Research progress on fundus examination methods and fundus image characteristics of retinopathy of prematurity / 国际眼科杂志(Guoji Yanke Zazhi)

Retinopathy of prematurity(ROP)is the primary cause of preventable childhood blindness. It is hard to screen, diagnose and objectively evaluate. There are various modalities for ROP screening, including various contact or non-contact imaging devices, smart phone-based fundus photography, and artificial intelligence-based fundus image analysis. The diagnosis of ROP is based on visualization and recording of the entire retinal fundus of ROP, which is also the basis for subsequent screening, treatment assessment. Fundus screening is critical for early recognition and facilitates early detection and prompt referral. Potential features may be found by analyzing and summarizing the characteristics of ROP fundus images. Subsequently, timely and targeted ROP prevention and treatment could be performed. Artificial intelligence promotes automatic, quantifiable and objective diagnosis of ROP. This article reviews commonly used clinical fundus examination methods and fundus image characteristics of ROP and summarizes the latest research progress on the application of artificial intelligence in the automatic diagnosis of ROP.

SCREENING OF RETINOPATHY OF PREMATURITY USING INDIRECT OPHTHALMOSCOPE AND RETCAM : A PROSPECTIVE OBSERVATIONAL STUDY

Background:Aim And Objectives:To study the incidence of Retinopathy of Prematurity in Low birth weight Neonates and Preterm who are at high risk, by screening with Binocular Indirect Ophthalmoscope and Ret Cam 3 resulting in early diagnosis and further management of disease will prevent blindness and other complications in children due to ROP. Material And Methods:Prospective Observational study included 60 Newborns (25 female,35 male) with GA <34 weeks and/or birth weight <1750 grams, and GA 34-36 weeks and/or birth weight 1750-2000 grams with risk factor, screened with First Binocular Indirect Ophthalmoscope and then after 30 minutes with Ret Cam 3. Result:Both the techniques are equally effective in detection and staging of Retinopathy of Prematurityscreening.Conclusion:Both techniques give satisfactory results for screening of Retinopathy ofPrematurity and are comparable to each other, both having their own pros and cons.

A Study Of Clinical Profile And Visual Outcome In Patients Undergoing Vitrectomy For Vitreous Hemorrhage

Background:Aim&Objective:To study the epidemiology of vitreous hemorrhage in patients presenting without retinal detachment. To study various etiology of vitreous hemorrhage. To study visual outcome in patients with non resolving vitreous hemorrhage required vitrectomy surgery. To study prognostic factors (age, sex,andvitreous hemorrhage in diabetic patients, hypertensivepatients, ARMD, Ealesdiseases) affecting visual outcome in vitreous hemorrhage. Material And Methods:Study included34patients out of which 13 have diabetes, 6 have hypertension, 7have both diabetes and hypertension, 6have past history of tuberculosis and 2 have no systemic illne ss. Examination includedpreoperative and postoperative best corrected visual acuity, slit lamp examination, intraocular pressure, ultrasound B scan and dilated funduswith indirect ophthalmoscope. Result:Majority patients (38. 2%) were in the age group of 51-60 years with the mean age 51. 35 years. Males [73. 5%] had higher incidence of vitreous hemorrhage than females and Incidence of vitreous hemorrhage was higher in lower socio-economic group. Diabetes Mellitus andHypertension werethe most common co-morbidities with Proliferative diabetic retinopathy,Eales diseases and Branch Retinal vein occlusion are the important Risk factors for vitreous hemorrhage. Most common presenting symptom of vitreous hemorrhage is sudden loss of vision [52. 9%] followed by gradual loss of vision and blurring loss of vision. Patients who received pan retinal photocoagulation and Anti-vegf have better visual outcome post-operativel. Pan retinal photocoagulation, Epiretinal membrane, traction band,macular edema,andchoroidalneovascular membrane are the intraoperative findings noted intra-operatively. Preoperatively most of the cases of vitreous hemorrhage had visual acquity in the group of Perception of light and finger counting close to face. Post-operatively 15 patients have visual acuity in group of 6/18-6/9. Among them 8 were PDR,4 cases of Eales disease and 3 were BRVO cases. Visual acuity of 8 cases belongs to group of 6/60 –6/24 which include 5 PDR , 2 BRVO and 1 Ealesdisease. Post-operatively 7 patients developed complications. Raised IOP seen in 3 cases which includes 2 PDR cases and 1 Eales disease. Cataractous lens noticed in 2 PDR cases. Retinal detachment developed in 1 PDR case. Revitreous hemorrhage occurred in 1 Eales disease. 2 cases underwent re-surgery. Revitrectomy done in 1 case of Eales disease for re-vitreous hemorrhage. Re-vitrectomy with silicone oil insertion done in 1 PDR case for retinal detachment. Conclusion:Visual impairment due to Vitreous hemorrhagemay be prevented by early detection of cause by appropriate investigations and treatment.

