Romanian journal of ophthalmology最新文献

Objective: Age-related macular degeneration (AMD) is the leading cause of vision loss in older populations of industrialized countries. Antibody-based therapy inhibiting the vascular endothelial growth factor (VEGF) has been very successful in the treatment of the neovascular form of AMD. This retrospective clinical study investigates the baseline characteristics and progression of neovascular age-related macular degeneration (nAMD) in patients who received over 60 anti-VEGF intravitreal injections. Methods: Retrospective analysis of 6812 eyes of 5678 patients undergoing anti-VEGF treatment at our clinic between November 2006 and December 2017 yielded 12 eyes of 12 patients who had received more than 60 intravitreal injections into one eye. We re-evaluated the baseline characteristics of visual acuity, intraocular pressure, optical coherence tomography, fluorescein angiography, as well as autofluorescence and analyzed the documented disease progress as monitored in our daily clinical practice. Data on the fellow eye were also analyzed. Results: Each of our 12 patients had the injected anti-VEGF agent (bevacizumab, ranibizumab, or aflibercept) changed at least once during treatment. After initial improvement, visual acuity decreased in most patients over time. The 2 patients with the best visual acuity at the beginning also showed the best visual acuity at the end of the study. No significant change was observed in the intraocular pressure. Conclusions: After the initial improvement, visual acuity decreased over time. Good visual acuity at the beginning of the study increased the chances of maintaining the same level throughout the treatment. Intravitreal treatment did not affect intraocular pressure. Abbreviations: AMD = age-related macular degeneration, nAMD = neovascular age-related macular degeneration, VEGF = vascular endothelial growth factor, OCT = optical coherence tomography, VA = visual acuity, PDT = photodynamic therapy.

A leading cause of irreversible vision loss, glaucoma needs early detection for effective management. Intraocular Pressure (IOP) is a significant risk factor for glaucoma. Convolutional Neural Networks (CNN) demonstrate exceptional capabilities in analyzing retinal fundus images, a non-invasive and cost-effective imaging technique widely used in glaucoma diagnosis. By learning from large datasets of annotated images, CNN can identify subtle changes in the optic nerve head and retinal structures indicative of glaucoma. This enables early and precise glaucoma diagnosis, empowering clinicians to implement timely interventions. CNNs excel in analyzing complex medical images, detecting subtle changes indicative of glaucoma with high precision. Another valuable diagnostic tool for glaucoma evaluation, Optical Coherence Tomography (OCT), provides high-resolution cross-sectional images of the retina. CNN can effectively analyze OCT scans and extract meaningful features, facilitating the identification of structural abnormalities associated with glaucoma. Visual field testing, performed using devices like the Humphrey Field Analyzer, is crucial for assessing functional vision loss in glaucoma. The integration of CNN with retinal fundus images, OCT scans, visual field testing, and IOP measurements represents a transformative approach to glaucoma detection. These advanced technologies have the potential to revolutionize ophthalmology by enabling early detection, personalized management, and improved patient outcomes. CNNs facilitate remote expert opinions and enhance treatment monitoring. Overcoming challenges such as data scarcity and interpretability can optimize CNN utilization in glaucoma diagnosis. Measuring retinal nerve fiber layer thickness as a diagnostic marker proves valuable. CNN implementation reduces healthcare costs and improves access to quality eye care. Future research should focus on optimizing architectures and incorporating novel biomarkers. CNN integration in glaucoma detection revolutionizes ophthalmology, improving patient outcomes and access to care. This review paves the way for innovative CNN-based glaucoma detection methods. Abbreviations: CNN = Convolutional Neural Networks, AI = Artificial Intelligence, IOP = Intraocular Pressure, OCT = Optical Coherence Tomography, CLSO = Confocal Scanning Laser Ophthalmoscopy, AUC-ROC = Area Under the Receiver Operating Characteristic Curve, RNFL = Retinal Nerve Fiber Layer, RNN = Recurrent Neural Networks, VF = Visual Field, AP = Average Precision, MD = Mean Defect, sLV = square-root of Loss Variance, NN = Neural Network, WHO = World Health Organization.

