Computer-Aided Diagnosis Software for Hypertensive Risk Determination Through Fundus Image Processing

"(c) 20xx IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works."The goal of the software proposed in this paper is to assist ophthalmologists in diagnosis and disease prevention, helping them to determine cardiovascular risk or other diseases where the vessels can be altered, as well as to monitor the pathology progression and response to different treatments. The performance of the tool has been evaluated by means of a double-blind study where its sensitivity, specificity, and reproducibility to discriminate between health fundus (without cardiovascular risk) and hypertensive patients has been calculated in contrast to an expert ophthalmologist opinion obtained through a visual inspection of the fundus image. An improvement of almost 20% has been achieved comparing the system results with the clinical visual classification.This work was supported in part by Ministerio de Economia y Competitividad of Spain, Project ACRIMA (TIN2013-46751-R) and partially by the Projects Consolider-C (SEJ2006 14301/PSIC), CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII, and the Excellence Research Program PROMETEO (Generalitat Valenciana. Conselleria de Educacion, 2008157).Morales Martínez, S.; Naranjo Ornedo, V.; Navea, A.; Alcañiz Raya, ML. (2014). Computer-Aided Diagnosis Software for Hypertensive Risk Determination Through Fundus Image Processing. IEEE Journal of Biomedical and Health Informatics. 18(6):1757-1763. https://doi.org/10.1109/JBHI.2014.2337960S1757176318

Non-mydriatic ultra-wide field imaging versus dilated fundus exam and intraoperative findings for assessment of rhegmatogenous retinal detachment

Background: to compare the extent of the detached retina and retinal tears location in rhegmatogenous retinal detachment (RRD) among non-mydriatic ultra-wide field (UWF) imaging, dilated fundus exam (DFE), and intraoperative evaluation. Methods: this retrospective chart review comprised 123 patients undergoing surgery for RRD. A masked retina specialist analyzed the UWF fundus images for RRD area, status of the macula, and presence and location of retinal breaks. The same variables were collected from a database including DFE and intraoperative recordings. Evaluation methods were compared. Results: mean age was 59.8 ± 14.9 years. Best-corrected visual acuity improved from 0.25 ± 0.3 (Snellen) to 0.67 ± 0.3 at 12 months (p = 0.009). The RRD description and assessment of macula status (34.5% macula-on) did not differ between UWF, DFE, and intraoperative examination. The inferior quadrant was involved most frequently (41.5%), followed by the superior (38.9%), temporal (27.8%) and nasal quadrant (14.8%). Intraoperative exam detected 96.7% of retinal tears compared with DFE (73.2%, p = 0.008) and UWF imaging (65%, p=0.003). UWF imaging and DFE did not differ significantly. Conclusion: RRD extent on DFE and UWF images was consistent with intraoperative findings. UWF and DFE detection of peripheral retinal tears was similar, but 25% of retinal breaks were missed until intraoperative evaluation

Computer-aided Glaucoma Diagnosis using Stochastic Watershed Transformation on Single Fundus Images

[EN] Glaucoma is a chronic eye disease and one of the major causes of permanent blindness. Since it does not show initial symptoms, early diagnosis is important to limit its progression. This paper presents an automatic optic nerve characterization algorithm for glaucoma diagnosis based only on retinal fundus images. For optic cup segmentation, we used a new method based on the stochastic watershed transformation applied on the YIQ colour space to extract clinical indicators such as the Cup/Disc ratio, the area Cup/Disc ratio and the ISNT rule. Afterwards, an assessment between normal and glaucomatous fundus images is performed. The proposed algorithm was evaluated on 6 different (private and public) databases containing 723 images (377 normal and 346 glaucomatous images) which achieved a specificity and sensitivity of 0.674 and 0.675, respectively. Moreover, an F-score of 0.770 was obtained when evaluating this method on the publicly available database Drishti-GS1. A comparison of the proposed work with other state-of-the-art methods demonstrates the robustness of the proposed algorithm; because it was tested using images from different databases with high variability, which is a common issue in this area. Additional comparisons with existing works for cup segmentation, that use the publicly available database Drishti-GS1, are also presented in this paper.The authors would like to thank K. Narasimhan from SASTRA University for facilitating access to their database and gratefully acknowledge the support of NVIDIA Corporation with the donation of the Titan V GPU used for this research. This work was supported by the Project GALAHAD [H2020-ICT-2016-2017, 732613]. In particular, the work of Andres Diaz-Pinto has been supported by the Generalitat Valenciana under the scholarship Santiago Grisolia [GRISOLIA/2015/027].Díaz-Pinto, AY.; Morales, S.; Naranjo Ornedo, V.; Navea, A. (2019). Computer-aided Glaucoma Diagnosis using Stochastic Watershed Transformation on Single Fundus Images. Journal of Medical Imaging and Health Informatics (Online). 9(6):1057-1065. https://doi.org/10.1166/jmihi.2019.2721S105710659

