Objectives: To define optical coherence tomographic (OCT)-criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ul...Objectives: To define optical coherence tomographic (OCT)-criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). Design: Retrospective observational case series. Participants: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. Methods: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. Main Outcome Measures: Standard and ultrahigh-resolution OCT images. Results: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37% ). Twelve of 19 eyes (63% ) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53% ) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89% ) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25% ) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. Conclusions: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting cautionwhen performing vitrectomy on lamellar holes.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
文摘Objectives: To define optical coherence tomographic (OCT)-criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). Design: Retrospective observational case series. Participants: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. Methods: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. Main Outcome Measures: Standard and ultrahigh-resolution OCT images. Results: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37% ). Twelve of 19 eyes (63% ) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53% ) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89% ) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25% ) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. Conclusions: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting cautionwhen performing vitrectomy on lamellar holes.
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.
