Showing papers in "Seminars in Ophthalmology in 2022"
TL;DR: Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade, including translational breakthroughs in terms of newer drug formulations and regenerative medicine.
Abstract: ABSTRACT Background Aqueous deficiency dry eye disease is a chronic and potentially sight-threatening condition, that occurs due to the dysfunction of the lacrimal glands. The aim of this review was to describe the various recent developments in the understanding, diagnosis and treatment of lacrimal gland insufficiency in aqueous deficiency dry eye disease. Methods A MEDLINE database search using PubMed was performed using the keywords: “dry eye disease/syndrome”, “aqueous deficient/deficiency dry eye disease”, “lacrimal gland” and “Sjogren’s syndrome”. After scanning through 750 relevant abstracts, 73 eligible articles published in the English language from 2016 to 2021 were included in the review. Results Histopathological and ultrastructural studies have revealed new insights into the pathogenesis of cicatrising conjunctivitis-induced aqueous deficiency, where the lacrimal gland acini remain uninvolved and retain their secretory property, while significant ultrastructural changes in the gland have been observed. Recent advances in diagnosis include the techniques of direct clinical assessment of the lacrimal gland morphology and secretion, tear film osmolarity, tear film lysozyme and lactoferrin levels, tear film interferometry and lacrimal gland confocal microscopy. Developments in the treatment of aqueous deficiency dry eye disease, apart from the nanoparticle-based tear substitutes, include secretagogues like diquafosol tetrasodium and rebamipide, anti-inflammatory topical agents like nanomicellar form of cyclosporine and lifitegrast, scleral contact lenses, neurostimulation, and acupuncture for increasing the amount of tear production, minor salivary gland transplantation, faecal microbial transplantation, lacrimal gland regeneration and mesenchymal stem cell therapy. Conclusions Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade. Of which, translational breakthroughs in terms of newer drug formulations and regenerative medicine are most promising.
10 citations
TL;DR: The prevalence rate and progression of myopia among elementary school students in Shanxi Province increased significantly during the COVID-19 pandemic, which was likely related to China’s home-based online learning programs.
Abstract: ABSTRACT Purpose To investigate the prevalence of myopia and the risk factors associated with its progression in elementary school students during the COVID-19 pandemic in Shanxi Province, China. Methods The investigation included 960 students spanning first to sixth grade from six elementary schools in Shanxi Province, China. All participants received non-cycloplegic refraction and vision tests in December of 2019 (before the COVID-19 pandemic) and in June of 2020 (after classes resumed). Information concerning the students’ eye-use behaviors, physical activities, diet and sleep during the pandemic was collected using a questionnaire survey. A total of 913 students (457 males) completed all tests and the questionnaire. Results The overall prevalence rate of myopia was 16.6% in December of 2019, and it increased with age. There was no gender difference in the prevalence of myopia (χ2 = 3.210, P = .073), but females exhibited a lower average spherical equivalent (SE) (P = .026). When the classes were resumed 6 months later, the overall prevalence rate of myopia was found to be 39.4%, which was significantly higher than it before the pandemic (χ2 = 117.425, P < .001). The average SE of the participants was −0.95D, which was significantly lower than the average SE (−0.43D) before the pandemic (P < .001). SE variation (ΔSE) in grade 6 was significantly higher than that in grade 1. No significant difference in ΔSE was found between males and females. Analyses of ordinary least squares (OLS)-estimated linear, natural logarithmic and quadratic functions revealed that the progression of myopia during the COVID-19 pandemic was significantly correlated with screen time, types of electronic devices, the amount of sleep, age, and the number of parents with myopia. Conclusions The prevalence rate and progression of myopia among elementary school students in Shanxi Province increased significantly during the COVID-19 pandemic, which was likely related to China’s home-based online learning programs. Therefore, it is necessary to optimize the educational programs for elementary school students when they study at home. We recommend increased time for outdoor activities and limiting screen time.
7 citations
TL;DR: In this paper , the authors present a checklist for constructing a scientific manuscript, which is divided into five parts with a total of 90 items in a question format, including pre-requisites and response checklists.
Abstract: The motivational speaker and author Brian Tracy once said, ‘The checklist is one of the most high-powered productivity tools ever discovered’. This is true across several disciplines, and scientific manuscripts are not an exception. There are several checklists designed for scientific publications like journal-specific submission checklists, clinical trial checklists, and data reporting checklists. While these serve a specific purpose and are very useful, the author thought of having a simple checklist for constructing any scientific manuscript. At a detailed level, any checklist would vary based on clinical or basic science work and the type of article being submitted. The purpose of this checklist is to help beginners avoid missing primary information while writing a paper. This checklist is by no means exhaustive and not intended to cover all the detailed aspects of specific manuscripts. The checklist is divided into five parts with a total of 90 items in a question format. The questions are framed in a way that almost all would require ‘yes’ as an answer for the item to be satisfactorily closed and proceed further. Part I gathers the desirable pre-requisites before the beginning of the study. Part II encompasses all the processes and aspects of a manuscript. Part III itemizes the response checklist when the manuscript comes for a revision. Part IV consists of items to consider in case the authors receive a letter to the editor. Part V contains general items to check before manuscript submission.
5 citations
TL;DR: For predictability, LASIK was superior to SMILE, and there were comparably safety and efficacy for the correction of myopia and myopic astigmatism in SMIle and LASik.
