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Sperlich K, Bohn S, Reichert KM, Stolz H, Guthoff RF, Stachs O, Allgeier S. [Chromatic Swept-Source Laser Scanning - Concept for a Cell-Resolving Confocal Laser Slit Lamp?]. Klin Monbl Augenheilkd 2023; 240:1375-1382. [PMID: 38092004 DOI: 10.1055/a-2184-9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND The in vivo characterisation of corneal epithelial tissue morphology is of considerable importance for diagnosis, disease prognosis, and the development of a treatment strategy for ocular surface diseases. In contrast to many alternative methods, in vivo corneal confocal microscopy (CCM) not only provides a macroscopic description of the corneal tissue but also allows its visualisation with cellular resolution. However, the translation of CCM from research to clinical practice is significantly limited by the complex and still largely manual operation of available CCM systems. In addition, for cross-sectional images, and analogously to conventional slit lamp microscopy, volume data must be acquired in time-consuming depth scans due to the frontal orientation of the image field in CCM, from which depth slices can subsequently be calculated. The pure acquisition time is already in the range of seconds, and additionally, motion artefacts have to be corrected in a sophisticated way. MATERIALS AND METHODS This paper presents the concept and optics simulation of a new imaging technique based on a swept-source laser in combination with special chromatic optics. Here, the laser periodically changes its wavelength and is focused at different depths due to the wavelength-dependent aberration of the chromatic optics. RESULTS The optics simulation results promise good optical resolution at a total imaging depth of 145 µm. CONCLUSION The long-term goal is cell-resolving in vivo corneal confocal microscopy in real time with differently oriented sectioning directions.
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Affiliation(s)
- Karsten Sperlich
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland
- Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Sebastian Bohn
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland
- Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Klaus-Martin Reichert
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | | | - Rudolf F Guthoff
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland
- Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Oliver Stachs
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland
- Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Stephan Allgeier
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
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Grijalva Garces D, Strauß S, Gretzinger S, Schmieg B, Jüngst T, Groll J, Meinel L, Schmidt I, Hartmann H, Schenke-Layland K, Brandt N, Selzer M, Zimmermann S, Koltay P, Southan A, Tovar GEM, Schmidt S, Weber A, Ahlfeld T, Gelinsky M, Scheibel T, Detsch R, Boccaccini AR, Naolou T, Lee-Thedieck C, Willems C, Groth T, Allgeier S, Köhler B, Friedrich T, Briesen H, Buchholz J, Paulus D, von Gladiss A, Hubbuch J. On the reproducibility of extrusion-based bioprinting: round robin study on standardization in the field. Biofabrication 2023; 16:015002. [PMID: 37769669 DOI: 10.1088/1758-5090/acfe3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
The outcome of three-dimensional (3D) bioprinting heavily depends, amongst others, on the interaction between the developed bioink, the printing process, and the printing equipment. However, if this interplay is ensured, bioprinting promises unmatched possibilities in the health care area. To pave the way for comparing newly developed biomaterials, clinical studies, and medical applications (i.e. printed organs, patient-specific tissues), there is a great need for standardization of manufacturing methods in order to enable technology transfers. Despite the importance of such standardization, there is currently a tremendous lack of empirical data that examines the reproducibility and robustness of production in more than one location at a time. In this work, we present data derived from a round robin test for extrusion-based 3D printing performance comprising 12 different academic laboratories throughout Germany and analyze the respective prints using automated image analysis (IA) in three independent academic groups. The fabrication of objects from polymer solutions was standardized as much as currently possible to allow studying the comparability of results from different laboratories. This study has led to the conclusion that current standardization conditions still leave room for the intervention of operators due to missing automation of the equipment. This affects significantly the reproducibility and comparability of bioprinting experiments in multiple laboratories. Nevertheless, automated IA proved to be a suitable methodology for quality assurance as three independently developed workflows achieved similar results. Moreover, the extracted data describing geometric features showed how the function of printers affects the quality of the printed object. A significant step toward standardization of the process was made as an infrastructure for distribution of material and methods, as well as for data transfer and storage was successfully established.
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Affiliation(s)
- David Grijalva Garces
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
- Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Svenja Strauß
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
- Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sarah Gretzinger
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
- Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Barbara Schmieg
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
- Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tomasz Jüngst
- Department for Functional Materials in Medicine and Dentistry, Institute of Functional Materials and Biofabrication, University of Würzburg, Würzburg, Germany
- Bavarian Polymer Institute, University of Bayreuth, Bayreuth, Germany
| | - Jürgen Groll
- Department for Functional Materials in Medicine and Dentistry, Institute of Functional Materials and Biofabrication, University of Würzburg, Würzburg, Germany
- Bavarian Polymer Institute, University of Bayreuth, Bayreuth, Germany
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Würzburg, Germany
| | - Isabelle Schmidt
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Hanna Hartmann
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Nico Brandt
- Institute for Applied Materials, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Michael Selzer
- Institute for Nanotechnology, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Stefan Zimmermann
- Laboratory for MEMS Applications, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Peter Koltay
- Laboratory for MEMS Applications, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Alexander Southan
- Institute of Interfacial Process Engineering and Plasma Technology, University of Stuttgart, Stuttgart, Germany
- Functional Surfaces and Materials, Fraunhofer Institute for Interfacial Engineering and Biotechnology, Stuttgart, Germany
| | - Günter E M Tovar
- Institute of Interfacial Process Engineering and Plasma Technology, University of Stuttgart, Stuttgart, Germany
- Functional Surfaces and Materials, Fraunhofer Institute for Interfacial Engineering and Biotechnology, Stuttgart, Germany
| | - Sarah Schmidt
- Functional Surfaces and Materials, Fraunhofer Institute for Interfacial Engineering and Biotechnology, Stuttgart, Germany
| | - Achim Weber
- Functional Surfaces and Materials, Fraunhofer Institute for Interfacial Engineering and Biotechnology, Stuttgart, Germany
| | - Tilman Ahlfeld
- Center for Translational Bone, Joint, and Soft Tissue Research, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michael Gelinsky
- Center for Translational Bone, Joint, and Soft Tissue Research, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thomas Scheibel
- Bavarian Polymer Institute, University of Bayreuth, Bayreuth, Germany
- Chair of Biomaterials, University of Bayreuth, Bayreuth, Germany
| | - Rainer Detsch
- Institute of Biomaterials, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Aldo R Boccaccini
- Institute of Biomaterials, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Toufik Naolou
- Institute of Cell Biology and Biophysics, Leibniz University Hannover, Hannover, Germany
| | - Cornelia Lee-Thedieck
- Institute of Cell Biology and Biophysics, Leibniz University Hannover, Hannover, Germany
| | - Christian Willems
- Department Biomedical Materials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Groth
- Department Biomedical Materials, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
| | - Tiaan Friedrich
- Process Systems Engineering, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Heiko Briesen
- Process Systems Engineering, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Janine Buchholz
- Institute for Computational Visualistics, Active Vision Group, University of Koblenz, Koblenz, Germany
| | - Dietrich Paulus
- Institute for Computational Visualistics, Active Vision Group, University of Koblenz, Koblenz, Germany
| | - Anselm von Gladiss
- Institute for Computational Visualistics, Active Vision Group, University of Koblenz, Koblenz, Germany
| | - Jürgen Hubbuch
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
- Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Stache N, Bohn S, Sperlich K, George C, Winter K, Schaub F, Do HV, Röhlig M, Reichert KM, Allgeier S, Stachs O, Stachs A, Sterenczak KA. Taxane-Induced Neuropathy and Its Ocular Effects-A Longitudinal Follow-up Study in Breast Cancer Patients. Cancers (Basel) 2023; 15:cancers15092444. [PMID: 37173911 PMCID: PMC10177451 DOI: 10.3390/cancers15092444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
A common severe neurotoxic side effect of breast cancer (BC) therapy is chemotherapy-induced peripheral neuropathy (CIPN) and intervention is highly needed for the detection, prevention, and treatment of CIPN at an early stage. As the eye is susceptible to neurotoxic stimuli, the present study aims to determine whether CIPN signs in paclitaxel-treated BC patients correlate with ocular changes by applying advanced non-invasive biophotonic in vivo imaging. Patients (n = 14, 10 controls) underwent monitoring sessions after diagnosis, during, and after therapy (T0-T3). Monitoring sessions included general anamnesis, assessment of their quality of life, neurological scores, ophthalmological status, macular optical coherence tomography (OCT), and imaging of their subbasal nerve plexus (SNP) by large-area confocal laser-scanning microscopy (CLSM). At T0, no significant differences were detected between patients and controls. During treatment, patients' scores significantly changed while the greatest differences were found between T0 and T3. None of the patients developed severe CIPN but retinal thickenings could be detected. CLSM revealed large SNP mosaics with identical areas while corneal nerves remained stable. The study represents the first longitudinal study combining oncological examinations with advanced biophotonic imaging techniques, demonstrating a powerful tool for the objective assessment of the severity of neurotoxic events with ocular structures acting as potential biomarkers.
