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Purpose: To compare 3-year iontophoretic transepithelial corneal cross-linking (I-ON CXL) outcomes with epithelium-off collagen cross-linking (epi-off CXL) in pediatric patients., Methods: Forty eyes of 28 consecutive pediatric patients [mean age 14.3 ± 2.5 (SD) years; range, 9-18 years] with keratoconus were evaluated. Twenty eyes of 15 patients underwent I-ON and 20 eyes of 13 patients epi-off CXL. Mean corrected distance visual acuity, spherical equivalent, maximum keratometry (Kmax), posterior elevation of the thinnest point, and thickness of the thinnest point were evaluated. The Student t test was used to compare baseline and postoperative data. Keratoconus progression as a function of preoperative Kmax and cone location was evaluated., Results: At 36 months, corrected distance visual acuity statistically improved (from 0.18 ± 0.1 to 0.10 ± 0.1 logarithm of the minimum angle of resolution) in epi-off CXL, whereas spherical equivalent and posterior elevation of the thinnest point did not significantly change. Mean Kmax increased from the baseline +0.8 diopters (D) in epi-off and +2.9D in I-ON. In both groups, the thinnest point decreased. Keratoconus progression, defined by an increase of Kmax reading of the anterior corneal surface of at least 1.00D, occurred in 25% of epi-off and 50% of I-ON CXL over the 3-year period. Kmax value in I-ON, and cone location in both groups, seemed to be factors influencing the disease progression., Conclusions: In pediatric patients, 3 years after treatment, epi-off CXL halted keratoconus progression in 75% of eyes, whereas I-ON CXL seemed to slow down keratoconus progression in 50% of eyes, mainly in those with highest Kmax and paracentral cone.

Purpose: The purpose was to evaluate indications and clinical outcomes in paediatric corneal keratoplasty., Methods: Fifty-four eyes of 43 patients who underwent corneal keratoplasty from the 1 st of January 2010 through the 31 st of December 2013 at the Bambino Gesù Children's Hospital in Rome, Italy, were retrospectively evaluated. To assess the effect of age on graft failure rate, the recipient age was considered as a dichotomous variable (≤5 or >5 years) and a 2X2 table was developed, using the chi-square test for testing the statistical significance. Furthermore, two separate subgroup analyses were conducted on patients of ≤5 years and those of >5 years, to evaluate the effect of penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) on the graft failure rate. The level of statistical significance was set at p < 0.05 RESULTS: Mean recipient age was 8.9 ± 5.7 [SD] years. Mean follow-up time was 22.8 months. Main preoperative diagnoses were keratoconus (37 %) and congenital glaucoma (20 %). Patients ≤5 years showed a higher percentage of graft failure (p = 0.0008). PK and DALK did not show statistically significant differences regarding the graft failure in both subgroups (p = 0.15 for ≤5 years group and p = 0.27 for >5 years group, respectively). However, across groups DALK provided a lower rate of graft failure., Conclusions: Our findings suggest that children older than 5 years show a significantly better graft outcome and that DALK seems to offer greatest benefits in terms of failure risk in paediatric patients.

Purpose: To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK)., Methods: Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 µm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 µm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble., Results: The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK., Conclusions: Preliminary results suggest that the BBFF technique could help in standardizing the big-bubble technique in DALK, reducing the "learning curve" for surgeons who approach this technique and the risks of intraoperative complications., (Copyright 2015, SLACK Incorporated.)

Purpose: To report the results 15 months after transepithelial corneal cross-linking by iontophoresis of riboflavin performed in pediatric patients affected by keratoconus., Methods: Fourteen eyes of 14 pediatric patients [mean age 13 ± 2.4 (SD) years; range, 10-18 years] were treated. Riboflavin solution was administered by iontophoresis for 5 minutes, and then UVA irradiation (10 mW/cm) was performed for 9 minutes. The corrected distance visual acuity measured as decimal number, spherical equivalent, refractive astigmatism, simulated K, corneal coma, spherical aberration, and high-order aberrations for 5.0-mm pupil and the thinnest point were measured preoperatively and 3, 6, 12, and 15 months postoperatively. The endothelial cell density was evaluated. The paired Student t test was used to compare data during the follow-up., Results: Fifteen months after the procedure, the corrected distance visual acuity improved from 0.7 ± 1.7 to 0.8 ± 1.8 (P = 0.005). Spherical equivalent and refractive astigmatism as well as topographic and aberrometric data did not show significant changes. Also, the mean thinnest point and the endothelial cell density remained unchanged. The optical coherence tomography showed a nonhomogeneous but deep hyperreflective band with a fading effect extending through the anterior 180 μm of the cornea. No side effects were recorded., Conclusions: Transepithelial collagen cross-linking by iontophoresis, unlike other transepithelial techniques, seems to halt pediatric keratoconus progression over 15 months. However, we did not record significant improvement in higher-order aberrations and topographic indices.

