Retina-The Journal of Retinal and Vitreous Diseases最新文献

Purpose: To assess the diagnostic capabilities of the most recent chatbots releases, GPT-4o and Gemini Advanced, facing different retinal diseases.

Methods: Exploratory analysis on 50 cases with different surgical (n=27) and medical (n=23) retinal pathologies, whose optical coherence tomography/angiography (OCT/OCTA) scans were dragged into ChatGPT and Gemini's interfaces. Then, we asked "Please describe this image" and classified the diagnosis as: 1) Correct; 2) Partially correct; 3) Wrong; 4) Unable to assess exam type and 5) Diagnosis not given.

Results: ChatGPT indicated the correct diagnosis in 31/50 cases (62%), significantly higher than Gemini Advanced 16/50 cases (p=0.0048). In 24% of cases, Gemini Advanced was not able to produce any answer, stating "That's not something I'm able to do yet". For both, primary misdiagnosis was macular edema, given erroneously in 16% and 14% of cases, respectively. ChatGPT-4o showed higher rates of correct diagnoses either in surgical (52% vs 30%) and medical retina (78% vs 43%). Notably, when presented without the corresponding structural image, in any case Gemini was able to recognize OCTA scans, confusing images for artworks.

Conclusion: ChatGPT-4o outperformed Gemini Advanced in terms of diagnostic accuracy facing OCT/OCTA images, even if the range of diagnoses is still limited.

Purpose: To assess repeatability of macular inner choroid flow deficit percentage (ICFD%) in intermediate age-related macular degeneration (iAMD) and controls employing various post-processing approaches.

Methods: Cross-sectional, observational study. We included (1) 22 iAMD and 24 control eyes, with (2) age >50 years, (3) visual acuity >20/32, and (4) no additional ocular and systemic confounders.

Participants: underwent four consecutive 6x6-mm OCTA scans (2 acquired at 100-kHz and 2 at 200-kHz speed; PLEX® Elite 9000) for intra-session analysis. Same protocol was repeated after 30 minutes for inter-session analysis. Three slabs of different thicknesses were generated underneath Bruch's membrane (4-14, 4-19, 4-24 µm). All slabs were processed with: (1) binarization-only using Phansalkar method (r=4-15 pixels); (2) compensation+binarization; (3) averaging+binarization; (4) averaging+compensation+binarization. ICFD% was measured within 3- and 5-mm circles, and measurements were repeated after excluding drusen areas.Repeatability was analyzed with generalized linear mixed-effects models, intraclass correlation coefficients (ICC) and Levene's variance test.

Results: Most post-processing approaches demonstrated high repeatability (ICC>0.75) with no significant test-retest differences (p>0.05). Compensation+binarization of 15-µm slabs at 200 kHz showed the highest repeatability (ICC: 0.96-0.98). Excluding drusen did not significantly impact ICFD% measurements (p>0.05), showing increased ICCs for 10 µm-thick and binarized-only slabs.

Conclusions: Strong repeatability can be achieved with various post-processing methods for assessing ICFD%, especially with compensation+binarization of 15-µm slabs acquired at 200 kHz. Drusen removal does not seem to impact repeatability in iAMD when using a swept-source device, except for specific settings.

Purpose: To investigate the use of intravitreal bevacizumab for the treatment of subretinal (SRF) and intraretinal fluid associated with circumscribed choroidal haemangiomas (CCH).

Methods: This was a retrospective review of all patients treated with at least 3 bevacizumab injections for CCH-associated SRF between May 2020 and August 2023 in Moorfields eye hospital. Outcome measures included change in best corrected visual acuity (BCVA), change in patient reported symptoms, change in SRF and change in central subfield thickness (CSFT). Data on further management following cessation of injections was analysed.

Results: The study included 9 patients. Median BCVA was 6/19 before and 6/24 after injections (p = 0.41). CSFT decreased from a median of 466 μm to 447 μm (p = 0.11). Two thirds of (n=6) patients did not show any reduction in foveal SRF, one third (n=3) showed a partial reduction and no patients had a complete resolution of SRF. Eight patients received rescue-photodynamic therapy and one received external beam radiotherapy. BCVA changed from a median of 6/60 to a median of 6/12 after rescue treatment (p = 0.63). The median CSFT decreased significantly from 470 μm to 249 μm (p = 0.01).

