Graefe’s Archive for Clinical and Experimental Ophthalmology最新文献

Purpose: In this study, artificial intelligence (AI) was used to deeply learn the classification of the anterior segment-Optical Coherence Tomography (AS-OCT) images. This AI systems automatically analyzed the angular structure of the AS-OCT images and automatically classified anterior chamber angle. It would improve the efficiency of AS-OCT image analysis.

Methods: The subjects were from the glaucoma disease screening and prevention project for elderly people in Shanghai community. Each scan contained 72 cross-sectional AS-OCT frames. We developed a deep learning-based AS-OCT image automatic anterior chamber angle analysis software. Classifier performance was evaluated against glaucoma experts' grading of AS-OCT images as standard. Outcome evaluation included accuracy (ACC) and area under the receiver operator curve (AUC).

Results: 94895 AS-OCT images were collected from 687 participants, in which 69,243 images were annotated as open, 16,433 images were annotated as closed, and 9219 images were annotated as non-gradable. The class-balanced train data were formed from randomly extracting the same number of open angle images as the closed angle images, which contained 22,393 images (11127 open, 11256 closed). The best-performing classifier was developed by applying transfer learning to the ResNet-50 architecture. against experts' grading, this classifier achieved an AUC of 0.9635.

Conclusion: Deep learning classifiers effectively detect angle closure based on automated analysis of AS-OCT images. This system could be used to automate clinical evaluations of the anterior chamber angle and improve efficiency of interpreting AS-OCT images. The results demonstrated the potential of the deep learning system for rapid recognition of high-risk populations of PACD.

Aim: To evaluate a useful, non-contact method for the follow-up of pericardium patch graft changes in patients undergoing PAUL^® Glaucoma Implant (PGI) surgery using high-resolution anterior segment optical coherence tomography (OCT) to predict tube erosions.

Methods: Prospective analysis over six months of tube pericardium patch graft thickness of PGI surgical cases at the University Eye Hospital Bonn, Germany, from November 2021 to August 2022. In all eyes, Tutopatch^® (RTI Surgical, United States) pericardium was used to cover the implant intra-operatively. Anterior segment OCT (AS-OCT, Heidelberg ANTERION^® Swept-Source-OCT) examinations were performed following a standardized protocol to measure quantitative and qualitative aspects of the patch grafts before surgery, and at three and six months after surgery.

Results: Twenty-six eyes of 26 patients were included. Thickness of the patch material was 1188 µm (IQR 415 µm) directly after implantation and decreased over time to 1068 µm (IQR 478 µm) at 3 months and 846 µm (IQR 677 µm) at 6 months. No significant differences between groups were shown concerning gender (p = 0.128), ethnicity (p = 1.000), age (p = 0.741), glaucoma type (p = 0.173), other concurrent diseases (p = 0.302), former glaucoma surgeries (p = 1.000) and the quadrant of implantation (p = 0.555). Five eyes developed implant exposure. When comparing eyes with and without tube exposure, no significant differences were shown in average patch thickness above the tube directly after implantation (p = 0.476). However, significant differences in average thickness were observed at 3 months (p = 0.013) and 6 months (p = 0.005).

Conclusions: Pericardial patch grafts tend to thin over time which can be assessed by AS-OCT, the latter proving to be a useful method to follow-up patients who undergo patch graft implantation during PGI surgery. This investigation could potentially help identify patients at risk of tube exposure which in turn could lead to modification of patient management. It could also possibly be used in future studies to find more suitable patch materials.

Inferior posterior staphyloma (IPS) is a rare disease typically associated with tilted disc syndrome, characterized by posterior staphyloma within the inferior fundus, without pathological myopia. Subretinal fluid (SRF) occurs in about 30-40% of IPS cases. This study investigated choroidal circulation and morphological changes in IPS using widefield indocyanine green angiography (ICGA). The study included 14 eyes of 8 Japanese patients (mean age: 65.1 years) with treatment-naïve IPS and utilized ICGA and optical coherence tomography. Exclusion criteria were high myopia, macular diseases, prior treatments, and contrast media allergy. The main ICGA findings were a downward shift of the watershed (85.7% of eyes), asymmetric dilated vortex vein (ADVV) (85.7%), anastomosis between the superior and inferior choroidal veins (57.1%), and delayed choroidal filling (100%). SRF was present in seven eyes. No statistical differences were found in the ratio of downward shift, ADVV, or delayed filling between eyes with or without SRF. However, anastomosis was significantly higher in eyes without SRF. The study concluded that IPS shows high prevalence of watershed shift, ADVV, anastomosis, and choroidal filling delay, with anastomosis potentially resolving SRF by reducing choroidal blood flow congestion, similar to pachychoroid spectrum diseases. KEY MESSAGES : WHAT IS KNOWN : Inferior posterior staphyloma (IPS) sometimes occurs subretinal fluid (SRF), however the mechanism of its appearance and disappearence is unknown. WHAT IS NEW : Indocyanine green angiography (ICGA) findings in IPS showed the downward shift in the watershed, asymmetric dilated vortex vein (ADVV), and choroidal filling delay, which was also found in pachychoroid spectrum diseases (PDS). Anastomosis between the superior and inferior choroidal veins across watershed contributes to the resolution of SRF in that it reduces the overload as the anastomosis progresses. We suggest that the mechanism for the appearance and disappearance of SRF in IPS may be due to the same mechanism that an imbalance in macular choroidal blood flow and localized hyperperfusion as in PDS.

