bluuebunny/crossref_metadata_2025_split huggingface dataset:
Femtosecond Laser Capsulotomy in Previous Radial Keratotomy
Authors: Friehmann Asaf , Assia Ehud I. 
Published: February 2023

Purpose:
The aim of this study was to describe clinical experience using femtosecond laser-assisted anterior capsulotomy in eyes with previous radial keratotomy.

Methods:
Eyes of patients with previous radial keratotomy and cataract-related vision impairment who underwent phacoemulsification and intraocular lens implantation were retrospectively reviewed. Eyes with any vision impairment cause other than cataract or previous radial keratotomy were excluded.

Results:
Sixteen postradial keratotomy eyes were included. In 5 patients, manual anterior capsulectomy was successfully performed. Six eyes underwent femtosecond laser capsulotomy using routine parameters (incision depth 500 μm and 4 μJ power), of which in 3 eyes capsulotomies were complete, whereas in the other 3 eyes incomplete capsulotomy was evident. In 3 patients, both incision depth and power parameters were doubled (incision depth 1000 μm and 8 μJ power), whereas in 2 patients, only the pulse energy was doubled (8 μJ power) and in all 6 cases, the capsulotomy was successfully completed. At the last follow-up, all capsulotomies were intact without radial tears, and the intraocular lenses were stable and central.

Conclusions:
Radial corneal scars after previous radial keratotomy may interfere with femtosecond laser-assisted anterior capsulotomy using routine parameters. Surgeons should be alert and ready to convert to manual anterior capsulectomy. Modification of the laser parameters may overcome this potential complication.
High Prevalence of Demodex Infestation is Associated With Poor Blood Glucose Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study in the Guangzhou Diabetic Eye Study
Authors: Zhang Nuan , Wen Kuiyao , Liu Yan , Huang Wenyong , Liang Xiaoling , Liang Lingyi 
Published: February 2023

Purpose:
The aim of this study was to investigate the association between type 2 diabetes mellitus (T2DM) and ocular Demodex mite infection.

Method:
About 381 patients with T2DM from nearby communities were enrolled, and 163 age-matched and sex-matched nondiabetic patients from the cataract clinic were included as the control group. All subjects underwent personal history and demographic data collection, ocular examination, and lash sampling, followed by microscopic identification and counting of Demodex mites. Binocular fundus photography was performed for diabetic patients. Statistical correlation between ocular Demodex infestation and T2DM and blood glucose control status was performed.

Results:
The Demodex mite infestation rate (62.5% vs. 44.8%, P < 0.001) and count [3 (0–12) vs. 2 (0–9.6), P = 0.01], especially of Demodex brevis (18.9% vs. 4.9%, P < 0.001) [0 (0–1) vs. 0 (0–0), P < 0.001], were significantly higher in the T2DM patient group than that in the control group. The ratio of Demodex brevis to Demodex folliculorum in the T2DM patient group was significantly higher than that in the control group (1:3 vs. 1:9, P < 0.001). Diabetic patients presented with more cylindrical dandruff (55.1% vs. 39.3%, P = 0.001). Ocular Demodex infestation was strongly associated with poor blood glucose control (HbA1c > 7%) (odds ratio = 1.82; 95% confidence interval, 1.12–2.94; P = 0.2) and female sex (odds ratio = 1.69, 95% confidence interval, 1.08–2.65, P = 0.02). No association was found between Demodex infestation and the severity of diabetic retinopathy.

Conclusions:
Patients with T2DM, especially those with poor blood glucose control, tend to have a higher prevalence of ocular Demodex infestation, suggesting that high blood glucose is a risk factor for demodicosis.
Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Disease Severity
Authors: Vasiliauskaite Indre , Kocaba Viridiana , van Dijk Korine , Baydoun Lamis , Lanser Charlotte , Lee Demi , Jager Martine J. , Melles Gerrit R. J. , Oellerich Silke 
Published: February 2023

Purpose:
The aim of this study was to evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after Descemet membrane endothelial keratoplasty (DMEK) based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity.

