Imaging Artifacts and Quality Evaluation with Ultrawide-Field Swept-Source OCTA in Diabetic Retinopathy.

PURPOSE: To evaluate the prevalence and types of artifacts in ultrawide-field swept-source optical coherence tomography angiography (SS-OCTA) scans of diabetic retinopathy (DR) patients. METHODS: This study was a prospective, observational study conducted from May 2022 to October 2022. Participants comprised individuals with proliferative diabetic retinopathy (PDR), nonproliferative diabetic retinopathy (NPDR), no diabetic retinopathy, and healthy controls. SS-OCTA imaging was performed, and a 5-scan composite with a larger field of view (23.5 mm × 17.5 mm) was captured using built-in software. Two experienced ophthalmologists analyzed the images independently, and the image quality and artifact prevalence were recorded and analyzed. RESULTS: The study included 70 eyes (16 with PDR, 24 with NPDR, 12 eyes of diabetic patients without DR, and 18 healthy eyes) in 70 subjects. Imaging artifacts were observed in a high percentage of eyes, with 98.57% of eyes presenting at least one type of artifact. A significant proportion of eyes (58.57%) exhibited a severe degree of artifacts. The most prevalent artifacts were loss of signal in 63 eyes (90%) and displacement artifact and masking artifact in 43 eyes (61.4%). Patients with more severe stages of DR had higher artifact scores (p < 0.05). Multivariate regression analysis indicated that DR severity was the most important factor influencing artifact scores (p < 0.05). CONCLUSIONS: In OCTA photos, various artifacts arise at different frequencies. It is crucial to qualitatively evaluate the images to ensure their quality. The results demonstrate that DR severity has a significant correlation with artifact scores.

Description of Flavimaribacter sediminis gen. nov., sp. nov., a New Member of the Family Rhizobiaceae Isolated from Marine Sediment.

A novel Gram-staining-negative, aerobic and rod-shaped bacterium, designated WL0058T, was isolated from coastal sediment sample collected in Nantong city, Jiangsu province of China (120° 51' 13″ E, 32° 6' 26″ N) in October 2020. Strain WL0058T was found to grow at 4-37 °C (optimum, 28 °C) with 1.5-4.0% NaCl (optimum, 4.0%) and displayed alkaliphilic growth with the pH range of pH 6.0-10.0 (optimum, pH 6.0). Phylogenetic trees constructed based on 16S rRNA gene sequence indicated that strain WL0058T is a member of the family Rhizobiaceae, shared the highest similarity with "Hoeflea prorocentri" CCTCC AB 2016294T (97.7%) and constituted a sub-cluster within the family with it, while the similarity with others in the family Rhizobiaceae was lower than 97.0%. The G + C content of genomic DNA was 59.5 mol%. Polar lipids profile of strain WL0058T included phosphatidylcholine (PC), phosphatidylethanolamine (PE), and glycolipid (GL), phosphatidylmonomethylethanolamine (PME) and two unidentified polar lipids (L). The major isoprenoid quinone was determined to be Q-10 and the major fatty acids were C16:0, C18:0, summed features 4 (iso-C17:1 and/or anteiso-C17:1), and summed features 8 (C18:1ω6c and/or C18:1ω7c). As inferred from the morphology, physiology, and biochemical analysis, genotypic characteristics, and the phylogenetic trees, strain WL0058T ought to be recognized as a novel genus in the family Rhizobiaceae, for which the name Flavimaribacter sediminis gen. nov., sp. nov. The type strain of Flavimaribacter sediminis gen. nov., sp. nov. is WL0058T (= MCCC 1K06063T = JCM 34659T = GDMCC 1.2448T).

Wide-field swept-source OCTA in the assessment of retinal microvasculature in early-stage diabetic retinopathy.

