Classifying and quantifying changes in papilloedema using machine learning.

Background: Machine learning (ML) can differentiate papilloedema from normal optic discs using fundus photos. Currently, papilloedema severity is assessed using the descriptive, ordinal Frisén scale. We hypothesise that ML can quantify papilloedema and detect a treatment effect on papilloedema due to idiopathic intracranial hypertension. Methods: We trained a convolutional neural network to assign a Frisén grade to fundus photos taken from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). We applied modified subject-based fivefold cross-validation to grade 2979 longitudinal images from 158 participants' study eyes (ie, the eye with the worst mean deviation) in the IIHTT. Compared with the human expert-determined grades, we hypothesise that ML-estimated grades can also demonstrate differential changes over time in the IIHTT study eyes between the treatment (acetazolamide (ACZ) plus diet) and placebo (diet only) groups. Findings: The average ML-determined grade correlated strongly with the reference standard (r=0.76, p<0.001; mean absolute error=0.54). At the presentation, treatment groups had similar expert-determined and ML-determined Frisén grades. The average ML-determined grade for the ACZ group (1.7, 95% CI 1.5 to 1.8) was significantly lower (p=0.0003) than for the placebo group (2.3, 95% CI 2.0 to 2.5) at the 6-month trial outcome. Interpretation: Supervised ML of fundus photos quantified the degree of papilloedema and changes over time reflecting the effects of ACZ. Given the increasing availability of fundus photography, neurologists will be able to use ML to quantify papilloedema on a continuous scale that incorporates the features of the Frisén grade to monitor interventions.

Case report: Management and long-term ophthalmic sequelae of monogenean ocular infestation in cownose rays (Rhinoptera bonasus).

Monogenean ectoparasitic flatworm infestations, particularly in closely confined populations, can result in severe epizootic disease that is often devastating and occasionally fatal. This case series describes a population of cownose rays (Rhinoptera bonasus) (n = 52) housed in an aquarium touch-tank exhibit that presented with severe ocular disease due to infestation with monogeneans, presumably Benedeniella posterocolpa of the Capsilidae family. The most severely affected individuals (n = 9), including several cases with bilaterally ruptured corneas, underwent serial examinations prior to and following treatment with praziquantel, systemic antibiotics, and corticosteroids. The entire population underwent frequent therapeutic water changes with a scheduled decrease in salinity, increase in temperature, and a series of seven praziquantel tank treatments. At the last follow up examination (3.75 years), the most common ocular findings were corneal fibrosis (18/18 eyes; 100%), cataract formation (13/18 eyes; 72.2%), synechia (8/18 eyes; 44.4%), and dyscoria (5/18 eyes; 27.8%). Despite severe corneal disease, including corneal rupture, all examined eyes (18/18; 100%) showed remarkable corneal remodeling and a largely clear visual axis. There are very few reports describing corneal disease in aquarium housed elasmobranchs, and no reports describe ophthalmic implications of monogenean infestation in these animals. This further underscores the importance of this case series in demonstrating the capacity for healing of elasmobranch eyes and can provide further guidance regarding prognosis and treatment in cases of severe corneal disease.

Australian Nurse Engagement in Eye Care: A National Survey.

Purpose: An estimated 13 million Australians live with one or more chronic eye conditions, with prevalence increasing. Eye care services today and in the future rely on effective workforces, in which nurses play a pivotal role. Despite nurse involvement in eye care, there is no information describing their engagement, deployment, training, and opinion. This paper offers the first review of nurse engagement in eye care in Australia. Methods: We conducted an e-survey on Australian nurse engagement in eye care. Quantitative questions were analysed by descriptive, chi-square and bivariate correlation coefficients with assumed power of 0.80, and significance of p=0.05. Grounded theory, sentiment and saturation analysis extracted key themes, meaning and opinion from the qualitative questions. Results: There were n=238 Australian nurse participants. Results indicated they were satisfied with their role, engaged in a wide range of healthcare and eye care setting and organisations, and adapted to their employer. Task-shifting "to" and "from" nurses was not universally supported but recognised by participants as necessary. Of concern, the results suggested that 68.6% of our participants would exit eye care over the next ten years, with insufficient entry pathways into the field for graduate and early-career nurses. Conclusion: For Australia to meet and sustain eye care services for its population, steps must be taken to improve exposure and entry to the field for students, graduates, and early-career nurses. Strategies to train and prepare nurses for task-shifting are urgently required and the eye care nursing sector must professionalise to achieve positive change.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship.

