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Ophthalmology and Therapy Oct 2023The objective of this scoping review is to understand the extent and type of evidence in relation to telemedicine imaging devices for cornea and external segment... (Review)
Review
OBJECTIVE
The objective of this scoping review is to understand the extent and type of evidence in relation to telemedicine imaging devices for cornea and external segment conditions.
INTRODUCTION
The coronavirus pandemic has emphasized the benefits of telemedicine in diagnosing and managing ocular diseases. With the rapid advancement of technology in slit lamp biomicroscopes, smartphones and other ocular surface imaging modalities, telemedicine applications for cornea and external diseases have become an active area of research.
INCLUSION CRITERIA
For studies to be included, they had to discuss the concept of imaging devices for cornea and external diseases in the context of telemedicine. There was no restriction on the studied population or participants.
METHODS
A scoping review was conducted according to an a priori protocol. Documents written in English were identified from the PubMed and Embase databases and searches. Anterior segment imaging devices were then classified into different categories.
RESULTS
Anterior segment imaging devices identified in this review included 19 slit lamp-based devices, 17 smartphone-based devices and 15 other devices. These tools can detect a wide variety of cornea and external diseases (e.g., pterygium, conjunctivitis, corneal opacity, corneal ulcer, and blepharitis). Fewer than half of the devices (24/51) were assessed for diagnostic performance. Their diagnostic accuracy varied greatly from condition to condition and from device to device. The inter-rater reliability of different photo-graders assessing images was assessed in only a few studies.
CONCLUSIONS
Anterior segment imaging devices are promising tools for remote diagnosis and management of patients with cornea and external disease. However, there are significant gaps in the literature regarding the diagnostic accuracy and inter-rater reliability of several devices. Future research with rigorous methods is required to validate the use of these devices in telemedicine settings.
PubMed: 37458978
DOI: 10.1007/s40123-023-00764-3 -
Clinical Ophthalmology (Auckland, N.Z.) 2023To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain,...
PURPOSE
To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS.
METHODS
Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1-5 (1-none; 5-severe) at POD1 and POW1.
RESULTS
Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p<0.0001, p<0.0001, p<0.0001) and POW1 (p=0.0002, p=0.0016, p<0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis.
CONCLUSION
The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies.
PubMed: 37457873
DOI: 10.2147/OPTH.S410452 -
Clinical Case Reports Jul 2023Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies,...
Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies, joint contracture, and skin webbing (pterygia). This disorder is fatal before birth or shortly after birth. We reported a case of lethal multiple pterygium syndrome with multiple anomalies including pterygia involving the axilla, bilateral antecubital fossa, and groin. Arthrogryposis involving multiple lower and upper extremities joints. Cleft palate, microstomia and limitation of mouth opening, webbed neck, asymmetric small and narrow chest, ambiguous genitalia, depressed and wide nasal bridge, antemongoloid slant, low-set, malformed, and posteriorly rotated ears, pterygia, syndactyly and camptodactyly of hands and rocket bottom feet. LMPS is a congenital genetic disease with multiple anomalies that is fatal in the second and third trimesters of pregnancy or shortly after birth. With genetic testing and counseling, it can be prevented from recurring in subsequent pregnancies.
PubMed: 37448946
DOI: 10.1002/ccr3.7678 -
Eye (London, England) Dec 2023Ocular surface squamous neoplasia (OSSN) and pterygia share risk factors and co-exist in only a minority of cases. Reported rates of OSSN in specimens sent as pterygium...
INTRODUCTION
Ocular surface squamous neoplasia (OSSN) and pterygia share risk factors and co-exist in only a minority of cases. Reported rates of OSSN in specimens sent as pterygium for histopathological analysis vary between 0% and nearly 10%, with the highest rates reported in countries with high levels of ultraviolet light exposure. As there is a paucity of data in European populations, the aim of this study was to report the prevalence of co-existent OSSN or other neoplastic disease in clinically suspected pterygium specimens sent to a specialist ophthalmic pathology service in London, United Kingdom.
METHODS
We performed a retrospective review of sequential histopathology records of patients with excised tissue submitted as suspected "pterygium" between 1997 and 2021.
RESULTS
In total, 2061 specimens of pterygia were received during the 24-year period, with a prevalence of neoplasia in those specimens of 0.6% (n = 12). On detailed review of the medical records of these patients, half (n = 6) had the pre-operative clinical suspicion of possible OSSN. Of those cases without clinical suspicion pre-operatively, one was diagnosed with invasive squamous cell carcinoma of the conjunctiva.
CONCLUSION
In this study, rates of unexpected diagnoses are reassuringly low. These results may challenge accepted dogma, and influence future guidance for the indications for submitting non-suspicious pterygia for histopathological analysis.
Topics: Humans; Pterygium; Eye Neoplasms; Prevalence; Conjunctiva; Conjunctival Neoplasms
PubMed: 37237231
DOI: 10.1038/s41433-023-02594-w -
Journal Francais D'ophtalmologie Sep 2023To evaluate the cosmetic surgical outcomes of primary corneal pterygia excision using the avulsion (snatching) technique.
AIM
To evaluate the cosmetic surgical outcomes of primary corneal pterygia excision using the avulsion (snatching) technique.
