An Automated Multi-scale Feature Fusion Network for Spine Fracture Segmentation Using Computed Tomography Images.

Spine fractures represent a critical health concern with far-reaching implications for patient care and clinical decision-making. Accurate segmentation of spine fractures from medical images is a crucial task due to its location, shape, type, and severity. Addressing these challenges often requires the use of advanced machine learning and deep learning techniques. In this research, a novel multi-scale feature fusion deep learning model is proposed for the automated spine fracture segmentation using Computed Tomography (CT) to these challenges. The proposed model consists of six modules; Feature Fusion Module (FFM), Squeeze and Excitation (SEM), Atrous Spatial Pyramid Pooling (ASPP), Residual Convolution Block Attention Module (RCBAM), Residual Border Refinement Attention Block (RBRAB), and Local Position Residual Attention Block (LPRAB). These modules are used to apply multi-scale feature fusion, spatial feature extraction, channel-wise feature improvement, segmentation border results border refinement, and positional focus on the region of interest. After that, a decoder network is used to predict the fractured spine. The experimental results show that the proposed approach achieves better accuracy results in solving the above challenges and also performs well compared to the existing segmentation methods.

A rare case of orbital inflammation complicated by hemophagocytic lymphohistiocytosis.

We report a rare case of orbital inflammation complicating hemophagocytic lymphohistiocytosis (HLH) patient. HLH is a rare, life-threatening disorder characterized by uncontrolled activation of cytotoxic T lymphocytes, natural killer cells, and macrophages. A 37-year-old man known to have HLH, presented with a left periorbital swelling that was unsuccessfully treated as an orbital cellulitis, with intravenous antibiotics. A computed tomography (CT) scan of the orbits revealed inflammatory changes with no orbital collection or paranasal sinus disease. An orbital biopsy demonstrated lymphoplasmacytic infiltrations admixed with histiocytes. The patient deteriorated and was admitted to the intensive care unit. Ensuing blood results supported a diagnosis of HLH, and the patient responded well to subsequent immunosuppression. This case report highlights the importance of re-considering the diagnosis of orbital cellulitis in treatment resistant cases, particularly in the absence of sinus disease. To our knowledge, this is the third case of orbital inflammation associated with HLH patients.

An Automated Deep Learning Approach for Spine Segmentation and Vertebrae Recognition Using Computed Tomography Images.

Spine image analysis is based on the accurate segmentation and vertebrae recognition of the spine. Several deep learning models have been proposed for spine segmentation and vertebrae recognition, but they are very computationally demanding. In this research, a novel deep learning model is introduced for spine segmentation and vertebrae recognition using CT images. The proposed model works in two steps: (1) A cascaded hierarchical atrous spatial pyramid pooling residual attention U-Net (CHASPPRAU-Net), which is a modified version of U-Net, is used for the segmentation of the spine. Cascaded spatial pyramid pooling layers, along with residual blocks, are used for feature extraction, while the attention module is used for focusing on regions of interest. (2) A 3D mobile residual U-Net (MRU-Net) is used for vertebrae recognition. MobileNetv2 includes residual and attention modules to accurately extract features from the axial, sagittal, and coronal views of 3D spine images. The features from these three views are concatenated to form a 3D feature map. After that, a 3D deep learning model is used for vertebrae recognition. The VerSe 20 and VerSe 19 datasets were used to validate the proposed model. The model achieved more accurate results in spine segmentation and vertebrae recognition than the state-of-the-art methods.

Neurological symptoms associated with acute multifocal placoid pigment epitheliopathy: treatment dilemma and diagnostic issues.

Acute multifocal placoid pigment epitheliopathy (AMPPE) is thought to be caused by vasculitis of the choroid. Central nervous system involvement is rare. We report a case of a 28-year-old male who developed blurred vision (6/12 OD, 6/24 OS). Past medical history involved non-specific viral meningitis treated with intravenous antibiotics and antivirals. Subsequently, the patient complained of recurrent headaches. Based on typical clinical findings and fluorescein angiogram, he was diagnosed with AMPPE. Visual disturbance resolved without any systemic treatment. Six months later, visual symptoms recurred and resolved spontaneously, but his headache continued. A few months later, the patient developed acute progressive neurological signs and symptoms necessitating inpatient admission. Lacunar infarcts in the CNS were found, which had not been noted in previous neuro-imaging studies. Cerebral vasculitis associated with AMPPE was diagnosed and treated with systemic steroids and immune suppression. Currently, the patient remains asymptomatic under joined care of an ophthalmologist and a neurologist.

