bluuebunny/crossref_metadata_2025_split huggingface dataset:
BIOMARKERS OF MATERNAL SMOKING AND THE RISK OF RETINOBLASTOMA IN OFFSPRING
Authors: He Di , Huang Xiwen , Uppal Karan , Coleman Anne L. , Walker Douglas D. , Ritz Beate , Jones Dean P. , Heck Julia E. 
Published: February 2023

Purpose:
Previous studies examining the risk of retinoblastoma with maternal smoking were inconclusive, likely due in part to the reliance on self-reported maternal smoking. This study uses biomarkers of tobacco smoking in neonatal dried blood spots to investigate associations between maternal smoking and retinoblastoma in offspring.

Methods:
The authors randomly selected 498 retinoblastoma cases and 895 control subjects born between 1983 and 2011 from a population-based case–control study in California. Maternal pregnancy-related smoking was measured using the following three metrics: provider or self-reported smoking during pregnancy, cotinine, and hydroxycotinine in neonatal blood. The authors used multivariable logistic regression to estimate the effects of maternal tobacco smoking on retinoblastoma.

Results:
Using all metrics (biomarkers or self-report), maternal smoking late in pregnancy or early postpartum was related to retinoblastoma (all types; odds ratio = 1.44, 95% confidence interval: 1.00–2.09). Relying on cotinine or hydroxycotinine to ascertain smoking, maternal smoking was related to unilateral retinoblastoma (odds ratio = 1.66, 95% confidence interval: 1.08–2.57).

Conclusion:
The results indicate that maternal smoking during pregnancy may be a risk factor for retinoblastoma, particularly among unilateral cases.
NATURAL COURSE AND CLASSIFICATION OF EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN-LIKE APPEARANCE
Authors: Romano Francesco , Cozzi Mariano , Monteduro Davide , Oldani Marta , Boon Camiel J. F. , Staurenghi Giovanni , Salvetti Anna Paola 
Published: February 2023

Purpose:
To describe the imaging characteristics and topographic expansion of retinal pigment epithelium (RPE) and outer retinal atrophy in extensive macular atrophy with pseudodrusen-like appearance.

Methods:
Three-year, prospective, observational study. Nine patients with extensive macular atrophy with pseudodrusen-like appearance (17 eyes; 6 women) with no other ocular conditions were annually examined; one eye was excluded because of macular neovascularization. Best-corrected visual acuity measurement, fundus photographs, blue-light autofluorescence, and optical coherence tomography were performed at each visit. Formation of atrophy was analyzed on optical coherence tomography at foveal and extrafoveal areas following the Classification of Atrophy Meeting recommendations. Spatial enlargement throughout four sectors was assessed on blue-light autofluorescence after placing an Early Treatment for Diabetic Retinopathy Study grid centered on the foveola.

Results:
Mean age was 53.0 ± 2.1 years at baseline with a follow-up of 36.6 ± 0.7 months. Thinning of the outer nuclear layer and disruption of the ellipsoid zone initially appeared above areas of RPE–Bruch membrane separation and preceded RPE atrophy. Subfoveal fibrosis was seen in 65% of the eyes. Superior sector involvement was found in all patients at baseline and was significantly larger than the other sectors at any time point (P < 0.001). Best-corrected visual acuity declined from 68.0 ± 15.7 letters to 44.8 ± 14.9 letters during the follow-up and was significantly associated with subfoveal atrophy (P < 0.001) and fibrosis (P = 0.02).

Conclusion:
Our findings suggest that primary alterations in patients with extensive macular atrophy with pseudodrusen-like appearance are present at the outer segment–RPE interface, with the superior Early Treatment for Diabetic Retinopathy Study sector being the most vulnerable, which progresses to extensive atrophy of the RPE and outer retinal layers. Accordingly, we propose a three-stage disease classification.
ACUTE- AND DELAYED-ONSET ENDOPHTHALMITIS AFTER OPEN GLOBE INJURIES
Authors: Hudson Julia L. , Fan Jason C. , Smiddy William E. , Sridhar Jayanth , Yannuzzi Nicolas A. , Flynn Harry W. 
Published: February 2023

Purpose:
The purpose of the study was to report the clinical features and best-corrected visual acuity outcomes in patients with acute- and delayed-onset endophthalmitis after open globe injuries.

