Descriptive analysis of dental X-ray images using various practical methods: A review.

In dentistry, practitioners interpret various dental X-ray imaging modalities to identify tooth-related problems, abnormalities, or teeth structure changes. Another aspect of dental imaging is that it can be helpful in the field of biometrics. Human dental image analysis is a challenging and time-consuming process due to the unspecified and uneven structures of various teeth, and hence the manual investigation of dental abnormalities is at par excellence. However, automation in the domain of dental image segmentation and examination is essentially the need of the hour in order to ensure error-free diagnosis and better treatment planning. In this article, we have provided a comprehensive survey of dental image segmentation and analysis by investigating more than 130 research works conducted through various dental imaging modalities, such as various modes of X-ray, CT (Computed Tomography), CBCT (Cone Beam Computed Tomography), etc. Overall state-of-the-art research works have been classified into three major categories, i.e., image processing, machine learning, and deep learning approaches, and their respective advantages and limitations are identified and discussed. The survey presents extensive details of the state-of-the-art methods, including image modalities, pre-processing applied for image enhancement, performance measures, and datasets utilized.

Long-term Clinical Outcomes of Pars Plana Versus Anterior Chamber Placement of Glaucoma Implant Tubes.

PURPOSE: To compare long-term surgical outcomes and complications of pars plana (PP) tube implantation with conventional anterior chamber (AC) tube implantation. MATERIALS AND METHODS: Records of patients undergoing glaucoma tube implant surgery at a single institution between 2007 and 2015 were retrospectively reviewed. Eyes were matched for glaucoma diagnosis and patient age. Demographics, baseline characteristics, and treatment outcomes were recorded. Surgical success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg, no subsequent glaucoma surgeries performed, and at least light perception vision. RESULTS: Fifty-seven eyes that underwent Ahmed or Baerveldt glaucoma drainage device surgery with PP tube placement were compared with 57 eyes with AC tube placement. Mean follow-up was 43.5 months in the PP group and 35.3 months in the AC group (P=0.02). Forty-nine (86.0%) PP eyes and 46 (80.7%) AC eyes achieved surgical success (P=0.45). At last follow-up, mean IOP decreased from 29.0 to 15.1 mm Hg in the PP group (P<0.01) and from 32.7 to 15.6 mm Hg in the AC group (P<0.01). Mean number of medications decreased from 2.9 to 1.1 in the PP group (P<0.01) and from 2.8 to 1.3 in the AC group (P<0.01). Mean IOP and number of medications were similar between PP and AC groups at baseline, last follow-up, and all interim time points (P>0.05 for all). There were 16 complications in the PP group and 14 in the AC group (P=0.67). CONCLUSIONS: Long-term results of glaucoma tube implant surgery with PP versus AC implantation shows effective IOP control with similar rates of surgical success.

Rates of Intraocular Pressure Elevation and Use of Topical Antihypertensive Medication After Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To investigate intraocular pressure (IOP) elevation and medication augmentation after Descemet stripping automated endothelial keratoplasty (DSAEK) in those with and without glaucoma. METHODS: The records of 379 patients who underwent DSAEK at the Cleveland Clinic Foundation between January 2009 and 2014 were retrospectively reviewed. Postoperative IOP elevations were considered significant if IOP was ≥22 mm Hg on at least 1 follow-up visit or if it increased by ≥10 mm Hg from baseline. RESULTS: The incidence rate of IOP elevation was 4% per person-month (confidence interval [CI], 3%-6%) in patients with preexisting glaucoma and 3% (CI, 2%-4%) in those without. Rates of medication augmentation were 4% per person-month (CI, 3%-5%) in patients with glaucoma and 1.8% (CI, 1.4%-2.4%) in those without. Incidence rates for both outcomes peaked at 1 month. Whites had nearly a 47% lower incidence of IOP elevation compared with nonwhites (P = 0.004); patients with pseudophakic bullous keratopathy had a 54% higher incidence of IOP elevation (P = 0.024); and those with Fuchs endothelial corneal dystrophy had a 36% lower incidence (P = 0.024). Patients with glaucoma had over a 2-fold higher incidence of medication augmentation compared with those without (hazard rate ratio = 2.08, P < 0.001). CONCLUSIONS: The incidence of post-DSAEK IOP elevation did not significantly differ by glaucoma status, although patients with glaucoma were more likely to have escalation of topical antihypertensive therapy. The incidence of IOP elevation was significantly associated with pseudophakic bullous keratopathy and nonwhite race. These patients should be followed closely in the early postoperative period, as elevated IOP can be a serious consequence of DSAEK.

