4D label-free proteomics analysis of oxygen-induced retinopathy with or without anti-VEGF treatment.

Oxygen-induced retinopathy (OIR) animal model is widely used for retinopathy of prematurity (ROP) researches. The purpose of this study was to identify proteins and related pathways of OIR with or without anti-vascular endothelial growth factor (VEGF) treatment, for use as biomarkers in diagnosing and treating ROP. Nine samples were subjected to proteomic analysis. Retina specimens were collected from 3 OIR mice, 3 OIR mice with anti-VEGF treatment and 3 normal mice (control group). Liquid chromatography-tandem mass spectrometry analysis was performed using the 4D label-free technique. Statistically significant differentially expressed proteins, gene ontology (GO) terms, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway representations, InterPro (IPR) and protein interactions were analyzed. In total, 4585 unique proteins were identified as differentially expressed proteins (DEPs). Enrichment analysis of the GO and KEGG indicated functional clusters related to peptide biosynthetic and metabolic process, cellular macromolecule biosynthetic process and nucleic acid binding in OIR group. For anti-VEGF treatment group, DEPs were clustered in DNA replication, PI3K/Akt signaling pathway and Jak/STAT signaling pathway. Proteomic profiling is useful for the exploration of molecular mechanisms of OIR and mechanisms of anti-VEGF treatment. These findings may be useful for identification of novel biomarkers for ROP pathogenesis and treatment.

Quantitative optical coherence tomography angiography assessments in the fellow eyes of those with central serous chorioretinopathy.

BACKGROUND: To analyze the vessel density (VD) of the retina and choriocapillaris (CC) layer and the structure of the foveal avascular zone (FAZ) in the fellow eyes of central serous chorioretinopathy (CSC) patients by using optical coherence tomography angiography (OCTA). METHODS: This was a case-control study. Unilateral CSC patients and age-matched healthy subjects were recruited from the Affiliated Eye Hospital of Wenzhou Medical University between July 2016 and July 2021. All eyes were divided into three groups: acute CSC (aCSC), chronic CSC (cCSC), and healthy controls. Both aCSC and cCSC were again divided into two subgroups: the affected eyes and the fellow eyes. In this study, all parameters of VD and FAZ were measured by self-software of OCTA. RESULTS: A total of 231 eyes of 137 subjects were included, with 47 aCSC patients, 47 cCSC patients, and 43 healthy controls. In the fellow eyes of CSC, the retinal VD was significantly lower (all P < 0.05), and the FAZ was significantly larger (all P < 0.05) in the cCSC group than in healthy controls, while no difference was detected in the CC layer. There was no significant difference between the aCSC group and healthy controls in all OCTA parameters. In the affected eyes of CSC, the superficial retinal vessel density (SRVD) was significantly higher (all P < 0.05) in healthy controls than in the aCSC and cCSC groups, while the deep retinal vessel density (DRVD) was significantly lower (all P < 0.05) and the FAZ was larger (all P < 0.05) in the cCSC group than in the aCSC group and healthy controls. A liner regression equation was established: Y (BCVA, best corrected visual acuity) = 3.692-0.036✱X1 (DRVD-Fovea)-0.031✱X2 (FD-300, vessel density around the 300 µm width of the FAZ), R2 = 0.427. CONCLUSION: Based on OCTA measurements, this study revealed that the retinal microvascular network was impaired even in the fellow eyes of those with cCSC, which should arouse attention to the observation of unilateral CSC.

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study.

BACKGROUND: Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence. PURPOSE: To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai. METHODS: A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model. RESULTS: The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (ß = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (ß = 0.087, P < 0.001). Health literacy directly influenced adherence (ß = 0.291, P < 0.001). Education indirectly affected adherence through both social support (ß = 0.048, P < 0.001) and health literacy (ß = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (ß = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit. CONCLUSIONS: The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

Screening of idiopathic epiretinal membrane using fundus images combined with blood oxygen saturation and vascular morphological features.

