Visual Prognosis of Eyes Recovering From Macular Hole Surgery Through Automated Quantitative Analysis of Spectral-Domain Optical Coherence Tomography (SD-OCT) Scans

Sisternes, Luís de; Hu, Julia; Rubin, Daniel L.; Leng, Theodore

doi:10.1167/iovs.14-16344

Cited by 25 publications

(22 citation statements)

References 43 publications

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“…A reliable automated segmentation approach, such as that presented herein, is crucial to enabling such work. Our work has also shown superior results to other state-of-the-art clinical software in eyes affected by hydroxychloroquine toxicity [15] and post-surgical macular hole eyes [6]. We plan to expand our segmentation method to SD-OCT scans acquired in the region surrounding the optic disc as well as to eyes presenting with other retinal pathologies, such as glaucoma and retinitis pigmentosa.…”

Section: Discussionmentioning

confidence: 90%

“…Our method is sought to address the aforementioned challenges of prior algorithms, producing accurate delineations of the intraretinal layered structure in scans acquired during clinical practice and maintaining a stable behavior in disease cases while also producing accurate outlines that follow the particular pathologies of the disease, not smoothing out important details. This method was used previously for the segmentation of the retina in hydroxychloroquine toxicity [15] and postsurgery in macular hole cases [6]. In these applications, the results of our methods were successful and superior to current commercial software by visual inspection, but details about the method and its evaluation have not yet been published.…”

Section: Introductionmentioning

confidence: 94%

“…The ability of SD-OCT to rapidly acquire three-dimensional (3D) retinal data, resolving structures in the depth axis, allows the direct visualization of its layered structure. Many new quantitative features extracted from SD-OCT data, such as the thickness of individual intraretinal layers [2], size, shape, and distribution of drusen (extracellular material accumulations that typically appear between the retinal pigment epithelium (RPE) and Bruch's membrane) [3,4], cysts and fluid-filled regions [5], and macular [6], are currently used or investigated as biomarkers in retinal disease diagnosis [7][8][9]. The accurate and reliable segmentation of retinal layers in SD-OCT scans is a fundamental problem for the identification of new quantitative features that could be useful as disease biomarkers.…”

Section: Introductionmentioning

confidence: 99%

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Automated intraretinal segmentation of SD-OCT images in normal and age-related macular degeneration eyes

Sisternes

Jonna

Moss

et al. 2017

Biomed. Opt. Express

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This work introduces and evaluates an automated intra-retinal segmentation method for spectral-domain optical coherence (SD-OCT) retinal images. While quantitative assessment of retinal features in SD-OCT data is important, manual segmentation is extremely time-consuming and subjective. We address challenges that have hindered prior automated methods, including poor performance with diseased retinas relative to healthy retinas, and data smoothing that obscures image features such as small retinal drusen. Our novel segmentation approach is based on the iterative adaptation of a weighted median process, wherein a three-dimensional weighting function is defined according to image intensity and gradient properties, and a set of smoothness constraints and pre-defined rules are considered. We compared the segmentation results for 9 segmented outlines associated with intra-retinal boundaries to those drawn by hand by two retinal specialists and to those produced by an independent state-of-the-art automated software tool in a set of 42 clinical images (from 14 patients). These images were obtained with a Zeiss Cirrus SD-OCT system, including healthy, early or intermediate AMD, and advanced AMD eyes. As a qualitative evaluation of accuracy, a highly experienced third independent reader blindly rated the quality of the outlines produced by each method. The accuracy and image detail of our method was superior in healthy and early or intermediate AMD eyes (98.15% and 97.78% of results not needing substantial editing) to the automated method we compared against. While the performance was not as good in advanced AMD (68.89%), it was still better than the manual outlines or the comparison method (which failed in such cases). We also tested our method's performance on images acquired with a different SD-OCT manufacturer, collected from a large publicly available data set (114 healthy and 255 AMD eyes), and compared the data quantitatively to reference standard markings of the internal limiting membrane and inner boundary of retinal pigment epithelium, producing a mean unsigned positioning error of 6.04 ± 7.83µm (mean under 2 pixels). Our automated method should be applicable to data from different OCT manufacturers and offers detailed layer segmentations in healthy and AMD eyes.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Automated intraretinal segmentation of SD-OCT images in normal and age-related macular degeneration eyes

Sisternes

Jonna

Moss

et al. 2017

Biomed. Opt. Express

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“…A study by de Sisternes et al [30] revealed that eyes that recently underwent MH repair surgery not only exhibited defects in the ellipsoid zone band, but also showed obvious damage in the inner retina layers when compared to the nonsurgical fellow eyes. Studies also demonstrated that the structure of the inner retina did not recover rapidly after MH surgical repair, in contrast to the ellipsoid zone band region, which quickly recovered [30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

