Corneal Epithelial Thickness Mapping: A Major Review.

The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.

Social Dynamics of Advice-Seeking: A Network Analysis of Two Residency Programs.

Phenomenon: Residents interact with their peers and supervisors to ask for advice in response to complicated situations occurring during patient care. To provide a deeper understanding of workplace learning, this study explores the structure and dynamics of advice-seeking networks in two residency programs. Approach: We conducted a survey-based social network study. To develop the survey, we conducted focus group discussions and identified three main categories of advice: factual knowledge, clinical reasoning, and procedural skills. We invited a total of 49 emergency medicine and psychiatry residents who had completed at least six months of their training, to nominate their supervisors and peer residents, as their sources of advice, from a roster. Participants identified the number of occasions during the previous month that they turned to each person to seek advice regarding the three broad categories. We calculated the density, centrality, and reciprocity measures for each advice category at each department. Findings: The response rates were 100% (n = 21) and 85.7% (n = 24) in the emergency medicine and psychiatry departments, respectively. The advice network of emergency medicine residents was denser, less hierarchical, and less reciprocated compared to the psychiatry residents' network. In both departments, PGY-1s were the top advice-seekers, who turned to PGY-2s, PGY-3s, and supervisors for advice. The "procedural skills" network had the lowest density in both departments. There was less overlap in the sources of advice for different advice types in the psychiatry department, implying more selectivity of sources. Insights: Complex social structures and dynamics among residents vary by discipline and level of seniority. Program directors can develop tailored educational interventions informed by their departments' specific network patterns to promote a timely and effective advice-seeking culture which in turn, could lead to optimally informed patient care.

Impact of first eye cataract surgery on falls among patients of advanced age: a comparative study.

OBJECTIVE: To compare the incidence of falls between patients with visually significant cataracts in both eyes and those who have undergone first-eye cataract surgery. METHODS: This retrospective case-control study involved patients with a history of cataracts in both eyes who had undergone first-eye cataract surgery within the past 9 to 12 months (pseudophakic group). The control group comprised patients with cataracts in both eyes (cataract group). We assessed best-corrected visual acuity (BCVA), systemic comorbidities and medications (using the Charlson comorbidity index), and independent daily activities (using the Lawton Instrumental Activities of Daily Living scale). The patients were questioned about experiencing two or more falls in the last 6 months. RESULTS: Each group comprised 50 patients. Binocular BCVA was significantly better in the pseudophakic group (0.05 ± 0.06 logMAR) than in the cataract group (0.77 ± 0.34 logMAR). Of all participants, 22% reported experiencing two or more falls in the last 6 months. Multivariate analysis demonstrated significantly better BCVA in participants with less than two falls. CONCLUSIONS: Patients of advanced age with visually significant cataracts in both eyes are at a higher risk of falling. First-eye cataract surgery may mitigate the occurrence of falls by improving binocular BCVA.

Urgent Subconjunctival Needle Decompression for Orbital Compartment Emphysema Caused by Compressed Air Injury.

Orbital compartment syndrome is a critical ophthalmic emergency that needs urgent diagnosis and treatment to prevent permanent vision loss caused by optic nerve compression or retinal ischemia. In this article, we present a child with orbital compartment syndrome caused by orbital emphysema as a result of a rare type of ocular trauma and introduce a simple technique to decompress the pressure. The patient was a 4-year-old boy who experienced a compressed air blast to his left eye. He presented to the emergency department with a frozen globe, tight orbit, and chemosis, without any evidence of globe rupture, conjunctival laceration, and orbital bone fracture. Computed tomographic scan demonstrated extensive subcutaneous, intraorbital, and intracranial emphysema. The pressure was immediately relieved under intravenous sedation by inserting a 27-gauge needle into the chemotic subconjunctival space at the lower lid fornix, followed by gentle manipulation of the globe to help the air escape through the needle. Compressed air injury is a rare type of orbital trauma, and this patient constituted the youngest case ever reported in the English literature, to our knowledge. Air decompression through the conjunctiva as described in this article is a useful technique that can be applied by emergency medicine specialists with special caution for patients with orbital compartment syndrome and orbital emphysema caused by compressed air injury.

Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients.

BACKGROUND: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients. MATERIALS AND METHODS: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated. RESULTS: Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100% but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100% but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90%. CONCLUSION: We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types.

