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Staurenghi G.,University of Milan | Sadda S.,University of Southern California | Chakravarthy U.,Queen's University of Belfast | Spaide R.F.,Vitreous Retina Macula Consultants of New York
Ophthalmology | Year: 2014

Purpose To develop a consensus nomenclature for the classification of retinal and choroidal layers and bands visible on spectral-domain optical coherence tomography (SD-OCT) images of a normal eye. Design An international panel with expertise in retinal imaging (International Nomenclature for Optical Coherence Tomography [IN•OCT] Panel) was assembled to define a consensus for OCT imaging terminology. Participants A panel of retina specialists. Methods A set of 3 B-scan images from a normal eye was circulated to the panel before the meeting for independent assignment of nomenclature to anatomic landmarks in the vitreous, retina, and choroid. The outputs were scrutinized, tabulated, and used as the starting point for discussions at a roundtable panel meeting. The history of anatomic landmark designations over time was reviewed for the various cellular layers of the ocular structures that are visible by SD-OCT. A process of open discussion and negotiation was undertaken until a unanimous consensus name was adopted for each feature. Main Outcome Measures Definitions of normal eye features showed by SD-OCT. Results Definitions for various layers changed frequently in the literature and were often inconsistent with retinal anatomy and histology. The panel introduced the term "zone" for OCT features that seem to localize to a particular anatomic region that lacks definitely proven evidence for a specific reflective structure. Such zones include the myoid, ellipsoid, and the interdigitation zones. Conclusions A nomenclature system for normal anatomic landmarks seen on SD-OCT outputs has been proposed and adopted by the IN•OCT Panel. The panel recommends this standardized nomenclature for use in future publications. The proposed harmonizing of terminology serves as a basis for future OCT research studies. © 2014 by the American Academy of Ophthalmology.

PURPOSE:: To compare optical coherence tomography (OCT) and histology of outer retinal tubulation (ORT) secondary to advanced age-related macular degeneration in patients and in postmortem specimens, with particular attention to the basis of the hyperreflective border of ORT.METHOD:: A private referral practice (imaging) and an academic research laboratory (histology) collaborated on two retrospective case series. High-resolution OCT raster scans of 43 eyes (34 patients) manifesting ORT secondary to advanced age-related macular degeneration were compared to high-resolution histologic sections through the fovea and superior perifovea of donor eyes (13 atrophic age-related macular degeneration and 40 neovascular age-related macular degeneration) preserved ≤4 hours after death.RESULTS:: Outer retinal tubulation seen on OCT correlated with histologic findings of tubular structures consisted largely of cones lacking outer segments and lacking inner segments. Four phases of cone degeneration were histologically distinguishable in ORT lumenal walls, nascent, mature, degenerate, and end stage (inner segments and outer segments, inner segments only, no inner segments, and no photoreceptors and only Müller cells forming external limiting membrane, respectively). Mitochondria, which are normally long and bundled within inner segment ellipsoids, were small and scattered within shrunken inner segments and cell bodies of surviving cones. A lumenal border was delimited by an external limiting membrane. Outer retinal tubulation observed in closed and open configurations was distinguishable from cysts and photoreceptor islands on both OCT and histology. Hyperreflective lumenal material seen on OCT represents trapped retinal pigment epithelium and nonretinal pigment epithelium cells.CONCLUSION:: The defining OCT features of ORT are location in the outer nuclear layer, a hyperreflective band differentiating it from cysts, and retinal pigment epithelium that is either dysmorphic or absent. Histologic and OCT findings of outer retinal tubulation corresponded in regard to composition, location, shape, and stages of formation. The reflectivity of ORT lumenal walls on OCT apparently does not require an outer segment or an inner/outer segment junction, indicating an independent reflectivity source, possibly mitochondria, in the inner segments. © 2015 by Ophthalmic Communications Society, Inc.

