PURPOSE: To describe clinical features, management, and outcomes of anterior segment-dominated persistent fetal vasculature (aPFV). DESIGN: A secondary analysis of aPFV data from a longitudinal cohort study. METHODS: The age and gender of each participant upon initial presentation, along with biological parameters, best-corrected visual acuity, and biomicroscopic assessments were collected. The aPFV eyes were categorized into 3 groups (type I: pupillary-iris-anterior lens plane, type II: retrolental-anterior hyaloid membrane plane, and type III: combined) according to the location of the vascular abnormalities and further classified into mild (a) and severe (b) according to the degree of severity. The surgical techniques used in this investigation were reported. Visual outcomes, ocular hypertension, postoperative adverse events, and additional surgical interventions were recorded at each follow-up visit. RESULTS: A total of 470 individuals (619 eyes) were enrolled (ages 36.7 +/- 45.4 months, range 1-193 months), divided into 129 eyes (20.8%) Type I, 420 eyes (67.9%) Type II, and 70 eyes (11.3%) Type III. Cataracts were identified in 505 eyes (81.6%): for type I, the common forms were nuclear and membranous opacity (both 12/50 eyes, 24%); type II: subcapsular opacity (214/399 eyes, 53.6%) and type III: complete cortex (17/56 eyes, 30.4%). Posterior capsular tear was mostly present in type IIa. Type III had the shallowest anterior chamber depth and the largest corneal astigmatism. Six hundred patients (96.9%) had surgery. After surgery, 119 eyes experienced adverse events: intravitreal hemorrhages occurred in 0.2% of eyes, visual axis obscuration occurred in 9.4% of eyes, and ocular hypertension which required eye drop medication occurred in 19.2% of eyes. In 47 patients (7.6%), a second surgery procedure was done. In 456 eyes (73.7%), visual acuity had improved at the last follow-up. The worst best-corrected visual acuity was associated with types IIb and IIIb. CONCLUSIONS: The magnitude of aPFV can be usefully characterized by a classification protocol focusing on the location and disease severity. Here, we propose a surgical and medical management algorithm for aPFV to achieve favorable outcomes with limited intraoperative and postoperative complications.

BackgroundThis study aimed to explore the postoperative myopic shift and its relationship to visual acuity rehabilitation in patients with bilateral congenital cataracts (CCs).MethodsBilateral CC patients who underwent cataract extraction and primary intraocular lens implantations before 6 years old were included and divided into five groups according to surgical ages (<2, 2–3, 3–4, 4–5, and 5–6 years). The postoperative myopic shift rates, spherical equivalents (SEs), and the best corrected visual acuity (BCVA) were measured and analyzed.ResultsA total of 1,137 refractive measurements from 234 patients were included, with a mean follow-up period of 34 months. The postoperative mean SEs at each follow-up in the five groups were linearly fitted with a mean R2 = 0.93 ± 0.03, which showed a downtrend of SE with age (linear regression). Among patients with a follow-up of 4 years, the mean postoperative myopic shift rate was 0.84, 0.81, 0.68, 0.24, and 0.28 diopters per year (D/y) in the five age groups (from young to old), respectively. The BCVA of those with a surgical age of <2 years at the 4-year visit was 0.26 (LogMAR), and the mean postoperative myopic shift rate was 0.84 D/y. For patients with a surgical age of 2–6 years, a poorer BCVA at the 4-year visit was found in those with higher postoperative myopic shift rates (r = 0.974, p = 0.026, Pearson’s correlation test).ConclusionPerforming cataract surgery for patients before 2 years old and decreasing the postoperative myopic shift rates for those with a surgical age of 2–6 years may benefit visual acuity rehabilitation.

