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Fully automated detection of retinal disorders by image-based deep learning
摘要： Purpose With the aging population and the global diabetes epidemic, the prevalence of age-related macular degeneration (AMD) and diabetic macular edema (DME) diseases which are the leading causes of blindness is further increasing. Intravitreal injections with anti-vascular endothelial growth factor (anti-VEGF) medications are the standard of care for their indications. Optical coherence tomography (OCT), as a noninvasive imaging modality, plays a major part in guiding the administration of anti-VEGF therapy by providing detailed cross-sectional scans of the retina pathology. Fully automating OCT image detection can significantly decrease the tedious clinician labor and obtain a faithful pre-diagnosis from the analysis of the structural elements of the retina. Thereby, we explore the use of deep transfer learning method based on the visual geometry group 16 (VGG-16) network for classifying AMD and DME in OCT images accurately and automatically. Method A total of 207,130 retinal OCT images between 2013 and 2017 were selected from retrospective cohorts of 5319 adult patients from the Shiley Eye Institute of the University of California San Diego, the California Retinal Research Foundation, Medical Center Ophthalmology Associates, the Shanghai First People’s Hospital, and the Beijing Tongren Eye Center, with 109,312 images (37,456 with choroidal neovascularization, 11,599 with diabetic macular edema, 8867 with drusen, and 51,390 normal) for the experiment. After images preprocessing, 1000 images (250 images from each category) from 633 patients were selected as validation dataset while the rest images from another 4686 patients were used as training dataset. We used deep transfer learning method to fine-tune the VGG-16 network pre-trained on the ImageNet dataset, and evaluated its performance on the validation dataset. Then, prediction accuracy, sensitivity, specificity, and receiver-operating characteristic (ROC) were calculated. Results Experimental results proved that the proposed approach had manifested superior performance in retinal OCT images detection, which achieved a prediction accuracy of 98.6%, with a sensitivity of 97.8%, a specificity of 99.4%, and introduced an area under the ROC curve of 100%. Conclusion Deep transfer learning method based on the VGG-16 network shows significant effectiveness on classification of retinal OCT images with a relatively small dataset, which can provide assistant support for medical decision-making. Moreover, the performance of the proposed approach is comparable to that of human experts with significant clinical experience. Thereby, it will find promising applications in an automatic diagnosis and classification of common retinal diseases.
关键词： Diabetic macular edema,Visual geometry group 16 network,Age-related macular degeneration,Optical coherence tomography,Deep transfer learning
更新于2025-09-23 15:22:29
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Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study
摘要： Background The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. Results Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3–6) with no significant difference between groups. Conclusions Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.
关键词： Anti-VEGF,Grid laser photocoagulation,Macular edema,Branch retinal vein occlusion,Bevacizumab
更新于2025-09-23 15:22:29
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[IEEE 2018 International Conference on Intelligent and Advanced System (ICIAS) - Kuala Lumpur, Malaysia (2018.8.13-2018.8.14)] 2018 International Conference on Intelligent and Advanced System (ICIAS) - Deep Features and Data Reduction for Classification of SD-OCT Images: Application to Diabetic Macular Edema
摘要： Diabetic Macular Edema (DME) is defined as the accumulation of extracellular fluids in the macular region of the eye, caused by Diabetic Retinopathy (DR) that will lead to irreversible vision loss if left untreated. This paper presents the use of a pre-trained Convolutional Neural Network (CNN) based model for the classification of Spectral Domain Optical Coherence Tomography (SD-OCT) images of Diabetic Macular Edema (DME) with feature reduction using Principal Component Analysis (PCA) and Bag of Words (BoW). The model is trained using SD-OCT dataset retrieved from the Singapore Eye Research Institute (SERI) and is evaluated using an 8-fold cross validation at the slide level and two patient leave out at the volume level. For the volume level, an accuracy of 96.88% is obtained for data that was preprocessed.
关键词： Diabetic Macular Edema,Dimension reduction,CNNs,SD-OCT
更新于2025-09-23 15:22:29
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Management of cystoid macular edema secondary to retinitis pigmentosa via subliminal micropulse yellow laser
摘要： To investigate the effects of subliminal micropulse yellow laser application on the central macular thickness and best-corrected visual acuity in cystoid macular edema secondary to retinitis pigmentosa patients. This prospective open-label clinical trial, conducted between January 2018 and October 2019, included 32 eyes of 29 patients who had cystoid macular edema secondary to retinitis pigmentosa. Patients were treated by subliminal micropulse yellow laser for one session. Central macular thickness and best-corrected visual acuity changes were investigated just before the treatment and 1 year later after the one session of the treatment. The mean central macular thickness was 651.3 μm before the treatment and 247.7 μm at 12 months after the treatment. The decrease in mean central macular thickness was statistically significant (p = 0.01). Median best-corrected visual acuity was 66.8 ETDRS letters before the treatment and 70.0 letters at 12 months after the treatment. The increase in best-corrected visual acuity was not statistically significant (p = 0.18). Eighty-six percent of the patients stated that the quality of central vision increased and that color vision, contrast sensitivity, and distortion improved. We did not encounter any serious adverse events related to the application of subliminal micropulse yellow laser. The subliminal micropulse yellow laser seems to be a therapeutic, effective, and safe option for the treatment of non-inflammatory and resistant cystoid macular edema secondary to retinitis pigmentosa patients. ClinicalTrials.gov ID: NCT04234438, January 17, 2020.
