Ophthalmology science最新文献_第2页

Automated Feature Segmentation of Ultra-Widefield OCT Images 超广角OCT图像的自动特征分割

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-13 DOI: 10.1016/j.xops.2025.101029

John D. Jackson MD , Mani K. Woodward MCR , David A. Sutter , Aaron S. Coyner PhD , Carol X. Wang , Susan R. Ostmo MS , Michael F. Chiang MD, MA , Yali Jia PhD , David Huang MD, PhD , Yifan Jian PhD , J. Peter Campbell MD, MPH , Benjamin K. Young MD, MS

Objective or Purpose

To develop a lightweight neural network for automated cross-sectional and en face segmentation of ultra-widefield (UWF) OCT images acquired for retinopathy of prematurity screening.

Design

Cross-sectional study.

Subjects

Twenty-five infants with a birth weight <1500 g or gestational age <31 weeks were scanned using a portable, handheld, swept-source UWF-OCT device.

Methods, Intervention, or Testing

For cross-sectional B-scans, 3040 B-scans from 5 OCT volumetric scans obtained from 5 patients were segmented by 2 graders for the choroid and retina using custom-built tools in the Napari image viewer. Using these segmentations, a u-net with an EfficientNet-B0 backbone was trained in combination with task-specific augmentations to perform automated segmentation of the retina and choroid data with varying levels of image processing applied. For en face scans, 40 en face images from 20 unique patients were manually segmented by a single grader for retinal vessels. Using these segmentations, a u-net with an EfficientNet-B0 backbone was trained. Validation for both B-scans and en face images was performed using fivefold cross-validation. The fivefold cross-validation metrics were then compared with the metrics obtained by comparing grader segmentations.

Main Outcome Measures

The Dice similarity coefficient (DSC) was used to assess B-scan and en face segmentations.

Results

The retinal and choroidal b-scan segmentations produced a DSC ± standard deviation of 0.925 ± 0.021 and 0.797 ± 0.062, respectively, averaged across the fivefolds. The en face vasculature segmentation produced a DSC ± standard deviation of 0.625 ± 0.0450.

Conclusions

Using u-net convolutional neural networks trained with task-specific augmentations, we developed en face and cross-sectional segmentations for UWF-OCT images, which will facilitate automated quantitative analysis with this novel modality.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的或目的建立一种轻量级的神经网络，用于对早产儿视网膜病变筛查中获得的超宽视场OCT图像进行自动横截面和正面分割。DesignCross-sectional研究。研究对象25名出生体重1500克或胎龄31周的婴儿，使用便携式、手持、扫描源UWF-OCT设备进行扫描。方法、干预或测试对于横断面b扫描，使用Napari图像查看器中定制的工具，对来自5名患者的5张OCT体积扫描的3040张b扫描片进行2级分级，对脉络膜和视网膜进行分割。使用这些分割，将一个带有EfficientNet-B0主干的u-net与特定任务增强相结合进行训练，以在应用不同级别的图像处理的情况下对视网膜和脉络膜数据进行自动分割。对于面部扫描，来自20个不同患者的40张面部图像被单个视网膜血管分级器手动分割。使用这些分割，训练了一个具有EfficientNet-B0主干的u-net。b扫描和面部图像的验证采用五倍交叉验证。然后将五重交叉验证指标与通过比较分级器分割获得的指标进行比较。Dice相似系数（DSC）用于评估b扫描和面部分割。结果视网膜和脉络膜b扫描的DSC±标准差分别为0.925±0.021和0.797±0.062，平均值为5倍。正面血管分割产生的DSC±标准差为0.625±0.0450。使用u-net卷积神经网络训练特定任务增强，我们开发了UWF-OCT图像的正面和横断面分割，这将有助于使用这种新模式进行自动定量分析。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Geographic Atrophy Structure-Function Relationships Based on Loss of OCT Outer Retinal Bands and Fundus Autofluorescence 基于OCT视网膜外带和眼底自体荧光丧失的地理萎缩结构-功能关系

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-12 DOI: 10.1016/j.xops.2025.101035

Joseph P.M. Blair PhD , Robyn H. Guymer MBBS, PhD , Alicja Krzemińska-Ściga MSc , Sandro De Zanet PhD , Carlos Ciller PhD , Stefanos Apostolopoulos PhD , Zhichao Wu BAppSc(Optom), PhD

Purpose

To examine the association between the loss of the OCT outer retinal bands and deep visual sensitivity losses quantified by defect-mapping microperimetry (DMP).

Design

Cross-sectional study.

Participants

Fifty individuals with geographic atrophy (GA) secondary to age-related macular degeneration.

Methods

All participants underwent DMP testing—a strategy optimized to quantify the spatial extent of deep visual sensitivity losses through single presentations of 10 decibel stimuli—with 208 locations sampled within the central 8° radius region. Participants also underwent OCT and fundus autofluorescence (FAF) imaging. OCT scans were automatically segmented to detect regions of retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) loss, and FAF images were manually annotated for GA. The extent of these parameters in the central 8° radius region where DMP testing was performed, and at each individual test location, was derived through image coregistration for evaluating structure-function associations.

Main Outcome Measures

Global structure-function correlation between the proportion of locations missed on DMP testing and the extent of loss of the structural parameters based on Spearman rank correlation coefficient (ρ), and spatial agreement between the presence of structural changes and missed stimuli on DMP testing at individual test locations based on the Dice similarity coefficient (DSC).

Results

There were strong global structure-function correlations based on loss of the OCT outer retinal bands (ρ = 0.85–0.86), similar to what was seen with FAF-defined GA (ρ = 0.89; P ≥ 0.326). However, the spatial agreement between OCT-defined EZ and ELM loss with missed stimuli on DMP testing (DSC = 0.64 for both) was higher than that seen with RPE loss (DSC = 0.60) and FAF-defined GA (DSC = 0.62; P = 0.008 for both), but the structure-function spatial agreement was similar between RPE loss and FAF-defined GA (P = 0.152).