PURPOSE: To achieve an accurate diagnosis of idiopathic epiretinal membrane (iERM) through analyzing retinal blood vessel oxygen saturation (SO2) and vascular morphological features in fundus images. METHODS: Dual-modal fundus camera was used to obtain color fundus image, 570-nm, and 610-nm images. As iERM affects the macular area, a macular-centered semicircle area as region of interest (MROI) was selected and analyzed SO2 and vascular morphologies in it. Eventually, random forest (RF) and support vector machine (SVM) were as classifiers to diagnose iERM patients. RESULTS: The arterial and venous SO2 levels of the iERM group were significantly higher than that of the control group. There were significant differences in the vessel density and fractal dimension on the artery for vascular morphology, while the tortuosity had a significant difference in the vein. By feeding the SO2 and the vascular morphological features into classifiers, an accuracy of over 82% was obtained, which is significantly better than the two separate inputs for classification. CONCLUSION: Significant differences in SO2 and vascular morphologies between control and iERM groups confirmed that the occurrence of iERM may affect blood supply and vascular structures. Benefiting from the dual-modal fundus camera and machine learning models, accurate judgments can be made on fundus images. Extensive experiments proved the importance of blood vessel SO2 and vascular morphologies for diagnosis, which is of great significance for clinical screening.

EFFICACY OF AIR TAMPONADE TREATMENT OF IDIOPATHIC MACULAR HOLES OF DIFFERENT DIAMETERS AND OF FOLLOW-UP INTRAVITREAL AIR TAMPONADE FOR PERSISTENT HOLES.

PURPOSE: To evaluate the efficacy of air tamponade in idiopathic macular hole (iMH) surgery and of an additional intravitreal air injection in the treatment of persistent holes. METHODS: Retrospective, observational case series. Sixty eyes of 60 patients with an iMH underwent phacoemulsification of cataract (when appropriate), pars plana vitrectomy, and internal limiting membrane peeling, followed by air tamponade. Eyes with persistent holes underwent an additional intravitreal air injection within 1 week after surgery. The iMH closure rate and the best-corrected visual acuity were evaluated. RESULTS: In all 30 eyes with an iMH diameter <400 µm, the iMH closed after the primary surgery; however, only 17 of 30 eyes with an iMH diameter of ≥400 µm closed after the primary surgery. For the 13 eyes with persistent holes, an additional intravitreal air injection resulted in successful hole closure. There was no significant difference in the best-corrected visual acuity at the final follow-up between the closed subgroup and the initially unclosed subgroup after closure. CONCLUSION: Pars plana vitrectomy combined with air tamponade effectively cured small iMHs. For large iMHs not closed after the primary surgery, an additional intravitreal air injection resulted in hole closure and achieved a good prognosis.

INTERNAL LIMITING MEMBRANE PEELING DISTORTS THE RETINAL LAYERS AND INDUCES SCOTOMA FORMATION IN THE PERIFOVEAL TEMPORAL MACULA.

PURPOSE: To determine whether internal limiting membrane peeling damages retinal function in patients with an idiopathic macular hole. METHODS: Retrospective case series. Forty-five eyes of 45 idiopathic macular hole patients who underwent vitrectomy with internal limiting membrane peeling with a minimum follow-up of 6 months. Each patient received a complete ophthalmological examination. The eyes were examined by microperimetry MP-3 in the central 20° visual field and optical coherence tomography angiography in the central 6 × 6 mm area. RESULTS: Six months after the surgery, macular hole closed in each patient. Retinal sensitivity decreased significantly in the perifoveal temporal ETDRS sector (from 24.97 ± 2.67-19.98 ± 5.68 dB, P = 0.001) but not in the other sectors. Six patients (13%) developed 24 scotomas, 62.5% presented in the perifoveal temporal sector. Anatomically, bumps in the outer nuclear layer were discovered concurrent with inner retinal dimples on B-scan images, predominantly (76.8%) in the perifoveal temporal sector, which have not been previously reported. The incidence of outer nuclear layer bumps was significantly higher in patients with scotomas than in those without (83% vs. 18%, P = 0.014). CONCLUSION: Internal limiting membrane peeling induced functional changes specifically in the perifoveal temporal macula. Distortion in the retinal layers is proposed to underly scotomas pathogenesis.

Macular Retinal Sensitivity and Microvasculature Changes before and after Vitrectomy in Idiopathic Macular Epiretinal Membrane with Classification.

