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Introduction: Metadolerite dykes in the Western Dharwar Craton represent the oldest generation of mafic dyke swarms in the craton. The emplacement of these dykes after a period of crust building activity and komatiite volcanism, helps to understand the evolution of Subcontinental Lithospheric Mantle (SCLM) and Archean dynamics.Methods: We report whole rock major, trace element geochemistry and Sr-Nd isotope characteristics for this weakly metamorphosed suite of dykes. Remnant igneous textures and mineralogy are well preserved.Results: The trace and rare earth element concentrations and an overall flat pattern suggests depleted mantle source for these dykes. Three groups are primarily identified: Group one with initial 87Sr/86Sr ratios varying between 0.70041 and 0.70102, Group two dykes and Group three dykes with initial ratios 0.70045–0.70154, and 0.70041–0.70153 respectively. Group one dykes show a good Rb-Sr isochron relationship and an errorchron age of ca. 3,003 ± 102 Ma is obtained. The initial 143Nd/144Nd ratios varies from 0.508,245 to 0.509,172. The epsilon Nd values are mostly negative, ranging between −12 and +5. Group one and two show an epsilon Nd value ranging between −1 and +5 and 0.1 to +5 respectively and group three varies between −0.5 and −12.Discussion: The geochemical characteristics suggest that the group one dykes are derived from a homogenous depleted SCLM source, group two formed by a lower degree of partial melting of a source mantle with enriched components. Group three may have formed from a progressively enriched group one source. All these dykes can be considered as exposed remnants of feeders for the greenstone volcanism in the Western Dharwar Craton.

AbstractKomatiites, greenstone volcanic rocks, and mafic dyke swarms are constituents of early earth magmatic activity, crucial for understanding the chemical evolution of the Archean mantle. The composition of the subcontinental lithospheric mantle (SCLM) is systematically modified throughout the Earth’s history by the addition of geochemically diverse oceanic and continental crustal materials through subduction and can be sampled through intraplate mafic/ultramafic volcanic activities. Here, we present a first report on the multiple sulfur isotope characteristics of the mafic dyke swarms and komatiites from the Dharwar craton in southern India and discuss the geochemical modifications of SCLM through crustal recycling. δ34SV-CDT values of the samples are all negative ranging from -0.15 to -2.91‰. Δ33S values for all the samples are close to 0 with the lowest value of -0.060‰ and highest of 0.146‰. Δ36S values are mostly negative with very few exceptions, ranging from -1.184 to 1.111‰. Near zero values of Δ33S and negative values for δ34S indicate an early formed mantle reservoir with a possible mixture of sulfur from subducting oceanic sediments. Together with trace element geochemistry, we suggest a depleted MORB source mantle (DMM) modified by oceanic crustal components and a depleted mantle (DM) modified by recycled continental crustal sediments as the two end members of the mantle source that produced mafic dyke swarms in the Late Archean to Proterozoic Dharwar craton.

We present the polarization image of the hybrid morphology and broad absorption line quasar PG 1004+130 at 694 MHz obtained with the upgraded Giant Metrewave Radio Telescope. We detect linear polarization in this source’s core, jets, and lobes. The visible discontinuity in total intensity between the inner jets and the kiloparsec-scale lobes suggests that the source is restarted. The inferred poloidal magnetic ( B -) field structure in the inner jet is consistent with that observed in Fanaroff–Riley (FR) type II sources, as are the B -fields aligned with the lobe edges. Moreover, archival Chandra and XMM-Newton data indicate that PG 1004+130 displays several FRII-jetlike properties in X-rays. We conclude that PG 1004+130 is a restarted quasar, with both episodes of activity being FRII type. The spectral index images show the presence of an inverted spectrum core ( α = +0.30 ± 0.01) and a steep spectrum inner jet ( α = −0.62 ± 0.06) surrounded by much steeper lobe emission ( α ≈ −1.2 ± 0.1), consistent with the suggestion that the lobes are from a previous activity episode. The spectral age difference between the two activity episodes is likely to be small (

Rydberg atoms have highly controllable exotic properties such as strong interatomic interaction, high polarizability, and long lifetimes which enabled unprecedented progress in Rydberg atom-based quantum Technologies. We present a brief review of recent progress in the development of quantum technologies using Rydberg atoms. We highlight the recent advances in the various regimes of quantum technologies such as quantum Information processing, quantum sensing, quantum simulation of many-body physics and single-photon sources for quantum communications. [ABSTRACT FROM AUTHOR]

