Eye Hospital Research Articles

Comparison of the efficacy of carelizumab combined with chemotherapy and chemotherapy alone in the induction therapy of locally advanced hypopharyngeal carcinoma

Objective: To compare the efficacy and safety of carrelizumab combined with the modified TPF regimen (docetaxel, cisplatinand capecitabine) and TPF regimen alone in larynx preservation strategy for locally advanced resectable hypopharyngeal squamous cell carcinoma. Methods: A cohort study was conducted. Patients with locally advanced resectable hypopharyngeal carcinoma (cT3-4aN0-3bM0) who were treated at the Eye & ENT Hospital of Fudan University from January 2017 to April 2023 were enrolled in the study. One group was treated with a modified TPF regimen (TPF group) for 2-3 cycles (retrospective data), and the other group was a prospective phase Ⅱ trial with a modified TPF regimen combined with carrelizumab (TPFC group) for three cycles. The patients with complete or partial remission of the primary focus were treated with sequential radical radiotherapy and/or drug therapy. The patients in the TPFC group were treated with carrelizumab at the end of radiotherapy with a maximum of up to 18 doses. The patients with stable or progressive disease were given radical surgery, and those who refused the surgery were given radical chemoradiotherapy. Objective response rate (ORR), overall survival rate, progression-free survival (PFS) rate, larynx preservation rate (LPR), and adverse reactions were compared between the two groups. Results: There were 51 male patients in the TPFC group, with an median age of 57 (35, 69) years. Meanwhile, 44 patients were in the TPF group, among which 43 were male and one was female, with an median age of 62 (46, 70) years. The ORR of the TPFC group was higher than that of the TPF group [82.4% (42/51) vs 63.6% (28/44), P=0.039]. During a median follow-up of 24.4 (18.5, 31.4) months, the TPFC group showed a higher 2-year survival rate (84.8% vs 64.6%, P=0.013) and 2-year LPR (66.6% vs 48.6%, P=0.045) than those in the TPF group. In patients with poor effect of induction therapy for hypopharyngeal carcinoma, surgical combination therapy significantly prolonged the 2-year PFS rate (77.9% vs 18.2%, P<0.001) and 2-year survival rate (76.9% vs 45.5%, P=0.005)than those of non-surgical combination therapy. The incidences of nausea and/or vomiting, reactive cutaneous capillary endothelial proliferation, thyroid dysfunction, and rash were increased in the TPFC group (all P<0.05). There was no treatment-related death. Conclusion: Carrelizumab combined with a modified TPF regimen has good efficacy and safety and can improve the LPR of locally advanced hypopharyngeal carcinoma.

Optical Biometry versus Ultrasound A-scan in Measuring Anterior Chamber Depth, Axial Length, and Lens Thickness in Patients Undergoing Cataract Surgery

Ocular biometry measurements use ultrasonography and optical biometry, offering high precision for noninvasive intraocular distance measurement in cataract surgery. This study aims to Compare agreement values between an optical biometry machine and an ocular ultrasound-based biometry device for axial length, anterior chamber depth, and lens thickness measurements. A study enrolled 64 eyes of 42 patients scheduled for cataract surgery at Benghazi Teaching Eye Hospital, Libya, from January 1st to February 1st, 2024. Patients' medical and ocular histories were taken, and slit lamp examinations were conducted. All eyes with visual impairment and good fixation were included. Axial length, anterior chamber depth, and lens thickness were measured using Aladdin optical biometer and an ellex eye-cubed ultrasonic contact biometer. The study involved 64 eyes with a mean age of 64.36 years, The most common type of cataract was posterior subcapsular cataract [46.9%], nuclear cataract [14.1%], and cortical cataract [14.1%]. Combined cataracts were also present in 31.3% of the participants. The ICC analysis showed a strong agreement [0.976] between the two measurement devices in assessing axial length. difference in measurements of the mean anterior chamber depth. ICC showed a high level of agreement between the two methods [0.545]. There was no significant difference in lens thickness as measured by optical biometry and A-scan ultrasound, with a medium positive correlation between lens thickness measurement by the two devices [P&lt;0.001]. The interclass correlation further supported these findings, with a strong correlation between lens thickness and cataract development [r = 0.753]. The study reveals consistency in the measurements between optical and ultrasound biometry, highlighting the need for future research, to address limitations like small sample size and potential biases.

