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Purpose: To report a rare case of a conjunctival blue nevus in a child. Observations: A 10-year-old girl underwent an excisional biopsy for an atypical growing melanocytic conjunctival lesion. The diagnosis of a conjunctival blue nevus was confirmed on histopathology. We describe the histopathology and the anterior segment optical coherence tomography features of a blue nevus in a 10-year-old child along with a review of literature. Conclusion and importance: Conjunctival blue nevus is rare and has rarely been reported in a child. Multimodal imaging may help document lesion progression. This condition should remain in the differential for a growing, pigmented conjunctival lesion.

Articular syndrome includes a spectrum of inflammatory and non-inflammatory joint involvement ranging from arthralgia to arthritis. Its phenotype, differentials and management differ slightly in the elderly, considering the added effect of physiological changes with ageing, comorbidity and multimorbidity. This review aims to provide an overview of the common differentials of articular syndrome in the elderly, including the inflammatory and degenerative causes. The common inflammatory arthritis in the elderly includes late-onset rheumatoid arthritis, polymyalgia rheumatica, paraneoplastic arthritis, crystal arthropathies, and systemic vasculitis, including ANCA-associated vasculitis, to name a few. The non-inflammatory articular syndromes in this age group predominantly include osteoarthritis and osteoporosis. There are also evident alterations in the gut microbiome associated with inflammatory arthritis and with physiological ageing and osteoarthritis, which have possible mechanistic significance. The management aspect in the geriatric population comes with challenges of addressing multimorbidity, polypharmacy, drug interactions, and not just disease activity. An integrated approach with effective physical therapy, and vocational activities, tailored to each patient is essential for optimal management.

Eliot R Dow,1– 3 Karen M Chen,1 Cindy S Zhao,1 Austen N Knapp,1 Anuradha Phadke,4 Kirsti Weng,4 Diana V Do,1 Vinit B Mahajan,1 Prithvi Mruthyunjaya,1 Theodore Leng,1 David Myung1,2 1Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA; 2Department of Ophthalmology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; 3Department of Ophthalmology, Duke Eye Center, Durham, NC, USA; 4Department of Internal Medicine, Stanford Health Care, Palo Alto, CA, USACorrespondence: David Myung, Byers Eye Institute at Stanford, Palo Alto, CA, 94303, USA, Tel +1 650 723-6995, Email djmyung@stanford.eduPurpose: We examine the rate of and reasons for follow-up in an Artificial Intelligence (AI)-based workflow for diabetic retinopathy (DR) screening relative to two human-based workflows.Patients and Methods: A DR screening program initiated September 2019 between one institution and its affiliated primary care and endocrinology clinics screened 2243 adult patients with type 1 or 2 diabetes without a diagnosis of DR in the previous year in the San Francisco Bay Area. For patients who screened positive for more-than-mild-DR (MTMDR), rates of follow-up were calculated under a store-and-forward human-based DR workflow (“Human Workflow”), an AI-based workflow involving IDx-DR (“AI Workflow”), and a two-step hybrid workflow (“AI–Human Hybrid Workflow”). The AI Workflow provided same-day results, whereas the other workflows took 1– 5 days. Patients were surveyed by phone about follow-up decisions.Results: Under the AI Workflow, 279 patients screened positive for MTMDR. Of these, 69.2% followed up with an ophthalmologist within 90 days. Altogether 70.5% (N=48) of patients who followed up chose their location based on primary care referral. Under the Human Workflow and AI–Human Hybrid Workflow, 12.0% (N=14/117) and 11.7% (N=12/103) of patients with a referrable screening result followed up compared to 35.5% of patients under the AI Workflow (N=99/279; χ2df=2 = 36.70, p < 0.00000001).Conclusion: Ophthalmology follow-up after a positive DR screening result is approximately three-fold higher under the AI Workflow than either the Human Workflow or AI–Human Hybrid Workflow. Improved follow-up behavior may be due to the decreased time to screening result.Keywords: telemedicine, teleophthalmology, fundus photography, deep learning, machine learning, referral

