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Recchioni A, Venkataraman AP, Rauz S, Domínguez-Vicent A. Swept-source optical coherence tomography in ocular surface diseases: anterior segment analysis repeatability and its limits. Front Med (Lausanne) 2024; 11:1385294. [PMID: 39156694 PMCID: PMC11327131 DOI: 10.3389/fmed.2024.1385294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/05/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose This study aims to evaluate the repeatability of anterior segment optical coherence tomography (AS-OCT) in diverse ocular surface disorder (OSD) cohorts, exploring various anterior segment parameters and their accuracy in different disease groups. Methods A total of 239 participants across six distinct OSD groups and healthy controls underwent nonmydriatic AS-OCT imaging using the Tomey CASIA 2 device. Anterior segment parameters including anterior chamber depth, width, angle metrics, corneal thickness, keratometry, lens vault, and others were meticulously assessed. Statistical analyses determined repeatability limits and coefficients of variation for each parameter within the different OSD cohorts. Results Repeatability for anterior chamber and corneal parameters remained consistent across all OSD groups, indicating minimal impact of ocular surface disease on accuracy. The coefficient of variation (CoV) for the trabecular iris-space area was about 20% for all cohorts. Ocular surface inflammation emerged as a key factor in dry eye, affecting immune-mediated and non-immune conditions alongside age-related ocular surface changes. While anterior chamber depth measurements showed variations, particularly in immune (CoV = 2.5%) and non-immune (CoV = 3.8%) OSD groups, parameters like anterior chamber width and angle to angle showed similar values among the cohorts. Keratometry measures remained stable despite OSD (CoV lower than 1%). Conclusion The Tomey CASIA 2 demonstrated reliable repeatability for measuring anterior segment parameters in diverse OSD cohorts. Despite challenges posed by dry eye conditions, this technology holds promise in assessing OSD, suggesting potential clinical protocols similar to those in healthy controls.
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Affiliation(s)
- Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Aging, University of Birmingham, Birmingham, United Kingdom
- Birmingham and Midland Eye Center, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
- Optometry and Vision Sciences Group, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | | | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Aging, University of Birmingham, Birmingham, United Kingdom
- Birmingham and Midland Eye Center, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Alberto Domínguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Wu H, Wang Z, Wang P, Meng Y, Wang Z, Xue Y, Jiang B, Pan S, Yan Z. Repeatability and Agreement of Central Vault for Implantable Collamer Lens Obtained by the Tomey OA-2000 Biometer and Spectralis OCT. J Ophthalmol 2024; 2024:3684626. [PMID: 38957378 PMCID: PMC11217569 DOI: 10.1155/2024/3684626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/04/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
Objective To assess repeatability and agreement of central vault for implantable collamer lens (ICL) measured by the Tomey OA-2000 biometry and Spectralis optical coherence tomography (OCT). Methods In this prospective study, the central vault was measured by the Tomey OA-2000 biometer and Spectralis OCT in 84 eyes (43 patients) after ICL implantation at six month follow-up. Three consecutive scans were obtained by one experienced technician using Tomey OA-2000 and the Spectralis OCT in the same day. The coefficient of variation (CoV), intraclass correlation coefficient (ICC), within-subject standard deviation (Sw), and 2.77 Sw were calculated to assess the repeatability and reproducibility. The paired t-test and Bland-Altman plots were used to analyze the differences and agreements of central vault measured by two devices. Results Repeatability of the central vault measured by Tomey OA-2000 biometer and Spectralis OCT showed that the CoV was 2.71% and 1.66%, respectively. The ICC for both devices was 0.996 and 0.999, respectively. The paired t-test showed that central vault measured by Tomey OA-2000 biometer was -7.25 ± 23.57 microns lower than that measured by Spectralis OCT (P = 0.006). The mean difference between measurements for Tomey OA-2000 and ASM-OCT with 95% limits of agreement (LoAs) was -38.94 to 53.44 μm. Conclusion Both Tomey OA-2000 biometer and Spectralis OCT displayed good repeatability for the measurement of central vault of ICL. Good reliability and agreement were observed between Tomey OA-2000 biometer and Spectralis OCT. Both instruments are useful but not replaced each other for central vault measurements.
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Affiliation(s)
- Hao Wu
- Department of OphthalmologyBengbu First People's Hospital, 229 Tushan Road, Bengbu 233000, China
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Zuocheng Wang
- School of ManagementShijiazhuang Tiedao University, Shijiazhuang 050043, China
| | - Pengfei Wang
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Yifei Meng
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Zengying Wang
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Yuhong Xue
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Bohua Jiang
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Shuaixi Pan
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
| | - Zhipeng Yan
- Department of OphthalmologyThe Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050000, China
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Zhao LL, Lu XZ, Tang GD, Zhang XY, Li RK, Xu J, Feng JJ, Xu Z, Song JK, Bi HS. Anterior chamber and angle characteristics in Chinese children (6-11 years old) with different refractive status using swept-source optical coherence tomography. BMC Ophthalmol 2024; 24:259. [PMID: 38880899 PMCID: PMC11181599 DOI: 10.1186/s12886-024-03520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 06/07/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The anatomic structure of the anterior chamber (AC) helps to explain differences in refractive status in school-aged children and is closely associated with primary angle closure (PAC). The aim of this study was to quantify and analyze the anterior chamber and angle (ACA) characteristics in Chinese children with different refractive status by swept-source optical coherence tomography (SS-OCT). METHODS In a cross-sectional observational study, 383 children from two primary schools in Shandong Province, China, underwent a complete ophthalmic examination. First, the anterior chamber depth (ACD), anterior chamber width (ACW), angle-opening distance (AOD), and trabecular-iris space area (TISA) were evaluated automatically using a CASIA2 imaging device. AOD and TISA were measured at 500, 750 μm nasal (N1 and N2, respectively), and temporal (T1 and T2, respectively) to the scleral spur (SS). Cycloplegic refraction and axial length (AL) were then measured. According to spherical equivalent refraction (SER), the children were assigned to hyperopic (SER > 0.50D), emmetropic (-0.50D < SER ≤ 0.50D), and myopic groups (SER ≤ -0.50D). RESULTS Out of the 383 children, 349 healthy children (160 girls) with a mean age of 8.23 ± 1.06 years (range: 6-11 years) were included. The mean SER and AL were - 0.10 ± 1.57D and 23.44 ± 0.95 mm, respectively. The mean ACD and ACW were 3.17 ± 0.24 mm and 11.69 ± 0.43 mm. The mean AOD were 0.72 ± 0.25, 0.63 ± 0.22 mm at N1, T1, and 0.98 ± 0.30, 0.84 ± 0.27 mm at N2, T2. The mean TISA were 0.24 ± 0.09, 0.22 ± 0.09mm2 at N1, T1, and 0.46 ± 0.16, 0.40 ± 0.14mm2 at N2, T2. The myopic group had the deepest AC and the widest angle. Compared with boys, girls had shorter AL, shallower ACD, narrower ACW, and ACA (all p < 0.05). By Pearson's correlation analysis, SER was negatively associated with ACD, AOD, and TISA. AL was positively associated with ACD, ACW, AOD, and TISA. In the multiple regression analysis, AOD and TISA were associated with deeper ACD, narrower ACW, and longer AL. CONCLUSION In primary school students, the myopic eyes have deeper AC and wider angle. ACD, ACW, AOD, and TISA all increase with axial elongation. ACA is highly correlated with deeper ACD.
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Affiliation(s)
- Li Li Zhao
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China
| | - Xiu Zhen Lu
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
| | - Guo Dong Tang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
| | - Xiu Yan Zhang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China
| | - Run Kuan Li
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China
| | - Jing Xu
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China
| | - Jiao Jiao Feng
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China
| | - Zhe Xu
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China
| | - Ji Ke Song
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, PR China.
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China.
| | - Hong Sheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China.
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, 250000, PR China.
