bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relatively anterior lens position in primary angle-closure glaucoma eyes with long axial length
Authors: Chen Jiawei , Zhang Yan , Huang Yuqiang , Ng Tsz Kin , Huang Chukai 
Published: May 2023

Purpose:
To evaluate the refractive status and ocular biometric parameters in primary angle-closure glaucoma (PACG) eyes with different axial lengths (ALs).

Methods:
In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ≤−0.5 D), emmetropia (−0.5 D < SE < +0.5 D), and hyperopia (SE ≥+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ≤ AL <23.5 mm), and long (AL ≥23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups.

Results:
The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68–25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ≥23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001).

Conclusion:
Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.
Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients
Authors: Jha Ujjwal P , Kumar Suresh , Jindal Varsha , Gupta Gayana , Ichhpujani Parul 
Published: May 2023

Purpose:
To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population

Methods:
This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti-glaucoma medications, best corrected visual acuity (BCVA), and complications.

Results:
Sixty-seven eyes of 66 patients were included in study with mean follow-up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow-up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042).

Conclusion:
Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow-up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.
Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness
Authors: Porwal Amit C , Shrishrimal Meghna , Punamia Ravin P , Mathew Bennet Chacko 
Published: May 2023

Purpose:
To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non-contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT).

Methods:
This was a prospective, cross-sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non-glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland–Altman graph was plotted.

Results:
Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037).

Conclusion:
The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.
Real-world outcomes and complications of different surgical approaches for significant submacular haemorrhages
Authors: Boral Subhendu Kumar , Agarwal Deepak , Das Arnab , Chakraborty Debdulal , Mandal Santanu 
Published: May 2023

Purpose:
To evaluate the outcomes and complications after different surgical management of cases with significant sumacular hemorrhage (SMH) of size more than 4 disc diameter (DD).

Methods:
It was a retrospective interventional study. All consecutive 103 cases of significant SMHs were treated by vitrectomy and divided into three groups. In Group A (<4 weeks, confined to the macula or extending inferiorly, n = 62), vitrectomy, subretinal cocktail of tissue plasminogen activator (tPA), antivascular endothelial growth factor, and air with SF6 gas; in Group B (4–8 weeks, extending beyond macula, n = 31), subretinal tPA followed by SMH drainage either by retinotomy (Group B-1, n = 17) or by temporal 180-degree retinectomy (Group B-2, n = 14) with silicone oil (SO) tamponade; and in Group C (>8 weeks, extending beyond macula, n = 10), SMH removal with autologous retinal pigment epithelium (RPE)-Choroid patch graft transplantations with SO tamponade were performed. Parameters evaluated were best corrected visual acuity (BCVA), Optos, optical computerized tomography, and ultrasonography as required.

Results:
Significant visual improvement was seen from mean preoperative to mean postoperative BCVA in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.001). Postoperative complications were recurrent SMH (4.84% vs 12.90% vs 10%), vitreous hemorrhage (6.45%, GroupA), hyphema (4.84% vs 12.90% vs 10%), hypotony (nil vs 3.23% vs 20%), macular hole formation (6.45%, Group A), epiretinal membrane (16.13%, Group B), and retinal detachment (3.23%, Group A and 10%, Group C).

Conclusion:
Surgical approaches for significant submacular hemorrhage are visually awarding, though certain specific complications may arise.
Visual outcome in pediatric uveitis: A retrospective data review in 277 children
Authors: Sivakoti Prasanna , Swaminathan Meenakshi , Magesan Kowsigan , Pyare Richa , George Amala E , Ganesh Sudha K , Biswas Jyotirmay , Dutta Majumder Parthopratim 
Published: May 2023

Purpose:
This study aimed to describe visual outcomes in cases of pediatric uveitis in an Indian population and to analyze various factors affecting these outcomes.

