Korean Journal of Ophthalmology author guidelines manuscript format 2024 2025

cd /tmp/workspace/attachments/bc88d09d-9c43-48e5-9d5c-2685f40aae02/ && python3 -c " import pdfplumber pdf_path = 'thesis_dr. reshma ragunath_knsmims.pdf' with pdfplumber.open(pdf_path) as pdf: print(f'Total pages: {len(pdf.pages)}') # Extract first 15 pages to understand structure for i, page in enumerate(pdf.pages[:15]): text = page.extract_text() if text: print(f'\\n=== PAGE {i+1} ===') print(text[:2000]) "

https://www.ekjo.org/authors/authors.php

cd /tmp/workspace/attachments/bc88d09d-9c43-48e5-9d5c-2685f40aae02/ && python3 -c " import pdfplumber pdf_path = 'thesis_dr. reshma ragunath_knsmims.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract pages 15-35 (introduction, aims, review of lit, methods) for i, page in enumerate(pdf.pages[14:35]): text = page.extract_text() if text: print(f'\\n=== PAGE {i+15} ===') print(text) " 2>&1 | head -600

cd /tmp/workspace/attachments/bc88d09d-9c43-48e5-9d5c-2685f40aae02/ && python3 -c " import pdfplumber pdf_path = 'thesis_dr. reshma ragunath_knsmims.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract pages 35-75 (methods, results, discussion, conclusion) for i, page in enumerate(pdf.pages[34:75]): text = page.extract_text() if text: print(f'\\n=== PAGE {i+35} ===') print(text) " 2>&1 | head -800

cd /tmp/workspace/attachments/bc88d09d-9c43-48e5-9d5c-2685f40aae02/ && python3 -c " import pdfplumber pdf_path = 'thesis_dr. reshma ragunath_knsmims.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract pages 64-90 (rest of results, discussion, conclusion, bibliography) for i, page in enumerate(pdf.pages[63:92]): text = page.extract_text() if text: print(f'\\n=== PAGE {i+64} ===') print(text) " 2>&1 | head -700

cd /tmp/workspace/attachments/bc88d09d-9c43-48e5-9d5c-2685f40aae02/ && python3 -c " import pdfplumber pdf_path = 'thesis_dr. reshma ragunath_knsmims.pdf' with pdfplumber.open(pdf_path) as pdf: # Extract bibliography pages 91-100 for i, page in enumerate(pdf.pages[90:102]): text = page.extract_text() if text: print(f'\\n=== PAGE {i+91} ===') print(text) " 2>&1

mkdir -p /tmp/workspace/kjo-article && ls /tmp/workspace/kjo-article/

python3 << 'PYEOF' from docx import Document from docx.shared import Pt, Cm, Inches from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.oxml.ns import qn from docx.oxml import OxmlElement import copy doc = Document() # ── Page setup: 2.5 cm margins, 10-pt font ────────────────────────────────── section = doc.sections[0] section.top_margin = Cm(2.5) section.bottom_margin = Cm(2.5) section.left_margin = Cm(2.5) section.right_margin = Cm(2.5) # Default style style = doc.styles['Normal'] style.font.name = 'Times New Roman' style.font.size = Pt(10) style.paragraph_format.space_after = Pt(0) style.paragraph_format.line_spacing = Pt(20) # double-spaced ~20pt def add_para(text, bold=False, italic=False, align=WD_ALIGN_PARAGRAPH.LEFT, space_before=Pt(0), space_after=Pt(0)): p = doc.add_paragraph() p.alignment = align p.paragraph_format.space_before = space_before p.paragraph_format.space_after = space_after p.paragraph_format.line_spacing = Pt(20) run = p.add_run(text) run.bold = bold run.italic = italic run.font.name = 'Times New Roman' run.font.size = Pt(10) return p def add_heading(text, level=1): """Section headings in bold, 10-pt, no numbering.""" p = add_para(text, bold=True, space_before=Pt(12), space_after=Pt(4)) return p def add_body(text): p = add_para(text, space_after=Pt(6)) return p def page_break(): doc.add_page_break() # ════════════════════════════════════════════════════════════════════════════ # TITLE PAGE # ════════════════════════════════════════════════════════════════════════════ page_break() # Running title (bottom of each page per KJO) - we note it here add_para("Running title: Intracameral Adrenaline in Cataract Surgery", italic=True, align=WD_ALIGN_PARAGRAPH.LEFT) doc.add_paragraph() # Title title_para = doc.add_paragraph() title_para.alignment = WD_ALIGN_PARAGRAPH.CENTER title_para.paragraph_format.space_after = Pt(12) title_para.paragraph_format.line_spacing = Pt(20) run = title_para.add_run( "Efficacy and Hemodynamic Safety of Intracameral Adrenaline Infusion " "for Maintaining Intraoperative Mydriasis During Manual Small Incision " "Cataract Surgery: A Prospective Randomized Controlled Trial" ) run.bold = True run.font.name = 'Times New Roman' run.font.size = Pt(10) # Authors add_para( "Reshma Ragunath, MS\u00b9", align=WD_ALIGN_PARAGRAPH.CENTER ) # Affiliations add_para( "\u00b9Department of Ophthalmology, Dr. K.N. Singh Memorial Institute of " "Medical Sciences, Barabanki, Uttar Pradesh, India", align=WD_ALIGN_PARAGRAPH.CENTER ) doc.add_paragraph() # Corresponding author add_para("Corresponding Author:", bold=True) add_para( "Reshma Ragunath, MS\n" "Department of Ophthalmology, Dr. K.N. Singh Memorial Institute of " "Medical Sciences, Barabanki, Uttar Pradesh, India\n" "E-mail: [author email]" ) doc.add_paragraph() # Conflict of interest / funding add_para("Conflict of Interest: None declared.", italic=True) add_para("Funding: None.", italic=True) page_break() # ════════════════════════════════════════════════════════════════════════════ # ABSTRACT (structured, ≤300 words) # ════════════════════════════════════════════════════════════════════════════ add_heading("ABSTRACT") abstract_sections = [ ("Purpose", "To evaluate the efficacy of intracameral adrenaline infusion in " "maintaining intraoperative mydriasis during manual small incision " "cataract surgery (MSICS) and to assess its systemic effects on pulse " "rate and blood pressure."), ("Methods", "A prospective randomized controlled trial was conducted on 86 patients " "(86 eyes) aged 40-70 years undergoing MSICS. Patients were randomly " "assigned to Group A (intracameral adrenaline 0.00001% added to 500 mL " "infusion fluid, n = 43) or Group B (control, no adrenaline, n = 43). " "All patients received preoperative topical mydriatics (tropicamide 0.5%, " "phenylephrine 5%, and an NSAID drop). Pupil diameter was measured at " "four intraoperative time points: before infusion, after intracameral " "infusion, after nucleus delivery, and at the end of surgery. Pulse rate " "and systolic and diastolic blood pressure were recorded preoperatively " "(30 minutes before), intraoperatively (after infusion), and " "postoperatively (30 minutes after surgery). Paired and independent " "t-tests, chi-square tests, Pearson correlation, and linear regression " "analyses were performed; p < 0.05 was considered statistically " "significant."), ("Results", "Baseline characteristics were comparable between groups. Group A " "demonstrated a significantly larger mean pupil diameter at the end of " "surgery (6.79 +/- 0.42 mm) compared to Group B (4.15 +/- 0.30 mm; " "p < 0.001). All 43 patients (100%) in Group A maintained adequate " "mydriasis (pupil >= 6 mm) at surgery completion, whereas no patient in " "Group B did (p < 0.001). Linear regression showed that intracameral " "adrenaline was an independent predictor of a 2.6 mm larger final pupil " "diameter (p < 0.001). Pulse rate and blood pressure remained stable and " "did not differ significantly between groups at any time point " "(all p > 0.3)."), ("Conclusions", "Intracameral adrenaline infusion at a concentration of 0.00001% is " "highly effective in maintaining intraoperative mydriasis during MSICS " "and does not cause clinically significant alterations in pulse rate or " "blood pressure, supporting its safety and clinical utility.") ] for heading, text in abstract_sections: p = doc.add_paragraph() p.paragraph_format.line_spacing = Pt(20) p.paragraph_format.space_after = Pt(4) r1 = p.add_run(heading + ": ") r1.bold = True r1.font.name = 'Times New Roman' r1.font.size = Pt(10) r2 = p.add_run(text) r2.font.name = 'Times New Roman' r2.font.size = Pt(10) doc.add_paragraph() add_para( "Keywords: Intracameral adrenaline, Intraoperative mydriasis, " "Small incision cataract surgery, Pupil diameter, Hemodynamic safety" ) page_break() # ════════════════════════════════════════════════════════════════════════════ # INTRODUCTION # ════════════════════════════════════════════════════════════════════════════ add_heading("INTRODUCTION") intro_paras = [ "Cataract remains the leading cause of reversible blindness globally, " "and manual small incision cataract surgery (MSICS) is the predominant " "surgical technique in high-volume, resource-limited settings worldwide.1 " "A well-dilated, stable pupil is a fundamental prerequisite for the safe " "performance of every critical step of MSICS, from continuous curvilinear " "capsulorhexis (CCC) and hydrodissection to nucleus delivery and " "intraocular lens (IOL) implantation. A pupil diameter of at least 6 mm " "is considered essential for adequate visualization; pupil diameters below " "this threshold exponentially increase the risk of intraoperative " "complications, including iris damage, incomplete cortex removal, posterior " "capsular rupture (PCR), and vitreous loss.2,3", "Surgically induced miosis is a major intraoperative challenge, resulting " "from mechanical iris trauma and the consequent release of prostaglandins " "during nucleus delivery.4 Unlike phacoemulsification, where the nucleus " "is fragmented in situ through a smaller incision, MSICS requires the " "physical displacement of the entire nucleus through the pupillary aperture " "into the anterior chamber, imposing far greater mechanical stress on iris " "tissues.5 This distinctive feature makes the maintenance of mydriasis " "throughout MSICS particularly demanding.", "Conventional preoperative topical mydriatics, including phenylephrine and " "tropicamide, are frequently limited by poor corneal bioavailability, the " 'melanin-binding "sink" effect in darkly pigmented irides, and the risk of ' "systemic absorption via the nasolacrimal duct.6,7 Intracameral delivery " "of mydriatic agents directly into the anterior chamber bypasses these " "limitations by providing a rapid, high-concentration, and localized " "pharmacological effect with minimal systemic exposure.", "Adrenaline (epinephrine), a potent non-selective sympathomimetic, " "stimulates alpha-1 adrenergic receptors on the iris dilator muscle, " "inducing and sustaining mydriasis, while its beta-2 receptor activity " "simultaneously relaxes the iris sphincter, providing a synergistic " "dilating effect.8 Several studies have reported the efficacy of " "intracameral adrenaline in maintaining pupillary dilation and countering " "intraoperative miosis.9-11 However, concerns persist