An Evaluation of the Efficacy and Safety of Timolol Maleate 0.5% Microdrops Administered with the Nanodropper®

OBJECTIVE OR PURPOSE

Examine if 12.5 μL timolol maleate 0.5% microdrops dispensed with the Nanodropper® Adaptor provide non-inferior intraocular pressure (IOP) reduction compared to conventional, 28 μL drops in open-angle glaucoma (OAG) and ocular hypertension (OHT) patients.

DESIGN

Prospective, non-inferiority, parallel, multicenter, single-masked, active-controlled, randomized trial.

SUBJECTS, PARTICIPANTS, AND/OR CONTROLS

Treatment-naïve subjects that were recently diagnosed with OAG/OHT at the Aravind Eye Care System.

METHODS, INTERVENTION, OR TESTING

Both eyes of subjects received either one commercially available drop or one microdrop of timolol maleate 0.5%. We measured IOP, resting heart rate (HR), and blood pressure (BP) at baseline and 1, 2, 5, and 8 hours after timolol administration.

MAIN OUTCOME MEASURES

IOP was the primary outcome measure. Secondary outcomes were resting HR, systolic BP (sBP), and diastolic BP (dBP).

RESULTS

Adaptor-mediated microdrops and conventional drops of timolol significantly decreased IOP compared to baseline at all timepoints. Non-inferiority was established at three of four timepoints. HR decreases with Nanodropper were ∼3 bpm less than with conventional drops.

CONCLUSIONS

Timolol microdrops appear to be as effective in ocular hypotensive action as conventional drops with a slightly lesser effect on resting HR and BP.

Performance evaluation and chemical oxygen demand removal of tannery wastewater through the aerobic-anaerobic route

With characterized for complex and maximum substance (suspended solids, broke up oil, a mixture of inorganic and chromium sulfides), tannery wastewater was subjected to a treatment process on removal of chemical oxygen demand (COD) via upstream anaerobic sludge blanket reactor where we found reduced departure efficiencies and that process limits were affected by the assortments in regular stacking rates, closeness of chromium, and sulfides. Hence, a combination of the aerobic-anaerobic hybrid reactor was set up for sequential treatment to determine possible COD reduction. This study investigated the biological degradation of tannery wastewater in a laboratory-scale sequential up-flow aerobic-anaerobic reactor. The aerobic zone at the top was packed with spherical ball-shaped polyhedral polypropylene, and the anaerobic zone at the bottom was packed medium with granular media. The aeration flow rate varied by 2 L/min, 4 L/min, and 6 L/min in the aerobic zone, and the reactor maintained an organic loading rate (OLR) of 5 kg COD/m3/d. Parameters like COD and gas yield assess the performance of the reactor. The maximum COD of 86% is removed in the anaerobic zone with an aeration rate of 6 L/min, and the 1800-mL methane gas yield is measured by the 29th day.

Wound modulation in glaucoma surgery: The role of anti-scarring agents

Filtration surgery is one of the most frequently performed surgeries in the management of glaucoma, and trabeculectomy is considered the gold standard surgical technique for the same. Though trabeculectomy has been reported to have an excellent initial success rate, about 30% of them fail in 3 years, and nearly 50% of them fail in 5 years. The most significant risk of failure still seems to be wound scarring, especially episcleral fibrosis, leading to bleb failure. As a result, it is essential to explore the role of anti-scarring agents, including mitomycin C, and 5-fluorouracil in wound modulation and improving the bleb survival rate. Since these agents are widely used in trabeculectomy, it is crucial to understand the various modes of application, advantages, and adverse effects of these agents. On an evidence-based approach, all these points have been highlighted in this review article. In addition, the newer agents available for wound modulation and their scope for practical application are discussed.

Charge Puddles Driven Complex Crossover of Magnetoresistance in Non-Topological Sulfur Doped Antimony Selenide Nanowires

A race to achieve a crossover from positive to negative magnetoresistance is intense in the field of nanostructured materials to reduce the size of memory devices. Here, the unusual complex magnetoresistance in nonmagnetic sulfur-doped Sb2 Se3  nanowires is demonstrated. Intentionally, sulfur is doped in such a way to nearly achieve the charge neutrality point that is evident from switching of carrier type from p-type to n-type at 13 K as inferred from the low-temperature thermoelectric power measurements. A change from 3D variable range hopping (VRH) to power law transport with α = 0.18  in resistivity measurement signifies a Luttinger liquid transport with weak links through the nanowires. Interestingly, high magnetic field induced negative magnetoresistance (NMR) occurring in hole dominated temperature regimes can only be explained by invoking the concept of charge puddles. Spot energy dispersive spectroscopy (EDS), magnetic force microscopy (MFM) measurements, Tmott  and Regel plot indicate an enhanced disorder in these sulfurized nanowires that are found to be the precursor for the formation of these charge puddles. Tunability of conducting states in these nanowires is investigated in the light of interplay of carrier type, magnetic field, temperature, and intricate intra-inter wire transport that makes this nanowires potential for large scale spintronic devices.