Purpose: To characterize the morphology of persistent pupillary membranes (PPMs) in pediatric patients and explore the corresponding surgical approaches. Setting: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Design: Prospective observational study. Methods: Consecutive pediatric patients with PPMs who underwent surgery from April 2020 to July 2022 were included. PPM morphology was assessed and categorized according to its anatomic relationship with crystalline lens and distribution of iris strands. The surgical approaches for different morphologies of PPMs were described in detail. The visual outcome and operation-related complications were recorded. Results: 31 eyes from 19 patients were included with the mean age of 7.2 years. 3 morphological variants of PPMs were observed: type I (51.6%, 16/31), a spider-like appearance and no adhesion to the anterior lens capsule (ALC); type II (38.7%, 12/31), a loose central adherence to the ALC and partially thick iris strands attached to the iris collarette; type III (9.7%, 3/31), a tight central adherence to the ALC and only silk-like iris strands. Surgeries were performed with a natural pupil size in type I, while dilated pupil in the other types. The adhesions between PPM and the ALC were separated by viscoelastic injection in type II and by discission needles in type III. The corrected distance visual acuity was significantly improved from 0.34 ± 0.18 logMAR preoperatively to 0.17 ± 0.09 logMAR postoperatively ( P < .001). No operation-related complications were observed during 9.5-month follow-up. Conclusions: PPMs were categorized into 3 types according to their different morphologies, which helped to determine the best surgical strategy.

AimsTo report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up.MethodsSecondary analysis of a prospective longitudinal cohort study. Bilateral CC patients who had undergone cataract surgery between January 2011 and December 2014 at Zhongshan Ophthalmic Centre were recruited. Suspected glaucoma was defined as persistent ocular hypertension requiring medical treatment. Definitive glaucoma was defined as accompanied by the progression of glaucomatous clinical features. According to postoperative lens status in 5 years follow-up: 130 eyes in the aphakia group; 219 in the primary intraocular lens (IOL) implantation group and 337 in the secondary IOL implantation group. The Kaplan-Meier survival and Cox regression analyses were used to explore the cumulative incidence and risk factors for suspected and definitive glaucoma.ResultsThree hundred fifty-one children (686 eyes) with bilateral CCs were enrolled in the study. The mean age at surgery was 1.82±2.08 years, and the mean follow-up duration was 6.26±0.97 years. Suspected and definitive glaucoma developed at a mean time of 2.84±1.75 years (range 0.02–7.33 years) postoperatively. The cumulative incidence of suspected and definitive glaucoma was 9.97% (35 of 351 patients), including 6.12% (42 eyes) for definitive glaucoma and 2.48% (17 eyes) for suspected glaucoma. Microcornea (HR 4.103, p<0.0001), CC family history (HR 3.285, p=0.001) and initial anterior vitrectomy (HR 2.365 p=0.036) were risk factors for suspected and definitive glaucoma. Gender, age at surgery, intraocular surgery frequency, length of follow-up and frequency of neodymium-doped yttrium aluminumaluminium garnet laser were non-statistically significant. Primary IOL implantation was a protective factor (HR 0.378, p=0.007).ConclusionsIdentifying suspected and definitive glaucoma after bilateral CC surgery can lower the risk of secondary blindness in children. Patients with related risk factors need to pay more attention and thus reach early intervention and treatment during clinical practice. Primary IOL implantation may be a potential protective factor, need more clinical trials to be verified.Trial registration numberNCT04342052.

