A comparison of iStent combined with phacoemulsification and endocyclophotocoagulation (ICE2) with the PreserFlo MicroShunt and XEN-45 implants

BACKGROUND: Minimally invasive glaucoma surgery (MIGS), including minimally invasive bleb surgery (MIBS), is a rapidly evolving area of research and clinical interest in ophthalmology. The growing number of devices has necessitated evaluations to identify subtle differences in outcomes between treatments. OBJECTIVES: To compare clinical effectiveness and safety outcomes of iStent combined with endoscopic cyclophotocoagulation (ICE2) with bleb forming PreserFlo MicroShunt (PMS) and XEN-45 gel implant in a 24-month retrospective review. DESIGN: A retrospective review of patient records. METHODS: We compared outcomes of 247 patients undergoing one of three glaucoma procedures (ICE2 = 162; PMS = 48; XEN-45 = 37) at a single facility in the United Kingdom. Clinical records were reviewed retrospectively between July 2016 and May 2020. Pairwise comparisons and within group analyses were performed to assess intraocular pressure (IOP), best-corrected LogMAR visual acuity (BCVA), the Humphrey visual fields and antiglaucoma medication outcomes across the three treatment groups. RESULTS: No statistically significantly differences in IOP between the groups at day 7, 6 months, 12 months and 24 months. PMS had statistically significantly change in IOP between baseline and day 7 compared with ICE2 (p = 0.003). BCVA was statistically significant different at 24 months between the ICE2 compared with PMS group (0.12 versus 0.33 LogMAR; p = 0.002). PMS group achieved the largest decline in medication usage between baseline a 24-month follow-up (2.9 versus 0.9; p < 0.001), with no statistically significant difference in the number of antiglaucoma medications being used between groups at 24 months. Postoperative complications in all three groups were transient and could be resolved with office-based interventions. CONCLUSION: Real-world outcomes after 24 months were similar between patients undergoing MIGS and MIBS procedures

Geriatric patients\u27 expectations of their physicians: findings from a tertiary care hospital in Pakistan

Background: Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric Patients from their physicians and the factors associated with Patient satisfaction in this particular age bracket. Methods: A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pretested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric Patient\u27s expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important. Results: Three hundred and eighty geriatric Patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 +/- 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric Patients. More than 50% of the Patients were visiting their physicians once every two to three months. Discussing treatment options and letting Patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physician\u27s holistic knowledge about the spectrum of care issues for geriatric Patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by Patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p \u3c 0.001) emerged as independent predictors of the satisfaction of geriatric Patients from care provided by physicians. Conclusion: We have documented the expectations of the geriatric Patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric Patients

Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric patients from their physicians and the factors associated with patient satisfaction in this particular age bracket.</p> <p>Methods</p> <p>A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pre-tested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric patient's expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important.</p> <p>Results</p> <p>Three hundred and eighty geriatric patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 ± 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric patients. More than 50% of the patients were visiting their physicians once every two to three months. Discussing treatment options and letting patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physician's holistic knowledge about the spectrum of care issues for geriatric patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p < 0.001) emerged as independent predictors of the satisfaction of geriatric patients from care provided by physicians.</p> <p>Conclusion</p> <p>We have documented the expectations of the geriatric patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric patients.</p

iMIGS: An innovative AI based prediction system for selecting the best patient-specific glaucoma treatment

The use of AI-based techniques in healthcare are becoming more and more common and more disease-specific. Glaucoma is a disorder in eye that causes damage to the optic nerve which can lead to permanent blindness. It is caused by the elevated pressure inside the eye due to the obstruction to the flow of the drainage fluid (aqueous humor). Most recent treatment options involve minimally invasive glaucoma surgery (MIGS) in which a stent is placed to improve drainage of aqueous humor from the eye. Each MIGS surgery has a different mechanism of action, and the relative efficacy and chance of success is dependent on multiple patient-specific factors. Hence the ophthalmologists are faced with the critical question; which method would be better for a specific patient, both in terms of glaucoma control but also taking into consideration patient quality of life? In this paper, an Adaptive Neuro-Fuzzy Inference System (ANFIS) has been developed in the form of a Treatment Advice prediction system that will offer the clinician a suggested MIGS treatment from the baseline clinical parameters. ANFIS was used with a real-world MIGS data set which was a retrospective case series of 372 patients who underwent either of the four MIGS procedures from July 2016 till May 2020 at a single center in the UK. • Inputs used: Clinical measurements of Age, Visual Acuity, Intraocular Pressure (IOP), and Visual Field, etc. • Output Classes: iStent, iStent and Endoscopic Cyclophotocoagulation (ICE2), PreserFlo MicroShunt (PMS) and XEN-45). • Results: The proposed ANFIS system was found to be 91% accurate with high Sensitivity (80%) and Specificity (90%)

Retinal image enhancement using Laplacian pyramidal multi-scaling

Early detection of retinal diseases is important to avoid complications and permanent vision loss. In this paper retinal neovascularization and molecular degeneration has been emphasized. Neovascularization is in form of randomly disoriented micro vessels in retina. So image enhancement techniques are excellent way to extract the vessels, find out blood leakages, determine direction of growth and estimate the growth rate with vessel localization. A comparative study has been done on prior retinal image enhancement algorithms. In this project multi-scale image analysis is used as main image enhancement technique with the help of Laplacian Pyramid. The target is achieved by translating an image into several image scales and reconstructing with enhancement tools available in MATLAB image processing toolbox. Results are evaluated with object background contrast ratio, contrast- noise -ratio and 2-D contour plot. The enhanced images appear as a better source for edge detection and vessel extraction compare with the primary image. For this project normal fundus images from publicly available database are chosen.Scopu

A multicentre review of the histology of 1012 periocular basal cell carcinomas

Aims: To evaluate primary periocular basal cell carcinomas (BCCs) in depth including comparing histological margins with subtype, location and surgical specialty after wide local excision.  Methods: A retrospective review was performed for all BCCs excised from three hospitals over 5 years, covering a population of just over 1 million. Tumours were classified according to histological subtype location. Incomplete excision rates and margins were analysed in detail and comparisons made.  Results: The most common subtype found was nodular followed by infiltrative. Lesions were most commonly located at the lower lid. Infiltrative BCCs were associated with perineural invasion and incomplete excision despite the largest peripheral margins. Superficial BCCs had the smallest mean peripheral margin but the largest mean deep margin. 2 mm histological margins gave an 83.7% complete excision rate, 6.4% incomplete excision rate and 7.1% where the clearance margin was 0.3 mm or less.  Conclusion: Distribution of eyelid BCCs based on subtype and periocular location mirrored the general consensus. Infiltrative BCCs should be excised with wider margins or referred for Mohs surgery, especially if the medial canthus is involved. Superficial BCCs should be excised with wider but shallower surgical margins. Ophthalmologists were more likely than dermatologists or plastic surgeons to incompletely excise a periocular BCC, which is reflective of their more difficult case mix

Ocular complications associated with diabetes and the risk of sustainable blindness; a real world analysis

Objective: To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. Method: The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. Results: Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision-threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). Conclusion: Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications. Key Words: Cataract, Glaucoma, Diabetic retinopathy