Methods:
Single-center, retrospective chart review of 277 cases of uveitis in patients under the age of 18 years. Variables assessed included age and sex distribution, anatomical location of uveitis, systemic associations, complications, and various treatment strategies used, including long-term immunomodulation and surgical management of complications if required. The main outcome was the final visual acuity.

Results:
At the final visit, 51.5% of the eyes showed improvement in the final visual acuity, while vision remained stable in 28.7% and 19.7% of the eyes showed worsening of vision at the final follow-up. A total of 19.4% of patients were blind in at least one eye at the final visit, and 16 patients (5.77%) remained bilaterally blind at the final follow-up. The presence of cataract (p = 0), posterior uveitis (p = 0.005), and retinal detachment (p = 0.014) were the most significant risk factors for predicting worse visual outcomes. More than half (65.7%) of patients reported a complication at some point in their follow-up, and the most common complication was cataract. In total, 50.9% of patients required long-term immunomodulatory therapy.

Conclusion:
Pediatric uveitis remains a challenging condition to treat and follow-up, and the visual outcome remains guarded for most patients.
Multifocal versus modified monovision corrections: A non-dispensing comparison of visual assessment in presbyopic neophytes
Authors: Parekh Dhruval , Asokan Rashima , Purkait Sutapa , Iqbal Asif 
Published: May 2023

Purpose:
To compare the visual performance of two simultaneous-vision soft multifocal contact lenses and to compare multifocal contact lens and its modified monovision counterpart in presbyopic neophytes.

Methods:
A double-masked, prospective, comparative study was conducted on 19 participants fitted with soft PureVision2 multifocal (PVMF) and clariti multifocal (CMF) lenses in random order. High- and low-contrast distance visual acuity, near visual acuity, stereopsis, contrast sensitivity, and glare acuity were measured. The measurements were conducted using multifocal and modified monovision design with one brand and then repeated with another brand of lens.

Results:
High-contrast distance visual acuity showed a significant difference between CMF (0.00 [−0.10–0.04]) and PureVision2 modified monovision (PVMMV; −0.10 [−0.14–0.00]) correction (P = 0.003) and also between CMF and clariti modified monovision (CMMV; −0.10 [−0.20–0.00]) correction (P = 0.002). Both modified monovision lenses outperformed CMF. The current study did not show any statistically significant difference between contact lens corrections for low-contrast visual acuity, near visual acuity, and contrast sensitivity (P > 0.01). Stereopsis at near distance was significantly lower with both modified monovision (PVMMV: 70 [50–85]; P = 0.007, CMMV: 70 [70–100]; P = 0.006) and with CMF (50 [40–70]; P = 0.005) when compared to spectacles (50 [30–70]). Glare acuity was significantly lower with multifocal (PVMF: 0.46 [0.40–0.50]; P = 0.001, CMF: 0.40 [0.40–0.46]; P = 0.007) compared with spectacles (0.40 [0.30–0.40]), but no significant difference was noted between the multifocal contact lenses (P = 0.033).

Conclusion:
Modified monovision provided superior high-contrast vision compared to multifocal correction. Multifocal corrections performed better for stereopsis when compared to modified monovision. In parameters like low-contrast visual acuity, near acuity, and contrast sensitivity, both the corrections performed similarly. Both multifocal designs showed comparable visual performances.
The 20/20/20 rule: Practicing pattern and associations with asthenopic symptoms
Authors: Datta Sourav , Sehgal Shivalika , Bhattacharya Bidisha , Satgunam Prem Nandhini 
Published: May 2023

Purpose:
The present work style and lifestyle have increased the digital device use. Therefore, an increase in digital eyestrain is to be expected. We undertook a survey during coronavirus disease 2019 (COVID-19) pandemic to investigate the practice of 20/20/20 rule and its association with digital device use and asthenopic symptoms. While this rule is commonly advised, little is known about its validity.

Methods:
An online survey form was disseminated through social media and emails. The questions for eye-related symptoms were similar to the convergence insufficiency symptom survey (CISS). Participants with age ≥5 years were included, with parents completing the survey for children (≤16 years).

