Numerous artificial intelligence (AI) models, including deep learning techniques, are being developed to segment choroids in optical coherence tomography (OCT) images. However, there is a need for consensus on which specific models to use, requiring further synthesis of their efficacy and role in choroid visualization in myopic patients. A systematic literature search was conducted on three main databases (PubMed, Web of Science, and Scopus) using the search terms: “Machine learning” OR “Artificial Intelligence” OR “Deep learning” AND “Myopia” AND “Choroid” OR “Choroidal” from inception to February 2024 removing duplicates. A total of 12 studies were included. The populations included myopic patients with varying degrees of myopia. The AI models applied were primarily deep learning models, including U-Net with a bidirectional Convolutional Long Short-Term Memory module, LASSO regression, Attention-based Dense U-Net network, ResNeSt101 architecture training five models, and Mask Region-Based Convolutional Neural Network. The reviewed AI models demonstrated high diagnostic accuracy, including sensitivity, specificity, and area under the curve values, in identifying and assessing myopia-related changes. Various biomarkers were assessed, such as choroidal thickness, choroidal vascularity index, choroidal vessel volume, luminal volume, and stromal volume, providing valuable insights into the structural and vascular changes associated with the condition. The integration of AI models in ophthalmological imaging represents a significant advancement in the diagnosis and management of myopia. The high diagnostic accuracy and efficiency of these models underscore their potential to revolutionize myopia care, improving patient outcomes through early detection and precise monitoring of disease progression. Future studies should focus on standardizing AI methodologies and expanding their application to broader clinical settings to fully realize their potential in ophthalmology.
With the approval of the Federal Drug Agency of the USA in 2018, femtosecond laser-assisted small incision lenticule extraction (SMILE) became an officially available option in several countries including Saudi Arabia to treat myopia and astigmatism. Intense marketing by industries has placed both clients and corneal surgeons into a dilemma of the plus and minuses of this option. Although several reviews compare SMILE to other conventional methods, especially laser in situ keratomileusis, this narrative review perhaps for the first time offers a detailed summary of this procedure and compares two sets of published literature, by authors from China and other countries. The efficacy and safety of SMILE seem to outnumber the complications and high cost of the investment. Its long-term usefulness for treating high myopia and hyperopia is still a matter of research.
Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatism characterized by common clinical, radiological, and biological manifestations occurring on a predisposing genetic background dominated by the HLA-B27 antigen. Acute anterior uveitis is the most common extra-articular feature of SpA. The objective of this review is to describe the prevalence, demographic characteristics, factors favoring the occurrence of uveitis in patients with SpA, clinical manifestations, and their therapeutic management.
Glaucoma is a leading cause of irreversible blindness worldwide which affects all age groups. It is often identified by high intraocular pressure, characteristic optic neuropathy, and vision loss. Due to multifactorial nature of glaucoma pathogenesis, the molecular events responsible for its precipitation are currently poorly understood. Mitochondrial DNA (mtDNA) variations which are inherited maternally are being closely studied in recent times to elucidate the effect on glaucoma. Mitochondrial genetic studies till date have found a possible link between Leber hereditary optic neuropathy loci and glaucoma but with conflicting views. Furthermore, whole mtDNA studies in glaucoma points at the involvement of oxidative phosphorylation complex I and specifically the NADH dehydrogenase 5 gene in glaucoma. This review focuses on identifying the potential genes and variations in the maternally inherited mtDNA which might be involved in glaucoma pathogenesis.
