bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of eyecare utilization at two service delivery levels during the COVID-19 pandemic as a measure of their impact: A multicentric retrospective analysis across four North Indian high-volume eyecare organizations
Authors: Sood Ishaana , Sabherwal Shalinder , Kuyyadiyil Subeesh , Khurana Ashi , Thakur Anshu , Chauhan Lokesh , Jain Elesh , Bhadauria Madhu , Majumdar Atanu 
Published: June 2022

Purpose:
The purpose of this study was to assess the performance of the tertiary centers (TCS) and vision centers (VCs) of the four organizations participating in this research, once the lockdown was lifted, and to compare it with the performance during the same period of the previous year.

Methods:
This was a cross-sectional study assessing eyecare utilization in the first 2 months after resumption of services post the lockdown in 2020 and comparing that across the same time period in 2019. Anonymized data containing basic demographic details, proportions of patient visits and their reasons, as well as referral information was collected. The drop percentage method was used, and P values were calculated using paired t-tests.

Results:
Four TCs and 60 VCs were included. Overall, outpatient attendance dipped 51.2% at TCs and 27.5% at VCs, across the 2 years. At both levels of care delivery, the percentage drop in females was more than that in males; however, the overall drop at VCs was less than that at TCs, for both sexes. Eyecare utilization in pediatric populations dropped significantly more than in adult populations, across the overall sample. There was no significant change in referrals for refractive error as a proportion of total outpatients, although there was a significant decline in the same for cataract and specialty treatment.

Conclusion:
VCs are valuable and successful model for eyecare delivery especially in the continued aftermath of the COVID-19 pandemic.
Correlation of meiboscale symptom score and sign score for primary meibomian gland dysfunction in Indian eyes – A cross-sectional study
Authors: Nishant Prateek , Ramawat Achala , Shrinkhal N , Gupta Neeti , Mittal Sanjeev K 
Published: June 2022

Purpose:
To evaluate the correlation of Meiboscale with symptom score (Ocular Surface Disease Index [OSDI]) and meibomian gland dysfunction (MGD) sign score.

Methods:
We performed a cross-sectional hospital-based study of 53 patients of primary MGD who filled the OSDI questionnaire form and underwent complete ocular examination. The MGD sign score was calculated in both eyes using the sum of six grading systems proposed by Arita et al. in 2016. The participants underwent imaging of the upper and lower eyelids of both eyes (212 eyelids) by specular microscope. The area of meibomian gland loss (MGL) was visually assessed and scored using the Meiboscale photographic card. Correlation between these three values – OSDI score, sign score, and MGL score based on Meiboscale - was calculated using Spearman’s correlation analysis and Jonckheere–Terpstra (J–T) test. Correlation coefficient r
s > 0.5 was considered clinically significant.

Results:
Associations between MGL score and OSDI score, as well as between OSDI and sign score were statistically significant, but not clinically significant (r
s = 0.3684, P < 0.001 and r
s = 0.41179, P < 0.001, respectively). The association between MGL score and MGD sign score was statistically as well as clinically significant (r
s = 0.8392, P < 0.001). J–T test revealed large effect size (P < 0.001, r-effect = 0.93).

Conclusion:
The Meiboscale card had not been tested for utility in the Indian outpatient setting yet. Meiboscale can be used for reliable assessment and grading of MGD, and has clinical utility similar to the sum of six MGD sign scores. Additionally, assessment of symptoms using OSDI or a similar questionnaire is also recommended.
Countering choroid prolapse in corneo scleral repair
Authors: Natarajan Radhika , Priyanka Maria T. , Krishnamoorthy Sugepriya 
Published: June 2022

Background:
The video shows the meticulous repair of the corneoscleral tear along with management of the choroidal prolapse.

Purpose:
The video demonstrates the steps to establish the anatomical integrity of the globe and tips to avoid suture bites through the choroid in a corneo-scleral tear repair.

Synopsis:
Identification of important landmarks helps in the establishment of anatomical integrity. Therefore, the limbal area of tear is first sutured with 10-O nylon. The extent of wound onto the sclera is checked on the other end of the tear. Second limbal suture at the opposite end of the tear is taken, followed by dividing the corneal extent of tear by rule of half and segmental suturing with 10-O nylon. Then conjunctival peritomy is done to explore the scleral extent and the uveal tissue prolapse. Blunt and atraumatic back tip of Weckel sponge is used perpendicular to the plane of the sclera to push the choroid back aiding the scleral bite. Sclera is sutured with 9-O nylon suture taking care not to include the choroidal tissue. Air injection is done to check for any wound leak. Side port is hydrated, and corneal sutures are buried. The conjunctiva is secured with fibrin glue. Anterior chamber is formed with air bubble. Povidone iodine is instilled and BCL placed.