Methods:
The cohort in this retrospective study included 750 eyes that underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3–4) and 440 eyes (68%) had advanced FECD (Krachmer grade 5–6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival.

Results:
The mean 10-year BCVA was 0.08 ± 0.28 logMAR (n = 96), and the BCVA remained stable between 5 and 10 years postoperatively (all P > 0.05). The mean ECL at 5 and 10 years was 56% ± 17% (n = 460) and 66% ± 14% (n = 96), respectively (P < 0.05). The 10-year graft survival rate for the total cohort was 0.85 (95% confidence interval, 0.82–0.89). BCVA and ECD differed at 1 to 5 years between eyes with different surgical indications (all P < 0.05), and FECD eyes had higher graft survival compared with BK eyes (0.90 vs. 0.60, P = 0.001). Moderate FECD eyes had better BCVA, ECD, and graft survival outcomes than advanced FECD eyes (all P < 0.05). Minor graft detachment (P = 0.04) and lower donor ECD (P = 0.01) were related to lower 10-year ECD.

Conclusions:
Long-term outcomes and graft survival after DMEK were better in FECD eyes than BK eyes and were also related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent long-term outcomes.
Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus
Authors: Grentzelos Michael A. , Liakopoulos Dimitrios A. , Kankariya Vardhaman P. , Siganos Charalambos S. , Tsilimbaris Miltiadis K. , Pallikaris Ioannis G. , Kymionis George D. 
Published: February 2023

Purpose:
The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus.

Methods:
In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively.

Results:
Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 (P < 0.001) and 0.06 ± 0.12 (P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from −5.39 ± 3.89 diopters (D) preoperatively to −2.29 ± 2.65 D (P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from −4.70 ± 2.86 D preoperatively to −3.55 ± 2.45 D (P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up (P > 0.05).

Conclusions:
Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.
Human MPox (Monkeypox) Virus Membranous Keratoconjunctivitis With Transient Corneal Hypoesthesia and Late Symblepharon Formation: A Novel Case and Clinical Implications
Authors: Uner Ogul E. , Hubbard Donald C. , Torres-Quinones Carlos , Pegany Roma , Huang Lingling , Ponsetto Momoko K. , Fletcher Miles , Sikka Monica K. , Nanji Afshan , Redd Travis K. , Stutzman Richard D. , Chamberlain Winston , Kim Donna H. 
Published: February 2023

Purpose:
The aim of this study was to describe a case of corneal involvement as an early manifestation of ocular disease in the 2022 human mpox (monkeypox) virus outbreak.

Methods:
This is a single case report with longitudinal care.

Results:
A 47-year-old immunocompetent man presented with viral conjunctivitis before development of skin lesions or systemic symptoms. Subsequently, he developed membranous keratoconjunctivitis and a corneal epithelial defect. Orthopoxvirus-positive polymerase chain reaction test from his ocular surface was positive. The epithelial defect did not heal with conservative treatment but was successfully treated with amniotic membrane transplantation over 8 days. Reduced corneal sensation was noted after epithelial healing, and polymerase chain reaction from the ocular surface remained positive at 17 days from symptom onset, with slowly recovering conjunctivitis at 21 days. Continued membrane formation required repeated removal but significantly improved with topical corticosteroid treatment after epithelial healing by 29 days of symptom onset. Corneal sensation normalized by 87 days from symptom onset at which time symblepharon were noted but PCR testing from the ocular surface was negative.

Conclusions:
Early corneal involvement of human monkeypox virus is possible. Transient corneal hypoesthesia may be due to acute inflammation. Chronic inflammatory changes can result in symblepharon. These findings have potential implications in patient care and corneal donation.
Prevalence of Meibomian Gland Atrophy in Patients Undergoing Cataract Surgery
Authors: Yeu Elizabeth , Koetting Cecelia , Calvelli Hannah 
Published: February 2023

Purpose:
The aim of this study was to determine the prevalence of meibomian gland (MG) atrophy in a US-based population of patients presenting for cataract surgery.

