Outcomes of toric intraocular lens realignment surgery done using slit-lamp method and wavefront aberrometry method

Purpose: To compare the slit?lamp method and wavefront aberrometry method based on outcomes of toric realignment surgeries. Settings: Tertiary care ophthalmic hospital. Design: Retrospective study. Methods: This study included all eyes undergoing toric intraocular lens (TIOL) realignment surgery between January 2019 and December 2021 for which TIOL axis assessment by slit?lamp method and wavefront aberrometry method was available. Data were retrieved from electronic medical records, and we documented demographics, uncorrected visual acuity (UCVA), subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods on postoperative day 1 and day 14. In patients with misalignment, TIOL was realigned to the original position in group 1 (27 patients) and to an axis based on calculations provided by wavefront aberrometer in group 2 (25 patients). Post?realignment surgery, UCVA, subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods were assessed and analyzed. Results: We analyzed 52 eyes and found that the mean preoperative misalignment with the slit?lamp method (44.9° ±20.0°) and wavefront aberrometry (47.1° ±19.5°) was similar. The corresponding degrees of misalignment post?TIOL repositioning surgeries were 5.2° ±5.2° (slit?lamp method) and 4.7° ±5.1° (wavefront aberrometry) (P = 0.615). Both groups showed significant improvement in median log of minimum angle of resolution (logMAR) UCVA and reduction in median refractive cylinder. Conclusions: Slit?lamp method is as good as wavefront aberrometer method to assess TIOL axis. Toric realignment surgery is found to be safe, and realigning TIOL based on either slit?lamp method or wavefront aberrometer method equally improved UCVA and decreased residual refractive cylinder.

ClinicalManifestations ofSteven'sJohnson Syndrome/Toxic Epidermal Necrolysis

BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) both reflect extreme manifestations of the same clinical entity responsible for significant, life Threatening hypersensitivity mucocutaneous reactions, caused by intraepidermal cell death resulting in epidermal sloughing and blistering; often induced by medications. The mucous membranes of the mouth, stomach, lungs,skin, and genitourinary system are all major sites of Involvement. Despite receiving effective treatment at the local and systemic levels, some survivors may have major ocular consequences that might ultimately result in blindness. It is still unknown whether or not SJS/TEN can be effectively treated locally or systemically. If you want to improve your long-term eye health, it's crucial to catch any problems early and treat them aggressively. Chronic ocular surface failure, including a lack of limbal cells and full keratinization of the ocular surface, may be detected by inspecting the eyelid edge,palpebral conjunctiva, and fornix. It is possible to lessen the danger of ocular surface failure using transplants of amniotic membrane or a cultured oralmucosal graft. AIM: The aim of this investigation is to learn more about the symptoms of SJS/TEN that emerge in the eyes. METHODOLOGY: Patients with ocular signs of SJS/TEN who sought treatment at C.U.Shah medical college and hospital, a tertiary hospital, via the OPD and IPD of skin and VD were included. Between January 2022 and May 2022, all patients had a documented ophthalmologic evaluation. RESULTS: The study had 17 participants. Ocular involvement was seen in 10 individuals, with 5 patients (50%) experiencing mild ocular indications, 2 patients (20%) experiencing moderate visual manifestations, and 3 patients (30%) experiencingsevere ocular signs. Two patients (20%) had involvement of the cornea, seven patients (70%) had involvement of the conjunctiva, and six

Cytotoxic and microbial studies of mixed metal complexes

Breast cancer and its treatment have become a prominent and challenging problem today. The increasing multidrug resistance to microbial pathogens is the root cause of breast cancer. Women suffering from cancer showed high levels of E. coli and S. aureus. In the last few decades, there has been a considerable need in the medical field for the discovery of new compounds endowed with antimicrobial activity, despite the fact that several antibiotics and chemotherapy drugs are currently accessible. Substantial research was conducted, particularly on transition complexes as metal-based drugs in pharmacological applications to provide therapeutic options. The synthesis, characterization, antibacterial activity, and cytotoxic activity of copper complexes with specific ligands of amino acids such as tyrosine and arginine are discussed in this work.

