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Fibre-reinforced polymer bars are rapidly becoming an approved alternative to conventional reinforcing steel bars, especially for severely exposed structures such as bridges. This paper reports on an experimental study on the bond characteristics of both sand-coated and ribbed-surface glass-fibre-reinforced polymer bars embedded in high-strength concrete (HSC). A total of 145 pull-out tests were conducted to examine the effect of varying parameters on the bond characteristics, namely embedment length, bar diameter, surface treatment and concrete cover. In addition, 45 pull-out tests were conducted to investigate the effect of providing headed-end anchorage for the sand-coated bars. The experimental results showed that the sand-coated bars exhibited better bond strength than the ribbed-surface bars, which entailed lower development lengths. Thus, based on the experimental results, expressions for the development length of both sand-coated and ribbed-surface bars embedded in HSC were developed and compared against the results of formulae in available design standards. The comparison revealed that ACI 440-1R-06 produced lower conservative results than CAN/CSA S806-12.

Objective To correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management. Design Retrospective chart review. Methods SETTING: Single tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.). Methods Twenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit. Main outcome measures Change in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens. Results After surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis. Conclusion Conjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.

Objective To evaluate clinical outcomes of a trifocal intraocular lens using femtosecond laser-assisted cataract surgery (FLACS), digital tracking (DT), and intraoperative aberrometry (IA). Setting One site (Abbotsford, B.C., Canada) Design Retrospective, single-surgeon study. Methods This was a retrospective, single-surgeon study examining 200 eyes of 100 bilaterally implanted patients. Eligible participants were those presenting with visually significant cataracts or as a candidate for clear lens extraction who were interested in implantation of a diffractive toric or non-toric intraocular lens. Preoperative and postoperative data were collected for manifest refraction spherical equivalent (MRSE), refractive astigmatism (RA), and monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Results Mean postoperative manifest refraction spherical equivalent (MRSE) was 0.006 ± 0.27 D. The absolute prediction error was 0.50 D or less in 88.0% (176/200) of eyes. Postoperative RA was 0.50 D or less in 98.5% (197/200) of eyes. Postoperative UDVA was 0.10 logMAR or better in 86% (172/200) of eyes, and 66.0% (132/200) of eyes were 0.00 logMAR or better. Postoperative UIVA was 0.10 logMAR or better in 99.5% (199/200) of eyes, and 95.0% (190/200) of eyes were 0.00 logMAR or better. Postoperative UNVA was 0.10 logMAR or better in 91.5% (183/200) of eyes, and 73.5% (147/200) of eyes were 0.00 logMAR or better. Conclusion The results demonstrate that trifocal implantation with FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Purpose: To study the effect of fluorescence imaging systemically administrated indocyanine green (ICG) for preventing bile leakage (BL) from the cut surface of the liver. Detection of ICG leakage from the resected surface of the liver was used to identify BL. We compared the bilirubin levels in drainage effluent between patients in whom BL from the resected liver was observed using conventional assessment with the naked eye and those in whom ICG leakage was used as an indicator of BL.Methods: Our sample comprised 26 patients who underwent hepatectomy without ICG (conventional observation group, CO-G) and 23 hepatectomy patients who underwent intraoperative detection of BL using systemically administrated ICG (ICG observation group, IO-G). In the IO-G, we also compared the number of BL spots on the resected plane visible to the naked eye with the number of visible spots on an ICG camera.Results: Three days after surgery, the bilirubin levels in the drainage fluid of the IO-G were significantly lower than those in the CO-G (1.3 vs. 1.9 mg/dL, p = 0.019). Two cases (7.7%) of ISGLS grade B biliary fistula occurred in the CO-G, but none in the IO-G. In the IO-G, the number of BL spots detected just after hepatectomy was significantly higher using ICG camera observation than the naked eye observation (0.22 vs. 0.91 spots, p < 0.001).Conclusion: Observation with systemically administrated ICG can detect BLs with more sensitivity than conventional observation with the naked eye. This enables rapid repair and may prevent biliary fistula.

We report a novel type of idiopathic bilateral vestibulopathy with acute simultaneous involvement of the vestibulo-ocular reflex limited to the low-frequency range. A 64-year-old female presented with dizziness, oscillopsia, and difficulty walking. She did not experience rotatory vertigo and did not show any nystagmus. Vestibular function tests showed absent caloric responses in both ears, while vestibulo-ocular reflex (VOR) gains in the video head impulse test (vHIT) were preserved in all six semicircular canals. Cervical and ocular vestibular evoked myogenic potentials in response to air-conducted sound were absent on both sides. Since the caloric test and vHIT measures low-frequency and high-frequency VOR, respectively, we diagnosed the patient as having a bilateral VOR deficit limited to the low-frequency range. During a 1-year follow-up with vestibular rehabilitation, the subjective symptom of dizziness gradually recovered while recovery of vestibular function was minimal.

BackgroundWe aimed to investigate corneal densitometry and correlations with corneal morphological parameters in bilateral keratoconus (KCN) patients with unilateral Vogt's striae.MethodsOne hundred and-twelve patients (224 eyes) with bilateral KCN and unilateral Vogt's striae were enrolled in this cross-sectional contralateral eye study. Corneal densitometry and morphological parameters were measured using Pentacam HR.ResultsOur study revealed that corneal densitometry values of the anterior 0–2 mm and 2–6 mm, intermediate 0–2 mm and 2–6 mm, posterior 2–6 mm, and total cornea 2–6 mm in eyes with Vogt’s striae were significantly higher than those in eyes without Vogt's striae (P P P P P

Objective. In this single-blind, observational prospective clinical trial, we aimed to determine and compare the effects of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of oculocardiac reflex (OCR). Methods. Forty-five patients were divided into three groups. Group M received 0.5 mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1 mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR, and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups. Results. The mean HR1, HR2, and HR3 values were significantly increased ( p = 0.002 , p < 0.001 , p < 0.001 ) and the incidence of OCR ( p = 0.004 ) was significantly decreased in Group H and in Group HM (for all, p < 0.01 ) compared to Group M. The most common orbital muscle in which OCR occurred was the rectus medialis. Conclusion. Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to premedication with midazolam alone. This study was registered on https://clinicaltrials.gov/ with number NCT03806270.

