Ophthalmology. Retina最新文献

{"title":"Synchronous Diagnosis of Diabetic Retinopathy by a Handheld Retinal Camera, Artificial Intelligence, and Simultaneous Specialist Confirmation","authors":"","doi":"10.1016/j.oret.2024.05.009","DOIUrl":"10.1016/j.oret.2024.05.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Diabetic retinopathy<span><span> (DR) is a leading cause of preventable blindness, particularly in underserved regions where access to </span>ophthalmic care is limited. This study presents a proof of concept for utilizing a portable handheld retinal camera with an embedded artificial intelligence (AI) platform, complemented by a synchronous remote confirmation by retina specialists, for DR screening in an underserved rural area.</span></div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 1115 individuals with diabetes.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a screening initiative conducted in 4 municipalities in Northeastern Brazil, targeting the diabetic population. A portable handheld retinal camera captured macula-centered and disc-centered images, which were analyzed by the AI system. Immediate push notifications were sent out to retina specialists upon the detection of significant abnormalities, enabling synchronous verification and confirmation, with on-site patient feedback within minutes. Referral criteria were established, and all referred patients underwent a complete ophthalmic work-up and subsequent treatment.</div></div><div><h3>Main Outcome Measures</h3><div>Proof-of-concept implementation success.</div></div><div><h3>Results</h3><div>Out of 2052 invited individuals, 1115 participated, with a mean age of 60.93 years and diabetes duration of 7.52 years; 66.03% were women. The screening covered 2222 eyes, revealing various retinal conditions. Referable eyes for DR were 11.84%, with an additional 13% for other conditions (diagnoses included various stages of DR, media opacity, nevus<span>, drusen, enlarged cup-to-disc ratio, pigmentary changes, and other). Artificial intelligence performance for overall detection of referable cases (both DR and other conditions) was as follows: sensitivity 84.23% (95% confidence interval (CI), 82.63–85.84), specificity 80.79% (95% CI, 79.05–82.53). When we assessed whether AI matched any clinical diagnosis, be it referable or not, sensitivity was 85.67% (95% CI, 84.12–87.22), specificity was 98.86 (95% CI, 98.39–99.33), and area under the curve was 0.92 (95% CI, 0.91–0.94).</span></div></div><div><h3>Conclusions</h3><div>The integration of a portable device, AI analysis, and synchronous medical validation has the potential to play a crucial role in preventing blindness from DR, especially in socially unequal scenarios.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"8 11","pages":"Pages 1083-1092"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhagic Occlusive Retinal Vasculitis in a Pregnant Woman","authors":"","doi":"10.1016/j.oret.2024.04.019","DOIUrl":"10.1016/j.oret.2024.04.019","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"8 11","pages":"Page e44"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Outcomes after Proton Therapy for Recurrent Uveal Melanoma","authors":"","doi":"10.1016/j.oret.2024.06.004","DOIUrl":"10.1016/j.oret.2024.06.004","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>Proton beam re-irradiation (PBI) remains an effective and globe-preserving alternative to enucleation in the treatment of local recurrence in </span>uveal melanoma. The study aimed to assess visual outcomes and </span>prognostic factors<span><span> in visual acuity (VA) after proton beam </span>salvage therapy.</span></div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Subjects</h3><div>A retrospective study evaluated patients with recurrent uveal melanoma treated with PBI from 1984 through 2019 at a single academic tertiary center.</div></div><div><h3>Methods</h3><div>Patient and tumor characteristics were collected from the medical record, as well as best visual acuity (BVA) and ocular outcomes after treatment of recurrent uveal melanoma with PBI.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome of the study was the BVA of patients after PBI for recurrent uveal melanoma. Additional outcome measures included enucleation rate of patients after salvage PBI and analysis of tumor and patient characteristics in the prognostication of VA.</div></div><div><h3>Results</h3><div><span>The study comprised 67 patients who received PBI for recurrent uveal melanoma. The median age at recurrence was 67.6 years (range, 31.6–91.0 years), and median follow-up from the time of recurrence to last examination was 4.4 years (range, 0.23–17.1 years). The median final BVA was hand motions (range, 20/20 to no light perception) and 6 (9.1%) patients maintained a Snellen VA 20/40 or better. The 5-year probability of VA retention of 20/200 or better was 19%. In a multivariable Cox model, VA at </span>tumor recurrence<span> of worse than 20/40 was found to be significantly associated with a VA of 20/200 or worse after retreatment with PBI. Twelve (18%) patients underwent enucleation after retreatment with PBI.</span></div></div><div><h3>Conclusions</h3><div>Proton beam irradiation for the treatment of recurrent uveal melanoma allows for ocular preservation and functional vision in select patients.