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Risk of stroke development following retinal vein occlusion: A systematic review and meta-analysis 视网膜静脉闭塞后发生中风的风险:系统回顾和荟萃分析。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-03 DOI: 10.1016/j.survophthal.2024.06.007

Retinal vein occlusion (RVO) and cerebrovascular disease share common risk factors and may be independently associated; however, the strength and nature of this association remain unclear. We conducted a systematic review and meta-analysis, informed by studies from PubMed, Scopus, EMBASE, Web of Science, and Google Scholar until January 6, 2024, aimed to clarify this relationship. Eligible studies included cohorts observing stroke incidence in RVO patients for over a year. Pooled effect estimates were calculated using random-effects models, with subgroup analyses evaluating associations between RVO types (central and branch) and stroke subtypes (ischemic and hemorrhagic). Ten cohort studies with a total of 428,650 participants (86,299 RVO patients) were included. Compared to controls, RVO patients exhibited a significantly increased risk of stroke (pooled risk ratio [RR]=1.38, 95 % confidence interval (95 %CI)=1.34–1.41). Subgroup analyses indicated elevated risk for both ischemic (RR=1.37, 95 %CI=1.32–1.42) and hemorrhagic (RR=1.55, 95 %CI=1.08–2.22) strokes in RVO patients. Additionally, both central (RR=1.50, 95 %CI=1.27–1.78) and branch (RR=1.41, 95 %CI=1.32–1.50) RVO were associated with stroke risk. Sensitivity analyses confirmed consistent results across various criteria, and funnel plots indicated no publication bias. RVO significantly increases the risk of both ischemic and hemorrhagic stroke, regardless of RVO type, suggesting a strong independent association between these conditions.

视网膜静脉闭塞(RVO)和脑血管疾病(CVD)有共同的风险因素,而且可能是独立相关的;然而,这种关联的强度和性质仍不清楚。我们进行了一项系统性综述和荟萃分析,参考了截至 2024 年 1 月 6 日来自 PubMed、Scopus、EMBASE、Web of Science 和 Google Scholar 的研究,旨在澄清这种关系。符合条件的研究包括观察 RVO 患者中风发生率一年以上的队列。采用随机效应模型计算汇总效应估计值,并通过亚组分析评估 RVO 类型(中央型和分支型)与中风亚型(缺血性和出血性)之间的关系。十项队列研究共纳入 428650 名参与者(86299 名 RVO 患者)。与对照组相比,RVO 患者发生中风的风险明显增加(汇总风险比 [RR]=1.38, 95% 置信区间 (95%CI)=1.34-1.41 )。亚组分析表明,RVO 患者缺血性中风(RR=1.37,95%CI=1.32-1.42)和出血性中风(RR=1.55,95%CI=1.08-2.22)的风险均升高。此外,中心型(RR=1.50,95%CI=1.27-1.78)和分支型(RR=1.41,95%CI=1.32-1.50)RVO 均与中风风险相关。敏感性分析证实各种标准的结果一致,漏斗图显示无发表偏倚。无论 RVO 类型如何,RVO 都会明显增加缺血性和出血性中风的风险,这表明这些疾病之间存在很强的独立关联。
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引用次数: 0
Diabetic retinopathy: New concepts of screening, monitoring, and interventions 糖尿病视网膜病变:筛查、监测和干预的新概念。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-02 DOI: 10.1016/j.survophthal.2024.07.001

The science of diabetes care has progressed to provide a better understanding of the oxidative and inflammatory lesions and pathophysiology of the neurovascular unit within the retina (and brain) that occur early in diabetes, even prediabetes. Screening for retinal structural abnormalities, has traditionally been performed by fundus examination or color fundus photography; however, these imaging techniques detect the disease only when there are sufficient lesions, predominantly hemorrhagic, that are recognized to occur late in the disease process after significant neuronal apoptosis and atrophy, as well as microvascular occlusion with alterations in vision. Thus, interventions have been primarily oriented toward the later-detected stages, and clinical trials, while demonstrating a slowing of the disease progression, demonstrate minimal visual improvement and modest reduction in the continued loss over prolonged periods. Similarly, vision measurement utilizing charts detects only problems of visual function late, as the process begins most often parafoveally with increasing number and progressive expansion, including into the fovea. While visual acuity has long been used to define endpoints of visual function for such trials, current methods reviewed herein are found to be imprecise. We review improved methods of testing visual function and newer imaging techniques with the recommendation that these must be utilized to discover and evaluate the injury earlier in the disease process, even in the prediabetic state. This would allow earlier therapy with ocular as well as systemic pharmacologic treatments that lower the and neuro-inflammatory processes within eye and brain. This also may include newer, micropulsed laser therapy that, if applied during the earlier cascade, should result in improved and often normalized retinal function without the adverse treatment effects of standard photocoagulation therapy.

