Discussion
foveolar detachment, iERM, CMT
MINOR, RETINA, REGRESSION, MACULAR EDEMA, COMPLICATIONS
Since iERM is inevitably complicated by macular complications, such as macular edema, disorganization of retinal inner layers, and photoreceptor disruption, the visual benefit from VMP remained hard to predict preoperatively. Therefore, we developed a DL model that could predict the post-VMP BCVA of iERM eyes using preoperative macular OCT images and clinical data as input.Regarding postoperative recovery and rehabilitation, most patients are concerned about postoperative BCVA, which is a scientific indicator of how they are affected in their daily lives. Owing to the satisfactory repeatability and reproducibility of OCT [In recent years, artificial intelligence (AI) technology, particularly DL, has been widely applied in processing highly complex tasks, such as image segmentation and medical image classification [In the present study, Grad-CAM helps ophthalmologists determine whether the predictive results are credible by highlighting the decision-making regions. While it effectively visualizes the importance of specific regions, it does not provide a measure of the model's certainty regarding its predictions. The reason why we did not look at the center but looked at the periphery is that it is appropriate to use the deformation of the periphery to measure the load on the neural retina of ERM. Moreover, GRAD-CAM's dependence on gradient information may not always capture all relevant features in an OCT image, as the gradients can be sensitive to minor perturbations and noise, potentially resulting in less accurate heatmaps.In the present study, we compared the DL model to the stepwise regression model from clinical data, including age, gender, preoperative BCVA, symptom duration, IS/OS integrity, foveolar detachment and CMT. We demonstrated that OCT-based DL model performed better than logistic regression in predicting postoperative BCVA. Despite similar methods, previous investigation differed in the prediction task assigned to the model. The previous investigation focused on binary classification (whether the VA will improve by ≥ 15 letters or not), while our study specifically aimed to predict the postoperative BCVA (the predicted BCVA could be generated automatically) [It might also help with surgical decision-making, such as choosing more advanced surgical techniques. For visually significant iERM patients, a previous study demonstrated intravitreal injection of 0.7 mg dexamethasone (Ozurdex®) at the conclusion of vitrectomy could significantly decrease macular edema and improve visual outcomes [There are several limitations to this study. First, the manually measured macular OCT parameters are prone to measurement errors. Nevertheless, the manual measurements by spectral-domain OCT were proven highly reproducible and repeatable in previous studies [