Ophthalmic Disease Research Articles

Artificial intelligence-based differential diagnosis of orbital MALT lymphoma and IgG4 related ophthalmic disease using hematoxylin-eosin images.

To investigate the possibility of distinguishing between IgG4-related ophthalmic disease (IgG4-ROD) and orbital MALT lymphoma using artificial intelligence (AI) and hematoxylin-eosin (HE) images. After identifying a total of 127 patients from whom we were able to procure tissue blocks with IgG4-ROD and orbital MALT lymphoma, we performed histological and molecular genetic analyses, such as gene rearrangement. Subsequently, pathological HE images were collected from these patients followed by the cutting out of 10 different image patches from the HE image of each patient. A total of 970 image patches from the 97 patients were used to construct nine different models of deep learning, and the 300 image patches from the remaining 30 patients were used to evaluate the diagnostic performance of the models. Area under the curve (AUC) and accuracy (ACC) were used for the performance evaluation of the deep learning models. In addition, four ophthalmologists performed the binary classification between IgG4-ROD and orbital MALT lymphoma. EVA, which is a vision-centric foundation model to explore the limits of visual representation, was the best deep learning model among the nine models. The results of EVA were ACC = 73.3% and AUC = 0.807. The ACC of the four ophthalmologists ranged from 40 to 60%. It was possible to construct an AI software based on deep learning that was able to distinguish between IgG4-ROD and orbital MALT. This AI model may be useful as an initial screening tool to direct further ancillary investigations.

Scope of Ayurveda treatment in Myopia: A systematic review of current trends

Abstract BACKGROUND: Though myopia is an ophthalmic refractive error disease that is commonly managed with refractive glasses and advanced surgeries, it still remains a refractive condition of great concern. Patients often resort to alternate methods to rectify or manage myopia and prevention of its progression. Ayurveda refers to myopia as Timira (errors of refraction), characterized by disturbances in vision; hence, it is considered to be a part of Drishtigata Rogas (eyesight disorders). According to the Ayurvedic perspective, myopia is primarily a result of vitiated Doshas, particularly the imbalance of the Vata Dosha, which impairs the eye muscles and lens, resulting in the inability to focus on distant objects. MATERIALS AND METHODS: This review adhered to the 2020 PRISMA guidelines and involved a comprehensive search of PubMed, Scopus, and UGC-CARE-listed Ayurveda journals from January 2000 to September 2023. The focus was on randomized controlled trials examining Ayurvedic interventions, including topical and oral therapies, for managing myopia or Timira. The search aimed to identify all relevant studies published within the specified timeframe. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was utilized to evaluate the risk of bias. RESULTS: A total of six publications in credible journals were found and analyzed, which revealed that practices such as Netra Tarpana (retaining of medicated ghee over the eye), Nasya (medication through the nasal route), Anjana (collyrium), use of Triphala, Ayurvedic formulations, yoga, and specific eye exercises can enhance the strength of ocular muscles, promote better nourishment of ocular tissues, and foster overall eye health. CONCLUSION: By implementing prophylactic measures, followed by therapeutic and systemic therapies, myopia can be controlled with a multidimensional approach, but due to limited sources of evidence, the certainty can only be proven after extensive clinical trials.

Infraorbital nerve involvement as a pathognomonic sign of IgG4-related ophthalmic disease

Infraorbital nerve involvement as a pathognomonic sign of IgG4-related ophthalmic disease

Developing a quantitative method of mangiferin in rabbit lacrimal fluid as a tool for investigating pre-cornea drug residence

