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Pawloff M, Gerendas BS, Deak G, Bogunovic H, Gruber A, Schmidt-Erfurth U. Performance of retinal fluid monitoring in OCT imaging by automated deep learning versus human expert grading in neovascular AMD. Eye (Lond) 2023; 37:3793-3800. [PMID: 37311835 PMCID: PMC10698046 DOI: 10.1038/s41433-023-02615-8] [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: 12/09/2022] [Revised: 03/02/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE To evaluate the reliability of automated fluid detection in identifying retinal fluid activity in OCT scans of patients treated with anti-VEGF therapy for neovascular age-related macular degeneration by correlating human expert and automated measurements with central retinal subfield thickness (CSFT) and fluid volume values. METHODS We utilized an automated deep learning approach to quantify macular fluid in SD-OCT volumes (Cirrus, Spectralis, Topcon) from patients of HAWK and HARRIER Studies. Three-dimensional volumes for IRF and SRF were measured at baseline and under therapy in the central millimeter and compared to fluid gradings, CSFT and foveal centerpoint thickness (CPT) values measured by the Vienna Reading Center. RESULTS 41.906 SD-OCT volume scans were included into the analysis. Concordance between human expert grading and automated algorithm performance reached AUC values of 0.93/0.85 for IRF and 0.87 for SRF in HARRIER/HAWK in the central millimeter. IRF volumes showed a moderate correlation with CSFT at baseline (HAWK: r = 0.54; HARRIER: r = 0.62) and weaker correlation under therapy (HAWK: r = 0.44; HARRIER: r = 0.34). SRF and CSFT correlations were low at baseline (HAWK: r = 0.29; HARRIER: r = 0.22) and under therapy (HAWK: r = 0.38; HARRIER: r = 0.45). The residual standard error (IRF: 75.90 µm; SRF: 95.26 µm) and marginal residual standard deviations (IRF: 46.35 µm; SRF: 44.19 µm) of fluid volume were high compared to the range of CSFT values. CONCLUSION Deep learning-based segmentation of retinal fluid performs reliably on OCT images. CSFT values are weak indicators for fluid activity in nAMD. Automated quantification of fluid types, highlight the potential of deep learning-based approaches to objectively monitor anti-VEGF therapy.
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Affiliation(s)
- Maximilian Pawloff
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabor Deak
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Anastasiia Gruber
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Li F, Pan W, Xiang W, Zou H. Automatic segmentation of multitype retinal fluid from optical coherence tomography images using semisupervised deep learning network. Br J Ophthalmol 2023; 107:1350-1355. [PMID: 35697498 DOI: 10.1136/bjophthalmol-2022-321348] [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: 02/22/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To develop and validate a deep learning model for automated segmentation of multitype retinal fluid using optical coherence tomography (OCT) images. METHODS We retrospectively collected a total of 2814 completely anonymised OCT images with subretinal fluid (SRF) and intraretinal fluid (IRF) from 141 patients between July 2018 and June 2020, constituting our in-house retinal OCT dataset. On this dataset, we developed a novel semisupervised retinal fluid segmentation deep network (Ref-Net) to automatically identify SRF and IRF in a coarse-to-refine fashion. We performed quantitative and qualitative analyses on the model's performance while verifying its generalisation ability by using our in-house retinal OCT dataset for training and an unseen Kermany dataset for testing. We also determined the importance of major components in the semisupervised Ref-Net through extensive ablation. The main outcome measures were Dice similarity coefficient (Dice), sensitivity (Sen), specificity (Spe) and mean absolute error (MAE). RESULTS Our model trained on a handful of labelled OCT images manifested higher performance (Dice: 81.2%, Sen: 87.3%, Spe: 98.8% and MAE: 1.1% for SRF; Dice: 78.0%, Sen: 83.6%, Spe: 99.3% and MAE: 0.5% for IRF) over most cutting-edge segmentation models. It obtained expert-level performance with only 80 labelled OCT images and even exceeded two out of three ophthalmologists with 160 labelled OCT images. Its satisfactory generalisation capability across an unseen dataset was also demonstrated. CONCLUSION The semisupervised Ref-Net required only la few labelled OCT images to generate outstanding performance in automate segmentation of multitype retinal fluid, which has the potential for providing assistance for clinicians in the management of ocular disease.
