bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ologen implant versus mitomycin C in combined trabeculectomy and phacoemulsification
Authors: Paul Chandrima , Divya J , Kamal Richa , Paul Anujeet 
Published: March 2022

Purpose:
To comparatively evaluate in Indian eyes with coexisting cataract and primary open-angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy.

Methods:
Eyes with primary open-angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty-four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology.

Results:
In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 ± 2.89 mm Hg with MMC and 14.56 ± 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed

Conclusion:
MMC and Ologen are both effective adjunctives in combined phaco-trabeculectomy. However, the Ologen implant provides better bleb health and safety.
Development and validation of an offline deep learning algorithm to detect vitreoretinal abnormalities on ocular ultrasound
Authors: Adithya Venkatesh Krishna , Baskaran Prabu , Aruna S , Mohankumar Arthi , Hubschman Jean Pierre , Shukla Aakriti Garg , Venkatesh Rengaraj 
Published: March 2022

Purpose:
We describe our offline deep learning algorithm (DLA) and validation of its diagnostic ability to identify vitreoretinal abnormalities (VRA) on ocular ultrasound (OUS).

Methods:
Enrolled participants underwent OUS. All images were classified as normal or abnormal by two masked vitreoretinal specialists (AS, AM). A data set of 4902 OUS images was collected, and 4740 images of satisfactory quality were used. Of this, 4319 were processed for further training and development of DLA, and 421 images were graded by vitreoretinal specialists (AS and AM) to obtain ground truth. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristic (AUROC).

Results:
Our algorithm demonstrated high sensitivity and specificity in identifying VRA on OUS ([90.8%; 95% confidence interval (CI): 86.1–94.3%] and [97.1% (95% CI: 93.7–98.9%], respectively). PPV and NPV of the algorithm were also high ([97.0%; 95% CI: 93.7–98.9%] and [90.8%; 95% CI: 86.2–94.3%], respectively). The AUROC was high at 0.939, and the intergrader agreement was nearly perfect with Cohen’s kappa of 0.938. The model demonstrated high sensitivity in predicting vitreous hemorrhage (100%), retinal detachment (97.4%), and choroidal detachment (100%)

Conclusion:
Our offline DLA software demonstrated reliable performance (high sensitivity, specificity, AUROC, PPV, NPV, and intergrader agreement) for predicting VRA on OUS. This might serve as an important tool for the ophthalmic technicians who are involved in community eye screening at rural settings where trained ophthalmologists are not available.
Impact of tear optics on the repeatability of Pentacam AXL wave and iTrace in measuring anterior segment parameters and aberrations
Authors: Kundu Gairik , Shetty Rohit , Khamar Pooja , Gupta Sneha , Mullick Ritika , Ganesan Vaitheeswaran L , D’Souza Sharon 
Published: March 2022

Purpose:
To assess impact of tear optics on repeatability of a Scheimpflug device with a Hartmann Shack aberrometer and a ray tracing aberrometer.

Methods:
One hundred healthy and 100 postrefractive surgery eyes underwent dry eye evaluation including Schirmer’s test and tear film break-up time (TBUT). They underwent optical quality analyzer (OQAS, Visio metrics S.L, Terrassa, Spain) to assess objective scatter index (OSI), three scans each on Pentacam AXL wave (OCULUS Optikgerate Gmbh, Wetzlar, Germany), iTrace (Tracey™ Technologies, Texas, USA) for flat, steep keratometry, thinnest corneal thickness, root mean square higher-order aberrations (RMS HOA), RMS lower-order aberrations (LOA), spherical aberrations, RMS COMA. Repeatability of Pentacam AXL wave and iTrace in healthy and postrefractive eyes (OSI >1 vs OSI <1) was studied using within-subject standard deviation (Sw) test–retest repeatability (TRT), coefficient of variation (COV).

