Montage Images of Spectral-Domain Optical Coherence Tomography in Eyes with Idiopathic Macular Holes

doi:10.1016/j.ophtha.2012.06.027

Ophthalmology

Volume 119, Issue 12, December 2012, Pages 2600-2608

https://doi.org/10.1016/j.ophtha.2012.06.027 Get rights and content

Purpose

To describe the morphologic and anatomic relationships at the vitreoretinal interface, from the macula into the periphery, in patients with idiopathic macular hole. Montaged images of posterior and peripheral spectral-domain (SD) optical coherence tomography (OCT) studies were used to describe the anatomic vitreoretinal relationships.

Design

Prospective, consecutive, observational case series.

Participants

Forty-six eyes of thirty-six consecutive patients with idiopathic macular hole and their fellow eyes.

Methods

Montage images of 4 radial OCT scans (horizontal, vertical, and 2 oblique scans) through the fovea were obtained in each case.

Main Outcome Measures

Montage SD OCT images.

Results

In fellow eyes, potential precursor changes to macular hole revealed shallow perifoveal vitreous separation that extends peripherally toward the equator. Two distinct configurations were noted at the posterior vitreous face; eyes without holes had a smooth curvature, whereas eyes with holes were more likely to have wavy, folded, or scalloped vitreous surfaces. At the onset of separation, most posterior vitreous cortex had a smooth curvature, but posterior vitreous folds increased with progressive separation. Also notable were zones of double-layered retinoschisis in regions of adherent posterior vitreous. Resulting granular hyperreflection in the peripheral vitreous was detectable in 50% to 60% of stage 1 or 2 holes but in only 33% of stage 3 or 4 holes.

Conclusions

The SD OCT montages taken at serial stages of idiopathic macular holes document distinct configurations of the posterior vitreous face, granular hyperreflection in the peripheral vitreous, and areas of peripheral retinoschisis. Montaging SD OCT images provides novel cross-sectional images of the vitreoretinal interface that may have broader application.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Study Design

This was a prospective, consecutive, observational case series. Forty-six consecutive eyes of 36 patients with a clinical diagnosis of idiopathic macular hole, but without other ocular complications were enrolled into this study. All investigations adhered to the tenets of the Declaration of Helsinki. This study was approved by the institutional review board of the Saitama Medical University. The composition of the patient population was 20 females and 16 males, ranging in age from 46 to 79

Results

The appearance and configuration of the posterior vitreous in fellow eyes and macular hole eyes grouped by Gass stages are described herein. A series of images is presented and, in most examples, there are 1 of 2 typical patterns, termed smooth (Figure 1, Figure 2) and wavy or scalloped (Figure 3, Figure 4, Figure 5).

Discussion

This study assembled montaged OCT images of the posterior vitreous, retina, and choroid that extended from the macula to the periphery and examined the morphologic relationships between these structures during development and progression of idiopathic macular holes. The posterior vitreous cortex was delineated clearly in all eyes except those with very anterior vitreous detachment. This finding was noted only in eyes with stage 4 holes. Eyes predisposed to macular hole formation were examined

Acknowledgments

The authors thank Fumi Yamato, MD, and Tatsuya Deguchi, OP, for their help in recruiting the subjects and creating montage images of optical coherence tomography scans and Hiroto Kuroda, PhD, for his thoughtful comments regarding the fundamentals of optical coherence tomography.

References (22)

J.D. Gass
Reappraisal of biomicroscopic classification of stages of development of a macular hole
Am J Ophthalmol
(1995)
R.T. Wendel et al.
Vitreous surgery for macular holes
Ophthalmology
(1993)
M.R. Hee et al.
Optical coherence tomography of macular holes
Ophthalmology
(1995)
A. Chan et al.
Stage 0 macular holes: observations by optical coherence tomography
Ophthalmology
(2004)
W.E. Smiddy et al.
Histopathology of tissue removed during vitrectomy for impending macular holes
Am J Ophthalmol
(1989)
L.K. Chang et al.
Ultrastructural correlation of spectral-domain optical coherence tomographic findings in vitreomacular traction syndrome
Am J Ophthalmol
(2008)
W.E. Smiddy et al.
Ultrastructural studies of vitreomacular traction syndrome
Am J Ophthalmol
(1989)
J.D. Gass
Idiopathic senile macular hole: its early stages and pathogenesis
Arch Ophthalmol
(1988)
W.E. Smiddy et al.
Vitrectomy for impending idiopathic macular holes
Am J Ophthalmol
(1988)
N.E. Kelly et al.
Vitreous surgery for idiopathic macular holes: results of a pilot study
Arch Ophthalmol
(1991)