Prophylactic effect of brimonidine to minimize the incidence of subconjunctival hemorrhage in the early postoperative period after 23G pars plana vitrectomy

Background: Several studies have investigated and demonstrated the prophylactic effect of brimonidine drops in preventing subconjunctival hemorrhage in some microincisional ophthalmic surgeries, such as intravitreal injections or cataract surgery. However, there are no previous studies investigating this prophylactic effect after 23G microincisional vitreoretinal surgery. Aim: The aim of the current study was to determine whether subconjunctival hemorrhage after 23G pars plana vitrectomy (PPV) could be prevented with the use of prophylactic topical brimonidine. Methods: This was a phase III, prospective, interventional, randomized, controlled single-center clinical trial with a follow-up of 2 weeks. A total of 77 eyes (mean age: 68.4 ± 10.7 years) undergoing 23G PPV were included and randomized into two groups: group 1 including 41 patients receiving prophylactic preoperative treatment with brimonidine, and group 2 (control group) including 36 patients not receiving this prophylactic treatment. Differences in terms of number of conjunctival quadrants affected with subconjunctival hemorrhage were evaluated in each of the follow-up visits. Results: The presence of subconjunctival hemorrhage was similar in both groups the first days after surgery (p > 0.05). At the last visit (10–14 days after surgery), this condition was significantly more frequent in control group where there was a significant difference, being more frequent in the control group (7.3% vs 28.6%, p = 0.022). The number of conjunctival quadrants affected was also similar in both groups, except for the last visit in which most of the patients treated with brimonidine (92.7%) showed no bleeding compared to 71.4% in control group. No effect on the efficacy of brimonidine treatment of the presence of blood hypertension, diabetes, and antiplatelet or anticoagulant treatment was observed. Conclusion: Brimonidine seems to be a useful option to decrease subconjunctival hemorrhage after microincisional vitreoretinal surgery or improve its resolution during the first postoperative week. This finding should be mainly due to the vasoconstrictor effect of brimonidine. Trial registration: EudraCT, 2012-002895-15 (registered 19 December 2012); https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-002895-15D.P.P. has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Efficacy and safety of an aflibercept treat-and-extend regimen in treatment-naive patients with macular oedema secondary to central retinal vein occlusion (CRVO): a prospective 12-month, single-arm, multicentre trial

Objectives: to evaluate efficacy and safety of an aflibercept treat-and-extend (TAE) regimen in patients with macular oedema (MO) secondary to central retinal vein occlusion (CRVO). Design setting and patients: phase IV, prospective, open-label, single-arm trial in 11 Spanish hospitals. Treatment-naïve patients with <6 month diagnosis of MO secondary to CRVO and best-corrected visual acuity (BCVA) of 73-24 ETDRS letters were included between 23 January 2015 and 17 March 2016. Intervention: intravitreal aflibercept 2 mg monthly (3 months) followed by proactive individualized dosing. Main outcomes: mean change in BCVA after 12 months. Results: 24 eyes (24 patients) were included; mean (SD) age: 62.8 (15.0) years; 54.2% male; median (IQR) time since diagnosis: 7.6 (3.0, 15.2) days. Mean BCVA scores significantly improved between baseline (56.0 (16.5)) and Month 12 (74.1 (17.6)); mean (95% CI) change: 14.8 (8.2, 21.4); P=0.0001. Twelve (50.0%) patients gained ≥15 ETDRS letters. Foveal thickness improved between baseline (mean: 569.4 (216.8) µm) and Month 12 (mean 257.4 (48.4) µm); P < 0.0001. At Month 12, 8.3% patients had MO. The mean (SD) number of injections: 8.3 (3.0). No treatment-related AEs were reported. Five (20.8%) patients experienced ocular AEs. Two nonocular serious AEs were reported. Conclusions: an aflibercept TAE regimen improves visual acuity in patients with MO secondary to CRVO over 12 months with good tolerability

Efficacy and safety of an aflibercept treat-and-extend regimen in treatment-naïve patients with macular oedema secondary to Central Retinal Vein Occlusion (CRVO) : A Prospective 12-Month, Single-Arm, Multicentre Trial

