A Fully Automated Pipeline for a Robust Conjunctival Hyperemia Estimation

Purpose: Many semi-automated and fully-automated approaches have been proposed in literature to improve the objectivity of the estimation of conjunctival hyperemia, based on image processing analysis of eyes’ photographs. The purpose is to improve its evaluation using faster fully-automated systems and independent by the human subjectivity. Methods: In this work, we introduce a fully-automated analysis of the redness grading scales able to completely automatize the clinical procedure, starting from the acquired image to the redness estimation. In particular, we introduce a neural network model for the conjunctival segmentation followed by an image processing pipeline for the vessels network segmentation. From these steps, we extract some features already known in literature and whose correlation with the conjunctival redness has already been proved. Lastly, we implemented a predictive model for the conjunctival hyperemia using these features. Results: In this work, we used a dataset of images acquired during clinical practice.We trained a neural network model for the conjunctival segmentation, obtaining an average accuracy of 0.94 and a corresponding IoU score of 0.88 on a test set of images. The set of features extracted on these ROIs is able to correctly predict the Efron scale values with a Spearman’s correlation coefficient of 0.701 on a set of not previously used samples. Conclusions: The robustness of our pipeline confirms its possible usage in a clinical practice as a viable decision support system for the ophthalmologists.

Effect of IPL in Patients with Meibomian Gland Dysfunction

Purpose To evaluate the effect of IPL (intense pulsed light) treatment in patients with meibomian gland dysfunction (MGD). Methods Clinical data of 25 patients with MGD who underwent IPL treatment at the department of ophthalmology of Ludwig-Maximilians-University between 2016 and 2018 were analyzed. Demographics, clinical history, examination findings (eyelid vascularization, meibomian gland findings, conjunctival redness, tear film break-up time [TFBUT], corneal staining (Oxford grading scale [OGS]), and subjective patientsʼ findings (including ocular surface disease index [OSDI]) were collected from each visit (D1, D15, D45, D75). Results All included patients underwent three sessions of IPL treatment in both eyes (D1, D15, D45). There was a significant improvement after IPL treatment (D75) in TFBUT (p < 0.001), corneal staining (OGS) (p < 0.001), conjunctival redness (p < 0.001), lid margin edema (p < 0.001) and redness (p < 0.001), meibum quality (p < 0.001), lid margin telangiectasia (p = 0.005), meibomian gland obstruction (p = 0.001), and OSDI score (p = 0.004). Even after the first IPL session, significant improvements in TFBUT (p < 0.001), corneal staining (OGS p < 0.001), conjunctival redness (p < 0.022), lid margin edema (p < 0.001) and redness (p < 0.016), meibum quality (p = 0.014), and OSDI score (p < 0.013) were noted. There were no relevant negative side effects. Subgroup analysis for age, sex, duration or severity of disease, and associated diagnosis of rosacea showed no significant difference in effectiveness. Conclusion IPL is an effective and safe treatment for patients with MGD, which can be used as a supportive therapeutic option.

Randomised assessor-masked trial evaluating topical manuka honey (Optimel) in treatment of meibomian gland dysfunction

PurposeTo evaluate the effects of manuka honey eye-drops in the treatment of meibomian gland dysfunction.MethodsThis is an assessor-masked (single-blind), randomised controlled trial comparing conventional treatment group with interventional group using Optimel 16% manuka honey topical eye-drops. 59 patients were recruited to the study and randomised into two groups: one given regular lubricants and the other given Optimel 16% manuka honey eye-drops. The Standard Patient Evaluation of Eye Dryness (SPEED) score was measured at baseline and on follow-up. 4 patients were lost to follow-up. Multiple ocular surface parameters were graded from slit lamp examination by a masked assessor. Results were compared from baseline to follow-up date 3 weeks later.ResultsPatients in the conventional treatment group demonstrated minimal difference in SPEED score at 3-week follow-up (mean difference 1.087, p=0.183), which was not statistically significant. However, measurements of tear film break-up time, corneal surface stain (Oxford), lid margin, conjunctival redness, as well as meibum quality and expressibility showed significant improvements at 3 weeks (p<0.01). Patients in the manuka honey eye-drops group showed significant difference after 3 weeks in SPEED score (mean difference 2.53, p=0.006), as well as in lid margin redness, conjunctival redness, corneal surface stain (Oxford), and meibum quality and expressibility (p=0.000).ConclusionsOptimel 16% manuka honey eye-drops showed significant improvement in symptoms and objective signs in meibomian gland dysfunction and are an effective alternative treatment for meibomian gland dysfunction.Trial registration numberNCT04457648.