Conclusions

Spatial agreement with pointwise deep visual sensitivity losses was comparable based on OCT-defined RPE loss and FAF-defined GA, but higher based on EZ and ELM loss. These findings confirm the expected functional relevance of these automatically derived OCT-defined parameters and support their utility as tools for monitoring GA progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的探讨缺陷定位显微术（DMP）量化的OCT视网膜外带丧失与深度视觉灵敏度丧失之间的关系。DesignCross-sectional研究。参与者：50例继发于年龄相关性黄斑变性的地理萎缩（GA）患者。方法所有参与者都进行了DMP测试——一种优化的策略，通过单次10分贝刺激来量化深度视觉灵敏度丧失的空间范围——在中央8°半径区域内采样了208个位置。参与者还接受了OCT和眼底自身荧光（FAF）成像。OCT扫描自动分割以检测视网膜色素上皮（RPE），椭球区（EZ）和外限制膜（ELM）丢失区域，并手动注释FAF图像以进行GA。在进行DMP测试的中心8°半径区域以及每个单独的测试位置，这些参数的范围通过图像共配得到，以评估结构-功能关联。主要结果测量：基于Spearman秩相关系数（ρ）的DMP测试中缺失的位置比例与结构参数丢失程度之间的整体结构-功能相关性，以及基于Dice相似系数（DSC）的单个测试位置上DMP测试中存在结构变化和缺失刺激之间的空间一致性。结果基于OCT视网膜外带丢失的整体结构-功能相关性强（ρ = 0.85-0.86），与faf定义的GA相似（ρ = 0.89; P≥0.326）。然而，在DMP测试中缺失刺激的oct定义的EZ和ELM损失之间的空间一致性（两者的DSC均为0.64）高于RPE损失（DSC = 0.60）和faf定义的GA (DSC = 0.62；两者的P = 0.008)，但RPE损失和faf定义的GA之间的结构-功能空间一致性相似（P = 0.152）。基于oct定义的RPE损失和faf定义的GA，深度视觉灵敏度损失与点相关的空间一致性相当，但基于EZ和ELM损失的空间一致性更高。这些发现证实了这些自动衍生的oct定义参数的预期功能相关性，并支持它们作为监测GA进展的工具。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

The Association among Corneal Nerve Metrics, Ocular Surface Integrity, and Renal Function in Type 2 Diabetes 2型糖尿病患者角膜神经指标、眼表完整性和肾功能之间的关系

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-08 DOI: 10.1016/j.xops.2025.101031

Chang Liu MD , Hong Chang Tan MBBS, PhD , Mingyi Yu MD , Isabelle Xin Yu Lee MSc , Ching-Yu Cheng MD, PhD , Yu-Chi Liu MD, PhD

Purpose

To investigate the association among corneal nerves, ocular surface, and renal function in diabetes, and to compare these variables in patients with and without chronic diabetic kidney disease (DKD).

Design

Cross-sectional study.

Participants

This study included 538 patients with type 2 diabetes.

Methods

All subjects received renal function tests, in vivo confocal microscopy examinations for corneal nerves, epithelial and immune cells, as well as ocular surface subjective and objective assessments. Univariable and multivariable regression analyses were used to determine the relationship between corneal nerve variables and renal function parameters. Multivariable logistic regression was performed to examine factors that were associated with DKD.

Main Outcome Measures

The association between corneal nerve metrics and renal function parameters.

Results

After adjusting for potential confounders, lower corneal nerve fiber density (CNFD) was significantly associated with higher urine albumin (P = 0.019), and higher corneal nerve fiber width was significantly associated with higher urine albumin and higher urine albumin-creatinine ratio (P < 0.001 and P = 0.001, respectively). Corneal nerve fiber length and width were significantly associated with DKD (P = 0.028 and P = 0.025, respectively). Compared with the non-DKD group, patients with DKD had significantly lower CNFD, length, area, and fractal dimension, as well as increased width, decreased epithelial cell density and count, and larger epithelial cell size (all P < 0.05). Patients with DKD presented with significantly lower Schirmer value and tear break-up time, and increased corneal staining and Ocular Surface Disease Index score than non-DKD patients (all P < 0.05).

Conclusions

In diabetes, the impairment of corneal nerves is associated with the deterioration of renal function. Patients who have poor corneal nerve status are at risk of DKD, and patients who have DKD should be examined for corneal neuropathy.

Financial Disclosure(s)

The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

目的探讨糖尿病患者角膜神经、眼表和肾功能之间的关系，并比较慢性糖尿病肾病（DKD）患者和非糖尿病患者的这些变量。DesignCross-sectional研究。这项研究包括538名2型糖尿病患者。方法所有受试者均接受肾功能检查、角膜神经、上皮细胞和免疫细胞的体内共聚焦显微镜检查以及眼表主客观评价。采用单变量和多变量回归分析确定角膜神经变量与肾功能参数的关系。采用多变量logistic回归检验与DKD相关的因素。主要观察指标：角膜神经指标与肾功能参数之间的关系。结果校正潜在混杂因素后，较低的角膜神经纤维密度（CNFD）与较高的尿白蛋白显著相关（P = 0.019），较高的角膜神经纤维宽度与较高的尿白蛋白和较高的尿白蛋白-肌酐比值显著相关（P <； 0.001和P = 0.001）。角膜神经纤维长度和宽度与DKD有显著相关性（P = 0.028和P = 0.025）。与非DKD组相比，DKD患者的CNFD、长度、面积和分形维数显著降低，上皮细胞宽度增加，上皮细胞密度和数量减少，上皮细胞大小增大（P < 0.05）。DKD患者的Schirmer值和泪液破裂时间明显低于非DKD患者，角膜染色和眼表疾病指数评分明显高于非DKD患者（P < 0.05）。结论糖尿病患者角膜神经损伤与肾功能恶化有关。角膜神经状态差的患者有发生DKD的风险，有DKD的患者应检查角膜神经病变。财务披露作者在本文中讨论的任何材料中没有/作者没有专有或商业利益。

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引用次数: 0

A Phase I Randomized Trial of Topical Insulin for Glaucoma: Safety and Efficacy Outcomes 局部胰岛素治疗青光眼的I期随机试验：安全性和有效性结果

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-06 DOI: 10.1016/j.xops.2025.101032

Mariella Saludares , Zachary Wennberg-Smith , Gala Beykin MD , Tasneem Z. Khatib MD, PhD , Mariana Nunez MD , QianQian Wang MD , Adriana Di Polo PhD , Jeffrey L. Goldberg MD, PhD

Purpose

Insulin is neuroprotective in mouse and nonhuman primate models of glaucoma. Here we evaluate the safety and efficacy of topical insulin in human patients with glaucoma.

