Search Results (29)

The fundus manifestations of pseudopapilledema closely resemble those of optic disc edema, making their differentiation particularly challenging in certain clinical situations. However, rapid and accurate diagnosis is crucial for alleviating patient anxiety and guiding treatment strategies. This study proposes an efficient low-complexity hybrid model, WHA-Net, which innovatively integrates three core modules to achieve precise auxiliary diagnosis of pseudopapilledema. First, the wavelet convolution (WTC) block is introduced to enhance the model’s characterization capability for vessel and optic disc edge details in fundus images through 2D wavelet transform and deep convolution. Additionally, the hybrid attention inverted residual (HAIR) block is incorporated to extract critical features such as vascular morphology, hemorrhages, and exudates. Finally, the Agent-MViT module effectively captures the continuity features of optic disc contours and retinal vessels in fundus images while reducing the computational complexity of traditional Transformers. The model was trained and evaluated on a dataset of 1793 rigorously curated fundus images, comprising 895 normal optic discs, 485 optic disc edema (ODE), and 413 pseudopapilledema (PPE) cases. On the test set, the model achieved outstanding performance, with 97.79% accuracy, 95.55% precision, 95.69% recall, and 98.53% specificity. Comparative experiments confirm the superiority of WHA-Net in classification tasks, while ablation studies validate the effectiveness and rationality of each module’s combined design. This research provides a clinically valuable solution for the automated differential diagnosis of pseudopapilledema, with both computational efficiency and diagnostic reliability. Full article

Objectives: To compare the 1-year visual outcomes of patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy or vitrectomy for large submacular hemorrhages (SMHs) due to neovascular age-related macular degeneration (nAMD). Methods: We retrospectively studied 31 eyes with severe SMHs exceeding 3 disc areas (DAs) secondary to nAMD treated with anti-VEGF agents or a vitrectomy. Patients undergoing anti-VEGF monotherapy received three monthly loading doses of intravitreal injections of aflibercept or brolucizumab followed by as-needed injections or proactive treatment (anti-VEGF group); those undergoing vitrectomies underwent a 25-gauge vitrectomy and a submacular injection of tissue plasminogen activator (25 μg) and 0.4 mL of air with a microneedle having an outer diameter of 50 μm. The best-corrected visual acuities (BCVAs) were compared before and 6 and 12 months after initial treatment. Factors affecting the visual acuity (VA) at 12 months and VA improvements were determined. Results: A total of 17 eyes from 16 patients (54.8%) received anti-VEGF treatment and 14 eyes from 14 patients (45.2%) underwent vitrectomy. The baseline and 12-month mean logarithm of the minimum angle of resolution BCVAs in all eyes after treatment were 0.78 and 0.82, respectively, which were not significantly different (p = 0.661). The lens status, central foveal thickness (CFT) height, and baseline VA were associated significantly with the 12-month BCVA (p = 0.028, p = 0.008, and p = 0.021, respectively) and VA improvement (p = 0.015, p = 0.002, and p = 0.003, respectively). Conclusions: Anti-VEGF monotherapy and vitrectomy maintained functionality in patients with large SMHs due to nAMD. Greater CFT was associated with worse 12-month BCVA and less BCVA improvement despite the treatment modality. Full article

Introduction: The aim of this study was to investigate the locational distribution and potential mechanisms of retinal hemorrhages in newborns using fundus photography. Methods: A retrospective analysis of 98 consecutive newborns with retinal hemorrhages in at least one eye and 30 control newborns without retinal hemorrhages after uneventful delivery was conducted. Retinal hemorrhages were diagnosed and characterized using fundus photography and indirect ophthalmoscopy. The location, grade, and features of the hemorrhages were analyzed, alongside their association with delivery mode. Visual function was assessed at a mean follow-up of 7.8 months to evaluate the long-term implications. Results: Retinal hemorrhages were significantly associated with normal spontaneous vaginal delivery (NSVD) compared to cesarean section (p = 0.004). Bilateral involvement was observed in 87.8% of cases, with hemorrhages predominantly located around the major vascular arcade (MVA) and near the optic disc. Higher grades of hemorrhages were linked to increased involvement of the macula and retinal capillary area (RCA) (p < 0.001). All hemorrhages resolved spontaneously within 45.6 ± 15.9 days. No significant differences in refractive errors or strabismus development were identified between the hemorrhage and control groups at follow-up. Conclusions: Neonatal retinal hemorrhages are commonly observed near the MVA and optic disc, with greater severity associated with macular and RCA involvement. These findings, along with the significant association with NSVD, support a mechanism related to elevated central venous pressure. Retinal hemorrhages resolve spontaneously without impacting refractive error or strabismus development in the short term follow-up. Full article

