American Journal of Ophthalmology最新文献

英文中文

Clinical Features, Risk Factors, and Outcomes Following Surgery for Late Intraocular Lens Decentration in the Dead Bag Syndrome 死袋综合征晚期人工晶状体脱位的临床特征、危险因素及手术后预后。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-17 DOI: 10.1016/j.ajo.2025.01.008

Vandana Nath , Abhay R. Vasavada , Suchi Dholu, Shail Vasavada, Shyamal Dwivedi, Bharti Shivnani, Vaishali Vasavada, Sankaranarayanan Rajkumar, Samaresh Srivastava

PURPOSE

To evaluate demographic profile, risk factors, and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in dead bag syndrome

DESIGN

Prospective, interventional case series

METHODS

This was a study conducted at Raghudeep Eye Hospital, India. Explantation of the decentered/dislocated IOL along with pars plana vitrectomy and intrascleral fixation of a 3-piece foldable IOL using the Yamane technique was performed for all eyes. A total of 46 eyes (43 patients) with late decentration/dislocation of IOLs and spontaneous posterior capsule rupture in a clear and relatively intact capsular bag were treated. None of the eyes had significant zonular weakness. The main outcome measures were demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange in dead bag syndrome.

RESULTS

A total of 30 eyes had in-the-bag IOL decentration and 16 had total dislocation of the IOL into the vitreous cavity. The mean (SD) age was 68.7 ± 8.9 years, and 91% patients were male. Of the patients, 36 had unilateral IOL disease, whereas 7 had bilateral dead bag syndrome, with or without clinically significant IOL decentration. The mean duration from primary cataract surgery to re-operation was 16.8 years. More than 50% eyes had axial myopia (axial length >24 mm). Only 4 eyes (9.3%) had associated pseudoexfoliation. Mean (SD) follow-up after IOL exchange surgery was 10.9 ± 9.8 months. The single-piece hydrophobic acrylic IOL was the most commonly explanted IOL. Intraoperatively, a Soemmering ring was seen in 71.7% (31) eyes. Of the eyes, 87% had an improvement in corrected-distance visual acuity (CDVA) following surgery, with 95% of eyes having a CDVA of ≤0.3 logMAR. Postoperative complications were a transient IOP spike in 8 (17%) eyes and cystoid macular edema in 6 eyes (13%). Three eyes had pre-existing glaucoma, which remained controlled at final follow-up.

CONCLUSIONS

The major risk factors for dead bag syndrome were male sex, axial myopia, and duration of posterior capsule rupture event from the cataract surgery. Bilaterality and presence of the Soemmering ring in the majority of cases were new observations warranting further research. Outcomes following surgery were satisfactory.

目的评估死袋综合征晚期IOL脱位患者人工晶状体（IOL）置换术后的人口统计学特征、危险因素和结果。设计：前瞻性、介入性病例系列。参与者：46只眼（43名患者），IOL晚期脱位和透明且相对完整的囊袋内自发性后囊膜破裂。所有的眼睛都没有明显的带状疲劳。方法研究在印度Raghudeep眼科医院进行。所有眼均行离心/脱位人工晶状体植入术，同时行玻璃体切割和三件套可折叠人工晶状体巩膜内固定。主要观察指标：死袋综合征患者人工晶状体置换术后的人口统计学特征、相关危险因素、视力结果和术后并发症。结果30眼人工晶状体袋内脱位，16眼人工晶状体完全脱位于玻璃体腔内。平均年龄为68.7±8.9（标准差，SD）岁，男性占91%。单侧人工晶状体病变36例，双侧死袋综合征7例，伴有或不伴有临床上明显的人工晶状体移位。从原发性白内障手术到再次手术的平均持续时间为16.8年。50%以上的眼为轴向近视（眼轴长约24mm）。仅有4只眼（9.3%）伴有假角质脱落。人工晶状体置换术后平均随访10.9 + 9.8 （SD）个月。单片疏水性丙烯酸人工晶状体是最常见的人工晶状体。术中，71.7%（31只）眼可见Soemmering环状物。87%的眼术后矫正距离视力（CDVA）改善，95%的眼矫正距离视力≤0.3 LogMAR。术后出现以下并发症：短暂性IOP升高8眼（17%），黄斑囊样水肿6眼（13%）。其中三只眼睛先前患有青光眼，在最后随访时仍得到控制。结论死袋综合征发生的主要危险因素是男性、轴型近视和白内障术后后囊膜破裂持续时间。在大多数情况下，双边性和索默林环的存在是新的观察结果，值得进一步研究。手术后的结果令人满意。

