Editorial

5 pages, 223 KiB

Open AccessEditorial

by Mariantonia Ferrara, Yalin Zheng and Vito Romano

J. Clin. Med. 2022, 11(18), 5433; https://doi.org/10.3390/jcm11185433 - 15 Sep 2022

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Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...] Read more.

Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...] Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

Research

Jump to: Editorial, Review

12 pages, 1795 KiB

Open AccessArticle

Long-Term Safety and Efficacy of Pars Plana Vitrectomy for Uveitis: Experience of a Tertiary Referral Centre in the United Kingdom

by Muhannd El Faouri, Naseer Ally, Myrta Lippera, Siddharth Subramani, George Moussa, Tsveta Ivanova, Niall Patton, Felipe Dhawahir-Scala, Carlos Rocha-de-Lossada, Mariantonia Ferrara and Assad Jalil

J. Clin. Med. 2023, 12(9), 3252; https://doi.org/10.3390/jcm12093252 - 02 May 2023

Cited by 2 | Viewed by 1406

Abstract

Aim: To evaluate the effectiveness of pars plana vitrectomy (PPV) without macular intervention on uveitis eyes with persistent vitreous inflammation/opacities in terms of visual acuity (VA), intraocular inflammation and macular profile. Methods: We carried out a single-center retrospective study of patients with uveitic [...] Read more.

Aim: To evaluate the effectiveness of pars plana vitrectomy (PPV) without macular intervention on uveitis eyes with persistent vitreous inflammation/opacities in terms of visual acuity (VA), intraocular inflammation and macular profile. Methods: We carried out a single-center retrospective study of patients with uveitic eyes that underwent PPV without intervention on the macula due to persistent vitreous inflammation/opacities. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular inflammation and macular profile at 3, 12 and 24 months after surgery. Results: Twenty-seven eyes of twenty-six patients were analyzed. Overall, 77.8% had an improvement of VA (55% by 0.3 LogMAR or more); 62.5% of patients had no intraocular inflammation, and the number of patients on systemic steroids and second-line immunosuppressives was reduced by 26% at 12 months; 87.5% of patients had resolution of macular oedema at 12 months. Conclusion: PPV for persistent vitreous inflammation/opacities is safe and effective, showing beneficial outcomes in terms of improvement of BCVA and the reduction in inflammation. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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11 pages, 274 KiB

Open AccessArticle

Long-Term Effect of SARS-CoV-2 Infection on the Retinal and Choroidal Microvasculature

by Magdalena Kal, Mateusz Winiarczyk, Dorota Zarębska-Michaluk, Dominik Odrobina, Elżbieta Cieśla, Bernadetta Płatkowska-Adamska, Michał Biskup, Paweł Pabjan, Stanisław Głuszek and Jerzy Mackiewicz

J. Clin. Med. 2023, 12(7), 2528; https://doi.org/10.3390/jcm12072528 - 27 Mar 2023

Cited by 3 | Viewed by 931

Abstract

The purpose of this study was to evaluate the persistent changes in microvascular parameters based on optical coherence tomography angiography (OCTA) in patients hospitalized due to COVID-19 bilateral pneumonia. The case-control prospective study was carried out among 49 patients with COVID-19 and 45 [...] Read more.

The purpose of this study was to evaluate the persistent changes in microvascular parameters based on optical coherence tomography angiography (OCTA) in patients hospitalized due to COVID-19 bilateral pneumonia. The case-control prospective study was carried out among 49 patients with COVID-19 and 45 healthy age- and gender-matched 2 and 8 months after hospital discharge. We found a significantly decreased vessel density (VD) in superficial capillary plexus (SCP) in COVID-19 patients. Significantly decreased vessel density (VD) in the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and choriocapillaris (CC), with significantly increased vessel density observed in the choriocapillaris in the foveal area (FCC). The foveal avascular zone in DCP (FAZd) was significantly increased in the COVID-19 group. We found differences between OCTA parameters according to gender. The foveal VD in SCP and DCP was significantly decreased in women compared to men. The FAZ area in SCP (FAZs) and superior VD in the choriocapillaris (SCC) were significantly increased in women. In conclusion, we noticed persistent changes in the ocular parameters of OCTA in COVID-19 patients. At the second follow-up visit, we observed a widened FAZ zone in SCP and decreased VD in some regions of the retina and choroid. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

11 pages, 3144 KiB

Open AccessArticle

The Short-Term Results of Autologous Platelet-Rich Plasma as an Adjuvant to Re-Intervention in the Treatment of Refractory Full-Thickness Macular Holes

by Matilde Buzzi, Guglielmo Parisi, Paola Marolo, Francesco Gelormini, Mariantonia Ferrara, Raffaele Raimondi, Davide Allegrini, Tommaso Rossi, Michele Reibaldi and Mario R. Romano

J. Clin. Med. 2023, 12(5), 2050; https://doi.org/10.3390/jcm12052050 - 04 Mar 2023

Cited by 2 | Viewed by 1455

Abstract

The purpose of this study was to investigate the short-term efficacy and safety of autologous platelet-rich plasma (a-PRP) as an adjuvant to revisional vitrectomy for refractory full-thickness macular holes (rFTMHs). We conducted a prospective, non-randomized interventional study including patients with rFTMH after a [...] Read more.

The purpose of this study was to investigate the short-term efficacy and safety of autologous platelet-rich plasma (a-PRP) as an adjuvant to revisional vitrectomy for refractory full-thickness macular holes (rFTMHs). We conducted a prospective, non-randomized interventional study including patients with rFTMH after a pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade. We included 28 eyes from 27 patients with rFTMHs: 12 rFTMHs in highly myopic eyes (axial length greater than 26.5 mm or a refractive error greater than -6D or both); 12 large rFTMHs (minimum hole width > 400 μm); and 4 rFTMHs secondary to the optic disc pit. All patients underwent 25-G PPV with a-PRP, a median time of 3.5 ± 1.8 months after the primary repair. At the six-month follow-up, the overall rFTMH closure rate was 92.9%, distributed as follows: 11 out of 12 eyes (91.7%) in the highly myopic group, 11 out of 12 eyes (91.7%) in the large rFTMH group, and 4 out of 4 eyes (100%) in the optic disc pit group. Median best-corrected visual acuity significantly improved in all groups, in particular from 1.00 (interquartile range: 0.85 to 1.30) to 0.70 (0.40 to 0.85) LogMAR in the highly myopic group (p = 0.016), from 0.90 (0.70 to 1.49) to 0.40 (0.35 to 0.70) LogMAR in the large rFTMH group (p = 0.005), and from 0.90 (0.75 to 1.00) to 0.50 (0.28 to 0.65) LogMAR in the optic disc pit group. No intraoperative or postoperative complications were reported. In conclusion, a-PRP can be an effective adjuvant to PPV in the management of rFTMHs. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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17 pages, 9660 KiB

Open AccessArticle

Does PLEX^® Elite 9000 OCT Identify and Characterize Most Posterior Pole Lesions in Highly Myopic Patients?

by Pablo Arlanzon-Lope, Miguel Angel. Campos, Ivan Fernandez-Bueno and Rosa M. Coco-Martin

J. Clin. Med. 2023, 12(5), 1846; https://doi.org/10.3390/jcm12051846 - 25 Feb 2023

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Abstract

High myopia (HM) is defined as an axial length (AL) ≥ 26 mm that may result in various pathologies that constitute pathologic myopia (PM). The PLEX^® Elite 9000 (Carl Zeiss AC, Jena, Germany) is a new swept-source optical coherence tomography (SS-OCT) underdevelopment [...] Read more.

