Purpose: To develop a deep convolutional neural network that enables the prediction of postoperative visual outcomes after epiretinal membrane surgery based on preoperative optical coherence tomography images and clinical parameters to refine surgical decision making.Methods: A total of 529 patients with idiopathic epiretinal membrane who underwent standard vitrectomy with epiretinal membrane peeling surgery by two surgeons between January 1, 2014, and June 1, 2020, were enrolled. The newly developed Heterogeneous Data Fusion Net was introduced to predict postoperative visual acuity outcomes (improvement $2 lines in Snellen chart) 12 months after surgery based on preoperative cross-sectional optical coherence tomography images and clinical factors, including age, sex, and preoperative visual acuity. The predictive accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the convolutional neural network model were evaluated.Results: The developed model demonstrated an overall accuracy for visual outcome prediction of 88.68% (95% CI, 79.0%-95.7%) with an area under the receiver operating characteristic curve of 97.8% (95% CI, 86.8%-98.0%), sensitivity of 87.0% (95% CI, 67.9%-95.5%), specificity of 92.9% (95% CI, 77.4%-98.0%), precision of 0.909, recall of 0.870, and F1 score of 0.889. The heatmaps identified the critical area for prediction as the ellipsoid zone of photoreceptors and the superficial retina, which was subjected to tangential traction of the proliferative membrane.
Conclusion:The novel Heterogeneous Data Fusion Net demonstrated high accuracy in the automated prediction of visual outcomes after weighing and leveraging multiple clinical parameters, including optical coherence tomography images. This approach may be helpful in establishing personalized therapeutic strategies for epiretinal membrane management.RETINA 43:767-774, 2023T he epiretinal membrane (ERM) is a macular disease characterized by fibrocellular proliferation at the vitreoretinal interface causing tractional force on the retina. 1 Globally, it is estimated to affect 2.2% to 18.5% of the population 2,3 and can lead to severe visual impairment with a debilitated quality of life in some patients. Surgical removal is the mainstay treatment for ERM, especially in patients presenting with symptoms such as metamorphopsia or poor visual acuity. However, in some cases, anatomical and postoperative vision recovery is limited. 4,5 Therefore, it is critical to identify prognostic factors and patients susceptible to surgical failure. The known prognostic factors include age of onset, preoperative visual acuity, duration of symptoms, and surgical complications. 4,6,7 Furthermore, the microstructure of the macula on optical coherence tomography (OCT) is believed to be associated with visual outcomes, including central foveal thickness, integrity of the ellipsoid zone and cone outer segment, photoreceptor outer segment length, and the integrity of retinal pigment epithelium. 8,9 However, there is a lack of obje...