AIM:To propose an algorithm for automatic detection of diabetic retinopathy(DR)lesions based on ultra-widefield scanning laser ophthalmoscopy(SLO).METHODS:The algorithm utilized the FasterRCNN(Faster Regions with CNN ...AIM:To propose an algorithm for automatic detection of diabetic retinopathy(DR)lesions based on ultra-widefield scanning laser ophthalmoscopy(SLO).METHODS:The algorithm utilized the FasterRCNN(Faster Regions with CNN features)+ResNet50(Residua Network 50)+FPN(Feature Pyramid Networks)method for detecting hemorrhagic spots,cotton wool spots,exudates,and microaneurysms in DR ultra-widefield SLO.Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate.Feature fusion was carried out by the feature pyramid network FPN,which significantly improved lesion detection rates in SLO fundus images.RESULTS:By analyzing 1076 ultra-widefield SLO images provided by our hospital,with a resolution of 2600×2048 dpi,the accuracy rates for hemorrhagic spots,cotton wool spots,exudates,and microaneurysms were found to be 87.23%,83.57%,86.75%,and 54.94%,respectively.CONCLUSION:The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO,providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.展开更多
AIM： To report the surgical result of pars plana vitrectomy（PPV） with air tamponade for rhegmatogenous retinal detachment（RRD） by ultra-widefield fundus imaging system. METHODS： Of 25 consecutive patients（25 e...AIM： To report the surgical result of pars plana vitrectomy（PPV） with air tamponade for rhegmatogenous retinal detachment（RRD） by ultra-widefield fundus imaging system. METHODS： Of 25 consecutive patients（25 eyes） with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity（VA） was examined postoperatively and images were captured by ultrawidefield scanning laser ophthalmoscope system（Optos）. RESULTS： Initial reattachment was achieved in 25 cases（100%）. The air volume was 〉60% on the postoperative day（POD） 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes（88%）. A missed retinal hole was found under intravitreal air bubble in 1 case（4%）. The air volume was range from 40% to 60% on POD 3. A doublelayered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases（24%） and bubble was completely disappeared in 4 cases（16%）. Small oval bubble in the superior area was observed in 15 cases（60%）. There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1 mo and last follow-up. Air disappeared completely on a mean of 9.84 d postoperatively. The mean final postoperative bestcorrected visual acuity（BCVA） was 0.35 log MAR. Mean final postoperative BCVA improved significantly relative to mean preoperative（P〈0.05）. Final VA of 0.3 log MAR or better was seen in 13 eyes. CONCLUSION： PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.展开更多
AIM:To quantify the area and density of retinal vascularity by ultra-widefield fluorescein angiography(UWFA).METHODS:In a retrospective study,UWFA images were obtained using an ultra-widefield imaging device in 42 nor...AIM:To quantify the area and density of retinal vascularity by ultra-widefield fluorescein angiography(UWFA).METHODS:In a retrospective study,UWFA images were obtained using an ultra-widefield imaging device in 42 normal eyes of 42 patients.Central and peripheral steered images were used to define the edge of retinal vasculature by a certified grader.The length from the center of the optic disc to the edge of retinal vascularity(RVL)in each quadrant and the total retinal vascular perfusion area(RVPA)were determined by the grader using OptosAdvance software.The density of retinal vascularity(RVD)was quantified in different zones of central-steered images using Image J software.RESULTS:Among 42 healthy eyes,the values for mean RVL in each quadrant were 19.007±0.781 mm(superior),18.467±0.869 mm(inferior),17.738±0.622 mm(nasal)and 24.241±1.336 mm(temporal).The mean RVPA was 1140.117±73.825 mm^(2).The mean RVD of the total retina was 4.850%±0.638%.RVD varied significantly between different retina zones(P<0.001),and significant differences existed in the RVD values for total retinal area in patients over 50 years old compared to those under 50 years old(P=0.033).No gender difference was found.CONCLUSION:The UWFA device can be a promising tool for analyzing the overall retinal vasculature and may provide a better understanding of retinal vascular morphology in normal eyes.Aging may be related to lower RVD.展开更多
AIM:To analyze differences in ultra-widefield fluorescein angiography(UWFA)findings between dynamic and static images of eyes with diabetic retinopathy(DR).METHODS:This cross-sectional study included 28 eyes of 28 pat...AIM:To analyze differences in ultra-widefield fluorescein angiography(UWFA)findings between dynamic and static images of eyes with diabetic retinopathy(DR).METHODS:This cross-sectional study included 28 eyes of 28 patients with DR undergoing UWFA.A series of UWFA images acquired from each patient were converted into a time-lapse video and used as a dynamic image.A single,clear,arteriovenous phase image was chosen as a static image.Non-perfusion index(NPI)and its correlation with vascular abnormalities in different zones were compared between dynamic and static UWFA imaging.RESULTS:NPI appeared to increase from the center to the far-periphery in both groups.Dynamic NPI was lower in the total retinal area(0.26 vs 0.29,P=0.009)and farperiphery(0.33 vs 0.36,adjusted P=0.042),which was contrary to the static NPI.Far-peripheral NPI was associated with intraretinal microvascular abnormality in the posterior area in both groups.CONCLUSION:Time-lapse dynamic UWFA imaging is a useful modality to differentially diagnose hypofluorescence in the most peripheral region.This modality could provide a reliable method for NPI measurement.展开更多