Mangiferin (MGF) has been evidenced to effectively treat infectious diseases caused by Herpes simplex virus, especially on the acyclovir-resistant strains. For ophthalmic disease treatment, prolonging drug retention in the eyes plays an essential role in effectively delivering drugs, which are prone to elimination by eye blinking and tear fluid secretion. The objective of this study was to develop a method for analysis of MGF in tear fluid that can be further utilised to evaluate the kinetics of precornea drug concentration. For sample collection, lacrimal tear fluid was absorbed into pre-weighed absorbing paper strips, which were then immediately weighed again right after sampling to calculate the sample mass. Subsequently, MGF was extracted from the paper strips using a mixture of methanol : acetic acid 0.6% (35:65, v/v). The extracted solution was finally injected into an HPLC system for MGF analysis (RP-column C18 - 4.6 x 250 mm, 5 μm was stabilised at 40oC; moblie phase methanol : acetic acid 0.6%; 35 : 65 (v/v) at a flow rate of 1.0 mL/min; autosampler, injection volume 10 µL; detection wavelength: 258 nm). The developed methodology was validated following the U.S. FDA and ICH M10 guidances for bioanalytical method validation, with respect to system suitability, linearity, recovery, accuracy and precision, dilution integrity and stability. The method was also successfully employed to determine MGF concentration in the tear fluid collected from rabbit eyes at one hour after instilling with MGF suspension. The methodology herein provides a practical tool to investigate kinetics of MGF in tear fluid that can be applied in ophthalmic drug development as well as drug quality evaluation activities.

Acupuncture therapy for isolated ischemic oculomotor nerve palsy: A case report.

Isolated ischemic oculomotor nerve palsy as a type of ophthalmic disease is rarely observed in clinical practice. Quality of life is frequently impacted by isolated ischemic oculomotor nerve palsy due to its lack of treatment options and long-term visual impairment. We describe an acupuncture-treated instance of isolated ischemic oculomotor paralysis. Acupoints including Jingming (BL 1), Chengqi (ST 1), Cuanzhu (BL 2), and Sizhukong (TE 23) on the right side, and bilateral Fengchi (GB 20), Waiguan (TE 5), Hegu (LI 4), and Zulinqi (GB 41) were selected for needling. Each treatment lasted for 30 minutes, once every other day. Acupuncture treatment was administered for a total of 11 times. Acupuncture is a promising treatment option for isolated ischemic oculomotor nerve palsy. Ischemic oculomotor nerve paralysis can affect the quality of life of patients. Acupuncture intervention can promote the recovery of the disease is a very effective treatment measure.

The timing and challenges of early intervention for infantile esotropia

Infantile esotropia is a common ophthalmic disease in children. A lot of clinical and basic research evidence suggests that early surgery enhances sensory and ocular motor development. However, the proper timing of surgery has been debated for decades. In addition, there is more likely instability of deviation in the preoperative evaluation of infants, and even if the patient achieved alignment after surgery, the defects in binocular vision may accompany for a lifetime. This article analyzes the difficulties and key points of early intervention for infantile esotropia, aiming to provide scientific ideas for the early treatment of children with infantile esotropia in China.

Awareness About Glaucoma and Associated Factors Among Glaucoma Patients Visiting Munawar Memorial Hospital Chakwal

Glaucoma is a significant public health problem worldwide blindness after cataract is attributed to this ophthalmic disease. The resultant blindness is mostly irreversible. Its earlier detection is imperative to prevent blindness. Objective: To ascertain the awareness about glaucoma and associated factors among glaucoma patients in association with family history. Methods: A cross-sectional descriptive hospital base study was done among 21 glaucoma patients at Munawar Memorial Hospital Chakwal from October – December 2021. The patients were enrolled through consecutive sampling. Data were gathered from the patients through self-structured questionnaire pertaining to demographics, family history, association of glaucoma with blindness, reversibility of resultant blindness, treatment in addition to prevention and cure of blindness. Data were analysed by SPSS version 25.0. Apart from descriptive statistics, Fisher’s exact test was also applied to measure the association of family history of glaucoma with other factors. p<0.05 was taken as significant. Results: Of the 21glaucoma patients, most (63%) were males and 11 patients had positive family history. Overall, 25% patients knew about the disease. Mean age of the respondents was 50.52 ± 22.5 years. Almost 72.2% of the patients with positive family history were aware about the prevention of blindness resulting from glaucoma (p<0.05). on the other hand, 81.8% of the patients with negative family knew about cure. 81.8% of the patients knew the purpose of treatment (p<0.05). Conclusions: There was scarcity of knowledge about glaucoma among patients. Despite the positive family history, knowledge of glaucoma patients about their disease was deficient.

