Ophthalmic Diseases Classification Based on YOLOv8

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.

Even in the era of intravitreal injection therapy (intravitreal operative injection of medication, IVOM) for the treatment of macular and retinal diseases, such as age-related macular degeneration (AMD), proliferative diabetic retinopathy (DR) and diabetic macular edema (DME) as well as proliferative stages and/or macular edema due to retinal vein occlusion (RVO), conventional retinal laser treatment is still of importance. It can be focally performed on an on-label basis for DME and macular edema due to branch RVO (BRVO) and its use as panretinal treatment for proliferative stages in retinal diseases as well as for the treatment of retinal holes is undisputed. The spectrum is extended by the treatment of less common diseases, such as retinal hemangioblastoma, macroaneurysms and subhyaloid macular hemorrhage. There is cause for concern that knowledge about the correct performance of retinal laser application might be shifted into the background due to an increase of IVOM treatment, which could lead to an increase in unnecessary errors. The aim of this manuscript is to increase awareness for the correct indications and execution of retinal laser treatment based on case examples of flawed or insufficient treatment.

Objective To study the changes of retinal vessel diameters in normal eyes and age-relatedmacular degeneration (AMD), diabetic retinopathy(DR), retinal vein occlusion(RVO). Methods 328 normaleyes were divided into 5 groups. The diameters of 6 largest retinal arterioles and venules coursing through aspecified area one-half to one disc diameter from the optic disc were measured with a computer program, then,measured those of AMD,DR and RVO with the same method,and compared with normal eyes of same age.Results The average retinal vessel diameters of normal eyes decreased in larger than 50 years old. Theaverage retinal arteriolar diameters of AMD,DR and RVO were also decreased. The average retinal venulardiameters of AMD and RVO were decreased, but the ones of DR were invariant. Conclusions The averageretinal arteriolar and venular diameters of normal eyes were narrower in larger than 50 years old. The averageretinal arteriolar diameters of AMD,DR and RVO were also narrower. The average retinal venular diameters ofAMD and RVO were narrower, but the ones of DR were invariant. Key words: Age; Age-related maeular degeneration; Diabetic retinopathy; Retinal vein occlusion; Vessel diameter

Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible, cost-effective screening and referral program is very important for the eye health care, prevention and treatment of blindness in China. Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program. Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity, intraocular pressure, and nonmydriatic fundus photography were obtained.Optic disc photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma, diabetic retinopathy(DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang, the informed consent of each subject was obtained. Results Totally, 15 303 subjects were enrolled and 15 197 of them finished the exanimations, giving a response rate of 99.3%.The overall percentage of blindness and moderate to severe visual impairment was 0.08% (12/15 197) and 2.34% (355/15 197). Two hundred and twenty-eight (1.50%) subjects were defined as glaucoma suspects and 80 individuals (0.53%) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41%), branchial retinal vessel occlusion (0.24%), macular degeneration (0.09%), and macular hole (0.06%). More than 95% of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36%) were defined as ocular hypertension suspects. Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project, as well as the work of prevention and treatment of blindness. Key words: Opportunistic eye disease screening; Prevention and treatment of blindness; Eye health care