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Kouroupaki AI, Triantafyllopoulos GI, Pateras E, Karabatsas CH, Plakitsi A. Anterior Segment Changes in Patients With Glaucoma Following Cataract Surgery. Cureus 2024; 16:e58703. [PMID: 38779247 PMCID: PMC11110096 DOI: 10.7759/cureus.58703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
This prospective observational study investigates the impact of cataract surgery on anterior segment parameters in nonglaucomatous and primary open-angle glaucoma (POAG) eyes, utilizing anterior segment optical coherence tomography (AS-OCT). The study involved 42 Caucasian patients, divided into a control group and a POAG group. Comprehensive ophthalmic examinations were performed along with AS-OCT imaging and biometry preoperatively, as well as on one day, one week, and one month following cataract surgery. The results showed significant post-operative changes in anterior chamber depth (ACD) and angle width in both groups, suggesting that cataract surgery may influence the structural parameters associated with glaucoma risk and management. Specifically, a marked increase in ACD and improvement in angle-opening distances were observed, highlighting the potential of cataract extraction to alter intraocular fluid dynamics favorably. Despite these changes, the study noted an initial spike in increased intraocular pressure (IOP) in POAG patients immediately post-operative, which stabilized during follow-up. For the control group, IOP showed gradually reducing IOP values in the follow-up visits. The findings underscore the role of advanced imaging technologies in understanding glaucoma's pathophysiology and the potential benefits of cataract surgery in glaucoma patients. The study advocates for further research with a larger, more diverse patient population and extended follow-up to explore the long-term implications of cataract surgery on glaucoma dynamics, emphasizing the importance of personalized management and treatment strategies particularly for glaucoma patients.
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Affiliation(s)
- Anna I Kouroupaki
- Biomedical Sciences Department, Course of Optics and Optometry, University of West Attica, Athens, GRC
- Ophthalmology Department, 'Korgialenio-Benakio' Hellenic Red Cross General Hospital, Athens, GRC
| | | | - Evangelos Pateras
- Biomedical Sciences Department, Course of Optics and Optometry, University of West Attica, Athens, GRC
| | - Costas H Karabatsas
- Biomedical Sciences Department, Course of Optics and Optometry, University of West Attica, Athens, GRC
| | - Athina Plakitsi
- Biomedical Sciences Department, Course of Optics and Optometry, University of West Attica, Athens, GRC
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Shan J, Li Z, Ma P, Tun TA, Yonamine S, Wu Y, Baskaran M, Nongpiur ME, Chen D, Aung T, Li S, He M, Yang Y, Han Y. Deep Learning Classification of Angle Closure based on Anterior Segment OCT. Ophthalmol Glaucoma 2024; 7:8-15. [PMID: 37437884 DOI: 10.1016/j.ogla.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To assess the performance and generalizability of a convolutional neural network (CNN) model for objective and high-throughput identification of primary angle-closure disease (PACD) as well as PACD stage differentiation on anterior segment swept-source OCT (AS-OCT). DESIGN Cross-sectional. PARTICIPANTS Patients from 3 different eye centers across China and Singapore were recruited for this study. Eight hundred forty-one eyes from the 2 Chinese centers were divided into 170 control eyes, 488 PACS, and 183 PAC + PACG eyes. An additional 300 eyes were recruited from Singapore National Eye Center as a testing data set, divided into 100 control eyes, 100 PACS, and 100 PAC + PACG eyes. METHODS Each participant underwent standardized ophthalmic examination and was classified by the presiding physician as either control, primary angle-closure suspect (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG). Deep Learning model was used to train 3 different CNN classifiers: classifier 1 aimed to separate control versus PACS versus PAC + PACG; classifier 2 aimed to separate control versus PACD; and classifier 3 aimed to separate PACS versus PAC + PACG. All classifiers were evaluated on independent validation sets from the same region, China and further tested using data from a different country, Singapore. MAIN OUTCOME MEASURES Area under receiver operator characteristic curve (AUC), precision, and recall. RESULTS Classifier 1 achieved an AUC of 0.96 on validation set from the same region, but dropped to an AUC of 0.84 on test set from a different country. Classifier 2 achieved the most generalizable performance with an AUC of 0.96 on validation set and AUC of 0.95 on test set. Classifier 3 showed the poorest performance, with an AUC of 0.83 and 0.64 on test and validation data sets, respectively. CONCLUSIONS Convolutional neural network classifiers can effectively distinguish PACD from controls on AS-OCT with good generalizability across different patient cohorts. However, their performance is moderate when trying to distinguish PACS versus PAC + PACG. FINANCIAL DISCLOSURES The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jing Shan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Zhixi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ping Ma
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Sean Yonamine
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Yangyan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Dake Chen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Shuning Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia.
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California.
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Moon S, Kim J, Lee J. Comparison of the Intrableb Characteristics of Anterior Segment Optical Coherence Tomography Imaging in Trabeculectomy according to Amniotic Membrane Transplantation. Ophthalmic Res 2023; 66:993-1005. [PMID: 37331353 PMCID: PMC10353305 DOI: 10.1159/000531036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION The purpose of this study was to compare the characteristics of filtering bleb with anterior segment optical coherence tomography (AS-OCT) according to amniotic membrane transplantation (AMT). METHODS One hundred and sixteen eyes of 103 glaucoma patients who underwent trabeculectomy with (AMT group; 85 eyes) or without AMT (control group; 31 eyes) were included. Intrableb parameters were evaluated with AS-OCT. Surgical success was defined as an intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥20% without medication at the time of AS-OCT examination. Logistic regression analyses were performed to determine factors associated with IOP control. RESULTS In the eyes with successful IOP control, the fluid-filled space area, score, and height were greater for the AMT group than the control group (all ps < 0.001), while stripping layer thickness was greater and bleb wall reflectivity was lower for the control group than the AMT group (all ps < 0.001). Surgical success in the AMT group was associated with greater fluid-filled space score, lower bleb wall reflectivity, and microcyst formation (odds ratio [OR] = 8.016, 0.913, and 16.202, respectively, all ps ≤ 0.041). Lower bleb wall reflectivity alone was associated with surgical success in the control group (OR = 0.815, p = 0.019). CONCLUSION The extent of the fluid-filled space was associated with successful IOP control after trabeculectomy with AMT. Hyporeflective bleb wall was associated with successful IOP control in AMT and control groups.
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Affiliation(s)
- Sangwoo Moon
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jinmi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jiwoong Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Monja-Alarcón N, Perucho-Martínez S, Buenasmañanas-Maeso M, Toledano-Fernández N. Does mitomycin-C concentration have any influence on XEN45 gel stent outcomes in a real-world setting? Graefes Arch Clin Exp Ophthalmol 2022; 260:2649-2661. [PMID: 35230475 DOI: 10.1007/s00417-022-05603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To compare the effectiveness and safety of XEN45 implanted with mitomycin-C (MMC) 0.01% versus (vs) XEN45 implanted with MMC 0.02%. METHODS Retrospective and single-center study conducted on consecutive patients with open-angle glaucoma or ocular hypertension who underwent XEN45-implant, either alone or in combination with cataract surgery. The primary end-point was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. RESULTS Fifty-five patients (63 eyes) were included. Thirty-seven (58.7%) eyes underwent surgery with MMC 0.01% and 26 (41.3%) ones with MMC 0.02%. In the overall study sample, the mean (standard error) IOP was significantly lowered from 17.6 (0.7) mm Hg at baseline to 12.6 (0.3) mm Hg at month 12. The IOP was significantly lowered from 17.3 (15.4 to 19.2) mm Hg and 17.9 (16.1 to 17.8) mm Hg at baseline to 12.3 (11.3 to 13.3) mm Hg and 13.1 (12.3 to 13.9) mm Hg at month 12 in the MMC 0.01% and MMC 0.02% groups, respectively; p < 0.0001 each. The mean number of ocular-hypotensive medications significantly decreased from 2.1 (1.9 to 2.3) at baseline to 0.2 (0.04 to 0.3) at month 12, p < 0.0001, with no significant differences between MMC 0.01% and MMC 0.02% groups, p = 0.5181. At month 12, 50 (80.6%) eyes had functioning blebs. Regarding safety, 18 (28.6%) eyes have experience adverse events. CONCLUSION XEN45, either alone or in combination with cataract surgery, showed a good effectiveness and safety profile. MMC dose had no influence on the IOP lowering, which may support the use of the lowest dose.
