Predicting Postoperative Intraocular Lens Dislocation in Cataract Surgery via Deep Learning

A critical yet unpredictable complication following cataract surgery is intraocular lens dislocation. Postoperative stability is imperative, as even a tiny decentration of multifocal lenses or inadequate alignment of the torus in toric lenses due to postoperative rotation can lead to a significant drop in visual acuity. Investigating possible intraoperative indicators that can predict post-surgical instabilities of intraocular lenses can help prevent this complication. In this paper, we develop and evaluate the first fully-automatic framework for the computation of lens unfolding delay, rotation, and instability during surgery. Adopting a combination of three types of CNNs, namely recurrent, region-based, and pixel-based, the proposed framework is employed to assess the possibility of predicting post-operative lens dislocation during cataract surgery. This is achieved via performing a large-scale study on the statistical differences between the behavior of different brands of intraocular lenses and aligning the results with expert surgeons' hypotheses and observations about the lenses. We exploit a large-scale dataset of cataract surgery videos featuring four intraocular lens brands. Experimental results confirm the reliability of the proposed framework in evaluating the lens' statistics during the surgery. The Pearson correlation and t-test results reveal significant correlations between lens unfolding delay and lens rotation and significant differences between the intra-operative rotations stability of four groups of lenses. These results suggest that the proposed framework can help surgeons select the lenses based on the patient's eye conditions and predict post-surgical lens dislocation.

ReCal-Net: Joint Region-Channel-Wise Calibrated Network for Semantic Segmentation in Cataract Surgery Videos

Semantic segmentation in surgical videos is a prerequisite for a broad range of applications towards improving surgical outcomes and surgical video analysis. However, semantic segmentation in surgical videos involves many challenges. In particular, in cataract surgery, various features of the relevant objects such as blunt edges, color and context variation, reflection, transparency, and motion blur pose a challenge for semantic segmentation. In this paper, we propose a novel convolutional module termed as \textit{ReCal} module, which can calibrate the feature maps by employing region intra-and-inter-dependencies and channel-region cross-dependencies. This calibration strategy can effectively enhance semantic representation by correlating different representations of the same semantic label, considering a multi-angle local view centering around each pixel. Thus the proposed module can deal with distant visual characteristics of unique objects as well as cross-similarities in the visual characteristics of different objects. Moreover, we propose a novel network architecture based on the proposed module termed as ReCal-Net. Experimental results confirm the superiority of ReCal-Net compared to rival state-of-the-art approaches for all relevant objects in cataract surgery. Moreover, ablation studies reveal the effectiveness of the ReCal module in boosting semantic segmentation accuracy.

LensID: A CNN-RNN-Based Framework Towards Lens Irregularity Detection in Cataract Surgery Videos

A critical complication after cataract surgery is the dislocation of the lens implant leading to vision deterioration and eye trauma. In order to reduce the risk of this complication, it is vital to discover the risk factors during the surgery. However, studying the relationship between lens dislocation and its suspicious risk factors using numerous videos is a time-extensive procedure. Hence, the surgeons demand an automatic approach to enable a larger-scale and, accordingly, more reliable study. In this paper, we propose a novel framework as the major step towards lens irregularity detection. In particular, we propose (I) an end-to-end recurrent neural network to recognize the lens-implantation phase and (II) a novel semantic segmentation network to segment the lens and pupil after the implantation phase. The phase recognition results reveal the effectiveness of the proposed surgical phase recognition approach. Moreover, the segmentation results confirm the proposed segmentation network's effectiveness compared to state-of-the-art rival approaches.

Relevance Detection in Cataract Surgery Videos by Spatio-Temporal Action Localization

In cataract surgery, the operation is performed with the help of a microscope. Since the microscope enables watching real-time surgery by up to two people only, a major part of surgical training is conducted using the recorded videos. To optimize the training procedure with the video content, the surgeons require an automatic relevance detection approach. In addition to relevance-based retrieval, these results can be further used for skill assessment and irregularity detection in cataract surgery videos. In this paper, a three-module framework is proposed to detect and classify the relevant phase segments in cataract videos. Taking advantage of an idle frame recognition network, the video is divided into idle and action segments. To boost the performance in relevance detection, the cornea where the relevant surgical actions are conducted is detected in all frames using Mask R-CNN. The spatiotemporally localized segments containing higher-resolution information about the pupil texture and actions, and complementary temporal information from the same phase are fed into the relevance detection module. This module consists of four parallel recurrent CNNs being responsible to detect four relevant phases that have been defined with medical experts. The results will then be integrated to classify the action phases as irrelevant or one of four relevant phases. Experimental results reveal that the proposed approach outperforms static CNNs and different configurations of feature-based and end-to-end recurrent networks.