PURPOSE:To compare macula and optic-disc optical coherence tomography angiography (OCTA) metrics of adult amblyopic eyes with healthy controls and investigate whether these differ according to amblyopia etiology. METHODS:This cross-sectional study included 35 unilateral amblyopic adults (n = 35 eyes) and 35 age-matched healthy controls (n = 35 eyes). Amblyopia subgroups consisted of anisometropic (n = 12 eyes), strabismic (n = 12 eyes), and combined-mechanism amblyopia (n = 11 eyes). Foveal avascular zone area (FAZA), vessel density (VD), and retinal thickness were obtained using OCTA. Retinal thicknesses were measured at the fovea, parafovea, perifovea, and retinal nerve fiber layer. Foveal, parafoveal, perifoveal, whole-macula, intradisc, peripapillary, and whole-disc VD were recorded. Groups were compared regarding OCTA metrics after adjusting for axial length, spherical equivalent, age, gender, and signal quality index using a one-way analysis of covariance test. RESULTS:Amblyopic eyes had significantly lower foveal, parafoveal, perifoveal, whole-macula VD in superficial capillary plexus (SCP), and deep capillary plexus (DCP) than control eyes after adjusting for confounders (P < 0.05 for all). All amblyopia subgroups had significantly lower parafoveal, perifoveal, and whole-macula VD in SCP and DCP than control eyes after adjusting for confounders (P < 0.05 for all). There was no significant difference in retinal thickness, FAZA, intradisc VD, peripapillary VD, and whole-disc VD between amblyopic and control eyes, as well as amblyopia subgroups and control eyes. CONCLUSION:These results suggest that effect of amblyopia on macular microvasculature should be considered when interpreting OCTA metrics of adults with concomitant diseases. It also supports that adult amblyopic eyes of different etiology have similar microvascular features.
PURPOSE:The purpose of this study was to examine demographic and tomographic parameters in pediatric patients diagnosed with keratoconus and to evaluate the difference between early and late age periods. METHODS:This retrospective study included patients younger than 18 years of age who were diagnosed with keratoconus. All examination findings, demographic data, tomography parameters, and keratoconus stages were recorded. The patients were divided into two groups: 14 years or younger (Group 1) and those between 14 and 18 years old (Group 2). All corneal tomography parameters were compared in the subgroups and were evaluated statistically. P <0.05 was considered statistically significant. RESULTS:A total of 131 eyes of 71 patients were included. The mean age was 15.7 ± 1.8 (range, 10-18) years, and the female-to-male ratio was 23/48. The mean best spectacle-corrected visual acuity was 0.36 ± 0.44 (range, 0-3.1) logMAR. The averages of K1, K2, Km, and Kmax were 49.0 ± 6.2 (range, 39.6-74.5) D, 53.5 ± 7.0 (range, 43.3-76.8) D, 51.3 ± 6.5 (range, 41.5-75) D, and 59.1 ± 9.0 (range, 44.7-85.2) D, respectively, and the mean central corneal thickness (CCT) was 456.9 ± 63.5 µm (range, 261-601). The distribution of eyes with keratoconus from stages 1-4 was 5.3%, 36.6%, 38.9%, and 19.1%, respectively. When the groups were compared, K1, K2, Km, and Kmax were significantly steeper in Group 1 compared to Group 2 (P = 0.006, P = 0.004, P = 0.004, and P = 0.007, respectively). CCT and the thinnest corneal thickness values were significantly less in Group 1 (P = 0.038 and P = 0.041, respectively). CONCLUSION:The decision for treatment - especially cross-linking - should be made at the right time due to the increased risk of progression in the earlier ages in pediatric keratoconus population.
PURPOSE:To describe the nature and response of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-negative patients with hematological malignancies and other immunosuppressive causes.METHODS:This is retrospective case series of CMV retinitis patients with known immunocompromised status and negative HIV results. Patients' data were reviewed for demographics, causes of the immunosuppressed status, concomitant systemic CMV infection, and its management. Ophthalmic findings included visual acuity (VA), anterior and posterior segments findings, CMV retinitis patterns and extensions, medications, number of intravitreal injections, fundus photographs, and CMV retinitis complications.RESULTS:During a study period of 2 years, 17 eyes of 9 patients were diagnosed with CMV retinitis with detected CMV in blood tests. Indolent granular retinitis pattern was found in 4 eyes (23.5%), and the fulminant necrotizing pattern in another 4 eyes (23.5%). In 1 eye (5.9%), frosted branch angiitis was observed. A mixed pattern between granular and necrotizing retinitis was seen in 4 eye (23.5%). The majority (n 11, 64.7%) of the affected eyes had an extensive retinal involvement (zone 1-3). Only two eyes had no macular involvement (11.8%). A large percentage of the included patients had controlled disease course with stable vision. Out of the studied 17 eyes, deterioration in terms of VA was seen in five eyes. In two patients, the disease course was complicated by vitreous hemorrhage.CONCLUSION:In the majority of the patients with HIV-negative tests who received intravitreal and/or systemic anti-CMV medications, the clinical course of CMV retinitis was controlled with final stable vision.
