Objective: To investigate the capabilities of ultrahighreso-lution optical coherence tomography (UHR OCT); to compare with the commercially available OCT standard-resolution system, StratusOCT, for imaging of idiopath...Objective: To investigate the capabilities of ultrahighreso-lution optical coherence tomography (UHR OCT); to compare with the commercially available OCT standard-resolution system, StratusOCT, for imaging of idiopathic juxtafoveal retinal telangiectasis (IJT); and to demonstrate that UHROCT provides additional information on disease morphology, pathogenesis, and management. Design: Retrospective, observational, interventional case series. Participants: Nineteen eyes of 10 patients diagnosed with IJT in at least one eye. Method: All patients were imaged with UHR OCT and StratusOCT at the same visit. A subset of patients was also imaged before and after treatment of IJT. Main Outcome Measures: Ultrahigh-and standard-resolution cross-sectional tomograms of IJT pathology. Results: Using both standard-and ultrahigh-resolution OCT, we identified the following features of IJT: (1) a lack of correlation between retinal thickening on OCT and leakage on fluorescein angiography, (2) loss and disruption of the photoreceptor layer, (3) cystlike structures in the foveola and within internal retinal layers such as the inner nuclear or ganglion cell layers, (4) a unique internal limiting membrane draping across the foveola related to an underlying loss of tissue, (5) intraretinal neovascularization near the fovea, and (6) central intraretinal deposits and plaques. In 63%of cases, the presence of abnormal vessels and a discontinuity of the photoreceptor layer correlatedwith visual acuity. Conclusions: Ultrahigh-resolution OCT improves visualization of the retinal pathology associated with IJT and allows identification of new features associated with it. Some of these features, such as discontinuity of the photoreceptor layer, are revealed only by UHR OCT.展开更多
To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patien ts with unilateral idiopathic macular holes, and to evalua...To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patien ts with unilateral idiopathic macular holes, and to evaluate the subsequent risk of progression to a full thickness macular hole. Retrospective observational c ase series. Ninety four patients with a unilateral stage 2, 3, or 4 full thick ness macular hole. The medical records of patients with a unilateral macular hol e diagnosed between 1994 and 2000 at the New England Eye Center were reviewed. D evelopment of a full thickness macular hole in the fellow eye on biomicroscopic fundoscopy or optical coherence tomography (OCT). In 27 (28.7%) of 94 clinical ly normal fellow eyes, OCT detected an abnormality of the vitreoretinal interfac e but normal foveal anatomy. The vitreoretinal abnormalities were further subcla ssified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes) based on the intensity and morphology of the OCT signal. One of the 4 (25%) severe cases pr ogressed to a full thickness macular hole, 4 of the 8(50%) moderate cases beca me full thickness macular holes, and no (0%) mild cases progressed to a full thickness macular hole. Severe and moderate eyes seemed to share characteristic features on OCT that increased their risk of macular hole development (stage 0 m acular hole). The macular hole free survival at 48 months was 94%for stage 0 ne gative patients, versus 54%for stage 0 positive patients. Univariate analysis r evealed that the presence of a stage 0 macular hole was significantly associated with an almost 6 fold increase in the risk of macular hole formation (relative risk: 5.8, 95%confidence interval: 1.16 28.61, P=0.03). A stage 0 macular hole has a normal biomicroscopic appearance clinically, but has salient features on OCT as a result of oblique vitreous traction. Optical coherence tomographic find ings consist of a normal foveal contour and normal retinal thickness and must in clude the presence of a preretinal, minimally reflective, thin band inserting ob liquely on at least one side of the fovea. The presence of a stage 0 macular hol e in the fellow eye is a significant risk factor for the development of a second macular hole.展开更多
Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UH...Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UHR OCT provides addi tional information on disease morphology, pathogenesis, and management; and to u se UHR OCT as a baseline for improving the interpretation of the standard reso lution images. Design Observational and interventional case series. Participants Twenty nine eyes of 24 patients clinically diagnosed with macular hole in at l east one eye. Methods A UHR OCT system has been developed and employed in a ter tiary care ophthalmology clinic. Using a femtosecond laser as the lowcoherence light source, this new UHR OCT system can achieve an unprecedented 3 μm axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR OCT and standard 10 μm resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the populati on before and after macular hole surgery. Main outcome measures Ultrahigh and s tandard reso lution cross sectional OCT images of macular hole pathologies. R esults Both UHR OCT and standard resolution OCT exhibited comparable performan ce in differentiating various stages of macular holes. The UHR OCT provided imp roved imaging of finer intraretinal structures, such as the external limiting me mbrane and photoreceptor inner segment (IS) and outer segment (OS), and identifi cation of the anatomy of successful surgical repair. The improved resolution of UHR OCT enabled imaging of previously unidentified changes in photoreceptor mor phology associated with macular hole pathology and postoperative repair. Visuali zation of the junction between the photoreceptor IS and OS was found to be an im portant indicator of photoreceptor integrity for both standard resolution and U HR OCT images. Conclusions Ultrahigh resolution optical coherence tomography i mproves the visualization of the macular hole architectural morphology. The incr eased resolution of UHR OCT enables the visualization of photoreceptor morpholo gy associated with macular holes. This promises to lead to a better understandin g of the pathogenesis of macular holes, the causes of visual loss secondary to m acular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh resolu tion optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR OCT images. Comparisons of UHR OCT images with standard resolution OCT images can establish a baseline for the better in terpretation of clinical standard resolution OCT images. The ability to visuali ze photoreceptors and their integrity or impairment is an indicator of macular h ole progression and surgical outcome.展开更多
