bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemedicine‐based eye screening program in Castilla and León: A reading centre‐assisted model
Authors: Lope Pablo Arlanzón , Espinilla Óscar García , Díez Andrea Novo , Recio Inmaculada Yepes , de la Iglesia Rodríguez Purificación , Gálvez María Isabel López , Jimeno José Carlos Pastor 
Published: January 2024

Aims/Purpose: Diabetes Mellitus is a disease with increased prevalence in the world with an estimation of 8 to 10% of the European population affected. Diabetic retinopathy (DR) is its main ocular complication (affecting up to 20% of diabetics) and the main cause of vision loss in European working population. DR screening via telemedicine is fully accepted as a powerful tool to maintain the standards of care. Castilla and León is an extensive autonomous community in Spain and developed a telemedicine eye screening program based on reading centre (RC) support. The purpose of this work was to analyse the results achieved by the program in the period 2018–2022.Methods: Program is currently active in two provinces and scheduled to be extended to all. It consists of 8 non mydriatic fundus cameras used by certified photographers acquiring images according to the JVN protocol under mydriasis. The images are analysed remotely at IOBA RC by a certified optometrist, or an ophthalmologist in case of suspicion of pathology.Results: Globally, 22 430 examinations (179 440 pictures) have been performed since the beginning. Only 8.7% of examinations were not valuable, mainly due to media opacities. Of gradable examinations 70% showed no signs of pathology and 13.2% showed any level of DR. Only 1.3% had sight‐threatening DR and were referred to secondary care (hospital). In addition, 8.1% showed other pathology but RD and 33 patients were referred (AMD, vascular occlusions, etc.). The range of recruitment referred of global diabetic census is 54.2%–21.51% despite the impact of the pandemic. Our goal is to reach 70% of census.Conclusions: RC assisted telemedicine is a successful model for DR screening. It allows for the identification of sight‐threatening RD, other prevalent eye pathology and its referral for treatment, thus maintaining the standards of care for the diabetic population contributing to reducing the care burden of hospitals and the health system sustainability.
Detection of subretinal and intraretinal fluids in optopol SD‐OCT using transfer learning
Authors: Assaf Abdelrahman , Orabi Mohamad , Loktyushin Alexander , Aydin Sökmen , Lanzl Ines 
Published: January 2024

Aims/Purpose: The detection of subretinal fluid (SRF) and intraretinal fluid (IRF) in optical coherence tomography (OCT) images plays a crucial role in the diagnosis and treatment of certain eye diseases. In this study, we investigated the performance of a Transfer Learning artificial intelligence (AI) technique, which we used to perform the model adaptation from the domain of Heidelberg OCT images to Optopol devices.Methods: A data set of 133 Optopol OCT images. 69 images indicating subretinal or intraretinal fluid and 64 fluid‐free images, were analysed. The AI algorithm that was initially trained on OCT images from Heidelberg device was fine‐tuned to perform the biomarker segmentation in Optopol (Revo NX, SOCT Copernicus REVO, REVO FC) OCT images. Manual assessments by the medical experts were used to evaluate the algorithm's performance.Results: Our findings demonstrate the promising performance of the domain‐adapted model. in detecting SRF and IRF, when initially trained on OCT images from a different device. The algorithm achieved an accuracy of 80% while classifying the presence versus absence of the fluids on the balanced test data set.Conclusions: The study demonstrates a successful application of a transfer learning technique for detection of subretinal and intraretinal fluids in OCT images acquired with the Optopol devices, indicating its potential for enhancing eye diagnostics. Further studies utilizing larger data sets, further biomarkers and diverse OCT devices are warranted to validate the algorithm's robustness and generalizability.
Retinal thickness as sensitivity as biomarkers of neurodegeneration in moderate diabetic retinopathy
Authors: Boned‐Murillo Ana , Fernández‐Espinosa Guisela , Hospital Elvira Orduna , Diaz Maria Dolores , cano Ana Sánchez , Pinilla Maria Sopeña , Bielsa Sofia , Lozano Isabel Pinilla 
Published: January 2024

