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  1. Article ; Online: Cerebral malaria-using the retina to study the brain.

    Beare, Nicholas A V

    Eye (London, England)

    2023  Volume 37, Issue 12, Page(s) 2379–2384

    Abstract: Cerebral malaria (CM) remains a common cause of death of children in Africa with annual mortality of 400 000. Malarial retinopathy is a unique set of fundus signs which has diagnostic and prognostic value in CM. Assessment of malarial retinopathy is now ... ...

    Abstract Cerebral malaria (CM) remains a common cause of death of children in Africa with annual mortality of 400 000. Malarial retinopathy is a unique set of fundus signs which has diagnostic and prognostic value in CM. Assessment of malarial retinopathy is now widely utilised in clinical care, and routinely incorporated into clinical studies to refine entry criteria. As a visible part of the central nervous system, the retina provides insights into the pathophysiology of this infectious small-vessel vasculitis with adherent parasitised red blood cells. Fluorescein angiography and optical coherence tomography (OCT) have shown that patchy capillary non-perfusion is common and causes ischaemic changes in the retina in CM. It is likely this is mirrored in the brain and may cause global neurological impairments evident on developmental follow up. Three types of blood-retina barrier breakdown are evident: large focal, punctate, and vessel leak. Punctate and large focal leak (haemorrhage in formation) are associated with severe brain swelling and fatal outcome. Vessel leak and capillary non-perfusion are associated with moderate brain swelling and neurological sequelae. These findings imply that death and neurological sequelae have separate mechanisms and are not a continuum of severity. Each haemorrhage causes a temporary uncontrolled outflow of fluid into the tissue. The rapid accumulation of haemorrhages, as evidenced by multiple focal leaks, is a proposed mechanism of severe brain swelling, and death. Current studies aim to use optic nerve head OCT to identify patients with severe brain swelling, and macula OCT to identify those at risk of neurological sequelae.
    MeSH term(s) Child ; Humans ; Malaria, Cerebral/diagnosis ; Malaria, Cerebral/complications ; Brain Edema/complications ; Retina ; Retinal Diseases/diagnosis ; Retinal Diseases/etiology ; Brain/diagnostic imaging ; Fluorescein Angiography ; Tomography, Optical Coherence/methods ; Retinal Vessels
    Language English
    Publishing date 2023-02-14
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-023-02432-z
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  2. Article ; Online: Hyperreflective spots in cerebral malaria.

    Wilson, Kyle J / Beare, Nicholas A V

    Eye (London, England)

    2023  Volume 37, Issue 15, Page(s) 3295

    MeSH term(s) Humans ; Malaria, Cerebral/diagnosis ; Fluorescein Angiography ; Tomography, Optical Coherence ; Retrospective Studies
    Language English
    Publishing date 2023-03-10
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-023-02485-0
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  3. Article ; Online: Correction: Hyperreflective spots in cerebral malaria.

    Wilson, Kyle J / Beare, Nicholas A V

    Eye (London, England)

    2023  Volume 37, Issue 18, Page(s) 3880

    Language English
    Publishing date 2023-07-03
    Publishing country England
    Document type Published Erratum
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-023-02611-y
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  4. Article: A systematic review of OCT and OCT angiography in retinal vasculitis.

    Dhirachaikulpanich, Dhanach / Chanthongdee, Kanat / Zheng, Yalin / Beare, Nicholas A V

    Journal of ophthalmic inflammation and infection

    2023  Volume 13, Issue 1, Page(s) 1

    Abstract: Background: Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess ... ...

    Abstract Background: Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess retinal vasculitis, but is invasive and time-consuming. Optical coherence tomography (OCT) provides non-invasive detailed imaging of retinal structures and abnormalities, including blood vessel architecture and flow with OCT angiography (OCT-A). However, use of OCT in retinal vasculitis beyond assessing macular oedema, is not well established. We conducted a systematic review to understand the features of retinal vasculitis in OCT, Enhanced-depth imaging OCT (OCT-EDI) and OCT-A imaging.
    Methods: The systematic search was done in March 2022 and updated in January 2023, through PubMed, EMBASE and the Web of Science database for studies related to OCT, OCT-EDI and OCT-A findings and retinal vasculitis. Bias assessment was assessed using JBI Critical Appraisal Checklist, and any findings associated with retinal vasculitis were extracted by qualitative analysis.
    Results: We identified 20 studies, including 8 articles on OCT, 6 on OCT-EDI and 6 on OCT-A. The studies included analytical retrospective studies, case-series, and a case-control study. Five OCT studies reported secondary complications could be detected, and four reported retinal thickness alteration in retinal vasculitis. Five studies explored choroidal thickness alteration in OCT-EDI, and four explored capillary density alterations in retinal vasculitis using OCT-A. The heterogeneity in the studies' analysis and design precluded a meta-analysis.
    Discussion: There were no clear OCT, OCT-EDI or OCT-A findings that demonstrated potential to supersede fluorescein angiography for assessing retinal vasculitis. Some signs of macular structural effects secondary to retinal vasculitis may help prognostication for vision. The OCT signs of inflamed retinal vessels and perivascular tissue is an unexplored area.
    Language English
    Publishing date 2023-01-30
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 2592309-2
    ISSN 1869-5760
    ISSN 1869-5760
    DOI 10.1186/s12348-023-00327-4
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  5. Article ; Online: Using Deep Learning to Segment Retinal Vascular Leakage and Occlusion in Retinal Vasculitis.

