Eye Hospital Research Articles

Phenotypic Screening and Antibiogram of Infectious Ulcerative Keratitis Cases in Tripoli Eye Hospital, Libya

Aims: This study to investigate the most prevalent pathogens that cause corneal ulcer in Tripoli-Libya, and to recognize the antibiogram of the isolated pathogens Study Design: This study was a prospective study performed in eye hospital (Zawyet-Aldahmany eye hospital). Place and Duration of Study: It was conducted at the microbiology laboratory of the hospital over a year from December 2018 to January 2020, The overall size of the sample enrolled in this study was 50 inpatients in the admission department, which was taken according to the incidence of the corneal ulceration cases admitted to the hospital. Methodology: The corneal scrapings and swabs were collected and subjected to microbiological examination. Demographic data and risk factors were collected for each patient. The antibiotic susceptibility of the bacterial microorganisms was determined by the Kirby-Bauer disk diffusion method, to identify the most appropriate antibiotic for each bacterial isolate. Results: 60% of the patients were males, the mean age of the patients was 46.5 years, unilateral right eye keratitis was involved in (54%) of cases, trauma was the major risk factor (24%), followed by systemic disease (14%). Concerning the seasonal distribution of the cases between months, our study revealed that summer and winter seasons in Libya (January, July, August, and September) involved most of the cases, and interestingly, fungal keratitis (Aspergillus) was higher in (July, August), which is the summer season in Libya. The culture positive rate was (80%), of which (36%) were bacterial, and (22%) were fungal pathogens, and the other (22%) were mixed fungal and bacterial cultures. The most common bacterial isolate was (26%) P.aeruginosa and (16%) staphylococcus aureus, while Aspergillus (40%) was the most common fungal isolate, followed by Penicillium and fusarium species. Our results showed that P.aeruginosa was the responsible microorganism for rapid keratitis progression in three cases who were using cosmetic lenses promptly. Concerning antibiotic sensitivity, all gram-negative bacteria and positive isolates were susceptible to old-generation fluoroquinolones such as ciprofloxacin and levofloxacin, while ceftazidime showed resistance to penicillins. Conclusion: In conclusion, with early suspicion and microbiological diagnostic procedures, appropriate therapy can only reduce the incidence of this threatening ocular case.

Comparative Efficacy of Posterior Subtenon Kenacort Compared to Standard Surgical Treatment for Macular Hole Closure

Background: Macular holes cause significant vision loss, particularly in older adults. Although standard surgical treatment (SDT) has been successful, there is increasing interest in less invasive treatments that might offer better outcomes, especially in terms of best-corrected visual acuity (BCVA) and macular hole closure. Objective: This study aimed to determine the effectiveness of posterior subtenon Kenacort (SBT) in closing macular holes and to compare its efficacy with standard surgical treatment (SDT). Additionally, the study examined the impact of macular hole classification on treatment outcomes in both groups. Methods: An interventional study was conducted at Al-Shifa Trust Eye Hospital in Rawalpindi, involving 60 subjects aged 45 to 65 years with idiopathic macular holes. Participants were selected using non-probability sampling. Group A (30 eyes) received two SBT injections three months apart, while Group B (30 eyes) underwent SDT, which included pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. OCT imaging and logarithm of the minimum angle of resolution (LogMAR) measurements were obtained for all subjects before treatment, with follow-up assessments conducted six months post-treatment. Data analysis was performed using SPSS version 25.0, with quantitative variables expressed as mean ± SD and inferential statistics explored using ANOVA and paired sample t-tests. A p-value ≤ 0.05 was considered statistically significant. Results: Both treatment groups had thirty patients each with similar average macular hole sizes (SBT: 436 ± 126 µm, SDT: 439 ± 127 µm). In the SBT group, average BCVA improved from 1.48 to 0.846, while in the SDT group, it changed from 1.44 to 1.25. Macular hole classification significantly affected post-treatment BCVA scores in both groups (p < 0.001). The SBT group showed significantly greater BCVA improvement compared to the SDT group. Conclusion: Posterior subtenon Kenacort effectively closed macular holes and improved BCVA more than standard surgical treatment. Macular hole classification influenced post-treatment BCVA scores in both treatment groups, highlighting its importance in predicting treatment outcomes.

