Related Articles

The purpose of this article is to compare spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) findings in patients with solar retinopathy. Complete ocular examinations and OCT were performed in two patients presenting with acute solar retinopathy soon after observation of an eclipse. Both patients were evaluated with SD-OCT and TD-OCT at the same time. SD-OCT demonstrated characteristic defects at the level of the inner and outer segment junction of the photoreceptors in all the affected eyes and decreased reflectiveness of the retinal pigment epithelium layer. TD-OCT images showed unremarkable findings in two eyes with deteriorated visual acuity. SD-OCT improves diagnosis and assessment of the degree and nature of foveal damage in patients with solar retinopathy and may be an important tool for use in identifying foveal damage not detected by TD-OCT. SD-OCT may be preferable to TD-OCT for confirmation or assessment of the degree of foveal damage in patients with solar retinopathy.

Purpose

To describe ocular findings for a 34-year-old man with chronic solar retinopathy using high-speed ultrahigh-resolution (UHR) optical coherence tomography (OCT).

Methods

Fundus photography, fluorescein angiography, and Stratus OCT (Carl Zeiss Meditec, Inc., Dublin, CA) were performed. A high-speed UHR OCT prototype developed in our ophthalmology clinic was used to obtain detailed images of the retina.

Patients

Two eyes of one patient with chronic solar retinopathy were studied.

Results

Both Stratus OCT and high-speed UHR OCT demonstrated foveal thinning bilaterally. In addition, high-speed UHR OCT showed distinct hyporeflective disruptions in the photoreceptor inner segment/outer segment junction and photoreceptor outer segments bilaterally. En face OCT images from three-dimensional OCT data sets revealed hyporeflective regions of photoreceptor atrophy in the outer retina.

Conclusions

High-speed UHR OCT showed more detail than standard OCT, and findings were consistent with histopathologic and ultrastructural features that have been reported previously. Solar retinopathy should be studied further with high-speed UHR OCT to determine the short- and long-term effects of solar radiation damage.

Purpose. Solar retinopathy is a rare clinical disturbance, for which spectral-domain optical coherence tomography (SD-OCT) findings are not always consistent. We report on two cases of solar retinopathy and discuss its differential diagnosis. Methods. This is an observational case study. Results. A 12-year-old female was referred to ophthalmology for bilateral scotoma. Visual acuity was 20/50 in both eyes. Fundus examination was unremarkable, except for slight yellowish material in the central macula, bilaterally. SD-OCT revealed juxtafoveal microcystic cavities in the outer retina, interruption of the external limiting membrane and the inner and outer segment junctions, with disorganized material in the vitelliform space. Fundus autofluorescence showed hypoautofluorescence surrounded by a relatively hyperautofluorescent ring, bilaterally. Similar clinical and morphological findings were detected in a 27-year-old male. Conclusions. Solar retinopathy has a subtle presentation and patients often deny sun-gazing. SD-OCT and fundus autofluorescence are noninvasive and useful tools for its diagnosis.

Purpose

We studied the appearance of margins of Geographic atrophy in high- resolution optical coherence tomography (OCT) images and correlate those changes with fundus autofluorescence imaging.

Design

Retrospective observational case study.

Methods

Patients with geographic atrophy secondary to dry age related macular degeneration (ARMD) were assessed by means of Spectral Domain OCT (Spectralis HRA/OCT; Heidelberg Engineering, Heidelberg, Germany or OTI, Inc, Toronto, Canada) as well as Autofluoresence Imaging (HRA or Spectralis Heidelberg Engineering, Heidelberg, Germany): The outer retinal layer alterations were analyzed in the junctional zone between normal retina and atrophic retina, and correlated with corresponding fundus autofluorescence.

Results

23 eyes of 16 patients aged between 62 years to 96 years were examined. There was a significant association between OCT findings and the fundus autofluorescence findings(r=0.67, p<0.0001). Severe alterations of the outer retinal layers at margins on Spectral OCT correspond significantly to increased autofluorescence; Smooth margins on OCT correspond significantly to normal fundus autofluorescence. (Kappa-0.7348, p<0.0001).

Conclusion

Spectral OCT provides in vivo insight into the pathogenesis of geographic atrophy and its progression. Visualization of reactive changes in the retinal pigment epithelial cells at the junctional zone and correlation with increased fundus autofluorescence; secondary to increased lipofuscin may together serve as determinants of progression of geographic atrophy.