BACKGROUND:The crystalline lens is a transparent structure of the eye to focus light on the retina. It becomes muddy, hard and dense with increasing age, which makes the crystalline lens gradually lose its function. We aim to develop a nuclear age predictor to reflect the degeneration of the crystalline lens nucleus. METHODS:First we trained and internally validated the nuclear age predictor with a deep-learning algorithm, using 12 904 anterior segment optical coherence tomography (AS-OCT) images from four diverse Asian and American cohorts: Zhongshan Ophthalmic Center with Machine0 (ZOM0), Tomey Corporation (TOMEY), University of California San Francisco and the Chinese University of Hong Kong. External testing was done on three independent datasets: Tokyo University (TU), ZOM1 and Shenzhen People's Hospital (SPH). We also demonstrate the possibility of detecting nuclear cataracts (NCs) from the nuclear age gap. FINDINGS:In the internal validation dataset, the nuclear age could be predicted with a mean absolute error (MAE) of 2.570 years (95% CI 1.886 to 2.863). Across the three external testing datasets, the algorithm achieved MAEs of 4.261 years (95% CI 3.391 to 5.094) in TU, 3.920 years (95% CI 3.332 to 4.637) in ZOM1-NonCata and 4.380 years (95% CI 3.730 to 5.061) in SPH-NonCata. The MAEs for NC eyes were 8.490 years (95% CI 7.219 to 9.766) in ZOM1-NC and 9.998 years (95% CI 5.673 to 14.642) in SPH-NC. The nuclear age gap outperformed both ophthalmologists in detecting NCs, with areas under the receiver operating characteristic curves of 0.853 years (95% CI 0.787 to 0.917) in ZOM1 and 0.909 years (95% CI 0.828 to 0.978) in SPH. INTERPRETATION:The nuclear age predictor shows good performance, validating the feasibility of using AS-OCT images as an effective screening tool for nucleus degeneration. Our work also demonstrates the potential use of the nuclear age gap to detect NCs.

PURPOSE:To explore the factors related to the diagnosis yield of syndromic congenital cataracts and describe the phenotype-genotype correlation in congenital cataract patients.DESIGN:Prospective cohort study.METHODS:Setting: the participants from underwent clinical examinations between 2021 and 2022. Facial and anterior eye segment photographs, pre- and postoperative ocular parameters, and medical and family histories were recorded. Bioinformatics analysis was performed using whole-exome sequencing data. Statistical and correlation analyses were performed using the basic characteristics, deep phenotype, and genotype data.PARTICIPANTS:115 patients with unrelated congenital cataract.INTERVENTIONS:performing clinical examinations, whole-exome sequencing, and bioinformatics analysis for all participants.MAIN OUTCOMES AND MEASURES:factors related to the genetic diagnosis yield of syndromic congenital cataracts.RESULTS:Bilaterally asymmetrical cataracts were identified to be associated with syndromic congenital cataracts. The overall genetic diagnostic yield in the cohort was 72.2%. In total, 34.8% of the probands were early diagnosed with various syndromes with the help of genetic information. A phenotype-genotype correlation was detected for some genes and deep phenotypes.CONCLUSIONS:We highlight the importance of screening syndromic diseases in the patients with asymmetrical congenital cataracts. Application of whole-exome sequencing helps provide early diagnosis and treatment for the patients with syndromic congenital cataracts. This study also achieved a high genetic diagnostic yield, expanded the genotypic spectrum, and found phenotype-genotype correlations. A comprehensive analysis of cataract symmetricity, family history, and deep phenotypes makes the genotype prediction of some congenital cataract patients possible.

Purpose: To present a surgical technique for reopening the capsular bag in pediatric aphakia. Setting: Zhongshan Ophthalmic Center, Guangzhou, China. Design: Case series study. Methods: Consecutive pediatric patients with bilateral aphakia requiring secondary intraocular lens (IOL) implantation between July 2021 and June 2022 were included. The diameter of the capsular proliferative membranous ring (PMR) and position of IOL implantation were documented. Various parameters of capsular bag opening during primary cataract removal and secondary surgery were also analyzed. Results: 48 eyes were included with a mean follow-up of 8.1 ± 4.4 months. Using the surgical technique developed in this study, the capsular bag was successfully reopened with in-the-bag (ITB) implantation in 43 eyes (89.6%). ITB implantation was accomplished in all eyes with an outer diameter of PMR ≤5.5 mm and in 3 of 8 eyes (37.5%) with an outer diameter of PMR >5.5 mm. A positive correlation was observed between the primary and secondary anterior capsular opening diameters (ACODs) ( r = 0.422, P = .007) and the primary and secondary posterior capsular opening diameters (PCODs) ( r = 0.619, P < .001). The inner diameter of PMR was found to be positively correlated with secondary PCOD ( r = 0.728, P < .001) and the outer diameter with secondary ACOD ( r = 0.669, P < .001). Conclusions: This was a safe and effective surgical technique for pediatric secondary IOL implantation with maximum preservation of the peripheral capsule. Aphakic eyes with an outer diameter of PMR ≤5.5 mm are preferred for secondary ITB implantation.

