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Interpretation of SD-OCT

Interpretation of SD-OCT. Gella Laxmi 2009PHXF013P. How to go about…. Interpretation should proceed sequentially from vitreous towards choroid Evaluate each layers. Gray scale or conventional colors?. Gray scale images – qualitatively superior Color images – misleading. Reflectivity.

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Interpretation of SD-OCT

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  1. Interpretation of SD-OCT Gella Laxmi 2009PHXF013P

  2. How to go about…. • Interpretation should proceed sequentially from vitreous towards choroid • Evaluate each layers

  3. Gray scale or conventional colors? • Gray scale images – qualitatively superior • Color images – misleading

  4. Reflectivity Hyper reflective Lesions(Red ) Hypo reflective Lesions (Black) (Fluid) ME DRUSEN PED HE SRF CNVM Fovealschisis ERM

  5. Thickness Increased (edema, CNVM) Decreased

  6. Morphology “Missing" retina "Extra" retinal tissue

  7. Before advising OCT ...... Answer 2 questions... “Why OCT in this case?” “What to look for in OCT?”

  8. Classify (FFA better) To R/O Foveolar detachment To R/O VMT ( Difficult clinically) Post treatment follow up Swelling – Focal /Diffuse / Cystoid Hard exudates Foveolar detachment Status of posterior hyaloid CWS, Hemorrhage Diabetic Macular Edema

  9. OCT classification of macular edema Cystoid Macular Edema (CME) Schitic Retinal Thickening (SRT) Neurosensory Detachment (NSD) Diffuse Retinal Thickening (DRT)

  10. Macular Hole Why OCT? What to look for? • Confirmation • Staging • Surgical planning • Patient education • FTMH • LMH • VMT

  11. OCT Staging of macular hole Stage 1B (Full thickness pseudocyst) Stage 2 (Partial opening of pseudooperculum focal Vitreous attachment ) Stage 3 (Operculated FTMH Vitreous traction released) Stage 4 (With complete PVD) Post surgery

  12. Surgical prognosis Preoperative macular hole configuration and size determined by OCT showed good correlation with anatomical and functional outcomes after surgery

  13. HFF > 0.9 - 100 % PRIMARY CLOSURE HFF = 0.5 - 67 % PRIMARY CLOSURE HFF < 0.5 - Poor closure rates

  14. ARMD • Diagnosis - Dry or Wet • Response to treatment Drusens • Lipofusin deposits • Bumpy RPE • High reflective • Normal inner retinal layers • No shadowing

  15. Types of PED Drusanoid Fibrovascular Hemorrhagic Serous

  16. Occult Classic Types of CNVM • Disruption of RPE band • Irregular thickening below RPE • CNVM not adequately visualized • Optical shadowing by detached RPE • Continuous RPE band • Well defined , Hyperreflective • fusiform thickening above RPE • Marked , posterior shadowing Intraretinal fluid is associated with the presence of neovascular membrane

  17. Central Serous Retinopathy • RPE defect • SRF • Cystoid spaces • Foveal atrophy/thinning • Subretinal fibrin • CNVM • Compare the reflectivity with vitreous • Granular outer segment in chronic cases

  18. Parafoveal Telangiectasia • Cystic spaces • Minimum/ moderate thickening • Defect at the level of photoreceptor layer • Intraretinal high reflective areas causing shadow (migrated pigments)

  19. OCT in ERM and VMT • Confirmation • Topographic localization • Surgical planning • R/O coincidental pathology • like macular hole /pseudohole

  20. References • M Brar, D-U G Bartsch. Colour versus grey-scale display of images on high-resolution spectral OCT. Br J Ophthalmol. 2009; 93: 597-602. • Brian Y. Kim, Scott D. Smith, et al. Optical Coherence Tomographic patterns of Diabetic Macular Edema. Am J Ophthalmol. 2006; 142;405-412. • S Ullrich, C Haritoglou, C Gass, M Schaumberger, M W Ulbig. Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol. 2002 April; 86(4): 390–393. • Kusuhara S, Teraoka Escano MF, Fujii S et al. Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes. Am J Ophthalmol 2004; 138: 709–16. • Lisandro M Sakata, Julio DeLeon-Ortega et al. Optical coherence tomography of the retina and optic nerve – a review. Clinical and Experimental Ophthalmology 2009; 37: 90–99.

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