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Pepin F, Sims JL, Niederer RL. Diabetes Mellitus Related Anterior Uveitis - An Overlooked Clinical Entity. Ocul Immunol Inflamm 2024; 32:1061-1064. [PMID: 37126639 DOI: 10.1080/09273948.2023.2203204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND This study aimed to evaluate the characteristics of anterior uveitis in patients presenting with poorly controlled diabetes mellitus and with no other identifiable cause for their uveitis. METHODS A retrospective study of 121 eyes in 89 patients who presented at Auckland District Health Board with idiopathic acute anterior uveitis and uncontrolled diabetes between September 2009 and January 2022. RESULTS The diagnosis of diabetes mellitus was known prior to presentation in 80 subjects (89.9%) and was discovered as a result of screening tests in the remainder. Mean HbA1c at presentation was 117.3 mmol/mol. Most uveitis was severe with 3+ (30 eyes, 25.4%) or 4+ cells (30 eyes, 25.4%) in the anterior chamber. Recurrence occurred in 22 eyes (18.2%) and was associated with elevated HbA1c. The visual prognosis was good with median visual acuity at 12 months of 6/7.5. CONCLUSION Poorly controlled diabetes can be associated with acute anterior uveitis.
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Affiliation(s)
- Francois Pepin
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Joanne L Sims
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
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Shapiro JN, Armenti ST, Levine H, Hood CT, Mian SI. Dexamethasone Intracanalicular Insert versus Standard Topical Steroids for the Prophylaxis of Inflammation after Cataract Surgery. Am J Ophthalmol 2024:S0002-9394(24)00322-2. [PMID: 39089352 DOI: 10.1016/j.ajo.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE To compare the efficacy of an intracanalicular dexamethasone intracanalicular insert (DII) to a topical prednisolone acetate 1% taper for preventing breakthrough inflammation (iritis or cystoid macular edema) during the first post-operative month (POM1) after cataract surgery DESIGN: Retrospective, non-randomized comparative interventional study METHODS: Patients received either DII or topical prednisolone acetate 1% eyedrops (control) during POM1. Exclusion criteria included history of iritis, glaucoma, intraoperative posterior capsular rupture or vitreous prolapse, immediate postoperative anterior chamber inflammation requiring treatment, or less than 1 month follow up post-operatively. Outcomes included development of breakthrough inflammation after >3 days postoperatively necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1. RESULTS 266 eyes of 174 patients were included in the DII group, and 258 eyes of 167 patients in the control group. Demographics, comorbidities, and baseline IOP were comparable between groups. The breakthrough inflammation rate was significantly higher in the DII group compared to control (9.0% vs 3.1%; p < .01); cystoid macular edema rates were similar between groups (4.9% vs 4.3%; p = .75). There were no cases of increased IOP >10mmHg at POM1 compared to baseline in either group. CONCLUSION After cataract surgery, DII demonstrated a higher rate of breakthrough inflammation than a standard topical steroid regimen with no significant differences in CME rate or IOP increase; however, overall, the rate of postoperative complications was low. DII can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery.
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Affiliation(s)
- Jeremy N Shapiro
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen T Armenti
- Scheie Eye Institute and Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harry Levine
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher T Hood
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Shahzad I Mian
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.
