Minimally Invasive Glaucoma Surgery: What Do We Know? Where Should We Go?

Chen, Xin; Wang, Huangzhou; Wang, Ningli

doi:10.1167/tvst.9.5.15

Cited by 11 publications

(8 citation statements)

References 88 publications

(132 reference statements)

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“…This study aimed to increase the accuracy of DL in diagnosing rare retinal diseases while maintaining the diagnostic performance for major diseases. Several previous studies have focused on building DL models for the diagnosis of rare retinal diseases, including macular hole [ 41 ], retinitis pigmentosa [ 42 , 43 ], and Stargardt disease [ 4 ]. However, these DL models were designed for binary classification using normal and pathological image data.…”

Section: Discussionmentioning

confidence: 99%

Feasibility study to improve deep learning in OCT diagnosis of rare retinal diseases with few-shot classification

Yoo

Choi

Kim

2021

Med Biol Eng Comput

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Deep learning (DL) has been successfully applied to the diagnosis of ophthalmic diseases. However, rare diseases are commonly neglected due to insufficient data. Here, we demonstrate that few-shot learning (FSL) using a generative adversarial network (GAN) can improve the applicability of DL in the optical coherence tomography (OCT) diagnosis of rare diseases. Four major classes with a large number of datasets and five rare disease classes with a few-shot dataset are included in this study. Before training the classifier, we constructed GAN models to generate pathological OCT images of each rare disease from normal OCT images. The Inception-v3 architecture was trained using an augmented training dataset, and the final model was validated using an independent test dataset. The synthetic images helped in the extraction of the characteristic features of each rare disease. The proposed DL model demonstrated a significant improvement in the accuracy of the OCT diagnosis of rare retinal diseases and outperformed the traditional DL models, Siamese network, and prototypical network. By increasing the accuracy of diagnosing rare retinal diseases through FSL, clinicians can avoid neglecting rare diseases with DL assistance, thereby reducing diagnosis delay and patient burden.

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Section: Discussionmentioning

confidence: 99%

Feasibility study to improve deep learning in OCT diagnosis of rare retinal diseases with few-shot classification

Yoo

Choi

Kim

2021

Med Biol Eng Comput

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“…Here, we present a case describing 12 years of follow-up (six years both before and after TLE) on a patient whose visual field sustained remarkably with the recovery of visual field progression, along with a reversal of glaucomatous optic disc changes after TLE. Although minimally invasive glaucoma surgeries are often preferred [1][2][3][4], this case report suggests that sustained maintenance of low IOP after TLE is important.…”

Section: Introductionmentioning

confidence: 92%

“…Trabeculectomy (TLE) is an important surgical procedure for glaucoma because it can be applied to all glaucoma types and it can lower the intraocular pressure (IOP) to a higher degree than that achieved by recently developed minimally invasive glaucoma surgeries [1][2][3][4]. However, complications associated with TLE, such as loss of visual acuity, hypotony, infection, cataracts, bleb leakage, and cataract progression, among others, have discouraged some surgeons from practicing this procedure [5].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up After Successful Trabeculectomy: A Case Report of Reversal of Cupping and Recovery of Visual Field Progression

Nakakura

Asaoka²,

Kiuchi³

2021

Cureus

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Glaucoma is one of the leading causes of blindness worldwide, and reduction of intraocular pressure (IOP) is the only available evidence-based treatment that reduces visual field deterioration in glaucoma. We present a representative case of structural recovery and recovery of visual field progression after successful trabeculectomy (TLE) with long-term follow-up. A 35-year-old woman with glaucoma visited our hospital in 2008. The IOP in her right eye was 11 mmHg at the first visit, and subsequently increased to values in the high teens to 20 mmHg despite treatment with anti-glaucoma eye drops. During this period, the progression of this eye’s visual field deterioration was fast (mean deviation [MD] slope = −0.63 dB/year) and the optic disc cupping was advanced. In the seven-year period after successful TLE in 2014, the IOP declined to between 8 and 12 mmHg without any anti-glaucoma medication. During the first two years after TLE, the MD values were poorer than those before TLE. However, by 2020, MD values improved gradually to a state better than that before the surgery (MD slope during this period was +0.75 dB/year). The appearance of the optic disc was monitored using fundus photography, which showed optic disc morphological changes during topical glaucoma medication before and after TLE. In particular, a remarkable reversal of optic disc cupping enlargement started at two weeks after TLE, and the optic disc shape in 2021 was similar to that in 2008. Minimally invasive glaucoma surgeries are often preferred; however, our findings suggest that successful TLE followed by long-term rigorous IOP control can result in structural recoveries. Additionally, despite the deterioration in visual field in the early years after TLE, in the long term, it may settle down to the same level before the surgery with recovery of visual field progression, which may be a part of functional recovery.

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“…Canal-based minimally invasive glaucoma surgeries produce far fewer complications and allow intervening earlier 11 , 12 because they lower the IOP by bypassing or removing the TM to enhance the physiological aqueous humor outflow route 11 , 13 , 14 . Leading modalities are trabecular bypass stents (TBS) 15 – 17 and ab interno trabeculectomy (AIT), in which the TM is either ablated 18 , incised 19 , or excised 20 .…”

Section: Introductionmentioning

confidence: 99%

Trabeculopuncture as a predictive test of distal outflow resistance in canal-based surgery

Verma-Fuehring

Dakroub

Han

et al. 2022

Sci Rep

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We investigated whether trabeculopuncture (TP) could detect distal outflow resistance to predict the outcome of canal-based glaucoma surgery such as ab interno trabeculectomy (AIT). These procedures have a high utilization in open angle glaucoma, but fail in eyes with an unidentified distal outflow resistance. We assigned 81 porcine eyes to two groups: trial (n = 42) and control (n = 39). At 24 h, four YAG-laser trabeculopunctures were placed nasally, followed by a 180° AIT at the same site at 48 h. The proportion of TP responders between both AIT groups was compared. Histology and outflow canalograms were determined. Both post-TP and post-AIT IOPs were lower than baseline IOP (p = 0.015 and p < 0.01, respectively). The success rates of TP and AIT were 69% and 85.7%, respectively. Sensitivity and specificity values of TP as predictive test for AIT success were 77.7% and 83.3%, respectively. The positive and negative predictive values were 96.6% and 38.5%, respectively. We conclude that a 10% reduction in IOP after TP can be used as a predictor for the success (> 20% IOP decrease) of 180° AIT in porcine eyes.

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Minimally Invasive Glaucoma Surgery: What Do We Know? Where Should We Go?

Cited by 11 publications

References 88 publications

Feasibility study to improve deep learning in OCT diagnosis of rare retinal diseases with few-shot classification

Feasibility study to improve deep learning in OCT diagnosis of rare retinal diseases with few-shot classification

Long-Term Follow-Up After Successful Trabeculectomy: A Case Report of Reversal of Cupping and Recovery of Visual Field Progression

Trabeculopuncture as a predictive test of distal outflow resistance in canal-based surgery

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