To what extent is the size of the blood-oxygen-level-dependent (BOLD) response influenced by factors other than neural activity? In a re-analysis of three neuroimaging datasets (male and female human participants), we find large systematic inhomogeneities in the BOLD response magnitude in primary visual cortex (V1): stimulus-evoked BOLD responses, expressed in units of percent signal change, are up to 50% larger along the representation of the horizontal meridian than the vertical meridian. To assess whether this surprising effect can be interpreted as differences in local neural activity, we quantified several factors that potentially contribute to the size of the BOLD response. We find relationships between BOLD response magnitude and cortical thickness, curvature, depth and macrovasculature. These relationships are consistently found across subjects and datasets and suggest that variation in BOLD response magnitudes across cortical locations reflects, in part, differences in anatomy and vascularization. To compensate for these factors, we implement a regression-based correction method and show that after correction, BOLD responses become more homogeneous across V1. The correction reduces the horizontal/vertical difference by about half, indicating that some of the difference is likely not due to neural activity differences. We conclude that interpretation of variation in BOLD response magnitude across cortical locations should consider the influence of the potential confounding factors of thickness, curvature, depth and vascularization.Significance statementThe magnitude of the BOLD signal is often used as a surrogate of neural activity, but the exact factors that contribute to its strength have not been studied on a voxel-wise level. Here, we examined several anatomical and measurement-related factors to assess their relationship with BOLD signal magnitude. We find that BOLD magnitude correlates with cortical anatomy, depth and macrovasculature. To remove the contribution of these factors, we propose a simple, data-driven correction method that can be used in any functional magnetic resonance imaging (fMRI) experiment. After accounting for the confounding factors, BOLD magnitude becomes more spatially homogenous. Our correction method improves the ability to make more accurate inferences about local neural activity from fMRI data.

Positively imagined activities may capture visual attention due to an increase in positive value. Increasing attention toward activities, in turn, may prove useful for clinical interventions aiming to motivate behavioral engagement. Employing a within-subject experimental design, we examined the effect of positive imagery on attention using a visual probe task with concurrent eye tracking. Adults from the general population (N = 54) imagined performing activities involving visually presented objects in a positive (focusing on the positive emotional impact) or neutral (focusing on a neutral circumstance) manner. They then completed a visual probe task using picture stimuli depicting one object per type of imagery. Positive compared to neutral imagery increased self-reported behavioral motivation and biased the direction, but not the duration, of gaze toward objects associated with the imagined activities. An exploratory analysis showed a positive association between the direction bias and depressive symptoms. Our findings build on existing literature on positive imagery as a motivational amplifier by highlighting early attention as an underlying cognitive mechanism.

Retinal circuits transform the pixel representation of photoreceptors into the feature representations of ganglion cells, whose axons transmit these representations to the brain. Functional, morphological, and transcriptomic surveys have identified more than 40 retinal ganglion cell (RGC) types in mice. RGCs extract features of varying complexity; some simply signal local differences in brightness (i.e., luminance contrast), whereas others detect specific motion trajectories. To understand the retina, we need to know how retinal circuits give rise to the diverse RGC feature representations. A catalog of the RGC feature set, in turn, is fundamental to understanding visual processing in the brain. Anterograde tracing indicates that RGCs innervate more than 50 areas in the mouse brain. Current maps connecting RGC types to brain areas are rudimentary, as is our understanding of how retinal signals are transformed downstream to guide behavior. In this article, I review the feature selectivities of mouse RGCs, how they arise, and how they are utilized downstream. Not only is knowledge of the behavioral purpose of RGC signals critical for understanding the retinal contributions to vision; it can also guide us to the most relevant areas of visual feature space.

The quantification of vision impairments dates to the mid-nineteenth century with standardization of visual acuity and visual field measures in the eye clinic. Attempts to quantify the impact of vision impairments on patients’ lives did not receive clinical attention until the close of the twentieth century. Although formal psychometric theories and measurement instruments were well developed and commonplace in educational testing, as well as in various areas in psychology and rehabilitation medicine, the late start applying them to clinical vision research created a vacuum that invited poorly developed and poorly functioning instruments and analytic methods. Although this research is still burdened with legacy instruments, mandates by regulatory agencies to include the patients’ perspectives and preferences in the evaluation of clinical outcomes have stimulated the development and validation of self-report instruments grounded in modern psychometric theory and methods. Here I review the progress and accomplishments of applying modern psychometrics to clinical vision research.

