Corey A Smith, Vanessa L Josey, Michael E West, Oksana M Dyachok, Glen P Sharpe, Jayme R Vianna, Paul E Rafuse, Lesya M Shuba, Marcelo T Nicolela, Balwantray C Chauhan
Background/aims: Optical coherence tomography angiography (OCT-A) images are subject to variability, but the extent to which learning impacts OCT-A measurements is unknown. We determined whether there is a learning effect in glaucoma patients and healthy controls imaged with OCT-A.
Methods: Ninety-one open-angle glaucoma patients and 54 healthy controls were imaged every 4 months over a period of approximately 1 year in this longitudinal cohort study. We analysed 15°×15° scans, centred on the fovea, in one eye of each participant. Two-dimensional projection images for the superficial, intermediate and deep vascular plexuses were exported and binarised after which perfusion density was calculated. Linear mixed-effects models were used to investigate the association between perfusion density and follow-up time.
Results: The mean (SD) age of glaucoma patients and healthy controls was 67.3 (8.1) years and 62.1 (9.0) years, respectively. There was a significant correlation between perfusion density and scan quality in both glaucoma patients (r=0.50 (95% CI 0.42 to 0.58); p<0.05) and healthy controls (r=0.41 (95% CI 0.29 to 0.52); p<0.05). An increase in perfusion density occurred over time and persisted, even after adjustment for scan quality (1.75% per year (95% CI 1.14 to 2.37), p<0.01).
Conclusions: Perfusion density measurements are subject to increasing experience of either the operator or participant, or a combination of both. These findings have implications for the interpretation of longitudinal measurements with OCT-A.
{"title":"Variability of scan quality and perfusion density in longitudinal optical coherence tomography angiography imaging.","authors":"Corey A Smith, Vanessa L Josey, Michael E West, Oksana M Dyachok, Glen P Sharpe, Jayme R Vianna, Paul E Rafuse, Lesya M Shuba, Marcelo T Nicolela, Balwantray C Chauhan","doi":"10.1136/bjo-2022-322979","DOIUrl":"10.1136/bjo-2022-322979","url":null,"abstract":"<p><strong>Background/aims: </strong>Optical coherence tomography angiography (OCT-A) images are subject to variability, but the extent to which learning impacts OCT-A measurements is unknown. We determined whether there is a learning effect in glaucoma patients and healthy controls imaged with OCT-A.</p><p><strong>Methods: </strong>Ninety-one open-angle glaucoma patients and 54 healthy controls were imaged every 4 months over a period of approximately 1 year in this longitudinal cohort study. We analysed 15°×15° scans, centred on the fovea, in one eye of each participant. Two-dimensional projection images for the superficial, intermediate and deep vascular plexuses were exported and binarised after which perfusion density was calculated. Linear mixed-effects models were used to investigate the association between perfusion density and follow-up time.</p><p><strong>Results: </strong>The mean (SD) age of glaucoma patients and healthy controls was 67.3 (8.1) years and 62.1 (9.0) years, respectively. There was a significant correlation between perfusion density and scan quality in both glaucoma patients (r=0.50 (95% CI 0.42 to 0.58); p<0.05) and healthy controls (r=0.41 (95% CI 0.29 to 0.52); p<0.05). An increase in perfusion density occurred over time and persisted, even after adjustment for scan quality (1.75% per year (95% CI 1.14 to 2.37), p<0.01).</p><p><strong>Conclusions: </strong>Perfusion density measurements are subject to increasing experience of either the operator or participant, or a combination of both. These findings have implications for the interpretation of longitudinal measurements with OCT-A.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49674524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Catt, Johanna M Pfeil, Daniel Barthelmes, Glen A Gole, Tim U Krohne, Wei-Chi Wu, Shunji Kusaka, Peiquan Zhao, Shuan Dai, James Elder, Matthias Heckmann, Jacqueline Stack, Gigi Khonyongwa-Fernandez, Andreas Stahl
Background/aims: The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes.
Methods: A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice.
Results: For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice.
Conclusions: We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.