Results:
A total of 432 participants (mean ± standard deviation [SD]: 26.06 ± 13.92 years) were enrolled, of which 125 responses were for children. The 20/20/20 rule was practiced only by 34% of the participants either regularly (n = 38) or occasionally (n = 109). Those who had complaints of burning sensation and headache tended to practice this rule. Among adult participants, more females (47%) practiced this rule when compared to males (23%). Also, adult females significantly (P = 0.04) had more symptoms score when compared to males. In children, no such gender difference was found.

Conclusion:
Only one-third of participants practice the 20/20/20 rule at least occasionally. More number of adult females being symptomatic and practicing in greater number could be due to higher prevalence of dry eye condition in females. While the symptom of burning sensation could be related to dry eye, that of headache could be related to refractive error or binocular vision dysfunctions.
A retrospective study to assess visual field improvement following augmented trabeculectomy
Authors: Fang Clarissa E H , Hakim Mohamad T , Siddiqui Muhammad M , Armstrong Deborah , Shankar Vikas 
Published: May 2023

Purpose:
To explore the visual field (VF) changes two years following augmented trabeculectomy.

Methods:
A retrospective study of patients who underwent augmented trabeculectomy surgery with mitomycin C by a single surgeon at East Lancashire Teaching Hospitals NHS Trust over 3 years. Patients with a minimum of two years postoperative follow-up were included. Baseline characteristics, intraocular pressure (IOP), VF, number of glaucoma medications, and complications were recorded.

Results:
In total, 206 eyes were included, 97 (47%) patients were female, and the mean age was 73.8 ± 10.3 (range 43 to 93) years. One hundred thirty-one (63.6%) eyes were pseudophakic before trabeculectomy. The patients were divided into three outcome groups according to VF outcome. Seventy-seven (37.4%) patients had stable VF, 35 (17.0%) patients showed VF improvement, and 94 (45.6%) had VF deterioration. The overall mean preoperative IOP was 22.7 ± 8.0 mmHg and postoperative IOP 10.4 ± 4.2 mmHg, with a reduction of 50.2% (P < 0.001). In total, 84.5% of postoperative patients did not require glaucoma medications. A higher number of patients with postoperative IOP ≥15 mmHg had deteriorating VF (P < 0.001). Based on preoperative MD distribution, VF improvement or stability was more achievable with patients with a preoperative VF defect up to −12 dB (n = 41, 59.4%) and in those with greater than −24 dB (n = 25, 64.1%).

Conclusion:
Trabeculectomy continues to be an effective means of lowering IOP in patients with uncontrolled glaucoma and is important in stabilizing or improving visual fields. We recommend early trabeculectomy to prevent further VF deterioration. This may help in maintaining VF for driving status and, thus, quality of life.
Rectus muscle pseudo-adherence syndrome
Authors: Pujari Amar , Virani Baiju , Chauhan Nidhi , Mahalingam Karthikeyan , Thangavel Rajeswari , Saxena Rohit 
Published: May 2023

Purpose:
To describe a clinical entity called “rectus muscle pseudo-adherence syndrome” following buckling surgery.

Methods:
A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed.

Results:
The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre-op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post-op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow-up. Intraoperatively, in the absence of a buckle, the thinned-out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons.

Conclusion:
While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned-out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo-adherence syndrome, where the culprit is the healing process and not the muscle.
Smartphone for retinal imaging – Case series in resource-limited rural settings
Authors: Vishwanath  , Swamy Deepak T , Gaddi Daneshwari S 
Published: May 2023

Purpose:
There is a clinical need for a cost-effective, reliable, easy-to-use, and portable retinal photography. The use of smartphone fundus photography for documentation of retinal changes in resource-limited settings, where retinal imaging was not previously possible, is studied here. The introduction of smartphone-based retinal imaging has resulted in the increase in available technologies for fundus photography. On account of the cost, fundus cameras are not readily available in ophthalmic practice in developing countries. Because smartphones are readily available, easy to use, and also portable, they present a low-cost alternative method in resource-limited settings. The aim is to explore the use of smartphones (iphones) for retinal imaging in resource-limited settings.