Methods

This prospective study of once-daily topical insulin for glaucoma was conducted in 2 parts: an open-label dose escalation phase evaluating low (100 units/mL) and high doses (500 units/mL), followed by a randomized masked trial comparing low- and high-dose topical insulin. The worse-affected eye served as the study eye while the contralateral eye served as a control. The primary endpoint was safety and tolerability, monitored by recording adverse events (AEs), intraocular pressure, and serum blood glucose and potassium levels. The secondary endpoints included structural and functional testing including visual acuity, 24-2 Humphrey visual field (HVF), OCT, and macular and peripapillary flavoprotein fluorescence (FPF).

Results

Safety and tolerability were favorable for topical insulin at both doses, with no serious AEs. The most frequent AE was transient stinging, resolving almost immediately after application to the study eyes. Blood glucose levels remained consistently stable before and after insulin administration for all groups. In group 3, 5 of 15 study eyes showed an increase of average retinal nerve fiber layer (RNFL) thickness by ≥5 μm, compared with 0 of 12 fellow eyes from baseline to the 1-month visit (P = 0.0476). On average, study eyes showed a larger increase in RNFL thickness compared with fellow eyes (1.11 μm in fellow eyes vs. 2.50 μm in study eyes) with no evidence of cystoid edema, and no difference detected between the 2 dose levels. The RNFL increase reversed to baseline by 1 month after cessation of insulin treatment. There were no changes in HVF or FPF during a 4-week administration period.

Conclusions

The application of topical insulin proved safe and well-tolerated among patients with glaucoma. Notably, 1 month of topical insulin led to a significant, reversible increase in RNFL thickness, indicating evidence for pharmacodynamic effect at the retina after topical delivery. These data support study initiation to evaluate topical insulin's neuroprotective or neuroenhancement effects.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的胰岛素对小鼠和非人灵长类青光眼模型具有神经保护作用。在这里，我们评估外用胰岛素治疗青光眼患者的安全性和有效性。方法：本前瞻性研究分两部分进行：开放标签剂量递增阶段评估低剂量（100单位/mL）和高剂量（500单位/mL），然后进行随机掩盖试验，比较低剂量和高剂量局部胰岛素。受影响最严重的一只眼作为研究眼，而对侧一只眼作为对照眼。主要终点是安全性和耐受性，通过记录不良事件（ae）、眼压、血清血糖和钾水平来监测。次要终点包括结构和功能测试，包括视力、24-2汉弗瑞视野（HVF）、OCT、黄斑和乳头周围黄蛋白荧光（FPF）。结果两种剂量外用胰岛素的安全性和耐受性均较好，未发生严重不良反应。最常见的AE是短暂的刺痛，几乎在应用于研究眼睛后立即解决。所有组的血糖水平在注射胰岛素前后都保持稳定。在第3组，15只研究眼中有5只显示视网膜神经纤维层（RNFL）平均厚度增加≥5 μm，而从基线到1个月的随访，12只研究眼中有0只（P = 0.0476）。平均而言，与对照组相比，实验组的RNFL厚度增加更大（对照组为1.11 μm，对照组为2.50 μm），无囊样水肿的证据，两种剂量水平之间无差异。停止胰岛素治疗1个月后，RNFL恢复到基线水平。在4周的给药期间，HVF或FPF没有变化。结论外用胰岛素治疗青光眼患者安全、耐受性好。值得注意的是，1个月的外用胰岛素导致视网膜视网膜厚度显著可逆增加，这表明外用胰岛素后视网膜的药效学效应。这些数据支持研究开始评估局部胰岛素的神经保护或神经增强作用。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

{"title":"A Phase I Randomized Trial of Topical Insulin for Glaucoma: Safety and Efficacy Outcomes","authors":"Mariella Saludares , Zachary Wennberg-Smith , Gala Beykin MD , Tasneem Z. Khatib MD, PhD , Mariana Nunez MD , QianQian Wang MD , Adriana Di Polo PhD , Jeffrey L. Goldberg MD, PhD","doi":"10.1016/j.xops.2025.101032","DOIUrl":"10.1016/j.xops.2025.101032","url":null,"abstract":"<div><h3>Purpose</h3><div>Insulin is neuroprotective in mouse and nonhuman primate models of glaucoma. Here we evaluate the safety and efficacy of topical insulin in human patients with glaucoma.</div></div><div><h3>Methods</h3><div>This prospective study of once-daily topical insulin for glaucoma was conducted in 2 parts: an open-label dose escalation phase evaluating low (100 units/mL) and high doses (500 units/mL), followed by a randomized masked trial comparing low- and high-dose topical insulin. The worse-affected eye served as the study eye while the contralateral eye served as a control. The primary endpoint was safety and tolerability, monitored by recording adverse events (AEs), intraocular pressure, and serum blood glucose and potassium levels. The secondary endpoints included structural and functional testing including visual acuity, 24-2 Humphrey visual field (HVF), OCT, and macular and peripapillary flavoprotein fluorescence (FPF).</div></div><div><h3>Results</h3><div>Safety and tolerability were favorable for topical insulin at both doses, with no serious AEs. The most frequent AE was transient stinging, resolving almost immediately after application to the study eyes. Blood glucose levels remained consistently stable before and after insulin administration for all groups. In group 3, 5 of 15 study eyes showed an increase of average retinal nerve fiber layer (RNFL) thickness by ≥5 μm, compared with 0 of 12 fellow eyes from baseline to the 1-month visit (<em>P</em> = 0.0476). On average, study eyes showed a larger increase in RNFL thickness compared with fellow eyes (1.11 μm in fellow eyes vs. 2.50 μm in study eyes) with no evidence of cystoid edema, and no difference detected between the 2 dose levels. The RNFL increase reversed to baseline by 1 month after cessation of insulin treatment. There were no changes in HVF or FPF during a 4-week administration period.</div></div><div><h3>Conclusions</h3><div>The application of topical insulin proved safe and well-tolerated among patients with glaucoma. Notably, 1 month of topical insulin led to a significant, reversible increase in RNFL thickness, indicating evidence for pharmacodynamic effect at the retina after topical delivery. These data support study initiation to evaluate topical insulin's neuroprotective or neuroenhancement effects.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 2","pages":"Article 101032"},"PeriodicalIF":4.6,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Performance of GPT-5 Frontier Models in Ophthalmology Question Answering GPT-5前沿模型在眼科答疑中的应用

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-06 DOI: 10.1016/j.xops.2025.101034

