Preexisting Ocular Disease Research Articles

Change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital.

To determine the change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital. This study was conducted at Department of Ophthalmology Jinnah Postgraduate Medical Centre Karachi, for 6 months from 10th Dec 2019 to 10th June 2020. Sample size calculation of 52 eyes was done by using open epi software. Patients who fulfilled the inclusion criteria that is age ranging from 50 to 75 years, either gender with senile cataract having no preexisting ocular or systemic disease and those giving consent were included in this study. Patients with any comorbidity ocular trauma, having pre-existing ocular diseases such as active ocular infection, glaucoma, maculopathy or retinopathy were excluded from study. Patients with secondary cataract also excluded from study. After complete history, all patients underwent detailed ophthalmologic examination and Pre-surgery macular thickness recorded by using swept source OCT (DRI-OCT-2 Triton; Topcon). Surgery was performed and intraocular lens was implanted in all cases. Post procedure Macular thickness was measured using swept source OCT at 1st postoperative day, 1st month and 6th month after surgery. The mean age of patients was 62.06 ± 5.1 years. Total of 52 eyes diagnosed with senile cataract were included in this study. There were 30 (57.7%) males and 22(42.3%) females. The mean preoperative central foveal thickness was 201.3±24.8μm. The postoperative central foveal thickness was 200.3±25.2μm (153-265μm) at day 1st of surgery, 224.1 ± 53.8 μm (151-458 μm) at 1st month and 212.4±28.3μm (167-255μm) 6th month after surgery. The mean preoperative BCVA was 0.70 ± 0.43 (0.1-1.7) logMAR. The postoperative mean BCVA was 0.26 ± 0.42 (0.00-3.10) logMAR at 1st day, 0.07± 0.10 (0.000.7) logMAR at 1st month and 0.05 ± 0.10 (0.00-0.3) logMAR at 6th month. In our study we found an increase in macular thickness but there was no loss of BCVA from changes of macular thickness after surgery and the mean BCVA increased progressively in postoperative period.

Clinical Features, Risk Factors, and Management of Candida Keratitis

ABSTRACT Background/Aims To determine the clinical features, predisposing factors, and management of infectious keratitis caused by Candida spp. Methods Retrospective chart review. Results The medical records of 52 patients (54 eyes) with Candida keratitis were available for statistical analysis. Thinning of the corneal stroma was identified in 34 eyes (63.0%), and corneal perforation occurred in 16 eyes (29.6%). Corneal thinning and perforation were more common in Candida albicans compared with non-albicans (P-val < .001, P = .09, respectively). The most common predisposing factors for Candida keratitis were topical steroid use (21 patients, 40.4%), previous corneal transplantation (17 patients, 32.7%), and preexisting ocular surface disease (15 patients, 28.8%). Fourteen eyes (25.9%) required cyanoacrylate glue application and 10 eyes (18.5%) underwent therapeutic penetrating keratoplasty (TPK). Conclusion Local immunosuppression and ocular surface disease play an important role in Candida keratitis. C. albicans appears to be more invasive compared with non-albicans spp.

Visual Acuity after Posterior Capsular Rupture during Cataract Surgery

Posterior capsular rupture (PCR) is a common and serious complication of cataract surgery. It complicates the process of inserting posterior chamber intraocular lens and affects the visual outcome. This study is a review on visual acuity of patients that had PCR during cataract surgery in Hospital Melaka, risk factors of PCR, and factors that cause poor visual outcome. The record of all patients that had PCR during cataract surgery from 1 January 2014 till 31 March 2017 was traced using National Eye Database (NED) and the patients’ folders were reviewed retrospectively. Data collected was demographic data, type of cataract surgery, status of surgeon, underlying ocular diseases, risks factors for PCR, postoperative visual acuity, and factors that cause poor visual outcome. There were 238 eyes that had PCR during cataract surgery, from 126 (53%) female and 112 (47%) male patients. The mean age was 66.62 years old, ranging from 9 to 87 years old. Major risk factors identified were hard cataract, polar cataract, uncooperative patients, extended continuous capsulorhexis, subluxated lens, myopia, vitrectomised eyes, and poor pupil dilatation. From 153 cases that had no pre-existing ocular diseases, 119 (78%) cases had normal vision (best corrected visual acuity – BCVA) two months after surgery, 10 (7%) cases had moderate visual impairment, and four (2%) cases had severe visual impairment. Causes of BCVA poorer than 6/18 were high astigmatism, CMO, and prolonged inflammation. Cataract surgery, even complicated by PCR, is compatible with good visual outcome if the complications are managed promptly.

