Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty.

PURPOSE: The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). METHODS: The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. RESULTS: A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates (P = 0.99). CONCLUSIONS: For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.

Uveomeningeal syndrome presenting with bilateral optic disc edema and multiple evanescent white dots syndrome (MEWDS).

Purpose: To report a uveomeningeal syndrome with bilateral optic disc edema and a MEWDS-like presentation. Observations: A 17-year-old female experienced daily fevers for 3 days (ranging from 101.4 F to 102 F), then received the first dose of the Pfizer SARS-CoV-2 vaccine nearly three weeks later. Within two days she experienced severe headaches with severity scale of 8/10. Retinal imaging at the time showed optic disc edema in both eyes (OU) and multifocal well-circumscribed chorioretinal white lesions in the periphery OU. Neuroimaging and routine infectious and inflammatory laboratory testing were normal. Lumbar puncture showed elevated opening pressure and cerebrospinal pleocytosis consistent with an aseptic meningitis. At follow up, one month later the symptoms and retinal findings resolved. Conclusions: MEWDS is typically an idiopathic condition but can occur in the setting of viral illness. Although other white dot syndromes have been associated with uveomeningeal presentations, to our knowledge this is the first such case to be described in the English language ophthalmic literature.

Examining the Relationship between Altmetric Score and Traditional Bibliometrics in the Pathology Literature.

BACKGROUND: Recently, research data are increasingly shared through social media and other digital platforms. Traditionally, the influence of a scientific article has been assessed by the publishing journal's impact factor (IF) and its citation count. The Altmetric scoring system, a new bibliometric that integrates research "mentions" over digital media platforms, has emerged as a metric of online research distribution. The aim of this study was to explore the relationship of the Altmetric Score with IF and citation number within the pathology literature. METHODS: Citation count and Altmetric scores were obtained from the top 10 most-cited articles from the 15 pathology journals with the highest IF for 2013 and 2016. These variables were analyzed and correlated with each other, as well as the age of the publishing journal's Twitter account. RESULTS: Three hundred articles were examined from the two cohorts. The total citation count of the articles decreased from 21,043 (2013) to 14,679 (2016), while the total Altmetric score increased from 830 (2013) to 4066 (2016). In 2013, Altmetric score weakly correlated with citation number (r = 0.284, P < 0.001) but not with journal IF (r = 0.024, P = 0.771). In 2016, there was strong correlation between citation count and Altmetric Score (r = 0.714, P < 0.0001) but not the IF (r = 0.0442, P = 0.591). Twitter was the single most important contributor to the Altmetric score; however, the age of the Twitter account was not associated with citation number nor Altmetric score. CONCLUSIONS: In the pathology literature studied, the Altmetric score correlates with article citation count, suggesting that the Altmetric score and conventional bibliometrics can be treated as complementary metrics. Given the trend towards increasing use of social media, additional investigation is warranted to evaluate the evolving role of social media metrics to assess the dissemination and impact of scientific findings in the field of pathology.

Examining the Relationship between Altmetric Score and Traditional Bibliometrics in the Ophthalmology Literature for 2013 and 2016 Cohorts.

Background In this study, we reviewed a select sample of ophthalmology literature to determine if there was a correlation between Altimetric and traditional citation-based and impact factor metrics. We hypothesized that Altmetric score would more closely correlate with impact factor and citations in 2016. Methods Journal Citation Reports for the year 2013 was used to find the 15 highest impact factor ophthalmology journals in 2013. Then Elsevier's Scopus was used to identify the 10 most cited articles from each journal for the years 2013 and 2016. Metrics for all identified articles were collected using the Altmetric Bookmarklet, and date of Twitter account creation was noted for journals with such an account. Altmetric scores, impact factor, and citation counts were tabulated for each article. Pearson's correlation coefficient ( r ) determined correlation of independent variables (number of citations or impact factor) with dependent variable (Altmetric score). For our Twitter analysis, account age was the independent variable and calculated correlation coefficients ( r ) were the dependent variable. Proportion of variance was determined with a coefficient of determination ( R 2 ). Results This study included 300 articles, evenly split between 2013 and 2016. Within the 2013 cohort, three journals had significant positive correlations between citation count and Altmetric score. For the 2016 cohort, both Altmetric score and citation count ( r = 0.583, p < 0.001) and Altmetric score and impact factor ( r = 0.183, p = 0.025) revealed significant positive correlations. In 2016, two journals were found to have significant correlations between Altmetric score and citation number. Neither year revealed a significant correlation between the age of a journal's Twitter profile and the relationship between Altmetric score and citation count. In each year, Twitter accounted for the highest number of mentions. Conclusion The findings suggest that correlation between Altmetric score and traditional quality metric scores may be increasing. Altmetric score was correlated with impact factor and number of citations in 2016 but not 2013. At this time, Altmetrics are best used as an adjunct that is complementary but not an alternative to traditional bibliometrics for assessing academic productivity and impact.

Significant visual improvement with vision rehabilitation delayed three decades from disease onset.

PURPOSE: This is a report of an adult patient showing improvement in visual function from rehabilitation for longstanding homonymous hemianopsia. We present his medical history and visual function testing pre- and post-therapy, demonstrating an improvement in both subjective and objective measures. OBSERVATIONS: A 40-year-old male with history of a ruptured arteriovenous malformation at age 10 years, treated with embolization therapy, was referred to the neuro-ophthalmology clinic for evaluation of right homonymous hemianopsia noted on Humphrey visual field (HVF) testing. At the most recent neuro-ophthalmology exam, the HVF showed a right homonymous hemianopsia with a mean deviation of -11.92 decibels (dB) in the right eye (OD) and -17.97 dB in the left eye (OS). He was referred to visual rehabilitation and showed marked improvement in visual functioning after a standard course of therapy. CONCLUSIONS AND IMPORTANCE: The efficacy of visual therapy is demonstrated in the literature. Notably lacking from the literature is a consideration of whether vision rehabilitation is similarly effective in patients that present distantly from the original insult. This case presents the potential for efficacy of visual rehabilitation even decades after the original insult.

Efficacy of quality improvement and patient safety workshops for students: a pilot study.

BACKGROUND: While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes. METHODS: In this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops. RESULTS: Data was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners' confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics. CONCLUSION: Few medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified 'flipped classroom' methodology, with a focus on active experiential learning and minimal didactic instruction.