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Affiliation(s)
- Feng Li
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - WenZhe Pan
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wenjie Xiang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Haidong Zou
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China
- Shanghai General Hospital, Shanghai, China
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Kumari N, Surve A, Kumar V, Azad SV, Chawla R, Venkatesh P, Vohra R, Kumar A. COMPARATIVE EVALUATION OF OUTCOMES OF DRAINAGE TECHNIQUES IN VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2022; 42:27-32. [PMID: 34267115 DOI: 10.1097/iae.0000000000003259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
PURPOSE To compare the anatomical and functional outcomes of drainage through posterior retinotomy versus perfluorocarbon liquid (PFCL)-assisted drainage in vitreoretinal surgery for rhegmatogenous retinal detachment and to study intraoperative and postoperative complications. METHODS This was a prospective randomized study of 52 cases who underwent vitreoretinal surgery for rhegmatogenous retinal detachment. Group 1 underwent PFCL-assisted drainage through preexisting break, whereas Group 2 had posterior retinotomy to drain subretinal fluid. Cases were evaluated for retinal reattachment rates, visual outcomes, optical coherence tomography parameters, and postoperative metamorphopsia. The patients were followed up for minimum period of 3 months. RESULTS Two groups were comparable in terms of demographic and preoperative parameters. Both groups had single surgery success rate of 100% by the end of follow-up. Final best-corrected visual acuity in Group 1 was 0.61 ± 0.33 and 0.61 ± 0.32 in Group 2 (P = 0.77). Optical coherence tomography parameters (foveal contour, retinal layers, central macular thickness, and epiretinal membrane formation) were similar between the two groups. Subjective metamorphopsia was present in 30.77% (8 of 26) patients in Group-1 and 69.23% (18 of 26) patients in Group-2 (P = 0.034). One eye had retained subretinal PFCL away from the macula in Group 1. CONCLUSION Anatomical and functional outcomes were similar in vitrectomy using PFCL-assisted drainage versus posterior retinotomy drainage. Postoperative metamorphopsia was lesser in patients who underwent PFCL-assisted drainage through the pre-existing break.
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Affiliation(s)
- Neha Kumari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Grechenig C, Reiter GS, Riedl S, Arnold J, Guymer R, Gerendas BS, Bogunović H, Schmidt-Erfurth U. IMPACT OF RESIDUAL SUBRETINAL FLUID VOLUMES ON TREATMENT OUTCOMES IN A SUBRETINAL FLUID-TOLERANT TREAT-AND-EXTEND REGIMEN. Retina 2021; 41:2221-2228. [PMID: 33830960 DOI: 10.1097/iae.0000000000003180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/26/2022]
Abstract
PURPOSE To investigate associations between residual subretinal fluid (rSRF) volumes, quantified using artificial intelligence and treatment outcomes in a subretinal fluid (SRF)-tolerant treat-and-extend (T&E) regimen in neovascular age-related macular degeneration. METHODS Patients enrolled in the prospective, multicenter FLUID study randomized in an SRF-tolerant T&E regimen were examined by spectral-domain optical coherence tomography and tested for best-corrected visual acuity (BCVA). Intraretinal fluid and SRF volumes were quantified using artificial intelligence tools. In total, 375 visits of 98 patients were divided into subgroups: extended intervals despite rSRF and extended intervals without fluid. Associations between BCVA change, SRF volume, subgroups, and treatment intervals were estimated using linear mixed models. RESULTS In extended intervals despite rSRF, increased SRF was associated with reduced BCVA at the next visit in the central 1 mm (-0.138 letters per nL; P = 0.014) and 6 mm (-0.024 letters per nL; P = 0.049). A negative association between increased interval and BCVA change was found for rSRF in 1 mm and 6 mm (-0.250 and -0.233 letter per week interval, respectively; both P < 0.001). Extended intervals despite rSRF had significantly higher SRF volumes in the central 6 mm at the following visit (P = 0.002). CONCLUSION Artificial intelligence-based analysis of extended visits despite rSRF demonstrated increasing SRF volumes associated with BCVA loss at the consecutive visit. This negative association contributes to the understanding of rSRF volumes on treatment outcomes in neovascular age-related macular degeneration.
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Affiliation(s)
- Christoph Grechenig
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Gregor S Reiter
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Sophie Riedl
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | | | - Robyn Guymer
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Bianca S Gerendas
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunović
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
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Core JQ, Pistilli M, Daniel E, Grunwald JE, Toth CA, Jaffe GJ, Hua P, Martin DF, Ying GS, Maguire MG. Predominantly Persistent Subretinal Fluid in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmol Retina 2021; 5:962-974. [PMID: 34126249 PMCID: PMC8478884 DOI: 10.1016/j.oret.2021.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe predominantly persistent subretinal fluid (SRF) in eyes receiving ranibizumab or bevacizumab for neovascular age-related macular degeneration and to compare visual acuity (VA) to eyes with nonpersistent SRF. DESIGN Cohort within randomized clinical trial. PARTICIPANTS Comparison of Age-related Macular Degeneration Treatments Trials patients assigned to pro re nata treatment. METHODS Graders evaluated monthly OCT scans for SRF. Predominantly persistent SRF through week 12 was defined as SRF at baseline and weeks 4, 8, and 12. Predominantly persistent SRF through 1 or 2 years was defined as SRF in 80% or more of visits by years 1 or 2, respectively. Linear regression models including baseline predictors of VA and predominantly persistent intraretinal fluid (IRF) were used to evaluate mean differences in vision outcomes. PRIMARY OUTCOME MEASURES Predominantly persistent SRF through year 1, adjusted VA score and VA change, and foveal SRF thickness. RESULTS Among 406 eyes with baseline SRF, SRF persisted in 108 eyes (26.6%) through week 12, in 94 eyes (23.2%) through year 1, and in 77 eyes (19.0%) through year 2. Adjusted VA means at year 1 were similar between eyes with predominantly persistent versus non persistent SRF by week 12 (68.1 vs. 70.2 letters; P = 0.18), year 1 (67.6 vs. 70.2 letters; P = 0.11), and year 2 (71.4 vs. 70.9 letters; P = 0.78). Adjusted changes in mean VA at year 1 were similar between eyes with predominantly persistent versus nonpersistent SRF by week 12 (6.3 vs. 7.6 letters; P = 0.38), year 1 (5.5 vs. 7.8 letters; P = 0.14), and year 2 (8.1 vs. 7.7 letters; P = 0.78). Among eyes with predominantly persistent SRF through year 1, foveal SRF was absent in 46 eyes (48.9%), thickness was 1 to 200 μm in 48 eyes (50.0%) and more than 200 μm in 1 eye (1.1%) at year 1. CONCLUSIONS Eyes with predominantly persistent and nonpersistent SRF through week 12, year 1, or year 2 showed similar VA outcomes after adjustment for baseline covariates and persistent IRF. At the foveal center, predominantly persistent SRF was most commonly absent or present in small quantities.
