Category: Nevin Manimala

Indian J Ophthalmol. 2021 Jun;69(6):1560-1562. doi: 10.4103/ijo.IJO_430_21.

ABSTRACT

PURPOSE: Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario.

METHODS: This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed.

RESULTS: 204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample.

CONCLUSION: Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

PMID:34011741 | DOI:10.4103/ijo.IJO_430_21

Indian J Ophthalmol. 2021 Jun;69(6):1527-1530. doi: 10.4103/ijo.IJO_2650_20.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the changes in corneal topography, cycloplegic refraction, and best-corrected visual acuity (BCVA) after ptosis correction surgery in patients with congenital ptosis.

METHODS: Our study represents a prospective observational study conducted on 27 eyes of 21 patients with congenital ptosis. All patients underwent complete ophthalmological evaluation, cycloplegic refraction, and baseline Orbscan prior to ptosis surgery. At 6 months postoperative review, the cycloplegic refraction and Orbscan were repeated to evaluate the changes in these parameters. The main outcome measures in our study were Steepest K, Inferior-Superior Asymmetry (I-S Asymmetry), cycloplegic refraction and BCVA.

RESULTS: A significant decrease in Steepest K postoperatively (P < 0.001) was noted. Superior K and Inferior K also decreased, but the decrease in Inferior K was statistically significant (P = 0.044). However, change in I-S Asymmetry was not significant. Variation in BCVA, and cycloplegic sphere and cylinder was minimal. Sim K astigmatism, Surface Regularity Index, I-S Asymmetry and Central Corneal Thickness did not show significant variation.

CONCLUSION: Ptotic eyelid constantly presses on the cornea causing significant changes in corneal contour and surface remodeling. This pressure when relieved, results in significant flattening and regression of anterior corneal surface to its near normal anatomy. This further resulted in improvement of corneal surface irregularity and symmetry.

PMID:34011735 | DOI:10.4103/ijo.IJO_2650_20

Indian J Ophthalmol. 2021 Jun;69(6):1531-1536. doi: 10.4103/ijo.IJO_1820_20.

ABSTRACT

PURPOSE: The aim of this study was to test a method for estimating corneal rigidity before and after cross-linking (CXL) using a Schiøtz tonometer.

METHODS: The study was performed in the Kyiv City Clinical Ophthalmological Hospital “Eye Microsurgical Center”, Ukraine. This was a prospective, consecutive, randomized, masked, case-by-case, clinical study. Corneal rigidity, indicated by the gradient (G) between lg applied weight and corresponding lg scale reading during Schiøtz tonometry, were obtained by increasing (A-mode) then reducing (D-mode) weights by two operators [A] in keratoconus, post-CXL and control subjects for estimation of (i) interoperator and (ii) intersessional errors, (iii) intergroup differences; [B] before and after CXL. Central corneal thickness CCT was measured by scanning slit pachymetry. ANOVA, t tests, linear regression were the statistical tools used.

RESULTS: Average interoperator difference (ΔG) was -0.120 (SD = ±0.294, 95%CI = -0.175 to -0.066). A significant correlation between ΔG and the mean of each pair of G values was found (r = -0.196, n = 112, P = 0.038). Intersessional differences in mean G values were insignificant (P > 0.05). There was a significant correlation between G at first session (X₁) and difference between sessions (ΔG) [Operator 1, ΔG = 0.598x₁-0.461, r = 0.601, n = 27, P = 0.009]. Significant intergroup differences in G were found (Operator 1, one-way ANOVA, F = 4.489, P = 0.014). The difference (Δ) between the pre-(X₂) and post-CXL treatment G values was significantly associated with the pre-CXL treatment value (Operator 1, Δ = 1.970x₂-1.622, r = 0.642, n = 18, P = <.001). G values were correlated with CCT in keratoconus and post-CXL.

CONCLUSION: Corneal rigidity (G) estimated using the Schiøtz tonometer can be useful for detecting changes after CXL. However, G values are linked to CCT, can vary from time-to-time and the procedure is operator dependent.

PMID:34011736 | DOI:10.4103/ijo.IJO_1820_20

Indian J Ophthalmol. 2021 Jun;69(6):1457-1463. doi: 10.4103/ijo.IJO_2964_20.

ABSTRACT

PURPOSE: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS).

METHODS: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients.

RESULTS: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 (P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with (P-value < 0.001).

CONCLUSION: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.

PMID:34011720 | DOI:10.4103/ijo.IJO_2964_20

Indian J Ophthalmol. 2021 Jun;69(6):1487-1490. doi: 10.4103/ijo.IJO_2956_20.

