Thesis (Ph. D.)--Duke University, 2008. / Includes bibliographical references.

Optical Coherence Tomography (OCT) is a catheter‐based imaging method that employs near‐infrared light to produce high‐resolution cross sectional intravascular images. Α new segmentation technique is implemented for automatic lumen area extraction and stent strut detection in intravascular OCT images for the purpose of quantitative analysis of neointimal hyperplasia (NIH). Also a graphical user interface (GUI) is designed based on the employed algorithm. Methods: Four clinical dataset of frequency‐domain OCT scans of the human femoral artery were analysed. First, a segmentation method based on Fuzzy C Means (FCM) clustering and Wavelet Transform (WT) was applied towards inner luminal contour extraction. Subsequently, stent strut positions were detected by utilizing metrics derived from the local maxima of the wavelet transform into the FCM membership function. Results: The inner lumen contour and the position of stent strut were extracted with very high accuracy. Compared with manual segmentation by an expert physician, the automatic segmentation had an average overlap value of 0.917 ± 0.065 for all OCT images included in the study. Also the proposed method and all automatic segmentation algorithms utilised in this thesis such as k‐means, FCM, MRF – ICM and MRF – Metropolis were compared by means of mean distance difference in mm and processing time in sec with the physician’s manual assessments.. The strut detection procedure successfully identified 9.57 ± 0.5 struts for each OCT image. Conclusions: A new fast and robust automatic segmentation technique combining FCM and WT for lumen border extraction and strut detection in intravascular OCT images was designed and implemented. The proposed algorithm may be employed for automated quantitative morphological analysis of in‐stent neointimal hyperplasia. / Η τομογραφία οπτικής συνοχής (OCT) είναι μια απεικονιστική μέθοδος βασισμένη στον καθετηριασμό και χρησιμοποίει υπέρυθρο φως για να παράγει ένδo‐αγγειακές εικόνες – εγκάρσιας τομής με υψηλή ανάλυση. Σε αυτήν την διατριβή, μια νέα τεχνική τμηματοποίησης υλοποιήθηκε για την αυτόματη εξαγωγή της περιοχής του αυλού καθώς και για την ανίχνευση των «strut» στις ένδo‐ αγγειακές OCT εικόνες με σκοπό την ποσοτική ανάλυση της υπερπλασίας. Επίσης ένα εύκολο στην χρήση περιβάλλον γραφικών για καθημερινή κλινική χρήση σχεδιάστηκε με τον υλοποιημένο αλγόριθμο. Μέθοδοι: Τέσσερις OCT κλινικές εξετάσεις πεδίου‐συχνότητας της ανθρώπινης μηριαίας αρτηρίας αναλύθηκαν. H προτεινόμενη μέθοδος τμηματοποίησης για την εξαγωγή του εσωτερικού περιγράμματος αυλού, είναι βασισμένη στον Fuzzy CMeans (FCM) clustering και τον μετασχηματισμό κυματιδίου. Στη συνέχεια, οι θέσεις των «strut» εντοπίστηκαν χρησιμοποιώντας διάφορες τοπικές παραμέτρους που προέρχονται από τα τοπικά μέγιστα του μετασχηματισμού κυματιδίων εντός της FCM συνάρτησης. Αποτελέσματα: Το εσωτερικό περίγραμμα αυλού και η θέση των «strut» εξήχθηκαν με πολύ μεγάλη ακρίβεια. Σε σύγκριση με την ποσοτική αξιολόγηση από έναν ειδικό ιατρό, η αυτόματη τμηματοποίηση είχε μέση τιμή επικάλυψης 0,917±0,065 για όλες τις OCT εικόνες που περιλαμβάνονται στη μελέτη. Επίσης, έγινε σύγκριση με τους k‐means, FCM, ICM και Μetropolis αυτόματους αλγόριθμους τμηματοποίησης για εξαγωγή του εσωτερικού περιγράμματος αυλού και επέδειξε υψηλής ακρίβειας αποτελέσματα στον μικρότερο δυνατό χρόνο επεξεργασίας. Η διαδικασία ανίχνευσης «strut» προσδιόρισε επιτυχώς 9.57± 0,5 «strut» για κάθε OCT εικόνα. Συμπεράσματα: Μια νέα αποτελεσματική και γρήγορη αυτόματη τεχνική τμηματοποίησης που συνδυάζει FCM και WT για την εξαγωγή των ορίων του αυλού και την ανίχνευση των «strut» στις ένδο‐αγγειακές εικόνες OCT σχεδιάστηκε και υλοποιήθηκε. Ο προτεινόμενος αλγόριθμος μπορεί να χρησιμοποιηθεί για την αυτοματοποιημένη ποσοτική μορφολογική ανάλυση της υπερπλασίας.