Aims/Purpose: To analyse total retinal thickness (RT) and inner retinal layers (IRL) in Type 2 diabetes mellitus (DM2) patients, measured with swept source OCT (SS‐OCT), and retinal sensibility with microperimetry.Methods: A total of 54 DM2 subjects with moderate diabetic retinopathy (DR) with no signs of diabetic macular oedema (DME) and 73 age‐matched healthy individuals were assessed by SS‐OCT to quantify retinal thickness in the nine macular areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Retinal sensibility was measured by microperimetry with MAIA.Results: Mean ages were 64.06 ± 11.98 years for the DM2 group and 60.79 ± 8.62 years for the control group. DM2 patients presented lower visual acuity (p < 0.001), RT was significantly higher in the outer temporal area (260.70 ± 19.22 μm in the control group vs. 271.90 ± 37.61 μm in the DM2 group, with p = 0.01), and retinal nerve fibre layer (RNFL) was significantly lower in the outer nasal area (50.38 ± 8.20 μm vs. 45.17 ± 11.25 μm, p = 0.005). Ganglion cells and inner plexiform layers (GCL+) in the parafoveal areas were thinner in DM2 and RT, GCL+ and GCL+ with RNFL (GCL++) significantly diminished with age in the outer ring. A positive correlation between LDL‐C and RNFL and a negative correlation between HDL‐C levels and inner temporal and central RNFL thickness were detected. The central and inner nasal areas presented a negative correlation between RNFL (p = 0.015) and MAIA (p = 0.008), while the outer inferior area showed a positive correlation (p = 0.025).Conclusions: Retinal sensitivity and macular RNFL thickness decrease in DM2 with moderate DR with no DME. Its correlation suggests the existence of diabetic retinal neurodegeneration.
Choroidal thickness after anti‐vascular endothelial growth factor in treatment‐naïve typical neovascular age‐related macular degeneration patients: A systematic review and meta‐analysis
Authors: Hoven Erlend , Michelet John‐Thomas , Vettore Mario , Lagali Neil 
Published: January 2024

Aims/Purpose: To evaluate the effect of anti‐vascular endothelial growth factor (anti‐VEGF) on choroidal thickness (CT) in treatment‐naïve typical neovascular age‐related macular degeneration (AMD) patients during the loading phase.Methods: A systematic literature search was conducted in CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, Clinical Trials, ICTRP and ISRCTN from inception to October 19, 2022. The protocol was registered with PROSPERO (CRD42022371192). We included both retrospective and prospective randomized controlled trials, cohort studies, case control and case series of typical neovascular AMD patients. Studies with polypoidal choroidal vasculopathy or unclear diagnoses and reports in other languages than English were excluded. Risk of bias was assessed using critical appraisal tools provided by Joanna Briggs Institute.Results: 43 studies were included in the review. Meta‐analysis of all studies reporting sufficient data and simultaneously disregarding measurement technique, macular neovascularization (MNV) type and anti‐VEGF type, yielded a significant decrease of CT with anti‐VEGF treatment. To decrease bias, sub‐analyses for Type 1 and 2 MNV sorted by anti‐VEGF type found a significant effect for both aflibercept and ranibizumab, and the effect appears greater in the aflibercept group. For Type 3 MNV, the baseline CT was generally thinner and the decrease more modest.Conclusions: Anti‐VEGF drugs decrease CT in typical neovascular AMD. There is a greater effect of aflibercept compared to ranibizumab. For bevacizumab and brolucizumab there are few studies, but available data show a tendency of greater effect in the latter. There are low numbers of randomized trials on the topic and publication bias might affect the results. More studies randomized to treatment of patients with a thin baseline choroid should be conducted.
Multimodal imaging study and clinical management in Coats' disease
Authors: Abellán Maria Victoria Navarro , Moreno Elisa Foulquié , Perea Juan Antonio Sánchez , Menargues Manuel Almarcha , López Carmen Miquel , Sánchez María De Los Reyes Retamero , Medina José Javier García 
Published: January 2024

