Ocular disorders in children with spastic subtype of cerebral palsy

AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors.METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student’s t tests were used in the statistical analysis.RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5% ) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P =0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6% ) had nystagmus and 107 children (55.2% ) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P =0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2% ). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P =0.000).CONCLUSION:Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.·

Autologous blood in the management of ocular surface disorders

Autologous blood therapy has emerged as a promising modality in managing ocular surface disorders.This review provides a comprehensive overview of the current literature regarding the use of autologous blood in ocular surface disorders,encompassing its physiological basis,clinical applications,techniques,challenges,and future perspectives.The ocular surface,comprising the cornea,conjunctiva,and tear film,plays a critical role in maintaining visual function,and its disruption can lead to various pathological conditions.With its rich composition of growth factors,cytokines,and other bioactive molecules,autologous blood offers therapeutic potential in promoting corneal wound healing,reducing inflammation,and improving tear film stability.Clinical studies have demonstrated the efficacy and safety of autologous blood therapy in diverse ocular surface disorders,including persistent epithelial defects,neurotrophic keratopathy,and dry eye disease.However,challenges such as variability in treatment response,adverse effects,and optimal patient selection remain areas of concern.Further research is needed to elucidate the underlying mechanisms of action,refine treatment protocols,and explore synergistic approaches with other therapeutic modalities.Despite these challenges,autologous blood therapy holds promise as a valuable adjunctive treatment option for ocular surface disorders,offering new avenues for improving patient outcomes and quality of life.This review examines the mechanisms underlying ocular surface disorders while discussing existing autologous blood-based therapies for managing these disorders.Current clinical trials are also summarized,and a comparison between autologous blood therapy and conventional eyedrops is attempted.Finally,safe techniques and protocols for autologous blood medicine are elucidated,and adverse effects and future perspectives of this novel therapy are reviewed.

Deep Transfer Learning Models for Mobile-Based Ocular Disorder Identification on Retinal Images

Mobile technology is developing significantly.Mobile phone technologies have been integrated into the healthcare industry to help medical practitioners.Typically,computer vision models focus on image detection and classification issues.MobileNetV2 is a computer vision model that performs well on mobile devices,but it requires cloud services to process biometric image information and provide predictions to users.This leads to increased latency.Processing biometrics image datasets on mobile devices will make the prediction faster,but mobiles are resource-restricted devices in terms of storage,power,and computational speed.Hence,a model that is small in size,efficient,and has good prediction quality for biometrics image classification problems is required.Quantizing pre-trained CNN(PCNN)MobileNetV2 architecture combined with a Support Vector Machine(SVM)compacts the model representation and reduces the computational cost and memory requirement.This proposed novel approach combines quantized pre-trained CNN(PCNN)MobileNetV2 architecture with a Support Vector Machine(SVM)to represent models efficiently with low computational cost and memory.Our contributions include evaluating three CNN models for ocular disease identification in transfer learning and deep feature plus SVM approaches,showing the superiority of deep features from MobileNetV2 and SVM classification models,comparing traditional methods,exploring six ocular diseases and normal classification with 20,111 images postdata augmentation,and reducing the number of trainable models.The model is trained on ocular disorder retinal fundus image datasets according to the severity of six age-related macular degeneration(AMD),one of the most common eye illnesses,Cataract,Diabetes,Glaucoma,Hypertension,andMyopia with one class Normal.From the experiment outcomes,it is observed that the suggested MobileNetV2-SVM model size is compressed.The testing accuracy for MobileNetV2-SVM,InceptionV3,and MobileNetV2 is 90.11%,86.88%,and 89.76%respectively while MobileNetV2-SVM,InceptionV3,and MobileNetV2 accuracy are observed to be 92.59%,83.38%,and 90.16%,respectively.The proposed novel technique can be used to classify all biometric medical image datasets on mobile devices.

Suprasellar cistern tuberculoma presenting as unilateral ocular motility disorder and ptosis:A case report

BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.