Objective: To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships. Methods: Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups. Results: More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group. Conclusion: FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.

Crizanlizumab for retinal vasculopathy with cerebral leukoencephalopathy in a phase II clinical study.

BackgroundRetinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) is a rare, autosomal dominant, universally fatal disease without effective treatment options. This study explores the safety and preliminary efficacy of crizanlizumab, a humanized monoclonal antibody against P-selectin approved for the prevention of sickle cell crises, in slowing retinal nonperfusion and preserving vision in patients with RVCL-S.METHODSEleven patients with RVCL-S with confirmed exonuclease 3 prime repair exonuclease 1 (TREX1) mutations received monthly crizanlizumab infusions over 2 years. The study measured the nonperfusion index within 3 retinal zones and the total retina with fluorescein angiography, visual acuity, intraocular pressure (IOP), and optical coherence tomography central subfield thickness (CST) at baseline, 1 year, and 2 years. A mixed repeated-measures analysis was performed to assess the progression rates and changes from baseline.RESULTSEleven participants received crizanlizumab infusions. All of the participants tolerated crizanlizumab well, with 8 of 11 (72.7%) reporting mild adverse effects such as nausea, fatigue, and gastrointestinal symptoms. The change in total retinal nonperfusion was 7.22% [4.47, 9.97] in year 1 and -0.69% [-4.06, 2.68] in year 2 (P < 0.001). In the mid periphery, the change in nonperfusion was 10.6% [5.1, 16.1] in year 1 and -0.68% [-3.98, 5.35] in year 2 (P < 0.01), demonstrating a reduction in progression of nonperfusion in the second year of treatment. Visual acuity, IOP, and CST remained stable.CONCLUSIONCrizanlizumab has an acceptable safety profile. These results show promising potential for examining crizanlizumab in larger studies of RVCL-S and similar small-vessel diseases and for using the retina as a biomarker for systemic disease.Trial registrationClinicalTrials.gov NCT04611880.FUNDINGThe Clayco Foundation; DeNardo Education and Research Foundation Grant; Jeffrey T. Fort Innovation Fund; Siteman Retina Research Fund; unrestricted grant from Research to Prevent Blindness Inc.; National Heart,Lung, and Blood Institute (NHLBI), NIH (R01HL129241); National Institute of Neurological Disorders and Stroke (NINDS), NIH (RF1NS116565).

SPEctacle Correction for the TReatment of Amblyopia (SPECTRA): study protocol for a prospective non-randomised interventional trial in adults with anisometropic/mixed mechanism amblyopia.

INTRODUCTION: Amblyopia is a neurodevelopmental vision disorder typically affecting one eye, resulting in compromised binocular function. While evidence-based treatments exist for children, there are no widely accepted treatments for adults. This trial aims to assess the efficacy of appropriate optical treatment in improving vision and visual functions in adults with amblyopia. This is hypothesised to significantly improve visual acuity of the amblyopic eye and other visual functions. METHODS AND ANALYSIS: SPEctacle Correction for the TReatment of Amblyopia is a prospective non-randomised interventional trial. The following criteria for amblyopia will be used: best corrected visual acuity (BCVA) in the amblyopic eye of 0.3 to 1.0 (inclusive) logMAR VA and in the fellow eye, 0.1 logMAR or better, with an interocular VA difference of ≥2 logMAR lines. Eligible participants aged 18-39 will receive full/near-full optical treatment requiring wear for at least half their waking hours for the trial duration. A difference of ≥1.00D spherical equivalent between a participant's current refractive correction and the study prescription is required for eligibility. Primary outcome is the change in amblyopic eye BCVA from baseline to 24-week postenrolment. Secondary outcomes include distance and near VA of both eyes, stereoacuity, contrast sensitivity, interocular suppression, angle of strabismus and fixation stability measured at monthly intervals. Visual evoked potentials will also be measured at baseline, week 12 and week 24. Treatment compliance and quality of life for all participants will be monitored.Analyses comparing baseline and week 24 will utilise pairwise comparisons. Linear mixed models will be fitted to the data for measures taken monthly. This allows estimates and inferences to be drawn from the coefficients of the model, while handling missing data. ETHICS AND DISSEMINATION: Human ethics approval was obtained from the respective ethics board of the Hong Kong Polytechnic University (HSEARS20210915002) and the University of Waterloo (#44235). The study protocol will conform to the principles of the Declaration of Helsinki. Results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT05394987; clinicaltrials.org.

