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  1. Article ; Online: Machine Learning Techniques in Clinical Vision Sciences.

    Caixinha, Miguel / Nunes, Sandrina

    Current eye research

    2017  Volume 42, Issue 1, Page(s) 1–15

    Abstract: This review presents and discusses the contribution of machine learning techniques for diagnosis and disease monitoring in the context of clinical vision science. Many ocular diseases leading to blindness can be halted or delayed when detected and ... ...

    Abstract This review presents and discusses the contribution of machine learning techniques for diagnosis and disease monitoring in the context of clinical vision science. Many ocular diseases leading to blindness can be halted or delayed when detected and treated at its earliest stages. With the recent developments in diagnostic devices, imaging and genomics, new sources of data for early disease detection and patients' management are now available. Machine learning techniques emerged in the biomedical sciences as clinical decision-support techniques to improve sensitivity and specificity of disease detection and monitoring, increasing objectively the clinical decision-making process. This manuscript presents a review in multimodal ocular disease diagnosis and monitoring based on machine learning approaches. In the first section, the technical issues related to the different machine learning approaches will be present. Machine learning techniques are used to automatically recognize complex patterns in a given dataset. These techniques allows creating homogeneous groups (unsupervised learning), or creating a classifier predicting group membership of new cases (supervised learning), when a group label is available for each case. To ensure a good performance of the machine learning techniques in a given dataset, all possible sources of bias should be removed or minimized. For that, the representativeness of the input dataset for the true population should be confirmed, the noise should be removed, the missing data should be treated and the data dimensionally (i.e., the number of parameters/features and the number of cases in the dataset) should be adjusted. The application of machine learning techniques in ocular disease diagnosis and monitoring will be presented and discussed in the second section of this manuscript. To show the clinical benefits of machine learning in clinical vision sciences, several examples will be presented in glaucoma, age-related macular degeneration, and diabetic retinopathy, these ocular pathologies being the major causes of irreversible visual impairment.
    MeSH term(s) Algorithms ; Diagnostic Techniques, Ophthalmological ; Eye Diseases/diagnosis ; Eye Diseases/physiopathology ; Humans ; Machine Learning ; Monitoring, Physiologic ; Multimodal Imaging ; Sensitivity and Specificity ; Vision, Ocular/physiology
    Language English
    Publishing date 2017-01
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 82079-9
    ISSN 1460-2202 ; 0271-3683
    ISSN (online) 1460-2202
    ISSN 0271-3683
    DOI 10.1080/02713683.2016.1175019
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  2. Article: Feasibility assessment of the Eye Scan Ultrasound System for cataract characterization and optimal phacoemulsification energy estimation: protocol for a pilot, nonblinded and monocentre study.

    Petrella, Lorena / Nunes, Sandrina / Perdigão, Fernando / Gomes, Marco / Santos, Mário / Pinto, Carlos / Morgado, Miguel / Travassos, António / Santos, Jaime / Caixinha, Miguel

    Pilot and feasibility studies

    2022  Volume 8, Issue 1, Page(s) 219

    Abstract: Background: Cataracts are lens opacifications that are responsible for more than half of blindness cases worldwide, and the only treatment is surgical intervention. Phacoemulsification surgery, the most frequently performed cataract surgery in developed ...

