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Kunihiko Akiyama, Ken Watanabe, Masaki Fukui, Hiroshi Higuchi, Yasufumi Fukuma, Toru Noda; Quantitative Evaluation of Digital-Image Enhancement during Heads-Up Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):872.
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Simultaneous enhancement of surgical images on a digital monitor is an advantage of heads-up surgery (HUS), but its effect has not been assessed quantitatively in a clinical setting. We performed a case series study to evaluate the enhancement effect on staining of the internal limiting membrane (ILM) with Brilliant blue G (BBG).
Twenty eyes of 20 cases (mean age, 64.4±8.1 years) that underwent vitrectomy with ILM peeling were included. The following surgeries were performed to treat epiretinal membranes (10 cases), macular holes (two cases), foveal schisis (3 cases), vitreomacular traction syndrome (1 case), rhegmatogenous retinal detachment (2 cases), and optic pit maculopathy (2 cases). A still image of the macula during ILM peeling was obtained from the surgical video of each case. The images were enhanced for contrast and color using the Advanced Image Multiple Enhancer (A.I.M.E.) algorithm, which is built into the commercially available 4K monitor for medical use (LMD-X550MT®, Sony Corporation, Tokyo, Japan). Images before (A.I.M.E. off) (Figure 1) and after enhancement (A.I.M.E. on) (Figure 2) were compared. To analyze the enhancement, two adjacent spots inside and outside the circular ILM peeling contour, i.e., without and with BBG staining, respectively, were selected (Figures 1, 2). The color difference between the two spots was calculated by 8-bit conversion and compared between the images from A.I.M.E. on and off using the two-tailed paired t-test. Color differences were evaluated using two methods: balance of RGB values and the delta E00 formula (provided by the International Commission on Illumination). The institutional review board of the National Tokyo Medical Center approved the study protocol.
The mean color differences between the spots with and without BBG staining were 10.10, 8.15, and 6.85 (R, G, and B, respectively) with A.I.M.E. off and 22.95, 18.50, and 14.50 (R, G, and B, respectively) with A.I.M.E. on images. A significant difference was seen between A.I.M.E. on and off regarding all three colors (p<0.001 for each comparison). The mean delta E00 between the two spots also increased significantly (p<0.001) from 4.49 for A.I.M.E. off to 8.00 for A.I.M.E. on.
ILM staining with BBG was enhanced significantly using the A.I.M.E. algorithm. Our results suggested that image enhancement notably facilitates HUS procedures such as membrane peeling.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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