Assessment of retinal vascular geometry in normal and diabetic subjects

M.D.Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and the leading cause of blindness in persons from age 20 to 74. The relative risk of blindness in persons with diabetes has been reported to be 5.2 times the risk of those without diabetes. The fundus abnormalities described in diabetic retinopathy result from structural damage to the microvasculature wall with subsequent leakage or as a result of retinal ischaemia with secondary overproduction of vascular growth factors. Several clinical and screening classifications schemes have been developed to categorize and quantify the severity of each of the retinopathic features based on the degree of retina involvement. The ultimate goals of these classification schemes have been to provide a system by which the natural history of the disease and the risk of progression of retinopathy and visual loss can be identified and the subsequent response to interventions can be evaluated to improve patient care. The present strategies for dealing with diabetic retinopathy address retinopathy that is already established. However, recent studies - supported by computer based imaging analysis – have focused on changes in retinal vascular caliber and demonstrated various associations with increased risk of diabetes and predicted the onset of microvascular retinal complications. This suggests that other structural and geometrical parameters might also be utilised, which can provide more information regarding the retinal vascular network. Few studies have reported different changes in retinal vascular geometry with age, systemic hypertension and peripheral vascular diseases. The objective of this thesis is to analyse the retinal vascular geometrical features in normal subjects and evaluate its role in diabetic subjects with different stages of diabetic retinopathy. For this purpose, a semi-manual vascular analysis technique is designed to measure and analyse the different retinal vascular geometrical parameters and ratios. The developed technique performance and precision is compared to other available manual and semi-manual vascular analysis techniques.The various sources of variability in retinal geometrical measurements are then evaluated, including observer’s measurement errors, variations in image capture, and potential short term changes in the subjects’ vascular geometrical features. The second step of this work is to perform a detailed analysis of the retinal vascular geometry in normal subjects, including the topographic distribution of different geometrical measurements across the fundus, the effect of different demographic and clinical factors, and the stability of measurements between both eyes. The next step evaluates the retinal vascular geometry in diabetic subjects with different grades of diabetic retinopathy to determine any changes of geometrical features with advancement of retinopathic stages. The results demonstrate significant associations of changes in vascular structural and geometrical features with increased stages of diabetic retinopathy. Finally, the predictive value of retinal vascular geometry analysis and its practical role on the individual level is analysed for a sample of subjects who progressed from no retinopathy to proliferative retinopathy as compared to a sample of subjects with no sign of progression. The preliminary results suggest that geometrical changes trend can be detected on the individual level with progression of diabetic retinopathy and those differences can be noted between progressors and non-progressors at baseline. In conclusion, this thesis describes novel retinal vascular geometrical markers indicative of establishment of advancing diabetic retinopathy, together with a potential predictive role in determining risk of future progression to proliferative retinopathy

REVIEW - A reference data set for retinal vessel profiles

This paper describes REVIEW, a new retinal vessel reference dataset. This dataset includes 16 images with 193 vessel segments, demonstrating a variety of pathologies and vessel types. The vessel edges are marked by three observers using a special drawing tool. The paper also describes the algorithm used to process these segments to produce vessel profiles, against which vessel width measurement algorithms can be assessed. Recommendations are given for use of the dataset in performance assessment. REVIEW can be downloaded from http://ReviewDB.lincoln.ac.uk

Semi-Automated Labelling of Cystoid Macular Edema in OCT Scans

The analysis of retinal Spectral-Domain Optical Coherence Tomography (SD-OCT) images by trained medical professionals can be used to provide useful insights into various diseases. It is the most popular method of retinal imaging due to its non-invasive nature and the useful information it provides for making an accurate diagnosis. A deep learning approach for automating the segmentation of Cystoid Macular Edema (fluid) in retinal OCT B-Scan images was developed that is consequently used for volumetric analysis of OCT scans. This solution is a fast and accurate semantic segmentation network that makes use of a shortened encoder-decoder UNet like architecture with an integrated Dense ASPP module and Attention Gate for producing an accurate and refined retinal fluid segmentation map. Our system was evaluated against both publicly and privately available datasets; on the former the network achieved a Dice coefficient of 0.804, thus making it the current best performing approach on this dataset, and on the very small and challenging private dataset, it achieved a score of 0.691. Due to the lack of publicly available data in this domain, a Graphical User Interface that aims to semi-automate the labelling process of OCT images was also created, thus greatly simplifying the process of the dataset creation and potentially leading to an increase in labelled data production

