Comparative evaluation of effect of two relaxation breathing exercises on anxiety during buccal infiltration anesthesia in children aged 6-12 years: A randomized clinical study.

BACKGROUND: Dental procedures, especially local anesthetic administration, are a source of great anxiety to children. Diaphragmatic breathing is defined as an efficient integrative body-mind training for dealing with stress and psychosomatic conditions. Pinwheel exercise is also a highly effective technique of "play therapy." AIM: This study aimed to compare dental anxiety using pinwheel breathing exercise and diaphragmatic breathing exercise during buccal infiltration anesthesia. METHODOLOGY: Sixty children in the age group of 6-12 years with Frankel's behavior rating score of 3 who required buccal infiltration local anesthesia were selected. Subjects were divided randomly into two groups, i.e., Group A: children who performed pinwheel breathing exercise and Group B: children who performed diaphragmatic breathing exercise. The level of anxiety of the patients was recorded using an animated emoji scale. The data were analyzed using IBM SPSS version 20 software with paired t-test and Chi-square test. RESULTS: There was a significant reduction in dental anxiety score from score 1 (before the anesthetic procedure) to score 2 (after the anesthetic procedure) in both the groups. On intergroup analysis, children who performed pinwheel breathing exercise (Group A) showed higher values than children who performed deep breathing exercise without pinwheel (Group B) with a t value of 1.42 but was not statistically significant with a P value of 0.161. CONCLUSION: Pinwheel breathing exercise as well as diaphragmatic breathing exercise proved to be significantly effective in reducing dental anxiety during local anesthesia.

Surgical management of complications in a case of progressive outer retinal necrosis.

We report a case of bilateral progressive outer retinal necrosis (PORN) in a patient with acquired immune deficiency syndrome with CD4 count 50 cells/µL. He was treated with standard intravenous and intravitreal antivirals but ultimately developed complications such as retinal detachment and epiretinal membrane. His vision was preserved with early pars plana vitrectomy. This case demonstrates that prompt clinical diagnosis of PORN with its successful medical and surgical management can help prevent progression of this frightening disease.

PREOPERATIVE AND POSTOPERATIVE MACULAR SENSITIVITY ASSESSMENT USING MICROPERIMETRY IN EYES UNDERGOING SILICONE OIL REMOVAL.

PURPOSE: To evaluate the functional changes on the macula, before and after silicone oil removal (SOR) using microperimetry (MP3) in patients originally operated for macula-off rhegmatogenous retinal detachments. METHODS: Prospective interventional study, N = 20. All cases underwent complete ophthalmic examination, including determination of Snellen best-corrected visual acuity, indirect ophthalmoscopy, and MP3 for measuring retinal sensitivity. Primary outcome measure was to describe the alterations in the retinal sensitivity on the macula after SOR. RESULTS: Mean retinal sensitivity increased in 100% patients (20/20) after SOR with a mean value of 97.44 dB. Best-corrected visual acuity after SOR remained unchanged in 90% (18/20) and improved by 2 lines in only 10% patients (2/20). Median retinal sensitivity of central 6° of the macula was 766.95 ± 173.29 dB before SOR and 863.8 ± 181.08 dB after SOR, P < 0.0001. Mean best-corrected visual acuity was 20/40 before SOR (range, 20/30-20/60) (logarithm of the minimum angle of resolution 0.314 ± 0.169) and 20/40 after SOR (range 20/30-20/80) (logarithm of the minimum angle of resolution 0.315 ± 0.159), P = 0.1628. CONCLUSION: MP3 was found to be a highly sensitive tool in detecting increased retinal sensitivity after SOR, particularly in central 6° of the macula without significant change in best-corrected visual acuity. Hence, MP3 is an important qualitative indicator of visual function.

Correlation of optical coherence tomography angiography and microperimetry (MP3) features in wet age-related macular degeneration.

PURPOSE: To evaluate and correlate the functional treatment response using microperimetry (MP3) with the morphological findings on optical coherence tomography angiography (OCTA) in wet AMD pre- and post-treatment with anti-vascular endothelial growth factor (VEGF). This was a single-centre prospective, interventional study. METHODS: Patients with wet AMD were treated with 3 injections of intravitreal anti-VEGF at monthly intervals for 3 months and followed at 1, 2, 3, and 6 months postinjection. Using "overlay" features, morphologic characteristics of OCTA at the site of choroidal neovascular membrane (CNVM) lesion were analyzed and correlated functionally with MP3. Data were collected including visual acuity at presentation and follow-up with multimodal imaging features, treatment details, complications (if any), and treatment given for that complication. Descriptive observational analysis and paired t-test was used to compare the appearance of the neovascular network on OCTA imaging with retinal sensitivity on MP3. RESULTS: OCTA in the pretreatment phase revealed CNVM as an abnormal vascular network arising from the choroid and invading the subretinal space. On MP3, decreased retinal sensitivity was observed corresponding to the area of CNVM. Post-treatment, OCTA revealed reduction in abnormal vascular network in 51 (91.07%) eyes that correlated with increased retinal sensitivity at the corresponding area on MP3. Statistical analysis showed baseline mean retinal sensitivity at the site of CNVM as 320.07 dB, which improved to 521.53 and 730.20 dB at 1 and 3 months postinjection follow-up, respectively. CONCLUSION: Combining the findings of OCTA and MP3 using "overlay" features gives us precise information of structure-function correlation at presentation and also in response to treatment. It also helps to improve patient's compliance, confidence to treatment, and their understanding of the disease process as well.

Dry eye: a protein conformational disease.

PURPOSE: The purpose of this study was to determine whether aqueous-deficient dry eyes (ADDE) is a protein conformational disease. Up to now the therapeutic regimen has been based on empirical results, but these observations may unfold new theranostic approaches for ADDE management. METHODS: Fifty ADDE patients and 46 healthy volunteers were recruited. Schirmer's test, tear breakup time, tear meniscus height, and fluorescein staining tests were conducted on the subjects. Tear protein for ADDE and control patients was collected and extracted using Schirmer's strip. Protein aggregation was studied by appraisal of average protein size, using dynamic light scattering (DLS), fast performance liquid chromatography (FPLC), and synchronous fluorescence spectroscopy (SFS). RESULTS: Dynamic light scattering data showed a comparatively higher abundance of aggregated proteins in ADDE patients than that in controls. For controls, the size distribution of tear proteins was <50 nm in diameter, whereas the size distribution for ADDE individuals was up to 300 nm in diameter. Fast performance liquid chromatography experiments in native tear proteins exhibited minimal difference in the FPLC profiles for ADDE patients and controls. Denatured tear protein FPLC profiles for patients indicated the presence of protein aggregates which were absent in controls. Our hypothesis was further verified by SFS; lower tryptophan fluorescence in ADDE patients is an indication of oxidative stress, which leads to protein aggregation. CONCLUSIONS: Aqueous-deficient dry eyes is likely to be a protein conformational disease. Unlike other conformational diseases where single proteins are involved, this may be a reflection of structural loss for a significant fraction of the tear proteome.