bluuebunny/crossref_metadata_2025_split huggingface dataset:
The undesirable wink
Authors: Backiavathy Varsha , Pal Soham , Poonam Nisar Sonam , Subramanian Nirmala 
Published: June 2022

Background:
Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.

Purpose:
Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity.

Synopsis:
We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell’s palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention.

Highlights:
Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options.

Video link:

https://youtu.be/YQbRecp449w
Vitrectomy with arteriotomy and neurotomy in retinal artery occlusion – A case series
Authors: Cisiecki Sławomir , Bonińska Karolina , Bednarski Maciej 
Published: June 2022

Purpose:
This study aimed to investigate the visual outcomes and anatomical changes after vitrectomy for retinal artery occlusion.

Methods:
Twelve patients with retinal artery occlusion (11 central retinal artery occlusion and 1 branch retinal artery occlusion) were part of this study. Our patients were treated with vitrectomy with arteriotomy or with neurotomy and arteriotomy. Complete ophthalmic examination was performed preoperatively, at 2 weeks, and 1, 3, 6, 9, and 12 months after surgery.

Results:
The mean preoperative best-corrected visual acuity (BCVA) was 1.94 logMAR, and the final BCVA after 12-months follow-up was 2.04 logMAR. After vitrectomy with arteriotomy, the BCVA in patients treated with neurotomy and arteriotomy was 1.65 and 2.45, respectively (P = 0.038).

Conclusion:
No benefits have been achieved from using vitrectomy in retinal artery occlusion cases.
Clinical and mycological profile of fungal keratitis from North and North-East India
Authors: Tawde Yamini , Singh Shreya , Das Sourav , Rudramurthy Shivaprakash M , Kaur Harsimran , Gupta Amit , Kataki Mounjuri , Gogoi Pranami , Ghosh Anup K 
Published: June 2022

Purpose:
To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary-care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations.

Methods:
All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts.

Results:
Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions.

Conclusion:
The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region-specific clinico-epidemiological profile.
Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study
Authors: Zor Kürşad Ramazan , Çınaroğlu Selim , Küçük Erkut , Keleş Hacı , Öztürk Ali 
Published: June 2022

Purpose:
In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening.

Methods:
40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye.

Results:
No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection.

Conclusion:
Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non-ophthalmologic surgeries.
Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study
Authors: Mannava Sunny , Borah Rishi Raj , Shamanna B R 
Published: June 2022

Purpose:
Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the “Vision 2020: The right to sight” initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations.

Methods:
We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the “cost of illness” methodology.

Results:
The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion).

Conclusion:
These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people-centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare.
Effects of low-concentration atropine eye drops on the optical quality of the eyes in myopic children
Authors: Li Weiran , Cao Yiting , Zhou Jibo 
Published: June 2022

Purpose:
The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different concentrations.

Methods:
In the study population of 71 patients (131 eyes), 34 patients (63 eyes) were given 0.01% atropine eye drops and 37 patients (68 eyes) were given 0.05% atropine eye drops. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs 100%, 20%, and 9%) under different lighting conditions were measured before and after two weeks of atropine treatment.

Results:
After using 0.05% atropine eye drops for two weeks, the Strehl ratio decreased from 0.27 ± 0.07 to 0.23 ± 0.07 (P = 0.0026), PVA 20% decreased from 1.15 ± 0.32 to 1.03 ± 0.36 (P = 0.0344), and PVA 9% decreased from 0.74 ± 0.23 to 0.64 ± 0.23 (P = 0.0073). The OSI was significantly higher after using 0.05% than 0.01% atropine eye drops (P = 0.0396), while both the Strehl ratio and PVA 20% were lower after using 0.05% than 0.01% atropine eye drops (P = 0.0087 and P = 0.0492, respectively).

Conclusion:
The children’s optical quality did not change significantly after using 0.01% atropine eye drops, whereas it decreased after using 0.05% atropine eye drops.
Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center
Authors: Ahmed Nishat H , Mishra Deepanshi , Rathod Prachala , Satpathy Gita , Titiyal Jeewan S , Tandon Radhika , Nandyala Sushma , Agarwal Tushar , Vanathi Murugesan , Sinha Rajesh , Gupta Noopur , Maharana Prafulla K , Kaur Manpreet , Sharma Namrata 
Published: June 2022

Purpose:
To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years.

