Optical Coherence Tomography (OCT) in Uveitis - · PDF fileOptical Coherence Tomography (OCT)...

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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

www.soie-soif.orgp.neri@univpm.it

Piergiorgio Neri

Secretary General