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Zixue Zeng,1,* Binh Duong Giap,2,* Ethan Kahana,3 Jefferson Lustre,4 Ossama Mahmoud,5 Shahzad I Mian,2 Bradford Tannen,2 Nambi Nallasamy2,6 1School of Public Health, University of Michigan, Ann Arbor, MI, USA; 2Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; 3Department of Computer Science, University of Michigan, Ann Arbor, MI, USA; 4School of Medicine, University of Michigan, Ann Arbor, MI, USA; 5School of Medicine, Wayne State University, Detroit, MI, USA; 6Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA*These authors contributed equally to this workCorrespondence: Nambi Nallasamy, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1 (734) 763-5506, Fax +1 (734) 936-2340, Email nnallasa@med.umich.eduBackground: The capsulorhexis is one of the most important and challenging maneuvers in cataract surgery. Automated analysis of the anterior capsulotomy could aid surgical training through the provision of objective feedback and guidance to trainees.Purpose: To develop and evaluate a deep learning-based system for the automated identification and semantic segmentation of the anterior capsulotomy in cataract surgery video.Methods: In this study, we established a BigCat-Capsulotomy dataset comprising 1556 video frames extracted from 190 recorded cataract surgery videos for developing and validating the capsulotomy recognition system. The proposed system involves three primary stages: video preprocessing, capsulotomy video frame classification, and capsulotomy segmentation. To thoroughly evaluate its efficacy, we examined the performance of a total of eight deep learning-based classification models and eleven segmentation models, assessing both accuracy and time consumption. Furthermore, we delved into the factors influencing system performance by deploying it across various surgical phases.Results: The ResNet-152 model employed in the classification step of the proposed capsulotomy recognition system attained strong performance with an overall Dice coefficient of 92.21%. Similarly, the UNet model with the DenseNet-169 backbone emerged as the most effective segmentation model among those investigated, achieving an overall Dice coefficient of 92.12%. Moreover, the time consumption of the system was low at 103.37 milliseconds per frame, facilitating its application in real-time scenarios. Phase-wise analysis indicated that the Phacoemulsification phase (nuclear disassembly) was the most challenging to segment (Dice coefficient of 86.02%).Conclusion: The experimental results showed that the proposed system is highly effective in intraoperative capsulotomy recognition during cataract surgery and demonstrates both high accuracy and real-time capabilities. This system holds significant potential for applications in surgical performance analysis, education, and intraoperative guidance systems.Keywords: cataract surgery, capsulotomy, deep learning, image segmentation, image classification

Anvesh Annadanam,1 Ethan Kahana,1 Chris Andrews,1 Alexa R Thibodeau,1 Shahzad I Mian,1 Bradford L Tannen,1 Nambi Nallasamy1,2 1Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; 2Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USACorrespondence: Nambi Nallasamy, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1 734-763-8122, Email nnallasa@med.umich.eduPurpose: Achieving competency in cataract surgery is an essential component of ophthalmology residency training. Video-based analysis of surgery can change training through its objective, reliable, and timely assessment of resident performance.Methods: Using the Image Labeler application in MATLAB, the capsulorrhexis step of 208 surgical videos, recorded at the University of Michigan, was annotated for subjective and objective analysis. Two expert surgeons graded the creation of the capsulorrhexis based on the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric:Phacoemulsification (ICO-OSCAR:phaco) rating scale and a custom rubric (eccentricity, roundness, size, centration) that focuses on the objective aspects of this step. The annotated rhexis frames were run through an automated analysis to obtain objective scores for these components. The subjective scores were compared using both intra and inter-rater analyses to assess the consistency of a human-graded scale. The subjective and objective scores were compared using intraclass correlation methods to determine relative agreement.Results: All rhexes were graded as 4/5 or 5/5 by both raters for both items 4 and 5 of the ICO-OSCAR:phaco rating scale. Only roundness scores were statistically different between the subjective graders (mean difference = − 0.149, p-value = 0.0023). Subjective scores were highly correlated for all components (> 0.6). Correlations between objective and subjective scores were low (0.09 to 0.39).Conclusion: Video-based analysis of cataract surgery presents significant opportunities, including the ability to asynchronously evaluate performance and provide longitudinal assessment. Subjective scoring between two raters was moderately correlated for each component.Keywords: capsulorrhexis, artificial intelligence, surgical training, cataract surgery

Ossama Mahmoud,1,2 Chris Andrews,1 Timothy Soeken,1 Sudha Nallasamy,3,4 Nambi Nallasamy1,5 1Kellogg Eye Center Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; 2School of Medicine, Wayne State University, Detroit, MI, USA; 3The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA; 4USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, LA, California, USA; 5Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USACorrespondence: Nambi Nallasamy, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48105, USA, Tel +1 734 763-5506, Fax +1 734 936-2340, Email nnallasa@med.umich.eduBackground: Orthokeratology has been shown to suppress progressive myopia in some children. We examine the changes in optical biometry parameters in orthokeratology (Ortho-K) patients, in a retrospective longitudinal study at a tertiary eye care center in Ann Arbor, MI, USA.Methods: Optical biometry measurements obtained with the Lenstar LS 900 (Haag-Streit USA Inc, EyeSuite software version i9.1.0.0) were aggregated from 170 patients who had undergone Ortho-K for myopia correction between 5 and 20 years of age. Pre-intervention biometry measurements were compared with follow-up measurements done 6– 18 months after initiation of Ortho-K. Linear mixed models were used to quantify associations in biometry changes with age of intervention allowing for correlation between measurements on two eyes of the same patient.Results: A total of 91 patients were included in the study. Axial length increased through the age of 15.7 ± 0.84 years for Ortho-K patients at our center. The growth curve in our Ortho-K population was comparable to previously published normal growth curves in Wuhan and Germany populations. Corneal thickness and keratometry decreased at a stable rate regardless of age of intervention (− 7.9 μm, 95% CI [− 10.2, − 5.7], p < 0.001).Conclusion: In our population, Ortho-K did not appear to affect the overall trajectory of axial length progression when compared to normal growth curves, despite showing a previously described reduction in corneal thickness. As Ortho-K has been shown to have varying effects that differ from individual to individual, it continues to be important to reassess its effects on new populations to better understand its ideal uses.Keywords: orthokeratology, biometry, pediatrics, axial length, corneal thickness

Alexa Thibodeau, Nambi Nallasamy Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USACorrespondence: Nambi NallasamyDepartment of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USATel +1 734 763 5506Fax +1 734 936 2340Email nnallasa@med.umich.eduAbstract: Enfortumab vedotin is an antibody–drug conjugate that was recently granted accelerated US Food and Drug Administration approval for the treatment of locally advanced or metastatic urothelial cancer. Early clinical trials identified blurry vision, increased lacrimation and other events associated with dry eye as potential side effects. We report a case of bilateral anterior subcapsular cataract development following initiation of enfortumab vedotin. Enfortumab vedotin is not previously known to cause cataract development or progression and, thus, our patient’s presentation may reflect the first report of an undocumented adverse effect of this novel agent.Keywords: anterior subcapsular cataract, enfortumab vedotin, urothelial carcinoma