High myopia (HM) is defined as an axial length (AL) ≥ 26 mm that may result in various pathologies that constitute pathologic myopia (PM). The PLEX^® Elite 9000 (Carl Zeiss AC, Jena, Germany) is a new swept-source optical coherence tomography (SS-OCT) underdevelopment that allows wider, deeper and more detailed posterior-segment visualization; it can acquire ultra-wide OCT angiography (OCTA) or new ultra-wide high-density scans in one image. We assessed the technology’s ability to identify/characterize/quantify staphylomas and posterior pole lesions or image biomarkers in highly myopic Spanish patients and estimate the technology’s potential to detect macular pathology. The instrument acquired 6 × 6 OCTA, 12 × 12 or 6 × 6 OCT cubes, and at least two high-definition spotlight single scans. A hundred consecutive patients (179 eyes; age, 51.4 ± 16.8 years; AL, 28.8 ± 2.33 mm) were recruited in one center for this prospective observational study. Six eyes were excluded because images were not acquired. The most common alterations were perforating scleral vessels (88.8%), classifiable staphyloma (68.7%), vascular folds (43%), extrafoveal retinoschisis (24%), dome-shaped macula (15.6%), and more uncommonly, scleral dehiscence (4.46%), intrachoroidal cavitation (3.35%), and macular pit (2.2%). The retinal thickness of these patients decreased, and the foveal avascular zone increased in the superficial plexus compared with normal eyes. SS-OCT is a novel potent tool that can detect most main posterior pole complications in PM and may provide us with a better understanding of the associated pathologies; some pathologies were identifiable only with this new kind of equipment, such as perforating scleral vessels, which seem to be the most common finding and not so frequently related to choroidal neovascularization, as previously reported. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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16 pages, 1636 KiB

Open AccessArticle

Recovery of Corneal Innervation after Treatment in Dry Eye Disease: A Confocal Microscopy Study

by Alberto Barros, Javier Lozano-Sanroma, Juan Queiruga-Piñeiro, Luis Fernández-Vega Cueto, Eduardo Anitua, Ignacio Alcalde and Jesús Merayo-Lloves

J. Clin. Med. 2023, 12(5), 1841; https://doi.org/10.3390/jcm12051841 - 25 Feb 2023

Cited by 3 | Viewed by 2128

Abstract

Purpose: To analyze the changes in corneal innervation by means of in vivo corneal confocal microscopy (IVCM) in patients diagnosed with Evaporative (EDE) and Aqueous Deficient Dry Eye (ADDE) and treated with a standard treatment for Dry Eye Disease (DED) in combination with [...] Read more.

Purpose: To analyze the changes in corneal innervation by means of in vivo corneal confocal microscopy (IVCM) in patients diagnosed with Evaporative (EDE) and Aqueous Deficient Dry Eye (ADDE) and treated with a standard treatment for Dry Eye Disease (DED) in combination with Plasma Rich in Growth Factors (PRGF). Methods: Eighty-three patients diagnosed with DED were enrolled in this study and included in the EDE or ADDE subtype. The primary variables analyzed were the length, density and number of nerve branches, and the secondary variables were those related to the quantity and stability of the tear film and the subjective response of the patients measured with psychometric questionnaires. Results: The combined treatment therapy with PRGF outperforms the standard treatment therapy in terms of subbasal nerve plexus regeneration, significantly increasing length, number of branches and nerve density, as well as significantly improving the stability of the tear film (p < 0.05 for all of them), and the most significant changes were located in the ADDE subtype. Conclusions: the corneal reinnervation process responds in a different way depending on the treatment prescribed and the subtype of dry eye disease. In vivo confocal microscopy is presented as a powerful technique in the diagnosis and management of neurosensory abnormalities in DED. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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11 pages, 1000 KiB

Open AccessArticle

Effect of Low-Temperature Preservation in Optisol-GS on Preloaded, Endothelium-Out DMEK Grafts

by Alessandro Ruzza, Stefano Ferrari, Matteo Airaldi, Vito Romano and Diego Ponzin

J. Clin. Med. 2023, 12(3), 1026; https://doi.org/10.3390/jcm12031026 - 28 Jan 2023

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Abstract

The aim of the study was to assess different temperature ranges for the preservation of pre-loaded Descemet Membrane Endothelial Keratoplasty (DMEK) grafts in the DMEK RAPID Mini device. Methods: Three groups of 15 DMEK grafts (five per group) were pre-loaded in the DMEK [...] Read more.

The aim of the study was to assess different temperature ranges for the preservation of pre-loaded Descemet Membrane Endothelial Keratoplasty (DMEK) grafts in the DMEK RAPID Mini device. Methods: Three groups of 15 DMEK grafts (five per group) were pre-loaded in the DMEK RAPID Mini and preserved in Optisol-GS for 72 h at different temperatures: group A at >8 °C, group B between 2–8 °C and group C at <2 °C. After stripping and preservation, the viability of the endothelium, cell loss and morphology were assessed through light microscopy following trypan blue and alizarin red staining. Results: Overall mortality was 4.07%, 3.97% and 7.66%, in groups A, B and C, respectively, with percentages of uncovered areas of 0.31%, 1.36% and 0.20% (all p > 0.05). Endothelial cell density variation was 5.51%, 3.06% and 2.82% in groups A, B and C, respectively (p = 0.19). Total Endothelial Cell Loss (ECL) was 4.37%, 5.32% and 7.84% in groups A, B and C, respectively (p = 0.39). Endothelial cell morphology was comparable in all three groups. Conclusions: In the DMEK RAPID Mini, low temperatures (<2 °C) may affect the quality of pre-loaded grafts, inducing a higher ECL after 72 h of preservation, although no significant differences among groups could be proved. Our data would suggest maintaining grafts loaded in the DMEK RAPID Mini at temperatures between 2–8 °C for appropriate preservation. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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9 pages, 7887 KiB

Open AccessArticle

Assessment of Corneal Angiography Filling Patterns in Corneal Neovascularization

by Luca Pagano, Haider Shah, Kunal Gadhvi, Mohammad Ahmad, Nardine Menassa, Giulia Coco, Stephen Kaye and Vito Romano

J. Clin. Med. 2023, 12(2), 633; https://doi.org/10.3390/jcm12020633 - 12 Jan 2023

Cited by 1 | Viewed by 1164

Abstract

The purpose of the paper is to describe vascular filling patterns in corneal neovascularization (CoNV) and evaluate the effect of corneal lesion location, CoNV surface area and multi-quadrant CoNV involvement on the filling pattern. It is a retrospective study of patients who were [...] Read more.

