Application effect of an artificial intelligence-based fundus screening system: evaluation in a clinical setting and population screening.

BACKGROUND: To investigate the application effect of artificial intelligence (AI)-based fundus screening system in real-world clinical environment. METHODS: A total of 637 color fundus images were included in the analysis of the application of the AI-based fundus screening system in the clinical environment and 20,355 images were analyzed in the population screening. RESULTS: The AI-based fundus screening system demonstrated superior diagnostic effectiveness for diabetic retinopathy (DR), retinal vein occlusion (RVO) and pathological myopia (PM) according to gold standard referral. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of three fundus abnormalities were greater (all > 80%) than those for age-related macular degeneration (ARMD), referable glaucoma and other abnormalities. The percentages of different diagnostic conditions were similar in both the clinical environment and the population screening. CONCLUSIONS: In a real-world setting, our AI-based fundus screening system could detect 7 conditions, with better performance for DR, RVO and PM. Testing in the clinical environment and through population screening demonstrated the clinical utility of our AI-based fundus screening system in the early detection of ocular fundus abnormalities and the prevention of blindness.

Normal palpebral anthropometric measurements in Uygur population： A cross-sectional study.

OBJECTIVE: To provide a normative palpebral database for the Uygur subjects to determine norms that may contribute to the diagnosis and prognosis of eyelid diseases. Methods: The cross-sectional study was conducted from March to May 2021 at the First People's Hospital of Kashi, China, and comprised Uygur subjects of either gender aged 18-70 years. The slant, height and width of the palpebral fissure, vertical brow-upper lid distance, intercanthal distance, pupillary distance, brow height, crease height and levator function were measured. Data was analysed using SPSS 22. RESULTS: Of the 335 subjects having mean age 41.41±14.53 years, 165(49.3%) were males with mean age 41.08±14.23 years and 170(50.7%) were females with mean age 41.74±14.85 years. There were 107(31.9%) subjects aged 18-30 years, 115(34.3%) aged 31-50 years and 113(33.7%) aged 51-70 years. Mean palpebral fissure width and margin reflex distance of the palpebrae were significantly different in terms of gender (p<0.05). Age was also a significant factor on several counts (p<0.05). Conclusion: Anthropometric measurements of eyelid in Uygur subjects indicated certain peculiarities.

A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy.

PURPOSE: This study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C. METHODS: A prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA). RESULTS: A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period. CONCLUSION: Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.

Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital.

BACKGROUND: The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. METHODS: In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. RESULTS: In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. CONCLUSIONS: This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.

Large-Scale Identification of T-Cell Epitopes Derived From Severe Acute Respiratory Syndrome Coronavirus 2 for the Development of Peptide Vaccines Against Coronavirus Disease 2019.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to be a major public health challenge globally. The identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-derived T-cell epitopes is of critical importance for peptide vaccines or diagnostic tools of COVID-19. METHODS: In this study, several SARS-CoV-2-derived human leukocyte antigen (HLA)-I binding peptides were predicted by NetMHCpan-4.1 and selected by Popcover to achieve pancoverage of the Chinese population. The top 5 ranked peptides derived from each protein of SARS-CoV-2 were then evaluated using peripheral blood mononuclear cells from unexposed individuals (negative for SARS-CoV-2 immunoglobulin G). RESULTS: Seven epitopes derived from 4 SARS-CoV-2 proteins were identified. It is interesting to note that most (5 of 7) of the SARS-CoV-2-derived peptides with predicted affinities for HLA-I molecules were identified as HLA-II-restricted epitopes and induced CD4+ T cell-dependent responses. These results complete missing pieces of pre-existing SARS-CoV-2-specific T cells and suggest that pre-existing T cells targeting all SARS-CoV-2-encoded proteins can be discovered in unexposed populations. CONCLUSIONS: In summary, in the current study, we present an alternative and effective strategy for the identification of T-cell epitopes of SARS-CoV-2 in healthy subjects, which may indicate an important role in the development of peptide vaccines for COVID-19.

CT-Measured Angulation Between the Frontal Bone and Bony Nasolacrimal Duct: Variations in Obstructed and Healthy Lacrimal Ducts.

PURPOSE: The aim of this study was to analyze the characteristics of CT-measured intersection angle (FB-BNLD) between the frontal bone and bony nasolacrimal duct and to provide suggestions for treating primary acquired nasolacrimal duct obstruction (PANDO) patients in West China. METHODS: Three hundred and nine participants' CT were, respectively, evaluated with RadiAnt DICOM Viewer. We defined the FB-BNLD angle >0° as the anterior type and the FB-BNLD angle ≤0° as the posterior type. RESULTS: The mean FB-BNLD was -2.52° (95% CI, -3.16° to -1.88°) across all participants, of whom 37.2% were of the anterior type and 62.8% of the posterior type. Approximately 65.0% of the female patients had a posterior FB-BNLD type, and 54.2% of the male patients had an anterior FB-BNLD type (p = .002). Posterior FB-BNLD was the dominant type in the PANDO and control groups (p = .011), and the angle of FB-BNLD was statistically different in both groups (PANDO group, -2.54° to -0.71°; control group, -4.42° to -2.67°; p < .001). Among the male participants, the type of FB-BNLD differed between the two groups (p = .036), with differences in the angle of FB-BNLD (PANDO group, 0.59° to 5.13°; control group, -4.08° to 1.89°; p = .034). There was no difference in the type of FB-BNLD in female participants between the two groups (p = .051). CONCLUSION: The present study revealed individual differences in the type of FB-BNLD, with anterior-type majority in males and posterior-type dominance in females. Evaluating the FB-BNLD type on CT can provide a fast method for knowing the nasolacrimal duct condition during planning for lacrimal manipulation.

Necrotizing scleritis and peripheral ulcerative keratitis associated with Wegener's granulomatosis.

INTRODUCTION: To evaluate the complications, efficacy of medical and surgical treatment, and outcome in patients with necrotizing scleritis and peripheral ulcerative keratitis associated with Wegener's granulomatosis. METHODS: The authors reviewed a series of seven patients with Wegener's granulomatosis treated in the Corneal Department of Zhongshan Ophthalmic Center and the Department of Ophthalmology of Kashgar First People's Hospital. A detailed chart review was performed to determine demographic characteristics, ocular presentation, biopsy and laboratory testing results, treatment, and final outcome. RESULTS: Wegener's granulomatosis was indicated by ocular and/or systemic findings; biopsy and immunohistochemistry results supported the diagnosis. Patients with necrotizing scleritis and/or peripheral ulcerative keratitis received cytotoxic immunosuppressive therapy; this, in conjunction with surgical treatment, halted the relentlessly progressive inflammation and preserved the integrity of the globe in 78% of eyes. Best-Corrected Visual Acuity remained stable in four of nine eyes, was improved in two of nine eyes, and decreased in three of nine eyes (secondary to cataract and/or stromal scarring). Although one patient died, treatment with corticosteroids and cytotoxic agents dramatically improved outcomes in these patients. CONCLUSION: Necrotizing scleritis and peripheral ulcerative keratitis often have a poor visual outcome, and may herald an underlying systemic vasculitis. Wegener's granulomatosis, with the associated necrotizing scleritis and peripheral ulcerative keratitis, should be managed with aggressive immunosuppression to avoid the associated morbidity and mortality. Thus, the ophthalmologist may play a significant role in its early diagnosis and treatment.