Purpose: We aim to present a case of disseminated fusariosis that occurred in the setting of immunosuppression and presented with bilateral endogenous endophthalmitis, along with a literature review of Fusarium endophthalmitis, highlighting management strategies. Observation: A 70-year-old male with acute myeloid leukemia who had recently undergone a bone marrow transplant noted bilateral floaters and decreased vision. He was found to have bilateral Fusarium endophthalmitis, with subsequent evidence of fungemia and fusariosis in his skin and joints. Despite aggressive local and systemic treatment, he succumbed to the disease. Endophthalmitis was initially stabilized with pars plana vitrectomy and intravitreal amphotericin and voriconazole until the patient transitioned to comfort measures. A review of 31 cases demonstrates that outcomes are poor and that the disease must be treated aggressively, often both systemically and surgically. Conclusion: This case highlights the recalcitrance of Fusarium bacteremia and Fusarium endophthalmitis.

Objective: Detection of diabetic retinopathy (DR) outside of specialized eye care settings is an important means of access to vision-preserving health maintenance. Remote interpretation of fundus photographs acquired in a primary care or other nonophthalmic setting in a store-and-forward manner is a predominant paradigm of teleophthalmology screening programs. Artificial intelligence (AI)-based image interpretation offers an alternative means of DR detection. IDx-DR (Digital Diagnostics Inc) is a Food and Drug Administration-authorized autonomous testing device for DR. We evaluated the diagnostic performance of IDx-DR compared with human-based teleophthalmology over 2 and a half years. Additionally, we evaluated an AI-human hybrid workflow that combines AI-system evaluation with human expert-based assessment for referable cases. Design: Prospective cohort study and retrospective analysis. Participants: Diabetic patients ≥ 18 years old without a prior DR diagnosis or DR examination in the past year presenting for routine DR screening in a primary care clinic. Methods: Macula-centered and optic nerve-centered fundus photographs were evaluated by an AI algorithm followed by consensus-based overreading by retina specialists at the Stanford Ophthalmic Reading Center. Detection of more-than-mild diabetic retinopathy (MTMDR) was compared with in-person examination by a retina specialist. Main Outcome Measures: Sensitivity, specificity, accuracy, positive predictive value, and gradability achieved by the AI algorithm and retina specialists. Results: The AI algorithm had higher sensitivity (95.5% sensitivity; 95% confidence interval [CI], 86.7%–100%) but lower specificity (60.3% specificity; 95% CI, 47.7%–72.9%) for detection of MTMDR compared with remote image interpretation by retina specialists (69.5% sensitivity; 95% CI, 50.7%–88.3%; 96.9% specificity; 95% CI, 93.5%–100%). Gradability of encounters was also lower for the AI algorithm (62.5%) compared with retina specialists (93.1%). A 2-step AI-human hybrid workflow in which the AI algorithm initially rendered an assessment followed by overread by a retina specialist of MTMDR-positive encounters resulted in a sensitivity of 95.5% (95% CI, 86.7%–100%) and a specificity of 98.2% (95% CI, 94.6%–100%). Similarly, a 2-step overread by retina specialists of AI-ungradable encounters improved gradability from 63.5% to 95.6% of encounters. Conclusions: Implementation of an AI-human hybrid teleophthalmology workflow may both decrease reliance on human specialist effort and improve diagnostic accuracy. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Only a few cases of lipofibromatous hamartoma (LFH) of the median nerve have been described in the literature. LFH is a rare and low growing benign fibro-fatty tumour. It is characterised by the proliferation of mature adipocytes within the epineurium and the perineurium of the peripheral nerves. The median nerve is most frequently affected in the upper extremities. Carpal tunnel syndrome, paraesthesia, numbness and pain are frequently the results of involvement of the median nerve. In presented case, in addition to fibrolipoma, there was also new blood vessel formation noted, which was attributed to the chronicity of the lesion. Diagnosis was missed by ultrasound and MRI due to the presence of blood vessels. Histopathological diagnosis was confirmed. Surgical treatment with carpal tunnel release and neurolysis were performed. This resulted in favourable outcome in 3 months.