{"title":"Development of a joint set of database parameters for the EU-ROP and Fight Childhood Blindness! ROP Registries.","authors":"Caroline Catt, Johanna M Pfeil, Daniel Barthelmes, Glen A Gole, Tim U Krohne, Wei-Chi Wu, Shunji Kusaka, Peiquan Zhao, Shuan Dai, James Elder, Matthias Heckmann, Jacqueline Stack, Gigi Khonyongwa-Fernandez, Andreas Stahl","doi":"10.1136/bjo-2023-323915","DOIUrl":"10.1136/bjo-2023-323915","url":null,"abstract":"<p><strong>Background/aims: </strong>The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes.</p><p><strong>Methods: </strong>A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice.</p><p><strong>Results: </strong>For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice.</p><p><strong>Conclusions: </strong>We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10579819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeremy Chiabo, Andreas Kauert, Barbara Casolla, Julie Contenti, Sacha Nahon-Esteve, Stephanie Baillif, Martel Arnaud
Aims: To assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO).
Methods: It is a prospective, non-comparative, monocentric study conducted between July 2016 and March 2022. All consecutive patients diagnosed with RAO within 7 days underwent visual acuity measurement, FA, macular optical coherence tomography (OCT) and OCT-angiography. They received two daily HBOT sessions (2.5 atmosphere absolute, 90 min) until revascularisation assessed by FA. Complete ophthalmic follow-up was scheduled at day 14, day 21 and at 1 month. The main outcome measure was a best-corrected visual acuity (BCVA) improvement defined as a decrease ≥0.3 logMAR at 1 month.
Results: Thirty-one patients were included and received a mean number of 33.9 (13-56) HBOT sessions. Retinal revascularisation was observed in 48.4% and 87.1% of patients at days 14 and 21, respectively. The mean BCVA on referral and at 1 month was 1.51 logMAR and 1.10 logMAR, respectively. Fifteen (48.4%) patients achieved the main outcome measure. Six (19.4%) patients experienced minor barotrauma that did not require HBOT discontinuation. The univariate analysis showed that antiplatelet-treated patients (p=0.044) and patients with a poor initial BCVA (p=0.008) were more likely to achieve a BCVA improvement. OCT-angiography was not sensitive enough to diagnose RAO or assess revascularisation.
Conclusion: In RAO patients monitored by FA until spontaneous revascularisation of the central retinal artery, HBOT was effective and safe.
{"title":"Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion.","authors":"Jeremy Chiabo, Andreas Kauert, Barbara Casolla, Julie Contenti, Sacha Nahon-Esteve, Stephanie Baillif, Martel Arnaud","doi":"10.1136/bjo-2023-323972","DOIUrl":"10.1136/bjo-2023-323972","url":null,"abstract":"<p><strong>Aims: </strong>To assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO).</p><p><strong>Methods: </strong>It is a prospective, non-comparative, monocentric study conducted between July 2016 and March 2022. All consecutive patients diagnosed with RAO within 7 days underwent visual acuity measurement, FA, macular optical coherence tomography (OCT) and OCT-angiography. They received two daily HBOT sessions (2.5 atmosphere absolute, 90 min) until revascularisation assessed by FA. Complete ophthalmic follow-up was scheduled at day 14, day 21 and at 1 month. The main outcome measure was a best-corrected visual acuity (BCVA) improvement defined as a decrease ≥0.3 logMAR at 1 month.</p><p><strong>Results: </strong>Thirty-one patients were included and received a mean number of 33.9 (13-56) HBOT sessions. Retinal revascularisation was observed in 48.4% and 87.1% of patients at days 14 and 21, respectively. The mean BCVA on referral and at 1 month was 1.51 logMAR and 1.10 logMAR, respectively. Fifteen (48.4%) patients achieved the main outcome measure. Six (19.4%) patients experienced minor barotrauma that did not require HBOT discontinuation. The univariate analysis showed that antiplatelet-treated patients (p=0.044) and patients with a poor initial BCVA (p=0.008) were more likely to achieve a BCVA improvement. OCT-angiography was not sensitive enough to diagnose RAO or assess revascularisation.</p><p><strong>Conclusion: </strong>In RAO patients monitored by FA until spontaneous revascularisation of the central retinal artery, HBOT was effective and safe.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rose Tan, Kelvin Yi Chong Teo, Rahat Husain, Ngiap Chuan Tan, Qian Xin Lee, Haslina Hamzah, Tina Wong, Tin Aung, Ching Yu Cheng, Ecosse Luc Lamoureux, Colin S Tan, Hon-Tym Wong, Tien Y Wong, Gavin Siew Wei Tan
Aims: To evaluate the effectiveness of glaucoma screening using glaucoma suspect (GS) referral criteria assessed on colour fundus photographs in Singapore's Integrated Diabetic Retinopathy Programme (SiDRP).
