International journal of ophthalmology最新文献

Aim: To construct an intelligent segmentation scheme for precise localization of central serous chorioretinopathy (CSC) leakage points, thereby enabling ophthalmologists to deliver accurate laser treatment without navigational laser equipment.

Methods: A dataset with dual labels (point-level and pixel-level) was first established based on fundus fluorescein angiography (FFA) images of CSC and subsequently divided into training (102 images), validation (40 images), and test (40 images) datasets. An intelligent segmentation method was then developed, based on the You Only Look Once version 8 Pose Estimation (YOLOv8-Pose) model and segment anything model (SAM), to segment CSC leakage points. Next, the YOLOv8-Pose model was trained for 200 epochs, and the best-performing model was selected to form the optimal combination with SAM. Additionally, the classic five types of U-Net series models [i.e., U-Net, recurrent residual U-Net (R2U-Net), attention U-Net (AttU-Net), recurrent residual attention U-Net (R2AttU-Net), and nested U-Net (UNet++)] were initialized with three random seeds and trained for 200 epochs, resulting in a total of 15 baseline models for comparison. Finally, based on the metrics including Dice similarity coefficient (DICE), intersection over union (IoU), precision, recall, precision-recall (PR) curve, and receiver operating characteristic (ROC) curve, the proposed method was compared with baseline models through quantitative and qualitative experiments for leakage point segmentation, thereby demonstrating its effectiveness.

Results: With the increase of training epochs, the mAP50-95, Recall, and precision of the YOLOv8-Pose model showed a significant increase and tended to stabilize, and it achieved a preliminary localization success rate of 90% (i.e., 36 images) for CSC leakage points in 40 test images. Using manually expert-annotated pixel-level labels as the ground truth, the proposed method achieved outcomes with a DICE of 57.13%, an IoU of 45.31%, a precision of 45.91%, a recall of 93.57%, an area under the PR curve (AUC-PR) of 0.78 and an area under the ROC curve (AUC-ROC) of 0.97, which enables more accurate segmentation of CSC leakage points.

Conclusion: By combining the precise localization capability of the YOLOv8-Pose model with the robust and flexible segmentation ability of SAM, the proposed method not only demonstrates the effectiveness of the YOLOv8-Pose model in detecting keypoint coordinates of CSC leakage points from the perspective of application innovation but also establishes a novel approach for accurate segmentation of CSC leakage points through the "detect-then-segment" strategy, thereby providing a potential auxiliary means for the automatic and precise real-time localization of leakage points during traditional laser photocoagulation for CSC.

Aim: To compare the efficacy of goniosynechialysis (GSL) under a microscope alone (GM) and under direct gonioscopy (GG) for chronic angle-closure glaucoma (CACG) coexisted with cataract.

Methods: A prospective, single-center, and randomized controlled trial was conducted. Patients diagnosed as CACG and cataract were randomly allocated into either GM group or GG group. In GM group, the range of peripheral anterior synechiae (PAS) was confirmed through gonio-lens after phacoemulsification with intraocular lens implantation (PEI). PAS was separated only under a microscope. After separating the closed angle of 360° by this method, we used a surgical gonioscope to confirm the PAS range. If any remaining PAS was present, we would separate them with an iris repositor under the direct gonio-lens until angle of 360° was reopened. In GG group, PAS was separated under direct gonioscopy after PEI until angle of 360° was reopened. The range of residual PAS after GSLs was the primary outcome. Intraoperative complications (hyphema), intraocular pressure (IOP) and anti-glaucoma medication usage after operation were the secondary outcomes.