Abstract: ABSTRACT Purposes The purpose of this meta-analysis is to systematically compare the safety, efficacy, and predictability of small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). Methods This study covered the data searched from the PubMed, the EMBASE and the Cochrane Library. The Cochrane Handbook was also referred to as evaluating the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. Results A total of 11 randomized controlled trails (RCTs) were included. The proportion of eyes with refraction within ±0.5D was higher in LASIK group compared with SMILE group (RR, 0.91; 95% CI, 0.83 to 0.99; p = .04). The spherical aberration (SA) was smaller in SMILE group compared with LASIK group (RR, −0.12; 95% CI, −0.23 to −0.01; p = .04). There were no significant differences between two groups with regard to final mean refractive spherical equivalent (SE) (MD, −0.04; 95% CI, −0.12 to 0.03; p = .22), proportion of eyes losing one or more lines of corrected distance visual acuity (CDVA) (RR, 1.14; 95% CI, 0.58 to 2.27; p = .70), proportion of eyes with uncorrected distance visual acuity (UCVA) of 20/20 or better (RR, 0.99; 95% CI, 0.94 to 1.05; p = .71), postoperative mean logMAR UCVA (MD, 0.01; 95% CI, −0.00 to 0.03; p = .13), postoperative refraction within ±1.0D (RR, 1.00; 95% CI, 0.98 to 1.02; p = .60), postoperative astigmatism within ±0.25, 0.5 and 1.0D (RR, 0.80, 0.99, 1.00; 95% CI, 0.35 to 1.83, 0.94 to 1.05, 0.98 to 1.02; p = .60, 0.86, 0.87), postoperative higher order aberrations (HOAs) (RR, 0.00; 95% CI, −0.16 to 0.16; p = .99). Conclusion For predictability, LASIK was superior to SMILE. There were comparably safety and efficacy for the correction of myopia and myopic astigmatism in SMILE and LASIK. SA was smaller after SMILE than after LASIK.
5 citations
TL;DR: Recreational users of poppers who develop maculopathy generally present with vision loss or a visual disturbance secondary to foveal disruption, with patients have a good visual prognosis, with cessation of popper use potentially having a role in improved outcomes.
Abstract: ABSTRACT Objective The aim of this systematic review and meta-analysis was to provide an overview of reported cases of poppers maculopathy and a statistical analysis of the clinical presentations, anatomical changes and treatment and follow-up of the rare disease. Methods A systematic search of CINAHL, Embase and PubMed databases was conducted, including a search of the grey literature. Data were pooled to provide a summary of the clinical characteristics and outcomes of poppers maculopathy. Studies were critically appraised using the Joanna Briggs Institute or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklists. Results Of the 493 articles obtained, 32 were included, consisting of 113 participants with a mean age of 40.2. Most patients were male with bilateral maculopathy and presented with either vision loss or a visual disturbance. Cessation of popper use was the most common form of management prescribed. The mean VA at baseline was 0.22 (logMAR units). For those followed-up, the mean VA significantly improved from 0.24 to 0.11 (Z = −5.800, p = <0.001). Bilateral yellow foveal spots were viewed on fundoscopy in 53 patients, and a sub-foveal disturbance of the ellipsoid layer was reported on spectral domain optical coherence tomography in 89 patients. By 6 months, SD-OCT anatomical changes mostly improved or resolved. Conclusion Recreational users of poppers who develop maculopathy generally present with vision loss or a visual disturbance secondary to foveal disruption. Patients have a good visual prognosis, with cessation of poppers potentially having a role in improved outcomes. With the high prevalence of use among gay and bisexual men, awareness of related maculopathy and presenting symptoms by clinicians is important to mitigate side effects.
4 citations
TL;DR: The peak of influential LASIK research occurred between 2000-2010, likely due to topics such as postprocedural corneal ectasia and the femtosecond laser approach.
Abstract: ABSTRACT Purpose To conduct a bibliometric analysis of the 100 most cited publications on LASIK using the Scientific Information (ISI) Web of Knowledge database. Methods This analysis used keyword-specific searches within the Web of Science database to isolate the 100 most frequently cited LASIK articles published between 1996 and 2019 (T100). Number of citations per article and per year were quantified from 1996 to 2019. Title, authors (as well as affiliated institutions and countries of origin), journal, year of publication, and citation frequency were variables analyzed. Results Of the T100 articles, each article was cited between 103 to 411 times with a mean of 167 citations. Between 0-11 articles in the T100 were published every year on average with a median of 5 publications per year. The highest concentration of T100 publications occurred between 2003 and 2008 at 51%. A decrease in the annual publication rate of influential articles was observed after 2010 at 23%; 39.1% of these articles compared LASIK to newer refractive surgical approaches. The highest number of T100 articles were from the Journal of Refractive Surgery. The University of California System produced the highest number of T100 articles. The author with the most articles in the T100 is Dan Z. Reinstein. Most T100 articles originated from the United States. Conclusion The peak of influential LASIK research occurred between 2000-2010, likely due to topics such as postprocedural corneal ectasia and the femtosecond laser approach. While newer surgical techniques such as SMILE may have contributed to the decline in the annual rate of LASIK-related publication, the underlying cause for this decline is unclear.
4 citations
TL;DR: Harvesting aqueous humor from eyes with retinoblastoma has been found safe and superior to blood for the detection of chromosomal changes and ctDNA in plasma also has potential to help in diagnosis and prognosis of RB.
Abstract: ABSTRACT Purpose Retinoblastoma (RB) is the most common intraocular malignancy in children. The diagnosis of RB is mainly based on clinical features and imaging characteristics. Prognosis is based on stage of disease and response to treatment. In salvaged globes, direct tumor biopsy for genetic analysis and prognostication is an absolute contraindication at this point of time for the fear of extraocular tumor spread. Currently, there is a search for surrogate markers to allow accurate diagnosis and for prognostication, to predict the chances of globe salvage in RB. Therefore, biofluids such as plasma or aqueous humor have been studied to detect circulating tumor DNA (ctDNA) or cell-free DNA (cfDNA), respectively, to allow for treatment decision making, monitoring treatment response, and prognostic counselling. Methods A search of electronic databases (PubMed, Google Scholar and MEDLINE) of all articles on liquid biopsy in retinoblastoma published in English was performed. The keywords used for the search included “retinoblastoma”, “liquid biopsy”, “aqueous humor” “circulating tumor cells”, “cell-free DNA”, “cfDNA”, “circulating tumor DNA”, “ctDNA”, “tumor fraction”, “RB1 mutation” and “SNCA”. Additionally, historic articles on the advent of liquid biopsy in medicine were also reviewed. Pertinent cross-references from the studies were reviewed. Retrospective interventional and observational case series, observational case series, prospective cohort studies, reviews, case reports, surgical techniques, invited commentary and letters were included. Results A total of 40 relevant articles were selected. Biomarkers in aqueous humor, serum and cerebrospinal fluid and their clinical applications are discussed. Conclusion Harvesting aqueous humor from eyes with retinoblastoma has been found safe and superior to blood for the detection of chromosomal changes. cfDNA from aqueous can be a surrogate marker to detect somatic copy number alterations and other genetic alterations in RB. ctDNA in plasma also has potential to help in diagnosis and prognosis of RB. Liquid biopsy in RB is an emerging topic, which could pave way for a better understanding of mechanisms for treatment response, resistance and recurrence in RB as well as possibly provide specific therapeutic targets to improve globe salvage.