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"8 11","pages":"Pages 1100-1106"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Purtscher-Like Retinopathy Associated with Antiphospholipid Syndrome and Thrombotic Microangiopathy","authors":"","doi":"10.1016/j.oret.2024.03.021","DOIUrl":"10.1016/j.oret.2024.03.021","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"8 11","pages":"Page e39"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cost Effectiveness Analysis of Avacincaptad Pegol for the Treatment of Geographic Atrophy with Comparison to Pegcetacoplan","authors":"","doi":"10.1016/j.oret.2024.05.011","DOIUrl":"10.1016/j.oret.2024.05.011","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>The purpose of this study was to evaluate the cost effectiveness of the treatment of </span>geographic atrophy (GA) with intravitreal </span>avacincaptad pegol<span> (ACP) and to compare it with pegcetacoplan (PEG).</span></div></div><div><h3>Design</h3><div>Cost analysis based on data from published studies.</div></div><div><h3>Subjects</h3><div>None; based on data from published sham control compared with 2 treatment groups in each of the index studies.</div></div><div><h3>Methods</h3><div>Costs were based on 2022 Medicare reimbursement data for both facility (hospital-based) and nonfacility settings in Miami. Specific usage and outcomes were derived from the GATHER2 study as well as DERBY and OAKS trials. For ACP, all patients were treated every month (EM) in year 1 then randomized to every other month (EOM) or EM in year 2. Two-year models were created for patients in the facility setting for extrafoveal (ACP and PEG) and all patients (PEG).</div></div><div><h3>Main Outcome Measures</h3><div>Cost, cost utility, and cost per area of GA (in United States dollars).</div></div><div><h3>Results</h3><div><span>The cost to treat GA with ACP in EM and EOM treatment groups over the 2 years as reported was $67 400 and $40 600, respectively. With ACP treatment over 2 years, the daily cost of delaying GA 3.4 months (EM) and 4.5 months (EOM) was $649 (EM) and $356 (EOM). The (facility-based) costs per unit area of retinal pigment epithelium saved for patients with extrafoveal GA over the 2-year period were $119 000/mm</span>² (EM ACP) versus $54 000/mm² (EM PEG) (<em>P</em> &lt; 0.001), $57 100/mm² (EOM ACP) versus $31 400/mm² (EOM PEG) (<em>P</em> &lt; 0.001), and $45 300/mm² (hypothetical EOM from outset ACP).</div></div><div><h3>Conclusion</h3><div>Treatment of GA with intravitreal ACP EOM was more cost effective than EM. When assessing extrafoveal lesions, ACP was less cost effective than PEG for both EM and EOM treatment.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"8 11","pages":"Pages 1061-1065"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141083088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Valsalva-Induced Choroidal Hemorrhage in High Myopia.","authors":"Livia Faes, Alessandro Feo, Jiwei Sheng, Prithvi Ramtohul, Bradley S Gundlach, J Michael Jumper, David Sarraf, K Bailey Freund","doi":"10.1016/j.oret.2024.10.021","DOIUrl":"10.1016/j.oret.2024.10.021","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraocular Melanocytoma in a 37-Year-Old Patient.","authors":"Blanca Casado-Pelaez, Romana García-Gil, Rafael Martínez-Costa","doi":"10.1016/j.oret.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.oret.2024.09.013","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphologic Stages of Full-Thickness Macular Hole on Spectral-Domain OCT.","authors":"Aurora Pecaku, Isabela Martins Melo, Jessica A Cao, Shiva Sabour, Sumana C Naidu, Sueellen Demian, Marko M Popovic, Charles C Wykoff, Andrea Govetto, Rajeev H Muni","doi":"10.1016/j.oret.2024.10.018","DOIUrl":"10.1016/j.oret.2024.10.018","url":null,"abstract":"<p><strong>Objective: </strong>To describe the sequential morphological changes of the outer retina after full-thickness macular hole (FTMH) formation utilizing a novel, objective staging system based on OCT, and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months.</p><p><strong>Design: </strong>Retrospective, observational, multicenter study.</p><p><strong>Participants: </strong>Patients with idiopathic FTMH presenting to St. Michael's Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, Texas from 2009 to 2022.</p><p><strong>Methods: </strong>The medical charts of 1000 patients with FTMH were reviewed, and those with ≥2 preoperative spectral-domain OCTs (SD-OCTs) were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans.</p><p><strong>Main outcome measures: </strong>Sequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes.</p><p><strong>Results: </strong>Fifty-two eyes of 52 patients with a mean age of 65.4 ± 8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages: stage A, separation of the neurosensory retina from the retinal pigment epithelium with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (4/52, 7.7%); stage B, thickening of the EZ (27/52, 52.0%); stage C, patchy (moth-eaten) photoreceptor loss (16/52, 30.7%); and stage D, severe or complete loss of inner and outer segments and bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 ± 350.4 days (range, 5-1841), 28.85% (15/52) of eyes were in stage B, 28.85% (15/52) were in stage C, and 42.3% (22/52) were in stage D. There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (P = 0.032) and worse visual acuity at baseline (P < 0.001). Additionally, patients presenting with stages B and C at the time point closest to surgery had better visual acuity outcomes 3 months postoperatively than those with stage D (P = 0.04).