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Meinert E, Milne-Ives M, Lim E, Higham A, Boege S, de Pennington N, Bajre M, Mole G, Normando E, Xue K. Accuracy and safety of an autonomous artificial intelligence clinical assistant conducting telemedicine follow-up assessment for cataract surgery. EClinicalMedicine 2024; 73:102692. [PMID: 39050586 PMCID: PMC11266473 DOI: 10.1016/j.eclinm.2024.102692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024] Open
Abstract
Background Artificial intelligence deployed to triage patients post-cataract surgery could help to identify and prioritise individuals who need clinical input and to expand clinical capacity. This study investigated the accuracy and safety of an autonomous telemedicine call (Dora, version R1) in detecting cataract surgery patients who need further management and compared its performance against ophthalmic specialists. Methods 225 participants were recruited from two UK public teaching hospitals after routine cataract surgery between 17 September 2021 and 31 January 2022. Eligible patients received a call from Dora R1 to conduct a follow-up assessment approximately 3 weeks post cataract surgery, which was supervised in real-time by an ophthalmologist. The primary analysis compared decisions made independently by Dora R1 and the supervising ophthalmologist about the clinical significance of five symptoms and whether the patient required further review. Secondary analyses used mixed methods to examine Dora R1's usability and acceptability and to assess cost impact compared to standard care. This study is registered with ClinicalTrials.gov (NCT05213390) and ISRCTN (16038063). Findings 202 patients were included in the analysis, with data collection completed on 23 March 2022. Dora R1 demonstrated an overall outcome sensitivity of 94% and specificity of 86% and showed moderate to strong agreement (kappa: 0.758-0.970) with clinicians in all parameters. Safety was validated by assessing subsequent outcomes: 11 of the 117 patients (9%) recommended for discharge by Dora R1 had unexpected management changes, but all were also recommended for discharge by the supervising clinician. Four patients were recommended for discharge by Dora R1 but not the clinician; none required further review on callback. Acceptability, from interviews with 20 participants, was generally good in routine circumstances but patients were concerned about the lack of a 'human element' in cases with complications. Feasibility was demonstrated by the high proportion of calls completed autonomously (195/202, 96.5%). Staff cost benefits for Dora R1 compared to standard care were £35.18 per patient. Interpretation The composite of mixed methods analysis provides preliminary evidence for the safety, acceptability, feasibility, and cost benefits for clinical adoption of an artificial intelligence conversational agent, Dora R1, to conduct follow-up assessment post-cataract surgery. Further evaluation in real-world implementation should be conducted to provide additional evidence around safety and effectiveness in a larger sample from a more diverse set of Trusts. Funding This manuscript is independent research funded by the National Institute for Health Research and NHSX (Artificial Intelligence in Health and Care Award, AI_AWARD01852).
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Affiliation(s)
- Edward Meinert
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Madison Milne-Ives
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Ernest Lim
- Ufonia Limited, 104 Gloucester Green, Oxford, UK
- Imperial College Healthcare NHS Trust, Western Eye Hospital, London, UK
- Department of Computer Science, University of York, York, UK
| | - Aisling Higham
- Ufonia Limited, 104 Gloucester Green, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Selina Boege
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | | | - Mamta Bajre
- Oxford Academic Health Science Network, Oxford Science Park, Robert Robinson Ave, Oxford, UK
| | - Guy Mole
- Ufonia Limited, 104 Gloucester Green, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Eduardo Normando
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Kanmin Xue
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Rabiee B, Festok M, Gaspari M, Haseeb A, Chaudhry A, Kamoun L, Chaudhry I, Chaudhry I. Combinative approach of transzonular triamcinolone-moxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery. Int J Ophthalmol 2024; 17:845-851. [PMID: 38766326 PMCID: PMC11074209 DOI: 10.18240/ijo.2024.05.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/02/2024] [Indexed: 05/22/2024] Open
Abstract
AIM To investigate the effectiveness of combination therapy with transzonular triamcinolone-moxifloxacin and conventional perioperative drops in reducing postoperative complications of cataract surgery. METHODS Electronic medical records of cataract surgery patients (single surgeon) were reviewed from January 2018 to September 2021. The rate of postoperative complications including prolonged and/or recurrent postoperative inflammation, endophthalmitis, cystoid macular edema (CME), and intraocular pressure (IOP) was compared between the patients receiving combinative therapy and patients receiving drops only. RESULTS Totally 596 patients and 1057 eyes (Combinative-Therapy group 493 and Drop-Only group 564) were included in this study. Using combination therapy reduced the relative risk of postoperative inflammation by 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0 in Combinative-Therapy group vs 0.5% in Drop-Only group (relative risk reduction 100%), although not statistically significant (P=0.10). The incidence of severe IOP spikes was not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33). The relative risk of postoperative CME was 51.4% less in three months follow up visit in Combinative-Therapy group, although not statistically significant (P=0.07). The visual outcome 1-month postop. (best corrected visual acuity) was significantly better in Combinative-Therapy (logMAR 0.10) compared to Drop-Only (logMAR 0.14) groups (P=0.02) while the baseline visual acuity was not significantly different. CONCLUSION The combinative approach of transzonular triamcinolone-moxifloxacin plus perioperative eyedrops is an effective method to minimize postoperative inflammation, with better visual outcomes. It could potentially reduce the risk of postoperative endophthalmitis and CME (near-significant P-values; larger studies could analyze better considering low incidence).
