Fig 1- - uploaded by Alan Cruess
Content may be subject to copyright.
Late-phase fluorescein (left) with simultaneous late-phase indocyanine green (right) angiographs showing the choroidal polyps characteristic of polypoidal choroidal vasculopathy.
Source publication
Exudative age-related macular degeneration (AMD) is a sight-threatening event in many elderly people. Some patients have a much better outcome in visual acuity (VA) than others after treatment with photodynamic therapy (PDT) with verteporfin. The combination of fluorescein angiography (FA) and indocyanine green (ICG) angiography using the Heidelber...
Context in source publication
Context 1
... were assessed at baseline and at 3-month intervals thereafter with dilated fundus examination and biomicro- scopic examination with a 78-diopter lens as long as there was active leakage, and at 2 additional 3-month follow-ups when there was no detectable leakage. Best-corrected VA was measured with a standard Snellen chart. To quantify the differences in vision, all Snellen VAs were converted to logMAR. A high-speed simultaneous intravenous angiogra- phy with FA and (or) ICG angiography was (were) done for follow-up at the investigator's discretion in a standard manner using the HRA 2 and (or) single FA with the OIS system (Ophthalmic Imaging Systems, Sacramento, Calif.) ( Figs. 1 and 2). Furthermore, a macular thickness measure- ment by OCT was obtained in some patients. The images were all read by 2 authors (Roman Windisch and Alan F. Cruess) on the HRA 2 monitor. Based on ICG angiography findings, PCV was defined using the description of Yannuzzi et al. 3 The macular type of PCV was defined as abnormal polypoidal and leaking lesions located within 1 disc diameter of the centre of the foveal vascular zone in ICG ...
Similar publications
Background
To compare the one-year outcomes between intravitreal brolucizumab (IVBr) monotherapy and photodynamic therapy (PDT) as a second-line treatment in patients with polypoidal choroidal vasculopathy (PCV) who did not respond to first-line therapy.
Methods
This case–control study included eyes with PCV that do not respond to aflibercept or r...
Purpose: To evaluate the clinical response of treatment-resistant choroidal neovascularization (CNV) to photodynamic therapy (PDT) combined with bevacizumab (BVZ) therapy. Methods: Retrospective, non-comparative evaluation of eyes diagnosed with CNV secondary to age-related macular degeneration that had no response after at least 3 intravitreal BVZ...
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration characterised by an abnormal branching vascular network with aneurysmal polypoidal choroidal vascular lesions. PCV is more prevalent in Asian populations than in Caucasians, which may explain its underdiagnosis in Western countries. Evidence regardi...
Introduction: Polypoidal choroidal vasculopathy (PCV) is an abnormality of the inner choroidal vasculature. The recommended treatment for PCV is a combination of standard verteporfin photodynamic therapy (PDT) with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). There have been reports ofsuccess with combination of h...
Polypoidal choroidal vasculopathy (PCV) is a prevalent retinal disease predominantly occurs in Asians that shares some similarities seen in neovascular age-related macular degeneration. Recent large multicenter clinical trials on intravitreal anti-vascular endothelial growth factor (VEGF) agents and photodynamic therapy (PDT) have shed lights on th...
Citations
... The field of medical imaging, which has recently seen an expansion in ophthalmology with an emphasis on retinal imaging, is home to many deep learning (DL) applications. On the other hand, image analysis and diagnosis are not the main uses of DL in medicine [7][8][9]. The above methods can be used to evaluate a different data type of data such as clinical and demographic data. ...