</p><p><strong>Conclusions: </strong>This SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation, providing a novel imaging biomarker.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Macular Neovascularization in Eyes Presenting with Macular Edema using OCT Angiography and a Deep Learning Model.","authors":"Nida Wongchaisuwat, Jie Wang, Elizabeth S White, Thomas S Hwang, Yali Jia, Steven T Bailey","doi":"10.1016/j.oret.2024.10.017","DOIUrl":"10.1016/j.oret.2024.10.017","url":null,"abstract":"<p><strong>Purpose: </strong>To test the diagnostic performance of an artificial intelligence algorithm for detecting and segmenting macular neovascularization (MNV) with OCT and OCT angiography (OCTA) in eyes with macular edema from various diagnoses.</p><p><strong>Design: </strong>Prospective cross-sectional study.</p><p><strong>Participants: </strong>Study participants with macular edema due to either treatment-naïve exudative age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO).</p><p><strong>Methods: </strong>Study participants were imaged with macular 3 × 3-mm and 6 × 6-mm spectral-domain OCTA. Eyes with exudative AMD were required to have MNV in the central 3 × 3-mm area. A previously developed hybrid multitask convolutional neural network for MNV detection (aiMNV), and segmentation was applied to all images, regardless of image quality.</p><p><strong>Main outcome measures: </strong>Sensitivity, specificity, positive predictive value, and negative predictive value of detecting MNV and intersection over union (IoU) score and F1 score for segmentation.</p><p><strong>Results: </strong>Of 114 eyes from 112 study participants, 56 eyes had MNV due to exudative AMD and 58 eyes with macular edema due to either DME or RVO. The 3 × 3-mm OCTA scans with aiMNV detected MNV with 96.4% sensitivity, 98.3% specificity, 98.2% positive predictive value, and 96.6% negative predictive value. For segmentation, the average IoU score was 0.947, and the F1 score was 0.973. The 6 × 6-mm scans performed well; however, sensitivity for MNV detection was lower than 3 × 3-mm scans due to lower scan sampling density.</p><p><strong>Conclusions: </strong>This novel aiMNV algorithm can accurately detect and segment MNV in eyes with exudative AMD from a control group of eyes that present with macular edema from either DME or RVO. Higher scan sampling density improved the aiMNV sensitivity for MNV detection.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Fluid and Thickness Fluctuations in Archway Trial for Port Delivery System with Ranibizumab versus Monthly Ranibizumab Injections.","authors":"Veeral S Sheth, Nancy M Holekamp, Arshad M Khanani, Aleksandra Rachitskaya, Steven Blotner, Shamika Gune, Dominic Heinrich, Katie F Maass, Usha Chakravarthy","doi":"10.1016/j.oret.2024.10.015","DOIUrl":"10.1016/j.oret.2024.10.015","url":null,"abstract":"<p><strong>Purpose: </strong>To determine proportion of eyes with neovascular age-related macular degeneration (nAMD) with retinal fluid and central subfield thickness (CST) fluctuations and evaluate their impact on best-corrected visual acuity (BCVA) in eyes treated with the Port Delivery System with ranibizumab (PDS) versus monthly intravitreal ranibizumab injections.</p><p><strong>Design: </strong>Post hoc analyses of phase 3 Archway trial (NCT03677934).</p><p><strong>Participants: </strong>Adults with nAMD responsive to anti-VEGF therapy.</p><p><strong>Intervention: </strong>Four hundred eighteen patients randomized 3:2 to the PDS (100 mg/mL) with refill-exchanges every 24 weeks (Q24W) or monthly intravitreal ranibizumab (0.5 mg) for 96 weeks.</p><p><strong>Outcomes: </strong>Proportion of eyes in each treatment arm with subretinal and/or intraretinal fluid (SRF/IRF) overall and in central 1 mm; BCVA changes from baseline by treatment arm and fluid presence/location; proportion of eyes with CST fluctuations from baseline to week 48, week 48 to 96, and baseline to week 96; effects of CST fluctuations on BCVA.</p><p><strong>Results: </strong>Four hundred fifteen eyes were assessed. In the PDS versus monthly ranibizumab arm, proportion of eyes with SRF/IRF, central SRF, and central IRF were 47.6% versus 50.9%, 29.0% versus 19.2%, and 11.7% versus 12.6% at baseline, and 57.8% versus 56.1%, 21.6% versus 14.8%, and 7.0% versus 8.4% at week 96, respectively. BCVA changes from baseline to week 96 were -1.1 letters with the PDS versus -1.4 with monthly ranibizumab in eyes with SRF/IRF, and -1.9 versus -1.8 in eyes with central SRF. In eyes with central IRF, BCVA changes from baseline to week 96 were -2.1 with the PDS versus -6.9 with monthly ranibizumab, respectively (mean BCVA at 96 weeks 68.9 [20/40] vs. 64.6 [20/50]). CST fluctuations occurred in 32.1% and 29.7% of PDS versus monthly ranibizumab eyes; corresponding BCVA changes from baseline to week 96 were -2.5 versus -2.6 (mean BCVA at 96 weeks 72.7 [20/35] vs. 71.5 [20/38]).</p><p><strong>Conclusions: </strong>Port Delivery System with ranibizumab Q24W maintained BCVA to 96 weeks regardless of SRF/IRF, central SRF, central IRF, or CST fluctuations, comparable with monthly ranibizumab, thus supporting the use of the PDS in stabilizing retinal anatomy without the need for monthly treatment in patients with nAMD.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}