Methods:
It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed.

Results:
Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase-negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non-fermenting gram-negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram-negative isolates were susceptible to carbapenems and polymyxin B.

Conclusion:
To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.
Correlation of quantitative polymerase chain reaction with clinical characteristics of patients with viral retinitis
Authors: Mohan Sashwanthi , Dhanurekha L , Janani M K , Biswas Jyotirmay 
Published: June 2022

Purpose:
To evaluate the correlation of quantitative real-time polymerase chain reaction (qRT-PCR) to the clinical characteristics of patients with viral retinitis.

Methods:
Retrospective case series.

Results:
Aqueous or vitreous samples of 20 out of 35 eyes showed qRT-PCR positivity for virus etiology (57.14%). Cytomegalovirus (CMV) was most commonly identified in nine eyes (45%). The mean DNA copy number was 2,68,339.65 copies/mL (range: 90–3205397). DNA copy number significantly correlated with the extent of clinical involvement (P = 0.013); however, there was no correlation between DNA copy number and presenting visual acuity (P = 0.31), macular involvement (P = 0.675), optic nerve involvement (P = 0.14), and development of retinal detachment (P = 0.73). There was a significant correlation between the number of DNA copies and the timing of sampling (P = 0.0005). Samples taken earlier in the course of the disease had higher viral copies than later ones.

Conclusion:
qRT-PCR is useful in confirming a viral etiology in over 50% of cases of suspected viral retinitis. It correlates well with the extent of clinical involvement and timing of sampling.
Comparison of patient satisfaction with red-free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination
Authors: Sharma Pragya , Dhami Abhinav , Dhami Nimrata B , Dhami Gobinder S 
Published: June 2022

Purpose:
Comparison of patient satisfaction with red-free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination.

Methods:
This is an observational questionnaire-based study of 100 myopes in the age group of 18–40 years coming for a routine check-up or for refractive surgery workup. The examination was done using an indirect ophthalmoscope and a 20D lens with green or yellow light and was assigned in two groups randomly using the coin toss method, following which, a questionnaire was used to assess the following parameters: a) level of comfort, b) any complaints of discomfort during examination, d) preference of the used light source in future, e) grading of discomfort on a linear scale, and f) patient cooperation and duration of examination.

Results:
Patients were randomized for observation with IDO using either green light (n = 55) or yellow light (n = 45) filter. In the study, 46 patients (83.6%) were very comfortable and only 9 patients (16.4%) experienced mild discomfort when using red-free (green) light, while only 3 patients (6.7%) were very comfortable and 31 (68.9%) had mild discomfort when using yellow light. The complaints of watering with yellow and green light were noted in 36 patients (80.0%) and 15 patients (27.3%), pain in 13 patients (28.9%) and 3 patients (5.5%), light sensitivity in 29 patients (64.4%) and 4 patients (7.3%), respectively, all being significantly more in yellow light category (P < 0.001). The time of examination was significantly more in yellow light category with 83 ± 10.75 seconds (P < 0.001).

Conclusion:
Retinal examination using the green filter of indirect ophthalmoscope is more comfortable in examining the patients as compared to routine yellow light with decreased number of complaints, lesser examination time, and better patient cooperation.
Early postoperative astigmatism in 2-mm manual small incision cataract surgery with phacofracture
Authors: Sahu Amulya , Bali Jatinder , Sahu Chinmaya , Mishra Deepak , Heda Aarti , Deori Nilutparna 
Published: June 2022

Purpose:
India’s cataract surgery rate has been hovering around a creditable 6000 per million population but the coverage is variable across the geography and demography with sharp urban rural divide. Smaller incisions in manual small incision cataract surgery (MSICS) with phacofracture have been credited with lower astigmatism and faster recovery, which is especially useful for patients traveling for surgeries.

Methods:
In this retrospective chart analysis based observational study of 66 eyes, we describe the early postoperative results with 2 mm MSICS with phacofracture.