BACKGROUND: To perform a quantitative analysis of retinal microvasculature in patients with early-stage diabetic retinopathy (DR) using wide-field swept-source optical coherence tomography angiography (SS-OCTA).  METHODS: One hundred nineteen eyes of 119 patents (67 eyes with no DR and 52 eyes with mild-moderate nonproliferative diabetic retinopathy (NPDR)) were enrolled in this observational and cross-sectional cohort study, and an age-matched group consisting of 39 eyes of 39 non-diabetic subjects were set as the control. Each participant underwent a full ophthalmic examination, including wide-field SS-OCTA imaging. On OCTA scans (12 mm * 12 mm), the mean perfusion area (PA) and vessel density (VD) were independently measured in all 16 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors. Linear regression analyses were conducted to evaluate the influences of PA. RESULTS: In the central ring, there were no significant differences in the average PA and VD among the groups. In the 3 mm radius, the PA and VD of the no DR and mild-moderate NPDR were significantly decreased compared with the control group in superior and inferior quadrants. In the wide-field scans (9 and 12 mm radius), there was no significant difference in average PA and VD between the groups in each sectors (p > 0.05). Regression analysis found that the effect of VD on PA was statistically different (b = 1.311, p < 0.001). CONCLUSION: Wide-field OCTA imaging is useful for evaluating peripheral capillary perfusion in eyes with early-stage DR. Decrease in PA and VD was greater in the S3 and I3 sectors, and reductions in PA and VD were uneven in wide-filed sectors (9 and 12 mm radius).

Peripapillary vessel density and retinal nerve fiber layer thickness changes in early diabetes retinopathy.

AIM: To perform a quantitative analysis of the peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness changes in patients with early stage of diabetic retinopathy (DR). METHODS: In this case-control study, swept-source optical coherence tomography angiography (SS-OCTA) imaging was used to examine diabetic and age-matched healthy subjects. The optic disc HD 6×6 mm2 blood flow imaging scan mode was selected. Automatic software was used to measure the peripapillary VD, capillary vessel density (CVD), and RNLF in an optic nerve head (ONH) filed based on the Garway-Heath map. In addition, the correlation between peripapillary VD, CVD, and RNFL was further investigated. RESULTS: The cohort consisted of 32 healthy individuals and 72 patients with diabetes (34 eyes with no DR and 38 eyes with mild-moderate NPDR). Peripapillary VD decreased in the mild-moderate NPDR group compared to the control group in most regions (P<0.05). Peripapillary CVD and RNFL thickness were significantly lower in the mild-moderate NPDR group in the superior temporal (ST) quadrants (P=0.018, P=0.030). In the correlation analysis of each region, the RNFL thickness in the NS region was positively correlated with the peripapillary VD and CVD (r=0.233, P=0.05; r=0.288, P=0.015). In the TI region, the RNFL thickness was positively correlated with the peripapillary CVD (r=0.237, P=0.047). CONCLUSION: The measurement based on the ONH topographic map may be helpful in detecting functional and structural impairments in DR. The peripapillary VD, CVD and RNFL decrease in early DR, and the RNFL thickness altered in association with the CVD or/and VD in some regions.

Optical coherence tomography angiography for the detection and evaluation of ptic disc neovascularization: a retrospective, observational study.

BACKGROUND: To assess and characterize neovascularization of the optic disc (NVD) using optical coherence tomography angiography (OCTA) and different OCTA-based methods. METHODS: This retrospective, observational study included patients who were suspected of having early PDR with no presence of clinically apparent neovascularization (NV) bur were clinically diagnosed with proliferative diabetic retinopathy (PDR), or severe NPDR. Patients underwent standard clinical examinations and OCTA imaging using a 6 × 6 montage scan. Two trained graders identified NVD using different imaging systems (ultra-widefield-colour fundus photography (UWF-CFP), OCT, OCTA and fluorescein angiography (FA)). Moreover, morphological classification of NVD was performed. The detection and morphological classification of NVD by different OCTA-based methods (B-scan OCTA, En-face OCTA, VRI Angio and VRI Structure) were compared. RESULTS: A total of 169 eyes (126 eyes with PDR and 43 eyes with severe NPDR) of 123 participants were included in this study. The detection rate of NVD was 34.91% by UWF-CFP compared with 59.76% by OCT, 59.76% by OCTA, and 62.72% by FA. After excluding 2 cases with epiretinal membranes, the NVD diagnosis detected by OCT was used as the standard. Among 99 eyes diagnosed with NVD by OCT, B-scan OCTA detected NVD with a sensitivity of 97.98%, which was higher than that by en face OCTA (80.81%), VRI Angio (65.66%), and VRI Structure (61.62%) (all P < 0.05). According to its characteristics on OCTA, NVD was divided into four types (12 cases of type I, 6 cases of type II, 39 cases of type III, and 42 cases of type IV). For type I, B-scan OCTA exhibited a higher diagnostic sensitivity than other methods (P < 0.05). For types II and IV, there were no statistically significant differences in the sensitivity of various methods between the two groups (P > 0.05). CONCLUSION: OCTA and different OCTA-based methods are significant to the diagnosis of NVD, and the diagnostic accuracy of different detection methods may be related to different types of NVD.

