Ophthalmology Outpatient Clinic Research Articles

Dysphotopsia after uneventful phacoemulsification

Background Unexpected negative visual outcomes, especially after uneventful phacoemulsification, are frustrating to patients and surgeons. Dysphotopsia is one of the main causes of this dissatisfaction after uneventful phacoemulsification. Our study aimed to describe the prevalence of this type of dysphotopsia after uneventful phacoemulsification in our practice at Suez hospitals department. Patients and methods This study was conducted at the Ophthalmology Outpatient Clinic of Suez General Hospital on 120 eyes from 120 patients who underwent uncomplicated phacoemulsification and intraocular lens implantation from January to April 2024. Subjectively, patients were asked about dysphotopsia symptoms 1 month after surgery, and their symptoms were improved with conservative treatment. We reviewed pathophysiology and various treatment modalities that are accessible, such as observation, nonsurgical correction options such as conservative management, medication-assisted miosis, optical correction, and surgical correction options as a last resort for serious cases. Results Six cases of dysphotopsia (5%) were identified among the 120 patients in the study: 2 patients recorded negative dysphotopsia (1.7%), and 4 patients had positive dysphotopsia (3.3%). Conclusion Patients now anticipate satisfaction from cataract surgery, which is becoming a common procedure. Both the patient and the surgeon may become frustrated when dysphotopsia occurs, which incidentally occurs in a flawlessly performed procedure. In our study, 6 patients out of 120 patients had dysphotopsia, which was resolved with conservative treatment only. Enhancing treatment and preventing this specific cause of postoperative complaints may be achieved by having a thorough understanding of this matter, its possible risk factors, and its successful methods of management.

Chorioretinal microvascular changes in slow flow coronary phenomenon: a multi-center study

We compared chorioretinal microvascular of Slow Coronary Flow Phenomenon (SCFP) patients using Optical Coherence Tomography Angiography (OCTA) to healthy controls. We recruited 21 patients from September 2023 until January 2024 from two referral centers. We enrolled 21 age-sex-matched controls retrospectively. Patients were referred to obtain OCTA in our outpatient ophthalmology clinic. The OCTA and Enhanced Depth Imaging (EDI) OCT findings were measured. Whole image and perifoveal Vascular Density (VD) of superficial and deep capillary plexuses and Parafoveal VD of superficial layer were diminished in SCFP groups compared to controls (p < 0.05) while both superficial and deep foveal VD and deep parafoveal VD were spared. Sub-Foveal Choroidal Thickness (SFCT) was significantly thinned compared to controls (p < 0.05), while central macular thickness, choroidal vascularity index, and choriocapillaris flow were similar between groups. SFCT was the only independent predictor of SCFP on multivariable regression analysis. Parafoveal superficial VD and SFCT showed the strongest ability to distinguish between SCFP patients and healthy controls (AUC: 0.80, 0.79, respectively). Additionally, whole image and perifoveal VD in both superficial and deep capillary plexus demonstrated at least moderate discriminatory power. We found that decreased retinal microvascular density may serve as a potential biomarker for the diagnosis of SCFP. Additionally, SCFP patients had considerably thinner SFCTs than controls. Parafoveal superficial VD and SFCT showed the highest potential in distinguishing between individuals with SCFP and healthy individuals. SCFP is likely linked to anomalies in the small blood vessels of the retina and choroid. However, further studies are needed to confirm this association and to control for the potential confounding effects of diabetes and hypertension.

Foundations of ophthalmology in Dutch East Indies: A look at distribution of early ophthalmology medical facilities (1900‒1942)

