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1.
J Assoc Physicians India ; 69(2): 54-57, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527812

RESUMO

There has been change in the guidelines for the management of tuberculosis in India. The new guidelines advocate the daily use of Ethambutol for both intensive and continuation phase of the treatment. This may be a matter of concern as increased cumulative dose may lead to increase in incidence of toxic optic neuropathy due to ethambutol. Indian Neuro-Ophthalmology Society has taken cognizance of the issue and has come-up with guidelines for prevention and early detection of the toxic optic neuropathy.


Assuntos
Doenças do Nervo Óptico , Tuberculose , Antituberculosos/efeitos adversos , Cegueira , Etambutol/efeitos adversos , Humanos , Índia/epidemiologia , Doenças do Nervo Óptico/induzido quimicamente , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/prevenção & controle , Tuberculose/tratamento farmacológico
2.
Curr Opin Ophthalmol ; 32(2): 83-91, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470671

RESUMO

PURPOSE OF REVIEW: The study was undertaken to assess the current importance of clinical examination of the optic nerve head (ONH) in glaucoma management. RECENT FINDINGS: ONH changes in glaucoma are easily assessed with good specificity on examination, whereas imaging has not been able to identify pallor of the neuroretinal rim (NRR), disc hemorrhages, or vascular signs of acquired cupping. Glaucomatous neuropathy in primary open angle glaucoma (POAG) has extensive databases on imaging machines, however, other glaucomas such as primary angle closure glaucoma (PACG), juvenile open angle glaucoma (JOAG), congenital, and secondary glaucomas have been reported to have a significantly different ONH morphology. Clinical evaluation with knowledge of the underlying cause of glaucoma allows easy diagnosis of any abnormality, whereas the absence of an imaging database in such eyes makes diagnosis difficult on optical coherence tomography (OCT) and so forth. In eyes with congenital anomalies and dysplastic discs, clinical examination and history provide better identification of glaucomatous damage. Staging of glaucoma on ONH examination when perimetry is unreliable provides a means of determining the amount of damage and appropriate reduction of intraocular pressure (IOP). SUMMARY: Clinical examination of the ONH is very relevant for screening, diagnosis, staging, and management of all glaucomas, and is irreplaceable in detecting nonglaucomatous causes of ONH cupping and visual field defects similar to those in glaucoma.


Assuntos
Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Exame Físico , Humanos , Pressão Intraocular , Tonometria Ocular , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
3.
Curr Opin Ophthalmol ; 32(2): 98-104, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332883

RESUMO

PURPOSE OF REVIEW: The aim of this article is to summarize findings of recent reports highlighting the utility of novel optical coherence tomography (OCT) parameters in the diagnosis and monitoring of glaucomatous optic neuropathy. RECENT FINDINGS: Optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular parameters show high levels of diagnostic capability. The Bruch's membrane opening-minimum rim width (BMO-MRW) measurement is a novel ONH parameter obtained using the Spectralis SD-OCT device (Heidelberg Engineering, Inc., Heidelberg, Germany). The inferotemporal BMO-MRW sector shows the highest diagnostic performance for this parameter. Minimum ganglion cell and inner plexiform layer thickness shows the highest diagnostic performance among macular parameters obtained with the Cirrus HD-OCT (Carl Zeiss, Inc., Dublin, CA, USA). Optic nerve head, macular, and retinal nerve fiber layer parameters are not interchangeable across protocols generated by varying OCT manufacturers. Novel machine-learning algorithms show promise with regards to achieving higher levels of diagnostic accuracy using OCT imaging platforms. SUMMARY: Digital imaging in glaucoma continues to evolve with novel parameters of the optic nerve head, retinal nerve fiber layer, and macula. Diagnostic abilities of these parameters are high and complementary to each other.