Sociodemographic Factors Associated With Emergent Eye-Related Emergency Department Visits: A Multicenter Analysis

ObjectiveTo compare sociodemographic factors in patients presenting to the emergency department (ED) with emergent and non-emergent eye-related concerns. DesignCross-sectional multicenter study. Subjects60,677 patients with eye-related concerns who visited EDs at Bascom Palmer Eye Institute, Wills Eye Hospital, Massachusetts Eye and Ear, and Johns Hopkins Hospital/Wilmer Eye Institute from January 1st, 2019 until December 31st, 2019. MethodsDescriptive statistics were performed using STATA 17. Main Outcome Measures1) Sociodemographic factors associated with emergent diagnoses, 2) Visit patterns across ED settings (i.e. standard ED vs eye ED), and 3) the most common emergent and non-emergent diagnoses. ResultsA total of 60,677 eye-related ED encounters were included in the study, including 22,434 at Bascom Palmer Eye Institute, 16,124 at Wills Eye Hospital, 15,487 at Massachusetts Eye and Ear, and 6,632 at Johns Hopkins Hospital/Wilmer Eye Institute. Most patients had non-emergent diagnoses (56.7%). Males (OR 1.85, 95% CI 1.79-1.92) were more likely to have an emergent diagnosis than females. Patients with private/employer-based insurance (OR 0.88, 95% CI 0.81-0.96), Medicare (OR 0.80, 95% CI 0.72-0.87), and Medicaid (OR 0.81, 95% CI 0.74-0.89) were all less likely to have an emergent diagnosis than uninsured patients. Those with veteran/military insurance (OR 1.08, 95% CI 0.87-1.34) were equally likely to have an emergent diagnosis compared to uninsured patients. Non-White Hispanic patients (OR 1.26, 95% CI 1.12-1.42) were more likely to present with an emergent condition than White patients. Patient seen in the standard ED setting were more likely to have emergent diagnoses than those who visited standalone eye EDs (P < 0.001). The most common emergent diagnoses were corneal abrasion (12.97%), extraocular foreign body (7.61%), and corneal ulcer (7.06%). The most common non-emergent diagnoses were dry eye (7.90%), posterior vitreous detachment (7.76%), and chalazion (6.57%). ConclusionsED setting was associated with the acuity of patient diagnoses. Lack of insurance coverage and non-White Hispanic race/ethnicity were associated with emergent eye-related ED visits. Improving access to ophthalmic care in these populations may reduce the incidence of preventable eye emergencies related to untreated chronic conditions. This combined with measures to redirect non-emergent issues to outpatient clinics may alleviate ED overload.

Overcoming the challenges of cataract blindness in Nigeria: An action plan for ophthalmologists

Abstract Purpose: The purpose of this study was to explore the eye care provider factors responsible for low cataract surgical rates (CSRs) in Nigeria and to develop an action plan to boost the CSR. Methods: This was a cross-sectional survey of ophthalmologists practicing in Nigeria. An online questionnaire was distributed via E-mail and social media platforms to respondents. Data collected included sociodemographic characteristics, type, and location of the eye hospital where respondents practiced, cataract surgeries performed monthly, frequency and type of outreach activities by the eye hospitals, barriers to uptake of cataract surgery at the hospitals, and suggestions on measures to overcome such barriers. Statistical analysis was done using IBM-SPSS version 20, and the level of significance was P &lt; 0.05. Results: A total of 201 ophthalmologists responded to the survey. Majority (88.0%) were practicing in university or government hospitals while only 8 (4.0%) were working in mission hospitals. The average monthly cataract surgeries performed per hospital ranged from 0 to 600, with a median of 30 surgeries. Mission hospitals were more likely to perform ≥50 cataract surgeries per month compared to other hospitals (P = 0.003). Majority (75.1%) of hospitals organized outreach activities to identify cataract patients. Higher frequency of outreach activities (P = 0.028) and combining surgery with screening (P = 0.036) were associated with a higher likelihood that the cataract patients that were identified received surgery. Conclusion: The conduct of frequent outreach activities in which eye screening and cataract surgery are combined should boost CSRs and reduce the burden of cataract blindness in Nigeria.