Corneal haze, a consequence of pathological wound healing, manifests as opacity and sometimes irregularity impairing vision. This condition arises from breaches in the epithelial barrier, triggering an inflammatory cascade culminating in myofibroblasts formation. Surgical procedures such as photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and corneal cross-linking (CXL) are major contributors, alongside non-surgical causes like trauma and infections. Research has extensively explored post-surgical corneal haze, focusing on the transforming growth factor beta (TGFβ) pathway, inflammation management, and extracellular matrix remodeling. Losartan, traditionally an antihypertensive, has gained attention in ophthalmology for its anti-fibrotic and anti-inflammatory properties. Studies have supported its efficacy in reducing corneal fibrosis post-descemetorhexis, alkali burn, and PRK injuries in animal models, and human case reports. This review aims to examine the topical use of losartan 0.08% in ophthalmology, assessing its effectiveness against post-surgical corneal haze and exploring its pharmacological profile and potential future applications. We provide a systematic review of all published in-human studies of the use of topical losartan in corneal disease.

Purpose: To investigate the efficacy of spectacle lenses designed to control myopia progression in individuals under 18 years old, focusing on changes in spherical equivalent refraction (SER), axial length (AL) and relative peripheral refraction (RPR).

Methods: A systematic review was conducted according to Prisma guidelines. Databases searched included PubMed, Embase, and Scopus, covering studies from the last six years without language restrictions. Studies were included based on specific criteria, and data were extracted and analysed using the metafor package in R. Separate meta-analyses were conducted for SER and AL at 12- and 24-month follow-ups, using random-effects models. RPR information was synthesized without meta-analysis.

Results: Out of the 796 studies screened, 21 were included in the review, with 17 selected for the meta-analysis, comprising a total of 6,175 patients. At 12 months, the intervention group showed a significant reduction in SER (d+ = -0.281, p < .0001) and AL (d+ = -0.155, p < .0001) compared to the control group, where d + is the pooled mean effect size estimate. However, at 24 months, no significant differences were observed in SER (d+ = -0.385, p = .067) or AL (d+ = -0.272, p = .137) between groups. Sensitivity analyses confirmed these findings, and publication bias was minimal. Regarding RPR, the results are limited and differ among model lenses.

Conclusion: Spectacle lenses designed to control myopia progression show short-term benefits, significantly reducing SER and AL at 12 months. However, their long-term efficacy remains uncertain, with no significant differences observed at 24 months. Further research is needed to understand treatment response factors and evaluate the long-term efficacy and safety of these lenses in myopia management.

Purpose: The effect of pre-triage visual acuity (VA) measurement on triage accuracy in a busy ophthalmic casualty department was investigated as a possible means to improve triage quality.

Methods: All 576 patients attending the accident and emergency department (A&E) at the Birmingham and Midland Eye Centre (BMEC) over a period of 4 days were included in this prospective cross-sectional study. Patients were assigned to two groups: those who underwent a VA measurement prior to triage (n = 242) and a control group who did not have a VA measurement (n = 234). Clinicians who were masked from the allocation also assessed whether they agreed with the triage decision after assessing each patient.

Results: Triage outcomes were recorded for 469 (81%) patients. Those with a pre-triage VA measurement were more likely to be assessed as more urgent (p = 0.005) and less likely to be discharged (p = 0.04). 248 (43%) patients had clinician response with corresponding triage records, of which 136 (55%) had prior VA measurement and 112 (45%) were in the control group. Clinicians responded that patients with VA measurement prior to triage were more accurately triaged than the control group (66% and 54%; p = 0.03).

Conclusion: VA measurement prior to triage can help improve triage accuracy and allow better allocation of resources at an overcrowded eye-dedicated emergency department. However, waiting times may increase due to longer triage duration and more patients to be triaged into urgent pathway. Greater staffing resources may be necessary to complement the proposed change to avoid undermining triage efficiency.

Purpose: The purpose of this study was to evaluate Retromode (Nidek Co., Gamagori, Japan) as an adjunct diagnostic tool in vitreoretinal lymphoma (VRL). By integrating Retromode findings with multimodal imaging, we aimed to enhance lesion detection of VRL lesions in the retina.

