Hypoxia increases adipogenesis and affects adipocytokine production in orbital fibroblasts-a possible explanation of the link between smoking and Graves' ophthalmopathy

AIM:To assess the effects of hypoxia on human orbital fibroblasts(OF)on adipogenesis and adipocytokine production.METHODS:Human OF were derived from tissues obtained from patients with Graves’ophthalmopathy(GO)and from patients without known thyroid diseases undergoing blepharoplasty.The OF were cultured separately under normoxic and hypoxic conditions.Comparisons of adipocytokine concentrations using multiplex ELISA and lipid accumulation in the cells using Oil Red O staining were subsequently performed.RESULTS:There was increased adipogenesis in OF from GO subject when exposed to hypoxic culture conditions.This was not observed in OF from normal controls.Hypoxia led to an increase in leptin and a decrease in MCP-1 secretion in OF cultures.CONCLUSION:Hypoxia induces adipogenesis in OF and may represent a mechanism by which smoking contributes to deterioration of GO.We also found novel changes to leptin and MCP-1 production in OF cultures exposed to hypoxia suggesting important roles of these cytokines in the disease process.

Ophthalmology simulation for undergraduate and postgraduate clinical education

This is a review education paper on the current ophthalmology simulators utilized worldwide for undergraduate and postgraduate training. At present, various simulators such as the EYE Exam Simulator （Kyoto Kagaku Co. Ltd., Kyoto, Japan）, Eyesi direct ophthalmoscope simulator （VRmagic, GmbH, Mannheim, Germany）, Eyesi indirect ophthalmoscope simulator （VRmagic, GmbH, Mannheim, Germany） and Eyesi cataract simulators （VRmagic, GmbH, Mannheim, Germany）. These simulators are thought to be able to reduce the initial learning curve for the ophthalmology training but further research will need to be conducted to assess the effectiveness of the simulation-assisted ophthalmology training. Future research will be of great value to assess the medical students and residents responses and performance regarding the usefulness of the individual eye simulator.

Bleb needling outcomes for failed trabeculectomy blebs in Asian eyes: a 2-year follow up

·AIM: To describe the outcomes of bleb needling in primary glaucoma in an Asian tertiary eye centre over a2 y period. To compare the success rates between primary angle-closure glaucoma(PACG) and primary open angle glaucoma(POAG). Lastly, to identify factors associated with success of bleb needling.·METHODS: This was a retrospective review of 227 patients who underwent bleb needling between June2009 and June 2011 in Singapore National Eye Centre.The 5-fluorouracil(5-FU) augmented bleb needling was performed either at the slit lamp or in the operating theatre. Repeat bleb needlings were performed as necessary. Complete success was defined as maintenance of intraocular pressure(IOP) ≥6 mm Hg and ≤21 mm Hg, in the absence of further surgery or use of antiglaucoma medication. Qualified success met the above criteria with or without use of antiglaucoma medications.· RESULTS: One hundred and seventy-five eyes completed the two-year follow up. Sixty-nine percent of participants had POAG and 31% had PACG. The mean interval between filtering surgery and bleb needling was299.9 ±616.4d for POAG and 167.1 ±272.2d for PACG.Mean needling attempts were 1.9±1.4 and 2±1.6 for POAG and PACG respectively. In general, there was a statistically significant reduction of IOP ranging from21.9% to 26.8% from month 1 through to month 24. The complete success rates at month 6 were 70.0% for POAG and 65.7% for PACG. At month 12, this decreased to62.2% for POAG and PACG and at month 24, 57.9% for POAG and 63.0% for PACG respectively. The qualified success rates at month 6 for POAG and PACG were23.8% and 29.9% respectively, 32.2% and 29.2% at month12, and 34.7% and 29.6% at month 24. The success ratesbetween POAG and PACG were not significantly different(P 】0.05 for complete and qualified success at months 6,12 and 24). An increased number of needlings and higher pre-needling IOP were associated with failure.·CONCLUSION: The 5-FU augmented bleb needling within one year of trabeculectomy in Asian eyes can provide clinically significant IOP lowering of more than20% for 2y. POAG and PACG had similar complete success rates(58% and 63% respectively). Factors associated with greater risk of procedure failure included increased number of needlings and higher pre-needling IOP. Asian eyes have a greater propensity for scarring but bleb needling, if performed in a timely manner can rescue bleb function.