    Abstract Background: Cataracts are lens opacifications that are responsible for more than half of blindness cases worldwide, and the only treatment is surgical intervention. Phacoemulsification surgery, the most frequently performed cataract surgery in developed countries, has associated risks, some of which are related to excessive phacoemulsification energy levels and times. The protocol proposed in herein will be used to evaluate the feasibility of a new experimental medical device, the Eye Scan Ultrasound System (ESUS), for the automatic classification of cataract type and severity and quantitative estimation of the optimal phacoemulsification energy.
    Methods: The pilot study protocol will be used to evaluate the feasibility and safety of the ESUS in clinical practice. The study will be conducted in subjects with age-related cataracts and on healthy subjects as controls. The procedures include data acquisition with the experimental ESUS, classification based on the Lens Opacity Classification System III (LOCS III, comparator) using a slit lamp, contrast sensitivity test, optical coherence tomography, specular microscopy and surgical parameters. ESUS works in A-scan pulse-echo mode, with a central frequency of 20 MHz. From the collected signals, acoustic parameters will be extracted and used for automatic cataract characterization and optimal phacoemulsification energy estimation. The study includes two phases. The data collected in the first phase (40 patients, 2 eyes per patient) will be used to train the ESUS algorithms, while the data collected in the second phase (10 patients, 2 eyes per patient) will be used to assess the classification performance. System safety will be monitored during the study.
    Discussion: The present pilot study protocol will evaluate the feasibility and safety of the ESUS for use in clinical practice, and the results will support a larger clinical study for the efficacy assessment of the ESUS as a diagnostic tool. Ultimately, the ESUS is expected to represent a valuable tool for surgical planning by reducing complications associated with excessive levels of phacoemulsification energy and surgical times, which will have a positive impact on healthcare systems and society. The study is not yet recruiting.
    Trial registration: ClinicalTrials.gov identifier NCT04461912 , registered on July 8, 2020.
    Language English
    Publishing date 2022-09-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2809935-7
    ISSN 2055-5784
    ISSN 2055-5784
    DOI 10.1186/s40814-022-01173-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Safety Assessment of an A-Scan Ultrasonic System for Ophthalmic Use.

    Petrella, Lorena / Fernandes, Paulo / Santos, Mário / Caixinha, Miguel / Nunes, Sandrina / Pinto, Carlos / Morgado, Miguel / Santos, Jaime / Perdigão, Fernando / Gomes, Marco

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2020  Volume 39, Issue 11, Page(s) 2143–2150

    Abstract: Objectives: This study describes the safety assessment of an A-scan ultrasonic system for ophthalmic use. The system is an investigational medical device for automatic cataract detection and classification.: Methods: The risk management was based on ... ...

    Abstract Objectives: This study describes the safety assessment of an A-scan ultrasonic system for ophthalmic use. The system is an investigational medical device for automatic cataract detection and classification.
    Methods: The risk management was based on the International Organization for Standardization (ISO) standard DIN EN ISO 14971:2009-10 and International Electrotechnical Commission (IEC) standard IEC 60601-2-37. The calibration of the ultrasonic field was conducted according to the standards IEC 62127-1:2007 and IEC 62359:2010. The uncertainty on measurements was delineated in agreement with the guide JCGM 100:2008.
    Results: After risk management, all risks were qualitatively classified as acceptable. The mechanical index (0.08 ± 0.05), soft tissue thermal index (0.08 ± 0.08) and spatial-peak temporal-average intensity (0.56 ± 0.59 mW/cm
    Conclusions: This study presents a practical approach for the safety assessment of A-scan ultrasonic systems for ophthalmic use. The safety evaluation of a medical device is mandatory before its use in clinical practice. However, the safety monitoring throughout its life cycle should also be considered, since many device components may deteriorate over time and use.
    MeSH term(s) Humans ; Reference Standards ; Transducers ; Ultrasonics ; Ultrasonography ; United States ; United States Food and Drug Administration
    Language English
    Publishing date 2020-05-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.1002/jum.15323
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  4. Article ; Online: Polypoidal Choroidal Vasculopathy in Caucasians: Morphological Findings from Multimodal Retinal Imaging.

    Simão, Jorge M / Farinha, Cláudia V / Marques, João P / Nunes, Sandrina / Pires, Isabel M / Cachulo, Maria L / Figueira, João P / Murta, Joaquim N / Silva, Rufino M

    Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde

    2021  Volume 244, Issue 4, Page(s) 315–325

    Abstract: Purpose: The aim of the study was to characterize the morphological features of polypoidal choroidal vasculopathy (PCV) in a large Caucasian population.: Methods: We conducteda multicenter, cross-sectional study of treatment-naïve patients with PCV. ... ...

