Posterior Scleritis Associated with Late-Onset Takayasu Arteritis: A Case Report.

PURPOSE: To describe a rare case of posterior scleritis associated with late-onset Takayasu arteritis. METHODS: A case report of a 75-year-old female presenting with posterior scleritis, eventually diagnosed with late-onset Takayasu arteritis was described. Several medical evaluation visits were conducted, including ophthalmological and rheumatological follow-up. Multiple diagnostic tests were carried out, and the cornerstones of the treatment were corticosteroids and the IL-6 inhibitor tocilizumab. RESULTS: The patient was admitted to our hospital's emergency room with right unilateral eyelid edema, chemosis and red eye. She had previously experienced two episodes that were misdiagnosed as preseptal cellulitis. The presence of choroidal folds and the T sign on the ultrasound exam were highly suggestive of posterior scleritis. Later, the patient was diagnosed with Takayasu arteritis, a type of large vessel vasculitis. Treatment with steroids was started, which was later switched to IL-6 inhibitors to achieve better control of the systemic disease. CONCLUSION: Posterior scleritis is often misdiagnosed, necessitating high clinical suspicion. Multimodal diagnosis is important to establish an accurate diagnosis. Up to 34% of cases may be associated with a systemic disease. This is the first case described in the literature of posterior scleritis associated with late-onset Takayasu arteritis.

Periorbital necrotizing fasciitis: clinical perspectives on nine cases.

A multicenter review of Periorbital Necrotizing Fasciitis including nine cases, aged 41 to 82, mostly female, and mainly post-traumatic or idiopathic. Streptococcus pyogenes was the most frequent pathogen. Treatment involved debridement alongside antibiotic therapy in all cases. Two cases experienced toxic shock, with no fatalities. Visual outcomes varied from exenteration to preserved visual acuity with minimal aesthetic impact. Early detection and prompt intervention are paramount due to the significant risks associated with this condition, which may lead to severe complications ranging from vision loss to systemic decline or death.

Modification of eating habits and lifestyle during COVID-19 in university students from Mexico and Peru.

Objective: It was to evaluate changes in lifestyle habits and health behavior among university students in Peru and Mexico during periods of confinement associated with the COVID-19 pandemic and to identify possible relationships between these changes and sociodemographic variables, health status, and technology consumption. Methods: It was a quantitative, observational, and cross-sectional study conducted among a population of 739 Mexican students and 305 Peruvian students, most of whom were women (n =778, 74.5%) and non-graduates (n =921, 88.2%). The questionnaire scale for changes in lifestyles during the quarantine period has been previously validated. Results: The association between sociodemographic factors and dimensions of change in healthy lifestyles was evaluated, and it was shown that gender and country of residence were significant for all dimensions of healthy lifestyle (p < 0.05), except for the level of education, which did not show significance about the change in the dimensions of media consumption (p = 0.875) and physical activity (p = 0.239). Within the dimensions mentioned, it can be stated that women are more likely than men to change their eating habits (adjusted prevalences (aPR) = 1.08, p < 0.001), media consumption (aPR = 1.04, p < 0.001), and physical activity (aPR = 1.02, p < 0.001). Meanwhile, participants from Peru are more likely than participants from Mexico to change physical activity (aPR = 1.14, p < 0.001) and media consumption (aPR = 1.22, p < 0.001). Finally, graduate students were more likely than undergraduate students to change eating habits (aPR = 1.09, p = 0.005) and unhealthy habits (aPR = 1.06, p = 0.030). Conclusion: It was concluded that there were lifestyle changes in Mexican and Peruvian university students in their eating habits, physical activity, internet consumption, and food delivery.

Witnessing inter-parental violence in childhood and help-seeking behaviours in violence against women in Peru.