AIM:To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap".METHODS:"Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously.RESULTS:The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery.CONCLUSION:"Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

Purpose: To report the outcomes of a 120-degree goniotomy (GT) with or without secondary intraocular lens (IOL) implantation in glaucoma following cataract surgery (GFCS).Design: Prospective, observational study.Methods: Pediatric patients with GFCS who underwent standalone 120-degree GT or 120-degree GT combined with secondary IOL implantation (GT+IOL) from March 2022 to August 2022 at the Zhongshan Ophthalmic Center were recruited. Primary outcomes were intraocular pressure (IOP) and the number of ocular hypotensive medications. A secondary outcome was the surgical success rate. Success was defined as a postoperative IOP within the range of 5-21 mm Hg. Complete and qualified successes were defined, as the above, without and with ocular hypotensive medications, respectively.Results: Thirty-two eyes of 22 patients were included. The mean age at the time of GT was 68.5 +/- 29.3 months. The mean follow-up duration was 12.2 +/- 2.3 months (9-15 mo). Mean IOP decreased from 30.9 +/- 4.8 mm Hg on 2 (interquartile range = 1) medications at baseline to 15.8 +/- 3.6 mm Hg on 0 (interquartile range = 1.5) medication at the latest visit in all eyes. The overall complete and qualified success rates were 68.8% and 90.6%, respectively. There were no significant differences in IOP, number of medications, and complete and qualified success rates between the standalone GT and GT+IOL groups at the latest follow-up at 9 months postoperatively.Conclusions: To reduce the need for additional surgery, 120-degree GT was a safe and effective surgical treatment for GFCS in children, which could be combined with secondary IOL implantation in aphakic eyes with GFCS.

AIM: To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device (OVD). METHODS: Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane (PPM) removal surgery were presented and followed up. This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) exposure. Then, to provide the pathological basis for our speculation, another four cataract patients were randomly exposed to different OVDs, and their anterior lens capsules were investigated with transmission electron microscopy (TEM). RESULTS: After months, the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration. For the cataract patients, similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ (sodium hyaluronate gel 1.0%). In addition, marked ultrastructural changes, including chromatin condensation, extensive cytoplasmic vacuoles, and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc, were observed by TEM. CONCLUSION: The lens vacuolar changes may be associated with a dispersive OVD exposure. Therefore, it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction. In addition, close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.

Deep neural networks (DNNs) are vulnerable to adversarial attacks which can fool the classifiers by adding small perturbations to the original example. The added perturbations in most existing attacks are mainly determined by the gradient of the loss function with respect to the current example. In this paper, a new average gradient-based adversarial attack is proposed. In our proposed method, via utilizing the gradient of each iteration in the past, a dynamic set of adversarial examples is constructed first in each iteration. Then, according to the gradient of the loss function with respect to all the examples in the constructed dynamic set and the current adversarial example, the average gradient can be calculated, which is used to determine the added perturbations. Different from the existing adversarial attacks, the proposed average gradient-based attack optimizes the added perturbations through a dynamic set of adversarial examples, where the size of the dynamic set increases with the number of iterations. Our proposed method possesses good extensibility and can be integrated into most existing gradient-based attacks. Extensive experiments demonstrate that, compared with the state-of-the-art gradient-based adversarial attacks, the proposed attack can achieve higher attack success rates and exhibit better transferability, which is helpful to evaluate the robustness of the network and the effectiveness of the defense method.

