Quantification of Choroidal Vascular Hyperpermeability on Ultra-Widefield Indocyanine Green Angiography in Macular Neovascularization.

To obtain a quantitative parameter for the measurement of choroidal vascular hyperpermeability (CVH) on ultra-widefield indocyanine green angiography (UWICGA) using an objective analysis method in macular choroidal neovascularization (CNV). A total of 113 UWICGA images from 113 subjects were obtained, including with 25 neovascular age-related macular degeneration (nAMD), 37 with polypoidal choroidal vasculopathy (PCV) (19 with thin-choroid and 18 with thick-choroid), 33 with pachychoroid neovasculopathy (PNV), and 18 age-matched controls. CVH was quantified on a gray image by the subtraction of 2 synchronized UWICGA images of early and late phases. The measured CVH parameter was compared with human graders and among CNV subtypes and correlated with choroidal vascular density (CVD) and subfoveal choroidal thickness (SFCT). The mean CVH values were 28.58 ± 4.97, 33.36 ± 8.40, 33.61 ± 11.50, 42.19 ± 13.25, and 43.59 ± 7.86 in controls and patients with nAMD, thin-choroid PCV, thick-choroid PCV, and PNV, respectively (p < 0.001). CVH was higher in thick-choroid PCV and PNV compared to the other groups (all p ≤ 0.006). The measured CVH value positively correlated with those reported by human graders (p < 0.001), CVD, and SFCT (p = 0.001 and p < 0.001, respectively). CVH can be measured objectively using quantitative UWICGA analysis. The CVH parameter differs among macular CNV subtypes and correlates with CVD and SFCT.

Quantitative analysis of choroidal morphology in preeclampsia during pregnancy according to retinal change.

We sought to investigate changes in choroidal hemodynamics in preeclampsia according to presence of retinal change by quantitatively assessing choroidal vessels using optical coherence tomography (OCT). This retrospective study included 106 eyes (of 53 patients) with preeclampsia, including 70 eyes without retinal change in patients with preeclampsia (Group A), 22 eyes with retinal change in patients with preeclampsia (Group B), and 14 eyes of normal pregnant women (controls). Subfoveal choroidal thickness (SFCT) was measured on OCT B-scan images, and choroidal vessel densities (CVDs) were calculated using binarized OCT B-scan and en face images. Their values were then correlated with clinical parameters associated with preeclampsia. SFCT was greater in Group B compared to Group A or controls (354.32 ± 65.13 vs. 288 ± 55.68 or 277.21 ± 50.08, both P < 0.001). CVD on B-scan images was greater in Group B compared to Group A or controls (76.4 ± 4.9 vs. 73.7 ± 5.3 or 71.5 ± 5.1; both P ≤ 0.046). CVD on en face images was also greater in Group B compared to Group A or controls (64.7 ± 0.8 vs. 63.6 ± 1.5 or 63.3 ± 1.3; both P ≤ 0.001). SFCT and CVD positively correlated with each other (P ≤ 0.009) and were greater in patients with blurred vision and vaginal bleeding (P ≤ 0.020 for blurred vision and P ≤ 0.024 for vaginal bleeding). SFCT and CVDs were higher in preeclampsia patients with retinal change compared to those without retinal change or controls. Both SFCT and CVD showed association with blurred vision and vaginal bleeding.

Carbon dioxide gasification characteristics of disposable COVID-19 masks using bubbling fluidized bed reactor.

The global demand for masks has increased significantly owing to COVID-19 and mutated viruses, resulting in a massive amount of mask waste of approximately 490,000 tons per month. Mask waste recycling is challenging because of the composition of multicomponent polymers and iron, which puts them at risk of viral infection. Conventional treatment methods also cause environmental pollution. Gasification is an effective method for processing multicomponent plastics and obtaining syngas for various applications. This study investigated the carbon dioxide gasification and tar removal characteristics of an activated carbon bed using a 1-kg/h laboratory-scale bubble fluidized bed gasifier. The syngas composition was analyzed as 10.52 vol% of hydrogen, 6.18 vol% of carbon monoxide, 12.05 vol% of methane, and 14.44 vol% of hydrocarbons (C2-C3). The results of carbon dioxide gasification with activated carbon showed a tar-reduction efficiency of 49%, carbon conversion efficiency of 45.16%, and cold gas efficiency of 88.92%. This study provides basic data on mask waste carbon dioxide gasification using greenhouse gases as useful product gases.

