actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2021-6.6-1.22actabiomedica-3126Research ArticleОФТАЛЬМОЛОГИЯOPHTHALMOLOGYСовременные тенденции диагностики и прогнозирования результатов терапии ингибиторами ангиогенеза отслоек пигментного эпителия при неоваскулярной возрастной макулярной дегенерации с применением методов глубокого машинного обучения (обзор литературы)Modern trends in diagnostics and prediction of results of anti-vascular endothelial growth factor therapy of pigment epithelial detachment in neovascular agerelated macular degeneration using deep machine learning method (literature review)https://orcid.org/0000-0002-2959-9649КозинаЕ. В.KozinaE. V.

 врач-офтальмолог

350012, г. Краснодар, ул. Красных Партизан, 6, Россия

 Ophthalmologist

Krasnykh Partizan str. 6, Krasnodar 350012, Russian Federation 

elena_eyedoc@mail.ruhttps://orcid.org/0000-0003-2100-2972СахновС. Н.SakhnovS. N.

 кандидат медицинских наук, кандидат экономических наук, директор; заведующий кафедрой глазных болезней

350012, г. Краснодар, ул. Красных Партизан, 6, Россия

350063, г. Краснодар, ул. Митрофана Седина, 4, Россия

 Cand. Sc. (Med.), Cand. Sc. (Econ.), Director; Head of the Department of Eye Diseases

Krasnykh Partizan str. 6, Krasnodar 350012, Russian Federation 

Mitrofana Sedina str. 4, Krasnodar 350063, Russian Federation 

s_sakhnov@inbox.ruhttps://orcid.org/0000-0003-1748-7962МясниковаВ. В.MyasnikovaV. V.

 доктор медицинских наук, доцент, заместитель директора по научной работе; доцент кафедры анестезиологии, реаниматологии и трансфузиологии ФПК и ППС

350012, г. Краснодар, ул. Красных Партизан, 6, Россия

350063, г. Краснодар, ул. Митрофана Седина, 4, Россия

 Dr. Sc. (Med.), Docent, Deputy Director for Science; Associate Professorat the Department of Anesthesiology, Rheanimatology and Transfusiology of the Advanced Training and Professional Retraining Faculty

Krasnykh Partizan str. 6, Krasnodar 350012, Russian Federation 

Mitrofana Sedina str. 4, Krasnodar 350063, Russian Federation 

vivlad7@mail.ruhttps://orcid.org/0000-0001-9187-4202БыковаЕ. В.BykovaE. V.

 кандидат медицинских наук, заведующая диагностическим отделением, врач-офтальмолог

350012, г. Краснодар, ул. Красных Партизан, 6, Россия

 Cand. Sc. (Med.), Head of the Department of Diagnostics, Ophthalmologist

Krasnykh Partizan str. 6, Krasnodar 350012, Russian Federation 

bikova_lena@bk.ruhttps://orcid.org/0000-0003-0885-1355АксеноваЛ. Е.AksenovaL. E.

 инженер по научно-технической информации

350012, г. Краснодар, ул. Красных Партизан, 6, Россия

 Engineer for Scientifi c and Technical Information

 Krasnykh Partizan str. 6, Krasnodar 350012, Russian Federation 

axenovalubov@gmail.comКраснодарский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» имени академика С.Н. Фёдорова» Минздрава РоссииKrasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution Краснодарский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» имени академика С.Н. Фёдорова» Минздрава России; ФГБОУ ВО Кубанский государственный медицинский университет Минздрава РоссииKrasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; Kuban State Medical University Краснодарский филиал ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» имени академика С.Н. Фёдорова» Минздрава РоссииKrasnodar Branch of the S. Fyodorov Eye Microsurgery Federal State Institution20212812202166-1190203Copyright © Козина Е.В., Сахнов С.Н., Мясникова В.В., Быкова Е.В., Аксенова Л.Е., 20212021Козина Е.В., Сахнов С.Н., Мясникова В.В., Быкова Е.В., Аксенова Л.Е.Kozina E.V., Sakhnov S.N., Myasnikova V.V., Bykova E.V., Aksenova L.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/3126