    Abstract Purpose: The aim of the study was to characterize the morphological features of polypoidal choroidal vasculopathy (PCV) in a large Caucasian population.
    Methods: We conducteda multicenter, cross-sectional study of treatment-naïve patients with PCV. Baseline fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) were assessed by trained medical graders. Typical PCV features were explored, and retinal thickness (RT) and choroidal thickness (CT) measurements were performed.
    Results: Seventy-nine eyes of 73 patients (mean age, 72.6 ± 11.9 years) were included. ICGA identified macular polyps in 89.9% of cases. SD-OCT revealed mostly subretinal fluid (93.6%) and a retinal pigment epithelium (RPE) detachment in 91.4%, with sharp protrusion in 67.0% of cases. Polyp-like structures were seen in 74.3% of cases, mostly adherent to an elevated RPE (69.6%). Type 1 neovascularization (NV) was identified in 74.7% of patients, while 16.5% had a mixed NV. The mean macular CT was 220.9 ± 83.2 μm (range, 67.9-403.6). Diffuse and focal pachychoroid were observed in 26.6 and 30.4% of patients, respectively. Soft drusen were reported in 62.0% of cases, but retinal hemorrhage occurred in only 19.0% of cases.
    Conclusion: The morphological features of PCV in Caucasians are similar to those reported in Asians. Pachychoroid signs were found in nearly half of our cohort. However, the mean age at presentation, high prevalence of soft drusen, and low prevalence of large subretinal hemorrhages make PCV closer to age-related macular degeneration in this ethnic group.
    MeSH term(s) Aged ; Aged, 80 and over ; Choroid/pathology ; Choroidal Neovascularization/pathology ; Coloring Agents ; Cross-Sectional Studies ; Fluorescein Angiography ; Humans ; Indocyanine Green ; Middle Aged ; Polyps/diagnosis ; Retrospective Studies ; Tomography, Optical Coherence
    Chemical Substances Coloring Agents ; Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2021-02-17
    Publishing country Switzerland
    Document type Journal Article ; Multicenter Study
    ZDB-ID 209735-7
    ISSN 1423-0267 ; 0030-3755
    ISSN (online) 1423-0267
    ISSN 0030-3755
    DOI 10.1159/000515295
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  5. Article ; Online: Retinal layer thicknesses and neurodegeneration in early age-related macular degeneration: insights from the Coimbra Eye Study.

    Farinha, Cláudia / Silva, Ana Luísa / Coimbra, Rita / Nunes, Sandrina / Cachulo, Maria Luz / Marques, João Pedro / Pires, Isabel / Cunha-Vaz, José / Silva, Rufino

    Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

    2021  Volume 259, Issue 9, Page(s) 2545–2557

    Abstract: Purpose: This study aims to analyze the retinal layers and choroidal thickness in a large set of eyes with early age-related macular degeneration (AMD), in order to detect differences by stage suggestive of early neurodegeneration, and to explore ... ...