    Dhirachaikulpanich, Dhanach / Xie, Jianyang / Chen, Xiuju / Li, Xiaoxin / Madhusudhan, Savita / Zheng, Yalin / Beare, Nicholas A V

    Ocular immunology and inflammation

    2024  , Page(s) 1–8

    Abstract: Purpose: Retinal vasculitis (RV) is characterised by retinal vascular leakage, occlusion or both on fluorescein angiography (FA). There is no standard scheme available to segment RV features. We aimed to develop a deep learning model to segment both ... ...

    Abstract Purpose: Retinal vasculitis (RV) is characterised by retinal vascular leakage, occlusion or both on fluorescein angiography (FA). There is no standard scheme available to segment RV features. We aimed to develop a deep learning model to segment both vascular leakage and occlusion in RV.
    Methods: Four hundred and sixty-three FA images from 82 patients with retinal vasculitis were used to develop a deep learning model, in 60:20:20 ratio for training:validation:testing. Parameters, including deep learning architectures (DeeplabV3+, UNet++ and UNet), were altered to find the best binary segmentation model separately for retinal vascular leakage and occlusion, using a Dice score to determine the reliability of each model.
    Results: Our best model for vascular leakage had a Dice score of 0.6279 (95% confidence interval (CI) 0.5584-0.6974). For occlusion, the best model achieved a Dice score of 0.6992 (95% CI 0.6109-0.7874).
    Conclusion: Our RV segmentation models could perform reliable segmentation for retinal vascular leakage and occlusion in FAs of RV patients.
    Language English
    Publishing date 2024-01-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1193873-0
    ISSN 1744-5078 ; 0927-3948
    ISSN (online) 1744-5078
    ISSN 0927-3948
    DOI 10.1080/09273948.2024.2305185
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  6. Article ; Online: RETINAL VASCULITIS SEVERITY ASSESSMENT: Intraobserver and Interobserver Reliability of a New Scheme for Grading Wide-Field Fluorescein Angiograms in Retinal Vasculitis.

    Dhirachaikulpanich, Dhanach / Madhusudhan, Savita / Parry, David / Babiker, Salma / Zheng, Yalin / Beare, Nicholas A V

    Retina (Philadelphia, Pa.)

    2023  Volume 43, Issue 9, Page(s) 1534–1543

    Abstract: Purpose: Wide-field fluorescein angiography is commonly used to assess retinal vasculitis (RV), which manifests as vascular leakage and occlusion. Currently, there is no standard grading scheme for RV severity. The authors propose a novel RV grading ... ...

    Abstract Purpose: Wide-field fluorescein angiography is commonly used to assess retinal vasculitis (RV), which manifests as vascular leakage and occlusion. Currently, there is no standard grading scheme for RV severity. The authors propose a novel RV grading scheme and assess its reliability and reproducibility.
    Methods: A grading scheme was developed to assess both leakage and occlusion in RV. Wide-field fluorescein angiography images from 50 patients with RV were graded by four graders, and one grader graded them twice. An intraclass correlation coefficient (ICC) was used to determine intraobserver-interobserver reliability. Generalized linear models were calculated to associate the scoring with visual acuity.
    Results: Repeated grading by the same grader showed good intraobserver reliability for both leakage (ICC = 0.85, 95% CI 0.78-0.89) and occlusion (ICC = 0.82, 95% CI 0.75-0.88) scores. Interobserver reliability among four independent graders showed good agreement for both leakage (ICC = 0.66, 95% CI 0.49-0.77) and occlusion (ICC = 0.75, 95% CI 0.68-0.81) scores. An increasing leakage score was significantly associated with worse concurrent visual acuity (generalized linear models, β = 0.090, P < 0.01) and at 1-year follow-up (generalized linear models, β = 0.063, P < 0.01).
    Conclusion: The proposed grading scheme for RV has good to excellent intraobserver and interobserver reliability across a range of graders. The leakage score related to present and future visual acuity.
    MeSH term(s) Humans ; Retinal Vasculitis/diagnosis ; Reproducibility of Results ; Fluorescein Angiography/methods ; Fluoresceins ; Observer Variation
    Chemical Substances Fluoresceins
    Language English
    Publishing date 2023-05-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603192-4
    ISSN 1539-2864 ; 0275-004X
    ISSN (online) 1539-2864
    ISSN 0275-004X
    DOI 10.1097/IAE.0000000000003838
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  7. Article ; Online: Comment on: Dark without pressure retinal changes in a paediatric age group.