Corneal Transplantation in a Patient With Nonperforating Ocular Contusion Caused by a High-Pressure Washer: A Case Report

Purpose: This report details a rare case of a high-pressure washer injury that caused ocular contusion, vitreous hemorrhage, and irreversible corneal edema without perforation necessitating corneal transplantation. Methods: The medical chart of a patient with a high-pressure washer injury at Miyata Eye Hospital (Miyazaki, Japan) was retrospectively reviewed. Results: A 57-year-old man presented to our hospital with a contusion in the left eye caused by a high-pressure washer 1 day prior to the visit. The visual acuity in the left eye was hand motion. Slit-lamp examination of the left eye revealed the presence of corneal epithelial defects, conjunctival lacerations, hyphema, and lacerated iris. Mild clouding of the lens was observed in the anterior chambers, suggestive of cataract. Anterior segment optical coherence tomography revealed the presence of blood in the anterior chamber and a thickened and edematous cornea. Ultrasound examination revealed the presence of vitreous hemorrhage. Therefore, vitreous surgery and traumatic cataract removal were performed under general anesthesia. Postoperatively, the corneal edema and marked opacity persisted, accompanied by glaucoma, and the visual acuity was measured at 0.01. Penetrating keratoplasty was performed 1 year and 2 months after the injury, and scleral fixation of the intraocular lens was performed under local anesthesia 2 years after the injury. The final visual acuity was 0.1 under rigid gas-permeable contact lens usage 3.5 years after sustaining the injury, and the patient required anti-glaucoma drugs. Conclusions: Our patient presented with ocular trauma caused by a high-pressure washer. Corneal transplantation was required although no ocular lacerations were detected. Sufficient instructions must be provided on the usage of heavy machinery to develop a safe working environment.

Prevalence and Pattern of Ocular Trauma in a Secondary Eye Care Center in Nepal: A Descriptive Cross-sectional Study.

Ocular trauma stands as the leading preventable cause of monocular blindness worldwide. The aim of the study was to calculate the prevalence of ocular trauma and the circumstances, causes, and types of ocular injuries at emergency department of Community Eye Hospital. This was a descriptive cross-sectional study conducted retrospectively on patientsvpresenting to the Emergency Department in the year 2020. Ethical clearance was received from the Institutional Review Board with reference number 12/2021. Data collection commenced in April 2021, following the approval in March 2021. Descriptive statistics with mean and frequency were used for analysis. Among the 6526 emergency cases visiting the emergency department of Hetauda community eye hospital the prevalence of ocular trauma was 2143 (32.83%; 95% CI: 31.69%-33.97%). The mean age among the 2143 trauma cases was 33.55±15.63 years. Among them, 1851 (86.40%) fell in the working age group. The male-to-female ratio was 3:1. Occupational injuries due to welding, agriculture and industries were in 604 (28.19%) of all ocular injuries. The prevalence of ocular trauma in our study was higher than other studies. Occupational ocular trauma mainly welding injury, cement factory injury and agricultural injury are common cause of ocular trauma.

Association Between Primary Open Angle Glaucoma and Type II Diabetes Mellitus in Benghazi, Libya

Glaucoma, a leading cause of permanent blindness in the world, primarily affects older adults and is classified into four types, with diabetes mellitus potentially influencing the condition. The study aims to identify the link between Diabetes mellitus type two and Primary open angle Glaucoma. Subject and method A case-control study at Benghazi Educational Eye Hospital from December 2023 to February 2024. examined diabetic patients with and without glaucoma. Participants underwent ophthalmic examinations, including visual acuity, and gonioscopy. Patients with history of type two diabetes were included. The mean age of cases was significantly higher than controls [P=0.001]. There were significant differences in best corrected visual acuity between the two groups [P=0.035], Participants with high a [HbA1c] were more likely to have an advanced primary open angle glaucoma type. Participants with uncontrolled diabetes mellitus had higher intraocular pressure levels compared to the control group, [p=0.013]. There was a statistically significant difference in Retinal nerve fibers layers thickness in right eye, and Retinal nerve fibers layer thickness in left eye, between the case and control groups, [P= 0.041, 0.005 respectively. The age 66-75 years had a significantly higher risk of primary open angle glaucoma. A negative correlation between the duration of diabetes and Pattern standard deviation in left eye [ P = 0.051], as well as Visual Field left [P = 0.002]. The study reveals a significant link between diabetes mellitus type two and primary open angle glaucoma, with factors like higher intraocular pressure and older age causing higher incidence. early detection and management of risk factors could prevent or delay glaucoma onset.

