bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retinal imaging biomarkers in assessing treatment response when switching from aflibercept to faricimab in resistant neovascular age‐related macular degeneration cases
Authors: Kabanarou Stamatina , Bitzanakis Nikolaos , Sgourou Chrysoula , Gkizis Ilias , Fragkiskos Petros , Xirou Tina 
Published: January 2025

Aims/Purpose: To assess treatment response when switching from aflibercept to faricimab in neovascular age‐related macular degeneration cases (nAMD) using imaging biomarkers in optical coherence tomography (OCT) and OCT‐angiography (OCTA).Methods: This is a retrospective study of nAMD patients attending our clinic who have switched from aflibercept to faricimab treatment. Data collected from patients’ medical and imaging records included: ETDRS best corrected visual acuity (BCVA), OCT and OCTA. During OCT imaging the following features were identified: Central Retinal Thickness (CRT), Pigment epithelial detachment (PED), subretinal fluid (SRF), intraretinal fluid (IRF), hypereflective foci (HF). Ιn OCTA imaging the CNV activity was assessed according to standard activity criteria (lacy‐wheel shape, widely anastomosed network etc). All the aforementioned biomarkers were evaluated for all included patients every month after the initiation of treatment with faricimab.Results: 14 eyes of 14 patients were assessed, after a mean number of 2.4 injections. BCVA remained unchanged in 3 eyes and improved by a mean of 0.13 in the remaining cases. CRT was stable in 2 eyes and decreased by a mean of 100μm (range 21‐306) in 12. PED, SRF, IRF and HF were present in 13, 12, 9 and 7 eyes respectively, decreased in 7,9,5, and 1 eyes respectively and increased in 0,1,2 and 2 eyes respectively. In OCTA CNV showed less signs of activity in 3 patients and remained stable in the rest.Conclusions: In our study most of nAMD cases resistant to aflibercept treatment after switching to faricimab treatment showed improvement in all OCT biomarkers apart from HF. Also, some of them showed less signs of activity in OCTA. BCVA improved in the majority of cases, although this improvement was compromised due to the chronicity of the disease. Switching from aflibercept to faricimab in resistant cases, can be a beneficial alternative as evidenced by positive changes in OCT/OCTA biomarkers.
Study of complement system C3 protein expression in glial cells during retinal neurodegeneration
Authors: Fernández‐Sánchez Laura , Ruiz‐Conca Mateo , Estalrich Marta , Tebar Estela , Tornero Lucia , Kutsyr Oksana , Cuenca Nicolas , Lax Pedro , Maneu Victoria 
Published: January 2025

Aims/Purpose: Inherited retinal dystrophies (IRD) are retinal neurodegenerations that course with photoreceptor cell death and neuroinflammation. Microglia, astrocytes and Müller cells are the main glial cells involved in retinal neuroinflammation, but its role is still not fully understood. These cells show evidence of both beneficial and harmful effects. Two different phenotypes of microglia and astrocyte cells have been described in brain inflammation, neuroprotectant (M2 and A2, respectively), and neurotoxic (M1 and A1). The neurotoxic phenotype has been related to the activation of the complement system. In fact, the protein C3 has been identified as a marker of the neurotoxic phenotype in the brain. We aim to identify the different inflammatory profiles of glial cells involved in retinal inflammation present in neurodegenerative diseases.Methods: We used two mice models of IRD for this study, a rd10 mice as a model of RP, and Prph2KI/KI mice, as a model of central areolar choroidal dystrophy (CACD). The C57Bl/6 mice were used as healthy controls. We used specific antibodies for labeling the three retinal glial cell types and the complement factor C3 for performing expression analysis by flow cytometry and immunohistochemistry, using samples at different stages of retinal degeneration in each animal model of study.Results: Our results show that in retinal degeneration, the microglia, Müller cells and astrocytes display two different phenotypes according to C3 expression. The profile of C3 expression varies among glial cells as the degeneration progresses, possibly indicating a different contribution of each of them to the degenerative process. Interestingly, at least three different subpopulations of Müller cells were detected according to the expression of GFAP and C3 markers.Conclusions: We identified different phenotypes of glial cells during the course of retinal neurodegeneration in two different mice models of inherited retinal dystrophies. These results can help to better understand both the function and role of these cells on neuroinflammation.
Dynamic retinal vessel analysis with flicker light stimulation: Higher stimulation frequencies lead to higher vascular responses
Authors: Link Dietmar , Freitag Stefanie , Klee Sascha 
Published: January 2025