QUANTITATIVE ANALYSIS OF CHOROIDAL MORPHOLOGY USING MULTIMODAL IMAGING IN ACUTE AND PERSISTENT CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To analyze quantitative differences in choroidal morphology between acute and persistent central serous chorioretinopathy using multimodal images. METHODS: Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography images of 72 eyes of 72 patients with acute (32 eyes) and persistent (40 eyes) central serous chorioretinopathy were collected. Choroidal thickness, area, vessel density, symmetry, and intervortex anastomosis were assessed. RESULTS: The choroidal area on optical coherence tomography B-scan images was smaller and the choroidal vessel density on UWICGA images was lower in the persistent group ( P < 0.001 and P = 0.028, respectively). Choroidal vessel density on UWICGA showed positive correlation with that of vortex ampullae (all P ≤ 0.046). The constitution of the intervortex anastomosis and dominant vessels in the macular area showed differences between the groups ( P = 0.014 and P = 0.010, respectively), with greater inferonasal vessel participation in the anastomosis and combined superotemporal and inferotemporal vessels as dominant vessels in the persistent groups. CONCLUSION: Acute and persistent central serous chorioretinopathy differed in subfoveal choroidal area, choroidal vessel density, and intervortex anastomosis constitution on UWICGA images. Choroidal vessel density on UWICGA images correlated with that of vortex ampullae. These findings enhance our understanding of the pathophysiology of central serous chorioretinopathy subtypes.

Choroidal Morphology on Ultra-Widefield Indocyanine Green Angiography and Response to Aflibercept in Pachychoroid Neovasculopathy.

Purpose: This study assessed the relationship between the choroidal morphology and short-term response to aflibercept treatment in pachychoroid neovasculopathy (PNV). Methods: This was a retrospective case-control study. Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography (OCT) images of 90 PNV eyes of 90 patients treated with aflibercept were enrolled. Responsiveness to aflibercept was defined as a complete resolution of sub- or intra-retinal fluid after three loading doses (50 dry and 40 non-dry eyes). Subfoveal choroidal thickness (SFCT) was measured on OCT images, and choroidal vessel density (CVD), CVD asymmetry, intervortex anastomosis, and choroidal vascular hyperpermeability (CVH) were assessed on UWICGA images. Results: CVD on UWICGA differed between groups in terms of the total area (0.323 ± 0.034 in dry vs. 0.286 ± 0.038 in non-dry, p < 0.001) and area of each quadrant (superotemporal: 0.317 ± 0.040 vs. 0.283 ± 0.040, superonasal: 0.334 ± 0.040 vs. 0.293 ± 0.045, inferonasal: 0.306 ± 0.051 vs. 0.278 ± 0.052, inferotemporal: 0.334 ± 0.047 vs. 0.290 ± 0.046; all p ≤ 0.010). The CVH grade differed between groups (mean 1.480 ± 0.735 vs. 1.875 ± 0.822, p = 0.013). ST and IT intervortex anastomoses were common in the dry group, while SN, ST, and IT were most common in the non-dry group (p = 0.001). Conclusions: A poor short-term response to aflibercept treatment in PNV eyes was associated with a lower Haller vessel density, higher CVH grade, and intervortex anastomosis involving more quadrants on UWICGA.

Automated segmentation of ultra-widefield fluorescein angiography of diabetic retinopathy using deep learning.

BACKGROUND/AIMS: Retinal capillary non-perfusion (NP) and neovascularisation (NV) are two of the most important angiographic changes in diabetic retinopathy (DR). This study investigated the feasibility of using deep learning (DL) models to automatically segment NP and NV on ultra-widefield fluorescein angiography (UWFA) images from patients with DR. METHODS: Retrospective cross-sectional chart review study. In total, 951 UWFA images were collected from patients with severe non-proliferative DR (NPDR) or proliferative DR (PDR). Each image was segmented and labelled for NP, NV, disc, background and outside areas. Using the labelled images, DL models were trained and validated (80%) using convolutional neural networks (CNNs) for automated segmentation and tested (20%) on test sets. Accuracy of each model and each label were assessed. RESULTS: The best accuracy from CNN models for each label was 0.8208, 0.8338, 0.9801, 0.9253 and 0.9766 for NP, NV, disc, background and outside areas, respectively. The best Intersection over Union for each label was 0.6806, 0.5675, 0.7107, 0.8551 and 0.924 and mean mean boundary F1 score (BF score) was 0.6702, 0.8742, 0.9092, 0.8103 and 0.9006, respectively. CONCLUSIONS: DL models can detect NV and NP as well as disc and outer margins on UWFA with good performance. This automated segmentation of important UWFA features will aid physicians in DR clinics and in overcoming grader subjectivity.