Macular hole morphology and measurement using an automated three dimensional image segmentation algorithm

Objective: Full-thickness macular holes (MH) are classified principally by size, which is one of the strongest predictors of anatomical and visual success. Using a three-dimensional (3D) automated image processing algorithm, we analysed optical coherence tomography (OCT) images of 104 MH of patients, comparing MH dimensions and morphology with clinician-acquired two-dimensional measurements. Methods and Analysis: All patients underwent a high-density central horizontal scanning OCT protocol. Two independent clinicians measured the minimum linear diameter (MLD) and maximum base diameter. OCT images were also analysed using an automated 3D segmentation algorithm which produced key parameters including the respective maximum and minimum diameter of the minimum area (MA) of the MH, as well as volume and surface area. Results: Using the algorithm-derived values, MH were found to have significant asymmetry in all dimensions. The minima of the MA were typically approximately 90° to the horizontal, and differed from their maxima by 55 μm. The minima of the MA differed from the human-measured MLD by a mean of nearly 50 μm, with significant interobserver variability. The resultant differences led to reclassification using the International Vitreomacular Traction Study Group classification in a quarter of the patients (p=0.07). Conclusion: MH are complex shapes with significant asymmetry in all dimensions. We have shown how 3D automated analysis of MH describes their dimensions more accurately and repeatably than human assessment. This could be used in future studies investigating hole progression and outcome to help guide optimum treatments

Robust 3D U-Net Segmentation of Macular Holes

Macular holes are a common eye condition which result in visual impairment. We look at the application of deep convolutional neural networks to the problem of macular hole segmentation. We use the 3D U-Net architecture as a basis and experiment with a number of design variants. Manually annotating and measuring macular holes is time consuming and error prone. Previous automated approaches to macular hole segmentation take minutes to segment a single 3D scan. Our proposed model generates significantly more accurate segmentations in less than a second. We found that an approach of architectural simplification, by greatly simplifying the network capacity and depth, exceeds both expert performance and state-of-the-art models such as residual 3D U-Nets

Graphene oxide-induced CuO reduction in TiO2/CaTiO3/Cu2O/Cu composites for photocatalytic degradation of drugs via peroxymonosulfate activation

Contamination of water bodies is a global environmental and human health issue. Conventional water treatment systems cannot efficiently eliminate organic contaminants, particularly drugs. Photocatalysis is a promising, environmentally friendly oxidation process for the removal of such compounds. A key point is the choice of material to be used as photocatalyst. Here, TiO2/CaTiO3/Cu2O/Cu composites were fabricated by adding different amounts (x) of graphene oxide (GO) (x wt% = 1, 3, and 5 %) to CaCu3Ti4O12 powder using the solid-state synthesis method. The produced pellets were sintered under inert nitrogen atmosphere at 1100 °C for 3 h. X-ray diffraction analysis showed that the Cu metal amount was increased upon GO addition, and the UV–Vis diffuse reflectance spectroscopy showed that the spectral response was extended to the visible range. Then, high performance liquid chromatography assessment of paracetamol degradation by a photocatalytic cell using TiO2/CaTiO3/Cu2O/Cu composites with different GO amounts showed that the removal efficiency was increased upon introduction of 0.5 mM peroxymonosulfate (PMS) as active component to generate radical dotSO4‾ radicals. After 3 h under visible light, 96 % of 10 ppm paracetamol was degraded by the composite with 3 % of GO (1 cm2 surface photocatalyst) compared with 50 % by the composite without GO in the same experimental conditions (PMS in 210 mL of aqueous solution). Free radical trapping and the acute toxicity of potential degradation by-products were also investigated. Our results indicate that TiO2/CaTiO3/Cu2O/Cu with 3 % GO displays long-term stability and durability for the photocatalytic removal of pharmaceutical pollutants from wastewater

Refractile superficial retinal crystals and chronic retinal detachment: Case report