The purpose of the paper is to describe vascular filling patterns in corneal neovascularization (CoNV) and evaluate the effect of corneal lesion location, CoNV surface area and multi-quadrant CoNV involvement on the filling pattern. It is a retrospective study of patients who were investigated for CoNV using fluorescein angiography (FA) or indocyanine green angiography (ICGA) between January 2010 and July 2020. Angiography images were graded and analyzed multiple independent corneal specialists. The corneal surface was divided into four quadrants and patient information was obtained through electronic records. A total of 133 eyes were analyzed. Corneal lesions were located on the peripheral (72%) or central (28%) cornea. Central lesions were associated with multi-quadrant CoNV more frequently than peripheral lesions (p = 0.15). CoNV located within the same quadrant of the corneal lesion was often first to fill (88.4%). In multi-quadrant CoNV, the physiological inferior–superior–nasal–temporal order of filling was usually respected (61.7%). Central lesions resulted in larger CoNV surface area than peripheral lesions (p = 0.09). In multi-quadrant CoNV, the largest area of neovascularization was also the first to fill in (peripheral lesion 74%, central lesion 65%). Fillings patterns in healthy corneas have previously been reported. Despite CoNV development, these patterns are usually respected. Several factors that may influence filling patterns have been identified, including corneal lesion location, CoNV surface area and aetiology of CoNV. Understanding filling patterns of neovascularization allows for the identification of areas at higher risk of developing CoNV, aiding in earlier detection and intervention of CoNV. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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8 pages, 1296 KiB

Open AccessArticle

OCT Analysis of Retinal Pigment Epithelium in Myopic Choroidal Neovascularization: Correlation Analysis with Different Treatments

by Davide Allegrini, Diego Vezzola, Alfredo Borgia, Raffaele Raimondi, Tania Sorrentino, Domenico Tripepi, Elisa Stradiotto, Marco Alì, Giovanni Montesano and Mario R. Romano

J. Clin. Med. 2022, 11(17), 5023; https://doi.org/10.3390/jcm11175023 - 26 Aug 2022

Cited by 1 | Viewed by 1260

Abstract

Objective: The objective of this study was to analyze the status of the retinal pigment epithelium (RPE) by means of the spectral domain optical coherence tomography (SD-OCT) overlying the myopic neovascular lesions in the involutive phase, looking for any correlations between the [...] Read more.

Objective: The objective of this study was to analyze the status of the retinal pigment epithelium (RPE) by means of the spectral domain optical coherence tomography (SD-OCT) overlying the myopic neovascular lesions in the involutive phase, looking for any correlations between the status of the RPE and the size of the lesions and the type and duration of the treatment. Methods: SD-OCT examinations of 83 consecutive patients with myopic choroidal neovascularization (CNV) were reviewed and divided into two groups: group A, patients with CNV characterized by uniformity of the overlying RPE, and group B, patients with CNV characterized by non-uniformity of the overlying RPE. Results: The median lesion area, major diameter, and minimum diameter were, respectively, 0.42 mm² (0.30–1.01 mm²), 0.76 mm² (0.54–1.28 mm²), and 0.47 mm² (0.63–0.77 mm²) in group A, and 1.60 mm² (0.72–2.67 mm²), 1.76 mm² (1.13–2.23 mm²), and 0.98 mm² (0.65–1.33 mm²) in group B. These values were lower in group A than in group B (p < 0.001). The number of treatments with a period free of disease recurrence for at least 6 months was greater (p < 0.010) in group B (6.54 ± 2.82) than in group A (3.67 ± 2.08), and treatments include intravitreal anti-vascular endothelial growth factor injection, photodynamic therapy, or both. Conclusions: Our results showed that the size of myopic neovascular lesion influences the development of a uniform RPE above the lesion and therefore the disease prognosis. The presence of uniform RPE was found to be extremely important in the follow-up of patients with myopic CNV, as it influences the duration of the disease and the number of treatments required. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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9 pages, 873 KiB

Open AccessArticle

3D Visualization System in Descemet Membrane Endothelial Keratoplasty (DMEK): A Six-Month Comparison with Conventional Microscope

by Alberto Morelli, Rosangela Ferrandina, Eleonora Favuzza, Michela Cennamo and Rita Mencucci

J. Clin. Med. 2022, 11(15), 4312; https://doi.org/10.3390/jcm11154312 - 25 Jul 2022

Cited by 2 | Viewed by 1256

Abstract

Background: To compare the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) surgery using the three-dimensional (3D) display system NGENUITY to DMEK surgery performed with the traditional microscope (TM) in patients affected by Fuchs Endothelial Corneal Disease (FECD). Methods: Retrospective comparative study [...] Read more.

Background: To compare the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) surgery using the three-dimensional (3D) display system NGENUITY to DMEK surgery performed with the traditional microscope (TM) in patients affected by Fuchs Endothelial Corneal Disease (FECD). Methods: Retrospective comparative study of 40 pseudophakic eyes of 40 patients affected by FECD who underwent DMEK surgery. Twenty patients (3D group) were operated on using the 3D display system and 20 patients (TM group) were operated on using the traditional microscope. Best spectacle corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD) and corneal densitometry (CD) values were documented before and at 1, 3 and 6 months after DMEK. Intra- and postoperative complications were recorded. Results: The baseline assessments did not differ between the two groups (p > 0.05). Global surgical time and time to perform descemetorhexis were significantly lower in the TM group (p = 0.04 and p = 0.02, respectively). BSCVA, CCT, ECD and CD values did not differ significantly in the two groups at all follow-ups (p > 0.05). Complication rate was similar between the two groups. Conclusion: Three-dimensional display systems can be securely employed in DMEK surgery considering the satisfactory clinical outcomes, including Scheimpflug CD. Nevertheless, the slightly longer surgical time of the 3D DMEKs may lead to surgeons’ hesitancy. The main advantages of the heads-up approach may be the improved ergonomic comfort during surgery and the utility of assistants in surgical training. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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9 pages, 2502 KiB

Open AccessArticle

Retromode Imaging Modality of Epiretinal Membranes

by Alfonso Savastano, Matteo Ripa, Maria Cristina Savastano, Tomaso Caporossi, Daniela Bacherini, Raphael Kilian, Clara Rizzo and Stanislao Rizzo

J. Clin. Med. 2022, 11(14), 3936; https://doi.org/10.3390/jcm11143936 - 06 Jul 2022

Cited by 5 | Viewed by 1454

Abstract

(1) Purpose: To determine the characteristics of macular epiretinal membranes (ERM) using non-invasive retromode imaging (RMI) and to compare retromode images with those acquired via fundus autofluorescence (FAF) and fundus photography. (2) Methods: Prospective observational case-series study including patients with macular ERM with [...] Read more.