Introduction: Hip fractures are the major cause of disability and functional impairment in the elderly. Studies have correlated the results from treating femoral neck fractures; however, little has been described the quality of life (QOL) after hemiarthroplasty in these patients. Objective: An assessment of physical, psychological, social relationships, and environmental domains of QOL after hemiarthroplasty in elderly patients and to analyze the postsurgical impact on the activity of daily living and functional outcome of the hip. Methods: Prospective observational study was conducted on 100 elderly patients who underwent hemiarthroplasty. The hip function was scored with the Harris Hip Score (HHS) and activities of daily living were rated by the Barthel Index. Health-related QOL was rated by the World Health Organization QOL: Brief version applied before and 6 months after surgery. Results: There was fair to good HHS and decreased dependency in the activities of daily living with preserved function by the end of 6 months. Postsurgery ambulation showed that 30% of them used a walker for ambulation due to fear of falls. QOL improved but did not return to presurgery levels. The psychological domain was the most affected, followed by the environmental and social domains. Conclusion: Results showed the need for improvisation of various aspects of postoperative care such as designated rehabilitation protocols, fall clinics, psychotherapy and relaxation, and geriatric care for associated comorbidities. Implementing such a comprehensive specialty care approach along with good surgery will improve the QOL to presurgical level.

Mg-doped Fe2O3 nanoparticles (M-FNPs) are successfully prepared first time by facile green-aided (almond gum) combustion route. The structural analysis of synthesized nanoparticles was well analyzed by Powder X-ray Diffraction (PXRD), Fourier Transform Infrared spectroscopy (FT-IR), Scanning Electron Microscope (SEM), Raman spectroscopy and UV-Visible spectral studies. PXRD showed a nanocrystalline nature and determined the average particle size to be 85 nm. The surface morphologies of the prepared nanocomposite was measured by SEM technique reveals the porous and spongy like structure. The photodegradation activity on 20 × 10−6 of Fast Orange Red (FOR) organic model dye using M-FNPs (50 mg) under UV light irradiation was investigatedin detail. Electrochemical examination of the prepared material was conducted using graphite–M-FNP electrode paste in 0.1 M KCl solution, and its performance in redox reaction was determined to be very good via cyclic voltammetry and electrochemical impedance spectroscopy. Further, an extension to sensor studies revealed broad differences in redox positions for paracetamol sensors, at 0.64 V and 0.41 V, confirming highly chemical sensor activity in alkaline medium for 1∼5 mM concentrations.

Brain tumor identification, along with an investigation, is harmful to the patient. Segmentation, therefore, of paying attention to near-neighborhood growth remains accurate, effective, and healthy. Fully Convolution Neural Network (FCNN) is a reliable picture model to capitulate the hide quality. The form of the multifaceted with the incessant pixels taught with the crest state and the symbolic picture taught. In this research, the making of a totally convoluted method to obtain the participation of a random element and the production of correspondingly large-scale output with a resourceful assumption and information.. The approach has had several difficulties, as measurements are accurate for a variety of images. The improvement in the mortality rate of the programmed order is a critical condition. The scheduling of the mind tumor is an exceedingly troublesome task in the exceptional spatial and basic fluctuation that accompanies the local brain tumor. In this research, a programmed detection of Brain tumors proposed using the characterization of CNN. The most critical method of construction is the completion of the use of small holes. CNN's has less predictability and 97.5 accuracies.

Introduction: Fibromyalgia is a chronic syndrome characterised by widespread musculoskeletal pain accompanied by fatigue, disability, sleep, memory and mood issues. The pain of fibromyalgia is difficult to manage and has no complete remission. While there is no cure for fibromyalgia, a variety of medications have been tried to minimise symptoms and improve general health. Hence, a trial was conducted to evaluate lignocaine and ketamine as pharmacological modalities to treat fibromyalgia. Aim: To evaluate effectiveness of intravenous (i.v.) lignocaine-ketamine infusions in reducing pain and disability in fibromyalgia syndrome. Materials and Methods: A prospective observational study was conducted at Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India, between March 2021 and March 2022, on patients aged between 18-60 years diagnosed with fibromyalgia syndrome. Sixty patients were included in the study. Escalating doses of i.v. lignocaine of 5 mg/kg, 6 mg/kg and 7 mg/kg followed by escalating doses of i.v. ketamine of 0.4 mg/kg, 0.5 mg/kg and 0.6 mg/kg were administered on alternate days over a period of 12 days. Infusions were given in 50 mL normal saline through syringe pump over a period of 45 minutes. Pre and postinfusion 11 point Numerical Rating Scale (NRS) score was used to assess pain and World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 score to assess disability. Data are presented as mean and standard deviation. Statistical analysis was done by using the t-test for pre and post-treatment score, with a p-value

Purpose: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. Observations: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0 × 6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence. Conclusions/importance: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component.