Retinal optical coherence tomography (OCT) imaging is a valuable tool for assessing
the condition of the back part of the eye. The condition has a great effect on the specificity of
diagnosis, the monitoring of many physiological and pathological procedures, and the response
and evaluation of therapeutic effectiveness in various fields of clinical practices, including primary
eye diseases and systemic diseases such as diabetes. Therefore, precise diagnosis, classification,
and automated image analysis models are crucial. In this paper, we propose an enhanced optical
coherence tomography (EOCT) model to classify retinal OCT based on modified ResNet (50) and
random forest algorithms, which are used in the proposed study’s training strategy to enhance
performance. The Adam optimizer is applied during the training process to increase the efficiency
of the ResNet (50) model compared with the common pre-trained models, such as spatial separable
convolutions and visual geometry group (VGG) (16). The experimentation results show that the
sensitivity, specificity, precision, negative predictive value, false discovery rate, false negative rate
accuracy, and Matthew’s correlation coefficient are 0.9836, 0.9615, 0.9740, 0.9756, 0.0385, 0.0260, 0.0164,
0.9747, 0.9788, and 0.9474, respectively.
... Indocyanine green angiography (ICGA) and fluorescein angiography (FA) are invasive methods that require 10-30 min of imaging and intravenous dye administration. They show dynamic imaging of blood flow through retinal vessels in 2D images [8,9]. Non-invasive approaches, on the other hand, include OCT angiography (OCTA) and optical coherence tomography (OCT) [10,11]. ...
... Training used a 0.3 dropout rate and 0.001 learning rate. To find the optimal set of hyper-parameters, such as the number of layers, the nodes number in each layer (range: 10-100), L2 regularisation (range: 103-106), sparseness control parameters (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and the sparsity parameter (range: 0.05-0.9), grid search algorithm was used with the reconstruction error as the metric to optimise. ...
Diabetic retinopathy (DR) refers to the ophthalmological complications of diabetes mellitus. It is primarily a disease of the retinal vasculature that can lead to vision loss. Optical coherence tomography angiography (OCTA) demonstrates the ability to detect the changes in the retinal vascular system, which can help in the early detection of DR. In this paper, we describe a novel framework that can detect DR from OCTA based on capturing the appearance and morphological markers of the retinal vascular system. This new framework consists of the following main steps: (1) extracting retinal vascular system from OCTA images based on using joint Markov-Gibbs Random Field (MGRF) model to model the appearance of OCTA images and (2) estimating the distance map inside the extracted vascular system to be used as imaging markers that describe the morphology of the retinal vascular (RV) system. The OCTA images, extracted vascular system, and the RV-estimated distance map is then composed into a three-dimensional matrix to be used as an input to a convolutional neural network (CNN). The main motivation for using this data representation is that it combines the low-level data as well as high-level processed data to allow the CNN to capture significant features to increase its ability to distinguish DR from the normal retina. This has been applied on multi-scale levels to include the original full dimension images as well as sub-images extracted from the original OCTA images. The proposed approach was tested on in-vivo data using about 91 patients, which were qualitatively graded by retinal experts. In addition, it was quantitatively validated using datasets based on three metrics: sensitivity, specificity, and overall accuracy. Results showed the capability of the proposed approach, outperforming the current deep learning as well as features-based detecting DR approaches.
... The diagnostic algorithms depend on the retinal medical imaging methods, which can be classified according to invasive or non-invasive image techniques into: 1) Invasive techniques: Fluorescein Angiography (FA) and Indocyanine Green Angiography (ICGA), which require up to 10-30 minutes of intravenous dye administration and imaging. They provide 2D images of dynamic visualization of blood flow through retinal vessels [33,34]. 2) Non-invasive techniques: the Optical Coherence Tomography Angiography (OCTA) is the latest non-invasive technique [35][36][37]. ...
Background
Diabetic retinopathy (DR) refers to the ocular effect of diabetes. It is one of the retinal vascular diseases that can cause loss of vision. DR leads to alterations in vascular networks, including angiogenesis and capillary regression.
Objective
The objective of this research is to provide an effective robust and accurate automatic methodology for the early detection of DR subjects. The methodology depends on two steps: 1) Blood vessel reconstruction, enhancement, and re-continuity using written custom programs, and 2) An Artificial Neural Network (ANN) as an automatic classifier between the diabetic without diabetic retinopathy (DR) and the Mild to Moderate Non-Proliferative Diabetic Retinopathy (NPDR) subjects.
