通过光学相干断层扫描图像进行自动视网膜分割评估黄斑水肿的投影面积

在本文中,我们提出了一种自动视网膜分割方法,以评估光学相干断层扫描（OCT）图像中黄斑水肿（ME）在视网膜特定层上的投影面积。首先使用基于权重矩阵的优化的最短路径最快算法对十个视网膜层边界进行分割,这有效降低了算法对血管阴影的敏感性。然而,ME的存在将导致水肿区域的分割不准确。因此,我们使用强度阈值方法提取每个OCT图像中的水肿区域,并将该区域中的值设置为零,并确保获得的分割边界可以自动穿过而不是绕过水肿区域。我们使用最小值投影来计算ME在不同层的投影面积。为了测试我们的方法,我们使用了从Topcon的OCT机器收集的数据。在轴向和B扫描方向上测得的黄斑区域分辨率分别为11.7微米和46.8微米。与手动分割相比,视网膜层边界分割的平均绝对误差和标准偏差为4.5±3.2微米。因此,所提出的方法为评估水肿提供了一种自动,无创和定量的工具。     

通过光学相干断层扫描图像进行自动视网膜分割评估黄斑水肿的投影面积（英文）

本文提出一种自动视网膜分割方法,以评估光学相干断层扫描(OCT)图像中黄斑水肿(ME)在视网膜特定层上的投影面积.首先使用基于权重矩阵的优化最短路径最快算法对10个视网膜层边界进行分割,这有效降低了算法对血管阴影的敏感性.然而,ME的存在将导致水肿区域的分割不准确.因此,使用强度阈值方法提取每个OCT图像中的水肿区域,并将该区域中的值设置为零,并确保获得的分割边界可以自动穿过而不是绕过水肿区域.同时使用最小值投影来计算ME在不同层的投影面积.为了测试该方法,使用了从Topcon OCT机器收集的数据.在轴向和B扫描方向上测得的黄斑区域分辨率分别为11.7μm和46.8μm.与手动分割相比,视网膜层边界分割的平均绝对误差和标准偏差为(4.5±3.2)μm.因此,所提出的方法为评估水肿提供了一种自动、无创和定量的工具.     

高压氧治疗糖尿病视网膜病变的研究进展

糖尿病视网膜病变是糖尿病最常见、最主要的微血管并发症之一,具有高发病率,高致盲率的特点,严重影响了人类的生存质量。控制高血糖和改善组织缺氧无疑是防治糖尿病微血管病变的有效方法。如果对糖尿病视网膜病变及时进行治疗,能延缓其发展并能提高病人的生活质量。近年来,随着对糖尿病发病机制的深入研究,很多方法用于防治糖尿病视网膜病人都取得了一定的疗效。而高压氧治疗是许多急慢性疾病的首选治疗方法。已有基础和临床研究证实,高压氧治疗对糖尿病视网膜病变安全有效。因此,作为一种新疗法,高压氧疗法可能会为糖尿病视网膜病变的治疗带来更广泛的应用前景。     

糖尿病视网膜病变的基因治疗

糖尿病视网膜病变（diabetic retinopathy,DR）是糖尿病的主要并发症之一,大量的研究表明DR早期表现为视网膜神经细胞退化性改变,晚期出现新生血管及增殖膜,目前尚没有有效的治疗方法,严重危害患者视力。基因治疗为探索DR的治疗方法提供了新的手段,本文就目前DR的基因治疗研究现状和进展作一综述。     