Autoimmune rheumatic diseases are often characterised by heterogeneity in presentation. The traditional approach to diseases guided by their phenotype may be suboptimal with the advent of precision medicine. Precision medicine is the integration and application of multiomics to predict the best-performing drug and its toxicity profile to derive optimal benefits. With novel drug discoveries and an expanding therapeutic armamentarium, it potentially aids in clinical and therapeutic decision-making, while saving time and averting adverse events. However, multiomics comes with 'big data', and owing to the costs, the sample size is usually small. Machine learning (ML) plays an important role in these scenarios where conventional statistics fall short. So, by integrating clinical data with the data from -omics, ML models can be built, which can accurately predict the clinical factors or even novel biomarkers that predict response. This approach has a potential for great benefit as valuable time or the 'therapeutic window of opportunity' would be saved, with fewer adverse events, eventually translating to lower damage accrual and better outcomes. Most of the evidence for the use of ML in precision rheumatology comes from rheumatoid arthritis and the factors predicting response to various drugs, including tumour necrosis factor inhibitors. This approach also has its limitations such as the lack of generalizability and the current scarcity of longitudinal data. These models must be tested in larger cohorts and population-based studies for validation, failing which there is a risk of apparent identification of multiple 'novel' biomarkers that may or may not be mechanistic. [ABSTRACT FROM AUTHOR]

A 2D Discrete Cosine Transform and Inverse Discrete Cosine Transform using the B.G. Lee algorithm, incorporating a signed error-tolerant adder for additions, and a signed low-power fixed-point multiplier to perform multiplications are proposed and designed in this research. A novel Application Specific Integrated Circuit hardware implementation is used for the 2D DCT/IDCT computation of each 8 × 8 image block by optimizing the input data using the concepts of pipelining. An enhanced speed in processing and optimized arithmetic computations was observed due to the eight-stage pipeline architecture. The 2D DCT/IDCT of each 8 × 8 image segment can be quickly processed in 34 clock cycles with a substantially reduced level of circuit complexity. The B.G. Lee algorithm has been implemented using signed error-tolerant adders, signed fixed-point multipliers, and shifters, reducing computational complexity, power, and area. The Cadence Genus tool synthesized the proposed architecture with gpdk-90 nm and gpdk-45 nm technology libraries. The proposed method showed a significant reduction of 31.01%, 12.17%, and 21.11% in power, area, and PDP in comparison to the existing image compression architectures. An improved PSNR of the reconstructed image was also achieved compared to existing designs.

Purpose: To describe the efficacy and safety of brolucizumab (Beovu®, Novartis Pharmaceuticals) in a case of cystoid macular edema associated with radiation retinopathy as a result of iodine-125 plaque brachytherapy (PBT) for choroidal melanoma, resistant to treatment with other anti-vascular endothelial growth factor (VEGF) agents. Observations: A 67-year-old woman with choroidal melanoma in the right eye and best-corrected visual acuity (BCVA) of 20/20, underwent uncomplicated PBT. On post-operative month 7, the patient developed early onset radiation retinopathy. She failed to improve significantly with sub-tenon triamcinolone and 3 injections of intravitreal bevacizumab; BCVA was 20/200. Intravitreal brolucizumab was administered, and one month after, macular edema had resolved completely on optical coherence tomography, and BCVA improved to 20/50. At last follow up, 1 month after the third brolucizumab injection, BCVA was 20/60 and there was sustained resolution of intraretinal fluid. There were no signs of intraocular inflammation, progressive RR or optic neuropathy on exam or fluorescein angiography. Conclusions: This case suggests a positive effect of brolucizumab in the management of radiation retinopathy following PBT refractory to other anti-VEGF agents. However, one must consider the risk of severe vision loss associated with retinal vasculitis from use of brolucizumab.