Fares Antaki MDCM , David Mikhail MSc , Daniel Milad MD , Danny A. Mammo MD , Sumit Sharma MD , Sunil K. Srivastava MD , Bing Yu Chen MDCM , Samir Touma MDCM , Mertcan Sevgi MD , Jonathan El-Khoury MD , Pearse A. Keane MD , Qingyu Chen PhD , Yih Chung Tham PhD , Renaud Duval MD

<div><h3>Purpose</h3><div>Novel large language models (LLMs) such as Generative Pretrained Transformer-5 (GPT-5) integrate advanced reasoning capabilities that may enhance performance on complex medical question-answering tasks. For this latest generation of reasoning models, the configurations that maximize both accuracy and cost-efficiency have yet to be established. Our objective was to evaluate the performance and cost-accuracy trade-offs of OpenAI’s GPT-5 compared with previous generation LLMs on ophthalmic question answering.</div></div><div><h3>Design</h3><div>Evaluation of diagnostic test or technology.</div></div><div><h3>Participants</h3><div>Generative Pretrained Transformer-5 is a publicly available LLM.</div></div><div><h3>Methods</h3><div>In August 2025, 12 configurations of OpenAI’s GPT-5 series (3 model tiers across 4 reasoning effort settings) were evaluated alongside o1-high, o3-high, and GPT-4o, using 260 closed-access multiple-choice questions from the American Academy of Ophthalmology Basic Clinical Science Course data set. The study did not include human participants.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was accuracy on the 260-item ophthalmology multiple-choice question set for each model configuration. The secondary outcomes included head-to-head ranking of configurations using a Bradley–Terry model applied to paired win/loss comparisons of answer accuracy, and evaluation of generated natural language rationales using a reference-anchored, pairwise LLM-as-a-judge framework. Additional analyses assessed the accuracy-cost trade-off by calculating mean per-question cost from token usage and identifying Pareto-efficient configurations.</div></div><div><h3>Results</h3><div>The configuration GPT-5-high achieved the highest accuracy (0.965; 95% confidence interval [CI], 0.942–0.985), significantly outperforming all GPT-5-nano variants (<em>P</em> < 0.001), o1-high (<em>P</em> = 0.04), and GPT-4o (<em>P</em> < 0.001), but not o3-high (0.958; 95% CI, 0.931–0.981). The configuration GPT-5-high ranked first in accuracy (1.66x stronger than o3-high) and rationale quality (1.11x stronger than o3-high), as judged by a reference-anchored LLM-as-a-judge autograder. Cost-accuracy analysis identified multiple GPT-5 configurations on the Pareto frontier, with GPT-5-mini-low providing the most optimal low-cost, high-performance configuration.</div></div><div><h3>Conclusions</h3><div>This study benchmarks the GPT-5 series on a high-quality ophthalmology question-answering data set, demonstrating that GPT-5 with high reasoning effort achieved near-perfect accuracy and outperformed prior reasoning LLMs. This study also introduces an autograder framework for scalable, automated evaluation of LLM-generated answers against reference standards in ophthalmology.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of t

目的：新型大型语言模型（llm），如生成预训练转换器-5 （GPT-5）集成了高级推理能力，可以提高复杂医学问答任务的性能。对于最新一代的推理模型，最大限度地提高准确性和成本效益的配置尚未建立。我们的目标是评估OpenAI的GPT-5与上一代法学硕士在眼科问题回答方面的性能和成本-准确性权衡。诊断试验或技术的设计评价。参与者生成预训练的变形金刚-5是一个公开可用的法学硕士。方法于2025年8月，使用来自美国眼科基础临床科学课程数据集的260道封闭选择题，对OpenAI GPT-5系列的12个配置（4个推理努力设置的3个模型层）以及o1-high、o3-high和gpt - 40进行评估。这项研究没有包括人类参与者。主要结果测量：主要结果是每种模型配置的260项眼科选择题集的准确性。次要结果包括使用Bradley-Terry模型对答案准确性进行配对输赢比较的配置进行正面排名，以及使用参考锚定的两两llm作为法官框架对生成的自然语言原理进行评估。其他分析通过计算令牌使用的平均每个问题成本和识别帕累托有效配置来评估准确性-成本权衡。结果配置GPT-5-high的准确率最高（0.965,95%可信区间[CI]， 0.942-0.985），显著优于所有GPT-5-nano变体（P < 0.001）、01 -high （P = 0.04）和gpt - 40 (P < 0.001)，但不优于03 -high （0.958, 95% CI, 0.931-0.981）。配置GPT-5-high在精度（比03 -high强1.66倍）和基本原理质量（比03 -high强1.11倍）方面排名第一，这是由参考锚定的llm作为法官的自动评分器判断的。成本-精度分析确定了Pareto前沿的多种GPT-5配置，其中GPT-5 mini-low提供了最优的低成本、高性能配置。本研究在高质量的眼科问答数据集上对GPT-5系列进行了基准测试，表明具有高推理能力的GPT-5达到了近乎完美的准确率，并且优于先前的推理llm。本研究还引入了一个自动评分器框架，用于根据眼科参考标准对法学硕士生成的答案进行可扩展的自动评估。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Standardization of Imaging Criteria for Detecting Macular Fibrosis in Neovascular Age-Related Macular Degeneration 新生血管性年龄相关性黄斑变性中黄斑纤维化检测成像标准的标准化

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-03 DOI: 10.1016/j.xops.2025.101027

Usha Chakravarthy MD, PhD , Lajos Csincsik , Kelvin Y.C. Teo MD, PhD , Marion R. Munk MD , Dilraj S. Grewal MD , Robyn H. Guymer MD , Glenn J. Jaffe MD , Tunde Peto MD , SriniVas R. Sadda MD , Giovanni Staurenghi MD , Chui M.G. Cheung MD

Purpose

To evaluate conventional imaging modalities for detecting fibrosis in neovascular age-related macular degeneration (nAMD) and to develop a standardized diagnostic workflow.

Design

Systematic discussion and grading exercise assessing multiple imaging modalities.

Participants

Retina specialists from the International Fibrosis Consensus workgroup and members of the International Retinal Imaging Society.