Basic science and early clinical trial evidence suggest the safe diuretic drug amiloride, may exert a neuroprotective effect in multiple sclerosis (MS) through blockade of the acid sensing ion channel. Neuroprotective treatments are a key unmet need in multiple sclerosis. Optic neuritis (ON) is a discrete CNS inflammatory event leading to neuro-axonal injury in the optic nerve and retina. The optic nerve is part of the visual system, one of the most functionally and structurally eloquent systems in the central nervous system, which affords a number of unique modalities to assess neurodegeneration and neuroprotection. The visual system can be classified into two parts, the anterior and posterior visual systems, which are defined by the lateral geniculate nucleus, where the two components synapse. The extent of neurodegeneration following ON in the anterior visual system can be imaged in vivo through scanning laser polarimetry (GDx) and optical coherence tomography (OCT). The posterior visual system can be imaged by quantitative and functional magnetic resonance imaging (MRI) of the brain, giving insights into white matter structural integrity and cortical plasticity over time. Combining these modalities in a longitudinal study, allows assessment of the impact of neurodegeneration in the anterior visual system on neurodegeneration downstream in the posterior visual system and on changes in functional connectivity over time in the visual cortex. Furthermore, in the clinical trial setting the neuroprotective effect of any intervention both on direct anterior neurodegeneration and downstream processes can be assessed. The functional relevance of changes in all of these biomarkers can be tested through a number of visual measures, including low contrast visual acuity. In MS, the contribution of transsynaptic neurodegeneration to the global neuronal loss experienced by patients is an area of incomplete understanding. In addition, the role of the visual cortex, through neuroplasticity, in aiding visual recovery from optic neuritis, is unclear. To address these issues, this thesis reports the results of the first clinical trial of amiloride in ON, and shows that despite the pre- and early clinical evidence of neuroprotection of amiloride, no neuroprotective benefit was found. It goes on to explore reasons for this lack of effect including the finding of early retinal neurodegeneration in ON, and the need for early recruitment windows in the future. From there, it makes a detailed assessment of the longitudinal changes in retinal OCT for 12 months following ON, including a novel finding of the temporal evolution of inner nuclear layer swelling, previously reported only cross-sectionally. Next, for the first time macular retinal neurodegeneration is shown to influence diffusion tensor MRI derived measures of white matter integrity in the optic radiations, indicating transsynaptic neurodegeneration. Finally, longitudinal changes in resting state functional connectivity following ON are found in the visual system for the first time. The interaction between this cortical functional, retinal neurodegeneration and visual recovery is probed.

The utilisation of near-infrared Raman spectroscopy for the discrimination of cancers and pre-cancers from normal tissue in the acro-digestive tract has been evaluated. A commercially available Raman microspectrometer has been modified to provide optimum throughput, sensitivity and fluorescence suppression for epithelial tissue measurements. Laser excitation at 830nm was demonstrated to be optimum. High quality (SN ratio 15-20) NIR-Raman spectra have been acquired from oesophageal and laryngeal tissues in time scales under 30 seconds. Pathological groupings covering the full range of normal and neoplastic tissues in the organs of interest have been studied. Both fresh (snap frozen) and formalin fixed tissue samples were investigated, firstly to indicate whether tissue-types can be distinguished in vivo and secondly to demonstrate the use of Raman spectroscopy as a tool for classification in the pathology lab. Results using multivariate statistical techniques to distinguish between spectra from specimens exhibiting different tissue pathologies have been extremely promising. Cross-validation of the spectral predictive models has shown that three groups of larynx tissue can be separated with sensitivities and specificities of between 86 and 90% and 87 and 95% respectively. Oesophageal prediction models have demonstrated sensitivities and specificities of 84 to 97% and 93 to 98% respectively for a three-group consensus model and 73 to 100% and 92 to 100% for an eight-group consensus model. Epithelial tissues including stomach, tonsil, endometrium, bladder and prostate have been studied to identify further tissues where Raman spectroscopy may be employed for detection of disease. Spectra were similar to those obtained from oesophagus and larynx, although sufficiently different for distinct discriminant models to be required. This work has demonstrated the generic nature of Raman spectroscopy for the detection and classification of cancers and pre-cancerous lesions in many tissues. The evidence provided by this study indicates that utilisation of Raman spectroscopy for non-invasive detection and classification of disease is a distinct possibility. Potential difficulties in the transferability from in vitro to in vivo have been evaluated and no significant barriers have been observed. However, further in vivo probe development and optimisation will be required before 'optical biopsy' with Raman spectroscopy can become a reality.