4 citations
TL;DR: Therapeutic PPV is effective in controlling vitreous inflammation, improving visual outcomes and reducing the need for immunosuppressive medications in a wide range of infectious and non-infectious uveitis.
Abstract: ABSTRACT Purpose Pars plana vitrectomy (PPV) has been traditionally used for diagnostic tapping or for management of posterior segment complications, in uveitis. The anti-inflammatory potential of therapeutic PPV, independent of its role in managing uveitis complications, is yet to be realised completely. In this narrative review, we have described the indications, surgical technique, and outcomes of therapeutic PPV in the management of uveitis. Methods Literature review of PubMed database for articles relating directly or indirectly, to the anti-inflammatory effect of therapeutic PPV in the management of uveitis. Of the 876 articles retrieved on initial review, only 37 articles were found to be relevant for the purpose of this review. Results Therapeutic PPV is effective in controlling vitreous inflammation, improving visual outcomes and reducing the need for immunosuppressive medications in a wide range of infectious and non-infectious uveitis. Careful patient selection and meticulous surgical handling are mandatory. Post-operative complications include cataract progression, raised intraocular pressure, hypotony, retinal breaks, and worsening of cystoid macular edema. Despite being introduced more than 40 years ago, most data on therapeutic PPV remain retrospective. The possibility of therapeutic PPV replacing conventional medical therapy remains unknown. Conclusions Therapeutic PPV can control intraocular inflammation, independent of its role in managing posterior segment complications of uveitis. However, its exact place in the anti-inflammatory armamentarium against uveitis remains uncertain.
3 citations
TL;DR: Changes in contrast sensitivity suggest that there is damage to the retina prior to the vascular ones and that they could be detected by this test.
Abstract: ABSTRACT Introduction The purpose of this systematic review was to study whether contrast sensitivity assessment in people with diabetes could be a reliable test in early detection of diabetic retinopathy. A systematic search based on population, intervention, comparison, and outcome strategy was performed. Methods PubMed, Scopus, and Web of Science were searched for English articles of human patients with type 1 and type 2 diabetes and contrast sensitivity measurements as domain studied. Results Twentyone comparative cross-sectional studies were included. All of them showed significant loss of contrast sensitivity in people with diabetes and diabetic retinopathy regarding control patients of the same age, regardless of the method used. However, those without diabetic retinopathy, involve a loss of contrast sensitivity, although not always significant. Conclusion Changes in contrast sensitivity suggest that there is damage to the retina prior to the vascular ones and that they could be detected by this test.
3 citations
TL;DR: Taking multivitamin supplementation may not prevent the development of late AMD, and the nutrient of zinc and carotenoids (lutein/zeaxanthin) supplementation were associated with better improvement in VA.
Abstract: ABSTRACT Aim Age-related macular degeneration (AMD) has become a predominant global health concern. The visual function of individuals with AMD seems to improve with dietary antioxidants. We assessed the efficacy of different antioxidants (carotenoids, zinc, vitamin E, and multivitamin) on visual function and the incidence of developing late AMD. Methods We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for related published studies. We considered randomized controlled trials (RCTs) comparing different nutrients. The main outcomes measurements included changes in visual acuity (VA), and the rate of developing late AMD. The network meta-analysis was registered on PROSPERO (CRD42020171288). Results We identified 13 studies, including 85321 individuals randomly assigned to different nutrients or placebo groups. In the network meta-analysis, we found that there was more risk of progression to late AMD in the multivitamin group than carotenoids and vitamin E groups (RR 0.45, 95% CI 0.32 to 0.65; RR 0.56, 95% CI 0.40 to 0.79; RR 0.42, 95% CI 0.26 to 0.67). The nutrients of zinc and carotenoids (Lutein/Zeaxanthin) ranked first and second and showed better improvement in VA. The efficacy of carotenoids (β-carotene) ranked first for delaying the progress of AMD among all of the four treatments. Conclusion Taking multivitamin supplementation may not prevent the development of late AMD. The nutrient of zinc and carotenoids (lutein/zeaxanthin) supplementation were associated with better improvement in VA. Carotenoids (β-carotene) were the most likely to prevent the progression of late AMD.
3 citations
TL;DR: Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.
Abstract: ABSTRACT Aim The current study was designed to provide detailed information on the prevalence of ocular abnormalities in patients with cerebral palsy (CP). Methods Four international online scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar were systemically searched. First, the titles of the articles were evaluated, and if relevant, their abstracts and full texts were reviewed. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results A total of 147 articles were found in the initial search. After applying the exclusion criteria, 65 articles were chosen for further review, from which 17 articles, comprising a total of 1734 patients with CP ranging in age from birth to 22 years, passed the STROBE quality check and were included in this review. The prevalence of ocular abnormalities in the CP patients reported in the evaluated studies ranged between 34% to 100%, with refractive error, strabismus, and nystagmus exhibiting the greatest overall prevalence at 52%, 48%, and 11%, respectively in this population. Conclusion Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.
