Artificial Intelligence to Detect Papilledema from Ocular Fundus Photographs.

BACKGROUND: Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. METHODS: We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists. RESULTS: The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1). CONCLUSIONS: A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities. (Funded by the Singapore National Medical Research Council and the SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Program.)

Characteristics And Visual Outcome Of Neuromyelitis Optica Spectrum Disorder-Related Optic Neuritis:Comparison Between Thais And Americans

Neuromyelitis optica spectrum disorder (NMOSD) is more common in Asian population. Few studies have examined the features of optic neuritis (ON) within NMOSD in different racial populations. We compared the clinical characteristics and long-term visual outcome of patients with NMOSD-related ON between a Thai and an American cohort

Pediatric Primary Optic Nerve Sheath Meningioma

"Primary optic nerve sheath meningioma (PONSM) is a proliferation of meningothelial cells within the nerve sheath of the orbital or intracanalicular portion of the optic nerve. It is not common in patients younger than 20 years of age, represent less than 5% of all cases of PONSM.

Pediatric Primary Optic Nerve Sheath Meningioma

"Primary optic nerve sheath meningioma (PONSM) is a proliferation of meningothelial cells within the nerve sheath of the orbital or intracanalicular portion of the optic nerve. It is not common in patients younger than 20 years of age, represent less than 5% of all cases of PONSM.

The Impact of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization, Presence of Thyroid Autoimmune Antibodies, and Thymoma

The importance of acetylcholine receptor(AChR) antibody titers in ocular myasthenia gravis(OMG) is scarcely studied. Therefore, we aim to evaluate the association between AChR antibody titers and conversion to generalized myasthenia gravis(GMG), presence of thyroid autoimmune antibodies, and presence of thymoma in subjects with positive AChR antibody OMG

Torsional Nystagmus Associated with Palatal Tremor in Vertebral Artery Dolichoectasia (.pdf)

"A 50 year-old woman presented with three-month history of oscillopsia. This accompanied with gait disturbance. Her previous medical history was significant for right-side hemiparesis for the last year, DM type2 and essential hypertension. She denied any history of drug abuse.On examination, BCVA was 20/20 in both eyes. Anterior segment and fundus exam were unremarkable. Binocular conjugated pure counter-clockwise torsional nystagmus synchronizing with palatal tremor was observed. The amplitude and frequency of nystagmus were similar in all gazes. Null point was absent. Ocular alignment was orthotropic. Extraocular muscles function, saccadic velocity and smooth pursuit eye movement were all within normal limit. Neurological examination showed rightsided hemiparesis and hyper-reflexia. Celebellar functions were impaired on the right-side including wide-base gaits, dysdiadokonesia and impaired Finger-to-Nose test. Thin slice axial T2 weighted MRI with fat suppression and Apparent Diffusion Coefficient(ADC) images show dolichoectatic left vertebral artery, exerting pressure effect to the left medulla. A hypersignal intensity T2 change with increased diffusion on the ADC image at the left medulla is also depicted. 3D Time of Flight (TOF) MRA of the posterior circulation reveals dolichoectatic left vertebral artery with redundancy to the right. Hypoplasia of the right vertebral artery is noted. To our knowledge, this is the first case of torsional nystagmus with palatal tremor in vertebral artery dolichoectasia.

Syphilitic Optic Neuropathy

"Although the ocular manifestation of syphilis can affect any structures of the eye, optic nerve involvement is not a common presentation. We report a series of 7 new cases of syphilitic optic neuropathy in a tertiary center.

Concurrent CRAO with Arteritic AION in Eosinophilic Granulomatosis with Polyangiitis

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic necrotizing vasculitis characterized by peripheral neuropathy, pulmonary involvement, and eosinophilia. EGPA has been associated with a number of ocular conditions, including retinal vascular occlusion, ocular motor cranial neuropathy, and optic neuropathy. We describe a case report of a concurrent central retinal artery occlusion(CRAO) with arteritic anterior ischemic optic neuropathy(AION)

Outcomes of descemet stripping automated endothelial keratoplasty using imported donor corneas

Abstract Background The lack of development of local donor tissue acquisition in several regions of the world has resulted in the necessity of performing keratoplasty with imported donor corneas. The greatest concern about the use of donor corneas supplied by foreign eye banks is the effect of the increased donor death-to-operation time which inevitably occurs during the tissue recovery, tissue processing, and tissue transfer between the countries. The purpose of this study was to report the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) using imported donor corneas. Methods This retrospective, non-comparative case series investigated the outcomes of the 102 consecutive DSAEK procedures using imported donor corneas performed at a single university-based hospital between August 2006–2014. The main outcome measures were postoperative best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications. Results The mean death-to-operation time was 9.52 ± 1.48 days (range, 8–13). The mean preoperative ECD was 2761 ± 285 cells/mm2. Fuchs’ endothelial dystrophy was the predominant indication for grafting. The mean follow-up duration was 65.3 months. Ninety-three eyes had improved vision postoperatively (91.18%). BCVA unchanged in 3 eyes due to preexisting macular scar and advanced glaucoma. Primary graft failure occurred in 6 eyes (5.88%). Of the 93 eyes with improved BCVA, 100% had their best corrected vision within the first 1 year. The mean ECD at 6, 12, 24, 36, and 60 months after surgery was 1762 ± 294 cells/mm2, 1681 ± 284 cells/mm2, 1579 ± 209 cells/mm2, 1389 ± 273 cells/mm2, and 1251 ± 264 cells/mm2 respectively. The mean ECD loss at 6 months, 1 year, 2 years, 3 years, and 5 years after surgery was 36.2%, 39.1%, 42.8%, 49.7%, and 54.7% respectively. The most common complication was graft detachment/dislocation (10.78%). There were no cases of any postoperative infection. Conclusions DSAEK with imported donor corneas provides rapid and good visual rehabilitation. The percentages of endothelial cell loss were comparable to those achieved in Western series using domestic corneas in which fresher tissues were available for transplantation

Occipital lobe infarction: a rare presentation of bilateral giant cavernous carotid aneurysms: a case report

Abstract Background Cavernous carotid aneurysm (CCA) represents 2–9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11–29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i.e., subarachnoid hemorrhage, cerebral infarction, or carotid cavernous fistula). Moreover, concurrent presentation with posterior circulation cerebral infarction is even rarer, given different circulation territory from CCA. Here, we report on a patient with bilateral giant CCAs who presented with both typical and atypical symptoms. Case presentation An 88-year-old hypertensive woman presented with acute vertical oblique binocular diplopia, followed by complete ptosis of the right eye. Ophthalmic examination showed dysfunction of the right third, fourth, and sixth cranial nerves. Further examination revealed hypesthesia of the areas supplied by the ophthalmic (V1) and maxillary (V2) branches of the right trigeminal nerve. Bilateral giant cavernous carotid aneurysms, with a concurrent subacute right occipital lobe infarction, were discovered on brain imaging and angiogram. Additionally, a prominent right posterior communicating artery (PCOM) was revealed. Seven months later, clinical improvement with stable radiographic findings was documented without any intervention. Conclusions Dysfunction of the third, fourth, and sixth cranial nerves, and the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerves, should necessitate brain imaging, with special attention given to the cavernous sinus. Despite unilateral symptomatic presentation, bilateral lesions cannot be excluded solely on the basis of clinical findings. CCA should be included in the differential diagnosis of cavernous sinus lesions. Although rare, ipsilateral posterior circulation cerebral infarction (i.e., occipital lobe infarction) can occur in CCA patients, presumably as a result of distal embolization through an ipsilateral, prominent PCOM. Spontaneous clinical improvement with stable radiographic support may occur