bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Frailty Indices and the Charlson Comorbidity Index in Traumatic Brain Injury
Authors: Maragkos Georgios A. , Matsoukas Stavros , Cho Logan D. , Legome Eric L. , Wedderburn Raymond V. , Margetis Konstantinos 
Published: February 2023

Background:
Comorbidity scales for outcome prediction in traumatic brain injury (TBI) include the 5-component modified Frailty Index (mFI-5), the 11-component modified Frailty Index (mFI-11), and the Charlson Comorbidity Index (CCI).

Objective:
To compare the accuracy in predicting clinical outcomes in TBI of mFI-5, mFI-11, and CCI.

Methods:
The National Trauma Data Bank (NTDB) of the American College of Surgeons (ACS) was utilized to study patients with isolated TBI for the years of 2017 and 2018. After controlling for age and injury severity, individual multivariable logistic regressions were conducted with each of the 3 scales (mFI-5, mFI-11, and CCI) against predefined outcomes, including any complication, home discharge, facility discharge, and mortality.

Results:
All 3 scales demonstrated adequate internal consistency throughout their individual components (0.63 for mFI-5, 0.60 for CCI, and 0.56 for mFI-11). Almost all studied complications were significantly more likely in frail patients. mFI-5 and mFI-11 had similar areas under the curve (AUC) for all outcomes, while CCI had lower AUCs (0.62-0.61-0.53 for any complication, 0.72-0.72-0.52 for home discharge, 0.78-0.78-0.53 for facility discharge, and 0.71-0.70-0.52 for mortality, respectively).

Conclusion:
mFI-5 and mFI-11 demonstrated similar accuracy in predicting any complication, home discharge, facility discharge, and mortality in TBI patients across the NTDB. In addition, CCI's performance was poor for the aforementioned metrics. Since mFI-5 is simpler, yet as accurate as the 2 other scales, it may be the most practical both for clinical practice and for future studies with the NTDB.
OUTER RETINAL TUBULATION IN BIETTI CRYSTALLINE DYSTROPHY ASSOCIATED WITH THE RETINAL PIGMENT EPITHELIUM ATROPHY
Authors: Wang Yusong , Chen Jieqiong , Sun Junran , Li Tong , Yu Suqin , Gong Yuanyuan , Yu Yang , Wan Xiaoling , Jia Huixun , Wu Jihong , Yuan Fei , Shen Xi , Wang Zhiliang , Qiao Tong , Wu Qiang , Xu Yu , Wang Zhaoyang , Yang Chenhao , Qu Jifang , Chen Jianjun , Sun Xiaodong ,   Shanghai Inherited Retinal Diseases (SHIRD) Study Group
Published: February 2023

Purpose:
To determine the prognostic value of outer retinal tubulation (ORT) in the eyes of a Chinese cohort with Bietti crystalline dystrophy (BCD).

Methods:
This retrospective, multicenter cohort study enrolled 42 patients with clinically and genetically diagnosed BCD. Eighty eyes with good-quality images of spectral domain optical coherence tomography were included. Demographic details and clinical data were collected. The characteristics of ORT, including prevalence, location, and morphologic characteristics were analyzed.

Results:
Forty-two patients with BCD harbored potentially CYP4V2 disease-causing mutations. The mutation spectrum comprised 17 unique variants, 9 of which were novel. Fifty-two of these 80 eyes demonstrated evidence of ORT. The incidence of ORT is significantly higher in Stage 2 than other stages (P < 0.001). ORT was mainly bilateral and located at the margin of the atrophic area of retinal pigment epithelium (RPE), and dynamically changed with the progressive RPE atrophy. The process of RPE atrophy was slower in eyes with ORT (P = 0.017), with significantly longer intact RPE width in Stage 3 (P = 0.024). Eyes with ORT had slower vision loss than eyes without ORT (P = 0.044).

Conclusion:
ORT may be a sign of the onset of RPE atrophy in early-stage BCD and may suggest less risk of rapid progression in late-stage BCD.
PATTERNS OF SUBRETINAL AND/OR INTRARETINAL FLUID RECURRENCE IN PATIENTS WHO RECEIVED AS-NEEDED RANIBIZUMAB THERAPY IN THE HARBOR TRIAL
Authors: Adrean Sean D. , Chaili Siyang , Hill Lauren , Amador-Patarroyo Manuel J. 
Published: February 2023

Purpose:
To evaluate subretinal fluid (SRF) and/or intraretinal fluid recurrence in patients with neovascular age-related macular degeneration who received as-needed (PRN) ranibizumab in a HARBOR (NCT00891735) post hoc analysis.