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Gut microbiota regulate multiple aspects of host health, including metabolism and the development of the immune system. However, we still know relatively little about how the gut microbiota influences host responses to parasitism in wild organisms, particularly whether host-microbiota interactions contribute to variation in parasitism across host species. The goal of this study was to determine the role of gut microbiota in shaping how birds respond to nest parasites and investigate whether this relationship varies between host species. Both eastern bluebirds (Sialia sialis) and tree swallows (Tachycineta bicolor) are parasitized by blow flies (Protocalliphora sialia), for which larval flies feed on nestlings' blood. We experimentally manipulated the gut microbiota of nestling bluebirds and tree swallows by dosing nestlings with an oral antibiotic or sterile water as a control. We then quantified nestling physiology (haemoglobin, glucose, parasite-specific IgY antibody levels), body morphometrics, and survival until fledging, as well as blow fly abundance and size. An experimental disruption of nestling gut microbiota increased parasite abundance in tree swallows, but decreased parasite abundance in bluebirds, which suggests that the disruption has opposing effects on resistance across host species. Furthermore, experimental treatment delayed parasite development and had variable effects on nestling body morphometrics and physiology across the two host species. Together, these results suggest that gut microbiota contribute to host differences in resistance to blow flies and can influence host-parasite interactions., (© 2024 The Author(s). Molecular Ecology published by John Wiley & Sons Ltd.)

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes. [ABSTRACT FROM AUTHOR]

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Purpose: To evaluate the clinical characteristics of pediatric patients with progression of keratoconus after accelerated iontophoresis-assisted epithelium-on corneal cross-linking (I-ON CXL) and to assess the efficacy and safety of re-treatment using accelerated epithelium-off CXL (epi-OFF CXL). Methods: Sixteen eyes of 16 patients (mean age: 14.6 ± 2.5 years) with keratoconus underwent I-ON CXL. The main outcome measures were uncorrected distance visual acuity, corrected distance visual acuity, maximum keratometry index (Kmax), minimum corneal thickness, elevation front and elevation back measured at the thinnest point, total higher order aberrations root main square (HOA RMS), coma RMS, and spherical aberration. An increment of Kmax greater than 1.00 diopter (D) and a decrease of greater than 20 µm in pachymetry were considered to determine the progression of keratoconus. Patients with progression of keratoconus after I-ON CXL were re-treated using an epi-OFF CXL protocol. Results: Two years after I-ON CXL, 12 patients showed progression of keratoconus, whereas 4 patients were stable. There was significant worsening of Kmax (P =.04) and steepest keratometric reading (P =.01). Furthermore, a significant correlation was documented between progression of keratoconus and age (P =.02). These patients were re-treated using an epi-OFF protocol and after 2 years all patients were stable, and a statistically significant reduction of the mean Kmax (P =.007), HOA RMS (P =.05), and coma RMS (P = 05) was observed. Conclusions: I-ON CXL was ineffective in the treatment of pediatric keratoconus in younger children, whereas it had an efficacy of 2 years in older children. Re-treatment using epi-OFF CXL proved effective to halt progression of keratoconus after I-ON CXL failure. [J Pediatr Ophthalmol Strabismus. 2024;61(1):44–50.] [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of repeated corneal collagen crosslinking assisted by transepithelial double-cycle iontophoresis (DI-CXL) in the management of keratoconus progression after primary CXL., Methods: A retrospective analysis was conducted in the patients who underwent repeated CXL between 2016 and 2018. These patients were treated with DI-CXL if keratoconus progression was confirmed after primary CXL. Scoring of ocular pain and corneal epithelial damage, visual acuity, corneal tomography, in vivo corneal confocal microscopy (IVCM) was performed before and at 3, 6, 12, and 24 months after DI-CXL., Results: Overall, 21 eyes of 12 patients (mean age 17.3 ± 1.9 years) were included in this study. Before DI-CXL, an average increase of 4.26 D in K max was detected in these patients with a mean follow-up interval of (23.0 ± 13.7) months. After DI-CXL, corneal epithelial damage rapidly recovered within days. Visual acuity remained unchanged with follow-up of 24 months. When compared to baseline, significant decreases were observed in K max (at 3 months) and K2 (at 3 and 6 months) after DI-CXL. Corneal thickness of thinnest point significantly decreased at 3 months postoperatively. When compared to baseline, no significant differences were found in any of the refractive or tomographic parameters at 12 and 24 months. IVCM revealed trabecular patterned hyperdense tissues after DI-CXL in the anterior stroma at the depth of 200 μm or more. No corneal infiltration or persistent epithelial defect was recorded after DI-CXL., Conclusion: DI-CXL is safe and effective as a good alternative in stabilizing keratoconus progression after primary CXL., (© 2021. The Author(s).)