Purpose: To establish and verify a nomogram based on computed tomography (CT) radiomics analysis to predict the histological types of gastric cancer preoperatively for patients with surgical indications.Methods: A sum of 143 patients with gastric cancer in Sir Run Run Shaw Hospital from January 2019 to December 2020 (differentiated type: 46 cases; undifferentiated type: 97 cases) were included into this retrospective study, and were randomly divided into training (n=99) and test cohort (n=44). The least absolute shrinkage and selection operator(LASSO) was used for feature selection while the multivariate Logistic regression method was used for radiomics model and nomogram building. The area under curve(AUC) was used for performance evaluation in this study.Results: The radiomics model got AUCs of 0.755 (95%CI, 0.650-0.859) and 0.71 (95%CI,0.543-0.875) for histological prediction in the training and test cohorts, respectively. The radiomics nomogram based on radiomics features and Carbohydrate antigen 125 (CA125) achieved an AUC of 0.777 (95%CI:0.679-0.875) in the training cohort with 0.726 (95%CI:0.559-0.893) in the test cohort. The calibration curve of the radiomics nomogram also showed good results. The decision curve analysis(DCA) shows that the radiomics nomogram is clinically practical.Conclusion: The radiomics nomogram established and verified in this study showed good performance for the preoperative histological prediction of gastric cancer, which might contribute to the formulation of a better clinical treatment plan.

Background: to demonstrate the safety and efficacy of the intracameral use of tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery, a combination widely used in adult patients but still off-label in childrenMethods: Design: two-center, prospective, observational studySetting: San Giuseppe Hospital, Milan and Meyer Children's Hospital, FlorenceStudy population: children from 0 to 4 years of age undergoing cataract surgery with or without intraocular IOL implantation, in the absence of clinically significant systemic conditions, history of ocular surgery, concurrent ocular medication, hypersensitivity to any of the substances and post-traumatic cataracts. During the surgery, patients received the combination drug after the primary access to the anterior chamber. Efficacy was evaluated by achieving an adequate mydriasis in order to perform capsulorhexis, while safety was assessed by recording vital signs (heart rate, blood pressure, respiratory rate, temperature) pre and post administration of the substance.Results: this study included 53 surgical procedures of 36 patients: 41 eyes were left aphakic while 12 eyes received primary IOL implantation. The pupil size was adequate to safely perform capsulorhexis in 52 procedures of 53. The difference in pupil enlargement was significant (6.0 ± 1.14mm, P = < 0.001). There were no notable changes in vital parameters. Conclusions: the administration of intracameral tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery is effective for obtaining an adequate mydriasis without any vital parameters changes throughout the procedure.

The greatest challenge in autism spectrum disorder (ASD) detection and treatment arises from the elusive etiological origins and heterogeneity of ASD. ET-EEG correlative analytics refers to correlating simultaneously recorded Eye tracking (ET) and Electroencephalography (EEG) data or combining them to yield diagnostic biomarkers. This approach was recently applied in ASD research as EEG and video-based ET are suitable for children and do not interfere with each other. It allows researchers to associate neural correlates with gaze patterns in the same cognitive task. Besides, correlative analytics has shed light on the inconsistent findings derived from the unimodal approach, reveals the developmental trajectory of ASD and provides biomarkers to assist ASD diagnosis or intervention. This review focuses on 8 articles applying ET-EEG correlative analytics and synthesized the reported correlation between ET and EEG patterns. Studies concerning such patterns that acquired either ET or EEG data were also reviewed to provide comparisons. In recent years, correlative analytics has also been developed in other research fields such as visual information processing and EEG artefact correction. Incorporating methodologies used in these research works into ASD studies would help identify cognitive alteration related to a specific visual pattern in naturalistic settings. The opportunities and limitations of this approach in ASD research are discussed at last.

Background Small incision lenticule extraction (SMILE) is femtosecond laser based, minimally invasive, flap-free refractive surgery gaining worldwide acceptance as a safe alternative to flap based refractive surgeries. Methods A retrospective data review study was done where preoperative and postoperative data were collected for 202 eyes of 101 patients who underwent SMILE surgery at a tertiary care Armed Forces hospital from Jan 2019 to Dec 2019. All participants included in the study were followed up for 3 months postoperative period. Results Mean age of the participants was 24.139 ± 0.515 years (males 22.1 years, females 25.3 years). Male participants were 36 (72 eyes) while female participants were 65 (130 eyes). Of the participants, 75.2% underwent the procedure for cosmetic indication, while 24.8% underwent clearing some medical examination later. Preoperative UCVA was 1.049 ± 0.028 logMAR units, which improved on first postoperative day to 0.038 ± 0.01 logMAR units, at 1 wk 0.015 ± 0.01 logMAR units, at 1 month 0.006 ± 0.005 logMAR units and at 3 months postoperative period to 0.03 ± 0.003 logMAR units. There were two adverse events of difficult lenticule extraction with small ( Conclusion SMILE surgery is a flap-free refractive surgical technique. It reduces postoperative complications like dry eyes and flap-related complications. Hence, it may be recommended for all serving personnel after a thorough preoperative screening protocol.

Glaucoma is currently leading retinal disease, which damages the eye because of the Intraocular pressure (IOP) on the eye. If glaucoma is left untreated it will lead to vision loss by damaging the Optic Nerve Head (ONH). The progression of glaucoma is examined on the retinal part of the eye by an experienced ophthalmologist. This approach is very tedious, and it consumes more time to do it manually. Hence this issue is right problem that can be solved by automatically diagnosing glaucoma with the help of the deep learning approaches. Convolutional Neural Networks (CNN's) are appropriate to find the solution for this type of issue as they can extract various levels of data from the input image, and which encourages to differentiate among non-glaucomic and glaucomic images. This proposed paper introduces an efficient glaucoma master framework to segment the optic cup and optic disc to find the Cup-to-Disc-Ratio (CDR). Here the diagnosis of glaucoma is achieved by using deep learning with novel CNN. The proposed system uses two individual CNN architecture to segment the Optic Cup (OC) and Optic Disc (OD) to get more accurate result. This model is trained and tested on DRISHTI – GS database, which is publicly available and an accuracy of 98% for optic disc and 97% for optic cup segmentation is achieved.

