HD OCT Cornea and Anterior Segment Case Presentations
Michael Cymbor, OD, FAAO Nittany Eye Associates State College, PA
Adjunct Professor, Pennsylvania College of Optometry, COPE Course ID:
I.
II.
III.
OCT Evolution
a. Benefits of Spectral Domain
i. Higher resolution
ii. Fewer moving parts – faster scan acquisition
iii. Acquisition of a cube of data
iv. Better visualization of tissue/pathology
v. Slightly better penetration of light
vi. Better registration
vii. 3D analysis
b. Cornea and Anterior Segment
i. A beam of light is directed onto the structure and the echo time delay of light is
then recorded.
ii. Ideal tissues for OCT Imaging
iii. OCT requires no contact or immersion and has higher spatial resolution than
ultrasound
Cornea Cases
a. 45 Y/O White Female, wants to know her treatment options
i. OcHx: Repeated HSK OD with stromal involvement, SHx: Stage 4 GI cancer with
liver involvement 2000, 6 months of chemo, clear until 2005 with lymph node
involvement, 6 months chemo, clear since. On acyclovir 400mg bid upon flare –
ups, BCVA OD 20/70 OS 20/25, PK?
b. 60 Y/O WM, Bilateral Keratoconus, Cc: Sudden vision loss OD
i. BCVA 20/80 OD, 20/40 OS, Wearing large diameter SoClear Scleral lens
c. 78 Y/O WF, Ocular History: Bilateral Phaco’s with IOL several years ago, Initial post-op
BCVA 20/25 OD and OS, Cc: decreased VA
i. Current BCVA 20/40 OD and OS, DSAEK
d. 19 y/o white male
i. Entered office as a problem visit. Pt was at work using a nail gun without safety
glasses. Reports that he got too close to gun, shot himself in the eye. Trouble
opening OS due to pain. Upon instillation of Proparacaine.
ii. Dx: open globe injury due to penetrating intraocular foreign body. A driver was
found and the patient was sent to tertiary care for immediate surgical repair
Angle
a. 61 year old white female, CC: Decreased vision and red eyes
i. BCVA: 20/40 OD and 20/20 OS at distance, IOP’s: 14 OU, Refractive Status:+1.000.50x27, -0.50-1.00x140, Anterior Segment:
IV.
V.
ii. Diagnoses: Cataracts OD>OS, Blepharitis OU, Narrow Angles OU (Grade 2 VH,
ATM 360 deg. OU by gonio), Posterior Segment: Mild RPE mottling OD, Angle OD,
Angles-OS, Narrow anatomical angles OU
iii. Angle Closure Risk Factors, Age: 60 or greater, Gender: Females 4:1, Family
History: first degree relatives at increased risk due to similar anatomical features,
Race: Most common in South-East Asians, Chinese and Eskimos, Fairly common
in Caucasians ~ 6% of all types of glaucoma, Uncommon among blacks,
Contributing Characteristics, Lens Size: The lens is the only structure that
continues to grow throughout life. As is grows the anterior surface slowly gets
closer to the cornea progressively swallowing the anterior chamber, Consider: AScan to measure the anterior chamber depth, Relative risk of angle-closure can
be assessed, 75% of angle closure glaucoma occurs in chambers less than 1.5
mm, ACG is rare in chambers greater than 2.5 mm Exception: Plateau Iris
Syndrome, V-H is small while AC is very large, LPI will fail in these patients,
Contributing Characteristics, Axial Length: Shorter eyes usually have both smaller
corneal diameters and narrower angles, usually hyperops have shorter eyes,
increasing their risk for angle closer, Mechanism of Angle Closure, Technique
iv. Treatment: Argon Laser, creates larger hole; used in pigmented pts. Coagulative
laser – boils water in tissue, Does not cause bleeding, Nd:YAG Laser, creates
smaller hole with jagged edge, Photodisruptive/photoablative laser, Cutting laser
– can cause hemorrhaging, Dark Iris, Use Argon for chipping technique and YAG
to finish, Light Iris, YAG Laser, Shoot between radial white iris cords, Before and
After: OD OS
b. 66 Y/O White Male, Cc: burning, tearing, FB sensation OS x 2 weeks, intermittent,
redness
i. SLE: eyelid margin telangectasia with MGD, mild inferior SPK, Gross inspection:
cheek and forehead erythema with nose pustules, Ta 19mmHg OD, 24mmHg OS
ii. Dx: 1) corneal SPK with MGD secondary to rosacea, 2) glaucoma suspect
iii. Treatment: Lotemax qid OU, return 2 weeks for glaucoma work-up, 2 weeks later
Ta 20 mmHg OD, 26 mmHg OS
Trabeculectomy Blebs
a. 77 YO/WF, Advanced glaucoma, Bilateral Trabeculectomies 2005, IOP 8-11 range,
Cataract Surgery OS 2 yrs ago, IOP 10-11 range, Cataract Surgery OD 6 months ago, IOP
16-19 range
Iris
a. Nevi
i. The annual incidence is approximately 1/million. The great majority of iris
melanomas occur on the inferior half of the iris. Sun exposure?The overall rate of
spread at 10 years is 3-5%.*
ii. Treatment options for iris melanomas include:
1. Observation, Excision, Enucleation, Plaque radiotherapy
b. Cysts
VI.
c. Iridoschisis
References
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2. The Wills Eye Manual: 5th edition
3. RTVue Fourier-Domain Optical Coherence Tomography Primer Series:
Vol. 111
4. Glaucoma, by Robert Weinreb and Rohit Varma
5. Pieramici DJ. Open-Globe Injuries Are Rarely Hopeless. Review of
Ophthalmology, 15 June 2005.
6. Rahman I, Maino A, Devadason D, Leatherbarrow B. Open Globe
Injuries: factors predictive of poor outcome. Eye (2006) 20, 1336-1341.
7. Havens S, Millicent P, Omofolasade K. Penetrating Eye Injury: A Case
Study. American Journal of Clin Med, Winter 2009; Volume 6, Number
1.
8. Friedman, N., Kaiser, P. Massachusetts Eye and Ear Infirmary. 3rd
edition, 2009.
9. Khurana RN, Li Y, Tang M, Lai MM, Huang D. High-speed optical
coherence tomography of corneal opacities. Ophthalmology
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Ophthalmol. 2000;11:133–139.
12. Sobara L, Maram J, Fonn D, et al. Metrics of the normal cornea: anterior
segment imaging with the Visante OCT. Clin Exp Optom. 2010
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13. Ratanasit A, GorovoyMS. Long-term results of Descemet stripping
automated endothelial keratoplasty. Cornea. 2011 Dec;30(12):1414-8.