The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals.

This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China's day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.

Management and Outcomes of Traumatic Cataract During Open Globe Repair

PurposeTo compare outcomes of primary lensectomy (PL) versus no lensectomy (NL) during repair of zone I (involving cornea and limbus) and II (up to 5mm posterior to the limbus) ruptured globe injuries (RGIs) with lens involvement. DesignRetrospective clinical cohort study. Methods107 patients with RGIs involving both blunt and penetrating injury to the lens who presented to Wills Eye Hospital between April 1, 2017 and August 31, 2022 were included. Data from presenting visit was collected including demographic information, time from injury to surgery, visual acuity (VA), intraocular pressure (IOP), injury characteristics, and years since residency graduation of surgeon. VA, IOP, retinal detachment (RD) rate, and endophthalmitis incidence were compared between PL and NL groups at postoperative week 1 (POW1) and postoperative month 1 (POM1). VA, peak IOP, need for further surgeries, and types of additional surgery were compared between the two groups at the final visit. Results19 (17.8%) patients underwent PL. Age, sex, and initial VA were similar between groups (all p≥0.05). The PL group had surgery later from the time of injury (6.1±14.6 days vs. 1.3±1.9 days; p=0.010), higher IOP at presentation (12.9±11.6 mmHg vs. 7.7±11.3 mmHg; p=0.046), shorter wounds (2.3±1.4mm vs. 4.7±3.2mm; p=0.003), more frequent lens capsule violation (89.5% vs. 50%; p=0.010), increased likelihood of intraocular foreign bodies (52.6% vs. 17.0%; p=0.004), and were more likely to be operated on by surgeons with ≥ 5 years of experience post-residency (68.4% vs. 28.4%; p<0.001). At POW1, the PL group had significantly better logMAR VA (1.2±0.9 vs. 2.0±1.0; p=0.002), and this continued at POM1 (1.0±0.8 vs. 1.6±1.1; p=0.031) and the final visit (0.4±0.7 vs. 1.0±1.1; p=0.010). The PL group had lower IOP at POW1 (12.4±3.0 mmHg vs. 17.3±8.2 mmHg; p=0.005) than the NL group. There was no difference in RD or endophthalmitis rates between the two groups at POW1 or POM1 (p>0.05 for all). The NL group was more likely to require additional surgery by final follow-up (77.3% vs. 47.4%; p<0.001). In the multivariable analysis, PL had better final VA and decreased need for further surgery (both p<0.05). ConclusionsIn the appropriate circumstance, PL during lens-involving anterior RGI repair may lead to improved patient outcomes.

Longitudinal evaluation of macular vascular density alterations in unilateral amblyopic children undergoing therapy: An optical coherence tomographic angiography study