视网膜微血管内皮细胞在糖尿病视网膜病变中的研究现状

糖尿病视网膜疾病是导致成年人失明的主要因素,是糖尿病的一种令人恐惧的并发症,高血糖被认为是促进其发展的主要原因。高血糖不断地破坏视网膜的微血管系统最终导致视网膜的许多代谢,结构和功能的紊乱。视网膜微血管内皮细胞在微脉管系统中形成树枝状供应视网膜神经,这些内皮细胞的解剖和生理符合重要视觉保护的营养需求[1]。一方面,内皮组织务必确保氧的供应和代谢活跃的视网膜营养供应;另一方面,内皮细胞有助于血-视网膜屏障将循环产生的毒素分子,白细胞促炎性物质排出体外来保护视网膜,这种特性也可能会引起疾病,比如:视网膜血管的渗漏和新生血管,炎性物质转移,因此,视网膜内皮细胞在视网膜缺血性病变,血管炎中起到重要作用,包括糖尿病视网膜病变和视网膜炎症或感染尤其是后葡萄膜炎。使用基因表达和蛋白质组学分析等研究方法,有助于了解这些疾病的发病机制。为了进一步开展对糖尿病视网膜疾病的研究,有必要就目前有关糖尿病视网膜病变患者微血管内皮细胞的研究进展予以综述,旨在为糖尿病视网膜病变的深入研究提供参考依据。     

2型糖尿病性视网膜病变临床因素分析

目的:探讨影响2型糖尿病视网膜病变(DR)发病的相关临床因素。方法:回顾性分析483例2型糖尿病患者的临床资料。结果:2型糖尿痛DR患病率为35%(169/483),其中非增殖型视网膜病变(NPDR)73.4%(124/169),增殖型视网膜病变(PDR)26.6% (45/169)。DR患者的病程、SBP、合并肾脏病变、合并心脏病变、HbA1c、TC、TG、LDL-c、BUN和Cr均显著高于NDR患者(P<0.05);Logistic回归分析显示病程、年龄、SBP、TC、LDL-c、合并心脏病变和/或肾脏病变是DR发病的危险因素。结论:DM病程、患病年龄、SBP、HbA1c、TC、LDL-c、合并心脏病变和/或肾脏病变、肾功能是DR发生发展的危险因素。     

延长糖尿病模型大鼠生存期对糖尿病视网膜病变的影响

目的延长糖尿病模型大鼠生存期,动态观察糖尿病视网膜病变(DR)的形成和发展过程。方法雄性SD大鼠70只,随机分成对照组(20只)和模型组(50只),采用链脲佐菌素(STZ)60 mg/(kg.bw)体重腹腔1次注射造模,分别于69、、12月时处死取眼球,采用视网膜微血管消化铺片技术观察糖尿病视网膜病变的微血管形态学改变。结果糖尿病大鼠DR样病变随着病程的延长病变呈多样性改变,以12月DR出现的小动脉硬化尤为严重。结论糖尿病大鼠生存期的延长对糖尿病视网膜病变的研究有着积极的意义。     

红参粉末治疗糖尿病视网膜病变的临床观察

目的：观察红参粉末治疗糖尿病视网膜病变的临床效果。方法：随机选取2012年1月至2012年12月在我院接受治疗的2型糖尿病合并糖尿病视网膜病变（Diabetic Retinopathy,DR）患者103例。其中30例（57眼）仅采用常规方法治疗,即对照组;其余73例（125眼）在常规治疗的基础上加用红参粉末,即观察组。治疗180天后,观察并比较两组患者的视力、眼底镜、荧光血管造影等检查结果的变化情况。结果：在观察组中,患者经红参粉末治疗后的视力与治疗前相比有所提高,差异具有统计学意义（P〈0．05）;而对照组中,患者治疗前后的视力变化无统计学意义（P〉0．05）;观察组治疗有效率为76．7％,而对照组治疗有效率为46．7％,差异有显著意义（P〈0．05）。观察组中,男性DR患者治疗有效率为68．8％、女性为92．0％;早期DR治疗有效率为85．4％、晚期为65．1％;糖尿病病程不超过10年的DR患者治疗有效率为88．9％、超过10年的为64．9％,差异均具有统计学意义（P〈0．05）。结论：尽早的发现和及时的治疗可减少糖尿病患者视网膜病变的发生率,从而避免因视网膜病变而引起的严重的视力下降,甚至失明。红参粉末治疗糖尿病视网膜病变有显著的临床效果,特别是对早期糖尿病视网膜病变的疗效更佳,值得临床推广。     