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Affiliation(s)
- Jason Q Core
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maxwell Pistilli
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan E Grunwald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Peiying Hua
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel F Martin
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, and National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Belin PJ, Mundae R, Tzu JH, Chang E, Parke DW. EXTERNAL DRAINAGE OF SUBRETINAL FLUID DURING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2021; 41:1828-1832. [PMID: 33512898 DOI: 10.1097/iae.0000000000003136] [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: 11/25/2022]
Abstract
PURPOSE To describe the safety and efficacy of rhegmatogenous retinal detachment (RRD) repair with external drainage of subretinal fluid using a 28-gauge External Drainage and Depression device (Vortex Surgical, Chesterfield, MO). METHODS Retrospective review of patients who underwent primary rhegmatogenous retinal detachment repair with scleral buckle, pars plana vitrectomy, or scleral buckle/pars plana vitrectomy using the drainage device from August 2018 through March 2020, performed by four surgeons at two vitreoretinal practices. RESULTS Eighty-three eyes of 83 patients were included. At presentation, 28% had proliferative vitreoretinopathy. Surgery included 65% scleral buckle/pars plana vitrectomy, 33% pars plana vitrectomy, and 2% scleral buckle. There were no cases of retinal incarceration and two subretinal hemorrhages at the drainage site (both < 2 DD), 2 cases of recurrent RD with proliferative vitreoretinopathy (1 had proliferative vitreoretinopathy at presentation), and 6 (10%) new epiretinal membranes (3 were mild). There were no other complications. Mean follow-up was 274 days. Single operation success rate for those with ≥ 6-month follow-up was 97% (57/59). CONCLUSION External drainage of subretinal fluid during rhegmatogenous retinal detachment repair demonstrated a favorable safety profile with a high single operation success rate. Further study of the role of external drainage in rhegmatogenous retinal detachment repair is warranted.
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Affiliation(s)
| | - Rusdeep Mundae
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota; and
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Hassan B, Qin S, Ahmed R, Hassan T, Taguri AH, Hashmi S, Werghi N. Deep learning based joint segmentation and characterization of multi-class retinal fluid lesions on OCT scans for clinical use in anti-VEGF therapy. Comput Biol Med 2021; 136:104727. [PMID: 34385089 DOI: 10.1016/j.compbiomed.2021.104727] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/19/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In anti-vascular endothelial growth factor (anti-VEGF) therapy, an accurate estimation of multi-class retinal fluid (MRF) is required for the activity prescription and intravitreal dose. This study proposes an end-to-end deep learning-based retinal fluids segmentation network (RFS-Net) to segment and recognize three MRF lesion manifestations, namely, intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED), from multi-vendor optical coherence tomography (OCT) imagery. The proposed image analysis tool will optimize anti-VEGF therapy and contribute to reducing the inter- and intra-observer variability. METHOD The proposed RFS-Net architecture integrates the atrous spatial pyramid pooling (ASPP), residual, and inception modules in the encoder path to learn better features and conserve more global information for precise segmentation and characterization of MRF lesions. The RFS-Net model is trained and validated using OCT scans from multiple vendors (Topcon, Cirrus, Spectralis), collected from three publicly available datasets. The first dataset consisted of OCT volumes obtained from 112 subjects (a total of 11,334 B-scans) is used for both training and evaluation purposes. Moreover, the remaining two datasets are only used for evaluation purposes to check the trained RFS-Net's generalizability on unseen OCT scans. The two evaluation datasets contain a total of 1572 OCT B-scans from 1255 subjects. The performance of the proposed RFS-Net model is assessed through various evaluation metrics. RESULTS The proposed RFS-Net model achieved the mean F1 scores of 0.762, 0.796, and 0.805 for segmenting IRF, SRF, and PED. Moreover, with the automated segmentation of the three retinal manifestations, the RFS-Net brings a considerable gain in efficiency compared to the tedious and demanding manual segmentation procedure of the MRF. CONCLUSIONS Our proposed RFS-Net is a potential diagnostic tool for the automatic segmentation of MRF (IRF, SRF, and PED) lesions. It is expected to strengthen the inter-observer agreement, and standardization of dosimetry is envisaged as a result.