Assuntos
Glaucoma/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Lâmina Basilar da Corioide/patologia , Humanos
4.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334752

RESUMO

Metronidazole is a nitroimidazole antibiotic used in treating anaerobic bacteria and protozoal infections. It was first licensed for the treatment of Trichomonas vaginalis but is now used in the management of various gastrointestinal and genitourinary infections. Many neurological side effects are well documented, although there is scarce literature illustrating optic neuropathy secondary to metronidazole. We describe a case report of a 36-year-old man who presented with symptomatically reduced central visual loss on a background of a 2-year history of metronidazole use for a perianal fistula. Electrophysiology demonstrated bilateral optic neuropathy, with pattern visual evoked potential traces demonstrating marked latency and small amplitude responses of the P100 waves, which improved to within normal limits on cessation of metronidazole. This case study demonstrates clinical and electrophysiological reversibility of optic neuropathy secondary to high dose and prolonged metronidazole use.


Assuntos
Metronidazol/efeitos adversos , Doenças do Nervo Óptico/induzido quimicamente , Fístula Retal/tratamento farmacológico , Baixa Visão/etiologia , Adulto , Doença de Crohn/complicações , Eletrorretinografia , Potenciais Evocados Visuais , Humanos , Masculino , Doenças do Nervo Óptico/complicações , Doenças do Nervo Óptico/diagnóstico , Fístula Retal/etiologia
5.
PLoS One ; 15(8): e0237796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804983

RESUMO

PURPOSE: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes. MATERIALS AND METHODS: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination. RESULTS: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes. CONCLUSION: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function.


Assuntos
Doenças do Nervo Óptico/complicações , Hemorragia Retiniana/complicações , Vasos Retinianos/patologia , Transtornos da Visão/etiologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Disco Óptico/fisiopatologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/fisiopatologia , Retina/diagnóstico por imagem , Retina/patologia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/estatística & dados numéricos , Campos Visuais/fisiologia
6.
J Glaucoma ; 29(10): 989-991, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32675556

RESUMO

PURPOSE: The coronavirus (COVID-19) pandemic has had a profound impact on how glaucoma care is delivered, necessitating reduced clinic flow, social distancing, and use of face coverings by patients and staff. This case highlights the need to be aware of improperly fitted face masks as a cause of artifact on standard automated perimetry (SAP). CLINICAL PRESENTATION: A 32-year-old female underwent SAP with the 24-2 SITA Fast test of the Humphrey Field Analyzer wearing an ear-loop surgical face mask. At the end of testing, it was noted that the mask had ridden up the patient's face. Small amounts of condensate were noted on the perimeter lens. CLINICAL FINDINGS: SAP demonstrated good reliability indices but in both eyes, there was a marked reduction in sensitivity inferiorly. The glaucoma hemifield test was outside normal limits. It was ensured the upper border of the mask was well sealed with the loops secured around the ears and nasal strip of the mask pinched down. Visual fields were repeated and were found to be normal. CONCLUSIONS: Poorly fitting face masks represent a new cause of visual field artifact which may mimic pathologic field defects. Without careful attention during testing, the cause of such artifacts may not be apparent, especially as reliability indices may be normal. Adjustments to the fit of face masks may help prevent fogging or mask slippage and increase test reliability.


Assuntos
Artefatos , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Glaucoma/diagnóstico , Máscaras/efeitos adversos , Doenças do Nervo Óptico/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Testes de Campo Visual , Adulto , Reações Falso-Positivas , Feminino , Humanos , Pressão Intraocular , Valor Preditivo dos Testes , Campos Visuais/fisiologia
7.
Am J Ophthalmol ; 218: 164-172, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32574771

