1. Articles from Carol L. Shields

    1-24 of 64 1 2 3 »
    1. A pilot exploration using optical coherence tomography angiography analysis of capillary vascular density and foveal avascular zone for the diagnosis of uveal melanoma

      A pilot exploration using optical coherence tomography angiography analysis of capillary vascular density and foveal avascular zone for the diagnosis of uveal melanoma

      Dear Editor, Choroidal melanoma is a rare malignancy, and in one study from the United Kingdom, up to 30% of patients referred by the general ophthalmologist to an ocular oncology center were misdiagnosed. [1] Later, the mnemonic “To find small ocular melanoma using helpful hints daily” [2] was established to aid in the detection of this malignancy at an early point. With the rapid advancements in ocular imaging technology, quantifiable and objective tests are becoming more ubiquitous in ophthalmology. In glaucoma, standardized, automated, quantifiable, and objective optical coherence tomography (OCT) peripapillary and macular diagnostic parameters have been shown to have ...

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    2. Wide-Field (15 × 9 mm) Swept-Source Optical Coherence Tomography Angiography Following Plaque Radiotherapy of Choroidal Melanoma: An Analysis of 105 eyes

      Wide-Field (15 × 9 mm) Swept-Source Optical Coherence Tomography Angiography Following Plaque Radiotherapy of Choroidal Melanoma: An Analysis of 105 eyes

      Purpose: The aim of this study was to evaluate retinal microvascular abnormalities following plaque radiotherapy of choroidal melanoma (CM) using wide-field swept-source optical coherence tomography angiography (OCTA). Design: Single-centre retrospective review. Methods: Retrospective case series of 105 CM patients treated with I-125 plaque radiotherapy and imaged with wide-field (15 × 9 mm) SS-OCTA from March 2018 to August 2018 at the Ocular Oncology Service, Wills Eye Hospital (Philadelphia, PA). Results: At mean follow-up of 49 months (range 4–297) after plaque radiotherapy, there were 52 eyes (50%) with clinically evident radiation retinopathy (CERR) and 53 eyes (50%) without CERR. Comparison (CERR ...

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    3. SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FEATURES OF VITREORETINAL LYMPHOMA IN 55 EYES

      SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FEATURES OF VITREORETINAL LYMPHOMA IN 55 EYES

      Purpose: To evaluate spectral domain optical coherence tomography (SD- OCT ) features of vitreoretinal lymphoma (VRL). Methods: Review of records and SD- OCT images of vitreoretinal lymphoma evaluated at Ocular Oncology Service, Wills Eye Hospital between July 1, 2000, and April 1, 2019. Results: There were 55 eyes of 32 patients included. At presentation, SD- OCT features included vitreous opacities (n = 36, 65%), preretinal deposits (n = 7, 13%), intraretinal deposits (n = 8, 15%), subretinal deposits (n = 20, 36%), retinal pigment epithelium abnormalities (n = 35, 64%), and subretinal pigment epithelium deposits (n = 35, 64%). Of 36 eyes with observed tumor progression, comparison ...

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    4. Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      A 17-month-old girl with group B retinoblastoma in her right eye developed recurrence of a parafoveal tumor ( Figure , A) after 6 cycles of intravenous chemotherapy. Despite treatment with indocyanine green–enhanced transpupillary thermotherapy, optical coherence tomography (vertical orientation) demonstrated continued tumor growth toward the foveola. The patient was subsequently treated with 2 cycles of intra-arterial chemotherapy, after which complete tumor regression to a flat scar was documented clinically and by optical coherence tomography (vertical orientation) ( Figure , B). The foveola remained intact. Optical coherence tomography may be a helpful tool in the documentation of retinoblastoma response, particularly in patients with small ...