Hydrogen-rich gas production from disposable COVID-19 mask by steam gasification.

Globally, the demand for masks has increased due to the COVID-19 pandemic, resulting in 490,201 tons of waste masks disposed of per month. Since masks are used in places with a high risk of virus infection, waste masks retain the risk of virus contamination. In this study, a 1 kg/h lab-scale (diameter: 0.114 m, height: 1 m) bubbling fluidized bed gasifier was used for steam gasification (temperature: 800 °C, steam/carbon (S/C) ratio: 1.5) of waste masks. The use of a downstream reactor with activated carbon (AC) for tar cracking and the enhancement of hydrogen production was examined. Steam gasification with AC produces syngas with H2, CO, CH4, and CO2 content of 38.89, 6.40, 21.69, and 7.34 vol%, respectively. The lower heating value of the product gas was 29.66 MJ/Nm3 and the cold gas efficiency was 74.55 %. This study showed that steam gasification can be used for the utilization of waste masks and the production of hydrogen-rich gas for further applications.

Quantitative analysis of ultra-widefield fluorescein angiography in uveitis associated with sarcoidosis.

Purpose: To quantitatively assess the angiographic features of uveitis associated with sarcoidosis on ultra-widefield fluorescein angiography (UWFA) and determine their correlations with clinical features. Design: A retrospective cohort study. Methods: Sixty-four eyes (64 patients) with sarcoidosis uveitis were included. On UWFA, presence of vasculitis, macular leakage, and optic disc leakage were assessed and features including peripheral ischemic area, vascular leakage area, and punched out lesions were quantitatively analyzed using FIJI (ImageJ2) and correlated with clinical features. Results: The mean peripheral ischemic area and leakage area were 0.0419 ± 0.113% and 0.0333 ± 0.0287% of the total retinal area, respectively. Macular and optic disc leakage were present in 18.8% and 59.4% of eyes, respectively. The average number of punched out lesions was 10.02 ± 21.95. Those changes were most abundant in the inferotemporal area. The presence of disc leakage correlated with all the other UWFA parameters (all r ≥ 0.260; all P ≤ 0.038). The leakage area correlated with vitreous cells, baseline and 6-month logMAR visual acuity, steroid dose and duration, erythrocyte sedimentation rate, and C-reactive protein (r = 0.472, 0.288, 0.321, 0.374, 0.250, 0.251, and 0.277; all P ≤ 0.46). Conclusions: This study quantitatively analyzed UWFA data in sarcoidosis uveitis. Angiographic changes were most frequent in the inferotemporal area. UWFA parameters correlated with one another and clinical variables. These quantitative imaging results warrant a subjective analysis of sarcoidosis uveitis.

Predicting persistent central serous chorioretinopathy using multiple optical coherence tomographic images by deep learning.

We sought to predict whether central serous chorioretinopathy (CSC) will persist after 6 months using multiple optical coherence tomography (OCT) images by deep convolutional neural network (CNN). This was a multicenter, retrospective, cohort study. Multiple OCT images, including B-scan and en face images of retinal thickness (RT), mid-retina, ellipsoid zone (EZ) layer, and choroidal layer, were collected from 832 eyes of 832 CSC patients (593 self-resolving and 239 persistent). Each image set and concatenated set were divided into training (70%), validation (15%), and test (15%) sets. Training and validation were performed using ResNet50 CNN architecture for predicting CSC requiring treatment. Model performance was analyzed using the test set. The accuracy of prediction was 0.8072, 0.9200, 0.6480, and 0.9200 for B-scan, RT, mid-retina, EZ, and choroid modalities, respectively. When image sets with high accuracy were concatenated, the accuracy was 0.9520, 0.8800, and 0.9280 for B-scan + RT, B-scan + EZ, and EZ + RT, respectively. OCT B-scan, RT, and EZ en face images demonstrated good performances for predicting the prognosis of CSC using CNN. The performance improved when these sets were concatenated. The results of this study can serve as a reference for choosing an optimal treatment for CSC patients.