Results:
OSI showed an inverse association with TBUT (P < 0.001). All measurements with Pentacam AXL wave with OSI < 1 had excellent repeatability, intraclass correlation coefficient (ICC) ranging from 0.88 for HOA, to 0.92 for LOA. The Sw, TRT, and COV of all aberration measurements were significantly lower (better) than those of iTrace. In eyes with OSI ≥1, the repeatability with Pentacam AXL wave dropped with ICC ranging from 0.77 for HOA, to 0.84 for LOA with lower Sw, TRT, and COV of all aberration measurements as compared to iTrace. Maximum variation was seen with HOA and minimum with LOA

Conclusion:
Tear optics affected repeatability of Pentacam wave and iTrace. Pentacam wave had better repeatability in eyes with a poor tear film as compared to iTrace. Thus, the tear film can impact repeatability of an instrument and it is important to assess the tear film prior to imaging patients, which can change the way we interpret and image these patients.
Comparative study on costs incurred for treatment of patients with bacterial and fungal keratitis - A retrospective analysis
Authors: Radhakrishnan Naveen , Pathak Neha , Raja Subramanian Krishnan , Das Daisy Rani , Ningombam Reagan , Khaitan Isha , Gandhi Neha , Rahul Ramesh , Prajna N Venkatesh 
Published: March 2022

Purpose:
To compare the costs associated with medications and travel of patients with smear-proven bacterial keratitis and fungal keratitis in a tertiary care center in India.

Methods:
Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear-positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program.

Results:
In total, 672 case records of 177 smear-positive bacterial keratitis (BK) and 495 smear-positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 ± 675.2) compared to BK (674.9 ± 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 ± 109.4) compared to BK (155.2 ± 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 ± 395.6 for BK, 801.5 ± 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 ± 653.1 for BK, 1374.6 ± 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK

Conclusion:
Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis.
Joint pain liniments and gum lotion in the eye - A consecutive case series of mistaken identity
Authors: Jayaprakash Anju Ajitha , Aswin PR , Rathinam SR 
Published: March 2022

Purpose:
Patient safety errors can arise due to similarity in packaging of medications. We aimed to describe the clinical features of patients presenting with accidental application of joint pain liniments and gum lotion in the eye due to confusion arising from similarity in packaging.

Methods:
This was a retrospective case series with eight consecutive patients presenting from December 2020 to August 2021 with history of accidental application of joint pain liniments or gum lotion in the eye instead of eye drops. All patients underwent visual acuity assessment and slit-lamp examination with fluorescein staining of the cornea to look for corneal involvement and was reassessed till complete resolution.

Results:
Of the eight patients, three were males and five were females. Seven had accidentally applied joint pain liniment, while one had applied gum lotion into the eye. Five of them had corneal involvement ranging from punctate erosions to near-total epithelial defects. Two patients needed referral to a tertiary center and hospital admission. Treatment duration ranged from 2 days to 1 month. Two patients were lost to follow-up

Conclusion:
This study highlights patient safety errors arising from confusion of medication due to similar labeling and packaging of different drugs. While there was no permanent morbidity, such confusions lead to needless discomfort and waste of time, money, and effort for the patient as well as the health-care system.
Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions
Authors: Zhang Riping , Wang Qiang , Li Jinyu , Sun Lixia , Jhanji Vishal , Jiang Jingjing , Zhang Mingzhi 
Published: March 2022

Purpose:
To evaluate the outcomes of transepithelial phototherapeutic keratectomy (transepithelial PTK) for treatment of posttraumatic recurrent corneal erosions.

Methods:
Twenty-four eyes of 22 patients with posttraumatic recurrent corneal erosions who were treated with transepithelial PTK from April 2018 to July 2020 were included in this retrospective study. The rates of recurrent erosions and complications were evaluated during the follow-up after surgery. Visual acuity and refraction were recorded preoperatively and 1 year after surgery. Total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations were recorded using corneal tomography preoperatively and 1 year after surgery.

Results:
Mean postoperative follow-up was 13 months (range: 12–32 months). None of the patients suffered from any complications or further erosions. Uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, and cylinder remained stable at 1-year postoperatively compared with the baseline (P = 0.214, P = 0.461, P = 0.084, and P = 0.879, respectively). Moreover, there was no significant difference in total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations between baseline and 1-year postoperative visit (P = 0.938, P = 0.136, and P = 0.981, respectively)

Conclusion:
Transepithelial PTK was an effective treatment for patients with posttraumatic recurrent corneal erosions.
Outcomes and favourable prognostic factors in patients of phacomorphic and phacolytic glaucoma managed by manual small-incision cataract surgery: A retrospective study
Authors: Chandrashekharan Shivkumar , Chakrabarty Sabyasachi , Tanwar Meghana , Madhuvarasu Bharadwaja , Uduman Mohammed Sithiq , Ramakrishnan Rengappa 
Published: March 2022

Purpose:
To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small-incision cataract surgery (MSICS).

