz Ayse Bozkurt , Bozkurt Banu 
Published: February 2023

Purpose:
The aim of this study was to evaluate the anterior segment swept source optical coherence tomography (SS-OCT) and in vivo confocal microscopy (IVCM) features in a patient with bleb-like epithelial basement membrane dystrophy (EBMD).

Methods:
A 67-year-old man was referred to the hospital for recurrent attacks of severe ocular pain, tearing, and photophobia, typically upon awakening in the right eye. Biomicroscopic examination revealed pebbled glass-like appearance in the corneal epithelium which was remarkable with retroillumination and the patient was suspected to have bleb-like EBMD. The cornea was further evaluated using SS-OCT DRI Triton (Topcon, Tokyo, Japan) and IVCM (Heidelberg Retina Tomograph 3, Rostock Cornea Module).

Results:
Using anterior segment SS-OCT, multiple, hyporeflective, round-oval structures within the size range of 30 to 90 μm were observed at the basal epithelial level. IVCM showed circular or oval hyporeflective areas with a diameter ranging from 30 to 140 μm at the level of the basal epithelium in a depth of 35 to 40 μm from the corneal surface and hyperreflective linear structures extending into the corneal epithelium. The corneal stroma was normal, while a few round hyperreflective deposits and guttae were noted at the endothelial cell layer.

Conclusions:
Anterior segment SS-OCT and IVCM can be used in the diagnosis of bleb-like EBMD and are very helpful in differentiating from other epithelial/subepithelial corneal dystrophies and cystic disorders of the corneal epithelium.
Detecting disease progression in mild, moderate and severe glaucoma
Authors: Liebman Daniel L. , Wen Joanne C. , Shen Lucy Q. 
Published: February 2023

Purpose of review
The purpose of this review is to examine contemporary techniques for detecting the progression of glaucoma. We provide a general overview of detection principles and review evidence-based diagnostic strategies and specific considerations for detecting glaucomatous progression in patients with mild, moderate and severe disease.

Recent findings
Diagnostic techniques and technologies for glaucoma have dramatically evolved in recent years, affording clinicians an expansive toolkit with which to detect glaucoma progression. Each stage of glaucoma, however, presents unique diagnostic challenges. In mild disease, either structural or functional changes can develop first in disease progression. In moderate disease, structural or functional changes can occur either in tandem or in isolation. In severe disease, standard techniques may fail to detect further disease progression, but such detection can still be measured using other modalities.

Summary
Detecting disease progression is central to the management of glaucoma. Glaucomatous progression has both structural and functional elements, both of which must be carefully monitored at all disease stages to determine when interventions are warranted.
Advances in innovative delivery systems for antiglaucoma drugs
Authors: Chen XinYi , Shen Ting 
Published: February 2023

Purpose of review
Currently, glaucoma treatment drugs are facing problems such as low bioavailability, poor patient compliance, discontinuous administration affecting the efficacy of intraocular pressure (IOP) lowering and chronic damage to the eye caused by side effects of drugs. In order to solve these problems and to better meet clinical needs, various new dosage forms have been developed and applied in the clinical setting.

Recent findings
A number of nano formulations and extended-release gels are in successive animal trials, some tear plugs, implants and contact lenses are in clinical trials, and it is believed that more new carrier materials and formulations to improve the bioavailability of drugs are being developed.

Summary
Novel delivery systems for antiglaucoma drugs offer patients more and better therapeutic options, and ongoing or completed studies are providing clear directions for subsequent research to improve clinical applications.
Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning
Authors: Kurysheva Natalia Ivanovna , Pomerantsev Alexey Leonidovich , Rodionova Oxana Yevgenievna , Sharova Galina Arkadievna 
Published: February 2023

Précis:
Treatment strategy of primary angle closure (PAC) is not clear due to the large number of clinical and anatomic-topographic parameters in PAC, influencing the treatment algorithm. Using the machine learning method DD-SIMCA, we justify the expediency of early lens extraction (LE) in PAC.