(1) Purpose: To determine the characteristics of macular epiretinal membranes (ERM) using non-invasive retromode imaging (RMI) and to compare retromode images with those acquired via fundus autofluorescence (FAF) and fundus photography. (2) Methods: Prospective observational case-series study including patients with macular ERM with no other ocular disease affecting their morphology and/or imaging quality. We compared RMI, FAF and fundus photography features by cropping and overlapping images to obtain topographic correspondence. (3) Results: In total, 21 eyes (21 patients) affected by ERM were included in this study. The mean area of retinal folds detected by RMI was significantly higher than that detected by FAF (11.85 ± 3.92 mm² and 5.67 ± 2.15 mm², respectively, p < 0.05) and similar to that revealed by fundus photography (11.85 ± 3.92 mm² and 10.58 ± 3.45 mm², respectively, p = 0.277). (4) Conclusions: RMI appears to be a useful tool in the evaluation of ERMs. It allows for an accurate visualization of the real extension of the retinal folds and provides a precise structural assessment of the macula before surgery. Clinicians should be aware of RMI’s advantages and should be able to use them to warrant a wide range of information and, thus, a more personalized therapeutic approach. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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11 pages, 1618 KiB

Open AccessArticle

Characteristics of the Ciliary Body in Healthy Chinese Subjects Evaluated by Radial and Transverse Imaging of Ultrasound Biometric Microscopy

by Jiawei Ren, Xinbo Gao, Liming Chen, Huishan Lin, Yao Liu, Yuying Zhou, Yunru Liao, Chunzi Xie, Chengguo Zuo and Mingkai Lin

J. Clin. Med. 2022, 11(13), 3696; https://doi.org/10.3390/jcm11133696 - 27 Jun 2022

Cited by 6 | Viewed by 1809

Abstract

Background: The imaging and analysis of the ciliary body (CB) are valuable in many potential clinical applications. This study aims to demonstrate the anatomy characteristics of CB using radial and transverse imaging of ultrasound biometric microscopy (UBM) in healthy Chinese subjects, and to [...] Read more.

Background: The imaging and analysis of the ciliary body (CB) are valuable in many potential clinical applications. This study aims to demonstrate the anatomy characteristics of CB using radial and transverse imaging of ultrasound biometric microscopy (UBM) in healthy Chinese subjects, and to explore the determining factors. Methods: Fifty-four eyes of 30 healthy Chinese subjects were evaluated. Clinical data, including age, body mass index (BMI), intraocular pressure (IOP), axial length (AL), and lens thickness (LT), were collected. Radial and transverse UBM measurements of the ciliary body were performed. Anterior chamber depth (ACD), ciliary sulcus diameter (CSD), ciliary process length (CPL), ciliary process density (CPD), ciliary process area (CPA), ciliary muscle area (CMA), ciliary body area (CBA), ciliary body thickness (CBT₀, CBT₁, and CBT_max), anterior placement of ciliary body (APCB), and trabecular-ciliary angle (TCA) of four (superior, nasal, inferior, and temporal) quadrants were measured. Results: The average CPL was 0.513 ± 0.074 mm, and the average CPA was 0.890 ± 0.141 mm². CPL and CPA tended to be longer and larger in the superior quadrant (p < 0.001) than in the other three quadrants. Average CPL was significantly correlated with AL (r = 0.535, p < 0.001), ACD (r = 0.511, p < 0.001), and LT (r = −0.512, p < 0.001). Intraclass correlation coefficient (ICC) scores were high for CPL (0.979), CPD (0.992), CPA (0.966), CMA (0.963), and CBA (0.951). Conclusions: In healthy Chinese subjects, CPL was greatest in the superior quadrant, followed by the inferior, temporal, and nasal quadrants, and CPA was largest in the superior quadrant, followed by the tempdoral, inferior, and nasal quadrants. Transverse UBM images can be used to measure the anatomy of the ciliary process with relatively good repeatability and reliability. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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11 pages, 5614 KiB

Open AccessArticle

Incidence and Risk Factors for Berger’s Space Development after Uneventful Cataract Surgery: Evidence from Swept-Source Optical Coherence Tomography

by Zhengwei Zhang, Jinhan Yao, Shuimiao Chang, Piotr Kanclerz, Ramin Khoramnia, Minghui Deng and Xiaogang Wang

J. Clin. Med. 2022, 11(13), 3580; https://doi.org/10.3390/jcm11133580 - 21 Jun 2022

Cited by 5 | Viewed by 2296

Abstract

Background: This study investigates the incidence and risk factors for the development of Berger’s space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. [...] Read more.

Background: This study investigates the incidence and risk factors for the development of Berger’s space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. Six high-resolution cross-sectional anterior segment SS-OCT images at 30° intervals were used for BS data measurements. BS width was measured at three points on each scanned meridian line: the central point line aligned with the cornea vertex and two point lines at the pupil’s margins. Results: A total of 223 eyes that underwent uneventful cataract surgery were evaluated. Preoperatively, only two eyes (2/223, 0.9%) were observed to have consistent BS in all six scanning directions. BS was observed postoperatively in 44 eyes (44/223, 19.7%). A total of 13 eyes (13/223, 5.8%) with insufficient image quality, pupil dilation, or lack of preoperative image data were excluded from the study. A total of 31 postoperative eyes with BS and 31 matched eyes without BS were included in the final data analysis. The smallest postoperative BS width was in the upper quadrant of the vertical meridian line (90°), with a mean value of 280 μm. The largest BS width was observed in the opposite area of the main clear corneal incision, with a mean value >500 μm. Conclusions: Uneven-width BS is observable after uneventful phacoemulsification. Locations with a much wider BS (indirect manifestation of Wieger zonular detachment) are predominantly located in the opposite direction to the main corneal incisions. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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8 pages, 747 KiB

Open AccessArticle

Exploring Retinal Blood Vessel Diameters as Biomarkers in Multiple Sclerosis

by Dragana Drobnjak Nes, Pål Berg-Hansen, Sigrid A. de Rodez Benavent, Einar A. Høgestøl, Mona K. Beyer, Daniel A. Rinker, Nina Veiby, Mia Karabeg, Beáta Éva Petrovski, Elisabeth G. Celius, Hanne F. Harbo and Goran Petrovski

J. Clin. Med. 2022, 11(11), 3109; https://doi.org/10.3390/jcm11113109 - 31 May 2022

Cited by 2 | Viewed by 1444

Abstract

We aimed to determine whether retinal vessel diameters and retinal oxygen saturation in newly diagnosed patients with multiple sclerosis (pwMS) are different from those of a healthy population. Retinal blood vessel diameters were measured using imaging with a spectrophotometric non-invasive retinal oximeter. Twenty-three [...] Read more.