Results:
The mean spherical equivalent of the autorefractor measured astigmatic error changed marginally to −0.51 diopters (SD = 0.58) from −0.44 diopters (SD = 0.42) (t = −8.410, P = 0.0) translating to mean change in astigmatism of 0.14 DCyl when the axis was ignored. The keratometric difference between steepest and flattest axis of the anterior surface of the central 3 mm zone of the cornea changed from a mean of 0.89 diopters (SD = 0.55) to 1.39 diopters (SD = 1.03). The visual acuity improved to mean logarithm of the minimum angle of resolution (logMAR) score of 0.27 (SD = 0.33) at 1 week and 0.007 (SD = 0.04) which corresponds to 6/6P on Snellen’s acuity at 1 month or more.

Conclusion:
A 2 mm MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery. The study underlines the need for considering the refraction at anterior and posterior corneal interfaces when the triplanar incision with separate interfaces is used.
Supplemental nutrition for retinal health: Evidence based analysis of commercial preparations in India
Authors: Sharma Ashish , Kumar Nilesh , Parachuri Nikulaa , Kuppermann Baruch D , Bandello Francesco 
Published: June 2022

Purpose:
Antioxidants have been lately postulated as supportive and prophylactic supplements for various retinal disorders, especially age-related macular degeneration (AMD). Forty-eight brands of such supplements containing lutein and zeaxanthin are available in India. The aim of the study was to assess the market leaders in supplements for ophthalmology in view of AREDS recommendations.

Methods:
Descriptive review of top-selling supplements for eye health were compared to the contents of the AREDS-recommended levels.

Results:
None of the top 10 selling brands had exact or near similar composition as recommended in the AREDS-2 study, which is the most widely accepted level-1 evidence in AMD prevention.

Conclusion:
Physicians prescribing these antioxidants, especially for the prevention of advanced AMD, should be vigilant and aware of the contents of the prescribed brands.
Refractive errors, road traffic accidents and long-term spectacle compliance amongst commercial taxi drivers in a major North-East Indian city
Authors: Kumar SG Prem , Basaiawmoit Aaron , Marbaniang Dorcas W , Nongsiej Kyntiew Daplin , Pongen Toshimenla , Basaiawmoit Jennifer Vaid 
Published: June 2022

Purpose:
To assess the prevalence of refractive error (RE) and its association with road traffic accidents (RTAs) and the subsequent long-term spectacle compliance and adherence to suggested appropriate strategies In Shillong, India.

Methods:
This prospective study was conducted between July and October 2019 among commercial taxi drivers (CTDs), with follow-up interviews conducted with a subset of respondents to assess long-term spectacle compliance after a year. Gross ophthalmologic examination was performed, including visual acuity and refraction. Descriptive statistics and Chi-square tests were conducted to assess the association between the type of REs, spectacle compliance, and selected sociodemographic and clinical variables. Multiple logistic regression was performed for analysis of the association between RTAs and sociodemographic, clinical, and work characteristics variables.

Results:
A total of 382 (95.5%) CTDs completed interviews and gross eye examination. The prevalence of any RE in the worst eye was 28.8% (95% CI: 24.3–33.6). Presbyopia with or without distance vision was the commonest type of RE with 21.7% (95% CI: 17.7%–26.2). Among those who were prescribed spectacles, 70.5% needed near correction. Drivers with RE were nearly two times (OR: 2.6; 95% CI: 1.4–5.1) more likely to be involved in RTAs compared to those without any RE. Long-term spectacle compliance was at 40.9%. The predominant barrier reported for spectacle compliance was “can manage well without spectacles.”

Conclusion:
This survey has demonstrated a significant relationship between poor vision and occurrence of RTAs. There is an urgent need for tailor-made targeted interventions to address the eye health needs of CTDs in India.
Analysis of COVID-19-associated rhino-orbital-cerebral mucormycosis patients in a tertiary care center in Northern India
Authors: Yadav Himanshu , Sen Snigdha , Nath Tirupati , Mazumdar Shefali , Jain Anu , Verma Pinky , Gupta Preeti 
Published: June 2022

Purpose:
An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021.

Methods:
All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed.

Results:
A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality.

Conclusion:
Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.