TO STUDY CONJUNCTIVAL BACTERIAL AND FUNGAL FLORA IN DIABETIC AND NON- DIABETIC INDIVIDUALS AND THEIR ANTIBIOGRAM IN TERTIARY CARE HOSPITAL

Introduction:The conjunctiva is a clear mucous membrane that borders the interior of the eye lids and protects the sclera. It consists of non-keratinized, stratified columnar epithelium with goblet cells. Normal microbial flora constitutes organisms which are present in eyelids and conjunctiva without causing any disease. The flora of the ocular surface consists more of gram positive microorganisms2.Gram positive organisms, particularly coagulase negative Staphylococci, are widely recognized to be the primary inhabitants of the normal eye. At birth eyes are sterile but they are later infected by various organisms. Diabetes mellitus is a multi factorial disease that can affect all ocular structures. Aim:To evaluate the Conjunctival bacterial and fungal flora of Non diabetic and diabetic individuals. Material &amp;Method:This was anCross sectional, Observational Study conducted on a total of 204 patients attending Department of Microbiology of Peoples Medical College and Hospital, Bhopal, India between February 2022 to February 2023. Conjunctival swab was collected from lower eyelid to expose the Conjunctival membrane of eyes by sterile swab sticks. to assess the conjunctival flora and antibiotic sensitivity pattern in diabetic and non-diabetic individuals without any pre-existing ocular diseases. Result: Conjunctival flora of a total of 204 patients, 102 diabetic and 102 non diabetic, were screened. Among the 102 diabetic patients, there were 51(49.5%)male and 51(49.5%)female. The most common isolated bacteria in diabetic and non diabetic groups were staphylococcus aureus (diabetic 26.92%, Non-Diabetic 61.11%). There was a statistically significant difference in microbial flora pattern between the diabetic and non diabetic group. There was higher proportion Gram negative bacilli grown in Diabetics. Conclusion:Present study found statistically significant difference in the microbial flora between diabetics and non diabetics. The observation of the present study and various other studies, infer that staphylococcal infections are common among both Diabetic and Non- diabetic individuals. Gram-negative bacteria Escherichia coli and Klebsiella pneumoniae were detected in higher ratios in the conjunctival flora of diabetic patients. Candida albicans were more common among the diabetics as compared to non- diabetics.

Pars Plana Vitrectomy for Retained Lens Fragments After Cataract Surgery: Outcomes Based on Timing of Surgery.

To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery. Retrospective case series of all patients who underwent PPV for RLF at Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery. The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (P = 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (P > 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (P > 0.05). In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.

The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness.

Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes. To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer. Prospective, longitudinal study. Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed. A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values. Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.

Is it time for a moratorium on the use of benzalkonium chloride in eyedrops?

Is it time for a moratorium on the use of benzalkonium chloride in eyedrops?

A study of ophthalmic co-morbidities in mild to moderate cases of COVID- 19 infection

To study the ophthalmic co-morbidities and post- COVID ophthalmic complications in mild to moderate COVID positive patients. This was a questionnaire based prospective longitudinal study conducted between August 2020 and December 2020. In the first phase, an ophthalmologist in personal protective equipment (PPE) physically visited the patients and a pre-designed structured questionnaire regarding any ophthalmic complaints was filled and scoring was done later. In the second phase, the patients were telephonically interviewed after 3-6 months of their discharge from the hospital, regarding the development of ocular symptoms for which they needed to consult an ophthalmologist and the treatment taken was noted. 9% of the total 77 patients included in the study reported severe symptoms (scores between 17-24/24). On comparing the mean questionnaire scores (out of 24) it was seen that more severe ophthalmic complaints were seen in patients aged &amp;#62;= 50 years than &amp;#60;50 years (11.35 vs 5.75, p&amp;#60;0.05), moderate category than mild category patients (11.70 vs 3.63, p&amp;#60;0.05), patients with systemic co-morbidities than those who had none (11.48 vs 4.04, p&amp;#60;0.05) and in patients who later needed to consult an ophthalmologist due to development of one or more complications than those who did not.(13.27 vs 6.63, p&amp;#60;0.05).Post- COVID complications were seen in 27 patients (35%). They included progression of pre-existing ocular disease like cataract, glaucoma, diabetic and hypertensive retinopathy, and new diagnosis of diabetic and hypertensive retinopathy and HCQ- related maculopathy. Ocular co-morbidities should be looked for in every COVID patient. Those at higher risk of developing complications, should undergo a detailed ophthalmic examination after they are discharged from the isolation wards. Hospitals need to work on capacity building and/or look for alternatives, like telemedicine, to ensure timely eye care to all patients.

