Dear Editor,We present the reported case of rapid onset bull’s eye maculopathy.Chloroquine(CQ)and its safer,more widely used analogue,hydroxychloroquine(HCQ),were originally developed as antimalarial medications.Howe...Dear Editor,We present the reported case of rapid onset bull’s eye maculopathy.Chloroquine(CQ)and its safer,more widely used analogue,hydroxychloroquine(HCQ),were originally developed as antimalarial medications.However,they have since become essential in the treatment of various autoimmune disorders due to their anti-inflammatory and immunomodulatory properties.HCQ is also being investigated for potential applications in diabetes mellitus,coronavirus disease 2019,heart disease,and as an adjunct in cancer therapy^([1-2]).展开更多
AIM:To identify a maculopathy patient caused by new recessive compound heterozygous variants in RP1L1.METHODS:Comprehensive retinal morphological and functional examinations were evaluated for the patient with RP1L1 m...AIM:To identify a maculopathy patient caused by new recessive compound heterozygous variants in RP1L1.METHODS:Comprehensive retinal morphological and functional examinations were evaluated for the patient with RP1L1 maculopathy.Targeted sequence capture array technique was used to screen potential pathologic variants.Polymerase chain reaction and Sanger sequencing were used to confirm the screening results.RESULTS:Fundus examination showed round macular lesions appeared in both eyes.Optical coherence tomography showed that the inner segment/outer segment continuity was disorganized and disruptive in the left eye,but it was uneven and slightly elevated in the right eye.Fundus autofluorescence showed patchy hyper-autofluorescence in the macula.Visual field examination indicates central defects in both eyes.Electroretinogram(ERG)and multifocal ERG showed no obvious abnormalities.Fundus fluorescein angiography in the macula showed obviously irregular hyper-fluorescence in the right eye and slightly hyper-fluorescence in the left eye.We found that the proband carried a missense variant(c.1972C>T)and a deletion variant(c.4717_4718del)of RP1L1,which were originated from the parents and formed compound heterozygous variants.Both variants are likely pathogenic according to the ACMG criteria.Multimodal imaging,ERG and detailed medical history are important diagnostic tools for differentiating between acquired and inherited retinal disorders.CONCLUSION:A maculopathy case with detailed retinal phenotype and new recessive compound heterozygous variants of RP1L1 is identified in a Chinese family,which expands the understanding of phenotype and genotype in RP1L1 maculopathy.展开更多
In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of my...In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of myopic traction maculopathy (MTM). Here, we review the latest developments in the diagnosis and treatment of MTM, including its conception, clinical characteristics, pathogenesis, clinical stages, and the options for surgical treatment.展开更多
AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observati...AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.展开更多
A 24 year-old Malay lady presented with high grade fever,myalgia,generalized rashes,severe headache and was positive for dengue serology test.Her lowest platelet count was 45×10~9 cells/L.She complained of sudden...A 24 year-old Malay lady presented with high grade fever,myalgia,generalized rashes,severe headache and was positive for dengue serology test.Her lowest platelet count was 45×10~9 cells/L.She complained of sudden onset of painlessness,profound loss of vision bilaterally 7 days after the onset of fever.On examination,her right eye best corrected vision was 6/30 and left eye was6/120.Her anterior segment examination was unremarkable.Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid.Systemic examination revealed normal findings except for residual petechial rashes.She was managed conservatively.Her vision improved tremendously after 2 months.The retinal hemorrhages and foveal elevation showed sign of resolving.Ocular manifestations following dengue fever is rare.However,bilateral visual loss can occur if both fovea arc involved.展开更多
AIM:To conduct a classification study of high myopic maculopathy(HMM)using limited datasets,including tessellated fundus,diffuse chorioretinal atrophy,patchy chorioretinal atrophy,and macular atrophy,and minimize anno...AIM:To conduct a classification study of high myopic maculopathy(HMM)using limited datasets,including tessellated fundus,diffuse chorioretinal atrophy,patchy chorioretinal atrophy,and macular atrophy,and minimize annotation costs,and to optimize the ALFA-Mix active learning algorithm and apply it to HMM classification.METHODS:The optimized ALFA-Mix algorithm(ALFAMix+)was compared with five algorithms,including ALFA-Mix.Four models,including Res Net18,were established.Each algorithm was combined with four models for experiments on the HMM dataset.Each experiment consisted of 20 active learning rounds,with 100 images selected per round.The algorithm was evaluated by comparing the number of rounds in which ALFA-Mix+outperformed other algorithms.Finally,this study employed six models,including Efficient Former,to classify HMM.The best-performing model among these models was selected as the baseline model and combined with the ALFA-Mix+algorithm to achieve satisfactor y classification results with a small dataset.RESULTS:ALFA-Mix+outperforms other algorithms with an average superiority of 16.6,14.75,16.8,and 16.7 rounds in terms of accuracy,sensitivity,specificity,and Kappa value,respectively.This study conducted experiments on classifying HMM using several advanced deep learning models with a complete training set of 4252 images.The Efficient Former achieved the best results with an accuracy,sensitivity,specificity,and Kappa value of 0.8821,0.8334,0.9693,and 0.8339,respectively.Therefore,by combining ALFA-Mix+with Efficient Former,this study achieved results with an accuracy,sensitivity,specificity,and Kappa value of 0.8964,0.8643,0.9721,and 0.8537,respectively.CONCLUSION:The ALFA-Mix+algorithm reduces the required samples without compromising accuracy.Compared to other algorithms,ALFA-Mix+outperforms in more rounds of experiments.It effectively selects valuable samples compared to other algorithms.In HMM classification,combining ALFA-Mix+with Efficient Former enhances model performance,further demonstrating the effectiveness of ALFA-Mix+.展开更多
