1
|
Mastropasqua L, Agnifili L, Brescia L, Figus M, Posarelli C, Oddone F, Giammaria S, Sacchi M, Pavan M, Innocenti DD, Olivotto V, Sensi SL, Mastropasqua R. A deep learning approach to investigate the filtration bleb functionality after glaucoma surgery: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2024; 262:149-160. [PMID: 37530849 PMCID: PMC10805808 DOI: 10.1007/s00417-023-06170-6] [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: 02/25/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To distinguish functioning from failed filtration blebs (FBs) implementing a deep learning (DL) model on slit-lamp images. METHODS Retrospective, cross-sectional, multicenter study for development and validation of an artificial intelligence classification algorithm. The dataset consisted of 119 post-trabeculectomy FB images of whom we were aware of the surgical outcome. The ground truth labels were annotated and images splitted into three outcome classes: complete (C) or qualified success (Q), and failure (F). Images were prepared implementing various data cleaning and data transformations techniques. A set of DL models were trained using different ResNet architectures as the backbone. Transfer and ensemble learning were then applied to obtain a final combined model. Accuracy, sensitivity, specificity, area under the ROC curve, and area under the precision-recall curve were calculated to evaluate the final model. Kappa coefficient and P value on the accuracy measure were used to prove the statistical significance level. RESULTS The DL approach reached good results in unraveling FB functionality. Overall, the model accuracy reached a score of 74%, with a sensitivity of 74% and a specificity of 87%. The area under the ROC curve was 0.8, whereas the area under the precision-recall curve was 0.74. The P value was equal to 0.00307, and the Kappa coefficient was 0.58. CONCLUSIONS All considered metrics supported that the final DL model was able to discriminate functioning from failed FBs, with good accuracy. This approach could support clinicians in the patients' management after glaucoma surgery in absence of adjunctive clinical data.
Collapse
Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy.
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Michele Figus
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | | | - Sara Giammaria
- IRCCS Fondazione Bietti, Via Livenza, 3, 00198, Rome, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Marco Pavan
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Dante Degli Innocenti
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Valentina Olivotto
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
| | - Rodolfo Mastropasqua
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
| |
Collapse
|
2
|
Mastropasqua R, Brescia L, Di Antonio L, Guarini D, Giattini D, Zuppardi E, Agnifili L. Angiographic biomarkers of filtering bleb function after XEN gel implantation for glaucoma: an optical coherence tomography-angiography study. Acta Ophthalmol 2020; 98:e761-e767. [PMID: 32020755 DOI: 10.1111/aos.14371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate, using optical coherence tomography-angiography (OCT-A), the vascular features of good bleb function after XEN gel implantation (XGI) for uncontrolled glaucoma. METHODS Forty-three patients (43 eyes), who underwent XGI, were enrolled. According to the intraocular pressure (IOP) reduction, patients were classified into Group 1 (21 eyes; success) and Group 2 (22 eyes; failure). Optical coherence tomography-angiography (OCT-A) was performed to image the vascularization of the conjunctival bleb-wall. The main outcomes were as follows: vessel displacement areas (VDAs), major vessel displacement area (MVDA; mm2 ), non-flow whole area (NFWA; mm2 ) and bleb-wall vessel density (BVD; %). Co-registered B-scans were also considered to evaluate the bleb-wall cyst-like structure density and area (BCSD, cysts/mm2 ; BCSA, mm2 ), and the bleb-wall thickness (BT, µm). RESULTS Mean postoperative follow-up was 7.5 ± 0.14 months; Group 1 and 2 IOP were 14.0 ± 2.5 and 25.3 ± 2.1 mmHg, respectively (p < 0.001). Greater VDA (p < 0.001), MVDA (p = 0.046) and NFWA (p = 0.001) values, and lower BVD (p < 0.001) was found in Group 1 compared to Group 2. Group 1 showed higher BSCD, BSCA and BT values compared to Group 2 (p < 0.001). Postoperative IOP positively correlated with BVD (r = 0.567; p = 0.003), but negatively with VDAs, MVDA (r = -0.581, p = 0.002; r = -0.619, p = 0.001, respectively), BCSD, BCSA (r = -0.580; p = 0.002; r = -0.664; p < 0.001) and BT (r = -0.627, p = 0.001). CONCLUSION Successful filtration blebs after XGI present numerous and large areas of vessel displacement within the bleb-wall, along with a rarefied vascular network. These OCT-A features can be considered angiographic biomarkers of a good aqueous humour percolation through the bleb-wall layers.