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Affiliation(s)
- Behnam Rabiee
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Muhamad Festok
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Michael Gaspari
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Abid Haseeb
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Aaila Chaudhry
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Layla Kamoun
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Imtiaz Chaudhry
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
| | - Iftikhar Chaudhry
- Department of Ophthalmology, Trinity Health Mid-Atlantic, Nazareth Hospital, Philadelphia, PA 19020, USA
- IC Laser Eye Care, Bensalem, PA 19020, USA
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Reddy AK, Pantcheva MB, Palestine AG. Re: Iftikhar et al.: Cystoid macular edema after cataract surgery in the United States: IRIS® Registry (Intelligent Research in Sight) analysis (Ophthalmology. 2023;130:1005-1014). Ophthalmology 2024; 131:e5-e6. [PMID: 37747376 DOI: 10.1016/j.ophtha.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 07/26/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
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Scott RA, Nau SA, Patnaik JL, Le CB, Kolfenbach JR, Palestine AG, Reddy AK. Cataract Surgery Outcomes in Patients with Non-ocular Autoimmune Disease. Ophthalmol Ther 2023; 12:3383-3393. [PMID: 37603160 PMCID: PMC10640514 DOI: 10.1007/s40123-023-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION While phacoemulsification cataract extraction is generally highly effective and safe, patients with a history of uveitis are at higher risk for postoperative complications and often require a modified perioperative medication regimen. No data exists on risks of postoperative complications and persistent anterior uveitis (PAU) in patients with non-ocular autoimmune disease. METHODS Medical records were reviewed of patients who underwent phacoemulsification cataract surgery with intraocular lens implantation between January 1, 2014 and December 31, 2019 at the University of Colorado Hospital (UCH) as part of a retrospective cohort study. Exclusion criteria included patient history of ocular inflammation and cataract surgery combined with another intraocular surgery. Patients were only included as having autoimmune disease if the diagnosis was confirmed by a relevant specialist at UCH. Patients with autoimmune disease were then stratified into systemic versus organ-specific autoimmune disease, and patients with systemic autoimmune disease were further stratified into immunosuppressed and not immunosuppressed at the time of cataract surgery. Patients with PAU were identified according to the Standardization of Uveitis Nomenclature Working Group. Data including sex, race/ethnicity, intraoperative cumulative dissipated energy (CDE), and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained. RESULTS A total of 422 eyes from 248 patients had confirmed autoimmune disease, compared to a control group of 10,201 eyes. The autoimmune and systemic autoimmune disease groups were not more likely to have postoperative complications or PAU compared to the control group. Immunosuppression status among the systemic autoimmune disease group was also not associated with postoperative complications or PAU. CONCLUSION Patients with non-ocular autoimmune disease do not appear to be at higher risk for postoperative complications, including worse BCVA or increased rates of IOP elevation and PAU, following phacoemulsification cataract surgery. These patients do not appear to require modification of the typical perioperative medication regimen.
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Affiliation(s)
- Rachel A Scott
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Shane A Nau
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Christopher B Le
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Jason R Kolfenbach
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, F731, Aurora, CO, 80045, USA.
