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Razavi P, Baldwin G, Garg I, Velazquez LM, Garcia M, Gan J, Choi H, Zeng R, Vingopoulos F, Husain D, Kim LA, Patel NA, Miller JB. Changes in wider field swept-source OCT angiography vascular metrics with anti-vascular endothelial growth factor therapy in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024; 262:2111-2120. [PMID: 38376563 DOI: 10.1007/s00417-024-06410-3] [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: 08/31/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
PURPOSE To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA). METHODS We included 23 eyes with macular edema associated with non-ischemic CRVO from 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured. RESULTS Median CST decreased significantly from 369 µm (305-531) to 267 µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12 mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12 mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12 mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA). CONCLUSION Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA.
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Affiliation(s)
| | | | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Luis Martinez Velazquez
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | | | - Jenny Gan
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | | | | | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Nimesh A Patel
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Retinal Imaging Lab, Harvard Medical School, 243 Charles St., Boston, MA, 02114, USA.
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Viggiano P, Grassi MO, Bisceglia G, Boscia G, Borrelli E, Malerba MG, Fracchiolla A, Alessio G, Boscia F. Short-term peripapillary structural and vascular changes following anti-VEGF vs. Dexamethasone intravitreal therapy in patients with DME. Eur J Ophthalmol 2023; 33:2236-2242. [PMID: 36938676 DOI: 10.1177/11206721231163615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE To evaluate short-term peripapillary structural and vascular changes in DME after treatment with dexamethasone implant (DEX-I) and anti-VEGFs using OCT-A. METHODS Sixty-five patients with naïve center-involving DME were enrolled. 33 of sixty five patients (group 1) underwent with single DEX-I 0.7 mg (Ozurdex, Allergan, Inc., USA), 32 of sixty-five (group 2) underwent with intravitreal injection of aflibercept 0.5 mg (Eylea, Bayer, Genentech, San Francisco, USA). The OCT acquisition was completed at the following visits: (i) "T1 visit" corresponding to the intravitreal injection of DEX-I or aflibercept in patients with naïve center-involving DME (ii) "T2 visit" corresponding to the examination performed 2 weeks after intravitreal injection of aflibercept and 1 month after DEX-I. The parameters analyzed were: (i) RPC vasculature density (VD); (ii) peripapillary retinal nerve fiber layer (pRNFL) thickness, and (iii) intraocular pressure (IOP). RESULTS The RPC analysis showed a VD increase at T2 in both groups, although values did not reach statistical significance (48.12± 4.17 and 49.04 ± 4.23; P = 0.081 in Group 1 and 46.93± 3.16 and 47.17 ± 3.70; P = 0.087 in Group 2). Likewise, the pRNFL thickness and IOP fluctuations did not show statistically significant changes in in both groups among the different study visits. CONCLUSIONS After intravitreal injection (anti-VEGF or DEX-I), no significant short-term changes were found in peripapillary microvasculature, IOP and pRNFL thickness in diabetic eyes treated with anti-VEGF or DEX-I.
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Affiliation(s)
- Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Giulia Bisceglia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Giacomo Boscia
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Maria Giovanna Malerba
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Fracchiolla
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
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Śpiewak D, Witek K, Drzyzga Ł, Mrukwa-Kominek E. An Analysis of Optical Coherence Tomography Angiography (OCT-A) Perfusion Density Maps in Patients Treated for Retinal Vein Occlusion with Intravitreal Aflibercept. Diagnostics (Basel) 2023; 13:3100. [PMID: 37835843 PMCID: PMC10572925 DOI: 10.3390/diagnostics13193100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
AIM The primary goal of this study was to evaluate the reduction in non-perfusion area and improvement in blood flow as well as the reduction in retinal edema on optical coherence tomography angiography (OCT-A) in patients with retinal vein occlusion treated with 2 mg intravitreal injections of aflibercept. MATERIAL AND METHODS Fifty eyes of nine patients with central retinal vein occlusion (CRVO) and sixteen patients with branch retinal vein occlusion (BRVO), aged 50 to 75 years, were collectively analyzed as retinal vein occlusion (RVO). The following parameters were analyzed: superficial vessel density (VDSF), deep vessel density (VDD), flow area in the outer retina (FAOR), choriocapillaris flow area (FACC), non-flow area (NFA) and the foveal avascular zone (FAZ). RESULTS OCT-A revealed a reduction in macular edema. The most significant change in central retinal thickness (CRT) was observed between measurement timepoint "5" and the baseline (46%). The non-flow area was also reduced. Following a significant decrease in superficial vessel density 30 days after the first dose of aflibercept, a non-significant increase was noted at the subsequent timepoints. An increase was also found in deep vessel density and choriocapillaris flow area. Improvements in the above OCT-A parameters resulted in increased retinal blood flow and improved visual acuity. CONCLUSIONS Patients with retinal vein occlusion treated with 2 mg aflibercept exhibited reduced macular edema and FAZ, increased vessel density, improved blood flow, and better visual acuity.
