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Chen X, Xu P, Li Y, Zhang W, Song F, He M, Shi D. ChatFFA: An ophthalmic chat system for unified vision-language understanding and question answering for fundus fluorescein angiography. iScience 2024; 27:110021. [PMID: 39055931 PMCID: PMC11269310 DOI: 10.1016/j.isci.2024.110021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 07/28/2024] Open
Abstract
Existing automatic analysis of fundus fluorescein angiography (FFA) images faces limitations, including a predetermined set of possible image classifications and being confined to text-based question-answering (QA) approaches. This study aims to address these limitations by developing an end-to-end unified model that utilizes synthetic data to train a visual question-answering model for FFA images. To achieve this, we employed ChatGPT to generate 4,110,581 QA pairs for a large FFA dataset, which encompassed a total of 654,343 FFA images from 9,392 participants. We then fine-tuned the Bootstrapping Language-Image Pre-training (BLIP) framework to enable simultaneous handling of vision and language. The performance of the fine-tuned model (ChatFFA) was thoroughly evaluated through automated and manual assessments, as well as case studies based on an external validation set, demonstrating satisfactory results. In conclusion, our ChatFFA system paves the way for improved efficiency and feasibility in medical imaging analysis by leveraging generative large language models.
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Affiliation(s)
- Xiaolan Chen
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Pusheng Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Yao Li
- University of Waterloo, Computer Science, 200 University Avenue W 0, Waterloo, Canada
| | - Weiyi Zhang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Fan Song
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Mingguang He
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Shatin, Hong Kong
| | - Danli Shi
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Sauesund ES, Hertzberg SNW, Jørstad ØK, Moe MC, Erke MG, Fosmark DS, Petrovski G. A health economic pilot study comparing two diabetic retinopathy screening strategies. Sci Rep 2024; 14:15618. [PMID: 38971860 PMCID: PMC11227515 DOI: 10.1038/s41598-024-66405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024] Open
Abstract
To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.
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Affiliation(s)
- Ellen Steffenssen Sauesund
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway.
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway.
| | - Silvia N W Hertzberg
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway
- University of Split, School of Medicine, 21000, Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000, Bitola, North Macedonia
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Yang F, Zou W, Li Z, Du Y, Gao W, Zhang J, Ji X, Huang J. Optical coherence tomography angiography for detection of microvascular changes in early diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3812. [PMID: 38738481 DOI: 10.1002/dmrr.3812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/04/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024]
Abstract
AIMS To evaluate the effectiveness of optical coherence tomography angiography (OCTA) in detecting early intraocular microvascular changes in diabetic patients. MATERIALS AND METHODS A systematic study search was performed on PubMed, Medline, Embase, and the Cochrane Library, ranging from January 2012 to March 2023. Controlled studies compared diabetes mellitus (DM) patients with non-diabetic retinopathy (NDR) or patients with mild non-proliferative diabetic retinopathy (mild NPDR) to healthy people. These studies included parameters of OCTA such as foveal avascular zone (FAZ), vessel density of superficial capillary plexus (VDscp), vessel density of deep capillary plexus (VDdcp), and peripapillary VD. The relevant effect model was used according to the heterogeneity, and the mean difference and 95% confidence intervals were calculated. RESULTS A total of 18 studies with 2101 eyes were eventually included in this meta-analysis. Our results demonstrated that early alterations of VDscp, VDdcp, and peripapillary VD in NDR patients had a significant difference compared with healthy people by OCTA (VDscp: WMD = -1.34, 95% CI: -1.99 to -0.68, P < 0.0001. VDdcp: WMD = -2.00, 95% CI: -2.95 to -1.04, P < 0.0001. Peripapillary VD: WMD = -1.07, 95% CI: -1.70 to -0.43, P = 0.0010). However, there was no statistically significant difference in total FAZ between them (WMD = -0.00, 95% CI: -0.02-0.01, P = 0.84). In addition, for patients with mild NPDR, OCTA could illustrate prominent changes in VDscp, VDdcp, and total FAZ compared with healthy people (VDscp: WMD = -6.11, 95% CI: -9.90 to -2.32, P = 0.002. VDdcp: WMD = -4.26, 95% CI: -5.95 to -2.57, P < 0.00001. FAZ: WMD = 0.06, 95% CI: 0.01-0.11, P = 0.03). CONCLUSIONS In diabetic patients with or without retinopathy, the parameters of OCTA such as VDscp, VDdcp, and peripapillary vessel density were demonstrated as potential biomarkers in monitoring the early alterations of retinal microangiopathy, while total FAZ may have no significant changes in diabetic patients without retinopathy.
