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Purpose: To determine the surface characteristics of porcine corneal lenticules after Femtosecond Lenticule Extraction. Methods: The Carl Zeiss Meditec AG VisuMax® femtosecond laser system was used to create refractive corneal lenticules on 10 freshly isolated porcine eyes. The surface regularity on the corneal lenticules recovered was evaluated by assessing scanning electron microscopy images using an established scoring system. Results: All specimens yielded comparable score results of 5–7 points (SD = 0.59) per lenticule (score range minimum 4 to maximum 11 points). Surface irregularities were caused by tissue bridges, cavitation bubbles or scratches. Conclusion: The Femtosecond Lenticule Extraction procedure is capable of creating corneal lenticules of predictable surface quality. However, future studies should focus on the optimization of laser parameters as well as surgical technique to improve the regularity of the corneal stromal bed.
The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.
Hintergrund
Seit 2018 ist mit IDx-DR ein Verfahren auf dem Markt, welches den Grad der diabetischen Retinopathie (DR) mittels künstlicher Intelligenz (KI) bestimmt.
Methoden
Wir haben IDx-DR in die Sprechstunde an einer diabetologischen Schwerpunktklinik integriert und berichten über die Übereinstimmung zwischen IDx-DR (IDx Technologies Inc., Coralville, IA, USA) und Funduskopie sowie IDx-DR und ophthalmologischer Bildbeurteilung sowie über den Einfluss unterschiedlicher Kamerasysteme.
Ergebnisse
Mit der Topcon-Kamera (n = 456; NW400, Topcon Medical Systems, Oakland, NJ, USA) konnte im Vergleich zur Zeiss-Kamera (n = 47; Zeiss VISUCAM 500, Carl Zeiss Meditec AG, Jena, Deutschland) häufiger eine ausreichende Bildqualität in Miosis erreicht werden. Insgesamt war bei etwa 60 % der Patienten eine IDx-DR-Analyse in Miosis möglich. Alle Patienten, bei denen keine IDx-DR-Analyse in Miosis möglich war, konnten in Mydriasis funduskopiert werden. Innerhalb der Gruppe der auswertbaren Befunde zeigte sich eine Übereinstimmung zwischen IDx-DR und augenärztlicher Funduoskopie in ca. 55 %, ein Überschätzen des Schweregrads durch IDx-DR in ca. 40 % und ein Unterschätzen in ca. 4 %. Die Sensitivität (Spezifität) für das Erkennen einer schweren, behandlungsbedürftigen Retinopathie lag bei 95,7 % (89,1 %) für Fälle mit auswertbaren Fundusaufnahmen und bei 65,2 % (66,7 %), wenn alle Fälle betrachtet werden (inklusive derjeniger ohne verwertbare Aufnahme in Miosis). Der Kappa-Koeffizient zeigt mit 0,334 (p < 0,001) eine ausreichende Übereinstimmung zwischen IDx-DR und ärztlicher Bildauswertung anhand des Fundusfotos unter Berücksichtigung aller Patienten mit auswertbarer IDx-DR-Analyse. Der Vergleich zwischen IDx-DR mit der ärztlichen Funduskopie ergibt unter denselben Voraussetzungen eine geringe Übereinstimmung mit einem Kappa-Wert von 0,168 (p < 0,001).
Schlussfolgerung
Die vorliegende Studie zeigt Möglichkeiten und Grenzen des KI-gestützten DR-Screenings auf. Eine wesentliche Einschränkung liegt in der Tatsache, dass bei ca. 40 % der Patienten keine ausreichenden Aufnahmen in Miosis gewonnen werden konnten. Wenn ausreichende Aufnahmen vorlagen, stimmten IDx-DR und augenärztliche Diagnose in über 50 % der Fälle überein. Ein Unterschätzen des Schweregrades durch IDx-DR kam selten vor. Für die Integration in augenärztlich unterstützten Sprechstunden erscheint uns das System grundsätzlich geeignet. Die hohe Rate an fehlenden Aufnahmen in Miosis stellt allerdings eine Limitation dar, die einen Einsatz ohne augenärztliche Kontrollmöglichkeit schwierig erscheinen lässt.
Background: To analyze the relation and distribution of mean, systolic and diastolic ocular perfusion pressure (OPP) in telemedical homemonitoring of patients with primary open-angle glaucoma (POAG). Methods: 70 patients with POAG measured intraocular pressure (IOP) and blood pressure at home for a period of 6 months with the Goldmann applanation self-tonometer Ocuton S and the blood pressure device boso medicus PC. Twenty-four-hour profiles were taken every 4 weeks in addition to single measurements in the morning and evening once a week. All measured values were transmitted to an electronic patient record, which calculated OPP by taking systolic, diastolic and mean arterial blood pressure and subtracting IOP. Results: We analyzed 3,282 values of mean, systolic and diastolic OPP. The quantity of values below the risk levels of the Barbados Eye Studies was calculated. We found values lower than the risk levels for LE: 49 (1.5%)/RE: 60 (1.8%) systolic OPP, LE: 1,623 (49.5%)/RE: 1,761 (53.7%) diastolic OPP and LE: 687 (20.9%)/RE: 794 (24.2%) mean OPP. The individual average OPP levels of all 70 patients below the risk levels showed the following distribution: LE: 4 (5.7%)/RE: 6 (8.6%) systolic OPP, LE: 19 (27.1%)/RE: 20 (28.6%) diastolic OPP and LE: 10 (14.3%)/RE: 10 (14.3%) mean OPP. Conclusion: The individual distribution of different OPP values in POAG patients is not easy to interpret for clinical ophthalmologists. Precise practicable guidelines for clinical use still have to be determined.