A 52-year-old women underwent penetrating keratoplasty for total corneal opacity after healed microbial keratitis with an uneventful postoperative period until six months when she developed gross diminution of vision. During examination, she was detected to have a membrane in the anterior chamber, creating a double anterior chamber with a total cataract. The graft was clear, and sutures were intact. Anterior segment optical coherence tomography (OCT) showed the membrane in the anterior chamber crossing the graft host junction, suggesting this membrane to be retained host descemet membrane. This was confirmed on histopathological examination. Double rhexis (descemetorhexis and capsulorhexis) was performed with cataract removal and intraocular lens (IOL) implantation, and patient had good visual recovery postoperatively.

Background: 4-(N-(S-glutathionylacetyl)amino) phenylarsonous acid (GSAO) when conjugated with a bifunctional chelator 2,2'-(7-(1-carboxy-4-((2,5-dioxopyrrolidin-1-yl)oxy)-4- oxobutyl)-1,4,7-triazonane-1,4-diyl)diacetic acid (NODAGA) (hereafter referred to as Cell Death Indicator [CDI]), enters dead and dying cells and binds to 90kDa heat shock proteins (hsp90). Objective: This study assesses stability, biodistribution, imaging, and radiation dosimetry of [68Ga]- Ga-CDI for positron emission tomography (PET). Methods: Preparation of [68Ga]Ga-CDI was performed as previously described. Product stability and stability in plasma were assessed using high-performance liquid chromatography. Biodistribution and imaging were conducted in ten healthy male Lewis rats at 1 and 2 h following intravenous [68Ga]Ga-CDI injection. Human radiation dosimetry was estimated by extrapolation for a standard reference man and calculated with OLINDA/EXM 1.1. Results: Radiochemical purity of [68Ga]Ga-CDI averaged 93.8% in the product and 86.7% in plasma at 4 h post-synthesis. The highest concentration of [68Ga]Ga-CDI is observed in the kidneys; [68Ga]Ga-CDI is excreted in the urine, and mean retained activity was 32.4% and 21.4% at 1 and 2 h post-injection. Lower concentrations of [68Ga]Ga-CDI were present in the small bowel and liver. PET CT was concordant and additionally demonstrated focal growth plate uptake. The effective dose for [68Ga]Ga-CDI is 2.16E-02 mSv/MBq, and the urinary bladder wall received the highest dose (1.65E-02 mSv/Mbq). Conclusions: [68Ga] Ga-CDI is stable and has favourable biodistribution, imaging, and radiation dosimetry for imaging of dead and dying cells. Human studies are underway.

Purpose To report a case of symptomatic multiple retinal emboli during a carotid doppler ultrasonography (CDU) procedure. Material and methods Case report documented with clinical records, fundus photography (FP), optical coherence tomography angiography (OCT-A) of the retina and computed tomography angiography (CT-A) of the supra-aortic vessels. Results A 60-year-old male patient, presented to the emergency department with sudden vision loss in the left eye (LE) and pain in the left upper eyelid noticed during a CDU procedure. On the LE, the best corrected visual acuity (BCVA) was 20/200 and fundus observation revealed retinal arteriolar attenuation, retinal whitening with cherry point and multiple intra-arterial emboli in all arcades of the central retinal artery. CT-A of the supra-aortic vessels revealed an absence of filling throughout the cervical, petrous and cavernous segment of the left internal carotid artery, resuming only in the ophthalmic segment and an important stenosis of the left external carotid artery. He had no indication to be submitted to left carotid endarterectomy and began ocular massage and oral anticoagulant. 4 months later, ptosis was no longer present, BCVA improved to 20/20 with a residual scotoma and emboli disappeared on FP. Conclusion Embolic occlusion of retinal arteries may be an extremely rare but serious complication associated with CDU and patients and clinicians should be aware of it.

Purpose To report a novel case of dark without pressure in a patient with a choroidal osteoma. To our knowledge this association has not been previously reported. Methods Observational case report. Review of clinical examination and multi-modal imaging findings in a patient with a choroidal osteoma and dark without pressure. Results A 21-year-old African American female with no significant past medical history presented with a large, unilateral, juxtapapillary, subretinal, orange-colored, ovoid shaped lesion with macular involvement. An overlying area of mottled pigmentary changes, fibrosis, and atrophy were present. Adjacent to and surrounding the osteoma was an annular band of hyperpigmented mid-peripheral retina with a sharply demarcated scalloped border that abruptly changed to normal-appearing peripheral retina. Multi-modal imaging including wide-field fluorescein angiography, optical coherence tomography, and ophthalmic B-scan were performed. The funduscopic and imaging findings were consistent with a diagnosis of choroidal osteoma and dark without pressure. Conclusion The examination and imaging findings in this patient suggest a unique association between two relatively uncommon lesions, choroidal osteoma and dark without pressure. Though these two lesions may simply be coinciding in the same eye, there may be an association with space- occupying lesions causing a change in photoreceptor structure.

To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after intravitreal injection in a patient with a history of fellow-eye NAION.Observational case report.An 82-year-old woman with a history of fellow eye NAION developed an inferior visual field defect 1 day after an intravitreal aflibercept injection for neovascular age-related macular degeneration. She was found to have optic disk edema and an inferior altitudinal defect, consistent with NAION. The mechanism may have involved compromised perfusion to the optic nerve head related to elevated intraocular pressure or vasoconstriction because of antivascular endothelial growth factor activity.Nonarteritic anterior ischemic optic neuropathy is a rare complication of intravitreal injection and may be related to postinjection elevation in intraocular pressure. Monitoring of intraocular pressure postinjection with low-threshold for preinjection aqueous suppression or postinjection anterior chamber paracentesis for persistently elevated intraocular pressure is recommended in patients with a history of NAION.