糖尿病性视网膜病变早期mfERG的研究

目的:探讨糖尿病患者糖尿病性视网膜病变早期多焦视网膜电图(multifocal electroretinogram,mfERG)的特点。方法:应用德国ROLAND公司RETIscan系统对24例40眼糖尿病患者,同时对27例40眼正常对照眼记录mfERG。按机器的默认值一阶反应进行记录。整个记录过程中可以分为12个时段,每个时段记录为时间47秒。结果:mERG测得的糖尿病患者组1～5环所在位置的P1波的振幅密度随离心度的增加而降低,P1波和N1波幅值降低和潜伏时延迟。各象限的P1、N1波振幅密度、波幅值降低,潜伏时延迟。结论:糖尿病性视网膜病变受累的区域多发生在黄斑部,功能上的改变早于形态学的变化;病变的早期功能改变最先出现于视网膜的后极偏颞上方;糖尿病患者在未出现眼底改变时各个象限视网膜的外层已经严重受累。     

基于主成分分析的随机森林视网膜OCT图像分层算法研究

视网膜是层状结构,临床上可以根据视网膜层厚度改变对一些疾病进行预测和诊断.为了快速且准确地分割出视网膜的不同层带,本论文提出一种基于主成分分析的随机森林视网膜光学相干断层扫描技术(optical coherence tomography,OCT)图像分层算法.该方法使用主成分分析(principal component analysis,PCA)法对随机森林采集到的特征进行重采样,保留重采样后权重大的特征信息维度,从而消除特征维度间的关联性和信息冗余.结果表明,总特征维度在29维的情况下,保留前18维度训练速度提高了23.20%,14维度训练速度提高了42.38%,而对图像分割精度方面影响较小,实验表明该方法有效地提高了算法的效率.     

An automated framework to quantify areas of regional ischemia in retinal vascular diseases with OCT angiography

In this observational and cross‐sectional study, capillary nonperfusion (CNP) and vascular changes in branch retinal vein occlusion (BRVO, sample size [n] = 26) and choroidal neovascularization (CNV, n = 29) were evaluated. Subjects underwent imaging using Optical coherence tomography angiography (Angiovue OCTA, RTVue XR, Optovue Inc., Fremont, California). Local fractal analysis was applied to the OCTA images of superficial, deep and choriocapillaris layer. CNP area (BRVO eyes) and vascular parameters were computed using local fractal‐based method. Sensitivity and specificity of vascular parameters were assessed with receiver operating characteristics curve. Automated CNP area showed excellent agreement with manually quantified CNP areas in both superficial (intraclass coefficient [ICC] = 0.96) and deep (ICC = 0.96) layers. BRVO eyes showed significantly altered (P < .05) vascular parameters in both superficial and deep layer as compared to normal eyes (n = 30). CNVM eyes had significantly higher capillary free zones (P < .001) as compared to normal eyes. In normal vs BRVO eyes, vessel density and spacing between the large vessels had similar area under the curve (AUC) (P > .05) in both superficial (0.97 and 0.97, respectively) and deep layer (0.99 and 0.98, respectively). Further, capillary free zones showed high AUC (0.92) in differentiating CNV eyes from normal eyes.      