This research examines the development of ophthalmology as a medical specialty in the Dutch East Indies between the years 1900 and 1942. The research is focus on the establishment of ophthalmology medical facilities, consist of ophthalmology hospitals, departments of ophthalmology, and ophthalmology outpatient clinics. The methods used in this research are a literature review of archival documents and spatio-temporal analysis. The primary source of archival documents for this study are the Medical Journal for the Dutch East Indies (Geneeskundig Tijdschrift voor Nederlandsch-Indie), Communications from the Civil Medical Service (Mededeelingen van den Burgerlijk Geneeskundige Dienst), Communications from the Public Health Service (Mededeelingen van den Dienst der Volksgezondheid), and Kolonial Verslaag. A spatio-temporal analysis was conducted to look at the distribution of medical facilities over time, using a phase division into three periods: 1900‒1910, 1901‒1930, and 1931‒1942. This research indicates that the establishment of ophthalmology medical facilities was a response to the prevalence of eye health problems in the Dutch East Indies during the nineteenth century. During the period between 1900 and 1910, a notable advancement in ophthalmology occurred with the establishment od ophthalmology hospital. These facilities were predominantly concentrated in Java, particularly in cities that served as administrative centers, such as Bandung and Semarang. From 1911 to 1930, the number of medical facilities increased with the establishment of departments of ophthalmology in hospital and ophthalmology outpatient clinics. The construction of medical facilities commenced in Sumatra, particularly in Padang and Perbaoengan. In contrast, the medical facilities constructed during the period between 1931 and 1942 were exclusively outpatient clinics. The findings indicate that the early ophthalmology medical facilities were concentrated in Java and Sumatra. Additionally, this study delves into the diagnostic and therapeutic measures employed by ophthalmologists to address a spectrum of eye diseases. Based on these findings, it can be inferred that the establishment of ophthalmology medical facilities in the Dutch East Indies signified the acceptance of ophthalmology as a specialized field dedicated to advancing public health and encouraged further research into eye diseases and their treatment.

Management Reconstruction of Eyelid Kissing Nevus

Introduction: An unusual type of congenital nevus known as "kissing nevus" develops on one eye's upper and lower lid and becomes enormous while the eyelids are closed. Reconstruction is complex since it creates both aesthetic and functional issues. Case Presentation: A 23-year-old female patient attended our ophthalmology outpatient clinic stating that she had a painless, non-progressing black nevus covering her left upper and lower eyelid since birth. The dark brown-black, 55 mm in size, with hypertrichosis that extended to the cheek and covered about two-thirds of the left upper and lower eyelid edges. A free supraclavicular skin transplant restored the complete nevus shortly after removal. We performed canthoplasty, lateral canthopexy, and full-thickness graft procedures. Three weeks following the procedures, the result was satisfactorily proved. Through histopathological examination, intradermal nevus pigmentosus was identified. Conclusions: A secure, trustworthy, and aesthetically pleasing option for head and neck deformities reconstruction involves a free supraclavicular graft.

Assessing Eye Clinic Accessibility: A Study Validating and Applying the SiteWise Survey.

To validate the SiteWise survey as a reliable tool for assessing the accessibility of outpatient ophthalmology clinics for visually impaired patients and to compare accessibility between hospital-based and satellite clinics. This quality improvement study, conducted from January to December 2023, used the SiteWise survey to assess design features in seven satellite and two hospital-based clinics within the Wilmer Eye Institute network. Independent surveyors evaluated elements such as parking, sidewalks, entrances, and interior areas. Reliability was measured using Krippendorf's alpha, and accessibility scores were compared using generalized estimated equations, analyses of variance, and t tests. The SiteWise survey demonstrated high reliability with a Krippendorf's alpha of 0.99. Hospital-based clinics had higher accessibility scores (mean 78.9%) compared to satellite clinics (mean 71.3%, P < 0.05). Areas such as hallways (mean 89%) and waiting areas (mean 87%) scored highest, whereas parking lots/sidewalks (mean 61%) and stairways (mean 61%) scored lowest, indicating significant room for improvement in these areas. The SiteWise tool is reliable and effective in identifying accessibility deficiencies in outpatient ophthalmology clinics. Although indoor areas generally scored well, outdoor and transitional spaces require significant enhancements to improve accessibility for visually impaired patients. This study bridges the gap between basic research and clinical care by providing a validated tool to assess and improve the accessibility of eye care facilities, ensuring they meet the needs of visually impaired patients.

Intelligent Verification Tool for Surgical Information of Ophthalmic Patients-A Study Based on Artificial Intelligence Technology.

