Fundus2Angio: A Conditional GAN Architecture for Generating Fluorescein Angiography Images from Retinal Fundus Photography

Carrying out clinical diagnosis of retinal vascular degeneration using Fluorescein Angiography (FA) is a time consuming process and can pose significant adverse effects on the patient. Angiography requires insertion of a dye that may cause severe adverse effects and can even be fatal. Currently, there are no non-invasive systems capable of generating Fluorescein Angiography images. However, retinal fundus photography is a non-invasive imaging technique that can be completed in a few seconds. In order to eliminate the need for FA, we propose a conditional generative adversarial network (GAN) to translate fundus images to FA images. The proposed GAN consists of a novel residual block capable of generating high quality FA images. These images are important tools in the differential diagnosis of retinal diseases without the need for invasive procedure with possible side effects. Our experiments show that the proposed architecture outperforms other state-of-the-art generative networks. Furthermore, our proposed model achieves better qualitative results indistinguishable from real angiograms.Comment: 14 pages, Accepted to 15th International Symposium on Visual Computing 202

Action of Botulinum Toxin on Isometric Contraction of Medial and Lateral Rectus Muscles in Esotropic or Exotropic Patients

Purpose: To study the action of botulinum toxin A on isometric contraction of the medial and lateral rectus muscles in esotropic or exotropic patients. Methods: Isometric contraction in patients with strabismus (exotropic and esotropic) and in volunteers without strabismus was compared 30 days after the use of botulinum toxin A. Results: Findings show that this drug has changed the strength ratio between direct agonist and antagonist muscles. This has promoted the displacement of the point of equilibrium between muscle strengths toward the nasal direction in esotropic cases, toward the temporal direction in exotropic cases, and subsequent deviation of the eye toward its primary position. The average achieved correction was approximately 10 prism diopters in both groups of patients. Conclusion: In both exotropia and esotropia, the average variations in the induced points of equilibrium related to injection of botulinum toxin A were similar. This means that the greatest percentage of corrections happened in cases of small deviations.481384

Corneal endothelial rejection after penetrating keratoplasty treated with intravenous and topic corticosteroid. One year follow up

Objective: To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid. Methods: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. Results: A total of 32 eyes from 32 patients (13 male and 19 female) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001). Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047). Conclusion: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment.721424

Demand incidence of retinal detachment in Brazil

Aim To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil. Methods A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, Sao Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0). Results There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100 000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100 000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100 000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments. Conclusions This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.21334835

Pain Perception at Laser Treatment of Peripheral Retinal Degenerations With Green and Infrared Wavelengths

PURPOSE: To compare the pain perception at laser treatment of peripheral retinal degenerations with green (532-nm) and infrared (810-nm) wavelengths. DESIGN: Prospective randomized clinical trial. METHODS: Sequential patients with indications for photocoagulation of bilateral peripheral retinal degenerations were invited to participate in the study. Thirty patients (60 eyes) were enrolled in the study. Each patient had 1 eye treated with infrared laser (diode, 810-nm wavelength) and the other eye treated with green laser (frequency-doubled solid-state laser, diode-pumped, with 532-nm wavelength). The eyes were randomized to infrared or green wavelengths. The right eye was the first treated in all cases regardless of the wavelength arrangement. Immediately after photocoagulation of each eye, the patient was asked to grade pain perception according to an 11-point (ie, 0-10) numerical rating scale (NRS), with 0 meaning "No pain" and 10 meaning "Pain as bad as you can imagine." The primary outcome was the assessment of pain. RESULTS: The mean grading of pain perception was 2.80 (SD 1.27; mode and median = 2) to green wavelengths and 5.07 (SD 1.36; mode = 4 and median = 5) to infrared wavelengths (P < .001). CONCLUSIONS: The results showed a statistically and clinically significant difference of pain perception between the 2 groups, with advantage to the green laser group. (Am J Ophthalmol 2010;150:726-730. (C) 2010 by Elsevier Inc. All rights reserved.)150572673

Influence of preoperative testing on cancellation of ambulatory cataract surgery in adults

A case-control study was performed to determine whether an association exists between cancellation of ambulatory cataract surgery in adults, preoperative test results, and systemic diseases present at clinical examination. Among 500 adults who were to undergo ambulatory cataract surgery, cancellation of surgery due to medical events was not associated with results of preoperative testing (hemoglobin, serum glucose, and electrocardiogram). The rate of surgery cancellation was higher only in patients having a history of arterial hypertension.34320320

Trimethoprim-Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrences of Toxoplasma Gondii Retinochoroiditis: Randomized Controlled Clinical Trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)PURPOSE: To compare the effects of trimethoprim-sulfamethoxazole vs placebo in reducing the risk of recurrences of Toxoplasma gondii retinochoroiditis. DESIGN: Single-center, prospective randomized double-masked clinical trial. METHODS: A total of 95 patients from Campinas, Brazil, with active recurrent Toxoplasma gondii retinochoroiditis were included. The initially active toxoplasmosis lesions were successfully treated in all cases using trimethoprim-sulfamethoxazole (800 mg/160 mg) twice daily for 45 days. Subsequently, 5 patients dropped out of the study. The remaining patients were randomized to Group 1 (trimethoprim/sulfamethoxazole tablet every 2 days) or Group 2 (identical placebo tablet every 2 days). Randomization was 1:1, was stratified by sex, and used block sizes of 4. The primary outcome was recurrent toxoplasmosis retinochoroiditis within 1 year, and the secondary outcome was a 1-year change in best-corrected visual acuity (BCVA) (ETDRS chart). RESULTS: The incidence of recurrent toxoplasmosis retinochoroiditis within 12 months was 0 of 46 (0%) and 6 of 47 (12.80%) in the trimethoprim-sulfamethoxazole and placebo groups, respectively (P = .026). Visual acuity improvements in the 2 groups were similar. No treatment-limiting toxicity was observed. CONCLUSIONS: Trimethoprim/sulfamethoxazole therapy resulted in a 100% reduction in the recurrence of Toxoplasma gondii retinochoroiditis over 1 year of treatment. (C) 2014 by Elsevier Inc. All rights reserved.1574762766Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial

Purpose: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. Design: Randomized clinical trial. Materials and Methods: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil >= 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil >= 6mm at the beginning of the surgery. Results: All the patients achieved pupil >= 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil >= 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 - P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =. 791). There were no complications during surgery or related to the preoperative use of the eye drops. Conclusion: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.60427728

Cryotherapy vs Laser Photocoagulation in Scleral Buckle Surgery A Randomized Clinical Trial

Objective: To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy). Methods: Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group. Main Outcome Measures: The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications. Results: The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups: 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant. Conclusions: In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy. Application to Clinical Practice: Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery.128121519152