Methods:
In this retrospective study, case records of 391 patients aged 50 years or older, who had undergone a preoperative cataract surgery workup with meibography, were included. The amount of atrophy in the lower eyelid was graded as described by Arita et al (grade 0 = no atrophy, grade 1 = 1%-33% atrophy, grade 2 = 34%-66% atrophy, and grade 3 = >66% atrophy), and the prevalence of MG atrophy was determined. Associations between MG atrophy and demography, comorbidities, and risk factors were evaluated.

Results:
Overall, 95.1% of patients (372/391) had MG atrophy ≥grade 1, with 50.4% (197/391) having grade 1, 25.8% (101/391) grade 2, and 18.9% (74/391) grade 3. MG atrophy had a statistically significant correlation with MG expressibility (R = 0.22; P = 0.001), but not with meibum grade (R = 0.103; P = 0.123) and telangiectasia (R = 0.014; P = 0.787). The prevalence of MG atrophy (≥grade 1) was comparable among patients who had previously been diagnosed with dry eye disease (DED) versus those who had not; however, the severity of MG atrophy was higher in patients with previous DED diagnosis (grade 2/3: 59% vs. 30.9%). Among patients with no previous history of DED, 18% (35/194) had moderate and 13% (25/194) had severe MG atrophy.

Conclusions:
MG atrophy is common in patients presenting for cataract surgery evaluation, indicating potential underdiagnosis. Routine use of meibography during preoperative screening in cataract surgery patients may facilitate more timely and effective diagnosis and treatment.
Novel Application of Conjunctival Anterior Segment Optical Coherence Tomography Angiography to Assess Ocular Redness
Authors: Binotti William W. , Nosé Ricardo M. , Pondelis Nicholas J. , Jamali Arsia , Kataguiri Paula , Akhlaq Anam , Kenyon Kenneth R. , Hamrah Pedram 
Published: February 2023

Purpose:
The aim of this study was to determine anterior segment optical coherence tomography angiography (AS-OCTA) parameters to assess ocular redness severity.

Methods:
AS-OCTA analyses of 60 eyes of 40 patients were grouped according to ocular redness stages using the 5-category validated bulbar redness scale in a cross-sectional retrospective study (groups 1–5). A subset of patients with slit-lamp photographs, total 35 eyes of 23 patients, were assessed with 10-category validated bulbar redness scale for comparison. AS-OCTA images of nasal and temporal bulbar conjunctiva were analyzed. Vessel density (VD) represented the blood flow pixels by the total pixels of image (%); vessel diameter index represented the VD by the skeletonized density; fractal dimension, measured with the box-count method, represented the vessel branching complexity. Averaged nasal and temporal parameters for each eye were correlated to validated bulbar redness scales.

Results:
There was no statistical difference between groups for age (P = 0.118), sex (P = 0.501), eye laterality (OD/OS; P = 0.111), or location (nasal/temporal; P = 0.932). In the 5-category scale, VD significantly increased from group 1 to 2 (31.5 ± 1.9% and 33.4 ± 2.2%, P = 0.023), 2 to 3 (36.0 ± 3.5%, P < 0.001), and 4 to 5 (40.2 ± 2.9 and 46.5 ± 2.8, P < 0.001). The correlations were 0.805 (P < 0.001) and 0.893 (P < 0.001) for the 5-category and 10-category scales, respectively. Vessel diameter index showed a significant increase from 1 to 2 (2.90 ± 0.17 and 3.00 ± 0.15; P = 0.004) and 4 to 5 (2.92 ± 0.31 and 3.33 ± 0.08; P = 0.001). The correlations were 0.550 (P < 0.001) and 0.625 (P < 0.001) for the respective scales. The fractal dimension showed no significant differences between subsequent groups. The correlations were 0.445 (P < 0.001) and 0.583 (P < 0.001), respectively.