Purpose: To describe a case of presumed bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with renal cell carcinoma (RCC) and provide an updated review of literature. Observations: A 58-year-old man, with a history of radical nephrectomy for RCC 8 years ago, presented with gradual diminution of vision. Based on multimodal imaging and detailed systemic evaluation, a diagnosis of presumed BDUMP and metastatic RCC was made. He was started on sunitinib malate as palliative chemotherapy. However, he refused plasmapheresis for BDUMP. The patient rapidly developed bilateral exudative retinal detachment. Subsequently, he progressed to bilateral neovascular glaucoma secondary to closed funnel retinal detachment. Eventually, he was lost to follow up after 13 months. Conclusions & Importance: BDUMP portends an underlying advanced systemic malignancy. Studies have not conclusively proven any definite treatment for BDUMP and survival is generally poor. Ocular side effects of palliative targeted chemotherapy for the primary malignancy, such as sunitinib, should be borne in mind.

PURPOSE: We describe two cases of intraoperative 4D microscope–integrated swept source optical coherence tomography (4D MIOCT) guided 27-gauge transvitreal retinochoroidal biopsy for choroidal melanoma. METHODS: Two 68-year-old females with choroidal melanomas underwent a transvitreal 27-gauge vitrectomy assisted chorioretinal biopsy for histologic and cytogenetic testing during I-125 radioactive episcleral plaque placement. A 4D (volumetric imaging through time) MIOCT device was used to simultaneously enable OCT image acquisition with surgical maneuvers during entry of and engagement of the vitreous cutter in the choroidal lesion. RESULTS: 4D MIOCT permitted real-time visualization of the choroidal tumor for selection of biopsy site in an area of adequate thickness and free of subretinal fluid, relatively perpendicular entry of the vitrectomy probe into the choroidal lesion, confirmation of adequate penetration depth prior to and during engagement of the vitreous cutter, and absence of subretinal fluid surrounding the retinotomy following removal of the probe. In both cases an adequate sample for histological and cytogenetic testing was obtained and no tamponade was required. CONCLUSION: Intraoperative 4D MIOCT imaging permits real-time visualization of vitreous cutter penetration and depth into the choroidal melanoma during a transvitreal choroidal biopsy.

Understanding the mechanisms and kinetics of membrane damage is of interest to researchers in several overlapping fields of biology. In this study, we describe the development and validation of a simple 32PO43− release radioassay used to track nanometer-scale damage to the bacterial cell membrane. Nanoscale membrane damage will result in the release of small cytoplasmic molecules, such as amino acids, sugars, and osmolytes. Our radioassay tracks the release of these molecules using the release of cytoplasmic 32PO43− as a proxy. Our assay can both detect 32PO43− release and track release kinetics in the order of minutes. We demonstrate the use of our radioassay using A. baumannii treated with colistin and Ω76: two agents known to cause membrane damage. Our assay tracks greater membrane damage in A. baumannii treated with both these agents, compared to an untreated control. Our assay fills a niche that is not covered by traditional 51Cr release radioassays and fluorescent staining techniques. Furthermore, our assay can potentially be used to track membrane damage in other membrane systems such as lipid vesicles, animal cells, and organelles.

Background: Methotrexate (MTX) at a dose of ≤25 mg/week is one of the most prescribed disease-modifying anti-rheumatic drugs (DMARDs) in a variety of rheumatic diseases. It can potentially cause life-threatening neutropenic sepsis, and acute renal and hepatotoxicity when taken inadvertently at high doses. We aim to analyse the clinical profile and risk factors of patients who presented with acute MTX toxicity. Methods: All patients presenting to the Rheumatology department with a history of inadvertent consumption of higher doses of MTX (>25 mg/week), from July 2021 to May 2023 were included. Additional data was extracted from hospital electronic medical health records. The clinical profile, risk factors, and outcome of patients with MTX toxicity were analysed. Results: The median age of the patients in our cohort was 52 IQR (40–62.5) years, with 80% females. The median cumulative dose of MTX was 120 mg (IQR 95–150). The reason for overdose in our cohort was medication error in comprehending once-weekly dosing. The most common major adverse event was neutropenia (80%). All our patients had stomatitis, with half of them having oral bleeding. Gastrointestinal adverse events like vomiting and diarrhoea were seen in 60% and 13% of the patients, respectively. Our cohort had two patients who succumbed to the complications due to neutropenic sepsis. The dose of MTX did not correlate with the severity of the disease or duration of hospital stay; however, the latter was significantly influenced by lower absolute neutrophil count (ANC). Conclusion: Acute MTX toxicity is one of the severe rheumatological emergencies and the toxicity profile includes haematological, gastrointestinal, hepatic, and renal adverse events. Severe neutropenia leading to sepsis can be fatal if not intervened early. [ABSTRACT FROM AUTHOR]

