Explore the vast range of titles available.

To evaluate long-term anatomical and functional outcomes of autologous retinal transplantation (ART) in refractory highly myopic macular holes (HMMHs). Retrospective interventional analysis of 9 eyes with refractory HMMH undergoing ART. Best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT) were performed at baseline and each follow-up visit (1, 3, 6, 12, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, central macular thickness (CMT), external limiting membrane (ELM)/ellipsoid zone (EZ) visibility, macular edema (ME) and retinal pigmented epithelium (RPE) atrophy were evaluated. Mean follow-up duration was 46.0 ± 19.6 months. Anatomical success was reached in 7/9 eyes (78%). Median BCVA went from 0.05 (IQR 0.065) at baseline to 0.075 (IQR 0.069) at final follow-up (p = 0.25). Only one eye showed a 2-lines improvement, while BCVA was stable in 4/9 (44%) and worsened in 1 eye (12%). CMT progressively thickened in the first 6 months (177 ± 68 μm), but then decreased to 122 ± 50 μm at final follow-up. Graft merging with the surrounding retina was visible in two eyes, showing partial ELM/EZ recovery and good outcomes. Microcystic-like refractory ME (33%) and long-term RPE atrophy (22%) were reported, while delayed displacement of the graft was seen in one case 6 months after first surgery. ART offered acceptable anatomical success but no visual improvement in our cohort. Lack of graft merging with the surrounding retina, persistent microcystic-like ME, RPE atrophy and hole recurrence were the most frequent shortfalls.

Purpose The aim of this study was to define the capability of ChatGPT-4 and Google Gemini in analyzing detailed glaucoma case descriptions and suggesting an accurate surgical plan. Methods Retrospective analysis of 60 medical records of surgical glaucoma was divided into “ordinary” ( n  = 40) and “challenging” ( n  = 20) scenarios. Case descriptions were entered into ChatGPT and Bard’s interfaces with the question “What kind of surgery would you perform?” and repeated three times to analyze the answers’ consistency. After collecting the answers, we assessed the level of agreement with the unified opinion of three glaucoma surgeons. Moreover, we graded the quality of the responses with scores from 1 (poor quality) to 5 (excellent quality), according to the Global Quality Score (GQS) and compared the results. Results ChatGPT surgical choice was consistent with those of glaucoma specialists in 35/60 cases (58%), compared to 19/60 (32%) of Gemini ( p  = 0.0001). Gemini was not able to complete the task in 16 cases (27%). Trabeculectomy was the most frequent choice for both chatbots (53% and 50% for ChatGPT and Gemini, respectively). In “challenging” cases, ChatGPT agreed with specialists in 9/20 choices (45%), outperforming Google Gemini performances (4/20, 20%). Overall, GQS scores were 3.5 ± 1.2 and 2.1 ± 1.5 for ChatGPT and Gemini ( p  = 0.002). This difference was even more marked if focusing only on “challenging” cases (1.5 ± 1.4 vs. 3.0 ± 1.5, p  = 0.001). Conclusion ChatGPT-4 showed a good analysis performance for glaucoma surgical cases, either ordinary or challenging. On the other side, Google Gemini showed strong limitations in this setting, presenting high rates of unprecise or missed answers.

BackgroundWe aimed to define the capability of three different publicly available large language models, Chat Generative Pretrained Transformer (ChatGPT-3.5), ChatGPT-4 and Google Gemini in analysing retinal detachment cases and suggesting the best possible surgical planning.MethodsAnalysis of 54 retinal detachments records entered into ChatGPT and Gemini’s interfaces. After asking ‘Specify what kind of surgical planning you would suggest and the eventual intraocular tamponade.’ and collecting the given answers, we assessed the level of agreement with the common opinion of three expert vitreoretinal surgeons. Moreover, ChatGPT and Gemini answers were graded 1–5 (from poor to excellent quality), according to the Global Quality Score (GQS).ResultsAfter excluding 4 controversial cases, 50 cases were included. Overall, ChatGPT-3.5, ChatGPT-4 and Google Gemini surgical choices agreed with those of vitreoretinal surgeons in 40/50 (80%), 42/50 (84%) and 35/50 (70%) of cases. Google Gemini was not able to respond in five cases. Contingency analysis showed significant differences between ChatGPT-4 and Gemini (p=0.03). ChatGPT’s GQS were 3.9±0.8 and 4.2±0.7 for versions 3.5 and 4, while Gemini scored 3.5±1.1. There was no statistical difference between the two ChatGPTs (p=0.22), while both outperformed Gemini scores (p=0.03 and p=0.002, respectively). The main source of error was endotamponade choice (14% for ChatGPT-3.5 and 4, and 12% for Google Gemini). Only ChatGPT-4 was able to suggest a combined phacovitrectomy approach.ConclusionIn conclusion, Google Gemini and ChatGPT evaluated vitreoretinal patients’ records in a coherent manner, showing a good level of agreement with expert surgeons. According to the GQS, ChatGPT’s recommendations were much more accurate and precise.