Purpose To describe a case of traumatic soft contact lens dislocation into the vitreous space after a large-sized corneal perforation with a clout nail, causing aniridia but leaving the crystalline lens intact. Methods A case report of a Forty-four-year-old male patient with a corneal perforation. Results A patient presented with a traumatic corneal perforation after a large clout nail impacted on his left eye. Aniridia and inferior zonulolysis were seen, but the crystalline lens was perfectly clear. Since computed tomography imaging and B-scan ultrasonography showed no signs of intraocular foreign body, a vitrectomy was performed seven days after primary repair to allow for proper wound closure. During vitrectomy, a completely intact soft contact lens was found in the vitreous cavity. The soft contact lens was stained with MembraneBlue-Dual® (D.O.R.C., the Netherlands) to enhance visualization and ensure complete removal by the vitreous cutter. Conclusion MembraneBlue-Dual® can be used to facilitate complete removal of a clear and otherwise difficult to see corneal contact lens from the vitreous cavity. This case also demonstrates the importance of exploratory vitrectomy in all trauma cases with posterior segment involvement, even when imaging modalities show no signs of intraocular foreign bodies.

PURPOSE To examine the three-dimensional foveal cone photoreceptor structure in a patient who had suffered laser pointer induced retinal injury. METHODS Patient underwent standard fundus photography and clinical spectral domain optical coherence tomography (SD-OCT) imaging. High-resolution imaging was performed using an Adaptive Optics-OCT-Scanning Laser Ophthalmoscope (AO-OCT-SLO). RESULTS AO imaging revealed loss of inner and outer segments of cone photoreceptors while the anterior retinal layers appeared healthy. Analysis of cone topology showed an increase in Voronoi domain area and a less regular hexagonal packing structure closer to the lesion site. CONCLUSION Exposure to laser pointer radiation, however brief, can result in damage to the retina. Here, repeated imaging nine months later showed a decrease in the size of the lesions (ranging from 3.7 to 23.9%) compared to the first time point. However, the longer-term prognosis is likely permanent scarring.

Purpose To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of airway obstruction. A promising drug for RRP is the vascular endothelial growth factor (VEGF) binding antibody bevacizumab. This chemotherapeutic agent has an angiogenesis-inhibiting effect which inhibits tumor growth. The objective of this review was to investigate the efficacy of bevacizumab as treatment option for RRP, and to explore the difference of its effects between intralesional and systemic treatment. Methods A systematic search was conducted in Cochrane, PubMed, and Embase. Articles were included if bevacizumab treatment was given intralesionally and/or systemically. The methodological quality of the studies was assessed using the CAse REport (CARE) guidelines. Results Of 585 unique articles screened by title and abstract, 15 studies were included, yielding a total of 64 patients. In 95% of the patients treated with systemic bevacizumab, the post-bevacizumab surgical interval was considerably prolonged. More than half of them did not need any surgical intervention during mean follow-up of 21.6 months. Treatment with intralesional bevacizumab showed a lower efficacy: in 62% of the patients, the post-bevacizumab surgical interval (mean, 1.8 months follow-up) was extended when compared to the interval before the treatment. Conclusion Systemically and intralesionally administered bevacizumab are effective treatment options for severe RRP. A systemic administration might be the treatment of first choice. Further prospective research with long term follow-up is advocated to elucidate this important topic.

Yttrium aluminum garnet (YAG) with cerium admixture (Ce:YAG) was plasma sprayed using two different devices – gas-stabilized plasma (GSP) torch and water-stabilized plasma (WSP) torch. Coatings on stainless steel as well as self-standing plates were produced. Besides microstructure and crystallographic characterizations, dielectric tests were performed on these coatings. They included capacitance (i.e. relative permittivity), loss tangent and volume resistivity measurements. After spraying, the YAG crystal phase was preserved without any decomposition, but an amorphous fraction was detected in the as-sprayed coatings deposited by both processes. The dielectric behavior of the coatings was influenced by imperfections like splat boundaries, pores and thin cracks. The Ce:YAG samples were successfully plasma sprayed by both spray techniques. Selected aspects of wear were measured and compared with a single-crystal. The dielectric properties are comparable with the single-crystal and highly promising, particularly the loss tangent with values so low that they were not found in any other as-sprayed ceramic coating.

Clinical Question: Do sports-related mild traumatic brain injury in adolescents and young adults produce changes that can be identified with functional magnetic resonance imaging that are associated with memory impairment? Clinical Bottom Line: After sport-related mild traumatic brain injury, functional magnetic resonance imaging identified inconsistent structural changes (e.g., cortical thickness changes, brain activation patterns), and negative performance changes in memory function (e.g., lower neuropsychological scores) in adolescents and young adults 9 days to more than a year following injury.