BACKGROUND: Few previous reports have described the presence of retinal refractile opacities at the macular area in patients presenting with longstanding peripheral retinal detachment. The exact nature of these opacities is unknown. CASE PRESENTATION: Two patients were referred with an abnormal appearance of refractile opacities in the macular area noted during routine examination. Both were found to have longstanding peripheral retinal detachments. Subretinal fluid analysis of one patient revealed the presence of multiple birefringent crystals. We hypothesise that these crystals are the origin of the refractile macular opacities noted. CONCLUSION: This report describes the rare presentation of asymptomatic peripheral retinal detachment by the detection of refractile macular opacities on routine examination. It highlights the importance of meticulous peripheral retinal examination in these cases. The article also describes the findings of the subretinal fluid analysis and discusses the possible hypothesis behind their appearance

The association between retinal vascular geometry changes and diabetic retinopathy and their role in prediction of progression: an exploratory study

Background: The study describes the relationship of retinal vascular geometry (RVG) to severity of diabetic retinopathy (DR), and its predictive role for subsequent development of proliferative diabetic retinopathy (PDR). Methods. The research project comprises of two stages. Firstly, a comparative study of diabetic patients with different grades of DR. (No DR: Minimal non-proliferative DR: Severe non-proliferative DR: PDR) (10:10: 12: 19). Analysed RVG features including vascular widths and branching angles were compared between patient cohorts. A preliminary statistical model for determination of the retinopathy grade of patients, using these features, is presented. Secondly, in a longitudinal predictive study, RVG features were analysed for diabetic patients with progressive DR over 7 years. RVG at baseline was examined to determine risk for subsequent PDR development. Results: In the comparative study, increased DR severity was associated with gradual vascular dilatation (p = 0.000), and widening of the bifurcating angle (p = 0.000) with increase in smaller-child-vessel branching angle (p = 0.027). Type 2 diabetes and increased diabetes duration were associated with increased vascular width (p = <0.05 In the predictive study, at baseline, reduced small-child vascular width (OR = 0.73 (95 CI 0.58-0.92)), was predictive of future progression to PDR. Conclusions: The study findings suggest that RVG alterations can act as novel markers indicative of progression of DR severity and establishment of PDR. RVG may also have a potential predictive role in determining the risk of future retinopathy progression. © 2014 Habib et al.; licensee BioMed Central Ltd

The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract

BACKGROUND: The management of diabetic patients with refractory macular oedema or patients with no adequate pre-operative view to administer laser treatment provide a challenge to the ophthalmologist. We wished to assess the use, safety and effect of intravitreal triamcinolone injection at the time of cataract surgery in patients with diabetic foveal oedema and sight limiting lens opacities. METHOD: This was a longitudinal non-randomised prospective pilot study in 18 eyes (12 patients). All patients had visually significant lens opacities and either persistent diabetic foveal oedema unresponsive to laser treatment-group A, or foveal oedema with no adequate pre-operative view for laser treatment- group B. The cataract surgery was carried out under full aseptic technique using a self-sealing temporal incision and a foldable acrylic lens. Intravitreal triamcinolone was given infratemporally pars plana at the completion of the cataract surgery. The patients were reviewed at day 5, 2 weeks, 2 months and then every 3 months as required. The Wilcoxin matched-pairs test was used to assess the significance of the improvement in visual acuity at 2 months. RESULTS: Twelve patients with a total of 18 eyes were included in the study. There were 10 patients (15 eyes) in group A and 3 patients (3 eyes) in group B. Preoperatively 16 of the 18 eyes had a visual acuity of 6/24 or worse. Postoperatively 83% of patients had completely dry foveae at 2 weeks. Best-corrected visual acuities at two months review ranged from 6/6 to CF with 9 eyes (50%) achieving 6/12 or better (7 eyes (47%) in group A and 2 eyes (67%) in group B). Three eyes had no recorded improvement in visual acuity, but no eyes had deterioration in acuity. The improvement in visual acuity was significant at p = 0.001. There were no significant sight threatening complications. CONCLUSION: Intravitreal triamcinolone has been shown to lead to an improvement in macular oedema and visual improvement in diabetic patients not undergoing cataract surgery but has not, to our knowledge, been previously used in a study like this one. We suggest that intravitreal injection at the time of cataract surgery could be carried out safely with encouraging visual outcomes in patients with diabetic foveal oedema and cataract