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-14T13:32:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertacao LUANA OSÓRIO FERNANDES.pdf: 1894600 bytes, checksum: 262777160a929e18e667f73cb8233ae7 (MD5) / Made available in DSpace on 2017-02-14T13:32:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertacao LUANA OSÓRIO FERNANDES.pdf: 1894600 bytes, checksum: 262777160a929e18e667f73cb8233ae7 (MD5) Previous issue date: 2015-02-11 / Este estudo avaliouo desempenho daTomografia de Coerência Ópticaem1325nmcomoum método não invasivopara medir a profundidadedo sulco gengivalde indivíduossaudáveisem comparação comsondasperiodontaistradicionais emumambiente clínico.Dois observadoresavaliaram aprofundidade dosulco gengivalde 445sitios emdentes anteriores, tanto superior einferior,de 23 indivíduos saudáveis, por meio de três ferramentas: sonda periodontal Carolinado Norte (NC), sonda computadorizadaFloridaProbe (FP)eTomografia por Coerência Óptica(OCT). Foi obtido oíndice de refraçãogengival,necessário para correção dos valores obtidos por OCT,a partir da análisede19 amostras provenientes de cirurgia periodontal. Para cada técnica, foiregistradoo grau de desconforto/dor, através da escala verbal de 4 pontos(VRS-4) e Escala Numérica da Dor (END), e o tempo com auxílio de cronômetro digital.As imagens de OCT mostraramestruturas anatômicasclinicamente relevantes do ponto de vista periodontalnaáreaavaliada.O valor médiocalculadopara o índicede refraçãoda gengivafoi de 1,41±0,06, dado utilizado para realizar a correção dos valores obtidos pelo OCT, através de regra de três simples.As imagens de OCT proporcionaram analisar o correspondente ao sulco gengivalhistológicocom valor médiode 0,86±0,27 milímetros.A sondaNCresultou em maiores valores de profundidade(1,43 ±0,56 milímetros), seguido pelaFP(1,25±0,58 milímetros) que proporcionou umamaior frequência dedesconforto edor.O tempo registrado para cada técnica foi maior para o OCT (19,61±8,98 minutos) decorrente do caráter laboratorial do equipamento, seguido da FP (2,44±1,04 minutos) e NC (1,77±0,40 minutos), ambas adaptadas para aplicação clínica.Diante dos resultados, pode-se concluir que o OCTéummétodo promissorparaa análise in vivodasaúde periodontal, permitindoo diagnósticoprecoce e preciso, de maneiranão invasiva, e que sua influência e interferênciasobre a avaliaçãoclínicaéinexistente, diferente dousodeumasonda periodontal.Porém, ainda se faz necessário a adaptação do equipamento para utilização na clinica odontológica. / This study evaluatedthe performance ofOpticalCoherenceTomographyin 1325nmas a noninvasivemethodto measure the depthof the gingival sulcusof healthysubjects compared totraditionalperiodontalprobesin a clinical setting.Twoobservers evaluatedthe depth of thegingival sulcusof 445sitesin anterior teeth, both top and bottomof 23individuals, using threetools: periodontal probeNorth Carolina (NC), electronic probeFloridaProbe (FP) and Optical CoherenceTomography(OCT). Was obtainedgingivalindex of refractionneeded tocorrect thevalues obtained byOCT,from the analysisof 19samples fromperiodontalsurgery. For eachtechnique,the degree of discomfort/painwas recordedbyverbal4-point scale(VRS-4) and NumericalPainScale (NPS), andtimeusing a digitalstopwatch.The OCTimages showedclinically relevantanatomical structures of theperiodontalviewpoint in thearea evaluated.Theaverage value calculated forthegumrefractive indexwas 1.41± 0.06, as used to perform thecorrection of values obtainedbyOCT,throughsimple rule of three.TheOCTimagesprovidedanalyze thehistologicalsulcuscorresponding toan average valueof 0.86±0.27 mm.The CNproberesulted in greaterdepth values(1.43± 0.56millimeters), followed by FP(1.25±0.58 mm) which gavea higher frequency ofdiscomfort and pain.Thetime recordedfor each techniquewas higher fortheOCT(19.61 ±8.98 minutes) due to thecharacter oflaboratoryequipment, followed by FP(2.44±1.04 minutes) andNC (1.77 ±0, 40 minutes), bothadaptedfor clinical application. With the results, we can concludethatOCTis apromising method forin vivoanalysisof periodontalhealth, enabling early and accurate diagnosis, noninvasively, andthat its influenceandinterferenceon clinical evaluationis lacking,differentthe use ofa periodontalprobe.However,the upgrading of equipmentis still neededfor usein the dentalclinic.