Objective: To investigate factors associated with 90-day visual acuity in microbial keratitis (MK) patients., Design: This multicenter prospective cohort study recruited patients with MK from the United States (US) and India from July 23, 2020 through May 1, 2024, and followed them for up to 90 days., Participants: Individuals 15 years and older with MK greater than 2mm 2 in stromal infiltrate area without study exclusion criteria of prior corneal surgery or gluing, impending corneal perforation or keratoplasty, no light perception vision, or current pregnancy or incarceration., Methods: Data on sociodemographic features, health and ocular history, symptoms, and clinical measures were gathered. Best-corrected visual acuity (BCVA) was measured in the affected eye at initial and 90-day visits with carried forward BCVA for those healed prior to 90 days. Features were summarized overall and by site. Site-stratified multivariable linear regression models were used to investigate associations with 90-day logMAR BCVA., Main Outcome Measures: 90-day logMAR BCVA., Results: There were 479 participants analyzed after exclusions (n=31) and participants without a final BCVA (n=52). Participants had an average 90-day BCVA of 1.36±1.40 logMAR units (Snellen approximate 20/460 ± 14.0 lines) in the US and 0.70±0.99 (Snellen approximate 20/100 ± 9.9 lines) in India (P<0.0001). For the US cohort, worse 90-day logMAR BCVA was associated with worse presenting BCVA (β=0.05 logMAR unit increase in 90-day logMAR BCVA per 0.1 logMAR unit increase in presenting BCVA, P<0.0001), longer time until presentation (β=0.01 per day, P<0.0001), no contact lens use (β=0.46, P=0.0131), and larger stromal infiltrate area (β=0.02 per 1mm 2 increase in area, P=0.0082 for bacterial ulcers; β=0.10 per 1 mm 2 increase in area, P=0.0002 for fungal; interaction p=0.0017). For the India cohort, worse 90-day logMAR BCVA was associated with worse presenting BCVA (β=0.04 logMAR unit increase in 90-day logMAR BCVA per 0.1 logMAR unit increase in presenting BCVA, P<0.0001), longer delays to presentation (β=0.03 per day, P=0.0004), diabetes mellitus (β=0.41, P=0.0019), hypopyon (β=0.27, P=0.0083), no recent ocular trauma (β=0.21, P=0.0370), and larger stromal infiltrate area (β=0.03 per 1mm 2 increase in area, P<0.0001 for fungal; interaction p=0.0001; nonsignificant β=-0.02 per 1mm 2 increase in area, P=0.07 for bacterial ulcers;)., Conclusions: Initial vision, longer time until presentation, and larger stromal infiltrate size conferred risk for worse 90-day BCVA in both cohorts, while other factors were unique. Systems to mitigate care delays and support communities to access care are needed so that clinicians can intervene and improve vision outcomes., (Copyright © 2025. Published by Elsevier Inc.)

Purpose: The objective of this study was to identify social risk factors (SRFs) that affect microbial keratitis (MK) care using the Penchansky-Thomas (P-T) health care access framework., Methods: This combined retrospective and prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed., Results: A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least 1 SRF affecting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, P = 0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared with those not LTFU, had more SRFs (100% vs. 52.4%, P = 0.0001) and reported a greater median number of SRFs (3.0 vs. 1.0, P < 0.0001)., Conclusions: SRFs affected most patients with MK, most notably accessibility and affordability. Participants with lower income had more SRFs. SRFs are linked to patients being lost to follow-up care., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To retrospectively evaluate and describe the relationship between the use of topical corticosteroids and the development of crystalline corneal opacities (steroid keratopathy) in a colony of research Beagles and Beagle-derived dogs., Methods: Medical records of 73 purpose-bred Beagles and Beagle-derived dogs were reviewed from June 2012 to May 2021. All dogs were treated with topical ophthalmic corticosteroids for at least 21 days. In addition to regular ophthalmic examination, some dogs also had a systemic lipid profile (n = 6) performed to work up further and characterize the crystalline corneal opacities. Globes of 3 dogs were examined histopathologically., Results: Axial stromal crystalline corneal opacities were appreciated in 25 eyes of 14 dogs after a median of 141 days after initiating treatment (35-396 days). Multiple corticosteroids were used, including neomycin-polymyxin b-dexamethasone 0.1% ophthalmic ointment, prednisolone acetate 1% ophthalmic suspension, and difluprednate 0.05% ophthalmic emulsion (Durezol). Resolution of corneal opacity was documented in 4 of 25 eyes when ophthalmic corticosteroids were discontinued after a median of 406.5 days (271-416 days). Histopathologic examination revealed a dense band of acellular material, poorly staining with periodic acid-Schiff, subtending the corneal epithelium, and being surrounded by spindle cells., Conclusions: This case series documents the onset of steroid keratopathy in Beagles and Beagle-derived dogs after treatment with ophthalmic corticosteroids. Clinical resolution of steroid keratopathy lesions may be possible after discontinuation of ophthalmic corticosteroids., Competing Interests: The authors have no conflicts of interest to disclose related to this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor. Concerns raised on PubPeer (https://pubpeer.com/publications/6B1D14C0DD4B045D5CAC66FA68CE06#) were investigated. Figures. 5B and 6B are composed of numerous individual images, and it is confirmed that despite these figures apparently demonstrating different phenomena, several of these images are duplicated within the same figure and/or appear in both figures. It is noteworthy that one of the duplicated images in figure. 5B has been rotated. Furthermore, it is additionally noted that one of the images duplicated in figures. 5B and 6B was originally published as part of the graphical abstract and figure. 4 of Journal of Drug Delivery Science and Technology 56 (2020) 101560 https://doi.org/10.1016/j.jddst.2020.101560; another image from figure. 4 of the same earlier publication also subsequently reappears as an unduplicated image forming part of figure. 6B. The corresponding author was contacted for comment about these concerns but was unable to provide a satisfactory explanation. The Editor has therefore lost confidence in the reliability of the findings presented in this article as a whole. Finally, unauthorised authorship changes were made when the revised version of this paper was submitted, following suggestions for relatively minor revisions from the reviewers and Guest Editor, with authors Kathirvel Brindhadevi, Hakim AL. Garalleh and Mazen Garaleh being added to the paper. No satisfactory explanation was given for this change, nor was it approved by the editor. This authorship change breaches the policies of the journal and as a result, the editor no longer has confidence in this paper and is retracting it. The journal apologises for not having identified the problematic authorship change during the review process and for any resulting inconvenience., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Purpose: Pupillary instability is a known risk factor for complications in cataract surgery. This study aims to develop and validate an innovative and reliable computational framework for the automated assessment of pupil morphologic changes during the various phases of cataract surgery., Design: Retrospective surgical video analysis., Subjects: Two hundred forty complete surgical video recordings, among which 190 surgeries were conducted without the use of pupil expansion devices (PEDs) and 50 were performed with the use of a PED., Methods: The proposed framework consists of 3 stages: feature extraction, deep learning (DL)-based anatomy recognition, and obstruction (OB) detection/compensation. In the first stage, surgical video frames undergo noise reduction using a tensor-based wavelet feature extraction method. In the second stage, DL-based segmentation models are trained and employed to segment the pupil, limbus, and palpebral fissure. In the third stage, obstructed visualization of the pupil is detected and compensated for using a DL-based algorithm. A dataset of 5700 intraoperative video frames across 190 cataract surgeries in the BigCat database was collected for validating algorithm performance., Main Outcome Measures: The pupil analysis framework was assessed on the basis of segmentation performance for both obstructed and unobstructed pupils. Classification performance of models utilizing the segmented pupil time series to predict surgeon use of a PED was also assessed., Results: An architecture based on the Feature Pyramid Network model with Visual Geometry Group 16 backbone integrated with the adaptive wavelet tensor feature extraction feature extraction method demonstrated the highest performance in anatomy segmentation, with Dice coefficient of 96.52%. Incorporation of an OB compensation algorithm improved performance further (Dice 96.82%). Downstream analysis of framework output enabled the development of a Support Vector Machine-based classifier that could predict surgeon usage of a PED prior to its placement with 96.67% accuracy and area under the curve of 99.44%., Conclusions: The experimental results demonstrate that the proposed framework (1) provides high accuracy in pupil analysis compared with human-annotated ground truth, (2) substantially outperforms isolated use of a DL segmentation model, and (3) can enable downstream analytics with clinically valuable predictive capacity., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (© 2024 by the American Academy of Ophthalmology.)

