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LONG-TERM VISUAL OUTCOMES AND CLINICAL FEATURES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION–RELATED ENDOPHTHALMITIS
摘要： Purpose: To determine long-term visual outcomes in patients who developed endophthalmitis after intravitreal anti–vascular endothelial growth factor injections and to correlate visual outcomes with clinical features. Methods: This is a retrospective, multicenter, consecutive case series of patients diagnosed with anti–vascular endothelial growth factor injection–related endophthalmitis who were treated at Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, PA, and the University of Southern California Roski Eye Institute, Los Angeles, CA. Patients were included if they had at least 1 year of follow-up. Primary outcome was to evaluate long-term visual outcomes up to 5 years of follow-up. The secondary outcome was to determine clinical features (e.g., culture results) that may predict long-term visual acuity outcomes. Results: A total of 56 cases of endophthalmitis from 168,247 anti–vascular endothelial growth factor injections were identi?ed (0.033%, 1/3,004 injections), from which 51 eyes met inclusion criteria. Mean follow-up period was 3.3 years (median 4 years; range 1–5 years). A total of 24 patients (47%) reached a maximum ?nal follow-up of 5 years. Mean Snellen visual acuity at the causative injection visit was 20/102 and decreased to counting ?ngers at diagnosis (P , 0.001). At 6-month follow-up, mean visual acuity improved to 20/644 (P , 0.001) and remained stable up to 5 years (20/480, P = 0.003) follow-up compared with diagnosis. At the ?nal follow-up, 20 eyes had visual acuity that returned to within one line of baseline visual acuity (visual recovery group), whereas 31 patients’ visual acuity was at least one line worse than initial visual acuity (visual deterioration group). The cultures for the visual recovery group were more likely to grow coagulase-negative Staphylococcus, whereas the visual deterioration group primarily grew Streptococcus species, Staphylococcus aureus, and Enterococcus faecalis (P = 0.002, comparing organisms isolated in the visual recovery and deterioration group). Conclusion: Visual outcomes after anti–vascular endothelial growth factor injection– related endophthalmitis seem to reach peak improvement by 6 months and remain stable up to a median of 4-year follow-up. Patients who develop culture-negative endophthalmitis or endophthalmitis secondary to coagulase-negative Staphylococcus are more likely to regain baseline visual acuity compared with cases secondary to Streptococcus species.
关键词： bevacizumab,anti-vascular endothelial growth factor,diabetic macular edema,intravitreal injection,endophthalmitis,a?ibercept,long-term,ranibizumab,neovascular age-related macular degeneration,retinal vein occlusion
更新于2025-09-10 09:29:36
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[IEEE 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) - Honolulu, HI, USA (2018.7.18-2018.7.21)] 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) - Fusing Results of Several Deep Learning Architectures for Automatic Classification of Normal and Diabetic Macular Edema in Optical Coherence Tomography
摘要： Diabetic Macular Edema (DME) is a severe eye disease that can lead to irreversible blindness if it is left untreated. DME diagnosis still relies on manual evaluation from opthalmologists, thus the process is time consuming and diagnosis may be subjective. This paper presents two novel DME detection frameworks: (1) combining features from three pre-trained Convolutional Neural Networks: AlexNet, VggNet and GoogleNet and performing feature space reduction using Principal Component Analysis and (2) a majority voting scheme based on a plurality rule between classifications from AlexNet, VggNet and GoogleNet. Experiments were conducted using Optical Coherence Tomography datasets retrieved from the Singapore Eye Research Institute and the Chinese University Hong Kong. The results are evaluated using a Leave-Two-Patients-Out Cross Validation at the volume level. This method improves DME classification with an accuracy of 93.75%, which is similar to the best algorithms so far on the same datasets.
关键词： GoogleNet,Convolutional Neural Networks,AlexNet,majority voting,Diabetic Macular Edema,Principal Component Analysis,VggNet,Optical Coherence Tomography
更新于2025-09-10 09:29:36
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Comparison of Reliability in Diabetic Macular Edema Estimates between Two Image Analysis Algorithms
摘要： Purpose: To evaluate segmentation reliability in diabetic macular edema (DME) estimates between a CirrusTM HD-OCT image analysis algorithm and an Iowa reference algorithm, which are an automatic segmentation software. Methods: Thirty eyes from 23 patients diagnosed with DME were included and underwent spectral-domain optical coherence scans (CirrusTM HD-OCT). Central foveal thickness (CFT) and ganglion cell layer-inner plexiform layer segmentation data were compared with those produced by the CirrusTM HD-OCT segmentation algorithm and Iowa reference algorithm. Measurement agreement was assessed using intraclass correlation (ICC) and segmentation errors were confirmed by 2 ophthalmologists. Results: The mean CFT in the 1-mm central area determined by the manufacturer-supplied Cirrus software and Iowa reference algorithm was 512.07 ± 182.35 μm and 476.53 ± 32.36 μm, respectively (p < 0.05). The mean paired difference was 35.53 ± 92.46 μm (ICC, 0.929). Segmentation errors were demonstrated in eyes with a CFT less than 400 μm, specifically for 45% of scans obtained by the Cirrus algorithm and 9% from the Iowa algorithm; in eyes with a CFT equal to or higher than 400 μm, the error rates were 95% and 42%, respectively. Conclusions: CFT measurement in eyes with diabetic macular edema using the Cirrus algorithm and Iowa algorithm showed relatively high degrees of agreement and significant correlation. In eyes with a CFT equal to or higher than 400 μm, the Iowa algorithm showed higher reliability in retinal segmentation than the Cirrus algorithm.