Prevalence of active trachoma among 1-9 years of age children in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: The objective of this study is to determine the pooled prevalence of active trachoma among 1-9 years old children in Ethiopia. DESIGN: A systematic review and meta-analysis were employed in accordance with the Preferred Reporting Items for Systematic Reviews. DATA SOURCES: Medline/PubMed, Scopus, Web of Science, African Journal of Online and Google scholar databases were systematically explored to find studies published in English until July 2023. ELIGIBILITY CRITERIA: The following criteria apply: (1) condition (Co): studies examined the prevalence of trachoma among children (1-9) years old; (2) context (Co): studies conducted in Ethiopia; (3) population (Pop): studies that were done among children (1-9) years old; (4) study type: observational studies and (5) language: studies published in English. DATA EXTRACTION AND SYNTHESIS: The data were extracted using a Microsoft Excel spreadsheet. DerSimonian-Laird random effect model was used to estimate the pooled prevalence of active trachoma among 1-9 years old children. Cochrane Q-tests and I2 statistics were used across studies to assess heterogeneity. To identify possible publication bias, Egger's test was performed. PRIMARY OUTCOME: Prevalence of active trachoma among children aged (1-9 years old)". RESULTS: Overall, a total of 42 articles with 235 005 study participants were included in the final analysis. The estimated pooled prevalence of active trachoma using random effect model was 24% (95% CI 20% to 27%). The subgroup analysis by region revealed that the highest prevalence of trachoma was 36% (95% CI 13% to 58%) in the Tigray region, and publication year revealed the prevalence of trachoma was decreasing from 32% to 19% after 2015. CONCLUSION: In this review, the pooled prevalence of active trachoma was found to be high in Ethiopia compared with WHO threshold level. This underscores the need for increased focus on high-risk age groups to decrease trachoma and to achieve the elimination of trachoma from the country by 2030.

High risk and low prevalence diseases: Cavernous sinus thrombosis.

INTRODUCTION: Cavernous sinus thrombosis (CST) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of CST, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: CST is a potentially deadly thrombophlebitic disease involving the cavernous sinuses. The most common underlying etiology is sinusitis or other facial infection several days prior to development of CST, though other causes include maxillofacial trauma or surgery, thrombophilia, dehydration, or medications. Staphylococcus aureus, streptococcal species, oral anaerobic species, and gram-negative bacilli are the most frequent bacterial etiologies. The most prevalent presenting signs and symptoms are fever, headache, and ocular manifestations (chemosis, periorbital edema, ptosis, ophthalmoplegia, vision changes). Cranial nerve (CN) VI is the most commonly affected CN, resulting in lateral rectus palsy. Other CNs that may be affected include III, IV, and V. The disease may also affect the pulmonary and central nervous systems. Laboratory testing typically reveals elevated inflammatory markers, and blood cultures are positive in up to 70% of cases. Computed tomography of the head and orbits with intravenous contrast delayed phase imaging is recommended in the ED setting, though magnetic resonance venography demonstrates the highest sensitivity. Management includes resuscitation, antibiotics, and anticoagulation with specialist consultation. CONCLUSION: An understanding of CST can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Primary cilia formation requires the Leigh syndrome-associated mitochondrial protein NDUFAF2.