急性原发性房角关闭的脉络膜扩张机制:发病最初2周的生物测量指标变化研究

Background/aim: Choroidal expansion with anterior movement of the lens was rec ently proposed as a mechanism for acute primary angle closure (APAC). The aim of this study was to compare the biometric parameters, central anterior chamber de pth, limbal chamber depth, lens thickness, and lens position, within 24 hours of presentation and 2 weeks later in eyes with APAC. Methods: This was a prospecti ve observational case series of 41 subjects with APAC. Subjects who presented wi th APAC were treated with medical therapy followed by laser iridotomy (LI) in bo th eyes once the acute attack was broken. Ocular biometry was performed in affec ted and fellow eyes before LI (baseline) and then 2 weeks later. Optical pachyme try was used to measure central anterior chamber depth (ACD) and the limbal cham ber depth (LCD) was graded at the slit lamp. A-scan ultrasound was used to measure lens thickness (LT) and axial len gth (AL). Lens position (LP) was defined as ACD +1/2LT. Results: The majority o f subjects were Chinese (83%)and female (61%), and the mean age was 60.4 (SD 1 0.3) years. In affected eyes, the ACD was 1.81 (0.29) mm before and 1.80 (0.28) mm 2 weeks after LI (p=0.63), while in fellow eyes, the ACD was 1.83 (0.29) mm a nd 1.81 (0.38) mm, respectively (p=0.21). There was no significant change in len s position, relative lens position, or axial length in both affected and fellow eyes over the 2 weeks. Conclusions: There was no change observed in central ante rior chamber depth, lens thickness, or lens position at the time of the acute at tack compared to 2 weeks later in both APAC affected and fellow eyes. The findin gs do not support the hypothesis of lens movement due to choroidal expansion in APAC.

视盘椭圆度作为视盘倾斜指数及其与近视和视野的联系

Purpose: To examine the association of optic disk ovality with myopic refractive error, axial length, and the visual field. Design: Prospective observational case series. Methods: The study included 150 randomly recruited male subjects with myopia. In all cases, one eye was randomly selected, and subjective refraction, slit- lamp examination, applanation tonometry, gonioscopy, A- scan ultrasonography, funduscopy, and color optic disk stereo photography were performed. Disk ovality was assessed using the ratio of minimum to maximum disk diameter (index of tilt). A ratio of ≤ 0.8 was considered as significant disk tilt. Visual fields were tested using static automated threshold perimetry with two methods of optical correction: trial lenses and contact lenses. Results: Of the total sample, 137 subjects completed the study. Mean age was 21.2± 1.1 year, and mean spherical equivalent was- 6.36± 3.56 diopters. Mean ovality ratio was 0.83± 0.09;55 subjects (40.2% ) had significant tilted optic disks. Greater optic disk ovality (tilt) correlated with greater myopia (P=.009) and longer axial length (P =.009); 95.6% of subjects had normal visual fields with both methods of optical correction. Using multiple linear regression analysis, greater tilt was independently related to a higher mean defect on testing with trial lenses (P< .01). Conclusions: Increased optic disk tilt was associated with higher myopia and reduced sensitivity on field testing. These factors are important in the assessment of glaucoma in patients with myopia.

在近视患者中评价OrbscanⅡ角膜地形图仪

Purpose: To evaluate Orbscan II (Bausch & Lomb,Orbtek Inc.,Salt Lake City,UT) corneal topography in individuals with myopia. Design: Retrospective,observational,consecutive,clinical case series. Participants: One hundred forty eyes of 70 persons with myopia. Methods: Manifest refraction results and the Orbscan II corneal topographic maps were reviewed retrospectively. Main Outcome Measures: Refractive powers and the following test indices produced by Orbscan II were analyzed: anterior elevation best-fit sphere (BFS),posterior elevation BFS,maximum posterior elevation (Max PE),radius of Max PE,maximum keratometry,minimum ker atometry,astigmatism,3-mm irregularity,3-mm mean power,3-mm astigmatism,5-mm irregularity,5-mm mean power,5-mm astigmatism,corneal diameter,pupil diameter,thinnest pachymetry,and anterior chamber depth. The correlations between right eyes and left eyes and between indices were explored. Results: Of the 140 eyes,the mean manifest refraction was-5.27± 2.19 diopters (D; range,-10.50 to 0.00 D),the mean Max PE was 28± 7 μ m,and the mean maximum keratometry was 44.5± 1.5 D. Correlation coefficient analyses of Orbscan II quantitative indices combined with pattern recognition showed that there were high degrees of correlations between the right and left eyes of each individual patient. Maximum posterior elevation,corneal irregularity,and thinnest pachymetry did not vary with the degree of maximum keratometry. Conclusions: This article provides a detailed description and analysis of Orbscan II corneal topography of a normal population with myopia. This helps in establishing normal standards in Orbscan II corneal topography that will aid in preoperative assessment in refractive surgery.

