Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Objective: Assess safety and effectiveness of subretinal gene replacement therapy at 18 months post treatment.

Design: Retrospective, longitudinal study conducted at the Hospital for Sick Children in Toronto, Canada.

Participants: Patients with bi-allelic RPE65 variants, early onset retinal degeneration, and residual viable retina who underwent voretigene neparvovec r-zyl gene replacement therapy.

Methods: Data collected included demographic information, molecular genetic results, and comprehensive ocular assessment results from preoperataive and postoperative visits up to 18 months. To assess the treatment's efficacy, postoperative best corrected visual acuity, full-field stimulus test (FST), visual field (VF) area, optical coherence tomography, and global satisfaction were compared to preoperative findings.

Results: The procedures were safe with no complications. There was no significant improvement in visual acuity. Three eyes showed a slight reduction in VF area. All showed a reduction in ellipsoid zone thickness and area, but the outer nuclear layer thickness and area were stable. All had a significant improvement in retinal sensitivity, as per FST, allowing better navigation in a dim environment. All 3 patients reported being "very satisfied".

Conclusion: Following a safe gene replacement therapy, the 3 first Canadian cases had an improvement in retinal sensitivity as per FST, and our patients described their experience as positively life changing.

Objective: To evaluate the performance of large language models (LLMs), specifically Microsoft Copilot, GPT-4 (GPT-4o and GPT-4o mini), and Google Gemini (Gemini and Gemini Advanced), in answering ophthalmological questions and assessing the impact of prompting techniques on their accuracy.

Design: Prospective qualitative study.

Participants: Microsoft Copilot, GPT-4 (GPT-4o and GPT-4o mini), and Google Gemini (Gemini and Gemini Advanced).

Methods: A total of 300 ophthalmological questions from StatPearls were tested, covering a range of subspecialties and image-based tasks. Each question was evaluated using 2 prompting techniques: zero-shot forced prompting (prompt 1) and combined role-based and zero-shot plan-and-solve+ prompting (prompt 2).

Results: With zero-shot forced prompting, GPT-4o demonstrated significantly superior overall performance, correctly answering 72.3% of questions and outperforming all other models, including Copilot (53.7%), GPT-4o mini (62.0%), Gemini (54.3%), and Gemini Advanced (62.0%) (p < 0.0001). Both Copilot and GPT-4o showed notable improvements with Prompt 2 over Prompt 1, elevating Copilot's accuracy from the lowest (53.7%) to the second highest (72.3%) among the evaluated LLMs.

Conclusions: While newer iterations of LLMs, such as GPT-4o and Gemini Advanced, outperformed their less advanced counterparts (GPT-4o mini and Gemini), this study emphasizes the need for caution in clinical applications of these models. The choice of prompting techniques significantly influences performance, highlighting the necessity for further research to refine LLMs capabilities, particularly in visual data interpretation, to ensure their safe integration into medical practice.

Objective: To assess the cataract surgery (CS) complication rates before and during the COVID-19 pandemic.

Design: Retrospective, cross sectional study.

Methods: Medical records of patients undergoing CS at two surgery centers in Winnipeg from January 2018 to April 2022 were reviewed. The study periods were pre-COVID-19 (January 1, 2018 to March 31, 2020) and COVID-19 (April 1, 2020 to April 30, 2022). Complication rates for endophthalmitis, sulcus-positioned intraocular lens (IOL) implant, anterior chamber IOL (ACIOL) implant, capsular tension ring (CTR) insertion, cumulative dissipated phacoemulsification energy (CDE), posterior capsular rupture (PCR), unplanned anterior vitrectomy, and return to the OR within one month of surgery were compared.

Results: 45,559 patients were included. Pre-COVID-19 rates were compared to COVID-19 rates and stated as per 100 cataract surgeries. Endophthalmitis rates increased from 0.008 to 0.028 (RR 0.27, p=0.09). Sulcus IOL implant rates increased from 0.61 to 1.00 (RR 0.61, p<0.0001). ACIOL implant rates increased from 0.53 to 0.68 (RR 0.78, p=0.05). CTR usage rates increased from 0.48 to 0.75 (RR 0.63, p=0.001). Average CDE increased from 4.6 to 6.7 (p=0.0030). PCR rates decreased from 0.49 to 0.38 (RR 1.3, p=0.14). Unplanned anterior vitrectomy rates decreased from 0.43 to 0.36 (RR 1.18, p=0.35). Return to OR rates remained unchanged at 0.59 and 0.58 (RR 1.01, p=0.93).

Conclusions: Our study found significant increases in some CS complication rates when comparing the defined pre-COVID interval to the COVID interval.