Ophthalmology Clinic Research Articles

A Retrospective Review of Endogenous Endophthalmitis: Three Years of Experience at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia.

Introduction Endogenous endophthalmitis is characterized by severe intraocular inflammation caused by the invasion of microorganisms into the anterior and posterior chambers of the eye. It results from hematogenous spread from distant foci of infection. This, in turn, leads to potential vision loss and blindness due to reduced anatomical and functional outcomes. The latest reported prevalence of endogenous endophthalmitis accounts for at least 2-8% of cases of general endophthalmitis which is fairly significant. Purpose This study aimed to analyze the clinical profile of endogenous endophthalmitis presented in the Ophthalmology Clinic, Sultan Ahmad Shah Medical Centre atInternational Islamic University Malaysia (SASMEC@IIUM). This study includes the patients' demographics, clinical manifestations, causative organism, treatment, and final visual outcome. Methods This is a retrospective case seriesof endogenous endophthalmitispatients from January 2020 to June 2023. The data were obtained from the patients' medical records in SASMEC@IIUM. Results A total of six patients (six eyes) were diagnosed with endogenous endophthalmitis from January 2020 to June 2023. Four patients (66.6%) were female, with a mean age of 51.6 ± 17.5 years. Presenting visual acuity ranged between 6/21 to hand movement (HM). Five patients (83.3%) presented with reduced vision, while one presented with eye redness (16.6%). Ocular signs included vitritis and retinitis (five eyes, 83.3%), hypopyon (five eyes, 83.3%), injected conjunctiva (five eyes, 83.3%), and eyelid swelling (one eye, 16.6%). The most common primary infection seen was intraabdominal sepsis (three patients, 50%), septic arthritis, hospital-acquired pneumonia (HAP), and urinary tract infection (UTI). Vitreous biopsy was only positive in two patients (33.3%) However, five out of the six patients (83.3%) had positive blood cultures (two Staphylococcus aureus,two Klebsiella pneumoniae and one Pseudomonas aeruginosa). All patients received intravitreal injections and intravenous antibiotics. Only one patient underwent subsequent trans pars plana vitrectomy (TPPV). Final visual acuity ranged from 6/6 to no light perception (NPL). Conclusion In this case series of six patients, we observed a variety of outcomes with similar presentations despite standardized treatment in all patients. Five out of six patients showed poorer visual outcomes and only one patient showed a final visual acuity of 6/6. Therefore, further study with a larger sample size is needed to evaluate the factors associated with the final visual outcome in endogenous endophthalmitis.

The Use of Non-Person-First Language in Consecutive General Ophthalmology Referrals

To investigate the prevalence of non-person-first language (PFL) in consecutive general ophthalmology referrals to a single tertiary ophthalmology clinic. Retrospective cross-sectional study. Participants included Ophthalmology patients seen for their initial visit to a single tertiary ophthalmology clinic from July 2018 to December 2022. Ten randomly selected referrals from each day were screened for non-PFL as per the American Medical Association and American Psychological Association guidelines. Non-PFL was further categorized into general, diabetes, stigma, obesity, or ageism subcategories. The Chi-square test was used to evaluate associations between non-PFL use and referring provider gender and specialty, length of referral, and patient age and gender. A total of 2625 referrals were included in the study and 136 (5.2%) used non-PFL, such as referring to a person with diabetes as a "diabetic". Error types included Diabetes (38.2%), Stigma (30.9%), General (23.5%), Disability (8.8%), and Obesity (4.4%). Year of referral was predictive of non-PFL (P = .0016), with most occurring in 2020 (9.5%). Non-PFL was significantly more likely to occur in long length referrals compared to medium and short length referrals (16.2% vs. 5.1% vs. 3.5%, P < .001). Referring provider specialty was also predictive of non-PFL (P < .001) with most received by Family Medicine (8.3%), Optometry (4.4%), Emergency Medicine (0.62%), Ophthalmology (4.2%), Others (2.9%). Patient gender (P = .5563), patient age (P = .3466), and referring provider gender (P = .9057) were not predictive of non-PFL. Non-PFL use was most prevalent in 2020, with the most common referral sources being Family Medicine and Optometry. The highest proportions of non-PFL errors made were diabetes and stigma errors. Increased use of PFL in physician-physician communication can decrease intersectional stigma and promote inclusive patient care for ophthalmology patients.