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Fabiani C, Agarwal M, Dogra M, Tosi GM, Davis JL. Exogenous Endophthalmitis. Ocul Immunol Inflamm 2023; 31:1386-1395. [PMID: 36534597 DOI: 10.1080/09273948.2022.2152699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Exogenous endophthalmitis (ExE) results from microbial infection as a complication of ocular surgery, penetrating ocular trauma, and intraocular foreign bodies. We herein review the classification of ExE, etiological agents, differential diagnosis and therapeutic challenges. METHODS Narrative Literature Review. RESULTS Identification of the causative agent through ocular fluid analysis is central in the diagnostic work-up of ExE. Prompt intravitreal antimicrobial therapy is key to successful management of ExE and vitrectomy is essential in severe cases. In culture-negative cases, and in the presence of specific features, a diagnosis of sterile intraocular inflammation or toxic syndrome should be suspected. CONCLUSION Strict adherence to treatment guidelines may improve outcomes of ExE, however the ultimate prognosis, especially in severe cases, may depend more on the virulence of the causative organism and associated ocular complications. Accurate differential diagnosis and effective treatment are crucial elements in the management and prognosis of non-infectious masquerades of ExE.
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Affiliation(s)
- Claudia Fabiani
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Manisha Agarwal
- Department of Vitreoretina and Uvea, Dr Shroff's Charity Eye Hospital New Delhi, Daryaganj, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gian Marco Tosi
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
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Tipton CW, Reilly GR, Chen K, Chang E, Ackert JM, Liberman P, Berkenstock MK. Analyzing the demographics of patients with uveitis in an indigent, urban population. BMC Ophthalmol 2023; 23:140. [PMID: 37020208 PMCID: PMC10077706 DOI: 10.1186/s12886-023-02888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE To study the types of uveitis examined in a hospital serving indigent populations in need of low-cost care. METHODS A retrospective chart review examined the electronic medical records of all patients with uveitis-related at Drexel Eye Physicians. Data collected included demographics, anatomic location of the uveitis, systemic disease associations, treatment modalities and insurance. Statistical analysis was performed using χ² or Fischer exact tests. RESULTS 270 patients (366 eyes) were included for analysis, 67% of patients identified as African American. Most eyes (95.3%, N = 349) were treated with topical corticosteroid drops, and only 6 (1.6%) received an intravitreal implant. Immunosuppressive medications were started in 24 patients (8.9%). Nearly 80% depended to some extent on Medicare or Medicaid Assistance for treatment coverage. There was no association between insurance type and use of biologics or difluprednate. CONCLUSION We found no association between insurance type and the prescription of medications for uveitis that should be used at home. There was a minimal number of patients prescribed medications for implantation in the office. The adherence of use of medications at home should be investigated.
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Affiliation(s)
| | - Grace R Reilly
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Kevin Chen
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Eileen Chang
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Paulina Liberman
- Departamento de Oftalmología, Escuela de Medicina. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Meghan K Berkenstock
- Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N. Wolfe Street Maumenee 3rd Floor, Baltimore, MD, 21087, USA.