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Affiliation(s)
- Natalia Monja-Alarcón
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Susana Perucho-Martínez
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Miriam Buenasmañanas-Maeso
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Nicolás Toledano-Fernández
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
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Abstract
PURPOSE OF REVIEW To summarize the literature on three-dimensional (3D) technological advances in ophthalmology, the quantitative methods associated with this, and their improved ability to help detect glaucoma disease progression. RECENT FINDINGS Improvements in measuring glaucomatous structural changes are the result of dual innovations in optical coherence tomography (OCT) imaging technology and in associated quantitative software. SUMMARY Compared with two-dimensional (2D) OCT parameters, newer 3D parameters provide more data and fewer artifacts.
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Affiliation(s)
- Maria A. Guzman Aparicio
- Harvard Medical School
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA
| | - Teresa C. Chen
- Harvard Medical School
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA
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Zhou Q, Wang J, Guo J, Huang Z, Ding M, Yuchi M, Zhang X. Anterior chamber angle classification in anterior segment optical coherence tomography images using hybrid attention based pyramidal convolutional network. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tekin S, Seven E, Batur M, Özer MD, Yasar T. Evaluation of Successful and Failed Filtering Blebs after Trabeculectomy Using Anterior Segment Optical Coherence Tomography. J Curr Ophthalmol 2021; 33:1-5. [PMID: 34084949 PMCID: PMC8102954 DOI: 10.4103/joco.joco_112_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/10/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate filtering bleb characteristics using anterior segment optical coherence tomography (AS-OCT) and analyze correlations between these parameters and intraocular pressure (IOP). Methods: The study included 54 eyes of 43 patients who underwent trabeculectomy with mitomycin-C. The patients were divided into two groups based on mean postoperative IOP. The criterion for surgical success was mean unmedicated postoperative IOP ≤18 mmHg. Patients with IOP values >18 mmHg were prescribed anti-glaucoma drops and classified as a surgical failure. All patients underwent AS-OCT, and maximum bleb height, maximum bleb wall thickness, and maximum fluid-filled cavity height were measured. AS-OCT bleb parameters were compared between the successful and failed groups. Results: Of the 54 eyes, 37 (68.5%) were in the successful group, and 17 (31.5%) were in the failed group. Mean preoperative IOP values in the successful and failed groups were 26.9 ± 6.5 mmHg and 22.9 ± 4.9 mmHg, preoperatively, versus postoperative values of 13.3 ± 2.1 mmHg and 22.8 ± 2.8 mmHg, respectively. Mean postoperative follow-up time was 17.4 ± 9.5 months in the successful group and 19.1 ± 10.1 months in the failed group (P = 0.22). In the successful and failed groups, mean bleb height was 1473.7 ± 150.6 μm and 1165.4 ± 217 μm (P < 0.001), bleb wall thickness was 670.5 ± 119.9 μm and 538.8 ± 144.3 μm (P = 0.001), and fluid-filled cavity height was 736.5 ± 196.8 μm versus 532.5 ± 226.2 μm (P = 0.001), respectively. Conclusions: The results of this study showed that higher AS-OCT values for bleb height, wall thickness, and fluid-filled cavity height were associated with greater functional success. These parameters may be helpful in determining bleb functionality.
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Affiliation(s)
- Serek Tekin
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Erbil Seven
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Muhammed Batur
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Muhammet Derda Özer
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Tekin Yasar
- Department of Ophthalmology, Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Edawaji BSA, Gottlob I, Proudlock FA. Anterior Chamber Measurements in Healthy Children: A Cross-Sectional Study Using Optical Coherence Tomography. Transl Vis Sci Technol 2021; 10:13. [PMID: 34111257 PMCID: PMC8114001 DOI: 10.1167/tvst.10.6.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To establish anterior chamber measurements in children and investigate the influence of demographic factors on anterior chamber development. Methods Handheld optical coherence tomography was used to scan the anterior chamber of participants' eyes, without sedation. ImageJ was used to generate quantitative anterior chamber measurements, including central corneal thickness (CCT), anterior chamber width, trabecular meshwork length (TML), Schwalbe's line-angle opening distance (SL-AOD), and trabecular iris surface area (SL-TISA). The average anterior chamber measurements per age group, with 95% prediction intervals, were estimated using fractional polynomial modeling. Mixed regression models were used to evaluate the influence of age, gender, eye, angle, and refractive error variation on anterior chamber measurements. Results Scans from 223 healthy children (2 days to 15 years of age) and 59 adults (16 to 47 years of age) were included. The anterior chamber width, TML, Schwalbe's line-angle opening distance, and Schwalbe's line-trabecular iris surface area significantly increased, whereas CCT decreased with aging (all P < 0.001). The anterior chamber has a rapid phase of development during the first 18 months of age and reaches maturity by the age of 5 years. Girls have significantly smaller anterior chambers compared with boys (all P < 0.001). There was no difference between right and left eye development (all P > 0.05). The temporal TML development was significantly greater than the nasal TML (P < 0.05). CCT development was negatively correlated with refractive power. Conclusions This novel, non-invasive study describes the postnatal development of anterior chamber in newborn children. Translational Relevance Our established quantitative measurements have potential clinical use in understanding anterior segment diseases.
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Affiliation(s)
- Budor S. A. Edawaji
- University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Irene Gottlob
- University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Frank A. Proudlock
- University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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Abstract
PURPOSE To quantitatively analyze the angle anatomy in eyes with a Boston type 1 keratoprosthesis (KPro) using anterior segment optical coherence tomography (AS-OCT) and to assess the diagnostic ability of AS-OCT in KPro-associated glaucoma. METHODS AS-OCT (RTVue) images from KPro eyes with and without glaucoma were reviewed. The angle opening distance at 500 μm from the scleral spur (AOD500), trabecular-iris angle at 500 μm from the scleral spur (TIA500), and trabecular-iris surface area at 500 μm from the scleral spur (TISA500) were measured by 2 observers masked to the diagnosis. The measurements for each visible quadrant were compared between KPro eyes with and without glaucoma. RESULTS Twenty-two eyes with glaucoma and 17 eyes without glaucoma from 39 patients with KPro were included. Of the 4 quadrants imaged, the temporal angle was the most visible (79.5%) and angle measurements of the temporal quadrant were the only ones that differentiated the 2 groups: the mean AOD500, TIA500, and TISA500 were significantly lower in KPro eyes with glaucoma than without glaucoma (388.2 ± 234.4 μm vs. 624.5 ± 310.5 μm, P = 0.02; 26.1 ± 14.0 degrees vs. 39.1 ± 17.1 degrees, P = 0.03; and 0.15 ± 0.09 mm vs. 0.23 ± 0.12 mm, P = 0.03; respectively). The highest area under the receiver operating characteristic curve for detecting glaucoma was 0.75 for temporal TIA500 (95% confidence interval 0.57-0.94, P = 0.02) with 50% specificity at 80% of sensitivity and a cutoff value of 37 degrees. CONCLUSIONS The temporal angle was the most visible on AS-OCT in eyes with a KPro. Significant narrowing of the temporal angle detected on AS-OCT was associated with glaucoma in these eyes.