PURPOSE: To observe retinal sensitivity (RS) and microvasculature changes in preoperative and postoperative idiopathic macular epiretinal membrane (iERM) with optical coherence tomography (OCT) classification by microperimetry (MP) and optical coherence tomography angiography (OCTA). METHODS: In this retrospective study, 53 eyes of 53 patients affected with iERM were enrolled and 35 iERM eyes underwent pars plana vitrectomy associated with internal limiting membrane peeling. All iERM eyes were evaluated and graded by OCT. According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into 3 grades. MP was used to measure RS of macular within 20° centered on the fovea and fixation stability (FS). OCTA was used to measure the superficial and deep capillary plexus (DCP) layers using 6 mm × 6 mm scans. Measurements were taken at the baseline visit and 3-month postoperation. Evaluated factors included: best corrected visual acuity, RS, FS, vessel density. RESULTS: Eyes with iERM had worse RS than control eyes (p < 0.0001), especially in higher grade iERM eyes. And higher grade iERM eyes had a marked increase foveal vessel density (FVD) (p < 0.0001) in superficial capillary plexus (SCP) and DCP, and a significant decrease parafoveal vessel density (Para VD) in DCP. After surgery, there was no difference in RS and FS than preoperation (p > 0.05), whether in grade 1 or 2 iERM eyes. However, in OCTA analyses, grade 1 iERM eyes had less whole vessel density (WVD) and perifoveal vessel density (Peri VD) in SCP, than preoperation (p < 0.05). And grade 1 iERM eyes had higher Para VD and Peri VD in DCP (p < 0.05), than preoperative OCTA results. Grade 2 iERM eyes had less WVD, FVD, and Peri VD in SCP, than preoperation (p < 0.05). After surgery, in grade 2 iERM eyes, there was a positive correlation between whole retinal sensitivity and WVD (p < 0.05) in SCP. And there were positive correlations between Para RS and Para VD (p < 0.05), Peri RS and Peri VD (p < 0.05) in SCP. CONCLUSIONS: Classification helps to reveal different changes in iERM eyes. Higher grade iERM eyes had worse RS and microvasculature changes. MP and OCTA play an important role in assessing iERM and help surgical decisions for patients with iERM.

ULTRA-WIDE-FIELD IMAGING AND INTRAVENOUS FUNDUS FLUORESCEIN ANGIOGRAPHY IN INFANTS WITH RETINOPATHY OF PREMATURITY.

PURPOSE: To determine the feasibility of ultra-wide-field imaging and ultra-wide-field intravenous fundus fluorescein angiography (UWF-IV-FFA) in infants with retinopathy of prematurity (ROP) using Optos 200Tx. METHODS: We performed Optos 200Tx capturing on 32 premature infants (14 females) and UWF-IV-FFA with Optos 200Tx on 12 of the 32 infants between April 2017 and July 2018 at the affiliated eye hospital of Wenzhou Medical University and analyzed their fundus images. RESULTS: Ultra-wide-field color images were acquired from 32 infants (64 eyes). UWF-IV-FFA was performed successfully in 12 premature infants (24 eyes). No adverse events were observed. The ultra-wide-field Optos 200Tx color images and UWF-IV-FFA images revealed Stages 1, 2, and 3 ROP and aggressive posterior ROP. CONCLUSION: Ultra-wide-field imaging and intravenous fundus fluorescein angiography using Optos 200Tx are feasible in infants with ROP, which have the potential to screen, diagnose, and follow-up for ROP.

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome.