Recurrent Conjunctival Myofibrosarcoma Managed With Triple Application of Episcleral Brachytherapy.

PURPOSE: To report a case of recurrent conjunctival myofibrosarcoma treated with wide surgical excision, cryotherapy, and triple sequential applications of episcleral brachytherapy. METHODS: A single case of recurrent conjunctival myofibrosarcoma. RESULTS: A 54-year-old man with a history of a renal transplant presented with a recurrent conjunctival tumor. Histopathologic diagnosis was established through immunohistochemistry. In total, 3 iodine radiation episcleral plaques were used over a period of 49 weeks. After cicatricial ectropion repair and cataract surgery, visual acuity was 20/20 at 4.5-year follow-up without evidence of recurrence or radiation retinopathy. CONCLUSIONS: Myofibrosarcoma is a rare mesenchymal tumor that can present as ocular surface tumor. Final histopathologic diagnosis can be challenging, and immunohistochemistry is important for evaluation. Myofibrosarcoma should be considered in the clinical differential diagnosis of atypical ocular surface lesions and the histopathologic differential diagnosis of ocular spindle neoplasms.

Ocular Adnexal Lymphoma Presenting as Refractory Unilateral Open-angle Glaucoma.

We report a single case of masquerade glaucoma caused by increased episcleral venous pressure from adnexal lymphoma. The patient presented as a referral for unilateral glaucoma with intraocular pressures (IOPs) consistently >40 mm Hg (right eye). We present data conclusively demonstrating extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in the involved eye, and provide an account of the treatment of the tumor with sustained regression and complete resolution of his elevated IOP. We conclude with a discussion of the proposed mechanism. This case serves as a reminder that unilateral open-angle glaucoma can be a sign of indolent ocular adnexal lymphoma. The case also provides a useful model for increased IOP with orbital lesions.

AGEs in human lens capsule promote the TGFß2-mediated EMT of lens epithelial cells: implications for age-associated fibrosis.

Proteins in basement membrane (BM) are long-lived and accumulate chemical modifications during aging; advanced glycation endproduct (AGE) formation is one such modification. The human lens capsule is a BM secreted by lens epithelial cells. In this study, we have investigated the effect of aging and cataracts on the AGE levels in the human lens capsule and determined their role in the epithelial-to-mesenchymal transition (EMT) of lens epithelial cells. EMT occurs during posterior capsule opacification (PCO), also known as secondary cataract formation. We found age-dependent increases in several AGEs and significantly higher levels in cataractous lens capsules than in normal lens capsules measured by LC-MS/MS. The TGFß2-mediated upregulation of the mRNA levels (by qPCR) of EMT-associated proteins was significantly enhanced in cells cultured on AGE-modified BM and human lens capsule compared with those on unmodified proteins. Such responses were also observed for TGFß1. In the human capsular bag model of PCO, the AGE content of the capsule proteins was correlated with the synthesis of TGFß2-mediated α-smooth muscle actin (αSMA). Taken together, our data imply that AGEs in the lens capsule promote the TGFß2-mediated fibrosis of lens epithelial cells during PCO and suggest that AGEs in BMs could have a broader role in aging and diabetes-associated fibrosis.

Acute corneal edema with subsequent thinning and hyperopic shift following selective laser trabeculoplasty.

UNLABELLED: We report 4 cases of acute corneal edema with subsequent thinning and hyperopic shift following routine selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma. Four women from 3 clinical sites developed acute corneal edema and haze within 2 days of uneventful SLT. In the following weeks to months, all treated corneas thinned to below pre-procedure thicknesses with resultant hyperopic shifts of nearly 2.0 diopters (D) to greater than 6.0 D. All eyes were moderately to highly myopic prior to SLT (spherical equivalent from -5.00 to -12.5 D). The corrected distance visual acuity 6 to 11 months after SLT was within 2 Snellen lines of the pre-procedure acuity in all patients; 2 patients required contact lenses. Corneal edema with subsequent corneal thinning and resultant hyperopic shift is an uncommon but possibly underrecognized complication of SLT, the etiology of which remains unknown but may be associated with moderate to high myopia. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Relationship Between Fuchs Endothelial Corneal Dystrophy Severity and Glaucoma and/or Ocular Hypertension.