ImportanceUnderstanding the pathophysiology of the macula in amblyopic eyes is an active research area. ObjectiveTo correlate macular retinal vascular density changes with best-corrected visual acuity changes following occlusion therapy for amblyopia in children. DesignA prospective cohort study of children visiting the Pediatric Ophthalmology Division of our institution between January 2020 and January 2022 was conducted. SettingA specialist eye hospital in Saudi Arabia. ParticipantsThirty children with unilateral amblyopia. ExposureOcclusion therapy for amblyopia.Main Outcome and Measures: Best corrected visual acuity (logMAR) before and at each of the four optical coherence tomographic angiographies was compared in amblyopic and fellow eyes. The effect of pretreatment determinants on the correlation between best-corrected visual acuity and retinal vascular density changes was reviewed. ResultsIn this cohort of 30 amblyopic and 30 fellow eyes from 30 children (mean age 8.7 ± 1.4 years; male: female 18:12. The best-corrected visual acuity improved from a median of 0.6 (interquartile range 0.5; 1.1) pretreatment to a median of 0.4 (interquartile range 0.2; 0.6) posttreatment in amblyopic eyes, and from a median of 0.1 to 0.05 in the fellow eyes. The total percentage change in retinal vascular density in the amblyopic eye was significantly higher than that in the fellow eye (Z = −1.92, P = 0.05). The change in best-corrected visual acuity in the amblyopic eye after a median of 98 months (interquartile range, 69–126 months) of intervention was significantly correlated with the refraction-adjusted change in retinal vascular density (B = −0.03, 95 % confidence interval −0.04, −0.02, P < 0.001) and was influenced by strabismus (B = −0.46, 95 % confidence interval −0.59, −0.34, P < 0.001), type of amblyopia (B = 0.24, 95 % confidence interval 0.12, 0.36, P < 0.001), duration of occlusion (B = −0.43, 95 % confidence interval −0.65, −0.22, P < 0.001), and occlusion compliance (B = 0.24, 95 % confidence interval 0.11, 0.36, P < 0.001). Conclusionsand Relevance: The RVD in amblyopic eyes in the first six months of therapy was significantly lower than that in fellow eyes, but not in subsequent assessments.

Clinical characteristics and associated factors of diabetic retinopathy in Sudanese patients

Background: Diabetic retinopathy (DR) is a leading cause of vision loss and preventable blindness, particularly in middle- and high-income countries.Aim: This study aimed to assess the characteristics and associated factors of DR in Sudanese patients with type 2 diabetes mellitus (DM).Setting: A cross-sectional hospital-based study included 119 patients with type 2 DM was conducted at EL-Walidain Eye Hospital, Khartoum, Sudan, from February 2021 to May 2021.Methods: A non-mydriatic digital fundus camera was used for fundus photography, and Scottish Diabetic Retinopathy Grading Scheme was used for the final classification of DR.Results: Females comprised 53.8% of patients, mean age of 58.8 ± 8.5 years. Uncontrolled DM was found in 37.8% with a mean duration of 10.5 ± 4.8 years. Myopia was the most common refractive error found in 57.8% of the uncontrolled group, followed by emmetropia (17.8%). Whereas in the controlled group, 47.3% were hyperopic and 39.2% were myopic. Maculopathy grade M1 was found to be 37.8% in the uncontrolled group and 18.9% in the controlled group, with no significant difference (p = 0.361). Conversely, the difference in retinopathy between the two groups was statistically significant (p = 0.043).Conclusion: Decreased vision and increased retinopathy were associated with an increase in patients’ age. More widespread diabetes awareness and screening programmes to improve diabetes management and control in Sudan and other developing countries.Contribution: This study observed maculopathy grade M1 and myopia were more common in uncontrolled DM, and vision function was inversely correlated with age (p 0.05).

Characteristics of Corneal Ulcer Patients at Bali Mandara Eye Hospital in 2021-2022