Methods:
The study included a retrospective, comparative, consecutive case series of patients with endophthalmitis after open globe injury between January 2016 and October 2020 at the Bascom Palmer Eye Institute.

Results:
Acute-onset endophthalmitis accounted for 16 of 20 cases (80%), and all cases were diagnosed at the initial examination. Delayed-onset endophthalmitis cases, occurring more than 2 weeks after injury, accounted for 4 of 20 cases (20%) and were because of Zone 1 wound leaks and infections. Factors associated with endophthalmitis included presence of a retained intraocular foreign body (11/20 [55%]) and delay of presentation >24 hours (15/20 [75%]) (P < 0.001 and 0.002, respectively). The mean presenting best-corrected visual acuity was logMAR 1.64 (20/800), and the mean best-corrected visual acuity at the last follow-up was logMAR 1.22 (20/300).

Conclusion:
In patients with open globe injury–related endophthalmitis, visual acuity outcomes are generally poor. Despite intravitreal antibiotics at primary closure, delayed-onset endophthalmitis cases may develop in the setting of compromised Zone 1 wound integrity.
IDENTIFICATION OF PATHOGENS IN THE INTRAOCULAR FLUID SAMPLES OF PATIENTS WITH ENDOGENOUS ENDOPHTHALMITIS USING RAPID NANOPORE TARGETED SEQUENCING
Authors: Hao Xinlei , Wang Ming , Yuan Man , Zhang Rui , Jin Wei , Yang Anhuai 
Published: February 2023

In Brief:
Nanopore targeted sequencing showed a higher positivity rate and a shorter turnaround time than did traditional culture in identifying pathogens in the intraocular fluid samples of patients with endogenous endophthalmitis.

Purpose:
To evaluate the feasibility of clinical application of nanopore targeted sequencing (NTS) for the identification of pathogens in patients with endogenous endophthalmitis, especially those with fungus-associated endophthalmitis.

Methods:
In this retrospective study, medical records and etiological results of 27 patients (34 eyes) with endogenous endophthalmitis were reviewed. The intraocular fluid samples were examined using both NTS and microbial culture. The results included the differences in detection time, positivity rate of pathogen detection, and positivity rate of fungus identification between two methods.

Results:
NTS and microbial culture enabled the detection of etiologic agents in 89.28% and 35.71% of the samples, respectively. The difference of positivity rate between these methods was statistically significant (P < 0.001). NTS also showed high sensitivity in both culture-positive and culture-negative samples (100% and 83.33%, respectively). Regarding culture-positive samples, the NTS results displayed a strong match with culture results. NTS showed a significantly higher positivity rate for fungal infection than did microbial culture (46.43% vs. 7.14%, P = 0.002). The average detection time of NTS was 1.11 ± 0.31 days, which was shorter than that of microbial culture (2.50 ± 0.58 days, Z = −4.686, P < 0.001). NTS technology facilitated an informed switch of intravitreal antimicrobial agents in 13 eyes.

Conclusion:
NTS, as a sensitive, specific, and timely complementary method, can be used along with traditional methods for the identification of pathogenic microorganisms in the intraocular fluid of patients with endogenous endophthalmitis.
INVERTED INTERNAL LIMITING MEMBRANE FLAP FOR SMALL-SIZED (<250 µm) FULL-THICKNESS MACULAR HOLE
Authors: Iuliano Lorenzo , Corbelli Eleonora , Bandello Francesco , Codenotti Marco 
Published: February 2023

Purpose:
To compare the anatomical and functional outcome of small (<250 µm) and medium (250–400 µm) full-thickness macular holes (FTMHs) treated with internal limiting membrane (ILM) inverted flap (IF) or with the standard technique.

Methods:
Retrospective longitudinal analysis of successfully operated eyes with small or intermediate FTMH. Outcome measures were best-corrected visual acuity (BCVA), microperimetric sensitivity (with fixation stability), and restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) at 6 months.