Assessment of refractive errors, amblyopia, strabismus, and low vision among hearing-impaired and deaf students in Kermanshah

Background and AimRefractive errors, amblyopia, strabismus, and low vision are more common among children with hearing impairments in comparison with their hearing peers. Neglecting visual disorders can pose educational and social problems for these children. The present study aimed to assess the prevalence of refractive errors, amblyopia, strabismus, and low vision among hearing-impaired and deaf students in Kermanshah.Materials and methodsA total of 79 deaf and hearing impaired students within the age range of 7–20 years (mean age of 15.01 ± 2.72) underwent optometric examinations, including autorefractometry, retinoscopy, ophthalmoscopy, slit lamp, visual acuity measurement, and cover-uncover test. Those who needed further evaluation were referred to the Ophthalmology Clinic of Imam Khomeini Hospital.ResultsRegarding the prevalence of refractive errors, 32 (40.5%) subjects had one or a combination of refractive errors, the most common of which was astigmatism (36.7%), followed by amblyopia (15.1%). The most common type of strabismus was latent strabismus (heterophoria) (88.6%), followed by exophoria (81%). Moreover, 3 (3.7%) cases had nystagmus. A significant difference was observed between the prevalence of amblyopia and the degree of hearing loss (P = 0.026), and no significant difference was detected in other cases.ConclusionAs evidenced by the obtained results, refractive errors, amblyopia, strabismus, and low vision are more prevalent among deaf and hearing-impaired children compared to normal children because deaf and hearing-impaired children are not able to convey their vision problems and need to compensate for their poor hearing with an enhanced sense of sight, inattention to these disorders can present these children with serious educational and social problems. Therefore, eye screening examinations are of paramount importance in deaf and hearing-impaired children.

Paying attention to safety of posterior chamber phakic intraocular lens implantation

Posterior chamber phakic intraocular lens implantation is a type of intraocular surgery. With advancements in implant materials and design, this procedure has seen rapid adoption and widespread use in ophthalmology clinics in recent years. However, the changes in surgical techniques and the occurrence of postoperative complications have raised safety concerns that require significant attention in clinical practice. This paper aims to address the key factors influencing the safety of posterior chamber phakic intraocular lens implantation, exploring relevant characteristics, mechanisms, and current challenges. By emphasizing the importance of this surgery and proposing effective measures, it aims to provide guidance for clinical practice, enhance the safety of posterior chamber phakic intraocular lens implantation, and foster the healthy advancement of this surgical technique.

Effects of orthokeratology on corneal reshaping and the delaying of axial eye growth in children

