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

Purpose: Given the significance and potential risks associated with Ocular Surface Squamous Neoplasia (OSSN) and the importance of its differentiation from other conditions, we aimed to develop a Deep Learning (DL) model differentiating OSSN from pterygium (PTG) using slit photographs.

Methods: A dataset comprising slit photographs of 162 patients including 77 images of OSSN and 85 images of PTG was assembled. After manual segmentation of the images, a Python-based transfer learning approach utilizing the EfficientNet B7 network was employed for automated image segmentation. GoogleNet, a pre-trained neural network was used to categorize the images into OSSN or PTG. To evaluate the performance of our DL model, K-Fold 10 Cross Validation was implemented, and various performance metrics were measured.

Results: There was a statistically significant difference in mean age between the OSSN (63.23 ± 13.74 years) and PTG groups (47.18 ± 11.53) (P-value =.000). Furthermore, 84.41% of patients in the OSSN group and 80.00% of the patients in the PTG group were male. Our classification model, trained on automatically segmented images, demonstrated reliable performance measures in distinguishing OSSN from PTG, with an Area Under Curve (AUC) of 98%, sensitivity, F1 score, and accuracy of 94%, and a Matthews Correlation Coefficient (MCC) of 88%.

Conclusions: This study presents a novel DL model that effectively segments and classifies OSSN from PTG images with a relatively high accuracy. In addition to its clinical use, this model can be potentially used as a telemedicine application.

Persistent avascular retina (PAR) has been increasingly reported with the increased use of anti-vascular endothelial growth factor (VEGF) agents in treatment-requiring ROP. However, they have also been observed in ROP eyes that did not meet treatment requirement and spontaneously regressed. PAR is highlighted in the updated nomenclature under the International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3) consensus statement, underscoring the increased emphasis in detecting PAR. PAR has been noted to persist beyond existing ROP screening guidelines, and were found to be associated with complications like retinal tear and detachment, especially in eyes with more posterior PAR. Thus, serial monitoring of retinal vascularization, facilitated by fluorescein angiography and wide-field imaging, for these associated complications have been encouraged. The current lack of consensus in the follow-up and management of PAR prompts further work in this area: understanding the natural course of retinal vascularization in both untreated and treated ROP, the modulation of anti-VEGF on retinal function, and the clinical significance of PAR-associated vascular patterns can help to guide management protocols for PAR in ROP eyes.

Purpose: To evaluate the refractive changes after congenital cataract surgery in persistent fetal vasculature (PFV) vs. non-PFV eyes.

Methods: Retrospective study of 75 eyes with PFV or non-PFV congenital cataract, who underwent surgery before age 7 months (unilateral/first operated eye), during 2007-2018 at a tertiary referral center, with follow-up ≥ one-year.

Results: 27 eyes (36%) had PFV, 48 were non-PFV cataracts. Mean age (± SD) at surgery in children with PFV was 2.24 ± 1.23 months and 2.44 ± 1.51 months in the non-PFV group. Mean post-operative follow-up was 64.94 ± 34.67 months. 60% of the eyes remained aphakic for the entire follow-up. In aphakic children, the mean post-operative spherical equivalent (SE) in the PFV eye was + 18.74D, + 15.73D, + 13.88D, + 12.51D, + 11.29D at one-month, one-year, two-years, three-years and five-years respectively. In the non-PFV eye the SE was + 23.00D, + 20.44D, + 17.84D, + 17.52D, + 18.48D at one-month, one-year, two-years, three-years and five-years respectively. During the entire post-operative course, the SE remained less hyperopic in the PFV eyes (p < 0.01). The rate of emmetropization was similar for PFV and non-PFV eyes. Five-years after surgery the mean myopic shift was -6.82 ± 4.32 D in the PFV eyes and -5.47 ± 2.44D in the non-PFV eyes (p > 0.05). The changes in refraction error did not correlate with either presence of glaucoma, secondary cataract, amblyopia or strabismus.