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13
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Venkateswaran N, Mercado C, Wall SC, Galor A, Wang J, Karp CL. High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 16:81-95. [DOI: 10.1080/17469899.2021.1851598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Mercado
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Grupo de Investigacion Escuela Barraquer, Escuela Superior de Oftalmologia del Instituto Barraquer de America, Bogota, Colombia
| | - Sarah C. Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
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14
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Fu H, Li F, Sun X, Cao X, Liao J, Orlando JI, Tao X, Li Y, Zhang S, Tan M, Yuan C, Bian C, Xie R, Li J, Li X, Wang J, Geng L, Li P, Hao H, Liu J, Kong Y, Ren Y, Bogunović H, Zhang X, Xu Y. AGE challenge: Angle Closure Glaucoma Evaluation in Anterior Segment Optical Coherence Tomography. Med Image Anal 2020; 66:101798. [DOI: 10.1016/j.media.2020.101798] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
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Bleb Morphology Using Anterior-Segment Optical Coherence Tomography after Ahmed Glaucoma Valve Surgery with Tenon Capsule Resection. J Ophthalmol 2020; 2020:8386135. [PMID: 33149944 PMCID: PMC7603617 DOI: 10.1155/2020/8386135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate the internal morphology of blebs using anterior-segment optical coherence tomography (AS-OCT) and the surgical outcomes of Ahmed glaucoma valve (AGV) surgery with Tenon capsule resection compared to conventional AGV surgery in patients with refractory glaucoma. Patients and Methods. This randomised prospective study included 30 eyes from 30 patients (age range: 42-55 y) with refractory glaucoma from March 2018 to February 2020. The study included two groups: AGV with the Tenon capsule resection group (n = 15) and the conventional AGV surgery group (n = 15). Follow-up continued until 6 months after surgery. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications, best corrected visual acuity, visual field, and postoperative complications. The internal morphology of the blebs in both groups was evaluated at 1-day, 1-week, 1-month, 3-month, and 6-month follow-up using AS-OCT in terms of the consequent changes in bleb wall thickness, bleb wall reflectivity, and bleb cavity morphology throughout the 6-month follow-up period. Results A significant reduction in IOP was found in both groups, with a greater reduction in group I, where the mean IOP decreased from 32.73 ± 2.12 mmHg in the preoperative period to 13.33 ± 1.59 mmHg after 6 months, whereas in group II, the mean IOP decreased from 33.2 ± 2.21 mmHg in the preoperative period to 14.27 ± 1.44 mmHg after 6 months (p value <0.05). The difference between the 2 groups in terms of the decrease in IOP was insignificant except at 1 and 3 months, where there was a significant difference (p value = 0.016 and 0.01 at 1 and 3 months, respectively). The bleb analysis revealed a significant reduction in the wall thickness in both groups at 1 and 3 months, which was mostly associated with the hypertensive phase. In group I, the bleb wall thickness decreased from 754.67 ± 53.93 μm in the first postoperative day to 684 ± 81.66 μm and 671.6 ± 69.48 μm at 1 and 3 months, respectively, while in group II, the bleb wall thickness decreased from 707.13 ± 31.7 μm in the first postoperative day to 499.53 ± 99.1 μm and 506 ± 76.91 μm at 1 and 3 months, respectively. There was a significant reduction in AS-OCT, and bleb reflectivity was insignificant throughout the follow-up period (p value >0.05). Regarding postoperative complications, the hypertensive phase occurred more frequently in group II (6 eyes, 40%) than in group I (2 eyes, 13.3%). Other complications were also reported more frequently in group II such as hypotony, shallow anterior chamber (AC), and tube exposure. Conclusion AS-OCT was beneficial in the analysis of bleb morphology after AGV surgery where there were more diffuse functioning multicystic blebs and less thinning in the bleb wall thickness during the hypertensive phase after resection of the Tenon capsule, which might be related to the less incidence of fibrosis around the surgical site.
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16
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Deep learning in glaucoma with optical coherence tomography: a review. Eye (Lond) 2020; 35:188-201. [PMID: 33028972 DOI: 10.1038/s41433-020-01191-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 01/27/2023] Open
Abstract
Deep learning (DL), a subset of artificial intelligence (AI) based on deep neural networks, has made significant breakthroughs in medical imaging, particularly for image classification and pattern recognition. In ophthalmology, applying DL for glaucoma assessment with optical coherence tomography (OCT), including OCT traditional reports, two-dimensional (2D) B-scans, and three-dimensional (3D) volumetric scans, has increasingly raised research interests. Studies have demonstrated that using DL for interpreting OCT is efficient, accurate, and with good performance for discriminating glaucomatous eyes from normal eyes, suggesting that incorporation of DL technology in OCT for glaucoma assessment could potentially address some gaps in the current practice and clinical workflow. However, further research is crucial in tackling some existing challenges, such as annotation standardization (i.e., setting a standard for ground truth labelling among different studies), development of DL-powered IT infrastructure for real-world implementation, prospective validation in unseen datasets for further evaluation of generalizability, cost-effectiveness analysis after integration of DL, the AI "black box" explanation problem. This review summarizes recent studies on the application of DL on OCT for glaucoma assessment, identifies the potential clinical impact arising from the development and deployment of the DL models, and discusses future research directions.
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Dua HS, Sinha R, D'Souza S, Potgieter F, Ross A, Kenawy M, Scott I, Said DG. "Descemet Membrane Detachment": A Novel Concept in Diagnosis and Classification. Am J Ophthalmol 2020; 218:84-98. [PMID: 32574777 DOI: 10.1016/j.ajo.2020.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the optical coherence tomography (OCT) and histologic features of Descemet membrane detachment (DMD) to ascertain the involvement of the pre-Descemet layer (PDL). DESIGN Retrospective, observational case series. METHODS Clinical, histopathologic, and OCT features of a cohort of 41 cases with diagnosis of DMD from 4 centers were studied. OCT images were evaluated independently by 3 observers for number of detached layers (1 or 2), reflectivity, configuration (straight line or wavy), distance from posterior stroma, and presence or absence of a tear with any scrolling of the torn edges. Five had a histology specimen. The main outcome measure was the involvement of the PDL in DMD and its confirmation by histology. RESULTS Three types of DMD were identified: type 1, where the PDL and DM were detached together; type 2, where only the DM was detached; and mixed, where the PDL and DM were detached but also separated from each other. These were further found to be rhegmatogenous or nonrhegmatogenous depending on the presence of absence of a tear in DM or both layers. Histology confirmed involvement of PDL in all 5 cases and showed it to be infiltrated by cells in 3 of 5 cases. CONCLUSIONS The PDL is involved in DMD. This fact significantly changes our understanding of DMD and could have implications for management. The detached PDL can be infiltrated with cells. A prospective study in relation to etiology and types of DMD is needed.
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18
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Biometric Measurement of Anterior Segment: A Review. SENSORS 2020; 20:s20154285. [PMID: 32752014 PMCID: PMC7435894 DOI: 10.3390/s20154285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022]
Abstract
Biometric measurement of the anterior segment is of great importance for the ophthalmology, human eye modeling, contact lens fitting, intraocular lens design, etc. This paper serves as a comprehensive review on the historical development and basic principles of the technologies for measuring the geometric profiles of the anterior segment. Both the advantages and drawbacks of the current technologies are illustrated. For in vivo measurement of the anterior segment, there are two main challenges that need to be addressed to achieve high speed, fine resolution, and large range imaging. One is the motion artefacts caused by the inevitable and random human eye movement. The other is the serious multiple scattering effects in intraocular turbid media. The future research perspectives are also outlined in this paper.
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Fu H, Xu Y, Lin S, Wong DWK, Baskaran M, Mahesh M, Aung T, Liu J. Angle-Closure Detection in Anterior Segment OCT Based on Multilevel Deep Network. IEEE TRANSACTIONS ON CYBERNETICS 2020; 50:3358-3366. [PMID: 30794201 DOI: 10.1109/tcyb.2019.2897162] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Irreversible visual impairment is often caused by primary angle-closure glaucoma, which could be detected via anterior segment optical coherence tomography (AS-OCT). In this paper, an automated system based on deep learning is presented for angle-closure detection in AS-OCT images. Our system learns a discriminative representation from training data that captures subtle visual cues not modeled by handcrafted features. A multilevel deep network is proposed to formulate this learning, which utilizes three particular AS-OCT regions based on clinical priors: 1) the global anterior segment structure; 2) local iris region; and 3) anterior chamber angle (ACA) patch. In our method, a sliding window-based detector is designed to localize the ACA region, which addresses ACA detection as a regression task. Then, three parallel subnetworks are applied to extract AS-OCT representations for the global image and at clinically relevant local regions. Finally, the extracted deep features of these subnetworks are concatenated into one fully connected layer to predict the angle-closure detection result. In the experiments, our system is shown to surpass previous detection methods and other deep learning systems on two clinical AS-OCT datasets.