regarding potential " "cardiovascular effects, particularly in elderly patients.12 " "Despite a growing body of evidence suggesting hemodynamic safety, " "dedicated studies specifically examining MSICS are limited.", "This study aimed to evaluate the efficacy of intracameral adrenaline " "infusion in maintaining intraoperative mydriasis as an adjunct to " "preoperative topical mydriatics during MSICS, and to assess its impact " "on pulse rate and blood pressure." ] for text in intro_paras: add_body(text) # ════════════════════════════════════════════════════════════════════════════ # MATERIALS AND METHODS # ════════════════════════════════════════════════════════════════════════════ add_heading("MATERIALS AND METHODS") add_heading("Study Design and Setting") add_body( "This prospective, randomized, controlled trial was conducted in the " "Department of Ophthalmology at Dr. K.N. Singh Memorial Institute of " "Medical Sciences (KNSMIMS), Barabanki, Uttar Pradesh, India, over " "a period of 18 months following institutional ethics committee approval. " "The study adhered to the tenets of the Declaration of Helsinki. Written " "informed consent was obtained from all participants." ) add_heading("Participants") add_body( "Eighty-six patients (86 eyes) aged 40 to 70 years diagnosed with " "cataract and scheduled for MSICS were enrolled. Sample size was " "calculated using the standard proportion formula (Z = 1.96, p = 0.06, " "e = 0.05), yielding a minimum of 86 patients." ) add_body( "Inclusion criteria: age 40-70 years; cataract requiring surgery; " "clinically normal pupil size and morphology." ) add_body( "Exclusion criteria: known diabetes mellitus, hypertension, or cardiac " "disease; prior intraocular inflammation; traumatic, congenital, or " "uveitic cataract; glaucoma; corneal opacities or degenerations; " "abnormal pupil size or shape; pseudoexfoliation syndrome; " "pre-operative non-dilating pupil." ) add_heading("Randomization and Grouping") add_body( "Patients were randomly assigned in a 1:1 ratio to one of two groups: " "Group A (intracameral adrenaline infusion, n = 43) and Group B " "(control, no adrenaline, n = 43)." ) add_heading("Preoperative Protocol") add_body( "All patients underwent a standardized preoperative evaluation including " "best-corrected visual acuity, slit-lamp biomicroscopy, intraocular " "pressure measurement, keratometry (Bausch and Lomb manual keratometer), " "axial length measurement (A-scan biometry), and fundus examination. " "General parameters including pulse rate, blood pressure, random blood " "sugar, and viral markers were recorded. " "Pupil dilation was achieved preoperatively for all patients using one " "drop each of tropicamide 0.5%, phenylephrine 5%, and an NSAID eye drop " "at 15-minute intervals for four instillations, commencing one hour " "before surgery." ) add_heading("Surgical Technique") add_body( "All surgeries were performed under peribulbar anaesthesia following " "standard MSICS guidelines. For Group A patients, 1 mL of preservative-" "free adrenaline 0.00001% (1:1,000,000) was added to 500 mL of " "balanced salt solution infusion fluid prior to surgery. Group B patients " "received standard infusion fluid without adrenaline. " "The surgical procedure comprised: superior rectus bridle suture, " "conjunctival peritomy, self-sealing sclero-corneal tunnel incision " "(5.5-7.5 mm length, depending on nucleus hardness), side-port entry, " "anterior capsule staining with trypan blue, CCC, hydrodissection, " "nucleus prolapse and delivery using a non-irrigating wire vectis, " "cortex aspiration using a two-way irrigation-aspiration cannula, " "and posterior chamber IOL implantation. " "Wound closure was achieved by self-sealing with hydration; rarely a " "single 10-0 nylon suture was placed. Subconjunctival gentamicin and " "dexamethasone were administered at the conclusion of surgery." ) add_heading("Outcome Measures and Data Collection") add_body( "The primary outcome was pupil diameter (mm), measured using a " "Castroviejo-Grancini surgical caliper at four intraoperative time " "points: (1) before intracameral infusion (baseline in the operating " "theatre after preoperative dilation), (2) 30 seconds after intracameral " "infusion (Group A only), (3) after nucleus delivery, and (4) at the end " "of surgery." ) add_body( "Secondary outcomes were pulse rate (beats/min) and systolic and " "diastolic blood pressure (mmHg), each recorded at three perioperative " "time points: 30 minutes preoperatively, intraoperatively (after " "intracameral infusion in Group A, at the equivalent time in Group B), " "and 30 minutes postoperatively. Adequacy of mydriasis was defined " "as a final pupil diameter >= 6 mm at the end of surgery, consistent " "with published clinical thresholds for safe intraocular manoeuvres.2" ) add_heading("Statistical Analysis") add_body( "Continuous variables are presented as mean +/- standard deviation (SD). " "Between-group comparisons at each time point were performed using the " "independent samples t-test. Within-group changes over time were assessed " "using the paired t-test. Categorical outcomes were analysed using the " "chi-square test or Fisher exact test as appropriate. Pearson correlation " "coefficients were calculated to assess relationships