Optical Coherence Tomography—Atlas and Text

168 Pages·2009·42.089 MB·English

by  Boyd Samuel, Brancato Rosario, Straatsma Bradley

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Boyd, Samuel, MD; Brancato, Rosario, MD; Straatsma, Bradley, MD.
“OPTICAL COHERENCE TOMOGRAPHY - ATLAS AND TEXT”
ISBN 978-9962-678-04-5
Published for : Jaypee - Highlights Medical Publishers, Inc.
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Editors
Samuel Boyd, M.D.
Editor in Chief and Executive Vice President, HIGHLIGHTS OF OPHTHALMOLOGY.
Di rec tor, La ser Sec tion and Asso cia te Di rec tor, Re ti na and Vi treo us De part ment,
Cli ni ca Bo yd - Ophthal mo lo gy Cen ter, Pa na ma, Rep. of Panama
Rosario Brancato, M.D.
Professor of Ophthalmology
Director of the School of Ophthalmologic Specialization.
San Raffaele University Hospital, Milan, Italy
Bradley Straatsma, M.D.
Professor and Director Emeritus, Jules Stein Eye Institute
University of California, Los Angeles (UCLA)
Los Angeles, California, U.S.A.
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Contributing Authors
Amar Agarwal, MS, FRCS, FRCOphth Anaika Concepcion, MD.
Dr. Agarwal's Group of Eye Hospitals Glaucoma and Visual Fields Department
Chennai, India Clinica Boyd - Ophthalmology Center,
Panama, Rep. of Panama.
Athiya Agarwal, MD, DO
Dr. Agarwal's Group of Eye Hospitals Jay S. Duker, MD.
Chennai, India New England Eye Center, Tufts-New England Medical
Center, Tufts University,
Sunita Agarwal, MS, DO Boston, MA, USA
Dr. Agarwal's Group of Eye Hospitals
Chennai, India Howard Fine, MD.
The Oregon Eye Institute
Georges Baikoff, MD. Eugene, Oregon, U.S.A.
Clinique Monticelli
Marseille, France Jeffrey G. Gross, MD.
Carolina Retina Center
Rosario Brancato, MD. Columbia, South Carolina, U.S.A.
Professor of Ophthalmology
Director of the School of Ophthalmologic Richard S. Hoffman, MD.
Specialization. The Oregon Eye Institute
San Raffaele University Hospital, Eugene, Oregon, U.S.A.
Milan, Italy
Soosan Jacob, MS, DNB, FRCS, MNAMS
Dan Bourla, MD. Dr. Agarwal's Group of Eye Hospitals
International Ophthalmology Fellow Chennai, India
Jules Stein Eye Institute and Department of
Ophthalmology Miguel A. Materin, MD.
University of California, Los Angeles (UCLA) Ocular Oncology Service, Wills Eye Institute,
Los Angeles, California, U.S.A. Thomas Jefferson University,
Philadelphia, PA, U.S.A.
Samuel Boyd, MD.
Director, Laser Section and Associate Director, Catalina Montoya, MD.
Retina and Vitreous Department, Opthalmologist. Vitreoretinal specialist
Clinica Boyd - Ophthalmology Center, Clínica de Oftalmología Sandiego
Panama, Rep. of Panama. Medellín, Colombia
Royce W. S. Chen, MD.
New England Eye Center, Tufts-New England Medical
Center, Tufts University,
Boston, MA, USA
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Tarkan Mumcuoglu, MD. Bradley R. Straatsma, MD.
UPMC Eye Center, Ophthalmology and Visual Science Professor and Director Emeritus,
Research Center, Eye and Ear Institute, Department of Jules Stein Eye Institute
Ophthalmology, University of Pittsburgh University of California, Los Angeles (UCLA)
School of Medicine, Los Angeles, California, U.S.A.
Pittsburgh, PA, U.S.A.
Juan Verdaguer, MD.