We present a study of molecular gas, traced via CO (3–2) from Atacama Large Millimeter/submillimeter Array data, of four z < 0.2, 'radio quiet', type 2 quasars (Lbol ∼ 1045.3–1046.2 erg s−1; L |$_{\mathrm{1.4\, GHz}}\sim 10^{23.7}\!-\!10^{24.3}$|   W  Hz−1). Targets were selected to have extended radio lobes (≥ 10 kpc), and compact, moderate-power jets (1–10 kpc; P jet ∼ 1043.2–1043.7 erg s−1). All targets show evidence of central molecular outflows, or injected turbulence, within the gas discs (traced via high-velocity wing components in CO emission-line profiles). The inferred velocities (V out = 250–440 km s−1) and spatial scales (0.6–1.6 kpc), are consistent with those of other samples of luminous low-redshift active galactic nuclei. In two targets, we observe extended molecular gas structures beyond the central discs, containing 9–53  per cent of the total molecular gas mass. These structures tend to be elongated, extending from the core, and wrap-around (or along) the radio lobes. Their properties are similar to the molecular gas filaments observed around radio lobes of, mostly 'radio loud', brightest cluster galaxies. They have the following: projected distances of 5–13 kpc; bulk velocities of 100–340 km s−1; velocity dispersion of 30–130 km s−1; inferred mass outflow rates of 4–20 M⊙ yr−1; and estimated kinetic powers of 1040.3–1041.7 erg s−1. Our observations are consistent with simulations that suggest moderate-power jets can have a direct (but modest) impact on molecular gas on small scales, through direct jet–cloud interactions. Then, on larger scales, jet-cocoons can push gas aside. Both processes could contribute to the long-term regulation of star formation. [ABSTRACT FROM AUTHOR]

We present here uGMRT band 4 (∼650 MHz) polarization images of 8 BL Lac objects belonging to the Palomar-Green (PG) 'blazar' sample. A large fraction of the sources (⁠|$\sim 63~{{\ \rm per\ cent}}$|⁠) reveal core-halo radio structures with most of the polarization detected in the inner core-jet regions. PG1101 + 385 and PG2254 + 075 exhibit a 'spine-sheath structure' in polarization. The core-halo and 'spine-sheath' structures are consistent with the Unified Scheme suggestion that BL Lacs are the pole-on beamed counterparts of Fanaroff–Riley (FR) type I radio galaxies. PG1418 + 546 and PG0851 + 203 (OJ287) show the presence of terminal hotspots similar to FR type II radio galaxies. They were also found to be low-spectrally peaked BL Lacs, supportive of the 'blazar envelope' scenario for BL Lacs and quasars. Fractional polarization ranges from 1 to 13 per cent in the cores and 2 to 26 per cent in the inner jets/lobes of the sample BL Lacs. Compared to the varied radio morphology of quasars from the PG 'blazar' sample, the BL Lacs appear to be less diverse. A comparison of the inferred core magnetic (B -) field structures on arcsec- (kpc-) scales w.r.t. the Very Long Baseline Interferometry jet direction does not reveal any preferred orientation, suggesting that if large-scale ordered B -fields exist, they do so on scales smaller than probed by the current observations. However, the presence of polarized emission on arcsec-scales suggests that any mixing of thermal plasma with the synchrotron emitting plasma is insufficient to fully depolarize the emission via the internal depolarization process. [ABSTRACT FROM AUTHOR]

Tapping the potential of solar thermal energy requires spectrally selective solar absorber coatings, which lead to high photothermal efficiency. Micro‐cavities are known to dramatically enhance or suppress light absorption and emission in a directional manner and are used in nanophotonics, photodetectors, lasing, etc. Here, a dielectric‐metal‐dielectric multilayer stack with an optical micro‐cavity of a 12 nm tungsten layer formed between two dielectric layers of transition metal oxide CuCo2O4 (CCO) is designed. The CCO‐W‐CCO thin film multilayers deposited on stainless steel substrate by DC‐radio frequency magnetron sputtering achieve a 90% solar absorptance for the entire solar spectrum and a thermal emittance of 19% for the infrared spectrum. Optimization of thicknesses of individual layers is achieved by numerical simulations done in COMSOL Multiphysics, thereby reproducing the optical properties of each layer. The simulation results satisfactorily reproduce the experimental reflectance and demonstrate maximum power dissipation in the metallic layer in visible as well as NIR regions. Nevertheless, CCO material characterizations reveal that the enhanced absorption over the entire solar spectrum could be attributed to the underlying spinel crystal structure and the nanostructure film morphology. [ABSTRACT FROM AUTHOR]

Gold nanoclusters (AuNCs) are an intensely pursued class of fluorophores with excellent biocompatibility, high water solubility, and ease of further conjugation. However, their low quantum yield limits their applications, such as ultra‐sensitive chemical or molecular sensing. To address this problem, various strategies have been adopted for augmenting their fluorescence intensity. Herein, we report a facile and scalable approach for the fluorescence enhancement of bovine serum albumin (BSA) capped AuNCs (BSA‐AuNCs) using periodic, close‐packed polystyrene colloidal photonic crystals (CPCs). The slow photon effect at the bandgap edges is utilized for the increased light‐matter interactions and thereby enhancing the fluorescence intensity of the BSA‐AuNCs. Compared to the planar polystyrene control sample, the CPC film yielded a 14‐fold enhancement in fluorescence intensity. Further, we demonstrated the as‐prepared BSA‐AuNCs‐CPC as a solid‐state platform for the highly sensitive and selective fluorescence turn‐off detection of creatinine at nanomolar level. [ABSTRACT FROM AUTHOR]