Conclusion: Eyes with PFV have a similar rate of emmetropization as other pediatric congenital cataracts. Interestingly, aphakic PFV eyes have a less hyperopic refraction during one-month and up to five-years after surgery as compared to non-PFV eyes.

Purpose: Subconjunctival bleb-forming devices (SBD) can provide greater intraocular pressure reductions than minimally invasive glaucoma surgery (MIGS) whilst remaining less invasive than traditional surgical techniques. However, variations in management practices and surgical techniques indicate the need for concise and clear guidance on these procedures in diverse patient populations. Here we describe current recommendations on the use of PRESERFLO MicroShunt, an ab externo SBD, according to a review of current literature and the opinions of 20 international glaucoma experts.

Methods: A literature search was performed to return all publications relating to the PRESERFLO MicroShunt, which were then reviewed to extract information or guidance on patient selection, pre-operative patient preparation, peri-operative practices and techniques, and post-operative management. Alongside the literature search findings, participants in an expert panel meeting discussed their current practices relating to these same four aspects of PRESERFLO MicroShunt use.

Results: PRESERFLO MicroShunt can be considered for the majority of patients with medically uncontrolled open-angle glaucoma, as well as in patients with uveitic glaucoma, advanced glaucoma and high myopia, adults with congenital glaucoma, and in some cases normal tension glaucoma patients. Prior to surgery, steroid drops may be given for 2-4 weeks if feasible, and acetazolamide may also be useful in patients with advanced glaucoma and high IOP. During surgery, a deep (8 mm) and wide sub-Tenon pocket is essential to surgical success. Mitomycin C is generally used at a concentration of 0.4 mg/mL for a minimum of 2-3 min. Intracameral bevacizumab and/or dexamethasone may be considered to increase the chance of surgical success. Post-operatively, antibiotics should be given for 7 days and steroid drops for 3-6 months. Monitoring visits may be less frequent than in patients undergoing trabeculectomy.

Conclusion: Management practices and surgical techniques for ab externo SBD vary, and surgeons must use their best clinical judgement based on the requirements of the individual patient. However, here we provide some recommendations for patient selection and pre-, peri- and post-surgical management based on the opinions of experts in the use of PRESERFLO MicroShunt, which we hope will prove useful in optimizing surgical outcomes.

Purpose: This systematic review and meta-analysis aims to evaluate the efficacy and safety of the combination of phenylephrine 1% and ketorolac 0.3% (OMIDRIA®) for optimizing pain management and maintaining pupil dilation during cataract surgery. Comparisons were made against placebo/vehicle, phenylephrine alone, and epinephrine.

Methods: A comprehensive search of PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science was conducted. Eligible studies were randomized clinical trials and observational studies assessing intracameral phenylephrine/ketorolac against control groups. Key outcomes included pain management, pupil diameter, and adverse events. Data were synthesized using meta-analysis with fixed and random-effects models, and heterogeneity was assessed using the I² statistic.

Results: Ten studies, including 220,061 patients, were analyzed. The combination of phenylephrine/ketorolac significantly reduced postoperative pain (RR = 0.72, 95% CI: 0.60-0.86) and opioid use (RR = 0.45, 95% CI: 0.23-0.89) compared to vehicle and epinephrine. PE/K also maintained a larger pupil diameter (MD = 0.54 mm, 95% CI: 0.32-0.75) with minimal heterogeneity (I² = 0%) and reduced the incidence of severe pain (RR = 0.41, 95% CI: 0.27-0.63). No significant differences in adverse events such as elevated intraocular pressure, inflammation, or headaches were observed.

Conclusion: Phenylephrine/ketorolac (OMIDRIA®) demonstrates superior efficacy in maintaining intraoperative mydriasis, reducing postoperative pain, and minimizing opioid use without increasing adverse events. This combination offers a preferable alternative to traditional agents, potentially setting a new standard for pain management and pupil dilation in cataract surgery.

Purpose: This study aimed to investigate the impact of the iris-ciliary angle (ICA) on the position of the implantable collamer lens (ICL) haptic and vault following ICL implantation.