Comparison of wide-angle digital retinal imaging system and binocular indirect ophthalmoscope in retinopathy of prematurity screening / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To compare the application effect on patients with retinopathy of prematurity (ROP) screened by wide-angle digital retinal imaging system (RetCam) and binocular indirect ophthalmoscope (BIO). ·METHODS:Totally 1624 cases(3248 eyes) of premature infants were detected by RetCam and BIO in our hospital from May 2014 to May 2017. The screening results of ROP and occurrence of adverse events were compared between two checking methods. ·RESULTS: In the 1 624 cases (3248 eyes) of premature infants,196 cases (392 eyes) of premature infants were detected by RetCam and 189 cases (378 eyes) of premature infants were detected by BIO, there was no statistical significance on staging results and partition pathological results between RetCam and BIO (P>0.05). Taking inspection result of BIO as standard, the sensibility, specificity, false positive rate and positive predictive value was 100. 00%, 99. 51%, 3. 57% and 96.43%, respectively. The adverse event rate of RetCam and BIO was 0.18% and 0.22%, respectively, there was no statistical significance (P>0.05). ·CONCLUSION:RetCam and BIO have similar application efficacy for screening ROP, and RetCam could take the place of BIO as the screening method of ROP.

Effects of two screening models for eye diseases in premature infants / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To investigate and compare the application of two screening models in the detection of retinopathy of prematurity (ROP). ·METHODS: The clinical data of 600 premature infants (1200 eyes) who underwent screening of eye diseases in the Department of Ophthalmology during the period from January 2016 to January 2017 were analyzed retrospectively. The fundus lesions were examined with binocular indirect ophthalmoscope (BIO) and the third generation of wide-angle digital retinal imaging system (RetCam Ⅲ). The examination results and adverse events during operation were statistically analyzed. ·RESULTS:In 1200 eyes of 600 patients,the probabilities of ROP detected by BIO and RetCam Ⅲ were 10.92% and 10.75%, respectively (P>0.05). With BIO as the golden standard, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of RetCam Ⅲ in examining ROP were 98.67%, 93.13%, 99.35%, 94.57% and 99.16%, respectively. There was no significant difference in the stage of ROP detected by BIO or RetCam Ⅲ (P>0.05). The probabilities of non-ROP lesions examined by BIO and RetCam Ⅲ were 4.83% and 4.58%, respectively (P>0.05). With BIO as the golden standard, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of RetCam Ⅲ in examining fundus non-ROP diseases were 99.67%, 94.83%, 99.91%, 98.21% and 99.74%, respectively. During the screening of BIO and RetCam Ⅲ,there were 17 cases (2.83%) and 7 cases(1.17%) with adverse events, respectively (P<0.05).·CONCLUSION: The examination results of RetCam Ⅲ are basically the same as those of BIO for ROP and non-ROP diseases. However,RetCam Ⅲ has more advantages in reducing adverse events during operation.

Scleral Buckling under a Slit-lamp Illumination System with a Contact Wide-angle Viewing Lens Compared with an Indirect Ophthalmoscope

PURPOSE: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.

