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Nicolosi C, Vicini G, Bacherini D, Giattini D, Lombardi N, Esposito C, Rizzo S, Giansanti F. Non-Invasive Retinal Imaging Modalities for the Identification of Prognostic Factors in Vitreoretinal Surgery for Full-Thickness Macular Holes. Diagnostics (Basel) 2023; 13:589. [PMID: 36832078 PMCID: PMC9955111 DOI: 10.3390/diagnostics13040589] [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: 12/31/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
In this review, we will focus on different non-invasive retinal imaging techniques that can be used to evaluate morphological and functional features in full-thickness macular holes with a prognostic purpose. Technological innovations and developments in recent years have increased the knowledge of vitreoretinal interface pathologies by identifying potential biomarkers useful for surgical outcomes prediction. Despite a successful surgery of full-thickness macular holes, the visual outcomes are often puzzling, so the study and the identification of prognostic factors is a current topic of interest. Our review aims to provide an overview of the current knowledge on prognostic biomarkers identified in full-thickness macular holes by means of different retinal imaging tools, such as optical coherence tomography, optical coherence tomography angiography, microperimetry, fundus autofluorescence, and adaptive optics.
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Affiliation(s)
- Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Dario Giattini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Noemi Lombardi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Claudio Esposito
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
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Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study. J Ophthalmol 2022; 2022:1553719. [PMID: 35529168 PMCID: PMC9076353 DOI: 10.1155/2022/1553719] [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: 11/16/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To identify predictive factors of visual outcomes in the eyes after successful macular hole (MH) surgery. Methods It is a retrospective monocentric study of the eyes that underwent successful vitrectomy for full-thickness MH in an academic, tertiary care center (CHU de Québec–Université Laval, Québec, Canada) between 2014 and 2018. We included a single eye per patient and excluded the eyes with ocular comorbidities. Clinical and anatomical features of patients were collected, including demographics, MH duration, baseline MH size, baseline visual acuity (VA), and final VA. Multiple logistic regressions were performed to determine predictive factors of VA ≥70 ETDRS letters (Snellen equivalent: 20/40) and VA gain ≥15 ETDRS letters at final follow-up. Areas under the receiver operating characteristic curve (AUC) were used to determine the performance of each model and identify the Youden index maximizing performance at a given threshold. Results A total of 460 eyes were included in this study; 274/460 eyes (60%) achieved final VA ≥70 ETDRS letters and 304/460 eyes (66%) had a VA gain ≥15 ETDRS letters at 24 months follow-up. Multiple logistic regression analyses showed that the main predictive factors for final VA ≥70 ETDRS letters (model AUC = 0.716) were baseline VA (OR = 1.064; p < 0.001), MH duration (OR = 0.950; p=0.005), and age (OR = 0.954; p=0.004). Predictors of VA gain ≥15 ETDRS letters at final follow-up (model AUC = 0.615) were baseline VA (OR = 0.878; p < 0.001), MH duration (OR = 0.940; p < 0.001), and MH size (OR = 0.998; p=0.036). Thresholds for the final VA ≥70 ETDRS letters model and the VA gain ≥15 ETDRS letters model were VA ≥55.5 ETDRS letters (Snellen equivalent: 6/30) and MH size of 237 μm, respectively. Conclusion The eyes with shorter MH duration, smaller MH size, and higher preoperative VA achieved better visual outcomes after successful MH surgery.
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Lachance A, Godbout M, Antaki F, Hébert M, Bourgault S, Caissie M, Tourville É, Durand A, Dirani A. Predicting Visual Improvement After Macular Hole Surgery: A Combined Model Using Deep Learning and Clinical Features. Transl Vis Sci Technol 2022; 11:6. [PMID: 35385045 PMCID: PMC8994199 DOI: 10.1167/tvst.11.4.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to assess the feasibility of deep learning (DL) methods to enhance the prediction of visual acuity (VA) improvement after macular hole (MH) surgery from a combined model using DL on high-definition optical coherence tomography (HD-OCT) B-scans and clinical features. Methods We trained a DL convolutional neural network (CNN) using pre-operative HD-OCT B-scans of the macula and combined with a logistic regression model of pre-operative clinical features to predict VA increase ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 6 months post-vitrectomy in closed MHs. A total of 121 MHs with 242 HD-OCT B-scans and 484 clinical data points were used to train, validate, and test the model. Prediction of VA increase was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 scores. We also extracted the weight of each input feature in the hybrid model. Results All performances are reported on the held-out test set, matching results obtained with cross-validation. Using a regression on clinical features, the AUROC was 80.6, with an F1 score of 79.7. For the CNN, relying solely on the HD-OCT B-scans, the AUROC was 72.8 ± 14.6, with an F1 score of 61.5 ± 23.7. For our hybrid regression model using clinical features and CNN prediction, the AUROC was 81.9 ± 5.2, with an F1 score of 80.4 ± 7.7. In the hybrid model, the baseline VA was the most important feature (weight = 59.1 ± 6.9%), while the weight of HD-OCT prediction was 9.6 ± 4.2%. Conclusions Both the clinical data and HD-OCT models can predict postoperative VA improvement in patients undergoing vitrectomy for a MH with good discriminative performances. Combining them into a hybrid model did not significantly improve performance. Translational Relevance OCT-based DL models can predict postoperative VA improvement following vitrectomy for MH but fusing those models with clinical data might not provide improved predictive performance.
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Affiliation(s)
- Alexandre Lachance
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Mathieu Godbout
- Département d'informatique et de Génie Logiciel, Université Laval, Québec, QC, Canada
| | - Fares Antaki
- Département d'ophtalmologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, QC, Canada
| | - Mélanie Hébert
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Serge Bourgault
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Mathieu Caissie
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Éric Tourville
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Audrey Durand
- Département d'informatique et de Génie Logiciel, Université Laval, Québec, QC, Canada.,Département de Génie Électrique et de Génie Informatique, Université Laval, Québec, QC, Canada
| | - Ali Dirani
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
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