Prevalence of Self-Reported Symptoms of Computer Vision Syndrome and Associated Risk Factors among School Students in China during the COVID-19 Pandemic

ABSTRACT Purpose To determine the prevalence and risk factors of self-reported symptoms of Computer Vision Syndrome (CVS) in school students during COVID-19 pandemic. Methods In this cross-sectional study in Nanjing, China, students (grades 1–12) from six randomly selected schools self-administered the online survey questionnaire about hours on electronic devices, outdoor activities, frequency and intensity of 17 CVS symptoms during virtual learning period of COVID-19 pandemic. Results Among 2363 invited students, 2005 (84.8%) completed the survey. Mean (SD) age was 12 (3.0) years, 51% were male, 53% wore glasses, 56% did not know the 20-20-20 rule (take a 20 second break every 20 min of close work and gaze at objects at least 20 feet away) and 6.5% knew but never followed the 20-20-20 rule. Mean (SD) hours/day was 4.6 (3.4) for screen time and 1.2 (1.0) for outdoor activities. Total of 1543 (77.0%) students reported at least one CVS symptom (median = 4) with eye dryness and itching the most common (48%). In multivariable analysis, CVS score 4 or more was independently associated with older age (adjusted odds ratio (aOR) = 1.05 for per-year increase, p = 0.02), children with myopia not wearing glasses (aOR = 2.12, p = 0.0003), astigmatism (aOR = 1.37, p = 0.04), other ocular diseases (aOR = 1.59, p = 0.005), not complying 20-20-20 rule (aOR = 2.13, p = 0.04), more screen time (aOR = 1.53 for >6 vs. ≤2 hours, p = 0.0001) and less outdoor activities (aOR = 1.37 for ≤0.6 vs. ≥1.9 hours, p = 0.005). Conclusions During COVID-19 pandemic, self-reported CVS symptoms occurred in more than three-quarters of students. Besides pre-existing ocular diseases, children with myopia not wearing glasses, excessive time on screens, non-compliance of the 20-20-20 rule and reduced outdoor activities were associated with higher risk of CVS.

Clinico-microbiological profile of Burkholderia cepacia keratitis: a case series

BackgroundBurkholderia cepacia, an opportunistic pathogen mainly affecting patients with cystic fibrosis or immunocompromised, has rarely been documented as a cause of corneal infection. The clinical and microbiological profiles of B. cepacia keratitis are reported herein.MethodsWe retrospectively reviewed the medical record of 17 patients with culture-proven B. cepacia keratitis, treated between 2000 and 2019 at Chang Gung Memorial Hospital, Taiwan. Our data included predisposing factors, clinical presentations, treatments, and visual outcomes of B. cepacia keratitis as well as the drug susceptibility of the causative agent.ResultsThe most common predisposing factor for B. cepacia keratitis was preexisting ocular disease (seven, 41.2%), particularly herpetic keratitis (five). Polymicrobial infection was detected in seven (41.2%) eyes. All B. cepacia isolates were susceptible to ceftazidime. Main medical treatments included levofloxacin or ceftazidime. Surgical treatment was required in five (29.4%) patients. Only four (23.5%) patients exhibited final visual acuity better than 20/200.ConclusionsB. cepacia keratitis primarily affects patients with preexisting ocular disease, particularly herpetic keratitis, and responds well to ceftazidime or fluoroquinolones. However, the visual outcomes are generally poor.

Corneal endothelial cells and central corneal thickness in patients with neurofibromatosis type 1.