We aimed to determine whether retinal vessel diameters and retinal oxygen saturation in newly diagnosed patients with multiple sclerosis (pwMS) are different from those of a healthy population. Retinal blood vessel diameters were measured using imaging with a spectrophotometric non-invasive retinal oximeter. Twenty-three newly diagnosed untreated relapsing-remitting MS (RRMS) patients (mean age: 32.2 ± 7.5 years, age range = 18–50 years, 56.5% female) were measured and compared to 23 age- and sex-matched healthy controls (HCs) (mean age: 34.8 ± 8.1 years). Patients with Optic Neuritis were excluded. Retinal venular diameter (143.8 µm versus 157.8 µm: mean; p = 0.0013) and retinal arteriolar diameter (112.6 µm versus 120.6 µm: mean; p = 0.0089) were smaller in pwMS when compared with HCs, respectively. There was no significant difference in the oxygen saturation in retinal venules and arterioles in pwMS (mean: 60.0% and 93.7%; p = 0.5980) compared to HCs (mean: 59.3% and 91.5%; p = 0.8934), respectively. There was a significant difference in the median low contrast visual acuity (2.5% contrast) between the pwMS and the HC groups (p = 0.0143) Retinal arteriolar and venular diameter may have potential as objective biomarkers for MS. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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11 pages, 6400 KiB

Open AccessArticle

Specular Microscopy of Human Corneas Stored in an Active Storage Machine

by Thibaud Garcin, Emmanuel Crouzet, Chantal Perrache, Thierry Lepine, Philippe Gain and Gilles Thuret

J. Clin. Med. 2022, 11(11), 3000; https://doi.org/10.3390/jcm11113000 - 26 May 2022

Cited by 1 | Viewed by 1341

Abstract

Purpose: Unlike corneas stored in cold storage (CS) which remain transparent and thin, corneas stored in organoculture (OC) cannot be assessed by specular microscopy (SM), because edema and posterior folds occur during storage and prevent from specular reflection. We previously developed an active [...] Read more.

Purpose: Unlike corneas stored in cold storage (CS) which remain transparent and thin, corneas stored in organoculture (OC) cannot be assessed by specular microscopy (SM), because edema and posterior folds occur during storage and prevent from specular reflection. We previously developed an active storage machine (ASM) which restores the intraocular pressure while renewing the storage medium, thus preventing major stromal edema. Its transparent windows allow multimodal corneal imaging in a closed system. Aim: to present SM of corneas stored in this ASM. Methods: Ancillary study of two preclinical studies on corneas stored for one and three months in the ASM. A prototype non-contact SM was developed (CMOS camera, ×10 objective, collimated LED source, micrometric stage). Five non-overlapping fields (935 × 748 μm) were acquired in exactly the same areas at regular intervals. Image quality was graded according to defined categories (American Cornea Donor Study). The endothelial cell density (ECD) was measured with a center method. Finally, _SMECD was also compared to Hoechst-stained cell nuclei count (_HoechstECD). Results: The 62 corneas remained thin during storage, allowing SM at all time points without corneal deconditioning. Image quality varied depending on donors and days of control but, overall, in the 1100 images, we observed 55% of excellent and 30% of good quality images. _SMECD did not differ from _HoechstECD (p = 0.084). Conclusions: The ASM combines the advantages of CS (closed system) and OC (long-term storage). Specular microscopy is possible at any time in the ASM with a large field of view, making endothelial controls easy and safe. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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7 pages, 1650 KiB

Open AccessArticle

Corneal Findings Associated to Belantamab-Mafodotin (Belamaf) Use in a Series of Patients Examined Longitudinally by Means of Advanced Corneal Imaging

by Rita Mencucci, Michela Cennamo, Ludovica Alonzo, Carlotta Senni, Aldo Vagge, Lorenzo Ferro Desideri, Vincenzo Scorcia and Giuseppe Giannaccare

J. Clin. Med. 2022, 11(10), 2884; https://doi.org/10.3390/jcm11102884 - 19 May 2022

Cited by 7 | Viewed by 1830

Abstract

Belantamab mafodotin (belamaf) is a novel antibody–drug conjugate developed for the treatment of patients with relapsed or refractory multiple myeloma (RRMM). Although the drug has demonstrated a good efficacy, corneal adverse events have been reported. In this prospective study, consecutive patients with RRMM [...] Read more.

Belantamab mafodotin (belamaf) is a novel antibody–drug conjugate developed for the treatment of patients with relapsed or refractory multiple myeloma (RRMM). Although the drug has demonstrated a good efficacy, corneal adverse events have been reported. In this prospective study, consecutive patients with RRMM who received belamaf infusions were included. The standard ophthalmological visit was implemented with anterior segment (AS)-optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM). Five patients (three males, two females; mean age 66 ± 6.0 years) with MMRR and unremarkable ocular findings at baseline who received belamaf infusion were included. After a median time of 28 days from the first infusion, four of them developed corneal alterations with transient vision reduction to a variable extent. In particular, corneal deposits of microcyst-like epithelial changes (MECs) were detected centrally in one patient and peripherally in three patients. AS-OCT scans showed a bilateral heterogeneous increase in signal intensity, together with hyper-reflective lesions confined within the epithelium in all cases, except for one case in which they also involved the stroma. Corneal maps showed a transient increase in epithelial thickness in the first phase that was followed by a diffuse decrease in the subsequent phase. IVCM scans showed MECs as hyper-reflective opacities located at the level of corneal epithelium, largely intracellular. Multimodal corneal imaging may implement the current clinical scale, helping us to detect corneal abnormalities in patients under belamaf therapy. This workup provides useful data for monitoring over time corneal findings and for optimizing systemic therapy. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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13 pages, 4111 KiB

Open AccessArticle

Meibomian Gland Density: An Effective Evaluation Index of Meibomian Gland Dysfunction Based on Deep Learning and Transfer Learning

by Zuhui Zhang, Xiaolei Lin, Xinxin Yu, Yana Fu, Xiaoyu Chen, Weihua Yang and Qi Dai

J. Clin. Med. 2022, 11(9), 2396; https://doi.org/10.3390/jcm11092396 - 25 Apr 2022

Cited by 12 | Viewed by 2367

Abstract

We aimed to establish an artificial intelligence (AI) system based on deep learning and transfer learning for meibomian gland (MG) segmentation and evaluate the efficacy of MG density in the diagnosis of MG dysfunction (MGD). First, 85 eyes of 85 subjects were enrolled [...] Read more.

We aimed to establish an artificial intelligence (AI) system based on deep learning and transfer learning for meibomian gland (MG) segmentation and evaluate the efficacy of MG density in the diagnosis of MG dysfunction (MGD). First, 85 eyes of 85 subjects were enrolled for AI system-based evaluation effectiveness testing. Then, from 2420 randomly selected subjects, 4006 meibography images (1620 upper eyelids and 2386 lower eyelids) graded by three experts according to the meiboscore were analyzed for MG density using the AI system. The updated AI system achieved 92% accuracy (intersection over union, IoU) and 100% repeatability in MG segmentation after 4 h of training. The processing time for each meibography was 100 ms. We discovered a significant and linear correlation between MG density and ocular surface disease index questionnaire (OSDI), tear break-up time (TBUT), lid margin score, meiboscore, and meibum expressibility score (all p < 0.05). The area under the curve (AUC) was 0.900 for MG density in the total eyelids. The sensitivity and specificity were 88% and 81%, respectively, at a cutoff value of 0.275. MG density is an effective index for MGD, particularly supported by the AI system, which could replace the meiboscore, significantly improve the accuracy of meibography analysis, reduce the analysis time and doctors’ workload, and improve the diagnostic efficiency. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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8 pages, 1438 KiB

Open AccessArticle

Improvement in Dacryoendoscopic Visibility after Image Processing Using Comb-Removal and Image-Sharpening Algorithms

by Sujin Hoshi, Kuniharu Tasaki, Kazushi Maruo, Yuta Ueno, Haruhiro Mori, Shohei Morikawa, Yuki Moriya, Shoko Takahashi, Takahiro Hiraoka and Tetsuro Oshika

J. Clin. Med. 2022, 11(8), 2073; https://doi.org/10.3390/jcm11082073 - 07 Apr 2022

Cited by 6 | Viewed by 1583

Abstract

Recently, a minimally invasive treatment for lacrimal passage diseases was developed using dacryoendoscopy. Good visibility of the lacrimal passage is important for examination and treatment. This study aimed to investigate whether image processing can improve the dacryoendoscopic visibility using comb-removal and image-sharpening algorithms. [...] Read more.