关键词： Reliability,Segmentation algorithm,Diabetic macular edema,Optical coherence tomography,Central foveal thickness
更新于2025-09-10 09:29:36
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Diabetic Nephropathy (Pathophysiology and Clinical Aspects) || Microvascular Complications in the?Eye: Diabetic Retinopathy
摘要： Diabetic retinopathy (DR) is a major cause of vision loss and blindness among persons with diabetes mellitus. It is estimated that approximately 35% of diabetes patients develop some form of DR [1]. DR is a progressive disease that is predominantly characterized by alterations in the retinal microvasculature. It may develop from an asymptomatic nonproliferative form associated with capillary non-perfusion, microaneurysms, and retinal hemorrhages, into a vision-threating disorder such as diabetic macular edema (DME) and proliferative DR (PDR).
关键词： vision loss,Diabetic retinopathy,retinal microvasculature,blindness,microvascular complications,diabetic macular edema,diabetes mellitus,proliferative diabetic retinopathy
更新于2025-09-10 09:29:36
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[IEEE 2018 International CET Conference on Control, Communication, and Computing (IC4) - Thiruvananthapuram, India (2018.7.5-2018.7.7)] 2018 International CET Conference on Control, Communication, and Computing (IC4) - Computerized Detection of Macular Edema Using OCT Images Based on Fractal Texture Analysis
摘要： Macular edema (ME) is a significant cause that results in blindness among majority. It happens due to the anomalous leakage and builds up of fluids within macular region. Anything that relates with the performance of eyes can drive the chances to become a ME patient. ME can occur as a downstream of eye related surgeries, degradation due to aging or any eye disorders causing inflammation. The main fact about ME that if the disease is not identified and diagnosed at the earlier stages, the chance of recovery is minimal and can ultimately affect the ability to see. One of the main causes of ME is the disease which can injure in the retina. Laser photocoagulation and blood vessels vitrectomy are the common method available now for diagnosing the disease. Optical Coherence Tomography alias OCT, an advanced imaging technique to capture retinal layer region. Different algorithms were implemented to detect ME from OCT images, but early detection of ME is not possible. This paper utilizes segmentation based fractal texture analysis (SFTA) to derive the feature vector. Graph based segmentation employs in the detection of layers and QDA classifies the ME images. This algorithm will help the ophthalmologist to treat the patient at early stages. The algorithm is deployed successfully on a macular edema dataset, with 97.5% accuracy rate.
关键词： layer detection,Graph shortest path,SFTA,thickness profile,OCT,Macular Edema,QDA
更新于2025-09-10 09:29:36
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Relative Importance and Contribiton of Risk Factors for Diabetic Retinopathy and Macular Edema
摘要： Purpose: This study determined the relative importance of risk factors for Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) and assessed their independent and joint contributions. Methods: A prospective study of patients with type 2 diabetes was conducted in a tertiary eye hospital in Melbourne, Australia. Patients underwent a comprehensive eye examination and completed standardized administered questionnaires. Blood samples were assessed for glycated haemoglobin (HbA1c); fasting blood glucose; and serum lipids. Dilated fundus photographs were obtained and graded for DR and DME. The relative importance of the risk factors was determined by the independent and common variance explained in DR and DME using Commonality analysis. Results: A total of 497 patients with type 2 diabetes were included in this analysis. The key risk factors accounted for 44.6% and 19.5% of total variances in DR and DME, respectively. The most important risk factor for any DR was duration of diabetes (16.5% of total explained variance), followed by insulin use (13.1%), HbA1c (8.5%), age (3.7%) and gender (2.8%). The most important risk factor for any DME was HbA1c (9.45%); followed by age (5.75%); duration of diabetes (3.92%) and systolic blood pressure (SBP) (0.36%). Sixty-one percent of the total explained variance in DR was due to common variance among these risk factors, compared to only 31% of the in DME. Conclusion: The total, independent and joint contributions of the key risk factors for DR and DME differ in patients with type 2 diabetes, which suggest that may require specific prevention and intervention strategies for these two diabetic complications.
