Purpose Retinopathy of prematurity (ROP) is a sight-threatening vasoproliferative retinal disease affecting premature infants. The detection of plus disease, a severe form of ROP requiring treatment, remains challenging owing to subjectivity, frequency, and time intensity of retinal examinations. Recent artificial intelligence (AI) algorithms developed to detect plus disease aims to alleviate these challenges; however, they have not been tested against a diverse neonatal population. Our study aims to validate ROP.AI, an AI algorithm developed from a single cohort, against a multicenter Australian cohort to determine its performance in detecting plus disease. Methods Retinal images captured during routine ROP screening from May 2021 to February 2022 across five major tertiary centers throughout Australia were collected and uploaded to ROP.AI. AI diagnostic output was compared with one of five ROP experts. Sensitivity, specificity, negative predictive value, and area under the receiver operator curve were determined. Results We collected 8052 images. The area under the receiver operator curve for the diagnosis of plus disease was 0.75. ROP.AI achieved 84% sensitivity, 43% specificity, and 96% negative predictive value for the detection of plus disease after operating point optimization. Conclusions ROP.AI was able to detect plus disease in an external, multicenter cohort despite being trained from a single center. Algorithm performance was demonstrated without preprocessing or augmentation, simulating real-world clinical applicability. Further training may improve generalizability for clinical implementation. Translational Relevance These results demonstrate ROP.AI's potential as a screening tool for the detection of plus disease in future clinical practice and provides a solution to overcome current diagnostic challenges.
Précis: Transscleral diode laser cyclophotocoagulation may trigger the development of proliferative vitreoretinopathy. Our article demonstrates one such case leading to tractional macula-off retinal detachment in a child with aphakic glaucoma.Purpose: The purpose of this article is to describe a case of proliferative vitreoretinopathy (PVR) developing subsequent to transscleral diode laser cyclophotocoagulation (cyclodiode) in a pediatric patient with aphakic glaucoma. PVR most commonly occurs following rhegmatogenous retinal detachment repair; however, to the best of our knowledge, it has never been reported to appear after cyclodiode.Methods: Retrospective evaluation of case presentation and intraoperative findings.Results: A 13-year-old girl with aphakic glaucoma presented 4 months after cyclodiode of the right eye with a retrolental fibrovascular membrane and anterior PVR. The PVR extended posteriorly over the next month, after which the patient developed a tractional macula-off retinal detachment. Pars Plana vitrectomy was performed, confirming dense anterior and posterior PVR. A review of the literature suggests that an inflammatory cascade, similar to that seen in PVR development following rhegmatogenous retinal detachment, may occur from the destruction of the ciliary body by cyclodiode. As a result, fibrous transformation may occur, likely accounting for the cause of PVR development in this case. Conclusion:The pathophysiology of PVR development remains unclear. This case demonstrates that PVR may occur following cyclodiode and should be considered during postoperative monitoring after this procedure.
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