Methods:
The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best-corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of <21 mm Hg. P < 0.05 was considered statistically significant.

Results:
The records of 209 patients with PMG and 279 patients with PLG were eligible for the review. The mean preoperative IOP for PMG and PLG were 43.15 ± 12.9 and 40.05 ± 12.0 mm Hg, respectively (P = 0.006). A younger age (<60 years) was associated with a lower risk of severe postoperative inflammation in both PMG and PLG [OR = 0.45 (0.21–0.99); P = 0.047 and OR = 0.44 (0.23–0.83); P = 0.011, respectively]. There was no significant difference in the final mean logMAR BCVA (P = 0.21) and IOP (P = 0.36) in the two groups. The likelihood of a final IOP of <21 mm Hg was significant for symptoms less than a week [OR = 3.52 (1.2–10.2); P = 0.02] in PMG and for absence of vitreous disturbance [OR = 35.0 (3.8–325.7); P = 0.002] in PLG. A BCVA of 6/18 or better was strongly associated with symptoms for less than a week [OR = 1.58 (1.0–2.4); P = 0.043] and absence of vitreous disturbance [OR = 23.53 (5.1–108.0); P < 0.001]

Conclusion:
Early diagnosis and management can translate to good outcomes in PMG and PLG.
Outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults
Authors: Natung Tanie , Pandey Ishita , Lyngdoh Laura A 
Published: March 2022

Purpose:
The aim of this study was to evaluate the outcomes of a simplified, fixed surgical dosage calculation for uncomplicated, horizontal, concomitant strabismus in adults.

Methods:
Outcomes analysis of a fixed-dose calculation method for uncomplicated, horizontal, concomitant strabismus in adults (≥18 years) wherein 1-mm recession/resection equals 2 PD for lateral rectus and 3 PD for medial rectus. This was a retrospective case series.

Results:
The mean age of the patients was 28.50 ± 8.43 years, the mean amount of preoperative deviation was 35.16 ± 9.97 PD, the mean expected correction was 36.26 ± 9.49 PD, and the mean correction achieved was 35.92 ± 10.74 PD. There were 22 monocular exotropias, six monocular esotropias, eight alternate divergent squints, and two alternate convergent squints. There were 20 cases of sensory strabismus (54.28%). There was no statistically significant difference between the expected correction and correction achieved (P = 0.519), meaning that our fixed-dose calculation method was effective. Thirty-five out of 38 patients had successful outcomes as per our criteria of less than 10-PD deviations from straight in primary position. Therefore, the success rate achieved by this procedure was 92.10%. There was no statistically significant correlation between age and the amount of deviation (P = 0.611)

Conclusion:
Our case series had a high postoperative success rate in terms of motor alignment. It is hoped that this simplified, fixed-dosage calculation method would help the numerous novice strabismus surgeons, make their starting steps easier and give them the confidence to do strabismus surgeries. They can modify the dosages later as per their own experiences.
Initial experience in treating polypoidal choroidal vasculopathy with brolucizumab in Indian eyes – A multicenter retrospective study
Authors: Chakraborty Debdulal , Maiti Aniruddha , Sengupta Sabyasachi , Mondal Soumen , Nandi Krishnendu , Chakraborty Somnath 
Published: March 2022

Purpose:
To report the initial experience of managing treatment-resistant and treatment-naïve eyes with polypoidal choroidal vasculopathy (PCV) by using brolucizumab 6 mg.

Methods:
This was a retrospective multicentric series of all consecutive eyes with PCV treated with brolucizumab. Treatment resistance was defined as taking at least six prior anti-VEGF injections over the past 1 year and showing persistent disease activity in the form of intra (IRF) or subretinal fluid (SRF) or both. All patients were treated on a pro re nata (PRN) basis and followed up monthly. Retreatment was considered when either SRF or IRF were present at any time point during the study.