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Affiliation(s)
- Dorota Śpiewak
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Katarzyna Witek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Łukasz Drzyzga
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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Yousif H, Rashad M, Abdel Dayem HK, Abdellatif MK. EVALUATION OF OPTIC DISK AND MACULAR VASCULARITY CHANGES IN CRVO USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2023; 43:1182-1188. [PMID: 36996459 DOI: 10.1097/iae.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
PURPOSE To quantify changes in optic disk and macular vasculature in patients with central retinal vein occlusion using optical coherence tomography angiography and detect its correlation with visual acuity. METHODS The study included 20 eyes of 20 patients with treatment-naive central retinal vein occlusion and 20 age-matched controls. Optical coherence tomography and optical coherence tomography angiographywere performed on the macula and optic disk. Central 1-mm subfield foveal thickness was measured. Vessel densities (VD) of superficial and deep macular capillary plexuses with whole disk VD, inside disk VD, and radial peripapillary capillary plexus were analyzed. Macular ischemia was evaluated by fundus fluorescein angiography. Visual acuity was correlated with measured parameters. RESULTS All measured macular and disk VDs differed significantly between cases and controls except inside disk VD. Visual acuity showed a highly significant negative correlation with whole disk VD ( P = 0.005) and radial peripapillary capillary ( P = 0.002), borderline correlation with central subfield foveal thickness ( P = 0.06), and insignificant correlation with macular VDs. Radial peripapillary capillary VD showed a significant correlation with deep parafoveal ( P = 0.04), and superficial and deep perifoveal VDs ( P = 0.01). CONCLUSION Optic disk VD could provide more accurate indication of retinal blood supply than macular VD in cases of central retinal vein occlusion with severe macular edema.
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Affiliation(s)
- Hussein Yousif
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
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Helmy AMR, Rashad MA, Gharieb HM, Gomaa WA, Zaki RGE. Optic nerve head perfusion changes in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab or photocoagulation: a randomized controlled trial. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2023; 11:144-150. [PMID: 37641606 PMCID: PMC10460245 DOI: 10.51329/mehdiophthal1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/02/2023] [Indexed: 08/31/2023]
Abstract
Background Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR. Methods This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months. Results Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001). Conclusions In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.
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Affiliation(s)
| | | | | | - Wael Adel Gomaa
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Yin S, Cui Y, Jiao W, Zhao B. Potential Prognostic Indicators for Patients With Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:839082. [PMID: 35692537 PMCID: PMC9174432 DOI: 10.3389/fmed.2022.839082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
The second most prevalent cause of retinal vascular disease is retinal vein occlusion (RVO). RVO raises intravascular pressure in the capillary and veins, triggering vessel barrier collapse and subsequent leaking of blood or plasma components into the tissue (edema). Macular edema (ME) is a major complication of RVO that results in significant visual impairment. Laser therapy, intravitreal steroid injections, and vascular endothelial growth factor (VEGF) inhibitors are the major therapeutic techniques. Different therapies reduce ME of RVO and improve visual activity. However, some people have no impact on the resolution of ME, while others have a poor visual prognosis despite full ME cure. There are many investigators who studied the relationship between indicators of various instruments with visual activity. However, a summary of those findings is currently lacking. Therefore, we will focus on the predictive factors of different studies associated with positive visual activity outcomes, which would be very useful and important to help address both treatment expectations and methods for patients with RVO.
