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Register a new userCorneal Pachymetry by AS-OCT after Descemets Membrane Endothelial Keratoplasty
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Corneal thickness (pachymetry) maps can be used to monitor restoration of corneal endothelial function, for example after Descemets membrane endothelial keratoplasty (DMEK). Automated delineation of the corneal interfaces in anterior segment optical coherence tomography (AS-OCT) can be challenging for corneas that are irregularly shaped due to pathology, or as a consequence of surgery, leading to incorrect thickness measurements. In this research, deep learning is used to automatically delineate the corneal interfaces and measure corneal thickness with high accuracy in post-DMEK AS-OCT B-scans. Three different deep learning strategies were developed based on 960 B-scans from 50 patients. On an independent test set of 320 B-scans, corneal thickness could be measured with an error of 13.98 to 15.50 micrometer for the central 9 mm range, which is less than 3% of the average corneal thickness. The accurate thickness measurements were used to construct detailed pachymetry maps. Moreover, follow-up scans could be registered based on anatomical landmarks to obtain differential pachymetry maps. These maps may enable a more comprehensive understanding of the restoration of the endothelial function after DMEK, where thickness often varies throughout different regions of the cornea, and subsequently contribute to a standardized postoperative regime.
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Purpose: We developed a method to automatically locate and quantify graft detachment after Descemets Membrane Endothelial Keratoplasty (DMEK) in Anterior Segment Optical Coherence Tomography (AS-OCT) scans. Methods: 1280 AS-OCT B-scans were annotated by a DMEK expert. Using the annotations, a deep learning pipeline was developed to localize scleral spur, center the AS-OCT B-scans and segment the detached graft sections. Detachment segmentation model performance was evaluated per B-scan by comparing (1) length of detachment and (2) horizontal projection of the detached sections with the expert annotations. Horizontal projections were used to construct graft detachment maps. All final evaluations were done on a test set that was set apart during training of the models. A second DMEK expert annotated the test set to determine inter-rater performance. Results: Mean scleral spur localization error was 0.155 mm, whereas the inter-rater difference was 0.090 mm. The estimated graft detachment lengths were in 69% of the cases within a 10-pixel (~150{mu}m) difference from the ground truth (77% for the second DMEK expert). Dice scores for the horizontal projections of all B-scans with detachments were 0.896 and 0.880 for our model and the second DMEK expert respectively. Conclusion: Our deep learning model can be used to automatically and instantly localize graft detachment in AS-OCT B-scans. Horizontal detachment projections can be determined with the same accuracy as a human DMEK expert, allowing for the construction of accurate graft detachment maps. Translational Relevance: Automated localization and quantification of graft detachment can support DMEK research and standardize clinical decision making.
Corneal endothelial cell segmentation plays a vital role inquantifying clinical indicators such as cell density, coefficient of variation,and hexagonality. However, the corneal endotheliums uneven reflectionand the subjects tremor and movement cause blurred cell edges in theimage, which is difficult to segment, and need more details and contextinformation to release this problem. Due to the limited receptive field oflocal convolution and continuous downsampling, the existing deep learn-ing segmentation methods cannot make full use of global context andmiss many details. This paper proposes a Multi-Branch hybrid Trans-former Network (MBT-Net) based on the transformer and body-edgebranch. Firstly, We use the convolutional block to focus on local tex-ture feature extraction and establish long-range dependencies over space,channel, and layer by the transformer and residual connection. Besides,We use the body-edge branch to promote local consistency and to provideedge position information. On the self-collected dataset TM-EM3000 andpublic Alisarine dataset, compared with other State-Of-The-Art (SOTA)methods, the proposed method achieves an improvement.
Purpose: This study aimed to investigate the actual changes of central corneal thickness (CCT) in keratoconus and normal corneas during air puff indentation, by using corneal visualization Scheimpflug technology (Corvis ST). Methods: A total of 32 keratoconic eyes and 46 normal eyes were included in this study. Three parameters of CCTinitial, CCTfinal and CCTpeak were selected to represent the CCT at initial time, final time and highest corneal concavity, respectively, during air puff indentation. Wilcoxon signed rank test (paired sample test) was used to assess the differences between these 3 parameters in both keratoconus and normal groups. Univariate linear regression analysis was performed to determine the effect of CCTinitial on CCTpeak and CCTfinal, as well as the impact of air puff force on CCT in each group. Receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative ability of the 3 parameters. Results: The results demonstrated that CCTpeak and CCTfinal were significantly decreased (p<0.01) compared to CCTinitial in both keratoconus and normal groups. Regression analysis indicated a significant positive correlation between CCTpeak and CCTinitial in normal cornea group (R2=0.337, p<0.01), but not in keratoconus group (R2=0.029, p=0.187). Likewise, regression models of air puff force and CCT revealed the different patterns of CCT changes between keratoconus and normal cornea groups. Furthermore, ROC curves showed that CCTpeak exhibited the greatest AUC (area under ROC curve) of 0.940, with accuracy, sensitivity and specificity of 94.9%, 87.5% and 100%, respectively. Conclusions: CCT may change during air puff indentation, and is significantly different between keratoconus and normal cornea groups. The changing pattern is useful for the diagnosis of keratoconus, and lays the foundation for corneal biomechanics.
In OCT angiography (OCTA), decorrelation computation has been widely used as a local motion index to identify dynamic flow from static tissues, but its dependence on SNR severely degrades the vascular visibility, particularly in low- SNR regions. To mathematically characterize the decorrelation-SNR dependence of OCT signals, we developed a multi-variate time series (MVTS) model. Based on the model, we derived a universal asymptotic linear relation of decorrelation to inverse SNR (iSNR), with the variance in static and noise regions determined by the average kernel size. Accordingly, with the population distribution of static and noise voxels being explicitly calculated in the iSNR and decorrelation (ID) space, a linear classifier is developed by removing static and noise voxels at all SNR, to generate a SNR-adaptive OCTA, termed as ID-OCTA. Then, flow phantom and human skin experiments were performed to validate the proposed ID-OCTA. Both qualitative and quantitative assessments demonstrated that ID-OCTA offers a superior visibility of blood vessels, particularly in the deep layer. Finally, implications of this work on both system design and hemodynamic quantification are further discussed.
Transcranial static magnetic stimulation is a novel noninvasive method of reduction of the cortical excitability in certain neurological diseases that, unlike ordinary transcranial magnetic stimulation, makes use of static magnetic fields generated by permanent magnets. The physical principle underlying transcranial magnetic stimulation is well known, that is, the Faradays law. By contrast, the physical mechanism that explains the interaction between neurons and static magnetic fields in transcranial static magnetic stimulation remains unclear, which makes it difficult to improve and fine tune the treatment. In the present work it is discussed the possibility that this mechanism might be the Lorentz force exerted on the ions flowing along the membrane channels of neurons. To support this hypothesis, a dimensional analysis it is carried out to compare the Larmor radius of the ions in the presence of a static magnetic field with the dimensions of the cross section of human axons and membrane channels in neurons. This analysis shows that whereas a moderate static magnetic field is not expected to affect the ion flux through axons, nevertheless it can affect the ion flux along membrane channels. The overall effect of the static magnetic field would be to introduce an additional friction between the ions and the walls of the membrane channels, thus reducing its conductance. Calculations performed by using a Hodgkin-Huxley model demonstrate that even a slight reduction of the conductance of the membrane channels can lead to the suppression of the action potential, thus inhibiting neuronal activity.
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