bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scleral cut-down technique of subretinal fluid drainage in scleral buckle surgery for rhegmatogenous retinal detachment
Authors: Varma Shobhit , Mohan Sashwanthi , Ratra Dhanashree , Nadig Ramya R , Kashyap Rengappa 
Published: October 2022

Background:
The art of scleral buckle (SB) surgery is being largely forgotten. However, it still remains a good option for selected cases of rhegmatogenous retinal detachment. Drainage of subretinal fluid (SRF) is one of the most crucial steps of the surgery. When performed correctly, it gives the advantage of immediate retinal reattachment, and it hastens recovery. However, it has its own set of complications.

Purpose:
To demonstrate, step by step, the scleral cut-down technique of SRF drainage in SB surgery for rhegmatogenous retinal detachment (RRD) and to discuss its indications, contraindications, and complications.

Synopsis:
Longstanding RRDs with bullous detachments, old age, inferior breaks, or multiple breaks are indications of SRF drainage. In shallow RDs or young patients, a non-drainage procedure may be preferred. It is safer to drain at the bed of the buckle. After the sclera is cut and dissected, it is essential to inspect the choroid for the presence of large vessels. Choroidal vessels are avoided from getting injured while perforating. The release of pigments indicates the end of the drainage. Various possible complications can be prevented by being careful in the surgical technique.

Highlights:
Diagrammatic illustrations explain the steps of the surgical technique. Intraoperative complications have been explained in an easy-to-understand manner with tips to manage such conditions and their prevention. The video highlights the correct way of performing SRF drainage.

Online Video Link:

https://youtu.be/L0TrdkCwk20

Key words: Scleral buckle, scleral cut-down technique, sub-retinal fluid drainage
When the savior becomes a demon: Silicon oil synechia-induced glaucoma
Authors: Agarwal Amar , Narang Priya , Narang Rhea 
Published: October 2022

Background:
Silicon oil is an important adjunct for achieving internal tamponade in the treatment of retinal detachment. Silicone oil tamponade often leads to narrowing of the angle and development of adhesions between the iris and anterior chamber angle structures, with consequential elevation of the intraocular pressure. The video showcases the management of these challenging scenarios.

Purpose:
To highlight the management of early synechial closures due to silicon oil tamponade.

Synopsis:
The video highlights the management of early synechial closure following silicon oil tamponade. Surgical pupilloplasty has been demonstrated to break the peripheral anterior synechias on intraoperative gonioscopy as well as on anterior segment optical coherence tomography (AS-OCT). Performing pupilloplasty in the early phase of development of peripheral anterior synechias (PAS) helps to break the existing synechias and prevent angle closure and sequential deterioration of vision.

Highlights:
Surgical pupilloplasty helps to relieve the post silicon oil-induced secondary angle closure glaucoma by breaking the peripheral anterior synechias and significantly opening the anterior chamber angles.

Online Video Link:

https://youtu.be/xe2NGlhPBF4

Key words: Angle Closure Glaucoma, glaucoma, retinal detachment, silicon oil, PAS, peripheral anterior synechias, pupilloplasty
Clinical characteristics in the misdiagnosis of cytomegalovirus retinitis: A retrospective analysis of eight patients
Authors: Du Kui-Fang , Huang Xiao-Jie , Chen Chao , Kong Wen-Jun , Xie Lian-Yong , Wei Wen-Bin 
Published: October 2022

Purpose
To highlight characteristics in the misdiagnosis of cytomegalovirus retinitis (CMVR).

Methods
Misdiagnosed cases related to CMVR were analyzed retrospectively at the Department of Ophthalmology, Beijing Youan Hospital, from July 2017 to October 2019. The medical records were reviewed by two independent senior ophthalmologists and the patients’ clinical characteristics were analyzed.

Results
Eight patients (16 eyes) were identified with misdiagnoses related to CMVR. Six of the patients with CMVR were previously unaware of their human immunodeficiency virus (HIV) infection; one patient with CMVR concealed their history of HIV infection. The cases were initially misdiagnosed as diabetic retinopathy (1/7, 14.3%), branch retinal vein occlusion (1/7, 14.3%), ischemic optic neuropathy (1/7, 14.3%), Behçet’s disease (1/7, 14.3%), iridocyclitis (2/7, 28.6%), and progressive outer retinal necrosis (1/7, 14.3%). One patient with binocular renal retinopathy and chronic renal insufficiency was misdiagnosed with CMVR. Four eyes (4/16, 25%) presented with pan-retinal involvement. Fourteen eyes (14/16, 87.5%) had optic disc or macular area involvement. At the final diagnosis, one patient was blind, and two patients had low vision. Seven AIDS patients showed an extremely low level of CD4+ T lymphocytes (median of 5 cells/ml; range 1–9 cells/ml).