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Affiliation(s)
- Nadine Stache
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Obstetrics and Gynecology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18059 Rostock, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18059 Rostock, Germany
| | - Christian George
- Department of Obstetrics and Gynecology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Ha-Vy Do
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Martin Röhlig
- Institute for Visual and Analytic Computing, University of Rostock, 18059 Rostock, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University Rostock, 18059 Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Katharina A Sterenczak
- Department of Obstetrics and Gynecology, Rostock University Medical Center, 18059 Rostock, Germany
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Matuszewska-Iwanicka A, Stratmann B, Stachs O, Allgeier S, Bartschat A, Winter K, Guthoff R, Tschoepe D, Hettlich HJ. Mosaic vs. Single Image Analysis with Confocal Microscopy of the Corneal Nerve Plexus for Diagnosis of Early Diabetic Peripheral Neuropathy. Ophthalmol Ther 2022; 11:2211-2223. [PMID: 36184730 DOI: 10.1007/s40123-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The assessment of the corneal nerve fibre plexus with corneal confocal microscopy (CCM) is an upcoming but still experimental method in the diagnosis of early stage diabetic peripheral neuropathy (DPN). Using an innovative imaging technique-Heidelberg Retina Tomograph equipped with the Rostock Cornea Module (HRT-RCM) and EyeGuidance module (EG)-we were able to look at greater areas of subbasal nerve plexus (SNP) in order to increase the diagnostic accuracy. The aim of our study was to evaluate the usefulness of EG instead of single image analysis in diagnosis of early stage DPN. METHODS This prospective study was performed on 60 patients with type 2 diabetes mellitus, classified equally into two subgroups based on neuropathy deficient score (NDS): patients without DPN (group 1) or with mild DPN (group 2). The following parameters were analysed in the two subgroups: corneal nerve fibre length (CNFL; mm/mm2), corneal nerve fibre density (CNFD; no./mm2), corneal nerve branch density (CNBD; no./mm2). Furthermore, we compared the data calculated with the novel mosaic, EG-based method with those received from single image analysis using different quantification tools. RESULTS Using EG we did not find a significant difference between group 1 and group 2: CNFL (16.81 ± 5.87 mm/mm2 vs. 17.19 ± 7.19 mm/mm2, p = 0.895), CNFD (254.05 ± 115.36 no./mm2 vs. 265.91 ± 161.63 no./mm2, p = 0.732) and CNBD (102.68 ± 62.28 no./mm2 vs. 115.38 ± 96.91 no./mm2, p = 0.541). No significant difference between the EG method of analysing the SNP and the single image analysis of 10 images per patient was detected. CONCLUSION On the basis of our results it was not possible to differentiate between early stages of large nerve fibre DPN in patients with type 2 diabetes mellitus via SNP analysis. To improve sensitivity and specificity of this method newer technologies are under current evaluation. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05326958.
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Affiliation(s)
- Aleksandra Matuszewska-Iwanicka
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany.
| | - Bernd Stratmann
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Diethelm Tschoepe
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
- Stiftung DHD (Der herzkranke Diabetiker) Stiftung in der Deutschen Diabetes-Stiftung, Bad Oeynhausen, Germany
| | - Hans-Joachim Hettlich
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany
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Stache N, Sterenczak KA, Sperlich K, Marfurt CF, Allgeier S, Köhler B, Mikut R, Bartschat A, Reichert KM, Guthoff RF, Stachs A, Stachs O, Bohn S. Assessment of dynamic corneal nerve changes using static landmarks by in vivo large-area confocal microscopy—a longitudinal proof-of-concept study. Quant Imaging Med Surg 2022; 12:4734-4746. [PMID: 36185050 PMCID: PMC9511428 DOI: 10.21037/qims-22-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022]
Abstract
Background The purpose of the present proof-of-concept study was to use large-area in vivo confocal laser scanning microscopy (CLSM) mosaics to determine the migration rates of nerve branching points in the human corneal subbasal nerve plexus (SNP). Methods Three healthy individuals were examined roughly weekly over a total period of six weeks by large-area in vivo confocal microscopy of the central cornea. An in-house developed prototype system for guided eye movement with an acquisition time of 40 s was used to image and generate large-area mosaics of the SNP. Kobayashi-structures and nerve entry points (EPs) were used as fixed structures to enable precise mosaic registration over time. The migration rate of 10 prominent nerve fiber branching points per participant was tracked and quantified over the longitudinal period. Results Total investigation times of 10 minutes maximum per participant were used to generate mosaic images with an average size of 3.61 mm2 (range: 3.18–4.42 mm2). Overall mean branching point migration rates of (46.4±14.3), (48.8±15.5), and (50.9±13.9) µm/week were found for the three participants with no statistically significant difference. Longitudinal analyses of nerve branching point migration over time revealed significant time-dependent changes in migration rate only in participant 3 between the last two measurements [(63.7±12.3) and (43.0±12.5) µm/week, P<0.01]. Considering individual branching point dynamics, significant differences in nerve migration rate from the mean were only found in a few exceptions. Conclusions The results of this proof-of-concept study have demonstrated the feasibility of using in vivo confocal microscopy to study the migration rates of corneal subbasal nerves within large areas of the central human cornea (>1 mm2). The ability to monitor dynamic changes in the SNP opens a window to future studies of corneal nerve health and regenerative capacity in a number of systemic and ocular diseases. Since corneal nerves are considered part of the peripheral nervous system, this technique could also offer an objective diagnostic tool and biomarker for disease- or treatment-induced neuropathic changes.