Balaratnasingam C.,Vitreous Retina Macula Consultants of New York
Retina | Year: 2015

PURPOSE:: To use volume-rendered optical coherence tomography angiography to investigate vascular proliferation in macular telangiectasia type 2 (MacTel2), extending beyond the retinal pigment epithelium (RPE). METHODS:: Six eyes of four patients with MacTel2 with neovascularization proliferating external to the RPE confines were studied. Eyes were scanned using optical coherence tomography using split-spectrum amplitude-decorrelation techniques to derive flow information (RTVue XR; Optovue). These data were extracted and used to create volume rendered images of the area of vascular proliferation. RESULTS:: Mean age was 66.2 years. There was demonstrable vascular proliferation in the sub-RPE space observable by both optical coherence tomography and optical coherence tomography angiography. Fibrovascular RPE detachments were identified in all eyes. The topographic distribution of abnormal vessels located below the plane of the deep retinal vascular plexus and above the RPE closely matched the pattern of hyperfluorescence and leakage on fluorescein angiography. Vessels under the RPE demonstrated different branching patterns and larger diameter lumens than those above the RPE, but anastomosis with the choroidal circulation was difficult to demonstrate. CONCLUSION:: This study provides evidence that sub-RPE vascular proliferation may be a complication of MacTel2. Retinal pigment epithelium abnormalities are known to occur in MacTel2 and may provide a conduit for abnormal vessels in the subretinal space to proliferate into the sub-RPE compartment. The authors have no reason to exclude the possibility that the choroid contributes to the deep proliferation. © 2015 by Ophthalmic Communications Society, Inc.

Spaide R.,Vitreous Retina Macula Consultants of New York | Spaide R.,Ear and Throat Hospital
Retina | Year: 2013

PURPOSE:: To investigate the effect that panretinal photocoagulation to peripheral areas of retinal vascular nonperfusion has on the visual acuity and injection frequency of ranibizumab in eyes with previous central retinal vein occlusion. METHODS:: Patients enrolled in a prospective study of ranibizumab for central retinal vein occlusion were imaged with wide-field angiography using the Optos P200 system. Laser photocoagulation was carried out and the extent of laser photocoagulation was evaluated with repeat wide-field angiography. Injection of ranibizumab was based on an as needed strategy throughout the study. The injection frequency in the 6 months before laser was compared with a 6-month period starting 2 months after the laser photocoagulation. The visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction at both the end of the 6-month follow-up period and at the time of laser photocoagulation. RESULTS:: There were 10 patients treated in this study with a mean number of 1,757 spots of laser photocoagulation in the peripheral retina. The injection frequency in the 6-month lead-in period was 3.4 and in the 6-month follow-up period was 3.1, a difference that was not significant (P = 0.26). The visual acuity at the time of laser photocoagulation was 54.2 letters (approximate Snellen equivalent of 20/80) and at the end of the observation period was 51.4 letters, a difference that was not significant (P = 0.33). CONCLUSION:: In this small study, laser photocoagulation to peripheral areas of nonperfusion as visualized by wide-field angiography did not result in either decreased injection frequency or improved visual acuity in eyes with central retinal vein occlusion treated with ranibizumab.

RESULTS:: All ten eyes of nine consecutively imaged patients showed a concordance between the pseudodrusen and the subretinal drusenoid deposit in every case. At their more internal aspects, subretinal drusenoid deposits were generally isolated foci of reflectivity and with decreasing distances above the reference plane appeared to become broader, reaching confluence with neighboring deposits analogous to a topographical map of mountains. In contrast to previous reports based on optical coherence tomography, and in keeping with histologic evaluation, no patient was seen to have widespread abnormalities in choriocapillaris imaging.CONCLUSION:: This study, using an unprecedented scan density, showed that pseudodrusen appearance can be attributed to subretinal drusenoid deposits. The results of this study have widespread applicability in the understanding of age-related macular degeneration and the associations of the lesions with other structures in the outer retinal neurovascular unit.PURPOSE:: To determine if pseudodrusen seen in fundus photography, particularly infrared scanning laser ophthalmoscopy, colocalize with subretinal drusenoid deposits imaged by optical coherence tomography.METHODS:: The patients were scanned with spectral domain optical coherence tomography having an A-scan spacing of 5.9 μm and a B-scan spacing of 11 μm. En face slabs were derived from this data set at distances 50 μm to 90 μm above the Bruch membrane reference plane to image the subretinal drusenoid deposit and also 6 μm below Bruch membrane to image the level of the choriocapillaris. The corresponding infrared scanning laser ophthalmoscopy image was registered to the optical coherence tomography data by aligning the retinal blood vessels in each imaging modality through elastic warping. © 2014 by Ophthalmic Communications Society, Inc.