Purpose: To describe the management of submacular hemorrhage (SMH), a vision threatening complication following transvitreal choroidal biopsy, with intravitreal tissue plasminogen activator (tPA) and pure perfluoropropane (C3F8) gas bubble injection. Observations: A 53 year old female with choroidal melanoma of the left eye underwent iodine-125 plaque brachytherapy placement and 27 gauge transvitreal fine needle aspiration choroidal biopsy for gene expression profiling. On postoperative day 2, large SMH was identified on dilated fundus examination. At the time of plaque brachytherapy removal, intravitreal tPA and pure C3F8 gas bubble injection with post operative positioning was also performed to attempt displacement of SMH. At postoperative month 1 following tPA and gas bubble displacement, the SMH was completely displaced inferotemporally outside of the macula and visual acuity improved from 20/70 at postoperative week 1 to 20/25 at postoperative month 1. Conclusions and importance: Subretinal hemorrhage can be a complication of transvitreal choroidal tumor biopsy but early detection and prompt treatment can result in good visual outcomes.

Enchondromas of the phalanx are common benign tumours. They exhibit a monostotic or polyostotic pattern of presentation.These lesions are symptomatic and are usually diagnosed coincidentally. We report a 56-year-old female patient who presented to us with complaints of pain and swelling of the left-hand fourth finger when it was jammed in a gate. Plain radiograph of the hand confirmed the diagnosis of an enchondroma. A surgical curettage and olecranon bone graft was performed in this patient. In this article, the authors attempt to highlight the advantages of olecranon bone harvesting and the good functional results associated with this graft. Our patient had a good functional outcome with no evidence of recurrence at the end of one year.

Abstract Background Wide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation. Summary of review Wide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases. Conclusions Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.

Visible Near infrared and Shortwave Infrared (VNIR/SWIR, 400–2500 nm) remote sensing data is becoming a tool for topsoil properties mapping, bringing spatial information for environmental modeling and land use management. These topsoil properties estimates are based on regression models, linking a key topsoil property to VNIR/SWIR reflectance data. Therefore, the regression model’s performances depend on the quality of both topsoil property analysis (measured on laboratory over-ground soil samples) and Bottom-of-Atmosphere (BOA) VNIR/SWIR reflectance which are retrieved from Top-Of-Atmosphere radiance using atmospheric correction (AC) methods. This paper examines the sensitivity of soil organic carbon (SOC) estimation to BOA images depending on two parameters used in AC methods: aerosol optical depth (AOD) in the FLAASH (Fast Line-of-Sight Atmospheric Analysis of Spectral Hypercubes) method and water vapor (WV) in the ATCOR (ATmospheric CORrection) method. This work was based on Earth Observing-1 Hyperion Hyperspectral data acquired over a cultivated area in Australia in 2006. Hyperion radiance data were converted to BOA reflectance using seven values of AOD (from 0.2 to 1.4) and six values of WV (from 0.4 to 5 cm), in FLAASH and ATCOR, respectively. Then a Partial Least Squares regression (PLSR) model was built from each Hyperion BOA data to estimate SOC over bare soil pixels. This study demonstrated that the PLSR models were insensitive to the AOD variation used in the FLAASH method, with R2cv and RMSEcv of 0.79 and 0.4%, respectively. The PLSR models were slightly sensitive to the WV variation used in the ATCOR method, with R2cv ranging from 0.72 to 0.79 and RMSEcv ranging from 0.41 to 0.47. Regardless of the AOD values, the PLSR model based on the best parametrization of the ATCOR model provided similar SOC prediction accuracy to PLSR models using the FLAASH method. Variation in AOD using the FLAASH method did not impact the identification of bare soil pixels coverage which corresponded to 82.35% of the study area, while a variation in WV using the ATCOR method provided a variation of bare soil pixels coverage from 75.04 to 84.04%. Therefore, this work recommends (1) the use of the FLAASH AC method to provide BOA reflectance values from Earth Observing-1 Hyperion Hyperspectral data before SOC mapping or (2) a careful selection of the WV parameter when using ATCOR.