Highlights:
1. Suturing the landmark areas first; 2. Exploring the extent of wound; 3. Segmental suturing of the cornea; 4. Pushing the choroid back to avoid bites through it while suturing sclera; 5. Air injection to check for wound leaks; 6. Anterior chamber formation with air at the end.

Video link:

https://youtu.be/e5lEyLsQR3U
Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole
Authors: Bodhankar Paurnima U , Joshi Ajit K , Dronadula Meghana , Patil Abhinandan N 
Published: June 2022

Purpose:
To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients with idiopathic full-thickness macular hole (FTMH).

Methods:
In this prospective study, pre and post-operative optical coherence tomography (OCT) scans of 36 eyes with idiopathic FTMH were analyzed. Hole indices and microstructural changes of all retinal layers such as ellipsoid zone (EZ), external limiting membrane (ELM) integrity, outer and inner retinal defects, and cystoid resolution were studied on follow-up visits.

Results:
Out of 36 eyes, type-1 closure was achieved in 23 eyes (65.7%) and type-2 closure in 11 eyes (31.42%), one eye showed persistent hole, and one eye was lost to follow-up. The mean minimum diameter of hole (P = 0.026), mean MHI (P = 0.001), DHI (P = 0.158), THI (P = 0.001), and HFF (P < 0.001) showed statistical significance with the type of hole closure. Postoperatively, eyes with intact ELM and EZ had better BCVA at the final visit. The BCVA was better by logMAR 0.73 ± 0.38 (P < 0.001) in patients with absent outer retinal defects. There was a significant difference in BCVA of 0.52 ± 0.35 at 1 month and 0.64 ± 0.34 at 6 months in eyes without inner retinal defects (P < 0.001). At 6 months, cystoid resolution was observed in 28 (80%) eyes. BCVA was significantly better at 1 month (P < 0.001) and at 6 months (P = 0.001) in eyes with no DONFL.

Conclusion:
Macular hole indices determine the closure type. Postoperative regeneration of outer retinal layers and resolution of retinal defects significantly influence the final visual outcomes. ELM recovery is seen as a prerequisite for EZ regeneration with no new IRD after a period of 3 months.
Comparative study of visual outcome of newly designed scleral tuck lens and suture-fixated lens for rehabilitation of aphakia in various aetiologies
Authors: Shah Mehul A , Shah Shreya M , Kataria Apeksha , Baranwal Rupali , Rana Parth 
Published: June 2022

Purpose:
Visual rehabilitation in aphakia can be performed using several modalities. However, these modalities could be either technically difficult or expensive. Herein, we developed a scleral tuck lens to provide a simple and cost-effective solution for aphakia and compared its outcome with standard methods.

Methods:
A specially designed posterior chamber self-sustaining lens was implanted in patients with aphakia without capsular support because of different primary etiologies. The visual outcomes, as well as intraoperative and postoperative complications, were examined. The data were retrieved from electronic medical records, and visual outcome and complication rates were compared. The outcomes were also compared according to the etiology and age groups (pediatric and adults).

Results:
We found significant improvement in preoperative and postoperative visual outcome. We did not find any significant difference in visual outcome amongst suture-supported scleral fixated lens with scleral tuck lens.

Conclusion:
Satisfactory visual outcomes were noted with minimal complications; and comparable with gold standard suture fixated lens, however long-term follow-up is required.
Prevalence of risk alleles in the lysyl oxidase-like 1 gene in pseudoexfoliation glaucoma patients in India
Authors: Vallabh Neeru A , Sambare Chitra , Muszynska-Lyons Dorota , Patiyal Sagarika , Kelkar Aditya , Killedar Milind , Malani Sangeeta , Prabhudesai Medha , Walimbe Tejaswini , McKay Gareth J , Willoughby Colin E 
Published: June 2022

Purpose:
The purpose of this study was to genotype two previously identified SNPs (rs1048661:R141L, and rs3825942:G153D) in the lysyl oxidase-like 1 (LOXL1) gene and determine their association with pseudoexfoliation glaucoma (XFG) in patients from Pune, India.

Methods:
All subjects underwent detailed phenotyping, and DNA extraction was performed on blood samples by using standardized techniques. Exon 1 of the LOXL1 gene containing the SNPs (rs3825942:G153D; rs1048661:R141L) were Sanger sequenced, and the results were analyzed using sequence analysis software SeqScape 2.1.1.