RESUMO

PURPOSE: A challenging clinical scenario is distinguishing between normal tension glaucoma (NTG) and non-glaucomatous optic neuropathies (NGON). The key to the assessment remains identifying the presence of optic nerve head cupping. Recent optical coherence tomography (OCT) measurements now allow objective assessment of cupping by minimum rim width at Bruch's membrane opening (MRW-BMO). This study assessed the hypothesis that the MRW-BMO measurement quantifies cupping and therefore can differentiate between NTG and NGON. DESIGN: Diagnostic evaluation with area under the curve. METHODS: Setting: multicenter tertiary hospitals and outpatient clinics. PATIENT POPULATION: 81 eyes of 81 patients were enrolled, 27 with NTG and 54 with NGON, including ischemic optic neuropathy, previous optic neuritis, and compressive and inherited optic neuropathies. All NGON patients with intraocular pressure >21 mm Hg, narrow drainage angles, or a family history of glaucoma were excluded. Observational procedure: optic disc OCT images were obtained of both the retinal nerve fiber layer thickness and the MRW-BMO. MAIN OUTCOME MEASUREMENTS: the utility of the MRW-BMO in differentiating GON from NGON was assessed using the area under the curve (AUC) estimated from a logistic regression model. RESULTS: The 5-fold cross-validated AUC for glaucoma versus nonglaucoma from logistic regression models using MRW-BMO values from all sectors was 0.95 (95% confidence interval: 0.86-1.00). CONCLUSIONS: The measurement of MRW-BMO effectively differentiates between NTG and NGON with a high level of sensitivity and specificity. Incorporating this measurement into routine glaucoma assessment may provide a robust method of assisting clinicians to improve diagnosis and therefore treatment of optic nerve diseases.


Assuntos
Lâmina Basilar da Corioide/patologia , Glaucoma de Baixa Tensão/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Adulto , Área Sob a Curva , Lâmina Basilar da Corioide/diagnóstico por imagem , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Curva ROC , Células Ganglionares da Retina/patologia , Sensibilidade e Especificidade , Tomografia de Coerência Óptica , Tonometria Ocular , Campos Visuais
8.
PLoS One ; 15(5): e0233079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407355

RESUMO

PURPOSE: To evaluate ways to improve the generalizability of a deep learning algorithm for identifying glaucomatous optic neuropathy (GON) using a limited number of fundus photographs, as well as the key features being used for classification. METHODS: A total of 944 fundus images from Taipei Veterans General Hospital (TVGH) were retrospectively collected. Clinical and demographic characteristics, including structural and functional measurements of the images with GON, were recorded. Transfer learning based on VGGNet was used to construct a convolutional neural network (CNN) to identify GON. To avoid missing cases with advanced GON, an ensemble model was adopted in which a support vector machine classifier would make final classification based on cup-to-disc ratio if the CNN classifier had low-confidence score. The CNN classifier was first established using TVGH dataset, and then fine-tuned by combining the training images of TVGH and Drishti-GS datasets. Class activation map (CAM) was used to identify key features used for CNN classification. Performance of each classifier was determined through area under receiver operating characteristic curve (AUC) and compared with the ensemble model by diagnostic accuracy. RESULTS: In 187 TVGH test images, the accuracy, sensitivity, and specificity of the CNN classifier were 95.0%, 95.7%, and 94.2%, respectively, and the AUC was 0.992 compared to the 92.8% accuracy rate of the ensemble model. For the Drishti-GS test images, the accuracy of the CNN, the fine-tuned CNN and ensemble model was 33.3%, 80.3%, and 80.3%, respectively. The CNN classifier did not misclassify images with moderate to severe diseases. Class-discriminative regions revealed by CAM co-localized with known characteristics of GON. CONCLUSIONS: The ensemble model or a fine-tuned CNN classifier may be potential designs to build a generalizable deep learning model for glaucoma detection when large image databases are not available.


Assuntos
Diagnóstico por Computador/métodos , Glaucoma/complicações , Glaucoma/diagnóstico , Doenças do Nervo Óptico/complicações , Doenças do Nervo Óptico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Área Sob a Curva , Bases de Dados Factuais , Aprendizado Profundo , Diagnóstico por Computador/estatística & dados numéricos , Feminino , Fundo de Olho , Glaucoma/classificação , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Doenças do Nervo Óptico/classificação , Estudos Retrospectivos , Máquina de Vetores de Suporte , Taiwan
9.
Am J Ophthalmol ; 216: 37-43, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278773