Objective: To describe a standardized method for reporting quantitative change s in macular thickening using optical coherence tomography (OCT). Methods: The p roposed method consists of calculating the actual change ...Objective: To describe a standardized method for reporting quantitative change s in macular thickening using optical coherence tomography (OCT). Methods: The p roposed method consists of calculating the actual change in central foveal thick ening (the initial pretreatment thickness minus the posttreatment thickness) usi ng OCT and dividing that value by the potential change (the initial pretreatment thickness minus the normal thickness based on normative data) to provide the to tal improvement in macular edema as a percentage. We refer to this method as the standardized change in macular thickening (SCMT). To illustrate the effectivene ss of this method, we performed a retrospective review of 2 studies that evaluat ed different strategies for treating refractory macular edema. Results: Patients treated with intravitreal triamcinolone acetonide for refractory diabetic macul ar edema had an overall SCMT of approximately 75%, 78%, and 55%at the 1-, 3 -, and 6-month follow-up visits, respectively. More than half of the patients in the study cohort (9 of 16 patients) experienced greater than 80%SCMT at the last follow-up visit. Patients who underwent vitrectomy for a taut, thickened posterior hyaloid on OCT responded with an SCMT of approximately 78%at the 3-m onth follow-up visit and 87%at the final follow-up visit (mean, 19 months). P atients who underwent vitrectomy for diabetic macular edema unresponsive to lase r photocoagulation but with no evidence of vitreomacular traction experienced an SCMT of 37%at the 3-month follow-up visit and 20%at the final follow-up vi sit (mean, 17 months). Conclusion: The proposed method offers an objective and i ntuitive basis for evaluating and comparing the efficacy of different therapeuti c modalities.展开更多
文摘Objective: To investigate the capabilities of ultrahighreso-lution optical coherence tomography (UHR OCT); to compare with the commercially available OCT standard-resolution system, StratusOCT, for imaging of idiopathic juxtafoveal retinal telangiectasis (IJT); and to demonstrate that UHROCT provides additional information on disease morphology, pathogenesis, and management. Design: Retrospective, observational, interventional case series. Participants: Nineteen eyes of 10 patients diagnosed with IJT in at least one eye. Method: All patients were imaged with UHR OCT and StratusOCT at the same visit. A subset of patients was also imaged before and after treatment of IJT. Main Outcome Measures: Ultrahigh-and standard-resolution cross-sectional tomograms of IJT pathology. Results: Using both standard-and ultrahigh-resolution OCT, we identified the following features of IJT: (1) a lack of correlation between retinal thickening on OCT and leakage on fluorescein angiography, (2) loss and disruption of the photoreceptor layer, (3) cystlike structures in the foveola and within internal retinal layers such as the inner nuclear or ganglion cell layers, (4) a unique internal limiting membrane draping across the foveola related to an underlying loss of tissue, (5) intraretinal neovascularization near the fovea, and (6) central intraretinal deposits and plaques. In 63%of cases, the presence of abnormal vessels and a discontinuity of the photoreceptor layer correlatedwith visual acuity. Conclusions: Ultrahigh-resolution OCT improves visualization of the retinal pathology associated with IJT and allows identification of new features associated with it. Some of these features, such as discontinuity of the photoreceptor layer, are revealed only by UHR OCT.
文摘To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patien ts with unilateral idiopathic macular holes, and to evaluate the subsequent risk of progression to a full thickness macular hole. Retrospective observational c ase series. Ninety four patients with a unilateral stage 2, 3, or 4 full thick ness macular hole. The medical records of patients with a unilateral macular hol e diagnosed between 1994 and 2000 at the New England Eye Center were reviewed. D evelopment of a full thickness macular hole in the fellow eye on biomicroscopic fundoscopy or optical coherence tomography (OCT). In 27 (28.7%) of 94 clinical ly normal fellow eyes, OCT detected an abnormality of the vitreoretinal interfac e but normal foveal anatomy. The vitreoretinal abnormalities were further subcla ssified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes) based on the intensity and morphology of the OCT signal. One of the 4 (25%) severe cases pr ogressed to a full thickness macular hole, 4 of the 8(50%) moderate cases beca me full thickness macular holes, and no (0%) mild cases progressed to a full thickness macular hole. Severe and moderate eyes seemed to share characteristic features on OCT that increased their risk of macular hole development (stage 0 m acular hole). The macular hole free survival at 48 months was 94%for stage 0 ne gative patients, versus 54%for stage 0 positive patients. Univariate analysis r evealed that the presence of a stage 0 macular hole was significantly associated with an almost 6 fold increase in the risk of macular hole formation (relative risk: 5.8, 95%confidence interval: 1.16 28.61, P=0.03). A stage 0 macular hole has a normal biomicroscopic appearance clinically, but has salient features on OCT as a result of oblique vitreous traction. Optical coherence tomographic find ings consist of a normal foveal contour and normal retinal thickness and must in clude the presence of a preretinal, minimally reflective, thin band inserting ob liquely on at least one side of the fovea. The presence of a stage 0 macular hol e in the fellow eye is a significant risk factor for the development of a second macular hole.