Mendelian randomization in eye disorders (review)

Background: Mendelian randomization (MR) is an analytic approach in genetic epidemiology which uses the results of genome-wide association studies (GWAS) to assess causal relationships between various risk factors and phenotypes of interest (or diseases) in ophthalmology. The aim of the study: To describe the current opportunities for the use of MR in ophthalmic research. Materials and methods: We searched Scopus, Medline and Web of Science journals up to August 2022 using the PRISMA protocol “Preferred Reporting Items for Systematic Review and Meta-Analysis”. The following information was extracted: identified risk factor(s) and disease(s), design of Mendelian randomization study, sensitivity analysis(es) performed if any, genetic instrument(s) used, and also whether the causal relationship between risk and outcome was confirmed by the results of the study. Results: The current review included a total of 37 publications that tested 211 associations of a risk factor with an ophthalmic disease. The articles included were published in peer-reviewed journals up to August 2022 with 25 of them (67,5%) published in 2020 or later. The MR method indicated the causal role of blood serum lipids, C-reactive protein, free thyroxine, smoking and alcohol intake in the development of age-related macular degeneration. For glaucoma, type 2 diabetes, serum glucose, refractive abnormalities, and elevated intraocular pressure have been shown to be significant. MR analysis revealed the role of elevated intraocular pressure, level of education, body weight at birth in the development of refractive errors. The role of type 2 diabetes, hypertension and smoking in the development of cataracts was determined using the MR method. Conclusion: The results of 97 MR analyses in ophthalmology have revealed a significant role of a number of risk factors in the development of eye diseases, which will serve as a guideline for clinical trials and drug development.

Clinical profile and challenges faced in the management of optic neuritis: the Indian scenario.

Optic neuritis (ON) is a relatively common ophthalmic disease that has recently received renewed attention owing to immunological breakthroughs. We studied the profile of patients with ON with special reference to antibody-mediated ON and the challenges faced in its management. Caserecords of patients with ON presenting to a tertiary eye-care center in South India were analyzed. Data on demographics, presenting visual acuity (VA), clinical features, seropositivity for aquaporin-4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG), details of magnetic resonance imaging (MRI) of orbits and brain, and treatment were collected. Among138cases with acute ON, male: female ratio was 1:2. Isolated ON was present in 41.3% of cases. Antibody testing of sera was performed in 68 patients only due to financial limitations. Among these, 48.5% were MOG-IgG-seropositive, 11.76% were AQP4-IgG-seropositive, and 30.88% samples were double seronegative. Other causes included multiple sclerosis (n = 4), lactational ON (n = 4), tuberculosis (n = 2), invasive perineuritis (n = 2), COVID-19 vaccination (n = 2), and COVID-19 (n = 1). The mean presenting best corrected visual acuity (BCVA) was 1.31 ± 1.16 logMAR (logarithm of the minimum angle of resolution). The mean BCVA at 3months was 0.167 ± 0.46 logMAR. Only initial VA ≤ 'Counting fingers' (CF) had a significant association with the visual outcome for final VA worse than CF. The steep cost of investigations and treatment posed challenges for many patients in the management of ON. MOG-IgG-associated ON is common in India. Unfortunately, financial constraints delay the diagnosis and timely management of ON, adversely affecting the outcome.

Ocular biometry in rabbits using computed tomography.