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    5. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DETECTS SUBCLINICAL RADIAL PERIPAPILLARY CAPILLARY DENSITY REDUCTION AFTER PLAQUE RADIOTHERAPY FOR CHOROIDAL MELANOMA

      OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DETECTS SUBCLINICAL RADIAL PERIPAPILLARY CAPILLARY DENSITY REDUCTION AFTER PLAQUE RADIOTHERAPY FOR CHOROIDAL MELANOMA

      Purpose: To evaluate radial peripapillary capillary density (RPCD) in irradiated eyes without radiation papillopathy clinically. Methods: Patients treated with plaque radiotherapy for unilateral choroidal melanoma without radiation papillopathy clinically received optical coherence tomography and optical coherence tomography angiography imaging at ∼12- to 24-month follow-up. Comparison of RPCD globally and meridian closest to plaque and meridian farthest to plaque of irradiated versus nonirradiated eyes was performed. Results: Mean age was 55 years (n = 10). Mean largest basal diameter and thickness were 10.1 and 4.4 mm, respectively. Mean radiation dose to the optic nerve head and foveola was 41.7 ...

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    6. Peripapillary versus macular combined hamartoma of the retina and retinal pigment epithelium: Imaging characteristics

      Peripapillary versus macular combined hamartoma of the retina and retinal pigment epithelium: Imaging characteristics

      Purpose To compare clinical, optical coherence tomography (OCT), and fundus autofluorescence (FAF) characteristics of peripapillary versus (vs.) macular variants of combined hamartoma of the retina and retinal pigment epithelium (combined hamartoma). Design Retrospective observational, comparative case series Methods:Setting Multicentre collaborative study Study Population 50 eyes with a clinical diagnosis of combined hamartoma Observational Analysis A comparative analysis of color fundus photographs (CFPs), OCT and FAF was performed for peripapillary and macular variants of combined hamartoma. Main Outcome Measures Pigmentation and OCT features of macular and peripapillary combined hamartoma Results The review of imaging from 50 eyes of 49 patients ...

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    7. Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study

      Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study

      Aim To study the macular structure and vasculature in consecutive nanophthalmic eyes using optical coherence tomography angiography. Methods This is a prospective, multicentre, cross-sectional study of patients with nanophthalmos (one or both eyes). The superficial and deep foveal avascular zones (FAZ) were measured both manually and with the machine’s built-in automated measurement tool. Correlations between best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT) were calculated. Results Sixty-five eyes of 35 subjects (16 men and 19 women) with a mean age of 37.4 years were analysed. The mean±SD of refractive error was ...

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    8. Hand-held optical coherence tomography monitoring of submillimeter retinoblastoma treated with indocyanine green-enhanced transpupillary therapy

      Hand-held optical coherence tomography monitoring of submillimeter retinoblastoma treated with indocyanine green-enhanced transpupillary therapy

      Over recent years, hand-held optical coherence tomography (HH-OCT) has become critical for retinoblastoma diagnosis and management. We report precise HH-OCT findings in a case of sub-millimeter retinoblastoma treated with foveal-sparing indocyanine green-enhanced transpupillary thermotherapy (ICG-TTT). A 2-month-old Caucasian female with bilateral Group B retinoblastoma showed two recurrent macular tumors in the right eye, demonstrating 88 μm and 37 μm of growth to 344 μm and 413 μm in thickness, respectively, on HH-OCT. Each was treated with additional intravenous chemotherapy and foveal-sparing ICG-TTT. Tumor regression to 154 μm and 224 μm was documented on HH-OCT and maintained on follow-up. HH-OCT is ...

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    9. Iris microhemangiomatosis: Clinical, fluorescein angiography, and optical coherence tomography angiography in 14 consecutive patients

      Iris microhemangiomatosis: Clinical, fluorescein angiography, and optical coherence tomography angiography in 14 consecutive patients

      Purpose To describe the clinical and imaging findings and treatment options in a series of patients with iris microhemangiomatosis. Design: Retrospective observational case series. Methods Setting : Single institution. Study Population : Twenty-two eyes of 14 consecutive patients with iris microhemangiomatosis were reviewed. Observation Procedures : Clinical examination and slit lamp photography were performed on every patient. Anterior segment optical coherence tomography (AS-OCT), anterior segment optical coherence tomography angiography (AS-OCTA), anterior segment intravenous fluorescein angiography (AS-IVFA) and ultrasound biomicroscopy were performed when possible. Main Outcome Measures : Clinical and imaging features and treatment strategies. Results Twenty-two eyes of 14 patients with iris microhemangiomatosis were ...