A 16-year-old female with Sturge-Weber syndrome (SWS) presented with decreased vision in the left eye (20/100). Examination and multimodal imaging showed diffuse choroidal hemangioma with choroidal neovascularization and macular edema. Treatment with three monthly injections of intravitreal aflibercept improved vision by 4 lines with complete resolution of the macular edema sustained 4 months after the last injection. A review of the literature showed that this is the first report of successful use of aflibercept to treat macular edema and choroidal neovascularization associated with diffuse choroidal hemangioma in SWS. We suggest that early antivascular endothelial growth factor injections should be considered when faced with choroidal neovascularization associated with diffuse choroidal hemangiomas.
Purtscher retinopathy is a hemorrhagic and vaso-occlusive vasculopathy that results from head trauma. Typically, patients present with sudden onset of painless reduction in visual acuity and a group of retinal findings including retinal hemorrhages, retinal whitening, and optic disc edema. The objectives of the study were to describe the rare occurrence of combined central retinal artery and central vein occlusion in a child with Purtscher retinopathy and to illustrate the course of visual recovery and anatomical changes over 6 months of follow-up. The data were collected from the patient file including circumstances of presentation, visual acuity, anterior segment examination, fundus photography, fundus fluorescein angiography (FFA), B scan ultrasonography (B scan), and optical coherence tomography (OCT). Follow-ups over a 6-month period with repeated imaging were documented. A 6-year-old boy presented with a complaint of bilateral vision loss which occurred 2 days after falling out of high bed. On examination, visual acuity was hand motion bilaterally. External and anterior segments exhibited regular examination, apart from traumatic iritis in both eyes. Posterior segment examination showed intraretinal hemorrhages, retinal whitening bilaterally, and exudative retinal detachment, which was confirmed by OCT and B-scan. FFA of both the eyes showed delayed arterial and venous filling with macular hypoperfusion. Comprehensive systemic workup including brain imaging, hematology, immunology, and uveitis screening was negative. The patient was treated with a high-dose oral steroid. Six months later, his vision improved to 20/40 OD and 20/28 OS. Fundus examination and OCT showed peripheral retinal atrophy but preserved subfoveal outer retinal layers, which explained the visual improvement. Treatment with corticosteroids seems to be effective in reducing retinal edema and hastened visual recovery in patients with Purtscher retinopathy. Cilioretinal artery sparing can preserve the central vision in cases with combined artery and vein occlusion.
PURPOSE:To report the clinical presentation, histopathological and immunohistological features of conjunctival lymphatic-venous lesions.METHODS:This was a retrospective review of 15 patients with symptomatic conjunctival lymphatic-venous lesions. The clinical features and histopathologic features of the excised tissues were reviewed. Immunohistochemical staining with antibodies against CD34 to label vascular endothelium and D2-40 to label lymphatic endothelium was performed.RESULTS:All patients had unilateral conjunctival involvement. The mean age was 48.9 +/- 18.9 years, with more women affected (67%). No patient had impaired visual acuity secondary to the lesion. The location of the lesion was temporal in 67% of patients. The presenting symptoms included conjunctival swelling, discomfort and/or foreign-body sensation, and tearing. All lesions were excised, and none recurred. All excised lesions showed dilated channels that were lined by a flattened endothelium staining positive with CD34, surrounded by edematous lamina propria. Larger ectatic lymphatic channels demonstrated scattered D2-40 staining in the endothelial cell lining and patchy CD34 staining within the endothelial cell cytoplasm. D2-40 and CD-34 immunoreactivity did not overlap in the same cells.CONCLUSION:The clinical features and outcomes of the lesions in this large cohort were similar to those reported in the literature. However, the mixed immunoreactivity of the endothelial cells lining these ectatic lymphatic channels in the conjunctiva suggests that these channels are lymphatic-venous lesions. We suggest that these channels be termed conjunctival lymphaticovenous malformation rather than lymphangiectasia, which suggests ectasia of existing lymphatics. Future studies are needed to understand these lesions and their histopathologic origins.