Methods: A case-control study. This study included diabetic subjects who were referred from SiDRP with and without GS between January 2017 and December 2018 and reviewed at Singapore National Eye Centre. The GS referral criteria were based on the presence of a vertical cup-to-disc ratio (VCDR) of ≥0.65 and other GS features. The final glaucoma diagnosis confirmed from electronic medical records was retrospectively matched with GS status. The sensitivity, specificity and positive predictive value (PPV) of the test were evaluated.
Results: Of 5023 patients (2625 with GS and 2398 without GS) reviewed for glaucoma, 451 (9.0%, 95% CI 8.2% to 9.8%) were confirmed as glaucoma. The average follow-up time was 21.5±10.2 months. Using our current GS referral criteria, the sensitivity, specificity and PPV were 81.6% (95% CI 77.7% to 85.1%), 50.6% (95% CI 49.2% to 52.1%) and 14.0% (95% CI 13.4% to 14.7%), respectively, resulting in 2257 false positive cases. Increasing the VCDR cut-off for referral to ≥0.80, the specificity increased to 93.9% (95% CI 93.1% to 94.5%) but the sensitivity decreased to 11.3% (95% CI 8.5% to 14.6%), with a PPV of 15.4% (95% CI 12.0% to 19.4%).
Conclusions: Opportunistic screening for glaucoma in a lower VCDR group could result in a high number of unnecessary referrals. If healthcare infrastructures are limited, targeting case findings on a larger VCDR group with high specificity will still be beneficial.
{"title":"Evaluating the outcome of screening for glaucoma using colour fundus photography-based referral criteria in a teleophthalmology screening programme for diabetic retinopathy.","authors":"Rose Tan, Kelvin Yi Chong Teo, Rahat Husain, Ngiap Chuan Tan, Qian Xin Lee, Haslina Hamzah, Tina Wong, Tin Aung, Ching Yu Cheng, Ecosse Luc Lamoureux, Colin S Tan, Hon-Tym Wong, Tien Y Wong, Gavin Siew Wei Tan","doi":"10.1136/bjo-2023-323339","DOIUrl":"10.1136/bjo-2023-323339","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the effectiveness of glaucoma screening using glaucoma suspect (GS) referral criteria assessed on colour fundus photographs in Singapore's Integrated Diabetic Retinopathy Programme (SiDRP).</p><p><strong>Methods: </strong>A case-control study. This study included diabetic subjects who were referred from SiDRP with and without GS between January 2017 and December 2018 and reviewed at Singapore National Eye Centre. The GS referral criteria were based on the presence of a vertical cup-to-disc ratio (VCDR) of ≥0.65 and other GS features. The final glaucoma diagnosis confirmed from electronic medical records was retrospectively matched with GS status. The sensitivity, specificity and positive predictive value (PPV) of the test were evaluated.</p><p><strong>Results: </strong>Of 5023 patients (2625 with GS and 2398 without GS) reviewed for glaucoma, 451 (9.0%, 95% CI 8.2% to 9.8%) were confirmed as glaucoma. The average follow-up time was 21.5±10.2 months. Using our current GS referral criteria, the sensitivity, specificity and PPV were 81.6% (95% CI 77.7% to 85.1%), 50.6% (95% CI 49.2% to 52.1%) and 14.0% (95% CI 13.4% to 14.7%), respectively, resulting in 2257 false positive cases. Increasing the VCDR cut-off for referral to ≥0.80, the specificity increased to 93.9% (95% CI 93.1% to 94.5%) but the sensitivity decreased to 11.3% (95% CI 8.5% to 14.6%), with a PPV of 15.4% (95% CI 12.0% to 19.4%).</p><p><strong>Conclusions: </strong>Opportunistic screening for glaucoma in a lower VCDR group could result in a high number of unnecessary referrals. If healthcare infrastructures are limited, targeting case findings on a larger VCDR group with high specificity will still be beneficial.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49674521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Virginia Mares, Ursula Margarethe Schmidt-Erfurth, Oliver Leingang, Philipp Fuchs, Marcio B Nehemy, Hrvoje Bogunovic, Daniel Barthelmes, Gregor S Reiter
Aim: To predict antivascular endothelial growth factor (VEGF) treatment requirements, visual acuity and morphological outcomes in neovascular age-related macular degeneration (nAMD) using fluid quantification by artificial intelligence (AI) in a real-world cohort.
