To determine changes in choroidal structure by binarization of optical coherence tomographic (OCT) images.
Choroidal images were recorded by enhanced depth imaging OCT. The subfoveal choroidal images ...were analyzed, and the luminal and interstitial areas were converted to binary images by the Niblack method. The interrater, intrarater, and intersession agreements of the binary images were determined for healthy eyes. In eyes with age-related macular degeneration (AMD), the binary images of the choroid before photodynamic therapy (PDT) were compared to those after PDT. The untreated fellow eyes were studied as controls.
In healthy eyes, the average ratio of the luminal to choroidal area was 65.4%. The interrater agreement rate was high, with intraclass correlation coefficient (ICC) 0.985 and 0.988 for the choroid and luminal areas, respectively. The intrarater ICC was 0.996 for the choroid and 0.997 for the luminal areas. The intersession ICC was 0.993 for the choroid and 0.984 for the luminal areas. In eyes with AMD, the subfoveal choroidal area, the luminal area, and the interstitial areas were thinner 6 months after PDT (all P < 0.01, Wilcoxon signed-rank sum test). The ratio of the luminal to choroidal area was significantly decreased to 62.8% (P < 0.01, Wilcoxon signed-rank sum test). The ratio for the fellow eyes was not significantly changed.
The Niblack binarization method can be used to analyze the luminal area of choroid in an OCT image with good repeatability and reproducibility. The change in the subfoveal choroidal area after PDT is due mainly to a decrease in the luminal areas.
Purpose To determine the proportion of luminal and stromal areas of normal choroids in the optical coherence tomographic (OCT) images obtained by enhanced depth imaging (EDI)-OCT. Design A ...prospective, masked, observational cross-sectional study. Methods setting : This study was performed at the Kagoshima University Hospital, Japan. study population : One hundred and eighty right eyes of 180 healthy volunteers (106 women; mean age of 55.9 years) without ocular pathology. observational procedures : The EDI-OCT images of the posterior choroid 7500 μm from the optic disc in the horizontal plane were converted to binary images. The total cross-sectional choroidal area, luminal area, and stromal area of the choroid were measured. main outcome measures : Correlations between clinical factors and each choroidal structure and ratio of luminal/stromal areas were determined. The correlations of each choroidal structure and the age, sex, axial length (AL), and refractive errors were calculated. Results The mean total cross-sectional choroidal area was 1.84 mm2 (luminal area 1.21 mm2 and stromal area 0.63 mm2 ). Multivariate analysis (standardized partial regression coefficient) showed that age (−0.723, P < .001) was significantly correlated with the reduced area of the choroid, and the correlation was greater than that for the AL (−0.408, P < .001). The ratio of luminal/stromal area was significantly reduced in eyes with longer ALs (−0.531, P < .001), and the strength of the correlation was greater than that of age (−0.389, P < .001). Conclusions Although both the luminal and the stromal areas decrease with increasing age and with longer ALs, the degree of decrease and areas affected were not the same.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Purpose
To determine the relationship between the peripapillary choroidal thickness (ppCT) and the degree and distribution of the tessellation in the fundus of normal eyes.
Methods
This was a ...prospective, observational cross-sectional study of 118 right eyes of young healthy volunteers. The ppCT was measured from the optical coherence tomography (OCT) circle scans manually at eight sectors: the nasal, supranasal superior, supratemporal, temporal, infratemporal, inferior, and infranasal sectors. The subjective degree of the tessellation in the color fundus photographs (CFPs) was classified into three categories: non-tessellated (NT), weakly tessellated (WT), and strongly tessellated (ST) in same sectors. The objective degree of tessellation designated by the tessellation fundus index (TFI) which was calculated as TFI = (
R
−
G
)/(
R
+
G
+
B
) using the mean value of the red-green-blue intensities of the CFPs. The differences in the ppCT and TFI for the three tessellation groups were analyzed. The correlations between the TFI and the ppCT were also determined.