Este estudo teve como objetivo avaliar a adaptação marginal em restaurações classe II em dentina e esmalte dental utilizando um sistema adesivo universal de acordo com três técnicas diferentes de aplicação: Autocondicionante, condicionamento seletivo e condicionamento total, através do sistema de tomografia por coerência óptica (OCT), antes e após ao envelhecimento por termociclagem (TC). Preparos classe II foram confeccionados nas paredes mesial e distal, em 30 molares hígidos humanos, com término da cavidade em esmalte e em dentina. Todos os espécimenes foram restaurados (adesivo Single Bond Universal e resina composta Filtek Z350 XT) nas três técnicas de aplicação. Os dentes foram distribuídos aleatoriamente em três grupos (n=10), sendo um para cada técnica de aplicação adesiva: Grupo I: autocondicionante, Grupo II: condicionamento seletivo e Grupo III: condicionamento total; em seguida os grupos foram avaliados antes e depois a termociclagem pelo sistema de tomografia por coerência ótica. De posse dos corpos de prova devidamente restaurados, partimos para os procedimentos de termociclagem (1000 ciclos de 1 minuto com intervalo de 30 segundos) e a avaliação pelo sistema de Tomografia por Coerência Óptica. Em seguida, as amostras foram examinadas por meio de imagens geradas pelo OCT e os dados foram submetidos ao teste estatístico não-paramétricos de Kruskal-Wallis e Dunn (p<0.05). Foi observada diferença estatisticamente significante da adaptação marginal entre os grupos com término em esmalte (p= 0.0073); para os grupos com término em dentina, não foi observada diferença estatisticamente significante na adaptação marginal (p=0.2063). Conclui-se que o OCT foi, então, capaz de diagnosticar a microinfiltração marginal nas restaurações em cavidades classe II. Existe deterioração das margens e alteração de padrão de infiltração marginal com as diferentes técnicas adesivas dos preparos classe II restauradas com resina em esmalte. Atribui-se à termociclagem a falha de vedamento marginal observada nos espécimes após em esmalte. / This study aimed to evaluate the marginal adaptation of Class II restorations in enamel and dentin using a universal adhesive according to three different application techniques: self-etching, selective packaging and selective conditioning through the system optical coherence tomography (OCT) before and after aging thermocycling (TC). Class II preparations were made in the mesial and distal surfaces in 30 healthy human molars, with completion in enamel and dentin. All samples were restored ( composite Filtek Z350 XT resin Universal Single Bond) in three application techniques. The teeth were randomized into three groups (n = 10), one for each adhesive application technique: Group I: etching, Group II: engraved selective and Group III: Engraving the total; then the groups were assessed before and after thermal cycling through the system optical coherence tomography (OCT). With properly restored specimens, we went to the procedures of thermal cycles (1000 cycles of one minute at intervals of 30 seconds) and evaluation system through optical coherence tomography. Then the samples were examined by OCT-generated images and data were subjected to a non-parametric statistical test Kruskal-Wallis and Dunn (p <0.05). Was observed found statistically significant difference in marginal adaptation between the groups ended in tooth enamel (p = 0.0073); for groups with completion in dental dentin, there was no statistically significant difference in marginal adaptation (p = 0.2063). It is concluded that the OCT was then able to diagnose the microleakage in restorations in class II cavities. There are margins deterioration and changes in microleakage standard with different adhesive techniques of class II preparations restored with resin enamel. Assigns to the thermal cycling the marginal sealing failure observed in specimens in enamel.