{"title":"Clinical Features, Risk Factors, and Outcomes Following Surgery for Late Intraocular Lens Decentration in the Dead Bag Syndrome","authors":"Vandana Nath , Abhay R. Vasavada , Suchi Dholu, Shail Vasavada, Shyamal Dwivedi, Bharti Shivnani, Vaishali Vasavada, Sankaranarayanan Rajkumar, Samaresh Srivastava","doi":"10.1016/j.ajo.2025.01.008","DOIUrl":"10.1016/j.ajo.2025.01.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate demographic profile, risk factors, and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in dead bag syndrome</div></div><div><h3>DESIGN</h3><div>Prospective, interventional case series</div></div><div><h3>METHODS</h3><div>This was a study conducted at Raghudeep Eye Hospital, India. Explantation of the decentered/dislocated IOL along with pars plana vitrectomy and intrascleral fixation of a 3-piece foldable IOL using the Yamane technique was performed for all eyes. A total of 46 eyes (43 patients) with late decentration/dislocation of IOLs and spontaneous posterior capsule rupture in a clear and relatively intact capsular bag were treated. None of the eyes had significant zonular weakness. The main outcome measures were demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange in dead bag syndrome.</div></div><div><h3>RESULTS</h3><div>A total of 30 eyes had in-the-bag IOL decentration and 16 had total dislocation of the IOL into the vitreous cavity. The mean (SD) age was 68.7 ± 8.9 years, and 91% patients were male. Of the patients, 36 had unilateral IOL disease, whereas 7 had bilateral dead bag syndrome, with or without clinically significant IOL decentration. The mean duration from primary cataract surgery to re-operation was 16.8 years. More than 50% eyes had axial myopia (axial length >24 mm). Only 4 eyes (9.3%) had associated pseudoexfoliation. Mean (SD) follow-up after IOL exchange surgery was 10.9 ± 9.8 months. The single-piece hydrophobic acrylic IOL was the most commonly explanted IOL. Intraoperatively, a Soemmering ring was seen in 71.7% (31) eyes. Of the eyes, 87% had an improvement in corrected-distance visual acuity (CDVA) following surgery, with 95% of eyes having a CDVA of ≤0.3 logMAR. Postoperative complications were a transient IOP spike in 8 (17%) eyes and cystoid macular edema in 6 eyes (13%). Three eyes had pre-existing glaucoma, which remained controlled at final follow-up.</div></div><div><h3>CONCLUSIONS</h3><div>The major risk factors for dead bag syndrome were male sex, axial myopia, and duration of posterior capsule rupture event from the cataract surgery. Bilaterality and presence of the Soemmering ring in the majority of cases were new observations warranting further research. Outcomes following surgery were satisfactory.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"272 ","pages":"Pages 38-47"},"PeriodicalIF":4.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on Accuracy of Toric Intraocular Lens Formulas With Measured Posterior Corneal Astigmatism of Different Orientations. 不同方向后角膜散光测量的环形人工晶状体配方准确性评价。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-16 DOI: 10.1016/j.ajo.2024.11.026

Alejandro Tello, Virgilio Galvis, Ana Maria Amaya

引用次数: 0

Risk of Cataract Surgery Complications in Patients With Prior Intravitreal Injection Therapy 既往玻璃体内注射治疗患者白内障手术并发症的风险。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-16 DOI: 10.1016/j.ajo.2025.01.004

CINDY S. ZHAO MD , KACPER CHWIALKOWSKI PhD , KAREN M. WAI MD , PRITHVI MRUTHYUNJAYA MD, MHS , EHSAN RAHIMY MD , EUBEE B. KOO MD

Objective

To compare cataract surgery complications in patients with and without prior intravitreal injection (IVI).

Design

A retrospective cohort study using the TriNetX aggregated research network.

Subjects

Patients with IVI therapy within twenty years of cataract surgery were compared to controls using propensity score matching (PSM) to balance for demographics, systemic, and ocular co-morbidities. Patients with lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded.

Intervention

IVI within twenty years of cataract surgery.