Results
The mean age of the subjects was 25.8 years and the mean axial length of the eye was 25.5 mm. The inter-rater agreement of the subjective classifications was high with a Fleiss kappa of 0.71. The ppCT was significantly thinner in eyes with higher degrees of tessellation (
P
< 0.05) in all sectors. The TFIs were significantly and negatively correlated with the ppCTs in all sectors (
r
= − 0.44 to − 0.24,
P
< 0.05) except the nasal and the supranasal sectors.
Conclusion
The degree of peripapillary tessellation is significantly correlated with the ppCT in young healthy eyes, and it has large individual and geographic variations.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objectives This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment. Background Owing to uncertainty of success of the procedure ...and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent. Methods Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥3). Results The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76). Conclusions This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To compare subfoveal choroidal thickness (SCT) measurements of three different commercially available spectral-domain optical coherence tomography instruments with healthy eyes of Japanese.
A ...prospective, cross-sectional study was performed at a single institution. SCT of the right eye of 43 normal subjects was measured using three different SD-OCTs: Heidelberg Spectralis-OCT (Spectralis), Cirrus HD-OCT (Cirrus), and Topcon 3D OCT-1000 Mark II (Topcon). Two separate measurements were performed for the same eye with a maximum by a single examiner. SCT was defined as the distance from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction. After manual segmentation, measurements were made using calipers equipped on each machine by masked raters. Intraclass, interrater, and intermachine agreements were assessed.
Forty-three subjects (mean age, 30.5 years) were enrolled. Of 43 eyes, the SCT of 39 eyes (90.7%) could be measured using each machine. Intraclass correlation coefficients (95% confidence intervals) were 0.976 (0.954-9.987), 0.958 (0.919-0.978), and 0.939 (0.895-0.971) with Spectralis, Cirrus, and Topcon, respectively. Interrater correlation coefficients (95% confident interval) were 0.944 (0.893 to 0.971), 0.956 (0.831 to 0.983), and 0.924 (0.825 to 0.964) with Spectralis, Cirrus, and Topcon, respectively. The average SCT was 272.6, 272.8, and 269.2 μm with Spectralis, Cirrus, and Topcon, respectively. The intermachine correlation coefficient was significantly high among the machines (P<0.001, Spearman), 0.97 (Spectralis-Cirrus), 0.96 (Cirrus-Topcon), and 0.98 (Topcon-Cirrus). Bland-Altman plot analysis showed no typical trend among the machines.
SCT measurements obtained with three different SD-OCTs were highly correlated and could be used interchangeably. (http://upload.umin.ac.jp number, UMIN000005287.).
Bleb leakage is a serious complication of glaucoma filtering surgery. This study describes the method and the results of a new repair method for ischemic bleb leaks. The subjects were consecutive ...eleven eyes of 11 patients with bleb leakage who underwent the bleb plication surgery. The bleb plication surgery consisted of two steps: 1) bleb needle redirection to float the conjunctiva away from the sclera as extensively as possible around the ischemic conjunctiva; and 2) multiple "O-shaped" sutures were applied between the non-ischemic conjunctiva just outside the ischemic conjunctiva and corneal limbus. The ischemic conjunctiva was not removed, but undermined beneath the advanced non-ischemic conjunctiva. This bleb plication method was repeated until the leakage was sealed. All patients were followed up for at least 6 months after final bleb plication. After final bleb plication, no recurrence of bleb leakage was observed. Moreover, ischemic changes were no longer observed in the advanced non-ischemic conjunctiva. Pre-operative and final intraocular pressure was 3.2 ± 4.1 and 11.9 ± 2.8 mmHg, respectively. This new repair method of bleb plication was safe and effective in sealing the leakage. The conjunctiva is not excised, and hence it does not run out.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
In a previous cross-sectional study, we reported that the sexes can be distinguished using known factors obtained from color fundus photography (CFP). However, it is not clear how sex differences in ...fundus parameters appear across the human lifespan. Therefore, we conducted a cohort study to investigate sex determination based on fundus parameters in elementary school students.