We present a study of a luminous, |$z\, =\, 0.15$|⁠ , type-2 quasar (⁠|$L_{[\rm O III]}$|  = 1042.8 erg s−1) from the Quasar Feedback Survey. It is classified as 'radio-quiet' (⁠|$L_{\mathrm{1.4\, GHz}}$|  = 1023.8 W Hz−1); however, radio imaging reveals ∼ 1 kpc low-power radio jets (Pjet = 1044 erg s−1) inclined into the plane of the galaxy disc. We combine MUSE and ALMA observations to map stellar kinematics and ionized and molecular gas properties. The jets are seen to drive galaxy-wide bi-conical turbulent outflows, reaching W 80  = 1000 – 1300 km s−1, in the ionized phase (traced via optical emission lines), which also have increased electron densities compared to the quiescent gas. The turbulent gas is driven perpendicular to the jet axis and is escaping along the galaxy minor axis, reaching 7.5 kpc on both sides. Traced via CO(3–2) emission, the turbulent material in molecular gas phase is one-third as spatially extended and has three times lower velocity-dispersion as compared to ionized gas. The jets are seen to be strongly interacting with the interstellar medium (ISM) through enhanced ionized emission and disturbed/depleted molecular gas at the jet termini. We see further evidence for jet-induced feedback through significantly higher stellar velocity-dispersion aligned, and co-spatial with, the jet axis (⁠|$\lt 5\, ^{\circ }$|⁠). We discuss possible negative and positive feedback scenarios arising due to the interaction of the low-power jets with the ISM in the context of recent jet–ISM interaction simulations, which qualitatively agree with our observations. We discuss how jet-induced feedback could be an important feedback mechanism even in bolometrically luminous 'radio-quiet' quasars. [ABSTRACT FROM AUTHOR]

Approaches to life can be different for different people. Some find solace in having a positive attitude in life to tackle difficult situations while others succumb to the negative aspect of it. Thus their personality plays a major role in helping a person live a better and fulfilling life. It discusses the signature strengths and virtues of a person and how it helps them in working for something much larger than the person themselves. It also describes in detail the happiness theory which can be discovered and explored with the unique combination of a person's signature strengths like humanity, temperance and persistence. Taking into account all the factors that matter in the subjective well-being of a person, this paper will analyse Rachna Bisht Rawat's book Kargil: Untold Stories from the War with heroes who have indirectly yet successfully used this theory on a practical level to make their lives better. [ABSTRACT FROM AUTHOR]

We present the first results from the Quasar Feedback Survey, a sample of 42 z < 0.2, [O  iii ] luminous AGNs (L [O III] > 1042.1 ergs s−1) with moderate radio luminosities (i.e. L 1.4GHz > 1023.4 W Hz−1; median L 1.4GHz = 5.9 × 1023 W Hz−1). Using high spatial resolution (∼0.3–1 arcsec), 1.5–6 GHz radio images from the Very Large Array, we find that 67 per cent of the sample have spatially extended radio features on ∼1–60 kpc scales. The radio sizes and morphologies suggest that these may be lower radio luminosity versions of compact, radio-loud AGNs. By combining the radio-to-infrared excess parameter, spectral index, radio morphology, and brightness temperature, we find radio emission in at least 57 per cent of the sample that is associated with AGN-related processes (e.g. jets, quasar-driven winds, or coronal emission). This is despite only 9.5–21 per cent being classified as radio-loud using traditional criteria. The origin of the radio emission in the remainder of the sample is unclear. We find that both the established anticorrelation between radio size and the width of the [O    iii ] line, and the known trend for the most [O  iii ] luminous AGNs to be associated with spatially extended radio emission, also hold for our sample of moderate radio luminosity quasars. These observations add to the growing evidence of a connection between the radio emission and ionized gas in quasar host galaxies. This work lays the foundation for deeper investigations into the drivers and impact of feedback in this unique sample. [ABSTRACT FROM AUTHOR]

We present the results from 685 MHz observations with the upgraded Giant Metrewave Radio Telescope (uGMRT) of 22 quasars belonging to the Palomar-Green (PG) quasar sample. Only four sources reveal extended radio structures on ∼10–30 kpc scales, while the rest are largely a combination of a radio core unresolved at the uGMRT resolution of ∼3–5 arcsec, surrounded by diffuse emission on few kpc to ∼10 kpc scales. A few sources reveal signatures of barely resolved jets and lobes in their spectral index images that are created using the 685 MHz uGMRT data and similar resolution GHz-frequency data from the Very Large Array. On the basis of their position on the radio–IR correlation as well as the spectral index images, we find that the radio emission in the two radio-loud (RL) quasars and nearly one-third of the radio-quiet (RQ) quasars is active galactic nucleus (AGN) dominated whereas the remaining sources appear to have significant contributions from stellar-related processes along with the AGN. While the two RL sources exhibit inverted spectral index in their cores, the RQ sources exhibit a range of spectral indices varying from flat to steep (−0.1 |$\gtrsim $| α R   |$\gtrsim $| −1.1) indicating the presence of unresolved jets/lobes or winds. Except for a significant correlation between the 685 MHz radio luminosity and the Eddington ratio, we do not find strong correlations between other 685 MHz radio properties and black hole (BH) properties in the RQ PG sources. This lack of correlations could be explained by the contribution of stellar-related emission, or radio emission from previous AGN activity episodes that may not be related to the current BH activity state. [ABSTRACT FROM AUTHOR]

