Retinal detachment can lead to severe visual loss if not treated timely. The early diagnosis of retinal detachment can improve the rate of successful reattachment and the visual results, especially before macular involvement. Manual retinal detachment screening is timeconsuming and labour-intensive, which is difficult for large-scale clinical applications. In this study, we developed a cascaded deep learning system based on the ultra-widefield fundus images for automated retinal detachment detection and macula-on/off retinal detachment discerning. The performance of this system is reliable and comparable to an experienced ophthalmologist. In addition, this system can automatically provide guidance to patients regarding appropriate preoperative posturing to reduce retinal detachment progression and the urgency of retinal detachment repair. The implementation of this system on a global scale may drastically reduce the extent of vision impairment resulting from retinal detachment by providing timely identification and referral.

Background/aimsTo apply deep learning technology to develop an artificial intelligence (AI) system that can identify vision-threatening conditions in high myopia patients based on optical coherence tomography (OCT) macular images.MethodsIn this cross-sectional, prospective study, a total of 5505 qualified OCT macular images obtained from 1048 high myopia patients admitted to Zhongshan Ophthalmic Centre (ZOC) from 2012 to 2017 were selected for the development of the AI system. The independent test dataset included 412 images obtained from 91 high myopia patients recruited at ZOC from January 2019 to May 2019. We adopted the InceptionResnetV2 architecture to train four independent convolutional neural network (CNN) models to identify the following four vision-threatening conditions in high myopia: retinoschisis, macular hole, retinal detachment and pathological myopic choroidal neovascularisation. Focal Loss was used to address class imbalance, and optimal operating thresholds were determined according to the Youden Index.ResultsIn the independent test dataset, the areas under the receiver operating characteristic curves were high for all conditions (0.961 to 0.999). Our AI system achieved sensitivities equal to or even better than those of retina specialists as well as high specificities (greater than 90%). Moreover, our AI system provided a transparent and interpretable diagnosis with heatmaps.ConclusionsWe used OCT macular images for the development of CNN models to identify vision-threatening conditions in high myopia patients. Our models achieved reliable sensitivities and high specificities, comparable to those of retina specialists and may be applied for large-scale high myopia screening and patient follow-up.

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Purpose To evaluate the effectiveness and safety of pars plana vitrectomy (PPV) combined with phacoemulsification and intraocular lens implantation in proliferative diabetic retinopathy (PDR) patients over 45 years old with mild-moderate cataract, in comparison with PPV with subsequent cataract surgery. Methods This multi-center randomized controlled trial was conducted in three Chinese hospitals. From February 2021 to October 2021, 168 PDR patients were assessed for eligibility. After exclusion, a total of 129 patients were recruited and randomly assigned to PPV combined with cataract surgery concurrently (the combined group) or PPV with subsequent cataract surgery 6 months later (the subsequent group). A 12-month follow-up period was scheduled. Changes of best correct visual acuity (BCVA), rate of complications were compared between groups. Results 66 patients were assigned to the combined group and 63 to the subsequent group. The change of BCVA in the combined group with mean 36.90 (95% confidence interval, 95% CI: 30.35-43.45) letters was significantly better (adjusted difference of 16.43, 95% CI: 8.77-24.08, P<0.001) than the subsequent group with 22.40 (95% CI: 15.55-29.24) letters 6 months after the PPV, and no significant difference was found after the cataract surgery in the subsequent group. Compared with the combined group, the rates of neovascular glaucoma (17.65% vs. 3.77%, P=0.005) were significantly higher in the subsequent group. Conclusion Compared with PPV with subsequent cataract surgery, PPV combined with cataract surgery concurrently was relatively effective, convenient and safe, being a promising and reliable surgical option for PDR patients over 45 years old with mild-moderate cataract. Trial registration number NCT04729023.