Actirhodobacter atriluteus gen. nov., sp. nov., isolated from the surface water of the Yellow Sea.

A Gram-stain-negative, aerobic, orange-pigmented bacterial strain, designated HHU K3-1 T, was isolated from the surface water of the Yellow Sea. The strain was observed to grow on 2216E agar medium, and growth occurred at pH 6.0-8.0 (optimum 7.0), 28-37 °C (optimum 28 °C), and in the presence of 0.5-5% (w/v) NaCl (optimum 1-3%). The major fatty acids (> 10%) were summed feature 3 (C16:1ω6c/C16:1ω7c), C17:1ω6c and summed feature 8 (C18:1ω6c/C18:1ω7c). Strain HHU K3-1 T was found to contain ubiquinone-10 as the predominant quinone and the major polar lipids were diphosphatidylglycerol (DPG), phosphatidylethanolamine (PE), phosphatidylglycerol (PG) and sphingoglycolipid (SGL). The 16S rRNA gene sequence analysis indicated that strain HHU K3-1 T shared highest similarities with Pelagerythrobacter marensis KCTC 22370 T (97.7%) and Qipengyuania oceanensis MCCC 1A09965T (96.9%). However, a phylogenetic tree based on 288 orthologous clusters (OCs) indicated that HHU K3-1 T was close related to Parapontixanthobacter aurantiacus MCCC 1A09962T. The pairwise AAI and evolutionary distance between HHU K3-1 T and Parapontixanthobacter aurantiacus MCCC 1A09962T are 67.1% and 0.43, respectively, which meet the recently proposed standard to differentiate genera in the family Erythrobacteraceae. On the basis of the result obtained by the polyphasic taxonomic study, strain HHU K3-1 T can be considered to represent a novel genus in the family Erythrobacteraceae, for which the name Actirhodobacter atriluteus gen. nov., sp. nov. is proposed. The type strain is HHU K3-1 T (= MCCC 1K04225T = KCTC 72834 T = CGMCC 1.17395 T).

Subfoveal choroidal thickness changes after intravitreal ranibizumab injections in different patterns of diabetic macular edema using a deep learning-based auto-segmentation.

PURPOSE: To evaluate the effect of intravitreal injection of ranibizumab (IVR) on subfoveal choroidal thickness (SFCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving DME (CI-DME) using a deep learning-based auto-segmentation. METHODS: This prospective interventional case series included 68 eyes of 68 patients with CI-DME naive to treatment. Morphological optical coherence tomography (OCT) findings of DME were classified into three patterns of structural change: (i) diffuse retinal thickening (DRT), (ii) cystoid macular edema (CME), and (iii) serous retinal detachment (SRD). All patients underwent 3+prorenata IVR. The treated eyes underwent BCVA evaluation and OCT scanning at baseline and months 1, 3, and 6 after the first injection. Then, the choroid layer was measured using a deep learning-based auto-segmentation. RESULTS: At baseline, the mean SFCT and CMT for SRD, DRT, and CME groups were 324.68 ± 65.58 µm and 624.37 ± 77.92 µm, 348.91 ± 45.81 µm and 443.5 ± 78.33 µm, 361.4 ± 64.62 µm, and 536.5 ± 66.02 µm, respectively. After anti-VEGF treatment, the SFCT and CMT have decreased by varying degrees. At 3 and 6 months of treatment, there were no significant changes among these groups. There was no correlation between baseline SFCT and the resulting BCVA (P = 0.670, P = 0.584). There was also no correlation between changes in SFCT and BCVA, CMT (P = 0.344, P = 0.336). CONCLUSION: After treating CI-DME with IVR, SFCT and CMT significantly decreased. However, there were no significant changes among the SRD, DRT, and CME groups. TRIAL REGISTRATION: Trial registration: ChiCTR, ChiCTR-ROC-17013360. Registered 13 November 2017, http://www.chictr.org.cn/ChiCTR-ROC-17013360 .

Automatic Grading System for Diabetic Retinopathy Diagnosis Using Deep Learning Artificial Intelligence Software.