Purpose: This study aimed to identify preoperative factors that predict visual acuity and Kmax 3 years after corneal cross-linking (CXL) in patients with keratoconus (KC), and to develop a prediction model., Methods: We enrolled 68 patients with KC and followed up on 100 eyes that received CXL for at least 3 years. Preoperative data, including age, UDVA, CDVA, cylinder, SE, and the parameters of tomography including Kmax were collected as predictors. The primary outcomes were changes in CDVA (Delta CDVA) and Kmax (Delta Kmax) postoperatively. Univariate and multivariate linear regression were used to identify the correlation between the primary outcomes and predictors and establish prediction models., Results: Both CDVA and Kmax remained stable from baseline to 3 years after CXL: from 0.25 ± 0.18 to 0.22 ± 0.20 (P = 0.308) and from 58.70 ± 9.52 D to 57.02 ± 8.83 D (P = 0.187), respectively. Multivariate analysis showed that worse preoperative CDVA (ß coefficient - 0.668, P < 0.001) and lower preoperative Kmean (ß coefficient 0.018,P < 0.001) were associated with greater improvement in CDVA after CXL. A smaller preoperative eccentricity (ß coefficient 8.896, P = 0.01) and a higher preoperative Kmean (ß coefficient - 1.264, P < 0.001) predicted a more flattening of postoperative Kmax. The prediction model for CDVA (R 2  = 0.43) and Kmax (R 2  = 0.37) could accurately estimate treatment outcomes., Conclusions: CXL is highly effective in halting or preventing further progression of KC. The preoperative factors CDVA and Kmean were able to predict visual acuity changes 3 years after CXL. And preoperative eccentricity and Kmean could predict Kmax changes 3 years after CXL., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The antioxidant defense system of the medicinal plant Raphanus sativus L. tuber root in terms of certain antioxidant enzymes (ascorbat peroxidase, glutathion reductase, catalase, superoxide dismutase) and lipid peroxidation against gray mold disease caused by Botrytis cinerea fungus on Vicia faba L. (bean) leaves was analyzed spectrophotometrically. V. faba plants were grown from seed under controlled conditions. A spore suspension of 105 spores/ml of B. cinerea was prepared. The leaves of V. faba were treated with 1-) only distilled water, 2-)only DMSO, 3-) only B. cinerea (positive control), 4-) only extract applications (distilled water, ethanol and methanol extract),5-) B. cinerea treatment after extract applications(extract:fungus). The leaves of V. faba were harvested 24 and 48 hours after the applications. Analyzes of the supernatants obtained from the extracts were performed spectrophotometrically. It has been revealed that the activity of all investigated enzymes generally increased in the extract:fungus application groups compared to the fungus application group. It was determined that the application of fungus alone caused an increase in the activity of enzymes compared to application groups other than the extract:fungus application groups. It was observed that there was an increase in lipid peroxidation (MDA) only in the fungus application group compared to all extract:fungus application groups except 10mg/ml distilled water extract:fungus treatment. As a result of the research, it was determined that the extract:fungus applications generally increased the antioxidant enzyme activity levels and decreased the MDA content when compared to the negative control and positive control groups. In extract:fungus applications, enzyme activities were obtained from 10mg/ml distilled water extract:fungus, 10mg/ml EtOH extract:fungus, 10mg/ml MeOH extract:fungus applications. From this point of view, it can be stated that R. sativus distilled water, ethanol and methanol extracts generally give an increased antioxidant defense response in V. faba leaves compared to B. cinerea inoculation alone. [ABSTRACT FROM AUTHOR]