BACKGROUND: Violence against women (VAW) severely impacts their physical and mental health. In some cultures, women can normalize certain types of violence if they were linked to home models in childhood and, eventually, do not seek for help in adulthood. We aimed to determine, in Peruvian women, (1) the association between witnessing violence in their family of origin and VAW experienced in adulthood, (2) the extent to which women who have experienced VAW seek some help, and (3) identify VAW prevalence by Peruvian region. METHODS: Cross-sectional study of secondary data obtained from the 2019 National Demographic and Family Health Survey (ENDES). The outcome was VAW (psychological, physical and sexual violence), whereas the exposure was witnessing violence in the home of origin. Help-seeking behavior was a secondary outcome, for which VAW was the exposure. Prevalence ratios (PR) were estimated to assess both associations, unadjusted and adjusted for covariates (aPR). RESULTS: Data from 14,256 women aged 15 to 49 years were analysed. 51.5% reported having experienced VAW and 43.8% witnessed violence in the home of origin during childhood. Witnessing inter-parental violence in childhood was associated with psychological violence aPR = 1.25 (95% CI: 1.17-1.33), physical aPR = 1.52 (95% CI: 1.38-1.67), and sexual aPR = 1.99 (95% CI: 1.57-2.52). Women who have experienced both types of violence (physical and sexual) were more likely to help-seeking (aPR = 1.30, 95% CI: 1.14-1.50) than women suffering only one type of violence. CONCLUSION: Women who reported having witnessed home violence in their childhood are more likely to experience Violence Against Women (VAW) by their current partner. Physical and sexual violence with a current partner was more associated with witnessing inter-parental violence in childhood, and when physical and sexual violence jointly occurred women were more help-seeking. The southern region of Peru is identified as an area of high vulnerability for women. It is crucial to promote educative and community-based programs aimed at the prevention and early recognition of VAW.

Medial Canthal Tendon Reflecting in Lower Eyelid Reconstruction After Palpebral Cancer Surgery: Description of a New Technique.

PURPOSE: The aim of this article is to describe a new reconstructive technique of the lower eyelid in the surgery of tumors involving the medial canthal tendon. METHODS: Our new technique consists of detaching and reflecting the most medial portion of the anterior medial canthal tendon and reinserting it into the posterior lamella. We describe the cases in which our technique can be useful, as well as the results we have obtained. RESULTS: The result after a year of follow-up showed no disruption of the angulation of the lower eyelid line and no changes in eyelid position. CONCLUSIONS: The medial canthal tendon reflection could provide both aesthetic and functional results that may be superior to the usual techniques.

Macular Neovascularization Type Influence on Anti-VEGF Intravitreal Therapy Outcomes in Age-Related Macular Degeneration.

PURPOSE: To evaluate the influence of macular neovascularization (MNV) lesion type on 12-month clinical outcomes in treatment-naive eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF drugs nationwide. DESIGN: Multicenter national nAMD database observational study. SUBJECTS: One thousand six hundred six treatment-naive nAMD eyes (1330 patients) undergoing anti-VEGF therapy for 12 months nationwide. METHODS: Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, number of injections and visits were was collected using a validated web-based tool. Neovascular lesion phenotype was classified as type 1 (T1, n = 711), type 2 (T2, n = 505), type 3 (T3, n = 315), and aneurysmal type 1 (A-T1, n = 75), according to the new proposed consensus classification. MAIN OUTCOME MEASURES: Mean VA change at 12 months, final VA at 12 months, number of injections, time to lesion inactivation. RESULTS: A total of 1606 treatment-naive nAMD eyes (1330 patients) received a median of 7 injections over 12 months. Mean (± standard deviation) baseline VA was significantly lower for T2 (49.4 ± 23.5 letters) compared with T1 (57.8 ± 20.8) and T3 (58.2 ± 19.4) (both P < 0.05) lesions. Mean VA change at 12 months was significantly greater for A-T1 (+9.5 letters) compared with T3 (+3.1 letters, P < 0.05). Patients with T3 lesions had fewer active visits (24.9%) than those with other lesion types (T1, 30.5%; T2, 32.6%; A-T1, 27.5%; all P < 0.05). Aflibercept was the most used drug in A-T1 lesions (70.1%) and ranibizumab in T1 (40.7%), T2 (57.7%), and T3 (47.6%) lesions. CONCLUSIONS: This study highlights the relevance of MNV type on clinical outcomes in nAMD and reports significant differences in baseline VA, VA change, and lesion activity at 12 months. This report provides data about lesion-specific clinical features, which may guide the management of nAMD cases and potentially support personalized clinical decision making for these patients. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

AIROGS: Artificial Intelligence for Robust Glaucoma Screening Challenge.