Multimodal Imaging of Bilateral Retinal Pigment Epithelial Immunoglobulin Light Chain Deposition in Patients with Systemic Immunoglobulin Light Chain Deposition

ObjectiveTo describe multimodal imaging of peculiar bilateral globular subretinal deposits and acquired serous retinal detachment in patients with systemic immunoglobulin light chain deposition. DesignA retrospective observational case series. ParticipantsWe examined six eyes in three patients (one with multiple myeloma, one with membranous nephropathy, and one with immunoglobulin A nephropathy) at the Eye and ENT Hospital of Fudan University. The patients presented with peculiar globular subretinal deposits along the retinal pigment epithelium (RPE)‒Bruch’s membrane complex and acquired serous retinal detachment. MethodsFundus appearance was documented with multimodal imaging, which included fundus photography, fundus autofluorescence, spectral domain optical coherence tomography (OCT), swept-source OCT (SS-OCT), en-face OCT, and SS-OCT angiography. Additional evaluations included serum protein electrophoreses, positron emission tomography computed tomography, and renal and bone biopsies to assess the primary diseases. Main Outcome MeasuresMultimodal imaging, course, and prognosis of bilateral RPE immunoglobulin light chain deposition in patients with systemic immunoglobulin light chain deposition. ResultsBilateral, multiple, speckled, or patchy RPE changes in the posterior fundus that corresponded to striking multifocal hyperautofluorescence on fundus autofluorescence and lumpy, globular hyperreflective deposits along the RPE‒Bruch’s membrane complex were identified as characteristic features of bilateral RPE light chain deposition. These features may be accompanied by dense light chain deposits in the choriocapillaris and choroid vessels, diffuse choroidal thickening, and “angiographically silent” serous retinal detachment in patients with systemic immunoglobulin light chain deposition. ConclusionsWe have documented the characteristic features, clinical course, and prognosis of bilateral RPE immunoglobulin light chain deposition in patients with systemic immunoglobulin light chain deposition. Appropriate evaluations, including serum protein electrophoresis and hematologic consultation, are recommended to manage patients with this fundus abnormality.

Safety and efficacy of capsular tension ring and capsular hook implantation for managing ectopia lentis in Marfan syndrome: real-world study.

To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL). Eye and ENT Hospital of Fudan University, Shanghai, China. Retrospective propensity score-matched cohort study. This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM). This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group. The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.

Primary Internal Limiting Membrane Peel and Its Effects on Epiretinal Membrane After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To determine the effect of internal limiting membrane (ILM) peel in post-operative development of epiretinal membrane and to see visual outcomes of patients undergoing pars plana vitrectomy with and without ILM peel. Study Design: Quasi experimental study. Place and Duration of Study: Retina clinic of Al-Ibrahim Eye Hospital from July, 2022 to Dec, 2022. Methods: A total of 60 eyes which underwent pars plana vitrectomy (PPV) with silicone oil for Rhegmatogenous retinal detachment (RRD) were included. Patients with previous vitreoretinal surgery or ocular trauma, macular diseases or coexisting conditions that could affect the outcomes or complicate the surgery were excluded. Group A included patients with ILM peel and Group B included patients with no ILM peel (30 eyes each). Frequency was calculated for gender, epiretinal membrane formation. and was compared between both groups using chi square. Results: Mean age in group A was 47.63 ± 8.61 years and in group B was 45.36 ± 6.63 years. Gender distribution showed 66.6% males in group A and 43.3% in group B. After 3 months the group A had significantly lower frequency of ERM formation (3.33%) as compared to group B (16.67%) with p &lt;0.05. However, post operativevisual acuity was not significantly different between the two groups (p &gt; 0.05). Conclusion: This study shows that primary ILM peel diminishes the development of ERM and decreases the need for second surgical procedure. However, postsurgical visual acuity between the two groups showed no significant difference.