随着糖尿病护理科学的进步,人们对糖尿病早期甚至糖尿病前期视网膜(和大脑)内神经血管单元的氧化和炎症病变及病理生理学有了更深入的了解。传统上,视网膜结构异常的筛查是通过眼底检查或彩色眼底照相来进行的;然而,目前的这些成像技术只有在出现足够的病变(主要是出血性病变)时才能检测到疾病,而这些病变被认为是在疾病进程的晚期,即神经元显著凋亡和萎缩以及微血管闭塞并导致视力改变之后发生的。因此,干预措施主要是针对后期发现的阶段,临床试验虽然显示疾病的发展速度有所减缓,但视力改善甚微,长期持续丧失的情况也略有减少。同样,利用视力表测量视力也只能在晚期发现视功能问题,因为这一过程通常从眼窝旁开始,数量越来越多,并逐渐扩大,包括扩大到眼窝。长期以来,视敏度一直被用来定义此类试验的视觉功能终点,但本文评述的现有方法并不精确。我们回顾了经改进的视功能测试方法和较新的成像技术,并建议必须利用这些方法在疾病进程的早期发现和评估损伤,即使是在糖尿病前期。这样就能更早地使用眼部和全身药物治疗来降低眼部和脑部的神经炎症过程。这也可能包括较新的微脉冲激光疗法,如果在早期级联过程中使用这种疗法,应能改善视网膜功能并使其恢复正常,而不会产生标准光凝疗法的不良治疗效果。
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引用次数: 0
Applications of artificial intelligence in diagnosis of uncommon cystoid macular edema using optical coherence tomography imaging: A systematic review 人工智能在利用光学相干断层成像诊断不常见囊样黄斑水肿中的应用:系统综述。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-27 DOI: 10.1016/j.survophthal.2024.06.005

Cystoid macular edema (CME) is a sight-threatening condition often associated with inflammatory and diabetic diseases. Early detection is crucial to prevent irreversible vision loss. Artificial intelligence (AI) has shown promise in automating CME diagnosis through optical coherence tomography (OCT) imaging, but its utility needs critical evaluation. This systematic review assesses the application of AI to diagnosis CME, specifically focusing on disorders like postoperative CME (Irvine Gass syndrome) and retinitis pigmentosa without obvious vasculopathy, using OCT imaging. A comprehensive search was conducted across 6 databases (PubMed, Scopus, Web of Science, Wiley, ScienceDirect, and IEEE) from 2018 to November, 2023. Twenty-three articles met the inclusion criteria and were selected for in-depth analysis. We evaluate AI's role in CME diagnosis and its performance in “detection”, “classification”, and “segmentation” of OCT retinal images. We found that convolutional neural network (CNN)-based methods consistently outperformed other machine learning techniques, achieving an average accuracy of over 96 % in detecting and identifying CME from OCT images. Despite certain limitations such as dataset size and ethical concerns, the synergy between AI and OCT, particularly through CNNs, holds promise for significantly advancing CME diagnostics.