The diagnosis of primary vitreoretinal lymphoma and central nervous system lymphoma is challenging. In cases with intraocular involvement, vitreous biopsy plays a pivotal role. Several diagnostic tests are employed to confirm a diagnosis and include cytologic evaluation, immunohistochemistry, flow cytometry, and cytokine analysis. The limitations of these conventional diagnostic tests stem from the often paucicellular nature of vitreous biopsy specimens and the fragility of malignant cells ex vivo. Several emerging molecular techniques show promise in improving the diagnostic yield of intraocular biopsy, possibly enabling more accurate and timely diagnoses. This article will review existing diagnostic modalities for intraocular lymphoma, with an emphasis on currently available molecular tests.

Nelson’s syndrome is an infrequent pituitary mass with an incidence of 8–43% in adults and 25–66% in children that develops following total bilateral adrenalectomy (TBA) for the treatment of Cushing’s disease. It is one of the most challenging of all endocrine conditions. The frequent aggressiveness of the underlying ACTH-secreting pituitary adenoma (corticotrophinoma) necessitates regular biochemical and radiological screening. Current evidence favours a lack of prophylactic neoadjuvant pituitary radiotherapy at the time of TBA and a rapid rise of ACTH levels in the year post TBA as factors that may predict the occurrence of Nelson’s syndrome. Though, computerized tomography (CT)/magnetic resonance imaging (MRI) have led to the early diagnosis and improvement in management. Nelson’s related tumours are sometimes detected late, through clinical manifestations of invasion and compression of the surrounding structures. With this perspective in mind, we describe a 22 year old gentleman 10 years after TBA who presented with right sided hemiparesis due to a corticotroph adenoma.

While color fundus photos are used in routine clinical practice to diagnose ophthalmic conditions, evidence suggests that ocular imaging contains valuable information regarding the systemic health features of patients. These features can be identified through computer vision techniques including deep learning (DL) artificial intelligence (AI) models. We aim to construct a DL model that can predict systemic features from fundus images and to determine the optimal method of model construction for this task. Data were collected from a cohort of patients undergoing diabetic retinopathy screening between March 2020 and March 2021. Two models were created for each of 12 systemic health features based on the DenseNet201 architecture: one utilizing transfer learning with images from ImageNet and another from 35,126 fundus images. Here, 1277 fundus images were used to train the AI models. Area under the receiver operating characteristics curve (AUROC) scores were used to compare the model performance. Models utilizing the ImageNet transfer learning data were superior to those using retinal images for transfer learning (mean AUROC 0.78 vs. 0.65, p-value < 0.001). Models using ImageNet pretraining were able to predict systemic features including ethnicity (AUROC 0.93), age > 70 (AUROC 0.90), gender (AUROC 0.85), ACE inhibitor (AUROC 0.82), and ARB medication use (AUROC 0.78). We conclude that fundus images contain valuable information about the systemic characteristics of a patient. To optimize DL model performance, we recommend that even domain specific models consider using transfer learning from more generalized image sets to improve accuracy.

Purpose: To report the association of pembrolizumab, an immune checkpoint inhibitor (ICI), with giant cell arteritis (GCA) presenting as paracentral acute middle maculopathy (PAMM) secondary to retinal arterial occlusion. Observations: 86-year old male with history of treated choroidal melanoma now with metastatic uveal melanoma to the liver on pembrolizumab, an ICI, who presented with acute vision loss in the uninvolved left eye. Spectral domain optical coherence tomography showed band-like increased hyperreflectivity in the middle retinal layers at the level of the inner nuclear layer consistent with PAMM. Intravenous fluorescein angiogram demonstrated significant delay in filling of the superotemporal and inferotemporal arteries with nonperfusion of the temporal retina consistent with multiple branch retinal arterial occlusions. Work-up for GCA was performed and temporal artery biopsy showed healed arteritis. Conclusions and Importance: Pembrolizumab can cause ocular and life-threatening systemic adverse effects and as use of ICIs has increased, it is important to be aware of these associations. There should be a low threshold for GCA work up in patients on ICI therapy who present with acute vision loss and evidence of retinal occlusive disease with or without classic GCA systemic symptoms.