One of the fields of medicine in which artificial intelligence techniques have made progress is ophthalmology. Artificial intelligence (A.I.) applications for preventing vision loss in eye illnesses have developed quickly. Artificial intelligence uses computer programs to execute various activities while mimicking human thought. Machine learning techniques are frequently utilized in the field of ophthalmology. Ophthalmology holds great promise for advancing artificial intelligence, thanks to various digital methods like optical coherence tomography (OCT) and visual field testing. Artificial intelligence has been used in ophthalmology to treat eye conditions impairing vision, including macular holes (M.H.), age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, and cataracts. The more common occurrence of these diseases has led to artificial intelligence development. It is important to get annual screenings to detect eye diseases such as glaucoma, diabetic retinopathy, and age-related macular degeneration. These conditions can cause decreased visual acuity, and it is necessary to identify any changes or progression in the disease to receive appropriate treatment. Numerous studies have been conducted based on artificial intelligence using different algorithms to improve and simplify current medical practice and for early detection of eye diseases to prevent vision loss. Abbreviations: AI = artificial intelligence, AMD = age-related macular degeneration, ANN = artificial neural networks, AAO = American Academy of Ophthalmology, CNN = convolutional neural network, DL = deep learning, DVP = deep vascular plexus, FDA = Food and Drug Administration, GCL = ganglion cell layer, IDP = Iowa Detection Program, ML = Machine learning techniques, MH = macular holes, MTANN = massive training of the artificial neural network, NLP = natural language processing methods, OCT = optical coherence tomography, RBS = Radial Basis Function, RNFL = nerve fiber layer, ROP = Retinopathy of Prematurity, SAP = standard automated perimetry, SVP = Superficial vascular plexus, U.S. = United States, VEGF = vascular endothelial growth factor.

Introduction. The topical medications containing benzalkonium chloride (BAK) as preservative is known to induce corneal toxicity and ocular surface disease (OSD) in glaucoma patients. Newer preservatives like SofZia or polyquaternium-1 (Polyquad) have been developed to replace BAK in many medications. The present study aimed at comparing the OSD in glaucoma patients receiving BAK preserved travoprost versus travoprost with polyquad as preservative and controls not receiving any medications. Methods. This prospective, controlled, observational study was conducted on patients of primary open angle glaucoma (POAG) on medications for more than 6 months. The first group comprised of 40 patients receiving BAK preserved travoprost, the second group included 40 patients receiving polyquad preserved travoprost and 30 of control group not receiving any medical treatment. Ocular Surface Disease Index (OSDI) scores using Ocular Surface Disease Index (OSDI) Questionnaire were assessed and compared in all subjects. Results. The mean OSDI score was 29.09 ± 13.45 in BAK group, 12.4 ± 5.085 in polyquad group and 10.93 ± 7.36 in controls. The mean difference in OSDI scores between BAK and polyquad group 16.63 (p < 0.05) and between the BAK and control group was 18.96 (p < 0.05). The mean difference in OSDI scores between the polyquad and control group was 1.53 (p > 0.05). The mean IOP in the BAK group was 19.2 ± 3.5 and in polyquad group was 20.1 ± 4.2. The IOP measured at 12 months of treatment was 13.2 ± 2.1 in BAK group and 12.8 ± 3.3 in polyquad group. The IOP measured at baseline and 12 months showed statistically significant difference in both the groups (p Conclusions. OSDI scores revealed significantly lesser symptoms in polyquad preserved travoprost when compared to BAK preserved travoprost. The OSDI scores in polyquad group were also comparable to the control group. Hence, for long term glaucoma management polyquad containing travoprost should be preferred over the BAK preserved travoprost.

Background. At high altitude changes in corneal thickness and intraocular pressure (IOP) has been a subject of investigation for decades. The mechanism of action of these changes is still unknown. Extensive research is carried out to know effect of hypoxia on humans at high altitude. Corneal thickness and intraocular pressure are important parameter in ophthalmology with both diagnostic and therapeutic implications. We studied the corneal thickness and intraocular pressure in highlanders and compared the same with lowlanders. Methods. This observational study included two groups, each consisting of 500 individuals residing at high altitude (more than 10,000 ft above sea level). Three measurements of intraocular pressure of both eyes in each group were noted with Goldmann applanation tonometer and mean of the three readings was taken. Central Corneal Thickness (CCT) was measured by ultra sound pachymetry. The parameters of two groups were compared statistically. Results. There was a statistically significant difference between corneal thicknesses of the two groups studied, however no overall statistically significant difference in intraocular pressure of both these groups was found. Conclusion. The highlanders have a thinner cornea as compared to lowlanders. The IOP is significantly higher in the highlander males as compared to lowlander males. However, the mean IOP is comparable between the overall population of the high altitude and that of low altitude.