Conclusion
CMVR may be misdiagnosed in the absence of known immune suppression. CMVR and HIV screening cannot be overlooked if a young male patient presents with yellowish-white retinal lesions. These misdiagnosed patients had severe retinitis associated with poor vision.
Relationship between refractive outcomes and quantitative retinal vascularization and severity of plus disease in eyes treated with intravitreal bevacizumab
Authors: Bayramoglu Sadik Etka , Sayin Nihat 
Published: October 2022

Purpose:
The study aimed to investigate the relationship between refractive outcomes with the extent of retinal vascularization and severity of the plus disease in infants treated with intravitreal bevacizumab (IVB).

Methods:
Pre-IVB fundus images (PFIs), final fundus images (FFIs), and refractive outcomes of the 93 infants who underwent IVB monotherapy for type 1 and aggressive retinopathy of prematurity (A-ROP) were retrospectively evaluated. Quantitative measurements were performed on PFIs and FFIs. Pre-IVB plus severity was scored on a five-leveled scale. Correlation between spherical equivalent (SE) with pre-treatment and final extent of the temporal retinal vascularization and pre-treatment severity of plus disease was analyzed.

Results:
There was a linear and low positive correlation between the extent of pre-IVB and final temporal retinal vascularization with final SE (p = 0.000, r = 0.267; P = 0.002, r = 0.274, respectively). There was a low negative correlation between the pre-IVB plus severity score with final SE (p = 0.012, r = -0.192). Gestational age (GA), birth weight (BW), IVB dose, presence of additional IVB, or laser treatments were not correlated with refractive outcome. Out of 171 eyes, 38 eyes had >1 D myopia. In the univariate logistic analyses, pre-IVB retinal zone and pre-IVB and final extent of the temporal retinal vascularization were found to be related to the development of >1 D myopia (p = 0.002, odds ratio (OR) = 0.298; P = 0.000, OR = 0.281; P = 0.001, OR = 0.317; respectively).

Conclusion:
Our study indicates that the pre-treatment and final extent of retinal vascularization were the main parameters that were related to final refractive outcomes in IVB-treated eyes for type 1 and A-ROP.
An insight into the altered ophthalmic dynamics during the COVID-19 pandemic
Authors: Kaushik Jaya , Riyaz Eram , Chaitanya YVK , Nair Renu , Kumar Ashok , Singh Ankita , Parihar JKS , Srikant S , Shetty Rakesh 
Published: October 2022

Purpose
The objective of this survey-based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology.

Methods
The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question.

Results
A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic-appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor.

Conclusion
The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department-based and surgical procedures in ophthalmology.
Evaluation of ocular pulse amplitude changes after the retinal detachment repair
Authors: Jeremic Miroslav , Kovacevic Igor , Vasilijevic Jelena , Kalezic Tanja , Bozic Marija 
Published: October 2022

Purpose
The study was conducted to determine the ocular pulse amplitude (OPA) changes, measured with a dynamic contour tonometer (DCT), after surgical retinal detachment repair.

Methods
This was a prospective and comparative study. Thirty patients (30 eyes) who had undergone uncomplicated unilateral scleral buckling and encircling procedures for quadrant or half-retinal rhegmatogenous retinal detachment were referred for DCT one day before the surgery was performed, on the 1st, 7th, and 30th postoperative day. Methods of descriptive (arithmetical mean, standard deviation) and analytical statistics (analysis of variance) were used to analyze the data and evaluate the significance of the difference. A value of P less than 0.05 was considered statistically significant. The data were evaluated for normality with the single-sample Kolmogorov–Smirnov test.

Results
OPA values decreased significantly after scleral buckling procedures (p < 0.0001), but regained near to preoperative values one month after the surgery.

Conclusion
OPA tends to decrease after retinal detachment surgery. Restoring patients’ vision with scleral buckling and encircling procedures gives early changes in blood supply to the choroid and ocular nerve, and since OPA is an indirect parameter of choroidal vascularization, measuring these values can help make an insight into ocular hemodynamics.
Comparison of measurements between manual and automated eyetracking systems in patients with strabismus – A preliminary study
Authors: Rajendran Janani , Rai Kshama , Shetty Shashikant , Mathangi V 
Published: October 2022

Purpose:
The main objective is to test the measurements made by an automated eye-tracking system in the presence of strabismus and to compare the data with manual measurements of deviation.