Background: A corneal ulcer is a pathological discontinuity of corneal epithelium surface. The incidence in developing countries reached 1.5-2 million per year and one of the causes of blindness. Corneal ulcers can occur at any age and gender which is influenced by geographic conditions. The causes of corneal ulcers vary depend on the region, predisposing factors, and microorganisms in the particular community. Purpose: To know the characteristics of corneal ulcers particularly at the Bali Mandara Eye Hospital and as a basic data for further research. Methods: A total of 77 selected medical records at Bali Mandara Hospital from January 2021–May 2022 were used in this descriptive study using a retrospective method. Patient characteristics, etiology, clinical characteristics, management, and complications were identified in this study. Descriptive analysis was performed on all data and presented in frequency tabulation. Results: In this study, 52 cases (67.5%) were male and 25 cases (32.5%) were female. The largest age group was 24-64 years with 34 cases (44.2%). All cases with corneal ulcers (100%) complained of red eye symptoms. Trauma (61.0%) as the most common predisposing factors that was caused by plants (24.7%). The most common etiologies were bacteria (46.8%) followed by fungi (5.2%), and mixed (28.6%). Most of the cases were managed without treatment (66.2%) with the outcome of improvement (55.8%), without complications (53.2%), perforation (28.6%), and descemetocele (15.6%). Conclusion: Most patients with corneal ulcers at the Bali Mandara Eye Hospital are male than female with range of 24-64 years and trauma being the most common predisposing factor. This is because it is the range for productive age and the majority of the population in Indonesia, especially Bali, works as farmers. Most microorganisms that cause corneal ulcers are bacteria. Most patients receive non-surgical treatment with more than 50% of patients experiencing improvements in vision and no complications. Keywords: Corneal Ulcers, keratitis, ocular trauma, visual impairment

A Deep Learning Model for Automatically Quantifying the Anterior Segment in Ultrasound Biomicroscopy Images of Implantable Collamer Lens Candidates

ObjectiveThis study aimed to develop and evaluate a deep learning-based model that could automatically measure anterior segment (AS) parameters on preoperative ultrasound biomicroscopy (UBM) images of implantable Collamer lens (ICL) surgery candidates. MethodsA total of 1164 panoramic UBM images were preoperatively obtained from 321 patients who received ICL surgery in the Eye Center of Renmin Hospital of Wuhan University (Wuhan, China) to develop an imaging database. First, the UNet++ network was utilized to segment AS tissues automatically, such as corneal lens and iris. In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks (ALs) of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA), and sulcus-to-sulcus distance (STS). Based on the results of the latter two processes, PD, ACD, ATA, and STS can be measured. Meanwhile, an external dataset of 294 images from Huangshi Aier Eye Hospital was employed to further assess the model's performance in other center. Lastly, a subset of 100 random images from the external test set was chosen to compare the performance of the model with senior experts. ResultsWhether in the internal test dataset or external test dataset, using manual labeling as the reference standard, the models achieved a mean Dice coefficient exceeding 0.880. Additionally, the intra-class correlation coefficients (ICCs) of ALs’ coordinates were all greater than 0.947, and the percentage of Euclidean distance distribution of ALs within 250 μm was over 95.24%.While the ICCs for PD, ACD, ATA, and STS were greater than 0.957, furthermore, the average relative error (ARE) of PD, ACD, ATA, and STS were below 2.41%. In terms of human versus machine performance, the ICCs between the measurements performed by the model and those by senior experts were all greater than 0.931. ConclusionA deep learning-based model could measure AS parameters using UBM images of ICL candidates, and exhibited a performance similar to that of a senior ophthalmologist.

Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema.

To explore the clinical effect of ranibizumab combined with laser photocoagulation (LP) in treating diabetic macular edema (DME). We retrospectively reviewed the clinical data of 118 patients with DME admitted to The Affiliated Eye Hospital of Nanchang University from May 2021 to March 2023. Among them, 38 patients received LP alone (Laser-group), 39 patients received ranibizumab alone (Ranibizumab-group), and 41 patients received LP combined with ranibizumab (Combined-group). The improvement of macular edema (ME), visual acuity, and complications between the groups were compared. The time of ME regression, exudation absorption and fundus hemorrhage absorption in the Combined-group was shorter than in the Laser-group and the Ranibizumab-group (P<0.05). After treatment, the CMT and RNV of the three groups decreased compared to pretreatment levels and were lower in the Combined-group compared to the Laser-group and the Ranibizumab-group (P<0.05). BCVA increased after the treatment in all groups, and was markedly higher in the Combined-group than in the Laser and the Ranibizumab-groups (P<0.05). NO were higher in the Combined-group compared to the Laser-group and the Ranibizumab-group. The post-treatment VEGF levels decreased in all groups, and were significantly lower in the Combined-group compared to the Laser-group and the Ranibizumab-group (P<0.05). The incidence of complications in the Combined-group was lower than in the Laser-group and the Ranibizumab-group (P<0.05). Compared to ranibizumab or LP alone, ranibizumab combined with LP is more effective in reducing ME in patients with DEM, and is associated with fewer complications.