BACKGROUND: To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict the restoration of retinal microstructure and visual outcomes. METHODS: This retrospective case series study included 53 MH patients. One eye each was assessed with iOCT during vitrectomy after internal limiting membrane (ILM) peeling. The MHs were categorized into three groups according to the morphology of the hole edge. The Hole-Door group had vertical pillars of tissue that projected into the vitreous cavity after ILM peeling. The Foveal Flap group had a preoperative foveal flap that adhered to the hole edge after ILM peeling, and the Negative group had neither a hole-door nor a foveal flap. At 6 months after surgery, the retinal microstructure restoration and visual outcomes were compared among the groups. RESULTS: All eyes had MH closure, and the postoperative best corrected visual acuity (BCVA) was significantly improved compared with the preoperative BCVA (P < 0.001). The Hole-Door group (n = 15) and Foveal Flap group (n = 14) had significantly better final visual acuity and postoperative restoration of the external limiting membrane (ELM) than the Negative group (n = 24) (P = 0.002, P = 0.012). For the group in which the MH diameter (MHD) was ≤400 µm (n = 25), there were no significant differences in ELM restoration, ellipsoid zone (EZ) restoration, or BCVA among the three groups (P = 0.516, P = 0.179, and P = 0.179 respectively). For the MHD > 400-µm group (n = 28, the Hole-Door group and Foveal Flap group had significantly better final visual acuity and restoration of ELM than the Negative group (P = 0.013, P = 0.005). CONCLUSIONS: The novel use of iOCT during MH surgery confirmed the presence of hole edges configured as door-holes, foveal flaps, or neither. The data acquired by iOCT can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcome of MH, especially large ones.

A study analyzing macular microvasculature features after vitrectomy using OCT angiography in patients with idiopathic macular epiretinal membrane.

BACKGROUND: To evaluate postoperative changes in retinal capillary plexus and to assess contributing factors in postoperative visual improvement using optical coherence tomography angiography (OCT-A) in patients with idiopathic epiretinal membrane (iERM) post membrane removal. METHODS: Patients scheduled for vitrectomy and membrane peel for iERM were enrolled. 35 subjects were included for this study. OCT-A was used to measure the FAZ related parameters and the superficial and deep capillary plexus layers using 3 mm × 3 mm scans. Measurements were taken before surgery and at every post-surgical follow-up. The unaffected fellow eyes were used as controls. Evaluated factors included: BCVA, vessel density (VD) and retinal thickness (RT) in five regions, FAZ area, FAZ perimeter (PERIM), acircularity index (AI) and foveal vessel density (FD). RESULTS: Compared with the control group, the foveal vessel density (FVD) in superficial capillary plexus (SCP) was greater in the epi-retinal membrane group (P < 0.0001), whereas both groups had comparable parafoveal vessel density (PRVD) in SCP (p > 0.05). After surgery there was a reduction in the PRVD in SCP. The FVD in DCP increased and the PRVD in DCP decreased at baseline (p < 0.001). After surgery there was an increase in PRVD in DCP. By 6 months post-op, the PRVD had no statistically significant difference compared with the control group (p > 0.05). D-value of LogMAR BCVA was positively correlated with pre-op LogMAR BCVA (p < 0.0001), FVD in SCP (p < 0.001). It was negatively correlated with FAZ area (P < 0.001) and PERIM (P < 0.05). CONCLUSIONS: Vitrectomy and membrane removal led to the decrease of VD in SCP and the increase of PRVD in DCP. Patients with a more severe iERM may receive greater visual improvement with surgery. TRIAL REGISTRATION: Trial registration number (TRN) and date of registration. ChiCTR2000031289, retrospectively registered, 2020.03.26.

Quantitative Assessment of Retinal Capillary Vessel Density and Foveal Avascular Zone Area in Central Serous Chorioretinopathy Using OCTA.

PURPOSE: To quantitatively assess the retinal capillary vessel density (VD) and foveal avascular zone (FAZ) area in acute and chronic central serous chorioretinopathy (CSC) patients compared to healthy subjects using optical coherence tomography angiography (OCTA) and determine their correlation with visual acuity (VA). METHODS: This was a cross-sectional, case-control study. All subjects were divided into three groups: acute CSC, chronic CSC, and healthy controls. The best-corrected VA test, optical coherence tomography, and OCTA were performed on the same day. In this study, we recorded and compared the main data of FAZ and VD in 3 × 3 mm OCTA images among three groups, also calculated the correlation between OCTA variables and VA in CSC patients. RESULTS: A total of 148 subjects (148 eyes) were included in this study, with 50 eyes in acute CSC, 48 eyes in chronic CSC, and 50 eyes in control groups. The mean age was 50.11 ± 8.14 years. Chronic CSC had the significantly lowest VD both on the superficial and deep retina and the largest FAZ (0.39 ± 0.13 mm2) compared to acute CSC and controls (all p < 0.05). There was no statistical difference between acute CSC and controls on VD or FAZ (both p > 0.05). In chronic CSC, both the decreased VD on deep retina and expanded FAZ were correlated with a worse VA (both p < 0.05). CONCLUSIONS: OCTA could serve as a reliable tool to evaluate different courses of CSC quantitively. In 3 × 3 mm OCTA images, both decreased VD and expanded FAZ were observed in chronic CSC patients.