AIM:Age-related macular degeneration(AMD)is a multifactorial disease and a prevalent cause of visual impairment in developed countries.Many studies suggest that age-related maculopathy susceptibility 2(ARMS2)is a seco...AIM:Age-related macular degeneration(AMD)is a multifactorial disease and a prevalent cause of visual impairment in developed countries.Many studies suggest that age-related maculopathy susceptibility 2(ARMS2)is a second major susceptibility gene for AMD.At present,there is no functional information on this gene.Therefore,the purpose of the present study was to detect the expression of ARMS2 in retinal pigment epithelium(RPE)cells and to investigate the effect of ARMS2 on the phagocytosis function of RPE cells.METHODS:Immunofluorescence and reverse transcriptase PCR were used to demonstrate the presence and location of ARMS2 in ARPE-19(human retinal pigment epithelial cell line,ATCC,catalog No.CRL-2302)cells.siRNA was used to knock down ARMS2 mRNA,and the effects of the knockdown on the phagocytosis function of the ARPE-19 cells were evaluated via Fluorescence Activated Cell Sorting(FACS).RESULTS:ARMS2 was present in ARPE-19 cells,localized in the cytosol of the perinuclear region.The expression of ARMS2 mRNA(messenger RNA)in ARPE-19 cells transfected with ARMS2-siRNA(small interfering RNA,0.73+/-0.08)was decreased compared with normal cells(1.00+/-0.00)or with cells transfected with scrambled siRNA(0.95+/-0.13)(P<0.05).After incubation of RPE cells with a latex beads medium for 12,18,or 24 hours,the fluorescence intensities were 38.04+/-1.02,68.92+/-0.92,and 78.00+/-0.12 in the ARMS2-siRNA-transfected groups,respectively,and 77.98+/-5.43,94.87+/-0.60,and 98.30+/-0.11 in the scrambled siRNA-transfected groups,respectively.The fluorescent intensities of the same time points in the two groups were compared using Student's t-test,and the p values were all less than 0.001 at the three different time points.CONCLUSION:There is endogenous expression of ARMS2 in ARPE-19 cells.ARMS2 plays a role in the phagocytosis function of RPE cells,and this role may be one of the mechanisms that participates in the development of AMD.展开更多
AIM: To investigate the outcomes of adaptive conjunctival flap advancement surgical techniques with or without scleral graft for patients undergoing revision surgery after trabeculectomy.METHODS: This retrospective st...AIM: To investigate the outcomes of adaptive conjunctival flap advancement surgical techniques with or without scleral graft for patients undergoing revision surgery after trabeculectomy.METHODS: This retrospective study included 28 eyes of 28 subjects from December 2015 to April 2018. A group of 15 eyes underwent conjunctival advancement only while the other 13 eyes did conjunctival advancement with partial thickness scleral graft. In both study groups, we considered the intraocular pressure(IOP) as our primary outcome and visual acuity(VA) as our secondary outcome. Both were assessed pre-and post-operatively till the last followup possible point. Additionally, we classified the patients according to complete and qualified success criteria.RESULTS: The mean age of the conjunctival advancement group was 36.87±19.25 y, while it was 44.08±18.04 in the other group. In both study groups, the mean IOP significantly increased after revision surgery at 1, 2, 3 mo and the last follow-up visit when compared to prior the surgery(P<0.001). Moreover, VA was significantly improved(P=0.03) in the final follow-up for both surgical techniques. When we compared the change from baseline in both groups, there was no significant difference between IOP improvement in 1 mo(P=0.263), while the difference was significant in 2 mo(P=0.03), 3 mo(P=0.02) and in the final follow-up visit postoperatively. However, this difference was not significant regarding VA(P=0.5).CONCLUSION: The both adaptive techniques of conjunctival advancement and conjunctival advancement with scleral graft are effective for treating patients with lateonset hypotony. Yet, more prospective studies are needed to assert upon these results.展开更多
The diagnosis of eye disease through deep learning (DL) technologyis the latest trend in the field of artificial intelligence (AI). Especially indiagnosing pathologic myopia (PM) lesions, the implementation of DL is a...The diagnosis of eye disease through deep learning (DL) technologyis the latest trend in the field of artificial intelligence (AI). Especially indiagnosing pathologic myopia (PM) lesions, the implementation of DL is adifficult task because of the classification complexity and definition system ofPM. However, it is possible to design an AI-based technique that can identifyPM automatically and help doctors make relevant decisions. To achieve thisobjective, it is important to have adequate resources such as a high-qualityPM image dataset and an expert team. The primary aim of this research isto design and train the DLs to automatically identify and classify PM intodifferent classes. In this article, we have developed a new class of DL models(SAN-FSL) for the segmentation and detection of PM through semanticadversarial networks (SAN) and few-short learning (FSL) methods, respectively.Compared to DL methods, the conventional segmentation methodsuse supervised learning models, so they (a) require a lot of data for trainingand (b) fixed weights are used after the completion of the training process.To solve such problems, the FSL technique was employed for model trainingwith few samples. The ability of FSL learning in UNet architectures is beingexplored, and to fine-tune the weights, a few new samples are being providedto the UNet. The outcomes show improvement in the detection area andclassification of PM stages. Betterment in the result is observed by sensitivity(SE) of 95%, specificity (SP) of 96%, and area under the receiver operatingcurve (AUC) of 98%, and the higher F1-score is achieved using 10-fold crossvalidation.Furthermore, the obtained results confirmed the superiority of theSAN-FSL method.展开更多
Dear Editor,We report our experience using a continuous intraoperative optical coherence tomography(OCT)-enabled microscope system for real-time anatomical evaluation of the optic pit during surgery in an 8-year-old g...Dear Editor,We report our experience using a continuous intraoperative optical coherence tomography(OCT)-enabled microscope system for real-time anatomical evaluation of the optic pit during surgery in an 8-year-old girl who presented with symptomatic optic disc pit(ODP) maculopathy. ODP is an extremely rare congenital anomaly secondary to colobomatous malformation of the optic nerve head, with a reported incidence of 0.00009%[1]. Although patients are frequently asymptomatic, approximately 40%-50% of patients experience visual symptoms because of subretinal fluid(SRF) accumulation beneath the macula.展开更多
AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and ...AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and visualization analyses from Web of Science(WOS)Core Collection.Exported records were analyzed for titles,publication years,research institutions,journal names,authors,keywords,and abstracts using CiteSpace software version 6.1.RESULTS:A total of 839 related studies were analyzed,the publication volume increased annually,with Asia the most active region of MTM research.Optical coherence tomography angiography,optical coherence tomography,macular hole,high myopia,macular buckling were identified as the focus of the current research.Progression,association,classification and shape were identified as the major research frontiers.CONCLUSION:MTM is a major cause of visual loss in pathological myopic eyes.During the preceding 17y,the number of annual publications in MTM research increased gradually.Studies on the progression nature of MTM,genome-wide association study and proper classification of MTM might still be the frontiers of MTM researches.展开更多
Diabetic maculopathy with marked exudation may lead to subretinal fibrosis. Two patients observed over multiple years evolved from macular exudation into subretinal fibrosis with severe visual loss. Spectral domain op...Diabetic maculopathy with marked exudation may lead to subretinal fibrosis. Two patients observed over multiple years evolved from macular exudation into subretinal fibrosis with severe visual loss. Spectral domain optical coherence tomography and color photographs document the clinical changes.展开更多
Purpose: To describe the clinical, angiographic, and Optical Coherence Tomography (OCT) findings in a patient with Unilateral Acute Idiopathic Maculopathy (UAIM) and to discuss a possible pattern of OCT findings in pa...Purpose: To describe the clinical, angiographic, and Optical Coherence Tomography (OCT) findings in a patient with Unilateral Acute Idiopathic Maculopathy (UAIM) and to discuss a possible pattern of OCT findings in patients with this disease. Methods: Case report. Results: A 34-year-old man with UAIM was evaluated. During the acute phase fundus examination revealed a yellow thickening in the macular area of the right eye, Fluorescein Angiography (FA) showed early alternating patches of hypofluorescence and hyperfluorescence and late hyperfluorescence and OCT showed thickening of the outer retina in the foveal zone. Six weeks later, the macula had pigmentary mottling, FA showed an area of central hypofluorescence surrounded by a hyperfluorescent ring that remained unchanged during the angiogram and the OCT examination was normal. Conclusion: OCT is a useful diagnostic tool for UAIM. OCT evaluation of patients with this disease will exhibit the heterogeneous hyperreflectivity and thickening of the outer retina and Retinal Pigment Epithelium (RPE). A serous macular detachment may not be a prominent finding in UAIM.展开更多
We report a case series of dengue maculopathy with different ocular manifestations, managements, visual outcomes and sequelae of patients. All three cases were diagnosed to have dengue fever. Patients presented with s...We report a case series of dengue maculopathy with different ocular manifestations, managements, visual outcomes and sequelae of patients. All three cases were diagnosed to have dengue fever. Patients presented with symptoms of central scotoma (case 1 and case 3) and blurring of vision (case 2) on Day 9 of dengue fever. Fundus examination showed intra retinal haemorrhages (case 1 and case 2) and macula thickening (case 3). Optical coherence tomography (OCT) revealed macular thickening with intra retinal fluid (case 1) and diffuse retinal thickening (case 3), while in case 2, it had irregular ellipsoid line in OCT. Fundus fluorescence angiography (FFA) revealed parafoveal vasculitis. After treatment with systemic steroids, one patient had good visual outcome (case 2), while two others had a persistent central scotoma due to macula atrophy (case 3). Although it is a self limiting disease, but the mode of treatment is variable. Treatment with corticosteroids may hasten recovery of vision and prevent permanent visual impairment.展开更多
Background:Myopic maculopathy(MM)has become a major cause of visual impairment and blindness worldwide,especially in East Asian countries.Deep learning approaches such as deep convolutional neural networks(DCNN)have b...Background:Myopic maculopathy(MM)has become a major cause of visual impairment and blindness worldwide,especially in East Asian countries.Deep learning approaches such as deep convolutional neural networks(DCNN)have been successfully applied to identify some common retinal diseases and show great potential for the intelligent analysis of MM.This study aimed to build a reliable approach for automated detection of MM from retinal fundus images using DCNN models.Methods:A dual-stream DCNN(DCNN-DS)model that perceives features from both original images and corresponding processed images by color histogram distribution optimization method was designed for classification of no MM,tessellated fundus(TF),and pathologic myopia(PM).A total of 36,515 gradable images from four hospitals were used for DCNN model development,and 14,986 gradable images from the other two hospitals for external testing.We also compared the performance of the DCNN-DS model and four ophthalmologists on 3000 randomly sampledfundus images.Results:The DCNN-DS model achieved sensitivities of 93.3%and 91.0%,specificities of 99.6%and 98.7%,areas under the receiver operating characteristic curves(AUCs)of 0.998 and 0.994 for detecting PM,whereas sensitivities of 98.8%and 92.8%,specificities of 95.6%and 94.1%,AUCs of 0.986 and 0.970 for detecting TF in two external testing datasets.In the sampled testing dataset,the sensitivities of four ophthalmologists ranged from 88.3%to 95.8%and 81.1%to 89.1%,and the specificities ranged from 95.9%to 99.2%and 77.8%to 97.3%for detecting PM and TF,respectively.Meanwhile,the DCNN-DS model achieved sensitivities of 90.8%and 97.9%and specificities of 99.1%and 94.0%for detecting PMand T,respectively.Conclusions:The proposed DCNN-DS approach demonstrated reliable performance with high sensitivity,specificity,and AUC to classify different MM levels on fundus photographs sourced from clinics.It can help identify MM automatically among the large myopic groups and show great potential for real-life applications.展开更多
AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.M...AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.METHODS:The clinical data of 50 eyes from 49 patients diagnosed with ERM,who were highly myopic and underwent PPV were retrospectively analyzed.The patients with ERM were classified into five groups based on the characteristics associated with different levels of myopic traction maculopathy.Group 1:Simple ERM without complex vertical and tangential direction traction on retina on optical coherence tomography(OCT)image;Group 2:ERM with obvious macular foveal schisis,without macular hole(MH);Group 3:ERM with inner lamellar MH,with or without macular foveal schisis;Group 4:ERM with outer lamellar MH,with or without foveal retinal detachment(RD);Group 5:ERM with full-thickness MH.Baseline characteristics,changes in best corrected visual acuity(BCVA)before and after surgery,and anatomical characteristics through spectral domain OCT were compared.RESULTS:The 50 eyes were followed for 6mo,with an average age of 58.66y and an average axial length(AL)of 28.69 mm.Among the five groups,postoperative logMAR BCVA improved(P<0.05).Group 1 had better mean BCVA at baseline(0.59±0.36)and at 6mo postoperatively(0.16±0.22)compared to the other groups,while Group 5 had worse mean BCVA at baseline(1.68±0.45)and at 6mo postoperatively(1.27±0.64).There were no statistically significant differences in sex,age or AL between the groups(P>0.05).OCT showed that Groups 4 and 5 exhibited poorer macular anatomy compared to the other three groups,as evidenced by lower rates of central retinal reattachment(64.3%in Group 4,86.7%in Group 5)and integrity of the inner segment/outer segment of photoreceptor junction(28.6%in Group 4,26.7%in Group 5).CONCLUSION:PPV is an effective treatment for ERM in patients with HM.All groups showed postoperative improvement in BCVA compared to preoperative levels,demonstrating the necessity of surgical intervention.Early intervention,particularly before the fourth stage of the disease,may lead to better visual outcomes.展开更多
Accidental exposure to the laser may result in visual impairment from retinal injury.Laser-induced damages to the macula include outer retinal disruption,foveal hemorrhage,macular edema,epiretinal membrane,full thickn...Accidental exposure to the laser may result in visual impairment from retinal injury.Laser-induced damages to the macula include outer retinal disruption,foveal hemorrhage,macular edema,epiretinal membrane,full thickness macular hole,etc.[1,2] There are some case reports of visual improvement following the use of oral corticosteroids,but till date,there is no known effective treatment for this condition.[3,4] We report a case series of laser-induced maculopathy treated with standard doses of oral corticosteroids.展开更多
BACKGROUND During the Coronavirus disease 2019(COVID-19)pandemic,a notable increase in acute macular neuroretinopathy(AMN)cases was observed.This study aimed to investigate the potential association between AMN and CO...BACKGROUND During the Coronavirus disease 2019(COVID-19)pandemic,a notable increase in acute macular neuroretinopathy(AMN)cases was observed.This study aimed to investigate the potential association between AMN and COVID-19 by examining 3 cases in China.CASE SUMMARY The first case involved a 30-year-old man who presented with progressive vision loss following a COVID-19 infection.Optical coherence tomography(OCT)and near-infrared imaging identified hallmark AMN lesions,hyperreflective disruptions within the outer plexiform layer,and hyporeflective anomalies in the ellipsoid zone,leading to an AMN diagnosis.Despite partial visual recovery,OCT angiography(OCTA)revealed persistent microvascular changes,specifically a decreased vascular density in the deep capillary plexus.The second case was a 24-year-old woman who experienced blurred vision and exhibited bilateral cottonwool spots on fundus examination post-COVID-19.Imaging confirmed the presence of AMN along with paracentral acute middle maculopathy(PAMM).Follow-up OCTA found a progressive reduction in vascular density,indicating ongoing microvascular compromise.The third case was a 28-year-old woman who reported sensations of occlusion in her right eye following a COVID-19 infection.Imaging confirmed both AMN and PAMM,revealing similar decreases of microvascular density on OCTA despite a significant improvement in visual acuity.We noted that all 3 patients had received the COVID-19 vaccine prior to the appearance of symptoms.CONCLUSION The findings highlight the diagnostic utility of advanced ocular imaging in detecting AMN in COVID-19 patients and the importance of comprehensive eye examinations.展开更多
Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic tract...Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic traction macula patchy,and myopic optic neuropathy(or glaucoma).The development of such vision-threatening complications is caused by eye deformity,characterized by a formation of posterior staphyloma.The recent advance in ocular imaging has greatly facilitated the clarification of pathologies and pathogenesis of pathological myopia and myopia-related complications.These technologies include ultra-wide field fundus imaging,swept-source optical coherence tomography,and 3D MRI.In addition,the new treatments such as anti-VEGF therapies for myopic choroid all neovascularization have improved the outcome of the patients.Swept-source OCT showed that some of the lesions of myopic maculopathy were not simply chorioretinal atrophy but were Bruch’s membrane holes.Features of myopic traction maculopathy have been analyzed extensively by using OCT.The understanding the pathophysiology of complications of pathologic myopia is considered useful for better management of this blinding eye disease.展开更多
Myopia poses a significant burden on the healthcare system,economy and quality of life.It is an emerging global public health challenge and requires interventions to delay or stop onset and progression.With changing t...Myopia poses a significant burden on the healthcare system,economy and quality of life.It is an emerging global public health challenge and requires interventions to delay or stop onset and progression.With changing times and evidence,the concepts of myopia are changing along with the treatment and control strategies.Behavioural modifications including increased outdoors time and reduced near work,optical and pharmaceutical management options are reviewed.This paper presents a current overview on the concepts of myopia,and is expected to summarize updates on myopia control methods.展开更多
文摘Dear Editor,We present the reported case of rapid onset bull’s eye maculopathy.Chloroquine(CQ)and its safer,more widely used analogue,hydroxychloroquine(HCQ),were originally developed as antimalarial medications.However,they have since become essential in the treatment of various autoimmune disorders due to their anti-inflammatory and immunomodulatory properties.HCQ is also being investigated for potential applications in diabetes mellitus,coronavirus disease 2019,heart disease,and as an adjunct in cancer therapy^([1-2]).