Methods: Spectral-domain optical coherence tomography data of 158 treatment-naïve patients with nAMD from the Fight Retinal Blindness! registry in Zurich were processed at baseline, and after initial treatment using intravitreal anti-VEGF to predict subsequent 1-year and 4-year outcomes. Intraretinal and subretinal fluid and pigment epithelial detachment volumes were segmented using a deep learning algorithm (Vienna Fluid Monitor, RetInSight, Vienna, Austria). A predictive machine learning model for future treatment requirements and morphological outcomes was built using the computed set of quantitative features.
Results: Two hundred and two eyes from 158 patients were evaluated. 107 eyes had a lower median (≤7) and 95 eyes had an upper median (≥8) number of injections in the first year, with a mean accuracy of prediction of 0.77 (95% CI 0.71 to 0.83) area under the curve (AUC). Best-corrected visual acuity at baseline was the most relevant predictive factor determining final visual outcomes after 1 year. Over 4 years, half of the eyes had progressed to macular atrophy (MA) with the model being able to distinguish MA from non-MA eyes with a mean AUC of 0.70 (95% CI 0.61 to 0.79). Prediction for subretinal fibrosis reached an AUC of 0.74 (95% CI 0.63 to 0.81).
Conclusions: The regulatory approved AI-based fluid monitoring allows clinicians to use automated algorithms in prospectively guided patient treatment in AMD. Furthermore, retinal fluid localisation and quantification can predict long-term morphological outcomes.
{"title":"Approved AI-based fluid monitoring to identify morphological and functional treatment outcomes in neovascular age-related macular degeneration in real-world routine.","authors":"Virginia Mares, Ursula Margarethe Schmidt-Erfurth, Oliver Leingang, Philipp Fuchs, Marcio B Nehemy, Hrvoje Bogunovic, Daniel Barthelmes, Gregor S Reiter","doi":"10.1136/bjo-2022-323014","DOIUrl":"10.1136/bjo-2022-323014","url":null,"abstract":"<p><strong>Aim: </strong>To predict antivascular endothelial growth factor (VEGF) treatment requirements, visual acuity and morphological outcomes in neovascular age-related macular degeneration (nAMD) using fluid quantification by artificial intelligence (AI) in a real-world cohort.</p><p><strong>Methods: </strong>Spectral-domain optical coherence tomography data of 158 treatment-naïve patients with nAMD from the Fight Retinal Blindness! registry in Zurich were processed at baseline, and after initial treatment using intravitreal anti-VEGF to predict subsequent 1-year and 4-year outcomes. Intraretinal and subretinal fluid and pigment epithelial detachment volumes were segmented using a deep learning algorithm (Vienna Fluid Monitor, RetInSight, Vienna, Austria). A predictive machine learning model for future treatment requirements and morphological outcomes was built using the computed set of quantitative features.</p><p><strong>Results: </strong>Two hundred and two eyes from 158 patients were evaluated. 107 eyes had a lower median (≤7) and 95 eyes had an upper median (≥8) number of injections in the first year, with a mean accuracy of prediction of 0.77 (95% CI 0.71 to 0.83) area under the curve (AUC). Best-corrected visual acuity at baseline was the most relevant predictive factor determining final visual outcomes after 1 year. Over 4 years, half of the eyes had progressed to macular atrophy (MA) with the model being able to distinguish MA from non-MA eyes with a mean AUC of 0.70 (95% CI 0.61 to 0.79). Prediction for subretinal fibrosis reached an AUC of 0.74 (95% CI 0.63 to 0.81).</p><p><strong>Conclusions: </strong>The regulatory approved AI-based fluid monitoring allows clinicians to use automated algorithms in prospectively guided patient treatment in AMD. Furthermore, retinal fluid localisation and quantification can predict long-term morphological outcomes.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahnul Ha, Sukkyu Sun, Young Kook Kim, Jin Wook Jeoung, Hee Chan Kim, Ki Ho Park
Background/aims: To assess the performance of deep-learning (DL) models for prediction of conversion to normal-tension glaucoma (NTG) in normotensive glaucoma suspect (GS) patients.