Aims/Purpose: Dynamic retinal vessel analysis (DVA) with flicker light is an established method of retinal vessel analysis. Stimulation is generally performed according to a standard protocol at 12.5 Hz. Technologically, a full‐field shutter is used, which is located in the illumination path. In 2002, Polak et al. investigated the flicker‐induced vascular response at different frequencies (2–64Hz). This showed that from frequencies > 4Hz, smaller responses tend to result. However, current developments in light stimulation are moving towards spatio‐temporal stimulators. We therefore used a spatial light modulator (SLM) in a DVA setup. In this work, we investigated vascular responses at a lower and higher stimulation frequency compared to 12.5Hz. The dilation maxima were determined and compared.Methods: We studied 12 subjects (7w, 5m, 26.6 ± 3.7yr, 1 eye). We measured two primary vessels each: a superior temporal artery and a vein. All subjects were free of ocular and systemic diseases. A high‐power LED (515nm) and a transmissive liquid crystal display (Sony LCX017AL) were connected to a mydriatic fundus camera. The SLM was controlled via standard graphics card and a customized software. The field of view was set to 30°. Each subject was measured two times. One measurement was carried out at 3.75Hz and one at 30Hz flicker frequency, randomized among the subjects. As in Polak et al. (2002), measurements were taken with 60s baseline, 60s flicker stimulation. Decay measurement was 120s. The pause time between two measurements was 15min. The mean value and standard deviation were calculated for each stimulation frequency and vessel type. The differences were tested for normal distribution and either the paired t‐test or the Wilcoxon signed‐rank test was performed.Results: All subjects were able to successfully complete the study (n = 12). Arteries showed a mean maximum dilatation of 2.8 ± 1.2% at 3.75Hz and 4.0 ± 1.6% at 30Hz (p = 0.023, Cohen's d = 0.765). Veins showed 2.8 ± 1.7% at 3.75Hz and 4.4 ± 2.5% at 30Hz (p = 0.005, Cohen's d = 1.015).Conclusions: We successfully performed a study on the generation of different flicker frequencies using a transmissive liquid crystal display. The results are contrary to those of Polak et al. (2002). Other parameters need to be compared in further studies.
Acute visual field loss as first presentation of cancer associated retinopathy
Authors: Moreno Sergio Inat , Fonseca Cristobal Andres Neira , Laguna Candela Congost , Peláez Blanca Casado , Gil Romana Garcia , Mirete Patricia Udaondo 
Published: January 2025

Aims/Purpose: To describe a case of cancer‐associated retinopathy (CAR) due to advanced bilateral ovarian cancer presenting with visual field loss, photopsia and nyctalopia.Methods: A case report of a 53‐year‐old female with bilateral serous surface papillary ovarian cancer stage IIIC with one week history of visual field defect, photopsia and nyctalopia. Patient has undergone multiple surgical interventions and chemotherapy cycles plus bevacizumab in the last 7 years.Results: At the presentation, best‐corrected visual acuity (BCVA) was 20/20 in both eyes, normal pupils with no relative afferent pupillary defect and no dyscromatopsia. She denied pain with ocular movements. Examination of anterior and posterior segment was unremarkable. Humphrey visual field test showed a bilateral concentric peripheral field loss. Macular spectral domain optic coherence tomography (SD‐OCT) was normal, however peripheral SD‐OCT revealed marked thinning of the outer retinal layers. Fundus Autofluorescence (FAF) exhibited hyperfluorescence in mid‐peripheral retina more notorious in perivascular areas. Full‐field electroretinogram showed asimmetrical cone and rod dysfunction. Given these clinical findings and the history of ovarian cancer, CAR diagnosis was made. Treatment was started with high dose corticosteroids, immunoglobulins and Rituximab achieving improvement of visual phenomena, stabilization of visual acuity and interruption of retinal damage on OCT and FAF after 3 months of follow‐up.Conclusions: CAR is a paraneoplastic syndrome with poor visual prognosis. A cross reaction occurs between tumor and retinal antigens triggering an autoimmune response leading to a retinal degeneration, being alpha enolase and anti recoverin the most common. More than fifty percent of cases test positive to these antibodies. Despite negative results, treatment is important because patients with visual improvement are described in literature.
Symptom management in melanoma associated retinopathy following intravitreal dexamethasone
Authors: Ilyas Ameerah , Mahroo Omar , Tan Jit Kai , Trepatchayakorn Supawat , Bloch Edward , Robson Anthony G. , Plant Gordon , Virgo Jonathon , Webster Andrew R. , Pavesio Carlos , Mohamed Moin 
Published: January 2025