    Abstract Purpose: This study aims to analyze the retinal layers and choroidal thickness in a large set of eyes with early age-related macular degeneration (AMD), in order to detect differences by stage suggestive of early neurodegeneration, and to explore biomarkers of different phenotypes.
    Methods: This study is a population-based, cross-sectional study. Patients from the incidence AMD study (NCT02748824) with early AMD (Rotterdam 2a, 2b, 3) were included. All performed spectral-domain optical coherence tomography (SD-OCT) (Spectralis, Heidelberg Engineering, Germany) and automatic segmentation of all retinal layers was obtained with built-in software. Manual correction was performed whenever necessary. The mean thicknesses (ETDRS grid) and volume of each layer were recorded. Subfoveal choroidal thickness was manually measured. Estimates for each layer thickness were calculated with linear mixed models and tested for pairwise differences between stages. Associations between layer thickness and microstructural findings were assessed by multivariate regression analysis.
    Results: The final cohort comprised 346 eyes (233 patients): 82.66% (n = 286) in stage 2a, 5.49% (n = 19) in stage 2b, and 11.85% (n = 41) in stage 3. A global tendency for lower/inferior thickness of the neuroretinal layers was found comparing stage 3 to 2a: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) were inferior in the inner/outer ETDRS circles and the outer nuclear layer (ONL) and photoreceptors' segments layer in the central circle (p ≤ 0.002). The retinal pigment epithelium-Bruch's membrane (RPE/BrM) layer was thicker in stage 3 (p ≤ 0.001). Subretinal drusenoid deposits (SDD) were associated with thinner neuroretinal layers and choroid (p < 0.05).
    Conclusions: Our results showed in a large population-based dataset that several inner and outer neuroretinal layers were thinner with a higher stage in early AMD. These findings support the existence of early and progressive neurodegeneration. Neuronal retinal layer thicknesses might thus be used as quantitative biomarkers of disease progression in AMD. The presence of SDD is possibly associated to more prominent and faster neurodegeneration.
    MeSH term(s) Cross-Sectional Studies ; Humans ; Macular Degeneration/diagnosis ; Retina/diagnostic imaging ; Retinal Ganglion Cells ; Tomography, Optical Coherence
    Language English
    Publishing date 2021-03-18
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 8435-9
    ISSN 1435-702X ; 0721-832X
    ISSN (online) 1435-702X
    ISSN 0721-832X
    DOI 10.1007/s00417-021-05140-0
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  6. Article ; Online: Protocol for a randomised, double-masked, sham-controlled phase 4 study on the efficacy, safety and tolerability of intravitreal aflibercept monotherapy compared with aflibercept with adjunctive photodynamic therapy in polypoidal choroidal vasculopathy: the ATLANTIC study.

    Marques, João Pedro / Farinha, Cláudia / Costa, Miguel Ângelo / Ferrão, Ângela / Nunes, Sandrina / Silva, Rufino

    BMJ open

    2017  Volume 7, Issue 8, Page(s) e015785

    Abstract: Purpose: The purpose of this study is to compare the efficacy and safety of intravitreal aflibercept (IVA) with sham photodynamic therapy (sPDT) versus IVA with verteporfin PDT (vPDT) in a Caucasian population with treatment-naive polypoidal choroidal ... ...

    Abstract Purpose: The purpose of this study is to compare the efficacy and safety of intravitreal aflibercept (IVA) with sham photodynamic therapy (sPDT) versus IVA with verteporfin PDT (vPDT) in a Caucasian population with treatment-naive polypoidal choroidal vasculopathy (PCV), enrolling into a treat and extend (T&E) regimen.
    Methods and analysis: Randomised, double-masked, sham-controlled, multicentre phase 4 investigator-driven clinical trial. The primary outcomes are (1) change in best-corrected visual acuity (BCVA) from baseline and (2) polyp regression at week 52, assessed by indocyanine green angiography (ICGA). Fifty patients with treatment-naive PCV will be recruited from Portuguese and Spanish clinical sites. Eligible patients will receive monthly IVA for 3 months (week 0, week 4 and week 8). At week 16, all patients will repeat ICGA and undergo central randomisation (1:1 ratio) into one of the following groups: Group 1-IVA T&E + vPDT; Group 2-IVA T&E + sPDT. PDT will be performed at week 16, week 28 and week 40 in the presence of active polyps. After week 16, the presence of macular fluid on optical coherence tomography will determine the schedule of observations. When present, the interval between visits/injections will decrease 2 weeks (minimum 6 weeks). When not, the interval between visits/injections will increase 2 weeks (maximum 12 weeks). Efficacy will be evaluated based on BCVA, central retinal thickness and polyp regression. Safety parameters will include assessment of intraocular pressure, adverse events and serious adverse events.
    Ethics and dissemination: This study was designed and shall be implemented and reported in accordance with the International Conference on Harmonisation (ICH) Harmonised Tripartite Guidelines for Good Clinical Practice, with applicable local regulations and with the ethical principles laid down in the Declaration of Helsinki. The study received approval from Comissão de Ética para a Investigação Clínica and Comité Ético de investigación Clínica del Hospital Universitari de Bellvitge.
    Trial registration number: This study is registered under the EudraCT number: 2015-001368-20 and the ClinicalTrials.gov Identifier: NCT02495181.
    MeSH term(s) Aged ; Choroid/drug effects ; Choroid/pathology ; Choroidal Neovascularization/drug therapy ; Female ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Photochemotherapy ; Photosensitizing Agents/therapeutic use ; Polyps ; Porphyrins/therapeutic use ; Receptors, Vascular Endothelial Growth Factor/administration & dosage ; Receptors, Vascular Endothelial Growth Factor/therapeutic use ; Recombinant Fusion Proteins/administration & dosage ; Recombinant Fusion Proteins/adverse effects ; Recombinant Fusion Proteins/therapeutic use ; Research Design ; Treatment Outcome ; Verteporfin ; Visual Acuity
    Chemical Substances Photosensitizing Agents ; Porphyrins ; Recombinant Fusion Proteins ; Verteporfin (0X9PA28K43) ; aflibercept (15C2VL427D) ; Receptors, Vascular Endothelial Growth Factor (EC 2.7.10.1)
    Language English
    Publishing date 2017-08-28
    Publishing country England
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2016-015785
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  7. Article ; Online: T and genetic variations between Asian and Caucasian polypoidal choroidal vasculopathy.