TL;DR: The algorithmic approach proposed will help the general ophthalmologists in routine practice to provide quality care and acceptable visual outcomes in patients with pre-existing DED and recommendations for performing biometry.
Abstract: ABSTRACT Purpose To understand the impact of dry eye disease (DED) on the components of ocular biometry and ways to optimize the visual outcomes of cataract surgery in eyes with DED. Methodology A thorough literature review of the components pertaining to this review was undertaken using the databases, PubMed (from the year 2000), MEDLINE, CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) (www.controlled-trials. com), ClinicalTrials.gov (www.clinicaltrial.gov) and WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). The keywords used for the search included “cataract surgery” or “phacoemulsification” combined with “dry eye”, “dry eye disease”,”biometry”, “keratometry”. Results Publications considered for this review included meta-analysis, systematic reviews, case–control and cohort studies, case series, and laboratory-based studies. Published articles reporting tear film alteration in DED, its impact on the quality of vision and optical aberrations, the effect of topical medications on keratometry variations, and reports on optimizing the ocular surface before cataract surgery were included. Conclusions DED is a common entity seen in patients presenting to routine cataract clinics and is known to impact the accuracy, reliability, and repeatability of ocular biometry and IOL power calculations in them. This review intends to emphasize the preoperative screening for the presence of DED, initiation of appropriate medical management for optimization of the ocular surface before cataract surgery, and recommendations for performing biometry. The algorithmic approach proposed will help the general ophthalmologists in routine practice to provide quality care and acceptable visual outcomes in patients with pre-existing DED.
TL;DR: The UBM is still preferred over the ASOCT for imaging of the ciliary body although a lot of lacunae of knowledge still exists and consensus has to be reached on defining all the parameters universally.
Abstract: ABSTRACT Purpose We conducted a systematic search of literature to understand the various methods of imaging of the ciliary body. Methods PubMed, Science Direct, Cochrane Library and Google Scholar were searched comprehensively and systematically to find studies related to the various modalities of ciliary body imaging. Results The various ciliary body parameters that have been described are Ciliary body thickness, Ciliary body length, ciliary muscle thickness, ciliary process length, ciliary muscle length, ciliary muscle anterior length, trabecular ciliary process distance and Iris ciliary process distance. The various angles which have been measured, which mostly have a significance in Primary angle closure glaucoma (PACG) are Iris ciliary angle, Trabecular ciliary angle, scleral ciliary process angle. Various authors have defined them in various ways with subtle differences. Plateau iris and PACG mechanisms, not forgetting malignant glaucoma are better understood with imaging of the ciliary body using the ultrasound biomicroscopy (UBM). The anterior segment optical coherence tomography (ASOCT) imaging of the ciliary body has been described albeit with its own disadvantages. A few other fields dependant on the importance of ciliary body imaging are intravitreal injections, pars plana vitrectomy, measurements for implantable collamer lens (ICL) and of utmost importance, the differentiating features of ciliary body masses. Conclusion The UBM is still preferred over the ASOCT for imaging of the ciliary body. A lot of lacunae of knowledge still exists and consensus has to be reached on defining all the parameters universally. Future studies will be able to shed more light on the role of the ciliary body in the many ocular disorders mentioned in this review.
TL;DR: Corneal disease and iatrogeny are useful models to understand the impact of optical degradation on retinal image quality and visual performance and will greatly benefit from equalizing retinal images quality of both eyes of these patients.
Abstract: ABSTRACT Purpose Optical imperfections of the eye, characterized by higher-order wavefront aberrations, are exaggerated in corneal disease (e.g., keratoconus) and iatrogeny (e.g., keratorefractive surgery for myopia correction, keratoplasty for optical clarity restoration). This article reviews the recent advances on this topic for a comprehensive understanding of how optical degradations in disease models impact retinal image quality and monocular and binocular visual performance. Methods Published literature over the last decade on retinal image quality and/or monocular and binocular visual functions with corneal irregularity was reviewed based on their relevance to the current topic, study population and strength of study design. The literature was summarized into four themes: 1) wavefront errors and retinal image quality of highly aberrated eyes, 2) monocular and binocular vision loss consequent to degraded optics and visual strategies to optimize performance, 3) impact of optical correction modalities on visual performance and 4) implications for clinical management of patients. Results Across the 46 articles reviewed, the results clearly indicated that an increase in higher-order aberrations across these conditions had a significant negative impact on the patient’s retinal image quality, and monocular and binocular visual functions. Interocular differences in retinal image quality deteriorated visual performance more than an overall worsening of image quality bilaterally. Minimizing optical degradation using rigid contact lenses and adaptive optics technology significantly improves retinal image quality and monocular and binocular vision, but performance remains sub-optimal relative to age-similar healthy controls. Conclusion Corneal disease and iatrogeny are useful models to understand the impact of optical degradation on retinal image quality and visual performance. Clinical management will greatly benefit from equalizing retinal image quality of both eyes of these patients. Future studies that deepen our understanding of the structure–function relation in these conditions are desirable for advancing vision science in this area and for developing novel clinical management strategies.
TL;DR: This meta-analysis systematically compares the IOP-lowering effect of different microstents combined with phacoemulsification versus phacoEMulsification for patients with OAG and cataract to result in a significant reduction in IOP.
Abstract: ABSTRACT Purposes The purpose of this meta-analysis is to systematically compare the IOP-lowering effect of different microstents combined with phacoemulsification versus phacoemulsification for patients with OAG and cataract. Methods This work was done through the data searched from PubMed, EMBASE, and the Cochrane Library. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. Results A total of 8 randomized controlled trials (RCTs) were included. Compared with phacoemulsification alone, microstent implantation with phacoemulsification resulted in significant reduction in the postoperative IOP (MD = −1.66, 95%CI: [−2.25 to −1.06]). Patients with medication free and patients with beyond 20% IOP reduction were significantly increased in the microstent implantation with phacoemulsification group compared with phacoemulsification alone group (RR = 1.54, 95%CI: [1.34 to 1.77]; RR = 1.34, 95%CI: [1.24 to 1.45]). Conclusion Both microstent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant reduction in IOP. In terms of both reductions, microstent implantation with phacoemulsification significantly outperforms phacoemulsification alone.