Etanercept in methotrexate-resistant JIA-related uveitis.

UNLABELLED: We report our results with systemic Etanercept in patients with juvenile idiopathic arthritis in a joint ophthalmology-rheumatology clinic at a tertiary hospital. METHODS: Patients with JIA on Etanercept were identified from a dedicated uveitis database. A retrospective review of electronic and paper-based patient records was performed. RESULTS: Nine patients with JIA and current or previous treatment with Etanercept were identified, including six females and three males. Five patients with previous or current uveitis were noted. A further four were under observation for uveitis and required Etanercept for their joint disease. All nine patients had previously been taking Methotrexate, which had a suboptimal response in controlling arthritis or uveitis. Six out of nine patients did not show any uveitis activity at their last follow-up. Eyes of three patients still show signs of active inflammation in the anterior chamber (two on Etanercept and one off Etanercept). Severely impaired visual acuity (PL) was recorded in both eyes of one patient with long-standing persistent uveitis. Moderate visual loss in one eye of one patient was seen. The remaining seven patients did not show any significant loss of vision. Intraocular inflammation was not induced in any patient started on Etanercept. CONCLUSION: Etanercept may be useful in controlling JIA-related uveitis or arthritis in a pediatric patient when Methotrexate has had a suboptimal response in controlling the inflammatory activity.

Presentation of suspected pediatric uveitis.

UNLABELLED: Presentation of suspected pediatric uveitis: Pediatric uveitis is usually managed in specialized ophthalmic centers in the UK. Meaningful data acquisition in these clinics may be helpful in clinical governance, and healthcare planning in a specialty that is gradually changing due to changes in treatment choices. METHODS: Retrospective analysis of prospectively acquired data in the Liverpool pediatric uveitis database was performed. RESULTS: Analysis of our data, based on 147 patients, with a mean age of 10 years, indicated a female to male ratio of 2:1. 99% of patients were Caucasian. Our data indicates 86% of all patients attending the uveitis clinic were diagnosed with juvenile idiopathic arthritis, followed by intermediate uveitis 5% and idiopathic uveitis 4%. 46% of patients required treatment. Systemic treatment included methotrexate (34%), prednisolone (14%), etanercept (6%), ciclosporin (6%), mycophenolate (3%), and infliximab (1%). Severe visual loss (defined by counting fingers or below vision) was seen in 10 eyes despite appropriately treated chronic uveitis. CONCLUSION: Our data shows uveitis-related ocular morbidity in a predominantly pediatric Caucasian population. Patients with severe and chronic uveitis may experience significant uveitis-related complications and subsequent visual loss despite aggressive treatment.

Emerging roles for antiangiogenesis factors in management of ocular disease.

The first antivascular endothelial growth factor (anti-VEGF) was developed as an anticancer drug for colonic carcinomas. Since then, anti-VEGFs have developed in scope and indications. They have revolutionized the treatment of exudative macular degeneration and have had a major impact on treatment of several other conditions. This has resulted in an increased number of patients seeking treatment with new treatment options and has had a considerable financial impact on health care resources. Anti-VEGFs have been used in the treatment of all age groups of the population ranging from infants where it is used for treatment of retinopathy of prematurity to the elderly where it is used in exudative macular eegeneration.

Follow-up of erlotinib related uveitis.

The authors report the follow-up of a 68-year-old lady with bilateral anterior uveitis secondary to erlotinib. Erlotinib was started and stopped after symptoms and signs suggestive of severe bilateral anterior uveitis were noted. The patient developed signs of a non-ST elevation myocardial infarction, 12 days after stopping the erlotinib, and recovered without major problems. The patient also reported intermittent low-grade fever since starting erlotinib which resolved after stopping this drug. No further symptoms of uveitis were noted up to 6 month follow-up. The patient reported improved well being, resolution of ocular symptoms and intermittent low-grade fever at last follow-up (6 months after stopping erlotinib).