Referral Patterns to an Ophthalmic Outpatient Clinic in a Tertiary Eye Care Center in Iraq

Purpose: We aim to conduct a comprehensive review of outpatients at a tertiary ophthalmology clinic to evaluate various aspects including the spectrum of eye disorders, referral patterns, reasons for referral, and patient self-assessment, with a particular focus on self-referrals. Study Design: A cross-sectional study. Place and Duration of Study: Ibn Al-Haitham Teaching Eye Hospital from April to May, 2023. Methods: Referral letters were grouped into the primary health center (PHC), secondary hospital, internal referral and private clinic. Referral letter quality was assessed based on clinical information and particular request. Results: A total of 1367 individuals aged 40.8 ± 22.17 years were eligible for study. There were 19.2% referrals form PHC, 18.4% from secondary hospitals, 10.7% from private clinics, 3.3% were internal referrals, 37.2% were self-referred and 11.3% had medical or surgical follow-up. Blurred vision was the predominant complaint of 677 (51.6%) patients. Out of 659 referral letters, 25% scored two essential information items, 5.2% scored three, and only 0.8% scored four items. The majority (97.2%) of letters provided specific requests. Among all, 26.3% of PHC, 38.2% of hospitals, 34.9% of private clinics, 21.7% self-referred and 51.1% of internally referred patients considered their situations difficult. Conclusion: Majority of cases seen in ophthalmology tertiary centers consist of common conditions that could be effectively managed by PHCs and general hospitals. Improved referral standards for specialized medical institutions may reduce tertiary hospital over population.

Effect of Retinectomy with Pars Plana Vitrectomy in Proliferative Vitreoretinopathy: Surgical Success and Recurrence Rate (A Comparative Study)

Purpose: To assess anatomical and functional success of pars plana vitrectomy with retinectomy in cases of proliferative vitreoretinopathy (PVR grade C). Study Design: Retrospective chart review. Place and Duration of Study: AL-Ferdous Private Eye Hospital, Baghdad, from July, 2019- June, 2023. Methods: Thirty eyes of thirty patients with PVR grade C were included in the study. One group (n=15) underwent pars plana vitrectomy (PPV) without retinectomy, while the other group (n=15) underwent PPV with retinectomy. Complications, anatomic success, and visual acuity were documented and evaluated. The relationship between retinectomy duration and postoperative visual acuity was examined using a chi-square test, with a p-value less than 0.05 considered statistically significant. Results: Mean age of the patients was 46.13±13.95 years. Retinectomy group had 8 (53.3%) males and 7 (46.7%) females. The other group had 10 (66.7%) males and 5 (33.33%) females. In group 1 there were 5 phakic and 10 pseudophakic eyes while in group 2, there were 4 phakic and11 pseudophakic eyes. Postoperative complete retinal re-attachment was achieved in 100% eyes in retinectomy group. After six months, the first group had 5 eyes (33.3%) with improved visual acuity, stable visual acuity in 7 eyes (46.6%) and worsening of vision in 3 eyes (20%). For the second group, 8 eyes (53.3%) showed improvement, stability in 4 eyes (26.7%), and worsening vision in 3 eyes (20%) with p-value &gt; 0.05. Conclusion: Retinectomy is beneficial in treating severe PVR and improves, ultimate retinal reattachment rate.

Pediatric keratoconus in a tertiary eye hospital in Eastern province, Saudi Arabia: Patient characteristics and management outcomes.

This study investigates pediatric keratoconus in a tertiary eye hospital in Eastern Province, Saudi Arabia, aiming to understand the presenting features and treatment outcomes in this high-prevalence region. The research addresses pediatric keratoconus clinical profile and management strategies. A retrospective cohort study was conducted from 2022 to 2023, reviewing medical records of pediatric keratoconus patients. Demographic data, clinical characteristics, risk factors, presenting symptoms, and treatment outcomes were recorded. Severity staging was performed based on Amsler-Krumeich's classification. The study included 218 eyes from 109 pediatric keratoconus patients, with 65% of male and 35% of female patients. Decreased vision was the most common symptom (92%), and risk factors included a family history of keratoconus (9%) and vernal keratoconjunctivitis (6%). Stage 1 was the most frequent in both age groups (<14 years and ≥ 14 years). Treatment strategies included corneal collagen cross-linking (CXL), hard contact lenses, corneal rings, deep anterior lamellar keratoplasty (DLK), and penetrating keratoplasty. Significant improvements were observed in visual acuity, refractive errors, and tomographic parameters following these interventions. This study provides valuable insights into pediatric keratoconus in Saudi Arabia, emphasizing the importance of early diagnosis and interventions for better outcomes. Larger, multicenter prospective studies are essential for a comprehensive understanding of pediatric keratoconus and its optimal management. The findings contribute to the knowledge base and guide future research to improve patient quality of life.