Recently, a minimally invasive treatment for lacrimal passage diseases was developed using dacryoendoscopy. Good visibility of the lacrimal passage is important for examination and treatment. This study aimed to investigate whether image processing can improve the dacryoendoscopic visibility using comb-removal and image-sharpening algorithms. We processed 20 dacryoendoscopic images (original images) using comb-removal and image-sharpening algorithms. Overall, 40 images (20 original and 20 post-processing) were randomly presented to the evaluators, who scored each image on a 10-point scale. The scores of the original and post-processing images were compared statistically. Additionally, in vitro experiments were performed using a test chart to examine whether image processing could improve the dacryoendoscopic visibility in a turbid fluid. The visual score (estimate ± standard error) of the images significantly improved from 3.52 ± 0.26 (original images) to 5.77 ± 0.28 (post-processing images; p < 0.001, linear mixed-effects model). The in vitro experiments revealed that the contrast and resolution of images in the turbid fluid improved after image processing. Image processing with our comb-removal and image-sharpening algorithms improved dacryoendoscopic visibility. The techniques used in this study are applicable for real-time processing and can be easily introduced in clinical practice. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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9 pages, 491 KiB

Open AccessArticle

Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

by Pasquale Napolitano, Fausto Tranfa, Luca D’Andrea, Ciro Caruso, Michele Rinaldi, Alberto Mazzucco, Nicola Ciampa, Antonietta Melenzane and Ciro Costagliola

J. Clin. Med. 2022, 11(7), 1785; https://doi.org/10.3390/jcm11071785 - 24 Mar 2022

Cited by 5 | Viewed by 1750

Abstract

Background: Corneal collagen cross-linking (CXL) has become the gold standard for mild and moderate stages to stop the progression of keratoconus. We analyzed some corneal topography indices to compare iontophoresis epi-on and iontophoresis epi-off techniques throughout a two-year follow-up. Methods: A total of [...] Read more.

Background: Corneal collagen cross-linking (CXL) has become the gold standard for mild and moderate stages to stop the progression of keratoconus. We analyzed some corneal topography indices to compare iontophoresis epi-on and iontophoresis epi-off techniques throughout a two-year follow-up. Methods: A total of 64 eyes of 49 patients who underwent CXL were recruited. In 30 eyes the epi-off technique was performed, whereas the remaining 34 eyes were treated with the epi-on technique. All patients underwent a complete ophthalmologic examination that included CDVA, central and thinnest corneal thickness, Schirmer test I, TBUT test, and the Ocular Surface Disease Index. Results: In both groups, a significant improvement in visual function was recorded. No statistically significant differences between Kmax, Mean K, Flat K, Steep K values were found. Statistically significant differences (p < 0.05) between the epi-on and epi-off groups’ pachymetry before and after 24 months follow-up as well as between the epi-on and epi-off groups’ topographically thinnest point in the immediate post-surgery and 24 months after surgery were recorded. Conclusion: Our study highlighted that both techniques are valid in mid-term corneal stabilization. The advantage of the new iontophoresis epi-off cross-linking technique could be found in a faster imbibing time of the cornea, therefore reducing surgical times, with a lower risk of complications. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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13 pages, 854 KiB

Open AccessArticle

Association of Neuroretinal Thinning and Microvascular Changes with Hypertension in an Older Population in Southern Italy

by Alfredo Niro, Giancarlo Sborgia, Luisa Lampignano, Gianluigi Giuliani, Fabio Castellana, Roberta Zupo, Ilaria Bortone, Pasquale Puzo, Angelo Pascale, Valentina Pastore, Rosa Buonamassa, Roberta Galati, Marco Bordinone, Flavio Cassano, Chiara Griseta, Sarah Tirelli, Madia Lozupone, Vitoantonio Bevilacqua, Francesco Panza, Rodolfo Sardone, Giovanni Alessio and Francesco Boscia Show full author list Hide full author list

J. Clin. Med. 2022, 11(4), 1098; https://doi.org/10.3390/jcm11041098 - 19 Feb 2022

Cited by 6 | Viewed by 2145

Abstract

Background: Retinal microvasculature assessment at capillary level may potentially aid the evaluation of early microvascular changes due to hypertension. We aimed to investigate associations between the measures obtained using optical coherence tomography (OCT) and OCT-angiography (OCT-A) and hypertension, in a southern Italian older [...] Read more.

Background: Retinal microvasculature assessment at capillary level may potentially aid the evaluation of early microvascular changes due to hypertension. We aimed to investigate associations between the measures obtained using optical coherence tomography (OCT) and OCT-angiography (OCT-A) and hypertension, in a southern Italian older population. Methods: We performed a cross-sectional analysis from a population-based study on 731 participants aged 65 years+ subdivided into two groups according to the presence or absence of blood hypertension without hypertensive retinopathy. The average thickness of the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) were measured. The foveal avascular zone area, vascular density (VD) at the macular site and of the optic nerve head (ONH) and radial peripapillary capillary (RPC) plexi were evaluated. Logistic regression was applied to assess the association of ocular measurements with hypertension. Results: GCC thickness was inversely associated with hypertension (odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97–1). A rarefaction of VD of the ONH plexus at the inferior temporal sector (OR: 0.95, 95% CI: 0.91–0.99) and, conversely, a higher VD of the ONH and RPC plexi inside optic disc (OR: 1.07, 95% CI: 1.04–1.10; OR: 1.04, 95% CI: 1.02–1.06, respectively) were significantly associated with hypertension. Conclusion: A neuroretinal thinning involving GCC and a change in capillary density at the peripapillary network were related to the hypertension in older patients without hypertensive retinopathy. Assessing peripapillary retinal microvasculature using OCT-A may be a useful non-invasive approach to detect early microvascular changes due to hypertension. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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10 pages, 5261 KiB

Open AccessArticle

Changes in Peripapillary and Macular Vessel Densities and Their Relationship with Visual Field Progression after Trabeculectomy

by Jooyoung Yoon, Kyung Rim Sung and Joong Won Shin

J. Clin. Med. 2021, 10(24), 5862; https://doi.org/10.3390/jcm10245862 - 14 Dec 2021

Cited by 3 | Viewed by 1886

Abstract

The aim of this study was to determine the factors associated with visual field (VF) deterioration after trabeculectomy, including the peripapillary vessel density (pVD) and macular vessel density (mVD) changes assessed by optical coherence tomography angiography (OCT-A). Primary open-angle glaucoma patients with more [...] Read more.

