Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.

Background: To explore the central and peripheral retinal and choroidal changes in diabetic patients without clinical diabetic retinopathy (DM-NoDR) using ultra-wide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA).Methods: 67 DM-NoDR eyes and 32 age-matched healthy eyes were recruited. Retinal and choroidal parameters, including qualitative retinal microangiopathy, vessel flow (VFD) and linear density (VLD), thickness, and volume, were measured in the central and peripheral areas of the 24 × 20 mm² UWF-SS-OCTA images.Results: DM-NoDR eyes had significantly more nonperfusion area and capillary tortuosity than controls in the central and peripheral areas (p < 0.05). The presence of central capillary tortuosity was associated with higher levels of serum creatinine (OR 1.049, 95%CI 1.001–1.098; p = 0.044) and blood urea nitrogen (OR 1.775, 95%CI 1.051–2.998; p = 0.032) in DM-NoDR eyes. For DM-NoDR eyes versus controls, VFD in the 300-μm annulus around the foveal avascular zone, superficial capillary plexus (SCP), and full retina, and SCP-VLD significantly decreased, while VFD in the deep capillary plexus (DCP), retinal thickness, and retinal volume increased (p < 0.05). Analysis in the central and peripheral areas recapitulated all these findings, except for decreased peripheral thickness and volume and no difference in peripheral DCP-VFD. In DM-NoDR eyes, choriocapillaris-VFD, choroidal thickness, and choroidal volume increased in the central area, while VFD in the large and medium choroidal vessel layer decreased in the whole image (p < 0.05).Conclusion: Retinal and choroidal changes already existed in the central and/or peripheral areas of DM-NoDR eyes. UWF-SS-OCTA, enabling the visualization of the peripheral fundus area, is a promising image technique for the early detection of fundus changes in DM-NoDR patients.

Purpose: To evaluate the performance of a deep learning (DL)-based artificial intelligence (AI) hierarchical diagnosis software, EyeWisdom V1 for diabetic retinopathy (DR).Materials and Methods: The prospective study was a multicenter, double-blind, and self-controlled clinical trial. Non-dilated posterior pole fundus images were evaluated by ophthalmologists and EyeWisdom V1, respectively. The diagnosis of manual grading was considered as the gold standard. Primary evaluation index (sensitivity and specificity) and secondary evaluation index like positive predictive values (PPV), negative predictive values (NPV), etc., were calculated to evaluate the performance of EyeWisdom V1.Results: A total of 1,089 fundus images from 630 patients were included, with a mean age of (56.52 ± 11.13) years. For any DR, the sensitivity, specificity, PPV, and NPV were 98.23% (95% CI 96.93–99.08%), 74.45% (95% CI 69.95-78.60%), 86.38% (95% CI 83.76-88.72%), and 96.23% (95% CI 93.50-98.04%), respectively; For sight-threatening DR (STDR, severe non-proliferative DR or worse), the above indicators were 80.47% (95% CI 75.07-85.14%), 97.96% (95% CI 96.75-98.81%), 92.38% (95% CI 88.07-95.50%), and 94.23% (95% CI 92.46-95.68%); For referral DR (moderate non-proliferative DR or worse), the sensitivity and specificity were 92.96% (95% CI 90.66-94.84%) and 93.32% (95% CI 90.65-95.42%), with the PPV of 94.93% (95% CI 92.89-96.53%) and the NPV of 90.78% (95% CI 87.81-93.22%). The kappa score of EyeWisdom V1 was 0.860 (0.827-0.890) with the AUC of 0.958 for referral DR.Conclusion: The EyeWisdom V1 could provide reliable DR grading and referral recommendation based on the fundus images of diabetics.

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs and systems. Ocular involvement is estimated to manifest in one-third of individuals with SLE, of which lupus retinopathy and choroidopathy represent the severe subtype accompanied by vision impairment. Advancements in multimodal ophthalmic imaging have allowed ophthalmologists to reveal subclinical microvascular and structural changes in fundus of patients with SLE without ocular manifestations. Both ocular manifestations and subclinical fundus damage have been shown to correlate with SLE disease activity and, in some patients, even precede other systemic injuries as the first presentation of SLE. Moreover, ocular fundus might serve as a window into the state of systemic vasculitis in patients with SLE. Given the similarities of the anatomy, physiological and pathological processes shared among ocular fundus, and other vital organ damage in SLE, such as kidney and brain, it is assumed that ocular fundus involvement has implications in the diagnosis and evaluation of other systemic impairments. Therefore, evaluating the fundus characteristics of patients with SLE not only contributes to the early diagnosis and intervention of potential vision damage, but also holds considerate significance for the evaluation of SLE vasculitis state and prediction of other systemic injuries.