Methods: Datasets of 12 458 GS eyes were reviewed. Two hundred and ten eyes (105 eyes showing NTG conversion and 105 without conversion), followed up for a minimum of 7 years during which intraocular pressure (IOP) was lower than 21 mm Hg, were included. The features of two fundus images (optic disc photography and red-free retinal nerve fibre layer (RNFL) photography) were extracted by convolutional auto encoder. The extracted features as well as 15 clinical features including age, sex, IOP, spherical equivalent, central corneal thickness, axial length, average circumpapillary RNFL thickness, systolic/diastolic blood pressure and body mass index were used to predict NTG conversion. Prediction was performed using three machine-learning classifiers (ie, XGBoost, Random Forest, Gradient Boosting) with different feature combinations.
Results: All three algorithms achieved high diagnostic accuracy for NTG conversion prediction. The AUCs ranged from 0.987 (95% CI 0.978 to 1.000; Random Forest trained with both fundus images and clinical features) and 0.994 (95% CI 0.984 to 1.000; XGBoost trained with both fundus images and clinical features). XGBoost showed the best prediction performance for time to NTG conversion (mean squared error, 2.24). The top three important clinical features for time-to-conversion prediction were baseline IOP, diastolic blood pressure and average circumpapillary RNFL thickness.
Conclusion: DL models, trained with both fundus images and clinical data, showed the potential to predict whether and when normotensive GS patients will show conversion to NTG.
{"title":"Deep-learning-based prediction of glaucoma conversion in normotensive glaucoma suspects.","authors":"Ahnul Ha, Sukkyu Sun, Young Kook Kim, Jin Wook Jeoung, Hee Chan Kim, Ki Ho Park","doi":"10.1136/bjo-2022-323167","DOIUrl":"10.1136/bjo-2022-323167","url":null,"abstract":"<p><strong>Background/aims: </strong>To assess the performance of deep-learning (DL) models for prediction of conversion to normal-tension glaucoma (NTG) in normotensive glaucoma suspect (GS) patients.</p><p><strong>Methods: </strong>Datasets of 12 458 GS eyes were reviewed. Two hundred and ten eyes (105 eyes showing NTG conversion and 105 without conversion), followed up for a minimum of 7 years during which intraocular pressure (IOP) was lower than 21 mm Hg, were included. The features of two fundus images (optic disc photography and red-free retinal nerve fibre layer (RNFL) photography) were extracted by convolutional auto encoder. The extracted features as well as 15 clinical features including age, sex, IOP, spherical equivalent, central corneal thickness, axial length, average circumpapillary RNFL thickness, systolic/diastolic blood pressure and body mass index were used to predict NTG conversion. Prediction was performed using three machine-learning classifiers (ie, XGBoost, Random Forest, Gradient Boosting) with different feature combinations.</p><p><strong>Results: </strong>All three algorithms achieved high diagnostic accuracy for NTG conversion prediction. The AUCs ranged from 0.987 (95% CI 0.978 to 1.000; Random Forest trained with both fundus images and clinical features) and 0.994 (95% CI 0.984 to 1.000; XGBoost trained with both fundus images and clinical features). XGBoost showed the best prediction performance for time to NTG conversion (mean squared error, 2.24). The top three important clinical features for time-to-conversion prediction were baseline IOP, diastolic blood pressure and average circumpapillary RNFL thickness.</p><p><strong>Conclusion: </strong>DL models, trained with both fundus images and clinical data, showed the potential to predict whether and when normotensive GS patients will show conversion to NTG.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/aims: Diabetic retinopathy is the most common eye disease that causes blindness in the working population. Neurodegeneration is the early sign of diabetic retinopathy, but no drug has been approved for delaying or reversing retinal neurodegeneration. Huperzine A, a natural alkaloid isolated from Huperzia serrata, displays neuroprotective and antiapoptotic effects in treating neurodegenerative disorders. Our study aims to investigate the effect of huperzine A in preventing retinal neurodegeneration of diabetic retinopathy and its possible mechanism.
