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IEEE Journal of Biomedical and Health... Mar 2024Early-stage diabetic retinopathy (DR) presents challenges in clinical diagnosis due to inconspicuous and minute microaneurysms (MAs), resulting in limited research in...
Early-stage diabetic retinopathy (DR) presents challenges in clinical diagnosis due to inconspicuous and minute microaneurysms (MAs), resulting in limited research in this area. Additionally, the potential of emerging foundation models, such as the segment anything model (SAM), in medical scenarios remains rarely explored. In this work, we propose a human-in-the-loop, label-free early DR diagnosis framework called GlanceSeg, based on SAM. GlanceSeg enables real-time segmentation of MA lesions as ophthalmologists review fundus images. Our human-in-the-loop framework integrates the ophthalmologist's gaze maps, allowing for rough localization of minute lesions in fundus images. Subsequently, a saliency map is generated based on the located region of interest, which provides prompt points to assist the foundation model in efficiently segmenting MAs. Finally, a domain knowledge filtering (DKF) module refines the segmentation of minute lesions. We conducted experiments on two newly-built public datasets, i.e., IDRiD and Retinal-Lesions, and validated the feasibility and superiority of GlanceSeg through visualized illustrations and quantitative measures. Additionally, we demonstrated that GlanceSeg improves annotation efficiency for clinicians and further enhances segmentation performance through fine-tuning using annotations. The clinician-friendly GlanceSeg is able to segment small lesions in real-time, showing potential for clinical applications.
PubMed: 38483801
DOI: 10.1109/JBHI.2024.3377592 -
Progress in Retinal and Eye Research Jul 2014Diabetic retinopathy (DR) remains a major cause of blindness as the prevalence of diabetes is expected to approximately double globally between 2000 and 2030. DR... (Review)
Review
Diabetic retinopathy (DR) remains a major cause of blindness as the prevalence of diabetes is expected to approximately double globally between 2000 and 2030. DR progresses over time at different rates in different individuals with only a limited number developing significant vision loss due to the two major vision-threatening complications, clinically significant macular edema and proliferative retinopathy. Good metabolic control is important to prevent and delay progression, but whereas some patients escape vision loss even with poor control, others develop vision loss despite good metabolic control. Our research group has been able to identify three different DR phenotypes characterized by different dominant retinal alterations and different risks of progression to vision-threatening complications. Microaneurysm turnover has been validated as a prognostic biomarker of development of clinically significant macular edema, whereas subclinical macular edema identified by OCT and mfERG appear to be also good candidates as organ-specific biomarkers of DR. Hemoglobin A1c remains the only confirmed systemic prognostic biomarker of DR progression. The availability of biomarkers of DR progression and the identification of different phenotypes of DR with different risks for development of vision-threatening complications offers new perspectives for understanding DR and for its personalized management.
Topics: Aneurysm; Biomarkers; Diabetic Retinopathy; Humans; Macular Edema; Phenotype; Tomography, Optical Coherence; Visual Acuity
PubMed: 24680929
DOI: 10.1016/j.preteyeres.2014.03.003 -
Acta Neurochirurgica May 2024A 40-year-old female with a history of ischemic moyamoya disease treated with indirect revascularization at ages 12 and 25 years presented with a sudden severe...
A 40-year-old female with a history of ischemic moyamoya disease treated with indirect revascularization at ages 12 and 25 years presented with a sudden severe headache. Imaging studies revealed focal parenchymal hemorrhage and acute subdural hematoma, confirming a microaneurysm formed on the postoperative transosseous vascular network as the source of bleeding. Conservative management was performed, and no hemorrhage recurred during the 6-month follow-up period. Interestingly, follow-up imaging revealed spontaneous occlusion of the microaneurysm. However, due to the rarity of this presentation, the efficacy of conservative treatment remains unclear. Further research on similar cases is warranted.
