Deep artificial neural networks show impressive performance on classification of retinal OCT scans. After training on historical clinical data, machine learning methods can offer the clinician support in the decision-making process. Care should be taken not to mistake neural network output as treatment recommendation and to ensure a final thorough evaluation by the treating physician.

PurposeOur aim was to evaluate an optical coherence tomography (OCT) and visual acuity (VA)-guided, variable-dosing regimen with intravitreal ranibizumab injection for treating patients with neovascular age-related macular degeneration (AMD) from 2007 to 2012.DesignThis was a retrospective clinical study of 5 years follow-up in a tertiary eye center.Patients and methodsIn this study, 66 patients with neovascular AMD (mean age of 74 years, SD 8.7 years) were included. We investigated the development of best-corrected visual acuity (BCVA), the number of intravitreal injections, and the central retinal thickness measured with OCT (OCT Spectralis) over 5 years of intravitreal treatment.ResultsThe mean number of intravitreal ranibizumab injections over 5 years was 8.8. The mean BCVA before therapy was 0.4 logarithm of the minimum angle of resolution (logMAR). After 5 years of therapy, the mean BCVA was 0.6 logMAR. In all, 16% of treated patients had stable VA over 5 years and 10% of study eyes approved their VA. The mean OCT-measured central retinal thickness at the beginning of this study was 295 µm; after 5 years of treatment, the mean central retinal thickness was 315 µm. There was an increase in central retinal thickness in 47.5% of examined eyes.ConclusionOther studies showed VA improvement in OCT-guided variable-dosing regimens. Our study revealed a moderate decrease in VA after a total mean injection number as low as 8.8 injections over 5 years. In OCT, an increase in central retinal thickness over 5 years could be observed. Probably, this is due to deficient treatment when comparing the total injection number to other treatment regimens. Anti-VEGF therapy helps to keep the VA stable for a period of time, but cannot totally stop the progression of the disease completely. Patients with late stages of neovascular AMD can maintain VA even if they are relatively undertreated.

In the case described here, there was a clear corneal graft without Fusarium recurrence 1 year after surgery and it is presumed the prolonged antifungal therapy before and after surgery was an important factor for this clinical outcome.

The monograph describes research methods and geoecological assessment of polder lands. The history of research and practical use of surface waters of the Kaliningrad region is characterized, modern problems of their geoecological state are revealed. The characteristic of polder lands as complex natural and economic systems is given, the necessity of geoecological studies of the catchments of small rivers located on them is substantiated. A methodological approach has been developed to assess the geoecological condition of the basins of small watercourses through the combined analysis of hydrological, hydrochemical and geoecological data. Hydrological calculations of the key characteristics of the river flow of small watercourses of polder lands were carried out, the dependencies between them were revealed. Field studies were carried out, hydrochemical data sets were obtained on the rivers of polder lands for four hydrological seasons of 2020-2021. Retrospective hydrochemical information has been processed. The prevailing pollutants, integral indicators of water quality and the main sources of pollution are calculated. Based on the results obtained, a scheme of spatial distribution of pollution of the river network of polder lands is constructed. The geoecological condition of the basins is assessed on the basis of a complex of natural and anthropogenic data; based on the result obtained, recommendations for its improvement are given. It is of interest to specialists in the field of geoecology, hydrology, hydrochemistry, environmental management and environmental protection.