Hasil untuk "Ophthalmology"

N. Ferrara, A. Adamis

R. Aggarwal, V. Sounderajah, G. Martin et al.

Deep learning (DL) has the potential to transform medical diagnostics. However, the diagnostic accuracy of DL is uncertain. Our aim was to evaluate the diagnostic accuracy of DL algorithms to identify pathology in medical imaging. Searches were conducted in Medline and EMBASE up to January 2020. We identified 11,921 studies, of which 503 were included in the systematic review. Eighty-two studies in ophthalmology, 82 in breast disease and 115 in respiratory disease were included for meta-analysis. Two hundred twenty-four studies in other specialities were included for qualitative review. Peer-reviewed studies that reported on the diagnostic accuracy of DL algorithms to identify pathology using medical imaging were included. Primary outcomes were measures of diagnostic accuracy, study design and reporting standards in the literature. Estimates were pooled using random-effects meta-analysis. In ophthalmology, AUC’s ranged between 0.933 and 1 for diagnosing diabetic retinopathy, age-related macular degeneration and glaucoma on retinal fundus photographs and optical coherence tomography. In respiratory imaging, AUC’s ranged between 0.864 and 0.937 for diagnosing lung nodules or lung cancer on chest X-ray or CT scan. For breast imaging, AUC’s ranged between 0.868 and 0.909 for diagnosing breast cancer on mammogram, ultrasound, MRI and digital breast tomosynthesis. Heterogeneity was high between studies and extensive variation in methodology, terminology and outcome measures was noted. This can lead to an overestimation of the diagnostic accuracy of DL algorithms on medical imaging. There is an immediate need for the development of artificial intelligence-specific EQUATOR guidelines, particularly STARD, in order to provide guidance around key issues in this field.

C. H. Lee, A. Singla, Yugyung Lee

Lawrence T. Post

Weiwen Ge, Lei Qi, Yun Wang et al.

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative joint disease characterized by progressive degradation of the cartilage matrix. Current clinical interventions mainly offer symptomatic relief but fail to halt disease progression. The pathogenesis of TMJOA is driven by mitochondrial dysfunction, which promotes both chondrocyte inflammation and extracellular matrix breakdown. To address these issues, an integrated therapeutic system was developed by encapsulating curcumin into M2 macrophage-derived extracellular vesicles (Cur@M2-EVs) through ultrasonic processing. In vitro studies demonstrated that Cur@M2-EVs effectively attenuated inflammatory responses and cartilage matrix degradation by scavenging reactive oxygen species (ROS), restoring mitochondrial membrane potential, and shifting cellular metabolism from glycolysis back to oxidative phosphorylation. Furthermore, transcriptomic analysis and experimental validation revealed that Cur@M2-EVs alleviate chondrocyte inflammation primarily by suppressing Thbs1 expression. To enable sustained drug release and enhance joint lubrication, Cur@M2-EVs were further encapsulated within poly (ethylene glycol) diacrylate (PEGDA) hydrogel microspheres, forming the Cur@M2-EVs@PEGDA system. In a monosodium iodoacetate (MIA)-induced rat model of TMJOA, intra-articular injection of Cur@M2-EVs@PEGDA microspheres significantly alleviated cartilage destruction and improved joint lubrication. This study proposes a novel disease-modifying strategy for TMJOA treatment by integrating mitochondrial regulation, immunomodulation, and sustained lubricating release within a single platform, offering a promising therapeutic approach for this challenging condition.

Sabyasachi Sengupta

V. Jyothi Kiran, Balamurugan Ramatchandirane

Anitha Venugopal, Aditee Madkaikar, Meenakshi Ravindran

Background: LASIK for refractive error correction has become a universal surgery. Despite its popularity, the estimated prevalence of traumatic flap dislocations in post-LASIK patients is 3.9%, and it is sometimes associated with epithelial ingrowth. The prognosis in such cases depends on the rapid surgical revision of the flap with the removal of the EI and perioperative steps to prevent Epithelial ingrowth (EI) recurrence in the future. Purpose: The video aims to display the steps involved in revising the flap, removing EI, and tips to prevent its recurrence. Synopsis: A 33-year-old post-LASIK patient presented with decreased vision, photophobia, and glare during the COVID pandemic in the right eye for 2 months. The best-corrected visual acuity was reduced to 6/60. The anterior segment revealed traumatic flap dislocation along with macro fold temporally and epithelial ingrowth. She underwent a successful flap revision surgery with no recurrence of epithelial ingrowth postoperatively. Highlights: A successful revision of a 2-month-old traumatic folded flap was performed along with the complete removal of EI. It explains the step-by-step approach to avoid the recurrence of EI in each step of the surgical revision of the flap. The video is self-explanatory and guides novice surgeons too. Video link: https://youtu.be/JuOSjhrfw0g