文摘Purpose To compare ultrahigh resolution optical coherence tomography (UHR OC T) technology to a standard resolution OCT instrument for the imaging of macula r hole pathology and repair; to identify situations where UHR OCT provides addi tional information on disease morphology, pathogenesis, and management; and to u se UHR OCT as a baseline for improving the interpretation of the standard reso lution images. Design Observational and interventional case series. Participants Twenty nine eyes of 24 patients clinically diagnosed with macular hole in at l east one eye. Methods A UHR OCT system has been developed and employed in a ter tiary care ophthalmology clinic. Using a femtosecond laser as the lowcoherence light source, this new UHR OCT system can achieve an unprecedented 3 μm axial resolution for retinal OCT imaging. Comparative imaging was performed with UHR OCT and standard 10 μm resolution OCT in 29 eyes of 24 patients with various stages of macular holes. Imaging was also performed on a subset of the populati on before and after macular hole surgery. Main outcome measures Ultrahigh and s tandard reso lution cross sectional OCT images of macular hole pathologies. R esults Both UHR OCT and standard resolution OCT exhibited comparable performan ce in differentiating various stages of macular holes. The UHR OCT provided imp roved imaging of finer intraretinal structures, such as the external limiting me mbrane and photoreceptor inner segment (IS) and outer segment (OS), and identifi cation of the anatomy of successful surgical repair. The improved resolution of UHR OCT enabled imaging of previously unidentified changes in photoreceptor mor phology associated with macular hole pathology and postoperative repair. Visuali zation of the junction between the photoreceptor IS and OS was found to be an im portant indicator of photoreceptor integrity for both standard resolution and U HR OCT images. Conclusions Ultrahigh resolution optical coherence tomography i mproves the visualization of the macular hole architectural morphology. The incr eased resolution of UHR OCT enables the visualization of photoreceptor morpholo gy associated with macular holes. This promises to lead to a better understandin g of the pathogenesis of macular holes, the causes of visual loss secondary to m acular holes, the timing of surgical repair, and the evaluation of postsurgical outcome. Ultrahigh resolu tion optical coherence tomography imaging of macular holes that correspond to known alterations in retinal morphology can be used to interpret retinal morphology in UHR OCT images. Comparisons of UHR OCT images with standard resolution OCT images can establish a baseline for the better in terpretation of clinical standard resolution OCT images. The ability to visuali ze photoreceptors and their integrity or impairment is an indicator of macular h ole progression and surgical outcome.
文摘Objective: To describe a standardized method for reporting quantitative change s in macular thickening using optical coherence tomography (OCT). Methods: The p roposed method consists of calculating the actual change in central foveal thick ening (the initial pretreatment thickness minus the posttreatment thickness) usi ng OCT and dividing that value by the potential change (the initial pretreatment thickness minus the normal thickness based on normative data) to provide the to tal improvement in macular edema as a percentage. We refer to this method as the standardized change in macular thickening (SCMT). To illustrate the effectivene ss of this method, we performed a retrospective review of 2 studies that evaluat ed different strategies for treating refractory macular edema. Results: Patients treated with intravitreal triamcinolone acetonide for refractory diabetic macul ar edema had an overall SCMT of approximately 75%, 78%, and 55%at the 1-, 3 -, and 6-month follow-up visits, respectively. More than half of the patients in the study cohort (9 of 16 patients) experienced greater than 80%SCMT at the last follow-up visit. Patients who underwent vitrectomy for a taut, thickened posterior hyaloid on OCT responded with an SCMT of approximately 78%at the 3-m onth follow-up visit and 87%at the final follow-up visit (mean, 19 months). P atients who underwent vitrectomy for diabetic macular edema unresponsive to lase r photocoagulation but with no evidence of vitreomacular traction experienced an SCMT of 37%at the 3-month follow-up visit and 20%at the final follow-up vi sit (mean, 17 months). Conclusion: The proposed method offers an objective and i ntuitive basis for evaluating and comparing the efficacy of different therapeuti c modalities.
