{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T16:10:46Z","timestamp":1792858246801,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation","doi-asserted-by":"publisher","award":["NRF-2022R1C1C1010643"],"award-info":[{"award-number":["NRF-2022R1C1C1010643"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: This study aimed to predict the unknown etiology of fundus-obscuring vitreous hemorrhage (FOVH) based on preoperative conditions using machine learning (ML) and to identify key preoperative factors. Methods: Medical records of 223 eyes from 204 patients who underwent vitrectomy for FOVH of unknown etiology between January 2012 and July 2022 were retrospectively reviewed. Preoperative data, including demographic information, systemic disease, ophthalmic history, and retinal status of the unaffected eye, were collected. The postoperatively identified etiologies of FOVH were categorized into six groups: proliferative diabetic retinopathy (PDR), retinal vein occlusion (RVO) or rupture of retinal arterial macroaneurysm, neovascular age-related macular degeneration (nAMD), retinal tear, Terson syndrome, and other causes. Four ML algorithms were trained and evaluated using seven-fold cross-validation. Results: The ML algorithms achieved mean accuracies of 76.2% for artificial neural network, 74.5% for XG-Boost, 74.4% for LASSO logistic regression, and 68.5% for decision tree. Key predictive factors commonly selected by the ML algorithms included PDR in the fellow eye, underlying diabetes mellitus, subarachnoid hemorrhage, and a history of retinal tear, RVO, or nAMD in the affected eye. Conclusions: The unknown etiology of FOVH could be predicted preoperatively with considerable accuracy by ML algorithms. Previous ophthalmic conditions in the affected eye and the condition of the fellow eye were important variables for prediction. This approach might assist in determining appropriate treatment plans.<\/jats:p>","DOI":"10.3390\/diagnostics15030371","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T04:15:41Z","timestamp":1738728941000},"page":"371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prediction of the Cause of Fundus-Obscuring Vitreous Hemorrhage Using Machine Learning"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4392-5583","authenticated-orcid":false,"given":"Jinsoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-7752","authenticated-orcid":false,"given":"Bo Sook","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo Eun","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Seon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-981X","authenticated-orcid":false,"given":"Soonil","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0244-388X","authenticated-orcid":false,"given":"Bum-Joo","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea"},{"name":"Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0039-6257(97)84041-6","article-title":"Vitreous hemorrhage","volume":"42","author":"Spraul","year":"1997","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","first-page":"461","article-title":"Vitreous haemorrhage: A population-based study of the incidence and risk factors in Taiwan","volume":"10","author":"Wang","year":"2017","journal-title":"Int. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/S0002-9394(14)71232-2","article-title":"A prospective study of dense spontaneous vitreous hemorrhage","volume":"119","author":"Lindgren","year":"1995","journal-title":"Am. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/ijo.IJO_928_22","article-title":"Vitreous hemorrhage\u2014Causes, diagnosis, and management","volume":"71","author":"Shaikh","year":"2023","journal-title":"Indian J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Confalonieri, F., Barone, G., Ferraro, V., Ambrosini, G., Gaeta, A., Petrovski, B., Lumi, X., Petrovski, G., and Di Maria, A. (2023). Early versus late pars plana vitrectomy in vitreous hemorrhage: A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206652"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2273","DOI":"10.1016\/S0161-6420(01)00822-3","article-title":"Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage","volume":"108","author":"Sarrafizadeh","year":"2001","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.preteyeres.2018.07.004","article-title":"Artificial intelligence in retina","volume":"67","author":"Sadeghipour","year":"2018","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"354","DOI":"10.18502\/jovr.v19i3.15893","article-title":"Application of artificial intelligence in ophthalmology: An updated comprehensive review","volume":"19","author":"Hashemian","year":"2024","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/aos.12210","article-title":"Retinal arterial macroaneurysms","volume":"92","author":"Tommila","year":"2014","journal-title":"Acta Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4297","DOI":"10.1167\/iovs.08-1826","article-title":"Traditional and novel cardiovascular risk factors for retinal vein occlusion: The multiethnic study of atherosclerosis","volume":"49","author":"Cheung","year":"2008","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Chen, T., and Guestrin, C. (2016, January 13\u201317). XGBoost: A scalable tree boosting system. KDD \u201916: Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, San Francisco, CA, USA. Available online: https:\/\/dl.acm.org\/doi\/10.1145\/2939672.2939785.","DOI":"10.1145\/2939672.2939785"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cho, B.J., Kim, K.M., Bilegsaikhan, S.E., and Suh, Y.J. (2020). Machine learning improves the prediction of febrile neutropenia in Korean inpatients undergoing chemotherapy for breast cancer. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-71927-6"},{"key":"ref_13","first-page":"1157","article-title":"An introduction to variable and feature selection","volume":"3","author":"Guyon","year":"2003","journal-title":"J. Mach. Learn. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1109\/MCI.2018.2866730","article-title":"Cross-validation for imbalanced datasets: Avoiding overoptimistic and overfitting approaches","volume":"13","author":"Santos","year":"2018","journal-title":"IEEE Comput. Intell. Mag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0161-6420(93)31472-7","article-title":"Spontaneous and traumatic vitreous hemorrhage","volume":"100","author":"Dana","year":"1993","journal-title":"Ophthalmology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1016\/S2214-109X(13)70145-1","article-title":"Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: A systematic review and meta-analysis","volume":"2","author":"Wong","year":"2014","journal-title":"Lancet Glob. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.2147\/OPTH.S133938","article-title":"Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer","volume":"11","author":"Sandinha","year":"2017","journal-title":"Clin. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/sj.eye.6700632","article-title":"Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage","volume":"18","author":"Rabinowitz","year":"2004","journal-title":"Eye"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.ophtha.2009.11.028","article-title":"The ocular pathology of Terson\u2019s syndrome","volume":"117","author":"Ko","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1159\/000501723","article-title":"Impact of early vitrectomy for dense vitreous hemorrhage of unknown etiology","volume":"242","author":"Hayashida","year":"2019","journal-title":"Ophthalmologica"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"P146","DOI":"10.1016\/j.ophtha.2019.09.027","article-title":"Posterior vitreous detachment, retinal breaks, and lattice degeneration Preferred Practice Pattern\u00ae","volume":"127","author":"Flaxel","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.optom.2017.11.005","article-title":"Symmetry of peripheral retinal nonperfusion in diabetic retinopathy by ischemic index","volume":"11","author":"Speilburg","year":"2018","journal-title":"J. Optom."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1097\/IAE.0000000000002472","article-title":"Association of retinal vein occlusion with cardiovascular events and mortality: A systematic review and meta-analysis","volume":"39","author":"Wu","year":"2019","journal-title":"Retina"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1001\/jamaophthalmol.2015.5052","article-title":"Risk of mortality and of atherosclerotic events among patients who underwent hemodialysis and subsequently developed retinal vascular occlusion: A Taiwanese retrospective cohort study","volume":"134","author":"Hsieh","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.ajo.2015.07.025","article-title":"Early vitrectomy for spontaneous, fundus-obscuring vitreous hemorrhage","volume":"160","author":"Melamud","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1001\/jama.2020.23027","article-title":"Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy: A randomized clinical trial","volume":"324","author":"Antoszyk","year":"2020","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Russo, A., Longo, A., Avitabile, T., Bonfiglio, V., Fallico, M., Boscia, F., Furino, C., Cillino, S., Toro, M., and Rejdak, R. (2019). Incidence and risk factors for tractional macular detachment after anti-vascular endothelial growth factor agent pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111960"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.ophtha.2023.04.014","article-title":"Surgery, tissue plasminogen activator, antiangiogenic agents, and age-related macular degeneration study: A randomized controlled trial for submacular hemorrhage secondary to age-related macular degeneration","volume":"130","author":"Gabrielle","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1097\/IAE.0000000000002570","article-title":"Outcomes of vitrectomy in Terson syndrome: A multicenter Canadian perspective","volume":"40","author":"Nazarali","year":"2020","journal-title":"Retina"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/3\/371\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:26:53Z","timestamp":1760027213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/3\/371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["diagnostics15030371"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15030371","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,4]]}}}