Neelakshi Bhagat

Purpose: To describe a case in which a large intraocular glass fragment was successfully retrieved using a basket device originally designed for kidney stone extraction. Methods: Retrospective case report. Case: A 17-year-old male presented four days after open globe repair following a motor vehicle accident with a large intravitreal glass fragment measuring 5 × 4 × 3.5 mm³. Surgical management included pars plana lensectomy and vitrectomy. A four-prong nephrolithiasis basket was ultimately successful in retrieving the thick, smooth-surfaced glass fragment after conventional instruments failed to achieve extraction. Conclusion: Removal of large, smooth intraocular glass or spherical plastic foreign bodies presents a significant surgical challenge. A kidney stone basket device may serve as an effective alternative for the removal of bulky foreign bodies that are too large or slippery to be securely grasped with conventional forceps.

Purpose The purpose of this study is to analyze the trends and characteristics of ocular trauma research published from 2000 to 2022 to delineate the trajectory of the field’s research, provide information about the network of key contributors, and help determine future research strategies and direction. Methods Web of Science was queried for published works using a series of keywords relating to ocular trauma: “globe rupture”, “ruptured globe”, “globe injury”, “ocular trauma”, “intraocular foreign body”, “eye trauma”, “eye injury”, and “traumatic endophthalmitis”. All article information was compiled using the VOSviewer software. Article information analyzed included year of publication, publishing journal, author, institution, country, and keywords/key terms. Results A total of 3362 articles were identified. In the time period studied, there is a noticeable trend for an increase in the number of papers pertaining to ocular trauma to be published annually. The journal, Eye published the most, and the United States produced the most articles of any country. Important keywords other than “ocular trauma” included “epidemiology”, “management”, “children”, “vitrectomy” and “endophthalmitis”. Conclusion Complications due to ocular trauma are seen worldwide. Many different institutions, journals, and countries have published research on ocular trauma with an increased frequency in recent years. This study provides valuable information on the status of scholarly investigation of ocular trauma in the last 2 decades and sheds light on the trajectory of recent research interest.

Background/Objectives: The purpose of this study was to identify demographic variables and systemic comorbidities that may increase risk of endogenous endophthalmitis (EE) development in patients with infective endocarditis (IE). Subjects/Methods: A retrospective database study was conducted using the 2002–2014 National Inpatient Sample (NIS). Patients with IE and EE were identified using ICD-9-CM codes. Descriptive chi-square and logistic regression analysis identified risk factors for EE in IE patients. Results: Of 769,472 inpatients with a diagnosis of IE, 2248 had a diagnosis of EE. Women comprised 39.7% of IE patients without EE and 42.6% of those with EE (p = 0.005). The majority of IE cases with EE were in those 21–64-year-old (58.5%) age cohort and 67.4% of cases were Whites. Multivariate analysis revealed IE patients in the 21–64 (OR, 3.660) and 65+ age group (OR, 2.852) had increased risk of developing EE compared to the 0–20-year-old group. Hispanic (OR, 1.377) and Asian/Pacific Islander (OR, 1.620) patients had increased risk compared to White patients. Diabetes with (OR, 2.043) and without (OR, 1.433) chronic complications, alcohol use disorder (AUD; OR, 1.795), and cirrhosis (OR, 1.452) conferred an increased risk of developing EE, whereas, congestive heart failure (CHF; OR, 0.716), arrhythmia (OR, 0.678), and having a cardiac device (OR, 0.336) decreased risk of EE in IE subjects. Conclusion: Older age (21+ years) and Hispanic and Asian/Pacific Islander background were associated with increased risk of developing EE in IE patients. Diabetes with and without chronic complications, AUD, or cirrhosis also conferred a 1.5–2 times increased risk. CHF, arrhythmia, or having a cardiac device were associated with decreased risk.

Purpose Early detection and treatment of diabetic retinopathy (DR) are critical for decreasing the risk of vision loss and preventing blindness. Community vision screenings may play an important role, especially in communities at higher risk for diabetes. To address the need for increased DR detection and referrals, we evaluated the use of artificial intelligence (AI) for screening DR. Methods Patient images of 124 eyes were obtained using a 45° Canon Non-Mydriatic CR-2 Plus AF retinal camera in the Department of Endocrinology Clinic (Newark, NJ) and in a community screening event (Newark, NJ). Images were initially classified by an onsite grader and uploaded for analysis by EyeArt, a cloud-based AI software developed by Eyenuk (California, USA). The images were also graded by an off-site retina specialist. Using Fleiss kappa analysis, a correlation was investigated between the three grading systems, the AI, onsite grader, and a US board-certified retina specialist, for a diagnosis of DR and referral pattern. Results The EyeArt results, onsite grader, and the retina specialist had a 79% overall agreement on the diagnosis of DR: 86 eyes with full agreement, 37 eyes with agreement between two graders, 1 eye with full disagreement. The kappa value for concordance on a diagnosis was 0.69 (95% CI 0.61–0.77), indicating substantial agreement. Referral patterns by EyeArt, the onsite grader, and the ophthalmologist had an 85% overall agreement: 96 eyes with full agreement, 28 eyes with disagreement. The kappa value for concordance on “whether to refer” was 0.70 (95% CI 0.60–0.80), indicating substantial agreement. Using the board-certified retina specialist as the gold standard, EyeArt had an 81% accuracy (101/124 eyes) for diagnosis and 83% accuracy (103/124 eyes) in referrals. For referrals, the sensitivity of EyeArt was 74%, specificity was 87%, positive predictive value was 72%, and negative predictive value was 88%. Conclusions This retrospective cross-sectional analysis offers insights into use of AI in diabetic screenings and the significant role it will play in automated detection of DR. The EyeArt readings were beneficial with some limitations in a community screening environment. These limitations included a decreased accuracy in the presence of cataracts and the functional cost of EyeArt uploads in a community setting.

Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.

Purpose: Patients with Type II Diabetes are at increased risk Diabetic Retinopathy (DR). Early detection and treatment of DR is critical for saving vision and preventing blindness. To address the need for increased DR detection and referrals, we evaluated the use of artificial intelligence (AI) for screening DR. Methods: Patient images were obtained using a 45-degree Canon Non-Mydriatic CR-2 Plus AF retinal camera in the Department of Endocrinology Clinic (Newark, NJ) and in a community screening event (Newark, NJ). Images were initially classified by an on-site grader and uploaded for analysis by EyeArt, a cloud-based AI software developed by Eyenuk (California, USA). The images were also graded by an off-site retina specialist. Using Fleiss kappa analysis, a correlation was investigated between the three grading systems, the AI, onsite grader, and a US board-certified retina specialist, for a diagnosis of DR and referral pattern. Results: The EyeArt results, onsite grader, and the retina specialist had a 79% overall agreement on the diagnosis of DR. The kappa value for concordance on a diagnosis was 0.69 (95% CI: 0.61-0.77), indicating substantial agreement. Referral patterns by EyeArt, the onsite grader, and the ophthalmologist had an 85% overall agreement. The kappa value for concordance on “whether to refer” was 0.70 (95% CI: 0.60-0.80), indicating substantial agreement. Conclusions: This retrospective cross-sectional analysis offers insights into use of AI in diabetic screenings and the significant role it will play in automated detection of DR. The EyeArt readings were beneficial with some limitations in a community screening environment.

Purpose This study aims to investigate trends and risk factors associated with work-related ocular injuries occurring in adults aged 19–64 using the National Trauma Databank (NTDB). Methods In this retrospective, cross-sectional study, the NTDB was used to collect all patients with an ICD-9 code of work-related ocular trauma from 2007 to 2014. Demographic data and risk factors collected included age, gender, race, setting, machinery, and mechanism. Descriptive statistics, univariate, and logistic regression multivariate analyses were conducted. Results Between 2007 and 2014, 234,983 cases of work-related trauma were identified, of which 11,097 (5.7%) cases involved ocular trauma. The mean age of patients was 40.7 years (SD = 12.2), and the majority of patients (93.7%) were male. Most injuries occurred in an industrial facility, and the most common injuries were orbital floor fractures (OFFs), ocular contusions, open wounds to the adnexa, and open globe injuries (OGIs). OFFs most commonly involved a concurrent fracture of another facial or skull bone. Male gender (RR = 1.22; CI 1.09–1.38), accidental falls (RR = 1.50; CI 1.41–1.60), trauma from falling objects (RR = 1.34; CI 1.21–1.48), involvement in an unarmed fight (RR = 1.63; CI 1.39–1.91), assault by a blunt object (RR = 1.59; CI 1.31–1.91), and injury caused by animals (RR = 1.63; CI 1.30–2.02) were risk factors for OFFs. Patients with OFFs were less likely to have a concurrent OGI (RR = 0.27; CI 0.23–0.32). On the other hand, injuries occurring in industrial facilities (RR = 1.29; CI 1.11–1.51) and injuries with a loose foreign body striking the eye or adnexa (RR = 1.54; CI 1.28–1.84) were risk factors for OGI. The most common causes of work-related ocular trauma were accidental falls, motor vehicle accidents, and accidentally being struck in the eye. The mean length of hospital stay was 6.56 days (SD = 10.82); 36.7% of patients required ICU admission, and the overall in-hospital mortality rate was 2.8%. Conclusion The majority of work-related ocular trauma occurred in men, most commonly in industrial locations. Accidental falls were the most common identified cause of trauma. OFF was the most common ocular injury; 80% of OFF cases involved additional facial and skull fractures. Patients with OFFs were less likely to have a concurrent OGI compared with patients without OFFs.