ABSTRACT

PURPOSE: To assess pre and post vergence and accommodation parameters after monitored reading on a smartphone device.

METHODS: This prospective comparative study was performed in a tertiary eye care center for a duration of 6 months (December 2017 – May 2018). A total of 47 healthy emmetropic subjects of age group ranging from 18-30 years were recruited for the study. Participants underwent an initial visual screening protocol, followed by accommodation and vergence parameters assessment. The subjects were given reading text of optotype N6 at 40cm working distance for 30 minutes in a smart phone device. Pre and post measurements were documented.

RESULTS: Among 47 subjects there were 17 male and 30 females with mean age group of 21.2+2.06 years. There was a statistically significant worsening of accommodative components (negative & positive relative accommodation, lag of accommodation). In vergence parameters, a statistically significant deterioration of negative (12.8 + 1.65 to 12.38 + 1.93 PD) and positive fusional vergence (15.48 + 1.53 to 16.08 +1.61 PD) was observed. The mean vergence facility also showed a statistically significant change in pre and post task measurements (13.51 + 1.64 to 10.71 + 1.91 cpm (cycles per minute)).

CONCLUSION: The current study investigated that perusing text with a smart phone for 30 minutes shows significant effect on accommodative and vergence components for near task, with greater impact on vergence parameters. Drawn out exposure to digital screens at near, may bring about visual quality dysfunction.

PMID:34011725 | DOI:10.4103/ijo.IJO_2956_20

Indian J Ophthalmol. 2021 Jun;69(6):1517-1521. doi: 10.4103/ijo.IJO_2455_20.

ABSTRACT

PURPOSE: This study aimed to share our experience in the hospital cornea retrieval program as a new eye bank.

METHODS: This was a retrospective study conducted in a tertiary care institute from August 26, 2019 to March 22, 2020. The medical and eye bank records were analyzed for hospital mortality, mortuary records, and donors approached. The corneal collection was divided between Voluntary (received from voluntary calls), HCRP (cornea received from hospital deaths), and Medico-Legal Cases (received from MLC deaths in hospital) to see the trend of donation and utilization over time.

RESULTS: During the study period, 154 corneas (77 pairs) were collected. The HCRP provided a major source of corneas 58.4% (90 corneas) as compared to voluntary 19.5% (30 corneas) and MLC 22.1%(34 corneas). There were younger tissues in MLC than HCRP donors, and older tissues in Voluntary donors, and the difference was statistically significant. There was no significant difference in the quality of optical grade tissues and the utilization of corneas for transplants between the three groups. Post hoc analysis showed more non-optical tissues in the voluntary donations (P = 0.004), maximum donors with medical contraindications in the HCRP group (P = 0.001), and time-lapse in corneal retrieval in MLC cases (P = 0.0001). Of these 154 corneas, 78 (50.6%) were assessed as suitable for transplantation, of which 59 (75.6%) tissues were optical grade tissues. The overall utilization was 39.6%.

CONCLUSION: HCRP is indeed challenging for a new eye bank, but proper understanding and implementing strategies may help for good utilization of tissues.

PMID:34011733 | DOI:10.4103/ijo.IJO_2455_20

Pediatrics. 2021 May 19:e2020042325. doi: 10.1542/peds.2020-042325. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital-associated venous thromboembolism (HA-VTE) is an increasing cause of morbidity in pediatric populations, yet identification of high-risk patients remains challenging. General pediatric models have been derived from case-control studies, but few have been validated. We developed and validated a predictive model for pediatric HA-VTE using a large, retrospective cohort.

METHODS: The derivation cohort included 111 352 admissions to Monroe Carell Jr. Children’s Hospital at Vanderbilt. Potential variables were identified a priori, and corresponding data were extracted. Logistic regression was used to estimate the association of potential risk factors with development of HA-VTE. Variable inclusion in the model was based on univariate analysis, availability in routine medical records, and clinician expertise. The model was validated by using a separate cohort with 44 138 admissions.

RESULTS: A total of 815 encounters were identified with HA-VTE in the derivation cohort. Variables strongly associated with HA-VTE include history of thrombosis (odds ratio [OR] 8.7; 95% confidence interval [CI] 6.6-11.3; P < .01), presence of a central line (OR 4.9; 95% CI 4.0-5.8; P < .01), and patients with cardiology conditions (OR 4.0; 95% CI 3.3-4.8; P < .01). Eleven variables were included, which yielded excellent discriminatory ability in both the derivation cohort (concordance statistic = 0.908) and the validation cohort (concordance statistic = 0.904).