PurposeTo investigate the inhibition of myopia progression and axial elongation in children wearing orthokeratology (OK) lenses, as well as to evaluate the status of corneal reshaping, this study explores the relationship between changes in central corneal curvature (K-value) and e-value induced by OK lenses and axial elongation. MethodsIn this study, it is planned to select children aged 8–15 who wear orthokeratology lenses at the Pediatric Ophthalmology and Strabismus Clinic of the Second Affiliated Hospital of Dalian Medical University. All children will undergo slit lamp examination, visual acuity assessment, computerized refraction, intraocular pressure measurement, biometry, and corneal topography examination before lens wear and at 1 month, 3 months, and 6 months after lens wear in the pediatric ophthalmology clinic. Based on age (lower age group (8 < age ≤12 years); higher age group (12 < age ≤15 years)) and baseline equivalent spherical (SE) value (mild myopia group (−1.00 D < SE ≤ −3.25D); moderate myopia group (−3.25 D < SE ≤ −6.00 D)), four groups will be formed by pairing these factors. Suitable data will be selected according to inclusion and exclusion criteria, and different groups will be included. Data will be organized, and statistical analysis will be performed using SPSS software to obtain the results. The expected results will be discussed and analyzed. ResultsAfter wearing OK lenses, all four groups achieved good visual acuity at follow-up. At 6 months, there were no significant differences in visual acuity among the four groups (P = 0.149, >0.05). There were no significant differences in refractive error among the four groups (P = 0.066, >0.05). Baseline axial length differed significantly among the four groups (P = 0.000, <0.001), with the LM group having longer axial length than the LL group (P < 0.001, paired samples t-test), and the HM group having longer axial length than the HL group (P < 0.001, paired samples t-test). However, there were no significant differences in axial length change compared to baseline among the groups at 1 month, 3 months, and 6 months (P1 = 0.053; P3 = 0.557; P6 = 0.329, >0.05). Significant differences were observed in corneal flat K-value change compared to baseline among the four groups at 1 month, 3 months, and 6 months (P1 = 0.001, P3 = 0.001, P6 = 0.004, <0.05). There were no significant differences in e-value change among the groups at 1 and 3 months (P1 = 0.205, P3 = 0.252, >0.05), but significant differences were found in e-value change compared to baseline at 6 months (P6 = 0.010, <0.05). Multiple regression analysis with changes in central corneal flat K-value and e-value as independent variables and axial elongation as the dependent variable showed a correlation between e-value change at 6 months and axial elongation (P = 0.004, <0.05), indicating a negative correlation. ConclusionOrthokeratology (OK) lenses effectively improve myopic children's vision by reshaping the cornea, leading to reduced central corneal curvature and flattening of its anterior surface. The effectiveness of OK lenses is not significantly affected by age or initial myopia severity. Children of varying ages and myopia levels experience similar levels of axial length control with OK lens wear. Changes in corneal shape due to OK lenses affect axial elongation, with greater changes in corneal morphology associated with smaller increases in axial length.

Eyelid retraction during smiling in a patient with monocular congenital ptosis: a case report

BackgroundBlepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis.Case descriptionA 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn’t have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation.ConclusionBlepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.

Creating Double Eyelids in the Japanese Colonial Era of Korea (1910-1945).

The aim of this study was to analyze the origins of the double-eyelid procedure in Korea during the Japanese colonial era. Through Google (www.google.com) and Naver (www.naver.com), the archives of newspapers and magazines were searched. The following topics were identified: ideal eyes in the Japanese colonial era, creating double eyelids using a non-surgical method, the first case of a double-eyelid operation in a Korean woman, and the presumed first case of a double-eyelid operation in Korea. By 1935, possessing double eyelids had come to be recognized as a symbol of modern beauty. An article suggested that women with small eyes consider surgery to transform their "single eyelid" into a "double-eyelid." It endorsed plastic surgery as a marker of "worldly progress." In 1939, a magazine featured an advertisement for Aihon tape, which was promoted to create "double eyelids." Oh Yeop-ju, the first Korean hairdresser, underwent double-eyelid surgery at an Ophthalmology Clinic in Japan, sometime between 1927 and 1932. She is celebrated as a beauty icon who broadened the beauty horizons of Korean women. After returning in 1933 with a "very beautiful" appearance resulting from successful double-eyelid surgery, she received a special invitation to the Kong Eye Center in Seoul, which opened in 1937. Upon hearing her detailed account and examining her eyelids, the clinic began offering double-eyelid surgery. The technique for double-eyelid surgery was introduced from Japan and disseminated through a medical journal and to patients who had undergone the procedure in Japan.

A compressive assessment of patient satisfaction with ophthalmology with ophthalmology clinic services: A study at a tertiary care academic institution amidst and after the COVID-19 pandemic.