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Affiliation(s)
- Bilal Hassan
- School of Automation Science and Electrical Engineering, Beihang University (BUAA), Beijing, 100191, China.
| | - Shiyin Qin
- School of Automation Science and Electrical Engineering, Beihang University (BUAA), Beijing, 100191, China; School of Electrical Engineering and Intelligentization, Dongguan University of Technology, Dongguan, 523808, China
| | - Ramsha Ahmed
- School of Computer and Communication Engineering, University of Science and Technology Beijing (USTB), Beijing, 100083, China
| | - Taimur Hassan
- Center for Cyber-Physical Systems, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Abdel Hakeem Taguri
- Abu Dhabi Healthcare Company (SEHA), Abu Dhabi, 127788, United Arab Emirates
| | - Shahrukh Hashmi
- Abu Dhabi Healthcare Company (SEHA), Abu Dhabi, 127788, United Arab Emirates
| | - Naoufel Werghi
- Center for Cyber-Physical Systems, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
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Kaiser PK, Wykoff CC, Singh RP, Khanani AM, Do DV, Patel H, Patel N. RETINAL FLUID AND THICKNESS AS MEASURES OF DISEASE ACTIVITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2021; 41:1579-1586. [PMID: 33949342 PMCID: PMC8297539 DOI: 10.1097/iae.0000000000003194] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Retinal fluid and thickness are important anatomical features of disease activity in neovascular age-related macular degeneration, as evidenced by clinical trials that have used these features for inclusion criteria, retreatment criteria, and outcome measures of the efficacy of intravitreal injections of anti-vascular endothelial growth factor agents. METHODS A literature review of anatomical measures of disease activity was conducted. RESULTS Treatment goals for neovascular age-related macular degeneration include improving/maintaining vision by drying the retina, and several analyses have evaluated the relationship between visual function and anatomy. The change in retinal thickness has been found to correlate with the change in the visual acuity, and variation in retinal thickness may predict visual acuity outcomes. In addition, specific fluid compartments may have different prognostic values. For example, the presence of intraretinal fluid has been associated with poorer visual acuity, whereas the presence of subretinal fluid has been associated with better visual acuity. Retinal fluid and thickness are important for selecting dosing interval durations in clinical trials and clinical practice. CONCLUSION Retinal thickness and retinal fluid are common anatomical measures of disease activity in neovascular age-related macular degeneration. Further research is required to fully elucidate the relationship between anatomical features and visual outcomes in neovascular age-related macular degeneration.
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Affiliation(s)
- Peter K. Kaiser
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Charles C. Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas;
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Arshad M. Khanani
- Sierra Eye Associates, Reno, Nevada
- University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Diana V. Do
- Byers Eye Institute, Stanford University, Palo Alto, California; and
| | - Hersh Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Nikhil Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
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Sappa LB, Okuwobi IP, Li M, Zhang Y, Xie S, Yuan S, Chen Q. RetFluidNet: Retinal Fluid Segmentation for SD-OCT Images Using Convolutional Neural Network. J Digit Imaging 2021; 34:691-704. [PMID: 34080105 PMCID: PMC8329142 DOI: 10.1007/s10278-021-00459-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of irreversible blindness and is characterized by fluid-related accumulations such as intra-retinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED). Spectral-domain optical coherence tomography (SD-OCT) is the primary modality used to diagnose AMD, yet it does not have algorithms that directly detect and quantify the fluid. This work presents an improved convolutional neural network (CNN)-based architecture called RetFluidNet to segment three types of fluid abnormalities from SD-OCT images. The model assimilates different skip-connect operations and atrous spatial pyramid pooling (ASPP) to integrate multi-scale contextual information; thus, achieving the best performance. This work also investigates between consequential and comparatively inconsequential hyperparameters and skip-connect techniques for fluid segmentation from the SD-OCT image to indicate the starting choice for future related researches. RetFluidNet was trained and tested on SD-OCT images from 124 patients and achieved an accuracy of 80.05%, 92.74%, and 95.53% for IRF, PED, and SRF, respectively. RetFluidNet showed significant improvement over competitive works to be clinically applicable in reasonable accuracy and time efficiency. RetFluidNet is a fully automated method that can support early detection and follow-up of AMD.
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Affiliation(s)
- Loza Bekalo Sappa
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China
| | - Idowu Paul Okuwobi
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China
| | - Mingchao Li
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China
| | - Yuhan Zhang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China
| | - Sha Xie
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, 200 Xiaolingwei, Nanjing, 210094, China.