Study of side effect profile of bedaquiline containing regimen among patients with extensively drug-resistant tuberculosis at a nodal drug-resistant center

Background: Extensively drug-resistant tuberculosis (XDR TB) is a type of tuberculosis (TB) characterized by resistance to isoniazid and rifampicin, along with resistance to one of the fluoroquinolones and at least one of the second line injectable drugs. Bedaquiline is a diarylquinoline antimycobacterial agent approved for the treatment of adults with pulmonary multidrug-resistant TB (MDR-TB) and XDR-TB by the food and drug administration. Aim and Objective: The aim of this study was to study the side effect profile of bedaquiline containing regimen among XDR TB patients. Materials and Methods: This study was conducted at outpatient and wards of nodal drug-resistant TB Center, Department of Pulmonary Medicine, SVRRGGH, Tirupati, for a period of 1 year. Forty patients of more than 18 years age and diagnosed with XDR TB were included in the study. Bedaquiline was started and daily monitoring was done with ECG and all organ function tests were repeated every 15 days. Results: All 40 cases were retreatment cases; no new XDR TB case was reported in study period. Most common age group of presentation in our study was 46 to 55 years (32.5%). Gastrointestinal adverse drug reactions were found to be more common (37.5%), cardiovascular QTc changes were observed in 10% of patients, 5% of patients had neurological reactions (Headache), 2.5% of patients had peripheral neuropathy, and 2.5% of patients had arthralgia. Conclusions: Bedaquiline containing regimen is very effective for the treatment of XDR TB cases. The study shows that compliance with this regimen is very good. Bedaquiline has minimal adverse reactions and even these are easily manageable. Bedaquiline has good safety profile and patients have improved quality of life.

MATERNAL NEAR MISS: AN INDIAN TERTIARY CARE CENTRE AUDIT

BACKGROUND: Despite advances in medical sciences and increased awareness of measures for safe child birth, unacceptably high maternal morbidity and mortality continues in developing countries like India. Ours being a tertiary care centre, draws a lot number of high risk pregnancies and referrals. By auditing the near miss cases2 i.e., a critically ill pregnant or recently delivered woman who was on the verge of death but survived a problem during pregnancy, childbirth, or within 42 days of the pregnancy's termination, we aim to identify the causes, factors leading to near miss2 and the management given to near miss2 and maternal deaths. The AIMS AND OBJECTIVES: present study aims to determine the magnitude, as well as to identify the pattern of Maternal Near Miss2 (MNM), at Siddhartha Medical College, Vijayawada, during the study period of two years. To anal OBJECTIVES: yse 1)Adverse events leading to a maternal near-miss2, 2) Disorders underlying these cases, 3)Sociodemographic factors and 4)Contributing factors A hospital based retros METHODOLOGY: pective observational study to assess the frequency and nature of maternal near miss2 events among the obstetric cases managed at Siddhartha Medical College, Vijayawada over a period of two years. The followi RESULTS: ng are the major causes identified leading to maternal near miss2 during our study Severe Eclampsia 17%, Post-partum Haemorrhage 17%, Pulmonary Edema due to severe pre eclampsia3 9%, Antepartum Eclampsia 9%, HELLP 9%, Ruptured ectopic pregnancy 7%, Cardiac failure 7%, Postpartum Eclampsia 7%, Imminent Eclampsia 4%, Abruption 4%, Rupture uterus 2%. In our study Maternal near miss2 ratio incidence: 0.0254, Severe maternal outcomes ratio : 3, Maternal near miss2 to mortality ratio: 0.433 CONCLUSION: We observed in majority of the cases level 1 and level 2 delays in reporting to our institution

Clinical outcomes of femtosecond laser–assisted cataract surgery versus conventional phacoemulsification: A retrospective study in a tertiary eye care center in South India