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Affiliation(s)
- Nadine Stache
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Katharina A. Sterenczak
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Carl F. Marfurt
- Department of Anatomy Cell Biology & Physiology, Indiana University School of Medicine-Northwest, Gary, USA
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ralf Mikut
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department Life, Light & Matter, University of Rostock, Rostock, Germany
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Bohn S, Stache N, Sperlich K, Allgeier S, Köhler B, Bartschat A, Do HV, George C, Guthoff RF, Stachs A, Stachs O, Sterenczak KA. In Vivo Monitoring of Corneal Dendritic Cells in the Subbasal Nerve Plexus during Trastuzumab and Paclitaxel Breast Cancer Therapy—A One-Year Follow-Up. Diagnostics (Basel) 2022; 12:diagnostics12051180. [PMID: 35626335 PMCID: PMC9139605 DOI: 10.3390/diagnostics12051180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Paclitaxel and trastuzumab have been associated with adverse effects including chemotherapy-induced peripheral neuropathy (CIPN) or ocular complications. In vivo confocal laser scanning microscopy (CLSM) of the cornea could be suitable for assessing side effects since the cornea is susceptible to, i.e., neurotoxic stimuli. The study represents a one-year follow-up of a breast cancer patient including large-area in vivo CLSM of the subbasal nerve plexus (SNP), nerve function testing, and questionnaires during paclitaxel and trastuzumab therapy. Six monitoring sessions (one baseline, four during, and one after therapy) over 58 weeks were carried out. Large-area mosaics of the SNP were generated, and identical regions within all sessions were assigned. While corneal nerve morphology did not cause alterations, the number of dendritic cells (DCs) showed dynamic changes with a local burst at 11 weeks after baseline. Simultaneously, paclitaxel treatment was terminated due to side effects, which, together with DCs, returned to normal levels as the therapy progressed. Longitudinal in vivo CLSM of the SNP could complement routine examinations and be helpful to generate a comprehensive clinical picture. The applied techniques, with corneal structures acting as biomarkers could represent a diagnostic tool for the objective assessment of the severity of adverse events and the outcome.
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Affiliation(s)
- Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Nadine Stache
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Ha-Vy Do
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
| | - Christian George
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Katharina Anna Sterenczak
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (S.B.); (N.S.); (K.S.); (H.-V.D.); (R.F.G.); (O.S.)
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
- Correspondence:
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Allgeier S, Bartschat A, Bohn S, Guthoff RF, Hagenmeyer V, Kornelius L, Mikut R, Reichert KM, Sperlich K, Stache N, Stachs O, Köhler B. Real-time large-area imaging of the corneal subbasal nerve plexus. Sci Rep 2022; 12:2481. [PMID: 35169133 PMCID: PMC8847362 DOI: 10.1038/s41598-022-05983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/21/2022] [Indexed: 11/21/2022] Open
Abstract
The morphometric assessment of the corneal subbasal nerve plexus (SNP) by confocal microscopy holds great potential as a sensitive biomarker for various ocular and systemic conditions and diseases. Automated wide-field montages (or large-area mosaic images) of the SNP provide an opportunity to overcome the limited field of view of the available imaging systems without the need for manual, subjective image selection for morphometric characterization. However, current wide-field montaging solutions usually calculate the mosaic image after the examination session, without a reliable means for the clinician to predict or estimate the resulting mosaic image quality during the examination. This contribution describes a novel approach for a real-time creation and visualization of a mosaic image of the SNP that facilitates an informed evaluation of the quality of the acquired image data immediately at the time of recording. In cases of insufficient data quality, the examination can be aborted and repeated immediately, while the patient is still at the microscope. Online mosaicking also offers the chance to identify an overlap of the imaged tissue region with previous SNP mosaic images, which can be particularly advantageous for follow-up examinations.
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Affiliation(s)
- Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Veit Hagenmeyer
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Lukas Kornelius
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ralf Mikut
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Nadine Stache
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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8
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Sterenczak KA, Stache N, Bohn S, Allgeier S, Köhler B, Bartschat A, George C, Guthoff RF, Stachs O, Stachs A. Burst of Corneal Dendritic Cells during Trastuzumab and Paclitaxel Treatment. Diagnostics (Basel) 2021; 11:diagnostics11050838. [PMID: 34066952 PMCID: PMC8148560 DOI: 10.3390/diagnostics11050838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022] Open
Abstract
During breast cancer therapy, paclitaxel and trastuzumab are both associated with adverse effects such as chemotherapy-induced peripheral neuropathy and other systemic side effects including ocular complications. Corneal nerves are considered part of the peripheral nervous system and can be imaged non-invasively by confocal laser scanning microscopy (CLSM) on the cellular level. Thus, in vivo CLSM imaging of structures of the corneal subbasal nerve plexus (SNP) such as sensory nerves or dendritic cells (DCs) can be a powerful tool for the assessment of corneal complications during cancer treatment. During the present study, the SNP of a breast cancer patient was analyzed over time by using large-scale in vivo CLSM in the course of paclitaxel and trastuzumab therapy. The same corneal regions could be re-identified over time. While the subbasal nerve morphology did not alter significantly, a change in dendritic cell density and an additional local burst within the first 11 weeks of therapy was detected, indicating treatment-mediated corneal inflammatory processes. Ocular structures such as nerves and dendritic cells could represent useful biomarkers for the assessment of ocular adverse effects during cancer therapy and their management, leading to a better visual prognosis.
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Affiliation(s)
- Katharina A. Sterenczak
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (N.S.); (S.B.); (R.F.G.); (O.S.)
- Correspondence:
| | - Nadine Stache
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (N.S.); (S.B.); (R.F.G.); (O.S.)
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (N.S.); (S.B.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76021 Karlsruhe, Germany; (S.A.); (B.K.); (A.B.)
| | - Christian George
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (N.S.); (S.B.); (R.F.G.); (O.S.)
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany; (N.S.); (S.B.); (R.F.G.); (O.S.)
- Department Life, Light & Matter, University of Rostock, 18059 Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, 18059 Rostock, Germany; (C.G.); (A.S.)
