International journal of ophthalmology最新文献

Aim: To evaluate the potential of artificial intelligence (AI) for automating corneal topography interpretation in orthokeratology patients, aiming to enhance diagnostic precision, efficiency, and clinical decision-making in myopia management.

Methods: The 1469 corneal topography images from 582 eyes of 326 myopic children treated with orthokeratology lenses over 47mo were collected. Each sample was categorized by decentration, treatment zone size, shape variation, and eye laterality. A multi-task AI model was developed to predict these parameters, with performance measured using area under curve (AUC), accuracy, and F1 scores. We compared AI-only, human-only, and combined Human+AI approaches on a subset of 100 images. External validation with images from additional hospitals tested model generalizability.

Results: The model achieved high accuracy in eye-side prediction (AUC 0.95) and AUC values of 0.52-0.74 for decentration, treatment zone, and shape variation tasks. The combined Human+AI method outperformed AI-only and human-only approaches, achieving the highest accuracy (up to 87%) and fastest processing time (80ms). External validation confirmed robust performance in simple tasks, though accuracy was lower for complex classifications due to imaging variations.

Conclusion: AI provides efficient routine corneal topography assessments, while complex cases benefit most from a Human+AI approach, particularly in scenarios requiring nuanced clinical interpretation. The model currently functions as an assistive tool.

Aim: To assess the refractive and functional outcomes of a novel trifocal intraocular lens (IOL) with smooth micro phase technology.

Methods: This prospective, single-arm, single-center, observational study included patients who underwent cataract surgery with the implantation of the AT ELANA 841P (Carl Zeiss Meditec, Berlin, Germany) IOL. Visual acuity (VA) at distance, intermediate, and near were evaluated 1- and 3-month postop as well as refractive outcomes. Monocular and binocular defocus curve, binocular contrast sensitivity (M&S® Technologies) and patient satisfaction with the Catquest-9SF questionnaire were measured at 3-month postop.

Results: In total, 46 eyes (23 patients) were bilaterally implanted with the IOL. Mean patient age was 59.86±5.55y. At 1-month postop, monocular corrected VA for distance, intermediate, and near were -0.15±0.09, 0.11±0.10, and 0.15±0.12 logMAR, respectively. These outcomes remained stable at the 3-month follow-up (P>0.05). Spherical equivalent (SE) at 1- and 3-month postop remained stable (P>0.05). Following surgery, 91% of the eyes at 1mo and 95% of the eyes at 3mo were within ±0.5 D of SE. Monocular defocus curve showed that the lens can be categorized as a steep transition IOL. The contrast sensitivity function revealed high values at low spatial frequencies and decreased values at high spatial frequencies. The results of the Catquest-9SF questionnaire showed that all patients were fairly or very satisfied with their vision after surgery.

Conclusion: The AT ELANA 841P IOL offers excellent visual outcomes across distance, intermediate, and near ranges, along with satisfactory contrast sensitivity. Additionally, the lens is associated with high patient satisfaction and minimal visual difficulties during daily activities.

Aim: To describe the alterations of the vitreous pathology and anterior chamber (AC) angle structures following transscleral cyclophotocoagulation (TSCP) and better understand the mechanism of post-laser intraocular pressure (IOP) reduction in angle-closure glaucoma (ACG).

Methods: Porcine eyes ex vivo and rabbit eyes in vivo were used. In porcine eyes, permeability rates of the anterior vitreous cortex (AVC) and anterior hyaloid membrane (AHM) were assessed using Schirmer's strips. Permeability rates in the circumlental space were compared with or without TSCP bursts. Fluorescein diffusion times from the vitreous to the AC were compared between eyes with and without TSCP. In rabbit eyes, changes in IOP and AC angle structures under ultrasound biomicroscopy (UBM) were evaluated at intervals of 30min, 7d, and 14d after TSCP. Vitreous pathology was examined using scanning electron microscopy (SEM) immediately and 14d after TSCP.