The study aims to systematically assess patient satisfaction concerning eye care services provided during and after the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care academic institution. This work seeks to analyze the various dimensions influencing the holistic measure of overall patient contentment. A cohort of 2485 patients seeking physical consultation for ocular conditions at a tertiary care academic institution between April 2020 and December 2022 were recruited in a cross-sectional study. They were divided into two groups, viz. during the COVID period and post-COVID period. The primary focus was on evaluating overall satisfaction, measured through a validated patient satisfaction questionnaire (PSQ-18). The study encompassed a total of 2485 participants, with 1242 individuals in the cohort during the COVID period and 1243 in the post-COVID phase. Within the COVID period subgroup, the mean age of male and female patients was 39.46 ± 19.31 and 39.58 ± 19.07 years, respectively. In the post-COVID subgroup, the mean age of male and female patients was 45.26 ± 19.38 and 45.36 ± 19.22 years, respectively. Examining the COVID subgroup, the highest satisfaction scores were observed in the domain of time spent with the doctor (3.3453 ± 0.59), followed by financial aspects (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Notably, technical quality received the lowest satisfaction score (2.4763 ± 0.42). A statistically significant difference ( P < 0.0001) was noted in the PSQ-18 scores between the two groups. In the post-COVID subgroup, patients expressed higher satisfaction with the technical quality of treatment, irrespective of the mode of management. However, financial satisfaction was better in the COVID group. Our study using the PSQ-18 questionnaire highlights significant variations in patient satisfaction with ophthalmology clinic services during and after the COVID era. Notably, time spent with the doctor scored the highest, emphasizing its positive impact. However, addressing concerns related to technical quality is crucial for overall improvement.

Synergistic Therapy for Graves’ Ophthalmopathy-Associated Eyelid Retraction: Steroid, 5-FU, and Botulinum Neurotoxin a Combination

Background: Graves’ ophthalmopathy (GO) is characterized by upper eyelid retraction (UER), the most prevalent clinical sign. We aimed to assess the clinical efficacy of a multimodal combination of steroids, 5-fluorouracil (5-FU), and botulinum neurotoxin A (BoNT-A) injections in managing UER with GO and analyze the clinical factors in relation to the injection response. Methods: A total of 37 eyes from 23 patients were enrolled for UER with GO. At the endocrinology clinic, the patients were referred to the ophthalmology clinic after taking antithyroid medication for an average of 5.76 months (13 patients), while 10 patients were initially diagnosed with GO and referred to the endocrinology clinic for management of the thyroid hormone function. They performed an orbital computed tomography (CT) scan and measured the cross-sectional area of the orbit, orbital fat, and each extra ocular muscle (EOM) except for the inferior oblique muscle 4 mm behind the eyeball. Each of the EOMs and orbital fat were calculated as a ratio to the total orbit area. A total of 0.1 cc of triamcinolone (40 mg/mL), dexamethasone (5 mg/mL), 5-FU, and BoNT-A (2.5 units) was injected transconjunctivally. Medical records were examined and photographs were utilized to assess MRD1, inferior palpebral fissure (IPF), and lid lag during down gaze before and after the injection. The patients were divided into two groups: responders (more than 1 mm decrease in MRD1 after injection) and non-responders. During the follow-up period (11.0 ± 11.6 months), any potential adverse effects were monitored. Results: CAS decreased from 3.0 ± 0.8 to 1.4 ± 0.5 after the injection, and MRD1 decreased from 5.0 ± 0.9 mm to 4.5 ± 1.3 mm. Sixty percent of the patients were responders. Before and after the injection, the difference between IPF and MRD1 in responders was 0.60 ± 1.10 mm and 0.90 ± 0.90 mm, respectively, whereas, in non-responders, it was −0.57 ± 0.88 mm and −0.15 ± 0.75 mm, respectively. In the responders, pre-injection IPF and FT4 were significantly higher (p &lt; 0.05). Responders had a larger EOM cross-sectional area (153.5 ± 18.0 mm2), including a larger lateral rectus muscle cross-sectional area (37.6 ± 9.7 mm2) than non-responders (132.0 ± 27.9 mm2; 29.1 ± 8.1 mm2). In responders, the treatment effect on IPF and MRD1 remained consistent at 1.2 ± 3.4 mm and 1.2 ± 1.6 mm, respectively, during the latest follow-up assessment. Conclusions: The combination injection of corticosteroids, 5-FU, and BoNT-A would be effective, especially, in patients with hyperthyroidism and an elongated IPF. Additionally, an increase in EOM cross-sectional area on CT, up to 150 mm2, may serve as an additional positive indicator for the use of multimodal injections in UER with GO.