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20
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Liu YC, Ji AJS, Tan TE, Fuest M, Mehta JS. Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery. Sci Rep 2020; 10:2674. [PMID: 32060326 PMCID: PMC7021803 DOI: 10.1038/s41598-020-59586-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 11/09/2022] Open
Abstract
Femtosecond laser-assisted conjunctival autografts (CAG) preparation was recently proposed. This study reports the outcomes of the first clinical trial on the use of laser to prepare CAG in pterygium surgery, and to compare the outcomes with those of manual technique. Forty eyes undergoing primary pterygium excision with laser-assisted CAG transplantation were prospectively included (L group). Two historical matched cohorts whose CAGs were prepared manually were compared (n = 78 eyes by the same experienced surgeon, M group; n = 78 eyes by trainees; TM group). We found the laser-created CAGs had only 11 μm deviation from the targeted thickness. The best-corrected visual acuity improved, and the astigmatism significantly decreased after surgery, with comparable efficacy across 3 groups. The 1-year recurrence rate was 2.5%, 3.8% and 7.7% in the L, M and TM groups, respectively (P = 0.12). There was no significant difference between the L and M groups in the complication rate (5.0% and 1.3%, respectively), surgical time (19.4 ± 5.1 and 19.1 ± 6.2 minutes, respectively), and postoperative discomfort scores (0.1 ± 0.3 and 0.2 ± 0.3, respectively), but these outcomes were significantly less favorable in the TM group. The results of this first comparative clinical trial suggest that femtosecond laser-assisted CAG preparation can be considered as an alternative technique for CAGs preparation.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Angel Jung Se Ji
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Tien-En Tan
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore. .,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. .,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.
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21
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Deep Learning Classifiers for Automated Detection of Gonioscopic Angle Closure Based on Anterior Segment OCT Images. Am J Ophthalmol 2019; 208:273-280. [PMID: 31445003 DOI: 10.1016/j.ajo.2019.08.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To develop and test deep learning classifiers that detect gonioscopic angle closure and primary angle closure disease (PACD) based on fully automated analysis of anterior segment OCT (AS-OCT) images. METHODS Subjects were recruited as part of the Chinese-American Eye Study (CHES), a population-based study of Chinese Americans in Los Angeles, California, USA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging in each quadrant of the anterior chamber angle (ACA). Deep learning methods were used to develop 3 competing multi-class convolutional neural network (CNN) classifiers for modified Shaffer grades 0, 1, 2, 3, and 4. Binary probabilities for closed (grades 0 and 1) and open (grades 2, 3, and 4) angles were calculated by summing over the corresponding grades. Classifier performance was evaluated by 5-fold cross-validation and on an independent test dataset. Outcome measures included area under the receiver operating characteristic curve (AUC) for detecting gonioscopic angle closure and PACD, defined as either 2 or 3 quadrants of gonioscopic angle closure per eye. RESULTS A total of 4036 AS-OCT images with corresponding gonioscopy grades (1943 open, 2093 closed) were obtained from 791 CHES subjects. Three competing CNN classifiers were developed with a cross-validation dataset of 3396 images (1632 open, 1764 closed) from 664 subjects. The remaining 640 images (311 open, 329 closed) from 127 subjects were segregated into a test dataset. The best-performing classifier was developed by applying transfer learning to the ResNet-18 architecture. For detecting gonioscopic angle closure, this classifier achieved an AUC of 0.933 (95% confidence interval, 0.925-0.941) on the cross-validation dataset and 0.928 on the test dataset. For detecting PACD based on 2- and 3-quadrant definitions, the ResNet-18 classifier achieved AUCs of 0.964 and 0.952, respectively, on the test dataset. CONCLUSION Deep learning classifiers effectively detect gonioscopic angle closure and PACD based on automated analysis of AS-OCT images. These methods could be used to automate clinical evaluations of the ACA and improve access to eye care in high-risk populations.
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Abdelrahman RM, AttaAllah HR, Abdelghany AA, Alio JL. Evaluation of acquired punctal stenosis using anterior segment optical coherence tomography. Eur J Ophthalmol 2019; 31:390-396. [PMID: 31736360 DOI: 10.1177/1120672119871396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this article was to study the lower punctum parameters in patients with acquired punctal stenosis using spectral-domain anterior segment optical coherence tomography. SUBJECTS/METHODS This was a prospective nonrandomized study that included two groups. Group 1 was composed of 32 puncta from 32 subjects (11 males and 21 females, aged 40-62 years) with epiphora and clinically diagnosed punctal stenosis. Group 2 (control group) included 30 puncta from 30 normal subjects (10 males and 20 females, aged 43-63 years). Anterior segment optical coherence tomography was employed to evaluate lower punctum parameters in all subjects; the inner and outer punctal diameters as well as punctal depth were measured. RESULTS External punctal diameter (mean: 466.1 ± 120.3 μm), internal punctal diameter (mean: 173.4 ± 55.6 μm) and punctal depth (mean: 188.4 ± 67 μm) values in Group 1 were statistically significantly lower than those in Group 2 (mean: 745.7 ± 156.9 μm, mean: 384 ± 119.1 μm, and mean: 284.9 ± 57.7 μm, respectively). CONCLUSION Anterior segment optical coherence tomography could possibly be used as a noncontact and noninvasive diagnostic modality for evaluating and measuring the lower punctum in patients with punctal stenosis. Further research is required to develop a normative database and grading system for stenosed puncta and to correlate the degree of stenosis with the severity of epiphora.
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Affiliation(s)
| | - Heba Radi AttaAllah
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed A Abdelghany
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Jorge L Alio
- Vissum Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Pilat AV, Proudlock FA, Shah S, Sheth V, Purohit R, Abbot J, Gottlob I. Assessment of the anterior segment of patients with primary congenital glaucoma using handheld optical coherence tomography. Eye (Lond) 2019; 33:1232-1239. [PMID: 30886322 PMCID: PMC7005739 DOI: 10.1038/s41433-019-0369-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the potential of handheld optical coherence tomography (HH-OCT) in assessing the anterior segment of the eye in patients with primary congenital glaucoma. DESIGN A prospective, case-controlled observational study. PARTICIPANTS Twenty-two patients with primary congenital glaucoma (PCG, 9 females and 13 males; mean age 4.36 ± 3.4 years) and age-, gender- and ethnicity-matched healthy participants. METHODS Anterior OCT was performed in all participants using a high-resolution HH SD-OCT device (Envisu 2300, Leica Microsystems, Germany) without anaesthesia or sedation. RESULTS Anterior HH-OCT in PCG visualised Haab's striae in 14.3%, uneven internal cornea in 9.5% and epithelial thickening in 11.9% of patients with central corneal thickening (CCT, p < 0.001). CCT was significantly correlated with the intraocular pressure (IOP, p < 0.001). The flat iris with a thin collarette zone was found in 59.5%, anterior iris insertion in 11.90% of eyes affected by PCG. Two independent examiners showed sensitivity and specificity of 87% and 77%, respectively, by instating iris thinning and flattening of the anterior profile. CONCLUSIONS Anterior HH-OCT has significant potential to improve diagnosis and management of PCG. Clinically relevant information can be obtained non-invasively and without sedation. High specificity makes anterior HH-OCT an important adjunct for management of PCG. Excellent visualisation of the iris insertion on OCT indicates potential for AS OCT to assist with surgical planning, including decision on the type of surgery and location of the incision.
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Affiliation(s)
| | | | - Sonal Shah
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Viral Sheth
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Ravi Purohit
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Joseph Abbot
- Ophthalmology Department, Birmingham Children's Hospital, Birmingham, UK
| | - Irene Gottlob
- Ophthalmology Group, University of Leicester, Leicester, UK.