Conclusions: Intravitreal bevacizumab is unlikely to be an effective treatment for exudative CCH.

Purpose: To determine the outcomes of sickle cell retinopathy (SCR) patients who experienced at least one episode of being lost to follow-up (LTFU) compared to those who attended all appointments.

Methods: Adult SCR patients who visited Wills Eye Hospital Retina service (January 2012-December 2021) with >2 visits were reviewed for LTFU events, defined as failure to return for a follow-up appointment within 6 months of the scheduled date.

Results: One hundred and eighty-one eyes of 94 patients were included. Fifty-one patients (99 eyes) attended all appointments ("attended group") whilst 43 patients (82 eyes), or 46%, had at least one LTFU event ("LTFU group"). The mean (standard deviation, SD) LTFU duration was 470 (329) days. In the LTFU group, mean (SD) VA was significantly worse at the final visit (logMAR 0.45 (0.63), Snellen 20/56) and at the post-LTFU visit (0.36 (0.59), 20/46) compared to the pre-LTFU visit (0.3 (0.47), 20/40, p = 0.001). In the attended group, mean (SD) VA was significantly better at the final visit (0.41 (0.63), 20/51) compared to the initial visit (0.52 (0.78), 20/66, p = 0.038).

Conclusion: Patients with SCR with an LTFU event have worse visual outcomes compared to patients who attend all appointments.

Purpose: To investigate the clinical implications of choroidal hyperreflective foci (HF) as biomarkers of disease severity in Stargardt disease (STGD).

Methods: 129 eyes from 66 patients with STGD were included. The primary outcome was the correlation between the number of foveal choroidal HF and indicators of disease severity. Secondary outcome included a comparison of choroidal HF between the pathological and healthy borders of atrophy, and the two-year longitudinal change of foveal choroidal HF.

Results: Long disease duration, thin central macular thickness, large definitely decreased autofluorescence area, atrophic foveal retinal pigment epithelium (RPE), high Fishman stage, and low visual acuity were associated with a higher number of foveal choroidal HF. Foveal RPE involvement (β = 0.522, p < 0.001) was the most strongly correlated factor in multivariate analysis. Genotype-phenotype relationships between the number of severe ABCA4 variants and choroidal HF could not be determined. The pathological border had significantly more choroidal HF than the healthy border (p < 0.001), and the number of foveal choroidal HF increased over two years (p = 0.003).

Conclusion: Choroidal HF could serve as a biomarker of disease severity in STGD, correlating with various severity indicators and especially reflecting the presence of RPE atrophy.

Purpose: To measure the displacement of retinal vascular plexi and choriocapillaris after Pars Plana Vitrectomy (PPV) for idiopathic Macular Hole (MH), using Optical Coherence Tomography Angiography (OCTA) and correlate it with clinical data.

Methods: Retrospective series with 6-month follow-up. Records included best-corrected visual acuity (BCVA), M-charts, structural OCT and OCTA. Coronal displacement was calculated comparing consecutive images across the 6.4 mm x 6.4 mm field and concentric circular regions of 0.5, 1.5 and 3.0mm radii. Each circular region was further divided in four quadrans indicated as follows: ST=SuperoTemporal; SN=SuperNasal; IT=InferoTemporal; IN=InferoNasal.

Results: The study comprised 33 patients (11 males and 22 females) with 68.9 ± 10.2 years mean age, similar among sexes. MH closed in 31/33 (93.9%) of cases and BCVA improved from mean 20/62 (0.50±0.62 logMAR) to 20/47 (0.23±0.63 logMAR; p=0.0064). Vertical and horizontal metamorphopsia decreased from 0.98±0.68 to 0.51±0.59 degrees (p=0.0028) and 0.84±0.63 to 0.29±0.45 degrees (p<0.001), respectively. The average retinal displacement was 81.2±44.1 μm for the superficial plexus and 79.4±45.7 μm for the deep one, both greater than the choriocapillaris displacement (60.9±20.2 μm; p<0.05). The temporal and superior quadrants displaced more than the others (p<0.05). MH size correlated to retinal displacement within the central 0.5 mm radius area at all layers (p<0.05 in all cases).

