Eur J Ophthalmol. 2009 May-Jun;19(3):404-10.
Evaluating a new disc staging scale for glaucomatous damage: the ability to
detect change over time.
Henderer J, Wang Y, Bayer A, Altangerel U, Schwartz L, Schmidt C.
Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.
Abstract
PURPOSE: To assess the ability of Disc Damage Likelihood Scale (DDLS) in detecting glaucomatous changes in
the optic nerve on sequential optic disc stereo-photographs as compared with three other different cup/disc
grading systems (C/D). METHODS: Eighty-three pairs of stereo-photographs with a minimum of 5-year follow-up
were examined by one group of three observers masked to chronological order by using their clinical expertise.
Their conclusions were considered gold standard. Another group of three glaucoma experts examined the same
masked pairs to evaluate glaucomatous changes using four different optic nerve grading systems: DDLS, vertical,
horizontal, and maximal cup/disc. Ratings of these four methods in the second group were then compared with
the gold standard. RESULTS: Baseline and follow-up photographs of 83 eyes were included. Mean follow-up was
6 years. The sensitivities for detecting glaucomatous nerve changes were 71.4%, 63.9%, 66.7%, and 47.2% for
DDLS, vertical, horizontal, and maximal cup/disc, respectively. The specificity for finding nerve change was
70.9%, 51.1%, 40.4%, and 48.9%, respectively. The proportion of photographs identified as showing
glaucomatous changes differed significantly between the DDLS and vertical C/D (VCD) (X2=7.900, p=0.005),
between the DDLS and horizontal C/D (HCD) (X2=13.89, p=0.000), and between DDLS and maximum C/D
(MCD) (X2=4.192, p=0.041). The largest area (74.4%) under the receiver operator characteristic curve was
obtained by using the DDLS. CONCLUSIONS: DDLS had higher sensitivity and specificity for detecting
glaucomatous changes versus the other three C/Ds when considering sequential stereo-photographs.
PMID: 19396786 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/19396786
Br J Ophthalmol. 2006 Apr;90(4):437-41.
Comparison of disc damage likelihood scale, cup to disc ratio, and
Heidelberg retina tomograph in the diagnosis of glaucoma.
Danesh-Meyer HV, Gaskin BJ, Jayusundera T, Donaldson M, Gamble GD.
Department of Ophthalmology, University of Auckland, Auckland, New Zealand. h.daneshmeyer@auckland.ac.nz
Comment in:

Br J Ophthalmol. 2006 Apr;90(4):395-6.
Abstract
AIM: To evaluate the relative diagnostic strength of cup to disc (C/D) ratio, clinical disc damage likelihood scale
(DDLS), a new clinical method of documenting glaucomatous optic disc changes, and Heidelberg retina
tomograph (HRT-II) in patients with glaucoma, glaucoma suspects, and normal controls. METHOD: Consecutive
observational case series. 110 eyes from 110 patients categorised as glaucoma, glaucoma suspect, or normal
were examined clinically to grade the DDLS score. HRT-II examination was performed by an examiner masked to
the clinical examination findings. Optic disc parameters and Moorfields regression analysis findings were
recorded. Stereophotographs of the optic disc were examined independently by two glaucoma specialists in
masked fashion to determine the C/D ratio. Zeiss SITA Standard 24-2 visual fields were obtained within 3 months
of HRT-II and clinical examination. For each patient, the eye with the worse mean deviation of the visual field test
was enrolled in the study, and each field was additionally graded by the four level Hodapp-Parrish-II-Anderson
staging. Specificity and sensitivity were calculated by receiver operating characteristic (ROC) curves. RESULTS:
Mean patient age was 58 years (SD 13.3) with 45 glaucoma patients, 23 glaucoma suspects, and 42 normals.
The mean deviation on Humphrey visual field assessment using SITA-Standard was -4.95 D (SD 5 D) Clinical
examination using DDLS had the best predictive power with an area under the ROC curve value of 0.95 when
glaucoma patients and suspects were separated from borderline or normals. This was followed by clinical
examination of C/D ratio (0.84), and HRT-II Moorfields analysis (0.68). The order of diagnostic strength did not
change when definite glaucoma was compared to borderline and normals. CONCLUSIONS: The DDLS grading
performs well compared to C/D ratio and HRT-II evaluation. Attention to disc diameter and to rim width may
increase the value of clinical optic disc examination.
