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Gao M, Hormel TT, Guo Y, Tsuboi K, Flaxel CJ, Huang D, Hwang TS, Jia Y. Perfused and Nonperfused Microaneurysms Identified and Characterized by Structural and Angiographic OCT. Ophthalmol Retina 2024; 8:108-115. [PMID: 37673397 DOI: 10.1016/j.oret.2023.08.019] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Microaneurysms (MAs) have distinct, oval-shaped, hyperreflective walls on structural OCT, and inconsistent flow signal in the lumen with OCT angiography (OCTA). Their relationship to regional macular edema in diabetic retinopathy (DR) has not been quantitatively explored. DESIGN Retrospective, cross-sectional study. PARTICIPANTS A total of 99 participants, including 23 with mild, nonproliferative DR (NPDR), 25 with moderate NPDR, 34 with severe NPDR, and 17 with proliferative DR. METHODS We obtained 3 × 3-mm scans with a commercial device (Solix, Visionix/Optovue) in 99 patients with DR. Trained graders manually identified MAs and their location relative to the anatomic layers from cross-sectional OCT. Microaneurysms were first classified as perfused if flow signal was present in the OCTA channel. Then, perfused MAs were further classified into fully and partially perfused MAs based on the flow characteristics in en face OCTA. The presence of retinal fluid based on OCT near MAs was compared between perfused and nonperfused types. We also compared OCT-based MA detection to fundus photography (FP)- and fluorescein angiography (FA)-based detection. MAIN OUTCOME MEASURES OCT-identified MAs can be classified according to colocalized OCTA flow signal into fully perfused, partially perfused, and nonperfused types. Fully perfused MAs may be more likely to be associated with diabetic macular edema (DME) than those without flow. RESULTS We identified 308 MAs (166 fully perfused, 88 partially perfused, 54 nonperfused) in 42 eyes using OCT and OCTA. Nearly half of the MAs identified in this study straddle the inner nuclear layer and outer plexiform layer. Compared with partially perfused and nonperfused MAs, fully perfused MAs were more likely to be associated with local retinal fluid. The associated fluid volumes were larger with fully perfused MAs compared with other types. OCT/OCTA detected all MAs found on FP. Although not all MAs seen with FA were identified with OCT, some MAs seen with OCT were not visible with FA or FP. CONCLUSIONS OCT-identified MAs with colocalized flow on OCTA are more likely to be associated with DME than those without flow. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Min Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Kotaro Tsuboi
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon.
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Takamura Y, Yamada Y, Morioka M, Gozawa M, Matsumura T, Inatani M. Turnover of Microaneurysms After Intravitreal Injections of Faricimab for Diabetic Macular Edema. Invest Ophthalmol Vis Sci 2023; 64:31. [PMID: 37856112 PMCID: PMC10593137 DOI: 10.1167/iovs.64.13.31] [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: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose Microaneurysm (MA) plays an important role in the pathogenesis of diabetic macular edema (DME) progression and response to anti-vascular endothelial growth factor (VEGF) therapy. This study aimed to investigate the effect of faricimab, a bispecific antibody against angiopoietin-2 and VEGF, on the number of MAs and their turnover in the treatment of DME. Methods We included that patients with DME who underwent three monthly injections of faricimab in one eye, with the other eye as control. We examined central retinal thickness (CRT) based on optical coherence tomography (OCT) and best-corrected visual acuity. Turnover, including loss and newly formed MAs, and the total number of MAs were counted based on merged images of the OCT map and fluorescein angiography. Results We enrolled 28 patients with DME. After 3 monthly injections of faricimab, CRT significantly improved, 66.0 ± 16.2% of MAs disappeared, and 6.71 ± 5.6% of new MAs were generated, resulting in total reduction to 40.7 ± 15.2%. In the treated eyes, MA disappearance (P < 0.0001) and turnover (P = 0.007) were significantly greater, and new formation was smaller (P < 0.0001) than in non-treated eyes. The size of the retained MAs decreased after treatment. Microaneurysm turnover was not significantly different between areas with and without edema before treatment. Conclusions In the process of improving edema in DME with faricimab, MAs shrink and disappear, and formation of MAs are inhibited, resulting in decreased total number of MAs. Intravitreal administration of faricimab suppresses vascular permeability and improves vascular structure.
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Affiliation(s)
- Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
| | - Yutaka Yamada
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken, Japan
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Abdel-Kader AA, Ramsey DJ, Yussuf WA, Mohalhal AA, Eldaly MA, Elnahry AG. Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography. Indian J Ophthalmol 2023; 71:3085-3090. [PMID: 37530285 PMCID: PMC10538827 DOI: 10.4103/ijo.ijo_3155_22] [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: 12/02/2022] [Revised: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual-Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results Twenty-eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low-flow regions, likely because capillary loss is associated with their regression.