Methods:
Analyses included patients with SRF and/or intraretinal fluid at baseline and fluid recurrence after a ≥3-month absence (N = 222). Baseline fluid location(s) were compared with location of recurrence after a ≥3-month absence.

Results:
At baseline, fluid was equally distributed across all locations. On recurrence, the location was most frequently central (69%). Eyes with central fluid at baseline typically had recurrence in the same location (72% vs. 47%–53% with fluid in other locations). The type of recurrent fluid was typically the same as at baseline (SRF, 64%; intraretinal fluid, 75%). Overall, 37% (39/105) of eyes exhibited fluid recurrence in a new location, most frequently central (53%). There was a significant gain in best-corrected visual acuity (mean [95% confidence interval], +2.2 [0.4–4.0] letters) between the months of SRF resolution and recurrence.

Conclusion:
Although the location of SRF and/or intraretinal fluid was equally distributed at baseline, recurrent fluid was typically centrally located. The authors identified a subgroup of eyes exhibiting fluid recurrence in a different location than at baseline, potentially indicating new choroidal neovascularization.
DEFINING “STRONG” VERSUS “WEAK” RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT FOR CENTER-INVOLVED DIABETIC MACULAR EDEMA
Authors: Sun Jennifer K. , Beaulieu Wesley T. , Melia Michele , Ferris Frederick L. , Maturi Raj K. , Nielsen Jared S. , Solomon Sharon D. , Jampol Lee M. ,   for the DRCR Retina Network
Published: February 2023

Background/Purpose:
To define “strong” versus “weak” antivascular endothelial growth factor (anti-VEGF) treatment response in eyes with center-involved diabetic macular edema (CI-DME).

Methods:
Exploratory analyses of three DRCR Retina Network randomized trials of eyes with CI-DME treated with aflibercept, bevacizumab, or ranibizumab. Thresholds of 5-, 10-, and 15-letter gain defined strong visual acuity (VA) response when baseline VA was 20/25–20/32, 20/40–20/63, or 20/80–20/320, respectively. Thresholds of 50, 100, or 200-µm reduction defined strong anatomical response when baseline central subfield thickness (CST) was <75, ≥75 to <175, or ≥175-µm above standard thresholds. Additional thresholds from regression equations were calculated.

Results:
At 24 weeks, outcomes for strong response were achieved by 476 of 958 eyes (50%) for VA and 505 eyes (53%) for CST. At 104 weeks among the 32% of eyes with strong VA and CST response at 24 weeks, 195 of 281 (69%) maintained strong VA and CST response, whereas 20 (7%) had neither strong VA nor strong CST response. Outcomes rates were similar across protocols and when defined using regression equations.

Conclusion:
These phenotypes are suitable for efforts to identify predictive biomarkers for response to anti-VEGF therapy for DME and might facilitate comparison of treatment response among diverse cohorts with DME.
LONG-TERM PROGNOSIS OF CHOROIDAL NEOVASCULARIZATION COMPLICATING ANGIOID STREAKS
Authors: Rohart Charlotte , Le Hoang-Mai , Estrada-Walker Juliana , Giocanti-Auregan Audrey , Cohen Salomon Y. 
Published: February 2023

Purpose:
To report the very long-term visual prognosis of choroidal neovascularization complicating angioid streaks in the antivascular endothelial growth factor era.

Methods:
Retrospective monocentric study aimed at analyzing patients' demographics, choroidal neovascularization features, angioid streak–associated conditions, and previous and current therapies for choroidal neovascularization. The main outcome measures were the quantitative measurement of central retinal pigment epithelial atrophy enlargement by comparing the ratio of pixels involved on automated infrared images acquired by spectral-domain optical coherence tomography and the changes in best-corrected visual acuity. The secondary outcome measures were the number of intravitreal injections and the changes in central choroidal thickness and central retinal thickness. Subgroup analyzes were performed to compare macular atrophy extent between eyes of patients with or without proven pseudoxanthoma elasticum (“PXE” or “no PXE”) and between eyes previously treated or not with photodynamic therapy (“PDT” or “no PDT”).

Results:
Thirty-three eyes of 23 patients were included. The mean best-corrected visual acuity decreased significantly from 66 ± 19 Early Treatment Diabetic Retinopathy Study letters at the time of the first antivascular endothelial growth factor injection to 52 ± 23 Early Treatment Diabetic Retinopathy Study letters at the end of the follow-up (mean follow-up duration: 109 ± 42 months, range: 47–175 months). The ratio of central retinal pigment epithelial atrophy enlargement was 201%, 110%, 240%, and 111% in the PXE, no PXE, PDT, and no PDT groups, respectively.