Aims/Purpose: Patients with melanoma‐associated retinopathy (MAR) experience visual impairment, which can persist even following remission of the melanoma. Here we report two patients in whom symptoms improved following intravitreal dexamethasone implants.Methods: An 81 year old man reported recent onset visual disturbance. Electroretinograms (ERGs) revealed loss of ON bipolar signals, raising the possibility of MAR. Further investigation revealed metastatic melanoma. The patient underwent treatment, resulting in melanoma remission. The second patient (an 87 year old man) was diagnosed with metastatic melanoma and later developed visual symptoms in his better eye (the other eye had a prior ischaemic retinal vein occlusion). ERGs revealed selective ON bipolar signal loss, consistent with MAR. In both patients, despite systemic melanoma treatment, visual symptoms persisted.Results: The first patient underwent cycles of plasma exchange, but vision continued to deteriorate, with visual acuity reaching 20/120 and 20/600 in right and left eye respectively. In light of prior reports of intravitreal steroids improving some cases of MAR, he underwent intravitreal dexamethasone implants. This was associated with subjective improvement of symptoms as well as improved acuity. Multiple treatments were performed to both eyes, with visual acuity stabilising around 20/80 in both eyes. The second patient found his symptoms of photopsia and impaired colour vision troubling. Visual acuity dropped to 20/40. After one intravitreal dexamethasone implant, symptoms improved markedly, with acuity also improving slightly to 20/30. Both patients remain under review.Conclusions: The cases highlight the importance of considering possible paraneoplastic retinopathy in visual dysfunction and apparently unremarkable examination (in the first case, the symptoms preceded the melanoma diagnosis). The cases add to the few existing case reports of possible benefit from intravitreal steroid in MAR.ReferencesAmeerah Ilyas,1 Jit Kai Tan,1–3 Supawat Trepatchayakorn,2 Edward Bloch,1–3 Anthony G. Robson,1,4 Gordon T. Plant,5 Jonny Virgo,3 Andrew R. Webster,1,2 Carlos Pavesio,1,2 Moin D. Mohamed,3 Omar A. Mahroo1–4
UCL Institute of Ophthalmology
Retinal Service, Moorfields Eye Hospital
Assessment of ophthalmology residents' perspectives on the utilization of artificial intelligence in contemporary practices
Authors: Fendouli Ines , Aoun Safa Ben , Maamouri Rim , Sakji Fatma , Slim Selmi , Amri Monia Cheour 
Published: January 2025

Aims/Purpose: To survey ophthalmology residents on their perspectives of artificial intelligence (AI) and their implications regarding its potential use in ophthalmology.Methods: Online anonymous questionnaire sent out via e‐mail toTunisian ophthalmology residents from all different educational levels (1st to 5th year) between May and June 2024. The survey contained 18items, assessing the extent participants either "Yes" or "No" or multiple choice with statements on the perceived benefits and concerns of AI in ophthalmology. Responses were analyzed using descriptive statistics. Data were analyzed using SPSS 26.0Results: Thirty ophthalmology residents were included. Of the participants, 70% were female,and 30% were male. The mean age was 28.26 years ± 3 years. Among the participants, 73.3% consider themselves to have enough potentials to understand AI, and 86.7% recognize the importance of adapting to AI in ophthalmology. According to Tunisian ophthalmology residents, AI most important applications in this field include diabetic retinopathy (30%) and optical coherence tomography angiography (26.7%). Eight residents thought that AI can improve the practice of ophthalmology by 50%. All participants agreed on that AI could save time for patients; 96.7% believed AI cannot replace physicians. For83.3% of residents, considering learning AI basics ought to be mandatory during the medical curriculum, as 90 % believed that this tool can help making more accurate diagnosis; 93.3% believed it may reduce consultation time for residents, and 90 % agreed it may help in management and treatment prescription. More than ¾ tried to adapt AI in clinical practice and almost 97% of residents are willing to adapt AI to facilitate research.Conclusions: Learning and applying AI for clinical practice may be a promising technology for ophthalmology residents, in order to save time, facilitate diagnosis and management. Moreover, Tunisian residents seem to be willing to improve their competences in this field and adapt this tool for research and medical publications.Reference
Ting DSW, Pasquale LR, Peng L, Campbell JP, Lee AY, Raman R, Tan GSW, Schmetterer L, Keane PA, Wong TY. Artificial intelligence and deep learning in ophthalmology. Br J Ophthalmol. 2019 Feb; 103(2): 167‐175.
Regulation of the stress response of müller cells after retinal detachment by amniotic membrane secretome in vitro
Authors: Hillenmayer Anna , Christian Wertheimer , Thomas Sterz , Azza Dammak , Armin Wolf 
Published: January 2025