Methods:
A smartphone (iphone) was used to acquire retinal images with the use of +20 D lens in patients with dilated pupils by activating the video mode of the camera.

Results:
Clear retinal images were obtained in different clinical conditions in adults and children, including branch retinal vein occlusion with fibro-vascular proliferation, choroidal neo-vascular membranes, presumed ocular toxoplasmosis, diabetic retinopathy, retinoblastoma, ocular albinism, and hypertensive retinopathy.

Conclusion:
New inexpensive, portable, easy-to-operate cameras have revolutionized retinal imaging and screening programs and play an innovative role in research, education, and information sharing.
Clinical study of profile of retinal detachment in vasculitis and its management at tertiary eye care hospital
Authors: Nagaraj Kalpana B , Hiremath Chandrashekarayya H , Tumbadi Kavitha L , Pankaja PS , Shilpa YD , Hemalatha BC 
Published: May 2023

Purpose:
The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention.

Methods:
It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection.

Results:
In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery.

Conclusion:
The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.
Augmented loop myopexy with concurrent intraocular lens implantation for myopic strabismus fixus
Authors: Shetty Shashikant B , Aguiar Marushka , Vijayalakshmi P , Pradhan Priyarthi 
Published: May 2023

Purpose:
To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra-ocular lens implantation in cases of myopic strabismus fixus (MSF).

Methods:
A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra-ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow-up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra-ocular motility postoperatively, intraoperative and postoperative complications and post-operative visual acuity.

Results:
12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32-65 years). 5 patients underwent bilateral loop myopexy with intra-ocular lens implantation whereas 2 patients underwent unilateral loop with intra-ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow-up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10-20 PD) from 80 PD (Range:60-90PD), P = 0.016; and success (deviation ≤20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6-14 PD), which improved to 0 PD (range 0-9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units.

Conclusion:
Loop myopexy combined with intra-ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.
Single-bolus dexmedetomidine in prevention of emergence delirium in pediatric ophthalmic surgeries: A randomized controlled trial
Authors: Raman Sonali , Viswanathan Jagadeesh , Surya Janani , Raman Rajiv 
Published: May 2023

Purpose:
Emergency delirium (ED), a common postoperative neurologic complication, causes behavioral disturbances leading to self-traumas and also has long-term adverse effects in children. Our aim was to investigate the efficacy of a single-bolus dose of dexmedetomidine in reducing the incidence of ED. Additionally, pain relief, number of patients who needed rescue analgesia, hemodynamic parameters, and adverse events were assessed.

Methods:
One hundred and one patients were randomly allocated into two groups: 50 patients received 15 mL of dexmedetomidine 0.4 μg/kg (group D) and 51 patients received volume-matched normal saline (group C). Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored regularly throughout the procedure. ED was assessed with Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and pain was measured using the modified Objective Pain Score (MOPS).

Results:
The incidences of ED and pain were higher in group C than group D (P < 0.0001 and P < 0.0001, respectively). Group D showed significant decrease in MOPS and PAEDS values at 5, 10, 15, and 20 min (P < 0.05), HR at 5 min (P < 0.0243), and SBP at 15 min (P < 0.0127). There was no significant difference in DBP between the two groups at any time point. The mean blood pressure (MBP) at 10 min was significantly less in group D than group C (P < 0.001).

Conclusion:
Dexmedetomidine 0.4 μg/kg as a single bolus over 10 min immediately after intubation is effective for the prevention of ED and significantly reduces the need of rescue analgesia without compromising the hemodynamic parameters in children undergoing ophthalmic surgery.