Objective: Brief computer-delivered interventions (CDIs) reduce college student drinking and related problems but can be less efficacious and enduring than in-person interventions. The present study examined: (a) the utility of emailed personalized boosters after an evidence-based online CDI for alcohol (i.e., eCHECKUP TO GO), and (b) the added value of including protective behavioral strategies (PBS) in boosters containing personalized normative feedback (PNF) versus PNF alone. Method: 528 young adult (ages 18-24) college drinkers (71.6% female; 52.5% Black, 40.3% White) with a mean age of 19.9 years (SD = 1.65) were randomized to receive: CDI-only; CDI plus a PNF-only booster; or CDI plus a booster containing both PNF and PBS feedback. Booster emails were sent 2 weeks post-intervention. Online surveys completed pre-intervention and at 1 and 3 months assessed alcohol consumption, problems, descriptive normative perceptions, and PBS use. Results: The CDI led to significant reductions in alcohol consumption across all conditions, with no effect of boosters on drinking. Controlling for quantity, no reductions in problems were observed. Descriptive norms reduced significantly, with no condition differences. Only PBS use showed condition effects, such that the CDI-only and PNF-only booster groups reported reduced PBS use at 1 month, but the norms-plus-PBS booster group did not. Conclusions: The CDI was sufficient to change alcohol consumption and perceived norms without boosters, although the inclusion of boosters with PBS feedback may mitigate against PBS use reductions. Longer follow-ups may detect delayed booster benefits, or a larger dose through repeated exposure over time may be needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

We report the case of a 27-year-old monocular woman with a history of sickle cell disease who received intra-arterial tissue plasminogen activator (tPA) after presenting with acute painless vision loss secondary to incomplete central retinal artery occlusion presenting as paracentral acute middle maculopathy in her left eye.Ultrawidefield fundus photography, ultrawidefield fluorescein angiography, en face optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were obtained and reviewed, followed by cerebral angiography and infusion of intra-arterial tissue plasminogen activator.A patient with a history of sickle cell disease presented with a new onset of a dense central scotoma, and the visual acuity diminished to 20 of 200 from baseline 20 of 20 in her left eye. Fluorescein angiogram was nondiagnostic. Optical coherence tomography revealed perifoveal hyper-reflective bands in the inner nuclear layer in a pattern characteristic of paracentral acute middle maculopathy. The patient received intra-arterial tissue plasminogen activator through her left ophthalmic artery shortly after presentation, resulting in a gradual restoration of the visual acuity to 20 of 20 in the three months after the procedure.This is the first report describing the use of intra-arterial tissue plasminogen activator to treat incomplete central retinal artery occlusion presenting as a paracentral acute middle maculopathy lesion in a patient with sickle cell disease.

To present immunocytochemical characterization of a surgically excised central posterior lens capsule (PLC) that was transplanted to close a secondary refractory full-thickness macular hole (FTMH) as an epiretinal flap. For comparison, tissue of both an unaffected internal limiting membrane and unexposed PLC was processed.Clinical-pathological case report.We report of a 38-year-old patient who underwent pars plana vitrectomy (PPV) with PLC tissue for patching secondary FTMH and silicone oil tamponade after tractional retinal detachment. The PLC was peeled off during a vitrectomy 1 year after positioning. For immunocytochemistry, the removed PLC was prepared as flat mount and showed a positive immunofluorescence of the Müller cells marker glutamine synthetase and for vimentin. The microglia marker IBA and the neuroprotective neurotrophic marker glia cell-derived neurotrophic factor were tested positive too. There was no immunoreactivity of cellular retinaldehyde-binding protein and glial fibrillary acidic protein. In comparison, tissue of a control internal limiting membrane that was obtained during standard FTMH surgery showed few single cells that were likewise positive for glutamine synthetase, glia cell-derived neurotrophic factor, and IBA. The control specimen of unexposed PLC showed rarely cells that were without positive immunostaining for the tested markers.Our analysis revealed positive immunoreactivity of macroglia and microglia cells of the PLC tissue that was used to patch a refractory FTMH. Similar immunostaining of PLC material and internal limiting membrane suggests the PLC transplantation as an alternative treatment option for refractory FTMH.

Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix–Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix–Hallpike maneuver again. If the repeated Dix–Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix–Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

SummaryAfrican populations are the most diverse in the world yet are sorely underrepresented in medical genetics research. Here, we examine the structure of African populations using genetic and comprehensive multigenerational ethnolinguistic data from the Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) consisting of 900 individuals from Ethiopia, Kenya, South Africa, and Uganda. We find that self-reported language classifications meaningfully tag underlying genetic variation that would be missed with consideration of geography alone, highlighting the importance of culture in shaping genetic diversity. Leveraging our uniquely rich multi-generational ethnolinguistic metadata, we track language transmission through the pedigree, observing the disappearance of several languages in our cohort as well as notable shifts in frequency over three generations. We find suggestive evidence for the rate of language transmission in matrilineal groups having been higher than that for patrilineal ones. We highlight both the diversity of variation within the African continent, as well as how within-Africa variation can be informative for broader variant interpretation; many variants appearing rare elsewhere are common in parts of Africa. The work presented here improves the understanding of the spectrum of genetic variation in African populations and highlights the enormous and complex genetic and ethnolinguistic diversity within Africa.

The parents of a 7-year-old boy reported to the ophthalmology clinic with complaints of a mass in both eyes of the child, noticed since birth, which had gradually increased in size. Antenatal, birth and family history were insignificant. On ocular evaluation, the best uncorrected visual acuity in

A 55-year-old patient presented with exposure of both the haptics beyond the conjunctiva of the scleral fixated multipiece intraocular lens (IOL). Two diagonally opposite scleral pockets were created, and the exposed haptics was redirected and repositioned aseptically into these pockets to facilitate intrascleral fixation. Herein, we report a simple rescue method for management of exposed haptic after Yamane technique of scleral fixated IOL.