The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study

BACKGROUND

Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use.

OBJECTIVE

We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India.

METHODS

We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources.

RESULTS

This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories.

CONCLUSIONS

The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.

S-FIX: A sutured way of doing sutureless SFIOL surgeries beyond X-NIT!

BACKGROUND

The video describes a technique in scleral fixation intraocular lens (SFIOL) surgery that is very simple and easily reproducible by any novice surgeon.

PURPOSE

This technique may serve as a simple option for tucking the haptic of a multipiece IOL into the sclera without the need for the scleral flap, scleral pocket, forceps, glue, or flange.

SYNOPSIS

The two most crucial steps in scleral fixation intraocular lens (SFIOL) surgery are 1) the exteriorization of the haptic, and 2) the fixation of the exteriorized haptic. The first half of the video describes the steps of our previously published technique of extraocular needle-guided haptic insertion technique (X-NIT), which simplifies the exteriorization step by shifting the intraocular hand-shake maneuver to an extraocular site. The second half describes a novel suture-guided haptic fixation (S-FIX) device, which simplifies the fixation step. S-FIX has three components: 1) a 380-micron spatulated needle, 2) a 5-o nylon suture thread, and 3) a polyimide tube. There are four steps involved in S-FIX: 1) docking of the exteriorized haptic into the polyimide tube, 2) pushing the docked polyimide tube into the eye, 3) suture bite starting from the point of sclerotomy, and 4) pulling the suture thread. As the suture thread is being pulled, the haptic along with the polyimide tube comes out and the haptic gets fixed into the narrow suture track.

HIGHLIGHTS

The technique enhances the overall safety in SFIOL surgeries by avoiding haptic slips during exteriorization and fixation steps. Most anterior segment and novice surgeons do not perform SFIOL surgeries due to fear of fall of IOL.

VIDEO LINK

https://youtu.be/ZoJBiw2SNaU.

Influence of heat input on the mechanical characteristics, corrosion and microstructure of ASTM A36 steel welded by GTAW technique

The Gas Tungsten Arc Welding process weld for the 4 mm thickness of the ASTM A36 steel plate with varied heat input parameters of 0.608 kJ/mm, 0.900 kJ/mm and 1.466 kJ/mm, respectively. The effect of different heat inputs on microstructure, corrosion, and mechanical characteristics of developed weld joints are examined by three zones: heat-affected zone, welded zone, and base metal zone. The optical microscopic results of weld joints illustrate that fine grain structure leads to enhance welding strength. It is revealed that the increased heat input parameter on the weld joint shows a decreased tensile strength and hardness of the weld joint. The corrosion resistance of the weld joint is evaluated by Potentio-dynamic polarization. It facilitates that the corrosion rate of the weld joint is decreased with increasing heat input, which results indicate the best and worst corrosion micrograph of the polygonal ferrite and ferrite plus polygonal ferrite. However, the weld joint prepared with 0.900 kJ/mm heat input found maximum corrosion resistance.

Optimization and prediction of CBN tool life sustainability during AA1100 CNC turning by response surface methodology

The aluminium alloy (AA1100) was familiar with automotive flexible shaft coupling applications due to its high strength, good machinability, and superior thermal and resistance to corrosion characteristics. Machining tool life drives the prominent role for deciding the product quality (machining) act aims to productivity target with zero interruptions. The novelty of this present investigation is the focus on increasing tool life during the complexity of CNC turning operation for AA1100 alloy by using CBN coated insert tool with varied input parameters of spindle speed (SS), feed rate (f), and depth of cut (DOC). Design of experiment (L16), analysis of variance (ANOVA) statistical system adopted with response surface methodology (RSM) is implemented for experimental analysis. The turning input parameters of SS, f and DOC are considered as factors and its SS (900, 1100, 1300, and 1500 rpm), f (0.1, 0.15, 0.2, and 0.25), and DOC (0.1, 0.2, 0.3, and 0.4 mm) values are treated as levels. The investigational analysis was made with the ANOVA technique and the desirability of high tool life with input turning parameters was optimized by RSM, and sample no 11/16 was predicted as high tool life and performed with extended working hours compared to other samples. The RSM optimized best turning parameter combinations are 0.1 mm DOC, 0.2mm/rev to 0.25mm/rev f, and 1300 rpm-1500 rpm SS, facilitating a higher tool life of more than 20min.

Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients' utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients' satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 -July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017-0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057-0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients' intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006-0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039-0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004-0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration: The trial was registered with Clinical Trials Registry of India (https://ctri.nic.in/) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.

4-Flanged intrascleral fixation of an intraocular lens through the dialing hole

The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.

Knowledge, attitude, and practice toward mucormycosis among patients discharged from a COVID-19 care tertiary center in South India: A questionnaire-based survey

Purpose

To study the awareness of mucormycosis among discharged inpatients after receiving treatment for COVID-19 infection at a tertiary COVID care center in south India.