between continuous " "variables. Linear regression analysis was used to quantify the " "independent effect of intracameral adrenaline on final pupil diameter " "and postoperative hemodynamic parameters, adjusting for corresponding " "baseline values. All tests were two-tailed; p < 0.05 was considered " "statistically significant. Analyses were conducted using SPSS version " "23.0 (IBM Corp., Armonk, NY, USA)." ) # ════════════════════════════════════════════════════════════════════════════ # RESULTS # ════════════════════════════════════════════════════════════════════════════ add_heading("RESULTS") add_heading("Baseline Characteristics") add_body( "Eighty-six patients were enrolled and completed the study (Group A, " "n = 43; Group B, n = 43). The mean age was 58.5 +/- 8.3 years in " "Group A and 55.1 +/- 9.1 years in Group B (p = 0.07). Sex distribution " "was similar between groups (Group A: 22 males, 21 females; Group B: " "20 males, 23 females; p = 0.83). All patients had no significant " "systemic comorbidities. Baseline (preoperative) pupil diameter was " "equivalent between groups (Group A: 8.12 +/- 0.57 mm; Group B: " "8.14 +/- 0.51 mm; p = 0.84). Preoperative pulse rate (Group A: " "85.4 +/- 1.9 bpm; Group B: 84.9 +/- 1.9 bpm; p = 0.54), systolic " "blood pressure (Group A: 128.4 +/- 6.0 mmHg; Group B: " "128.3 +/- 6.2 mmHg; p = 0.97), and diastolic blood pressure " "(Group A: 85.2 +/- 4.5 mmHg; Group B: 86.0 +/- 4.8 mmHg; p = 0.30) " "were also comparable. Randomization was therefore successful with " "respect to all measured baseline parameters (Table 1)." ) add_heading("Intraoperative Pupil Diameter") add_body( "Serial pupil diameter measurements are summarized in Table 2. In Group A, " "intracameral adrenaline infusion produced a small but statistically " "significant immediate increase in pupil diameter from 8.12 +/- 0.57 mm " "to 8.41 +/- 0.60 mm (mean increase +0.29 mm; p < 0.001, paired t-test). " "Both groups then experienced marked intraoperative miosis during nucleus " "delivery (Group A: 5.33 +/- 0.35 mm; Group B: 5.34 +/- 0.30 mm; " "intergroup p = 0.91), demonstrating that the mechanical stress of nucleus " "delivery produced profound miosis even in the presence of adrenaline." ) add_body( "The decisive divergence between groups occurred after nucleus delivery " "and continued until surgery completion. Group A demonstrated pupillary " "re-dilation from 5.33 mm to 6.79 +/- 0.42 mm (mean increase +1.46 mm; " "p < 0.001), whereas Group B continued to constrict from 5.34 mm to " "4.15 +/- 0.30 mm (mean decrease -1.19 mm; p < 0.001). The final " "between-group difference in pupil diameter was 2.64 mm (p < 0.001). " "Linear regression confirmed that intracameral adrenaline was an " "independent predictor of a 2.6 mm larger final pupil size after " "controlling for baseline pupil diameter (p < 0.001; R2 = 0.93)." ) add_body( "Regarding the adequacy of mydriasis, all 43 patients (100%) in Group A " "finished surgery with a pupil diameter >= 6 mm, whereas none of the " "43 patients (0%) in Group B did (chi-square, p < 0.001; Table 3)." ) add_heading("Hemodynamic Parameters") add_body( "Pulse rate and blood pressure measurements at all three perioperative " "time points are presented in Tables 4 and 5. Pulse rates remained " "stable throughout in both groups (Group A: 85.4 +/- 1.9 bpm " "preoperatively, 85.0 +/- 2.0 bpm intraoperatively, 85.5 +/- 1.7 bpm " "postoperatively; Group B: 84.9 +/- 1.9, 84.8 +/- 1.7, " "85.0 +/- 2.0 bpm, respectively). No significant intergroup differences " "were observed at any time point (pre-op p = 0.54; intra-op p = 0.75; " "post-op p = 0.58). Intra-group paired comparisons likewise showed no " "significant changes in pulse rate within either group at any interval " "(all p > 0.30)." ) add_body( "Systolic blood pressure was virtually unchanged across all time points " "in both groups and did not differ significantly between groups (all " "intergroup p > 0.90). Similarly, diastolic blood pressure remained " "stable with no clinically meaningful between-group differences " "(all intergroup p > 0.30). A marginally significant but clinically " "negligible intraoperative decrease in diastolic blood pressure was " "observed in Group B (86.0 vs 85.3 mmHg, p = 0.02); this transient " "change resolved by the postoperative measurement and was attributed to " "the anaesthetic effect. No clinically significant cardiovascular events " "were recorded in either group." ) add_body( "Pearson correlation analysis showed no significant correlation between " "pupil diameter and pulse rate (r = -0.10, p = 0.37 at baseline; " "r = +0.10, p = 0.36 at end of surgery) or between pulse rate and " "blood pressure (r = -0.03, p = 0.84 at baseline), further confirming " "the independence of the local mydriatic effect from systemic " "cardiovascular responses (Table 6). Linear regression analysis " "demonstrated that group assignment (adrenaline vs control) had no " "significant predictive effect on postoperative pulse rate " "(coefficient +0.1 bpm, p = 0.80), systolic BP (coefficient +0.0 mmHg, " "p = 0.95), or diastolic BP (coefficient +0.0 mmHg, p = 0.90)." ) # ════════════════════════════════════════════════════════════════════════════ # DISCUSSION # ════════════════════════════════════════════════════════════════════════════ add_heading("DISCUSSION") discussion_paras = [ "This prospective randomized controlled trial demonstrates that the " "addition of preservative-free adrenaline at a 0.00001% (1:1,000,000) " "concentration to the infusion fluid during MSICS is highly effective " "in maintaining intraoperative mydriasis. The primary finding - a " "100% rate of adequate mydriasis in the adrenaline group compared to " "0% in the control group at surgery completion - constitutes compelling " "evidence of both statistical and clinical significance.", "The temporal pupillary dynamics observed in this study reflect the " "physiological reality of MSICS. Both groups began surgery with well-" "dilated pupils (~8.1 mm) after standardized preoperative topical " "mydriatic regimens, confirming the adequate baseline pharmacological " "preparation. The profound miosis observed in both groups during nucleus " "delivery (to approximately 5.3 mm) underscores the intense mechanical " "stimulus associated with this manoeuvre.5 In MSICS, unlike " "phacoemulsification, the whole nucleus must be displaced through the " "pupillary aperture, directly stretching the iris stroma and triggering " "a surge in endogenous prostaglandins.13 The key clinical advantage of " "intracameral adrenaline is not the prevention of this acute constriction " "but rather its ability to facilitate re-dilation following this stimulus, " "sustaining a safe surgical field for the critical subsequent steps of " "cortex aspiration and IOL implantation.", "The present results corroborate those of Muley et al.,9 who similarly " "reported a mean post-injection pupil diameter of 7.67 mm in the " "adrenaline group versus 4.20 mm in controls (p < 0.0001) using a " "preservative-free bolus injection during SICS. The findings also align " "with Abdel-salam et al.,10 who observed a significant increase from " "4.53 +/- 1.27 mm to 6.46 +/- 1.00 mm after intracameral epinephrine " "injection in phacoemulsification patients, and with Ajay et al.,14 who " "reported superior maintenance of mydriasis with intracameral agents " "compared to topical drops in MSICS (6.1 vs 5.2 mm at end of surgery; " "p < 0.05).", "The clinical implications of the observed 6 mm threshold are substantial. " "A pupil reducing from 7 mm to 6 mm results in a loss of over 10 mm2 " "of surgical working area.2 Evidence suggests that with a pupil in the " 'range 4-6 mm ("small"), complication rates escalate approximately ' "eightfold compared to well-dilated conditions.15 The control group's " "mean final diameter of 4.15 mm places most control patients squarely " "within this high-risk zone, whereas the adrenaline group consistently " "remained in the safe range. This pharmacological intervention therefore " "has direct implications for reducing PCR, vitreous loss, and retained " "lens material - the most consequential intraoperative complications in " "cataract surgery.", "Regarding systemic safety, the complete absence of significant " "cardiovascular changes in either group across all time points represents " "a critical finding. The concentration employed (0.00001%) represents an " "extremely low dose confined to the anterior chamber, with minimal " "systemic absorption. These findings are consistent with Al-sebani,11 " "who reported no incremental effect on blood pressure or pulse in 421 " "dark-irides patients, and with Bhallil et al.,16 who reported stable " "haemodynamics in hypertensive patients undergoing phacoemulsification. " "The contrast with systemic epinephrine toxicity reports - for instance, " "the cardiovascular crisis described after nasal mucosal infiltration of " "a far larger volume17 - underscores that route of administration and " "dose are the critical determinants of systemic effect.", "Several limitations of this study merit consideration. The exclusion of " "patients with diabetes, hypertension, and cardiovascular disease, while " "necessary to isolate the pharmacological effect of adrenaline, limits " "the direct generalizability of the safety findings to these higher-risk " "populations. Future studies should specifically evaluate intracameral " "adrenaline in patients with pseudoexfoliation, intraoperative floppy " "iris syndrome (IFIS), and other \"small pupil\" syndromes. Additionally, " "the absence of long-term follow-up (specular microscopy, optical " "coherence tomography) precludes conclusions regarding long-term " "corneal endothelial and macular safety. Finally, the study examined a " "single concentration (0.00001%); comparative dose-response studies are " "warranted to determine the optimal balance between mydriatic potency and " "safety.", "In summary, the present study provides strong evidence that intracameral " "adrenaline infusion during MSICS is both highly effective in maintaining " "adequate mydriasis and haemodynamically safe in patients without " "significant systemic comorbidities. The technique offers a low-cost, " "pharmacological alternative to mechanical pupil expansion devices, " "which is particularly valuable in high-volume, resource-limited settings " "where MSICS is the primary cataract surgical modality." ] for text in discussion_paras: add_body(text) # ════════════════════════════════════════════════════════════════════════════ # REFERENCES # ════════════════════════════════════════════════════════════════════════════ add_heading("REFERENCES") refs = [ "1. Gogate PM. Small incision cataract surgery: complications and mini-review. Indian J Ophthalmol 2009;57:45-9.", "2. Jindal R, Saroha V, Arora R. Patient considerations in cataract surgery - the role of combined topical phenylephrine-ketorolac (Omidria). Patient Prefer Adherence 2017;11:153-64.", "3. Shaikh BK, Deshmukh S. A clinical study on causes of small pupil and its management in small incision cataract surgery. IP Int J Ocul Oncol Oculoplasty 2022;8:83-6.", "4. Sharma S, Vasavada V, Praveen MR, Vasavada AR, Shah SK, Patel U. Intra-operative miosis in cataract surgery: a review. Indian J Ophthalmol 2023;71:3225-32.", "5. Megbelayin EO, Pindikura S. Managing challenges of recalcitrant intra-operative miosis during small incision cataract surgery. J Dent Med Sci 2013;12:74-9.", "6. Lundberg B, Behndig A. Intracameral mydriatics in phacoemulsification cataract surgery. J Cataract Refract Surg 2003;29:2366-71.", "7. Valtari A, Kalinin S, Jantti J, et al. Melanin-binding-based discovery of topically instilled carbonic anhydrase inhibitors for targeted delivery and prolonged action in the eye. Mol Pharm 2025;22:721-32.", "8. Khamar P, Mehta N, Manda S, Patel P. Efficacy and safety of intracameral epinephrine as a mydriatic agent in cataract surgery: a systematic review. Int J Ophthalmol 2021;14:159-65.", "9. Muley P, Ramteerthakar N, Kulkarni A, Muley P. The effect of intracameral adrenaline bolus injection on pupil size, pulse rate and blood pressure during small incision cataract surgery. Int J Cur Res Rev 2020;12(14):114-8.", "10. Abdel-salam AM, El-hifnawy D, El-sayed YM. The effect of intracameral epinephrine on pupil size during phacoemulsification and its postoperative effect on specular findings and macular thickness. Rev Bras Oftalmol 2019;78:303-8.", "11. Al-sebani K. Efficacy and effect of intracameral adrenaline infusion on pulse rate and blood pressure during phacoemulsification in patients with dark irides. Eur Rev Med Pharmacol Sci 2021;25:4773-8.", "12. Yu A, Zhao G, He J, Song W, Sun S. Pupil dilation with intracameral epinephrine hydrochloride during phacoemulsification and intraocular lens implantation. Int J Ophthalmol 2012;5:730-4.", "13. Grzybowski A, Kanclerz P. Intracameral mydriatics and anesthetics for cataract surgery. Curr Opin Ophthalmol 2019;30:47-54.", "14. Ajay K, Saranya S, Sundaresh DD, et al. Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - a randomized controlled trial. Indian J Ophthalmol 2017;65:584-8.", "15. Malyugin B. Small pupil in cataract surgery: a review of definitions, pathogenesis, and management. J Cataract Refract Surg 2022;48:1077-87.", "16. Bhallil S, Andalloussi I, El Abdouni O, Mahjoubi I, Tahri H. Is there a perioperative circulatory side effect of intracameral epinephrine in hypertensive patients undergoing phacoemulsification? Oman J Ophthalmol 2010;3:141-2.", "17. Yu Y, Ma H, Sun Z, Liu Y, Jin X, Zhang J. Epinephrine-induced hypertension and cardiac arrest during nasal septoplasty. Anesth Cardiovasc Res 2017;1:21-4.", "18. Suresha AR, Gunashree KN. Safety and efficacy of intracameral mydriatics: lignocaine and epinephrine in manual small-incision cataract surgery and their effect on blood pressure and heart rate. Indian J Ophthalmol 2021;69:1343-5.", "19. Ameen AA, Mohamed MF, Mohamed NM. Intracameral epinephrine: a randomized controlled trial of its efficacy and safety in papillary dilatation during phacoemulsification. Br J Ophthalmol 2011;95:112-4.", "20. Adeogun IJ, Adekoya BJ, Balogun MM. Comparison of pupil dilation in manual small incision cataract surgery using topical versus intracameral mydriatic agents - a randomised controlled trial. Glob J Cataract Surg Res Ophthalmol 2024;3:4-9.", "21. Bamdad S, Khalili MR, Rahimi R. Comparison of the effects of 1/10,000 and 1/100,000 concentrations of intracameral epinephrine on corneal endothelium and macular thickness after uncomplicated phacoemulsification. Eye (Lond) 2020;34:2300-6.", "22. Zetterström C, Behndig A, Gylfe A, et al. Mydriasis stability in patients with systemic comorbidities after a standardised combination of intracameral mydriatics and anaesthetic during cataract surgery. J Pers Med 2024;15:119.", "23. Li Z, Zhang Y, Wang W, Hu Y. Pupil dilation with intracameral epinephrine hydrochloride during phacoemulsification and intraocular lens implantation. J Ophthalmol 2015;2015:875853." ] for ref in refs: p = doc.add_paragraph() p.paragraph_format.line_spacing = Pt(20) p.paragraph_format.space_after = Pt(3) p.paragraph_format.left_indent = Cm(0.5) p.paragraph_format.first_line_indent = Cm(-0.5) run = p.add_run(ref) run.font.name = 'Times New Roman' run.font.size = Pt(10) page_break() # ════════════════════════════════════════════════════════════════════════════ # TABLES # ════════════════════════════════════════════════════════════════════════════ add_heading("TABLES") # Helper function for tables def add_table_caption(text): p = doc.add_paragraph() p.paragraph_format.space_before = Pt(12) p.paragraph_format.space_after = Pt(4) p.paragraph_format.line_spacing = Pt(20) r = p.add_run(text) r.bold = True r.font.name = 'Times New Roman' r.font.size = Pt(10) def