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Song Z, Xu L, Wang J, Rasti R, Sastry A, Li JD, Raynor W, Izatt JA, Toth CA, Vajzovic L, Deng B, Farsiu S. Lightweight Learning-Based Automatic Segmentation of Subretinal Blebs on Microscope-Integrated Optical Coherence Tomography Images. Am J Ophthalmol 2021; 221:154-168. [PMID: 32707207 PMCID: PMC8120705 DOI: 10.1016/j.ajo.2020.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Subretinal injections of therapeutics are commonly used to treat ocular diseases. Accurate dosing of therapeutics at target locations is crucial but difficult to achieve using subretinal injections due to leakage, and there is no method available to measure the volume of therapeutics successfully administered to the subretinal location during surgery. Here, we introduce the first automatic method for quantifying the volume of subretinal blebs, using porcine eyes injected with Ringer's lactate solution as samples. DESIGN Ex vivo animal study. METHODS Microscope-integrated optical coherence tomography was used to obtain 3D visualization of subretinal blebs in porcine eyes at Duke Eye Center. Two different injection phases were imaged and analyzed in 15 eyes (30 volumes), selected from a total of 37 eyes. The inclusion/exclusion criteria were set independently from the algorithm-development and testing team. A novel lightweight, deep learning-based algorithm was designed to segment subretinal bleb boundaries. A cross-validation method was used to avoid selection bias. An ensemble-classifier strategy was applied to generate final results for the test dataset. RESULTS The algorithm performs notably better than 4 other state-of-the-art deep learning-based segmentation methods, achieving an F1 score of 93.86 ± 1.17% and 96.90 ± 0.59% on the independent test data for entry and full blebs, respectively. CONCLUSION The proposed algorithm accurately segmented the volumetric boundaries of Ringer's lactate solution delivered into the subretinal space of porcine eyes with robust performance and real-time speed. This is the first step for future applications in computer-guided delivery of therapeutics into the subretinal space in human subjects.
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Affiliation(s)
- Zhenxi Song
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China; Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Liangyu Xu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Reza Rasti
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Ananth Sastry
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jianwei D Li
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - William Raynor
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph A Izatt
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia A Toth
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bin Deng
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA.
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Mehta N, Lee CS, Mendonça LSM, Raza K, Braun PX, Duker JS, Waheed NK, Lee AY. Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation. JAMA Ophthalmol 2020; 138:1017-1024. [PMID: 32761143 PMCID: PMC7411940 DOI: 10.1001/jamaophthalmol.2020.2769] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/06/2020] [Indexed: 12/27/2022]
Abstract
Importance Amid an explosion of interest in deep learning in medicine, including within ophthalmology, concerns regarding data privacy, security, and sharing are of increasing importance. A model-to-data approach, in which the model itself is transferred rather than data, can circumvent many of these challenges but has not been previously demonstrated in ophthalmology. Objective To determine whether a model-to-data deep learning approach (ie, validation of the algorithm without any data transfer) can be applied in ophthalmology. Design, Setting, and Participants This single-center cross-sectional study included patients with active exudative age-related macular degeneration undergoing optical coherence tomography (OCT) at the New England Eye Center from August 1, 2018, to February 28, 2019. Data were primarily analyzed from March 1 to June 20, 2019. Main Outcomes and Measures Training of the deep learning model, using a model-to-data approach, in recognizing intraretinal fluid (IRF) on OCT B-scans. Results The model was trained (learning curve Dice coefficient, >80%) using 400 OCT B-scans from 128 participants (69 female [54%] and 59 male [46%]; mean [SD] age, 77.5 [9.1] years). In comparing the model with manual human grading of IRF pockets, no statistically significant difference in Dice coefficients or intersection over union scores was found (P > .05). Conclusions and Relevance A model-to-data approach to deep learning applied in ophthalmology avoided many of the traditional hurdles in large-scale deep learning, including data sharing, security, and privacy concerns. Although the clinical relevance of these results is limited at this time, this proof-of-concept study suggests that such a paradigm should be further examined in larger-scale, multicenter deep learning studies.
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Affiliation(s)
- Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Luísa S. M. Mendonça
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Khadija Raza
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Phillip X. Braun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Yale School of Medicine, New Haven, Connecticut
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
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Srinivas S, Verma A, Nittala MG, Alagorie AR, Nassisi M, Gasperini J, Sadda SR. Effect of Intravitreal Ranibizumab on Intraretinal Hard Exudates in Eyes with Diabetic Macular Edema. Am J Ophthalmol 2020; 211:183-190. [PMID: 31758926 DOI: 10.1016/j.ajo.2019.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the effect of monthly 0.3-mg intravitreal ranibizumab injections on intraretinal hard exudates (HEs) and correlate the effect with macular thickness in eyes with diabetic macular edema (DME). DESIGN Randomized, controlled trial. METHODS Twenty-four eyes of 24 subjects with DME were included in this institutional review board-approved, prospective longitudinal study. Subjects were randomly assigned to receive monthly intravitreal ranibizumab injections either until macular edema resolved or until both macular edema and HEs resolved. All subjects underwent spectral-domain optical coherence tomography imaging (Cirrus OCT), at baseline and monthly for 12 months. Mean HE area and mean macular thickness at baseline and month 12 were compared using a paired t test and correlated with Pearson analysis. RESULTS The average age of the 24 subjects was 65 (±8.55) years. There was a significant decrease (P = .001) in mean HE area from baseline (0.48 ± 0.43 mm2) to month 12 (0.17 ± 0.19 mm2). There was a significant increase (P < .001) in best-corrected visual acuity from a letter score of 63.38 (±7.92) at baseline to 76.38 (±8.93) at month 12. There was no additional vision benefit for continuing to treat with monthly injections for persistent HE in the absence of macular thickening. CONCLUSION In eyes with DME, monthly intravitreal ranibizumab injections resulted in significant reduction in intraretinal HEs that paralleled reductions in macular thickness and volume. Baseline foveal HEs were associated with worse vision outcomes, and continued treatment for persistent HEs in the absence of edema did not result in better vision.
