ObjectiveTo compare the consistency of artificial analysis and artificial intelligence analysis in the identification of fundus lesions in diabetic patients.MethodsA retrospective study. From May 2018 to May 2019, 1053 consecutive diabetic patients (2106 eyes) of the endocrinology department of the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 888 patients were males and 165 were females. They were 20-70 years old, with an average age of 53 years old. All patients were performed fundus imaging on diabetic Inspection by useing Japanese Kowa non-mydriatic fundus cameras. The artificial intelligence analysis of Shanggong's ophthalmology cloud network screening platform automatically detected diabetic retinopathy (DR) such as exudation, bleeding, and microaneurysms, and automatically classifies the image detection results according to the DR international staging standard. Manual analysis was performed by two attending physicians and reviewed by the chief physician to ensure the accuracy of manual analysis. When differences appeared between the analysis results of the two analysis methods, the manual analysis results shall be used as the standard. Consistency rate were calculated and compared. Consistency rate = (number of eyes with the same diagnosis result/total number of effective eyes collected) × 100%. Kappa consistency test was performed on the results of manual analysis and artificial intelligence analysis, 0.0≤κ＜0.2 was a very poor degree of consistency, 0.2≤κ＜0.4 meant poor consistency, 0.4≤κ＜0.6 meant medium consistency, and 0.6≤κ＜1.0 meant good consistency.ResultsAmong the 2106 eyes, 64 eyes were excluded that cannot be identified by artificial intelligence due to serious illness, 2042 eyes were finally included in the analysis. The results of artificial analysis and artificial intelligence analysis were completely consistent with 1835 eyes, accounting for 89.86%. There were differences in analysis of 207 eyes, accounting for 10.14%. The main differences between the two are as follows: (1) Artificial intelligence analysis points Bleeding, oozing, and manual analysis of 96 eyes (96/2042, 4.70%); (2) Artificial intelligence analysis of drusen, and manual analysis of 71 eyes (71/2042, 3.48%); (3) Artificial intelligence analyzes normal or vitreous degeneration, while manual analysis of punctate exudation or hemorrhage or microaneurysms in 40 eyes (40/2042, 1.95%). The diagnostic rates for non-DR were 23.2% and 20.2%, respectively. The diagnostic rates for non-DR were 76.8% and 79.8%, respectively. The accuracy of artificial intelligence interpretation is 87.8%. The results of the Kappa consistency test showed that the diagnostic results of manual analysis and artificial intelligence analysis were moderately consistent (κ=0.576, P＜0.01).ConclusionsManual analysis and artificial intelligence analysis showed moderate consistency in the diagnosis of fundus lesions in diabetic patients. The accuracy of artificial intelligence interpretation is 87.8%.
Purpose To investigate the blood dynamic feature of choroid in normal eyes. Methods Indocyanine green angiography (ICGA) was performed in each of fifty consecutive normal eyes. Results The earliest fundus fluorescence emerged at the mean timiest fundus fluorescence emerged at the mean time of (14.25plusmn;3.59) seconds,it represented the beginning of filling of choroidal arteries located at the posterior pole.The irrigation of choroidal veins appeared at the mean time of (15.03plusmn;3.44) seconds.At the time threre was the overlapping imaging appearance of choroisal arteries and veins.The most hyperfluorescent areas appered at the mean time of(16.75plusmn;3.78) seconds with definite shapes located at the posterior pole,and this stood for the fluorescence stage of choroidal arteries,veins and capillaries.The fluorescence of choroidal vein began to weaken at 11prime;58Prime;15plusmn;2prime;39Prime;86,and revealed the imaging of late stage of choroidal veins.The latest stage of ICGA was at 22prime;13Prime;22plusmn;3prime;30Prime;55,and presented obscure fluorescence. Conclusion The measurement results and fluorescent features of ICGA of normal eyes can offer consulted bases for the clinical diagnosis of the choroidal diseases. (Chin J Ocul Fundus Dis,1998,14:68-71)
ObjectiveTo observe the features of the manifestations of fundus fluorescein angiography （FFA） in multiple sclerosis （MS） and their value in clinical diagnosis.MethodsThe clinical data of 42 patients (84 eyes) with MS diagnosed by magnetic resonance imaging (MRI) and examination of cerebrospinal fluid (CSF) were retrospectively analyzed. The clinical data included visual acuity, ocular fundus examined by direct ophthalmoscope after mydriasis, FFA, visual field, CSF，visual evoked potential (VEP) and MRI examination.ResultsIn 42 patients (84 eyes),the positive detectable rate of examination of direct ophthalmoscope, CSF, visual field, VEP, and MRI was 36.9%, 21.4%, 71.4%, and 83.3% respectively. Abnormal results of FFA were found in 44 eyes (52.38%), including papillitis in 4 eyes（4.76%）at the early stage with extended physiological scotoma and central scotoma; neuroretinitis in 7 eyes （8.33%）at the medium stage with central or para-central scotoma; optic atrophy in 33 eyes（39.29%） at the late stage with centripetal constriction and even tubular visual field. ConclusionThe main angiographic features of MS are papillitis, neuroretinitis and optic atrophy. The manifestations of FFA combined with the results of examination of CSF，visual field, VEP and MRI is helpful for comprehensive and exact diagnosis of MS.(Chin J Ocul Fundus Dis, 2005,21:300-302)