With the development of day surgery, the characteristics of "short, frequent and fast" ophthalmic surgery are becoming more prominent. However, nurses are not efficient in verifying patients' surgical information, and problems such as patient privacy leakage are becoming more prominent. To improve the situation, we developed a new augmented reality (AR)-based tool for visual recognition and artificial intelligent (AI) interpretation of the pattern and location of patient surgical skin markings for the verification of the correct surgical site and procedure. The tool can also display a variety of other verbally requested patient information. The purpose of this proposal is to evaluate its feasibility of use by surgical nurses in a real clinical setting. We developed a tool with image recognition technologies to interpretation patient surgical skin markings and match the information obtained with the patients surgical records, thus, verify the patient's surgical information. Verification includes the proper surgical site and type of procedure to be performed. Nurses can interact with the device through its speech recognition capabilities and the device provides them with a variety of other requested patient information via a heads-up display. Three hundred patients in an outpatient ophthalmology clinic were divided into an AR intelligent verification experimental group and a manual verification control group. The accuracy of information verification, work time consumption, and economic cost data were compared between the 2 groups to evaluate the effectiveness of the AR Surgical Information Intelligent Verification Tool in clinical patient surgical information verification. There was no statistically difference in the correct rates of patient surgical information review between the experimental group (95.33%) and the control group (98.67%) (χ2 = 2.934, P = 0.087). The median time for information verification was 10.00 (10.00, 11.00) seconds in the experimental group and 21.00 (20.00, 24.00) seconds in the control group, a statistically difference (Z = 0.000, P < 0.001). The experimental group saved 11 seconds per patient per review compared with the control group. Considering 10,531 surgeries in 2023, printing 1 page of surgical information per 9 patients and requiring 4 copies, 4680 pages of printing paper could be saved. The AR Surgical Information Intelligent Verification Tool has advantages in assisting medical staff in patient surgical information verification, improving nursing efficiency, preventing surgical mark errors or nonstandardization, protecting patient privacy, and saving costs. It has certain research and application value in the scenario of patient surgical information verification in ophthalmic day ward.

OCT Angiography Biomarkers in Diabetic Macular Edema Patients Treated with Intravitreal Injection of Anti-VEGF

Abstract Purpose To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the responce after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers. Design Non randomized non controlled observational study on 20 eyes with DME set in the Ophthalmology Department, Ain Shams University. Study subjects were selected randomly from patients attending the ophthalmology outpatient clinics during the recruitment period, which took place between December 2020 and December 2022. Participants The study was conducted on twenty eyes from 20 patients of with diabetic macular edema, with the exception of media opacity and high refractive error, from Ain Shams University hospital. Methods All patients underwent Spectral Domain Optical Coherence Tomography (SD-OCT) (RTVue XR OCT Avanti; Optovue, Fremont, USA) with Macular scan including 6x6mm scans centered on the fovea at baseline evaluation and at 1 month, 3 months and 6 months while on treatment with intravitreal antiVEGF (Ranibizumab) injections following the PRN protocol without loading. Main Outcome Measures OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ acircularity index (FAZ-AI), FAZ perimeter and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained. Results After the ranibizumab treatment, there was a statistically significant decrease in the FAZ area and FAZ perimeter during the follow up period denoting improved vascular perfusion, and the FAZ AI decreased significantly denoting that the FAZ regained its regularity. There was a statistically significant increase in the mean vessel density including the overall, parafoveal and perifoveal vessel density in the superficial and deep plexus during the follow up period, this might be explained by decreased artifacts due to macular edema. There was a statistically significant difference in the parafoveal vessel density in the SCP, FAZ area, FAZ perimeter, and AI at baseline between good and poor responders. These biomarkers could be used as predictors for response after treatment with anti VEGF in eyes with DME. Conclusions For eyes with DME, parafoveal VD in the superficial layer, FAZ area and perimeter at baseline were independent predictors for visual improvement after the ranibizumab treatment.

