Search Results (1,994)

Objectives: Primary vitreoretinal lymphoma (PVRL) is a rare intraocular malignancy that can frequently masquerade as chronic uveitis, leading to substantial diagnostic delay. This study aimed to evaluate the diagnostic contribution of clinical examination and optical coherence tomography (OCT) in PVRL, to quantify the relationship between structural OCT findings and visual acuity (VA), and to identify factors associated with the yield of diagnostic vitrectomy. Methods: We retrospectively analyzed 17 patients with cytologically confirmed PVRL evaluated at two ophthalmology centers in Bucharest, Romania (2018–2023). Demographic, clinical, and OCT data were collected. An exploratory five-item OCT score (retinal infiltrates, sub-retinal pigment epithelium [sub-RPE] lesions, outer retinal hyperreflectivity, outer retinal disorganization, and foveal involvement) was constructed. Associations with VA (logMAR) were assessed using Spearman correlation, Mann–Whitney U, and Fisher’s exact tests. Results: Mean age was 66.1 ± 9.6 years (76.5% female); 76.5% had bilateral involvement at diagnosis, rising to 88.2% during follow-up. Median symptom duration before diagnosis was 250 days. The OCT score correlated strongly with VA (ρ = 0.772, p < 0.001). Outer retinal hyperreflectivity, sub-RPE lesions, retinal infiltrates, and outer retinal disorganization were each associated with significantly worse VA (all p < 0.05), whereas foveal involvement and subretinal fluid were not. A first vitrectomy was diagnostic in 82.4% of cases; prior corticosteroid exposure was significantly associated with an inconclusive initial cytology (Fisher’s exact p = 0.015). Conclusions: OCT findings correlated with visual impairment may help stratify disease severity at diagnosis. Prior corticosteroid exposure was associated with a lower yield of first-attempt vitrectomy, supporting steroid withdrawal before biopsy when feasible. These OCT features occurred together rather than independently, and are therefore best interpreted as a single imaging phenotype. Full article

Age-related macular degeneration (AMD) remains the leading cause of irreversible, severe visual loss among elderly populations in industrialized nations. The clinical spectrum ranges from early forms, characterized by the accumulation of extracellular deposits known as drusen, to advanced, vision-threatening late stages. While anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular AMD is the standard of care, geographic atrophy has remained a progressive condition. Geographic atrophy is a chronic neurodegenerative disease defined pathologically by the concurrent, progressive loss of the retinal pigment epithelium (RPE), the overlying photoreceptors, and the underlying choriocapillaris. Historically, the diagnosis and monitoring of GA relied on color fundus photography, which identified the lesions as sharply demarcated, well-circumscribed round or oval areas of depigmentation through which underlying choroidal vessels became clinically visible. However, the advent of high-resolution multimodal imaging—particularly fundus autofluorescence (FAF) and optical coherence tomography (OCT)—has necessitated a modernization of this terminology. Despite the imaging consensus, the fundamental pathophysiology of GA remains the subject of intense academic and clinical debate. The controversy focuses on identifying the primary cellular culprit responsible for initiating the cascade of degeneration. The “top-down” hypothesis suggests that intracellular metabolic failure, oxidative stress, and senescence within the RPE trigger the secondary dysfunction and death of the adjacent photoreceptors and choriocapillaris. Conversely, the “bottom-up” vascular hypothesis argues that age-related and complement activation–driven hemodynamic insufficiency, ischemic dropout, and structural involution of the choriocapillaris precede RPE dysfunction, creating a hypoxic microenvironment that drives the subsequent epithelial collapse. This narrative review scrutinizes the exact molecular, genetic, and structural mechanisms governing the expansion of geographic atrophy. By dissecting the evidence supporting both the RPE and the choriocapillaris as primary instigators, this analysis explores the paradigm that GA represents a synergistic failure of the outer blood–retinal barrier—a symbiotic trophic unit highly dependent on precise vascular and epithelial crosstalk, tightly regulated complement cascades, and extracellular matrix integrity. Full article