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9
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Sterenczak KA, Winter K, Sperlich K, Stahnke T, Linke S, Farrokhi S, Klemm M, Allgeier S, Köhler B, Reichert KM, Guthoff RF, Bohn S, Stachs O. Morphological characterization of the human corneal epithelium by in vivo confocal laser scanning microscopy. Quant Imaging Med Surg 2021; 11:1737-1750. [PMID: 33936961 DOI: 10.21037/qims-20-1052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Regarding the growing interest and importance of understanding the cellular changes of the cornea in diseases, a quantitative cellular characterization of the epithelium is becoming increasingly important. Towards this, the latest research offers considerable improvements in imaging of the cornea by confocal laser scanning microscopy (CLSM). This study presents a pipeline to generate normative morphological data of epithelial cell layers of healthy human corneas. Methods 3D in vivo CLSM was performed on the eyes of volunteers (n=25) with a Heidelberg Retina Tomograph II equipped with an in-house modified version of the Rostock Cornea Module implementing two dedicated piezo actuators and a concave contact cap. Image data were acquired with nearly isotropic voxel resolution. After image registration, stacks of en-face sections were used to generate full-thickness volume data sets of the epithelium. Beyond that, an image analysis algorithm quantified en-face sections of epithelial cells regarding the depth-dependent mean of cell density, area, diameter, aggregation (Clark and Evans index of aggregation), neighbor count and polygonality. Results Imaging and cell segmentation were successfully performed in all subjects. Thereby intermediated cells were efficiently recognized by the segmentation algorithm while efficiency for superficial and basal cells was reduced. Morphological parameters showed an increased mean cell density, decreased mean cell area and mean diameter from anterior to posterior (5,197.02 to 8,190.39 cells/mm2; 160.51 to 90.29 µm2; 15.9 to 12.3 µm respectively). Aggregation gradually increased from anterior to posterior ranging from 1.45 to 1.53. Average neighbor count increased from 5.50 to a maximum of 5.66 followed by a gradual decrease to 5.45 within the normalized depth from anterior to posterior. Polygonality gradually decreased ranging from 4.93 to 4.64 sides of cells. The neighbor count and polygonality parameters exhibited profound depth-dependent changes. Conclusions This in vivo study demonstrates the successful implementation of a CLSM-based imaging pipeline for cellular characterization of the human corneal epithelium. The dedicated hardware in combination with an adapted image registration method to correct the remaining motion-induced image distortions followed by a dedicated algorithm to calculate characteristic quantities of different epithelial cell layers enabled the generation of normative data. Further significant effort is necessary to improve the algorithm for superficial and basal cell segmentation.
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Affiliation(s)
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Thomas Stahnke
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Stephan Linke
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Zentrumsehstärke, Hamburg, Germany
| | - Sanaz Farrokhi
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Klemm
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
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10
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Andréasson M, Lagali N, Badian RA, Utheim TP, Scarpa F, Colonna A, Allgeier S, Bartschat A, Köhler B, Mikut R, Reichert KM, Solders G, Samuelsson K, Zetterberg H, Blennow K, Svenningsson P. Parkinson's disease with restless legs syndrome-an in vivo corneal confocal microscopy study. NPJ Parkinsons Dis 2021; 7:4. [PMID: 33402694 PMCID: PMC7785738 DOI: 10.1038/s41531-020-00148-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
Small fiber neuropathy (SFN) has been suggested as a trigger of restless legs syndrome (RLS). An increased prevalence of peripheral neuropathy has been demonstrated in Parkinson's disease (PD). We aimed to investigate, in a cross-sectional manner, whether SFN is overrepresented in PD patients with concurrent RLS relative to PD patients without RLS, using in vivo corneal confocal microscopy (IVCCM) and quantitative sensory testing (QST) as part of small fiber assessment. Study participants comprised of age- and sex-matched PD patients with (n = 21) and without RLS (n = 21), and controls (n = 13). Diagnosis of RLS was consolidated with the sensory suggested immobilization test. Assessments included nerve conduction studies (NCS), Utah Early Neuropathy Scale (UENS), QST, and IVCCM, with automated determination of corneal nerve fiber length (CNFL) and branch density (CNBD) from wide-area mosaics of the subbasal nerve plexus. Plasma neurofilament light (p-NfL) was determined as a measure of axonal degeneration. No significant differences were found between groups when comparing CNFL (p = 0.81), CNBD (p = 0.92), NCS (p = 0.82), and QST (minimum p = 0.54). UENS scores, however, differed significantly (p = 0.001), with post-hoc pairwise testing revealing higher scores in both PD groups relative to controls (p = 0.018 and p = 0.001). Analysis of all PD patients (n = 42) revealed a correlation between the duration of L-dopa therapy and CNBD (ρ = -0.36, p = 0.022), and p-NfL correlated with UENS (ρ = 0.35, p = 0.026) and NCS (ρ = -0.51, p = 0.001). Small and large fiber neuropathy do not appear to be associated with RLS in PD. Whether peripheral small and/or large fiber pathology associates with central neurodegeneration in PD merits further longitudinal studies.
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Grants
- Received funding from Hofgren’s fond, NEURO Sweden, for the present study
- Massachusetts Department of Fish and Game (DFG)
- Parts of the work were funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Project 273371152
- HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG-720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), and the UK Dementia Research Institute at UCL. KB is supported by the Swedish Research Council (#2017-00915), the Alzheimer Drug Discovery Foundation (ADDF), USA (#RDAPB-201809-2016615), the Swedish Alzheimer Foundation (#AF-742881), Hjärnfonden, Sweden (#FO2017-0243), the Swedish State under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986), and European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236).
- Received funding from Region Stockholm ALF programme
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Affiliation(s)
- Mattias Andréasson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden.
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Reza A Badian
- Unit of Regenerative Medicine, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Fabio Scarpa
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Alessia Colonna
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ralf Mikut
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Göran Solders
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UCL Institute of Neurology, Department of Neurodegenerative Disease, Queen Square, London, UK
- UK Dementia Research Institute, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Per Svenningsson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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11
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Bohn S, Stahnke T, Sperlich K, Linke SJ, Farrokhi S, Klemm M, Allgeier S, Köhler B, Reichert KM, Witt M, Stachs O, Guthoff RF. In vivo Histology of the Cornea - from the "Rostock Cornea Module" to the "Rostock Electronic Slit Lamp" - a Clinical "Proof of Concept" Study. Klin Monbl Augenheilkd 2020; 237:1442-1454. [PMID: 33231276 DOI: 10.1055/a-1297-4717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Confocal in vivo microscopy is an established method in ophthalmology research. As it requires contact coupling and calibration of the instruments is suboptimal, this method has been only rarely used in clinical routine work. As a result of close collaboration between physicists, information scientists and ophthalmologists, confocal laser scanning microscopy (CLSM) of the eye has been developed in recent years and a prototype can now be used in patients. The present study evaluates possible clinical uses of this method. MATERIAL AND METHODS The essential innovations in CLSM are (1) a newly designed coupling element with superficial adaptation to corneal curvature and (2) the use of a dual computerised piezo drive for rapid and precise focusing. In post-processing and after elastic imaging registration of the individual images parallel to the surface, it is also possible to produce sagittal sections resembling a split lamp and with resolution in the micrometer range. The concept was tested on enucleated pig bulbi and tested on normal volunteers and selected patients with diseases of the cornea. RESULTS Simultaneous imaging in planes parallel to the surface and in sagittal planes provided additional information that can help us to understand the processes of wound healing in all substructures of the cornea and the role of immune competent cells. Possible clinical uses were demonstrated in a volunteer with healthy eyes and several groups of patients (keratoconus after CXL, recurrent keratitis, status after PRK). These show that this new approach can be used in morphological studies at cellular level in any desired and appropriate test plane. CONCLUSIONS It could be shown that this new concept of CLSM can be used clinically. It can provide valuable and novel information to both preclinical researchers and to ophthalmologists interested in corneal disease, e.g. density of Langerhans cells and epithelial stratification in ocular surface diseases.