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Younger Age and Longer Case Times Associated With Emergency Department Visits After Cataract Surgery. Am J Ophthalmol 2023; 245:1-7. [PMID: 36029826 DOI: 10.1016/j.ajo.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To characterize the frequency, reasons, hospital costs, and risk factors for emergency department (ED) visits within 30 days of cataract surgery. DESIGN Retrospective cohort study. METHODS A retrospective review of all cataract surgeries at Duke Health between 2013 and 2021 was conducted. Demographics, case characteristics (length, complexity by billing codes, anesthesia type), ED visit findings, and hospital costs were collected. Logistic regression models were used to determine the odds of ED visits based on several risk factors. RESULTS Of 34 246 patients (57 656 eyes) undergoing cataract surgery at Duke Health from 2013 to 2021, a total of 607 patients (1.77%) had 680 ED visits within 30 days of surgery. The most common ED diagnosis was cardiovascular (24.4%), whereas ocular complaints constituted 15.4% of visits. The most common ocular diagnoses were high intraocular pressure, rebound iritis, and posterior vitreous detachment. Hospital costs were lowest for ocular diagnoses (mean $467.72) and highest for trauma diagnoses (mean $4660.55). Risk factors for ED visits included case lengths greater than 30 minutes (OR 2.1, 95% CI 1.56-2.83, P < .001), the combination of Monitored Anesthesia Care (MAC) and retrobulbar anesthesia or general anesthesia (OR 2.98, 95% CI 1.73-5.12, P < .001), and age less than 70 years (OR 1.39, 95% CI 1.16-1.65, P < .001). CONCLUSIONS ED visits within 30 days of cataract surgery are uncommon. Longer case lengths, anesthesia other than MAC alone, and younger age are associated with higher odds of ED visits.
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Adetunji MO, Meer E, Whitehead G, Hua P, Badami A, Addis V, Gorry T, Lehman A, Sankar PS, Miller-Ellis E, Ying GS, Cui QN. Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy. J Glaucoma 2022; 31:218-223. [PMID: 35131983 PMCID: PMC8963523 DOI: 10.1097/ijg.0000000000001995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
PRCIS In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis. PURPOSE The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS. MATERIALS AND METHODS The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension. RESULTS The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all). CONCLUSIONS The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.
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Affiliation(s)
| | - Elana Meer
- Department of Ophthalmology, Scheie Eye Institute
| | | | - Peiying Hua
- Department of Ophthalmology, Scheie Eye Institute
- Department of Ophthalmology, Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine
| | - Avni Badami
- Department of Ophthalmology, Scheie Eye Institute
| | | | | | - Amanda Lehman
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | | | | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute
- Department of Ophthalmology, Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine
| | - Qi N. Cui
- Department of Ophthalmology, Scheie Eye Institute
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Jiang Z, Zhang N, Dong J. Reversible deposition of inflammatory cells on the surface of an intraocular lens in a patient with uveitis: Case report and literature review. Eur J Ophthalmol 2022; 33:NP126-NP130. [PMID: 35243920 DOI: 10.1177/11206721221086156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The deposition of inflammatory cells on an intraocular lens (IOL) is a rare but potentially serious complication. We report a patient who presented with reversible severe deposition of inflammatory cells on the anterior surface of a hydrophobic IOL. CASE DESCRIPTION A 68-year-old woman with remissive uveitis presented with blurred vision in her right eye that persisted for 1 month. She had undergone cataract surgery and hydrophobic IOL (ZA9003, Johnson & Johnson Surgical Vision) implantation 3 months before presentation. Deposition of inflammatory cells was diagnosed by ocular examination. The IOL became transparent after 6 months of treatment with combined antibiotic/steroid eyedrops (tobramycin/dexamethasone eyedrops) and atropine. However, the cellular deposition recurred after either discontinuing the tobramycin/dexamethasone eyedrops or switching to steroid-only eyedrops (fluorometholone). Therefore, she was prescribed continuous tobramycin/dexamethasone eyedrops, twice-daily, and her IOL remained transparent at the time of submission of this article. CONCLUSIONS We have reported a case of reversible severe deposition of inflammatory cells on the anterior surface of a hydrophobic IOL in a patient with uveitis that was managed by continuous administration of combined antibiotic/steroid eyedrops. The morphology of the inflammatory cells deposits and the treatment differed from those of previously reported cases.