Awareness of Diabetic Retinopathy among Patients with Diabetes Mellitus Attending the Tertiary Eye Hospital in Nepal: A Descriptive Cross-sectional Study

Abstract Introduction: Lack of knowledge of the need for regular diabetic retinopathy screening (DRS) has turned many patients in the advanced stage of DR before first eye check-ups. Unfortunately, data on the knowledge, attitude, and behaviour of diabetic patients with DR are not satisfactory in Nepal. Here, we aim to assess the factors predisposing to awareness levels in the Nepalese context. Methods: This was an observational cross-sectional study enrolling 369 diabetic patients visiting the Hospital for Children, Eye, ENT and Rehabilitation Services between March 2020 and February 2021 after obtaining ethical clearance from the Nepal Health Research Council. A convenience sampling technique was used. The questionnaire was utilized to assess basic demographic profiles, awareness about diabetic retinopathy, and sources of information on the need for diabetic eye check-ups. Results: The mean (standard deviation) age of diabetes mellitus (DM) patients was 56.26 (11.13) years. The age group of 40–59 years comprised more than half of the total patients. Awareness of DR was 86.7% in this study. Education level and the duration of DM were directly proportional to the awareness level. Healthcare workers or physicians were the primary sources of information on awareness. Conclusions: Awareness of poor visual consequences of DR among patients with diabetes in Nepal is relatively satisfactory. However, patients’ willingness to undergo retinopathy check-ups was not up to the mark. Therefore, we recommend finding out the barrier to poor compliance with diabetic retinopathy in the future. The consumer-focussed health educational interventions and physician-based skills and the DRS facility would improve the awareness level in Nepal.

Real-World 1-Year Outcomes of Treatment-Intensive Neovascular Age-Related Macular Degeneration Switched to Faricimab

PurposeTo report one-year anatomical and functional real-world outcomes of treatment intensive neovascular age related macular degeneration (nAMD) patients switched to faricimab DesignRetrospective multi-centre cohort study SubjectsConsecutive nAMD patients on 4-weekly treatment interval with either ranibizumab or aflibercept 2mg in the last three visits within a treat and extend protocol (high treatment burden) prior to switch to faricimab at Moorfields Eye Hospital between 5/9/2022- 5/12/2022. MethodsTotal number of nAMD patients switched to faricimab were identified from electronic medical records and those who met criteria of high treatment burden were included. Data collected included pre and post-switch visual acuity (VA), treatment intervals, length of follow-up, baseline macular morphology, changes in central subfield thickness (CST), macular fluid status and adverse events. Main outcome measuresVA, CST, presence of intraretinal fluid (IRF), subretinal fluid (SRF) and injection intervals over one-year following switch to faricimab. ResultsA total of 130/ 286 (45.5%) eyes met inclusion criteria of being switched due to high treatment burden and 117 were included in analysis. Prior to switch to faricimab, these eyes received mean total number of injections of 33.4±19.6 over mean of 51.3±34.9 months. Mean number of injections in 12 months preceding switch was 10.1±1.6 and mean interval of the preceding three injections was 4.2±0.3 weeks. Mean VA, CST and percentage of patients with dry macula prior to switch were 66.0±11.9 ETDRS letters, 259.6±76.0μm and 18.3% respectively. Following switch, there was no statistical difference in mean VA after each visit and at 12 months. Mean CST statistically significantly reduced following the 3rd faricimab injection and at 12 months by 20.0μm (p=0.035) and 22.1μm (p=0.041) respectively. Mean treatment intervals increased to 6.9±2.3 weeks (p<0.005) at 12 months with 42.9% and 11.4% of patients being on ≥8 weekly and ≥12 weekly treatment intervals respectively. ConclusionAt 12 months, patients with nAMD with previous record of high treatment burden when switched to faricimab maintained visual acuities and improved anatomical outcomes on extended treatment intervals. Physician bias is inherent in these types of observational studies so a prospective randomised controlled trial is recommended to validate these findings.