Jeroni Nadal Reus, MD. Professor of Ophthalmology
Centro de Oftalmologia Barraquer University of Chile and University of Los Andes
Barcelona, Spain Academic Director,
Fundacion Ofalmologica Los Andes,
Luisa Pierro, MD. Santiago, Chile
Department of Ophthalmology and Visual Science,
San Raffaele University Hospital, Alexander Walsh, MD.
Milan, Italy Assistant Professor, Ophthalmology
Doheny Eye Institute
Ana Piñero Rodríguez, MD. USC Keck School of Medicine
Centro de Oftalmologia Barraquer Los Angeles, CA
Barcelona, Spain
Gadi Wollstein, MD.
Jose A. Roca, MD. UPMC Eye Center, Ophthalmology and Visual Science
Associate Professor Research Center, Eye and Ear Institute, Department of
Cayetano Heredia University Ophthalmology, University of Pittsburgh
Ricardo Palma Clinic School of Medicine,
Lima, Peru Pittsburgh, PA, U.S.A.
Joel S. Schuman, MD. Tara A. Young, MD.
UPMC Eye Center, Ophthalmology and Visual Science Assistant Professor of Ophthalmology
Research Center, Eye and Ear Institute, Department of Jules Stein Eye Institute and Department of
Ophthalmology, University of Pittsburgh Ophthalmology
School of Medicine, University of California, Los Angeles (UCLA)
Pittsburgh, PA, U.S.A. Los Angeles, California, U.S.A.
Carol L. Shields, MD
Ocular Oncology Service, Wills Eye Institute,
Thomas Jefferson University,
Philadelphia, PA, U.S.A.
Herbert Stern, MD.
President, Dominican Society of Ophthalmology
Chief, Department of Ophthalmology
Hospital Regional General
Dr. Marcelino Velez Santana
Santo Domingo, Dominican Republic
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Table of Contents
Chapter 1: Introduction to OCT 1 Time-Efficient or Fast Scans 16
Rosario Brancato, MD Fast Macular Thickness Map 16
L. Pierro, MD Fast Optic Disc 16
Fast RNFL Thickness 16
Fast RNFL Map 16
What is OCT? 1
Analyze Scans 16
Interpretation of OCT Maps 1
Initiate an Analysis 16
Current Clinical Application 7
Select an Analysis Protocol 17
Imaging of Anterior Segment Structures 7
Quantitative Analysis Protocols 17
Glaucoma 7
Measurements of Retinal and RNFL Thickness 17
Evaluation of RNFL in Glaucoma 7
Retinal Thickness Volume 17
Refractive Surgery Application 7
Retinal Thickness / Volume Tabular 17
High - Resolution OCT Corneal Scans 7
Imaging of Abnormal Retinal Structures 7 Retinal Thickness / Volume Change 18
Enhanced Visualization of Macular Holes 7 RNFL Thickness 19
Application of OCT in Diabetic Retinopathy 9 RNFL Thickness Average 19
Age-related Macular Degeneration 10 RNFL Thickness Map 20
Cystoid Macular Edema (CME) 10 RNFL Thickness Change 20
Pathological Macular Disorders 11 RNFL Thickness Serial Analysis 20
Optic Nerve Head 20
Individual Scan Image Measurements 21
Chapter 2: OCT Scan Applications, Retinal Thickness 21
Protocols and Procedures 13 Retinal Map 22
Samuel Boyd, MD
The Scan Tab 13 Chapter 3: Application of Optical
Scan Tab Views 13 Coherence Tomography in Ophthalmology 25
The Protocol Groups 13 Soosan Jacob, MS; Sunita Agarwal, MS;
Activity Radio Buttons 13 Athiya Agarwal, MD; Amar Agarwal, MS
Glaucoma Protocols 13
Retina Protocols 13 Introduction 25
General Tips 13 Principle of OCT 25
Scan Protocol Descriptions, Options and Tips 14 Color Coding in OCT 25
Repeat 14 Interpretation of OCT: The Normal Retina 26
Line 14 Interpretation of OCT: Optic Nerve Head (ONH) 26
Circle 14 Scanning Protocols 26
Raster Lines 14 Circumpapillary OCT Scans 26
Cross Hair 14 Radial Scans Through the Optic Nerve Head 27
Radial Lines 14 Macular Raster Scans 27
Macular Thickness Map 14 Macular Radial Scans 27
Optic Disc 14 Quantitative Analysis Algorithms 27
Proportional Circle 15 Retinal Thickness Measurement 27
Concentric 3 Rings 15 Nerve Fibre Layer Thickness Measurement and Analysis 27
RNFL Thickness 15 Optic Nerve Head Analysis 28
Nerve Head Circle 15 Retinal Topography 28
X-Line 15 OCT in Different Situations 28
RNFL Map 16 Retinal Vein Occlusions 28
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Non-proliferative Diabetic Retinopathy 28 Chapter 7: Optic Disc Evaluation with OCT 63
Proliferative Diabetic Retinopathy 28 Herbert Stern, MD.