The degradation of water bodies caused by organic pollutants from industrial wastewater discharge has made it necessary to develop new functional materials like hydrophobic-oleophilic materials that can efficiently remediate water. It is factual that many of the synthetic methods for creating hydrophobic-oleophilic materials involve the use of toxic or harmful reactants, such as fluorine or sulfur compounds. However, these methods often have significant drawbacks, including being hazardous to the environment, expensive, and complex to utilize. Therefore, there is an urgent need to develop a hydrophobic/oleophilic material that is non-toxic and eco-friendly in order to overcome the existing drawbacks. In this regard, we have proposed a modest and eco-friendly approach for constructing a hydrophobic-oleophilic Ph-POSS@HKUST-1 composite material by solution-assisted self-assembly for the conversion of hydrophilic HKUST-1 into hydrophobic HKUST-1 for separation applications. The incorporation of fluorine-free, low surface energy and hydrophobic POSS into HKUST-1 increased the hydrophobicity and oleophilicity of the system. The synthesized Ph-POSS@HKUST-1 composite material has been thoroughly characterized through FT-IR, PXRD, HR-SEM, BET, and thermogravimetric analysis. It has been observed that the material exhibits a contact angle of 137 ± 4° and shows high selectivity and absorption capacity towards organic solvents and oils from water mixtures. Concurrently, the Ph-POSS@HKUST-1@PDA@sponge has been effectively utilized for the separation of solvents and oils and it has shown more than 95% separation efficiency for up to 15 cycles. It is interesting to note that Ph-POSS@HKUST-1 and the Ph-POSS@HKUST-1@PDA@sponge have outstanding stability in abrasive chemical environments which is due to the presence of a mechanically and chemically stable inorganic-organic hybrid POSS nanocage. In addition, ab initio and DFT calculations elicit that the Ph-POSS@HKUST-1 composite is stabilized through π⋯π stacking instead of the C-H⋯π mode of interaction at the HKUST-1⋯Ph-POSS interface. Further electron density features confirm the interfacial interaction at the interface. Our latest research has led us to propose an eco-friendly and non-toxic hybrid composite material for efficiently tackling the issue of organic solvent and oil pollution in water mixtures.

Purpose: To report and evaluate a multicenter series of 18 cases of severe, spontaneous IOL tilt involving the flanged intrascleral haptic fixation technique (FISHF)., Design: Clinical study with historical controls., Methods: We report a cross-sectional study of 46 FISHF cases using the CT Lucia 602 IOL at a single academic center over a period of 24 weeks to determine the incidence of severe rotisserie-style rotational tilt. These rates were then compared with the same time-frame the prior year to help determine if this is a new phenomenon. Additional cases of severe tilt were solicited from another 4 academic centers., Results: Among 46 FISHF cases at a single center, 5 developed severe tilt. No clear pattern in surgical technique, ocular history, or ocular anatomy was evident in these cases compared with controls, although the involved IOLs clustered within a narrow diopter range, indicative of a batch effect. In the same 24-week interval the year before, 33 FISHF cases were performed, none of which exhibited severe rotational tilt. In our multicenter dataset, 18 cases of tilt were identified. Surgeons included fellow and early-career physicians as well as surgeons with multiple years of experience with the Yamane technique. A variety of surgical approaches for FISHF were represented. In at least 8 of the cases, haptic rotation and/or dehiscence at the optic-haptic junction were documented., Conclusions: The identification of haptic rotation and dehiscence intraoperatively in several cases may reflect a new stability issue involving the optic-haptic junction., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: The aim of this study was to facilitate deep learning systems in image annotations for diagnosing keratitis type by developing an automated algorithm to classify slit-lamp photographs (SLPs) based on illumination technique., Methods: SLPs were collected from patients with corneal ulcer at Kellogg Eye Center, Bascom Palmer Eye Institute, and Aravind Eye Care Systems. Illumination techniques were slit beam, diffuse white light, diffuse blue light with fluorescein, and sclerotic scatter (ScS). Images were manually labeled for illumination and randomly split into training, validation, and testing data sets (70%:15%:15%). Classification algorithms including MobileNetV2, ResNet50, LeNet, AlexNet, multilayer perceptron, and k-nearest neighborhood were trained to distinguish 4 type of illumination techniques. The algorithm performances on the test data set were evaluated with 95% confidence intervals (CIs) for accuracy, F1 score, and area under the receiver operator characteristics curve (AUC-ROC), overall and by class (one-vs-rest)., Results: A total of 12,132 images from 409 patients were analyzed, including 41.8% (n = 5069) slit-beam photographs, 21.2% (2571) diffuse white light, 19.5% (2364) diffuse blue light, and 17.5% (2128) ScS. MobileNetV2 achieved the highest overall F1 score of 97.95% (CI, 97.94%-97.97%), AUC-ROC of 99.83% (99.72%-99.9%), and accuracy of 98.98% (98.97%-98.98%). The F1 scores for slit beam, diffuse white light, diffuse blue light, and ScS were 97.82% (97.80%-97.84%), 96.62% (96.58%-96.66%), 99.88% (99.87%-99.89%), and 97.59% (97.55%-97.62%), respectively. Slit beam and ScS were the 2 most frequently misclassified illumination., Conclusions: MobileNetV2 accurately labeled illumination of SLPs using a large data set of corneal images. Effective, automatic classification of SLPs is key to integrating deep learning systems for clinical decision support into practice workflows., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Cataract surgery remains the only definitive treatment for visually significant cataracts, which are a major cause of preventable blindness worldwide. Successful performance of cataract surgery relies on stable dilation of the pupil. Automated pupil segmentation from surgical videos can assist surgeons in detecting risk factors for pupillary instability prior to the development of surgical complications. However, surgical illumination variations, surgical instrument obstruction, and lens material hydration during cataract surgery can limit pupil segmentation accuracy. To address these problems, we propose a novel method named adaptive wavelet tensor feature extraction (AWTFE). AWTFE is designed to enhance the accuracy of deep learning-powered pupil recognition systems. First, we represent the correlations among spatial information, color channels, and wavelet subbands by constructing a third-order tensor. We then utilize higher-order singular value decomposition to eliminate redundant information adaptively and estimate pupil feature information. We evaluated the proposed method by conducting experiments with state-of-the-art deep learning segmentation models on our BigCat dataset consisting of 5,700 annotated intraoperative images from 190 cataract surgeries and a public CaDIS dataset. The experimental results reveal that the AWTFE method effectively identifies features relevant to the pupil region and improved the overall performance of segmentation models by up to 2.26% (BigCat) and 3.31% (CaDIS). Incorporation of the AWTFE method led to statistically significant improvements in segmentation performance (P < 1.29  ×  10 -10 for each model) and yielded the highest-performing model overall (Dice coefficients of 94.74% and 96.71% for the BigCat and CaDIS datasets, respectively). In performance comparisons, the AWTFE consistently outperformed other feature extraction methods in enhancing model performance. In addition, the proposed AWTFE method significantly improved pupil recognition performance by up to 2.87% in particularly challenging phases of cataract surgery.