Changes in ocular biometrics following cycloplegic refraction in strabismic and amblyopic children.

This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to measure refractive error accurately by paralyzing accommodation. However, effects on axial length (AL), anterior chamber depth (ACD), keratometry (Km), and white-to-white distance (WTW) are not well studied in this population. This retrospective study examined 797 patients (1566 eyes) undergoing cycloplegic refraction at a Samsung Kangbuk hospital pediatric ophthalmology clinic from 2010 to 2023. Ocular biometry was measured before and after instilling 1% cyclopentolate and 0.5% phenylephrine/0.5% tropicamide. Patients were categorized by strabismus diagnosis, age, refractive error and amblyopia status. Differences in AL, ACD, Km, WTW, and refractive error pre- and post-cycloplegia were analyzed using paired t tests. ACD (3.44 ± 0.33 vs 3.58 ± 0.29 mm, P < .05) and WTW (12.09 ± 0.42 vs 12.30 ± 0.60 mm, P < .05) increased significantly after cycloplegia in all groups except other strabismus subgroup (Cs) in both parameters and youngest subgroup (G1) in ACD. Refractive error demonstrated a hyperopic shift from -0.48 ± 3.00 D to -0.06 ± 3.32 D (P < .05) in overall and a myopic shift from -6.97 ± 4.27 to -8.10 ± 2.26 in high myopia (HM). Also, AL and Km did not change significantly. In conclusion, cycloplegia impacts ocular biometrics in children with strabismus and amblyopia, significantly increasing ACD and WTW. Refractive error shifts hyperopically in esotropia subgroup (ET) and myopically in high myopia subgroup (HM), eldest subgroup (G3) relating more to anterior segment changes than AL/Km. Understanding cycloplegic effects on biometry is important for optimizing refractive correction in these patients.

Detection and treatment of active retinopathy of prematurity by specialists of the federal ophthalmology clinic in a perinatal center

Detection and treatment of active retinopathy of prematurity by specialists of the federal ophthalmology clinic in a perinatal center

Prediction of the small aperture intraocular lens on visual acuity in patients with keratoconus.

To investigate the impact of corneal higher-order aberrations (HOAs) on predicted corrected distance visual acuity (CDVA) in patients with keratoconus at varying simulated pupil apertures. Ophthalmology Clinics, Medical University of South Carolina, Charleston, South Carolina. Retrospective chart review study. 56 eyes with keratoconus were examined using Scheimpflug tomography during routine examinations before medical intervention. The severity of keratoconus was graded using the Amsler-Krumeich classification. Zernike analysis was used to obtain corneal aberrations using simulated pupil diameters of 6 mm, 4 mm, and 2 mm. These data were extrapolated to obtain the total root mean square HOAs for a 1.6 mm simulated pupil to evaluate the potential effect of a small aperture intraocular lens (IOL). Correlation analysis was used to study the impact and relative contributions of HOAs on CDVA. Convolution of HOAs from OPD-Scan III provided a clinical method to predict CDVA with different simulated pupil sizes in corneas with irregular astigmatism. There were statistically significant positive correlations between photopic CDVA and the magnitude of total and individual (coma, spherical aberration, and trefoil) HOAs in this cohort of keratoconus participants. A keratoconus case with the small aperture IOL confirms the improvement in vision due to the pinhole effect. The small aperture IOL is expected to markedly reduce aberrations in patients with keratoconus up to Amsler-Krumeich class 4 severity to levels consistent with the levels seen in healthy patients. Convolution of corneal HOAs with the Early Treatment Diabetic Retinopathy Study chart provides a useful simulation of the impact of pinhole optics in aberrated eyes.