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    10. MULTIMODAL IMAGING OF MACULAR CHOROIDAL MACROVESSEL: A REPORT OF TWO CASES

      MULTIMODAL IMAGING OF MACULAR CHOROIDAL MACROVESSEL: A REPORT OF TWO CASES

      Purpose: To report two cases of macular choroidal macrovessel with description of multimodal imaging and review of published cases. Methods: Medical and imaging records were retrospectively reviewed. A literature review was performed to identify other cases of macular choroidal macrovessel published between 1990 and 2018. Results: There were 2 patients referred for evaluation of a potential choroidal tumor , including a 55-year-old white woman with no visual symptoms and a 68-year-old white woman with blurred vision. Funduscopic examination in each case revealed a focal area of choroidal elevation in the temporal foveal area with a single, dilated, slightly tortuous choroidal vessel ...

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    11. Optical Coherence Tomography of Small Retinoblastoma

      Optical Coherence Tomography of Small Retinoblastoma

      Purpose: To investigate hand-held optical coherence tomography (HHOCT) characteristics of small (<1 mm thickness) retinoblastoma. Design: Retrospective observational case series. Methods: Patient and tumor data were extracted from the medical record and analyzed along with HH-OCT scans. Determination of tumor layer of origin was performed using a layer-by-layer analysis of HH-OCT data and specific HH-OCT–related features were described. Results: There were 20 sub-millimeter retinoblastomas from 16 eyes of 15 patients. Mean largest tumor basal diameter by HH-OCT was 2.2 mm (median, 1.9; range, 0.7–4.1 mm), and mean tumor thickness was 468 µm (median, 441 ...

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    12. Submillimeter retinoblastoma monitoring following transpupillary thermotherapy using hand-held optical coherence tomography

      Submillimeter retinoblastoma monitoring following transpupillary thermotherapy using hand-held optical coherence tomography

      Background Precise, submillimeter visualization of retinal microstructures is useful for treatment monitoring of retinoblastoma. Herein, we report the use of hand-held optical coherence tomography (HH-OCT) to document a nearly-invisible retinoblastoma and monitor tumor response to transpupillary thermotherapy (TTT). Case presentation A 3-week-old boy was diagnosed with unilateral familial retinoblastoma in the left eye, classified as group B, and treated with intravenous chemoreduction. At 13-month follow-up, the tumor in the left eye was regressed, and evaluation of the right eye revealed a microscopic, nearly invisible tumor measuring 372 µm in thickness and 1.51 mm in basal dimension. The tumor was ...

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    13. Parafoveolar retinoblastoma regression with foveal preservation following intra-arterial chemotherapy documented on hand-held optical coherence tomography in a newborn

      Parafoveolar retinoblastoma regression with foveal preservation following intra-arterial chemotherapy documented on hand-held optical coherence tomography in a newborn

      Background Optical coherence tomography (OCT) has become an invaluable tool in retinoblastoma management, providing submillimeter visualization of tumor control following treatment. Herein, we document OCT-detection of a subtle tumor recurrence, allowing early intervention and achieving foveal microanatomy preservation. Case presentation A 3-week-old girl was diagnosed with bilateral familial retinoblastoma, classified as group D in the right eye (OD) and group B in the left eye (OS), and treated with intravenous chemoreduction. At 6-months follow-up, the right eye was under control, but the left eye revealed a subtle juxtafoveal tumor recurrence, documented on handheld OCT (HH-OCT) and measuring 2750 µm in ...