PURPOSE:It is a controversial issue whether to discontinue antithrombotic drugs during the perioperative period of cataract surgery. There are few reports on the safety of long-term aspirin use after percutaneous coronary intervention (PCI). In this study, we evaluated the bleeding risk and surgical safety of cataract phacoemulsification in patients who took aspirin for a long time after PCI, so as to provide relevant evidence for this problem. METHODS:Retrospective analysis of the cases of cataract surgery. The incidence of bleeding-related complications in patients without history of antithrombotic drugs, patients without cardiac surgery who had taken aspirin at least 1 year for secondary prevention, and patients with long-term aspirin use 1 year after PCI were compared. RESULTS:A total of 81 patients (81 eyes, n = 81) after PCI (≥1 year) were collected. One hundred fifty-eight patients (158 eyes, n = 158) without cardiac surgery in the aspirin group and 285 patients (285 eyes, n = 285) without history of antithrombotic drugs were collected. Subconjunctival hemorrhage and hyphema occurred in all three groups, but the difference was not statistically significant (P > 0.05). No other serious bleeding-related complications occurred in the three groups during the operation, 1 day and 1 week after operation. CONCLUSION:No matter intraoperative or postoperative, bleeding-related complications are rare in patients after PCI, which demonstrates a certain degree of surgical safety and can prove the safety of cataract surgery without stopping antithrombotic drugs.
PURPOSE:To evaluate whether the level of ambient illumination in winter at different locations, time of a day, sun protection, and source position remains optimum (≥1000 lux) for controlling myopia progression. METHODS:Illuminance level was recorded for 6 outdoor and 5 indoor locations using factory calibrated digital lux meter and under different measurement conditions. Outdoor locations included "open playground," "between two buildings," "between three buildings," "under a porch facing east," "under a big tree," and "under a porch facing west." Similarly, indoor locations included "rooms with multiple large windows," "rooms with a combination of light sources," "room with single artificial light," "room with multiple artificial lights," and "canopy covering the buildings." RESULTS:The overall median illumination level across 6 outdoor locations and 5 indoor locations were 1900 lux (803-4300 lux) and 227 lux (82-556 lux) respectively. Indoor locations showed an overall low median illuminance level (<1000 lux) irrespective of the locations and source positions. However, the illuminance level >1000 lux was recorded for "Room with multiple large windows" for specific points of time (10:00-11:00 and 13:00-14:00) in both sunny and foggy weather. The highest illumination level was recorded only in the "open playground" irrespective of various conditions such as time of the day, weather of the day, relative source position, and sun protection. CONCLUSION:The ambient illumination level was optimum (≥1000 lux) for antimyopia strategy in winter for maximum outdoor locations. However, children should be motivated to spend their outdoor time during the afternoon (13:00-14:00 h) so that light intensities reaching the eye should be optimum in winter.
PURPOSE: This study aims to correlate optical coherence tomography angiography (OCTA)-based retinal microvasculature changes in cases of full-thickness macular hole (FTMH) before and after vitreoretinal surgery and its relation to patient’s visual recovery. METHODS: Data of 31 eyes with FTMH were evaluated preoperatively and post-operatively at 6, 12, and 24 weeks for OCTA parameters and compared. RESULTS: 93.55% eyes (29 eyes) showed improvement in best-corrected visual acuity at 24 weeks. The mean foveal avascular zone (FAZ) significantly reduced from 0.41 ± 0.13 mm2 (preoperatively) to 0.25 ± 0.01 mm2 (postoperatively at 24 weeks). Mean preoperative vessel density (VD) in the superficial vascular plexus (SVP) progressively improved to 24.2% ± 2.2%, 25.2% ± 2.1% and 25.8% ± 2.3% at 6, 12, and 24 weeks respectively from 24.4% ± 2.1% preoperatively (P = 0.0, F = 5.1). The mean VD of foveal region in the SVP significantly improved (P < 0.0, F = 13.9) while that of the parafoveal region did not improve at 24 weeks (P = 0.3, F = 1.2) when compared with its preoperative status. The mean preoperative VD in the deep vascular plexus (DVP) was 20.2% ± 2.6%. It significantly improved at 6, 12, and 24 weeks (20.3% ± 2.4%, 21.8% ± 2.3% and 22.1% ± 2.2%, respectively; P = 0.0, F = 6.9). The mean VD of foveal region and parafoveal region in the DVP showed significant improvement when compared with its preoperative status (P < 0.0, F = 39.3, P < 0.0, F = 13.7). CONCLUSION: This study showed reduction in mean FAZ area and improvement in mean VD at SVP and DVP in the macula postoperatively. Routine perioperative OCTA-based documentation of macular vascularity in FTMH may throw a light in cases with anatomico-functional postoperative disparities in future.