Inflammatory cytokines and retinal nonperfusion area in quiescent proliferative diabetic retinopathy.

PURPOSE: We sought to investigate the association between inflammatory cytokine levels and retinal capillary nonperfusion area in eyes with quiescent proliferative diabetic retinopathy (PDR). METHODS: Samples of aqueous humor were collected from 67 eyes (n = 42 patients) with treatment-naïve PDR. Levels of interleukin (IL)-10, IL-1ß, IL-6, IL-8, monocyte chemoattractant protein 1 (MCP-1), and tumor necrosis factor-α (TNF-α) were obtained using multiplex bead assay. Areas of capillary nonperfusion at the posterior pole and peripheral retina were measured via ultra-widefield fluorescein angiography and correlated with cytokine levels. RESULTS: The levels of IL-10, IL-6, IL-8, MCP-1, and TNF-α were positively correlated with the nonperfusion area of the peripheral retina (r = 0.298, 0.401, 0.265, 0.435, and 0.393; all P ≤ 0.030). There were positive correlations between IL and 10, IL-6, IL-8, MCP-1, and TNF-α (all R ≥ 0.247; all P ≤ 0.043). IL-1ß did not show a significant correlation with the nonperfusion area (P = 0.972 for posterior pole and 0.392 for periphery) but was positively correlated with TNF-α (r = 0.334; P = 0.006). CONCLUSIONS: An increased level of inflammation was observed in PDR eyes with larger nonperfusion areas, which suggests inflammation as a possible target for suppressing PDR progression associated with nonperfusion.

Collagen fibrous scaffolds for sustained delivery of growth factors for meniscal tissue engineering.

Aim: To mimic the ultrastructural morphology of the meniscus with nanofiber scaffolds coupled with controlled growth factor delivery to modulate cellular performance for tissue engineering of menisci. Methods: The authors functionalized collagen nanofibers by conjugating heparin to the following growth factors for sustained release: PDGF-BB, TGF-ß1 and CTGF. Results: Incorporating growth factors increased human meniscal and synovial cell viability, proliferation and infiltration in vitro, ex vivo and in vivo; upregulated key genes involved in meniscal extracellular matrix synthesis and enhanced generation of meniscus-like tissue. Conclusion: The authors' results indicate that functionalizing collagen nanofibers can create a cell-favorable micro- and nanoenvironment and can serve as a system for sustained release of bioactive factors.

Lay abstract Meniscal tears are a common injury to the part of the knee called the meniscus. Loss of meniscal tissue can lead to arthritis. In this study, the authors aimed to recreate the structure of the human meniscus using very thin (nanometers in diameter) fibers made of collagen. The authors also attached proteins called growth factors to the fibers. The addition of these proteins increased the growth rate of cells collected from human knee tissue. The levels of important genes involved in meniscal tissue formation were increased in these cells. These results show that adding proteins such as growth factors to collagen nanofibers can create an environment beneficial to growing meniscal tissue. Successful development of this technology could help in repairing meniscal damage in people.

Usefulness of three-dimensional computed tomography for patellofemoral measurement.

