Learning from minimal human supervision is a long-standing goal in medical image analysis, where dense expert annotations are costly. We study retinal vessel segmentation in an extreme semi-supervised setting with one annotated image and a pool of unlabeled images. We propose ESRVS, which selects a representative reference image for manual annotation and transfers vessel cues using target-domain-adapted DINOv3 features. ESRVS constructs a multi granular vessel prototype, combines prototype-similarity maps with a physics-inspired prior to generate initial pseudo-labels, and refines the transferred supervision through weighted pseudo-label training and adversarial refinement. Across eight public datasets, ESRVS achieves the best Dice and clDice on six datasets, and the best HD95 on all eight datasets among the compared semi-supervised methods, although those methods use 10 to 20% labeled data. With Mask2Former, ESRVS retains on average 93.7% of fully supervised Dice and 95.1% of fully supervised clDice. These results demonstrate the potential of foundation-model label propagation for highly label-efficient retinal vessel segmentation. Code is available at https://github.com/IAANNH/ESRVS.
Retinal blood vessel segmentation plays a vital role in the early detection of diabetic retinopathy and glaucoma. While recent deep learning models have achieved great segmentation accuracy, they typically require heavy computational resources, making real-world deployment on edge devices difficult. In this paper, we propose LightVesselNet, an efficient neural network designed for retinal vessel segmentation in a resource-constrained environment. Despite containing only 75K parameters, LightVesselNet performs competitively with much larger models. The network employs a compact encoder decoder architecture enhanced with channel and spatial attention mechanisms, a multi-scale feature aggregation module at the bottleneck, and a subpixel upsampling strategy in the decoder. A dedicated edge residual connection preserves fine vessel detail throughout decoding. Extensive experiments on five publicly available datasets: DRIVE, STARE, CHASEDB1, FIVES, and HRF, yield sensitivity scores of 0.8189, 0.8499, 0.8640, 0.8634, 0.8096, and Dice coefficients of 0.8070, 0.8072, 0.8181, 0.8649, and 0.7686, respectively. LightVesselNet shows improved efficiency (Performance vs Parameter or GFlops) compared to State-of-the-Art models. Cross-dataset evaluation confirms the model's generalisation capability. Overall, LightVesselNet is a strong candidate for deployment in low-resource clinical settings and mobile screening tools.