Topics: Humans; Moyamoya Disease; Female; Adult; Cerebral Revascularization; Aneurysm, Ruptured; Postoperative Complications; Intracranial Aneurysm; Anastomosis, Surgical
PubMed: 38719974
DOI: 10.1007/s00701-024-06102-1 -
Computerized Medical Imaging and... 2013In this paper, we present two approaches to improve microaneurysm detector ensembles. First, we provide an approach to select a set of preprocessing methods for a...
In this paper, we present two approaches to improve microaneurysm detector ensembles. First, we provide an approach to select a set of preprocessing methods for a microaneurysm candidate extractor to enhance its detection performance in color fundus images. The performance of the candidate extractor with each preprocessing method is measured in six microaneurysm categories. The best performing preprocessing method for each category is selected and organized into an ensemble-based method. We tested our approach on the publicly available DiaretDB1 database, where the proposed approach led to an improvement regarding the individual approaches. Second, an adaptive weighting approach for microaneurysm detector ensembles is presented.The basis of the adaptive weighting approach is the spatial location and contrast of the detected microaneurysm. During training, the performance of ensemble members is measured with respect to these contextual information, which serves as a basis for the optimal weights assigned to the detectors. We have tested this approach on two publicly available datasets, where it showed its competitiveness compared without previously published ensemble-based approach for microaneurysm detection. Moreover, the proposed approach outperformed all the investigated individual detectors.
Topics: Aneurysm; Color; Diabetic Retinopathy; Fundus Oculi; Humans; Image Interpretation, Computer-Assisted; Image Processing, Computer-Assisted; Reproducibility of Results
PubMed: 23746595
DOI: 10.1016/j.compmedimag.2013.05.001 -
Journal of Personalized Medicine Nov 2021Eyes with proliferative diabetic retinopathy (PDR) have been shown to improve in the leakage index and microaneurysm (MA) count after intravitreal aflibercept (IAI)...
The 2-Year Leakage Index and Quantitative Microaneurysm Results of the RECOVERY Study: Quantitative Ultra-Widefield Findings in Proliferative Diabetic Retinopathy Treated with Intravitreal Aflibercept.
Eyes with proliferative diabetic retinopathy (PDR) have been shown to improve in the leakage index and microaneurysm (MA) count after intravitreal aflibercept (IAI) treatment. The authors investigated these changes via automatic segmentation on ultra-widefield fluorescein angiography (UWFA). Forty subjects with PDR were randomized to receive either 2 mg IAI every 4 weeks (Arm 1) or every 12 weeks (Arm 2) through Year 1. After Year 1, Arm 1 switched to quarterly IAI and Arm 2 to monthly IAI through Year 2. By Year 2, the Arm 1 leakage index decreased by 43% from Baseline ( = 0.03) but increased by 59% from Year 1 ( = 0.04). Arm 2 decreased by 61% from Baseline ( = 0.008) and by 31% from Year 1 ( = 0.12). Both cohorts exhibited a significant decline in MAs from Baseline to Year 2 (871 to 410; < 0.001; 776 to 207; < 0.001, respectively). Subjects with an improved leakage and MA count showed a more significant improvement in the Diabetic Retinopathy Severity Scale (DRSS) score. Moreover, central subfield thickness (CST) was positively associated with changes in the leakage index. In conclusion, the leakage index and MA counts significantly improved from Baseline following IAI treatment, and monthly injections provided a more rapid and sustained reduction in these parameters compared with quarterly injections.
PubMed: 34834478
DOI: 10.3390/jpm11111126 -
American Journal of Ophthalmology May 2013To characterize microaneurysm closure following focal laser photocoagulation in diabetic macular edema (DME) using simultaneous fluorescein angiography (FA) and... (Comparative Study)
Comparative Study
PURPOSE
To characterize microaneurysm closure following focal laser photocoagulation in diabetic macular edema (DME) using simultaneous fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT).
DESIGN
Retrospective observational case series.
METHODS
Leaking microaneurysms (n = 123) were analyzed in eyes (n = 29) with nonproliferative diabetic retinopathy (NPDR) that underwent navigated focal laser photocoagulation in DME and were followed at 3, 6, and 12 months. Closure of diabetic microaneurysms was characterized in detail following focal laser using SD-OCT.