PMID: 16547323 [PubMed - indexed for http://www.ncbi.nlm.nih.gov/pubmed/16547323
http://bmctoday.net/retinatoday/2009/03/article.asp?f=0309RT_F18_OCT_Michelewska.php
March 2009
Macular Hole Closure After Vitrectomy: The Inverted
Flap Technique
SOCT Copernicus HR improves visualization of the retina and increases the
understanding of retina pathology.
By Zosia Michalewska, MD; Janusz Michalewski, MD; and Jerzy Nawrocki, MD, PhD
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Spectral-domain (SD) optical coherence tomography (OCT) is an innovative technology that
enables high-speed, high-resolution imaging of the retina. Spectral OCT (SOCT) Copernicus
HR (Optopol, Zawiercie, Poland) is a device with axial resolution of 3 μm, the highest
resolution among commercially available SD OCT devices. Furthermore, it produces Cscans
and maps of particular retinal layers. Imaging of the optic nerve head and cornea are also
possible.
Vitrectomy with internal limiting membrane (ILM) peeling has become the method of choice
in macular hole treatment. Anatomic success of 90% to 98%1,2 is described by most authors
in stage 2 and 3 macular holes. However, large, long-lasting stage 4 macular holes are still a
surgical challenge. In these cases, not often described, a closure rate of 56% to 76% was
noted.3 Additionally in 18.0% to 38.7% cases with flat/closed configuration of the macular
hole, characterized by flat margins of the macular hole, bare retinal pigment epithelium (RPE)
is noted.4,5 Visual acuity does not improve much in cases. This article describes a new
technique developed in our department for the treatment of large macular holes and the use of
SOCT in postoperative evaluation.
MACULAR HOLE CASE
A 20-year-old patient with a history of ocular trauma was diagnosed with neovascularization
in a posttraumatic scar in both eyes and had three antivascular endothelial growth factor
injections in each eye in another center (Figure 1). After the third injection, a macular hole
was noted in his left eye, and the patient was referred to our clinic (Figure 2). Imaging with
SOCT was performed and a macular hole with minimum diameter of 1,268 μm of and base
diameter of 1,958 μm was noted. Initial visual acuity was 0.05 logMAR. In the foveal area,
multiple RPE changes were noted.
Because of the large size of the macular hole and suspected poor visual and anatomical
outcome, a modification of standard vitrectomy—the inverted flap technique—was used.
Core vitrectomy and trypan blue staining (0.5% solution of trypan blue irrigated after 1
minute) was performed, and the epiretinal membrane was removed. The ILM was grasped
with vitreous forceps and peeled off in a circular fashion on an area of about two-disc
diameters around the macular hole. After circumferential peeling, the peeled-off ILM was not
removed completely from the retina, but left still attached to the edges of the macular hole. In
this way, a rolled fragment of the peeled-off ILM was “hanging” into the vitreous cavity. A
piece of the ILM slightly bigger than the size of the macular hole was cut at the edge of the
macular hole with a vitreous cutter and left on the surface of the macular hole. Then the ILM
was gently massaged over the macular hole from all sides. The ILM became inverted, so that
the surface normally directed toward the vitreous body was turned toward the RPE. The
macular hole remained closed with the inverted ILM flap.
At the end of surgery, the vitreous cavity was filled with air. The patient was advised to spend
3 to 4 days in a position in which he could see the air bubble in the center of the visual field at
all times. One week after surgery, on SOCT flat margins of the macular hole were noted with
an overhanging flap of hyperreflective tissue, probably ILM (Figure 3). Visual acuity was
0.15 logMAR. Three months after surgery the hyperreflective line connecting the borders of
the macular hole became thicker, probably due to glial cells proliferation on top of the ILM.
Visual acuity improved to 0.2 logMAR.
DISCUSSION
The inverted flap modification of standard vitrectomy for macular hole was performed in
about 40 cases in the last 2 years (article in review). This innovative technique which allows
the surgeon to achieve good anatomical and functional results in large stage 4 macular holes,
was presented for the first time by our group in 2008. Spectral OCT enables not only
improved visualization of the vitreoretinal interface but also explains the pathology and
healing processes of retinal diseases. ■
Zosia Michalewska, MD, is an ophthalmologist at Jasne Blonia Eye Clinic, Lodz, Poland.