RESUMO

PURPOSE: To describe the development of a new algorithm for detecting progressive changes in 10-2 visual field (VF) tests using event-based analysis and to test its validity in a second, independent glaucoma cohort. DESIGN: Prospective cohort study. METHODS: Patients with established open-angle glaucoma from the Macular Assessment and Progression Study (MAPS; development cohort, n = 151), and the African Descent and Glaucoma Evaluation Study (ADAGES; validation cohort, n = 52) were evaluated. The 10-2 VF results from MAPS were obtained during 4 test-retest sessions within a 4-month period. For the validation analysis, 10-2 VF results from ADAGES performed on at least 5 visits were used. The event-based pointwise changes on 10-2 tests in the validation cohort were determined using 2 progression criteria: at least 3 progressing VF locations on 2 or 3 consecutive tests ("possible" or "likely" progression). Linear mixed-effects models were used to evaluate VF progression. RESULTS: In the validation cohort, the mean (SD) follow-up time was 2.3 (0.7) years. The number of eyes experiencing 10-2 VF progression based on "possible" and "likely" progression was 36 (54.5%) and 11 (16.6%), respectively. Eyes experiencing "possible" progression had MD changes (-0.60 dB/year [95% confidence interval (CI): -0.93 to -0.28]) faster than those not meeting this criterion (P < .001), whereas for those with "likely" progression the difference was -0.91 dB/year (95% CI: -1.26 to -0.56, P < .001). CONCLUSIONS: A new event-based progression algorithm using the 10-2 VF can identify eyes experiencing more rapid MD progression and may be used as a tool to assess progressive macular functional changes in glaucoma.


Assuntos
Algoritmos , Glaucoma de Ângulo Aberto/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/fisiopatologia , Doenças do Nervo Óptico/fisiopatologia , Estudos Prospectivos , Células Ganglionares da Retina/patologia , Tonometria Ocular , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos
10.
J Glaucoma ; 29(6): e44-e49, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32282435

RESUMO

Optic disc pit maculopathy (ODP-M) is a subtype of ODP, characterized by a serous retinal detachment and/or macular retinoschisis. Currently, ODP and ODP-M pathogenesis remain unknown although many hypotheses exist about their clinical features. In this study, we report a case of new ODP-M detected after surgical iridectomy in a patient with primary angle-closure glaucoma (PACG) with a preoperative normal retina and optic nerve. Fine optic disc and the macular area structures were investigated using several imaging techniques. Findings revealed that the course of ODP and ODP-M provide us with some insights and understanding of their underlying pathogenesis.


Assuntos
Glaucoma de Ângulo Fechado/cirurgia , Iridectomia/efeitos adversos , Degeneração Macular/etiologia , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Adulto , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/genética , Mutação , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/genética , Fator de Transcrição PAX2/genética , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/genética , Retinosquise/diagnóstico , Retinosquise/etiologia , Retinosquise/genética , Tomografia de Coerência Óptica
11.
Am J Ophthalmol ; 217: 27-37, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32283093

RESUMO

PURPOSE: To investigate and compare the longitudinal rate of change of Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in eyes showing optic disc hemorrhage(DH). DESIGN: Observational case series. METHODS: A total of 82 subjects(82 eyes) showing DH who had undergone more than five reliable spectral-domain optical coherence tomography (OCT) tests were included. BMO-MRW and RNFL were measured with OCT at 3-month intervals. The rates of change in global and each Garway-Heath sector were calculated with a linear mixed-effects model after adjusting for age, sex, and BMO area. RESULTS: The mean follow-up period was 21.57 ± 7.88 months with a mean number of 7.88 ± 2.39 OCT tests. Baseline demographics were age (58.37 ± 10.65 y); 46.3% were female; and the mean deviation was -4.41 ± 5.04 dB. The global rate of change in BMO-MRW was -3.507 ± 0.675 µm/y and in -1.404 ± 0.208 µm/y in RNFL. The rate of change was the greatest in the inferotemporal sector, which was -9.141 ± 1.254 µm/y in BMO-MRW and -4.204 ± 0.490 µm/y in the RNFL. The rate of change was significantly greater in BMO-MRW than in the RNFL in all sectors, except for the nasal sector (P < .05). Percentage of reduction was significantly greater in BMO-MRW than in RNFL in the inferotemporal and superotemporal sectors (P < .05). CONCLUSIONS: BMO-MRW showed a significantly greater rate of change than RNFL in eyes showing DH, especially in the inferotemporal and superotemporal sectors in percentage of reduction. Thus, it may be more advantageous to detect glaucomatous progression earlier in BMO-MRW than in the RNFL in eyes showing DH that are more likely to progress.