Results: In porcine eyes (n=20), the median (range) permeability rates were 10.3 (range 9.8-10.8) mm/min for the AVC and 4.3 (range 3.9-4.9) mm/min for the AHM (P=0.009). Permeability rates in the circumlental space were 4.2 (range 3.8-4.9) mm/min in areas without TSCP, 6.2 (range 5.7-6.8) mm/min in areas with non-burst TSCP, and 11.3 (range 10.9-11.8) mm/min in areas with burst TSCP (P=0.002). The median (range) fluorescein diffusion time was 5 (range 3-8)min in eyes undergoing TSCP, whereas it was 40min (range 35-68) in eyes without TSCP (P<0.001). In rabbit eyes (n=20), SEM showed immediate localized damage to the AHM, AVC, and posterior lens zonules in areas subjected to TSCP bursts, and obvious lens zonule loss with cellular infiltration and possible vitreous liquefaction by post-op day 14. Persistent widening of AC angles was noted at postoperative days 7 and 14, although a significant reduction in IOP was only observed at postoperative day 7.

Conclusion: TSCP-induced damage on the zonules, AHM, and AVC potentially enhances fluid outflow from the vitreous, leading to a widened AC angle and vitreous liquefaction in rabbits. These observations offer insights into mechanisms of TSCP in lowering IOP and pathogenic roles of vitreous in ACG.

Aim: To report two cases of Jalili syndrome (JS) harboring a novel mutation in the CNNM4 gene, review previously published studies on JS, and analyze factors potentially associated with visual acuity in patients with JS.

Methods: Two JS patients from a non-consanguineous Chinese family underwent comprehensive ophthalmic evaluations. Next-generation sequencing (NGS) was performed to identify pathogenic variants, and Sanger sequencing was used for validation. A literature search was conducted to retrieve studies on JS published up to January 31, 2025; only studies with detailed records of visual acuity and mutation sites were included. Correlations between visual acuity and age, as well as between visual acuity and mutation domain, were analyzed.

Results: A total of 53 patients with detailed visual acuity and mutation site records from previous studies were included in the analysis. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity was 1.15 (range: 0.69-2.00). Spearman's correlation analysis showed a positive correlation between visual acuity (logMAR) and age (r_s =0.502, P<0.001). No association was found between logMAR visual acuity and mutation domain (P=0.748). The 6-year-old proband and her 3-year-old brother carried a novel homozygous missense variant c.949A>C (p.Ser317Arg) in CNNM4. Both patients presented with reduced visual acuity, pendular nystagmus, photophobia, night blindness, color vision loss, macular atrophy, and amelogenesis imperfecta. Optical coherence tomography (OCT) revealed atrophy of the outer retinal layers, and electroretinography (ERG) showed extinguished cone and rod responses. Fundus autofluorescence (FAF) and fundus fluorescein angiography (FFA) of the proband demonstrated bilateral retinal pigment epithelium (RPE) defects around the optic disc, vascular arcades, and macular region. At the latest follow-up (30mo), the proband's condition remained stable: best-corrected visual acuity was 2.00 logMAR (right eye) and 1.30 (left eye), with no changes in fundus appearance. The younger brother had a best-corrected visual acuity of 1.52 logMAR in both eyes at the latest follow-up, accompanied by severe bilateral macular atrophy and obvious dentin discoloration due to progressive enamel thinning.

Conclusion: This study reports a novel homozygous missense variant c.949A>C (p.Ser317Arg) in CNNM4 in a Chinese JS family. Visual acuity in JS patients deteriorates with increasing age.

Aim: To find the effective contrast enhancement method on retinal images for effective segmentation of retinal features.

Methods: A novel image preprocessing method that used neighbourhood-based improved contrast limited adaptive histogram equalization (NICLAHE) to improve retinal image contrast was suggested to aid in the accurate identification of retinal disorders and improve the visibility of fine retinal structures. Additionally, a minimal-order filter was applied to effectively denoise the images without compromising important retinal structures. The novel NICLAHE algorithm was inspired by the classical CLAHE algorithm, but enhanced it by selecting the clip limits and tile sized in a dynamical manner relative to the pixel values in an image as opposed to using fixed values. It was evaluated on the Drive and high-resolution fundus (HRF) datasets on conventional quality measures.