Methods:
A prospective observational cross-sectional masked double-blinded study was conducted in a tertiary eye care center with 39 participants included in our study, aged 3–41 years. Initial screening of all participants was performed by an ophthalmologist. Ocular deviations were evaluated and compared between manual measurements and an automated eye-tracking system. The device is based on eye-tracking technology. The participants had either a congenital or acquired type of manifest or latent strabismus. Children less than 3 years of age, visual acuity <6/36, and abnormal configuration of the anterior segment were excluded from the study.

Results:
The prism alternate cover test (PACT) manual measurements and the automated alternate cover test for measuring horizontal deviation, the manual measurement, and the automated eye track system showed a highly positive correlation (r = 0.932, P < 0.001). The Bland Altman plot analysis shows good agreement between the two measurements, with the mean difference between the two measurements being 1.55 PD, and the 95% limit of agreement was ± 10 PD.

Conclusion:
The results obtained with an automated eye-tracking system correlate well with manual strabismus measurements with PACT in terms of diagnosis, precision, and accuracy, with an added benefit of lesser time consumption in performing the test in cooperative/motivated patients. Considering these aspects, patients above the age of 3 years could be assessed with the equipment.
Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation
Authors: Bhadra Tania Ray , Ghosh Rudra Prosad , Saurabh Kumar , Mitra Ankita , Ghosh Asim Kumar , Bhadra Tanmoy 
Published: October 2022

Purpose:
To assess the incidence and cause of idiopathic, irreversible loss of vision (“wipe-out”) in the early post-operative period after glaucoma-filtration surgery in advanced glaucoma.

Methods:
It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco-emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra-ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed.

Results:
Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre-operative and post-operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed “wipe-out”.

Conclusion:
“Wipe-out” is a rare phenomenon after surgery in advanced glaucoma.
Ophthalmology as a career choice among medical students in Eastern India – A cross-sectional study
Authors: Parija Sucheta , Gupta Ashna , Nayak Saurav , Banerjee Aparajita , Poddar Chanchal 
Published: October 2022

Purpose:
Several factors influence medical students to choose a specialty branch for post-graduate training, and it is important to understand them so that strategies can be made to make it more attractive and hence the shortage in the workforce can be addressed. This study aimed to identify the factors that influenced under-graduate medical students to choose ophthalmology as their specialty for post-graduate training.

Methods
It was a descriptive, cross-sectional, questionnaire-based study, carried out among medical students at a tertiary academic institute in eastern India. In this survey tool, 25 questions were divided into different sections: demographic data, factors influencing the choice and perceptions about ophthalmology as a career option, and the impact of rotatory internship posting on the choice of subject. The various factors were then scored and indexed appropriately.

Results
There were 515 participants. The median age was 23 years. The major influencing factor for choosing ophthalmology was “adequate time” (52.04%), and the discouraging factor was “steep learning curve” (58.64%). Age had an odds ratio of 0.781, showing that the lower the age, the higher the chances of being positively inclined toward ophthalmology as a career choice. Similarly, major deciding factors, perceptions, and experiences in ophthalmology had odds ratios of 1.841, 1.725, and 2.057, respectively, showing a positive inclination.

Conclusion
The study states that a steep learning curve, personal attitudes, and misconceptions may dissuade the students from taking this subject, but adequate clinical exposure and experience, as well as role models during the internship, can create a positive impact on career choice.
Vector analysis of astigmatic correction after single-step transepithelial photorefractive keratectomy and femtosecond-assisted laser in-situ keratomileusis for low to moderate myopic astigmatism
Authors: Sun Lixia , Jhanji Vishal , Li Senmao , Li Jinyu , Ji Ruifeng , Zeng Hongqiang , Ng Tsz Kin , Zhang Mingzhi , Zhang Riping 
Published: October 2022

Purpose:
This study aimed to evaluate the outcomes of astigmatic correction by single-step transepithelial photorefractive keratectomy (TransPRK) and femtosecond-assisted laser in-situ keratomileusis (Femto-LASIK) surgeries.

Methods:
A total of 218 subjects received TransPRK or Femto-LASIK surgery for the treatment of myopia and astigmatism (−2.25 to −0.25 D). Refraction errors and uncorrected (UDVA) and corrected distance visual acuity (CDVA) were examined before and at 3 months after surgery. Astigmatism changes were assessed by vector analysis.