Aims/Purpose: Coats' disease is an idiopathic ocular condition characterized by retinal telangiectasia, aneurysms, and exudation, frequently affects unilateral eyes of young males. Rare pathology of difficult diagnosis and clinical management. Follow‐up by multimodal imaging of clinical improvement after correct treatment in Coats' Disease.Methods: Morales Meseguer University Hospital, Murcia, Spain. Observational study using multimodal imaging of clinical cases in patients diagnosed with Coats' disease. Retrospective follow‐up during several visits between 2021–2023. Images taken with optical coherence tomography (OCT), fluorescein angiography (FA) and autofluorescence.Results: Presentation two clinical cases. A 56‐year‐old female and a 28‐year‐old male diagnosed with Coats disease in right eye. Best corrected visual acuity (BVAC) of 0.6 and 0.5, respectively. Female had macular oedema (ME) with hard exudates in temporal arcade territory with areas of venous and arterial sheathing, macroaneurysm in inferior temporal arcade territory. Hypertrophy of the peripheral retinal pigment epithelium. OCT shows EM, subretinal fluid (SRF) and hyperreflective dots in middle layers. Male with a history of vitrectomy and phacoemulsification after regmatogenous and tractional retinal detachment secondary to the disease, presents pseudophakia, angular synechiae and iridotomies, vascular malformations, inferior haemorrhages, zone of temporal and nasal inferior exudation with FSR area, inferior tear pigmented with laser. OCT shows ME with FSR. Both cases, FA proves blood fluids levels and saccular aneurysms of arterial arterioles and venules. We note an improvement BVAC and EM with resolution of FSR on multimodal imaging study after intravitreal and focal laser treatment.Conclusions: Multimodal imaging in the follow‐up of Coats' disease is essential to assess correct treatment. Treatment with focal laser and intravitreal therapy is safe and effective in control of Coats disease.
Sarcoidosis‐related uveitis: A case series study
Authors: Chafter Camilia , Maamouri Rym , Ammar Nadia Ben , Somai Mehdi , Boussema Fatma , Cheour Monia 
Published: January 2024

Purpose: The aim of this study was to characterize the epidemiological and clinical characteristics of ocular involvement in patients with systemic sarcoidosis.Methods: Retrospective case series study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between the 1st January 2022 and the 1st January 2023. Fifteen patients (30 eyes) were included. Based on the International Workshop on Ocular Sarcoidosis criteria, three patients had biopsy‐proven sarcoidosis; eight had presumed sarcoidosis and four had probable sarcoidosis. All patients had a complete ocular examination and systemic work‐up.Results: The median age at presentation was 45 years (range: 29–66). The sex ratio was 1:13. Ocular involvement was the presenting symptom in 11 patients. Bilateral granulomatous uveitis was the presenting form in all patients. Panuveitis was the most common anatomic pattern (9), followed by anterior (3), anterior and intermediate (2) and intermediate (1) uveitis. Posterior segment involvement included multifocal choroiditis (3) retinal vasculitis (5) macular oedema (4) and optic nerve head granuloma (1). Systemic manifestations included bilateral hilar lymphadenopathy (8) eyelid granuloma (2) neurosarcoidosis (3) Peripheral facial nerve palsy (2).Conclusions: Uveitis was the initial presentation of sarcoidosis in the majority of our subjects. Panuveitis was the most commonly encountered anatomic form. Our findings support the prominent role of the ocular examination in the early detection of sarcoidosis.
Characterization of a new fluorescence lifetime imaging ophthalmoscope
Authors: Nycz Julia , Link Dietmar , Klemm Matthias , Klee Sascha , Haueisen Jens 
Published: January 2024

Aims/Purpose: Fluorescence lifetime imaging ophthalmoscopy (FLIO) allows in vivo measurement of autofluorescence intensity decays of endogenous fluorophores in the ocular fundus. So far, only devices from Heidelberg Engineering based on the Spectralis system have been used in FLIO research. Here, we present and characterize a new FLIO device based on the RETImap system from Roland Consult.Methods: The device is based on a confocal scanning laser ophthalmoscope (35° field, 512 × 512 px). A ps diode laser (BDL‐SMN 473 nm, Becker & Hickl GmbH, Berlin, Germany) excites autofluorescence. The fluorescence photons are split into a short (498–560 nm, SSC) and a long (560–720 nm, LSC) spectral channel (one HPM‐100‐40 detector [Becker & Hickl GmbH] each) and are detected by time‐correlated single photon counting (SPC‐160, Becker & Hickl GmbH). We determined the maximum laser power (ILT2400, International Light Technologies, Inc. Peabody, MA, USA) and analysed the instrument's behaviour at three different laser power levels (150 μW, 200 μW and max.) in terms of laser spectrum (CAS140CT, Instrument Systems GmbH, Munich, Germany) and instrument response function (IRF). The IRF was determined using a 25 μM Eosin Y solution, mixed with a 5 M solution of potassium iodide, placed in a flat cuvette (110‐OS, Hellma GmbH & Co. KG, Müllheim, Germany) in front of the objective lens of the FLIO device. Fluorescence measurements of approximately 1‐min duration were performed three times for all three laser powers. The IRF and the full width at half maximum (FWHM) were calculated using FLIMX software (www.flimx.de).Results: The max. laser power was 280 μW. The peak wavelengths of the laser spectra were 467.6 (150 μW), 467.9 (200 μW) and 468.0 nm (280 μW). IRF FWHM in SSC were 298.6 ± 1.1 ps (150 μW), 341.0 ± 2.5 ps (200 μW) and 347.5 ± 6.0 ps (280 μW). In LSC, the IRF FWHM were 290.4 ± 3.8 ps (150 μW), 344.0 ± 3.4 ps (200 μW) and 358.8 ± 1.3 ps (280 μW). Results are mean ± standard deviation.Conclusions: A new fluorescence lifetime imaging ophthalmoscope has been characterized. The device offers a high laser power for fluorescence excitation, a large field of view, a high spatial resolution, and a sufficiently high time resolution. Thus, it is suitable for fluorescence lifetime studies.
Emergency treatment approaches for central retinal artery occlusion
Authors: Smiri Meryam , Nassim Haddoum Karim , Abdeldjalil Mansouri , Mohamed El Sanharawi 
Published: January 2024

