Percorrer por autor "Cabral, Diogo"
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- Dril influences short-term visual outcome after intravitreal corticosteroid injection for refractory diabetic macular edemaPublication . Luís, Maria Elisa; Sampaio, Filipa; Costa, José; Cabral, Diogo; Teixeira, Carla; Ferreira, Joana TavaresPurpose: Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) are considered the gold standard for diabetic macular edema (DME). Despite adequate anti-VEGF treatments, many patients present persistent DME. The aim of this study is to identify systemic, ocular and anatomical characteristics influencing functional and anatomical outcomes in refractory DME patients treated with IVI of corticosteroid. Materials and Methods: Retrospective multicenter hospital-based cohort study including type 2 diabetic adult patients with refractory DME that switched from intravitreal anti-VEGF to intravitreal corticosteroid between January 2017 and September 2018. Sociodemographic, clinical data, DME and treatment characteristics were collected at baseline (visit before switch), as well as spectral domain OCT features. Results: A total of 101 eyes were included. The median number of anti-VEGF injections before switch was 5.0 (min-max: 4.0-9.0) and the median anti-VEGF treatment duration before switch was 33.2 (min-max: 19.5-50.3) months. More than half of the patients (56; 54.9%) were diagnosed with diffuse DME. At baseline, 80 (88%) patients had cystoid DME, 55 (62.5%) patients had disorganization of retinal inner layers (DRIL) and 16 (17.6%) had subretinal fluid. Dexamethasone was the corticosteroid more commonly used (71.4%), followed by triamcinolone (24.4%) and fluocinolone (4.2%). Regarding best corrected visual acuity (BCVA), post-switch results showed no statistically significant improvement at three-month follow-up (p = .048/0.096), but the mean central macular thickness (CMT) decreased significantly from 486.3 (SD = 159) µm to 369.3 (SD = 129) µm at three-month follow-up (p < .001). DRIL was the tomographic characteristic able to influence significantly both CMT and BCVA final results (p = .02 and 0.012, respectively). Conclusions: Subfoveal DRIL on structural OCT was the DME factor influencing significantly clinical and imaging outcomes in refractory DME patients treated with intravitreal corticosteroid. Portuguese care trend towards DME shows preference for the use of dexamethasone implant after therapeutic failure with ranibizumab or bevacizumab injection.
- Foveation after spontaneous closure of an outer lamellar macular holePublication . Mendo, Inês; Camacho, Pedro; Carreira, Pedro; Cabral, DiogoVisual loss without relevant findings on examination often leads to multiple tests to distinguish true visual loss from malingering. Here, we used precise registration of MAIA microperimetry with spectral-domain optical coherence tomography (SD-OCT) to align retinal sensitivity data with anatomical tomographic indings in a patient with visual loss and normal clinical findings. This report followed the tenets of the Declaration of Helsinki. Summary statement: To evaluate retinal sensitivity in a patient with visual loss and normal clinical findings using a precise registration of microperimetry with spectral-domain optical coherence tomography.
- Morphological structure of lamina cribrosa and peripapillary microvasculature for glaucoma diagnosis, using deep-range imagingPublication . Silva, Rita; Camacho, Pedro; Cabral, Diogo; Henriques, Pedro; Marques, Manuel; Dias, Catarina; Valadares, Joana; Segurado, João; Fernandes, JoséPurpose: To compare the diagnostic power of lamina cribrosa depth (LCD), lamina cribrosa curve depth (LCCD) and lamina cribrosa curvature index (LCCI) with vessel density and fractal analysis in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).
- Outer retina and choroidal thickness in intermediate age-related macular degeneration: reticular pseudodrusen findingsPublication . Camacho, Pedro; Dutra-Medeiros, Marco; Cabral, Diogo; Silva, RufinoPurpose: To evaluate outer retina and choroidal thickness in subjects with intermediate age-related macular degeneration (iAMD) and to describe associations with the presence of reticular pseudodrusen (RPD). Methods: This was a retrospective, cross-sectional analysis of 157 consecutive eyes (specifically: 62 eyes classified as having RPD and 95 eyes with drusen ≥125 μm). Only cases with digital color fundus photographs, red-free, and infrared, obtained and graded according to the Age-Related Eye Disease Study to define iAMD, were used for this study. Outer retina and choroidal thickness were manually segmented and quantified at 12 locations in the horizontal meridian. Results: RPD appeared to be associated with thinning of the outer layers even after adjustment for gender and age. The presence of RPD in iAMD decreased with increase of choroidal thickness (total odds ratio [OR] 0.991, 95% confidence interval [CI] 0.985-0.996; nasal OR 0.992, 95% CI 0.986-0.997), with increased thickness of the myoid zone of the photoreceptors (total OR 0.812, 95% CI 0.688-0.958; nasal OR 0.863, 95% CI 0.755-0.987) and with increased thickness of the outer segment of the photoreceptors (total OR 0.850, 95% CI 0.731-0.989; nasal OR 0.857, 95% CI 0.736-0.989). Conclusions: The greatest differences between eyes with and without RPD are found at the level of the choroidal thickness and at the level of the photoreceptors.
- Outer retinal band segmentation in healthy subjects: comparative study between human grading and deep convolutional neural networksPublication . Afonso, João Duarte; Camacho, Pedro; Pereira, Bruno; Marques, João Pedro; Lopes, Daniel Simões; Cabral, DiogoBackground: Accurate identification of outer retinal bands (ORBs) on spectral-domain optical coherence tomography (SD-OCT) is clinically important for the assessment and monitoring of several retinal diseases. However, manual segmentation of these ORBs is time-consuming and subject to considerable intra- and inter-observer variability. Deep convolutional neural networks (dCNNs) offer a promising approach for achieving more consistent and reproducible segmentation of retinal microstructures, yet their performance for individual ORBs and their dependence on grader reliability remain insufficiently characterized. This study aimed to compare manual grading and different dCNN architectures for the segmentation of individual ORBs in healthy subjects, while assessing the reproducibility of human annotations and the performance of automated methods. Methods: A cross-sectional observational study was conducted using foveal-centered SD-OCT scans obtained from healthy participants. Manual segmentation of the second hyperreflective band (Band 2), the third and fourth hyperreflective bands (Band 3+4), and photoreceptor outer segments (POS) was performed by two trained graders using onboard OCT software. Reproducibility was assessed using the intraclass and interclass correlation coefficient (ICC). Human annotations were used to train different dCNNs pretrained with Sparse masked modelling on unlabelled data. The performance of the dCNNs was evaluated using the dice score and pixel difference analyses. Results: One hundred eyes of healthy subjects were included. The intraclass correlation values were 0.737 (0.689, 0.779), 0.830 (0.795, 0.860), and 0.878 (0.852, 0.900), and the ICCs were 0.104 (-0.049, 0.253), 0.810 (0.740, 0.862), and 0.752 (0.678, 0.812) for Band 2, Band 3+4, and POS, respectively. From the dCNN, DRUNET showed the best performance: 0.916 for Band 2, 0.924 for Band 3+4, and 0.910 for POS. Pixel difference analysis between DRUNET and grader 1 showed a deviation of 0.89±0.44. Conclusions: Manual segmentation of ORBs demonstrated moderate to high repeatability, whereas Band 2 segmentation showed low reproducibility. DRUNET outperformed other dCNN architectures, showing great potential to reduce inter-observer variability.