Background The aim of this study is to evaluate long-term anatomical and functional outcomes of autologous internal limiting membrane (ILM) transplantation in refractory highly myopic macular holes (HMMHs). Methods Retrospective interventional analysis of 13 eyes with refractory HMMH undergoing autologous ILM transplantation with gas tamponade. Best-corrected visual acuity (BCVA, Snellen), optical coherence tomography and fundus photography were scheduled at baseline and every follow-up visit (1, 3, 6, 12, 18, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, rates of external limiting membrane (ELM)/ellipsoid zone (EZ) restoration, excessive gliosis and subfoveal retinal pigmented epithelium (RPE) atrophy were evaluated. Results Average AXL was 31.45 ± 2.07 mm and mean follow-up was 47.2 ± 31.4 months. Anatomical success was reached in 7/13 eyes (54%), while 2 cases showed persisting HMMH, 2 cases had early recurrence and 2 cases late recurrence. BCVA went from 0.19 ± 0.18 to 0.22 ± 0.20 at final follow-up ( p  = 0.64), improving in 5/13 eyes (38%). One eye showed continuous ELM and EZ lines, while another eye showed an irregular ELM but no EZ. Post-operatively, 5 eyes (71%) developed progressive atrophy of the subfoveal RPE, while excessive gliosis was reported in 3 eyes (43%). Furthermore, one patient developed post-operative chronic macular edema-like changes in the perifoveal area. Conclusion Autologous ILM transplantation showed controversial anatomical outcomes and and poor visual results in refractory HMMH. Moreover, progressive subfoveal patchy atrophy and excessive gliosis are possible post-operative complications. Key messages What is known: • Various surgical techniques have been proposed to treat refractory highly myopic macular holes (HMMHs), including autologous internal limiting membrane (ILM) flap transplantation, autologous retinal transplantation and lens capsule transplantation. • Long-term analysis of the outcomes of autologous ILM transplantation still lacks in HMMH. What is new: • Primary anatomical success was reached in 54% of cases and only 38% of eyes showed improvements in visual outcomes. • Progressive subfoveal patchy atrophy and excessive gliosis were two of the most frequent adverse effects, negatively influencing visual outcomes.

Purpose To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS). Methods Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12 months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RT NAS and RT TEM ), peri-HMMH nasal and temporal O-RS height (O-RS NAS and O-RS TEM ). The ratios O-RS NAS / RT NAS and O-RS TEM /RT TEM were defined as %O-RS NAS and %O-RS TEM . Postoperatively, we distinguished classic HMMH closure ( n  = 14) from a newly described “delayed” closure pattern ( n  = 5). Results Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up ( p  = 0.009 and p  = 0.001, respectively). At every follow-up, “classic” vs. “delayed closure” did not influence BCVA (all p  > 0.05). Baseline O-RS NAS ( p  = 0.026), O-RS TEM ( p  = 0.04), %O-RS NAS ( p  = 0.04) and %O-RS TEM (0.004), were significantly associated with the “flap closure” pattern, differently from MLD and BD. In the “delayed closure” subgroup we reported a 100% closure rate, but 65.8 ± 64.4 days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RS NAS and O-RS TEM progressively reduced until HMMH closure. Conclusion Inverted flap is useful to close HMMH with O-RS. In case of “delayed closure” pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA. Key messages What is known Inverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is new HMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or “delayed closure” pattern. In cases of delayed closure, it took a variable range of 30–179 days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing “delayed” and “classic” closure subgroups.