Causes of Visual Impairment in a Sample of Adult Iraqi Patients

Purpose: To identify causes of visual impairment in adult patients seeking treatment at teaching hospital in Iraq. Study Design: Descriptive observational. Place and Duration of Study: Ibn Al-Haytham Teaching Eye Hospital (IAHTEH) in Baghdad, Iraq during the year 2023. Methods: This study comprised of 125,804 adults. All the participants had comprehensive history and ocular examination. Mild, moderate and sever visual impairment were defined as from 6/9 to 6/18, 6/24 to 6/36 and 6/60 or below respectively. Results: Among 125,804 patients, the breakdown of conditions was as follows: 60,650 (48%) had cataracts, 37,741 (30%) had refractive errors, 12,071 (10%) had diabetic retinopathy, 8,328 (7%) had glaucoma, and 7,014 (5%) had experienced trauma. Most patients (54%) had severe visual impairment, followed by moderate (29%) and mild (17%) impairment. The majority of cases (45%) were in individuals aged 60 years and older, with 26% in the 40-59 years age group and 29% in the 20-39 years age group. Diabetic retinopathy was most common in the 40-59 years age group, while glaucoma and cataracts were predominantly in those aged 60 and above. Refractive errors and trauma were mainly found in the 20-39 years age group. Females accounted for 63% of patients with reduced vision, whereas males predominated among trauma cases, with 29% of trauma cases involving blunt trauma. Conclusion: Cataract is the most prevalent condition in older patients. Younger adults frequently experience refractive errors and trauma. Females are more likely to have reduced vision, whereas males are more prone to trauma-related vision issues.

Quantiferon-TB Gold Test in Diagnosis of Tubercular Uveitis

Background: Tuberculosis can occur in eye as a result of an active infection or immunological reaction to the tuberculosis antigen. One of the most accurate tests for suspected ocular tuberculosis is the Quantiferon TB Gold (QFT-G) test, which has a higher specificity than the Tuberculin Skin Test (TST) especially among persons vaccinated with bacillus Calmette-Guérin (BCG) and the fact that most environmental mycobacteria give TST positive results. Methods: We retrospectively reviewed thirty nine presumed ocular tuberculosis cases who had both TST and QFT-G test prior to anti-tuberculosis treatment (ATT) in the National Institute of Ophthalmology and Hospital and Vision Eye Hospital, Dhaka from January, 2019 to December, 2021. Patients who had concomitant pulmonary or other extra pulmonary tuberculosis were excluded from the study. Results: The most common anatomical type of uveitis was posterior uveitis 24(61.5%) and vasculitis retinae 8(20.5%) was the commonest form of specific pattern of uveitis. MT test was positive in 18(46.2%) and QFT-G test was positive in 17 (43.6%) patients. Multifocal choroiditis was commonest form of QFT-G positive uveitis 5(29.5%). There was no significant association of positive QFT-G test with any subset of uveitis (p&gt;0.05). Conclusion: As our study found no significant association of positive QFT-G in patients with any anatomical variety of uveitis or specific variety of uveitis we should advice QFT-G judicially to patients of suspected TBU who have positive TST.