C.A. Puliafito et al.

Optical Coherence Tomography in Ocular Diseases

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Mechanistic Insights into the Pathogenesis of Proliferative and Nonproliferative Vitreomacular Traction
2022, American Journal of Ophthalmology
Citation Excerpt :
In support of this hypothesis, we found that macular holes were much more commonly associated with the dynamic traction of nonproliferative VMT than with the static traction of proliferative VMT. Regarding macular hole progression, we have previously demonstrated that the dynamic posterior vitreous movements have a significant impact on anteroposterior tractional forces on the parafovea.11,12 Likewise, eyes with nonproliferative VMT had a wavy-contoured posterior vitreous, which was very flexible and mobile immediately after eye motion, implicating the dynamic traction forces applied to the macula with resulting fluid currents playing potentially important pathogenetic roles.
To describe the vitreoretinal interface in vitreomacular traction (VMT) by using novel optical coherence tomography (OCT) methods; wide-angle montage, and pseudomotion OCT imaging systems.
Observational case series.
Wide-angle montage OCT images of horizontal and vertical scans through the fovea were acquired in 50 eyes of 46 consecutive patients with VMT. Baseline fundus scans were obtained. These were followed by scans acquired with an eye-tracking system performed immediately after vertical and horizontal eye movements. Three scans were then superimposed to compare changes in the contour and position of the posterior vitreous.
The subjects were classified as VMT with (“proliferative”; 48.0%) and without (“nonproliferative”; 52.0%) thickened posterior vitreous. Epiretinal membrane was observed in 26.9% of nonproliferative and 95.8% of proliferative VMT eyes (P = 3.6 × 10^–7). No eye of proliferative and 57.7% of nonproliferative VMT eyes had wavy contoured posterior vitreous (P = 4.0 × 10^–6). None with proliferative VMT, but 91.7% of nonproliferative VMT eyes, showed motion induced changes of posterior vitreous following eye movement (P = 2.0 × 10^–8). The posterior vitreous detachment extended beyond the scanned area in 34.6% of nonproliferative and 8.3% of proliferative VMT eyes (P = .040).
By dynamically evaluating the vitreoretinal interface of patients with VMT, the static contraction forces of a thickened posterior vitreous at the macula are implicated in proliferative VMT. This contractile force is not strongly implicated in the majority of VMT eyes with nontaut and more mobile vitreous (nonproliferative VMT). VMT and its associated complications are determined by at least 2 different pathophysiological mechanisms.
Classification and Guidelines for Widefield Imaging: Recommendations from the International Widefield Imaging Study Group
2019, Ophthalmology Retina
To summarize the results of a consensus meeting aimed at defining terminology for widefield imaging across all retinal imaging methods and to provide recommendations for the nomenclature used to describe related images.
An international panel with expertise in retinal imaging was assembled to define consensus terminology for widefield imaging and associated terminology.
A panel of retina specialists with expertise in retinal imaging.
Before the consensus meeting, a set of 7 images acquired with a range of imaging methods and representing both healthy and diseased eyes was circulated to the expert panel for independent assignment of nomenclature for each example. The outputs were assembled and used as the starting point for discussions occurring at a subsequent roundtable meeting. The anatomic location, field of view, and perspective provided by each image example was reviewed. A process of open discussion and negotiation was undertaken until unanimous terminology for widefield imaging was achieved.
Definitions of widefield imaging applicable to multiple imaging methods.
Across a range of different imaging methods, the expert panel identified a lack of uniform terminology being used in recent literature to describe widefield images. The panel recommended the term widefield be limited to images depicting retinal anatomic features beyond the posterior pole, but posterior to the vortex vein ampulla, in all 4 quadrants. The term ultra widefield was recommended to describe images showing retinal anatomic features anterior to the vortex vein ampullae in all 4 quadrants. The definitions were recommended over other device-specific terminology.