Methods

This was a telephone-based survey conducted using a questionnaire consisting of 38 questions in five sections in the month of June-July 2021. COVID-positive inpatients who had been admitted, treated, and discharged from a government medical college were contacted via phones, and their responses were directly entered into the Google Forms platform.

Results

A total of 222 participants were included in the study. Among all the participants, a cumulative 66% of participants had some knowledge of mucormycosis and 98/222 (44%) did not have any idea of mucormycosis in spite of being admitted to the hospital. More than 40% of them reported that their prime source of information was through mass communication. Around 81% of the respondents were aware that it can occur after COVID-19 infection. Among them, only 25 knew that systemic steroids were the main risk factor. Sixty-four out of 124 knew that diabetes is a major risk factor. Fifty percent agreed that a vaccine for COVID can prevent mucormycosis.

Conclusion

Such knowledge, attitude, and practice (KAP) studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 66% of participants had some knowledge of mucormycosis and 34.7% were diabetics who had better knowledge and practice scores than non-diabetics. Sixty-six point nine percent felt that it was possible to prevent this condition.

Incremental innovations in operation theaters

Background

The field of ophthalmology has been built upon continuous innovations. COVID-19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology.

Purpose

In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery.

Synopsis

A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills.

Highlights

Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow.

Video Link

https://youtu.be/thFLvC-XykE.

Comparison of a New Head Mount Virtual Reality Perimeter (C3 Field Analyzer) With Automated Field Analyzer in Neuro-Ophthalmic Disorders

BACKGROUND

Automated perimetry in neurologically disabled patients is a challenge. We have devised a patient-friendly virtual reality perimeter, the C3 field analyzer (CFA). We aim to assess the utility of this as a visual field-testing device in neuro-ophthalmic patients for screening and monitoring.

METHODS

Neuro-ophthalmic patients and controls were selected to participate in the study between September and December 2018. They randomly underwent either the CFA or automated field analyzer (HFA) first followed by the other in an undilated state. The CFA results were compared with the HFA, and the correlation of the pattern of the field defect was assessed by an independent masked physician.

RESULTS

In total, 59 eyes of 33 neuro-ophthalmic patients (cases) and another 95 normal individuals (controls) were enrolled. CFA was found to have greater proportion of reliable fields (81.4%) than HFA (59.3%) ( P = 0.009). There were less false negatives ( P < 0.001) and more false positives in CFA ( P < 0.001) among neuro-ophthalmic patients compared with controls. Among neuro-ophthalmology patients, the number of fixation losses was greater with CFA ( P < 0.001), whereas false negatives were greater in HFA ( P < 0.001). On assessing the pattern of the field defects, we found that there was almost 70% correlation of CFA with HFA. Moreover, in classical neurological fields such as hemianopia, the correlation was 87.5%.

CONCLUSIONS

The CFA seems to correlate well with HFA in classic neurological fields such as hemianopias and may serve as an alternative in patients unable to perform a standard automated perimetry. Further developments are currently underway to incorporate threshold testing.

Retrospective analysis of the role of anterior segment optical coherence tomography and outcomes of cataract surgery in posterior polar cataract

Purpose

To evaluate the visual and surgical outcomes of cataract surgery in patients with posterior polar cataract (PPC) and to evaluate the benefits of preoperative anterior segment optical coherence tomography (AS-OCT).

Methods

This was a retrospective, single-center study. Case records of patients diagnosed with PPC who underwent cataract surgery either by phacoemulsification or manual small-incision cataract surgery (MSICS) from January to December 2019 were analyzed. Data collected include demographic details, preoperative best corrected visual acuity (BCVA), AS-OCT, type of cataract surgery, intraoperative and postoperative complications, and visual outcome at 1-month follow-up.

Results

One hundred patients were included in the study. Preoperative posterior capsular defect was noted on AS-OCT in 14 patients (14%). Seventy-eight underwent phacoemulsification and 22 underwent MSICS. Intraoperatively, posterior capsular rupture (PCR) was seen in 13 patients (13%) and cortex drop was noted in one among them (1%). Out of 13 PCRs, 12 were found to have posterior capsular dehiscence preoperatively in AS-OCT. The sensitivity of AS-OCT for detecting posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value and negative predictive value were 85.7% and 98.8%, respectively. There was no significant difference in the incidence of PCR between phacoemulsification and MSICS (P = 0.475). The mean BCVA at 1 month was found to be better with phacoemulsification than MSICS (P = 0.004).

Conclusion

Preoperative AS-OCT has excellent specificity and negative predictive value in identifying posterior capsular dehiscence. It thus helps to plan the surgery and counsel patients appropriately. Both phacoemulsification and MSICS provide good visual outcome with similar complication rates.