Purpose:The aim of this study was to evaluate the morphological properties of corneal endothelial cells and central corneal thickness (CCT) in patients with neurofibromatosis type 1 (NF1) and to compare them with age-matched healthy controls.Methods:Nineteen NF1 patients and 38 healthy individuals were recruited. All participants underwent complete ophthalmological examination as well as noncontact specular microscopy to measure endothelial cell density (ECD), average cell area (AVG), coefficient of variation of cell area (CV), the percentage of hexagonal cells, and CCT. Eyes with previous ocular trauma, inflammation or surgery, and preexisting corneal and ocular surface diseases were excluded.Results:NF1 patients had higher ECD compared to healthy controls of the same age (2764.2 ± 270.4 versus 2570.4 ± 449.2 cells/mm, respectively), although at a borderline level (P = 0.051). Patients with NF1 presented significantly lower CV and AVG when compared to controls (32.9 ± 4.6 versus 37.8 ± 9.5%, P = 0.011 and 364.9 ± 34.4 versus 406.0 ± 107.4 µm, P = 0.038, respectively). The NF1 group had significantly higher hexagonality in comparison with controls (55.7 ± 6.5 versus 50.5 ± 9.9%, P = 0.025). CCT was similar between the two groups (P = 0.955).Conclusion:Our results show that corneal endothelium has more favorable morphological characteristics in NF1 patients compared to healthy individuals of the same age.

Visual acuity and retinal line disruption in ocular trauma

Purpose: Study to find out relationship between visual acuity and retinal visual line disruption in ocular coherence tomogram (OCT) due to (1) changes in the inner segment and outer segment retinal junction (IS/OS), (2) external limiting membrane (ELM) in the foveal region in ocular blunt injuries and to find out it’s prognostic value. Materials and Methods: Prospective, observational study conducted on 100 eyes of 100 patients who visited the department of ophthalmology with blunt ocular injuries. Patients with associated pre-existing ocular and systemic diseases were excluded. Refraction was done to know the best corrected visual acuity in logarithm of minimum angle of resolution (log MAR) after regression of anterior segment signs. OCT was done to scan and study macular pathology and visual lines. Integrity of IS/OS junction and ELM were studied and analyzed the relationship with visual acuity to consider for prognostic value. Result: Statistically significant relation was noted between the visual acuity and disruption of lines at retinal IS/OS junction and ELM (P Conclusion: The retinal visual line disruption can be used as prognostic indication for future vision.]. Keywords: External limiting membrane, Inner segment outer segment junction, Trauma, Visual acuity.

Analysis of conjunctival flora in diabetic and non-diabetic individuals and their antibiotic sensitivity pattern

To compare the conjunctival flora of diabetic individuals and non-diabetic individuals and assess their antibiotic sensitivity pattern. A hospital based cross-sectional and descriptive study was carried out from September 2016 to August 2018 with 92 patients of age group from 40-70 years, to assess the conjunctival flora and antibiotic sensitivity pattern in diabetic and non-diabetic individuals without any pre-existing ocular diseases and adnexal disease. The rate of positive culture in Group A (Diabetics) was significantly higher as compared to Group B (Non-Diabetics) (21.7% vs. 4.3% respectively) (p&amp;#60;0.05). It was noted that there was a significantly higher incidence of the bacteria, Staphylococcus epidermidis in Group A (Diabetics) as compared to Group B (Non-Diabetics) (p&amp;#60;0.05). The antibiotic sensitivity of bacteria isolated in patients in Group A (Diabetics) showed the following observations - in Staphylococcus epidermidis, Staphlococcusaureus maximum sensitivity was seen with Gentamicin. A higher positive culture rate was seen in diabetic individuals as compared to non-diabetic individuals. It was then concluded that, as gentamicin shows maximum sensitivity to gram-posit ive and gram-negative organisms, Gentamicin is the drug of choice which takes cares of gram positive as well as gram negative bacteria and can be considered as routine pre-operative topical medication.Pre-operative cataract work up.