RESULTS
Closure rate of microaneurysms by both FA and SD-OCT was 69.9% (84/123), 79.7% (98/123), and 82.9% (102/123) at 3, 6, and 12 months, respectively. Microaneurysm closure rate increased at 6 and 12 months compared to 3 months (P < .003, P < .001). Over half of closed microaneurysms (45/86, 52.3%) left hyperreflective spots while the remaining half (41/86, 47.7%) disappeared without any hyperreflectivity by SD-OCT at 3 months. Hyperreflective spots decreased at 6 (36/99, 36.4%) and 12 months (17/102, 16.7%) with a concomitant increase in complete loss of reflectivity at 6 (63/99, 63.6%) and 12 months (85/102, 83.3%). Smaller outer and inner diameters and heterogeneous lumen reflectivity were positively associated with microaneurysm closure at 12 months (P < .0001, P < .001, P < .03).
CONCLUSIONS
Characterization of microaneurysms following focal laser photocoagulation resulted in hyperreflective spots and complete resolution of all reflectivity using SD-OCT. Smaller microaneurysms and those with heterogeneous lumen were positively associated with microaneurysm closure. These findings provide greater understanding of localized retinal changes following focal laser photocoagulation in DME treatment.
Topics: Aneurysm; Diabetic Retinopathy; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Laser Coagulation; Macular Edema; Male; Middle Aged; Retina; Retinal Artery; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity
PubMed: 23394906
DOI: 10.1016/j.ajo.2012.12.005 -
CEN Case Reports May 2018An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10 days earlier, her oral intake gradually decreased with no other specific symptoms,...
An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10 days earlier, her oral intake gradually decreased with no other specific symptoms, such as abdominal pain, nausea, vomiting, headache, or low back pain. Abdominal computed tomography (CT) scan revealed a left subcapsular renal hematoma. We suspected infective subcapsular renal hematoma, so percutaneous needle aspiration and drainage were performed. Intravenous sulbactam-ampicillin was started immediately. On day 9 after admission, repeat CT scan revealed the subcapsular hematoma had reduced in size. The drain was removed, and intravenous antibiotics were discontinued. Follow-up CT scan on day 21 revealed increased subcapsular renal hematoma size. The patient also had high fever. Suspecting recurrence of infective subcapsular renal hematoma, we repeated the drainage of the hematoma and restarted intravenous antibiotics. Renal arteriography showed a renal artery microaneurysm and her condition improved with renal artery embolization. Renal arteriography was useful for detecting renal artery microaneurysm in infective subcapsular renal hematoma that did not resolve after antibiotic treatment and drainage.
PubMed: 29344911
DOI: 10.1007/s13730-018-0305-6 -
Seminars in Thrombosis and Hemostasis Nov 2013Cerebral amyloid angiopathy (CAA) is cerebrovascular amyloid deposition. It is classified into several types according to the cerebrovascular amyloid proteins involved.... (Review)
Review
Cerebral amyloid angiopathy (CAA) is cerebrovascular amyloid deposition. It is classified into several types according to the cerebrovascular amyloid proteins involved. Sporadic amyloid β-protein (Aβ)-type CAA is commonly found in elderly individuals and patients with Alzheimer disease. CAA-related disorders include hemorrhagic and ischemic stroke and dementia. CAA-related hemorrhages include intracerebral lobar macrohemorrhages, cortical microhemorrhages, and focal subarachnoidal hemorrhages/superficial siderosis. CAA-associated vasculopathies, such as microaneurysmal formation with fibrinoid necrosis, underlie such cerebrovascular events. Sensitive magnetic resonance imaging procedures, such as gradient-echo T2* imaging and susceptibility-weighted images, are useful to detect microhemorrhagic lesions. Amyloid images with amyloid-binding positron emission tomography ligands can detect CAA, although they cannot discriminate vascular from parenchymal amyloid deposits. Hemorrhage-inducing factors for sporadic Aβ-type CAA include apolipoprotein E genotype, thrombolytic, anticoagulation, and antiplatelet therapies, hypertension, minor head trauma, and antiamyloid therapies. We need future strategies for protection of vessel walls against amyloid-related vascular damage, such as toxicity of Aβ oligomers, Aβ-induced oxidative stress, and inflammation, as well as development of antiamyloid therapies for CAA.