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Affiliation(s)
- Sebastian Bohn
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Thomas Stahnke
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Karsten Sperlich
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Stephan J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland.,Augenarztpraxis am UKE, Zentrumsehstärke, Hamburg, Deutschland
| | - Sanaz Farrokhi
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland
| | - Maren Klemm
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland
| | - Stephan Allgeier
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Bernd Köhler
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Klaus-Martin Reichert
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Martin Witt
- Institut für Anatomie, Universitätsmedizin Rostock, Deutschland
| | - Oliver Stachs
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Rudolf F Guthoff
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
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12
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Bartschat A, Allgeier S, Bohn S, Scherr T, Blessing D, Reichert KM, Reischl M, Stachs O, Koehler B, Mikut R. [Digital Image Processing and Deep Neural Networks in Ophthalmology - Current Trends]. Klin Monbl Augenheilkd 2019; 236:1399-1406. [PMID: 31671462 DOI: 10.1055/a-1008-9400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of deep neural networks ("deep learning") creates new possibilities in digital image processing. This approach has been widely applied and successfully used for the evaluation of image data in ophthalmology. In this article, the methodological approach of deep learning is examined and compared to the classical approach for digital image processing. The differences between the approaches are discussed and the increasingly important role of training data for model generation is explained. Furthermore, the approach of transfer learning for deep learning is presented with a representative data set from the field of corneal confocal microscopy. In this context, the advantages of the method and the specific problems when dealing with medical microscope data will be discussed.
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Affiliation(s)
- Andreas Bartschat
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Stephan Allgeier
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Sebastian Bohn
- Augenklinik, Universitätsmedizin Rostock.,Department Leben, Licht und Materie, Universität Rostock
| | - Tim Scherr
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Denis Blessing
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Klaus-Martin Reichert
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Markus Reischl
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Oliver Stachs
- Augenklinik, Universitätsmedizin Rostock.,Department Leben, Licht und Materie, Universität Rostock
| | - Bernd Koehler
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
| | - Ralf Mikut
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie, Eggenstein-Leopoldshafen
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13
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Köhler B, Allgeier S, Bartschat A, Guthoff RF, Bohn S, Reichert KM, Stachs O, Winter K, Mikut R. [In vivo imaging of the corneal nerve plexus : From single image to large scale map]. Ophthalmologe 2018; 114:601-607. [PMID: 28283769 DOI: 10.1007/s00347-017-0464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The sub-basal nerve plexus (SNP) of the cornea provides the possibility of in vivo and non-invasive examination of peripheral nerve structures by corneal confocal microscopy (CCM). Thus morphological alterations of the SNP can be directly detected and quantified. A single CCM image is insufficient for a well-founded diagnosis because of the inhomogeneous distribution of the nerve fibers; therefore, there is a demand for techniques for large area imaging of the SNP. This article provides an overview of published approaches to the problem. Current developmental work at the Karlsruhe Institute of Technology and the University of Rostock Eye Clinic is expected to lead to a simplified handling of the technology and a further improvement in the image quality.
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Affiliation(s)
- B Köhler
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Kaiserstraße 12, 76131, Karlsruhe, Deutschland.
| | - S Allgeier
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Kaiserstraße 12, 76131, Karlsruhe, Deutschland
| | - A Bartschat
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Kaiserstraße 12, 76131, Karlsruhe, Deutschland
| | - R F Guthoff
- Universitätsaugenklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - S Bohn
- Universitätsaugenklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - K-M Reichert
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Kaiserstraße 12, 76131, Karlsruhe, Deutschland
| | - O Stachs
- Universitätsaugenklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - K Winter
- Institut für Anatomie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - R Mikut
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Kaiserstraße 12, 76131, Karlsruhe, Deutschland
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14
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Bohn S, Sperlich K, Allgeier S, Bartschat A, Prakasam R, Reichert KM, Stolz H, Guthoff R, Mikut R, Köhler B, Stachs O. Cellular in vivo 3D imaging of the cornea by confocal laser scanning microscopy. Biomed Opt Express 2018; 9:2511-2525. [PMID: 30258669 PMCID: PMC6154195 DOI: 10.1364/boe.9.002511] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 05/07/2023]
Abstract
We present an in vivo confocal laser scanning microscopy based method for large 3D reconstruction of the cornea on a cellular level with cropped volume sizes up to 266 x 286 x 396 µm3. The microscope objective used is equipped with a piezo actuator for automated, fast and precise closed-loop focal plane control. Furthermore, we present a novel concave surface contact cap, which significantly reduces eye movements by up to 87%, hence increasing the overlapping image area of the whole stack. This increases the cuboid volume of the generated 3D reconstruction significantly. The possibility to generate oblique sections using isotropic volume stacks opens the window to slit lamp microscopy on a cellular level.
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Affiliation(s)
- Sebastian Bohn
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Ruby Prakasam
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Klaus-Martin Reichert
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Heinrich Stolz
- Institute of Physics, University of Rostock, 18059 Rostock, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Ralf Mikut
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany
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Herlyn A, Prakasam RK, Peschel S, Allgeier S, Köhler B, Winter K, Guthoff RF, Mittlmeier T, Stachs O. Corneal Subbasal Nerve Plexus Changes in Severe Diabetic Charcot Foot Deformity: A Pilot Study in Search for a DNOAP Biomarker. J Diabetes Res 2018; 2018:5910639. [PMID: 30525053 PMCID: PMC6247393 DOI: 10.1155/2018/5910639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/26/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Diabetic neuroosteoarthropathy (DNOAP) early symptoms are unspecific, mimicking general infectious symptoms and rendering a diagnosis challenging. Consequently, unfavourable outcomes occur frequently, with recurrent foot ulceration, infectious complications, and eventually amputation. Corneal confocal microscopy (CCM) of the subbasal nerve plexus (SNP) is used to detect early peripheral neuropathy in diabetic patients without diabetic retinopathy. This pilot study was designed to determine if specific SNP changes manifest in severe DNOAP in comparison to a healthy control group. METHODS This pilot study utilized a matched-pair analysis to investigate SNP changes by in vivo CCM for 26 patients (mean patient age 63.7 years, range 27 to 78) with severe DNOAP defined by condition after the need for reconstructive foot surgery (n = 13) and a healthy control group (n = 13). Corneal nerve fibre length (CNFL), nerve fibre density (CNFD), nerve branch density (CNBD), average weighted corneal nerve fibre thickness (CNFTh), nerve connecting points (CNCP), and average weighted corneal nerve fibre tortuosity (CNFTo) were assessed as well as the general clinical status, diabetic status, and ophthalmologic basic criteria. RESULTS In vivo CCM revealed significantly reduced SNP parameters in the DNOAP group for CNFL (p = 0.010), CNFD (p = 0.037), CNBD (p = 0.049), and CNCP (p = 0.012) when compared to the healthy control group. Six patients (46%) of the DNOAP group suffered from diabetic retinopathy and none of the control group. CONCLUSIONS This pilot study revealed a rarefication of SNP in all measured parameters in patients with severe DNOAP. We see a potential value of CCM providing a SNP-based biomarker for early stages of DNOAP prior to the development of any foot deformities that needs to be evaluated in further studies. This trial is registered with German Clinical Trials Register (DKRS) DRKS00007537.