Conclusion:
Despite the use of antivascular endothelial growth factor agents, the very long-term prognosis appeared relatively poor, especially in patients with PXE. This study also suggests that PDT should be used with caution in the management of choroidal neovascularization in eyes with angioid streaks.
MULTIMODAL RETINAL IMAGING REVEALS NEW PATHOGENIC INSIGHTS IN CENTRAL AREOLAR CHOROIDAL DYSTROPHY: A CASE SERIES
Authors: Romano Francesco , Cozzi Elisa , Boon Camiel J.F. , Staurenghi Giovanni , Salvetti Anna Paola 
Published: February 2023

Purpose:
To describe novel imaging findings in a family affected by central areolar choroidal dystrophy.

Methods:
Case series with multimodal retinal imaging assessment.

Results:
A 19-year-old asymptomatic woman was referred for bilateral macular defects of the retinal pigment epithelium. Blue-light autofluorescence of her right eye revealed a speckled pattern in the macular area with a ring of decreased autofluorescence using near-infrared autofluorescence. Multimodal assessment of her left eye disclosed a single parafoveal spot of decreased pigmentation that was clearly visible as hyperautofluorescent using blue-light autofluorescence and as hypoautofluorescent using near-infrared autofluorescence. Optical coherence tomography angiography revealed several tiny areas of flow voids in correspondence of the retinal pigment epithelium alterations of both eyes. Three family members were recently diagnosed with presumed age-related macular degeneration and demonstrated well-demarcated areas of retinal pigment epithelium atrophy surrounded by yellowish deposits and a hypopigmented halo. Next-generation genetic analysis for inherited macular dystrophies was performed on the index case and the affected family members and revealed a p.Arg172Gln missense mutation in PRPH2 gene, leading to the diagnosis of central areolar choroidal dystrophy.

Conclusion:
Multimodal imaging can reveal new pathogenic insights in central areolar choroidal dystrophy. Of notice, near-infrared autofluorescence and optical coherence tomography angiography are able to detect retinal pigment epithelium hypopigmentation and choriocapillaris rarefaction, respectively, since the earliest stages of the disease.
Hair Transplantation Complicated by Methicillin-resistant Staphylococcus Aureus Sepsis and Endogenous Endophthalmitis
Authors: Abraham Joseph R. , Singh Rishi P. , Srivastava Sunil K. , Mammo Danny A. 
Published: February 2023

Abstract

Purpose:
To describe a case of endogenous endophthalmitis as a complication from hair transplantation

Methods:
Case report of a 53-year-old male with history of recent hair transplantation

Results:
The patient presented with a febrile illness and blurry vision one week after hair transplantation. Infectious workup included blood cultures positive for Methicillin-resistant Staphylococcus aureus and he was treated with intravenous antibiotics. Initial ocular exam demonstrated 20/30 and hand motions in the right and left eyes, respectively, with significant vitritis. He underwent vitreous tap and injections of vancomycin and dexamethasone in both eyes and removal of purulent staple from site of recently transplanted hair. His ocular and systemic symptoms improved. Approximately 3 months after initial clearing of the initial infection he had recurrence of bacteremia that prompted repeat intravitreal and systemic antibiotics. His vision returned to baseline with mild residual optic nerve pallor and atrophic retinal changes in the left eye.

Conclusion:
Hair transplantation is associated with minimal systemic complications, but in rare cases, sepsis is possible and can result in intraocular seeding causing endophthalmitis. MRSA endogenous endophthalmitis frequently results in negative vitreous taps and treatment outcomes in the literature have been shown to vary widely including a return to baseline vision as in the described case.
Kearns-Sayre Syndrome Masquerading as Myasthenia Gravis
Authors: Sokol Jared T. , Hoyek Sandra , Fulton Anne B. , Patel Nimesh A. 
Published: February 2023

Abstract:

Purpose:
Kearns-Sayre syndrome (KSS) is a mitochondrial DNA (mtDNA) deletion syndrome that is characterized by the triad of onset commonly before age twenty, pigmentary retinopathy, and chronic progressive external ophthalmoplegia. Here we present a case of KSS masquerading as myasthenia gravis (MG).

Methods:
Case report.

Results:
A 15-year-old male with a presumed diagnosis of MG presented with blurry vision, ophthalmoplegia, and ptosis. He was found to have a mitochondrial pigmentary retinopathy and was eventually diagnosed with KSS after mtDNA sequencing revealed a novel large-scale deletion of 7.9kb of mtDNA from nucleotides 6578 to 14,460.