Отслойка пигментного эпителия – отделение базальной мембраны ретинального пигментного эпителия от внутреннего коллагенового слоя мембраны Бруха, встречающееся в 80 % случаев у пациентов с неоваскулярной возрастной макулодистрофией. Исходом антиангиогенной терапии отслойки пигментного эпителия может быть прилегание пигментного эпителия, формирование разрыва пигментного эпителия либо сохранение отслойки. Разрыв пигментного эпителия 3–4-й степени может приводить к резкому снижению остроты зрения. Большинством ретроспективных исследований подтверждается отсутствие доказанной корреляции между анатомическими и функциональными исходами при терапии отслоек пигментного эпителия в случаях сохранения целостности монослоя пигментного эпителия, в связи с чем основное внимание исследователей сосредоточено на исследовании морфологических особенностей отслойки пигментного эпителия в течение терапии ингибиторами ангиогенеза. Современные технологии спектральной оптической когерентной томографии позволяют оценивать детальные количественные параметры отслойки пигментного эпителия, такие как высота, ширина, наибольший линейный диаметр, площадь, объём и отражательная способность внутри отслойки. Группы отечественных и зарубежных авторов выделяют различные биомаркеры, фиксируемые на снимках оптической когерентной томографии. Динамическая регистрация подобных биомаркеров расширяет возможности клиницистов в прогнозировании морфологических изменений отслоек пигментного эпителия в течение терапии ингибиторами ангиогенеза, а также в оптимизации режимов назначения лечения с целью предотвращения осложнений в виде разрыва пигментного эпителия, приводящего к снижению остроты зрения. Современные методы глубокого машинного обучения и применение нейросетей позволяют достигать более высокой точности в дифференцировке типов ретинальных жидкостей и автоматизации количественного определения жидкости под пигментным эпителием. Данные технологии позволяют достигать высокого уровня соответствия с ручной экспертной оценкой и повышать точность и скорость прогнозирования морфологических результатов лечения отслоек пигментного эпителия.

Detachment of the pigment epithelium is the separation of the basement membrane of the retinal pigment epithelium from the inner collagen layer of Bruch’s membrane, which occurs in 80 % of cases in patients with neovascular age-related macular degeneration. The outcome of anti-VEGF therapy for pigment epithelial detachment may be adherence of the pigment epithelium, the formation of pigment epithelium tear, or preservation of the detachment. The pigment epithelium tear of 3–4th degrees can lead to a sharp decrease in visual acuity.Most retrospective studies confi rm the absence of a proven correlation between anatomical and functional outcomes in the treatment of pigment epithelial detachment in cases of maintaining the integrity of the pigment epithelium monolayer, and therefore the main attention of researchers is focused on studying the morphological features of pigment epithelial detachment during therapy with angiogenesis inhibitors. Modern technologies of spectral optical coherence tomography make it possible to evaluate detailed quantitative parameters of pigment epithelium detachment, such as height, width, maximum linear diameter, area, volume and refl ectivity within the detachment.Groups of Russian and foreign authors identify various biomarkers recorded on optical coherence tomography images. Dynamic registration of such biomarkers expands the ability of clinicians to predict morphological changes in pigment epithelial detachment during anti-VEGF therapy, as well as to optimize treatment regimens to prevent complications in the form of pigment epithelium tear leading to a decrease in visual acuity.Modern methods of deep machine learning and the use of neural networks allow achieving higher accuracy in diff erentiating the types of retinal fluids and automating the quantitative determination of fl uid under the pigment epithelium. These technologies allow achieving a high level of compliance with manual expert assessment and increasing the accuracy and speed of predicting morphological results of treatment of pigment epithelium detachments.

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The authors declare that there are no conflicts of interest present.