Cystoid Macular Edema 28
Epiretinal Membrane 30
Macular Hole 30
Chapter 8: Integration of OCT and
Central Serous Retinopathy 30
Fluorescein Angiography in Retinal Diseases 73
Age Related Macular Degeneration 30
Samuel Boyd, MD
Choroidal Nevus 32
Optic Atrophy 32
Knowledge for Interpretation of OCT Images 74
Glaucoma 34
Interpretation of Abnormal OCT Imaging 74
Myelinated Nerve Fibre Layer 36
Hyper--reflectivity 74
Hypo-reflectivity 74
Subretinal Fluid 74
Chapter 4: Optical Coherence Tomography
Detachments of Neurosensory Retina and RPE 74
for Exploring the Anterior Segment of the Eye 37
OCT vs Fluorescein Angiography (FA) 75
George Baikoff, MD.
When to and When Not To 75
Application and Follow-Up 76
Introduction 37
The Anterior Chamber OCT
("Visante™" Developed by Carl Zeiss Meditec) 37
Chapter 9: Optical Coherence
Applications for Exploring the Anterior Segment
Tomography for Intraocular Tumors 79
with the OCT 38
Carol L. Shields, MD; Miguel A. Materin, MD
a. Static Measurement of the Anterior Segment 38
b. Dynamic Evaluation of the Anterior Segment 39
History 79
c. Evaluation of the Crystalline Lens with the AC OCT 39
Choroidal Tumors 79
d. Pseudophakic Artificial Crystalline Lens 39
Choroidal Nevus 79
e. Phakic Implants 40
Choroidal Melanoma 81
f. The Cornea 40
Choroidal Metastasis 82
g. Glaucoma 41
Choroidal Hemangioma 83
Conclusions and the Future of Anterior Segment
Choroidal Osteoma 85
OCT Exploration 42
Lesions of the RPE 85
Congenital Hypertrophy of the RPE 85
Congenital Simple Hamartoma of the RPE 86
Chapter 5: Architecture of Clear
Combined Hamartoma of the Retina and RPE 86
Corneal Incisions Demonstrated by OCT 45
Tumors of the Retina and Optic Disc 87
I. Howard Fine, MD; Richard S. Hoffman, MD.
Capillary Hemangioma 87
Cavernous Hemangiomas 88
Side Port Incision 51
Racemose Hemangioma 88
Astrocytic Hamartoma of the Retina 89
Retinoblastoma 90
Chapter 6: Optical Coherence Tomography Melanocytoma of the Optic Nerve 92
and Retinal Tomography in Glaucoma 53 Summary 92
Tarkan Mumcuoglu, MD; Gadi Wollstein, MD,
Joel S. Schuman, MD.
Chapter 10: Highlights of Optical Coherence
Optical Coherence Tomography (OCT) 53 Tomography for Evaluation of Choroidal Tumors 95
What is OCT? 53 Bradley R. Straatsma, MD.; Dan Bourla, MD.;
Importance of Nerve Fiber Layer 53 Tara A. Young, MD.
