Revisiting Pentacam Parameters in the Diagnosis of Subclinical and Mild Keratoconus Based on Different Grading System Definitions

Objectives: To retest the performance of Pentacam parameters in the detection of eyes with subclinical keratoconus (KC) and mild KC based on different definitions from the Amsler-Krumeich (AK), Collaborative Longitudinal Evaluation of Keratoconus (CLEK), and ABCD systems. Materials and Methods: This cross-sectional university-based study comprised 24 eyes with subclinical KC, 144 eyes with mild KC (based on AK in 101 eyes, CLEK in 28 eyes, and ABCD in 15 eyes), and 70 controls. Diagnostic ability of the thinnest point (TP) pachymetry, KISA% index, inferior-superior asymmetry, corneal aberrations, Pentacam indices, front/back elevations, pachymetric progression index, Ambrósio-Relational Thickness (ARTmax), and Belin/Ambrósio Enhanced Ectasia Display scores (Df, Db, Dp, Dt, Da, and D-final) were evaluated. Results: ARTmax (83.3% sensitivity/74.3% specificity) had the highest ability in distinguishing subclinical KC from normal, followed by TP pachymetry, Dt, and Da. D-final showed excellent sensitivity/specificity in mild KC diagnosis based on AK (98%/100%) and CLEK (97.4%/100%) descriptions. In the mild KC-ABCD group, index of vertical asymmetry accurately detected all eyes with mild KC and 97.1% of the controls. Conclusion: This study points out the gray zone in the detection of eyes with subclinical and mild KC due to overlapping terminology and grading criteria. Pentacam parameters seem to have modest capability in subclinical KC detection, indicating the necessity for additional diagnostic modalities. However, eyes with mild KC can be diagnosed with high accuracy using Pentacam parameters, although the strongest parameters may vary according to the definition of "mild KC." Nevertheless, uniform and definitive criteria for subclinical and clinical KC classification are required for a diagnostic and therapeutic consensus in KC.

Increased epithelial backscatter: A novel finding in subclinical and clinical keratoconus.

BACKGROUND: To assess alterations in backscatter from the corneal epithelium, anterior stroma and lens surface in eyes with subclinical, mild and moderate keratoconus (KC). METHODS: In this single-centre, cross-sectional study involving 24 eyes with subclinical KC, 107 eyes with manifest KC (mild = 40 and moderate = 67 eyes) and 90 controls, line densitometry was performed with Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) to obtain simultaneous backscatter values for the corneal epithelium, anterior stroma and anterior lens surface. Backscatter values and Pentacam parameters were used in subsequent statistical analyses. RESULTS: Eyes with subclinical, mild and moderate KC had similar epithelial and stromal backscatter (P > 0.05) that was significantly increased compared with the controls (P < 0.05). Although anterior lens surface backscatter did not differ between the control and KC groups (P > 0.05), it was significantly higher in the mild and moderate KC groups than in the subclinical KC group (P < 0.05). In the KC group (n = 131) epithelial backscatter was strongly correlated with stromal backscatter (r = 0.911, P < 0.0001). CONCLUSIONS: Increased epithelial backscatter and a strong correlation with anterior stromal backscatter in the KC groups were consistent with the epithelium-stroma interaction involved in KC pathogenesis. Single-point backscatter analysis can be used with point clouds to construct epithelial and stromal backscatter maps in Pentacam to aid the detection of KC as a novel feature.

Severe Intraocular Inflammation following Hydrophilic Acrylic Phakic Intraocular Lens Implantation in A Case with Concealed History of COVID-19: A Case Report and Literature Review.

Purpose: To firstly present management of toxic anterior segment syndrome (TASS) and possible postoperative endophthalmitis (POE) after implantation of a new hydrophilic-acrylic posterior chamber (PC) phakic intraocular lens (pIOL) in a case with undeclared history of COVID-19.Methods: A 21-year-old male without known disease represented severe anterior chamber inflammation (hypopyon), poor vision and corneal edema without vitreous involvement (TASS) at 24-hours after PC-pIOL implantation for unilateral high myopia (amblyopic).Results: Preoperative best-corrected visual acuity (BCVA) was 0.2 OS (-13 diopters). At 56-hours, vitreous was involved with visual loss indicating POE. The patient confessed that he had COVID-19 1-month ago. COVID-19 immunoglobulin M/G tests were positive, while other markers were negative. Intracameral/intravitreal antibiotics were applied. BCVA was 0.15 without hypopyon at 24-hours. Cultures were negative. Final BCVA was 0.6 with normal examination.Conclusion: TASS/POE etiology could not be demonstrated in this case, whereas COVID-19-related proinflammatory systemic background could have effect on triggering/aggravating this scenario.].

The role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions.