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Affiliation(s)
- Fan Yang
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weijie Zou
- Department of Ophthalmology, Changshu No. 1 People's Hospital, Suzhou, China
| | - Zhiwei Li
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Du
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiyun Gao
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji Zhang
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyan Ji
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Huang
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
- Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Zhao C, Ma G, Tao S, Wang M, Chen Z, Fang Y, Shi W. Qi-Ju-Di-Huang-Pill delays the progression of diabetic retinopathy. JOURNAL OF ETHNOPHARMACOLOGY 2024; 323:117751. [PMID: 38216102 DOI: 10.1016/j.jep.2024.117751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/24/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Qi-Ju-Di-Huang-Pill (QJDH pill) is a Chinese decoction. Although it is commonly used to treat eye conditions, such as diabetic retinopathy (DR), its exact mechanism of action is unknown. AIM OF THE STUDY To investigate the specific mechanism by which QJDH pill slows the progression of diabetic retinopathy (DR) based on animal and cellular experiments. MATERIAL AND METHODS The major components of QJDH pill were characterized by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLCMS/MS). C57BL/6J mice were randomly divided into five groups as follows: normal group (control group), model group (STZ group), low-dosage QJDH pill group (QJDH-L group), medium-dosage QJDH pill group (QJDH-M group) and high-dosage QJDH pill group (QJDH-H group). Changes in water intake, urination, food intake, and body mass were monitored weekly, while changes in blood glucose were monitored monthly. Fluorescein fundus angiography (FFA), optical coherence tomography angiography (OCTA), and optical coherence tomography (OCT) were utilized to analyze the changes in fundus imaging indications. Hematoxylin & eosin (H&E) and transmission electron microscopy (TEM) were employed to examine histopathologic and ultrastructural changes in retina. The levels of interleukin-6 (IL-6), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) in peripheral blood were detected using Enzyme-linked immunosorbent assay (ELISA). The mouse retina apoptotic cells were labeled with green fluorescence via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (Tunel). The protein levels of Bcl-2-Associated X (Bax), B cell lymphoma 2 (Bcl-2), Caspase-3, PI3K, phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKT (p-AKT) were quantified by Western blot (WB). The retinal pigment epithelium (RPE) cells were cultured and classified into five groups as follows: normal glucose group (NG group), high glucose group (HG group), high glucose + QJDH pill group (HG + QJDH group), high glucose + inhibitor group (HG + LY294002 group), and high glucose + inhibitor + QJDH pill group (HG + LY294002 + QJDH group). Cell viability and apoptosis were detected via Cell Counting Kit-8 (CCK8) and then analyzed by flow cytometry. RESULTS In vivo experiments revealed that the QJDH pill effectively reduced blood glucose, symptoms of increased water intake, elevated urination, increased food intake and decreased body mass in DR mice. QJDH pill also slowed the development of a series of fundus imaging signs, such as retinal microangiomas, tortuous dilatation of blood vessels, decreased vascular density, and thinning of retinal thickness, downregulated IL-6, IL-17, TNF-α, and VEGF levels in peripheral blood, and inhibited retinal cell apoptosis by activating the PI3K/AKT signaling pathway. Moreover, in vitro experiments showed that high glucose environment inhibited RPE cell viability and activated RPE cell apoptosis pathway. In contrast, lyophilized powder of QJDH pill increased RPE cell viability, protected RPE cells from high glucose-induced damage, and decreased apoptosis of RPE cells by activating the pi3k pathway. CONCLUSION QJDH pill induces hypoglycemic, anti-inflammatory effects, anti-VEGF and anti-retinal cell apoptosis by activating PI3K/AKT signaling pathway, and thus can protect the retina and slow the DR progression.