Classification accuracy in retinal optical coherence tomography (OCT) alone does not establish whether a model is reliable or whether to refer to a specialist. To address this, we propose DAVis-Net, a VGG16-based architecture that is equipped with two Convolutional Block Attention Modules (CBAMs), an auxiliary deep-supervision head, and an integrated reliability framework that includes Monte Carlo Dropout uncertainty estimation, model calibration, split conformal prediction, and quantitative multi-method attribution analysis. DAVis-Net has achieved a cross-validated accuracy of 98.02% ± 0.12% on the four classes of OCT (CNV, DME, DRUSEN, NORMAL), statistically significantly higher than the VGG16 baseline in a matched-fold paired comparison (accuracy: p = 0.023; macro-F1: p = 0.004), with the highest gain on the hardest class (DRUSEN F1 +4.57 pp). Joint correlation analysis showed strong redundancy between predictive entropy and conformal set size (r = 0.67–0.78) across all classes, and a near zero linear correlation between both of these and a geometric proxy for spatial attention placement (|r| < 0.08), suggesting that, as captured by this central-region localization proxy, distributional uncertainty and spatial attention placement may reflect largely distinct reliability dimensions. A composite Trust/Refer triage rule achieved an accuracy of 99.76% on the 73.9% of cases it retained. All reported figures are internal estimates derived from a single dataset at the image-level, and multi-center validation is still required. The results show that the multi-dimensional reliability assessment is a more informative characterization of a medical image classifier than accuracy alone. Full article

Vitamin D is involved in endothelial regulation, inflammatory control, oxidative stress responses, angiogenesis, and neurovascular homeostasis, providing a biological basis for its potential involvement in the retinal and choroidal circulation. This narrative review synthesizes evidence from studies investigating associations between serum 25-hydroxyvitamin D [25(OH)D] concentrations and ocular vascular parameters assessed using optical coherence tomography (OCT), OCT angiography (OCTA), and retinal vascular imaging. Evidence from adult and pediatric populations generally associated vitamin D deficiency (VDD) with lower vessel density in the superficial and deep capillary plexuses, altered retinal vascular caliber and foveal avascular zone morphology, and reduced choroidal thickness or vascularity. However, the direction and magnitude of retinal OCTA findings were inconsistent, and conventional retinal structural measurements frequently remained unchanged. Supplementation studies reported relatively consistent increases in choroidal thickness and vascularity, whereas retinal perfusion responses were limited. Preliminary studies suggested that correction of VDD might support a more sustained response to bevacizumab in diabetic macular edema and central retinal vein occlusion, although this effect was not demonstrated consistently across retinal vascular diseases. Lower 25(OH)D concentrations were also more frequent among patients with retinal vascular occlusions, but residual systemic vascular confounding limits causal interpretation. Overall, current evidence supports a biologically plausible association between vitamin D status and ocular microvascular health but does not establish causality, functional visual benefit, or a specific therapeutic indication for supplementation. Longitudinal multicenter studies and randomized trials using standardized imaging protocols, functional outcomes, biochemical confirmation of vitamin D correction, and validated automated image analysis are required to determine the clinical relevance and reversibility of these findings. Full article

Background: Optical coherence tomography (OCT) has been recognised as a non-invasive imaging modality capable of offering high-resolution visualisation of the corneal tissue. Objective: This review evaluates the role of OCT in chronic corneal disease, focusing on how descriptive imaging has progressed to quantitative imaging biomarkers with translational potential. Methods: A comprehensive review of the published literature on OCT imaging in corneal disease was conducted, emphasising structural features, quantitative parameters, and biomarkers. Results: OCT facilitates detailed visualisation of corneal microstructure, including variations in epithelial thickness, stromal reflectivity patterns, corneal thickness distribution, and interface abnormalities. These morphological observations are converted into quantitative measures that function as imaging biomarkers for disease severity, progression, and therapeutic effectiveness. In conditions such as keratoconus, chronic infectious keratitis, and corneal dystrophies, OCT-derived parameters offer valuable information for phenotyping and longitudinal monitoring. Additionally, advances in automated image analysis and artificial intelligence further increase the potential of OCT for biomarker discovery and evidence-based clinical decision-making. Conclusions: The development and validation of robust OCT-based biomarkers have the potential to enable earlier diagnosis, improved disease monitoring, and personalised treatment strategies. Future research that integrates quantitative imaging, computational analysis, and longitudinal clinical data will be essential to fully realise the translational potential of OCT in corneal disease management. Full article