Economic Considerations of Macular Edema Therapies

<h3>Background and Importance</h3> Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents, such as aflibercept and ranibizumab, are widely used. Although generally safe, they carry a risk of endophthalmitis, a rare but severe adverse event. Understanding its incidence is essential to enhance patient safety. <h3>Aim and Objectives</h3> To determine the incidence of endophthalmitis as an adverse reaction following intravitreal injection of prefilled syringe formulations of aflibercept and ranibizumab. <h3>Material and Methods</h3> A retrospective descriptive study was conducted including patients treated with aflibercept or ranibizumab between January 2021 and August 2025. They were identified using the hospital pharmacy dispensing software, filtered by indications: age-related macular degeneration (AMD), diabetic macular oedema (DMO), choroidal neovascularisation (CNV), retinal vein occlusion (RVO) and other eye diseases. Suspected cases of endophthalmitis were identified by searching for compounded ceftazidime and vancomycin eye drops or intravitreal syringes, both used in initial endophthalmitis management. Electronic medical records were reviewed to confirm the diagnosis and clinical courses. <h3>Results</h3> We identified 2019 patients treated with aflibercept and 1689 with ranibizumab. Among 101 patients who received compounded ceftazidime and vancomycin, 12 had previously been treated with anti-VEGF agents (2 aflibercept only, 4 ranibizumab only and 6 with both). 6 confirmed cases of post-injection endophthalmitis were detected (4 women, 2 men), with a median age of 82.5 (55-94) years. Details of cases (case number, indication, anti-VEGF agent, onset of symptoms in days, previous injections of aflibercept/ranibizumab): CNV, aflibercept, 3, 9/2 DMO, aflibercept, 5, 9/1 RVO, ranibizumab, 7, 0/13 AMD, aflibercept, 28, 10/6 AMD, ranibizumab, 7, 0/6 AMD, aflibercept, 7, 14/6 <h3>Conclusion and Relevance</h3> Endophthalmitis represents a low-incidence adverse event associated with intravitreal anti-VEGF injections for AMD, DMO, CNV and RVO. No apparent differences were observed between aflibercept and ranibizumab regarding endophthalmitis occurrence. Ongoing pharmacovigilance and aseptic technique remain essential to ensure safe clinical practice. <h3>Conflict of Interest</h3> No conflict of interest

&lt;p&gt;Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences.&lt;/p&gt;&lt;p&gt;Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT).&lt;/p&gt;&lt;p&gt;Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p &gt; 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO.&lt;/p&gt;&lt;p&gt;Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.&lt;/p&gt;

Purpose:The purpose of this study was to evaluate the safety profile of intravitreal bevacizumab (Avastin) as an off-label pharmacotherapeutic agent for various ocular conditions.Methods:Retrospective analysis was carried out on 3806 injections of 1761 patients that were administered with intravitreal bevacizumab injection at a tertiary eye care center in India. The injections were administered on a pro re nata basis for various indications such as age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO).Results:The mean age of the patients was 61.8 ± 11.59 years. A total of 59.2% of the patients were men and 40.8% women. The most common indications for which the injection was administered were DME (27.5%), AMD (26%), and branch RVO (12.3%). Among the ocular side effects, endophthalmitis was seen in three eyes (0.08%), retinal breaks in none of the eyes whereas 35 eyes had a rise in intraocular pressure (IOP) >21 mmHg (0.9%). Preexisting glaucoma was present in four eyes while remaining 31 eyes did not have any history of glaucoma. IOP rise was significantly more in eyes with preexisting glaucoma as compared to nonglaucomatous eyes (P = 0.04). No systemic adverse events were noted in our study population.Conclusion:Our study provides real-world evidence regarding the safety profile of intravitreal bevacizumab (Avastin). These data suggest that bevacizumab is a safe and economical pharmacotherapeutic agent that can be administered for a variety of ocular disorders. Analyzing the safety of bevacizumab is necessary for a developing country like India as the majority of the population cannot afford the costly ranibizumab as compared to bevacizumab for ocular healthcare.