Methods: Diabetic retinopathy model was induced by streptozotocin. H&E staining, optical coherence tomography, immunofluorescence staining and angiogenic factors were used to determine the degree of retinal pathological injury. The possible molecular mechanism was unrevealed by network pharmacology analysis and further validated by biochemical experiments.
Results: In our study, we demonstrated that huperzine A has a protective effect on the diabetes retina in a diabetic rat model. Based on the network pharmacology analysis and biochemical studies, huperzine A may treat diabetic retinopathy via key target HSP27 and apoptosis-related pathways. Huperzine A may modulate the phosphorylation of HSP27 and activate the antiapoptotic signalling pathway.
Conclusion: Our findings revealed that huperzine A might be a potential therapeutic drug to prevent diabetic retinopathy. It is the first-time combining network pharmacology analysis with biochemical studies to explore the mechanism of huperzine A in preventing diabetic retinopathy.
背景/目的:糖尿病视网膜病变是导致工作人群失明的最常见眼病。神经变性是糖尿病视网膜病变的早期征兆,但目前尚无药物获准用于延缓或逆转视网膜神经变性。从蛇床子中分离出的天然生物碱 Huperzine A 在治疗神经退行性疾病方面具有保护神经和抗细胞凋亡的作用。我们的研究旨在探讨石杉碱甲在预防糖尿病视网膜病变的视网膜神经变性方面的作用及其可能的机制:方法:用链脲佐菌素诱导糖尿病视网膜病变模型。方法:用链脲佐菌素诱导糖尿病视网膜病变模型,采用 H&E 染色、光学相干断层扫描、免疫荧光染色和血管生成因子测定视网膜的病理损伤程度。网络药理学分析未揭示可能的分子机制,生化实验进一步验证了这一机制:结果:我们的研究表明,在糖尿病大鼠模型中,胡朴素 A 对糖尿病视网膜具有保护作用。基于网络药理学分析和生化研究,胡朴素 A 可通过关键靶点 HSP27 和细胞凋亡相关途径治疗糖尿病视网膜病变。结论:我们的研究结果表明,Huperzine A 可能是一种预防糖尿病视网膜病变的潜在治疗药物。这是首次将网络药理学分析与生化研究结合起来,探讨胡朴素 A 预防糖尿病视网膜病变的机制。
{"title":"Network pharmacology and biochemical experiments reveal the antiapoptotic mechanism of huperzine A for treating diabetic retinopathy.","authors":"Ying Zhang, Wunan Huang, Qing Tian, Guannan Bai, Wei Wu, Houfa Yin, Lidan Hu, Xiangjun Chen","doi":"10.1136/bjo-2023-323639","DOIUrl":"10.1136/bjo-2023-323639","url":null,"abstract":"<p><strong>Background/aims: </strong>Diabetic retinopathy is the most common eye disease that causes blindness in the working population. Neurodegeneration is the early sign of diabetic retinopathy, but no drug has been approved for delaying or reversing retinal neurodegeneration. Huperzine A, a natural alkaloid isolated from Huperzia serrata, displays neuroprotective and antiapoptotic effects in treating neurodegenerative disorders. Our study aims to investigate the effect of huperzine A in preventing retinal neurodegeneration of diabetic retinopathy and its possible mechanism.</p><p><strong>Methods: </strong>Diabetic retinopathy model was induced by streptozotocin. H&E staining, optical coherence tomography, immunofluorescence staining and angiogenic factors were used to determine the degree of retinal pathological injury. The possible molecular mechanism was unrevealed by network pharmacology analysis and further validated by biochemical experiments.</p><p><strong>Results: </strong>In our study, we demonstrated that huperzine A has a protective effect on the diabetes retina in a diabetic rat model. Based on the network pharmacology analysis and biochemical studies, huperzine A may treat diabetic retinopathy via key target HSP27 and apoptosis-related pathways. Huperzine A may modulate the phosphorylation of HSP27 and activate the antiapoptotic signalling pathway.</p><p><strong>Conclusion: </strong>Our findings revealed that huperzine A might be a potential therapeutic drug to prevent diabetic retinopathy. It is the first-time combining network pharmacology analysis with biochemical studies to explore the mechanism of huperzine A in preventing diabetic retinopathy.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean-Baptiste Ducloyer, Yannick Eude, Christelle Volteau, Olivier Lebreton, Alexandre Bonissent, Paul Fossum, Ramin Tadayoni, Catherine P Creuzot-Garcher, Yannick Le Mer, Julien Perol, June Fortin, Alexandra Jobert, Fanny Billaud, Catherine Ivan, Alexandra Poinas, Michel Weber
Background: After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas.