Visual activities of daily living survey for retinitis pigmentosa

PurposeTo gauge the value of low-vision-specific function and activities of daily living measures (LVFAM) in the assessment of Patient Reported Outcomes (PRO) of Retinitis Pigmentosa (RP).Study designProspective observation study.MethodsThe May-July 2023 Visual activities of daily living (ADL) Survey of the low-vision-specific function and activities of daily living measure (LVFAM) was conducted on 15 RP patients attending our Ophthalmology outpatient clinic. We used the better corrected visual acuity, and the better Mean Deviation (MD) values of the central 10 degrees of Humphrey’s visual field as macular sensitivity, and examined the total scores after Rasch Analysis for each of the low-vision-specific function of Daily Living (LVFDL) and the low-vision-specific activities of Daily Living (LVADL) among LVFAM, as well as the relationship between the items.ResultsAge 26–78 (mean 60.8), 5 men and 10 women, corrected visual acuity of 0.01-1.0 (mean 0.45) in the better eye, macular sensitivity of 3.47-40.00 (mean 18.60) dB, mean 52.2 for LVFDL and 66.4 for LVADL. The correlations were positive for visual acuity and LVFDL and LVADL, and negative for macular sensitivity, LVFDL and LVADL. In addition, four items were scored 0 by at least 5 (33%) of the LVFDL respondents, and two items were scored 1 by at least 5 (33%) of the LVADL respondents, suggesting that the results differed by question items.ConclusionThe LVFAM was useful not only for the total score but also for each question item in the development strategy of PROs in RP with no treatment.

Association Between Eyelid Twitching and Digital Screen Time, Uncorrected Refractive Error, Intraocular Pressure, and Blood Electrolyte Imbalances.

Previous studies have shown that isolated eyelid myokymia (EM) is usually caused by stress, fatigue, and caffeine consumption. The purpose of this study was to evaluate the association between EM and digital screen time, uncorrected refractive error, intraocular pressure (IOP), and blood electrolyte levels. Between February 2023 and June 2024, 103 eyes of 103 patients who applied to the ophthalmology outpatient clinic with complaints of eyelid twitching lasting for more than two weeksand 103 eyes of 103 healthy individuals as a control group were included in the study. All participants were asked to record their daily time spent with digital screens for two weeks. Cycloplegic refractive error, IOP, optic nerve head cup/disc (C/D) ratio, and blood calcium, sodium, potassium, and magnesium levels were recorded and compared between the two groups. Mean digital screen time was 4.84±1.74 hours in the control group and 6.88±2.01 hours in the EM group. It was found that digital screen time was significantly higher in the EM group compared to the control group (p<0.001). There was a strong positive correlation between the duration of eyelid twitching and the time spent in front of digital screens (p<0.001, r=0.670). There was no significant difference in cycloplegic refractive error, IOP, C/D ratio, and blood electrolyte levels between the two groups (p>0.05). Prolonged digital screen time might play a role in the development of EM. On the other hand, no relationship was found between eyelid twitching and uncorrected refractive error, glaucoma, or blood electrolyte levels.

Impact of Sociodemographic and Psychological Factors on Adherence to Glaucoma Treatment - A Cross-Sectional Study.

Glaucoma is a group of eye diseases characterized by progressive and irreversible damage to the optic nerve. The aim of the study was to examine the impact of sociodemographic and psychological factors on adherence to glaucoma therapy. The study was carried out among 190 adults treated for glaucoma at the Ophthalmology Outpatient Clinic of the University Teaching Hospital in Wroclaw between January 2019 and September 2019. Treatment adherence was measured using the Adherence to Refills and Medications Scale (ARMS). We used the Acceptance of Illness Scale (AIS), the Revised Life Orientation Test (LOT-R) and the Satisfaction with Life Scale (SWLS). 58.9% patients reported low treatment adherence. Educated females aged 68 or under living in cities had higher adherence. The regression analysis showed an association between dispositional optimism and glaucoma treatment adherence. The higher the level of dispositional optimism, the better the adherence. Higher dispositional optimism is directly associated with a sense of self-esteem and self-efficacy and a feeling of internal control. Patients reporting a high level of illness acceptance were found to have 2.5 times higher odds of adhering to glaucoma therapy. Illness acceptance is an indicator of the degree of adaptation to an illness and is positively correlated with a sense of self-esteem and self-efficacy and engagement in healthy behavior. More than half of patients with glaucoma have low adherence. Sociodemographic characteristics (female gender, age 68 or under, tertiary education and living in an urban area) and psychological characteristics (high level of illness acceptance, dispositional optimism and satisfaction with life) are significant predictors of high adherence.