Janusz Michalewski, MD, is an ophthalmologist at Jasne Blonia Eye Clinic.
Jerzy Nawrocki, MD, PhD, is a Professor of Ophthalmology at Jasne Blonia Eye Clinic. The
authors report no financial relationships. They can be reached at zosia_n@yahoo.com
1. Beutel J, Dahmen G, Ziegler A, Hoerauf H. Internal limiting membrane peeling with
indocyanine green or trypan blue in macular hole surgery: a randomized trial. Arch
Ophthalmol. 2007;125:326–332. 2. Brooks Hl Jr. Macular hole surgery with and without
internal limiting membrane peeling. Ophthalmology. 2000;107:1939–1949. 3. Ip MS, Baker
BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as
determined by optical coherence tomography. Arch Ophthalmol. 2002;120(1):29–35. 4. Kang
SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications. Br J
Ophthalmol. 2003;87:1015–1019. 5. Michalewska Z, Michalewski J, Cisiecki S, Nawrocki J.
High speed, high resolution spectral optical coherence tomography after macular hole surgery.
Graefes Arch of Clin and Exp Ophthalmol. 2008;246:823–830.
http://bmctoday.net/retinatoday/pdfs/0508_14.pdf
May 2008
Peeling Through the Layers: SD OCT
The technology is useful for imaging a variety of retinal diseases.
By Zosia Michalewska, MD; Janusz Michalewski, MD; and Jerzy Nawrocki, MD, PhD
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From its first description in the early 1990s, optical coherence tomography (OCT)1 has
evolved to be an integral tool for examination of the macula. Many structural changes,
however, remain below the ~10 µm axial resolution capability of standard OCT. Spectraldomain (SD) OCT is an innovative technology that enables exact presentation of all retinal
layers with axial resolution of up to ~3 µm. With SD OCT, retinal images are acquired 10- to
100-times faster than with time-domain (TD) OCT, thus enabling 3-D presentation of the
retina and production of maps of particular retinal layers.
Spectral OCT (SOCT) Copernicus HR (Optopol, Zawiercie, Poland; distributed in the United
States by Reichert) has been used in our clinic for more than 2 years. In this article, we
discuss the features of the SOCT Copernicus and describe how we have used it clinically in
our practice.
FEATURES
The SOCT Copernicus system visualizes particular retinal layers with an axial resolution of 3
µm. It allows the user to choose the exact number of A-scans, B-scans, and scanning area
required for each individual patient, making it possible to obtain good quality images in
patients with minimal fixation loss in a short period of time. It is also possible to produce
high-quality 3-D images of the macula and the optic nerve at the same time. This system
produces 3-D thickness maps of an area from 3 to 10 mm.
The system also enables the user to produce C-scans and particular retinal maps such as a
retinal thickness map, a nerve-fiber-layer (NFL) map, an inner segment/outer segment
(IS/OS) map, and a retinal pigment epithelium (RPE) map. This information can be
particularly useful in evaluation of patients after anti-VEGF treatment. Moreover, it enables
performing multiple scans of the same area through time, which enables the presentation of
pulse of retinal vessels.
Because many features are determined manually (eg, number of A and B scans), the learning
curve can be a disadvantage of this device. The most important advantage of this device is the
high resolution of a single B-scan and of single scans in the 3-D mode.
A cornea module can be attached to the device. The experimental version allows the
presentation of 3-D cornea maps, measuring the corneal thickness and identifying structures
of the angle.
