The patient was a 3½-month-old male infant who became apneic and unresponsive at home. On transport to the hospital, she developed seizures, was found to have intracranial hemorrhage, and was admitted to the ICU. Fundus examination demonstrated extensive, bilateral retinal hemorrhages in multiple layers, including large dome-shaped hemorrhages overlying both maculae. Subsequently, the left eye developed break-through vitreous hemorrhage. Two months later, once she was sufficiently stable, she underwent examination under anesthesia (EUA) and vitrectomy in the left eye.
During the EUA, RetCam (Clarity Medical Systems, Inc., Pleasanton, CA) photographs were taken of the right eye. A handheld SD-OCT probe (Bioptigen Inc., Research Triangle Park, NC) was used to acquire images of the right eye as well. The handheld SD-OCT probe does not afford acquisition of a simultaneous fundus image, as is possible with a standard SD-OCT interface. However the “summed volume intensity projection,” which is a surface image created from the OCT volumetric data, can be used to precisely localize the retinal location of the OCT scans. This is done by registering the “summed volume intensity projection” to the fundus image obtained with the RetCam using the vasculature visible in both images. The results are in and . The SD-OCT images show the retinoschisis cavity overlying the macula with sub-ILM hemorrhage extending to the optic nerve. Features that were not visible in the RetCam image were seen in the corresponding OCT image, illustrating the complementary relationship between these imaging modalities.
Figure 1 RetCam photo with spectral domain optical coherence tomography (SD OCT) fundus image overlaid on top after image registration. The lines show the locations of the SD OCT scans in the boxes to the right; each line and SD OCT image has a corresponding label. (more ...)
RetCam photo without spectral domain optical coherence tomography (SD-OCT) fundus image overlay but with scan positions depicted.
Vitrectomy was performed on the left eye using a lens sparing technique and an irrigating light pipe. Once the vitreous hemorrhage was cleared, a large, dome shaped, sub-ILM hemorrhage was seen to overlie the macula, just as in the right eye. A small incision was made in the inferior aspect of the ILM, with the goal of allowing the hemorrhage to disperse and become absorbed. At the most recent follow-up, 3 weeks post-surgery, both eyes were seen to have improved substantially. The hemorrhages overlying both maculae had largely resorbed, and the remainder had layered inferior to the central macula.