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Affiliation(s)
- Shan Yin
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanyan Cui
- Department of Ophthalmology, Liaocheng People’s Hospital, Liaocheng, China
| | - Wanzhen Jiao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Bojun Zhao,
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Ozcalıskan S, Pehlıvanoglu S, Huseyınhan Z, Alagoz C, Erdogan G, Artunay O. Macular and peripapillary microvasculature after dexamethasone injection in diabetic macular edema. Eur J Ophthalmol 2021; 32:2752-2759. [PMID: 34766511 DOI: 10.1177/11206721211057695] [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: 11/16/2022]
Abstract
PURPOSE To evaluate the microvascular changes in the macular and peripapillary area after intravitreal dexamethasone implant in diabetic macular edema (DME). MATERIAL AND METHODS We included 31 eyes of 31 patients treated with a single dose dexamethasone implant for DME. All subjects underwent swept-source optical coherence tomography (OCT) and OCT angiography imaging before (T0), and one month (T1), two months (T2), and four months (T4) after dexamethasone injection. The foveal avascular zone (FAZ) area of superficial and deep capillary plexus (SCP and DCP) was calculated by delineating the FAZ border using the measurement tool of the device. The vessel density (VD) of SCP and DCP and choriocapillaris (CC) in the macular and peripapillary area were automatically calculated. RESULTS There was an insignificant reduction in FAZ area measurements of SCP after dexamethasone injection in DME patients (p = 0.846). The FAZ area of DCP were significantly smaller compared to T0 measurements at T1, T2, and T4 (p = 0.013, p = 0.031, and p = 0.029, respectively). The mean average parafoveal VD measurements were significantly decreased after dexamethasone injection in SCP and DCP (p = 0.004, p = 0.005). The peripapillary VD in retinal capillary plexuses and choriocapillaris showed no significant difference after dexamethasone injection. CONCLUSION Intravitreal dexamethasone leads to a significant FAZ area decrease in DCP with a reduction in parafoveal VD measurements. In addition, no significant VD changes were observed in the peripapillary area after dexamethasone. These findings indicate that dexamethasone may improve macular ischemia with no significant effects on peripapillary microvasculature in DME patients.
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Affiliation(s)
- Sehnaz Ozcalıskan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Seren Pehlıvanoglu
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Zahid Huseyınhan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Alagoz
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Erdogan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Artunay
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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ElShazly MI, Elessawy KB, Salama MM. Short-term effect of weight loss after bariatric surgery on IOP, RNFL thickness, and the optic nerve head blood flow measured by OCTA. Eur J Ophthalmol 2021; 32:2153-2158. [PMID: 34617478 DOI: 10.1177/11206721211048365] [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: 11/15/2022]
Abstract
PURPOSE To study the influence of weight reduction after bariatric surgery on the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, and blood flow of optic nerve head by optical coherence tomography angiography (OCTA). METHODS This prospective observational cohort study included 60 obese patients. Body mass index (BMI), IOP, RNFL, and ganglion cell complex (GCC) thickness, rim area, and radial peripapillary capillary (RPC) vessel density were assessed before and 3 months after bariatric surgery. RESULTS The BMI and the IOP showed significant postoperative reduction to 40.45 ± 4.3 kg/m2 and 14.83 ± 2.5 mmHg while the preoperative results were 51.13 ± 4.83 kg/m2 and 16.95 ± 4.2 mm (p < 0.0001), respectively. No statistically significant change was detected in the RNFL, GCC thickness, rim area, or the RPC vessel density (p > 0.05). No statistically significant correlation was detected between the BMI changes and changes in the IOP, RNFL thickness, rim area, GCC thickness, or RPC vessel density. CONCLUSION No significant effect of bariatric surgery on the RNFL thickness and the optic nerve head blood flow measured by OCTA despite a significant IOP reduction 3 months post-surgical. OCTA can be a useful tool to assess the short-term influence of significant weight reduction on the retinal microcirculation. SUMMARY Despite a significant BMI and IOP reduction following bariatric surgery in obese patients, the vascular flow of the ONH, measured by OCTA, and the RNFL thickness were not significantly affected. The former might be attributed to the complex autoregulatory mechanisms related to the ONH and its microcirculation.