Effect of fiber layer formation on mechanical and wear properties of natural fiber filled epoxy hybrid composites

Natural fiber-reinforced polymer matrix composites are gathering significance in future trend applications such as automotive, aerospace, sport, and other engineering applications due to their superior enhanced mechanical, wear, and thermal properties. Compared to synthetic fiber, natural fiber is low adhesive and flexural strength properties. The research aims to synthesize the epoxy hybrid composites by utilizing the silane (pH = 4) treated Kenaf (KF) and sisal fiber (SF) as layering by uni, bi, and multi-unidirectional via hand layup techniques. Thirteen composite samples have been prepared by three-layer formation adopted with different weight ratios of E/KF/SF such as 100E/0KF/0SF, 70E/30KF/0SF, 70E/0KF/30SF, 70E/20KF/10SF, and 70E/10KF/20SF respectively. The effect of layer formation on the tensile, flexural, and impact strength of composites is studied by ASTM D638, D790, and D256 standards. The unidirectional fiber layer formed (sample 5) 70E/10KF/20SF composite is found maximum tensile and flexural strength of 57.9 ± 1.2 MPa and 78.65 ± 1.8 MPa. This composite is subjected to wear studies by pin-on-disc wear apparatus configured with a hardened grey cast-iron plate under an applied load of 10, 20, 30, and 40 N at different sliding velocities of 0.1, 0.3, 0.5, and 0.7 m/s. The wear rate of the sample progressively increases with increasing load and sliding speed of the composite. The minimum wear rate of 0.012 mg/min (sample 4) is found on 7.6 N frictional force at 0.1 m/s sliding speed. Moreover, sample 4 at a high velocity of 0.7 m/s with a low load (10 N) shows a wear rate of 0.034 mg/min. The wear-worn surface is examined and found adhesive and abrasive wear on a high frictional force of 18.54 N at 0.7 m/s. The enhanced mechanical and wear behavior of sample 5 is recommended for automotive seat frame applications.

Prostaglandin analogs in ophthalmology

Glaucoma is a major cause of irreversible blindness worldwide. Reducing intraocular pressure (IOP) is currently the only approach to prevent further optic nerve head damage. Pharmacotherapy is the mainstay of treatment for glaucoma patients. In recent years, a significant milestone in glaucoma treatment has been a transition to prostaglandin analogs (PGAs) as the first line of drugs. The rapid shift from traditional β-blockers to PGAs is primarily due to their excellent efficacy, convenient once-a-day usage, better diurnal control of IOP, and systemic safety profiles. This review article aims to provide information regarding the various PGAs in practice and also the newer promising drugs.

"Dye another day!" - dyes in ophthalmology

Background

Dyes are substances that are an integral part of ocular procedures and surgeries. In Clinical practice, dyes help in better visualization and aid in diagnoses of ocular surface disorders. In Surgical practice, dyes help in better resolution of the structures that are otherwise naked to the surgeon's eyes.

Purpose

To educate ophthalmologists about the importance and uses of dyes.

Synopsis

Dyes have become an important part of an ophthalmologists' clinical as well as surgical practice. This video aims at educating the different characteristics, uses, advantages and disadvantages of each dye. Dyes help in identifying the obscure and highlighting the invisible. The indications and contraindications as well as the side effects of each dye are discussed which would help ophthalmologists in the correct usage of these wonder substances. This video will also help the new eye doctors understand and utilize these dyes judiciously which would aid in their learning process and provide better patient care.

Highlights

This video highlights the uses, indications, contraindications and side effects of all the dyes used in ophthalmology.

Video Link

https://youtu.be/shdV4a6oc20.

A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair

Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient's symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up.

Mechanical alloying of Mg0.8-XTi0.2 and study the effect of adding (x = 0.2 wt%) transition metal like Sc, Zr, or Nb on their phase transitions, activation energy, and hydrogen storage properties

Till now Mg-based alloys have attracted much attention due to the high storage capacity of hydrogen. An effort was made to evaluate the apparent activation energy and electrochemical behavior of transition metals such as scandium (Sc), zirconium (Zr), and niobium (Nb) alloyed with Mg-Ti. Mg_0.8Ti_0.2, Mg_0.6Ti_0.2Sc_0.2, Mg_0.6Ti_0.2Zr_0.2, and Mg_0.6Ti_0.2Nb_0.2 alloy powders were synthesized using high-energy ball milling. Ballmilled powders were subjected to structural and morphological characterization using X-ray diffraction and scanning electron microscopy respectively. A strong shift in the inter-planar spacing value of milled powders confirmed supersaturated solid solution of Ti and transition metals in Mg. The inter-planar spacing values before and after milling are found to be 0.24 and 0.21 nm, respectively. Mg_0.8Ti_0.2, Mg_0.6Ti_0.2Sc_0.2, and Mg_0.6Ti_0.2Zr_0.2 alloy powders result in the FCC phase while Mg_0.6Ti_0.2Nb_0.2 powders result in BCC phase, however, the entire powders have an amorphous background. SEM-EDS analysis of the milled powders confirmed the presence of Mg, Ti, Sc, Zr, and Nb elements with a small amount of oxygen. Selected area electron diffraction (SAED) pattern of Mg_0.8Ti_0.2 alloy powders exhibits a nanocrystalline nature owing to their polycrystalline ring pattern. Exothermic peak broadening increases after the substitution of Nb and Zr in Mg_0.8Ti_0.2 alloy powder, which exhibits a lower activation energy (188 kJ mol^-1) than others. In cyclic voltammetry, a drenched cathodic peak is observed for Mg_0.8Ti_0.2 at a potential around -0.83 V. In electrochemical impedance spectroscopy, the charge transfer resistance of Mg_0.6Ti_0.2Sc_0.2 is lower than that of Mg_0.6Ti_0.2Zr_0.2 and Mg_0.6Ti_0.2Nb_0.2 alloy but higher than Mg_0.8Ti_0.2 electrode materials, and charge-discharge studies were done on the developed electrode materials. It shows that Mg_0.8Ti_0.2 electrode material delivers a maximum discharge capacity of 535 mA h g^-1.