Main Outcome Measures

Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery.

Results

Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI:1.16-1.54) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI:1.27-2.66) and 90 days (RR 2.05; 95% CI:1.65-2.54). IVI was only associated with higher rates of anterior vitrectomy in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI:0.85-1.79). Patients with DR and IVI exposure had more lensectomies, RD repairs, and secondary procedures.

Conclusions

Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.

目的比较玻璃体内注射（IVI）药物治疗前后白内障手术并发症的发生率。采用TriNetX （Cambridge， MA）汇总电子健康记录研究网络进行回顾性队列研究。受试者：使用倾向评分匹配（PSM）来平衡基线人口统计学、全身和眼部合并症，将白内障手术后20年内有IVI治疗史的患者与对照组进行比较。排除白内障手术前有晶状体切除术或玻璃体部切除术（PPV）病史的患者。白内障手术后20年内的介入治疗。主要观察指标：白内障手术后14、30和90天内，视网膜脱离（RD）、视网膜脱离修复、前体玻璃体切除术、晶状体保留、人工晶状体脱位、需要二次晶状体手术和眼内炎的发生率。结果在PSM之前，分别有16,356例和512,152例患者在白内障手术前接受和未接受IVI药物治疗。经PSM后，两组均有14240例患者。较高的发病率(RR 1.34；95% ci, 1.16-1.54；p<0.0005)，既往IVI组白内障手术后90天内的总并发症发生率（447/ 13719 = 3.3%）相对于对照组（340/ 13945 =2.4%）。暴露组在30天RD修复的风险增加(RR 1.84；95% ci, 1.27-2.66；p=0.001)和90天(RR 2.05；95% ci, 1.65-2.54；p < 0.0005)。IVI无其他并发症。特别地，IVI与较高的前玻璃体切除术率无关，除了糖尿病视网膜病变（DR）患者在第90天(RR 1.24；95% ci, 0.85-1.79；p = 0.001)。与没有IVI病史的DR患者相比，DR患者有更高的晶状体切除术、RD修复和二次手术的风险（p < 0.0005）。结论既往IVI患者白内障术后并发症较多，主要为RD，术前规划应考虑IVI治疗史。

{"title":"Risk of Cataract Surgery Complications in Patients With Prior Intravitreal Injection Therapy","authors":"CINDY S. ZHAO MD , KACPER CHWIALKOWSKI PhD , KAREN M. WAI MD , PRITHVI MRUTHYUNJAYA MD, MHS , EHSAN RAHIMY MD , EUBEE B. KOO MD","doi":"10.1016/j.ajo.2025.01.004","DOIUrl":"10.1016/j.ajo.2025.01.004","url":null,"abstract":"<div><h3>Objective</h3><div>To compare cataract surgery complications in patients with and without prior intravitreal injection (IVI).</div></div><div><h3>Design</h3><div>A retrospective cohort study using the TriNetX aggregated research network.</div></div><div><h3>Subjects</h3><div>Patients with IVI therapy within twenty years of cataract surgery were compared to controls using propensity score matching (PSM) to balance for demographics, systemic, and ocular co-morbidities. Patients with lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded.</div></div><div><h3>Intervention</h3><div>IVI within twenty years of cataract surgery.</div></div><div><h3>Main Outcome Measures</h3><div>Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery.</div></div><div><h3>Results</h3><div>Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI:1.16-1.54) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI:1.27-2.66) and 90 days (RR 2.05; 95% CI:1.65-2.54). IVI was only associated with higher rates of anterior vitrectomy in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI:0.85-1.79). Patients with DR and IVI exposure had more lensectomies, RD repairs, and secondary procedures.</div></div><div><h3>Conclusions</h3><div>Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"272 ","pages":"Pages 106-116"},"PeriodicalIF":4.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Role of Ageing in the Clinical Presentation of Uveitis 衰老在葡萄膜炎临床表现中的作用。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-16 DOI: 10.1016/j.ajo.2025.01.007

PRIYA SAMALIA , JOANNE SIMS , RACHAEL NIEDERER

PURPOSE

The primary aim of this study was to determine age-related patterns of uveitis entities. Secondary aims included age-related patterns of uveitic treatments and complications.

DESIGN

Retrospective clinical cohort study.