Purpose: To report a case of neovascularization against autologous grafts after simple limbal epithelial transplantation (SLET) despite successful corneal epithelialization, as well as its subsequent regression without intervention., Methods: A case report and review of the literature., Results: A 52-year-old woman underwent uncomplicated autologous SLET for asymmetric limbal stem cell deficiency (LSCD) in the left eye. One month after the surgery, the patient had successful adherence of the graft and corneal epithelialization; however, new neovascularization developed in the left eye towards the graft sites. With only a slow taper of topical prednisolone acetate and polymyxin b/trimethoprim, the neovascularization regressed to ghost vessels over the following three months with improvement of her LSCD symptoms and increased clarity of her cornea., Conclusion: The limbus does not enjoy relative immune privilege like other parts of the eye; therefore, autologous limbal stem cell transplantation (along with the minimal immune response generated) is valuable for restoration of the ocular surface. Here, we describe neovascularization against autologous donor grafts despite an otherwise uncomplicated surgery and expected epithelialization course. Inflammation-mediated angiogenesis likely initiated the neovascularization, suggesting that immune mediators of inflammation may be inadvertently part of the graft tissue in bilateral LSCD., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Accurate identification of surgical phases during cataract surgery is essential for improving surgical feedback and performance analysis. Time spent in each surgical phase is an indicator of performance, and segmenting out specific phases for further analysis can simplify providing both qualitative and quantitative feedback on surgical maneuvers., Study Design: Retrospective surgical video analysis., Subjects: One hundred ninety cataract surgical videos from the BigCat dataset (comprising nearly 4 million frames, each labeled with 1 of 11 nonoverlapping surgical phases)., Methods: Four machine learning architectures were developed for segmentation of surgical phases. Models were trained using cataract surgical videos from the BigCat dataset., Main Outcome Measures: Models were evaluated using metrics applied to frame-by-frame output and, uniquely in this work, metrics applied to phase output., Results: The final model, CatStep, a combination of a temporally sensitive model (Inflated 3D Densenet) and a spatially sensitive model (Densenet169), achieved an F1-score of 0.91 and area under the receiver operating characteristic curve of 0.95. Phase-level metrics showed considerable boundary segmentation performance with a median absolute error of phase start and end time of just 0.3 seconds and 0.1 seconds, respectively, a segmental F1-score @70 of 0.94, an oversegmentation score of 0.89, and a segmental edit score of 0.92., Conclusion: This study demonstrates the feasibility of high-performance automated surgical phase identification for cataract surgery and highlights the potential for improved surgical feedback and performance analysis., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (© 2023 by the American Academy of Ophthalmology.)

Aims: To develop a new intraocular lens power selection method with improved accuracy for general cataract patients receiving Alcon SN60WF lenses., Methods and Analysis: A total of 5016 patients (6893 eyes) who underwent cataract surgery at University of Michigan's Kellogg Eye Center and received the Alcon SN60WF lens were included in the study. A machine learning-based method was developed using a training dataset of 4013 patients (5890 eyes), and evaluated on a testing dataset of 1003 patients (1003 eyes). The performance of our method was compared with that of Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hoffer Q, Holladay 1, PearlDGS and SRK/T., Results: Mean absolute error (MAE) of the Nallasamy formula in the testing dataset was 0.312 Dioptres and the median absolute error (MedAE) was 0.242 D. Performance of existing methods were as follows: Barrett Universal II MAE=0.328 D, MedAE=0.256 D; EVO MAE=0.322 D, MedAE=0.251 D; Haigis MAE=0.363 D, MedAE=0.289 D; Hoffer Q MAE=0.404 D, MedAE=0.331 D; Holladay 1 MAE=0.371 D, MedAE=0.298 D; PearlDGS MAE=0.329 D, MedAE=0.258 D; SRK/T MAE=0.376 D, MedAE=0.300 D. The Nallasamy formula performed significantly better than seven existing methods based on the paired Wilcoxon test with Bonferroni correction (p<0.05)., Conclusions: The Nallasamy formula (available at https://lenscalc.com/) outperformed the seven other formulas studied on overall MAE, MedAE, and percentage of eyes within 0.5 D of prediction. Clinical significance may be primarily at the population level., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cataract surgery remains the definitive treatment for cataracts, which are a major cause of preventable blindness worldwide. Adequate and stable dilation of the pupil are necessary for the successful performance of cataract surgery. Pupillary instability is a known risk factor for cataract surgery complications, and the accurate segmentation of the pupil from surgical video streams can enable the analysis of intraoperative pupil changes in cataract surgery. However, pupil segmentation performance can suffer due to variations in surgical illumination, obscuration of the pupil with surgical instruments, and hydration of the lens material intraoperatively. To overcome these challenges, we present a novel method called tensor-based pupil feature extraction (TPFE) to improve the accuracy of pupil recognition systems. We analyzed the efficacy of this approach with experiments performed on a dataset of 4,560 intraoperative annotated images from 190 cataract surgeries in human patients. Our results indicate that TPFE can identify features relevant to pupil segmentation and that pupil segmentation with state-of-the-art deep learning models can be significantly improved with the TPFE method.

Aims: To assess whether incorporating a machine learning (ML) method for accurate prediction of postoperative anterior chamber depth (ACD) improves cataract surgery refraction prediction performance of a commonly used ray tracing power calculation suite (OKULIX)., Methods and Analysis: A dataset of 4357 eyes of 4357 patients with cataract was gathered at the Kellogg Eye Center, University of Michigan. A previously developed machine learning (ML)-based method was used to predict the postoperative ACD based on preoperative biometry measured with the Lenstar LS900 optical biometer. Refraction predictions were computed with standard OKULIX postoperative ACD predictions and ML-based predictions of postoperative ACD. The performance of the ray tracing approach with and without ML-based ACD prediction was evaluated using mean absolute error (MAE) and median absolute error (MedAE) in refraction prediction as metrics., Results: Replacing the standard OKULIX postoperative ACD with the ML-predicted ACD resulted in statistically significant reductions in both MAE (1.7% after zeroing mean error) and MedAE (2.1% after zeroing mean error). ML-predicted ACD substantially improved performance in eyes with short and long axial lengths (p<0.01)., Conclusions: Using an ML-powered postoperative ACD prediction method improves the prediction accuracy of the OKULIX ray tracing suite by a clinically small but statistically significant amount, with the greatest effect seen in long eyes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A new set of multi-donor [ferrocene (D) and methoxyphenyl (D')] conjugated D-D'-π-A based dyes [Fc-(OCH 3 -Ph)C[double bond, length as m-dash]CH-CH[double bond, length as m-dash]CN-R{R[double bond, length as m-dash]COOH (1) and C 6 H 4 -COOH (2)}] were synthesized as sensitizers for dye-sensitized solar cell (DSSC) applications. These dyes were characterized with the aid of analytical and spectroscopic techniques such as FT-IR, HR-Mass, and 1 H and 13 C NMR. The thermal stability of the dyes 1 and 2 were investigated using thermogravimetric analysis (TGA) and was found to be stable around 180 °C for dye 1 and 240 °C for dye 2. The electronic absorption spectra for sensitizers display major bands between 400 and 585 nm that could be ascribed to an intramolecular charge transfer (ICT) between the electron donor and acceptor to create an efficient charge separation. The redox behaviour of the dyes was determined by cyclic voltammetry, which revealed the one-electron transfer from the ferrocene to ferrocenium ion (Fe 2+ ⇌ Fe 3+ ), and potential was utilized to determine the band gap of the dyes (2.16 eV for 1 and 2.12 eV for 2). Further, the carboxylic anchor dyes 1 and 2 have been utilized as photosensitizers in TiO 2 -based DSSCs with and without co-adsorbance of chenodeoxycholic acid (CDCA), and the photovoltaic performances were studied. The obtained photovoltaic parameters of dye 2 are open-circuit voltage ( V oc ) = 0.428 V, short-circuit current density ( J sc ) = 0.086 mA cm -2 , the fill factor (FF) = 0.432 and the energy efficiencies ( η ) = 0.015%, the overall power conversion efficiencies were found to be increased in the presence of CDCA as a co-adsorbent. The photosensitizers with the addition of CDCA show higher efficiencies compared to those in the absence of CDCA, which can prevent the formation of aggregation and increased electron injection of the dyes. Among the dyes, the 4-(cyanomethyl) benzoic acid (2) anchor showed higher photovoltaic performance compared with the cyanoacrylic acid (1) anchor due to the introduction of additional π-linkers and acceptor unit, which enables the lowering of the energy barrier and charge recombination process. In addition, the experimentally observed HOMO and LUMO values were in good agreement with the theoretical calculation by the DFT-B3LYP/6-31+G**/LanL2TZf level of theory., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Purpose: To develop a class of new metrics for evaluating the performance of intraocular lens power calculation formulas robust to issues that can arise with AI-based methods., Methods: The dataset consists of surgical information and biometry measurements of 6893 eyes of 5016 cataract patients who received Alcon SN60WF lenses at University of Michigan's Kellogg Eye Center. We designed two types of new metrics: the MAEPI (Mean Absolute Error in Prediction of Intraocular Lens [IOL]) and the CIR (Correct IOL Rate) and compared the new metrics with traditional metrics including the mean absolute error (MAE), median absolute error, and standard deviation. We evaluated the new metrics with simulation analysis, machine learning (ML) methods, as well as existing IOL formulas (Barrett Universal II, Haigis, Hoffer Q, Holladay 1, PearlDGS, and SRK/T)., Results: Results of traditional metrics did not accurately reflect the performance of overfitted ML formulas. By contrast, MAEPI and CIR discriminated between accurate and inaccurate formulas. The standard IOL formulas received low MAEPI and high CIR, which were consistent with the results of the traditional metrics., Conclusions: MAEPI and CIR provide a more accurate reflection of the real-life performance of AI-based IOL formula than traditional metrics. They should be computed in conjunction with conventional metrics when evaluating the performance of new and existing IOL formulas., Translational Relevance: The proposed new metrics would help cataract patients avoid the risks caused by inaccurate AI-based formulas, whose true performance cannot be determined by traditional metrics.

The present focused on comparative study on synthesis of ZnO nanoparticles (ZnO NPs) using chemical method via alkaline precipitation method (ZnO(A) NPs) using NaOH and biogenic method using termite mound extract (ZnO(B) NPs). GC-MS analysis revealed that D-limonene present in termite mound extract might be responsible for the synthesis of ZnO(B) NPs. XRD patterns confirmed hexagonal crystalline structure of ZnO(A) and (B) NPs. Results of antibacterial activity illustrated that ZnO(B) NPs showed its potential against Pseudomonas aeruginosa, ESBL-1, ESBL-2 and EBSL-3. Antibiofilm studies revealed that ZnO(B) NPs exhibited optimum decline in MRSA biofilm formation than ZnO(A) NPs. In addition, ZnO(B) NPs showed potent cytotoxic effect against lung cancer cell lines A549 with IC 50 of 35.16 ± 0.10 μg/mL in comparison with ZnO(A) NPs (IC 50- 55.09 ± 0.30 μg/mL). Overall, the results revealed that biogenic synthesis of ZnO NPs ensures its biosafety level and enhanced biological activity when compared to chemical synthesis method., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

A new ferrocene appended linear donor-π-acceptor (D-π-A) type 1,8-naphthalimide chromophores [FcPhNap-n-butyl (1) and Fc(Ph) 2 Nap-n-butyl (2)] have been synthesized and characterized using various analytical and spectroscopic techniques. The chromophores 1 and 2 show the one-electron transfer process, which was examined through cyclic voltammetric (CV) method. The solvatochromic studies show red shift by increasing the solvent polarity from non-polar to polar for both the chromophores 1 and 2, due to the better stabilization of the more polarized excited state than the ground state in the polar solvent. The fluorescence studies show low fluorescence emission, which was enhanced by aggregation in THF/water mixture when the water ratio is increased upto 60%, due to the restricted intramolecular rotation (RIR) process in the aggregated state. Also, the quantum yield increases 3.4 (1) and 6.8 (2) times in the aggregation induced enhanced emission (AIEE) state than THF solution for both the chromophores [THF/AIEE = 0.05/0.17 for 1 and 0.03/0.22 for 2]. The second-order non-linear optical properties of the chromophores 1 and 2 were studied using Kurtz and Perry powder technique, chromophore 2 shows 1.2 times higher SHG efficiency than 1, owing to the presence of additional phenyl group in 2, which further supports the effective charge transfer process from donor to acceptor. Furthermore, optical and non-linear optical properties of chromophores 1 and 2 were analyzed by DFT/TD-DFT calculations using different functionals (B3LYP, long-range corrected CAM-B3LYP and LC-BLYP) with 6-31+G** level of theory. The B3LYP functional shows higher hyperpolarizability values [β 0  = 109.2 × 10 -30 esu (1), 299.7 × 10 -30 esu (2)], due to the overestimation of the dipole moment, polarizability and hyperpolarizabilities between the donor-π-acceptor systems in B3LYP-hybrid functional, which leads to incorrect long-range charge transfer., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Aims: To assess whether incorporating a machine learning (ML) method for accurate prediction of postoperative anterior chamber depth (ACD) improves the refraction prediction performance of existing intraocular lens (IOL) calculation formulas., Methods: A dataset of 4806 patients with cataract was gathered at the Kellogg Eye Center, University of Michigan, and split into a training set (80% of patients, 5761 eyes) and a testing set (20% of patients, 961 eyes). A previously developed ML-based method was used to predict the postoperative ACD based on preoperative biometry. This ML-based postoperative ACD was integrated into new effective lens position (ELP) predictions using regression models to rescale the ML output for each of four existing formulas (Haigis, Hoffer Q, Holladay and SRK/T). The performance of the formulas with ML-modified ELP was compared using a testing dataset. Performance was measured by the mean absolute error (MAE) in refraction prediction., Results: When the ELP was replaced with a linear combination of the original ELP and the ML-predicted ELP, the MAEs±SD (in Diopters) in the testing set were: 0.356±0.329 for Haigis, 0.352±0.319 for Hoffer Q, 0.371±0.336 for Holladay, and 0.361±0.331 for SRK/T which were significantly lower (p<0.05) than those of the original formulas: 0.373±0.328 for Haigis, 0.408±0.337 for Hoffer Q, 0.384±0.341 for Holladay and 0.394±0.351 for SRK/T., Conclusion: Using a more accurately predicted postoperative ACD significantly improves the prediction accuracy of four existing IOL power formulas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To develop a method for accurate automated real-time identification of instruments in cataract surgery videos., Methods: Cataract surgery videos were collected at University of Michigan's Kellogg Eye Center between 2020 and 2021. Videos were annotated for the presence of instruments to aid in the development, validation, and testing of machine learning (ML) models for multiclass, multilabel instrument identification., Results: A new cataract surgery database, BigCat, was assembled, containing 190 videos with over 3.9 million annotated frames, the largest reported cataract surgery annotation database to date. Using a dense convolutional neural network (CNN) and a recursive averaging method, we were able to achieve a test F1 score of 0.9528 and test area under the receiver operator characteristic curve of 0.9985 for surgical instrument identification. These prove to be state-of-the-art results compared to previous works, while also only using a fraction of the model parameters of the previous architectures., Conclusions: Accurate automated surgical instrument identification is possible with lightweight CNNs and large datasets. Increasingly complex model architecture is not necessary to retain a well-performing model. Recurrent neural network architectures add additional complexity to a model and are unnecessary to attain state-of-the-art performance., Translational Relevance: Instrument identification in the operative field can be used for further applications such as evaluating surgical trainee skill level and developing early warning detection systems for use during surgery.

Background: Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation., Case Presentation: A 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery., Conclusion: To our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL., (© 2021. The Author(s).)

A series of new β-ketoimines containing a ferrocene moiety and their BF 2 complexes have been synthesized and structurally characterized. The solvatochromism of the β-ketoimines was studied, putting in evidence a redshift with increasing solvent polarity. This positive solvatochromism can be attributed to a more polarized excited state compared with the ground state, due to intramolecular charge transfer (ICT) transitions. The β-ketoimines exhibited weak emission, attributable to the excited-state intramolecular proton transfer (ESIPT) phenomenon. This ESIPT effect is suppressed upon restriction of the keto-enamine tautomerism, induced upon addition of BF 3 ⋅OEt 2 , which afforded the related BF 2 complexes, characterized by an enhancement of the fluorescence through the ICT effect. Both the β-ketoimines and BF 2 complexes exhibited significant aggregation-induced emission behavior in mixtures of CH 3 CN/H 2 O, due to restriction of intramolecular rotation in the aggregated state. The frontier molecular orbital levels, ground- and excited-state dipole moments (μ g and μ e ), and the origin of electronic absorption spectra were studied by time-dependent DFT calculations. The second-order nonlinear optical (NLO) properties were determined by the electric-field-induced second-harmonic generation technique. The μβ 1907 values of the β-ketoimines increased upon the formation of the related BF 2 complexes, mainly due to an enhancement of the ground-state dipole moment. The results presented here reveal that some of these novel compounds are excellent multifunctional candidates for NLO and luminescence applications., (© 2021 Wiley-VCH GmbH.)

Objectives: To evaluate gender differences in optical biometry measurements and lens power calculations., Methods: Eight thousand four hundred thirty-one eyes of five thousand five hundred nineteen patients who underwent cataract surgery at University of Michigan's Kellogg Eye Center were included in this retrospective study. Data including age, gender, optical biometry, postoperative refraction, implanted intraocular lens (IOL) power, and IOL formula refraction predictions were gathered and/or calculated utilizing the Sight Outcomes Research Collaborative (SOURCE) database and analyzed., Results: There was a statistical difference between every optical biometry measure between genders. Despite lens constant optimization, mean signed prediction errors (SPEs) of modern IOL formulas differed significantly between genders, with predictions skewed more hyperopic for males and myopic for females for all 5 of the modern IOL formulas tested. Optimization of lens constants by gender significantly decreased prediction error for 2 of the 5 modern IOL formulas tested., Conclusions: Gender was found to be an independent predictor of refraction prediction error for all 5 formulas studied. Optimization of lens constants by gender can decrease refraction prediction error for certain modern IOL formulas.

Alzheimer's disease (AD) is a multifaceted neuronal disorder and a challenge to medical practitioners, as the blood-brain barrier (BBB) acts as a major obstacle for drug delivery to the brain. Development of a nanomaterial-based drug delivery system (DDS) paved a way to penetrate the BBB. Starch, a ubiquitous natural biopolymer, has received much attention as a DDS due to its biocompatibility, biodegradability and eco-friendly nature. The present study focuses on encapsulating methyl gallate (MG) within starch nanoparticles (starch-encapsulated MG (SEMG)) and assesses its neuroprotective potential against β-amyloid (Aβ)-induced toxicity, the key factor for AD pathogenesis in Neuro2A cells. SEMG showed potent acetylcholinesterase inhibitory, antioxidant activity and anti-amyloidogenic activity by attenuating the fibrillation of Aβ and destabilizing the preformed mature fibrils. Furthermore, SEMG also attenuated the cytotoxic effect induced by Aβ in Neuro2A cells (50% inhibitory concentration 18.25 ± 0.025 μg/mL) by mitigating reactive oxygen species (ROS)-mediated macromolecular damage, restoring mitochondrial membrane potential and attenuating apoptosis. Characterization of SEMG revealed amorphous rock-shaped structure with average particle size of 264.6 nm, exhibiting 83% loading efficiency and sustained release of drug, with 73% release within 24 h at physiological pH. Overall, the outcome of the present study signifies starch as a promising nanocarrier for the delivery of drugs for the treatment of AD.

Purpose: To develop a method for predicting postoperative anterior chamber depth (ACD) in cataract surgery patients based on preoperative biometry, demographics, and intraocular lens (IOL) power., Methods: Patients who underwent cataract surgery and had both preoperative and postoperative biometry measurements were included. Patient demographics and IOL power were collected from the Sight Outcomes Research Collaborative (SOURCE) database. A gradient-boosting decision tree model was developed to predict the postoperative ACD. The mean absolute error (MAE) and median absolute error (MedAE) were used as evaluation metrics. The performance of the proposed method was compared with five existing formulas., Results: In total, 847 patients were assigned randomly in a 4:1 ratio to a training/validation set (678 patients) and a testing set (169 patients). Using preoperative biometry and patient sex as predictors, the presented method achieved an MAE of 0.106 ± 0.098 (SD) on the testing set, and a MedAE of 0.082. MAE was significantly lower than that of the five existing methods ( P < 0.01). When keratometry was excluded, our method attained an MAE of 0.123 ± 0.109, and a MedAE of 0.093. When IOL power was used as an additional predictor, our method achieved an MAE of 0.105 ± 0.091 and a MedAE of 0.080., Conclusions: The presented machine learning method achieved greater accuracy than previously reported methods for the prediction of postoperative ACD., Translational Relevance: Increasing accuracy of postoperative ACD prediction with the presented algorithm has the potential to improve refractive outcomes in cataract surgery., Competing Interests: Disclosure: T. Li, None; K. Yang, None; J.D. Stein, None; N. Nallasamy, None, (Copyright 2020 The Authors.)

Aims: To assess whether incorporating a machine learning (ML) method for accurate prediction of postoperative anterior chamber depth (ACD) improves the refraction prediction performance of existing intraocular lens (IOL) calculation formulas., Methods: A dataset of 4806 cataract patients were gathered at the Kellogg Eye Center, University of Michigan, and split into a training set (80% of patients, 5761 eyes) and a testing set (20% of patients, 961 eyes). A previously developed ML-based method was used to predict the postoperative ACD based on preoperative biometry. This ML-based postoperative ACD was integrated into new effective lens position (ELP) predictions using regression models to rescale the ML output for each of four existing formulas (Haigis, Hoffer Q, Holladay, and SRK/T). The performance of the formulas with ML-modified ELP was compared using a testing dataset. Performance was measured by the mean absolute error (MAE) in refraction prediction., Results: When the ELP was replaced with a linear combination of the original ELP and the ML-predicted ELP, the MAEs ± SD (in Diopters) in the testing set were: 0.356 ± 0.329 for Haigis, 0.352 ± 0.319 for Hoffer Q, 0.371 ± 0.336 for Holladay, and 0.361 ± 0.331 for SRK/T which were significantly lower than those of the original formulas: 0.373 ± 0.328 for Haigis, 0.408 ± 0.337 for Hoffer Q, 0.384 ± 0.341 for Holladay, and 0.394 ± 0.351 for SRK/T., Conclusion: Using a more accurately predicted postoperative ACD significantly improves the prediction accuracy of four existing IOL power formulas.

Purpose: To report a case of corneal epithelial plaque formation associated with recombinant human nerve growth factor (cenegermin 0.002%; Oxervate, Dompe[Combining Acute Accent] US Inc., Boston, MA), an as-yet unreported adverse event., Methods: A case report and review of literature., Results: A 45-year-old woman presented with a nonhealing 3.25- × 4.25-mm corneal epithelial defect secondary to multifactorial neurotrophic keratitis in the right eye. The epithelial defect was resistant to maximal medical therapy, and so cenegermin 0.002% was initiated, resulting in resolution of the corneal epithelial defect. After 6.5 weeks of treatment, she developed an unusual corneal epithelial plaque, decreased visual acuity, and eye pain. Cenegermin was ceased, after which the lesion resolved, visual acuity improved, and eye pain resolved., Conclusions: Cenegermin 0.002% has emerged as a promising treatment for neurotrophic keratitis. Reported adverse events with this agent have been minor and typically not vision threatening. Here, we describe corneal epithelial plaque formation as a visually significant adverse event that resolved with cessation of cenegermin 0.002%. Although the underlying mechanism is unknown, clinicians should be alerted to the possibility of epithelial plaque formation in patients being treated with recombinant human nerve growth factor for neurotrophic keratitis.

Purpose: Intravenous antibiotic prophylaxis is used for many clean-contaminated surgeries or clean surgeries with an implant, but its value for clean orbital surgery has not been determined. This study investigated infection risks and adverse effects related to antibiotics in patients undergoing orbital surgery., Methods: A prospective, nonrandomized comparative case series of all patients undergoing orbital surgery with participating surgeons between October 1, 2013, and March 1, 2015. Types of surgery, antibiotic regimens, corticosteroid use, antibiotic side effects, and surgical site infections (SSIs) were entered into an electronic database and subsequently analyzed. Cases in which patients received postoperative oral antibiotics were analyzed separately., Results: Of 1,250 consecutive orbital surgeries, 1,225 met inclusion criteria. A total of 1208 patients were included in the primary analysis: 603 received no antibiotic prophylaxis (group A), and 605 received a single dose of intravenous antibiotic (group B). Five patients (0.42%) developed an SSI, 3 in group A and 2 in group B. The difference in SSI rates was not statistically significant between the 2 groups (p = 0.66). Antibiotic prophylaxis, alloplastic implants, paranasal sinus entry, and corticosteroid use were not associated with differences in SSI rates. All SSIs resolved on a single course of oral antibiotics; an implant was removed in 1 case. There were no complications associated with a single dose of intravenous prophylaxis. However, 12% of 17 patients (group C) who received 1 week of oral postoperative prophylactic antibiotics developed antibiotic-related complications (diarrhea, renal injury), yielding a number needed to harm of 8.5., Conclusions: In this large series, antibiotic prophylaxis does not appear to have reduced the already low incidence of SSI following orbital surgery. Given the detriments of systemic antibiotics, the rarity of infections related to orbital surgery, and the efficacy of treating such infections should they occur, patients undergoing orbital surgery should be educated to the early symptoms of postoperative infection and followed closely, but do not routinely require perioperative antibiotics.

New Y-shaped ferrocene and non-ferrocene conjugated quinoxaline derivatives {[R-(CH) 2 -N=CH-) 2 C 10 H 4 ], R = C 5 H 5 -Fe-C 5 H 5 (1) and R = C 6 H 4 -OCH 3 (2)} have been synthesized and characterized using analytical and spectroscopic techniques. The thermal stability of the compounds 1 and 2 were examined by thermogravimetric analysis (TGA), both were stable up to 250 °C. The optical properties were studied using UV-Visible and fluorescence spectroscopic methods and Y-shaped ferrocene appended quinoxaline derivative 1 show a weak emission due to the quenching nature of ferrocene. The compound 2 shows enhanced fluorescence intensity in their aggregation state due to Restricted Intramolecular Rotation (RIR). Hence, the compound 2 have further utilized for the detection of picric acid (PA) by fluorimetric method and the detection limit of 1.37 × 10 -6  M was obtained. Further, paper sensor was made using compound 2 which resulted in the instant 'naked eye' response for trace detection of picric acid. Consequently, the compound 2 acts as a colorimetric sensor and can be used as a new probe for the detection of nitro aromatic explosives., (Copyright © 2019 Elsevier B.V. All rights reserved.)

New Y-shaped ferrocene conjugated imidazole chromophores were prepared and fully characterized. The Y-shaped structure was confirmed by the single crystal X-ray diffraction technique. The chromophores show interesting second-order nonlinear optical (NLO) properties in solution, as determined by the Electric-Field Induced Second Harmonic generation (EFISH) technique. Remarkably, the trifluoro substituted compound 3 is characterized by a high μβEFISH value and has good potential as a molecular building block for composite films with Second Harmonic Generation (SHG) properties. For all compounds, the dipole moments and frontier orbital energies were calculated by the Density Functional Theoretical method.

Purpose: The purpose of this study was to evaluate patterns of vascular and lung parenchymal enhancement in patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH) and in those with acute pulmonary embolism (PE) and compare those two groups., Materials and Methods: We retrospectively studied 186 thoracic DECT studies referred for evaluation of CTEPH or pulmonary hypertension. A total of 80 of these patients had a negative scan (control group), 13 had acute PE, and 53 had chronic thromboembolic disease (CTED)/CTEPH. Five different DECT-based parameters were evaluated that highlight patterns of vascular kinetics. Specifically, total DECT-based parenchymal attenuation in Hounsfield Unit (HU) (LungHU), percentage of perfused blood volume (PBV), peak enhancement of main pulmonary artery (PApeak in HU), maximum enhancement corresponding to 100 (PAmax), and the ratio of PApeak to LungHU were calculated., Results: Compared with patients with negative CT, patients with CTED/CTEPH tended to have lower LungHU (median: 27 vs. 38, P<0.001), lower PBV (median: 39 vs. 51, P=0.003), and higher PApeak/LungHU ratio (median: 17 vs. 13, P=0.003). Compared with patients with acute PE, patients with CTED/CTEPH tended to have lower LungHU (median: 27 vs. 39, P=0.006), lower PBV (median: 39 vs. 62, P=0.023), and higher PApeak/LungHU ratio (median: 17 vs. 11, P=0.023). No statistically significant differences were observed between patients with acute PE and those with negative CT., Conclusions: DECT-based vascular parameters offer the potential to differentiate patients with acute versus chronic PE. These various anatomic and functional vascular DECT-based parameters might be reflective of the state of the underlying vascular bed.

Epithelial-to-mesenchymal transition (EMT) is an orchestrated event where epithelial cells progressively undergo biochemical changes and transition into mesenchymal-like cells by gradually losing their epithelial characteristics. EMT plays a crucial pathologic role in renal abnormalities, especially renal fibrosis. A number of bench studies suggest the potential involvement of renin-angiotensin-aldosterone system (RAAS) in renal EMT process and associated renal abnormalities. EMT appears to be an important pathologic mechanism for the deleterious renal effects of angiotensin II and aldosterone, the two major RAAS components. Mechanistically, the renal RAAS-TGF-β-Smad3 signalling pathway plays an important pathologic role in EMT-associated renal abnormalities. Intriguingly, the RAAS antagonists such as losartan, telmisartan, eplerenone, and spironolactone have the potential to prevent renal EMT in bench studies. This review describes the key mechanistic role of RAAS overactivation in EMT-induced renal abnormalities. Moreover, drugs interrupting the RAAS at different levels in the cascade ameliorating the EMT-associated renal abnormalities are described., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The activation of peroxisome proliferator-activated receptor α (PPARα) is a key pharmacological drug target for dyslipidemic management. Dyslipidemia is associated with abnormal serum lipid profiles viz. elevated total cholesterol, high triglyceride, elevated low-density lipoprotein cholesterol, and reduced high-density lipoprotein cholesterol levels. Fenofibrate, a third-generation fibric acid derivative, is an activator of PPARα indicated for the treatment of mixed dyslipidemia and hypertriglyceridemia in adults. Fenofibrate is considered an important lipid-lowering medication employed in patients afflicted with atherogenic dyslipidemia. Intriguingly, recent bench studies have demonstrated an array of cardiovascular and renal pleiotropic beneficial activities of fenofibrate, besides its foremost lipid-lowering action. The activation of PPARα by fenofibrate could negatively regulate the cardiomyocyte hypertrophy. In addition, fenofibrate has been suggested to have a protective effect against experimental ischemia/reperfusion injury in the myocardium in part via endoplasmic reticulum stress inhibition. Fenofibrate has also been shown to suppress arrhythmias in isolated rat hearts subjected to ischemic/reperfusion-induced cardiac injury. Moreover, in a rat model of metabolic syndrome and myocardial ischemia, fenofibrate therapy has been shown to restore antioxidant protection and improve myocardial insulin resistance. Furthermore, studies have highlighted the pleiotropic vascular endothelial protective and antihypertensive actions of fenofibrate. Interestingly, recent bench studies have demonstrated renoprotective actions of fenofibrate by implicating diverse mechanisms. This review sheds light on the current perspectives and molecular mechanistic aspects pertaining to the cardiovascular pleiotropic actions of fenofibrate. Additionally, the renal pleiotropic actions of fenofibrate by focusing its possible modulatory role on renal fibrosis, inflammation and renal epithelial-to-mesenchymal transition have been enlightened., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Strabismus is common in children after glaucoma drainage device (GDD) implantation, but the risk factors for postoperative strabismus remain speculative. The purpose of this study was to investigate possible risk factors for strabismus following GDD implantation for refractory childhood glaucoma., Methods: The medical records of consecutive patients who underwent GDD implantation for refractory childhood glaucoma at Duke Eye Center from 2005 to 2016 were reviewed retrospectively. Pre- and postoperative motility and alignment, best-corrected visual acuity, and demographic and surgical data were extracted from the record for analysis., Results: A total of 81 patients (mean age, 7.9 ± 4.8 years) met inclusion criteria. The most common glaucoma type was glaucoma following cataract surgery (GFCS), and the most common GDD was a Baerveldt 250 mm 2 device. Before GDD surgery, 38 patients (47%) had documented strabismus. After GDD implantation, 25 (31%) had new or worsened strabismus, with vertical (16% of new/worsened), horizontal strabismus (exotropia, 48% of new/worsened; esotropia, 12% of new/worsened) and vertical and horizontal (24% of new/worsened) noted. New motility limitation occurred in 32 of 81 (40%) patients. Risk factors including age, type/location/number of GDD, revision, motility limitation, glaucoma type, asymmetric visual acuity, and visual impairment were not significantly associated with new or worsened post-GDD strabismus., Conclusions: Children with refractory childhood glaucoma are at high risk for strabismus, which increases after GDD implantation; this study identified no clear risk factors for new or worsened post-GDD strabismus., (Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

The Carbon nanotubes (CNT) are potential candidate for many biomedical applications especially in targeted drug delivery for cancer diseases. However, the use of CNT has limitations due to its insolubility in aqueous media. The self-assembly of cyclic peptide encased on the CNT has enhanced its dispersion in aqueous medium which extend their applications as antibacterial and drug delivery agents. To understand this process, an attempt has been made to investigate the dynamics and stability of trimer cyclic peptide encasing with CNT using classical molecular dynamics. The model cyclic peptide monomer constitutes 14 series of amino acids viz.; (cyclo-[(D-ARG-L-VAL-D-ARG-L-THR-D-AGR-L-LYS-D-GLY-L-ARG-D-ARG-L-ILE-D-ARG-L-ILE-D-PRO-L-PRO)]). Each cyclic peptide in the assembly stacking far apart at approximately 15 Å each other beyond hydrogen bond cut-off distance. The trimer was observed to be stable only over 10 ns of entire MD trajectory. But when there is electrostatic interaction between cyclic peptides at 6.5 Å distance then assembly is stable for entire 50 ns. Our result reveals that for a stable assembly, beyond the hydrogen bond cut-off distance, the electrostatic interaction plays significant role.

Purpose: To assess the relationship between use of a hydrogel ocular sealant (Resure) to secure clear corneal incisions (CCIs) in cataract surgery and surgeon efficiency, patient symptomatology, and postoperative results., Setting: Duke University Eye Center, Durham, North Carolina, USA., Design: Retrospective case series., Methods: A 1:1 matched cohort of hydrogel sealant exposure-discordant eyes of cataract surgery patients was retrospectively generated. Consecutive patients who had bilateral cataract surgery during the study period and in whom the hydrogel sealant was used to secure the CCI in only 1 of the 2 eyes were included in the study. The relationship between use of the hydrogel sealant and surgical time, 1-day postoperative foreign-body sensation, clinically noted corneal edema, and intraocular pressure (IOP) was evaluated., Results: Ninety eyes of 45 patients were included in the study. One day postoperatively, no wound leak was found in any eye; the sealant was noted to be out of place in 2 (4.4%) of 45 cases. No statistically significant difference was found between sealant and non-sealant eyes in total surgical time (P = .16) or in IOP (P = .55), corneal edema (P = 1.00), or foreign-body sensation (P = .38) 1 day postoperatively., Conclusion: The hydrogel sealant was not observed to affect duration of surgery or 1-day postoperative IOP, corneal edema, or foreign-body sensation., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Retinal astrocytic hamartomas (RAH) are the most frequent ocular manifestation of tuberous sclerosis complex and are usually indolent, requiring only observation. We report an aggressive RAH subtype in a child unresponsive to anti-VEGF and laser therapy. Treatment with systemic everolimus was well-tolerated and significantly reduced ocular (and nonocular) tumor size and fluid exudation., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

A convenient synthesis of a library of tetrazoles through a novel and operationally simple protocol effecting the direct conversion of arylboronic acids catalyzed by a new ONO pincer-type Pd(II) complex under mild reaction conditions using the readily available reagents is reported. The palladium complex was reused up to four cycles in an open-flask condition.

The first example of a Y-shaped ferrocene quinoxaline derivative with a surprisingly high and stable second harmonic generation (SHG) response in composite polymeric films is reported. The interesting quadratic hyperpolarizability values of different substituted Y-shaped chromophores are also investigated in solution by the EFISH technique.

Background/aims: In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A)., Methods: This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15 days and 2, 3 and 4 months., Results: 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98 mm, 122.09±39.37 mm 2 , 44.99±1.45 D and 0.9±0.64 D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm, 67.68±28.49 mm 2 , 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15 days (8.36±1.91 mm and 115.92±34.44 mm 2 , respectively), 2 months (8.18±1.80 mm and 112.22±33.57 mm 2 , respectively) and 3 months (7.27±1.65 mm and 95.48±27.80 mm 2 , respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D and 1.36±1.31 D, respectively) after treatment., Conclusions: The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvature assessed with Scheimpflug (Pentacam) and Placido (Atlas) systems., Setting: Federal University of São Paulo, São Paulo, Brazil., Design: Prospective interventional case series., Methods: Patients with hemifacial spasm were evaluated. Steep keratometry (K) and corneal astigmatism (magnitudes and treatment-induced astigmatism) obtained with the Placido and Scheimpflug systems were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months., Results: The study evaluated 48 eyes (24 affected and 24 normal contralateral eyes) of 24 patients. The mean steep K and astigmatism values obtained with the Placido system on the affected side before treatment were 46.91 diopters (D) ± 3.57 (SD) and 2.63 ± 2.46 D, respectively. A significant decrease in steep K (45.14 ± 1.20 D) and astigmatism (1.01 ± 0.58 D) was observed 2 months (P = .003 and P = .0004, respectively) and 3 months (45.64 ± 1.77 D and 1.36 ± 1.31 D, respectively) (P = .03 and P = .01, respectively) after treatment. The Scheimpflug system did not show significant changes in steep K measurements during the 4-month period. The mean astigmatism in the affected eye before treatment was 1.27 ± 0.88 D. A significant reduction was observed at 15 days (1.16 ± 1.16 D) and at 4 months (0.91 ± 0.59 D) (P = .02 and P = .03, respectively)., Conclusion: The Placido system was more sensitive in detecting a temporary reduction in corneal curvature after eyelid-spasm treatment., Financial Disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

A set each of new bivalent and trivalent ruthenium complexes, [Ru(III)(HL)Cl2(EPh3)2] and [Ru(II)(L)(CO)(EPh3)2] (E = P (complexes and ) or As (complexes and )) were synthesised from the reactions of [Ru(III)Cl3(EPh3)3] with 2-hydroxynaphthaldehyde benzoic acid hydrazone (H2L) in methanol-chloroform and characterized by elemental analysis, spectral data and XRD study. A suitable mechanism to account for the formation of bivalent ruthenium carbonyl complexes from the corresponding trivalent precursors is provided by considering the role of added base in the reaction. Interaction of complexes with CT-DNA/bovine serum albumin was analysed with absorption and emission spectral titration studies. In vitro cytotoxic potential of the above ruthenium hydrazone complexes assayed against the A549 cell line revealed a significant growth inhibition. The test complexes added in IC50 concentration into the cell culture medium enhanced the release of lactate dehydrogenase, NO and reactive oxygen species in comparison with the control. Cell death induced by the complexes was studied using a propidium iodide staining assay and showed noticeable changes in the cell morphology which resembled apoptosis.