To describe a repeatable method of measuring ocular structures and to establish ocular biometry reference ranges in adult domestic rabbits (Oryctolagus cuniculus) without medical history or imaging findings consistent with ophthalmic disease using a 64-slice multidetector computed tomography scanner. In this retrospective and observational anatomic study, 100 eyes from 50 rabbits without medical history or imaging findings consistent with ophthalmic disease who received a head computed tomography scan were selected for measurement of globe length, width, and height using 3D multiplanar reconstruction. Lens width and length, the anteroposterior length of the anterior and vitreous chambers, and attenuation of the lens and vitreous chamber were collected. These parameters were compared against age, sex, weight, body condition, and ear conformation. A reference guide was established, with globe width being the largest dimension (18.03 ± 0.81 mm), followed by height (17.18 ± 0.69 mm) and then length (16.64 ± 0.66 mm). Increased weight was associated with an increase in globe height (p = 2.43 × 10-5 ), length (p = 1.63 × 10-4 ), and width (p = 7.0 × 10-3 ). Increased age was associated with increased lens attenuation (p = 1.28 × 10-7 ) and increased transverse lens width (p = 1.64 × 10-3 ). Inter- and intra-observer agreement was excellent. CT is a reliable modality for measurement of ocular biometry dimensions in rabbits. These reference values can be applied to aid in identifying diseases that affect the dimensions of the ocular structures in rabbits over 18 months of age.

Extracellular vesicle biomarkers in ocular fluids associated with ophthalmic diseases

Extracellular vesicles (EVs) are released as highly stable lipid bilayer particles carrying proteins, lipids, glycans and miRNAs. The contents of EVs vary based on the cellular origin, biogenesis route and the functional state of the cell suggesting certain diseased conditions. A growing body of evidence show that EVs carry important molecules implicated in the development and progression of ophthalmic diseases. EVs associated with ophthalmic diseases are mainly carried by one of the three ocular biofluids which include tears, aqueous humor and vitreous humor. This review summarizes the list of EV derived biomarkers identified thus far in ocular fluids for ophthalmic disease diagnosis. Further, the methods used for sample collection, sample volume and the sample numbers used in these studies have been highlighted. Emphasis has been given to describe the EV isolation and the characterization methods used, EV size profiled and the EV concentrations analyzed by these studies, thus providing a roadmap for future EV biomarker studies in ocular fluids.

Design and Characterization of Ocular Inserts Loaded with Dexamethasone for the Treatment of Inflammatory Ophthalmic Disease.

The short precorneal residence time of ophthalmic drops is associated with their low absorption; therefore, the development of ocular inserts capable of prolonging and controlling the ophthalmic release of drugs is an interesting option in the design and development of these drugs. A surface response design was developed, specifically the Central Composite Design (CCD), to produce ophthalmic films loaded with Dexamethasone (DEX) by the solvent evaporation method having experimental levels of different concentrations of previously selected polymers (PVP K-30 and Eudragit RS100.). Once optimization of the formulation was obtained, the in vivo test was continued. The optimal formulation obtained a thickness of 0.265 ± 0.095 mm, pH of 7.11 ± 0.04, tensile strength of 15.50 ± 3.94 gF, humidity (%) of 22.54 ± 1.7, mucoadhesion strength of 16.89 ± 3.46 gF, chemical content (%) of 98.19 ± 1.124, release of (%) 13,510.71, and swelling of 0.0403 ± 0.023 g; furthermore, in the in vivo testing the number and residence time of PMN cells were lower compared to the Ophthalmic Drops. The present study confirms the potential use of polymeric systems using PVPK30 and ERS100 as a new strategy of controlled release of ophthalmic drugs by controlling and prolonging the release of DEX at the affected site by decreasing the systemic effects of the drug.

Retrospective assessment of ophthalmic disease development in domestic dogs and cats when hospitalised with tick paralysis caused by Ixodes holocyclus.