Results:
Fifty small and 50 intermediate eyes with FTMH were included, half of each group (25) treated with the standard technique, half with IF. BCVA increased in every subgroup, similarly within the same stage regardless the technique. Small FTMH treated with IF disclosed inferior foveal sensitivity at 6 months (20.79 ± 0.48 dB) compared with the standard technique (21.51 ± 0.79 dB; P = 0.0035). At 1 month, inferior rates of ELM (24%) and EZ (24%) restoration were also found, compared with the standard technique (56% ELM P = 0.0420; 64% EZ P = 0.0095). At 6 months, ELM and EZ were similarly restored.

Conclusion:
The surgical repair of small FMTH with ILM IF seem to delay the foveal structural repair and to gain an inferior foveal sensitivity compared to the standard technique.
RETINOBLASTOMA ASSOCIATED WITH TOTAL EXUDATIVE RETINAL DETACHMENT
Authors: Ghose Neha , Agarwal Purva , Palkonda Vijay Anand Reddy , Kaliki Swathi 
Published: February 2023

Purpose:
To study the clinical presentation, treatment, and outcomes of eyes presenting with retinoblastoma and total retinal detachment.

Methods:
A retrospective study of 50 eyes in 43 patients.

Results:
The mean age at presentation was 15 months (median, 9 months). Retinoblastoma-associated total retinal detachment was unilateral (n = 36; 84%) or bilateral (n = 7; 16%). The mean tumor basal diameter was 17 mm (median, 18 mm), and the mean tumor thickness was 13 mm (median, 12 mm). Associated features included subretinal seeds (n = 26; 52%), vitreous seeds (n = 13; 26%), and subretinal exudation (n = 4; 8%). Based on eighth edition of American Joint Committee on Cancer classification, the tumors were classified as cT2a (n = 19; 38%), cT2b (n = 28; 56%), or cT3c (n = 3; 6%). Primary treatment included intravenous (n = 48; 96%) or intraarterial chemotherapy (n = 2; 4%). Over a mean follow-up period of 30 months (median, 29 months; range, 7–62 months), retinal detachment resolved in 41 eyes (82%), tumor recurrence was noted in 39 eyes (78%), globe salvage was achieved in 35 eyes (70%), and one patient (2%) died due to metastasis.

Conclusion:
Relatively high tumor recurrence rate is noted in retinoblastoma presenting with total retinal detachment. With appropriate treatment, 70% of the globes can be salvaged.
CLINICAL CHARACTERISTICS AND SURGICAL PROGNOSIS OF IDIOPATHIC MACULAR HOLES WITH EPIRETINAL PROLIFERATION
Authors: Qi Biying , Yu Yanping , Yang Xiaohan , Zhang Ke , Wu Xijin , Wang Xinbo , Liu Wu 
Published: February 2023

Purpose:
To investigate the clinical features and surgical outcomes of idiopathic macular holes with epiretinal proliferation (EP).

Methods:
This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for idiopathic macular holes. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity, and postoperative closure rate were compared between eyes with and without EP.

Results:
EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P < 0.001), and a larger base diameter (P = 0.014) than those without EP. In addition, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and a thicker central fovea (P = 0.012) at 1 month postoperatively and a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively.

Conclusion:
The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.
GOOD SYNDROME: CYTOMEGALOVIRUS RETINITIS CASE CHALLENGE
Authors: Baquero-Ospina Pablo , Cantu-Rosales Carolina , Concha-del-Rio Luz Elena 
Published: February 2023

Purpose:
To describe cytomegalovirus retinitis in a patient with Good syndrome (hypogammaglobulinemia and thymoma), ocular progression despite treatment and fatal outcome.

Methods:
A 71-year-old woman with unilateral panuveitis of unknown cause and a history of thymoma resection was referred to the clinic. Visual acuity was 20/100 in her right eye and light perception in her left eye. In slit-lamp examination, the right eye had inferior, fine, pigmented keratic precipitates, 2+ anterior chamber cells, cataract, and 2+ vitreous cells, with no fundus detail and normal ocular ultrasound results. Left eye presented a white cataract, chronic hypotony, and increased choroidal thickness with calcifications. Laboratory evaluations showed normal or negative results for common causes of infection and inflammation. Prednisolone acetate eye drops were started, with improvement of AC inflammation. Cataract surgery was performed, reaching visual acuity of 20/30. Two years later, visual acuity had decreased and 2+ vitritis and retinitis were found. On clinical suspicion of masquerade syndrome, a vitrectomy biopsy was performed; pathologic assessments reported no data on ocular lymphoma. Leukopenia and lymphopenia were found: immunoglobulin levels, CD4 count, and viral load revealed systemic immunosuppression. The aqueous tap was positive for cytomegalovirus. Oral valganciclovir and intravitreal ganciclovir were initiated.

