A Rare Cause of Leukocoria in Children: Persistent Hyperplastic Primary Vitreous

Introduction: Leukocoria, a whitish pupillary reflection, is a common warning sign of various pediatric ocular pathologies, including Persistent hyperplastic primary vitreous (PHVP). This case report describes the observation of a 3-year-old child with melanoderma, presenting with a white spot in the left eye since birth. Observation: Uncorrected distance visual acuity was 2/10 in the right eye and hand movements were perceived at 2 meters in the left eye. Examination of the anterior segment in the left eye revealed leukocoria and microphthalmia. The fundus examination was normal in the right eye but revealed a white mass extending from the center of the optic disc towards the temporal region in the left eye. Ocular imaging, including ocular ultrasound and optical coherence tomography, confirmed the diagnosis of PHVP, illustrated by a residual white mass at the center of the optic disc in the left eye. Conclusion: PHVP should be considered in the presence of leukocoria in a child, with urgent exclusion of retinoblastoma. This observation underscores the importance of early diagnosis for appropriate management. .

Recommendation on data collection and annotation of ocular appearance images in ptosis

Ptosis is a common ophthalmologic condition,and the diagnosis is primarily based on ocular appearance.Thediagnosis of such conditions can be improved using emerging technology such as artificial intelligence-basedmethods.However,unified data collection and labeling standards have not yet been established.This directlyimpacts the accuracy of ptosis diagnosis based on appearance alone.Therefore,in the present study,we aimedto establish a procedure to obtain and label images to devise a recommendation system for optimal recognitionof ptosis based on ocular appearances.This would help to standardize and facilitate data sharing and serve as aguideline for the development and improvisation of algorithms in artificial intelligence for ptosis.

Optical coherence tomography for ocular surface and corneal diseases: a review

The advent of optical coherence tomography(OCT)imaging has changed the way ophthalmologists image the ocular surface and anterior segment of the eye.Its ability to obtain dynamic,high and ultra-high resolution,cross-sectional images of the ocular surface and anterior segment in a noninvasive and rapid manner allows for ease of use.In this review,we focus on the use of anterior segment OCT,which provides an“optical biopsy”or in vivo imaging of various ocular surface and corneal pathologies,allowing the clinician to diagnose diseases otherwise not visualized by traditional methods.The utility of anterior segment OCT for various anterior segment pathologies is reviewed.

Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

Background:To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia(OSSN)detected by high-resolution anterior segment tomography(HR-OCT)in patients with clinically unapparent disease following topical treatment.Methods:A retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted.Patients undergoing primary therapy with topical 5-fluorouracil 1%(5-FU)(4 times a day for 7 days with a 21-day break)or interferon-alpha-2b(IFN)(4 times a day)were reviewed.Patients were separated into two groups.Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT.Group 2(sub-clinical OSSN group)included individuals with clinical OSSN resolution but with features of persistent disease on HR-OCT.Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct.Results:A total of 95 patients(95 eyes)were reviewed.Sub-clinical OSSN was detected at a frequency of 17%in our study patients(n=16 patients,9 treated with 5-FU and 7 treated with IFN).In the 16 individuals,the mean time to clinical resolution was 3.6±1.0 cycles for 5-FU and 4.0±0.0 months for IFN.An additional 2.1±0.8 cycles for 5-FU and 1.2±0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN.Recurrence in Group 1 was noted in 10 patients(12%)while no recurrences occurred in Group 2,the cohort with subclinical disease that received the extended medical therapy.The mean follow-up was 24.0±17.9 months.Conclusion:We found that at least 17%of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT.This information can be used to optimize treatment and extend therapy past the point of clinical resolution.

Ocular image-based deep learning for predicting refractive error:A systematic review

ackground:Uncorrected refractive error is a major cause of vision impairment worldwide and its increasing prevalent necessitates effective screening and management strategies.Meanwhile,deep learning,a subset of Artificial Intelligence,has significantly advanced ophthalmological diagnostics by automating tasks that required extensive clinical expertise.Although recent studies have investigated the use of deep learning models for refractive power detection through various imaging techniques,a comprehensive systematic review on this topic is has yet be done.This review aims to summarise and evaluate the performance of ocular image-based deep learning models in predicting refractive errors.Main text:We search on three databases(PubMed,Scopus,Web of Science)up till June 2023,focusing on deep learning applications in detecting refractive error from ocular images.We included studies that had reported refractive error outcomes,regardless of publication years.We systematically extracted and evaluated the continuous outcomes(sphere,SE,cylinder)and categorical outcomes(myopia),ground truth measurements,ocular imaging modalities,deep learning models,and performance metrics,adhering to PRISMA guidelines.Nine studies were identified and categorised into three groups:retinal photo-based(n=5),OCT-based(n=1),and external ocular photo-based(n=3).For high myopia prediction,retinal photo-based models achieved AUC between 0.91 and 0.98,sensitivity levels between 85.10%and 97.80%,and specificity levels between 76.40%and 94.50%.For continuous prediction,retinal photo-based models reported MAE ranging from 0.31D to 2.19D,and R^(2) between 0.05 and 0.96.The OCT-based model achieved an AUC of 0.79–0.81,sensitivity of 82.30%and 87.20%and specificity of 61.70%–68.90%.For external ocular photo-based models,the AUC ranged from 0.91 to 0.99,sensitivity of 81.13%–84.00%and specificity of 74.00%–86.42%,MAE ranges from 0.07D to 0.18D and accuracy ranges from 81.60%to 96.70%.The reported papers collectively showed promising performances,in particular the retinal photo-based and external eye photo-based DL models.Conclusions:The integration of deep learning model and ocular imaging for refractive error detection appear promising.However,their real-world clinical utility in current screening workflow have yet been evaluated and would require thoughtful consideration in design and implementation.

The use of high resolution anterior segment optical coherence tomography for the characterization of conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia

Background:Conjunctival lymphoma,conjunctival amyloidosis and benign reactive lymphoid hyperplasia(BRLH)are conditions that often have a similar appearance on the ocular surface.The use of high resolution anterior segment optical coherence tomography(HR-OCT)enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions.In this study,we characterize the morphological differences seen in conjunctival lymphoma,conjunctival amyloidosis and BRLH on HR-OCT imaging.Methods:A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma,conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute.Patients were excluded if HR-OCT imaging was not performed on initial presentation.Results:Thirty-four total eyes of 27 patients were identified.Twenty eyes had conjunctival lymphoma(16 patients),8 eyes had conjunctival amyloidosis(6 patients)and 6 eyes had BRLH(5 patients).All conditions appeared clinically as pink,red or yellow subepithelial lesions but had different features on HR-OCT.In lymphoma,HR-OCT images typically showed homogenous,dark subepithelial lesions with smooth borders,containing monomorphic dot-like infiltrates.HR-OCT images of amyloidosis typically showed heterogeneous,dark lesions with irregular borders,often containing hyperreflective linear infiltrates.HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue,at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective,subepithelial tissue.Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions.Conclusions:Distinctive features on HR-OCT of conjunctival lymphoma,conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination.Future studies can further validate this technology’s use with more subtle and challenging lesions.