Results:
Data were analyzed from 71 patients with XFG and 81 disease-negative, age-matched controls. There was a strong association between the G allele of rs3825942 and XFG with an odds ratio of 10.2 (CI: 3.92–26.6; P < 0.001). The G allele of rs1048661 also showed an increase in risk relative to the T allele (OR = 1.49; CI: 0.88–2.51; P = 0.13), but this was not significant. Haplotype combination frequencies were estimated for rs1048661 and rs3825942; the GG haplotype was associated with a significant increase in risk (OR = 3.91; CI: 2.27–6.73; P < 0.001). Both the GA and TG haplotypes were associated with decreased XFG risk, although the latter was not significant (GA: OR = 0.08; CI: 0.03–0.21; P < 0.001; TG: OR = 0.67; CI: 0.40–1.13; P = 0.13).

Conclusion:
The risk G allele in rs3852942 (G153D) is strongly associated with the development of XFG in the Western Indian population. Genetic screening strategies to identify LOXL1 risk alleles in the population can assist in case definition and early diagnosis, targeting precious resources to high-risk patients.
The electromyographic analysis of orbicularis oculi muscle in epiphora
Authors: Yazicioglu Titap , Inan Rahsan , Agaçkesen Anıl , Oklar Murat , Şimşek Saban 
Published: June 2022

Purpose:
Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner’s muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis.

Methods:
Twenty-eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type.

Results:
Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group (P < 0.001). In the evaluation of the patients’ medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant (P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively).

Conclusion:
These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail.
Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension
Authors: Eslami Yadollah , Mohammadi Massood , Safizadeh Mona , Tabatabaei Seyed Mehdi 
Published: June 2022

Purpose:
Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN).

Methods:
In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes.

Results:
Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%).

Conclusion:
Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).
Feasibility study for measuring patients’ visual acuity at home by their caregivers
Authors: Davara Navya Deepthi , Chintoju Raghavachary , Manchikanti Neelima , Thinley Chodup , Vaddavalli Pravin Krishna , Rani Padmaja Kumari , Satgunam PremNandhini 
Published: June 2022

Purpose:
To assess the feasibility of measuring patients’ visual acuity (VA) in their homes by their caregivers.

Methods:
Patients consulting in a tertiary eye care institute were prospectively enrolled with informed consent. All underwent standard COMPlog distance VA testing. Patients and caregivers were oriented to test distance VA using the Peek Acuity app. The app was installed on the caregiver’s or patient’s smartphone. The patient’s VA was measured by the caregiver in the clinic (baseline value) under supervision. After 1 week, the caregivers recorded the patient’s VA with the Peek Acuity app at their home and reported the value in a telephone consultation. A questionnaire to assess the ease of using the app was administered at both the baseline visit and 1 week later.

Results:
A total of 100 patients (age group: 13 to 76 years) and 100 caregivers (age group: 17 to 65 years) participated. VA measurements with the Peek Acuity app were comparable with COMPlog (P > 0.1) both during the baseline and after 1-week measurement, regardless of the underlying ocular condition or educational level of the caregivers/patients. Most caregivers (95%) felt the app was easy to use.

Conclusion:
Though the Peek Acuity app was originally developed for health care workers to be used in field visits, we found that with proper orientation, the layperson can also use it. Such orientation can enable caregivers to effectively measure VA at home. Such a tool would enhance teleophthalmology consultations and can minimize the need for short follow-up visits.
How does anisometropia affect the choroidal vascularity index?
Authors: Cevher Selim , Üçer Mehmet Barış , Şahin Tayfun 
Published: June 2022

Purpose:
To investigate the choroidal vascularity index (CVI) and morphological features of the choroid in anisometropic amblyopia.

Methods:
In this prospective cross-sectional study, 39 patients with unilateral anisometropic amblyopic patients and 33 eyes of 33 healthy control participants were involved. These participants were examined in terms of axial length (AL), spherical equivalent (SE), central macular thickness (CMT), choroidal thickness (CT), total choroidal area (TCA), luminal area (LA), stromal area (SA), LA/SA ratio, and CVI. All parameters were compared between amblyopic eyes, healthy fellow eyes, and healthy control eyes. The Shapiro–Wilk tests, Chi-square test, the paired t-test, Wilcoxon signed-rank test, Mann–Whitney U test, Kruskal–Wallis test, and Pearson/Spearman correlation tests were used.