采用OCT系统对组织光学通透的研究

组织通透方法采用高折射率化学试剂对生物组织进行渗透,改变组织的光学均匀性,可以有效地改善光学成像的穿透深度,受到生物医学光学研究领域的重视。利用光学相干层析成像技术,测量通透过程中不同测量深度下组织的散射特征的变化。通过采用系统信号对数的梯度值近似地表征光学散射系数,研究了通透过程中组织的散射特征随渗透时间和测量深度的动态关系。实验证明了组织通透可以有效地增加光子的穿透深度,并改善成像质量。研究发现:不同测量深度处组织的散射系数及其变化幅度、变化过程和变化趋势等均存在一定的差异性,并与组织的微观结构、其通透效果,化学试剂在组织中的渗透行为等有密切关系,有助于组织通透过程的理解,并为组织通透机制提供可能的实验依据。     

Vascular changes precede tomographic changes in diabetic eyes without retinopathy and improve artificial intelligence diagnostics

The purpose of this study was to evaluate early vascular and tomographic changes in the retina of diabetic patients using artificial intelligence (AI). The study included 74 age‐matched normal eyes, 171 diabetic eyes without retinopathy (DWR) eyes and 69 mild non‐proliferative diabetic retinopathy (NPDR) eyes. All patients underwent optical coherence tomography angiography (OCTA) imaging. Tomographic features (thickness and volume) were derived from the OCTA B‐scans. These features were used in AI models. Both OCT and OCTA features showed significant differences between the groups (P < .05). However, the OCTA features indicated early retinal changes in DWR eyes better than OCT (P < .05). In the AI model using both OCT and OCTA features simultaneously, the best area under the curve of 0.91 ± 0.02 was obtained (P < .05). Thus, the combined use of AI, OCT and OCTA significantly improved the early diagnosis of diabetic changes in the retina.     

川芎嗪联合前列地尔治疗背景性糖尿病视网膜病变疗效的临床观察

目的:探讨川芎嗪(Ligustrazine)联合前列地尔(Alprostadil)治疗背景性糖尿病视网膜病变(Diabetic retinopathy,DR)的作用与疗效。方法:收集近年我院糖尿病伴背景性DR共73例(112只眼),分别按治疗中应用川芎嗪联合前列地尔或拜阿司匹林分为治疗组与对照组,比较两组治疗前后患者眼底病变改善情况。结果:川芎嗪联合前列地尔的治疗组疗效比拜阿司匹林的对照组好;眼底荧光检查表明,治疗组眼底病变改善明显好于对照组,差异显著(P<0.05)。结论:川芎嗪联合前列地尔对DR有较好的疗效。     

OCT imaging of rod mitochondrial respiration in vivo

There remains a need for high spatial resolution imaging indices of mitochondrial respiration in the outer retina that probe normal physiology and measure pathogenic and reversible conditions underlying loss of vision. Mitochondria are involved in a critical, but somewhat underappreciated, support system that maintains the health of the outer retina involving stimulus-evoked changes in subretinal space hydration. The subretinal space hydration light–dark response is important because it controls the distribution of vision-critical interphotoreceptor matrix components, including anti-oxidants, pro-survival factors, ions, and metabolites. The underlying signaling pathway controlling subretinal space water management has been worked out over the past 30 years and involves cGMP/mitochondria respiration/pH/RPE water efflux. This signaling pathway has also been shown to be modified by disease-generating conditions, such as hypoxia or oxidative stress. Here, we review recent advances in MRI and commercially available OCT technologies that can measure stimulus-evoked changes in subretinal space water content based on changes in the external limiting membrane-retinal pigment epithelium region. Each step within the above signaling pathway can also be interrogated with FDA-approved pharmaceuticals. A highlight of these studies is the demonstration of first-in-kind in vivo imaging of mitochondria respiration of any cell in the body. Future examinations of subretinal space hydration are expected to be useful for diagnosing threats to sight in aging and disease, and improving the success rate when translating treatments from bench-to-bedside.     

