Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model.

INTRODUCTION: The number of people with diabetes mellitus is increasing globally and consequently so too is diabetic retinopathy (DR). Most patients with diabetes are monitored through the diabetic eye screening programme (DESP) until they have signs of retinopathy and these changes progress, requiring referral into hospital eye services (HES). Here, they continue to be monitored until they require treatment. Due to current pressures on HES, delays can occur, leading to harm. There is a need to triage patients based on their individual risk. At present, patients are stratified according to retinopathy stage alone, yet other risk factors like glycated haemoglobin (HbA1c) may be useful. Therefore, a prediction model that combines multiple prognostic factors to predict progression will be useful for triage in this setting to improve care.We previously developed a Diabetic Retinopathy Progression model to Treatment or Vision Loss (DRPTVL-UK) using a large primary care database. The aim of the present study is to externally validate the DRPTVL-UK model in a secondary care setting, specifically in a population under care by HES. This study will also provide an opportunity to update the model by considering additional predictors not previously available. METHODS AND ANALYSIS: We will use a retrospective cohort of 2400 patients with diabetes aged 12 years and over, referred from DESP to the NHS hospital trusts with referable DR between 2013 and 2016, with follow-up information recorded until December 2021.We will evaluate the external validity of the DRPTVL-UK model using measures of discrimination, calibration and net benefit. In addition, consensus meetings will be held to agree on acceptable risk thresholds for triage within the HES system. ETHICS AND DISSEMINATION: This study was approved by REC (ref 22/SC/0425, 05/12/2022, Hampshire A Research Ethics Committee). The results of the study will be published in a peer-reviewed journal, presented at clinical conferences. TRIAL REGISTRATION NUMBER: ISRCTN 10956293.

The Utility of Smartphone-Based Artificial Intelligence Approaches for Diabetic Retinopathy: A Literature Review and Meta-Analysis.

PURPOSE: To assess the diagnostic accuracy measures such as sensitivity and specificity of smartphone-based artificial intelligence (AI) approaches in the detection of diabetic retinopathy (DR). METHODS: A literature search of the EMBASE and MEDLINE databases (up to March 2020) was conducted. Only studies using both smartphone-based cameras and AI software for image analysis were included. The main outcome measures were pooled sensitivity and specificity, diagnostic odds ratios and relative risk of smartphone-based AI approaches in detecting DR (of all types), and referable DR (RDR) (moderate nonproliferative retinopathy or worse and/or the presence of diabetic macular edema). RESULTS: Smartphone-based AI has a pooled sensitivity of 89.5% (95% confidence interval [CI]: 82.3%-94.0%) and pooled specificity of 92.4% (95% CI: 86.4%-95.9%) in detecting DR. For referable disease, sensitivity is 97.9% (95% CI: 92.6%-99.4%), and the pooled specificity is 85.9% (95% CI: 76.5%-91.9%). The technology is better at correctly identifying referable retinopathy. CONCLUSIONS: The smartphone-based AI programs demonstrate high diagnostic accuracy for the detection of DR and RDR and are potentially viable substitutes for conventional diabetic screening approaches. Further, high-quality randomized controlled trials are required to establish the effectiveness of this approach in different populations.

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.

The management of eyelid burns.

Eyelid involvement is common in facial burns. Ocular sequelae, including corneal ulceration, are usually preventable and secondary to the development of eyelid deformities, exposure keratopathy, and rarely, orbital compartment syndrome. Early ophthalmic review and prophylactic ocular lubrication is mandatory in burns involving the eyelids. Early surgical intervention, often requiring repeat procedures, is indicated if eyelid retraction causing corneal exposure occurs. Permanent visual impairment is rare with such prompt management. No binding aphorisms exist regarding the tissue used for eyelid reconstruction, with each case requiring an individual approach based on available skin. This review article covers the principles of ophthalmic management in addition to intermediate and long-term management of eyelid burns.

Endonasal endoscopic assisted replacement of lacrimal drainage tubes.

PURPOSE: To describe an endonasal endoscopic assisted replacement of migrated or lost Lester-Jones (LJ) tubes. METHODS: In three consecutive cases of LJ tube migration or loss and an absent obvious transconjunctival tract, a curved paediatric Lusk ball-probe was passed under endoscopic visualization to the conjunctival surface through the internal nasal osteum. The drainage tube was then passed over the tip of the probe and replaced by retracting the probe back into the nose. RESULTS: In all cases, the drainage tube was successfully replaced using an endonasal endoscopic assisted technique. None of the cases, done 1-7 weeks after tube migration or loss, required the use of a K-wire and trephine for tube re-insertion. CONCLUSION: The conjunctivodacryocystorhinostomy tract appears to be retained following LJ tube migration or loss in selected cases. It can be accessed endonasally, allowing external tube replacement without the need for a repeat trephine.

Pericranium grafts for exposed orbital implants.

PURPOSE: To report the use of autologous pericranium grafts to cover exposed orbital implants. METHODS: A two-center consecutive case series of exposed orbital implants covered with autologous pericranium grafts. A patch of pericranium was harvested from the parieto-occipital region and was placed over the implant within a pocket between the implant and the Tenon capsule, followed by layered closure of Tenon and conjunctiva. RESULTS: Four patients (2 women, 2 men) with a mean age of 37 years (range, 26 to 45 years) were included in the study. The mean follow-up period was 9.5 months (range, 7 to 12 months). In all cases, there was no recurrence of exposure and no donor site morbidity. A small pyogenic granuloma, arising from the conjunctival suture line, developed in one case. CONCLUSIONS: Autologous pericranium is a useful covering material for exposed orbital implants and may be used as an alternative to frontal periosteum.