    Jordan-Yu, Janice Marie / Teo, Kelvin / Fan, Qiao / Gana, Jose Carlos / Leopando, Anna Karina / Nunes, Sandrina / Farinha, Cláudia / Barreto, Patricia / Melo, Joana Barbosa / Carreira, Isabel / Murta, Joaquim Neto / Silva, Rufino / Cheung, Chui Ming Gemmy

    The British journal of ophthalmology

    2020  Volume 105, Issue 12, Page(s) 1716–1723

    Abstract: Purpose: To compare phenotypic and genetic variations in polypoidal choroidal vasculopathy (PCV) between Caucasian and Asian patients.: Methods: We analysed phenotypic and genotypic data from two sites, Association for Innovation and Biomedical ... ...

    Abstract Purpose: To compare phenotypic and genetic variations in polypoidal choroidal vasculopathy (PCV) between Caucasian and Asian patients.
    Methods: We analysed phenotypic and genotypic data from two sites, Association for Innovation and Biomedical Research on Light and Image, Portugal and Singapore National Eye Centre, Singapore. Baseline fundus photography, spectral domain-optical coherence tomography, indocyanine green and fluorescein angiography scans were analysed by respective reading centres using a standardised grading protocol. Single nucleotide polymorphisms across 8 PCV loci were compared between cases and controls selected from each population.
    Results: One hundred and forty treatment-naïve PCV participants (35 Portuguese and 105 Singaporean) were included. The Portuguese cohort were older (72.33±8.44 vs 68.71±9.40 years, p=0.043) and were comprised of a lower proportion of males (43% vs 71%, p=0.005) compared with the Singaporean cohort. Differences in imaging features include higher prevalence of soft drusen (66% vs 30%, p=0.004), lower prevalence of subretinal haemorrhage (14% vs 67%, p<0.001), smaller polypoidal lesion (PL) area (0.09±0.09 vs 0.76±0.93 mm
    Conclusion: Among Asian and Caucasian patients with PCV, there are significant differences in the expression of phenotype. We also identified different polymorphisms associated with PCV in the two populations.
    MeSH term(s) Choroid/pathology ; Choroidal Neovascularization/diagnosis ; Choroidal Neovascularization/genetics ; Choroidal Neovascularization/pathology ; Coloring Agents ; Eye Diseases/pathology ; Fluorescein Angiography/methods ; Genetic Variation ; Humans ; Indocyanine Green ; Male ; Polyps/diagnosis ; Polyps/genetics ; Tomography, Optical Coherence/methods
    Chemical Substances Coloring Agents ; Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2020-10-09
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80078-8
    ISSN 1468-2079 ; 0007-1161
    ISSN (online) 1468-2079
    ISSN 0007-1161
    DOI 10.1136/bjophthalmol-2020-317537
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  8. Article ; Online: Three different phenotypes of mild nonproliferative diabetic retinopathy with different risks for development of clinically significant macular edema.