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Affiliation(s)
| | | | | | - Ahmed Roshdy Alagorie
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.
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Ghoraba HH, Ghoraba HH, Heikal MA, Elgouhary SM, Mansour HO, Abdelhafez MA, Zaky AG. Submacular perfluorocarbon liquid: long-term follow-up. Int Ophthalmol 2020; 40:1209-1219. [PMID: 31981001 DOI: 10.1007/s10792-020-01287-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/03/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the long-term follow-up of patients with inadvertent retained submacular perfluorocarbon liquid (PFCL) bubbles after vitrectomy surgery. BACKGROUND PFCL has unique chemical and physical features which facilitate displacement of subretinal fluid from central toward periphery allowing intraoperative reattachment of the mobile retina and manipulation of the anterior part of the detached retina without performing drainage retinotomy. Despite these advantages, PFCL droplets may be inadvertently retained in the submacular space. METHODS A retrospective case series study was conducted. We reviewed 1224 consecutive patients who had undergone primary pars plana vitrectomy at one vitreoretinal center operated by single surgeon (Hammouda Ghoraba). Chart review was performed to identify patients and procedural factors that could predispose to retained submacular PFCL with anatomical and functional outcomes with follow-up at least 18 months. RESULTS The retina was completely attached in 97% of eyes where PFCL was used after one or two vitrectomy surgeries. Submacular PFCL was found in 12 (0.98%) eyes. There was no statistical difference between perfluorodecalin and perfluoro-n-octane as regards retention rate. The possible risk factors associated with submacular retention of PFCL phenomenon are the presence of post-equatorial retinal breaks in six patients (50%) and large retinal break (2-3 clock hours) in three patients (25%). CONCLUSIONS Submacular PFC migration occurs in nearly 1% of cases when it is used. It occurred in cases of RRD with post-equatorial or large breaks. Using perfluoro-n-octane or perfluorodecalin had no statistical difference. Different behaviors of submacular PFC droplets occurred. Some cases of small submacular PFC droplets maintained fair VA for a long period.
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Affiliation(s)
- Hamouda Hamdy Ghoraba
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Magrabi Eye Hospital, Tanta, Egypt
| | - Hashem Hamouda Ghoraba
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Magrabi Eye Hospital, Tanta, Egypt
| | - Mohamed Amin Heikal
- Ophthalmology Department, Faculty of Medicine, Banha University, Banha, Egypt
| | | | - Hosam Othman Mansour
- Ophthalmology Department, Faculty of Medicine, Al Azhar University Damiette branch, Damietta, Egypt
| | | | - Adel Galal Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.
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Khoo CT, Dalvin LA, Lim LAS, Mazloumi M, Atalay HT, Udyaver S, Shields JA, Shields CL. Factors Predictive of Subretinal Fluid Resolution in Coats Disease: Analysis of 177 Eyes in 177 Patients at a Single Center. Asia Pac J Ophthalmol (Phila) 2019; 8:290-297. [PMID: 31356365 PMCID: PMC6727930 DOI: 10.1097/apo.0000000000000246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to investigate factors predictive of subretinal fluid (SRF) resolution in Coats disease. DESIGN Retrospective cohort study. METHODS Institutional review board-approved review of patients diagnosed with Coats disease demonstrating SRF (stage 3-5) at a single center from November 1973 to July 2018 with comparison of eyes that had resolution of SRF to those in which SRF persisted. RESULTS There were 177 cases (154 males, 87%) of Coats disease diagnosed at a mean age of 8 years. After a mean follow-up of 62 months, SRF resolved in 110 (62%) and persisted in 67 (38%) eyes. Comparison (resolved SRF vs persistent SRF) revealed classification as stage 3A [63 (57%) vs 20 (29%)], stage 3B [47 (43%) vs 40 (60%)], or stage 4 [0 (0%) vs 7 (11%)] (P < 0.001). Eyes with resolved SRF presented with fewer clock hours of telangiectasia (mean: 5 vs 7 clock hours, P < 0.001), light bulb aneurysms (mean: 5 vs 7 clock hours, P < 0.001), exudation (mean: 7 vs 10 clock hours, P < 0.001), and extent of SRF (mean: 7 vs 10 clock hours, P < 0.001). Factors predictive of SRF resolution included absence of iris neovascularization on fluorescein angiography [odds ratio 0.05 (95% confidence interval 0.01-0.60), P = 0.02], and less elevated SRF by ultrasonography [odds ratio 0.84 (95% confidence interval 0.76-0.95), P = 0.004). For every 1-mm decrease in SRF, likelihood of SRF resolution increased by 16%. CONCLUSIONS Resolution of SRF was achieved in the majority of eyes (62%) with stage 3 to 5 Coats disease. Predictors of SRF resolution included lack of neovascularization on fluorescein angiography and less elevation of SRF by ultrasonography.