make_table(headers, rows): tbl = doc.add_table(rows=1 + len(rows), cols=len(headers)) tbl.style = 'Table Grid' # Header row hdr_cells = tbl.rows[0].cells for i, h in enumerate(headers): hdr_cells[i].text = h for para in hdr_cells[i].paragraphs: for run in para.runs: run.bold = True run.font.name = 'Times New Roman' run.font.size = Pt(9) para.paragraph_format.line_spacing = Pt(14) # Data rows for ri, row in enumerate(rows): row_cells = tbl.rows[ri+1].cells for ci, val in enumerate(row): row_cells[ci].text = val for para in row_cells[ci].paragraphs: for run in para.runs: run.font.name = 'Times New Roman' run.font.size = Pt(9) para.paragraph_format.line_spacing = Pt(14) doc.add_paragraph() # Table 1 add_table_caption("Table 1. Baseline Demographic and Preoperative Clinical Characteristics") make_table( ["Variable", "Group A (Adrenaline, n=43)", "Group B (Control, n=43)", "p-value"], [ ["Age (years), mean +/- SD", "58.5 +/- 8.3", "55.1 +/- 9.1", "0.07"], ["Male sex, n (%)", "22 (51.2%)", "20 (46.5%)", "0.83"], ["Pupil diameter (mm), mean +/- SD", "8.12 +/- 0.57", "8.14 +/- 0.51", "0.84"], ["Pulse rate (bpm), mean +/- SD", "85.4 +/- 1.9", "84.9 +/- 1.9", "0.54"], ["Systolic BP (mmHg), mean +/- SD", "128.4 +/- 6.0", "128.3 +/- 6.2", "0.97"], ["Diastolic BP (mmHg), mean +/- SD", "85.2 +/- 4.5", "86.0 +/- 4.8", "0.30"], ] ) add_para("BP = blood pressure; SD = standard deviation.", italic=True) # Table 2 doc.add_paragraph() add_table_caption("Table 2. Pupil Diameter (mm) at Key Intraoperative Time Points") make_table( ["Time Point", "Group A (Adrenaline)", "Group B (Control)", "p-value (A vs B)"], [ ["Before infusion (OR baseline)", "8.12 +/- 0.57", "8.14 +/- 0.51", "0.84"], ["After intracameral infusion", "8.41 +/- 0.60", "N/A", "-"], ["After nucleus delivery", "5.33 +/- 0.35", "5.34 +/- 0.30", "0.91"], ["End of surgery", "6.79 +/- 0.42", "4.15 +/- 0.30", "< 0.001"], ] ) add_para("OR = operating room; N/A = not applicable (no infusion in control group).", italic=True) # Table 3 doc.add_paragraph() add_table_caption("Table 3. Maintenance of Adequate Mydriasis (Pupil >= 6 mm) at End of Surgery") make_table( ["Group", "Maintained (Yes)", "Did Not Maintain (No)", "p-value"], [ ["Group A (Adrenaline)", "43/43 (100%)", "0/43 (0%)", "< 0.001"], ["Group B (Control)", "0/43 (0%)", "43/43 (100%)", ""], ] ) # Table 4 doc.add_paragraph() add_table_caption("Table 4. Pulse Rate (bpm) and Blood Pressure (mmHg) at Perioperative Time Points") make_table( ["Parameter", "Time Point", "Group A (Adrenaline)", "Group B (Control)", "p-value (A vs B)"], [ ["Pulse rate (bpm)", "Preoperative (30 min before)", "85.4 +/- 1.9", "84.9 +/- 1.9", "0.54"], ["", "Intraoperative (after infusion)", "85.0 +/- 2.0", "84.8 +/- 1.7", "0.75"], ["", "Postoperative (30 min after)", "85.5 +/- 1.7", "85.0 +/- 2.0", "0.58"], ["Systolic BP (mmHg)", "Preoperative", "128.4 +/- 6.0", "128.3 +/- 6.2", "0.97"], ["", "Intraoperative", "128.2 +/- 5.8", "128.4 +/- 6.1", "0.90"], ["", "Postoperative", "128.5 +/- 5.9", "128.4 +/- 6.0", "0.98"], ["Diastolic BP (mmHg)", "Preoperative", "85.2 +/- 4.5", "86.0 +/- 4.8", "0.30"], ["", "Intraoperative", "85.2 +/- 4.6", "85.3 +/- 4.2", "0.95"], ["", "Postoperative", "85.3 +/- 4.4", "85.3 +/- 4.2", "0.96"], ] ) add_para("BP = blood pressure.", italic=True) # Table 5 doc.add_paragraph() add_table_caption("Table 5. Linear Regression: Effect of Intracameral Adrenaline on Outcomes") make_table( ["Outcome Variable", "Regression Coefficient (Group A vs B)", "p-value"], [ ["Final pupil diameter (mm)", "+2.6 mm", "< 0.001"], ["Postoperative pulse rate (bpm)", "+0.1 bpm", "0.80"], ["Postoperative systolic BP (mmHg)", "+0.0 mmHg", "0.95"], ["Postoperative diastolic BP (mmHg)", "+0.0 mmHg", "0.90"], ] ) add_para("Each model adjusted for the corresponding baseline value. BP = blood pressure.", italic=True) # Table 6 doc.add_paragraph() add_table_caption("Table 6. Selected Pearson Correlations Between Physiological Variables") make_table( ["Variables", "Pearson r", "p-value"], [ ["Pulse (pre-op) vs Systolic BP (pre-op)", "-0.03", "0.84"], ["Pulse (pre-op) vs Diastolic BP (pre-op)", "+0.01", "0.93"], ["Pupil diameter (OR baseline) vs Pulse (pre-op)", "-0.10", "0.37"], ["Pupil diameter (end of surgery) vs Pulse (post-op)", "+0.10", "0.36"], ] ) add_para("BP = blood pressure; OR = operating room.", italic=True) # ════════════════════════════════════════════════════════════════════════════ # FIGURE LEGENDS # ════════════════════════════════════════════════════════════════════════════ page_break() add_heading("FIGURE LEGENDS") figure_legends = [ "Fig. 1. Mean pupil diameter (mm) at key intraoperative time points in " "Group A (intracameral adrenaline) and Group B (control). Error bars " "represent standard deviation. * p < 0.001 between groups.", "Fig. 2. Maintenance of adequate mydriasis (pupil diameter >= 6 mm) at " "the end of surgery. All patients in Group A (100%) maintained adequate " "mydriasis, compared to none (0%) in Group B.", "Fig. 3. Perioperative pulse rate (bpm) in Group A and Group B at " "preoperative, intraoperative, and postoperative time points. No " "significant between-group differences were observed at any time point.", "Fig. 4. Perioperative systolic blood pressure (mmHg) in Group A and " "Group B at preoperative, intraoperative, and postoperative time points.", "Fig. 5. Perioperative diastolic blood pressure (mmHg) in Group A and " "Group B at preoperative, intraoperative, and postoperative time points." ] for i, legend in enumerate(figure_legends, 1): add_body(legend) doc.add_paragraph() # ════════════════════════════════════════════════════════════════════════════ # SAVE # ════════════════════════════════════════════════════════════════════════════ output_path = "/tmp/workspace/kjo-article/KJO_Intracameral_Adrenaline_MSICS.docx" doc.save(output_path) print(f"Saved: {output_path}") PYEOF

