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Huang S, Jin K, Gao Z, Yang B, Shi X, Zhou J, Grzybowski A, Gawecki M, Ye J. Automated interpretation of retinal vein occlusion based on fundus fluorescein angiography images using deep learning: A retrospective, multi-center study. Heliyon 2024; 10:e33108. [PMID: 39027617 PMCID: PMC11255597 DOI: 10.1016/j.heliyon.2024.e33108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose Fundus fluorescein angiography (FFA) is the gold standard for retinal vein occlusion (RVO) diagnosis. This study aims to develop a deep learning-based system to diagnose and classify RVO using FFA images, addressing the challenges of time-consuming and variable interpretations by ophthalmologists. Methods 4028 FFA images of 467 eyes from 463 patients were collected and annotated. Three convolutional neural networks (CNN) models (ResNet50, VGG19, InceptionV3) were trained to generate the label of image quality, eye, location, phase, lesions, diagnosis, and macular involvement. The performance of the models was evaluated by accuracy, precision, recall, F-1 score, the area under the curve, confusion matrix, human-machine comparison, and Clinical validation on three external data sets. Results The InceptionV3 model outperformed ResNet50 and VGG19 in labeling and interpreting FFA images for RVO diagnosis, achieving 77.63%-96.45% accuracy for basic information labels and 81.72%-96.45% for RVO-relevant labels. The comparison between the best CNN and ophthalmologists showed up to 19% accuracy improvement with the inceptionV3. Conclusion This study developed a deep learning model capable of automatically multi-label and multi-classification of FFA images for RVO diagnosis. The proposed system is anticipated to serve as a new tool for diagnosing RVO in places short of medical resources.
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Affiliation(s)
- Shenyu Huang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Kai Jin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Zhiyuan Gao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Boyuan Yang
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Xin Shi
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Jingxin Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Maciej Gawecki
- Department of Ophthalmology of Specialist Hospital in Chojnice, Lesna 10, 89-600, Chojnice, Poland
- Dobry Wzrok Ophthalmological Clinic, Zabi Kruk 10, 80-402, Gdańsk, Poland
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
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Sun G, Wang X, Tian M, Yi Z, Xu A, He L, Zheng H, Chen C. Relationship between ischemic index, leakage index, and macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024; 262:1499-1506. [PMID: 38147156 DOI: 10.1007/s00417-023-06343-3] [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: 09/04/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To investigate the combined association of the ischemic index and leakage index with macular edema on ultra-widefield fluorescein angiography (UWFFA) in patients with branch retinal vein occlusion (BRVO). METHODS Retrospective image analysis study. The leakage index and ischemic index were calculated using Fiji after aligning early and late UWFFA images. Differences in the ischemic index, leakage index, and central macular thickness (CMT) between ischemic and non-ischemic BRVO were compared. Moreover, the association between the ischemic index, leakage index, and macular edema was analyzed. RESULTS Eighty-three patients with BRVO were enrolled, including 53 non-ischemic BRVO and 30 ischemic BRVO patients. No significant differences were observed in leakage index and CMT between ischemic BRVO and non-ischemic BRVO (all P > 0.05). In all included patients, CMT correlated with the panretina and all subregion leakage indexes (all P < 0.01), but not with the ischemic index (all P > 0.05). In the ischemic BRVO group, CMT showed a correlation with the leakage index in several regions, but not with the ischemic index. After adjusting for the ischemic index and other clinical features, CMT remained significantly correlated with the leakage index in all regions. CONCLUSION The leakage index may be a more effective biomarker for monitoring BRVO-associated macular edema compared to the ischemic index. Further follow-up studies are warranted to validate these findings.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Miao Tian
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Amin Xu
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Lu He
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China.
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Sun G, Wang X, Yi Z, He L, Zheng H, Chen C. Distribution of leakage index using ultra-widefield fluorescein angiography in patients with non-ischemic branch retinal vein occlusion and its association with macular edema. Photodiagnosis Photodyn Ther 2023; 43:103731. [PMID: 37549817 DOI: 10.1016/j.pdpdt.2023.103731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/25/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND To investigate the distribution of leakage index in patients with non-ischemic branch retinal vein occlusion (BRVO) and its correlation with the severity of macular edema. METHODS Retrospective observational study. Forty-five eyes of 45 patients with BRVO were included. Late ultra-widefield fluorescein angiography images of the affected eyes were processed and analyzed for their leakage index using Fiji software. The visible panretinal area was further divided into the peri‑macular area (PMA), near-peripheral area (NPA), midperipheral area (MPA), and far-peripheral area (FPA). The relationship between the leakage index and central retinal thickness (CMT) was analyzed for the panretina and each subregion. RESULTS The median (interquartile range) leakage indexes of the panretina, PMA, NPA, MPA, and FPA were 5.532% (7.667%), 23.127% (26.073%), 8.303% (16.807%), 1.588% (6.204%), and 0.408% (2.215%), respectively, with a mean CMT of 552.800 ± 183.335 μm. The CMT was positively correlated with the leakage index in the panretina, PMA, NPA, MPA and FPA (r = 0.468, 0.426, 0.463, 0.447, 0.320, respectively; all p < 0.05). CONCLUSIONS The leakage index in non-ischemic BRVO patients is associated with macular edema severity. The leakage index has the potential to be a useful indicator for monitoring and guiding treatment of macular edema in BRVO patients.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lu He
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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Ong CJT, Wong MYZ, Cheong KX, Zhao J, Teo KYC, Tan TE. Optical Coherence Tomography Angiography in Retinal Vascular Disorders. Diagnostics (Basel) 2023; 13:diagnostics13091620. [PMID: 37175011 PMCID: PMC10178415 DOI: 10.3390/diagnostics13091620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Traditionally, abnormalities of the retinal vasculature and perfusion in retinal vascular disorders, such as diabetic retinopathy and retinal vascular occlusions, have been visualized with dye-based fluorescein angiography (FA). Optical coherence tomography angiography (OCTA) is a newer, alternative modality for imaging the retinal vasculature, which has some advantages over FA, such as its dye-free, non-invasive nature, and depth resolution. The depth resolution of OCTA allows for characterization of the retinal microvasculature in distinct anatomic layers, and commercial OCTA platforms also provide automated quantitative vascular and perfusion metrics. Quantitative and qualitative OCTA analysis in various retinal vascular disorders has facilitated the detection of pre-clinical vascular changes, greater understanding of known clinical signs, and the development of imaging biomarkers to prognosticate and guide treatment. With further technological improvements, such as a greater field of view and better image quality processing algorithms, it is likely that OCTA will play an integral role in the study and management of retinal vascular disorders. Artificial intelligence methods-in particular, deep learning-show promise in refining the insights to be gained from the use of OCTA in retinal vascular disorders. This review aims to summarize the current literature on this imaging modality in relation to common retinal vascular disorders.