Whether neutrophils exert an anti- or pro-tumorigenic function has remained controversial; now, expression of the receptor molecule MET in neutrophils is shown to be required for their ability to restrict tumour growth in several mouse cancer models, with potential implications for human cancer therapy. Anti-tumour function for MET Whether neutrophils exert and anti- or pro-tumorigenic function has remained controversial. Massimiliano Mazzone and colleagues now show in several mouse models of cancer that expression of the receptor molecule MET in neutrophils is required for their ability to restrict tumour growth. MET expression in neutrophils is triggered by inflammatory signals, which can also be tumour-derived. MET activity is required for neutrophils to cross an activated endothelium to reach a tumour and to kill cancer cells. MET has been shown to be a therapeutic target in cancer cells which express MET, therefore the findings suggest that any beneficial effect is countered by inhibition of the anti-tumour neutrophil response, and the authors indeed demonstrate this in their mouse model. These findings are of relevance to therapeutic decisions based on anti-MET drugs, where it may be useful to monitor effects of the treatment in tumours showing a neutrophil response. Mutations or amplification of the MET proto-oncogene are involved in the pathogenesis of several tumours 1 , 2 , 3 , 4 , which rely on the constitutive engagement of this pathway for their growth and survival 1 , 5 . However, MET is expressed not only by cancer cells but also by tumour-associated stromal cells, although its precise role in this compartment is not well characterized 6 , 7 , 8 , 9 , 10 , 11 . Here we show that MET is required for neutrophil chemoattraction and cytotoxicity in response to its ligand hepatocyte growth factor (HGF). Met deletion in mouse neutrophils enhances tumour growth and metastasis. This phenotype correlates with reduced neutrophil infiltration to both the primary tumour and metastatic sites. Similarly, Met is necessary for neutrophil transudation during colitis, skin rash or peritonitis. Mechanistically, Met is induced by tumour-derived tumour necrosis factor (TNF)-α or other inflammatory stimuli in both mouse and human neutrophils. This induction is instrumental for neutrophil transmigration across an activated endothelium and for inducible nitric oxide synthase production upon HGF stimulation. Consequently, HGF/MET-dependent nitric oxide release by neutrophils promotes cancer cell killing, which abates tumour growth and metastasis. After systemic administration of a MET kinase inhibitor, we prove that the therapeutic benefit of MET targeting in cancer cells is partly countered by the pro-tumoural effect arising from MET blockade in neutrophils. Our work identifies an unprecedented role of MET in neutrophils, suggests a potential ‘Achilles’ heel’ of MET-targeted therapies in cancer, and supports the rationale for evaluating anti-MET drugs in certain inflammatory diseases.

Aim: A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction. Method: This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer reviewed journals between January 1980 and August 2014 and in the English language were included. We included 109 articles for the synthesis. Results: We found several number of determinants of patient satisfaction investigated in a wide diversity of studies. However, study results were varied due to no globally accepted formulation of patient satisfaction and measurement system. Conclusions: Health care service quality indicators were the most influential determinants of patient satisfaction across the studies. Among them, health providers’ interpersonal care quality was the essential determinant of patient satisfaction. Sociodemographic characteristics were the most varied in the review. The strength and directions of associations with patient satisfaction were found inconsistent. Therefore, person-related characteristics should be considered to be the potential determinants and confounders simultaneously. The selected studies were not able to show all potential characteristics which may have had effects on satisfaction. There is a need for more studies on how cultural, behavioural, and socio-demographic differences affect patient satisfaction, using a standardised questionnaire.

A 64-year-old highly myopic woman with macular hole retinal detachment (MHRD) in her left eye underwent vitrectomy, internal limiting membrane (ILM) peeling, and epiretinal implantation of a 4-mm diameter human amniotic membrane (hAM) patch. One month later, she developed a bullous superior RD in her right eye, associated with a huge MH and multiple posterior breaks. Vitrectomy and ILM peeling were combined with a 15-mm epiretinal hAM patch implantation. One year later, both eyes showed successful MH closure, but the right eye developed an eccentric hAM patch contraction starting 6 months postoperatively, causing a localized stable superonasal RD. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX–XX.]

Purpose This review focuses on extensive macular atrophy with pseudodrusen-like appearance (EMAP), a recently described maculopathy presenting with pseudodrusen-like lesions and chorioretinal atrophy more pronounced in the vertical axis. Methods Narrative review of the literature published until May 2024. Results The early onset age of EMAP (50–55 years) and its distinctive natural history, which includes night blindness followed by severe vision loss, differentiate it from atrophic age-related macular degeneration (AMD). A clear pathogenesis has not been determined, but risk factors include female gender and complement system abnormalities (altered levels of C3 and CH50). Moreover, lifelong exposure to pesticides has been suggested as risk factor for direct neuronal degeneration involving rods and cones. In the early phase of the disease, reticular pseudodrusen-like lesions appear in the superior perifovea and tend to coalescence horizontally into a flat, continuous, reflective material localized between the retinal pigmented epithelium and Bruch’s membrane. Over time, EMAP causes profound RPE and outer retinal atrophy in the macular area, with a recent classification reporting a 3-stages evolution pattern. Blue autofluorescence showed rapidly evolving atrophy with either hyperautofluorescent or isoautofluorescent borders. Significant similarities between the diffuse-trickling phenotype of geographic atrophy and EMAP have been reported. Macular neovascularization is a possible complication. Conclusion EMAP is specific form of early-onset atrophic macular degeneration with rapid evolution and no treatment. Further studies are needed to assess the best management. Key messages What is known • Extensive Macular Atrophy with Pseudodrusen (EMAP) is a rapidly-progressive macular atrophy developing in the fifth-decade and leading to legal blindness. • Typical characteristics at multimodal imaging are reticular pseudodrusen-like lesions starting at the superior perifovea and vertically-oriented macular atrophy. What is new • Dysregulated complement cascade and pesticide-related toxicity have been proposed as possible etiologies. • In the late stages of the disease 50% of EMAP patients were legally blind by US standards and, after 7 years on average, atrophy reaches the mid-periphery.