Cystoid macular edema (CME)

  • 文章类型: Journal Article
    囊样黄斑水肿(CME)是一种威胁视力的疾病,通常与炎症和糖尿病相关。早期检测对于防止不可逆的视力丧失至关重要。人工智能(AI)已显示出通过光学相干断层扫描(OCT)成像自动化CME诊断的前景。但是它的效用需要严格的评估。这篇系统综述评估了人工智能在诊断CME中的应用,特别关注疾病,如术后CME(IrvineGass综合征)和视网膜色素变性无明显血管病变,使用OCT成像。在6个数据库中进行了全面搜索(PubMed,Scopus,WebofScience,威利,ScienceDirect,和IEEE)从2018年到11月,2023年。23篇文章符合纳入标准,并被选中进行深入分析。我们评估AI在CME诊断中的作用及其在“检测”中的表现,OCT视网膜图像的“分类”和“分割”。我们发现,基于卷积神经网络(CNN)的方法始终优于其他机器学习技术,从OCT图像中检测和识别CME的平均准确率超过96%。尽管存在某些限制,如数据集大小和道德问题,人工智能和OCT之间的协同作用,特别是通过CNN,有望显著推进CME诊断。
    Cystoid macular edema (CME) is a sight-threatening condition often associated with inflammatory and diabetic diseases. Early detection is crucial to prevent irreversible vision loss. Artificial intelligence (AI) has shown promise in automating CME diagnosis through optical coherence tomography (OCT) imaging, but its utility needs critical evaluation. This systematic review assesses the application of AI to diagnosis CME, specifically focusing on disorders like postoperative CME (Irvine Gass syndrome) and retinitis pigmentosa without obvious vasculopathy, using OCT imaging. A comprehensive search was conducted across 6 databases (PubMed, Scopus, Web of Science, Wiley, ScienceDirect, and IEEE) from 2018 to November, 2023. Twenty-three articles met the inclusion criteria and were selected for in-depth analysis. We evaluate AI\'s role in CME diagnosis and its performance in \"detection\", \"classification\", and \"segmentation\" of OCT retinal images. We found that convolutional neural network (CNN)-based methods consistently outperformed other machine learning techniques, achieving an average accuracy of over 96 % in detecting and identifying CME from OCT images. Despite certain limitations such as dataset size and ethical concerns, the synergy between AI and OCT, particularly through CNNs, holds promise for significantly advancing CME diagnostics.
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  • 文章类型: Case Reports
    背景:乳头周围超反射卵形团状结构(PHOMS)是新特征的病变,楔入视盘周围,以前被误诊了.更好地理解和识别PHOMS对于监测视神经状况很重要。
    方法:一位年轻女性出现双眼视力模糊的眼科诊所。发现了类似“C形甜甜圈”的突起,两侧环绕视盘。这些病变在OCT上是均匀的高反射,同时它们也是低自发荧光和低回声的。同时,两只眼睛也发现了黄斑囊样水肿(CME)。然后将患者诊断为具有CME的PHOMS。系统规定了短期糖皮质激素治疗。随着CME的恢复,双眼的logMAR最佳矫正视力(BCVA)在4个月内达到0.0,而PHOMS仍然存在。
    结论:目前没有关于PHOMS与CME的报告。应该更多地关注PHOMS,因为它们是与视神经不同疾病有关的轴质淤滞的潜在生物标志物。
    BACKGROUND: Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are newly characterized lesions wedged around the optic discs, which used to be misdiagnosed. Better understanding and identifying PHOMS are important for monitoring the condition of optic nerve.
    METHODS: A young female presented to the ophthalmic clinic with blurred vision of both eyes. Protrusions resembling \"C-shaped donut\" were found circling the optic discs bilaterally. These lesions were homogenous hyperreflective on OCT, while they were also hypoautofluorescent and hypoechogenic. Meanwhile, cystoid macular edema (CME) was also identified in both eyes. The patient was then diagnosed as PHOMS with CME. A short-term glucocorticoids therapy was prescribed systemically. The logMAR best-corrected visual acuity (BCVA) of both eyes reached 0.0 in 4 months with recovery of CME, while the PHOMS remained.
    CONCLUSIONS: There is currently no report on PHOMS with CME. More attentions should be paid to PHOMS, for they are potential biomarkers for axoplasmic stasis involved in different diseases of the optic nerve.
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  • 文章类型: Case Reports
    描述最初诊断患有年龄相关性黄斑变性(AMD)的患者,其最终确定患有进行性戊聚糖聚硫酸钠(PPS)相关黄斑病变,导致在停止PPS后10年继发性囊样黄斑水肿(CME)。
    提供了介入病例报告。
    一名57岁的女性被诊断患有AMD,表现为单侧视力恶化和来自CME的变形。详细的历史记录显示了3年的PPS课程,10年前已经停产。这导致PPS相关黄斑病变的诊断。局部NSAID和皮质类固醇治疗失败后,玻璃体内贝伐单抗缓解了症状。5个月后,CME在另一只眼睛中出现,并且对贝伐单抗也有反应。
    本病例强调全面回顾色素性视网膜病变患者过去的用药和病史的重要性,并支持使用抗血管内皮生长因子治疗作为治疗PPS相关性黄斑病变继发CME的一种选择。
    UNASSIGNED: To describe a patient initially diagnosed with age-related macular degeneration (AMD) who was ultimately determined to have progressing pentosan polysulfate sodium (PPS)-associated maculopathy leading to secondary cystoid macular edema (CME) 10 years after cessation of PPS.
    UNASSIGNED: An interventional case report is presented.
    UNASSIGNED: A 57-year-old woman diagnosed with AMD presented with unilateral worsening vision and metamorphopsia from CME. A detailed history showed a 3-year course of PPS, which had been discontinued 10 years previously. This led to the diagnosis of PPS-associated maculopathy. After topical NSAID and corticosteroid treatment failed, intravitreal bevacizumab resolved the symptoms. CME developed in the fellow eye 5 months later and also responded to bevacizumab.
    UNASSIGNED: This case emphasizes the importance of a thorough review of past medication and medical histories in patients with pigmentary retinopathy and supports the use of antivascular endothelial growth factor therapy as an option to treat CME secondary to PPS-associated maculopathy.
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  • 文章类型: Journal Article
    UNASSIGNED:比较非增殖性糖尿病视网膜病变(NPDR)患者行联合超声乳化和平坦部玻璃体切除术的术中和术后并发症增殖性糖尿病视网膜病变(PDR)。
    未经批准:回顾性,病例系列糖尿病视网膜病变患者在2008年至2017年期间接受了玻璃体切割联合手术。我们比较了术中并发症,包括后囊破裂和视网膜撕裂,术后并发症包括角膜水肿,黄斑水肿(ME),视网膜前膜(ERM),新生血管性青光眼和持续性炎症。
    UNASSIGNED:本研究共纳入104例患者的104只眼。24只眼(23.1%)被归类为NPDR,80只眼(76.9%)被归类为PDR。NPDR组最常见的手术指征是ERM(67%)和孔源性视网膜脱离(12.5%),而在PDR组,适应症为玻璃体出血(56%)和牵引性视网膜脱离(19%).术中最常见的并发症是视网膜撕裂(NPDR为8%,PDR为19%,p=0.195),术后并发症为ME(NPDR为29%,PDR为26%,p=0.778)。NPDR组和PDR组之间的术中和术后并发症发生率无统计学差异,即使在调整了混杂因素后;手术时的患者年龄和手术指征。
    UASSIGNED:在NPDR和PDR患者行联合晶状体切除术后,在两组中约1/4眼发现新发ME.术中抗VEGF或类固醇给药,无论DR水平如何,超声玻璃体切除术后都应考虑术后强烈的抗炎药和随访。
    UNASSIGNED: To compare intra- and postoperative complications in combined phacoemulsification and pars plana vitrectomy surgeries performed in patients with non-proliferative diabetic retinopathy (NPDR) vs. proliferative diabetic retinopathy (PDR).
    UNASSIGNED: Retrospective, case series of patients with diabetic retinopathy who underwent combined phacovitrectomy surgery between 2008 and 2017. We compared intraoperative complications including posterior capsular rupture and retinal tear, and postoperative complications including corneal edema, macular edema (ME), epiretinal membrane (ERM), neovascular glaucoma and persistent inflammation.
    UNASSIGNED: A total of 104 eyes of 104 patients were included in this study. Twenty-four eyes (23.1%) were categorized as NPDR and 80 eyes (76.9%) as PDR. The most common indications for surgery in the NPDR group were ERM (67%) and rhegmatogenous retinal detachment (12.5%), while in the PDR group, indications were vitreous hemorrhage (56%) and tractional retinal detachment (19%). The most common intraoperative complication was retinal tear (8% in NPDR and 19% in PDR, p = 0.195) and postoperative complication was ME (29% in NPDR and 26% in PDR, p = 0.778). There were no statistically significant differences in intra- and postoperative complication rates between the NPDR and PDR groups, even after adjusting for confounders; patient age at surgery and indication for surgery.
    UNASSIGNED: After combined phacovitrectomy in NPDR and PDR patients, new-onset ME was found in about a quarter of eyes in both groups. Intraoperative anti-VEGF or steroid administration, and intense postoperative anti-inflammatory medication and follow-up should be regarded after phacovitrectomy regardless of the DR level.
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  • 文章类型: Case Reports
    简介:急性视网膜坏死(ARN)后的炎症环境可能导致内部和外部血视网膜屏障的破坏,从而导致囊样黄斑水肿(CME),并积聚视网膜内和视网膜下液。到目前为止,ARN患者的CME尚无既定的治疗方法。病例报告:我们报告了一例免疫功能正常的14岁女性,患有慢性ARN相关CME,对伐昔洛韦没有反应,泼尼松和玻璃体内注射雷珠单抗。托珠单抗的联合治疗,白细胞介素-6受体抑制剂,玻璃体内阿柏西普成功控制了CME。结论:在选择的ARN后难治性CME患者中,可以考虑使用托珠单抗和玻璃体内阿柏西普治疗。
    Introduction: The inflammatory milieu after acute retinal necrosis (ARN) may lead to a breakdown of the inner and outer blood-retinal barrier and consequently to a cystoid macular edema (CME) with accumulation of intra- and subretinal fluid. Up to now, there is no established therapeutic approach for CME in ARN patients.Case report: We report a case of an immunocompetent 14-year-old female with chronic ARN-related CME, which was unresponsive to valacyclovir, prednisone and intravitreal ranibizumab injections. A combination treatment of tocilizumab, an interleukin-6 receptor inhibitor, and intravitreal aflibercept was successful to control the CME.Conclusion: In selected patients with treatment-refractory CME following ARN a therapy with tocilizumab and intravitreal aflibercept might be considered.
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  • 文章类型: Case Reports
    To report abnormal full-field electroretinograms (ERGs) in a patient with cystoid macular edema (CME) induced by systemic paclitaxel.
    This is an observational case report. Full-field ERGs were recorded to evaluate the retinal function using the RETeval system and conventional ERGs using contact lens electrodes with built-in white light-emitting diodes. Optical coherence tomography (OCT) was also used to assess the retinal morphology.
    A 70-year-old man, who was diagnosed with gastric cancer, had undergone gastrectomy. Subsequently, systemic paclitaxel was administered once a week as an adjuvant therapy. After the tenth course of paclitaxel, he experienced blurred vision in both eyes and visited our department of ophthalmology. OCT revealed the presence of CME in both eyes, and the RETeval flicker ERGs showed a marked reduction in the amplitudes and a prolongation of the implicit times in both eyes. Conventional ERGs showed that the amplitudes of the oscillatory potentials (OPs) were also severely attenuated. The abnormal OCT findings and reduced visual acuity recovered to normal at 1 and 2 months, respectively, after the discontinuation of paclitaxel. However, the flicker ERGs did not recover to normal values until 4 months after the discontinuation of paclitaxel.
    These results suggest that the ERGs can be used to monitor the changes in the overall retinal function in patients receiving paclitaxel.
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  • 文章类型: Journal Article
    UNASSIGNED: To compare the efficacy between fixed and variable treatment regimens of subthreshold yellow micropulse laser for the treatment of diabetic macular edema.
    UNASSIGNED: This is a retrospective, comparative, 12-month study of 39 eyes: 24 eyes received fixed treatment regimen of subthreshold micropulse laser treatment and 15 eyes underwent variable treatment regimen of subthreshold micropulse laser, all eyes were followed up for 12 months. Subthreshold micropulse laser was performed with the following parameters: 100 μm spot size on slit lamp, 5% duty cycle of 0.2 s, and 250 mW power. To choose the power of the variable treatment regimen of subthreshold micropulse laser group, continuous laser power was titrated to a barely visible burn and then switched to MicroPulse mode, multiplying the test burn power by 4 and using a 5% duty cycle of 0.2 s. Main outcomes included changes in central macular thickness and best-corrected visual acuity.
    UNASSIGNED: At baseline, the mean LogMAR best-corrected visual acuity was 0.297 ± 0.431 in the variable treatment regimen of subthreshold micropulse laser group and 0.228 ± 0.341 in the fixed treatment regimen of subthreshold micropulse laser group. At the end of follow-up, the mean LogMAR best-corrected visual acuity was 0.289 ± 0.473 (p = 0.785) and 0.245 ± 0.376 (p = 0.480) in the variable and fixed treatment regimens of subthreshold micropulse laser groups, respectively. Similarly, central macular thickness decreased in both groups after treatment; at baseline, the mean central macular thickness was 371.06 ± 37.8 in the variable treatment regimen of subthreshold micropulse laser group and improved to 325.60 ± 110.0 μm (p = 0.025) at the end of the follow-ups, while it was 342.30 ± 35.4 in the fixed treatment regimen of subthreshold micropulse laser group and improved to 308.51 ± 67.5 (p = 0.037).
    UNASSIGNED: Both treatment regimens are effective for the treatment of mild center-involving diabetic macular edema: fixed treatment appears more suitable minimizing treatment time and reducing the possible errors due to wrong titration in the switch from continuous to micropulse mode.
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