bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective analysis of real-world data to evaluate the safety and effectiveness of topical amorolfine in tinea infection
Authors: Jain Devendra , Kumar Pradeep , Chowdhuri Sanjib , Doshi Hitesh , Jain Umesh , Beergouder Savitha L. , Maganti Krishnasree , Rani Rashmi , Mohod Bhagyashree , Jaiswal Ashok 
Published: January 2023

Background:
Conventional antifungals are becoming resistant against dermatophytosis due to development of recalcitrant tinea. These patients may get benefit from newer topical antifungals or combination therapy. Topical antifungal therapy is the mainstay in the treatment of dermatophytosis.

Aims/Objectives:
To evaluate the safety and effectiveness of topical amorolfine in tinea infection in real-world settings.

Materials and Methods:
This was a real-world retrospective study; data was collected from 106 centers across India on the usage of amorolfine in the management of tinea infections. The treatment response was evaluated at the end of 2 and 4 week. It was determined by the reduction in severity of the classic symptoms of disease viz. pruritus, burning sensation, erythema, and scaling and crusting at Week 2 and Week 4 of treatment. The severity of symptoms was classified and quantified as mild (1), moderate (2), and severe (3). Safety was determined based on the occurrence of any adverse events during the treatment.

Results:
An improvement in symptoms score was observed for all the classic symptoms of infection viz. pruritus, burning sensation, erythema, and scaling and crusting at Week 2 and Week 4 compared to baseline. Mean total symptom score (TSS) was reduced to 0.88 ± 1.19 from 7.18 ± 2.84 at week 4 (P < 0.05). Only 10 (0.73%) patients out of 1358 showed mild and non-treatment-related adverse events.

Conclusion:
Amorolfine alone or in combination therapy with oral antifungals in real world clinical setting represents an improved treatment strategy for patients with tinea infections.
Evaluation of effects of riboflavin and/or ultraviolet-A on survival of rat limbal epithelial stem cells in ex-vivo
Authors: Zamani Mitra , Nejaddehbashi Fereshteh , Bayati Vahid , Nasrolahi Ava 
Published: January 2023

Purpose:
To investigate the effects of riboflavin and/or ultraviolet-A (UV-A) irradiation on the cell viability of ex-vivo-cultured rat limbal stem cells (LSCs).

Methods:
LSCs of male Wistar rats (N = 12 eyes) were cultured, and immunofluorescence staining was performed to evaluate them. After characterization, these cells were assigned to four groups of control (C), a group that was exposed to UV-A radiation (UV), a group that was treated with riboflavin (R), and a group that cotreated with both UV-A and riboflavin (UV+R). To determine the cell viability of LSCs, these cells were subjected to MTT assay on days 1, 3, and 7 after exposure to UV-A and/or riboflavin. The duration of exposure to UV-A and riboflavin was similar to levels used during the conventional corneal collagen cross-linking procedure.

Results:
Compared with the viable cells in the control group, there was a significant decrease (P < 0.0001) in the number of LSCs in the UV group during all study days. In the R group, the level of viable LSCs was as same as the level of viable LSCs in the C group. Combined treatment with UV-A plus riboflavin significantly decreased the survival of LSCs on days 1 and 3 (P < 0.0001, P < 0.001, respectively) compared with the control group. Interestingly, in the UV+R group, the photosensitizing effect of riboflavin significantly decreased the cytotoxic effect of UV irradiation 7 days after exposure.

Conclusion:
These results suggest that the administered UV energy in the presence or absence of riboflavin can damage LSCs. Likewise, riboflavin could decrease the toxic effect of UVA on LSCs.
Prevalence and causes of low vision in a population-based study on childhood visual impairment in North India (CHVI 4)
Authors: Wadhwani Meenakshi , Vashist Praveen , Senjam S. Suraj , Gupta Vivek , Saxena Rohit , Tandon Radhika 
Published: January 2023

Purpose:
The present study was a population-based study to determine the prevalence and causes of low vision in children less than 16 years in North India.

Methods:
This cross-sectional study was conducted in 40 clusters of urban Delhi. Children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. All children with visual acuity of <6/12 in any eye in the age group between 3 and 15 years and inability to follow the light in age less than 3 years were referred for detailed ophthalmic examination in a centrally based clinic. Cycloplegic examination and best-corrected visual acuity (BCVA) were assessed. They were examined by an ophthalmologist to determine the prevalence and causes of functional low vision (FLV). The prevalence of FLV was compared with other population-based studies across India and other parts of the world.