Objective

This study aims to describe changes in high-resolution spectral domain optical coherence tomography (SD-OCT) scans with simultaneous fundus autoflorescence (FAF) signals in tubercular serpiginouslike choroiditis (SLC).

Methods

Simultaneous SD-OCT and FAF imaging of eyes affected with SLC from acute stage until resolution of lesions was obtained using Spectralis HRA+OCT system (Heidelberg Engineering, Heidelberg, Germany).

Patients

Four eyes (three patients) with SLC were prospectively followed.

Results

Acute lesions of SLC (diffusely hyperautofluorescent) corresponded to hyperreflective areas on SD-OCT involving the retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with a minimal distortion of inner retinal layers. There was no backscattering from inner choroid. During healing, lesions became discrete with a hypoautofluorescent border and predominant hyperautofluorescence centrally. The hyperreflective fuzzy areas on SD-OCT scans disappeared, and irregular, knobbly elevations of outer retinal layers appeared. The RPE, POST, IS/OS junction, and ELM could not be distinguished. The ONL appeared normal. The choroid showed an increased reflectance. As the lesions healed further over the next 3–6 months, they became predominantly hypoautofluorescent with loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan.

Conclusion

The SD-OCT provided an insight into the ultrastructural changes in the outer retina during the course of acute SLC lesions. The changes on OCT correlated with abnormal FAF findings.

Objective

This study aims to describe changes in high-resolution spectral domain optical coherence tomography (SD-OCT) scans with simultaneous fundus autoflorescence (FAF) signals in tubercular serpiginouslike choroiditis (SLC).

Methods

Simultaneous SD-OCT and FAF imaging of eyes affected with SLC from acute stage until resolution of lesions was obtained using Spectralis HRA+OCT system (Heidelberg Engineering, Heidelberg, Germany).

Patients

Four eyes (three patients) with SLC were prospectively followed.

Results

Acute lesions of SLC (diffusely hyperautofluorescent) corresponded to hyperreflective areas on SD-OCT involving the retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with a minimal distortion of inner retinal layers. There was no backscattering from inner choroid. During healing, lesions became discrete with a hypoautofluorescent border and predominant hyperautofluorescence centrally. The hyperreflective fuzzy areas on SD-OCT scans disappeared, and irregular, knobbly elevations of outer retinal layers appeared. The RPE, POST, IS/OS junction, and ELM could not be distinguished. The ONL appeared normal. The choroid showed an increased reflectance. As the lesions healed further over the next 3–6 months, they became predominantly hypoautofluorescent with loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan.

Conclusion

The SD-OCT provided an insight into the ultrastructural changes in the outer retina during the course of acute SLC lesions. The changes on OCT correlated with abnormal FAF findings.

Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence.

Objective

To characterize foveal atrophy in a heterogeneous group of uveitis patients using clinical findings and high-definition optical coherence tomography (HD-OCT).

Design

Cross-sectional, retrospective case series.

Results

HD-OCT scans of 140 patients seen in a tertiary referral center were reviewed and 23 patients (33 eyes) with foveal atrophy were identified. All patients with foveal atrophy were diagnosed with intermediate uveitis, posterior uveitis, or panuveitis. The status of the photoreceptor layer as visualized with HD-OCT was associated with significant differences in mean visual acuity (p<0.0001). Clinical findings associated with foveal atrophy included atrophy of the retinal pigment epithelium (RPE) and/or choroid (91%), macular ischemia (39%), cystoid macular edema (15%), choroidal neovascularization (12%), retinal detachment involving the macula (6%), and serum antiretinal antibodies (6%).

Conclusions

Foveal atrophy can be a complication of intraocular inflammation in a variety of uveitic syndromes. The etiology of foveal atrophy is multi-factorial and may include dysfunction and atrophy of the RPE and/or choroid, cystoid macular edema, macular ischemia secondary to occlusive retinal vasculitis, choroidal neovascularization, retinal detachment, and possibly antibody-mediated damage directed against photoreceptors. Careful observation of the photoreceptor layer using HD-OCT may help to identify patients who are at risk for visual loss secondary to foveal atrophy.