Prasanna V Ramesh, Aji Kunnath Devadas, Tensingh Joshua et al.

Practical sessions facilitate teaching, critical thinking, and coping skills, especially among medical students and professionals. Currently, in ophthalmology, virtual and augmented reality are employed for surgical training by using three-dimensional (3D) eyeball models. These 3D models when printed can be used not only for surgical training but also in teaching ophthalmic residents and fellows for concept learning through tactile 3D puzzle assembly. 3D printing is perfectly suited for the creation of complex bespoke items in a cost-effective manner, making it ideal for rapid prototyping. Puzzle making, when combined with 3D printing can evolve into a different level of learning in the field of ophthalmology. Though various 3D eyeball models are currently available, complex structures such as the cerebral venous system and the circle of Willis have never been 3D printed and presented as 3D puzzles for assembling and learning. According to our knowledge, this concept of ophthalmic pedagogy has never been reported. In this manuscript, we discuss in detail the 3D models created by us (patent pending), for printing into multiple puzzle pieces for effective tactile learning by cognitive assembling.

Xinyu Zhang, Yueye Wang, Wei Wang et al.

Abstract Background Dual sensory impairment is affecting over 10% of older adults worldwide. However, the long-term effect of dual sensory impairment (DSI) on the risk of mortality remains controversial. We aim to investigate the impact of single or/and dual sensory impairment on the risk of mortality in a large population-based sample of the adult in the UK with 14-years of follow-up. Methods This population-based prospective cohort study included participants aged 40 and over with complete records of visual and hearing functions from the UK Biobank study. Measurements of visual and hearing functions were performed at baseline examinations between 2006 and 2010, and data on mortality was obtained by 2021. Dual sensory impairment was defined as concurrent visual and hearing impairments. Cox proportional hazards regression models were employed to evaluate the impact of sensory impairment (dual sensory impairment, single visual or hearing impairment) on the hazard of mortality. Results Of the 113,563 participants included in this study, the mean age (standard deviation) was 56.8 (8.09) years, and 61,849 (54.5%) were female. At baseline measurements, there were 733 (0.65%) participants with dual sensory impairment, 2,973 (2.62%) participants with single visual impairment, and 13,560 (11.94%) with single hearing impairment. After a follow-up period of 14 years (mean duration of 11 years), 5,992 (5.28%) participants died from all causes. Compared with no sensory impairment, dual sensory impairment was significantly associated with an estimated 44% higher hazard of mortality (hazard ratio: 1.44 [95% confidence interval, 1.11–1.88], p = 0.007) after multiple adjustments. Conclusions Individuals with dual sensory impairment were found to have an independently 44% higher hazard of mortality than those with neither sensory impairment. Timely intervention of sensory impairment and early prevention of its underlying causes should help to reduce the associated risk of mortality.

Sanira Vaghmare, Ramesh Rahul, N Venkatesh Prajna et al.

Purpose: To describe the process development of a multimodal intervention and the pre- and postintervention results on the completeness of case records of patients with penetrating ocular trauma in a high-volume tertiary eye care hospital in south India. Methods: A multimodal intervention including an objective-validated case sheet template, an education program, a physical template case record reminder, a continuous near-real time audit process, and a feedback system was developed. Analysis on the completeness of the case records of patients with ocular trauma from October 2020 to December 2020 (preintervention) and from January 2021 to March 2021 (postintervention) was performed. These case records and the personnel involved in the documentation, were given scores based on the scores assigned to the subsections of the validated template case sheet. The mean total score of the case records and of the personnel involved were analyzed. Results: One hundred and eleven case records of patients with ocular trauma who underwent primary wound repair were included in the study. Of these 111 case records, 46 belonged to preintervention group and 65 belonged to postintervention group. The mean total score for preintervention group during the study period was 57.93 ± 24 out of 100 and for postintervention group was 99.07 ± 4.49 out of 100. The temporal trend of postintervention group showed a consistent improvement every month (97.14, 100,100) during the 3-month study period. Postintervention improvement was noted in all the sections of case records completed by both fellows and consultants. Conclusion: A sustained improvement in ocular trauma case record documentation among all levels of medical professionals was noted following the five-component multimodal intervention.