Objective To observe serum homocysteine (Hcy) levels in retinal vein occlusion (RVO) patients with different ages and types. Methods A total of 79 patients (79 eyes) diagnosed with RVO were enrolled. There were 33 females and 46 males, the mean age was (57.00±9.29) years. Eighty-two age- and sex-matched patients (82 eyes) without retinal vascular disease were included as controls. There were 32 females and 50 males, the mean age was (60.00±10.15) years. Among RVO patients, there were 24 patients younger than 50 years old (young patients) and 55 patients older than 50 years old (elderly patients); 35 patients with central RVO (CRVO) and 44 patients with branch RVO (BRVO). Fasting plasma Hcy, serum vitamin (Vit) B6, B12 and folate levels were measured in all patients. The relationship of high Hcy, low VitB6, low folate and RVO with different age were analyzed. Results Hcy level was significantly higher in RVO patients than control subjects (t=2.946, P 0.05). Concentrations of Hcy, folate, VitB12 and VitB6 were not different between patients with CRVO and BRVO (t=0.756, 1.306, 0.682, 1.306; P>0.05). Hcy level was significantly higher in the young RVO patients than in the elderly RVO patients (t=2.394, P 0.05). The number of patients with high Hcy[χ2=13.67, odds ratio (OR)=3.327, 95% confidence interval (CI)=1.742 - 6.354], low VitB6 (χ2=5.28, OR=2.068, 95%CI=1.103 - 3.878) and low folate status (χ2=8.642, OR=2.546, 95%CI=1.349 - 4.806) in RVO patients were more than control subjects (P=0.0001, 0.023, 0.004). Conclusions High Hcy, low folate and low VitB6 were risk factors for the onset of RVO. Hcy may play more important role in young patients with RVO. Hcy, folate and VitB6 levels were similar in CRVO and BRVO patients. Key words: Retinal vein occlusion/etiology; Homocysteine; Folic acid deficiency/ complications; Vitamin B 6 deficiency/complications

Background Retinal vein occlusion (RVO) is the second most prevalent retinal vascular disorder after diabetic retinopathy, it may be categorized as central, hemi-central, and branch RVO. The most important risk factors are hypertension, diabetes mellitus, and hyperlipidaemia. Aim The objective of the research is to assess the ocular condition of patients with central retinal vein occlusion (CRVO) using optical coherence tomography angiography (OCT-A). Patient and methods This prospective cross-sectional controlled trial was conducted on a total of 44 individuals, who were separated into two distinct groups: group 1: 24 eyes of 24 patients with central RVO, group 2: 20 eyes of 20 healthy persons. Results Foveal avascular zone (FAZ) was significantly larger in both superficial and deep plexi levels in CRVO cases in comparison to the values of the same levels in normal subjects with predominance FAZ enlargement in the deep plexus than superficial plexus. Measurement of vascular density was significantly less in both superficial and deep plexi levels in CRVO cases in comparison to the same levels in normal subjects. Central macular thickness (CMT) detected by OCT was significantly more in CRVO cases in comparison to normal subjects. There were negative correlation between best-corrected visual acuity in decimal and CMT, Increased CMT was associated with diminish best-corrected visual acuity. Conclusion OCTA has the advantage of being a non-invasive method in assessing CRVO patients which makes it more practical than FFA in some clinical situations like patients with chronic kidney disease.

Vascular Endothelial Growth Factor Promotes Progressive Retinal Nonperfusion in Patients with Retinal Vein Occlusion

New Examination Methods for Macular Disorders: Application of Diagnosis and Treatment

To evaluate the efficacy and safety of ranibizumab 0.5mg in Japanese patients with visual impairment due to macular oedema secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) and to support the applicability of the phase III results from Caucasian to Japanese populations. This is a 3-month, open-label, single-arm, multicentre, phase III study. Thirty-one patients (15 BRVO and 16 CRVO) aged ≥18years with a best-corrected visual acuity (BCVA) letter score of 19-73 (BRVO) or 24-73 (CRVO) were included. The primary end-point was the mean average change in BCVA from baseline to month 1 through month 3 after three consecutive monthly intravitreal injections of ranibizumab 0.5mg. Secondary end-points were mean change in BCVA and central subfield thickness (CSFT), categorized BCVA, and safety over 3months. At month 3, the mean average change in BCVA improved substantially from baseline for BRVO (11.3 letters, p=0.001) and CRVO (6.7 letters, p=0.019). The mean BCVA improved (12.8 and 9.1 letters) and the mean CSFT decreased (212.5 and 442.1μm) from baseline to month 3. At month 3, 26.7% (BRVO) and 31.3% (CRVO) of the patients had a gain of ≥15 letters from baseline. Safety findings in this study were similar to those reported in the previous clinical trials. Ranibizumab was effective in improving BCVA and was well tolerated in Japanese patients with BRVO and CRVO. The findings from this study were consistent with those reported in the Caucasian population.