Purpose. To report clinical aspects, tomographic, angiographic, and autofluorescence patterns of two cases of isolated foveal hypoplasia. Methods. Foveal hypoplasia was found in a 23-year-old male patient and in a 64-year-old woman with impaired visual acuity of unknown etiology that remained unchanged for years. Results. In the first case, spectral-domain optical coherence tomography (SD-OCT) showed reduced foveal pit and continuity of inner retinal layers in the fovea. Photoreceptor layer had a normal thickness centrally. The foveal avascular zone (FAZ) was absent in the flourescein angiogram (FA). Fundus autofluorescence showed reduced foveal attenuation of autofluorescence. In the second patient, there was the same pattern in SD-OCT, with normal aspect in FA and only a slightly reduced foveal attenuation of autofluorescence. Conclusion. OCT, as a noninvasive and quick method, is helpful in the diagnosis of foveal hypoplasia. FA and fundus autofluorescence were less sensitive.

Purpose

To describe the morphology of the retina at the convalescent stage of acute zonal occult outer retinopathy (AZOOR) from images obtained by spectral domain optical coherence tomography (SD-OCT).

Methods

The visual fields, electroretinograms (ERGs), and OCT images were reviewed in two women aged 24 and 33 years. The patients were followed for one and four years, respectively.

Results

In both cases, the anterior and posterior segments were almost normal, although both patients had a sudden unilateral vision decrease and photopsia. Goldmann perimetry revealed enlarged blind spots and scotomas. The ERGs were reduced in both cases. SD-OCT showed that the junction of the inner and outer segment, the IS/OS line, of the photoreceptors was irregular or lost in the affected retinas. The retina in these areas was thinner due to a decrease in the thickness of both the outer nuclear layer (ONL) and inner nuclear layer (INL) in Case 2.

Conclusions

The decrease in retinal thickness at the convalescent stage of AZOOR is most likely due to a shortening of not only the photoreceptors and ONL but also to a thinning of the INL in a severe case.

PURPOSE

To report optical coherence tomography (OCT) features of patients with autoimmune retinopathy.

DESIGN

Consecutive case series.

METHOD

Eight patients who presented with unexplained loss of central vision, visual field defects, and/or photopsia were diagnosed with autoimmune retinopathy based on clinical features, electroretinogram (ERG) findings, and serum antiretinal antibody analysis. All patients underwent OCT testing of the macula and nerve fiber layer (NFL).

RESULTS

Outer retinal abnormalities and/or decreased macular thickness on OCT were seen in all patients. Macular OCT showed reduced central macular and foveal thicknesses in 6 patients (mean thickness 143 ± 30 μm and 131 ± 29 μm respectively). In all but 1 patient, loss of the photoreceptor layer or disruption of the photoreceptor outer and inner segment junction was noted. Three patients showed only mild to moderate focal NFL loss.

CONCLUSIONS

Retinal atrophy and reduced macular thickness on OCT are predominant features in patients with autoimmune retinopathy. OCT provides objective measures of retinal damage and may offer clues toward understanding the mechanism of visual dysfunction and the diagnosis of autoimmune retinopathy.

Background and Objective

A retrospective cross-sectional study was conducted to demonstrate an analysis of an outer retinal layer reconstructed by the three-dimensional and high-speed spectral domain optical coherence tomography (SD-OCT) instrument.

Patients and Methods

New measurement protocols for SD-OCT and methods of analysis and visualization of the individual segmented retinal layer reconstructed by SD-OCT were proposed. Three contour maps representing mutual distances between the basal part of the retinal pigment epithelium, the junction between the inner and outer segments of photoreceptors, and a reference contour representing the shape of a healthy retina were introduced.

Results

The analysis of the outer retina was performed on pathological eyes. Three cases of central serous chorioretinopathy, age-related macular degeneration, and acute zonal occult outer retinopathy are demonstrated.

Conclusion

Three contour maps reconstructed for clinical cases demonstrate high variability of observed patterns depending on analyzed pathology. The authors believe this can help to present OCT data simultaneously in a more comprehensive and convenient way to assist in everyday clinical diagnosis.

