CNN with Multiple Inputs for Automatic Glaucoma Assessment Using Fundus Images

In the area of ophthalmology, glaucoma affects an increasing number of people. It is a major cause of blindness. Early detection avoids severe ocular complications such as glaucoma, cystoid macular edema, or diabetic proliferative retinopathy. Intelligent artificial intelligence has been confirmed beneficial for glaucoma assessment. In this paper, we describe an approach to automate glaucoma diagnosis using funds images. The setup of the proposed framework is in order: The Bi-dimensional Empirical Mode Decomposition (BEMD) algorithm is applied to decompose the Regions of Interest (ROI) to components (BIMFs+residue). CNN architecture VGG19 is implemented to extract features from decomposed BEMD components. Then, we fuse the features of the same ROI in a bag of features. These last very long; therefore, Principal Component Analysis (PCA) are used to reduce features dimensions. The bags of features obtained are the input parameters of the implemented classifier based on the Support Vector Machine (SVM). To train the built models, we have used two public datasets, which are ACRIMA and REFUGE. For testing our models, we have used a part of ACRIMA and REFUGE plus four other public datasets, which are RIM-ONE, ORIGA-light, Drishti-GS1, and sjchoi86-HRF. The overall precision of 98.31%, 98.61%, 96.43%, 96.67%, 95.24%, and 98.60% is obtained on ACRIMA, REFUGE, RIM-ONE, ORIGA-light, Drishti-GS1, and sjchoi86-HRF datasets, respectively, by using the model trained on REFUGE. Again an accuracy of 98.92%, 99.06%, 98.27%, 97.10%, 96.97%, and 96.36% is obtained in the ACRIMA, REFUGE, RIM-ONE, ORIGA-light, Drishti-GS1, and sjchoi86-HRF datasets, respectively, using the model training on ACRIMA. The experimental results obtained from different datasets demonstrate the efficiency and robustness of the proposed approach. A comparison with some recent previous work in the literature has shown a significant advancement in our proposal.

Uveitis and Other Ocular Complications Following COVID-19 Vaccination

Coronavirus disease 2019 (COVID-19) vaccines can cause transient local and systemic post-vaccination reactions. The aim of this study was to report uveitis and other ocular complications following COVID-19 vaccination. The study included 42 eyes of 34 patients (20 females, 14 males), with a mean age of 49.8 years (range 18–83 years). The cases reported were three herpetic keratitis, two anterior scleritis, five anterior uveitis (AU), three toxoplasma retinochoroiditis, two Vogt-Koyanagi-Harada (VKH) disease reactivations, two pars planitis, two retinal vasculitis, one bilateral panuveitis in new-onset Behçet’s disease, three multiple evanescent white dot syndromes (MEWDS), one acute macular neuroretinopathy (AMN), five retinal vein occlusions (RVO), one non-arteritic ischemic optic neuropathy (NAION), three activations of quiescent choroidal neovascularization (CNV) secondary to myopia or uveitis, and one central serous chorioretinopathy (CSCR). Mean time between vaccination and ocular complication onset was 9.4 days (range 1–30 days). Twenty-three cases occurred after Pfizer-BioNTech vaccination (BNT162b2 mRNA), 7 after Oxford-AstraZeneca vaccine (ChAdOx1 nCoV-19), 3 after ModernaTX vaccination (mRNA-1273), and 1 after Janssen Johnson & Johnson vaccine (Ad26.COV2). Uveitis and other ocular complications may develop after the administration of COVID-19 vaccine.

The Corneal Changes in Diabetic Patients

Diabetes mellitus (DM) represents a systemic disorder which afects different organs. Ocular complications of the DM are the worldwide leading cause of blindness. The most common complications are diabetic retinopathy, diabetic cataract, neovascular glaucoma. Recently many investigations point out that DM can cause comlications at ocular surface as well. Condition such as decreased corneal sensitivity, dry eye or neurotrophic corneal ulceraction are the main clinical manifestations of the diabetic keratopathy (DK). Untreated, these conditions can lead to serious visual acuity decrease. Pathological processes, based on chronic inflammation, due to chronic hyperglycemia, are the main step in the process of DK development. Adequate treatment of the main disease - DM is an imperative in maintaining the healthy cornea without subjective sensations of diabetic patients.