PURPOSE: This study aimed to establish the normal values for knee patellofemoral alignment as measured using 3-dimensional computed tomography (3D CT), to standardize the technique, and to show the inter- and intra-observer reliability of this measurement. METHODS: The present study included 62 asymptomatic volunteers (124 knees). 3D CT scanning was performed with each volunteer in the supine position with 15° of knee flexion, and consistent 3D axial images of the patellofemoral joint were obtained with alignment in the desired stereographic baseline direction in anterior-posterior, lateral, and axial rotations. Two independent observers measured patellofemoral alignment parameters, including the sulcus angle, congruence angle, lateral patellofemoral angle, condyle-patellar angle, and lateral trochlear inclination angle. RESULTS: Based on 3D CT measurement, the mean values of the parameters were 145.9° ± 9.2° for the sulcus angle, 12.6° ± 22.6° for the congruence angle, 9.2° ± 4.6° for the lateral patellofemoral angle, 14.1° ± 6.4° for the condyle-patellar (lateral facets) angle, - 8.5° ± 8.4° for condyle-patellar (patellar axis) angle, and 16.5° ± 6.3° for the lateral trochlear inclination angle. A statistically significant difference was observed between men and women in the sulcus and condyle-patellar (patellar axis) angles (p = 0.045, 0.011, respectively). All parameters showed excellent inter- and intra-observer reliability. CONCLUSION: The normal values and ranges for patellofemoral alignment parameters were evaluated using 3D CT. The results of this study provide reference information that may facilitate diagnosis and treatment planning of patellofemoral disorders in skeletally mature non-pathologic patients. LEVEL OF EVIDENCE: II.

Therapeutic Efficacy of Autologous Platelet Concentrate Injection on Macular Holes with High Myopia, Large Macular Holes, or Recurrent Macular Holes: A Multicenter Randomized Controlled Trial.

We aimed to evaluate the anatomical and functional outcomes of pars-plana vitrectomy (PPV) with or without autologous platelet concentrate (APC) injection in patients with recurrent macular holes (MHs), large MHs, or MHs with high myopia. This multicenter, prospective, interventional randomized controlled trial was conducted from March 2017 to April 2020. Participants were randomly allocated to a PPV group or a PPV+APC group. All participants underwent standard 25-gauge PPV, and eyes in the PPV+APC group underwent PPV with intravitreal APC injection before air-gas exchange. A total of 117 patients were enrolled (PPV group: n = 59, PPV+APC group: n = 58). Hole closure was achieved in 47 participants (79.7%) in the PPV group and 52 participants (89.7%) in the PPV+APC group. There were no between-group differences in the anatomical closure rate or functional outcomes including best-corrected visual acuity, metamorphopsia, pattern-reversal visual evoked potential, or Visual Function Questionnaire-25 score. The use of APC injection does not improve the anatomical and functional outcomes of surgery for large MHs, recurrent MHs, or MHs with high myopia. The adjunctive use of APC can be considered in selected cases because it is not inferior to conventional MH surgery, is relatively simple to perform, and is not affected by the surgeon's skill.

Classification of Pachychoroid on Optical Coherence Tomographic En Face Images Using Deep Convolutional Neural Networks.

Purpose: To study the efficacy of deep convolutional neural networks (DCNNs) to differentiate pachychoroid from nonpachychoroid on en face optical coherence tomography (OCT) images at the large choroidal vessel. Methods: En face OCT images were collected from eyes with neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. All images were prelabeled pachychoroid or nonpachychoroid based on quantitative and qualitative criteria for choroidal morphology on multimodal imaging by two retina specialists. In total, 1188 nonpachychoroid and 884 pachychoroid images were used for training (80%) and validation (20%). Accuracy for identification of pachychoroid by DCNN models was analyzed. Trained models were tested on a test set containing 79 nonpachychoroid and 93 pachychoroid images. Results: The accuracy on the validation set was 94.1%, 93.2%, 94.7%, and 94.4% in DenseNet, GoogLeNet, ResNet50, and Inception-v3, respectively. On a test set, each model demonstrated accuracy of 80.2%, 83.1%, 89.5%, and 90.1% and an F1 score of 0.782, 0.824, 0.904, and 0.901, respectively. Conclusions: DCNN models could classify pachychoroid and nonpachychoroid with good performance on OCT en face images. Automated classification of pachychoroid will be useful for tailored treatment of individual patients with exudative maculopathy. Translational Relevance: En face OCT images can be used by DCNN for classification of pachychoroid.

Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair.