Methods
This approach depends on extracting the seven features, which are the most changeable features according to the morphological retinal vascular network changes. These features are the mean of the intercapillary areas as regions of interest for the largest 10 and 20 selected regions, either including or excluding the Foveal Avascular Zone (FAZ) region, FAZ perimeter, circularity index, and vascular density. The OCTA images were obtained and approved by the Ophthalmology Center in Mansoura University-Egypt.
Results
One hundred images were processed, distributed as follows: 40 eyes were normal, 30 eyes were diabetic without DR, and 30 eyes were NPDR subjects. The total system accuracy reached 97%. The performance parameters of the classification system for normal versus diabetic were 97.5% for sensitivity, 96.67% for specificity, and 95.2% for precision. While, the measures for a diabetic without DR versus non-proliferative DR (mild to moderate) were 96.67% for sensitivity, 96.67% for specificity, and 96.67% for precision. The maximum misclassification error was 3.33%.
Conclusion
The proposed methodology is capable of accurate classification of the diabetic without DR and Non-proliferative diabetic retinopathy subjects. This methodology depends on using written custom programs and a plugin for MATLAB and Fiji based Image-J software with a supervised artificial neural network. This technique achieves high accuracy, resolution, specificity, and precision with only a short time needed for diagnosis.
... 30,175,178 Polypoidal choroidal vasculopathy is a chronic, recurrent condition: the need for retreatment with verteporfin PDT or ranibizumab in some patients, especially with longer-term follow-up, is well documented. 30,[55][56][57][58]61,62,66,69,[71][72][73]78,86,89,[91][92][93]126 The recommendations of the panel for monitoring are consistent with the methodology of the majority of the studies retrieved in the literature search on PCV. ...
Background:
Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration. Currently, no evidence-based guidelines exist for its diagnosis and treatment.
Methods:
A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV. At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion.
Results:
Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography. Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab. If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.
Conclusion:
Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.
... Because they show complementary information in the retina and choroid, respectively, static FA, d-ICG, and optical coherence tomography (OCT), 5 described later in this article, are often imaged simultaneously. 6,7 Algorithms were designed that produce d-ICG images that are easier to interpret compared to movies. Imaged measures include the peak magnitude, dye fill-time, and dispersion of the dye dilution temporal curves associated with image pixels. ...
Dynamic indocyanine green imaging uses a scanning laser ophthalmoscope and a fluorescent dye to produce movies of the dye-filling pattern in the retina and choroid of the eye. It is used for evaluating choroidal neovascularization. Movies are examined to identify the anatomy of the pathology for planning treatment and to evaluate progression or response to treatment. The popularity of this approach is affected by the complexity and difficulty in interpreting the movies. Software algorithms were developed to produce images from the movies that are easy to interpret. A mathematical model is formulated of the flow dynamics, and a fitting algorithm is designed that solves for the flow parameters. The images provide information about flow and perfusion, including regions of change between examinations. Imaged measures include the dye fill-time, temporal dispersion, and magnitude of the dye dilution temporal curves associated with image pixels. Cases show how the software can help to identify clinically relevant anatomy such as feeder vessels, drain vessels, capillary networks, and normal choroidal draining vessels. As a potential tool for research into the character of neovascular conditions and treatments, it reveals the flow dynamics and character of the lesion. Future varieties of this methodology may be used for evaluating the success of engineered tissue transplants, surgical flaps, reconstructive surgery, breast surgery, and many other surgical applications where flow, perfusion, and vascularity of tissue are important.
... Indocyanine green (ICG) is a water soluble tricarbocyanine dye that is widely used for ophthalmic angiography [1] and in physiological studies such as, the measurement of cardiac output [2] or hepatic blood flow [3]. It has recently been introduced for intra-operative angiography during neurovascular surgery [3]. ...
... Our interest in ICG as a marker of BBB disruption arises due to several reasons. First, ICG is a valuable tracer for a number of physiological and diagnostic studies and is approved for a variety of human uses [1][2][3]24]. Second, ICG concentrations in the brain tissue of human subjects can be measured by modification of commercially available noninvasive NIRS technology [4]. ...