Findings by an International Collaboration on SJS/TEN With Severe Ocular Complications

Stevens-Johnson Syndrome (SJS) is an acute inflammatory vesiculobullous reaction of the skin and mucosa, e.g., the ocular surface, oral cavity, and genitals. In patients with extensive skin detachment and a poor prognosis, the condition is called toxic epidermal necrolysis (TEN). Not all, but some patients with SJS/TEN manifest severe ocular lesions. Approximately 50% of SJS/TEN patients diagnosed by dermatologists and in burn units suffer from severe ocular complications (SOC) such as severe conjunctivitis with pseudomembrane and ocular surface epithelial defects in the acute stage. In the chronic stage, this results in sequelae such as severe dry eye and visual disturbance. Before 2005, our group of Japanese scientists started focusing on ophthalmic SJS/TEN with SOC. We found that cold medicines were the main causative drugs of SJS/TEN with SOC and that in Japanese patients, HLA-A*02:06 and HLA-B*44:03 were significantly associated with cold medicine-related SJS/TEN with SOC (CM-SJS/TEN with SOC). We expanded our studies and joined scientists from Korea, Brazil, India, Taiwan, Thailand, and the United Kingdom in an international collaboration to detect the genetic predisposition for SJS/TEN with SOC. This collaboration suggested that in Japanese patients, cold medicines, including NSAIDs, were the main causative drugs, and that HLA-A*02:06 was implicated in Japanese and Korean patients and HLA-B*44:03 in Japanese-, Indian-, and European ancestry Brazilian patients. Our joint findings reveal that there are ethnic differences in the HLA types associated with SJS/TEN with SOC.

Tylectomy Safety in Salvage of Eyes with Retinoblastoma

Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage including tylectomy (Group I), eye salvage without tylectomy (Group II), and primary enucleation (Group III). A total of 960 patients (1243 eyes) were diagnosed: 256 in Group I, 370 in Group II, and 293 in Group III; 41 patients abandoned treatment upfront. The estimated 5-year overall survivals (OS) were, for Group I, 94%, for Group II 89%, and for Group III 95%. The estimated 5-year disease-specific survivals (DSS) were, for Group I, 96%, for Group II 90%, and for Group III 95%. Patients in Group I had a significantly higher 5-year DSS than patients in Group II (p = 0.003) and not significantly different than patients in Group III (p = 0.367). Overall survival was not compromised by the inclusion of tylectomy in eye salvage therapy compared to eye salvage without tylectomy or primary enucleation. Disease-specific survival was better when tylectomy was included in eye salvage treatments. Tylectomy as part of multimodal treatment may contribute to the care of retinoblastoma patients with chemotherapy-resistant tumor, eyes with concomitant ocular complications, or at the risk of treatment abandonment.

Bell's palsy

Bell's palsy is the term given to an idiopathic lower motor neurone facial nerve paresis or paralysis. It is of rapid onset, almost always unilateral, and may be associated with facial or retro-auricular pain or otalgia. It is the most common diagnosis associated with facial nerve palsy; a GP will see a case approximately every 2 years in practice in the United Kingdom. Early diagnosis and steroid treatment increase the likelihood of full recovery, whereas ocular complications can be prevented by lubricants and lid taping. Over 70% of patients recover within a year. Options to improve facial appearance and function, in those who do not experience a complete recovery, include surgery.