Results: Sixty eyes were included, each group comprising 30 eyes. The average age [GM group: 66.3±6.8y (12 males), GG group: 67.6±8.9y (7 males), P=0.550], the baseline IOP (GM group: 29.6±11.5 mm Hg, GG group: 32.4±12.2 mm Hg, P=0.366) and the average initial PAS extent (GM group: 8.9±2.6h, GG group: 9.4±2.5h, P=0.425) were similar in the two groups. In GM group, the PAS range reduced from 8.9±2.6h before operation to 7.2±2.9h after PEI and 3.3±2.2h after GSL. In GG group, the PAS range reduced from 9.4±2.5h before operation to 7.5±2.9h after PEI and 0.1±0.3h after GSL. The PAS after PEI was significantly reduced compared to the pre-operative PAS in both groups (all P<0.001). The extent of residual PAS after GSL in GM group was larger than that in GG group with significant statistical difference (P<0.001). Patients who underwent GSL without a gonioscope were more likely to develop hyphema than those who underwent GSL under direct gonioscopy. The difference of hyphema grade between the two groups was statistically significant (P=0.019).

Conclusion: PEI alone can not open 360° of angle completely. PEI+GSL significantly reduced PAS range. But for patients with CACG, GSL under a microscope alone is more difficult to separate stable PAS completely and adequately than GSL under direct gonioscopy.

Aim: To investigate the association between anti-DFS70 antibody positivity and ocular parameters, specifically, the choroidal vascularity index (CVI) and other optical coherence tomography (OCT) metrics, in a healthy population.

Methods: This age- and sex-matched case-control study enrolled 84 healthy individuals with positive anti-DFS70 antibody findings and 84 healthy negative controls. All participants underwent detailed ophthalmological examinations, including biometry and OCT imaging. Anti-DFS70 positivity was determined by indirect immunofluorescence and scored semi-quantitatively (1+ to 3+). CVI was calculated from OCT images using a standardized protocol with Image J software. Statistical analyses, including Student's t-test, Mann-Whitney U test, Spearman correlation, and logistic regression, were used to compare groups and identify predictive factors.

Results: The individuals who tested positive and negative for anti-DFS70 included in the study were matched for age (median age=47y) and sex (F:M=7:1). CVI was significantly lower in the anti-DFS70-positive group compared to the negative group. A higher anti-DFS70 antibody titer was significantly associated with decreased subfoveal and nasal choroidal thickness (P=0.016 and P=0.014, respectively). In univariate regression analysis, CVI was the only significant predictor of anti-DFS70 positivity [odds ratio (OR)=0.02, P=0.025]. Multivariate analysis revealed a positive correlation between macular thinning outside the subfoveal area and anti-DFS70 status (P<0.05).

Conclusion: Our study demonstrates a novel association between anti-DFS70 antibody positivity and reduced choroidal vascularity in healthy individuals. These findings suggest that anti-DFS70 antibodies may be associated with subtle choroidal vascular changes detectable by OCT, even in asymptomatic individuals. Further longitudinal research is warranted to clarify the underlying mechanisms and long-term clinical significance of these ocular changes.

Aim: To clarify the clinical correlations and causal relationships between lipid metabolism and the progression of thyroid-associated ophthalmopathy (TAO).

Methods: This case-control study retrieved clinical data from 2018 to 2023. A total of 2591 patients were enrolled, including 197 patients with TAO (case group) and 2394 patients with hyperthyroidism without TAO (control group). Serum lipid parameters, including triglycerides, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the HDL/total cholesterol ratio, as well as thyroid function markers, were compared between the two groups. Correlation analyses were performed to evaluate the associations between serum lipid levels and key ocular manifestations of TAO, including exophthalmos degree, clinical activity score, and disease severity. Furthermore, Mendelian randomization (MR) analysis was conducted using genome-wide association study (GWAS) datasets, with hyperthyroidism as the exposure variable and serum lipid parameters as the outcome variables, to infer the causal relationship between hyperthyroidism, lipid metabolism, and TAO progression.