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Ly A, Phu J, Katalinic P, Kalloniatis M. An evidence-based approach to the routine use of optical coherence tomography. Clin Exp Optom 2018; 102:242-259. [PMID: 30560558 PMCID: PMC6590481 DOI: 10.1111/cxo.12847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Optical coherence tomography is an imaging technology that has revolutionised the detection, assessment and management of ocular disease. It is now a mainstream technology in clinical practice and is performed by non-specialised personnel in some settings. This article provides a clinical perspective on the implications of that movement and describes best practice using multimodal imaging and an evidence-based approach. Practical, illustrative guides on the interpretation of optical coherence tomography are provided for three major diseases of the ocular fundus, in which optical coherence tomography is often crucial to management: age-related macular degeneration, diabetic retinopathy and glaucoma. Topics discussed include: cross-sectional and longitudinal signs in ocular disease, so-called 'red-green' disease whereby clinicians rely on machine/statistical comparisons for diagnosis in managing treatment-naïve patients, and the utility of optical coherence tomography angiography and machine learning.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Paula Katalinic
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Science, School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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25
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Avetisov SE, Petrov SY, Volzhanin AV. [Optical coherence tomography for examination of glaucoma surgery site]. Vestn Oftalmol 2018; 134:250-256. [PMID: 30499525 DOI: 10.17116/oftalma2018134051250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article reviews the results of using optical coherence tomography (OCT) - a non-invasive non-contact examination method for obtaining a tomographic slice image of the site of glaucoma surgery. The method helped reveal the functional relationships between the newly created outflow pathways and various parameters of the filtering bleb such as its linear dimensions, wall structure, presence of microcysts, position of drainage, etc. Due to its high resolution and noninvasiveness, OCT can be reliably used to examine the structure of aqueous outflow pathways in different postoperative periods with accuracy close to morphometric. The amount of data that had been obtained with the method has allowed the creation of new classifications and clarification of OCT-relevant prognostic signs for glaucoma surgery site.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - S Yu Petrov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A V Volzhanin
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Cuppusamy P, Makhanya N, Methula M, Essop KM, Sibisi D, Wohabally N, Gcabashe N, Rampersad N. Retinal nerve fibre layer and ganglion cell complex thickness in patients with keratoconus. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Keratoconus, a corneal ectasia, is associated with corneal thinning and altered optical media. Consequently, assessment of the visual field, optic nerve head and intraocular pressure measurements may be challenging in patients with keratoconus. Few studies have investigated posterior segment variables including the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thickness in patients with keratoconus.Aim: To investigate RNFL and GCC thickness in patients with keratoconus.Methods: A comparative quantitative research design was used. The sample consisted of 56 participants (28 with mild, moderate or severe keratoconus, and 28 controls) who accessed the optometry clinic at the University of KwaZulu-Natal. There was an equal distribution of male (n = 14) and female (n = 14) participants in the keratoconus and control groups. Most participants were black (n = 34) or Indian (n = 18). Corneal power and refractive error were assessed with the Oculus Keratograph and subjective refraction respectively. The iVue-100 optical coherence topography device was used to measure RNFL and GCC thickness. Data were analysed by descriptive and inferential statistics.Results: The mean global RNFL thickness was slightly higher in the control group than the keratoconus group for the right (106 µm vs. 99 µm) and left (103 µm vs. 98 µm) eyes but these differences were not significant (p ≥ 0.057). For all RNFL quadrants, slightly lower mean RNFL measurements were found in the keratoconus group. The mean GCC thicknesses were marginally higher (3 µm – 6 µm) in the control group.Conclusion: The RNFL and GCC thickness differences between patients with keratoconus and controls are not clinically significant. Therefore, abnormally reduced RNFL and GCC thickness measurements in patients with keratoconus warrant further investigation for other pathologies specifically glaucoma.
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Mashige KP. Reproducibility of corneal, macular and retinal nerve fiber layer thickness measurements using the iVue-100 optical coherence tomography. Afr Health Sci 2017; 17:1222-1228. [PMID: 29937896 PMCID: PMC5870293 DOI: 10.4314/ahs.v17i4.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the intra-session and inter-session reproducibility of corneal, macular and retinal nerve fiber layer thickness (RNFL) measurements with the iVue-100 optical coherence tomography in normal eyes. Methods These parameters were measured in the right eyes of 50 healthy participants with normal vision. Six scans each for corneal thickness, macular and optic nerve head were taken on one day (intra-session), followed by similar repeated measures on five separate days (inter-session). Reproducibility was computed using intra-class correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRV). Results For intra-session reproducibility, the ICC, COV and TRV values for mean corneal thickness were 0.924, 2.82%, and 3.06 µm respectively. For the mean macular thickness, they were 0.978, 4.64% and 4.51 µm respectively, while for mean RNFL thickness they were 0.946, 3.19%, and 5.66 µm respectively. Inter-session values for mean corneal thickness were 0.926, 2.65% and 3.48 µm, and 0.916, 2.24% and 2.03 µm for mean macular thickness. For mean RNFL thickness, they were 0.962, 2.21%, and 4.72 µm respectively. Conclusion There was good reproducibility of all measured parameters. However, mean RNFL thickness measurements were the most reproducible, suggesting that this may be the best parameter to use to determine measured changes over time.
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Pinilla Lozano I, López de la Fuente C, Segura F, Orduna Hospital E, Sánchez-Cano A. Evaluation of anterior chamber parameters with spectral-domain optical coherence tomography. Jpn J Ophthalmol 2017; 62:209-215. [PMID: 29188463 DOI: 10.1007/s10384-017-0548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate several anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography and to describe the repeatability and reproducibility of this method. STUDY DESIGN Prospective clinical study. METHODS Fifty-two eyes of 52 healthy volunteers were enrolled. Manual measurements of the anterior chamber angle (ACA500 and ACA750), angle opening distance (AOD500 and AOD750), angle-to-angle distance (ATA), anterior chamber width (ACW), and lens vault (LV) were obtained. RESULTS The mean nasal ACA500 was 44.87 ± 12.92°; ACA750, 43.94 ± 10.41°; AOD500, 672.54 ± 270.19 µm; AOD750, 881.87 ± 290.55 µm. The mean temporal ACA500 was 41.46 ± 11.20°; ACA750, 41.27 ± 11.31°; AOD500, 603.15 ± 232.28 µm; AOD750, 823.46 ± 308.76 µm. The differences between the corresponding nasal and temporal parameters were statistically significant. The ACW was 11.97 ± 0.42 mm, the ATA was 12.10 ± 0.43 mm, and the LV was 3.71 ± 232.93 µm. The ACA was highly associated with the LV. The intraclass correlation coefficients ranged from 0.984 to 0.999 for the intraobserver repeatability and from 0.966 to 0.998 for the interobserver reproducibility. CONCLUSIONS This study assessed anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography. This technique reveals the spatial relationships of the ocular structures, provides high-resolution images, and results in high degrees of intraobserver and interobserver repeatabilities.
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Affiliation(s)
- Isabel Pinilla Lozano
- Department of Surgery, Gynecology and Obstetrics, University of Zaragoza, Zaragoza, Spain.
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.
- Department of Ophthalmology, Lozano Blesa University Hospital, Zaragoza, Spain.
| | - Carmen López de la Fuente
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Francisco Segura
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Elvira Orduna Hospital
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Physiology and Pharmacology, University of Zaragoza, Zaragoza, Spain
| | - Ana Sánchez-Cano
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
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Two-year Results After Deep Sclerectomy With Nonabsorbable Uveoscleral Implant (Esnoper-Clip): Surgical Area Analysis Using Anterior Segment Optical Coherence Tomography. J Glaucoma 2017; 26:929-935. [DOI: 10.1097/ijg.0000000000000756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Fu H, Xu Y, Lin S, Zhang X, Wong DWK, Liu J, Frangi AF, Baskaran M, Aung T. Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1930-1938. [PMID: 28499992 DOI: 10.1109/tmi.2017.2703147] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.