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Affiliation(s)
- Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Wael A Yussuf
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Mohalhal
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Eldaly
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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Tsukui D, Kono H. Multiple Renal Microaneurysms in Polyarteritis Nodosa. Mayo Clin Proc 2021; 96:2277-2278. [PMID: 34353474 DOI: 10.1016/j.mayocp.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Daisuke Tsukui
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
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Marques IP, Madeira MH, Messias AL, Martinho ACV, Santos T, Sousa DC, Figueira J, Cunha-Vaz J. Different retinopathy phenotypes in type 2 diabetes predict retinopathy progression. Acta Diabetol 2021; 58:197-205. [PMID: 33025221 PMCID: PMC7889686 DOI: 10.1007/s00592-020-01602-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To characterize the progression in retinopathy severity of different phenotypes of mild nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes. DESIGN AND METHODS Patients with type 2 diabetes and mild NPDR (ETDRS 20 or 35) were followed in a 5-year longitudinal study. Examinations, including color fundus photography (CFP) and optical coherence tomography (OCT and OCTA), were performed at baseline, 6 months and then annually. Phenotype classification was performed based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Phenotype A is characterized by low MAT (< 6) and normal CRT; Phenotype B by low MAT (< 6) and increased CRT; and Phenotype C by higher MAT (≥ 6) with or without increased CRT. ETDRS grading of seven fields CFP was performed at the initial and last visits. RESULTS Analysis of ETDRS grade step changes showed significant differences in diabetic retinopathy (DR) progression between the different phenotypes (p < 0.001). Of the 66 participants with phenotype A only 2 eyes (3%) presented 2-or-more-step worsening. None of the 50 participants characterized as phenotype B developed 2-step worsening, whereas 13 eyes (23.2%) characterized as phenotype C had 2-or-more-steps worsening. Phenotype C presents the higher risk for 2-or-more step worsening (OR: 15.94 95% CI: 3.45-73.71; p < 0.001) and higher sensitivity, correctly identifying 86.7% of cases at risk (AUC: 0.84 95% CI: 0.72-0.96; p < 0.001). Diabetic retinopathy severity progression was associated with HbA1c (p = 0.019), LDL levels (p = 0.043), and ocular factors as MAT (p = 0.010), MA formation rate (p = 0.014) and MA disappearance rate (p = 0.005). Capillary closure at 5-year follow-up, identified by lower vessel density (VD) on OCTA, was also associated with diabetic DR severity progression (p = 0.035). CONCLUSIONS Different DR phenotypes in type 2 diabetes show different risks of retinopathy progression. Phenotype C is associated with increased HbA1c values and presents a higher risk of a 2-or-more-step worsening of the ETDRS severity score.
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Affiliation(s)
- Inês P. Marques
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Maria H. Madeira
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana L. Messias
- Dentistry Department, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - António C.-V. Martinho
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Torcato Santos
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - David C. Sousa
- Ophthalmology Department, Hospital de Santa Maria, 1649-028 Lisbon, Portugal
- Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - João Figueira
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-548 Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - José Cunha-Vaz
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-548 Coimbra, Portugal
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Nakai M, Iwami H, Fukuyama H, Gomi F. Visualization of microaneurysms in macular telangiectasia type 1 on optical coherence tomography angiography before and after photocoagulation. Graefes Arch Clin Exp Ophthalmol 2020; 259:1513-1520. [PMID: 33006655 PMCID: PMC8166721 DOI: 10.1007/s00417-020-04953-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate changes in the visualization of microaneurysms (MAs) in cases of macular telangiectasia (Mac Tel) type 1 on optical coherence tomography angiography (OCTA) before and after treatment with direct photocoagulation and to evaluate their relationship with treatment efficacy. Methods The study included 12 eyes from 12 patients (8 men, 4 women; mean age 72.1 years) with Mac Tel type 1 accompanied by cystoid macular edema. OCTA for the evaluation of MAs was performed before and 15 min and 6, 12, and 24 weeks after photocoagulation. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were also evaluated. Results A total of 73 MAs were detected within the areas of macular edema on OCTA, and 39 of these underwent photocoagulation. At 15 min after treatment, 17 MAs were no longer visible on OCTA. At 6 weeks, two MAs had reappeared, whereas five additional MAs were no longer visible. The CRT in eyes with resolved MA was significantly less than that in eyes with persistent MAs (p = 0.016). At 24 weeks, seven eyes had no visible MAs, and the BCVA was not significantly different from baseline. Conclusion OCTA can monitor changes in the visualization of MAs associated with Mac Tel type 1 after direct photocoagulation. Eyes in which MAs disappeared after treatment could recover from cystoid macular edema.
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Affiliation(s)
- Mitsuko Nakai
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Hisashi Iwami
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, 663-8501, Japan.