    Nunes, Sandrina / Ribeiro, Luisa / Lobo, Conceição / Cunha-Vaz, José

    Investigative ophthalmology & visual science

    2013  Volume 54, Issue 7, Page(s) 4595–4604

    Abstract: Purpose: To identify different phenotypes of nonproliferative diabetic retinopathy (NPDR) and their progression to clinically significant macular edema (CSME).: Methods: A prospective observational study was designed to follow eyes/patients with ... ...

    Abstract Purpose: To identify different phenotypes of nonproliferative diabetic retinopathy (NPDR) and their progression to clinically significant macular edema (CSME).
    Methods: A prospective observational study was designed to follow eyes/patients with diabetes type 2 and NPDR with no prior laser treatment for 2 years or until development of CSME. A total of 410 patients, one eye per patient, fulfilled the inclusion/exclusion criteria and were included in the study. Ophthalmological examinations, including BCVA, fundus photography with Retmarker analysis, and optical coherence tomography (OCT), were performed at baseline, month 6 and month 24, or before laser treatment. Hierarchical cluster analysis was used to identify homogeneous subgroups and clinically significant thresholds of the data collected.
    Results: A total of 376 eyes/patients performed the 6-month visit and were considered for cluster analysis. This mathematical method identified three different phenotypes based on statistically significant differences for the microaneurysm (MA) turnover and for the central retinal thickness (RT): phenotype A (low MA turnover and normal RT, 48.1%); phenotype B (low MA turnover and increased central RT, 23.2%); and phenotype C (high MA turnover, 28.7%). From the 348 eyes/patients that reached the study end point or completed the 24-month visit, 26 developed CSME: 3 from phenotype A (1.8%), 7 from phenotype B (8.5%), and 16 from phenotype C (16.2%). Eyes/patients from phenotype C showed a higher risk for CSME development (OR = 3.536; P < 0.001).
    Conclusions: Hierarchical cluster analysis identifies three different phenotypes of NPDR based on MA turnover and central macular thickness. Eyes/patients from phenotype C show a higher risk for the development of CSME. (ClinicalTrials.gov number, NCT00763802.)
    MeSH term(s) Aged ; Cluster Analysis ; Diabetes Mellitus, Type 2/complications ; Diabetic Retinopathy/classification ; Diabetic Retinopathy/pathology ; Diabetic Retinopathy/physiopathology ; Disease Progression ; Female ; Humans ; Macular Edema/classification ; Macular Edema/pathology ; Macular Edema/physiopathology ; Male ; Middle Aged ; Phenotype ; Prospective Studies ; Risk Factors ; Tomography, Optical Coherence ; Visual Acuity/physiology
    Language English
    Publishing date 2013-07-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 391794-0
    ISSN 1552-5783 ; 0146-0404
    ISSN (online) 1552-5783
    ISSN 0146-0404
    DOI 10.1167/iovs.13-11895
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  9. Article ; Online: Macular thickness measured by stratus optical coherence tomography in patients with diabetes type 2 and mild nonproliferative retinopathy without clinical evidence of macular edema.

    Pires, Isabel / Santos, Ana Rita / Nunes, Sandrina / Lobo, Conceição

    Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde

    2013  Volume 229, Issue 4, Page(s) 181–186

    Abstract: To evaluate macular thickness in eyes with mild nonproliferative diabetic retinopathy (NPDR), patients with diabetes type 2, NPDR level 20 or 35, and without evidence of clinical macular edema underwent best-corrected visual acuity assessment, color ... ...