A detecção de lesões cariosas nos estágios iniciais possibilita a escolha de tratamentos baseados na preservação da estrutura dental. Dessa forma, a utilização de exames capazes de diagnosticar precocemente essas lesões, como a Tomografia por Coerência Óptica (OCT Optical Coherence Tomography) é adequada. Assim, o objetivo do trabalho foi avaliar a capacidade da OCT em quantificar os estágios de desmineralização do esmalte durante o desenvolvimento de lesões simuladas de cárie, tendo como padrão de referência o teste de microdureza seccional. Foram utilizados 53 dentes terceiros molares hígidos, os quais tiveram as coroas seccionadas para obtenção de 210 amostras. Para avaliar as possíveis alterações sofridas por cada amostra, essas foram examinadas através da técnica de OCT no início do experimento e novamente examinadas após o término do período de ciclagem estabelecido para cada grupo, utilizando os coeficientes de atenuação óptica total e o cálculo de área em gráficos de intensidade de sinal de OCT, como parâmetros de análise. Posteriormente, as amostras foram submetidas a testes de microdureza seccional. A diferença entre os coeficientes de atenuação óptica obtidos antes e depois da ciclagem de pH apresentou elevado grau de correlação com os resultados de microdureza seccional. Por meio da análise das áreas provenientes de gráficos de intensidade de sinal de OCT e microdureza Knoop, ambos em função da profundidade, foi observada relação de linearidade entre os resultados e elevada correlação entre as técnicas avaliadas (&rho; = 0,99). De acordo com os resultados, a técnica de OCT foi capaz de detectar diferentes graus de desmineralização do esmalte dental humano em lesões simuladas de cárie. / The detection of carious lesions in early stages enables treatment choose based on dental structure preservation. This way, the utilization of exams capable of early diagnosis of these lesions, like OCT (Optical Coherence Tomography), is appropriate. Therefore, the objective of this work was to assess the capability of OCT in quantifying the enamel demineralization stages during the development of simulated caries lesions, having as reference standard the sectional microhardness test. There were used 53 sound third molars, which had their crowns sectioned to obtain 210 samples. To assess possible changes in each sample, these were examined by the OCT technique in the beginning of the experiment and again in the end of the cycling period established to each group, using the total optical attenuation coefficient and the area calculations using OCT signal intensity as analysis parameters. After that, the samples were submitted to sectional microhardness test. The difference between optical attenuation coefficients taken before and after the pH cycling, showed a high level of correlation with the microhardness results. Through areas analysis of OCT signal intensity and Knoop microhardness against depth, it was observed linearity relation between results and high correlation among assessed techniques (&rho;=0,99). According to the results, the OCT technique was capable of detecting different degrees of demineralization of the human enamel in carious simulated lesions.

Orientador: Vital Paulino Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T06:08:01Z (GMT). No. of bitstreams: 1 Cremasco_Fernanda_D.pdf: 5564009 bytes, checksum: bb04dfbdd0809568c204a7076f6df39f (MD5) Previous issue date: 2013 / Resumo: Esta pesquisa teve por finalidade avaliar a variabilidade intrasessão, intersessão e interexaminador das medidas de espessura da camada de fibras nervosas da retina peripapilar (CFNRP) com a Tomografia de Coerência Óptica de Domínio Espectral (TCO-DE). Foi incluído no estudo apenas um olho de 32 indivíduos saudáveis e de 34 pacientes com glaucoma. As medidas da CFNRP foram obtidas com o Cirrus HD-OCT 4000 (Carl Zeiss Meditec, Dublin, Califórnia, EUA) cinco vezes no mesmo dia, por um único examinador, para avaliação da variabilidade intrasessão. O mesmo examinador realizou medidas de espessura da CFNRP nos mesmos sujeitos em cinco dias diferentes, para avaliação da variabilidade intersessão. Um segundo examinador realizou medidas da espessura da CFNRP nos mesmos pacientes para avaliação da variabilidade interexaminador. O coeficiente de variação (CDV) e o coeficiente de correlação intraclasse (CCI) foram obtidos para os seguintes parâmetros: espessura média, espessura nos quadrantes e espessuras setoriais. Em relação à variabilidade intrasessão, em pacientes com glaucoma, os CDVs variaram de 4,51% a 