Multimodal large language models (MLLMs) and vision–language models (VLMs) have rapidly entered medicine, demonstrating promising performance in clinical reasoning, radiology report generation, and visual question answering (VQA). However, many current multimodal architectures and pretrained visual backbones remain fundamentally rooted in two-dimensional (2D) image processing, even though major clinical imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), optical coherence tomography (OCT), and echocardiography, are inherently volumetric or temporal. This narrative review examines the transition from 2D vision–language systems to volumetric multimodal AI, tracing the evolution from 2D and slice- or projection-based approaches through sequential and video-like methods to three-dimensional (3D) vision foundation models and native 3D VLMs/MLLMs. We examine their representational and computational trade-offs, evaluation gaps, and clinically grounded benchmarks. Approaches differ substantially in how they represent and preserve 3D information. Slice- and projection-based methods offer computational efficiency but may discard spatial context, whereas sequential and native volumetric approaches increasingly model relationships across the full imaging study. Recent 3D foundation models and multimodal systems demonstrate the feasibility of reusable volumetric representations and language-enabled 3D image interpretation, but face barriers in computational cost, training-data scale, evaluation methodology, and clinical reliability. Only 53% of Med-Gemini-3D reports were judged clinically acceptable, and natural language processing (NLP) metrics such as BLEU and ROUGE correlate poorly with diagnostic correctness. True 3D multimodal medical intelligence remains in its early stages. Future progress requires efficient volumetric representation strategies, clinically grounded evaluation frameworks, standardized benchmarks, and robust cross-institution validation. Full article

Background/Objectives: Wide-field swept-source optical coherence tomography angiography (WF-SS-OCTA) enables non-invasive, layer-specific retinal microvascular assessment. We explored treatment-associated microvascular change in acute leukemia and its concurrent association with post-induction response. Methods: In this prospective single-center cohort (ChiCTR2300077558), 111 newly diagnosed adults (58 AML, 53 ALL) and 40 healthy controls underwent pre-induction 16 × 16 mm WF-SS-OCTA; 77 were re-imaged at first response assessment. Response (complete remission (CR)/CRi vs. partial/no response (PR/NR)) was adjudicated independently of OCTA. The focal exploratory outcome was deep capillary plexus vessel density change (ΔDCP-VD). This outcome was designated after completion of data collection, and all analyses are exploratory and hypothesis-generating. Results: DCP-VD showed an AML < ALL < control baseline gradient (42.49 ± 3.15%, 43.45 ± 2.89%, 44.27 ± 2.78%; ANOVA p = 0.014), and 10 of 20 baseline metrics survived false-discovery-rate correction. ΔDCP-VD was higher in CR/CRi than PR/NR (1.50 (1.00, 2.00) vs. 0.50 ± 0.83 percentage points; difference 0.97, 95% CI 0.57–1.37; p < 0.01) and correlated with hemoglobin change (r_s = +0.546, p < 0.01); in-sample discrimination gave an AUC of 0.799 (95% CI 0.674–0.907). Conclusions: ΔDCP-VD differed by concurrent response and tracked hemoglobin change; findings establish no causality, prediction, or clinical threshold and require independent prospective validation. Full article

Background: Measurement of anterior chamber depth (ACD) is an important screening method for angle-closure glaucoma risk. We aimed to determine the precision and agreement of a smartphone-based method for measuring ACD when compared with anterior segment optical coherence tomography (AS-OCT) and Smith’s technique. Methods: A total of 43 participants (22 female, 21 male) were recruited. The mean age ± standard deviation of participants was 21.9 ± 2.1 years (range = 19–27 years). Three measurements were taken on each participant’s right eye in a random order for each technique. For this comparative study, differences in ACD, test–retest variability of a given method, and Bland–Altman level of agreement were computed to compare differences in performance between all three methods. Results: Smith’s technique over-estimated ACD, while smartphone photography under-estimated ACD, when compared to the reference AS-OCT. There was proportional bias between all three techniques. Smith’s technique had the largest degree of variability, whereas there was no statistically significant difference in test–retest variability between AS-OCT and smartphone photography. Conclusions: Zamir’s smartphone photography technique could be used for measuring ACD. Although there are some limitations compared to other established approaches, smartphone photography may have potential as a low-cost screening tool for estimating ACD in settings where specialised equipment is not available. Further studies are required to establish diagnostic performance for angle-closure screening in clinically relevant populations. Full article