Intraocular lens and capsule opacification with hydrophilic and hydrophobic acrylic materials.

PURPOSE: To report posterior capsular opacification in acrylic intraocular lenses. METHODS: Retrospective review of notes of patients with cataract surgery involving implantation of a hydrophilic acrylic intraocular lens (IOL) (MDR SC-60B-0UV) in at least one eye. This was done as a retrospective audit for clinical risk following adverse event reports, regarding MDR SC-60B-0UV intraocular lens, were published. Data regarding the pre- and post-operative visual acuity, ocular co-morbidity, posterior capsular thickening, Nd-YAG capsulotomy, final visual acuity, and changes in the lens clarity in both eyes were noted from the clinical notes. RESULTS: 45 patients and 90 eyes were identified. Posterior capsular opacification (PCO) as determined by slit-lamp examination was 40% for the hydrophilic IOL (SC-60B-0UV) and 8% for the contra-lateral eye (hydrophobic IOL). In 22 eyes opacification of the SC-60-0UV IOL was observed at slit-lamp examination (44%). CONCLUSION: The hydrophilic acrylic IOL (SC60B-0UV) appears to have a high incidence of PCO.

Bilateral viral retinitis in a patient with immune deficiency because of purine nucleoside phosphorylase deficiency.

BACKGROUND: Progressive retinal outer necrosis is a devastating viral necrotizing retinitis, which affects predominantly immunocompromised patients. We report a case in which the ocular findings led to a search for an underlying immune deficiency, established as congenital purine nucleoside phosphorylase deficiency. METHODS: Retrospective, interventional case report. RESULTS: We describe the clinical features and management of the disease. CONCLUSION: This is the first report of bilateral varicella zoster virus retinitis with underlying purine nucleoside phosphorylase deficiency. It highlights the importance of thorough investigation in apparent immunocompetent patients presenting with viral retinitis, as this may indicate an undiagnosed primary immunodeficiency.

Effect of reflux of drug during intravitreal anti-VEGF therapies on foveal thickness.

PURPOSE: To report any variation in foveal thickness in eyes with and without reflux during anti-VEGF injection. METHOD: Review of electronic case notes and scans. RESULTS: 18 patients receiving bevazicumab were identified as having reflux (n = 3) or no reflux (n = 15). Pre-injection average central foveal thickness (CFT) was 439 microns (µ) and post-injection average CFT was 417µ. The change in mean CFT was -22 µ (range -330 to 336 µ). 70 patients receiving ranibizumab (lucentis) were identified as having reflux (n = 22) or no reflux (n = 48). Average pre-injection CFT was 336 µ and post-injection average CFT was 289 µ. The change in mean CFT was -48 µ (range -163 to 443 µ). The change in CFT between the group with reflux and no reflux in bevazicumab and ranibizumab injections was statistically insignificant. CONCLUSION: Reflux following injection of anti-VEGF agents does not appear to cause a sub-therapeutic effect.

Relatively spared central multifocal electroretinogram responses in acute quinine toxicity.

A 71-year-old man was investigated with electrodiagnostic testing 4 months after a deliberate quinine overdose. Initially he was admitted to intensive care unit with visual acuity (VA) of perception of light in both eyes. VA recovered to 6/6 right eye and 6/12 left eye, though severely constricted fields were noted. Slow stimulus (base period of 83 ms) multifocal electroretinogram (ERG) showed electronegative responses outside the inner 5 degrees, with a reduced but electropositive response seen in this central area. It appears that in this case of bilaterally negative ERGs that the macula/fovea (which has a vascular supply through the choroid) is relatively spared as is seen in bilateral vascular electronegative ERGs. This may indicate that quinine toxicity to the retina may be secondary to effects similar to vascular occlusion or severe ischemia during the acute phase of quinine poisoning.

Management of cataract caused by inadvertent capsule penetration during intravitreal injection of ranibizumab.