“…Studies also demonstrated that the structure of the inner retina did not recover rapidly after MH surgical repair, in contrast to the ellipsoid zone band region, which quickly recovered [30][31][32][33] . Surgical damage of the inner retinal layers may also affect the retinal capillary plexus, and a reduced flow index in the capillary plexus may impede the healing of inner retinal layers.…”

Section: Discussionmentioning

confidence: 99%

The Recovery of Microvascular Status Evaluated by Optical Coherence Tomography Angiography in Patients after Successful Macular Hole Surgery

Demirel¹,

Değirmenci²,

Bilici³

et al. 2017

Ophthalmic Res

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Purpose: The aim of this study was to evaluate the optical coherence tomography angiography (OCTA) features of patients who underwent successful macular hole (MH) surgery. Methods: Nineteen patients who underwent surgery in a single eye due to MH and 13 healthy subjects as a control group were included in the study. Vascular densities, flow indexes, and the foveal avascular zone (FAZ) area in superficial and deep retinal capillary plexuses were evaluated by OCTA in the right eyes of the control group, and both the surgical and healthy fellow eyes of the patients. Results: The mean vascular densities of the superficial and deep capillary plexuses were significantly lower in the surgical eyes than in the control group (44.1 vs. 49.6%, p = 0.002, and 47.3 vs. 59.1%, p = 0.009, respectively). The mean superficial and deep capillary flow indexes were significantly lower in the surgical eyes than in the control group (0.85 vs. 1.35, p = 0.003, and 0.57 vs. 1.45, p = 0.001, respectively), while the mean superficial and deep FAZ area were significantly greater in the surgical eyes in comparison to the control group (0.55 vs. 0.32, p < 0.001, and 0.64 vs. 0.37, p = 0.001, respectively). There was no difference between the flow indexes of both layers of the healthy fellow eyes and the control group. Conclusions: These preliminary results may be an explanation for unsatisfactory visual gain after surgery, despite the successful anatomical closure of the MH.

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Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy

Sisternes

Rubin

et al. 2016

JAMA Ophthalmol

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IMPORTANCE Retinopathy is a known risk of long-term use of hydroxychloroquine sulfate. However, whether the inner as well as outer retina are involved before retinopathy develops and whether changes in the retina might signal impending toxic effects during screening remain unknown. OBJECTIVE To determine the degree of inner and outer retinal involvement in short-and long-term use of hydroxychloroquine before the development of retinopathy. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review of spectral-domain optical coherence tomography (SD-OCT) findings was performed at an academic medical center. Thirty-two patients without retinopathy and with high-quality SD-OCT images were studied. Twenty-seven patients were age matched (49-65 years old) for comparison of retinal layers among patients who used the drug less than 5 years (n = 12) or longer than 15 years (n = 15) at the initial visit. Populations were also defined (without age limitation) for comparison of change during 25 to 52 months of follow-up among patients with initial use of less than 5 years (n = 7) or longer than 15 years (n = 8). Data were collected from 2010 to 2015. MAIN OUTCOMES AND MEASURES Measurements of inner and outer retinal thickness in SD-OCT images using commercial software and a Stanford pixel-by-pixel segmentation software that also provided topographic maps of thickness dimensions and change. RESULTS Thirty-two patients (5 men and 27 women) were included in the analysis. Measurements of inner retinal thickness between short-and long-term hydroxychloroquine users (n = 27) in different retinal regions, and during a median 39 months of follow-up (n = 15), showed no statistically significant differences or change. Similarly, no significant differences or changes were identified in outer retinal thickness except for the final visit of 1 patient who developed focal parafoveal thinning, a toxic effect of hydroxychloroquine use. Cirrus ganglion cell analysis measurements were inaccurate in the presence of outer retinal damage. CONCLUSIONS AND RELEVANCE The inner retina appears not to be involved in hydroxychloroquine-induced retinopathy to any clinically relevant degree within the limitations of our sample size. No clinically apparent warning of outer retinal damage was seen in the SD-OCT images of long-term hydroxychloroquine users until the actual appearance of focal retinopathy. Early detection of hydroxychloroquine-induced retinopathy is known to prevent visual acuity loss and serious progression after the therapy is stopped, and these data suggest that screening should seek distinct new areas of retinopathy (shown by topographic thickness maps) rather than long-term progressive thinning.

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Visual Prognosis of Eyes Recovering From Macular Hole Surgery Through Automated Quantitative Analysis of Spectral-Domain Optical Coherence Tomography (SD-OCT) Scans

Cited by 25 publications

References 43 publications

Automated intraretinal segmentation of SD-OCT images in normal and age-related macular degeneration eyes

Automated intraretinal segmentation of SD-OCT images in normal and age-related macular degeneration eyes

The Recovery of Microvascular Status Evaluated by Optical Coherence Tomography Angiography in Patients after Successful Macular Hole Surgery

Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy

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