Background: Central and branch retinal artery occlusion (CRAO and BRAO) are critical causes of acute vision loss, predominantly affecting older adults with systemic vascular pathology. These occlusions typically result from embolic events, leading to partial or complete retinal ischemia. Methods: This retrospective case series report details of our 10-year experience using the 1064 nm Nd:YAG laser for Transluminal Nd:YAG Embolysis (TYE) in order to lyse visible emboli within the retinal arteries. Results: We conducted a retrospective case series involving 18 patients treated by TYE for different retinal arteries occlusions between 2014 and 2024. TYE effectively restored blood flow in the occluded arteries, with variable but generally favorable visual outcomes. Our article highlights significant clinical and interventional aspects of three treated patients: a BRAO case with multiple transluminal emboli, a case of double BRAO and a CRAO case. We also report the successful use of TYE for intraluminal lysing of an embolus located outside the optic disc. The procedures were well-tolerated, with minor complications such as preretinal or vitreous hemorrhages resolving spontaneously. Conclusions: TYE is a minimally invasive therapeutic option for retinal artery occlusion with visible emboli, particularly when intervention occurs shortly after the onset of symptoms. Compared to observation, TYE can improve visual outcomes and reduce the risk of permanent vision loss, presenting a significant advancement in the management of this ophthalmic emergency. The worldwide experience with TYE is continuously increasing. Further research with larger cohorts is recommended to validate these results and refine the treatment protocol. Full article

(1) Background: Intervertebral disc extrusion may be accompanied by extensive epidural hemorrhage (EEH) and result in spinal cord compression. EEH is more commonly seen in French Bulldogs compared to other breeds. The majority of French Bulldogs have lumbar intervertebral disc extrusion, but it is unclear if there is an association between the site of thoracolumbar disc extrusion and EEH. This retrospective study’s aim was to investigate the association and prevalence between the site of thoracolumbar intervertebral disc extrusion and EEH in French Bulldogs. (2) Methods: Thoracolumbar MRI of French Bulldogs was examined for the site of intervertebral disc extrusion and the presence, distribution, and extent of EEH. (3) Results: In 148 French Bulldogs with thoracolumbar intervertebral disc extrusion, the most common location was L4/L5 (22%), followed by L3/L4 (20%) and T13/L1 (15%), and 70.3% had EEH. The highest incidence of EEH across all thoracolumbar sites was seen at L1/L2 (84.2%), followed by L5/L6 (81.3%) and L2/L3 (72.2%). The incidence of EEH was 70.5% across all lumbar sites and 66.9% for all thoracic sites. (4) Conclusion: In this population of French Bulldogs, the prevalence of lumbar disc extrusion was high, and 70.3% had EEH. There was no significant difference between the site of thoracolumbar intervertebral disc extrusion and EEH. Full article