Endometrial stromal tumors (EST) arise from stromal component of endometrium and are rare and common in peri or postmenopausal age group. EST are partially estrogen dependent tumors and their histopathology resemble the stromal cells of normal proliferative endometrium. They present in varied forms pathologically ranging from most benign to most malignant variants. Diagnosis essentially is by histopathology and prognosis is based on the mitotic activity of the tumor. We have presented here a case of EST presenting in a young nulliparous woman. [ABSTRACT FROM AUTHOR]

Atypical presentations of filariasis have posed diagnostic challenges due to the complexity of identifying the causative species and the difficulties in both diagnosis and treatment. In this study, we present the integrative histological and molecular analysis of seven atypical filariasis cases observed in regions of nonendemicity of Thailand. All filariasis cases were initially diagnosed based on histological findings. To confirm the causative species, molecular characterization based on both filarial mitochondrial (mt 12S rRNA and COI genes) and nuclear ITS1 markers was performed, together with the identification of associated Wolbachia bacterial endosymbionts. Among the cases studied, Brugia pahangi (N = 3), Brugia malayi (N = 1), Dirofilaria sp. "hongkongensis" (N = 2), and a suspected novel filarial species genetically related to Pelecitus copsychi (N = 1) were identified. By targeting the 16S rRNA gene, Wolbachia was also molecularly amplified in two cases of infection with Dirofilaria sp. "hongkongensis." Phylogenetic analysis further revealed that the detected Wolbachia could be classified into supergroups C and F, indicating the high genetic diversity of this endosymbiont in Dirofilaria sp. "hongkongensis." Furthermore, this study demonstrates the consistency between histological findings and species identification based on mitochondrial loci rather than on the nuclear ITS1. This suggests the utility of mitochondrial markers, particularly COI, as a highly sensitive and reliable diagnostic tool for the detection and differentiation of filarial species in clinical specimens. Precise identification of the causative species will facilitate accurate diagnosis and treatment and is also essential for the development of epidemiological and preventive strategies for filariasis.

Purpose: To describe a new surgical technique that uses a relay suture to optimize sutureless scleral fixation of intraocular lens in eyes with capsular insufficiency and to evaluate the outcomes of this technique versus Flanged, double needle-guided, scleral fixation of intraocular lens with haptic trimming (modified Yamane approach)., Methods: Relay intrascleral 6-0 polypropylene sutures with flanges generated at the intraocular ends were used to fixate and securely hold a rigid intraocular lens with haptic eyelets against the inner scleral wall. The results were analyzed at 3-, 6-, and 12-month follow-up., Results: This retrospective cohort study found that compared with the control group (n = 27), the relay-sutured group (n = 26) had greater mean changes in corneal astigmatism (0.44 vs. -0.52 diopters [D]) and fewer mean degrees of intraocular lens astigmatism (0.62 vs. 1.1 D). The mean intraocular lens decentration was comparable between both the groups; however, in the control group, there was a significant increase in intraocular lens tilt degrees from 3 to 12 months. Moreover, significantly higher proportions of patients with persistent macular edema and iris-optic capture were seen in the control group., Conclusion: The relay-sutured technique may be an alternative to flapless scleral fixation of intraocular lens and provides a stable intraocular lens position with acceptable complication rates.

Introduction and Importance: The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature., Case Presentation: A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration., Clinical Discussion: Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD., Conclusions: In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated., Competing Interests: There are no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To report a sutureless and equipment-free technique for contact lens wide-angle viewing system during vitreoretinal surgery., Methods: A step-by-step procedure and a surgical video using this technique were proposed., Results: This technique needs only three-finger control of contact lens either by the left hand (for the right-handed surgeon) or right hand (for the left-handed surgeon). The contact lens is not fixed to the environment (lid speculums, cannulas, corneoscleral limbus); therefore, it allows the surgeon to move and tilt the contact lens freely while keeping a clear view of the retina., Conclusion: The sutureless and equipment-free technique for contact lens viewing system during vitreoretinal surgery has been tried and tested, and it is practical and effective in the real world.

Purpose: To report the development of a novel, simple-to-use technique for the salvage of a haptic of dislocated flanged intraocular lens during a retinal detachment surgery., Methods: A 25-gauge regular-wall needle was prepared and threaded by the dislocated flanged haptic before the flanged haptic was heated and enlarged by low-temperature cautery., Results: The dislocated flanged haptic was probably the result of too small of a diameter of the previously flanged haptic and was triggered by scleral indentation. The rescue technique required only a 25-gauge regular-wall needle to conduct the conventional procedure of flanged haptic intraocular lens fixation before being enlarged by low-temperature cautery. The intraocular lens remained centered and stable at a 3-month postoperative follow-up examination., Conclusion: The application of a 25-gauge needle in the salvage of a haptic of dislocated flanged intraocular lens is simple and effective without the need for trimming the flanged tip.