Methods

An international panel assessed the advantages and limitations of 5 imaging modalities—color fundus photography (CFP), fluorescein angiography (FA), spectral domain OCT (SD-OCT), near-infrared reflectance, and fundus autofluorescence—for detecting fibrosis in nAMD. A structured debate was followed by 2 online, masked image grading surveys. Sensitivity, specificity, and predictive accuracy of each modality, alone and in combination, were determined. Intergrader agreement was calculated. Imaging features were also correlated with histology in a nonhuman primate laser model. Based on consensus discussions at 2 in-person meetings and survey results, a 2-step diagnostic approach using SD-OCT as the primary modality was proposed.

Main Outcome Measures

Recommendation for a standardized approach for diagnosing fibrosis in eyes with nAMD.

Results

Among the 5 modalities, SD-OCT was considered essential by all workgroup members. Hyperreflective material on OCT was unanimously identified as a key indicator of fibrosis. However, its limited specificity was acknowledged. In 2 masked grading exercises, SD-OCT showed the highest sensitivity (0.88 and 0.84) but only moderate specificity (0.56 and 0.57). The area under the curve (AUC) for SD-OCT was 0.72 and 0.70. A 2-step strategy combining SD-OCT with CFP or FA improved diagnostic accuracy. Hyperreflective material was defined as material with reflectivity equal to or greater than normal retinal pigment epithelium (RPE), well-defined margins, RPE disruption, and a laminated appearance. Corresponding CFP findings included well-defined yellow/white/gray subretinal lesions, and FA findings included early blocked fluorescence and late staining. This 2-step approach increased AUC to 0.85, with sensitivity of 0.83 and specificity of 0.87.

Conclusions

The study establishes a 2-step approach using OCT as the primary modality in clinical studies for the detection of fibrosis.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的评价常规成像方式在新生血管性年龄相关性黄斑变性（nAMD）中检测纤维化的作用，并建立标准化的诊断流程。设计系统的讨论和分级练习，评估多种成像方式。参与者：来自国际纤维化共识工作组的视网膜专家和国际视网膜成像学会的成员。方法一个国际小组评估了5种成像方式——彩色眼底摄影（CFP）、荧光素血管造影（FA）、光谱域OCT （SD-OCT）、近红外反射和眼底自身荧光——检测nAMD纤维化的优势和局限性。一场有组织的辩论之后，是两次在线的蒙面图像分级调查。分别测定每一种方法单独或联合的敏感性、特异性和预测准确性。计算整合商协议。在非人灵长类动物激光模型中，成像特征也与组织学相关。基于两次面对面会议的共识讨论和调查结果，提出了以SD-OCT为主要方式的两步诊断方法。推荐一种标准化的方法来诊断nAMD眼部纤维化。结果在5种模式中，SD-OCT被所有工作组成员认为是必不可少的。OCT上的高反射物质被一致认为是纤维化的关键指标。但是，承认其有限的特殊性。在2个模糊分级练习中，SD-OCT显示出最高的敏感性（0.88和0.84），但只有中等的特异性（0.56和0.57）。SD-OCT的曲线下面积（AUC）分别为0.72和0.70。SD-OCT联合CFP或FA的两步策略提高了诊断准确性。高反射材料被定义为反射率等于或大于正常视网膜色素上皮（RPE），边缘明确，RPE破坏，层压外观的材料。相应的CFP表现为明确的黄/白/灰色视网膜下病变，FA表现为早期荧光阻滞和晚期染色。该方法将AUC提高至0.85，敏感性为0.83，特异性为0.87。该研究建立了一种两步方法，使用OCT作为临床研究中检测纤维化的主要方式。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Longitudinal Study of Macular Preservation and Geographic Atrophy Progression in Age-Related Eye Disease Study 2 年龄相关性眼病黄斑保存和地理萎缩进展的纵向研究

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-02 DOI: 10.1016/j.xops.2025.101028

Sairi Zhang MD , Thomas F. Saunders OD , Karl G. Csaky MD , Elvira Agrón MS , Tiarnán D.L. Keenan BM BCh, PhD , Emily Y. Chew MD , Barbara A. Blodi MD , Amitha Domalpally MD, PhD

Purpose

To investigate the natural history of macular tissue preservation in geographic atrophy (GA) by evaluating the relationship between the macular tissue integrity index (MTII) and best-corrected visual acuity (BCVA) over time.

Design

Post hoc analysis of Age-Related Eye Disease Study 2 (AREDS2), a multi-center, randomized clinical trial.

Participants

Participants from the AREDS2 fundus autofluorescence ancillary study with nonsubfoveal GA.

Methods

Areas of GA were segmented by a deep learning algorithm and verified by expert graders. Macular tissue integrity index was defined as the percentage of the macula without GA within the central 1-mm and 3-mm circles. Baseline associations with BCVA were assessed, and longitudinal analyses evaluated GA progression, MTII loss, and BCVA decline over time.

Main Outcome Measures

Geographic atrophy area, MTII, and BCVA.

Results

Two hundred forty-three eyes (194 participants) were included. The median follow-up was 2 years. At baseline, the mean GA area was 1.8 mm² (standard deviation 2.7), and the growth rate was 1.3 mm²/year. Baseline mean MTII in the 1-mm zone was 95.2% (standard deviation 9.1) with a decrease of 5.4%/year, and 87.3% (standard deviation 14.5) in the 3-mm zone with a decrease of 6.7%/year. Baseline mean BCVA was 76.4 letters (standard deviation 11.8; Snellen equivalent 20/30) with a 1.5-letter loss/year. Baseline MTII showed significant correlations with BCVA (1 mm: r = 0.17, P = 0.01; 3 mm: r = 0.14, P = 0.03), while GA area was not significantly associated with BCVA (r = –0.02, P = 0.71). Multivariable analysis showed that MTII in the 1-mm and 3-mm zones was associated with visual loss (both P < 0.0001). When eyes were stratified by MTII decline rate (stable/moderate/rapid), those in the rapid group showed numerically greater vision loss and GA growth.