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Pilat AV, Sheth V, Purohit R, Proudlock FA, Anwar S, Gottlob I. Hand-held optical coherence tomography imaging in children with anterior segment dysgenesis. Acta Ophthalmol 2017; 95:537-541. [PMID: 27130748 PMCID: PMC5516133 DOI: 10.1111/aos.13053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Anastasia V. Pilat
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Viral Sheth
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Ravi Purohit
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Frank A. Proudlock
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Samira Anwar
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
| | - Irene Gottlob
- Department of Neuroscience, Psychology and Behaviour; The University of Leicester Ulverscroft Eye Unit; Leicester UK
- Ophthalmology Group; University of Leicester; Leicester UK
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Xu BY, Israelsen P, Pan BX, Wang D, Jiang X, Varma R. Benefit of Measuring Anterior Segment Structures Using an Increased Number of Optical Coherence Tomography Images: The Chinese American Eye Study. Invest Ophthalmol Vis Sci 2017; 57:6313-6319. [PMID: 27893097 PMCID: PMC5119487 DOI: 10.1167/iovs.16-19755] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the benefit of analyzing an increased number of anterior segment optical coherence tomography (AS-OCT) images on measurement values of various anterior segment parameters. Methods Subjects for this cross-sectional study were recruited from the Chinese American Eye Study (CHES), a population-based study in Los Angeles, CA. Thirty-two AS-OCT images were acquired from one eye each of 83 consecutive subjects. Sixteen parameters were analyzed in each image, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), scleral spur angle (SSAngle), lens vault (LV), pupillary diameter (PD), anterior chamber depth (ACD), anterior chamber width (ACW), iris area (IA), and anterior chamber area (ACA). Data from 1, 2, 4, 8, 16, or 32 OCT images were averaged across subjects to calculate the range and mean of measurement values for each parameter. Results Anatomical variations were poorly captured with fewer OCT images for AOD, ARA, TISA, SSAngle, IA, and LV. For these parameters, the range and mean of measurement values obtained from one OCT image deviated from 32-image values by up to 43.9% and 13.3% of the 32-image mean, respectively. These deviations decreased when additional OCT images were analyzed. Deviations from 32-image range and mean values were less pronounced regardless of image number for PD, ACD, ACW, and ACA, measuring up to 3.5% and 5.0%, respectively. Conclusions A multi-image approach should be the standard in OCT-based studies of AOD, ARA, TISA, TIA, SSAngle, IA, and LV.
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Affiliation(s)
- Benjamin Y Xu
- Roski Eye Institute, Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
| | - Paul Israelsen
- Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
| | - Billy X Pan
- Roski Eye Institute, Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
| | - Dandan Wang
- Roski Eye Institute, Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
| | - Xuejuan Jiang
- Roski Eye Institute, Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
| | - Rohit Varma
- Roski Eye Institute, Keck School of Medicine at the University of Southern California Los Angeles, Los Angeles, California, United States
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Intraocular Pressure Reduction after Phacoemulsification versus Manual Small-Incision Cataract Surgery: A Randomized Controlled Trial. Ophthalmology 2016; 123:1695-1703. [PMID: 27234929 DOI: 10.1016/j.ophtha.2016.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/29/2016] [Accepted: 04/06/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare reduction in intraocular pressure (IOP) and change in anterior chamber angle configuration between eyes undergoing phacoemulsification versus those undergoing manual small-incision cataract surgery (MSICS). DESIGN Prospective, randomized, double-masked, parallel assignment clinical trial. PARTICIPANTS Five hundred eyes of 500 participants 40 to 70 years of age with normal IOP, gonioscopically open angles, and age-related cataract. METHODS Eyes underwent phacoemulsification or MSICS after a 1:1 randomization and allocation code. Best-corrected vision, IOP, comprehensive slit-lamp evaluation, and anterior segment (AS) optical coherence tomography (OCT) were performed at baseline and at 1, 3, and 6 months follow-up. MAIN OUTCOME MEASURES Change in IOP (ΔIOP) and AS OCT parameters between baseline and 6 months after surgery. RESULTS Six months, similar IOP reduction was observed in eyes undergoing phacoemulsification (ΔIOP = 2.7±2.9 mmHg) and MSICS (ΔIOP = 2.6±2.6 mmHg; P = 0.70). Widening of the angle opening distance (AOD) 500 μm from the scleral spur (median ΔAOD500 = 103 μm; interquartile range = 39-179 μm) was also similar in both groups (P = 0.28). Multivariate linear regression analysis showed that eyes with higher baseline IOP experienced significantly greater reduction in IOP at 6 months (ΔIOP = 0.46-mmHg reduction for every 1-mmHg increment in baseline IOP; 95% confidence interval [CI], 0.4-0.5 mmHg; P < 0.001). After adjusting for covariates, the magnitude of widening of AOD500 was not associated significantly with reduction in IOP (1.33-mmHg reduction for every 1-mm increment in AOD500; P = 0.07). Baseline AOD500 (β = -0.60-mm change/1-mm increment of baseline AOD; 95% CI, -0.67 to -0.53 mm) and anterior chamber depth (β = 0.07-mm change/1-mm increment of baseline anterior chamber depth; 95% CI, 0.04-0.1 mm) were significant predictors of AOD500 widening at 6 months. CONCLUSIONS Both phacoemulsification and MSICS led to significant and similar IOP reductions 6 months after surgery, and both surgeries produced similar changes in anterior chamber and angle parameters. Higher baseline IOP was associated with greater IOP reduction; IOP reduction also can be attributed partly to changes in angle and anterior chamber configuration, although these parameters were unable to predict significantly predict IOP drop at 6 months.
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Ma XY, Zhu D, Zou J, Zhang WJ, Cao YL. Comparison of ultrasound biomicroscopy and spectral-domain anterior segment optical coherence tomography in evaluation of anterior segment after laser peripheral iridotomy. Int J Ophthalmol 2016; 9:417-23. [PMID: 27158613 DOI: 10.18240/ijo.2016.03.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To quantitatively assess narrow anterior chamber angle using spectral-domain anterior segment optical coherence tomography (SD-AS-OCT) and ultrasound biomicroscopy (UBM), and to evaluate the correlations and consistency between SD-AS-OCT and UBM. METHODS Fifty-five eyes from 40 patients were examined. Patients were diagnosed with primary angle-closure glaucoma (PACG) remission (11 eyes from 8 patients), primary angle closure (PAC, 20 eyes from 20 patients) and PAC suspect (24 eyes from 12 patients). Each eye was examined by SD-AS-OCT and UBM after laser peripheral iridotomy (LPI). The measurements of SD-AS-OCT were angle open distance (AOD), anterior chamber angle (ACA), trabecular iris angle (TIA), and trabecular iris space area (TISA). UBM measurements were AOD and TIA. Correlations of AOD500 and TIA500 between UBM and AS-OCT were assessed. All parameters were analysed by SPSS 16.0 and MedCalc. RESULTS ACA, TIA and AOD measured by SD-AS-OCT reached a maximum at the temporal quadrant and minimum at the nasal quadrant. TISA reached the maximum at the inferior and minimum at the superior quadrant. Group parameters of AOD500 and AOD750 showed a linear positive correlation, and AOD750 had less variability. UBM outcomes of AOD500 and TIA500 were significantly smaller than those of SD-AS-OCT. The results of the two techniques were correlated at the superior, nasal and inferior quadrants. CONCLUSION Both UBM and SD-AS-OCT are efficient tools for follow-up during the course of PACG. We recommended using parameters at 750 µm anterior to the sclera spur for the screening and follow-up of PACG and PAC. The two methods might be alternatives to each other.