The early detection of glaucoma is essential in preventing visual impairment. Artificial intelligence (AI) can be used to analyze color fundus photographs (CFPs) in a cost-effective manner, making glaucoma screening more accessible. While AI models for glaucoma screening from CFPs have shown promising results in laboratory settings, their performance decreases significantly in real-world scenarios due to the presence of out-of-distribution and low-quality images. To address this issue, we propose the Artificial Intelligence for Robust Glaucoma Screening (AIROGS) challenge. This challenge includes a large dataset of around 113,000 images from about 60,000 patients and 500 different screening centers, and encourages the development of algorithms that are robust to ungradable and unexpected input data. We evaluated solutions from 14 teams in this paper and found that the best teams performed similarly to a set of 20 expert ophthalmologists and optometrists. The highest-scoring team achieved an area under the receiver operating characteristic curve of 0.99 (95% CI: 0.98-0.99) for detecting ungradable images on-the-fly. Additionally, many of the algorithms showed robust performance when tested on three other publicly available datasets. These results demonstrate the feasibility of robust AI-enabled glaucoma screening.

Artificial intelligence-based fluid quantification and associated visual outcomes in a real-world, multicentre neovascular age-related macular degeneration national database.

AIM: To explore associations between artificial intelligence (AI)-based fluid compartment quantifications and 12 months visual outcomes in OCT images from a real-world, multicentre, national cohort of naïve neovascular age-related macular degeneration (nAMD) treated eyes. METHODS: Demographics, visual acuity (VA), drug and number of injections data were collected using a validated web-based tool. Fluid compartment quantifications including intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) in the fovea (1 mm), parafovea (3 mm) and perifovea (6 mm) were measured in nanoliters (nL) using a validated AI-tool. RESULTS: 452 naïve nAMD eyes presented a mean VA gain of +5.5 letters with a median of 7 injections over 12 months. Baseline foveal IRF associated poorer baseline (44.7 vs 63.4 letters) and final VA (52.1 vs 69.1), SRF better final VA (67.1 vs 59.0) and greater VA gains (+7.1 vs +1.9), and PED poorer baseline (48.8 vs 57.3) and final VA (55.1 vs 64.1). Predicted VA gains were greater for foveal SRF (+6.2 vs +0.6), parafoveal SRF (+6.9 vs +1.3), perifoveal SRF (+6.2 vs -0.1) and parafoveal IRF (+7.4 vs +3.6, all p<0.05). Fluid dynamics analysis revealed the greatest relative volume reduction for foveal SRF (-16.4 nL, -86.8%), followed by IRF (-17.2 nL, -84.7%) and PED (-19.1 nL, -28.6%). Subgroup analysis showed greater reductions in eyes with higher number of injections. CONCLUSION: This real-world study describes an AI-based analysis of fluid dynamics and defines baseline OCT-based patient profiles that associate 12-month visual outcomes in a large cohort of treated naïve nAMD eyes nationwide.

Differences in family functioning before and during the COVID-19 pandemic: an observational study in Peruvian families.