    Abstract To evaluate macular thickness in eyes with mild nonproliferative diabetic retinopathy (NPDR), patients with diabetes type 2, NPDR level 20 or 35, and without evidence of clinical macular edema underwent best-corrected visual acuity assessment, color fundus photography and Stratus optical coherence tomography. Mean center point thickness (CPT) and mean central subfield (CSF) thickness were compared with those of a healthy control population. 410 eyes/patients aged 61.2 ± 8.3 years, and with glycosylated hemoglobin of 7.9 ± 1.5% were included. Mean CPT and CSF were 186.6 ± 28.4 and 215.2 ± 25 µm, respectively, significantly increased compared to healthy subjects (p < 0.001). CSF thickness was abnormally increased in 17.6% of the patients, with values within the normal range in 79.5%, and abnormally decreased in 2.9%. CPT and CSF thickness were significantly thicker in men. No systemic factors showed a significant association. A significant increase in the macular thickness was found in eyes/patients with mild NPDR without clinical macular edema; however, only 17.6% of the eyes/patients had abnormally increased values and less than 3% abnormally decreased values.
    MeSH term(s) Adult ; Aged ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/diagnosis ; Diabetic Retinopathy/diagnosis ; Female ; Glycated Hemoglobin A/metabolism ; Humans ; Macula Lutea/pathology ; Macular Edema/diagnosis ; Male ; Middle Aged ; Severity of Illness Index ; Tomography, Optical Coherence/methods
    Chemical Substances Glycated Hemoglobin A
    Language English
    Publishing date 2013
    Publishing country Switzerland
    Document type Clinical Trial ; Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 209735-7
    ISSN 1423-0267 ; 0030-3755
    ISSN (online) 1423-0267
    ISSN 0030-3755
    DOI 10.1159/000350593
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  10. Article ; Online: Microaneurysm turnover at the macula predicts risk of development of clinically significant macular edema in persons with mild nonproliferative diabetic retinopathy.

    Ribeiro, Maria Luisa / Nunes, Sandrina G / Cunha-Vaz, José G

    Diabetes care

    2012  Volume 36, Issue 5, Page(s) 1254–1259

    Abstract: Objective: To examine the relationship between microaneurysm (MA) turnover using automated analysis of fundus photographs (RetmarkerDR; Critical Health SA) and development of clinically significant macular edema (CSME) in nonproliferative diabetic ... ...

    Abstract Objective: To examine the relationship between microaneurysm (MA) turnover using automated analysis of fundus photographs (RetmarkerDR; Critical Health SA) and development of clinically significant macular edema (CSME) in nonproliferative diabetic retinopathy (NPDR).
    Research design and methods: A prospective, monocenter, observational study was designed to follow eyes/patients with type 2 diabetes and NPDR (Early Treatment Diabetic Retinopathy Study levels 20 and 35) with no prior laser treatment for 2 years or until development of CSME. A total of 410 patients, one eye per patient, fulfilled the inclusion/exclusion criteria and were included in the study. Ophthalmologic examinations including best corrected visual acuity, fundus photography, and optical coherence tomography were performed at baseline, 6 months, and at the last study visit (24 months or before laser treatment).
    Results: A total of 348 eyes/patients performed the 24-month visit or developed CSME. Of these 348 eyes/patients, 26 developed CSME. HbA1c levels at baseline and MA turnover (i.e., the sum of the MA formation and disappearance rates) computed during the first 6 months of follow-up were found to be independently predictive factors for development of CSME. MA turnover was 11.2 ± 11.2 in the 26 eyes/patients that developed CSME and 5.0 ± 5.2 in the remaining 322 (P < 0.001). Higher MA turnover values correlated with earlier development of CSME. MA turnover predictive values for CSME development were, for the positive predictive value, 20% and for the negative predictive value, 96%.
    Conclusions: MA turnover calculated with the RetmarkerDR predicts development of CSME in eyes with NPDR. Low MA turnover values identify well the eyes that are less likely to develop CSME in a 2-year period.
    MeSH term(s) Adult ; Aged ; Aneurysm/pathology ; Diabetes Mellitus, Type 2/complications ; Diabetic Retinopathy/complications ; Female ; Humans ; Macula Lutea/pathology ; Macular Edema/etiology ; Male ; Middle Aged ; Prospective Studies
    Language English
    Publishing date 2012-11-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 441231-x
    ISSN 1935-5548 ; 0149-5992
    ISSN (online) 1935-5548
    ISSN 0149-5992
    DOI 10.2337/dc12-1491
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