Previous studies have found that metformin can reduce cardiovascular risk, but its association with retinal vein occlusion (RVO) is unknown. In this population-based cohort study using the Taiwan National Health Insurance Research Database (NHIRD), we demonstrated the protective effect of metformin against RVO in diabetes mellitus (DM) and explored the incidence rate and factors associated with RVO development in general and diabetic populations. One million patients were randomly selected from the registry files of the NHIRD, and all their claims data were collected for the 1996–2011 period. Patients with a new diagnosis of central or branch RVO were identified using International Classification of Disease codes. DM was defined for patients with diagnoses and treatments. Factors associated with RVO development in the non-DM and DM cohorts were explored using Cox proportional regression models. In total, 1,018 RVO patients were identified from the database. The average incidence of RVO was 9.93 and 53.5 cases per 100,000 person-years in the non-DM and DM cohorts, respectively. Older age, DM, hypertension, and glaucoma were significant risk factors for RVO, whereas the prescription of anticoagulants was a significant protective factor. In the DM cohort, older age, hypertension, and diabetic retinopathy were significant risk factors for RVO, whereas metformin treatment was a significant protective factor. These results confirmed the risk factors for RVO and demonstrated the protective effect of metformin against RVO in DM patients. Prescribing metformin for DM patients may be beneficial for reducing the incidence of RVO, along with its hypoglycemic action.

PurposeTo compare the ability of ocular fundus images obtained by Spectralis MultiColor scanning laser ophthalmoscope (MC-SLO) to that obtained by conventional color fundus images (CF) in detecting non-glaucomatous nerve fiber layer defects (NFLDs).MethodsA cross-sectional, retrospective study. Patients with retinal diseases who had ocular examination with both the MC-SLO and CF instruments at the Kagoshima University from December 2016 to February 2017 were studied. Eyes that had NFLDs with non-glaucomatous optic discs were analyzed. The visibility of the NFLDs was classified into three grades: grade 0, not visible; grade 1, barely visible; and grade 2, clearly visible. The NFLD grade for blue, green, and red scanning lights of the MC-SLO, merged images with three wavelengths and the color and red-free images were determined by two ophthalmologists. These scores were compared by Steel-Dwass tests.ResultsThirty-one eyes of 26 patients with a mean age of 63.1 ± 11.2 years were studied. There were 14 eyes with diabetic retinopathy, 11 eyes with age-related macular degeneration, 3 eyes with a branch retinal vein occlusion, and 3 eyes with an epiretinal membrane/macular hole. Both the intra-rater (0.631–0.790) and inter-rater (0.637–0.733) agreements were good. NFLDs were detected by the blue wavelength in all cases and by green wavelength and merged wavelengths in 90.3% of the images. The mean NFLD grade was 1.58 ± 0.49 for blue light images, 1.13 ± 0.54 for green light images, 0.07 ± 0.24 for red light images, and 1.16 ± 0.56 for merged images. The NFLD score for blue wavelength was significantly higher than that for green and red wavelength images (P < 0.05 and P < 0.01) but not significantly higher than that for the merged images. NFLDs were detected in 12 eyes (38.7%) in the color images and 16 eyes (51.6%) in the red-free images. The NFLD score for the CF and the red-free image was 0.41 ± 0.55 and 0.70 ± 0.67 which is significantly lower than that of blue MC-SLO images.ConclusionThe images obtained by MC-SLO are superior to that obtained by CF in detecting NFLDs in eyes with retinal diseases. We recommend MC-SLO imaging to screen for NFLDs in eyes with retinal diseases.