MACULAR HOLE
The SOCT Copernicus can present the entire area of a macular hole, not only a cross sectional
scan, as with standard resolution OCT. Moreover, it is possible to notice whether the
photoreceptor layer is intact at the borders of the macular hole. These advances can influence
treatment decisions. After surgery, various defects observed in SOCT, such as photoreceptor
layer defect, nerve fiber layer defect, elevation of the photoreceptor layer and intraretinal
cysts, can explain the lack of full visual recovery in some cases of macular hole surgery.2,3 Cscans of the macular holes, presented for the first time by Hangai et al, are a rather new
examination type. A "crown" or "rosette" can be seen on C-scans around the macular hole
(Figure 1).4,5
MACULAR PUCKER
Enhanced resolution of SOCT has enabled us to observe that epiretinal membranes often
coexist with lamellar macular hole. Similar to macular hole studies, defects in photoreceptor
layer have been detected in cases of epiretinal membranes. Patients without any changes in
photoreceptor layer had significantly better visual acuity than patients with structural changes
in photoreceptors. This observation, together with correlation of visual acuity with central
retinal thickness, gave additional explanation of decreased retinal function.6
AGE-RELATED MACULAR DEGENERATION
Spectral OCT can be used as a diagnostic tool that can distinguish leaking neovascularization
by presentation of small amounts of subretinal fluid in the 3-D scanning mode. In combined
SOCT-angiography photographs, the correlation between those findings can be noted. Retina
maps also seem to be valuable not only in AMD diagnostics but also in post–anti-VEGF
evaluation (Figure 2).
OTHER RETINAL DYSTROPHIES
It is not only possible to present thinning of the central retina but also to detect slight
irregularities in the photoreceptor layer, which can have influence on visual outcome in
heriditary diseases such as retinitis pigmentosa.
Spectral OCT enables imaging of IS/OS defects or elevation, which can explain visual
deterioration in vitreomacular traction syndrome, central serous chorioretinopathy,7
hydrochloroquine retinopathy,8 in eyes after retinal detachment surgery9 and other diseases.
Future advances in imaging technology will bring forth devices that will enable presentation
of the retina in molecular or even nanoresolution. Until that time, SD OCT is currently the
most precise examination in ophthalmology. Surely the growing availability of commercially
available devices will enable not only more exact diagnostics and evaluation of our patients,
but also new developments in the field of clinical science.
Zosia Michalewska, MD, is an ophthalmologist at Jasne Blonia Eye Clinic, Lodz, Poland.
Janusz Michalewski, MD, is an ophthalmologist at Jasne Blonia Eye Clinic.
Jerzy Nawrocki, MD, PhD, is Professor of Ophthalmology at Jasne Blonia Eye Clinic where
he is a vitreoretinal specialist. The authors report no financial relationships. They can be
reached at: zosia_n@yahoo.com.
1. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254:1178–
1181.
2. Ko TH, Witkin AJ, Fujimoto JG, et al. Ultrahigh-resolution optical coherence tomography of
surgically closed macular holes. Arch Ophthalmol. 2006;124:827–836.
3. Michalewska Z, Michalewski J, Cisiecki S, Adelman R, Nawrocki J. Correlation between foveal
structure and visual outcome following macular hole surgery: a spectral optical coherence
tomography study. Graefes Arch Clin Exp Ophthalmol. 2008;246(6):823–830. Epub 2008 Apr
2.
4. Hangai M, Ojima Y, Gotoh N, et al. Three-dimensional imaging of macular holes with highspeed optical coherence tomography. Ophthalmology. 2007;114(4):763–773. Epub 2006 Dec
20.
5. Brinkmann CK, Wolf S, Wolf- Schnurrbusch UEK. Multimodal imaging in macular diagnostics:
combined OCT- SLO improves therapeutical monitoring Greafes Arch Clin Exp Ophthalmol.
2008;246:9–17.
6. Michalewski J, Michalewska Z, Cisiecki S, Nawrocki J. Graefes Arch Clin Exp Ophthalmol.
2007;245:1623–1631.
7. Fujimoto H, Gomi F, Wakabayashi T, Sawa M, Tsujikawa M, Tano Y. Morphologic changes in
acute central serous chorioretinopathy evaluated by Fourier-domain optical coherence
tomography. Ophthalmology. 2008; Apr 3 [Epub ahead of print]
8. Rodriguez-Padilla JA, Hedges TR 3rd, Monson B, et al. High-speed ultra-high-resolution
optical coherence tomography findings in hydroxychloroquine retinopathy. Arch Ophthalmol.
2007;125(6):775–780.
9. Schocket LS, Witkin AJ, Fujimoto JG et al. Ultrahigh-resolution optical coherence tomography
in patients with decreased visual acuity after retinal detachment repair. Ophthalmology.
2006;113:666–672.
1. http://www.ophsource.org/periodicals/ophtha/article/PIIS0161642011000613/abstract?rss=
yes
Article in Press
Structural Grading of Foveal Hypoplasia Using SpectralDomain Optical Coherence Tomography:
A Predictor of Visual Acuity?