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Tripathy S, Le HG, Cicinelli MV, Gill MK. Longitudinal Changes on Optical Coherence Tomography Angiography in Retinal Vein Occlusion. J Clin Med 2021; 10:jcm10071423. [PMID: 33916005 PMCID: PMC8037411 DOI: 10.3390/jcm10071423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 01/26/2023] Open
Abstract
Background: To evaluate the longitudinal changes on optical coherence tomography angiography (OCTA) in retinal vein occlusion (RVO). Methods: Retrospective study of patients with RVO treated with intravitreal anti-vascular endothelial growth factors (VEGF) for macular edema. Foveal avascular zone (FAZ) area, vessel density (VD), vessel length density (VLD), and adjusted flow index (AFI) were calculated. The unaffected eye of each participant was used as a control. Results: Twelve RVO eyes were included, receiving 6 ± 3 anti-VEGF injections over a follow-up of 10.4 ± 3.1 months. Compared to fellow eyes, RVO eyes had lower VD and VLD at inclusion (p = 0.07 and p = 0.04) and last visit (p = 0.002 and p < 0.001). VD, AFI, and VLD did not change over time, while FAZ area increased in RVO eyes (+0.016 ± 0.024 mm2, p = 0.04). AFI correlated with duration of disease (r = 0.63, p = 0.02). Visual acuity was inversely related to VD and VLD over the follow-up. Conclusions: OCTA parameters remained stable with sustained anti-VEGF treatment in RVO, while changes in the FAZ area may suggest capillary remodeling after RVO.
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Affiliation(s)
- Swetapadma Tripathy
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
| | - Hong-Gam Le
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Manjot K. Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
- Correspondence:
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Towards Automated Eye Diagnosis: An Improved Retinal Vessel Segmentation Framework Using Ensemble Block Matching 3D Filter. Diagnostics (Basel) 2021; 11:diagnostics11010114. [PMID: 33445723 PMCID: PMC7828181 DOI: 10.3390/diagnostics11010114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Automated detection of vision threatening eye disease based on high resolution retinal fundus images requires accurate segmentation of the blood vessels. In this regard, detection and segmentation of finer vessels, which are obscured by a considerable degree of noise and poor illumination, is particularly challenging. These noises include (systematic) additive noise and multiplicative (speckle) noise, which arise due to various practical limitations of the fundus imaging systems. To address this inherent issue, we present an efficient unsupervised vessel segmentation strategy as a step towards accurate classification of eye diseases from the noisy fundus images. To that end, an ensemble block matching 3D (BM3D) speckle filter is proposed for removal of unwanted noise leading to improved detection. The BM3D-speckle filter, despite its ability to recover finer details (i.e., vessels in fundus images), yields a pattern of checkerboard artifacts in the aftermath of multiplicative (speckle) noise removal. These artifacts are generally ignored in the case of satellite images; however, in the case of fundus images, these artifacts have a degenerating effect on the segmentation or detection of fine vessels. To counter that, an ensemble of BM3D-speckle filter is proposed to suppress these artifacts while further sharpening the recovered vessels. This is subsequently used to devise an improved unsupervised segmentation strategy that can detect fine vessels even in the presence of dominant noise and yields an overall much improved accuracy. Testing was carried out on three publicly available databases namely Structured Analysis of the Retina (STARE), Digital Retinal Images for Vessel Extraction (DRIVE) and CHASE_DB1. We have achieved a sensitivity of 82.88, 81.41 and 82.03 on DRIVE, SATARE, and CHASE_DB1, respectively. The accuracy is also boosted to 95.41, 95.70 and 95.61 on DRIVE, SATARE, and CHASE_DB1, respectively. The performance of the proposed methods on images with pathologies was observed to be more convincing than the performance of similar state-of-the-art methods.
