Purpose
The purpose of this prospective study was to predict the effectiveness of subthreshold micropulse laser (SML) based on morphological parameters in patients with central serous ...chorioretinopathy (CSC).
Methods
Thirty-one patients were examined at presentation, 3 months, and 6 months after the disease onset. In patients with persistent subretinal fluid (SRF) at 3 months, SML was performed. The following morphological parameters were observed just before treatment: central retinal thickness (CRT), maximal SRF, choroidal thickness (CT), pigment epithelial detachment (PED) height and width, number of hyperreflective foci (HF) at fovea and leakage site, secondary choroidal neovascularization (CNV), and severity of retinal pigment epithelium (RPE) alterations using multimodal imaging.
Results
Good response was associated with lower SRF (
p
= 0.038), narrower PED (
p
= 0.078), and decreasing number of HF at fovea (difHFf) (
p
= 0 .016) just before the treatment. From a bivariate and multivariate point of view, the two groups differed significantly in the pair (SRF, PED width) (
p
= 0.048) and in the triple (SRF, PED width, difHFf) (
p
= 0.026).
Conclusion
Lower SRF, narrower PED, and decreasing HF could be associated with good response to SML in CSC patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Umetna inteligenca predstavlja zaradi možnosti podpore pri odkrivanju in spremljanju bolezni ter napovedovanju izida novi mejnik v sodobni medicinski tehnologiji. Njena klinična uporabnost se je v ...zadnjih letih dramatično povečala predvsem na račun uvedbe konvolucijskih nevronskih mrež v modeliranje računalniško podprtih sistemov umetne inteligence. Celotna oftalmologija, zlasti pa področje bolezni mrežnice, pri kateri diagnosticiranje sloni na slikovnih preiskavah, se vodi izrazito tehnološko. Zato je edinstvena stroka pri vpeljavi novosti s področja umetne inteligence v klinično uporabo. Kljub temu pa je integracija umetne inteligence v presejanje, diagnosticiranje in zdravljenje oftalmoloških bolezni predvsem zaradi prevelikega posploševanja pri zaznavanju sprememb in slabih zmožnosti sočasnega prepoznavanja različnih kliničnih entitet zaenkrat še omejena. V članku se osredinjamo na nedavno predstavljene algoritme umetne inteligence, ki so prvenstveno namenjeni odkrivanju najpogostejših bolezni mrežnice in so, ali se še bodo, z morebitnimi izboljšavami, pridobljeno višjo občutljivostjo in specifičnostjo, vendarle uvedli v klinično prakso.
New Findings
What is the central question of this study?
Astronauts on‐board the International Space Station (ISS) perform daily exercises designed to prevent muscle atrophy and bone ...demineralization: what is the effect of resistive exercise performed by subjects while exposed to the same level of hypercapnia as on the ISS on intraocular pressure (IOP)?
What is the main finding and its importance?
The static exercise‐induced elevation in IOP during 6° prone head‐down tilt (simulating the headward shift of body fluids in microgravity) is augmented by hypercapnia and exceeds the ocular hypertension threshold.
The present study assessed the effect of 6° head‐down (establishing the cephalad fluid displacement noted in astronauts in microgravity) prone (simulating the effect on the eye) tilt during rest and exercise (simulating exercise performed by astronauts to mitigate the sarcopenia induced by unloading of weight‐bearing limbs), in normocapnic and hypercapnic conditions (the latter simulating conditions on the International Space Station) on intraocular pressure (IOP). Volunteers (mean age = 57.8 ± 6 years, n = 10) participated in two experimental sessions, each comprising: (i) 10 min rest, (ii) 3 min static handgrip exercise (30% max), and (iii) 2 min recovery, inspiring either room air (NCAP) or a hypercapnic mixture (1% CO2, HCAP). We measured IOP in the right eye, cardiac output (CO), stroke volume (SV), heart rate (HR) and mean arterial pressure (MAP) at regular intervals. Baseline IOP in the upright seated position while breathing room air was 14.1 ± 2.9 mmHg. Prone 6° head‐down tilt significantly (P < 0.01) elevated IOP in all three phases of the NCAP (rest: 27.0 ± 3.7 mmHg; exercise: 32.2 ± 4.8 mmHg; recovery: 27.4 ± 4.0 mmHg) and HCAP (rest: 27.3 ± 4.3 mmHg; exercise: 34.2 ± 6.0 mmHg; recovery: 29.1 ± 5.8 mmHg) trials, with hypercapnia augmenting the exercise‐induced elevation in IOP (P < 0.01). CO, SV, HR and MAP were significantly increased during handgrip dynamometry, but there was no effect of hypercapnia. The observed IOP measured during prone 6° HDT in all phases of the NCAP and HCAP trials exceeded the threshold pressure defining ocular hypertension. The exercise‐induced increase in IOP is exacerbated by hypercapnia.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose
The purpose of this study was to identify biomarkers at presentation that are associated with a persistent central serous chorioretinopathy (CSC) episode.
Methods
The prospective study ...included 35 patients with an acute CSC episode. Potential clinical and imaging biomarkers were evaluated at baseline and 3 months from the episode onset. As biomarkers age, sex, steroid use, episode recurrence, central retinal thickness (CRT), macular volume (MV), choroidal thickness (CT), pigment epithelial detachment (PED) height, and width, number of retinal hyperreflective foci (HF), leakage pattern, and area of retinal pigment epithelial (RPE) alterations were investigated.