Topics: Amyloid beta-Peptides; Apolipoproteins E; Cerebral Amyloid Angiopathy; Humans; Intracranial Hemorrhages; Magnetic Resonance Imaging; Mutation; Positron-Emission Tomography; Risk Factors
PubMed: 24108472
DOI: 10.1055/s-0033-1357489 -
Journal Francais D'ophtalmologie Jun 2018
Topics: Fluorescein Angiography; Humans; Male; Microaneurysm; Morocco; Optic Atrophy, Hereditary, Leber; Retinal Telangiectasis; Retinal Vessels; Tomography, Optical Coherence; Young Adult
PubMed: 29887406
DOI: 10.1016/j.jfo.2017.10.012 -
Ophthalmology Nov 2019To investigate the relationship between the diabetic retinopathy (DR) severity and quantitative ultra-widefield angiographic metrics, including leakage index, ischemic...
PURPOSE
To investigate the relationship between the diabetic retinopathy (DR) severity and quantitative ultra-widefield angiographic metrics, including leakage index, ischemic index, and microaneurysm count.
DESIGN
Retrospective image analysis study.
METHODS
Eyes with DR that had undergone ultra-widefield fluorescein angiography (UWFA) with associated color photography were identified. All eyes were laser-naive and had not received any intravitreal pharmacotherapy within 6 months of UWFA. Each eye was graded for DR severity. Quantitative angiographic parameters were evaluated with a semiautomated analysis platform with expert reader correction, as needed. Angiographic parameters included panretinal leakage index, ischemic index, and microaneurysm count. Clinical characteristics analyzed included age, gender, race, hemoglobin A1C level, hypertension, systolic blood pressure, diastolic blood pressure, and smoking history.
MAIN OUTCOME MEASURES
Association of DR severity with panretinal leakage index, ischemic index, and microaneurysm count.
RESULTS
Three hundred thirty-nine eyes were included with mean age of 62±13 years. Forty-two percent of eyes were from women and 57.5% were from men. Distribution of DR severity was as follows: mild NPDR in 11.2%, moderate NPDR in 23.9%, severe NPDR in 40.1%, and PDR with 24.8%. Panretinal leakage index [mild NPDR (mean = 0.51%), moderate NPDR mean = 1.20%, severe NPDR (mean = 2.75%), and PDR (mean = 5.84%); P<2×10], panretinal ischemic index [mild NPDR (mean = 0.95%, moderate NPDR (mean = 1.37%), severe NPDR (mean = 2.80%), and PDR (mean = 9.53%); P<2×10], and panretinal microaneurysm count [mild NPDR (mean = 36), moderate NPDR (mean = 129), severe NPDR (mean = 203), and PDR (mean = 254); P<5×10] were strongly associated with DR severity. Multivariate analysis demonstrated that ischemic index and leakage index were the parameters associated most strongly with level of DR severity.
CONCLUSIONS
Panretinal leakage index, panretinal ischemic index, and panretinal microaneurysm count are associated with DR severity. Additional research is needed to understand the clinical implications of these parameters related to progression risk, prognosis, and implications for therapeutic response.
Topics: Adult; Aged; Blood Pressure; Capillary Permeability; Diabetic Retinopathy; Female; Fluorescein Angiography; Glycated Hemoglobin; Humans; Hypertension; Ischemia; Male; Microaneurysm; Middle Aged; Retinal Vessels; Retrospective Studies; Severity of Illness Index; Smoking; Visual Acuity
PubMed: 31383482
DOI: 10.1016/j.ophtha.2019.05.034