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Affiliation(s)
- Xiao-Yun Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China; Department of Ophthalmology, Shanghai Guanghua Integrative Medicine Hospital, Shanghai 200052, China
| | - Dan Zhu
- Department of Ophthalmology, Shanghai Guanghua Integrative Medicine Hospital, Shanghai 200052, China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Wen-Jie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China
| | - Yi-Lin Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China
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Fricker GV, Smith K, Gould DJ. Survey of the incidence of pectinate ligament dysplasia and glaucoma in the UK Leonberger population. Vet Ophthalmol 2015; 19:379-85. [DOI: 10.1111/vop.12311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Georgina V. Fricker
- Davies Veterinary Specialists; Manor Farm Business Park; Higham Road, Higham Gobion Hertfordshire SG5 3HR UK
| | - Kerry Smith
- Davies Veterinary Specialists; Manor Farm Business Park; Higham Road, Higham Gobion Hertfordshire SG5 3HR UK
| | - David J. Gould
- Davies Veterinary Specialists; Manor Farm Business Park; Higham Road, Higham Gobion Hertfordshire SG5 3HR UK
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Intraoperative optical coherence tomography-assisted descemet membrane endothelial keratoplasty in the DISCOVER study. Am J Ophthalmol 2015; 160:430-7. [PMID: 26026264 DOI: 10.1016/j.ajo.2015.05.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the utility of intraoperative optical coherence tomography (OCT) for Descemet membrane endothelial keratoplasty (DMEK) surgery. DESIGN Prospective consecutive interventional case series. METHODS DISCOVER (NCT02423213) is a prospective consecutive interventional case series examining the feasibility and utility of microscope-integrated intraoperative OCT in ophthalmic surgery. This report focuses on those eyes in the DISCOVER study undergoing DMEK surgery. The 8 cases were the first DMEK cases performed by the primary surgeon (J.M.G.) with microscope-integrated intraoperative OCT feedback. Qualitative OCT analysis was performed at multiple surgeon-defined time points, including host and donor tissue preparation, graft orientation, graft apposition, and tissue interface fluid dynamics. RESULTS Correct graft orientation was confirmed by intraoperative OCT prior to unscrolling in 100% of cases. Seven of 8 grafts were fully attached at the conclusion of surgery and on postoperative day 1. One graft had a linear paracentral fixed area of interface separation corresponding to posterior stromal irregularities that was visible during surgery and unchanged on postoperative day 1. Two eyes developed significant peripheral graft dehiscence visible by the first postoperative week. Both grafts were successfully reattached with repeat gas injection. All eyes demonstrated improvement in best-corrected visual acuity and there was a 100% graft survival rate at last follow-up (minimum 4 months). Surgeon feedback indicated that intraoperative OCT provided valuable information in all 8 cases. CONCLUSIONS Real-time intraoperative OCT can provide useful information that may directly impact surgical decision making during DMEK surgery. Intraoperative OCT may facilitate the transition for novice DMEK surgeons by increasing surgeon confidence and reducing the risk of iatrogenic graft failure.
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Ebneter A, Häner NU, Zinkernagel MS. Metrics of the normal anterior sclera: imaging with optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2015; 253:1575-80. [PMID: 26067393 PMCID: PMC4548011 DOI: 10.1007/s00417-015-3072-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 05/17/2015] [Accepted: 05/25/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To investigate anterior scleral thickness in a cohort of healthy subjects using enhanced depth imaging anterior segment optical coherence tomography. METHODS Observational case series. The mean scleral thickness in the inferonasal, inferotemporal, superotemporal, and superonasal quadrant was measured 2 mm from the scleral spur on optical coherence tomography in healthy volunteers. RESULTS Fifty-three eyes of 53 Caucasian patients (25 male and 28 female) with an average age of 48.6 years (range: 18 to 92 years) were analysed. The mean scleral thickness was 571 μm (SD 84 μm) in the inferonasal quadrant, 511 μm (SD 80 μm) in the inferotemporal quadrant, 475 (SD 81 μm) in the superotemporal, and 463 (SD 64 μm) in the superonasal quadrant. The mean scleral thickness was significantly different between quadrants (p < 0.0001, repeated measures one-way ANOVA). The association between average scleral thickness and age was statistically significant (p < 0.0001, Pearson r = 0.704). CONCLUSIONS Enhanced depth imaging optical coherence tomography revealed the detailed anatomy of the anterior sclera and enabled non-invasive measurements of scleral thickness in a non-contact approach. The anterior scleral thickness varies significantly between quadrants, resembling the spiral of Tillaux. An association of increasing scleral thickness with age was found.
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Affiliation(s)
- Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland,
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Evaluation of the Lower Punctum Parameters and Morphology Using Spectral Domain Anterior Segment Optical Coherence Tomography. J Ophthalmol 2015; 2015:591845. [PMID: 26090219 PMCID: PMC4454766 DOI: 10.1155/2015/591845] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose. To study features of the lower punctum in normal subjects using spectral domain anterior segment optical coherence tomography (SD AS-OCT). Methods. Observational cross-sectional study that included 147 punctae (76 subjects). Punctae were evaluated clinically for appearance, position, and size. AS-OCT was used to evaluate the punctal shape, contents, and junction with the vertical canaliculus. Inner and outer diameters as well as depth were measured. Results. 24 males and 52 females (mean age 44 ± 14.35 y) were included. Lower punctum was perceived by OCT to be an area with an outer diameter (mean 412.16 ± 163 μm), inner diameter (mean 233.67 ± 138.73 μm), and depth (mean 251.7 ± 126.58 μm). The OCT measured outer punctum diameter was significantly less than that measured clinically (P: 0.000). Seven major shapes were identified. The junction with the vertical canaliculus was detectable in 44%. Fluid was detected in 34%, one of which had an air bubble; however, 63% of punctae showed no contents and 4% had debris. Conclusions. AS-OCT can be a useful tool in understanding the anatomy of the punctum and distal lacrimal system as well as tear drainage physiology. Measuring the punctum size may play a role in plugs fitting.
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Kumar RS, Jariwala MU, V SA, Venugopal JP, Puttaiah NK, Balu R, Rao A S D, Shetty R. A Pilot Study on Feasibility and Effectiveness of Intraoperative Spectral-Domain Optical Coherence Tomography in Glaucoma Procedures. Transl Vis Sci Technol 2015; 4:2. [PMID: 25767745 DOI: 10.1167/tvst.4.2.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/13/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To demonstrate the use of a spectral-domain optical coherence tomography (SDOCT) integrated surgical microscope in glaucoma surgery. METHODS An SDOCT system was used to interface directly with an ophthalmic surgical microscope, to allow real-time intraoperative SDOCT (iOCT) imaging during glaucoma procedures like phaco-trabeculectomy, Ahmed glaucoma valve (AGV) implantation, gonio-synechiolysis, and bleb needling. The various surgical steps during glaucoma surgeries where iOCT can be of potential help in guiding the surgeon were recorded. RESULTS High-resolution, cross-sectional images of the relevant structures were achieved with the iOCT system in all procedures. The surgeon could determine the depth of the scleral dissection, the intrastomal bed, the path of the AGV tube in the eye, the release of peripheral anterior synechiae and the efficacy of needling with respect to breakage of loculations; most of these are technically 'blind' procedures, where the outcomes are determined postoperatively. Metallic instruments cast a shadow on tissues below, thereby restricting the use of the device in its current state. CONCLUSIONS The iOCT system provided high quality, intraoperative, real-time imaging, which could possibly improve the safety and efficacy of the surgical procedures in glaucoma. Further studies and modifications to the iOCT are required to better understand and increase the uptake of this technology in daily practice. TRANSLATIONAL RELEVANCE The iOCT, with further advancements in its technology, could potentially provide the surgeon both quantitative and qualitative, real-time depth and tissue proximity details, thus improving the safety and accuracy of glaucoma surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - Rohit Shetty
- Narayana Nethralaya Eye Hospital, Bangalore, India
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Anterior segment optical coherence tomography imaging of conjunctival filtering blebs after glaucoma surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:610623. [PMID: 25136603 PMCID: PMC4127298 DOI: 10.1155/2014/610623] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/25/2014] [Indexed: 12/11/2022]
Abstract
Time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) are cross-sectional, noncontact, high-resolution diagnostic modalities for posterior and anterior segment (AS) imaging. The AS-OCT provides tomographic imaging of the cornea, iris, lens, and anterior chamber (AC) angle in several ophthalmic diseases. In glaucoma, AS-OCT is utilized to evaluate the morphology of AS structures involved in the pathogenesis of the disease, to obtain morphometric measures of the AC, to evaluate the suitability for laser or surgical approaches, and to assess modifications after treatment. In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis. In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening. This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs. In this review, we summarize the applications of AS-OCT in the conjunctival bleb assessment.
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