Results: The TAO group consisted of 101 males and 96 females, while the hyperthyroidism group included 706 males and 1688 females. Compared with the control group, patients with TAO had significantly higher levels of triglycerides (1.83±1.21 vs 1.40±1.08 mmol/L, P<0.01), total cholesterol, LDL, and HDL. Correlation analysis showed that triglyceride levels were positively correlated with exophthalmos degree, whereas HDL levels were inversely correlated with exophthalmos degree. No significant associations were found between serum lipid levels and clinical activity score (P>0.1). MR analysis confirmed that hyperthyroidism exerted a causal effect in reducing serum triglycerides [inverse-variance weighting odds ratio (OR)=0.035, 95% confidence interval (CI): 0.01-0.12] and total cholesterol (OR=0.085, 95%CI: 0.02-0.34), with no evidence of horizontal pleiotropy (MR-PRESSO P>0.05).

Conclusion: Elevated serum triglyceride levels are an independent risk factor for TAO severity, especially exophthalmos, and triglyceride metabolism is inversely regulated by thyroid function.

Aim: To explore the repeatability, reproducibility, and agreement in the measurement of the choroidal vascularity index (CVI) for different swept-source optical coherence tomography (OCT) devices and between OCT and OCT angiography (OCTA) images.

Methods: Two swept-source OCT imaging systems, VG200I and Topcon DRI OCT Triton, were used to capture OCT and OCTA images in triplicate. The first and third images were taken by one operator, and the second image was taken by another operator. The built-in software was used to calculate the CVI from the OCTA images (CVI-OCTA), and a custom-designed algorithm was used to calculate the CVI from the OCT images (CVI-OCT). Repeatability and reproducibility were assessed with the intraclass correlation coefficient (ICC), and agreement between devices and between OCT and OCTA were evaluated with Bland-Altman analysis.

Results: Sixty-eight eyes from 35 adults (17 females) were included in the analysis. The average age of the participants was 23.6±2.3y, with an average spherical equivalent refraction of -3.08±2.47 D and an average AL of 25.21±1.20 mm. Both OCT devices demonstrated high repeatability and reproducibility in measuring the CVI-OCTA (all ICCs>0.894 across five choroidal regions) and CVI-OCT (all ICCs>0.838). Furthermore, the between-device agreement in measuring the CVI-OCT was good [mean difference (MD) ranging from -2.32% to -3.07%], but that in measuring the CVI-OCTA was poor (MD, 1.48% to -7.43%). Additionally, the between-imaging agreement (CVI-OCTA versus CVI-OCT) was poor for both devices (Triton, MD, 6.05% to 12.68%; VG200I, MD, 6.67% to 12.09%).

Conclusion: Both OCT devices and the two analytical methods demonstrate good stability. The inter-device consistency of CVI-OCT is good, while the inter-device consistency of CVI-OCTA and the consistency between the two analytical methods in the same device are both poor.

Aim: To assess the success rate of lacrimal sac hydrostatic pressure application (HPA) maneuver, a conservative office procedure for treatment of congenital nasolacrimal duct obstruction (CNLDO).

Methods: The medical records of pediatric patients, 36mo old or younger, diagnosed with CNLDO between the years 2016-2022, were retrospectively reviewed. In all children, HPA was performed by a pediatric ophthalmologist. Success was defined as the resolution of epiphora and discharge within 48h of the intervention.

Results: A total of 281 eyes (194 patients) with CNLDO underwent HPA. Follow-up data were available for 261 eyes (179 patients, 50.3% male) and these patients were included in the analysis. The mean follow-up time was 11.6±13mo. Ninety-seven patients (54.2%) had unilateral nasolacrimal duct obstruction, while 82 patients (45.8%) had bilateral CNLDO. The mean age at the time of HPA was 5.8±5.9mo. Complete resolution of symptoms was achieved in 102 (39.1%) eyes. Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo (43.7% vs 30.9%, P=0.04). Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO (OR 0.93, P=0.004). Sex assigned at birth, prematurity, laterality of the obstruction and type of symptoms (epiphora, discharge) were not correlated with success. A second HPA was performed in 46 eyes, with resolution of symptoms in 12 eyes (26.1%).

Conclusion: Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO. We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO, especially those younger than 6mo.

