Anatomic outcomes after retinal detachment surgery in patients with retinal detachment associated with choroidal detachment

PURPOSE: To investigate relationships between preoperative and intraoperative characteristics with outcome variables in patients suffering from primary rhegmatogenous retinal detachment (RRD) or traction retinal detachment (TRD) complicated by serous choroidal detachment (CD). Choroidal detachment is a rare complication of retinal detachment and the current literature cites generally poor visual outcome variables. By investigating a retrospective case series, we hope to elucidate new relationships and embolden existing ones so that future physicians can make more educated decisions regarding the care for these complicated patients. METHODS: A retrospective case series analyzed 18 patient’s medical records (18 eyes) who had been diagnosed and surgically treated for RRD or TRD associated with a CD at the Longwood Medical Eye Center at Beth Israel Deaconess Medical Center. Patients with RDCD who had undergone 23-gauge pars plana vitrectomy with silicone oil tamponade were selected. Exclusionary criteria included ocular complications such as phthisis bulbi and open globe trauma. Patients experienced a variety of surgical procedures including by not limited to relaxing retinotomy (n=12 eyes), choroidal drainage (n=10 eyes), endoscopy-assisted PPV (n=10 eyes), and ERM peeling (n=8 eyes). Primary outcome variables tabulated were primary and final anatomic success, defined as successful reattachment of the retina to the underlying choroid, and final visual acuity. RESULTS: The mean age of the sample group was 69 with 8 patients (44%) diagnosed with preoperative hypotony (IOP <= 6 mmHg). A total of 12 patients were pseudophakic (67%). With a mean follow-up of 21.6 months, patients exhibited expected visual outcomes with 6 patients (33%) improving visual acuity and 7 patients (39%) decreasing visual acuity. Final anatomic success was seen in 17 cases (94%). A significant correlation was found between decreased number of previous surgeries and better visual outcomes (change in BCVA). Another significant relationship correlates choroidal drainage with worse visual outcomes (change in BCVA). Finally, patients who received ERM peeling had better rates of primary anatomic success. CONCLUSION: The advanced age of the sample lends itself to increased risk for cataracts and thus pseudophakia. In addition, high rates of diabetes and macular degeneration follow. The pathophysiology of RDCD in relation to the risk factors of hypotony and macular holes is possibly based on the Starling forces and favorable fluid transudation into the suprachoroidal space. Although the outcomes of this study were similar to previous literature, the visual outcomes are still poor at best. Reducing the number of previous, invasive, ocular surgeries was seen to be correlated with better visual outcomes. In addition, performing ERM peels is seen to be correlated with improved rates of primary anatomic success. More research is required on the etiology of the disease process and a case-controlled longitudinal study may be helpful in determining more relationships with outcome variables

A Foundation LAnguage-Image model of the Retina (FLAIR): Encoding expert knowledge in text supervision

Foundation vision-language models are currently transforming computer vision, and are on the rise in medical imaging fueled by their very promising generalization capabilities. However, the initial attempts to transfer this new paradigm to medical imaging have shown less impressive performances than those observed in other domains, due to the significant domain shift and the complex, expert domain knowledge inherent to medical-imaging tasks. Motivated by the need for domain-expert foundation models, we present FLAIR, a pre-trained vision-language model for universal retinal fundus image understanding. To this end, we compiled 37 open-access, mostly categorical fundus imaging datasets from various sources, with up to 97 different target conditions and 284,660 images. We integrate the expert's domain knowledge in the form of descriptive textual prompts, during both pre-training and zero-shot inference, enhancing the less-informative categorical supervision of the data. Such a textual expert's knowledge, which we compiled from the relevant clinical literature and community standards, describes the fine-grained features of the pathologies as well as the hierarchies and dependencies between them. We report comprehensive evaluations, which illustrate the benefit of integrating expert knowledge and the strong generalization capabilities of FLAIR under difficult scenarios with domain shifts or unseen categories. When adapted with a lightweight linear probe, FLAIR outperforms fully-trained, dataset-focused models, more so in the few-shot regimes. Interestingly, FLAIR outperforms by a large margin more generalist, larger-scale image-language models, which emphasizes the potential of embedding experts' domain knowledge and the limitations of generalist models in medical imaging.Comment: The pre-trained model is available at: https://github.com/jusiro/FLAI

inSIGHT, Volume 4, Issue 1, 2024

Contents 8 - The Myopia Epidemic: Exploring the Pathology and Management of the World’s Most Common Eye Disorder By Gabriella Baldassare 15 - Evolution of Lamellar Keratoplasty By Ishan Kasat 19 - Bridging the Global Gap of Blindness Through Artificial Intelligence By Nathan Delacth 24 - CMV Retinitis: An Expert’s Perspective By Caitlyn Kwun 29 - Macular Holes: Diagnosis, Treatment, and Complications By Ayra Khan 36 - Chronic Progressive External OphthalmoplegiaBy Bahram Pashaee 39 - Medical Missions, Ethical Considerations, and the Future for Healthcare Delivery in Ophthalmology By Robert Medina 43 - Shaping the Future of Vision: The Rise of Light Adjustable Intraocular Lenses in Presbyopia Treatment By Shady Mina 48 - Cavernous Wonders: Delving into Cavernous Sinus Syndrome in Neuro-Ophthalmology By Anza Rizv