Background/Objectives: We aimed to investigate the genetic loci related to disc hemorrhage (DH) and the relationship of causation between DH and primary open-angle glaucoma (POAG) using a genome-wide association study (GWAS) in East Asian individuals. Methods: The GWAS included 8488 Koreans who underwent ocular examination including fundus photography to determine the presence of DH and POAG. We performed a GWAS to identify significant single-nucleotide polymorphisms (SNPs) associated with DH and analyzed the heritability of DH and genetic correlation between DH and POAG. The identified SNPs were utilized as instrumental variables (IVs) for two-sample Mendelian randomization (MR) analysis. The POAG outcome dataset was adopted from Biobank Japan data (n = 179,351). Results: We found that the rs62463744 (TMEM270;ELN), rs11658281 (CCDC42), and rs77127203 (PDE10A;LINC00473) SNPs were associated with DH. The SNP heritability of DH was estimated to be 6.7%, with an absence of a genetic correlation with POAG. MR analysis did not reveal a causal association between DH and POAG for East Asian individuals. Conclusions: The novel loci underlying DH in the Korean cohort revealed SNPs in the ELN, CCDC41, and LINC00473 genes. The absence of a causal association between DH and POAG implies that DH is a shared risk factor, rather than an independent culprit factor, and warrants further investigation. Full article

Computer vision is a powerful tool in medical image analysis, supporting the early detection and classification of eye diseases. Diabetic retinopathy (DR), a severe eye disease secondary to diabetes, accompanies several early signs of eye-threatening conditions, such as microaneurysms (MAs), hemorrhages (HEMOs), and exudates (EXs), which have been widely studied and targeted as objects to be detected by computer vision models. In this work, we tested the performances of the state-of-the-art YOLOv8 and YOLOv9 architectures on DR fundus features segmentation without coding experience or a programming background. We took one hundred DR images from the public MESSIDOR database, manually labelled and prepared them for pixel segmentation, and tested the detection abilities of different model variants. We increased the diversity of the training sample by data augmentation, including tiling, flipping, and rotating the fundus images. The proposed approaches reached an acceptable mean average precision (mAP) in detecting DR lesions such as MA, HEMO, and EX, as well as a hallmark of the posterior pole of the eye, such as the optic disc. We compared our results with related works in the literature involving different neural networks. Our results are promising, but far from being ready for implementation into clinical practice. Accurate lesion detection is mandatory to ensure early and correct diagnoses. Future works will investigate lesion detection further, especially MA segmentation, with improved extraction techniques, image pre-processing, and standardized datasets. Full article

Background: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. Methods: This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen–Dice coefficients were calculated to compare the location of different features. Results: Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. Conclusions: Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening. Full article

A well-known eye disorder called diabetic retinopathy (DR) is linked to elevated blood glucose levels. Cotton wool spots, confined veins in the cranial nerve, AV nicking, and hemorrhages in the optic disc are some of its symptoms, which often appear later. Serious side effects of DR might include vision loss, damage to the visual nerves, and obstruction of the retinal arteries. Researchers have devised an automated method utilizing AI and deep learning models to enable the early diagnosis of this illness. This research gathered digital fundus images from renowned Pakistani eye hospitals to generate a new “DR-Insight” dataset and known online sources. A novel methodology named the residual-dense system (RDS-DR) was then devised to assess diabetic retinopathy. To develop this model, we have integrated residual and dense blocks, along with a transition layer, into a deep neural network. The RDS-DR system is trained on the collected dataset of 9860 fundus images. The RDS-DR categorization method demonstrated an impressive accuracy of 97.5% on this dataset. These findings show that the model produces beneficial outcomes and may be used by healthcare practitioners as a diagnostic tool. It is important to emphasize that the system’s goal is to augment optometrists’ expertise rather than replace it. In terms of accuracy, the RDS-DR technique fared better than the cutting-edge models VGG19, VGG16, Inception V-3, and Xception. This emphasizes how successful the suggested method is for classifying diabetic retinopathy (DR). Full article

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases. Full article

Disc hemorrhage (DH) is often associated with glaucoma progression. A vertically asymmetrical pattern is typical of glaucoma progression, but it remains unclear whether the association between DH and glaucoma progression differs between the superior and inferior hemiretinas. We compared the thickness changes of the macular ganglion cell complex (GCC) in the hemiretinas of normal-tension glaucoma patients with or without DH, as well as between hemiretinas positive and negative for DH, during five years. Both the superior and inferior hemiretinas in the DH-positive group had a more negative GCC thickness slope in association with more DH counts compared to those in the DH-negative group. Conversely, only the inferior hemiretina exhibited a significant relationship between GCC thickness slope and DH counts when hemiretinas positive and negative for DH in the DH-positive group were compared. In the superior hemifield, the slope of the total deviation changes in the DH-positive hemifield of the DH-positive group was more negative compared to that of the DH-negative group. The association between DH and glaucoma progression in the macular GCC may be stronger in the inferior hemiretina, suggesting that more attention should be paid to DH in the inferior disc area as a sign of glaucoma progression. Full article