Changes in emergency glaucoma care during the COVID-19 pandemic in South India

Purpose

To assess the differences in the pattern of presentation of glaucoma emergency conditions during the various phases of pandemic-related travel restrictions: first wave-related lockdown, unlock period, and the second wave-related lockdown.

Methods

The number of new emergency glaucoma conditions, the various diagnoses, and the total number of all new glaucoma patients presenting to the glaucoma services at five tertiary eye care centers in south India from 24^th March 2020 to 30^th June 2021 were collected from the electronic medical records and were analyzed. The data were compared with the corresponding time period in the year 2019.

Results

In total, 620 patients presented with an emergency glaucoma diagnosis during the first wave-related lockdown as against 1337 during the same period in 2019 (P < 0.0001). During the unlock period, 2659 such patients visited the hospital compared with 2122 in 2019 (P = 0.0145). During the second wave-related lockdown, there were 351 emergency patients compared with 526 patients in 2019 (P < 0.0001). Lens-induced glaucomas (50.4%) and neovascular glaucoma (20.6%) were the most common diagnoses during the first wave-related lockdown. During the unlock period, there was a greater proportion of neovascular glaucoma (P = 0.0123). The second wave-related lockdown had a greater proportion of phacolytic glaucomas (P = 0.005) and acute primary angle closure (P = 0.0397) patients.

Conclusion

The study demonstrates that emergency glaucoma care was grossly underutilized by the people during the lockdowns. Trivial conditions like cataracts or retinal vascular diseases if not treated appropriately may progress to become emergencies in the future.

Single haptic iris fixation of posterior chamber intraocular lens

Single haptic iris fixation technique is used where there is a loss of 6 clock hours anterior capsular support. It helps the anterior segment surgeon to fix the intraocular lens to the iris on the side of absent capsular support and place the other haptic over the capsular support. A 10-0 polypropylene suture on a long-curved needle is only used to take a suture bite on the side of capsule loss. Meticulous automated anterior vitrectomy is done. Then, the suture loop below the iris is taken out and the loops are twirled multiple times around the haptic. The leading haptic is then gently glided behind the iris, and the trailing haptic is gently placed on the other side using forceps. The suture ends are trimmed and internalized into the anterior chamber and then externalized through the paracentesis using a Kuglen hook, and the knot is tied and secured.

Automatic detection of glaucoma via fundus imaging and artificial intelligence: A review

Glaucoma is a leading cause of irreversible vision impairment globally, and cases are continuously rising worldwide. Early detection is crucial, allowing timely intervention that can prevent further visual field loss. To detect glaucoma an examination of the optic nerve head via fundus imaging can be performed, at the center of which is the assessment of the optic cup and disc boundaries. Fundus imaging is noninvasive and low-cost; however, image examination relies on subjective, time-consuming, and costly expert assessments. A timely question to ask is: "Can artificial intelligence mimic glaucoma assessments made by experts?" Specifically, can artificial intelligence automatically find the boundaries of the optic cup and disc (providing a so-called segmented fundus image) and then use the segmented image to identify glaucoma with high accuracy? We conducted a comprehensive review on artificial intelligence-enabled glaucoma detection frameworks that produce and use segmented fundus images and summarized the advantages and disadvantages of such frameworks. We identified 36 relevant papers from 2011 to 2021 and 2 main approaches: 1) logical rule-based frameworks, based on a set of rules; and 2) machine learning/statistical modeling-based frameworks. We critically evaluated the state-of-art of the 2 approaches, identified gaps in the literature and pointed at areas for future research.

Important signs to check posterior capsule integrity

For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.

Do motivational cards really benefit sibling screening of primary open-angle glaucoma probands?

Purpose

To compare the impact of Sibling Motivational Card (SMC) and oral counseling in screening siblings of primary open-angle glaucoma (POAG) probands.

Methods

Two hundred and thirty-four newly diagnosed POAG probands were randomized to receive either oral counseling or SMC to motivate their siblings for a glaucoma screening at a tertiary eye care hospital in South India from July 2015 and June 2017. A total of 116 probands were orally counseled with a standard template of dialogs about the importance of family screening to motivate their siblings for a screening. One hundred and eighteen probands were randomized to receive SMC, bearing the details of the proband, sibling, and a message stressing the importance of family screening, in addition to oral counseling. We assessed the response rate in each group. Additionally, we evaluated the prevalence of POAG in the siblings.