Javier Placeres Dabán, Juan Carlos Elvira, César Azrak et al.

Purpose. To analyse the posterior capsular opacification (PCO) development pattern in the long term in eyes implanted with a monofocal intraocular lens (IOL) with a square edge all around the optic. Methods. Longitudinal retrospective study is data analyzed from a total of 7059 eyes from 4764 patients (mean age: 75.8 years) undergoing cataract surgery with implantation of an aspheric monofocal IOL (Bi-Flex HL 677AB/677P, Medicontur, Budapest, Hungary). These data were retrospectively collected using the electronic medical record of the hospitals involved. Nd : YAG capsulotomy rates were calculated per year during a follow-up of more than 10 years. The Kaplan–Meier analysis was used to establish the transparent capsule survival rate. Results. The Nd : YAG capsulotomy rate increased from 1.1% at 1 year postoperatively to 17.2% at 5 years after surgery. No significant differences were found between eyes with and without capsulotomy in terms of age p=0.202, gender p=0.061, type of anaesthesia used p=0.128, and presence of conditions such as hard cataract p=0.111 or pseudoexfoliation p=0.137. IOL power was significantly lower in those eyes of patients requiring Nd : YAG capsulotomy during the follow-up p<0.001. Significantly more eyes implanted with the preloaded model of the IOL required capsulotomy p<0.001. Mean survival time and rate were 9.38 years and 85.9%, respectively. Conclusions. Most eyes undergoing cataract with implantation of the Bi-Flex IOL do not develop a clinically significant PCO requiring Nd : YAG capsulotomy in the long term. IOL material and design may be the main factors accounting for this finding.

Woong-Sun Yoo, Gyu-Nam Kim, Inyoung Chung et al.

Abstract Aim of the study is to report the clinical characteristics and prognostic factors in hypertensive anterior uveitis (AU) diagnosed with multiplex polymerase chain reaction (PCR). Eighty-eight eyes of 88 patients with hypertensive AU were enrolled from 2015 to 2019 in a tertiary center in South Korea. All patients underwent multiplex PCR that was performed using aqueous humor samples collected at first visit to detect the DNA of six herpesviruses. Twenty-eight (31.8%) eyes were PCR positive. Herpes simplex virus was found in 6 (6.8%) eyes, varicella-zoster virus in 7 (8.0%) eyes, cytomegalovirus in 14 (15.9%) eyes, and Epstein–Barr virus in 1 (1.1%) eye. On multivariate regression analysis, PCR positivity was significantly associated with coin-shaped keratic precipitates (odds ratio (OR) = 6.01, P = 0.044). Recurrence and final visual acuity were significantly associated with a presumed diagnosis of viral endotheliitis (OR = 21.69, P = 0.04 and OR = 6.3, P = 0.004, respectively). This study showed the importance of PCR positivity, suggesting that identification of the virus through active PCR testing could affect the course, treatment, and prognosis of hypertensive AU.

Andrew J. Tatham, Ian C. Murray, Alice D. McTrusty et al.