Conclusion: MH closure is associated with significant retinal displacement of all retinal layers as well as choriocapillaris remodelling. Surgical peeling removes the constraining effect of the Internal Limiting Membrane and promotes a multi-layered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the Retinal Nerve Fiber Layer.

Purpose: To validate the presence of residual non-emulsified silicone oil (SO) following conventional surgical removal techniques used in vitreoretinal surgery and provide insights for optimizing surgical parameters and reducing subsequent emulsification-related complications.

Methods: The two surgical steps of repeated fluid-air exchange (FAX), including aspiration and infusion, were simulated in vitro to investigate their effectiveness in removing residual non-emulsified SO under various clinical settings. Aspiration was performed at three different positions with respect to the SO interface (i.e., within the SO phase, at the SO/BSS interface, and within the BSS phase) with a 25-gauge probe. An infusion was positioned near the SO/BSS interface with an intraoperatively standardized flow rate (5mL/min). In a further ex vivo study, the volume of residual non-emulsified SO (collected by Dichloromethane) was quantified by Flourier-transform infrared spectroscopy (FTIR) in both repeated FAX and passive drainage (PD) groups.

Results: In the in vitro model, regardless of which position a 25-gauge probe was located, residual non-emulsified SO could not be effectively removed even under high aspiration levels (p>0.05). Continuous BSS infusion led to small SO droplet formation. Residual SO in both non-emulsified and emulsified forms was observed in the ex-vivo model subjected to repeated FAX. The volume of residual non-emulsified SO was quantified, ranging from 2.75 to 24.71 μL, without significant difference among experimental groups (p>0.05).

Conclusions: Complete residual non-emulsified SO removal was technically challenging by conventional surgical techniques. This residual non-emulsified SO could serve as a source of ongoing SO emulsification.

Purpose: To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) and the changes in these findings over time.

Methods: Fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FA), spectral domain optical coherence tomography (OCT), B-scan ultrasonography (US), and ultrasound biomicroscopy (UBM) images of the patients diagnosed with BDUMP at a single institution between years 2006-2023 were evaluated.

Results: Sixteen eyes of 8 patients with BDUMP were included. The median age was 68 years (Range: 49 - 77 years), and the median follow-up time was 11 months (Range: 1 - 79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in FAF and FA. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in OCT; optic disc hyperfluorescence, and peripheral vascular leakage in FA; 360° ciliary body thickening, and anterior rotation of the ciliary body in UBM were detected.

Conclusions: We presented various novel multimodal imaging features of BDUMP that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to BDUMP pathogenesis, which may have implications for treatment.

Purpose: Retinal ischemic perivascular lesions (RIPLs) have been reported as potential biomarkers for cardiovascular diseases and stroke. We aimed to investigate the RIPLs in carotid artery stenosis (CAS) patients and their association with stenotic degree.

Methods: Patients with unilateral CAS or carotid artery occlusion were recruited. Optical coherence tomography (OCT) was conducted for assessing the presence, number, and distribution of RIPLs. OCT angiography (OCTA) was used for evaluating microvascular density in superficial vascular complex (SVC) and deep vascular complex (DVC).

Results: Eighty hundred and fifty-four eyes from 474 CAS patients were included. Ipsilateral eyes had more PRILs compared to contralateral eyes (all p < 0.01). CAS patients with cerebral infarction had a higher incidence and broader distribution of RIPLs compared to those without infarction (both p <0.05). The presence, number, and distribution of RIPLs were positively associated with stenotic degree (all p < 0.001). Eyes with RIPLs had lower SVC density (p = 0.020) compared to eyes without RIPLs.

Conclusions: RIPLs are anatomical markers of ischemia and are suggested to be associated with cerebral infarction and stenotic degree in CAS patients. OCT/OCTA is a noninvasive tool to detect retinal ischemic changes and quantitatively measure retinal microvascular changes in CAS patients.