A Rare Coexistence of Isolated Unilateral Conjunctival Telangiectasia and Retinal Vascular Tortuosity

A 55-year-old woman with no known systemic disorder and without any history of ocular disease, trauma, and surgery presented with a nonremitting conjunctival redness on her left eye that was existing since her childhood. On ophthalmological examination, an extremely rare coexistence of isolated unilateral bulbar conjunctival telangiectasia and ipsilateral retinal vascular tortuosity without any systemic and neuroradiological association was detected. We aimed to demonstrate this rare vascular coexistence and discuss differential diagnosis of the underlying causes.

A clinical and biochemical study of dengue fever in Kosi region of Bihar, India

Background: Dengue is a debilitating arthropod-borne viral (arboviral) disease in humans. To improve diagnostics for patients with dengue so that they can receive effective treatments at earliest. In addition, a better understanding of clinical and biochemical study of dengue cases, effective measures can be aimed for the prevention and control of dengue epidemics.Methods: A retrospective clinical and laboratory study was undertaken among admitted patients in the Department of Physiology at Katihar Medical College and Hospital, Katihar, Kosi region of Bihar, India. Forty-two (42) patients admitted over a period of two years, with laboratory results for NS1 antigen and or /IgM positive, for dengue fever, were taken in the study. Clinical features, haematological and biochemical parameters were noted.Results: Out of the 42 patients, 38 patients were male (90.4%) and 4 patients were female (9.6%). Pyrexia was the major symptom (100%) followed by splitting headache (90.40%), myalgia (76.19%), conjunctival redness (50.00%), skin rash (42.80%), abdominal pain (30.95%), hepatosplenomegaly (28.57) ascites (26.19%) and retro orbital pain (19.04%). Severe thrombocytopenia (69.51%), leukopenia (20.19%) and elevated serum SGOT and SGPT (88.54%) were observed.Conclusions: Dengue infection is increasing proportional to increased urbanization and compromised sanitation measures. Fever associated with headache, retro orbital pain, erythematous morbilliform rash, conjunctival redness and itching in palms and soles along with thrombocytopenia, leukopenia, elevated SGPT should prompt a clinician on the possibility of dengue infection.

Defining the Optimal Region of Interest for Hyperemia Grading in the Bulbar Conjunctiva

Conjunctival hyperemia or conjunctival redness is a symptom that can be associated with a broad group of ocular diseases. Its levels of severity are represented by standard photographic charts that are visually compared with the patient’s eye. This way, the hyperemia diagnosis becomes a nonrepeatable task that depends on the experience of the grader. To solve this problem, we have proposed a computer-aided methodology that comprises three main stages: the segmentation of the conjunctiva, the extraction of features in this region based on colour and the presence of blood vessels, and, finally, the transformation of these features into grading scale values by means of regression techniques. However, the conjunctival segmentation can be slightly inaccurate mainly due to illumination issues. In this work, we analyse the relevance of different features with respect to their location within the conjunctiva in order to delimit a reliable region of interest for the grading. The results show that the automatic procedure behaves like an expert using only a limited region of interest within the conjunctiva.

Scleral thinning after eye-whitening surgery

We report the case of a 32-year-old male patient who presented with conjunctival redness after multiple bilateral eye-whitening surgeries. Slit-lamp examination revealed scleral melting, avascular areas, and demarcation lines in both eyes. Considering the treatment history and the clinical findings of the patient, we conclude that the removal of the conjunctiva and Tenon’s layer and use of mitomycin C is not desirable for a healthy ocular surface.