Real-world insights and outcomes related to ciclosporin A 0.1% cationic emulsion for the long-term treatment of dry eye disease in Germany: Country-level sub-analysis of the PERSPECTIVE study

PurposeThe PERSPECTIVE study was a real-world European, non-interventional, multicenter, observational study that evaluated the effectiveness, tolerability, and safety of ciclosporin A (CsA) 0.1% cationic emulsion (CE) in routine clinical practice as a treatment for adults with severe keratitis and dry eye disease (DED) that remained insufficiently controlled with artificial tears. This sub-analysis examined data from ophthalmology clinics in Germany to provide more precise insights into treatment patterns, outcomes, and clinical decision-making related to CsA 0.1% CE.MethodsStudy data were collected from adults starting CsA 0.1% CE (one drop in both eyes at bedtime) and followed up at Week 4, 12, and 24, and Month 12. The primary endpoint was mean change from baseline in corneal fluorescein staining (CFS) score (Oxford Grade Scale) at Month 12. Secondary endpoints examined the severity of ocular signs and symptoms, and adverse events (AEs).ResultsA total of 236 patients from 20 ophthalmology clinics in Germany participated in the PERSPECTIVE study (69.9% female; mean age 60.8 years). Following treatment with CsA 0.1% CE, patients experienced significant reductions in CFS score from Week 4, which were maintained through to Month 12 (P < 0.0001). From baseline, 81.6% of patients experienced an improvement in CFS score at Month 12. CsA 0.1% CE provided significant reductions in the severity of eyelid and conjunctival erythema at Month 12 compared with baseline (P < 0.001), as well as significant reductions in the severity of subjective ocular symptoms (all P ≤ 0.015). Safety data were consistent with the known safety profile of CsA 0.1% CE. Tolerability was rated as “satisfactory,” “good,” or “very good” by 97.2% of physicians and 95.7% of patients.ConclusionOutcomes in Germany were similar to those reported for the overall European study population and are indicative of the treatment results that ophthalmologists may expect to see with CsA 0.1% CE treatment in real-life clinical practice. Treatment with CsA 0.1% CE provided long-term improvements over 12 months and was generally well tolerated.

Artificial intelligence to automate assessment of ocular and periocular measurements.

To develop and validate a deep learning facial landmark detection network to automate the assessment of periocular anthropometric measurements. Patients presenting to the ophthalmology clinic were prospectively enrolled and had their images taken using a standardised protocol. Facial landmarks were segmented on the images to enable calculation of marginal reflex distance (MRD) 1 and 2, palpebral fissure height (PFH), inner intercanthal distance (IICD), outer intercanthal distance (OICD), interpupillary distance (IPD) and horizontal palpebral aperture (HPA). These manual segmentations were used to train a machine learning algorithm to automatically detect facial landmarks and calculate these measurements. The main outcomes were the mean absolute error and intraclass correlation coefficient. A total of 958 eyes from 479 participants were included. The testing set consisted of 290 eyes from 145 patients. The AI algorithm demonstrated close agreement with human measurements, with mean absolute errors ranging from 0.22 mm for IPD to 0.88 mm for IICD. The intraclass correlation coefficients indicated excellent reliability (ICC > 0.90) for MRD1, MRD2, PFH, OICD, IICD, and IPD, while HPA showed good reliability (ICC 0.84). The landmark detection model was highly accurate and achieved a mean error rate of 0.51% and failure rate at 0.1 of 0%. The automated facial landmark detection network provided accurate and reliable periocular measurements. This may help increase the objectivity of periocular measurements in the clinic and may facilitate remote assessment of patients with tele-health.