Methods: The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6.
Results: 213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12.
Conclusion: Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery.
{"title":"Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial with microperimetry (PEELING).","authors":"Jean-Baptiste Ducloyer, Yannick Eude, Christelle Volteau, Olivier Lebreton, Alexandre Bonissent, Paul Fossum, Ramin Tadayoni, Catherine P Creuzot-Garcher, Yannick Le Mer, Julien Perol, June Fortin, Alexandra Jobert, Fanny Billaud, Catherine Ivan, Alexandra Poinas, Michel Weber","doi":"10.1136/bjo-2023-324990","DOIUrl":"https://doi.org/10.1136/bjo-2023-324990","url":null,"abstract":"<p><strong>Background: </strong>After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas.</p><p><strong>Methods: </strong>The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6.</p><p><strong>Results: </strong>213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12.</p><p><strong>Conclusion: </strong>Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery.</p><p><strong>Trial registration: </strong>NCT02146144.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoning Yu, Weiyi Pan, Xiajing Tang, Yidong Zhang, Lixia Lou, Sifan Zheng, Ke Yao, Zhaohui Sun
Background/aims: This study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential risk factors associated with recurrence.
Methods: A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse.
Results: A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R2=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001).
Conclusion: Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery.
背景/目的:本研究旨在评估A型肉毒毒素(BTXA)注射和增量手术治疗急性获得性并发内斜视(AACE)的临床疗效,并探讨与复发相关的潜在风险因素:纳入2020年10月至2021年1月期间确诊为AACE的104名患者,他们自愿选择接受增量手术或BTXA注射。随访评估于2022年11月结束。多变量线性回归分析用于确定影响双侧内侧直肌后缩(MRrec)剂量反应的潜在因素。采用卡普兰-米尔生存分析法和考克斯比例危险模型评估AACE复发率和风险因素:共有31名AACE患者选择了增量内斜手术,73名患者选择了BTXA治疗。在两年的随访中,手术组的术后效果更稳定,复视没有复发,而 BTXA 组只有 68.68%(95% CI 55.31% 至 78.79%)的患者达到了正视角。对于接受 BTXA 治疗的患者来说,每天近距离工作的时间被证明是 AACE 复发的一个重要风险因素(HR 1.29,95% CI 1.00 至 1.67)。增加剂量的双侧 MRrec 的剂量-反应与术前偏角呈正相关(R2=0.833;β=0.043,95% CI 0.031 至 0.055;p结论:我们的研究结果提供了量化证据,证明与注射 BTXA 相比,AACE 患者的扩容手术能获得更稳定、更有利的手术效果。然而,由于 BTXA 具有创伤小、操作简单、费用低和恢复快等优点,因此仍建议对偏角小的患者进行 BTXA 治疗。
{"title":"Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia: a 2-year follow-up.","authors":"Xiaoning Yu, Weiyi Pan, Xiajing Tang, Yidong Zhang, Lixia Lou, Sifan Zheng, Ke Yao, Zhaohui Sun","doi":"10.1136/bjo-2023-323646","DOIUrl":"10.1136/bjo-2023-323646","url":null,"abstract":"<p><strong>Background/aims: </strong>This study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential risk factors associated with recurrence.</p><p><strong>Methods: </strong>A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse.</p><p><strong>Results: </strong>A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R<sup>2</sup>=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001).</p><p><strong>Conclusion: </strong>Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Julian Fink, Jennifer Dell, Carsten Heinz, Maximilian W M Wintergerst, Tobias Höller, Moritz Berger, Matthias Schmid, Karl Thomas Boden, Uwe Pleyer, Herbert Reitsamer, Christoph M E Deuter, Tibor K Lohmann, Robert P Finger
Purpose: The Treatment exit Options For non-infectious Uveitis (TOFU) registry documents disease courses for non-anterior non-infectious uveitis entities with and without treatment to generate more evidence for clinical management recommendations including treatment exit strategies. In this article, we present the participants' baseline characteristics after the first 3 years.