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Climate change predicts the increased frequency, duration, and intensity of inclement weather periods such as unseasonably low temperatures (i.e., cold snaps) and prolonged precipitation. Many migratory species have advanced the phenology of important life history stages and, as a result, are likely to be exposed to these periods of inclement spring weather more often, therefore risking reduced fitness and population growth. For declining avian species, including aerial insectivores, anthropogenic landscape changes such as agricultural intensification are another driver of population declines. These landscape changes may affect the foraging ability of food provisioning parents and reduce the survival of nestlings exposed to inclement weather through, for example, pesticide exposure impairing thermoregulation and punctual anorexia. Breeding in agro‐intensive landscapes may therefore exacerbate the negative effects of inclement weather under climate change. We observed that a significant reduction in the availability of insect prey occurred when daily maximum temperatures fell below 18.3°C, and thereby defined any day when the maximum temperature fell below this value as a day witnessing a cold snap. We then combined daily information on the occurrence of cold snaps and measures of precipitation to assess their impact on the fledging success of Tree Swallows (Tachycineta bicolor) occupying a nest box system placed across a gradient of agricultural intensification. Estimated fledging success of this declining aerial insectivore was 36.2% lower for broods experiencing 4 cold‐snap days during the 12 days post‐hatching period versus broods experiencing none, and this relationship was worsened when facing more precipitation. We further found that the overall negative effects of a brood experiencing periods of inclement weather was exacerbated in more agro‐intensive landscapes. Our results indicate that two of the primary hypothesized drivers of many avian population declines may interact to further increase the rate of declines in certain landscape contexts. [ABSTRACT FROM AUTHOR]

Background: Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for rehabilitation. However, new treatments may halt the disease and prevent worse outcomes that require penetrating keratoplasty and its associated morbidity and high cost, irreversible loss of vision, and amblyopia. Few systematic reviews focus on keratoconus-and even fewer, on pediatric KC., Methods: Here, we report a systematic scoping review of pediatric KC epidemiology and discuss the studies reporting data on pediatric KC. We used PRISMA-ScR methodology and checklists in the elaboration of the manuscript. The inclusion criteria were: English language; publication between August 7, 1998, and August 7, 2019 (20 years); theme of the study pediatric KC epidemiology. The search strategy: searches of the PubMed-MEDLINE database and Cochrane Database of Systematic Reviews, using eight combinations of the following MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology., Results: We charted and reviewed the selected articles. Initial searches included 1802 records; after the exclusion of article duplicates, we screened 777 records, read 97 articles in full text, and included 76 articles in this review., Conclusions: Recent epidemiological studies with better methodologies demonstrated increased prevalence rates in comparison to the older literature. This effect may be due to better diagnostic methods and better sample selection than those in historical studies. Diagnosis remains a major challenge as the early disease is usually asymptomatic. Economic and social aspects of pediatric KC remain understudied in the pediatric literature. Global, inclusive, and proactive screening studies in schools are imperative to better understand the great impact of this disease in the young., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To analyse long-term outcomes of standard cross-linking (SCXL), accelerated cross-linking (ACXL) and transepithelial cross-linking (TCXL) in the treatment of progressive paediatric keratoconus regarding stability, safety and efficacy., Methods: This prospective multicentre randomized controlled trial included 97 eyes of 97 paediatric patients with stages I-III ABCD keratoconus grading system, who were randomized into three groups; SCXL group (control group, n = 32; 3 mW/cm 2  × 30 min/5.4 J/cm 2 ), ACXL (n = 33; 18 mW/cm 2  × 5 min/5.4 J/cm 2 ) and TCXL (n = 32; 18 mW/cm 2  × 5 min/5.4 J/cm 2 ). Subjective refraction, uncorrected and corrected visual acuity, keratometry and pachymetry measurements using corneal topography were recorded preoperatively and 1, 2 and 3 years postoperatively., Results: SCXL group exhibited significant successive improvements in the mean visual, refractive and keratometric parameters throughout the entire postoperative 3 years while ACXL group exhibited significant improvements in visual and keratometric parameters in the first postoperative year that remained stable in second and third postoperative years. TCXL group exhibited significant progressive deterioration in all mean parameters compared to SCXL and ACXL (p < 0.0001). Both SCXL and ACXL revealed final 100% success rate with good stability while TCXL revealed final 22% failure rate with keratoconus progression (p < 0.0001)., Conclusion: SCXL and ACXL were comparable in halting keratoconus progression and achieved good stability and safety; however, SCXL was more efficient than ACXL as it yielded greater significant postoperative mean visual, refractive and keratometric improvements achieving smoother corneal remodelling. Both SCXL and ACXL were much superior to TCXL. SCXL is the best CXL treatment option for paediatric keratoconus while ACXL is a good and effective alternative., (© 2023 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The historical rise of intensive agricultural practices is hypothesized to be related to declines of grassland and aerial insectivorous birds. Drivers of declines may also influence the overall abundance and spatial distribution of insects within agricultural landscapes. Subsequently, the food provisioning rate of birds breeding within more agro‐intensive landscapes may be impacted. Lower provisioning rates in agro‐intensive landscapes may lead not only to reduced growth rate, body condition, or fledging success of nestlings but also to diminished body condition of food provisioning adults. Results from a previous study supported this hypothesis as the fledging success and proxies of nestling body condition were lowest for an aerial insectivore breeding in more agro‐intensive landscapes. Of the multiple hypotheses put forward to explain these correlations, one mechanism may act through variation in food provisioning rates. In this study, we expounded on this hypothesis using data derived from the aforementioned study system and assessed if provisioning rates to nestlings and food provisioning behavior of adults varied across a gradient of agricultural intensification in a declining aerial insectivore, the Tree Swallow (Tachycineta bicolor). We found that the hourly provisioning rate was lower in agro‐intensive landscapes, and yet travel distances were longest within less agro‐intensive landscapes. Our results highlight that, in order to maximize long‐term average gain rates, Tree Swallows breeding within agro‐intensive landscapes must forage with greater intensity, perhaps at a cost to themselves, or else costs will transfer to growing broods. Our work provides further evidence that agricultural intensification on the breeding grounds can contribute to the declines of aerial insectivores in part through a trophic pathway. [ABSTRACT FROM AUTHOR]