Results

A total of 95 siblings of 234 POAG probands were screened. The mean age distribution was 53.33 ± 10.9 years (range 28-79 years). The male to female ratio was 3:4. The percentage of siblings screened was more in the oral counseling group (63.2%) than in the SMC group (36.8). About 43 (45%) siblings had some form of glaucoma, and 13.6% had POAG. An additional 22.1% were disk suspects, and 5.2% had ocular hypertension.

Conclusion

SMC did not have an additional benefit over the standard oral counseling in promoting sibling screening. Our study stresses the importance of sibling screening in POAG probands. Targeting siblings of POAG probands with oral counseling may offer a relatively inexpensive way of detecting glaucoma.

Clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services at a tertiary care eye hospital in South India

Purpose

To study the clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services including the reasons for referral.

Methods

Patients in the age group of 5 to 39 years, visiting the glaucoma clinic, who were either suspected to have glaucoma or who had been newly/previously diagnosed with glaucoma were included in the study. After informed written consent, basic demographic details of the participants including age, gender, education, socioeconomic status, and family history were obtained. A comprehensive ophthalmological evaluation was performed by glaucoma specialists.

Results

The proportion of glaucoma in the study population (n = 384) was found to be 31.25%, and the incidence of glaucoma among new patients was found to be 11.9%. Among all glaucomas (n = 120), 44.2% of patients had secondary glaucomas, 27.5% had primary glaucomas, and 28.3% had congenital glaucomas. Also, 67.3% of all glaucoma patients were males. Newly diagnosed glaucoma patients presented with a mean intraocular pressure (IOP) of 32.9 mmHg and mild-moderate disc damage with a mean cup-disc ratio of 0.65. Nearly one-third of them had a presenting visual acuity worse than 5/60. The most common reason for referral was raised IOP. Univariate and multivariate analysis revealed that the odds of developing glaucoma were less in females (P = 0.04) and in patients with a higher standard of living index (P < 0.001).

Conclusion

One-third of the patients had glaucoma and another one-third were suspects. Secondary glaucomas are more common than primary/congenital glaucomas. A comprehensive eye evaluation is a must, especially in those with predisposing factors.

Vacuum-assisted cortex removal - A novel change to the tradition

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum.

Analysis of hesitancy and motivational factors for COVID-19 vaccination among patients presenting to eye care hospitals - A multicenter questionnaire-based survey

Purpose

To analyze the hesitancy and motivational factors related to coronavirus disease 2019 (COVID-19) vaccination among patients visiting for eye care.

Methods

A telephonic survey was conducted using validated questionnaires consisting of 36 questions in five sections from July 1 to July 31, 2021. Patients visiting six tertiary centers and one secondary center of our eye hospitals were interviewed over their phones, and their responses were entered onto the Google forms. The responses were recorded as demographics, health status, awareness about vaccination, factors contributing to hesitancy or acceptance to vaccinate, and general perception about the vaccine.

Results

A total of 5033 patients were surveyed. The mean age was 49.0 ± 14.2 years. A total of 563 (11.2%) patients gave a history of symptoms or were tested positive for COVID-19; 2225 (44.2%) patients were already COVID-19 vaccinated. Around 2883 (56%) patients were aware of getting infection despite vaccination, and 4092 (81.3%) perceived vaccination should be compulsory. The main reason for vaccination hesitancy was the fear of side effects (n = 487, 17.3%). The fear of getting infected was the most common reason for vaccination (n = 911, 40.9%). Factors associated with a lower proportion of vaccinated individuals included younger age (P < 0.001), female gender (P < 0.001), lower education (P < 0.001), lower income (P < 0.001), and rural residence (P = 0.33).

Conclusion

Creating awareness about the minor side effects and reassurance can allay an individual's fears. The fear associated with the rapid spread of infection and associated mortality needs to be utilized to increase vaccination acceptance. A targeted approach toward groups with poor uptake of vaccination is necessary.

Analysis of motivating factors for eye donation among families of eye donors in South India - A questionnaire-based study

Purpose

To report the factors influencing eye donation among families of successful eye donors in India.

Methods

The consenting family members of 434 deceased individuals who donated eyes between April 2019 and March 2020 were retrospectively interviewed via a telephonic questionnaire survey. Details regarding the donors and their families, motivating factors for eye donation, and time taken for tissue recovery were collected and analyzed.

Results

The mean age of donors was 66.8 years, and only 13.9% of them had pledged to donate their eyes before death. For 62.3% of donations, children of donors were the primary consenters for eye donation. In 18.8% of donors, there was a previous history of eye donation in the family. Many donations were motivated by a non-governmental organization volunteer (40.5%) or by a grief counselor at the hospital (27.4%). Hospital-based corneal retrieval programs and donations where the first eye bank contact was made through hospital personnel had the greatest percentage of rapid enucleations (performed within 3 h after death) (48.7% and 49.1%, respectively; P = 0.001 and P = 0.02, respectively).