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine &amp; quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients &amp; Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery &amp; had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary &amp; secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye &amp; PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size &amp; percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

Guidelines for setting up low-vision and rehabilitation services in India.

Low vision and blindness are increasing public health issues impacting individuals' quality of life. During clinical low-vision services, vision rehabilitation is crucial for enhancing daily living skills and improving life quality. Low-vision and rehabilitation (LVR) services encompass comprehensive measures that aid visually disabled individuals in restoring function, autonomy, and social participation. Such holistic management requires a multidisciplinary approach, facilitating adaptation to environmental and sociocultural changes. However, the lack of awareness about the principles and practices of LVR services poses a major hindrance to setting up such a special clinic in the eye hospital. This article is about a consensus statement on the guidelines for establishing LVR services focusing on basic requirements, especially in low-resource countries. The present recommendation to set up an LVR clinic was made after group discussions and debates among various experts and stakeholders during the National Workshop on Strengthening Low-Vision and Rehabilitation Services organized at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. The event was participated by many ophthalmologists and optometrists coming from across the country. The recommendations required at the tertiary level are outlined under the four headings: Human resources and training: two ophthalmologists, that is, a low vision specialist or a well-experienced in low vision and one who has received one-week orientation and training, one optometrist, one rehabilitation supervisor, and two rehabilitation assistants; Assessment equipment: basic screening and diagnostic; Assistive devices for low vision, including, digital and non-digital; Assistive devices for rehabilitation, and methods for records maintenance. The institution may not follow strictly the present guidelines but will provide an idea on LVR services initiation.

Primary eyecare in paediatrics population (PREPP) - II study: Study of satisfaction of services and barrier for not reporting to the base hospital on referral among pediatric patients treated in six major vision centers of a tertiary eye care facility in Southern India.

This study was conducted in continuation of Primary Eyecare in Paediatrics Population (PREPP-I) and was aimed to assess parents' satisfaction with pediatric-eye-care services across six vision centers (VCs) of a tertiary eye hospital in Southern India. The barriers among the parents for not attending the base hospital (BH) when referred from these VCs were also evaluated. A standard-validated-satisfaction questionnaire (VSQ) was used to assess patient satisfaction. Responses were assessed on a 5-point Likert scale: 0 (very dissatisfied) to 4 (very satisfied) against each response. Responses were expressed as percentages with 0 (very dissatisfied) and 100% (very satisfied). Patients were referred with a form mentioning reasons for referral (urgent/non-urgent). All referrals were evaluated by the principal investigator. In case of failure to report, parents were enquired about the barrier based on the validated barrier questionnaire (VBQ) over a telephonic conversation. All 250 patients of the PREPP-1 study were included in the satisfaction study. Different domains were evaluated using VSQ (accessibility of VC, waiting hours, financial aspects, spectacle dispensing service, and teleophthalmology). The overall satisfaction was 75%. The most common reason for dissatisfaction was the lack of meeting the ophthalmologist in person, followed by waiting time. 58 patients wanted to visit BH to consult a pediatric ophthalmologist in person (23%). For the barrier study, 14 out of 47 referrals did not report and were evaluated using VBQ (knowledge, physical, time, and financial barriers). The majority had a financial barrier (43%), followed by knowledge (28.6%) and time barrier (14%). PREPP-II demonstrated that 3/4 th of pediatric patients are happy to be treated at VC with teleophthalmology services. However, a significant percentage want to consult a specialist at BH. One-fourth of total referrals did not report to BH due to financial constraints and a lack of awareness of the child's condition.