Deep neural networks (DNNs) are vulnerable to adversarial examples obtained by adding small perturbations to original examples. The added perturbations in existing attacks are mainly determined by the gradient of the loss function with respect to the inputs. In this paper, the close relationship between gradient-based attacks and the numerical methods for solving ordinary differential equation (ODE) is studied for the first time. Inspired by the numerical solution of ODE, a new prediction-correction (PC) based adversarial attack is proposed. In our proposed PC-based attack, some existing attack can be selected to produce a predicted example first, and then the predicted example and the current example are combined together to determine the added perturbations. The proposed method possesses good extensibility and can be applied to all available gradient-based attacks easily. Extensive experiments demonstrate that compared with the state-of-the-art gradient-based adversarial attacks, our proposed PC-based attacks have higher attack success rates, and exhibit better transferability.

Corneal injury can lead to severe vision impairment or even blindness. Although numerous methods are developed to accelerate corneal wound healing, most of them are passive treatments that rarely participate in controlling endogenous cell behaviors or are incompatible with nontransparent bandage. In this work, a wireless-powered electrical bandage contact lens (EBCL) is developed to generate a localized external electric field to accelerate corneal wound healing and vision recovery. The wireless electrical stimulation circuit employed a flower-shaped layout design that can be compactly integrated on bandage contact lens without blocking the vision. The role of the external electric field in promoting corneal wound healing is examined in vitro, where the responses of directional migration and corneal cells alignment to the electric field are observed. The RNA sequencing (RNA-seq) analysis indicates that the electrical stimulation can participate in controlling cell division, proliferation, and migration. Furthermore, the wireless EBCL is demonstrated to accelerate the completed recovery of corneal wounds on rabbits' eyes by electrical stimulation, while the control group exhibits delayed recovery and obvious corneal defects. As a new generation of intelligent device, the wireless and patient-friendly EBCL can provide a promising therapeutic strategy for ocular diseases.

Nuclear cataract (NC) is a priority ocular disease of blindness and vision impairment globally. Early intervention and cataract surgery can improve the vision and life quality of NC patients. Anterior segment coherence tomography (AS-OCT) imaging is a non-invasive way to capture the NC opacity objectively and quantitatively. Recent clinical research has shown that there exists a strong opacity correlation relationship between NC severity levels and the mean density on AS-OCT images. In this paper, we present an effective NC classification framework on AS-OCT images, based on feature extraction and feature importance analysis. Motivated by previous clinical knowledge, our method extracts the clinical global–local features, and then applies Pearson’s correlation coefficient and recursive feature elimination methods to analyze the feature importance. Finally, an ensemble logistic regression is employed to distinguish NC, which considers different optimization methods’ characteristics. A dataset with 11,442 AS-OCT images is collected to evaluate the method. The results show that the proposed method achieves 86.96% accuracy and 88.70% macro-sensitivity, respectively. The performance comparison analysis also demonstrates that the global–local feature extraction method improves about 2% accuracy than the single region-based feature extraction method.