METHODS

4395 participants presenting with uveitis to a single center from January 2009 to December 2023 were included.

RESULTS

The median age at presentation was 45.1 years (IQR 32.2-60.3). Infections were more frequent in both younger (0-19 years) and older (≥60 years) participants. Toxoplasmosis was the most frequent cause of infectious uveitis in younger (0-19 years; 12.5%) participants and herpes zoster virus was the most prevalent cause of uveitis in adults 40+ years of age (40-59 years, 7.1%; 60-79 years, 20.5%; 80+years, 38.6%). Tumor-related uveitic masquerades demonstrated a significant association with increasing age (P <.001). Younger individuals were more likely to require steroid-sparing immunosuppression (P <.001) and more likely to require a switch from initial DMARD therapy (P <.001). Older subjects were more likely to develop cystoid macular edema, raised intraocular pressure and cataract (P <.001), while younger subjects were more likely to develop posterior synechiae (P =.001), papillitis (P <.001) and choroidal neovascular membrane (P =.002).

CONCLUSIONS

Age appears to be a key factor influencing the underlying etiology and clinical course of uveitis. Investigations should be tailored to the clinical presentation and consideration of the individuals presenting age may provide clues as to the underlying cause of disease and to guide treatment.

目的本研究的主要目的是确定葡萄膜炎实体的年龄相关模式。次要目的包括与年龄相关的葡萄膜治疗模式和并发症。回顾性临床队列研究方法：从2009年1月到2023年12月，4395名以葡萄膜炎为临床表现的参与者被纳入一个研究中心。结果患者就诊时中位年龄为45.1岁（IQR 32.2-60.3）。感染在年轻（0-19岁）和年长（≥60岁）的参与者中更常见。弓形虫病是年轻人(0-19岁；12.5%)，带状疱疹病毒是40岁以上成人葡萄膜炎最常见的原因(40-59岁，7.1%；60-79岁，20.5%；80年,38.6%)。肿瘤相关的葡萄膜假面与年龄增长有显著相关性（p<0.001）。年轻个体更有可能需要保留类固醇的免疫抑制（p<0.001），更有可能需要从最初的DMARD治疗切换（p<0.001）。老年受试者更容易出现囊样黄斑水肿、眼压升高和白内障（p<0.001），而年轻受试者更容易出现后粘稠（p= 0.001）、乳头炎（p<0.001）和脉络膜新生血管膜（p=0.002）。结论sage是影响葡萄膜炎病因和临床病程的关键因素。调查应根据临床表现量身定制，并考虑到个人的年龄可能为疾病的潜在原因提供线索并指导治疗。

{"title":"The Role of Ageing in the Clinical Presentation of Uveitis","authors":"PRIYA SAMALIA , JOANNE SIMS , RACHAEL NIEDERER","doi":"10.1016/j.ajo.2025.01.007","DOIUrl":"10.1016/j.ajo.2025.01.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The primary aim of this study was to determine age-related patterns of uveitis entities. Secondary aims included age-related patterns of uveitic treatments and complications.</div></div><div><h3>DESIGN</h3><div>Retrospective clinical cohort study.</div></div><div><h3>METHODS</h3><div>4395 participants presenting with uveitis to a single center from January 2009 to December 2023 were included.</div></div><div><h3>RESULTS</h3><div>The median age at presentation was 45.1 years (IQR 32.2-60.3). Infections were more frequent in both younger (0-19 years) and older (≥60 years) participants. Toxoplasmosis was the most frequent cause of infectious uveitis in younger (0-19 years; 12.5%) participants and herpes zoster virus was the most prevalent cause of uveitis in adults 40+ years of age (40-59 years, 7.1%; 60-79 years, 20.5%; 80+years, 38.6%). Tumor-related uveitic masquerades demonstrated a significant association with increasing age (<em>P <</em>.001). Younger individuals were more likely to require steroid-sparing immunosuppression (<em>P <</em>.001) and more likely to require a switch from initial DMARD therapy (<em>P <</em>.001). Older subjects were more likely to develop cystoid macular edema, raised intraocular pressure and cataract (<em>P <</em>.001), while younger subjects were more likely to develop posterior synechiae (<em>P =</em>.001), papillitis (<em>P <</em>.001) and choroidal neovascular membrane (<em>P =</em>.002).</div></div><div><h3>CONCLUSIONS</h3><div>Age appears to be a key factor influencing the underlying etiology and clinical course of uveitis. Investigations should be tailored to the clinical presentation and consideration of the individuals presenting age may provide clues as to the underlying cause of disease and to guide treatment.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"272 ","pages":"Pages 58-66"},"PeriodicalIF":4.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reply to Comment on: Subretinal Gene Therapy for Treatment of Retinal and Choroidal Vascular Diseases. 视网膜下基因疗法治疗视网膜和脉络膜血管疾病。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-14 DOI: 10.1016/j.ajo.2025.01.009