New grading criterion for retinal haemorrhages in term newborns based on deep convolutional neural networks.

BACKGROUND: To define a new quantitative grading criterion for retinal haemorrhages in term newborns based on the segmentation results of a deep convolutional neural network. METHODS: We constructed a dataset of 1543 retina images acquired from 847 term newborns, and developed a deep convolutional neural network to segment retinal haemorrhages, blood vessels and optic discs and locate the macular region. Based on the ratio of areas of retinal haemorrhage to optic disc, and the location of retinal haemorrhages relative to the macular region, we defined a new criterion to grade the degree of retinal haemorrhages in term newborns. RESULTS: The F1 scores of the proposed network for segmenting retinal haemorrhages, blood vessels and optic discs were 0.84, 0.73 and 0.94, respectively. Compared with two commonly used retinal haemorrhage grading criteria, this new method is more accurate, objective and quantitative, with the relative location of the retinal haemorrhages to the macula as an important factor. CONCLUSIONS: Based on a deep convolutional neural network, we can segment retinal haemorrhages, blood vessels and optic disc with high accuracy. The proposed grading criterion considers not only the area of the haemorrhages but also the locations relative to the macular region. It provides a more objective and comprehensive evaluation criterion. The developed deep convolutional neural network offers an end-to-end solution that can assist doctors to grade retinal haemorrhages in term newborns.

Retinoschisis: A Predictive Factor in Vitrectomy for Lamellar Macular Holes in Highly Myopic Eyes.

PURPOSE: To evaluate the effect of pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for lamellar macular hole (LMH) with or without macular retinoschisis in highly myopic eyes. METHODS: In this retrospective, consecutive case-control study, 21 highly myopic patients (22 eyes) with LMH were divided into two groups based on preoperative optical coherence tomography (OCT): the "flat group" had no macular retinoschisis (n = 10), and the "retinoschisis group" had macular retinoschisis (n = 12). The average follow-up time was 17.2 ± 12.6 months. Outcomes were based on 6-month postoperative best-corrected visual acuity (BCVA), integrity of the ellipsoid zone (EZ), external limiting membrane (ELM), and residual foveal thickness (RFT). RESULTS: The appearance of the macula on OCT was normalized in 19 eyes (86.3%) at the final follow-up visit. Compared to the flat group, the retinoschisis group presented a significantly higher incidence of epiretinal membrane (p = 0.046) and lower refractive error (p = 0.033), shorter axial length (p = 0.0009), better integrity of ELM and EZ (p = 0.005 and p = 0.005, respectively), and better preoperative and postoperative BCVAs (p = 0.015). CONCLUSIONS: PPV is an effective method to achieve a high anatomical success, improve postoperative vision, and prevent foveal thinning in highly myopic eyes with LMH. In these eyes, the presence of retinoschisis strongly indicates the need for vitrectomy.

The impact of green finance on total factor carbon emission reduction efficiency in China.

Based on an analysis of the relationship between green finance and total factor carbon emission reduction efficiency, this article measures the levels of green finance and total factor carbon emission reduction efficiency in 30 provinces and cities in China. It also establishes a spatial Durbin model to quantitatively explore the impact of green finance on China's total factor carbon emission reduction efficiency. The results indicate that currently, green finance and total factor carbon emission reduction efficiency in China follow a distribution pattern of high in the east, medium in the central region, and low in the west. The impact of green finance on total factor carbon emission reduction efficiency demonstrates a U-shaped relationship, and the spatial spillover effect between the two displays a similar U-shaped trend. The mechanism analysis demonstrates that green finance exerts a U-shaped influence on the efficiency of reducing total factor carbon emissions through the interplay of technological progress and technical efficiency enhancements. Other variables, such as research and development investment, comprehensive energy consumption, human capital, infrastructure construction, and government regulation, also have an impact on total factor carbon emission reduction efficiency. Therefore, it is recommended that regions strengthen their green finance initiatives, support efforts to carbon emission reduction, and contribute towards achieving the "dual-carbon" goal.