Background We aimed to evaluate the morphological characteristics of the subfoveal choroid and explore the possible association of these characteristics with best-corrected visual acuity (BCVA) in postoperative patients with unilateral congenital cataracts (CCs). Methods This was a cross-sectional study. Subfoveal choroidal structures were measured by spectral-domain optical coherence tomography with enhanced depth imaging (EDI-OCT). Several choroidal parameters, including subfoveal choroidal thickness (SFCT), total choroidal area (TCA), luminal area (LA), stromal area (SA) and choroidal vascularity index (CVI), were compared between pseudophakic and contralateral healthy eyes. Then, the choroidal parameters were compared between pseudophakic eyes with a poor BCVA (>0.3 logMAR) and those with a good BCVA (≤0.3 logMAR). The performance of the choroidal parameters in detecting a poor BCVA in pseudophakic eyes was evaluated by using the area under the receiver operating characteristic curve (AUC). A logistic regression model was used to assess the association between choroidal parameters and BCVA in postoperative patients with unilateral CCs. Results A total of 55 postoperative patients with unilateral CCs were included. The age was 6.67±2.64 years. Thinner SFCT and smaller TCA, LA, SA and CVI were observed in pseudophakic eyes than in contralateral healthy eyes. In addition, in pseudophakic eyes, those with a poor BCVA had a thinner SFCT and a smaller TCA, LA and SA than those with a good BCVA. TCA [AUC, 0.75; 95% confidence interval (CI), 0.62, 0.88], LA (AUC, 0.74; 0.61, 0.87) and SA (AUC, 0.74; 0.60, 0.87) showed acceptable discriminatory abilities on BCVA. Pseudophakic eyes with TCA ≤0.594 mm² [odds ratio (OR), 8.90; 95% CI: 1.99, 39.94; P=0.004], LA ≤0.402 mm² (OR 8.90; 95% CI: 1.99, 39.94; P=0.004) or SA ≤0.218 mm (OR, 6.53; 95% CI: 1.69, 25.27; P=0.007) were more likely to have a poor visual acuity. Conclusions The pseudophakic eyes in patients with unilateral CCs had thinner SFCT and smaller TCA, LA, SA and CVI than the contralateral healthy eyes. In pseudophakic eyes, smaller TCA, LA and SA values were associated with a poor visual acuity.

Cataract is the leading cause for visual impairment and blindness. Cataract screening can effectively improve the recovery rate of cataract, and the left and right eye classification is a significant step in cataract screening. Anterior segment optical coherence tomography (AS-OCT) is a non-contact, high-resolution ophthalmic imaging technique, which can quickly obtain pathological information of cataract and left and right eye position information through three-dimensional (3D) imaging. In order to improve the efficiency of cataract screening, we propose a multi-task three-dimensional convolutional neural network (MT-CNN) for automatic cataract detection and left and right eye classification simultaneously based on the 3D AS-OCT images. The MT-CNN is designed based on the hard sharing mechanism, achieving better performance with fewer parameters than single-task learning. The results on an AS-OCT image dataset show that the 3D CNN model obtains better classification performance than the 2D CNN model. Compared with the single-task 3D CNN model, MT-CNN achieves higher accuracy under the premise of greatly parameters reduction and computational complexity reduction.

Posterior capsular opacification (PCO) is the leading complication after cataract surgery, and is mainly induced by the proliferation and migration of residual lens epithelial cells (LECs). Although numerous attempts have been made to reduce the incidence of PCO, this complication remains a critical challenge in postoperative visual recovery. This study aims to report a functionalized intraocular lens (R-IOL) with a region-confined photothermal effect for the active prevention of PCO after implantation. The outer rim of R-IOL (non-optical area) is decorated with a nanoporous gold (NPG) ring, which can effectively eliminate the LECs around R-IOL, ultimately inhibiting the migration of LECs from the periphery to the visual axis center in the initial stage, and preventing the subsequent PCO. Furthermore, the mechanism of LECs elimination can be attributed to apoptosis induced by mild photothermal therapy. After in vivo implantation for 30 days, PCO is rarely observed in the R-IOL group, whereas the considerably higher incidence of PCO (75%) is found in the pristine IOL (P-IOL) group. The region-confined photothermal effect based on NPG not only provides an active strategy to effectively prevent PCO, but also introduces new opportunities for the treatment of undesirable hyperplasia.