Mervyn G. Thomas, BSc Anil Kumar, MDSarim Mohammad, BSc Frank A. Proudlock, PhD Elizabeth C. Engle, MD
,
Caroline Andrews, MS Wai-Man Chan, BS Shery Thomas, PhD Irene Gottlob, MD
Received 26 July 2010; received in revised form 10 January 2011; accepted 10 January 2011. published online 29 April
2011.
Purpose
To characterize and grade the spectrum of foveal hypoplasia based on different stages of arrested development
of the fovea. Grading was performed using morphologic findings obtained by ultra high-resolution spectral-domain
optical coherence tomography. Best-corrected visual acuity (BCVA) was calculated for different grades.
Design
Observational case series.
Participants and Controls
Sixty-nine patients with foveal hypoplasia (albinism, n = 34; PAX6 mutations, n = 10; isolated cases, n = 14;
achromatopsia, n = 11) and 65 control subjects were examined.
Methods
A 7×7-mm retinal area was sampled using a 3-dimensional scanning protocol (743×75, A scans×B scans) with
ultra high-resolution spectral-domain optical coherence tomography (SOCT Copernicus HR; 3-μm axial
resolution). Gross morphologic abnormalities were documented. B-scans at the fovea were segmented using a
longitudinal reflectivity profile. Logarithm of the minimum angle of resolution BCVA was obtained.
Main Outcome Measures
Grading was based on presence or absence of foveal pit and widening of the outer nuclear layer (ONL) and outer
segment (OS) at the fovea. Quantitative measurements were obtained for comparing atypical foveal hypoplasia in
achromatopsia. Best-corrected visual acuity was compared with the grade of foveal hypoplasia.
Results
Four grades of foveal hypoplasia were distinguished: grade 1, shallow foveal pit, presence of ONL widening,
presence of OS lengthening; grade 2, grade 1 but absence of foveal pit; grade 3, grade 2 but absence of OS
lengthening; grade 4, grade 3 but absence of ONL widening. There was significant difference in visual acuity (VA)
associated with each grade (P<0.0001). Grade 1 was associated with the best VA (median VA, 0.2), whereas
grades 2, 3, and 4 were associated with progressively poorer VA with a median VA of 0.44, 0.60, and 0.78,
respectively. The atypical features seen with foveal hypoplasia associated with achromatopsia were characterized
by decreased retinal and ONL thickness and deeper foveal depth.
Conclusions
A system for foveal hypoplasia was developed based on the stage at which foveal development was arrested,
which helps to provide a prognostic indicator for VA and is applicable in a range of disorders associated with
foveal hypoplasia. Atypical foveal hypoplasia in achromatopsia shows different characteristics.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
http://www.ophsource.org/periodicals/ophtha/article/PIIS0161642010009401/abstract?rss=yes
High-Resolution In Vivo Imaging in Achromatopsia

Mervyn G. Thomas, BSc Anil Kumar, MRCS, MRCOphth Susanne Kohl, MSc, PhD Frank A. Proudlock, MSc, PhD Irene Gottlob, MD, FRCOphth
Received 9 April 2010; received in revised form 27 August 2010; accepted 31 August 2010. published online 06 January 2011.
Available online: February 11, 2011.
Purpose
To characterize the retinal changes in patients with achromatopsia using an ultrahigh-resolution (UHR) spectral-domain optical coherence
tomography (OCT) to examine how human achromatopsia corresponds to its animal model.
Design
Comparative case series.
Participants and Controls
Ultrahigh-resolution OCT (Copernicus; OPTOPOL Technology S.A., Zawiercie, Poland; 3-μm axial resolution) was used to obtain scans from 13
patients (26 eyes) with achromatopsia and from 20 controls (40 eyes).
Methods
A 3-dimensional scan program (743×75; A×B scan) sampling a 7×7-mm retinal area centered at the fovea was used to obtain tomograms of the
fovea. Individual B-scans at the fovea were exported and analyzed using ImageJ (Wayne Rasband, National Institute of Health) for reflectance
profiles and morphologic abnormalities.