    Steptoe, Paul J / Beare, Nicholas A V / Semple, Malcolm G

    Eye (London, England)

    2020  Volume 35, Issue 11, Page(s) 3163–3164

    MeSH term(s) Child ; Fluorescein Angiography ; Humans ; Retina/diagnostic imaging
    Language English
    Publishing date 2020-10-30
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-020-01252-9
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  8. Article ; Online: Retinal imaging technologies in cerebral malaria: a systematic review.

    Wilson, Kyle J / Dhalla, Amit / Meng, Yanda / Tu, Zhanhan / Zheng, Yalin / Mhango, Priscilla / Seydel, Karl B / Beare, Nicholas A V

    Malaria journal

    2023  Volume 22, Issue 1, Page(s) 139

    Abstract: Background: Cerebral malaria (CM) continues to present a major health challenge, particularly in sub-Saharan Africa. CM is associated with a characteristic malarial retinopathy (MR) with diagnostic and prognostic significance. Advances in retinal ... ...

    Abstract Background: Cerebral malaria (CM) continues to present a major health challenge, particularly in sub-Saharan Africa. CM is associated with a characteristic malarial retinopathy (MR) with diagnostic and prognostic significance. Advances in retinal imaging have allowed researchers to better characterize the changes seen in MR and to make inferences about the pathophysiology of the disease. The study aimed to explore the role of retinal imaging in diagnosis and prognostication in CM; establish insights into pathophysiology of CM from retinal imaging; establish future research directions.
    Methods: The literature was systematically reviewed using the African Index Medicus, MEDLINE, Scopus and Web of Science databases. A total of 35 full texts were included in the final analysis. The descriptive nature of the included studies and heterogeneity precluded meta-analysis.
    Results: Available research clearly shows retinal imaging is useful both as a clinical tool for the assessment of CM and as a scientific instrument to aid the understanding of the condition. Modalities which can be performed at the bedside, such as fundus photography and optical coherence tomography, are best positioned to take advantage of artificial intelligence-assisted image analysis, unlocking the clinical potential of retinal imaging for real-time diagnosis in low-resource environments where extensively trained clinicians may be few in number, and for guiding adjunctive therapies as they develop.
    Conclusions: Further research into retinal imaging technologies in CM is justified. In particular, co-ordinated interdisciplinary work shows promise in unpicking the pathophysiology of a complex disease.
    MeSH term(s) Humans ; Malaria, Cerebral ; Artificial Intelligence ; Retina/diagnostic imaging ; Retinal Diseases/diagnostic imaging ; Tomography, Optical Coherence/methods
    Language English
    Publishing date 2023-04-26
    Publishing country England
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 2091229-8
    ISSN 1475-2875 ; 1475-2875
    ISSN (online) 1475-2875
    ISSN 1475-2875
    DOI 10.1186/s12936-023-04566-7
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  9. Article ; Online: Clinical Outcomes of Observed and Treated Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis.

    Steptoe, Paul J / Pearce, Ian / Beare, Nicholas A V / Sreekantham, Sreekanth / Mohammed, Bashar R / Barry, Robert J / Denniston, Alastair K / Murray, Philip I

    Ocular immunology and inflammation

    2023  , Page(s) 1–7

    Abstract: Purpose: To assess the efficacy of treatment on acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinopathy (RPC).: Methods: Cases were identified from three UK uveitis centers. Retrospective analysis ... ...

    Abstract Purpose: To assess the efficacy of treatment on acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinopathy (RPC).
    Methods: Cases were identified from three UK uveitis centers. Retrospective analysis of visual acuity recovery; OCT structural outcomes; and retinal lesion quantification in observed and treated cases of APMPPE/RPC.
    Results: There were nine APMPPE and three RPC cases. Out of 12 patients, six were female. Median age: 26.5 years (range, 20-57 years). Four cases (six eyes) were observed, and eight cases (15 eyes) received corticosteroids ± immunosuppression. 4/4 observed and 6/10 treated foveal involving eyes regained 0.00 LogMAR vision. Observed lesions achieved more favorable anatomical outcomes. New lesions post-presentation developed in 1/6 (16%) observed eye versus 10/15 (66%) treated eyes. In three cases, a delayed, rebound lesion occurrence was observed post-high-dose corticosteroids.
    Conclusions: While subject to potential treatment bias, in this small case series, natural history alone appears non-inferior to corticosteroid treatment.
    Language English
    Publishing date 2023-05-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1193873-0
    ISSN 1744-5078 ; 0927-3948
    ISSN (online) 1744-5078
    ISSN 0927-3948
    DOI 10.1080/09273948.2023.2195934
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  10. Article ; Online: The retinal contribution to the kidney-brain axis in severe malaria.

    Burke, Jamie / Dhaun, Neeraj / Dhillon, Baljean / Wilson, Kyle J / Beare, Nicholas A V / MacCormick, Ian J C

    Trends in parasitology

    2023  Volume 39, Issue 6, Page(s) 410–411

    MeSH term(s) Humans ; Retina ; Malaria ; Brain ; Kidney
    Language English
    Publishing date 2023-03-22
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2036227-4
    ISSN 1471-5007 ; 1471-4922
    ISSN (online) 1471-5007
    ISSN 1471-4922
    DOI 10.1016/j.pt.2023.03.002
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