Purpose:
To compare the anatomic and functional efficacy of LE and laser peripheral iridotomy (LPI) in patients with PAC using Machine Learning.

Materials and Methods:
This prospective study included 120 patients aged 41–80 years: 60 eyes with PAC, 30 with PAC suspects, and 30 with healthy eyes (control). Thirty PAC eyes with intraocular pressure (IOP) up to 30 mm Hg were treated using LE with intraocular lens implantation and 30 eyes with LPI. All subjects underwent Swept Source optical coherence tomography. We analyzed 35 parameters of each eye including the lens vault, the choroidal thickness, the anterior chamber angle, and iris specifications such as iris curvature. Considering the correlations between them, the machine learning method DD-SIMCA 1-class classification was applied: the proximity of each sample to the target class (control) was characterized by the total distance to it.

Results:
After LE, IOP was significantly lower than after LPI (P=0). Every third eye with PAC after LE reached the target class: specificity according to DD-SIMCA equals 0.67. This was not observed for the eyes after LPI: specificity equals 1.0. After LE, all parameters of the anterior chamber angle did not differ from the control (all P>0.05). After LPI, there was an increase in anterior chamber depth (P=0) and a decrease in lens vault (P=0), but results comparable to the control were achieved only for iris curvature (P=1.000).

Conclusion:
The efficacy of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. This study lends further clinical and anatomic support to the emerging notion of LE as an effective treatment for PAC.
Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness for Diagnosing Early to Moderate Glaucoma
Authors: Zangalli Camila S. , Jammal Alessandro A. , Reis Alexandre S.C. , Ayub Gabriel , Diniz-Filho Alberto , Paranhos Augusto , Paula Jayter S. , Costa Vital P. 
Published: February 2023

Précis:
In a cross-sectional study from a Brazilian multiracial population, minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness measurements from OCT showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes.

Purpose:
The purpose of this study is to compare the ability of MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in discriminating early to moderate glaucoma from healthy eyes in a Brazilian population.

Methods:
A total of 155 healthy controls and 118 patients with mild to moderate glaucoma (mean deviation >−12 dB) underwent MRW and RNFLT measurements with optical coherence tomography. Only 1 eye per patient was included in the analysis. A receiver operating characteristic (ROC) regression model was used to evaluate the diagnostic accuracy of MRW and RNFLT, whereas adjusting for age and Bruch membrane opening area. Sensitivities at fixed specificities of 95% were calculated for each parameter.

Results:
Global RNFLT and MRW showed comparable area under the ROC curves [0.93 (0.91–0.96) and 0.93 (0.89–0.96), respectively; P=0.973]. Both parameters had similar sensitivities (75% vs. 74%, respectively; P=0.852) at a fixed specificity of 95%. The best sector for diagnosing glaucoma for both parameters was the temporal inferior sector, which showed an area under the ROC curve of 0.93 (0.87–0.96) for RNFLT and 0.91 (0.86–0.95) for MRW (P=0.320). The temporal inferior sector showed similar sensitivities for RNFLT and MRW measurements (83% vs. 77%, respectively) at a fixed specificity of 95% (P=0.230).

Conclusions:
MRW and RNFLT measurements showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes in a Brazilian multiracial population.
Prolonged SARS-CoV-2 Infection and Intra-Patient Viral Evolution in an Immunodeficient Child
Authors: Filippi Micheli , Ribeiro Amorim Mariene , Soares da Silva Mariana , Schons Gularte Juliana , Demoliner Meriane , Girardi Viviane , de Abreu Goes Pereira Vyctoria Malayhka , Witt Hansen Alana , Fleck Juliane Deise. , Frohlich Júlia , de-Paris Fernanda , Motta Rodrigues Grazielle , Aparecida Risczik Arruda Correa Janaina , Machado Arlindo De Mattos Elissandra , Minuto Paiva Rodrigo , Deutschendorf Caroline , Soares Falcetta Frederico , Proença Modena José Luiz , Rosado Spilki Fernando 
Published: February 2023