Purpose. To evaluate macular thickness, agreement, and intraclass repeatability in three optical coherence tomography (OCT) devices: the time domain (TD) Stratus OCT and two spectral domain (SD) OCTs, Spectralis and Cirrus SD-OCT, in eyes with macular edema secondary to diabetic retinopathy (DR) and retinal vein occlusion (VO). Methods. In a prospective observational study at a university-based retina practice, retinal thickness tomography was performed simultaneously for fifty-eight patients (91 eyes) with DR and VO employing a time domain and two spectral domain OCTs. Agreement in macular measurements was assessed by constructing Bland-Altman plots. Intraclass repeatability was assessed by intraclass correlation coefficients (ICCs). Results. Based on the Bland-Altman plots for central macular thickness, there was low agreement between the measurements of Cirrus SD-OCT and Stratus OCT, Spectralis OCT and Stratus OCT, as well as Spectralis OCT and Cirrus SD-OCT among DR and RVO patients. All three devices demonstrated high intraclass repeatability, with ICC of 98% for Stratus OCT, 97% for Cirrus SD-OCT, and 100% for Spectralis OCT among DR patients. The ICC was 97% for Stratus OCT, 79% for Cirrus SD-OCT, and 91% for Spectralis OCT among RVO patients. Conclusion. There are low agreements among interdevice measurements. However, intraclass repeatability is high in both TD and SD-OCT devices.

Aim: To describe the tomographic findings of a case of myopic traction maculopathy using Spectral Domain Optical Coherence Tomography (SD-OCT) and present the results of its surgical intervention.

Design: Observational case report and review of the literature.

Methods: A 61-year-old male with metamorphopsia was examined clinically and with the use of SD-OCT. The diagnosis of myopic traction maculopathy was made. The patient underwent pars plana vitrectomy with removal of the vitreomacular adhesions, the epiretinal and the internal limiting membrane.

Results: Visual acuity increased by two Snellen lines, metamorphopsia disappeared, macular morphology was improved and myopic traction maculopathy was resolved.

Conclusions: Imaging with SD-OCT is capable of documentation and measurement of the early stages of myopic traction maculopathy. Moreover, vitrectomy was beneficial for the visual and anatomic outcome of the patient.

Purpose

To investigate morphologic changes of acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy.

Methods

This retrospective study included 63 eyes of 63 patients with unilateral acute CSC. All patients underwent simultaneous SD-OCT and fluorescein angiography examination using Spectralis HRA+OCT.

Results

The external limiting membrane could be seen on SD-OCT, although the junction between photoreceptor inner and outer segments (IS/OS) was not detected in all eyes with retinal detachment (RD). However, IS/OS became visible after resolution of serous RD in 51 eyes (81.0%). SD-OCT images at the leakage sites showed a bump of retinal pigment epithelium (RPE) in in 47 cases (68.1%) and pigment epithelial detachment (PED) in 22 of 69 leakage sites (31.9%). In 14 of 69 leakage sites (20.3%), highly reflective areas suggesting fibrinous exudate were observed in the subretinal space. In nine leakage sites (13.0%), sagging or dipping of the posterior retinal layer was seen. Abnormal RPE changes such as RPE bump and PED were observed in 12 of 22 fellow eyes (54.5%).

Conclusions

A variety of morphologic changes could be identified on SD-OCT, and those findings may contribute more information to our understanding of the pathophysiology of CSC.

Introduction:

To assess photoreceptor (PR) layer morphology in patients with Stargardt’s disease (STGD) and fundus flavimaculatus (FFM) using high resolution spectral domain optical coherence tomography (HD-OCT; OCT 4000 Cirrus, Humphrey-Zeiss, San Leandro, CA).

Methods:

This was a prospective observational case series. Sixteen consecutive patients with STGD and FFM underwent a complete ophthalmologic examination. Optical coherence tomography examination was performed with HD-OCT, a high-speed (27,000 axial scans per second) OCT system using spectral/Fourier domain detection, with an axial image resolution of 5 μm.

Results:

A total of 31 eyes were included in the study. Transverse loss of the PR layer in the foveal region was shown by HD-OCT. Twenty eyes with clinically evident central atrophy had a disruption of either the Verhoeff‘s membrane (VM) or the layer corresponding to the interface of inner segment (IS) and outer segment (OS) of PR in the foveal region. Among these eyes, 12/20 eyes had a loss of the PR layer (loss of both VM and IS-OS interface) in the foveal region. Eleven eyes (11/31) without clinically evident central atrophy had an intact interface of IS and OS of PR centrally. Moreover, we observed hyperreflective deposits: type 1 lesions located within the retinal pigment epithelium (RPE) layer and at the level of the outer segments of PR, and type 2 lesions located at the level of the outer nuclear layer and clearly separated from the RPE layer. Type 1 lesions alone were associated with absence of loss of the PR layer in the foveal region in all eyes; type 2 lesions were always associated with presence of type 1 lesions, and often (8/12 eyes) associated with loss of the PR layer within the foveal region. Mean best-corrected visual acuity (BCVA) was significantly correlated with loss of the PR layer in the foveal region (P < 0.001), as well as to presence of type 2 flecks (P = 0.03).