The COVID-19 pandemic has had a major impact on family relationships, as several families have lost family members due to COVID-19 pandemic and become physically and emotionally estranged due to lockdown measures and critically economic periods. Our study contrasted two hypotheses: (1) family functioning changed notably before and after the COVID-19 pandemic initiation in terms of cohesion, flexibility, communication and satisfaction; (2) balanced families have a greater capacity to strictly comply with quarantine (i.e., social confinement), compared to unbalanced families. We performed an observational study comparing family functioning between two independent groups, evaluated before and during the first wave of the COVID-19 pandemic in Peru. A total of 7,980 participants were included in the study. For the first hypothesis, we found that, during the pandemic, families became more balanced in terms of cohesion (adjusted before-during mean difference or ß1 = 1.4; 95% CI [1.0-1.7]) and flexibility (ß2 = 2.0; 95% CI [1.6-2.4]), and families were less disengaged (ß3 = -1.9; 95% CI [-2.3 to -1.5]) and chaotic (ß4 = -2.9; 95% CI [-3.3 to -2.4]). Regarding the second hypothesis, we confirmed that families with balanced cohesion (adjusted prevalence ratio or aPR = 1.16; 95% CI [1.12-1.19) and flexibility (aPR = 1.23; 95% CI [1.18-1.27]) allowed greater compliance with quarantine restrictions; while disengaged (aPR = 0.91; 95% CI [0.88-0.93]) and chaotic families (aPR = 0.89; 95% CI [0.87-0.92]) were more likely to partially comply or not comply with the quarantine. Finally, family communication (aPR = 1.17; 95% CI [1.11-1.24]) and satisfaction (aPR = 1.18; 95% CI [1.11-1.25]) also played a role in favouring quarantine compliance. This new evidence enlightens the family systems theory while informing future interventions for improving compliance with quarantine measures in the context of social confinement.

Modulation of the Altered Intestinal Microbiota by Use of Antibiotics with a Novel Synbiotic on Wistar Rats.

The use of antibiotics unbalances the intestinal microbiota. Probiotics, prebiotics, and synbiotics are alternatives for these unbalances. The effects of a new synbiotic composed of probiotic Saccharomyces boulardii CNCM I-745 and fructans from Agave salmiana (fAs) as prebiotics were assessed to modulate the intestinal microbiota. Two probiotic presentations, the commercial probiotic (CP) and the microencapsulated probiotic (MP) to improve those effects, were used to prepare the synbiotics and feed Wistar rats subjected to antibiotics (AB). Eight groups were studied, including five controls and three groups to modulate the microbiota after the use of antibiotics: G5: AB + MP-synbiotic, G6: AB + CP-synbiotic, and G8: AB + fAs. All treatments were administered daily for 7 days. On days 7 and 21, euthanasia was performed, cecum tissue was recovered and used to evaluate histological analysis and to study microphotograph by TEM, and finally, bacterial DNA was extracted and 16S rRNA gene metabarcode sequencing was performed. Histological analysis showed less epithelial damage and more abundance of the intestinal microbiota in the groups G5, G6, and G8 in comparison with the AB control group after 7 days. Microphotograph of the cecum at 2 weeks post treatment showed that G5 and G6 presented beneficial effects in epithelial reconstruction. Interestingly, in the groups that used the synbiotic without AB (G3 and G4) in addition to contributing to the recovery of the autochthonous microbiota, it promotes the development of beneficial microorganisms; those results were also achieved in the groups that used the synbiotic with AB enhancing the bacterial diversity and regulating the impact of AB.

Neovascular Progression and Retinal Dysfunction in the Laser-Induced Choroidal Neovascularization Mouse Model.

The mouse model of laser-induced choroidal neovascularization (LI-CNV) has been widely used to study neovascular age-related macular degeneration; however, it still lacks a comprehensive characterization. Here, CNV was induced in the eyes of 12-week-old C57BL/6J male mice by argon laser irradiation. We studied the CNV lesion progression of an LI-CNV mouse cohort by using multimodal imaging (color fundus, optical coherence tomography (OCT), and fluorescence angiography, focal electroretinography features for 14 days, and related cytokines, angiogenic factors, and reactive gliosis for 5 days. CNV lesions involving the rupture of the Bruch's membrane were confirmed using funduscopy and OCT after laser photocoagulation. During the initial stage, from the CNV induction until day 7, CNV lesions presented leakage observed by using fluorescence angiography and a typical hyperreflective area with cell infiltration, subretinal leakage, and degeneration of photoreceptors observed through OCT. This correlated with decreased retinal responses to light. Moreover, inflammatory and angiogenic markers were reduced to basal levels in the first 5 days of CNV progression. In contrast, reactive gliosis and the VEGF expression in retinal sections were sustained, with infiltration of endothelial cells in the subretinal space. In the second stage, between days 7 and 14 post-induction, we observed stabilization of the CNV lesions, a hyperfluorescent area corresponding to the formation of fibrosis, and a partial rescue of retinal function. These findings suggest that the LI-CNV lesion development goes through an acute phase during the first seven days following induction, and then the CNV lesion stabilizes. According to these results, this model is suitable for screening anti-inflammatory and anti-angiogenic drugs in the early stages of LI-CNV. At the same time, it is more convenient for screening anti-fibrotic compounds in the later stages.