阿托品治疗近视儿童的多焦视网膜电图

Aim: To assess retinal function by multifocal electroretin-ogram (mfERG) in children on atropine eye drops for the treatment of myopia. Methods: mfERGs were recorded in children receiving atropine eye drops (n=48) once daily for 2 years and in those receiving placebo eye drops (n=57) for a similar time. All recordings were performed between the second and third month of cessation of atropine/placebo treatment by a masked investigator. The amplitude and implicit time of the first order kernel (k1) and first slice of the second order kernel (k21) of mfERG responseswere used to study the outer and inner retinal function, respectively. Results: There was no significant reduction in k1 response amplitudes of the atropine group compared to that of the placebo group (N1, P=0.181; P1, P=0.150). No significant difference in the k1 response implicit times between the groups was found (N1, P=0.767; P1, P=0.849). The differences in the k21 amplitudes and implicit times between the groups were not statistically significant (k21 amplitude, P=0.058; k21 implicit time, P=0.156). Conclusions: Daily atropine usage over 2 years for the treatment of myopia has no significant effect on retinal function as demonstrated by recordings of mfERG.

Use of Perfluorocarbon Liquids in Complicated Retinal Detachments

We now have an additional tool to help in managing complicated retinal detachments. We look forward to the day when we can leave the liquid without having to remove it because of the possibility of ocular complications.

登革热病的眼部表现

Purpose To evaluate ocular manifestations associated with dengue fever. Design Retrospective case series and literature review. Methods Clinical records of pa tients with dengue fever who subsequently had ocular symptoms and signs develop were reviewed. The clinical presentation and ocular complication s were evaluated. Results Six patients, 5 females and 1 male, were seen with a s udden decrease in vision 6 to 7 days after the initial manifestations of dengue fever were identified. The diagnosis was confirmed by detection of dengue speci fic IgM antibodies (IgM enzyme linked immunoassay). The presenting best correc ted visual acuity ranged from 20/30 to counting fingers, and ocular involvement was bilateral but asymmetric in 5 cases and unilateral in 1 case. Fundus finding s included small, intraretinal, whitish lesions, with localized retinal and reti nal pigment epithelium (RPE) disturbance, small dot hemorrhages, and vascular sh eathing around the macula and the papillomacular bundle. Fluorescein angiography showed arteriolar focal knobby hyperfluorescence at the macula with mild staini ng of the vascular walls and leakage at the level of the RPE.All 5 cases that ha d indocyanine green angiography done showed early diffuse choroidal hyperfluores cence with late silhouetting of the larger choroidal vessels. Five patients rece ived steroid therapy: 1 topical, 2 periocular, and 2 oral. Over 2 to 4 months, R PE discoloration was observed over the affected areas. After the acute episode, 3 patients showed partial recovery of vision, and in the remaining patients, the visual acuity remained stable. Conclusions Ocular complications associated with dengue fever are rare but may result in permanent visual impairment.

进行性视网膜下纤维增生的免疫病理学研究:一种特殊的交感性眼炎

Purpose We report the immunopathology of progressive subretinal fibrosis, a va riant of sympathetic ophthalmia. Design Brief case report. Method Review of medi cal record and immunopathology of a chorioretinal biopsy of a 40 year old man who presented with left total retinal detachment (RD) following multiple vitrect omies in the right eye for RD. Small peripherally retinal holes, snow banks, and inflammatory nodules along the ora serrata were observed during left vitrectomy . Both eyes deteriorated rapidly to blindness with progressive subretinal fibros is and inflammation over 3 months, and the patient was unresponsive to systemic prednisolone and azathioprine. Result Immunopathology of the chorioretinal biops y of the right eye revealed aggregates of CD20+B cells, surrounded by CD3+T ce lls. CD68+macrophages were scattered throughout. Conclusion The rapid clinical course described in this case may be related to the unique immunopathology of ra pidly forming peudogerminal centers in the choroids and retina.