Conclusion:

Type 2 deposits in STGD/FFM patients seem to represent a marker of the possible evolution towards foveal atrophy.

Purpose

This pilot study investigated whether high-resolution spectral-domain optical coherence tomography (SD-OCT) could detect differences in inner retinal layer (IRL), peripapillary retinal nerve fiber layer (RNFL), and macular thickness between patients with Parkinson’s disease (PD) and controls.

Methods

Both eyes of patients with PD and age-matched controls were imaged with the Heidelberg Spectralis® HRA + OCT. RNFL, IRL, and macular thickness were measured for each eye using Heidelberg software. These measurements were compared with validated, published normal values for macular and RNFL thickness, and compared with matched controls for IRL thickness.

Results

Eighteen eyes from nine subjects with PD and 19 eyes of 16 control subjects were evaluated using SD-OCT. The average age of PD patients was 64 years with a range of 52–75 years. The average age of controls was 67 years with a range of 50–81 years. No significant reduction in IRL thickness was detected between PD patients and age-matched controls at 13 points along a 6 mm horizontal section through the fovea. No significant difference in RNFL thickness was detected between PD patients and published normal values. Overall average RNFL thickness was 97 μm for PD patients, which exactly matched the normative database value. However, significant differences in macular thickness were detected in three of nine subfields between PD subjects and published normal values. In PD subjects, the outer superior subfield was 2.8% thinner (P = 0.026), while the outer nasal and inner inferior subfields were 2.8% (P = 0.016) and 2.7% (P = 0.001) thicker compared to published normal values.

Conclusion

In this pilot study, significant differences in macular thickness were detected in three of nine subfields by SD-OCT. However, SD-OCT did not detect significant reductions in peripapillary RNFL and IRL thickness between PD patients and controls. This suggests that macular thickness measurements by SD-OCT may potentially be used as an objective, noninvasive, and easily quantifiable in vivo biomarker in PD. Larger, longitudinal studies are needed to explore these relationships further.

AIM

To study macular features in patients with congenital nystagmus and to assess the utility of spectral-domain optical coherence tomography (SD-OCT) in nystagmus.

METHODS

The macular areas of 51 outpatients with congenital nystagmus were examined using SD-OCT. Morphological changes in the retinal layers of the macular area were analysed.

RESULTS

Macular images were successfully obtained with SD-OCT from 50 (98%) patients. Patients with ocular albinism mainly have macular hypoplasia, abnormal foveal depression, and increased foveal thickness with persistence of an inner nuclear layer, an inner plexiform layer, a ganglion cell layer and a nerve fiber layer. Macular morphology similar to albinism was observed in three patients with idiopathic macular hypoplasia. The OCT findings of cone dystrophy included unclear, disrupted or invisible photoreceptor outer segment/inner segment in the fovea; fusion, thickening and uneven reflection of the outer segment/inner segment with external limiting membrane. Some patients with congenital idiopathic nystagmus showed normal macular morphology and structure, and others showed indistinct macular external limiting membrane reflection.

CONCLUSION

SD-OCT is an effective and reliable method to detect the macular morphology of congenital nystagmus patients. This technique has diagnostic value in particular for patients with macular hypoplasia and cone cell dystrophy with no distinct abnormality on fundoscopy.

Background

Neuronal loss in the retina has been demonstrated pathologically in eyes of patients with multiple sclerosis (MS). In vivo, MS eyes have reduced total macular volumes by optical coherence tomography (OCT). Using high-resolution spectral-domain OCT, this pilot study used a manual method to measure ganglion cell layer (GCL) volumes and to determine the relation of these volumes to visual function in MS eyes.

Methods

Sixteen eyes of eight patients with MS and eight eyes of five disease-free control participants were studied using fast macular OCT scans performed with Spectralis OCT (Heidelberg Engineering). Visual function tests of low-contrast letter acuity and high-contrast visual acuity (VA) were administered.