AIM:To evaluate the peripheral arterial filling time(PAFT)and venous filling time(VFT)in eyes without known diseases that may influence filling process using ultra-widefield(UWF)fluorescein angiography(FA),and to revi...AIM:To evaluate the peripheral arterial filling time(PAFT)and venous filling time(VFT)in eyes without known diseases that may influence filling process using ultra-widefield(UWF)fluorescein angiography(FA),and to review the peripheral retina fluorescence features.METHODS:A total of 30 eyes of 30 patients were retrospectively reviewed in this observational study.UWFFA was performed using Optos 200Tx.PAFT and VFT was recorded.The interval between the arterial or venous filling completion and the previous photo was documented.The appearance of the far peripheral retina was described as either granular background fluorescence or mottled fluorescent band or vascular leakage.Terminal vascular patterns was described as loop pattern or branching pattern.Microvascular abnormalities such as arteriovenous shunting,vessels crossing the horizontal raphe,right angle vessels,terminal networks,capillary nonperfusion,drusen or microaneurysms were evaluated.RESULTS:The normal limits of PAFT was 3.397-8.984s and 4.399-11.753s for VFT.The appearance of the far peripheral retina,defined as granular background(63%),mottled fluorescence(20%),or vascular leakage(17%),was symmetrical between both eyes.Capillary nonperfusion(23%)and microaneurysms(40%)were more frequently found in eyes with loop pattern than in eyes with branching pattern.Other peripheral signs such as right-angle vessels(73%),and terminal networks(80%)were commonly seen on UWF-FA in the normal peripheral retina.CONCLUSION:The main courses of retinal artery and vein filling time are overlapping with each other on UWF-FA.Notably,the arterial filling process is completed in the arteriovenous phase rather than the traditionally named arterial phase.There are various manifestations in the peripheral retina of normal eyes.展开更多
AIM: To compare ultra-widefield(24×20 mm^(2)) sweptsource optical coherence tomography angiography(SSOCTA) and fluorescein angiography(FA) in the evaluation of diabetic retinopathy(DR) lesions. METHODS: Forty-six...AIM: To compare ultra-widefield(24×20 mm^(2)) sweptsource optical coherence tomography angiography(SSOCTA) and fluorescein angiography(FA) in the evaluation of diabetic retinopathy(DR) lesions. METHODS: Forty-six eyes of 23 patients with treatmentna?ve DR were included at Peking University People’s Hospital from September 1, 2021, until December 31, 2021, as well as 23 age and gender matched healthy controls. Quantitative assessments of DR lesions on FA and SS-OCTA(superficial capillary plexus, SCP, 24×20 mm^(2)) were performed.RESULTS: Area of fovea avascular zone(FAZ) was larger in DR cases than controls(0.34±0.069 mm^(2) vs 0.287±0.108 mm^(2), P=0.006). In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm^(2) on SS-OCTA and FA, respectively(P=0.428), while the median FAZ perimeter was 2.382(IQR, 2.201-2.59) and 2.333(IQR, 2.138-2.6) mm on SS-OCTA and FA images(P=0.733). There was no significant difference in the size of the non-perfusion area(NPA) between the images on SS-OCTA and FA(12.389, IQR 4.96-28.3 and 11.125, IQR 5-28.31 mm^(2), P=0.197). The median total microaneurysm(MA) count was 35(IQR, 19-46) and 73(IQR, 43-93) on SS-OCTA and FA(P<0.001), respectively. No significant difference in intra-retinal microvascular abnormality(IRMA) and neovascularization (NV) count was found between the two techniques. The intraclass coefficient(ICCs) of all the parameters above indicated stable repeatability.CONCLUSION: Ultra-widefield SS-OCTA represents a reliable, noninvasive, and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.展开更多
基金Supported by Hunan Provincial Science and Technology Department Clinical Medical Technology Innovation Guidance Project(No.2021SK50103)。
文摘AIM:To propose an algorithm for automatic detection of diabetic retinopathy(DR)lesions based on ultra-widefield scanning laser ophthalmoscopy(SLO).METHODS:The algorithm utilized the FasterRCNN(Faster Regions with CNN features)+ResNet50(Residua Network 50)+FPN(Feature Pyramid Networks)method for detecting hemorrhagic spots,cotton wool spots,exudates,and microaneurysms in DR ultra-widefield SLO.Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate.Feature fusion was carried out by the feature pyramid network FPN,which significantly improved lesion detection rates in SLO fundus images.RESULTS:By analyzing 1076 ultra-widefield SLO images provided by our hospital,with a resolution of 2600×2048 dpi,the accuracy rates for hemorrhagic spots,cotton wool spots,exudates,and microaneurysms were found to be 87.23%,83.57%,86.75%,and 54.94%,respectively.CONCLUSION:The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO,providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.