Osmotic disruption of the blood-brain barrier (BBB) by intraarterial mannitol injection is sometimes required for the delivery of chemotherapeutic drugs to brain tissue. Osmotic disruption is affected by a number of factors, and there is a significant variability in the degree and distribution of BBB disruption in clinical and experimental settings. Brain tissue concentrations of indocyanine green (ICG) can be measured by optical techniques. The aim of this experiment was to determine whether the disruption of the BBB significantly altered the regional pharmacokinetics of ICG. We were able to track in vivo brain tissue concentrations of ICG in 13 New Zealand white rabbits by employing a novel optical approach. Evan's blue was used to assess the distribution of BBB disruption on post mortem examination. BBB disruption by intraarterial mannitol injection was found to be highly variable, and only five of the 13 animals demonstrated the disruption at the site of optical measurements. In these animals, we observed a ninefold increase in ICG concentrations and fourfold increase in the area under the concentration-time curve, compared to those without BBB disruption at the site of measurement. This study shows the feasibility of optical monitoring of BBB disruption with intravenous (IV) ICG injections. Virtual real-time optical monitoring of the BBB disruption could help improve intraarterial delivery of chemotherapeutic drugs.
... One of these techniques is fluorescein angiography, which can be used to visualize retinal hemodynamic. However, this technique requires dye injection and this usually cause nausea and occasional vomiting for patients[1] [2]. Another technique is pulsatile ocular blood flow (POBF), which is a penumtonometer that uses a pressurized tip places in contact with the cornea to measure intraocular pressure in real time. ...
Noninvasive monitoring of blood flow in retinal circulation will reveal the progression and treatment of ocular disorders, such as diabetic retinopathy, age-related macular degeneration and glaucoma. A non-invasive and direct BF measurement technique with high spatial-temporal resolution is needed for retinal imaging. Laser speckle imaging (LSI) is such a method. Currently, there are two analysis methods for LSI: spatial statistics LSI (SS-LSI) and temporal statistical LSI (TS-LSI). Comparing these two analysis methods, SS-LSI has higher signal to noise ratio (SNR) and TS-LSI is less susceptible to artifacts from stationary speckle. We proposed a hybrid temporal and spatial analysis method (HTS-LSI) to measure the retinal blood flow. Gas challenge experiment was performed and images were analyzed by HTS-LSI. Results showed that HTS-LSI can not only remove the stationary speckle but also increase the SNR. Under 100% O 2 , retinal BF decreased by 20-30%. This was consistent with the results observed with laser Doppler technique. As retinal blood flow is a critical physiological parameter and its perturbation has been implicated in the early stages of many retinal diseases, HTS-LSI will be an efficient method in early detection of retina diseases.
Infectious and noninfectious uveitis can produce potentially serious complications, including inflammatory choroidal neovascularization (CNV). Its diagnosis is challenging and often requires the support of different retinal imaging tests. Local therapies, and in particular intravitreal anti-vascular endothelial growth factor (VEGF) drugs, are considered as first-line, but also intravitreal steroids and systemic therapies such as anti-TNF drugs, steroid-sparing agents, and immunosuppressants may have a role, even though the evidence is limited to small case series. These inflammatory CNV represent a significant risk of permanent vision loss, as a delayed diagnosis and treatment may confer a significant threat to the visual function of these patients.
Polypoidal choroidal vasculopathy (PCV) is an important subtype of neovascular AMD. While it is more commonly seen in people of East Asian origin, it has been well-described in Afro-Caribbean individuals and accounts for up to 20% of Caucasian wet AMD sufferers. Hence it is a truly global problem affecting all ethnic races. Recognition and diagnosis of PCV is important because there is a high non-response rate to anti-VEGF therapy; PCV cases often require high number of injections to control activity; and there is an attendant risk of massive submacular hemorrhage if polypoidal lesions are persistent even while on anti-VEGF therapy.