Results:
Amongst 20,955 children examined for visual acuity, 789 children were referred to the central clinic for detailed ophthalmic examination. The overall prevalence of low vision was 0.62 per 1,000 children (95% confidence interval [CI] 0.12–1.90). The main anatomical cause of low vision was retinal abnormalities.

Conclusion:
Although the prevalence of children with low vision decreased as compared to previous population-based studies. There is an important need to create awareness among parents on appropriate and timely usage of low-vision devices (LVDs) at an affordable cost to improve the visual quality in children with low vision.
Impact of pandemic COVID-19 lockdown on penetrating keratoplasty patients
Authors: Sharma Rajan , Mamatha B , Sharma Suresh , Gyanchand Rekha 
Published: January 2023

Purpose:
To study the impact of the COVID-19 lockdown on the regular follow-up of keratoplasty patients.

Methods:
This retrospective interventional case series included 30 patients who had immunological corneal endothelial rejection out of 190 patients who came for post-PKP follow-up between September 15, 2019, and September 30, 2020. The demographics, primary diagnosis, surgical technique, time of presentation, recovery of graft, associated ocular problems, and visual acuity at 1 month were analyzed. Forward stepwise (likelihood ratio) binary logistic regression was used to find significant variables.

Results:
The study population had 19 males (63.33%) and 11 females (36.67%). The mean age of the study group was 42.83 ± 18.89 (8–80) years. Of 30 patients, 19 (63.3%) presented before and 11 (36.7%) after the COVID-19 lockdown. Overall, 23 (77%) showed a reversal of graft rejection. Logistic regression showed that preoperative indications, large-sized grafts, and deep corneal vascularization were significant risk factors for non-resolution of graft rejection. It was noted that patients who presented to the hospital late had poor recovery (P = 0.002). The delay in the presentation was a significant risk factor for non-resolution of graft rejection (P < 0.01). Z-test for proportions revealed that the difference in the non-resolution of rejection on immediate or delayed treatment in patients presenting during lockdown (P = 0.002) was significant.

Conclusion:
This article is to highlight the impact of the COVID-19 lockdown on graft rejection recovery of PKP patients due to delays in follow-up. Early treatment helps in the recovery of graft transparency and the reversal of immunological graft rejection. Also, primary diagnosis, deep vascularization, and large-sized grafts were significant risk factors for non-resolution of graft rejection.
Uptake pattern of training programs over two decades at an International Ophthalmic Training Institute in India
Authors: Krishnaveni G , Joseph Sanil , Thulasiraj Ravilla 
Published: January 2023

Purpose:
Inadequacy of trained human resources is a critical challenge for eye-care delivery worldwide. Recognizing this, the World Health Organization (WHO) and the International Agency for Prevention of Blindness had identified the development of human resources as one of the focal areas in the global initiative “Vision 2020: The Right to Sight.” The global action plan of the WHO also emphasized the need for trained workforce for ensuring comprehensive eye-care services. We aimed to present the uptake pattern of training programs offered at a high-volume training institute in India.

Methods:
We did a retrospective analysis of data related to training programs conducted between 2000 and 2019. Trainees included ophthalmologists, allied ophthalmic personnel, and eye-care management professionals from all over the world. We analyzed the overall growth over the 20 years in the WHO regions. The uptake patterns were also analyzed across four segments of 5-year-periods by the type of training.

Results:
Overall, 9091 trainees from 118 countries attended training in over 40 courses that included long- and short-term clinical training for ophthalmologists (54.2%) and short-term training for eye-care managers (29.5%), allied ophthalmic personnel (6.2%), and eye-care technicians (10.2%). The majority of the trainees (81.3%) came from the Southeast Asian region, of which 87.4% were from India. Most (98.3%) of the trainees belonged to developing countries. We found an overall average growth of 4.8% in the training uptake across the four 5-year segments over the 20 years.

Conclusion:
Comparatively better representation of trainees from the developing countries is encouraging as the prevalence of blindness and visual impairment is higher in those countries, warranting improved eye-care delivery. Given the strong influence of distance and associated costs of accessing training, the development of similar institutes in other regions might help enhance the global efforts to eliminate needless blindness.
Prescribing patterns of low vision devices in patients with cone-related dystrophies
Authors: Mahalingam Maanasi , Gopalakrishnan Sarika , Parasuraman Dhanalakshmi , Jayaraj P Jeni , Raman Rajiv 
Published: January 2023

Purpose:
The aim of this study was to elucidate the type of low vision devices (LVDs) prescribed for patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy and to analyze the visual improvement with the devices.