目的 核性白内障是主要致盲和导致视觉损害的眼科疾病,早期干预和白内障手术可以有效改善患者的视力和生活质量.眼前节光学相干断层成像图像(anterior segment optical coherence tomography,AS-OCT)能够非接触、客观和快速地获取白内障混浊信息.临床研究已经发现在AS-OCT图像中核性白内障严重程度与核性区域像素特征,如均值存在强相关性和高可重复性.但目前基于AS-OCT图像的自动核性白内障分类工作较少且分类结果还有较大提升空间.为此,本文提出一种新颖的多区域融合注意力网络(multi-region fusion attention network,MRA-Net)对AS-OCT图像中的核性白内障严重程度进行精准分类.方法 在提出的多区域融合注意力模型中,本文设计了一个多区域融合注意力模块(multi-region fusion attention,MRA),对不同核性区域特征表示进行融合来增强分类结果;另外,本文验证了以人和眼为单位的AS-OCT图像数据集拆分方式对核性白内障分类结果的影响.结果 在一个自建的AS-OCT图像数据集上结果表明,本文模型的总体分类准确率为87.78％,比对比方法至少提高了1％.在10种分类算法上的结果表明:以眼为单位的AS-OCT数据集优于以人为单位的AS-OCT数据集的分类结果,F1和Kappa评价指标分别最大提升了4.03％和8％.结论 本文模型考虑了特征图不同区域特征分布的差异性,使核性白内障分类更加准确;不同数据集拆分方式的结果表明,考虑到同一个人两只眼的核性白内障严重程度相似,建议白内障的AS-OCT图像数据集拆分以人为单位.

Purpose:To compare the effects of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) on subfoveal choroidal thickness (SFCT) in patients with age-related cataracts.Methods:In this prospective consecutive study, 26 patients (26 eyes) with age-related cataracts without previous ocular surgery or other ocular diseases who had FLACS were included as the study group. Twenty-six age-matched patients (26 eyes) who underwent CPS in the same period were also included as the control group. The SFCT and the foveal retinal thickness (FRT) were measured at baseline and at 1 day (D1), 7 days (D7), 1 month (M1), and 3 months (M3) postoperatively by spectral-domain optical coherence tomography. Aqueous flare was also measured with a laser flare meter.Results:The mean SFCTs of the FLACS group at baseline and at D1, D7, M1, and M3 were 185.2, 174.3, 184.2, 180.8, and 184.1 μm, respectively. A Bonferroni posttest showed that the choroid became thinner on postoperative D1 (P = 0.006). The measurements at 1 week, 1 month, and 3 months postoperatively showed no significant differences in the SFCTs compared with that at baseline (P = 0.66, P = 0.22, and P = 0.53, respectively). A different trend was observed in the CPS group. The choroid became thicker by the 3-month postoperative measurement, as follows: 1 day (P = 0.28), 1 week (P = 0.016), 1 month (P = 0.020), and 3 months (P < 0.001).Conclusion:The mean SFCT significantly and temporarily decreased following FLACS. In contrast, an increased SFCT was observed following CPS.

白内障是一种主要导致视觉损伤的眼病.早期干预和白内障手术是改善患者视力和生活质量的主要手段.眼前节光学相干断层成像图像（anterior segment optical coherence tomography, AS-OCT）是一种新型眼科图像,其具有非接触、高分辨率、检查快速等特点.在临床上,眼科医生已经逐渐采用AS-OCT图像进行眼科疾病如青光眼的诊断,然而尚未有研究工作利用它进行皮质性白内障（cortical cataract, CC）自动分类.为此,提出了一个基于ASOCT图像的自动皮质性白内障分类框架,由图像预处理、特征提取、特征筛选和分类等4部分组成.首先,利用反光区域去除和对比度增强方法进行图像预处理;紧接着使用灰度共生矩阵（grey level co-occurrence matrix,GLCM）、灰度区域大小矩阵（grey level size zone matrix, GLSZM）和邻域灰度差矩阵（neighborhood grey tone difference matrix, NGTDM）方法从皮质区域提取了22个特征;然后,采用斯皮尔曼相关系数方法对提取的特征进行特征重要性分析并筛除冗余特征;最后利用线性支持向量机方法进行分类.在一个临床AS-OCT图像数据集上的实验结果表明,所提出的皮质性白内障分类框架准确率、召回率、精确率和F1分别达到86.04%, 86.18%,88.27%和86.35%,取得与先进的深度学习算法接近的性能,表明其具有作为辅助眼科医生进行皮质性白内障临床诊断工具的潜力.