Arshad M Khanani, Aamir A Aziz, Zoha A Khanani, Hannah Khan, Ohidul Mojumder, Humza Sulahria, Ibrahim Khanani, Huma Khan, Greggory M Gahn, Kapil Mishra

引用次数: 0

Comment on, "Associations Between Contrast Sensitivity, OCT Features, and Progression From Intermediate to Late AMD". “对比敏感度、OCT特征与中晚期AMD进展之间的关系”。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-14 DOI: 10.1016/j.ajo.2024.12.031

Víctor Manuel Asensio-Sánchez

引用次数: 0

Comment on: Subretinal Gene Therapy for Treatment of Retinal and Choroidal Vascular Diseases. 视网膜下基因治疗视网膜和脉络膜血管疾病综述

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-14 DOI: 10.1016/j.ajo.2024.12.032

Gary D Novack

引用次数: 0

Reply to Comment on Accuracy of Toric Intraocular Lens Formulas With Measured Posterior Corneal Astigmatism of Different Orientations. 对测量不同方位角膜后散光的环形人工晶状体配方准确性的回复。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-14 DOI: 10.1016/j.ajo.2025.01.010

Stephen Stewart, Tun Kuan Yeo, Salissou Moutari, Richard McNeely, Jonathan E Moore

引用次数: 0

Validation of a Visual Field Prediction Tool for Glaucoma: A Multicenter Study Involving Patients With Glaucoma in the United Kingdom 青光眼视野预测工具的验证：一项涉及英国青光眼患者的多中心研究。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-13 DOI: 10.1016/j.ajo.2025.01.006

Arlen Dean , Dun Jack Fu , Mohammad Zhalechian , Mark P. Van Oyen , Mariel S. Lavieri , Anthony P. Khawaja , Joshua D. Stein

PURPOSE

A previously developed machine-learning approach with Kalman filtering technology accurately predicted the disease trajectory for patients with various glaucoma types and severities using clinical trial data. This study assesses performance of the KF approach with real-world data.

DESIGN

Retrospective cohort study.

METHODS

We tested the performance of a previously validated KF model (PKF) initially trained using data from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study in patients with different types and severities of glaucoma receiving care in the United Kingdom (UK), comparing the predictive accuracy to 2 conventional linear regression (LR) models and a newly developed KF trained on UK patients (UK-KF).

RESULTS

A total of 3116 patients with open-angle glaucoma or suspects were divided into training (n=1584) and testing (n=1532) sets. The predictive accuracy for MD within 2.5 dB of the observed value at 60 months’ follow-up for PKF (75.7%) was substantially better than those for the LR models (P < .01 for both) and similar to that for UK-KF (75.2%, P = .70). The proportion of MD predictions in the 95% repeatability intervals at 60 months’ follow-up for PKF (67.9%) was higher than those for the LR models (40.2%, 40.9%) and similar to that for UK-KF (71.4%).

CONCLUSIONS

This study validates the performance of our previously developed KF model on a real-world, multicenter patient population. Our model substantially outperforms the current clinical standard (LR) and forecasts well for patients with different glaucoma types and severities. This study supports the generalizability of PKF performance and supports prospective study of implementation into clinical practice.