Purpose: To compare the clinical outcomes of femtosecond laser–assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) in terms of refractive outcomes, cumulative dissipated energy, and intraoperative complications. Methods: In this retrospective study performed in a tertiary care ophthalmic hospital, we reviewed 2124 eyes that underwent FLACS or CP. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cumulative dissipated energy (CDE), and intraoperative complications were analyzed in the study. Results: Out of 2124 eyes, 873 underwent FLACS and 1251 underwent CP. The postoperative mean UCVA after one month was 0.05 ± 0.11 logMAR and 0.14 ± 0.23 logMAR for FLACS and CP, respectively (P < 0.00001). Mean CDVA one month post operation was 0.02 ± 0.07 logMAR and 0.06 ± 0.19 logMAR for FLACS and CP, respectively (P < 0.0001). The CDE for the FLACS group was 6.17 ± 3.86 (P < 0.00001) and it was 9.74 ± 6.02 for the CP group. The intraoperative complication for the FLACS group was 1.60% and the CP group was 2.39% (P < 0.00001). Conclusion: The visual outcomes were better in FLACS compared to CP. The CDE was lower for the FLACS group and FLACS had significantly less intraoperative complications

Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India

Purpose: To report the demographic profile of patients registered through e?Sanjeevani OPD seeking teleophthalmology services. Methods: This was a cross?sectional data analysis of patients with ocular complaints registered through the e?Sanjeevani platform at a tertiary care center. It was a doctor?to?doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results: In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion: e?Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment

Prevalence of Drug Interactions and Potentially Inappropriate Medications Among Geriatric Patients in India.

Aim: The study aimed to determine the prevalence of potential drug-drug interactions (PDDIs) and potentially inappropriate medications (PIMs) among geriatrics. Methods: A prospective observational study was conducted for six months in the Department of Geriatrics, M.S. Ramaiah Teaching Hospital, Bangalore. PDDIs and PIMS were analyzed using micromedex database and Beer's criteria respectively. Results: Among 395 prescriptions, 221(56%) prescriptions showed 559 pDDIs and 41(10.4%) PIMs. Almost 281(50.3%), 260(46.5%), 16(2.7%) and 2(0.3%) pDDIs were categorised as major, moderate, minor and contraindicated respectively. Almost 321(57.5%) were synergistic and 196(35.0%) were antagonistic drug interactions. Pearson correlation value (R) is 0.9957 which showed a strong positive correlation. Conclusion: This study created awareness on drug interactions among geriatrics and help the practitioners to prescribe drugs with a low risk of pDDIs. The authors suggest PIM monitoring in geriatrics to avoid adverse effects and improve patients' quality of life.

Media Reporting of Suicide in the Bengaluru E-Edition of Three Major Indian Dailies: An Archival Study

India has the world’s largest newspaper market, with over 100 million copies sold daily. The media scapegoat, simplify, speculate, and sensationalize suicide?related news instead of signposting people to seek help. Suicide affects individuals, families, and communities and is worthy of responsible reporting. This study examined the quality of newspaper coverage of suicides from January to December 2017 in three popular English dailies in Bengaluru, South India. Three hundred and ninety?five online suicide reports were evaluated for compliance with the 2017 WHO recommendations for responsible suicide reporting by media professionals. The secondary data were obtained from digital newspaper archives and analyzed. Ahandful of the sampled articles met key recommendations. While reporting on suicide in the Indian media, three critical areas that require the most attention are reducing sensationalism, providing help-seeking information, and educating the public on suicide prevention without perpetuating myths.

Survival outcomes with 12 weeks of adjuvant or neoadjuvant trastuzumab in breast cancer

Background: There is limited access to 1 year of adjuvant trastuzumab in resource-constrained settings. Most randomized studies have failed to prove non-inferiority of shorter durations of adjuvant trastuzumab compared to 1 year However, shorter durations are often used when 1 year is not financially viable. We report the outcomes with 12 weeks of trastuzumab administered as part of curative-intent treatment. Methods: This is a retrospective analysis of patients treated at Tata Memorial Centre, Mumbai, a tertiary care cancer center in India. Patients with human epidermal growth factor receptor (HER2)-positive early or locally advanced breast cancer who received 12 weeks of adjuvant or neoadjuvant trastuzumab with paclitaxel and four cycles of an anthracycline-based regimen in either sequence, through a patient assistance program between January 2011 and December 2012, were analyzed for disease-free survival (DFS), overall survival (OS), and toxicity. Results: A total of 102 patients were analyzed with a data cutoff in September 2019. The median follow-up was 72 months (range 6–90 months), the median age was 46 (24–65) years, 51 (50%) were postmenopausal, 37 (36%) were hormone receptor-positive, and 61 (60%) had stage-III disease. There were 37 DFS events and 26 had OS events. The 5-year DFS was 66% (95% Confidence Interval [CI] 56–75%) and the OS was 76% (95% CI 67–85%), respectively. Cardiac dysfunction developed in 11 (10.7%) patients. Conclusion: The use of neoadjuvant or adjuvant 12-week trastuzumab-paclitaxel in sequence with four anthracycline-based regimens resulted in acceptable long-term outcomes in a group of patients, most of whom had advanced-stage nonmetastatic breast cancer.