METHODS
A prospective, interventional study included twenty-five eyes of 25 patients with primary pterygium underwent excision were followed up for at least 6 months. In all patients, snatching (modified avulsion) technique was utilised to avulse the pterygium head off the corneal surface and remove any residual fibres by Colibri without need for keratectomy with a scalpel.
RESULTS
The study involved 25 eyes of 25 patients with an average age of 42.5±56.5 years. The mean follow-up was 6 months. One-week post-op, 8 patients (32%) reported they can tell which is the operated eye but looked untouched while 17 (68%) patients reported that the operated eye looked red but is accepted. Twenty patients (80%) reported some discomfort while the remaining 5 patients (20%) reported no discomfort. Cornea examination showed a clear cornea in 18 eyes (72%), 6 eyes (24%) had mild keratitis, and 1 eye (4%) had clouding at the surgical site. Over an average of six months post-op follow-up period, all the patients (100%) reported they cannot tell which eye had the surgery and none (0%) of them reported discomfort. Examination of the cornea was clear in 24 (96%) eyes, but 1 (4%) eye had mild keratitis.
CONCLUSION
Snatching (modified avulsion) technique was found to be effective, safe, and presents decent aesthetic appearance for the management of primary corneal pterygia when safety points are firmly followed.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Pterygium; Prospective Studies; Conjunctiva; Cornea; Follow-Up Studies; Recurrence
PubMed: 37085358
DOI: 10.1016/j.jfo.2023.02.002 -
The British Journal of Ophthalmology Feb 2024To improve the accuracy of pterygium screening and detection through smartphones, we established a fusion training model by blending a large number of slit-lamp image...
BACKGROUND/AIMS
To improve the accuracy of pterygium screening and detection through smartphones, we established a fusion training model by blending a large number of slit-lamp image data with a small proportion of smartphone data.
METHOD
Two datasets were used, a slit-lamp image dataset containing 20 987 images and a smartphone-based image dataset containing 1094 images. The RFRC (Faster RCNN based on ResNet101) model for the detection model. The SRU-Net (U-Net based on SE-ResNeXt50) for the segmentation models. The open-cv algorithm measured the width, length and area of pterygium in the cornea.
RESULTS
The detection model (trained by slit-lamp images) obtained the mean accuracy of 95.24%. The fusion segmentation model (trained by smartphone and slit-lamp images) achieved a microaverage F score of 0.8981, sensitivity of 0.8709, specificity of 0.9668 and area under the curve (AUC) of 0.9295. Compared with the same group of patients' smartphone and slit-lamp images, the fusion model performance in smartphone-based images (F score of 0.9313, sensitivity of 0.9360, specificity of 0.9613, AUC of 0.9426, accuracy of 92.38%) is close to the model (trained by slit-lamp images) in slit-lamp images (F score of 0.9448, sensitivity of 0.9165, specificity of 0.9689, AUC of 0.9569 and accuracy of 94.29%).
CONCLUSION
Our fusion model method got high pterygium detection and grading accuracy in insufficient smartphone data, and its performance is comparable to experienced ophthalmologists and works well in different smartphone brands.
Topics: Humans; Smartphone; Pterygium; Cornea; Slit Lamp; Conjunctiva
PubMed: 36858799
DOI: 10.1136/bjo-2022-322552 -
Cornea Jan 2024The objective of this study was to evaluate the clinical outcomes of the TissueTuck technique in the treatment of eyes with recurrent pterygium.
PURPOSE
The objective of this study was to evaluate the clinical outcomes of the TissueTuck technique in the treatment of eyes with recurrent pterygium.
METHODS
A retrospective review was performed on patients with recurrent pterygium who underwent surgical excision, followed by the application of cryopreserved amniotic membrane, using the TissueTuck technique between January 2012 and May 2019. Only patients with at least 3 months of follow-up were included for analysis. Baseline characteristics, operative time, best-corrected visual acuity, and complications were assessed.
RESULTS
A total of 44 eyes of 42 patients (age 60.5 ± 10.9 yrs) with single-headed (84.1%) or double-headed (15.9%) recurrent pterygium were included for analysis. The average surgical duration was 22.4 ± 8.0 minutes, and mitomycin C was administered intraoperatively in 31 eyes (72.1%). During a mean postoperative follow-up of 24.6 ± 18.3 months, there was only 1 case of recurrence (2.3%). Other complications include scarring (9.1%), granuloma formation (20.5%), and corneal melt in 1 patient with preexisting ectasia (2.3%). Best-corrected visual acuity significantly improved from 0.16 Logarithm of the Minimum Angle of Resolution at baseline to 0.10 Logarithm of the Minimum Angle of Resolution at the last postoperative follow-up ( P = 0.014).
CONCLUSIONS
TissueTuck surgery with cryopreserved amniotic membrane is safe and effective for recurrent pterygium cases with a low risk of recurrence and complications.
Topics: Humans; Middle Aged; Aged; Pterygium; Treatment Outcome; Follow-Up Studies; Mitomycin; Conjunctiva; Recurrence
PubMed: 36796012
DOI: 10.1097/ICO.0000000000003255