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Affiliation(s)
- Anica Herlyn
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Ruby Kala Prakasam
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße 140, 18057 Rostock, Germany
| | - Sabine Peschel
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße 140, 18057 Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - Bernd Köhler
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Liebigstrasse 13, 04103 Leipzig, Germany
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße 140, 18057 Rostock, Germany
| | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße 140, 18057 Rostock, Germany
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Lagali NS, Allgeier S, Guimarães P, Badian RA, Ruggeri A, Köhler B, Utheim TP, Peebo B, Peterson M, Dahlin LB, Rolandsson O. Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis. Invest Ophthalmol Vis Sci 2017; 58:6318-6327. [PMID: 29242906 DOI: 10.1167/iovs.17-22257] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine if corneal subbasal nerve plexus (SBP) parameters derived from wide-area depth-corrected mosaic images are associated with type 2 diabetes. Methods One hundred sixty-three mosaics were produced from eyes of 82 subjects by laser-scanning in vivo confocal microscopy (IVCM). Subjects were of the same age, without (43 subjects) or with type 2 diabetes (39 subjects). Mosaic corneal nerve fiber length density (mCNFL) and apical whorl corneal nerve fiber length density (wCNFL) were quantified and related to the presence and duration of diabetes (short duration < 10 years and long duration ≥ 10 years). Results In mosaics with a mean size of 6 mm2 in subjects aged 69.1 ± 1.2 years, mCNFL in type 2 diabetes was reduced relative to nondiabetic subjects (13.1 ± 4.2 vs. 15.0 ± 3.2 mm/mm2, P = 0.018). Also reduced relative to nondiabetic subjects was mCNFL in both short-duration (14.0 ± 4.0 mm/mm2, 3.2 ± 3.9 years since diagnosis) and long-duration diabetes (12.7 ± 4.2 mm/mm2, 15.4 ± 4.2 years since diagnosis; ANOVA P = 0.023). Lower mCNFL was associated with presence of diabetes (P = 0.032) and increased hemoglobin A1c (HbA1c) levels (P = 0.047). By contrast, wCNFL was unaffected by diabetes or HbA1c (P > 0.05). Global SBP patterns revealed marked degeneration of secondary nerve fiber branches outside the whorl region in long-duration diabetes. Conclusions Wide-area mosaic images provide reference values for mCNFL and wCNFL and reveal a progressive degeneration of the SBP with increasing duration of type 2 diabetes.
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Affiliation(s)
- Neil S Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Stephan Allgeier
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Pedro Guimarães
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Reza A Badian
- Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Stavanger University Hospital, Stavanger/Clinical Institute 1, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Alfredo Ruggeri
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Bernd Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tor Paaske Utheim
- Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Beatrice Peebo
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden
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Allgeier S, Reichert K, Stachs O, Köhler B. Mosaicking the subbasal nerve plexus. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.03122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Allgeier
- Institute for Applied Computer Science; Karlsruhe Institute of Technology KIT; Eggenstein-Leopoldshafen Germany
| | - K.M. Reichert
- Institute for Applied Computer Science; Karlsruhe Institute of Technology KIT; Eggenstein-Leopoldshafen Germany
| | - O. Stachs
- Department of Ophthalmology; University of Rostock; Rostock Germany
| | - B. Köhler
- Institute for Applied Computer Science; Karlsruhe Institute of Technology KIT; Eggenstein-Leopoldshafen Germany
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Ziegler D, Winter K, Strom A, Zhivov A, Allgeier S, Papanas N, Ziegler I, Brüggemann J, Ringel B, Peschel S, Köhler B, Stachs O, Guthoff RF, Roden M. Spatial analysis improves the detection of early corneal nerve fiber loss in patients with recently diagnosed type 2 diabetes. PLoS One 2017; 12:e0173832. [PMID: 28296936 PMCID: PMC5352008 DOI: 10.1371/journal.pone.0173832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022] Open
Abstract
Corneal confocal microscopy (CCM) has revealed reduced corneal nerve fiber (CNF) length and density (CNFL, CNFD) in patients with diabetes, but the spatial pattern of CNF loss has not been studied. We aimed to determine whether spatial analysis of the distribution of corneal nerve branching points (CNBPs) may contribute to improving the detection of early CNF loss. We hypothesized that early CNF decline follows a clustered rather than random distribution pattern of CNBPs. CCM, nerve conduction studies (NCS), and quantitative sensory testing (QST) were performed in a cross-sectional study including 86 patients recently diagnosed with type 2 diabetes and 47 control subjects. In addition to CNFL, CNFD, and branch density (CNBD), CNBPs were analyzed using spatial point pattern analysis (SPPA) including 10 indices and functional statistics. Compared to controls, patients with diabetes showed lower CNBP density and higher nearest neighbor distances, and all SPPA parameters indicated increased clustering of CNBPs (all P<0.05). SPPA parameters were abnormally increased >97.5th percentile of controls in up to 23.5% of patients. When combining an individual SPPA parameter with CNFL, ≥1 of 2 indices were >99th or <1st percentile of controls in 28.6% of patients compared to 2.1% of controls, while for the conventional CNFL/CNFD/CNBD combination the corresponding rates were 16.3% vs 2.1%. SPPA parameters correlated with CNFL and several NCS and QST indices in the controls (all P<0.001), whereas in patients with diabetes these correlations were markedly weaker or lost. In conclusion, SPPA reveals increased clustering of early CNF loss and substantially improves its detection when combined with a conventional CCM measure in patients with recently diagnosed type 2 diabetes.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrey Zhivov
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Stephan Allgeier
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Iris Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Jutta Brüggemann
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Bernd Ringel
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Sabine Peschel
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Bernd Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Rudolf F. Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Winter K, Scheibe P, Guthoff RF, Allgeier S, Stachs O. [Morphometric characterization of the subbasal nerve plexus : Detection and analysis of networks of nerve fibers]. Ophthalmologe 2017; 114:608-616. [PMID: 28224218 DOI: 10.1007/s00347-017-0465-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Confocal laser scanning microscopy is a versatile tool in medical research and enables noninvasive in vivo imaging of the corneal subbasal nerve plexus. The aim of this work is to provide a structured overview about the detection and quantification of nerve fibers of the subbasal nerve plexus from images acquired by confocal laser scanning microscopy. Relevant steps are explained and potential factors influencing the quality of the results are pointed out. Information obtained from the quantification of subbasal nerve fiber structure can be potentially used as clinical parameters in the context of diagnostics and therapy control of diabetic neuropathy.