关键词： Intraretinal cysts,Retinitis pigmentosa,Subliminal micropulse laser,Cystoid macular edema
更新于2025-09-23 15:21:01
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Multifocal electroretinogram in diabetic macular edema; Correlation with visual acuity and optical coherence tomography
摘要： Purpose: To evaluate multifocal electroretinogram (mfERG) changes in eyes with diabetic macular edema (DME) and investigate any possible correlation with optical coherence tomography (OCT) features and visual acuity (VA). Methods: Twenty?nine right eyes of 29 subjects with DME due to non?proliferative diabetic retinopathy and 30 eyes of 30 normal subjects were evaluated. All patients underwent a complete ophthalmic examination. Sixty?one scaled hexagon mfERG responses were recorded. Components of the first order kernel of N1, N2, and P1 in five concentric rings centered on the fovea, were measured in both groups. Correlation and regression analyses were performed among VA, central macular thickness (CMT) based on OCT, mfERG amplitude, and latency of the N1, N2 and P1 waves. Results: Significant differences were observed in all mfERG parameters in five?ring regions of the retina between eyes with DME versus controls (P < 0.05). There were significant correlations among VA with N2 (P = 0,001, b = 0.73) and P1 amplitudes (P = 0.001, b = ?0.84) in the central macular area, and there was a borderline association between VA and CMT (P = 0.042, b = 0.392). Conclusion: Amplitudes of mfERG components (N1, P1, and N2) are significantly reduced and their latencies are delayed in eyes with DME indicating functional impairment in the outer retina. The mfERG total amplitude was significantly correlated with VA even more than CMT, therefore the combined use of OCT and mfERG for macular evaluation may better evaluate visual status in DME patients.
关键词： Diabetes Mellitus,Multi?focal Electroretinography,Diabetic Macular Edema,Optical Coherence Tomography,Visual Acuity
更新于2025-09-23 15:21:01
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Disorganization of Retinal Inner Layers and Ellipsoid Zone Disruption Predict Visual Outcomes in Central Retinal Vein Occlusion
摘要： To assess the associations and predictive value of spectral-domain (SD) OCT inner and outer retinal structural parameters and visual acuity (VA) outcomes in macular edema (ME) secondary to central retinal vein occlusion (CRVO).
关键词： disorganization of retinal inner layers,visual acuity,ellipsoid zone disruption,macular edema,spectral-domain OCT,central retinal vein occlusion
更新于2025-09-23 15:21:01
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Subthreshold yellow micropulse laser for treatment of diabetic macular edema: Comparison between fixed and variable treatment regimen
摘要： Purpose: To compare the efficacy between fixed and variable treatment regimens of subthreshold yellow micropulse laser for the treatment of diabetic macular edema. Methods: This is a retrospective, comparative, 12-month study of 39 eyes: 24 eyes received fixed treatment regimen of subthreshold micropulse laser treatment and 15 eyes underwent variable treatment regimen of subthreshold micropulse laser, all eyes were followed up for 12 months. Subthreshold micropulse laser was performed with the following parameters: 100 μm spot size on slit lamp, 5% duty cycle of 0.2 s, and 250 mW power. To choose the power of the variable treatment regimen of subthreshold micropulse laser group, continuous laser power was titrated to a barely visible burn and then switched to MicroPulse mode, multiplying the test burn power by 4 and using a 5% duty cycle of 0.2 s. Main outcomes included changes in central macular thickness and best-corrected visual acuity. Results: At baseline, the mean LogMAR best-corrected visual acuity was 0.297 ± 0.431 in the variable treatment regimen of subthreshold micropulse laser group and 0.228 ± 0.341 in the fixed treatment regimen of subthreshold micropulse laser group. At the end of follow-up, the mean LogMAR best-corrected visual acuity was 0.289 ± 0.473 (p = 0.785) and 0.245 ± 0.376 (p = 0.480) in the variable and fixed treatment regimens of subthreshold micropulse laser groups, respectively. Similarly, central macular thickness decreased in both groups after treatment; at baseline, the mean central macular thickness was 371.06 ± 37.8 in the variable treatment regimen of subthreshold micropulse laser group and improved to 325.60 ± 110.0 μm (p = 0.025) at the end of the follow-ups, while it was 342.30 ± 35.4 in the fixed treatment regimen of subthreshold micropulse laser group and improved to 308.51 ± 67.5 (p = 0.037). Conclusion: Both treatment regimens are effective for the treatment of mild center-involving diabetic macular edema: fixed treatment appears more suitable minimizing treatment time and reducing the possible errors due to wrong titration in the switch from continuous to micropulse mode.
