Smartphone-based, rapid, wide-field fundus photography for diagnosis of pediatric retinal diseases

PurposeAn important, unmet clinical need is for cost-effective, reliable, easy-to-use, and portable retinal photography to evaluate preventable causes of vision loss in children. This study presents the feasibility of a novel smartphone-based retinal imaging device tailored to imaging the pediatric fundus.MethodsSeveral modifications for children were made to our previous device, including a child-friendly 3D printed housing of animals, attention-grabbing targets, enhanced image stitching, and video-recording capabilities. Retinal photographs were obtained in children undergoing routine dilated eye examination. Experienced masked retina-specialist graders determined photograph quality and made diagnoses based on the images, which were compared to the treating clinician's diagnosis.ResultsDilated fundus photographs were acquired in 43 patients with a mean age of 6.7 years. The diagnoses included retinoblastoma, Coats' disease, commotio retinae, and optic nerve hypoplasia, among others. Mean time to acquire five standard photographs totaling 90-degree field of vision was 2.3 ± 1.1 minutes. Patients rated their experience of image acquisition favorably, with a Likert score of 4.6 ± 0.8 out of 5. There was 96% agreement between image-based diagnosis and the treating clinician's diagnosis.ConclusionsWe report a handheld smartphone-based device with modifications tailored for wide-field fundus photography in pediatric patients that can rapidly acquire fundus photos while being well-tolerated.Translational relevanceAdvances in handheld smartphone-based fundus photography devices decrease the technical barrier for image acquisition in children and may potentially increase access to ophthalmic care in communities with limited resources

Chaotropic chromatography method development for the determination of aripiprazole and its impurities following analytical quality by design principles

In this paper, development of robust and reliable chaotropic chromatography method for the determination of aripiprazole and its impurities, following Analytical Quality by Design principles is presented. The efficient baseline separation and accurate determination of aripiprazole and its four impurities from tablets were set as Analytical Target Profile. In line with it, the influence of Critical Method Parameters (acetonitrile content, concentration of perchloric acid in water phase, and column temperature) on predefined Critical Method Attributes (separation of the critical pair of peaks, retention of the first and last eluting peak) was investigated with aid of the Central Composite Design. Further on Design Space, where Critical Method Parameters meet predefined acceptance limits with a high level of probability (π ≥ 85%), was computed as a result of performed Monte Carlo simulations. A normal operating conditions corresponding to 34% of acetonitrile, 66% of 42.5 mM perchloric acid, and column temperature at 35°C were selected from created Design Space. Robustness testing of the quantitative performances of the developed method was conducted combining Plackett–Burman design with alias matrix approach. Through the additional validation testing, reliability of the developed method for the use in the routine practice was completely confirme

A comparison of outcomes following robotic-assisted staging and laparotomy in patients with early stage endometrioid adenocarcinoma of the uterus with uterine weight under 480 g

Study Objective: To directly compare perioperative morbidity and hospital stay after robotic-assisted staging and laparotomy in patients with early stage endometrial endometrioid adenocarcinoma and uterine weight under 480 g. Design: Retrospective cohort study. Setting: The West Clinic in Memphis, TN, USA. Patients: Patients with Stage IA and Stage IB endometrial endometrioid adenocarcinoma and uterine weight less than 480 g from June 2007 to January 2011. Interventions: Patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection using robotic-assisted surgery or open laparotomy. Measurements: Perioperative complications and morbidity, length of hospital stay, progression-free survival, overall survival, time to recurrence, and time do death from disease. Main Results: A total of 160 patients who underwent laparotomy and 165 patients who received robotic-assisted staging were identified. Compared with robotic-assisted staging, laparotomy was associated with increased hospital stay (3 days vs. 1.4 days, p < 0.001), greater estimated blood loss (237 cm3 vs. 102 cm3, p < 0.001), larger uterine weight (136 g vs. 116 g, p < 0.001), as well as higher incidence of postoperative complications [29.3% vs. 6.7%, odds ratio (OR) 5.82, 95% confidence interval (CI) 2.1–11.7] including postoperative ileus (9.0% vs. 1.0%, OR 7.82, 95% CI 1.7–35.0), wound infection (6.0% vs. 1.0%, OR 5.43, 95% CI 1.2–25.2), and postoperative atelectasis (4.0% vs. 0%, p < 0.01). There were no differences in projected 5-year progression-free and overall survival rates. Conclusion: Use of the daVinci robotic system was associated with less intraoperative blood loss, fewer postoperative complications, and shorter hospital stay compared with laparotomy for patients with uterine weight less than 480 g

Smartphone-based fundus photography for screening of plus-disease retinopathy of prematurity

BackgroundInadequate screening of treatment-warranted retinopathy of prematurity (ROP) can lead to devastating visual outcomes. Especially in resource-poor communities, the use of an affordable, portable, and easy to use smartphone-based non-contact fundus photography device may prove useful for screening for high-risk ROP. This study evaluates the feasibility of screening for high-risk ROP using a novel smartphone-based fundus photography device, RetinaScope.MethodsRetinal images were obtained using RetinaScope on a cohort of prematurely born infants during routine examinations for ROP. Images were reviewed by two masked graders who determined the image quality, the presence or absence of plus disease, and whether there was retinopathy that met predefined criteria for referral. The agreement between image-based assessments was compared to the gold standard indirect ophthalmoscopic assessment.ResultsFifty-four eyes of 27 infants were included. A wide-field fundus photograph was obtained using RetinaScope. Image quality was acceptable or excellent in 98% and 95% of cases. There was substantial agreement between the gold standard and photographic assessment of presence or absence of plus disease (Cohen's κ = 0.85). Intergrader agreement on the presence of any retinopathy in photographs was also high (κ = 0.92).ConclusionsRetinaScope can capture digital retinal photographs of prematurely born infants with good image quality for grading of plus disease