Methods: This monocentric retrospective pilot study was conducted at the Ocular Oncology unit of San Raffaele Scientific Institute, Milan. Six consecutive patients with biopsy-proven vitreoretinal lymphoma (VRL) were analyzed. Comprehensive retinal examinations and multimodal imaging, encompassing Retromode, pseudocolor fundus photography, fundus autofluorescence (FAF), and optical coherence tomography (OCT). The study specifically focused on the role of Retromode findings used in conjunction with traditional imaging modalities like FAF and OCT to enhance lesion detection associated with VRL. Imaging analysis was conducted using ImageJ software.

Results: Retromode identified detailed structural abnormalities in the deep retinal layers and RPE, revealing additional or more widespread lesions compared to FAF imaging. Retromode pinpointed areas affected by VRL for further examination with OCT. However, in patients with vitritis-a common condition in VRL-Retromode did not yield quality images or meaningful information.

Conclusion: Retromode imaging proved to be a valuable adjunct in the multimodal imaging approach to VRL. Its capacity to delineate subtle retinal changes facilitates a tailored diagnostic strategy, enhancing lesion detection and characterization in VRL.

Purpose: To describe vascular anomalies and nonperfusion areas (NPAs) of stage 4 familial exudative vitreoretinopathy (FEVR) with radial retinal folds (RFs) and analyze their potential clinical significance.

Methods: Retinal detachment (RD) could exceed the RFs due to exudative, rhegmatogenous, or tractional factors, which we could call secondary RD. Fluorescein fundus angiography (FFA) and risk factors for progression to secondary RD of pediatric stage 4 FEVR patients with radial RFs were respectively explored.

Results: Fifty-eight eyes with RFs from 49 stage 4 pediatric FEVR patients were studied. Various angiographic changes were noted, including peripheral NPAs (93.1%), thinning retinal arteries (48.3%), straightened retinal vessels (34.5%), supernumerary vascular branching (32.8%), arteriovenous shunt (20.7%), aberrant circumferential vessels (13.8%), bulbous vascular endings (10.3%) and peripheral vascular dilation (6.9%). Nineteen (35.2%), 21(38.2%), and 14 (25.9%) of 58 eyes showed severe, moderate, and mild peripheral NPAs, respectively. The rate of secondary RDwas higher in eyes with severe peripheral NPAs (p = 0.004). The severity of the nonperfusion area (p = 0.040) was higher in eyes with exudation. Eight eyes (42.1%) with exudation and 12 eyes (30.8%) without exudation on color fundus pictures exhibited fluorescein leakage (p = 0.394). The rate of secondary RD was 26.3% in eyes with exudation, and 2.6% in eyes without exudation (p = 0.012).

Conclusions: The majority of stage 4 FEVR eyes with RFs have severe peripheral NPAs. Exudation is related to more severe peripheral NPAs. Exudation and NPAs are predictive factors for secondary RD.

Key messages: What is known • Radial retinal folds are a typical clinical sign of FEVR, observed in 50.9% of FEVR patients, but little is known about the angiographic characteristics of these individuals. What is new • The severity of the nonperfusion area was graded into 3 levels. The severity of the nonperfusion area and hard exudation are risk factors for progression to total retinal detachment.

Background: After 2 years of pandemic sales ban, on New Year`s Eve 2022/23 consumer firework articles were officially available again in Germany and the Netherlands.

Methods: In the Netherlands we prospectively and anonymously collected data on patients treated for firework induced eye injuries from 2009 on, in Germany since 2016.

Results: Around New Year ́s Eve 2022/23 the number of patients with firework inflicted eye injuries increased in the Netherlands to 133 and in Germany to 838. In both countries the participation of eye departments was 90%. The incidence of firework induced eye injuries in the Netherlands was 0,8 /100 000 in 2022/23, in Germany 1,0 /100 000 in 2022/23. Comparing age groups of minors with firework induced eye injuries, in the Netherlands, total numbers of children below 12 years was lower than total numbers of adolescents between 12 and 17 years. Yet, in Germany from 2016 on every year, total number of children below 12 years were higher than total number of adolescents. The number of patients who reported on being injured as bystander was between 34% in 2020/21 and 53% in both countries.

Conclusions: While the incidence of firework induced eye injuries in the Netherlands was reduced due to awareness campaigns and regulatory work, the incidence was increasing on the first New Year`s Eve after the pandemic regulations of consumer fireworks in Germany. Especially young children below 12 years need more protection in Germany. In both countries, effective measures of protection need to be implemented for protection of bystanders, whose numbers were low during the first pandemic years.

Key messages: What is known: overrepresentation of affected minors below 18 years and a rate of up to 50% of injured bystanders according to our data collection over 15 years in the Netherlands and 7 years in Germany What is new: In 2022/2023, total numbers of patients with fire work induced eye injuries in the Netherlands and Germany increased significantly after 2 years of pandemic regulations with a sales ban of consumer fire work articles In 2022/23, incidence of firework induced eye injuries is 1/100 000 in Germany, 0,8/100 000 in the Netherlands Among affected minors in Germany school children up to 12 years are at higher risk than adolescents.