To investigate the incidence and predisposing factors leading to the development of corneal ulcers and the loss of a palpebral reflex in hospitalised canine and feline patients with tick paralysis (TP). A total of 102 dogs and 100 cats retrospectively were assessed from previously hospitalised patients. A retrospective cohort study was performed on 102 different canine and 100 different feline patients who were hospitalised for TP from October 2020-January 2022. Patient data were collected, and logistic regression was conducted to determine factors affecting the palpebral reflex and the development of corneal ulcers. Corneal ulcers occurred in 23/102 (22.5%) dogs during hospitalisation and were strongly associated with an incomplete palpebral reflex ipsilaterally during hospitalisation (P < 0.001), hospitalisation ≥3 days (P = 0.004), mechanical ventilation ≥3 days (P = 0.015) or a tick location cranial to C1 (P = 0.003). An incomplete palpebral reflex during hospitalisation was observed in 29/102 (28.4%) dogs and was significantly associated with decreasing patient weight (P = 0.018), increasing days hospitalised (P = 0.001), having a tick found cranial to C1 (P = 0.004), highest recorded GP grade (P = 0.01), highest recorded RP grade (P = 0.005), use of amoxycillin-clavulanic acid during hospitalisation (P = 0.002) and use of piperacillin/tazobactam during hospitalisation (P = 0.003). There was a significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in dogs (OR = 4.5, P = 0.029). Corneal ulcers occurred in 10/100 (10.0%) cats during hospitalisation, and was significantly more likely to occur to an eye if an incomplete palpebral reflex was observed ipsilaterally during hospitalisation (OR = 20.1, P < 0.0001) and with increasing patient age (P = 0.019). The absence of a complete palpebral reflex during hospitalisation was observed in 18/10 (18.0%) cats and was significantly associated with increasing days hospitalised (P = 0.034). There was no significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in cats. The frequency of corneal ulcers and loss of palpebral reflexes were significant in dogs and cats hospitalised by TP, with many factors contributing to the risk of these developing.

Self-attention CNN for retinal layer segmentation in OCT.

The structure of the retinal layers provides valuable diagnostic information for many ophthalmic diseases. Optical coherence tomography (OCT) obtains cross-sectional images of the retina, which reveals information about the retinal layers. The U-net based approaches are prominent in retinal layering methods, which are usually beneficial to local characteristics but not good at obtaining long-distance dependence for contextual information. Furthermore, the morphology of retinal layers with the disease is more complex, which brings more significant challenges to the task of retinal layer segmentation. We propose a U-shaped network combining an encoder-decoder architecture and self-attention mechanisms. In response to the characteristics of retinal OCT cross-sectional images, a self-attentive module in the vertical direction is added to the bottom of the U-shaped network, and an attention mechanism is also added in skip connection and up-sampling to enhance essential features. In this method, the transformer's self-attentive mechanism obtains the global field of perception, thus providing the missing context information for convolutions, and the convolutional neural network also efficiently extracts local features, compensating the local details the transformer ignores. The experiment results showed that our method is accurate and better than other methods for segmentation of the retinal layers, with the average Dice scores of 0.871 and 0.820, respectively, on two public retinal OCT image datasets. To perform the layer segmentation of retinal OCT image better, the proposed method incorporates the transformer's self-attention mechanism in a U-shaped network, which is helpful for ophthalmic disease diagnosis.

Challenges in Diagnosing Functional Visual Loss and Malingering: a Case Report

Abstract&#x0D; Introduction : Functional Visual Loss (FVL) is decreased visual acuity and/or altered visual fields without any associated organic pathology and is considered within the spectrum of malingering. It manifests as either simulating an ophthalmic disease or denying ophthalmic disease. Thorough history-taking and careful examination of the patient are essential in reaching the diagnosis.&#x0D; Case Illustration : A 17-year-old female came with complaints of a spinning headache, sudden and painless blurry vision in both eyes, double vision, and a history of syncope for the last two days. Ophthalmology examination revealed UCVA was 0.5/60 for both eyes with inconsistent answers from the patient. The confrontation test, light reflex, funduscopy, Humphrey visual test, OCT, and MRI were normal. Malingering was suspected and a psychiatric consultation was made. The patient was found to be a victim of bullying and had a history of visual hallucinations. The patient was then diagnosed with severe depression with psychotic signs.&#x0D; Discussion : &#x0D; Conclusion : FVL can be suspected when there is inconsistency in the results of some clinical basic tests. Despite the association between FVL and psychological problems like depression is complicated, this condition may occur in a bidirectional relationship in which depression leads to disability or contrarily. In conclusion, diagnosing visual problems in malingering patients can be challenging. Subjective and objective tests are needed to help practitioners confirm the malingering state of the patient. Practitioners also should be aware of the underlying risk of psychological problems among persons reporting visual function loss.