OBJECTIVE: In the present study, we aimed to differentiate between transudative and exudative pleural effusions using thiol sulphide homoeostasis, an oxidative stress marker. DESIGN: This was a prospective study. SETTING: Emergency Department of Ankara City Hospital, between 1 January 2020 and 15 May 2020. SUBJECTS: Patients who were diagnosed with pleural effusion and underwent thoracentesis to make a differentiation between transudative and exudative pleural effusions. The patients were divided into two groups as those who have transudative pleural effusion and those who have exudative pleural effusion. These two groups were assessed with respect to demographic features and oxidative stress parameters. MAIN OUTCOME MEASURES: Oxidative stress parameters (The native thiol (NT), total thiol (TT), and disulphide (D) levels and their ratios to one another were calculated (index 1: D/NT, index 2:D/TT, index 3: NT/TT). RESULTS: This study enrolled a total of 50 patients with pleural effusion. Twenty patients (40%) were men, and 30 patients (60%) were women. In the transudative pleural effusion group, 14 patients (56%) had decompensated heart failure, 9 patients (36%) had hepatic cirrhosis, and 2 patients (8%) had hypoalbuminemia. In the exudative pleural effusion group, 17 patients (68%) had malignancy, 7 patients (28%) had parapneumonic effusion, and 1 patient (4%) had pulmonary embolism. TT (P < .001) and NT (P = .001) values were significantly lower in the transudative pleural effusion group compared with the exudative pleural effusion group whereas there was no significant difference between the two groups with respect to D (P = .489), index 1 (P = .07), index 2 (P = .064), and index 3 (P = .063) values. CONCLUSION: We believe that a differentiation can be made between transudative and exudative pleural fluids by using thiol sulphide homoeostasis, an oxidative stress marker.

Retrospective analysis of asymptomatic COVID-19 patients presenting to emergency department.

OBJECTIVE: In this study, we aimed to investigate the clinical and demographic characteristics of asymptomatic COVID-19 cases incidentally diagnosed at the emergency department. METHODOLOGY: This study retrospectively analysed the medical data of patients who presented to the emergency department, between March 1 and May 1, 2020, without COVID-19 symptoms such as fever, cough, myalgia on admission but were incidentally detected to have thoracic computerised tomography (CT) findings suggestive of COVID-19. The patients' sociodemographic and epidemiological characteristics, laboratory test results, clinical and radiological findings, treatment protocols and prognoses were recorded. RESULTS: We incidentally diagnosed COVID-19 pneumonia in 81 asymptomatic patients. All patients presented to the emergency department with traumatic injuries. Of these, 38 (46%) were injured in in-vehicle traffic accidents; 27 (34%) out-of-vehicle traffic accidents; 14 (18%) simple falls; and 2 (2%) falls from a height. Only 42 (48%) patients had a history of suspected contact with a COVID-19 positive individual. The mean time to symptom onset of 81 patients was 5 ± 2 days. An analysis based on thoracic computerised tomography findings showed that the common finding found in all patients was ground glass opacity (GGO). While 55 (68%) patients had GGO alone, 10 (12%) had additional fine reticulations; 6 (7%) had an additional halo sign; 6 (7%) had an additional air bronchogram and 4 (5%) had an additional area of consolidation. None of the patients died during follow-up, and all of them were discharged. CONCLUSION: Early identification and isolation of asymptomatic patients are of great importance for reducing the speed of propagation of the COVID-19 pandemic. Incidentally diagnosed cases have made us consider that there is a need to increase the number of screening tests. We also believe that healthcare staff should suspect COVID-19 pneumonia in every patient irrespective of presentation type, place importance on the use of personal protective equipment (PPE), and not examine any patient without wearing PPE.

How has Covid-19 pandemic affected crowded emergency services?

OBJECTIVE: We aimed to investigate the demographic shifts in emergency service admissions, possible measures and room for improvement in emergency services during the Covid-19 pandemic. METHODOLOGY: Our study retrospectively analysed the demographic features and clinical admission types of patients admitted to Batman District State Hospital Emergency Service at two different time periods, one between 28 March 2019 and 28 April 2019 (prior to the Covid-19 pandemic) and the other between 28 March 2020 and 28 April 2020 (during the Covid-19 pandemic). The results were compared between the two periods designated as the pandemic period and the pre-pandemic period. RESULTS: The number of patients admitted to emergency service was 47,681 in the pre-pandemic period and 9455 in the pandemic period (P < .01). The number of patients examined in green zone (non-urgent cases) was 27,701 (58%) in the pre-pandemic period and 3668 (38.7%) in the pandemic period (P < .01). The number of patients admitted for trauma was 1247 (2.61%) in the pre-pandemic period and 59 (0.62%) in the pandemic period (P < .01). The number of patients hospitalised to cardiology department or coronary care unit for acute coronary syndrome was 602 (1.26%) in the pre-pandemic period and 29 (0.3%) in the pandemic period (P < .01). The number of patients hospitalised to neurological intensive care unit for acute cerebrovascular disease was 542 (1.13%) in the pre-pandemic period and 22 (0.2%) in the pandemic period (P < .01). The number of patients hospitalised to pulmonary diseases department or intensive care unit for dyspnea was 622 (1.21%) in the pre-pandemic period and 515 (5.4%) in the pandemic period (P < .01). CONCLUSION: Measures taken to prevent the spread of Covid-19 infection have caused a significant drop in emergency service admissions. We are of the opinion that this will lead to an increase in deaths occurring at home, and we will soon encounter patients with worse prognosis and overcrowded emergency services. We are in opinion that the public awareness about emergency conditions requiring emergency service admission should be heightened alongside of the "stay home" calls. As: "In order to reduce morbidity and mortality from non-covid-19 conditions, we call for heightened public awareness on other emergency and urgent symptoms, which should prompt urgent attendance to medical services."