Two-year follow-up of a post-traumatic choroidal rupture with a lens luxation patient: a case report

Background: A choroidal rupture is a break in the choroid, Bruch membrane, and retinal pigment epithelium (RPE) that occurs most commonly as a result of blunt ocular trauma. It may be a secondary effect of direct or indirect trauma. This case illustrates an indirect post-traumatic choroidal rupture with lens luxation. Three months following the incident, the patient presented with impaired vision. The posterior segment was found to have a luxated lens during the objective examination of the eye. The funduscopy revealed a white, curvilinear, crescent-shaped streak that was concentric to the optic nerve. Case description: A 45-year-old male from East Java visited the ophthalmology outpatient clinic with a chief complaint of blurred vision in the left eye for three months, followed by pain in the left eye. On examination, the visual acuity was a one-meter counting finger. The lens was luxated to the posterior. The funduscopy examination revealed a curvilinear crescent-shaped streak. Vitrectomy and lensectomy were implemented. After four months of aphakia, the patient underwent a scleral fixation intraocular lens (IOL) implantation. The visual acuity was satisfactory, and no complications were observed during the two-year follow-up. Conclusion: We reported a post-traumatic choroidal rupture and a lens luxation with an optimal outcome after a two-year follow-up.

Patient Experience and Barriers to the Visual Field Test for Glaucoma.

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma. To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing. This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes. Of the 152 participants [M:F 79 (52.0%):73 (48.0%)], the age group with the highest proportion of participants was 71-80 years [n=56 (36.8%)], and most had a primary ocular diagnosis of glaucoma [n=107 (70.4%)]. The mean VAS score for visual field testing experience was 60.45 (SD=30.38). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma [55.34 (31.13) vs. 72.67 (25.04); P <0.05]. Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, sex, and mean visual field index did not influence participant experiences of visual field testing. Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Protective properties of spectacle lenses used as ultraviolet blockers

In this study, we evaluated the UV transmittance of spectacle lenses in the Turkish market, which are reported to have UV blocking properties, and tested their suitability. Samples were obtained from patients who were admitted to the ophthalmology outpatient clinic of our hospital for refractive error and who wore glasses as UV block. No limitation was made regarding the spectacle size and duration of spectacle wear. Measurements were tested by the principal investigator using an ultraviolet detector. The right and left lens were measured separately. All measurements were performed at room temperature (22-25°C) in a humidity regulated (20-40%) room without direct light. UV protection level was measured for 120 spectacles used for refractive errors. Only 28 (23.3%) of 120 glasses had protection level up to 400 nm UV. Twenty-four (20%) of the glasses had a protection level of 0 even though they were labeled as having UV blocking properties. It is clear that strict regulations need to be implemented to improve the protection levels of glasses.

Relationship between Serum Zinc Level and Retinopathy in Type 2 Diabetic Patients