Big data to guide glaucoma treatment.

Ophthalmology has been at the forefront of the medical application of big data. Often harnessed with a machine learning approach, big data has demonstrated potential to transform ophthalmic care, as evidenced by prior success on clinical tasks such as the screening of ophthalmic diseases and lesions via retinal images. With the recent establishment of various large ophthalmic datasets, there has been greater interest in determining whether the benefits of big data may extend to the downstream process of ophthalmic disease management. An area of substantial investigation has been the use of big data to help guide or streamline management of glaucoma, which remains a leading cause of irreversible blindness worldwide. In this review, we summarize relevant studies utilizing big data and discuss the application of the findings in the risk assessment and treatment of glaucoma.

The effect of sarcopenic obesity and age-related ophthalmopathology on the state of basic functional activity

BACKGROUND: Along with an increase in the number of elderly and senile populations, there will simultaneously be an increase in the prevalence of age-associated ophthalmopathology and sarcopenic obesity, which can potentially contribute to a decrease in patients’ activities in everyday life, but the latter remains practically unexplored, and if analyzed, then without the use of special scales for patients with visual organ pathology or quality of life indicators.&#x0D; AIM: To study the effect of sarcopenic obesity and age–associated ophthalmopathology on the activities of patients in everyday life.&#x0D; MATERIALS AND METHODS: 125 mature and elderly patients suffering from sarcopenic obesity combined with cataract and 138 patients of similar age with sarcopenic obesity combined with glaucoma were examined. Sarcopenic obesity was detected by the presence of obesity with a body mass index ≥30,0 kg/m2 and sarcopenia on the scale of the European Working Group on Sarcopenia in older people, supplemented by carpal dynamometry.&#x0D; RESULTS: It was found that, in comparison sarcopenic obesity with age-related cataracts, it has a more significant effect on changing activities in daily life, contributing to the formation of complete dependence on outside help (12,18 points) compared with sarcopenic obesity and glaucoma (10,18 points) (p 0,001), when moderate dependence on others was found. However, regardless of the nosology of the ophthalmic disease, in both clinical groups, the leading limitations of activities in daily life were needle threading (1,84±0,03 vs 1,52±0,02 points), nail clipping (1,75±0,03 vs 1,43±0,04 points), respectively.&#x0D; CONCLUSIONS: The results obtained can be used in gerontology in the implementation of measures to correct and maintain functionality in the daily life of patients with sarcopenic obesity combined with glaucoma and cataracts.

Applications of deep learning for detecting ophthalmic diseases with ultrawide-field fundus images.

To summarize the application of deep learning in detecting ophthalmic disease with ultrawide-field fundus images and analyze the advantages, limitations, and possible solutions common to all tasks. We searched three academic databases, including PubMed, Web of Science, and Ovid, with the date of August 2022. We matched and screened according to the target keywords and publication year and retrieved a total of 4358 research papers according to the keywords, of which 23 studies were retrieved on applying deep learning in diagnosing ophthalmic disease with ultrawide-field images. Deep learning in ultrawide-field images can detect various ophthalmic diseases and achieve great performance, including diabetic retinopathy, glaucoma, age-related macular degeneration, retinal vein occlusions, retinal detachment, and other peripheral retinal diseases. Compared to fundus images, the ultrawide-field fundus scanning laser ophthalmoscopy enables the capture of the ocular fundus up to 200° in a single exposure, which can observe more areas of the retina. The combination of ultrawide-field fundus images and artificial intelligence will achieve great performance in diagnosing multiple ophthalmic diseases in the future.