Background/Aims
Prematurely born infants undergo costly, stressful eye examinations to uncover the small fraction with retinopathy of prematurity (ROP) that needs treatment to prevent blindness. The aim was to develop a prediction tool (DIGIROP-Screen) with 100% sensitivity and high specificity to safely reduce screening of those infants not needing treatment. DIGIROP-Screen was compared with four other ROP models based on longitudinal weights.
Methods
Data, including infants born at 24–30 weeks of gestational age (GA), for DIGIROP-Screen development (DevGroup, N=6991) originate from the Swedish National Registry for ROP. Three international cohorts comprised the external validation groups (ValGroups, N=1241). Multivariable logistic regressions, over postnatal ages (PNAs) 6–14 weeks, were validated. Predictors were birth characteristics, status and age at first diagnosed ROP and essential interactions.
Results
ROP treatment was required in 287 (4.1%)/6991 infants in DevGroup and 49 (3.9%)/1241 in ValGroups. To allow 100% sensitivity in DevGroup, specificity at birth was 53.1% and cumulatively 60.5% at PNA 8 weeks. Applying the same cut-offs in ValGroups, specificities were similar (46.3% and 53.5%). One infant with severe malformations in ValGroups was incorrectly classified as not needing screening. For all other infants, at PNA 6–14 weeks, sensitivity was 100%. In other published models, sensitivity ranged from 88.5% to 100% and specificity ranged from 9.6% to 45.2%.
Conclusions
DIGIROP-Screen, a clinical decision support tool using readily available birth and ROP screening data for infants born GA 24–30 weeks, in the European and North American populations tested can safely identify infants not needing ROP screening. DIGIROP-Screen had equal or higher sensitivity and specificity compared with other models. DIGIROP-Screen should be tested in any new cohort for validation and if not validated it can be modified using the same statistical approaches applied to a specific clinical setting.
Purpose
The German Retina.net ROP registry and its Europe-wide successor, the EU-ROP registry, collect data from patients treated for ROP. This analysis compares input parameters of these two registries to establish a procedure for joint analyses of different registry data using exemplary datasets from the two registries.
Methods
Exemplary datasets from the two databases over a 1-year period each (German Retina.net ROP Registry, 2011, 22 infants; EU-ROP Registry, 2021, 44 infants) were compared. The parameters documented in the two databases were aligned and analysed regarding demographic parameters, treatment modalities, complications within first 24 h and retreatments.
Results
The current analysis showed that data can be aligned for joint analyses with some adjustments within the data structure. The registry with more detailed data collection (EU-ROP) needs to be reduced regarding granularity in order to align the different registries, as the registry with lower granularity determines the level of analyses that can be performed in a comparative approach. In the exemplary datasets, we observed that the overall most common ROP severity in both registries was zone II, 3+ (2011: 70.5%; 2021: 65%), with decreasing numbers of clock hours showing preretinal neovascularisations (2011: 10–12 clock hours in 29% of cases, 2021: 4–6 clock hours in 38%). The most prevalent treatment method was laser coagulation in 2011 (75%) and anti-VEGF therapy in 2021 (86.1%). Within the anti-VEGF group, all patients were treated with bevacizumab in 2011 and with ranibizumab in 2021. Retreatment rates were comparable in 2011 and 2021.
Conclusion
Data from two different ROP registries can be aligned and jointly analysed. The analysis reveals a paradigm shift in treatment modalities, from predominantly laser to anti-VEGF, and within the anti-VEGF group from bevacizumab to ranibizumab in Germany. In addition, there was a trend towards earlier treatment in 2021.
Introduction: Vessel-associated retinal diseases are a major cause of blindness and severe visual impairment. The identification of appropriate biomarkers is of great importance to better anticipate disease progression and establish more targeted treatment options. MicroRNAs (miRNAs) are short, single-stranded, noncoding ribonucleic acids that are involved in the posttranscriptional regulation of gene expression through hybridization with messenger RNA. The expression of certain miRNAs can be different in patients with pathological processes and can be used for the detection and differentiation of various diseases. In this study, we investigate to what extent previously in vitro identified miRNAs are present as cell-free circulating miRNAs in the serum and vitreous of human patients with and without vessel-associated retinal diseases. Methods: Relative quantification by quantitative real-time polymerase chain reaction was used to analyze miRNA expression in patients with vessel-associated retinal diseases such as age-related macular degeneration (AMD), diabetic retinopathy (DR), and retinal vein occlusion compared with control patients. Results: In serum samples, miR-29a-3p and miR-192-5p showed increased expression in patients with neovascular AMD relative to control patients. Similarly, miR-335-5p, miR-192-5p, and miR-194-5p showed increased expression in serum from patients with proliferative DR. In vitreous samples, miR-100-5p was decreased in patients with proliferative DR. Differentially expressed miRNAs showed good diagnostic accuracy in receiver operating characteristic (ROC) and area under the ROC curve analysis. Conclusion: The miRNAs investigated in this study may have the potential to serve as biomarkers for vessel-associated retinal diseases. Combining multiple miRNAs may enhance the predictive power of the analysis.