目的：先前开发的机器学习方法与卡尔曼滤波技术，准确预测各种青光眼类型和严重程度的患者的疾病轨迹，使用临床试验数据。本研究用真实世界的数据评估了KF方法的性能。设计回顾性队列研究。方法我们测试了先前验证的KF模型（PKF）的性能，该模型最初使用非洲裔和青光眼评估研究和青光眼诊断创新研究数据对在英国（UK）接受治疗的不同类型和严重程度的青光眼患者进行了训练，并将其预测准确性与2种传统线性回归（LR）模型和新开发的KF模型进行了比较。结果3116例开角型或疑似青光眼患者分为训练组（n=1584）和测试组（n=1532）。在60个月的随访中，PKF的MD预测精度在2.5 dB内（75.7%）明显优于LR模型（P<0.01），与UK-KF的预测精度相似（75.2%,P =0.70）。在60个月随访的95%可重复区间内，PKF的MD预测比例（67.9%）高于LR模型（40.2%,40.9%），与UK-KF相似（71.4%）。本研究验证了我们之前开发的KF模型在真实世界多中心患者群体中的表现。我们的模型大大优于目前的临床标准（LR），并能很好地预测不同类型和严重程度的青光眼患者。本研究支持PKF表现的普遍性，并支持在临床实践中实施的前瞻性研究。

{"title":"Validation of a Visual Field Prediction Tool for Glaucoma: A Multicenter Study Involving Patients With Glaucoma in the United Kingdom","authors":"Arlen Dean , Dun Jack Fu , Mohammad Zhalechian , Mark P. Van Oyen , Mariel S. Lavieri , Anthony P. Khawaja , Joshua D. Stein","doi":"10.1016/j.ajo.2025.01.006","DOIUrl":"10.1016/j.ajo.2025.01.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>A previously developed machine-learning approach with Kalman filtering technology accurately predicted the disease trajectory for patients with various glaucoma types and severities using clinical trial data. This study assesses performance of the KF approach with real-world data.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort study.</div></div><div><h3>METHODS</h3><div>We tested the performance of a previously validated KF model (PKF) initially trained using data from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study in patients with different types and severities of glaucoma receiving care in the United Kingdom (UK), comparing the predictive accuracy to 2 conventional linear regression (LR) models and a newly developed KF trained on UK patients (UK-KF).</div></div><div><h3>RESULTS</h3><div>A total of 3116 patients with open-angle glaucoma or suspects were divided into training (n=1584) and testing (n=1532) sets. The predictive accuracy for MD within 2.5 dB of the observed value at 60 months’ follow-up for PKF (75.7%) was substantially better than those for the LR models (<em>P</em> < .01 for both) and similar to that for UK-KF (75.2%, <em>P</em> = .70). The proportion of MD predictions in the 95% repeatability intervals at 60 months’ follow-up for PKF (67.9%) was higher than those for the LR models (40.2%, 40.9%) and similar to that for UK-KF (71.4%).</div></div><div><h3>CONCLUSIONS</h3><div>This study validates the performance of our previously developed KF model on a real-world, multicenter patient population. Our model substantially outperforms the current clinical standard (LR) and forecasts well for patients with different glaucoma types and severities. This study supports the generalizability of PKF performance and supports prospective study of implementation into clinical practice.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"272 ","pages":"Pages 87-97"},"PeriodicalIF":4.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using a Deep Learning Model to Predict Postoperative Visual Outcomes of Idiopathic Epiretinal Membrane Surgery 利用深度学习模型预测特发性视网膜前膜手术术后视力结果。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-01-13 DOI: 10.1016/j.ajo.2025.01.003

HSIN-LE LIN , PO-CHEN TSENG , MIN-HUEI HSU , SYU-JYUN PENG

Purpose

This study assessed the performance of various deep learning models in predicting the postoperative outcomes of idiopathic epiretinal membrane (ERM) surgery based on preoperative optical coherence tomography (OCT) images.

Design

Validation of algorithms to predict the outcomes of ERM surgery based on OCT data.

Methods

Internal training and validation were performed using 1,392 OCT images from 696 eyes. External testing was performed using 152 OCT images from 76 eyes. This study assessed three deep learning models, including Inception-v3, ResNet-101, and VGG-19. Grad-CAM was employed for hotspot analysis. The dataset was split into a training set (80%) and a validation set (20%). Subjects presenting an improvement of ≥2 lines on the Snellen chart at 1-year postsurgery were classified as pronounced visual improvement, whereas those presenting an improvement of <2 lines were classified as limited visual improvement. Using an external test dataset, we compared assessments by seven ophthalmologists with the prediction of deep learning model. The main outcome measures were recall, specificity, precision, F1 score, accuracy, and area under the receiver operating characteristic curve (AUROC).