Experimental investigation on the transient vascular thermal response to laser irradiation by a high-speed infrared thermal camera

Based on the photothermal effect, laser can be used to treat vascular diseases (VD) in clinic of dermatology and ophthalmology. Transient vascular thermal response to laser irradiation during millisecond laser pulse is the key phenomenon in treatment process, which has not been carefully investigated before. In this study, target blood vessels in dorsal skin chamber (DSC) animal model were irradiated by a pulsed 532 nm diode laser and a 1064 nm Nd:YAG laser. The directed thermal responses (temperature variation) were recorded by a high-speed infrared thermal camera with a repetition rate of 1000 Hz. The temperature variation during and after single pulse irradiation and multipulse irradiation were investigated. The variation of blood absorption coefficient was explored based on the temperature increment in each laser pulse. The thermal properties of dorsal skin, especially the thermal diffusivity, were evaluated based on the temperature decay after each laser pulse. The interfacial heat transfer between the blood and the surroundings was also calculated based on the thermal images and compared to the correlation proposed before. The results show that the blood absorption to laser will increase by a maximum of 1.9 immediately after blood temperature exceeds threshold value, e.g., 68oC in both single pulse (pulse duration >100 ms) and multi-pulse laser irradiation. The tissue optical properties (thermal diffusivity) keep almost constant after millisecond laser heating. Also, a general correlation for interfacial heating transfer between blood and surroundings was developed, in which the influences of vessel shape and laser wavelength are incorporated. The interfacial heat transfer between blood and surrounding can be accurately quantified.

Quantitative evaluation of metamorphopsia with M-CHARTS™ and evaluation of retinal morphologic changes by optical coherence tomography before and after pars plana vitrectomy in patients with idiopathic epiretinal membrane

Purpose: We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores.Materials and Methods: This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (Group1) and patients with decreasing metamorphopsia scores as the other group (Group 2).Results: In “Group 2,” preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (p:0.028) higher than in “Group 1.”Conclusion: A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery.

Viral Conjunctivitis Rates Unchanged Before and During the COVID-19 Pandemic in an Ophthalmology Clinic.

Millions of acute conjunctivitis cases occur in the United States annually. The impact of COVID-19 mitigation practices on viral conjunctivitis incidence within ophthalmology clinics has not been reported. We hypothesized that viral conjunctivitis rates would decrease with implementation of such practices. A retrospective chart review was conducted at a single academic center's ophthalmology clinics. Electronic health record data was queried using ICD-10 diagnostic codes to include 649 patients aged 2-97 with viral, bacterial, or allergic conjunctivitis diagnosed either before (6/1/2018-5/1/2019) or during (6/1/2020-5/1/2021) COVID-19 precautions. Conjunctivitis rates per ophthalmology clinic visit were compared using rate-ratio analysis. Logistic regression evaluated the effects of age, sex, and race among those with conjunctivitis. A total of 66,027 ophthalmology clinic visits occurred during the study period. Viral conjunctivitis rates per visit did not significantly change after enacting COVID-19 mitigation strategies, but allergic conjunctivitis rates significantly increased (viral: RR 0.82, 95% CI 0.51 to 1.31, p=0.408; allergic: RR 1.70, 95% CI 1.43 to 2.03, p<0.001). When controlling for time, younger age (≤ median age 55) (p=0.005) and Caucasian race (p=0.009) were associated with higher viral conjunctivitis frequency. Contrary to trends reported in emergency departments, viral conjunctivitis rates within an ophthalmology clinic did not significantly change after COVID-19 mitigation strategies, though allergic conjunctivitis rates increased. Patients' avoidance of emergency departments during the pandemic may have contributed. Further investigation is required to explore variation in ophthalmology patient populations and needs based on care setting.