Results:
We included 21 eyes of 21 patients with PCV with a mean age of 65.1 ± 9.9 years, of which 16 eyes (76%) were treatment-resistant. The mean follow-up period from receiving the first brolucizumab was 27.3 ± 3.3 weeks. Of the 21 eyes, seven eyes (33%) received three injections during follow-up, 13 eyes (62%) received two injections, and one eye received one injection. The mean injection-free interval was 12 ± 1.2 weeks. The median pretreatment vision was 0.6 logMAR (IQR = 0.47–1 logMAR) and improved to 0.3 logMAR (IQR = 0.25–0.6 logMAR), whereas the mean macular thickness improved from 443 ± 60 mm at baseline to 289 ± 25 mm (P < 0.001) at the last follow-up period. None of the eyes experienced any intraocular inflammation across 48 injection sessions

Conclusion:
Brolucizumab is safe and effective in controlling PCV disease in both treatment-resistant and treatment-naïve eyes.
Complete and incomplete lower motor neuron facial palsy in post-COVID-19 mucormycosis
Authors: Gautam Manushree , Soni Meenal , Bhaisare Vijay , Rawat Preeti , Walia Shweta , Kori Neetu 
Published: March 2022

Purpose:
To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization.

Methods:
A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher’s test.

Results:
A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial muscles

Conclusion:
FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.
Curious case of bilateral non-resolving vitritis - Unmasking the masquerade on ultra-widefield imaging
Authors: Delhiwala Kushal 
Published: March 2022

Background:
Recognizing vitreous haze (VH) patterns on ultra-widefield imaging (UWFI) in nonresolving vitritis can reduce delay in suspecting vitreoretinal lymphoma (VRL) and in performing an early vitreous biopsy for definitive diagnosis.

Purpose:
To demonstrate role of UWFI in providing a clue for suspecting VRL in case of bilateral nonresolving dense vitritis and demonstrate precautions for high yield of lymphoma cells on vitreous biopsy.

Synopsis:
A 52-year-old healthy phakic lady came with gradual, painless blurred vision OS>OD for 6 months.Treated elsewhere for OU vitritis with steroids (local and systemic), anti-tubercular therapy for 2 months, and azathioprine, she had no improvement. Presenting best-corrected visual acuty was counting fingers OD and hand movement OS. Anterior segment OU was quiet. Fundus showed OD 3+ and OS 4+ vireous haze (VH). UWFI showed “aurora borealis” pattern of VH (OS>OD) and “string of pearls” OD. Ultrasonography B-scan OU showed complete posterior vitreous detachment and attached retina. OU VRL was suspected. MRI brain and orbit with contrast was found to be normal. After stopping steroids for 2 weeks, OS underwent pars plana vitrectomy (PPV) and intravitreal (IV) methotrexate 400 mcg/0.1 ml + rituximab 1mg/0.1ml. Vitreous sample sent for cytology and immunohistochemistry showed diffuse large B-cell non-Hodgkins lymphoma with CD20 and MUM1-positive cells. OD underwent two IV rituximab injections at monthly interval initially followed by PPV with IV rituximab and methotrexate. The patient remained in remission during close follow-up. Recognizing VH patterns on UWFI can reduce the delay in the diagnosis of VRL and early initiation of treatment.

Highlights:
VH patterns in VRL depend on state of vitreous liquefaction and syneresis.Aurora borealis pattern on UWFI results from linear opacities with lymphoma cells uniformly aligned along formed vitreous fibrils.String of pearls pattern results from clumps of lymphoma cells and inflammatory material over the scaffold of vitreous fibrils.These patterns provide high index of suspicion for considering VRL as d iagnosis.IV rituximab has minimal side effects and has been effective in managing VRL with isolated ocular involvement.

Video Link:
https://youtu.be/uTplGPStmrM
Bleb revision with bleborhexis and clear corneal lamellar patch graft for overhanging cystic bleb
Authors: Maheshwari Devendra , Tara Techi Dodum , Madhavi R. , Pawar Neelam , Ramakrishnan R. 
Published: March 2022

Background:
Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft.

Purpose:
To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision.

Synopsis:
This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections.

Highlights:
Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs.

Video link:
https://youtu.be/GeFYHWToueU