基金Supported by Shenzhen Science and Technology Program,Shenzhen,China(No.JCYJ20200109145001814,No.SGDX20211123120001001)the National Natural Science Foundation of China(No.81970790)Sanming Project of Medicine in Shenzhen(No.SZSM202011015).
文摘AIM:To identify a maculopathy patient caused by new recessive compound heterozygous variants in RP1L1.METHODS:Comprehensive retinal morphological and functional examinations were evaluated for the patient with RP1L1 maculopathy.Targeted sequence capture array technique was used to screen potential pathologic variants.Polymerase chain reaction and Sanger sequencing were used to confirm the screening results.RESULTS:Fundus examination showed round macular lesions appeared in both eyes.Optical coherence tomography showed that the inner segment/outer segment continuity was disorganized and disruptive in the left eye,but it was uneven and slightly elevated in the right eye.Fundus autofluorescence showed patchy hyper-autofluorescence in the macula.Visual field examination indicates central defects in both eyes.Electroretinogram(ERG)and multifocal ERG showed no obvious abnormalities.Fundus fluorescein angiography in the macula showed obviously irregular hyper-fluorescence in the right eye and slightly hyper-fluorescence in the left eye.We found that the proband carried a missense variant(c.1972C>T)and a deletion variant(c.4717_4718del)of RP1L1,which were originated from the parents and formed compound heterozygous variants.Both variants are likely pathogenic according to the ACMG criteria.Multimodal imaging,ERG and detailed medical history are important diagnostic tools for differentiating between acquired and inherited retinal disorders.CONCLUSION:A maculopathy case with detailed retinal phenotype and new recessive compound heterozygous variants of RP1L1 is identified in a Chinese family,which expands the understanding of phenotype and genotype in RP1L1 maculopathy.
文摘In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of myopic traction maculopathy (MTM). Here, we review the latest developments in the diagnosis and treatment of MTM, including its conception, clinical characteristics, pathogenesis, clinical stages, and the options for surgical treatment.
基金Supported by the National Natural Science Foundation of China(No.81870686)Beijing Municipal Natural Science Foundation(No.7184201)Capital’s Funds for Health Improvement and Research(No.2018-1-2021)。
文摘AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.
文摘A 24 year-old Malay lady presented with high grade fever,myalgia,generalized rashes,severe headache and was positive for dengue serology test.Her lowest platelet count was 45×10~9 cells/L.She complained of sudden onset of painlessness,profound loss of vision bilaterally 7 days after the onset of fever.On examination,her right eye best corrected vision was 6/30 and left eye was6/120.Her anterior segment examination was unremarkable.Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid.Systemic examination revealed normal findings except for residual petechial rashes.She was managed conservatively.Her vision improved tremendously after 2 months.The retinal hemorrhages and foveal elevation showed sign of resolving.Ocular manifestations following dengue fever is rare.However,bilateral visual loss can occur if both fovea arc involved.
基金Supported by the National Natural Science Foundation of China(No.61906066)the Zhejiang Provincial Philosophy and Social Science Planning Project(No.21NDJC021Z)+4 种基金Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties(No.SZGSP014)Sanming Project of Medicine in Shenzhen(No.SZSM202011015)Shenzhen Science and Technology Planning Project(No.KCXFZ20211020163813019)the Natural Science Foundation of Ningbo City(No.202003N4072)the Postgraduate Research and Innovation Project of Huzhou University(No.2023KYCX52)。
文摘AIM:To conduct a classification study of high myopic maculopathy(HMM)using limited datasets,including tessellated fundus,diffuse chorioretinal atrophy,patchy chorioretinal atrophy,and macular atrophy,and minimize annotation costs,and to optimize the ALFA-Mix active learning algorithm and apply it to HMM classification.METHODS:The optimized ALFA-Mix algorithm(ALFAMix+)was compared with five algorithms,including ALFA-Mix.Four models,including Res Net18,were established.Each algorithm was combined with four models for experiments on the HMM dataset.Each experiment consisted of 20 active learning rounds,with 100 images selected per round.The algorithm was evaluated by comparing the number of rounds in which ALFA-Mix+outperformed other algorithms.Finally,this study employed six models,including Efficient Former,to classify HMM.The best-performing model among these models was selected as the baseline model and combined with the ALFA-Mix+algorithm to achieve satisfactor y classification results with a small dataset.RESULTS:ALFA-Mix+outperforms other algorithms with an average superiority of 16.6,14.75,16.8,and 16.7 rounds in terms of accuracy,sensitivity,specificity,and Kappa value,respectively.This study conducted experiments on classifying HMM using several advanced deep learning models with a complete training set of 4252 images.The Efficient Former achieved the best results with an accuracy,sensitivity,specificity,and Kappa value of 0.8821,0.8334,0.9693,and 0.8339,respectively.Therefore,by combining ALFA-Mix+with Efficient Former,this study achieved results with an accuracy,sensitivity,specificity,and Kappa value of 0.8964,0.8643,0.9721,and 0.8537,respectively.CONCLUSION:The ALFA-Mix+algorithm reduces the required samples without compromising accuracy.Compared to other algorithms,ALFA-Mix+outperforms in more rounds of experiments.It effectively selects valuable samples compared to other algorithms.In HMM classification,combining ALFA-Mix+with Efficient Former enhances model performance,further demonstrating the effectiveness of ALFA-Mix+.