Main Outcome Measures
Gross morphologic changes in OCT were characterized. Specifically, inner segment and outer segment (IS/OS) junction and cone outer segment
tip (COST) disruption was noted. Using the reflectance profiles, foveal depth, thickness of the outer nuclear layer (ONL), and retinal thickness (RT)
were measured.
Results
A characteristic so-called punched out hyporeflective zone (HRZ) was noted in 7 of 13 patients; this was age-dependent (P = 0.001). The area of
the HRZ was asymmetric with the nasal area being significantly greater than the temporal area (P = 0.002). In all patients, there was disruption of
the IS/OS junction at the foveal or parafoveal regions, or both. Five of 13 patients also had a disrupted COST reflectivity. There was significant
(P = 1.1×10−6) ONL thinning in the achromats compared with controls, which was age-dependent (P = 0.0002). Foveal maldevelopment was seen
in 9 of 13 patients. The achromats also had a significantly reduced foveal depth (P = 7.7×10−6) and RT (P = 1.46×10−9) compared with controls.
Conclusions
A range of signs in achromatopsia are described that can be detected using UHR OCT. The IS/OS junction and COST reflectivity disruption and
presence of HRZ and ONL thinning are signs of cone photoreceptor degeneration. The latter 2 are age-dependent, which suggests that
achromatopsia is a progressive disorder. In addition, foveal maldevelopment is described; this represents a fetal developmental defect linked to
cone photoreceptor degeneration.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
http://journals.lww.com/corneajrnl/Abstract/2010/12000/High_Resolution_Spectral_Domain_Optic
al_Coherence.4.aspx
Cornea:
December 2010 - Volume 29 - Issue 12 - pp 1359-1367
doi: 10.1097/ICO.0b013e3181d25ce2
Clinical Science
High-Resolution Spectral Domain Optical Coherence Tomography Technology for the
Visualization of Contact Lens to Cornea Relationships
Gonzalez-Meijome, Jose M OD, PhD, FIACLE*†; Cerviño, Alejandro OD, PhD*‡; Carracedo, Gonzalo OD, MSc§; Queiros, Antonio OD†;
Garcia-Lázaro, Santiago OD, MSc*‡; Ferrer-Blasco, Teresa OD, PhD*‡
Abstract
Purpose: To study the utility of high-resolution spectral domain optical coherence tomography (HR SOCT) in imaging the contact lens
(CL) to cornea relationships with advanced CL designs for ecstatic corneas and corneal refractive therapy.
Methods: Copernicus HR SOCT (Optopol Technology SA, Zawiercie, Poland) was used to evaluate different lens materials and designs
in situ and for the preliminary assessment of the materials and corneal response to hypoxic situations.
Results: SOCT is capable of highlighting very subtle and interesting features of the CL-cornea relationships in a wide range of
applications such as in rigid gas-permeable corneal and semiscleral lenses, in corneal refractive therapy and application of CLs in ocular
pathology, and in the evaluation of the physiological response of the cornea.
Conclusions: HR SOCT is a powerful tool capable of providing sharp images of the anterior ocular surface highlighting the relationship
between lens and cornea with great detail. This methodology has several applications to enhance fitting modeling with modern designs
for advanced CL treatments.
© 2010 Lippincott Williams & Wilkins, Inc.
http://www.springerlink.com/content/8670n47157384657/
GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
Volume 248, Number 9, 1249-1255, DOI: 10.1007/s00417-010-1370-5
RETINAL DISORDERS
Continuous changes in macular morphology after macular hole closure visualized with spectral optical
coherence tomography
Zofia Michalewska, Janusz Michalewski and Jerzy Nawrocki
Abstract
Background
To report on changes in retinal morphology during the 12 months after macular hole surgery.
Methods
Seventy one eyes of 66 patients after pars plana vitrectomy with ILM peeling and air tamponade were evaluated with spectral
OCT for 12 months and additionally before surgery. Macular hole size was measured. On consecutive visits, the size of
photoreceptor layer defects and elevation of the outer retinal layers were measured. Additionally, changes in foveal contour,
nerve fibre layer defects, and retinal pigment epithelium defects were evaluated.