Multimedia interactiva para el desarrollo de habilidades en el uso del oftalmoscopio indirecto / Interactive Multimedia development skills in the use of indirect ophthalmoscope

El oftalmoscopio indirecto es un medio diagnóstico y terapéutico muy necesario y con una amplia utilidad para todos los oftalmólogos, pues este contribuye al desarrollo del proceso de enseñanza-aprendizaje de la asignatura Oftalmología y en especial del segmento posterior del ojo. El objetivo es presentar una multimedia interactiva "Oftalmoscopio indirecto" para el desarrollo de las habilidades profesionales en el uso correcto de este medio diagnóstico en los residentes del Servicio Oftalmológico del Hospital Militar Central "Dr. Carlos J. Finlay". La multimedia contiene diferentes acápites relacionados con el examen oftalmológico, historia, videos, simuladores, posturas y ventajas del oftalmoscopio indirecto. La implementación de esta herramienta de trabajo, a partir del cumplimiento de las acciones que se establecen en la guía elaborada al efecto, permitirá a los residentes que se encuentran en ejercicio o en formación autoprepararse y contribuir a resolver los problemas que detecten a través del oftalmoscopio indirecto en el diagnóstico y tratamiento oportuno de afecciones oftalmológicas que constituyen un problema de salud en Cuba.

The indirect ophthalmoscope is a very necessary diagnostic and therapeutic tool, widely used by all ophthalmologists, as this contributes to the development of teaching and learning Ophthalmology in general and particularly the posterior segment of the eye. Our purpose was to present the interactive multimedia "Indirect Ophthalmoscope" for the development of professional skills in residents of the ophthalmology Service at the Central Military Hospital concerning the proper use of this diagnostic tool. The multimedia contains different headings related to eye exam, history, videos, simulators, positions and advantages of indirect ophthalmoscope. From the fulfillment of the actions set out in the guide produced for this purpose, the implementation of this tool will allow residents to prepare themselves and help to solve problems detected through the indirect ophthalmoscope when diagnosing and treating eye conditions that constitute a health problem in Cuba.

Converting a conventional wired‑halogen illuminated indirect ophthalmoscope to a wireless‑light emitting diode illuminated indirect ophthalmoscope in less than 1000/‑ rupees.

Aim: To report the “do it yourself” method of converting an existing wired‑halogen indirect ophthalmoscope (IO) to a wireless‑light emitting diode (LED) IO and report the preferences of the patients and the ophthalmologists. Subjects and Methods: In this prospective observational study, a conventional IO was converted to wireless‑LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo‑stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. Results: The cost of conversion to wireless‑LED was 815/‑ rupees. Twenty‑nine subjects, mean age 34.3 ± 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo‑stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009). The ophthalmologists rated wireless‑LED IO higher than wired‑halogen IO on the handling, examination comfort, patient’s visual comfort and quality of the image. Twenty‑two (81%) ophthalmologists wanted to change over to wireless‑LED IO. Conclusions: Converting to wireless‑LED IO is easy, cost‑effective and preferred over a wired‑halogen indirect ophthalmoscope.

Comparison of efficacy of scleral buckling surgery for retinal detachment under microscope and under indirect ophthalmoscope / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the effects of scleral buckling surgery for retinal detachment under microscope and under indirect ophthalmoscope. METHODS: Forty - six patients ( 46 eyes ) with rhegmatogenous retinal detachment were retrospectively analyzed. Twenty-six patients received surgeries under microscope was retrospectively analyzed and compared to that of 20 patients who received surgeries under indirect ophthalmoscope by the same operator. RESULTS: No statistical difference was found in patients' operation method choice, including condensation reaction reattachment situation and the retina reset operation at a time ( P> 0. 05 ). The best corrected visual acuity of microscopic group after 1mo of operation was better than before operation, and the improving rate of vision after operation was higher than that of the traditional group (P CONCLUSION:The curative effect of external approach microsurgery has the similar efficacy with the conventional external approach surgery, and gets better visual acuity.

Feature of binocular indirect ophthalmoscope and its application in ophthalmologic examination and operation / 医疗卫生装备

This paper introduces the feature of binocular indirect ophthalmoscope and its application in ophthalmologic examination and operation. Compared with direct ophthalmoscope, binocular indirect ophthalmoscope has many special advantages owing to its unique illumination system and principle of formation of image. Most of ocular fundus diseases can be diagnosed correctly by binocular indirect ophthalmoscope. The view is that the inspection technique of binocular indirect ophthalmoscope is the most convenient and predominant in fundus examination, ophthalmology operation and treatment until now, and is of value in use.