文摘AIM： To report the surgical result of pars plana vitrectomy（PPV） with air tamponade for rhegmatogenous retinal detachment（RRD） by ultra-widefield fundus imaging system. METHODS： Of 25 consecutive patients（25 eyes） with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity（VA） was examined postoperatively and images were captured by ultrawidefield scanning laser ophthalmoscope system（Optos）. RESULTS： Initial reattachment was achieved in 25 cases（100%）. The air volume was 〉60% on the postoperative day（POD） 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes（88%）. A missed retinal hole was found under intravitreal air bubble in 1 case（4%）. The air volume was range from 40% to 60% on POD 3. A doublelayered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases（24%） and bubble was completely disappeared in 4 cases（16%）. Small oval bubble in the superior area was observed in 15 cases（60%）. There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1 mo and last follow-up. Air disappeared completely on a mean of 9.84 d postoperatively. The mean final postoperative bestcorrected visual acuity（BCVA） was 0.35 log MAR. Mean final postoperative BCVA improved significantly relative to mean preoperative（P〈0.05）. Final VA of 0.3 log MAR or better was seen in 13 eyes. CONCLUSION： PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.
文摘AIM:To quantify the area and density of retinal vascularity by ultra-widefield fluorescein angiography(UWFA).METHODS:In a retrospective study,UWFA images were obtained using an ultra-widefield imaging device in 42 normal eyes of 42 patients.Central and peripheral steered images were used to define the edge of retinal vasculature by a certified grader.The length from the center of the optic disc to the edge of retinal vascularity(RVL)in each quadrant and the total retinal vascular perfusion area(RVPA)were determined by the grader using OptosAdvance software.The density of retinal vascularity(RVD)was quantified in different zones of central-steered images using Image J software.RESULTS:Among 42 healthy eyes,the values for mean RVL in each quadrant were 19.007±0.781 mm(superior),18.467±0.869 mm(inferior),17.738±0.622 mm(nasal)and 24.241±1.336 mm(temporal).The mean RVPA was 1140.117±73.825 mm^(2).The mean RVD of the total retina was 4.850%±0.638%.RVD varied significantly between different retina zones(P<0.001),and significant differences existed in the RVD values for total retinal area in patients over 50 years old compared to those under 50 years old(P=0.033).No gender difference was found.CONCLUSION:The UWFA device can be a promising tool for analyzing the overall retinal vasculature and may provide a better understanding of retinal vascular morphology in normal eyes.Aging may be related to lower RVD.