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Affiliation(s)
- Zhijian Jiang
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
| | - Nan Zhang
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianhong Dong
- Department of Ophthalmology, 117880Shanghai Xuhui Central Hospital, Shanghai, China
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Belfort AFL, Nunes BF, Araújo WFD, Suzuki CLB, Souza CFDD, Suzuki ER. Postoperative anterior uveitis in a patient submitted to combined treatment with cataract surgery and iStent inject®. How to manage? REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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SOIFER MATIAS, MOUSA HAZEMM, JAMMAL ALESSANDROA, SAVARAIN CHRISTIAN, PEREZ VICTORL. Diagnosis and Management of Idiopathic Persistent Iritis after Cataract Surgery (IPICS). Am J Ophthalmol 2022; 234:250-258. [PMID: 34653354 DOI: 10.1016/j.ajo.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the diagnosis and management of patients with idiopathic persistent iritis after cataract surgery (IPICS). DESIGN Retrospective interventional case series. METHODS Patients diagnosed with IPICS were evaluated for demographic and clinical characteristics and immune blood markers. Those with more than 6 months of follow-up were evaluated for treatment efficacy to achieve remission (ie, absence of inflammation for 3 months), with either exclusive slow tapering of topical steroids or the need for systemic immunosuppression. RESULTS Forty-five patients presented with IPICS. Most were African American (39, 86.7%) or female (33, 77.3%). Antinuclear antibodies were present in 23 (69.9%) of patients. Main complications were steroid dependency (38,84.4%), glaucoma (24,53.5%), and macular edema (11,37.5%). Thirty two patients presented treatment follow up. On these,the proposed treatment strategy achieved remission in 30 (93.8%) of cases in a mean of 6.1 months via tapering of topical steroids in 15 (46.9%) of patients. However, in 17 (53.1%) of cases, adjuvant anti-inflammatory systemic medication was indicated. Meloxicam use was associated with remission in 11 (64.7%) of these patients and, in a minority with persistent iritis, treatment was escalated to methotrexate, which was successful in 4 (100%) of the cases. CONCLUSIONS IPICS is a distinct clinical anterior uveitis most common in African American and female patients, characterized by an unexpected onset of iritis after cataract surgery and high rates of steroid dependency, glaucoma, and macular edema. It is best treated with an initial slow taper of topical steroids; although adjuvant systemic anti-inflammatory therapy may be necessary to obtain remission and avoid complications.
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Halim J, Westcott F, Cascone N, Coombes A. Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study. Eye (Lond) 2022; 36:198-205. [PMID: 33674727 PMCID: PMC8727621 DOI: 10.1038/s41433-021-01486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis. METHODS A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders. RESULTS One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis. CONCLUSIONS The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.
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Affiliation(s)
- Jonathan Halim
- grid.4868.20000 0001 2171 1133Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Felix Westcott
- grid.4991.50000 0004 1936 8948Oxford University Medical School, University of Oxford, Oxford, UK
| | - Nikhil Cascone
- grid.139534.90000 0001 0372 5777Ophthalmology Department, Barts Health NHS Trust, London, UK
| | - Andrew Coombes
- grid.139534.90000 0001 0372 5777Ophthalmology Department, Barts Health NHS Trust, London, UK
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Mohan R, Arthi M, Balamurugan S. Anti VEGF for post op CME- Boon or Bane! TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_127_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raval N, Yao WJM, Kim G, Kang JJ. Rebound iritis with a well-circumscribed anterior chamber fibrin mass after uncomplicated cataract surgery. J Ophthalmic Inflamm Infect 2021; 11:39. [PMID: 34637008 PMCID: PMC8511218 DOI: 10.1186/s12348-021-00270-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nilesh Raval
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Ave, 3rd Floor, Bronx, NY, 10467, USA.