A consistent nomenclature for widefield imaging based on normal anatomic landmarks that is applicable to multiple retinal imaging methods has been proposed by the International Widefield Imaging Study Group. The panel recommends this standardized nomenclature for use in future publications.
Posterior Vitreous Detachment as Observed by Wide-Angle OCT Imaging
2018, Ophthalmology
Citation Excerpt :
To enhance visualization of the vitreous image, contrast was adjusted by the planimetric image-editing system, enhanced vitreous visualization.22–24 To examine the morphologic features of the entire posterior vitreous cortex and the vitreoretinal interface, wide-angle montage OCT images from the macula to the periphery (approximately to the equator) were obtained as previously described.15–17 Montaged images were assembled using picture-editing software (Photoshop version 5.5, Adobe, San Jose, CA).
Posterior vitreous detachment (PVD) plays an important role in vitreoretinal interface disorders. Historically, observations of PVD using OCT have been limited to the macular region. The purpose of this study is to image the wide-angle vitreoretinal interface after PVD in normal subjects using montaged OCT images.
An observational cross-sectional study.
A total of 144 healthy eyes of 98 normal subjects aged 21 to 95 years (51.4±22.0 [mean ± standard deviation]).
Montaged images of horizontal and vertical OCT scans through the fovea were obtained in each subject.
Montaged OCT images.
By using wide-angle OCT, we imaged the vitreoretinal interface from the macula to the periphery. PVD was classified into 5 stages: stage 0, no PVD (2 eyes, both aged 21 years); stage 1, peripheral PVD limited to paramacular to peripheral zones (88 eyes, mean age 38.9±16.2 years, mean ± standard deviation); stage 2, perifoveal PVD extending to the periphery (12 eyes, mean age 67.9±8.4 years); stage 3, peripapillary PVD with persistent vitreopapillary adhesion alone (7 eyes, mean age 70.9±11.9 years); stage 4, complete PVD (35 eyes, mean age 75.1±10.1 years). All stage 1 PVDs (100%) were observed in the paramacular to peripheral region where the vitreous gel adheres directly to the cortical vitreous and retinal surface. After progression to stage 2 PVD, the area of PVD extends posteriorly to the perifovea and anteriorly to the periphery. Vitreoschisis was observed in 41.2% at PVD initiation (stage 1a).
Whereas prior work suggests that PVD originates in the perifoveal region and after the sixth decade, our observations demonstrate that (1) PVD first appears even in the third decade of life and gradually appears more extensively throughout life; (2) more than 40% of eyes without fundus diseases at their PVD initiation are associated with vitreoschisis; and (3) PVD is first noted primarily in the paramacular-peripheral region where vitreous gel adheres to the retinal surface and is noted to be more extensive in older ages to ultimately involve the fovea.
Peripheral optical coherence tomography montage guided successful management of retinal detachment with sub retinal bands
2017, Saudi Journal of Ophthalmology
Citation Excerpt :
Later these pictures were combined to create a montage (Figs. 1 and 2). OCT montage systems have been analyzed1 and used in cases with retinoschisis2 and macular holes.3 Shallow non-resolving localized RD with SRB near macula is a challenging situation especially with good visual acuity.
Imaging Choroidal Disorders: The Future
2017, Choroidal Disorders
Choroidal imaging is a fast developing field of research. This chapter highlights the use of new technology in this field including; spectral domain optical coherence tomography (SD-OCT), enhanced-depth imaging OCT (EDI-OCT), swept-source OCT (SS-OCT), OCT angiography, wide field OCT/ICGA, and en-face imaging. It is hoped that as these techniques become ingrained in clinical practice, there will be an improved understanding of the choroid and the development of choroid-specific biomarkers that will improve understanding in this field.
Ultra-Widefield Steering-Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery
2016, Ophthalmology
Citation Excerpt :