关键词： Diabetic retinopathy,retina,diabetic macular edema,cystoid macular edema (CME),retina—medical therapies,retinal pathology/research
更新于2025-09-23 15:19:57
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The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema
摘要： Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon’s triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.
关键词： micropulse yellow laser,cataract surgery,refractory macular edema,post-surgical cystoid macular edema
更新于2025-09-23 15:19:57
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Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography
摘要： Aim To analyze the efficacy of navigated focal laser photocoagulation (FLP) of microaneurysms in diabetic macular edema (DME) planned using en face optical coherence tomography (OCT) as against fluorescein angiography (FA). Methods Twenty-six eyes of 21 DME patients (12 males, 9 females, 69.5 ± 12.3 years) with mean BCVA of 0.52 ± 0.44 LogMAR were included. En face OCT images of deep capillary plexus slab and FA images were used to plan FLP targeting of leaky microaneurysms. The primary outcome measures were central retinal thickness (CRT) and macular volume. The secondary outcome measure was best-corrected visual acuity (BCVA). Results The difference in the change of CRT and macular volume between en face OCT and FA-planned FLP after 1 month and at the end of follow-up was not statistically significant (p > 0.05), except for a higher CRT reduction in the en face OCT-planning group (p = 0.007) at the end of mean follow-up of 2.6 ± 0.9 months. There was no difference in BCVA change between the two planning options (p = 0.42). Conclusion En face OCT is a non-inferior alternative for FA in the planning of navigated FLP of microaneurysms in DME.
关键词： Navigated laser,Optical coherence tomography,Diabetic macular edema,Focal laser photocoagulation,Optical coherence tomography angiography,Fluorescein angiography,Microaneurysms
更新于2025-09-23 15:19:57
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<p>Intravitreal Aflibercept versus Laser Photocoagulation in Asian Patients with Diabetic Macular Edema: The VIVID-East Study</p>
摘要： Purpose: The prevalence of diabetes and diabetes-related complications, including diabetic macular edema (DME), is increasing in Asia and worldwide. Methods: VIVID-East was a 12-month, double-masked, randomized, active-controlled, Phase 3 trial (NCT01783886) enrolling adult patients (aged ≥18 years) with DME at 25 centers across China, Hong Kong, Republic of Korea, and Russia. Eyes were randomized 1:1:1 to 2 mg intravitreal a?ibercept (IVT-AFL) every 4 weeks (2q4; N=127), 2 mg IVT-AFL every 8 weeks (after 5 initial monthly doses from baseline to week 16) with sham injections on nontreatment visits (2q8; N=127), or macular laser photocoagulation at baseline and sham injections at every visit (laser control group; N=124). The primary ef?cacy endpoint was mean change in best corrected visual acuity (BCVA) from baseline to week 52. Results: Compared with baseline, at week 52 the mean (SE) BCVA in the 2q4 and 2q8 groups gained +13.6 (0.9) and +13.1 (1.0) letters, respectively, versus ?0.5 (1.4) letters in the laser group (P<0.0001 for both). A signi?cantly higher proportion of patients treated with IVT-AFL (2q4 and 2q8) achieved a ≥10-letter or ≥15-letter gain compared with laser (both P<0.0001) (≥10-letter gain: 70.9%, 62.7%, and 23.4%, respectively; ≥15-letter gain: 43.3%, 36.5%, and 12.1%, respectively). Mean reduction in central retinal thickness from baseline to week 52 was signi?cantly greater with IVT-AFL versus laser treatment. Incidence of treatment-emergent adverse events was low and similar across groups; conjunctival hemorrhage (11.8%), retinal hemorrhage (8.7%), retinal aneurysm (7.5%), and retinal exudates (5.5%) being the most frequently reported. Visual and anatomic outcomes in the Chinese subgroup were consistent with the overall population. Conclusion: IVT-AFL treatment resulted in signi?cant visual and anatomic improvements in Asian patients with DME. Treatment bene?ts observed in the overall study population were mirrored in the subgroup of Chinese patients, who made up the largest population group in the study. Study Registration: NCT01783886.
关键词： diabetic macular edema,Chinese,intravitreal a?ibercept,Asia
更新于2025-09-23 15:19:57