Retinal Nonperfusion in Proliferative Diabetic Retinopathy Before and After Panretinal Photocoagulation Assessed by Widefield OCT Angiography

Russell, Jonathan F.; Al-Khersan, Hasenin; Shi, Yingying; Scott, Nathan L.; Hinkle, John W.; Fan, Kenneth C.; Lyu, Cancan; Feuer, William J.; Gregori, Giovanni; Rosenfeld, Philip J.

doi:10.1016/j.ajo.2020.01.024

Cited by 38 publications

(32 citation statements)

References 33 publications

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“…Areas of nonperfusion detection on UWF-FA co-localized with areas of nonperfusion on WF-OCTA, although the latter detected significantly greater ischemia [ 64 , 65 ]. Given that WF-OCTA accurately demonstrates the vascular network in neovascularization without the effect of leakage, quantifying the size of the NVE or NVD may prove to be a prognostic factor for the risk of vitreous hemorrhage development [ 66 ].…”

Section: Wide Field Optical Coherence Tomography Angiography (Wf-octa) Quantitative Metricsmentioning

confidence: 99%

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ashraf

Cavallerano

Sun

et al. 2021

JCM

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Ultrawide field imaging (UWF) has allowed the visualization of a significantly greater area of the retina than previous standard approaches. In diabetic retinopathy (DR), significantly more lesions are seen on UWF imaging compared to the seven-standard ETDRS fields. In addition, some eyes have lesions that are located predominantly in the peripheral retina that are associated with an increased risk of DR progression. The current DR severity scales are still largely based on clinically visible retinal microvascular lesions and do not incorporate retinal periphery, neuroretinal, or pathophysiologic changes. Thus, current scales are not well suited for documenting progression or regression in eyes with very early or advanced DR, nor in the setting of vascular endothelial growth factor inhibitors (antiVEGF). In addition, the categorical system is highly subjective, and grading is variable between different graders based on experience level and training background. Recently, there have been efforts to quantify DR lesions on UWF imaging in an attempt to generate objective metrics for classification, disease prognostication and prediction of treatment response. The purpose of this review is to examine current quantitative metrics derived from UWF fluorescein angiograms and UWF color imaging to determine their feasibility in any potential future DR classification.

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Section: Wide Field Optical Coherence Tomography Angiography (Wf-octa) Quantitative Metricsmentioning

confidence: 99%

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ashraf

Cavallerano

Sun

et al. 2021

JCM

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“…In addition to facilitating retinal vascular disease diagnosis, our methods can help guide retinal disease treatment such as panretinal laser photocoagulation (PRP), which can treat RNP and reduce rates of vision loss by suppressing neovascularization 3 . Anti‐VEGF drugs such as ranibizumab are effective to block neovascularization, prevent RNP deterioration and promote reperfusion, 39 and can be used for PRP supplementation or pretreatment 40 . Although our methods were initially developed for RNP segmentation in RVO patients, they may also be used for DR diagnosis and management 41 because the features of RNP are similar.…”

Section: Discussionmentioning

confidence: 99%

“…3 Anti-VEGF drugs such as ranibizumab are effective to block neovascularization, prevent RNP deterioration and promote reperfusion, 39 and can be used for PRP supplementation or pretreatment. 40 Although our methods were initially developed for RNP segmentation in RVO patients, they may also be used for DR diagnosis and management 41 because the features of RNP are similar. There are several limitations in this study.…”

Section: Discussionmentioning

confidence: 99%

Automated segmentation of retinal nonperfusion area in fluorescein angiography in retinal vein occlusion using convolutional neural networks