Background:
With the progression of the Coronavirus disease pandemic, the number of mutations in the viral genome has increased, showing the adaptive evolution of severe acute respiratory syndrome coronavirus 2 in humans and intensification in transmissibility. Long-term infections also allow the development of viral diversity. In this study, we report the case of a child with severe combined immu presenting a prolonged severe acute respiratory syndrome coronavirus 2 infection. We aimed to analyze 3 naso-oropharyngeal swab samples collected between August and December 2021 to describe the amino acid changes present in the sequence reads that may have a role in the emergence of new viral variants.

Methods:
The whole genome from clinical samples was sequenced through high throughput sequencing and analyzed using a workflow to map reads and then find variations/single-nucleotide polymorphisms. In addition, the samples were isolated in cell culture, and a plaque forming units assay was performed, which indicates the presence of viable viral particles.

Results:
The results obtained showed that the virus present in all samples is infectious. Also, there were 20 common mutations among the 3 sequence reads, found in the ORF1ab and ORF10 proteins. As well, a considerable number of uncommon mutations were found.

Conclusions:
In conclusion, we emphasize that genomic surveillance can be a useful tool to assess possible evolution signals in long-term patients.
Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series
Authors: Lohuis Steven J. , de Groot Eric , Kamps Arvid W. A. , Ottink Mark D. , de Vries Tjalling W. , Bekhof Jolita 
Published: February 2023

Background:
In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE.

Methods:
A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1–18 years treated for PPE between January 2010 and June 2020.

Results:
One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%–77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%–70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%–66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4–112) compared with 19 days (IQR 15–24) in the drainage group (P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: –8%–21%).

Conclusion:
This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.
Interferon Gamma Release Assay Results and Testing Trends Among Patients Younger Than 2 Years Old at Two US Health Centers
Authors: Tabatneck Mary E. , He Wei , Lamb Gabriella S. , Sun Mingwei , Goldmann Don , Sabharwal Vishakha , Sandora Thomas J. , Haberer Jessica E. , Campbell Jeffrey I. 
Published: February 2023

Background:
Interferon-gamma release assays (IGRAs) are approved for children ≥2 years old to aid in diagnosis of Mycobacterium tuberculosis (TB) infection and disease. Tuberculin skin tests (TSTs) continue to be the recommended method for diagnosis of TB infection in children <2 years, in part due to limited data and concern for high rates of uninterpretable results.

Methods:
We performed a retrospective cohort study of IGRA use in patients <2 years old in 2 large Boston healthcare systems. The primary outcome was the proportion of valid versus invalid/indeterminate IGRA results. Secondary outcomes included concordance of IGRAs with paired TSTs and trends in IGRA usage over time.

Results:
A total of 321 IGRA results were analyzed; 308 tests (96%) were valid and 13 (4%) were invalid/indeterminate. Thirty-seven IGRAs were obtained in immunocompromised patients; the proportion of invalid/indeterminate results was significantly higher among immunocompromised (27%) compared with immunocompetent (1%) patients (P < 0.001). Paired IGRAs and TSTs had a concordance rate of 64%, with most discordant results in bacille Calmette-Guérin–vaccinated patients. The proportion of total TB tests that were IGRAs increased over the study period (Pearson correlation coefficient 0.85, P < 0.001).