11,84% e os CCIs variaram de 0,74 a 0,99; em indivíduos saudáveis, os CDVs variaram de 2,92% a 6,99% e os CCIs variaram de 0,89 a 0,98. Na análise da variabilidade intersessão observou-se que, em pacientes com glaucoma, os CDVs variaram de 3,68% a 10,50% e os CCIs variaram de 0,82 a 0,99; em indivíduos saudáveis, os CDVs variaram de 3,13% a 6,92% e os CCIs variaram de 0,87 a 0,99. Em relação à variabilidade interexaminador, em pacientes com glaucoma, os CDVs variaram de 2,62% a 14,94% e os CCIs variaram de 0,55 a 0,98; em indivíduos saudáveis, os CDVs variaram de 2,04% a 7,31% e os CCIs variaram de 0,86 a 0,98. Estes resultados indicam que as medidas de espessura da CFNRP com a TCO-DE apresentam reprodutibilidade excelente, com baixa variabilidade intrasessão, intersessão e interexaminador / Abstract: The purpose of this study was to evaluate the intrasession, intersession and interexaminer variabilities of peripapillary retinal nerve fiber layer (PRNFL) thickness measurements with Spectral Domain Optical Coherence Tomography. One eye of 32 healthy individuals and 34 patients with glaucoma were included in the study. The PRNFL measurements were obtained with the Cirrus HD-OCT Model 4000 (Carl Zeiss Meditec, Dublin, Califórnia, USA) five times during the same sitting by one examiner to assess intrasession variability. The same examiner performed PRNFL measurements in the same patients in five different days to assess intersession variability. A second examiner performed PRNFL measurements in the same patients to assess interexaminer variability. The coefficient of variation (COV) and the intraclass correlation coefficient (ICC) were obtained for the following parameters: average thickness, quadrant thickness and clock-hour thickness measurements. The analysis of the intrasession variability, in glaucoma patients, showed that COVs ranged from 4.51% to 11.84% and ICCs varied from 0.74 to 0.99, whereas in healthy individuals, COVs ranged from 2.92% to 6.99% and ICCs varied from 0.89 to 0.98. Regarding the intersession variability, in glaucoma patients COVs ranged from 3.68% to 10.50% and ICCs varied from 0.82 to 0.99; whereas in healthy individuals, COVs ranged from 3.13% to 6.92% and ICCs varied from 0.87 to 0.99. In interexaminer variability, between glaucoma patients, COVs ranged from 2.62% to 14.94% and ICCs varied from 0.55 to 0.98, whereas in healthy individuals, COVs ranged from 2.04% to 7.31% and ICCs varied from 0.86 to 0.98. These findings indicate that PRNFL measurements with Spectral Domain Optical Coherence Tomography display excellent reproducibility, with low intrasession, intersession and interexaminer variabilities / Doutorado / Oftalmologia / Doutor em Ciências Médicas

Orientador: Vital Paulino Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T16:05:44Z (GMT). No. of bitstreams: 1 Silva_FabricioReis_M.pdf: 2953091 bytes, checksum: 5a1660d55c27fcad4aeb1be8cceeb33f (MD5) Previous issue date: 2013 / Resumo: Objetivo: Avaliar a sensibilidade e especificidade dos classificadores de aprendizagem de máquina no diagnóstico de glaucoma usando dados do Spectral Domain OCT (SD-OCT) e perimetria automatizada acromática (PAA). Desenho do estudo: Estudo transversal observacional. Método: Sessenta e dois pacientes com glaucoma e 48 indivíduos normais foram incluídos. Todos os pacientes foram submetidos a exame oftalmológico completo, PAA (24-2 SITA; Humphrey Field Analyzer II, Carl Zeiss Meditec, Inc., Dublin, CA) e exame de imagem da camada de fibras nervosas utilizando SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California). Curvas ROC (Receiver Operating Characteristic) foram obtidas para todos os parâmetros do SD-OCT e índices globais da perimetria acromática (MD, PSD, GHT). Subsequentemente, os seguintes classificadores de aprendizagem de máquina (CAMs) foram testados usando parâmetros do OCT e PAA: Bagging (BAG), Naive-Bayes (NB), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Random Forest (RAN), Ensemble Selection (ENS), Classification Tree (CTREE), Ada Boost M1(ADA), Support Vector Machine Linear (SVML) e Support Vector Machine Gaussian (SVMG). Áreas abaixo da curva ROC (aROC) obtidas com os parâmetros isolados do campo visual (CV) e OCT foram comparados com os CAMs usando dados combinados do OCT e CV. Resultados: A média de idade foi de 57,0 ± 9,2 anos para os indivíduos normais e 59,9 ± 9,0 anos para os pacientes glaucomatosos (p=0,103). As médias dos valores do Mean Deviation (MD) foram -4,1 ± 2,4 dB para glaucomatosos e -1,5 ± 1,6 dB para indivíduos normais (p<0,001). Os parâmetros do SD-OCT com maiores aROCs foram: quadrante inferior (aROC=0,813) e espessura média (aROC=0,807). O melhor parâmetro do CV foi PSD (aROC=0,915). Combinando os dados do OCT e do CV, aROCs dos CAMs variaram entre 0,777 (CTREE) e 0,946 (RAN). A maior aROC dos CAMs OCT+CV, obtida com RAN (0,946) foi significativamente maior que o melhor parâmetro do OCT (p=0,003), mas não houve diferença estatisticamente significante com o melhor parâmetro do CV (p=0,37). Conclusão: Os classificadores de aprendizagem de máquina treinados com dados do OCT e CV podem discriminar entre olhos normais e glaucomatosos com sucesso. A combinação das medidas do OCT e CV melhoraram a acurácia diagnóstica comparados aos parâmetros do OCT / Abstract: Purpose: To evaluate the sensitivity and specificity of machine learning classifiers (MLCs) for glaucoma diagnosis using Spectral Domain OCT (SD-OCT) and standard automated perimetry (SAP). Design: Observational cross-sectional study. Population: Sixty two glaucoma patients and 48 healthy individuals were included. Methods: All patients underwent a complete ophthalmologic examination, SAP and retinal nerve fiber layer (RNFL) imaging with SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California). Receiver operating characteristic (ROC) curves were obtained for all SD-OCT parameters and some SAP parameters (MD, PSD, GHT). Subsequently, the following MLCs were tested using parameters from SD-OCT and SAP: Bagging (BAG), Naive-Bayes (NB), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Random Forest (RAN), Ensemble Selection (ENS), Classification Tree (CTREE), Ada Boost M1 (ADA), Support Vector Machine Linear (SVML) and Support Vector Machine Gaussian (SVMG). Areas under the ROC (aROC) obtained with SAP and OCT parameters were compared with those obtained with MLCs using combined OCT+SAP data. Results: The mean age was 57.0 ± 9.2 years for healthy individuals and 59.9 ± 9.0 years for glaucoma patients (p=0.103). Mean Deviation (MD) values were -4.1 ± 2.4 dB for glaucoma patients and -1.5 ± 1.6 dB for healthy individuals (p<0.001). SD-OCT parameters with the greater aROCs were inferior quadrant (0.813) and average thickness (0.807). The best SAP parameter was PSD (aROC=0.915). Combining OCT and SAP data, MLCs'aROCs varied from 0.777(CTREE) to 0.946 (RAN). The best combined OCT+SAP aROC, obtained with RAN (0.946), was significantly larger than the best single OCT parameter (p=0.003), but was not significantly different from the aROC obtained with the best single SAP parameter (p=0.37). Conclusion: Machine learning classifiers trained with OCT and SAP data can successfully discriminate between healthy and glaucomatous eyes. The combination of OCT and SAP measurements improved the diagnostic accuracy compared with OCT data alone / Mestrado / Oftalmologia / Mestre em Ciências Médicas

Objetivo: A partir das medidas anatômicas isoladas (altura, diâmetro externo e interno) do BMI construir um novo índice prognóstico para a cirurgia de correção do Buraco Macular Idiopático (IPBM). Tipo de estudo: intervencional, série de casos. Pacientes e Métodos: Estudo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e no Instituto Suel Abujamra, São Paulo-SP, entre outubro de 2005 e outubro de 2007. Foram incluídos 36 olhos de 36 pacientes com BMI, que foram avaliados segundo as medidas apresentadas ao exame de TCO (Stratus - Zeiss, versão 4.01) antes da cirurgia do BMI. Utilizando o compasso do TCO, obteve-se a medida dos maiores diâmetros externo e interno e da altura dos BMI. Por meio dessas medidas, foi criado o IPBM. Após vitrectomia posterior com retirada de Membrana Limitante Interna (MLI), sem utilização de corantes, os pacientes foram acompanhados por seis meses. Após a cirurgia, os pacientes foram avaliados no primeiro e sétimo dias, duas semanas, um, três e seis meses. Ao final do seguimento, o IBPM e outras variáveis (sexo, idade, raça, estádio do BMI pela classificação biomicroscópica de Gass, tempo decorrido desde a piora da acuidade visual informada pelo paciente e a acuidade visual pré-operatória), foram correlacionadas com o resultado anatômico e a acuidade visual pós-operatória. Resultados: Vinte e nove (80,6%) dos 36 olhos com BMI obtiveram fechamento anatômico ao final de seis meses de acompanhamento (8,86 ± 4,23 meses). Dezenove (52,7%) dos BMI eram do estádio IV de Gass, com tempo de duração maior que um ano em 21 pacientes (58,3%). A AV LogMAR corrigida pré-operatória média foi de 1,10 (0,60 a 1,62) e a pós-operatória média foi de 0,69 (0,0 a 