Methods:
A retrospective review of 300 electronic medical records of patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy referred to the low vision care (LVC) clinic for the first time between 2014 and 2016 at a tertiary eye care center was done. Collected data included the demographic profile of patients, details of LVDs, and best-corrected vision.

Results:
Out of 300 patients, 62.6% (n = 188) were male and 37.3% (n = 112) were female. Of the cases, 50% (n = 150) had cone–rod dystrophy, 45% (n = 135) had cone dystrophy, and 5% (n = 15) had rod–cone dystrophy. The most commonly prescribed LVD was SEE-TV binocular telescope (n = 6, 2.0%) for distance and dome magnifier (n = 60, 20%) for near. ET-40 dark grey tint (20.6%) was preferred for managing photophobia. There was a statistically significant difference in both distance and near visual acuities with LVDs (P < 0.05) in all categories, except rod–cone dystrophy.

Conclusion:
Early diagnosis with appropriate prescription of LVDs including tints helps in achieving good quality of vision in patients with cone-related dystrophies.
Assessment of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during COVID-19 pandemic
Authors: Behera Himansu Sekhar , Ghana Madhusmita , Parida Priyadarshini , Sahu Srikant K , Das Sujata , Priyadarshini Smruti Rekha , Priyadarshini Kshyanaprava , Mohanty Amrita 
Published: January 2023

Purpose:
To determine the presence of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during the COVID-19 pandemic.

Methods:
This observational, cross-sectional study was conducted in clinically diagnosed patients with conjunctivitis attending the outpatient services of our institute from July 2021 to December 2021. The tear samples were collected from patients using Schirmer’s strips or capillary tubes to detect the presence of SARS-CoV-2 by real-time PCR assay. COVID-19 vaccination and infection status, visual acuity, and clinical features were documented in all cases.

Results:
A total of 111 patients with symptoms of conjunctivitis were included during the study period. The mean age was 41.1 ± 13.1 years, and the mean duration of symptoms was 7.1 ± 4.4 days, with 74% males. Conjunctival congestion was mild in 69 (62.1%) patients, moderate in 30 (27%) patients, and severe in 12 (10.8%) patients. All except four had superficial punctate keratitis (SPK). Five (4.3%) patients were positive for SARS-CoV-2 RNA in their tear samples. All had mild–moderate conjunctival congestions with variable papiliofollicular reaction and SPKs, superficial hemorrhages were seen in three and pseudomembrane in one patient. They were followed up with telemedicine and three of them developed mild COVID-19-related symptoms and recovered after in-home quarantine. None of them had a previous history of COVID-19 infection and all had received COVID-19 vaccination within 2 weeks to 2 months.

Conclusion:
SARS-CoV-2 transmission through ocular secretion of conjunctivitis patients cannot be ignored and appropriate COVID-19-preventive behavior should be followed in ocular settings.
Improving assistive technology access to students with low vision and blindness in Delhi: A school-based model
Authors: Senjam Suraj Singh , Manna Souvik , Vashist Praveen , Gupta Vivek , Grover Sumit , Kumar Vikas Ajeet , Titiyal Jeewan Singh 
Published: January 2023

Purpose:
Assistive technology (AT) has recently received considerable attention around the world. Studies have shown poor access to assistive technology for visual impairment (ATVI) in schools for the blind in India. The present article aimed at designing a school-based model to improve AT access in schools and provide hands-on training, and identify types of ocular morbidities present among students.

Methods:
The vision rehabilitation (VR) team of a tertiary eye-care center visited schools for the blind as a part of community-based VR services. The team conducted a basic eye examination and assessed best-corrected vision acuity (BCVA) and provided VR services. Furthermore, two schools were selected to establish an ATVI learning center as a pilot model.

Results:
In total, 1887 students were registered for VR and obtained their disability certificates in 2019-20. Retina problems (25.7%), globe abnormalities (25.5%), optic nerve atrophy (13.6%), and squint (12.0%) were common ocular problems identified in students. Around 50.3% of students had BCVA ³ 1/60 in the better eye who would be benefited from visual-based AT, and the remaining students with visual substitution AT. Further, 20.8% of them who had near vision between N18 to N24 would be benefitted from large print books. Two schools were provided ATVI with support from the WHO. Familiarization, demonstration, and initial training for ATVI were carried out.