We describe a case with complex Descemet membrane detachment (DMD) which persisted despite initial two failed surgical attempts to appose the ocular tissues. However, over time, tissue alignment was obtained spontaneously. A 60-year-old woman, operated trabeculectomy, had a total DMD intraoperatively during a complicated cataract surgery. Initial attempt to DM repositioning with intracameral air injection failed. Anterior Segment Optical Coherence Tomography (ASOCT) showed detachment of both DM and pre-Descemet’s layer (PDL). After consultation with a corneal surgeon, patient was again attempted for Intra-operative Optical Coherence Tomography (iOCT)-guided settlement of DMD with intracameral air which again failed. So, the patient was registered for lamellar corneal transplant, but at 3 months follow-up, DM had spontaneously attached, confirmed on ASOCT. This case shows for the first time that even complex DMDs involving PDL, can spontaneously appose despite failed surgical interventions.

The purpose of this report is to highlight the early clinical signs and management of ocular surface neoplasia following penetrating keratoplasty in xeroderma pigmentosa. A 14-year-old girl reported increased conjunctival hyperemia, tearing, photophobia in the right eye at 6 months after penetrating keratoplasty that worsened rapidly over the subsequent 2 weeks. Slit lamp examination showed increased vascularity, epithelial haze and raised whitish lesions at the graft–host junction. Alcohol keratoepithelectomy was performed for confirming the diagnosis. Histology of the sample revealed severe dysplasia. The lesion resolved after surface plaque brachytherapy. The graft clarity was restored and maintained until the last follow-up of 15 months following brachytherapy. Exacerbated symptoms and clinical signs of increased vascularisation and epithelial lesions should arouse the suspicion of ocular surface neoplasia in grafted eyes. Early diagnosis and management can salvage the graft clarity.

We describe a case of spontaneous conversion from type 2 macular hole (MH) closure to type 1 closure following MH surgery in high myopia. A 42-year-old male patient with myopia was diagnosed with full-thickness MH and localised neurosensory detachment. His best-corrected vision in the right eye was 20/120, N18. He underwent pars plana vitrectomy with internal limiting membrane peeling and silicone oil tamponade. Nine days after surgery, optical coherence tomography (OCT) showed type 2 MH closure and presence of epiretinal tissue. At 6 weeks of follow-up, there was spontaneous conversion from type 2 to type 1 closure of MH with a thin epimacular tissue bridging across the fovea and vision improving to 20/80. At 3 months after surgery, silicon oil removal was done. OCT showed a closed type 1 MH and visual acuity of 20/80 at the final visit. Early spontaneous conversion in closure can occur over time, leading to better anatomical and visual outcomes.

Acrodermatitis enteropathica is a rare autosomal recessive metabolic disease with occasional ocular manifestations. It was first described by Brandt in 1936 and named so by Danbolt.[1][1] It occurs worldwide with an estimated incidence of 1 per 500 000 children with no apparent predilection for race

A 59-year-old man who has sex with men presented to the emergency department with a 1-week history of bilateral central vision loss. Visual acuity (VA) was 6/60 and 6/18 in the left and right eye, respectively. Slit-lamp examination revealed mild, bilateral anterior and intermediate uveitis, optic

A 78-year-old man presented with moderate lens opacity and end-stage dry age-related macular degeneration (AMD) with visual acuity of logMAR 0.7 and 1.6 for right and left eyes, respectively. He was tested with an external telescope simulator device, showing an improvement of 20 letters and 2

Morning glory disc (MGD) is known to develop secondary maculopathy and vision loss. We followed a 7-year-old girl with MGD in right eye from 2010 to 2021. Her best-corrected Snellen visual acuity (BCVA) was 20/20 in both eyes till 2017. She presented with reduced vision in right eye with BCVA of 20/80 in 2018. Optical Coherence Tomography (OCT) revealed maculopathy related to MGD in right eye and arcuate Vitelliform neurosensory detachment (V-NSD) temporal to fovea. She underwent 25G vitrectomy with internal limiting membrane peeling. Resolution of retinoschisis and V-NSD was analysed by OCT and fundus autofluorescence (FAF) postoperatively. Arcuate V-NSD was hyperfluorescent on FAF and concentric to optic disc. It resolved slowly with BCVA improving to 20/20 at 18 and 30 months postoperatively. We report excellent outcome following early vitrectomy for MGD-related maculopathy and recommend serial follow-up and considering early vitrectomy whenever traction and BCVA worsens. We also describe arcuate V-NSD with MGD.

A 35-year-old woman presented with acute-onset painless diminution of vision for both distance and near in her left eye for 1 month. She is a known case of hypothyroidism controlled on oral thyroxine. The best-corrected visual acuity (BCVA) at presentation was 20/20 (spherical equivalent of −0.5 D

Objective: Autism spectrum disorder (ASD) in very young children with significant cognitive impairment is difficult to diagnose, depriving them of the earliest opportunities for autism-specific intervention. This study delineated specific symptoms in this group, compared to symptoms in children with Global Developmental Delay (GDD) and in ASD with milder developmental delays.Method: Autism Diagnostic Observation Schedule, 2nd Edition, Toddler Module revealed symptoms in three groups of toddlers, with mean ages of 17-20 months: (1) ASD and cognitive/language functioning below the 12-month level (ASD-MA < 12 mos; n = 28), (2) GDD (n = 27), and (3) ASD and cognitive/language functioning at or above the 12-month level (ASD-MA ≥ 12 mos; n = 29). Logistic regression models were fit to control for developmental level. Results: Items in all domains (social interaction, communication, repetitive movements) discriminated ASD-MA < 12 mos from GDD. The two ASD groups, matched for age but differing on developmental level, showed strikingly similar ASD symptomatology. Conclusion: ADOS-2 symptoms differentiated ASD-MA < 12 mos from GDD, after controlling for cognitive impairment. Symptoms in the two ASD groups were minimally related to developmental level. The ADOS-2 Toddler Module successfully captured ASD symptomatology even in children whose developmental level was below the recommended ADOS-2 cutoff of 12 months, which may increase their access to early ASD-specific intervention.