PATIENT FEEDBACK AS A TOOL FOR IMPROVING EYE CARE SERVICES: INSIGHTS FROM THREE HOSPITALS IN NEPAL

This study evaluates the quality of care and patient satisfaction across three eye hospitals in Nepal: Rapti Eye Hospital, Lamahi Eye Hospital, and Chhanda Kalebabu Eye Hospital. Although these institutions operate under the same overarching management, they are situated in different locations and governed by distinct administrative management subcommittees. The main purpose of the study is to identify differences in patient satisfaction levels among the three hospitals. Additionally, the research seeks to assess the effectiveness of management, recognizing that while these hospitals share a common management board, the quality of care is heavily influenced by the technical and administrative leadership unique to each hospital. A total of 300 patients were surveyed—100 from each hospital—using the SERVQUAL model questionnaire to measure patient satisfaction, a critical indicator of healthcare service quality. The findings reveal key insights into each hospital's performance, highlighting areas of strength and potential improvement. By understanding patient satisfaction levels, hospital management can address weaker aspects of service delivery and enhance overall patient care. This research underscores the importance of patient feedback in evaluating hospital services and informs strategic efforts for continuous improvement in the healthcare system.

Prevalence of Amiodarone induced vortex keratopathy at Benghazi National Cardiac Centre

Abstract: Aim: to find out the prevalence of amiodarone induced vortex keratopathy among patients admitted to Benghazi cardiac center, and to grade this finding according to dose and duration of use. Patients and Method: The descriptive cross-sectional study was conducted from 1st of January to end of February 2024 at national cardiac center and Benghazi teaching eye hospital, all patients admitted to cardiac center during six months period (from June to November 2023) and received amiodarone as part of their treatment (45) cases were included in this study. Result: A total of 1056 cases admitted to cardiac center, 45 (4.3) cases received amiodarone Among the 45 cases, 24 were male and 21 were female. Their age ranged from 20 to 80. 41 were Libyan, 4 were non-Libyan. 39 were from Benghazi. From the 45 cases, 24 (53%) were able to come for ophthalmic assessment. Out of 24 cases, 18(75%) had vortex keratopathy, most of them with grade II (33%). Among those with vortex keratopathy, nine had visual complains as reduced vision, halos around light. six out of nine who had visual complains had other findings contribute to reduced vision other than keratopathy (cataract, posterior capsular opacification, high myopia, diabetic retinopathy and its complications). Three out of those nine patients had visual complains but no other findings except for vortex keratopathy. Nine patients showed vortex keratopathy with no other pathology and didn't have any complains and their visual acuity was 6\6. No other ocular complications of amiodarone use were found among our study group.

Cash Waqf Linked Sukuk (CWLS) sebagai Implementasi Filantropi Islam Berkelanjutan

Cash Waqf Linked Sukuk (CWLS) is an innovative instrument of state sukuk with waqf. The novelty of this innovation needs to be analyzed for the distribution of funds and their usefulness. The purpose of this research is to analyze the impact of CWLS in Islamic philanthropy. This research uses qualitative methods with library research. The data obtained comes from OJK financial reports, journals, articles, and documents related to CWLS. The results of this study show that the first series of CWLS (SW0001) was used for the development of the Retina and Glaucoma center at Achmad Wardi Eye Hospital, Serang, Banten Province. This is in accordance with Islamic philanthropy as a form of social and sustainable generosity.

Two-Year Clinical Outcomes of the PAUL Glaucoma Implant in White Patients With Refractory Glaucoma.

This prospectively collected case series of 56 eyes having PAUL glaucoma implant (PGI) surgery is the first to demonstrate its medium-term safety and effectiveness in what is essentially an exclusively Caucasian population. To report 2-year outcomes from a single-center cohort undergoing PGI surgery. Prospectively collected data on patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. Of 53 patients, 56 eyes were included. Complete and qualified success rates (95% CI) were 52% (37-66) and 89% (80-96) for criterion A ( intraocular pressure [IOP]≤21mm Hg), 48% (36-61) and 79% (67-88) for criterion B (IOP≤18mm Hg), 45% (32-57) and 64% (52-77%) for criterion C (IOP≤15mm Hg) and 27% (16-40) and 38% (25-50) for criterion D (IOP≤12mm Hg), respectively. Mean IOP decreased from 25.43mm Hg (7-48mm Hg) to 11.25mm Hg (3-24mm Hg) (reduction of 50%) after 24 months with a reduction of IOP-lowering agents from 3.50 (1-5) to 0.46 (0-3). One eye needed an injection of viscoelastic due to significant hypotony with AC shallowing; 3 eyes received a Descemet membrane endothelial keratoplasty because of persistent corneal decompensation; 9 eyes developed tube exposure which required conjunctival revision with additional pericardial patch graft, with 5 of these eyes eventually needing tube explantation. An intraluminal prolene stent was removed in 24 eyes (42.9%) after a mean time period of 5.67 months (2-15m). Mean IOP before removal was 21.4mm Hg (12-40mm Hg) and decreased to 11.15mm Hg (6-20mm Hg). PGI surgery is an effective procedure for reducing IOP and pressure-lowering therapy. The use of an intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further noninvasive IOP lowering during the postoperative course.