Ocular involvement in psoriatic disease is often underrecognized, particularly when inflammation affects posterior segments and remains undetectable on routine examination or conventional imaging modalities. We report a 38-year-old woman with palmoplantar psoriasis and psoriatic arthritis, characterized by ultrasound-confirmed dactylitis and inflammatory left hip pain, receiving methotrexate and guselkumab. Disease activity was low (DAPSA 7.6; CRP 5.8 mg/L). She presented with increased intraocular pressure, progressive visual blurring, and headache of 8 months’ duration, without a previous history of uveitis. Multimodal imaging was performed, including slit-lamp examination, grayscale B-mode ocular ultrasound, optical coherence tomography (OCT), and strain elastography. Slit-lamp examination and grayscale B-mode ultrasound were unremarkable, with no detectable vitreous echoes (grade 0). OCT demonstrated preserved retinal architecture with subtle hyperreflective vitreous dots in the right eye, compatible with low-grade vitreous cellularity, while the left eye was unremarkable. In contrast, strain elastography revealed increased stiffness and marked heterogeneity within the vitreous and periocular tissues, suggesting biomechanical alterations not detected by conventional structural imaging. These findings suggest biomechanical alterations compatible with possible inflammatory tissue remodeling. In our patient, strain elastography revealed biomechanical heterogeneity that was not apparent on conventional B-mode ultrasound. These findings should be considered hypothesis-generating and warrant further investigation in prospective controlled studies. Full article

Introduction and Clinical Significance: Descemet membrane detachment (DMD) is an uncommon but potentially vision-threatening complication of anterior segment surgery. Although immune-mediated graft rejection is a recognized cause of postoperative graft edema following arcuate keratotomy (AK) in eyes with previous penetrating keratoplasty (PKP), structural complications such as DMD may present with similar clinical findings and require fundamentally different management. We report a case of DMD initially misdiagnosed as acute graft rejection following manual AK in a post-PKP eye. Case Presentation: A 47-year-old female with a 20-year history of PKP in the right eye (RE) presented with decreased vision three weeks after undergoing manual AK using a diamond blade to correct high astigmatism. The procedure was complicated by an intraoperative wound leak requiring suturing. Postoperatively, she developed corneal edema and was initially misdiagnosed with acute graft rejection. Despite treatment with topical and systemic corticosteroids, her condition did not improve. Upon referral to our clinic, slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) revealed a near-total, nonplanar DMD. The patient underwent a single air descemetopexy session involving three sequential intracameral air injections, resulting in Descemet membrane apposition and improvement in graft clarity. At 3-month follow-up, visual acuity had improved from hand motion to 20/200, with IOP within normal limits. Longer-term follow-up was unavailable. Conclusions: DMD should be considered as a cause of graft edema after AK in post keratoplasty eyes especially in the presence of complications. Full article