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Affiliation(s)
- Chloe T.L. Khoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Lauren A. Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
- Dr. Dalvin has an appointment with the Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Li-Anne S. Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Hatice T. Atalay
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Sanika Udyaver
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107
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Lee H, Kang KE, Chung H, Kim HC. Three-dimensional analysis of morphologic changes and visual outcomes in diabetic macular edema. Jpn J Ophthalmol 2019; 63:234-242. [PMID: 30783942 DOI: 10.1007/s10384-019-00657-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/31/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the association of retinal fluid volume with the visual and anatomic outcomes of patients with diabetic macular edema (DME) after treatment with bevacizumab. STUDY DESIGN Retrospective observational study. METHODS We retrospectively analyzed 65 eyes of 58 DME patients treated with bevacizumab. The volumes of the inner intraretinal fluid (IRF) in the inner nuclear layer (INL), outer IRF in the outer plexiform layer (OPL)/outer nuclear layer (ONL), and subretinal fluid (SRF) were calculated. The correlations between the baseline fluid volumes and best-corrected visual acuity (BCVA), area of disorganization of the retinal inner layers (DRIL), disrupted external limiting membrane (ELM), and disrupted ellipsoid zone (EZ) at 12 months after treatment were assessed. RESULTS The baseline volume of the inner IRF correlated with poor BCVA at the final visit (r = 0.52, P < .001) whereas the baseline volume of the outer IRF and SRF volume did not show a significant correlation with BCVA at the final visit (P = .07 and P = .61, respectively). The improvement in BCVA correlated with the reduction in the baseline volume of the inner IRF and outer IRF (r = 0.25, P = .04 and r = 0.36, P = .003), but not with the SRF volume (P = .59). The baseline volume of the inner IRF correlated positively with the area of DRIL and the disrupted ELM at the final visit (r = 0.56, P < .001 and r = 0.25, P = .04, respectively). Such relationship remained in each quadrant of the macula (P < .005 for all quadrants). CONCLUSION The baseline volume of the inner IRF correlated with a poor visual outcome, an increased DRIL area, and a more disrupted ELM area in patients with DME after treatment with bevacizumab.
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Affiliation(s)
- Hyungwoo Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Kyung Eun Kang
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hyewon Chung
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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Mishra P, Bhatnagar C. Statistically Evaluating Detection Capabilities of Sub Retinal Fluid Detection Methodology in Optical Coherence Tomographic Images. Altern Ther Health Med 2019; 25:16-20. [PMID: 30860983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Significance of therapeutic imaging in medical image based diagnostics and treatment, and there in practice implementation in image investigation is undebatable. The cyst (fluid accumulation) development just above the Retinal Pigment Epithelium (RPE) Layer is known as Sub-Retinal Fluid (SRF). This distinct anatomical localization of SRF, differs it from normal cysts. Progressive increase of SRF, adversely affects the visual acuity. Improvement in visual acuity by reduction in SRF is a desired outcome of currently available treatments. In this paper, we assess and evaluate the detection capabilities of the Sub Retinal Fluid (SRF) detection technique through the statistical analytical methodologies. Receiver Operating Characteristic (ROC) curve analysis, projects the system's ability to discriminate between the images with and without pathology (in this research pathology is SRF). Overall Sensitivity and Specificity of the SRF detection technique is 96.2% and 92.9% respectively.
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von der Burchard C, Treumer F, Ehlken C, Koinzer S, Purtskhvanidze K, Tode J, Roider J. Retinal volume change is a reliable OCT biomarker for disease activity in neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2018; 256:1623-1629. [PMID: 29915918 DOI: 10.1007/s00417-018-4040-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/29/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Current algorithms for automated computer interpretation of optical coherence tomography (OCT) imaging of patients suffering from neovascular age-related macular degeneration (AMD) mostly rely on fluid detection. However, fluid detection itself and correct interpretation of the fluid currently limits diagnostic accuracy. We therefore performed a detailed analysis of the requirements that would have to be met for fluid detection approaches. We further investigated if monitoring retinal volume would be a viable alternative to detect disease activity. METHODS Retrospective analysis and manual grading of 764 OCT volume scans of 44 patients with exudative AMD treated with intravitreal anti-VEGF injections at a pro-re-nata (PRN) treatment regimen for at least 24 months. RESULTS Detection of subretinal fluid (SRF) or intraretinal fluid (IRF) alone is not sufficient for disease detection. A combination of SRF and IRF can detect disease activity with a sensitivity of 98.6% and a specificity of 82%. With further characterization of IRF into exudative and degenerative cysts, specificity can be increased to 100%. However, correct characterization is currently not achieved by published fluid detection approaches. Change of macular retinal volume (MRV) can depict disease activity with sensitivity of 88.4% and specificity of 89.6%. Combination with the detection of SRF can further improve diagnostic accuracy to a specificity of 93.3% and sensitivity of 93.9% without relying on IRF or IRF characterization. CONCLUSION Fluid detection without further characterization is not sufficient for AMD monitoring. Either further distinction between exudative and degenerative cysts is necessary, or other activity markers have to be taken into account. MRV offers good potential to fill this diagnostic gap and might become an important monitoring marker.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Felix Treumer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Simonett JM, Grewal DS, Fawzi AA, Lyon AT, Gill MK. Fundus Autofluorescence Patterns of Submacular Fluid Resolution Following Repair of Macula-Involving Rhegmatogenous Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina 2017; 47:1020-1029. [PMID: 27842197 DOI: 10.3928/23258160-20161031-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Submacular fluid (SMF) can persist for months to years following rhegmatogenous retinal detachment (RD) repair. The authors' objective was to describe fundus autofluorescence (FAF) and optical coherence tomography (OCT) findings associated with the absorption of persistent submacular fluid (SMF) following RD repair. PATIENTS AND METHODS Retrospective review of clinical data and FAF and OCT imaging from sequential postoperative visits in a cohort of patients with persistent SMF following RD repair. RESULTS In 11 of 13 eyes with persistent SMF, patches of decreased FAF signal corresponded to SMF on OCT. In eight eyes, there was a hypo- to hyperautofluorescence transition at the time of SMF resolution. These areas of increased FAF signal correlated with inner segment/outer segment (IS/OS) junction loss on OCT. CONCLUSION FAF imaging can be informative when following SMF after RD repair; a hypo- to hyper-FAF signal transition correlates with SMF resolution and photoreceptor loss. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1020-1029.].