Quantifying Changes on OCT in Eyes Receiving Treatment for Neovascular Age-Related Macular Degeneration

PurposeApplication of artificial intelligence (AI) to macular optical coherence tomography (OCT) scans to segment and quantify volumetric change of anatomical and pathological features during intravitreal treatment for neovascular age-related macular degeneration (AMD). DesignRetrospective analysis of OCT images from the Moorfields Eye Hospital AMD Database. Participants2115 eyes from 1883 patients that started anti-vascular endothelial growth factor (anti-VEGF) treatment between 1st June 2012 and 30th June 2017. MethodsThe Moorfields Eye Hospital neovascular AMD database was queried for first and second eyes that received anti-VEGF treatment and had an OCT scan at baseline and at 12 months. Follow-up scans were input into the AI system to derive volumetric outputs for the following variables: intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), subretinal hyperreflective material (SHRM), hyperreflective foci (HRF), neurosensory retina (NSR) and retinal pigment epithelium (RPE). Volumes were studied at different time points and comparisons made with respect to baseline volume groups. Cross-sectional comparisons between time points were conducted using Mann-Whitney U test. ResultsMean volumes of analysed features decreased significantly from baseline to both four and 12 months, in both first and second-treated eyes. Pathological features that reflect exudation, including pure fluid components (IRF and SRF) and those with a mixture of fluid and fibrovascular tissue (PED and SHRM), displayed similar response to treatment over 12 months. Mean PED and SHRM volumes showed less pronounced but also substantial decreases over the first two months, reaching a plateau post loading phase, and minimal change to 12 months. Both NSR and RPE volumes showed gradual reductions over time, and not as substantial as exudative features. Conclusion:We report the results of a quantitative analysis of change in retinal segmented features over time, enabled by an AI segmentation system. Cross-sectional analysis at multiple time points demonstrated significant associations between baseline OCT-derived segmented features and the volume of biomarkers at follow-up. Demonstrating how certain OCT biomarkers progress with treatment and the impact of pre-treatment retinal morphology on different structural volumes may provide novel insights into disease mechanisms and aid personalization of care. Data will be made public for future studies.

Reusing surgical materials for cataract surgery: an assessment of potential contamination.

To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases. Aravind Eye Hospital, Pondicherry, Tamil Nadu, India. Prospective cohort study. Samples from multiple surgical instruments and products that were reused for consecutive cataract surgeries underwent bacterial and fungal cultures and were monitored alongside positive controls for 7 days. This included instruments that were processed using immediate use steam sterilization (IUSS) between cases (eg, surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation/aspiration [I/A] tips, phacoemulsification and I/A sleeves) (Group 1), instruments that were used without sterilization between cases (eg, phacoemulsification tubing/handpieces, coaxial I/A handpieces) (Group 2), and the residual (unused) fluid from balanced salt solution bags after being used for multiple patients (Group 3). 3333 discrete samples were collected from all 3 product groups that were reused across multiple patients. In all collected samples, no bacterial or fungal growth was observed. Of the 3241 cataract surgeries that used reused and IUSS-sterilized instruments alongside instrument sets cultured on the same day and balanced salt solution bags shared across multiple patients, no eyes developed endophthalmitis over a 6-week follow-up period. Bacterial or fungal growth was not found in extensive microbiological cultures of IUSS-sterilized ophthalmic surgical instruments and cataract surgical products that were reused in multiple patients. This microbiological data complements clinical endophthalmitis data from 2 million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care.