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OCT IN MACULAR HOLES & ARMD

OCT in macular holes :- document & size a full thickness hole , prognosticate the hole -anatomical closure and functional outcome, planning surgery & intraoperative OCT, timing of prone positioning. <br>OCT in age related macular degeneration (ARMD) :- defines the location and nature of changes, detects newly emerging changes like intra & sub retinal fluid, helps understand differences between various membranes like classic, occult and scars.<br>Visit for more info :- https://mumbaieyeretinaclinic.com/

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OCT IN MACULAR HOLES & ARMD

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  1. OCT IN MACULAR HOLES & ARMD MADHUSUDAN DAVDA, MD,FMRF MUMBAI EYE &RETINA CLINIC, CHEMBUR A Super Speciality Retina Care Centre

  2. The Normal OCT

  3. When & Why do you need an OCT in macular holes? • document & size a full thickness hole • prognosticate the hole - anatomical closure and functional outcome • planning surgery & intraoperative OCT • timing of prone positioning

  4. small <250 microns medium 250-500 microns large > 400 microns Sizing of holes ILM peel is not mandatory for holes upto 400 microns

  5. Anatomy of a macular hole minimum diameter i base diameter a height h b arm length macular hole inner opening

  6. Macular hole indices • minimum diameter: a • height:b • base diameter: c • arm lengths: d,e HFF = d+e/c MHI = b/c THI = b/a DHI = a/c

  7. Hole closure & Visual outcome • min dia <311 mic • THI>1.41 (more the height, better is closure) • DHI < 0.5 • HFF >0.9 (<0.5 poor closure rates) Optical Coherence tomography predictive factors for macular hole surgery outcome, Ruiz-Morena JM et al, Br J Ophthalmol. 2008

  8. Types of hole closure • type 1 : closed hole without any defect of the foveal neurosensory retina • type 2: persistent foveal defect of neurosensory retina despite the whole rim of hole attached to the underlying RPE with resolution of SRF and CME

  9. visual outcome • Type 1 has better prognosis • intact IS-OS junction has better prognosis • Intact ELM has better prognosis • Increased photoreceptor outer segment thickness (COST) • High THI values(>1.41) & low DHI values (<0.50) have better visual prognosis

  10. Type 1 closure Intact ELM BCVA 6/9 post surgery

  11. Type 1 closure Disrupted ELM, IS/OS & COST

  12. Type 1 closure Disrupted ELM, IS/OS & COST BCVA 6/36 post surgery from <6/60

  13. Type 1 closure Reasonably intact ELM, IS/OS & COST However note the RPE

  14. Spontaneous Closure

  15. take home.. • OCT is not just to confirm presence of hole • smaller the size of hole better is the anatomical closure • more the height better is the closure rate • look for the 4 outer lines for prognosis

  16. OCT in Age Related Macular Degeneration (ARMD) • Document presence/abscence of activity • Morphological variants • Prognosticate - visual, number of injections, likelihood of alternative treatments • Follow up

  17. OCT in Dry ARMD

  18. OCT in Dry ARMD • confluent drusen • presence of pigment changes • wet ARMD in the other eye

  19. OCT in Wet ARMD • identify morphological type • understand prognosis • decide additional investigations • line of management

  20. components • RPE detachments • sub retinal space • intraretinal fluid

  21. RPED & RPE rip

  22. sub retinal space

  23. PRE RPE (classic) CNVM

  24. Sub RPE (occult) CNVM

  25. IPCV

  26. oct criteria for PCV • multiple RPEDs • a sharp RPED peak • Notched RPED • Hyporeflective lumen of polyp adhered to hyper reflective lesions beneath the RPE • hyper reflective intraretinal hard exudates

  27. take home • multiple serosanguinous PEDs • massive sub retinal bleeds • presence of polyps multiple PEDs notched PED presence of hypo lucent polyps

  28. RAP lesions

  29. Retinal Angiomatosis Proliferans (RAP lesions) • inner retinal cyst • outer retinal cyst • FVPED • SRF

  30. Take Home.. • patient with intra, sub retinal haemorrhage, hard exudates and cme • right angled venue • usually require quite a few injections • develop extensive RPE atrophy post PDT

  31. OCT & Treatment

  32. special situations

  33. RPE Rip

  34. adult vitelliform dystrophy

  35. “Thank you” -team merc

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