囊样黄斑水肿(CME)是一种威胁视力的疾病,通常与炎症和糖尿病相关。早期发现对于防止不可逆转的视力丧失至关重要。人工智能(AI)在通过光学相干断层扫描(OCT)成像自动诊断 CME 方面已显示出前景,但其实用性还需要严格评估。本系统性综述评估了人工智能在CME诊断中的应用,特别关注术后CME(欧文-加斯综合征)和无明显血管病变的视网膜色素变性等疾病的OCT成像。从 2018 年到 2023 年 11 月,我们在 6 个数据库(PubMed、Scopus、Web of Science、Wiley、ScienceDirect 和 IEEE)中进行了全面检索。有 23 篇文章符合纳入标准,并被选中进行深入分析。我们评估了人工智能在 CME 诊断中的作用及其在 OCT 视网膜图像的 "检测"、"分类 "和 "分割 "中的性能。我们发现,基于卷积神经网络(CNN)的方法始终优于其他机器学习技术,在从 OCT 图像检测和识别 CME 方面的平均准确率超过 96%。尽管存在数据集规模和伦理问题等某些限制,但人工智能与 OCT 之间的协同作用,特别是通过 CNN,有望显著推进 CME 诊断。
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引用次数: 0
Multimodal imaging in diabetic retinopathy and macular edema: An update about biomarkers 糖尿病视网膜病变和黄斑水肿的多模态成像:生物标志物的最新进展。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-26 DOI: 10.1016/j.survophthal.2024.06.006

Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and blindness in patients with diabetes. Current knowledge of retina anatomy and function and DME pathophysiology has taken great advantage of the availability of several techniques for visualizing the retina. Combining these techniques in a multimodal imaging approach to DME is recommended to improve diagnosis and to guide treatment decisions. We review the recent literature about the following retinal imaging technologies: optical coherence tomography (OCT), OCT angiography (OCTA), wide-field and ultrawide-field techniques applied to fundus photography, fluorescein angiography, and OCTA. The emphasis will be on characteristic DME features identified by these imaging technologies and their potential or established role as diagnostic, prognostic, or predictive biomarkers. The role of artificial intelligence in the assessment and interpretation of retina images is also discussed.

糖尿病黄斑水肿(DME)是指由于视网膜内液体积聚引起的眼窝附近或涉及眼窝的视网膜增厚,可导致糖尿病患者视力受损和失明。目前,人们对视网膜解剖和功能以及 DME 病理生理学的了解,已极大地利用了多种视网膜可视化技术。我们建议将这些技术结合起来,对DME进行多模式成像,以改善诊断并指导治疗决策。我们回顾了有关以下视网膜成像技术的最新文献:光学相干断层扫描(OCT)、OCT 血管造影(OCTA)、应用于眼底摄影的宽视场和超宽视场技术、荧光素血管造影和 OCTA。重点将放在这些成像技术所发现的 DME 特征及其作为诊断、预后或预测性生物标志物的潜在或既定作用。此外,还将讨论人工智能在视网膜图像评估和解读中的作用。
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引用次数: 0
A journey through the world of vitreous 玻璃体世界之旅
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-15 DOI: 10.1016/j.survophthal.2024.06.004

Vitreous, one of the largest components of the human eye, mostly contains water. Despite decades of studying the vitreous structure, numerous unanswered questions still remain, fueling ongoing active research. We attempt to provide a comprehensive overview of the current understanding of the development, morphology, biochemical composition, and function of the vitreous. We emphasize the impact of the vitreous structure and composition on the distribution of drugs. Fast-developing imaging technologies, such as modern optical coherence tomography, unlocked multiple new approaches, offering the potential for in vivo study of the vitreous structure. They allowed to analyze in vivo a range of vitreous structures, such as posterior precortical vitreous pockets, Cloquet canal, channels that interconnect them, perivascular vitreous fissures, and cisterns. We provide an overview of such imaging techniques and their principles and of some challenges in visualizing vitreous structures. Finally, we explores the potential of combining the latest technologies and machine learning to enhance our understanding of vitreous structures.

玻璃体是人眼最大的组成部分之一,主要含水。尽管对玻璃体结构进行了数十年的研究,但仍有许多未解之谜,这也推动了当前的积极研究。我们试图全面概述目前对玻璃体的发育、形态、生化成分和功能的理解。我们强调玻璃体结构和组成对药物分布的影响。快速发展的成像技术,如现代光学相干断层扫描,开启了多种新方法,为玻璃体结构的活体研究提供了可能。这些技术可以在体内分析一系列玻璃体结构,如后皮质前玻璃体袋、Cloquet 管、相互连接的通道、血管周围玻璃体裂隙和贮水池。我们概述了此类成像技术及其原理,以及玻璃体结构可视化所面临的一些挑战。最后,我们探讨了将最新技术与机器学习相结合以增强我们对玻璃体结构的理解的潜力。
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引用次数: 0
Corrigendum to “Fibrosis in neovascular age-related macular degeneration: a review of definitions based on clinical imaging” [Surv Ophthalmol 68 (2023) 835–848/5] 新生血管性老年黄斑变性中的纤维化:基于临床成像的定义回顾》[Surv Ophthalmol 68 (2023) 835-848/5]的更正。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-05-28 DOI: 10.1016/j.survophthal.2023.10.007
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引用次数: 0
Not everything is ischemic optic neuropathy 并非所有病症都是缺血性视神经病变
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-05-23 DOI: 10.1016/j.survophthal.2024.05.005