Effect of Four Horizontal Rectus Muscle Tenotomy and Replacement (TAR) Alone and in Combination with Recessions for Strabismus, on Visual Function and Eye Movements in Patients with Infantile Nystagmus Syndrome (INS) Without Abnormal Head Posture (AHP).

PURPOSE: To evaluate and compare the effect of four horizontal rectus muscle Tenotomy And Replacement (TAR) alone and in combination with recessions for strabismus, on visual function and eye movement records in patients with INS without AHP, and to compare these results. METHODS: This was a prospective interventional case series of 14 patients with INS with no AHP or eccentric null point. Patients underwent 4 horizontal eye muscle tenotomy and replacement (TAR) alone or 2 muscle TAR in combination with conventional bilateral horizontal muscle recession according to the presence and type of strabismus. Outcome measures included best corrected visual acuity and nystagmus intensity from eye movement recordings pre and post operatively. Data were compared between patients with strabismus and those without. RESULTS: Overall nystagmus amplitude and velocity was decreased 28.7% and 21.9% respectively for 4 muscle TAR and 2 muscle TAR with paired strabismus recessions. Visual outcome of combined procedure in patients with INS and strabismus was less comparing with 4 muscle tenotomy. All binocular deviations were surgically corrected and there was no undercorrection or complication. Visual acuity showed improvement in patients who had more impaired pre-operation vision. Most patients were satisfied with cosmetic outcomes. CONCLUSIONS: Tenotomy alone and combined with recession improves both visual function and eye movement records in INS. The procedures show better results in more visually impaired patients. We should consider patients preop VA and their visual potential as prognostic factors for their visual gain. Although visual outcomes are not advanced in all patients, nystagmus dampening effect and cosmetic outcome of these procedures can make them reconstructive options for patients with INS who will not achieve better vision.

Retinitis Pigmentosa Associated with Vasoproliferative Tumors and Coats-like Fundus.

PURPOSE: To report two cases of retinitis pigmentosa (RP) associated with vasoproliferative tumors (VPTs) and Coats-like fundus. CASE REPORTS: Two patients with RP presented with recent loss of vision due to combined VPTs and Coats-like retinal vascular alterations. One patient had two VPTs with adjacent capillary nonperfusion, telangiectasia and aneurysmal vascular changes in one eye. The other patient had prominent VPT with Coats-like retinal vascular alterations in both eyes. These lesions received treatment resulting in improved vision in both patients. CONCLUSION: Although rare, VPTs and Coats-like retinal vascular alterations including retinal exudation associated with telangiectatic vessels, aneurysmal changes and capillary nonperfusion may occur in patients with RP.

Association between co-authorship network and scientific productivity and impact indicators in academic medical research centers: a case study in Iran.

BACKGROUND: We aimed to examine the co-authorship networks in three successful Iranian academic research centers, in order to find the association between the scientific productivity and impact indicators with network features in a case study. METHODS: We searched for English articles of the three research centers. We drew co-authorship maps of each center and calculated social network measures. RESULTS: The collaboration networks in centers shared many structural features, including a "star-like" pattern of relations. Centers with more successful scientific profile showed denser and more cooperative networks. Key figures in each center were interviewed for their understandings of the reasons for the emergence of these patterns. CONCLUSION: Star shape network structure and dependency on a single big member is a common feature observed in our case study. Scientific output measures correlate with the network structure of research centers. Network analysis seems a useful method to explore the subtle scientific contexts in research organizations.

Transition from congress abstract to full publication for clinical trials presented at laser meetings.

The present study aims to identify (1) what proportion of abstracts of clinical trials presented at The American Society for Laser Medicine and Surgery (ASLMS) annual meetings are published as full reports, (2) time to publication, and (3) factors that may predict the publication of research in peer-reviewed journals. Two investigators independently hand-searched all abstracts of the ASLMS meetings to identify all reports of clinical trials. Details of sample size, the country of origin, topic of research, type of presentation, type of laser, direction of outcome, and statistical significance were recorded for each abstract. To determine the full publication status of each study, The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE was searched. A total of 198 abstracts were identified. Of these, 87 abstracts (44%) have been fully published. The average time from presentation at the meeting to full publication was 57 months (95% confidence interval = 52-61), and the estimated rate of abstracts published at 1, 2, and 4 years was 15, 30, and 38%, respectively. There is significant tendency for being fully published in high-power laser studies, with USA as country of origin, and orally presented. Our findings supports this opinion that conference abstracts can be an important source for systematic reviews and failure to identify trials presented in congresses might threaten the validity of systematic reviews.