Purpose To investigate the clinical features and pathogenesis of acute posterior multifocal placoid pigment epitheliopathy(APMPPE). Methods To observe the features in 8 eyes of 6 cases of APMPPE with fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA).One of the cases had been observed continuously for 160 days. Results 1.FFA: at the acute stage of APMPPE,the affected foci showed low fluorescence in the early phase and stained gradually in 3 eyes;the fluorescence of recessive foci were still lower in 4 eyes,and the stale one showed window defect fluorescence due to some RPE fading and fluorescence sheltering due to pigment deposit.2.ICGA:at acuted stage,the fluorescence of choroid lobules was ofen defected untill in late period of pathogenical changes. Conclusion The findings demonstrate the obstruction of choriocapillaries may be the primary pathogenesis of APMPPE. (Chin J Ocul Fundus Dis,1998,14:84-87)
ObjectiveTo deeply explore the clinical features and gene mutations of Waardenburg syndrome (WS) by tested of the eyes and genes of three patients. MethodsA Case series study. From 2019 to 2021, 3 children with WS who were diagnosed at Department of Ophthalmology, West China Hospital of Sichuan University were included in the study. Among them, there were 2 males and 1 female; the ages were 3, 4, and 12 months, respectively. All children underwent external eye, anterior segment, fundus and fluorescein fundus angiography, the clinical features of the eyes were observed. The peripheral venous blood of 3 children was collected, and the whole genome DNA was extracted for whole exome sequencing to analyze the gene mutation sites. ResultsAll children had different degrees of iris heterochromia and fundus pigment abnormalities, and were accompanied by sensorineural hearing impairment. Case 1 had dystopia canthorum; case 2 had macular fovea hypoplasia. The sequencing results of case 1 showed that there were large fragments of heterozygous deletion in exons 2-8 of the Paired box 3 (PAX3) gene, who was diagnosed as WS Ⅰ type. The sequencing results of of case 2 showed heterozygous mutation in exon 9 of Microphthalmia-associated transcription factor (MITF) gene (c.1066 C＞T), combined with heterozygous mutation in exon 1 of HPS6 gene (c.1417 G＞T), who was diagnosed as WS Ⅱ type. The sequencing result of case 3 showed that the exon 3 of SOX10 gene had loss of heterozygosity (c.497_500 delAAGA), who was diagnosed as WS Ⅳ type. Both PAX3 and SOX10 gene mutations were newly discovered mutations. ConclusionsThe ocular clinical features of Waardenburg syndrome include hypopigmentation of the iris and choroid, and dystopia canthorum, etc. Early screening of the eye and hearing will help to better diagnose the disease. The large fragments of heterozygous deletion in exons 2-8 of the PAX3 gene, the heterozygous mutation in exon 9 of MITF gene (c.1066 C＞T), and the loss of heterozygosity in exon 3 of SOX10 gene are pathogenic genetic variations of 3 children.
Objective To discuss the image of indocyanine green angiography (ICGA) about high myopia． Methods Tweenty-seven patients (54 eyes) with high myopia underwent ocular examination, funduscolorphotography, simultaneous ICGA and fluorescein angiograp hy (FFA) with theconfocalscanning laser ophthalmoscope．The findings for the two modes of amgiographies were compared． Results Lacquer crack was evident on ICGA in 19 eyes among which the focal, plaque choroidal neovascularization (CNV) were apparent in the middle part of lacquer cracks in 10 eyes (52．6%) ．In comparison the lacquer cracks were seen in only 7 eyes on FFA． Choroidal capillary atrophy was seen on ICGA and FFA in 14 eyes and ICGA shew thick choroidal vessels in 3 eyes． Conclusion ICGA is superior to FFA for showing choroidoretinal degeneration and atrophy,lacquer crack and CNV in high myopic eyes, and conduce to evaluating prognosis． (Chin J Ocul Fundus Dis, 2001,17:201-203
OBJECTIVE:To elucidate the nature of degenerations in canine peripheral retina and compare the degenerations with those in human peripheral retina. METHODS: Examining randomly the peripberal fundus of eighty eye balls of forty dogs wdh dissecting microscope. The lesions of degenerations were photographed and processed for light microscopic examination. RESULTS:Typical Cystoid degeneralion,reticular degenerative retinoschisis, paving-stone degeneration, and lattice degeneration were discovered. The pathologic findings of these degenerations were same as or similar to those of the degenerations in human peripheral retina. CONCLUSIONS:The atrophic retinal degenerations that are similar to human' s are present at peripheral fundus in canine eyes. （Chin J Ocul Fundus Dis,1996,12: 151-152）