The aim of this study is to present a case of severe chronic blepharitis secondary to psoriasis in an eye that developed phthisis bulbi during the treatment of juvenile glaucoma. A 19-year-old male patient, who had been treated for bilateral juvenile glaucoma for many years and had phthisis bulbi in his left eye for the last 4 years, presented with the complaint of chronic eyelid inflammation in the same eye for 2 years. Examination revealed hyperemia, discharge, scaling, inflammation, and diffuse edema on the lower and upper eyelids. It was determined that she had been diagnosed with psoriasis by the dermatology clinic 3 years before her history. Psoriasis-like hyperplasia was observed in the lower eyelid biopsy. He was treated with topical periocular low potency steroid ointment (1% hydrocortisone). Clinicians should be vigilant about eyelid and eye involvement in psoriasis.
PURPOSE:The purpose of this study was to validate the artificial intelligence-based Screening Corneal Objective Risk of Ectasia (SCORE) for the detection of corneal ectasia/risk of ectasia and to find the mean SCORE value in normal eyes. METHODS:This prospective observational study included 320 eyes of 160 patients undergoing screening for refractive surgery and keratoconus. All were subjected to Anterion (Heidelberg, Germany) corneal tomography. The maps were read by trained cornea specialists masked with respect to system-generated SCORE. The SCORE values were retrieved by another masked observer. The SCORE was labeled true positive if the eye was tomographically positive for ectasia/ risk of ectasia with or without clinical evidence of ectasia (i.e., clinician's diagnosis as ectasia/ risk of ectasia) and SCORE was >/=0. The SCORE test was labeled as true negative if all the maps were normal and SCORE was <0. A false-positive test was where the eye was normal but SCORE was ≥0. A false-negative test was one tomographically there was definite evidence of ectasia/ risk; with or without clinical evidence of ectasia (i.e.,clinician's diagnosis as ectasia/ at risk of ectasia) but SCORE was <0. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS:The mean SCORE in normal eyes was -0.7 ± 0.6. Sensitivity was 83.3% and specificity was 80%. PPV and NPV were 46% and 96% respectively. In the keratoconus subgroup, specificity and PPV were 100%; sensitivity was 79% and NPV was 76.3%. CONCLUSION:SCORE in Anterion has moderate sensitivity and specificity for detection of ectasia/risk of ectasia. It performs best in the detection of corneal ectasia. It needs to be interpreted with caution.
PURPOSE: We aimed to evaluate the success of Chat Generative Pre-trained Transformer (ChatGPT), Bing, and Bard artificial intelligence programs, which were released free of charge by three different manufacturers, in correctly answering questions about lenses, cataract, and refractive surgery, and to investigate whether they are superior to each other.METHODS: Seventy questions related to lens, cataract, and refractive surgery were obtained from the study questions section of the American Academy of Ophthalmology 2022 to 2023 Basic and Clinical Science Course Lens and Cataract and Refractive Surgery Books. The questions were asked separately for the ChatGPT, Bing, and Bard artificial intelligence programs. The answers were compared with answer keys and grouped as correct or incorrect. The accuracy rates of artificial intelligence programs were compared statistically.RESULTS: ChatGPT, Bing, and Bard chatbots gave correct answers to 35 (50%), 43 (61.4%), and 50 (71.4%) questions asked, respectively. The rate of correct answers to the questions of the Bard artificial intelligence program was significantly higher than that of ChatGPT (P = 0.009, Pearson's Chi-square test).CONCLUSION: Although the currently released artificial intelligence chatbots can be used to access accurate information about lenses, cataracts, and refractive surgery, one should always be careful about the accuracy of the answers given.