基金Supported by National Natural Science Foundation of China(No.30901637)Qingdao Sci-Tec Bureau,China(No.08-2-1-3-nsh)
文摘AIM:Age-related macular degeneration(AMD)is a multifactorial disease and a prevalent cause of visual impairment in developed countries.Many studies suggest that age-related maculopathy susceptibility 2(ARMS2)is a second major susceptibility gene for AMD.At present,there is no functional information on this gene.Therefore,the purpose of the present study was to detect the expression of ARMS2 in retinal pigment epithelium(RPE)cells and to investigate the effect of ARMS2 on the phagocytosis function of RPE cells.METHODS:Immunofluorescence and reverse transcriptase PCR were used to demonstrate the presence and location of ARMS2 in ARPE-19(human retinal pigment epithelial cell line,ATCC,catalog No.CRL-2302)cells.siRNA was used to knock down ARMS2 mRNA,and the effects of the knockdown on the phagocytosis function of the ARPE-19 cells were evaluated via Fluorescence Activated Cell Sorting(FACS).RESULTS:ARMS2 was present in ARPE-19 cells,localized in the cytosol of the perinuclear region.The expression of ARMS2 mRNA(messenger RNA)in ARPE-19 cells transfected with ARMS2-siRNA(small interfering RNA,0.73+/-0.08)was decreased compared with normal cells(1.00+/-0.00)or with cells transfected with scrambled siRNA(0.95+/-0.13)(P<0.05).After incubation of RPE cells with a latex beads medium for 12,18,or 24 hours,the fluorescence intensities were 38.04+/-1.02,68.92+/-0.92,and 78.00+/-0.12 in the ARMS2-siRNA-transfected groups,respectively,and 77.98+/-5.43,94.87+/-0.60,and 98.30+/-0.11 in the scrambled siRNA-transfected groups,respectively.The fluorescent intensities of the same time points in the two groups were compared using Student's t-test,and the p values were all less than 0.001 at the three different time points.CONCLUSION:There is endogenous expression of ARMS2 in ARPE-19 cells.ARMS2 plays a role in the phagocytosis function of RPE cells,and this role may be one of the mechanisms that participates in the development of AMD.
文摘AIM: To investigate the outcomes of adaptive conjunctival flap advancement surgical techniques with or without scleral graft for patients undergoing revision surgery after trabeculectomy.METHODS: This retrospective study included 28 eyes of 28 subjects from December 2015 to April 2018. A group of 15 eyes underwent conjunctival advancement only while the other 13 eyes did conjunctival advancement with partial thickness scleral graft. In both study groups, we considered the intraocular pressure(IOP) as our primary outcome and visual acuity(VA) as our secondary outcome. Both were assessed pre-and post-operatively till the last followup possible point. Additionally, we classified the patients according to complete and qualified success criteria.RESULTS: The mean age of the conjunctival advancement group was 36.87±19.25 y, while it was 44.08±18.04 in the other group. In both study groups, the mean IOP significantly increased after revision surgery at 1, 2, 3 mo and the last follow-up visit when compared to prior the surgery(P<0.001). Moreover, VA was significantly improved(P=0.03) in the final follow-up for both surgical techniques. When we compared the change from baseline in both groups, there was no significant difference between IOP improvement in 1 mo(P=0.263), while the difference was significant in 2 mo(P=0.03), 3 mo(P=0.02) and in the final follow-up visit postoperatively. However, this difference was not significant regarding VA(P=0.5).CONCLUSION: The both adaptive techniques of conjunctival advancement and conjunctival advancement with scleral graft are effective for treating patients with lateonset hypotony. Yet, more prospective studies are needed to assert upon these results.
基金the Deanship of Scientific Researchat Imam Mohammad Ibn Saud Islamic University (IMSIU) for funding and supporting this workthrough Research Partnership Program no. RP-21-07-04.
文摘The diagnosis of eye disease through deep learning (DL) technologyis the latest trend in the field of artificial intelligence (AI). Especially indiagnosing pathologic myopia (PM) lesions, the implementation of DL is adifficult task because of the classification complexity and definition system ofPM. However, it is possible to design an AI-based technique that can identifyPM automatically and help doctors make relevant decisions. To achieve thisobjective, it is important to have adequate resources such as a high-qualityPM image dataset and an expert team. The primary aim of this research isto design and train the DLs to automatically identify and classify PM intodifferent classes. In this article, we have developed a new class of DL models(SAN-FSL) for the segmentation and detection of PM through semanticadversarial networks (SAN) and few-short learning (FSL) methods, respectively.Compared to DL methods, the conventional segmentation methodsuse supervised learning models, so they (a) require a lot of data for trainingand (b) fixed weights are used after the completion of the training process.To solve such problems, the FSL technique was employed for model trainingwith few samples. The ability of FSL learning in UNet architectures is beingexplored, and to fine-tune the weights, a few new samples are being providedto the UNet. The outcomes show improvement in the detection area andclassification of PM stages. Betterment in the result is observed by sensitivity(SE) of 95%, specificity (SP) of 96%, and area under the receiver operatingcurve (AUC) of 98%, and the higher F1-score is achieved using 10-fold crossvalidation.Furthermore, the obtained results confirmed the superiority of theSAN-FSL method.