1,60). A média de melhora da AV foi de 3,94 linhas. Em relação ao fechamento anatômico, não houve significância em relação ao tempo de história da doença entre os grupos aberto (grupo 1) e fechado (grupo 2) (Teste t-Student, p=0,072). O diâmetro da base interna foi maior no grupo 1 em relação ao grupo 2 (Teste t-Student, p=0,007). Na análise do índice IPBM, houve diferença significativa entre o grupo 1 (média 0,49) e o grupo 2 (média 0,91). (Teste t-Student, p< 0,001) A análise de regressão logística apontou que BMIs com IPBM maior que 0,53 apresentam chance de fechamento anatômico 9,6 vezes maior (Odds Ratio= 9,6, p = 0,018). Pacientes com IPBM > 0,53 apresentaram AV pós-operatória ao final do sexto mês significativamente melhor do que pacientes com IPBM < 0,53 (Mann-Whitney, p=0,005). O ganho percentual da AV foi de 41,93% nos pacientes com IBPM>0,53, quando comparado com os 7,14% do grupo com IPBM <0,53 (p=0,002). No que diz respeito à AV final LogMAR, todas as variáveis estudadas anteriormente foram submetidas ao teste de correlação de Pearson. Observou-se que o IPBM tem uma correlação negativa significante com a AV, e foi selecionado juntamente com a AV pré-operatória através de regressão linear como os melhores preditores de AV final (p<0,001 e p=0,005, respectivamente). O modelo aponta que 58,4% da AV pós-operatória está sendo explicada pelo IPBM e AV pré-operatória. Conclusões: Foi construído um novo índice Prognóstico do Buraco Macular Idiopático (IPBM) representado pela razão altura / diâmetro interno do BMI. Verificou-se que o IPBM pode ser utilizado como fator prognóstico de fechamento anatômico do BMI. O IPBM e a AV pré-operatória foram os fatores prognósticos com melhor relação para a AV no sexto mês após o tratamento cirúrgico do BMI. / Purpose: To create a new prognostic index for IMH surgery based on anatomical values of IMH height, external and internal diameters (MHPI). Type of Study: Prospective, interventional, case of series. Patients and Methods: 36 eyes with IMH of 36 patients followed at Hospital das Clinicas, University of São Paulo Medical School (HC-FMUSP) and Suel Abujamra Institute (ISA), São Paulo-SP, between October 2006 and October 2007, were included. IMH OCT measurements were obtained before surgery (Stratus - Zeiss version 4.01) Values of the larger external and internal diameters, and the IMH height were obtained using the OCT compass. The prognostic index of IMH (MHPI) was defined as the index height / internal base. MHPI was defined by using those OCT measurements. Patients underwent pars plana vitrectomy with ILM peeling without dye and were followed by 6 months. Patients were seen at days 1, 7, 14, and months 1, 2, 3, and 6 after surgery. At the end of the follow-up period, MHPI and, other variables (sex, age, ethnic group, stage of IMH following the biomicroscopic classification of Gass, the time of visual loss reported by the patient, and pre surgical visual acuity) were correlated with anatomical results and post-surgical visual acuity. Results: Twenty nine eyes (80.6%) of thirty six patients with IMH had anatomical closure at the end of the six-month follow-up (8.86 ± 4.23 months). Nineteen (52.7%) IMH were stage IV of Gass with more than one year duration in twenty one patients. Pre-surgical medium LogMAR VA was 1.10 (0.60 to 1.62) and post-surgical was 0.69 (0.0 to 1.60). Medium VA improvement was 3.94 lines. The internal base diameter (BINT) was larger in group 1 than in group 2 (t-Student Test, p=0.373). MHPI analisys showed significant difference between group 1 (average 0.49) and group 2 (average 0.91) (t-Student Test, p> 0.001). Logistical regression showed that IMH with MHPI higher than 0.53 present 9.6 times more risk of failure than those with MHPI lower than 0.53 (Mann-Whitney, p=0.005). The percentage gain of VA was 41.93% in patients with MHPI > 0.53, and 7.14% in patients with MHPI lower than 0.53 (p=0.002). In regards to the final LogMAR VA, all studied variables above submitted to Pearson correlation test. MHPI is inversely correlated with VA by linear regression with gradient procedure as best predictor of final VA (p< 0.001 and p= 0.005 respectively). The sample shows that 58.4% of post-surgery VA is being explained by the MHPI and pre-surgery VA. Conclusions: A new prognostic index for IMH surgery was defined as IMH height/internal diameter. We concluded that MHPI may be used as a prognostic factor for IMH anatomical closure after surgical treatment. MHPI and preoperatory VA were the best correlated prognostic factors for 6-month VA.