Purposes: To describe the development and validation of an artificial intelligence-based, deep learning algorithm (DeepDR) for the detection of diabetic retinopathy (DR) in retinal fundus photographs. Methods: Five hundred fundus images, which had detailed labelling of DR lesions, were transmitted to be analysed, including localization of the optic disk and macular, vessel segmentation, detection of lesions, and grading of DR. The multi-level iterative method of convolutional neural network and the strategy of enhanced learning were used to improve the accuracy of the system (DeepDR) for grading DR. Three public data sets were used to further train the software. The final grading results were tested based on the fundus images provided by the hospitals. Results: For 6788 fundus images (both macular and disc centred) of two Hospital Eye Center, the detection of microaneurysm, haemorrhage and hard exudates had an accuracy of 99.7%, 98.4% and 98.1%, respectively. The current algorithm accuracy was 0.96. Another 20,000 fundus images from community screening were selected, and 7593 photos of poor quality were excluded according to quality standards. Accuracy for accurate staging of fundus photos: accuracy was 0.9179. The sensitivity, specificity and area under the curve (AUC) were 80.58%, 95.77% and 0.9327, respectively. Conclusions: This artificial intelligence-based DeepDR can be used with high accuracy for the detection of DR in retinal images. This technology offers the potential to increase the efficiency and accessibility of DR screening programs.

The thickness and volume of the choroid, outer retinal layers and retinal pigment epithelium layer changes in patients with diabetic retinopathy.

AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers (ORL) and retinal pigment epithelium (RPE) in patients with diabetic retinopathy (DR) using optical coherence tomography (OCT) and correlate them with visual acuity. METHODS: We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity (BCVA) was also investigated. RESULTS: The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema (DME) patients, 34 eyes of 20 DR without DME (non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group (P<0.05). The mean macular ORL thickness in DME (73.02±15.34 µm) and non-DME groups (76.35±7.32 µm) were decreased statistically significantly compared with the control group (80.20±5.85 µm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group (P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group (r=0.115, P<0.001, r=-0.013, P=0.017, respectively). CONCLUSION: The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.

Comparison of spectral-domain optical coherence tomography for intra-retinal layers thickness measurements between healthy and diabetic eyes among Chinese adults.

PURPOSE: To compare intra-retinal layer thickness measurements between eyes with no or mild diabetic retinopathy (DR) and age-matched controls using Spectralis spectral-domain optical coherence tomography (SD-OCT). METHODS: Cross-sectional observational analysis study. High-resolution macular volume scans (30° * 25°) were obtained for 133 type 2 diabetes mellitus (T2DM) patients with no DR, 42 T2DM patients with mild DR and 115 healthy controls. The mean thickness was measured in all 9 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors for 8 separate layers, inner retinal layer (IRL), outer retinal layer (ORL) and total retina (TR), after automated segmentation. The ETDRS grid consisted of three concentric circles of 1-, 3-, and 6-mm diameter. The superior, inferior, temporal, and nasal sectors of the 3- and 6-mm circles were respectively designated as S3, I3, T3, and N3 and S6, I6, T6, and N6. Linear regression analyses were conducted to evaluate the associations between the intra-retinal layer thicknesses, age, diabetes duration, fasting blood glucose and HbA1c. RESULTS: The mean age and duration of T2DM were 61.1 and 13.7 years, respectively. Although no significant differences in the average TR and ORL volumes were observed among the groups, significant differences were found in the volume and sectorial thicknesses of the inner plexiform layer (IPL), outer plexiform layer (OPL) and IRL among the groups. In particular, the thicknesses of the IPL (S3, T3, S6, I6 and T6 sectors) and the IRL (S6 sector) were decreased in the no-DR group compared with the controls (P < 0.05). The thickness of the OPL (S3, N3, S6 and N6 sectors) was thinner in the no-DR group than in mild DR (P < 0.05). The average IPL thickness was significantly negatively correlated with age and the duration of diabetes. CONCLUSION: The assessment of the intra-retinal layer thickness showed a significant decrease in the IPL and IRL thicknesses in Chinese adults with T2DM, even in the absence of visible microvascular signs of DR.

Application of Rose and Wright's algorithm in the diagnosis of lacrimal gland masses: a study of 93 cases.