Conclusions:
We report a case of KSS found to have a novel large-scale mtDNA deletion. The presence of a mitochondrial pigmentary retinopathy found on dilated examination led to reconsideration of the previous diagnosis of MG and ultimately led to the correct diagnosis of KSS.
Monkeypox-Associated Disciform Keratitis
Authors: Alsarhani Waleed K. , Chan Clara C. , Boyd Shelley R. , Hasso Maan , Almeer Ahmed , Tan Darrell H. S. 
Published: February 2023

Purpose:
The purpose of this study was to describe a case of monkeypox (MPX)-associated disciform keratitis.

Methods:
This is a case report.

Results:
A 36-year-old male patient presented to the infectious diseases clinic with a 1-week history of disseminated pustular skin lesions, a 4-day history of constitutional symptoms, and redness in the left eye. Testing of blood, 2 skin lesions, and a conjunctival swab confirmed the presence of MPX virus by polymerase chain reaction. On ophthalmologic examination on the 17th day of illness, there was a corneal epithelial ridge that stained with fluorescein with disciform corneal edema and underlying keratic precipitates. The patient was treated with oral tecovirimat 600 mg twice a day for 14 days and topical prednisolone acetate 1% 4 times daily, starting 2 days later. On completion of oral treatment, his corneal findings had resolved except for a small subepithelial scar at which time topical steroids were tapered.

Conclusions:
MPX may cause disciform keratitis and scarring that closely resembles other ocular viral infections. Clinical trials are urgently needed to define the optimal management of human MPX infections and reduce vision loss.
Age-Related Changes in Corneal Sensitivity
Authors: Nosch Daniela S. , Käser Emanuele , Bracher Tobias , Joos Roland E. 
Published: February 2023

Purpose:
The aim of this prospective cross-sectional cohort study was to clinically test whether corneal sensation decreases with age, based on subject feedback (psychophysical method), and whether it correlates with general pain perception.

Methods:
Subjects were recruited from 2 equally large age groups: group A (18–30 years) and group B (50–70 years; n = 45 per group). The inclusion criteria were healthy eyes, Ocular Surface Disease Index ≤13, and no contact lens wear. Corneal sensitivity threshold (CST) measurements were performed twice during each of the 2 visits, with the aid of the new Swiss liquid jet esthesiometer for corneal sensitivity (SLACS) and Cochet–Bonnet (CB) esthesiometer. A general pain sensitivity score was obtained from all participants.

Results:
Ninety subjects completed the study (n = 45 per age group, average age in group A: 24.2 ± 2.94 years, group B: 58.5 ± 5.71 years). Statistically higher CSTs for age group B were only observed for SLACS (mean difference: 1.58 dB, P < 0.001). No correlation was observed between the pain score and the CSTs obtained with either esthesiometry method (r = 0.11, P = 0.25 for liquid jet and r=−0.076, P = 0.61 CB).

Conclusions:
A statistically significant decrease in corneal sensitivity was observed for the older age group with SLACS in this study, with CB however only a trend in the same direction was noted. General pain perception was not found to correlate with ocular surface sensation.
Comparison of Corneal Biomechanics Treated With Femtosecond Laser-Assisted In Situ Keratomileusis and Small-Incision Lenticule Extraction by New Corneal Biomechanical Parameters of Corvis ST II
Authors: Liu Mingna , Li Na , Chen Tong , Tian Ge , Lin Yue , Gao Hua , Shi Weiyun 
Published: February 2023

Purpose:
The aim of this study was to compare corneal biomechanics treated with femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) for myopia and astigmatism using the new corneal biomechanical parameters of Corvis ST II.

Methods:
This was a prospective nonrandomized controlled study. Patients treated with FS-LASIK or SMILE between January 2018 and July 2018 were included. Corvis ST II was performed to measure corneal biomechanical parameters, including deformation amplitude ratio 2.0 mm (DA ratio 2.0 mm), integrated inverse radius (Integr Radius), stiffness parameter at first applanation (SP-A1), and Ambrosio relational thickness through the horizontal meridian (ARTh), preoperatively, 1 month postoperatively, and 6 months postoperatively. Pentacam pachymetry was used to assess the reduction in pachymetry.