We compared the performance of deep learning (DL) in the classification of optical coherence tomography (OCT) images of macular diseases between automated classification alone and in combination with automated segmentation. OCT images were collected from patients with neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusion, cystoid macular edema in Irvine-Gass syndrome, and other macular diseases, along with the normal fellow eyes. A total of 14,327 OCT images were used to train DL models. Three experiments were conducted: classification alone (CA), use of automated segmentation of the OCT images by RelayNet, and the graph-cut technique before the classification (combination method 1 (CM1) and 2 (CM2), respectively). For validation of classification of the macular diseases, the sensitivity, specificity, and accuracy of CA were found at 62.55%, 95.16%, and 93.14%, respectively, whereas the sensitivity, specificity, and accuracy of CM1 were found at 72.90%, 96.20%, and 93.92%, respectively, and of CM2 at 71.36%, 96.42%, and 94.80%, respectively. The accuracy of CM2 was statistically higher than that of CA ( p = 0.05878). All three methods achieved AUC at 97%. Applying DL for segmentation of OCT images prior to classification of the images by another DL model may improve the performance of the classification.

Purpose: To determine the sensitivity and specificity of syphilis antibody tests in vitreous samples and to propose an algorithm using vitreous syphilis antibody as a supplementary test to confirm syphilitic uveitis (SU)., Methods: A prospective case-control study was conducted at the Retina and Uveitis Clinic from May 2017 to January 2020. Initially, patients were classified based on syphilis serology into group 1 (positive testing) and group 2 (negative testing). Group 1 was further divided into 2 subgroups (group 1A and 1B) depending on their relevant clinical manifestations and clinical improvement. Group 2 served as a control group., Results: Thirty-eight patients were enrolled in the study: 14 in group 1A, 5 in group 1B, and 19 in group 2B. No patient was assigned to group 2A. All patients in group 1A, representing definite SU, completed syphilis test (rapid plasma reagin [RPR], enzyme immunoassay [EIA], and fluorescent treponemal antibody-absorption [FTA-ABS]) for vitreous, and all vitreous samples yielded positive results. Of the 5 subjects in group 1B, 3 cases were considered to be not SU with different conditions, and 2 were indeterminate for SU. They presented with different features not typical of SU, and they had variable and fewer positive syphilis antibody responses. The most sensitive test for detecting syphilis antibodies in vitreous was EIA (90.9%), followed by RPR (80.0%) and FTA-ABS IgG (78.9%). EIA and FTA-ABS had the highest specificity, detecting 100% of the syphilis antibody., Conclusions: Vitreous analysis of syphilis antibody can serve as a supplementary test to confirm SU in selected cases as the proposed algorithm., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To identify prognostic factors for poor visual outcomes in patients with isolated retinal vasculitis and to elucidate the outcome of immunosuppressive treatment without the use of antituberculosis drugs for patients with retinal vasculitis associated with a positive QuantiFERON-TB Gold In-Tube (QFT) test., Methods: A retrospective chart review was performed of patients presenting with retinal vasculitis. After the diagnosis of active retinal vasculitis had been confirmed by fluorescein angiography and other possible causes of retinal vasculitis had been excluded, patients were categorized into two groups by their QFT result. Potential associated factors between the poor and good visual outcome groups were statistically analyzed by the chi-square test and logistic regression model with generalized estimating equations., Results: Seventy-three eyes (48 patients) were enrolled in this study. After univariate analysis, multivariate logistic regression analysis was performed and revealed that logMAR visual acuity at the initial visit ( P = 0.01) and outer retinal disruption ( P = 0.03) were the two factors significantly associated with poor visual outcomes. Systemic corticosteroids were administered without the use of antituberculosis drugs to all 16 cases of presumed tuberculous retinal vasculitis associated with positive QFT (26 eyes), 10 (63%) of whom were given nonsteroidal immunosuppressive drugs and achieved inflammatory control and treatment success., Conclusion: Risk factors leading to poor visual outcome in patients with isolated retinal vasculitis have been identified. Immunosuppressive treatment without antituberculosis drugs seems to be a promising regimen for selected patients with presumed tuberculous retinal vasculitis under vigilant care.

Thyrotoxic periodic paralysis (TPP) is an uncommon disorder characterized by acute onset of hypokalemia (serum potassium level less than 3.5 mmol/L) and paralysis secondary to thyrotoxicosis. Patients can present with TPP as the first clinical manifestation of thyrotoxicosis. In patients presenting with acute episodes, the presence of hypokalemia and elevated levels of thyroid hormones with low thyroid-stimulating hormone levels (less than 0.35 µIU/mL) are important diagnostic clues. We report one case of TPP in which the acute onset of paralysis was the first clinical presentation of underlying thyrotoxicosis. After treatment with propranolol and carbimazole, the patient became symptom-free and euthyroid., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kaeley et al.)