Objective. To evaluate the correlation between visual outcomes and fluid configuration observed on spectral-domain optical coherence tomography (SD-OCT) in patients with wet age-related macular degeneration (AMD). Methods. Sixty-five eyes of 53 patients with AMD who were administered intravitreal ranibizumab treatment with 12 months of follow-up were included in this retrospective study. Presence of intraretinal cystoid fluid (IRC) and pigment epithelial detachment (PED), thickness of subretinal fluid (SRF), central macular thickness (CMT), and central macular volume (CMV) were assessed. Results. Subretinal fluid was observed in 29 eyes (45%), IRC in 36 eyes (55%), and PED in 39 eyes (60%). Baseline and final best-corrected visual acuity (BCVA) were 0.69±0.4 and 0.60±0.4 logMAR in the IRC negative group and 1.17±0.5 and 0.97±0.5 logMAR in the IRC positive group. BCVA was lower in IRC positive group (baseline p=0.001 and final=0.003); however, marked improvement was detected in both groups. Anatomic improvement and increased visual acuity were observed in groups with and without PED, IRC, and SRF. An inverse correlation was detected between pre-treatment CMT, IRC and post-treatment IRC, and final BCVA. Conclusion. Significant visual and anatomic improvement was observed after one-year of ranibizumab treatment regardless of fluid configuration. However, the presence of IRC was observed to be associated with worse visual acuity. Baseline retinal fluid configuration may have prognostic effects on functional success in patients treated with ranibizumab for wet AMD. Abbreviations. AMD = Age-related macular degeneration, VEGF = Vascular endothelial growth factor, IRC = intraretinal cystoid fluid, PED = pigment epithelial detachment, SRF = subretinal fluid, SD-OCT = spectral-domain ocular coherence tomography, IVR = intravitreal ranibizumab, BCVA = best-corrected visual acuity, FFA = fundus fluorescein angiography, CMT = central macular thickness, CMV = central macular volume.

A 53-year-old male developed acute diminution of vision in his right eye while on FOLFOX chemotherapy for stage C colon cancer. Examination revealed bilateral optic nerve head swelling with flame shaped hemorrhages over the right optic disc and anomalous left retinal vasculature. Computed tomography scan of the brain and orbit revealed no cerebral pathology, however bilateral optic disc drusen (ODD) was suspected. B scan ultrasonography confirmed the presence of bilateral ODD. Fluorescein angiography showed early hypofluorescence of the right optic disc with bilateral late disc staining and a diagnosis of right anterior ischemic optic neuropathy (AION) with bilateral ODD was made. A literature review was performed and possible mechanisms for the development of AION in this case were discussed.

Purpose: To quantitatively evaluate the cardiopulmonary effects of various topical antiglaucoma drugs. Material & method: In this study, forty consecutive cases of newly diagnosed primary open angle glaucoma were recruited. After taking a detailed history, an ophthalmological examination and a systemic examination including resting pulse rate, blood pressure, ECG, auscultation of the chest and spirometry were performed. Then the patients were randomly divided into four groups and one of the four topical anti glaucoma medication (Timolol, Latanoprost, Brimonidine, and Dorzolamide) prescribed. Patients were reviewed 4 weeks later and the same ocular and systemic examinations were performed. Result: Timolol therapy reduced all the spirometry parameters that are statistically significant difference with the P value of less than 0.1. Timolol therapy resulted in the mean reduction of pulse rate by 3.2 beats/ minute and a mean reduction of systolic and diastolic blood pressure by 5.8 mmHg and 5.6 mmHg, respectively all the spirometry & cardiovascular parameters remained unchanged in the other three groups after 4 weeks of treatment. Conclusion: Timolol significantly affects the cardiopulmonary status. Therefore, we could advice the assessment of cardiopulmonary status mandatory in patients receiving topical beta-blockers. Bronchospasm may be of clinical significance in the elderly, who commonly have undiagnosed reversible airway obstruction.

Introduction: The iris vascular supply originates in the anterior and long posterior ciliary arteries. The endothelium influences local blood flow by releasing endothelium relaxing and contracting substances. From a functional perspective, the ocular vascular tonus adjustment is humoral and neural dependent. Objectives: The present article aims to evaluate the possible implications of topical administration of selective COX2 and nonselective COX inhibitors generically named nonsteroidal anti-inflammatory drugs (NSAIDs) and their possible interactions with the endocannabinoid system and the way they could interfere with the vascular tone at the level of ocular iris territory in Wistar rats. Materials and methods: Experimental protocol on Wistar rats was performed in accordance with present laws regarding animal welfare and ethics in animal experiments (Directive 86/ 609EEC/ 1986; Romanian Law 205/ 2004; Romanian Laws 206/ 2004, 471/ 2002 and 9/ 2008; Romanian Order 143/ 400). The studied substances were instilled topically under general anesthesia, and images of the rat iris vessels were captured over a period of 10 minutes. The obtained images were further analyzed using an appropriate hardware and software program. Results: The nonselective NSAIDs induced vascular dilation in the iris vessels, while the selective COX2 inhibitors determined a variable degree of vasoconstriction. Conclusion: In view of the results of this experiment and the added evidence found in literature, we consider that further research will show the potential benefits for the additional use of NSAIDs in ocular pathology, otherwise unaffected by this medication until the present time (for example, glaucoma treatment).