Assuntos
Lâmina Basilar da Corioide/patologia , Disco Óptico/irrigação sanguínea , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodos , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Estudos Retrospectivos , Fatores de Tempo
12.
J Glaucoma ; 29(6): 429-434, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32287146

RESUMO

PRECIS: In this prospective cohort study, disc hemorrhages were associated with more severe central damage on 24-2 and 10-2 visual fields (VFs), and faster progression globally on 24-2 VFs and centrally on 10-2 VFs. PURPOSE: To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage. METHODS: Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF. RESULTS: DH was detected in 21 of 335 eyes (6.2%). In the cross-sectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio=1.47; 95% confidence interval (CI)=1.02-2.12; P=0.035] and 10-2 VFs (incidence rate ratio=1.81; 95% CI=1.26-2.60; P=0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, ß=-0.06; 95% CI=-0.11 to -0.01; P=0.009) and 10-2 MTD rates (ß=-0.10; 95% CI=-0.14 to -0.06; P< 0.001), but not 24-2 central MTD rates (ß=-0.02; 95% CI=-0.078 to 0.026; P=0.338). CONCLUSION: DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.


Assuntos
Glaucoma/complicações , Disco Óptico/irrigação sanguínea , Hemorragia Retiniana/complicações , Transtornos da Visão/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Progressão da Doença , Feminino , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma/patologia , Humanos , Incidência , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Disco Óptico/patologia , Doenças do Nervo Óptico/complicações , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/patologia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/epidemiologia , Hemorragia Retiniana/patologia , Estudos Retrospectivos , Fatores de Risco , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/patologia , Testes de Campo Visual , Campos Visuais
13.
Am J Ophthalmol ; 216: 140-146, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32247778

RESUMO

PURPOSE: We sought to assess the performance of deep learning approaches for differentiating nonglaucomatous optic neuropathy with disc pallor (NGON) vs glaucomatous optic neuropathy (GON) on color fundus photographs by the use of image recognition. DESIGN: Development of an Artificial Intelligence Classification algorithm. METHODS: This single-institution analysis included 3815 fundus images from the picture archiving and communication system of Seoul National University Bundang Hospital consisting of 2883 normal optic disc images, 446 NGON images, and 486 GON images. The presence of NGON and GON was interpreted by 2 expert neuro-ophthalmologists and had corroborated evidence on visual field testing and optical coherence tomography. Images were preprocessed in size and color enhancement before input. We applied the convolutional neural network (CNN) of ResNet-50 architecture. The area under the precision-recall curve (average precision) was evaluated for the efficacy of deep learning algorithms to assess the performance of classifying NGON and GON. RESULTS: The diagnostic accuracy of the ResNet-50 model to detect GON among NGON images showed a sensitivity of 93.4% and specificity of 81.8%. The area under the precision-recall curve for differentiating NGON vs GON showed an average precision value of 0.874. False positive cases were found with extensive areas of peripapillary atrophy and tilted optic discs. CONCLUSION: Artificial intelligence-based deep learning algorithms for detecting optic disc diseases showed excellent performance in differentiating NGON and GON on color fundus photographs, necessitating further research for clinical application.