Diabetes is a global problem which impacts people of all ages. Diabetic retinopathy (DR) is a main ailment of the eyes resulting from diabetes which can result in loss of eyesight if not detected and treated on time. The current process of detecting DR and its progress involves manual examination by experts, which is time-consuming. Extracting the retinal vasculature, and segmentation of the optic disc (OD)/fovea play a significant part in detecting DR. Detecting DR lesions like microaneurysms (MA), hemorrhages (HM), and exudates (EX), helps to establish the current stage of DR. Recently with the advancement in artificial intelligence (AI), and deep learning(DL), which is a division of AI, is widely being used in DR related studies. Our study surveys the latest literature in “DR segmentation and lesion detection from fundus images using DL”. Full article

Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications. Full article

Automatic screening of diabetic retinopathy (DR) is a well-identified area of research in the domain of computer vision. It is challenging due to structural complexity and a marginal contrast difference between the retinal vessels and the background of the fundus image. As bright lesions are prominent in the green channel, we applied contrast-limited adaptive histogram equalization (CLAHE) on the green channel for image enhancement. This work proposes a novel diabetic retinopathy screening technique using an asymmetric deep learning feature. The asymmetric deep learning features are extracted using U-Net for segmentation of the optic disc and blood vessels. Then a convolutional neural network (CNN) with a support vector machine (SVM) is used for the DR lesions classification. The lesions are classified into four classes, i.e., normal, microaneurysms, hemorrhages, and exudates. The proposed method is tested with two publicly available retinal image datasets, i.e., APTOS and MESSIDOR. The accuracy achieved for non-diabetic retinopathy detection is 98.6% and 91.9% for the APTOS and MESSIDOR datasets, respectively. The accuracies of exudate detection for these two datasets are 96.9% and 98.3%, respectively. The accuracy of the DR screening system is improved due to the precise retinal image segmentation. Full article

In this paper, a real-time knee extension monitoring and rehabilitation system for people, such as patients, the elderly, athletes, etc., is developed and tested. The proposed system has three major functions. The first function is two-channel surface electromyography (EMG) signal measurement and processing for the vastus lateralis (VL) and vastus medialis (VM) muscles using a developed EMG device set. The second function is the knee extension range of motion (ROM) measurement using an angle sensor device set (i.e., accelerometer sensor). Both functions are connected and parallelly processed by the NI-myRIO embedded device. Finally, the third function is the graphical user interface (GUI) using LabVIEW, where the knee rehabilitation program can be defined and flexibly set, as recommended by physical therapists and physicians. Experimental results obtained from six healthy subjects demonstrated that the proposed system can efficiently work with real-time response. It can support multiple rehabilitation users with data collection, where EMG signals with mean absolute value (MAV) and root mean square value (RMS) results and knee extension ROM data can be automatically measured and recorded based on the defined rehabilitation program. Furthermore, the proposed system is also employed in the hospital for validation and evaluation, where bio-feedback EMG and ROM data from six patients, including (a) knee osteoarthritis, (b) herniated disc, (c) knee ligament injury, (d) ischemic stroke, (e) hemorrhagic stroke, and (f) Parkinson are obtained. Such data are also collected for one month for tracking, evaluation, and treatment. With our proposed system, results indicate that the rehabilitation people can practice themselves and know their rehabilitation progress during the time of testing. The system can also evaluate (as a primary treatment) whether the therapy training is successful or not, while experts can simultaneously review the progress and set the optimal treatment program in response to the rehabilitation users. This technology can also be integrated as a part of the Internet of Things (IoT) and smart healthcare systems. Full article