Results:
In a patient with previous resection of thymoma and hypogammaglobulinemia, final diagnosis was Good syndrome, with cytomegalovirus retinitis being secondary to immunosuppression. Despite treatment, cytomegalovirus retinitis progressed and systemic deterioration resulted in mortal outcome.

Conclusion:
Good syndrome is an extremely rare disease, and association with cytomegalovirus retinitis is uncommon. To the authors’ knowledge, only 14 cases exist in the literature.
Acute syphilitic necrotizing retinitis associated with placoid chorioretinitis in an immunocompetent patient.
Authors: Kreps Elke O. , Jasim Haneen , Mamtora Sunil , Dick Andrew D. 
Published: February 2023

Abstract

Purpose:
We report an atypical case of combined acute syphilitic necrotizing retinitis and a contiguous acute syphilitic posterior placoid chorioretinitis (ASPPC) in an HIV-negative, immunocompetent patient.

Method:
Observational case report.

Results:
A 56-year-old male presented with a one-week history of pain and blurred vision in the left eye. He also complained of left-sided hearing loss for several months. Ocular examination demonstrated a unilateral panuveitis with a yellowish placoid macular lesion involving the outer retina contiguous with an ovoid area of full-thickness retinitis extending temporally. Vitreal polymerase chain reaction (PCR) analysis for HSV, CMV, VZV and T. gondii were negative but syphilis serology was reported as positive. An MRI of the head revealed bilateral enhancement along the facial nerves, more marked on the left side, consistent with syphilitic involvement. He was treated as neurosyphilis with a 14-day course of systemic procaine penicillin and oral probenecid. Oral prednisolone (1 mg/kg/day) was commenced 24 hours prior to initiating antibiotics to prevent Jarisch-Herxheimer reaction and treat his panuveitis.

Conclusion:
To our knowledge, this is the first report of combined syphilitic necrotizing retinitis and ASPPC occurring in continuity in the same eye. This case highlights the diversity of possible presentations of ocular syphilis, even in HIV-negative immunocompetent patients.
Three-year Follow-up of Progressive Chorioretinal Atrophy in Atypical Alagille Syndrome: a Case Report
Authors: Umemura Kyohei , Fujita Kyoko , Kamei Motohiro 
Published: February 2023

Abstract:

Purpose:
To report a case of atypical Alagille syndrome (ALGS) with progressive chorioretinal atrophy.

Methods:
Case report

Results:
A 42-year-old Japanese man presented with atypical ALGS. At the first visit, funduscopy revealed anterior circumferential chorioretinal atrophy in peripheral retina and in peripapillary region with posterior pole sparing in both eyes. Fundus autofluorescence (FAF) showed hypoautofluorescence in the peripheral and peripapillary regions, but normal findings in the macular region. After follow-up for three years, hypopigmentated area with well visualized large choroidal vessels extended to mid-peripheral region. On FAF images, hypoautofluorescence newly appeared in macular region in both eyes. Perivascular hypoautofluorescence and granular hyperautofluorescence scattering within the posterior pole were also observed. BCVA deteriorated and concentric visual field contraction worsened progressively.

Conclusion:
ALGS is known to have many ophthalmic manifestations, most of which are stable with minimal threat to vision. In the present case, chorioretinal atrophy progressed during three-year follow-up, suggesting that progression of chorioretinal atrophy with vision loss may occur over time in ALGS.
Five-year follow-up of a spontaneously progressive retinal racemose hemangioma
Authors: Xu Yu , Luo Lifu , Yang Bo , Xiao Jun 
Published: February 2023

Abstract

Purpose:
To report the progression of a patient with retinal racemose hemangioma after five years of follow-up.

Methods:
Observational case report.

Results:
A 14-year-old girl was diagnosed with an isolated retinal racemose hemangioma with retinal arteriovenous malformation in the posterior pole of the left eye fundus. At the fifth year of follow-up, a spontaneous enlargement of the previously normal vessel was found above the original lesion. The patient’s vision remained stable and no complication was observed.