基金Supported by National Natural Science Foundation of China(No.81570851)Project of Shanghai Medical Key Specialty Construction(No.ZK2019B27)+3 种基金National Project of Shanghai Municipal Commission of Health and Family Planning(No.201740001)Project of Shanghai Jingan District Municipal Commission of Health and Family Planning(No.2018MS12)Advanced and Appropriate Technology Promotion Project of Shanghai Health Commission(No.2019SY012)Shanghai Jiao Tong University Translation Medicine Cross Research Fund Project(No.YG2019QNA61)。
文摘AIM:To analyze differences in ultra-widefield fluorescein angiography(UWFA)findings between dynamic and static images of eyes with diabetic retinopathy(DR).METHODS:This cross-sectional study included 28 eyes of 28 patients with DR undergoing UWFA.A series of UWFA images acquired from each patient were converted into a time-lapse video and used as a dynamic image.A single,clear,arteriovenous phase image was chosen as a static image.Non-perfusion index(NPI)and its correlation with vascular abnormalities in different zones were compared between dynamic and static UWFA imaging.RESULTS:NPI appeared to increase from the center to the far-periphery in both groups.Dynamic NPI was lower in the total retinal area(0.26 vs 0.29,P=0.009)and farperiphery(0.33 vs 0.36,adjusted P=0.042),which was contrary to the static NPI.Far-peripheral NPI was associated with intraretinal microvascular abnormality in the posterior area in both groups.CONCLUSION:Time-lapse dynamic UWFA imaging is a useful modality to differentially diagnose hypofluorescence in the most peripheral region.This modality could provide a reliable method for NPI measurement.
基金Supported by Capital Health Development Research Special Fund(No.2020-2-2053)。
文摘AIM:To evaluate the peripheral arterial filling time(PAFT)and venous filling time(VFT)in eyes without known diseases that may influence filling process using ultra-widefield(UWF)fluorescein angiography(FA),and to review the peripheral retina fluorescence features.METHODS:A total of 30 eyes of 30 patients were retrospectively reviewed in this observational study.UWFFA was performed using Optos 200Tx.PAFT and VFT was recorded.The interval between the arterial or venous filling completion and the previous photo was documented.The appearance of the far peripheral retina was described as either granular background fluorescence or mottled fluorescent band or vascular leakage.Terminal vascular patterns was described as loop pattern or branching pattern.Microvascular abnormalities such as arteriovenous shunting,vessels crossing the horizontal raphe,right angle vessels,terminal networks,capillary nonperfusion,drusen or microaneurysms were evaluated.RESULTS:The normal limits of PAFT was 3.397-8.984s and 4.399-11.753s for VFT.The appearance of the far peripheral retina,defined as granular background(63%),mottled fluorescence(20%),or vascular leakage(17%),was symmetrical between both eyes.Capillary nonperfusion(23%)and microaneurysms(40%)were more frequently found in eyes with loop pattern than in eyes with branching pattern.Other peripheral signs such as right-angle vessels(73%),and terminal networks(80%)were commonly seen on UWF-FA in the normal peripheral retina.CONCLUSION:The main courses of retinal artery and vein filling time are overlapping with each other on UWF-FA.Notably,the arterial filling process is completed in the arteriovenous phase rather than the traditionally named arterial phase.There are various manifestations in the peripheral retina of normal eyes.
基金Supported by the National Key R&D Program of China (No.2020YFC2008200)。
文摘AIM: To compare ultra-widefield(24×20 mm^(2)) sweptsource optical coherence tomography angiography(SSOCTA) and fluorescein angiography(FA) in the evaluation of diabetic retinopathy(DR) lesions. METHODS: Forty-six eyes of 23 patients with treatmentna?ve DR were included at Peking University People’s Hospital from September 1, 2021, until December 31, 2021, as well as 23 age and gender matched healthy controls. Quantitative assessments of DR lesions on FA and SS-OCTA(superficial capillary plexus, SCP, 24×20 mm^(2)) were performed.RESULTS: Area of fovea avascular zone(FAZ) was larger in DR cases than controls(0.34±0.069 mm^(2) vs 0.287±0.108 mm^(2), P=0.006). In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm^(2) on SS-OCTA and FA, respectively(P=0.428), while the median FAZ perimeter was 2.382(IQR, 2.201-2.59) and 2.333(IQR, 2.138-2.6) mm on SS-OCTA and FA images(P=0.733). There was no significant difference in the size of the non-perfusion area(NPA) between the images on SS-OCTA and FA(12.389, IQR 4.96-28.3 and 11.125, IQR 5-28.31 mm^(2), P=0.197). The median total microaneurysm(MA) count was 35(IQR, 19-46) and 73(IQR, 43-93) on SS-OCTA and FA(P<0.001), respectively. No significant difference in intra-retinal microvascular abnormality(IRMA) and neovascularization (NV) count was found between the two techniques. The intraclass coefficient(ICCs) of all the parameters above indicated stable repeatability.CONCLUSION: Ultra-widefield SS-OCTA represents a reliable, noninvasive, and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.