Measurement of Myopia and Normal Human Choroidal Thickness Using Spectral Domain Optical Coherence Tomography

Myopia is a common ophthalmic deficiency. The structure and function of choroid layer is assumed to be associated with myopia. In this study, a laboratory developed spectral domain optical coherence tomography scanning system is used to image human eyes. The axial resolution of the system is about 7 μm, and the acquisition rate is 100 kHz. Firstly, a cross-sectional image was acquired by averaging 100 images from imaging posterior segment of each eye. The choroid thickness was measured by 11 discrete points. The average thickness of normal human eyes was (0.296 ± 0.126) mm, whereas the average choroid thickness of myopic eyes was (0.220 ± 0.095) mm. Afterwards, the T test is used to calculate the data statistically. The analysis of the final result is based on the average thickness measured and the thickness of each measuring point. There was a significant difference in choroid thickness between myopia and normal eyes (P value < 0.01), which indicates that the choroid thickness of myopia was significantly thinner than that of normal eyes. Besides, there are findings that the choroidal thickness in nasal side is thinner than that in the fovea and temporal side in each eye. The choroidal thickness on temporal side in myopia eye has the most significant difference comparing with that in normal eye. The comprehensive evaluation of myopia and normal choroidal thickness using spectral domain optical coherence tomography may provide an important reference for the development of medical methods for diagnosis and treatment of myopia.     

A feasibility study of OCT for anatomical and vascular phenotyping of mouse embryo

The embryo phenotyping of genetic murine model is invaluable when investigating functions of genes underlying embryonic development and birth defect. Although traditional imaging technologies such as ultrasound are very useful for evaluating phenotype of murine embryos, the use of advanced techniques for phenotyping is desirable to obtain more information from genetic research. This letter tests the feasibility of optical coherence tomography (OCT) as a high‐throughput phenotyping tool for murine embryos. Three‐dimensional OCT imaging is performed for live and cleared mouse embryos in the late developmental stage (embryonic day 17.5). By using a dynamic focusing method and OCT angiography (OCTA) approach, our OCT imaging of the embryo exhibits rapid and clean visualization of organ structures deeper than 5 mm and complex microvasculature of perfused blood vessels in the murine embryonic body. This demonstration suggests that OCT imaging can be useful for comprehensively assessing embryo anatomy and angiography of genetically engineered mice.     

早期胚胎全场OCT图像的边界去模糊研究

全场光学相干层析成像技术(全场OCT)是研究早期胚胎形态发育的最理想成像设备,然而所采集图像难免受噪声干扰.这些噪声可模糊早期胚胎内不同组织结构的边界,从而给基于图像边界的结构划分带来干扰.为解决这一问题,本文运用中值滤波、维纳滤波、各向异性扩散算法处理全场OCT获得的早期胚胎图像,并运用信噪比、均方误差、峰值信噪比和边缘保留等指标评价图像处理效果.结果表明:经各向异性扩散算法处理的早期胚胎图像,可完整地保留原始图像信息,且边界最清晰,视觉效果最好.     

A Multi-Branch Convolutional Neural Network for Screening and Staging of Diabetic Retinopathy Based on Wide-Field Optical Coherence Tomography Angiography

BackgroundDiabetic retinopathy (DR) is one of the major causes of blindness in adults suffering from diabetes. With the development of wide-field optical coherence tomography angiography (WF-OCTA), it is to become a gold standard for diagnosing DR. The demand for automated DR diagnosis system based on OCTA images have been fostered due to large diabetic population and pervasiveness of retinopathy cases.Materials and methodsIn this study, 288 diabetic patients and 97 healthy people were imaged by the swept-source optical coherence tomography (SS-OCT) with 12 mm × 12 mm single scan centered on the fovea. A multi-branch convolutional neural network (CNN) was proposed to classify WF-OCTA images into four grades: no DR, mild non-proliferative diabetic retinopathy (NPDR), moderate to severe NPDR, and proliferative diabetic retinopathy (PDR).ResultsThe proposed model achieved a classification accuracy of 96.11%, sensitivity of 98.08% and specificity of 89.43% in detecting DR. The accuracy of the model for DR staging is 90.56%, which is higher than that of other mainstream convolution neural network models.ConclusionThis technology enables early diagnosis and objective tracking of disease progression, which may be useful for optimal treatment to reduce vision loss.