The Role of Imaging in Age-Related Macular Degeneration

Age-related macular degeneration (ARMD) is the leading cause of blindness affecting adults. The disease alters the macula, center of the retina, responsible for the keenest vision. Although ARMD is part of the aging process, the exact pathophysiology is still unknown. The evidence suggests that oxidative stress, lipofuscin accumulation, drusen accumulation, chronic inflammation, choroidal neovascularization, and mutations of the complement contribute to the development of ARMD. Early recognition and prompt treatment halt the progression of the disease. The advanced technology in imaging modalities provides comprehensive and complete management at the earliest stage of ARMD

Optic Nerve Changes in Diabetic Retinopathy

Diabetic retinopathy (DR) is a devastating sight-threatening complication of diabetes mellitus (DM). Besides damaging the vascular system of the retina, DM will also destruct the tissue surrounding the retina, including the optic nerve. DR impairs the optic nerve by damaging its conduction and integrity. There are few clinical manifestations of optic nerve changes in DR such as diabetic papillopathy, neovascularization of optic disc, and optic nerve atrophy. These involve metabolic alterations related to DM, production of advanced glycation end products (AGEs), oxidative stress, and hemodynamic changes. Diagnostic tests including visual evoked potential (VEP) and optical coherence tomography (OCT) can detect functional and structural changes. This finding is important as it may reflect the early loss of retinal ganglion cell axons. As the neuronal loss is irreversible, it is pivotal to be able to screen these nervous system changes in the early stage of DR and prevent further deterioration

Proliferative Diabetic Retinopathy: An Overview of Vitreous Immune and Biomarkers

This chapter discusses about the effect of vitreous immune system and biomarkers on the progression of proliferative diabetic retinopathy. Immune system and biomarkers have been believed to have an important role in the progression of diabetic retinopathy (DR) severity. Hyperglycemic will influence immune cells resulting in chronic inflammation on the retina. This condition progressively disrupts the blood-retinal barrier in retina causing those inflammatory molecules and immune cells to transfer from circulation. The transfer of these molecules plays an important part in the progression of proliferative diabetic retinopathy. In addition, biomarkers are indicators for some complex processes happened in our body, and are measured to determine diagnosis and prognosis of some treatment. There are several biomarkers that have been identified in DR patients including biomarkers of oxidative stress, hypoxia-inducible factors, angiogenic factors, pro-inflammatory cytokines, chemokines, cell adhesion molecules, and soluble CD200. The value of these biomarkers will tell us their possible role in the progression of DR. By improving the knowledge of molecular pathway in DR pathophysiology, the advancement of selective therapy approaches could be discovered and the management of DR could be more efficient

Ocular Manifestations in Epstein Barr Virus Infection

The Epstein-Barr Virus (EBV), a member of the Herpesvirus family, occurs commonly and infects more than 90% of people worldwide. Most of systemic EBV infections throughout childhood and adulthood are typically asymptomatic or paucisymptomatic. Even though ocular involvements in EBV infections are infrequently reported, an increasing number of ocular manifestations have been previously reported . Ocular manifestation caused by EBV infection involved all segments of the eye, including oculoglandular syndrome, dry eye syndrome, dacryoadenitis, conjunctivitis, episcleritis, keratitis, uveitis, choroiditis, retinitis, retinal vasculitis, and papillitis. Previous reports found neurologic complications such as papilledema, optic neuritis, ophthalmoplegia, impaired accommodation, and facial nerve palsy. Any atypical ocular inflammatory process should be considered EBV infection in the differential diagnosis. The ocular manifestations of systemic EBV infection are varied and have not been emphasized. And the role of EBV infection in ocular manifestations should be fully described

Atopobiosis and Dysbiosis in Ocular Diseases: Is Fecal Microbiota Transplant and Probiotics a Promising Solution?

Purpose: To highlight the role of atopobiosis and dysbiosis in the pathomechanism of autoimmune uveitis, therefore supporting fecal microbiota transplant (FMT) and probiotics as potential targeted-treatment for uveitis. Methods: This review synthesized literatures upon the relation between gut microbiota, autoimmune uveitis, FMT, and probiotics, published from January 2001 to March 2021 and indexed in PubMed, Google Scholar, CrossRef. Results: The basis of the gut–eye axis revolves around occurrences of molecular mimicry, increase in pro-inflammatory cytokines, gut epithelial barrier disruption, and translocation of microbes to distant sites. In patients with autoimmune uveitis, an increase of gut Fusobacterium and Enterobacterium were found. With current knowledge of aforementioned mechanisms, studies modifying the gut microbiome and restoring the physiologic gut barrier has been the main focus for pathomechanism-based therapy. In mice models, FMT and probiotics targeting repopulation of gut microbiota has shown significant improvement in clinical manifestations of uveitis. Consequently, a better understanding in the homeostasis of gut microbiome along with their role in the gut–eye axis is needed to develop practical targeted treatment. Conclusion: Current preliminary studies are promising in establishing a causative gut–eye axis relationship and the possibility of conducting FMT and probiotics as targeted treatment to mitigate autoimmune uveitis, to shorten disease duration, and to prevent further complications

Additional file 1 of Pro re nata versus fixed aflibercept regimen for neovascular age-related macular degeneration: a systematic review and meta-analysis

Additional file 1: Table S1. Search strategy for databases. Table S2. Summary of RCT outcome in T&E aflibercept regimen for neovascular AMD. Figure S1. Sensitivity analysis without retrospective study [11]. Figure S2. Sensitivity analysis without studies with high-risk of bias [12, 14]

Comparison of Topical Nepafenac 0.1 % and Prednisolone Acetate 1% as an Anti-Inflammatory after Vitrectomy in Rhegmatogenous Retinal Detachment

Post-operative ocular inflammation is treated with topical steroids but with side effects. Nepafenac isan effective NSAID with minimal side effects. This study aims to compare effectiveness topical nepafenac0.1% (nepafenac) and prednisolone acetate 1% (prednisolone) post-pars plana vitrectomy (PPV) forrhegmatogenous retinal detachment (RRD). This is a prospective, single blind, randomized, single centerclinical study performed on December 2015 to May 2016 at dr. Cipto Mangunkusumo Hospital, Jakarta. Atotal of 46 eyes (n=46) with RRD underwent PPV were included and randomized to topical nepafenac (23eyes) or prednisolone 1% (23 eyes). The median of anterior chamber inflammation, scores of pain, centralmacular thickness (CMT), and intraocular pressure (IOP) were evaluated at day 1, followed by 1st, 2nd, and4th week post-surgery. Median anterior chamber inflammation was grade 2 (1-4) in prednisolone group andgrade 3 (0.5-4) in nepafenac group at day 1 (p>0.05). Number of cell of anterior chamber inflammation andpain perception were not significantly different between groups (p>0.05) on follow-up. At day 1, nepafenacand prednisolone groups showed median CMT of 206 μm (131-299) and 208 μm (129-451). At 4th week, meanCMT were 174.9±30.7μm in prednisolone and 185.5±50.1μm in nepafenac group (p>0.05). Post-operativetopical nepafenac was equal to prednisolone in reducing inflammation in eyes undergoing PPV. Nepafenaccould be an alternative for post-PPV in RRD. Keywords: inflammation, nepafenac, prednisolone acetate, vitrectomy.   Perbandingan Topikal Nepafenak 0,1% dan Prednisolon Asetat 1% sebagaiAnti-Inflamasi setelah Vitrektomi pada Ablasio Retinae Regmatogen Abstrak Steroid topikal digunakan untuk inflamasi mata setelah operasi namun memiliki efek samping. Nepafenakmerupakan NSAID yang efektif dengan efek samping minimal. Studi ini bertujuan membandingkan efektivitasnepafenak 0,1% (nepafenak) dan prednisolon asetat 1% (prednisolon) topikal post-pars plana vitrectomy(PPV) pada ablasio retina regmatogen (RRD). Desain studi klinis ini adalah prospektif, single blind,randomized, single center, yang dilakukan pada bulan Desember 2015 sampai Mei 2016 di Rumah Sakitdr. Cipto Mangunkusumo, Jakarta. Sebanyak 46 mata (n=46) dengan RRD yang melalui PPV diikutsertakandalam penelitian ini. Subjek dirandomisasi untuk mendapatkan nepafenak (23 mata) dan prednisolon (23mata) topikal. Median inflamasi bilik mata depan (BMD), skor nyeri, ketebalan makula sentral (CMT) dantekanan intraokular (IOP) diukur pada hari pertama, minggu ke- 1, ke-2, dan ke-4 setelah operasi. Medianinflamasi BMD hari pertama adalah tingkat 2 (1-4) pada grup prednisolon dan tingkat 3 (0,5-4) pada grupnepafenak. Jumlah sel inflamasi BMD dan persepsi nyeri pada kedua grup tidak berbeda bermakna (p>0,05).Pada hari pertama, grup nepafenak dan prednisolon menunjukkan CMT 206 μm (131-299) dan 208 μm (129-451). Pada minggu ke-4, CMT 174,9±30,7 μm pada grup prednisolon dan 185,5±50,1 μm pada nepafenak(p>0,05). Penggunaan nepafenak topikal dan prednisolon sama dalam meredakan inflamasi setelah operasi.Nepafenak dapat menjadi alternatif setelah tindakan PPV pada RRD. Kata kunci: inflamasi, nepafenak, prednisolon asetat, vitrektomi

The Effect of Near-work Activity Time to The Incidence of Myopia in Children

Myopia has been a global problem leading to visual impairment and blinding complications with associated factors including time spent outdoor and near-work activity time. Excessive near-work activities are inevitable in children nowadays. However, the association between near-work activity time and myopia are still inconsistent between studies. The aim of this study is to review whether excessive near-work activities is associated with myopia incidence. A literature search on six different database (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost). Articles matched with inclusion criteria were appraised using Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Three cohort trials were obtained from the literature search. Incidence of myopia and the hazard ratio (HR) in Ku et al, Tsai et al, and You et al are 27.7%, HR 1.31 (95% CI 1.03-1.68) for ≥2 hours/day cram school attendance; 25.2% HR 1.12 (95%CI 1.02-1.22) for ≥5 hours/week after-school program; 16% HR 1.05 (0.96-1.16) for ≥2.95 ± 1.72 hours/day near work time, respectively. The protective factor pointed out by the studies was outdoor time. Tsai et al showed HR 0.90 (95%CI 0.82-0.99, p<0.001) for ≥30 minute time spent on outdoor activities after school on weekdays; and Ku et al showed a protective dose-response relationship (p<0.001) between increased outdoor activity time and myopia. Near-work activity is a strong risk factor candidate for myopia incidence, while outdoor activity is a strong protective candidate.  Hubungan Aktivitas Jarak Dekat terhadap Insidens Miopia pada Anak  Miopia merupakan penyakit mata terbanyak yang dapat mengakibatkan kebutaan. Faktor yang berpengaruh antara lain aktivitas luar ruangan dan aktivitas jarak dekat. Pada era milenial olahraga luar ruangan jarang dilakukan dan aktivitas jarak dekat sangat melekat dengan kehidupan sehari-hari. Studi ini bertujuan untuk meninjau hubungan aktivitas jarak dekat dengan insidens miopia. Pencarian melalui enam basis data ilmiah (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost) menghasilkan tiga studi kohort yang selanjutnya ditelaah menggunakan Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Insidens miopia dan hazard ratio (HR) aktivitas jarak dekat pada Ku et al, Tsai et al, dan You et al adalah 27,7%, HR 1,31 (95% CI 1,03-1,68) untuk ≥2 jam/hari les akademik; 25,2% HR 1,12 (95% CI 1,02-1,22) untuk ≥5 jam/minggu program akademik; 16% HR 1,05 (0,96-1,16) untuk ≥2,95 ± 1,72 jam/hari aktivitas jarak dekat. Aktivitas luar ruangan merupakan faktor protektif terhadap insidens miopia dengan HR 0,90 (95% CI 0,82-0,99, p<0,001) untuk ≥30 menit kegiatan luar ruangan pada hari kerja. Terdapat hubungan dosis-respons protektif (p<0,001) antara aktivitas luar ruangan dan miopia. Aktivitas jarak dekat merupakan faktor risiko kuat untuk miopia sedangkan aktivitas luar ruangan merupakan faktor protektif.  &nbsp

Deep Feature Vectors Concatenation for Eye Disease Detection Using Fundus Image

Fundus image is an image that captures the back of the eye (retina), which plays an important role in the detection of a disease, including diabetic retinopathy (DR). It is the most common complication in diabetics that remains an important cause of visual impairment, especially in the young and economically active age group. In patients with DR, early diagnosis can effectively help prevent the risk of vision loss. DR screening was performed by an ophthalmologist by analysing the lesions on the fundus image. However, the increasing prevalence of DR is not proportional to the availability of ophthalmologists who can read fundus images. It can lead to delayed prevention and management of DR. Therefore, there is a need for an automated diagnostic system as it can help ophthalmologists increase the efficiency of the diagnostic process. This paper provides a deep learning approach with the concatenate model for fundus image classification with three classes: no DR, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). The model architecture used is DenseNet121 and Inception-ResNetV2. The feature extraction results from the two models are combined and classified using the multilayer perceptron (MLP) method. The method that we propose gives an improvement compared to a single model with the results of accuracy, and average precision and recall of 91% and 90% for the F1-score, respectively. This experiment demonstrates that our proposed deep-learning approach is effective for the automatic DR classification using fundus photo data

Deep Feature Vectors Concatenation for Eye Disease Detection Using Fundus Image

Fundus image is an image that captures the back of the eye (retina), which plays an important role in the detection of a disease, including diabetic retinopathy (DR). It is the most common complication in diabetics that remains an important cause of visual impairment, especially in the young and economically active age group. In patients with DR, early diagnosis can effectively help prevent the risk of vision loss. DR screening was performed by an ophthalmologist by analysing the lesions on the fundus image. However, the increasing prevalence of DR is not proportional to the availability of ophthalmologists who can read fundus images. It can lead to delayed prevention and management of DR. Therefore, there is a need for an automated diagnostic system as it can help ophthalmologists increase the efficiency of the diagnostic process. This paper provides a deep learning approach with the concatenate model for fundus image classification with three classes: no DR, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). The model architecture used is DenseNet121 and Inception-ResNetV2. The feature extraction results from the two models are combined and classified using the multilayer perceptron (MLP) method. The method that we propose gives an improvement compared to a single model with the results of accuracy, and average precision and recall of 91% and 90% for the F1-score, respectively. This experiment demonstrates that our proposed deep-learning approach is effective for the automatic DR classification using fundus photo data