Post operative visual outcomes after cataract surgery in a teaching hospital

An uneventful cataract surgery with intraocular lens implant is capable of providing normal vision. Good visual outcome increases patient’s satisfaction and quality of life. Aim is to evaluate the postoperative complications and visual outcomes after manual small incision cataract surgery at a teaching hospital. In this study 100 patients who underwent uneventful SICS with PCIOL implant were followed up. Patients having pre-existing ocular disease were excluded. IOL power was accurately estimated. Visual acuity, anterior segment and fundus findings were recorded at each postoperative visit upto 6 weeks and in some cases upto 3months. We followed the visual outcome standards set by WHO. 53 males and 47 females in the age group of 45 to 75 and above were selected. On 1st post operative day 38% patients had quiet eyes. In 62% patients, decreased vision and complications observed on 1st post operative day and upto 1st week were: Striate keratopathy and corneal edema, anterior uveitis with pupillary membrane, residual lens matter, macular edema, endophthalmitis, intraocular hemorrhage with secondary glaucoma and IOL related causes. On the 6th postoperative week during spectacles prescription, 60% had uncorrected Astigmatism, 5% consecutive myopia/ hypermetropia and 8% had posterior capsular opacity. At 3 months follow up, 92% had good outcome, 3% patients had borderline outcome. 5% poor visual outcome was seen in patients with Bullous keratopathy, endophthalmitis, vitreous hemorrhage and longstanding macular edema.Our hospital based study reports 5% patients with poor visual outcome 3 months after uneventful cataract surgery.

Assessment of Corneal Epithelial Thickness in Chronic Contact Lens Users Using Anterior Segment Optical Coherence Tomography

Abstract Introduction The corneal epithelium is stratified epithelium that is continuously renewed and provides the frontline of defence against invading ocular pathogens and a smooth refractive surface essential for vision. In the absence of a contact lens, pre-existing ocular trauma or disease, the epithelium maintains an inaccessible defence against attacks from pathogenic microorganisms, affording a high level of resistance against microbial invasion. Aim The aim of this study is to determine the effect of chronic use of contact lens on corneal epithelium thickness using anterior segment optical coherence topography as a non- invasive diagnostic accurate measure. Patients and Methods 30 eyes of control subjects who don’t wear contact lens along their life aged between 15-45 years ,where compared with similar age group of 30 eyes of chronic contact lens users; who wear contact lens every day not less than 8 hours per day for along time interval between 6 months up to 5 years. Results The average corneal epithelial thickness in the central, paracentral and midperipheral zones was 47.767 ± 5.550 µm, 46.267 ± 5.644 µm, 44.300 ± 4.858 µm, respectively, in chronic soft contact lens users; and 49.800 ± 3.316 µm, 49.200 ± 3.367 µm, 45.733 ± 2.333 µm ,in control group who had never worn contact lens. There were insignificant thinning of corneal epithelium of soft contact group compared to control group regarding the average corneal epithelial thickness in those 3 zones. In all the 8 sectors of corneal epithelium of paracentral zone and midperipheral zones there is insignificant thinning between the two groups except for the inferior temporal sector in the paracentral zone and mid peripheral zone, which shows significant thinning in soft contact lens group compared to control group. The corneal epithelial thickness in the inferior temporal sector of paracentral and mid peripheral zones was 46.333 ± 5.677 µm, 44.933 ± 4.813 µm, respectively, in chronic soft contact lens users compared to 48.767 ± 3.266 µm, 46.900 ± 2.510 µm in control group (p = 0.046, p = 0.052, respectively). Conclusion AS-OCT helps us to evaluate the corneal epithelium of contact lens users, which could be very useful in corneal refractive surgeries in patients depending on contact lens in their lives as a comfortable refractive aid, It is necessary to do AS-OCT hand on hand with pentacam in patients underwhelming refractive surgery to give a proper assessment to their corneal epithelium before determining which type of refractive surgery suits them.

Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation.

Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome. A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented. Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management. Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.

Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound.

BackgroundThe early detection of elevated intracranial pressure (ICP) can not only prevent mortality but also aid in more aggressive management. Brain computed tomography (CT) is a mainstay modality in detecting elevated ICP, but the feasibility of using brain CTs to detect elevated ICP in critically ill patients is limited, especially for patients who require high levels of inotropic support. The optic nerve sheath is a direct extension of the brain meninges. Therefore, the elevation of ICP is directly transmitted to the sheath. Measuring the optic nerve sheath diameter (ONSD) through ultrasound (US) is a bedside, noninvasive means to detect elevated ICP. The goal of this study was to assess the correlation of ONSD with elevated ICP as measured via US in an intensive care unit (ICU).MethodsWe conducted a six-month prospective, single-center, observational study of mass effect stroke patients aged 18 to 65 years who had a traumatic brain injury (TBI) and were admitted to the ICU. Patients with chronic hydrocephalus, extensive local orbit trauma, a pre-existing ocular disease affecting the optic nerve and/or orbital cavity, hyperthyroidism with exophthalmos, and facial trauma affecting the orbits and/or eyeballs were excluded. We measured the ONSD at the entry of optic nerve into the globe using two-dimensional (2D) US.ResultsOne hundred patients were included in the study. Forty-nine patients had diffuse cerebral edema detected on CT scan correlating with increased ONSD notable via bedside US. The mean ONSD related to CT-detectable elevated ICP was 0.61 cm. The sensitivity for the ONSD cut-off value of ≥5.8 mm was 94% (95% confidence interval [CI], 84.05% to 98.79%), and the specificity was 96.08% (95% CI, 86.7% to 99.52%).The positive predictive value was 92.08% (95% CI, 86.28% to 98.96%), and the negative predictive value was 94.23% (95% CI, 84.47% to 98.00%).ConclusionThe greatest accuracy in ONSD was found with a cut-off of >0.58 cm in patients with positive CT brain findings. Therefore, US can be used as an initial screening test when physicians suspect a patient has elevated ICP.

