Notch Volume Measured on Magnetic Resonance Imaging Is Better Than 2-Dimensional Notch Parameters for Predicting Noncontact Anterior Cruciate Ligament Injury in Males.

PURPOSE: To evaluate and compare intercondylar notch volume with other 2-dimensional notch parameters (measured on magnetic resonance imaging [MRI]) for prediction of noncontact anterior cruciate ligament (ACL) injury in males. METHODS: Retrospective case-control study in males based on MRI images. The case group consisted of 80 noncontact ACL-injured males and a control group of 80 age- and height-matched ACL-intact males. Inclusion criteria were 18 to 50 years old, full-thickness tear, MRI obtained within 1 year of injury, and ACL tear visually documented during arthroscopy. Multiligamentous, bilateral, or concomitant bony injuries were excluded. Notch volume and 2D parameters in both planes, including notch depth, notch width, intercondylar notch angle, notch-width index, and notch-shape index, were measured on MRI and compared. Slice interval was included in the formula for notch-volume assessment. Bivariate Pearson correlation between notch volume and 2D parameters was estimated. Multivariate conditional logistic regression analysis was used for predictor model. Receiver operating characteristic (ROC) curves were plotted. RESULTS: All MRIs had a standard slice thickness of 3 mm and slice interval of 0.3 mm. Notch volume (P < .001), notch angle in the axial plane (P = .001), and notch width in the coronal plane (P = .009) were significantly smaller in the ACL-injured group. Notch volume had inconsistent and negligible to low correlation with 2D parameters. Notch volume was the only significant contributor in the predictor model (P < .001). ROC curve showed that notch volume had highest area under the curve of 84.1% and optimal cutoff at 7.1550 cm3 (specificity, 88.7%; sensitivity, 65%). CONCLUSION: Significantly smaller intercondylar notch volume is associated with noncontact ACL injury in men and is the most important predictor for such an injury (optimal cutoff of 7.1550 cm3). Two-dimensional notch parameters are inconsistently associated with noncontact ACL injury in men, and none of the 2D parameters can be used as a surrogate for notch volume. Two-dimensional notch parameters fare poorly in predicting noncontact ACL injury in males. Notch volume measurement should include slice interval as a factor. LEVEL OF EVIDENCE: III, retrospective case-control study.

Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in Indian patients with retinal vein occlusion, age-related macular degeneration, and diabetic macular edema.

PURPOSE: To evaluate the rate of compliance and the reasons for loss to follow-up in Indian patients with diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) being treated with anti-vascular endothelial growth factor (VEGF) therapy. METHODS: This was a retrospective single-center study. Patients with DME, AMD, or RVO were eligible if they initiated anti-VEGF therapy between January 2013 and December 2017. Patients' data were obtained from hospital electronic records, including the number of injections received, visits, details of follow-up, missed appointments, and reasons for loss to follow-up (>365 days). RESULTS: A total of 648 patients were eligible for the study, of which 334 (51.54%) patients were lost to follow-up. Overall, 343 (64.96%) were males and the overall mean (SD) age was 66.40 (7.44) years. A total of 376 (58.0%) patients had a history of diabetes and 364 (56.2%) patients had a history of hypertension. Further, 127 (38.0), 112 (33.5), and 95 (28.4) had DME, AMD, and RVO, respectively and were lost to follow-up. The most commonly reported reason for loss to follow-up was "non-affordability" (n = 120; 41.1%) followed by "no improvement in vision" (n = 83; 28.4%). "No improvement in vision" (42.2%) and "non-affordability" (37.5%) were higher among patients with DME. No association was found in gender- and treatment-wise distribution of reasons for loss to follow-up. CONCLUSION: The results showed that around half of the patients with DME, AMD, and RVO were lost to follow-up to intravitreal anti-VEGF therapy, and the most common factors were "non-affordability" and "no improvement in vision."

A prospective comparative study on endothelial cell loss and morphology after femtolaser-assisted cataract surgery and phacoemulsification.

PURPOSE: To compare changes in endothelial cell count and morphology at 6 months follow-up in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification. DESIGN: Prospective, comparative and open-label study. METHODS: All consenting patients between 50 and 75 years of age with uncomplicated cataract underwent either FLACS [Catalys Precision Laser System (OptiMedica Corp.; Abbott Medical Optics)] or conventional phacoemulsification [Bausch + Lomb Stellaris® (Rochester, USA)] based on their preference and were followed up on day 15 and at 2 and 6 months postoperatively. The endothelial cell count (ECC), % of hexagonal cells and coefficient of variation were noted at baseline and at each follow-up visit and compared between groups. RESULTS: A total of 187 eyes of 187 patients (n = 98 in phaco vs. n = 89 in FLACS) were enrolled. At 15 days follow-up, there was a significant decline in the endothelial cell count in both groups (187 ± 156 in phaco vs. 193 ± 240 in FLACS, p < 0.001). In subsequent visits, the ECC remained stable (8% decline in phaco vs. 7.7% decline in femto, p = 0.87) till last follow-up at 6 months. The %hexagonal cells also decreased significantly at 15 days post-op (p < 0.001) but did not show any change in subsequent visits. The coefficient of variation in ECC did not change significantly throughout the study period. Eyes with higher endothelial cell count at baseline tended to lose more cells (b = 25.7 cells/mm3, 95% CI 16-35 cells, p = 0.01) irrespective of age and type of surgery. CONCLUSIONS: Both procedures are equally safe with < 10% ECC loss at 6 months. Longer studies are required to determine influence of FLACS on ECC.

Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review.

Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.