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

Introduction: Ocular tumours are detrimental to quality of life and survival. The diagnostic capabilities of artificial intelligence (AI) have increased in the past decade. This systematic review aims to evaluate the diagnostic performance of AI models across external, anterior segment, and posterior segment ocular tumours.

Methods: A systematic literature search of Ovid Embase, MEDLINE, and the Cochrane Library was performed for studies on AI in ocular tumour diagnosis published from January 2000 to January 2025. Quantitative outcomes were diagnostic accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve. Findings were synthesized using descriptive statistics. The QUADAS-2 tool assessed the risk of bias and applicability.

Results: Of the 1 947 studies screened, 23 studies were included and categorized as external ocular tumour diagnosis (n = 12), anterior segment tumour diagnosis (n = 2), posterior ocular tumour diagnosis (n = 8), or general ocular tumour diagnosis (n = 1). The main AI models used were DenseNet (n = 4) and ResNet models (n = 3). Weighted mean AI accuracy was 91.4% (81.8% to 98.3%) for external ocular tumour diagnosis, 89.8% (78.1% to 99.0%) for posterior segment ocular tumour diagnosis, and 98.5% for anterior segment tumour diagnosis in the only reporting study. Of the 10 studies comparing AI diagnostic accuracy with physicians, 2 reported significantly higher diagnostic accuracy among ophthalmologists (p < 0.05). Quality assessment demonstrated low or unclear risk of bias and applicability concerns in 69.5% of studies.

Conclusions: AI tools are a potential avenue for efficient and accurate ocular tumour diagnosis. Further studies comparing ophthalmologists' diagnostic performance to AI diagnostic performance are needed.

Objective: To validate a newly proposed anatomic staging system for choroidal and ciliary body melanoma, based on tumour volume estimated from routine clinical measurements, and compare its prognostic performance with the American Joint Committee on Cancer (AJCC) 8th edition classification.

Design: A retrospective, multicentre cohort study.

Participants: A total of 5 410 consecutive patients diagnosed with choroidal and/or ciliary body melanoma at 6 European ocular oncology centres.

Methods: Tumours were staged according to both classifications. Prognostic performance was evaluated using competing risk regression, Cox regression, Kaplan-Meier survival analyses, and net reclassification improvement.

Results: The new classification showed better prognostic discrimination than the AJCC system, with a net reclassification improvement of 23%. In competing risk regression, it produced a higher Wald statistic (761 vs 628) and a subdistribution hazard ratio of 1.42 versus 1.22. Cox regression for melanoma-related mortality demonstrated higher hazard ratios, peaking at 24 for the new model compared with 13 for the AJCC classification. Cumulative incidence analyses revealed 15-year metastatic death rates ranging from 7% to 76% with the new system versus 11% to 69% with AJCC, widening the absolute range by 11 percentage points.

Conclusions: This large international validation study demonstrates that the new volume-based classification provides more accurate prognostic stratification for choroidal and ciliary body melanoma. Its improved risk discrimination, using readily available clinical measurements, supports its applicability in clinical practice and potential utility for guiding follow-up and resource allocation.

Objective: Vitreomacular traction is a common presentation that can benefit from surgical intervention. The decision to peel the internal limiting membrane (ILM) is made at the discretion of the operating surgeon. We describe a large cohort of eyes that had surgery with or without ILM peeling to give more evidence for the decision-making process.

Design: A retrospective cohort study.

Participants: Eyes with the diagnosis of vitreomacular traction (VMT) that underwent surgery between January 1, 2016, and January 1, 2025, at a group retina practice in Edmonton, Canada.

Methods: Eyes at a single center underwent vitrectomy surgery for the treatment of VMT with or without peeling of the ILM. Baseline visual and anatomic measures were captured and compared to postoperative findings. The main outcome measures were visual acuity and anatomic outcomes postsurgery. Complication rates were also captured.

Results: A total of 250 surgeries were performed during the study period. There was a significant improvement in vision in all eyes (0.19 logMAR). There was no difference in visual improvement when comparing ILM peeling versus ILM sparing. There was better anatomical resolution in cases that had sparing of the ILM. Complication rates were low with no difference in secondary macular hole formation when comparing ILM peeling to ILM sparing.

Conclusions: Pars plana vitrectomy with or without peeling of the ILM is an effective treatment for symptomatic VMT. There may be better anatomic preservation with sparing of the ILM secondary to less surgical manipulation. Complication rates are low regardless of surgical technique.

Objective: To measure the incidence and risk factors of rhegmatogenous retinal detachment (RRD) in a Canadian population from 2010 to 2023.

Design: A retrospective cohort study.

Participants: Patients with ICD-10 diagnostic code H33.0 (retinal detachment with retinal break) and controls who had cataract surgery but no prior history of detachment, age (±2 years) and is sex-matched.

Methods: Patients reporting to the QEII Health Sciences Centre between January 1, 2010, to December 31, 2023, were included. The primary outcome was the incidence rate of RRD estimated using negative binomial regression. Generalized linear model was used to compare the risk of RRD and Cox-proportional hazards to model time to RRD following cataract surgery.

Results: Annual RRD incidence rates increased from 15.2 to 27.5 cases per 100,000 between 2010 and 2023. Mean axial length of RRD patients with prior cataract surgery was 25.0 (1.55) mm compared with the control population of 24.1 (1.60) mm. An increased risk of RRD was associated with each 1-mm increase in axial length (hazard ratio [HR] 1.31), male sex (HR 1.29), and per 1 year age increase (HR 1.03) post-cataract surgery. Time-to-event analyses identified that the mean time from cataract surgery to RRD was 9.43 years.

Conclusions: Increases in RRD cases have been seen over the last 14 years. While the total risk for RRD is still small, male sex and a 1-2 mm increase in axial length can significantly change a patient's risk. Furthermore, the increased risk of RRD after cataract surgery is not only an early event.

Purpose: To describe the clinical outcomes of combined Descemet stripping automated endothelial keratoplasty (DSAEK) and intraocular lens (IOL) exchange using the Yamane technique, and a review of the literature.

Methods: This is a retrospective interventional case series. Included were patients with decompensated cornea and dislocated IOL, anterior-chamber IOL, or iris-claw IOL that underwent IOL exchange using the Yamane technique combined with suture pull-through DSAEK. Best-corrected visual acuity (BCVA), graft survival, and complications were evaluated at year 1.

Results: Twenty-four eyes from 24 patients were included. Mean age was 71 ± 14.2 years. All except 1 patient (95.8%) had concomitant issues that could limit visual outcome or success of surgery, such as glaucoma (62.5%, of which 47.0% had previously undergone glaucoma tube surgery). Mean BCVA improved from 20/590 to 20/93 1 year after surgery (p = 0.0001). Rebubbling was performed in 4 eyes (16.7%), and 2 eyes (8.3%) had graft failure requiring repeat DSAEK. None had graft rejection. Two eyes (8.3%) developed IOL issues (1 haptic-optic junction dislocation and 1 haptic-optic junction rotation), 6 eyes (25.0%) had ocular hypertension requiring topical treatment, and 1 eye had suprachoroidal hemorrhage.

Conclusions: Combined DSAEK and IOL exchange using the Yamane technique was shown to be a safe and effective method for visual rehabilitation in patients with decompensated cornea and anterior chamber/iris-claw/dislocated IOL. Further studies are required to evaluate the long-term stability of the graft and the IOL.