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Retinopathy of prematurity and ischemic brain injury resulting in periventricular white matter damage are the main causes of visual impairment in premature infants. Accurate optic disc (OD) segmentation has important prognostic significance for the auxiliary diagnosis of the above two diseases of premature infants. Because of the complexity and non-uniform illumination and low contrast between background and the target area of the fundus images, the segmentation of OD for infants is challenging and rarely reported in the literature. In this article, to tackle these problems, we propose a novel attention fusion enhancement network (AFENet) for the accurate segmentation of OD in the fundus images of premature infants by fusing adjacent high-level semantic information and multiscale low-level detailed information from different levels based on encoder–decoder network. Specifically, we first design a dual-scale semantic enhancement (DsSE) module between the encoder and the decoder inspired by self-attention mechanism, which can enhance the semantic contextual information for the decoder by reconstructing skip connection. Then, to reduce the semantic gaps between the high-level and low-level features, a multiscale feature fusion (MsFF) module is developed to fuse multiple features of different levels at the top of encoder by using attention mechanism. Finally, the proposed AFENet was evaluated on the fundus images of preterm infants for OD segmentation, which shows that the proposed two modules are both promising. Based on the baseline (Res34UNet), using DsSE or MsFF module alone can increase Dice similarity coefficients by 1.51 and 1.70%, respectively, whereas the integration of the two modules together can increase 2.11%. Compared with other state-of-the-art segmentation methods, the proposed AFENet achieves a high segmentation performance.

AFENet: Attention Fusion Enhancement Network for Optic Disc Segmentation of Premature Infants