Interpretation of OCT 54
Retinal Tomography (HRT) 58
Tumors of the Choroid and Ciliary Body 95
Interpretation of HRT 59
Choroidal Nevus 95
Choroidal Melanoma 95
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Choroidal Metastasis 97 Chapter 15: Interpretation of OCT -
Choroidal Hemangioma 98 Pearls in Macular Holes 123
Summary 99 Jeffrey G. Gross, MD
Introduction 123
Chapter 11: OCT Benefits in the Macular Hole 123
Diagnosis of Retinal Diseases 101 Post Operative Imaging 124
Jose A. Roca, MD. Lamellar Macular Hole 125
Spontaneous Macular Hole Closure 126
Preoperative Diagnosis 101 Pseudomacular Hole 126
Postoperative Diagnosis 101 Vitreomacular Traction 127
How OCT Works 103 Summary 127
Chapter 12: Observations Comparing Chapter 16: Indications and Applications
Conventional and 3D-OCT in the Evaluation of OCT in Cystoid Macular Edema 129
of Retinal Disease 105 Herbert Stern, MD.
Alexander Walsh, MD.
Conventional OCT 105 Chapter 17: Interpretation of OCT -
Fourier Domain OCT 107 Pearls in Age-Related Macular Degeneration 133
New Horizons 107 Royce W. S. Chen, MD.; Jay S. Duker, MD.
Introduction 133
Chapter 13: OCT in Diabetic Retinopathy 109 Clinical Manifestations of OCT 133
Catalina Montoya, MD. “Dry” AMD: Drusen, Geographic Atrophy 133
“Wet” AMD: Pigment Epithelial Detachment,
Introduction 109 Choroidal Neovascularization, Retinal Pigment
OCT and Diagnosis of Diabetic Macular Edema 110 Epithelial Tear, Subretinal Hemorrhage,
Follow-up 113 Intraretinal/Subretinal Fluid, Disciform Scar 135
When to Order an OCT in Diabetic Macular Edema 114 Response to Therapy and Future Applications 135
Conclusions 114
Chapter 18: Funduscopic Alterations in
Chapter 14: Diagnosis and Treatment of Myopic Patients - A Study of Findings from
Diabetic Macular Edema: Application of the Clinical Examination and Optical Coherence
Optical Coherence Tomography 117 Tomography (OCT) 139
Juan Verdaguer, MD. Ana Piñero Rodríguez, MD.; Jeroni Nadal Reus, MD.
Evaluation of Diabetic Macular Edema 117 Introduction 139
Objective vs Subjective Methods of Evaluation 117 Clinical Findings 141
Fluorescein Angiography and OCT 117 Posterior Detachment of the Vitreous (PDV) 141
Type 1. DME with focal leakage on fluorescein Posterior Staphyloma (PS) 141
angiography and without vitreous traction on OCT 117 Posterior Retinal Detachment (RD),
Type 2. Diffuse DME without Vitreous Myopic Macular Hole (MH) and Retinoschisis 142
Traction on OCT 119 Chorioretinal Thinning and Atrophy of the Retinal
Type 3. Tractional Diabetic Macular Edema 120 Pigment Epithelium (RPE) 142
Type 4. Ischemic Macular Edema 121 Lacquer Cracks 142
Type 5. Massive Old Lipid Exudation at the Macula 121 Tractional Myopic Maculopathy 142
Indication of OCT in DME 121 Choroidal Neovascularization and Fuchs Spot 145
Conclusion 121
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Chapter 19: The Evolution of the Optical
Coherence Tomography: Time Domain vs
Spectral Domain OCT 147
Samuel Boyd, MD.; Anaika Concepcion, MD.
Introduction 147
Principles of Operation 148
Time-Domain OCT vs Spectral-Domain OCT 148
Time-Domain OCT (TD-OCT) 150
Fourier-Domain OCT (FD-OCT) 150
New Improvements in OCT 150