Bilateral neurotrophic keratopathy following laser retinopexy for high myopia in a child with autism

Background/aimsTo apply deep learning technology to develop an artificial intelligence (AI) system that can identify vision-threatening conditions in high myopia patients based on optical coherence tomography (OCT) macular images.MethodsIn this cross-sectional, prospective study, a total of 5505 qualified OCT macular images obtained from 1048 high myopia patients admitted to Zhongshan Ophthalmic Centre (ZOC) from 2012 to 2017 were selected for the development of the AI system. The independent test dataset included 412 images obtained from 91 high myopia patients recruited at ZOC from January 2019 to May 2019. We adopted the InceptionResnetV2 architecture to train four independent convolutional neural network (CNN) models to identify the following four vision-threatening conditions in high myopia: retinoschisis, macular hole, retinal detachment and pathological myopic choroidal neovascularisation. Focal Loss was used to address class imbalance, and optimal operating thresholds were determined according to the Youden Index.ResultsIn the independent test dataset, the areas under the receiver operating characteristic curves were high for all conditions (0.961 to 0.999). Our AI system achieved sensitivities equal to or even better than those of retina specialists as well as high specificities (greater than 90%). Moreover, our AI system provided a transparent and interpretable diagnosis with heatmaps.ConclusionsWe used OCT macular images for the development of CNN models to identify vision-threatening conditions in high myopia patients. Our models achieved reliable sensitivities and high specificities, comparable to those of retina specialists and may be applied for large-scale high myopia screening and patient follow-up.

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Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317800 ◽

2021 ◽

pp. bjophthalmol-2020-317800

Author(s):

Xiujuan Zhao ◽

Yonghao Li ◽

Wei Ma ◽

Ping Lian ◽

Xiling Yu ◽

...

Keyword(s):

Success Rate ◽

Macular Hole ◽

High Myopia ◽

Randomised Trial ◽

Case Series ◽

Primary Treatment ◽

Closure Rate ◽

Macular Detachment ◽

The Difference ◽

Myopic Maculopathy

AimTo compare the efficacy of macular buckling (MB) and pars plana vitrectomy (PPV) for full-thickness macular holes (FTMH) and associated macular detachment (MD) in highly myopic eyes.MethodsProspective interventional case series of eyes undergoing PPV or MB for FTMH and MD.Main outcome measuresBest-corrected visual acuity (BCVA) at postoperative month 24. Other measured outcomes include the initial surgical success rate, macular hole closure rate and the progression of myopic maculopathy.ResultsA total of 53 eyes from 53 participants were included in this study (26 participants receiving MB and 27 participants receiving PPV), and finally 49 eyes from 49 participants (25 participants in the MB group and 24 participants in the PPV group) were analysed. At postoperative month 24, the BCVA had improved significantly in those that underwent either MB (p<0.001) or PPV (p=0.04). The difference between the groups was not significant (p=0.653). The surgical failure rate after the primary treatment was significantly higher in the PPV group than the MB group (25.00% vs 4.00%, respectively; p=0.04). The macular closure rate was higher in the MB group compared with the PPV group, but the difference was not statistically significant (64.00% vs 58.33%, respectively; p=0.45). Myopic maculopathy development may be more severe following PPV than following MB surgery.ConclusionPatients with high myopia obtained anatomical and functional improvements from either MB or PPV. However, MB achieved a significantly higher success rate in retinal reattachment compared with PPV.Trial registration numberNCT03433547.

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Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

European Journal of Ophthalmology ◽

10.1177/1120672121998960 ◽

2021 ◽

pp. 112067212199896

Author(s):

János Németh ◽

Beáta Tapasztó ◽

Wagih A Aclimandos ◽

Philippe Kestelyn ◽

Jost B Jonas ◽

...

Keyword(s):

European Society ◽

High Myopia ◽

Treatment Options ◽

Vision Impairment ◽

Pathological Myopia ◽

Myopia Progression ◽

Preventive Actions ◽

Prevalence Estimates ◽

Number Of Individuals ◽

Myopia Control

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.

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Myopia-26, the female-limited form of early-onset high myopia, occurring in a European family

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01673-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Noémi Széll ◽

Tamás Fehér ◽

Zoltán Maróti ◽

Tibor Kalmár ◽

Dóra Latinovics ◽

...

Keyword(s):

Middle Ages ◽

Early Onset ◽

Colour Vision ◽

High Myopia ◽

Field Testing ◽

Cone Dystrophy ◽

Ophthalmological Examination ◽

Whole Exome ◽

Caucasian Family ◽

Cone System

Abstract Background Female-limited early-onset high myopia, also called Myopia-26 is a rare monogenic disorder characterized by severe short sightedness starting in early childhood and progressing to blindness potentially by the middle ages. Despite the X-linked locus of the mutated ARR3 gene, the disease paradoxically affects females only, with males being asymptomatic carriers. Previously, this disease has only been observed in Asian families and has not gone through detailed investigation concerning collateral symptoms or pathogenesis. Results We found a large Hungarian family displaying female-limited early-onset high myopia. Whole exome sequencing of two individuals identified a novel nonsense mutation (c.214C>T, p.Arg72*) in the ARR3 gene. We carried out basic ophthalmological testing for 18 family members, as well as detailed ophthalmological examination (intraocular pressure, axial length, fundus appearance, optical coherence tomography, visual field- testing) as well as colour vision- and electrophysiology tests (standard and multifocal electroretinography, pattern electroretinography and visual evoked potentials) for eight individuals. Ophthalmological examinations did not reveal any signs of cone dystrophy as opposed to animal models. Electrophysiology and colour vision tests similarly did not evidence a general cone system alteration, rather a central macular dysfunction affecting both the inner and outer (postreceptoral and receptoral) retinal structures in all patients with ARR3 mutation. Conclusions This is the first description of a Caucasian family displaying Myopia-26. We present two hypotheses that could potentially explain the pathomechanism of this disease.

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