Aims/Purpose: Central retinal artery occlusion (CRAO), which can be likened to a stroke in the eye, is considered a critical condition requiring immediate attention. The aim of this case was to assess whether anterior chamber paracentesis has a notable impact on the ultimate visual acuity in eye experiencing acute CRAO.Methods: We present the case of a 62‐year‐old man with no significant ophthalmological history, only hypertension under treatment. Presented to the emergency care within an hour after experiencing a sudden decrease in visual acuity in his left eye, whose visual prognosis improved after an urgent ocular chamber paracentesis.Results: The ophthalmological examination revealed a visual acuity of 10/10 on the right (OD) and positive light perception/10 on his left eye (OS). The intraocular pressure was normal in both eyes. Slit lamp and fundus examination showed on OS a positive reflex afferent pupillary defect and a whitish appearance of the retina, with narrowed retinal blood vessels and a cherry red spot in the macula while all was normal on OD. In this case an anterior chamber paracentesis was conducted, involving the removal of 0.3 mL of aqueous fluid from the anterior chamber using a small (30 gauge) needle. By decreasing the intraocular pressure through medical means (acetazolamide 250 mg 1cp 3 times a day for 7 days) and performing the anterior chamber paracentesis, the aim is to optimize the conditions for promoting the movement of any potential embolus away from the central retina and along the vessel. After one week, significant improvement was observed. The visual acuity in the OS was measured at 9/10, and the intraocular pressure was 10 mmHg. Ophthalmoscopic examination revealed the disappearance of the previously observed whitish retina, with a granular appearance of the macula. Despite these positive changes, impairment in the visual field has been noted and still persistent even after six months of follow‐up.Conclusions: Paracentesis, by reducing intraocular pressure, can enhance retinal arterial perfusion pressure, vasodilatation and the dislodgement of thrombi or emboli. Despite the prognosis often being poor, it is essential to take quick action and implement appropriate management strategies to prevent permanent vision loss.
Pre‐operative OCT in idiopathic epiretinal membrane surgery: The importance of biomarkers in predicting visual outcomes
Authors: Monteiro Catarina , da Costa Tomás Reis , Dias Maria Teixeira , Almeida Júlio , Ramalho Mário , Pires Graça , Teixeira Susana , Prieto Isabel 
Published: January 2024

Aims/Purpose: To evaluate the influence of inner segment (IS)/outer segment (OS) junction integrity in the post‐operative visual outcomes in patients submitted to idiopathic epiretinal membrane surgery.Methods: This was a retrospective observational study that included patients who underwent plana vitrectomy with internal limiting membrane (ILM) peeling between 2017 and 2022 our centre. All patients were submitted to a complete ophthalmological observation and high‐resolution (HR) spectral domain optical coherence tomography (SD‐OCT) (Spectralis® Heidelberg) scans centred on the fovea. Best corrected visual acuity (BCVA) and OCT morphology were evaluated pre‐operatively and at 1, 3, 6 and 12 months after the surgery. Our main outcome was to understand if there was a statistical correlation between the pre‐operative IS/OS junction integrity status and post‐operative BCVA gain.Results: This retrospective study included 39 eyes from 39 patients (19 male and 20 female) with a mean age of 70.9 ± 7.8 years. Pre‐operatively, mean BCVA was 0.23 ± 0.12. Pre‐operative OCT scans revealed a mean central foveal thickness (CFT) of 549 ± 110 μm. BCVA showed a mean post‐operative improvement of 0.09 ± 0.14 at 1 month, 0.19 ± 0.17 at 3 months, 0.26 ± 0.21 at 6 months and 0.29 ± 0.23 at 12 months. There was a mean CFT reduction of 77 ± 87 μm, 129 ± 116 μm, 136 ± 121 μm and 160 ± 135 μm at 1, 3, 6 and 12 months post‐operatively. Regarding IS/OS junction status, 20 patients presented with an intact IS/OS junction and 19 patients with a disrupted or irregular junction. At 6 and 12 months post‐operatively, the correlation between visual acuity gain and IS/OS status was statistically very significant (p‐value = 0.008 and 0.002, respectively).Conclusions: IS/OS junction status in pre‐operative OCT seems to be a strong predictor of visual outcomes in patients submitted to vitreoretinal surgery for idiopathic epiretinal membrane. This biomarker should be taken into account regarding the visual prognosis of these patients.
Research of branched retinal vein occlusion with arteriovenous crossing site
Authors: Noh Seung Yoon , Kim Taehwan , Kwon Yoonhyung 
Published: January 2024