预防性激光周边虹膜切开术后白内障的进展:可能与预防青光眼致盲相关

Purpose: To evaluate changes in lens opacity in the first year after prophylactic laser peripheral iridotomy (LPI) performed in fellow eyes of subjects with acute primary angle closure (APAC). Design: Prospective observational case series. Participants: Sixty Asian subjects with unilateral APAC. Methods: All fellow eyes underwent prophylactic LPI within the first week of presentation, followed by 1 week of topical steroids. The degree of lens opacity was graded at the slit-lamp examination using the Lens Opacity Classification System III (LOCS III) with standard color photographs as the reference for grading of lens opacity. This was performed 2 weeks, 4 months, and 12 months after LPI. Progression in lens opacity was defined as an increase in LOCS III grade by 2 or more units in any lens region. Main Outcome Measures: Lens Opacity Classification Sytem III grades in nuclear, cortical, and posterior subcapsular (PSC) regions. Results: Most patients were Chinese (85% ) and female (63.3% ), with an average age of 61.5 ± 10.6 years. The mean baseline LOCS grades in the nuclear, cortical, and PSC regions were 3.58 ± 0.74, 0.57 ± 1.08, and 0.23 ± 0.72, respectively. With 12 months of follow-up, 14 of the 60 eyes (23.3% ; 95% confidence interval, 16.9- 29.7% ) showed signifi-cant progression in any lens region. Progression in the nuclear, cortical, and PSC regions was documented in 5% , 6.7% , and 16.7% of cases, respectively. By use of logistic regression, the following factors were not found to be significant for cataract progression in any lens region: age, race, gender, history of hypertension or diabetes, presence of peripheral anterior synechiae or angle width at baseline, and total laser energy delivered. Conclusions: In fellow eyes of APAC, prophylactic LPI is complicated by significant cataract progression, mainly in the posterior subcapsular region. These findings may have implications for the role of prophylactic LPI in the prevention of angle-closure blindness.

思诺迪清在超声乳化联合小梁切除术中的应用

PURPOSE: To evaluate the use of Surodex (Oculex Pharmaceuticals, Sunnyvale, California) a drug delivery system incorporating 60 micrograms of dexamethasone in a pellet, in phacotrabeculectomy surgery. DESIGN: Nonrandomized, prospective, interventional case series. METHODS: Phacotrabeculectomy was performed on 37 Asian subjects with primary open-angle glaucoma (POAG) using a standardized technique. All subjects received a Surodex pellet underneath the scleral flap. Results were compared with those of 31 POAG subjects who had undergone phacotrabeculectomy augmented with 50 mg/ml of intraoperative 5-fluorouracil (5-FU) during the same period. RESULTS: Mean follow-up in months was 19.7±7.9 and 22.1±6.2 for the Surodex and 5-FU groups, respectively (P=.29). Therewas a 20.1%decrease in intraocular pressure in the Surodex group compared with 28.5%decrease in the 5-FU group (P=.6). Postoperative complications occurred in three cases (8.1%) and six cases (19.3%), respectively (P=.04). CONCLUSIONS: Combined phacotrabeculectomy surgery augmented by intra-scleral placement of Surodex results in good control of IOPand a low incidence of complications.

急性原发性房角关闭后视神经纤维层厚度的变化

Purpose To evaluate the changes in re tinal nerve fiber layer(RNFL)thickness in the first 16weeks after acute primary angle closure(APAC)using scanning laser polarimetry(SLP)-Design Prospective,observational case series.Par-ticipants Thirty-seven Asian subje cts with APAC.Methods For all cases,APAC had resolved afte r treatment,and the study was conducted during the follo w-up period after the acute episode.Using the GDx Nerve Fi ber Analyzer(Laser Diagnostic Technologies,San Diego,CA),the RNFL was assessed in both eyes 2weeks after APAC,and again after16weeks.The SLP parameters were com pared between week 2and week 16within affected and fellow eyes.A multiple logistic regression analy sis was carried out to an-alyze factors likely to influence RN FL outcome.Main out-come measures Superior and inferior average RNFL thick-ness.Results The mean age of study su bjects was 60.1±10.3years(range,46-91years),and most subjects were female(68%)and Chinese(86%).In APAC eyes,the superior average RNFL thic kness decreased from63.8±13.6μm to 61.4±11.2μm(P=0.04)and the inferior average RNFL thickness decreased from 69.5±14.4μm to 66.3±12.6μm(P=0.005).There was also a decrease in inferior ratio(P=0.008)-and ellipse modulation(P=0.02).In the fellow eyes,there was no difference found between week 2and w eek 16for any of the SLP parameters studied.Logisti c regression analysis showed no significant association b etween developing a 10%reduction in either superior or i nferior RNFL thick-ness with age,gender,history of isc hemic risk factors,duration of symptoms during APAC,th e level of present-ing intraocular pressure(IOP),or the development of a rise in IOP between study visits.Con clusions After an episode of APAC,superior and inferior average RNFL thickness was found to decrease sign ificantly from week 2to week 16.