This prospective observational longitudinal study investigated 109 right eyes of elementary school students over 4 years (age, 8.5 to 11.5 years). From each CFP, the tessellation fundus index was calculated as red/red + green + blue (R/R+G+B) using the mean value of red-green-blue intensity in eight locations around the optic disc and macular region. Optic disc area, ovality ratio, papillomacular angle, and retinal vessel angles and distances were quantified according to the data in our previous report. Using 54 fundus parameters, sex was predicted by L2 regularized binomial logistic regression for each grade.
The right eyes of 53 boys and 56 girls were analyzed. The discrimination accuracy rate significantly increased with age: 56.3% at 8.5 years, 46.1% at 9.5 years, 65.5% at 10.5 years and 73.1% at 11.5 years.
The accuracy of sex discrimination by fundus photography improved during a 3-year cohort study of elementary school students.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We compared the subfoveal choroidal thickness (SFCT) measured on the images obtained by two spectral-domain optical coherence tomographic (SD-OCT) instruments and one swept-source OCT (SS-OCT) ...instrument.
A cross-sectional, prospective noninterventional study was done in which SFCT was measured in the images obtained by two SD-OCT instruments; Heidelberg Spectralis-OCT (Spectralis-SD-OCT) and Topcon 3D OCT-1000 Mark II (Topcon-SD-OCT). Images also were obtained with SS-OCT Atlantis DRI OCT-1 (DRI-SS-OCT). After manual segmentation, the measurements were made using the calipers embedded in each instrument. The intrarater, interrater, and intermachine agreements were assessed.
We studied 35 subjects. The intrarater correlation coefficient (95% confidence interval) was 0.994 (0.988-0.994) for Spectralis-SD-OCT, 0.996 (0.993-0.998) for Topcon-SD-OCT, and 0.997 (0.991-0.998) for DRI-SS-OCT (P < 0.001). The interrater correlation coefficient was 0.995 (0.991-0.998) for Spectralis-SD-OCT, 0.995 (0.990-0.998) for Topcon-SD-OCT, and 0.996 (0.992-0.998) for DRI-SS-OCT (P < 0.001). The average SFCT was 273.2 μm with Spectralis-SD-OCT, 269.1 μm with the Topcon-SD-OCT, and 280.5 μm with DRI-SS-OCT. The intermachine correlation coefficient was 0.982 (0.964-0.991) for Spectralis-SD-OCT versus Topcon-SD-OCT, 0.907 (0.815-0.953) for Topcon-SD-OCT versus DRI-SS-OCT, and 0.911 (0.832-0.954) for DRI-SS-OCT versus Spectralis-SD-OCT (P < 0.001). The SFCT measured with DRI-SS-OCT was significantly thicker than that with Topcon-SD-OCT, with a mean difference of 11.41 ± 30.27 μm (P = 0.032).
In normal adult eyes, there was good reproducibility and repeatability of SFCT measurements obtained by the SD-OCT and SS-OCT instruments. However, the choroid measured with DRI-SS-OCT was thicker than that measured with both SD-OCT instruments, and, thus, the choroidal thickness should not be compared between the SD-OCT and SS-OCT instruments. (www.umin.ac.jp/ctr number, UMIN000011259.).
The purpose of this study was to compare the incidences of macular irregularities of elementary school (ES) and junior high school (JHS) students. This was a prospective cross-sectional observational ...study of 122 right eyes of 122 ES students (8-9 years) and 173 right eyes of 173 JHS students (12-13 years). Vertical cross-sectional images of the macula were obtained by optical coherence tomography. The eyes were classified based on the vertical symmetry of the posterior pole, and then sub-classified as convex-, flat-, concave-, or dome-shaped based on the direction of the curvature of the retinal pigment epithelium. One hundred and two eyes (83.6%) were placed in the symmetrical group in the ES students and 149 eyes (86.1%) in the JHS students. Twenty eyes (16.4%) were placed in the asymmetric groups in the ES students and 24 eyes (13.9%) in the JHS students. In symmetrical group, 78 and 118 eyes had a convex-shape (76.4 and 79.2%), followed by 22 and 29 eyes of dome-shaped group (21.6 and 19.4%) in ES and JHS students respectively. Because the incidences of the posterior pole shapes were not significantly different between the groups, it is likely that the macular irregularities develop before the age of ES.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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