Abstract Background Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia caused by insulin resistance (IR) or impaired insulin production. Diabetic retinopathy (DR) is a common microvascular disorder which occurs in type 2 diabetes mellitus (T2DM) patients due to chronic hyperglycemia. Previous studies reported that serum zinc (Zn) was associated with certain diabetic microvascular complications. Objective To evaluate relation between serum zinc level and diabetic retinopathy in patients with type 2 diabetes mellitus. Subjects and Methods The current study included 60 subjects with their ages ranging from 18- 60, selected from diabetes and ophthalmology outpatient clinics of Ain Shams University Hospitals for 7 months in a period from July 2022 to January 2023 with matched age and sex . fasting and post prandial blood glucose, hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP),serum creatnine, LDL, HDL, TG,TC and serum zinc levels were measured among groups. Results The study shows statistically significant difference between DM type II subgroups regarding duration of disease (yrs) being higher in DM II with retinopathy 12.5 (10.5 – 16.5) than DM II without retinopathy 9 (6 – 12) with p &amp;lt; 0.001. serum Zn levels were significantly lower in the DR group than the controls and diabetic without retinopathy.in whole DM type II group, there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, LDL, TC, FBS, 2PP and serum creatinine level, while in DM II without retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, LDL, TC and FBS and also in DM type II retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, FBS, 2PP and serum cretainine level .There is no statistically significant difference found between control group and DM type II group regarding weight, height and BMI of the studied patients with p-value = 0.108, 0.198 and 0.343; respectively. There is no statistically significant difference found between control group and DM type II group regarding systolic and diastolic blood pressure of the studied patients with p- value = 0.554 and 0.405; respectively. Conclusion Our study suggested that lower serum zinc level in T2D patients was related to higher prevalence of diabetic microvascular complications. Patients with lower serum zinc level were more likely to have a longer duration of diabetes, poorer glucose control, and worse β-cell function. Older age, higher HbA1c level, and the prevalence of DN were risk factors related to the lower serum zinc level.

Assessment of Conjunctival Surface Changes in Post COVID Patients by Impression Cytology

Abstract Background The conjunctiva is a transparent, clear, thin membrane that covers part of the eye’s front surface and the inner surface of the eyelids. It is divided into three regions: the palpebral or tarsal conjunctiva, the bulbar or ocular conjunctiva, and the conjunctival fornices. The novel coronavirus (COVID-19), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019 after a series of acute atypical lung disease cases occurred in Wuhan, China. Aim of the Work The aim of the our study is assessment of the inflammatory and neoplastic changes that happened on the ocular surface especially the conjunctiva according to Nelson staging system in post-COVID-19 patients and evaluated by impression cytology. Patients and Methods This study was conducted on a selected sample of patients attending the Ophthalmology outpatient clinic of Ain Shams University Hospitals in Cairo, specimens of impression cytology were stained and examined in the Pathology department of Ain Shams University. Results In the present study, comparison between cases and controls groups as regards epithelial cells showed that in cases group there was normal, small, round cells in 19(59.4%) cases, slightly larger, more polygonal cell in 11(34.4%), and Larger, polygonal cells in 2(6.3%), and in controls group, there was normal, small, round cells in 25(78.1%) cases, slightly larger, more polygonal cell in 7(21.9%), there was no statistically significant difference between the two groups as regards epithelial cells (p &amp;gt; 0.05). Furthermore, As regards N/C ratio where in cases group the ratio was 1:2 in 19(59.4%) cases, 1:3 in 11(34.4%), and 1:4-1:5 in 2(6.3%), and in controls group, it was 1:2 in 25(78.1%) cases, 1:3 in 7(21.9%), there was no statistically significant difference between the two groups as regards N/C ratio. In the current study, as regards Keratinization where 6(18.8%) cases had mild keratinization in cases group in comparison to 2(6.3%) cases in controls group. There was no statistically significant difference between the two groups as regards Keratinization (p &amp;gt; 0.05). Moreover, we found that there was no dysplasia in both cases and controls groups. The comparison between cases and controls groups as regard Goblet cells where in cases group the goblet cells was stage 0 in 17(53.1%) cases, others was stage 1 in 13(40.6%), and the cells was stage 2 in 2(6.3%), and in controls group, there was stage 0 cells in 22(68.8%) cases, stage 1 in 10(31.3%), there was no statistically significant difference between the two groups as regard goblet cells density. Conclusion There is non significant inflammatory or neoplastic changes that have been occurred in conjunctival surface in post-COVID-19 patients. Except for lymphocytes infiltration.

Could Triglyceride-Glucose Index, a Predictor of Atherosclerosis, Be Associated with Retinal Vein Occlusion?