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Affiliation(s)
- Chunlin Zhao
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Guangcheng Ma
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Sihan Tao
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Mingyue Wang
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China.
| | - Zhuolin Chen
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China.
| | - Yiming Fang
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210000, China.
| | - Wei Shi
- Department of Ophthalmology, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, 210003, China.
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Ma X, Ji Z, Chen Q, Ge L, Wang X, Chen C, Fan W. Controllable editing via diffusion inversion on ultra-widefield fluorescein angiography for the comprehensive analysis of diabetic retinopathy. BIOMEDICAL OPTICS EXPRESS 2024; 15:1831-1846. [PMID: 38495723 PMCID: PMC10942674 DOI: 10.1364/boe.517819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
By incorporating multiple indicators that facilitate clinical decision making and effective management of diabetic retinopathy (DR), a comprehensive understanding of the progression of the disease can be achieved. However, the diversity of DR complications poses challenges to the automatic analysis of various information within images. This study aims to establish a deep learning system designed to examine various metrics linked to DR in ultra-widefield fluorescein angiography (UWFA) images. We have developed a unified model based on image generation that transforms input images into corresponding disease-free versions. By incorporating an image-level supervised training process, the model significantly reduces the need for extensive manual involvement in clinical applications. Furthermore, compared to other comparative methods, the quality of our generated images is significantly superior.
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Affiliation(s)
- Xiao Ma
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 XiaoLinwei, Nanjing, Jiangsu 210094, China
| | - Zexuan Ji
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 XiaoLinwei, Nanjing, Jiangsu 210094, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 XiaoLinwei, Nanjing, Jiangsu 210094, China
| | - Lexin Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, Hubei 430060, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, Hubei 430060, China
| | - Wen Fan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
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Shi D, Zhang W, He S, Chen Y, Song F, Liu S, Wang R, Zheng Y, He M. Translation of Color Fundus Photography into Fluorescein Angiography Using Deep Learning for Enhanced Diabetic Retinopathy Screening. OPHTHALMOLOGY SCIENCE 2023; 3:100401. [PMID: 38025160 PMCID: PMC10630672 DOI: 10.1016/j.xops.2023.100401] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023]
Abstract
Purpose To develop and validate a deep learning model that can transform color fundus (CF) photography into corresponding venous and late-phase fundus fluorescein angiography (FFA) images. Design Cross-sectional study. Participants We included 51 370 CF-venous FFA pairs and 14 644 CF-late FFA pairs from 4438 patients for model development. External testing involved 50 eyes with CF-FFA pairs and 2 public datasets for diabetic retinopathy (DR) classification, with 86 952 CF from EyePACs, and 1744 CF from MESSIDOR2. Methods We trained a deep-learning model to transform CF into corresponding venous and late-phase FFA images. The translated FFA images' quality was evaluated quantitatively on the internal test set and subjectively on 100 eyes with CF-FFA paired images (50 from external), based on the realisticity of the global image, anatomical landmarks (macula, optic disc, and vessels), and lesions. Moreover, we validated the clinical utility of the translated FFA for classifying 5-class DR and diabetic macular edema (DME) in the EyePACs and MESSIDOR2 datasets. Main Outcome Measures Image generation was quantitatively assessed by structural similarity measures (SSIM), and subjectively by 2 clinical experts on a 5-point scale (1 refers real FFA); intragrader agreement was assessed by kappa. The DR classification accuracy was assessed by area under the receiver operating characteristic curve. Results The SSIM of the translated FFA images were > 0.6, and the subjective quality scores ranged from 1.37 to 2.60. Both experts reported similar quality scores with substantial agreement (all kappas > 0.8). Adding the generated FFA on top of CF improved DR classification in the EyePACs and MESSIDOR2 datasets, with the area under the receiver operating characteristic curve increased from 0.912 to 0.939 on the EyePACs dataset and from 0.952 to 0.972 on the MESSIDOR2 dataset. The DME area under the receiver operating characteristic curve also increased from 0.927 to 0.974 in the MESSIDOR2 dataset. Conclusions Our CF-to-FFA framework produced realistic FFA images. Moreover, adding the translated FFA images on top of CF improved the accuracy of DR screening. These results suggest that CF-to-FFA translation could be used as a surrogate method when FFA examination is not feasible and as a simple add-on to improve DR screening. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Danli Shi