Introduction and Importance: In an immunocompromised patient, there has never been a report of Epstein-Barr virus (EBV) and Talaromyces marneffei co-infection. Treatment with intravenous ganciclovir for EBV-associated uveitis has only been explored in a few cases., Case Presentation: A 47-year-old HIV-positive female presented with scleral nodule and vascularized iris tumor in the left eye. After the ancillary laboratory workup, EBV was detected by polymerase chain reaction on aqueous humor and scleral tissue analysis. The lesion subsided completely with systemic and local ganciclovir therapy. Subsequently, recurrent scleral nodule with iris plaque developed and was pathologically diagnosed as Talaromyces marneffei . The employed treatment, including intravenous amphotericin B and intracameral amphotericin B injection, was successful in attaining a significant regression of the lesion., Clinical Discussion: Although EBV treatment is debatable, our combination of systemic and local ganciclovir therapy demonstrated regression of EBV-caused scleral nodule and iris plaque. The organism's identification was complicated by Talaromyces marneffei , but it was easily treated., Conclusions: In HIV-infected patients, EBV-associated sclerouveitis can be successfully treated with systemic and local ganciclovir therapy, and there is a possibility of coinfection with Talaromyces marneffei., Competing Interests: None., (© 2022 The Authors.)

Purpose: Patients with hypercortisolism have been associated with a higher prevalence of the pachychoroid spectrum including central serous chorioretinopathy (CSCR), which may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor antagonist because hyperaldosteronism has rarely been detected in patients with CSCR. Therefore, this study aimed to evaluate the effects of ketoconazole, the first-line cortisol inhibitor, on the resolution of subretinal fluid (SRF) in CSCR and to analyze correlations between choroidal thickness and steroid hormones., Patients and Methods: This retrospective cohort study included 41 naïve CSCR eyes of 41 patients categorized into control (20 eyes) and treatment (21 eyes) groups. Patients in the treatment group were administered oral ketoconazole at a daily dose of 400 or 600 mg for 3-6 weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent SRF. Thus, a survival analysis was performed to determine the time interval from presentation to clinical resolution of SRF. Secondary outcomes consisted of eyes with persistent SRF and factors affecting the therapeutic response., Results: The mean 24-hour urinary free cortisol (UFC) levels were elevated at 181 ± 70 and 150 ± 68 µg/day (range: 20-150) in the treatment and control groups, respectively (p = 0.21). After controlling for age and gender, baseline UFC levels were significantly associated with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly increased the CSCR resolution with the median time to resolution of 7 vs 16 weeks (p < 0.01) and decreased the proportion of eyes receiving rescue therapy at 12 weeks (23.8% vs 50%; p = 0.01). Prolonged CSCR durations were likely found in elderly patients with thick choroids in fellow eyes., Conclusion: Patients with CSCR showed elevated glucocorticoids, which further correlated with their choroidal thickness. Using cortisol blockers may shorten the duration of existing SRF., Competing Interests: The authors report no conflicts of interest in relation to this work. No financial disclosures or conflicting relationship exists for any authors. Oral ketoconazole is not yet approved for the treatment of CSCR., (© 2022 Chantarasorn et al.)

Objective: The incidence, risk factors, and time to diagnosis of rheumatologic disease (RD) in patients with isolated inflammatory eye diseases (IED) were investigated., Material and Methods: A 12-year bidirectional cohort study was conducted in IED patients who were tested for antinuclear antibody (ANA) and rheumatoid factor (RF). Patients with prior RD were excluded. Impacts of relevant symptoms, signs, and laboratory investigations were analyzed., Results: Seventy-five patients presented with IED including scleritis, anterior uveitis (AU), retinal vasculitis (RV), keratopathy, and optic neuritis (OP). AU, RV, keratopathy, and OP were associated with RD development. The incidence of RD was 36% during 12 years. RD developed most frequently in AU (55.5%) and RV (22.2%). The longest duration for RD development was 5.5 years. Prevalence of positive ANA and RF were 57.3% and 13.3%, respectively. The three most common RDs developed after IEDs were spondyloarthropathy (44.4%), systemic lupus erythematosus (SLE) (18.5%), and Sjogren's syndrome (pSS) (11.1%). The risk factors of RD from univariate analysis were age below 35 years old at onset of IED [relative risk (RR) 3.45; 95% CI (1.13-10.55), p =0.026], positive pertinent findings from history [RR 2.125; 95% CI (1.39-3.25), p<0.001], and physical examination [RR 3.23; 95% CI (1.84-5.66), p<0.001]. Multivariable logistic regression showed that bilateral eye involvement of IED was the significant risk of RD [RR 4.33; 95% CI (1.57-11.96), p=0.004]. IED patients with bilateral eye involvement had shorter time to develop RD (p=0.018). Positive ANA was the predictor for SLE and pSS in RV or OP patients [RR 2.00; 95% CI (1.14-3.52), p=0.04]., Conclusions: IED with bilateral eye involvement was the risk of RD development. Positive ANA was the predictor of RD in RV and OP patients, but not for the other IEDs. Follow-up period of at least 5 years was required to identify RD., Key Points: • Bilateral involvement of isolated inflammatory eye disease was a significant risk factor of rheumatologic disease development., (© 2021. International League of Associations for Rheumatology (ILAR).)