Long-Term Quantitative Analysis of Inner Retinal Dimples and Visual Function Post Internal Limiting Membrane Peeling in Macular Diseases.

INTRODUCTION: Inner retinal dimples (IRDs) are frequently detected after internal limiting membrane (ILM) peeling. However, the distribution of IRDs and its effect on postoperative visual function remain unclear. We aim to quantify the distribution of IRDs after ILM peeling in different macular diseases and analyze its influence on postoperative visual function. METHODS: We retrospectively reviewed patients undergoing vitrectomy with ILM peeling and followed up until 12 months in our center. The distribution of IRDs were quantitatively determined using optical coherence tomography (OCT) and OCT angiography in a different sector of Early Treatment Diabetic Retinopathy Study grid. Visual function was evaluated by retinal sensitivity (RS) using microperimetry. Spearman correlation was performed between RS and IRDs within the same sectors. Multivariate linear regression analysis was performed to analyze the association between baseline characteristics and IRDs. RESULTS: A total of 43 idiopathic macular hole (iMH) cases, 56 idiopathic epiretinal membrane (iERM) cases and 42 myopic foveoschisis (mFS) cases were included. IRDs increased gradually at ILM-peeled area, interrupting ganglion cell layer. Most IRDs were observed in temporal sector. A negative correlation was depicted between the increase of IRDs and the progress of RS at both perifovea and parafovea in iERM, but only at perifovea in iMH. No significant correlation between the change of IRDs and RS was found in mFS. Multivariable linear regression model showed that preoperative axial length was significantly associated with postoperative IRDs in all patients. CONCLUSIONS: IRDs distributed mostly at temporal sector after ILM peeling, interrupting ganglion cell layer. IRD progression may influence postoperative RS only in iMH and iERM. Ophthalmologists may avoid temporal sector especially in eyes with normal axial length or strong ILM-ERM adherence.

Edge-Guided Contrastive Adaptation Network for Arteriovenous Nicking Classification Using Synthetic Data.

Retinal arteriovenous nicking (AVN) manifests as a reduced venular caliber of an arteriovenous crossing. AVNs are signs of many systemic, particularly cardiovascular diseases. Studies have shown that people with AVN are twice as likely to have a stroke. However, AVN classification faces two challenges. One is the lack of data, especially AVNs compared to the normal arteriovenous (AV) crossings. The other is the significant intra-class variations and minute inter-class differences. AVNs may look different in shape, scale, pose, and color. On the other hand, the AVN could be different from the normal AV crossing only by slight thinning of the vein. To address these challenges, first, we develop a data synthesis method to generate AV crossings, including normal and AVNs. Second, to mitigate the domain shift between the synthetic and real data, an edge-guided unsupervised domain adaptation network is designed to guide the transfer of domain invariant information. Third, a semantic contrastive learning branch (SCLB) is introduced and a set of semantically related images, as a semantic triplet, are input to the network simultaneously to guide the network to focus on the subtle differences in venular width and to ignore the differences in appearance. These strategies effectively mitigate the lack of data, domain shift between synthetic and real data, and significant intra- but minute inter-class differences. Extensive experiments have been performed to demonstrate the outstanding performance of the proposed method.

Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images.

AIM: To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy (DR) and in patients with or without diabetic macular edema (DME). METHODS: The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study. The severity of DR patients was graded as mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) according to the international clinical diabetic retinopathy (ICDR) disease severity scale classification, and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods. The presence of DME was determined by optical coherence tomography (OCT), and differences in vascular morphological characteristics were compared between patients with and without DME. RESULTS: Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99% and a Dice metric of 0.76. Compared with the healthy group, the DR group had smaller vessel angles (33.68±3.01 vs 37.78±1.60), smaller fractal dimension (Df) values (1.33±0.05 vs 1.41±0.03), less vessel density (1.12±0.44 vs 2.09±0.36) and fewer vascular branches (206.1±88.8 vs 396.5±91.3), all P<0.001. As the severity of DR increased, Df values decreased, P=0.031. No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics. CONCLUSION: In this study, an artificial intelligence retinal vessel segmentation system is used with 99% accuracy, thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology. DR patients have a tendency of vascular occlusion and dropout. The presence of DME does not compromise the integral retinal vascular pattern.