The triglyceride-glucose (TyG) index is a sign of atherosclerosis in cardiovascular diseases. The TyG index is thought to have clinical significance for the assessment of vascular damage. In this study we aimed to demonstrate the connection between the TyG index and retinal vein occlusion (RVO). This case-control observational study involved 492 participants aged 40-90, admitted to the ophthalmology outpatient clinic of our hospital. TyG index was calculated using the formula: ln(fasting TG [mg/dL] × fasting plasma glucose [mg/dL]/2). The RVO group included 387 patients (181 women and 206 men) and the control group included 115 patients (61 women and 54 men). The average patient age was 62.9±11.1 years in the RVO group and 56.7±8.7 years in the control group. The TyG index was higher in the RVO group (8.9±0.7) than in the control group (8.8±0.6). This difference was statistically significant (p=0.04). The correlation was statistically significant when evaluated according to age and sex by multivariate logistic regression analysis (odds ratio: 1.45, confidence interval: 1.03- 2.02, p=0.03). The TyG index is a novel atherogenicity index that is derived from routine blood tests and can be used to determine the risk of RVO in at-risk individuals with a simple calculation. Therefore, the TyG index could help as a reliable guide to identify individuals at RVO with high risk and initiate early intervention.

Machine learning approach for ambient-light-corrected parameters and the Pupil Reactivity (PuRe) score in smartphone-based pupillometry.

The pupillary light reflex (PLR) is the constriction of the pupil in response to light. The PLR in response to a pulse of light follows a complex waveform that can be characterized by several parameters. It is a sensitive marker of acute neurological deterioration, but is also sensitive to the background illumination in the environment in which it is measured. To detect a pathological change in the PLR, it is therefore necessary to separate the contributions of neuro-ophthalmic factors from ambient illumination. Illumination varies over several orders of magnitude and is difficult to control due to diurnal, seasonal, and location variations. We assessed the sensitivity of seven PLR parameters to differences in ambient light, using a smartphone-based pupillometer (AI Pupillometer, Solvemed Inc.). Nine subjects underwent 345 measurements in ambient conditions ranging from complete darkness (<5 lx) to bright lighting (≲10,000 lx). Lighting most strongly affected the initial pupil size, constriction amplitude, and velocity. Nonlinear models were fitted to find the correction function that maximally stabilized PLR parameters across different ambient light levels. Next, we demonstrated that the lighting-corrected parameters still discriminated reactive from unreactive pupils. Ten patients underwent PLR testing in an ophthalmology outpatient clinic setting following the administration of tropicamide eye drops, which rendered the pupils unreactive. The parameters corrected for lighting were combined as predictors in a machine learning model to produce a scalar value, the Pupil Reactivity (PuRe) score, which quantifies Pupil Reactivity on a scale 0-5 (0, non-reactive pupil; 0-3, abnormal/"sluggish" response; 3-5, normal/brisk response). The score discriminated unreactive pupils with 100% accuracy and was stable under changes in ambient illumination across four orders of magnitude. This is the first time that a correction method has been proposed to effectively mitigate the confounding influence of ambient light on PLR measurements, which could improve the reliability of pupillometric parameters both in pre-hospital and inpatient care settings. In particular, the PuRe score offers a robust measure of Pupil Reactivity directly applicable to clinical practice. Importantly, the formulae behind the score are openly available for the benefit of the clinical research community.

Comparison of Smartphone and internet addiction and Optical Coherence Tomography findings among University students

