Ultra-Widefield Steering-Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery

doi:10.1016/j.ophtha.2016.01.045

Ophthalmology

Volume 123, Issue 6, June 2016, Pages 1368-1374

Presented at the Retina Society Meeting, October 7–11, 2015, Paris, France.

https://doi.org/10.1016/j.ophtha.2016.01.045 Get rights and content

Purpose

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.

Design

Observational study.

Participants

A total of 68 patients (68 eyes) with 19 peripheral retinal features.

Main Outcome Measures

Spectral-domain OCT–based structural features.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Methods

The procedures used in this research adhered to the tenets of the Declaration of Helsinki, and Institutional Review Board approval for this study was obtained from the local Ethics Committee. A total of 124 consecutive eyes with previously diagnosed peripheral retinal findings underwent UWF steering-based SD OCT imaging from January 2014 to May 2015. Fifty-six eyes with advanced cataract, poorly dilating pupils, and poor fixation, and patients with limited cooperation were excluded. Subjects

Results

In all 68 eyes successfully imaged, there was no evidence of macular disease. The vitreoretinal interface and choroidal-scleral boundary were clearly visible in all examined eyes. Nineteen different peripheral findings were imaged in the 68 eyes (Supplemental Table 1, available at www.aaojournal.org). Among these, the most prevalent were retinal hole in 26.5% (18/68, Fig 2), cystic retinal tuft in 16.1% (11/68, Supplemental Fig 6, available at www.aaojournal.org), typical degenerative senile

Discussion

In this study, we used a UWF steering technique to register UWF color images with corresponding peripheral SD OCT scans, which allowed an unprecedented acquisition of high-resolution cross-sectional structural information of a variety of peripheral retinal entities and pathologies. We also used this approach to assemble a continuous, near 200° SD OCT montage image from retinal periphery to periphery (Fig 3B).

Carrai et al¹³ reported on wide-field SD OCT imaging in central serous

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Citation Excerpt :
Additional studies have used OCT to document both ILH and OLH (Fig. 6) as well as the presence of “double-schisis cavities” (with splitting both between the inner nuclear and outer plexiform layers and between the outer plexiform and outer nuclear layers) and have suggested that OCT is more sensitive than clinical exam or fundus photography for detection of schisis progression.32 In 2016, Choudhry and coworkers published their technique for UWF steering-based SD-OCT, whereby montaging of line scans using a conventional, clinically-available OCT device allowed for a 200° field of view.23 They imaged a case of degenerative RS, demonstrating splitting in both the inner nuclear and outer plexiform layers.
Degenerative retinoschisis is a common condition characterized by elevation of the inner layers of the peripheral retina. While uncomplicated retinoschisis (i.e., with no associated retinal layer breaks) is almost invariably a benign process, retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) is fairly common. Historically, schisis-detachment has been treated with a variety of interventions, ranging from retinopexy to intraocular surgery. Based on published descriptions of the natural history of the disease, these interventions are likely unnecessary in many cases and may place the patient's vision at unnecessary risk. Progressive symptomatic schisis-related retinal detachment, on the other hand, is a vision threatening condition that requires intervention. While clinical examination remains the mainstay of diagnosis, recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring. When evaluating patients with peripheral retinal elevation, it is important for ophthalmologists to make an accurate diagnosis and to understand the risk-benefit ratio associated with intervention. Thus, we summarize the current literature on the natural history, clinical and imaging diagnosis, and surgical management of degenerative retinoschisis and its related complications.
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: Supplemental material is available at www.aaojournal.org.

: Financial Disclosure(s): The author(s) have made the following disclosure(s): N.C.: Received honoraria as a speaker for Optos Plc.

: Supported by the National Eye Institute (K12EY022299 to RCR).

: Author Contributions:

: Conception and design: Choudhry, Rao

: Data collection: Choudhry, Golding, Manry, Rao

: Analysis and interpretation: Choudhry, Golding, Manry, Rao

: Obtained funding: Rao

: Overall responsibility: Choudhry, Rao

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© 2016 by the American Academy of OphthalmologyThis is an open access article under the CC BY license ?(<inter-ref xlink: href=http://creativecommons.org/licenses/by/4.0/>http://?creativecommons.org/licenses/by/4.0/</inter-ref>).

Original articleUltra-Widefield Steering-Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery

Purpose

Design

Participants

Main Outcome Measures

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Optical coherence tomography

Science

Ranibizumab and bevacizumab for neovascular age-related macular degeneration

N Engl J Med

Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial

JAMA

Areas of nonperfusion in peripheral retina of eyes with pathologic myopia detected by ultra-widefield fluorescein angiography

Invest Ophthalmol Vis Sci

Original article
Ultra-Widefield Steering-Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery