Cornea

Diabetes Mellitus Type 1 has a Higher Impact on Corneal Endothelial Cell Density and Pachymetry than Diabetes Mellitus Type 2, Independent of Age: A Meta-Regression Model

imagePurpose:

Patients with diabetes mellitus (DM) often have keratopathy. However, the compromise of the corneal endothelium in type 1 DM (T1DM) and type 2 DM (T2DM) has so far not been well characterized.

Methods:

We performed a systematic literature search to find articles on humans combining T1DM and/or T2DM and the corneal endothelium. The period was from inception to June 2020. The meta-regression evaluated the role of each type of DM on corneal endothelial cell density (CED) and pachymetry. The statistical models included age as a modulator to discriminate between the normal changes due to age and the effect of the disease and to determine the impact of the disease duration.

Results:

The initial search identified 752 records, of which 17 were included in the meta-regression. Patients with T1DM had, on average, 193 cells/mm2 lesser than control patients (P

By , ago

Development and Validation of a Model to Predict Anterior Segment Vision-Threatening Eye Disease Using Primary Care Clinical Notes

imagePurpose:

The purpose of this study was to develop a decision-support tool to predict anterior segment vision-threatening disease (asVTD) to aid primary care physicians (PCPs) with patient triage and referral.

Methods:

The University of Michigan electronic health record data between January 1, 2016, and May 31, 2019, were obtained from patients presenting to a PCP with anterior eye symptoms and then saw an ophthalmologist within 30 days. asVTD included diagnosis of corneal ulcer, iridocyclitis, hyphema, anterior scleritis, or scleritis with corneal involvement by an ophthalmologist. Elastic net logistic regression with 10-fold cross-validation was used for prediction modeling of asVTD. Predictors evaluated included patient demographics and PCP notes processed using clinical natural language processing software (clinspacy).

Results:

Two thousand nine hundred forty-two patients met the inclusion criteria, of which 133 patients (4.5%) had asVTD. The age was significantly lower among those with asVTD versus those without (median = 42 vs. 53 yrs, P

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Trends in the Microbiological Spectrum of Nonviral Keratitis at a Single Tertiary Care Ophthalmic Hospital in India: A Review of 30 years

imagePurpose:

The aims of this study were to assess the trends in microorganisms from patients with infectious keratitis and to assess their antibiogram patterns at a tertiary eye care center in India.

Methods:

In this retrospective observational case series, microbiological records of all corneal ulcers were reviewed from 1991 to 2020 and assessed for trends in keratitis and antibiotic susceptibility using the χ2 test.

Results:

Of the total of 51,747 patients, 51.13% were culture positive. A decrease in bacteria was noted from 56% to 38%, with a parallel increase in fungal isolates from 24% to 51%. Gram-positive bacteria accounted for 70.8% of the total bacteria, a trend in rise of Streptococcus pneumoniae (31%) and a decreasing trend in prevalence of Staphylococcus epidermidis was observed over 30 years. Pseudomonas aeruginosa (55.5%) was the most prevalent gram-negative pathogen, whereas Fusarium spp. (33.1%) and Aspergillus spp. (32.4%) were the most common fungal isolates. The susceptibility of gram-positive organisms to cefazolin decreased from 95.5% to 66% (P = 0.0001), amikacin from 88% to 55% (P= 0.0001), and vancomycin from 98.9% to 90.7% (P

By , ago