CONCLUSIONS: We created and validated a risk-prediction model that identifies pediatric patients at risk for HA-VTE development. We anticipate early identification of high-risk patients will increase prophylactic interventions and decrease the incidence of pediatric HA-VTE.

PMID:34011634 | DOI:10.1542/peds.2020-042325

Indian J Ophthalmol. 2021 Jun;69(6):1369-1374. doi: 10.4103/ijo.IJO_2491_20.

ABSTRACT

PURPOSE: The aim of this study was to create vision standards for various tasks performed by hairdressers and to assess the spectacle compliance and its impact at work.

METHODS: The observational cross-sectional study enrolled hairdressers in and around Chennai, Tamil Nadu. It was done in three phases: (i) Job profiling from visual task analysis, creating vision standards for various hairdressing tasks and arriving at test protocols; (ii) Comprehensive eye examination, and (iii) Assessment of spectacle compliance and its impact on work. Descriptive analysis using Microsoft Excel and SPSS (IBM SPSS Statistics Version 21.0) was performed.

RESULTS: There were 305 participants with a mean age of 48 (SD ± 12) years. The visual acuity demand was found to be 6/18 and N15, for distance and near, respectively. Appropriate spectacles were prescribed for 203 (67%) hairdressers. Even with the best possible refractive correction, a few hairdressers did not meet the distance (13) and near (11) visual acuity standard. In all, 54 hairdressers were referred for further examination to a tertiary eye care center for lenticular changes, retinal abnormalities, and glaucoma screening. Among the subjects who were dispensed with spectacles, 181 (86%) were available for telephonic spectacle compliance assessment, and 164 (90%) were compliant with spectacle usage at work. Improved visual ability was reported by 133 (81%) hairdressers at work.

CONCLUSION: This study provides vision standards for hairdressers. From the visual task analysis, hairdressing tasks were found to be visually demanding and hazardous. The study emphasizes that providing appropriate spectacle correction showed a clinically evident positive impact at work.

PMID:34011702 | DOI:10.4103/ijo.IJO_2491_20

BMJ Open. 2021 May 19;11(5):e046274. doi: 10.1136/bmjopen-2020-046274.

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) has high morbidity and mortality in intensive care units, which can lead to chronic kidney disease, more costs and longer hospital stay. Early identification of AKI is crucial for clinical intervention. Although various risk prediction models have been developed to identify AKI, the overall predictive performance varies widely across studies. Owing to the different disease scenarios and the small number of externally validated cohorts in different prediction models, the stability and applicability of these models for AKI in critically ill patients are controversial. Moreover, there are no current risk-classification tools that are standardised for prediction of AKI in critically ill patients. The purpose of this systematic review is to map and assess prediction models for AKI in critically ill patients based on a comprehensive literature review.

METHODS AND ANALYSIS: A systematic review with meta-analysis is designed and will be conducted according to the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Three databases including PubMed, Cochrane Library and EMBASE from inception through October 2020 will be searched to identify all studies describing development and/or external validation of original multivariable models for predicting AKI in critically ill patients. Random-effects meta-analyses for external validation studies will be performed to estimate the performance of each model. The restricted maximum likelihood estimation and the Hartung-Knapp-Sidik-Jonkman method under a random-effects model will be applied to estimate the summary C statistic and 95% CI. 95% prediction interval integrating the heterogeneity will also be calculated to pool C-statistics to predict a possible range of C-statistics of future validation studies. Two investigators will extract data independently using the CHARMS checklist. Study quality or risk of bias will be assessed using the Prediction Model Risk of Bias Assessment Tool.

ETHICS AND DISSEMINATION: Ethical approval and patient informed consent are not required because all information will be abstracted from published literatures. We plan to share our results with clinicians and publish them in a general or critical care medicine peer-reviewed journal. We also plan to present our results at critical care international conferences.

OSF REGISTRATION NUMBER: 10.17605/OSF.IO/X25AT.

PMID:34011595 | DOI:10.1136/bmjopen-2020-046274

BMJ Open. 2021 May 19;11(5):e049763. doi: 10.1136/bmjopen-2021-049763.

ABSTRACT

INTRODUCTION: Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care.

METHODS AND ANALYSIS: Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016-2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an ‘Implementation Toolkit’ to inform and improve commissioning and delivery of hip fracture services.

ETHICS AND DISSEMINATION: This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.

PMID:34011603 | DOI:10.1136/bmjopen-2021-049763