We describe an approach to phacoemulsification of complicated cataract with preexisting posterior capsule tear caused by an intravitreal injection. Careful preoperative planning and attention to fluidics, low bottle height, appropriate incisions, careful hydrodelineation without hydrodissection, avoidance of nuclear rotation, and use of a dispersive ophthalmic viscosurgical device to tamponade vitreous allows safe phacoemulsification with secure posterior chamber intraocular lens implantation. Biaxial microincision cataract surgery can achieve efficient removal of the lens matter without rotating the nucleus, reducing the chance of capsule tear extension and loss of nuclear fragments into the posterior pole.

Heavy silicone oil tamponade after failed macular hole surgery with perfluoropropane (C3F8): a report of five cases.

UNLABELLED: We report five cases of persistent macular holes following conventional surgery. Subsequent management included pars plana vitrectomy, extended Trypan Blue-assisted ILM peel and heavy silicone oil (HSO) tamponade with supine posture. PURPOSE: To report results of redo macular hole surgery using heavy silicone oil (HSO) tamponade. METHODS: Retrospective study of patients with primary failure of macular hole surgery, who failed to posture prone due to medical reasons. Further surgery consisted of vitrectomy, extended-dye-assisted ILM peel, and HSO tamponade with supine posture. RESULTS: Anatomical closure of macular holes was achieved in three out of five cases with parallel improvement in visual acuity after 3 months of removal of heavy silicone oil. These were confirmed clinically and by ocular coherence tomography (OCT). CONCLUSIONS: HSO may be used as tamponade in patients with unsuccessful primary macular-hole surgery, negating the need of prone posturing post-operatively.

Atrophy of the retinal pigment epithelium following vitrectomy with trypan blue.

PURPOSE: To report a case of possible trypan blue retinotoxicity after macular hole surgery. METHODS: Retrospective review of case notes and follow-up in one patient with unusual appearance of the fundus after macular hole surgery with trypan blue. RESULTS: A 69-year-old female presented to our eye clinic with a complaint of loss of vision over the last 6 months. Examination showed a full-thickness macular hole in the right eye. She underwent right pars plana vitrectomy with internal limiting peel assisted by trypan blue. Surgery was routine with no difficulty during surgical peel of the inner limiting membrane. Two weeks postoperatively, increased pigmentation and atrophy at the level of the retinal pigment epithelium (RPE) was noted temporal to the fovea. The macular hole appeared closed. Fundus fluorescein angiography showed this to be a lesion with characteristics of RPE atrophy. CONCLUSION: In the absence of excessive peroperative surgical trauma to the region of the scar, the retinal changes may be secondary to possible toxicity due to trypan blue stain, light toxicity or a combination of both.

Nd:YAG laser treatment for Valsalva premacular hemorrhages: 6 month follow up : alternative management options for preretinal premacular hemorrhages in Valsalva retinopathy.

The aim of this study was to determine visual outcomes, complications, and long-term effects of drainage of preretinal (premacular) hemorrhage into the vitreous with Neodymium (Nd)-YAG laser in patients due to Valsalva retinopathy. A total of 12 patients with preretinal and premacular hemorrhage presumably caused by Valsalva maneuver was studied. All patients denied any history of ocular disease prior to presentation. Conservative treatment with observation, Nd-YAG hyaloidotomy, and vitrectomy were offered to all patients. A total of 11 patients opted for laser treatment, and one opted for conservative treatment with observation after counseling and informed consent. Nd-YAG-laser hyaloidotomy was performed to drain the hemorrhage into the vitreous cavity. Visual acuity and was recorded prior to treatment and at 1- and 6-month intervals after treatment. Complete retinal examination was undertaken at each visit when possible. Visual acuity improved in 11 patients after the Nd-YAG hyaloidotomy. No postlaser complications were noted at 6 months follow-up. One patient declined treatment and was monitored. Drainage of premacular preretinal hemorrhage due to Valsalva retinopathy into the vitreous with a Nd-YAG laser is a treatment alternative with potential of quick visual rehabilitation. Long-term results are unknown; however, short-term (up to 6 months) follow-up showed good results.