Eleven Years of Cataract Surgery in Veterans Without Pre-existing Ocular Comorbidities.

In 2017, over 75,000 cataract surgeries were performed within the Veterans Health Administration System (VHA). Previous reports of outcomes of cataract surgery in veterans include patients with pre-existing ocular disease, which can affect vision. To exclude the confounding factor of pre-existing ocular comorbidities, we investigated the long-term visual outcomes and complications associated with small incision cataract surgery performed on veterans without any pre-existing eye disease. Institutional Review Board approved cohort study with detailed retrospective chart review of all phacoemulsification (small incision) cataract surgeries performed at the Veterans Affairs Medical Center in Washington D.C. over 11 years, including all pre-and postoperative visits until postoperative month 12. A total of 1,513 consecutive surgical cases without any pre-existing ocular disease except the cataract were included. Vision improved significantly after cataract surgery compared to the preoperative best-corrected visual acuity (BCVA) (p = 0.0001) and remained stable over the first intra- and postoperative year. All eyes without complicated surgery and 99.1% of eyes with complications achieved 20/40 or better final vision postoperatively. The most common intra-and postoperative complications were vitreous loss (3.1%) and cystoid macular edema (CME; 1.4%). Patients with complications achieved final mean BCVA of 0.04 (20/22, vitreous loss) and 0.06 (20/23, CME) mean logMAR (Snellen). Analysis of 11 years of small incision cataract surgery in eyes without pre-existing ocular disease within the VHA showed significant improvement in vision and stability 12 months after uncomplicated and complicated surgery in veterans.

Understanding the Role of Pro-resolving Lipid Mediators in Infectious Keratitis.

Keratitis is a sight-threatening inflammatory condition of the cornea that can be caused by both infectious and non-infectious agents. Physical or chemical trauma are typically related to non-infectious keratitis, which may then become secondarily infected or remain non-infected. Etiology of infectious keratitis is most often associated with bacteria; but viruses, fungi, and parasites are common causative pathogens as well. As a global concern, common risk factors include: systemic immunosuppression (secondary to malnutrition, alcoholism, diabetes, steroid use), previous corneal surgery (refractive corneal surgery, penetrating keratoplasty), extended wear contact lens use, pre-existing ocular surface diseases (dry eye, epithelial defect) and ocular trauma (agriculture- or farm-related) [1-8]. Annual rates of incidence include nearly one million clinical visits due to keratitis in the United States, while it has been reported that roughly two million people develop corneal ulcers in India. Clinically, patients may show signs of eye pain (ranging from mild to severe), blurred vision, photophobia, chemosis and redness. Pathogenesis is generally characterized by rapid progression, focal white infiltrates with underlying stromal inflammation, corneal thinning, stromal edema, mucopurulent discharge and hypopyon, which can lead to corneal scarring, endophthalmitis, and perforation. In fact, corneal opacity is not only a complication of keratitis, but among the leading causes of legal blindness worldwide. Despite that empirical treatment effectively controls most of the pathogens implicated in infectious keratitis, improved clinical outcomes are not guaranteed. Further, if treatment is not initiated in a timely manner, good visual outcome is reduced to approximately 50% of keratitis patients [9]. Moreover, resultant structural alterations, loss of tissue and an unresolved host response remain unaddressed through current clinical management of this condition.

Effects of Preservative on the Meibomian Gland in Glaucoma Patients Treated with Prostaglandin Analogues.

This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.