Intraoperative Intraocular Lens Waste: Incidence, Cost and Reasons

ABSTRACT Purpose To evaluate the incidence and cost of intraocular lens(IOL) waste during IOL implantation, as well as the reasons for it. Methods A retrospective analysis was conducted on the data of 485 patients from the IOL waste registers of a single tertiary eye hospital in China during 2016–2020. The primary outcomes were the incidence, cost, and reasons for different IOL properties. Cases were examined to ascertain IOL material, design, procedural details, and causes of waste. Results IOL waste occurred in 485 (6.62‰) of the 73,246 IOL implantations during the study period. The total cost of IOL waste was 429, 850.26 Chinese Yuan (CNY) related to waste with an average cost of 2, 442.33 CNY per procedure during the study period. Comparisons between IOL properties showed that polymethyl methacrylate (PMMA) material (39, 2.05%), three-piece design (142, 1.49%), and secondary IOL implantation (26, 2.16%) were associated with IOL wastage, and the difference was statistically significant. The causes of IOL waste were damage (107, 60.80%), patient reasons (37, 21.26%), aseptic errors (22, 12.50%), IOL quality problems (8, 4.55%), and loss (2, 1.14%). Conclusions The incidence of IOL waste is low, but still leads to a significant cost burden due to a large number of cataract surgeries. PMMA material, three-piece design, and secondary implantation were identified as factors increasing IOL waste. Damage emerged as the primary reason for waste, largely attributed to human error. Therefore, the development of strategies to mitigate IOL waste is imperative.

Evaluation of dry eye disease symptomatology and mental health status among patients with different COVID-19 statuses.

To evaluate dry eye disease (DED) symptomatology and mental health status in different COVID-19 patients. A cross-sectional observational design was used. Totally 123 eligible adults (46.34% of men, age range, 18-59y) with COVID-19 included in the study from August to November, 2022. Ocular Surface Disease Index (OSDI), Five-item Dry Eye Questionnaire (DEQ-5), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) were used in this study. OSDI scores were 6.82 (1.25, 15.91) in asymptomatic carriers, 7.35 (2.50, 18.38) in mild cases, and 16.67 (4.43, 28.04) in recurrent cases, with 30.00%, 35.56%, and 57.89%, respectively evaluated as having DED symptoms (χ2=7.049, P=0.029). DEQ-5 score varied from 2.00 (0, 6.00) in asymptomatic carriers, 3.00 (0, 8.00) in mild cases, and 8.00 (5.00, 10.00) in recurrent cases, with 27.50%, 33.33%, and 55.26%, respectively assessed as having DED symptoms (χ2=8.532, P=0.014). The prevalence of clinical anxiety (50.00%) and depression (47.37%) symptoms were also significantly higher in patients with recurrent infection (χ2=24.541, P<0.001; χ2=30.871, P<0.001). Recurrent infection was a risk factor for high OSDI scores [odds ratio, 2.562; 95% confidence interval (CI), 1.631-7.979; P=0.033] and DEQ-5 scores (odds ratio, 3.353; 95%CI, 1.038-8.834; P=0.043), whereas having a fixed occupation was a protective factor for OSDI scores (odds ratio, 0.088; 95%CI, 0.022-0.360; P=0.001) and DEQ-5 scores (odds ratio, 0.126; 95%CI, 0.039-0.405; P=0.001). Patients with recurrent COVID-19 have more severe symptoms of DED, anxiety, and depression.

The Impact of Back Optic Zone Design in Orthokeratology on Visual Performance.

To evaluate the visual performance in adolescents undergoing orthokeratology (OrthoK) treatment with two different optical zone diameters (OZDs). This randomized, double-masked, self-controlled prospective study was conducted at Tianjin Eye Hospital (Tianjin, China) in June 2022. Thirty-six eligible schoolchildren were enrolled and fitted with corneal refractive therapy lenses with two sizes of OZDs (5 mm [5OZ] and 6 mm [6OZ]). Each participant was randomized to wear the 5OZ in one eye and the 6OZ in the contralateral eye. Subjective visual quality was assessed using visual acuity, refraction, contrast sensitivity function, and visual symptoms, and the objective optical quality was assessed using ocular higher order aberrations (HOAs) and modulation transfer function (MTF). Thirty-five myopic children completed a 1-month follow-up visit. The 5OZ lens induced significantly smaller treatment zone diameters than the 6OZ lens (P < 0.001). Subjective visual quality did not differ significantly between the two groups. Compared to baseline, aberrations of Z40, coma-like, spherical-like, and total HOAs in both groups increased significantly (P < 0.05). For the 3-mm pupils, spherical aberration in the 5OZ group was significantly higher than that in the 6OZ group (P < 0.05). The MTF value of the 6OZ group was significantly higher than that of 5OZ group for 0.3 and 1.5 cycles per degree for the 3-mm pupils (P = 0.006 and P = 0.026, respectively). However, HOAs or MTF did not differ significantly between the two groups for the 5-mm pupils. The difference induced by varying OZD was significant only in the smaller pupil condition. The selection of OZD in OrthoK designs in real-world patient management should be done while considering individual pupil size. This study revealed that the objective visual quality of small OZD lenses was only slightly affected for the small pupil size.