Background: There are still many research challenges and unanswered questions in relation to Epstein-Barr virus-associated uveitis. These include the presence of Epstein-Barr virus (EBV) DNA in asymptomatic patients, its pathogenicity in the uveitis eye, and the role of antiviral therapy for EBV-associated intraocular inflammation., Methods: This was a retrospective review of prospectively collected data from the Ophthalmology Department, Rajavithi Hospital between 2015 and 2020. A qualitative assay using multiplex real-time PCR was performed to detect pathogen genes from specimens obtained from a total of 344 patients. The main outcome measure was treatment success defined by clinical improvement and absence of viral DNA confirmed by PCR., Results: Of the 35 cases, 24 with complete data were enrolled in the study, including 22 with post-treatment PCR results. Sixty-seven percent were HIV-infected, and other plausible causes or coinfection with other pathogens were found in 75% of patients. Cytomegalovirus (38%) was the most common co-infecting pathogen. The most commonly employed regimen was a combination of systemic acyclovir and intravitreal ganciclovir injection (58%). Of the 22 cases who had post-treatment PCR results, absence of detection of the virus by PCR in the intraocular fluid after treatment was demonstrated in 73% of patients., Conclusion: Patients with EBV infection can be simultaneously co-infected with other pathogens. Systemic acyclovir and ganciclovir achieved clinical improvement in most cases, and EBV infection was cured in the majority of patients., (Copyright © 2022 Elsevier B.V. All rights reserved.)

A 19-year-old male presented with a history of pulsatile tinnitus on the left side after he underwent drainage for a tonsillar swelling. He had noticed a painless neck swelling one month ago that was associated with difficulty in swallowing. His physician had made a diagnosis of peritonsillar abscess, and drainage had been performed. After the procedure, the swelling had progressed further, leading to drooling of saliva and disabling tinnitus. When he presented to the emergency, local examination revealed a pulsatile neck swelling with peritonsillar mass. CT angiography/digital subtraction angiography (DSA) of the neck and brain revealed a large aneurysm of the distal cervical segment of the left internal carotid artery (ICA). The patient successfully underwent an urgent open repair. This case highlights the importance of a thorough history and examination in identifying a rare cause of pulsatile tinnitus. A stepwise approach to determine the reason behind tinnitus revealed an underlying ICA aneurysm of the extracranial segment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Pillai et al.)

The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists., Competing Interests: None

Purpose : To demonstrate changes in three-dimensional choroidal volume with enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with recurrent stage of Vogt-Koyanagi-Harada disease (VKH). Materials and Methods : This prospective comparative case series included 9 patients with recurrent VKH, 10 patients with quiet VKH, and 15 healthy controls after sample size was calculated. All VKH cases with recurrences underwent raster scanning with EDI-OCT at active and inactive stages of the disease. Results : All choroidal parameters in the active stage significantly reduced when the inflammation subsided: total choroidal volume ( P = .02), central choroidal volume ( P = .01), central choroidal thickness ( P = .03). The changes in central choroidal volume over the resolution phase were more pronounced than the changes in central choroidal thickness in 56% of cases. Two cases presenting with only subclinical posterior segment recurrence had their choroidal parameters recovered after prompt treatment. Conclusions : In the recurrent stage of VKH, alteration in choroidal volume was evident by EDI-OCT even in an absence of anterior segment inflammation. Central choroidal volume may serve as a biomarker for detecting choroidal morphological change.

Background: To describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed., Methods: Medical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes., Results: Over the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case., Conclusions: The rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

Aim: To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury., Methods: A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model., Results: In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P =0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units., Conclusion: In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism., (International Journal of Ophthalmology Press.)

Purpose: To report the novel application of nontreponemal and treponemal antibody to confirm diagnosis of ocular syphilis from vitreous samples., Methods: Two distinct case reports emphasizing the importance of confirmatory vitreous treponemal antibody. Multimodal imaging of patients was also applied., Results: We report two distinct cases with positive serum treponemal antibody but opposing vitreous treponemal antibody results. One case with a positive vitreous test responded well to antisyphilitic treatment. By contrast, a case with a negative vitreous result was changed to serpiginous choroiditis, eventually cured by immunomodulatory treatment., Conclusion: Intraocular fluid analysis of nontreponemal and treponemal antibody may play an important role in ruling out suspected ocular syphilis in settings without a polymerase chain reaction facility, especially immunocompromised patients who are at risk of multiple infections. Further studies are needed to establish the sensitivity and specificity of nontreponemal and treponemal antibody test on vitreous samples.