Aim: To determine the prevalence of tropia, phoria, and abnormality of near point of convergence (NPC), along with associated ocular symptoms, in high school students.

Methods: This cross-sectional study was conducted in Erbil, Iraq. The target population consisted of high school students selected through a multi-stage cluster sampling method. Comprehensive visual examinations were performed for all students, including measurement of uncorrected and corrected visual acuity, objective and subjective refraction, and distance and near cover tests. NPC was evaluated using a single 6/12 visual target mounted on a centrally positioned Gulden fixation stick. Ocular symptoms were investigated through interviews.

Results: Of the 996 selected students, 921 participated in the study. Of them, 543 (58.96%) were female, and their ages ranged from 13 to 22y. The prevalence of tropia was 3.58% [95% confidence interval (CI): 2.38%-4.78%], observed in 3.44% of males and 3.68% of females. Exotropia (1.95%, 95%CI: 1.06%-2.85%) was more common than esotropia (1.52%, 95%CI: 0.73%-2.31%). The 15.42% (95%CI: 13.09%-17.75%) of students had phoria. Exophoria (13.79%, 95%CI: 11.56%-16.02%) was significantly more prevalent than esophoria (1.63%, 95%CI: 0.81%-2.45%). The prevalence of NPC abnormality in the total study population was 24.97% (95%CI: 22.18%-27.77%). It was 26.72% (95%CI: 22.26%-31.18%) in males and 23.76% (95%CI: 20.18%-27.34%) in females (P=0.307). The most common symptom in phoria was headache (86.62%, 95%CI: 81.02%-92.22%), followed by tired or sore eyes (61.97%, 95%CI: 53.99%-69.96%). The most common symptoms in tropia were blurry vision (93.94%, 95%CI: 79.77%-99.26%) and difficulty concentrating (87.88%, 95%CI: 76.74%-99.01%).

Conclusion: Among Erbil's high school students, the prevalence of strabismus, particularly the exodeviation type, is relatively high, and a significant percentage of students have NPC abnormalities. Addressing and correcting these binocular vision problems, due to their associated visual symptoms, can lead to an improvement in students' quality of life and academic performance.

Aim: To explore the factors influencing the treatment duration and visual prognosis of cytomegalovirus (CMV) retinitis (CMVR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods: All participants received ganciclovir intravenous infusion or oral and intravitreal injection of ganciclovir (IVG) 3 mg twice a week for 4 consecutive times (induction phase). The affected eyes were divided into stop treatment group (Group A), continue treatment group (Group B), and relapse after treatment group (Group C) according to whether local therapy could be terminated at the end of the induction phase and whether CMVR recurred within 3mo after the termination of local therapy.

Results: The study included 31 participants (48 eyes) diagnosed with CMVR including 11 males and 20 females. The mean age was (28±8.2)y. There were 17 cases of binocular disease (34 eyes) and 14 cases of monocular disease (14 eyes). Visual acuity improved in 26 eyes (54.1%), remained unchanged in 9 eyes (18.8%), and decreased in 13 eyes (27.1%). The peak value of blood CMV in Group B was significantly higher than that in Group A (P=0.013). The number of eyes with anterior chamber inflammation in Group C was significantly lower than that in Groups A and B (P=0.015, P=0.016). The average number of interval days was higher in Group A than in Group B. For Group A, there was a strong positive correlation between the number of eyes with CMV positive blood (r=0.712, P=0.031) and visual acuity changes. For Group B, there was a moderately strong positive correlation between the days of blood CMV after transplantation (r=0.371, P=0.043) and the times of injections. For Group C, there was a strong positive correlation between the peak value of blood CMV (r=0.719, P=0.029) and the times of injection.

Conclusion: Systemic use of antivirals combined with intravitreal injection of antivirals is effective for patients with CMVR after allo-HSCT surgery. Patients with shorter interval days, higher peak or more days of blood CMV need more injections. Patients with positive blood CMV at initial diagnosis have worse visual prognosis.