A classification of idiopathic epiretinal membrane based on foveal avascular zone area using optical coherence tomography angiography.

OBJECTIVE: To evaluate the characteristics and prognoses of idiopathic macular epiretinal membrane (iERM) using a classification based on the foveal avascular zone (FAZ) area. METHOD: IERMs were classified into four stages based on the FAZ area. Baseline FAZ-related parameters, pre-and postoperative central macular thickness (CMT), and best corrected visual acuity (BCVA) were observed and compared between different stages. The correlations of structural parameters with pre-and postoperative logMAR BCVA were analyzed. RESULTS: 162 iERM eyes were enrolled, including 105 eyes followed up for 12 months after surgery. The preoperative BCVA was better at the early stage. Postoperative BCVA at Stages 2 and 3 were better compared to Stage 4. The early stage was associated with thinner CMT pre-and postoperatively. However, there was no significant difference in CMT between postoperative Stages 1 and 2 or Stages 3 and 4. Preoperative logMAR BCVA was negatively correlated with FAZ area, perimeter, and FD-300 and was positively correlated with CMT and acircularity index (AI). CMT correlated positively with BCVA for each stage, except Stage 4; FAZ area, perimeter, and FD-300 had a negative correlation at Stage 1. Baseline BCVA and CMT positively correlated with BCVA at the last follow-up, while FAZ area and FD-300 were negatively correlated. Baseline BCVA had a positive correlation for each stage, except Stage 1; FD-300 had a negative correlation at Stages 2 and 3; CMT had a positive correlation at Stage 3. CONCLUSION: A classification based on the FAZ area was established innovatively. This classification can reflect the progression of iERM and is helpful to the postoperative prognosis.

(1) Classification based on FAZ area facilitate automation and consistency compared to the previous OCT-based qualitative grading.(2) With baseline FAZ stage advanced, thickened CMT and worsened BCVA was observed at baseline and 1-year post-operation. (3) Baseline FAZ area and FD-300 negatively correlated with logMAR BCVA at the last follow-up, reflecting the nonnegligible prognostic impact of macular vascular changes.

Myopic choroidal neovascularization with neovascular signal around perforating scleral vessel prone to recur after anti-VEGF therapy.

BACKGROUND: To compare the recurrence of myopic choroidal neovascularization (mCNV) based on the neovascular signal of mCNV around the perforating scleral vessel (PSV). METHODS: A consecutive series of naïve patients with mCNV accepted anti-VEGF therapy with a minimum 12-month follow-up period. The neovascular signal relationship between PSV and mCNV were classified into the presence of neovascular signal of CNV around PSV or not. The recurrence of mCNV, best-corrected visual acuity (BCVA), hyperreflective foci height, CNV area and CNV flow area were analyzed between two groups. RESULTS: Neovascular signal of CNV around PSV was detected in 20 eyes (39.2%). The one-year recurrence rate in the group with neovascular signal of CNV around PSV was significantly higher than that in the group without neovascular signal of CNV around PSV (P = 0.045). The recurrence time in the group with neovascular signal around PSV was shorter than that in the group without neovascular signal around PSV (P = 0.030). Cox proportional hazard model showed that the presence of neovascular signal of CNV around PSV [hazard ratio (HR): 2.904] and subfoveal choroidal thickness ≤ 50 µm (HR: 0.368) were risk factors for recurrence of mCNV. In the group with neovascular signal around PSV, the BCVA was worse (P = 0.024) and the CNV flow area was more unstable (P = 0.027) after therapy. CONCLUSIONS: PSV was commonly detected in patients with mCNV. The presence of neovascular signal of CNV around PSV was prone to recur with a shorter time in mCNV patients.

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

AIM: To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. METHODS: Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. RESULTS: Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. CONCLUSION: This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.