Results
At 3 months from the CSC episode onset, spontaneous resolution occurred in 19 patients, while 16 patients had a persistent CSC episode. The group of patients with a persistent episode was statistically significantly associated with female sex (p = 0.032), older age (p = 0.015), wider PED (p = 0.005), and higher number of HF (p = 0.02). Moreover, this group of patients had a significant association with thinner choroid and diffuse RPE alterations as a pair (p = 0.008).
Conclusions
Older and female CSC patients with wider PED, increased number of HF, thinner choroid, and diffuse RPE alterations at presentation are inclined to episode persistence and could benefit from earlier treatment.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Purpose
To evaluate visual function parameters during and after an acute central serous chorioretinopathy (CSC) episode.
Methods
A prospective study included 19 fovea involving acute CSC patients ...with episode resolution within 3 months from the episode onset. Optical coherence tomography, best corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG) were performed at baseline, 3 and 6 months from the episode onset. In a sub analysis, patients were divided into groups with greater (gMV,
N
= 9) and lower (lMV,
N
= 10) macular volume at presentation, and functional outcomes were observed.
Results
BCVA (
p
< 0.001), average CS (CS-A) (
p
< 0.001), average retinal sensitivity (MP-A) (
p
< 0.001), mfERG amplitude densities in the first and second ring (mfERG-A1,
p
< 0.001; mfERG-A2,
p
= 0.017), and implicit times in the first, second, and third ring (mfERG-IT1,
p
= 0.024; mfERG-IT2,
p
= 0.002; mfERG-IT3,
p
= 0.018) improved with episode resolution 3 months after the episode onset. From 3 to 6 months after the episode onset, only CS-A (
p
= 0.045) continued to improve. Patients in the gMV group had lower mfERG-A1 (
p
= 0.017) and central retinal sensitivity (MP-C,
p
= 0.05) 6 months from the episode onset.
Conclusions
Although all functional parameters mostly improve with CSC episode resolution, only CS continues to improve thereafter. Patients with greater MV at presentation have worse functional outcomes. Visual function impairment in acute CSC patients is confined to the topographical area of subretinal fluid detachment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
We evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).
Methods
A prospective study was conducted on 50 patients with an acute CSC ...episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.
Results
Among the morphological parameters, SRF showed the strongest correlations with functional parameters (
r
absolute value range = 0.10–0.70). Weak correlations were observed between BCVA and morphological parameters (
r
absolute value range = 0.14–0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (
r
absolute value range = 0.61–0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (
r
absolute value range = 0.35–0.56) yet statistically significantly nonzero correlations.
Conclusions
SRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Age-related macular degeneration (AMD) is the leading cause of loss of visual acuity in developed countries. Antagonists of Vascular Endothelial Growth Factor (anti-VEGF) have been successfully used ...intravitreally in treating the neovascular form of this disease (nAMD) and limiting vision loss. With the latest developments in multimodal imaging we can discern multiple types of neovascularization, some of which have an unusual course, despite treatment with anti-VEGF. Indocianine green angiography (ICGA) and optical coherence tomography (OCT) have been used to distinguish two special forms of nARMD, i.e., retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV). RAP appears in 10–15 % of newly discovered nARMD, usually in older patients and is also known as type 3 neovascularisation, which starts intraretinally. It responds well to anti-VEGF. However, it requires closer monitoring, since in 75 % of patients it requires repeated treatment. In contrast, PCV evolves in the choroid and typically causes hemorrhagic exudative maculopathy, which is relatively unresponsive to anti-VEGF. It appears in 4–14 % of nAMD, and in somewhat younger patients. It requires a specifc approach to treatment, combining anti-VEGF with laser therapy, and close monitoring.Although PCV and RAP are less common forms of nARMD, we should use and properly interpret FA, ICGA and OCT in order to initiate recommended treatments and follow-up. Herewith we can lessen the adverse impact on the visual acuity and increase the quality of life of our patients.
This study aimed to quantify possible long-term impairment of the retinal microcirculation and microvasculature by reassessing a cohort of patients with acute COVID-19 without other known ...comorbidities one year after their discharge from the hospital. Thirty patients in the acute phase of COVID-19 without known systemic comorbidities were enrolled in this prospective longitudinal cohort study. Fundus photography, SS-OCT, and SS-OCTA using swept-source OCT (SS-OCT, Topcon DRI OCT Triton; Topcon Corp., Tokyo, Japan) were performed in the COVID-19 unit and 1-year after hospital discharge. The cohort's median age was 60 years (range 28-65) and 18 (60%) were male. Mean vein diameter (MVD) significantly decreased over time, from 134.8 μm in the acute phase to 112.4 μm at a 1-year follow-up (
< 0.001). A significantly reduced retinal nerve fiber layer (RNFL) thickness was observed at follow-up in the inferior quadrant of the inner ring (mean diff. 0.80 95% CI 0.01-1.60,
= 0.047) and inferior (mean diff. 1.56 95% CI 0.50-2.61,
< 0.001), nasal (mean diff. 2.21 95% CI 1.16-3.27,
< 0.001), and superior (mean diff. 1.69 95% CI 0.63-2.74,
< 0.001) quadrants of the outer ring. There were no statistically significant differences between the groups regarding vessel density of the superior and deep capillary plexuses. The transient dilatation of the retinal vessels in the acute phase of COVID-19, as well as RNFL thickness changes, could become a biomarker of angiopathy in patients with severe COVID-19.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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