ls -lh /tmp/workspace/kjo-article/

python3 << 'PYEOF' from docx import Document import re doc = Document("/tmp/workspace/kjo-article/KJO_Intracameral_Adrenaline_MSICS.docx") # Extract all text from document full_text = "" for para in doc.paragraphs: full_text += para.text + "\n" # Also extract from tables for table in doc.tables: for row in table.rows: for cell in row.cells: full_text += cell.text + "\n" # Find all citation numbers used in the body text (superscript-style inline numbers like .1, ,2 ,3-5 etc.) # In this article, citations are written as plain numbers like "1,2,3" or "4-11" in the text body # Let's find all numeric citation patterns citation_pattern = re.findall(r'(\d+)', full_text) # Now extract just the body text (before REFERENCES heading) parts = full_text.split("REFERENCES") body = parts[0] if len(parts) > 1 else full_text # Find citation numbers in the body body_citations = re.findall(r'[\.,\s](\d+)(?:[,\-\d]*)', body) # More targeted: look for superscript-style citations in text like "blindness globally.1" # or "as adjunct.5,9-11" etc. inline_refs = re.findall(r'\.(\d+)(?:[,\-](\d+))?', body) print("=== FULL BODY TEXT (first 8000 chars) ===") print(body[:8000]) PYEOF

python3 << 'PYEOF' from docx import Document import re doc = Document("/tmp/workspace/kjo-article/KJO_Intracameral_Adrenaline_MSICS.docx") full_text = "" for para in doc.paragraphs: full_text += para.text + "\n" for table in doc.tables: for row in table.rows: for cell in row.cells: full_text += cell.text + "\n" # Split body from references section parts = full_text.split("REFERENCES") body = parts[0] ref_section = parts[1] if len(parts) > 1 else "" # ── Find every inline citation number in the body ── # Patterns: .1 .2,3 .9-11 ,9-11 .14 etc. # We grab all digit sequences that appear after a period, comma, or hyphen # following a non-digit (i.e., in a citation cluster) # Find all citation clusters like ".1" ",3" "9-11" "9,10,11" clusters = re.findall(r'[.,](\d+(?:[,\-]\d+)*)', body) cited_numbers = set() for cluster in clusters: # expand ranges like 9-11 → 9,10,11 parts2 = re.split(r',', cluster) for part in parts2: if '-' in part: start, end = part.split('-') try: for n in range(int(start), int(end)+1): cited_numbers.add(n) except: pass else: try: cited_numbers.add(int(part)) except: pass # Filter to plausible citation numbers (1-23) cited_in_body = sorted([n for n in cited_numbers if 1 <= n <= 23]) print("Citation numbers found in body text:", cited_in_body) print(f"Total: {len(cited_in_body)}") print() # Which are missing? all_refs = set(range(1, 24)) missing = sorted(all_refs - set(cited_in_body)) print("References NOT cited in body text:", missing) # ── Show context around each found citation ────────────────────────────── print("\n=== Context for each citation ===") for n in range(1, 24): # Look for the number preceded by . or , or followed by , or . pattern = rf'[.,]{n}[,.\s]|\.{n}$|\,{n}[,\-]' matches = [(m.start(), body[max(0,m.start()-80):m.end()+30]) for m in re.finditer(rf'\.{n}(?=[,.\s\n])|,{n}(?=[,.\s\n])', body)] if matches: print(f"\nRef {n}: CITED -- example: ...{matches[0][1].strip()}...") else: print(f"\nRef {n}: ** NOT FOUND in body **") PYEOF

python3 << 'PYEOF' from docx import Document import re doc = Document("/tmp/workspace/kjo-article/KJO_Intracameral_Adrenaline_MSICS.docx") full_text = "" for para in doc.paragraphs: full_text += para.text + "\n" parts = full_text.split("REFERENCES") body = parts[0] # Check each cited reference for TRUE citation context vs false positive # True citation = number appears after a sentence-ending period (like "worldwide.1") # or as part of a superscript cluster like ".9-11" or ",16" # False positive = number appears inside data like "84.9" or "0.10" true_cite_pattern = re.compile(r'(?<=[a-z)\]])\.(\d+)(?=[,.\s\n])|(?<=\d),(\d+)(?=[,.\s\n])') # Let's look at actual citation-like occurrences more carefully # Pattern: word/punctuation.NUMBER or ,NUMBER where NUMBER is 1-23 # We want to exclude things like 84.9, 0.10, 1.9, etc. (decimal numbers) # Find positions of all "word.N" patterns real_citations = {} for n in range(1, 24): # Only match when N appears after a letter, ), or ] (not after another digit) pattern = rf'(?<=[a-zA-Z)\].])\.{n}(?=[,.\s\n])|(?<=[a-zA-Z)\].]),{n}(?=[,.\s\n])|{n}(?=-\d{{1,2}}(?=[,.\s\n]))' matches = list(re.finditer(rf'(?<=[a-zA-Z)\].])[.,]{n}(?=[,.\s\n])', body)) if matches: ctx = body[max(0,matches[0].start()-60):matches[0].end()+40].replace('\n',' ') real_citations[n] = f"YES -- ...{ctx}..." else: real_citations[n] = "NOT CITED" print("=== True citation check (number only after text/punctuation, not digit) ===") for n in range(1, 24): print(f"Ref {n:2d}: {real_citations[n]}") PYEOF