Results:
Preoperative parameters of the TransPRK group were similar to the Femto-LASIK group. UDVA and CDVA at 3 months were similar between both groups. Manifest refraction (MR) spherical equivalent in the TransPRK group (0 ± 0.20 D) was slightly lower compared with the Femto-LASIK group at 3 months (0.11 ± 0.25 D, P = 0.001). MR cylinder was -0.06 ± 0.19 D in the TransPRK group and -0.02 ± 0.15 D in the Femto-LASIK group at 3 months (P = 0.135). The index of success (IS) was 0.15 ± 0.36 in the TransPRK group and 0.06 ± 0.17 in the Femto-LASIK group (P = 0.125). The correction index (CI) was 1.03 ± 0.19 in the TransPRK group and 1.01 ± 0.11 in the Femto-LASIK group (P = 0.815).

Conclusion:
For low to moderate myopic astigmatism, TransPRK provided a comparable astigmatic treatment effect as Femto-LASIK. Myopic astigmatism was both slightly overcorrected after TransPRK and Femto-LASIK surgeries.
Complications in deep anterior lamellar keratoplasty – A retrospective interventional analysis in a large series
Authors: Kodavoor Shreesha Kumar , Rathi Neha , Dandapani Ramamurthy 
Published: October 2022

Purpose:
To analyze the complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of the anterior corneal stroma.

Methods:
This is a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2020. A total of 474 eyes in 373 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman’s membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post–laser-assisted in situ keratomileusis ectasia, descematocele, post-collagen cross-linking aborted melt and dense scar, and post-radial keratotomy were included in the study. The patients were followed up for 17.2 +/- 9.2 months (1–9 years).

Results:
Complications noted in the surgery were intra-operatively Descemet’s membrane perforation in 31 eyes (6.54%), post-operatively secondary glaucoma in 16 eyes (3.37%), cataract in seven eyes (1.47%), suture-related complications in five eyes (1.05%), graft rejection in three eyes (0.63%), traumatic dehiscence in two eyes (0.42%), filamentary keratitis in two eyes (0.42%), interface infiltrate in one eye (0.21%), and recurrence of disease in four eyes (7.14%) out of 57 eyes with corneal dystrophy.

Conclusion:
DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases. It has become an automatic choice for diseases of the anterior cornea requiring keratoplasty. Complications can occur at any stage of surgery; however, if identified and managed early, they can result in optimal outcome.
Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India
Authors: Dubey Suneeta , Bansal Tanima , Garg Prerna , Hegde Aparna , Das Ranajit , Rekha PD 
Published: October 2022

Purpose:
This study was done to report intermediate-term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross-sectional, longitudinal, observational study design.

Methods:
Fifty-three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post-operative data included IOP changes during the follow-up till 1-year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction of IOP from pre-operative IOP with no additional glaucoma surgery.

Results:
The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1-year follow-up. The AGMs reduced from 2.4 ± 1.4 pre-surgery to 1.6 ± 1.4 at 1-year follow-up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra-operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent.

Conclusion:
This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.
Acremonium keratitis: Risk factors, clinical characteristics, management, and outcome in 65 cases
Authors: Priyadarshini Smruti Rekha , Soni Tanvi , Sahu Srikant Kumar , Mohanty Amrita , Sharma Savitri , Mitra Sanchita , Ali Mohammad Hasnat , Das Sujata 
Published: October 2022

Purpose:
To study the risk factors, clinical presentation, management options, and outcomes in cases of culture-proven Acremonium keratitis.

Methods:
Medical and microbiology records of culture-proven Acremonium keratitis from Jan 2007 to Dec 2019 at a tertiary eye care center were reviewed. Details of clinical findings on each visit and operating notes were reviewed from the medical records. All cases were subjected to corneal scraping at the first visit for microbiological investigation consisting of direct smear examination and culture. Topical natamycin 5% was the mainstay of medical treatment. Surgical treatment was considered for nonresponding patients.

Results:
During the 13-year study period, 65 cases of culture-proven Acremonium keratitis were identified out of 1605 cases of fungal keratitis. Trauma was the most common predisposing factor in 32 cases (49.2%). The average area of the corneal stromal infiltrate was 24.8 mm2 at the initial presentation. Hypopyon at the time of presentation was evident in 28 (43.1%) cases. Staphylococcus spp. was the most common (n = 22, 33.8%) organism coexistent with Acremonium. Direct microscopy of corneal scraping was positive for fungal filaments in 57/65 (87.6%) cases. Medical management alone was given in 44 patients (67.6%). Age (>50 years) and treatment delay (>15 days) were found to be independent risk factors for the poor final visual outcome (VA <20/60).

Conclusion:
When treated early, Acremonium keratitis responds well to medical therapy with currently available topical antifungals. However, advanced and nonresponding cases require surgical intervention for resolution of the infection.