Aims/Purpose: Müller cells play a key role in retinal homeostasis, structural support and immune response. They respond to retinal detachment and subsequent hypoxic conditions with increased stress response leading to structural changes. Due to the stabilizing properties of the amniotic membrane, first potential intraocular applications in vitreoretinal pathologies have been published. The aim was to investigate possible effects of amnion on Müller cells in the context of hypoxic damage after retinal detachment in vitro.Methods: Secretome was isolated from cryopreserved amniotic membranes. Immortalized Müller cells (MIO‐M1) with and without hypoxia treatment were incubated with the secretome and toxicity was excluded by a life/death assay and a cell death detection ELISA. A Wst‐1 and BrdU assay were performed for cell activity and proliferation; Western blot analysis and immunofluorescence staining were used to detect changes in protein expression of alpha‐SMA, SOX‐2 and GFAP.Results: Both hypoxia and the addition of amniotic secretome significantly reduced the metabolic activity of the cells. Incubation with secretome led to a statistically significant stagnation under both normoxic (p = 0.005) and hypoxic conditions (p > 0.01) in cell proliferation. Hypoxia led to increased expression of alpha‐SMA (p = 0.6), GFAP (p = 0.02) and SOX‐2 (p = 0.03) in Western blot analysis while secretome led to a normalization of alpha‐SMA (p = 0.03), GFAP (p = 0.1) and SOX‐2 (p = 0.001) under normoxic as well as hypoxic conditions. This observation was affirmed in immunofluorescence. Toxicity was excluded.Conclusions: In vitro simulation of hypoxic conditions in retinal detachment leads to stress responses of Müller cells. The amniotic secretome appears to regulate Müller cell behavior in vitro by supporting a stable phenotype under normoxic and hypoxic conditions. Further studies are needed to evaluate the clinical potential of the amniotic secretome after retinal detachment.
Evaluation of macular ganglion cell layer‐inner plexiform layer (GCL‐IPL) thickness in patients treated with ozurdex: A retrospective study from a swiss cohort of patients
Authors: Rizzato Angelica , Kochkorov Asan , Katamay Robert , Katja Hatz 
Published: January 2025

Aims/Purpose: To investigate the effect of Dexamethasone intravitreal implants (Ozurdex®) on macular GCL‐IPL thickness in patients treated for diabetic macular edema (DME), retinal vein occlusion (RVO), and non‐infectious uveitic macular edema (UME).Methods: All eyes receiving Ozurdex® between 2013 and 2021 were included and assigned to group 1 ( ≤ 5 implants) or group 2 ( > 5 implants). Clinical records were reviewed, and SD‐OCT images manually segmented. Data were evaluated at baseline and at 3 years ± 4 months. Exclusion criteria were poor imaging quality, lack of adequate follow‐up, and absence of dry SD‐OCT at the timepoints. Primary outcome is change in macular GCL‐IPL thickness between baseline and 3‐year follow‐up, compared using paired t‐test. Secondary outcome: incidence of ocular hypertension (IOP > 25mmHg) at three years, compared using Fisher's exact test.Results: 82 eyes of 73 patients were included (mean age 67.5 years). 30 eyes with DME, 26 with RVO, and 26 with UME. Group 1 (40 eyes) received a mean of 3.0 injections (SD = 1.5; range = 1‐5), while group 2 (42 eyes) received a mean of 7.9 injections (SD = 1.7; range = 6‐14). Macular GCL‐IPL thickness in group 1 was not significantly reduced after 3 years (mean difference: ‐1.8μm, 95% CI: ‐4.4; 0.8, p = 0.18), while group 2 showed significant reduction (mean difference: ‐5.9μm, 95% CI: ‐10.5; ‐1.3, p < 0.05). However, no significant difference in new ocular hypertension cases between group 1 (42.5%) and group 2 (38.0%), p = 0.82 was found.Conclusions: The study shows that repeated Ozurdex® injections are associated with significant reduction in macular GCL‐IPL thickness over 3 years, however, despite increased ocular hypertension in both groups, no significant differences between groups were found. These findings highlight the need for long‐term monitoring of macular GCL‐IPL thickness and intraocular pressure in patients receiving multiple Ozurdex® injections for DME, RVO, and UME.
Association between atherosclerotic cardiovascular disease risk and diabetic retinopathy in patients with type 2 diabetes mellitus
Authors: Agapitou Chrysa , Lampsas Stamatios , Risi‐Koziona Alexia , Kyratzidis Fotis , Pappelis Konstantinos , Theodossiadis Panagiotis , Chatziralli Irini 
Published: January 2025