Conclusion

Children of donors, typically in the working-age group, most often make the decision for donation, and hence, future awareness programs should focus on this specific population. All types of hospitals should advocate for eye donation as they are a common point of contact for a grieving family, and health-care professionals at all levels should be considered for training as motivators for eye donation.

Optimization of NaCl based spray corrosion test process parameters of heat treated hybrid metal matrix composites

ABSTRACT. Aluminium hybrid metal matrix composites (AHMMCs) have widely employed in aerospace, transportation, and automotive applications since for their excellent mechanical qualities and high corrosion resistance. In this research, Al8079 is selected as a matrix material. The titanium diboride (TiB2) is selected as hard reinforcement and molybdenum disulfide (MoS2) is used as soft reinforcement. The Al8079/15 wt.% TiB2/x wt.% MoS2 (x = 0, 2.5, 5 and 7.5) HMMCs are fabricated by using stir casting. The composites are heat treated under T6 condition. The density and micro hardness tests are conducted. The optimization on NaCl based spray corrosion test process parameters is done using grey relational analysis (GRA). The selected input process parameters are Al8079/15 wt.% TiB2/wt.% MoS2 (x = 0, 2.5 and 5), pH value of NaCl solution (x = 6, 9 and 12), hang time (x = 24, 48, and 72 h) and pressure (x = 0.7, 0.9 and 1.1 kg/cm2). The selected response parameters are micro hardness, mass loss and wear loss. The L9 Taguchi design is used for optimization. The wear test is conducted at the constant speed of 0.5 m/s, loading rate of 20 N and the sliding distance of 1000 m. The percentage of improvement of GRG from initial setting to experimental is 10.4%.   KEY WORDS: Reinforcement, Stir casting, Optimization, GRA, NaCl Bull. Chem. Soc. Ethiop. 2022, 36(4), 903-914.                                                         DOI: https://dx.doi.org/10.4314/bcse.v36i4.15

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia

Purpose

To evaluate the impact of video and verbal counselling on patients' undergoing phacoemulsification under topical anaesthesia.

Methods

This is a prospective randomized controlled trial conducted at Aravind Eye Care System, Pondicherry, India. All patients had a 15 ​min one-on-one verbal counselling covering surgical technique, implant options, anaesthesia and payment options one day prior to surgery. On the day of surgery, patients were randomized into two groups; in the first group, patients were provided with video counselling and in the second group, patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia. Measurements of blood pressure, heart rate, respiration rate, and the Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points.

Results

A group of 186 patients (aged 45-70 years) were provided video counselling via portable iPad before first-time phacoemulsification, and a second group of 186 patients underwent surgery with verbal counselling. Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point. Furthermore, during the intraoperative period, 123 (66.1%) video counselled patients felt relaxed compared to 119 (64%) patients who were provided verbal counselling (P ​= ​0.6636). Patient cooperation during surgery was excellent in 76(40.9%) video counselled patients and 67(36%) verbally counselled patients (P ​= ​0.3374). 25.8% and 21% (P ​= ​0.2703) of patients experienced no pain during surgery in the video and verbal counselled groups respectively.

Conclusions

Although measures such as pulse rate, respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling, patients marked cooperation during surgery and furthermore, the level of anxiety is most reassuring.

Knowledge, attitude, and practice toward mucormycosis among patients presenting to six tertiary eye care hospitals in South India - A multicentric online questionnaire-based survey

Purpose:

To study the awareness on mucormycosis among outpatients who visited six tertiary eye care hospitals at Madurai, Pondicherry, Coimbatore, Tirunelveli, Chennai, and Tirupati.

Methods:

This was a telephone-based survey conducted using questionnaires consisting of 38 questions in five sections from July 5 to 25, 2021. Patients visiting the eye hospitals for an examination were contacted over their phones and responses were directly entered onto the Google forms platform.

Results:

A total of 4573 participants were included in the study. Among all participants, a cumulative 83% of participants had some knowledge of mucormycosis. More than 80% of them reported that their prime source of information was through mass communication like television or radio. Around 34.8% of the respondents were aware that it can occur after treatment for coronavirus disease 2019 (COVID-19) infection, only half of them (54.3%) knew that systemic steroids were the main risk factor. The knowledge scores were higher for participants who were diabetics (n = 1235) or had been affected by COVID-19 earlier (n = 456) or whose friends had mucormycosis earlier (n = 312). Knowledge, attitude, and practice (KAP) scores of nonprofessional health-care workers (n = 103) were much better compared to patients.

Conclusion:

Such KAP studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 83% of participants had some knowledge of mucormycosis and 86% knew that this was an emergency. More than 50% of the participants were not aware that diabetes is a risk factor for mucormycosis.

Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic

Purpose:

To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.

Methods:

This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed.

Results:

One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity.

Conclusion:

The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.