A 71-year-old woman developed sudden, painful, decreased vision in the left eye accompanied by progressive instability. Initial examination revealed left optic disc edema, and macular optical coherence tomography confirmed the presence of intraretinal and subretinal fluid, as well as hyperreflective material under the retinal pigment epithelium. Subsequent investigations, including brain magnetic resonance imaging and a comprehensive serological analysis, ruled out infectious and autoimmune causes, further complicating the diagnostic picture. The patient's vision in both eyes continued to deteriorate, prompting empirical corticosteroid treatment. While the vision improved, the case took an unexpected turn with worsening neurological symptoms. Ultimately a brain biopsy was consistent with diffuse large B-cell lymphoma.

一名 71 岁的妇女左眼突然出现疼痛性视力下降,并伴有进行性不稳定。初步检查发现左眼视盘水肿,黄斑光学相干断层扫描证实存在视网膜内和视网膜下积液以及视网膜色素上皮下的高反射物质。随后的检查,包括脑磁共振成像和全面的血清学分析,排除了感染和自身免疫原因,使诊断结果更加复杂。患者的双眼视力持续恶化,需要接受皮质类固醇治疗。在视力得到改善的同时,患者的神经系统症状却出现了意想不到的恶化。最终,脑活检结果与弥漫大B细胞淋巴瘤一致。
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引用次数: 0
Generative artificial intelligence in ophthalmology. 眼科生成人工智能。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-05-16 DOI: 10.1016/j.survophthal.2024.04.009
Ethan Waisberg, Joshua Ong, Sharif Amit Kamran, Mouayad Masalkhi, Phani Paladugu, Nasif Zaman, Andrew G Lee, Alireza Tavakkoli

Generative artificial intelligence (AI) has revolutionized medicine over the past several years. A generative adversarial network (GAN) is a deep learning framework that has become a powerful technique in medicine, particularly in ophthalmology for image analysis. In this paper we review the current ophthalmic literature involving GANs, and highlight key contributions in the field. We briefly touch on ChatGPT, another application of generative AI, and its potential in ophthalmology. We also explore the potential uses for GANs in ocular imaging, with a specific emphasis on 3 primary domains: image enhancement, disease identification, and generating of synthetic data. PubMed, Ovid MEDLINE, Google Scholar were searched from inception to October 30, 2022, to identify applications of GAN in ophthalmology. A total of 40 papers were included in this review. We cover various applications of GANs in ophthalmic-related imaging including optical coherence tomography, orbital magnetic resonance imaging, fundus photography, and ultrasound; however, we also highlight several challenges that resulted in the generation of inaccurate and atypical results during certain iterations. Finally, we examine future directions and considerations for generative AI in ophthalmology.

在过去几年里,生成式人工智能给医学带来了革命性的变化。生成式对抗网络(GAN)是一种深度学习框架,已成为医学领域的一项强大技术,尤其是在眼科和图像分析领域。在本文中,我们回顾了当前涉及生成式对抗网络的眼科文献,并重点介绍了该领域的主要贡献。我们简要介绍了生成式人工智能的另一种应用 ChatGPT 及其在眼科领域的潜力。我们还探讨了 GANs 在眼科成像中的潜在用途,特别强调了三个主要领域:图像增强、疾病识别和生成合成数据。我们对 PubMed、Ovid MEDLINE 和 Google Scholar 进行了检索,以确定 GAN 在眼科中的应用,检索时间从开始到 2022 年 10 月 30 日。本综述共收录了 40 篇论文。我们涵盖了 GANs 在眼科相关成像中的各种应用,包括光学相干断层扫描、眼眶磁共振成像、眼底摄影和超声波;不过,我们也强调了一些挑战,这些挑战导致在某些迭代过程中产生了不准确和不典型的结果。最后,我们探讨了生成式人工智能在眼科领域的未来发展方向和注意事项。
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引用次数: 0
Denial. 丹尼尔
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-05-13 DOI: 10.1016/j.survophthal.2024.05.003
M. Tariq Bhatti, Jennifer R Long, Andrew R Carey