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    14. Optical Coherence Tomography Angiography Features of Iris Racemose Hemangioma in 4 Cases

      Optical Coherence Tomography Angiography Features of Iris Racemose Hemangioma in 4 Cases

      Importance Optical coherence tomography angiography (OCTA) allows visualization of iris racemose hemangioma course and its relation to the normal iris microvasculature. Objective To describe OCTA features of iris racemose hemangioma. Design, Setting, and Participants Descriptive, noncomparative case series at a tertiary referral center (Ocular Oncology Service of Wills Eye Hospital). Patients diagnosed with unilateral iris racemose hemangioma were included in the study. Main Outcomes and Measures Features of iris racemose hemangioma on OCTA. Results Four eyes of 4 patients with unilateral iris racemose hemangioma were included in the study. Mean patient age was 50 years, all patients were white, and ...

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    15. Optical Coherence Tomography Angiography Features of Iris Racemose Hemangioma in 4 Cases

      Optical Coherence Tomography Angiography Features of Iris Racemose Hemangioma in 4 Cases

      Importance Optical coherence tomography angiography (OCTA) allows visualization of iris racemose hemangioma course and its relation to the normal iris microvasculature. Objective To describe OCTA features of iris racemose hemangioma. Design, Setting, and Participants Descriptive, noncomparative case series at a tertiary referral center (Ocular Oncology Service of Wills Eye Hospital). Patients diagnosed with unilateral iris racemose hemangioma were included in the study. Main Outcomes and Measures Features of iris racemose hemangioma on OCTA. Results Four eyes of 4 patients with unilateral iris racemose hemangioma were included in the study. Mean patient age was 50 years, all patients were white, and ...

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    16. PARAFOVEAL MICROVASCULAR FEATURES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA

      PARAFOVEAL MICROVASCULAR FEATURES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA

      Purpose: To evaluate parafoveal microvasculature in eyes with circumscribed choroidal hemangioma using optical coherence tomography angiography. Methods: Fourteen eyes with unilateral circumscribed choroidal hemangioma were imaged using OCT for central macular thickness and optical coherence tomography angiography for superficial and deep foveal avascular zone area, and superficial and deep capillary density (CD), comparing affected and paired fellow eyes. Results: Mean patient age was 53 years, and mean visual acuity was 20/60 in the involved eye and 20/25 in the fellow eye. In the affected eye, clinical findings included cystoid macular edema (CME) in 1, parafoveal/subfoveal subretinal fluid ...

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    17. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM

      OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM

      Purpose: To describe the optical coherence tomography angiography features of congenital simple hamartoma of the retinal pigment epithelium. Methods: Case report. Results: A 14-year-old boy was referred for an asymptomatic fundus tumor in the left eye. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. The right fundus was normal. The left fundus disclosed a gray-white nodular retinal mass of 2-mm diameter in the juxtafoveal region, protruding into the vitreous cavity and causing radial retinal folds. The mass demonstrated echodensity without calcification on ultrasonography, hypoautofluorescence on short-wavelength autofluorescence, and mixed hyporeflective and hyperreflective ...

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    18. Optical Coherence Tomography Angiography of Conjunctival Racemose Hemangioma

      Optical Coherence Tomography Angiography of Conjunctival Racemose Hemangioma

      A 29-year-old man observed a red spot on his left eye. By slit-lamp biomicroscopy, the base of the lesion measured 1.5 mm and was located at the inferonasal limbus (Fig 1A). Anterior segment fluorescein angiography (FA) (Fig 1B) and optical coherence tomography angiography (OCTA) (Fig 1C; Optovue Inc, Fremont, CA) showed a vascular mass compatible with racemose hemangioma. The hemangioma and related vessels were better depicted on noninvasive OCTA compared with FA.

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    19. Optical coherence tomography angiography of iris microhemangiomatosis

      Optical coherence tomography angiography of iris microhemangiomatosis

      Purpose To report optical coherence tomography angiography (OCTA) of iris microhemangiomatosis. Observations A 75-year-old asymptomatic Caucasian man was found to have bilateral pupillary vascular lesions during cataract evaluation. Visual acuity was counting fingers in the right eye (OD) and 20/40 in the left eye (OS) with normal intraocular pressures in both eyes (OU). In each eye there were multifocal, round, dark red, pinpoint vascular tufts at the pupillary margin, randomly distributed and numbering 1 in OD and 7 in OS, each measuring 0.2–0.3 mm in diameter and without active bleeding or hyphema. Fundus examination OU was ...