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Affiliation(s)
- Charles Jit Teng Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Mark Yu Zheng Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Jinzhi Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
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Li L, Ma Q, Mou J, Wang M, Ye J, Sun G. Basic fibroblast growth factor gel preparation induces angiogenesis during wound healing. Int J Artif Organs 2023; 46:171-181. [PMID: 36625364 DOI: 10.1177/03913988221145525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE This study aimed to observe the effect of basic fibroblast growth factor (bFGF) gel preparation on wound repair in a full-thickness skin defect rat model and to further explore its mechanism. METHODS The full-thickness skin defect model of Wistar rats was created with circular wounds of 20 mm or 10 mm in diameter on both sides of the spine. The animals were divided into the normal, model, control gel, and bFGF gel groups (300 IU/cm2). The effects of the bFGF gel on wound healing were evaluated and compared. Optical coherence tomography (OCT)-based angiography (OCTA) was used to investigate the effects of bFGF on angiogenesis during wound healing. Western blotting, polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay (ELISA) kits were used to detect the effect of the gel preparation on the levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMP2 and MMP9) on the wound surface to explore the mechanism. RESULTS The bFGF gel significantly reduced wound area, promoted the formation of wound granulation tissue, and accelerated wound healing in the bFGF gel group on days 7 and 14, compared with the control gel group. OCTA results showed that bFGF significantly improved wound vascular density, diameter, and circumference. Western blot, PCR, and ELISA results showed that the gel preparation could promote the expression levels of MMP2, MMP9, and VEGF on the wound surface 7 and 14 days after injury. CONCLUSION bFGF promotes angiogenesis in wound areas. Topical gel preparations of bFGF can be developed for use in wound repair.
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Affiliation(s)
- Lanfang Li
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuxiao Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junyu Mou
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Harbin University of Commerce, Harbin, China
| | - Min Wang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingxue Ye
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guibo Sun
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Siedlecki J, Hattenbach LO, Feltgen N, Priglinger SG. [Biomarkers in the treatment of retinal vein occlusion]. DIE OPHTHALMOLOGIE 2022; 119:1111-1120. [PMID: 36201041 DOI: 10.1007/s00347-022-01732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Retinal vein occlusion, subdivided into central retinal and branch retinal vein occlusion, is one of the most frequent vascular diseases of the retina. Biomarkers of optical coherence tomography (OCT), OCT-angiography and (ultra-widefield) fluorescein angiography are of exceptional importance in the initial diagnosis and also in the treatment of complications associated with retinal vascular occlusion, particularly macular edema. METHODS A systematic literature review was carried out in PubMed with the keywords central retinal vein occlusion, branch retinal vein occlusion, biomarker, OCT, OCT angiography, ultra-widefield fluorescein angiography with prioritization of the most important aspects. RESULTS Relevant biomarkers in OCT include central retinal thickness (CRT), macular fluid, the integrity of the photoreceptor bands (external limiting membrane and ellipsoid zone), disorganization of retinal inner layers (DRIL), hyperreflective foci, choroidal thickness and signs of ischemia, such as a prominent middle limiting membrane (p-MLM), paracentral acute middle maculopathy (PAMM) as well as hyperreflectivity of inner retinal layers (HIRL). The importance of OCT-angiography lies particularly in the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra-widefield angiography, such as peripheral ischemia (ischemic index) and neovascularízation are essential with respect to treatment decisions for retinal laser. CONCLUSION A multitude of simple and complex biomarkers currently enable an effective individualized evaluation of treatment and prognosis in retinal vein occlusion. A shift from invasive to noninvasive biomarkers can be observed.
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Affiliation(s)
- Jakob Siedlecki
- Augenklinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Mathildenstr. 8, 80336, München, Deutschland.
| | | | - Nikolas Feltgen
- Augenklinik, Georg-August-Universität Göttingen Universitätsmedizin, Göttingen, Deutschland
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