The aim of this study was to determine the factors associated with visual field (VF) deterioration after trabeculectomy, including the peripapillary vessel density (pVD) and macular vessel density (mVD) changes assessed by optical coherence tomography angiography (OCT-A). Primary open-angle glaucoma patients with more than two years of follow-up after trabeculectomy were included. pVD was calculated in a region defined as a 750 μm-wide elliptical annulus extending from the optic disc boundary. mVD was calculated in the parafoveal (1–3 mm) and perifoveal (3–6 mm) regions. VF deterioration was defined as the rate of mean deviation (MD) worse than −1.5 dB/year. The change rates of pVD and mVD were compared between the deteriorated VF and non-deteriorated VF groups. The factors associated with the rate of MD were determined by linear regression analyses. VF deterioration was noted in 14 (21.5%) of the 65 eyes that underwent trabeculectomy. The pVD (−2.26 ± 2.67 vs. −0.02 ± 1.74%/year, p ≤ 0.001) reduction rate was significantly greater in the deteriorated VF group than in the non-deteriorated VF group, while that of parafoveal (p = 0.267) and perifoveal (p = 0.350) VD did not show a significant difference. The linear regression analysis showed that the postoperative MD reduction rate was significantly associated with the rate of pVD reduction (p = 0.016), while other clinical parameters and preoperative vascular parameters did not show any association. Eyes with greater loss of peripapillary retinal circulation after trabeculectomy tended to exhibit VF deterioration. The assessment of peripapillary vascular status can be an adjunctive strategy to predict visual function after trabeculectomy. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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9 pages, 1510 KiB

Open AccessArticle

Anterior-Segment Swept-Source Ocular Coherence Tomography and Scheimpflug Imaging Agreement for Keratometry and Pupil Measurements in Healthy Eyes

by Francisco Pérez-Bartolomé, Carlos Rocha-De-Lossada, José-María Sánchez-González, Silvia Feu-Basilio, Josep Torras-Sanvicens and Jorge Peraza-Nieves

J. Clin. Med. 2021, 10(24), 5789; https://doi.org/10.3390/jcm10245789 - 10 Dec 2021

Cited by 5 | Viewed by 1950

Abstract

This study examines agreement between the devices Anterion^® and Pentacam HR^® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), [...] Read more.

This study examines agreement between the devices Anterion^® and Pentacam HR^® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (µm), thinnest point thickness (µm), thinnest point X-coordinate (mm), thinnest point Y-coordinate (mm), pupil diameter (mm), pupil center-corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X-coordinate (mm), and pupil centroid Y-coordinate (mm). The Student’s t test for independent samples identified significant differences (p < 0.005) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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13 pages, 1462 KiB

Open AccessArticle

An Artificial Intelligent Risk Classification Method of High Myopia Based on Fundus Images

by Cheng Wan, Han Li, Guo-Fan Cao, Qin Jiang and Wei-Hua Yang

J. Clin. Med. 2021, 10(19), 4488; https://doi.org/10.3390/jcm10194488 - 29 Sep 2021

Cited by 17 | Viewed by 2290

Abstract

High myopia is a global ocular disease and one of the most common causes of blindness. Fundus images can be obtained in a noninvasive manner and can be used to monitor and follow up on many fundus diseases, such as high myopia. In [...] Read more.

High myopia is a global ocular disease and one of the most common causes of blindness. Fundus images can be obtained in a noninvasive manner and can be used to monitor and follow up on many fundus diseases, such as high myopia. In this paper, we proposed a computer-aided diagnosis algorithm using deep convolutional neural networks (DCNNs) to grade the risk of high myopia. The input images were automatically classified into three categories: normal fundus images were labeled class 0, low-risk high-myopia images were labeled class 1, and high-risk high-myopia images were labeled class 2. We conducted model training on 758 clinical fundus images collected locally, and the average accuracy reached 98.15% according to the results of fivefold cross-validation. An additional 100 fundus images were used to evaluate the performance of DCNNs, with ophthalmologists performing external validation. The experimental results showed that DCNNs outperformed human experts with an area under the curve (AUC) of 0.9968 for the recognition of low-risk high myopia and 0.9964 for the recognition of high-risk high myopia. In this study, we were able to accurately and automatically perform high myopia classification solely using fundus images. This has great practical significance in terms of improving early diagnosis, prevention, and treatment in clinical practice. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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10 pages, 1458 KiB

Open AccessArticle

Wide-Field Swept-Source OCT Analysis of Interocular Symmetry of Choroidal Thickness in Subjects with Uncomplicated Pachychoroid

by Min-Su Kim, Hyung-Bin Lim, Woo-Hyuk Lee, Yeo-Kyoung Won, Ki-Yup Nam and Jung-Yeul Kim

J. Clin. Med. 2021, 10(18), 4253; https://doi.org/10.3390/jcm10184253 - 19 Sep 2021

Cited by 2 | Viewed by 2084

Abstract

Background: We aimed to study the bilateral choroidal thickness (CT) symmetry and difference in uncomplicated pachychoroid subjects using wide-field swept-source optical coherence tomography (SS-OCT). Methods: All subjects underwent a wide-field 16-mm one-line scan using SS-OCT. Bilateral CT was measured at, and compared among, [...] Read more.

Background: We aimed to study the bilateral choroidal thickness (CT) symmetry and difference in uncomplicated pachychoroid subjects using wide-field swept-source optical coherence tomography (SS-OCT). Methods: All subjects underwent a wide-field 16-mm one-line scan using SS-OCT. Bilateral CT was measured at, and compared among, the following 12 points: three points at 900-µm intervals from the nasal optic disc margin (nasal peripapillary area), one point at the subfovea, six points at 900-µm intervals from the fovea to the nasal and temporal areas (macular area), and two peripheral points 5400 and 8100 µm from the fovea (peripheral area). Results: There were no statistically significant differences in CT between the right and left eyes in any area (all p > 0.05); they all showed significant positive correlations (all p < 0.01). However, the correlation coefficients (ρ) were smaller for the nasal peripapillary and peripheral areas compared to the macular area. Conclusions: The CTs in each region were bilaterally symmetrical in subjects with uncomplicated pachychoroid. However, interocular difference in CT increased from the center to the periphery, indicating that the anatomical variation of the nasal peripapillary and peripheral choroid was greater than that of the macula. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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Review

Jump to: Editorial, Research

14 pages, 5280 KiB

Open AccessReview

Deceptive Tricks in Artificial Intelligence: Adversarial Attacks in Ophthalmology

by Agnieszka M. Zbrzezny and Andrzej E. Grzybowski

J. Clin. Med. 2023, 12(9), 3266; https://doi.org/10.3390/jcm12093266 - 04 May 2023

Cited by 2 | Viewed by 2776

Abstract

The artificial intelligence (AI) systems used for diagnosing ophthalmic diseases have significantly progressed in recent years. The diagnosis of difficult eye conditions, such as cataracts, diabetic retinopathy, age-related macular degeneration, glaucoma, and retinopathy of prematurity, has become significantly less complicated as a result [...] Read more.