Results

MS patient eyes had significantly lower GCL volumes than the control eyes (p<0.001 vs. controls, GEE regression models accounting for age and within-patient, inter-eye correlations). Within the MS group, eyes with a prior history of optic neuritis (ON, n=4) had significantly lower GCL volumes than MS eyes with no ON history (P<0.001). In contrast to measures of high-contrast VA (P=0.14), decreased GCL volumes were associated with worse performance on low-contrast letter acuity testing (P=0.003).

Conclusions

This pilot study has characterized thinning of the GCL in MS patient eyes, particularly in those with a history of acute ON, which corresponded to a reduced performance on low-contrast letter acuity testing. Studies utilizing computerized segmentation algorithms will continue to facilitate the detection of GCL loss on a larger scale and provide important information in vivo on the role and timing of neuronal vs. axonal loss in MS eyes.

We investigated the case of a young man with blurred vision in his left eye. His visual acuity was slightly decreased, and ophthalmoscopy disclosed a gray-white lesion in the macula. He had no systemic or ocular history. On the visual field test, the threshold sensitivity was decreased in the corresponding region. Spectral domain optical coherence tomography (OCT) demonstrated a disruption in the photoreceptor inner and outer segment (IS/OS) junction and undulation of the retinal pigment epithelium (RPE) with backscattering. We re-examined the patient after two weeks and after three months without any treatment. Visual acuity and visual field results were gradually normalized, and OCT demonstrated the recovery of continuity in the photoreceptor IS/OS junction, as well as decreased RPE irregularity with minimal backscattering. We used spectral domain OCT instead of time domain OCT (OCT3) so that we could provide better image resolution of the acute retinal pigment epitheliitis (ARPE). Finally, we observed recovery of the functional and anatomical changes in the ARPE patient with a resolution of the condition within three months following the initial examination, using OCT and visual field tests.

Purpose

To investigate the morphologic changes in the outer retina of patients with cone dystrophy, using spectral-domain optical coherence tomography (SD-OCT).

Methods

The medical records of 15 cone dystrophy patients examined from January 2007 to January 2012 were reviewed retrospectively. All patients underwent ophthalmic evaluation including best-corrected visual acuity (BCVA), color vision testing, fundus examination, full-field standard electroretinography (ERG), multifocal (mf) ERG, and SD-OCT. Qualitative and quantitative SD-OCT data and ERG responses were analyzed and compared among the patient categories and the normal control group.

Results

There were 4 major categories of SD-OCT findings, based on the status of the ellipsoid portion of the photoreceptor inner segment (ISe), outer segment (OS) contact cylinder, and retinal pigment epithelium (RPE) layer. Category 0 showed no structural abnormalities. Category 1 showed foveal ISe loss and obscurity of the border between the ISe band and the external limiting membrane (ELM). Category 2 showed foveal thinning and focal foveal ISe disruption with an intact ELM. Category 3 showed foveal thickening and perifoveal disruption of the ISe layer. Category 1 to 3 showed OS contact cylinder layer absence and RPE thickening. The patients in category 0 tended to be younger (mean, 10.0 years) than those in categories 1 to 3 (mean, 17.6 years), although this difference was not statistically significant. Category 1 to 3 patients exhibited statistically significant thinning of the central retina and outer nuclear layer and thickening of the RPE layer relative to the category 0 and normal control group. There was a significant correlation between the central foveal thickness and BCVA in the patients with cone dystrophy. ERG and mfERG responses did not differ significantly among the different cone dystrophy categories.

Conclusions

The morphologic features of cone dystrophy as revealed by SD-OCT, could be categorized as either normal or 1 of 3 different types of outer retinal changes. The presence of normal retinal structures in young cone dystrophy patients with functional impairment (category 0) indicates that electrophysiologic studies are superior to current imaging modalities for the early diagnosis of cone dystrophy. The characteristic SD-OCT findings in cone dystrophy patients may aid in differential diagnosis and be useful for future research on the pathology of cone dystrophy.

Purpose

The aim of this study is to report a patient with multipe evanescent white dot syndrome (MEWDS) presenting with classic foveal granularity and pathology localized to the outer retina.

Methods

Case study methodology was used in the current study.

Results

A 34-year-old Caucasian female presented with photopsias and blurry vision in her left eye. Examination, particularly the foveal granularity noted in her affected eye, was archetypal for the diagnosis of MEWDS. Fundus autofluorescence, fluorescein and indocyanine green angiography were also consistent with this diagnosis. Spectral-domain optical coherence tomography (SD-OCT) demonstrated increased retinal pigment epithelium granularity and disruption of the photoreceptor inner segment–outer segment junction subfoveally.