OBJECTIVE To investigate whether Fuchs endothelial corneal dystrophy (FECD) severity is associated with glaucoma and/or ocular hypertension (G/OHTN). METHODS A subset of eyes (n = 1610) from the FECD Genetics Multi-Center Study were examined to estimate the association between FECD severity (grades 0-6 based on guttae confluence) and G/OHTN. Logistic regression models that accounted for the correlation between eyes and adjusted for age, sex, central corneal thickness, intraocular pressure, presence of diabetes, and time of day of the initial evaluation were fit. RESULTS A total of 107 eyes (6.6%) had G/OHTN based on the study definition. The prevalence of G/OHTN in the control group was 6.0%. The prevalence was lower in index cases with an FECD grade of 1 through 3 and family members with a grade of 0 or 1 through 3 (0.0% and 2.1%, respectively) but higher in index cases and family members with a grade of 4 through 6 (11.2% and 8.5%, respectively). Adjusting for covariates, eyes with a grade of 4 through 6 were more likely to have concurrent G/OHTN than eyes with no FECD (index cases vs controls: odds ratio [OR] = 2.10, P = .04; affected vs unaffected family members: OR = 7.06, P = .07). Age (OR = 1.06 per 1-year increase, P < .001) and intraocular pressure (OR = 1.15 per 1-mm Hg increase, P < .001) were also associated with an increased prevalence of G/OHTN. Sex, diabetes, time of day of evaluation, and central corneal thickness were not associated with the prevalence of G/OHTN (P ≥ .15). CONCLUSIONS Glaucoma and/or ocular hypertension occurs more often in eyes with severe FECD compared with unaffected eyes. Therefore, it may be beneficial to monitor for the development of glaucoma in these patients.

Cognitive profile of elders in an ophthalmic ambulatory setting.

AIMS: To assess the potential association between vision and cognition in an ambulatory older population. METHODS: A sample of 84 adults aged 65 and older seeking non-emergent ophthalmic care. Participants were interviewed with the Mini-Mental State Examination (MMSE) during their regular scheduled visit. RESULTS: The average individual was a 78-year-old female, with at least a high school diploma and mildly affected vision (logMAR 0.27). Vision and cognition scores were unrelated (Pearson=-0.09, p=0.41). An MMSE<24 (out of 30) was found in 19% of individuals. A score of 16 in the MMSE(blind) (out of 22) identified 14 (88%) of them. Memory was the most frequently affected component (13 patients, 81%), and recall the most frequently involved item (nine patients, 56%). More individuals (16-26%) with moderate to severe vision impairment (logMAR 0.6 to 1.3) tended to have psychomotor and concentration deficiencies and fewer (14%) memory problems compared with those with normal vision or mild impairment (logMAR -0.3 to 0.5). Language was uniformly affected across levels of vision impairment. CONCLUSIONS: An absent relationship between cognition and vision based on overall scores of standard instruments does not preclude the existence of such association as characterised by more comprehensive measures, and thus greater vision impairment may confer some cognitive ageing in specific abilities.

Recurrent bleeding following traumatic hyphema due to mild hemophilia B (Christmas disease).

Traumatic hyphemas generally resolve spontaneously. When recurrent bleeding occurs, a coagulopathy should be suspected. We present a unique case of a traumatic hyphema with recurrent bleeding in association with mild hemophilia B (factor IX deficiency).

Medical therapy of glaucoma.

Prescribing medical treatment for glaucoma requires a complex decision-making process that involves the patient, the severity of the disease, the therapeutic options available, and their potential side effects. Lowering intraocular pressure, a known risk factor for progression, has been the mainstay of glaucoma treatment. Most patients who are first diagnosed with glaucoma in the United States are started on topical medications. As our understanding of the disease changes and newer treatments become available, glaucoma therapies may need to be reassessed and changed if necessary.