Conclusions:
Retinal racemose hemangioma was once considered stable and non-progressive, but progression and expansion of the lesion may also occur, so long-term follow-up is necessary.
PARACENTRAL ACUTE MIDDLE MACULOPATHY (PAMM) IN GIANT CELL ARTERITIS
Authors: Pellegrini Francesco , Mairot Kevin , Cuna Alessandra , Lee Andrew G 
Published: February 2023

Abstract:

Purpose:
To describe a representative case and review the literature on paracentral acute middle maculopathy (PAMM) and giant cell arteritis (GCA).

Methods:
A review of the English language ophthalmic literature was performed using the search terms of PAMM, giant cell arteritis, and temporal arteritis.

Results:
We describe a 72-year-old woman with PAMM as the presenting ophthalmic manifestation of GCA with a review the prior cases from the literature. We found a total of 26 cases of PAMM in GCA. In 19 out of 26 cases PAMM was associated with no other fundus abnormalities and was only seen on multimodal imaging including OCT.

Conclusion:
PAMM can cause acute paracentral visual loss and GCA should be suspected in all cases of PAMM of the elderly, even when isolated and not associated with constitutional symptoms of GCA.
Sub-tenon’s vancomycin injection for subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis: a case report and literature review.
Authors: Rowe Lucas W. , McVeigh Luke G. , Hajrasouliha Amir R. 
Published: February 2023

Abstract

Purpose:
To report the use of a sub-tenon’s vancomycin injection for treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus (MRSA) endogenous endophthalmitis (EE).

Methods:
A 17-year-old male developed EE with subretinal abscess in his right eye secondary to MRSA bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with intravenous vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a sub-tenon’s vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses.

Results:
On presentation, exam revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to macula with subretinal fluid inferotemporally involving macula. Four days post-intravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the sub-tenon’s space with no complications during the procedure or during his post-operative recovery. At seven days post-injection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess.

Conclusion:
We present the first successful case of sub-tenon’s vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that sub-tenon’s injection of antibiotics is a safe and effective non-surgical management option for bacterial subretinal abscesses.
Outcomes of Conventional 8.0-mm Versus Large 9.0-mm Diameter Deep Anterior Lamellar Keratoplasty for Keratoconus
Authors: Lucisano Andrea , Lionetti Giovanna , Yu Angeli Christy , Giannaccare Giuseppe , D'Angelo Sergio , Busin Massimo , Scorcia Vincenzo 
Published: February 2023

Purpose:
The purpose of the study was to compare the clinical outcomes of large 9.0-mm diameter and conventional 8.0-mm big-bubble deep anterior lamellar keratoplasty (DALK).

Methods:
In this comparative, retrospective interventional case series, medical records of 124 cases of large 9.0-mm diameter DALK from January 2017 to December 2019 and 133 conventional 8.0-mm DALK from January 2014 to December 2016 performed by a single surgeon for the indication of keratoconus were reviewed. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), and postoperative complication rates.

Results:
Postoperative logarithm of the minimum angle of resolution BSCVA did not significantly differ between 9.0-mm and 8.0-mm DALK at any time points. Although the cumulative percentage of eyes achieving Snellen BSCVA of 20/40 or better was comparable between groups (9.0-mm DALK: 93%, 8.0-mm DALK: 90%, P = 0.571), the cumulative percentage of eyes achieving 20/20 or better (9.0-mm DALK: 44%, 8.0-mm DALK: 26%, P = 0.01) and 20/25 or better (9.0-mm DALK: 74%, 8.0-mm DALK: 59%, P = 0.03) was significantly higher in the 9.0-mm DALK group. RA was significantly lower in the 9.0-mm DALK group compared with the 8.0-mm DALK group during all time points (P < 0.001). The percentage of eyes with RA less than or equal to 4.0 D was significantly lower in the 9.0-mm DALK patients (90%) compared with in 8.0-mm DALK group (72%) (P = 0.002). Postoperative complication rates were similar between groups.

Conclusions:
Compared with conventional 8.0-mm DALK, large 9.0-mm DALK can provide superior visual outcomes at higher levels of Snellen BSCVA and significantly lower degrees of astigmatism without an increased risk of immune rejection and graft failure.