Conclusions

This study characterizes the natural history of central macular preservation in GA using MTII. Results show moderate but significant associations with BCVA cross-sectionally and longitudinally. These findings suggest that MTII may offer complementary functional context for evaluating disease progression in GA, warranting further validation in clinical trial settings.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的通过评价黄斑组织完整性指数（MTII）与最佳矫正视力（BCVA）随时间变化的关系，探讨地理萎缩（GA）患者黄斑组织保存的自然历史。设计对年龄相关性眼病研究2 （AREDS2）进行事后分析，这是一项多中心随机临床试验。非中央凹下GA的AREDS2眼底自体荧光辅助研究的参与者。方法采用深度学习算法对遗传算法进行区域分割，并进行专家评分验证。黄斑组织完整性指数定义为中心1-mm和3-mm圆圈内无GA的黄斑的百分比。评估基线与BCVA的相关性，纵向分析评估GA进展、MTII损失和BCVA随时间的下降。主要观察指标：地理萎缩面积、MTII和BCVA。结果共纳入234只眼（194例）。中位随访时间为2年。基线时，平均GA面积为1.8 mm2（标准差为2.7），增长率为1.3 mm2/年。基线平均MTII在1 mm区域为95.2%（标准差9.1），下降5.4%/年，在3 mm区域为87.3%（标准差14.5），下降6.7%/年。基线平均BCVA为76.4个字母（标准差11.8；Snellen等效20/30），每年损失1.5个字母。基线MTII与BCVA有显著相关性（1 mm: r = 0.17, P = 0.01; 3 mm: r = 0.14, P = 0.03），而GA面积与BCVA无显著相关性（r = -0.02, P = 0.71）。多变量分析显示，1-mm和3-mm区域的MTII与视力丧失相关（P < 0.0001）。当眼睛按MTII下降率（稳定/中等/快速）分层时，快速组的人在数字上表现出更大的视力下降和GA增长。结论本研究利用MTII表征了GA中枢性黄斑保存的自然历史。结果显示与BCVA在横断面和纵向上有中度但显著的相关性。这些发现表明MTII可能为评估GA的疾病进展提供补充功能背景，需要在临床试验环境中进一步验证。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

{"title":"Longitudinal Study of Macular Preservation and Geographic Atrophy Progression in Age-Related Eye Disease Study 2","authors":"Sairi Zhang MD , Thomas F. Saunders OD , Karl G. Csaky MD , Elvira Agrón MS , Tiarnán D.L. Keenan BM BCh, PhD , Emily Y. Chew MD , Barbara A. Blodi MD , Amitha Domalpally MD, PhD","doi":"10.1016/j.xops.2025.101028","DOIUrl":"10.1016/j.xops.2025.101028","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the natural history of macular tissue preservation in geographic atrophy (GA) by evaluating the relationship between the macular tissue integrity index (MTII) and best-corrected visual acuity (BCVA) over time.</div></div><div><h3>Design</h3><div>Post hoc analysis of Age-Related Eye Disease Study 2 (AREDS2), a multi-center, randomized clinical trial.</div></div><div><h3>Participants</h3><div>Participants from the AREDS2 fundus autofluorescence ancillary study with nonsubfoveal GA.</div></div><div><h3>Methods</h3><div>Areas of GA were segmented by a deep learning algorithm and verified by expert graders. Macular tissue integrity index was defined as the percentage of the macula without GA within the central 1-mm and 3-mm circles. Baseline associations with BCVA were assessed, and longitudinal analyses evaluated GA progression, MTII loss, and BCVA decline over time.</div></div><div><h3>Main Outcome Measures</h3><div>Geographic atrophy area, MTII, and BCVA.</div></div><div><h3>Results</h3><div>Two hundred forty-three eyes (194 participants) were included. The median follow-up was 2 years. At baseline, the mean GA area was 1.8 mm<sup>2</sup> (standard deviation 2.7), and the growth rate was 1.3 mm<sup>2</sup>/year. Baseline mean MTII in the 1-mm zone was 95.2% (standard deviation 9.1) with a decrease of 5.4%/year, and 87.3% (standard deviation 14.5) in the 3-mm zone with a decrease of 6.7%/year. Baseline mean BCVA was 76.4 letters (standard deviation 11.8; Snellen equivalent 20/30) with a 1.5-letter loss/year. Baseline MTII showed significant correlations with BCVA (1 mm: r = 0.17, <em>P</em> = 0.01; 3 mm: r = 0.14, <em>P</em> = 0.03), while GA area was not significantly associated with BCVA (r = –0.02, <em>P</em> = 0.71). Multivariable analysis showed that MTII in the 1-mm and 3-mm zones was associated with visual loss (both <em>P</em> < 0.0001). When eyes were stratified by MTII decline rate (stable/moderate/rapid), those in the rapid group showed numerically greater vision loss and GA growth.</div></div><div><h3>Conclusions</h3><div>This study characterizes the natural history of central macular preservation in GA using MTII. Results show moderate but significant associations with BCVA cross-sectionally and longitudinally. These findings suggest that MTII may offer complementary functional context for evaluating disease progression in GA, warranting further validation in clinical trial settings.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 2","pages":"Article 101028"},"PeriodicalIF":4.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing Agreement between Blue-Light and Green-Light Autofluorescence of Macular Hyperautofluorescent Rings in Inherited Retinal Diseases 遗传性视网膜疾病黄斑高自荧光环蓝光和绿光自身荧光一致性评估

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-12-02 DOI: 10.1016/j.xops.2025.101026

Malena Daich Varela MD, PhD , Nancy Aychoua MD , Memuna Rashid MSc , Andre Lopes PhD , Michel Michaelides MD

Purpose

To assess the agreement between blue autofluorescence (BAF) and green autofluorescence (GAF) fundus imaging in measuring the macular hyperautofluorescent (hyperAF) ring in patients with inherited retinal diseases (IRDs).

Design

A prospective, within-subject agreement study.

Subjects

A total of 124 patients with IRD (67% with retinitis pigmentosa, 33% with cone–rod/macular dystrophies) from Moorfields Eye Hospital were included. Mean age was 36.5 years; 60% were male. Most (99%) had a genetically confirmed diagnosis.

Methods

Participants underwent BAF (Heidelberg) and GAF (Optos) imaging during the same visit. Hyperautofluorescent ring area and horizontal and vertical diameters were independently measured by 2 ophthalmologists. Agreement between imaging modalities was assessed using intraclass correlation coefficients, Pearson correlation, paired t tests, linear and mixed-effects regression, Bland–Altman plots, and 1-sided z-tests for equivalence within a ±10% margin.

Main Outcome Measures

Comparison of hyperAF ring area and diameters between BAF and GAF.