To evaluate efficacy and safety of an aflibercept treat-and-extend (TAE) regimen in patients with macular oedema (MO) secondary to central retinal vein occlusion (CRVO). Design, Setting, and Patients. Phase IV, prospective, open-label, single-arm trial in 11 Spanish hospitals. Treatment-naïve patients with <6 month diagnosis of MO secondary to CRVO and best-corrected visual acuity (BCVA) of 73-24 ETDRS letters were included between 23 January 2015 and 17 March 2016. Intravitreal aflibercept 2 mg monthly (3 months) followed by proactive individualized dosing. Mean change in BCVA after 12 months. 24 eyes (24 patients) were included; mean (SD) age: 62.8 (15.0) years; 54.2% male; median (IQR) time since diagnosis: 7.6 (3.0, 15.2) days. Mean BCVA scores significantly improved between baseline (56.0 (16.5)) and Month 12 (74.1 (17.6)); mean (95% CI) change: 14.8 (8.2, 21.4); P = 0.0001. Twelve (50.0%) patients gained ≥15 ETDRS letters. Foveal thickness improved between baseline (mean: 569.4 (216.8) μm) and Month 12 (mean 257.4 (48.4) μm); P < 0.0001. At Month 12, 8.3% patients had MO. & The mean (SD) number of injections: 8.3 (3.0). No treatmentrelated AEs were reported. Five (20.8%) patients experienced ocular AEs. Two nonocular serious AEs were reported. An aflibercept TAE regimen improves visual acuity in patients with MO secondary to CRVO over 12 months with good tolerability

Bevacizumab Diminishes Inflammation in an Acute Endotoxin-Induced Uveitis Model

Introduction: Uveitis is an eye disease characterized by inflammation of the uvea and an early and exhaustive diagnosis is essential for its treatment. The aim of our study is to assess the potential toxicity and anti-inflammatory efficacy of Bevacizumab in an experimental uveitis model by subcutaneously injecting lipopolysaccharide into Lewis rats and to clarify its mechanism.Material and Methods: Blood–aqueous barrier integrity was assessed 24 h after endotoxin-induced uveitis (EIU) by analyzing two parameters: cell count and protein concentration in aqueous humors. Histopathology of all eye structures was also studied. Enzyme-linked immunosorbent analyses of the aqueous humor samples were performed in order to calculate the diverse chemokine and cytokine protein levels and oxidative stress-related markers were also evaluated.Results: The aqueous humor’s cellular content significantly increased in the group treated with only Bevacizumab, but it had no effect on retina histopathological grading. Nevertheless, the inflammation noted in ocular structures when administering Bevacizumab with endotoxin was mostly prevented since aqueous humor cell content considerably lowered, and concomitantly with a sharp drop in uveal, vitreous, and retina histopathological grading. The values of the multi-faceted cytokine IL-2 also significantly decreased (p &lt; 0.05 vs. endotoxin group), and the protective IL-6 and IL-10 cytokines values rose with related anti-oxidant system recovery (p &lt; 0.05 vs. endotoxin group). Concurrently, some related M1 macrophage chemokines substantially increased, e.g., GRO/KC, a chemokine that also displays any kind of protective role.Conclusion: All these results revealed that 24 h after being administered, Bevacizumab treatment in EIU significantly prevented inflammation in various eye structures and correct results in efficacy vs. toxicity balance were obtained

CNNs for automatic glaucoma assessment using fundus images: an extensive validation

Background Most current algorithms for automatic glaucoma assessment using fundus images rely on handcrafted features based on segmentation, which are affected by the performance of the chosen segmentation method and the extracted features. Among other characteristics, convolutional neural networks (CNNs) are known because of their ability to learn highly discriminative features from raw pixel intensities. Methods In this paper, we employed five different ImageNet-trained models (VGG16, VGG19, InceptionV3, ResNet50 and Xception) for automatic glaucoma assessment using fundus images. Results from an extensive validation using cross-validation and cross-testing strategies were compared with previous works in the literature. Results Using five public databases (1707 images), an average AUC of 0.9605 with a 95% confidence interval of 95.92–97.07%, an average specificity of 0.8580 and an average sensitivity of 0.9346 were obtained after using the Xception architecture, significantly improving the performance of other state-of-the-art works. Moreover, a new clinical database, ACRIMA, has been made publicly available, containing 705 labelled images. It is composed of 396 glaucomatous images and 309 normal images, which means, the largest public database for glaucoma diagnosis. The high specificity and sensitivity obtained from the proposed approach are supported by an extensive validation using not only the cross-validation strategy but also the cross-testing validation on, to the best of the authors’ knowledge, all publicly available glaucoma-labelled databases. Conclusions These results suggest that using ImageNet-trained models is a robust alternative for automatic glaucoma screening system. All images, CNN weights and software used to fine-tune and test the five CNNs are publicly available, which could be used as a testbed for further comparisons