Spaide R.F.,Vitreous Retina Macula Consultants of New York | Spaide R.F.,Ear and Throat Hospital
Retina | Year: 2011

Purpose: To develop a method of imaging the retina using wide-field fluorescein angiography and use this method to investigate the areas of perfusion abnormalities in patients treated with ranibizumab for central retinal vein occlusion. Methods: Cross-sectional analysis of patients recruited to a prospective study. Patients in a prospective study of ranibizumab for central retinal vein occlusion were imaged with wide-field angiography. Fluorescein angiograms taken with the Optos P200 Scanning Laser Ophthalmoscope were obtained of the posterior portion of the eye and of the periphery through ocular steering. Resultant images of the periphery were registered to the posterior image using thin-plate spline warping. A transformation was used to measure the retinal surface area. Perfusion characteristics were compared with injection frequencies and protocol refraction visual acuity measurements. Results: Of 22 patients imaged, 7 would be classified as nonperfused by the Central Retinal Vein Occlusion Study (CVOS) angiographic criteria. However, all patients showed confluent areas of nonperfusion in the retinal periphery ranging in size from 16 disk areas to 242 disk areas. The areas of peripheral nonperfusion were not significantly different in the Central Retinal Vein Occlusion Study-perfused group versus nonperfused group. The area of peripheral nonperfusion was not correlated with the number of injections (r = -0.13, P = 0.58), but was inversely correlated with visual acuity (r = -0.52, P = 0.013). Blood vessels at the border of the peripheral nonperfusion did not show signs of neovascular growth or profuse leakage. Conclusion: Angiographic mapping of the retina is possible using image-processing techniques with wide-field images. Eyes with central retinal vein occlusion develop widespread peripheral vascular obliteration in regions that are difficult to image with conventional fundus cameras. These nonperfused areas may have important implications for visual function. Copyright © Ophthalmic Communications Society, Inc.

PURPOSE:: To describe the use of optical coherence tomography angiography (OCT-A) for evaluating the spectrum of polypoidal vascular diseases. METHODS:: Retrospective observational case series of seven patients with polypoidal choroidal vasculopathy (three cases) or polypoidal choroidal neovascularization (four cases). Optical coherence tomography angiography information was acquired using two different OCT-A devices (the Optovue RTVue XR Avanti SD-OCT and the Spectralis OCT angiography). Flow signals within branching vascular networks, type 1 neovascularization and polyps were evaluated. Comparisons were made between en face and cross-sectional OCT-A images. Vascular information from OCT-A was also compared with indocyanine green angiography. RESULTS:: En face images from OCT-A provided anatomical information about branching vascular networks that were comparable to indocyanine green angiography. Polyps were poorly resolved on en face OCT-A images but were clearly defined on cross-sectional OCT-A images. Cross-sectional OCT-A revealed flow signals within focal regions of the polyps with a significant portion of the polyp lumen being devoid of flow signal. Flow signals from cross-sectional OCT-A images also showed that branching vascular networks, type 1 neovascularization, and polyps were confined to the anatomic compartment between the retinal pigment epithelium and Bruchʼs membrane. It was not possible to detect leakage on en face or cross-sectional OCT-A. CONCLUSION:: The combination of en face and cross-sectional OCT-A images provides anatomical information about polypoidal structures that is comparable to indocyanine green angiography. OCT-A may be a useful modality for the management of polypoidal diseases. However, the limitations of OCT-A identified in this study suggest that it is not a replacement for indocyanine green angiography. © 2015 by Ophthalmic Communications Society, Inc.

Pang C.E.,Vitreous Retina Macula Consultants of New York
Retina | Year: 2015

PURPOSE:: To compare the effect of 30-gauge versus 32-gauge needle size on postinjection reflux and immediate postinjection intraocular pressure (IOPimmed_post) spikes in eyes injected with anti-vascular endothelial growth factor agents.METHODS:: This was a prospective interventional case series of 65 eyes of 54 consecutive patients in a clinical practice setting who received intravitreal anti-vascular endothelial growth factor therapy. All eyes had preinjection IOP, IOPimmed_post, postinjection reflux, and axial lengths recorded.RESULTS:: There was a higher incidence of postinjection reflux in eyes injected with 30-gauge (53%) compared with those injected with 32-gauge (13%, P = 0.0007). Among 34 eyes injected with 30-gauge, 16 eyes without appreciable postinjection reflux had mean IOPimmed_post of 44.3 ± 7.48 mmHg and mean IOPimmed_post elevation of 29.6 ± 2.10 mmHg, which was significantly higher than the 18 eyes with reflux (mean IOPimmed_post of 18.8 ± 7.15 mmHg and mean IOPimmed_post elevation of 4.5 ± 1.74 mmHg, P < 0.0001). Among 31 eyes injected with 32-gauge, 27 eyes without appreciable postinjection reflux had mean IOPimmed_post of 44.4 ± 10.82 mmHg and mean IOPimmed_post elevation of 29.5 ± 1.99 mmHg, which was significantly higher than the 4 eyes with reflux (mean IOPimmed_post of 21.3 ± 8.54 mmHg and mean IOPimmed_post elevation of 9.5 ± 4.05 mmHg, P < 0.001). The differences in reflux and IOP between the two groups were unrelated to axial lengths (P = 0.451).CONCLUSION:: Eyes receiving injections with 32-gauge needles had a lower incidence of postinjection reflux and higher mean IOP immediately after injection. © 2015 by Ophthalmic Communications Society, Inc.

Schaal K.B.,Vitreous Retina Macula Consultants of New York | Pang C.E.,Vitreous Retina Macula Consultants of New York | Pozzoni M.C.,Hospital Italiano Of Buenos Aires | Engelbert M.,Vitreous Retina Macula Consultants of New York
Ophthalmology | Year: 2014

Objective To resolve the controversy surrounding the shape and relationship of posterior vitreous spaces by characterizing the connections between the premacular bursa, the area of Martegiani, and Cloquet's canal. Design Comprehensive posterior vitreous maps were created using swept-source optical coherence tomography (SS OCT) in a cross-sectional study. Participants The posterior vitreous of 102 eyes of 51 volunteers 21 to 54 years of age without ocular pathologic features was imaged using SS OCT. Methods The DRI OCT-1 Atlantis 3D SS OCT (Topcon Medical Systems, Oakland, NJ) was used to acquire scans of the posterior vitreous over an 18×18-mm area. Main Outcome Measures Posterior vitreous spaces and their relationships were identified. Results The premacular bursa was identified in all 102 eyes and was found to extend superiorly beyond our scanning ability at a variable angle. No discernible superior borders could be identified. Instead, a connection of the bursa with the preoptic area of Martegiani or its extension, Cloquet's canal, was found in 101 of 102 eyes. This connection occurred at a variable distance from the optic nerve, where it formed a flat and broad superior channel. The skyward direction of this channel was found to be gravity dependent in all 14 eyes of the 7 subjects examined in various head positions. Although SS OCT was able to identify vitreous degeneration, the above changes were present in 28 eyes even without any discernible vitreous degeneration. Conclusions The premacular bursa, also called the posterior precortical vitreous pocket, was found to continue superiorly beyond the posterior pole without a detectable border. The bursa fused broadly with the extension of the preoptic area of Martegiani, namely Cloquet's canal, or the hyaloidal tract of Eisner. These findings suggest that there is a direct anteroposterior connection between the retrolental and premacular and preoptic spaces already existent in the eyes of young adults before the occurrence of vitreous degeneration. This observation may have important implications with respect to the movement of intrinsic and extrinsic mediators between the anterior and posterior segments. © 2014 by the American Academy of Ophthalmology.

Imamura Y.,Ear and Throat Hospital | Fujiwara T.,Ear and Throat Hospital | Spaide R.F.,Vitreous Retina Macula Consultants of New York
Ophthalmology | Year: 2011

Purpose: To investigate the fundus autofluorescence (FAF) abnormalities in central serous chorioretinopathy (CSC) and evaluate potential correlations with visual acuity. Design: Retrospective, observational case series. Participants: Four hundred seventy-five eyes of 238 patients with CSC. Methods: Consecutive patients with CSC underwent FAF imaging, as well as routine ophthalmologic examinations. Confluent hypoautofluorescence was defined as a region of absent autofluorescence greater than one fourth of a disk diameter. Granular hypoautofluorescence was defined if there was a grainy or coarse region of decreased fluorescence as compared with normal surrounding areas greater than one fourth of a disc diameter in size. A descending tract was a downward leading swathe of decreased autofluorescence originating from the posterior pole to extend below the inferior arcade. Main Outcome Measures: The pattern and frequency of FAF abnormalities and their correlations with corrected visual acuity. Results: The mean age of the subjects was 57.1 years (standard deviation, 13.3), and 181 (76.1%) were male. Confluent and granular hypoautofluorescence was detected in the macula of 54 (11.4%) and 300 (63.2%) of 475 eyes, respectively. Descending tracts from the macula were observed in 43 (9.1%) eyes and from the optic disc in 43 (9.1%) eyes. Multiple regression analysis revealed that confluent hypoautofluorescence of the macula, granular hypoautofluorescence of the macula, and increasing age all were independent predictors of decreased visual acuity. Conclusions: The FAF abnormalities in CSC show multiple distinct patterns and seem to provide functional information. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.

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