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To characterize the clinical outcomes of a novel ab interno minimally invasive procedure with the STREAMLINE Surgical System for creation of incisional goniotomies and canal of Schlemm viscodilation in eyes with mild to severe primary open-angle glaucoma (POAG). In a prospective, single-arm, first-in-human case series, 20 eyes of 20 subjects with mild to severe POAG underwent creation of incisional goniotomies and canal of Schlemm viscodilation following phacoemulsification cataract extraction after washout of all intraocular pressure (IOP)-lowering medications. The angle surgery portion was performed with a single-use handpiece tipped with a microcannula that creates precise goniotomies through the trabecular meshwork into the canal of Schlemm and delivers a small volume of ophthalmic viscosurgical device directly into the canal via precise catheterization. Outcomes in this interim analysis included mean reduction in IOP and medications through 6 months of follow-up, as well as the proportion of eyes achieving IOP reduction ≥20% from baseline. At month 6, mean IOP reduction of ≥20% from baseline was achieved in 89.5% of eyes (17/19). Mean (standard deviation) medicated IOP at screening was 16.3 (3.6) mmHg and unmedicated baseline IOP (after washout) was 23.5 (2.5) mmHg. Mean IOP was significantly reduced from baseline through 6 months of follow-up to 14.7 (2.4) mmHg ( <0.001), representing an IOP reduction of 8.8 mmHg (36.9%). Overall, 57.9% (11/19) of eyes decreased dependence on IOP-lowering medications by at least one medication, and 42.1% (8/19) were medication free. Mean medication use was reduced from 2.0 (0.8) at screening to 1.1 (1.1) at 6 months ( <0.001). Three eyes had transient IOP spikes treated with topical medications. The creation of incisional goniotomies and canal of Schlemm viscodilation safely and effectively reduced IOP and the need for IOP-lowering medications by both clinically and statistically significant magnitudes in eyes with mild to severe POAG undergoing concomitant phacoemulsification cataract extraction through the first 6 months of follow-up.

Dry eye disease (DED) is a common ocular condition, but the diagnosis relative to other ocular conditions and the evaluation of severity of the condition has often been difficult. This challenge can be due to clinical signs and symptoms not always correlating with each other. An understanding of the various components which create the condition, as well as the diagnostic measures used to evaluate these components, is useful to the clinician working with DED patients. This review paper will discuss traditional diagnostic options, diagnostic imaging, and Advanced Point of Care testing capabilities to determine the severity level of dry eye disease more adequately.

Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans. We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 bio markers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma N-terminal pro–B-type natriuretic peptide and plasma high-sensitivity C-reactive protein). Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9). Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media. ClinicalTrials.gov, no. NCT01225094.

Chester T, Garg S, Johnston J, Ayers B, Gupta P. Clin Ophthalmol. 2023;17:1587-1604. Page 1587, author list, the text \"Brandon Ayers\" should read \"Brandon Ayres\". The authors have also advised the units of measurement for Lactoferrin in Figure 1 on page 1597 is incorrect. The correct Figure 1 is shown below. Figure 1 (A and B) Identification and management of aqueous-deficient dry eye. (C and D) Identification and management of evaporative dry eye. The authors apologize for this error and advise it does not affect the results of the paper.

To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India. A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM. The age of patients ranged from 29 to 75 years and male-female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned. SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.

Background: Yoga and meditation are associated with improvement in both physical and mental health. Brahmakumari meditation is concerned with awareness of the metaphysical self with reorientating thought patterns and feelings so one can live with positive thinking, greater harmony, and contentment. EEG gives meaningful insight about the state of mind of an individual. Aims and Objectives: The present study was designed to review the effects of meditation on the state of mind based on changing EEG brainwave patterns in long-term Brahmakumari meditators. Materials and Methods: Fifteen Brahmakumari meditators aged between 30 and 50 years who were involved in regular meditation for >10 years and with no history of any neurological disorders were enrolled. Twenty-one channels EEG with EKG and EMG were recorded in all subjects during pre-meditative, meditative, and post-meditative state at an interval of 20 min. Qualitative EEG was analyzed for the appearance of wave patterns based on different voltages and frequencies. Results: High voltage alpha rhythm was observed in the majority of subjects during pre-meditation and theta waves in most subjects during meditation. During meditation, their minds progress further to a deep state of calmness and relaxation as indicated by the appearance of theta waves. Even delta waves were observed during meditation in some of the subjects indicating a phase similar to a deep sleep. Conclusion: Stress and mental unrest are major problem in the present era which is responsible for many non-communicable diseases. Regular meditation is a very important de-stressor and should be regularly practiced to lead a happy and peaceful life.