Aerial insectivores show worldwide population declines coinciding with shifts in agricultural practices. Increasing reliance on certain agricultural practices is thought to have led to an overall reduction in insect abundance that negatively affects aerial insectivore fitness. The relationship between prey availability and the fitness of insectivores may thus vary with the extent of agricultural intensity. It is therefore imperative to quantify the strength and direction of these associations. Here we used data from an 11‐year study monitoring the breeding of Tree Swallows (Tachycineta bicolor) and the availability of Diptera (their main prey) across a gradient of agricultural intensification in southern Québec, Canada. This gradient was characterized by a shift in agricultural production, whereby landscapes composed of forage and pastures represented less agro‐intensive landscapes and those focusing on large‐scale arable row crop monocultures, such as corn (Zea mays) or soybean (Glycine max) that are innately associated with significant mechanization and agro‐chemical inputs, represented more agro‐intensive landscapes. We evaluated the landscape characteristics affecting prey availability and how this relationship influences the fledging success, duration of the nestling period, fledgling body mass, and wing length as these variables are known to influence the population dynamics of this species. Diptera availability was greatest within predominately forested landscapes, while within landscapes dominated by agriculture, it was marginally greater in less agro‐intensive areas. Of the measured fitness and body condition proxies, both fledging success and nestling body mass were positively related to prey availability. The impact of prey availability varied across the agricultural gradient as fledging success improved with increasing prey levels within forage landscapes yet declined in more agro‐intensive landscapes. Finally, after accounting for prey availability, fledging success was lowest, nestling periods were the longest, and wing length of fledglings were shortest within more agro‐intensive landscapes. Our results highlight the interacting roles that aerial insect availability and agricultural intensification have on the fitness of aerial insectivores, and by extension how food availability may interact with other aspects of breeding habitats to influence the population dynamics of predators. [ABSTRACT FROM AUTHOR]

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Purpose: To report eye bank records for pediatric keratoplasty in Iran between 2006 and 2019. Methods: In a retrospective study, all electronic records of the Central Eye Bank of Iran for pediatric keratoplasty between April 2006 and March 2019 were analyzed in terms of indications for keratoplasty, surgical techniques, their corresponding trends, and post-transplantation graft clarity. Results: Our database included 2178 eyes from 2050 pediatric cases. The leading indications for keratoplasty included acquired nontraumatic diseases (75.8%), congenital abnormalities (12.7%), corneal regraft (8.3%), and acquired traumatic diseases (3.2%). Keratoconus was the most common acquired nontraumatic cause (58%) and more common in the age group >12 years than those ≤12 years (P < 0.001). Congenital corneal abnormalities and regrafts were more common in the age group ≤12 years (both P < 0.001). The most common surgical technique was penetrating keratoplasty (PKP, 90.9%) followed by deep anterior lamellar keratoplasty (DALK, 7.3%), Descemet stripping automated endothelial keratoplasty (DSAEK, 1.1%), anterior lamellar keratoplasty (0.5%), and keratolimbal allograft transplantation (0.2%). DSAEK was more common in the age group ≤12 years (P = 0.002), which, unlike PKP and DALK, showed a significant ascending trend over the 14-year period (P = 0.018). Posttransplantation graft clarity was 96.8%. Conclusion: Keratoconus was the leading indication for pediatric keratoplasty in Iran. Although PKP was the predominant keratoplasty procedure for the treatment of pediatric corneal disorders, it showed a significant descending trend over the 14 years. [ABSTRACT FROM AUTHOR]

Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an "epithelium-on" method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the changes in posterior corneal elevations (PCEs) in the circular areas and local points after corneal collagen cross-linking (CXL) for the treatment of keratoconus. Methods: Method 1 divided the cornea into 0–2, 2–4, 4–6, and 6–8 mm regions centering on the apex. Method 2 obtained other 34 PCE values of local point that were identified on the nasal, supra-nasal, sub-nasal, superior, inferior, temporal, supra-temporal, and sub-temporal sides of the circle with diameters of 2, 4, 6, and 8 mm, and the apex and thinnest point. Results: Method 1 showed a forward displacement of PCE at 1 month after CXL and then a backward displacement at 3 months. In Method 2, the points on the temporal side of 2 mm and 4 mm showed the same trend. The backward displacements of PCE on the temporal side of 2 mm at 6 months and on the temporal side of 4 mm at 12 months after CXL were both statistically different than those at 1 month after CXL (P < 0.05). No significant forward displacement of PCE was found in all local points in different quadrants at 1 year after CXL. Conclusion: The PCEs in circular areas and characteristic points of different diameters in keratoconic eyes after CXL change with time. Local point assessment of the PCE is more clinically significant. In points selected in different quadrants of the cornea, the change in temporal points was more significant after CXL. [ABSTRACT FROM AUTHOR]

Since the early 1990s, aerial insectivorous birds have shown serious population declines in North America, but it is not clear if factors common to all species within this guild account for these declines. Among sympatric swallows, population trends differ, and this may be due to differences in ecology operating throughout the annual cycle. Although these species all feed on aerial insects, prey taxa can differ tremendously in their “aeroecology” and use by swallows. We examined the potential for dietary differences among three species of swallows, Barn Swallow (Hirundo rustica), Cliff Swallow (Petrochelidon pyrrhonota), and Tree Swallow (Tachycineta bicolor), breeding sympatrically in southern Ontario, Canada. Potential interspecific differences in nestling diet were examined using two endogenous biomarkers, DNA barcoding of nestling feces and stable isotope analysis (δ 2H, δ 13C, δ 15N) of nestling feathers. We found evidence for differences in dietary sources of provisioned young where Barn Swallows provisioned more terrestrial-based prey, Cliff Swallows provisioned an intermediate diet, and Tree Swallows the most aquatic-emergent insect diet. We suggest this information may help to identify potential factors contributing to differential declines of aerial insectivores operating on the breeding grounds, including diet quality. [ABSTRACT FROM AUTHOR]

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Aerial insectivorous birds have experienced alarming population declines in eastern North America. Meanwhile, urbanization continues to increase rapidly, with urban land use comprising 69.4 million acres (1 acre = 0.40 ha), or 3.6% of total land area, in the contiguous United States. Multiple environmental changes are associated with urbanization, including alterations to local climate, changes in habitat structure, and potential shifts in both terrestrial and emergent aquatic flying insects on which aerial insectivorous birds rely. Here, we investigated the linkages between urbanization, water quality, and Tree Swallow (Tachycineta bicolor) reproductive success and body condition at seven river‐riparian sites representing urban and protected land use in Columbus, Ohio (USA) over five consecutive years (2014–2018). Tree Swallows at urban and protected sites relied on emergent aquatic insects for 37.4% and 30.8% (SD = 28.4% and 24.1%) of their nutritional subsidies, respectively. Despite the loss of environmental quality generally attributed to cities, Tree Swallows exhibited greater reproductive success in urban settings where climate was more amenable to egg and nestling survival, and the breeding season was longer. Urban‐nesting Tree Swallows initiated laying 7.9 d earlier and fledged 35% more young per nest than those at protected sites. Multiple characteristics of urban sites appeared to drive these patterns, including differences in mean and extreme air temperatures and measures of water quality (e.g., water temperature, nutrient concentrations, turbidity). However, chronic effects of elevated Hg concentrations, which were 482% greater in adult swallow blood at urban sites than at protected sites where swallows exhibited a 17.4% lower trophic position, may disadvantage individuals in other ways. Further, although Tree Swallows are a good model aerial insectivore bird species, characteristics of urban landscapes that benefit Tree Swallows may not advantage other aerial insectivorous birds owing to differences in life‐history and foraging strategies. These findings implicate urbanization, local climate, and water quality as important considerations in the conservation of aerial insectivorous birds. [ABSTRACT FROM AUTHOR]

Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this study is to compare the long-term effects of transepithelial corneal crosslinking with two continuous cycles of iontophoresis (EI-CXL) and conventional corneal crosslinking (C-CXL) in adults with progressive keratoconus. Methods: A retrospective analysis was conducted in adults who underwent C-CXL or EI-CXL between 2013 and 2015. Visual acuity, corneal tomography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy (IVCM), and endothelial cell count (ECC) were performed preoperatively and 5 years postoperatively. Results: Sixty-eight patients with a mean age of (24.3 ± 3.8) years were included, 34 for each group. After CXL, UCVA or BCVA remained stable, while the spherical diopter, cylinder diopter, spherical equivalent, and Kmax significantly decreased at 1, 2, and 3 years in both groups than baseline (P < 0.05). No significant differences were found in any refractive or tomographic parameters as well as the minimal corneal thickness between groups during follow-up. At 5 years, Kmax was slightly higher in EI-CXL group (58.16 ± 6.28) than that of C-CXL group (57.46 ± 4.98). At 3 and 5 years, the minimal corneal thickness in C-CXL group was still significantly lower than baseline (P < 0.05). IVCM demonstrated the demarcation zone at a mean depth of (302.0 ± 41.7) μm after C-CXL, and at (251.2 ± 28.1) μm after EI-CXL (P < 0.001). Keratocyte repopulation was detectable at all follow-up timepoint in both groups. Postoperative complications including progression were recorded in 6 patients (11.7%) after C-CXL and 3 patients (8.8%) after EI-CXL. ECC remained stable in both groups. Conclusion: EI-CXL showed approximate efficacy with C-CXL in stabilizing progressive keratoconus in adults. EI-CXL has the potential to be a preferable transepithelial protocol. [ABSTRACT FROM AUTHOR]

Animals must balance various costs and benefits when deciding when to breed. The costs and benefits of breeding at different times have received much attention, but most studies have been limited to investigating short‐term season‐to‐season fitness effects. However, breeding early, versus late, in a season may influence lifetime fitness over many years, trading off in complex ways across the breeder's lifespan. In this study, we examined the complete life histories of 867 female tree swallows (Tachycineta bicolor) breeding in Ithaca, New York, between 2002 and 2016. Earlier breeders outperformed later breeders in short‐term measures of reproductive output and offspring quality. Though there were weak indications that females paid long‐term future survival costs for breeding early, lifetime fledgling output was markedly higher overall in early‐breeding birds. Importantly, older females breeding later in the season did not experience compensating life history advantages that suggested an alternative equal‐fitness breeding strategy. Rather, most or all of the swallows appear to be breeding as early as they can, and differences in lay dates appear to be determined primarily by differences in individual quality or condition. Lay date had a significant repeatability across breeding attempts by the same female, and the first lay date of females fledged in our population was strongly influenced by the first lay date of their mothers, indicating the potential for ongoing selection on lay date. By examining performance over the entire lifespan of a large number of individuals, we were able to clarify the relationship between timing of breeding and fitness and gain new insight into the sources of variability in this important life history trait. [ABSTRACT FROM AUTHOR]

The ecology of Pustulated Burying Beetle (Nicrophorus pustulatus, Coleoptera: Silphidae) appears distinct among Nicrophorus species, with evidence of it parasitizing snake eggs and foraging primarily above the ground and into the forest canopy. Here we document an extension of its aberrant ecology and behaviour: a case of N. pustulatus burying 2-day-old live and dead nestlings of Tree Swallow (Tachycineta bicolor, Passeriformes: Hirundinidae) under the nest, behaviour consistent with the early stages of breeding in N. pustulatus. Based on different levels of decomposition, we suspect that N. pustulatus responded to one dead swallow nestling in the brood of five and went on to bury all of the nestlings at the bottom of the nest box. The observation provides the first evidence, to our knowledge, of Nicrophorus burying live vertebrates. [ABSTRACT FROM AUTHOR]