OBJECTIVE: To investigate the application of Rose and Wright's algorithm in diagnosing lacrimal gland masses. DESIGN: Retrospective observational cases series. PARTICIPANTS: A total of 93 consecutive patients with primary masses within the orbital lobe of the lacrimal gland were reviewed. METHODS: Before treatment, patients' detailed history was collected verbally and all patients underwent image examination (computed tomography and magnetic resonance imaging). The clinical and radiological features of every patient were evaluated by experienced orbital surgeons. Based on Rose and Wright's criteria, patients were scored and then treated using surgery with radiotherapy and/or chemotherapy. The final diagnoses were based on the histopathologic results. Based on the histopathologic diagnosis, the data from Rose and Wright's algorithm were evaluated. RESULTS: The accuracy of Rose and Wright's algorithm for benign and malignant tumour diagnoses was 75% and 50%, respectively. The diagnostic sensitivity, specificity, and accuracy of Rose and Wright's algorithm were 64%, 93%, and 86%, respectively. The algorithm demonstrated significant accuracy in the clinicoradiological criterion in differentiating between benign tumours and malignant tumours (p < 0.05). CONCLUSIONS: Rose and Wright's algorithm has great advantages in distinguishing benign from malignant tumours within the orbital lobe of the lacrimal gland. However, the algorithm should be used with great caution because of its low diagnostic sensitivity for malignant tumours.

[Effects of drought stress at the bud stage on quality of cut lily.] / 蕾期干旱胁迫对百合切花品质的影响.

Under the climatic conditions of the central Yunnan, with oriental lily cultivar 'Sorbonne' as material, the influences of different degrees of drought stress on physiological and biochemical changes of leaf and on quality of cut flowers after re-watering during the growth of bud were studied. The results showed that as the period of drought stress extended, the levels of leaf relative water content and chlorophyll content decreased significantly, while the stomatal density, MDA and proline content increased. Under mild drought, MDA increased slowly while it rose rapidly in the later stage of moderate drought stress, indicating that severe drought aggravated harm to the plasma membrane and ultimately affect the synthesis of MDA. Proline only experienced some slight changes in early period of mild drought, however, it increased sharply under severe drought conditions, which indicated that the sensitivity of proline to water deficit was lower than that to MDA. From re-watering to flowering, the effects of drought during bud growth reflected abnormal flowering traits. Compared with the normal group, there were significant differences in shoot growth, plant height, flower diameter, length and width of petal and flower pigment content. All indicators were in verse relation with the length of drought stress period because a longer drought period resulted in shorter plants, smaller flowers, shallower color. The differences among seven treatments during the flowe-ring stage of leaf morphology (length and width) were not significant. The drought during bud stage resulted in the delay of the flowering time, and the flowering quality of plants experiencing severe drought stress could not return to the normal levels even after re-watering. Overall, mild drought during early period had small influence on the quality of lily cut flowers as well as the grade of flo-wering branches. Under moderate or severe drought, the quality of cut flowers declined dramatically and even lost their commercial values.

[Tear film and lacrimal excretion changes after lacrimal gland tumor removal].

OBJECTIVE: To study the change of tear film and lacrimal secretion after lacrimal gland tumor removal operation. METHODS: It was a retrospective case series study. Nineteen cases (19 eyes) with pleomorphic adenoma of the lacrimal gland from January, 2010 to July, 2011 in Eye and ENT Hospital of Fudan University were elected. The evaluation included subjective complaints of dry eye, tear break up time (BUT), reflex lacrimal secretion, corneal fluorescein staining, and size of lacrimal lake were analyzed before surgery and 3 days, 1 month and 6 months postoperatively. Simultaneously, the opposite eye was set as control. RESULTS: Subjective complaints of dry eye increased and the mean tear break up time, reflex lacrimal secretion, and size of lacrimal lake were significantly reduced (t = 23.91, 16.90, 11.47; t = 19.31, 20.81, 11.95, P < 0.05) on day 3 and 1 month after operation which were (4.9 ± 2.0) s (3 d), (5.2 ± 1.6) s (1 moth); (4.05 ± 2.07) mm (3 d), (3.58 ± 1.98) mm (1 moth); (0.009 ± 0.004) mm(2) (3 d), (0.008 ± 0.003) mm(2)(1 moth) respectively. However, only reflex secretion test (3.53 ± 1.50 mm) was significantly reduced (t = 21.57, P < 0.05), other values (BUT: 17.4 ± 4.9 s, size of lake: 0.032 ± 0.005 mm(2)) recovered to preoperative levels by the time of the sixth month follow up visit. Corneal fluorescein staining score increased greatly when measured at day 3 and 1 month visit (t = 0.23, 1.69, P < 0.05), but had returned to preoperative values at the sixth month visit. The result of the opposite eye control is the same as preoperative control. CONCLUSIONS: During the early stage after lacrimal gland tumor removal, tear film present abnormal changes, mainly in tear stability and reduction of reflex lacrimal secretion.

Space-occupying lesions of the lacrimal gland at one tertiary eye center in China: a retrospective clinical study of 95 patients.

AIM: To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS: A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS: Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION: Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis.