Search Results (1,971)

Purpose: We aimed to describe retinal pigment epithelium (RPE) tears in patients with neovascular age-related macular degeneration (AMD) and pigment epithelial detachment (PED), focusing on OCT features and AI-assisted image analysis. Methods: This retrospective case series included patients with neovascular AMD and PED who developed RPE tears between 2020 and 2025 after treatment with intravitreal aflibercept (2 mg or 8 mg) or faricimab. Multimodal imaging, including spectral-domain OCT and infrared imaging, was reviewed. PED morphology, fluid characteristics, RPE denudation, timing of RPE tear, and visual outcomes were analyzed using manual grading and AI-assisted software. Results: Among 375 PED-bearing eyes, 11 eyes of 11 patients developed an RPE tear (2.9%), of which 10 (90.9%) were temporally associated with anti-VEGF treatment. Rates were similar across agents—2.7% (aflibercept 2 mg), 3.0% (aflibercept 8 mg) and 2.4% (faricimab)—with no significant difference. Eight eyes (72.7%) were treatment-naïve and one tear (9.1%) occurred spontaneously after hemorrhage without recent injection. Among treatment-associated tears, 30% followed the first and 50% the second injection (mean 2.1 injections), detected a mean of 44 ± 30 days after the last injection. Mean baseline PED height was 594.8 ± 239.2 μm and median AI-derived PED volume was 2922 nL. Mean RPE-denudation area at detection was 5.25 ± 3.87 mm², remaining stable in 7 of 9 evaluable eyes. Visual acuity was stable or improved in seven eyes; four lost ≥15 ETDRS letters. Conclusions: RPE tears were an uncommon, predominantly early complication occurring in eyes with large PEDs, with no excess risk from second-generation agents. AI-assisted OCT may aid anatomical characterisation, and most eyes retained vision with continued therapy. Full article

Background/Objectives: Retinal imaging has considerable potential for monitoring Alzheimer’s disease (AD) neurodegeneration, as retinal ganglion cell dendritic atrophy within the inner plexiform layer (IPL) is an early event. We tested whether quantitative optical coherence tomography (OCT) speckle texture analysis combined with supervised machine learning could discriminate AD-related IPL alterations without exogenous contrast agents in a mouse model. Methods: Retinal explants from triple-transgenic AD mice (n = 7, aged 12 months) and C57BL/6 controls (n = 3, aged 15 months) were imaged ex vivo using a custom 1040 nm spectral-domain OCT system. Five grey-level co-occurrence matrix (GLCM) features were extracted from IPL volumes of interest (VOIs) and classified using a linear support vector machine (SVM). Results: AD and control IPL textures formed two completely separable clusters in a two-dimensional feature space defined by contrast and entropy (0°), achieving 100% VOI-level classification accuracy (95% CI: 96.4–100%). However, given the small sample size, VOI-level rather than animal-level validation, lack of histological confirmation, non-interleaved image acquisition, and differences in age/strain between groups, these results represent exploratory dataset separability rather than a validated diagnostic test. Conclusions: These findings demonstrate the feasibility of the ligand-free, texture-based OCT discrimination of IPL alterations, indicating a strong underlying optical signal. Adequately powered, in vivo longitudinal studies with matched controls, interleaved acquisition, animal-level cross-validation, and histological validation are required before any clinical translation. Full article

Optical imaging technologies are increasingly reshaping the interface between clinical dermatology and dermatopathology. In vivo reflectance confocal microscopy (IV-RCM), line-field confocal optical coherence tomography (LC-OCT), and ex vivo confocal microscopy (EV-CM) provide tissue-level morphological information without the need for conventional histopathologic processing or with substantially reduced processing times. These technologies have enabled the concept of the “virtual biopsy” and are increasingly integrated into diagnostic workflows. However, their clinical value cannot be understood solely through conventional diagnostic performance metrics such as sensitivity and specificity. Rather, their impact depends on how the information they generate is incorporated into sequential diagnostic pathways and clinical decision-making processes. This review summarizes the principles, current applications, diagnostic performance, limitations, and future prospects of IV-RCM, LC-OCT, and EV-CM. We discuss the complementary strengths of these modalities and propose a systems perspective in which imaging technologies are viewed as components of diagnostic ecosystems linking clinical examination, dermatoscopy, pathology, surgery, and computational decision support. Emerging developments in artificial intelligence, multimodal imaging, and digital pathology are likely to further strengthen these connections and expand the role of optical imaging in dermatology and dermatopathology. Full article

Optical coherence tomography (OCT) and photoacoustic imaging (PAI) provide complementary structural and absorption contrasts but require different coupling conditions: 1310 nm swept-source OCT is attenuated by water, whereas PAI requires acoustic coupling. We developed a large-field dual-modal imaging system combining temporal medium separation with hardware-based coordinate locking. The OCT head, linear-array ultrasound transducer, and photoacoustic excitation fiber bundle were mounted on a rigid common platform, and a one-time calibration established a two-dimensional affine transformation between the modality coordinate systems. OCT was acquired in air and PAI in deionized water within a common large-field coordinate range. In five paired air–water measurements with an approximately 23 mm water path, the displayed OCT peak level decreased from 98.4 ± 1.5 dB in air to 79.4 ± 1.8 dB in water, corresponding to a mean reduction of 19.0 ± 1.4 dB. Quantitative registration was evaluated using a 5 × 5 dual-modal landmark phantom, with nine landmarks used for affine calibration and 16 excluded landmarks reserved for independent validation. The mean two-dimensional validation error was 0.235 ± 0.128 mm, with an RMSE of 0.266 mm and a maximum error of 0.446 mm. Five additional medium-switching cycles performed without recalibration yielded an overall registration error of 0.369 ± 0.163 mm across 80 validation measurements. PA spatial resolution was further characterized using six thin hair targets, yielding lateral and axial FWHM values of 0.342 ± 0.069 mm and 0.394 ± 0.073 mm, respectively. These results demonstrate reproducible two-dimensional en face OCT–PA coordinate mapping under modality-specific coupling conditions and support the proposed workflow as a phantom-based technical validation for large-field multimodal imaging. Full article

Objectives: We sought to evaluate the early efficacy of faricimab (Vabysmo^®) in treating diabetic macular edema (DME) and to explore the predictive value of multi-slice optical coherence tomography (OCT) biomarkers for anatomical and visual outcomes. Methods: In this retrospective cohort study, 26 anti-VEGF-naive DME patients (36 eyes) treated with intravitreal faricimab were analyzed from baseline through 6 months of follow-up. Best-corrected visual acuity (BCVA) was recorded, while central subfield thickness (CST) and various OCT biomarkers were evaluated using multi-slice OCT quantitative analysis. Logistic and linear regression models were utilized to examine predictive factors, and scatter plots were employed to assess the correlation between anatomical improvement and functional visual gain. Results: Changes in CST and BCVA, along with the evolution and predictive power of OCT biomarkers—including vitreomacular interface (VMI), epiretinal membrane (ERM), disorganization of the retinal inner layers (DRIL), intraretinal cysts (IRCs), hyperreflective foci (HRF), hard exudates (HEs), large outer-nuclear-layer cavities (LONLCs), ellipsoid zone disruption (EZD), and subretinal fluid (SRF)—were assessed. Post-treatment CST demonstrated rapid and significant reduction, decreasing from 377.7 μm (95% CI: 347.0–408.4) at baseline to 312.8 μm (95% CI: 287.5–338.2; p < 0.0001) at month 3 and 291.5 μm (95% CI: 275.6–307.4; p < 0.0001) at month 6, with an approximately 48 μm reduction post-first injection. Overall intraocular pressure (IOP) and BCVA showed no statistically significant improvement. Baseline analysis indicated that EZD was significantly associated with older age (p = 0.029), worse initial BCVA (p = 0.005), and thicker CST (p = 0.002). After adjusting for initial CST in the linear regression model, we identified the presence of baseline HEs as the sole independent predictor of substantial anatomical improvement (B = 45.9, p = 0.002). Conclusions: Faricimab demonstrated rapid and significant early anatomical improvements. Baseline HEs independently predicted the extent of CST reduction, potentially reflecting the greater fluid burden of eyes with more severe barrier breakdown. Baseline EZD was observed exclusively among eyes that did not achieve complete anatomical remission, although the small number of EZD-positive eyes (n = 7) precludes firm conclusions. Full article

The aim of this narrative review was to provide a disease-oriented diagnostic framework for selecting and integrating multimodal imaging techniques according to the suspected optic disc disorder. A non-systematic PubMed search was performed to identify relevant literature on optic disc diseases and related imaging appearances. Searches included a combination of terms related to disease features and imaging modalities. The recent introduction of non-invasive imaging devices, such as optical coherence tomography (OCT) and OCT angiography (OCTA), has allowed a remarkable step forward in the knowledge of the optic disc. OCT has revolutionized the diagnosis and monitoring of glaucomatous eyes, providing useful quantitative biomarkers. Fundus examination and color fundus photography are the first step for evaluation of optic disc edema, which requires further exams, including fundus autofluorescence, to exclude the presence of optic disc drusen, ocular ultrasound and in certain cases, fluorescein angiography. Although still limited, OCTA could give a support in the evaluation of vascular diseases that involve the optic disc, such as anterior ischemic optic neuropathy, retinal vein occlusion and proliferative diabetic retinopathy. Analyzing the radial peripapillary capillary plexus, OCTA can also highlight early vascular changes in degenerative diseases (i.e., glaucoma, Alzheimer’s disease or multiple sclerosis). Multimodal imaging is a cornerstone in the neuro-ophthalmology field, offering unparalleled insight into optic nerve head architecture and vascular integrity in both normal and diseased states. Full article

Introduction: Diabetic retinopathy (DR) is characterized by early retinal neurodegeneration accompanied by progressive alterations of the retinal microvasculature, both exacerbated by hyperglycemia-induced oxidative stress and inflammation. Mitochondrial dysfunction critically contributes to neuronal loss and vascular impairment. The 18 kDa Translocator Protein (TSPO) is a mitochondrial outer membrane protein whose expression is increased in activated retinal glial cells and represents a promising target to modulate neuroinflammation and oxidative stress. This study evaluates the therapeutic potential of the TSPO ligand PIGA-1138 in experimental models of DR. Methods: PIGA-1138 (3 µM in vitro; 10 mg/kg/day, i.p., in vivo) was evaluated in high glucose (HG)-exposed 661W retinal cells and in streptozotocin (STZ, 150 mg/kg)-induced diabetic C57BL/6J mice. Cell viability, mitochondrial function, oxidative stress, and Nrf2, HO-1, and SOD1 expression were assessed in vitro. Retinal function and morphology were evaluated in vivo by electroretinography (ERG), visual acuity testing, and optical coherence tomography (OCT) at 30 and 60 days after diabetes induction. Results: PIGA-1138 significantly improved cell viability, reducing apoptosis (TUNEL p ≤ 0.01), preserving mitochondrial membrane potential (MitoRed p ≤ 0.01), reducing oxidative damage, and enhancing Nrf2 nuclear translocation together with HO-1 (p ≤ 0.05) and SOD1 (p ≤ 0.01) expression in HG-treated retinal cells. In diabetic mice, treatment preserved ERG responses and limited retinal thinning at 60 days (p ≤ 0.01), while showing a trend toward preserving visual acuity. Conclusions: Targeting mitochondrial TSPO with PIGA-1138 attenuates key hallmarks of DR by mitigating oxidative stress, suppressing neuroinflammation, and preserving retinal structure and function. These findings support TSPO as a potential disease-modifying target for DR. Full article

Vision-language models (VLMs) are increasingly evaluated for retinal image interpretation, but end-task discrimination does not establish whether a prediction depends on the optical coherence tomography (OCT) image. We evaluated RetinaVLM, LLaVA-Med, and Qwen3.6-27B under zero-shot and parameter-efficient adaptation using an APTOS-2021 cohort (128 training, 21 validation, and 69 test eyes) and a 100-eye cross-site stress-test cohort. The primary readout compared forced-choice continue/stop scores obtained with a real OCT B-scan and a uniform-grey image while holding the generated rationale fixed; it therefore estimates a rationale-conditioned direct image contrast rather than total image dependence. Across 22 internal cells, 21 confidence intervals included an AUC of 0.5, while one Qwen zero-shot cell was inversely aligned (AUC 0.354, 95% CI 0.224–0.493). No positively aligned cells survived the Benjamini–Hochberg adjustment. Selected backbones produced image-responsive biomarker outputs, including pigment epithelial detachment balanced accuracy up to 0.93, whereas a five-field tabular reference model achieved decision AUC 0.731 (95% CI 0.603–0.846). Similar direct-contrast findings occurred in the second-site stress test. Because the generated rationales were not verified as faithful representations of latent computation, the grey image was out of distribution, and the cohorts were small, null direct contrasts cannot show that the models ignored OCT or establish equivalence to no discrimination. Full article

Background/Objectives: To evaluate macular structural changes after uncomplicated phacoemulsification using optical coherence tomography (OCT) and to investigate whether cardiometabolic disease influences the early postoperative retinal response. Methods: This retrospective observational study included 111 eyes from 111 patients undergoing uncomplicated phacoemulsification with intraocular lens implantation. Macular OCT parameters were evaluated preoperatively and at postoperative days 1, 7, and 30. Patients were stratified according to the presence of cardiometabolic disease, and retinal changes were compared between groups. Results: Exploratory visit-specific comparisons produced nominal differences in average retinal thickness and macular volume at several assessments; however, none remained statistically significant after Holm adjustment across the 16 parameter-by-visit comparisons. The adjusted models provided no statistically significant evidence that postoperative changes from baseline differed according to cardiometabolic status. Model-derived interaction contrasts at days 1, 7, and 30 were small and their 95% confidence intervals included zero for all OCT outcomes. Accordingly, no statistically significant differences in postoperative change from baseline were detected between groups; equivalence was not assessed. Conclusions: Although nominal differences were observed in exploratory visit-specific comparisons, none remained statistically significant after multiplicity adjustment. Furthermore, the adjusted analyses did not detect statistically significant differences in postoperative change from baseline according to cardiometabolic status after adjustment for baseline retinal structure and relevant demographic and surgical confounders. No statistically significant evidence of different postoperative OCT trajectories was detected between groups; equivalence was not assessed. Full article

Background and Objectives: Arterial hypertension is a major cause of systemic microvascular damage involving target organs such as the kidneys and retina. Because the retinal and renal microcirculations share common pathogenic mechanisms, retinal imaging may provide non-invasive biomarkers of hypertensive microvascular injury. This study investigated the association between the renal resistive index (RRI), systemic oxidative stress biomarkers, and retinal abnormalities in patients with essential hypertension. Retinal structural and microvascular parameters were evaluated using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Materials and Methods: In this cross-sectional exploratory study, 32 patients with essential hypertension (64 eyes) underwent comprehensive ophthalmic examination, OCT/OCTA imaging, renal Doppler ultrasonography for RRI assessment, and evaluation of systemic oxidative stress biomarkers. Associations between renal, ocular, and biochemical parameters were analyzed. Results: No significant differences were observed in most global OCT/OCTA parameters. However, higher RRI values were associated with localized macular thinning and reduced optic nerve head perfusion metrics. Patients with RRI values ≥ the 75th percentile showed significantly increased hydrogen peroxide levels (p = 0.004) and reduced nitric oxide bioavailability (p = 0.033), together with thinning of selected inner macular sectors. A trend toward reduced optic nerve head flow index was also observed, suggesting early microvascular impairment that may not be detected by conventional global OCT measurements. Conclusions: These exploratory findings suggest a possible association among increased renal vascular resistance, oxidative stress, and localized retinal structural alterations in patients with essential hypertension. The coexistence of systemic redox imbalance and sectorial retinal changes supports the hypothesis of an eye–kidney–redox interplay and indicates that advanced retinal imaging, particularly detailed sectorial OCT analysis, may represent a complementary non-invasive tool for the early detection of subclinical microvascular damage. Larger prospective studies are warranted to validate these findings. Full article