Summary: Antimicrobial peptides (AMPs) are the body’s natural innate immune defense against a spectrum of pathogens and can also modulate cell proliferation, chemotaxis, angiogenesis, wound healing, and immune cell activity. Harnessing these diverse functions for prophylactic use is contingent upon understanding the regulatory mechanisms governing their unconventional secretion from cells. Analysis of the secretion of S100A7 (Psoriasin), an abundant AMP stored in differentiated keratinocytes of the skin, has revealed an unexpected biphasic secretory response to bacterial exposure. The core components regulating S100A7 secretion are NFκB/p38MAPK, caspase-1, and interleukin (IL)-1α. The initial activation of this core machinery is mediated by Toll-like receptor signaling, whereas the chronic response is mediated by Caspase-8 downregulation. Interestingly, there is a concomitant downregulation of Caspase-8 in inflammatory skin diseases wherein S100A7 is constitutively released. These results highlight the potential of targeting these components to control the release of AMPs from the skin in both homeostatic and disease conditions. : The global explosion of antibiotic-resistant microorganisms has spurred interest in alternative strategies to combat these “superbugs.” Antimicrobial peptides (AMPs) have emerged as a promising solution. Bhatt et al. show downregulation of epidermal caspase-8 can mediate sustained release of AMPs from the skin and provide an effective defense against infection. keywords: caspase, antimicrobial peptides, skin, TLR, IL-1, NFkB, psoriasis, antibiotic resistance

Pathologies of the vitreomacular interface are implicated in a variety of sight-threatening clinical entities. The authors present a photo essay of a case of Terson syndrome with a striking premacular dehemoglobinized hemorrhage with ovoid morphology. This unique “vitelliform” finding highlights the distinct structure of the premacular vitreous space and its important implications in both health and disease.

Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically “invisible” tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.

Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.

Trans-radial intervention increases patient comfort and reduces vascular complications. Trans-radial access has become the preferred choice of patients and cardiologists. Radial artery spasm is commonly encountered during procedure and it depends upon factors like artery anatomy, built of the patient, procedure variables. We report a case of radial artery spasm leading to avulsion in a 69-year old short Asian female during coronary angiogram, which was managed successfully by conservative measures. A brief note of various management procedures like drugs and device are mentioned.

India has experienced significant Land-Use and Land-Cover Change (LULCC) over the past few decades. In this context, careful observation and mapping of LULCC using satellite data of high to medium spatial resolution is crucial for understanding the long-term usage patterns of natural resources and facilitating sustainable management to plan, monitor and evaluate development. The present study utilizes the satellite images to generate national level LULC maps at decadal intervals for 1985, 1995 and 2005 using onscreen visual interpretation techniques with minimum mapping unit of 2.5 hectares. These maps follow the classification scheme of the International Geosphere Biosphere Programme (IGBP) to ensure compatibility with other global/regional LULC datasets for comparison and integration. Our LULC maps with more than 90% overall accuracy highlight the changes prominent at regional level, i.e., loss of forest cover in central and northeast India, increase of cropland area in Western India, growth of peri-urban area, and relative increase in plantations. We also found spatial correlation between the cropping area and precipitation, which in turn confirms the monsoon dependent agriculture system in the country. On comparison with the existing global LULC products (GlobCover and MODIS), it can be concluded that our dataset has captured the maximum cumulative patch diversity frequency indicating the detailed representation that can be attributed to the on-screen visual interpretation technique. Comparisons with global LULC products (GlobCover and MODIS) show that our dataset captures maximum landscape diversity, which is partly attributable to the on-screen visual interpretation techniques. We advocate the utility of this database for national and regional studies on land dynamics and climate change research. The database would be updated to 2015 as a continuing effort of this study.