Addressing the environmental sustainability of eye health-care delivery: a scoping review

The demand for eye care-the most common medical speciality in some countries-is increasing globally due to both demographic change and the development of eye health-care services in low-income and middle-income countries. This expansion of service provision needs to be environmentally sustainable. We conducted a scoping review to establish the nature and extent of the literature describing the environmental costs of delivering eye-care services, identify interventions to diminish the environmental impact of eye care, and identify key sustainability themes that are not yet being addressed. We identified 16 peer-reviewed articles for analysis, all published since 2009. Despite a paucity of research evidence, there is a need for the measurement of environmental impacts associated with eye care to be standardised along with the methodological tools to assess these impacts. The vastly different environmental costs of delivering clinical services with similar clinical outcomes in different regulatory settings is striking; in one example, a phacoemulsification cataract extraction in a UK hospital produced more than 20 times the greenhouse gas emission of the same procedure in an Indian hospital. The environmental costs must be systematically included when evaluating the risks and benefits of new interventions or policies aimed at promoting safety in high-income countries.

Artificial intelligence in glaucoma

Background:

Artificial Intelligence (AI) is an area of computer science that encompasses the creation of intelligent machines that work and react like humans. It deals with the development algorithms that seek to simulate human brain and also mimic cognitive functions typically associated with the human mind such as learning and problem solving.

Purpose:

Do we need artificial intelligence in Glaucoma? Glaucoma is the second most common cause of blindness in the world. Its prevalence was over 60 million in 2010 and over 80 million by 2020. It is so common, yet so easily overlooked. More importantly, about 50% of patients in developed countries and 90% in developing countries are unaware of having glaucoma. Early detection can delay the progression of glaucoma. Hence the time is ripe to advovate glaucoma screening.

Synopsis:

The application of AI in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, age-related macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract etc AI involves mainly 1. machine learning that are algorithms with the ability to learn without being explicitly programmed and 2. deep learning in which artificial neural networks adapt and learn from vast amounts of data. But there are limitations to screening - such as disparity between ophthalmologist:patient ratio and also the availability of the specialty services. The large amount of data acquired from patients makes it nearly impossible for ophthalmologists to screen them with equal efficacy and consistency.

Highlights:

AI in glaucoma aims at including factors such as clinical data, genomic data, life style behaviors, risk factors, and medical history to predict the risk of developing glaucoma, help customise the most appropriate management protocol for a given patient, and estimate prognosis and surgical success.

Video Link:

https://youtu.be/IwYS7wDMhkY

Development and validation of an offline deep learning algorithm to detect vitreoretinal abnormalities on ocular ultrasound

Purpose

We describe our offline deep learning algorithm (DLA) and validation of its diagnostic ability to identify vitreoretinal abnormalities (VRA) on ocular ultrasound (OUS).

Methods

Enrolled participants underwent OUS. All images were classified as normal or abnormal by two masked vitreoretinal specialists (AS, AM). A data set of 4902 OUS images was collected, and 4740 images of satisfactory quality were used. Of this, 4319 were processed for further training and development of DLA, and 421 images were graded by vitreoretinal specialists (AS and AM) to obtain ground truth. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristic (AUROC).

Results

Our algorithm demonstrated high sensitivity and specificity in identifying VRA on OUS ([90.8%; 95% confidence interval (CI): 86.1-94.3%] and [97.1% (95% CI: 93.7-98.9%], respectively). PPV and NPV of the algorithm were also high ([97.0%; 95% CI: 93.7-98.9%] and [90.8%; 95% CI: 86.2-94.3%], respectively). The AUROC was high at 0.939, and the intergrader agreement was nearly perfect with Cohen's kappa of 0.938. The model demonstrated high sensitivity in predicting vitreous hemorrhage (100%), retinal detachment (97.4%), and choroidal detachment (100%).

Conclusion

Our offline DLA software demonstrated reliable performance (high sensitivity, specificity, AUROC, PPV, NPV, and intergrader agreement) for predicting VRA on OUS. This might serve as an important tool for the ophthalmic technicians who are involved in community eye screening at rural settings where trained ophthalmologists are not available.

Two-Dimensional Weak Antilocalization Signatures Due to Quantum Coherent Transport in Nanocrystalline SnTe

Nanostructured topological crystalline insulators (TCIs) in the presence of exotic surface states with spin momentum locking reported in individual nanostructures are predicted to hold a great promise for spintronics and quantum computing applications. However, practical application demands a strategy with large-scale production and integration for device applications. In this work, we demonstrate through prominent signatures of weak antilocalization (WAL), arising predominantly from destructive quantum interference on robust surface states, that a correlated TCI phase is possible in the nanobulk assembly of carefully nanostructured quasi-two-dimensional SnTe (edge-to-edge length ∼ 382 nm) synthesized by a simple, rapid, and scalable microwave-assisted solvothermal method. Hikami-Larkin-Nagaoka analysis (T^-0.71), as well as the temperature dependence of resistivity, illustrates an interplay of both conductions from 2D channels and 3D EEI effects as the precursor for the observed WAL at low temperatures (2-6 K). Interestingly, the enhanced thermoelectric power of the sample of ∼45 μV/K, with a p-type carrier concentration of ∼10¹⁸/cm³ at 300 K, makes this SnTe nanocrystalline assembly more attractive as a multifunctional material for large-scale technological applications.