Conclusion:
A sizable number of the students would be benefitted from visual-based AT apart from visual substitutions AT. Students were interested to have such ATVI centers in the school for academic and non-academic skills development.
Novel optical coherence tomography angiography biomarkers in the diagnosis and assessment of diabetic macular edema and diabetic macular ischemia in patients with non-proliferative diabetic retinopathy
Authors: Thaker Shivna , Kumar Vinod , Singh Upasna , Kumar Santosh 
Published: January 2023

Purpose:
The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non-proliferative diabetic retinopathy (NPDR).

Methods:
In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT-1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ-CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant.

Results:
Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ-CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients.

Conclusion:
A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.
Clinical profile and management of granulomatosis with polyangiitis–associated scleritis from a tertiary care hospital in South India
Authors: Mohanan-Earatt Amanda , Biswas Jyotirmay 
Published: January 2023

Purpose:
To describe the clinical features and management of patients with scleritis associated with granulomatosis with polyangiitis (GPA) at a tertiary eye care center in South India.

Methods:
The clinical profile and management of patients presenting to a tertiary eye care center in South India with scleritis secondary to GPA from 2003 to 2021 were analyzed retrospectively. Scleritis was classified into anterior diffuse, nodular, and necrotizing scleritis with inflammation according to Watson and Hayreh’s classification. Demographic characteristics, clinical features, anti-neutrophil cytoplasmic antibody (ANCA) positivity, treatment response, ocular complications, and status at the last follow-up were analyzed. Statistical analysis of data was performed using Microsoft Excel 2019.

Results:
Nineteen eyes of 17 patients (15 cytoplasmic staining ANCA [c-ANCA], two p-ANCA positive) were included. Fifteen eyes had necrotizing scleritis, two had diffuse anterior scleritis, and two had nodular scleritis. Remission was induced using a combination of steroids and cyclophosphamide or rituximab. Maintenance therapy was instituted using tapering steroids and immunosuppressants like cyclophosphamide, mycophenolate mofetil, methotrexate, or rituximab. Three eyes required a scleral patch graft. Fourteen patients had good anatomical and visual outcomes, and three were lost to follow-up.

Conclusion:
GPA is a rare disease, while it is the most common ANCA-associated vasculitis with scleritis. As scleritis may be the presenting sign of the disease, ophthalmologists must be aware of the various features suggestive of GPA. GPA-associated scleritis can have a good prognosis when diagnosed promptly and managed aggressively in the acute stage, and remission is maintained with adequate systemic immunosuppression.
Effect of pupil dilation on biometric iris recognition systems for personal authentication
Authors: Singh Tanushree , Zaka-Ur-Rab Simi , Arrin Shazia 
Published: January 2023

Purpose:
To study the effect of pupil dilation on a biometric iris recognition (BIR) system for personal authentication and identification.

Methods:
A prospective, non-randomized, single-center cohort study was conducted on patients who reported for a routine eye check-up from November 2017 to November 2019 (2 years). An iris scanning device “IRITECH-MK2120U” was used to initially enroll the undilated eyes. Baseline scans were taken after matching with the enrolled database. All eyes were topically dilated and matched again with the enrolled database. The Hamming distance (a measure of disagreement between two iris codes) and recognition status were recorded from the device output, and eyes were evaluated by slit-lamp ophthalmoscopy with special emphasis on pupil shape, size, and texture.

Results:
All 321 enrolled eyes matched after topical dilation. The pupil size had a significant effect on Hamming distance with a P value <0.05. There were no false matches. A correct recognition rate of 100% was obtained after dilation. No loss of iris texture or pupil shape was observed after dilation.

Conclusion:
A BIR system is a reliable method for identification and personal authentication after pupil dilation. Topically dilated pupils are not a cause for non-recognition of iris scans.
Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis
Authors: Yadav Rekha , Madan Siddharth , Rohatgi Jolly , Sahu Pramod Kumar , Das Shukla , Tandon Anupama , Rai Puja , Verma Priya , Singh Jubin , Bajaj Ishita 
Published: January 2023

Purpose:
TO report the corneal manifestations in patients with COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM).

Methods:
This study was a retrospective, observational, and record-based analysis of patients of ROCM with corneal involvement.

Results:
A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty-two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID-19 infection, and injudicious use of systemic steroids. Twenty-nine patients were known diabetics, 32 had recent COVID-19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round-oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals.

Conclusion:
Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.