Aims/Purpose: The study was designed to analyse the incidence of branch retinal vein occlusion with characteristics of arteriovenous crossing.Methods: Patients diagnosed with branch retinal vein occlusion from January 2012 to January 2017 were enrolled. We selected 117 patients with recognizable arteriovenous crossing on fundus photography. The control group consisted of 120 patients who had no eye disorders and normal fundus photography. To analyse the characteristics of BRVO arteriovenous crossing, the sites were compared with arteriovenous crossing sites in similar locations in the contralateral vascular arcade of the BRVO site. Second, the numbers of arteriovenous crossings and crossings in which the positions of an artery and a vein alternated in the main venous pathways were studied. Last, distances between arteriovenous crossings at the main venous pathway were analysed.Results: Of branch retinal vein occlusion patients, 75.2% showed an artery anterior to the vein at arteriovenous crossing sites. In the control group, 61.5% of arteriovenous crossing sites showed artery anterior to the vein. The total number of arteriovenous crossing sites was not different from that of the contralateral arcade in the same eye, but the number of arteries anterior to veins was significantly different. The total number of arteriovenous crossing sites was statistically different from that of the control group of normal people. Distance between arteriovenous crossings were measured by the ImageJ program. Group A showed a 2.619 ± 0.859 DD (Disc Diameter) and group C was 3.505 ± 0.859 DD, a significant difference.Conclusions: The study shows that arteriovenous crossing sites play an important role in branch retinal vein occlusion, and an artery anterior to a vein is more important at such crossing sites. Moreover, the distance between arteriovenous crossing sites can affect the incidence of BRVO.
Role of heparin‐binding mediators in the resistance to anti‐VEGF therapies in diabetic retinopathy
Authors: Rezzola Sara , Loda Alessandra , Mutti Greta , Romano Vito , Morescalchi Francesco , Tabellini Giovanna , Parolini Silvia , Semeraro Francesco 
Published: January 2024

Aims/Purpose: Anti‐vascular endothelial growth factor (VEGF) drugs represent the standard of care for diabetic retinopathy (DR); however, lack of response occurs in approximately 50% of patients. Aim of our work is the identification of the mediators responsible for anti‐VEGF drug resistance.Methods: Vitreous samples were collected from anti‐VEGF non‐responder (non‐RES) patients; non‐RES heat‐inactivated (HI) vitreous were used as control. To develop a new orthotopic model of DR, non‐RES or HI vitreous were injected intravitreally in mice and after 48 h retinas were explanted and analysed. The composition of non‐RES vitreous was assessed by an angio‐inflammatory protein array. The effect of the inhibition of the bioactive heparin‐binding mediators (HBMs) present in non‐RES vitreous was evaluated in the endothelial spheroid sprouting assay.Results: Mouse orthotopic intravitreal injection of non‐RES vitreous upregulated the expression of pro‐angiogenic/pro‐inflammatory mediators; moreover, it induced alterations of retinal vessels, accumulation of inflammatory infiltrate, and activation of astrocyte gliosis. Notably, HI vitreous was ineffective, pointing to a proteinaceous nature of the non‐RES vitreal mediators acting on mouse retinae. In this context, the blockade of vitreal HBMs mediated by the biotechnological heparin‐like molecule K5‐N, OS (H) or by the pentapeptide Boc2, completely abrogated the activity of non‐RES samples. It is worth noticing that the potency of anti‐HBP compounds was significantly higher than the anti‐VEGF ranibizumab, which was partially effective only at the clinically relevant and saturating concentration of 10 μM, with no further improvement at a double dose.Conclusions: Our data show that VEGF is only part of a complex machinery regulating angiogenesis, inflammation and oedema formation during DR and that drug resistance is due to the activation of compensatory mechanisms mediated by HBMs besides VEGF.