Results: The new proposed preprocessing technique was applied to two retinal image databases, Drive and HRF, with four quality metrics being, root mean square error (RMSE), peak signal to noise ratio (PSNR), root mean square contrast (RMSC), and overall contrast. The technique performed superiorly on both the data sets as compared to the traditional enhancement methods. In order to assess the compatibility of the method with automated diagnosis, a deep learning framework named ResNet was applied in the segmentation of retinal blood vessels. Sensitivity, specificity, precision and accuracy were used to analyse the performance. NICLAHE-enhanced images outperformed the traditional techniques on both the datasets with improved accuracy.

Conclusion: NICLAHE provides better results than traditional methods with less error and improved contrast-related values. These enhanced images are subsequently measured by sensitivity, specificity, precision, and accuracy, which yield a better result in both datasets.

Aim: To demonstrate the imaging findings of nonarteritic anterior ischemic optic neuropathy (NAION) using high-resolution magnetic resonance imaging (MRI) sequences.

Methods: A retrospective review of 4y of medical records and MRIs of nine patients suspected of having NAION who underwent orbit protocol MRI was conducted. The orbit MRI protocol included high-resolution three-dimensional (3D) T2-weighted imaging (HR 3D T2WI), high-resolution 3D contrast-enhanced T1-weighted imaging (HR-CE 3D T1WI), and high-resolution 3D T2-fluid-attenuated inversion recovery imaging (HR-CE 3D T2-FLAIR) and diffusion-weighted imaging, if applicable. To rule out other causes of optic neuropathy such as inflammatory optic neuritis, we evaluated the presence of optic disc swelling, contrast enhancement at the optic disc, and other abnormal findings on these sequences.

Results: Among the 715 patients, 9 were diagnosed with NAION. The median age of the patients was 62y (range, 46-79y), and five patients (56%) were men. Two of these patients demonstrated optic disc swelling on HR 3D T2WI and focal contrast enhancement on HR-CE 3D T1WI. Eight patients showed focal contrast enhancement on HR-CE 3D T2-FLAIR imaging. Among these patients, five showed a focal contrast enhancement only on HR-CE 3D T2-FLAIR imaging. The most frequent location of the focal contrast enhancement was the superomedial (n=5, 56%) followed by the medial (n=2, 22%) and central (n=2, 22%), and superior (n=1) aspects. In all three patients for whom diffusion-weighted imaging was available, there was no evidence of diffusion restriction in the optic disc.

Conclusion: This study demonstrates the imaging finding of NAION using high-resolution MRI sequences. HR-CE T2-FLAIR imaging is particularly useful in detecting NAION when combined with other high-resolution MRI sequences. It can provide additional insights into the pathophysiology of NAION, which may aid in obtaining an appropriate diagnosis and follow-up.

Aim: To investigate the postnatal development of parvalbumin (PV)-positive gamma-aminobutyric acid (GABA) interneurons and the co-expression of perineuronal nets (PNNs) and PV in the visual cortex of rats, as well as the regulatory effects of fluoxetine (FLX) treatment and binocular form deprivation (BFD) on these indices.

Methods: Wistar rats were assigned to three experimental cohorts: 1) Age-related groups: postnatal week (PW) 1, PW3, PW5, PW7, and PW9; 2) FLX treatment duration groups: FLX 0W, FLX 2W, FLX 4W, FLX 6W, and FLX 8W; 3) Intervention groups: control (Cont), FLX, BFD, and BFD+FLX. The levels of PNNs, PV, and PNNs/PV co-expression in the visual cortex were detected and analyzed.

Results: The density of PV-positive cells and the co-expression of PNNs and PV increased gradually with the maturation of the visual cortex (b=0.960, P<0.01). The ratio of PV-positive cells surrounded by PNNs to total PV-positive cells (PNNs⁺/PV⁺/total PV⁺) was significantly decreased in the FLX 4W group (χ²=9.03, P=0.003). There was no significant difference in the PNNs⁺/PV⁺/total PV⁺ ratio between the FLX and BFD groups (χ²=1.08, P=0.161), but a significant difference was observed between the BFD+FLX group and the BFD group (χ²=5.82, P<0.01).

Conclusion: The number of PV-positive neurons and PNNs-surrounded PV neurons in the rat visual cortex increases postnatally and reaches adult levels by postnatal week 7. Chronic FLX treatment downregulates these expressions. Combined 4-week FLX treatment and BFD exerts a more significant inhibitory effect on the PNNs⁺/PV⁺/total PV⁺ ratio than either intervention alone.