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Optical CoherenceTomography (OCT) in Uveitis
Piergiorgio Neri, BMedSc, MD, PhDHead Ocular Immunology Unit
The The Eye Eye ClinicClinicPolytechnic Polytechnic University of MarcheUniversity of MarcheHead: Prof Alfonso Head: Prof Alfonso GiovanniniGiovannini
November,
1991
How OCT changed
• 1994: Aspecialized testfor retinalspecialists
• 2013: A broadbased tool forcomprehensiveophthalmologists
OCT main features
• Similar principle to B Scan ultrasonography• Non invasive, non contact transpupillary imaging• Can image retinal structures in vivo• Resolution (longitudinal) of 5-17 microns (10 xsuperior to ultrasound B-Scan)• The anatomic layers within the retina can bedifferentiated and retinal thickness can be measured.• Difficulties with opacified media (cataract, cornealedema, band kerathopathy…)
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OCT Types
• Time domain
• Spectral domain
Jean Baptiste Fourier
Why SD-OCT changes the view of Ophthalmlogy
Stratus Time Domain OCT Spectral Domain OCTTime Domain OCT
1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
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OCT in evaluation of inflammatoryinvolvement in uveitis
1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
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1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
Courtesy Prof N Cassoux
Guagnini et al: Graefe’s 2007; 245:158
Can You differentiate it?
Toxoplasmosis
Lymphoma
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1. Exclusion of macular lesion2. Confirmation of identified lesions3. Essential information given by OCT4. Therapeutic follow-up
OCT in evaluation of inflammatoryinvolvement in uveitis
Neri P et Al. Clin Exp Rheumetol 2013
Neri P et Al. Clin Exp Rheumetol 2013
1. Increased or decreased retinal thickness2. Cystoid changes3. Subretinal fluid4. Vitreous traction5. Epiretinal membrane6. Choroidal exploration
OCT in evaluation of inflammatory involvement inuveitis can help to detect:
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Ozdemir H, Mudun B, Karacorlu M, Karacorlu S. Serous detachment of macula inBehçet disease.Retina. 2005 Apr-May;25(3):361-2.
Behçet disease
Central Foveal Thickness Table
CFT (µm)
Baseline
3 Months
12 Months
Last follow-up
Media 441,3 167,4 167,2 162,7
SD 48,6 12,8 14,3 5,6
Mean
Before
After
OCT-Pregnancy
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7-yr old
After steroids+MMF
Steroids+MMF+anti-VEGF
Failed Failed surgical removal-1996surgical removal-1996POHS
6 Days after
1. Increased or decreased retinal thickness2. Cystoid changes3. Subretinal fluid4. Vitreous traction5. Epiretinal membrane6. Choroidal exploration
OCT in evaluation of inflammatory involvement inuveitis can help to detect:
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1. Increased or decreased retinal thickness2. Cystoid changes3. Subretinal fluid4. Vitreous traction5. Epiretinal membrane6. Choroidal exploration
OCT in evaluation of inflammatory involvement inuveitis can help to detect:
Enhanced depth imaging OCTSwept Source OCT
Exploring choroid by the OCT
Enhanced depth imaging (EDI)-OCT
Spaide et Al. Am J Ophthalmol 2008
Enhanced depth imaging (EDI)-OCT
Placing the objective lens of the Spectralis SDOCT(SD-OCT) device closer to the eye so that an invertedimage is obtained Deeper structures placed closer to the zero delay, Better visualization of the choroid
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Courtesy of Professor Paulo E. Stanga, the Royal Eye Hospital & University of ManchesterProfessor Jose Maria Ruiz Moreno, University of Albacete, SpainDepartment of Ophthalmology, Fukushima Medical University.
Take the slice!
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Prognosis• Atrophy• Fibrosis• Loss of Layers Figure 2. Representative High-Definition Optical Coherence Tomography Image of a Normal Macula
The right eye of patient 22 had normal macular thickness with a preserved photoreceptor layer. White arrowindicates hypereflective line corresponding to the photoreceptor layer, while the blue arrow indicates thehypereflective line corresponding to the RPE. The hyporeflective space in between these lines, denoted bythe red arrow, corresponds to the photoreceptor outer segments. Image represents horizontal line scanthrough center of fovea.
Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic fovealatrophy: clinical features and associations. Arch Ophthalmol.2009 Feb;127(2):179-86.
Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic fovealatrophy: clinical features and associations. Arch Ophthalmol.2009 Feb;127(2):179-86.
Figure 1. Relationship Between Photoreceptor Layer Status and Visual AcuityVisual acuities of eyes with intact, partially intact, or absent photoreceptor layers were significantly different fromeach other (p < 0.0001). All pairwise comparisons between these groups were also significantly different (p <0.001). Horizontal lines indicate mean values.
Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic fovealatrophy: clinical features and associations. Arch Ophthalmol.2009 Feb;127(2):179-86.
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Limits1. Opacified media:
• AS anomalies(cataract, posteriorsynechiae, etc…)
• Vitreous opacities2. Scarce collaboration
ConclusionsConclusions•In patients with uveitis, optical coherencetomography (OCT) is a non-invasive method thatgives additional accuracy in the assessment andfollow-up of the disease• In clinical studies, OCT is unavoidable as is it thecase for all methods that give objective & quantifiabledata• The OCT technology is still undergoing gradualimprovement of its performance and has not reachedyet the limits of its possibilities higher resolutionOCT, higher speed of acquisition, spectral domainOCT, swept source OCT
Combined with other methods such asindocyanine green angiography, laser flarephotometry and UBM, OCT contributes toimprove the diagnosis and management ofuveitis.
ConclusionsConclusions
Piergiorgio Neri
Secretary General