Tung Wah Eastern Hospital

BACKGROUNDSilicone oil (SiO) migration to the central nervous system (CNS) is a rare complication of SiO tamponade after vitreo-retinal surgeries, it could masquerade hemorrhage on computed tomography neuro-imaging. Only limited cases were reported in the literature, certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIMTo study the risk factors for cerebral ventricular migration (CVM) on top of visual pathway migration (VPM).METHODSConforming to the preferred reporting items for systematic reviews and meta-analyses guidelines, literature searches on PubMed, MEDLINE, EMBASE were performed on June 1, 2024. Publications on SiO migration to CNS were included in this review. Non-English articles, and studies without neuro-imaging of the CNS were excluded. Patient demographics, SiO filled eyes' ocular characteristics and vitrectomy surgical details were extracted from included studies in this review. VPM and CVM were assigned as group 1 and group 2 respectively. Fisher's exact tests, Mann-Whitney U tests and binary logistic regression were performed.RESULTSTotal 68 articles were obtained after searches, 48 publications were included for analysis. Total 54 SiO filled eyes were analyzed. Post-vitrectomy intraocular pressure (IOP) was found to be significant in both Mann-Whitney U test (P = 0.047) and binary logistic regression (P = 0.012). Diabetic was found to be significant in binary logistic regression (P = 0.037), but at borderline risk for CVM in Fisher's exact test (P = 0.05). Other significant factors include longer SiO tamponade time (P = 0.002 in Fisher's exact test) and visual acuity (P = 0.011 in binary logistic regression). Optic nerve atrophy or disc cupping (P = 1.00, P = 0.790) and congenital optic disc anomalies (P = 0.424) were all with P > 0.05.CONCLUSIONSiO migration to CNS is rare with limited case reports only. Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM, followed by patients’ diabetic status, longer SiO tamponade time and visual acuity. Optic nerve atrophy, disc cupping and congenital optic disc anomalies were not associated. Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreo-retinal surgeons. Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.

Abstract Introduction Sleep metrics are essential for diagnosing insomnia and co-morbid insomnia with obstructive sleep apnea (COMISA). Single-night polysomnography (PSG) is insufficient for comprehensive evaluation, and actigraphy lacks the capability to measure apnea-hypopnea index (AHI). The optimal number of nights required for reliable assessment of insomnia and COMISA has not been established. This study aims to determine the minimum nights needed for accurate estimation of sleep metrics using the Belun Ring (BR). Methods Sixty-six participants with insomnia complaints (median age: 61 years; 61% female; 30% COMISA; median BMI: 23.6) were screened by a clinical psychologist and pulmonologist and underwent multiple-night BR testing. Insomnia was defined by an Insomnia Severity Index (ISI) ≥15 or a diagnosis per ICSD-3 criteria, and COMISA by insomnia criteria with PSG-AHI ≥15 events/h. Sleep metrics included total sleep time (TST), sleep efficiency (SE), REM sleep, wakefulness, sleep onset latency (SOL), wake after sleep onset (WASO), AHI4% and HRV time-domain metrics. Reference values were calculated as the average of all available nights. Concordance correlation coefficient (CCC) assessed agreement between 1-N night averages and reference values, with 1,000 bootstrapped simulations performed for each N-night scenario. Results Participants completed a median of 5 nights (IQR: 4–6; ≥100 minutes/night). Actual data showed key metrics reached a lower 95% CI CCC of ≥0.95 by the fourth night (e.g. AHI 4%, WASO, SOL, TST, SE, REM, RMSSD, SDNN, PNN50). Simulations confirmed that 4 nights were sufficient for good agreement (CCC ≥0.85) across most metrics, though SOL variability persisted beyond 6 nights. Sensitivity analysis, restricted to participants with ≥6 nights (N=27), yielded consistent results, with all metrics stabilising after 4 nights. Conclusion This study establishes that a minimum of four nights is required for reliable sleep metric assessment in insomnia and COMISA using the BR. This duration ensures accurate evaluation of HRV, OSA, and insomnia-related metrics. The BR offers significant advantages over PSG, actigraphy, and self-reports, delivering more precise diagnostics. The findings highlight how wearable-based sleep evaluations enhance the detection and management workflow for insomnia and underdiagnosed COMISA, especially in psychiatric settings. Support (if any)

Potential competing interests: No potential competing interests to declare.The definition of "Use of light-activated drugs (photosensitizing agents) to kill cancer cells." is too narrow and incomplete in modern medicine.Photodynamic therapy (PDT) is widely used in medicine across different specialties other than oncology alone, including but not limited to dermatology, [1] dentistry, [2] ophthalmology, [3] infectious diseases, [4] wound management, etc. [5] Therefore, the definition could be rewritten as: Use of light-activated drugs (photosensitizing agents) to achieve therapeutic purposes.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Objective: This study evaluated the real-world performance in an Asian population with diabetes mellitus (DM) of the EyeArt system, which is the only United States Food and Drug Administration-approved system available in Hong Kong.Methods: Fundus photographs taken from December 2020 to June 2021 during a diabetic retinopathy (DR) screening program in patients with DM who attended Pamela Youde Nethersole Eastern Hospital in Hong Kong were retrieved.Two vitreoretinal-trained ophthalmologists independently graded the fundus photographs for DR and concomitant pathologies.Discrepancies were resolved through discussion with a senior vitreoretinal ophthalmologist for a final decision.Fundus photographs (in jpg format) were then uploaded to the EyeArt AI system.The EyeArt system's sensitivity and specificity on detecting (1) referable DR (moderate or severe non-proliferative DR, proliferative DR, or diabetic macular edema [DME]) and (2) any DR or DME were calculated based on the ophthalmologists' diagnoses (the gold standard).Results: 23 men and 79 women (93 Chinese, 3 Pakistanis,