Assuntos
Aprendizado Profundo , Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Algoritmos , Área Sob a Curva , Aprendizado Profundo/classificação , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Redes Neurais de Computação , Fotografação , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Testes de Campo Visual
15.
Am J Ophthalmol ; 216: 121-131, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32222365

RESUMO

PURPOSE: To investigate the natural clinical course of more than 5 years and the risk factors of progression in patients with pre-perimetric open angle glaucoma (OAG) of "young age of onset (under age 40)" without treatment. DESIGN: Retrospective observational case series. METHODS: Optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, optical coherence tomography, and visual field (VF) examinations were performed every 6 months. Glaucoma progression was defined as structural or functional deterioration. A linear mixed-effects model was used to estimate the rate of structural and functional changes. Kaplan-Meier survival analysis and log-rank testing were used to compare survival experiences, and Cox proportional hazards modeling was performed to identify risk factors for glaucoma progression. RESULTS: Of the 98 eyes of 98 patients (mean age, 30.6 years old), glaucoma progression was detected in 42 eyes (42.9%). The rate of average RNFL thickness thinning was -0.46 ± 0.50 µm/y, and the mean deviation (MD) change was -0.03 ± 0.13 dB/y. The glaucoma progression probability at 5 years was 39% by structural criteria and 5% by functional criteria. Older age at diagnosis (P = .004), presence of temporal raphe sign (horizontal straight line on macular ganglion cell-inner plexiform layer thickness map) (P = .011), lamina pore visibility (P = .034), and greater pattern standard deviation (P = .005) were significant factors for glaucoma progression. CONCLUSIONS: In untreated pre-perimetric OAG patients with a "young age of onset" condition, the estimated MD slope for the disease course of more than 5 years was -0.03 dB/y, and the average RNFL thinning rate was -0.46 µm/y. The predictors for progression were structural parameters of temporal raphe sign, lamina pore visibility, and functional parameter of pattern standard deviation.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Campos Visuais/fisiologia , Adulto , Idade de Início , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Estimativa de Kaplan-Meier , Masculino , Doenças do Nervo Óptico/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Tonometria Ocular , Testes de Campo Visual , Adulto Jovem
17.
BMJ Case Rep ; 13(2)2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32086325

RESUMO

We report a case of 'occult' bilateral optic nerve aplasia (ONA) where pituitary dysfunction was discovered subsequently. The initial ultrasonography had missed ONA in a child with bilateral microcornea, small non-dilating pupils and roving eye movements. Due to presence of relevant clinical signs in this case, ONA was re-evaluated with MRI, and was subsequently discovered to be associated with life-endangering hypopituitarism. This case raises the possible underestimation of ONA, and hence also the risk of missing life-threatening endocrine disorders.


Assuntos
Anormalidades do Olho/fisiopatologia , Hipopituitarismo/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Nervo Óptico/diagnóstico por imagem , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Diagnóstico Ausente , Ultrassonografia
18.
Exp Eye Res ; 193: 107957, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32032627

RESUMO

Vision loss is a devastating consequence of systemic hypoxia, but the cellular mechanisms are unclear. We investigated the impact of acute hypoxia in the retina and optic nerve. We induced systemic hypoxia (10% O2) in 6-8w mice for 48 h and performed in vivo imaging using optical coherence tomography (OCT) at baseline and after 48 h to analyze structural changes in the retina and optic nerve. We analyzed glial cellular and molecular changes by histology and immunofluorescence and the impact of pretreatment with 4-phenylbutyric acid (4-PBA) in oligodendroglia survival. After 48 h hypoxia, we found no change in ganglion cell complex thickness and no loss of retinal ganglion cells. Despite this, there was significantly increased expression of CCAAT-enhancer-binding protein homologous protein (CHOP), a marker of endoplasmic reticulum stress, in the retina and optic nerve. In addition, hypoxia induced obvious increase of GFAP expression in the anterior optic nerve, where it co-localized with CHOP, and significant loss of Olig2+ oligodendrocytes. Pretreatment with 4-PBA, which has been shown to reduce endoplasmic reticulum stress, rescued total Olig2+ oligodendrocytes and increased the pool of mature (CC-1+) but not of immature (PDGFRa+) oligodendrocytes. Consistent with a selective vulnerability of the retina and optic nerve in hypoxia, the most striking changes in the 48 h murine model of hypoxia were in glial cells in the optic nerve, including increased CHOP expression in the astrocytes and loss of oligodendrocytes. Our data support a model where glial dysfunction is among the earliest events in systemic hypoxia - suggesting that glia may be a novel target in treatment of hypoxia.