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Weiyi Zhang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shuang He
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Yanxian Chen
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Fan Song
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shunming Liu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Ruobing Wang
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
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Romano MR, Ferrara M, Coco-Martin RM, Rickmann A, Spitzer MS, Steel DHW, Pastor JC. INTRAOCULAR EMULSION OF SILICONE OIL (ITEMS) GRADING SYSTEM: An Evidence-Based Expert-Led Consensus. Retina 2023; 43:1370-1376. [PMID: 37071921 DOI: 10.1097/iae.0000000000003811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To propose the InTraocular EMulsion of Silicone oil (ITEMS) grading system for the assessment of silicone oil (SiO) emulsion, applicable in a routine clinical setting and validated through an expert-led consensus procedure. METHODS Seven experts on intraocular liquid tamponades, led by a facilitator, performed a literature review on the detection of SiO emulsion. Based on the proposed ideas, a questionnaire was developed and submitted to the experts on the methods to detect SiO emulsion and the items to grade. After 2 rounds of individual ranking using a 9-point scale and related discussion, the final grading system was developed including items that reached consensus (score ≥7 from ≥75% of members). RESULTS The agreed ITEMS grading system includes the identification of SiO microbubbles and large SiO bubbles through slit-lamp biomicroscopy, gonioscopy, fundus examination under mydriasis, or ultra-wide-field fundus photography. Moreover, macular and disk optical coherence tomography are used to detect SiO-associated hyperreflective dots. CONCLUSION An evidence-based expert-led consensus was conducted to develop grading system of SiO emulsion, allowing, for the first time, homogenous collection of data on SiO emulsion. This has the potential to improve the understanding of the role and clinical relevance of SiO emulsion, allowing comparisons between different studies.
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Affiliation(s)
- Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
- Eye Center, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | | | - Rosa M Coco-Martin
- Retina Group, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Campus Miguel Delibes, Paseo de Belén, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla Y León, Valladolid, Spain
- RICORS de Enfermedades Inflamatorias, Carlos III National Institute of Health, Madrid, Spain
| | | | - Martin S Spitzer
- University Medical Center Hamburg-Eppendorf, Departrment of Ophthalmology, University of Hamburg, Hamburg, Germany
| | - David H W Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; and
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - J Carlos Pastor
- Retina Group, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Campus Miguel Delibes, Paseo de Belén, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla Y León, Valladolid, Spain
- RICORS de Enfermedades Inflamatorias, Carlos III National Institute of Health, Madrid, Spain
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Pollreisz A, Gasser-Steiner V, Gerendas B, Mennel S, Radda S, Sacu S, Scholda C, Stolba U, Wedrich A. [Diagnosis, treatment and monitoring of diabetic eye disease (Update 2023)]. Wien Klin Wochenschr 2023; 135:195-200. [PMID: 37101041 PMCID: PMC10133029 DOI: 10.1007/s00508-022-02119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these disorders correlates with disease duration and quality of metabolic control. Regular ophthalmological examinations are needed to prevent sight-threatening advanced stages of diabetic eye diseases.
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Affiliation(s)
- Andreas Pollreisz
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | | | - Bianca Gerendas
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Stefan Mennel
- Abteilung für Augenheilkunde, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Stephan Radda
- Abteilung für Augenheilkunde, Hanusch-Krankenhaus, Wien, Österreich
| | - Stefan Sacu
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Christoph Scholda
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Andreas Wedrich
- Universitäts-Augenklinik, Medizinische Universität Graz, Graz, Österreich
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Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade. J Clin Med 2022; 11:jcm11175234. [PMID: 36079165 PMCID: PMC9457190 DOI: 10.3390/jcm11175234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 12/22/2022] Open
Abstract
Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.