A 51-year-old man presented with decreased vision, fever, confusion, headaches, agitation, nausea, vomiting and diarrhea. Magnetic resonance imaging of the brain demonstrated bilateral T2 hyperintense lesions in the region of the mesial temporal lobe and optic radiations. There was a predominantly polymorphonuclear leukocyte pleocytosis in the cerebrospinal fluid (CSF) with hyperproteinorachia. A meningoencephalitis was diagnosed. Intravenous fluorescein angiography (IVFA) demonstrated a multifocal chorioretinitis that was in a linear pattern in the left eye. CSF enzyme-linked immunosorbent assay was positive for West Nile virus (WNV) IgM. We review the clinical manifestations of WNV disease and highlight the value of IVFA in determining the diagnosis.

一名 51 岁的男子因视力下降、发热、精神错乱、头痛、烦躁、恶心、呕吐和腹泻就诊。脑部磁共振成像显示,颞叶中叶和视神经放射区域出现双侧 T2 超强病变。脑脊液(CSF)中主要是多形核白细胞增多,并伴有高蛋白血症。诊断为脑膜脑炎。静脉荧光素血管造影显示,左眼出现线状多灶性脉络膜视网膜炎。脑脊液酶联免疫吸附试验显示西尼罗河病毒(WNV)IgM呈阳性。我们回顾了 WNV 疾病的临床表现,并强调了 IVFA 在确定诊断方面的诊断价值。
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引用次数: 0
Risk factors for complications in resident-performed cataract surgery: A systematic review 住院医师实施白内障手术并发症的风险因素:系统综述。
IF 5.1 2区 医学 Q1 Medicine Pub Date : 2024-04-20 DOI: 10.1016/j.survophthal.2024.04.002
Chaerim Kang , Matthew J. Lee BA , Amy Chomsky MD , Thomas A. Oetting MS, MD , Paul B. Greenberg MD, MPH

We assessed risk factors for complications associated with resident-performed cataract surgery. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched 4databases in September, 2023. We included peer-reviewed, full-text, English-language articles assessing risk factors for complications in resident performed cataract surgery. We excluded studies describing cataract surgeries performed by fellows, combined surgeries, and studies with insufficient information. Our initial search yielded 6244 articles; 15 articles were included after title/abstract and full-text review. Patient-related risk factors included older age, hypertension, prior vitrectomy, zonular pathology, pseudoexfoliation, poor preoperative visual acuity, small pupils, and selected types of cataracts. Surgeon-related risk factors included resident postgraduate year and surgeon right-handedness. Other risk factors included absence of supervision, long phacoemulsification time, and phacoemulsification with high power and torsion. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation; most studies graded as moderate, primarily due to risk of bias. When assigning cases to residents, graduate medical educators should consider general and resident-specific risk factors to facilitate teaching and preserve patient safety.

我们评估了与住院医生实施的白内障手术相关的并发症风险因素。根据《系统综述和元分析首选报告项目》指南,我们在 2023 年 9 月检索了 4 个数据库。我们纳入了经同行评议、全文发表的、评估住院医师实施白内障手术并发症风险因素的英文文章。我们排除了描述由研究员实施的白内障手术、联合手术以及信息不充分的研究。我们的初步搜索结果为 6244 篇文章;经过标题/摘要和全文审阅后,纳入了 15 篇文章。与患者相关的风险因素包括年龄较大、高血压、曾接受过玻璃体切除术、带状病变、假性角膜外翻、术前视力差、小瞳孔以及某些类型的白内障。与外科医生相关的风险因素包括住院医师的研究生年限和外科医生的右撇子。其他风险因素包括缺乏监护、乳化时间长、乳化功率大和扭转。研究质量采用建议、评估、发展和评价分级法进行评估;大多数研究被评为中等,主要原因是存在偏倚风险。在给住院医师分配病例时,毕业医学教育者应考虑一般和住院医师特有的风险因素,以促进教学和保护患者安全。
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引用次数: 0
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Survey of ophthalmology
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