急性原发性闭角型青光眼:激光虹膜周边切开术后第1年内房角的引流结构

Purpose To evaluate the changes in th e configuration of the drainage angle in the first year afte r acute primary angle closure(APAC).Design Prospective observational case series.Participants Forty-four As ian subjects with APAC.Methods Acute primary angle closure cases were treated with medical therapy followed by laser peripheral iridotomy (LPI ).Static and dynamic gonioscopies we re performed in APAC-affected and fellow eyes before LPI (baseline)and then at 2weeks,4months,and 12month s after presen-tation.The angles were graded in eac h quadrant according to the Shaffer scheme,and the number of clock hours of peripheral anterior synechiae(PAS)was recorded.Pa-tients who underwent intraocular su rgery at any point during follow-up were excluded from the stu dy.Intraocular pressure(IOP)and medical treatment were document ed at each visit,and gonioscopic changes were correlated with the development of elevation in IOP requiring medi-cal treatment.Main outcome measure s Average Shaffer grade and the number of clock hours of PAS.Results The majority of subjects were Chinese(84%)and female(64%),and the mean age was 60.2±10.7years.At presentation,73%of both affected a nd fellow eyes had very narrow angles(average Shaffer grade≤1),with affected eyes having more extensive PAS(P<0.001),a third of whom had≥8clock hours of PAS.In APAC eyes,there was a significant increase in angle width from baseline to 2weeks after LPI (P=0.045),but no change in angle width subsequently.Fellow eyes showed a widening of the angle between baseline and week 2(P=0.01)and from week 2to month 4(P=0.001).There was no significant change in PAS in either affected or fe llow eyes over the 12months of follow-up.Of the 44subjects,19(41.3%)subsequently developed IOP elevati on during follow-up that required treatment.However,there was no difference in angle width or amount of PAS between e yes with and without a subsequent rise in IOP,and the angle configu-ration did not change significantly in either group over 1year.Conclusion In Asian eyes with A PAC,the angle widened in the first 2weeks after LPI ,but did not change there after over 1year,and the amount of PAS remained stable throughout.The results indi cate the effectiveness of LPI in preventing progressive closu re of the angle in the first year after APAC.

有压缩力的C形板层角膜移植术:一种治疗周边角膜变性后严重散光的手术方法

Objective: To describe a compressive lamellar surgical technique for treating severe astigmatism in peripheral corneal ectasia. Design: Retrospective, noncomparative, interventional case series. Participants: Four eyes of 3 patientswith either pellucid or Terrien’ s marginal corneal degeneration were included in this series. Methods: C- shaped lamellar keratoplasty using multiple trephines of different sizes, with deliberate undersizing of the donor graft for a controlled compressive effect, was performed on these patients. Main Outcome Measures: Visual acuity outcome and refraction were measured at different intervals at up to 40 months of follow- up. Results: All eyes achieved Snellen visual acuity of 20/40 or better and stable astigmatism ranging from 0 to- 2.75 diopter cylinder within 6 months, with no recurrence of corneal thinning or peripheral corneal vascularization. Conclusions: Compressive C- shaped lamellar keratoplasty is able to reduce severe corneal astigmatism in peripheral corneal ectasia and can result in good visual and refractive outcomeswith early visual rehabilitation.