Conclusions:
Conjunctival AS-OCTA VD was the most reliable parameter to assess ocular redness.
Assistive applications of artificial intelligence in ophthalmology
Authors: Hubbard Donald C. , Cox Parker , Redd Travis K. 
Published: February 2023

Purpose of review
Assistive (nonautonomous) artificial intelligence (AI) models designed to support (rather than function independently of) clinicians have received increasing attention in medicine. This review aims to highlight several recent developments in these models over the past year and their ophthalmic implications.

Recent findings
Artificial intelligence models with a diverse range of applications in ophthalmology have been reported in the literature over the past year. Many of these systems have reported high performance in detection, classification, prognostication, and/or monitoring of retinal, glaucomatous, anterior segment, and other ocular pathologies.

Summary
Over the past year, developments in AI have been made that have implications affecting ophthalmic surgical training and refractive outcomes after cataract surgery, therapeutic monitoring of disease, disease classification, and prognostication. Many of these recently developed models have obtained encouraging results and have the potential to serve as powerful clinical decision-making tools pending further external validation and evaluation of their generalizability.
Risk Factors for Hyphema Following Kahook Dual Blade Goniotomy Combined With Phacoemulsification
Authors: Pratte Eli L. , Ramachandran Maya , Landreneau James R. , An Jella A. 
Published: February 2023

Précis:
Hyphema development after Kahook Dual Blade (KDB) excisional goniotomy was significantly associated with postoperative day 1 intraocular pressure (IOP) ≤12 mm Hg, male sex, and narrow iridocorneal angles, but not with continuation of anticoagulation or antiplatelet therapy.

Purpose:
To identify risk factors of hyphema development after KDB goniotomy combined with phacoemulsification.

Methods:
In all, 202 eyes in 145 patients who received a KDB goniotomy combined with phacoemulsification between February 21, 2017 and February 18, 2020 were evaluated for preoperative factors that were predictive of postoperative hyphema. Hyphema was defined as the development of ≥1 mm layered blood in the anterior chamber. The primary outcome was the association between various preoperative factors and the development of postoperative hyphema. Binomial logistic regression was used to analyze risk factors of hyphema development while controlling for other variables.

Results:
Hyphema occurred in 8.4% (17/202) of patients on day 1 after KDB goniotomy combined with phacoemulsification. Male sex (P=0.008), angle closure glaucoma (P=0.036), and postoperative day 1 IOP ≤12 mm Hg (P=0.049) were significantly correlated with hyphema development while controlling for other variables. Preoperative anticoagulation and antiplatelet therapy had no association with hyphema development (P=0.538).

Conclusions:
Postoperative hyphema was associated with male sex, narrow iridocorneal angles, and a postoperative day 1 IOP lower than typical episcleral venous pressure when controlling for other variables. Preoperative anticoagulation or antiplatelet therapy was not associated with developing postoperative hyphema in this study; however, further investigation is needed before recommendations can be made.
Optical Coherence Tomography Angiography of the Retinal Circulation Following Trabeculectomy for Glaucoma
Authors: Hong Ji Wook , Sung Kyung Rim , Shin Joong Won 
Published: February 2023

Précis:
Despite successful trabeculectomy, eyes with similar levels of peripapillary and macular vessel densities but with worse preoperative visual field mean deviations may experience functional and vascular decline after surgery.

Purpose:
To evaluate the retinal microcirculation change after trabeculectomy according to glaucoma severity using optical coherence tomography angiography (OCTA).

Methods:
We enrolled 59 eyes of primary open angle glaucoma patients who underwent trabeculectomy. The eyes were categorized into 3 groups by preoperative visual field (VF) mean deviation (MD), group 1: MD>−12.0 dB, group 2: MD −12.0 to −20.0 dB, and group 3: MD <−20.0 dB. OCTA was performed preoperatively and 1 year after trabeculectomy. The differences in the radial peripapillary capillary vessel density (pVD) and macular VD between preoperative and postoperative assessment were analyzed and compared in each group. Factors associated with the VD change after trabeculecomy were determined using linear regression analysis.