Results:
In the hyperopic patients; SE, subfoveal CT, nasal CT, temporal CT, TCA, LA, SA, and CMT were greater in amblyopic eyes than in healthy fellow eyes and control eyes (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively), and CVI, LA/SA ratio, and AL were smaller in amblyopic eyes than in healthy fellow eyes and control eyes ([P < 0.001, P = 0.006], P < 0.001, and P < 0.001, respectively). In the myopic patients, subfoveal CT, nasal CT, temporal CT, TCA, LA, SA values were statistically smaller in amblyopic eyes than in healthy eyes and control eyes ([P < 0.001, P = 0.002), [P = 0.004, P = 0.012], [P = 0.012, P = 0.032], [P < 0.001, P = 0.013], [P < 0.001, P = 0.024], and [P < 0.001, P = 0.047], respectively). The differences in the AL and choroidal parameters were due to myopia and hyperopia.

Conclusion:
The choroidal structural parameters of the amblyopic eyes were different from that of the healthy eyes.
Multidrug-resistant Organisms in Urinary Tract Infections in Bangladeshi Children
Authors: Chowdhury Md Ziaur R. , Benzamin Md , Khatoon Mohsina , Tamal Tuhin B. 
Published: June 2022

Background:
The incidence of antibiotic-resistant urinary tract infections (UTIs) in children, particularly multidrug-resistant (MDR) UTIs, is increasing day by day.

Aims:
The aim of this article is to describe the incidence of MDR UTIs in a pediatric population of Bangladesh.

Materials and Methods:
This retrospective, observational study was carried out by the Microbiology Department of Sylhet Women’s Medical College, Sylhet and Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. We reviewed the data record software of Microbiology Department of Sylhet Women’s Medical College and Popular Diagnostic Centre, Sylhet from April 2021 to October 2021 and collected all the urine culture-positive reports with symptom (UTI) and without symptom (asymptomatic bacteriuria) of children (0–18 years) and antibiotic sensitivity to different organisms. Patients with incomplete data were excluded from this study. A total of 39 patients were evaluated, and data were entered into Microsoft Excel and analyzed by SPSS software. This study got ethical approval from Departmental Review Board of Sylhet Women’s Medical College, Sylhet, Bangladesh.

Results:
Thirty-nine patients, including 13 (33.3%) males and 26 (66.7%) females, were included in this study, with a 1.92:1 female-to-male ratio. The mean age was 100.5 months (SD 90.5 months). MDR organism was identified in 23 patients (55%). Escherichia coli was the most common organism, found in 23 (59%) of the cultures, with the next being Klebsiella spp. 12 (30.8%), Enterococcus spp. 2 (5.1%), Pseudomonas aeruginosa 1 (2.6%), and Staphylococcus aureus 1 (2.6%). About 48% of E. coli, 75% of Klebsiella, 100% of Enterococcus, and 100% of Pseudomonas were MDR. Imipenem is 100% sensitive and linezolid is 100% resistant. Among the oral drugs, nitrofurantoin had less resistance.

Conclusion:
The majority of UTIs in children are MDR, with E. coli being the most common organism.
MRI and ultrasonography in the evaluation of causes of shoulder pain
Authors: Elshenawy Esraa , Nassar Ibrahim A. , Elkhouly Radwa M. , Dabees Naglaa 
Published: June 2022

Background
The shoulder is a complex joint that is essential for daily activities. Shoulder pain is a common musculoskeletal complaint. Shoulder ultrasound (US) is one of the best imaging techniques for the evaluation of shoulder pain. MRI is a powerful tool in the diagnosis of causes of shoulder pain because it is noninvasive and it provides good evaluation of the soft tissue, labrum, and bones.

Aim
The aim of our study was to evaluate the role of MRI and US in the diagnosis of the etiology of shoulder pain.

Patients and methods
This study was performed on 30 patients complaining of shoulder pain referred to the Radiodiagnosis Department at Tanta University Hospitals for performing shoulder US and MRI.

Results
The most common cause of shoulder pain in this study was rotator cuff muscle injury especially supraspinatus muscle. There was good agreement between US and MRI in the diagnosis of rotator cuff muscle lesions with kappa test=0.734, while there was no agreement between US and MRI in the diagnosis of labral tears with kappa test=0, and in cases with bony lesions the agreement between US and MRI was moderate with kappa test=0.420.

Conclusion
US is an effective imaging modality in evaluating patients with shoulder pain. US is the modality of first choice for the evaluation of rotator cuff tears. MRI is superior to US in the assessment of correct site and the extent of rotator cuff muscle tear and in evaluating bony and labral lesions.