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Affiliation(s)
- K Winter
- Institut für Anatomie, Medizinische Fakultät, Universität Leipzig, Liebigstr. 13, 04103, Leipzig, Deutschland.
| | - P Scheibe
- Sächsischer Inkubator für Klinische Translation (SIKT) Leipzig, Universität Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland
| | - R F Guthoff
- Universitätsaugenklinik, Universitätsmedizin Rostock, Doberaner Str. 140, Rostock, 18057, Deutschland
| | - S Allgeier
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie, Hermann-von-Helmholtz-Platz 1, Eggenstein-Leopoldshafen, 76344, Deutschland
| | - O Stachs
- Universitätsaugenklinik, Universitätsmedizin Rostock, Doberaner Str. 140, Rostock, 18057, Deutschland
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Allgeier S, Winter K, Bretthauer G, Guthoff RF, Peschel S, Reichert KM, Stachs O, Köhler B. A Novel Approach to Analyze the Progression of Measured Corneal Sub-Basal Nerve Fiber Length in Continuously Expanding Mosaic Images. Curr Eye Res 2016; 42:549-556. [PMID: 27767360 DOI: 10.1080/02713683.2016.1221977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose/Aim of the study: A recently proposed technique enables the generation of continuously increasing mosaic images of the corneal sub-basal nerve plexus (SNP) using in vivo corneal confocal microscopy (CCM). The aim of the present study was to investigate the progression of the corneal nerve fiber length (CNFL) measured in the growing mosaic images with regard to their increasing area. MATERIALS AND METHODS Five large datasets from three healthy volunteers were examined using the proposed CCM technique. Intermediate mosaic images were created and assessed for CNFL. RESULTS The measured CNFL progression shows both over- and underestimation of the CNFL for small observed areas. Increasing the mosaic image area stabilizes the CNFL values and reduces the moving variance in all five datasets. The relative deviation of means from values of first and second examination of two of the subjects shows high differences for an observed area of <1.5 mm2. CONCLUSIONS The present examination provides two measures to quantify different area-dependent aspects of the CNFL measured in an expanding mosaic image. The moving variance measures how stable the CNFL can be considered at a certain mosaic size. The relative deviation of means from two repeated CCM examinations on the other hand gives some indication on the level of reliability that can be expected from the measured CNFL. The progression of CNFL in the examined datasets manifests a potentially very high variability for mosaic sizes of less than about 1.5 mm2. Above that size, CNFL progression and the intra-patient relative deviations both stabilize significantly in all five datasets. The results of the present examination suggest a recommendation for a minimum sampled area of the central SNP of 1.5 mm2 for reliable and meaningful measurement of CNFL.
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Affiliation(s)
- Stephan Allgeier
- a Institute for Applied Computer Science , Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany
| | - Karsten Winter
- b Institute of Anatomy , University of Leipzig , Leipzig , Germany
| | - Georg Bretthauer
- a Institute for Applied Computer Science , Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany
| | - Rudolf F Guthoff
- c Department of Ophthalmology , University of Rostock , Rostock , Germany
| | - Sabine Peschel
- c Department of Ophthalmology , University of Rostock , Rostock , Germany
| | - Klaus-Martin Reichert
- a Institute for Applied Computer Science , Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany
| | - Oliver Stachs
- c Department of Ophthalmology , University of Rostock , Rostock , Germany
| | - Bernd Köhler
- a Institute for Applied Computer Science , Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany
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Köhler B, Bretthauer G, Guthoff RF, Reichert KM, Sieber I, Stachs O, Toso L, Allgeier S. EyeGuidance – a computer controlled system to guide eye movements. Current Directions in Biomedical Engineering 2016. [DOI: 10.1515/cdbme-2016-0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe densely innervated human cornea is the only superficial tissue of the human body in which nerve fibres are accessible in vivo by corneal confocal microscopy (CCM). Morphological parameters of the corneal sub-basal nerve plexus (SNP) derived from CCM images can potentially serve as a sensitive biomarker for early diagnosis of various neurodegenerative diseases. The evaluation of a single image with a typical field of view of 0.16 mm2 is insufficient for robust morphometric assessment. Mosaicking approaches have therefore been proposed to examine the SNP on a larger scale. Here we present a highly automated technique that significantly facilitates the generation of mosaic images of the SNP and is suitable for clinical tests.
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Affiliation(s)
- Bernd Köhler
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
| | - Georg Bretthauer
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
| | | | - Klaus-Martin Reichert
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
| | - Ingo Sieber
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
| | | | - Lorenzo Toso
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
| | - Stephan Allgeier
- 1Karlsruhe Institute of Technology (KIT), Institute for Applied Computer Science, POB 3640, D-76021 Karlsruhe, Germany
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Winter K, Scheibe P, Köhler B, Allgeier S, Guthoff RF, Stachs O. Local Variability of Parameters for Characterization of the Corneal Subbasal Nerve Plexus. Curr Eye Res 2015; 41:186-98. [DOI: 10.3109/02713683.2015.1010686] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Köhler B, Allgeier S, Eberle F, Maier S, Peschel S, Reichert KM, Stachs O. Großflächige Abbildung kornealer Nervenfasern durch geführte Augenbewegungen. Klin Monbl Augenheilkd 2014; 231:1170-3. [DOI: 10.1055/s-0034-1383331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B. Köhler
- Karlsruher Institut für Technologie (KIT), Institut für Angewandte Informatik, Karlsruhe
| | - S. Allgeier
- Karlsruher Institut für Technologie (KIT), Institut für Angewandte Informatik/Automatisierungstechnik, Karlsruhe
| | - F. Eberle
- Karlsruher Institut für Technologie (KIT), Institut für Angewandte Informatik, Karlsruhe
| | - S. Maier
- Karlsruher Institut für Technologie (KIT), Institut für Angewandte Informatik/Automatisierungstechnik, Karlsruhe
| | - S. Peschel
- Klinik und Poliklinik für Augenheilkunde, Universität Rostock
| | - K.-M. Reichert
- Karlsruher Institut für Technologie (KIT), Institut für Angewandte Informatik, Karlsruhe
| | - O. Stachs
- Klinik und Poliklinik für Augenheilkunde, Universität Rostock
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Allgeier S, Maier S, Mikut R, Peschel S, Reichert KM, Stachs O, Köhler B. Mosaicking the subbasal nerve plexus by guided eye movements. Invest Ophthalmol Vis Sci 2014; 55:6082-9. [PMID: 25159207 DOI: 10.1167/iovs.14-14698] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE A growing number of studies provide evidence that the morphology of the corneal subbasal nerve plexus (SNP), examined by corneal confocal microscopy (CCM), is a sensitive marker for diabetic peripheral neuropathy. However, it has been established that the field of view of a single CCM image (≈0.16 mm(2)) is insufficient for reliable assessment of corneal nerve fiber morphology. The present work proposes a highly automated technique for imaging an extended area of the SNP and creating large-scale montages. METHODS A moving fixation target is presented on a small display in front of the nonexamined eye. By guiding the viewing direction of the subject in an expanding spiral pattern, the scanned corneal area is continuously expanded. Specialized software algorithms subsequently assemble a mosaic image from the acquired CCM image data. The proposed technique was applied in 12 healthy subjects. RESULTS Montage images of the SNP were successfully created from all examinations performed. The mean imaged SNP area was 9.86 mm(2) (range, 1.62-18.31 mm(2)). The mean CCM duration was 65.33 seconds (range, 14.58-142.58 seconds). CONCLUSIONS The key advances embodied in the proposed technique are its high degree of integration and automation (both for image acquisition and image processing) and the resulting short duration of CCM. By providing an easy-to-use tool for obtaining large-scale mosaic images of the SNP, this technique has the potential to facilitate larger clinical trials where SNP morphology is used as a surrogate marker for peripheral neuropathy.