TL;DR: This review has summarised evidence published till December 2021 related to evaluation of structural and functional changes in the retina and optic nerve in eyes with EON.
Abstract: ABSTRACT BACKGROUD Ethambutol hydrochloride (EMB) is used in the treatment of tuberculosis and is used as first line modality in combination with other medications. Ethambutol optic neuropathy (EON) is a rare but well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections and may be potentially devastating with reversible to irreversible changes in visual acuity. KEY FINDINGS Optical coherence tomography has been used to evaluate the thickness of retinal nerve fibre and ganglion cell layers to look for degenerative changes and early markers. Electrophysiological tests like multifocal electroretinogram, visual evoked potentials and visual fields have been used to understand the functional changes associated with established EON and also whether these can be used to detect subclinical EON and correlate them with the structural changes. In this review, we have summarised evidence published till December 2021 related to evaluation of structural and functional changes in the retina and optic nerve in eyes with EON.
TL;DR: Even in larger preterm infants and without severe retinopathy and anti-VEGF treatment, PAR and peripheral pigmentary changes may be detected, and mild angiographic vascular activity may continue, which may lead to late-onset retinal pathologies that may threaten vision.
Abstract: ABSTRACT Purpose To evaluate the fluorescein angiography (FA) findings in eyes with spontaneously regressed retinopathy of prematurity (ROP). Methods Fluorescein angiography images of 162 eyes of 81 treatment-naive infants who underwent FA due to retinal vascular immaturity and persistent avascular retina (PAR) despite exceeding postmenstrual age of 60 weeks were analyzed retrospectively. Disc diameter (DD), optic disc-to-fovea distance (FD), the length of temporal retinal vascularization (LTRV), and the length of measurable temporal avascular retina distance (LMTAR), were quantitatively measured. Results The mean gestational age and FA imaging age were 29.39 ± 3.13 and 86.51 ± 24.80 weeks postmenstrual, respectively. The mean ratios of LTRV/FD and LMTAR /DD were 4.47 ± 0.36 and 2.21 ± 1.01, respectively. Pigmentary changes were detected in the peripheral retina in 21% of the eyes. There was at least one angiographic finding in 88% of the eyes, but these findings were usually mild. Based on the FA findings, laser photocoagulation was performed to the peripheral avascular retina in ten eyes of five patients Conclusion Even in larger preterm infants and without severe retinopathy and anti-VEGF treatment, PAR and peripheral pigmentary changes may be detected, and mild angiographic vascular activity may continue. These findings may lead to late-onset retinal pathologies that may threaten vision. In eyes with PAR, follow-up with FA and prophylactic laser application may be applicable. Further investigation is required for this topic.
TL;DR: The modified technique of compression sutures facilitate rapid recovery of corneal edema in acute hydrops seen in keratoconus and pellucid marginal cornean degeneration.
Abstract: ABSTRACT Purpose To report rapid resolution of corneal clearing with the application of a modified technique of compression sutures in large hydrops. Methods Interventional case series of seven patients. Results Three patients had acute hydrops secondary to keratoconus, three had pellucid marginal corneal degeneration and another one had ectasia of undetermined etiology. A thorough slit-lamp evaluation and anterior segment optical coherence tomography was performed. The surgical technique involved paracentesis, anterior chamber decompression, compression suture placement within the stroma against the background of partial air fill in the anterior chamber, and bandage contact lens application. All eyes showed a remarkable reduction in corneal edema at 1 h (documented in four eyes) and 1 day (documented on the rest), which continued to improve in further follow up. Conclusions The modified technique of compression sutures facilitate rapid recovery of corneal edema in acute hydrops seen in keratoconus and pellucid marginal corneal degeneration. The physiologic basis is akin to the external tamponade achieved with buckle in retinal detachment surgeries.
TL;DR: In this paper , an overview of different AI-based applications in ophthalmology and a discussion on future challenges is presented. But, implementation of AI in clinical routine is not widely spread due to availability, heterogeneity in imaging techniques and AI methods.
Abstract: ABSTRACT Artificial intelligence (AI) is an emerging technology in healthcare and holds the potential to disrupt many arms in medical care. In particular, disciplines using medical imaging modalities, including e.g. radiology but ophthalmology as well, are already confronted with a wide variety of AI implications. In ophthalmologic research, AI has demonstrated promising results limited to specific diseases and imaging tools, respectively. Yet, implementation of AI in clinical routine is not widely spread due to availability, heterogeneity in imaging techniques and AI methods. In order to describe the status quo, this narrational review provides a brief introduction to AI (“what the ophthalmologist needs to know”), followed by an overview of different AI-based applications in ophthalmology and a discussion on future challenges. Abbreviations: Age-related macular degeneration, AMD; Artificial intelligence, AI; Anterior segment OCT, AS-OCT; Coronary artery calcium score, CACS; Convolutional neural network, CNN; Deep convolutional neural network, DCNN; Diabetic retinopathy, DR; Machine learning, ML; Optical coherence tomography, OCT; Retinopathy of prematurity, ROP; Support vector machine, SVM; Thyroid-associated ophthalmopathy, TAO
TL;DR: A literature review was performed by searching the PubMed and Cochrane databases from 2016 to 2021, identified 483 articles, of which 51 were included in the review as mentioned in this paper , and identified 15 new IOL formulas (including updates on older formulas) of which, only 8 newer formulas (BUII, Hill-RBF 2.0, Kane, Pearl DGS, LSF AI, Naesar 2, EVO2.0 and VRF) met the eligibility criteria.