Results:
Mean postoperative IOP and IOP reduction did not differ among the 3 groups after trabeculectomy. Preoperative pVD (37.2 vs. 36.6%, P=1.00) and macular VD (39.0 vs. 38.4%, P=1.00) did not differ between groups 1 and 2. Group 1 and 3 showed no changes in VD parameters after trabeculectomy (all, P>0.05). However, group 2 showed statistically significant decreases in pVD (36.6 vs. 32.9%, P<0.001) and macular VD (38.4 vs. 36.0%, P=0.010) after trabeculectomy. The reduction of pVD was associated with a decrease of IOP (Coefficient (β); 0.14, P=0.032) and VF MD (β; 0.15, P=0.0116) in group 2, respectively.

Conclusion:
Following successful trabeculectomy surgery for uncontrolled glaucoma with similar IOP reduction, glaucoma eyes with advanced visual field loss showed reduced pVD and macular VD measured by OCT-A. These findings may be relevant to disease progression.
Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey
Authors: Lee Moon Hyung , Kim Hong Kyu , Kim Sung Soo 
Published: February 2023

Précis:
Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR).

Purpose:
To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008–2012).

Materials and Methods:
Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6.

Results:
Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high (P<0.001, P<0.001, and P<0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 (P<0.001, P=0.006, P=0.005, P<0.001).

Conclusions:
In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.
Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes
Authors: Waldner Derek M. , Chaban Yuri , Penny Michael D. , Al-Ani Abdullah , Belkin Avner , Ahmed Iqbal Ike K. , Schlenker Matthew B. , Gooi Patrick 
Published: February 2023

Précis:
Analysis of efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental gonioscopy-assisted transluminal trabeculectomy showed no significant difference between approaches, with novel risk factors for failure identified.

Purpose:
Compare the efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental suture gonioscopy-assisted transluminal trabeculotomy (GATT).

Design:
Multicenter, retrospective interventional cohort study of 297 eyes of 243 glaucomatous patients, which underwent superior or inferior 180-degree suture hemi-GATT surgery combined with phacoemulsification at one of 3 Canadian ophthalmological surgical centres in Calgary, Alberta or Toronto, Ontario

Main Outcome Measures:
The primary outcome measure was the hazard ratio (HR) of failure for the “primary success” criteria. “Primary success” was defined as an intraocular pressure (IOP) <18 mm Hg and either 1) IOP reduced by ≥20% from baseline on the same number of IOP-lowering medications or 2) IOP ≤ baseline on fewer medications. Secondary outcome measures included HRs of failure for alternative criteria (“complete success”, “qualified success” and “20% IOP reduction”), cross-sectional analysis, and Cox proportional hazard analysis for risk factors associated with increased failure for the complete cohort.

Results:
Baseline characteristics were similar between groups. The crude and adjusted HR of failure for the “primary success” criteria for superior surgeries relative to inferior surgeries were 1.27 (95% CI = 0.86–1.88) and 1.50 (95% CI = 0.91–2.46), with no statistically significant difference between approaches. Of the secondary criteria, there was statistical significance in favor of inferior surgeries only for crude analysis of the “20% reduction” criteria (1.40/1.27 (95% CI = 1.01–1.92). Increased risk of failure by the “primary success” measure for either intervention was seen with primary open angle glaucoma, advanced disease, and age below 70 years. There were no significant differences in the frequency of postoperative complications between cohorts, which were present in 72 superior (44.4%) and 67 inferior (49.6%; P value = 0.41) eyes; mostly early postoperative hyphema, iritis, and corneal edema.

Conclusions:
This retrospective study showed no difference in inferior versus superior 180 degrees of hemi-GATT/phacoemulsification cataract surgeries through the majority of analyses. Nonmodifiable factors including glaucoma type, advanced disease, and younger age were associated with a significantly higher risk of failure in this cohort. Further study is warranted.