Purpose Observation on changes of choroidal circulation in 21 cases (42 eyes) of retinal dystrophies. Methods Fundus fluorescein angiography (ICGA) were used for comparartive analyses of the retinal and choroidal blood circulation of 21 cases (42 eyes) of retinal dystrophic diseases. Results The changes of choroidal circulation,i.e.slow perfusion or filling defects were observed in four kinds of retinal dystrophies. Conclusion ICGA may assist in providing valuable informations on choroidal circulation of retinal dystrophic diseases. (Chin J Ocul Fundus Dis,1998,14:88-91)
OBJECTIVE:To inwestigate the value of fundus fluorescein angiography in evaluation of idiopathic senile macular hole(ISMH). METHODS:fundus fluorescein angiography(FFA)and other clinical examination were performed in 26 cases (31eyes)of ISMH patients. RESULTS:Full-thickness macular holes were in 17 and lamellar holes were in 14 of the 31 eyes. Hyperfluorescencequot;window defectquot;was found at the base of all the eyes with full-thickness maeular holes and 2 eyes with lamellar holes. The size of hyperfluorescence zone was smaller than that of those seen in redfree film, hyperfluorescence in 6 eyes (19.4%) showed homogenous ancl 10 eyes (32.5%) granular in pattern. The small yellowish dots in macular hole showed blocked fluorescence,while the halo of macular hole showed hyperfluorescence. CONCLUSION:Fundus fluorescein angiography was useful in differentiating lamellar from full-thickness macular hole and understanding the degree of retinal pigment epithelium damages in macular holes. （Chin J Ocul Fundus Dis,1996,12: 208-210 ）
ObjectiveTo comparatively analyze for the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR) between first-visit and non-first-visit in ophthalmology.MethodsA retrospective study was performed for 22 patients (41 eyes) diagnosed as CMVR with AIDS by ophthalmology in the Affiliated Municipal Hospital of Xuzhou Medical University from July 2004 to September 2017. The patients were divided into two groups: one with the first-visit in ophthalmology (FVO) and the other with the first-visit in non-ophthalmology (FVNO). All patients underwent visual acuity, intraocular pressure, slit lamp microscope and indirect ophthalmoscope examinations. Thirty-nine eyes of 21 patients with clear refractive media were examined by color fundus photography, of which 5 patients were examined by FFA. Five patients examined by OCT and B-mode ultrasound. The CMVR were characterized as fulminant type or indolent type. All the 22 patients (41 eyes) except 2 patients (4 eyes) accepted highly active antiroviral therapy, and all patients were treated with ganciclovir intravenously. Nine patients (12 eyes) received intravitreal injection of ganciclovir, 7 patients (10 eyes) underwent vitrectomy because of retinal detachment, 6 patients (7 eyes) gave up surgery because of extensive retinal detachment, and the other 12 eyes did not undergo any eye surgery. All patients were followed for 6-58 months (average 23±39 months). The incidences and fundus characteristics of the patients with fulminant or indolent CMVR were compared and analyzed. Between the two groups, the difference of visual acuity and CD4+T cell count at the first vist and the last follow-up were analyzed by a t-test, and the macular involvement and spread of the two groups were compared by a chi-square test.ResultsFulminant CMVR showed dense yellow-white necrotic lesions along the great vessels with or without satellite lesions, while indolent CMVR showed sparse yellow-white granular lesions with a little bleeding. The concomitant signs included frost-like dendritic vascular sheath, retinal artery occlusion and optic disc edema. Fourteen eyes of 7 patients in FVO group were fulminant, including 2 patients (2 eyes) with retinal artery occlusion and 1 patient (two eyes) with optic disc edema. In FVNO group, there were 27 eyes of 15 patients, including 21 eyes of 13 cases identified as fulminant type and 6 eyes of 4 patients as indolent type. In the fulminant type, there were 4 patients (6 eyes) with frost-like dendritic vascular sheath, 10 patients (12 eyes) with retinal artery occlusion and 4 patients (4 eyes) with optic disc edema. There was no significant difference in initial visual acuity (t=－1.534, P=0.133), but there was a significant difference in visual acuity at the last follow-up (t=－3.420, P=0.001). There was no significant difference in CD4+ T cells between the two groups at the first visit (t=－0.902, P=0.378). The proportions of macular involvement and 3-4 quadrant involvement in FVO group were significantly higher than those in FVNO group (χ2=7.552, 7.865; P=0.006, 0.005).ConclusionFor AIDS patients with CMVR, the first-visit in ophthalmology showed more dense necrotic lesions involving macular and a wider range of lesions than the first-visit in non-ophthalmology.