Results:
Forty-five eyes underwent FS-LASIK, and 45 eyes underwent SMILE. The new parameters obtained by Corvis ST II between preoperative and postoperative measurements showed significant changes after FS-LASIK or SMILE (all P < 0.001). Postoperative SP-A1 significantly decreased in the 2 groups (108.88 ± 14.47–73.32 ± 13.2 in FS-LASIK and 105.79 ± 17.68–73.91 ± 14.81 in SMILE). Eyes with equal preoperative pachymetry, intraocular pressure, and spherical equivalents showed no significant differences in these new parameters measured using Corvis ST II (all P > 0.05) between the 2 groups. The prediction of the laser platform overestimated the measured pachymetry reduction in the SMILE group (111.93 ± 15.18 μm vs. 87.16 ± 15.47 μm).

Conclusions:
New corneal biomechanical parameters measured using Corvis ST II showed no significant differences between FS-LASIK and SMILE in eyes with homogeneous preoperative parameters. The laser software platform may have overestimated the actual corneal reduction in the eyes treated with SMILE.
Novel Treatments for Chronic Ocular Surface Pain
Authors: Mangwani-Mordani Simran , Goodman Courtney F. , Galor Anat 
Published: February 2023

Abstract:
Several etiologies can contribute to ocular surface pain including nociceptive, peripheral neuropathic, and central neuropathic mechanisms. Clinical clues can help identify contributors to ocular surface pain in a patient. In individuals whose pain persists despite targeting nociceptive contributors, neuropathic mechanisms should be considered and addressed using oral, topical, and/or adjuvant agents.
BRAF Immunohistochemical Studies of Pediatric Conjunctival Lesions
Authors: Chen Kelsey , McInnis-Smith Kerri , Tiwari Nishant , Moser Justin C. , Ramasubramanian Aparna 
Published: February 2023

Purpose:
The purpose of this study was to analyze the prevalence of an activating mutation in the B-Raf proto-oncogene (BRAF) V600E immunoreactivity in pediatric conjunctival lesions.

Methods:
This retrospective case–control study included 32 pediatric patients who underwent surgical excision of conjunctival lesions between Jan 2019 and May 2022. The collected data included demographic data, clinical features, and histopathologic characteristics of the lesion, including BRAF V600E positivity. The Student t test and the Fisher exact test were used to determine the significance of the associations between clinical variables and BRAF positivity.

Results:
BRAF immunoreactivity was positive in 11/32 lesions (34%). Age at diagnosis did not correlate with BRAF positivity, with a mean age at diagnosis of 131.7 months for patients with BRAF+ lesions and 134.7 months for those with BRAF− lesions (P > 0.1). No clinical or pathological features were found to be significantly correlated with BRAF positivity, although there was a trend toward BRAF positivity in the presence of cysts (P = 0.072).

Conclusions:
BRAF reactivity was present in approximately one-third of pediatric conjunctival nevi but does not correlate significantly with unique clinical or histopathological features.
Establishing a Virtual Corneal Clinic: A Real-Time Teleophthalmology Approach
Authors: Siregar Sharita Rosalyne , Ardiani Lily Silva , Chua Anna , Chong Berlisa Yong Qin , Tan Donald Tiang Hwee 
Published: February 2023

Purpose:
Keratoplasty patients require regular and timely follow-ups. During this COVID-19 pandemic which restricted global travel, we developed a novel real-time, hybrid teleophthalmology approach to comanage international keratoplasty patients between Singapore and Indonesia.

Methods:
A retrospective consecutive observational study of 72 corneal patients (63 were postkeratoplasty) who attended a virtual corneal clinic (VCC) between June 2020 and April 2021 at JEC Eye Hospitals (JEC) in Jakarta, Indonesia. ZOOM Meeting software (Zoom Video Communication Inc, San Jose, CA) was used to simultaneously connect the Singapore corneal specialist at Eye & Cornea Surgeons (ECS), Singapore, using a real-time approach. Clinical examinations included full panels of video-linked corneal, glaucoma, and retinal imaging and investigations performed before real-time video-linked slit-lamp examination, with immediate clinical decision making between corneal specialists and patients.

Results:
VCC enabled effective real-time clinical evaluation and collaborative clinical decisions, with full patient interaction, with the aim of maintenance of graft clarity, visual function, and management of comorbidities—a) topical and systemic medications were adjusted in 79.2% of patients; b) further referrals to glaucoma, retinal, and oculoplastic subspecialists were made in 16.6% of cases; c) additional adjunctive surgical procedures were performed at JEC in 6.9% cases; and d) government permission was obtained for 4 patients (5.6%) to fly to Singapore for urgent corneal surgery.

Conclusions:
The virtual corneal clinic is a novel real-time hybrid teleophthalmology approach which is effective in the comanagement of international keratoplasty patients and represents the advances in ophthalmic telemedicine.