Background/Objectives: Cutaneous squamous cell carcinoma (cSCC) treated with high-dose-rate (HDR) surface brachytherapy using patient-specific 3D-printed applicators lacks a validated non-invasive follow-up modality capable of resolving microscopic residual disease. Line-field confocal optical coherence tomography (LC-OCT) provides real-time, cellular resolution, three-dimensional imaging of the epidermis and superficial dermis and has been proposed as a candidate tool for post-radiotherapy monitoring. We evaluated the feasibility of LC-OCT for pre- and post-treatment imaging of cSCC and assessed whether an LC-OCT-defined remission phenotype, operationally defined a priori as the absence of all malignancy-associated LC-OCT criteria, can be documented after 3D-printed HDR surface brachytherapy. Methods: Eight consecutive patients with histologically confirmed cSCC, unsuitable for surgery, were treated with HDR surface brachytherapy delivered through patient-specific 3D-printed applicators. LC-OCT imaging was performed immediately before brachytherapy and at short-term follow-up (six months). Nineteen pre-treatment LC-OCT criteria derived from the Cinotti 2021 descriptive criterion set for cSCC were scored: seventeen malignancy-associated criteria, plus elastosis (scored as a background photodamage covariate, not counted towards remission) and fibrosis (scored post-treatment only). Presence/absence of each criterion was rated by two blinded dermatologists; inter-assessor agreement was quantified using percentage agreement and Cohen’s kappa. Results: Baseline LC-OCT showed a rich malignant signature: hyperkeratosis, parakeratosis, disarranged epidermal architecture, dyskeratotic keratinocytes, atypical and crowded nuclei, and dermoepidermal junction alterations were present in eight out of eight lesions (100%) under an inclusive two-reader rule. At short-term follow-up, six months after the final brachytherapy fraction, all seventeen malignancy-associated criteria constituting the pre-specified remission set were absent in all eight patients under the decision rule described in the article—which classifies isolated dilated linear vessels occurring in an otherwise criterion-negative, fibrotic dermis as post-radiation telangiectasia rather than residual tumour, yielding an LC-OCT-defined remission phenotype rate of 100% (eight out of eight; 95% exact binomial [Clopper–Pearson] CI 63.1–100%). Post-radiation fibrosis was observed in 8/8 patients (100%), and dilated linear vessels were observed in six out of eight patients (75%, evaluated under the same decision rule (Observer 1: 4/8; Observer 2: 6/8). Elastosis, a marker of background actinic photodamage present in eight out of eight lesions at baseline and excluded from the malignancy-associated criterion count, is distinct from post-treatment fibrosis, a radiation-induced dermal remodelling feature scored only at follow-up; the two should not be conflated. Conclusions: In this proof-of-concept cohort, LC-OCT was feasible for pre- and post-treatment imaging of cSCC after 3D-printed HDR surface brachytherapy, produced highly reproducible dual-observer readings (κ = 0.903), and documented, at a single short-term time point six months after the final fraction, an LC-OCT-defined remission phenotype in every treated lesion, with a consistent fibrosis signature. Persistent dilated linear vessels in a fibrotic, otherwise criterion-negative dermis were classified as a non-specific post-radiation vascular change and did not preclude LC-OCT-defined complete remission. Because this remission phenotype rests on a pre-specified but not externally validated imaging definition and was not anchored to post-treatment histopathology or reflectance confocal microscopy, it constitutes an imaging surrogate rather than a confirmed complete remission, and microscopic residual disease below the resolution limit of LC-OCT cannot be excluded. These hypothesis-generating findings support LC-OCT as a candidate non-invasive monitoring modality, requiring confirmation in larger, biopsy-anchored prospective studies with longer follow-up. Full article

Alzheimer’s disease (AD) pathology is increasingly recognized to manifest in the retina, offering a non-invasive window for early biomarker discovery. This proof-of-concept study investigated whether multimodal retinal imaging—hyperspectral imaging (HSI), optical coherence tomography (OCT), and color fundus photography (CFP)—can differentiate individuals with and without cerebral amyloid-beta (Aβ) pathology in 40 participants with PET-confirmed Aβ status (17 Aβ+, cognitively normal or with mild cognitive impairment; 23 Aβ− cognitively normal controls). HSI-derived gray-level co-occurrence matrix (GLCM) texture, OCT-derived ganglion cell–inner plexiform layer (GC-IPL) thickness, and CFP-derived vascular biomarkers (VBMs) were extracted, and logistic regression with leave-one-out cross-validation assessed classification performance per modality, alone and combined; the cohort was supplemented with AD dementia patients for an exploratory cross-sectional comparison across disease-stage groups. HSI showed nominally lower GLCM correlation at 466 nm in Aβ+ participants, most pronounced in the inferior macula (AUC = 0.72). GC-IPL thickness showed a similar inferior-predominant regional pattern. Combining HSI and GC-IPL features yielded the best performance (AUC = 0.84; sensitivity = 0.82; specificity = 0.78), although this improvement over the unimodal models did not reach statistical significance, whereas vascular biomarkers contributed minimally. In an exploratory cross-sectional comparison across AD stage groups drawn from two cohorts, HSI features showed a non-monotonic pattern, decreasing in early Aβ+ stages and rising again in dementia. These findings provide preliminary evidence of complementary information between HSI and OCT for detecting retinal biomarkers of early-stage AD, supporting multimodal retinal imaging as a scalable screening approach warranting validation in larger, longitudinal cohorts. Full article