Methods: A prospective, observational study was conducted using data from 135 patients who underwent horizontal ICL implantation. Patients were categorized into three groups by ICA: ICA1 (0-32°), ICA2 (32-64°), and ICA3 (64-96°) to compare parameters. The parameters correlated with the distance from the iris root to the end of the ICL haptic (IRH) and vault was analysed respectively. A multiple linear stepwise regression model was constructed to estimate IRH.

Results: The vault decreased sequentially across the three groups (P < 0.001) and was negatively correlated with ICA (P < 0.001). The proportion of ICL haptic insertion under the ciliary body was significantly higher in the ICA3 group compared with the ICA1 and ICA2 groups (P = 0.039). Stepwise regression analysis showed that IRH = -1.174 + 0.005 × ICA + 0.118 × horizontal sulcus-to-sulcus (STS) distance (adjusted R² = 0.334, Durbin-Watson value = 1.908, P < 0.001), with ICA as the primary influencing factor (β = 0.536, P < 0.001), followed by horizontal STS distance (β = 0.348, P < 0.001).

Conclusions: When the ICA is excessively large, the ICL haptic is more likely to be inserted under the ciliary body. An increase in ICA is associated with a greater IRH and a lower vault.

Key messages: What is known: • More posterior chamber anatomical parameters of eyes are needed to improve the accuracy of predicting the vault. • A negative correlation exists between the iris-ciliary angle (ICA) and vault.

What is new: • When the ICA is excessively large, the ICL haptic is more likely to be inserted under the ciliary body. • The ICA is the primary influencing factor when predicting the distance from the iris root to the end of the ICL haptic (IRH).

Aim: To identify the potential tear fluid biomarkers in premature infants with and without retinopathy of prematurity (ROP) based on proteomic and transcriptomic analysis.

Methods: Tears were collected from the 46 eyes of the 23 enrolled premature infants, with and without ROP. Data-independent acquisition (DIA) mass spectrometry was utilized for the quantitative proteomic analysis of the two groups. Two published transcriptome datasets involving mouse oxygen-induced retinopathy (OIR) model data were selected from the Gene Expression Omnibus (GEO) database. iDEP (integrated Differential Expression and Pathway analysis) were used for differential expression analysis. Gene Ontology (GO)-based functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed.

Results: In this study, a total of 1742 proteins were quantified from the two groups. 55 differentially expressed proteins closely related to immune and angiogenesis processes were identified, including 33 highly expressed as well as 22 lowly expressed in the ROP group. Combined with RNA-seq data from OIR model, we screened two particularly critical proteins, LYN and filamin A (FLNA), which were both expressed at significantly elevated levels.

Conclusions: According to the findings of the tear proteomics data, we hypothesized two particularly critical proteins, LYN and FLNA, may serve as pivotal regulators of immune and angiogenesis processes in ROP. These results will assist in the provision of new potential targets for the diagnosis of ROP.

Neovascular age-related macular degeneration (NV-AMD) is a leading cause of preventable blindness in the elderly. Intravitreal injections of anti-VEGF agents are currently the treatment of choice for NV-AMD. However this treatment is burdensome and fosters non-compliance which leads to inferior visual outcomes. Gene therapy has emerged as a promising therapeutic option for NV-AMD that may improve these outcomes. Potential risks of gene therapy include a potential immune response that may be elicited by the vector, accidental activation of oncogenes or inactivation of tumor suppresor genes leading to malignant transformation via insertational mutagenesis and integration of the viral DNA inserts into the host's DNA. The main strategy of current gene therapy for NV-AMD has focused on delivering transgenes that express anti-angiogenic proteins that directly or indirectly inhibit the VEGF pathway. Ixoberogene soroparvovec, RGX-314 and 4D-150 are the leading NV-AMD genetic treatment programs. Pre-clinical models suggest that genome surgery with clustered regularly interspaced short palindromic repeats (CRISPR) may be another option in the future.