Abstract: ABSTRACT Background The precision of refractive outcomes after uneventful cataract surgery largely depends on the biometry and intraocular lens (IOL) formula used for selecting the IOL. To improve the accuracy of post-op refractive outcomes, several new IOL power calculation formulae have come up. This review would aim to summarise the differences among the new formulae in their performance among normal and variable ocular biometry conditions like short and long axial lengths. Methods A literature review was performed by searching the PubMed and Cochrane databases from 2016 to 2021, identified 483 articles, of which 51 were included in the review. Results We identified 15 new IOL formulas (including updates on older formulas) of which, only 8 newer formulas (BUII, Hill-RBF 2.0, Kane, Pearl DGS, LSF AI, Naesar 2, EVO 2.0 and VRF) met the eligibility criteria. They were compared according to the reported median absolute error, mean absolute error and percentage of eyes within 0.5D. Conclusion The Kane formula and Barrett Universal-II formula performed better than other formulas over the entire axial length (AL) spectrum. In the long eye (AL > 26.0 mm) sub-group, the Kane formula was the most accurate, while in the short eye (AL < 22.0 mm) sub-group, both Kane and EVO 2.0 formulas fared better than other formulas.
TL;DR: The results suggest success even in refractory cases and with less inflammation than more traditional surgeries.
Abstract: ABSTRACT Minimally invasive glaucoma surgeries (MIGS) and non-penetrating glaucoma procedures have changed the surgical management of glaucoma in recent years and are being explored in the management of uveitic glaucoma. Deep sclerectomy, Xen45 gel stent, gonioscopy-assisted transluminal trabeculotomy (GATT), trabectome, and canaloplasty are described in the literature as alternative surgeries that may work for uveitic glaucoma. While most of the published studies are retrospective case series, the results suggest success even in refractory cases and with less inflammation than more traditional surgeries.
TL;DR: In this article , a large survey of 3859 authors who submitted their works to BMJ journals from 2014 to 2018, 34% (n = 1305) reported being involved in a study where someone had significantly contributed but was not listed as an author.
Abstract: Inappropriate authorship constitutes a grave threat to the integrity of science. The culture of ‘publish or perish’ has fuelled the rise of inappropriate authorships across the scientific disciplines. One such type is the ‘ghost authorship’, which can simply be defined as non-listing or omission of the contributing authors. These authors fulfill the ICMJE criteria for authorship but have not been listed on the authorship. Why is there a ‘ghost authorship’ in scientific papers? The most common reason is a significant contributor (mostly a subordinate or a junior researcher) being denied authorship by the senior or the team leader. The presence of only a few authors helps boost the contribution weightage of each and enhances the fractional counts of scholarly productivity. The other prevalent reason is to hide potential conflicts of interest. For example, a company may hire ghost writers to construct manuscripts either on behalf of the researchers or in collaboration with them. Such studies typically promote or potentially promote the products manufactured by the said company. Subsequently, the absence of ghost-writers from the authorship list would preclude the readership from interpreting the study in the proper context simply because they are unaware of the financial and other conflicts of interest. Occasionally, researchers decline authorships themselves because of their perception that the study findings could be wrong or dubious and may have detrimental effects on their future careers. How prevalent is the ‘ghost authorship’? In a large survey of 3859 authors who submitted their works to BMJ journals from 2014 to 2018, 34% (n = 1305) reported being involved in a study where someone had significantly contributed but was not listed as an author. A cross-sectional survey among select ophthalmology journals reported that 16.3% (37/227) of the corresponding authors indicated presence of a ghost authorship. Similarly, a high prevalence of ghost authorship was found across the disciplines of social sciences. The geographical variations can be influenced by several factors, including the level of awareness of ICMJE criteria. For example, 50% of participants from a middle eastern study were unaware of guest or ghost authorships. The prevalence of ghost authorships is likely to be influenced by the institutional mandate and encouragement to adhere to ICMJE policies, cultural norms, and settings with power imbalances, unhealthy competition, and discrimination. Why is it important to know about ‘ghost authorship’? Recognizing individual contributions in team science is crucial for the individuals and the team leaders. It is also the right of the readership to have desired information in the form of contributorship statements. The presence of ghost authors has an enormous potential to distort individual credits, publication counts, citation counts, and several academic productivity metrics linked to them. Hence, it influences the very fundamental basis of academic reward systems. Besides, the presence of ghost authors would promote mistrust between researchers (which can be detrimental to the overall progress of science) and public distrust of scientific research. The World Association of Medical Editors (WAME) articulates the threat of ghost authorship as ‘to persuade readers in favour of a special interest’. Concealing an author’s name could also help conceal his or her misconduct (for example – data fabrication) and can potentially have a detrimental effect on the patient care in clinical studies. How can we address this menace of ‘ghost authorship’? The problem must be addressed at individual, institutional and journal levels. Awareness of the ICMJE criteria for authorship and its nuances must be taught early in medical schools. In a large survey conducted in Europe, several beneficial aspects were observed when the institutions explicitly encouraged the adherence to appropriate authorship guidelines. The authorship eligibilities and the order were discussed more frequently in the early stages of the project. The final authorship was commonly perceived as fair, and the ghost authorship was less prevalent. A high level of awareness along with institutional policies to ensure appropriate authorship would prove instrumental in curbing the menace of ghost authorships. Most journals have now introduced the concept of contributorship statements, where each author would have to declare all aspects of their contribution individually. For example, study design, methodology, data collection, data analysis, manuscript drafting, critical manuscript review, result validation and project administration. This would help the readership assess who has contributed what and can vigorously promote authors’ accountability. While obtaining the contributorship statements would not eliminate the ghost authorship, it would make it very hard to pursue or justify such behaviours. The role of the journals in dealing with ghost authorship is mostly misunderstood. The journals have a limited role when it comes to arbitrating authorship disputes or policing the authors’ research integrity. The ultimate responsibility for adhering to appropriate authorship lies with the authors and their institutions. It is easier to deal with ethical transgressions early on at the institutional level than after their submission to the journal. Unlike Albert Einstein, who single-handedly penned down his paper on the ‘Theory of Relativity’, the researchers of today are mostly part of big teams. A publication is one of the most awaited rewards a young researcher hopes for after putting in many efforts. The scientific community should make every effort to ensure this hope is not crushed by forcing ghost authorships. SEMINARS IN OPHTHALMOLOGY 2022, VOL. 37, NOS. 7–8, 793–794 https://doi.org/10.1080/08820538.2022.2112852
TL;DR: This study proved that canaloplasty is an efficient and safe procedure in OAG eyes and reduction in IOP values and in the number of glaucoma medications after the intervention.