Histological Outcome of Conjunctival Lesions at a Tertiary Hospital in North East Nigeria

Objective: The objective of this study was to determine the relative frequency of histologically diagnosed conjunctival lesions at a tertiary hospital over a 12-month period. Methods: It was a prospective study in which all patients who presented to the ophthalmology clinic with suspicious conjunctival lesions between January and December 2022 were recruited. Data recorded were age, sex, duration of the growth and the affected eye. All the patients underwent basic ocular examination and an examination of the growth to document its site and size. Lesions were excised in the operating theatre under anaesthesia. The excised tissue was preserved in a formalin bottle and sent for histology. Data were entered into Excel and analysed using SPSS version 20.0. Results: A total of 73 eyes were recruited during the period of study. There were 41 males (56.2%) with M:F ratio of 1.3:1. Mean age was 38.44 ± 19.07 years with a range of 2–77 years. Forty patients (54.8%) presented with lesions in the right eye and 33 (45.2%) in the left eye. Fifteen types of conjunctival lesions were diagnosed, including pterygium 37%, conjunctival intraepithelial neoplasia 2.7%, melanoma 2.7%, ocular surface squamous neoplasia 4.1% and squamous cell carcinoma 4.1%, respectively. Conclusion: Pterygium was the most common benign lesion in this study. When conjunctival lesions appear suspicious, it is of utmost importance for the surgeons to differentiate between benign, premalignant and malignant lesions as this may aid in prompt patient management as well as better outcomes.

Validity and reliability of the Thai version of the ASCRS SPEED II preoperative OSD questionnaire in Thai cataract surgery candidates.

To develop a Thai version of the American Society of Cataract and Refractive Surgery (ASCRS)-modified Standard Patient Evaluation of Eye Dryness (SPEED) II© preoperative ocular surface disease (OSD) questionnaire (ASCRS SPEED II-Thai) and evaluate its validity and reliability in Thai cataract surgery candidates. The original English version of the questionnaire was translated and adapted cross-culturally to Thai language. The ASCRS SPEED II-Thai was evaluated for content validity, internal consistency, and test-retest reliability. Five experts in the ocular surface field critically reviewed the ASCRS SPEED II-Thai to measure the content validity indexes (CVI). A total of 105 cataract surgery candidates were recruited from an ophthalmology clinic to complete the questionnaire. Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to assess internal consistency and test-retest reliability, respectively. During the translation and cross-cultural adaptation processes, only two minor modifications were made to the original version for clarification without changing their meaning. All items in the ASCRS SPEED II-Thai had an item-level CVI of 1.00, representing complete agreement among content experts. The scale-level CVI was 1.00, indicating excellent content validity of the questionnaire. The participants found no difficulty in understanding each question in the pilot test. Cronbach's alpha for the ASCRS SPEED II-Thai was 0.82, indicating good internal consistency. The test-retest reliability was good to excellent, with ICC values ranging from 0.83 to 1.00 (P < 0.001). The ASCRS SPEED II-Thai is a valid clinical tool with adequate reliability for preoperative OSD screening among Thai cataract surgery candidates.

Association of Vernal Keratoconjunctivitis (VKC) with Keratoconus in Patients Presenting to Ophthalmology Clinics of Rawal Institute of Health Sciences, Pakistan

Objective: To establish an association of vernal keratoconjunctivitis with keratoconus. Study Design: cross-sectional study. Place and Duration of Study: Department of Ophthalmology, Rawal Institute of Health Sciences, Rawalpindi Pakistanv from Dec 2019 to Feb 2020. Methodology: Patients with an age less than 16 years and a history of VKC were included. Ulcers or scars, systemic connective tissues, and blue sclera were excluded. Follow-up after two weeks and later three months was conducted. Individuals with K readings of less than 45 diopters were considered normal. Results: Among the 135 individuals enrolled in the study, more males 95(70%) than women 40(30%) were observed. The study also showed more individuals from age groups 1-10 years of age 107(79%). After three months, biomicroscopic findings and corneal topography (Oculus Pentacam HR) revealed that 20 individuals (14.8%) developed keratoconus (p˂0.001). The disease severity, periodicity, and eye rubbing lead to the development of keratoconus. Conclusion: Pediatric keratoconus deteriorates faster than adults, and the management differs for various reasons, such as faster progression and advanced stage of disease at the time of diagnosis. It burdens society as it influences children's quality of life and development. Hence, predisposing conditions such as Vernal keratoconjunctivitis need early diagnosis, recognition of progression, and appropriate intervention to prevent vision-threatening conditions such as keratoconus.