et al. 2020

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Purpose: Retinal vein occlusion (RVO) is the second most common cause of vision loss after diabetic retinopathy due to retinal vascular disease. Retinal nonperfusion (RNP), identified on fluorescein angiograms (FA) and appearing as hypofluorescence regions, is one of the most significant characteristics of RVO. Quantification of RNP is crucial for assessing the severity and progression of RVO. However, in current clinical practice, it is mostly conducted manually, which is time-consuming, subjective, and error-prone. The purpose of this study is to develop fully automated methods for segmentation of RNP using convolutional neural networks (CNNs). Methods: FA images from 161 patients were analyzed, and RNP areas were annotated by three independent physicians. The optimal method to use multi-physicians' labeled data to train the CNNs was evaluated. An adaptive histogram-based data augmentation method was utilized to boost the CNN performance. CNN methods based on context encoder module were developed for automated segmentation of RNP and compared with existing state-of-the-art methods. Results: The proposed methods achieved excellent agreements with physicians for segmentation of RNP in FA images. The CNN performance can be improved significantly by the proposed adaptive histogram-based data augmentation method. Using the averaged labels from physicians to train the CNNs achieved the best consensus with all physicians, with a mean accuracy of 0.883AE0.166 with fivefold cross-validation. Conclusions: We reported CNN methods to segment RNP in RVO in FA images. Our work can help improve clinical workflow, and can be useful for further investigating the association between RNP and retinal disease progression, as well as for evaluating the optimal treatments for the management of RVO.

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“…Recent studies that reported no statistically significant changes in retinal non-perfused areas on wide-field OCT-angiograms 3 months after PRP, might potentially suffer from limitations due to rarefied B-scan sampling in a 12 × 12 mm OCT-A. 31 An interesting approach might be to simultaneously evaluate both the macular and peripheral (underneath RNVs) VPD, because it has been hypothesized an improved flow in macular vascular plexuses after the laser procedure. 32 This phenomenon could be a directly related to the occlusion of the peripheral neovascular and microvascular intraretinal abnormalities, with improved perfusion of the posterior pole.…”

Section: Discussionmentioning

confidence: 99%

OCT-Angiography as a reliable prognostic tool in laser-treated proliferative diabetic retinopathy: The RENOCTA Study

Lupidi

Gujar

Cerquaglia

et al. 2020

European Journal of Ophthalmology

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Purpose: To quantitatively assess retinal neovascularizations (RNVs) in proliferative diabetic retinopathy (PDR) before and after photocoagulative laser treatment (PLT) using Optical Coherence Tomography Angiography (OCT-A). Methods: Consecutive patients with PDR were examined with fluorescein angiography (FA) and OCT-A before and after PLT. Baseline and after-treatment FA images were quantitatively analyzed to assess both the RNVs area and leakage area. On OCT-A RNVs area, vascular perfusion density (VPD), vessel length density (VLD) and fractal dimension were computed. VPD of the full-retina OCT-A underneath the RNV was determined to evaluate potential laser-induced changes in vascular perfusion. Results: Fifteen eyes of 13 patients with PDR were enrolled. The mean area of the RNVs was 0.47 ± 0.50 mm2 in the baseline OCT-A and 0.32 ± 0.40 mm2 in the post-treatment assessment ( p = 0.0002). The mean RNV VPD of RNV was 2% ± 4% in pre-treatment and 1% ± 1% for the post-treatment ( p = 0.0001). The mean VLD of RNV was 7.26 ± 1.53 at baseline and 6.64 ± 1.65 in the post treatment ( p = 0.0002). A significant difference in terms of mean RNVs area and VPD reduction between eyes that needed additional treatment and those that did not (~40% vs ~20%; p < 0.05), was observed. Mean VPD of full-retinal thickness OCT-angiogram was 55% ± 10% for the pre-treatment and 53% ± 8% for the post treatment scan ( p = 0.02). Conclusion: The quantitative OCT-A assessment of laser-induced changes of RNVs can be a useful non-invasive approach for determining treatment efficacy. A reduction of RNVs area or VPD ⩾ 40% might reveal those eyes that won’t require additional treatment. Retinal perfusion impairment seemed to progress independently from the treatment.

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Retinal Nonperfusion in Proliferative Diabetic Retinopathy Before and After Panretinal Photocoagulation Assessed by Widefield OCT Angiography

Cited by 38 publications

References 33 publications

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Automated segmentation of retinal nonperfusion area in fluorescein angiography in retinal vein occlusion using convolutional neural networks

OCT-Angiography as a reliable prognostic tool in laser-treated proliferative diabetic retinopathy: The RENOCTA Study

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