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Cao D, Yang D, Huang Z, Zeng Y, Wang J, Hu Y, Zhang L. Optical coherence tomography angiography discerns preclinical diabetic retinopathy in eyes of patients with type 2 diabetes without clinical diabetic retinopathy. Acta Diabetol 2018; 55:469-477. [PMID: 29453673 DOI: 10.1007/s00592-018-1115-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/06/2018] [Indexed: 02/05/2023]
Abstract
AIMS To investigate changes in retinal vascular plexuses and choriocapillaris in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy (DR) and healthy controls using optical coherence tomography angiography (OCTA). METHODS A total of 71 DM2 and 67 healthy control subjects were included. All subjects underwent OCTA examination (RTVue-XR Avanti; Optovue, Fremont, CA, USA). Average vessel density in superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris, parafoveal vessel density in SCP and DCP, FAZ area (mm2) in SCP, microaneurysms and capillary nonperfusion were taken into analysis. RESULTS Parafoveal vessel density in both SCP and DCP decreased in the eyes without clinical DR compared to normal controls (p < 0.001). Diabetic patients with no signs of DR also had a significant reduction in average vessel density of SCP, DCP and choriocapillaris (p < 0.001, p < 0.001 and p = 0.006, respectively). No significant difference was found in FAZ area of SCP between DM2 eyes and healthy controls (p = 0.253). The average vessel density of SCP and DCP is not correlated with HbA1c or serum creatinine in DM2 patients. Microaneurysms seen in OCTA but not in fundus examination were found in 8 out of the 71 (11.3%) diabetic eyes, and capillary nonperfusion was noted in 18 of 71 diabetic eyes. CONCLUSIONS We demonstrated that OCTA can identify preclinical DR before the manifestation of clinically apparent retinopathy in diabetic eyes. DM2 patients without DR have SCP, DCP and choriocapillaris impairment. Our results suggested that OCTA might be a promising tool for regular screening of diabetic eyes for DR.
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Affiliation(s)
- Dan Cao
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Dawei Yang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Zhongning Huang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yunkao Zeng
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Jun Wang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yunyan Hu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China.
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Chudzik P, Majumdar S, Calivá F, Al-Diri B, Hunter A. Microaneurysm detection using fully convolutional neural networks. Comput Methods Programs Biomed 2018; 158:185-192. [PMID: 29544784 DOI: 10.1016/j.cmpb.2018.02.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 05/11/2023]
Abstract
BACKROUND AND OBJECTIVES Diabetic retinopathy is a microvascular complication of diabetes that can lead to sight loss if treated not early enough. Microaneurysms are the earliest clinical signs of diabetic retinopathy. This paper presents an automatic method for detecting microaneurysms in fundus photographies. METHODS A novel patch-based fully convolutional neural network with batch normalization layers and Dice loss function is proposed. Compared to other methods that require up to five processing stages, it requires only three. Furthermore, to the best of the authors' knowledge, this is the first paper that shows how to successfully transfer knowledge between datasets in the microaneurysm detection domain. RESULTS The proposed method was evaluated using three publicly available and widely used datasets: E-Ophtha, DIARETDB1, and ROC. It achieved better results than state-of-the-art methods using the FROC metric. The proposed algorithm accomplished highest sensitivities for low false positive rates, which is particularly important for screening purposes. CONCLUSIONS Performance, simplicity, and robustness of the proposed method demonstrates its suitability for diabetic retinopathy screening applications.
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Affiliation(s)
- Piotr Chudzik
- School of Computer Science, University of Lincoln, Lincoln LN6 7TS, UK.
| | - Somshubra Majumdar
- Department of Computer Science, University of Illinois, Chicago, IL 60607, USA
| | - Francesco Calivá
- School of Computer Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Bashir Al-Diri
- School of Computer Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Andrew Hunter
- School of Computer Science, University of Lincoln, Lincoln LN6 7TS, UK
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Cho YH, Craig ME, Januszewski AS, Benitez-Aguirre P, Hing S, Jenkins AJ, Donaghue KC. Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications. Diabet Med 2017; 34:543-550. [PMID: 27770590 DOI: 10.1111/dme.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Accepted: 10/19/2016] [Indexed: 01/06/2023]
Abstract
AIM To test the hypothesis that non-invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long-term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes. METHODS Forearm skin autofluorescence (arbitrary units) was measured in a cross-sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA1c 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven-field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10-min continuous electrocardiogram recording, as a measure of heart rate variability. RESULTS Skin autofluorescence was significantly associated with age (R2 = 0.15; P < 0.001). Age- and gender-adjusted skin autofluorescence was associated with concurrent HbA1c (R2 = 0.32; P < 0.001) and HbA1c over the previous 2.5-10 years (R2 = 0.34-0.43; P < 0.002). Age- and gender-adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration (R2 = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence (R2 = 0.11; P = 0.006). CONCLUSIONS Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non-invasive screening tool to predict future microvascular complications.
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Affiliation(s)
- Y H Cho
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - M E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - P Benitez-Aguirre
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - S Hing
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - K C Donaghue
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
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