A 62-year-old woman presented with non-specific abdominal pain, elevated alkaline phosphatase levels and bilateral sequential visual loss. Visual acuity was counting fingers in right eye (RE) and 20/400 in left eye (LE). She was noted to have optic nerve pallor in RE and mildly elevated optic disc with signs of ocular inflammation in LE. After 2 weeks, vision deteriorated to light perception bilaterally with now extensive vitreal inflammation present in both eyes. Positive rapid plasma reagen and Treponema pallidum’s antibody tites confirmed syphilis infection. Unfortunately, as the diagnosis was delayed by many months, her visual acuity remained poor (hand motions in RE and 20/50 in LE) despite treatment with intravenous penicillin. This case reminds us of the re-emergence of this ‘great masquerader’ and highlights the importance of maintaining high suspicion for syphilis in patients with unexplained visual loss and systemic symptoms, even in older adults without identifiable risk factors.

A 54-years-old man, a known case of oculocutaneous albinism (OCA) type 1, presented to us with gradual-onset diminution of vision both eyes (OU) for 5 years. The patient had no prior history of ocular trauma. There was no history of any systemic illness, especially collagen vascular disorder. The

Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.

This case report demostrates an unusual occurence of orbital metastasis along with liver metastasis 5 years following enucleation for ciliochoroidal melanoma with no extraocular extension. It exemplifies that metastasis of the tumour can occur in the ipsilateral orbit after enucleation. Importance of close clinical follow-up after enucleation for choroidal melanoma, careful socket examination, and regular systemic metastatic workup is demonstrated. To the best of our knowledge, this is the first case report of uveal melanoma with ipsilateral orbital metastasis.

A 66-year-old man, diabetic, hypertensive and dyslipidaemia, presented with gradual onset of blurring of vision in both eyes (OU) since past 3 months. The best corrected visual acuity (BCVA) at presentation was 20/200 in right eye (OD) and 20/160 in left eye (OS). While, the anterior segment

Observers can make independent aesthetic judgements of at least two images presented briefly and simultaneously. However, it is unknown whether this is the case for two stimuli of different sensory modalities. Here, we investigated whether individuals can judge auditory and visual stimuli independently, and whether stimulus duration influences such judgments. Participants (N=120, across two experiments and a replication) saw images of paintings and heard excerpts of music, presented simultaneously for 2 s (Experiment 1) or 5 s (Experiment 2). After the stimuli were presented, participants rated how much pleasure they felt from the stimulus (music, image, or combined pleasure of both, depending on which was cued) on a 9-point scale. Finally, participants completed a baseline rating block where they rated each stimulus in isolation. We used the baseline ratings to predict ratings of audio-visual presentations. Across both experiments, the root-mean-square errors (RMSEs) obtained from leave-one-out-cross-validation analyses showed that people’s ratings of music and images were unbiased by the simultaneously presented other stimulus, and ratings of both were best described as the arithmetic mean of the ratings from the individual presentations at the end of the experiment. This pattern of results replicates previous findings on simultaneously presented images, indicating that participants can ignore the pleasure of an irrelevant stimulus regardless of the sensory modality and duration of stimulus presentation.

Cerebrovascular reactivity (CVR) to a physiological stimulus is a commonly used surrogate of cerebrovascular health. Cross-sectional studies using blood oxygen level dependent (BOLD) neuroimaging demonstrated lower BOLD-CVR to hypercapnia among adults with high compared with lower cardiorespiratory fitness (CRF) in contrast to transcranial Doppler studies. However, whether BOLD-CVR changes following chronic aerobic exercise in older, cognitively intact adults is unclear. This study evaluated relations between BOLD-CVR with CRF (V̇o(2peak)) using a cross-sectional and interventional study design. We hypothesized that 1) greater CRF would be associated with lower BOLD-CVR in older adults (n = 114; 65 ± 6.5 yr) with a wide range of CRF and 2) BOLD-CVR would be attenuated after exercise training in a subset (n = 33) randomized to 3-mo of moderate- or light-intensity cycling. CVR was quantified as the change in the BOLD signal in response to acute hypercapnia using a blocked breath-hold design from a region-of-interest analysis for cortical networks. In the cross-sectional analysis, there was a quadratic relation between V̇o(2peak) (P = 0.03), but not linear (P = 0.87) and cortical BOLD-CVR. BOLD-CVR increased until a V̇o(2peak) ∼28 mL/kg/min after which BOLD-CVR declined. The nonlinear trend was consistent across all networks (P = 0.04–0.07). In the intervention, both the active and light-intensity exercise groups improved CRF similarly (6% vs. 10.8%, P = 0.28). The percent change in CRF was positively associated with change in BOLD-CVR in the default mode network only. These data suggest that BOLD-CVR is nonlinearly associated with CRF and that in lower-fit adults default mode network may be most sensitive to CRF-related increases in BOLD-CVR. NEW & NOTEWORTHY Earlier studies evaluating associations between cardiorespiratory fitness (CRF) and cerebrovascular reactivity (CVR) have demonstrated conflicting findings dependent on imaging modality or subject characteristics in individuals across a narrow range of CRF. This study demonstrates that CRF is nonlinearly associated with CVR measured by blood oxygen level dependent (BOLD) fMRI in a large sample of middle-aged and older adults across a wide range of CRF, suggesting that conflicting prior findings are related to the range of CRFs studied.