Conclusions:
The high proportion of valid IGRA test results in patients <2 years of age in a low TB prevalence setting in combination with the known logistical and interpretation challenges associated with TSTs support the adoption of IGRAs for this age group in certain clinical scenarios. Interpretation of IGRAs, particularly in immunocompromised patients, should involve consideration of the broader clinical context.
Clinical and Biologic Characteristics of Kingella kingae-Induced Septic Arthritis of the Knee in Young Children
Authors: Ramadani Ardian , Coulin Benoit , De Marco Giacomo , Vazquez Oscar , Tabard-Fougère Anne , Gavira Nathaly , Steiger Christina N. , Dayer Romain , Ceroni Dimitri 
Published: February 2023

Background and Objectives:
Septic arthritis of the knee is presumed to be the most frequent form of Kingella kingae-induced osteoarticular infection. This study aimed to report on the clinical course, biological parameters, and results of microbiological investigations among children with K. kingae-induced septic arthritis of the knee. It also assessed the modified Kocher–Caird criteria’s ability to predict K. kingae-induced septic arthritis of the knee.

Methods:
The medical charts of 51 children below 4 years old with confirmed or highly probable K. kingae-induced arthritis of the knee were reviewed. Data were gathered on the five variables in the commonly-used Kocher–Caird prediction algorithm (body temperature, refusal to bear weight, leukocytosis, erythrocyte sedimentation rate, and C-reactive protein level).

Results:
Patients with K. kingae-induced arthritis of the knee usually presented with a mildly abnormal clinical picture and normal or near-normal serum levels of acute-phase reactants. Data on all five variables were available for all the children: 7 children had zero predictors; 8, 20, 12, and 4 children had 1, 2, 3, and 4 predictors, respectively; no children had 5 predictors. This gave an average of 1.96 predictive factors and a subsequent probability of ≤ 62.4% of infectious arthritis in this pediatric cohort.

Conclusions:
Because the clinical features of K. kingae-induced arthritis of the knee overlap with many other conditions affecting this joint, the Kocher–Caird prediction algorithm is not sensitive enough to effectively detect K. kingae-induced septic arthritis of the knee. Excluding K. kingae-induced arthritis of the knee requires performing nucleic acid amplification assays on oropharyngeal swabs and joint fluid from those young children presenting with effusion of the knee, even in the absence of fever, leukocytosis, or a high Kocher–Caird score.
Clinical and Health System Impact of Biofire Filmarray Meningitis/Encephalitis Routine Testing of CSF in a Pediatric Hospital: An Observational Study
Authors: Berkhout Angela , Cheng Daryl R. , McNab Sarah , Lee Lai-yang , Daley Andrew J. , Clifford Vanessa 
Published: February 2023

Background:
Rapid cartridge-based molecular test panels targeting multiple pathogens are increasingly available, improve pathogen detection and reduce turn-around-time but are more expensive than standard testing. Confirmation that these test panels contribute to improved patient or health service outcomes is required.

Methods:
In March 2021, our pediatric hospital laboratory implemented the BioFire Filmarray™ meningitis/encephalitis (M/E) panel as an additional routine test for all cerebrospinal fluid (CSF) samples collected from infants <90 days or from any patient in the emergency department. A retrospective chart review was done to ascertain changes in clinical outcomes, antimicrobial prescribing practices, and hospital length of stay, comparing two discrete 6-month periods: preimplementation (March–August 2019) and postimplementation (March-August 2021).

Results:
Both pre- and postimplementation groups were similar at baseline, except the preimplementation group had a higher proportion of infants with enterovirus and parechovirus meningitis. There was no significant difference between the groups in terms of median length of stay (2.94 vs 3.47 days, p = 0.41), duration of antibiotic treatment (2.0 vs 2.3 days, p = 0.25), need for central venous access (12.9% vs 17%, p = 0.38) or hospital-in-the-home admission (9.4% vs 9%, p = 0.92). A similar proportion of infants received aciclovir (33% vs 31%), however, a reduction in duration was observed (1.36 vs 0.90 days, p = 0.03) in the postimplementation period.

Conclusions:
Introduction of the Biofire Filmarray™ M/E panel for routine testing of CSF samples reduced the duration of antiviral prescribing but had only a minor impact on antibiotic prescribing practices or health service outcomes in our pediatric hospital. The introduction of new laboratory testing needs to be supported by a comprehensive stewardship program to see optimal outcomes from new testing platforms.