Aims/Purpose: The purpose of this study is to examine the association between diabetic retinopathy (DR) and the atherosclerotic cardiovascular disease (ASCVD) risk in patients with type 2 diabetes mellitus (DM) and to assess risk factors potentially associated with DR.Methods: Participants in the study were 215 patients with type 2 DM, who underwent a thorough ophthalmic examination, including best‐corrected visual acuity (BCVA) measurement, dilated fundoscopy, fundus photography, optical coherence tomography (OCT) and OCT angiography (OCTA). DR was graded as no apparent retinopathy (NDR), mild non‐proliferative (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). In addition, a detailed medical history of patients was recorded, while the ASCVD risk estimator plus by the American College of Cardiology was used to calculate the ASCVD risk.Results: Multivariate logistic regression analysis showed that factors associated with DR independently were: DM duration (multivariate OR = 3.16, 95% CI: 1.55‐6.44, p = 0.002), HbA1c levels (multivariate OR = 2.94, 95% CI: 1.37‐6.32, p = 0.006) and presence of neuropathy (multivariate OR = 3.59, 95% CI: 1.43‐9.05, p = 0.007). At the multivariate multinomial logistic regression analysis, NPDR development was associated with duration of DM (multivariate RR = 3.31, 95% CI: 1.57‐6.97, p = 0.002), HbA1c levels (multivariate RR = 2.24, 95% CI: 1.00‐5.02, p = 0.050) and neuropathy (multivariate RR: 3.94, 95% CI: 1.54‐10.11, p = 0.004), while PDR development was only associated with HbA1c levels (multivariate RR = 6.88, 95% CI: 2.19‐21.63, p = 0.001). The ASCVD score was not found to be significantly correlated with DR (p = 0.191).Conclusions: Factors associated with DR were DM duration, HbA1c levels and presence of neuropathy, while the ASCVD score was not found to be significantly associated with DR.
Optical coherence tomography findings in persistent hyaloid artery: A prospective study
Authors: Sakji Fatma , Aoun Safa Ben , Maamouri Rym , Ferchichi Molka , Fendouli Ines , Cheour Monia 
Published: January 2025

Aims/Purpose: To describe the features of peripapillary persistent hyaloid artery and its effects on disc parameters using Swept‐source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCT A).Methods: Seven eyes of 7 patients diagnosed with Persistent hyaloid artery were prospectively reviewed at the department of Ophthalmology in the Habib Thameur Hospital, Tunisia, between January 2024 and June 2024. All patients were assessed for peripapillary retinal nerve fibers layer (pRNFL) thickness by SS‐OCT, and blood flow by papillary OCT‐A, 4.5 mm*4.5 mm cubes.Results: Mean age was 36.33 years, with 4 women and 3 men. SS‐OCT showed peripapillary hyperreflective tubular material of the persistent hyaloid artery in the right eye of 3 patients and in the left eye of 4 patients. On analysis of the pRNFL thickness, the mean average thickness was 110.8, Inferior quadrant (150.8), superior quadrant (134), nasal quadrant (83.4) and temporal quadrant (74.8). pRNFL were thickened in one eye, altered in one eye in the superior quadrant, and preserved in five eyes. SS‐OCT A revealed no blood flow at the lesion in all eyes.Conclusions: A persistent hyaloid artery is an uncommon lesion whose diagnosis, evaluation and monitoring have become easily possible using SS‐OCT and SS‐OCT A. Evaluating the vascular flow at the level of the optic nerve head would be of great importance in order to prevent certain complications, notably vitreous hemorrhage and retinal detachment.References
Jeon, H., Kim, J., & Kwon, S. OCT angiography of persistent hyaloid artery: a case report. BMC Ophthalmol. 2019 Jul 4; 19(1): 141.
Gamidov AA, Durzhinskaya MH, Makashova NV, Sakalova ED, Velieva IA. Persistent hyaloid artery in an adult (a case report). Vestn Oftalmol. 2020; 136(4): 214.