Fear of COVID-19, risk perception and preventive behavior in health workers: a cross-sectional analysis in middle-income Latin American countries.

The aim of this study was to examine the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from four Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and unstandardized beta coefficient and value of ps were calculated. Four hundred and thirty-five health professionals were included, the majority were aged 42 years or older (45.29, 95%CI: 40.65-50.01) and female (67.82, 95%CI: 63.27-72.05). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B = 2.21, p = 0.002 for total behavior; B = 1.12, p = 0.037 for additional protection at work; B = 1.11, p < 0.010 for hand washing). The risk perception of COVID-19 infection had a slight direct relationship with preventive behaviours (B = 0.28, p = 0.021 for total behavior; B = 0.13, p = 0.015 for hand washing), with the exception of the preventive behavior of using additional protection at work (p = 0.339). We found that fear and risk perception are associated with increased practice of hand washing and use of additional protection at work. Further studies are required on the influence of working conditions, job performance and the occurrence of mental health problems in frontline personnel with regard to COVID-19.

The impact of artificial intelligence on retinal disease management: Vision Academy retinal expert consensus.

PURPOSE OF REVIEW: The aim of this review is to define the "state-of-the-art" in artificial intelligence (AI)-enabled devices that support the management of retinal conditions and to provide Vision Academy recommendations on the topic. RECENT FINDINGS: Most of the AI models described in the literature have not been approved for disease management purposes by regulatory authorities. These new technologies are promising as they may be able to provide personalized treatments as well as a personalized risk score for various retinal diseases. However, several issues still need to be addressed, such as the lack of a common regulatory pathway and a lack of clarity regarding the applicability of AI-enabled medical devices in different populations. SUMMARY: It is likely that current clinical practice will need to change following the application of AI-enabled medical devices. These devices are likely to have an impact on the management of retinal disease. However, a consensus needs to be reached to ensure they are safe and effective for the overall population.

Current status and practical considerations of artificial intelligence use in screening and diagnosing retinal diseases: Vision Academy retinal expert consensus.

PURPOSE OF REVIEW: The application of artificial intelligence (AI) technologies in screening and diagnosing retinal diseases may play an important role in telemedicine and has potential to shape modern healthcare ecosystems, including within ophthalmology. RECENT FINDINGS: In this article, we examine the latest publications relevant to AI in retinal disease and discuss the currently available algorithms. We summarize four key requirements underlining the successful application of AI algorithms in real-world practice: processing massive data; practicability of an AI model in ophthalmology; policy compliance and the regulatory environment; and balancing profit and cost when developing and maintaining AI models. SUMMARY: The Vision Academy recognizes the advantages and disadvantages of AI-based technologies and gives insightful recommendations for future directions.

Research skills for university students' thesis in E-learning: Scale development and validation in Peru.

Background: The aims of the study was to evaluate the psychometric properties and to characteristics of a scale on research skills as well as to characterize the experience of university thesis students using information databases (i.e., Scopus or Web of Science) and bibliographic reference managers. Methods: A sample of 1598 university students from five departments, acroos the different campuses of one Peruvian university. The psychometric properties of the instrument were evaluated using factor analysis and measurement invariance according to sex and age groups. In addition, an internal consistency analysis was conducted for scale reliability using Cronbach's alpha, ordinal alpha, and the omega index. Results: Our study identified that the unidimensional model with correlated errors showed adequate indicators of reliability and goodness of fit, with the exception of the RMSEA, which shows values higher than 0.08. Measurement invariance by sex and age group was present. The majority of university students in E-learning showed use of the bibliographic manager Mendeley (52.13%), low ability to use information databases such as Scopus (22.24%) or Web of Science (17.26%), and the least skilled research skills were in formulating the problem, objectives, and hypotheses (51.63%) and carrying out data analysis and processing using statistical techniques (49.37%). Conclusions: The conclusions of the study were that the 8-item research skills instrument presents acceptable psychometric indicators in Peruvian university students in thesis courses. Likewise, a scarce use of global databases, the approach to the research topic, and carrying out its statistical processing.