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    20. Detection of Minimally Visible Recurrent Retinoblastoma by Hand-held Spectral-Domain Optical Coherence Tomography

      Detection of Minimally Visible Recurrent Retinoblastoma by Hand-held Spectral-Domain Optical Coherence Tomography

      A 2-month-old male infant with bilateral familial retinoblastoma was treated with intravenous chemotherapy and focal adjuvant therapy. At 5 months of follow-up, fundus examination and ultrasonography disclosed no recurrence; however, hand-held spectral-domain optical coherence tomography (SD-OCT) demonstrated subclinical recurrence within a previous regression scar. Subsequent treatment led to flat scar. Hand-held SD-OCT can be a useful tool for detection of subclinical recurrent retinoblastoma.

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    21. IMAGE QUALITY AND ARTIFACTS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: Comparison of Pathologic and Paired Fellow Eyes in 65 Patients With Unilateral Choroidal Melanoma Treated With Plaque Radiotherapy

      IMAGE QUALITY AND ARTIFACTS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: Comparison of Pathologic and Paired Fellow Eyes in 65 Patients With Unilateral Choroidal Melanoma Treated With Plaque Radiotherapy

      Purpose: To study image quality and artifacts seen on optical coherence tomography angiography (OCTA). Methods: Sixty-five consecutive patients with unilateral posterior uveal melanoma treated with plaque radiotherapy had OCTA during follow-up. Optical coherence tomography angiography was performed on both the affected and fellow eye. Signal strength and frequency of image artifacts on en face images were compared between affected and fellow eyes. Results: A total of 130 eyes in 65 patients were analyzed, the mean age at time of OCTA was 55 years (median: 56, range: 12-81 years), and 39 (39/65, 60%) were female. Majority of tumors were located ...

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    22. CLINICALLY INVISIBLE RETINAL HEMANGIOBLASTOMAS DETECTED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND FLUORESCEIN ANGIOGRAPHY IN TWINS

      CLINICALLY INVISIBLE RETINAL HEMANGIOBLASTOMAS DETECTED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND FLUORESCEIN ANGIOGRAPHY IN TWINS

      Purpose: To report subclinical retinal hemangioblastoma detected by enhanced depth imaging optical coherence tomography and fluorescein angiography in at-risk twins. Methods: Case report. Results: A set of twins, age 7 years, (Twin A and Twin B) with known family history of von Hippel-Lindau disease (gene test positive) and no systemic manifestations were evaluated. Visual acuity was 20/20 in both eyes of both twins. Anterior segment examination and intraocular pressures were unremarkable in both eyes. Twin A showed no clinically visible tumor in the right eye, and a clinically evident 4-mm hemangioblastoma in the superior retina of the left eye ...

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    23. ALTERED PARAFOVEAL MICROVASCULATURE IN TREATMENT-NAIVE CHOROIDAL MELANOMA EYES DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      ALTERED PARAFOVEAL MICROVASCULATURE IN TREATMENT-NAIVE CHOROIDAL MELANOMA EYES DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      Purpose: To determine whether parafoveal microvascular changes have occurred in choroidal melanoma eyes before radiotherapy. Methods: A retrospective cohort study included 30 consecutive patients with unilateral choroidal melanoma. The microvascular structure was analyzed by optical coherence tomography angiography. Fellow eyes served as control for affected eyes. Results: Optical coherence tomography angiography demonstrated no difference in superficial foveal avascular zone (P = 0.316), but showed significant enlargement in deep foveal avascular zone (P < 0.0001) in affected eyes as compared with fellow eyes. It also showed significant decrease in superficial (P = 0.004) and deep (P = 0.0003) capillary vascular density ...

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