Abstract: ABSTRACT Purpose Open-angle glaucoma (OAG), accounting for 90% of all glaucoma cases, is a progressive optic nerve neuropathy. It may lead to irreversible loss of visual field and complete blindness. When conservative treatment becomes insufficient to stop OAG progression, a surgical intervention is considered. Currently, canaloplasty procedure is being introduced instead of conventional trabeculectomy for invasive OAG treatment. The aim of the study is to asses safety and efficacy of canaloplasty. Methods This prospective study included 67 eyes that received 360° canaloplasty with placement of a tensioning suture. Primary OAG (n = 35), secondary OAG in pseudoexfoliative syndrome (n = 13), and pigmentary glaucoma (n = 19) patients were included. Control check-ups were conducted pre-operatively and in a 18-month follow-up time. Study endpoints involved reduction in IOP values and in the number of glaucoma medications after the intervention. Results The intervention led to a significant 38% reduction in IOP value from the preoperative baseline to 18 months after the intervention. The number of medications decreased significantly by 89%. At 18 months postoperative, 79% eyes did not require any glaucoma medications. The incidence of complications after canaloplasty was low, and none of the adverse effects were vision threatening. A surgically-induced astigmatism was the most frequent complication. Pigmentary glaucoma patients were the most beneficial subgroup, with 50% reduction in IOP, the highest success rate, and 98% reduction in the number of medications used. Conclusion This study proved that canaloplasty is an efficient and safe procedure in OAG eyes.
TL;DR: Delays in in-person clinical evaluation and alleged failure to inform patients of possible irreversible vision loss may lead to potential malpractice litigation among ophthalmologists.
Abstract: ABSTRACT Purpose To determine the allegation, precipitating medical issue, and outcome of telephone triage focused malpractice litigation among ophthalmologists. Methods The WestLaw Edge database was reviewed using terms pertaining to ophthalmology and telemedicine. The search ranged from 4/7/30 to 1/25/22. Results Of the 510 lawsuits, 3.5% (18/510) met inclusion criteria. 94.5% (17/18) alleged delays in evaluation and/or treatment. 61.1% (11/18) alleged incorrect diagnoses, 38.9% (7/18) claimed improper discussion of risks or informed consent, and 5.6% (1/18) alleged delayed referrals. The precipitating medical issues included retinal detachment in 33.3% (6/18) of cases, post-procedure and post-trauma endophthalmitis in 33.3% (6/18) of cases, ocular trauma without endophthalmitis in 22.2% (4/18) of cases, and bilateral acute retinal necrosis and allergic reactions each accounting for 5.6% (1/18) of cases. Conclusion Telephone triage creates potential malpractice litigation. Delay in in-person clinical evaluation and alleged failure to inform patients of possible irreversible vision loss may lead to potential malpractice litigation. We suggest offering the option of same day in person evaluation and informing the patient how delay may lead to irreversible vision loss.
TL;DR: In this paper , the authors conducted a literature search of PubMed, MEDLINE, and Google Scholar databases and identified 155 relevant studies from 41 countries published between 1987 and 2021, and evaluated the indications for corneal transplant and rates of transplant survival around the world by geographic region.
Abstract: ABSTRACT Corneal transplantation, or penetrating keratoplasty (PK), is the most common form of solid-organ transplantation performed worldwide. Here, we evaluated the indications for PK and rates of transplant survival around the world by geographic region. We conducted a literature search of PubMed, MEDLINE, and Google Scholar databases and identified 155 relevant studies from 41 countries published between 1987 and 2021. The most common indications for PK were keratoconus in Europe, Africa, the Middle East, Australia, New Zealand, and Central and South America, bullous keratopathy in North America, and corneal scarring in Asia. The overall global mean graft survival rates at 1-, 2-, 3-, 5-, and 10-years were 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, respectively. Through this systematic analysis of PK by region, we hope to bring a new perspective to the corneal transplantation literature and to potentially highlight global differences and unmet needs in patient care.
TL;DR: An updated, critical summary of the literature on the topic of persistent subretinal fluid following successful rhegmatogenous retinal detachment surgery is provided to help elucidate incidence rate, etiological factors, and sequelae of PSF, as well as the value of different interventions in its prevention and management.
Abstract: ABSTRACT Purpose To provide an updated, critical summary of the literature on the topic of persistent subretinal fluid (PSF) following successful rhegmatogenous retinal detachment surgery. Methods Narrative literature review. Results PSF remains an insufficiently studied topic. Incidence rates vary significantly between reports, but pars plana vitrectomy seems associated with lower rates than buckle surgery. Multiple etiologies and risk factors have been proposed, none being conclusive. PSF gradually resolves in most cases which may be a lengthy process, often with no effect on potential final visual acuity. There is concern that some cases with PSF may sustain photoreceptor damage, retinal displacement, or retinal fold formation. There is no current evidence to support any treatment modality over observation in uncomplicated cases of PSF. Conclusion Future large, well-controlled, prospective trials could help elucidate incidence rate, etiological factors, and sequelae of PSF, as well as the value of different interventions in its prevention and management.
TL;DR: Topical antiglaucoma medications (with their preservatives) can induce severe ocular surface and periorbital changes and early identification and withdrawal of the offending drug/preservative can help to reverse the changes except in eyes with extensive cicatrization.