PURPOSE: No studies have been conducted to determine long-term predictors of clinical failure after surgical root repair. This study identified long-term prognostic factors of clinical failure after pull-out repair of medial meniscus posterior root tears (MMPRTs) at a minimum of 10 year follow-up. METHODS: A total of 37 patients who underwent MMPRT pull-out repair and had been observed for more than 10 years were recruited for this study. The mean follow-up period was 125.9 ± 21.2 months. Clinical failure of the procedures was defined as conversion to total knee arthroplasty (TKA). Participants were categorized into two groups: non-failure and failure groups. Various factors, including demographic features and radiologic findings, were analyzed and compared between the two groups. Meniscus extrusion was assessed at coronal magnetic resonance imaging preoperatively and 1 year postoperatively. Independent risk factors were determined by univariate analysis and logistic regression analysis. To determine the cut-off value for risk factors, the receiver-operating characteristic curve analysis was performed. RESULTS: In total, eight patients (22%) were converted to TKA during the follow-up period. With univariate analysis, statistically significant differences between two groups were observed in mechanical varus alignment (P = 0.018), rate of the number of patient with more meniscal extrusion values after surgery (P = 0.024), and the difference between the preoperative and 1-year postoperative value of meniscus extrusion (mm) (P = 0.010). In a logistic analysis, OR of mechanical varus alignment and differences in meniscus extrusion value before and 1 year after surgery was 1.5 (P = 0.048) and 3.7 (P = 0.034). The cut-off values of mechanical varus alignment and differences in meniscus extrusion values were 5 degrees and 0.7 mm. CONCLUSION: Clinically, preoperative varus alignment and increased meniscal extrusion after surgery were found to be predictive for a clinical failure after meniscal root repair in a long-term perspective. Thus, these negative prognostic factors should be taken into consideration for performing root repair in MMPRTs. LEVEL OF EVIDENCE: Level III.

Discordance in Retinal and Choroidal Vascular Densities in Patients with Type 2 Diabetes Mellitus on Optical Coherence Tomography Angiography.

PURPOSE: In the present study, the retinal and choroidal vascular densities (VDs) in type 2 diabetes mellitus (DM) patients were analyzed using optical coherence tomography angiography (OCTA). METHODS: The study included 282 eyes of 152 patients with type 2 DM (114 without retinopathy, 79 nonproliferative diabetic retinopathy (NPDR), 48 severe NPDR, and 41 proliferative diabetic retinopathy (PDR) eyes). The superficial and deep retinal vessel, choriocapillaris, and choroidal VDs were measured using a binarization method on OCTA images. VDs were compared based on retinopathy severity. Correlations among densities were analyzed. RESULTS: Retinal and choriocapillaris VDs were lower in PDR than in NPDR (all P < 0.05). Correlation analysis showed significant positive correlations among densities of superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Choroidal VD showed a negative correlation with superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Retinal and choriocapillaris VDs showed a negative correlation with diabetic retinopathy (DR) grade (all P < 0.001); however, the choroidal VD showed a weak positive correlation (P=0.030). CONCLUSION: Choroidal VD increased as retinal and choriocapillaris VDs decreased, indicating that the outer layer of the choroid is less affected by DR severity and VD of larger choroidal vessels may even be increased as a compensatory mechanism for decreased retinal and choriocapillaris VDs in type 2 DM patients.

Classification of pachychoroid on optical coherence tomography using deep learning.

PURPOSE: Pachychoroid is characterized by dilated Haller vessels and choriocapillaris attenuation that are seen on optical coherence tomography (OCT) B-scans. This study investigated the feasibility of using deep learning (DL) models to classify pachychoroid and non-pachychoroid eyes from OCT B-scan images. METHODS: In total, 1898 OCT B-scan images were collected from eyes with macular diseases. Images were labeled as pachychoroid or non-pachychoroid based on strict quantitative and qualitative criteria for multimodal imaging analysis by two retina specialists. DL models were trained (80%) and validated (20%) using pretrained convolutional neural networks (CNNs). Model performance was assessed using an independent test set of 50 non-pachychoroid and 50 pachychoroid images. RESULTS: The final accuracy of AlexNet and VGG-16 was 57.52% for both models. ResNet50, Inception-v3, Inception-ResNet-v2, and Xception showed a final accuracy of 96.31%, 95.25%, 93.40%, and 92.61%, respectively, for the validation set. These models demonstrated accuracy on an independent test set of 78.00%, 86.00%, 90.00%, and 92.00%, and an F1 score of 0.718, 0.841, 0.894, and 0.920, respectively. CONCLUSION: DL models classified pachychoroid and non-pachychoroid images with good performance. Accurate classification can be achieved using CNN models with deep rather than shallow neural networks.