Smart grading of diabetic retinopathy: an intelligent recommendation-based fine-tuned EfficientNetB0 framework

Diabetic retinopathy is a condition that affects the retina and causes vision loss due to blood vessel destruction. The retina is the layer of the eye responsible for visual processing and nerve signaling. Diabetic retinopathy causes vision loss, floaters, and sometimes blindness; however, it often shows no warning signals in the early stages. Deep learning-based techniques have emerged as viable options for automated illness classification as large-scale medical imaging datasets have become more widely available. To adapt to medical image analysis tasks, transfer learning makes use of pre-trained models to extract high-level characteristics from natural images. In this research, an intelligent recommendation-based fine-tuned EfficientNetB0 model has been proposed for quick and precise assessment for the diagnosis of diabetic retinopathy from fundus images, which will help ophthalmologists in early diagnosis and detection. The proposed EfficientNetB0 model is compared with three transfer learning-based models, namely, ResNet152, VGG16, and DenseNet169. The experimental work is carried out using publicly available datasets from Kaggle consisting of 3,200 fundus images. Out of all the transfer learning models, the EfficientNetB0 model has outperformed with an accuracy of 0.91, followed by DenseNet169 with an accuracy of 0.90. In comparison to other approaches, the proposed intelligent recommendation-based fine-tuned EfficientNetB0 approach delivers state-of-the-art performance on the accuracy, recall, precision, and F1-score criteria. The system aims to assist ophthalmologists in early detection, potentially alleviating the burden on healthcare units

Corneal complications related to retinal surgical patients including analysis on silicone oil use

Postoperative corneal complications from pars plana vitrectomy surgery on the retina have been studied extensively in the literature. Researchers are aware of possible issues with oil tamponades, laser techniques, and other methods used. There could be clear markers to focus on a pattern of retina diagnoses of the patients that seem more prone to these problems in the front of the eye. Studies have noted refractive issues and increased cataract or posterior capsule opacification (PCO) progression but it is inconclusive in many studies on a corneal safety standpoint. Furthermore, a 23 or 27gauge pars plana vitrectomy has varying protocols depending on the diagnosis of the retina patient including endolaser, tamponade exchange, or even endoscopic cyclophotocoagulation. This study was conducted to research data looking at varying combinations of surgical type, diagnosis, and other patient characteristics to gain statistical evidence or relative frequency to better understand what type of retinal demographics cause corneal complications. The list of corneal complications in this study include: visual distortion involving anisometropia or photophobia, increased intraocular pressure including Uveitis-Glaucoma Hyphema syndrome, allergic conjunctivitis, a lens subluxation, herpes virus (zoster or simplex), a corneal scar or lesion, neurotrophic cornea, bullous keratopathy and corneal neovascularization. This was a retrospective case study evaulating 57 patients and 58 eyes that underwent a retinal surgery, with corneal complications at Beth Israel Deaconess Medical Center between October 2013 to December 2016. Number of patients, systemic demographics including frequency of hypertension and diabetes, and frequency of retina surgery per eye was analyzed. Moreover, we looked at different retina diagnoses to view which groups have a higher occurrence of complications after surgery. We used silicone oil as a way to divide the corneal complication patients to determine if the use of oil had an effect on a higher rate of issues after surgery. Eyes were divided into treatment with silicone oil group (n=23) and a non-silicone oil group (n=34), and we found that the silicone group had a significantly higher frequency of retinal surgeries (p<0.001). Moreover, there was no significant evidence between certain systemic factors (p<0.05), that allowed us to include the silicone oil and non-silicone oil patients as a unified group. When looking at our retina diagnoses we saw some groups had a higher percentage of complications when we took total number of problematic postoperative outcomes and divided that by total number of surgeries. Over one quarter of the surgeries per category leading to corneal complications occurred in the categories of subluxed lens, endophthalmitis, trauma, and uveitis-glaucoma hyphema Syndrome or neovascular glaucoma. Vitreomacular traction similarly had a high percentage of patients with corneal complications. Retinal detachment and epiretinal membrane were largest quantities of a specific retinal problem with low percentages of fewer than 15% with complications postoperatively. The study found that in our patient demographic silicone oil did not seem to be a factor in causing more corneal complications but it did cause more retinal surgeries. Moreover, certain retina diagnoses seem more prone to cause challenging outcomes, which leaves room for further studies distinguishing certain factors that could cause such specific issues