Prediction of the Cause of Fundus-Obscuring Vitreous Hemorrhage Using Machine Learning

<b>Objectives:</b> 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. <b>Methods:</b> 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.