Mitochondria-related neurodegenerative diseases have been implicated in the disruption of primary cilia function. Mutation in an intrinsic mitochondrial complex I component NDUFAF2 has been identified in Leigh syndrome, a severe inherited mitochondriopathy. Mutations in ARMC9, which encodes a basal body protein, cause Joubert syndrome, a ciliopathy with defects in the brain, kidney, and eye. Here, we report a mechanistic link between mitochondria metabolism and primary cilia signaling. We discovered that loss of NDUFAF2 caused both mitochondrial and ciliary defects in vitro and in vivo and identified NDUFAF2 as a binding partner for ARMC9. We also found that NDUFAF2 was both necessary and sufficient for cilia formation and that exogenous expression of NDUFAF2 rescued the ciliary and mitochondrial defects observed in cells from patients with known ARMC9 deficiency. NAD+ supplementation restored mitochondrial and ciliary dysfunction in ARMC9-deficient cells and zebrafish and ameliorated the ocular motility and motor deficits of a patient with ARMC9 deficiency. The present results provide a compelling mechanistic link, supported by evidence from human studies, between primary cilia and mitochondrial signaling. Importantly, our findings have significant implications for the development of therapeutic approaches targeting ciliopathies.

Factors associated with the quality of corneas retrieved for transplantation by Eye Banks: a scoping review protocol.

INTRODUCTION: The cornea is an avascular and transparent layer of connective tissue crucial to retinal image quality. Diseases can impair its quality, affecting vision. Keratoplasty is the only therapy capable of restoring vision quality in severe corneal involvement. Despite the established practice of transplantation, access to corneal tissue is limited in many places, and the quality of retrieved corneas is not always adequate, resulting in disqualification. Not all factors affecting tissue quality are fully understood due to the multifactorial nature of processes and variations in procedures globally. OBJECTIVE: The objective is to map the global literature to establish the factors associated with the clinical and sociodemographic conditions of donors, and the conditions inherent in the processing of corneas that can influence the quality of this tissue for transplantation purposes. METHODS AND ANALYSIS: A scoping review will be developed based on the methodological framework of the Joanna Briggs Institute. The scientific report will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension checklist for Scoping Reviews. Searches will be conducted in 30 indexed and 12 grey literature databases, without time or location restrictions. The selection of studies will be carried out in three distinct phases: screening, eligibility and inclusion. After defining the sample, data from the selected studies will be systematically extracted into an electronic spreadsheet. The results will be presented descriptively through tables and graphs of absolute and relative frequency. In addition, the PRISMA Scoping Review flow chart will be presented to present the process of searching, including and excluding articles and documents. ETHICS AND DISSEMINATION: This scoping review study does not require prior ethical approval as it uses publicly available and already published studies. The research protocol is registered in the Open Science Framework (osf.io/bw6r7). The findings will be submitted for publication in peer-reviewed scientific journals and presented at ophthalmology and/or transplantation conferences through oral presentations or posters.

Functional effects of the spatial-varying lens mechanical properties in accommodation.

Lens biomechanical properties are critical for our eyes to accommodate. While it is well understood that lens mechanical properties change with age, different experimental techniques have been used over the years, with varying results on how the lens modulus changes. In this study, we developed a spatial-varying elasticity model to characterize the overall elastic modulus of the lens and establish its effect on accommodation. First, to validate the model, ex vivo porcine lenses underwent compression testing using biopsy punches of different diameters to change the percentage of nucleus within samples. Importantly, we found that, indeed, changing nucleus/cortex spatial ratio produces dramatic (∼7-fold) increase in overall sample modulus. Comparing the model with human lens spatial ratios, we demonstrate how changing spatial mechanics are more influential than peak modulus changes on overall elastic modulus. Next, in vivo clinical measurements of the spatial-varying lens modulus were used to generate a simplified mechanical-optical model of accommodation. We defined an ellipsoid lens with patient-derived modulus and geometry measurements, and a statics simulation and ray tracing analysis were performed through the deformed and undeformed lens. The resulting accommodation estimates agree with general accommodation expectations.