A case report of hereditary spherocytosis (HS): Approach to diagnosis and management of HS

Hereditary spherocytosis (HS) is a type of congenital hemolytic anemia, in which heterogeneous alterations in one of the six genes that encode for proteins involved in vertical associations which tie the red blood cell (RBC) membrane skeleton to the lipid bilayer causes dysfunction or deficiency of cell membrane protein resulting in spherical-shaped, hyper-dense, and poorly deformable RBCs with a shortened life span. We report a case of HS in a 2-month-old female who presented with severe anemia, jaundice, and hepatosplenomegaly. The peripheral blood smear showed spherocytosis and reticulocytosis. The osmotic fragility was positive and direct antiglobin test was negative. The osmotic fragility test and direct antiglobulin test were positive. She was managed with packed RBCs (PRBCs) transfusion and folic acid supplementation

EVALUATION OF VARIOUS RISK FACTORS OF PERINATAL MORTALITY IN A TERTIARY HOSPITAL, AP

Background- It is important to know various maternal risk factors which lead to adverse perinatal outcome and enable us to form some strategies to reach our goals to reduce the perinatal deaths. Aims and Objectives of the study: is to evaluate the causes and risk factor for perinatal deaths in a tertiary institute and form strategies and protocols in our hospital to reduce perinatal deaths Prospective study Material and Methods- Study design: This study was conducted at OBGYN department, Siddhartha Medical College, Vijayawada done during the period of 1.01.2021 to 31.12.2021. All antenatal women admitted in labor room and antenatal wards were studied by means of a preformed proforma and viewed their outcome. In all cases of perinatal deaths risk factors were analysed in detail. - Results Total number of deliveries in the hospital were 9698. Out of which the perinatal deaths studied were 568 [5.85%]. Among these 252 [44%] were IUFD/ Still births and 316 [56%] were early neonatal deaths. In these cases of deaths 121 cases were Respiratory distress syndrome mostly due to prematurity, 82 birth asphyxia, 79 sepsis. The results were presented as percentages, rates and proportions. The results are compared with 5 studies and WHO standards. All studies had similar percentage except Philippine study 3 showed very low PNMR. [3][1,2,47] Analysis of perinatal deaths is important as it is an important index of Conclusion: antenatal care and quality of new born care in an institution

Microbial Profile of Neonatal Septicemia and its Antibiogram Prevalent in a Tertiary Care Hospital of Western Odisha

Introduction : A disseminated disease with positive Blood Culture during the first month of life and encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and Urinary Tract Infection is defined as Neonatal Sepsis. It is one of the leading causes of morbidity and mortality amongst neonates of developing countries. Aim : To determine the microbial profile of Blood Culture-positive Septicemia cases and study their antimicrobial susceptibility pattern. Materials and Methods : Blood Culture and C-reactive Protein (CRP) estimation were done for all 220 clinically suspected neonates. All the pure Bacterial and Candida isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was done for all bacterial isolates using the Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results : Out of 220 cases, 68.2% were culture positive. Early-onset Neonatal Septicemia (EONS) cases were 74% and Late-onset Neonatal Septicemia (LONS) 26%. The male to female ratio was 1.9:1. Bacterial cases were 66% and 34% were due to Candida. Gram-negative isolates predominated, with Klebsiella pneumonia being the most common one. In the case of Gram-positive isolates, Staphylococcus aureus was most common. The best overall sensitivity of Gram-negative isolates was to Amikacin (100%), Colistin (100%), and Imipenem (96%). Grampositive isolates reported 100% sensitivity to Vancomycin, Teicoplanin and 97.4% to Linezolid. Conclusion : Gram-negative isolates were the leading cause of Sepsis in our study. Strict antimicrobial stewardship should be implemented to prevent the emergence of multi-drug resistant strains.