IntroductionInternet and smartphone use that reaches the level of addiction often leads to deterioration in the quality of life and functionality of individuals.ObjectivesIn our study, we aimed to investigate possible differences in retinal nerve fiber layer (RNFL) thickness and central macular thickness obtained by optical coherence tomography in internet and smartphone addiction.MethodsA total of 212 volunteer university students participated in our study. All participants were administered the Sociodemographic Information Form, Chen Internet Addiction Scale, Smartphone Addiction Scale-Short Form. Participants who completed the scales underwent routine eye examinations by experienced physicians in the ophthalmology outpatient clinic. Retinal nerve fiber layer (RNFL) thickness and central macular thickness were measured by optical coherence tomography (OCT).ResultsIn our study, internet addiction rate was 17% and smartphone addiction rate was 38.2%. RNFL thickness was found to be statistically significantly increased in the temporal superior and temporal inferior quadrants in those with internet addiction compared to healthy subjects (p&lt;0.05). In smartphone addiction, RNFL thickness was found to be statistically significantly increased in the temporal inferior quadrant compared to healthy subjects (p&lt;0.05). In the analyses comparing OCT measurements according to sex, it was found that nasal inferior (p&lt;0.01) and global (p&lt;0.05) quadrants in women and central macular thickness (p&lt;0.01) in men were statistically significantly increased.The correlation analyses in our study revealed statistically significant positive correlations between internet addiction scale scores (p&lt;0.01) and smartphone addiction scale scores (p&lt;0.01), RNFL temporal superior quadrant thickness (p&lt;0.01); smartphone addiction scale scores and RNFL temporal superior quadrant thickness (p&lt;0.05).ConclusionsInternet and smartphone addiction are seen considerable rates among university students. In OCT measurements, RNFL thickness was found to be increased in various quadrants in patients with addiction. In addition, RNFL thickness was found to be increased in all quadrants in female gender and central macular thickness was found to be increased in male gender. Correlation analysis revealed that internet addiction scale scores, smartphone addiction scale scores, and RNFL temporal superior quadrant thickness were positively correlated. In addition, there was a positive correlation between smartphone addiction scale scores, and RNFL temporal superior quadrant thicknessDisclosure of InterestNone Declared

Is Blepharoplasty Cost-effective? Utility Analysis of Dermatochalasis and Cost-effectiveness Analysis of Upper Eyelid Blepharoplasty.

This cross-sectional prospective study measured utility values of upper eyelid dermatochalasis to quantify its impact on quality of life and assess cost-effectiveness of upper blepharoplasty. Utility of dermatochalasis was assessed using the standard reference gamble and time trade-off methods, with dual anchor points of perfect eye function and perfect health. The utility value obtained was used to create a Markov model and run a cost-effectiveness analysis of blepharoplasty as a treatment for dermatochalasis while utilizing the societal perspective. One hundred three patients with dermatochalasis recruited from an urban outpatient ophthalmology clinic completed the utility survey. The authors determined utility values for dermatochalasis ranging from 0.74 to 0.92 depending on the measurement method (standard reference gamble/time trade-off) and anchor points. The cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of $3,146 per quality-adjusted life year, well under the conventional willingness-to-pay threshold of $50,000 per quality-adjusted life year. Probabilistic sensitivity analysis with Monte Carlo simulation demonstrated that blepharoplasty would be cost-effective in 88.1% of cases at this willingness-to-pay threshold. Dermatochalasis has an impact on quality of life that is significantly associated with level of perceived functional impairment. Rising health care costs have underscored the importance of providing value-based treatment to patients, and the results of this study suggest that blepharoplasty is a cost-effective treatment option for symptomatic bilateral upper eyelid dermatochalasis.

The Effect of Cardiometabolic Control and Malnutrition on the Prevalence and Prognosis of Diabetic Retinopathy in Type 2 Diabetes

Purpose:It is estimated that type 2 diabetes mellitus affects 530 million people worldwide and 10.5 per cent of these patients have diabetic retinopathy. This study aims to investigate the predictive value of cardiometabolic control, GGT and malnutrition-related inflammation markers for predicting Diabetic retinopathy prevalence and prognosis.&#x0D; Materials and Methods:Type 2 Diabetes Mellitus patients who were consecutively admitted to Internal and Ophthalmology outpatient clinics were included in this study. Clinical, haematological and biochemical data were recorded. Cut-off values of GGT, PNI, NRI and HALP scores were determined by receiver operator characteristic curve analysis. Univariate and multivariate analyses were performed to determine the association of all variables with Diabetic retinopathy. As a result, we evaluated which of these tests were predictive and prognostic for the development of diabetic retinopathy.&#x0D; Results:This study included 166 patients. Fasting blood glucose(p