拉坦前列素降低慢性闭角型青光眼患者眼压的效果与房角关闭程度之间关系的研究

Objective: To examine the relationship between the con- figuration of the drainage angle and intraocular pressure (IOP)- lowering efficacy of latanoprost in subjects with chronic angle- closure glaucoma (CACG). Design: Prospective observational case series. Participants: One hundred thirty- seven Asian subjects with CACG. Methods: Study subjects had participated in a 12- week, randomized, double- masked study that assessed the IOP- reducing effect of latanoprost. Chronic angle- closure glaucoma was defined as optic neuropathy with or without a visual field defect, an anterior chamber angle in which the trabecular meshwork was not visible for at least 180° on gonioscopy, and evidence of peripheral anterior synechiae (PAS) in association with a chronically elevated IOP. Static and dynamic gonioscopy was performed at baseline. The angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of PAS was recorded. The change in daily IOP (defined as the mean of the 9:00 AM and 5:00 PM IOP time point values) from baseline to week 12 was analyzed and correlated with mean angle width and extent of PAS. Results: One hundred thirty- seven Asian subjects with CACG completed the study in the latanoprost- treated group. Most subjects were female (75% ), and the mean age was 62.6± 9.4 years. At baseline, the mean angle width was 0.84± 0.55, and the mean number of clock hours of PAS was4.67± 2.95. After 12 weeks of treatment, latanoprost reduced IOP from 25.0± 5.5 mmHg to 17.5± 5.0 mmHg (P< 0.001). The percent change in IOP produced by latanoprost was not associated with mean anglewidth (Spearman’ s r=0.04, P=0.64) or the number of clock hours of PAS (Spearman’ s r=- 0.15, P=0.08). Conclusions: In subjects with CACG, the IOP- reducing efficacy of latanoprost was not affected by the degree of angle narrowing or extent of synechial angle closure.

前部深板层角膜移植术治疗淋病性角膜炎导致的后弹力层膨出1例

Purpose To describe the presentation and subsequent management of a case of se vere gonococcal keratitis in a young man. Design Case report. Methods A young ma n presented with severe gonococcal keratitis. Topical and systemic antibiotics w ere given with no improvement, and progressive corneal melting was noted. Deep l amellar keratoplasty was performed. The clarity and state of corneal graft and t he postoperative visual acuity were noted. Results At 6 months posttreatment, th e graft was clear, and no recurrence of infection was noticed. Corrected visual acuity was 20/25. Conclusion Deep lamellar keratoplasty should be considered as a therapeutic option in patients with severe gonococcal keratitis that does not respond to antibiotic treatment.

Application of artifcial intelligence in cataract management:current and future directions

The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of prematurity.Cataract management is another feld that can beneft from greater AI application.Cataract is the leading cause of reversible visual impairment with a rising global clinical burden.Improved diagnosis,monitoring,and surgical management are necessary to address this challenge.In addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 pandemic.AI on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical barriers.First,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs.This utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts appropriately.Second,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional formulas.Third,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical procedures.Fourth,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser capsulotomy.These advances in AI could transform cataract management and enable delivery of efcient ophthalmic services.The key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of end-users.

Cosmetic outcome of femtosecond laserassisted pterygium surgery

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive factors.Methods:This Was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent FLAPS.Cosmetic outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4:excellent-poor).Weighted Cohen's kappa analysis was performed to examine the intra-and inter-rater reliability.The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned intraoperatively.An excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6 months(1.0±0.0)and 12 months(1.0±0.0)postoperatively.At final fllow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium removal.Weighted kappa analysis of Hirst grading system showed excellent intra-rater(k:0.86-0.95)and inter-rater reliability(k:0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG thickness.Conclusions:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathinCAG.Trial registration:ClinicalTrials.gov,NCT02866968.Registered in July 2016.

Different fundus imaging modalities and technical factors in AI screening for diabetic retinopathy:a review

Background:Effective screening is a desirable method for the early detection and successful treatment for diabetic retinopathy,and fundus photography is currently the dominant medium for retinal imaging due to its convenience and accessibility.Manual screening using fundus photographs has however involved considerable costs for patients,clinicians and national health systems,which has limited its application particularly in less-developed countries.The advent of artificial intelligence,and in particular deep learning techniques,has however raised the possibility of widespread automated screening.Main text:In this review,we first briefly survey major published advances in retinal analysis using artificial intelligence.We take care to separately describe standard multiple-field fundus photography,and the newer modalities of ultrawide field photography and smartphone-based photography.Finally,we consider several machine learning concepts that have been particularly relevant to the domain and illustrate their usage with extant works.Conclusions:In the ophthalmology field,it was demonstrated that deep learning tools for diabetic retinopathy show clinically acceptable diagnostic performance when using colour retinal fundus images.Artificial intelligence models are among the most promising solutions to tackle the burden of diabetic retinopathy management in a comprehensive manner.However,future research is crucial to assess the potential clinical deployment,evaluate the cost-effectiveness of different DL systems in clinical practice and improve clinical acceptance.