关键词： Commonality analysis,Haemoglobin A1c,Diabetic retinopathy,Diabetic macular edema,Duration of diabetes
更新于2025-09-09 09:28:46
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Matched control study of visual outcomes after arteriovenous sheathotomy for branch retinal vein occlusion
摘要： Background: The purpose of this study was to evaluate visual outcomes of arteriovenous sheathotomy for macular edema due to branch retinal vein occlusion (BRVO). Methods: The medical records of 45 eyes from 45 patients who had undergone vitrectomy surgery with arteriovenous sheathotomy for BRVO were studied. Forty-five eyes of 45 patients with a BRVO but without intervention were studied as the control group. The best-corrected visual acuity and central macular thickness were compared between the two groups at baseline and at 1, 3, 6, and 12 months postoperatively. Results: Improvement of best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) units in the sheathotomy group and 0.22 logMAR units in the control group (P=0.007). The mean postoperative central macular thickness was significantly thinner in the sheathotomy group at 1 month (P=0.01), but not at 3, 6, and 12 months (P=0.75, P=0.81, and P=0.46, respectively). Improvement of best-corrected visual acuity at 12 months was significantly correlated with baseline best-corrected visual acuity, age, duration of symptoms, and sheathotomy (P,0.05). Conclusion: Arteriovenous sheathotomy for BRVO improves best-corrected visual acuity significantly more than the natural course of the BRVO disease process.
关键词： macular edema,sheathotomy,branch retinal vein occlusion,vitrectomy,observation
更新于2025-09-09 09:28:46
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Hyperreflective Intraretinal Foci as an OCT Biomarker of Retinal Inflammation in Diabetic Macular Edema
摘要： We read with great interest the article titled ‘Association Between Soluble CD14 in the Aqueous Humor and Hyperre?ective Foci on Optical Coherence Tomography in Patients with Diabetic Macular Edema’ by Lee et al. The authors investigated the expression of soluble CD14 (sCD14) in aqueous humor (AH) samples of patients with diabetic macular edema (DME), and the presence of hyperre?ective foci (HF) on spectral-domain optical coherence tomography (SD-OCT) in these eyes. The authors found both higher levels of sCD14, and increased number of HF in the inner retina compared to controls, and concluded that, since sCD14 is released by retinal microglia, HF might represent aggregates of activated microglial cells in DME eyes. The presence of and changes in OCT HF, also called hyperre?ective spots, have been previously described in detail in diabetic eyes and reported to depend on activated microglia. DME-affected eyes treated with intravitreal anti-VEGF and steroids have also been investigated, demonstrating a reduction of HF number with both treatments—con?rming HF as a retinal in?ammatory biomarker. To improve this observation, we also investigated diabetic eyes in a large population to identify HF-speci?c characteristics, a topic not suf?ciently addressed by Lee et al. In particular, we disagree with the statement that HF, as aggregates of retinal microglial cells, have the same re?ectivity as the retinal pigment epithelium (RPE), whereas it is more similar to that of the retinal nerve ?ber layer (RNFL). Other clinical characteristics (size < 30 lm, absence of back-shadowing, presence in both inner and outer retinal layers in DME) allow differentiation of HF, as an in?ammatory biomarker, from hard exudates, small intraretinal hemorrhages, microaneurysms, and tiny capillaries, which also appear as OCT hyperre?ective foci (spots). The correct identi?cation of in?ammation-driven HF from other forms of hyperre?ective material is relevant when using this new biomarker in the follow-up of any DME treatment. As consequence, any investigation of HF on OCT in diabetic eyes should be more precise to avoid inconsistent results.
关键词： Hyperre?ective intraretinal foci,Retinal in?ammation,Diabetic macular edema,OCT biomarker
更新于2025-09-09 09:28:46
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Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema
摘要： ● AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT). ● METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. ● RESULTS: Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. ● CONCLUSION: Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.
关键词： diabetic macular edema,optical coherence tomography,serous retinal detachment,diffuse retinal thickness,cystoid macular edema
更新于2025-09-04 15:30:14
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OCT-Leakage: A New Method to Identify and Locate Abnormal Fluid Accumulation in Diabetic Retinal Edema
摘要： To identify retinal extracellular fluid changes and their correlation with increased retinal thickness (RT) in eyes with subclinical and clinical macular edema in diabetes type 2. A cohort of 48 eyes from 48 type 2 diabetic patients with mild or moderate nonproliferative diabetic retinopathy (Early Treatment Diabetic Retinopathy Study levels 20/35) were classified as having normal RT (10), subclinical macular edema (30), or clinical macular edema (8). They were examined with Cirrus spectral-domain optical coherence tomography (OCT) at baseline visits (ClinicalTrials.gov number, NCT01145599) in the Coimbra center. Results from automated analysis of the retinal extracellular space, using our OCT-Leakage algorithm to identify sites of low optical reflectivity, were compared with those from a control group of 25 healthy eyes. The highest increases in RT in the eyes with subclinical and clinical macular edema were found in the inner nuclear layer (INL). These increases were, on average, 49.9% in subclinical macular edema and 104.7% in clinical macular edema. Extracellular space increases in the INL that were identified with the OCT-Leakage algorithm showed a strong positive correlation with the increases in RT in the central subfield (r ? 0.71, P < 0.001). Increases in number of sites with lower optical reflectivity positively correlate with the increase in RT in the initial stages of macular edema in diabetes type 2. Diabetic macular edema is represented mainly by extracellular fluid accumulation that preferentially involves the INL of the retina.
关键词： diabetes,optical coherence tomography,macular edema,retinal leakage,blood-retinal barrier
更新于2025-09-04 15:30:14