Equine ulcerative keratitis in the Netherlands (2012-2021): Bacterial and fungal isolates and antibiotic susceptibility.

Ulcerative keratitis is a common ophthalmic disease in horses which can be complicated by microbial infection and requires immediate, accurate treatment to prevent loss of visual function or the eye. To report the results of microbial cultures, antibiotic susceptibility tests and corneal cytology in horses with ulcerative keratitis presented to a referral clinic, to assess agreement between cytology and culture results, to investigate whether previous topical treatment affected microbial culture results and whether the incidence of antimicrobial resistance changed during the study period. Retrospective analysis. Case characteristics and results of cytology and microbial cultures were retrieved. Statistical analyses included descriptive statistics, χ2 or Fisher's exact test and McNemar test. Samples for bacterial culturing (n = 187), fungal culturing (n = 153) and cytology (n = 153) were collected from 178 horses. Bacterial and fungal cultures were positive in 36% (n = 67) and 20% (n = 30), respectively. Staphylococcus (n = 35/67; 48%), Streptococcus (n = 12/67; 16%) and Aspergillus species (n = 22/30; 81%) were most frequently found. Microorganisms were observed in 14% of cytology samples (n = 22/153). Acquired antibiotic resistance was commonly observed amongst Streptococcus and Staphylococcus species. Acquired antibiotic resistance to gentamicin was more common in cases previously treated with gentamicin (p < 0.001). The incidence of acquired antibiotic resistance did not increase significantly between Cohort 2012-2017 and Cohort 2018-2021. Neither bacterial nor fungal culturing results were in agreement with cytology findings (p < 0.001 and p = 0.02, respectively). In 6 of 104 samples that were negative on fungal culturing, cytology revealed fungal elements. Due to the retrospective nature of this study, some case characteristics and test results were unavailable. Acquired resistance was commonly observed amongst Streptococcus and Staphylococcus species, and in bacteria previously exposed to topical gentamicin. The incidence of acquired antibiotic resistance did not increase over time. When fungal cultures prove negative, cytology may have some added benefit in identifying keratomycosis.

The negative association between the docosapentaenoic acid intake and the incidence of AMD based on NHANES 2005-2008.

Age-related macular degeneration (AMD) is an ophthalmic disease that causes visual impairment and is one of the leading causes of blindness in the elderly. Fatty acids are essential nutrients required by the body and play a cornerstone role in the life activities of the body. Many studies have reported that fatty acids are involved in the development of AMD. To confirm this association, we conducted the present study. We analyzed the association between all fatty acid intake and AMD using National Health and Nutrition Examination Survey (NHANES) data from 2005-2008. Quantile regression was performed to assess the effect of fatty acids on AMD at different intake levels. After adjusting for covariates, only saturated fatty acids showed no significant difference between AMD patients and non-AMD patients (23.64 g vs. 26.03 g, p = 0.052). Total fat (70.88 g vs. 78.86 g, p = 0.024), monounsaturated fatty acids (25.87 g vs. 28.95 g, p = 0.019), polyunsaturated fatty acids (15.10 g vs. 17.07 g, p = 0.017) showed significant differences between the two groups. When AMD was considered as an outcome, the association between AMD and docosaentaenoic acid (DPA) was negative in the multivariate logic model (model 1: OR = <0.001, 95% CI = <0.001 ~ 0.734; model 2: OR = <0.001, 95% CI = <0.001 ~ 0.002; model 3: OR = <0.001, 95% CI = <0.001 ~ 0.002). In the quantile regression, DPA was shown to be negatively associated with the presence of AMD only in the fourth quartile in model 2 and model 3 (model 2: OR = <0.001, 95% CI = <0.001 ~ 0.927; model 3: OR = <0.001, 95% CI = <0.001 ~ 0.775). Therefore, based on above results, we concluded that DPA intake could prevent the development of AMD.