Collapse
Affiliation(s)
- Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenza Brescia
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Daniele Guarini
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Dario Giattini
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Eduardo Zuppardi
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Department of Medicine and Aging Sciences, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
3
|
Zhang J, Vikash V, Wang P, Zheng T, Chen DL, Wang Q, Ke M. Effect of subconjunctival injection with conbercept as an adjuvant to filtration surgery for open angle glaucoma: a prospective randomized interventional 6-month follow-up study. Int J Ophthalmol 2019; 12:235-240. [PMID: 30809478 DOI: 10.18240/ijo.2019.02.08] [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] [Received: 03/23/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022] Open
Abstract
AIM To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil (5-FU) for open angle glaucoma (OAG) patients after filtration surgery. METHODS As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept (0.2 mL) or 5-FU (0.2 mL) on the 5th day post-operatively. The intraocular pressure (IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS There were significant differences in IOP between the conbercept and 5-FU groups 1mo (conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo (conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection (conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo (t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d (3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk (3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection (3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group (χ 2=4.500, P=0.034). CONCLUSION Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Vikash Vikash
- Department of Gastroenterology and Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Ping Wang
- Department of Ophthalmology, Wuhan Third Hospital-Tongren Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Tian Zheng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Dong-Lai Chen
- Department of Ophthalmology, the Second People's Hospital of Honghu, Honghu 433202, Hubei Province, China
| | - Qing Wang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Min Ke
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| |
Collapse
|
4
|
Comparison of Anterior Segment Optical Coherence Tomography Bleb Grading, Moorfields Bleb Grading System, and Intraocular Pressure After Trabeculectomy. J Glaucoma 2017; 26:403-408. [DOI: 10.1097/ijg.0000000000000636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
5
|
Solus JF, Jampel HD, Tracey PA, Gilbert DL, Loyd TL, Jefferys JL, Quigley HA. Comparison of limbus-based and fornix-based trabeculectomy: success, bleb-related complications, and bleb morphology. Ophthalmology 2012; 119:703-11. [PMID: 22226886 DOI: 10.1016/j.ophtha.2011.09.046] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 09/11/2011] [Accepted: 09/26/2011] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare the success and complications of trabeculectomy performed with limbus-based and fornix-based conjunctival approaches. DESIGN Retrospective case series with some prospective data collection. PARTICIPANTS Consecutive patients undergoing trabeculectomy by 2 surgeons between May 2000 and October 2008. INTERVENTION We performed limbus-based operations during the first 4 years and fornix-based operations during the last 4 years. We collected data by chart review and by examination at the most recent visit. For each follow-up visit, we defined success as undergoing no further glaucoma procedure and achieving one of our intraocular pressure (IOP) criteria. We used Kaplan-Meier survival analysis, Cox proportional hazards models, and generalized estimating equation (GEE) analysis. During 2009, 439 trabeculectomy sites of 347 patients were quantitatively assessed by the Indiana bleb grading system. MAIN OUTCOME MEASURES (1) Success rate of trabeculectomy, as determined by the achievement of each of our different IOP goals, with or without IOP-lowering medications; and (2) incidence of surgical complications. RESULTS During the 4 years after surgery, the success rates of limbus-based and fornix-based trabeculectomy were not statistically different for any of our IOP criteria. Blebs after limbus-based surgery were more likely to be graded as higher and to be avascular (GEE model, both P < 0.0001). Four percent of eyes experienced late-onset bleb leaks within 4 years after both limbus- and fornix-based operations; however, limbus-based cases developed bleb leaks significantly later than did fornix-based cases (2.1 vs. 1.0 years; P=0.002, GEE model). Late bleb-associated infection during the first 4 years after surgery occurred more often in limbus-based operations, although statistical significance was borderline (P=0.054, Cox model). Symptomatic hypotony during all available follow-up was more common with fornix-based operations (P=0.01, GEE model). Eyes undergoing the fornix-based operation had a greater risk of cataract surgery in the 4-year period after surgery (P=0.02, Cox model), and fornix-based cases requiring cataract surgery had the operation earlier than limbus-based cases (P=0.002, GEE model). CONCLUSIONS Success rates are similar between limbus-based and fornix-based trabeculectomy. Limbus-based procedures produce higher, more avascular blebs, with a greater risk of infection. Fornix-based procedures have more symptomatic hypotony and more and earlier cataract development.
Collapse
Affiliation(s)
- Jason F Solus
- Glaucoma Service and Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
6
|
Restricted post-trabeculectomy bleb formation by conjunctival scarring. Graefes Arch Clin Exp Ophthalmol 2009; 247:1095-101. [PMID: 19214551 DOI: 10.1007/s00417-009-1051-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 01/16/2009] [Accepted: 01/18/2009] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the effects of radial conjunctival incision during fornix-based trabeculectomy, and conjunctival scarring associated with previous ocular surgeries, for the restriction of bleb formation. METHODS Digital photo-slit lamp images of filtering blebs, which had undergone fornix-based trabeculectomy with mitomycin C previously, were analysed. The area and the height of the bleb in the conjunctivae with radial incision (Ain and Hin, respectively) were compared with the area and the height of the bleb in the conjunctivae without radial incision (Ano and Hno, respectively). We compared the parameters of bleb area (total bleb area, Ain and Ano) and bleb height (the bleb height at the centre of the scleral flap; Hc, Hin and Hno) in eyes without previous ocular surgeries, with those in eyes that underwent previous ocular surgeries. RESULTS The study population consisted of 51 eyes. The Ano and the Hno were significantly larger than the Ain (p < 0.001) and the Hin (p < 0.001) respectively. Subgroup analyses in eyes without previous ocular surgeries and eyes with phacoemulsification cataract surgery also showed that the Ano was significantly larger than the Ain. However, there was no significant difference between the Ano and the Ain in eyes with previous trabeculectomy. A comparison of bleb formation between eyes without previous ocular surgeries and eyes with cataract surgery showed no significant differences in each of the bleb area and bleb height parameters. By contrast, the total bleb area (p = 0.021), the Ano (p = 0.017) and the Hc (p = 0.045) were significantly smaller in eyes with previous trabeculectomy than in eyes without previous ocular surgeries. CONCLUSIONS Our data demonstrate that bleb formation depends on radial conjunctival incision during fornix-based trabeculectomy and surgical conjunctival scarring from previous trabeculectomy.
Collapse
|