In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep ( <0.001), reduced N3 NREM sleep ( <0.001), higher AHI severity ( <0.001), higher NREM AHI ( <0.001), and high arousal index ( <0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, =0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.

Background/aimsTo describe the results of pars plana vitrectomy (PPV) for persistent symptomatic vitreomacular traction (VMT) with or without macular hole (MH) after intravitreal ocriplasmin injection.MethodsMulticentre retrospective study of eyes that received intravitreal ocriplasmin between January 2013 and January 2014 for symptomatic VMT with or without MH, and then went on to PPV (ocriplasmin-treated group) for persistent pathology, compared with a control group of patients with symptomatic VMT with or without MH who were offered ocriplasmin injection but proceeded directly to PPV (PPV-only group). Intraoperative characteristics, visual acuity (VA) outcomes and spectral-domain optical coherence tomography images were reviewed for the two groups. Primary outcome measure was VA after PPV.Results51 eyes of 51 patients underwent PPV after receiving ocriplasmin, and 22 eyes of 22 patients proceeded directly to PPV. Although VA was significantly better at all time points in the PPV-only compared with the ocriplasmin-treated group, at 3 and 6 months after PPV both groups had similar amount of visual improvement. Both groups had similar rates of pathology resolution; 50/51 (98%) eyes in the ocriplasmin group and 22/22 (100%) eyes in the PPV-only group had release of VMT and/or MH closure after PPV. The two groups had similar PPV-related complication rates.ConclusionsEyes with persistent symptomatic VMT and/or MH have similarly high rates of pathology resolution as well as similar VA gains regardless of whether they received ocriplasmin prior to PPV.

Purpose. To compare the preoperative measurements of the anterior chamber depth (ACD) by the IOLMaster and Catalys; additionally, to compare the accuracy of the IOL power calculated by the Barrett Universal II formula using the two different measurements. Setting. University of California, Irvine, Gavin Herbert Eye Institute in Irvine, California. Design. Retrospective comparative study. Methods. This study included 144 eyes of 90 patients with a mean age of 72.0 years (range 40.8 to 92.1 years) that underwent femtosecond laser-assisted cataract surgery using Catalys. Preoperative measurements of ACD were taken by the IOLMaster and Catalys. Manifest refraction and refractive spherical equivalent were measured 1 month postoperatively. Expected refractive results were compared with actual postoperative refractive results. Results. The correlation between the ACD values from the two devices was good (r = 0.80). The Catalys ACD measurements yielded a larger ACD compared to the IOLMaster, with a mean difference of 0.22 mm (P<0.0001). The correlation between the postoperative and predicted RSE of the implanted IOL power was excellent (r = 0.96). There was no statistically significant difference between the mean absolute error derived from the IOLMaster, 0.37 diopter (D) ± 0.34 (SD), and the Catalys, 0.37 ± 0.35 D (P=0.50). Conclusions. The Catalys biometry yielded a significantly larger ACD value than the IOLMaster. This difference in ACD value, however, did not reflect in a statistically significant difference in IOL power calculation and refractive prediction error using the Barrett Universal II Formula.

Purpose To determine whether combining spinal or epidural anesthesia with general anesthesia (combined anesthesia) reduces major medical complications of elective surgery compared with general anesthesia alone. Methods We conducted a propensity-matched population-based historical cohort study using large healthcare databases from Ontario, Canada. We identified patients undergoing 21 different elective procedures that were amenable to either combined anesthesia or general anesthesia alone in 108 hospitals from 2004 to 2011. We assessed the following four outcomes together as a composite and individually in the 30 days following surgery: acute kidney injury, stroke, myocardial infarction, and all-cause mortality. Results Prior to matching, we identified 21,701 patients receiving general anesthesia and 8,042 patients receiving combined anesthesia. After matching, our cohort included 12,379 patients. Twenty-eight baseline characteristics were well-matched between the combined ( n  = 4,773) and general anesthesia groups ( n  = 7,606). Mean patient age was 66 yr. Relative to general anesthesia alone, combined anesthesia was not associated with a reduced risk for the composite outcome [104/4,773 (2.2%) vs 162/7,606 (2.1%); odds ratio (OR) 0.97; 95% confidence interval (CI) 0.75 to 1.24] or for any of the four component outcomes when examined separately: acute kidney injury (OR 0.93; 95% CI 0.58 to 1.51), stroke (OR 0.79; 95% CI 0.36 to 1.73), myocardial infarction (OR 1.04; 95% CI 0.69 to 1.57), and all-cause mortality (OR 0.91; 95% CI 0.59 to 1.42). Conclusion The addition of spinal or epidural anesthesia to general anesthesia was not associated with a reduced risk of major medical complications among 21 different elective procedures when compared with general anesthesia alone.