Conclusions

Foveal granularity may be the most specific feature of MEWDS with SD-OCT capable of localizing pathology to the outer retina—a historically controversial finding.

Objective

The aim of this article is to characterize pathomorphologic changes within particular layers of fluorescein angiographically ‘ischemic’ compared to ‘nonischemic’ retina in patients with diabetic retinopathy.

Methods

Cross-sectional images of ischemic retinal areas were obtained using Heidelberg Spectralis optical coherence tomography (OCT). Presumed retinal ischemia was defined as focal hypofluorescence in early or early and late phase fluorescein angiography. Pathomorphologic changes on OCT were evaluated and the thickness of retinal layers measured and compared with nonischemic retina at corresponding topographic locations in a matched-pairs design based on 22 eyes (mean age 64 ± 14).

Results

In all eyes, based on spectral domain-OCT cross-section images, the retina layers in ischemic retinal areas could be segmented. Total retinal thickness was significantly increased in ischemic compared to nonischemic areas (381 ± 94 μm versus 323 ± 89 μm, P = 0.005). Middle retinal layers (inner nuclear layer, outer plexiform layer, and outer nuclear layer) were significantly thickened in retinal ischemic areas (215 ± 82 μm versus 168 ± 62 μm, P = 0.002). The inner retinal layers (retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer) showed a nonsignificant change (117 ± 53 μm versus 98 ± 30 μm), while the outer layers were slightly thinned (photoreceptors plus retinal pigment epithelium layer; 51 ± 9 μm versus 57 ± 8 μm, P = 0.02) in ischemic versus nonischemic retina.

Conclusions

Ischemic diabetic retina seems to be thickened due to thickening of, in particular, middle retinal layers, which can be measured with high-resolution OCT.

Purpose

While the long-term incidence of hydroxychloroquine (HCQ) retinopathy is low, there remains no definitive clinical screening test to recognize HCQ toxicity before ophthalmoscopic fundus changes or visual symptoms. Patients receiving HCQ were evaluated with spectral domain optical coherence tomography (SD OCT) to assess the feasibility of identifying HCQ retinopathy at an early stage.

Methods

Twenty-five patients referred for the evaluation of hydroxychloroquine toxicity underwent a comprehensive ocular examination, Humphrey visual field (HVF) perimetry, time domain OCT, and SD OCT. Some patients with screening abnormalities also underwent further diagnostic testing at the discretion of the treating providers.

Results

Five patients were found to have SD OCT findings corresponding to HCQ toxicity and retinal damage as seen by clinical exam and/or HVF perimetry. Two patients with advanced toxicity were found to have significant outer retina disruption in the macula on SD OCT. Three patients with early HCQ toxicity and HVF 10-2 perifoveal defects were found to have loss of the perifoveal photoreceptor inner segment/outer segment (IS/OS) junction with intact outer retina directly under the fovea, creating the “flying saucer” sign. While two of these three patients had early ophthalmoscopic fundus changes, one had none.

Conclusion

Outer retinal abnormalities including perifoveal photoreceptor IS/OS junction disruption can be identified by SD OCT in early HCQ toxicity, sometimes even before ophthalmoscopic fundus changes are apparent. SD OCT may have a potential complementary role in screening for HCQ retinopathy due to its quick acquisition and because it is more objective than automated perimetry.

Background

New technology allows more precise definition of structural alterations of all retinal layers although it has not been used previously in cases of optic disc drusen.

Methods

Using Stratus and Fourier domain (FD) optical coherence tomography (OCT) and adaptive optics (AO) through a flood-illuminated fundus camera, we studied the retinas of a patient with long-standing optic disc drusen and acute visual loss at high altitude attributed to ischemic optic neuropathy.

Results

Stratus OCT and FD-OCT confirmed severe thinning of the retinal nerve fiber layer (RNFL). FD-OCT revealed disturbances in the photoreceptor layer heretofore not described in optic disc drusen patients. AO confirmed the FD-OCT findings in the photoreceptor layer and also showed reduced cone density at retinal locations associated with reduced visual sensitivity.

Conclusions

Based on this study, changes occur not only in the RNFL but also in the photoreceptor layer in optic nerve drusen complicated by ischemic optic neuropathy. This is the first reported application of FD-OCT and the AO to this condition. Such new imaging technology may in the future allow monitoring of disease progression more precisely and accurately.