Methods: TOFU is an observational, prospective registry and recruits patients ≥18 years of age with non-anterior non-infectious uveitis with or without a history of previous disease-modifying antirheumatic drugs (DMARDs) treatment. The data are collected in the electronic data capture software REDCap and include ophthalmological and general medical history as well as clinical findings.
Results: Between 24.10.2019 and 27.12.2022, 628 patients were enrolled at 25 clinical sites in Germany and Austria. Patients with intermediate uveitis were most frequently included (n=252; 40.1%) followed by posterior uveitis (181; 28.8%), panuveitis (n=154; 24.5%) and retinal vasculitis (n=41, 6.5%). At baseline, 39.6% were treated with systemic corticosteroids, 22.3% with conventional synthetic (cs) DMARDs, 20.5% with biological (b) DMARDs and 3.6% with other systemic treatments. Average best corrected visual acuity (BCVA) was 0.69 decimal. Patients with panuveitis had the worst BCVA with 0.63 decimal. Overall, only 8 patients (1.3%) suffered from severe visual impairment.
Conclusions: Less than half of participants required DMARD treatment at baseline, with csDMARDs used more frequently than bDMARDs. The presence of severe visual impairment was low, mostly affecting patients with panuveitis. These findings are in line with comparable monocentric cross-sectional studies of tertiary uveitis centres in Germany and will allow us to generate generalisable evidence in TOFU.
{"title":"Treatment exit options for non-infectious uveitis registry: participant characteristics at 3 years.","authors":"David Julian Fink, Jennifer Dell, Carsten Heinz, Maximilian W M Wintergerst, Tobias Höller, Moritz Berger, Matthias Schmid, Karl Thomas Boden, Uwe Pleyer, Herbert Reitsamer, Christoph M E Deuter, Tibor K Lohmann, Robert P Finger","doi":"10.1136/bjo-2023-324927","DOIUrl":"https://doi.org/10.1136/bjo-2023-324927","url":null,"abstract":"<p><strong>Purpose: </strong>The Treatment exit Options For non-infectious Uveitis (TOFU) registry documents disease courses for non-anterior non-infectious uveitis entities with and without treatment to generate more evidence for clinical management recommendations including treatment exit strategies. In this article, we present the participants' baseline characteristics after the first 3 years.</p><p><strong>Methods: </strong>TOFU is an observational, prospective registry and recruits patients ≥18 years of age with non-anterior non-infectious uveitis with or without a history of previous disease-modifying antirheumatic drugs (DMARDs) treatment. The data are collected in the electronic data capture software REDCap and include ophthalmological and general medical history as well as clinical findings.</p><p><strong>Results: </strong>Between 24.10.2019 and 27.12.2022, 628 patients were enrolled at 25 clinical sites in Germany and Austria. Patients with intermediate uveitis were most frequently included (n=252; 40.1%) followed by posterior uveitis (181; 28.8%), panuveitis (n=154; 24.5%) and retinal vasculitis (n=41, 6.5%). At baseline, 39.6% were treated with systemic corticosteroids, 22.3% with conventional synthetic (cs) DMARDs, 20.5% with biological (b) DMARDs and 3.6% with other systemic treatments. Average best corrected visual acuity (BCVA) was 0.69 decimal. Patients with panuveitis had the worst BCVA with 0.63 decimal. Overall, only 8 patients (1.3%) suffered from severe visual impairment.</p><p><strong>Conclusions: </strong>Less than half of participants required DMARD treatment at baseline, with csDMARDs used more frequently than bDMARDs. The presence of severe visual impairment was low, mostly affecting patients with panuveitis. These findings are in line with comparable monocentric cross-sectional studies of tertiary uveitis centres in Germany and will allow us to generate generalisable evidence in TOFU.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}