Results

Intergrader agreement was excellent (intraclass correlation coefficient: 0.93–0.98). Blue autofluorescence measured slightly larger ring areas than GAF (mean difference: 0.7 mm², P = 0.006), while horizontal and vertical diameters were nearly equivalent (mean differences: 0.03 μm and 0.08 μm, P = 0.96 and P = 0.04, respectively). Discrepancies >10% were observed in 17% of cases in horizontal diameter, 27% of cases in vertical, and 42% of cases in area. Correlations were high (r = 0.98) for all metrics. Mixed-effects models including both eyes (n = 217) estimated that the area measured in GAF is 4.1% smaller than in BAF, the horizontal is approximately 0.5% smaller, and the vertical is around 2.2% smaller, with evidence of agreement within a ±6% margin at a 5% significance level.

Conclusions

High correlation and consistent regression slopes were seen between BAF and GAF macular hyperAF ring. These results suggest that while the 2 modalities yield broadly comparable measurements, with BAF yielding larger values, these modalities should ideally not be used interchangeably.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的评价蓝色自体荧光（BAF）和绿色自体荧光（GAF）眼底成像在遗传性视网膜疾病（IRDs）患者黄斑超自体荧光（hyperautofluorescence, hyperAF）环测量中的一致性。设计一项前瞻性、主题内一致性研究。研究对象来自Moorfields眼科医院的124例IRD患者（67%为视网膜色素变性，33%为锥杆状/黄斑营养不良）。平均年龄36.5岁；60%为男性。大多数（99%）有基因确诊。方法受试者在同一就诊期间分别行BAF （Heidelberg）和GAF （Optos）成像。由2名眼科医生独立测量超自荧光环面积、水平直径和垂直直径。采用类内相关系数、Pearson相关、配对t检验、线性和混合效应回归、Bland-Altman图以及在±10%范围内的单侧z检验来评估成像方式之间的一致性。主要观察指标：BAF和GAF超af环面积和直径的比较。结果分级一致性极好（类内相关系数为0.93 ~ 0.98）。蓝色自身荧光测量到的环面积略大于GAF（平均差值为0.7 mm2, P = 0.006），而水平和垂直直径几乎相等（平均差值分别为0.03 μm和0.08 μm, P = 0.96和P = 0.04）。水平直径的差异为17%，垂直直径的差异为27%，面积的差异为42%。所有指标的相关性都很高（r = 0.98）。包括双眼在内的混合效应模型（n = 217）估计，GAF测量的面积比BAF测量的面积小4.1%，水平方向约小0.5%，垂直方向约小2.2%，在5%的显著性水平下，一致性在±6%的范围内。结论BAF与GAF黄斑高af环具有高度相关性和一致的回归斜率。这些结果表明，虽然这两种模式产生的测量结果大致相当，但BAF产生的值更大，理想情况下，这些模式不应互换使用。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Burden of Pseudoexfoliation and Pigmentary Glaucoma among American Indian or Alaska Native Patients 美国印第安人和阿拉斯加原住民患者的假角质脱落和色素性青光眼负担

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-11-29 DOI: 10.1016/j.xops.2025.101023

Samuel A. Cohen MD , Md Enamul Haque PhD , Suzann Pershing MD, MS , Ann Caroline Fisher MD

<div><h3>Objective</h3><div>To evaluate differences in glaucoma subtype, patient characteristics, and treatment among American Indian or Alaska Native patients compared with other demographic groups.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Participants</h3><div>A total of 1 855 970 patients were diagnosed with glaucoma, 2011 to 2020.</div></div><div><h3>Methods</h3><div>Glaucoma was identified from diagnosis codes. Incidence and associated patient characteristics were determined for primary open-angle glaucoma, juvenile open-angle glaucoma, pigmentary glaucoma, and pseudoexfoliation glaucoma. Treatments (selective laser trabeculoplasty, microinvasive glaucoma surgery [MIGS], and incisional glaucoma surgery) and inferred subspecialty of the treating physician were evaluated for each subtype. Results were stratified by patient race and ethnicity, and multivariable logistic regression was used to evaluate the likelihood of pseudoexfoliation and pigmentary glaucoma, respectively, among American Indian or Alaska Native patients compared with other race/ethnicities.</div></div><div><h3>Main Outcomes Measures</h3><div>Glaucoma incidence by subtype and race and ethnicity; incidence of incisional procedures, MIGS, and selective laser trabeculoplasty in American Indian or Alaska Native patients; and adjusted odds ratios (ORs) for the likelihood of pseudoexfoliation and pigmentary glaucoma based on race/ethnicity.</div></div><div><h3>Results</h3><div>We identified 6270 American Indian or Alaska Native patients with incident glaucoma (0.34%). Compared with other non-White demographic groups, American Indian or Alaska Native patients were >3 times more frequently affected by pseudoexfoliation (4.49% vs. 1.60%) and pigmentary glaucoma (1.37% vs. 0.49%). After adjusting for confounders, American Indian or Alaska Native patients had the highest odds of pseudoexfoliation glaucoma diagnosis (OR, 2.12; 95% confidence interval [CI], 1.85–2.42) compared with other demographic groups, and the second-highest odds of pigmentary glaucoma (OR, 1.33; 95% CI, 1.14–1.56). Pigmentary glaucoma was more often diagnosed at younger ages among American Indian or Alaska Native patients. More American Indian or Alaska Native patients with glaucoma underwent MIGS (15.24%) compared with patients of other races and ethnicities, with more MIGS procedures performed by a glaucoma specialist (33.9%).</div></div><div><h3>Conclusions</h3><div>American Indian or Alaska Native patients have a strikingly increased burden of pigmentary and pseudoexfoliation glaucoma. Because of a smaller population size, these groups are historically less studied and may not be recognized as higher risk. Vigilance is warranted to identify pseudoexfoliation and pigmentary glaucoma among American Indian or Alaska Native patients.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosur

目的评价美国印第安人和阿拉斯加原住民青光眼患者与其他人群相比在青光眼亚型、患者特征和治疗方面的差异。设计回顾性观察性研究。2011年至2020年，共有1855970名患者被诊断为青光眼。方法根据诊断代码对青光眼进行鉴定。确定原发性开角型青光眼、青少年型开角型青光眼、色素性青光眼和假剥脱性青光眼的发病率和相关患者特征。对每种亚型的治疗方法（选择性激光小梁成形术、微创青光眼手术和切口青光眼手术）和治疗医师推断的亚专科进行评估。结果按患者种族和民族分层，并使用多变量logistic回归分别评估与其他种族/民族相比，美国印第安人或阿拉斯加原住民患者的假角质脱落和色素性青光眼的可能性。青光眼发病率按亚型、人种和民族划分；切口手术、MIGS和选择性激光小梁成形术在美国印第安人或阿拉斯加原住民患者中的发生率；并根据种族/民族调整了假脱落和色素性青光眼可能性的比值比（ORs）。结果6270例美国印第安人或阿拉斯加原住民患者发生青光眼（0.34%）。与其他非白人人群相比，美国印第安人或阿拉斯加原住民患者发生假角质脱落（4.49% vs. 1.60%）和色素性青光眼（1.37% vs. 0.49%）的频率是其他非白人人群的3倍。在调整混杂因素后，与其他人群相比，美洲印第安人或阿拉斯加原住民患者的假脱落性青光眼诊断几率最高（or, 2.12； 95%可信区间[CI]， 1.85-2.42），色素青光眼的诊断几率第二高（or, 1.33; 95% CI, 1.14-1.56）。色素性青光眼在美国印第安人和阿拉斯加原住民患者中更常在年轻时被诊断出来。与其他种族和民族的患者相比，更多的美国印第安人或阿拉斯加原住民青光眼患者接受了MIGS(15.24%)，青光眼专家进行了更多的MIGS手术（33.9%）。结论美洲印第安人和阿拉斯加原住民患者的色素性和假脱落性青光眼负担明显增加。由于人口规模较小，历史上对这些群体的研究较少，可能不会被认为是高风险群体。在美洲印第安人或阿拉斯加土著患者中，应警惕识别假性脱落和色素性青光眼。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Choroidal Vascular Remodeling and Retinal Response After Aflibercept Loading in Diabetic Macular Edema 糖尿病性黄斑水肿患者服用阿替西普后脉络膜血管重构和视网膜反应

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-11-28 DOI: 10.1016/j.xops.2025.101025

Ye Eun Han MD, PhD , Leegoni Choi , Dahye Jung , Yulim Kim BA , Soo Jin Kim PhD , Yoon Jeon Kim MD, PhD , Young Hee Yoon MD, PhD , Junyeop Lee MD, PhD

Purpose

To investigate choroidal changes after aflibercept treatment for diabetic macular edema (DME) and to assess their association with treatment response.

Design

A retrospective interventional cohort study.

Subjects

Thirty eyes from 30 patients who were injection-naïve for DME and received initial 5 monthly loading injections of aflibercept.

Methods

Choroidal and retinal changes after loading injections were analyzed using spectral-domain OCT with enhanced depth imaging (EDI-SD-OCT) and ultra-widefield indocyanine green angiography (UWF-ICGA). The correlation between choroidal and retinal changes, along with factors associated with a good treatment response, was investigated.

Main Outcome Measures

Changes in subfoveal choroidal thickness (sfCT), total choroidal area (TA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) measured by EDI-SD-OCT; choroidal vascular density (CVD) and choroidal fractal dimension (CFD) of macula and widefield assessed by UWF-ICGA; as well as treatment response, including central retinal thickness (CRT) and inflammatory hyperreflective foci (HRF) evaluated through EDI-SD-OCT.

Results

Aflibercept induced a significant reduction in sfCT, TA, LA, and SA (all P < 0.001), accompanied by an increase in CVI (P=0.005) on EDI-SD-OCT. On UWF-ICGA, CVD showed no significant change in either macular or widefield (P = 0.127 and 0.517, respectively), while CFD significantly decreased in both fields (P = 0.033 and 0.040, respectively). Decrease in TA, especially SA, and consequent CVI increase were significant factors associated with CRT reduction (P = 0.017, 0.004, and 0.044) and good treatment response in univariate analysis (P = 0.049, 0.026, and 0.047); however, only the reduction in inflammatory HRF maintained significance in multivariable analysis (P = 0.021 and 0.045). The reduction in inflammatory HRF was significantly associated with the decrease in TA, LA, and SA in univariate analysis (P = 0.001, 0.003, and 0.002), whereas only the decrease in sfCT remained significant in multivariable analysis (P = 0.027).

Conclusions

Aflibercept treatment induces stromal-dominant choroidal thinning with a consequent increase in CVI. This choroidal remodeling may be associated with the anatomical resolution of DME through mechanisms involving reduction of inflammatory HRF.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

目的探讨阿布西普治疗糖尿病性黄斑水肿（DME）后脉络膜的变化，并评价其与治疗反应的关系。设计：回顾性介入队列研究。受试者：30例DME患者30只眼，injection-naïve，最初接受5个月负荷注射阿伯西普。方法采用增强深度成像（EDI-SD-OCT）和超宽视场吲哚菁绿血管造影（UWF-ICGA）分析加载注射后视网膜和巩膜的变化。研究了脉络膜和视网膜变化之间的相关性，以及与良好治疗反应相关的因素。主要观察指标：edii - sd - oct测量的中央凹下脉络膜厚度（sfCT）、总脉络膜面积（TA）、管腔面积（LA）、基质面积（SA）和脉络膜血管指数（CVI）的变化；UWF-ICGA评价黄斑和广角脉络膜血管密度（CVD）和脉络膜分形维数（CFD）；以及治疗反应，包括中央视网膜厚度（CRT）和炎症高反射灶（HRF）通过EDI-SD-OCT评估。结果沙伐西普可显著降低患者的sfCT、TA、LA和SA (P均为0.001)，同时增加EDI-SD-OCT的CVI （P=0.005）。在UWF-ICGA中，CVD在黄斑和宽视场均无显著变化（P值分别为0.127和0.517），而CFD在两个视场均显著降低（P值分别为0.033和0.040）。在单变量分析中，TA的减少，尤其是SA的减少，以及随之而来的CVI的增加与CRT减少（P = 0.017, 0.004和0.044）和良好的治疗反应相关（P = 0.049, 0.026和0.047）；然而，在多变量分析中，只有炎症HRF的降低保持了显著性（P = 0.021和0.045）。在单变量分析中，炎症HRF的降低与TA、LA和SA的降低显著相关（P = 0.001、0.003和0.002），而在多变量分析中，仅sfCT的降低仍然显著（P = 0.027）。结论利伯赛普治疗可引起间质显性脉络膜变薄，导致CVI升高。这种脉络膜重塑可能通过炎症HRF减少的机制与DME的解剖分解有关。作者在本文中讨论的任何材料中没有专有或商业利益。

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