This anatomic association, which we observed in our images, remains consistent with commonly accepted mechanisms that link vitreous traction to peripheral retinal pathologies. We observed other features of the peripheral neural retina that are consistent with previous reports, including relative thinning, or effacement, of all nuclear layers and the attenuation of choroidal vessels.8 Our observations regarding cystoid degeneration, which was commonly observed in a variety of peripheral retinal findings, including retinal hole (Fig 2), ora serrata pearl (Supplemental Fig 5, available at www.aaojournal.org), cystic retinal tuft (Supplemental Fig 6, available at www.aaojournal.org), and meridional fold (Supplemental Fig 7, available at www.aaojournal.org), are unique to this study and have not been reported in peripheral SD OCT studies.
To describe the spectral-domain optical coherence tomography (SD OCT) features of peripheral retinal findings using an ultra-widefield (UWF) steering technique to image the retinal periphery.
Observational study.
A total of 68 patients (68 eyes) with 19 peripheral retinal features.
Spectral-domain OCT–based structural features.
Nineteen peripheral retinal features, including vortex vein, congenital hypertrophy of the retinal pigment epithelium, pars plana, ora serrata pearl, typical cystoid degeneration (TCD), cystic retinal tuft, meridional fold, lattice and cobblestone degeneration, retinal hole, retinal tear, rhegmatogenous retinal detachment, typical degenerative senile retinoschisis, peripheral laser coagulation scars, ora tooth, cryopexy scars (retinal tear and treated retinoblastoma scar), bone spicules, white without pressure, and peripheral drusen, were identified by peripheral clinical examination. Near-infrared scanning laser ophthalmoscopy images and SD OCT of these entities were registered to UWF color photographs.
Spectral-domain OCT resolved structural features of all peripheral findings. Dilated hyporeflective tubular structures within the choroid were observed in the vortex vein. Loss of retinal lamination, neural retinal attenuation, retinal pigment epithelium loss, or hypertrophy was seen in several entities, including congenital hypertrophy of the retinal pigment epithelium, ora serrata pearl, TCD, cystic retinal tuft, meridional fold, lattice, and cobblestone degenerations. Hyporeflective intraretinal spaces, indicating cystoid or schitic fluid, were seen in ora serrata pearl, ora tooth, TCD, cystic retinal tuft, meridional fold, retinal hole, and typical degenerative senile retinoschisis. The vitreoretinal interface, which often consisted of lamellae-like structures of the condensed cortical vitreous near or adherent to the neural retina, appeared clearly in most peripheral findings, confirming its association with many low-risk and vision-threatening pathologies, such as lattice degeneration, meridional folds, retinal breaks, and rhegmatogenous retinal detachments.
Ultra-widefield steering-based SD OCT imaging of the retinal periphery is feasible with current commercially available devices and provides detailed anatomic information of the peripheral retina, including benign and pathologic entities, not previously imaged. This imaging technique may deepen our structural understanding of these entities and their potentially associated macular and systemic pathologies, and may influence decision-making in clinical practice, particularly in areas with teleretinal capabilities but poor access to retinal specialists.

View all citing articles on Scopus

: Manuscript no. 2011-1793.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: This research was supported in part by a grant-in-aid for scientific research from the Ministry of Education, Culture and Science in Japan (grant no.: 24592641; K.M.).

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Original articleMontage Images of Spectral-Domain Optical Coherence Tomography in Eyes with Idiopathic Macular Holes

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients and Study Design

Results

Discussion

Acknowledgments

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Idiopathic senile macular hole: its early stages and pathogenesis

Arch Ophthalmol

Vitrectomy for impending idiopathic macular holes

Am J Ophthalmol

Vitreous surgery for idiopathic macular holes: results of a pilot study

Arch Ophthalmol

Optical Coherence Tomography in Ocular Diseases

Original article
Montage Images of Spectral-Domain Optical Coherence Tomography in Eyes with Idiopathic Macular Holes