Repeated Topical Administration of 3 nm Cerium Oxide Nanoparticles Reverts Disease Atrophic Phenotype and Arrests Neovascular Degeneration in AMD Mouse Models.

Increased oxidative stress in the retina and retinal pigment epithelium is implicated in age-related macular degeneration (AMD). Antioxidant cerium oxide nanoparticles (CeO2NPs) have been used to treat degenerative retinal pathologies in animal models, although their delivery route is not ideal for chronic patient treatment. In this work, we prepared a formulation for ocular topical delivery that contains small (3 nm), nonaggregated biocompatible CeO2NPs. In vitro results indicate the biocompatible and protective character of the CeO2NPs, reducing oxidative stress in ARPE19 cells and inhibiting neovascularization related to pathological angiogenesis in both HUVEC and in in vitro models of neovascular growth. In the in vivo experiments, we observed the capacity of CeO2NPs to reach the retina after topical delivery and a subsequent reversion of the altered retinal transcriptome of the retinal degenerative mouse model DKOrd8 toward that of healthy control mice, together with signs of decreased inflammation and arrest of degeneration. Furthermore, CeO2NP eye drops' treatment reduced laser-induced choroidal neovascular lesions in mice by lowering VEGF and increasing PEDF levels. These results indicate that CeO2NP eye drops are a beneficial antioxidant and neuroprotective treatment for both dry and wet forms of AMD disease.

Binary and multi-class automated detection of age-related macular degeneration using convolutional- and transformer-based architectures.

BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) is an eye disease that happens when ageing causes damage to the macula, and it is the leading cause of blindness in developed countries. Screening retinal fundus images allows ophthalmologists to early detect, diagnose and treat this disease; however, the manual interpretation of images is a time-consuming task. In this paper, we aim to study different deep learning methods to diagnose AMD. METHODS: We have conducted a thorough study of two families of deep learning models based on convolutional neural networks (CNN) and transformer architectures to automatically diagnose referable/non-referable AMD, and grade AMD severity scales (no AMD, early AMD, intermediate AMD, and advanced AMD). In addition, we have analysed several progressive resizing strategies and ensemble methods for convolutional-based architectures to further improve the performance of the models. RESULTS: As a first result, we have shown that transformer-based architectures obtain considerably worse results than convolutional-based architectures for diagnosing AMD. Moreover, we have built a model for diagnosing referable AMD that yielded a mean F1-score (SD) of 92.60% (0.47), a mean AUROC (SD) of 97.53% (0.40), and a mean weighted kappa coefficient (SD) of 85.28% (0.91); and an ensemble of models for grading AMD severity scales with a mean accuracy (SD) of 82.55% (2.92), and a mean weighted kappa coefficient (SD) of 84.76% (2.45). CONCLUSIONS: This work shows that working with convolutional based architectures is more suitable than using transformer based models for classifying and grading AMD from retinal fundus images. Furthermore, convolutional models can be improved by means of progressive resizing strategies and ensemble methods.

Space Analysis of School Violence in the Educational Setting of Peru, 2019.