Categorization of the Ocular Microbiome in Japanese Stevens–Johnson Syndrome Patients With Severe Ocular Complications

The commensal microbiota is involved in a variety of diseases. Our group has noticed that patients with Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) often present with persistent inflammation of the ocular surface, even in the chronic stage, and that this inflammation is exacerbated by colonization of the mucosa by certain bacteria. However, the changes in the composition of the ocular microbiome in SJS/TEN patients with severe ocular complications (SOCs) remain to be fully investigated. Here, we conducted a cross-sectional study of 46 Japanese subjects comprising 9 healthy control subjects and 37 SJS/TEN patients with SOC. The 16S rRNA-based genetic analyses revealed that the diversity of the ocular microbiome was reduced in SJS/TEN patients with SOC compared with that in healthy control subjects. Principal coordinate analysis based on Bray–Curtis distance at the genus level revealed that the relative composition of the ocular microbiome was different in healthy control subjects and SJS/TEN patients with SOC, and that the SJS/TEN patients with SOC could be divided into four groups based on whether their microbiome was characterized by enrichment of species in genus Corynebacterium 1, Neisseriaceae uncultured, or Staphylococcus or by simultaneous enrichment in species in genera Propionibacterium, Streptococcus, Fusobacterium, Lawsonella, and Serratia. Collectively, our findings indicate that enrichment of certain bacteria at the ocular surface could be associated with ocular surface inflammation in SJS/TEN patients with SOC.

Pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications

Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is an acute inflammatory vesiculobullous reaction of the mucosa of the ocular surface, oral cavity, and genitals, and of the skin. Severe ocular complications (SOC) are observed in about half of SJS/TEN patients diagnosed by dermatologists and in burn units. Ophthalmologists treat SOC, and they tend to encounter the patients not only in the acute stage, but also in the chronic stage. Our investigation of the pathogenesis of SJS/TEN with SOC led us to suspect that abnormal innate mucosal immunity contributes to the ocular surface inflammation seen in SJS/TEN with SOC. We confirmed that cold medicines such as NSAIDs and multi-ingredient cold medications are the main causative drugs for SJS/TEN with SOC. Single nucleotide polymorphism (SNP) association analysis of cold medicine-related SJS/TEN with SOC showed that the Toll-like receptor 3 (TLR3)-, the prostaglandin-E receptor 3 (PTGER3)-, and the IKZF1 gene were significantly associated with SNPs and that these genes could regulate mucocutaneous inflammation including that of the ocular surface. We also examined the tear cytokines of SJS/TEN with SOC in the chronic stage and found that IL-8, IL-6, IFN-γ, RANTES, eotaxin, and MIP-1β were significantly upregulated in SJS/TEN with SOC in the chronic stage. Only IP-10 was significantly downregulated in SJS/TEN with SOC in the chronic stage. This mini-review summarizes the pathological mechanisms that we identified as underlying the development of SJS/TEN with SOC.

Psychological Effects and Parent Quality of Life in Children of Vision Loss for Uveitis

Purpose: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease common in children and young adults. Uveitis is most frequent serious extra-articular JIA manifestation and can lead to severe ocular complications, vision loss and permanent blindness. The aim of this study is to evaluate the quality of life and the psychological effects of JIA associated with uveitis (JIA-U) on these children and to explore the effect of a child’s chronic illness on parents. Materials and Methods: 30 children and adolescents with active uveitis referred to Unit of Ophthalmology, Giovanni XXIII Hospital of Bari and 30 subjects of control group were enrolled with their parents. Informed consent was signed by the subjects and four questionnaires were administered: Child Behaviour Checklist (CBCL), Parent Stress Index in short form (PSI), Pediatric Quality of Life Inventory (PedsQL) and Coping Inventory for Stressful Situations (CISS). Data were collected from February 2020 to December 2020.Results: The analysis of the emotional and behavioral problems of children (CBCL) with JIA associated with uveitis, the rate of parent’s stress (PSI) and the strategies of coping with the stress (CISS) of their families did not show statistically significant differences between the clinical sample and the control group. Significant differences were observed in quality of life between the two groups. In particular, significant differences (p<0,05) were found in all domains of PedsQL: physical functioning (PF), emotional functioning (EF), social functioning (SF) and school functioning (ScF). Conclusions: This study shows a worse quality of life in children with JIA-U. Several ocular complications, eye examinations and the rigor of long-term treatment influence health-related quality of life in these children. This study suggests the importance of helping children with uveitis cope with chronic disease and may improve outcome. Inclusion of a screening related quality of life should be considered in management of children with JIA-U. Further studies are needed to evaluate the long-term impact on psychological health in these children.