Assuntos
Hipóxia/complicações , Neuroglia/patologia , Doenças do Nervo Óptico/diagnóstico , Nervo Óptico/patologia , Animais , Sobrevivência Celular , Modelos Animais de Doenças , Feminino , Hipóxia/diagnóstico , Marcação In Situ das Extremidades Cortadas , Camundongos , Camundongos Endogâmicos C57BL , Doenças do Nervo Óptico/etiologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos
19.
Exp Eye Res ; 193: 107955, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32017940

RESUMO

Gene therapy has been proposed as a feasible strategy for RGC survival and optic nerve regeneration. Some preclinical and clinical studies revealed intraocular inflammation after intravitreal injection of adeno-associated virus (AAV) by slit-lamp or indirect ophthalmoscope. Here we evaluate the longitudinal profile of immediate inflammatory responses after AAV2 injection in rat retina and vitreous body by optical coherence tomography (OCT). Adult Fischer F344 rats were intravitreally injected once with saline, AAV2 or zymosan. Retinal thickness and cell infiltration were recorded by OCT longitudinally for 2 months and verified by histological analysis. The transduction rate of single intravitreal AAV2 injection was 21.3 ± 4.9% of whole retina, and the transduction efficiency on RGCs was 91.5 ± 2.5% in the transduced area. Significant increase in cell infiltration was observed from Day 1-3 after AAV2 injection, compared to very few infiltrating cells observed in the saline-injected group. The infiltrating cells ceased at Day 5 after intravitreal injection and remained absent at 2 months. The thicknesses of total and inner retina were increased along Day 1-3 after AAV2 injection, but reverted to normal afterwards. The surviving RGCs in the AAV2-injected groups at Day 14 showed no significant difference compared to saline-injected group. In summary, this study revealed the immediate inflammatory responses and retinal edema after intravitreal AAV2 injection in normal rats, without influencing long-term retinal thickness and RGC survival. OCT can be implemented for the time-lapse in vivo evaluation of inflammatory response after AAV-mediated gene therapy through intravitreal injection.


Assuntos
Dependovirus , Terapia Genética/métodos , Doenças do Nervo Óptico/terapia , Células Ganglionares da Retina/patologia , Animais , Sobrevivência Celular , Modelos Animais de Doenças , Injeções Intravítreas , Doenças do Nervo Óptico/diagnóstico , Ratos , Ratos Endogâmicos F344 , Tomografia de Coerência Óptica , Transdução Genética
20.
J Glaucoma ; 29(3): 191-197, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32108691

RESUMO

PRECIS: We used the Open Perimetry Interface (OPI) to design a static automated perimetry test of the full visual field. About half of our glaucoma cohort had defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. AIMS: To test the hypothesis that in glaucoma patients with mild visual loss, perimetric nerve fiber bundle defects present outside 30 degrees will correlate well with areas of Cirrus ocular coherence tomography (OCT) retinal nerve fiber layer thinning. METHODS: We tested 27 consecutive glaucoma subjects with mild vision loss (mean deviation better than -4 dB) with a SITA standard test, 2 size V custom OPI tests (OPI 30-2 and OPI Peripheral) and Cirrus OCT. Two observers assigned qualitative grades to each type of visual field test based on their level of correlation with OCT retinal nerve fiber layer and ganglion cell thickness. RESULTS: Discrete temporal wedge defects were found on the OPI peripheral V test in 26% of cases whereas more extensive inferior temporal loss (including inferior temporal wedge defect region) was present in 22% of other cases. OCT data correlated best with the OPI peripheral test for 8 glaucoma subjects. The OPI central 30-2 test correlated best for 9 glaucoma subjects; the remainder of subjects had equal central/peripheral correlations. CONCLUSIONS: About half of our glaucoma cohort have defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. Adding a threshold automated perimetry test of the far periphery improves structure/function correlations and adds useful clinical information.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/fisiopatologia , Doenças do Nervo Óptico/diagnóstico , Campos Visuais/fisiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/fisiopatologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Adulto Jovem
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