BACKGROUND: Schools are increasingly experiencing physical, psychological, and sexual violence, which impacts students' academic achievement and physical and emotional health. Our objective was to identify regional prevalence rates, average prevalence by aggressor type, and provincial spatial conglomerates with higher rates for each type of school violence reported in educational settings in Peru during 2019. METHODS: An analysis was made of 12,132 cases reported through Peru's Specialized School Violence System (SíseVe). The Moran indices were calculated using provincial prevalence rates to identify conglomerates with high prevalence. RESULTS: In the coast region, the Department of Tacna reported the highest prevalence rates for physical (99.7) and psychological (107); the Department of Amazonas, which is in the jungle, reported the highest prevalence rate for sexual violence (74.6), with teachers in public schools accounting for the majority of sexual assaults against students (56%). CONCLUSIONS: Sexual violence predominated in the jungle zone, with a significant percentage of teachers participating in violence with sexual connotations. Physical and psychological violence prevailed in the coastal region.

Prevalence and implications of the presence of intraocular silicone oil droplets in patients treated with intravitreal injections of anti-VEGF.

BACKGROUND: To determine the percentage of patients who have silicone droplets in the vitreous after treatment with different anti-Vascular Endothelial Growth Factor (anti-VEGF) intravitreal injections (IVI) and how symptomatic they are. METHODS: One hundred fifty-two eyes of 140 patients who had at least received an IVI were recruited for this study. Data collection included the number and type of IVI (aflibercept, ranibizumab and bevacizumab) and the follow-up time. A complete ophthalmologic examination was carried out and patients were classified in four groups according to the amount of silicone droplets found in dilated fundoscopy (nonexistent, scarce, moderate and abundant). Measurement of intraocular pressure (IOP) was also carried out. An interview was conducted to report the presence and intensity of the symptomatology. RESULTS: Silicone oil droplets were reported in 109 eyes (71.7%). A positive correlation was found between the number of IVIs received and the quantity of droplets found, especially when aflibercept was used. Posterior vitreous detachment (PVD) was present in 65.8% of the patients, showing a positive correlation with the number of bubbles. Regarding the symptomatology, 60 eyes (39.5%) had floaters and the disturbance was reported to be 4 out of 10. The group with a moderate amount of silicone droplets had the highest percentage of floaters (60%). No statistical differences in the IOP were found between groups, although the group with abundant droplets had a higher mean IOP. CONCLUSION: A high prevalence of silicone droplets in vitreous of patients who undergo IVI treatment was found. It appears to have little impact on symptomatology and rise of IOP.

Validation of an autonomous artificial intelligence-based diagnostic system for holistic maculopathy screening in a routine occupational health checkup context.

PURPOSE: This study aims to evaluate the ability of an autonomous artificial intelligence (AI) system for detection of the most common central retinal pathologies in fundus photography. METHODS: Retrospective diagnostic test evaluation on a raw dataset of 5918 images (2839 individuals) evaluated with non-mydriatic cameras during routine occupational health checkups. Three camera models were employed: Optomed Aurora (field of view - FOV 50º, 88% of the dataset), ZEISS VISUSCOUT 100 (FOV 40º, 9%), and Optomed SmartScope M5 (FOV 40º, 3%). Image acquisition took 2 min per patient. Ground truth for each image of the dataset was determined by 2 masked retina specialists, and disagreements were resolved by a 3rd retina specialist. The specific pathologies considered for evaluation were "diabetic retinopathy" (DR), "Age-related macular degeneration" (AMD), "glaucomatous optic neuropathy" (GON), and "Nevus." Images with maculopathy signs that did not match the described taxonomy were classified as "Other." RESULTS: The combination of algorithms to detect any abnormalities had an area under the curve (AUC) of 0.963 with a sensitivity of 92.9% and a specificity of 86.8%. The algorithms individually obtained are as follows: AMD AUC 0.980 (sensitivity 93.8%; specificity 95.7%), DR AUC 0.950 (sensitivity 81.1%; specificity 94.8%), GON AUC 0.889 (sensitivity 53.6% specificity 95.7%), Nevus AUC 0.931 (sensitivity 86.7%; specificity 90.7%). CONCLUSION: Our holistic AI approach reaches high diagnostic accuracy at simultaneous detection of DR, AMD, and Nevus. The integration of pathology-specific algorithms permits higher sensitivities with minimal impact on its specificity. It also reduces the risk of missing incidental findings. Deep learning may facilitate wider screenings of eye diseases.