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Wu M, Chen Q, He X, Li P, Fan W, Yuan S, Park H. Automatic Subretinal Fluid Segmentation of Retinal SD-OCT Images With Neurosensory Retinal Detachment Guided by Enface Fundus Imaging. IEEE Trans Biomed Eng 2017; 65:87-95. [PMID: 28436839 DOI: 10.1109/tbme.2017.2695461] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Accurate segmentation of neurosensory retinal detachment (NRD) associated subretinal fluid in spectral domain optical coherence tomography (SD-OCT) is vital for the assessment of central serous chorioretinopathy (CSC). A novel two-stage segmentation algorithm was proposed, guided by Enface fundus imaging. METHODS In the first stage, Enface fundus image was segmented using thickness map prior to detecting the fluid-associated abnormalities with diffuse boundaries. In the second stage, the locations of the abnormalities were used to restrict the spatial extent of the fluid region, and a fuzzy level set method with a spatial smoothness constraint was applied to subretinal fluid segmentation in the SD-OCT scans. RESULTS Experimental results from 31 retinal SD-OCT volumes with CSC demonstrate that our method can achieve a true positive volume fraction (TPVF), false positive volume fraction (FPVF), and positive predicative value (PPV) of 94.3%, 0.97%, and 93.6%, respectively, for NRD regions. Our approach can also discriminate NRD-associated subretinal fluid from subretinal pigment epithelium fluid associated with pigment epithelial detachment with a TPVF, FPVF, and PPV of 93.8%, 0.40%, and 90.5%, respectively. CONCLUSION We report a fully automatic method for the segmentation of subretinal fluid. SIGNIFICANCE Our method shows the potential to improve clinical therapy for CSC.
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Bertolotto M, Serafini G, Sconfienza LM, Lacelli F, Cavallaro M, Coslovich A, Tognetto D, Cova MA. The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses - preliminary investigation in patients with equivocal findings at conventional ultrasound. Ultraschall Med 2014; 35:173-180. [PMID: 23450377 DOI: 10.1055/s-0032-1330321] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes. MATERIALS AND METHODS The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8 mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non-tumor masses from tumor masses. RESULTS According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ± 0.031 and 0.900 ± 0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors. CONCLUSION CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/choroidal detachment and when intraocular lumps cannot be characterized as tumor or non-tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.
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Affiliation(s)
| | | | | | | | | | - A Coslovich
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano
| | - D Tognetto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano
| | - M A Cova
- Radiology, University of Trieste
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Budzinskaia MV, Pogoda TV, Generozov ÉV, Chikun EA, Shchegoleva IV, Kazarian ÉÉ, Galoian NS. [Influence of genetic mutations on clinical presentation of subretinal neovascularization. Report 1: The impact of CFH and IL-8 genes polymorphism]. Vestn Oftalmol 2011; 127:3-8. [PMID: 21882633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Genetic analysis was performed in patients with subretinal neovascularization (CNV). The results showed significant association of CFH (compliment factor H) gene polymorphism with increase (rs1061170, rs514943 and rs380390) or decrease (rs529825, rs7524776, rs1831281, rs2274700, rs1576340, rs12144939, rs7540032) of CNV development risk. The incidence of IL-8 gene mutation was significantly (p = 0.008) higher in patients after chorioretinitis. Apparently -125 > A polymorphism in patients with chorioretinitis increases risk of CNV development, thus promoting raise of proangiogenic factors concentration in eyes with inflammatory background. The clinical presentation in patients with AMD and myopic disease associated with (-125) A mutation of promoter region of IL-8 gene was similar to that of patients with chorioretinitis. The features are the following: focal pattern, no drusen and RPE detachment, predominantly classic form of CNV (without occult pattern), formation of well-organized newly developed vessels.
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