The artificial intelligence (AI) systems used for diagnosing ophthalmic diseases have significantly progressed in recent years. The diagnosis of difficult eye conditions, such as cataracts, diabetic retinopathy, age-related macular degeneration, glaucoma, and retinopathy of prematurity, has become significantly less complicated as a result of the development of AI algorithms, which are currently on par with ophthalmologists in terms of their level of effectiveness. However, in the context of building AI systems for medical applications such as identifying eye diseases, addressing the challenges of safety and trustworthiness is paramount, including the emerging threat of adversarial attacks. Research has increasingly focused on understanding and mitigating these attacks, with numerous articles discussing this topic in recent years. As a starting point for our discussion, we used the paper by Ma et al. “Understanding Adversarial Attacks on Deep Learning Based Medical Image Analysis Systems”. A literature review was performed for this study, which included a thorough search of open-access research papers using online sources (PubMed and Google). The research provides examples of unique attack strategies for medical images. Unfortunately, unique algorithms for attacks on the various ophthalmic image types have yet to be developed. It is a task that needs to be performed. As a result, it is necessary to build algorithms that validate the computation and explain the findings of artificial intelligence models. In this article, we focus on adversarial attacks, one of the most well-known attack methods, which provide evidence (i.e., adversarial examples) of the lack of resilience of decision models that do not include provable guarantees. Adversarial attacks have the potential to provide inaccurate findings in deep learning systems and can have catastrophic effects in the healthcare industry, such as healthcare financing fraud and wrong diagnosis. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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14 pages, 2762 KiB

Open AccessReview

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

by Antonio Moramarco, Natalie di Geronimo, Matteo Airaldi, Lorenzo Gardini, Francesco Semeraro, Danilo Iannetta, Vito Romano and Luigi Fontana

J. Clin. Med. 2023, 12(9), 3048; https://doi.org/10.3390/jcm12093048 - 22 Apr 2023

Cited by 1 | Viewed by 1390

Abstract

Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of [...] Read more.

Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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35 pages, 2812 KiB

Open AccessEditor’s ChoiceReview

Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration

by Sarah Hammadi, Nikolaos Tzoumas, Mariantonia Ferrara, Ingrid Porpino Meschede, Katharina Lo, Claire Harris, Majlinda Lako and David H. Steel

J. Clin. Med. 2023, 12(8), 2870; https://doi.org/10.3390/jcm12082870 - 14 Apr 2023

Cited by 8 | Viewed by 5174

Abstract

The complement system is crucial for immune surveillance, providing the body’s first line of defence against pathogens. However, an imbalance in its regulators can lead to inappropriate overactivation, resulting in diseases such as age-related macular degeneration (AMD), a leading cause of irreversible blindness [...] Read more.

The complement system is crucial for immune surveillance, providing the body’s first line of defence against pathogens. However, an imbalance in its regulators can lead to inappropriate overactivation, resulting in diseases such as age-related macular degeneration (AMD), a leading cause of irreversible blindness globally affecting around 200 million people. Complement activation in AMD is believed to begin in the choriocapillaris, but it also plays a critical role in the subretinal and retinal pigment epithelium (RPE) spaces. Bruch’s membrane (BrM) acts as a barrier between the retina/RPE and choroid, hindering complement protein diffusion. This impediment increases with age and AMD, leading to compartmentalisation of complement activation. In this review, we comprehensively examine the structure and function of BrM, including its age-related changes visible through in vivo imaging, and the consequences of complement dysfunction on AMD pathogenesis. We also explore the potential and limitations of various delivery routes (systemic, intravitreal, subretinal, and suprachoroidal) for safe and effective delivery of conventional and gene therapy-based complement inhibitors to treat AMD. Further research is needed to understand the diffusion of complement proteins across BrM and optimise therapeutic delivery to the retina. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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18 pages, 4007 KiB

Open AccessReview

In Vivo Confocal Microscopy Evaluation in Patients with Keratoconus

by Alvin Wei Jun Teo, Hassan Mansoor, Nigel Sim, Molly Tzu-Yu Lin and Yu-Chi Liu

J. Clin. Med. 2022, 11(2), 393; https://doi.org/10.3390/jcm11020393 - 13 Jan 2022

Cited by 11 | Viewed by 2291

Abstract

Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined [...] Read more.

Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined to ex vivo settings. In vivo confocal microscopy (IVCM) has been used to examine the corneal microstructure clinically. In this review, we discuss keratoconus cellular changes evaluated by IVCM before and after CXL. Cellular changes before CXL include decreased keratocyte and nerve densities, disorganized subbasal nerves with thickening, increased nerve tortuosity and shortened nerve fibre length. Repopulation of keratocytes occurs up to 1 year post procedure. IVCM also correlates corneal nerve status to functional corneal sensitivity. Immediately after CXL, there is reduced nerve density and keratocyte absence due to mechanical removal of the epithelium and CXL effect. Nerve regeneration begins after 1 month, with nerve fibre densities recovering to pre-operative levels between 6 months to 1 year and remains stable up to 5 years. Nerves remain tortuous and nerve densities are reduced. Corneal sensitivity is reduced immediately postoperatively but recovers with nerve regeneration. Our article provides comprehensive review on the use of IVCM imaging in keratoconus patients. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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12 pages, 881 KiB

Open AccessReview

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

by Sandrine Anne Zweifel, Nastasia Foa, Maximilian Robert Justus Wiest, Adriano Carnevali, Katarzyna Zaluska-Ogryzek, Robert Rejdak and Mario Damiano Toro

J. Clin. Med. 2021, 10(21), 4880; https://doi.org/10.3390/jcm10214880 - 23 Oct 2021

Cited by 7 | Viewed by 2742

Abstract

Due to their non-specific diagnostic patterns of ocular infection, differential diagnosis between Mycobacterium (M.) chimaera and tuberculosis can be challenging. In both disorders, ocular manifestation can be the first sign of a systemic infection, and a delayed diagnosis might reduce the [...] Read more.

Due to their non-specific diagnostic patterns of ocular infection, differential diagnosis between Mycobacterium (M.) chimaera and tuberculosis can be challenging. In both disorders, ocular manifestation can be the first sign of a systemic infection, and a delayed diagnosis might reduce the response to treatment leading to negative outcomes. Thus, it becomes imperative to distinguish chorioretinal lesions associated with M. chimaera, from lesions due to M. tuberculosis and other infectious disorders. To date, multimodal non-invasive imaging modalities that include ultra-wide field fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography and optical coherence tomography angiography, facilitate in vivo examination of retinal and choroidal tissues, enabling early diagnosis, monitoring treatment response, and relapse detection. This approach is crucial to differentiate between active and inactive ocular disease, and guides clinicians in their decisional-tree during the patients’ follow-up. In this review, we summarized and compared the available literature on multimodal imaging data of M. chimaera infection and tuberculosis, emphasizing similarities and differences in imaging patterns between these two entities and highlighting the relevance of multimodal imaging in the management of the infections. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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