Unveiling the Potential: A Comprehensive Review of Artificial Intelligence Applications in Ophthalmology and Future Prospects.

Artificial intelligence (AI) has emerged as a transformative force in healthcare, particularly in the field of ophthalmology. This comprehensive review examines the current applications of AI in ophthalmology, highlighting its significant contributions to diagnostic accuracy, treatment efficacy, and patient care. AI technologies, such as deep learning algorithms, have demonstrated exceptional performance in the early detection and diagnosis of various eye conditions, including diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma. Additionally, AI has enhanced the analysis of ophthalmic imaging techniques like optical coherence tomography (OCT) and fundus photography, facilitating more precise disease monitoring and management. The review also explores AI's role in surgical assistance, predictive analytics, and personalized treatment plans, showcasing its potential to revolutionize clinical practice and improve patient outcomes. Despite these advancements, challenges such as data privacy, regulatory hurdles, and ethical considerations remain. The review underscores the need for continued research and collaboration among clinicians, researchers, technology developers, and policymakers to address these challenges and fully harness the potential of AI in improving eye health worldwide. By integrating AI with teleophthalmology and developing AI-driven wearable devices, the future of ophthalmic care promises enhanced accessibility, efficiency, and efficacy, ultimately reducing the global burden of visual impairment and blindness.

Microbial keratitis in the subtropical region of Korea: a comprehensive 12-year retrospective review at a single referral center.

OBJECTIVES: To investigate the epidemiological characteristics and clinical outcomes of culture-proven bacterial and fungal keratitis at a single tertiary referral centre on Jeju Island, South Korea. DESIGN: A retrospective study design. SETTING: Data from a solitary referral centre on Jeju Island spanning January 2011 to December 2022. PARTICIPANTS: Among the 245 patients clinically diagnosed with infectious microbial keratitis, 110 individuals had culture-positive results. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the identification of causative microbial profiles and epidemiological characteristics, while the secondary outcome was the correlation of these factors with treatment outcomes. RESULTS: Of 245 patients, 110 (44.9%) had culture-positive infectious keratitis, showing 69 bacterial, 32 fungal, 4 superimposed bacterial and 5 cases with coinfection by bacteria and fungus. The most common pathogen was Pseudomonas species in 14.4% of the bacterial keratitis cases, followed by Staphylococcus epidermidis (9%), Staphylococcus aureus (8%) and Moraxella species (7%). The total treatment success rate for bacterial keratitis was 67.5%. The frequency of methicillin-resistant Staphylococcus on Jeju Island did increase during the study period. Fusarium species had the highest incidence at 22.2%, followed by Candida (16.7%) and Colletotrichum species (11.1%). 56.7% of fungal keratitis patients were successfully treated. An initial large corneal lesion (>3 mm) showed a statistically significant association with treatment failure. CONCLUSION: The incidence of Moraxella and Colletotrichum species in our study was higher than that reported in other districts with different climates and environments. The results reported here reflect the unique environmental features of Jeju Island, characterised by high humidity and temperatures.

Experience of focused workshop intervention in presentation skills - Importance of foundational skills for ophthalmologists in training.

Background: The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training. Methods: A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1-10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results: Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention. Conclusions: Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

Assessment of eye health programme reach by comparison with rapid assessment of avoidable blindness (RAAB) survey data, Talagang, Pakistan.

BACKGROUND: The purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts. METHODS: A RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI. RESULTS: Among those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women. CONCLUSIONS: Robustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level.

Are adverse events higher among patients with acute optic neuritis prescribed glucocorticoids? A retrospective, longitudinal cohort study.