Background/Objectives: Dental biofilm formation on prosthetic materials contributes to oral diseases and material degradation. This pilot study evaluated the feasibility of combining time-domain optical coherence tomography (TD-OCT) and non-contact atomic force microscopy (NC-AFM) to characterize biofilm-associated optical and surface changes in dental prosthesis materials following antiseptic treatment. Methods: Acrylic resin, composite resin, and stainless-steel specimens were inoculated with Streptococcus mutans biofilms and exposed to water, Orahex, and Watsons mouthwash. TD-OCT was used to obtain extinction coefficient (EC) and optical thickness measurements, while NC-AFM was performed on Orahex-treated specimens to assess nanoscale surface morphology. EC distributions were analyzed descriptively from valid TD-OCT A-scans. Results: Within the examined specimens, EC distributions varied following biofilm formation and antiseptic treatment, with material-dependent responses. Composite resin exhibited the clearest reduction in EC following Watsons treatment, whereas acrylic resin and stainless-steel specimens showed more variable responses. Physical thickness remained relatively stable, while NC-AFM observations of the Orahex-treated specimens supported the TD-OCT findings by demonstrating corresponding surface morphological changes. Conclusions: This pilot study demonstrates the preliminary feasibility of integrating TD-OCT with NC-AFM for non-destructive evaluation of biofilm-associated optical and surface changes in dental prosthesis materials. The findings are descriptive and exploratory, highlighting the potential of TD-OCT for monitoring prosthetic materials while emphasizing the need for future studies incorporating independent biological replicates and complementary biological validation techniques. Full article

Primary glaucoma is a leading global cause of irreversible visual impairment, necessitating management strategies to preserve visual function over a lifetime. This narrative review synthesizes contemporary evidence on risk stratification, target intraocular pressure (IOP), and interventional decision-making for primary open-angle glaucoma (POAG) and the primary angle-closure disease (PACD) spectrum. A risk-stratified approach integrates baseline risk factors, gonioscopic anatomy, structural optical coherence tomography (OCT), standard automated perimetry, rate of progression, life expectancy, ocular surface status, medication adherence, patient preference, and resource setting. Early laser or surgical intervention can reduce medication burden and improve IOP control in selected patients. However, conservative medical management and observation remain appropriate when progression risk is low or procedural risk is disproportionate. Landmark trials support first-line selective laser trabeculoplasty in suitable POAG. Additionally, evidence supports primary trabeculectomy as an option for advanced disease and early lens extraction for selected older patients with primary angle closure or primary angle-closure glaucoma. Artificial intelligence, polygenic risk scores, and sustained-release platforms serve as promising adjuncts. Nevertheless, these technologies require external validation, equitable implementation, and clearly defined clinical action thresholds before routine adoption. Overall, glaucoma care should transition from a uniform sequence prioritizing topical medications toward an individualized, evidence-based escalation strategy. This approach optimally balances visual prognosis, procedural risk, and patient-centered outcomes. Full article

Background: To evaluate structural and microvascular parameters in proliferative diabetic retinopathy (PDR) eyes, based on topographical location of neovessels (NVs). Methods: Retrospective cross-sectional study including PDR eyes without clinically significant macular edema. Patients were stratified on NVs location: disc (NVD), elsewhere (NVE), both (NVD + NVE). Optical coherence tomography (OCT) and OCT-angiography (OCTA) were performed to measure central macular thickness (CMT), choroidal thickness (ChT), retinal layer thicknesses, foveal avascular zone (FAZ) area, retinal perfusion density (PD) and choriocapillaris flow deficit (CC FD%). Results: Twenty-six PDR eyes from 26 patients (20 males, mean age 53.3 ± 14.2 years) were analyzed, 6 with NVD, 14 with NVE and 6 with NVD + NVE, respectively. No significant differences in CMT, ChT, PD and CC FD% between groups were found. OCT layer-by-layer analysis showed lower inner retinal layer thicknesses in NVE group. FAZ area was larger in NVD (p = 0.05). In presence of NVD, the regression analysis between FAZ and OCTA metrics showed a negative linear relationship with PD, and a positive relationship with CC FD%. Conclusions: In NVD group, a thickening of inner retinal layers and FAZ enlargement were found. These results support the hypothesis of a more pronounced ischemic damage in PDR eyes with NVs at the optic disc. Full article