Results
Photoreceptor defects were observed in 66 eyes (93%) 1 week after surgery, and in only 21 eyes (29.5%) 12 months after
surgery. The linear photoreceptor defect continuously decreased in size with time (from the mean of 882 µm 1 week after
surgery to 60 µm 12 months after surgery). Elevations of the outer retinal layers were observed in 42 eyes (59%) 1 month
after surgery and in six eyes (8.4%) 12 months after surgery. Nerve fibre layers defects (observed in 17 cases; 24%) and
retinal pigment epithelium defects (present in four eyes, 3%) did not change with time.
Conclusions
Macular holes close with a bridge-like glial proliferation. The size of the elevation of outer retinal layers decreases with
time. Photoreceptor defects get continuously smaller for at least 12 months postoperatively, which statistically significantly
correlates with visual acuity improvement (p < 0.01). Additionally, foveal contour improves with time. Possible mechanisms
are glial cells pushing the photoreceptors onto new positions or restoration of the outer segments from the intact
photoreceptor body.
http://informahealthcare.com/doi/abs/10.3109/15569520903331674
High-resolution optical coherence tomography correlates in
ischemic radiation retinopathy
March 2010, Vol. 29, No. 1 , Pages 57-61 (doi:10.3109/15569520903331674)
Rajiv Raman, Swakshyar Saumya Pal, Tandava Krishnan, Gella Laxmi, Nishant Radke, Tarun Sharma
Shri Bhagwan Mahavir Vitreoretinal Services, Tamil Nadu, India
Address for Correspondence:Rajiv Raman, MD, DNB, Consultant, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, College
Road, Chennai, 600 006, Tamil Nadu, India. E-mail: rajivpgraman@gmail.com
Purpose: To find the abnormalities in various retinal layers caused by radiation retinopathy using spectral domain optical coherence tomography
(SD-OCT).
Methods: We report a case of radiation retinopathy that was imaged using SD-OCT Copernicus (Optopol, Zawiercie, Poland). Analysis and
synthesis of the OCT image were done using information both at the fovea and 2.5 mm temporal to the fovea.
Results: The layers that were reduced in thickness included the inner plexiform layer (47 μm vs. 74 μm), the inner nuclear layer (17 μm vs. 48 μm),
and the outer plexiform layer (25 μm vs. 45 μm), whereas the layers with comparable thickness included the nerve fiber layer (24 μm vs. 25 μm),
the outer nuclear layer (42 μm vs. 43 μm), the outer segment–inner segment junction (52 μm vs. 54 μm), and the retinal pigment epithelium (RPE)
choriocapillaris layer (30 μm vs. 28 μm).
Conclusion: This report suggests that the radiation-induced damage was confined to the inner layers of the retina. However, secondary outer
retinal layer changes may also occur, as suggested by functional derangements.
Read More: http://informahealthcare.com/doi/abs/10.3109/15569520903331674
http://www.ncbi.nlm.nih.gov/pubmed/18454407?dopt=Abstract
Klin Monbl Augenheilkd. 2008 May;225(5):488-90.
Spectral optical coherence tomography findings in adult-onset foveomacular vitelliform dystrophy.
Petropoulos IK, Desmangles PM, Matter MA.
Source
Centre Ophtalmologique de la Terrassière, Geneva, Switzerland. ipetropoulos@cot-ge.ch
Abstract
BACKGROUND:
Adult-onset foveomacular vitelliform dystrophy (AOFVD) is typically bilateral and symmetrical. We present the spectral optical coherence
tomography (OCT) findings in two patients with unilateral AOFVD.
PATIENTS AND METHODS:
Case 1 represents a 76-year-old man followed angiographically over the last 6 years for a macular lesion in his right eye. Visual acuity in the right
eye has decreased from 1.0 to 0.6. In case 2, a 69-year-old man presented with blurred vision in his right eye. Visual acuity was 0.7 in the right
eye and 1.0 in the left eye. In both patients, spectral OCT (Copernicus SOCT System) was performed.
RESULTS:
In case 1, fluorescein angiography showed a juxtafoveal hyperfluorescent lesion 2 / 3 of disc area in size, without late leakage. OCT showed a
cystic oval lesion with thick walls, located between the retinal pigment epithelium (RPE) and photoreceptor layers. In case 2, OCT showed a
hyperreflective round lesion also located between the RPE and photoreceptor layers, elevating the overlying inner retina.
CONCLUSIONS:
Spectral OCT enables enhanced visualization of the retinal layers and provides useful information regarding the diagnosis and the exact location
of AOFVD.