Cytokines associated with hemorrhage in proliferative diabetic retinopathy.

PURPOSE: To investigate aqueous cytokine levels in association with hemorrhage in proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes mellitus. METHODS: Sixty-six eyes with treatment-naïve PDR, including 26 hemorrhagic and 40 nonhemorrhagic eyes were included in this institutional study. Aqueous humor levels of interleukin (IL)-1b, IL-6, IL-8, IL-10, monocyte chemoattractant protein (MCP)-1, tumor necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF), and soluble VEGF receptor-1 were obtained by multiplex bead assay. Visual acuity and hemorrhage area measurements were obtained, and correlations between cytokine levels and hemorrhage were identified. RESULTS: Levels of MCP-1, TNF-α, and VEGF were higher in hemorrhagic eyes (1506.77 vs. 2131.31 pg/mL, 0.43 vs. 0.63 pg/mL, and 103.96 vs. 206.96 pg/mL; P = 0.050, 0.022, and 0.027, respectively). The levels of IL-8, MCP-1, TNF-α, and VEGF showed positive correlation with visual acuity (P = 0.019, 0.015, 0.001, and 0.014, respectively). The hemorrhage area revealed positive correlation with TNF-α and VEGF levels (P = 0.001 and < 0.001, respectively). CONCLUSION: The presence and amount of hemorrhage in PDR were associated not only with VEGF concentration, but also with the levels of certain inflammatory cytokines, suggesting a role of both VEGF and inflammation in hemorrhagic eyes.

Multimodal Imaging of Annular Choroidal Detachment in a Patient with Vogt-Koyanagi-Harada Disease.

Purpose: To report a rare case of Vogt-Koyanagi-Harada (VKH) patient with bilateral annular choroidal detachment and describe ultra-widefield angiographic findings.Method: Case report.Results: A 61-year-old male was diagnosed as VKH based on ocular signs and neurologic findings. Annular choroidal detachment anterior to the equator was noted in both eyes. Ultra-wide field (UWF) fluorescein angiography revealed multiple leakages at posterior pole and disc with dye pooling at the margin of choroidal detachment. Late-phase UWF indocyanine green angiography (ICGA) revealed hyperpermeability with dilated veins and many vortex ampullae obscured by detached choroid. Choroidal detachment and other manifestations improved after a high-dose systemic steroid treatment. UWF ICGA after the treatment revealed decreased choroidal vessel caliber with visible vortex ampullae.Conclusion: Vortex obstruction and choroidal vein dilatation were observed in a VKH patient with choroidal detachment, which might be related to its pathophysiology.

Relationship Between Retinal Capillary Nonperfusion Area and Renal Function in Patients With Type 2 Diabetes.

Purpose: We sought to assess the relationship between retinal nonperfusion area (NPA) on ultra-widefield fluorescein angiography (UWFA) and renal function in type 2 diabetes mellitus (DM) patients with diabetic retinopathy (DR) and nephropathy. Methods: UWFA was performed in 248 eyes (124 patients) with DR, comprising 94 eyes from patients with chronic kidney disease (CKD) caused by diabetes and 154 eyes without CKD (non-CKD). Serum creatinine level (Cr), estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR), and urine protein/creatinine ratio (UPCR) were collected. On UWFA, retinal NPA was measured in an automated manner. The correlation between NPA and renal function was analyzed. Results: The mean NPA value of the total eye was 33.11 ± 45.77-disc diameter (DA) in non-CKD and 100.57 ± 69.52 in CKD (P < 0.001). NPA of posterior pole was 1.21 ± 3.28 DA in non-CKD and 7.99 ± 6.75 in CKD group (P < 0.001). The NPA values of both the total eye and posterior pole were significantly correlated with Cr (r = 0.585 and 0.483), eGFR (r = -0.572 and -0.524), UACR (r = 0.541 and 0.482), and UPCR (r = 0.509 and 0.529, respectively) (all P ≤ 0.001). Linear modeling encompassing all clinical factors and relative clinical factors suggested eGFR as the most important predictor for NPAs of the total eye and posterior pole. Conclusions: Larger retinal NPA on UWFA is associated with worse renal function in DM patients. Renal function can be used to predict retinal NPA in type 2 DM patients with nephropathy and DR.