Congenital corneal anesthesia: A case series

Congenital corneal anesthesia (CCA) is an extremely rare condition where the cornea is affected in isolation or as a part of congenital syndrome, or can be associated with systemic anomalies. This case series of 12 eyes provides an overview of various clinical presentations and their final treatment outcomes. The average age of presentation was 3.2 years with a female preponderance (75%). Fifty percent of the patients had bilateral involvement and 50% had corneal ulcers at presentation. Two eyes required therapeutic keratoplasty for corneal perforation. All patients had isolated CCA except for one who had an associated hereditary and sensory autonomic neuropathy.

Antibody profile in post-vaccinated & SARS-CoV-2 infected individuals

Background & objectives: During the COVID-19 pandemic it was important to assess the antibody profile in individuals vaccinated with Covaxin (BBV152) and Covishield (ChAdOx1 nCoV-19) with both 28 and 84 days gaps between two doses, those infected with SARS-CoV-2 and post-COVID-19-infected individuals vaccinated with only one dose of either of the vaccines. The present study was aimed to assess these objectives. Methods: Fifty real time reverse transcription–polymerase chain reaction (qRT-PCR)-confirmed COVID-19-infected individuals, along with 90 COVID-19-naïve (BBV152 and ChAdOx1 nCov-19)–vaccinated individuals, were included in the study. Individuals who received a single dose of either vaccine with a confirmed past diagnosis of SARS-CoV-2 infection (n=15) were also included. Blood samples were collected strictly between the 4th and 5th wk after development of symptoms for SARS-CoV-2 infected individuals and after the first/second vaccination dose. Antibody profile assessment was done using whole-virus, spike-receptor binding domain (RBD) and nucleocapsid-specific ELISA kits along with neutralizing antibody kit. Results: There was an overall 97.7 per cent seropositivity rate in vaccinated individuals, and a strong correlation (R2=0.8, P<0.001) between neutralizing and spike-RBD antibodies. Among individuals who received two standard doses of ChAdOx1 nCoV-19 vaccine, the spike antibody levels developed were of higher titre with a longer prime boost interval than in those with shorter intervals (P<0.01). Individuals vaccinated with two doses as well as only one dose post-SARS-CoV-2 infection had high neutralizing and spike-specific antibodies. Interpretation & conclusions: High neutralizing and spike-specific antibodies were developed in individuals vaccinated only with one dose of either vaccine post-SARS-CoV-2 infection. With the main priority being vaccinating majority of the population in our country, single-dose administration to such individuals would be a sensible way to make the most of the limited supplies. Furthermore, neutralizing antibody levels observed in COVID-19-naïve vaccinees imply the need for booster vaccination.

Video-dermoscopic Assessment of Capillaroscopic Pattern in Hansen's Disease

Leprosy is a chronic granulomatous infectious disease with a proven role of Mycobacterium leprae invasion into endothelial cells. Animal studies have shown evidence of involvement of vasa nervorum in the process of nerve invasion. Capillaries act as the mirror image of vascular involvement in any rheumatic disorder and holds good for leprosy also. Nailfold capillaroscopy (NFC) is a non-invasive, easily reproducible technique to study proximal nailfold capillaries. The aim of this study is to investigate morphological nailfold capillaroscopic alterations in patients with leprosy in its various forms and comparison with the normal individual. Total 20 Leprosy patients and 20 normal age and sex matched individuals recruited for nailfold capillaroscopic examination using video dermoscopye. Among 20 normal individuals, 3(15%) individuals showed tortuous capillaries and microhemorrhages each, 2(10%) showed meandering vessels, 1(5%) each showed megacapillaries, dilated/ectatic capillaries and bizarre vessels. Out of 20 leprosy patients, 11 (55%) patients showed bizarre and meandering capillaries, 10(50%) showed dilated vessels and avascular areas, 9(45%) showed capillary dropouts and neovascularisation, 8(40%) showed tortuous vessels, 6(30%) haemorrhages and 4 (20%) showed megacapillaries. Findings like avascular areas, capillary dropouts, haemorrhages were more noticed in lepromatous and borderline lepromatous leprosy, whereas early capillary abnormalities like dilated, meandering, bizarre vessels and neoangiogenesis were noticed more in borderline tuberculoid leprosy. However, statistical significant difference between clinical and dermoscopic observations was not seen in this study. Further studies with a large sample size are required to find out the same. Morphological changes may denote micro-vascular invasion by Mycobacterium leprae and may act as warning signs of fore- coming complications like loss of sensation and trophic ulcers. Follow-up studies are required to understand such correlation, if any.