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11
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Ghassemi F, Berijani S, Roohipoor R, Mohebbi M, Babeli A, Gholizadeh A, Sabour S. Vascular density of optic nerve head in diabetic retinopathy using optical coherence tomography angiography. Int J Retina Vitreous 2020; 6:62. [PMID: 33292768 PMCID: PMC7709440 DOI: 10.1186/s40942-020-00269-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/24/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To measure optic nerve head (ONH) blood perfusion using optical coherence tomography angiography (OCTA) at various stages of diabetic retinopathy (DR). METHODS One hundred seventy six eyes of 94 patients included in this retrospective single-centre cross-sectional study. The subjects were studied in normal, no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR) and proliferative retinopathy (PDR) groups. The eyes were subjected to AngioDisc ONH imaging using OCTA for papillary (Disc) and peripapillary (RPC) vascular density (VD) evaluation. RESULTS The mean age of the participants was 56.08 ± 8.87 years and 34 (36.2 percent) were male. With increased DR severity, a statistically significant decrease in peripapillary VD was found. The study showed that only VD of the whole RPC (W-RPC) could be a valid biomarker in the staging assessment. VD of RPC, in all subsections, was considerably different from normal cases in the PDR group. Visual acuity was correlated with whole image ONH VD. The duration of DM, FBS, hyperlipidemia and DME had no effect on the ONH perfusion. CONCLUSIONS The study showed that only the W-RPC VD could be a reasonable marker in the staging assessment. VDs assessed by OCTA can be useful for assessing and tracking early ONH changes in DR patients.
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Affiliation(s)
- Fariba Ghassemi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
- Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sahar Berijani
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Ramak Roohipoor
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mohebbi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Babeli
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Alireza Gholizadeh
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Siamak Sabour
- Cornea Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Epidemiology, School of Health and Safety, Safety Promotion and Injury Prevention Research Centre, Tehran, Iran
- Department of Clinical Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim KM, Lee MW, Lim HB, Koo HM, Shin YI, Kim JY. Repeatability of measuring the vessel density in patients with retinal vein occlusion: An optical coherence tomography angiography study. PLoS One 2020; 15:e0234933. [PMID: 32584907 PMCID: PMC7316309 DOI: 10.1371/journal.pone.0234933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the repeatability of superficial vessel density measurements using Spectral domain Ocular coherence tomography angiography(SD-OCTA) in patients diagnosed with retinal vein occlusion(RVO). Design Prospective observational study. Subjects Patients who visited our retinal clinic from August 2017 to August 2018, diagnosed with RVO were recruited for the study. Methods Two consecutive 3×3 mm pattern scans were performed using the Cirrus HD-OCT 5000 along with AngioPlex software (Carl Zeiss Meditec) in each eye by single skilled examiner. All scans were analyzed using en face OCTA images to measure vessel density (VD) automatically. For further analysis of the effect of central macular thickness(CMT), eyes were divided into two groups according to CMT of 400μm (Group 1: CMT > 400μm, Group 2: CMT < 400μm). To identify factors affecting the repeatability of VD measurements, linear regression analyses were conducted for the coefficient of variation (CV) of VD by investigating demographics and ocular variables. Main outcome measures The intraclass correlation coefficient (ICC), coefficient of variation (CV) of VD measurements. Results A total of 57 eyes from 57 patients were examined: 35 eyes with BRVO and 22 eyes with CRVO. In all 57 eyes with RVO, the ICC and CV of the full VD(VD of 3mm diameter circle) were 0.800 and 10.61%, respectively. Univariate analyses showed that the mean CMT (B, 0.001; p<0.001) and mean ganglion cell-Inner plexiform layer (GC-IPL) thickness (B, −0.002; p = 0.020) were significant factors that affected the repeatability. Multivariate analyses of these two factors showed that only mean CMT was a significant factor. The ICC and CV of the full VD in group 1 (CMT > 400μm) were 0.348 and 22.55% respectively. In group 2 (CMT < 400μm), the ICC and CV of the full VD were 0.910 and 7.76%, respectively. Conclusions The repeatability of VD measurement in eyes with RVO was reasonably comparable to previous studies. Repeatability of VD measurement was significantly affected by central macular thickness.
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Affiliation(s)
- Kyeung-Min Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hyung-Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyung-Moon Koo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong-Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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