The Eye Clinic Polytechnic University of Marche Head: Prof Alfonso Giovannini November, 1991 Optical Coherence Tomography (OCT) in Uveitis Piergiorgio Neri, BMedSc, MD, PhD Head Ocular Immunology Unit How OCT changed 1994: A specialized test for retinal specialists 2013: A broad based tool for comprehensive ophthalmologists OCT main features Similar principle to B Scan ultrasonography Non invasive, non contact transpupillary imaging Can image retinal structures in vivo Resolution (longitudinal) of 5-17 microns (10 x superior to ultrasound B-Scan) The anatomic layers within the retina can be differentiated and retinal thickness can be measured. Difficulties with opacified media (cataract, corneal edema, band kerathopathy ) 1
OCT Types Why SD-OCT changes the view of Ophthalmlogy Time Stratus Domain Time Domain OCT OCT Spectral Domain OCT Time domain Spectral domain Jean Baptiste Fourier OCT in evaluation of inflammatory 2
OCT in evaluation of inflammatory OCT in evaluation of inflammatory OCT in evaluation of inflammatory OCT in evaluation of inflammatory 3
OCT in evaluation of inflammatory Can You differentiate it? Toxoplasmosis Guagnini et al: Graefe s 2007; 245:158 Lymphoma Courtesy Prof N Cassoux 4
OCT in evaluation of inflammatory Neri P et Al. Clin Exp Rheumetol 2013 OCT in evaluation of inflammatory involvement in uveitis can help to detect: 1. Increased or decreased retinal thickness 2. Cystoid changes 3. Subretinal fluid 4. Vitreous traction 5. Epiretinal membrane 6. Choroidal exploration Neri P et Al. Clin Exp Rheumetol 2013 5
Behçet disease Central Foveal Thickness Table CFT (µm) Baseline 3 Months 12 Months Last follow-up Mean Media 441,3 167,4 167,2 162,7 Ozdemir H, Mudun B, Karacorlu M, Karacorlu S. Serous detachment of macula in Behçet disease.retina. 2005 Apr-May;25(3):361-2. SD 48,6 12,8 14,3 5,6 OCT-Pregnancy Before After 6
7-yr old After steroids+mmf POHS Failed surgical removal-1996 6 Days after OCT in evaluation of inflammatory involvement in uveitis can help to detect: 1. Increased or decreased retinal thickness 2. Cystoid changes 3. Subretinal fluid 4. Vitreous traction 5. Epiretinal membrane 6. Choroidal exploration Steroids+MMF+anti-VEGF 7
OCT in evaluation of inflammatory involvement in uveitis can help to detect: 1. Increased or decreased retinal thickness 2. Cystoid changes 3. Subretinal fluid 4. Vitreous traction 5. Epiretinal membrane 6. Choroidal exploration Exploring choroid by the OCT Enhanced depth imaging OCT Swept Source OCT Enhanced depth imaging (EDI)-OCT Enhanced depth imaging (EDI)-OCT Placing the objective lens of the Spectralis SDOCT (SD-OCT) device closer to the eye so that an inverted image is obtained Deeper structures placed closer to the zero delay, Better visualization of the choroid Spaide et Al. Am J Ophthalmol 2008 8
Courtesy of Professor Paulo E. Stanga, the Royal Eye Hospital & University of Manchester Professor Jose Maria Ruiz Moreno, University of Albacete, Spain Department of Ophthalmology, Fukushima Medical University. Take the slice! 9
Prognosis Atrophy Fibrosis Loss of Layers Figure 2. Representative High-Definition Optical Coherence Tomography Image of a Normal Macula The right eye of patient 22 had normal macular thickness with a preserved photoreceptor layer. White arrow indicates hypereflective line corresponding to the photoreceptor layer, while the blue arrow indicates the hypereflective line corresponding to the RPE. The hyporeflective space in between these lines, denoted by the red arrow, corresponds to the photoreceptor outer segments. Image represents horizontal line scan through center of fovea. Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic foveal atrophy: clinical features and associations. Arch Ophthalmol. 2009 Feb;127(2):179-86. Figure 1. Relationship Between Photoreceptor Layer Status and Visual Acuity Visual acuities of eyes with intact, partially intact, or absent photoreceptor layers were significantly different from each other (p < 0.0001). All pairwise comparisons between these groups were also significantly different (p < 0.001). Horizontal lines indicate mean values. Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic foveal atrophy: clinical features and associations. Arch Ophthalmol. 2009 Feb;127(2):179-86. Forooghian F, Yeh S, Faia LJ, Nussenblatt RB Uveitic foveal atrophy: clinical features and associations. Arch Ophthalmol. 2009 Feb;127(2):179-86. 10
Limits 1. Opacified media: AS anomalies (cataract, posterior synechiae, etc ) Vitreous opacities 2. Scarce collaboration Conclusions In patients with uveitis, optical coherence tomography (OCT) is a non-invasive method that gives additional accuracy in the assessment and follow-up of the disease In clinical studies, OCT is unavoidable as is it the case for all methods that give objective & quantifiable data The OCT technology is still undergoing gradual improvement of its performance and has not reached yet the limits of its possibilities higher resolution OCT, higher speed of acquisition, spectral domain OCT, swept source OCT Conclusions Combined with other methods such as indocyanine green angiography, laser flare photometry and UBM, OCT contributes to improve the diagnosis and management of uveitis. Piergiorgio Neri Secretary General www.soie-soif.org p.neri@univpm.it 11