Spurious thrombocytopenia in the mother and baby – A red herring clinical entity

Spurious thrombocytopenia or pseudothrombocytopenia (PTCP) is an important clinical entity, in which the presence of autoantibodies or anticoagulants used during blood sampling causes in vitro clumping of platelet and thereby resulting in a falsely low automated platelet count. The most common cause of platelet clumping is ethylenediaminetetraacetic acid used as an anticoagulant in the blood samples. The other reasons for PTCP include the presence of autoantibodies such as cold agglutinin, giant platelet, and platelet satellitism. There are very few cases of spurious thrombocytopenia in the newborn period published in the literature. We are reporting a case of PTCP due to platelet satellitism in a baby born to a mother with a similar condition

APPLICATIONS OF COLD IN ENDODONTICS

Historically cryotherapy, the application of cold for treatment has been used to manage pain and in?ammation. Its role in medicine and dentistry is well established while its applications in endodontics is promising. This review is aimed to cover the aspects of cold applications in endodontics such as in manufacture of endodontic ?les, diagnosis and therapeutics especially during root canal treatment.

Depression And Quality of Life Among Type-2 Diabetes Mellitus Patients: A Case Control Study

Background: Diabetes is accompanied by a distinct decreased in subject抯 quality of life (QOL) and it shows to elevated disability-adjusted life years than most diseases. Depression shows the degrade QOL and is associated with wretched treatment outcomes and lesser the glycaemic control in diabetes. Objective of this study is to study the association between Quality of Life (QoL) and depression among type2 diabetes mellitus in Andhra Pradesh. Methodology: The present study is a case control study. There were 300 participants including 150 type2 diabetes mellitus patients, & 150 healthy individuals (age and gender matched) were also selected as a control to meet the purpose of the study. Subjects age range was set between 35-65 years. Beck depression inventory (BDI-II) and WHO quality of life scale (QOL BREF) were used for data collection, SPSS-26(v). Results: The study findings showed that significant but negative relation between depression scores and quality of life. 65% have Poor Quality of life & 57% have high depression in Diabetes Patients. 54% have good Quality of life & 78% have Mild Depression in Healthy Individuals. Conclusion: It is concluded that association between depression and sub-scales of quality of life indicating that high depression scores may lead to lower physical and psychological health impacting social relationship and environmental health.

Development and validation of an offline deep learning algorithm to detect vitreoretinal abnormalities on ocular ultrasound

Purpose: We describe our offline deep learning algorithm (DLA) and validation of its diagnostic ability to identify vitreoretinal abnormalities (VRA) on ocular ultrasound (OUS). Methods: Enrolled participants underwent OUS. All images were classified as normal or abnormal by two masked vitreoretinal specialists (AS, AM). A data set of 4902 OUS images was collected, and 4740 images of satisfactory quality were used. Of this, 4319 were processed for further training and development of DLA, and 421 images were graded by vitreoretinal specialists (AS and AM) to obtain ground truth. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristic (AUROC). Results: Our algorithm demonstrated high sensitivity and specificity in identifying VRA on OUS ([90.8%; 95% confidence interval (CI): 86.1�.3%] and [97.1% (95% CI: 93.7�.9%], respectively). PPV and NPV of the algorithm were also high ([97.0%; 95% CI: 93.7�.9%] and [90.8%; 95% CI: 86.2�.3%], respectively). The AUROC was high at 0.939, and the intergrader agreement was nearly perfect with Cohen抯 kappa of 0.938. The model demonstrated high sensitivity in predicting vitreous hemorrhage (100%), retinal detachment (97.4%), and choroidal detachment (100%). Conclusion: Our offline DLA software demonstrated reliable performance (high sensitivity, specificity, AUROC, PPV, NPV, and intergrader agreement) for predicting VRA on OUS. This might serve as an important tool for the ophthalmic technicians who are involved in community eye screening at rural settings where trained ophthalmologists are not available