Results

ResNet-101 achieved the best overall performance, as evidenced by the following metrics: recall (0.90), specificity (0.90), precision (0.91), F1-score (0.90), accuracy (0.90), and AUROC (0.97). In Grad-CAM heatmap analysis, the logic of ResNet-101 closely resembled that of clinical physicians. Overall, the performance of this deep learning model was significantly better than that of general ophthalmologists and non-retina specialists and was slightly superior to that of retina specialists.

Conclusions

Deep learning based on preoperative OCT images proved highly effective in predicting the outcomes of ERM surgery and elucidating the structural mechanisms underlying the phenomena observed in OCT images.

目的：本研究评估了基于术前光学相干断层扫描（OCT）图像的各种深度学习模型在预测特发性视网膜前膜（ERM）手术预后方面的性能。设计验证基于OCT数据预测ERM手术结果的算法。方法使用696只眼的1392张OCT图像进行内部训练和验证。外部测试使用76只眼睛的152张OCT图像。本研究评估了三种深度学习模型，包括Inception-v3、ResNet-101和VGG-19。采用Grad-CAM进行热点分析。数据集被分成训练集（80%）和验证集（20%）。术后1年Snellen图上改善≥2条线的受试者被归类为明显的视力改善，而改善<2条线的受试者被归类为视力改善有限。使用外部测试数据集，我们将7位眼科医生的评估与深度学习模型的预测进行了比较。主要结局指标为召回率、特异性、精密度、F1评分、准确度和受试者工作特征曲线下面积（AUROC）。结果resnet -101在召回率（0.90）、特异性（0.90）、精密度（0.91）、f1评分（0.90）、准确度（0.90）和AUROC（0.97）方面取得了最佳的综合性能。在Grad-CAM热图分析中，ResNet-101的逻辑与临床医生的逻辑非常相似。总体而言，该深度学习模型的性能明显优于普通眼科医生和非视网膜专家，略优于视网膜专家。结论基于术前OCT图像的深度学习在预测ERM手术结果和阐明OCT图像现象背后的结构机制方面是非常有效的。

{"title":"Using a Deep Learning Model to Predict Postoperative Visual Outcomes of Idiopathic Epiretinal Membrane Surgery","authors":"HSIN-LE LIN , PO-CHEN TSENG , MIN-HUEI HSU , SYU-JYUN PENG","doi":"10.1016/j.ajo.2025.01.003","DOIUrl":"10.1016/j.ajo.2025.01.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study assessed the performance of various deep learning models in predicting the postoperative outcomes of idiopathic epiretinal membrane (ERM) surgery based on preoperative optical coherence tomography (OCT) images.</div></div><div><h3>Design</h3><div>Validation of algorithms to predict the outcomes of ERM surgery based on OCT data.</div></div><div><h3>Methods</h3><div>Internal training and validation were performed using 1,392 OCT images from 696 eyes. External testing was performed using 152 OCT images from 76 eyes. This study assessed three deep learning models, including Inception-v3, ResNet-101, and VGG-19. Grad-CAM was employed for hotspot analysis. The dataset was split into a training set (80%) and a validation set (20%). Subjects presenting an improvement of ≥2 lines on the Snellen chart at 1-year postsurgery were classified as <em>pronounced visual improvement</em>, whereas those presenting an improvement of <2 lines were classified as <em>limited visual improvement</em>. Using an external test dataset, we compared assessments by seven ophthalmologists with the prediction of deep learning model. The main outcome measures were recall, specificity, precision, F1 score, accuracy, and area under the receiver operating characteristic curve (AUROC).</div></div><div><h3>Results</h3><div>ResNet-101 achieved the best overall performance, as evidenced by the following metrics: recall (0.90), specificity (0.90), precision (0.91), F1-score (0.90), accuracy (0.90), and AUROC (0.97). In Grad-CAM heatmap analysis, the logic of ResNet-101 closely resembled that of clinical physicians. Overall, the performance of this deep learning model was significantly better than that of general ophthalmologists and non-retina specialists and was slightly superior to that of retina specialists.</div></div><div><h3>Conclusions</h3><div>Deep learning based on preoperative OCT images proved highly effective in predicting the outcomes of ERM surgery and elucidating the structural mechanisms underlying the phenomena observed in OCT images.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"272 ","pages":"Pages 67-78"},"PeriodicalIF":4.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

American Journal of Ophthalmology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