| | - Wen-Jeng Melissa Yao
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Ave, 3rd Floor, Bronx, NY, 10467, USA
| | - Gene Kim
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Ave, 3rd Floor, Bronx, NY, 10467, USA
| | - Joann J Kang
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Ave, 3rd Floor, Bronx, NY, 10467, USA
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Križanović A, Bjeloš M, Bušić M, Elabjer BK, Rak B, Vukojević N. Macular perfusion analysed by optical coherence tomography angiography after uncomplicated phacoemulsification: benefits beyond restoring vision. BMC Ophthalmol 2021; 21:71. [PMID: 33541327 PMCID: PMC7863317 DOI: 10.1186/s12886-021-01837-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the study is to investigate the changes of macular perfusion by OCT-angiography (OCT-A) after uncomplicated phacoemulsification. Methods OCT-A was performed before cataract surgery, 1 week, 1 month, and 3 months after surgery recording superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), as well as large choroidal blood vessels and choriocapillaris (CC). Explant area (EA), vessels area (VA), vessels percentage area (VPA), total number of junctions (TNJ), junctions density (JD), total vessels length (TVL), average vessels length (AVL), total number of end points (TNEP), and mean lacunarity (ML) throughout all layers were analysed. Results Significant changes of vascular parameters in 55 eyes of 55 patients mostly reached plateau one week after surgery and remained stable up to 3 m after surgery, occurring in all retinal layers but not in choroid and CC. The greatest increase in VPA (22.79%), TVL (16.71%), AVL (166.71%) and JD (29.49%) was in SVC. On the contrary, the greatest change of ML (− 53.41%) appeared in DVC. Conclusions This is the first OCT-A study demonstrating perfusion alterations in macula after phacoemulsification due to functional hyperaemia. We presume the effect is evoked by increased light intensity stimulation of retina after cataract removal. Accordingly, phacoemulsification in elderly population could have advantageous feature in addition to restoring visual acuity. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01837-2.
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Affiliation(s)
- Ana Križanović
- Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia.,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Mirjana Bjeloš
- Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia. .,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia. .,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Mladen Bušić
- Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia.,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Biljana Kuzmanović Elabjer
- Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia.,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Benedict Rak
- Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - Nenad Vukojević
- University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Ophthalmology, University Hospital Centre Zagreb, Zagreb, Croatia
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Koduri VA, Reddy AK, Patnaik JL, Palestine AG, Lynch AM, Pantcheva MB. Endoscopic Cyclophotocoagulation Combined with Phacoemulsification Increases Risk of Persistent Anterior Uveitis Compared to Phacoemulsification Surgery Alone. Clin Ophthalmol 2021; 15:437-443. [PMID: 33574652 PMCID: PMC7873618 DOI: 10.2147/opth.s294791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate if the addition of endoscopic cyclophotocoagulation (ECP) to uncomplicated phacoemulsification cataract extraction increases the risk of persistent anterior uveitis (PAU) compared to phacoemulsification alone. PATIENTS AND METHODS Retrospective analysis of patients who had either phacoemulsification alone or combined with endoscopic cyclophotocoagulation from January 1, 2014 to December 31, 2017. Visual acuity, intraocular pressure, presence of anterior chamber cells, and steroid usage were analyzed pre- and post-operatively. Patient eyes with a history of uveitis, autoimmune disease, complicated cataract surgery, combined surgery other than ECP, and less than 3 months of follow-up were excluded. RESULTS This study consisted of 4423 eyes from 2903 patients, meeting the inclusion criteria (phacoemulsification only group n=4242 and phacoemulsification/ECP group n=181 eyes). PAU developed in 14.9% in the phacoemulsification with ECP group compared to 1.7% who had phacoemulsification alone. White patients had a 17.9 (95% CI: 7.8-41.1, p<0.0001) increased odds of developing persistent anterior uveitis with a combined procedure compared to phacoemulsification only, while Non-white patients had a 5.8 (95% CI: 2.8-12.1, p<0.0001) increased odds. Despite the higher odds ratio in White patients, this group had a significantly lower rate of PAU compared to Non-white patients after phacoemulsification/ECP. CONCLUSION The addition of endoscopic cyclophotocoagulation to phacoemulsification significantly increases the risk of developing PAU in the post-operative period compared to phacoemulsification alone.
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Affiliation(s)
- Vivek A Koduri
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery. J Cataract Refract Surg 2020; 46:867-872. [DOI: 10.1097/j.jcrs.0000000000000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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