文摘Dear Editor,We report our experience using a continuous intraoperative optical coherence tomography(OCT)-enabled microscope system for real-time anatomical evaluation of the optic pit during surgery in an 8-year-old girl who presented with symptomatic optic disc pit(ODP) maculopathy. ODP is an extremely rare congenital anomaly secondary to colobomatous malformation of the optic nerve head, with a reported incidence of 0.00009%[1]. Although patients are frequently asymptomatic, approximately 40%-50% of patients experience visual symptoms because of subretinal fluid(SRF) accumulation beneath the macula.
基金Supported by Sichuan Administration of Traditional Chinese Medicine(No.2021MS422).
文摘AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and visualization analyses from Web of Science(WOS)Core Collection.Exported records were analyzed for titles,publication years,research institutions,journal names,authors,keywords,and abstracts using CiteSpace software version 6.1.RESULTS:A total of 839 related studies were analyzed,the publication volume increased annually,with Asia the most active region of MTM research.Optical coherence tomography angiography,optical coherence tomography,macular hole,high myopia,macular buckling were identified as the focus of the current research.Progression,association,classification and shape were identified as the major research frontiers.CONCLUSION:MTM is a major cause of visual loss in pathological myopic eyes.During the preceding 17y,the number of annual publications in MTM research increased gradually.Studies on the progression nature of MTM,genome-wide association study and proper classification of MTM might still be the frontiers of MTM researches.
文摘Diabetic maculopathy with marked exudation may lead to subretinal fibrosis. Two patients observed over multiple years evolved from macular exudation into subretinal fibrosis with severe visual loss. Spectral domain optical coherence tomography and color photographs document the clinical changes.
文摘Purpose: To describe the clinical, angiographic, and Optical Coherence Tomography (OCT) findings in a patient with Unilateral Acute Idiopathic Maculopathy (UAIM) and to discuss a possible pattern of OCT findings in patients with this disease. Methods: Case report. Results: A 34-year-old man with UAIM was evaluated. During the acute phase fundus examination revealed a yellow thickening in the macular area of the right eye, Fluorescein Angiography (FA) showed early alternating patches of hypofluorescence and hyperfluorescence and late hyperfluorescence and OCT showed thickening of the outer retina in the foveal zone. Six weeks later, the macula had pigmentary mottling, FA showed an area of central hypofluorescence surrounded by a hyperfluorescent ring that remained unchanged during the angiogram and the OCT examination was normal. Conclusion: OCT is a useful diagnostic tool for UAIM. OCT evaluation of patients with this disease will exhibit the heterogeneous hyperreflectivity and thickening of the outer retina and Retinal Pigment Epithelium (RPE). A serous macular detachment may not be a prominent finding in UAIM.
文摘We report a case series of dengue maculopathy with different ocular manifestations, managements, visual outcomes and sequelae of patients. All three cases were diagnosed to have dengue fever. Patients presented with symptoms of central scotoma (case 1 and case 3) and blurring of vision (case 2) on Day 9 of dengue fever. Fundus examination showed intra retinal haemorrhages (case 1 and case 2) and macula thickening (case 3). Optical coherence tomography (OCT) revealed macular thickening with intra retinal fluid (case 1) and diffuse retinal thickening (case 3), while in case 2, it had irregular ellipsoid line in OCT. Fundus fluorescence angiography (FFA) revealed parafoveal vasculitis. After treatment with systemic steroids, one patient had good visual outcome (case 2), while two others had a persistent central scotoma due to macula atrophy (case 3). Although it is a self limiting disease, but the mode of treatment is variable. Treatment with corticosteroids may hasten recovery of vision and prevent permanent visual impairment.
基金The research has been supported by the Qingdao Science and Technology Demonstration and Guidance Project(Grant No.20-3-4-45-nsh)Academic Promotion Plan of Shandong First Medical University&Shandong Academy of Medical Sciences(Grant No.2019ZL001)National Science and Technology Major Project of China(Grant No.2017ZX09304010).
文摘Background:Myopic maculopathy(MM)has become a major cause of visual impairment and blindness worldwide,especially in East Asian countries.Deep learning approaches such as deep convolutional neural networks(DCNN)have been successfully applied to identify some common retinal diseases and show great potential for the intelligent analysis of MM.This study aimed to build a reliable approach for automated detection of MM from retinal fundus images using DCNN models.Methods:A dual-stream DCNN(DCNN-DS)model that perceives features from both original images and corresponding processed images by color histogram distribution optimization method was designed for classification of no MM,tessellated fundus(TF),and pathologic myopia(PM).A total of 36,515 gradable images from four hospitals were used for DCNN model development,and 14,986 gradable images from the other two hospitals for external testing.We also compared the performance of the DCNN-DS model and four ophthalmologists on 3000 randomly sampledfundus images.Results:The DCNN-DS model achieved sensitivities of 93.3%and 91.0%,specificities of 99.6%and 98.7%,areas under the receiver operating characteristic curves(AUCs)of 0.998 and 0.994 for detecting PM,whereas sensitivities of 98.8%and 92.8%,specificities of 95.6%and 94.1%,AUCs of 0.986 and 0.970 for detecting TF in two external testing datasets.In the sampled testing dataset,the sensitivities of four ophthalmologists ranged from 88.3%to 95.8%and 81.1%to 89.1%,and the specificities ranged from 95.9%to 99.2%and 77.8%to 97.3%for detecting PM and TF,respectively.Meanwhile,the DCNN-DS model achieved sensitivities of 90.8%and 97.9%and specificities of 99.1%and 94.0%for detecting PMand T,respectively.Conclusions:The proposed DCNN-DS approach demonstrated reliable performance with high sensitivity,specificity,and AUC to classify different MM levels on fundus photographs sourced from clinics.It can help identify MM automatically among the large myopic groups and show great potential for real-life applications.