OBJECTIVE: Optic neuritis (ON) is an acute focal inflammation of the optic nerve routinely treated with glucocorticoids. We aimed to compare adverse events (AE) among glucocorticoid-treated and untreated patients in the real world to guide clinical decision making about treatment tradeoffs. DESIGN: Retrospective, longitudinal cohort study. SETTING: Claims study from a large, private insurer in the USA (2005-2019). PARTICIPANTS: Adults≥18 years old with ≥1 ICD9/10 ON diagnosis with an evaluation/management visit code, and ≥6 months continuous enrolment prior to and following ON diagnosis. INTERVENTION: Glucocorticoid prescription exposure. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was any AE within 90 days of glucocorticoid prescription. Secondary outcome was AE assessment by severity. Generalised estimating equations with logit link assessed relationships between glucocorticoid prescription and AEs. High-dimensional propensity score analyses accounted for potential confounding (eg, sociodemographics and comorbidities). Sensitivity analyses restricted the cohort to high-dose prescriptions (≥100 mg prednisone equivalent, injection/infusion), AEs within 30 days, highly specific ON definition and traditional propensity score match. RESULTS: Of the 14 311 people with 17 404 ON claims, 66.3% were women (n=9481), predominantly White (78.2%; n=9940), with median age (IQR)=48 (37,60) years. Within 90 days of the claim, 15.7% (n=2733/17 404) were prescribed glucocorticoids. The median (IQR) prescription duration=10 (6,20) days. Any and severe AEs were higher among patients prescribed glucocorticoids versus none (any AEs: n=437/2733 (16.0%) vs n=1784/14 671 (12.2%), adjusted OR 1.33 (95% CI: 1.18 to 1.50); severe AEs: n=72/2733 (2.6%) vs n=273/14 671 (1.9%), adjusted OR 1.82 (95% CI: 1.37 to 2.35)). Sensitivity analyses were similar. CONCLUSIONS: Real-world glucocorticoid prescriptions among ON patients were short-term, associated with a 30% relative increase in potentially serious AEs captured within healthcare encounters, including those not previously observed, such as VTE. These results can inform treatment decisions, particularly for ON patients likely to experience only marginal benefits.

Efficacy and Safety of the Subtenon Injection of 0.01% Mitomycin C-augmented Trabeculectomy.

Background Trabeculectomy, with the application of mitomycin C (MMC), has been the gold standard glaucoma-filtering surgery. The conventional method of applying MMC using soaked sponges does not ensure a controlled amount of delivery of MMC, and incidences of blebitis are reported to be associated with leftover sponges. This study aims to assess the safety and efficacy of a low dose (0.1 mg/ml) of MMC administered through subtenon injection during trabeculectomy combined with cataract extraction, addressing existing research gaps. Methods It is a prospective interventional study on patients who underwent trabeculectomy with a subtenon injection of 0.1 mg/ml of MMC combined with cataract extraction and were followed up over six months. Efficacy was determined in terms of intraocular pressure (IOP) reduction; bleb architecture was graded using the Indiana Bleb Appearance Grading System (IBAGS) and success rate, and safety was commented upon in terms of complications. Results Thirty patients were enrolled, with the majority having primary open-angle glaucoma (63.33%), while 36.67% had primary angle-closure glaucoma. Baseline IOP was 31.40(±10.38) mmHg. It significantly reduced to 14.60(±3.75) mmHg on the first postoperative day, decreasing to 9.55(±1.57) mmHg by the sixth postoperative month (p=0.001). The percentage reduction in IOP was substantial, 69.57%, by the sixth postoperative visit. Bleb morphology assessment using IBAGS revealed significant improvements in bleb height and extent and a reduction in vascularity over the six-month follow-up (p=0.001), and no eyes had bleb encapsulation. Out of the total patients, 93.33% achieved controlled IOP without anti-glaucoma medications, while 6.67% required one medication for IOP control. Complications were minimal, with transient corneal edema in six patients and manageable postoperative hypotony in one case. Conclusion A subtenon injection of MMC during trabeculectomy effectively reduces IOP and promotes favorable bleb architecture, offering an effective and safer alternative to the conventional approach.