Background: Artificial intelligence has significantly improved the diagnosis of retinal diseases using fundus and optical coherence tomography. However, the pathway between the accuracy of the models and their clinical application is still unclear. Objective: The objective of this systematic review is to overcome this gap by correlating the quality of methodology with clinical preparation in the current studies and to critically examine the translation readiness possibility. Methods: The PRISMA-based review clearly addresses the six research questions in an organized manner. A comprehensive search is conducted across six electronic databases, resulting in a total of 883 records. After rigorous screening, a final set of 43 fundus- and OCT-based articles published between 2020 and August 2025 that passed a comprehensive eligibility criterion was selected. The selected studies are assessed using the custom AI-specific risk-of-bias assessment tool and the CLAIM checklist to measure the quality of technical reporting. The reviewer’s agreement is calculated using Cohen’s kappa, interrater reliability, and the intraclass correlation coefficient. Results: Although convolutional and hybrid deep-learning-based studies are often reported to have an accuracy of more than 95.0%, only 14.3% are truly clinically validated, and 23.1% do not include code or implementation data details. Reviewers’ agreement scores are from moderate to high (fundus-based ICC(2, 1) = 0.911, CI = [0.896, 0.923]) and (OCT based ICC(2, 1) = 0.643, CI = [0.422, 0.792]), supporting the reliability of the quality assessments. In order to combine these dimensions, we come up with a composite Technical-Clinical Integrity Index, which measures data transparency, rigor of validation, and reporting of performance. Conclusions: Retinal disease diagnosis has achieved high performance with low clinical transfer. This review provides the guidelines of a Translational Readiness Framework that can be used by researchers, clinicians, and health analytics teams to assess and implement credible artificial intelligence systems in ophthalmology. Full article

Background/Objectives: Glaucoma represents a progressive optic neuropathy and is the leading cause of irreversible blindness worldwide. The disease is classified as primary angle-closure glaucoma (PACG) or as primary open-angle glaucoma (POAG) depending on the iridocorneal angle. Although gonioscopy remains the gold standard investigation, anterior segment optical coherence tomography (AS-OCT) may provide important data about these structures, offering a quantitative assessment of the angle. The purpose of this study is to evaluate AS-OCT parameters in patients with primary angle-closure disease (PACD). Methods: This retrospective exploratory study included 75 eyes from 60 patients with PACD, classified as primary-angle closure suspect (PACS), primary-angle closure (PAC) and PACG. Participants underwent comprehensive ophthalmic examination: best-corrected visual acuity (BCVA), gonioscopy, AS-OCT, optic nerve OCT, visual field examination, and specular microscopy. Associations between AS-OCT angle parameters, intraocular pressure (IOP), and ocular biometrics were assessed using correlation analyses with Benjamini–Hochberg correction for the primary analyses and generalized estimating equation (GEE) models to account for inter-eye correlation. Results: In the overall PACD cohort, AS-OCT angle parameters were inversely associated with IOP, with all primary correlations remaining significant after multiple-testing correction. GEE analysis confirmed significant associations for TISA500, AOD500, and AOD750. Exploratory analyses in the PACS, PAC and PACG subgroups were not significant after correction for multiple testing, while anterior segment biometric parameters showed expected intercorrelations. Conclusions: Quantitative angle parameters demonstrated robust inverse associations with IOP in the overall PACD cohort. These exploratory findings support the complementary role of AS-OCT in the PACD anatomical evaluation and warrant confirmation in larger prospective studies to determine their clinical and prognostic relevance. Full article

Anterior segment optical coherence tomography (AS-OCT) is essential for structural assessment of the anterior eye, yet automated landmark localization remains challenged by pervasive speckle noise, indistinct tissue interfaces, and labor-intensive manual annotation with notable inter-observer variability. This study presents NSE YOLO, an enhanced YOLOv11 framework for high-precision landmark localization in AS-OCT images after implantable collamer lens (ICL) implantation. It integrates a dual-branch NewConv module for multi-scale feature extraction, a dual-additive residual self-attention block (SABlock) to suppress background interference, and a Mamba-based EfficientViMBlock embedded in the C3k2 module to balance global contextual modeling and computational efficiency. Validated on 672 expert-annotated postoperative ICL images from 60 patients, NSE YOLO achieved an mAP@0.5 of 90.7% and mAP@0.5:0.95 of 85.1%, outperforming the YOLOv11 baseline by 5.2% and 6.6% with only 2.86 million parameters. Bland–Altman analysis showed negligible systematic bias and narrow limits of agreement for anterior chamber depth. For iridocorneal angle measurements, directional deviations and wider limits of agreement were observed, with performance approaching the level of inter-observer variability among human annotators. NSE YOLO enables automated quantification of anterior chamber depth and bilateral iridocorneal angles for post-ICL follow-up assessment, providing preliminary technical validation supporting further external and device-level evaluation. Full article

Objectives: Visual Evoked Potential (VEP) abnormalities in Friedreich Ataxia (FA) may result from dysfunction of retinal ganglion cells (RGC), post-retinal visual pathways, or both. Therefore, we aimed to clarify whether in Friedreich Ataxia (FA), abnormal neural conduction is due to dysfunctional RGC, impaired conduction along the post-retinal visual pathways, or both. The secondary aim of the study was to clarify the relationship between a possible RGC and/or post-retinal dysfunction and the patient’s age, age at disease onset, and disease duration. Method: Fourteen FA patients (14 eyes; mean age 38.64 ± 8.21 years) without functional or structural macular abnormalities, confirmed by multifocal electroretinogram (mfERG) and spectral domain–optical coherence tomography (SD-OCT), and 20 age-matched healthy controls were enrolled. Patients were classified as late-onset (FA1, disease onset > 25 years) or early-onset (FA2, disease onset < 25 years). All participants underwent comprehensive ophthalmological and neurological evaluations. RGC function and visual pathway conduction were assessed through simultaneous pattern electroretinogram (PERG) and VEP recordings using 60′ and 15′ checkerboard stimuli. Retino-cortical time (RCT) was calculated as the difference between VEP P100 and PERG P50 implicit times. Statistical analyses included a general linear model. Results: 60′ PERG amplitude (A) was significantly (p < 0.01) reduced in the FA group compared to the Control group. FA patients showed significantly delayed 60′ and 15′ VEP ITs and significantly increased 60′ and 15′ RCT values, particularly in the FA1 group. In late-onset patients, no significant relationships were found between age at onset of disease and all electrophysiological parameters (60′ and 15′ VEP and PERG ITs and As and RCTs). Conclusions: In our selected FA, RCG function and neural conduction along the post-retinal visual pathways are impaired. The abnormal neuronal conduction is greater in late-onset FA patients and is not related to patients’ age and the age at the onset of the disease. The duration of the disease has a slight effect on the post-retinal neural conduction on small optic nerve fibers. Full article

Background/Objectives: Rapid optical assessment of freshly excised basal cell carcinoma (BCC) specimens may shorten the interval between excision and margin evaluation. This prospective pilot study estimated the diagnostic performance of ex vivo line-field confocal optical coherence tomography (LC-OCT) for detecting residual BCC at lateral surgical margins, using histopathology as the reference standard. Methods: Fifty-five clinically suspicious lesions from 48 patients were examined at two centers. Results were analyzed for the complete cohort and for a post-training inclusion phase comprising 32 lesions from 31 patients. Overall lesion-level consensus classifications were recorded separately from classifications of the four clock-face quadrants. Lesions with a negative overall LC-OCT assessment and at least one non-evaluable quadrant were classified as indeterminate and excluded from the primary lesion-level analysis. Thirteen lesions also underwent exploratory ex vivo fusion confocal microscopy (evFCM). Results: In the inclusion phase, 125 of 128 quadrants were evaluable. Thirteen true-positive, 106 true-negative, 2 false-negative, and 4 false-positive quadrant results yielded 86.7% sensitivity, 96.4% specificity, and 95.2% accuracy. At the lesion level, 2 of 32 results were indeterminate. Among the remaining 30 lesions, LC-OCT yielded 5 true-positive, 22 true-negative, 2 false-negative, and 1 false-positive results, corresponding to 71.4% sensitivity, 95.7% specificity, and 90.0% accuracy. The evFCM analysis was descriptive because the subset was small and nonconsecutive. Conclusions: Ex vivo LC-OCT showed promising specificity and overall accuracy for assessing lateral BCC margins after training. The limited number of margin-positive lesions, indeterminate results, clustered quadrant data, and absence of systematic deep-margin imaging require cautious interpretation. LC-OCT should not replace histopathological margin assessment on the basis of the present data. Full article