基金Supported by the National Natural Science Foundation of China(No.82371084).
文摘AIM:To investigate the outcomes and prognosis of macular epiretinal membrane(ERM)after pars plana vitrectomy(PPV)in patients with high myopia(HM),focusing on the optimal timing of surgery and its impact on prognosis.METHODS:The clinical data of 50 eyes from 49 patients diagnosed with ERM,who were highly myopic and underwent PPV were retrospectively analyzed.The patients with ERM were classified into five groups based on the characteristics associated with different levels of myopic traction maculopathy.Group 1:Simple ERM without complex vertical and tangential direction traction on retina on optical coherence tomography(OCT)image;Group 2:ERM with obvious macular foveal schisis,without macular hole(MH);Group 3:ERM with inner lamellar MH,with or without macular foveal schisis;Group 4:ERM with outer lamellar MH,with or without foveal retinal detachment(RD);Group 5:ERM with full-thickness MH.Baseline characteristics,changes in best corrected visual acuity(BCVA)before and after surgery,and anatomical characteristics through spectral domain OCT were compared.RESULTS:The 50 eyes were followed for 6mo,with an average age of 58.66y and an average axial length(AL)of 28.69 mm.Among the five groups,postoperative logMAR BCVA improved(P<0.05).Group 1 had better mean BCVA at baseline(0.59±0.36)and at 6mo postoperatively(0.16±0.22)compared to the other groups,while Group 5 had worse mean BCVA at baseline(1.68±0.45)and at 6mo postoperatively(1.27±0.64).There were no statistically significant differences in sex,age or AL between the groups(P>0.05).OCT showed that Groups 4 and 5 exhibited poorer macular anatomy compared to the other three groups,as evidenced by lower rates of central retinal reattachment(64.3%in Group 4,86.7%in Group 5)and integrity of the inner segment/outer segment of photoreceptor junction(28.6%in Group 4,26.7%in Group 5).CONCLUSION:PPV is an effective treatment for ERM in patients with HM.All groups showed postoperative improvement in BCVA compared to preoperative levels,demonstrating the necessity of surgical intervention.Early intervention,particularly before the fourth stage of the disease,may lead to better visual outcomes.
文摘Accidental exposure to the laser may result in visual impairment from retinal injury.Laser-induced damages to the macula include outer retinal disruption,foveal hemorrhage,macular edema,epiretinal membrane,full thickness macular hole,etc.[1,2] There are some case reports of visual improvement following the use of oral corticosteroids,but till date,there is no known effective treatment for this condition.[3,4] We report a case series of laser-induced maculopathy treated with standard doses of oral corticosteroids.
文摘BACKGROUND During the Coronavirus disease 2019(COVID-19)pandemic,a notable increase in acute macular neuroretinopathy(AMN)cases was observed.This study aimed to investigate the potential association between AMN and COVID-19 by examining 3 cases in China.CASE SUMMARY The first case involved a 30-year-old man who presented with progressive vision loss following a COVID-19 infection.Optical coherence tomography(OCT)and near-infrared imaging identified hallmark AMN lesions,hyperreflective disruptions within the outer plexiform layer,and hyporeflective anomalies in the ellipsoid zone,leading to an AMN diagnosis.Despite partial visual recovery,OCT angiography(OCTA)revealed persistent microvascular changes,specifically a decreased vascular density in the deep capillary plexus.The second case was a 24-year-old woman who experienced blurred vision and exhibited bilateral cottonwool spots on fundus examination post-COVID-19.Imaging confirmed the presence of AMN along with paracentral acute middle maculopathy(PAMM).Follow-up OCTA found a progressive reduction in vascular density,indicating ongoing microvascular compromise.The third case was a 28-year-old woman who reported sensations of occlusion in her right eye following a COVID-19 infection.Imaging confirmed both AMN and PAMM,revealing similar decreases of microvascular density on OCTA despite a significant improvement in visual acuity.We noted that all 3 patients had received the COVID-19 vaccine prior to the appearance of symptoms.CONCLUSION The findings highlight the diagnostic utility of advanced ocular imaging in detecting AMN in COVID-19 patients and the importance of comprehensive eye examinations.
文摘Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic traction macula patchy,and myopic optic neuropathy(or glaucoma).The development of such vision-threatening complications is caused by eye deformity,characterized by a formation of posterior staphyloma.The recent advance in ocular imaging has greatly facilitated the clarification of pathologies and pathogenesis of pathological myopia and myopia-related complications.These technologies include ultra-wide field fundus imaging,swept-source optical coherence tomography,and 3D MRI.In addition,the new treatments such as anti-VEGF therapies for myopic choroid all neovascularization have improved the outcome of the patients.Swept-source OCT showed that some of the lesions of myopic maculopathy were not simply chorioretinal atrophy but were Bruch’s membrane holes.Features of myopic traction maculopathy have been analyzed extensively by using OCT.The understanding the pathophysiology of complications of pathologic myopia is considered useful for better management of this blinding eye disease.
文摘Myopia poses a significant burden on the healthcare system,economy and quality of life.It is an emerging global public health challenge and requires interventions to delay or stop onset and progression.With changing times and evidence,the concepts of myopia are changing along with the treatment and control strategies.Behavioural modifications including increased outdoors time and reduced near work,optical and pharmaceutical management options are reviewed.This paper presents a current overview on the concepts of myopia,and is expected to summarize updates on myopia control methods.