Abstract Background To examine the speed and accuracy of saccadic eye movements during a novel eye tracking threshold visual field assessment and determine whether eye movement parameters may improve ability to detect glaucoma. Methods A prospective study including both eyes of 31 patients with glaucoma and 23 controls. Standard automated perimetry (SAP) and eye tracking perimetry (saccadic vector optokinetic perimetry, SVOP) was performed. SVOP provided data on threshold sensitivity, saccade latency, and two measures of accuracy of saccades (direction bias and amplitude bias). The relationship between eye movement parameters and severity of glaucoma was examined and Receiver Operating Characteristic curves were used to assess ability to detect glaucoma. Results Patients with glaucoma had significantly slower saccades (602.9 ± 50.0 ms versus 578.3 ± 44.6 ms for controls, P = 0.009) and reduced saccade accuracy (direction bias = 7.4 ± 1.8 versus 6.5 ± 1.5 degrees, P = 0.006). There was a significant slowing of saccades and saccades became less accurate with worsening SAP sensitivity. Slower saccades were associated with increased odds of glaucoma; however, the AUC for saccade latency was only 0.635 compared to 0.914 for SVOP sensitivity. Conclusion Patients with glaucoma had significant differences in eye movements compared to healthy subjects, with a relationship between slower and less accurate eye movements and worse glaucoma severity. However, in a multivariable model, eye movement parameters were not of additional benefit in differentiating eyes with glaucoma from healthy controls.

Christian U. Kim, William A. Pearce

Purpose: To report a rare case of unilateral optic nerve metastasis without choroidal involvement in a patient with known metastatic carcinoma of the breast. Observations: A 65-year old female with a history of metastatic breast carcinoma presented to our clinic with a one-month history of blurred vision and floaters of the left eye. Fundoscopy of the left eye revealed a flesh colored nodule with white lobules demonstrating an endophytic growth pattern from the optic nerve. Magnetic resonance imaging of the brain and orbits revealed multiple intraparenchymal enhancing lesions, leptomeningeal enhancement, and enhancement of the left optic disc and proximal optic nerve all consistent with metastatic disease. The diffuse cranial disease was treated with whole brain radiation leading to regression of the optic nerve lesion and stabilization of visual acuity. Conclusions and Importance: Intraocular metastases are the most common malignant tumor of the eye. Prompt identification and treatment of intraocular metastases is vital to prevent severe visual loss. Here, we document an unusual case of optic disc metastasis with unique fundoscopic features.

Byung Ju Jung, Mee Yon Lee, Sohee Jeon

This study is for identifying systemic factors correlating with intraocular levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in diabetic retinopathy. Forty-two consecutive patients undergoing pars plana vitrectomy (PPV) for PDR were included in this cross-sectional study. The aqueous humor was sampled just prior to PPV for assay of IL-6 and VEGF. One day before PPV, patient characteristics were recorded and a number of systemic markers were amassed, including fasting and postprandial glucose, homeostasis model assessment- (HOMA-) IR, HOMA-beta, C-peptide, insulin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein- (Apo-) A, Apo-B, and lipoprotein A (Lp-A). Relationships between systemic determinants and intraocular cytokine levels were analyzed by regression analysis. Mean levels of IL-6 and VEGF were 15.3 pg/mL (range, 2.4–10124.5 pg/mL) and 21.1 pg/mL (range, 3.2–766.1 pg/mL), respectively. After adjustment for age, gender, duration of diabetes, and BMI, multivariate analysis showed significant association of smoking (p=0.002) and HOMA-IR (p=0.003) with intraocular IL-6 levels, while intraocular VEGF and systemic Lp-A levels correlated significantly (p=0.032). Insulin resistance and smoking status impacted intraocular levels of IL-6, while intraocular VEGF levels were influenced by Lp-A. An appreciation for the relationship between systemic factors and intraocular cytokines may help elucidate the complex pathophysiology of diabetic retinopathy.

P. Romano

A. Sugar, C. Rapuano, W. Culbertson et al.

Sowmya Parameswaran, Subramanian Krishnakumar

Age-related macular degeneration (AMD) leads to progressive loss of central vision in the elderly. At a cellular level, there is aging of the retinal pigment epithelial (RPE) cells, and accumulation of lipofuscin that interferes with the proper functioning of RPE which eventually leads to apoptosis. Treatment depends on the stage of the disease. Wet AMD which has neovascularization is managed by local therapies such as laser photocoagulation and photodynamic therapy and is managed with injections of antivascular endothelial growth factor-based therapy. Unlike the wet AMD, an effective therapy does not exist for dry AMD and geographic atrophy. Cell replacement therapy has shown promise. This review discusses the opportunities in the various types of cell-based therapy, their limitations, and what is possible for India.