Efficacy of intraorbital electroacupuncture for diabetic abducens nerve palsy： study protocol for a prospective single-center randomized controlled trial

Abducens nerve palsy（ANP） is commonly seen in patients with diabetes mellitus. The validity of acupuncture as a traditional Chinese medicine method in peripheral nerve repair is well established. However, its efficacy in randomized controlled trials remains unclear. Herein, we designed a protocol for a prospective, single-center, randomized controlled trial to investigate the effect of intraorbital electroacupuncture on diabetic ANP. We plan to recruit 60 patients with diabetic ANP, and randomly divide them into treatment and control groups. Patients in both groups will continue their glucose-lowering therapy. A neural nutrition drug will be given to both groups for six weeks. The treatment group will also receive intraorbital electroacupuncture therapy. We will assess efficacy of treatment, eyeball movement, diplopia deviation and the levels of fasting blood-glucose and glycosylated hemoglobin before treatment at 2, 4, and 6 weeks after treatment. The efficacy and recurrence will be investigated during follow-up（1 month after intervention）. This protocol was registered at Chinese Clinical Trial Registry on 16 January 2015（Chi CTR-IPR-15005836）. This study was approved by the Ethics Committee of First Affiliated Hospital of Harbin Medical University of China（approval number： 201452）. All protocols will be in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by participants. We envisage that the results of this clinical trial will provide evidence for promoting clinical use of this new therapy for management of ANP.

The promise of stem cell-based therapeutics in ophthalmology

The promising role of cellular therapies in the preservation and restoration of visual function has prompted intensive efforts to characterize embryonic, adult, and induced pluripotent stem cells for regenerative purposes. Three main approaches to the use of stem cells have been described： sustained drug delivery, immunomodulation, and differentiation into various ocular structures. Studies of the differentiation capacity of all three types of stem cells into epithelial, neural, glial and vascular phenotypes have reached proof-of-concept in culture, but the correction of vision is still in the early developmental stages, and the requirements for effective in vivo implementation are still unclear. We present an overview of some of the preclinical findings on stem-cell rescue and regeneration of the cornea and retina in acute injury and degenerative disorders.

Bioinspired self-assembly supramolecular hydrogel for ocular drug delivery

Based on a recent report concerning endogenous agents(i.e., pyridoxal phosphate, adenosine triphosphate, adenosine monophosphate, folinic acid) that modulate the oligomerization of apoptosis-associated speck-like protein(ASC) via the peptide epitope of KKFKLKL, we rationally designed and synthesized a nonapeptide(Nap FFKKFKLKL), which can co-assemble with dexamethasone sodium phosphate(Dexp) to generate a Nap FFKKFKLKL/Dexp supramolecular hydrogel for ocular drug delivery.The Nap FFKKFKLKL/Dexp hydrogel formed instantly after the complexation of Nap FFKKFKLKL with Dexp in aqueous solution. The formed supramolecular hydrogels were thoroughly characterized by transmission electron microscopy(TEM), fluorescent spectrum, circular dichroism(CD) spectra and rheology. The peptide concentration significantly affected the in vitro release behavior of Dexp from the supramolecular hydrogel, and the higher peptide concentration resulted in the slower drug release.Following a single intravitreal injection, the proposed Nap FFKKFKLKL/Dexp hydrogel displayed good intraocular biocompatibility without having an adverse impact on the retinal architecture and eyesight functions during one month of follow-up. Using an experimental autoimmune uveitis(EAU) rat model,we demonstrated that the resulting Nap FFKKFKLKL/Dexp hydrogel had potent capacity to alleviate the intraocular inflammation and retain the morphology of retinal architecture. Overall, the resulting Nap FFKKFKLKL/Dexp hydrogel may be a promising drug carrier system to treat various posterior disorders(i.e., uveitis).

Application of anterior scleral thickness measurement in different ocular conditions using anterior segment optical coherence tomography:a systemic review

Purpose:To conduct a review to systematically evaluate the use of anterior segment optical coherence tomography(AS-OCT)in measuring anterior scleral thickness across diverse ocular conditions and its clinical implications.Methods:Literature search was conducted across electronic databases,including PubMed,Scopus,and Embase,to identify relevant studies.The risk of bias was assessed,and the main characteristics of each studies were analyzed.We calculated the overall mean anterior scleral thickness using the data which have measurement at the same locations.Results:A total of 32 studies were included that utilized AS-OCT to measure anterior scleral thickness in both healthy subjects and individuals with ocular disorders such as myopia,keratoconus,scleritis,and others.The review found that anterior scleral thickness is significantly influenced by age,diurnal variation,and specific ocular conditions.For example,myopic eyes may exhibit thinner sclera,particularly along certain meridians,while conditions like scleritis showed increased scleral thickness due to inflammation.However,some studies have inconsistent results.Additionally,AS-OCT proved effective in detecting subtle variations in anterior scleral thickness,which could be linked to the progression of ocular diseases.Conclusions:Anterior scleral thickness varies considerably depending on age,time of day,and ocular health,making it a valuable parameter in the assessment of eye conditions.AS-OCT's ability to measure these variations non-invasively broadens its application in both clinical practice and research,offering new insights into the biomechanical properties of the sclera and their implications for ocular diseases.