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Affiliation(s)
- Stephan Allgeier
- Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Susanne Maier
- Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ralf Mikut
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sabine Peschel
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Klaus-Martin Reichert
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Bernd Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Ziegler D, Papanas N, Zhivov A, Allgeier S, Winter K, Ziegler I, Brüggemann J, Strom A, Peschel S, Köhler B, Stachs O, Guthoff RF, Roden M. Early detection of nerve fiber loss by corneal confocal microscopy and skin biopsy in recently diagnosed type 2 diabetes. Diabetes 2014; 63:2454-63. [PMID: 24574045 DOI: 10.2337/db13-1819] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We sought to determine whether early nerve damage may be detected by corneal confocal microscopy (CCM), skin biopsy, and neurophysiological tests in 86 recently diagnosed type 2 diabetic patients compared with 48 control subjects. CCM analysis using novel algorithms to reconstruct nerve fiber images was performed for all fibers and major nerve fibers (MNF) only. Intraepidermal nerve fiber density (IENFD) was assessed in skin specimens. Neurophysiological measures included nerve conduction studies (NCS), quantitative sensory testing (QST), and cardiovascular autonomic function tests (AFTs). Compared with control subjects, diabetic patients exhibited significantly reduced corneal nerve fiber length (CNFL-MNF), fiber density (CNFD-MNF), branch density (CNBD-MNF), connecting points (CNCP), IENFD, NCS, QST, and AFTs. CNFD-MNF and IENFD were reduced below the 2.5th percentile in 21% and 14% of the diabetic patients, respectively. However, the vast majority of patients with abnormal CNFD showed concomitantly normal IENFD and vice versa. In conclusion, CCM and skin biopsy both detect nerve fiber loss in recently diagnosed type 2 diabetes, but largely in different patients, suggesting a patchy manifestation pattern of small fiber neuropathy. Concomitant NCS impairment points to an early parallel involvement of small and large fibers, but the precise temporal sequence should be clarified in prospective studies.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, GermanyDepartment of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
| | - Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Andrey Zhivov
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Stephan Allgeier
- Institute for Applied Computer Science and Automation, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Karsten Winter
- Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Iris Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Jutta Brüggemann
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Sabine Peschel
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Bernd Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Rudolf F Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, GermanyDepartment of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
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Winter K, Allgeier S, Eberle F, Köhler B, Maier S, Stachs O, Bretthauer G. Software-Based Imaging and Segmentation of Corneal Nerve Fibres. ACTA ACUST UNITED AC 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-L/bmt-2013-4293/bmt-2013-4293.xml. [PMID: 24042934 DOI: 10.1515/bmt-2013-4293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Allgeier S, Eberle F, Köhler B, Maier S, van Wezel J, Zhivov A, Bretthauer G. A Confocal Microscopy Study of the Anterior Corneal Mosaic in the Sub-Basal Nerve Plexus. ACTA ACUST UNITED AC 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-L/bmt-2013-4270/bmt-2013-4270.xml. [PMID: 24042953 DOI: 10.1515/bmt-2013-4270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Köhler B, Allgeier S, Eberle F, Reichert K, Stachs O, Bretthauer G. Generating extended images of the corneal nerve plexus by guided eye movements. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- B. Köhler
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - S. Allgeier
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - F. Eberle
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - K. Reichert
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - O. Stachs
- University of Rostock, Rostock, Germany
| | - G. Bretthauer
- Karlsruhe Institute of Technology, Karlsruhe, Germany
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Allgeier S, Eberle F, Köhler B, Maier S, Zhivov A, Bretthauer G. Mosaicking images of the corneal sub-basal nerve plexus using hierarchical block-based image registration. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Allgeier
- Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - F. Eberle
- Institute for Applied Computer Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - B. Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - S. Maier
- Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - A. Zhivov
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - G. Bretthauer
- Institute for Applied Computer Science/Automation, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Institute for Applied Computer Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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Birn J, Allgeier S, Croteau D, Sturza S, Getzen T. Abstract No. 150: Transarterial bland embolization of focal nodular hyperplasia. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Köhler B, Allgeier S, Eberle F, Guthoff R, Maier S, Stachs O, Zhivov A, Ziegler D, Bretthauer G. [Image reconstruction of the corneal subbasal nerve plexus with extended field of view from focus image stacks of a confocal laser scanning microscope]. Klin Monbl Augenheilkd 2011; 228:1060-6. [PMID: 22167357 DOI: 10.1055/s-0031-1281959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Confocal laser scanning microscopy (CLSM) allows the in vivo analysis of nerve structures of the human cornea. In this way, pathological alterations of the peripheral nervous system that also affect the corneal subbasal nerve plexus (SNP) can be diagnosed non-invasively and possibly earlier than with other methods. The field of view of in vivo CLSM images of the cornea (ca. 0.4 × 0.4 mm²) is not sufficient for a reliable assessment. Two phenomena make the image assessment difficult: the presence of ridge-like tissue deformations in the neighbourhood of the SNP and image distortions that are induced by involuntary and unavoidable eye movements during image acquisition. This paper presents an image processing method for generating undistorted images of the SNP with an extended field of view. METHODS The presented method has been tested on five volunteers. Eight focus image stacks have been taken and processed from each subject using a Heidelberg Retina Tomograph with Rostock Cornea Module (HRT). An image registration scheme specifically adapted to the image acquisition system corrects the non-linear motion-induced image distortions and reconstructs a volume from each focus image stack. The epithelial basal boundary surface including the SNP appears as a distinctive hyper-reflective layer inside the reconstructed volume. Extracting this continuous layer generates a depth map and finally a two-dimensional image of the SNP. A final fusion step of the single reconstructed SNP images leads to laterally extended images. RESULTS Out of 40 focus image stacks, 34 have been fully processed into two-dimensional SNP reconstruction images. Six focus image stacks could not be transformed into volumes because of extremely fast eye movements during the image acquisition that prevented the complete image registration of the stacks. The 34 SNP reconstruction images depict an average area of 94.7 % ( ± 6.2 %) with respect to the field of view of a single HRT image. The final fusion of the reconstructed images resulted in an average increase of the image area by a factor of 2.6 (ranging from 2.2 to 3.1). CONCLUSION The presented image processing algorithms are capable of correcting the motion-induced image distortions and of generating larger two-dimensional images of the SNP even in presence of severe tissue deformations. These images provide the basis for a more reliable assessment of the corneal nerve fibres.
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Affiliation(s)
- B Köhler
- Institut für Angewandte Informatik, Karlsruher Institut für Technologie (KIT).
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Allgeier S, Zhivov A, Eberle F, Koehler B, Maier S, Bretthauer G, Guthoff RF, Stachs O. Image Reconstruction of the Subbasal Nerve Plexus with In Vivo Confocal Microscopy. ACTA ACUST UNITED AC 2011; 52:5022-8. [DOI: 10.1167/iovs.10-6065] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stephan Allgeier
- From the Institute for Applied Computer Science and Automation, Karlsruhe Institute of Technology, Karlsruhe
| | - Andrey Zhivov
- Department of Ophthalmology, University of Rostock, Rostock
| | - Franz Eberle
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Bernd Koehler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Susanne Maier
- From the Institute for Applied Computer Science and Automation, Karlsruhe Institute of Technology, Karlsruhe
| | - Georg Bretthauer
- From the Institute for Applied Computer Science and Automation, Karlsruhe Institute of Technology, Karlsruhe; 4Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock
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