A comparison of deep sclerectomy outcomes in eyes with pseudoexfoliation versus primary open angle glaucoma

PurposeTo compare outcomes of augmented deep sclerectomy surgery (DS) with mitomycin C.(MMC) between pseudoexfoliative glaucoma (PEXG) and primary open angle.glaucoma (POAG) patients.. DesignRetrospective cohort study MethodsRetrospective review of patients undergoing DS surgery at the University Eye Hospital Bonn, Germany, from 04/2021 to 09/2022. We performed a matched-pair analysis.between eyes with PEXG (group 1, n = 45) and eyes with POAG (group 2, n = 45). Results90 eyes of 85 patients were included. Complete and qualified success rates for Groups.1 and 2 at one year were 55.6 % and 86.7 % (p = 0.002) and 91.1 % and 93.3 % (p = 0.78).for ≤21 mmHg, and 55.6 % and 86.7 % (p = 0.002) and 88.9 % and 93.3 % (p = 0.53) for.≤18 mmHg respectively..Mean preoperative IOP decreased from 21.11 mmHg in group 1 and 19.64 mmHg in.group 2 (p = 0.31) to 13.64 mmHg and 11.42 mmHg after surgery, respectively, whilst it.was significantly lower in eyes with POAG (p = 0.01). The number of pressure-lowering.drops was also significantly lower in eyes with POAG after 12 months (PEXG: 0.58;.POAG: 0.18; p = 0.01). Eyes with PEXG had a significantly higher rate of Nd:YAG laser.goniopuncture (PEXG: 64.4 %, POAG: 40 %, p = 0.02)..Postoperative complications occurred in 6 eyes (6.7 %) with no vision-threatening.sequelae in either group.There were no significant differences between complication.rates in the two groups (p = 0.18) ConclusionsDS is a safe and effective procedure for lowering IOP in eyes with both POAG and PEXG, with lower overall IOP levels being achieved in eyes with POAG. Significantly more postoperative laser goniopunctures were needed in eyes with PEXG.

Lens subluxation combined with parry-romberg syndrome: case report

BackgroundParry-Romberg syndrome (PRS) is a rare progressive degenerative disorder of unknown etiology. Here we report a rare case of PRS combined with lens subluxation in Eye and ENT hospital of Fudan University, Shanghai. To our knowledge, it is the first reported case of PRS combined with lens subluxation that has been managed surgically with phacoemulsification and CTR placement and IOL implantation in Shanghai.Case presentationA 60-year-old woman was referred for “right visual blur for 2 years” and had persistent right facial paralysis of unknown etiology since the age 12. She had right facial muscle atrophy and paralysis. Eye examination also showed the right eyelid pseudoptosis, enophthalmos, age-related cataract combined with lens subluxation existed in the right eye. The patient was diagnosed as age-related cataract and lens subluxation in the right eye and progressive hemifacial atrophy (Parry-Romberg syndrome). We conducted a combined phacoemulsification, IOL and CTR implantation and pupilloplasty surgery for the patient under general anesthesia and the postoperative UCVA was 20/30 and remained for 1 year’s follow up.ConclusionsHere we reported a rare case of PHA combined with lens subluxation in China. After appropriate eye surgery, the patient achieved satisfying vision result in the right eye.