Abstract: ABSTRACT Purpose Assessment of ocular surface in patients using anti-glaucoma medications (AGM) is rarely a priority for clinicians since glaucoma management targets intraocular pressure and preserves vision. This review summarizes the various adverse effects of topical AGM on the ocular surface and highlights the importance of ocular surface assessment in these patients. Methods A literature search of articles (English only) on the subject matter was conducted focusing on recent articles published in the past 5 years. Results The use of multiple anti-glaucoma medications in glaucoma patients increases patients’ exposure to the drug and the preservatives present in these medications. Long-term use of these medications has deleterious effects on the conjunctiva, cornea, eyelids, and periocular tissues like trichiasis, entropion, symblepharon, forniceal shortening, punctate keratopathy, non-healing epithelial defects, and pannus. Treatment requires drug withdrawal or substitution by oral or topical non-preserved and less toxic preparations of AGMs. The ocular surface and symptoms can improve if the condition is diagnosed early and after drug withdrawal in over 90% of eyes. However, stopping or changing AGMs can often present with its own unique set of challenges in intra-ocular pressure control which may often need glaucoma surgery in close to 20% of eyes for IOP control. Conclusion Topical antiglaucoma medications (with their preservatives) can induce severe ocular surface and periorbital changes. Early identification and withdrawal of the offending drug/preservative can help to reverse the changes except in eyes with extensive cicatrization.
TL;DR: Findings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from CO VID-19 infection, but medical practitioners should remain mindful of potential ophthalmic complications, given the greater likelihood of occurrence with increasing vaccination booster rates.
Abstract: ABSTRACT Introduction A 43-year-old Caucasian male presented to our ophthalmology clinic with blurry vision and metamorphopsia in his right eye, 24 hours after receiving the first dose of the Pfizer–BioNTech COVID-19 vaccine. Methods Clinical examination and imaging tests were consistent with acute unilateral central serous chorioretinopathy (CSCR) that completely resolved after 2 months without any treatment. He had no significant ophthalmic or medical history. He also lacked the classical risk factors for CSCR such as recent psychosocial stressors, Type-A personality traits, history of exogenous steroid use, connective tissue disorders and obstructive sleep apnea. Results This appears to be only the second reported case of CSCR, temporally associated with a recombinant COVID-19 mRNA vaccine. We also present a summary of published reports demonstrating intraocular complications associated with the novel recombinant COVID-19 mRNA vaccines. Conclusion Findings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from COVID-19 infection. Medical practitioners, however, should remain mindful of potential ocular complications, given the greater likelihood of occurrence with increasing vaccination booster rates.
TL;DR: A practical review of all aspects of Continuous curvilinear capsulorhexis, which has become the gold standard technique for anterior capsulotomy, a cardinal development in modern cataract surgery, is provided.
Abstract: ABSTRACT Background Continuous curvilinear capsulorhexis (CCC) has become the gold standard technique for anterior capsulotomy, a cardinal development in modern cataract surgery. CCC enables safer and relatively convenient access to the crystalline lens, however it is more challenging to master than older methods. Understanding the physics underlying this procedure is key to achieving the desired results and avoiding complications. Purpose To review and present the established information about CCC, and to create a practical guide to this important step in cataract surgery. Methods A literature review was conducted using PubMed, Embase, Cochrane and Scopus databases, with emphasis on up-to-date information. The first part of this review describes the evolution of CCC and discusses the different approaches, the various instruments available, tips and pearls and the general setup for best results. The second half covers more recent innovations and common complications, and strategies to prevent or manage them. This paper provides a practical review of all aspects of CCC.
TL;DR: Sports-related trauma remains a highly prevalent cause of eye-related visits to the emergency room, particularly in young male adolescents in the spring and summertime, and paintball and soccer were more significantly associated with 'major' anterior and posterior ocular injuries.
Abstract: ABSTRACT Importance Traumatic eye injury is one of the leading causes of visual impairment in the United States, but there is limited information available in the literature about ocular trauma related to sports. Objective To evaluate the primary ocular diagnosis, type of sport, seasonal prevalence, and injury severity following ocular sports-related trauma. Design Cross-sectional study Setting United States (US) hospital emergency departments (ED). Participants Patients with sports-related ocular injuries in the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database from January 1, 2010 to December 31, 2019. Main Outcome and Measure To identify and compare the type of sport, primary diagnosis of ocular injury, and injury severity. Results For 4,671 sports-related ocular injuries identified, the mean age of injury was 19.4±15.2 years (median: 15.0 years, 79% male). The largest proportion of injuries occurred in the 12–17 years of age cohort (38.6%), occurring during summer months (P< .001). The most common sports associated with eye injury were basketball (37.8%), baseball (13.8%),, and football (12.3%). There were 3,214 injuries (68.8%) deemed ‘minor’ anterior segment injuries, 359 injuries (7.7%) deemed ‘major’ anterior segment injuries, 31 injuries (0.7%) deemed ‘minor’ posterior segment injuries, 77 injuries (1.7%) deemed ‘major’ posterior segment injuries, and 990 injuries (21.2%) of unknown severity. Basketball-related ocular trauma had a greater frequency of corneal/scleral abrasions than baseball (P < .001), soccer (P < .001), tennis (P = .03), softball (P = .001), and paintball (P = .02). Baseball-related ocular trauma had a greater frequency of contusions than basketball (P < .001), football (P < .001), soccer (P < .001), volleyball (P< .001). Paintball and soccer were more associated with ‘major’ anterior and posterior ocular injuries than basketball (P < .001, for both). Conclusion and Relevance Sports-related trauma remains a highly prevalent cause of eye-related visits to the emergency room, particularly in young male adolescents in the spring and summertime. While most diagnoses were deemed ‘minor’ injuries with basketball associated with corneal/scleral abrasions and baseball with contusions, paintball, and soccer were more significantly associated with ‘major’ anterior and posterior ocular injuries.