Bilateral acute iris transillumination (BAIT) syndrome is an uncommon disorder marked by sudden dispersion of pigment in the anterior chamber, iris sphincter muscle paralysis, and elevated intraocular pressure. This syndrome has been linked to viral infections and the administration of fluoroquinolones such as moxifloxacin. This study presents a case of a 54-year-old male, otherwise in good health, who developed BAIT syndrome 1 week after experiencing an upper respiratory tract infection that followed a coronavirus disease 2019 (COVID-19) diagnosis. The patient was effectively treated with topical prednisolone acetate and antiglaucoma medications. Further studies are required to investigate the relationship between COVID-19 and BAIT to enhance understanding of its pathophysiology.
PURPOSE: The purpose of the to determine the prevalence of cataract and study the relationship of smoking and other potential risk factors with visually significant cataract. METHODS: This is a cross-sectional study based on the Azar cohort databases including 11,208 participants aged 35–70 years of the general population. According to the questionnaire, participants were divided into five groups in terms of smoking. Eye examinations were performed in two steps. The first step was performed by an optometrist, and in the second step, participants with poor red reflex or visual acuity of <8/10 were examined by an ophthalmologist for diagnosing cataract. RESULTS: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of visually significant cataract was 7.2%. The frequency of ex-smoking in the male and female population in the cataract group was significantly higher than that in the noncataract group (male: P = 0.008, female: P = 0.01), but after adjustment for age and education level, lost its significance (male odds ratio [OR] = 1.1 [0.8–1.5], P = 0.4; female OR = 1.5 [0.5–4], P = 0.3). CONCLUSION: There is no association between cigarette smoking in different doses and the history of smoking with cataracts but other factors such as aging, education level, and underlying diseases including diabetes mellitus, hypertension, and myopia have statistically significant association with visually significant cataract.
PURPOSE: A fresh-frozen human cadaveric feasibility study to investigate the feasibility of probing and stenting the nasolacrimal ducts (NLDs) of human cadavers with a novel flexible bicanalicular nasolacrimal stent. METHODS: A custom-designed bicanalicular nasolacrimal stent was made by connecting a 250 mm long, 0.9 mm diameter silicone tube to a 200 mm long stainless-steel, snake-chain probe at each end. The punctum was dilated, and the snake-chain stent fed into the nasolacrimal drainage system. The emergence of the stents from the terminal end of the NLD and retrieval with a ball probe was conducted under endoscopic guidance. RESULTS: Bicanalicular nasolacrimal stenting with intranasal retrieval under endoscopic guidance was successfully achieved in six NLDs of three adult cadaveric nasolacrimal drainage systems. CONCLUSION: Despite being soft and flexible, the snake-chain silicon stent passes smoothly and freely through cadaveric human NLD and is easily retrieved from the nasal cavity. This novel NLD stent design may make stenting of the NLD easier and less traumatic.
PURPOSE: The purpose of this study was to analyze the incidence of retinopathy of prematurity (ROP), treatment requiring ROP (TROP), course, and systemic risk factors in extreme preterm or extreme low-birth-weight babies. METHODS: A retrospective analysis of neonatal intensive care unit-based ROP screening from January to December 2021 in a tier-2 city in Kerala, India, was done. Inclusion criteria were gestational age (GA) ≤28 weeks or birth weight ≤1000 g. ROP screening and treatment were done according to the International Classification of ROP guidelines. Treatment was indicated in babies with type 1 ROP or aggressive ROP. Details of ROP screening, treatment, and neonatal risk factors were collected from the records. The results were statistically analyzed, and P < 0.05 was considered statistically significant. RESULTS: The study included 54 babies with a mean GA of 27.47 ± 1.76 weeks and a mean BW of 847.43 ± 189.22 g. ROP was detected at an average postmenstrual age of 33.8 ± 1.7 weeks. The incidence of any ROP and TROP was 87% and 19.14%, respectively. All babies with TROP were managed with laser or intravitreal antivascular endothelial growth factor injection or both. ROP resolved spontaneously in 60%, but those with Zone 2 disease had delayed regression. Inotropic support and anemia were found to increase the risk for ROP. CONCLUSION: The incidence and outcome of any ROP and TROP in this study are comparable to the rates reported globally, and this reflects the improvement in neonatal care. The use of inotropes and anemia may increase the risk for ROP and needs to be managed judiciously.
