RESUMO
PURPOSE: In diabetic patients presenting with macular edema (ME) shortly after cataract surgery, identifying the underlying pathology can be challenging and influence management. Our aim was to develop a simple clinical classifier able to confirm a diabetic etiology using few spectral domain optical coherence tomography parameters. METHODS: We analyzed spectral domain optical coherence tomography data of 153 patients with either pseudophakic cystoid ME (n = 57), diabetic ME (n = 86), or "mixed" (n = 10). We used advanced machine learning algorithms to develop a predictive classifier using the smallest number of parameters. RESULTS: Most differentiating were the existence of hard exudates, hyperreflective foci, subretinal fluid, ME pattern, and the location of cysts within retinal layers. Using only 3 to 6 spectral domain optical coherence tomography parameters, we achieved a sensitivity of 94% to 98%, specificity of 94% to 95%, and an area under the curve of 0.937 to 0.987 (depending on the method) for confirming a diabetic etiology. A simple decision flowchart achieved a sensitivity of 96%, a specificity of 95%, and an area under the curve of 0.937. CONCLUSION: Confirming a diabetic etiology for edema in cases with uncertainty between diabetic cystoid ME and pseudophakic ME was possible using few spectral domain optical coherence tomography parameters with high accuracy. We propose a clinical decision flowchart for cases with uncertainty, which may support the decision for intravitreal injections rather than topical treatment.
Assuntos
Biomarcadores , Retinopatia Diabética/diagnóstico , Diagnóstico por Computador/métodos , Aprendizado de Máquina , Edema Macular/diagnóstico , Pseudofacia/diagnóstico , Tomografia de Coerência Óptica , Idoso , Área Sob a Curva , Retinopatia Diabética/classificação , Feminino , Angiofluoresceinografia , Humanos , Edema Macular/classificação , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pseudofacia/classificação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Líquido Sub-Retiniano , Acuidade VisualRESUMO
Self-enucleation is a very unusual form of self-mutilation directly linked to mental illness. In this case we present a 26-year-old schizophrenic patient who attempted to enucleate his eye with a rollerball pen. Antipsychotic therapy and emergency surgery saved the patient eye and emphasize the importance of quick response and good collaboration between psychiatric and ophthalmic teams.