A radio frequency identification (RFID) system was modified for implementation into nest boxes to study the nesting behaviour of Tree Swallows (Tachycineta bicolor) at Colony Farm Regional Park in Coquitlam, B.C. Ten nest boxes were equipped with RFID technology and monitored for three consecutive breeding seasons (2015-2017). The RFID systems recorded each nest visit made by 39 adult Tree Swallows tagged with passive integrated transponder (PIT) tags, amassing over 20,290h of data and recording 30,482 nest box visits with an investment of approximately 7h of labour per week. Our results indicate that female Tree Swallows play a greater role in provisioning than males by making more frequent and numerous daily nest visits over a greater period of time during the day. The data also revealed interesting nesting behaviour, detecting one case of polygyny in the nest box colony, where one adult male was consistently provisioning for two broods in neighbouring nest boxes. While our sample size was small, the data collected provides an example of the large volume of automated and continuous data that can be collected by integrating RFID technology with nest boxes. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Field Ornithology is the property of Resilience Alliance and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus. Methods: This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18 years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications. Results: The mean participant age was 16.8 ± 1.4 years, and the mean follow-up period was 68.5 ± 39.9 months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P < 0.001). The mean keratometry decreased from 59.54 ± 5.17 D preoperatively to 46.23 ± 2.17 D postoperatively (P < 0.001). The complications encountered during the study period were intraoperative Descemet's membrane perforation (n = 5, 11.4%), the Urrets Zavalia syndrome (n = 1, 2.3%), graft epithelial problems (n = 3, 6.8%), subepithelial graft rejection (n = 5, 11.4%), high intraocular pressure (n = 8, 18.2%), and traumatic wound dehiscence (n = 2, 4.6%). Suture-related complications included premature loosening (n = 13, 29.6%), broken sutures (n = 12, 27.3%), suture-tract vascularization (n = 6, 13.6%), suture-associated abscesses (n = 5, 11.4%), and suture cheese wiring (n = 2, 4.6%). A clear graft was found in 40 eyes (90.9%) at the last follow-up examination. Conclusion: This study showed promising results with big-bubble DALK in keratoconus-affected children. A frequent and close follow-up with dedicated parental involvement is essential for the early recognition and management of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Iontophoresis is a noninvasive delivery system designed to overcome barriers to ocular penetration of topical ophthalmic medications by employing a low-amplitude electrical current to promote the migration of a charged drug substance across biological membranes. Trans-scleral iontophoresis of dexamethasone phosphate has demonstrated dramatically increased intraocular concentrations of dexamethasone in rabbit ocular tissues compared with topical instillation, including 50- to 100-fold greater aqueous humor concentrations. Methods: This article reviews available data on recent clinical applications of iontophoretic ophthalmic drug delivery. Results: The EyeGate II delivery system (EGDS) is a trans-scleral iontophoresis system that has been used in conjunction with EGP-437, a proprietary-charged formulation of dexamethasone phosphate for iontophoretic delivery. In patients with noninfectious anterior uveitis, EGP-437, delivered through 2 iontophoretic treatments using the EGDS, demonstrated similar efficacy to topical prednisolone acetate 1% eye drops instilled 8 times daily over 28 days, suggesting the potential to decrease or eliminate the need for daily dosing of topical steroids in this patient population. Other applications for EGP-437 delivered through the EGDS that have been explored in clinical trials include treatment of dry eye, postsurgical inflammation and pain, and scleritis. In addition, transcorneal iontophoresis has been used outside of the United States to enhance riboflavin penetration in patients undergoing corneal cross-linking as therapy for progressive keratoconus. Conclusions: The reviewed studies demonstrate the feasibility of using iontophoresis to enhance drug delivery to ocular tissues and support the potential of this noninvasive technique across a range of ophthalmic indications. [ABSTRACT FROM AUTHOR]

Collagen corneal cross-linking (CXL) is an invasive pharmacological treatment strategy used for corneal ectatic disorders and is currently the only treatment capable of halting the progression of the disease. In the past 20 years, the conservative management of progressive corneal ectasia has changed, thanks to this procedure that produces strengthening of the corneal tissue through the photochemical reaction generated by the combined action of riboflavin and ultraviolet A radiation. Many modified protocols have been implemented to halt the progression of the disease and to delay or prevent visual loss and surgical procedures such as corneal transplantation. Because of the variety of different protocols that are currently used, the results that are being reported are very variable, and could generate some confusion in relation to the true efficacy of the procedure. The aim of this review was to provide an overview of the aforementioned protocols that are designed to maintain the efficacy of CXL in halting the progression of the disease but avoiding the major limitations of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate corneal edema in different-aged pediatric patients with Peters anomaly and to correlate in vivo with ex vivo histopathologic findings. Methods: A retrospective cross-sectional study was performed. The medical records of patients diagnosed with Peters anomaly who underwent examination under anesthesia (EUA) between 2011 and 2015 were reviewed. Eyes in which central corneal thickness (CCT) measurements were taken were included. The thickest point in the CCT pachymetric map was used to objectively quantify corneal edema. Correlation between CCT and age was calculated. Additionally, a retrospective review of histopathologic studies of excised corneal buttons from pediatric eyes with Peters anomaly between 2011 and 2015 was performed. Results: Eighteen eyes of 12 children were included. Mean age was 14 ± 15 months, and mean CCT was 842 ± 304 µm. A significant inverse correlation was noted between the CCT and the age of the patients, with lower CCT values in older children (r = 0.6; P = 0.01). Seven excised corneal buttons that underwent penetrating keratoplasty were reviewed. All corneal buttons showed absence of Descemet membrane and localized absence of endothelium. However, three specimens showed presence of corneal endothelium in areas of absent or attenuated Descemet membrane. Conclusions: In Peters anomaly, the CCT decreases with age, possibly due to a decrease in corneal edema. Histopathologic studies show cases of endothelial expansion in areas of absent or attenuated Descemet membrane. This may contribute to improved endothelial function and decreased edema with age. [ABSTRACT FROM AUTHOR]

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Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)