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Horie S, Ohno-Matsui K. Progress of Imaging in Diabetic Retinopathy-From the Past to the Present. Diagnostics (Basel) 2022; 12:diagnostics12071684. [PMID: 35885588 PMCID: PMC9319818 DOI: 10.3390/diagnostics12071684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Advancement of imaging technology in retinal diseases provides us more precise understanding and new insights into the diseases' pathologies. Diabetic retinopathy (DR) is one of the leading causes of sight-threatening retinal diseases worldwide. Colour fundus photography and fluorescein angiography have long been golden standard methods in detecting retinal vascular pathology in this disease. One of the major advancements is macular observation given by optical coherence tomography (OCT). OCT dramatically improves the diagnostic quality in macular edema in DR. The technology of OCT is also applied to angiography (OCT angiograph: OCTA), which enables retinal vascular imaging without venous dye injection. Similar to OCTA, in terms of their low invasiveness, single blue color SLO image could be an alternative method in detecting non-perfused areas. Conventional optical photography has been gradually replaced to scanning laser ophthalmoscopy (SLO), which also make it possible to produce spectacular ultra-widefield (UWF) images. Since retinal vascular changes of DR are found in the whole retina up to periphery, it would be one of the best targets in UWF imaging. Additionally, evolvement of artificial intelligence (AI) has been applied to automated diagnosis of DR, and AI-based DR management is one of the major topics in this field. This review is trying to look back on the progress of imaging of DR comprehensively from the past to the present.
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Affiliation(s)
- Shintaro Horie
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Correspondence: ; Tel.: +81-3-5803-5302
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Ma L, Wen Y, Li Z, Wu N, Wang Q. Circulating MicroRNAs as Potential Diagnostic Biomarkers for Diabetic Retinopathy: A Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:929924. [PMID: 35898469 PMCID: PMC9309261 DOI: 10.3389/fendo.2022.929924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a common diabetic microvascular complication and a major cause of acquired vision loss. Finding effective biomarkers for the early identification and diagnosis of DR is crucial. This study aimed to comprehensively evaluate the accuracy of microRNAs (miRNAs) in the diagnosis of DR via a meta-analysis of previously published diagnostic studies. This study has been registered on the PROSPERO website, with the number CRD42022323238. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, China Wanfang database, and China Knowledge Network database to identify relevant articles published from the time of database creation to April 10, 2022. Stata 14.0 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), and area under the summary receiver operating characteristic (ROC) curve to assess the accuracy of miRNAs in the diagnosis of DR. Heterogeneity between studies was assessed using Cochran-Q test and I2 statistic for quantitative analysis. The random-effect model was selected due to significant heterogeneity. Subgroup analysis and regression analysis were also performed to determine the potential sources of heterogeneity. RESULTS We included 25 articles detailing 52 studies with 1987 patients with DR and 1771 non-DR controls. The findings demonstrated overall sensitivity (0.82, 95% CI: 0.78 ~ 0.85), specificity (0.84, 95% CI: 0.81 ~ 0.86), PLR (5.0, 95% CI: 4.2 ~ 5.9), NLR (0.22, 95% CI: 0.18 ~ 0.26), and the area under the summary ROC curve (0.90, 95% CI: 0.87 ~ 0.92). Furthermore, we performed subgroup analysis and found that panels of multiple miRNAs could enhance the pooled sensitivity (sensitivity, specificity, and AUC values were 0.89, 0.87, and 0.94, respectively). CONCLUSION The meta-analysis showed that miRNAs can be used as potential diagnostic markers for DR, with high accuracy of diagnoses observed with the detection of miRNAs in plasma and serum.
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Affiliation(s)
- Lingli Ma
- Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wen
- Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zimeng Li
- Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Nan Wu
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Wang
- Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Qing Wang,
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