Center-involved diabetic macular edema (ci-DME) is a major cause of vision loss. Although the gold standard for diagnosis involves 3D imaging, 2D imaging by fundus photography is usually used in screening settings, resulting in high false-positive and false-negative calls. To address this, we train a deep learning model to predict ci-DME from fundus photographs, with an ROC-AUC of 0.89 (95% CI: 0.87-0.91), corresponding to 85% sensitivity at 80% specificity. In comparison, retinal specialists have similar sensitivities (82-85%), but only half the specificity (45-50%, p < 0.001). Our model can also detect the presence of intraretinal fluid (AUC: 0.81; 95% CI: 0.81-0.86) and subretinal fluid (AUC 0.88; 95% CI: 0.85-0.91). Using deep learning to make predictions via simple 2D images without sophisticated 3D-imaging equipment and with better than specialist performance, has broad relevance to many other applications in medical imaging.

Purpose: Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis., Methods: We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease., Results: We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2-3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of "sunset glow fundus." Several studies additionally report series in which the disease could be cured, using such an approach., Conclusions: There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and "sunset glow fundus," and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.

Deep learning algorithms have been used to detect diabetic retinopathy (DR) with specialist-level accuracy. This study aims to validate one such algorithm on a large-scale clinical population, and compare the algorithm performance with that of human graders. A total of 25,326 gradable retinal images of patients with diabetes from the community-based, nationwide screening program of DR in Thailand were analyzed for DR severity and referable diabetic macular edema (DME). Grades adjudicated by a panel of international retinal specialists served as the reference standard. Relative to human graders, for detecting referable DR (moderate NPDR or worse), the deep learning algorithm had significantly higher sensitivity (0.97 vs. 0.74, p  < 0.001), and a slightly lower specificity (0.96 vs. 0.98, p  < 0.001). Higher sensitivity of the algorithm was also observed for each of the categories of severe or worse NPDR, PDR, and DME ( p  < 0.001 for all comparisons). The quadratic-weighted kappa for determination of DR severity levels by the algorithm and human graders was 0.85 and 0.78 respectively ( p  < 0.001 for the difference). Across different severity levels of DR for determining referable disease, deep learning significantly reduced the false negative rate (by 23%) at the cost of slightly higher false positive rates (2%). Deep learning algorithms may serve as a valuable tool for DR screening., Competing Interests: Competing interestsJ.K., R.S., K.W., B.J.L.C., G.S.C., L.P., S.P. and D.R.W. are Google employees and receive salary and stock as a part of the standard compensation package. O.K., J.J. and J.T. are consultants for Google.

Aim: To identify risk factors associated with post-cataract surgery endophthalmitis (PCE) in type 2 diabetic patients., Methods: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model., Results: Within the case group, 53% were females and the median age was 68y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE (OR 3.9, 95%CI 1.0-15.0, P =0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria (89%). Staphylococcus species represented the most common group (67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR (20/100)., Conclusion: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin (HbA 1c ) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.

Purpose: To examine the efficacy and safety of Ruthenium-106 plaque radiotherapy in the treatment of circumscribed choroidal hemangioma., Methods: Twenty-one eyes of 21 patients diagnosed with symptomatic circumscribed choroidal hemangioma who underwent Ruthenium-106 plaque radiotherapy were included in the study. Clinical response, ancillary tests finding improvement, and major side effects were evaluated., Results: From the initial to the 1-year follow-up visits, vision improved in 12 eyes (57%), was stable in 7 eyes (33%), and became worse in 2 eyes (10%). Based on fluorescein angiography and optical coherence tomography, subretinal fluid and cystoid macular edema resolved in all patients. Changes in logarithm of minimum angle of resolution visual acuity (P = 0.038); tumor thickness (P = 0.0001) and largest diameter (P = 0.007) on ultrasonography; and subfoveal thickness on optical coherence tomography (P < 0.0001), were statistically significant between the initial and the 1-year follow-up visits. Side effects as observed during the follow-up period included: radiation-related retinopathy in 5 (24%) eyes, radiation-related papillopathy in 1 eye (5%), and subretinal fibrosis in 2 eyes (10%). Subretinal fibrosis was the only permanent radiation-related side effect., Conclusion: Ruthenium-106 plaque radiotherapy is an effective and safe method of treatment for symptomatic circumscribed choroidal hemangiomas. The incidence of permanent visual loss is low with prompt treatment of complications.

Purpose: To describe a case of bilateral endogenous cryptococcal endophthalmitis in an immunocompetent host and to review adjunctive ophthalmic imaging patterns and treatment., Methods: A retrospective case report., Results: A 45-year-old female patient with two distinct presentations of endogenous cryptococcal endophthalmitis in each eye presented initially with progressive blurred vision in the left eye, beginning more than 10 years after a craniotomy with ventriculoperitoneal shunt. Complete ophthalmic imaging was conducted and compared with data from previous literature. Administration of amphotericin-B had poorly responded; however, consolidation of fluconazole resulted in disease stabilization., Conclusions: Bilateral intraocular cryptococcal infection can present with two distinct patterns of posterior segment findings. A review of ophthalmic imaging patterns found consistency in some characteristics of A-scan ultrasonogram and fundus fluorescein angiogram. Besides conventional treatment, voriconazole is likely to play an important role in the management of cryptococcal endophthalmitis.